A loophole that acted as a barrier to older adults getting potentially life-saving colonoscopies has been closed thanks in part to the efforts of Mather Hospital gastroenterologist Ramona Rajapakse, MD.
Colon cancer is the second leading cause of cancer death in the USA and, according to the American Cancer Society, causes approximately 50,000 deaths annually. Current guidelines suggest that colon cancer screening begin at age 50 in adults without risk factors and age 45 in African Americans. Colonoscopy allows for removal of precancerous lesions – polyps – thus not only providing a mode of detection but also prevention of colon cancer.
Screening colonoscopies have been covered by Medicare. But if the procedure discovered polyps, which are tested for cancer, the visit changed from a screening to a therapeutic procedure and patients could receive a surprise bill. “Covering a screening colonoscopy but not removal of polyps, the precancerous lesions, didn’t make sense” said Dr. Rajapakse, who practices with Mather Gastroenterology, a practice of Harbor View Medical Services.
Dr Rajapakse is passionate about colon cancer screening and in 2018, as part of a Public Policy Council delegation of the American College of Gastroenterology, she met with U.S. Rep. Donald Payne, Jr. (NJ), whose father had died from colon cancer. The College had, in 2012, joined a coalition of organizations advocating to advance the “Removing Barriers to Colorectal Cancer Screening Act,” which allowed for the removal and testing of polyps to be covered by Medicare. Rep. Payne sponsored bill H.R.1570, and a bi-partisan group of U.S. representatives and U.S. senators sponsored the legislation, which passed both houses and was signed into law by former President Donald Trump in December 2020.
“Many people on Medicare are retired and don’t have an independent income. They were afraid that Medicare would not cover polypectomy during a routine screening colonoscopy. This law means that seniors need not delay colonoscopy for fear of receiving a surprise bill after the procedure. It can potentially save thousands of lives every year” Dr. Rajapakse said.
Dr. Rajapakse said that advocating for patients sometimes requires working outside the physician’s office. She commended the American College of Gastroenterology for the work they do, not only in advancing the profession, but also on behalf of patients. “As physicians we need to advocate for our patients, not just in the office but wherever and whenever we can, sometimes on Capitol Hill.”