Colon Health Centers Develops New Virtual Colonoscopy Program to Screen More Patients

According to Mark Baumel, MD, MS, president and CEO of Colon Health Centers of America, colorectal cancer is one of the most preventable types of cancer if detected early yet it remains the second-leading cause of cancer death in the United States. "Despite this opportunity for early detection and prevention, only 50 percent or fewer of Americans are screened for colorectal cancer," he says. "The result: Colon cancer kills more Americans than AIDS and breast cancer combined."

One of the main reasons patients are not screened for colorectal cancer is the invasiveness of traditional colonoscopy procedures. The advent of computed tomography colonography, or virtual colonoscopy, has provided an alternative to the traditional procedure by using CT scans to detect polyps. However, up to 20 percent of Americans who undergo this procedure will have polyps, necessitating a second, traditional procedure, according to Dr. Baumel.

As a result of these concerns, Colon Health Centers developed the concept of Integrated Virtual Colonoscopy, a progressive colorectal screening program that combines virtual colonoscopy with existing endoscopic technology at one location.

In order to make the best use of this technology, Colon Health Centers uses a unique business model; the company partners with community GI physicians who already own an endoscopy ASC or office-based endoscopy centers in order to provide a second comprehensive screening option for colorectal cancer. Under the operational model, patients undergo a virtual colonoscopy scan, wait 30-60 minutes for results and, if needed, are immediately directed to the co-located endoscopy center to have any polyps removed on the same day with the same preparation. Patients are able to have their second procedure without the need to schedule an additional appointment.

Including a leveraged radiology reading solution for the center is essential to making this model work, according to Dr. Baumel. "The interpretation of CT colonography studies requires specific expertise and experience," he says. "While some GIs think they can read these studies, it's probably not worth the significant time and effort for them to develop the necessary 2-D CT radiology interpretation skills critical for accurate interpretation of CTCs."

To aid in this process, Colon Health Centers uses a "hub-and-spoke" reading solution to service their centers — a single, centralized CTC reading "hub" with teleradiology technology (CHC Radiology) receives the CTC scans from all affiliated centers and then distributes the results eliminating the need for centers to send the scans to outside radiology departments.

"This solution guarantees high-quality, cost-effective and timely CTC interpretations for all of our centers," Dr. Baumel says. "There's little chance of accomplishing this level of service [using local radiology departments.]"

In addition, Colon Health Centers provides startup expertise, including legal expertise, CON support, design/build, payor contracting, equipment procurement and ongoing operational management for the centers, including human resources support, data transfer technology, study interpretation and marketing/branding efforts.

Dr. Baumel has faced some challenges in creating this model. Federal regulations, such as the Stark Act, prohibit self-referral to a physician-owned imaging center unless it qualifies as an "in-office ancillary exception." This requires the center to be wholly owned by a single tax ID group and prohibits the joint venturing that is allowed in other areas, such as ASC endoscopy centers. Also, some states have CON regulations that govern the acquisition of CT scanners.

Finally, payors have not uniformly reimbursed for screening CTC. For example, CMS recently finalized its decision not to cover screening CTC, citing the need for more data in the 65 and older age group, although Dr. Baumel views this as a temporary setback.

"Fortunately, most major commercial payors have now embraced CTC as a cost-effective option to invasive colonoscopy for CRC screening." He adds that screening CTC is now covered by national payors such as UnitedHealthcare, WellPoint, Cigna and many local Blue Cross Blue Shield affiliate plans.

Last year, Colon Health Centers opened its first center, the Colon Health Center of Delaware in Newark, with the support of BCBS of Delaware and other local payors. "CHC of Delaware has screened nearly 1,000 patients with Integrated Virtual Colonoscopy, and the patients love it," says Dr. Baumel. "The most gratifying aspect is that we are definitely getting people off the 'screening sidelines' with Integrated VC. Statistics from our first center show that nearly 50 percent of patients screened report that they would have remained unscreened had Integrated VC not been made available to them."

Colon Health Centers aims to spread its screening model throughout the Mid-Atlantic region and across the country. Currently, the company has three GI groups in Virginia that are applying for CON approval to open a center and has been in talks with several groups in the Philadelphia market looking to open centers.

"We have formally presented the concept to over 80 progressive GI groups across the country, the majority of whom absolutely 'get' the concept of Integrated VC and are just waiting for the right timing to add it to their CRC screening services."

Learn more about Colon Health Centers of America.