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Extending Medicare Coverage for Preventive and Other Services (2000)

Chapter: Appendix A: Study Activities

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Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
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APPENDIX A
Study Activities

Consistent with the provisions in the Balanced Budget Act of 1997, the Institute of Medicine (IOM) created a seven-person committee that was charged with studying the effects of expanded Medicare coverage in the areas of skin cancer screening, medically necessary dental care, and elimination of the time limitation for coverage of immunosuppressive drugs for transplant patients. The committee included specialists in public health, dermatology, transplantation, hospital dentistry, health policy, and cost-effectiveness analysis. From February 1999 to August 1999 the committee met five times. A workshop in April focused on medically necessary dental services, and workshops in June focused on skin cancer screening and immunosuppressive drugs. These workshops, which were open to the public, included presentations on the evidence base for these interventions, the estimated costs to Medicare of extending coverage, and other relevant topics. Public statements and comments were invited. Agendas follow in this appendix. In addition, four background papers were commissioned by the committee, and these are included as Appendixes BE of this report.

The other two topics specified in the Balanced Budget Act were certain nutrition services and routine patient care costs in clinical trials. Two separate committees were created to examine these topics. Their reports, Extending Medicare Reimbursement in Clinical Trials and The Role of Nutrition Therapy in Maintaining the Health of the Nation’s Elderly: Evaluating Coverage of Nutrition Services for Medicare Beneficiaries, are also available from the National Academy Press, including on-line at www.nap.edu.

Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
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INSTITUTE OF MEDICINE COMMITTEE ON MEDICARE COVERAGE EXTENSIONS WORKSHOP ON MEDICALLY NECESSARY DENTAL CARE

May 19–20, 1999, Washington, D.C.

Agenda

Wednesday, May 19

9:00

Welcome, Introductions, Workshop Overview

Robert S.Lawrence, M.D., Committee Chair, Johns Hopkins University School of Hygiene and Public Health

Marilyn J.Field, Ph.D., Study Director, Institute of Medicine

Background and Logistics

Following each presentation there will be a discussion and comments by invited discussants, registered members of the audience, and the audience at large.

9:30

Remarks on Current Dental Care Issues

Current Coverage for Oral Health Care by Medicare Health Care Financing Administration

9:45

Dushanka V.Kleinman, D.D.S., M.Sc.D.

Deputy Director, National Institute of Dental and Craniofacial Research

Caswell Evans, D.D.S., M.P.H.

Executive Editor and Project Director, Surgeon General’s Report on Oral Health, National Institute of Dental and Craniofacial Research

Charles (Bud) Conklin, D.D.S.

Director, Carilion Dental Care, Roanoke, Virginia

Speaking for the Federation of Special Care Organizations in Dentistry

11:00

Review Issues of Defining “Medically Necessary Dental Care”

Alexander White, D.D.S., Dr.P.H., M.P.H., M.S., Lead Author, Commissioned Paper, Kaiser Permanente Center for Health Research

1:00

Care for Lymphoma or Leukemia

James A.Lipton, D.D.S., Ph.D. National Institute of Dental and Craniofacial Research

Lead Discussant: Dr. Kathryn Atchison

Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
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1:50

Head and Neck Cancers

Lauren Patton, D.D.S.

University of North Carolina, Chapel Hill

Lead Discussant: Dr. Carter Van Waes

2:50

Organ Transplants

William G.Kohn, D.D.S.

Centers for Disease Control and Prevention

Lead Discussant: Dr. Michele Saunders

3:40

Valve Repair

Alexander White, D.D.S., Dr.P.H., M.P.H., M.S.

Kaiser Permanente Center for Health Research

Lead Discussant: Dr. David Pearle

4:30

General discussion led by Dr. Lawrence, assisted by Dr. White

5:00

ADJOURN

Thursday, May 20, 1999

8:30

Public Statements and Discussion

Attendees wishing to make public statements are requested to notify a staff member.

9:00

Methods of Cost Analysis

Allen Dobson, Ph.D., and Joan DaVanzo, Ph.D., M.S.W.

The Lewin Group, Inc.

10:15

Further Discussion

12:00

ADJOURN

Other Participants and Observers: Akintoye Adelakun, M.D., Health Care Financing Administration Fellow; Robert E.Barsley, D.D.S.; Randy Burkholder, HBK Publishing; Jodi Chappell, Academy of Osseointegration; Robert Collins, D.M.D., International and American Association for Dental Research; Jesse Kerns, M.P.P., The Lewin Group, Inc., Gina Luke, American Association of Dental Schools; Chris Maynard, HBK Publishing; Craig Palmer, ADA News; Ira R.Parker, D.D.S., University of California at San Diego.

Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
×

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

June 17, 1999, Washington, D.C.

Agenda

8:30

Welcome, Introductions, Workshop Overview, Charge to the Committee

Robert S.Lawrence, M.D., Committee Chair, Johns Hopkins University School of Hygiene and Public Health

Marilyn J.Field, Ph.D., Study Director, Institute of Medicine

Public Statements and Discussion

Attendees wishing to make formal public statements are requested to notify a staff member.

9:00

Epidemiology of Skin Cancer

Marianne Berwick, Ph.D.

Associate Attending Epidemiologist, Memorial Sloan Kettering Cancer Center

9:30

Current Approaches to Screening for Skin Cancer

Alan Geller, R.N., M.P.H.

Associate Director, Cancer Prevention and Control Center, Boston University, School of Medicine

10:00

General Discussion and Questions

10:30

Presentation of Draft Commissioned Paper

Mark Helfand, M.D., Lead Author, Commissioned Paper Assistant Professor, Oregon Health Sciences University

11:00

Discussion/Questions

Discussants

Lowell A.Goldsmith, M.D.

Dean, School of Medicine and Dentistry, University of Rochester

Alan Moshell, M.D.

Chief, Skin Diseases Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases

Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
×

12:30

Cost-Effectiveness of Screening for Melanoma

Kenneth A.Freedberg, M.D., M.Sc.

Associate Professor of Medicine and Public Health, Boston Medical Center

1:00

Cost Estimations of Screening Medicare Beneficiaries for Skin Cancer

Allen Dobson, Ph.D.

Senior Vice President, The Lewin Group, Inc.

1:30

Public Comment

American Academy of Dermatology

June Robinson, M.D., Secretary Treasurer

1:45

General Discussion and Questions

2:30

ADJOURN

Other Participants and Observers: Clifford Amend, M.D., Blue Cross/Blue Shield of Maryland; Joseph Chin, M.D., Health Care Financing Administration; Joan DaVanzo, Ph.D., The Lewin Group, Inc.; Karen Eden, Ph.D., Oregon Health Sciences University; Cheryl Hayden, American Academy of Dermatology; Jesse Kerns, M.P.P., Study Consultant, The Lewin Group, Inc.; William Larsen, Health Care Financing Administration; Donald R.Miller, Sc.D., Boston University; Katharine Pirotte, Health Care Financing Administration.

Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
×

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

June 18, 1999, Washington, D.C.

Agenda

8:30

Welcome, Introductions, Workshop Overview, Charge to the Committee

Robert S.Lawrence, M.D., Committee Chair, Johns Hopkins University School of Hygiene and Public Health

Marilyn J.Field, Ph.D., Study Director, Institute of Medicine

Public Statements and Discussion

Attendees wishing to make public statements are requested to notify a staff member.

8:45

Presentation of Draft Commissioned Paper and Remarks on Compliance

Dr. Robert S.Gaston, M.D., Author, Commissioned Paper

Associate Professor, Division of Nephrology, University of Alabama at Birmingham

9:30

Parallel Considerations for Liver Transplants

Michael R.Lucey, M.D.

Associate Professor of Medicine, Medical Director, Liver Transplantation Program, Hospital of the University of Pennsylvania

9:45

Coverage Options/Strategies Beyond Medicare Coverage

Cheryl Jacobs, MSW, LICSW

Clinical Transplant Social Worker, Fairview University Transplant Services, Minneapolis

10:00

General Discussion and Questions

11:00

Cost Considerations

Paul W.Eggers, Ph.D., Director, Division of Beneficiaries Research, Health Care Financing Administration

11:30

General Discussion and Questions

Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
×

1:00

Cost Estimations

Allen Dobson, Ph.D.

Senior Vice President, The Lewin Group, Inc.

1:30

Public Comment

Mark Schnizler, Ph.D., Graduate Program in Health Administration, Washington University, St. Louis

National Kidney Foundation: transAction Council

Dr. Andrew Silverman, Pharm.D.

Pharmacotherapy Specialist, Transplantation Services, Tampa General Hospital

2:00

General Discussion and Questions

2:30

ADJOURN

Other Participants and Observers: Clifford Amend, M.D., Blue Cross and Blue Shield of Maryland; Dolph Chianchiano, National Kidney Foundation; Joseph Chin, M.D., Health Care Financing Administration; Julia Christensen, Congressional Budget Office; Lauren Geyer, Health Care Financing Administration; Melody Hughson, Hoffman-La Roche; Kim Jackson, Transplant Recipients International Organization; Jesse Kerns, M.P.P., The Lewin Group, Inc.; Lizzy O’Hara, Congressman Boggs’s Office; Linda Ohler, National Association of Transplant Coordinators; Jackie Sheidan, Health Care Financing Administration; Alex Shipman, Covance; Andy Swire, Pharmaceutical Research and Manufacturers of America; Patricia Weitzkittel, American Nephrology Nurses Association; Stacey Windham, Congressman Canady’s Office; Troy Zimmerman, National Kidney Foundation.

Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
×
Page 165
Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
×
Page 166
Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
×
Page 167
Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
×
Page 168
Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
×
Page 169
Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
×
Page 170
Suggested Citation:"Appendix A: Study Activities." Institute of Medicine. 2000. Extending Medicare Coverage for Preventive and Other Services. Washington, DC: The National Academies Press. doi: 10.17226/9740.
×
Page 171
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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.

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