Despite significant evidence of CT colonography’s
effectiveness as a screening tool for colorectal cancer, on Feb. 11, the Centers
for Medicare and Medicaid Services (CMS) announced
a proposed decision not to cover the exam, stating that the evidence was
inadequate to conclude that CTC would provide health benefits to the average
Medicare beneficiary.
In the CMS proposed decision memo, opponents to coverage cited unknown effects from radiation exposure associated with the exam, questions as to the amount of training necessary to properly read the exam, and concern that it would be difficult to generalize the results of the ACRIN CT Colonography Trial to the average practice setting and specifically to the Medicare population.
The ACR and other societies have been working together to reverse CMS’s proposal by educating members of Congress that using CTC as a screening method for colorectal cancer will help more people to get screened, aid in early detection and ultimately help save lives.
At a Capitol Hill briefing last Monday, Elizabeth McFarland, M.D., chair of the ACR Colon Cancer Committee, made a presentation to congressional and regulatory staff members on behalf of the College as to the effectiveness and importance of this exam. In response to these efforts, several lawmakers have signed on to letters written to CMS urging them to cover CTC.
In a letter to the editor published in Saturday’s New York Times, Andrew R. Spiegel, chief executive of the Colon Cancer Alliance, Ilyse Schuman, managing director of the Medical Imaging and Technology Alliance, and myself, reinforced the proven cost-effectiveness of CTC as well as its “potential to enhance colon cancer screening compliance.”
The 30-day public comment period for the proposal ended on Friday, CMS is expected to make a final (at least for the immediate future) decision on coverage by May 12.
For those of you who currently offer/perform CTC:
Has your practice seen an increase in CTC volume since the results of the ACRIN study were published in the New England Journal of Medicine last fall or a decrease since CMS proposed not to cover the exam?
And if you do not currently offer/perform CTC:
Will Medicare’s final coverage decision determine whether or not you add this exam to your practice or seek out training?
I look forward to your thoughts.








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