Tag Archives: CMS

FDA approves first non-invasive DNA test for colorectal cancer

Big news in the colorectal cancer prevention and screening community yesterday! In a never-before-seen move, the Food & Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS) jointly proposed Cologuard as a new option for colorectal cancer screening. What is Cologuard? Cologuard, produced by Exact Sciences, is a non-invasive (not requiring insertion of instruments into the body), stool-based (you test your poo) DNA test designed to analyze the presence of blood and certain DNA mutations in a patient’s stool sample that can indicate cancer and/or precancerous polyps. Cells of DNA are released into the stool continuously as part of the digestive process. There are already at-home screening options

Medicare Now Covers Obesity Counseling

Obese people on Medicare  now have the opportunity to have regular weight loss counseling paid for when offered by a primary care provider.  Since this is considered prevention, there is no co-pay. On November 29, the Centers for Medicare and Medicaid Services announced that there was enough evidence that intensive behavioral counseling was reasonable and necessary to prevent disease or disability and that Medicare beneficiaries were entitled to coverage as a preventive service. This is particularly good news for people trying to prevent colon or rectal cancer since studies have consistently found a link between body mass index (fatness) and colorectal cancer, including the World  Cancer Research Foundation which included

ACS's Brawley Disappointed by CMS CT Colonography Denial

American Cancer Society Chief Medical Officer Otis W. Brawley, M.D., says that he is disappointed in the decision by the Centers of Medicare and Medicaid Services not to cover CT colonography screening for elderly Americans on Medicare. Dr. Brawley points out that randomized clinical trials have shown the CTC option as effective as traditional optical colonoscopy in finding early cancers and precancerous polyps.  He also concerned that there is not a sufficient supply of trained specialists providing colonoscopy to meet the need for screening and that new options are needed. The American Cancer Society believes, Brawley says, that a full battery of testing for colorectal cancer screening should be available,

CMS Says CT Colonography Evidence Insufficient: Medicare Won't Cover It

The Centers for Medicare and Medicaid issued a final National Coverage Decision on May 12, 2009 denying Medicare payments for CT colonography (virtual colonoscopy) to screen for colorectal cancer. Despite an overwhelming number of comments urging that CMS overturn their provisional determination not to cover the test, the agency remained unconvinced that there was sufficient evidence to conclude that CT colonography was appropriate to screen for colorectal cancer. Almost 95 percent of 357 comments supported CT colonography screening, including comments from the American Cancer Society and C3:Colorectal Cancer Coalition. Briefly, The Centers for Medicare and Medicaid Services (CMS) concludes the following: The evidence is inadequate to conclude that CT colonography

C3 Asks Medicare to Reconsider Decision Not to Cover CT Colonography

In response to a proposed national coverage decision by the Centers for Medicare and Medicaid Services not to pay for screening CT colonography (CTC) for Medicare enrollees, C3 has submitted comments asking that CMS cover screening CT colonography (virtual colonoscopy) as part of a Coverage with Evidence Development (CED) process. A CED would enable CMS to determine if CT colonography is safe and effective in the older Medicare population and which patients might benefit from screening using CTC rather than optical colonoscopy. We believe that older patients should have a choice for colorectal cancer screening methods after a discussion of the risks and benefits of each method with their doctors. 

Medicare Won't Cover CT Colonography

On February 11, 2009 the Centers for Medicare and Medicaid Services (CMS) issued a proposed national coverage decision memorandum not to pay for computed tomographic colonography (so-called virtual colonoscopy) to screen for colorectal cancer. The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test under §1861(pp)(1) of the Social Security Act. CT colonography for colorectal cancer screening remains noncovered. The national coverage decision will not be final until 30 days after February 11 to allow for public comments.  Individuals and organizations concerned about the proposed decision can submit a comment online. However, CMS does not now cover screening CT colonography. IMPORTANT: If you want

US Health Care Spending Growth Slowed in 2007

Although US health care spending grew more slowly in 2007, its rate still outpaced general economic growth.  Total health care costs in 2007 reached $2.2 trillion or $7,421 for every American. The Centers for Medicare and Medicaid Services released a report from the CMS Office of the Actuary on Tuesday that showed overall health care spending grew at a 6.1 percent rate in 2007, down from 6.7 in 2006 and the slowest rate of growth since 1998.  Overall economic growth was 4.8 percent. Health care spending’s share of the Gross Domestic Product continued to increase, reaching 16.2 percent, an increase of 0.2 percent over 2006.