3 part series on advocacy issues for the training of our advocates attending Call_on Congress 2013

1. MARCH 2013
WEBINAR
Three Part Series on Advocacy Issues in prep for our advocates.
- Presented by Camille S. Bonta, MHS
Principal of Summit Health Care Consulting

2. Welcome!
Medicare Cost Sharing for
Screening Colonoscopy
Part of Fight Colorectal Cancer’s Monthly Patient Webinar
Series – Part 1
www.FightColorectalCancer.org
877-427-2111

3. Fight Colorectal Cancer
1. Our speaker: Camille Bonta, MHS, Policy Expert
2. Archived webinars: Link.FightCRC.org/Webinars
3. Or call the Fight Colorectal Cancer Answer Line at 877-427-2111
www.FightColorectalCancer.org
877-427-2111

4. Fight Colorectal Cancer
Funding Research Directly
Lisa Dubow Fund
http://fightcolorectalcancer.org/research/lisa-fund

5. Fight Colorectal Cancer
Disclaimer
The information and services provided by Fight Colorectal Cancer are
for general informational purposes only.
The information and services are not intended to be substitutes for
professional medical advice, diagnosis, or treatment.
If you are ill, or suspect that you are ill, see a doctor immediately. In
an emergency, call 911 or go to the nearest emergency room.
Fight Colorectal Cancer never recommends or endorses any specific
physicians, products or treatments for any condition.
www.FightColorectalCancer.org
877-427-2111

6. Fight Colorectal Cancer
Camille S. Bonta, MHS
Principal of Summit Health Care Consulting
www.FightColorectalCancer.org
877-427-2111

7. Medicare Cost Sharing for Screening Colonoscopy
Preparing to Talk with Members of Congress about Cost Barriers to
Colorectal Cancer Screening for Medicare Beneficiaries
Call-on Congress
March 18-20, 2013

8. Medicare Cost Sharing for Screening Colonoscopy
• Current Medicare Law
– Colorectal cancer screenings are free, including
screening colonoscopy.
– However, if polyp is removed during
colonoscopy, Medicare beneficiary must pay
coinsurance.
– February 20 Administration communication
clarifies, under health reform law private
insurers cannot impose cost sharing for
screening colonoscopy when polyp is removed.
• Coinsurance liability persists for Medicare patients.

9. Medicare Cost Sharing for Screening Colonoscopy
• Why Current Law Requires Correction
– Cost sharing creates disincentive to screening.
• March 2012 study – During recent economic
recession, insured Americans (age 50-64) reduced
use of screening colonoscopy.
– Trends in decreased colorectal cancer
incidence, but screening rates still lag behind
the Healthy People 2020 goal of 70.5%.
• 1 in 3 Americans are not up-to-date with
recommended screening.

10. Medicare Cost Sharing for Screening Colonoscopy
• Key Messages
– Current Medicare policy is confusing to patients
and health care providers.
– Coinsurance “gap” due to unintentional
oversight in the law.

11. Medicare Cost Sharing for Screening Colonoscopy
• Key Messages
– Screening colonoscopy is the most effective
test for the prevention of colorectal cancer.
• Allows for the removal of potentially precancerous
polyps during the procedure, making it a unique
preventive service.
• Medicare pays roughly $600-$1,300 for screening
colonoscopy (with anesthesia); $300,000 annually to
treat an advanced case of colorectal cancer.

12. Medicare Cost Sharing for Screening Colonoscopy
• Cost Sharing Definitions
– Deductible: Amount beneficiary has to pay out
of pocket for expenses before Medicare will
cover the remaining costs.
– Coinsurance: Set percentage the beneficiary
must pay of the covered costs after the
deductible has been reached.

13. Medicare Cost Sharing for Screening Colonoscopy
• Colorectal Cancer Screening Coverage
and Cost Sharing History
– 1998: Medicare coverage of screening
colonoscopy for high-risk individuals.
– 2001: Medicare coverage of screening
colonoscopy for average-risk individuals.

14. Medicare Cost Sharing for Screening Colonoscopy
• Colorectal Cancer Screening Coverage
and Cost Sharing History
– 2006: Deficit Reduction Act waived Medicare
beneficiary deductible for colorectal cancer
screening.
• However, if a polyp was removed during screening
colonoscopy, beneficiary was liable for the
deductible.

15. Medicare Cost Sharing for Screening Colonoscopy
• Colorectal Cancer Screening Coverage
and Cost Sharing History
– 2010: Affordable Care Act corrected previous
law. Now deductible is always waived, even if a
polyp is removed during a screening
colonoscopy.

16. Medicare Cost Sharing for Screening Colonoscopy
• Colorectal Cancer Screening Coverage
and Cost Sharing History
– 2010: Affordable Care Act waives coinsurance
for colorectal cancer screenings.
• Colonoscopy, Sigmoidoscopy, FOBT
– But, Medicare beneficiary must still pay
coinsurance if polyp is removed during
screening colonoscopy.

17. Medicare Cost Sharing for Screening Colonoscopy
• Fight Colorectal Cancer’s Request to
Congress
– Congressional Action is Needed this Year to
Correct Coinsurance Gap
• House and Senate legislation poised for introduction in
March.
• Legislation same as 112th Congress - H.R. 4120,
“Removing Barriers to Colorectal Cancer Screening Act.”

18. Medicare Cost Sharing for Screening Colonoscopy
• Parting Words
– An effective advocate ties their personal story
with key messages and facts.
– Colorectal cancer prevention has a history of
bipartisan support.
– Despite claims, colorectal cancer screenings
are not without cost sharing for all Medicare
beneficiaries.
– Congress needs to take action this year.

19. Fight Colorectal Cancer
CONTACT US
Fight Colorectal Cancer
1414 Prince Street, Suite 204
Alexandria, VA 22314
(703) 548-1225
Toll-Free Answer Line: 1-877-427-2111
www.FightColorectalCancer.org
Email us: Info@FightColorectalCancer.org

20. Welcome!
Supporting Colorectal
Cancer Research
Part of Fight Colorectal Cancer’s Monthly Patient Webinar
Series – Part 2
www.FightColorectalCancer.org
877-427-2111

21. Fight Colorectal Cancer
1. Tonight’s speaker: Camille Bonta, MHS, Policy Expert
2. Archived webinars: Link.FightCRC.org/Webinars
3. Or call the Fight Colorectal Cancer Answer Line at 877-427-
2111
www.FightColorectalCancer.org
877-427-2111

22. Fight Colorectal Cancer
Disclaimer
The information and services provided by Fight Colorectal
Cancer are for general informational purposes only.
The information and services are not intended to be substitutes
for professional medical advice, diagnosis, or treatment.
If you are ill, or suspect that you are ill, see a doctor
immediately. In an emergency, call 911 or go to the nearest
emergency room.
Fight Colorectal Cancer never recommends or endorses any
specific physicians, products or treatments for any condition.
www.FightColorectalCancer.org
877-427-2111

23. Fight Colorectal Cancer
Camille S. Bonta, MHS
Principal of Summit Health Care Consulting
www.FightColorectalCancer.org
877-427-2111

24. Supporting Colorectal Cancer Research
Preparing to Talk with Members of Congress about Funding for
Colorectal Cancer Research
Call-on Congress
March 18-20, 2013

25. Supporting Colorectal Cancer Research
• Lawmakers can demonstrate their
commitment to colorectal cancer
research by:
– Providing increased funding for the DoD Peer
Reviewed Cancer Research Program
(PRCRP).
– Funding the National Cancer Institute (NCI).

26. Supporting Colorectal Cancer Research
• Key Messages
– Difficult budget environment lends urgency to
grassroots advocacy.
– Millions invested in cancer research to date
have led to great advances.
– Cancer incidence will nearly double by 2020.
– 5-year survival rate for colorectal cancer is now
67 percent.
– Now is not the time to pull back on federal
funding.

27. DoD Peer Reviewed Cancer Research Program
• Supports research into specific cancers,
including colorectal cancer, with relevance
to military service members.
• Program is one of several medical
research programs under the
Congressionally Directed Medical
Research Programs (CDMRP).

28. DoD Peer Reviewed Cancer Research Program
– Innovative, high-reward research.
– Supports early-career researchers and
clinicians.
– Focused on delivering breakthroughs in
prevention, detection, and treatment of cancer.
– Complements, not duplicates, research
conducted through the National Institutes of
Health (NIH).

29. DoD Peer Reviewed Cancer Research Program
• Funding History
– Fiscal Year 2009 - $16 million
– Fiscal Year 2010 - $15 million
– Fiscal Year 2011 - $16 million
– Fiscal Year 2012 - $12.8 million
– Fiscal Year 2013 - Continuing Resolution
– Fiscal Year 2014 - $16 million (Fight
Colorectal Cancer Request)

30. DoD Peer Reviewed Cancer Research Program
• Colorectal Cancer Funding History
– Colorectal cancer first included in the PRCRP
in fiscal year 2010.
– Fiscal year 2010 – 472 applications; 101 for
colorectal cancer research.
• Four colorectal cancer grants funded for total of just
under $2 million.
– Fiscal year 2011 – 845 applications; 135 for
colorectal cancer research.
• Four colorectal cancer grants funded for total of $1.3
million.

31. DoD Peer Reviewed Cancer Research Program
• Military Relevance
– Colorectal cancer is one of the most common forms of
cancer among active duty military personnel.
– Colorectal cancer screening rates low (58%) among
military personnel.
– Service members are exposed to ionizing radiation in the
field, which increases risk of colorectal cancer.
– PRCRP-supported research into non-invasive genetic
urine test for colorectal cancer.
– PRCRP-supported research on genes associated with
ionizing radiation sensitivity and resistance.

32. National Cancer Institute
• National Cancer Institute
– One of 27 Institutes and Centers at the NIH.
– Leads a national effort to eliminate the suffering
and death from cancer.

33. NIH Appropriations

34. National Cancer Institute
• Funds critical colorectal cancer research.
• Congressional support for cancer research
has contributed to the overall reduction in
cancer incidence and mortality and an
improved quality of life for survivors.
• Today’s progress in research and promising
scientific opportunities require a sustained
commitment from Congress.
– The Cancer Genome Atlas is studying 20
different cancers, including CRC, which will lead
to more targeted and personalized therapies.

35. National Cancer Institute
• NIH Funding Supports Economic Growth
– NIH spending in 2011
• Produced $62.13 billion in new economic activity.
• 432,094 new jobs.
– $3.8 billion in funding for the Human Genome
Project from 1988-2003 resulted in a return on
investment of $141 in economic output for every $1
spent.

36. National Cancer Institute
• Federal government spends through
the NIH just over $5 billion on cancer
research annually.
• Annual direct cost of cancer care is
$158 billion.

37. National Cancer Institute
• NIH Funding History
– Fiscal Year 2011 - $30.388 billion
– Fiscal Year 2012 - $30.623 billion
– Fiscal Year 2013 – Continuing Resolution
– Fiscal Year 2014 - $32.623 billion (Fight Colorectal Cancer
Request = 6.5% increase)
• NCI Funding History
– Fiscal Year 2011 - $5.058 billion
– Fiscal Year 2012 - $5.081 billion
– Fiscal Year 2013 – Continuing Resolution
– Fiscal Year 2014 - $5.349 (Fight Colorectal Cancer Request =
5.5% increase)

38. Supporting Colorectal Cancer Research
• Parting Words
– An effective advocate ties their personal story
with key messages and facts.
– Help lawmakers understand in human terms
the importance of DoD and NIH medical
research.
– We are on the brink of losing the next
generation of researchers.
– Cultivate new congressional cancer research
champions.

39. Fight Colorectal Cancer
CONTACT US
Fight Colorectal Cancer
1414 Prince Street, Suite 204
Alexandria, VA 22314
(703) 548-1225
Toll-Free Answer Line: 1-877-427-2111
www.FightColorectalCancer.org
Email us: Info@FightColorectalCancer.org

40. Welcome!
Centers for Disease Control
and Prevention
Colorectal Cancer Control
Program
Part of Fight Colorectal Cancer’s Monthly Patient
Webinar Series – Part 3
www.FightColorectalCancer.org
877-427-2111

41. Fight Colorectal Cancer
1. Tonight’s speaker: Camille Bonta, MHS, Policy Expert
2. Archived webinars: Link.FightCRC.org/Webinars
3. Or call the Fight Colorectal Cancer Answer Line at 877-427-2111
www.FightColorectalCancer.org
877-427-2111

42. Fight Colorectal Cancer
The information and services provided by Fight Colorectal Cancer are
for general informational purposes only.
The information and services are not intended to be substitutes for
professional medical advice, diagnosis, or treatment.
If you are ill, or suspect that you are ill, see a doctor immediately. In
an emergency, call 911 or go to the nearest emergency room.
Fight Colorectal Cancer never recommends or endorses any specific
physicians, products or treatments for any condition.
www.FightColorectalCancer.org
877-427-2111

43. Fight Colorectal Cancer
Camille S. Bonta, MHS
Principal of Summit Health Care Consulting
www.FightColorectalCancer.org
877-427-2111

44. Centers for Disease Control and Prevention
Colorectal Cancer Control Program
Preparing to Talk with Members of Congress about the
CDC Colorectal Cancer Control Program
Call-on Congress
March 18-20, 2013

45. Colorectal Cancer Control Program

46. Colorectal Cancer Control Program
• CRCCP Track Record Since 2009
– Screened 20,000+ Individuals
– Identified 50 Cancers
– Prevented 2,917 Potential Cancers by Polyp
Removal

47. Colorectal Cancer Control Program
• Key Messages
– Colorectal cancer screening saves lives.
– Colorectal cancer screening saves costs.
– The CRCCP should be a national program, not
just a program limited to 25 states and 4 tribal
organizations.
– Fund the CRCCP at $70 million in fiscal year
2014.

48. Colorectal Cancer Control Program
• Recent Federal Funding History
– Fiscal Year 2010 - $44.53 million
– Fiscal Year 2011 - $43.07 million
– Fiscal Year 2012 - $43 million
– Fiscal Year 2013 – Continuing Resolution

49. Colorectal Cancer Control Program
• Colorectal Cancer Screening Goals
– Healthy People 2020 – 70.5% national
screening rate (adults age 50-75), which would
represent 1,000 additional deaths prevented
each year.
– CRCCP – 80% in CRCCP funded states by
2014.
– CRC screening rates increased 13% among
adults from 2002 to 2010.
– Just under 60% the U.S. population (age 50+)
is up-to-date with screening. 1 in 3 adults are
not being screened.

50. Colorectal Cancer Control Program
• Colorectal Cancer Incidence and
Mortality is Decreasing
– Incidence declining since 2000 – 3.2% per year
in men and by 2.8% per year in women.
– Acceleration in the decline has been largely
attributed to detection and removal of
precancerous polyps.
– Mortality also decreasing – 3.1% per year in
both men and women.

51. Colorectal Cancer Control Program
• More Americans have access to colorectal
cancer screenings without cost sharing.
• Awareness remains low about why
colorectal cancer screening at
recommended intervals is important.
• CDC Program dedicates a majority of
funds to education and outreach strategies.

52. Colorectal Cancer Control Program
• Fight Colorectal Cancer’s Request to
Congress
– Fund the CRCCP at $70 million for fiscal year
2014.
• $27 million increase over fiscal year 2012.
• Allows for nationwide implementation.

53. Colorectal Cancer Control Program
• Funding Challenges
– Difficult federal budget environment.
• Unresolved fiscal year 2013 spending bill.
• Sequestration.
– $350+ million less for CDC this year if sequestration
occurs.
• Budget Control Act discretionary spending caps.
– $1 trillion cut in discretionary spending 2012-2021.

54. Colorectal Cancer Control Program
• Parting Words
– An effective advocate ties their personal story
with key messages and facts.
– Don’t be apologetic for asking your lawmaker to
fund the CRCCP at $70 million.
– In this fiscal environment, if you ask for it, you
have a better chance of getting it. If you don’t
ask for it, you won’t. Or, worse, you may get
less than what you have now.

55. Fight Colorectal Cancer
CONTACT US
Fight Colorectal Cancer
1414 Prince Street, Suite 204
Alexandria, VA 22314
(703) 548-1225
Toll-Free Answer Line: 1-877-427-2111
www.FightColorectalCancer.org
Email us: Info@FightColorectalCancer.org

56. If you are unable to attend Call-on
Thank You!
Congress this year, you can still
participate in our advocacy efforts.
Join us on March 20th for our
Congressional Call-in by calling 1-866-
615-3375. You will be connected with
your congressional members – take the
opportunity to explain what it is we need
Congress to do.