Jan. 22, 2024 – In recent weeks, lawmakers and healthcare organizations called on the federal government to act and ensure surveillance colonoscopy is correctly classified by insurers as a preventive service.
In December, the American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Fight Colorectal Cancer, and 90 medical societies and patient advocacy groups sent a letter to the Departments of HHS, Labor, and Treasury asking for new guidance. Last week, Rep. Debbie Dingell (D-MI) led 45 members of the House of Representatives in similarly urging HHS to act.
Surveillance colonoscopies are critical follow-up exams for patients whose initial colonoscopy required polyp removal. This repeat, or surveillance, colonoscopy is conducted at a shorter interval than normal, potentially reducing colorectal cancer risk by 43–48%. Even though surveillance colonoscopy is for asymptomatic patients, commercial insurers classify it as a ‘diagnostic’ rather than preventive service. This unjustly subjects the very patients who need this screening the most to additional cost-sharing.
“Screening and adherence to surveillance exams are powerful tools in the fight against colorectal cancer, yet patient cost-sharing is a demonstrated barrier to screening,” the healthcare organizations wrote. “It is imperative that we have in place policies that foster the continuum of screening and reduce barriers to preventive care.”
“In adopting this update, the federal government would eliminate a significant barrier to screening and directly improve access to care,” the lawmakers wrote. “This is especially true in minority populations where we are seeing a 20% higher incidence rate and 40% greater likelihood to die from colorectal cancer compared to other racial and ethnic groups.”
The United States is at an inflection point in the fight against colorectal cancer. The disease is already the leading cause of cancer death in men younger than 50, and by 2030, it is expected to be the leading cause of cancer death among all Americans aged 20 to 49. Colorectal cancer is unique in that when detected early, the 5-year survival rate is 90% – unfortunately, early detection occurs in less than 40% of cases, underscoring the crucial importance of eliminating barriers to cancer screening and preventive care.
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AGA media contact: Rachel Shubert, [email protected]
