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CMS proposes to add annual lung cancer screening for high-risk seniors

November 17, 2014
by Pamela Tabar, Editor-in-Chief
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The Centers for Medicare & Medicaid Services (CMS) has released a proposal to add coverage for lung cancer screenings in people aged 55 to 74 years who have a history of smoking a minimum of one pack of cigarettes a day for 30 years. The proposal follows the January 2013 recommendations of the United States Preventive Services Task Force (USPSTF), which gave lung cancer screening a Grade-B recommendation for high-risk seniors. By law, any screening tool given a grade of A or B by the USPSTF must be included as an essential benefit under private insurers, and now Medicare seems willing to include the benefit as well.

Under the proposal, beneficiaries within the age range would be eligible for a annual low-dose computed tomography (CT) scan of the lungs with a practitioner’s written order, as well as for smoking cessation counseling. Even ex-smokers are eligible, as long as they quit smoking within the past 15 years. The proposal also requires that radiology clinics that perform lung cancer screenings for beneficiaries be accredited or specifically experienced in diagnostic imaging to reduce the number of false-positives.

The American Lung Association applauds the CMS move, saying it will save lives and treatment costs in the long run. In its early stages, many types of lung cancer are treatable, but catching it early is the challenge. Lung cancer, the leading cause of U.S. cancer-related deaths, has symptoms that often don’t surface until the disease is well under way.

Low-dose CT scans are effective at catching even small tumors, but some people are concerned that expanding coverage and access will result in over-treatment and unneccessary procedures.

"Although no physician has the intention to overtreat or overdiagnose cancer, screening and patient awareness have increased the chance of identifying a spectrum of cancers, some of which are not life threatening," researchers wrote in JAMA in 2013.

But questions remain as to how the cash-strapped Medicare system will pay for it. The USPSTF estimates that if everyone who is at high risk is screened, U.S. lung cancer deaths could drop by 14 percent. At about $241 per person per screening, “LDCT screening is a low-cost and cost-effective strategy that fits well within the standard Medicare benefit, including its claims payment and quality monitoring,” notes a report in the journal American Health & Drug Benefits.  In 2014, nearly 5 million people have the qualifications for the free screening; Medicare would be responsible for those aged more than 65 years.

The proposal is open for comment until Dec. 10. Click on the first link in the first paragraph to do so.