[Congressional Record (Bound Edition), Volume 148 (2002), Part 1]
[Extensions of Remarks]
[Page 938]
[From the U.S. Government Publishing Office, www.gpo.gov]



[[Page 938]]

                          EXTENSIONS OF REMARKS

                COLON CANCER SCREEN FOR LIFE ACT OF 2002

                                 ______
                                 

                        HON. BENJAMIN L. CARDIN

                              of maryland

                    in the house of representatives

                        Friday, February 8, 2002

  Mr. CARDIN. Mr. Speaker, I rise today to introduce the Colon Cancer 
Screen for Life Act of 2002. Colorectal cancer is the number two cancer 
killer in the United States. This year, an estimated 135,400 new cases 
will be diagnosed and 56,700 Americans will die from the disease. My 
home state of Maryland ranks 7th in the nation in the number of new 
cases and in the number of deaths. Our nation's capital, Washington, 
D.C., ranks first in the nation.
  Colorectal cancer disproportionately impacts the elderly. The risk of 
colorectal cancer begins to increase after the age of 40 and rises 
sharply at the ages of 50 to 55, when the risk doubles with each 
succeeding decade. Despite advances in surgical techniques and adjuvant 
therapy, there has been only a modest improvement in survival for 
patients who present with advanced cancers.
  The good news is that colorectal cancer can be prevented, and is 
highly treatable when discovered early. Most cases of the disease begin 
as non-cancerous polyps which can be detected and removed during 
routine screenings--preventing the development of colorectal cancer. 
Screening tests also save lives even when they detect polyps that have 
become cancerous by catching the disease in its earliest, most curable 
stages. The cure rate is up to 93 percent when colorectal cancer is 
discovered early.
  Recognizing the importance of early detection in preventing 
colorectal cancer deaths, Congress in 1997 enacted a Medicare 
colorectal cancer screening benefit. Medicare currently covers either a 
screening colonoscopy every ten years or a flexible sigmoidoscopy every 
four years for average-risk individuals. Beneficiaries identified as 
high risk are entitled to a colonoscopy every two years.
  Despite the availability of this benefit, very few seniors are 
actually being screened for colorectal cancer. Since its implementation 
in 1998, the percentage of Medicare beneficiaries receiving either a 
screening or diagnostic colonoscopy has increased by only one percent.
  Why aren't more seniors being screened? I believe the problem is due, 
in part, to rapidly declining colorectal screening reimbursement 
levels. By 2002, Medicare reimbursement for diagnostic colonoscopies 
performed in an outpatient setting will have declined 36% from initial 
1998 levels. For flexible sigmoidoscopies, payment in 2002 will be 54% 
less. Colorectal cancer screening will not be effective if it is a 
``loss leader'' for doctors.
  While reimbursement has dropped across the board, cuts have been 
particularly harsh for screenings provided in hospital outpatient 
departments (HOPDs) and ambulatory surgery centers (ASCs). In 1997, a 
colonoscopy performed in one of these settings was reimbursed at 
approximately $301. Now in 2002, the rate has fallen to about $213.
  The facility-specific cuts provide incentives for physicians to 
perform screenings in their offices, where reimbursement rates have 
remained between 68% and 108% higher. As you know, Medicare has 
established its own criteria for both ASCs and HOPDs to ensure high 
quality of care and patient safety. While there are office facilities 
where endoscopy is safely performed, physicians' offices are, for the 
most part, unregulated environments. The site-of-service differential 
could interfere with the clinical decision-making process, at the 
expense of patient safety.
  In addition, Medicare currently pays for a consultation prior to a 
diagnostic colonoscopy, but not for a screening colonoscopy. Since 
colonoscopy involves conscious sedation, physicians generally do not 
perform them without a pre-procedure office visit to ascertain a 
patient's medical history and to educate patients as to the required 
preparatory steps. In fact, several states now require physicians to 
consult with patients prior to procedures involving conscious sedation. 
Because Medicare will not pay for pre-screening consultations, many 
physicians must provide them for free.
  And, unlike screening mammography, colorectal cancer screening tests 
are subject to the Medicare Part B deductible, which discourages 
beneficiaries from seeking screening.
  My colleague, Representative Phil English, joins me today to 
introduce this important legislation. This bill is supported by the 
American College of Gastroenterology, the American Society for 
Gastrointestinal Endoscopy, and the American Gastroenterological 
Association. It would improve beneficiary utilization and help ensure 
the safety of colorectal cancer screening by doing three things.
  First, it would increase reimbursement for colorectal cancer related 
procedures to ensure that physicians are able to cover the costs of 
providing these valuable services.
  Second, our bill will provide Medicare coverage for a pre-screening 
office visit. If Medicare will pay for a consultation prior to 
diagnostic colonoscopy, it also should pay for a consultation before a 
screening colonoscopy.
  Third, the bill would exempt colorectal cancer screening procedures 
from the customary Medicare deductible requirement. By reducing the 
financial requirements on the beneficiary, this law will encourage 
increased access to colorectal screening services.
  The preventive benefits we authorized in 1997 were an important step 
toward fighting this deadly disease. But the colorectal cancer 
screening program is in danger of failing without our intervention. I 
strongly urge all my colleagues to support this critical legislation.

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