Bridging the Colorectal Cancer Screening Gap

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Bridging the Colorectal Cancer Screening Gap

ASCs and legislation impact access

BY DAVID OPONG-WADEE | MARCH 21, 2025

March marks Colorectal Cancer (CRC) Awareness Month. CRC remains the second leading cause of cancer-related deaths in the US, but many of these deaths are preventable. While colonoscopies stand as the gold standard for prevention, these life-saving procedures are far from equitably available.

Beyond the crucial role of colonoscopies themselves, the strategic use of pre-colonoscopy screening tools is vital for optimizing healthcare resources. Using stool-based tests like the fecal immunochemical test (FIT) or other preliminary screenings helps providers prioritize colonoscopies for individuals at higher risk of CRC, ensuring that those with positive preliminary tests receive timely access to this critical diagnostic and preventative procedure. Streamlining the screening process can help increase the availability of colonoscopies for high-risk individuals, ultimately saving lives and reducing burdens on our healthcare system.

The Role of ASCs in Fighting CRC

ASCs play an important role in the fight against CRC, primarily through their facilitation of crucial, lower-cost screening procedures, especially colonoscopies. Amsurg ASCs performed more than a million colonoscopies in 2022 alone.

ASCs’ flexible scheduling and shorter wait times compared to other healthcare settings increase accessibility, which is vital for encouraging regular screenings, an essential part of early CRC detection and prevention. In addition to this flexibility, colonoscopies performed in ASCs also allow for the detection and removal of precancerous polyps, effectively preventing the development of CRC.

ASCA’s Engagement at the Federal Level

ASCA supports federal legislation that expands access to preventative healthcare, particularly for underserved and rural communities. This commitment is exemplified by ASCA’s support of the late Representative Donald Payne’s landmark Removing Barriers to Colorectal Cancer Screening Act of 2020, which eliminated copays for polyp removal during colonoscopies and was enacted as part of the year-end funding and COVID-19 relief legislation in 2020.

While the Removing Barriers to Colorectal Cancer Screening Act was a significant victory, especially for reducing financial barriers in underserved populations, ASCA continues to advocate for the immediate implementation of full coverage, as the original legislation includes a phase-in period delaying complete access until 2030. To that end, ASCA endorsed the Colorectal Cancer Payment Fairness Act in the 118th Congress, a bill that proposed to accelerate full coverage for Medicare beneficiaries by 2023.

MCED as a Screening Tool

Multi-cancer early detection (MCED) blood tests detect signals of multiple cancers, including CRC, and offer a promising avenue for early detection. For underserved and rural populations that often face limited access to healthcare facilities and specialists, MCEDs can act as a more accessible initial screening tool.

However, the promise of MCED tests is tempered by the reality of unequal access. Out-of-pocket costs for uninsured individuals create a significant deterrent. Data from the Kaiser Family Foundation reveals that in 2022, uninsured rates for adults between the ages of 19 and 64 were highest among Hispanic individuals at 18 percent, followed by Black individuals at 11 percent, with White individuals at just 7 percent. These disparities in insurance coverage directly translate to lower screening rates.

Legislation to address these disparities in the Medicare program has been reintroduced in Congress. ASCA legislative champion Representative Terri Sewell (D-AL) and House Budget Committee Chairman Jodey Arrington (R-TX) have reintroduced the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act which aims to revolutionize cancer detection by expanding Medicare coverage for FDA-approved MCED tests. This bipartisan legislation has gained significant traction. Named in honor of Representative Sewell’s late mother, Nancy Gardner Sewell, who succumbed to pancreatic cancer, this bipartisan legislation has gained significant traction.

Specifically, the legislation would

  • create the authority for the Centers for Medicare & Medicaid
  • maintain CMS' authority to use an evidence-based process to determine coverage parameters for these new tests.

These new tools would complement, not replace, existing screenings, and coverage and cost sharing would not be impacted.

ASCs perform more than 40 percent of Medicare colonoscopies. Surgery centers are uniquely positioned to handle any anticipated increase in demand for timely colonoscopies that might result from expanded MCED access. While increasing access to MCED tests is critical, this initiative also underscores the broader importance of increasing access to cancer screenings.

ASCA is watching the bipartisan Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act and looking for other legislation that could help ASCs play a greater role in curbing this and other deadly diseases. Write David Opong-Wadee at dopongwadee@ascassociation.org to learn more about federal legislation and ASCA’s congressional advocacy efforts.