Medicare Gets This One Right--For Now!

abbaIf you change your mind...

...I'm the first in line.

ABBA-1978

A few months ago I wrote a blog post about a Medicare proposal that was absolutely blowing my mind. CMS, the agency that runs Medicare, had it in it's collective head that the prostate specific antigen (PSA) blood test, the test that checks men for prostate cancer, should get the boot, giving men a literal kick in the ass. The proposal apparently would have penalized the quality score of physicians who ordered the test to screen men for the disease. This prohibition even extended to men of an appropriate age for testing and in a high risk group such as being African American or having a strong family history of prostate cancer. Now I know the test isn't perfect, but as a pathologist who sees about 30 cases of prostate cancer a week, and have also had my father die of the disease, I can tell you that any steps that help identify prostate cancer can't be all bad.

I was not alone in my belief. CMS received 358 public comments about the proposed new policy. One of them came from me, maybe a few came from readers of my earlier blog post. The American Medical Association, The American Urological Association and The Large Urology Group Practice Association all chimed in. And CMS listened! Medicare has announced it has "temporarily suspended development of the draft measure." That's not exactly a strong endorsement for having a PSA test, but at least physicians who order it on their patients won't face any penalties or sanctions. Thanks for coming to your senses, CMS!

As we have discussed before, PSA has its drawbacks.  Many men with an increased PSA do not have prostate cancer. Some men who will be biopsied will have a cancer that does not require treatment. But as part of an all around health plan for men, and when the pros and cons are explained by a primary physician or urologist, the PSA test, definitely has a role. Maybe in the future we will have another test that is more reliable, equally available, and equally inexpensive. But right now, we don't.

My dentist has a placard in his exam room reading "You only need to floss ... the teeth you want to keep." That is how I feel about PSA testing. I think I'll hang a sign in MY office "You only need a PSA ... for the men you want to keep." Pass it on.

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