A need for improved understanding about USPSTF and other evidence-based recommendations

摘要

Anderson et al. (Anderson et al., 2014) have provided valuable insights regarding the opinions of obstetrician and gynecologists (ob-gyns) from a survey conducted in 2010, when the Patient Protection and Affordable Care Act (as amended by the Healthcare and Education Reconciliation Act and referred to collectively as the Affordable Health Care Act) was passed (The Patient Protection Affordable Care Act, 2010). One provision of the Act is the requirement that new private health plans eliminate cost-sharing for a variety of preventive services, including those recommended by US Preventive Services Task Force (USPSTF) with an 'A' or 'B' rating (Koh and Sebelius, 2010). In 2009 the USPSTF released new breast cancer recommendations changing the recommended screening frequency from 1-2 years to biennial screening and drawing a distinction on the overall effectiveness of mammography for women older and younger than 50 years of age. In 2009, the USPSTF concluded that the overall benefit was smaller for women 40 to 49 years old and recommended that these women discuss the potential harms and benefits of screening with their doctors before making an individualized decision. This occurred during the time period when the health reform legislation was being finalized. As a result, some may have misunderstood the revised recommendations for less frequent screening as a cost reduction measure under the Affordable Care Act rather than the evidence-based decision that the USPSTF intended it to be. Congress chose to allow for more expansive coverage than would have been required based on the 2009 USPSTF recommendations. As a result, when it was enacted in 2010 the Affordable Care Act required that annual breast cancer screenings be covered by new private health plans without cost-sharing to women aged 40 and older, based on the 2002 USPSTF recommendations USPSTF, 2002.