PSA testing in older men adds unnecessary expenditures to Medicare Advantage plans.

Abstract

CancerVolume 129, Issue 7 p. 980-980 CancerScopeFree Access PSA testing in older men adds unnecessary expenditures to Medicare Advantage plans Mary Beth Nierengarten, Mary Beth NierengartenSearch for more papers by this author Mary Beth Nierengarten, Mary Beth NierengartenSearch for more papers by this author First published: 08 March 2023 https://doi.org/10.1002/cncr.34720AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat The use of low-value prostate-specific antigen (PSA) tests for prostate cancer screening in men aged 70 years or older remains prevalent among Medicare Advantage plans and is associated with unnecessary expenditures according to a study published in JAMA Network Open.1 In the cross-sectional study, which included nearly 1 million men aged 70 years or older without preexisting prostate cancer conditions who were enrolled in a Medicare Advantage plan between 2016 and 2018, investigators found that 38.6% of enrollees received a low-value PSA cancer screening. Of these, 62.8% received at least one follow-up service, with repeat PSA testing being the most common service. For 7.1% of the patients receiving follow-up, services included imaging, radiation therapy, and prostatectomy. The study also found that an additional $6 was spent on follow-up care for every $1 spent on low-value PSA cancer screening. Lead author David Kim, PhD, assistant professor of medicine at the University of Chicago in Illinois, notes that the PSA cancer screening rates found in the study among Medicare Advantage plan enrollees are similar to those reported among patients with traditional Medicare plans, which show an annual total of 1.8 million low-value PSA screenings at a cost of $46.5 million.2 When the authors extrapolated their Medicare Advantage plan findings to the traditional Medicare plan population, they found that the associated costs of low-value PSA cancer screening “care cascades” (care that occurs after unclear or abnormal findings) could reach more than $275 million. The risks of care cascades and their unnecessary cost for cancer screening deemed to be of low value often outweigh the benefit of screening. Prostate cancer screening for men aged 70 years or older is deemed to be of low value, with multiple guidelines recommending against its routine use. On the basis of these results, Dr Kim and his colleagues underscore the need for additional efforts beyond the guidelines to reduce initial unnecessary care and the avoidable downstream costs of low-value PSA cancer testing. One suggestion is to implement a provision within the Affordable Care Act that gives authority to the Secretary of Health and Human Services to not provide payment for services that are not recommended by the US Preventive Services Task Force. References 1 Kim DD, Daly AT, Koethe BC, et al. Low-value prostate-specific antigen test for prostate cancer screening and subsequent health care utilization and spending. JAMA Netw Open. 2022; 5(11):e2243449. doi:10.1001/jamanetworkopen.2022.43449 2 Oronce CIA, Fendrick AM, Ladapo JA, et al. The utilization and costs of grade D USPSTF services in Medicare, 2007–2016. J Gen Intern Med. 2021; 36(12): 3711- 3718. doi:10.1007/s11606-021-06784-8 Volume129, Issue71 April 2023Pages 980-980 ReferencesRelatedInformation