Comparison Between US Preventive Services Task Force Recommendations and Medicare Coverage

• Published in: Annals of family medicine Vol. 9; no. 1; pp. 44 - 49
• Main Authors: Lesser, Lenard I., MD, Krist, Alex H., MD, MPH, Kamerow, Douglas B., MD, MPH, Bazemore, Andrew W., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States American Academy of Family Physicians 2011
• Subjects: Aged; Evidence-Based Medicine; Humans; Internal Medicine; Medicare; Original Research; Preventive Health Services - economics; Preventive Health Services - standards; United States; United States Dept. of Health and Human Services; United States; USPSTF; Medicare; preventive health services
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.1194

Abstract Purpose The US Preventives Services Task Force (USPSTF) is authorized by the US government to review and disseminate the scientific evidence for clinical preventive services. The purpose of this study was to evaluate the alignment of Medicare preventive services coverage with the recommendations of the USPSTF before implementation of health reform. Methods We recorded all Medicare coverage for preventive services as listed in the Medicare preventive services guide of 2007 (including the 2009 update) for all recommended (A- or B-rated) USPSTF and not recommended (D-rated) guidelines for preventive screening and counseling in adults aged 65 years and older. We analyzed 2 components of preventive care: preventive coordination (risk assessment, patient motivation, and arranging of preventive service) and the preventive service itself. The main outcome measure was the percentage of agreement between USPSTF recommendations and Medicare coverage. Results The USPSTF recommended 15 preventive interventions for adults aged 65 years and older. Although Medicare partially reimbursed 93% of recommended services, full reimbursement for the preventive coordination, as well as the service, was available for only 7% of these services. This partial coverage is available mostly as part of the Welcome to Medicare Visit. Further, the USPSTF recommended against 16 preventive services; Medicare reimbursed clinicians for 44% of these services. Conclusions Medicare coverage for preventive services needs to be reassessed, with special focus on preventive coordination. Continuing previous practices will likely promote both inadequate and excessive delivery of preventive services. The new health care reform law has the potential to improve the provision of preventive services to Medicare beneficiaries.