How to make Real Estate a Valuable Part of any Medical Practice

By William Ledbetter of Harris Tynes Realty Group

In today’s uncertain medical environment, physicians and practices are looking at many approaches to maximize efficiency and performance while providing the best care possible to their patients.  While most of the practice’s efforts are reviewed and critiqued, many physicians don’t realize they have another partner involved in the daily operations of their practice.  Real estate is a contributor to each and every medical practice and can produce very positive, minimal, or sometimes negative results which have a direct correlation to the practice’s overall performance.  Thus each practice should examine their “silent” partner and ensure the real estate is producing maximum benefits for the practice and its patients.

Real estate can take on several different roles and affect practices in many different ways.  The two basic roles of real estate for a practice are to become either an owner (landlord) or to become a tenant.  The concept of both roles is simple, but the characteristics and details can be complex and confusing and should be analyzed and approached on a case by case basis.

When a practice purchases real estate to house their operation, the practice has made a fundamental choice to become a landlord.  This can affect the practice both positively and negatively.  A positive example could be that the practice has decided to start seeing patients outside of routine business hours.  The practice, as its own landlord, will sacrifice and absorb increased costs or resources used to operate the building to help the practice benefit from seeing patients at odd hours.  On the contrary, a negative could be derived from the same example above.  If the practice began seeing patients after hours, the landlord will have to sacrifice and absorb increased costs and resources spent to achieve the extended hours which could include security, maintenance, and personnel costs outside the costs associated with the normal operation of the practice.

Another aspect to consider when becoming an owner of real estate is from an investment standpoint.  Purchasing real estate can be expensive, especially in desirable locations within the market. Further, once a practice enters the market, they become a market participant and the asset is subject to supply and demand factors which cause increases or decreases in the price of the real estate.  Many owners have benefited from participating in the market over a long period of time. Purchasing real estate should be a long term investment with its performance measured over at least a 7-10 year timeline.  Typically, investment parameters outweigh operational concerns when dealing with real estate, and this could negatively impact a practice’s performance.

If a practice has concerns becoming a Landlord, leasing is a viable option to secure the real estate.  Some of the concerns could be the practice has a complex ownership structure and disagreement could exist or concerns of the risks faced from being an investor and market participant.  Real estate leases can take on a variety of identities, but for our purpose, we’ll consider two basic types: 1) a “Full Service Lease” & 2) a “Net Lease” or a “Triple Net Lease.”  A “Full Service Lease” is a lease agreement between a Landlord and a Tenant where the Tenant pays a premium rent, but the landlord is required to perform more services to accommodate the tenant.  These leases are typically found in larger, multi-tenant medical office buildings and office buildings.  A “Net Lease” is an agreement that defines the base rent required by the landlord and also defines and transfers the operational costs associated with the real estate to the tenant.  These leases are typically found in buildings where each tenant’s consumption of the operational costs can be easily defined.  For example, a tenant in a “Full Service Lease” agreement would not have to pay for its monthly power service in addition to the monthly rent, the service would be included.  On the contrary, a tenant with a “Net Lease” would have to pay for its monthly power service in addition to the base rent paid to the landlord.

While becoming a tenant can be construed with a negative reflection from an investment standpoint, it certainly has positives from the operational side of the practice.  Some of the costs and burdens faced with practices are passed along to the landlords and this allows practices to focus more resources to providing the best patient care possible.  Certainly, becoming an owner has its advantages as well.  Practices have more operational freedoms that allow for more customized patient care which could positively impact performance.

Each practice and physician should asses its own needs, requirements, and the objectives they would like to see their partner contribute.  For further information or help in analyzing your current position as it relates to Real Estate, please contact William Ledbetter at Harris Tynes Realty Group.

William Ledbetter

Associate Broker

Harris Tynes Realty Group Inc.

2001 Park Place North

Suite 580

Birmingham, Alabama 35203

(205)879-6366

wledbetter@harristynesrealty.com

www.harristynesrealty.com

Mid-Year Reality Check: Covering Your Bases in Uncertain Times

BY Patrick Cummings, CFP®, CRPC®, CLU®, ChFC®

Ameriprise Financial 

Imagine playing a complicated game, but the rules of the game are changing, and the new rules have yet to be announced. That's what income tax planning is like this year. In fact, if there was ever a year to spend some quality time with your financial professional, this is it. Here are a few items to discuss.

How will higher rates next year affect you?

Federal income tax rates are scheduled to jump in 2013, with the bottom (10%) rate disappearing, and the top rate increasing from 35% to 39.6%. Starting in 2013, high wage earners--those with wages exceeding $200,000 ($250,000 for married couples filing jointly and $125,000 for married individuals filing separately)--will also have to pay an additional 0.9% in the hospital insurance (HI) portion of their payroll tax, commonly referred to as the Medicare portion.

Could the current federal income tax rates be extended again? Of course, but it's far from a certain bet, and the odds are that any action would not take place until after the presidential election. That means any financial plan you put in place has to account for this uncertainty. And the uncertainty extends beyond just tax rates, because a number of popular tax breaks are also scheduled to expire at the end of the year, while others have already expired. So, any potential moves have to be considered in the context of several "what if" scenarios. For example, if you have the opportunity to defer compensation to next year, you have to really think about whether that makes sense, or if you would be better off paying tax on the income at this year's rates.

Potential investment moves

In addition to increased tax rates on earnings, the rates that apply to long-term capital gain and qualifying dividends are scheduled to increase in 2013. The maximum rate on long-term capital gain will jump from 15% to 20%. And while qualifying dividends currently benefit from being taxed at the rates that apply to long-term capital gain, in 2013 they'll be taxed at ordinary income tax rates. Also beginning in 2013, a new 3.8% Medicare contribution tax will be imposed on the net investment income of individuals with modified adjusted gross income that exceeds $200,000 ($250,000 for married couples filing jointly and $125,000 for married individuals filing separately). That means someone in the top tax bracket could potentially end up paying tax on some investment income at a total rate of 43.4%.

Potentially higher rates in 2013 could be a motivating factor in your investment strategy. For example, you might want to consider selling investments that have appreciated in value to recognize long-term capital gain in 2012, before the maximum rate is scheduled to increase. Alternatively, you might consider timing the sale of an investment to postpone the recognition of a capital loss until 2013, when it could be more valuable.

Roth conversions--is this the year?

If you've been on the fence about converting traditional IRA funds or pretax 401(k) contributions to a Roth account, you ought to give the matter one last hard look before the year ends. That's because when you convert a traditional IRA to a Roth IRA, or pretax dollars in a 401(k) plan to a Roth account, the converted funds are subject to federal income tax (to the extent the funds represent investment earnings, tax-deductible IRA contributions, or pretax 401(k) contributions) in the year that you make the conversion.

If tax rates go up next year, so will the effective cost of doing a Roth conversion. Additionally, qualified distributions from Roth IRAs and Roth 401(k)s are free from federal income tax. That could make a big difference in retirement if you're paying tax at a higher rate at the time. Whether a Roth conversion is right for you depends on a number of factors. If it makes sense for you, though, it might pay to think about acting now, rather than later.

Patrick Cummings, CFP®, CRPC®, CLU®, ChFC®

Financial Advisor | Vice President

CERTIFIED FINANCIAL PLANNER^™ practitioner

 "An Ameriprise Platinum Financial Services^® practice"

Ameriprise Financial

Ameriprise Financial Services, Inc.

1500 Urban Center Drive Suite 200 | Birmingham, AL 35242

Office: 205.967.2627 | Fax: 205.967.8021

Direct: 205.909.3119 | patrick.2.cummings@ampf.com

 www.ameripriseadvisors.com/patrick.2.cummings |  ameriprise.com

CA Insurance License #0E25881

We shape financial solutions for a lifetime^®

Ameriprise Financial Services, Inc. offers financial advisory services, investments, insurance and annuity products.  RiverSource^® and Columbia Management^SM products are offered by affiliates of Ameriprise Financial Services, Inc., Member FINRA and SIPC.

References & Resources:

Forfield Advisor

Supreme Court Upholds Federal Health Care Reform

By Lenora W. Pate,  Cynthia Ransburg-Brown, and Kelli F. Robinson of Sirote & Permutt

Supreme Court Upholds Federal Health Care Reform

On June 28, 2012, the U.S. Supreme Court issued its highly-anticipated opinion in National Federation of Independent Business v. Sebelius deciding the constitutionality of the Act.  By a 5-4 margin – with Chief Justice Roberts casting the deciding vote - the Court ruled that the Act’s highly-debated “individual mandate,” which requires most Americans to maintain “minimum essential” health care coverage or pay a “shared responsibility payment” (penalty) to the IRS, was not constitutional under Congress’ Commerce Clause power. 

Writing for the majority, however, Chief Justice Roberts creatively upheld the Act under Congress’ Taxing power, stating that “it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance.”  Hence, what was written by Congress as an individual “mandate,” with a penalty, was converted by the Chief Justice’s creative construction to an individual “option,” with a tax on certain individuals who choose to go without health insurance.  The Chief Justice concluded that the financial “penalty” could be reasonably characterized as a “tax,” in part because “for most Americans the amount due will be far less than the price of insurance and by statute can never be more,” and “may often be a reasonable financial decision to make the payment rather than purchase insurance.” If, instead, the “tax” had been coercive, or so great that it would have compelled action, Chief Justice Roberts noted that it would have been an actual “penalty” and could not have been upheld under the Congress’ Taxing power.

The majority of the Court also ruled that the Medicaid expansion provisions of the Act, while constitutional, could not be forced upon the States by coercively threatening the loss of existing federal Medicaid funding if a State chose not to expand its Medicaid program to cover all adults at or below 133% of the poverty level.  While Congress may offer the States certain funding under its Spending power and require certain conditions relating specifically to such offer of funds, the States must, however, have a “genuine choice” whether to accept the offer.  Finding that the Medicaid expansion provisions could be severed without affecting the remainder of the Act, the Court, in its opinion, removed the coercive threat by prohibiting the Federal Government from withdrawing existing Medicaid funds from any State which chooses not to expand its Medicaid program.

While upholding the constitutionality of the Act, the Court, in essence, converted an individual “mandate” to purchase health insurance to an individual “option” with a tax on certain individuals if not purchased, and converted what was, in effect, a coercive mandatory Medicaid expansion on the States to an option by the States.  It is not clear what impact these two judicially created “options” will have on the overall goal of the Act of insuring all Americans, considering that the individual mandate and the Medicaid expansion provisions were considered key to achieving near universal health insurance coverage under the Act.  We can expect much cost benefit analysis, assessing the cost of coverage versus the limited tax, and the potential cost of expansion of Medicaid by the States, before the verdict is in on such impact!

What we do know, however, is that all of the other provisions of the Act are on track to move forward on what has now become an aggressive timetable, with numerous penalties, taxes and other incentives and disincentives embedded throughout the Act.   To learn more about the Act and its implications for individuals and employers, see Sirote & Permutt’s library of Health Care Alerts HERE. 

Background.  The suit challenging the Act was originally brought by two individuals, twenty-six (26) States, and the National Federation of Independent Business.  Two additional individual plaintiffs were added when questions arose as to whether the two original private plaintiffs had standing to challenge the Act.  In October 2010, the U.S. District Court for the Northern District of Florida invalidated the entire Act.  In August 2011, the U.S. Court of Appeals for the Eleventh Circuit agreed that the individual mandate was unconstitutional, but reversed and upheld the rest of the Act.  The U.S. Supreme Court agreed to review the case, and heard extensive oral arguments in late March 2012. 

The Court considered four central issues in its opinion:

1. Anti-Injunction Act.  The Court first considered whether the case was premature under the Anti-Injunction Act, a federal law requiring a taxpayer to first pay the tax assessment before he can challenge a tax’s legality.  The challenge before the Court involved collection of the “shared responsibility payment” from those who do not comply with the individual mandate, which will not be payable by anyone until 2014.  The Court decided that Congress did not intend the payment to be treated as a “tax” for purposes of the Anti-Injunction Act and noted that the Act describes the payment as a “penalty,” not a “tax.”  While the “penalty” label did not control whether the payment is a tax for purposes of the Court’s Constitutional analysis, it did determine application of the Anti-Injunction Act.  Therefore, the Court held that the Anti-Injunction Act did not bar this suit.

2. Individual Mandate.  The Court held that the individual mandate exceeded Congress’ power under the Commerce Clause and the Necessary and Proper Clause of the U.S. Constitution.  The individual mandate’s imposition of a penalty for failing to purchase health insurance was not commerce that could be regulated by Congress.  Although Congress has the power to regulate an existing business or activity, it does not have the power to regulate inactivity or compel the creation of a new business or activity or commerce.  Thus, the Court found the individual mandate to be impermissible and unconstitutional under the Commerce Clause, as well as the Necessary and Proper Clause of the U.S Constitution.

Five justices, however, agreed that the individual mandate “penalty” may reasonably be characterized as a “tax,” and held that Congress has power under the U.S. Constitution’s Taxing and Spending Clause to order individuals to pay a tax for failure to have health insurance.  According to the Court’s opinion, “the shared responsibility payment merely imposes a tax citizens may lawfully choose to pay in lieu of buying health insurance.”  Consequently, the Court upheld the penalty as a constitutional exercise of Congress’ power to tax.

3. Severability.  Because the individual mandate was in effect converted to an option with a tax and held to be constitutional, the issue of whether it could be severed from the rest of the Act was declared moot.

4. Expansion of Medicaid Program.  The Court ruled that Congress could not threaten to withhold all existing Medicaid funding from a State for failure to expand its Medicaid coverage under the Act, but noted that this threatened withholding could be severed from the Medicaid expansion provisions without otherwise invalidating the rest of the Act.  In essence, the Court determined that Congress cannot penalize States that choose not to participate in the expansion of Medicaid coverage under the Act by taking away their existing Medicaid funding. 

We will continue to monitor the effects of this important Supreme Court decision.

Sirote & Permutt’s Health Care Practice Group stands ready to assist you with any questions that you may have concerning PPACA.  For additional information, please contact Lenora W. Pate at 205-930-5162 (lpate@sirote.com), Cynthia Ransburg-Brown at 205-930-5389 (cransburgbrown@sirote.com), or Kelli F. Robinson (krobinson@sirote.com) at 205-930-5158.

Obesity: Prevention and Reversal

By: Robert A. Shaffer M.D., Gastroenterology Associates N.A.P.C. & Medical Director of Shaffer Weight Loss Center

            As gastroenterologists we treat people with a multitude of GI disorders, many of the disorders that we treat are related directly or indirectly to obesity or improper diet. Obesity is the second leading cause of preventable death in the United States due to consuming high energy, low nutrient diets, living a more sedentary lifestyle watching oversized flat screens and playing video games or many tiring work days with longer commutes compared to the1960’s.  In Alabama over 30% of the population is obese and over 60% of the United States is either overweight or obese. Overweight and obesity are both preventable and reversible with proper nutrition and exercise; our goal is to consistently educate people on how to become successful in reaching their long term health goals.

Overweight and obesity is described as having excess of adipose tissue causing a person to be at a high risk for certain diseases. A measurement of these risks can be taken by measuring an individual’s Body Mass Index or BMI. BMI consists of a formula that uses a person’s height and weight that will give an accurate estimate of disease risk. BMI of 25-29.9 is considered overweight, 30 and above is obese.

What does this mean for 60% of the population that is overweight or obese? It means that they will at some point begin to experience some type of health issues as a direct result of this unwanted excess adipose tissue: atherosclerosis, hypertension, diabetes mellitus, joint pain and degeneration, kidney stones, gallstones, cancers of the breast, uterus, and liver in women and cancer of the colon, rectum and prostate gland in men. Excess fat in the thoracic cavity impairs breathing leading to increased levels of carbon dioxide in the blood causing fatigue. These aliments require medications to help maintain homeostasis and can also cause unwanted side effects.

Reducing body fat by 8% - 10% could make an obese patient less dependent on medication. Overweight patients may not have health issues yet but if they were to begin a good nutrition and exercise plan they could greatly reduce the future risk for these health concerns. We have become a society that is addicted to bad foods, and bad habits and we help our patients to break out of the cycle of eating the wrong foods for the wrong reasons, and changing the attitudes towards exercise and fitness to take away the fear of starting that road to lifelong fitness by giving them the tools they need to get there.

We are now offering the Serotonin Plus Weight Loss Program® at our Saint Vincent’s East Location. This is a program that focuses on reducing carbohydrate cravings by using an oral supplement that does this very effectively in combination with a reasonable diet low in carbohydrates and starches. The dietary plan is based on real foods and educates patients on nutritious food selections and portion control along with regular exercise based on the individual’s tolerance for an average weight loss of 35 pounds in 12 weeks. With great success, 99% of or patients are able to achieve their weight loss goals and are feeling the benefits of maintaining a healthy lifestyle.

 

 For more information on our weight loss programs please contact:

 

Robert A. Shaffer Medical Director of Shaffer Weight Loss Center

Denise Biro Weight Loss Coordinator

Shaffer Weight Loss Center

100 Pilot Medical Drive

Suite 250

Birmingham AL 35235

(p) 205 397 1448

(w) gastrodocs.info

(e) weightloss@ganapc.net                                                                                

facebook.com/ shafferweightlosscenter.com

References & Resources:

http://www.cdc.gov/obesity/data/adult.html http://www.nhlbi.nih.gov/meetings/workshops/overweight/report.htm

www.mckinley.illinois.edu/Handouts/pdfs/​body_mass_index.pdf  http://www.mckinley.illinois.edu/interactive/bmi_calculator.htm)

www.spweightlossmd.com

Mobile Health and Innovation

By Kristen McManus, RD LD and Melanie Rubery, MS RD LD CLT

“There’s an app for that.” How often do we hear that catchy phrase on a weekly basis? It seems there is an app for just about everything, and it’s no question the convenience of smartphones has helped make the lives of busy Americans much easier.

Because we spend so much time on our phones, the smartphone platform is the perfect way to engage people in the field of health and wellness. Worldwide, chronic disease management has emerged as a area of particular interest and innovation. Research has shown that people who keep a food journal will reduce the amount of food they eat by about 10%, but most people do not have the time to keep a detailed, hand-written food and exercise journal. That’s where smartphone applications step in-- with the emerging technology of mobile fitness, tracking calories consumed and calories burned through exercise has never been so simple. With just the touch of a finger, people have the ability to document their entire day’s worth of calories and exercise. 

Based out of Birmingham AL, Healthy Life and Nutrition has developed a wellness program called Sensibalance. This innovative platform has taken mobile health to the professional level. In addition to providing services 100% online, each client has 24/7 access to a registered dietitian (RD) via email and web-based portal. Clients are placed on an individualized calorie level program and are given an allotted number of daily food bars for the 3 macronutrients:  carbohydrates, protein, and fat. A food bar is the equivalent of a serving size. Along with having an equal distribution of the macronutrients, clients are also able to track their water, fruit, vegetable, and fiber intake to ensure they are meeting their daily needs. Clients are able to record their food and exercise with an app compatible with the iPhone and Android.  All information syncs with their online profile. The greatest advantage of Sensibalance is clients are able to work with registered dietitians who are experts in the field of food and nutrition. They can actually learn what foods are good for them and why, instead of just trying to stay under a certain calorie limit for the day. It teaches individuals how to make healthful eating choices and facilitate an actual lifestyle change. Dietitians are also able to provide medical nutrition therapy for various nutrition-related diseases such as diabetes, hypertension, and high cholesterol.  With such tools and support, Sensibalance works as a program for individuals, corporate wellness, and physician referrals.

For More Information:

Website:  www.healthylifeandnutrition.com

Email:  melanie@healthylifeandnutrition.com

205-492-0404

                                     

Be Careful With Automatic Contract Renewals

By Debbie West, Practice Administrator with Birmingham Pediatric Associates and Owner of WestMed Disposal

It is so easy to overlook the fine print in contracts when they sit in a stack on your desk while administrators are putting out the day to day fires that arise in a medical practice. Often times they go from office desk to brief case to bedroom night stand in hopes of a quick glance before the 10:00 news. Those are the pieces of paper that end up in the "Scarlet" pile for tomorrow is another day.

Automatic contract renewals can come back to haunt you if the service provider is not providing adequate service and you have several years remaining on a contract. In some cases where companies have a monopoly in the industry, there is not much incentive to correct the issue. If there is no financial benefit to a long term contract, then keep it to a minimum or 1 to 2 years. Financial benefits such as price guarantee would be a separate issue.

It is very important to know expiration dates of contracts as many companies require 90 day notice in writing. I also suggest sending the letter certified with a return receipt request. Good documentation is critical when ending a contract that has an automatic renewal. When it comes down to providing documentation that the cancellation letter was sent, it can alleviate wasted time by having all your ducks in a row.

Allow yourself plenty of time to price shop. It is a very competitive market due to the economy so make sure to capitalize on this. 

Don't feel bad about asking for references. Also ask counterparts in other practices, round table groups, management organizations or specialty organizations for this information. Other managers are great resources so don't hesitate to utilize this valuable benefit.

The Controversy Over Prostate Cancer Screening

By The Physicians of Urology Centers of Alabama

Prostate cancer is the most commonly diagnosed non-skin cancer and the second leading cause of cancer death in American men. One in nine men will develop prostate cancer.

Contrary to common belief, prostate cancer iis not just a disease of the elderly. The disease affects one in 15 men from ages 60 to 69. Those with a family history and African Americans are at the greatest risk. Screening for prostate cancer consists of a simple blood test called a “PSA” and a rectal examination. Generally, men ages 40 to 75 are the candidates for screening.

Since the PSA test came into widespread use for early detection by the mid-1990s, the

death rate due to prostate cancer has fallen by almost 40 percent. Despite this, there is much controversy regarding screening for prostate cancer. The screening is not “perfect,” but no “screening” is, nor is intended to be. The success of prostate cancer screening is similar to that of screening mammography for breast cancer and colonoscopy for colorectal cancer.

Adding to this controversy is the recommendation by the U.S. Preventive Services Task

Force (USPSTF) against prostate-specific antigen (PSA) based screening for prostate

cancer released on May 21, 2012. The USPSTF is “an independent panel of non-Federal experts” funded by the US Department of Health and Human Services.

We believe that the above recommendation is substantially flawed and support this statement with the following facts:

· Since the PSA test came into widespread use for early detection by the mid-

1990s, the death rate due to prostate cancer has fallen by almost 40 percent.

· 90% of all prostate cancers are now confined to the prostate gland (likely curable)

at the time of diagnosis. Prior to PSA screening, only 30-40% of prostate cancers

were curable at discovery.

· This decision is coming from a “panel of experts” with no urologists, medical

oncologists or radiation oncologists, the physicians most familiar with prostate

cancer.

· One of the most influential studies cited by the USPSTF is the PLCO study

published in the New England Journal of Medicine in March 2009. Many flaws

were found with this study, including the fact that the median follow up of the

“unscreened” patients was 5.2 years (far too short to see many deaths from

untreated prostate cancer), 40% of the “unscreened” patients had actually had a

normal PSA prior to entry into the study (therefore they were actually “screened”)

and 33% of patients were lost to follow-up and not included in the data analysis.

· A second influential study from Europe, the European Randomized Study of

Screening for Prostate Cancer (ERSPC), also in the NEJM in March 2009,

showed “only” a 20% reduction in death rate in screened patients (median

follow-up was almost 7.5 years, long enough to start seeing an impact of

screening). Analyzing only these study patients with the longest follow-up (over

10 years), the decrease in death rate rose to 38%.

· The results of the Göteborg Randomized Population-based Prostate Cancer

Screening Trial, a 14 year Swedish study partially funded by the National Cancer

Institute (July 2010), showed a 44 percent decline in prostate cancer deaths as a

result of PSA testing.

· The USPSTF panel itself graded the studies used in drawing their conclusions as

either “good, fair or poor” regarding their underlying scientific methods. The

PLCO and ERSPC studies each graded “fair.” Of the 20 studies examined

regarding the benefits of screening for prostate cancer, one was graded “good,” 18

were graded “fair,” and one graded “poor.”

· The USPSTF bases their objections not on the risks of screening,

which are negligible, but the risks of diagnosis and treatment of cancer. This

is a scientific bait and switch of the worst order. Screening is not diagnosis,

nor is it treatment; it is a method to provide patients and their doctors with

information that is then used to determine the appropriateness of further

evaluation and/or treatment.

The task force’s recommendation is not binding, but as a government funded

initiative, the concern is that Medicare will stop paying for screening and, if so,

private insurance companies will follow suit. Every man has a right to make his

own decision about screening after reviewing the potential risks and benefits with

his own doctor. We cannot allow an unaccountable government entity to deny

patients access to tests that saves the lives of thousands of Americans every year.

The final recommendation by the USPSTF is a one size fits all philosophy that states that patients cannot be trusted to make informed decisions on their own. This same task force suggested mammograms were unnecessary for women ages 40 to 49 and has also recommended against teaching women breast self exams, both of which were retracted after massive public outcry. The USPSTF’s recommendation risks undoing 20 years of progress in patient education.

We, as practicing Urologists, have seen that early detection leads to better outcomes for

our patients. Ask any man whose life has been saved as a result of taking the PSA test.

They'll tell you early detection of prostate cancer is the real difference between life and

death. They’ll tell you the PSA test identifies cancer early, before it has spread.

We believe the decision on how best to test and treat for prostate cancer must be made

between a man and his doctor, not from a government funded panel that doesn’t even

include experts in the disease.