CMS proposes 'drastic' cuts to LDCT lung cancer screening reimbursement
September 07, 2016
by Thomas Dworetzky, Contributing Reporter
Calling cuts to reimbursement for low-dose computed tomography (LDCT) lung cancer screening “drastic,” over 80 medical associations and advocacy groups have slammed the latest rule proposed by CMS.
The new ruling is part of the 2017 Hospital Outpatient Prospective Payment System. It calls for a 64 percent cut for decision-making sessions about smoking between doctor and patient and a 44 percent cut to coverage of LDCT scans.
The letter by the groups objecting to the reimbursement plan was led by the Lung Cancer Alliance, the Prevent Cancer Foundation, the Society of Thoracic Surgeons, the American College of Radiology, and the Medical Imaging and Technology Alliance.
"CT lung cancer screening is a game changer in the battle against lung cancer. Slashing reimbursement by up to two-thirds before screening can be implemented in most American communities may be a death knell for many existing and planned screening programs nationwide. The resulting lack of access may contribute to unnecessary lung cancer deaths. We strongly urge CMS to reconsider these cuts," James A. Brink, M.D., FACR, chair of the American College of Radiology Board of Chancellors, said in the statement.
“Without access to LDCT scans, most lung cancers are not diagnosed until it is too late. Lung cancer screening provides critical early detection that saves lives — but the best test in the world won’t be effective if patients can’t gain access to it in their communities,” said Carolyn Aldigé, president and founder of the Prevent Cancer Foundation.
Lung cancer will be found in over 220,000 people in this year alone and almost 160,000 will die from the disease. That's “more than from breast, colon and prostate cancers combined,” the letter stated.
"As we have long reinforced, LDCT lung cancer screening is a proven, valuable tool in finding the number one cancer killer at its most treatable, and even curable, stage," said Laurie Fenton Ambrose, president and CEO of Lung Cancer Alliance.
The reality is that right now screening is still rolling out nationwide, especially in smaller communities. "The impact of these proposed reimbursement cuts would limit access to this lifesaving benefit for the most at-risk, underserved members of our population who have the highest rates of lung cancer mortality," noted Ambrose.
The bottom line, argue opponents to the cuts, is that they will effectively limit screening programs to big city hospitals. People living in the suburbs or rural communities will face long trips, long wait times — and may not even be able to find screening at all.
“For CMS to undercut lung cancer screening and restrict access to these exams with massive cuts accentuates disparities in health care delivery and undermines our ability to save thousands of lives,” said Dr. Douglas E. Wood, past president of The Society of Thoracic Surgeons.
CMS announced its final decision for coverage of LDCT for lung cancer in early February 2015. As HCB News reported at the time, “CMS will now reimburse annual LDCT lung cancer screening for individuals between 55 and 77 who are current smokers or who have quit smoking within the past 15 years and have a smoking history of at least 30 pack-years. They are required to get a written order for screening during a visit with a physician or a physician assistant, nurse practitioner or clinical nurse specialist.”
At the time, Ambrose stated, "Today is a transformative moment. Lung cancer screening can now stand shoulder to shoulder with mammography, colonoscopy, pap smears and other proven cancer screenings that have saved countless lives," adding, "This signals a new day, where lung cancer transitions from the number one cancer killer to a treatable, even curable disease."
A U.K. study of screening in May showed that “if patients with a high risk of developing lung cancer are diagnosed at an early stage, then they have a 73 percent chance of surviving for five or more years.”
For the UKLS trial, researchers screened 1,994 patients with LDCT. They found that 42 had lung cancer, of which 36 were stage 1 or 2. A total of 35 of these patients had surgery as their primary treatment.
The new ruling is part of the 2017 Hospital Outpatient Prospective Payment System. It calls for a 64 percent cut for decision-making sessions about smoking between doctor and patient and a 44 percent cut to coverage of LDCT scans.
The letter by the groups objecting to the reimbursement plan was led by the Lung Cancer Alliance, the Prevent Cancer Foundation, the Society of Thoracic Surgeons, the American College of Radiology, and the Medical Imaging and Technology Alliance.
"CT lung cancer screening is a game changer in the battle against lung cancer. Slashing reimbursement by up to two-thirds before screening can be implemented in most American communities may be a death knell for many existing and planned screening programs nationwide. The resulting lack of access may contribute to unnecessary lung cancer deaths. We strongly urge CMS to reconsider these cuts," James A. Brink, M.D., FACR, chair of the American College of Radiology Board of Chancellors, said in the statement.
“Without access to LDCT scans, most lung cancers are not diagnosed until it is too late. Lung cancer screening provides critical early detection that saves lives — but the best test in the world won’t be effective if patients can’t gain access to it in their communities,” said Carolyn Aldigé, president and founder of the Prevent Cancer Foundation.
Lung cancer will be found in over 220,000 people in this year alone and almost 160,000 will die from the disease. That's “more than from breast, colon and prostate cancers combined,” the letter stated.
"As we have long reinforced, LDCT lung cancer screening is a proven, valuable tool in finding the number one cancer killer at its most treatable, and even curable, stage," said Laurie Fenton Ambrose, president and CEO of Lung Cancer Alliance.
The reality is that right now screening is still rolling out nationwide, especially in smaller communities. "The impact of these proposed reimbursement cuts would limit access to this lifesaving benefit for the most at-risk, underserved members of our population who have the highest rates of lung cancer mortality," noted Ambrose.
The bottom line, argue opponents to the cuts, is that they will effectively limit screening programs to big city hospitals. People living in the suburbs or rural communities will face long trips, long wait times — and may not even be able to find screening at all.
“For CMS to undercut lung cancer screening and restrict access to these exams with massive cuts accentuates disparities in health care delivery and undermines our ability to save thousands of lives,” said Dr. Douglas E. Wood, past president of The Society of Thoracic Surgeons.
CMS announced its final decision for coverage of LDCT for lung cancer in early February 2015. As HCB News reported at the time, “CMS will now reimburse annual LDCT lung cancer screening for individuals between 55 and 77 who are current smokers or who have quit smoking within the past 15 years and have a smoking history of at least 30 pack-years. They are required to get a written order for screening during a visit with a physician or a physician assistant, nurse practitioner or clinical nurse specialist.”
At the time, Ambrose stated, "Today is a transformative moment. Lung cancer screening can now stand shoulder to shoulder with mammography, colonoscopy, pap smears and other proven cancer screenings that have saved countless lives," adding, "This signals a new day, where lung cancer transitions from the number one cancer killer to a treatable, even curable disease."
A U.K. study of screening in May showed that “if patients with a high risk of developing lung cancer are diagnosed at an early stage, then they have a 73 percent chance of surviving for five or more years.”
For the UKLS trial, researchers screened 1,994 patients with LDCT. They found that 42 had lung cancer, of which 36 were stage 1 or 2. A total of 35 of these patients had surgery as their primary treatment.