Extending Medicare coverage for preventive and other services / Marilyn J. Field, Robert L. [i.e. Robert S.] Lawrence, and Lee Zwanziger, editors ; Committee on Medicare Coverage Extensions, Division of Health Care Services, Institute of Medicine.

Format:

Book

Contributor:

Field, Marilyn J. (Marilyn Jane)

Lawrence, Robert S., 1938-

Zwanziger, Lee.

Series:

Compass series (Washington, D.C.)

Compass series

Language:

English

Subjects (All):

Medicare.

Preventive health services.

Medical screening.

Skin--Cancer--Prevention.

Skin.

Physical Description:

1 online resource (410 p.)

Edition:

1st ed.

Other Title:

Medicare coverage for preventive and other services

Preventive and other services

Place of Publication:

Washington, D.C. : National Academy Press, c2000.

Language Note:

English

Summary:

This report, which was developed by an expert committee of the Institute of Medicine, reviews the first three services listed above. It is intended to assist policymakers by providing syntheses of the best evidence available about the effectiveness of these services and by estimating the cost to Medicare of covering them. For each service or condition examined, the committee commissioned a review of the scientific literature that was presented and discussed at a public workshop. As requested by Congress, this report includes explicit estimates only of costs to Medicare, not costs to beneficiaries, their families, or others. It also does not include cost-effectiveness analyses. That is, the extent of the benefits relative to the costs to Medicare-or to society generally-is not evaluated for the services examined. The method for estimating Medicare costs follows the generic estimation practices of the Congressional Budget Office (CBO). The objective was to provide Congress with estimates that were based on familiar procedures and could be compared readily with earlier and later CBO estimates. For each condition or service, the estimates are intended to suggest the order of magnitude of the costs to Medicare of extending coverage, but the estimates could be considerably higher or lower than what Medicare might actually spend were coverage policies changed. The estimates cover the five-year period 2000-2004. In addition to the conclusions about specific coverage issues, the report examines some broader concerns about the processes for making coverage decisions and about the research and organizational infrastructure for these decisions. It also briefly examines the limits of coverage as a means of improving health services and outcomes and the limits of evidence as a means of resolving policy and ethical questions.

Contents:

Extending Medicare Coverage for Preventive and Other Services

Copyright

Acknowledgments

REVIEWERS

Preface

Contents

Extending Medicare Coverage for Preventive and Other Services

Summary

EVIDENCE AND COST ESTIMATES FOR SELECTED SERVICES

Skin Cancer Screening

Current Coverage

Evidence Review, Conclusions, and Cost Estimates

Medically Necessary Dental Services

Eliminating the Time Limit on Coverage of Immunosuppressive Drugs for Transplant Recipients

DECIDING COVERAGE FOR PREVENTIVE AND OTHER SERVICES

Linking Evidence to Medicare Coverage: The Case of Preventive Services

The Infrastructure for Making Coverage Decisions

BEYOND COVERAGE

BEYOND EVIDENCE

1 Introduction

THE MEDICARE PROGRAM

Historical Background

Enrollment and Expenditure Trends

MEDICARE COVERAGE DECISIONS

Congress

Health Care Financing Administration

Administrative Contractors

COVERAGE, ACCESS TO CARE, AND OUTCOMES

Rationales for Extending Medicare Coverage

Insurance and the Use of Health Care Services

OVERVIEW OF THE REPORT

2 Objectives, Principles, and Methods

OBJECTIVES AND PRINCIPLES

Criteria and Trade-Offs

ANALYTIC STRATEGY

Defining the Intervention, Population, and Outcomes

Identifying and Assessing the Scientific Literature

Linking Evidence to Conclusions

ESTIMATING COSTS TO MEDICARE OF EXTENDING COVERAGE

Considering Health Outcomes and Costs Together

3 Screening for Skin Cancer

ASSESSMENT APPROACH: INTERVENTION, POPULATION, AND OUTCOMES

POPULATION BURDEN OF DISEASE

Melanoma

Nonmelanoma Skin Cancers

AVAILABILITY OF EFFECTIVE TREATMENT

Nonmelanoma Skin Cancers.

SCREENING AND DIAGNOSTIC PROCEDURES

Screening

Diagnosis

Accuracy of Screening Tests

Accuracy of Diagnostic Tests

BENEFITS AND HARMS OF SKIN CANCER SCREENING

General Issues

EVIDENCE OF BENEFITS FROM EARLY DETECTION OF SKIN CANCER THROUGH SCREENING

ESTIMATED COSTS TO MEDICARE OF EXTENDING COVERAGE

STATEMENTS OF OTHERS ABOUT SKIN CANCER SCREENING

COMMITTEE FINDINGS AND CONCLUSIONS

Findings

Possible Directions for Future Research

Conclusions

4 Medically Necessary Dental Services

DEFINING MEDICALLY NECESSARY DENTAL SERVICES

HEAD AND NECK CANCER

Burden of Disease

Treatment of Cancers of the Head and Neck

Oral Health Problems Associated with Radiation Treatment of Cancers of the Head and Neck

Dental Care for Patients Undergoing Radiation Therapy for Cancer of the Head and Neck

Effectiveness of Dental Care in Improving Health Outcomes for Head and Neck Cancer Patients Treated with Radiation

LEUKEMIA AND LYMPHOMA

Leukemia

Oral Health Problems and Leukemias

Treatment for Leukemias

Lymphoma

Oral Health Problems and Lymphomas

Treatment for Lymphomas

Oral Health Problems Related to Treatment for Leukemia and Lymphoma

Dental Care for Patients with Leukemia or Lymphoma

Effectiveness of Dental Care in Improving Health Outcomes for Leukemia and Lymphoma Patients

SOLID ORGAN TRANSPLANTS

Oral Health Problems and Organ Transplantation

Dental Care for Patients Before or After Organ Transplantation

Effectiveness of Dental Care in Improving Health Outcomes for Organ Transplant Recipients

HEART VALVE REPAIR OR REPLACEMENT

Oral Health Problems and Heart Valve Disease.

Dental Care for Patients Undergoing Surgery for Heart Valve Disease

Effectiveness of Dental Care in Promoting Better Health Outcomes for Patients with Heart Valve Disease

STATEMENTS OF OTHERS ON "MEDICALLY NECESSARY DENTAL SERVICES"

Cancers of the Head and Neck

Organ Transplantation

Heart Valve Repair and Replacement

5 Immunosuppressive Drugs for Transplant Patients

EVOLUTION OF IMMUNOSUPPRESSIVE DRUG COVERAGE BY MEDICARE

ASSESSMENT APPROACH

BURDEN OF DISEASE

Need for Immunosuppression

Waiting Lists for Transplantation

BARRIERS TO ADEQUATE THERAPY

Following Complex Drug Regimens: General Issues

Cost of Immunosuppressive Drugs

Expiration of Medicare Coverage and Alternative Funding

Evidence About the Effects of Providing or Withdrawing Coverage13

STATEMENTS OF OTHERS ON COVERAGE FOR IMMUNOSUPPRESSANTS

Possible Directions for Further Research

6 Future Directions

LINKING EVIDENCE TO MEDICARE COVERAGE: THE CASE OF PREVENTIVE SERVICES

STRENGTHENING THE INFRASTRUCTURE FOR COVERAGE DECISIONS

Commitment to Technology Assessment

Examples of Specific Infrastructure Weaknesses

Role of Cost and Cost-Effectiveness Analyses

Linking Evidence to Recommendations

THE LIMITS OF COVERAGE

THE LIMITS OF EVIDENCE

References

APPENDIX A Study Activities

INSTITUTE OF MEDICINE COMMITTEE ON MEDICARE COVERAGE EXTENSIONS WORKSHOP ON MEDICALLY NECESSARY DENTAL CARE

Agenda.

INSTITUTE OF MEDICINE COMMITTEE ON MEDICARE COVERAGE EXTENSIONS WORKSHOP ON SKIN CANCER SCREENING

Agenda

INSTITUTE OF MEDICINE COMMITTEE ON MEDICARE COVERAGE EXTENSIONS WORKSHOP ON IMMUNOSUPPRESSIVE DRUG THERAPY

APPENDIX B Screening for Skin Cancer

INTRODUCTION

EPIDEMIOLOGY AND BURDEN OF SUFFERING

Nonmelanoma Skin Cancer

NATURAL HISTORY, DIAGNOSIS, AND STAGING OF SKIN CANCER

RECOMMENDATIONS OF SECOND TASK FORCE AND OTHERS

ANALYTIC FRAMEWORK AND KEY QUESTIONS

METHODS

Literature Review

Data Extraction and Synthesis

RESULTS

Screening Studies

Non-Screening Studies

Risk Factors for Nonmelanoma Skin Cancer

Risk Factors for Melanoma

Reliability of Measures of Risk

Use of Risk Assessment in Practice

Consequences of Screening

Type of Skin Examination

Recruitment Strategy

Procedure for Referring Patients for Follow-Up

Effectiveness of Early Treatment

Case-Control Study of Self-Examination

Comparing Stages of Cancers and Mortality Found in Screening to Those Found in Usual Practice

Retrospective Studies of the Consequences of Delay in Diagnosis

Cost-Effectiveness Studies of Screening for Skin Cancer

SUMMARY

ADDENDUM B-1 STRATEGY FOR SKIN CANCER SEARCH

ADDENDUM B-2 SCREENING FOR SKIN CANCER: INCLUSION CRITERIA FOR EVIDENCE TABLES

REFERENCES

APPENDIX C Medically Necessary Dental Services

OVERVIEW

What Are Medically Necessary Dental Services?

Selected Clinical Conditions Under Consideration

Currently Covered Dental Services Under Medicare

Increasing Number of Persons 65 and Above Who Are Retaining Natural Teeth

Decision Framework for Medically Necessary Dental Services

Decision Analytical Framework

General Analytic Approach.

CONDITION 1: HEAD AND NECK CANCER

Introduction

Methods

General Observations from the Literature Search

Acute and Chronic Complications of Radiation Therapy to the Head and Neck Region

Pretreatment Dental Assessment

Prevalence of Dental Disease in the At-Risk Population

Preventive Dental Treatment Needs

Efficacy of Pretreatment Care: Aggressive Extraction-No Prevention Versus Dental Preservation Approach

Influence of Paradigm Shift to Dental Preservation on Incidence of Osteoradionecrosis

Is There a Role for Prophylactic Hyperbaric Oxygen Therapy in the Prevention of Osteoradionecrosis from Postradiation…

What Treatment Is Required to Manage Osteoradionecrosis of the Jaws?

What Is the Quality of Life Impact of Head and Neck Cancer Treatment?

CONDITIONS 2 AND 3: LEUKEMIA AND LYMPHOMA

Leukemia Incidence and Burden

Leukemia-Clinical Oral Aspects

Lymphoma Incidence and Burden

Lymphoma-Clinical Oral Aspects

Oral Complications of Treatment for Leukemia and Lymphoma: Chemotherapy and Bone Marrow Transplantation

Oral Sources of Septicemia in Patients with Hematologic or Lymphatic Malignancies

Role of Prechemotherapy Dental Treatment in Reducing Septicemias

Oral Mucositis Treatment

CONDITION 4: ORGAN TRANSPLANTATION

Infections

Immunosuppression Therapy

Pre-Transplant Oral Considerations

What Type of Dental Services Could Be Considered Medically Necessary?

Early Detection of Dental Problems

Posttransplant Considerations

Other Oral Lesions in Transplant Recipients

CONDITION 5: HEART VALVE REPAIR OR REPLACEMENT

Medicare Utilization and Reimbursement of Valvular Heart Disease

Results

ACKNOWLEDGMENTS

Overview.

Head and Neck Cancer.

Notes:

"Support for this project was provided by the Department of Health and Human Services (Contract Number 500-98-0275)"--T.p. verso.

Includes bibliographical references and index.

ISBN:

9786610185580

9780309183505

0309183502

9781280185588

1280185589

9780309592369

0309592364

9780585317755

0585317755

OCLC:

45732690