Author of

• 20177

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  P2.13 - Radiology/Staging/Screening (ID 714)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Radiology/Staging/Screening
  • Presentations: 2
  • Moderators:
  • Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 23484

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    P2.13-015 - The Primary Care Provider Role in the US Screening Context: Current Practices and Strategies for Physician Engagement (ID 10249)

    09:30 - 09:30  |  Author(s): A. Copeland
    • Abstract

    Background:
    As lung cancer screening has become more mainstream in the US, increasing attention has been paid to appropriate referral and follow up to minimize harms. This has been particularly focused on community-based programs as concerns have been voiced about the dearth of RCT evidence to support screening implementation in that setting. In addition, with the release of the US Preventive Services Task Force (USPSTF) and Centers for Medicare/Medicaid Services (CMS) recommendations for screening, more of the decision-making has been shifted to the primary care community. Primary care providers (PCPs) are expected to increase awareness of screening with their high-risk patients, perform counseling and shared decision-making (SDM), and manage screening outcomes more than ever before.
    
    Method:
    In a sample of mostly hospital-based lung cancer screening programs, program managers completed an application update as required for their continued participation in a national network. The applications were completed between March-June 2017 and covered areas of requirement for the designation, including: eligibility criteria, screening protocols, smoking cessation resources, multidisciplinary team make-up, SDM, and results reporting. 222 health systems responded, which represents 473 individual health care facilities out of 549 facilities that received the application (an 86% response rate).
    
    Result:
    Regarding counseling and SDM – required by CMS prior to generation of a written order - 82% of respondents reported that patients accessed SDM via the PCP. However, the majority of these respondents also indicated that the patient accessed SDM via a member of the screening team in addition to the PCP. Academic programs were less likely to see screening patients who received SDM through the referring provider and screening team (59%) compared to community/non-academic programs where 75% of patients received SDM through a referring provider and the screening team. We also examined the make-up of multidisciplinary clinical teams. 36% of respondents reported primary care as a team member. This was more common with community/non-academic programs when compared to academic programs.
    
    Conclusion:
    Data collected from screening program self-reporting indicates interesting trends in how primary care is incorporated into the lung cancer screening process prior to the referral through shared decision-making and during the review of screening results through the multidisciplinary care team. With patient awareness of lung cancer screening still reported to be low and PCP awareness and buy-in for lung cancer screening still considered to be inconsistent, supporting the integration of primary care into the workflow may help increase uptake of screening in a high risk population.
    
    

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    P2.13-016 - Self-Reported Program Barriers to Increasing Lung Cancer Screening Rates in the US and Implications for the Screening Community (ID 10258)

    09:30 - 09:30  |  Author(s): A. Copeland
    • Abstract

    Background:
    Despite approval and coverage for lung cancer screening in the US for a high-risk population, recent research indicates that screening rates are still far lower than anticipated. Jemal and Fedewa (2016) looked at rates during 2011-2015 and found only a 3.9% screening rate in the eligible population. While some of that low rate may be due to lack of insurance coverage in both private and Medicare populations during the bulk of the study time period, screening programs continue to report challenges that may be barriers to increasing screening rates even though it is covered by most insurance plans and Medicare.
    
    Method:
    In a network of mostly hospital-based lung cancer screening programs in the US, 152 programs representing both academic and community programs completed a survey on practices and statistics, achieving a 61% response rate. The survey was completed using SurveyMonkey between March-June 2017 and asked a range of questions based on the 2016 program experience, including program statistics, current smoking cessation referrals, participation in research and programmatic barriers. The reported data here represent screening program managers’ perceptions of continued challenges to screening as captured through two specific questions: “What barriers continued to cause problems for you in 2016?” and because insurance/billing issues constitute a broader category, “What was the nature of the insurance/billing issues you faced in 2016?”
    
    Result:
    The majority of respondents indicated that insurance/billing issues, lack of patient awareness, internal workflow challenges, and lack of support from referring providers were barriers that continued to cause problems in 2016. Only 30% of respondents indicated that lack of patient interest in screening was a barrier and 41% indicated that staffing/time limitations was a barrier. Other barriers identified by respondents included lack of provider awareness and challenges (often technical) with complying with the Medicare requirement for submission of registry data. Because insurance/billing issues continue to be significant, respondents provided more detail about the nature of these issues, including claims denials, coverage co-pays or deductibles, coding errors, and receiving prior authorizations.
    
    Conclusion:
    Despite widespread insurance coverage in the eligible screening population in the US, screening programs are still facing barriers to increasing screening service usage. It is clear that communities and professionals supportive of screening need to focus attention in increased patient and provider education around lung cancer screening. However, insurance and billing issues remain a major challenge, even though coverage is theoretically in place.