- The Washington Times - Tuesday, December 19, 2006

Increased Medicare reimbursement for colon-cancer screening since 1998 has resulted in more colonoscopies for older Americans and more early diagnoses, according to a new study.

The findings are reported by Dr. Cary P. Gross and colleagues at the Yale University School of Medicine in today’s issue of Journal of the American Medical Association and are supported in an accompanying editorial by a cancer surgeon at the University of Michigan at Ann Arbor.

“We found that the proportion of older colon cancer patients who were diagnosed with early-stage disease increased significantly after the initiation of new Medicare screening reimbursement policies,” wrote Dr. Gross, associate professor of medicine at Yale.

He said Medicare began paying for colonoscopies for those considered to be at high risk for colon cancer based on family history in January 1998.

Starting in July 2001, he said, Medicare expanded that coverage for anyone older than 50.

“The rate of colonoscopies tripled after the first change in Medicare coverage,” Dr. Gross said. “After the second change, when colonoscopy coverage became universal for Medicare beneficiaries, the rate doubled again. So overall it went up sixfold, which is a huge increase.”

In addition, he said, the Yale research found that the proportion of seniors diagnosed early for colon cancer rose from 22.5 percent during the five years before the first Medicare funding change to 26.3 percent from July 2001 to December 2002.

The researchers looked at a database of more than 44,000 Medicare patients diagnosed with colon cancer from 1992 to 2002 and from a group of Medicare beneficiaries who were not diagnosed with cancer.

Dr. Gross said colorectal cancer is the nation’s second-leading cause of cancer death after lung cancer. He said 150,000 new cases are diagnosed yearly — 60,000 of them among those 65 and older — and there are about 55,000 deaths.

Colonoscopies, which typically range in price from $800 to $2,000, “can prevent colon cancer,” he said. So he said it’s still disappointing that “we’re only catching one-fourth of cases at an early stage.”

In her editorial in JAMA, Dr. Arden M. Morris, an assistant professor of surgery of the University of Michigan, said the Yale findings “demonstrate that the change in Medicare policy was effective.”

“A target population received screening at a higher rate, and this resulted in an increase in the detection of early-stage and right-sided cancers.”

But Dr. Morris said she questions how long Medicare can be expected to provide universal colonoscopies for beneficiaries, given the high costs involved. “It remains to be seen if future screening will continue to increase the rates of early identification of colorectal cancer,” she said in her editorial.

Dr. Gross said he supports continued universal Medicare coverage of colonoscopies. But Dr. Morris said it is “not at all realistic,” and she foresees the need for a “feasible rationing plan for broader colon screening.”

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