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The Screen Act

Tuesday, June 11, 2013

 

The Patient Protection and Affordable Care Act (PPACA) provides that preventative care services, including a CRC screening colonoscopy, shall be covered by a health benefit plan with no copayment or coinsurance costs to the patients. However, PPACA did not address what happens when a screening colonoscopy procedure becomes a polypectomy. Before PPACA was revised to require health plans to cover polypectomy as part of preventative colonoscopy (see lead story in this newsletter), the procedure was deemed to be “therapeutic,” not “preventative,” and health insurance copays and coinsurances kicked in. The outcome was patients being hit with unexpected colonoscopy costs.

We all celebrated when the Centers for Medicare and Medicaid Services (CMS) issued the new PPACA ruling that changed this policy. However, the CMS ruling does not address Medicare procedures. Under Medicare, colonoscopies are reclassified as therapeutic if polyps are removed during the procedure, and patients must pay coinsurance of 20% of the Medicare-approved charge. Changing the Medicare policy will require action by Congress.

In order to address this inequity, Sen. Ben Cardin (D-MD) recently introduced S. 608, the Supporting Colorectal Examination and Education Now (SCREEN) Act. The bill will waive cost-sharing for Medicare patients when polyps are removed during a colonoscopy.

The SCREEN Act will amend Section 2713(a)(1) of the Public Health Service Act (42 U.S.C. 300gg-13(a)(1)) by inserting: “(including related activities occurring as part of the same clinical encounter, such as conducting a biopsy or by removing a lesion or growth)”.

The proposed legislation also provides for the notification of all Medicare beneficiaries about the screening benefit and will cover a prescreening visit under Medicare. The SCREEN Act provides:

“...prior to a colorectal cancer screening test consisting of a screening colonoscopy or in conjunction with an individual’s decision regarding the performance of such a test on the individual, an outpatient office visit or consultation for the purpose of beneficiary education, assuring selection of the proper screening test, and securing information relating to the procedure and the sedation of the individual.”

A companion bill, H.R. 1320, has been introduced by Rep. Richard Neal (D-Mass.) in the House of Representatives. Finally, the SCREEN Act also would provide physicians the opportunity to earn higher reimbursements for providing colonoscopies. The legislation would create a preventive services payment modifier for colorectal cancer screening. Under the bill, physicians could earn incentive payments by meeting national colorectal cancer screening goals and minimum standards for knowledge, training, continuing education, and documentation.

We applaud the actions of Sen. Cardin and Rep. Neal, and urge you to write or phone your lawmakers in Congress to voice your support of these important pieces of legislation.

Randall H.H. Madry, Executive
Preventing Colorectal Cancer

Advocacy at a Young Age: Family, Heredity and CRC

Friday, May 17, 2013

 

Editor’s Note: Shane and Alexandra Plavin are high school students at Riverwood International Charter School in Sandy Springs, GA. The siblings are advocates for Preventing Colorectal Cancer and have written this article in hopes of highlighting the relationship between heredity, colorectal cancer (CRC) rates and the importance of screening.

What is the likelihood that we will get diagnosed with colon cancer? What does it mean if a great uncle has the disease? Does it increase our chances of having the disease? What are some resources to learn more about symptoms and healthy choices that may help prevent CRC?

An estimated 142,820 Americans will be diagnosed with colon cancer in 2013, which is approximately one in every 17-18 individuals. That is why we would like to focus on educating our friends and family members about the prevalence of CRC and the importance of screening.  A cancer prevented is better than a cancer cured. The opportunity to remove polyps before they become cancerous exists when patients receive the "gold standard" screening, a colonoscopy.

My sister and I were discussing heredity and why certain traits and diseases run in families. We have always had a close knit and supportive family and wanted to look more closely at the relationship between CRC and family histories. This issue is very important to us as we have several family members who have been diagnosed with CRC and were concerned that our immediate family could also be at an increased risk due to genetics; so we decided to do a little reading.

Gathering data from reliable and reputable sources, we found there is a strong family history and genetic component with regards to colorectal cancer. People who have a first-degree relative (parent, brother, sister, or child) with CRC or adenomatous polyps at a young age (defined as before 60), or have two first-degree relatives diagnosed at any age, should begin screening for colon cancer earlier, typically at age 40, or 10 years younger than the earliest diagnosis in their family, whichever comes first. This should be repeated every five years.

For first-degree relatives who have had CRC or adenomatous polyps at age 60 or older, or two or more second-degree relatives (grandparent, aunt, uncle) with CRC should begin screening colonoscopy at age 50 and should be repeated as per average risk patients.

People with a second-degree relative or third-degree relative (great-grandparent or cousin) with CRC are considered to have average risk of colorectal cancer.

Some of the earliest studies of family history with colorectal cancer were based in Utah, where families reported a higher number of deaths from CRC (3.9%) among first-degree relatives of patients who had died from CRC than among sex-matched and age-matched controls (1.2%). These studies have been reproduced on many occasions.

Genetics also play a significant role in CRC and have shown to have a specific component in about 5% of all colorectal cancers. One of those specific genetic susceptible subsets is called Hereditary Nonpolyposis Colorectal Cancer (HNPCC), also known as Lynch Syndrome. The average age in which Lynch Syndrome presents is typically around age 45, and over 70% of people with HNPCC will experience CRC by age 65.

Familial adenomatous polyposis (FAP) is an uncommon condition that increases the risk of CRC. Nearly 100% of people with this condition will develop CRC during their lifetime, and most of these cancers occur before age 50. FAP causes hundreds of polyps to develop throughout the colon.

It is our understanding that PCC will devote upcoming newsletters to furthering the discussion of genetics and testing options and new frontiers in the diagnosis of CRC.

So how can kids stress the importance of “closing the loop” and educate our friends and family members? It is our hope that through articles like this and talking to our friends that we can advocate and perpetuate the process of learning. Using the family unit as a force from within the home, we can hopefully provide that benefit to each of our own family members. My sister and I sometimes feel like we are invincible and don’t realize how many young patients and family members can be afflicted with CRC.

Alexandra and I hope that we were able to share a bit of ourselves and know that as siblings, families can be the greatest messenger for education and advocacy for prevention and diagnosis of CRC and other diseases.

Shane and Alexandra Plavin

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