Friday Shorts: Cancer deaths down, inaccurate provider directories, CRC screening, Z codes, rural hospitals closing and marijuana in pregnancy
May 23, 2025
A. Cancer diagnosis is up but death rate is down
The American Cancer Society published its annual report on cancer incidence and death rates, and the number of new cancers being found has gone up, but the death rate from cancer is going down. Here are the two figures worth looking at:
Rate of cancer diagnosis (age adjusted)
Rate of death from cancer (age and delay adjusted)
Source: American Cancer Society, April, 2025
B. Provider directories remain inaccurate
Source: Haeder, et al Health Affairs Scholar, April, 2025
Plan members depend on provider directories to find physicians, and people who need to find a new provider need to know who is accepting new patients. This research from secret shopper calls to over 97,000 providers shows that provider directories often provide inaccurate information about which providers are taking new patients, especially for mental health services. One plan had errors in 69% of their provider listings!
Here’s a post from 2024 about secret shopper research published by the same author that showed that even when health plans are notified of inaccuracies, it takes them some time to respond. Employers can ask their carriers what they are doing to increase the accuracy of their directories.
C. Colorectal cancer screening program decreased cancer incidence and deaths
Age adjusted colorectal cancer incidence rate (per 100,000)
Source: Corley, D et al Digestive Disease Week, May 6, 2025
A 20-year program at Kaiser Permanente of Northern California that prioritized mailed FIT (fecal immunochemical test) screening for colorectal cancer doubled the likelihood of members being screened, and cut the colorectal cancer death rate by half. The program also eliminated pre-existing racial disparities in deaths from colorectal cancer. Annual FIT tests are almost as effective as colonoscopy every ten years in detecting early colon cancers as long as positive tests are appropriately followed up.
Here’s a link to a past post on colorectal cancer screening.
D. Providers rarely use billing codes that identify social needs
The current diagnostic coding system (ICD-10) includes “Z” codes in seven dimensions: education and literacy, employment, occupational exposure to risk factors, housing and economic circumstances, social environment, upbringing, and psychosocial circumstances. Some researchers and health plans were hoping to use Z codes to perform social risk adjustment.
Alas, researchers report in Health Affairs that these codes are used infrequently by providers. Only one in 200 outpatient visits had a Z code attached, and one in 2,000 inpatient claims. Use of Z codes doubled from 2018 to 2022, but less than 1% of members had an associated Z code.
E. Rural hospital closures raise prices of remaining hospitals
Rural hospitals have been in crisis for years, as the population in many rural communities shrinks and gets older and poorer. Rural hospitals have failed in higher proportions in states which have not expanded Medicaid, and Medicaid cuts proposed for the next fiscal year could lead to more rural hospital failures. Researchers in Health Affairs this month demonstrate that rural hospitals that closed on average had lower unit costs, and subsequent to their closure remaining hospitals increased their rates by an average of 3.6%. The researchers concluded that rural hospital closures had “meaningful impact on commercial prices.”
F. Marijuana use is not safe in pregnancy
Source: Aswani, JAMA Pediatrics, May, 2025
Researchers reported in JAMA Pediatrics on a meta-analysis of 51 published studies of marijuana use during pregnancy. They found that women who reported marijuana use during pregnancy had statistically significantly worse outcomes. More widespread education on risk factors can improve pregnancy outcomes.
Hope you have a good weekend when it comes!