- Medicare has finalized its decision to cover yearly CT scans for older adults at risk for lung cancer, making the integration of population health management into the routine workflow just that much more enticing for physicians. Heavy smokers and recent quitters aged 55 to 77 will be eligible for a cost-free screening – if their providers have the data reporting capabilities to send information to approved patient registries.
“Medicare got this right. Screening coverage will help save thousands of seniors each year from the nation’s leading cancer killer. Screening programs can also help lower smoking rates. The process may even lead to better understanding of addiction as well as lung cancer in those who have never smoked,” said Laurie Fenton Ambrose, president and chief executive officer of the Lung Cancer Alliance (LCA), in a press release.
“This is a great day for those at high-risk for lung cancer and their families. Now, we can save tens of thousands of people each year from this terrible disease that now kills more women in wealthy countries than breast cancer,” added Douglas E. Wood, MD, past president of The Society of Thoracic Surgeons.
CMS announced its intentions to reimburse for the annual scans last November, contravening recommendations from the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), which suggested that the benefits would not outweigh the potential for harm. The healthcare community largely disagreed with MEDCAC’s decision, noting that increased screenings could double the number of cancer cases caught early enough for effective treatment despite adding close to $9 billion in costs to the Medicare system over the next half a decade.
“Without national Medicare coverage for CT lung cancer screening, seniors face a two-tier coverage system in which those with private insurance will be covered for these exams and many of their lives saved, while Medicare beneficiaries are left with lesser access to these exams and placed at increased risk of dying from lung cancer,” Ella Kazerooni, MD, chair of the American College of Radiology Lung Cancer Screening Committee said at the time.
Radiologists taking the image and reading the exam must be able to meet data reporting requirements in order to receive reimbursement for the service. Providers must be able to transmit a minimum data set to patient registries with elements including patient and provider identifiers, smoking history and status, screening date and equipment information, and indications and results from the exam.
“All CMS-approved registries must have the capacity and capability to collect data from any Medicare-eligible imaging facility/department that furnishes lung cancer screening with LDCT, with a catchment area that includes all 50 States, United States Territories, and the District of Columbia,” the announcement states. To qualify as an approved patient registry, entities must have a steering committee, registry management plan, a working description of data management and quality assurance methods, and a way to submit information on participating facilities to CMS. “CMS will evaluate each entity interested in participating as a CMS-approved registry to determine if they are capable of meeting the registry and data collection requirements.”