Urologists Dispute Prostate Cancer Screening Recommendation

Alicia Ault

May 22, 2015

NEW ORLEANS — Representatives of the American Urological Association (AUA) say they disagree with the US Preventive Services Task Force recommendation against prostate cancer screening.

The task force has argued there is no good evidence supporting prostate-specific antigen screening.

David Penson, MD, chair of public policy for the AUA, told Medscape Medical News this has led to a decrease in screening and potentially to an increase in high-risk cancers.

As time goes on, "I suspect we'll see a return to days when men present with prostate cancer and it's already spread all over their body," Dr Penson said.

There's some urgency now because the Affordable Care Act requires Medicare to cover services that receive an A or B rating from the task force. Prostate cancer screening received a D, which means there could be co-pays, or it could even open the door for Medicare to deny payment, Dr Penson explained.

I suspect we'll see a return to days when men present with prostate cancer and it's already spread all over their body. Dr David Penson

"We have to undo the link between the US Preventive Services Task Force and Medicare reimbursement," he told Medscape Medical News.

Now that the Sustainable Growth Rate formula has been replaced, urology associations are making an overhaul of the task force recommendations their top legislative and policy priority.

Dr Penson, chairman of the Department of Urologic Surgery at the Vanderbilt University Medical Center, in Nashville, Tennessee, rallied his colleagues at a plenary session here at the American Urological Association 2015 Annual Meeting, telling attendees that he is committed to reform.

The AUA will also make its case on Capitol Hill with staffers at a lunch in late June, Dr Penson told plenary attendees. "This is a key legislative ask for us," he said.

In March of this year, the AUA, along with the American Association of Clinical Urologists and the Large Urology Group Practice Association, issued a statement in support of the US Preventive Services Task Force Transparency and Accountability Act of 2015 (HR 1151), which was introduced by congressional representatives Marsha Blackburn (R-Tennessee) and Bobby Rush (D-Illinois).

The bill calls for significant changes to the task force and the process by which it makes formal recommendations about preventive care services, including ensuring a "balanced representation of primary and specialty care providers" during the decision-making process.

Dr Penson said the "AUA believes first and foremost that the process is inherently flawed."

The payment system for physicians is evolving, not just with the Sustainable Growth Rate replacement but also with the government trying to move medicine away from a fee-for-service model.

New Payment System

The Centers for Medicare and Medicaid Services (CMS) has set some fairly aggressive goals for alternate payment models, said Norm Smith, MD, the AUA's Gallagher Health Policy Scholar, speaking to meeting attendees; 25% of Medicare Part B reimbursements are to be made to alternate payment models in 2019, 50% in 2021, and 75% in 2023.

By 2026, the CMS is aiming to have two different conversion factors — one for fee-for-service and another for alternate payment models — said Dr Smith, associate professor of surgery and urology at the University of Chicago Medical Center, in Illinois.

The AUA has created a workgroup in conjunction with several other physician organizations to develop an alternate payment model for urinary tract infections, he added.

"We're trying to be proactive," Dr Penson told Medscape Medical News. If urologists contribute to the discussion in the beginning, the odds are increased that they will like the models that are developed, he said.

Urinary tract infections are seen by urologists, internists, and gynecologists, so it makes sense to have some sort of bundled or collaborative care model, said Dr Penson, adding that the AUA is partnering with other specialty societies to create guidelines and different models of risk sharing.

Beyond that, there are few details, because it is early in the process. And there are plenty of unknowns.

"The fact is, we're in uncharted waters here," he said.

Dr Penson is involved in studies with Astellas, Medivation, and the Patient-Centered Outcomes Research Institute. He has financial relationships with the National Institutes of Health and the US Agency for Healthcare Research and Quality. Dr Smith has disclosed no relevant financial relationships.

American Urological Association (AUA) 2015 Annual Meeting: Presented May 17, 2015.


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