Recently enacted health care reform legislation that calls for insurance plans to cover evidence-based services that have A or B grades in United States Preventive Services Task Force, or USPSTF, recommendations, led delegates to the 2010 National Conference of Special Constituencies, or NCSC, to question whether physicians understand the USPSTF grades. They urged the Academy to develop relevant education resources for members and their patients.
Anne Kittendorf, M.D., of Dexter, Mich., testifies before the Reference Committee on Health of the Public and Science on a resolution she co-authored that calls on the Academy to create resources for physicians and patients that outline A or B grade recommendations from the U.S. Preventive Services Task Force.
Specifically, the Reference Committee on Health of the Public and Science supported a resolution May 1 that calls for the AAFP to:
- create resources for physicians that clearly outline USPSTF evidence-based items or services that have A or B grades and, thus will be mandated for full coverage by group health plans, as well as services with C, D or I grades that may not be covered; and
- develop educational programs and resources for patients that explain USPSTF grades and the fact that items and services with A and B grades are mandated for coverage, but patients may need to investigate whether items and services with C, D or I grades are covered by their plans.
The reform bill's provisions for coverage of preventive health services, which also include vaccinations recommended by the CDC's Advisory Committee on Immunization Practices, take effect Sept. 23.
Anne Kittendorf, M.D., of Dexter, Mich., who co-authored the resolution, said some tests that physicians have routinely ordered in the past might no longer be covered. For example, USPSTF gives an I grade to screening men younger than 75 for prostate cancer(www.uspreventiveservicestaskforce.org).
"I think there are a lot of practicing physicians that don't understand the USPSTF guidelines system," Kittendorf said.
Here are brief definitions of the USPSTF grades:
- an A means the USPSTF recommends a service, and the task force has concluded there is high certainty that the net benefit is substantial;
- a B indicates the USPSTF recommends a service, and there is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial;
- a C means the USPSTF recommends against routinely providing a service. There is at least moderate certainty that the net benefit is small, but there may be considerations that support providing the service in an individual patient;
- a D means the USPSTF recommends against a service, and that there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits; and
- an I indicates that USPSTF concludes that current evidence is insufficient to assess the balance of benefits and harms of a service.
Kittendorf said physicians should encourage patients to contact their insurers to make sure certain services are covered.
Physicians will need to be informed as well, said Rachel Franklin, M.D., of Oklahoma City. Franklin, associate professor in the department of family and preventive medicine at the University of Oklahoma College of Medicine, said physicians might need to get prior authorization for certain services that aren't recommended by USPSTF, such as mammography more than once every two years.
"There are a lot of things we do in response to what we believe are our patients' reasonable concerns or requests that could potentially be universally uncovered as a result of this legislation," she said.