The major organizations representing urologists are continuing their push for congressional approval of legislation designed to reform the operations of the U.S. Preventive Services Task Force, which in May 2012 recommended against PSA-based screening for prostate cancer.
Bob GattyWashington-The major organizations representing urologists are continuing their push for congressional approval of legislation designed to reform the operations of the U.S. Preventive Services Task Force (USPSTF), which in May 2012 recommended against PSA-based screening for prostate cancer.
Ever since those recommendations were published, the AUA, the American Association of Clinical Urologists (AACU), and LUGPA (formerly the Large Urology Group Practice Association) have been pushing Congress to make certain that specialists and other health care providers are involved in the development and review of USPSTF recommendations.
The May 2012 recommendation noted that the lifetime risk of dying from prostate cancer is only 2.8%, with 70% of deaths occurring after age 75. USPSTF said there is “convincing evidence that PSA-based screening programs result in the detection of many cases of asymptomatic prostate cancer.”
The USPSTF concluded that the rate of “over-diagnosis” is high and that many men undergo unnecessary surgery. As a result, the task force gave the use of PSA for prostate cancer screening a grade “D” and said the procedure is not recommended.
In early March, the three major urologic groups reiterated their support for the USPSTF Transparency and Accountability Act of 2015, introduced by Reps. Marsha Blackburn (R-TN) and Bobby Rush (D-IL)-an exercise they have been going through for the past 3 years.
The bill seeks to reform the process by which USPSTF reviews are conducted and recommendations are developed by requiring relevant representation of medical personnel in the process. It requires task force members to disclose conflicts of interest and requires consultation with those who treat the specific disease in question.
“I am concerned that decisions are being made without proper input from the specialists who treat these diseases. Our legislation would require common sense coordination among relevant agencies and stakeholders while protecting the doctor-patient relationship,” Blackburn said.
She said the bill would ensure that preventive care recommendations are not made in a vacuum.
“Patients and their physicians have the right to choose which tests are best for them,” she asserted.
“The USPSTF made its prostate cancer testing recommendations without input or perspective from the urology community or any other cancer care experts, and that continues to be a real concern as patients get mixed messages about testing,” said AUA Public Policy Chair David F. Penson, MD, MPH. “We don’t yet know the long-term impact that the USPSTF prostate cancer recommendations will have on U.S. men, but recent data from the National Oncology Data Alliance just presented [in February 2015] indicate that men newly diagnosed with prostate cancer are presenting with higher PSA levels since 2011, perhaps due to decreased screening earlier in the disease course in response to the USPSTF recommendation.”
Dr. Penson said the data also indicate an increase in the number of higher-risk prostate cancer cases diagnosed between 2011 and 2013, and said it is unclear whether that trend is “definitely” related to the recommendation, “but this is what one would expect if PSA testing declined in response to the USPSTF recommendation.”
“USPSTF could benefit from the input of specialists when evaluating this data,” he said.
The flurry of press releases about the USPSTF reform legislation came as Congress was working on a new plan to repeal the Medicare sustainable growth rate (SGR) formula, which would also include a 2-year extension of the Children’s Health Insurance Program at a total cost exceeding $200 billion. A “doc fix” had to be enacted by April 1 to prevent a 21% reduction in Medicare physician payments from taking effect.
According to knowledgeable sources, only about $70 billion of the cost would be offset by spending cuts under the plan. Previous efforts to repeal the SGR have been thwarted by the inability of Congress to agree how the cost would be covered. Early reports said cuts to providers and changes in benefits would cover the $70 billion.
As the negotiations continued on Capitol Hill, health-related organizations were attempting to include their pet provisions in the legislation, a common practice in Washington.
For example, hospital lobbyists were trying to modify a penalty for readmitting a higher-than-average number of discharged patients by including a provision requiring the Centers for Medicare & Medicaid Services to account for patients’ socioeconomic status when calculating risk-adjusted readmission policies.
“Hospitals serving disproportionate numbers of disadvantaged, low-income patients have higher rates of readmissions, even when those hospitals provide high-quality, patient-focused care,” said Sen. Joe Manchin, III (D-WV), the bill’s sponsor. “Failing to recognize this reality has led to unfair penalties at many rural hospitals in West Virginia and around the country.”
At press time, there appeared to be a good chance that an SGR compromise bill could be enacted in time to avoid the Medicare physician cuts from taking place. Whether the USPSTF legislation has an equally good chance for passage, however, is another story.
That initiative has been underway ever since the May 2012 recommendation was announced, and legislation introduced ever since has stalled in committee. Currently, bill-tracking services give it less than 1% of passage.
But, as backers of SGR reform will tell you, there is always hope.
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