“My expectation is that with this recommendation, as well as a couple of others that have come out over the past few months, that it's likely we will see an increase in people who do get screened,” said task force Co-vice Chair Dr. Michael LeFevre. “What we hope to do for physicians is to lay out what they can expect from screening their patients and lay out for them specifically the criteria for high risk where we think the benefits outweigh the harms.”
Other factors aside, LeFevre said those who fall within the task force's criteria include people between 55 and 80 who have smoked at least a pack of cigarettes daily for 30 years. They would be included if they currently smoke or quit within the last 15 years.
The task force's recommendation is largely based on findings from the National Lung Screening Trial, which assessed more than 53,000 high-risk patients over a period of three years.
“We feel very strongly that low-dose CT screening of the high-risk population is one of the greatest advances that we've made for our patients with lung cancer or at risk for lung cancer in decades,” said Dr. Andrea McKee, chair of radiation oncology at Lahey Hospital and Medical Center in Burlington, Mass., and director of its free lung cancer screening program. “The opportunity to at least bring about a 20% mortality benefit for the high-risk population is really an amazing development.”
According to McKee, the recommendation by the task force may help address the challenges she and other physicians have faced in recent years in trying to screen as many of the roughly 9 million high-risk patients as possible without receiving reimbursement for their services by most insurers or through Medicare and Medicaid.
“Now what you have is physicians and centers wanting to screen these patients but they understand that the self-pay rate of $300, $200 or $100 is just a prohibitive barrier,” said McKee, whose screening program saw just four patients between spring of 2011 and January of 2012 when they were charging a $300 fee. “In January of 2012, we opened access by allowing high-risk patients to be screened at no cost and we've screened over 1,300 patients since that time.”
Under the guidelines of the Patient Protection and Affordable Care Act regarding preventive care, the task force's recommendation for low-dose CT scans would, if made final, require insurers and the CMS to cover their expense, with no deductible or other cost-sharing imposed on patients.
But as America's Health Insurance Plans spokeswoman Susan Pisano pointed out, the recommendation is still only a draft. Most health insurers have not covered these types of procedures because they were following the task force's existing recommendations.
“I don't think most health plans cover this service because it currently has an 'I' recommendation, which is for insufficient evidence,” Pisano said. “So I don't think currently there are a lot of plans that do cover it.”
Pisano said AHIP plans to provide comment about the recommendation within the next 30 days, the period the task force has allotted for feedback. After such time, the panel is expected to make a final determination in the next three to six months, according to LeFevre.
Follow Steven Ross Johnson on Twitter: @MHSjohnson
