[Congressional Record (Bound Edition), Volume 149 (2003), Part 6]
[Extensions of Remarks]
[Pages 7450-7451]
[From the U.S. Government Publishing Office, www.gpo.gov]




                COLON CANCER SCREEN FOR LIFE ACT OF 2003

                                 ______
                                 

                        HON. BENJAMIN L. CARDIN

                              of maryland

                    in the house of representatives

                        Tuesday, March 25, 2003

  Mr. CARDIN. Mr. Speaker, I rise today to introduce the Colon Cancer 
Screen for Life Act of 2003. Colorectal cancer is the number two cancer 
killer in the United States. This year, an estimated 147,000 new cases 
will be diagnosed and more than 57,000 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 capital city, 
Washington, DC, ranks first in the nation.
  Colorectal cancer disproportionately impacts the elderly. The risk 
begins to increase after the age or 40 and rises sharply between the 
ages of 50 to 55, when it doubles with each succeeding decade. Despite 
advances in surgical techniques and adjudvant therapy, there has been 
only a modest improvement in survival for patients with advanced 
cancers.
  The good news is that colorectal cancer is preventable, and it is 
highly treatable when discovered early. Most cases of the disease begin 
an 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, 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 coloercal screening reimbursement levels. 
By 2002, Medicare reimbursement for diagnostic colonoscopies performed 
in an outpatient setting had declined 36 percent from initial 1998 
level. For flexible sigmoidoscopies, payment in 2002 was 54 percent 
less.
  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 percent and 108 percent

[[Page 7451]]

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. 
This site-of-service differential may 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, as well as my colleagues in the 
Senate, Joseph Lieberman and Susan Collins. 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 screenings 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 a 
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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