AAFP President: No Subspecialists on Prevention Task Force

Testimony to House Subcommittee Highlights Importance of Preventing Disease

December 05, 2016 04:37 pm Michael Laff Washington, D.C. –

AAFP President John Meigs, M.D., (left) tells the House Energy and Commerce Committee's Subcommittee on Health that the U.S. Preventive Services Task Force should not be expanded to include subspecialist physicians.

The AAFP is standing against a bill in Congress that would mandate the addition of subspecialist physicians and industry representatives to a federal task force that was established to offer valuable preventive guidance to primary care physicians.

AAFP President John Meigs, M.D., of Centreville, Ala., testified against the bill(6 page PDF) last week before the House Energy and Commerce Committee's Subcommittee on Health.(energycommerce.house.gov)

In his testimony, Meigs urged members of the subcommittee -- including physicians Larry Bucshon, M.D., R-Ind., and Michael Burgess, M.D., R-Texas -- to maintain the existing membership structure of the U.S. Preventive Services Task Force (USPSTF) so it can continue to make evidence-based recommendations that primary care physicians use when advising patients about the need for preventive care screenings or services.

Story Highlights
  • AAFP President John Meigs, M.D., recently testified before the House Energy and Commerce Committee's Subcommittee on Health against a proposal to add subspecialists and industry representatives to the U.S. Preventive Services Task Force.
  • The task force is composed of 16 individuals, including four family physicians.
  • Subspecialists and the organizations they represent already contribute to the task force's mission by nominating topics for consideration and assisting with development of research plans.

Currently, four family physicians serve on the USPSTF, which was formed in 1984, and the AAFP also has a liaison who attends its meetings.

"Primary care physicians, due to the diversity and complexity of the patients we care for, are uniquely situated to provide a comprehensive and whole-person perspective to the task force, as compared to physicians and clinicians who care for a single disease process or organ system," Meigs testified.

"This process works best when the participating physicians and scientists, as well as the entity itself, are insulated from commercial and political pressures," he added.

Subspecialists and the organizations they represent already contribute to the task force's mission by nominating topics for consideration and assisting with development of research plans.

"We have found that engaging subspecialists on specific recommendations where they have expertise to offer is the most effective and efficient approach to our work," USPSTF Chair Kirsten Bibbins-Domingo, Ph.D., M.D., M.A.S., told the subcommittee.

After carefully reviewing the existing medical literature on each topic, the task force first issues a draft recommendation for public comment, and only after reviewing those comments does it make a final recommendation.

In his testimony, Meigs discussed the importance of keeping the task force focused on its core function. That essential work is to create guidelines that complement and optimize the expertise and type of care provided by preventive health specialists -- specifically, primary care physicians.

"While we have the highest level of respect for our specialty and subspecialty colleagues, their role in treating specific conditions and organ systems is not the same as developing guidelines to prevent such conditions," Meigs stated.

In addition to expanding task force membership, the USPSTF Transparency and Accountability Act(docs.house.gov) calls for representatives from the health care industry to be included on an advisory council that would have authority to review task force recommendations, another proposal the AAFP opposes. It also would require the task force to incorporate nonmedical factors, such as "how its specific assignment of a grade to a product or service may affect coverage and access to such product or service," and it would restrict Medicare's authority to deny coverage for preventive services that do not meet the task force's recommendation criteria.

Bill sponsor Rep. Marsha Blackburn, R-Tenn., and other proponents of the legislation raised concerns about the need for cost analysis and asked why more experts would not produce results that were equally or more valuable for patients.

Bibbins-Domingo reinforced the message that the USPSTF focuses on preventive measures and guidelines suitable for primary care physicians so they can inform their patients about screenings, medication and counseling services intended to help patients avoid developing adverse health conditions in the first place.

"This is what we do in primary care: We make recommendations without signs or symptoms of disease about services aimed at preventing future disease," she testified, noting the range of services that assist patients with prevention. "Primary care is on the front line doing that. No other specialty is doing that."

For instance, the task force has recommended mammograms every two years for women ages 50 to 74 and recommended against prostate-specific antigen-based screening for prostate cancer in asymptomatic men.

Meigs told the committee that such unbiased recommendations offer a valuable starting point for consultations with patients who might benefit from preventive screenings.

"The research tells us what screenings and tests are necessary," Meigs testified. "It also tells us when exams are unnecessary or even harmful.

"Family physicians play a significant role in supporting preventive health efforts, but we also rely on research and utilizing our public health system that complements the care we provide."

The legislation is considered unlikely to pass during the current lame duck session of Congress.