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Reform Update: Lobbyists push lung cancer scan coverage for smokers

Representatives of the American College of Radiology, the Medical Imaging & Technology Alliance and the Lung Cancer Alliance met on Thursday with CMS officials in Washington to try to convince the agency to cover CT scans for Medicare beneficiaries who have been heavy smokers.

The gathering was not the first effort to persuade agency officials that paying for the scans is the correct course of action. During the American College of Radiology's annual meeting in Washington at the end of April, more than 500 members of the group visited congressional offices to make their case.

“This is a door-to-door, office-to-office kind of effort,” said Dr. Bibb Allen, a Birmingham, Ala.-based radiologist and chair of the American College of Radiology's board of chancellors.

The stakes are significant. According to a study conducted by Joshua Roth of the Seattle-based Fred Hutchinson Cancer Research Center, the scans would result in 55,000 additional lung cancer diagnoses over a five-year period. But the cost would also be substantial: $9.3 billion over five years, with $5.6 billion of that total spent on screening expenditures.

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“We're coming at this from a lot of different directions,” said Gail Rodriguez, executive director of the Medical Imaging & Technology Alliance, which represents more than 50 companies in the field. “We've been working together for months to make sure that our evidentiary package is solid and bulletproof.”

Last December, the U.S. Preventive Services Task Force recommended a Grade B rating for offering such annual screening to current or past heavy smokers ages 55 to 80. That decision was based in large part on a study that found that the screenings reduced lung cancer fatalities by 14%. Under the Patient Protection and Affordable Care Act, that recommendation means that private insurers are required to cover the screening on a first-dollar basis for their members. The test typically costs $300 to $400.

“It will save lives,” Bibb said. “This is something that really can prevent people from dying from lung cancer.”

But in April, the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) recommended against covering the annual screenings, citing insufficient research evidence to justify the expenditure. The CMS typically shows strong deference to the recommendations of MEDCAC's panel of experts (PDF). That raises the specter that individuals with private insurance would have such screenings covered, but Medicare beneficiaries would not.

The CMS is expected to release a proposed decision on the issue in November, followed by a final determination in February.

The organizations working to convince the CMS to cover the screenings bring significant lobbying muscle to the task. In the first quarter of this year, the American College of Radiology spent roughly $1 million on lobbying, according to a Senate database. Last year its total lobbying expenditures topped $4 million.

Many organizational members of the Medical Imaging & Technology Alliance also devote significant resources to lobbying. For example, Siemens spent $1.5 million on lobbying in the first quarter of 2014. Last year the multinational firm devoted $5.6 million to influencing policy decisions in Washington.

“We don't tell them how to lobby,” Rodriguez said of alliance members. “My sense is that they're out there talking about it too.”

Those efforts have already paid dividends. Last month, a bipartisan group of 44 senators sent a letter to CMS administrator Marilyn Tavenner urging the agency to cover the scans for Medicare beneficiaries. That plea was followed a week later by a similar bipartisan appeal signed by 134 House members.

Thomas Scully, who served as the CMS administrator under President George W. Bush and is now senior counsel with the law and lobbying firm Alston & Bird, said that's an unusually large group of legislators weighing in on a Medicare payment issue.

“If you get a letter from 10 members of Congress you certainly take it seriously,” Scully said. “If you don't take a long look at it, the members will be angry.”

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