Saturday, November 21, 2009

And it gets worse ...

I've been reading the Senate Health Care Reform bill (HR3590). While there is no specific mention of mammogram screening, check out the wording relative to recommendations made by the US Preventive Services Task Force on pages 1189-1190:

SEC. 4105. EVIDENCE-BASED COVERAGE OF PREVENTIVE
SERVICES IN MEDICARE.

(a) AUTHORITY TO MODIFY OR ELIMINATE COVERAGE OF
CERTAIN PREVENTIVE SERVICES.—

Section 1834 of the Social Security Act (42 U.S.C. 1395m) is
amended by adding at the end the following new subsection:

AUTHORITY TO MODIFY OR ELIMINATE COVERAGE OF
CERTAIN PREVENTIVE SERVICES.—

Notwithstanding any other provision of this title, effective
beginning on January 1, 2010, if the Secretary determines
appropriate, the Secretary may—

‘‘(1) modify—

‘‘(A) the coverage of any preventive service described in
subparagraph (A) of section 1861(ddd)(3) to the extent
that such modification is consistent with the
recommendations of the United States Preventive
Services Task Force; and

‘‘(B) the services included in the initial preventive physical
examination described in subparagraph (B) of such
section; and

‘‘(2) provide that no payment shall be made under this title
for a preventive service described in subparagraph (A) of
such section that has not received a grade of A, B, C, or I
by such Task Force.’’
.


Here we go again. It appears that HHS Secretary is going to have to say, "I'm sorry, I mis-spoke when I said women should consult with their doctors to determine whether they should continue participating in annual mammogram screenings." If this bill passes, it does appear the recommendations of the US Preventive Services Task Force will have some weight in what insurance companies are required to reimburse/pay for.

If this passes, it will pass at the horrendous expense of 1 death per every 1900 women.

3 comments:

bluelyon said...

Actually, it should be covered, based on that language as mammograms between 40=49 are rated C. See this link.

However, what I fear is that because the new recommendations discourage providing the service, most insurance companies will no longer include it as a standard part of women's health coverage and would need to be "explained" by her physician why it's medically "necessary." Currently, I do not need a referral by my physician to obtain a mammogram (though I usually get one).

bluelyon said...

Might have given you the wrong link. Try this:

http://www.ahrq.gov/CLINIC/uspstf/uspsbrca.htm

bluelyon said...

I love this quote:

"So, what does this mean if you are a woman in your 40s? You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health, and personal values."

Informed decision translated: Can you pay for it yourself?