This additional screening population not only adds to outpatient diagnostic volumes but also to downstream colorectal cancer treatment volumes for positive diagnoses. Given that colorectal cancer treatment contributes 22% of outpatient oncology profits and 14% of inpatient oncology profits to hospitals, leaders may want to start considering how they can capture the latent demand likely to be unlocked due to the ACS recommendation.
Why screening ages dropped
Colorectal cancer is the second-leading cause of cancer death in the United States—and ACS' recommendation is largely a response to an increase in diagnoses among younger patients. While active screening has reduced colorectal cancer deaths in the above-50 population, there has been a 51% increase in colorectal cancer incidence in adults under 50 in the last 20 years, and many of these cases are found at an advanced stage, when outcomes are poor.
Impact on screening and treatment volumes
ACS' new guidelines recommend that individuals 45 years of age or older who have an average risk for colorectal cancer get annual screening using the stool-based Fecal immunochemical test (FiT) or the guaiac-based fecal occult blood test (gFOBT) test, with a follow-up visual exam (such as colonoscopy) if the stool tests are positive. For individuals without positive tests, colonoscopy is advised once every 10 years.
While volumes of both stool-based and visual exams are expected to increase with the guidelines, payers are not required to cover screening for the under-50 population unless the U.S. Preventative Service Task Force (USPSTF) changes guidelines. However, stool-based tests are relatively affordable out-of-pocket, and several payers, including Medicare, cover diagnostic colonoscopy if stool-based tests are positive. Private payers could expand coverage in the future if evidence points to this expanded screening as a cost-effective prevention technique.
Next steps for planners
- Promote patient and physician awareness
To grow screening volumes, hospitals should educate both referring physicians and patients through marketing campaigns to ensure they are aware of the new guidelines. In addition, hospitals should engage community organizations (such as religious organizations, hobby and recreational groups, and civic organizations), employers, and federally qualified health centers to improve screening rates among eligible patients.
- Leverage EHRs to increase screening utilization
Hospitals should mine EHRs to identify and inform individuals who are eligible for screening. Kaiser Permanente, a 28-hospital integrated care delivery system in Colorado, embraced this technique to target eligible patients with combined interactive voice response calling and follow-up fecal immunochemical test kit mailings. Nearly half of all 26,003 contacted individuals competed their screening—a rate almost four times higher than seen with typical care models.
- Improve access for patients with positive results
Hospitals should also provide an early touchpoint for patients who have a positive screening result, such as a seamless transition to a patient navigator trained to answer patient questions and concerns related to a positive diagnosis.