I’ve written many posts that reference the United States Preventive Services Task Force, aka the USPSTF. But I’ve never really explained what it is, other than its recommendations (or not) are the basis for Obamacare’s “free” screening tests and preventive health benefits. (As I’ve said before, I consider these benefits pre-paid.)
The Washington Post has a recent article on the USPSTF that I found very informative. It explains how the task force was formed, and how it’s struggling to maintain its directive to provide non-biased, evidence-based health care advice in today’s political climate.
The USPSTF was created under the Reagan administration in 1984. At that time, health insurance was undergoing the first of many changes, and there was interest is knowing whether paying for certain screening exams and preventive services would save money over time.
The task force is made up of 16 primary care physicians, appointed by the Department of Health and Human Services.
Primary care doctors are chosen as members rather than specialists because it was thought specialists would have “too much skin in the game” and would be biased.
The physicians thoroughly review all the research done on a particular screening test, such as annual mammograms, Pap smears, or PSAs (prostate-specific antigen), and then make a letter grade recommendation (A, B, C, D, F or I) indicating whether the test is of benefit or not.
To be included under Obamacare’s umbrella of preventive health benefits, a screening test must receive an A or B grade.
You can see the USPSTF recommendations page here.
I’m all about evidence-based medicine, and I believe the task force plays an important role in helping both care providers and patients make informed health care choices. I refer to it all the time.
But as this article makes clear, many times the recommendations meet with objections from the public, medical specialist groups, or the government. And then it gets tricky.
In 2009…the task force concluded that women would get the most benefit from regular mammograms starting at age 50 — not 40, as the American Cancer Society and other organizations had long advised. The rationale was that the older-age threshold would prevent more patients from being subjected to unnecessary biopsies, radiation and stress.
The shift sparked a firestorm. Then-HHS Secretary Kathleen Sebelius was forced to issue a statement reassuring women that they could do what they had always done: consult with their doctors and make individual decisions. The new guidelines did not set federal policy, she stressed — and Congress made sure of that by voting to waive the panel’s guideline.
Hmm, so much for Congress trusting the USPSTF to make informed and non-biased recommendations!
In January [of this year], the task force reaffirmed its breast cancer screening recommendation: Regular mammograms should start at age 50. But Congress had done an end run weeks before, directing insurers to rely on a 13-year-old guideline calling for screening to begin at 40.
The lawmakers’ move…means that most women in their 40s will be able to keep getting annual mammograms at no cost.
The USPSTF actually recommends (B grade) screening mammograms be performed every other year on women ages 50 to 75, not annually.
It really bothers me that Congress has the power to decide which recommendations insurance companies should or shouldn’t follow. What’s the point, then, of even having the task force?
Dr. Kenny Lin, a primary care doc who blogs at Common Sense Family Doctor and KevinMD, and who served on the task force, also worries about its future now that it’s so closely tied to the Affordable Care Act:
Within the small circle of physicians and policymakers who were aware of their work, the USPSTF won accolades and respect for “calling it as they saw it,” sticking strictly to the evidence and writing screening recommendations that frequently conflicted with more expansive guidelines promulgated by other professional organizations.
Since the passage of health reform, the USPSTF has been only a shadow of its independent self.
Of course, a Task Force that makes few waves is exactly what the current Administration wants.
How likely is it that the USPSTF will be permitted to advance any science with even remotely political implications? And – though it pains me to ask – is a Task Force that is forced to pull its punches due to politics really that much better than no Task Force at all?
I would argue that it is. Those physicians have the thankless task of shifting through mountains of research data, but they do it because they are passionate about evidence-based health care. At least I assume and hope they are.
Congress or special interest groups might choose to ignore them, but the USPSTF’s recommendations, along with a summary of all the evidence they looked at, are easily accessible on their website. And they are presented in a format that is relatively simple to understand and use.
Do you have a question about a screening test? Print out the task force’s recommendation and use it to start a conversation with your doctor.
Although the task force focuses on screening, they also make recommendations for other preventive therapies, such as supplements.
It’s not perfect, and I hate it that our health care has become so entangled with the federal government, but the USPSTF is a tool that I can and do use to guide my health care decisions.