The most visible impact of Affordable Care Act is surely the expansion of health insurance coverage to 30 million uninsured Americans, but a lesser known provision in the overhaul will have far-reaching implications as well.
The provision catapults the US Preventive Services Task Force (USPSTF) from an obscure agency that produced unenforceable guidelines about screening and preventive services into one whose recommendations directly impact reimbursement.
According to the terms of the new provision, insurers will be required to pay in full for services receiving an A or B recommendation from the Task Force, such as the ones it released last month which call for broadened screening for osteoporosis. Decisions like this increase access to osteoporosis screening services and create myriad new business opportunities as well.
The flip-side of course, is that insurers may not have to pay at all for services not recommended by the Task Force.
As a result, the Task Force’s new best friends include lobbyists and disease advocates who want their priorities – things like screening for Alzheimer’s disease, HIV and diabetes for example – to get covered.
For example, the HIV Medicine Association recently lobbied the USPSTF to broaden its HIV screening recommendations. In doing so, the Association called attention to an appalling statistic, which is that 20% of people who are infected HIV don’t know it. It argued that this knowledge gap can be closed if insurers covered the costs of routine HIV testing, and that will happen only if the Task Force broadens its current recommendations from those “in certain risk groups” to those “in the general population.”
Similarly, the American Diabetes Association is advocating that insurers should cover diabetes screening tests for a broader population than current Task Force recommendations suggest. Current USPSTF recommendations are that such screening should be done only for people with high blood pressure.
The private sector has also been involved in the lobbying effort. For example General Electric, which produces mammography screening tools, has recently lobbied the Task Force.
The risk of exposing the Task Force to lobbying interests like these is that it could undermine the Task Force’s tradition of neutrality and scholarly dedication to science. “If you want to be evidence-based, lobbying just doesn’t fit,” Ned Calonge, the panel’s chairman told Kaiser HealthNews.
The 16-member volunteer USPSTF began work in 1984. Over the years, it has examined issues ranging from colonoscopy screening to fluoride treatment. It consists of primary care physicians and public health officials but not medical specialists, because of concerns about conflicts of interest.
The Task Force, by the way, is the same one that caused a stir just before the last Presidential election by releasing recommendations that women should begin receiving screening mammography at the age of 50 rather than 40, as called for in its earlier recommendation on the matter.
In changing its position, the USPSTF relied on evidence that mammogram screening resulted in too many false positives and trivial benefits for women in their 40s. Unfortunately, the announcement reinforced fringe-Right fears that candidate Obama’s health reform plans included rationing health care and “death panels for Granny.”
Ironically, it was an amendment to the Affordable Care Act—the same bill that bestowed new powers upon the USPSTF—that required insurers to cover the costs of mammograms for women in their 40s. The mammography backlash also prompted the Task Force to begin accepting public comments before finalizing its recommendations.
The Task Force won’t cower in the face of criticism, Calonge insisted. But nor will it be “immune” to input that might add a beneficial perspective. That’s what we call business as usual in the US health care system.
Glenn Laffel is Sr. VP, Clinical Affairs at Practice Fusion.
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