Wednesday, August 15, 2018

President's 2019 Budget Proposes Cutting USPSTF Budget

I ran across the President's 2019 Proposed Budget for AHRQ, which includes a discussion of the sub-budget for U.S. Preventive Services Task Force.  See online here.

A paragraph on page 7 proposes reducing USPSTF budget by -$4.2M to $7.4M.  Stating this will reduce recommendations per year from 12 to 6.   Here.  (For more discussion see PDF pages 27-28).

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Note that many factors go into the final budget from Congress.   The executive branch can propose a large expansion or cut in budget that is unlikely to actually occur in the Congressional budget.  However, the executive branch requests do reflect the positioning of its priorities and messaging.

The budget per review appears to be almost exactly $1M.  Reviews are prepared through exhaustive internal staff research and approved and endorsed by a public board of experts.

The discussion of  "number of evaluations per year" would include new topics as well as revisions of the existing USPSTF library.  A revision requires a very long review and article, just like a new topic. 

The timelines for work products are pretty long.  For example, USPTF announced its was starting a new BRCA policy review in March 2017 and even the draft version isn't out by August 2018.   (There will be another 6 months or more between draft and final.) 

The Affordable Care Act requires US insurers to cover USPSTF-endorsed services, and to cover them  without a copay.  Medicare legislation allows CMS to "import" USPSTF-endorsed services into the Medicare program, after an NCD review that finds the preventive service is applicable to Medicare patients. 


I don't know what the right budget for USPSTF is.   But a simplistic back-of-envelope projection from halving the bandwidth of outputs could be, for example, stopping the opening of new-area topics and doing updates at half the frequency (e.g. from every 4-5 years to every 8-10 years).