Two new 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.
Medicare and private payers will save as much as $4,700 and $6,400 per patient who receives a free follow-up colonoscopy following positive screenings results, respectively. That's accounting for the fact that each follow-up colonoscopy costs Medicare over $1,100 and private payers over $2,000.
Payers will see savings even if absorbing the cost for follow-up only resulted in a small increase in the number of people seeking screenings and potential follow-ups, according to the study. This is because even with a small increase in screenings and follow-ups, the early detection of CRC reduces long-term costs associated with treating CRC in later stages.
Prior to the extended coverage, nearly half of people in the eligible age group –– 45 to 75 –– didn't get any sort of CRC screening. And nearly half of those who did get screened via stool test and had positive results still did not seek a follow-up colonoscopy. The rates of screenings and follow-ups tended to be lower in low-income populations and among people of color.