March is National Colorectal Cancer (CRC) Awareness Month, a good time to reflect on the incidence and life-threatening consequences of this disease. It is also a good time to consider the many lives that have been saved through early screenings and the use of colonoscopy, the gold standard for detection and prevention.
According to the American Cancer Society, CRC is the second leading cause of cancer-related deaths in the U.S., responsible for an estimated 50,000 deaths annually. Early detection through screening significantly improves outcomes by identifying precancerous polyps or cancer at an early stage.
The Role of ASCs
ASCs have emerged as a cornerstone in CRC prevention and early detection due to the vital role they play in enhancing the accessibility and efficiency of CRC screening. In 2022, the most recent full year for which Medicare data is available, they performed 896,774 colonoscopies that involved either a lesion removal or a biopsy. That figure represented half of Medicare’s total volume of those procedures that year and has remained consistent for three years, a period when the total number of colonoscopies performed each year continued to grow.
Colonoscopy is well-suited to the streamlined processes offered by ASCs, which often feature shorter wait times, reduced infection risks and lower costs compared to hospitals. Patients also benefit from the efficiencies and patient-centered approach ASCs offer.
Technological advancements, like high-definition endoscopy equipment and artificial intelligence (AI)-assisted polyp detection tools that improve the sensitivity and accuracy of colonoscopies, are also helping ASCs improve the care they provide. These tools enable clinicians to identify and remove polyps during the same procedure, preventing cancer development and reducing the likelihood of missed lesions.
ASCs also excel in addressing patient comfort and compliance. Since the incidence of early-onset CRC has been rising, CRC screening is now strongly recommended for adults age 45 and older. ASCs’ ability to provide the patient-friendly environment and flexible scheduling these patients want and need encourages adherence to these guidelines, which is critical for reducing CRC-related mortality. Many ASCs also offer open-access colonoscopy programs, allowing patients to bypass multiple pre-procedure consultations, thus simplifying the screening process.
Challenges in ASC CRC Screening
Despite their many benefits, ASCs face challenges in delivering equitable and widespread access to CRC screening. Geographic disparities remain a significant barrier since rural populations and underserved communities often lack access to well-equipped ASCs, forcing patients to travel long distances. Financial constraints further compound the issue, particularly for individuals without comprehensive insurance coverage.
Insurance reimbursement policies also can impact the affordability of CRC screening in ASCs. While ASCs typically provide cost-effective care, reimbursement rates might not fully cover the costs of advanced technology and anesthesia services, which are critical for patient comfort and safety during colonoscopies. Addressing these financial barriers is essential to expanding the reach of ASCs for CRC prevention.
Regulatory compliance can be expensive. ASCs adhere to strict quality and safety standards, including infection control protocols, credentialing of providers and regular reporting of performance metrics. These requirements, while necessary, demand ongoing investment in staff training and infrastructure.
Legislation Can Help
Legislation has already played a critical role in shaping the accessibility and affordability of colorectal cancer screening in ASCs and can do more.
The Removing Barriers to Colorectal Cancer Screening Act, passed in 2020, eliminated Medicare beneficiaries’ cost-sharing when a screening colonoscopy becomes therapeutic due to polyp removal. This landmark law ensures that patients are not deterred from screening by unexpected out-of-pocket costs, encouraging broader utilization of these life-saving procedures.
ASCA is currently monitoring two additional legislative proposals that could affect CRC screening rates and coverage. The Nancy Gardner Sewell Multi-Cancer Early Detection Act, which was introduced by Representative Terri Sewell (D-AL), would ensure Medicare provides coverage and payment for multicancer early detection screening tests approved by the U.S. Food and Drug Administration. The bill has received bipartisan support, including during its 38-0 passage in the House Committee on Ways & Means.
The other bill, the Colorectal Cancer Early Detection Act, would award grants to states to promote colorectal cancer prevention and early detection efforts to individuals under age 45. Representative Yadira Caraveo, MD, (D-CO) introduced the bill in March 2024, but she was not re-elected. ASCA believes the bill might eventually be reintroduced by one of its cosponsors.
At the state level, numerous bills aim to expand coverage for colorectal cancer screening. For instance, New Jersey’s A3523, enacted in 2023, mandates that private insurers cover screenings in accordance with United States Preventive Services Task Force recommendations, including those performed in ASCs, and eliminates patient cost-sharing for a colonoscopy performed following a positive result on a CRC screening test. Such measures align with national guidelines that emphasize the importance of early detection and prevention.
Efforts to address disparities in access have also gained momentum. Proposed legislation includes funding for mobile endoscopy units to serve rural areas and initiatives to expand Medicaid coverage for CRC screening in ASCs. These measures aim to reduce geographic and financial barriers, ensuring equitable access to screening services for all populations.
The Future of CRC Screening in ASCs
Looking ahead, the integration of value-based payment models in healthcare represents a promising development for CRC screening in ASCs. These models reward facilities for achieving high screening rates, early cancer detection and improved patient outcomes, creating financial incentives that align with public health objectives.
Additionally, standardizing quality reporting across ASCs could play a pivotal role in enhancing accountability and transparency. Policymakers are advocating for uniform benchmarks that evaluate patient outcomes, procedural safety and cost efficiency to help all ASCs ensure they are consistently delivering high-quality care.
Innovations such as liquid biopsy tests and non-invasive stool DNA tests are becoming more prevalent, complementing traditional colonoscopy and increasing screening uptake. Integrating these tools into ASC workflows could broaden their patient base and further improve early detection rates.
In Summation
ASCs are indispensable in the fight against CRC, providing efficient, accessible and patient-centered screening services. Legislative advancements, such as the removal of cost-sharing barriers and expanded insurance coverage, have already significantly improved access to these essential procedures. Still, challenges related to geographic disparities, financial barriers and regulatory compliance remain.
Continued advocacy for equitable policies, technological innovation and value-based care models will be crucial for maximizing the potential of ASCs in reducing the burden of CRC. By addressing these challenges and building on recent successes, ASCs can play an even greater role in saving lives through early detection and prevention.
