MMC Lung Cancer Screening Program Provider Education

Welcome to MMC Lung Cancer Screening Program

The purpose of this education packet is to provide information about our centralized lung cancer screening model and how we can combine alliances to ease the burden of lung cancer screening to increase MMC screening rates.

Overview of Research

Many research studies have shown that screening high-risk individuals prior to their having symptoms can prevent lung-cancer-related deaths. The National Lung Screening Trial (NLST) published in August 2011 reported that lung cancer screening by low-dose computed tomography (LDCT) reduces the risk of dying by 20%. The Dutch-Belgian Lung Cancer Screening Trial (NELSON) published in February 2020 confirmed that cancers detected at earlier stages with screening resulted in significantly lower mortality rates compared with those who did not have screening. Early detection is the best way to treat lung cancer when it is more likely to be cured.

Eligibility Criteria

Criteria

USPSTF (U.S. Preventive Services Task Force)

50 to 80

Smoking status

CMS (Centers for Medicare & Medicaid)

50 to 77

Current or former smoker who has quit within the last 15 years

Smoking history 20 pack-years

Lung cancer signs

Asymptomatic

No new or worsening cough, shortness of breath, chest pain, or unintentional weight loss

Screening frequency Yearly

When to stop screening

When the patient exceeds upper-age criterion, has not smoked for more than 15 years, and/or develops a health problem that limits life expectancy or the ability or willingness to have curative treatment

Patients diagnosed with cancer while undergoing treatment must be in remission for five years before participating

Patients who recently had a computed tomography angiography (CTA) or diagnostic CT chest will be deferred one year from last scan.

Exclusively for patients with history of cigarette smoking; those with history of using cigar, pipe, chewing tobacco, marijuana, or electronic cigarettes DO NOT QUALIFY.

Insurance Coverage

• Private insurers and Medicare offer coverage for annual low-dose computed tomography (LDCT) screening for lung cancer among high-risk individuals who meet all eligibility criteria.

• Medicare and MOST private insurance plans cover lung screening with no out-of-pocket costs. Most private insurers require prior authorization.

• Follow-up invasive diagnostic procedures and repeat imaging to evaluate an abnormal LDCT scan may require out-of-pocket expense and is no longer considered screening

• Some insurance providers may require out-of-pocket expense for covered individuals. We recommend that patients check with their insurers to find out what benefits are covered for lung cancer screening.

Self-pay: If a patient with no insurance meets eligibility, they may still have a LDCT scan. Cost of LDCT and interpretation subject to change yearly.

Shared Decision-Making Encounter

CMS requires a one-time shared decision-making encounter for beneficiaries who are eligible for lung cancer screening prior to the first LDCT. The shared decision-making discussion must include the following key points and must be documented in the beneficiary’s medical records:

• Confirm eligibility with patient.

• Discuss risks and benefits:

o False-positive findings, overdiagnosing, incidental findings, radiation exposure, and the importance of early detection.

o Patient will be educated about the CT scan procedure and what to expect during a CT scan.

• Include one or more decision-making aids (literature, pamphlets, video, etc.).

• Include importance of adherence to annual lung cancer screening.

• Include impact of comorbidities and ability or willingness to undergo diagnosis and treatment.

• Include importance of smoking cessation/smoking abstinence.

Centralized Model

The MMC Lung Cancer Screening Program uses a centralized model which ensures that the screening process is standardized and that patients receive continuity of care.

PCP identifies screening-eligible individual.

LCSP reviews RADS 3, contacts patient and PCP

LCSP sends results letter to patient. (Lung-RADS 1, 2, 3).

LCSP sends annual and RADS 3 reminder letters to patient.

LCSP performs SDM. Tobacco cessation.

LCSP orders LDCT, completes PA, LDCT is scheduled.

LCSP confirms eligibility for all returning patients, completes PA, LDCT is scheduled.

Results in Radiant (EPIC-LCS database)

Lung-RADS 4 reviewed at MATRIx and recommendations provided.

PCP may manage or opt for MATRIx to manage.

PCP orders diagnostic work-up and/or refers to specialist.

OR

MATRIx manages.

MATRIx completes work-up.

KEY

LCS Lung cancer screening

LCSP Lung cancer screening program

LDCT Low-dose computed tomography

MATRIx Multidisciplinary Thoracic Review Program at MMC

PA Prior authorization

PCP Primary care provider

All standard follow-up LDCT scans are completed by MMC Lung Cancer Screening Program.

Multidisciplinary Review Board

According to National Comprehensive Cancer Network (NCCN) Guidelines, evaluation for suspicion of lung cancer requires a multidisciplinary approach with expertise in lung nodule management (including thoracic radiology, pulmonary medicine, and thoracic surgery).

MATRIx

Purpose: Evaluation of abnormal chest CT imaging

Goals

• Streamline evaluation and treatment of patients with abnormal CT findings

• Provide a system to expedite further management of case

Support

• Nurse Navigator from MATRIx team can provide:

o Recommendations to referring providers

o Arrangement of consultation with appropriate specialists

o Assistance with tracking diagnostic work up until patient reaches treatment phase

How to Refer

Lung Cancer Screening Program

Epic

• MMC Lung Cancer Screening Program at REF210105

Non-Epic Provider

• Fax referral to 207-800-4314; include clinical notes and insurance information

Epic

• MATRIx REF50004

Non-Epic Provider

• Fax referral to 207-800-4314; include clinical notes and external radiology report

MATRIx Lung Nodule Conference

References

1. The National Lung Screening Trail Research Team, 2011 Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening - PMC (nih.gov)

2. The Dutch-Belgian Lung Cancer Screening Trial (NELSON) Published in October 2011, NELSON lung cancer screening study - PubMed (nih.gov)

3. Strengthening-Adherence.pdf (go2.org)

4. Recommendation: Lung Cancer: Screening | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)

5. https://www.public-health.uiowa.edu/wp-content/uploads/2021/08/lung-cancerscreening-clin-summary-160316-3.pdf

6. https://www.nccn.org/professionals/physician_gls/pdf/lung_screening.pdf