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M. Wahidi
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P1.03 - Poster Session with Presenters Present (ID 455)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-048 - A Structured Lung Cancer Screening Program Facilitates Patient and Provider Compliance (ID 5892)
14:30 - 14:30 | Author(s): M. Wahidi
- Abstract
Background:
In the United States, both private insurers and Medicare provide coverage for low-dose computed tomography (LDCT) screening for lung cancer. Medicare has defined specific criteria for coverage to include “lung cancer screening counseling and shared decision making visit”[1]. Currently, in many institutions, it is possible for LDCT screening to be performed without documentation of these discussions. We hypothesize that performing LDCT screening in the context of a structured lung cancer screening program results in improved compliance with coverage regulations.
Methods:
Medical records of patients undergoing LDCT screening at our institution between January 1, 2015 and June 30, 2016 were reviewed. Chart abstraction included eligibility criteria and documentation of shared decision making, discussion of adherence to annual screening and discussion of tobacco cessation/continued abstinence.
Results:
Of the 591 patients who had LDCT screening in the defined time period, 223 (37.7%) were seen in the Lung Cancer Screening Clinic and 368 (62.3%) had studies ordered by other providers. Within the Lung Cancer Screening Clinic (LCSC) cohort, 202/223 (90.6%) met Medicare eligibility and 17/223 (7.6%) met National Comprehensive Cancer Network (NCCN) “Category 2” criteria for lung cancer screening. In the “other provider” (OP) cohort, 281 (76.4%) met Medicare eligibility and 24 (6.5%) met NCCN “Category 2” criteria for screening (p<0.0001). Current smokers were more likely to have documented discussion of tobacco cessation counseling (99.2% vs. 64.2%, respectively; p<0.0001). Similarly, patients seen in the LCSC were more likely to have documentation of shared decision making than those in the OP cohort (97.3% vs. 19.3%, respectively; p<0.0001).Table 1. Compliance with Medicare criteria for LDCT screening.
LCSC (n = 223) OP (n = 368) p-value Medicare-eligible for screening NCCN “Category 2” Do not meet criteria for lung cancer screening 202 (90.6%) 17 (7.6%) 4 (1.8%) 281 (76.4%) 25 (6.8%) 62 (16.8%) <0.0001 Former smoker, quit within 15 years Current smoker 99 (44.4%) 124 (55.6%) 181 (49.2%) 187 (51.8%) 0.2958 Documented Tobacco Cessation Counseling (current smokers) 123/124 (99.2%) 119/187 (63.6%) <0.0001 Mean time spent in tobacco cessation counseling 23 minutes 5 minutes 0.0075 Documentation of shared decision making 182/187 (97.3%) 68/353 (19.3%) <0.0001
Conclusion:
LDCT screening conducted in the context of a dedicated lung cancer screening clinic facilitates compliance with Medicare criteria and improves patient education and decision-making. Opportunities exist for those providing LDCT to improve the elements of patient education that are essential to LDCT screening. References 1. https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274
