Dozens of House members caution against further cuts to lung screening reimbursement

45 members of the House of Representatives sent a letter to the Secretary of Health and Human Services and the Administrator of the Centers for Medicare and Medicaid Services, imploring against future cuts to lung cancer screening reimbursement. The bipartisan effort is backed by the American College of Radiology (ACR) and led by Representatives Jim Renacci, R-Ohio, Larry Bucshon, MD, R-Indiana, Bill Pascrell, D-New Jersey, and John Larson, D-Conneticut.

Lung cancer is the leading cause of cancer death in every ethnic and racial group in the country. Low dose computed tomography (LDTC) screening has been associated with a 20% decrease in lung cancer mortality, but consolidation of Ambulatory Payment Classifications (APC’s) threaten access to the screening exams, according to the ACR.

APC’s are the payment categories the federal government uses to simplify Medicare payments, comprised of services that are similar in clinical intensity, resource utilization and cost. The 2017 Hospital Prospective Payment system (HOPPS) rule reduced the number of APC levels from 17 to just seven. 

“Since it’s a fixed level of reimbursement to the hospital, the facility accepts any potential financial profit or loss from each APC payment,” wrote the ACR. “As a result, alignment of services within proper APCs is essential to a hospital receiving ample reimbursement for care provided to patients.”

Flattening the APC levels combined with an analysis of LDCT data that was flawed in the eyes of the ACR resulted in 44 percent reimbursement cuts in 2017—something the bipartisan group of representatives desperately hopes to avoid in 2018.

“As Medicare, as well as the entire health delivery system, places greater emphasis on preventative medicine and population screening in order to prevent further costs in the future, we urge HHS and CMS to consider the impact of any further LDCT payment cuts in the CY 2018 HOPPS rulemaking cycle,” wrote the Representatives.

It’s important to note there are no scheduled cuts for the 2018 cycle, but the draft rule hasn’t come out yet—stakeholders will have to wait until late June or early July to see where LDCT fits into the APC’s for 2018.

“The ACR is hopeful that this bipartisan letter will encourage CMS not to pursue any further consolidation of HOPPS APCs for fear that it will negatively impact patient access to annual LDCTs,” the ACR wrote. “The College applauds Representatives Renacci, Bucshon, Pascrell and Larson for their leadership on this important screening procedure."