Wednesday, November 18, 2015

My PSA Metric Comment

For the main article, here

"Non recommended PSA screening," as proposed, is a faulty metric for CMS.  First, there is a statutory benefit for PSA screening.  It is unfair to doctors to be placed between legal patient benefits Congress has voted for, and the position of the metric.   Second, there is substantial difference of opinion among major policy bodies on PSA testing, particularly, if a patient and doctor do it appropriately, even if USPSTF does not endorse it.  Third, the text of the metric is confusing and contradicts a CMS National Coverage Determination.  The metric text blocks screening for example "except with history of cancer" and of course that is NOT screening at all.  The text also has rare exceptions like "known dysplasia" but the CMS NCD for PSA  is much broader and endorses PSA for workup of nocturia, hesitancy, and other conditions. Arguably, that is "not screening" but most of the exceptions listed by the metric are not screening either. Hence, it is very confusing.

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