PSA test downgrade creates needed debate

Reimbursement
By Healthcare Finance Staff | October 21, 2011 | 1:44 PM

In early October the U.S. Preventive Services Task Force, an advisory panel that helps inform the government on preventive healthcare, downgrade its recommendation on the PSA test for prostate cancer screening to a grade of D. It recommended doctors not routinely prescribe the test because "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits."

Not surprisingly, the news was greeted by howls of protest from many corners of the healthcare community as well as those who have had the test, successfully treated their cancer and have gone on to live their lives.

Prostate cancer, they rightly point out, is the cause of more than 30,000 deaths each year and is the second most common cancer among men. The problem, the USPSTF noted in its report, is that if a man lives long enough there is a very good chance he will develop prostate cancer, however, the vast majority of those with the cancer will die from other causes
 
At once, the recommendation brings into play some of the thorny questions and problems as this country struggles to find the balance between controlling runaway healthcare spending while simultaneously providing for better healthcare.
 
In essence it is asking us to determine the value of specific healthcare services.
 
This is the debate that A. Mark Fendrick, MD, has spent the better part of his adult life preparing for. As co-director of the Center for Value-Based Insurance Design at the University of Michigan, Fendrick has a unique perspective on how to pay for and prioritize which health services provide a bigger bang for the buck and produce better health.
 
A favorite example of his concerns screening for colorectal cancer, which has been shown to be highly effective in detecting and treating issues that prevent colon cancer. Not only should public and private payers foot the entire bill for the screening, Fendrick has stated, they should, in fact, even consider paying certain patients to have the screening, so great are the savings in future healthcare spending.
 
That said, Fendrick's work suggests that quite often the answers of what provides real value in the health setting are not black and white and create the need for what he calls "nuanced care" – essentially different sets of incentives for different patients based on their risk factors and other medical history.
 
His take on the PSA controversy reflects this understanding.
 
Fendrick will tell you that from his perspective he would not recommend against the PSA test, per se. "Men should be more strongly encourage to get their cholesterol checked, be counseled for weight loss and smoking and get their colonoscopies before the doctor even decides to bring up the prostate cancer issue."
 
In other words, in terms of the things that will kill a man or lead to serious and costly health expense, there are plenty of other diseases and conditions ahead of prostate cancer and they should get first dibs on both the attention of the doctor and first dibs at the money to pay for it.

If you accept the fact that in the future of healthcare, you can't have and simultaneously pay for everything, then the debate around the PSA and its relative value is as good a place to start as any.

Topic:
Reimbursement