KATHY KROL GOES TO WASHINGTON
As the Legislative Special Interest Group Facilitator for SGNA, Kathy Krol had the privilege of going to Washington, D.C. for a Day on the Hill to speak with Congressmen and Senators from California to explain and encourage there support for the legislation to include"The Colon Cancer Screen for Life Act of 2003" that was introduced in March in the Medicare reform bill S.1: The Prescription Drug and Medicare Improvement Act of 2003.
As you know colorectal cancer is the number two cancer killer in the United States. This year, 147,500 new cases will be diagnosed and 57,100 Americans will die from the disease. Medicare currently covers either a screening colonoscopy once every 10 years or a flexible sigmoidoscopy every 4 years for individuals not at high risk. Beneficiaries at high risk are entitled to a full colonoscopy every 2 years.
However, seniors are not utilizing these colorectal cancer screening services. This is due in part to drastic cuts in reimbursement. Cuts have been particularly harsh for screenings provided in hospital outpatient departments and ambulatory surgery centers. In 1997, a colonoscopy performed in these settings was reimbursed at approximately $301. In 2003, the rate will fall to about $206. Colorectal cancer screening will not be effective if it is a " loss leader" for doctors.
The goal of this bill is to improve access to colorectal cancer screeing tests for theMedicare beneficiaries, and to improve Medicare coverage of these tests. The bill accomplishes this by making three changes to current law: first, the bill increases Medicare payments for screening tests to make sure that doctors can cover the costs of providing these valuable services. The bill would increase payments for tests performed in a doctor's office by 10%, and would increase payments for tests performed in a Hospital Outpatient Department or Ambulatory Surgery Center by 30%. Second, the bill would require Medicare pay for an office visit with a doctor prior to a screening colonoscopy.
Since colonoscopy involves conscious sedation,doctors usually do not perform this test without talking to patients beforehand to discuss their medical history and tell them how to prepare for the test. Medicare currently pays for an office visit before a diagnostic colonoscopy, but not before a screening colonoscopy. But the visit is no less necessary in the case of a screening and therefore Medicare should pay for it in both cases. And finally, the bill would exempt colorectal cancer screening tests from the usual Medicare Part B deductible. By reducing the financial requirements on beneficiaries, the bill will encourage more people to take advantage of the colorectal cancer screening benefit.