Covering a virtual colonoscopy, or not, will test the cost-cutting will of Medicare

Medicare is in the midst of deciding whether to cover virtual colonoscopies.

I wrote two prior pieces on their pending decision::

Should Medicare cover a virtual colonoscopy?

Medicare will not cover virtual colonoscopies, gastroenterologists breathe a sigh of relief

In February, after reviewing the evidence, a federal agency simply said, “The evidence is inadequate.”

Predictably, the move created instant dissent, mainly from CT-scan makers who stand to profit handsomely from the surge in scanner sales should virtual colonoscopies (via Schwitzer) be approved.

The problem is one of cost. Although virtual colonoscopies are cheaper than the traditional route, 20 percent of these scans will find polyps that will necessitate an endoscopic colonoscopy anyways. The potential for duplicating tests, and further driving up spending, is at the center of the debate.

This will be one of the higher profile issues that will test Medicare’s resolve. Whether or not they will bow to the lobbyists will go a long way to see how serious they are to contain spending.

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  • Anonymous

    Medicare should allow reimbursement that reflects that. Reflecting that a certain number will need duplicate testing. Would be interesting to see if they really did something along those lines.

  • Michael Kirsch, M.D.

    Let me disclose that I am a gastroenterologist with bias on this issue. I discuss virtual colonography by CAT scan with patients in the office before scheduling their colonscopy. When patients learn that CAT scan study requires a full laxative preparation and that polyps found cannot be removed, they reply with a spirited ‘no thank you’! In addition, CAT scans have risks of radiation and may discover ‘lesions’ outside the colon that can lead to unnecessary medical care and anxiety. This latter issue is not considered by patients and is explained in more detail at http://mdwhistleblower.blogspot.com/2009/04/beware-radiologic-incidentaloma.html

  • Realist

    If gastroenterologists owned ct scanners and could make money from virtual colonoscopies predictably followed by conventional colonoscopies (because a lesion possibly, perhaps, may be present), I bet GI docs would be whistling a different tune. They wouldn’t care about radiation dose, extra colonic findings, bowel prep or anything else.

  • Michael Kirsch, M.D.

    No argument with me. For many physicians and others, money drives the policy. Each specialty protects its turf, always claiming to be protecting the patient. Like REALIST, I am also somewhat cynical. I think CAT colonography will dominate when it can be performed without a prep. Once fecal DNA testing is perfected, then both gastroenterologists and radiologists can commiserate with each other.

  • Anonymous

    Michael Kirsch, or anyone else who knows……..

    What is the status of the fecal DNA testing?

    I thought there actually was a test available, but was cost-prohibitive so far. Is that accurate?

  • Michael Kirsch, M.D.

    I am not aware if fecal DNA has been FDA approved yet. I believe that most experts still view colonoscopy as the preferred screening test. Fecal DNA, which requires no prep, is obviously an attractive option if the accuracy will be sufficient. I suspect that within my own career, colonoscopy will be an exhibit in a museum of medical history. Of course, someone will still need endoscopic skills if fecal DNA or other tests for colon tumors are positive. But who knows? Scientists are working on robotic technology that may facilitate remote controlled devices that can be directed throughout the intestines to diagnose and treat.

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