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MEDCAC Ruling on Lung Cancer Screening

DAVID TOM COOKE, MD, FCCP, FACS
Thursday, May 01, 2014
The ruling of the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) is both disappointing and discouraging. Its ruling, which will likely lead to non-coverage of lung cancer screening with low dose CT scans for Medicare and Medicaid beneficiaries, will inhibit our ability to make a dent in reducing the negative impact of the number 1 cancer killer in the US, and will have unattended health disparity consequences.

In regards to health disparity, under rules of the Patient Protection Affordable Care Act (ACA), private insurers are required to cover effective prevention measures graded A or B by the US Preventative Services Task Force (USPSTF) as part of an Essential Health Benefit. The USPSTF gave lung cancer screening for high risk patients with low dose CT a grade B. Therefore, under the rules of the ACA, private insurers will be required to cover patients aged 55-64. Centers for Medicare and Medicaid (CMS) beneficiaries without private insurance will not be able to obtain the same benefits of lung cancer screening.

I do understand the worries of MEDCAC, specifically:
  1. High false positives
  2. Lack of evidence based oversight (ala colonoscopy)
  3. Proliferation of suboptimal programs.
I believe an alternative final ruling should approve CMS coverage of lung cancer screening with low dose CT with the following caveats that would address the committees concerns:

  1. A lung cancer screening program that is repaid by Medicare can only be reimbursed if it fits CMS criteria for quality and comprehensiveness (e.g. specific low dose CT specifications, multidisciplinary oversight, smoking cessation counseling, upfront selection screening for USPSTF criteria, communication with PCP and patient, Continuous Quality Improvement oversight, etc.)
  2. Screening limited to centers that have the above resources, but encourage connection to rural and under-resourced centers through telemedicine
  3. Specific measures to prevent indication creep


David Tom Cooke, MD, FCCP, FACS
Blog Info
A blog provided by the UC Davis Department of Thoracic Surgery that allows patients, physicians, and anyone else who is interested or curious to learn about the important and not so publicized disease processes that affect thousands of individuals each day, such as Lung Cancer, Esophageal Cancer, Emphysema/COPD and Hyperhidrosis.
Author Bio
Dr. David Tom Cooke is an Assistant Professor in the Division of Cardiothoracic Surgery at the University of California, Davis Medical Center. He is the Section Head of General Thoracic Surgery, and the Associate Program Director of the UC Davis Cardiothoracic Surgery Residencies. He completed his cardiothoracic surgery training at the University of Michigan in Ann Arbor, general surgery residency at the Massachusetts General Hospital/Harvard Medical School in Boston, and medical school at Harvard.

Dr. Cooke specializes in non-cardiac general thoracic surgery, thoracic oncology, and surgical treatment of malignant and benign esophageal disease, and minimally invasive thoracic surgery, including VATS pulmonary resection. Dr. Cooke's research interests involve clinical studies including oncologic trials, surgical outcomes/health services research, translational research, surgical education and medical social media. He currently serves on the governing board of directors of the American Lung Association of California, and the Medial Advisory Committee of the Esophageal Cancer Education Foundation. He is the co-founder of #lcsm, the bi-monthly lung cancer social media Twitter chat.
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