Q&A: Laurie Fenton Ambrose on fighting CMS reimbursement cuts through ‘power in numbers’

On Sept. 6, more than 80 patient advocacy groups, health providers, and medical associations published a letter that urged CMS not to follow through with the low-dose computer tomography (LDCT) lung cancer screening reimbursement cuts included in the 2017 Hospital Outpatient Prospective Payment System proposed rule. The cuts could reduce reimbursement for LDCT shared decision making sessions by 64 percent and LDCT scans by 44 percent.

The letter highlighted several reasons these organizations were against the potential cuts, including the proven effectiveness of shared decision-making sessions and the fact that lung cancer disproportionately impacts minority populations, where access to screening is often difficult to find.

Laurie Fenton Ambrose, president and CEO of Lung Cancer Alliance, was one of many leaders who contributed to the letter. She spoke with Radiology Business on the phone about the importance of LDCT screening, the work Lung Cancer Alliance has done to increase screening access, and more.

Radiology Business: What was your initial reaction when you learned of the proposed cuts to LDCT lung cancer screening reimbursements? Were you surprised?

Laurie Fenton Ambrose: I was stunned and perplexed. It was not anticipated, and it surprised us, particularly given the work we had done only months earlier to achieve support for expanding this preventive service to the at-risk public.  

Can you speak on the importance of both the shared decision-making sessions and the screenings?

They go hand in hand. Research shows those who are current smokers and have the opportunity to have this interactive conversation have a higher quit rate. It is another opportunity to counsel on smoking behaviors and help those who are current smokers quit.

And the bottom line is that we know screening those at risk will save lives. It’s a life-saving service that, for a long time, had been out of reach for high-risk constituents in some communities. The screening is an extraordinary opportunity to see a dramatic reduction in cancer mortality.

Why was it important for so many entities to work together in this fight against LDCT lung cancer screening reimbursement cuts?

It’s power in numbers. The opportunity to galvanize the largest public health coalition with a broad, deep and diverse community all aligned and advocating as one was an exciting, purposeful endeavor, and one met with strong enthusiasm. We could show there was a very deep group coming together to advance this point, and it’s important to show the power in numbers, particularly with a public health initiative that has pushback from certain corners.

We just went in with as much power and strength and depth as we could, and we did what we needed to do.

Do you think your voices will be heard by CMS?

I certainly can’t predict, but I can’t believe that CMS would do something that could so adversely impact communities that need it most. The net result of such a cut would be to limit access to a service where the underserved population and minority population gets its care. I would hope that CMS would realize the adverse impact of this and not make such a draconian rule.

What will be your reaction if the cuts remain? What’s the next step?

There would always be another step to advocate for these health benefits for these at-risk communities, and I think we will size up whatever the situation may be and then work collectively to again advocate on behalf of those who would be adversely impacted.

But I’d like to be the optimist and think that CMS will realize this would adversely impact the community that we are trying to connect this benefit to. Doing so would actually thwart our work to expand access.

Other than fighting these potential cuts, what else has the Lung Cancer Alliance been focused on?

We have been working with hospitals all across the country to ensure that lung cancer screening is embedded in the most responsible and equitable way and we have identified hospitals as screening centers of excellence. We now have close to 450 that meet that criteria, and we will continue to work to expand that and ensure that the roll out of this life-saving benefit is done right from the beginning.

Click here to read the full letter sent to CMS.

This text was edited for clarity and space.