Sen. Brown Announces Plan to Prevent Seniors Receiving Preventive Screening from Being Hit with Unfair Costs

While Medicare Allows Free Preventive Screenings for Colon Cancer, Seniors are Hit with Unexpected Bills if Doctors Take Additional Preventive Action During Screening - Among Cancers Affecting Both Men and Women, Colon Cancer 2nd Leading Cause of Cancer-Related Deaths in the Country

CLEVELAND, OH — Today, U.S. Sen. Sherrod Brown (D-OH) announced legislation that would ensure seniors who receive potentially lifesaving colon cancer preventive procedures are not hit with unfair and burdensome costs. Under current law, seniors covered by Medicare are eligible for free colorectal cancer screenings. However, if a doctor needs to take a further lifesaving, preventive action—like removing a polyp—while the patient is under anesthesia, the patient is billed as if the procedure was treatment rather than prevention. This billing issue not only hurts the pocketbooks of seniors trying to protect themselves from cancer, it deters other seniors from seeking this preventive care.

“Colorectal cancer is the third leading cause of cancer death in the country,” Brown said. “But too many seniors who go in expecting a free, preventive screening, wake up to an unexpected and significant bill. We must do everything we can to make potentially lifesaving procedures as easy and affordable as possible. My legislation would eliminate billing problems so that seniors can stay healthy and protected without taking a hit to their pocketbooks.”    

This year, approximately 140,000 adults will be diagnosed with colorectal cancer and more than 50,000 will die from the disease. Colorectal cancer, in fact, is the third leading cause of cancer death in the country. Regular screenings for colon cancer could help save up to 60 percent of these lives. In order to prevent colorectal cancer from forming, doctors can perform tests to screen for potentially cancerous polyps and remove them from patients. One of the tests used to screen for polyps is a colonoscopy, where a patient is put to sleep while her doctor checks for polyps or irregular tissues. A physician, however, has no way of knowing before a colonoscopy is performed whether a polyp will need to be removed. Medicare beneficiaries therefore assume that they will have no out-of-pocket expense for a colorectal screening and are often surprised to learn they must pay an expensive coinsurance because of polyp removal.

Brown’s legislation, the Removing Barriers to Colorectal Cancer Screening Act, would ensure that all colorectal cancer screenings remain cost-free for Medicare beneficiaries, whether or not a polyp is removed. By allowing Medicare to cover the costs of this potentially lifesaving procedure, this bill would eliminate the Medicare billing problem that disincentives seniors from getting screened and enable Medicare beneficiaries to live healthier lives without breaking the bank. While colorectal cancer screening is a proven preventive tool that saves lives, only about one in every three adults aged 50-75 will get screened. Many of those who don’t choose to get screened cite cost as the reason.

Joining Brown at the Cleveland Clinic to share his story was Ohioan Edwin Murphy. Edwin recently lost his wife to colorectal cancer after she fought the disease for six years. His wife did not have many of the risk factors associated with colorectal cancer and chose not to get screened early. But by the time she was diagnosed, she had Stage 3 cancer. Edwin, on the other hand, gets screened often because he is high risk for colon cancer.

Also joining Brown to discuss the need for this legislation was Dr. John Vargo, the Chairman of the Gastroenterology and Hepatology Department at the Cleveland Clinic.  

“Senator Brown’s legislation will help us reach our goal by eliminating a remaining cost barrier to screening colonoscopy for Medicare beneficiaries,” Vargo said. “That cost barrier is the beneficiary’s liability for paying coinsurance when a polyp is taken out during the screening exam. A screening colonoscopy doesn’t cost a Medicare beneficiary anything when there are no polyps or other tissue removed. Unfortunately, Medicare rules change when the physician takes the preventive action of removing a polyp, which then triggers a coinsurance liability for the patient to pay. Patients have no way of knowing before the colonoscopy screening if they will owe coinsurance.”

Organizations which have endorsed Brown’s legislation include the Ohio Gastroenterology Society (OGS), American Society for Gastrointestinal Endoscopy (ASGE), American Cancer Society Cancer Action Network (ACSCAN), Fight Colorectal Cancer, and the American Association of Retired Persons (AARP).

“We thank Sen. Brown for introducing this important legislation in the Senate,” said Dr. Colleen M. Schmitt, President of the ASGE. “Not enough people are being screened for colorectal cancer and this cost-sharing creates unforeseen financial burdens in those patients that benefit most from screening: those with colon polyps. Ultimately this change in procedural classification discourages the use of colonoscopy a life-saving exam. In March, the American Cancer Society reported a 30 percent decrease in colorectal cancer incidence attributed largely to colonoscopy, which finds and removes precancerous polyps. The legislation is vital in achieving higher colorectal cancer screening rates and reducing deaths from this largely preventable disease. ASGE will continue to advocate for Congress to pass this legislation and remove cost-sharing for Medicare patients.”

The Removing Barriers to Colorectal Cancer Screening Act is just one of Brown’s many efforts to promote the health and wellness of Ohio’s citizens. In November 2013, the U.S. Congress passed the National Pediatric Research Network Act, which Brown introduced. Brown’s bipartisan legislation will create a more streamlined and efficient system for maximizing pediatric medical research, with an emphasis on rare pediatric diseases.

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