You may have already heard about the SCREEN ACT (S. 1079, HR 2035), new legislation introduced in April that would remove the barriers Medicare beneficiaries face when it comes to colorectal cancer and hepatitis C screening. This legislation is not only vital to addressing these two major public health challenges, but is potentially lifesaving for millions of Americans who receive health benefits under Medicare.
You (and your legislators) should support the SCREEN ACT to:
1. Remove Financial Barriers: Medicare currently waives patient cost-sharing by beneficiaries for any colorectal cancer screening test recommended by the United States Preventive Services Task Force (USPSTF). However, the requisite follow-up diagnostic colonoscopy upon a positive finding from another screening test, such as a stool test, is not considered part of the “screening.” Also, if a polyp is removed during the screening colonoscopy, the procedure is no longer considered a “screening test” for Medicare purposes. Thus, under both scenarios, patient cost-sharing applies.
- removes all financial barriers for Medicare beneficiaries throughout the screening continuum, so that cost-sharing would not apply whether a polyp is removed during a screening colonoscopy or as the result of a positive finding from another type of screening test.
2. Improve Quality: Medicare is expected to cut colonoscopy reimbursement in 2016, and unfortunately right at a time when our nation is making significant progress in lowering colorectal cancer incidence and mortality rates.
- encourages higher quality at time of lower reimbursement, which would result in more quality examinations for many Medicare beneficiaries;
- creates incentives to ensure that these patients receive the highest quality exams. (This provision would end when Medicare reimbursement reform begins in 2018.)
3. Remove Emotional Barriers: Medicare does not currently provide an office visit prior to screening colonoscopy so there is no opportunity for the patient to address any fear of the procedure with the physician prior to the procedure—and this fear is one of the main reasons individuals don’t undergo colorectal cancer screening.
- creates an innovative Medicare demonstration project which authorizes a colonoscopy pre-screening visit and an opportunity for Medicare beneficiaries to ask questions, learn about the importance of pre-procedure preparation, and learn more about what to expect on the day of the procedure.
- gives patients a chance to address any fears related to colonoscopy with the physician prior to the procedure.
4. Streamline care coordination: Medicare beneficiaries must first have a referral from a primary care doctor to receive a hepatitis C screening test. Yet, it is unclear whether these beneficiaries will first see a primary care physician for a referral if they are asymptomatic.
- allows the pre-screening visit to satisfy the current law’s hepatitis C referral requirement.
5. Save Lives: Colorectal cancer is the second leading cause of cancer death in the United States, with approximately 50,000 Americans expected to die from colorectal cancer this year alone. While this country is making progress against colorectal cancer mortality, more needs to be done to increase the use of screening tests by Medicare beneficiaries.
With 3.4 million Medicare beneficiaries in the dark about whether they are infected with the hepatitis C virus, this is a serious public health issue, according to the U.S. Centers for Disease Control (CDC) and the United States Preventative Task Force (USPTF). The CDC recommends one-time Hepatitis C screening for “Baby Boomers” in the 1945 to 1965 birth cohort who make up about 30 percent of the United State population and account for two-thirds of those infected with hepatitis C in this country. Yet roughly 85 to 90 percent of those infected with hepatitis C are asymptomatic, meaning they have no outward signs of disease, according to Centers for Medicare & Medicaid Services (CMC).
- eliminates barriers to potentially lifesaving colorectal screenings for Medicare beneficiaries and ensures they are screened regularly through a variety of recommended methods, including colonoscopy.
- allows the Medicare beneficiary to schedule an age appropriate hepatitis C screening at the same time as the screening colonoscopy, thus promoting two important public health imperatives in the same encounter.
Notable: Recent findings from a small study in Texas at Scott & White Hospital demonstrate that more patients will elect to undergo a Hepatitis C screening test if it is offered by a gastroenterologist at the same time that the patient schedules a screening colonoscopy. (Sears, et al. “Birth Cohort Screening for Chronic Hepatitis During Colonoscopy Appointments,” Am J Gastroenterol 2013; 108:981–989)
What You Can Do
Urge Congress to Support the SCREEN Act
Senator Ben Cardin and Congressman Richard Neal Introduce SCREEN Act
New Demonstration Project Links Colorectal Cancer Screening to Discussion and Testing for Hepatitis C
Medicare Beneficiaries Gain Access to Hepatitis C Info & Screening Under SCREEN Act
Sen. Benjamin Cardin (D-MD)
Rep. Richard Neal (D-MA)
Carroll D. Koscheski, MD, Chair, ACG National Affairs Committee