Proposed IOASE repeal threatens patient choice

It may not seem so, but men like me have the deck stacked against us. We die earlier. Many of us are stubborn and find excuses not to see the doctor. Despite this, there is hope; improved diagnostic tools and advances in treatment have reduced the death rate from prostate cancer by nearly 40 percent during the last two decades. 

Inexplicably, there are policy proposals on the table that risk undoing these gains.  Based on bad science, the United States Preventive Services Task Force - a board lacking a clinical oncologist - recently told men that prostate cancer testing is, essentially, useless. Now, flawed data stemming from a New England Journal of Medicine study are pitting doctors against each other, leaving prostate cancer patients with potentially limited treatment options.

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To understand the clash, we must first understand the history of the delivery of cancer services. Once the sole purview of hospitals, advances in technology have permitted services such as radiation and chemotherapy treatments to be delivered safely in physicians’ offices. At first, these outpatient centers were part of the historical “silo” model of healthcare delivery, a model that by its very disconnected nature was inefficient and inconvenient for patients. In the last decade, breakthroughs in health informatics have enabled physicians of different specialties to band together to form groups that can provide integrated, comprehensive services – the model that is universally agreed to be the future of cancer care. Fortunately, laws governing physician ownership of these services were written in such a way to specifically allow these types of groups to develop, improving access to specialty care for millions of Americans. The rule governing this specialty care is the In-Office Ancillary Services Exception, or IOASE.

As more patients choose to receive care at outpatient multi-specialty groups, those physicians who are unwilling or unable to modify their practices from historical silos have seen their patients seek care elsewhere. In an attempt to preserve their market share, organizations representing these doctors have resorted to lobbying Congress to change the rules, limiting how patients access health care services. To bolster their arguments, these groups have funded research that claims multi-specialty groups are prescribing an unbalanced amount of treatment to keep patients within their own healthcare practice.

Not only is this research fundamentally flawed due to a lack of credible data, it gives men another excuse to avoid the doctor by instigating mistrust and confusion. Prostate cancer patients have no interest in an internecine turf war between medical specialists; they simply want to be assured that the care they deserve will be there where and when they need it.

The simple fact is that changing the IOASE would restrict men’s ability to choose where they receive their cancer care – a change that neither the Medicare Payment Advisory Commission (MedPAC) nor the Government Accountability Office (GAO) support. It is for these reasons that ZERO – The End of Prostate Cancer has joined with other patient advocacy organizations asking Congress to listen to patients and preserve access to integrated, coordinated care at the health care setting of their choosing.

Bearse is president & CEO of ZERO – The End of Prostate Cancer.