An Interesting Development: Virtual Colonoscopy

The U.S. Centers for Medicare and Medicaid Services toady announced that Medicare would not pay for virtual colonoscopy. Specifically they state:

"The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test under §1861(pp)(1) of the Social Security Act. CT colonography for colorectal cancer screening remains noncovered," the May 12 memo states.

The decision comes as a blow to advocates of CTC, who held out hope that the agency would reverse its proposed February 11 decision to deny reimbursement for screening CTC based on the body of evidence presented to it since the analysis of CTC as a screening tool began last year."

The opposition states:

"Dr. James Thrall, chair of the American College of Radiology Board of Chancellors, was even more emphatic.

“Make no mistake: If it stands, this CMS decision not to pay for CT colonography will cost lives. More than 140,000 Americans are diagnosed with colorectal cancer each year. Nearly 50,000 of them die due to late detection. How can CMS ignore the fact that people are dying because they do not want to have the tests that are currently covered?” Thrall said in a statement to the American College of Radiology.

“For CMS to turn its back to a technology that can attract more patents to be screened and save countless lives is deeply concerning," he continued. "CMS should reverse this determination immediately or Congress should step in and vote to mandate coverage of CTC.""

I knew Dr Thrall from Mass General many years ago and he is a highly respected radiologist. This may seem like an inside baseball issue but it does raise many questions as we see Health Care go through many changes.

The New England Journal of Medicine has reported five years ago:

"CT virtual colonoscopy with the use of a three-dimensional approach is an accurate screening method for the detection of colorectal neoplasia in asymptomatic average risk adults and compares favorably with optical colonoscopy in terms of the detection of clinically relevant lesions."

However there is a battle between other specialties and radiologists as to who will "own" the patient. This argument in many ways is centered around that issue. Does this cause the patient any increased risk. Unlikely since the standard procedure with and endoscopist leads to the ability to immediately remove lesions. In addition a competent endoscopist can detect sessile lesions with greater accuracy and it is those lesions that often are missed and also are the most lethal.

Thus is this a decision to control medicine or to improve care. I believe the evidence is the latter. Fear not from the Government, at least on this one.