[Congressional Record (Bound Edition), Volume 153 (2007), Part 7]
[Extensions of Remarks]
[Page 9290]
[From the U.S. Government Publishing Office, www.gpo.gov]




      THE INTRODUCTION OF THE COLON CANCER SCREENING FOR LIFE ACT

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                          HON. RICHARD E. NEAL

                            of massachusetts

                    in the house of representatives

                       Wednesday, April 18, 2007

  Mr. NEAL of Massachusetts. Madam Speaker, I rise today in support of 
the Colon Cancer Screen for Life Act, which I am introducing along with 
Congressman Phil English (R-PA) and Congressman Ed Towns (D-NY). 
According to the American Cancer Society, this year alone, 52,180 
Americans will die from colon cancer. In my own state of Massachusetts, 
1,180 people will lose their life to this deadly disease. What makes 
statistics such as these all the more tragic is that unlike other forms 
of cancer, colorectal cancer is highly detectable and even treatable if 
it is caught early through a colonoscopy screening examination.
  Recognizing the importance of early intervention, Congress acted to 
provide Medicare coverage for colorectal cancer screening (CRC) through 
colonoscopy in the Balanced Budget Act of 1997 and further expanded in 
2000 when the colonoscopy benefit was added for high risk 
beneficiaries. Under this 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 (GAO), since the implementation of the benefit in 1998, the 
percentage of Medicare beneficiaries receiving either a screening or a 
diagnostic colonoscopy has increased by only one percent.
  A key reason for the low rate of colonoscopy screening in the 
Medicare population is rapidly declining rates of reimbursement for the 
procedure. Medicare reimbursement for colonoscopies performed in the 
outpatient setting has dropped by 33 percent from the initial 1998 
levels. In many states today, Medicaid payment rates actually exceed 
Medicare reimbursement for colonoscopy. Unless we reverse this trend 
toward declining reimbursement, physicians will no longer be able to 
offer colonoscopies to Medicare beneficiaries. This bill increases 
Medicare reimbursement rates by 30 percent for colonoscopies performed 
in an outpatient setting, and by 10 percent for procedures performed in 
the physician's office, to ensure that Medicare beneficiaries have 
access to these lifesaving procedures. Moreover, increasing colonoscopy 
screening rates will generate significant long-term savings for the 
Medicare program, in the form of foregone costs for costly colorectal 
cancer treatment.
  Medicare also does not currently pay for a physician office visit 
prior to a screening colonoscopy. Colonoscopy procedures involve 
sedation, so physicians generally do not perform them without an office 
visit prior to the procedure to obtain the patient's medical history 
and to educate the patient about the steps he or she needs to take in 
order to prepare for the colonoscopy. A number of states actually 
require this pre-operative consultation. Medicare pays for this pre-
operative visit when a colonoscopy is being performed in order to 
diagnose a patient--but it does not pay for such a visit prior to 
screening colonoscopies, even though the procedure is the same and 
presents the same risks to the patient. This bill fixes this 
discrepancy by providing Medicare reimbursement for the office visit 
that takes place prior to the screening colonoscopy.
  Finally, reducing financial requirements on beneficiaries will 
encourage more people to take advantage of this preventive benefit. It 
was with this intent that Congress agreed to waive the Part B 
deductible as part of the Deficit Reduction Act of 2005. Unfortunately, 
since that time, CMS has misinterpreted this provision of law, claiming 
that the deductible is only waived if the beneficiary has a ``clean'' 
screening, but maintaining that the deductible still applies if the 
screening results in taking a biopsy or if a cancerous or pre-cancerous 
polyp. Under this nonsensical policy, a beneficiary is left not knowing 
whether or not the deductible is waived until after the screening. 
Those whose ability to pay is limited are therefore simply choosing not 
to take the risk. This bill would require that the deductible be waived 
for all screenings, regardless of the outcome.
  Madam Speaker, as the old saying goes, ``an ounce of prevention is 
worth a pound of cure.'' This bill embodies this wisdom. In passing the 
Colon Cancer Screen for Life Act, we will not only be able to save 
lives but we will also be able to save money. According to the American 
Cancer Society, 153,760 new cases were diagnosed this year. Each of 
these cases will cost Medicare between $35,000 and $80,000 per patient 
to treat. For the bargain price of a little over $200 dollars, we can 
stop this cancer before it starts. Seems to me that is not only the 
right thing to do, it is the smart thing to do.
  I hope my Colleagues agree and will join me and Representatives 
English and Towns in support of this important piece of legislation.

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