CTC Appropriately Used Despite Reimbursement Limitations

April 5, 2013

Concerns over inappropriate use of CTC prompted CMS to halt reimbursement, but research shows that CTC is not being used inappropriately.

CT colonography (CTC) was performed appropriately among asymptomatic patients with the proper clinical indications who did not undergo standard optical colonoscopy before 2009, when CMS halted reimbursement, according to a study published in the Journal of General Internal Medicine.

CTC, also known as virtual colonoscopy, may be preferable for many patients because it does not require sedation and is significantly less expensive than standard colonoscopy, averaging $400 to $800, compared with $1,500 to $3,000 for colonoscopy. The CMS stopped reimbursing CTCs because of concerns that the test was being used inappropriately in the elderly population.

To address this issue, researchers from the Perelman School of Medicine at the University of Pennsylvania evaluated patient characteristics and known relative clinical indications for screening CTC among patients who received CTC compared with standard colonoscopy.

The researchers studied the records of all 10,538 asymptomatic Medicare beneficiaries who underwent CTC between January 2007 and December 2008. Their findings were compared to a cohort of 160,113 asymptomatic beneficiaries who underwent standard colonoscopy, matched on county of residence and year of examination.

Results showed that CTC was performed more often in women, patients who were older than 65 years, and among patients whose household income was above 75 percent. In addition, the vast majority of patients who received CTC had presumed incomplete standard colonoscopies and thus were considered to be appropriate candidates for CTC. Furthermore, almost half of the patients studied who underwent CTC following incomplete optical colonoscopy did so on the same day as their colonoscopy.

"Given that bowel preparation is a stronger barrier to screening, offering the same day CTC could improve completion of screening by eliminating the need for an additional bowel preparation," Hanna M. Zafar, MD, MHS, said in a release. Zafar was the lead researcher and is an assistant professor of radiology.

Patients undergoing high-risk screening, an inappropriate indication for CTC, were less likely to undergo the procedure. Overall, 83 percent of asymptomatic patients referred to CTC had at least one clinical indication relatively appropriate for the screening. Indications include risk of bleeding or sedation complications.

The researchers concluded that CTS was being targeted appropriately, however it was found to be lower among some demographic groups, such among asymptomatic nonwhite patients.

"These findings raise the possibility that future coverage of screening CTC might exacerbate disparities in colorectal cancer screening while increasing overall screening rates," researchers noted.