Use of Colonoscopy in Medicare Beneficiaries Increased Substantially Between 1999 and 2002 While the Use of Other Colorectal Cancer Diagnostic Tests Declined

Abstract

Purpose: To examine trends in the use of colonoscopy, flexible sigmoidoscopy, double-contrast barium enema, and fecal occult blood test (FOBT) in Medicare beneficiaries from 1999 to 2002. Background: In January 1998, Medicare began paying for colorectal cancer screening in average risk persons over age 50 using annual FOBT and/or flexible sigmoidoscopy every five years, or double-contrast barium enema every five to ten years. Screening colonoscopy for high risk persons once every ten years also was paid for. Payment was expanded to include average risk persons in July 2001. Methods: The Medicare 5% Carrier Standard Analytic File (SAF) for 1999 to 2002 was used to identify patient records with claims for colonoscopy, flexible sigmoidoscopy, double-contrast barium enema, and FOBT. The Carrier SAF is a representative 5% sample of final action claims for physician/supplier Part B services for all settings of care. The 5% Denominator SAF was used to obtain patient demographic information. Standard sampling methodology was used to extrapolate total volumes. Results: From 1999 to 2002, the number of Medicare beneficiaries increased by 4%. Beneficiaries in the study sample averaged 72 years of age, were 61% female, and 90% Caucasian. The number of procedures performed to evaluate colon health increased by 2% (from 7.77 to 7.92 million), and the number of colonoscopies increased by 52% (from 2.14 to 3.25 million). Conversely, there was a 59% decrease in sigmoidoscopy (810,000 to 334,000), 41% decrease in barium enema (522,000 to 306,000), and 6% decrease in FOBT (4.30 to 4.03 million). The percent of procedures with a primary diagnosis of polyp detection (ICD-9 211.3) remained constant for both colonoscopy (32% in 1999 and 33% in 2002) and sigmoidoscopy (7% in both 1999 and 2002). Conclusions: From 1999 to 2002, the number of procedures performed to evaluate colon health in Medicare beneficiaries remained steady, but the mix of procedures used changed. Colonoscopy use increased substantially while there was a marked decline in sigmoidoscopy and barium enema. Of note, the percent of colonoscopies with polyp detection remained unchanged despite a large increase in colonoscopy use. This may be explained by changes in screening patterns, patient mix, and increased public awareness. This study showed a dramatic shift in use of colon procedures over four years. Future study should monitor trends in colonoscopy use and patient outcomes, and the impact on system capacity. Purpose: To examine trends in the use of colonoscopy, flexible sigmoidoscopy, double-contrast barium enema, and fecal occult blood test (FOBT) in Medicare beneficiaries from 1999 to 2002. Background: In January 1998, Medicare began paying for colorectal cancer screening in average risk persons over age 50 using annual FOBT and/or flexible sigmoidoscopy every five years, or double-contrast barium enema every five to ten years. Screening colonoscopy for high risk persons once every ten years also was paid for. Payment was expanded to include average risk persons in July 2001. Methods: The Medicare 5% Carrier Standard Analytic File (SAF) for 1999 to 2002 was used to identify patient records with claims for colonoscopy, flexible sigmoidoscopy, double-contrast barium enema, and FOBT. The Carrier SAF is a representative 5% sample of final action claims for physician/supplier Part B services for all settings of care. The 5% Denominator SAF was used to obtain patient demographic information. Standard sampling methodology was used to extrapolate total volumes. Results: From 1999 to 2002, the number of Medicare beneficiaries increased by 4%. Beneficiaries in the study sample averaged 72 years of age, were 61% female, and 90% Caucasian. The number of procedures performed to evaluate colon health increased by 2% (from 7.77 to 7.92 million), and the number of colonoscopies increased by 52% (from 2.14 to 3.25 million). Conversely, there was a 59% decrease in sigmoidoscopy (810,000 to 334,000), 41% decrease in barium enema (522,000 to 306,000), and 6% decrease in FOBT (4.30 to 4.03 million). The percent of procedures with a primary diagnosis of polyp detection (ICD-9 211.3) remained constant for both colonoscopy (32% in 1999 and 33% in 2002) and sigmoidoscopy (7% in both 1999 and 2002). Conclusions: From 1999 to 2002, the number of procedures performed to evaluate colon health in Medicare beneficiaries remained steady, but the mix of procedures used changed. Colonoscopy use increased substantially while there was a marked decline in sigmoidoscopy and barium enema. Of note, the percent of colonoscopies with polyp detection remained unchanged despite a large increase in colonoscopy use. This may be explained by changes in screening patterns, patient mix, and increased public awareness. This study showed a dramatic shift in use of colon procedures over four years. Future study should monitor trends in colonoscopy use and patient outcomes, and the impact on system capacity.