Site-by-site lung cancer screening coverage: An optimal approach for CMS?

Back in April, many observers were stunned when the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) gave a no-confidence vote to the idea of Medicare coverage for low dose CT lung cancer screening for persons at risk for lung cancer.

MEDCAC's decision was particularly surprising considering that the United States Preventive Services Task Force (USPSTF) last year gave low dose CT lung cancer screening its recommendation, which means that starting in 2015 private insurers will have to cover CT lung cancer screening consistent with the USPSTF guidelines.

In a recent opinion article published in the Annals of Internal Medicine, however, a Boston-based radiologist offers an intriguing compromise.

Renda Wiener, M.D., of the Boston University School of Medicine, echoed Aberle, suggests that the Centers for Medicare & Medicaid Services cover LDCT screening "only when it is done in facilities that are certified as comprehensive, patient-centered programs designed to maximize benefits and minimize harms."

In other words, on a site-by-site basis.

Generally, CMS tends to follow MEDCAC's lead when deciding on a Medicare coverage determination, but things could be different this time. For example, we are already seeing a lot of political pressure being applied in favor of lung cancer screening coverage. Two letters have already been sent to the Centers for Medicare and Medicaid Services--one signed by 45 U.S. senators and the other by 134 members of the House of Representatives.

The legislators pointed out that with the USPSTF recommendation, patients with private insurance will get access to screening that will be unavailable to Medicare beneficiaries. And that's a problem, the representatives wrote, considering that "Americans pay into Medicare throughout their working lives and deserve to have access to potentially life-saving screening."

However, Denise Aberle--national principal investigator of the radiology component of the National Lung Screening Trial--recently said in an interview with AuntMinnie.com that like some of the MEDCAC panelists, she has concerns about "quality control." For instance, she said, she wouldn't want to see "a screening center set up for entrepreneurial intent outside my Nordstrom in a shopping center."

Instead, if lung cancer screening is to be expanded to populations like those covered by Medicare, it should be done responsibly, she said, with a commitment toward providing systematic, evidence-based programs that maximize the benefits and minimize the harms that many of the MEDCAC panelists are so concerned about.

Those comments echo Wiener's more recent suggestion, which could create an interesting coverage dynamic.

From the point of view of lung screening advocates, and considering the alternative--the possibility that CMS could end up completely denying coverage of lung cancer screening altogether--the approach laid out by Wiener may be the one that is most optimal.

At least for now. - Mike (@FierceHealthIT)

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