Last September, I wrote about growing your practice through offering Ankle–Brachial Index (ABI) screening for adults at risk for Peripheral Arterial Disease (PAD). In my honest opinion, during these trying times of reduced reimbursements (and until all radiology payments shift to value based payments), we should be considering how to legitimately offer new services to support our radiology practices, imaging centers, and hospitals.
Under the new Affordable Care Act (Obamacare) when the U.S. Preventive Services Task Force (USPTF) recommendation reaches an A or B; Medicare is then obligated to cover and pay for the service. This now appears to be the case as Lung Cancer Screening with Low Dose Computed Tomography has the USPSTF "B" recommendation rating as of July 30, 2013.
CMS has completed their process of soliciting comments for covering this screening service. They were primarily interested in evidence to determine:
1.) Identification of patients eligible for screening
2.) The appropriate frequency and duration of screening
3.) Facility and provider characteristics that predict benefit or harm
4.) Precise criteria for test positivity and the impact of false positive results and follow-up tests or treatments.
As of the March 12, 2014 closure date for submitting comments CMS received around 400 responses. Comments came from individuals with family history to expert researchers and included representatives from cancer centers, thoracic physicians, and professional societies/associations.
While I expected everyone to be supportive, there were those who were in opposition. The most obvious uninformed comment that I read was, "The Lung Cancer Screening with Low Dose Computed Tomography process, as it exists, is already a cash cow. Why feed it? It is functioning well on its own." Obviously, this person has no clue that there is currently no screening program on the books! Conversely, there was another individual who recognized the social-economic element, "Because lower income, less educated populations remain the last major demographic population that still smokes heavily; and this is the same population that this early screening could help really save substantial lives". Finally, a more informed commenter stated that patient education on smoking cessation should be part of this process.
The CMS Proposed Decision Memo Due Date is scheduled to be published on November 10, 2014. Mark your calendars! In the meantime, those practices that believe in the value of this service and the likelihood of coverage can begin putting a marketing plan together now for rolling out a screening program. Commercial carriers will likely be forced to follow suit and cover this service, too. And as I say this, I personally never expect this type of service to compare to the success of breast cancer screening.
In composing this article, I spoke with my own local primary care physician on his perspective of this matter. What I found revealing is that his initial comment was that he would likely not be among the first to start ordering these screening tests. Knowing customer objections is important to any marketing plan! He was initially concerned with radiation exposure and what the frequency might be for follow up studies. Second, he was concerned over the potential of false positives and related clinical care from the pulmonologists. His concerns included collapsed lungs, challenging lung biopsies, and unnecessary surgeries. All valid concerns and being evaluated by CMS! And while I am repeating myself, it is important to perform in-depth marketplace research for how your customers may accept the new service.
ABOUT THE AUTHORSteve Schreiber is a Senior Management Consultant at IMAGINE Software. Schreiber has 24 years of medical practice management experience with the emphasis being in radiology. He has managed hospital-based and combined hospital/imaging center practices in highly competitive environments and has been an active member of RBMA since 2002. He is currently serving on the Board of Directors, past Parliamentarian, Vendor Relations Committee chair and as a member of various other committees. The RBMA has recognized Schreiber in the 2013 class of RBMA Fellows and has also presented Schreiber with special recognition awards in both 2005 and 2011 for his contributions to the RBMA practice management forums.