[Congressional Record Volume 153, Number 63 (Thursday, April 19, 2007)]
[Senate]
[Page S4756]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CARDIN (for himself, Ms. Collins, Mr. Lieberman, Mr. 
        Graham, and Mr. Nelson of Nebraska):
  S. 1164. A bill to amend title XVIII of the Social Security Act to 
improve patient access to, and utilization of, the colorectal cancer 
screening benefit under the Medicare Program; to the Committee on 
Finance.
  Mr. CARDIN. Mr. President, today I introduce the Colon Cancer Screen 
for Life Act of 2007 along with my colleagues, Senator Collins, Senator 
Lieberman, and Senator Graham. Many people are aware that colon cancer 
is the second most deadly cancer in the United States. In 2006 alone, 
according to the American Cancer Society, more than 150,000 new cases 
were diagnosed and more than 50,000 Americans died from colon cancer. 
In my own State of Maryland, nearly 1,000 people lost their lives to 
this disease last year. What people are not as aware of, however, is 
that colon cancer is preventable with appropriate screening, highly 
detectable, and curable if found early. The purpose of our bill is to 
increase the rate of participation in colon cancer screening and ensure 
that we are saving every life that we can from this deadly disease.
  Medicare coverage for colorectal cancer screening through colonoscopy 
was authorized in the Balanced Budget Act of 1997 and further expanded 
in 2000 when the colonoscopy benefit was added for high risk 
beneficiaries. Under this Medicare benefit, a low risk beneficiary is 
entitled to receive a colonoscopy once every ten years and a high risk 
beneficiary is entitled to a colonoscopy every two years. Despite this, 
recent studies have shown that patients are not utilizing coverage of 
CRC preventive screenings. According to the Government Accountability 
Office, since the implementation of the benefit in 1998, the percentage 
of Medicare beneficiaries receiving either a screening or a diagnostic 
colonoscopy has increased by 1 percent.
  Since providing coverage for this lifesaving service, Congress has 
discovered many barriers that stand in the way of patients having 
access to the colonoscopy benefit. One reason for such low utilization 
is that the physician reimbursement has been cut by 33 percent since 
this benefit was enacted. In 1997, a colonoscopy performed in a 
hospital outpatient department or an ambulatory surgery center was 
reimbursed at approximately $301. Now, in 2007, that reimbursement is 
only $198.20.
  Some may argue that reductions in Medicare payments are necessary to 
keep the Medicare Program financially viable. While I strongly support 
efforts to eliminate wasteful spending in Medicare, I can assure my 
colleagues that is not the case here. To the contrary, providing 
adequate reimbursement for screening will result in Medicare savings 
and better health outcomes. Let me explain. Our health care system 
spends an estimated $8.3 billion annually to treat newly diagnosed 
cases of colon cancer. The average cost of direct medical care for each 
cancer episode is estimated to be between $35,000 for early stage 
detection and $80,000 for later stage detection. So each time that 
cancer is not detected early, that individual faces an increased risk 
of developing the disease and needing treatment that costs Medicare 
Program tens of thousands of dollars.
  Patient participation has also been is that currently Medicare does 
not cover a preoperative visit with a physician prior to screening. 
While it is true that a colonoscopy is a minimally invasive procedure, 
an anesthetic is used to sedate the patient to make the colonoscopy 
less uncomfortable. Because the patient is going to be sedated, medical 
standards require doctors to visit with the patient before surgery to 
determine and protect against any risks, such as drug interaction, and 
to give them preoperative instructions. Recognizing the importance of 
these visits, Medicare does reimburse for a consultation prior to a 
diagnostic colonoscopy. A preoperative visit is no less medically 
necessary before a preventive screening, and therefore should be 
reimbursed in the same manner.
  Finally, some beneficiaries may delay seeking colorectal cancer 
screening because they cannot afford Medicare's Part B deductible. 
Recognizing this, Congress recently took an important step by waiving 
the Part B deductible for preventive colon cancer screenings, effective 
January 1, 2007. However, gastroenterologists are now reporting that, 
if polyps or other signs of cancer are discovered in the course of a 
preventive colonoscopy, the procedure is then considered to be 
diagnostic and Medicare requires that the beneficiary pay a deductible. 
Congress needs to ensure that beneficiaries are not dissuaded from 
getting this lifesaving procedure by the concern that they might have 
to pay a deductible if a polyp is discovered. Our legislation clarifies 
congressional intent to ensure that CMS will waive the deductible in 
all screenings so that Medicare beneficiaries are not confronted with 
an unexpected additional expense, should the procedure's coding change.
  The Colon Cancer Screen for Life Act would eliminate every one of 
these barriers, and in doing so, save lives. First, this legislation 
would increase reimbursement for colorectal cancer related procedures 
to ensure that physicians are able to continue to perform these 
valuable services. Reimbursement for procedures performed in a 
physician's office would be increased by up to 10 percent and 
reimbursement for procedures performed in Hospital Outpatient 
Department, HOPD, or Ambulatory Surgery Center, ASC, would be increased 
by up to 30 percent. The bill would also provide Medicare coverage for 
the preoperative doctor's visit conducted prior to a screening 
colonoscopy. Finally, the bill contains a technical provision to 
require that the deductible is waived whether or not the beneficiary's 
screening was clean or results in a biopsy or lesion removal.
  More than 50,000 Americans will die from colon cancer this year 
alone. Ninety percent of these cases might have been prevented. We 
cannot afford to wait another moment before doing something to 
eliminate these and other barriers that are standing in the way of 
preventing colon cancer.
  I urge my colleagues to join me in support of this important 
legislation and enact it this year.
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