Colon Cancer Screening:
Not Just for the 50-Plus Set
From this article in todays WSJ.....
"...In addition, a new DNA test that looks for colon-cancer markers in a stool sample will be available this year. Unlike other tests that simply look for blood in the stool, the DNA test is highly specific. If it does find a problem, it is right 96% of the time -- so it won't trigger a large number of unnecessary colonoscopies. However, if it doesn't find anything, you're not necessarily in the clear; it still may miss cancer one-third of the time. And it's expensive, costing about $795 a test."
Doctors say you should be screened for colon cancer starting at age 50. But every year, 13,000 people younger than that are diagnosed with the often-deadly disease.
The large number of cases missed by the current colon-cancer screening recommendations has sparked a heated debate among doctors, insurers, patients and advocacy groups. The medical community says screening by colonoscopy -- the gold standard for finding colon cancer before it starts -- can't be justified for the average person under 50. They say the test is expensive, costing $1,000 or more, and the risk, while small, outweighs the benefit to a relatively small number of people.
But patient advocates say doctors do a poor job of identifying patients at high risk for the disease, and that more young people should at least consider getting the screening test.
"Are those 13,000 people just disposable?" asks Katie Couric, the "Today" show anchor who underwent a colonoscopy on national television at the age of 43 as part of a highly public awareness effort after her husband died of colon cancer at 42. While she understands the dilemma about widespread screening, she says: "If you know somebody in the 13,000 people who are diagnosed, of course you think everybody should get screened."
Colon cancer is the second-biggest cancer killer, behind lung cancer. Each year, 147,000 people are diagnosed with the disease in the U.S., and 57,000 die. But unlike other cancers, it is remarkably preventable because the first signs of the disease are polyps, which can take years to turn into cancer. If caught early, the survival rate is 90% but plummets to 9% if detected at a later stage.
During a colonoscopy, the patient is sedated, and doctors insert a scope through the rectum to get a direct view of the colon. If a polyp is found, it is usually removed on the spot. While the test is considered very safe, there is a 1-in-1,000 chance of perforation of the colon wall, which can lead to surgery and in rare cases, even death. Risk is highest if a large polyp is removed. Also, the test involves some discomfort, as the patient must take bowel-cleansing medications to prepare.
Ninety percent of colon cancers occur in people over 50, and many doctors say screening people under 50 doesn't find enough cancer to justify the risk of the test itself. In a well-known Indianapolis study of about 900 people age 40 to 49, about 10% of patients had polyps. None of those patients had cancer, and researchers said the vast majority of the polyps didn't appear threatening, meaning the patients likely could have waited until age 50 to be screened.
FINDING A KILLER
Here's a look at the pros and cons of various screening tests for detecting colon cancer.
following up on our discussion regarding testing reimbursement...
The following colorectal screening tests are covered under Medicare effective Jan. 1, 1998:
* Annual screening fecal-occult blood tests for beneficiaries 50 years or older (use HCPCS code G0107),
* Screening flexible sigmoidoscopy every four years for beneficiaries 50 years or older (use HCPCS code G0104),
* Screening colonoscopy for beneficiaries with high risk (e.g., those with family history of cancer or previous cancer illness) every two years (use HCPCS code G0105).
Medicare will reimburse for these screening tests at the same rate as their diagnostic equivalents.
In addition, Medicare now covers a screening barium enema as a substitute for either a screening sigmoidoscopy or a screening colonoscopy under the same conditions applied to those two tests. Use HCPCS code G0106 when a screening barium enema is substituted for a screening sigmoidoscopy and G0120 when a screening barium enema is substituted for a screening colonoscopy. Reimbursement for the screening barium enema will equal reimbursement for a diagnostic barium enema. Finally, note that Medicare considers the double-contrast barium enema to be the standard, but in the case of some patients who are infirm, immobile or debilitated, Medicare will cover the single contrast test.
based on your lab experience, is the reimbursement cost for "diagnostic equivalents" $15 for code G0107? I don't know.
I tend to agree with tealeaves7 regarding the cost savings for noninvasive testing versus traditional methods.
The premise of my long EXAS investment is based on the economics of this technology, not "hope".
The aggregate cost of traditional testing methods (colonoscopy, treating patients that were misdiagnosed, treating patients that refused invasive tests, etc.) is far more then the cost of employing noninvasive early detection tests developed by EXAS. I will stick by my argument that $500-$800 is properly priced based on aggregate cost savings.
ot... yes, thanks, the camping trip was fun... up until our our last night when it poured :-)
thanks for the response. Being in lab diagnostics for 10+ years would afford you insight.
Perhaps you may be right in the $15 coverage. for now, however, the family and I are going camping for a bit so I won't be able to do this research until the weekend.
enjoy your week.
mbp. I understand where you are coming from, but lets give Labcorp just a little credit and a little bit of brain material.They are not totally foolish. With the cost of invasive colon drilling compared to the cost of non-invasive testing. Who do you think is the winner?
I'll make a bet that exas's test will be required before any invasive test is to be conducted and all payors will join in the decision. Cost my boy, Cost !
Good luck to all !
All I have tried to do is display some of the barriers thst are still in front of this company. In my first two polite posts I have been told I have know idea what I am talking about. Hence the change in tone. I have been in lab diagnostics for over ten years. I understand the dynamics. I have owned this stock twice, but currently do not hold a position. Reimbursement will make or break this product, the other stuff CPT code, FDA approval get youi to the dance. Then you need to execute, this is a long process. (years) Cash looks short in reference to that long of timeline. Yeh Labcorp has been puttin up the money. The will only continue if the see improvement on the coverage and payment front. Why offer a test that you lose money on every time a doc orders one. In regards to the code you found if you post it exactly no pun intended , I will look it up on the Medicare Fee Schedule. My bet it pays less that $15.
Please post and I will get back to you.
so you're response is "Do your homework" and let me sell you some beachfront? lol ...
I certainly don't proclaim to be a CPT code expert, but I am trying to advance the discussion by providing actual URLs & quotes. If you're not a total Socratic follower, perhaps you could find it in your heart to offer some scholarly direction?
Do me a favor go ahead a get the reimbursment for that code you found. Do your homework and come back and tell us all does this the $500-$800 business model. Please post your research. You folks are underestimating the importance of reimbursement and the second component is adequate reimbursement. They are equally important. And if you believe BCBS Tech Committee is going to lead the way, I have some ocean front property in Kansas to sell you. Hope is not an investment strategy.
Well, contrary to what mbp1232003 said regarding no CPT codes (msg #498), I found one relating to "COLORECTAL cancer screening" during a search in the Medicare Coverage Database database:
Specifically in this Publication for Fecal Occult Blood testing:
(*note, you have to select the "Accept" button at the bottom of the page to acknowledge the disclaimer)
This makes reference to HCPCS code: G0107
"[W]hen testing is done for the purpose of screening for COLORECTAL cancer in the absence of signs, symptoms, conditions, or complaints associated with gastrointestinal blood loss".
Now, whether or not Exact can use this code, or wants to use this code is the question. Perhaps they want a code that offers a greater reimbursement?
I would hope they aim for one that covers more of the cost, considering the time, expense, & risk they have invested bringing this innovation to market.
However, I would bet that it would take many months and would needs medical community support.
I am pretty sure Blue Cross and Blue Shield are going to insist Exas' product is first choice (because of cost and accuracy).If anything is suspect then probable colonoscopy.
Don't have any info re medicare or medicaid. Anybody help??
Thank you, sec_woman.
If you hadn't read the General's introduction of himself to this mb (messages #390 and #391), you'd find that bringing humor to the mbs he posts on is part of what he's been about or at least tries to be about for the past 5 i/2 years. It may also explain the (apparent) pomposity. If it doesn't, well, you know what they say about teaching old dogs new tricks.
The important thing is that you seem to appreciate his efforts.
As for kissing and telling, the General wasn't asking for the former, and you've already told the "easy-to-please" General what he wanted to know, so he's satisfied.
In fact, he's so satisfied, that he'd feel in need of a cigarette, except for one thing, the General doesn't smoke. He doesn't drink either.
Well, at least that's two out of three.
But like others here, the General is glad to have you as a contributor on this mb.