When bureaucracy gets in the way of preventive care

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This week, the Energy and Commerce Health Subcommittee will hold a hearing on a discussion draft of the United States Preventive Services Task Force (USPSTF) Transparency and Accountability Act, H.R. 1151. 

This legislation has bipartisan support and seeks to ensure greater specialty-appropriate and patient input into the development of preventive services recommendations that impact coverage for millions of patients.

{mosads}Created in 1984 as an independent entity, there has been growing concern regarding a number of USPSTF recommendations. As an urologist, I found it quite surprising that the USPSTF came out with its prostate-specific antigen (PSA) screening recommendations without consulting any urologists or any of the affected patient populations, such as African American men and men with a strong family history of prostate cancer.  

USPSTF guidelines on prostate cancer screening is in direct conflict with the American Urological Association’s (AUA) evidence-based clinical practice guideline on the early detection of prostate cancer.   

However, the PSA screening recommendation had been preceded by even more controversial recommendations on mammograms to screen for breast cancer, leading to an act of Congress to place a moratorium on the recommendation following an outcry from the medical community and several cancer patient support groups.  

Similarly, the task force’s determination that there is not enough evidence to make a recommendation to screen for skin cancer ignores the critical importance of early detection achieved through skin exams, and contradicts physician clinical guidelines based on medical literature.  

USPSTF recommendations concerning diabetes screening and colorectal cancer screening have also left many patients groups confused as the Affordable Care Act gives the USPSTF’s guidance great weight on which preventive care health treatments insurers may cover.

Currently, the USPSTF has little accountability. The Task Force members are appointed by the Director of the Agency for Healthcare Research and Quality (AHRQ), who is not confirmed by Congress. In addition, the Task Force does not meet with relevant stakeholders during their review process, nor do medical specialists in the subject under review serve on the Task Force.

The American Urological Association as well as my colleagues at the Alliance of Specialty Medicine believe the USPSTF should implement and adhere to procedures that allow for meaningful clinical and patient input and transparency during recommendation development.

The specialty community strongly supports the original intent of the USPSTF and its goal to improve the overall health of the American population.

However, in order to best serve the public, we urge the panel follow a more transparent and open process where subject-matter experts, patients, and other stakeholders are consulted and invited to weigh in as appropriate.

The USPSTF Transparency and Accountability Act is designed to do just that.

It ensures a transparent process for informing the public of matters under review and accepting comments. It provides for balanced representation on the Task Force, including that of a medical specialist. The legislation establishes an Advisory Board to ensure consistent stakeholder input.  As specialists, we are delighted to see Congress focus on this important issue and hope for permanent reforms to the USPSTF.   

Richard K. Babayan, MD is a Professor and Chairman at the Department of Urology, Boston University School of Medicine and Chief of Urology at Boston Medical Center.


The views expressed by contributors are their own and not the views of The Hill.
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