Medicare payment for lung-cancer scans hailed

In In The News by Barbara Jacoby

By Misti Crane


Lung-cancer experts are heralding news that the federal government will pick up the tab for CT scans to screen for the disease in longtime smokers.

All three adult-care hospital systems in Columbus have been offering the scans for $99 out-of-pocket. So far, they’ve screened about 1,600 people and found close to 30 cancers, mostly of the lung.

Following Medicare’s announcement last month, programs here and throughout the country are preparing to consult with, and offer scans to, a broader group of men and women at high risk of developing lung cancer. Private insurers typically follow the federal government’s lead when determining what they will cover.

“It’s fantastic news. It’s really a long time coming and really a validation of what we’ve known for a few years,” said Dr. Patrick Nana-Sinkam, a pulmonologist who oversees the screening program at Ohio State University’s Arthur G. James Cancer Hospital.

The scan “does save lives,” he said.

Lung cancer is the top cancer killer. It usually is found after a patient experiences symptoms associated with later stages of the disease, when it often is inoperable.

Five-year survival rates for those with advanced disease are in the single digits.

Medicare’s conditions for coverage are stringent and include a required meeting during which a doctor explains the potential benefits, limitations and risks (false-positive results and subsequent biopsies) of screening. The requirements also stress the importance of smoking cessation.

“Screening should not be a replacement for smoking cessation,” Nana-Sinkam said.

Annual low-dose CT scans will be available to Medicare beneficiaries 55 to 77 years old who are current smokers or who quit within the past 15 years. They also must have a smoking history of at least 30 “pack years.” That’s equivalent to a pack a day for 30 years or two packs a day for 15 years.

For a scan to be covered, smokers and former smokers must have a written order from a physician or qualified practitioner. The scan must be done at a center with radiologists well-trained in interpreting lung CTs.

Medicare’s approval came after an advisory panel last year initially recommended against coverage out of concerns about false-positive results and radiation exposure.

That recommendation surprised many observers because scans had the blessing of the U.S. Preventive Services Task Force, which advises the government on the worth of medical-screening tests. The group based its approval largely on a study of more than 53,000 people that found scans resulted in a 20 percent decrease in lung-cancer deaths.

In approving coverage, Medicare set its upper cutoff age at 77, rather than 80, as the task force did.

Buffy Jansak, OhioHealth’s program director for lung cancer, called the guidelines “a good starting point” but said she would still like to see the age limit set higher.

“This is really going to change a lot of seniors’ lives,” Jansak said of the sign-off by Medicare. “In the early stages, there’s so much more opportunity for them to have a cure, to have surgical removal and be done with it.”

Dr. Brian Hamburg, a pulmonologist with Mount Carmel Pulmonary, is similarly enthusiastic about the Medicare-coverage news.

“We were a little worried before this that they weren’t going to approve it,” Hamburg said. “We’re very happy.”

He and other lung-cancer experts in Columbus said they’re working with primary-care providers to make sure they’re aware of the rules and can help ensure that those who might benefit from a CT scan receive appropriate counseling to make that decision.

Previous research has found that about a quarter of screened individuals will have a scan with abnormal results, but about 96 percent of them will not have cancer. But because lung cancer is so deadly and so costly, most experts have concluded that benefits outweigh risks.

Hamburg characterized attempts so far at trying to seek coverage from private insurers as “bumpy” but said he anticipates that will change now.

A study released last year estimated that Medicare screening would find 54,900 more lung-cancer cases in five years and come with an annual cost of $2 billion. The study estimated that Medicare-covered screenings would result in more than 11 million more lung scans in five years, including 2 million false-positive results.