por Lisa Chamoff
, Contributing Reporter | October 13, 2015
From the October 2015 issue of HealthCare Business News magazine
Radiologists achieved a long-awaited victory at the beginning of 2015 when the Centers for Medicare and Medicaid Services (CMS) announced that it would reimburse annual low-dose CT lung cancer screening for longtime smokers between the ages of 55 and 77.
But, as with any slice of success in health care, there are still a number of challenges facing the CT market.
While the organizers of currently up-and-running and new lung screening programs create protocols to meet the stringent CMS requirements for reimbursement, hospitals have also been working to make sure CT scanners meet the Medical Imaging & Technology Alliance’s (MITA) Smart Dose Standard, to avoid Medicare cuts beginning next year. At the same time, new Joint Commission standards that took effect July 1 put even more emphasis on making sure the radiation dose from CT scans is as low as possible.
The CMS made a “landmark decision” in reimbursing low-dose CT lung screening, says Dr. Andrea McKee
, a radiation oncologist who runs the CT lung cancer screening program at Lahey Hospital & Medical Center in Burlington, Mass.
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“It’s really going to dramatically change the way we manage lung cancer, and we’re all very excited about it,” McKee says. In order to qualify for CMS reimbursement for a scan, patients with no signs or symptoms of lung cancer must be current smokers or must have quit smoking within the past 15 years, with a smoking history of at least 30 pack-years, an average of one pack a day for 30 years. Patients must then receive a written order for screening during a visit with a physician, physician assistant, nurse practitioner or clinical nurse specialist who reviews and discusses the benefits and harms of screening, including the possibility of a false positive and the exposure to radiation, and provides counseling on smoking cessation.
Providers must also utilize a standardized lung nodule identification, classification and reporting system, such as the American College of Radiology (ACR) Lung Imaging Reporting and Data System (Lung-RADS), and collect and submit data on each scan to a CMS-approved registry. While the requirements for CMS reimbursement may seem onerous, they ensure the quality and safety of screening programs, says Dr. Ella Kazerooni
, who chairs the ACR’s Lung Cancer Screening Committee.