[Histonet] In House Labs in WSJ
Timothy.Morken <@t> ucsfmedctr.org
Tue Apr 10 16:48:32 CDT 2012
>From the New York Times:
U.S. Panel Says No to Prostate Screening for Healthy Men
By GARDINER HARRIS
Published: October 6, 2011
Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided.
The draft recommendation, by the United States Preventive Services Task Force and due for official release next week, is based on the results of five well-controlled clinical trials and could substantially change the care given to men 50 and older. There are 44 million such men in the United States, and 33 million of them have already had a P.S.A. test - sometimes without their knowledge - during routine physicals.
The task force's recommendations are followed by most medical groups. Two years ago the task force recommended that women in their 40s should no longer get routine mammograms, setting off a firestorm of controversy. The recommendation to avoid the P.S.A. test is even more forceful and applies to healthy men of all ages.
"Unfortunately, the evidence now shows that this test does not save men's lives," said Dr. Virginia Moyer, a professor of pediatrics at Baylor College of Medicine and chairwoman of the task force. "This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does."
Prostate Test Found to Save Few Lives
By GINA KOLATA
Published: March 18, 2009
The PSA blood test, used to screen for prostate cancer, saves few lives and leads to risky and unnecessary treatments for large numbers of men, two large studies have found.
Mortality Results from a Randomized Prostate-Cancer Screening Trial (The New England Journal of Medicine)
Screening and Prostate-Cancer Mortality in a Randomized European Study (The New England Journal of Medicine)
The findings, the first based on rigorous, randomized studies, confirm some longstanding concerns about the wisdom of widespread prostate cancer screening. Although the studies are continuing, results so far are considered significant and the most definitive to date.
The PSA test, which measures a protein released by prostate cells, does what it is supposed to do - indicates a cancer might be present, leading to biopsies to determine if there is a tumor. But it has been difficult to know whether finding prostate cancer early saves lives. Most of the cancers tend to grow very slowly and are never a threat and, with the faster-growing ones, even early diagnosis might be too late.
The studies - one in Europe and the other in the United States - are "some of the most important studies in the history of men's health," said Dr. Otis Brawley, the chief medical officer of the American Cancer Society.
In the European study, 48 men were told they had prostate cancer and needlessly treated for it for every man whose death was prevented within a decade after having had a PSA test.
Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center, says one way to think of the data is to suppose he has a PSA test today. It leads to a biopsy that reveals he has prostate cancer, and he is treated for it. There is a one in 50 chance that, in 2019 or later, he will be spared death from a cancer that would otherwise have killed him. And there is a 49 in 50 chance that he will have been treated unnecessarily for a cancer that was never a threat to his life.
From: Kim Donadio [mailto:one_angel_secret <@t> yahoo.com]
Sent: Tuesday, April 10, 2012 2:33 PM
To: Morken, Timothy
Cc: Daniel Schneider; Histonet
Subject: Re: [Histonet] In House Labs in WSJ
> Less screening = fewer biopsies = less revenue = less prostate cancers caught early = more deaths to prostate cancers.
Would you not agree?
And for all those advocating closure of private labs, do you also feel the same way about private pathologist owned labs who reep the benefits of getting all the out PT work from affiliated physicians while they also get a fee to serve as medical directors of hospital labs and get the pc portion of hospital work of which they can order as many test they want so they get the pc portion while the hospital gets the tc and all the big bills associated with doing the test making it hard on tax payer as well because so much in a hospital is already subsidize by the gov.
Is what you really want is to have all pathologist as employees of the hospitals? And have the hospital bill global.
And a few walmart like reference labs
I'm just curious as to the exact position of some on here.
Sent from my iPhone
On Apr 10, 2012, at 2:39 PM, "Morken, Timothy" <Timothy.Morken <@t> ucsfmedctr.org> wrote:
> Not surprising since our health care system is biased to pay for tests and treatments, not results. On top of this there are serious questions as to whether the PSA screening that leads to biopsies is useful in the long term. There is a recommendation out there to stop PSA screening for most men since it is largely non-specific. That test is what leads to the biopsies. Less screening = fewer biopsies = less revenue.
> Tim Morken
> -----Original Message-----
> From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Daniel Schneider
> Sent: Tuesday, April 10, 2012 11:22 AM
> To: Histonet
> Subject: [Histonet] In House Labs in WSJ
> The Wall Street Journal served up a timely article for us.
> You'll see both sides of the argument below. One side is right.
> HEALTH INDUSTRY
> April 9, 2012, 7:22 p.m. ET
> Prostate-Test Fees Challenged
> By CHRISTOPHER WEAVER
> Doctors in urology groups that profit from tests for prostate cancer order more of them than doctors who send samples to independent laboratories, according to a study Monday in the journal Health Affairs.
> The study found that doctors' practices that do their own lab work bill the federal Medicare program for analyzing 72% more prostate tissue samples per biopsy while detecting fewer cases of cancer than counterparts who send specimens to outside labs.
> Hiring pathologists boosts revenue for a practice and creates a potential incentive to increase the number of tests ordered, said Jean Mitchell, a Georgetown University economist and author of the study.
> That fewer cancers were detected-21% versus 35% for those sent to external labs, according to the study-suggests "financial incentives"
> may play a role in decisions to order the tests, Ms. Mitchell said.
> Some urologists said the research doesn't necessarily indicate financial motives. Urologists in larger group practices that have in-house pathologists may be more aggressive in testing because they seek to catch cancer earlier, said Steven Schlossberg, a Yale urologist who heads a health-policy panel for the American Urological Association and wasn't involved in the research. Also, Dr. Schlossberg noted, the figures, which cover 36,261 biopsies from 2005 through 2007, are five years old.
> The study was financed by the College of American Pathologists and the American Clinical Laboratory Association. It is the last salvo in a turf war between laboratory companies and physician groups that have opened their own labs to conduct tests.
> Regulators and economists scrutinizing the growing costs of health care have targeted a range of related activities by doctors, known as self-referrals.
> Although a set of 1990s-era laws, named for their proponent, Rep. Pete Stark (D., Calif.), ban doctors from referring patients to most companies in which they have a financial interest, urology groups can enter the pathology business because of an exemption for certain services performed within physicians' offices. The pathologists and other groups are lobbying Congress to end the exemption.
> At issue in the study is a quirk of billing for lab procedures. Labs get paid based on the number of jars used to hold specimens from a prostate biopsy. Doctors can choose to put several specimens in one jar or put each in its own jar, potentially boosting lab fees, which averaged about $104 a jar in 2010, according to the study.
> Urologists in practices with in-house pathologists sent 11.4 jars per biopsy for testing versus 5.9 jars per biopsy for other doctors in 2005.
> Some doctors say that separating the samples can help them better map any cancer.
> In addition, urologists in recent years have been taking more samples during a biopsy to better identify the location of any cancer, said John Hollingsworth, an assistant professor of urology at the University of Michigan. The standard number of samples taken doubled to 12 over the last decade, he said.
> The Health Affairs study's conclusions are "largely around billing practices, not around clinical practices," said George Kwass, a pathologist based in Massachusetts and board member of the College of American Pathologists. Urologists who team up with pathologists appear to bill more, he said, leading to potential waste.
> Urology groups are consolidating, and increasingly moving into the pathology business. One large practice based on New York's Long Island, Integrated Medical Professionals, opened its lab in 2010 to control costs and because doctors encountered errors in outside test results, said the group's chairman, Deepak Kapoor.
> "We don't make a fortune on pathology," Dr. Kapoor said.
> But lab businesses are seeing revenue vanish. Texas pathology group ProPath stopped getting prostate tissue from large urology groups more than four years ago, said executive director Krista Crews, when these clients began doing lab work in-house. The group still gets referrals from small, one and two-doctor practices, she said.
> Large laboratory companies are worried about the trend, too. Quest Diagnostics Inc. DGX -2.52%said in its latest annual filings that if physicians, including urologists as well as gastroenterologists and skin and cancer doctors, continued to "internalize" testing services, it could reduce the company's sales.
> Write to Christopher Weaver at christopher.weaver <@t> wsj.com
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