Medicare Shoots Down Virtual Colonoscopy Reimbursement (GE, SI)

Today was a big day for the world of colonoscopies and the battle in detecting colon cancer and polyps.  The Center for Medicare and Medicaid Services issued a final decision that Medicare would not cover the reimbursement for virtual colonoscopies.  This is a blow for the medical imaging sector, particularly for leaders such as General Electric Co. (NYSE: GE) and Siemens AG (NYSE: SI).  This is also a blow in the battle for detecting of polyps or early stages of colon cancer.

The CMS noted in its memo, “The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test….  CT colonography for colorectal cancer screening remains noncovered.”

Whether you have to get a colonoscopy done the old fashioned way or virtually it still requires the material you have to consume to clear out the bowels.  The difference of a virtual or traditional method is rather simple.  The CT machine scan is a relatively non-invasive procedure besides an ingestion of a chemical marker and requires no real sedation followed by a CT/MRI scan.  For the traditional exam, sedation is required and a fiber optic camera on a flexible tube is inserted through the anus and snaked up all the way through your intestine.  Guess which one is more desirable if you are the patient.

Detecting colon cancer while it is a mere polyp or in the very early stages is far better from a cost-basis, a quality of life basis, and on the basis of what is a better use of the medical system.  The belief is that there would be many more colonoscopies conducted if this was approved in a virtual manner, and in theory much fewer colon cancer cases.  The downside to the virtual colonoscopy is that if polyps (or worse are detected, then a traditional colonoscopy and then whatever procedure would be required anyhow.

This is perhaps one of the first tests of what may or may not be coming down the pipe with the new healthcare system, yet this decision may be independent of any of the comparisons between the healthcare system of today versus the system of tomorrow.  Some form of universal healthcare is much more likely than ever.  That will be a welcome wagon for the army of uninsured or underinsured Americans.  For the rest of us we all really want to know what the new system will really be, and what sort of service we can expect.

When it comes to old fashioned colonoscopies versus the virtual colonoscopies, the CMS just said “Up Yours!”… Quite literally in this case.

JON C. OGG