The USPSTF

The USPSTF, first convened in 1984, is an independent panel of non-federal experts in primary care that conducts evidence-based reviews. These reviews represent the gold standard for clinical preventive medicine.

The United States Preventative Services Task Force (USPSTF) is a volunteer group made up of primary care and public health experts.  Its sixteen members make recommendations concerning clinical preventative screening, medication, and counseling based on current scientific evidence and is purposefully devoid of specialty involvement in order to avoid potential conflicts of interest.  USPSTF recommendations are given specific gradings:

A:  Recommended, with high certainty that the net benefit is substantial.

B:  Recommended, with high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

C:  Recommended against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.

D:  Recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

I:  Current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

On July 14, 2010, the Department of Health and Human Services issued regulations under the Patient Protection and Affordable Care Act requiring private health plans to cover evidence-based preventative services for new policies beginning on or after September 23, 2010.   Insurance companies can no longer charge copayment, coinsurance or deductibles for any services that receive an “A” or “B” grade as determined by the USPSTF.

These “A” or “B” level recommendations include:  abdominal aortic aneurysm screening by ultrasound in men age 65-75 who have ever smoked; mammograms every 1-2 years for women aged 40 and older, cervical cancer screening; syphilis, chlamydia and gonorrhea screening in sexually active women; cholesterol screening for men aged 35 and older and women aged 40 and older unless at increased risk for coronary heart disease; depression screening; HIV screening for those at risk; and obesity screening.  The recommendations also include counseling on alcohol abuse, tobacco use, sexually transmitted infection prevention, and healthy diet.

Commentary

The recent political and academic debate surrounding the United States Preventive Services Task Force’s decision to delay routine mammograms until age 50 forecasts future discussions surrounding its recommendations.  In response to significant protest, an actual amendment was inserted in the Patient Protection and Affordable Care Act that covered mammograms between ages 40 and 50.  Challenges from a range of interests groups will definitely remain a frequent burden for task force members; insurance companies particularly now have a strong interest as they are now required to pay for these services.  The United States Congress and Department of Health and Human Services will need to determine if it is proper for political procedures to be utilized to supersede evidenced-based determinations. If so, it will need to be plainly obvious as to why the USPSTF might choose to disobey the evidence.  The task force now accepts public comment in order to allow additional perspective to new recommendations.  This process will need to remain transparent, perhaps even through public hearings, in order to elucidate any possible lobbying influence that may occur.

USPSTF A and B Recommendations, http://www.ahrq.gov/clinic/uspstf/uspsabrecs.htm

by

Kameron L. Matthews, MD, Esq.