The ABC’s of the ‘Health’ Bill…

Ok back to health policy…many of you may be aware of the group the USPSTF – the US Preventative Services Taskforce.  From their site they are, “non-Federal experts in prevention and evidence-based medicine” who “develop recommendations for primary care clinicians and health systems”.

They have had some controversial recommendations in the last couple of years. The first was a well publicized recommendation concerning the need for women under 50 to receive a mammogram. They recommended –no.

There are problems with this.  Some aggressive forms  of breast cancer , hit younger African American and Hispanic women at higher rates than for White women.  The recommendations are based on research- the same research that has historically not included minorities for a variety of reasons.  Will this result in more health disparity, while trying to save the health care system money? Considering cost-effectiveness is one of their charges.

A more recent recommendation is similar around prostate cancer- that is wait and watch after diagnosis but don’t treat as the treatment may be worse than the disease.  The problem here is that there is no real answer.  People who are not treated and should have been will suffer, and those who are treated needlessly may suffer.

The answer then, one would think, is to have the treating health care practitioner make treatment decisions in concert with the patient.  What a concept! The recommendations should be just that- recommendations. They are based on available research and evidence but are certainly not –conclusive. I have no doubt that the taskforce members do due diligence with available evidence and come up with their recommendations.  The recommendations are likely good for 80% of the population.  It is the group for which they may not make sense for that I am most worried.

And then, when the recommendations affect payment streams, funding, policy etc. they in effect come between the patient and their practitioner.  The practitioner, who knows the patient’s history, ethnicity, stress levels, eating and exercise habits and so forth should decide with them as to what screening, treatment and medications they may or may not take. They may decide a ‘C’, ‘D’ or ‘I’ recommendation makes the most sense.

The Health Law and USPSTF

In the Affordable Health Care Act- you will find the following:

SEC. 2713. <<NOTE: 42 USC 300gg-13.>> COVERAGE OF PREVENTIVE HEALTH

SERVICES.

“(a) In General.–A group health plan and a health insurance issuer

offering group or individual health insurance coverage shall, at a

minimum provide coverage for and shall not impose any cost sharing

requirements for–

“(1) evidence-based items or services that have in effect a

rating of `A’ or `B’ in the current recommendations of the

United States Preventive Services Task Force;

Now on its surface-I am sure that probably reads as reasonable-until maybe you LOOK at what does and more importantly does NOT fall under A and B.

I focus my work in large part in aging-

Screening for Dementia

Not A or B

“The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for dementia in older adults.”

-50% of all persons over 85+ years will have Alzheimer’s. FIFTY percent!

Interventions to Prevent Falls in Older Adults

Not A or B

Screening for Hearing Loss

Not A or B

“The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in asymptomatic adults ages 50 years and older (I statement).”

 Screening for Impaired Visual Acuity in Older Adults

Not A or B

“The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for visual acuity for the improvement of outcomes in older adults.
Grade: I statement.”

Behavioral Counseling in Primary Care to Promote Physical Activity

Not A or B

The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against behavioral counseling in primary care settings to promote physical activity.
Grade: I Statement.”

Disclaimer

While there is the disclaimer in the bill that nothing precludes plans from adding these things on their own dime ostensibly- A and B are the minimum- i.e. what will be covered unless the plan goes over and above.  In this economic climate what do you think the chances are?

Are the Boomers, diverse persons and their practitioners actually reading this bill? And if they did, did they get past A and B????  I encourage all of you whether consumer or practitioner to see what is paid recommended for you!

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