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Tuesday Dec 06, 2016

AAFP to Congress: Hands Off USPSTF

Last week, AAFP President John Meigs, M.D., testified before the House Energy and Commerce Committee Subcommittee on Health in defense of the U.S. Preventive Services Task Force (USPSTF). 

The hearing was scheduled to examine the task force and discuss the USPSTF Transparency and Accountability Act (HR 1151), legislation that would alter the composition and scope of work of the task force. Meigs was invited to share the AAFP's views on the USPSTF and the important role it plays in assisting family physicians in their daily interactions with patients. 

The AAFP is a strong supporter of the task force and is an active participant in its work. The Academy actively engages with the task force to identify and evaluate clinical guidelines to ensure that family physicians have the most timely and relevant information to assist them in the care of their patients. The AAFP's clinical recommendations typically align with recommendations made by the task force.

In his testimony, Meigs outlined our strong support for the USPSTF and its existing composition.

"My work and that of hundreds of thousands of primary care physicians relies on the integrity of the U.S. Preventive Services Task Force (USPSTF or the task force)," he said. "The task force was designed to be, and has been, a non-partisan, independent body of physicians and other health professionals who make valuable recommendations for primary care. Many recommendations within H.R. 1151, the USPSTF Transparency and Accountability Act, in our opinion, would undermine the work and progress that has been achieved since the task force was established in the early 1980s."

In recent years, the task force and its recommendations have faced increased political scrutiny. Although some of this scrutiny was in response to recommendations made by the task force (specifically related to mammography and prostate cancer screening), the more significant attention came about as a result of Section 1302 of the Patient Protection and Affordable Care Act. Section 1302 of the ACA requires all insurers (public and private) to provide preventive services that receive an A or B grade from the USPSTF and vaccination recommendations from the CDC's Advisory Committee on Immunization Practices independent of patient cost-sharing (co-pay and deductible).

The AAFP has policy supporting this provision, but recognizes that the inclusion of the coverage provisions in the ACA changed the impact of the work for the task force and elevated its significance in the eyes of many in the health care industry.

HR 1151 would make four significant changes:

  • alter the composition of the task force to include subspecialists;
  • allow representation and participation by the broader health care industry, including pharmaceutical and medical device companies;
  • require that the task force to assess how its grades would impact access to a health care service or device; and
  • require that the task force publish its research plan, including the analytic framework, key questions and literature search strategy.

Although HR 1151 will not advance in the current Congress, it likely will be re-introduced in the 115th Congress. The AAFP will continue to support the task force, its work and its recommendations. We also will aggressively oppose efforts to diminish the task force's work. 

The USPSTF, created in 1984, is a panel of national experts in prevention, epidemiology and evidence-based medicine. These experts include family physicians and other primary care physicians. The task force is charged with making evidence-based recommendations about clinical preventive services such as screening exams and preventive medications. The task force gives each recommendation a grade of A, B, C, or D or an I Statement based on the strength of the evidence considered during the rigorous review of evidence.  The recommendations are applicable to individuals who do not demonstrate signs or symptoms of the specific disease or condition under evaluation and only apply to services provided by primary care physicians. The recommendations are not designed to prohibit or restrict patient access to any preventive service.

Presidential Transition Update
In recent days, President-elect Trump has begun announcing nominees for key post in his administration. These nominations have spurred a flurry of reactions -- positive and negative -- from individuals across the nation, including family physicians. In my previous post, I discussed the impact of the elections and the AAFP's approach to working with the Trump Administration and the incoming 115th Congress. I would like to build on my previous post and offer some additional perspective on how the AAFP can best represent our members and advocate on behalf of our patients.

The AAFP is a professional organization that has the tremendous honor and obligation of representing the nation's family physicians and, more importantly, being an advocate for patients. The AAFP has been and remains a bi-partisan organization. We are an organization grounded in a set of core beliefs that each individual, regardless of their personal or economic situation, deserves access to affordable and quality health care. We are guided by our strategic plan and policies adopted by our Congress of Delegates. Although elections and politicians come and go, the AAFP's steadfast commitment to these fundamental objectives remains constant. 

Elections, by design, create disruption. This disruption contributes to a sense of uncertainty about what is to come and what is to be expected of new leaders. This is why it is important to be grounded as an organization. The AAFPs inclusive and comprehensive set of policies allow us to advance our mission and advocate for our members with any individual, regardless of their party affiliation or ideology. These same policies also allow the AAFP to hold elected officials accountable for their decisions and actions.

It would be a disservice to our members and their patients to not engage with an individual or political party simply because they hold or have advanced a point of view contrary to ours. Our job is to advocate on behalf of family medicine and patients, to the best of our ability, with all elected officials. We are a professional organization that feeds on the passion and commitment of our current and future members, while looking to our Board of Directors and professional staff to harness that passion and advance our goals and mission. 

There is a professional standard that guides how an organization such as the AAFP should conduct itself. This includes an effort to adhere to respectful dialogue on issues and representing our organization and members in a reputable manner at all times.

Although we all have our personal opinions on the various individuals who serve in government, it is important to remind ourselves that we all share a set of common goals for family medicine and patients. Now is the time to rally around those goals and objectives that unite us.  To this end, I urge you to engage with the AAFP to advocate for our profession and our patients. The best way to do this is by joining the Family Physician Action Network.  

Comments:

Thank you Shawn and Dr Meigs for your thoughtful comments and summation of this important issue. It is vitally important that the USPSTF remain as it exists today. Adding sub-specialists, with their special interests and agendas, to the panel would dilute its effectiveness in helping to guide us Family Physicians in what is in the best interests of our patients.

Posted by Carlos R Gonzales MD FAAFP on December 06, 2016 at 11:27 AM CST #

As a medical student and physician working in Australia and the UK, the last place I wanted to work was the US, due to my perception/understanding that the system here cared nothing about health and was perceived as a business with patients merely being sources of revenue
I have now worked here for 20+ years, and all the gains that have been made in that time seem to be eroding rapidly.
I feel so sad that there are so many in this country in positions of power/decision- making who care nothing about public health and the basic human right of all citizens.to a healthy life.

Posted by ginette Archinal on December 06, 2016 at 11:30 AM CST #

Great commentary, Shawn. I wholeheartedly agree with not changing the USPSTF structure. I also found your comments regarding working together with all political parties to be thoughtful. The country seems highly divisive as it is. Our organization should try to represent all members and all patients in a non-divisive way. Well-written, Shawn. Thank you.

Posted by Mark H. Belfer, DO, FAAFP on December 06, 2016 at 11:35 AM CST #

I feel that all the USPSTF does is give recommendations that are based upon cost effectiveness of care instead of what is best for my patients.

Posted by Caroline Battles M.D. on December 06, 2016 at 11:42 AM CST #

because abamocare has tied coverage to task force recommendations, the financial interest now want to control those recommendations. Hence, new legislation and the corruption that goes with it. Your support for computers, medical home models, guidelines and MOC continues to corrupt medicine at every level. Nothing the AAFP has supported has gone as intended. Trump may be nutty in many ways but these endless rules, laws, regulations and guidelines are creating a huge backlash we now call Trump; president-elect. I am blackmailed to be a member of the AAFP. Maybe I can Trump the AAFP one day. If I could find work without being board certified today I would not be board certified. I will quit medicine ASAP but, unfortunately, I still need to work.

Will the AAFP allow me to be board certified with the National Board of Physicians and Surgeons? Of coarse not, they lick each others butt.

Posted by mark on December 06, 2016 at 12:14 PM CST #

I've spent my career as a family physician lucky to be able to work with top academic subspecialists on rotation from many different countries (in addition to my dedicated family medicine colleagues). While recognizing that en vogue investigations, diagnoses, and treatments have come and gone in the history of medicine, I'm troubled (and embarrassed) by the reticence of the the family medicine Academy to accept and promote practices that are standard in the subspecialties (meanwhile, we continue to emphasize the role of Vitamin D in preventing falls!?!). As time goes on, I'm dismayed by what seems to me to be a haughty protectionist presumption that "only the family physician knows best" along with an unwillingness to accept that, for example, my nephrology colleague loves, cares for, and contributes just as much concern for the mutual patient with whom we are BOTH sharing responsibility. It is otherwise absurd to start an article promoting divisiveness then end the same article promoting unity. HR 1151 SHOULD let subspecialists in, SHOULD require a "systems based practice" accounting of USPSTF recommendations, SHOULD require transparency and follow-up research of the consequences of its recommendations, but should NOT let pharma/device companies in. I do not support turf wars, only my patients.

Posted by Ben, MD on December 06, 2016 at 02:06 PM CST #

I applaud the firm stand the AAFP is taking to help protect the integrity of the USPSTF. I agree we enter uncertain times as a new administration and congress promises to roll back the ACA and privatize Medicare and Medicaid. I fully expect the AAFP to endorse future changes in health care financing legislation that fulfill our mission of affordable care for everyone regardless of income, race, age and ability.

The Congress of Delegates has given the Board of the AAFP a mandate to study a privately delivered publicly financed method of health care and its impact on both patients and physicians. I expect this to carry forth regardless of the current political climate. We need to stand behind parts of the ACA that work well and abandon the parts that do not. Millions remain uninsured and underinsured. The specter of medical bankruptcy still exists. We are not seeing any meaningful changes with the quadruple aim.

Posted by Andrea DeSantis DO on December 06, 2016 at 04:53 PM CST #

Thank you Shawn, I appreciate your thoughtful commentary. The USPSTF does not set policy, it makes recommendations based on a careful consideration of the evidence. This was my typical opening statement with patients when the uninformed hullabaloo broke out about the task force's recommendation regarding mammography. I would then proceed to have an open dialogue with the patient, to include ACC recommendations and the evidence as we knew it. We should continue in the same practice, allowing the patient to make as informed a consent as we can help them come to. Now, with PSA recommendations, I continue that, to include the "standard of care" in our area. I think mandating the AVAILABILITY of screening with a high level of evidence is good, it doesn't mean that it HAS to be done. Subjecting patients to tests with questionable evidence for value does not serve them well, however strongly an individual physician might feel about it. Though any given physician still has the ability to order the test.
At the end of the day, our patients come first, not the physician and not the current particular political wave of opinion. Therefore, I agree with Shawn that we have an obligation to our patients to continue a respectful approach with whoever is in the seat of power, to champion the right of the people to have high quality, affordable health care that includes effective preventive medical practice.

Posted by Robert Callahan MD on December 06, 2016 at 09:20 PM CST #

Without an unbiased body to evaluate existing data with regard to cost effectiveness, we will be left at the mercy of expert opinion sub-specialty recommendations. These recommendations are often tied to reimbursement benefits for sub-specialists and do not consider overall cost to the system at large. We need USPSTF to help us control health care costs and make smart and informed decisions with our patients' best interests in mind.

Posted by Margaret Baylson on December 07, 2016 at 07:17 AM CST #

No such thing as an "unbiased body". The needs of a 26YO suma wrestler in NYC is not the same as a 98YO in rural NC, both who happen to have diabetes. The Suma wrestler doesn't want to lose weight and the 98YO doesn't care about anything. So much for ADA guidelines (or any other)!
The need for guidelines is greatly exaggerated and, as the number of guidelines increase, the value of the important ones are simply diluted by the increasing number of trivial ones. Most of the latest and greatest "discoveries" do not survive the test of time. Scientific research used to be controlled by scientists who were curious about nature. Now it is controlled by money. Small private practices loved their patients and vice-versa. Now big corporations run the business of medicine. The care of medicine is being replaced by guidelines and regulations implemented by corporate america. Every office now posts the same "patient's rights and responsibility" (so much for freedom of speech). This is not progress.
The best standard of care is kindness, not the prescription pad or the laboratory.
The task force should not influence insurance coverage nor change its makeup. They should be restricted to how many recommendations they can make. The sky should not be the limit. No one should be obliged to follow their recommendations.
Health care decisions should be personalized. The patient chooses the doctor and the advice, however flawed it may be. It wasn't "broke", just not perfect (like any human being). Stop trying to fix what ain't broke. Medical care was never perfect because it never will be. The truth will never go away.
Finally.no one should be obliged to be board certified, as the AAFP is now as corrupt and self-serving as everyone else. Bur now we are obliged, thanks to the AAFP!

Posted by mark on December 07, 2016 at 11:04 AM CST #

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About the Author



Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.