Frequently Asked Questions: For GI Physicians
Patients / Primary Care Providers / GI Physicians / Payors
Why should GI physicians be interested in partnering with CHC America? Like it or not, Virtual Colonoscopy/CT Colonography (CTC) is coming
and will eventually replace Traditional/Optical Colonoscopy (OP) as the
initial colorectal cancer screening modality of choice. Studies featuring
the most advanced techniques and standardization show that CTC is equivalent
to OP in detecting clinically significant polyps. And that's not all.
Advantages in convenience, non-invasiveness, safety, and cost will
all contribute to an overall preference for CTC by both patients and
third-party payors.
A disaster for the specialty of GI?... Perhaps yes... if GIs refuse
to change. But the emergence of CTC does not have to be a disaster if
GI physicians embrace it rather that shun it. In fact, GI physicians
are actually in a better position for offering CTC as part of a comprehensive
patient screening regimen that radiologists or other specialists who
might provide stand-alone CTC.
Here's why: For several reasons, CTC is not an ideal stand-alone test,
because it has no capability for polyp removal. If used as a stand-alone
procedure--as most radiologists who adopt it will likely do--there will
be no option for immediate polyp removal, and patients will be forced
to face further inconvenience and--worse--the prospect of a second prep.
See What are the major limitations of CTC? and What is so innovative
about the Colon Health Centers of America CRC screening process?
GI physicians on the other hand, because of their connection to endoscopic
services and typical ownership interest in endoscopy centers, are actually
in a stronger position to provide a comprehensive range of patient-satisfying,
cost-effective colorectal cancer screening services than radiologists
or any other provider of CTC. For CHC America, GI physicians are a critical
component to our screening model.
CHC America is dedicated to helping GI physicians survive and thrive
in the new era of CTC. Please contact us to find out how a partnership
with CHC America can help your practice thrive while you provide the
most comprehensive, convenient, and patient-satisfying methodology for
colorectal cancer.
[top of this page] What is Virtual Colonoscopy/CT Colonography (CTC)? CTC is a revolutionary and technologically-advanced new screening test
for CRC. CTC is an imaging test that is performed by an advanced CT scanner.
Images of the patient's abdomen are taken by the CT scanner. With special
software, these images are put together to create a three-dimensional
image of the colon. This 3-D image of the colon provides the same view
of the inside of the colon that is seen by traditional colonoscopy. In
fact, the views provided by CTC, in many ways, are even better than those
seen by traditional colonoscopy.
[top of this page] Why is CT Colonography (CTC) such a breakthrough screening test? CTC is a non-invasive test. It does not require the insertion of an
endoscope throughout the colon. It is quick--completed in about 10-15
minutes. Further, it does not require sedation or anesthesia. Therefore
the patient is able to immediately resume all activities, including driving
and work.
Recent studies of CTC show that it is as sensitive for detecting polyps
and cancers as traditional colonoscopy. In fact, in many ways, the images
provided by CTC are even better than those seen by traditional colonoscopy.
This is because CTC can often see polyps behind haustral folds of the
bowel easier and better than traditional colonoscopy.
Furthermore, unlike traditional colonoscopy, which only sees the inside
of the colon, a CTC also provides images of the rest of the abdomen.
While CTC images are not a substitute for a complete abdominal CT scan,
if one is indicated, these CTC images often detect early cancers and
other abnormalities in abdominal organs. Many people have been cured
of asymptomatic abdominal cancers because they were detected early by
CTC.
With CTC, patients not only receive a very sensitive screening test
for CRC, but they also get a chance to detect any other early cancers
that might be present in the abdomen.
[top of this page] What do the research studies show for CTC? In past years, the results of the research studies on CTC have shown a wide range of sensitivity . There are several reasons for this wide range of sensitivity, including the use different scanning equipment, different reading protocols, different image processing techniques, and varied experience of radiologists.
The best studies have been shown in programs with consistent equipment types, image processing software, reading techniques, and reader training. Pickhardt, et al. performed a multi-center trial of CTC as a screening method for CRC in over 1233 asymptomatic, average risk patients. They maintained a uniformity of training, scanning, and reading techniques. The study authors used strategy using 3-D endoluminal displays as the primary reading source, with clarification and problem-solving in 2-D windows.
This technique resulted in a high sensitivity and specificity (93.9%, 92.2%) for CTC similar to than traditional colonoscopy. Sensitivities and specificities of CTC have continued in the research done by two of the large CTC clinical programs across the country, at the University of Wisconsin, Madison, and the Bethesda National Naval Medical Center.
The National CT Colonography Trial (ACRIN 6664) is another large, multi-center trial of the efficacy of CTC for CRC screening. The results of this study were released in Fall 2007, and validated the findings of Pickhardt, et.al. that CTC was a sensitive and accurate screening test for colorectal cancer. See ACRIN results.
[top of this page] Do payors currently reimburse for CTC? Generally not yet. But commercial reimbursement is only months away. The American Cancer Society is expected to release updated colon cancer screening guidelines in early 2008, which will endorse CTC. This ACS endorsement will open the door for commercial payor reimbursement for CTC.
Further, a bill was recently introduced into Congress that would provide reimbursement for Medicare beneficiaries.
Because of some of the early variability in CTC studies, CTC is still officially considered "investigational" by the AMA, CMS, and the major cancer screening guidelines.
Ironically, tests that are clearly inferior to CTC, such as FOBT, Flex Sig, and DCBE are currently "acceptable" and reimbursed modalities of CRC screening. These tests have a significantly lower sensitivity and specificity for CRC screening compared with CTC.
A small number of commercial payors do currently reimburse for CTC in the state of Wisconsin. The AMA is currently reviewing the possibility of creating a full CPT code for CTC. Commercial payors and Medicare will likely see the benefits of CTC with respect to cost and patient acceptability and will begin to reimburse for it as a screening test.
[top of this page] What are the major limitations of CTC? While CTC is a powerful new technology, and a test that most patients
prefer over traditional colonoscopy, there are a few limitations. First,
CTC has no polyp removal capability. If polyps are detected (approximately
20-30% of average risk patients), a traditional colonoscopy needs to
be performed to remove them.
Second, patients who undergo CTC will need to perform a 12 hour, pre-test
colon preparation, exactly like patients who undergo traditional colonoscopy.
The innovative process employed by Colon Health Centers of America greatly
reduces the impact of these two limitations. The CHC America process
allows patients to fully benefit from all the many advantages of CTC,
while greatly reducing the impact of the two limitations. (See What
is so innovative about the Colon Health Centers of America CRC screening
process?)
[top of this page] What is so innovative about the Colon Health Centers of America? The CHC America CRC screening process represents the ultimate in patient
convenience, comprehensiveness, and safety. The patent-pending CHC America
process brings together the best aspects of CTC and traditional colonoscopy,
and minimizes the limitations of both, in a way that cannot be replicated
elsewhere.
The majority of average risk patients (70-80%) who present for screening
will not be found to have colon polyps or other abnormalities that
would need to be removed. It is unfortunate that these patients have
to undergo the additional risk and inconvenience of a traditional colonoscopy,
only to find a "clean" colon. On the other hand, 20-30% of
patients will have polyps and early cancers detected on CTC that will
need to be removed. It is unfortunate that these patients need to undergo
a colon prep for the CTC, and later will be notified that they will
have to schedule an appointment for a traditional colonoscopy to remove
the abnormalities, and undergo a second colon prep all over
again! These patients have every right to be angry!
The CHC America process streamlines and eliminates these problems
by creating a "Colon Health Center"--a CTC imaging center
together with traditional colonoscopy endoscopy center.
Patients arrive at the Colon Health Center after an overnight colon
prep. They receive their CTC, which takes approximately 10-15 minutes.
The CTC images will be immediately sent to the CHC America reading site,
staffed by the most expert CTC readers in the country. Within one hour's
time, the patient's CTC reading will return and the patient will be notified
whether or not they have any abnormalities. If they are one of the lucky
70-80% of average risk individuals, they are done and can immediately
resume all activities.
If they are among the 20-30% of individuals with polyps or other abnormalities,
they will be immediately directed to the co-located endoscopy center
where they will undergo a traditional colonoscopy and remove the abnormalities.
No need for a second prep! No second day off work! Pure convenience
designed around the needs of patients.
[top of this page] Why choose Colon Health Centers of America over stand-alone radiology/imaging centers? CTC is a test that is also offered at stand-alone radiology and imaging centers. But the vast majority of these centers will have no capability to follow-up with a traditional colonoscopy. Therefore, many patients will be forced to take a second day off work and undergo a second colon prep! Who would want to take that risk?
Furthermore, the CTCs done at stand-alone radiology/imaging centers will likely be read by the local staff radiologist. While they may be fine radiologists, they will typically be generalists who read chest x-rays, MRIs, mammograms, ultrasounds, etc. along with CTCs. The radiologists who read CHC America studies are national experts in CTC. In many cases, CTC is all they read--all day, every day. Studies have clearly shown that experience dramatically improves one's ability to read CTCs. With CHC America, you will only have the best CTC readers in America reading your study.
[top of this page] Is there radiation involved in CTC? Yes, there is radiation exposure with any x-ray or CT scan. Fortunately,
with advances in CT technology the radiation exposure from is minimal
and is similar to the environmental radiation exposure that one encounters
by being outdoors for a period of time. Equipment used at CHC America
centers is the latest technology and therefore performs CTC with the
smallest possible radiation exposure.
[top of this page] Where else can your patients receive a similar comprehensive, same-day process? The short answer is "no". CHC America has a patent pending
with the US Patent and Trademark Office on their innovative and comprehensive,
same-day screening methodology in the community. Furthermore, CHC America
has a passion for improving patient satisfaction with its CRC screening
process. After all, satisfied patients are more likely to get screened
and therefore prevent colon continues to improve and perfect this patient-centered
approach to CRC screening.
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