WV Lung Cancer Project CE video


Thank you for participating in today’s Continuing
Education Program. It is being offered through the West Virginia
University Cancer Institute’s Cancer Prevention and Control, the West Virginia Lung Cancer
Project, and West Virginia’s statewide cancer coalition, Mountains of Hope. After today’s session, you should be able
to explain the current lung cancer screening guidelines, demonstrate competence using at
least one shared decision-making tool, and correctly fill out an order for a low-dose
CT for lung cancer screening. To give you a background of why lung cancer
screening is so important, we want to first review some of the data that led to the West Virginia Lung Cancer Project and the need to offer this program to health professionals. In West Virginia, almost 27% of adults smoke. Smoking is the leading cause of lung cancer. About 80% of lung cancer deaths are caused
by smoking, and many others are caused by exposure to secondhand smoke. West Virginia has a higher rate of lung cancer than the
nation as a whole. Cancer is the leading cause of death in West Virginia. And, lung cancer is the leading cause of cancer
deaths in the state. So, as you can see, screening for lung cancer
is an important tool in increasing the health equity within the state. Screening guidelines are provided through
the US Preventive Services Taskforce, or USPSTF. Their lung cancer screening recommendations came out in 2013 and received a grade of “B”. The grade B rating indicates that the USPSTF recommended the service and that there is high certainty that the net benefit is moderate
or there is moderate certainty that the net benefit is moderate to substantial. The screening guidelines indicated that yearly low-dose CT is recommended for people who: are 55 to 80 years old, and have a 30 pack-year smoking history, and are either current smokers or have quit in
the past 15 years. The Centers for Medicare and Medicaid Services
have their own guidelines, and although similar, a few of their eligibility criteria are different. They are: age 55 to 77, and asymptomatic, and have a 30 pack-year history, and be a current smoker, or one who has quit within
the last 15 years, and receive a written order for LDCT from a qualified
healthcare provider. In addition, for the initial LDCT screening,
they must receive a written order during a lung cancer screening counseling visit and
shared decision-making visit (sometimes referred to as the clinical encounter), furnished by a physician or qualified non-physician practitioner such as a physician’s assistant, nurse practitioner,
or clinical nurse specialist. This can be completed during a visit for other
services as long as it is documented and the correct CPT codes are used. The clinical encounter must be appropriately
documented in the beneficiary’s medical record and include the following information: Determination of eligibility. Shared decision making, including the use
of one or more decision aids. Counseling on:
The importance of adherence to annual lung cancer LDCT screening, impact of comorbidities, and ability or willingness to undergo diagnosis
and treatment. Counseling on:
The importance of maintaining cigarette smoking abstinence if a former smoker, or the importance of smoking cessation if a current smoker, and if appropriate, furnishing of information about tobacco cessation. If appropriate, the furnishing of a written
order for lung cancer screening with LDCT. This slide and the next one are to give a
quick visual of the amount of cigarettes a person has to smoke in order to be eligible. At a minimum, a person has to have at least
a 30 pack-year history to meet screening criteria. At one pack per day for 30 years, they would
smoke at least 10,957 packs of cigarettes. If those packs were stacked end to end it
would be equivalent to the height of two Empire State Buildings. Or, 219,140 cigarettes at a MINIMUM!!! That’s 17 Empire State Buildings if the
cigarettes were stacked end to end. Before we go into the process of writing an
order, we want to review eligibility first, with a few case studies. For these studies, the date of the clinical
encounter is July 1, 2017. Nurse: Hello, I’m Gwen. As part of your appointment today I’d
like to review your smoking history. Male: Okay, that’s fine. Nurse: Can you confirm your date of birth? Male: It’s April 7th, 1962. Nurse: Thank you. And, do you currently smoke? Male: Yes. Yes, I do. Nurse: Okay. And, how long have you smoked? Male: It’s been about 40 years now. Nurse: About 40 years. And, how many packs a day would you say you smoke? Male: I smoke about two packs a day. Nurse: About two packs a day. Thank you. Narrator: Is this person eligible for LDCT? YES – he is between the ages of 55 and 77
(for Medicaid) and 80 for other insurers and he has a greater than 30 pack-year history. Nurse: Hello, I’m Gwen. Hi, Gwen. Nice to meet you. Nurse: I’m here to assess your smoking history for part of your appointment today. Female: Okay. Nurse: Can you confirm your date of birth for me? Female: Uh huh. 9-16-63. Nurse: And, do you currently smoke? Female: Yes. Nurse: Okay, and how long have you smoked? Female: Oh, about 20 years. Nurse: About 20 years. How many packs a day would you say you smoke? Female: Oh, about a half a pack. Nurse: About a half a pack. Okay. Thank you. Female: You’re welcome. Narrator: Is this person eligible for LDCT? NO – she is not over 55 and she does not
have a 30 pack-year history. Nurse: Hi, I’m Gwen. Male: Hi. I’m going to review your smoking history. Male: Uh, alright. Nurse: What’s your date of birth? Male: Uh, March 12th, 1956.
Nurse: Okay. Thank you. And, do you smoke? Male: I used to.
Nurse: Used to. Nurse: How long ago did you quit? Male: Hmm, 2014. So two years, three years. Nurse: Three years, now. Okay. Congratulations! Male: Oh, thanks.
Nurse: How long did you smoke before you quit? Male: Oh, 35 – 36 years.
Nurse: Okay. And, how many packs a day would you say you smoked during that time? Male: A pack a day. Nurse: About a pack a day–
Male: Most days, sometimes more. Usually, just a pack. Nurse: Sounds good! Thank you.
Male: Uh huh. Narrator: Is this person eligible for LDCT? YES – he is between the ages of 55 and 77
(for Medicaid) and 80 for other insurers, he quit smoking less than 15 years ago, and
he has a greater than 30 pack-year history. There are several different decision aids
available for providers to use during the clinical encounter. Health systems may want to develop one of
their own, but here are a few of the most widely-used tools. It doesn’t matter which decision aid is
used, as long as one is used, and its use is documented in the patient’s medical records. This is an online tool provided by Memorial
Sloan Kettering Cancer Center. It can be found at: http://nomograms.mskcc.org/Lung/Screening.aspx The University of Michigan also has an online tool available at www.shouldiscreen.com. The Agency for Healthcare Research and Quality
(AHRQ) offers a paper version using a checklist that highlights the main points. It was designed specifically to meet the CMS
criteria for lung cancer screening counseling and shared decision-making visits. Here are a few of the other decision aids available. As we already stated, it doesn’t matter
which one is used as long it is used and documented. After the clinical encounter is over, and a
patient is determined to be eligible for LDCT, an order must be written. The written order for all LDCT lung cancer
screenings MUST include: Date of birth, actual pack-year smoking history (the number) 30 pack-years, 45 pack-years, etc., current smoking status, and for former smokers, the number of years since quitting smoking, statement that the beneficiary is asymptomatic, and the National Provider Identifier (NPI) of the ordering practitioner. What is different with annual years? For subsequent LDCT lung cancer screenings
the beneficiary must receive a written order for LDCT lung cancer screening, which may
be furnished during any appropriate visit with a physician or qualified non-physician
practitioner. If the provider elects to provide a lung cancer screening counseling and shared decision-making visit for subsequent lung cancer screenings, the visit must meet the criteria already described. For most providers, this is a straight-forward
calculation. It is the number of packs a day a person smokes
multiplied by the number of years smoking. This will give you their pack-year history. For example, if a member is 65 years old and
a current smoker who smokes 1.5 packs a day and has done so for 25 years, we would multiply 1.5 packs a day by 25 years to get a 37 1/2 a half pack-year history. If a person has started and stopped a few
times, then look at the big picture. When did they start smoking and how much did they smoke while they were actively smoking? Unless there are several years of smoking
cessation involved, use the overall smoking time frame to do the calculation. At this point in time, when there is a large
time frame of smoking cessation, you will need to use your best judgement on how to accurately calculate the pack-year history. The billing codes for CMS were recently approved by the state of West Virginia. The current procedural terminology (CPT) healthcare common procedure coding system (HCPCS) codes are:
G0296 for the counseling visit, eligibility determination, and shared decision-making
visit, and G0297 for the LDCT for lung cancer screening. During the shared decision-making visit, the
provider needs to make sure that the patient is healthy enough and willing to go through
treatment if cancer is found. In addition, you need to involve the patient
in the discussion while determining their eligibility. Explore the pros and cons, using one or more decision aids. Counsel on the importance of adherence to
annual lung cancer LDCT screening, impact of comorbidities, and ability or willingness to undergo diagnosis and treatment. Counseling on the importance of maintaining
cigarette smoking abstinence, if former smoker, or the importance of smoking cessation if
a current smoker and, if appropriate, furnishing of information about tobacco cessation. Assess the patient’s values and feelings, and reach a decision together If appropriate, the furnishing of a written order for lung cancer screening with LDCT should be completed. To practice using the decision aid, let’s
take a look at a few case studies. Dr.: Ken, I see that the
nurse reviewed your smoking history. It looks like you are eligible for lung cancer
screening. Ken: There’s a test for lung cancer? Dr.: Yeah, it’s a low-dose CT scan. It’s not invasive and you don’t have to
do anything to prepare for it other than just show up. Ken: Okay. That sounds good. Dr.: Like any test or screening, there
are some pros and cons. There is always a chance of a false-positive
result or a possibility that if the scan showed something you would have to have more tests. Plus, there’s some radiation exposure. However, if lung cancer is found through this test, it would be found earlier than if you had come in with symptoms, so it would likely
be at an earlier stage and more treatable. Ken: I like the sound of that. Dr.: Since you’re healthy overall, I feel
comfortable that you would be able to handle the screenings or additional testing if needed
without much trouble. Are you willing and do you think you are able
to do this? Ken: Yeah! Dr.: It’s a yearly screening for cancer, so you would be expected to have the scan done every year. It is covered by insurance, so you wouldn’t have to worry about the cost. Ken: Ok. Dr.: Now, the last thing I want to discuss
is your smoking. I’m sure you’ve been told more than once
how bad smoking is, but I want to go over it again with you. While quitting smoking is hard, it’s not
impossible. Ken: I have tried to quit so many times now, I’ve
lost count. Dr.: It takes many people a lot of tries
to finally quit. At our clinic, we have a few different interventions,
or methods, that we use to help people quit. Here is a list of all of the different interventions we use, including medical and non-medical approaches. We even have support groups that help a lot of people, even if they are using either gum or patch as well. The next group’s going to meets on the 28th at 6pm. Ken: I mean, I’ll give it a try. I’m not even really sure I want to quit. Dr.: I understand. Even if you aren’t ready, I would still like
you to go check out the support group and see what others who are trying to quit have to say. It might spark something for you. Ken: Okay, I’ll give it a try. Dr.: That’s all I’m asking. Now, I know we talked about a lot today,
but I would like to write you an order to get that lung cancer screening. Is that okay? Ken: That sounds good. I’d rather have the test done and find out for sure what’s going on, rather than discover something, you know, horrible, later. Dr.: That’s a great attitude. Let me get it all down. Ken, 4-7-46, 80 pack-year,
current smoker, asymptomatic, and NPI is 86753 . . . Now, that I’ve updated you record, is there anything else you wanted to talk about today? Narrator: In this case, we saw the provider
writing in the patient’s chart, discussing the potential benefits and harms of lung cancer screening, counseling about smoking cessation, and establishing next steps by writing the
order. Dr.: Hi, Jordan. How are you today? Jordan: Hey, Doc. I’m doing fine. Dr.: I have you scheduled for a wellness exam. But, before we get started with that, is there anything you’d like to discuss? Jordan: Well, yeah, actually. A few days ago, we were in town, and we saw this flyer about lung screening. And, Phillis here, said that I should probably talk to you about it. So, I was wondering if you can tell me about it, or, what you know about it? Phyllis: He’d never do anything if I didn’t
make him. Dr.: Well, it’s a great question. It’s just a low-dose CT scan that checks for any abnormalities in the lungs. Now, if I remember correctly, you are 56 years old, smoked for 10 years, and smoked about four packs a day? Jordan: Yeah. That’s right. But, I quit back in 2004, I think. Phyllis: Only ‘cause I made him… Dr.: Well, we appreciate your help. And, good job staying tobacco free. The scan is for people that quit in the last
15 years. We can decide together if it’s something you would be interested in. Let’s go over the pros and cons. Jordan: But, you know I’m feeling pretty good. I’m not having any trouble breathing or anything. Dr.: For someone like yourself who has a heavy history of smoking, tests like this are important to help identify cancer when it’s in an early stage. Lung cancer is very aggressive, and if we wait until symptoms appear, it might already be very advanced. Phyllis: See? It is just like what I told you. Jordan: But, isn’t radiation dangerous? I mean, I don’t want to glow in the dark, or anything. Dr.: There is a risk, as with everything,
but the scan has a very low-dose amount of radiation, up to seven times less than an average regular CT scan. See? Jordan: Oh, ok. Sure. That doesn’t look too bad. Dr.: It’s important for you to know the scan sometimes picks up other things, as well, things that aren’t cancer. And, if we see any of that, we might have to follow it for a while with additional testing. But, the basic scan itself is performed once a year. Jordan: Ok, well. Okay, sure. Phyllis: That sounds expensive. All we have is Medicaid. So, would that be covered? Dr.: Yeah. The screening is covered by insurers, including Medicaid, now. So, you don’t have too worry about the cost. Now that we’ve gone over the details, can you tell me your feelings about the scan? I think you’d be a pretty good candidate. Jordan: Well, I guess when you think about it, I guess I’d rather know than not know. So, can you set me up for the screening? Dr.: Absolutely. I’ll write you a referral now. Also, it’s really important that you continue
to stay away from tobacco products. And, remember, the scan itself will be once a year from now on. Keep up the good work. Jordan: Thanks, Doc. Narrator: Again, we see and hear the provider going over all of the points required in a clinical encounter for lung cancer screening. Dr.: Good afternoon, Mark. You’re here for your annual wellness visit, right? Mark: Yes, I am. Dr.: Good. I’m going to ask you a few questions to
update your chart and see what screenings you should have done this year. Mark: Okay. It says here that you are 59 this year, and
that you quit smoking back in 2016. Mark: Right.
Dr.: How is that going? Do you still have cravings? Mark: Well, I quit for my granddaughter. So, you do just go through it. You do it. It’s fine. Dr.: Are you using any nicotine replacement
at this point? Mark: No, not anymore. I don’t need those. Dr.: When you were smoking, how much did you smoke a day? Mark: Oh. Less than a pack a day. I would always make sure I kept at least 3-4 for the next day, in case, you know, I needed them before I could get another pack. Dr.: Well, it’s good to hear that
you’re doing well being smoke free. I’d like to talk to you about considering beginning lung cancer screenings this year. Mark: Okay. What’s up with that? Dr.: I’m concerned about the damage that
40 years of heavy smoking could have done to your lungs. Once you quit, the lungs can begin to heal,
but it can take a while. When Kaylee asked you to quit, it was because
she wanted you to be healthy, right? Mark: Well, yeah. Dr.: Lung cancer screenings can help us do that. It’s an annual test that finds lung cancer
early when it is most treatable. It is just another way of helping me keep
you healthy. Mark: Is it safe? Are there risks? Dr.: It’s a low-dose CT
scan that you get at your local hospital. They do the scan of your chest and we look
for spots in your lungs that could be cancer. It is safe. The biggest drawback to screening is that
sometimes we find something that looks suspicious, and we order diagnostic tests to check it
out, but might turn out not to be cancer. Mark: That sounds kind of like my wife’s mammograms, then. Dr.: It’s a very similar idea. Once we decide to start lung cancer screenings,
you’ll get a CT scan done once a year, until you are 80, so we can keep an eye on it. Mark: Huh. And what about insurance? Will insurance cover it? Dr.: Insurers do cover it now, including Medicaid. So, you don’t have to worry about costs. Mark: It sounds like we should set that up. Dr.: I think you made a good decision here,
Mark. I’m going to write down your order. Now, tell me if you’re having any other problems today? Mark: Well . . . Narrator: While not every clinical encounter
will result in patients ready and willing to go for a lung cancer screening like these
three cases did, they were done to reiterate the important elements of the clinical encounter. Even if a patient is not ready for screening,
it’s an opportunity for education and discussion. In order for Medicare and Medicaid to pay
for LDCT for lung cancer screening, the screening facility must be on the Lung Cancer Screening Registry. The list is constantly updated as new sites
join the registry. Please use the link on this screen to find
the most up-to-date list for West Virginia. Now, we would like to share with you some BONUS information. As part of the West Virginia Lung Cancer Project, the Patient Advocate Foundation set up a WV Lung Cancer CareLine to offer ancillary support
to lung cancer patients. It is available to anyone in West Virginia who has lung cancer or who is in the process of getting screened or diagnosed for lung cancer. It is free to patients, providers, navigators,
or anyone else authorized to seek assistance on behalf of the patient. The phone number to call them is 1-866-684-2479. The Patient Advocate Foundation has worked
for more than 20 years to assist patients with chronic, life threatening, or debilitating
diagnoses. Their patient services are focused in the
following five core areas of assistance: case management, specialized programs, co-pay relief, partnership programs, and outreach and support programs. In addition to their support of West Virginia lung cancer patients through the CareLine, they offer a wide variety of support in many different
areas, and we hope that you will check them out, and add them as a resource you can use
with your patients. As a review of the material we have covered
today, lung cancer screening requires an ANNUAL screening
for those people who are: Between the ages of 55 and 80 (77 for Medicaid),
and are a current smoker, or who have quit in the last 15 years, and have or had at least a 30 pack-year history. At least one decision-making tool must be used and documented during the clinical encounter. The order for the LDCT needs to include:
The patient’s date of birth, their pack-year smoking history, current smoking status (or number of years since they quit), a statement that the patient is asymptomatic, and the provider’s national provider identifier number. Here are PSAs that were developed, and can be used in offices or other settings. To use them, call Jenny at 304-293-2370. If you are between the ages of 55 – 80, and smoke (or used to smoke) about a pack a day, talk to your doctor about yearly lung cancer screening. Did you know, there is now a screening for lung cancer? If you are a smoker, and between the ages of 55 – 80, and currently smoke (or have quit) within the last 15 years, talk to your doctor today. Lung cancer screening can save lives. ♪ ♫ ♪ What if you could see the danger behind the door before you walked into the trap? Wouldn’t you want to? Now, you can. If you are a smoker, your chances of getting lung cancer are high. But, now, your doctor can check for cancer early with lung cancer screening. It requires a yearly, low-dose CT scan. We already know that early detection saves lives. The life you save could be your own. ♪ ♫ ♪ The West Virginia Lung Cancer Project is working to promote screening for lung cancer in West Virginia, especially in the under-served population. Lung cancer is a very big problem in West Virginia. We have some of the highest smoking rates in the country. Recently, we’ve been seeing more and more female patients who never smoked. Besides smoking yourself, the risk factor of second-hand smoking is a risk factor. So, it’s really important in West Virginia to be screened early for lung cancer, because in West Virginia lung cancer kills more people than breast cancer, or colon cancer, and prostate cancer combined. The screening guidelines include: Those who are 55 – 80 years old, have a 30 pack-year history. That means you smoke an average of one pack a day for 30 years. And, if you’re either currently smoking or have quit in the last 15 years. The nice thing about detecting lung cancer at an earlier stage is, one, you don’t necessarily need as intensive treatments as you might need if you waited for it to be symptomatic later. And, the other thing is that those treatments are much more likely to be effective. The West Virginia Lung Cancer Project came about with a partnership through the Patient Advocate Foundation from a grant they received through the Bristol-Myers Squibb Foundation. So, as a thoracic surgeon, we deal with all the cancers in the chest. And, lung cancer has a special place in my heart, because it is the leading cause of cancer-related death in the world, and the United States, and West Virginia. And, it’s something which is preventable. Prevention and early detection are the best ways for us to improve outcomes for the people of West Virginia. It’s important to talk to your doctor about lung cancer screening. It’s a relatively new thing. And, not all doctors will think to offer it to you. So, if you a history of smoking, you should definitely inquire about it. Just hearing the outcomes of community education and talking with providers, we know that we’re making an impact. People are getting screened earlier, and are being watched and followed, before the disease gets developed to an untreatable state. We now have data that absolutely proves that early detection through screening CT scans can save lives. We’d like to save your life. Contact us to learn more about your lung cancer screening options. ♪ ♫ ♪ My name is Duke Jordan. I’m a Marine Corps vet. I’m a Charleston Police retiree. I’m also an ex-smoker. I had a couple of uncles that worked in the mines that also smoked. And, they passed away due to lung cancer. You know, it was almost as though they were going through torture. And, you know, it was just a slow death. And, you could just see them, kind of, withering away. Every now and then, I do wonder, you know, the time that I put in with cigarettes, cigars being my friends. I’m just wondering will those ever come back and knock at my door? There’s a test out there, I understand. And, I as soon as I can, I will be going in to take that test, because I think it’s a great thing to know: There’s something going on with my body. This test could reveal those things. I’m all for that. I’m going in. ♪ ♫ ♪ Contact us to learn more about your lung cancer screening options. Like a lot of kids, I had a very special, pink blanket that I had with me all the time. And, one of the most stark memories I have is really loving the way that blanket smelled. And, I was living in a household where both of my parents smoked inside, all the time. I’m a registered nurse. And, hearing that something is seen in your mother’s lung that may or may not be cancer, my mind automatically jumped to the worst. We had lost my father to cancer in that past year. And, I immediately thought that I could lose both of my parents in a year from cancer. And, I was scared to death. I picked up smoking when I was a teenager. You know, unfortunately, that turned into a smoking habit for me. My mother and father, my sister smoked at one point. My grandparents had smoked. So, I grew up around it. I have my mother’s genes and I’ve also been around second-hand smoke a lot of my life. And, as I get older, I would definitely talk to my doctor about being screened. I’m 41 now. And, I’ll be planning on having that test when the time comes. I know that it saved my mom’s life. And, I know that it’s saving other patient’s lives. And, I know that it’s available. I know that it is a preventative measure for cancer. And, I know that if my mom had waited that it could have been a much more detrimental outcome for her, and of course, for us, for our family. ♪ ♫ ♪ Contact us to learn more about your lung cancer screening options. ♪ ♫ ♪ My name is Sara Jane Gainor and I’m a cancer survivor. So, I remember when I was young, my parents would smoke in the car, and I would breathe in that smoke. Did that make me want to smoke when I grew up? Or, did that expose me to secondhand smoke and affect my lungs even then? And, now, I wonder, “Did my smoking affect my children?” My family doctor–I was just there for a checkup— and she said to me, “You’re 65 and you used to smoke. I think that you should have a lung cancer screening.” And, then, they called me, and said, “We found something on your scan.” And, it was malignant. It was adenocarcinoma. The same cancer that my mother had. It was too late for her. She died of lung cancer. If she had had access to lung cancer screening like I did, she wouldn’t have had to die, because they would have found it sooner. That is what’s important about the screening. Lung cancer patients should be able to find their lung cancer early. It can be treated early and they can survive. And, I’m really happy that I can share this message with other people. Most people think that when you have lung cancer, it’s a death sentence. And, it doesn’t have to be anymore. I am healthy. I’m active. You know, I still play with my grandkids. I’m thinking about what’s next in my life. If you are a West Virginian and you are 55 or over, and you have smoked, talk to your doctor about the lung cancer screening. It could save your life. It saved my life. ♪ ♫ ♪ Contact us to learn more about your lung cancer screening options. We would like to recognize and thank all of our partners, volunteers, and staff who made this CE program possible. We hope that with the educational information you just received, you will be better able to serve your patient population and encourage them to get screened for lung cancer.