Here are five legislative moves and studies that are shifting colorectal cancer care:
1. Beginning Jan. 1, all insured Illinois residents will have free access to all colonoscopies deemed medically necessary. On Aug. 9, Illinois' governor signed House Bill 2385, which requires insurance coverage for all colonoscopies in patients that show signs or symptoms of colon cancer or have an existing colon condition.
2. A new study shows that vertical integration of physician groups and health systems is pushing colonoscopies to be performed in hospital outpatient departments over ASCs, ultimately driving Medicare and patient out-of-pocket costs up. Scaling the change in Medicare payments by the increased use of ASCs equates to estimated 35% higher Medicare payments at HOPDs than ASCs for colonoscopy.
3. UnitedHealthcare's new gold card prior authorization program, which is set to take effect Oct. 1, could create more obstacles to securing gastroenterology reimbursements, according to the American Gastroenterological Association.
"This program, which comes with few details to date, is concerning to many gastroenterologists who see this as a familiar strategy by UHC to implement prior authorization for various procedures, including life-saving colonoscopies and endoscopies for the millions of patients who need them," AGA President Maria Abreu, MD, wrote in an Aug. 7 news release from the organization.
4. Two recent studies suggest that free colonoscopies –– covered under CMS provisions set in 2023 –– not only save lives, but also money for both Medicare and private payers. The study, published in Cancer Research Communications and Populations Health Management, found that the new benefit saved money for both Medicare and private insurers even though they'll be paying more for people to receive both an initial screening and a follow-up colonoscopy if needed.
5. The FDA approved a new, noninvasive screening test for colorectal cancer created by Palo Alto, Calif.-based Guardant Health that requires only a blood sample. The test can find most cancers when they are early stage and usually curable.