By Aine Cryts
The Centers for Medicare & Medicaid Services (CMS) is proposing to tie physicians' recommendations for screenings for the prostate-specific antigen (PSA) for non-recommended patients to their quality scores.
About 28,000 men die in the United States each year because of aggressive prostate cancers--even after being tested and receiving treatment, according to statistics from the American Cancer Society. Still, studies show that screenings for PSA have a minimal benefit in terms of reducing the chance of death from typically slow-growing prostate cancer.
For example, a study published this month in The Journal of the American Medical Association revealed that both early-stage prostate cancer and rates of PSA screening have gone down and that this coincides with the U.S. Task Force for Preventative Medicine's 2012 recommendation against using the test.
The task force recommends against using the test because its benefits don't outweigh its drawbacks, which include the potential of lifelong side effects of surgery and radiation to treat the slow-growing cancer. The study recommends that longer follow up will determine "whether these decreases are associated with trends in mortality."
The issue is getting wrapped up in the government's value-based care initiatives, including a goal that 50 percent of Medicare payments will be tied to quality measures by 2018, according to the Wall Street Journal.
The argument against CMS' proposed measure is it would discourage physicians from having conversations with patients about the pros and cons of screening for the test.
"PSA screening is a very controversial topic. The debate is ongoing and people feel very strongly about it, one way or another," David Penson, M.D., chair of public policy and practice support for the American Urological Association, told the WSJ. "To make it a quality measure would say, 'You're a poor quality doctor if your patients get this test.' "
However, the agency's proposal only refers to "non-recommended PSA screenings" and shouldn't restrict medically necessary testing for the disease, a CMS official told the newspaper. Physicians can still order the test if they deem it necessary and patients can also request it, she said.
The agency's 26-day public comment period on its proposed measure ends today, November 20.
To learn more:
- read the JAMA study abstract
- check out the WSJ article
- here are the cancer statistics
- here's the CMS request for comments and link to download the zip file about the proposal