The Medicare loophole: cost-sharing for screening colonoscopy

Abstract

Colorectal cancer (CRC) is the second most common cause of death from cancer in men and women in the USA. The American Cancer Society estimates that more than 132,000 people will be diagnosed with CRC, and almost 50,000 will die from the disease, in the USA in 2015 [1]. Treatment costs can be very high, especially for advanced forms of CRC. Total expenditures of about US$13.8 billion for treatment of CRC each year have been estimated, with Medicare bearing more than one half of these costs [2]. Indeed, treating a single advanced case of CRC may exceed US$300,000 per year [3]. Yet, the morbidity and costs due to CRC are largely avoidable. It is well documented that regular screening can identify CRC at early stages, when it is easiest and least expensive to treat, and when the possibility of long-term survival is the greatest. Additionally, screening can actually prevent the development of CRC through the detection and removal of precancerous polyps (abnormal growths in the lining of the colon), eliminating the possibility that they may progress into cancer. Recently, a systematic review of 39 screening tests for 19 diseases revealed that only four tests, two of which were for CRC, exhibited a significant diseasespecific mortality benefit [4]. It is therefore clear that preventive screening is a highly efficacious strategy to reducing the incidence and mortality of CRC. Over 300 health-related organizations, led by the National Colorectal Cancer Roundtable, have committed to increasing the nation’s CRC screening rate to 80% of eligible individuals by the year 2018. To achieve this goal, barriers that prevent Americans from getting screened must be removed. The American Cancer Society, the US Preventive Services Task Force (USPSTF) and other expert medical and scientific panels have issued evidence-based recommendations for CRC screening [5]. Even with expanded access to insurance coverage under the Affordable Care Act (ACA), too many Americans are still not getting screened for CRC. Reasons for this vary. Although many factors, including awareness, physician recommendations, access to “Over 300 health-related organizations, led by the National Colorectal Cancer Roundtable, have committed to increasing the nation’s colorectal cancer screening rate to 80% of eligible individuals by the year 2018.”