March 15, 2018

ACR Advocates for CT Colonography CRC Screening

The American College of Radiology (ACR) Colon Cancer Committee met at the recent 2018 Society of Abdominal Radiology conference to discuss continued efforts to gain Medicare coverage for CT colonography CTC.

The American Cancer Society-recommended screening exam is as accurate as standard colonoscopy in most people — including those 65 and older. It is also shown to increase screening rates (where offered) at a lower overall cost than standard colonoscopy.

Increased screening is vital. More than 140,000 Americans are diagnosed with CRC, and nearly 50,000 die from the disease annually. Approximately 40% of the U.S. population, 50 years of age and older, are not getting screened. Shocking racial and regional disparities in screening rates and outcomes remain.

Members of the Colon Cancer Committee discussed such public health issues surrounding CRC. We applaud the United States Preventive Services Task Force (USPSTF) recommendation to expand screening techniques to include CTC for individuals aged 50-75 years. ACR members addressed the two-tiered coverage policy by the Centers for Medicare and Medicaid Services (CMS) that denies CTC screening to Medicare beneficiaries age 65 years and older.

Thirty-seven states require private payers to cover CTC. The 2016 USPSTF recommendation recognizes CTC CRC screening nationally as a preventive service for individuals 50-75 years. The National Committee for Quality Assurance (NCQA) has updated the HEDIS® Colorectal Cancer Screening measure to include CTC CRC screening. Yet, CMS continues to state there is “insufficient evidence” and has restrictive coverage (i.e., non-coverage) for CTC CRC screening across the board.

The ACR and the CTC Coalition have formally written to CMS to request that they reconsider their 2009 CTC Non-Coverage Determination. These groups submitted over a decade of robust literature in support of CTC CRC screening including the Medicare age population. CMS has communicated with the ACR that their gold standard for meeting evidence benchmarks are large randomized clinical trials (RCT). Despite the fact that HHS representatives helped plan the ACRIN CT Colonography Trial, CMS would prefer another “ACRIN-like” trial be done.

In addition, CMS indicated that CRC screening has existing covered techniques (e.g., colonoscopy, FIT, DNA-stool test) for the Medicare age population and implied this is another component of their rationale for denying CTC coverage.

Unfortunately, Medicare has not taken into account the public health issues surrounding CRC and instead has maintained a restrictive non-coverage policy. Providing Medicare patients with another effective screening option for colorectal cancer will help advance early detection and save thousands of lives through earlier treatment. This approach has been recognized by the USPSTF and numerous national groups.

It is astounding that an individual up to age 75 with private insurance may obtain a covered CTC CRC screening in the majority of states, but if you are a Medicare patient age 65 and older, it will not be covered. Medicare beneficiaries are not approved to receive a CTC screening and would have to pay out of pocket in full. This, in essence, is a two-tiered coverage policy in place by Medicare.

We will continue to urge CMS to reconsider its Medicare policy and ruling to finally authorize Medicare CTC coverage. We ask that you also support this effort. Colorectal cancer is the second most common cancer in the U.S. and the third leading cause of cancer death, despite a 90 percent cure rate with early detection.

The Colon Cancer Committee and public affairs teams are working on projects advocating for CTC screening including the following:

  • We will issue a joint press release with various patient groups in support of the Senate version of the CT Colonography Screening for Colorectal Cancer Act (H.R. 1298) — expected to be introduced in late March 2018. The bill would mandate Medicare coverage for CTC.
  • The ACR championed a CTC educational article to appear in nearly 1,200 print and online media and small-market news outlets nationwide touting:
    • The ability of CTC to help address shocking racial disparities in CRC outcomes
    • That the Affordable Care Act requires insurers taking part in federal exchanges to cover CTC
    • That 37 states, as well as District of Columbia, now require CTC coverage in policies sold in their states
    • That CIGNA, Aetna, UnitedHealthcare, Anthem Blue Cross Blue Shield and others cover the test irrespective of ACA requirements
  • Members of the ACR Colon Cancer Committee are featured in English and Spanish radio public service announcements (PSAs) distributed to urban and Spanish-language stations nationwide. The PSAs and the educational article direct the audience to RadiologyInfo.org for more information on CTC.
  • Colon Cancer Committee doctors will also take part in a joint Twitter chat with Montefiore Medical Center in late March.
  • Social media posts (Facebook, Twitter, Instagram, etc.) for the ACR and patient groups to use during March — leveraging the hashtag #virtualCT.
  • A Voice of Radiology Blog post outlining CTC efforts and the need for wider coverage of CTC to run the last Friday in March.

The ACR and Colon Cancer Committee will continue to advocate for equal CTC CRC screening coverage among the Medicare and privately insured population. Steps will include:

  • Comments to CMS
  • Model policy work
  • Medical policy reviews
  • Patient education
  • Updates to the ACR CTC resource page
  • Development of a CTC tool kit
  • A CTC stakeholder or summit-type meeting
  • CTC Coalition efforts
  • CTC legislative efforts
  • CTC registry work
  • A standardized reporting and management tool (C-RADS)
  • Programs addressing increased CRC risk in young adults and the need for screening of family members

Questions regarding the Colon Cancer Committee and CTC can be sent to amcglothlin@acr.org and/or kkeysor@acr.org