A free lung cancer screening program implemented at Lahey Hospital in Burlington, Mass., aims to resolve lingering reimbursement issues with such CT procedures. The program's success is detailed in a recent issue of the Journal of the American College of Radiology.
Since most public and private payers, including the Centers for Medicare & Medicaid Services, don't cover CT lung screening--which can cost up to $1,000--the "most important and vexing decision we made during the conception of our screening program was whether to charge for screening examinations," wrote researchers, led by Brady McKee, M.D., of Lahey's department of radiology. "To fulfill what we felt was an ethical responsibility to provide equal screening access to all persons at high risk regardless of socioeconomic status and to encourage persons at high risk to present for screening, we decided to offer CT lung screening at no cost to patients until CMS and commercial insurers establish reimbursement on a broad scale."
The authors said they believe this approach is consistent with the rationale behind the Affordable Health Care Act's mandate to eliminate healthcare disparities and barriers to preventive services.
In the Lahey program, the initial screening examination is provided free of charge; any follow up exams or interventions are covered by insurance, which provides revenue to help support the screening program.
By modeling it's own situation, Lahey's radiology department determined that in the first two years of its screening program, 60 to 80 percent of the revenue available to offset its costs would come from treating lung cancer. Meanwhile, in years three through 10, revenue from interval low dose CT follow-up of small pulmonary nodules and lung cancer treatment "become equally important revenue sources," according to the authors.
"A vigorous lobbying effort is needed to expedite reimbursement to eliminate the healthcare disparities this situation creates and make CT lung screening equally available to all patients at high risk," the authors added. "Lung cancer screening with [low dose CT] is an example of the tremendous value radiologists can contribute to patient care."
Frank Detterbeck, M.D., chief of thoracic surgery at Yale University School of Medicine, told Reuters that while offering free CT screening may appear to be a public service, there is an "inherent conflict" in sustaining a loss with the objective of making "up for it with profits and procedures on things that you find." Free screening, he said, could create pressure to intervene more frequently instead of only when a practitioner is suspicious of cancer.