[Congressional Record Volume 159, Number 42 (Thursday, March 21, 2013)]
[Extensions of Remarks]
[Pages E352-E353]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                          HON. RICHARD E. NEAL

                            of massachusetts

                    in the house of representatives

                        Thursday, March 21, 2013

  Mr. NEAL. Mr. Speaker, the month of March is national colorectal 
cancer awareness month. I introduce today the Supporting Colorectal 
Examination and Education Now (SCREEN) Act. This legislation removes 
barriers in colon cancer screening, one of the most effective 
preventive health screenings available. The bill helps save lives, 
improve quality of care, while also reducing Medicare costs in the 
process. I urge all of my colleagues to support this important 
  The statistics surrounding colon cancer are startling. Over 50,000 
people will die this year from this disease according to the American 
Cancer Society. Colon cancer is the number two cancer killer in the 
United States for both men and women. Many of us in this chamber have 
had friends, family members, and associates affected by this terrible 
  Thankfully, colorectal cancer is highly preventable with appropriate 
screening. According to an important study recently published in the 
New England Journal of Medicine, colorectal cancer deaths may be 
reduced by over 50 percent by removing precancerous polyps during the 
screening colonoscopy. Colon cancer screening is a unique preventive 
service as pre-cancerous polyps are removed during the same encounter, 
thus preventing cancer from developing, as opposed to other cancer 
screenings where early detection is the goal. That is one reason why 
the U.S. Preventive Services Task Force provides an ``A'' rating for 
CRC screenings.
  Unfortunately, only half of the Medicare population is being 
screened, despite the availability of a Medicare colon cancer screening 
benefit. According to CMS and the American Cancer Society, Medicare 
claims indicate that only 55-58 percent of beneficiaries have had a 
colonoscopy or any colorectal cancer test. Screening rates among 
minority populations are especially low despite the fact that 
incidences of colon cancer are higher in these populations. The Centers 
for Disease Control and Prevention (CDC) concludes that 1,000 
additional colorectal cancer deaths will be prevented each year if 
screening rates reached 70 percent.
  In addition to saving lives, colorectal cancer screening has been 
demonstrated to save Medicare long-term costs as noted by the New 
England Journal of Medicine in a recent article. The direct costs of 
treating colorectal cancer in 2010 reached $4 billion. These costs can 
be partially avoided with proper screening.

[[Page E353]]

  Congress can and should help increase the number of individuals 
receiving colorectal cancer screenings. The SCREEN Act takes several 
much-needed steps to increase access to life-saving colorectal cancer 
screenings for Medicare beneficiaries.
  The SCREEN Act waives all Medicare beneficiary cost-sharing for 
colorectal cancer screenings where polyps are removed during the 
examination. Currently, Medicare waives cost-sharing for any colorectal 
cancer screening recommended by the U.S. Preventive Services Task 
Force. However, should the beneficiary have a precancerous polyp 
removed, the procedure is no longer considered a ``screening'' for 
Medicare purposes. The unintended consequence of this is that the 
beneficiary is obligated to pay the Medicare coinsurance. This is an 
unexpected and unwelcome ``sticker shock'' that does nothing to promote 
screening or improve patient care. The Administration announced in 
February 2013 that private insurers participating in state-based health 
insurance exchanges must remove all cost sharing for colon cancer 
screenings where a polyp was removed. We must have a similar policy in 
the Medicare program.
  The SCREEN Act also provides incentives for Medicare providers to 
participate in nationally recognized quality improvement registries so 
that our Medicare beneficiaries are in fact receiving the quality 
screening they deserve. Congress and other organizations can look to 
the SCREEN Act as a model for Medicare reimbursement reform as the bill 
reimburses providers in a budget neutral manner based on the quality of 
the procedure and not on the quantity of services.
  Lastly, the SCREEN Act would allow a Medicare beneficiary to sit down 
and discuss the screening with a physician before undergoing the 
procedure. The federal government and patient advocacy groups have 
concluded that the ``fear of the procedure'' is a major impediment to 
increasing colorectal cancer screening rates. This pre-procedure visit 
is good clinical practice and would help improve screening utilization. 
The patient plays an integral role in colon cancer screening aside from 
just showing up for the procedure. This role dictates the quality of 
the screening itself. Medicare should recognize this and provide 
coverage for a pre-screening visit to review the preparation and 
procedure itself. There is no reason why a Medicare beneficiary sees 
the physician for the first time right before being sedated for the 
  Promoting access to colorectal cancer screening is good policy. It 
will save lives and reduce costs to families and the health care 
system. Please join with me in the fight against colorectal cancer by 
cosponsoring this legislation.