As medical guidelines evolve, MagnaCare aims to keep you informed and recommend the best course of care for your members.
The American Cancer Society recently released new guidelines regarding colorectal cancer screening for average-risk individuals, lowering the recommended age for screening from age 50 to age 45.
The cost implications of these recommendations are potentially significant. Under the new guidelines, your member population would receive the screening at an earlier age, and therefore get more screenings over their lifetime. Additionally, screenings are not without risk to the patient. For example, colonoscopies can tear the lining of the colon and virtual colonoscopies subject the patient to high levels of radiation.
It’s important to note that other guideline-producing organizations such as the US Multi-Society Task Force on Colorectal Cancer and the U.S. Preventive Services Task Force (USPSTF) have not changed their recommended starting age for colorectal screening, which remains at age 50. Based on these standard guidelines, MagnaCare continues to recommend colorectal screenings starting at age 50 in average-risk people, except for African-Americans in whom evidence supports screening starting at age 45.
We also recommend benefit designs that encourage performing the procedure at a participating doctor’s office or ambulatory surgical facility, not in an outpatient hospital setting which is typically much more expensive without providing any additional benefit.
MagnaCare will keep abreast of this issue as the medical organizations build consensus and make strong, clear, and consistent recommendations, and we will recommend coverage determinations based on their decisions.