Have we reached a tipping point for lung cancer screening reimbursement?

Another group has weighed on the issue of lung cancer screening, as the American Academy of Chest Physicians (AACP) last week issued guidelines recommending that people with a significant risk of developing lung cancer undergo annual low dose CT scans. It's the latest group to issue screening guidelines based on the results of the National Lung Screening Trial (NLST).

While more and more organizations have issued screening guidelines, reimbursement issues remain at play here. Most private insurers and--more importantly--the Centers for Medicare & Medicaid Services, don't cover this type of screening.

Lahey Hospital, as described in this issue of FierceMedicalImaging, offers free, low-dose CT lung cancer screening for individuals at high risk of developing the disease. That includes people who are between the ages of 55 and 74, are currently smokers or who have quit in the past 15 years, and those who have smoked at least a pack of cigarettes a day for 30 or more years. The program also includes people as young as 50 and up to the age of 74 if they smoked at least one pack of cigarettes per day for 20 or more years and have an additional lung cancer risk factor.

Radiologists at Lahey determined that costs of the program could be offset by revenue from follow-up exams and interventions that are eligible for reimbursement.

Lahey's approach is the right thing to do. Earlier this year, researchers from the American Cancer Society published a study in which they estimated that if all current and former smokers who fall within the guideline recommendations were screened, it could prevent as many as 12,000 deaths a year from lung cancer.

Considering the benefits of screening, the radiologists at Leahy said they felt that offering free tests fulfills "an ethical responsibility to provide equal screening access to all persons at high risk, regardless of socioeconomic status."

This begs the question: Why aren't such scans covered by payers in the first place? The AACP is the seventh national organization to endorse offering CT lung cancer screening to individuals at a high risk for lung cancer. Following their recommendation, the Lung Cancer Alliance also called on CMS for coverage.

Medical professionals are doing their part to provide this screening, Laurie Fenton Ambrose, president and CEO of the Lung Cancer Alliance, said in a statement. "The federal government must now do the same. It is unconscionable that it has not acted with greater expediency given the strength of the scientific evidence and the magnitude of lung cancer's impact."

I agree, and hope that the AACP's guidelines serve as a tipping point in efforts to boost coverage. - Mike  @FierceHealthIT


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