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Congressional Testimony
March 06, 2000
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 4796 words
HEADLINE:
TESTIMONY March 06, 2000 MICHAEL MCMULLAN DEPUTY DIRECTOR HEALTH CARE FINANCING
ADMINISTRATION SENATE special aging COLON CANCER
BODY:
MICHAEL McNIULLAN DEPUTY DIRECTOR HEALTH CARE
FINANCING ADMINISTRATION SENATE SPECIAL COMMITTEE ON AGING March 6, 2000
CHAIRMAN Grassley, Senator Breaux, distinquished committee members, thank you
for inviting us to discuss Medicare's efforts to increase awareness and
screening for colon cancer. We are especially proud to be here as partners in
National Colorectal Cancer Awareness Month. Colon cancer kills more than 55,000
Americans each year. But many of these deaths call be prevented by screening
tests that Medicare now covers. These tests can detect polyps that can be
removed before they become cancerous, and find early stage cancers for which
treatments are highly effective. This is one of several important new preventive
health benefits enacted as a part of the Balanced Budget Act of 1997 (BBA). We
have several outreach efforts underway to help Medicare beneficiaries and their
physicians understand and take advantage of Medicare's colon cancer screening
benefit. Our colleagues at the Centers for Disease Control and Prevention and
the Agency for Healthcare Research and Quality are also working to promote
screening However, far too few people are being screened. Only about I million
Of Our 38 million beneficiaries had claims submitted for these life-saving tests
in 1998, the first year they were covered by Medicare. We are eager to explore
new ways to educate beneficiaries and providers about these important tests, and
to address special challenges among group Such as women and minorities. That
makes this hearing very valuable and timely. We greatly appreciate the support
of this Committee in helping us to raise awareness of the benefit of earlv
detection and Medicare's coverage for screening tests. With your help and the
assistance Of our many partners in this effort, we believe we can meet the
challenges before LIS, increase the number of beneficiaries who are Screened,
and save lives as a result, Colon cancer is the second leading cause of cancer
-related deaths in the United States for both men and women. When caught early,
the five-year Survival rate is 91 percent. However, if not caught before
spreading locally, the five year survival rate drops to 60 percent. And if not
caught before further spreading, the five- year survival rate plummets to only 6
percent. The U. S. Preventive Services Task Force recommends colorectal cancer
screening for all persons aged 50 or over. However, the National Colorectal
Cancer Roundtable found that half of all Americans over age 50 are not getting
these tests. Women and members of minority groups have particularly low
screening rates. And most not screened say physicians never recommended
screening to them. Prior to the Balanced Budget Act (BBA) of'1997, the Medicare
stature prohibited coverage for colorectal cancer screening and most other
preventive care services. Medicare could cover tests for colon cancer only when
conducted to investigate related symptoms OF to monitor all individual with a
history of colon cancer or inflammatory bowel disease.' Congress and the Clinton
Administration changed this policy in the BBA. It authorized coverage for colon
cancer screening , along with several other important preventive services, most
of which took effect January 1, 1998. Regulations implementing the colon cancer
screening benefit, published in the 11'ederal Register on October 3 1, 1997, are
based on recommendations by tile American Gastroenterological Association, the
Agencv for . Healthcare Research arid Quality, and other appropriate agencies,
associations. and medical groups. - Fecal occult blood tests are covered
annually for all beneficiaries age 50 and over. Tills is the least expensive and
least Invasive colorectal cancer screening test. It detects blood in the stool
that is an indication of the need for further investigation. - Flexible
sigmoidoscopy is covered every four years for beneficiaries not at high risk. It
is more expensive and invasive and can require local anesthesia. But it gives a
view of one- third to one-half of the colon, there are fewer false positive
results than with fecal occult blood tests, and lesions can be removed for
biopsy. 'This is consistent with other preventive screening services. Section
1862 of the Social Security Act prohibits Medicare coverage for services which
"are not reasonable and necessary for the diagnosis or treatment of illness or
injury or to improve the funcitoning of a malformed body member." Unless
Congress specifically authorizes coverage of specific screening services (e.g.,
colorectal cancer or prostate screening as authorized in the BBA), screening
services are not covered by Medicare. Colonoscopy is covered every two years for
beneficiaries at hi h risk. This is the most expensive and invasive colorectal
screening option and can require anesthesia. But it -1ves the best view of
entire colon and lesions can be removed for testing In Barium enemas are covered
as, an alternative if a physician determines that its screening value is equal
to or greater than sigmoidoscopy or colonoscopy. Other Preventive Services The
BBA authorized or expanded coverage of preventive services for several other
diseases, as well, and in some cases reduced beneficiary cost sharing in order
to further encourage use. Breast Cancer: Annual marnmography screening is
covered for all female beneficiaries age 40 and over, and a one-time baseline
mommogram for beneficiaries ages 35-39. Patients pay 20 percent of the Medicare
approved amount, but there is no deductible. Cervical Cancer: Screening exams,
screening pap test and clinical breast exams are covered every three years for
most women, and every year for women at high risk. Patients do not have to pay
either a co-payment or deductible for pap
tests. For pelvic and breast exams, they must pay the standard 20 percent
coinsurance but not the deductible. Prostate Cancer: Annual digital rectal exams
and prostate specific antigen (PSA) tests are covered for all males age 50 and
over, with no coinsurance or deductible for the PSA test. Diabetes: Glucose
monitors, lancets, and test strips which help patients control blood sugar are
covered, as are programs to teach diabetics how to care for their condition.
0steoporosis: Bone density measurement is covered for all beneficiaries at risk.
Vaccinations: Annual vaccinations for influenza, as well as vaccinations for
pneumococcal pneumonia, are covered with no coinsurance or deductible. Hepatitis
B shots are also covered for patients at medium to high risk. The Presidents
fiscal 2200 I budget would further encourage beneficiaries to take advantage of
life- saving preventive benefits. It would - eliminate existing cost-sharing for
all Medicare-covered preventive benefits, including colorectal screening (NOTE:
As indicated earlier in my testimony, there are a varietv of different
beneficiary cost-sharing requirements for the individual preventive semices
authorized for coverage(,e Linder Medicare. The President's Budget would waive
all existing cost-sharing for these services to simplify the process for
beneficiaries and to encourage their utilization.)-, - initiate a three-year
demonstration to evaluate the most successful and cost-effective smoking-
cessation services- and - launch a two-year, nationwide education campaign to
promote the use of preventive health services by older Americans and people with
disabilities. We believe these provisions are important and prudent steps that
will help increase use of and costs related to preventable conditions, and save
lives. We preventive services, reduce 1 look forward to working, with this
Committee to secure their Pascal)e Beneficiary and Provider Education Helping
beneficiaries and providers understand and take advantage of the colorectal
cancer screening benefit is a high priority for us. We are working to raise
consciousness and encourage use of these tests among both beneficiaries and
their physicians. We have several educational efforts already underway.
"Screen-for-life" posters and tear-off sheets. We have produced and distributed
Ronnie than 2'1,000 of these posters with tear- off sheets that beneficiaries
can take with their to their physician as a reminder to discuss their screening
options. The tear-off sheets are particularly helpful, since screening can
involve unfamiliar words, sensitive Issues. and unpleasant options that may be
difficult for patients to bring up on then- OW11. Public Service Announcements.
We distributed to 873 television and radio stations public service announcements
(Spas) that address the misconception that colorectal cancer is a man s disease
and promote discussion with physicians. CDC Partnership. We are partners with
the Centers for Disease Control and Prevention (CDC) in its national colorectal
cancer screening campaign, Screening . This campaign, which began in ', /larch
1999, encourages Medicare beneficiaries and other take advantage of screening
and prornotes the new Medicare coverage of colorectal cancer Screening
procedures. We are also working with the CDC in conducting formative research
and developing targeted messages for this national effort. AHRQ Consumer Guide.
Our colleagues at the Agency for Healthcare Research and Quality have produced a
consumer guide with information on colorectal cancer Screening. National
Colorectal Cancer Roundtable. We participate with several other public and
private organizations on this Roundtable, which was established by CDC and the
American Cancer Society. Through this effort we are strengthening the network of
public and private organizations promoting colorectal cancer screening among all
people f( whom screening is appropriate. Medicare.gov. We provide information on
colorectal cancer on Out- beneficiarv web site, including information on
N.4edicare coverage of colorectal screening tests questions and answers on the
colon and colorectal cancer.- causes of the disease, symptoms who is at risk,
screening techniques, risk and treatment, and where to find additional
inforniatioll. Medicare & You Handbook. Information on C01OFectal cancer
Screening and other preventive benefits Is featured In this -year sent to all
Medicare beneficiaries each year. We are sharing these materials through senior
centers, hospitals, health plans and insurers, state and local health
departments, medical colleges and foundation , Aging Councils, Medicare Peer
Review Organization, advocacy groups including" those focused in minorities, and
others. We face important challenges in Our efforts to encourage colorectal
Screening. One of these challenges is the need to address the misperception that
colorectal cancer is a man's disease. We therefore have campaign materials that
target women. For example, we and our CDC partners aired a live, interactive
satellite broadcast on women s health to more than 5000 physicians last August
that focused on colon cancer screening. A booklet explaining Medicare coverage
for colorectal screening tests was distributed to all attendees. Another
challenge is reaching, African Americans, who are at h1uher risk of colon cancer
than other population groups, We therefore, have materials targeted
Africa-American, Caucasian , Hispanic and Asian Populations. We are sharing
materials with organizations such as The National Black Leadership Initiative on
Cancer and disseminating them through our Medicare claims processing
contractors, who have specific Contract requirements to outreach to minority
Populations on health care Issues. We are also now working with partners to
expand effiorts to specifically educate physicians and 'de them with materials
and Support to help them educate their patients. These include: provide - a fact
sheet for physicians on the importance of screening - a decision aid tool that
physicians can use to help patients understand and choose among the various
screening options. - a brochure to share with patients on how removing polyps
can prevent cancer, - a teaching aid poster illustrating the colon and
explaining screening options - a "Get Screened" poster that physicians can put
up their office waiting rooms- and - public service announcements discussing
screening and prevention through polyp removal. To further these efforts,
Medicare's physician-lead Peer Review Organizations are beginning a special
study to better understand the use of colorectal cancer screening and determine
effective ways to promote testing through such things as physician office
reminder systems. We will also calculate national and state screening rates
among Medicare beneficiaries to help us target our outreach efforts. Colorectal
Cancer Awareness Month As mentioned above, we are proud participants with the
Cancer Research Foundation of America, the National Colorectal Cancer
Roundtable, and the American Digestive Health Foundation, the CDC, National
Cancer Institute, and others, in National Colorectal Cancer Awareness month,
This collaborative effort can help to generate widespread awareness of how to
prevent the disease through a healthy lifestyle and regular screening During the
month, participants will - distribute a video news release that we have prepared
on colorectal cancer screening- - air a colorectal cancer television segment on
CNBC and the Bravo Network-, - develop radio and print PSAs and articles for
distribution in medical journals-, and - conduct an advertising campaign.
Conclusion While we have made some progress, much work remains to be done to
increase use of Medicare's colorectal cancer prevention benefit. With support
from this Committee and our- many other partners, we believe we can meet this
challenge. Enactment of the President's fiscal year 200 I budget proposals would
provide further incentive to Medicare beneficiaries to use their preventive
benefits and further resources for Medicare to publicize their availability and
importance. We look forward to working with you further in all these efforts.
Thank you again for inviting me to be here today, and I would be happy to answer
any of your questions.
LOAD-DATE: March 8, 2000