Thursday, March 10, 2016

"The most powerful group of doctors no one has ever heard of"

I would disagree with Washington Post reporter Lena Sun's dramatic description of the U.S. Preventive Services Task Force - the American Medical Association's Relative Value Scale Update Committee (RUC), which recommends how much Medicare should pay for practically every piece of work that doctors do, would have my vote for "most powerful physician group." However, her recently published investigative piece provides rare behind-the-scenes insight on the inner workings of the USPSTF panel, the scientific and political controversies its work has engendered over the years, and the unwanted regulatory authority that was bestowed on it by the Affordable Care Act. It's a must-read for anyone interested in the intersection of preventive medicine and health policy. Even though it has been more than 5 years since I was a staffer for the Task Force, the concluding paragraphs resonate with the end of my experience:

Such groups as the American Cancer Society say the best way to shelter the task force from even subliminal pressure is to keep it focused on what the evidence shows. Figuring out how that translates into what insurance should pay for ought to be the job of a separate entity, one that ACS notes could weigh broader public-health and social impacts.

For instance, if colonoscopies are strongly recommended as a preventive service — therefore costing consumers nothing extra — does the coverage also include the anesthesiologist involved in the procedure? What about the office visit that takes place beforehand? And what happens if the doctor finds a polyp and a pathologist determines it is benign — is it still covered? (Yes to all.)

Task force members “were pigeonholed into this role,” said Caroline Powers, a director of federal affairs for the cancer society’s advocacy arm. “It’s an inappropriate role.”

Also this week, my editorial "A Public Health Framework for Screening Mammography: Evidence-Based vs Politically Mandated Care" appeared in print in the Journal of the American Medical Association (it was posted online in mid-January). My students were more impressed at my being mentioned in the Post, but this publication was a personal milestone. Many thanks to my co-author, Georgetown University law professor Larry Gostin, for organizing my initial thoughts and helping to complete and publish this paper in record time.