CT lung cancer screening rates in the U.S. remain abysmally low, over a decade after the exam was recommended. Is part of lung screening’s problem its reliance on provider referrals? A new research letter in JAMA Network Open examines this question.
Unlike breast screening, in which eligible women are able to self-refer themselves for exams, CT lung screening revolves around provider referrals to start the process.
- CMS requires a shared decision-making session that results in a written order from a practitioner for a CT lung screening exam in order to pay for screening through Medicare and Medicaid.
When CMS created the rules in 2015, provider referrals and shared decision-making were seen as ways to get patients involved in their own care by making choices in coordination with their caregivers.
- But many are starting to see the requirements as a barrier, especially given low CT lung screening rates in the U.S.
In the new article, researchers investigated how easy it would be for an eligible individual to secure a CT lung screening appointment by just calling hospitals – without a provider referral.
- They note that one-third of Americans don’t have primary care clinicians, and are often told to call hospitals directly to set up appointments.
So they did just that, placing phone calls to 527 hospitals asking to arrange CT lung screening appointments, finding …
- 317 calls (60%) failed because the caller did not have a primary care provider’s order.
- Only 51 hospitals (9.7%) were able to connect callers to any component of a lung cancer screening process.
The study authors note that the provider referral requirement isn’t the only thing holding CT lung cancer screening back, as even patients with primary care providers aren’t getting screened, and managing nodule follow-up can also be challenging.
- But Medicare’s cumbersome reimbursement rules certainly don’t help bring new people into the fold.
The Takeaway
Given CT lung cancer screening’s undisputed life-saving value, there’s no reason to put unnecessary barriers in its way. The provider referral and shared decision-making requirements are lung screening’s weak link to securing greater adoption, and CMS should rescind them to put CT lung cancer screening on the path to greater adoption.
