A. Patient out-of-pocket costs for breast cancer screening
NBC News reported on women who had abnormal mammograms and were surprised to find themselves with large medical bills for follow up ultrasounds, MRIs and biopsies. NBC pointed to a small survey in Radiology in 2023, which found that about 10% of those with commercial insurance said they would not get follow up tests if they knew they would have to pay for them.
Here’s an article from HR Executive last summer by Patricia Toro and me about this topic.
B. Executive Order promotes price transparency
A new executive order directs the Departments of Treasury, Labor and Health and Human Services to “rapidly implement and enforce the health care price transparency regulations.” Health care providers, pharmaceutical companies, pharmacy benefit managers and health insurance carriers are all at best ambivalent about transparency, often because they believe that transparency could reveal their proprietary secrets.
More effective transparency regulations could decrease the opacity of the current payment system, which offers many opportunities for various intermediaries to increase costs. Clear pricing information could help improve plan design, although most studies have not shown that sick patients are effective at shopping based on price. We need robust research on the impact of price transparency on total medical spending, too. I’ve heard many anecdotal reports of health care systems using price transparency data to justify demands for large rate increases.
C. Nonprofit hospitals spend less on community benefits in needier communities
Researchers in JAMA Health Forum combed through Internal Revenue Service filings from 2018 to 2023, and found that nonprofit hospitals spent less on community benefits in communities that were more socially vulnerable, had lower educational and income levels, and had more Black and Hispanic residents. Counties in the top 20% (least social vulnerability) had mean hospital community benefit expenditures of $540 per resident, while counties in the 20% of highest social vulnerability received just $22 per resident in nonprofit hospital community benefit spending. Community benefit spending ranges from forgiven medical bills to public health spending to investments in interventions to address social determinants of health. More vulnerable communities have more potential to benefit from such spending.
D. Rare eye complications from GLP-1 medication
Researchers previously noted a four-fold increase in nonarteritic anterior ischemic optic neuropathy (NAION) in those who recently started semaglutide (Ozempic, Wegovy and Rybelsus). NAION causes sudden painless vision loss usually in a single eye, and is otherwise associated with high blood pressure, diabetes, and hyperlipidemia. This condition had previously been associated with erectile dysfunction drugs like sildenafil (Viagra). There is currently no effective treatment of NAION currently.
JAMA Ophthalmology published a review of 37.1 million adults with diabetes that included over 800,000 new semaglutide users and found a rate of NAION of 14.5 per 100,000 users, which was 32% higher than the rate for those taking other classes of diabetes medication. Tirzepatide (Mounjaro and Zepbound) was marketed later than semaglutide and is not included in this observational study. This risk is relatively small, but those taking GLP-1 medications should be aware and seek medical care immediately if they suffer from visual symptoms.
E. Screening for pancreatic cancer
The press provided extensive coverage of an early stage study of a blood test for pancreatic cancer. The test, a combination of a free cell DNA test (blood biopsy) and a biomarker test (CA 19-9) was highly accurate at diagnosing recurrence of pancreatic cancer after surgery. This test detected 85% of Stage 1 pancreatic cancer with a 96% specificity - meaning that there was a 4% false positive rate. This is a laboratory developed test, and has not been submitted to the Food and Drug Administration for approval.
While that might “seem” pretty good, pancreatic cancer is rare in the employed population - about 20 per 100,000 people ages 50-64. Therefore, a test with a 4% false positive rate used on employed adults from 50-64 would detect about 17 pancreatic cancers early but would have 4000 false positives. This test and its successors will likely continue to improve, offering hope that there will eventually be a practical screening test to find pancreatic cancer while it can still be cured.
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Illustration by DallE