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Important CRC Access Bill Introduced in Senate

Friday, May 23, 2014

On May 15, 2014, Senator Sherrod Brown (D-OH) introduced legislation that would improve access to colorectal cancer (CRC) screenings for seniors who receive health coverage through Medicare. This legislation, if enacted, would eliminate cost sharing regarding Medicare beneficiaries receiving a routine colonoscopy screening in which a polyp was removed.

Under the Affordable Care Act (ACA), many preventive medical services, including colorectal cancer screenings, must be offered with no cost-sharing to a patient. The goal of this new policy is to encourage all Americans to undergo important screenings that will detect potential illnesses such as cancer before they become dangerous and avoid the costs associated with more intense treatment. An individual’s colonoscopy is therefore covered by private health insurance as well as Medicare.

A question that has arisen, though, is whether the removal of polyps that are found during a colonoscopy is considered preventive service, and therefore covered without cost-sharing. The U.S. Centers for Medicare and Medicaid Services (CMS) has previously said that commercial insurance plans must cover polyp removal with no cost-sharing, since the removal is an integral part of the screening. This was an important victory in the fight against cancer. Without it, many patients would have been saddled with the costs of removing potentially cancerous tissue.

However, the ruling did not apply to Medicare. Because colonoscopies are recommended mostly for people over age 50, many of those who need colonoscopies most are enrolled in Medicare. Sen. Brown’s bill would eliminate the coinsurance associated with a polypectomy. This bill would give patients more financial peace of mind, and likely prevent many from avoiding the screening for fear of the potential costs.

S. 2348 has a companion bill in the U.S. House of Representatives, H.R. 1070, which was introduced by Rep. Charles Dent (R-PA), titled “Removing Barriers to Colorectal Cancer Screening Act.” Rep. Dent introduced the House legislation on March 12, 2013, and it has bipartisan support.

Judy Behm & Eric Auslander

Where Have All the Doctors Gone?

Tuesday, May 20, 2014

It will not come as a surprise to most of our readers that our nation is facing a critical shortage of primary care and specialty care physicians. According to the AARP, the United States is short about 16,000 primary care doctors and that deficit is only going to grow over the next few decades. These doctors are important to the balance of the health care industry because they are the professionals who offer the treatments and preventive screenings that save lives and reduce expensive emergency room visits and hospitalizations.

Supply and Demand

There are powerful forces at work depressing the supply of doctors. The Balanced Budget Act of 1997 imposed a cap on federally funded residency positions at medical schools and teaching hospitals, which has reduced significantly the number of new doctors in training. Adding to the woes, some legislators on Capitol Hill want to further curtail the dollars Medicare spends on this program as part of a federal deficit reduction.

A 2012 Physicians Foundation survey indicates nearly half of the nation’s physicians are over age 50, seeing less patients and nearing retirement. At the same time, many physicians are refusing to treat Medicare patients, wary that “Sustained Growth Rate” legislation will not only curtail Medicare expenditures, but physician compensation as well. It is a false economy at best.

The physician shortage is especially concerning as the demand for care is about to rise dramatically. The Patient Protection and Affordable Care Act is adding millions of uninsured people to the insurance roster—estimates indicate an additional 30 million patients will acquire private health insurance or be covered by expanded government health insurance programs. Many of these people will have significant, unmet health needs that will require a physician’s care. Combine this fact with an aging population, and you can see where this is leading. Did you know that about 10,000 seniors will become eligible for Medicare every day for the next 18 years?

Fortunately, there are several bills pending in Congress to address this issue. Rep. Aaron Shock (D-IL) has introduced H.R.1201 - Training Tomorrow's Doctors Today Act, which would amend Title XVIII of the Social Security Act to provide for additional residency positions. A Senate companion bill, S. 577 - Resident Physician Shortage Reduction Act of 2013 was proposed by Sen. Bill Nelson (D-FL).

Only Congress can amend the legislation that caps the residency positions, so stay tuned for updates on these important bills.

Randall H.H. Madry
Preventing Colorectal Cancer


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