Low-dose CT exams underutilized, causing needless lung cancer deaths

Medicare reimbursement has been slashed, and doctors are ill-informed about test benefits, ACR contends.

Low Medicare reimbursement for low-dose computed tomography screening exams for lung cancer may be restraining use of the imaging studies and be one of the major factors leading to thousands of needless deaths from the disease each year.

Also contributing to higher than necessary rates for lung cancer mortality is physician ignorance of lung cancer screening guidelines, and the lack of patient and physician education on the benefits of screening, according to a recent study by the American College of Radiology.

The professional organization released its findings last week at a meeting of the American Society of Clinical Oncology. Lack of adherence to clinical guidelines, as a result of ignorance or cost, is significant because more than 220,000 people will be diagnosed with lung cancer in 2018, and nearly 160,000 people will die from the disease.

The United States Preventive Services Task Force (USPSTF) has established guidelines recommending cancer screening for high-risk, older current and former smokers, but these exams are relatively unused, according to the study.

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‘CT lung cancer screening can save more lives than any other cancer screening test, but patients are not hearing about this test from their doctors,” the ACR statement indicated. “Medicare is not adequately covering these exams,” adds Ella Kazerooni, MD, chair of the ACR’s Lung Cancer Screening Committee and ACR Thoracic Imaging Panel.

Some of the reluctance to use CT exams for lung cancer may stem from preconceived notions about the efficacy of the exams that no longer exist, ACR contends. For example, updates to Lung-RADS—a quality assurance tool used to standardize reporting on lung cancer screenings—has reduced false positive rates by 75 percent, compared with past studies.

Exams for Medicare beneficiaries are not reimbursed at sufficient levels, ACR contends. The group says that shortly after the Centers for Medicare and Medicaid Services acted to cover the exams, it slashed Medicare reimbursement to about $60 per exam, less than half of what it pays for a mammogram. That’s limited the number of facilities that can cover the difference between the payment and the cost.

Physician unfamiliarity with the screening exam also may be leading to underutilization, ACR contends. That’s important, because doctors must approve orders for the exam; also, the lack of familiarity means the clinicians may not be telling patients about the benefits.

"Thousands of people each year should not be allowed to die needlessly while the medical community fine tunes the only exam proven to save lives from the nation's leading cancer killer. Medicare must also provide adequate reimbursement," Kazerooni says.

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