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Medicare to cover low-dose CT scans

Medicare will now pay for lung cancer screenings for those at the highest risk


In February, Medicare said it will pay for lung cancer screenings for those at the highest risk. The candidates for coverage are current or former smokers, ages 55 to 74, with a smoking history of at least 30 pack years, which can equal one pack a day for 30 years or two packs a day for 15 years, and so on.

Dr. James O’Brien with Mecklenburg Radiology Associates in Charlotte, North Carolina, said the push for coverage came from a study published in the New England Journal of Medicine. The National Lung Cancer Screening Trial examined more than 50,000 patients over several years, focusing on the impact a low-dose CT screening had on mortality rates.

According to the American Cancer Society, lung cancer kills 160,000 people a year.  The mortality rate is so high because lung cancer doesn’t cause symptoms until it’s too late to treat effectively.

The National Lung Screening Trial found participants who received a low-dose CT scan had a 15 to 20 percent lower risk of dying from lung cancer than participants who received standard chest X-rays.

“The findings were so significant, the trial was stopped to get the results out early,” O’Brien said. “Research trials look at something called the ‘power of the trial.’ With 50,000 participants, the trial had a lot of power and was extremely representative of the patient population. Now everyone is on board that the CT screening does help detect lung cancer while decreasing mortality rates for the determined patient population.”

O’Brien mentioned the test is meant to be like a mammogram – those at risk will be reminded to get the screening done each year. For those patients outside the qualifications set by Medicare, the screening is not covered and can cost anywhere from $250 to $300.

“When you’re doing widespread screenings for certain groups, you want to keep the population very specific,” O’Brien said. “Like mammography and men – men are not reminded annually to get a mammogram. We want to narrow down the population to those patients who are at the highest risk.”

O’Brien works with the Novant Health Cancer Center and Novant Health Multidisciplinary Clinic to make sure patients at high risk are referred for the screening.

“We discuss the screening at length so physicians are involved and recommend it to their patients,” O’Brien said. “Our goal is to start recommending the screening through primary care and family medicine doctors because that’s where a majority of these patients are seen annually.”

For patients outside the screening parameters, there’s still a chance Medicare will change the qualifications in the future. O’Brien said his practice is looking at how low-dose CT screenings affect patients outside the current parameters. If a larger population of patients is found where the screening is proven to work, there’s a chance Medicare could change their parameters. O’Brien noted it would be several years before Medicare reconsiders its qualifications.





Published: 2/24/2015