Medicare May Cut Benefits for Virtual Colonoscopy; Millions of Patients Would be Affected

Millions of Medicare patients may soon lose coverage for virtual colonoscopy, a technique preferred by many physicians as a non-invasive alternative to more conventional colonoscopies for the screening of colon cancer.

An estimated 40 million people in the United States, many of them over the age of 65, have health insurance through the federal Medicare program. Colon and rectal cancer are leading killers of Americans, with 150,000 new cases and nearly 50,000 deaths associated with the diseases each year.

Cutting virtual colonoscopy from the roster of covered Medicare procedures could reduce the numbers of colon cancers which are detected at an early stage and therefore increase the number of people who succumb to the deadly disease.

Virtual as Good as the Real Thing?

The Centers for Medicare and Medicaid Services has said there is “insufficient evidence” to conclude that virtual colonoscopy “improves outcomes in Medicare beneficiaries.” The agency has tentatively decided to discontinue coverage for the procedure, also called CT colonography, but a final decision will not be made until after the agency receives public comments on the idea.

Virtual colonoscopy uses noninvasive CT scans and X-rays to produce images of the inside of the colon so a physician can scan the organ for abnormal growths, called polyps. In conventional colonoscopy, a probe with a camera on the end is inserted through the rectum and into colon. There have long been questions about whether virtual colonoscopy is as effective as the conventional procedure.

Advocates of virtual colonoscopy called is “better, safer, faster, and cheaper” than conventional colonoscopy and said Medicare’s tentative decision to stop paying for the procedure did not make sense. Eliminating coverage for virtual colonoscopy would leave physicians with one less treatment option for patients who, for whatever reason, cannot or do not want to undergo conventional colonoscopy surgery.

In 2008, the American Cancer Society began recommending virtual colonoscopy as one option for colon cancer screening.

Insufficient Evidence of Virtual Benefits?

The United States Preventive Services Task Force, which advises the government on disease prevention, has said there is insufficient evidence available to determine the harms and benefits of virtual colonoscopy. Private insurers are split on the issue, with some paying for the tests and some not.

Colonoscopy is not more effective at detecting larger polyps than simple CT scans, but is better at picking up smaller polyps. However, there is no consensus about whether the smaller growths are dangerous, officials said.

Virtual colonoscopy does not require sedation, which is often used for conventionl colonoscopy, and result in a lower risk of bowel perforations than the conventional procedures. However, even the virtual CT procedures require bowel preparation and expose patients to radiation. If polyps are detected during a virtual colonoscopy, a patient would typically undergo a regular colonoscopy to have them removed.

Medicare Statistics

Medicare said many studies supporting virtual colonoscopy as a viable alternative for colon cancer screening were done in people younger than Medicare’s older population, so the same positive results reached in the study may not translate to Medicare patients. Most studies of virtual colonoscopy have been on people with an average age around 58, officials said.

Older people who may be on Medicare are more likely to have polyps and are more likely to require a conventional colonoscopy after the virtual procedure, making the CT scan exam less cost-effective, Medicare officials said.

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