The Reading Room

Five reasons to invest in lung cancer screening—despite the MEDCAC recommendation

Solomon Banjo, Imaging Performance Partnership

This past Wednesday, the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) convened to discuss whether or not Medicare should cover low-dose CT (LDCT) lung cancer screening. The committee ultimately expressed low confidence that Medicare should cover lung cancer screening. 

Does that mean you should forgo implementing a comprehensive, patient-centered LDCT lung cancer screening program at your institution? We don’t think so, and here are five reasons why.

1. There is still hope for Medicare reimbursement

While MEDCAC’s decision is a blow to efforts to gain Medicare coverage for the exam, MEDCAC is an advisory panel and as such their decision is not binding. CMS can still decide to cover the exam. As we mentioned in our post last week, this meeting was just one step in the Medicare reimbursement approval process.

The next step is for MEDCAC to publish its formal recommendations to CMS this fall, after which there will be a public commenting period. The commenting period can be used to address some of the concerns raised by the MEDCAC panel. Once both these steps are completed, a final national coverage determination will be made early next year. 

2. Reimbursement from private payers coming in 2015

Even if CMS decides not to cover lung cancer screening, the United States Preventive Services Task Force’s (USPSTF) “B” recommendation means that private insurers are required to cover lung cancer screening in 2015.

Advocates for lung cancer screening note that if CMS does not cover the exam, the decision will create a two-tiered system where price remains a barrier for the Medicare population, while those with private insurance benefit from the early detection afforded by lung cancer screening. For more information on private reimbursement for lung cancer screening, read our lung cancer screening reimbursement FAQ post. 

3. Lung cancer screening saves lives

MEDCAC’s decision does not change the fact that the National Lung Screening Trial (NLST) clearly demonstrates that comprehensive lung cancer screening programs save lives. This is a fundamental part of lung screening’s value proposition.

The NLST predicts that LDCT lung cancer screening could save as many as 20,000 Americans a year if fully implemented. Lung cancer screening provides a unique opportunity for providers to improve patient outcomes by catching lung cancer, the leading cause of cancer-related deaths, early in its progression when it is most treatable. These attributes also serve to make lung cancer screening a natural fit for providers moving towards population health management. 

4. Lung cancer screening is cost-effective

Lung cancer screening compares favorably to other established screening exams in terms of cost-effectiveness.

An actuarial analysis of lung cancer screening by Milliman found that in terms of cost per life-year saved lung cancer screening ($11-26K) was more effective than cervical screening ($50-75K), breast screening ($31-51K) and colorectal screening ($18-28K).

5. Downstream revenue unaffected by MEDCAC decision

While reimbursement would certainly help to offset the costs of running a lung screening program, much of the financial value of lung cancer screening programs comes from downstream utilization generated by screening. 

Even though most providers currently offer screening at discounted rates, our analysis shows hospitals can more than make up for the costs associated with the program through downstream revenue. 

More from the Imaging Performance Partnership

A comprehensive lung cancer screening program is more than a radiologist, a technologist and a machine. 

Our upcoming national meeting will present best practices for developing or enhancing your lung cancer screening program. For a preview of our research, register for our upcoming webconference on “How to Maximize Your Screening Program Investments