Medicare Coverage of Routine Screening for Thyroid Dysfunction
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
Support for this project was provided by the Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services (Contract Number 500-01-0055). The views presented in this report are those of the Institute of Medicine Committee on Medicare Coverage of Routine Thyroid Screening and are not necessarily those of the funding agencies.
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COMMITTEE ON MEDICARE COVERAGE OF ROUTINE THYROID SCREENING
ROBERT B. WALLACE, M.D. (Chair), the Irene Ensminger Stecher Professor of Epidemiology and Internal Medicine,
University of Iowa College of Medicine
GAY J. CANARIS, M.D., M.S.P.H., Assistant Professor of Medicine in the Department of Internal Medicine,
University of Nebraska Medical Center, College of Medicine
INDER J. CHOPRA, M.D., Professor of Medicine,
University of California at Los Angeles Center for Health Services
LAURENCE MAURICE DEMERS, Ph.D., Distinguished Professor of Pathology and Medicine,
Pennsylvania State University College of Medicine
NEIL R. POWE, M.D., M.P.H., M.B.A., Professor of Medicine in the Department of Medicine,
Johns Hopkins University School of Medicine
JANE E. SISK, Ph.D., Professor of Health Policy,
Mount Sinai School of Medicine
ROBERT D. UTIGER, M.D., Clinical Professor of Medicine,
Harvard University School of Medicine
STEPHEN D. WALTER, Ph.D., Professor of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences,
STEVEN H. WOOLF, M.D., M.P.H., Professor of Family Practice and Preventive and Community Medicine,
Virginia Commonwealth University
MARC B. STONE, M.D., Study Director and Senior Program Officer,
Board on Health Care Services
STELLA OPARA, Senior Program Assistant
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
Alfred O. Berg, M.D., M.P.H., Professor and Chair, Department of Family Medicine, University of Washington School of Medicine
Byron Wm. Brown, Jr., Ph.D., Professor of Biostatistics, Emeritus, Department of Health Research and Policy, Stanford University
Gerard N. Burrow, M.D. Dean Emeritus, Yale University School of Medicine,
David Cooper, M.D., Professor of Medicine Johns Hopkins University School of Medicine
Danny O. Jacobs, M.D., M.P.H., Arnold K. Lempka Distinguished Professor of Surgery and Chairman, Department of Surgery, Creighton University
Judith R. Lave, Ph.D. Professor of Health Economics, Department of Health Policy & Management, Graduate School of Public Health, University of Pittsburgh
Adrian M. Ostfeld, M.D. Anna M.R. Lauder Professor of Epidemiology and Public Health and of Medicine, Emeritus, Yale University School of Medicine
Frank A. Riddick Jr., M.D., Chief Executive Officer Emeritus, Ochsner Clinic Foundation
Carole Spencer, Ph.D., F.A.C.B., Professor of Medicine, University of Southern California
Judith L. Wagner, Ph.D. National Cancer Policy Board
Noel S. Weiss, M.D., Dr.P.H., Professor, Department of Epidemiology, School of Public Health and Community Medicine, University of Washington
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Barbara J. McNeil, M.D., Ph.D., Ridley Watts Professor and Head Department of Health Care Policy, Harvard Medical School, and Joseph P. Newhouse, Ph.D., John D. MacArthur Professor of Health Policy and Management Harvard University. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
When the Medicare program was established in 1965, it was viewed as a form of financial protection for the elderly against catastrophic medical expenses, primarily those related to hospitalization for unexpected illnesses. The first expansions to the program increased the eligible population from the retired to the disabled and to persons receiving chronic renal dialysis. It was not until 1980 that an expansion of services beyond those required “for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member”1 was included in Medicare. These services, known as preventive services, are intended either to prevent disease (by vaccination) or to detect disease (by diagnostic test) before the symptoms of illness appear.
Our Committee was formed “to conduct a study on the addition of coverage of routine thyroid screening using a thyroid stimulating hormone test as a preventive benefit provided to Medicare beneficiaries under Title XVIII of the Social Security Act for some or all Medicare beneficiaries.”2 We approached this task in the context of another Institute of Medicine report published in 2000, Extend ing Medicare Coverage for Preventive and Other Services. In addressing this issue, we were aided by a background paper commissioned by the United States Preventive Services Task Force that reviewed the evidence published in peer-reviewed scientific papers, heard from a broad range of experts in relevant fields,
The Committee would like to express its appreciation for the fine assistance it received from a number of individuals:
David Atkins and the United States Preventive Services Task Force, in response to the legislation ordering this volume, commissioned the Systematic Evidence Review that is the principal background paper for this document as well as part of the process for the Task Force’s new clinical practice recommendations for screening for thyroid disease.
Mark Helfand developed the comprehensive Evidence Review (presented in Appendix B) and provided additional advice and insight.
Robert Lindeman provided additional data and analysis pursuant to his work on the New Mexico Elder Health Survey.
Mark Helfand, Robert Lindeman, Douglas Bauer, Chester Ridgway, Marshall McBean, and Mark Danese provided thoughtful presentations and discussion at the October workshop (Appendix A).
Mary Gabay and Anthony D’Andrea of Peterson Consulting developed and executed the technical specifications and programming for the claims data analysis.
Katharine Pirotte of the Centers for Medicare and Medicaid Services served as project officer for this volume and was helpful in all matters, particularly in securing access to Medicare claims data for analysis.
At the Institute of Medicine, the staff would like to thank, among others, Clyde Behney, Janet Corrigan, Tony Burton, Teresa Redd, Bronwyn Schrecker, Jennifer Bitticks, Sue Barron, Linda Kilroy, Donald Holmes, and Bill McLeod.