New lung cancer screenings could cause spike in hospital spending

While reimbursement is still being determined, it’s estimated that lung cancer scans for eligible individuals could cost Medicare more than $9 billion for the scans, biopsies and treatments through 2020.

New Medicare coverage for lung cancer screenings in high-risk beneficiaries could set off a frenzy of spending and invasive testing if abused. On the other hand, health systems can take the opportunity to save lives and avoid harm with effective planning.

Following the U.S. Preventive Services Task Force, Medicare has issued a new policy covering CT scan lung cancer screenings for non-symptomatic patients ages 55 to 77 years old who are current smokers or quit within 15 years and had an average pack-a-day habit for 30 years. Beneficiaries must also have a written order from a physician or other practitioner, and if they’re still smoking, receive cessation counseling. The screening could give 5 million seniors a chance to add years to their lives.

“We believe this final decision strikes an appropriate balance between providing access to this important preventive service and ensuring, to the best extent possible, that Medicare beneficiaries receive maximum benefit from a lung cancer screening program,” said Patrick Conway, MD, Centers for Medicare & Medicaid Services chief medical officer and deputy administrator.

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The decision was based in large part on the findings of the National Lung Screening Trial of 52,000 high-risk smokers. The trial concluded that current and former heavy smokers ages 55 to 74 had a nearly 20 percent lower risk of dying from lung cancer when screened with low-dose radiation CT scans — about three fewer deaths per 1,000 people.

By raising the lung nodule thresholds, the incidence of false positives is reduced, which will help avoid unnecessary biopsies, and cancers that are caught early can add high quality years to life, said Albert Rizzo, MD, chief of pulmonary and critical care at Christiana Care Health System in Wilmington, Delaware.

“I’ve had patients who were seen for some other reason and got a chest CT scan. Stage 1 cancers were found and in some of those cases patients with resected Stage 1 cancers have up to 80 percent 5 year survivals and many are cured of the cancer,” said Rizzo. With more accurate, lower-intensity CT technology, “radiation risk can be mitigated and it can be a risk worth taking if you’re going to find lung cancer early.”

The great challenge, said Rizzo, will be for health systems to set up comprehensive lung cancer screening programs with robust protocols to flag patients not likely to benefit because of limited life expectancy, such as individuals suffering from advanced cardiovascular disease or kidney failure.

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Christiana Care Health System is setting up a screening program and is also participating in a statewide screening program for the uninsured. At Christiana, a nurse navigator will check records of patients referred to the program, and multi-disciplinary teams communicate with patients and review scans and the course of care.

While reimbursement is still being determined, it’s estimated that screening for eligible individuals could cost Medicare more than $9 billion for the scans, biopsies and treatments through 2020. There are concerns that some of that spending will be paying for low-value healthcare — screening patients who show a mass that upon biopsy turns out to be benign, or patients who need a biopsy and then suffer a collapsed lung or other complication. Of the lung masses detected in the study, 24 percent were determined to be non-cancerous false positives.

“We’re trying to be very diligent of shared decision making,” Rizzo said. “Stick with the regulations and guidelines and we’ll be able to study the results over the next several years,” he said. Also, he said providers should keep an eye out for emerging diagnostics that could help early detection and treatment even more, including blood biomarkers being approved by the FDA and breathalyzer screenings in the pipeline.

“Later stage lung cancers have such dismal survival, any other screening could be helpful,” Rizzo said.

Twitter: @AnthonyBrino