The U.S. Preventive Services Task Force (USPSTF) has long been recognized as an important decision maker in the coverage of screening and other preventive services, for both public and private payers. But with enactment of the new law providing the physician fee-schedule fix, the task force, an AHRQ entity that reviews evidence and issues clinical guidelines, seems poised to become a genuine gateway for the entry of certain preventive services into Medicare.
Medicare has traditionally covered preventive benefits by exception, requiring line-item statutory permission for each new service. A key provision of the new law, however, establishes a self-executing pathway through which preventive services can become Medicare-covered without the need to amend the statute each time.
The new pathway has a number of important aspects, such as the role of the national coverage process and the ability to weigh expenditures in making a decision. But the law also carves out an unmistakable assignment for USPSTF, stationing it virtually at the pathway's center by barring coverage of a preventive service unless the task force has recommended it "with a grade of A or B." Such will no doubt lead many service sponsors to beat a path to the task force's door. And USPSTF issuances that in the past may have seemed innocuous -- like the procedure manual it released a few days ago -- will now elicit a good deal more scrutiny.
In the bigger picture, an emphasis on prevention figures into all the major health reform plans. USPSTF seems well-positioned to be a key enabler of this important new policy direction.
Comments