FIGHT COLORECTAL CANCER RESPONSE TO NEW YORK TIMES ARTICLE (6/03/2013):

Fight Colorectal Cancer applauds the New York Times for shedding light on how revenue is generated by medical practices. Importantly however, the crux of the issue is not the use or overuse of colonoscopies and the variance in pricing. Rather, the main problem to be fixed in the United States is a broken fee-reimbursement structure that puts pressure on local practices and hospitals to inflate the price of reliable and needed services, like colonoscopies, to compensate for under-reimbursement for other medical services.

It is unfortunate that colorectal cancer screening is used in this article as a primary example of failure of the medical fee-for-service structure. One relevant fact that is not highlighted in this article is that colonoscopies and other screening modalities for colorectal cancer have demonstrated a reduction in the incidence of colorectal cancer and death from the disease.

Taking a step back and looking at the bigger treatment picture, with the increase in chemotherapy costs for advanced colorectal cancer, reveals that most colorectal cancer screening strategies have actually delivered long run cost savings. Screening not only reduces colorectal cancer incidence and mortality but also controls the costs of colorectal cancer treatment.

The article does highlight another important point: we need transparency in addressing the cost of care and reducing the burden for patients seeking lifesaving services like colorectal cancer screening. Fight Colorectal Cancer has worked with a coalition of government and non-profit partners who support the introduction of H.R. 1070, Eliminating Cost Sharing for Colorectal Cancer Screening Colonoscopy.

Under current law, Medicare beneficiaries must pay a coinsurance fee when their colorectal cancer screening colonoscopy also involves the removal of polyps or other tissue. This policy is confusing to Medicare beneficiaries and serves as a financial deterrent to this highly effective method of colorectal cancer prevention. Additionally, while current law also requires most private payers to cover colorectal cancer screenings without cost sharing (copays/coinsurance/deductible), until recently, regulations resulted in private payers applying the cost sharing requirements differently. Some private payers waived cost sharing when a screening involved the removal of polyps or other tissue, others did not (the Obama Administration issued a regulation change on this issue in February 2013).

To the point that was made in the article regarding a lack of comparative studies between screening colonoscopies versus less invasive and cheaper screening methods, we say:

Support increased funding for prevention research to find these answers.

Fight Colorectal Cancer has advocated for full funding for the Centers for Disease Control and Prevention’s (CDC) Colorectal Cancer Control Program (CRCCP) so that every state in the nation may have such a program (currently only 25 states and 5 territories do). Since the program’s inception in 2009, the CRCCP has provided screening to nearly 20,000 people, finding 2,917 cases of precancerous adenomatous polyps and 50 cancers. The CRCCP program has opened the door for researchers to develop needed modeling studies. The current research pipeline includes studies by Memorial Sloan-Kettering (led by Dr. Ann Zauber) looking at colonoscopy versus fecal immunochemical testing (FIT).

The bottom line is: the best screening test is the screening test someone gets. As an organization we do not recommend one screening test over the other.

The current screening tests and intervals (2) are—

• High-sensitivity fecal occult blood test (FOBT), which checks for hidden blood in three consecutive stool samples, should be done every year.
• Flexible sigmoidoscopy, where physicians use a flexible, lighted tube (sigmoidoscope) to look at the interior walls of the rectum and part of the colon, should be done every five years with FOBT every three years.
• Colonoscopy, where physicians use a flexible, lighted tube (colonoscope) to look at the interior walls of the rectum and the entire colon, should be done every 10 years. During this procedure, samples of tissue may be collected for closer examination, or polyps may be removed. Colonoscopies can be used as screening tests or as follow-up diagnostic tools when the results of another screening test are positive.
• Colonoscopy also is used as a diagnostic test when a person has symptoms, and it can be used as a follow-up test when the results of another colorectal cancer screening test are unclear or abnormal.

We want to save lives, don’t you?

Carlea Bauman
President, Fight Colorectal Cancer

References:

1 U.S. Preventive Services Task Force. Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. AHRQ Publication 08-05124-EF-3, October 2008. Agency for Healthcare Research and Quality, Rockville, MD.
2 U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2008: Recommendations of the U.S. Preventive Services Task Force. AHRQ Publication No. 08-05122, September 2008. Agency for Healthcare Research and Quality, Rockville, MD.

Under the new health care law, millions of Americans will benefit from more accessible and affordable health care – but the key will be getting individuals actually enrolled.

Enroll America is a new nonpartisan, nonprofit organization whose mission is to ensure that all Americans are enrolled in and retain health coverage. It will work at the state and federal levels to push for streamlined enrollment procedures and will also raise awareness of enrollment options among the uninsured.

If you are uninsured, learn about your options at the Enroll America website.

The U.S. sticker price for cancer care by 2020 will likely increase at least 27% over the next decade, to a minimum $158 billion yearly by 2020, according to the National Cancer Institute.

Colorectal cancer ranks 2^nd behind breast cancer in 2010 total costs of care by cancer type, and will remain one of the top 5 most costly cancers in 2020.

Projections of the Cost of Cancer Care in the United States: 2010–2020

Those are just two of many facts in an important paper published in the Jan. 19 Journal of the National Cancer Institute. The predicted costs are much higher than previous estimates because the authors used the most current cost data (2006 Medicare) which, for the first time, includes costs of expensive targeted treatments.

The study is powerful because it analyzed different scenarios and assumptions, and broke down costs of three stages of care (initial and final years, and middle years of continuing care) for each type of cancer. Read the rest of this entry »

With the increasing expense of treating colorectal cancer, treatment cost savings in the near future will more than double when screening prevents colon and rectal cancers or finds them early.

Looking at expense for an entire population, all screening methods except colonoscopy cost less than treating those cancers that developed, and the net cost of colonoscopy screening fell from over $1,300 to less than $300 per individual in the population. Read the rest of this entry »

This week’s reports include information about mismatch repair genes in stage IV colorectal cancer, colon surgery complications for very obese patients, and the impact of computerization on hospital outcomes.

In addition, there are links to the Surgeon General’s new Family Health Portrait and a report from Families USA on health care insurance costs for laid off workers. Read the rest of this entry »