Study Finds Discrepancy in Medicare Coverage of Preventive Care Services
Medicare pays for certain preventive procedures that are not recommended by experts and does not cover services that have been recommended, according to a study published in the Annals of Family Medicine, Reuters reports.
Researchers examined how frequently Medicare reimbursement followed medical screening recommendations from the U.S. Preventive Services Task Force, an independent expert panel selected by the Agency for Healthcare Research and Quality to review scientific evidence for certain preventive services and care.
The study found that as of 2009, Medicare partly covered 93% of preventive services suggested by USPSTF. However, in most cases, Medicare paid only for the coordination of these services.
Researchers also found that Medicare covered seven of 16 services for which evidence of their benefits does not outweigh their risks. For example, Medicare pays for screenings for:
- Abdominal aortic aneurysms in women, which are recommended only for older men with a history of smoking;
- Colon cancer screenings in people older than age 85; and
- Prostate cancer screenings in men older than age 74.
The study authors were unclear about the reasons for the discrepancies but noted that it has traditionally been Congress, not CMS, that authorized payments for certain preventive services.
Furthermore, researchers noted that the federal health reform law could resolve the issue. The overhaul permits HHS to remove coverage for services USPSTF does not recommend (Norton, Reuters, 1/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.