Friday Shorts: Preventive care, sepsis, female surgeons, medical credit cards and cancer from CT scans

May 9, 2025

A. Preventive services that could have cost-sharing reinstated based on Supreme Court Braidwood case

The Supreme Court heard oral arguments in the Braidwood Management vs. Kennedy case last week. The justices seem likely to uphold the Affordable Care Act designation of the U.S. Preventive Services Task Force to make preventive care recommendations. Researchers in JAMA Health Forum calculated what portion of those on employer-sponsored health insurance received services that could have been subject to cost sharing if the Supreme Court finds for the plaintiffs. This ruling is expected in late Spring or early Summer.

Source: Bronsard, et al JAMA Health Forum, April 17, 2025

Here’s a link to an op-ed I wrote for StatNews last week about why employers should pay for preventive care without cost sharing regardless of the eventual Supreme Court ruling.

B. Sepsis overtreatment can lead to patient harm (by Patricia Toro, MD MPH)

Sepsis is a serious clinical condition, where the body’s response to an infection can lead to extreme inflammation throughout the body. Sepsis can lead to organ failure and even death, and patients with sepsis can be high-cost claimants. The earlier that sepsis is identified, the more likely it is to be treated effectively. As a result, many emergency departments and hospitals have put in place protocols to automatically test and treat individuals who may have sepsis.

Research published in Clinical Infectious Disease last month shows that among 600 patients treated with broad-spectrum antibiotics for possible sepsis, up to 1 in 3 patients likely did not have a treatable bacterial infection. Four out of five patients were overtreated with antibiotics, and 1 in 6 developed antibiotic-associated complications.

This study comes on the heels of multiple state efforts to promote earlier identification and treatment of patients with sepsis. On the national front, the Centers for Medicare and Medicaid Services established the Severe Sepsis and Septic Shock Management Bundle (SEP-1) in 2015 and included this bundle as a pay-for-performance measure in the Hospital Value-Based Purchasing program in 2023. The Infectious Disease Society of America (IDSA) has pushed back on this payment bundle due to a lack of data that shows that the bundled payment saves lives and the potential harms of overtreatment with antibiotics.

Even well-meaning quality improvement efforts can inadvertently lead to patient harm, highlighting the need to continue to study patient outcomes.

C. CT scans could account for 5% of future cancers

I wrote a brief post in March about excess radiation from many U.S. CT scanners, which could cause preventable cancers. Last month, researchers in JAMA Internal Medicine reported on a simulation model of the impact of the 93 million CT scans performed on 62 million people in the U.S. in 2023. They found that the radiation from these CT scans would be responsible for about 103,000 future cancers.

Clearly, we should only perform CT scans (or any other diagnostic procedure) if they are medically necessary. MRI scans or ultrasounds, which have no radiation, could be substituted in some instances, but no imaging at all should be performed unless the results will impact treatment decisions. This research supports prior authorization programs for imaging services.

Efforts to be sure that all CT scan equipment is properly calibrated to avoid excess exposure can also reduce the population risk.

D. Medical credit card availability is expanding

Source: Dov Bruch, et al JAMA Health Forum, April 11, 2025

Medical cards are essentially patients taking a loan to pay for medical services. While medical credit cards can help patients spread an unexpected expense over many months, these cards usually have high interest rates after an initial interest-free period, and patients who are late on even a single month’s bill will face accumulated interest at high rates that accrue from the beginning of the loan.

Researchers gathered data from the websites of the three major medical credit card issuers and matched these to records of physician practices to identify the likelihood that these practices accepted a medical credit card. They found that 180,000 medical practices accepted medical credit cards. This is an indication that many patients have difficulty finding funds for out-of-pocket medical costs.

E. Female surgeons have better surgical outcomes

Source: Ikesu, et al, JAMA Surgery, April 23, 2025.

Researchers reviewed the claims of 2.3 million Medicare beneficiaries who had one of 14 major surgical procedures from 2016-2019. They found that female surgeons performed 6% of all the procedures and had statistically significantly lower long-term mortality rates than their male counterparts for all procedures and elective procedures. They also had lower mortality for emergency procedures, but this did not reach statistical significance. The researchers also found that long-term readmissions and complications rates were lower for female patients of female surgeons. The study team adjusted for patient and surgeon characteristics and hospital fixed effects, effectively comparing outcomes of patients within the same hospital, making these findings especially compelling.

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