By Durado Brooks, MD, MPH
Imagine that you dropped your car off at a service station for what you thought was a free oil change. You return an hour later to be informed that while the service was underway a small problem was found and repaired (with no input from you), and you now owe $250. How would you take this news? This is the predicament that a number of people face every day due to an oversight in existing Medicare regulations. Colorectal cancer remains the third leading cause of cancer death in the U.S. Screening is inarguably one of the most effective tools in our fight against the disease, since colorectal cancer screening not only helps find cancer in early, more treatable stages, but can actually prevent cancer altogether. Detection of precancerous polyps is a frequent occurrence during screening exams, occurring in approximately 15% of colonoscopies performed on women, and in up to a quarter of procedures in men. Removing these growths has contributed significantly to the steady fall in colorectal cancer cases and deaths over the past 15 years. Colorectal cancer screening has also been proven to be highly cost-effective. An important provision of the Patient Protection and Affordable Care Act makes a number of proven preventive services, including colonoscopy screenings, available at no cost to Medicare beneficiaries. However, if a polyp is found and removed during the course of a routine colonoscopy, the procedure is no longer coded as a screening exam, but is reclassified as a therapeutic procedure at which point the patient becomes responsible for a payment. This fee can range as high as $200, an amount that can be difficult to afford for seniors living on a fixed income. A substantial body of evidence demonstrates that lack of insurance coverage and other financial barriers are associated with lower rates of cancer screening. At a time when 4 out of 10 at-risk individuals are not getting screened for colorectal cancer, we should be doing everything possible to eliminate these barriers and increase utilization of this health-preserving and life-saving technology. Fortunately there may soon be a solution to this vexing problem. The Removing Barriers to Colorectal Cancer Screening Act of 2012' (H.R. 4120), sponsored by U.S. Representative Charlie Dent (R-PA), would close this loophole and eliminate the possibility of unexpected costs for Medicare beneficiaries receiving a screening colonoscopy, even if a polyp ends up being removed during the procedure. The American Cancer Society Cancer Action Network (ACS CAN) has teamed with a host of organizations involved in the fight against colorectal cancer to support of this legislation. Your legislators need to know that you too are concerned about this barrier to high quality healthcare, so please call or write your elected representatives and encourage them to get behind (pun intended) this important piece of legislation.
Dr. Brooks has served as the director of prostate and colorectal cancers at the American Cancer Society's National Home Office since 2000. In this role he is involved in creating and implementing strategies to improve the prevention and early detection of prostate and colorectal cancers, and is engaged in a number of the Society's disparities-reductions efforts. After graduating from the Ohio State University and the Wright State University School of Medicine, Dr. Brooks practiced primary care internal medicine in community health centers, initially in Ohio and later in his current hometown of Dallas, TX. Prior to joining the ACS he was awarded a Commonwealth Fund/Harvard University Fellowship and earned his MPH degree at the Harvard School of Public Health.
The true costs of cancer are heavy, they are deep, and they are ultimately unaffordable for many, a challenge further exacerbated by this year’s COVID-19 pandemic and spotlighted by the upcoming Supreme Court case challenging the Affordable Care Act.