Extending Medicare Coverage for Preventive and Other Services (2000) / Chapter Skim
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The services were screening for skin cancer; medically necessary dental services; elimination of time restrictions on coverage for immunosuppressive drugs after transplants; routine patient care costs in clinical trials; and nutrition therapy.
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EVIDENCE AND COST ESTIMATES FOR SELECTED SERVICES Skin Cancer Screening The three major kinds of skin cancers are melanoma, basal cell carcinoma, and squamous cell carcinoma. The latter two are often grouped together as nonmelanoma skin cancers.
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In recent years, Congress has approved coverage under certain circumstances for several preventive services including screening for breast cancer and colorectal cancer. Clinical screening of asymptomatic people for skin cancer is not explicitly authorized.
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. For a new program of skin cancer screening, the estimated net five-year cost to Medicare could range from about $150 million to nearly $900 million, depending on the screening approach adopted.
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No randomized clinical trials have investigated outcomes of dental care for head and neck cancer patients receiving radiation therapy to the jaws. Small retrospective studies provide limited direct evidence that replacing aggressive tooth-extraction protocols with tooth-preserving protocols prior to radiation can reduce radiation-related caries and tooth extractions that place patients at high risk for osteoradionecrosis.
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Indirect evidence and biologic plausibility are suggestive but not conclusive that health outcomes may be improved by eliminating oral sources of infection that may cause septicemia in immunosuppressed lymphoma or organ transplant patients or endocarditis in patients with a diseased, abnormal, or surgically repaired or replaced heart valve. The committee notes, however, that widely accepted clinical protocols for identifying and eliminating all infections and potential sources of infection before organ transplantation and certain other procedures are based largely on biological principles, animal studies, and clinical experience, not direct evidence from controlled trials.
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Some return to dialysis or receive a second transplant, but others die. Given this evidence and the existing Medicare policy of supporting organ transplants, the rationale for eliminating the current time limits for coverage of immunosuppressive drugs for all solid organ transplant recipients is strong.
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private contractors that administer Medicare claims for the government deciding whether specific services billed for a specific beneficiary are covered and also establishing policies for services and circumstances for which HCFA has no policy. One criticism of Congress's service-by-service approach to coverage decisions about preventive services and other generally excluded categories of care 3As this report was being completed, Congress approved an extension of coverage for eight months for this group of beneficiaries.
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Of the eight screening services recommended by USPSTF for those over age 64, Medicare does not explicitly cover blood pressure testing, height and weight checks, and screening for vision and hearing impairment and problem drinking. Of the 15 recommended counseling and education services, Medicare explicitly covers only diabetes education.
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For example, as suggested above, Congress could direct the HCFA to develop evidence-based recommendations for covering dental care in conjunction with certain serious medical conditions and treatments. Similarly, for the preventive services recommended by the USPSTF based on reviews of relevant evidence, Congress could direct the Health Care Financing Administration to assess these services in the context of the Medicare program and then make coverage recommendations.
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The uneven consideration of cost-effectiveness and costs is a further concern. Currently, congressional decisions about extending coverage for nowexcluded care are governed by budget neutrality rules that favor services projected to save the Medicare program money.
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Medicare does and does not cover. Thus, the availability and scope of coverage varies for people with and without an ESRD diagnosis; for ESRD patients on dialysis versus those who receive kidney transplants; for kidney versus other transplant candidates or recipients; and for Medicare-covered transplant recipients versus other beneficiaries needing expensive prescription drugs.
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