by
Lisa Chamoff, Contributing Reporter | October 13, 2015
From the October 2015 issue of HealthCare Business News magazine
“I think whenever there are requirements instead of outright coverage, it’s natural for people to think of them as obstacles,” Kazerooni says. “But when you think about the reasons behind them, they make sense.” Since the National Lung Screening Trial (NLST), which looked at 53,000 patients across 33 facilities, the threshold for a positive exam has also increased from a 4-millimeter nodule to a 6-millimeter nodule, which has been found to decrease the false positive rate from 27 percent to less than 10 percent.
Through its program, started in 2012, Lahey has screened more than 3,000 patients, finding early-stage disease in 75 percent of them. The facility also worked with the ACR to develop Lung-RADS. Though the requirements are extensive, having a good lung cancer screening program requires proper training and the right multi-disciplinary team to do the scans the right way and to manage the findings, McKee says. “We were able to demonstrate to CMS what a community screening program is like once you have these systems in place,” McKee says.
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Providers are still waiting for CMS to issue a Current Procedural Terminology (CPT) code for the scans (providers anticipate the code will be issued in November) and are responding in different ways. Lahey, for example, has already been providing the scans free of charge through its community benefit program.
The lung cancer screening program at New York-Presbyterian/Weill Cornell Medical College is holding its bills and waiting for the CPT code to be issued before applying for reimbursement. They’re asking patients to sign a waiver, which states that if CMS does not reimburse the scan, the patient will be required to pay the fee. Before the CMS decision, all Medicare and Medicaid patients paid for the scans themselves.
Dr. Bradley Pua, director of the lung cancer screening program at New York-Presbyterian/Weill Cornell Medical College, says the language from CMS states that if facilities meet the requirements of shared decision-making visits and adding information to the ACR lung cancer screening registry, they “may” be reimbursed. “We decided that to protect patients in the long run, we needed to approach this from a practical mindset,” Pua says. “We weren’t comfortable saying to patients, ‘You will definitely get reimbursed,’ and sending them a bill later.”
