Carroll D. Koscheski, MD, FACG
Carroll D. Koscheski, MD, FACG

A study published this week concluded that higher quality colonoscopies in terms of better adenoma detection were associated with as high as 50 to 60 percent lower lifetime risk for colorectal cancer incidence and death without incurring higher costs, according to findings from an analysis by researchers at Kaiser Permanente in Northern California. These conclusions suggest that the physician performing your colonoscopy makes a difference in whether you’ll develop colon cancer, or die from it.

Researchers developed a microsimulation model to estimate lifetime benefits, complications and costs of an initial colonoscopy and found estimated net screening costs were on average 3.2% for every five percentage point increase in adenonma detection.

Colonoscopy saves lives, and high quality colonoscopies save even more. Adenoma detection rate is an important measure of colonoscopy quality. An important conclusion of the study is that higher-quality screenings did not translate into more expensive screenings, the research team noted in the June 16 issue of the Journal of the American Medical Association.

So what are GI physicians doing to promote higher quality colonoscopies?

Private GI practitioners are all too familiar with the buzzwords of “pay for performance” and “value-based care.” We also understand that many government initiatives requiring us to demonstrate our “performance” or “value” may not actually translate into what we think is “quality” or better outcomes.

What’s more, we often struggle to balance the need to invest in initiatives that will improve the quality of care we provide with just trying to stay afloat as an independent medical practice. This balancing act is becoming increasingly difficult as colonoscopy reimbursement continues to be threatened in Medicare and in private insurance world.

Legislation before Congress (the SCREEN Act S. 1079/H.R. 2035) aims to ensure that the use of colonoscopy for the screening and detection of colorectal cancer remains accessible for all Medicare beneficiaries. The bill also helps protect GI physicians from any forthcoming Medicare cuts in order to invest in more quality improvement activities (in addition to current requirements).

A Call-to-Action

It is important that the GI community continue to remind policymakers of any unintentional consequences from unwarranted and untimely cuts to Medicare reimbursement for colonoscopy under Medicare and let them know that this bill is the only legislation currently before Congress that proposes to deal with this issue. Reach out to your Members of Congress.

The Medicare-age population, which is at the greatest risk for developing colorectal cancer based on age, has screening rates far below the target for a national public health goal of 80% by 2018 – only 64% according to the American Cancer Society’s “Colorectal Cancer Fact & Figures 2014-2016.” This is an urgent challenge because Medicare beneficiaries account for two-thirds of all new cases of colorectal cancer each year, according to the U.S. Centers for Disease Control (CDC).

It is counter-intuitive and short-sighted to cut Medicare reimbursement for screening tests just at the point when our nation is gaining traction in lowering incidence/death rates and as many providers are assuming significant practice costs to participate in quality improvement registries to help achieve high quality colonoscopies and better outcomes.


What You Can Do

Urge Congress to Support the SCREEN Act

Learn more

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Sen. Benjamin Cardin (D-MD)
Rep. Richard Neal (D-MA)