Blogs

Late last year, the AUA alerted the urology community to multiple activities at the federal level that threatened a man’s right to prostate cancer screening: a quality measure recommending against PSA screening  and a draft research plan from the U.S. Preventive Services Task Force (USPSTF) that will inform revisions to its 2012 PSA recommendations. While seemingly separate issues, the proposed quality measure is based on recommendations from the USPSTF, which we believe are flawed and do a disservice to American men. As you may recall, the urology community (including AUA members, patients and an AUA-led coalition of physician and patient advocacy groups) responded swiftly and strongly, with substantive and extensive comments on the measure to the Centers for Medicare & Medicaid Services (CMS) and the Measure Applications Partnership (MAP) as well as the draft research plan. The AUA, through its Holtgrewe Fellow Dr. C.J. Stimson, also communicated with the Congressional Doctors Caucus during the PSA quality measure open comment period. These efforts resulted in a letter, signed by nearly every member of the Physician Caucus (15 members), sent to CMS’ Acting Administrator. Specifically, it asked CMS to not accept the draft measure due, in-part, to the controversial nature of the USPSTF’s recommendation against PSA screening.

Our impact was powerful and effective. Earlier this week, in the CMS response to public comments on the measure, the agency specifically states that “CMS will continue to work with the American Urological Association as well as engage additional members of the community such as providers and patients.” Earlier this month, the AUA was advised that the MAP Clinician Workgroup will recommend that CMS not consider further recommendation of the measure.

“This is a perfect example of how strong we can be when we all work together and speak loudly with one voice,” said AUA Public Policy Council Chair David F. Penson, MD. “Essentially, our galvanized response to these threats to PSA helped stop these measures from moving forward without input from urologists and patients.”

 “But our work isn’t over. These measures were rooted in flawed USPSTF recommendations that were developed without input from the urology community,” he cautioned. “Therefore, our work to reform the USPSTF continues.”

In anticipation of the task force’s upcoming review of its original 2012 PSA recommendation, the AUA remains focused on educating lawmakers on the need for passing real USPSTF reform this Congress. For example, the AUA continues to meet with House and Senate offices in an effort to solicit additional cosponsors for the USPSTF Transparency and Accountability Act. This is a bill that would, among other things, mandate the inclusion of appropriate experts such as urologists and oncologists in the development of future USPSTF recommendations. The AUA has also been using the non-PSA quality measure as the impetus for a new round of communication from the bill’s chief sponsor in the House, Representative Marsha Blackburn (R-TN), to her fellow members of Congress to generate more cosponsors. This included drafting a “Dear Colleague” letter in which the congresswoman’s office began circulating on Capitol Hill in January. The one-pager links the PSA quality measure issue as yet another reason to cosponsor the USPSTF Transparency and Accountability Act.

Besides communicating with legislators, the AUA has used several other means to advocate for passage of the USPSTF reform legislation. Last summer, the association hosted a congressional briefing to educate the 60 committee and personal staffers in attendance on the make-up and recommendations process of the task force. Also invited was the Urology Care Foundation’s Know Your Stats spokesman and NFL Hall-of-Famer Mike Haynes, along with the Men’s Health Network, to share with the audience the importance of prostate cancer screening from a patient perspective.

In addition, the Alliance of Specialty Medicine’s fall 2015 newsletter included an article written by Dr. David Penson on the importance of multiple specialty organizations working together to pass legislation that would improve the USPSTF recommendations process. This electronic publication was sent to every U.S. House and Senate office and had a relatively high open rate among health policy staffers.

Late last year, the AUA sponsored a series of advertisements on RollCall.com discussing the problem with “one-size-fits-all” recommendations process carried out by the USPSTF. The viewer, when clicking on the online ad, was taken to AUAnet.org and its advocacy page on the subject. Analytics show that more than 400,000 people viewed the advertisements over the nine days it ran on the website.

Background on Measure Advocacy

On February 25, in its public response to the comments received on the measure, CMS shared that, between November 14 and November 20, CMS received more than 350 comments, many representing the views of the urology community. More than half (58 percent) of the comments opposed limitations on PSA screening for the general male adult population, and 40 percent contains statements that disagreed with the evidence on which the measure was based (which included the 2012 USPSTF recommendations). Most importantly, CMS specifically states this feedback as a key reason for not moving forward with the measure as proposed, and for its continued work with the AUA as the measure progresses.

During the public comment period for the measure when it went before the MAP Clinician Workgroup, at least 46 members submitted comments on the measure. Following the MAP Clinician Workgroup meeting in December, the AUA was advised that the workgroup followed the comments submitted by the AUA and its partner organizations and has officially decided not to recommend to CMS further consideration of this measure. That is, the measure as currently drafted will not progress at this time; however, CMS may consider altering the measure in the future, for example, to include additional exclusions or limit the patient population by age. In February 2016, we were advised that the MAP Clinician Workgroup’s recommendation was then approved by the MAP Coordinating Committee. The MAP guides the Department of Health and Human Services on the selection of measures for federal quality programs; consequently, all MAP recommendations are submitted to CMS for its consideration.