Some Medicare Patients Receive Inappropriate Colonoscopies
March 14, 2013

Twenty Percent Of Medicare-Approved Colonoscopies Could Violate Guidelines

redOrbit Staff & Wire Reports - Your Universe Online

As many as one-fourth of all colonoscopies paid for by Medicare are potentially inappropriate under current US Preventive Services Task Force (USPSTF) screening guidelines, according to research published online Monday in the journal JAMA Internal Medicine.

Under USPSTF guidelines, a colonoscopy is inappropriate if it is a repeat screening taking place less than 10 years following a negative screening result in patients who are between 70 and 75 years of age and who are not experiencing symptoms, researchers from the University of Texas Medical Branch at Galveston (UTMB) explained in a recent statement. In addition, routine colon cancer screenings are not recommended for anyone between the ages of 76 to 85 years of age, and are actively discouraged in patients over the age of 85.

Despite that, an analysis of some Medicare patients over the age of 70 revealed that 23.4 percent of colonoscopies paid for by Medicare were potentially inappropriate under USPSTF guidelines. In their study, the researchers reviewed all Texas-based claims that met the criteria during a one-year period that encompassed parts of 2008 and 2009, as well as five percent of all US Medicare patients at least 70 years of age who underwent colonoscopies that were reimbursed by the federal social insurance program during that same time period.

“Screening colonoscopy comes with a real risk of complications for older adults, such as perforation, bleeding or incontinence,” said lead researcher Kristin Sheffield, an assistant professor of surgery at UTMB. “At the same time, however, older adults are less likely to benefit from early detection because the natural history of colon cancer usually involves a slow progression from polyp to cancer.”

Sheffield and her co-authors emphasize that they are not telling patients who are experiencing colon cancer-related symptoms such as anemia, abdominal pain or gastrointestinal bleeding to pass on potentially life-saving screenings. In fact, they emphasize the importance of additional testing for those concerned that they may be among the five percent of adults which the American Cancer Society says are at risk of developing colorectal cancer during their lives.

The study was supported by a grant from Comparative Effectiveness Research (CER) on Cancer in Texas, the Cancer Prevention and Research Institute of Texas and the National Institutes of Health (NIH).