Here’s some good news: Use of lifesaving colorectal screening tests is on the upswing according to American Cancer Society investigators who tracked data from the National Health Interview Survey and found that overall colorectal cancer screening rates among people ages 50 to 75 rose from about 57 percent in 2008 to about 61 percent in 2013.
The increase was seen most notably among people who had low incomes, low levels of education and/or were covered by Medicare, but not among wealthier people, the study found. (Elimination of Cost-Sharing and Receipt of Screening for Colorectal and Breast Cancer, Fedewa et al. Published online June 4, 2015,)
While the study couldn’t prove cause and effect, the recent increase in colon cancer screening rates could be due to expanded coverage of preventive services such as colorectal screening under The Patient Protection and Affordable Care Act (now known as the ACA). The ACA was signed into law in 2010. On June 9, President Obama in a speech on the ACA touted the law’s impact on increased use of preventive services in populations that were previously uninsured or underinsured, including a mention of mammography
Colorectal cancer screening rates trending upward in the United States is great news in the fight against colorectal cancer because each year more than 132,000 Americans are diagnosed with colorectal cancer and annually almost 50,000 Americans die from a malignancy that is highly preventable with screening and removal of precancerous polyps.
Here’s some bad news: Quirks in the Affordable Care Act require a legislative fix if Americans are to receive the full benefit of expanded preventive services while at the same time cuts to reimbursement loom on the horizon threatening access to colorectal screening tests under Medicare.
ACGt recognizes an urgent need for Congress to fix quirks in current law that that would remove financial and other barriers to colorectal cancer screening and supports legislation introduced in Congress this spring to address these challenges. (See “Top Five Reasons to Support the SCREEN Act (S. 1079/H.R. 2035”)
While this country is making progress against colorectal cancer incidence and mortality, more needs to be done to increase the use of screening tests in the general population but especially among Medicare beneficiaries.
The Medicare-age population, which is at the greatest risk for developing colorectal cancer based on age, has screening rates far below the target for a national public health goal of 80% by 2018 – only 64% according to the American Cancer Society’s “Colorectal Cancer Fact & Figures 2014-2016.” This is an urgent challenge because Medicare beneficiaries account for two-thirds of all new cases of colorectal cancer each year, according to the U.S. Centers for Disease Control (CDC).
The American College of Gastroenterology and over 300 private and public sector partners, including the American Cancer Society and CDC, are committed to the ambitious public health goal of screening 80 percent of eligible adults for colorectal cancer by 2018. Barriers to screening under Medicare are not the only threats to progress in the fight against colorectal cancer in the United States. The American College of Gastroenterology is concerned that the Centers for Medicare/Medicaid Services (CMS)is expected to announce cuts to colonoscopy reimbursement beginning in 2016. Cuts to lifesaving cancer screening tests are inconsistent with the efforts by other divisions within HHS to increase screening rates including the excellent work by the Centers for Disease Control & Prevention and the coalition of federal health agencies committed to the national “80% by 2018” colorectal cancer screening goal [LINK HERE].
It is counter-intuitive and short-sighted to cut Medicare reimbursement for screening tests just at the point when our nation is gaining traction in increasing use of the very same screening tests. Legislation before Congress (the SCREEN Act) aims to ensure the use of colonoscopy for the screening and detection of colorectal cancer remains accessible for all Medicare beneficiaries. Lawmakers need to understand the implications of this bill for patients and its potential impact on public health. Moreover, it is important that the GI community continues to remind policymakers of any unintentional consequences from unwarranted and untimely cuts to Medicare reimbursement that may be lying in wait.
Carroll D. Koscheski, MD, Chair, ACG National Affairs Committee
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