Colonoscopy practice patterns since introduction of medicare coverage for average-risk screening.

BACKGROUND AND AIMS

Recent legislation passed in July 2001 provides coverage for all Medicare beneficiaries for average-risk screening colonoscopy.

METHODS

We analyzed the Clinical Outcomes Research Initiative national endoscopic database to characterize colonoscopy practice patterns before and after the introduction of this coverage.

RESULTS

Between January 1998 and May 2002, 205,638 patients underwent colonoscopy, of whom 8.3% underwent average-risk colon cancer screening. The proportion of procedures performed for average-risk screening has increased dramatically from 4.6% (before July 2001) to 14.2% (after July 2001). With the increased volume of average-risk screening examinations, colonic lesion detection (masses and polyps greater than 9 mm) has declined (4.9% before July 2001 to 3.8% after July 2001).

CONCLUSIONS

There has been a dramatic increase in the rates of screening colonoscopy during the past 4 years. If rates continue to increase, optimal resource utilization will assume increasing importance.