Lawmakers introduce colonoscopy coverage act

Sen. Ben Cardin (D-Md.) and Rep. Richard Neal (D-Mass.) have introduced the Supporting ColoRectal Examination and Education Now (SCREEN) Act (S. 608/H.R. 1320). The act would waive Medicare beneficiary cost-sharing for those colorectal cancer screenings where polyps are removed during colonoscopy. 

Currently, Medicare waives cost-sharing for any colorectal cancer screening recommended by the U.S. Preventive Services Task Force. However, should the beneficiary have a polyp removed, the procedure is no longer considered a screening for Medicare purposes and cost-sharing applies. 

"For Medicare patients, the unintended consequence of polyps being removed during colonoscopy is that the beneficiary is obligated to pay the coinsurance. This is an unexpected and unwelcome 'sticker shock' that deters others from being screened, and undermines the intended purpose of the procedure – to prevent cancer from developing in the first place," explained Ronald J. Vender, MD, president of the American College of Gastroenterology (ACG), in a press release.

The Obama Administration announced in February that, beginning in 2014, certain private insurers participating in state-based health insurance exchanges must remove all patient cost-sharing for colorectal cancer screenings where a polyp is removed. The SCREEN Act extends this fix to the Medicare program as well, addressing an unintended legislative quirk of the Patient Protection and Affordable Care Act.

"Physicians cannot accurately predict which patients will have polyps prior to a screening colonoscopy. If we knew with certainty that someone did not have any polyps, then we would not perform the procedure in the first place. The purpose of this extremely accurate test is to detect and remove precancerous lesions and to prevent cancer. It is unfair to penalize the individuals who happen to have a polyp when they are trying to do the right thing for their own health. The law as it is presently written is well intended, but there are some gaps that need to be filled," March E. Seabrook, MD, chair of ACG's National Affairs Committee, added.

In addition to waiving the cost-sharing for therapeutic colonoscopies, the SCREEN Act provides Medicare coverage for a prescreening visit. Currently, Medicare does not cover this evaluation. 

Lastly, the legislation helps reform the Medicare reimbursement system by ensuring providers are paid for the quality of the services as opposed to the quantity of the services. The SCREEN Act provides for a Medicare incentive conditional upon voluntary participation in a nationally recognized quality improvement registry that compares the physician to accepted colorectal cancer screening quality metrics developed in the medical literature. Those providers who do not demonstrate quality care according to these accepted standards of care would receive a lower reimbursement.  

Medicare claims indicate only 55 to 58 percent of beneficiaries have had a colonoscopy or any colorectal cancer test. Research suggests colorectal cancer deaths may be reduced by over 50 percent by removing precancerous polyps during the screening colonoscopy. Colorectal cancer screening also has been demonstrated to save Medicare long-term costs; the direct annual costs of treating colon cancer of $4 billion may be reduced with proper screening, according to ACG.