From its creation in 1984, the U.S. Preventive Services Task Force (USPSTF) has been a significant influence in healthcare, helping to recommend and determine the most beneficial and effective clinical preventive services. With the goal of creating a positive impact on the health of all Americans, the Preventive Services Task Force reviews and updates existing clinical preventive service guidelines and evaluates new preventive service recommendations. Through the diligent work of USPSTF, practitioners are armed with the most reliable and current clinical prevention tactics available, helping them to create a positive and lasting impact on the health and wellness of their patients.
Read on to learn about six things you should know about the Preventive Services Task Force.
1. The Preventive Services Task Force is made up of a panel of volunteers.
The Preventive Services Task Force is comprised of 16 nationally recognized expert volunteers who each specialize in their own field of practice. This 16-person panel includes practitioners from the fields of primary care, internal medicine, family medicine, pediatrics, behavioral health, obstetrics and gynecology, and nursing. Collectively, their primary goal is to improve the health and wellness of all Americans through evidence-based preventive service recommendations. All recommendations from USPSTF are sourced from existing, peer-reviewed evidence. Once evaluated, all recommendations are thoughtfully categorized and given a letter grade to help practitioners easily guide their patients through best-practice preventive care service guidelines based on individual patient criteria and needs.
2. Each recommendation is given a letter grade based on importance, significance, and other criteria.
Each recommendation from the Preventive Services Task Force is assigned a letter grade of A, B, C, or D, or assigned an "I statement." The letter grade is given based on the strength of the evidence supporting the recommendation and takes into consideration the balance between risks and harms for each specific preventive service. Recommendations are made across the entire patient spectrum, from young to old, with the general focus being on preventive services for asymptomatic people. Some recommended services can be listed in multiple grade categories, so it's important that you review the recommendation criteria in detail to ensure relevant usage. The Preventive Services Task Force list of grades is defined as follows:
- Grade A: Services that receive the A grade are highly recommended by USPSTF. The service is believed to have a substantial net benefit. The suggested use for practice is for practitioners to offer or provide this service. Some examples of Grade A recommendations include cervical cancer screening for women, colorectal cancer screenings for adults and seniors, high blood pressure screenings, and tobacco cessation interventions that include pharmacotherapy and behavioral approaches.
- Grade B: A level B grade means that the service is highly recommended and there is a high certainty that the net benefit of the service is moderate or there is moderate certainty that the benefits of the service will be moderate to substantial. Some examples of grade B recommendations include depression screening, BRCA-related cancer risk assessment, genetic counseling and genetic testing for adults and seniors, behavioral interventions for weight loss and obesity prevention, osteoporosis screenings, and skin cancer prevention behavioral counseling.
- Grade C: These services are recommended on a selective basis. The Preventive Services Task Force urges practitioners to use their professional judgment to determine the patient benefit of these services based on individual circumstances and do so on a case-by-case basis. Grade C recommendations include abdominal aortic aneurysm screening in adult seniors, prostate cancer screening, statin use for the primary prevention of cardiovascular disease in adults, and aspirin use to prevent cardiovascular disease and colorectal cancer.
- Grade D: USPSTF recommends against the provision of grade D services. Services that receive such a grade have been shown to have no net benefit or the harm of the services outweighs the benefits. Some examples of grade D services include hormone therapy in postmenopausal women as a primary prevention of chronic conditions, thyroid cancer screening, vitamin supplementation to prevent cancer and cardiovascular disease, and carotid artery stenosis screening.
- I Statement: An I statement is given to a service if there is insufficient evidence that the benefits of the service outweigh the potential harms or if the full extent of benefits versus harms cannot be determined. Some I statement service examples include atrial fibrillation screening with electrocardiography, peripheral artery disease and cardiovascular disease screening and risk assessment with the ankle-brachial index, and cardiovascular risk assessment with nontraditional risk factors.
To access the Preventive Services Task Force list of published recommendations, click here.
3. The Preventive Services Task Force makes recommendations about three types of preventive services.
All recommendations from USPSTF are meant to help prevent the onset, spread, or the complications associated with specific diseases. To accomplish this, the task force makes three types of preventive services recommendations.
- Screening tests: A screening test helps to detect potential health issues or diseases in people who are not exhibiting any symptoms. With the goal of early detection, screening tests can help patients make changes to their lifestyle to help further ward off disease onset or progression. Examples include depression screening and high blood pressure screening.
- Preventive medications: USPSTF looks closely at medications that can help prevent disease progression or exacerbation. Examples include aspirin use to prevent cardiovascular disease and statin use for the primary prevention of cardiovascular disease.
- Counseling: When the task force recommends counseling, the main goal is to encourage behavioral changes in patients who are on the path to developing diseases based on their lifestyle choices. Examples include weight loss to prevent obesity-related morbidity and mortality and tobacco cessation.
4. Cost is not a consideration in preventive services recommendations.
While the cost of medical care in the United States is a highly debated topic, when it comes to preventive health services, the cost of prevention is almost always more economical than the cost of disease treatment. For this reason, the Preventive Services Task Force does not consider the cost of any preventive services under evaluation. While USPSTF has the authority to review the cost-effectiveness of any preventive services under consideration, it chooses not to so that the focus can be based solely on clinical effectiveness.
5. Anyone can nominate a topic to the Preventive Services Task Force list for consideration.
USPSTF recognizes that preventing chronic disease and illness is a team effort between practitioners, patients, payers, and all other vested parties. For this reason, anyone, including individuals and organizations, can nominate a topic to be evaluated by the Preventive Services Task Force. Once a topic has been selected, the task force reviews all evidence about the topic, including peer-reviewed scientific studies published in medical journals. For the topic to become a recommendation, the preventive service must be proven effective and the benefit must outweigh any potential for harm. The selected topic is also evaluated based on patient age, sex, and other risk factors that may be relevant. Find out more about nominating a topic for Preventive Services Task Force review here.
6. Preventive Services Task Force recommendations impact insurance coverage.
Finally, it is worth understanding that the Affordable Care Act (ACA) includes provisions aimed at improving coverage of and access to preventive health services, with the provisions referring to USPSTF grading that directly affect health plan coverage.
For example, under ACA, non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage must provide coverage of items or services with an A or B recommendation rating from the USPSTF. For Medicare coverage, USPSTF services with a grade A or B must be covered without cost sharing if the HHS secretary determines they are reasonable and necessary for the prevention or early detection of an illness or disability and appropriate for individuals entitled to benefits under Medicare part A or enrolled under Medicare part B preventive care recommendations. And for traditional Medicaid plans, states that cover all USPSTF grade A or B recommended preventive services without cost-sharing receive a one percentage point increase in the federal medical assistance percentage for those services.
This information is not only important for understanding coverage but it also helps explain the significance of USPSTF in healthcare past its pre-ACA history of essentially serving an “ivory tower” organization tasked with making general recommendations.