What does a USPSTF Grade Mean?
Here's the rundown.
On October 5, 2015, the U.S. Preventive Services Task Force (USPSTF) released a draft statement regarding colorectal cancer screening.
Unfortunately, CT colonography (CTC) was absent from the list of recommended screening strategies. The task force indicated in the draft that CTC may be appropriate in certain clinical settings. However, failure to explicitly include CTC in the list of recommended screenings creates uncertainty regarding reimbursements. Regardless of the USPSTF’s decision, the release of the draft provides the opportunity to discuss the impact of a USPSTF recommendation on reimbursement.
What is the USPSTF?
The USPSTF makes “evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.” Recommendations are assigned a grade based on available evidence in the medical literature; the available grades are A, B, C, D, and I. In the case of the proposed colorectal cancer screening recommendations, the USPSTF gave an A grade to “screening for colorectal cancer starting at age 50 years and continuing until age 75 years.” The recommendation also includes a list of “screening strategies,” which does not include CT colonography. Instead, CTC appears under “alternative tests,” along with stool DNA testing.
What does the grade mean?
The USPSTF’s grading system directly affects reimbursement from commercial payers. A grade of A or B indicates that the USPSTF finds sufficient evidence to recommend the screening. A grade of C indicates there is sufficient evidence to recommend screening in certain patients. A grade of I indicates insufficient evidence to recommend for or against screening, and a grade of D indicates a recommendation against screening. A screening recommendation of A or B requires that commercial payers both cover and pay for the screening.