Study finds low uptake of lung cancer screening in eligible Medicare patients
Although Medicare has covered lung cancer screening for eligible patients since 2015, the study found that screening numbers were low in 2016 among Medicare fee-for-service beneficiaries, with lower frequency among nonwhite patients and those in regions other than the Northeast.
While CMS in 2015 announced that lung cancer screening with low-dose CT would be covered for certain Medicare beneficiaries, overall uptake was low the following year, a retrospective study found.
Medicare beneficiaries ages 55 to 77 years with a smoking history of 30 pack-years or more who currently smoke or have quit within 15 years are eligible to receive lung cancer screening as a preventive health benefit. To evaluate early use of lung cancer screening in this population, researchers used Medicare fee-for-service claims for lung cancer screening between Jan. 1, 2016, and Dec. 31, 2016. They also assessed variation in screening rates by beneficiary characteristics and U.S. region, including how interactions between geographical location and race/ethnicity influenced screening. Results were published online on June 17 by CHEST.
A total of 103,892 Medicare fee-for-service beneficiaries (mean age, 68.3 years) received lung cancer screening in 2016, comprising an estimated 4.1% (95% CI, 3.9% to 4.3%) of the eligible Medicare population. Overall, there was a positive time trend over the course of the year, with 4,976 beneficiaries screened in January 2016 and 10,258 screened in December 2016. Black, Hispanic, and other nonwhite beneficiaries had lower screening rates compared to white beneficiaries (adjusted rate ratios, 0.41 [95% CI, 0.32 to 0.52], 0.09 [95% CI, 0.06 to 0.11], and 0.12 [95% CI, 0.09 to 0.16], respectively; P<0.001). Screening rates in the Northeast were significantly higher relative to the South (adjusted rate ratio, 1.83 (95% CI, 1.36 to 2.46; P<0.001), whereas screening rates in the West and Midwest did not significantly differ relative to the South. Massachusetts had the highest screening rate (15.1%; 6,389 of 42,389 beneficiaries), and Tennessee had the lowest (1.4%; 1,674 of 122,531 beneficiaries).
Limitations of the study include the fact that the dataset did not capture Medicare beneficiaries insured through Medicare Advantage plans, dual users of Medicare, and screen-eligible individuals who were not enrolled in Medicare, the study authors noted. “Also important, the [U.S. Preventive Services Task Force lung cancer screening] recommendation and Medicare coverage decision were released in 2013 and 2015 respectively; therefore, it may be premature to make broad conclusions,” they wrote.
Newer data have suggested increasing lung cancer screening utilization in more recent years, the authors added. As screening expands, “It will be important to ensure that screening is consistently utilized across all high-risk populations,” they concluded.