Tag Archives: Tia Sawhney

Comparison of colorectal cancer screening methods for commercially insured patients

In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among men and women and the second leading cause of death from cancer. The majority of cases of CRC can be prevented by the detection and removal of noncancerous adenomatous polyps. As in other types of cancer, survival is significantly better when CRC is diagnosed early while the disease is still localized.

Although optical colonoscopy has been the dominant method for CRC screening in the United States to date, there are other methods recommended by established guidelines. These include computed tomography (CT) colonography, guaiac-based fecal occult blood test, fecal immunochemical test-DNA, flexible sigmoidoscopy, and flexible sigmoidoscopy with fecal immunochemical test. Offering patients choices for CRC screening appears to lead to higher screening rates and better screening compliance.

CT colonography’s effectiveness, its associated patient advantages, and its potential role to increase CRC screening rates have been demonstrated in previous research, but whether CT colonography has a cost advantage relative to optical colonoscopy for the commercially insured U.S. population has not been assessed.

This research report by Milliman consultants compares the costs of CRC screening using CT colonography or optical colonoscopy for commercially insured people in the United States.

Dr. Judy Yee, chair of the Department of Radiology at Montefiore Medical Center, also coauthored this report.

Medicare ACO assignment methodology change may have unintended consequences

A number of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) experienced significant, unanticipated changes in their 2017 performance year historical benchmarks and performance expenditures. These changes were not consistent in direction or magnitude. The exclusion of some nursing facility visits from MSSP assignment, effective in 2017, is the likely cause of the unanticipated changes.

The Centers for Medicare and Medicaid Services (CMS) now excludes nursing facility provider evaluation and management visit codes with place of service (POS) 31 as a qualifying claim type for beneficiary assignment. This assignment methodology change is referred to as the POS 31 exclusion. It started with the 2017 performance year and is also applied to the corresponding baseline years for all MSSP tracks.

Some ACOs likely lost and some likely gained costly nursing facility beneficiaries due to the new exclusion in both the baseline and performance years. The POS 31 exclusion only works as intended if POS codes correctly differentiate between Part A skilled nursing facilities and other nursing facility patient services. Unfortunately, our analysis across the Medicare 5% sample indicates that POS codes for nursing facility-based claims may not always be reliable.

To read more about the possible impact of these changes, read this article by Tia Sawhney, Kate Fitch, and Cory Gusland.