Physicians spar over preventive services task force role in health reform plans

Lobbying groups representing radiologists, mammographers, and general practice physicians are engaged in a political tug of war over how much of a role the U.S. Preventive Services Task Force should have in proposed federal healthcare reforms.

In a Nov. 24 statement, the American College of Radiology and Society of Breast Imaging jointly called for legislators to reject language in Senate healthcare reform legislation requiring private insurers, Medicare, and Medicaid to cover only services receiving a specific grade from the USPSTF. This provision includes enforcing the task force's controversial new guidelines recommending biennial screening mammography beginning for women at age 50 and ending at age 74.

Dr. James H. Thrall, chair of the ACR board of chancellors, warned that mandating the guidelines as part of more general reforms awaiting Senate floor debate after Thanksgiving might help to cut costs, but would lead to unnecessary deaths from breast cancer.

"This is not a political argument. This is a matter of life of death," he said in a statement.

The 129,000-member American College of Physicians countered with its own statement Nov. 24 backing the USPSTF and warning against political maneuvering directed against task force guidelines. The ACP lamented that critics would use the USPSTF recommendations, published in the ACP's flagship journal, the Annals of Internal Medicine, to charge that their inclusion in the reform bill directions would lead to healthcare rationing.

The task force is a unit of the Agency for Health Care Research and Quality in the Department of Health and Human Services. It is considered high on the list of the federal agencies likely to be assigned responsibility for administering billions of dollars of comparative-effectiveness research grants included in the healthcare reform package. The Medicare Improvement for Patients and Providers Act of 2008 gave the DHS the authority to consider USPSTF recommendations when making Medicare coverage decisions.

Radiologists have been unhappy with the USPSTF since at least October 2008, when it issued guidelines against screening CT colonography. That recommendation may have helped lead the Centers for Medicare and Medicaid Services to deny Medicare payment for CT colonography screening in February.

In its Nov. 24 statement, the ACR charged that the task force lacks representation from radiologists, oncologists, or breast surgeons qualified to assess research evaluating the clinical efficacy of medical imaging procedures.

Dr. W. Phil Evans, president of the Society of Breast Imaging, urged Congress to exclude the task force's mammography guidelines from the reform legislation and alert its members to "guard against such unacceptable recommendations moving forward without any input from experts in breast cancer diagnosis and treatment."

In its statement, the ACP confirmed that Congressional legislation would give the USPSTF an important role in making evidence-based recommendations on preventive services that insurers would be required to cover, but it stressed the bills do not give the task force or any other government entity the authority to impose limitations on coverage, ration care, or require that insurers deny coverage.

Without naming the ACR or SBI specifically, the ACP complained that critics have made "unfair and unsubstantiated attacks on the expertise, motivation, and independence of the scientists and clinician experts on the USPSTF."

The ACR's Thrall called for Congress to require the preventive services task force to include experts from the field in which they are making recommendations. Draft guidelines should be submitted to outside stakeholders for review before they are finalized, he said.

"Allowing a small number of people with no demonstrated expertise in the subject matter to make recommendations regarding diagnosis of (breast cancer), a disease that kills more than 40,000 women each year, makes no scientific sense and is a mistake that many women will pay for with their lives," Thrall said.