Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleOriginal Research

Comparison Between US Preventive Services Task Force Recommendations and Medicare Coverage

Lenard I. Lesser, Alex H. Krist, Douglas B. Kamerow and Andrew W. Bazemore
The Annals of Family Medicine January 2011, 9 (1) 44-49; DOI: https://doi.org/10.1370/afm.1194
Lenard I. Lesser
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alex H. Krist
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Douglas B. Kamerow
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrew W. Bazemore
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Additional Files
  • Figure 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1.

    Proportion of services recommended by the US Preventive Services Task Force (USPSTF) and covered by Medicare.

Tables

  • Figures
  • Additional Files
    • View popup
    Table 1.

    United States Preventive Services Task Force (USPSTF) Recommended Services and Medicare Coverage for Prevention in Adults 65 Years of Age and Older

    ServiceRatingDetailsPreventive Coordination: Risk Assessment, Patient Motivation, and Arranging the ServicePreventive Service: Test, Screening Instrument, or Counseling
    Partially reproduced and reprinted with permission from: Lesser LI, Bazemore AW. Improving the delivery of preventive services to Medicare beneficiaries. JAMA. 2009;302(24):2699–2700.
    BMD = bone mineral density; Pap = Papanicolaou; WMV = Welcome to Medicare Visit.
    aFor services where the USPSTF including screening and counseling in the same recommendation, the screening portion was considered as “risk assessment and arrangement.”
    bColonoscopy would be fully covered, as, if normal, would only need one-time screen. Sigmoidoscopy and fecal occult blood testing would not be, as repeated screenings would be needed.
    Abdominal aortic aneurysm (screening)BOne-time ultrasound for men ≥65 y who have ever smokedFullyFully
    Alcohol (screening and counseling)aBScreen and counsel all adultsPartial: WMV onlyFully
    Breast cancer, genetic risk assessment (screening)BReferral for genetic counseling with option for testing for women with a family history suggestive of breast cancer mutationFullyNone
    Breast cancer, mammographyBScreen all women, ages 50–74 y, every 2 yPartial: WMV onlyFully
    Cervical cancer, at increased riskAScreen all women who have been sexually active and have a cervix. Recommends against screening women >65 y if they have had adequate recent screening with normal Pap smears and are at otherwise not at high riskPartial: WMV onlyFully
    Colon cancer ages 50–75 yAScreen with fecal occult blood testing, sigmoidoscopy, or colonoscopy, from the ages of 50 to 75 yPartial: WMV onlybFully
    Depression (screening)BScreen adults for depression, when care supports are availablePartial: WMV onlyPartial: WMV only
    Diabetes, if at riskBScreen adults with sustained blood pressure (either treated or untreated) >135/80 mm HgPartial: WMV onlyFully
    Healthy diet, if at risk (counseling)BIntensive counseling (usually multiple sessions lasting 30 min or more) for adults with risks for cardiovascular or diet-related chronic diseasePartial: WMV onlyPartial: inconsistent indication
    High blood pressureACheck the blood pressure of all adultsPartial: WMV only
 Partial: inconsistent indicationPartial: WMV only
    Lipid disorders, men >35 yAScreen all, with an uncertain, but likely interval of every 5 y. Repeated screening less likely of benefit in those >65 yPartial: WMV onlyFully
    Lipid disorders, women >45 y at increased riskAScreen all, with an uncertain, but likely interval of every 5 y. Repeated screening less likely of benefit in those >65 yPartial: WMV onlyFully
    Obesity (screening with intensive counseling)aBScreen all adults and offer high-intensity counseling for obese adultsPartial: WMV onlyPartial: inconsistent indication
    Osteoporosis, women at riskBScreen all women >65 y. Interval uncertain, but yield of repeated screening will be higher in older women, those with lower BMD at baseline, and those with other risk factors for fracturePartial: WMV onlyFully
    Tobacco useAAsk all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco productsPartial: WMV onlyFully
    • View popup
    Table 2.

    Preventive Services Covered by Medicare Which the US Preventive Services Task Force (USPSTF) Recommends Against

    Preventive Screening with D RecommendationMedicare Coverage
    ECG=electrocardiogram; WMV=Welcome to Medicare Visit.
    aMedicare covers a screening ECG as part of WMV, although it is optional.
    bSpecifically required as part of screening pelvic examination.
    Abdominal aortic aneurysm, womenYes
    Asymptomatic bacteriuriaNo
    Bladder cancerNo
    Breast cancer genetic testing, not high risk because of family historyNo
    Carotid stenosisNo
    Cervical cancer, women >65 y and not at high risk, with adequate screeningYes
    Cervical cancer, women with hysterectomy for benign diseaseYes
    Colon cancer aged >85 yYes
    Chronic obstructive pulmonary diseaseNo
    Coronary heart disease, in low-risk patientsYesa
    HemochromatosisNo
    Ovarian cancerYesb
    Pancreatic cancerNo
    Peripheral arterial diseaseNo
    Prostate cancer, aged 75 y and olderYes
    Testicular cancerNo

Additional Files

  • Figures
  • Tables
  • The Article in Brief

    Comparison Between US Preventive Services Task Force Recommendations and Medicare Coverage

    Lenard I. Lesser , and colleagues

    Background A 2008 law allows Medicare to pay for medical services rated A or B by the US Preventives Services Task Force (USPSTF), a government-authorized and -sponsored independent panel of experts in primary care and prevention. This study compares preventive medical services offered by Medicare with those recommended by the USPSTF.

    What This Study Found Of the 15 USPSTF recommended interventions for adults aged 65 years and older, Medicare reimburses fully for only 1 service. For most preventive services (60 percent), Medicare reimburses fully for the service or test, but only partially for the coordination of obtaining that service. For 4 services (27 percent), Medicare reimburses clinicians partially for both the preventive coordination and the actual service. For 1 service, Medicare reimburses fully for the coordination and assessment but not for the test/service itself. Further, instead of providing payment to clinicians for recommended preventive services, Medicare pays clinicians to provide 7 services that are not recommended, potentially increasing harm to patients as well as medical costs.

    Implications

    • Medicare coverage for preventive services needs to be reassessed, with special focus on preventive coordination.
    • Current Medicare coverage will likely promote both inadequate and excessive delivery of preventive services. The new health care reform law, however, has the potential to improve the provision of preventive services to Medicare beneficiaries.
    • The authors call for Medicare to align itself with the USPSTF recommendations and usher in an era of improved quality of care through effective prevention.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 9 (1)
The Annals of Family Medicine
Vol. 9, Issue 1
1 Jan 2011
  • Table of Contents
  • Index by author
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Comparison Between US Preventive Services Task Force Recommendations and Medicare Coverage
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
2 + 11 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Comparison Between US Preventive Services Task Force Recommendations and Medicare Coverage
Lenard I. Lesser, Alex H. Krist, Douglas B. Kamerow, Andrew W. Bazemore
The Annals of Family Medicine Jan 2011, 9 (1) 44-49; DOI: 10.1370/afm.1194

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Comparison Between US Preventive Services Task Force Recommendations and Medicare Coverage
Lenard I. Lesser, Alex H. Krist, Douglas B. Kamerow, Andrew W. Bazemore
The Annals of Family Medicine Jan 2011, 9 (1) 44-49; DOI: 10.1370/afm.1194
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Acknowledgments
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • US Medicare, Medicaid, and nurse practitioners all turn 50
  • Management of Falls in Community-Dwelling Older Adults: Clinical Guidance Statement From the Academy of Geriatric Physical Therapy of the American Physical Therapy Association
  • Medicare Annual Preventive Care Visits: Use Increased Among Fee-For-Service Patients, But Many Do Not Participate
  • Residency and specialties training in nutrition: a call for action
  • The US Preventive Services Task Force Should Consider A Broader Evidence Base In Updating Its Diabetes Screening Guidelines
  • In This Issue: Clinical Decision Support
  • Google Scholar

More in this TOC Section

  • Building a Data Bridge: Policies, Structures, and Governance Integrating Primary Care Into the Public Health Response to COVID-19
  • Adaptation and External Validation of Pathogenic Urine Culture Prediction in Primary Care Using Machine Learning
  • Primary Care Physicians’ and Patients’ Perspectives on Equity and Health Security of Infectious Disease Digital Surveillance
Show more Original Research

Similar Articles

Subjects

  • Domains of illness & health:
    • Prevention
  • Methods:
    • Quantitative methods
  • Other research types:
    • Health policy
    • Health services
  • Other topics:
    • Clinical practice guidelines

Content

  • Current Issue
  • Past Issues
  • Past Issues in Brief
  • Multimedia
  • Articles by Type
  • Articles by Subject
  • Multimedia
  • Supplements
  • Online First
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Media
  • Job Seekers

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2023 Annals of Family Medicine