Medicare makes evidence-based decision on virtual colonoscopy

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The great hue and cry about rationing and about socialized medicine has begun following Medicare's decision yesterday that it would not pay for so-called "virtual" colonoscopies.

The agency concluded that "the evidence is not sufficient to conclude that screening CT colonography improves health benefits for asymptomatic, average risk Medicare beneficiaries."

I haven't seen one news account yet, though, that actually explored in detail what that evidence was.

This was a bold move by Medicare administrators - in the face of intense industry pressure to approve the scans.

The American College of Radiology has posted a statement that says the decision will "cost lives" and mentions a study but doesn't address the very issue that Medicare acted on - evidence in "asymptomatic, average risk Medicare beneficiaries." The ACR statement then even plays the race card, saying the test "can help overcome the disparity in colorectal care that exists in minority communities."

I wish news stories and press releases would skip the rhetoric and explain the evidence. Otherwise the rationing rhetoric is bound to continue - without advancing true public understanding of the issues at play. It's another early bellwether of what any true comparative effectiveness research effort will be up against.

1 Comment

This is another classic example of the financial end of the health care system leading the clinical end to a more expensive outcome. Virtual colonoscopies work! They find clinical pathology, and equally important they find systems without clinical pathology that don't require more expensive and invasive treatment. If the goal should be to promote prevention and early detection, then we should be manipulating the financial system to promote clinical effectiveness. Pay for virtual colonoscopies performed by Gastroenterologists and not by Radiologists. Pay them a small yet compensating amount for the test so that there is an incentive to have large segments of the population screened. Then pay a smaller and modest fee for those GI physicians to follow up on positive screens with an invasive procedure to remove suspect polups. Only about 20% of the standard colonoscopy patients have pathology which needs to be removed as I understand the data - so 80% of these patients could have been adequately served with a simple non-invasive 5 minute Scan.

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This page contains a single entry by Gary Schwitzer published on May 13, 2009 8:48 AM.

Do people need their heads examined regarding brain scans? was the previous entry in this blog.

Press releases from academic medical centers - continued is the next entry in this blog.

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