Adding Medicare-funded lung cancer screenings into a registry requires “system change,” agreed Richard Wender, MD, chief cancer control officer at the American Cancer Society.
Medicare reimbursement also requires that LDCT be performed at a high-quality, high-volume screening center, added Dr Jemal. “It must be a high-volume, high-quality screening center where you have all the specialists needed not only for the screening but also for follow-up and treatment. I don’t think we have enough of those centers.”
Lung cancer screening is “complex,” Dr Wender said. “A process of informed decision-making must be in place. A tobacco cessation program must also be offered to smokers. There are specifications that must be met by the radiologist and the facility.”
But those rules help ensure that high-quality screening services are provided to Medicare patients.
“We worked hard to achieve Medicare coverage,” he said. “Medicare would not have covered the service without these specifications. Combining coverage with assurances and expectations of quality is a good thing.”
Coverage of lung cancer screening expenses is complete for Medicare patients, with no co-pay, Dr Wender noted. Yet downstream costs are subject to Medicare’s regular rules, and entail a 20% co-pay.
Nearly half of high-risk smokers who meet the USPSTF criteria are low-income, uninsured (or Medicaid insured) individuals with “limited access” to such facilities, Dr Jemal said.
Even patients with private, commercial health insurance that completely covers initial LDCT screening might have out-of-pocket expenses for follow-up testing.
“This can get expensive and may discourage some people from being screened,” Dr Wender said.
This article originally appeared on Cancer Therapy Advisor