Medicare Alignment with US Preventive Task Force Important for Health Reform

Kathleen Blanchard's picture
Researchers say without coordination from Medicare, preventive screenings could be costly and inadequate

Health reform should improve rates of preventive screening exams, but researchers say it’s up to Medicare to get in line with U.S. Preventive Services Task Force recommendations.

Researchers from UCLA looked at how well U.S. Preventive Services Task Force (USPSTF) recommendations match up with Medicare reimbursement, finding a disconnect that could put a glitch in how preventive services are delivered.

The study, published in the January/February issue of the Annals of Family Medicine, found it would be important for Medicare to coordinate with USPSTF goals, with a focus on preventive screening exams and counseling.

They are also urging Congress to support research on how to deliver preventive heath care services, of which only 6 percent of Medicare recipients take advantage.


"By expanding coverage for the preventive health visit, the health care reform law provides avenues to align Medicare payments with the recommendations of the USPSTF, and for better coordination between screenings and clinical services, said Dr. Lenard Lesser, the study's lead author and a family physician and researcher with the Robert Wood Johnson Foundation Clinical Scholars at UCLA. "For these reforms to be effective, however, Medicare beneficiaries must take advantage of the expanded coverage and get their annual check-ups."

The researchers looked at how well Medicare and the USPSTF guidelines matched up before health care reform. “A”-rated preventive services that take priority include screening for cervical and colon cancer, high blood pressure, cholesterol and tobacco use, for men and women separately because of different risk factors. Services rated “B” include screenings for abdominal aortic aneurysm, alcohol use with counseling if needed, genetic risk for breast cancer, depression, diabetes, obesity and weight management counseling and osteoporosis as well as breast cancer screening and counseling for a healthy diet.

The researchers divided Medicare coverage for preventive screening into two categories – assessment and scheduling preventive screening tests and the actual test with counseling. They found the only service completely covered was screening for abdominal aortic aneurysm. The other 14 services were only partly covered in one of the categories- assessment and scheduling the test or the test itself with counseling.

They also noted Medicare reimbursed 44 percent to physicians for 16 services not recommended from the US Preventive Service Task Force, spiking costs for non-recommended screenings. Examples include heart screening exams in low-risk individuals, colon cancer screening over age 85 and cervical cancer screening for women who no longer need it.

Health care reform should mean better coverage for preventive medical services. According to the UCLA findings, Medicare has an important opportunity to coordinate with recommendations from the U.S. Preventive Services Task Force to provide better quality of care to recipients. The authors say otherwise, "practices will likely promote both inadequate and excessive delivery of preventive services."

Annals of Family Medicine, Inc.
doi: 10.1370/afm.119