P1.03-048 A Structured Lung Cancer Screening Program Facilitates Patient and Provider Compliance

Abstract

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. 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. 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 1Compliance with Medicare criteria for LDCT screeningLCSC (n = 223)OP (n = 368)p-valueMedicare-eligible for screening NCCN “Category 2” Do not meet criteria for lung cancer screening202 (90.6%) 17 (7.6%) 4 (1.8%)281 (76.4%) 25 (6.8%) 62 (16.8%)<0.0001Former smoker, quit within 15 years Current smoker99 (44.4%) 124 (55.6%)181 (49.2%) 187 (51.8%)0.2958Documented Tobacco Cessation Counseling (current smokers)123/124 (99.2%)119/187 (63.6%)<0.0001Mean time spent in tobacco cessation counseling23 minutes5 minutes0.0075Documentation of shared decision making182/187 (97.3%)68/353 (19.3%)<0.0001 Open table in a new tab 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.