Lack of Medicare Coverage Limits CT Colongraphy Use in Minority Patients

CT colonography (CTC) exams occur less often in patients over age 65, a new study has found, and this downward trend could affect racial and ethnic minority patients the most.

In an article published Oct. 18 in the Journal of the American College of Radiology, a team of investigators from Emory University School of Medicine, led by Courtney Moreno, M.D., associate professor of radiology and imaging sciences in the Winship Cancer Institute, revealed the impetus for this drop could be because Medicare does not cover the exam.

“We observed that the relative utilization of screening CTC in individuals typically eligible for Medicare coverage decreased after age 65, suggesting access barriers related to a more restrictive Medicare coverage policy,” the team said.

Despite being a preventable condition with appropriate screening, colorectal cancer remains the second leading cause of cancer death in the United States. CTC is designed to detect colorectal cancer, as well as other types of colon cancer, but the Center for Medicare & Medicaid Services (CMS) announced in 2009 that evidence on the efficacy of CTC was lacking.

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Given the agency’s position, Moreno’s team set out to determine whether this stance is detrimentally impacting the quality of care given to patients. To do so, they examined CTC use, pulling 12,648 screening exams from the American College of Radiology’s CTC registry. They looked at both the age of patients, as well as any association between use of the exam and Medicare-eligible patient race.

Based on their analysis, the team identified a significant uptick in colon cancer rates in patients over age 50 – an annual increase of 5.3 percent in individuals between ages 52 and 64. On the flip-side, though, CTC screening rates began a noticeable decline after age 65, falling off by 6.9 percent for each additional year of age.

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In addition, they noticed a difference in the screening rates between white and African American patients. For white patients, the CTC screening rate was highest between ages 65 and 69, but the test was administered most often in African American patients between ages 55 and 59.

This difference, the team said, could be attributed to Medicare’s lack of CTC coverage for patients over age 65. The average out-of-pocket expense for CTC screening, according to Costhelper.com, is $2,400, they said. Consequently, by not covering the test, the agency is likely making it harder for patients who cannot afford to pay for the test without insurance to secure the screening.

The factors behind this disparity are largely social and structural in nature, the team concluded, and they equate to a reduced ability to afford effective screening services. Not only is the average annual income lower for African American patients than it is for white patients, but African American Medicare beneficiaries also have, on average, lower levels of savings.

Due to these factors, the team determined, Medicare should change its course and move to cover CTC.

“Medicare coverage of screening CTC is needed so that Medicare patients who cannot afford to pay for this test out of pocket can undergo screening CTC,” they said.

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