American College of
Radiology (ACR)
Radiology (ACR)
ACR lobbies for Medicare to pay for virtual colonoscopies
June 03, 2010
by Brendon Nafziger, DOTmed News Associate Editor
A bill backed by the American College of Radiology could make Medicare pay for virtual colonoscopies.
On Friday, Representatives Danny Davis (D-IL) and co-sponsors Mark Kirk (R-IL) and Dan Boren (D-OK) introduced the Virtual Screening for Colorectal Cancer Act of 2010, or H.R. 5461, into the House of Representatives. The bill calls for the Centers for Medicare and Medicaid Services to provide coverage for CT scans of the colon, known as computed tomography colonographies.
"Fifty to 70 percent of the people who should be being screened for colon cancer aren't getting screened, and those numbers [of people getting exams] aren't going up drastically," Shawn Farley, a spokesman for ACR, told DOTmed News.
CT colonography exams involve a 3D X-ray scan of the colon. Some consider the procedure attractive to patients wary of getting colonoscopies. Unlike the colonoscopy, the CTC procedure only takes a few minutes. And while a 2-inch tube is inserted in the rectum to inflate the bowels with gas or liquid, the colonoscope is much longer. ACR and the American Cancer Society both note that it could be less expensive than conventional colonoscopies.
While no official studies have been done on whether virtual colonoscopies increase compliance for screening, the Walter Reed Hospital in Washington, D.C. found a 70 percent increase in compliance once they started offering the CT exams, Farley said.
Some health plans already cover the procedure, one of the first screening exams President Barack Obama received after he took office. CIGNA, UnitedHealthcare and Anthem Blue Cross Blue Shield all cover screening and diagnostic CT colon scans, ACR noted. The American Cancer Society also includes it among its recommended screening tools.
Because it's not covered by Medicare, ACR warns of a "two-tiered" approach to screening coverage, hurting those reliant on Medicare who lack private health insurance or who can't afford to pay for exams out of pocket.
"It's time for all patients who want a CT colonography to be covered for this lifesaving exam," Dr. Judy Yee, chair of the ACR Colon Cancer Committee, said in a statement.
But not all doctors are as supportive of virtual colonoscopies. In a letter to the U.S. Food and Drug Administration in April, the American College of Gastroenterology said that CT colonographies might be useful for some patients but cautioned that "there is no demonstrable evidence that CT colonography prevents the development of CRC [colorectal cancer] or reduces CRC mortality rates" and argued that using the exams might increase health care costs.
Conventional colonoscopies are still their recommended screening tool, the doctors group said. On its website, the National Institutes of Health noted that virtual colonoscopies can't detect precancerous polyps smaller than 10 millimeters, and as doctors can't remove tissue samples during the procedure, if any suspicious findings are detected they'll have to order a follow-up conventional colonoscopy anyway.
But Farley pointed out most research suggests this would only apply to about 10 percent of people who are screened.
"Also you have to remember the cost of treating advanced colon cancer will be far more than the cost of treating a polyp. In the long run, you'll be saving money or a least not spending more money than you would have otherwise," he said.
But there is the radiation issue. The gastroenterologists group also worries that CT scans of the colon boost patients' exposure to ionizing radiation, which could lead to increased rates of radiation-induced cancers.
The average dose for the exam is about 10 mSv, equivalent to what someone would receive from background radiation over three years, according to the Radiological Society of North America's website. But the ACR said recent studies have shown CTC exams use one-third to one-half the radiation dose of a typical CT exam, and continue to fall.
According to American Cancer Society guidelines, CT colonographies are recommended about once every five years.
Farley was quick to point out that the ACR doesn't believe CT colonographies are a replacement for standard colonoscopies. Rather, it believes they're a way to boost compliance for screening and prevent unnecessary deaths from colon cancer, a largely treatable disease if caught early.
"For those people who are not getting screening, the choice is not a CT conolography versus a colonoscopy," Farley said. "It's a CT colonography versus nothing at all."
On Friday, Representatives Danny Davis (D-IL) and co-sponsors Mark Kirk (R-IL) and Dan Boren (D-OK) introduced the Virtual Screening for Colorectal Cancer Act of 2010, or H.R. 5461, into the House of Representatives. The bill calls for the Centers for Medicare and Medicaid Services to provide coverage for CT scans of the colon, known as computed tomography colonographies.
"Fifty to 70 percent of the people who should be being screened for colon cancer aren't getting screened, and those numbers [of people getting exams] aren't going up drastically," Shawn Farley, a spokesman for ACR, told DOTmed News.
CT colonography exams involve a 3D X-ray scan of the colon. Some consider the procedure attractive to patients wary of getting colonoscopies. Unlike the colonoscopy, the CTC procedure only takes a few minutes. And while a 2-inch tube is inserted in the rectum to inflate the bowels with gas or liquid, the colonoscope is much longer. ACR and the American Cancer Society both note that it could be less expensive than conventional colonoscopies.
While no official studies have been done on whether virtual colonoscopies increase compliance for screening, the Walter Reed Hospital in Washington, D.C. found a 70 percent increase in compliance once they started offering the CT exams, Farley said.
Some health plans already cover the procedure, one of the first screening exams President Barack Obama received after he took office. CIGNA, UnitedHealthcare and Anthem Blue Cross Blue Shield all cover screening and diagnostic CT colon scans, ACR noted. The American Cancer Society also includes it among its recommended screening tools.
Because it's not covered by Medicare, ACR warns of a "two-tiered" approach to screening coverage, hurting those reliant on Medicare who lack private health insurance or who can't afford to pay for exams out of pocket.
"It's time for all patients who want a CT colonography to be covered for this lifesaving exam," Dr. Judy Yee, chair of the ACR Colon Cancer Committee, said in a statement.
But not all doctors are as supportive of virtual colonoscopies. In a letter to the U.S. Food and Drug Administration in April, the American College of Gastroenterology said that CT colonographies might be useful for some patients but cautioned that "there is no demonstrable evidence that CT colonography prevents the development of CRC [colorectal cancer] or reduces CRC mortality rates" and argued that using the exams might increase health care costs.
Conventional colonoscopies are still their recommended screening tool, the doctors group said. On its website, the National Institutes of Health noted that virtual colonoscopies can't detect precancerous polyps smaller than 10 millimeters, and as doctors can't remove tissue samples during the procedure, if any suspicious findings are detected they'll have to order a follow-up conventional colonoscopy anyway.
But Farley pointed out most research suggests this would only apply to about 10 percent of people who are screened.
"Also you have to remember the cost of treating advanced colon cancer will be far more than the cost of treating a polyp. In the long run, you'll be saving money or a least not spending more money than you would have otherwise," he said.
But there is the radiation issue. The gastroenterologists group also worries that CT scans of the colon boost patients' exposure to ionizing radiation, which could lead to increased rates of radiation-induced cancers.
The average dose for the exam is about 10 mSv, equivalent to what someone would receive from background radiation over three years, according to the Radiological Society of North America's website. But the ACR said recent studies have shown CTC exams use one-third to one-half the radiation dose of a typical CT exam, and continue to fall.
According to American Cancer Society guidelines, CT colonographies are recommended about once every five years.
Farley was quick to point out that the ACR doesn't believe CT colonographies are a replacement for standard colonoscopies. Rather, it believes they're a way to boost compliance for screening and prevent unnecessary deaths from colon cancer, a largely treatable disease if caught early.
"For those people who are not getting screening, the choice is not a CT conolography versus a colonoscopy," Farley said. "It's a CT colonography versus nothing at all."