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Could LDCT screening for lung cancer move decision out of the primary care office?

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Large potential benefit to patients

Dr. Vera De Palo

Dr. Vera De Palo, FCCP, comments: Routine radiographic screening for lung cancer has long been debated. On November 10, CMS announced a proposal to cover low-dose CT screening for asymptomatic patients with a high risk for lung cancer. The proposal stresses the documentation of multiple elements including the requirement for scheduling a counseling and shared decision-making session before issuing an order for the low-dose CT scanning. While the required elements are many, the potential benefit to patients is great. A CHEST press release welcoming the preliminary decision may be accessed at http://www.chestnet.org/News/Press-Releases/2014/11/CHEST-ATS-CMS-Lung-Cancer.

Dr. De Palo is CMO, Chief of Medicine at Signature Healthcare Brockton Hospital in Brockton, Massachussetts.


 

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Such centers exist now, he noted. “They hire counselors and [conduct] an hour-long prescreening visit that happens with a counselor to talk about lung cancer screening, [the length of which] could never happen in a primary care setting.”

The CMS is soliciting comments on the proposed national coverage decision until Dec. 10. ©picsfive/Fotolia.com

The CMS is soliciting comments on the proposed national coverage decision until Dec. 10.

This model does not take advantage of the physician/patient relationship, he added. “There is an opportunity for a familiar provider to engage patients around counseling, so the more that we move CT screening outside of primary care, it takes away from the long-term relationship that providers have” with their patients, he said, including knowing more deeply the risks a patient has, as well as the patient’s history with smoking and attempts to quit.

It also takes away opportunities to maintain conversations about smoking cessation, which could be important as screening sometimes deemphasizes the need to quit in patient’s eyes because patients “feel protected by screening.”

The CMS is soliciting comments on the proposed national coverage decision until Dec. 10.

gtwachtman@frontlinemedcom.com

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