PSA is a protein measurable in the blood of all males with prostates that is loosely connected to prostatic cancer.
Medicare officials are considering a measure that would penalize doctors who order routine prostate-cancer screening tests for their patients, as part of a federal effort to define and reward quality in health-care services.
The proposal, which hasn’t been widely publicized, has prompted a flurry of last-minute comments to the Centers for Medicare and Medicaid Services, virtually all in opposition. The official comment period is now expired and the government is holding off on their decision.
Many of those commenting said the measure would discourage doctors from discussing the pros and cons of screening for prostate-specific antigen (PSA) with their patients and allowing them to decide, as several major medical groups recommend.
“PSA screening is a very controversial topic. The debate is ongoing and people feel very strongly about it, one way or another,” said David Penson, chair of public policy and practice support for the American Urological Association, which urged CMS to reject the proposal. “To make it a quality measure would say, ‘You’re a poor quality doctor if your patients get this test.’ ”
The proposed measure is part of continuing federal efforts to develop ways to identify and reward value in health care. The Obama administration has said it plans to tie 50% of Medicare payments to such quality measures by 2018.
Since 2012, the U.S. Preventive Services Task Force has recommended against routine screening for prostate cancer for men of any age on the grounds that the benefits don’t outweigh the harms.
This is an astonishing development. There are two points here: First, there is a wide spectrum of prostate cancer. That is "cancer," as it is generally understood, does not adequately describe the entity we see under the microscope when "prostate cancer" is diagnosed. It fits the microscopic criteria but does not behave physiologically like other cancers all the time. Second, PSA testing finds the "prostate cancer" at a high rate, regardless of its position on the spectrum.
It is the disease that is complicated, not the test. In true bureaucratic, anti-science fashion, the government would ban the test.
Medicare officials are considering a measure that would penalize doctors who order routine prostate-cancer screening tests for their patients, as part of a federal effort to define and reward quality in health-care services.
The proposal, which hasn’t been widely publicized, has prompted a flurry of last-minute comments to the Centers for Medicare and Medicaid Services, virtually all in opposition. The official comment period is now expired and the government is holding off on their decision.
Many of those commenting said the measure would discourage doctors from discussing the pros and cons of screening for prostate-specific antigen (PSA) with their patients and allowing them to decide, as several major medical groups recommend.
“PSA screening is a very controversial topic. The debate is ongoing and people feel very strongly about it, one way or another,” said David Penson, chair of public policy and practice support for the American Urological Association, which urged CMS to reject the proposal. “To make it a quality measure would say, ‘You’re a poor quality doctor if your patients get this test.’ ”
The proposed measure is part of continuing federal efforts to develop ways to identify and reward value in health care. The Obama administration has said it plans to tie 50% of Medicare payments to such quality measures by 2018.
Since 2012, the U.S. Preventive Services Task Force has recommended against routine screening for prostate cancer for men of any age on the grounds that the benefits don’t outweigh the harms.
This is an astonishing development. There are two points here: First, there is a wide spectrum of prostate cancer. That is "cancer," as it is generally understood, does not adequately describe the entity we see under the microscope when "prostate cancer" is diagnosed. It fits the microscopic criteria but does not behave physiologically like other cancers all the time. Second, PSA testing finds the "prostate cancer" at a high rate, regardless of its position on the spectrum.
It is the disease that is complicated, not the test. In true bureaucratic, anti-science fashion, the government would ban the test.
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