Radiologists and surgeons want CMS to eliminate ‘misguided’ payment barriers to lung cancer screening
Radiologists and thoracic surgeons are urging the federal government to think big while contemplating whether to expand payment for lung cancer screening.
The Centers for Medicare & Medicaid Services recently launched a National Coverage Analysis to decide if it should widen the net cast for these low-dose CT exams. Its move was in response to revised guidance from the U.S. Preventative Services Task Force. The volunteer group in March recommended dropping the eligible age from 55 down to 50 for such screening, among other changes, expanding the eligible population by more than 14 million.
However, the American College of Radiology, Society of Thoracic Surgeons, and GO2 Foundation for Lung Cancer want CMS to go further. In recent comments submitted to the agency, physicians asked the feds to eliminate a 15-year smoking cessation quit date to be eligible for low-dose CT.
“The joint societies strongly disagree with the CMS and USPSTF criteria that continues to limit screening to current smokers or those who have quit smoking within 15 years,” the groups wrote June 14. “First, there is no substantive data that supports a 15-year quit date resulting in a significant diminution in lung cancer risk that would warrant cessation of lung cancer screening. Second, our joint societies call attention to the potential harms of continued smoking that could result from the 15-year quit smoking screening requirement and argue that this is misguided,” they added later.
ACR et al. additionally expressed “substantial concerns” that counseling and shared decision-making criteria suggested by the feds could pose a “major barrier” to lung cancer screening. They want CMS to eliminate that provision, too, along with quashing any upper-age limit for exams, believing such cutoffs should be made on a case-by-case basis. And finally, they’re asking the agency to formally instruct all Medicare Administrative Contractors to cover low-dose CT in all healthcare settings, including independent diagnostic testing facilities.
“Our joint societies strongly urge CMS to provide explicit instruction to MACs that LDCT at IDTFs be fully reimbursed with no additional delay and/or denial,” the groups wrote, noting that previous coverage determinations lacked clarity on this front.
The Centers for Medicare & Medicaid Services first launched its coverage review in May and was accepting comments through Thursday, June 17. Officials said they hope to reach a decision by November and complete the process by February 2022. Insurance giant Aetna also recently revised its coverage parameters for LDCT in response to the new task force guidance.
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.