AUA’s USPSTF reform efforts continue

Bob GattyThe AUA is continuing its efforts to aggressively come to the defense of PSA screening, a simple test that has been under siege by federal government regulators who have essentially flunked it as a routine procedure for assessing prostate health.

Despite the action earlier this year by the U.S. Preventive Services Task Force (USPSTF) to modify its recommendations for PSA testing, the effort to convince Congress to pass USPSTF reform legislation is continuing in Washington, and, in fact, is being broadened to emphasize the importance of the test to the African-American community as advocates seek support from African-American lawmakers.

The AUA’s legislative push comes amid public discussion about a new analysis of major PSA clinical trials showing that screening may be more effective than previously reported and can lower prostate cancer mortality by 25% to 32% (Ann Intern Med, Sept. 5, 2017 [Epub ahead of print]).

In April, the influential government advisory panel recommended that the previous D grade for PSA screening be upgraded to C for men aged 55 to 69 years, but that the current D rating be maintained for men ages 70 years and older. That decision applies to adult men who have not been previously diagnosed with prostate cancer and have no signs or symptoms of the disease, as well as to men at average risk and those who are at increased risk, such as African-American men and those with a family history of prostate cancer.

Reform urged despite new ‘C’ grade

While that decision was generally met with muted approval by organizations representing urology that had long contended the D rating for all men was misguided and could cause harm, key urology organizations have continued to maintain that the USPSTF’s procedures must be more transparent and specialty experts need to be included in the decision-making process when new recommendations are being developed.

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With that objective in mind, the AUA, LUGPA, and the AACU all are pushing Congress to approve the U.S. Preventive Services Task Force Accountability and Transparency Act sponsored by Reps. Marsha Blackburn (R-TN) and Bobby Rush (D-IL).

“The bill is important because the processes of the committee are not transparent,” AUA Legislative Affairs Committee Chair Thomas Rechtschaffen, MD, told Urology Times. “That’s especially true because under the ACA they, in effect, have the power to create health policy laws.”

While USPSTF recommendations do not determine if Medicare will cover a procedure, the grade can affect Medicare payments for procedures that are covered. Under the ACA, only evidence-based services that have an “A” or “B” rating by USPSTF must be covered without cost sharing by the individual.

“Improving the grade from D to C was a move in the right direction, but it’s still inadequate because it does not address the fact that there is no content expert on the committee and USPSTF continues to make recommendations without input from such an expert,” Dr. Rechtschaffen said.

While the Task Force included a urologist as it considered its latest decision regarding PSA screening, Dr. Rechtschaffen said there is no guarantee that will continue.

“They recently have been reaching out to the groups to ask for input, but they have no obligation to follow those recommendations,” he said. “In 2012 (when the original ‘D’ grade was given to all PSA screening), we had a lot of really smart people and really good staff people explaining why they were making a mistake. They had no obligation to listen to us, and they didn’t.”

The Blackburn-Rush bill includes a mandate requiring that a “balanced representation of primary and specialty care providers” and other key stakeholders in health care are involved in the development and review of USPSTF recommendations. It also requires the Task Force to publish a draft research plan to guide systematic evidence review, consider findings and research by federal agencies and departments, and make the evidence review available for public comment.

Next: AUA reaches out to African-Americans

AUA reaches out to African-Americans

Whether that legislation or other modifications to the USPSTF will be approved by Congress, even with a Trump administration bent on reducing regulatory burdens generally, remains to be seen. But Dr. Rechtschaffen said the AUA continues to push for passage and has reached out to members of the Congressional Black Caucus seeking their support.

Given the higher incidence rate of prostate cancer in the African-American population, the availability of the PSA test around the country is especially important to this community, he said. As a result, the AUA met in August with the health staff of Reps. Mia Love (R-UT), Robin Kelly (D-IL), David Scott (D-GA), and Lisa Blunt Rochester (D-DE). Kelly chairs the Congressional Black Caucus’ Health Braintrust.

That initiative, Dr. Rechtschaffen said, is just part of a broad initiative by the AUA to raise awareness within the African-American community about prostate cancer and the need for men to be tested.

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“Many of us in the AUA decided that we had to start a grassroots effort to reach out to other physicians to emphasize that the PSA test is needed,” he said. “We’ve spoken in black churches, too, because the USPSTF’s recommendations are particularly dangerous to African-Americans.”

In addition to the meetings with members of the Congressional Black Caucus, the AUA has continued a series of meetings with members of the House Committee of Ways and Means to familiarize them with the association’s legislative priorities, including USPSTF reform and the need to address the physician work force shortage. AUA representatives also met in August with legislative staff of previous USPSTF reform bill sponsors, urging their continued support. They included Reps. John Culberson (R-TX), Rod Blum (R-IA), and Jeff Denham (R-CA).

“I think the bill has good bipartisan support, certainly in the House,” said Dr. Rechtschaffen. “It doesn’t cost any money. It’s not a partisan issue. This is a good bill that should be passable.”

He urged his fellow urologists to join in the fight for the legislation by contacting their congressmen and senators and coming to Washington to participate in meetings on Capitol Hill.

“This has to be a grassroots effort,” he said. “Help us push this bill forward.”

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