Minority groups protest CMS’ rejection of VC screening

ABSTRACT: Members of the Congressional Black Caucus have joined the ranks of virtual colonoscopy (VC or CT colonography [CTC]) advocates to pressure the Centers for Medicare and Medicaid Services to reverse a proposal to deny reimbursement for VC screening. Proponents argue that the policy could widen existing colon cancer screening inequalities.

In a February 2009 Proposed Decision Memorandum, CMS suggested that current scientific evidence is inadequate to conclude that VC improves net health benefits for asymptomatic average-risk Medicare beneficiaries.

CMS thus decided that VC for colorectal cancer screening should remain uncovered.

This week, Rep. Danny K. Davis (D-Ill.) and 10 other members of the Congressional Black Caucus sent a letter to CMS’ acting administrator Charlene Frizzera urging the agency to reconsider its VC screening coverage proposal.

Colorectal cancer is the third most common cancer among African Americans, who deal with disproportionately high incidence and death rates. African Americans are less likely to receive recommended screening, however, and the invasiveness of the standard colonoscopy may be a contributing factor to the low rate of compliance, Mr. Davis explained in the letter.

Private insurance plans provide VC screening coverage in 26 states, according to Mr. Davis. CMS’ proposed decision, however, would deny that same access to Medicare beneficiaries in those states.

Findings of a study published in the March Journal of the American Geriatrics Society showed that the disparity between white and nonwhite Medicare enrollees receiving colorectal cancer screening increased between 1995 and 2003 (57:412-418, 2009).

“Medicare coverage of VC as a minimally invasive screening test for colorectal cancer would not just encourage more patients to undergo screening, but it would potentially close or eliminate the gap in colorectal cancer screening between African American and other populations,” Mr. Davis continued in his letter.

The U.S. public overall is underscreened for colon cancer, even with current reimbursed screening tools, according to Judy Yee, MD, a member of the American College of Radiology Colon Cancer Committee. She is also the vice chair of radiology at the University of California, San Francisco.

However, studies confirm the notion that people of color have even lower screening rates than the general public, Dr. Yee said. “A lot of effort has been put into the science behind CTC. Having a tool available that would make colon cancer screening more appealing to the underscreened groups is important.”