Los Angeles Times Examines Debate Over Medicare Coverage For Virtual Colonoscopies

Main Category: Colorectal Cancer
Also Included In: Medicare / Medicaid / SCHIP;  IT / Internet / E-mail
Article Date: 22 Apr 2009 - 7:00 PDT

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A "heated debate" over whether CMS should end Medicare coverage of virtual colonoscopies has created conflict between "powerful sectors of the health care industry" and government programs attempting to rein in spending, the Los Angeles Times reports. According to the Times, the debate over virtual colonoscopies -- in which a computed tomography machine scans a person's abdomen for signs of cancer -- illustrates how difficult it is to ensure money intended for health care is spent efficiently, which is a "key goal of the Obama administration."

A 2008 report by the Government Accountability Office found that Medicare in 2006 spent more than $14 billion on medical imaging services, which was twice the amount it spent in 2000. As a result, Medicare officials conducted a comprehensive year-long review of virtual colonoscopies by examining medical journal articles, meeting with physicians and health policy experts and evaluating more than 400 opinions on the issue that were submitted during two public comment periods, according to the Times. However, there was no agreement whether to cover virtual colonoscopies.

Proponents of virtual colonoscopies say they are less costly and more comfortable than the conventional colonoscopy procedure. Proponents also say virtual colonoscopies would attract more people to receive screenings for colon cancer and potentially save more lives. Some critics say that virtual colonoscopies are inefficient because traditional colonoscopies are required to confirm any findings in a virtual colonoscopy. Some experts say that eliminating such inefficient procedures will be essential to keeping health care costs under control, the Times reports. Sean Tunis, a former chief medical officer at CMS, said the issue "may be a bellwether for how the hard choices around expanding access and controlling costs will play out."

In February, CMS announced a tentative decision to end Medicare coverage for the procedure, prompting "an immediate backlash" from proponents and some lawmakers, the Times reports. Last month, interest groups held briefings with lawmakers on Capitol Hill and more than 50 members of Congress co-signed a letter against CMS' decision. CMS is expected to issue its final decision in May (Levey, Los Angeles Times, 4/18).

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