November 18, 2020

Data Reveals Medicare Screening CTC Noncoverage Policy’s Negative Effect on Patients

Fewer patients age 65 and older are receiving screening CT Colonography (CTC) examinations for colorectal cancer (CRC), according to results of a study published online last month in the Journal of the American College of Radiology. Reviewing data for nearly 13,000 screening CTC cases performed over a 13-year period and submitted to the American College of Radiology® (ACR®) CTC Registry, the authors found an average increase in screening CTC of 5.3% per year between ages 52 and 64, but average decreases of 6.9% per year of age after age 65. They postulate the decrease in CTC exams after 65 is likely due, at least in part, to lack of Medicare coverage. Their research also suggests that Medicare noncoverage may have a disproportionate impact on Black patients and other racial minorities.

Commercial insurance coverage of screening CTC is mandated by the Affordable Care Act of 2010, due to the exam’s A grade from the United States Preventive Services Task Force; however, Medicare does not cover screening CTC. “In our practice, for example, we have a conversation with patients referred to us for a screening barium enema about changing to CTC based upon the ACR Appropriateness Criteria®,” says lead author Courtney Moreno, MD, Associate Professor in the department of radiology and imaging sciences at Emory University School of Medicine and the CTC Registry Committee Chair. “Unfortunately, some Medicare patients say that they cannot afford the out-of-pocket cost and are unable to undergo CTC.” This circumstance led Moreno to undertake the research project to demonstrate the negative impact of Medicare policy on patients.

The authors also found significant differences in screening CTC use based on race and age. Specifically, the number of white people undergoing CTC did not drop significantly once they reached age 65. However, the age group of Black patients with the highest utilization of CTC was 55–59 years — an age group typically not covered by Medicare. Additionally, the number of screening exams decreased considerably after the age of 65 for individuals who identify themselves as a race other than Black or white.

According to Moreno, the CTC Registry research is particularly important in that other work has looked at CTC utilization using insurance claims data, but that approach is limited by not capturing data about patients who may have paid out of pocket for an exam not covered by insurance.

“These research results reinforce ACR efforts to encourage Medicare to follow the science and make all validated colorectal cancer screenings available to all patients,” says Judy Yee, MD, FACR, Chair of the ACR Colon Cancer Committee, “The best test is the one that gets done.”