Innovative payment reform needed to combat high out-of-pocket costs after lung cancer screenings
High out-of-pocket costs after positive or abnormal lung cancer screenings may signal the need for payment reform as more qualify for the exam, imaging experts charged Thursday.
The U.S. Preventive Services Task Force recently revised its recommendations for such low-dose CT, opening eligibility to millions more Americans. High-profile investigations have proven LDCT’s powerful effect, but hefty expenses for biopsies and other tests could present barriers to realizing their full benefit.
About 7.4% of commercially insured patients receive at least one invasive procedure after their screening, with patients’ responsibility ranging from $0 to $7,500, or an average per-episode cost of $424. Radiology researchers believe these numbers underline the need to reform how lung cancer care is covered to eliminate disparities among patient populations.
“Even a small [out-of-pocket] cost can induce burden among the financially fragile, such as those living at or below the federal poverty level, necessitating trade-offs between paying their cost share and other household or health expenses,” Tina Tailor, MD, with Duke University Medical Center’s Department of Radiology, and colleagues wrote Sept. 30 in the Journal of the American College of Radiology. “Innovative insurance design needs to align insurance premiums or an OOP bundle covering the entire [lung cancer screening] episode to decrease the financial burden across the population of LCS-eligible individuals.”
For their study, Tailor et al. tapped Optum’s Clinformatics Data Mart, analyzing info for patients ages 55-79 screened between 2015 and 2017. Nearly 6,300 patients received LDCT during the study period while more than 460 had a follow-up procedure within the following year (about 7%). Those included a needle biopsy (69%), surgery (24%), cytology (24%) and bronchoscopy (19%). Seniors over age 65 and women were more likely to receive one of these procedures, and roughly 20% of patients were diagnosed with the disease after LCS. Tailor and colleagues calculated an overall cost of managing this population at more than $5 million or $740 per episode. Meanwhile, out-of-pocket costs totaled about $427,000 or about $62.50 per episode.
The investigation found higher rates of downstream procedures when compared to the National Lung Screening Trial. Several factors may have caused this difference, with the high-profile study including a younger, less racially diverse and more well-educated population. Tailor and co-authors believe further work is needed to ensure that downstream services do not worsen inequalities in care.
“Given the existing disparities in lung cancer incidence and outcomes that cause disproportionate burden to vulnerable populations, failure to comprehensively address costs associated with LCS may disincentivize or discourage screening or necessary follow-up testing for certain populations,” the authors advised. “This may inadvertently widen existing lung cancer disparities. Future work is necessary to empirically test interventions that promote cost transparency related to LCS and subsequent recommended care.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.