Lung cancer screening validated, but is radiology ready for the business?

CMS’s willingness to pay for CT lung cancer screenings isn’t likely to spur a stampede. “The average at-risk smoking public is not a seeker of this kind of service,” notes Reginald Munden, MD, a principal investigator in the National Lung Screening Trial. But that doesn’t mean some radiology practices won’t see an uptick in demand. Are they ready?

“We’ve been doing lung cancer screening for at least a year, and we’ve probably interpreted maybe 50 or 75 exams,” Worth Saunders, MHA, CEO of 55-physician Greensboro Radiology in North Carolina, told “I would expect that now that we believe Medicare is going to cover it, sometime early next year we will be incorporating this into our program. I anticipate that we will market it for our outpatient imaging center joint venture.”

He’s referring to Greensboro Imaging, which is 50% owned by physicians of Greensboro Radiology and 50% owned by the regional, six-hospital Cone Health system.

Adding to the potential for increased demand is that, as of January, all private payors will be required by the Affordable Care Act to cover the screenings for their at-risk policyholders. 

“There are definitely things involved” with preparing, said Saunders, pointing to protocols for radiologists and IT solutions for tracking and follow-up, which he expects to become similar to mammography with its MQSA requirements. “You have to send reminder letters, and somebody has to track the patients,” he said. “Since it’s been low-volume so far, we’ve done all that somewhat manually. We’re using some IT systems, but I definitely anticipate developing some more IT solutions to help with the workload as the volume picks up. That may become a regional solution; we’ll have to see.”

Saunders said that, when it comes to following up with patients who test positive for lung cancer, the ideal program will be set up to automatically include relevant medical specialties such as pulmonology, thoracic surgery and perhaps radiation oncology or medical oncology. Some programs have set up multidisciplinary clinics to coordinate among multiple specialties, he said, adding that follow-up will likely be the most time-consuming aspect of program development.

Saunders isn’t planning to hire new people over the development, but neither is he ruling that option out. “It just depends on what the volume is. If it really picks up, then we’ll have to add staff. But initially any additional duties will probably go to the nurse navigators or support staff.

One front-end challenge with serving the Medicare population might be developing processes to ensure compliance with CMS’s criteria for patient participation, said Saunders.

“It’s good to see Medicare approve this, because it’s a well proven test that has a lot of benefit for patients who fit the criteria,” concluded Saunders. “I think it’s really good from a public policy and public health standpoint. I also think it’s another indication that radiology can be a really effective tool to save lives. This is a validation of that.