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 -- Current Coverage -- Evidence Review, Conclusions, and Cost Estimates -- Eliminating the Time Limit on Coverage of Immunosuppressive Drugs for Transplant Recipients -- Current Coverage -- Evidence Review, Conclusions, and Cost Estimates -- 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 -- Melanoma -- 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 -- ASSESSMENT APPROACH: INTERVENTION, POPULATION, AND OUTCOMES -- 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 -- Burden of Disease -- Oral Health Problems and Leukemias -- Treatment for Leukemias -- Lymphoma -- Burden of Disease -- 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 -- Burden of Disease -- 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 -- Burden of Disease -- 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 -- ESTIMATED COSTS TO MEDICARE OF EXTENDING COVERAGE -- STATEMENTS OF OTHERS ON "MEDICALLY NECESSARY DENTAL SERVICES" -- COMMITTEE FINDINGS AND CONCLUSIONS -- Findings -- Cancers of the Head and Neck -- Leukemia -- Lymphoma -- Organ Transplantation -- Heart Valve Repair and Replacement -- Possible Directions for Future Research -- Conclusions -- 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 -- AVAILABILITY OF EFFECTIVE TREATMENT -- 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 -- ESTIMATED COSTS TO MEDICARE OF EXTENDING COVERAGE -- STATEMENTS OF OTHERS ON COVERAGE FOR IMMUNOSUPPRESSANTS -- COMMITTEE FINDINGS AND CONCLUSIONS -- Findings -- Possible Directions for Further Research -- Conclusions -- 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 -- Agenda -- APPENDIX B Screening for Skin Cancer -- INTRODUCTION -- EPIDEMIOLOGY AND BURDEN OF SUFFERING -- Melanoma -- Nonmelanoma Skin Cancer -- NATURAL HISTORY, DIAGNOSIS, AND STAGING OF SKIN CANCER -- Melanoma -- Nonmelanoma Skin Cancers -- RECOMMENDATIONS OF SECOND TASK FORCE AND OTHERS -- ANALYTIC FRAMEWORK AND KEY QUESTIONS -- METHODS -- Literature Review -- Data Extraction and Synthesis -- RESULTS -- Accuracy of Screening Tests -- 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? -- Summary -- CONDITIONS 2 AND 3: LEUKEMIA AND LYMPHOMA -- Introduction -- Methods -- Leukemia -- Leukemia Incidence and Burden -- Leukemia-Clinical Oral Aspects -- Lymphoma -- 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 -- Introduction -- Methods -- 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 -- Summary -- CONDITION 5: HEART VALVE REPAIR OR REPLACEMENT -- Introduction -- Medicare Utilization and Reimbursement of Valvular Heart Disease -- Methods -- Results -- ACKNOWLEDGMENTS -- REFERENCES -- Overview.

Head and Neck Cancer.