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1. Over 20% of screening colonoscopies among older Medicare beneficiaries may be unnecessary.
2. Rates of colonoscopy overuse vary by provider and geographic region.
Colonoscopy is the primary screening modality for colorectal cancer in the US. Despite its invaluable role in cancer screening, the procedure must be used judiciously to limit risks to individual patients and prevent unnecessary healthcare spending. Current guidelines recommend against screening colonoscopy in the oldest age groups and within 10 years of a negative screening result. However, this study demonstrates that inappropriate screening colonoscopy in Medicare beneficiaries is widespread, with variable rates among physicians and across geographic regions. Further research is necessary to determine the patient- and provider-related factors underlying these differential rates of overuse, which have been documented across other realms of Medicare spending.
Click to read the study in JAMA Internal Medicine
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1. Over 20% of screening colonoscopies among older Medicare beneficiaries may be unnecessary.
2. Rates of colonoscopy overuse vary by provider and geographic region.
This [retrospective cohort] study evaluated 100% Medicare claims data from Texas and a 5% sample from the US and identified Medicare beneficiaries aged 70 and older who underwent a colonoscopy between October 1, 2008 and September 30, 2009. Colonoscopies were classified as diagnostic or screening, and screening colonoscopies were further sub-classified as potentially inappropriate (on the basis of patient age or occurrence too soon after a colonoscopy with negative findings) or appropriate. The percentage of inappropriate screening colonoscopy was estimated for each colonoscopist and hospital service area. Across the US, 23.5% (range 19.5% to 30.5%) of screening colonoscopies were potentially inappropriate, with similar rates (23.4%, rangie 13.3% to 34.9%) in Texas. These rates varied significantly across colonoscopists, with approximately 6% of the variation in outcome attributable to the physician. Higher rates of potentially inappropriate screening were seen among surgeons, US medical school graduates, higher-volume colonoscopists, and physicians who had been in practice longer. Â
In sum: Colonoscopy is the primary screening modality for colorectal cancer in the US. Despite its invaluable role in cancer screening, the procedure must be used judiciously to limit risks to individual patients and prevent unnecessary healthcare spending. Current guidelines recommend against screening colonoscopy in the oldest age groups and within 10 years of a negative screening result. However, this study demonstrates that inappropriate screening colonoscopy in Medicare beneficiaries is widespread, with variable rates among physicians and across geographic regions. Further research is necessary to determine the patient- and provider-related factors underlying these differential rates of overuse, which have been documented across other realms of Medicare spending.
Click to read the study in JAMA Internal Medicine
By Elizabeth Kersten and Andrew Bishara
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