Research article
Trends in Colorectal Cancer Test Use in the Medicare Population, 1998–2005

https://doi.org/10.1016/j.amepre.2009.03.009Get rights and content

Background

Colorectal cancer (CRC) screening has been covered under the Medicare program since 1998. No prior study has addressed the question of the completeness of CRC screening in the entire Medicare cohort.

Methods

In 2008, CRC test-use rates were analyzed for the national fee-for-service Medicare population using Medicare enrollment and claims data from 1998 through 2005. Annual test-use rates were calculated for fecal occult blood testing, sigmoidoscopy, barium enema, and colonoscopy for each year by the demographic characteristics of enrollees. A current-in-Medicare rate was calculated to assess the percentage of enrollees with CRC testing according to recommended intervals.

Results

Colonoscopy rates have increased every year since the introduction of CRC screening coverage. Test-use rates for all other test modalities have steadily decreased. The percentage of Medicare enrollees receiving appropriate tests has slowly increased. In 2005, 47% of enrollees aged ≥65 years and 33% of enrollees aged 50–64 years had claims indicating that they had been tested according to recommended intervals.

Conclusions

CRC test-use rates in the Medicare population are low. Disparities are apparent by age, race/ethnicity, gender, disability, income, and geographic residence. Much work remains to be done to increase testing to acceptable levels.

Section snippets

Background

The majority of colorectal cancer (CRC) cases in the U.S. occur in individuals aged ≥60 years, making CRC an important medical condition for the Medicare program.1 Regular screening for CRC is recommended by expert groups.2, 3, 4 Since 1998, Medicare has covered CRC screening for average-risk enrollees aged ≥50 years with four different tests at varying recommended test intervals: fecal occult blood testing (FOBT) every year; sigmoidoscopy every 4 years; barium enema every 5 years; or, for

Methods

In 2000, The Carolinas Center for Medical Excellence (CCME), the quality-improvement organization responsible for Medicare quality of care in North and South Carolina, was asked by the Centers for Medicare & Medicaid Services to develop CRC screening measures and national- and state-level reports of CRC test use in the Medicare population. CCME used enrollment and claims data for the FFS Medicare population in the U.S. to create a web-based report that allows users to obtain estimates of

Results

In 2005, 29 million FFS Medicare aged and disabled enrollees were eligible for CRC testing, an 11.6% increase over the eligible population in 1998 (Table 1). The growth in the population eligible for CRC testing was uneven across demographic groups—the younger enrollee population (aged 50–64 years) increased 50.5% compared to 8.3% for the population aged ≥65 years. In the group aged ≥65 years, greater growth was also seen among men (13.1%) compared to women (5.2%), but an opposite pattern was

Discussion

The results of this study offer both encouraging and discouraging news. It demonstrates that as of 2005, nearly half (47.2%) of Medicare enrollees aged ≥65 years were current with CRC testing as recommended in guidelines. This finding is encouraging because it is substantially higher than in the previous estimate of CRC test compliance based on Medicare claims.15 In that earlier study, data from enrollees aged ≥70 years were analyzed to determine whether individuals had complete screening over

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