ACR Asks MEDCAC to Back LDCT; AIM Voices Protocol, Tech Concerns

When it meets in Baltimore on April 30 to weigh recommending Medicare coverage of low-dose CT lung-cancer screening, the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) will consider public comments from 16 speakers including four radiologists, a radiation oncologist and a radiation physicist.  As the chair of the ACR committee on Lung Cancer Screening, Dr. Ella Kazerooni will represent the ACR in urging Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) to recommend coverage. 

“Lung cancer kills more people each year than breast, colon and prostate cancers combined,” said Dr. Kazerooni in a press release issued today by the ACR. “MEDCAC should recommend, and CMS should implement, broad national coverage for CT lung cancer screening so that those at high risk can be tested and thousands more people each year can be saved from this terrible disease.”

The committee also will consider input from AIM Specialty Health, a Chicago-based radiology benefits management company, which voiced concerns about the inability of CMS and private Medicare Advantage plans to ensure that low-dose protocols are used on technology capable of optimizing CT radiation dose.

“Lack of adherence to LDCT standards would reduce and potentially invalidate many of the calculations of benefits versus harms that the MEDCAC may undertake in considering the safety of a screening program in the Medicare population,” wrote Dr. Susan Nedza, CMO, AIM, in a letter addressed to MEDCAC.

Acknowledging that evidence for coverage is compelling, AIM recommends the use of a modifier code to identify low-dose CT imaging equipment. An HCPCS modifier could be appended to the appropriate CPS code and would not create an additional administrative burden for imaging providers and facilities, the letter says.

Invited guest speakers include Laurie Fenton Ambrose, president and CEO, Lung Cancer Alliance, Dr. Peter Bach, director, Center for Health Policy and Outcomes, Memorial Sloan-Kettering Cancer Center; Dr. Doug Campos-Outcalt, chair, department of family, community, and preventive medicine, University of Arizona College of Medicine; and Dr. Paul Pinsky, division of cancer prevention, National Cancer Institute, National Institute of Health. Pinsky wrote a guest editorial on the challenges of translating research into clinical practice in the most recent edition of Radiology Business Journal.

The United States Preventive Services Task Force gave LDCT lung-cancer screening a B recommendation last year, and the Affordable Care Act requires private payors to cover without co-pay any exam or procedure that receives a B or better recommendation. ACA does not extend that requirement to the Medicare program.

After MEDPAC hears a full day of presentations from invited speakers, testimony from experts and open panel discussions, chairperson Dr. Rita Redberg, professor and cardiologist at the University of California, San Francisco, will ask each panel member to state his or her position on the voting questions.

The questions seek to gauge panel member confidence in the evidence that benefits outweigh harms; that harms will be minimized in the Medicare population; and that clinically significant evidence gaps remain regarding the use of LDCT in the Medicare population outside a clinical trial.

The panel also will discuss if the following topics should be considered for further research in the beneficiary population:

• risk factors/criteria for eligibility of screening asymptomatic individuals;

•frequency and duration of testing;

• the impact adherence will have on lung cancer detection (National Lung Screening Trial adherence was 95%);

• definition of a positive screen and variability of false positives and how false positives should be resolved;

• the rate, classification and standard evaluation of incidental findings; and

• impact of lung cancer screening on smoking cessation rates?

Joining Kazerooni from radiology are Dr. Claudia I. Henschke, professor of radiology, Icahn School of Medicine at Mount Sinai and principal investigator of ELCAP, NY-ELCAP, and I-ELCAP; Dr. Charles S. White, director of cardiothoracic imaging in the radiology department at University of Maryland; Dr. Michael McNitt-Gray, chair of the CT subcommittee of the American Association of Physicists in Medicine, and director, Biomedical Physics Graduate Program, David Geffen School of Medicine at UCLA; and Dr. Francine Jacobson, assistant professor of radiology, Brigham & Women’s Hospital.

MEDCAC also will hear public comments from radiation oncologists, pulmonologists, cardiothoracic surgeons, internists and lung-cancer screening coordinators, as well as representatives from MITA and the American Cancer Society.