1. McGraw, Mark

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A new study finds that one in five women is likely to forgo additional testing after a screening mammogram reveals an abnormal finding if there is a deductible associated with the additional test. Presenting at the 2022 Radiological Society of North America (RSNA) annual meeting, researchers discussed how increases in health care costs and insurance premiums, along with the advent of the Affordable Care Act (ACA), have led to the growing popularity of high-deductible health plans (HDHPs), particularly among younger, healthy individuals.

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"It is believed that HDHPs lower overall health care costs by making individuals more cognizant of their medical expenses. The higher deductible also lowers monthly insurance premiums, making these plans an attractive option for healthy people who may typically need coverage only for preventative care or health emergencies," according to an RSNA statement.


"But while HDHPs offer some advantages, the high out-of-pocket deductible cost-in excess of $1,400 for individuals and $2,800 for families-may prevent people from seeking necessary care."


The ACA's passage removed out-of-pocket costs for screening mammograms under most health plans, which encouraged women to undergo mammograms. But these tests are only the first step in detecting breast cancer, according to the authors, who noted that additional images and a biopsy are necessary to determine cancer if a radiologist has detected an abnormal finding on a screening mammogram.


Led by Michael Ngo, MD, a radiology resident at Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, the researchers sought to determine the relationship between HDHPs and patients' willingness to undergo indicated breast imaging.


"We noticed that some women were not showing up for diagnostic imaging at our imaging center in Boston Medical Center," Ngo stated. "We believed that the deductible payment associated with this imaging could be a contributing factor for the no-shows."


The investigators' hypothesis in taking on this study was that out-of-pocket payments will deter patients from completing important indicated diagnostic imaging for abnormal findings seen on screening mammography, noted Ngo, adding that he and his co-authors hope to use the results of the study to convince lawmakers in Massachusetts to pass a bill that would provide first-dollar coverage for diagnostic breast imaging.


Study Details

To test their hypothesis for this study, Ngo and colleagues surveyed 932 patients presenting for breast imaging at Boston Medical Center between September 2021 and February 2022. The survey was comprised of demographic questions on race, education level, annual household income, and insurance payor, along with scenarios about utilization of breast imaging. There was a variable response rate on questions.


When survey participants were asked whether they would skip indicated imaging they knew they had to pay a deductible, 151 of the 714 respondents (21%) said they would skip imaging. Another 424 (59%) said they would not skip additional imaging, with 139 respondents saying they were undecided. The groups with the highest percentage of responses indicating they would skip additional imaging were Hispanic patients (33%), those who were high school educated or less (31%), individuals on Medicaid or uninsured (32%), or those with a household income of less than $35,000 (27%).


The researchers also asked respondents if they would forgo the initial screening mammography exam if they knew they would have to pay a deductible for follow-up tests. Among 707 respondents, 129 said they would skip the screening mammography exam (18%), 465 indicated they would not skip mammography (66%), and 113 were undecided (16%).


The authors describe identifying socioeconomic barriers to health care as "critical" to the effort to address existing disparities and ensuring better outcomes for vulnerable patient populations. They are hopeful these findings will aid the overall effort to remove those obstacles.


"We expected that a deductible would discourage some women from obtaining diagnostic imaging," stated Ngo, "but the finding was still surprising, because we did not expect the number to be that high."


In terms of what radiologists and radiology teams can be doing to encourage more women to undergo the necessary additional testing after a screening mammogram has identified an abnormality, Ngo advises focusing on removing financial hurdles that prevent patients from undergoing further testing when warranted.


"One way is to advocate for bills that would mandate insurers to fully cover diagnostic breast imaging," he noted. "Another possible method is to identify women who may need help with paying for this additional testing and refer them to resources that could provide financial support."


Mark McGraw is a contributing writer.