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Helping Healthcare Get Better | mpro.org
Prevention and Early Detection of Lung Cancer
MPRO’s Michigan Cancer Control Initiative
Tesia Looper, MSAQuality Program Manager
Elise DeYoung, MPHQuality Consultant
Evidence based, data-driven quality
improvement insights
Thoughtful, impartial utilization review and dispute
resolution services
Innovative problem solving solutions and technical assistance
“HELPING HEALTHCARE GET BETTER”
QUALITYIMPROVEMENT
REVIEWSERVICES
CONSULTING SERVICES
Who is MPRO?
What is LCDT Lung Screening?
A low dose lung cancer screening is a non-contrast Cat Scan exam that is performed on patients who
are at risk of developing lung cancer
Eligibility Criteria for LDCT Lung Screening• To qualify for LDCT Lung Screening patients must
meet the following criteria:– 55 to 77 years of age– Be asymptomatic
• Meaning no signs or symptoms of lung cancer– Have a tobacco smoking history of at least 30 pack-
years • 1 pack-year = 1 pack per day for 1 year• 1 pack = 20 cigarettes
– Be a current smoker or have quit within the last 15 years
– Not have had a CT of the chest within the past year
Calculating Pack Years
• shouldiscreen.com • smokingpackyears.com
A Note on Coverage
• Medicare coinsurance and Part B deductible are waived for this preventative service
• Medicare Patients will not have a financial responsibility for the counseling or lung cancer screening LDCT scan
Counseling and Shared Decision-Making Visit
Before the first lung cancer LDCT screening occurs, the patient must receive a written order for LDCT lung cancer screening during a lung cancer screening counseling and shared decision-making visit
Counseling and Shared Decision-Making visits must include the following elements and be appropriately documented in the patient’s medical record
Elements of a Counseling and Shared Decision-Making Visit
• Conducted by a physician or qualified non-physician practitioner
• Determination of patients’ eligibility for screening as stated above
• “Shared decision-making” includes:– Use of one or more decision aids– Benefits and harms of screening – Follow-up diagnostic testing– Over-diagnosis and treatment
Initiative Objectives Increasing Community
Awareness for Early Detection
Evidence-Based
Interventions
Personalized Technical
AssistanceLeveraging
EHR and Data
Provider and Community Education
Michigan Cancer Control
Initiative
Education for Providers• Educate providers related to:
– Procedure benefits and requirements– Benefits of LDCT vs. chest X-ray– Billing requirements– Ordering requirements– Tracking and monitoring eligible patients– Availability of smoking cessation programming
Patient Reminders
• Utilizing EHR– Targeted messaging
through patient portals– Retrospective
identification of eligible patients
• Updating current patient recall methods– Letters, emails, texting,
widgit
Provider Reminders• Utilizing EHR
– Updating and implementing clinical decision support (CDS) and point-of-care alerts based on patient criteria
– Implementing and refining practice-wide screening protocols
NCCN Clinical Practice Guidelines of Oncology, Lung Cancer Screening, 2016,
Resources & Small Media• Updated screening
recommendations• Current news and legislation
relating to cancer screening• Financial assistance
resources• Provider- and patient-facing
tools– Pack year calculator
(http://www.shouldiscreen.com/pack-year-calculator/)
Provider Assessment & Feedback
• Benchmark screening data on multiple levels:– Provider– Practice– Health System– All Participants
• Focus and individualize technical assistance
Program Partner Success
May 2016
Average of 3 to 4 patients
per month
Today
Average of 8 to 10 patients
per month
Today
Average of 14 patients per
month
QUESTIONS?
Tesia Looper, MSAQuality Program Manager
Elise DeYoung, MPHQuality Consultant
References1. LungRADS Assessment Categories. American College of Radiology. https://www.acr.org/Quality-Safety/Resources/LungRADS2. Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. The New England Journal of Medicine.
http://www.nejm.org/doi/full/10.1056/NEJMoa1102873#t=article3. Lung Cancer: Screening. U.S. Preventive Services Task Force.
https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening4. Lung Cancer in Michigan. MDHHS. http://www.michigan.gov/documents/mdch/LungCaFactSheet_497920_7.pdf5. Michigan Cancer Consortium Tool of the Month. November is National Lung Cancer Awareness Month.
http://www.michigancancer.org/PDFs/ToolOfTheMonth/November2016.pdf6. State Cancer Profiles. CDC.
https://statecancerprofiles.cancer.gov/map/map.withimage.php?26&001&047&00&0&01&0&1&5&0#results7. Age-Adjusted Invasive Cancer Incidence Rates in Michigan. Michigan Cancer Surveillance Program. http://www.cancer-
rates.info/mi/8. Cancer Statistics Center. American Cancer Society.
https://cancerstatisticscenter.cancer.org/?_ga=1.55783851.1299241662.1479700022#/state/Michigan9. Screen for Life: National Colorectal Cancer Action Campaign. https://www.cdc.gov/cancer/colorectal/sfl/index.htm10. Clinical Protocol for the Early Detection of Colorectal Cancer (CRC), March 2017.
http://www.michigancancer.org/colorectal/PDFs/Guidelines/CRCClinicalProtocol.pdf11. Michigan Tobacco Quitline. https://michigan.quitlogix.org/12. The Great American Smokeout. American Cancer Society.
https://www.cancer.org/healthy/stay-away-from-tobacco/great-american-smokeout.html13. Lung Cancer CT Screening: Should I get screened? University of Michigan. http://www.shouldiscreen.com/14. About Lung Cancer: Pack year calculator. University of Michigan. http://www.shouldiscreen.com/pack-year-calculator/15. Michigan Cancer Control Initiative Webinar Schedule. MPRO.
http://media.wix.com/ugd/50392a_000ca8eb677d4880ae349db4bb21d960.pdf16. Lung Cancer Screening Decision Tools: Patient and Provider versions. MPRO. http://www.mpro.org/lung-cancer