Extending Medicare Coverage for Preventive and Other Services (2000) / Chapter Skim
Currently Skimming:
6 Future Directions
6 Future Directions
Pages 127-140
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From page 127... ...
Preventive Services Task Force. LINKING EVIDENCE TO MEDICARE COVERAGE: THE CASE OF PREVENTIVE SERVICES One criticism of Congress's service-by-service approach to coverage decisions about preventive services, prescription drugs, and other generally excluded categories of care is that it may favor services for high-profile conditions and technologies that have strong lobbying groups but not necessarily a strong evidence base.
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From page 128... ...
All the covered services listed in the body of Table 6-1 involve either pnmary prevention (keeping people from developing disease) or secondary prevention (identifying risk factors or detecting disease early)
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From page 129... ...
. The other noncovered preventive services that the Task Force recommends for those over age 64 involve patient education and counseling about tobacco cessation, diet, alcohol, physical activity, seat belts, motorcycle and bicycle helmets, firearms, fall prevention, hormone replacement therapy, sexually transmitted diseases, CPR training, dental visits and dental hygiene, smoke detectors, and settings for hot water heaters.
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From page 130... ...
from adequately considering the potential of some preventive services to harm people who undergo unnecessary testing or treatment based on false positive screening results. Some argue that preventive
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From page 131... ...
For services recommended for inclusion in a periodic health examination, Congress could then direct the Health Care Financing Administration (HCFA) through the new Medicare Coverage Advisory Committee to consider costs, cost-effectiveness, and feasibility in the context of the Medicare program.
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From page 132... ...
clinical, epidemiological, health services, and other research that helps clinicians and policymakers judge the extent to which different health care strategies are effective in improving health outcomes and have benefits that exceed harms; 2. methods for conducting valid research, measuring outcomes accurately and meaningfully, summarizing data usefully, assessing resource implications of decisions, and otherwise helping ensure the credibility and utility of research to clinicians, policymakers, and others; and 3.
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From page 133... ...
Even when special efforts have been made to present risk information clearly, a number of studies have found that people vary greatly in their ability to accurately interpret quantitative information about health risks and benefits and that misinterpretations are common (e.g., see Hux and Naylor, 1995; Ransohoff and Harris, 1997; Schwartz et al., 1997; Woloshin et al., 1999a)
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From page 134... ...
Currently, the extent to which cost, costeffectiveness, or both are explicitly considered in coverage decisions varies depending on who makes the decision and whether the decision involves a new technology or a previously excluded service. For example: .
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From page 135... ...
A small step in this direction would be for Congress to encourage and support AHCPR, HCFA, and other relevant agencies in preparing cost-effectiveness analyses for informational purposes, if not for coverage decisionmaking. For example, as suggested in Chapter 4, Congress could direct the Health Care Financing Administration to develop evidence-based recommendations for covering dental care in conjunction with certain serious medical conditions and treatments.
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From page 136... ...
One additional reason for explicitly linking practice or coverage recommendations to evidence reviews is that such reviews along with judgments about the population burden of disease, costs, and productive avenues for research~an help decisionmakers set priorities for future biomedical, clinical and health services research. THE LIMITS OF COVERAGE Even those fortunate enough to have coverage from Medicare or other sources often do not receive recommended preventive (or other)
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From page 137... ...
, performance feedback, peer comparison data, and other strategies to encourage clinicians to provide or advise recommended services.2 For 2In addition, because the provision of certain preventive services is fairly easy to track, their provision is frequently monitored by groups assessing and comparing the performance of health plans, for example, the National Committee for Quality Assurance (NCQA, 1999~. If services not demonstrated to be effective are covered and monitored, some plans could divert resources from other more effective services that were not
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From page 138... ...
For example, a health plan might work to increase the use of clearly effective services, especially in higher-risk groups with lower levels of utilization, while providing marginally beneficial or disputed services only to those who request and still want such services after a discussion of potential benefits and harms (Thompson, 1996~. As is true for health care services themselves, the effectiveness of organizational efforts to improve the delivery of services cannot be assumed.
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From page 139... ...
Subsequent attempts to breach the exclusion have encouraged efforts to systematically assess rather than assume the effectiveness and cost-effectiveness of specific clinical preventive services. Such analyses appear to have helped persuade decisionmakers to authorize coverage for effective services and even to favor some of these services over treatment services by waiving beneficiary cost sharing.
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From page 140... ...
Health Care Financing Review 16: 197-222, 1994.
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