Image by Dan Simpson via flickr.
For years, health policy experts have asked whether high-deductible health plans (HDHPs) with health savings accounts (HSAs) cause some patients to forego needed medical care. Rather than pay their high deductibles, these patients postpone visits to doctors or don’t get other necessary care, policy experts argue.
Now, researchers at the University of Michigan’s Center for Value-Based Insurance Design (VBID), Harvard University Medical School and the Carlson School of Management at the University of Minnesota suggest in a new report that the IRS should expand its definition of preventive services so that employers and health plans can structure incentives under HDHPs so that patients would not sacrifice necessary services. Changing the definition of preventive services would allow patients with chronic conditions to access more covered care, called secondary preventive services, just as insurers cover primary preventive-care services under the Affordable Care Act, meaning no charges, copayments or deductibles.
In a report released today, the researchers said millions of Americans in HSA-qualified HDHPs could benefit from expanded coverage of preventive services. The report was funded by the Gary and Mary West Policy Center. Among the researchers who prepared the report were A. Mark Fendrick, M.D., the director of the VBID center and professor of health management and policy in the School of Public Health at the University of Michigan; Michael E. Chernew, Ph.D., Leonard D. Schaeffer professor of health care policy at Harvard Medical School; and Stephen T. Parente, Ph.D., Minnesota insurance industry professor of health finance and insurance in the Department of Finance in the Carlson School of Management at the University of Minnesota. Continue reading
The U.S. Preventive Services Task Force issued recommendations on Tuesday on the value of routine cognitive screening for older adults, concluding “the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment.”
The task force said there was inadequate direct evidence on the benefits, and that several drug therapies and non-pharmacologic interventions have a “small effect” on the short term cognitive function measures in patients with mild to moderate dementia. They said the extent of clinically relevant benefit is uncertain. This is the same conclusion reached in previous assessments of the clinical benefit of cognitive screening.
They did find evidence that interventions targeted to caregivers have a small effect on caregiver burden and depression, but the scope of clinical relevance is still uncertain. This recommendation applies to universal screening with formal screening instruments in community-dwelling adults in the general primary care population who are older than 65 and have no signs or symptoms of cognitive impairment. Early detection and diagnosis of dementia through the assessment of patient-, family-, or physician-recognized signs and symptoms, some of which may be subtle, are not considered screening and are not the focus of this recommendation. Continue reading
The U.S. Preventive Services Task Force often finds itself in the news when determining what works and doesn’t work in screenings and preventive care. It told healthy women not to bother with calcium and vitamin D pills, said many women could wait on mammograms until age 50 and recently clarified who might benefit from regular lung cancer screening tests.
The task force’s work lies in translating medical evidence into clinical practice, which can be a difficult and contentious task. Its recommendations are often nuanced and misunderstood.
How does the group come to these determinations and how can you report on the science and not just the heat a recommendation generates? What is evidence-based medicine and how does the USPSTF use it to make recommendations on health care services? Continue reading
With mammograms in the news lately, it’s worth noting that the U.S. Preventive Services Task Force has posted its plan for reviewing and updating its recommendations for screening for breast cancer. The draft research plan lays out the “strategy the Task Force will use to collect and examine research and is the first step in updating the 2009 recommendation,” according to Ana Fullmer at USPTF. Recommendations are updated every five to seven years, so she says a new recommendation probably won’t be finished for a few years.
The panel is seeking answers about the specific benefits and harms of screening mammography for women over 40, they’re asking if benefits and risks vary by imaging technique – digital mammograms, ultrasound or MRIs; and importantly, they’re trying to find out how common ductal carcinoma in situ (DCIS) is in the U.S. and what benefits and harms are involved in treating it.
Experts recently recommended renaming DCIS to exclude the word “carcinoma” so the finding wouldn’t be so frightening to patients. DCIS is an abnormal pattern of cell growth in the milk ducts of the breast. In many cases, it doesn’t progress to cancer. Yet a growing number of women have decided to remove both breasts rather than take their chances that it isn’t dangerous.
Interested parties who want to weigh in on the draft plan are encouraged to submit comments and questions to the Task Force by Dec. 11.
Under the Affordable Care Act, certain high-value preventive services – such as colonoscopies – are supposed to be free. No co-pay for the patient.
But some patients are getting charged when they don’t expect it and perhaps shouldn’t be.
And there is a lot of inconsistency on who gets charged, depending on individual circumstances, what state they live in and what health plan they have. Part of it is confusion about what constitutes “screening” and what constitutes treatment. Plus doctors vary in how they “code” and bill for these services.
The variance is not just based on the individuals’ health circumstances (i.e. whether they had a polyp or not), but what state they live in, what health plan they have. The whole thing is generating confusion and complaints – and it’s a good story.
The thinking behind making preventive care free – specific preventive services, graded A or B by the U.S. Preventive Services Task Force (USPSTF) – is that it makes it more accessible. It’s easy to put off – and put off and put off – screening. Research has shown that having to pay for it is an additional barrier.
The Kaiser Family Foundation, the American Cancer Society and the National Colorectal Cancer Roundtable just put out a report examining the problem. Three scenarios seem common: Continue reading