How Medicare Should Handle PSA Screening

PSA screening can be a controversial topic. Prostate-specific antigen (PSA) tests are used to detect possible prostate cancer. As the New York Times recently published, the case against prostate cancer screening is strong. Over half of men age 60 and older have small, indolent, nonlethal prostate cancers — many more than those who have harmful ones. That’s why men are much more likely to die with prostate cancer than from it. Screening is excellent at detecting prostate cancer, but it does not differentiate between the slow-moving, nonlethal variety and the more aggressive strains that could prove fatal. As a result, numerous men are treated, and can suffer a host of adverse issues from that treatment.

To address the problem, Medicare has proposed changing its rules and penalizing doctors who order PSA tests. There are numerous issues with this proposal. First, it is yet another measure that doctors have to live up to. More importantly, it could penalize doctors for performing a test that saves someone’s life. Screening is a gamble: There may be a few winners who win big (avoid a cancer death), but there are often many more losers (patients who go through false alarms, subsequent testing and unneeded treatment). There is no single formula to solve this equation; individuals in the same situation can look at the same data and legitimately make different decisions. When it comes to medical ethics, patient autonomy is about as fundamental as it gets.

Nevertheless, screening is a choice. Medicare should not penalize doctors for ordering PSA tests, but it should make sure it is not giving the test away free. Perhaps requiring doctors to bear a portion of the costs for the tests would encourage more selective testing, and more collaborative decision making with patients.

NJCPCU doctors never make decisions on PSA screening alone – we perform a variety of other tests in order to determine the aggressiveness of any prostate cancer, and always have informed consultations with our patients before advising any action. We think it would be better to support the screening process by rewarding doctors for taking the time to discuss the trade-offs with patients. Medicare already requires, and reimburses for, shared decision making for lung cancer screening; it should do the same for PSA screening.

By |January 20th, 2016|Uncategorized|0 Comments

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