Many older people with Medicare are avoiding cancer screening instead of risking a surprise bill. If Trump brings a regulatory solution, many lives could be saved.

Surprise billing became a problem that sparked bipartite support and the president himself declared a priority. Until now, the discussion has mainly focused on how to solve the problem of private insurance. But Medicare seniors who are trying to avail themselves of an early proven cancer screening have not been spared from their own surprise bills.

Colonoscopies detect and, in many cases, prevent colorectal cancer – the second leading cause of cancer death in men and women. The tests not only detect pre-cancerous lesions known as polyps, but in most cases the discovered polyps can also be removed, effectively preventing a potential diagnosis of cancer.

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The law requires that all prevention services rated "A" or "B", as determined by the Prevention Services Working Group, be covered by a cost-free insurance for patients. For ages 50 to 75, colonoscopies receive the grade "A".

However, in Medicare, if, during preventive screening, a polyp is removed, this results in a reclassification of the test from a screening procedure to a diagnostic procedure. This change causes seniors to wake up with a surprise bill that can reach hundreds of dollars.

Missed opportunity of Medicare

Older people receiving Medicare are particularly vulnerable to cost-sharing, with about 31% of beneficiaries representing less than 200% of the federal poverty line. For those with fixed incomes, these unforeseen medical expenses can lead to financial hardship. Research shows that cost-sharing discourages patients from having access to proven preventative screenings, and the American Cancer Society has been informed by many seniors who have deferred or avoided the test instead of risking a surprise bill. .

Doctor sitting next to a senior man on the exam table. (Photo: GETTY IMAGES)

This is a total missed opportunity to improve patient health and achieve long-term savings for the Medicare program. According to a recent analysis conducted by the American Cancer Society on the Cancer Action Network, if Medicare operated this change and treated colonoscopies for screening after polyp removal as a preventative, up to 2,000 cases Colorectal cancer could be prevented every year in the elderly. The same analysis estimates that treatment avoidance would reduce Medicare spending by $ 525 million over 10 years. Ninety percent of people diagnosed with colorectal cancer at an early stage are still alive five years later, with an estimated average cost of treatment estimated to be 25% lower, according to the analysis.

A 2014 study estimated that 58% of all colorectal cancer deaths in 2020 will be due to "non-screening", which means that thousands of colorectal cancer deaths could be prevented if people were screened. Unfortunately, only 39% of all colorectal cancers are diagnosed at the local level, in part because of the underutilization of screening.

Give people a chance to live

Treatment of advanced colon cancer can cost $ 250,000 the chances of survival are greatly reduced. An affordable screening test to prevent cancer at one go embodies the old saying that "prevention is better than cure".

The previous administration has corrected unexpected billing issues related to colorectal cancer screening in private insurance. This administration has the opportunity to turn around the situation of the elderly – and this is a solution that can be resolved quickly by regulation.

The American Cancer Society knows that colorectal cancer screening is an effective and evidence-based method for reducing the incidence rates and deaths of colorectal cancer. It is estimated that 145,000 cases of colorectal cancer will be diagnosed in America this year, and more than 50,000 deaths are expected in the same amount of time. The president has the opportunity to directly influence these statistics by solving this surprise billing problem for the elderly through a regulatory body. This change will save lives and benefit from strong bipartite support.

Gary Reedy is the CEO of the American Cancer Society and the American Cancer Action Network. Follow him on Twitter @AmerCancerCEO.

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