John R. Graham | NCPA Prostate Specific Antigen (PSA) tests are back in the news, as they are one entry point for the government to start micromanaging how it pays doctors in Medicare. To set the stage:
The American Cancer Society favors PSA tests for men over 50, and as early as 40 for men with more than one first-degree relative diagnosed with prostate cancer.
You can be forgiven for being confused. The issue, put most bluntly, is that 70 percent of prostate cancer deaths occur after age 70. Much medical opinion claims that testing men at 50 leads to false positive diagnoses, causing mean to undergo treatment that is unnecessary, expensive, and has a high risk of serious side effects (including incontinence and impotence). Many of these men will die of other causes long before prostate cancer gets them, and it can always be diagnosed later if necessary. This is not an issue to be taken lightly. The U.S. Preventive Services Task Force has re-opened the question, inviting input on a research plan that should lead to more risk-based guidelines. Further, Medicare has commissioned a consulting firm to develop quality measures (to be collected via electronic health records) that will have an impact on physicians’ pay: Those who order too many PSA tests will have their Medicare payments cut. (You can thank bipartisan super-majorities in the current Congress for this. They granted Medicare this power via the extremely flawed so-called “doc fix” passed last spring.) There is a better way than giving the government the power to decide the value of PSA tests. Let’s accept that some physicians believe PSA tests are overused, but others disagree based on a different understanding of the evidence. Let’s accept that medical directors at some insurers believe PSA tests for 50-year olds are appropriate and some believe they are not. Why not just allow individuals to choose doctors and insurers based on their own preferences? Researchers could conduct observational studies on the results. And we would get a lot closer to the truth than by giving the government the power to decide the question. Source: Health Policy Blog]]>