Medicare PSA Screening Reversal: Yesterday’s Quality Measure is Today’s Rejected Claim

(So much for “The Conversation”)

There are two versions of “The Conversation” we have with men: One is for teenage boys and it is about wet dreams, sexually transmitted disease, unwanted pregnancy and at one point also about testicular self-examinations. Those have now been edited out of the script, which makes sense to me since I have seen only three cases of that in forty years of practice, all but a couple of them diligently preaching that particular gospel.

The other one is with men of the age I now am, explaining, a few years ago, the benefits of blood tests (and, remember the rubber glove exam?) for prostate cancer screening and more lately the confusing intricacies of PSA blood tests.

For several years I’ve been spending a lot of time during physicals and wellness visits talking about the pros and cons of prostate cancer screening. I tell people you have to treat maybe 36 patients with prostate cancer to save one life. I tell patients that a recent long term study of men with early prostate cancer showed that 10 years into it only half of them had needed to do anything about the cancer. Still, many people want to be screened and I just encourage them not to panic if the result is abnormal.

A few weeks ago I got my first rejection of a Medicare PSA test for cancer screening purposes (ICD-10 diagnosis Z12.5, screening for prostate cancer).

My first, primitive, reaction was “here I have to spend all this time soft pedaling the news that PSA testing, which men (and doctors) were brainwashed into performing, is a general waste of time” and Medicare simply stops paying for it overnight without even telling me to save my breath.

Medicare will now only pay for PSA testing if you have the dribbles or something like that, not for screening for prostate cancer. On my iPhone I get notifications of all kinds of stupid things that don’t bother me a whole lot. Why couldn’t somebody tell me that Medicare no longer covers PSA for screening? Or maybe there’s an App or social network I’m not on?

Medical Quality is a fickle mistress, reminding me of the mythical Swedish “älva” (fairy), or is she just one of those random formations in the foggy mist I drove through on my way up from Bucksport to Caribou last night?

3 Responses to “Medicare PSA Screening Reversal: Yesterday’s Quality Measure is Today’s Rejected Claim”

  1. 1 dhaugen July 4, 2019 at 1:20 pm

    My husband is a physician in a rural area where people often live far longer than those in more populated areas. He sees men die of prostate cancer because of these new guidelines, that is, something else will kill you first. He’s seen patients told that they will die before the kidney cancer kills them. Well, no, when you live a long time, the kidney cancer will get you. Perhaps it’s the prejudice against older patients that contributes to this problem. I really don’t know. What I do know that in rural areas, there are many people who grow to be 90 and over and many nursing homes have patients over 100. For them, these PSA guidelines do not serve them well.

  2. 2 drstanw July 18, 2019 at 9:51 pm

    According to the Medicare site “What’s Covered”, the PSA, if billed properly, is a covered preventive benefit.

    • 3 acountrydoctorwrites July 18, 2019 at 9:54 pm

      The paper provided to me through our (mutual) lab listed all kinds of symptoms, like urinary frequency or dribbling, but NOT screening for prostate cancer. Feels like back before lipid testing was covered only if you already knew your lipids were abnormal.

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