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USPSTF Reform and Preserving Access to PSA-based Testing

Urologists urge Representatives to cosponsor H.R. 539, the "USPSTF Transparency and Accountability Act of 2017," introduced by Reps. Marsha Blackburn (R-TN) and Bobby Rush (D-IL).

The "USPSTF Transparency and Accountability Act" includes critical reforms that would require the USPSTF to: (1) publish research plans and make available reports on such evidence and recommendations for public comment; (3) ensure medical specialty physicians are included on the Task Force; (4) establish a stakeholders board to advise it on developing, updating, publishing and disseminating evidence-based recommendations; (4) codify the grading system so it cannot be changed without appropriate review; (5) ensure that Medicare or other payors cannot deny payment for a preventive service solely based on the task force grade; and (6) require that a quality measure related to a USPSTF recommendation may only be applied if it was developed or updated in accordance with the USPSTF Transparency and Accountability Act and if the Secretary of Health and Human Services concurs with the rating.

Currently, the USPSTF has little accountability. The task force members are appointed by an unelected official, and they do not meet with relevant stakeholders during their review process nor do medical specialists serve on the task force. Although recommendations are intended for a primary care audience, they impact patient access to appropriate specialty care.

Urology is specifically concerned about its 2012 recommendation against prostate-specific antigen (PSA) based screening for prostate cancer for all men, regardless of risk. This is particularly true in light of recent studies which indicate that the positive trends we had been seeing in the early diagnosis and treatment of prostate have been negatively impacted since the release of the 2012 recommendations. In recent years, the USPSTF has issued multiple other controversial ratings on a variety of health care services, including routine breast cancer screening, skin cancer screenings, vision services for children and seniors, and dementia screening in older Americans.

Moreover, the Centers for Medicare and Medicaid Services (CMS) notified the public in the fall of 2015 that it was considering adopting a new quality measure entitled, "Non-recommended PSA-Based Screening," that would penalize physicians for ordering PSA tests for their patients subject to a limited number of exclusions. The CMS contractor that developed this proposed quality measure cited the controversial 2012 USPSTF prostate screening guidelines – guidelines not developed by experts in the field of prostate cancer – as the rationale behind the proposal. The USPSTF is expected to release updated recommendations on prostate cancer screening later this year.

In 2013, the American Urological Association released a clinical practice Guideline on the Early Detection of Prostate Cancer developed using evidence from a systematic literature review. This guideline supports the use of the PSA test in a more-targeted manner, whereas the USPSTF recommendation does not encourage its use in men of any age. We support a man’s right to be tested for prostate cancer – and to have his insurance pay for it, if medically necessary – if, in fact, he decides to do so following a detailed conversation with his physician about the benefits and harms of screening.

To cosponsor the "USPSTF Transparency and Accountability Act of 2017,"
please contact Kristi Thompson (Rep. Blackburn) at 5-2811 or Yardly Pollas (Rep. Rush) at 5-4372.

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