More colonoscopy fraud

As I’ve said before, colonoscopy is one “routine” cancer-screening test you might not really need. Despite what some celebrities–and most doctors–say. Plus, it’s far too expensive. In fact, according to some experts, colonoscopy is the sole reason why the U.S. leads the world in health care expenditures.

And this just doesn’t make any sense.

Especially since we have other screening methods for colorectal cancer that are safer and just as effective.

Plus, they’re cheaper. Much cheaper.

I’ll explain more about this safe, effective option in a moment. But first, let’s take a look at how colonoscopy became such a lucrative business.

Recently, two reporters for the Washington Post shined a spotlight on the problem. They investigated the workings of a powerful, yet little-known subcommittee of the American Medical Association (AMA).

This small subcommittee meets confidentially each year to decide “values” for the many services that doctors perform. In other words, they decide how much medical procedures cost.

(In the business world, this is called “price fixing.” And it’s illegal. But medicine is no longer a free market, since it now lies in the hands of the government and third-party insurers. And in their hands, price-fixing isn’t illegal.)

Supposedly, this subcommittee comes up with these values based on how much time a doctor spends performing the service. And how much effort it requires.

The subcommittee then presents the values to the Center for Medicare and Medicaid Services (CMS). And private insurance companies reference them as well.

The CMS uses these recommendations to set Medicare/Medicaid payment rates. This determines how much a doctor gets paid when the patient has Medicare or Medicaid. And private health insurance companies use the AMA recommendations too.

As I said earlier, this is one powerful subcommittee. And its decisions have far-reaching effects. Yet, there’s very little oversight or transparency about their work. The CMS actually even pays the AMA to develop these recommendations!

So, what stops the committee from inflating prices arbitrarily? Or even purposefully?

Not much, apparently.

In fact, the Post reporters found that the AMA subcommittee grossly overestimates how much time doctors spend performing many common procedures. Especially colonoscopies.

In fact, the AMA estimates that a basic colonoscopy takes 75 minutes of a physician’s time. This includes the work performed before, during and after the scoping.

But here’s the problem…

It doesn’t take doctors this long to perform colonoscopies.

Well, let me rephrase that.

Maybe it should take that long. But gastroenterologists don’t take that much time.

In the Post article, one Florida gastroenterologist said he routinely performs 16 procedures a day. This includes 12 colonoscopies. He said it generally takes him nine to 10 hours to complete this work in a day.

But, according to the AMA estimates, it should take that doctor 26 hours to perform all these procedures.

So, either the doctor works more than twice as fast as the AMA says he should. Or he’s being overpaid.

My guess is that it’s a little of both.

The doctor is probably pushing to complete as many colon screenings as he can in one day to beef up his “bottom” line. And I’m sure he’s not the only one. In fact, most gastroenterologists allot just 30 minutes for a routine colonoscopy.

Without a doubt, the AMA is still way off base in its time estimate.

As a result, the taxpayers (through Medicare/Medicaid) foot the bill for three days of work. But it only takes the doctor one day to do the work. The insurance companies overpay too because they use the same AMA estimates. (And once Obamacare hits, the taxpayers will do even more to help foot these bills.)

But from a health standpoint, there’s an even bigger issue…

As I mentioned earlier, some experts say colonoscopies aren’t even the best screening tool for colorectal cancer.

Another test works just as well. Plus, it’s safer and cheaper.

According to a recent article in the Journal of the American Medical Association, this is test is highly effective. It’s even more effective than offering a “free” colonoscopy to patients. (Of course, there’s no such thing as a free lunch. Or a free colonoscopy. When it comes to healthcare, somebody always pays. When it’s not the patient, it’s the taxpayers.)

The study’s lead author, Samir Gupta, M.D., told Medscape Medical News, “Physicians should not assume that the use of colonoscopies is the best and only way to reduce colon cancer rates.”

William Chey, M.D., co-editor-in-chief of the American Journal of Gastroenterology, also weighed in on the issue. He said, “Almost everyone would agree that the most effective form of colorectal cancer screening is the one that person will adhere to.”

The study team also added that this alternative screening test might have broader appeal. In their report, they wrote, “our findings raise the possibility that large-scale public health efforts to boost screening may be successful if non-invasive tests… are offered over colonoscopy.”

Sources:

1. “How a secretive panel uses data that distort doctors’ pay,” Washington Post (www.washingtonpost.com), July 20, 2013

2. “Comparative Effectiveness of Fecal Immunochemical Test Outreach, Colonoscopy Outreach, and Usual Care for Boosting Colorectal Cancer Screening Among the Underserved: A Randomized Clinical Trial,” JAMA Intern Med August 5, 2013; online ahead of print


CLOSE
CLOSE