General Thoracic

Doctors providing primary care services could earn some additional money next year under a new Medicare proposal that would pay them for coordinating the care of their patients who have been discharged from a hospital or nursing home.

Medicare proposes to create a new G code that would allow physicians to bill for postdischarge transitional care services such as obtaining and reviewing the patient’s discharge summary; reviewing diagnostic tests and treatments; updating the medical record within 14 business days post discharge; establishing a new care plan; educating the patient or caregiver within 2 business days post discharge; and communicating with other health care providers.

The G code would apply when a Medicare beneficiary is discharged from an inpatient stay, a skilled nursing facility, an outpatient hospital observation unit, partial hospitalization services, or a community mental health center.

Officials at the Centers for Medicare and Medicaid Services (CMS) estimate that the use of the new G code could increase payments to family physicians by 7%; other doctors who provide primary care services could see a bump of 3%-5% starting in January 2013.

"Helping primary care doctors will help improve patient care and lower health care costs long term," CMS Acting Administrator Marilyn B. Tavenner said in a statement.

The news that CMS will pay physicians specifically for providing these non face-to-face postdischarge services is "very encouraging," said Shari Erickson, director of regulatory and insurer affairs at the American College of Physicians. CMS is projecting that most internists will see about a 5% increase in Medicare payments due to the policy change. Ms. Erickson said the amount will vary based on how often different types of physicians bill for the codes.

The rule does not specify which physicians can use the new G code but Medicare will only pay one physician to perform the service. Ms. Erickson said most of the time it will likely be a primary care physician.

The ACP is now waiting to see how the CMS proposal aligns with work already underway by the American Medical Association’s CPT Editorial Panel and its Specialty Society Relative Value Scale Update Committee (RUC) to develop codes for these services.

The addition of the new G code is a "good step," said Dr. Glen Stream, president of the American Academy of Family Physicians. The AAFP has been working on this issue for a while and earlier this year issued recommendations on better ways to pay for primary care services. Dr. Stream said they would next like to see CMS develop evaluation and management codes that are specific to primary care, rather than simply increase payments for the 99213 and 99214 codes that are used by many specialties.

The postdischarge transitional care services plan was part of the 2013 Medicare Physician Fee Schedule proposed rule, which was released July 6.

But the fee schedule proposal is not all good news. The proposed rule also details the 27% across-the-board cut to physician fees scheduled to take effect on Jan. 1. The reduction is required by law, based in part on spending targets set under the Sustainable Growth Rate (SGR) formula, which links fees to changes in the gross domestic product.

That formula has been criticized by physicians and lawmakers for years. While no long-term solution to the SGR problem has ever been formulated, lawmakers have taken short-term measures to keep the physician fee cuts from going into effect over the last several years.

The proposed rule would also mean cuts to payments for many cardiology diagnostic tests. Under the proposal, CMS is seeking to expand its multiple-procedure payment reduction policy to diagnostic tests in both cardiology and ophthalmology.

Starting in January 2013, there would be an across-the-board reduction of 25% to the technical component for second and subsequent procedures performed by the same physician or physicians in the same group practice for the same patient on the same day. The cut will not apply to the professional component of the fee. The proposed rule lists 131 diagnostic cardiovascular services that would be subject to the multiple-procedure payment reduction policy.

Dr. William Zoghbi, president of the American College of Cardiology, said the planned reductions in cardiology diagnostic test fees would be bad for both physicians and patients. "This policy disadvantages physicians who aim for efficiency, and reduces payments based on a misguided understanding of how different services, such as echocardiology and SPECT imaging, are from one another," Dr. Zoghbi said in a statement. "Furthermore, it would lead to a major inconvenience to patients."

The 2013 fee schedule proposal also outlines the implementation of the physician value-based payment modifier, which adjusts physician payments based on the quality and cost of the care they provide. The program, which was mandated under the Affordable Care Act, will be phased in over 3 years starting in 2015.

The proposed rule also would implement the physician value-based payment modifier for all medical groups with 25 or more eligible providers starting in 2015.

Groups that do not participate in the Physician Quality Reporting System would see a 1% cut in Medicare payments. Groups that do participate would be paid in part based on their performance.

Groups with higher quality and lower costs would be paid more, and those with lower quality and higher costs would be paid less, according to CMS. The payment adjustments made in 2015 will be based on 2013 performance in the PQRS.

CMS will publish the proposed rule in the Federal Register on July 30, and will accept public comments until Sept. 4. The agency plans to finalize the physician payment rule by Nov. 1.

Doctors providing primary care services could earn some additional money next year under a new Medicare proposal that would pay them for coordinating the care of their patients who have been discharged from a hospital or nursing home.

Medicare proposes to create a new G code that would allow physicians to bill for postdischarge transitional care services such as obtaining and reviewing the patient’s discharge summary; reviewing diagnostic tests and treatments; updating the medical record within 14 business days post discharge; establishing a new care plan; educating the patient or caregiver within 2 business days post discharge; and communicating with other health care providers.

The G code would apply when a Medicare beneficiary is discharged from an inpatient stay, a skilled nursing facility, an outpatient hospital observation unit, partial hospitalization services, or a community mental health center.

Officials at the Centers for Medicare and Medicaid Services (CMS) estimate that the use of the new G code could increase payments to family physicians by 7%; other doctors who provide primary care services could see a bump of 3%-5% starting in January 2013.

"Helping primary care doctors will help improve patient care and lower health care costs long term," CMS Acting Administrator Marilyn B. Tavenner said in a statement.

The news that CMS will pay physicians specifically for providing these non face-to-face postdischarge services is "very encouraging," said Shari Erickson, director of regulatory and insurer affairs at the American College of Physicians. CMS is projecting that most internists will see about a 5% increase in Medicare payments due to the policy change. Ms. Erickson said the amount will vary based on how often different types of physicians bill for the codes.

The rule does not specify which physicians can use the new G code but Medicare will only pay one physician to perform the service. Ms. Erickson said most of the time it will likely be a primary care physician.

The ACP is now waiting to see how the CMS proposal aligns with work already underway by the American Medical Association’s CPT Editorial Panel and its Specialty Society Relative Value Scale Update Committee (RUC) to develop codes for these services.

The addition of the new G code is a "good step," said Dr. Glen Stream, president of the American Academy of Family Physicians. The AAFP has been working on this issue for a while and earlier this year issued recommendations on better ways to pay for primary care services. Dr. Stream said they would next like to see CMS develop evaluation and management codes that are specific to primary care, rather than simply increase payments for the 99213 and 99214 codes that are used by many specialties.

The postdischarge transitional care services plan was part of the 2013 Medicare Physician Fee Schedule proposed rule, which was released July 6.

But the fee schedule proposal is not all good news. The proposed rule also details the 27% across-the-board cut to physician fees scheduled to take effect on Jan. 1. The reduction is required by law, based in part on spending targets set under the Sustainable Growth Rate (SGR) formula, which links fees to changes in the gross domestic product.

That formula has been criticized by physicians and lawmakers for years. While no long-term solution to the SGR problem has ever been formulated, lawmakers have taken short-term measures to keep the physician fee cuts from going into effect over the last several years.

The proposed rule would also mean cuts to payments for many cardiology diagnostic tests. Under the proposal, CMS is seeking to expand its multiple-procedure payment reduction policy to diagnostic tests in both cardiology and ophthalmology.

Starting in January 2013, there would be an across-the-board reduction of 25% to the technical component for second and subsequent procedures performed by the same physician or physicians in the same group practice for the same patient on the same day. The cut will not apply to the professional component of the fee. The proposed rule lists 131 diagnostic cardiovascular services that would be subject to the multiple-procedure payment reduction policy.

Dr. William Zoghbi, president of the American College of Cardiology, said the planned reductions in cardiology diagnostic test fees would be bad for both physicians and patients. "This policy disadvantages physicians who aim for efficiency, and reduces payments based on a misguided understanding of how different services, such as echocardiology and SPECT imaging, are from one another," Dr. Zoghbi said in a statement. "Furthermore, it would lead to a major inconvenience to patients."

The 2013 fee schedule proposal also outlines the implementation of the physician value-based payment modifier, which adjusts physician payments based on the quality and cost of the care they provide. The program, which was mandated under the Affordable Care Act, will be phased in over 3 years starting in 2015.

The proposed rule also would implement the physician value-based payment modifier for all medical groups with 25 or more eligible providers starting in 2015.

Groups that do not participate in the Physician Quality Reporting System would see a 1% cut in Medicare payments. Groups that do participate would be paid in part based on their performance.

Groups with higher quality and lower costs would be paid more, and those with lower quality and higher costs would be paid less, according to CMS. The payment adjustments made in 2015 will be based on 2013 performance in the PQRS.

CMS will publish the proposed rule in the Federal Register on July 30, and will accept public comments until Sept. 4. The agency plans to finalize the physician payment rule by Nov. 1.

Doctors providing primary care services could earn some additional money next year under a new Medicare proposal that would pay them for coordinating the care of their patients who have been discharged from a hospital or nursing home.

Medicare proposes to create a new G code that would allow physicians to bill for postdischarge transitional care services such as obtaining and reviewing the patient’s discharge summary; reviewing diagnostic tests and treatments; updating the medical record within 14 business days post discharge; establishing a new care plan; educating the patient or caregiver within 2 business days post discharge; and communicating with other health care providers.

The G code would apply when a Medicare beneficiary is discharged from an inpatient stay, a skilled nursing facility, an outpatient hospital observation unit, partial hospitalization services, or a community mental health center.

Officials at the Centers for Medicare and Medicaid Services (CMS) estimate that the use of the new G code could increase payments to family physicians by 7%; other doctors who provide primary care services could see a bump of 3%-5% starting in January 2013.

"Helping primary care doctors will help improve patient care and lower health care costs long term," CMS Acting Administrator Marilyn B. Tavenner said in a statement.

The news that CMS will pay physicians specifically for providing these non face-to-face postdischarge services is "very encouraging," said Shari Erickson, director of regulatory and insurer affairs at the American College of Physicians. CMS is projecting that most internists will see about a 5% increase in Medicare payments due to the policy change. Ms. Erickson said the amount will vary based on how often different types of physicians bill for the codes.

The rule does not specify which physicians can use the new G code but Medicare will only pay one physician to perform the service. Ms. Erickson said most of the time it will likely be a primary care physician.

The ACP is now waiting to see how the CMS proposal aligns with work already underway by the American Medical Association’s CPT Editorial Panel and its Specialty Society Relative Value Scale Update Committee (RUC) to develop codes for these services.

The addition of the new G code is a "good step," said Dr. Glen Stream, president of the American Academy of Family Physicians. The AAFP has been working on this issue for a while and earlier this year issued recommendations on better ways to pay for primary care services. Dr. Stream said they would next like to see CMS develop evaluation and management codes that are specific to primary care, rather than simply increase payments for the 99213 and 99214 codes that are used by many specialties.

The postdischarge transitional care services plan was part of the 2013 Medicare Physician Fee Schedule proposed rule, which was released July 6.

But the fee schedule proposal is not all good news. The proposed rule also details the 27% across-the-board cut to physician fees scheduled to take effect on Jan. 1. The reduction is required by law, based in part on spending targets set under the Sustainable Growth Rate (SGR) formula, which links fees to changes in the gross domestic product.

That formula has been criticized by physicians and lawmakers for years. While no long-term solution to the SGR problem has ever been formulated, lawmakers have taken short-term measures to keep the physician fee cuts from going into effect over the last several years.

The proposed rule would also mean cuts to payments for many cardiology diagnostic tests. Under the proposal, CMS is seeking to expand its multiple-procedure payment reduction policy to diagnostic tests in both cardiology and ophthalmology.

Starting in January 2013, there would be an across-the-board reduction of 25% to the technical component for second and subsequent procedures performed by the same physician or physicians in the same group practice for the same patient on the same day. The cut will not apply to the professional component of the fee. The proposed rule lists 131 diagnostic cardiovascular services that would be subject to the multiple-procedure payment reduction policy.

Dr. William Zoghbi, president of the American College of Cardiology, said the planned reductions in cardiology diagnostic test fees would be bad for both physicians and patients. "This policy disadvantages physicians who aim for efficiency, and reduces payments based on a misguided understanding of how different services, such as echocardiology and SPECT imaging, are from one another," Dr. Zoghbi said in a statement. "Furthermore, it would lead to a major inconvenience to patients."

The 2013 fee schedule proposal also outlines the implementation of the physician value-based payment modifier, which adjusts physician payments based on the quality and cost of the care they provide. The program, which was mandated under the Affordable Care Act, will be phased in over 3 years starting in 2015.

The proposed rule also would implement the physician value-based payment modifier for all medical groups with 25 or more eligible providers starting in 2015.

Groups that do not participate in the Physician Quality Reporting System would see a 1% cut in Medicare payments. Groups that do participate would be paid in part based on their performance.

Groups with higher quality and lower costs would be paid more, and those with lower quality and higher costs would be paid less, according to CMS. The payment adjustments made in 2015 will be based on 2013 performance in the PQRS.

CMS will publish the proposed rule in the Federal Register on July 30, and will accept public comments until Sept. 4. The agency plans to finalize the physician payment rule by Nov. 1.

The Supreme Court's decision to largely uphold the Affordable Care Act in essence preserved the status quo for the health system and took away some uncertainty - but only in the short term. The congressional and presidential elections in November could bring further changes to the law.

For now, though, the nation's physicians are pondering the court's ruling and how it will affect their practices. Concerns remain regarding some aspects of the law, and there is uncertainty on what the justices' Medicaid decision means.

Christian Shalgian, director of the division of advocacy and health policy at the American College of Surgeons, said he was surprised by the ruling, adding that surgeons are more concerned about what the law doesn't do than what it does.

"The biggest issue in my mind [with] the Affordable Care Act is what's not included in the [law]," said Mr. Shalgian. "The Medicare physician payment issue is one that's driving health care costs, and it needs to be fixed."

However, many other physician groups praised the court's opinions, noting that keeping the law in place would increase health care coverage and maintain the ACA's enhanced preventive care benefits.

"We are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy," said Dr. Jeremy Lazarus, president of the American Medical Association, in a statement. "This decision protects important improvements, such as ending coverage denials due to preexisting conditions and lifetime caps on insurance and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies."

Dr. David L. Bronson, president of the American College of Physicians, noted in a statement that although the group did not take a position on the constitutional issues, "we believe that the individual insurance mandate, combined with the ACA's subsidies to buy qualified coverage through state marketplaces (exchanges), Medicaid expansion to more low-income persons, and consumer protections against insurance practices that deny or limit coverage, are the most effective ways to expand coverage to nearly all Americans."

The American Academy of Family Physicians said that keeping the law in place will also allow the continuation of efforts to boost the breadth and depth of primary care.

"The Supreme Court decision maintains already-launched initiatives that support wider implementation of the patient-centered medical home and that value primary medical care through payment incentives for primary care physicians," said Dr. Glen Stream, AAFP president, in a statement.

Oncologists noted that they were pleased that many provisions that protect cancer patients would continue to stay intact, such as coverage for preventive screenings like colonoscopies and mammograms, the elimination of lifetime caps and preexisting condition exclusions for insurance plans, and the requirement that private insurers cover the cost of participating in clinical trials.

Cardiologists also applauded the fact that provisions ensuring preventive care and coverage of preexisting conditions would stay in place. American College of Cardiology president William Zoghbi said in a statement that the organization "favors provisions in the law that support preventive care, access to care, elimination of waste, and a payment system that encourages quality." However, the transformation is not complete. "Hard work remains ahead before we arrive at a sustainable payment system that emphasizes value and a strong patient-doctor relationship," said Dr. Zoghbi.

Because the law basically remains the same - for now - the 2.3% excise tax on medical devices will still go into effect on Jan. 1, 2013. AdvaMed, an industry lobbying group, said that it will continue to try to overturn that tax, which could end up driving up the cost of devices such as pacemakers.

The largely positive statements from organized medicine did not hide the fact that many individual physicians are still fearful of the law's effect on their practice.

In a survey of 644 primary care physicians that was conducted the day the Supreme Court ruled, 66% of respondents said that they did not believe the law could achieve health care coverage for all Americans. The poll was conducted by MDLinx, a Web-based information provider for doctors. "The survey showed a surprisingly high level of skepticism among primary care physicians," said Stephen Smith, chief marketing officer for MDLinx, in a statement. The poll also found that only 21% said that increased patient volume would have an "extremely positive" impact on their medical practice. Almost half said it would have an "extremely negative" impact. Respondents expressed concerns about the shortage of primary care doctors.

And most physician organizations indicated their continuing dissatisfaction with some parts of the law, including the Independent Payment Advisory Board, or IPAB, and the lack of any concrete malpractice reform.

The American Association of Clinical Urologists (AACU), the American Urological Association (AUA), and the Large Urology Group Practice Association (LUGPA) issued a joint statement, noting that "we are concerned that there are key aspects to this law that will, ultimately, hurt this nation's ability to provide widespread care for its citizens," including the IPAB. Mr. Shalgian said that the IPAB has been an issue for the ACS since it was first proposed.

At a press briefing called by the Republican Doctors Caucus, Rep. Phil Gingrey (R-Ga.), an ob.gyn., said that he and his fellow caucus members would work to overturn most if not all of the ACA, starting with the IPAB.

Some of Rep. Gingrey's colleagues were adamant that they'd do everything possible to overturn the law. Rep. Tom Price (R-Ga.), an orthopedic surgeon, said that the ACA "violates accessibility, violates affordability, violates quality, violates choices."

Rep. Paul Broun (R-Ga.) called the Act a "destroyer." He said it would "destroy a patient's ability to go to see a doctor and get the quality care they desperately need." Added Dr. Broun, "Obamacare must be repealed. It must be replaced with some policy that will make health care cheaper for everyone, provide coverage for all Americans, and save Medicare from going broke."

With the Supreme Court's efforts in the rear-view mirror, Republicans renewed their vow to repeal all or part of the ACA; however, that's unlikely to happen as long as Democrats maintain control of the Senate and the White House.

If Republicans win a majority in the Senate in November, and if Mitt Romney wins the presidential election, there could be major change.

In the meantime, most physician groups said they would work to fix the parts of the law that were objectionable.

Mr. Shalgian said that the ACS will be exploring options for medical liability reform during the annual Clinical Congress in Chicago.

Dr. Stream of the AAFP said that such reform is essential. "The [ACA] provides a foundation for reforming our health care system, but much work still lies ahead including a permanent replacement for the Sustainable Growth Rate formula and meaningful medical liability reform," he said.

Dr. Bronson of the ACP said that the organization realizes that "even with the Supreme Court's ruling, the political debate over the ACA continues and that its future is a major issue in the 2012 election."

He added, "We hope that a day will come when the debate will no longer be polarized between repeal on one hand, or keeping the law exactly as it is on the other, but on preserving all of the good things that it does while making needed improvements," among which would be "meaningful reforms to the medical liability system."

The Supreme Court's decision to largely uphold the Affordable Care Act in essence preserved the status quo for the health system and took away some uncertainty - but only in the short term. The congressional and presidential elections in November could bring further changes to the law.

For now, though, the nation's physicians are pondering the court's ruling and how it will affect their practices. Concerns remain regarding some aspects of the law, and there is uncertainty on what the justices' Medicaid decision means.

Christian Shalgian, director of the division of advocacy and health policy at the American College of Surgeons, said he was surprised by the ruling, adding that surgeons are more concerned about what the law doesn't do than what it does.

"The biggest issue in my mind [with] the Affordable Care Act is what's not included in the [law]," said Mr. Shalgian. "The Medicare physician payment issue is one that's driving health care costs, and it needs to be fixed."

However, many other physician groups praised the court's opinions, noting that keeping the law in place would increase health care coverage and maintain the ACA's enhanced preventive care benefits.

"We are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy," said Dr. Jeremy Lazarus, president of the American Medical Association, in a statement. "This decision protects important improvements, such as ending coverage denials due to preexisting conditions and lifetime caps on insurance and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies."

Dr. David L. Bronson, president of the American College of Physicians, noted in a statement that although the group did not take a position on the constitutional issues, "we believe that the individual insurance mandate, combined with the ACA's subsidies to buy qualified coverage through state marketplaces (exchanges), Medicaid expansion to more low-income persons, and consumer protections against insurance practices that deny or limit coverage, are the most effective ways to expand coverage to nearly all Americans."

The American Academy of Family Physicians said that keeping the law in place will also allow the continuation of efforts to boost the breadth and depth of primary care.

"The Supreme Court decision maintains already-launched initiatives that support wider implementation of the patient-centered medical home and that value primary medical care through payment incentives for primary care physicians," said Dr. Glen Stream, AAFP president, in a statement.

Oncologists noted that they were pleased that many provisions that protect cancer patients would continue to stay intact, such as coverage for preventive screenings like colonoscopies and mammograms, the elimination of lifetime caps and preexisting condition exclusions for insurance plans, and the requirement that private insurers cover the cost of participating in clinical trials.

Cardiologists also applauded the fact that provisions ensuring preventive care and coverage of preexisting conditions would stay in place. American College of Cardiology president William Zoghbi said in a statement that the organization "favors provisions in the law that support preventive care, access to care, elimination of waste, and a payment system that encourages quality." However, the transformation is not complete. "Hard work remains ahead before we arrive at a sustainable payment system that emphasizes value and a strong patient-doctor relationship," said Dr. Zoghbi.

Because the law basically remains the same - for now - the 2.3% excise tax on medical devices will still go into effect on Jan. 1, 2013. AdvaMed, an industry lobbying group, said that it will continue to try to overturn that tax, which could end up driving up the cost of devices such as pacemakers.

The largely positive statements from organized medicine did not hide the fact that many individual physicians are still fearful of the law's effect on their practice.

In a survey of 644 primary care physicians that was conducted the day the Supreme Court ruled, 66% of respondents said that they did not believe the law could achieve health care coverage for all Americans. The poll was conducted by MDLinx, a Web-based information provider for doctors. "The survey showed a surprisingly high level of skepticism among primary care physicians," said Stephen Smith, chief marketing officer for MDLinx, in a statement. The poll also found that only 21% said that increased patient volume would have an "extremely positive" impact on their medical practice. Almost half said it would have an "extremely negative" impact. Respondents expressed concerns about the shortage of primary care doctors.

And most physician organizations indicated their continuing dissatisfaction with some parts of the law, including the Independent Payment Advisory Board, or IPAB, and the lack of any concrete malpractice reform.

The American Association of Clinical Urologists (AACU), the American Urological Association (AUA), and the Large Urology Group Practice Association (LUGPA) issued a joint statement, noting that "we are concerned that there are key aspects to this law that will, ultimately, hurt this nation's ability to provide widespread care for its citizens," including the IPAB. Mr. Shalgian said that the IPAB has been an issue for the ACS since it was first proposed.

At a press briefing called by the Republican Doctors Caucus, Rep. Phil Gingrey (R-Ga.), an ob.gyn., said that he and his fellow caucus members would work to overturn most if not all of the ACA, starting with the IPAB.

Some of Rep. Gingrey's colleagues were adamant that they'd do everything possible to overturn the law. Rep. Tom Price (R-Ga.), an orthopedic surgeon, said that the ACA "violates accessibility, violates affordability, violates quality, violates choices."

Rep. Paul Broun (R-Ga.) called the Act a "destroyer." He said it would "destroy a patient's ability to go to see a doctor and get the quality care they desperately need." Added Dr. Broun, "Obamacare must be repealed. It must be replaced with some policy that will make health care cheaper for everyone, provide coverage for all Americans, and save Medicare from going broke."

With the Supreme Court's efforts in the rear-view mirror, Republicans renewed their vow to repeal all or part of the ACA; however, that's unlikely to happen as long as Democrats maintain control of the Senate and the White House.

If Republicans win a majority in the Senate in November, and if Mitt Romney wins the presidential election, there could be major change.

In the meantime, most physician groups said they would work to fix the parts of the law that were objectionable.

Mr. Shalgian said that the ACS will be exploring options for medical liability reform during the annual Clinical Congress in Chicago.

Dr. Stream of the AAFP said that such reform is essential. "The [ACA] provides a foundation for reforming our health care system, but much work still lies ahead including a permanent replacement for the Sustainable Growth Rate formula and meaningful medical liability reform," he said.

Dr. Bronson of the ACP said that the organization realizes that "even with the Supreme Court's ruling, the political debate over the ACA continues and that its future is a major issue in the 2012 election."

He added, "We hope that a day will come when the debate will no longer be polarized between repeal on one hand, or keeping the law exactly as it is on the other, but on preserving all of the good things that it does while making needed improvements," among which would be "meaningful reforms to the medical liability system."

The Supreme Court's decision to largely uphold the Affordable Care Act in essence preserved the status quo for the health system and took away some uncertainty - but only in the short term. The congressional and presidential elections in November could bring further changes to the law.

For now, though, the nation's physicians are pondering the court's ruling and how it will affect their practices. Concerns remain regarding some aspects of the law, and there is uncertainty on what the justices' Medicaid decision means.

Christian Shalgian, director of the division of advocacy and health policy at the American College of Surgeons, said he was surprised by the ruling, adding that surgeons are more concerned about what the law doesn't do than what it does.

"The biggest issue in my mind [with] the Affordable Care Act is what's not included in the [law]," said Mr. Shalgian. "The Medicare physician payment issue is one that's driving health care costs, and it needs to be fixed."

However, many other physician groups praised the court's opinions, noting that keeping the law in place would increase health care coverage and maintain the ACA's enhanced preventive care benefits.

"We are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy," said Dr. Jeremy Lazarus, president of the American Medical Association, in a statement. "This decision protects important improvements, such as ending coverage denials due to preexisting conditions and lifetime caps on insurance and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies."

Dr. David L. Bronson, president of the American College of Physicians, noted in a statement that although the group did not take a position on the constitutional issues, "we believe that the individual insurance mandate, combined with the ACA's subsidies to buy qualified coverage through state marketplaces (exchanges), Medicaid expansion to more low-income persons, and consumer protections against insurance practices that deny or limit coverage, are the most effective ways to expand coverage to nearly all Americans."

The American Academy of Family Physicians said that keeping the law in place will also allow the continuation of efforts to boost the breadth and depth of primary care.

"The Supreme Court decision maintains already-launched initiatives that support wider implementation of the patient-centered medical home and that value primary medical care through payment incentives for primary care physicians," said Dr. Glen Stream, AAFP president, in a statement.

Oncologists noted that they were pleased that many provisions that protect cancer patients would continue to stay intact, such as coverage for preventive screenings like colonoscopies and mammograms, the elimination of lifetime caps and preexisting condition exclusions for insurance plans, and the requirement that private insurers cover the cost of participating in clinical trials.

Cardiologists also applauded the fact that provisions ensuring preventive care and coverage of preexisting conditions would stay in place. American College of Cardiology president William Zoghbi said in a statement that the organization "favors provisions in the law that support preventive care, access to care, elimination of waste, and a payment system that encourages quality." However, the transformation is not complete. "Hard work remains ahead before we arrive at a sustainable payment system that emphasizes value and a strong patient-doctor relationship," said Dr. Zoghbi.

Because the law basically remains the same - for now - the 2.3% excise tax on medical devices will still go into effect on Jan. 1, 2013. AdvaMed, an industry lobbying group, said that it will continue to try to overturn that tax, which could end up driving up the cost of devices such as pacemakers.

The largely positive statements from organized medicine did not hide the fact that many individual physicians are still fearful of the law's effect on their practice.

In a survey of 644 primary care physicians that was conducted the day the Supreme Court ruled, 66% of respondents said that they did not believe the law could achieve health care coverage for all Americans. The poll was conducted by MDLinx, a Web-based information provider for doctors. "The survey showed a surprisingly high level of skepticism among primary care physicians," said Stephen Smith, chief marketing officer for MDLinx, in a statement. The poll also found that only 21% said that increased patient volume would have an "extremely positive" impact on their medical practice. Almost half said it would have an "extremely negative" impact. Respondents expressed concerns about the shortage of primary care doctors.

And most physician organizations indicated their continuing dissatisfaction with some parts of the law, including the Independent Payment Advisory Board, or IPAB, and the lack of any concrete malpractice reform.

The American Association of Clinical Urologists (AACU), the American Urological Association (AUA), and the Large Urology Group Practice Association (LUGPA) issued a joint statement, noting that "we are concerned that there are key aspects to this law that will, ultimately, hurt this nation's ability to provide widespread care for its citizens," including the IPAB. Mr. Shalgian said that the IPAB has been an issue for the ACS since it was first proposed.

At a press briefing called by the Republican Doctors Caucus, Rep. Phil Gingrey (R-Ga.), an ob.gyn., said that he and his fellow caucus members would work to overturn most if not all of the ACA, starting with the IPAB.

Some of Rep. Gingrey's colleagues were adamant that they'd do everything possible to overturn the law. Rep. Tom Price (R-Ga.), an orthopedic surgeon, said that the ACA "violates accessibility, violates affordability, violates quality, violates choices."

Rep. Paul Broun (R-Ga.) called the Act a "destroyer." He said it would "destroy a patient's ability to go to see a doctor and get the quality care they desperately need." Added Dr. Broun, "Obamacare must be repealed. It must be replaced with some policy that will make health care cheaper for everyone, provide coverage for all Americans, and save Medicare from going broke."

With the Supreme Court's efforts in the rear-view mirror, Republicans renewed their vow to repeal all or part of the ACA; however, that's unlikely to happen as long as Democrats maintain control of the Senate and the White House.

If Republicans win a majority in the Senate in November, and if Mitt Romney wins the presidential election, there could be major change.

In the meantime, most physician groups said they would work to fix the parts of the law that were objectionable.

Mr. Shalgian said that the ACS will be exploring options for medical liability reform during the annual Clinical Congress in Chicago.

Dr. Stream of the AAFP said that such reform is essential. "The [ACA] provides a foundation for reforming our health care system, but much work still lies ahead including a permanent replacement for the Sustainable Growth Rate formula and meaningful medical liability reform," he said.

Dr. Bronson of the ACP said that the organization realizes that "even with the Supreme Court's ruling, the political debate over the ACA continues and that its future is a major issue in the 2012 election."

He added, "We hope that a day will come when the debate will no longer be polarized between repeal on one hand, or keeping the law exactly as it is on the other, but on preserving all of the good things that it does while making needed improvements," among which would be "meaningful reforms to the medical liability system."

San Francisco – The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTDB) is the largest clinical thoracic surgical database in the United States. However, it is not known whether the outstanding outcomes for esophageal cancer resection from the GTDB are representative of nationwide results, said Dr. Benjamin D. Kozower at the annual meeting of the American Association for Thoracic Surgery. He and his colleagues at the University of Virginia performed a study to see if GTDB esophagectomy outcomes are representative of nationwide outcomes by comparing them to other national clinical and administrative databases.

From 2002 to 2008, esophageal cancer resection outcomes from the GTDB were compared with the National Surgery Quality Improvement Program (NSQIP) and the Nationwide Inpatient Sample (NIS), the largest all-payer, inpatient care database in the United States. Primary outcomes were the number of procedures reported from each database and differences in mortality and resource utilization. Observed differences in patient characteristics and postoperative events were also analyzed.

Annual esophageal resection volume has increased over time. However, the GTDB (n = 6,740) and NSQIP (n = 1,030) capture only a small proportion of resections performed nationally: 30% and 5%, respectively. Median patient age was between 64 and 65 years; between 18% and 21% were women, similar in all three databases. Mortality was significantly lower within the GTDB (3.2%) and NSQIP (2.6%) compared with the NIS (6.1%). In addition, the median length of stay was lower in the GTDB (10 days) compared with both the NSQIP (12 days) and NIS (12 days).

"The STS GTDB reports outstanding mortality results and hospital resource utilization for esophageal cancer resection. However, surgical outcomes from the STS GTDB are not representative of national results from programs not participating in the database," said Dr. Kozower.

"These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and utilization of the STS GTDB," he concluded.

San Francisco – The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTDB) is the largest clinical thoracic surgical database in the United States. However, it is not known whether the outstanding outcomes for esophageal cancer resection from the GTDB are representative of nationwide results, said Dr. Benjamin D. Kozower at the annual meeting of the American Association for Thoracic Surgery. He and his colleagues at the University of Virginia performed a study to see if GTDB esophagectomy outcomes are representative of nationwide outcomes by comparing them to other national clinical and administrative databases.

From 2002 to 2008, esophageal cancer resection outcomes from the GTDB were compared with the National Surgery Quality Improvement Program (NSQIP) and the Nationwide Inpatient Sample (NIS), the largest all-payer, inpatient care database in the United States. Primary outcomes were the number of procedures reported from each database and differences in mortality and resource utilization. Observed differences in patient characteristics and postoperative events were also analyzed.

Annual esophageal resection volume has increased over time. However, the GTDB (n = 6,740) and NSQIP (n = 1,030) capture only a small proportion of resections performed nationally: 30% and 5%, respectively. Median patient age was between 64 and 65 years; between 18% and 21% were women, similar in all three databases. Mortality was significantly lower within the GTDB (3.2%) and NSQIP (2.6%) compared with the NIS (6.1%). In addition, the median length of stay was lower in the GTDB (10 days) compared with both the NSQIP (12 days) and NIS (12 days).

"The STS GTDB reports outstanding mortality results and hospital resource utilization for esophageal cancer resection. However, surgical outcomes from the STS GTDB are not representative of national results from programs not participating in the database," said Dr. Kozower.

"These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and utilization of the STS GTDB," he concluded.

San Francisco – The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTDB) is the largest clinical thoracic surgical database in the United States. However, it is not known whether the outstanding outcomes for esophageal cancer resection from the GTDB are representative of nationwide results, said Dr. Benjamin D. Kozower at the annual meeting of the American Association for Thoracic Surgery. He and his colleagues at the University of Virginia performed a study to see if GTDB esophagectomy outcomes are representative of nationwide outcomes by comparing them to other national clinical and administrative databases.

From 2002 to 2008, esophageal cancer resection outcomes from the GTDB were compared with the National Surgery Quality Improvement Program (NSQIP) and the Nationwide Inpatient Sample (NIS), the largest all-payer, inpatient care database in the United States. Primary outcomes were the number of procedures reported from each database and differences in mortality and resource utilization. Observed differences in patient characteristics and postoperative events were also analyzed.

Annual esophageal resection volume has increased over time. However, the GTDB (n = 6,740) and NSQIP (n = 1,030) capture only a small proportion of resections performed nationally: 30% and 5%, respectively. Median patient age was between 64 and 65 years; between 18% and 21% were women, similar in all three databases. Mortality was significantly lower within the GTDB (3.2%) and NSQIP (2.6%) compared with the NIS (6.1%). In addition, the median length of stay was lower in the GTDB (10 days) compared with both the NSQIP (12 days) and NIS (12 days).

"The STS GTDB reports outstanding mortality results and hospital resource utilization for esophageal cancer resection. However, surgical outcomes from the STS GTDB are not representative of national results from programs not participating in the database," said Dr. Kozower.

"These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and utilization of the STS GTDB," he concluded.

San Francisco – The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTDB) is the largest clinical thoracic surgical database in the United States. However, it is not known whether the outstanding outcomes for esophageal cancer resection from the GTDB are representative of nationwide results, said Dr. Benjamin D. Kozower at the annual meeting of the American Association for Thoracic Surgery. He and his colleagues at the University of Virginia performed a study to see if GTDB esophagectomy outcomes are representative of nationwide outcomes by comparing them to other national clinical and administrative databases.

From 2002 to 2008, esophageal cancer resection outcomes from the GTDB were compared with the National Surgery Quality Improvement Program (NSQIP) and the Nationwide Inpatient Sample (NIS), the largest all-payer, inpatient care database in the United States. Primary outcomes were the number of procedures reported from each database and differences in mortality and resource utilization. Observed differences in patient characteristics and postoperative events were also analyzed.

Annual esophageal resection volume has increased over time. However, the GTDB (n = 6,740) and NSQIP (n = 1,030) capture only a small proportion of resections performed nationally: 30% and 5%, respectively. Median patient age was between 64 and 65 years; between 18% and 21% were women, similar in all three databases. Mortality was significantly lower within the GTDB (3.2%) and NSQIP (2.6%) compared with the NIS (6.1%). In addition, the median length of stay was lower in the GTDB (10 days) compared with both the NSQIP (12 days) and NIS (12 days).

"The STS GTDB reports outstanding mortality results and hospital resource utilization for esophageal cancer resection. However, surgical outcomes from the STS GTDB are not representative of national results from programs not participating in the database," said Dr. Kozower.

"These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and utilization of the STS GTDB," he concluded.

San Francisco – The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTDB) is the largest clinical thoracic surgical database in the United States. However, it is not known whether the outstanding outcomes for esophageal cancer resection from the GTDB are representative of nationwide results, said Dr. Benjamin D. Kozower at the annual meeting of the American Association for Thoracic Surgery. He and his colleagues at the University of Virginia performed a study to see if GTDB esophagectomy outcomes are representative of nationwide outcomes by comparing them to other national clinical and administrative databases.

From 2002 to 2008, esophageal cancer resection outcomes from the GTDB were compared with the National Surgery Quality Improvement Program (NSQIP) and the Nationwide Inpatient Sample (NIS), the largest all-payer, inpatient care database in the United States. Primary outcomes were the number of procedures reported from each database and differences in mortality and resource utilization. Observed differences in patient characteristics and postoperative events were also analyzed.

Annual esophageal resection volume has increased over time. However, the GTDB (n = 6,740) and NSQIP (n = 1,030) capture only a small proportion of resections performed nationally: 30% and 5%, respectively. Median patient age was between 64 and 65 years; between 18% and 21% were women, similar in all three databases. Mortality was significantly lower within the GTDB (3.2%) and NSQIP (2.6%) compared with the NIS (6.1%). In addition, the median length of stay was lower in the GTDB (10 days) compared with both the NSQIP (12 days) and NIS (12 days).

"The STS GTDB reports outstanding mortality results and hospital resource utilization for esophageal cancer resection. However, surgical outcomes from the STS GTDB are not representative of national results from programs not participating in the database," said Dr. Kozower.

"These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and utilization of the STS GTDB," he concluded.

San Francisco – The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTDB) is the largest clinical thoracic surgical database in the United States. However, it is not known whether the outstanding outcomes for esophageal cancer resection from the GTDB are representative of nationwide results, said Dr. Benjamin D. Kozower at the annual meeting of the American Association for Thoracic Surgery. He and his colleagues at the University of Virginia performed a study to see if GTDB esophagectomy outcomes are representative of nationwide outcomes by comparing them to other national clinical and administrative databases.

From 2002 to 2008, esophageal cancer resection outcomes from the GTDB were compared with the National Surgery Quality Improvement Program (NSQIP) and the Nationwide Inpatient Sample (NIS), the largest all-payer, inpatient care database in the United States. Primary outcomes were the number of procedures reported from each database and differences in mortality and resource utilization. Observed differences in patient characteristics and postoperative events were also analyzed.

Annual esophageal resection volume has increased over time. However, the GTDB (n = 6,740) and NSQIP (n = 1,030) capture only a small proportion of resections performed nationally: 30% and 5%, respectively. Median patient age was between 64 and 65 years; between 18% and 21% were women, similar in all three databases. Mortality was significantly lower within the GTDB (3.2%) and NSQIP (2.6%) compared with the NIS (6.1%). In addition, the median length of stay was lower in the GTDB (10 days) compared with both the NSQIP (12 days) and NIS (12 days).

"The STS GTDB reports outstanding mortality results and hospital resource utilization for esophageal cancer resection. However, surgical outcomes from the STS GTDB are not representative of national results from programs not participating in the database," said Dr. Kozower.

"These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and utilization of the STS GTDB," he concluded.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

The American Lung Association has also thrown its weight behind low-dose CT screening of heavy smokers who meet criteria set forth in the National Lung Screening Trial.

The group emphasized that it does not recommend universal screening at this time, and that it believes chest x-rays should not be used for lung cancer screening. It only recommends low-dose computed axial tomography screening – and only for current or past smokers aged 55-74 years, who have smoked at least 30 pack-years and have no history of lung cancer.

"For those who choose to undergo the screening process, smoking cessation should be continuously emphasized as it remains the best method of reducing lung cancer risk," according to an interim report outlining the new guidance.

The document comes from a seven-member Lung Cancer Screening Committee formed to assess the American Lung Association (ALA)’s position in light of the National Lung Screening Trial (NLST) results – the study was the first to show a screening program could reduce lung cancer deaths.

The panel’s charge was to review current evidence about lung cancer screening that would "offer the best possible guidance to the public and those suffering from lung disease."

The NLST randomized subjects at risk of lung cancer to three annual screenings with either low-dose CT or single-view posteroanterior chest x-rays. Investigators reported that low-dose CT was associated with a 20% decrease in mortality compared with chest x-rays. The false-positive rate reported in the publication of the trial results was 96% (N. Engl. J. Med. 2011;365:395-409).

Since the results were announced, the National Comprehensive Cancer Network (NCCN) has similarly endorsed screening of high-risk smokers, and the International Association for the Study of Lung Cancer (IASLC) has urged physicians to discuss screening with patients who smoke. Many other groups have yet to take a stand, however.

Although the landmark trial found solid evidence supporting annual screens in the population studied, the ALA noted it also raised many "personal and public health issues": among them, what to do about false positive results, the physical and emotional risks of screening and any resultant invasive procedures, cost implications, and equitable access to the CT procedure.

–Michele G. Sullivan

The American Lung Association has also thrown its weight behind low-dose CT screening of heavy smokers who meet criteria set forth in the National Lung Screening Trial.

The group emphasized that it does not recommend universal screening at this time, and that it believes chest x-rays should not be used for lung cancer screening. It only recommends low-dose computed axial tomography screening – and only for current or past smokers aged 55-74 years, who have smoked at least 30 pack-years and have no history of lung cancer.

"For those who choose to undergo the screening process, smoking cessation should be continuously emphasized as it remains the best method of reducing lung cancer risk," according to an interim report outlining the new guidance.

The document comes from a seven-member Lung Cancer Screening Committee formed to assess the American Lung Association (ALA)’s position in light of the National Lung Screening Trial (NLST) results – the study was the first to show a screening program could reduce lung cancer deaths.

The panel’s charge was to review current evidence about lung cancer screening that would "offer the best possible guidance to the public and those suffering from lung disease."

The NLST randomized subjects at risk of lung cancer to three annual screenings with either low-dose CT or single-view posteroanterior chest x-rays. Investigators reported that low-dose CT was associated with a 20% decrease in mortality compared with chest x-rays. The false-positive rate reported in the publication of the trial results was 96% (N. Engl. J. Med. 2011;365:395-409).

Since the results were announced, the National Comprehensive Cancer Network (NCCN) has similarly endorsed screening of high-risk smokers, and the International Association for the Study of Lung Cancer (IASLC) has urged physicians to discuss screening with patients who smoke. Many other groups have yet to take a stand, however.

Although the landmark trial found solid evidence supporting annual screens in the population studied, the ALA noted it also raised many "personal and public health issues": among them, what to do about false positive results, the physical and emotional risks of screening and any resultant invasive procedures, cost implications, and equitable access to the CT procedure.

–Michele G. Sullivan

The American Lung Association has also thrown its weight behind low-dose CT screening of heavy smokers who meet criteria set forth in the National Lung Screening Trial.

The group emphasized that it does not recommend universal screening at this time, and that it believes chest x-rays should not be used for lung cancer screening. It only recommends low-dose computed axial tomography screening – and only for current or past smokers aged 55-74 years, who have smoked at least 30 pack-years and have no history of lung cancer.

"For those who choose to undergo the screening process, smoking cessation should be continuously emphasized as it remains the best method of reducing lung cancer risk," according to an interim report outlining the new guidance.

The document comes from a seven-member Lung Cancer Screening Committee formed to assess the American Lung Association (ALA)’s position in light of the National Lung Screening Trial (NLST) results – the study was the first to show a screening program could reduce lung cancer deaths.

The panel’s charge was to review current evidence about lung cancer screening that would "offer the best possible guidance to the public and those suffering from lung disease."

The NLST randomized subjects at risk of lung cancer to three annual screenings with either low-dose CT or single-view posteroanterior chest x-rays. Investigators reported that low-dose CT was associated with a 20% decrease in mortality compared with chest x-rays. The false-positive rate reported in the publication of the trial results was 96% (N. Engl. J. Med. 2011;365:395-409).

Since the results were announced, the National Comprehensive Cancer Network (NCCN) has similarly endorsed screening of high-risk smokers, and the International Association for the Study of Lung Cancer (IASLC) has urged physicians to discuss screening with patients who smoke. Many other groups have yet to take a stand, however.

Although the landmark trial found solid evidence supporting annual screens in the population studied, the ALA noted it also raised many "personal and public health issues": among them, what to do about false positive results, the physical and emotional risks of screening and any resultant invasive procedures, cost implications, and equitable access to the CT procedure.

–Michele G. Sullivan

The American Lung Association has also thrown its weight behind low-dose CT screening of heavy smokers who meet criteria set forth in the National Lung Screening Trial.

The group emphasized that it does not recommend universal screening at this time, and that it believes chest x-rays should not be used for lung cancer screening. It only recommends low-dose computed axial tomography screening – and only for current or past smokers aged 55-74 years, who have smoked at least 30 pack-years and have no history of lung cancer.

"For those who choose to undergo the screening process, smoking cessation should be continuously emphasized as it remains the best method of reducing lung cancer risk," according to an interim report outlining the new guidance.

The document comes from a seven-member Lung Cancer Screening Committee formed to assess the American Lung Association (ALA)’s position in light of the National Lung Screening Trial (NLST) results – the study was the first to show a screening program could reduce lung cancer deaths.

The panel’s charge was to review current evidence about lung cancer screening that would "offer the best possible guidance to the public and those suffering from lung disease."

The NLST randomized subjects at risk of lung cancer to three annual screenings with either low-dose CT or single-view posteroanterior chest x-rays. Investigators reported that low-dose CT was associated with a 20% decrease in mortality compared with chest x-rays. The false-positive rate reported in the publication of the trial results was 96% (N. Engl. J. Med. 2011;365:395-409).

Since the results were announced, the National Comprehensive Cancer Network (NCCN) has similarly endorsed screening of high-risk smokers, and the International Association for the Study of Lung Cancer (IASLC) has urged physicians to discuss screening with patients who smoke. Many other groups have yet to take a stand, however.

Although the landmark trial found solid evidence supporting annual screens in the population studied, the ALA noted it also raised many "personal and public health issues": among them, what to do about false positive results, the physical and emotional risks of screening and any resultant invasive procedures, cost implications, and equitable access to the CT procedure.

–Michele G. Sullivan

The American Lung Association has also thrown its weight behind low-dose CT screening of heavy smokers who meet criteria set forth in the National Lung Screening Trial.

The group emphasized that it does not recommend universal screening at this time, and that it believes chest x-rays should not be used for lung cancer screening. It only recommends low-dose computed axial tomography screening – and only for current or past smokers aged 55-74 years, who have smoked at least 30 pack-years and have no history of lung cancer.

"For those who choose to undergo the screening process, smoking cessation should be continuously emphasized as it remains the best method of reducing lung cancer risk," according to an interim report outlining the new guidance.

The document comes from a seven-member Lung Cancer Screening Committee formed to assess the American Lung Association (ALA)’s position in light of the National Lung Screening Trial (NLST) results – the study was the first to show a screening program could reduce lung cancer deaths.

The panel’s charge was to review current evidence about lung cancer screening that would "offer the best possible guidance to the public and those suffering from lung disease."

The NLST randomized subjects at risk of lung cancer to three annual screenings with either low-dose CT or single-view posteroanterior chest x-rays. Investigators reported that low-dose CT was associated with a 20% decrease in mortality compared with chest x-rays. The false-positive rate reported in the publication of the trial results was 96% (N. Engl. J. Med. 2011;365:395-409).

Since the results were announced, the National Comprehensive Cancer Network (NCCN) has similarly endorsed screening of high-risk smokers, and the International Association for the Study of Lung Cancer (IASLC) has urged physicians to discuss screening with patients who smoke. Many other groups have yet to take a stand, however.

Although the landmark trial found solid evidence supporting annual screens in the population studied, the ALA noted it also raised many "personal and public health issues": among them, what to do about false positive results, the physical and emotional risks of screening and any resultant invasive procedures, cost implications, and equitable access to the CT procedure.

–Michele G. Sullivan

The American Lung Association has also thrown its weight behind low-dose CT screening of heavy smokers who meet criteria set forth in the National Lung Screening Trial.

The group emphasized that it does not recommend universal screening at this time, and that it believes chest x-rays should not be used for lung cancer screening. It only recommends low-dose computed axial tomography screening – and only for current or past smokers aged 55-74 years, who have smoked at least 30 pack-years and have no history of lung cancer.

"For those who choose to undergo the screening process, smoking cessation should be continuously emphasized as it remains the best method of reducing lung cancer risk," according to an interim report outlining the new guidance.

The document comes from a seven-member Lung Cancer Screening Committee formed to assess the American Lung Association (ALA)’s position in light of the National Lung Screening Trial (NLST) results – the study was the first to show a screening program could reduce lung cancer deaths.

The panel’s charge was to review current evidence about lung cancer screening that would "offer the best possible guidance to the public and those suffering from lung disease."

The NLST randomized subjects at risk of lung cancer to three annual screenings with either low-dose CT or single-view posteroanterior chest x-rays. Investigators reported that low-dose CT was associated with a 20% decrease in mortality compared with chest x-rays. The false-positive rate reported in the publication of the trial results was 96% (N. Engl. J. Med. 2011;365:395-409).

Since the results were announced, the National Comprehensive Cancer Network (NCCN) has similarly endorsed screening of high-risk smokers, and the International Association for the Study of Lung Cancer (IASLC) has urged physicians to discuss screening with patients who smoke. Many other groups have yet to take a stand, however.

Although the landmark trial found solid evidence supporting annual screens in the population studied, the ALA noted it also raised many "personal and public health issues": among them, what to do about false positive results, the physical and emotional risks of screening and any resultant invasive procedures, cost implications, and equitable access to the CT procedure.

–Michele G. Sullivan

SAN FRANCISCO - Pulmonary resection outcomes vary with respect to the kind of hospital in which the procedure is performed, particularly whether it is a teaching hospital, according to Dr. Castigliano M. Bhamidipati, of the University of Virginia Medical School, Charlottesville.

"In comparison to other hospitals, including general surgery teaching hospitals, cardiothoracic surgery teaching hospitals have lower morbidity and mortality," Dr. Bhamidipati said at the AATS annual meeting.

He and his colleagues examined the results of pulmonary resections performed at cardiothoracic (CT) teaching, general surgery (GS) teaching, nonsurgical (NS) teaching, and nonteaching (NT) hospitals.

The researchers evaluated the discharge records of nearly 500,000 adults who underwent either pneumonectomy, segmentectomy, lobar resections, or nonanatomic resections in an all-payer inpatient database for the time period between 2003 and 2009, according to Dr. Bhamidipati.

The hospital's teaching status as used in the study was determined by a linkage to the Association of American Medical Colleges’ Graduate Medical Education Tracking System.

The researchers examined patient demographics, risk factors, and hospital characteristics, and used multiple logistic regression models to examine in-hospital mortality, occurrence of any complications, and failure to rescue (death following a complication).

The mean annual percent of pulmonary resection volume among hospitals was CT (16%), GS (17%), NS (28%), and NT (39%).

The average age of pulmonary resection recipients among hospitals was similar, as were their mean number of comorbidities. The CT hospitals treated the smallest number of Medicare patients and the highest number of patients with Medicaid, a significant difference, said Dr. Bhamidipati.

He reported that the unadjusted mortality for all procedures was significantly lowest at the CT hospitals (CT: 2.6%; GS: 2.8%; NS: 3.4%; NT 3.6%).

Similarly, any complication was also least likely to occur at a CT hospital (CT: 20.5%, GS: 23.5%, NS: 24.6%, NT: 24.9%), he added.

Unadjusted procedural complications were found to be similar across hospitals, although pulmonary complications were significantly less likely to occur at CT hospitals compared with the others, according to Dr. Bhamidipati.

Following case-mix adjustment, the risk of having any complication after segmentectomy or nonanatomic resection was found to be significantly lower at CT hospitals than at the GS hospitals, he said.

In addition, among the pneumonectomy recipients, CT teaching status independently and significantly reduced the adjusted odds ratio (AOR) of failure to rescue by more than 25% compared with NS (AOR 0.34 vs. AOR 0.62).

Similarly, for the pneumonectomy patients, performance of the surgery at CT centers significantly lowered the AOR of death by more than 30% compared with GS hospitals (AOR 0.33 vs. AOR 0.69).

"These results support using CT hospital teaching status as an independent prognosticator of outcomes in pulmonary resections," concluded Dr. Bhamidipati.

Dr. Bhamidipati reported that he and his colleagues had no relevant disclosures.

SAN FRANCISCO - Pulmonary resection outcomes vary with respect to the kind of hospital in which the procedure is performed, particularly whether it is a teaching hospital, according to Dr. Castigliano M. Bhamidipati, of the University of Virginia Medical School, Charlottesville.

"In comparison to other hospitals, including general surgery teaching hospitals, cardiothoracic surgery teaching hospitals have lower morbidity and mortality," Dr. Bhamidipati said at the AATS annual meeting.

He and his colleagues examined the results of pulmonary resections performed at cardiothoracic (CT) teaching, general surgery (GS) teaching, nonsurgical (NS) teaching, and nonteaching (NT) hospitals.

The researchers evaluated the discharge records of nearly 500,000 adults who underwent either pneumonectomy, segmentectomy, lobar resections, or nonanatomic resections in an all-payer inpatient database for the time period between 2003 and 2009, according to Dr. Bhamidipati.

The hospital's teaching status as used in the study was determined by a linkage to the Association of American Medical Colleges’ Graduate Medical Education Tracking System.

The researchers examined patient demographics, risk factors, and hospital characteristics, and used multiple logistic regression models to examine in-hospital mortality, occurrence of any complications, and failure to rescue (death following a complication).

The mean annual percent of pulmonary resection volume among hospitals was CT (16%), GS (17%), NS (28%), and NT (39%).

The average age of pulmonary resection recipients among hospitals was similar, as were their mean number of comorbidities. The CT hospitals treated the smallest number of Medicare patients and the highest number of patients with Medicaid, a significant difference, said Dr. Bhamidipati.

He reported that the unadjusted mortality for all procedures was significantly lowest at the CT hospitals (CT: 2.6%; GS: 2.8%; NS: 3.4%; NT 3.6%).

Similarly, any complication was also least likely to occur at a CT hospital (CT: 20.5%, GS: 23.5%, NS: 24.6%, NT: 24.9%), he added.

Unadjusted procedural complications were found to be similar across hospitals, although pulmonary complications were significantly less likely to occur at CT hospitals compared with the others, according to Dr. Bhamidipati.

Following case-mix adjustment, the risk of having any complication after segmentectomy or nonanatomic resection was found to be significantly lower at CT hospitals than at the GS hospitals, he said.

In addition, among the pneumonectomy recipients, CT teaching status independently and significantly reduced the adjusted odds ratio (AOR) of failure to rescue by more than 25% compared with NS (AOR 0.34 vs. AOR 0.62).

Similarly, for the pneumonectomy patients, performance of the surgery at CT centers significantly lowered the AOR of death by more than 30% compared with GS hospitals (AOR 0.33 vs. AOR 0.69).

"These results support using CT hospital teaching status as an independent prognosticator of outcomes in pulmonary resections," concluded Dr. Bhamidipati.

Dr. Bhamidipati reported that he and his colleagues had no relevant disclosures.

SAN FRANCISCO - Pulmonary resection outcomes vary with respect to the kind of hospital in which the procedure is performed, particularly whether it is a teaching hospital, according to Dr. Castigliano M. Bhamidipati, of the University of Virginia Medical School, Charlottesville.

"In comparison to other hospitals, including general surgery teaching hospitals, cardiothoracic surgery teaching hospitals have lower morbidity and mortality," Dr. Bhamidipati said at the AATS annual meeting.

He and his colleagues examined the results of pulmonary resections performed at cardiothoracic (CT) teaching, general surgery (GS) teaching, nonsurgical (NS) teaching, and nonteaching (NT) hospitals.

The researchers evaluated the discharge records of nearly 500,000 adults who underwent either pneumonectomy, segmentectomy, lobar resections, or nonanatomic resections in an all-payer inpatient database for the time period between 2003 and 2009, according to Dr. Bhamidipati.

The hospital's teaching status as used in the study was determined by a linkage to the Association of American Medical Colleges’ Graduate Medical Education Tracking System.

The researchers examined patient demographics, risk factors, and hospital characteristics, and used multiple logistic regression models to examine in-hospital mortality, occurrence of any complications, and failure to rescue (death following a complication).

The mean annual percent of pulmonary resection volume among hospitals was CT (16%), GS (17%), NS (28%), and NT (39%).

The average age of pulmonary resection recipients among hospitals was similar, as were their mean number of comorbidities. The CT hospitals treated the smallest number of Medicare patients and the highest number of patients with Medicaid, a significant difference, said Dr. Bhamidipati.

He reported that the unadjusted mortality for all procedures was significantly lowest at the CT hospitals (CT: 2.6%; GS: 2.8%; NS: 3.4%; NT 3.6%).

Similarly, any complication was also least likely to occur at a CT hospital (CT: 20.5%, GS: 23.5%, NS: 24.6%, NT: 24.9%), he added.

Unadjusted procedural complications were found to be similar across hospitals, although pulmonary complications were significantly less likely to occur at CT hospitals compared with the others, according to Dr. Bhamidipati.

Following case-mix adjustment, the risk of having any complication after segmentectomy or nonanatomic resection was found to be significantly lower at CT hospitals than at the GS hospitals, he said.

In addition, among the pneumonectomy recipients, CT teaching status independently and significantly reduced the adjusted odds ratio (AOR) of failure to rescue by more than 25% compared with NS (AOR 0.34 vs. AOR 0.62).

Similarly, for the pneumonectomy patients, performance of the surgery at CT centers significantly lowered the AOR of death by more than 30% compared with GS hospitals (AOR 0.33 vs. AOR 0.69).

"These results support using CT hospital teaching status as an independent prognosticator of outcomes in pulmonary resections," concluded Dr. Bhamidipati.

Dr. Bhamidipati reported that he and his colleagues had no relevant disclosures.