Advocates Flog CMS for Ending CT Colonography Coverage

John Commins, for HealthLeaders Media , May 15, 2009

The American Cancer Society and other patient care and medical advocacy groups are bashing CMS for its decision this week to end Medicare coverage for CT colonographies.

"To say the least, I am personally very disappointed. Not that my opinion should be the driving force on a decision that may affect the lives of thousands of people,” wrote Len Lichtenfeld, MD, the American Cancer Society's CMO, on his blog. "It was an opportunity to start setting the stage on how we can do things the right way in healthcare going forward, which will be a critical part of any reform effort.”

CMS says it decided against covering CT colonography after evaluating health outcomes for people ages 65 years and older and determining that "the evidence is not sufficient to conclude that screening CT colonography improves health benefits for asymptomatic, average risk Medicare beneficiaries.”

"While it is a promising technology, many questions on the use of CT colonography need to be answered with well designed clinical studies that focus on health outcomes for the Medicare population,” CMS wrote in its summary. CMS reportedly spent $16 billion on various scans in 2006, which is double what it spent in 2000.

Colorectal cancer is the third most common cancer among both men and women in the United States. About 140,000 new cases of colorectal cancer are diagnosed each year, and about 50,000 people die because of late detection, says James H. Thrall, MD, chair of the American College of Radiology.

"Make no mistake: If let stand, this CMS decision not to pay for CT colonography will cost lives,” Thrall says. "For CMS to turn its back to a technology that can attract more patients to be screened and save countless lives is deeply concerning. CMS should reverse this determination immediately or Congress should step in and vote to mandate coverage of CTC.”

A recent study by National Cancer Institute found that a CT colonography is as effective as a standard colonoscopy to screen for cancer and precancerous polyps. The American Cancer Society last year added CT colonography to its list of recommended colorectal cancer screening exams. The National Cancer Institute Colorectal Cancer Progress Review Group has estimated that wider use of screening could save 20,000 lives annually.

Several major private health insurance companies, including CIGNA and UnitedHealthcare, cover CT colonography. Elizabeth McFarland, MD, chair of ACR's Colon Cancer Committee, says CMS' decision to drop CT colonography creates two-tiered coverage that will adversely impact poor, minority, and underserved areas.

"This noncoverage determination is a setback to efforts to provide better care to underserved areas of the population," McFarland says.

John Commins is a senior editor with HealthLeaders Media.

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