Archive for May 2nd, 2014

Latest Court Ruling Gets HealthSmart Audit Step Closer To Becoming Public

Friday, May 2nd, 2014

Company’s options running out

Posted: April 28, 2014 – 5:24pm  |  Updated: April 29, 2014 – 12:29am


 A story more than a decade in the making is a step closer to being told.


Medicare Panel Votes Against Annual CT Scans For Heavy Smokers

Friday, May 2nd, 2014


Yesterday a Medicare panel surprised many in the medical community by recommending against Medicare coverage of annual CT scans for current or former heavy smokers.  The nonbinding recommendation was issued by CMS’s nine-member Medicare Evidence Development & Coverage Advisory Committee.

The vote comes as a surprise for at least two, interrelated reasons.  First, it is squarely at odds with a recent (December 2013) recommendation by the U.S. Preventive Services Task Force that current and former heavy smokers aged 55 to 80 should get scans.  Second, under the Patient Protection & Affordable Care Act that Task Force recommendation means that commercial insurers are required to cover screenings for non-Medicare members without any out-of-pocket cost to the members.  A test typically costs from $300 to $400.

The Advisory Committee acknowledged that a National Lung Screening Trial found a 20% reduction in mortality among current and former heavy smokers who underwent CT scans, compared to those who had chest X-rays.  But the Committee noted that it doesn’t rely on a single trial in formulating national policy.  The Committee was also impressed by the negative effects that often accompany CT scans—particularly the psychological trauma, cost, and unnecessary surgeries that result from false positives.

CMS is expected to issue a proposed decision this November and make a final decision by next February.

Today’s post was contributed by Norman G. Tabler, Jr.