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Senior Citizen Politics

House Bill Would Make Colonoscopy, Polyp Removal Free for Medicare Patients

Groups want to allow removal of polyps during procedure with no unexpected co-pay

March 1, 2012 - Colonoscopy for colorectal cancer screening saves lives, but a loophole in current Medicare law may cause patients to think twice before undergoing this vital test, says three medical groups. Legislation introduced today seeks to ensure that colorectal cancer screening for all Medicare beneficiaries is free, as was intended.

The Patient Protection and Affordable Care Act, sometimes referred to as “Obamacare,” waives the coinsurance and deductible for many cancer screening tests, including colonoscopy, sigmoidoscopy and fecal occult blood testing (FOBT), which screen for colorectal cancer.

 

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Colonoscopy is a unique screening test because gastroenterologists are able to remove precancerous polyps and small cancers during the screening procedure. Under Medicare billing rules, removal of any polyp reclassifies the screening as a therapeutic procedure, for which patients will receive an unexpected coinsurance bill. In some cases this may be covered by other supplemental insurance.

The Removing Barriers to Colorectal Cancer Screening Act of 2012 introduced today by Rep. Charlie Dent, R-PA, waives the coinsurance for a screening colonoscopy regardless of whether a polyp or lesion is found.

Congressman Dent represents Pennsylvania’s 15th District, which is home to a large life sciences industry that includes research universities, national healthcare providers and biotech firms.

Last year, Rep. Dent, introduced a bill for the U.S. Postal Service to issue a stamp promoting the fight against colorectal cancer. It was referred to a subcomittee on military personnel.

Under current Medicare policy, the beneficiary deductible is waived regardless of whether a polyp or lesion is found. Congressman Dent's bill applies the same rational policy to beneficiary coinsurance.

The American Cancer Society Cancer Action Network (ACS CAN), the American Gastroenterological Association (AGA) and the American Society for Gastrointestinal Endoscopy (ASGE) have been advocating for the past year and half that Congress corrects this "cost-sharing" problem, which continues to cause confusion for patients and providers.

Cost sharing creates financial barriers, which could discourage the use of colonoscopy. The Removing Barriers to Colorectal Cancer Screening Act of 2012 is critical to achieving higher screening rates and reducing the incidence of colorectal cancer.

Almost 38 percent of U.S. adults age 50 and older have never been screened, despite the fact that removing precancerous polyps cuts the death rate from colorectal cancer by half.

Christopher W. Hansen, president, ACS CAN, said, "I commend Representative Dent for this important effort to ensure that everyone has access to life saving cancer screenings, without regard to their ability pay. Too many Americans are going without lifesaving screenings because they cannot afford it. We urge Congress to help stop a cancer that can be prevented in many cases."

Medicare on Colon Cancer Screenings (Colorectal)

How often is it covered?

  • Fecal Occult Blood Test: Once every 12 months.
  • Flexible Sigmoidoscopy: Generally, once every 48 months, or 120 months after a previous screening colonoscopy for people not at high risk.
  • Screening Colonoscopy: Generally once every 120 months (once every 24 months if you're at high risk), or 48 months after a previous flexible sigmoidoscopy.
  • Barium Enema: Your doctor can decide to use this test instead of a flexible sigmoidoscopy or colonoscopy. This test is covered every 24 months if you are at high risk for colorectal cancer and every 48 months if you aren't at high risk.

You're at high risk if you have any of the following risk factors:

  • A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp (a type of polyp that could become cancerous)
  • A family history of familial adenomatous polyposis (this involves multiple adenomatous polyps, often in the hundreds, and carries a very high risk of colon cancer)
  • A family history of hereditary nonpolyposis colorectal cancer (a type of colorectal cancer that runs in families and tends to cause cancer at a relatively young age - under 45 years)
  • A personal history of adenomatous polyps
  • A personal history of colorectal cancer
  • A personal history of inflammatory bowel disease, including Crohn's Disease and ulcerative colitis

Who’s eligible?

All people with Medicare are eligible for a screening colonoscopy. All other colorectal screenings are available to people with Medicare age 50 and older.

Your costs in Original Medicare

  • You pay nothing for the fecal occult blood test. You pay nothing for the flexible sigmoidoscopy or screening colonoscopy, if your doctor accepts assignment.
  • For barium enemas, you pay 20% of the Medicare-approved amount for the doctor's services. The Part B deductible doesn't apply. If it's done in a hospital outpatient setting, you pay a copayment.

Colorectal Cancer Resources

 

"The rate of colorectal cancers and deaths can be decreased through the increased use of screening,” added Lawrence S. Kim, MD, AGAF, Community Private Practice Councillor. “However, a majority of Americans are still not participating in these lifesaving tests.

“The Removing Barriers to Colorectal Cancer Screening Act of 2012 will provide consistency and security for patients seeking colorectal cancer screenings by eliminating financial barriers and removing the confusion facing patients and their physicians over the current health-care policy."

"Colorectal cancer is a largely preventable disease,” noted Gregory G. Ginsberg, MD, FASGE, president, American Society for Gastrointestinal Endoscopy. The greatest benefit of colonoscopy screening is removing polyps that are discovered during screening and by so doing, significantly decreasing the risk for later cancer development.

“Converting a screening procedure that is fully covered by insurance with no cost-sharing, to one that does require cost-sharing by the patient after a polyp is found, is both a barrier to screening and inconsistent with the goal of the preventive services provision,” he said.

Following are descriptions provided by the groups pushing this action.

About the American Cancer Society Cancer Action Network

ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit http://www.acscan.org.

About the American Gastroenterological Association

The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include 17,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. http://www.gastro.org. Become an AGA fan on Facebook. Join our LinkedIn group. Follow us on Twitter @AmerGastroAssn.

About the American Society for Gastrointestinal Endoscopy

Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. ASGE, with nearly 12,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit http://www.asge.org and http://www.screen4coloncancer.org for more information and to find a qualified doctor in your area.

 

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