MEDCAC Ruling on Lung Cancer Screening

The MEDCAC ruling will likely lead to non-coverage of lung cancer screening with low dose CT scans for Medicare and Medicaid beneficiaries.

the Medicare Evidence Development & Coverage Advisory Committee

The ruling of (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
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