Introductory Statement on S. 1164
Mr. President, today I introduce the Colon Cancer Screen for Life Act of 2007 along with my colleagues, Senator Collins, Senator Lieberman, and Senator Graham. Many people are aware that colon cancer is the second most deadly cancer in the…
Mr. President, today I introduce the Colon Cancer Screen for Life Act of 2007 along with my colleagues, Senator Collins, Senator Lieberman, and Senator Graham. Many people are aware that colon cancer is the second most deadly cancer in the United States. In 2006 alone, according to the American Cancer Society, more than 150,000 new cases were diagnosed and more than 50,000 Americans died from colon cancer. In my own State of Maryland, nearly 1,000 people lost their lives to this disease last year. What people are not as aware of, however, is that colon cancer is preventable with appropriate screening, highly detectable, and curable if found early. The purpose of our bill is to increase the rate of participation in colon cancer screening and ensure that we are saving every life that we can from this deadly disease.
Medicare coverage for colorectal cancer screening through colonoscopy was authorized in the Balanced Budget Act of 1997 and further expanded in 2000 when the colonoscopy benefit was added for high risk beneficiaries. Under this Medicare benefit, a low risk beneficiary is entitled to receive a colonoscopy once every ten years and a high risk beneficiary is entitled to a colonoscopy every two years. Despite this, recent studies have shown that patients are not utilizing coverage of CRC preventive screenings. According to the Government Accountability Office, since the implementation of the benefit in 1998, the percentage of Medicare beneficiaries receiving either a screening or a diagnostic colonoscopy has increased by 1 percent.
Since providing coverage for this lifesaving service, Congress has discovered many barriers that stand in the way of patients having access to the colonoscopy benefit. One reason for such low utilization is that the physician reimbursement has been cut by 33 percent since this benefit was enacted. In 1997, a colonoscopy performed in a hospital outpatient department or an ambulatory surgery center was reimbursed at approximately $301. Now, in 2007, that reimbursement is only $198.20.
Some may argue that reductions in Medicare payments are necessary to keep the Medicare Program financially viable. While I strongly support efforts to eliminate wasteful spending in Medicare, I can assure my colleagues that is not the case here. To the contrary, providing adequate reimbursement for screening will result in Medicare savings and better health outcomes. Let me explain. Our health care system spends an estimated $8.3 billion annually to treat newly diagnosed cases of colon cancer. The average cost of direct medical care for each cancer episode is estimated to be between $35,000 for early stage detection and $80,000 for later stage detection. So each time that cancer is not detected early, that individual faces an increased risk of developing the disease and needing treatment that costs Medicare Program tens of thousands of dollars.
Patient participation has also been is that currently Medicare does not cover a preoperative visit with a physician prior to screening. While it is true that a colonoscopy is a minimally invasive procedure, an anesthetic is used to sedate the patient to make the colonoscopy less uncomfortable. Because the patient is going to be sedated, medical standards require doctors to visit with the patient before surgery to determine and protect against any risks, such as drug interaction, and to give them preoperative instructions. Recognizing the importance of these visits, Medicare does reimburse for a consultation prior to a diagnostic colonoscopy. A preoperative visit is no less medically necessary before a preventive screening, and therefore should be reimbursed in the same manner.
Finally, some beneficiaries may delay seeking colorectal cancer screening because they cannot afford Medicare's Part B deductible. Recognizing this, Congress recently took an important step by waiving the Part B deductible for preventive colon cancer screenings, effective January 1, 2007. However, gastroenterologists are now reporting that, if polyps or other signs of cancer are discovered in the course of a preventive colonoscopy, the procedure is then considered to be diagnostic and Medicare requires that the beneficiary pay a deductible. Congress needs to ensure that beneficiaries are not dissuaded from getting this lifesaving procedure by the concern that they might have to pay a deductible if a polyp is discovered. Our legislation clarifies congressional intent to ensure that CMS will waive the deductible in all screenings so that Medicare beneficiaries are not confronted with an unexpected additional expense, should the procedure's coding change.
The Colon Cancer Screen for Life Act would eliminate every one of these barriers, and in doing so, save lives. First, this legislation would increase reimbursement for colorectal cancer related procedures to ensure that physicians are able to continue to perform these valuable services. Reimbursement for procedures performed in a physician's office would be increased by up to 10 percent and reimbursement for procedures performed in Hospital Outpatient Department, HOPD, or Ambulatory Surgery Center, ASC, would be increased by up to 30 percent. The bill would also provide Medicare coverage for the preoperative doctor's visit conducted prior to a screening colonoscopy. Finally, the bill contains a technical provision to require that the deductible is waived whether or not the beneficiary's screening was clean or results in a biopsy or lesion removal.
More than 50,000 Americans will die from colon cancer this year alone. Ninety percent of these cases might have been prevented. We cannot afford to wait another moment before doing something to eliminate these and other barriers that are standing in the way of preventing colon cancer.
I urge my colleagues to join me in support of this important legislation and enact it this year.