I wanted to look at the idea of virtual colonoscopy, and the recent memo issued by CMS stating that they would not reimburse for the procedure, from three different aspects. The first is general health care reform as some state this is the beginning of changing times (more on this in a moment). The second is through the perspective of the patient. The third is through the perspective of the provider. The latter two will have a much more marketing perspective to them.
Last month the Centers for Medicare and Medicaid Services (CMS) issued a memo stating that they would not be reimbursing for Virtual Colonoscopy as a screening method for Colorectal Cancer. Many different articles and editorials, such as this one from the New York Times, suggest that these type of decisions are "fundamental to any successful health care reform effort". The author goes on to say that "Eliminating unproven procedures and reducing needless costs is necessary if the nation is to improve the quality and lower the cost of care over all."
Now, I don't disagree with this sentiment, per se. However, are we really going about this the right way? Currently there are other "screening" tests that are reimbursed by CMS, such as Fecal Occult Blood Test, that have been proven to be far less effective than CTC. Wouldn't it make more sense to review current procedures that are reimbursed as to their efficacy? Or do we leave them because at one point they were the gold standard, but as technology has advanced, it would be too much of a hassle to reevaluate these antiquated methods?
Taking this a step further, shouldn't it also be important to look at the types of procedures that are being reimbursed? By this I mean screening, diagnostic, treatment, monitoring, etc. When looking at it from this perspective, preventative medicine is far less expensive than treatment of a disease. Just ask anyone that has had an overnight stay in a hospital, or a surgical procedure. And how much of that is paid for by Medicare and Medicaid? By simply preventing the disease in the first place, how much money would be saved? I don't have the answer to this, but I would assume it is quite a bit.
So, let's return to the case for Virtual Colonoscopy. Why is this become a hot topic? Colorectal cancer is the second leading cause of cancer death in the U.S. annually (nearly 50,000 deaths per year), but is one of the most treatable if caught early. Unfortunately, less than 50% of the at-risk population (adults over the age of 50) are screened using any method including those that are less effective. Not only do there exist numerous studies that indicate that this procedure is as effect as optical colonoscopy (the current gold standard) at identifying lesions of 10 mm and greater, but there are additional studies that show the at-risk population is more likely to be screened using this method. On top of this, the numbers indicate that 80% of those that are screened do not have lesions that need to be removed, thus saving additional time and money (no anesthesia and CTC costs less per procedure than optical).
In my opinion, this decision by CMS concerning Virtual Colonoscopy is a short-sighted view that could affect access to an proven procedure, and is at best a veiled attempt at reform without really digging deep and asking some tough questions about the entire system. Are all currently reimbursable procedures still adequate? Can money be saved by removing older, less effective, but still reimbursable procedures? What types of procedures are being reimbursed? Can money be saved in the long-term by putting more emphasis on screening procedures? It won't be until CMS begins looking at things from this perspective that we will see actual reform begin to take place.
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