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?
President, Fight Colorectal Cancer
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.