APPENDIX A
Study Activities

Consistent with the provisions in the Balanced Budget Act of 1997, the Institute of Medicine (IOM) created a seven-person committee that was charged with studying the effects of expanded Medicare coverage in the areas of skin cancer screening, medically necessary dental care, and elimination of the time limitation for coverage of immunosuppressive drugs for transplant patients. The committee included specialists in public health, dermatology, transplantation, hospital dentistry, health policy, and cost-effectiveness analysis. From February 1999 to August 1999 the committee met five times. A workshop in April focused on medically necessary dental services, and workshops in June focused on skin cancer screening and immunosuppressive drugs. These workshops, which were open to the public, included presentations on the evidence base for these interventions, the estimated costs to Medicare of extending coverage, and other relevant topics. Public statements and comments were invited. Agendas follow in this appendix. In addition, four background papers were commissioned by the committee, and these are included as Appendixes BE of this report.

The other two topics specified in the Balanced Budget Act were certain nutrition services and routine patient care costs in clinical trials. Two separate committees were created to examine these topics. Their reports, Extending Medicare Reimbursement in Clinical Trials and The Role of Nutrition Therapy in Maintaining the Health of the Nation’s Elderly: Evaluating Coverage of Nutrition Services for Medicare Beneficiaries, are also available from the National Academy Press, including on-line at www.nap.edu.



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Extending Medicare Coverage for Preventive and Other Services APPENDIX A Study Activities Consistent with the provisions in the Balanced Budget Act of 1997, the Institute of Medicine (IOM) created a seven-person committee that was charged with studying the effects of expanded Medicare coverage in the areas of skin cancer screening, medically necessary dental care, and elimination of the time limitation for coverage of immunosuppressive drugs for transplant patients. The committee included specialists in public health, dermatology, transplantation, hospital dentistry, health policy, and cost-effectiveness analysis. From February 1999 to August 1999 the committee met five times. A workshop in April focused on medically necessary dental services, and workshops in June focused on skin cancer screening and immunosuppressive drugs. These workshops, which were open to the public, included presentations on the evidence base for these interventions, the estimated costs to Medicare of extending coverage, and other relevant topics. Public statements and comments were invited. Agendas follow in this appendix. In addition, four background papers were commissioned by the committee, and these are included as Appendixes B–E of this report. The other two topics specified in the Balanced Budget Act were certain nutrition services and routine patient care costs in clinical trials. Two separate committees were created to examine these topics. Their reports, Extending Medicare Reimbursement in Clinical Trials and The Role of Nutrition Therapy in Maintaining the Health of the Nation’s Elderly: Evaluating Coverage of Nutrition Services for Medicare Beneficiaries, are also available from the National Academy Press, including on-line at www.nap.edu.

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Extending Medicare Coverage for Preventive and Other Services INSTITUTE OF MEDICINE COMMITTEE ON MEDICARE COVERAGE EXTENSIONS WORKSHOP ON MEDICALLY NECESSARY DENTAL CARE May 19–20, 1999, Washington, D.C. Agenda Wednesday, May 19 9:00 Welcome, Introductions, Workshop Overview Robert S.Lawrence, M.D., Committee Chair, Johns Hopkins University School of Hygiene and Public Health Marilyn J.Field, Ph.D., Study Director, Institute of Medicine Background and Logistics Following each presentation there will be a discussion and comments by invited discussants, registered members of the audience, and the audience at large. 9:30 Remarks on Current Dental Care Issues Current Coverage for Oral Health Care by Medicare Health Care Financing Administration 9:45 Dushanka V.Kleinman, D.D.S., M.Sc.D. Deputy Director, National Institute of Dental and Craniofacial Research Caswell Evans, D.D.S., M.P.H. Executive Editor and Project Director, Surgeon General’s Report on Oral Health, National Institute of Dental and Craniofacial Research Charles (Bud) Conklin, D.D.S. Director, Carilion Dental Care, Roanoke, Virginia Speaking for the Federation of Special Care Organizations in Dentistry 11:00 Review Issues of Defining “Medically Necessary Dental Care” Alexander White, D.D.S., Dr.P.H., M.P.H., M.S., Lead Author, Commissioned Paper, Kaiser Permanente Center for Health Research 1:00 Care for Lymphoma or Leukemia James A.Lipton, D.D.S., Ph.D. National Institute of Dental and Craniofacial Research Lead Discussant: Dr. Kathryn Atchison

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Extending Medicare Coverage for Preventive and Other Services 1:50 Head and Neck Cancers Lauren Patton, D.D.S. University of North Carolina, Chapel Hill Lead Discussant: Dr. Carter Van Waes 2:50 Organ Transplants William G.Kohn, D.D.S. Centers for Disease Control and Prevention Lead Discussant: Dr. Michele Saunders 3:40 Valve Repair Alexander White, D.D.S., Dr.P.H., M.P.H., M.S. Kaiser Permanente Center for Health Research Lead Discussant: Dr. David Pearle 4:30 General discussion led by Dr. Lawrence, assisted by Dr. White 5:00 ADJOURN Thursday, May 20, 1999 8:30 Public Statements and Discussion Attendees wishing to make public statements are requested to notify a staff member. 9:00 Methods of Cost Analysis Allen Dobson, Ph.D., and Joan DaVanzo, Ph.D., M.S.W. The Lewin Group, Inc. 10:15 Further Discussion 12:00 ADJOURN Other Participants and Observers: Akintoye Adelakun, M.D., Health Care Financing Administration Fellow; Robert E.Barsley, D.D.S.; Randy Burkholder, HBK Publishing; Jodi Chappell, Academy of Osseointegration; Robert Collins, D.M.D., International and American Association for Dental Research; Jesse Kerns, M.P.P., The Lewin Group, Inc., Gina Luke, American Association of Dental Schools; Chris Maynard, HBK Publishing; Craig Palmer, ADA News; Ira R.Parker, D.D.S., University of California at San Diego.

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Extending Medicare Coverage for Preventive and Other Services INSTITUTE OF MEDICINE COMMITTEE ON MEDICARE COVERAGE EXTENSIONS WORKSHOP ON SKIN CANCER SCREENING June 17, 1999, Washington, D.C. Agenda 8:30 Welcome, Introductions, Workshop Overview, Charge to the Committee Robert S.Lawrence, M.D., Committee Chair, Johns Hopkins University School of Hygiene and Public Health Marilyn J.Field, Ph.D., Study Director, Institute of Medicine Public Statements and Discussion Attendees wishing to make formal public statements are requested to notify a staff member. 9:00 Epidemiology of Skin Cancer Marianne Berwick, Ph.D. Associate Attending Epidemiologist, Memorial Sloan Kettering Cancer Center 9:30 Current Approaches to Screening for Skin Cancer Alan Geller, R.N., M.P.H. Associate Director, Cancer Prevention and Control Center, Boston University, School of Medicine 10:00 General Discussion and Questions 10:30 Presentation of Draft Commissioned Paper Mark Helfand, M.D., Lead Author, Commissioned Paper Assistant Professor, Oregon Health Sciences University 11:00 Discussion/Questions Discussants Lowell A.Goldsmith, M.D. Dean, School of Medicine and Dentistry, University of Rochester Alan Moshell, M.D. Chief, Skin Diseases Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases

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Extending Medicare Coverage for Preventive and Other Services 12:30 Cost-Effectiveness of Screening for Melanoma Kenneth A.Freedberg, M.D., M.Sc. Associate Professor of Medicine and Public Health, Boston Medical Center 1:00 Cost Estimations of Screening Medicare Beneficiaries for Skin Cancer Allen Dobson, Ph.D. Senior Vice President, The Lewin Group, Inc. 1:30 Public Comment American Academy of Dermatology June Robinson, M.D., Secretary Treasurer 1:45 General Discussion and Questions 2:30 ADJOURN Other Participants and Observers: Clifford Amend, M.D., Blue Cross/Blue Shield of Maryland; Joseph Chin, M.D., Health Care Financing Administration; Joan DaVanzo, Ph.D., The Lewin Group, Inc.; Karen Eden, Ph.D., Oregon Health Sciences University; Cheryl Hayden, American Academy of Dermatology; Jesse Kerns, M.P.P., Study Consultant, The Lewin Group, Inc.; William Larsen, Health Care Financing Administration; Donald R.Miller, Sc.D., Boston University; Katharine Pirotte, Health Care Financing Administration.

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Extending Medicare Coverage for Preventive and Other Services INSTITUTE OF MEDICINE COMMITTEE ON MEDICARE COVERAGE EXTENSIONS WORKSHOP ON IMMUNOSUPPRESSIVE DRUG THERAPY June 18, 1999, Washington, D.C. Agenda 8:30 Welcome, Introductions, Workshop Overview, Charge to the Committee Robert S.Lawrence, M.D., Committee Chair, Johns Hopkins University School of Hygiene and Public Health Marilyn J.Field, Ph.D., Study Director, Institute of Medicine Public Statements and Discussion Attendees wishing to make public statements are requested to notify a staff member. 8:45 Presentation of Draft Commissioned Paper and Remarks on Compliance Dr. Robert S.Gaston, M.D., Author, Commissioned Paper Associate Professor, Division of Nephrology, University of Alabama at Birmingham 9:30 Parallel Considerations for Liver Transplants Michael R.Lucey, M.D. Associate Professor of Medicine, Medical Director, Liver Transplantation Program, Hospital of the University of Pennsylvania 9:45 Coverage Options/Strategies Beyond Medicare Coverage Cheryl Jacobs, MSW, LICSW Clinical Transplant Social Worker, Fairview University Transplant Services, Minneapolis 10:00 General Discussion and Questions 11:00 Cost Considerations Paul W.Eggers, Ph.D., Director, Division of Beneficiaries Research, Health Care Financing Administration 11:30 General Discussion and Questions

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Extending Medicare Coverage for Preventive and Other Services 1:00 Cost Estimations Allen Dobson, Ph.D. Senior Vice President, The Lewin Group, Inc. 1:30 Public Comment Mark Schnizler, Ph.D., Graduate Program in Health Administration, Washington University, St. Louis National Kidney Foundation: transAction Council Dr. Andrew Silverman, Pharm.D. Pharmacotherapy Specialist, Transplantation Services, Tampa General Hospital 2:00 General Discussion and Questions 2:30 ADJOURN Other Participants and Observers: Clifford Amend, M.D., Blue Cross and Blue Shield of Maryland; Dolph Chianchiano, National Kidney Foundation; Joseph Chin, M.D., Health Care Financing Administration; Julia Christensen, Congressional Budget Office; Lauren Geyer, Health Care Financing Administration; Melody Hughson, Hoffman-La Roche; Kim Jackson, Transplant Recipients International Organization; Jesse Kerns, M.P.P., The Lewin Group, Inc.; Lizzy O’Hara, Congressman Boggs’s Office; Linda Ohler, National Association of Transplant Coordinators; Jackie Sheidan, Health Care Financing Administration; Alex Shipman, Covance; Andy Swire, Pharmaceutical Research and Manufacturers of America; Patricia Weitzkittel, American Nephrology Nurses Association; Stacey Windham, Congressman Canady’s Office; Troy Zimmerman, National Kidney Foundation.