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In 2001, Medicare coverage for screening colonoscopy in average-risk older people was implemented. The effect of this policy on gastroenterology practices has been enormous; but, obviously, whether detection of colorectal cancer has been improved by the higher rate of screening colonoscopies is of greater consequence.
Researchers obtained rates of colonoscopy among older people (age, ≥67) from the Surveillance, Epidemiology, and End Results (SEER) data and a Medicare-linked database. Three periods were considered: 1992 through 1997 (no Medicare coverage for colonoscopy screening), January 1998 through June 2001 (limited coverage for screening), and July 2001 through December 2002 (full coverage for screening). The primary outcome was the stage of colorectal tumors at diagnosis.
Colonoscopy rates increased from 285 per 100,000 Medicare enrollees per quarter in the earliest period to 889 and 1919 per 100,000 per quarter in the second and third periods, respectively. Among 44,924 patients who were diagnosed with colorectal cancer during the study periods, the proportion of patients diagnosed with stage I disease increased significantly, from 22.5% in the earliest period to 25.5% and 26.3% in the second and third periods, respectively. The stage shift was confined to proximal colon lesions and to the fee-for-service segment of the Medicare population (not HMO participants).
Gross CP et al. Relation between Medicare screening reimbursement and stage at diagnosis for older patients with colon cancer. JAMA 2006 Dec 20; 296:2815-22.
Comment
These results provide important evidence that screening colonoscopy coverage is beneficial for Medicare enrollees.