With the U.S. Preventive Services Task Force (USPSTF) grade B recommendation in hand, proponents of responsible screening for lung cancer with low-dose CT now turn toward the critical problem of actually getting those at high risk for lung cancer tested.
In an interview with ImagingBiz, Laurie Fenton-Ambrose, president and CEO of the Lung Cancer Alliance (LCA), explained that there were three main components to this.
The first is education. While the Affordable Care Act (ACA) requires preventive services with a A or B recommendation from the USPSTF to be a covered service in all new health plans, this does little good if people who could benefit from the test are unaware of it.
“It is critically important that those at risk have education that could be life saving to them,” Fenton-Ambrose said. “This includes information about what it could mean to them and where to go to be screened responsibly.”
The LCA plans on continuing its “Live More Moments” public awareness campaign in 2014 and directing people to its online risk-assessment tool and list of providers who meet its criteria for responsible screening. It also is working with providers to get educational materials into the hands of patients at risk for lung cancer.
The second component is ensuring that the expansion of both public and private reimbursement moves as swiftly as possible. Following the lead of Wellpoint, many private payors had already begun covering the test, but a Medicare and Medicaid coverage decision from CMS could be 9 months away or more. In addition, the ACA requirement for private payor plan coverage only applies to new plans starting on Jan. 1, 2015. “Grandfathered” plans do not need to add coverage for the test, even though, as Fenton-Ambrose points out, the cost effectiveness of low-dose CT lung cancer screening is significant and has been demonstrated by published research.
“Last October, the LCA sent a formal letter to CMS asking that they initiate a national coverage decision process. That is underway. We should know by the end of this month how CMS will approach this,” Fenton-Ambrose said.
Finally, the last component is working with imaging providers and radiologists to ensure that screening programs are implemented in accordance with best practices and with the well being of patients at the center of the process. “We hope to avoid any legislative mandate on how to go about this,” Fenton-Ambrose said.
Rather, Fenton-Ambrose hopes that with strong leadership from the field of radiology, as well as other specialties involved in cancer care, quality screening programs in a community setting can give CMS and private payors confidence in covering the test without strict restrictions that could make getting access to the test more difficult for patients.
The LCA currently works with more 140 hospitals, and has 100 more in the pipeline, pursuing screening in accordance with the LCA’s guiding principles for screening centers. National guidelines from the ACR that are currently under development also will help ensure responsible expansion of testing. (Read the ACR press release.)
“The radiologists are in the leading the role, and their role will be constant throughout the screening process,” Fenton-Ambrose said. “They need to be the leading voice for how the screening of the lung cancer is implemented … We are grateful they are embracing this now.”