Ending “Post-Polypectomy Surprise” included in Larger COVID-19 Stimulus Package

The American College of Gastroenterology (ACG) is grateful to Congress for passing a long-overdue resolution to a problem that has been impacting GI patients for decades. The Removing Barriers to Colorectal Cancer Screening Act (S. 668; HR 1570), as passed by the House of Representatives on December 9th, was included in the $900 billion COVID-19 relief and stimulus agreement, and $1.4 trillion omnibus federal government spending bill cleared by Congress December 21, 2020.

“On behalf of the American College of Gastroenterology, I want to thank Congress for including the Removing Barriers to Colorectal Cancer Screening Act (S. 668; HR 1570) in the larger spending and COVID-19 relief packages today. This legislation is long overdue and will help increase colorectal cancer screening rates in the Medicare population. Thank you, Rep. Donald Payne, Jr. (D-NJ), Sen. Sherrod Brown (D-OH), and all current and former members of the U.S. Congress for championing this important bipartisan issue throughout the years. ACG is grateful to partner with many patient advocacy groups and professional societies, who have all joined together to get this passed through Congress.

Colorectal cancer is still a major public health issue, yet still is largely preventable. Over 50,000 Americans are estimated to die from colorectal cancer this year. It does not take a pause due to COVID-19, or any other public health crisis. Thus, it is important for policy makers to do everything we can do to incentivize and increase colorectal cancer screening rates in the Medicare population.”

–David A. Greenwald, MD, FACG; ACG President

Years in the Making

The College has advocated for removing patient cost-sharing and increasing Medicare reimbursement for screening colonoscopy for decades. The College worked closely with then-Representative Ben Cardin (MD) and former Senator Joseph Lieberman (CT) as they first introduced the Screen for Life Act in 2002, and then via various iterations of the SCREEN Act in the years that followed. Congress partially addressed these issues in 2010 when passing the Affordable Care Act and waiving cost-sharing for colorectal cancer screening. However, the implementation of the new law led to an unintended quirk we refer to as the “post polypectomy surprise”—when a screening procedure finds a polyp, the visit switches from a screening to a therapeutic procedure and the waiver of cost-sharing goes away, leaving patients with unexpected bills. Notwithstanding the fact that finding and removing polyps is the purpose of screening, policymakers have thus far failed to resolve this issue. 

The College joined a coalition of organizations in 2012 advocating to advance the Removing Barriers to Colorectal Cancer Screening Act. The elimination of cost-sharing is a critical component to increasing screening utilization rates. The College is proud of the work of the ACG Board of Governors and ACG leadership who have been advocating on this issue for many years, since various public health initiatives to provide insurance coverage for colorectal cancer screening were set into motion beginning in the late 1990s and July 2001 when Medicare began covering colorectal cancer screening in average-risk individuals.

“On behalf of the ACG Legislative and Public Policy Council, I wanted to convey my appreciation to the members of Congress for passing this important legislation and for mitigating scheduled cuts to GI services. The ACG Leadership, Public Policy Council, ACG Board of Governors, and many committee volunteers have advocated to increase colorectal cancer screening rates for a long time. We truly appreciate your persistence and efforts. While there are still improvements we would like to see, like realizing an increase in screening rates and eradicating the current disparities in screening and health care across the U.S., this is a significant step in the right direction. Thank you, distinguished members of Congress.”

–James C. Hobley, MD, MSc, FACG; Chair, ACG Legislative and Public Policy Council

The American College of Gastroenterology thanks all members of Congress who championed this issue over the years on behalf of our patients.