Only one-fourth of Medicare beneficiaries receive recommended screenings for colorectal cancer since Medicare initiated coverage for screening colonoscopies, according to an American Cancer Society study printed in the association’s journal CANCER in January. The study looked at a sample group of more than 150,000 Medicare beneficiaries.
While it’s not particularly good news that millions of older Americans are missing out on potentially life-saving colonoscopies — and, it’s likely, so are working-age people who have commercial insurance coverage — it does show that there’s a large, untapped market for GI ASCs’ services.
“Not everybody’s compliant with getting their colonoscopies when they reach the appropriate age,” says Rodney H. Lunn, the CEO of Surgical Health Group in Brentwood, Tenn., “As a result, I think there are a whole lot of people out there who need and could be having procedures done, but who aren’t.”
Community outreach is one key to finding those patients and bringing them into your center, says Mr. Lunn. The president of the ACG believes improved reimbursement for these tests and payments to ASCs can help strengthen access to screenings. (For tips on casting a wider net, increasing reimbursement and more, see “Four Tips for Profitable Endoscopy in ASCs,” which starts on the front page.)
“The good news is that colorectal cancer deaths are down, but marked differences in the experience of colorectal cancer, its impact on quality of life, and death rates are seen between whites and blacks, and between the
uninsured, and even those with health coverage under Medicare and Medicaid,” says Amy E. Foxx-Orenstein, DO, FACG, the president of the American College of Gastroenterology. “The [ACG] is committed to national policy changes to improve access to colorectal screening and increased use of these proven prevention strategies, including reversing Medicare’s massive cuts to reimbursement for these tests since the benefit was first introduced, as well as to payments in ambulatory surgery centers where many screening tests are performed.”
GI as a whole, especially single-specialty GI ASCs, has been the hardest hit by CMS’s restructuring of the ASC payment system, suffering a 4.3 percent average cut per procedure. While it might seem counter-intuitive to bring in more Medicare cases, adding even one of these underserved patients per day can help make up for the cuts, according to calculations from John Poisson, the executive vice president at Physicians Endoscopy. See how it all breaks down — it’s not as bad as has been billed — on page 8.
In another spot of good news, Aetna has announced that it will delay indefinitely its plans to institute a new policy under which it would cover monitored anesthesia care only for high-risk patients. Critics of the policy change, which was announced in December and had been slated to take effect April 1, said it would taken patient-care decision-making out of the hands of physicians and restricted use of propofol, which they said would deter patients from undergoing screening colonoscopies. Outcry from providers and specialty societies prompted Aetna to wait until patient-friendly alternatives that do not require the added expense of an anesthesiologist become available, the insurer said on its Web site.
Contact Stephanie Wasek at stephanie@beckersasc.com or (484) 866-1292
