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

Abstract

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. 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?” 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. 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.