Don’t Order That PSA


I find this to be amusing.  Imagine a scenario where if you order a test on a Medicare patient that you get PENALIZED for it.  Well, that is not some fantasy.  News has come out that the CMS is pushing this new type of stick training program where they will penalize doctors for doing something they don’t like. The “move by Medicare would be part of a federal effort to define and reward quality in health-care services”.  Do you see how this trojan horse worked?  Under the guise of the bogus term “quality” the government now controls how you treat and test and deal with patients.  Remember, once the government starts something then the insurance companies are not far behind.

There is a positive side to this.  A PSA test is only a few bucks (wholesale). But it doesn’t have to be the PSA.  There are tons of tests that the government won’t let you order now already.  How about vitamin D?  There is no symptoms of it but 90% of us are low.  If you order that now then your patient has to pay.  So what?  It costs about $25 (wholesale). My point is that when you walk from the system then the only one deciding what test to order is you and the patient.  So, by all means, let the government keep doing this overreaching tactic.  It only makes me laugh.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “Don’t Order That PSA

  1. DrG
    November 25, 2015 at 10:49 am

    I am amazed at how long it takes supposedly intelligent docs to figure out they should stop taking all insurance. Grow a pair folks and stop being a hamster on a wheel.

  2. David Grant, MD
    November 25, 2015 at 9:26 am

    Anyone or any system that purports to measure “quality” of health care should be considered a charlatan until proven otherwise.
    Anyone who reports a “quality” measurement as a single number IS a charlatan, period.

  3. Bridget Reidy MD
    November 23, 2015 at 2:11 am

    It should have been obvious all along that “quality” would eventually mean not doing things that cost the system money. Why else would anyone think that insurance companies were interested in it?

  4. Steve O'
    November 22, 2015 at 12:49 pm

    “Just click on the box that you ” discuss(ed) the positives and negatives with the patient and come to a common decision” not to test.” It’s that easy!

    As canny readers of Authentic Medicine know from the Strategic Studies Institute of the Army War College, the tang of lying wears off quickly. What becomes routine no longer is immoral, or what George Costanza offered, “It’s not really lying if you believe it.”

    “Untruthfulness is surprisingly common in the U.S. military even though members of the profession are loath to admit it. Further, much of the deception and dishonesty that occurs in the profession of arms is actually encouraged and sanctioned by the military institution. The end result is a profession whose members often hold and propagate a false sense of integrity that prevents the profession from addressing—or even acknowledging—the duplicity and deceit throughout the formation. It takes remarkable courage and candor for leaders to admit the gritty shortcomings and embarrassing frailties of the military as an organization in order to better the military as a profession. Such a discussion, however, is both essential and necessary for the health of the military profession.”

    The “Lügnertanz” is one of three ways of making a decision in a rigid bureaucracy. The first is obedience to the rules – Lieutenant Calley was shamefully honest some years ago that following the rules is a way to make a decision. The second, assembling a complex set of concepts and facts to make a studied decision, is now being rejected, in medicine and elsewhere, and arbitrary, subjective and soft.

    The Lügnertanz – “the liar’s dance” – is now what is mandated in medicine. If there are not enough hours in a week to do what is proper and decent, well, blame God for only putting 1440 hours in, and check the box. Until they put video cameras in the examination room, who’s to know?

    The way they WILL get video cameras in the examination room, will be when they unmask the Lügnertanz which they have always known about – actually, which they created – and broadcast the scandal of what the doctors aren’t doing.

    You can already be punished for all three alternatives – Doing the PSA, Not doing the PSA, and deciding individually with the input of the patient. What will they say a few years from now, when your Quality is being Assessed?

    You have the right to remain obedient. Anything you say or do will be used against you in a court of law or media. The Conformity Mindthink answer will be in next week’s JAMA, and in the Boards. If the wind blows the Right Answer about from yes to no to whatever, it will be your fault.

    Groupthink’s so easy these days!

  5. Randy
    November 22, 2015 at 10:44 am

    Personally I don’t like doing PSA’s since there has been so much disagreement, but I think the current recommendation by the American Urological Association for patients 55-69 is something like ” discuss the positives and negatives with the patient and come to a common decision”. That’s what I do, and it takes a lot of time, and often the patient decides to get the PSA. After age 70 it depends on life expectancy, but I don’t have a crystal ball available. If I am following a professional society guideline I shouldn’t get penalized for it.

    The situation is complicated by charitable groups pushing prostate cancer screening. In the Chicago area I still hear a lot of retired athletes exhorting men to go out and get that prostate check.

    Really the whole concept of CMS quality guidelines is a mess and the current guidelines often lag behind current recommendations, putting you in the position of either doing the right thing or making CMS happy.

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