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Preventive Care, Private Health Plans, and Your Practice

  • Authors: Suzanne Landis, MD, MPH
  • CME/CE Released: 10/25/2012
  • Valid for credit through: 10/25/2013
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Target Audience and Goal Statement

This activity is intended for family physicians, internists, pediatricians, OB/GYNs, nurses and pharmacists.

The goal of this activity is to help primary care providers and other healthcare professionals familiarize patients with free preventive services covered under the Affordable Care Act, who is eligible, and how to code for these services.

Upon completion of this activity, participants will be able to:

  1. Describe the free preventive services available to many patients under the Affordable Care Act
  2. Review the mission of and services offered by the US Preventive Services Task Force


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Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • Suzanne Landis, MD, MPH

    Director, Division of Healthcare Innovation; Director, Center for Healthy Aging MAHEC; Professor, Department of Family Medicine, University of North Carolina-Chapel Hill, Asheville, NC


    Disclosure: Dr Landis has disclosed no relevant financial relationships.

    Dr Landis does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

    Dr Landis does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.


  • Jane Lowers

    Group Scientific Director, Medscape, LLC


    Disclosure: Jane Lowers has disclosed no relevant financial relationships.

  • Neil Chesanow

    Senior Clinical Editor, Medscape, LLC


    Disclosure: Neil Chesanow has disclosed no relevant financial relationships.

CME Reviewer(s)

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC


    Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Nurse Planner

  • Laurie E. Scudder, DNP, NP

    Nurse Planner, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC


    Disclosure: Laurie E. Scudder, DNP, NP, has disclosed no relevant financial relationships.

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    Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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    For Nurses

  • Medscape, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

    Awarded 0.25 contact hour(s) of continuing nursing education for RNs and APNs; none of these credits is in the area of pharmacology.

    Accreditation of this program does not imply endorsement by either Medscape, LLC or ANCC.

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    For Pharmacists

  • Medscape, LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

    Medscape, LLC designates this continuing education activity for 0.25 contact hour(s) (0.025 CEUs) (Universal Activity Number 0461-0000-12-105-H03-P).

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

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Preventive Care, Private Health Plans, and Your Practice

Authors: Suzanne Landis, MD, MPHFaculty and Disclosures

CME/CE Released: 10/25/2012

Valid for credit through: 10/25/2013


This activity has expired.

The accredited provider can no longer issue certificates for this activity. Medscape cannot attest to the timeliness of expired CME activities.

Moreover, because statutes, regulations, and policy information may change over time, the information available in this course may be out-of-date. If you need additional information concerning CMS programs, we recommend that you access


An integral component of the Patient Protection and Affordable Care Act of 2010 (ACA) is the National Prevention Strategy, which is designed to shift the focus of healthcare from the treatment of sickness and disease to prevention and the maintenance of health.[1] Included in the strategic directions outlined in the National Prevention Strategy are recommendations for increasing the use of effective and high-impact evidence-based clinical preventive services and medications, including the reduction of barriers to accessing them.[1,2]

In addition, the ACA includes a requirement that private insurers and employment-based plans cover certain preventive services without cost-sharing. The Departments of Health and Human Services (HHS), Labor, and Treasury issued interim final regulations requiring new health insurance plans and issuers to cover a cadre of preventive services without cost-sharing for enrollees.[3,4] While the interim final regulations do not apply to plans implemented before that date, as new plans are introduced into the marketplace, access to these services is expected to grow.

The coverage required by the ACA has made a difference in what services patients are willing to accept, according to Suzanne Landis, MD, MPH, a clinician with the Mountain Area Family Health Center in Asheville, North Carolina. Patients who in the past worried about the expense of a lipid panel, for example, now have access to the service at no additional charge based on risk factors and their age.

The selection of covered preventive services is based on the recommendations of the US Preventive Services Task Force (USPSTF), an independent, revolving panel of 16 non-federal primary care providers considered to be experts in prevention and evidence-based medicine.[5] Members of the panel are volunteers and represent the primary care disciplines of family medicine, internal medicine, nursing, obstetrics/gynecology, pediatrics, and behavioral medicine. The purpose of the panel is to conduct scientific evidence reviews of a broad range of clinical preventive healthcare services and develop recommendations for primary care clinicians and health systems, with the ultimate goal of improving clinical practice and promoting public health.[5,6]

"I feel that the level of scrutiny that is provided by the USPSTF is the best around and applaud the use of sound criteria to evaluate the existing data," states Dr Landis. "My practice generally supports these recommendations, so we don’t have extensive discussions on the specific services that we think should be provided."

The Task Force aims to update topics every 5 years to keep the recommendations in the Task Force library current, and solicits suggestions for new topics every 2 years through notices sent to partner organizations and posted in the Federal Register.[6] Topics are prioritized and assigned to "topic teams," which develop work plans and draft evidence reports. Based on these evidence reports, recommendations are drafted and reviewed by the Task Force for approval.

Each recommendation statement is assigned a letter grade, as shown in the table below:

US Preventive Services Task Force Recommendation Grades[7]
Grade Definition
A The US Preventive Services Task Force (USPSTF) recommends the service. There is a high certainty that the net benefit is substantial.
B The USPSTF recommends the service. There is a high certainty that the net benefit is moderate to substantial.
C Clinicians may provide this service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit from this service. (Note: This statement is under revision)
D The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
I Statement The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service.
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