CHICAGO — What are the practical considerations for implementing a lung cancer screening program in a health care system? This question was addressed by Abbie Begnaud, MD, assistant professor, pulmonary, critical care, University of Minnesota, in a presentation at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting.1
She reviewed a program started on December 12, 2013, at her institution, highlighting initial early decisions and subsequent challenges to its implementation.
Early program decisions included patient eligibility criteria, cost, whether to offer a self-referral option, the order/referral process, an interpretation strategy, and follow-up workflow.
The team includes clinicians from diagnostic radiology, thoracic surgery, interventional radiology and pulmonology, and RNs and APRNs. Nonclinical components included an imaging center manager; staff from business development, billing and coding, compliance and quality, and IT/HER support; and a health information management system.
The program created a unique screening order other radiology groups and imaging center management could use within the university and community health system.
Challenges included awareness of the program, performing shared decision making, ensuring patient eligibility, incorporating smoking cessation, order completion, ensuring appropriate follow-up, and data collection and management.
Eleven organizations currently have lung cancer screening guidelines, with the US Preventive Services Task Force (USPSTF) and the Centers for Medicare and Medicaid Services (CMS) the primary standards. Common threads running throughout all of the guidelines are patient age, smoking history and duration of cessation, and imaging technique/interpretation.
Currently, coverage of the cost of low-dose lung cancer screening varies by insurance. The USPSTF recommends patients age 55 to 80 years with a smoking history of 30-plus pack years, who are still smoking or have quit within the past 15 years be screened, while CMS recommends that patients age 55 to 77 years be screened.
Additional requirements include documentation of a share decision making visit, eligibility for order and note document, that smoking cessation be offered, that the radiologist be experience and certified, that the imaging center meet certain requirements, and that the absence or signs or symptoms of lung cancer be documented.
For reimbursement, CMS also requires all screening data are captured in the American College of Radiology’s National Radiology Data Registry, which opened in May 2015.
Dr. Begnaud concluded by highlighting the components of a high-quality program from a recent publication.2 This encompasses collecting risk data for screened persons, that at least 90% of patients meet the eligibility policy, patients be screened annually until ineligible, low-dose CT meets American Thoracic Society/Society of Thoracic Radiology specification data, radiation dose and nodule positivity cutoff data be collected, a structured reporting system is in place and data about compliance collected, smoking cessation is offered, providers and patients are educated, data are reviewed for quality assurance, and that results are reported annually to an oversight committee.
1. Begnaud A. Practical implementation of a lung cancer screening program in a healthcare system. Oral presentation at: 2016 ASCO Annual Meeting; June 3-7, 2016; Chicago, IL.
2. Mazzone P, Powell CA, Arenberg D, et al. Components necessary for high-quality lung cancer screening: American College of Chest Physicians and American Thoracic Society Policy Statement. Chest. 2015;147(2):295-303.