What does one-time hepatitis C screening of baby boomers mean for radiology?

An estimated four million Americans are infected with the hepatitis C virus, and half of them are undiagnosed.  CMS announced this week that it will cover a one-time screening for all beneficiaries born between 1945 and 1965, better known as the baby-boomer generation.

In an interview with Christoph Wald, MD, principle investigator of ACRIN Trial #6690, RadiologyBusiness.com explores the implications for radiology and for liver imaging, touching on yet another reporting system—Liver Imaging Reporting and Data System or LI-RADS—and the increasingly complex task of reporting medical imaging results.

Radiology, it turns out, has a very important responsibility in the management of a precious national resource—the liver transplant list. A cancer diagnosis bumps a patient awaiting transplant up the list and closer to receiving an organ. As of 11:48 PM last night, 78,809 active candidates were waiting for an organ transplant.  Since October 2013, new and much more specific image criteria are now being enforced by the United Network for Organ Sharing.

Until the $80,000-a-treatment wonder drug Sovaldi is made widely available and HCV is eradicated, radiologists should definitely sit up, take notice of the new guidelines, and assume what Wald refers to as a “gatekeeper” responsibility.

Meanwhile, the movement to give Medicare patients access to LDCT lung-cancer screening gained some important allies in the House of Representatives this week. Last week, a group of 45 Senators asked CMS to speed up the decision-making process. This week a group of 134 legislators from the House of Representatives sent a letter to CMS requesting that it expedite the National Coverage Decision review.

Earlier in the week, the ACR pounced on a paper presented at the American Society of Clinical Oncology that overestimated the potential cost to Medicare of LDCT lung-cancer screening. The authors, it seems, had used the threshold for a positive screen used at the outset of the National Ling Trial (4mm), revised midstream.  What a difference a millimeter makes.

Cheryl Proval