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Healthcare Business News

Reimbursement guaranteed after task force backs CT scans for older smokers

By Modern Healthcare
Posted: December 30, 2013 - 6:45 pm ET

The U.S. Preventive Services Task Force (USPSTF) today gave a final “B” grade to its earlier recommendation that current or heavy smokers between 55 and 80 receive annual CT scans to detect lung cancer. Preventive services given an “A” or “B” rating by USPSTF must be reimbursed by insurers at no cost to patients under the Affordable Care Act.

The American Lung Association was quick to endorse the decision, saying in a statement that, “We hope that over time, this screening will have a similar, positive impact by increasing lung cancer early detection, treatment and survival rates as have other USPSTF screening recommendations.”

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The recommendation remains controversial. The panel's draft report in July noted that 96% of CT lung cancer tests that initially tested positive were false positives. The 96% false-positive rate means the vast majority of cases would lead to further tests, exposing the patients to more radiation and possibly more invasive and costly procedures that carry higher risks of complications.

In announcing the final recommendation, task force officials advised some caution in the use of CT scans for screening.

“The benefit of screening may be significantly less in people with serious medical problems and there is no benefit in screening someone for whom treatment is not an option. In these people, screening may lead to unintended harms such as unnecessary tests and invasive procedures,” noted Task Force Chair Virginia Moyer in a statement.

Said Task Force Co-vice Chair Michael LeFevre, “When clinicians are determining who would most benefit from screening, they need to look at a person's age, overall health, how much the person has smoked, and whether the person is still smoking or how many years it has been since the person quit.”

Nearly 90 million Americans are smokers or former smokers. About 7 million of these are in the target age group and have smoked at least a pack a day for 30 years. If these 7 million each received a CT scan annually for lung cancer, at an average cost of $300 to $500 a scan, the result would be from $2.1 billion to $3.5 billion in additional healthcare costs.

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