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Case Costing: Creating a Clean Inventory Master
66 Plays5 days ago
In this week’s episode, the second installment in our case costing series, Grant Duncan sits down with VMG Health’s Vanessa Sindell and Nancy Stephens to unpack the unsung hero of accurate case costing: a clean inventory master. They cover practical, do-it-today tactics like using naming conventions that work at the point of care, leveraging GPO data to understand all of your pricing options, and keeping preference cards current, so cost-per-case is surgeon ready. They also make the case for dedicating an FTE to the process to maximize cost savings.
In the news: the still-pending OPPS/ASC final rule, the implications of CMS site-neutrality efforts, a new analysis drawing scrutiny to UnitedHealthcare’s payments to Optum-employed physicians compared with market peers, and encouraging results for a multi-cancer blood test showing high detection accuracy alongside standard screening.
Resources Mentioned:
CMS’ delayed ASC rule release, explained (Becker’s ASC Review)
CMS’ site-neutral reform poised to upend hospital-ASC dynamics (Becker’s ASC Review)
Study suggests UnitedHealthcare pays Optum docs more than other providers (Fierce Healthcare)
A simple blood test can detect 50 types of cancer: We explain (USA Today)
Brought to you by HST Pathways.
Recommended
Transcript
Introduction to Episode
00:00:00
Speaker
Welcome to this week in surgery centers. If you're in the ASC industry, then you're in the right place. Every week we'll start the episode off by sharing an interesting conversation we had with our featured guest, and then we'll close the episode by recapping the latest news impacting surgery centers. We're excited to share with you what we have. So let's get started and see what the industry has been up to.
Importance of Clean Inventory Master
00:00:24
Speaker
Hi everyone, and welcome back to this week in Surgery Centers. On today's episode, the second in our case costing series, Grant Duncan welcomes Vanessa Sindel and Nancy Stevens of VMG Health to the show to discuss the importance of a clean inventory master.
00:00:39
Speaker
They break down why the inventory master is the backbone of accurate case costing and recommend strategies for keeping it clean, like consistent naming that makes sense at the point of care, tight control of units of measure and pack sizes,
00:00:52
Speaker
and routine sweeps for pricing drift. We also get into building a real three-way match on purchase orders, why more ASCs should lean on GPO data, and the importance of keeping preference cards current so cost per case is reliable enough to drive surge in conversations.
00:01:09
Speaker
Vanessa and Nancy share a ton of practical tips and recommendations, so this is definitely a conversation you wanna hear.
CMS Actions and ASC Rules
00:01:15
Speaker
Then in our new segment, we dig into what CMS is poised to do amid a prolonged federal shutdown.
00:01:21
Speaker
The ASC final roll is still pending after the October 31st physician fee schedule was released, with ASC leaders watching for quality updates and a bigger covered procedures list.
00:01:32
Speaker
We also discuss CMS's push towards site-neutral payments, which could squeeze hospital margins while giving ASCs a relative tailwind. Next, we touch on a health affairs analysis covered by Healthcare Dive and Fierce Healthcare last week, suggesting that UnitedHealthcare pays Optum employed physicians more than peers in the same markets, roughly 17% on average in higher and higher in concentrated markets, a finding UHC disputes.
00:01:58
Speaker
And we close on some encouraging clinical news. New Pathfinder 2 data for Gallery, a multi-cancer blood test, show high specificity and helpful tissue of origin signals, making it a promising add-on to standard cancer screening.
00:02:12
Speaker
I hope you enjoy today's episode, and here's what's going on this week in surgery centers.
00:02:27
Speaker
Nancy and Vanessa, welcome to This Week in Surgery Centers.
Consultants' Expertise in Inventory Management
00:02:30
Speaker
We are very excited to have you on today to talk about inventory and case costing. Would you mind briefly introducing yourself to the audience first?
00:02:40
Speaker
Sure, I'll go first, Nancy Stevens, senior consultant with VMG Health. 20 years in the industry, focusing on ambulatory surgery center, financials, RCM, database cleanup, any kind of efficiencies, room and profitability.
00:02:57
Speaker
That's sort of my niche. My name is Vanessa Sindel. I'm also a senior consultant at VMG Health. I've been in the ASC industry for maybe like 15-ish years.
00:03:07
Speaker
I'm a nurse. I've been a nurse for 22 We do all kinds of things with ASCs, but it just so happens that Nancy and I love inventory management. So that's what we're talking about today. Yeah, I'm excited to dive in.
00:03:22
Speaker
So just to start with the basics, to give everyone a refresher and similar context, what is the inventory master and why does it play such a crucial role in ASCs and especially in case costing?
00:03:38
Speaker
Normally when we're looking at but financial overview of a facility, let's say they feel like they could be more profitable. they want to know maybe what's going on, what's wrong. There's always two areas of the financial statement that have the biggest hit, right?
00:03:53
Speaker
Supplies and labor. So when we dig into generating more profits and doing turnarounds, we need go directly to supplies and that filters down to supply cost, inventory masters. Some of our clients don't even have systems that have inventory tracking in them, which makes it very cumbersome, hard, almost impossible.
00:04:16
Speaker
We try to coach and train to that, to to make sure they understand that An inventory master rolls up into everything, right? You see it in the P&L and l you see where the supply costs per case are not being trapped. They don't know their profitability per case.
00:04:33
Speaker
It's literally impossible to do anything with payer contracting if you don't know how much a case costs. and We find nowadays with doctors and just the sign of the times that drug costs are way up.
00:04:46
Speaker
There are specialty drugs. So knowing and understanding that cost per unit of measure is just so
Challenges of Manual Inventory Systems
00:04:52
Speaker
important, right? I don't think you can turn around an ASC in profitability unless you have an inventory master. So that's everything from the supplies used in the case to the non-stock, making sure all your implants are in there, all your drugs are in there.
00:05:07
Speaker
It has to be a very cohesive list of everything that's used. to The good ones includes everything from trash bag to toilet paper. And just understanding what runs through an ASC and what we're buying and who we're buying it from is critical.
00:05:21
Speaker
I think it's just kind of the foundation. And I think what Nancy mentioned, you know, fortunately or unfortunately for some of us in the ASC space, we don't maybe have, you know, like an electronic or PM system that we can use to do our materials management. So we may not have an item master that's working in a system like HST or Envy or something.
00:05:44
Speaker
But we do see some success, although very challenging to keep up, you know, with having an Excel file or having some sort of other system where they at least have a list of the items that they're keeping on hand and ordering regularly.
00:06:00
Speaker
Yeah, that makes a lot of sense. And so if you do have ah good inventory master, i think an important part of that is keeping it up to date, scrubbing it.
00:06:14
Speaker
What does that process actually look like? And what are the most common problems you see? I imagine this also looks different. Like you're saying, if you actually have a system for materials management or data.
00:06:26
Speaker
yeah data position office system that wasn't built and you're in Excel. Yeah, exactly. Yeah. So I think the process of cleaning or scrubbing an inventory master basically just means is pulling up that item list and reviewing all parts of it. So I think there's a couple of key areas that we look at when we do that.
00:06:46
Speaker
So Nancy and I are very often called in to kind of look at supply costs. And when we do that, we always start with the item master. So we always look at the naming convention or nomenclature. I mean, there is a way to do that, to name your items, believe it or not. It starts with a noun, which should always start with the noun. And then there should be, you know, like the description of it afterwards. So if we're looking at gloves, you know, are maybe a surgical glove, that's a size five, you would want to have the word glove or gloves.
00:07:21
Speaker
and then size five sterile or something like that. And I think also when we're talking about naming and nomenclature, you know, we really don't want to see any like dashes or periods if you can avoid it. I know sometimes with medications, you need that.
00:07:36
Speaker
But no extra like characters that could make it a challenge when you're trying to run reports or identify an item. So most item masters, if you're using an electronic one like HST,
00:07:50
Speaker
They only feed off of like the first four to five characters. So that's why it's so important to start with that noun, because as an OR nurse, if I'm the OR nurse and I'm in there and I need to add an item, that's what I'm going to call it first. Right? So you want to have a nomenclature or naming convention that works for everyone in the facility.
00:08:09
Speaker
And I think also just and the second area that we like to look at is just validating the data. So looking at the unit of measure and how that is reflected in the purchasing, right? So um do we have 10 Each is in a box or however that looks for you with what you're ordering. But unit of measures can really mess up a lot of things, not just the case costing, but also your purchase orders.
00:08:34
Speaker
And then making sure the prices are correct, right? Because prices change a lot. So sometimes we have systems that automatically update that price, but sometimes we don't. And so if we don't, we really want to make sure that pricing change is reflected in our item master.
00:08:49
Speaker
And then i think also looking at duplicates. So there is a whole process of making sure that we don't have items that are named maybe differently, but are the same item. And so just deleting those duplicates and getting rid of those, because, again, that is going to affect your case costing.
00:09:09
Speaker
um And I think also any items that you don't use anymore, you either want to make them inactive or delete them if you've never used them. If you can, that just makes your item master cleaner. So again, as the materials manager, it may be really easy for you to identify which item would be used when. But as the OR circulator, who's usually the one who's in inputting this information in real time,
00:09:35
Speaker
or should be entering the information in real time, I should say. It may not be that obvious to that person because we kind of all use different names, right? So that's that's what we do when we clean or scrub the item master. And I think that's really something that's easy or can be easy for somebody to do who, you know, manages the item master on a regular basis.
00:09:58
Speaker
Anything else, Nancy?
Effective Inventory Management Practices
00:10:00
Speaker
I think you hit on all the the high plates of me from my standpoint on the accounting side, just making sure that you do. If someone's done on a three-way match, which I think a lot of people forget about that, you know, you can do purchase orders all day long.
00:10:15
Speaker
ah But if you don't match them to the invoice and you don't check the price and you don't look at the deltas, then your inventory master, no matter how hard you work on it, isn't any good. i mean, it's just as good as the last price that someone entered and put a purchase order in there for. So.
00:10:31
Speaker
Without that three way match component, I'm going get asked that a lot. Is it necessary? Do I need to do it? Accounting doesn't want to do it. It's critical. It's really critical. So um without that, you're, if the price isn't right, then don't spend a lot of time on the inventory master.
00:10:48
Speaker
Yeah, keeping that price current is so important. And ASCs have multiple ways to purchase buys as well. One of those is through GPOs.
00:11:02
Speaker
What role do you see GPOs and related pricing playing in this conversation? I think GPOs to me seem like the most underutilized, uninformed, like just, I'm just feeling that every time we go to an AFC, day they think they have a GPO. They're not sure what the name is.
00:11:22
Speaker
Sometimes they know the name. They're not sure what the grace is. They've never seen a contract list. They've never loaded it. It's just completely underutilized. And we try to train and educate to that to say, your GPO has access to data of what you purchase and what other people are paying for items. you know Utilize them, meet with them quarterly, if not at least once a year.
00:11:45
Speaker
Get your contracted rates and understand them. And stick to a GPO that can match it for your specialty, right? There's just a bunch out there. And just because there's one in your zip code doesn't mean that's the right one for you to use.
00:11:59
Speaker
A lot of them are tied to your primary general supply vendor, but not your specialty vendor. Again, maybe not in the facilities best interest. And if you're not really going to them and finding out what you're using, then, you know, it's just a lot of our clients do so much work on their own when they could rely on a GPO and they could go out and see if they're getting better pricing and they could really compare what they pay compared to the price they're supposed to get.
00:12:27
Speaker
And the other thing I think is just in general, you have to understand your volume and the relationship with your vendor, right? So on your big specialty items, you may get a better price if you sit down with your vendor and just say, Hey, I'm going to do X amount of cases this year.
00:12:43
Speaker
What can you give me? Otherwise I'm going switch to a different brand and they might beat your GPO pricing. And that's okay. But if you never ask and you don't know the data and you can't compare it, then, you know, we just see people overpay for things a lot because they don't take advantage of the GPO and they don't understand it Yeah, that makes lot of sense.
00:13:04
Speaker
And for the ASC specific systems, they can also put in tiering like, Hey, this is the best priced vendor and our preference. Maybe that's the GPO, maybe it's direct.
00:13:17
Speaker
You could have a tier two, et cetera, so that if there's an issue, ah shortage, you can still go to that, that next tier. So it really lines up well with how you're suggesting they approach it.
00:13:31
Speaker
Where do you see things typically go wrong? Do you see that more often about having bad data from the start? Or is it more about the upkeep and the maintenance over time? Maybe you've set up well, but then drifted over time.
00:13:47
Speaker
I think it could go really bad both in both situations. ah But I do think more so with the setup or the build, because when you're building your original item master, that's kind of setting up your parameters of how...
00:14:03
Speaker
you're gonna classify or organize or categorize your data. And when we're looking at it from the accounting perspective or the financial perspective, you know we really wanna be able to take this data and organize it in a way that we can get useful information out of it so we can make better decisions, right? If I'm building the system and I didn't create, let's say a category for, i don't know, specifically related to ortho implants,
00:14:32
Speaker
And so if I'm trying to run reports and I can't isolate just the, um it's not really that helpful, right, for me to find out or to figure out where I'm spending too much money or where I'm spending the majority of my money and where I should be focusing my efforts first, right?
00:14:48
Speaker
So I think it can go, and think it can go really bad in the setup. And I do think just please never, ever, if you are starting this process, you know, don't ever get the export from your vendor, from your McKesson or your Medline and just automatically upload that as your item master, because that is the kind of stuff that makes it really hard to do that scrubbing or cleaning that we were talking about before.
00:15:12
Speaker
And then I think the other thing that we see, if they do set it up correctly and they do have all the information that they need to create an item master that includes all of the stuff that we wanted to include, right? The correct unit of measure or the category, the second secondary classification of it, all of that is the turnover with staff, right? And in the in a all healthcare, we have turnover. And I think just that transition of educating maybe the person who's taking over sometimes can get lost in translation or maybe there isn't anybody who's taking
Justifying Inventory Management Staffing
00:15:44
Speaker
over at all. So I think that maintenance can really fall through the cracks if it isn't something that we're focusing on, right? And the way that you focus on it is by having good financial reporting to the board. So-
00:15:56
Speaker
Yeah, and dedicated resources, right? So we yeah do a lot of pro forma and development work with new AFCs and, you know, that are in the process of potentially selecting a software and like Vanessa said, learning it from scratch and not even knowing who their vendors are. But when we build that pro forma, we build in staff.
00:16:16
Speaker
to handle inventory management, right? It requires an FTE to really, if you want to get the best prices and you want to take advantage of a GPA or not a clean item master, it takes a dedicated person.
00:16:29
Speaker
And that person is a really unique skillset, either a surgical tech or and a nurse who's got some background and and likes computers, which is sometimes hard to decide. So there's none of this.
00:16:45
Speaker
Yeah, but, um, you know, you have to have the resources and so you've got to maintain it. Like Vanessa said, you've got to backfill it when that person goes on vacation. mean, more than one person has to know how to order. It has to be simplified and, and you really just have to train to the inventory master. Yeah. And I can imagine some listener is going a whole FTE, and I can barely afford the staff I have. How do i dedicate someone to this?
00:17:12
Speaker
They They could build a business case to be able to say, Hey, if we have someone, we'll pay them this much. We expect X dollars of savings.
00:17:25
Speaker
This will actually be a benefit to us and take load off of others. Or they could also work with a group like you guys, VMG Health to at least do some of that. Are there other ways that you've seen people build that case to say, Hey, this is something that we need to hire for.
00:17:45
Speaker
Well, I mean, there has to be motivation for it, right? So I think when we, when VMG Health goes into places and we're asked to look at a ah facility and its operation and it's underperforming, we always, because it's just such an important part of managing expenses, we always focus on inventory management.
00:18:08
Speaker
So Right then and there, the case has been made, right? So if you want to lower your expenses, you have to have somebody who's dedicated to it. And yeah, they probably have to be trained.
00:18:19
Speaker
And yeah, they probably to have spend most of their time doing it. There is some other stuff that you can give to them besides just inventory management, you know, depending on, you know, how busy your surgery center is. You know, sometimes those people also scrub in cases. Sometimes they can help.
00:18:36
Speaker
with instrumentation cleaning, not a lot of the time, but some of the time. And then I think, you know, they can also work with managing like your ancillary contract. So I think you can use them like in a couple of different places.
00:18:51
Speaker
But yeah, I mean, I think you just have to have the motivation from the ownership, right? That this is an important part of the entire operation and it's a very important part of profitability.
00:19:03
Speaker
And, you know, every time we do it, you know, we see success with decreasing that expense line of supplies. so Yeah, I'd say it's not uncommon for our operational assessments to find half a million dollar s swing in supply costs that we can motivate a client client quickly to say, a you need a better system.
00:19:25
Speaker
B, you need to be doing case costing. And then the last thing really is the key components of the communication between the team, because a lot of times this is tying in revenue cycle management, right? So you have costly implants and someone's not billing for them because the materials manager never went out and like told someone what they're doing and that this is, you know, we just got this new drug or we just got this new implant, but it's a billable implant and you have to supply, let's just say the invoice to get paid on it.
00:19:55
Speaker
If there's a disconnect easily, we can find half a million dollars and see just right off the bat of just, you know, that one full-time FTE let's call it even, you know, a hundred thousand dollars, even though that's probably a a lot, but that's nothing compared to what you're seeing, what you can see. Mm-hmm.
00:20:16
Speaker
Yeah, i completely agree. So let's say someone is working on their item master, they're cleaning it and ah trying to keep it in good shape, ah ideally with a full FTE for it have We have that item master. How does that data feed into preference cars, knowing the supplies used on cases, and ultimately the accurate case costing at that IDA level, like you were talking So I think, you know, if you don't have a clean and good item master, right, you can't have good preference cards.
00:20:50
Speaker
It kind of goes back to that, having that person who's dedicated to this and the education of the entire team. So, you know, in order to have accurate case costing, you have to have accurate preference cards. So they kind of all build on top of each other.
00:21:05
Speaker
And I think the preference card situation in the ASC space, probably in the hospital space too, is sometimes we don't see them at all. Sometimes people are like, oh, it just lives in my brain. And I know what, you know, they need on their preference card. But having it actually written down and in a system where you can...
00:21:28
Speaker
accurately identify what items are being used for every case feeds directly into the case costing, right? um Having one also that is accurate cuts down on the labor it takes to do in real time case costing, which is our favorite kind of case costing real time um data entry, like in the case.
00:21:49
Speaker
You know, if you have an accurate preference card, asking the circulator to maybe just add one or two items during that case is not that much of a heavy lift. And they're more inclined to do that than if you're saying, oh, well, we never look at our preference cards. You know, you have to add 25 items during this case. I mean, that's just not going to happen and it's not going to be accurate. So I think your regular...
00:22:10
Speaker
You know, you can look at it two ways. I think preference cards do the best when everybody knows that they're supposed to be current and accurate because then the nurses and the scrub techs in the rooms will communicate that to the materials manager or whoever is managing the the preference cards. And then additionally, i think, you know, just checking them, you know, whether that be on an annual basis, deleting the ones you no longer use, refining the process, you know, is always going to help in the long run when we're looking at case costing and preference cards.
00:22:40
Speaker
Yeah. So assuming you have clean data, right? And a great inventory master, like you said, in a system and ah someone's checking all those preference cards and they're not, you know, out of control. Sometimes see people with instead of 20, 30 preference cards, like 200.
00:22:54
Speaker
two hundred You know, they they don't use the tools within the software that allow them to duplicate, replicate and update easily. But once you do have that data, then the best thing to do is at least once a year, if not twice a year, sit down with your physicians and show them they're close per case.
00:23:13
Speaker
Ideally, you're showing them the same similar CPT code and procedure. ever geared to each other. That is always a win-win. It's a great way for them to discuss what the clinical outcomes are in the case and why they prefer their drugs or their instruments over others.
00:23:30
Speaker
It's a great way to show them that, you know, one doc might be $20 less per case than the other and and When you add that up, it's a financial, a huge financial improvement.
00:23:41
Speaker
And just being able to use and utilize an inventory master's system from the accounting standpoint is huge. So if you are a surgery center on the accrual basis and you want to really have your P&L be accurate, it should be based on not the supplies purchased and paid for during the month, right? The supplies used in the case and during the month. So you cannot do that without a correct inventory master that helps you, you know, use it as a sub-lender and create a journal entry.
00:24:11
Speaker
And that's when you really have an accurate P&L. So without having an inventory master, you can't do any of that. And we we find that a lot when we're looking at a cruel audited financial statements and we try and tie it back to what was used in the case, right? And what their inventory master looks like. So it goes full
Using Inventory Data to Improve Financial Practices
00:24:30
Speaker
circle.
00:24:30
Speaker
And ideally, like Vanessa said, if it is going to hit the P and L, it's easy to categorize it, right? This is my ortho expense for the month. This is my urology expense for the month and really narrow it down.
00:24:42
Speaker
And I specifically like to be able to call out implants because of the reimbursement issue. So if you can get a great data dump from your inventory system that allows you to kind manipulate that data before it hits the P and accurately,
00:24:57
Speaker
Then you can look, did we get reimbursed for this? Are we upside down? You know, there's just no way you can talk to any payer out there and renegotiate your contract rates without it looking and cleaning and scrubbing your inventory master.
00:25:12
Speaker
Yeah. Those are really great insights. I hope people have some actionable takeaways from today. We do this every week with our guests. What is one thing our listeners can do this week to improve their surgery centers?
00:25:26
Speaker
You know, if you have the capability, print out or export that item master and clean it. You know, that can definitely be done this week. I think just taking the time to focus on that and, you know, maybe you can't get through every item in one fell swoop, but working through it, you know, updating the names, looking at the unit of measures, looking at how they're categorized and looking at the prices, I think will go a mile to just, you know, improve what you have as a foundation.
00:25:58
Speaker
I would say and collaborate and benchmark. You know, if you go in for the the best case scenario, set a goal for you to be able to show your docs their case costing against each other. And then really important to measure yourself against the industry.
00:26:15
Speaker
What else is going on in the industry for your cost per case data? And then also compared to revenue. So that's really the biggest thing is what is that supply ratio?
00:26:26
Speaker
look like for you, your ANC compared to other ANCs in the same space. You know, we publish for a long time, benchmarking data cost, supply costs, supply ratios.
00:26:38
Speaker
You really have to figure out where your facility is compared to your peers, right? So having that benchmarking data is so important. And that's the first thing that docs are going to ask, you know, so this is where we are, where are we compared to others? And if you don't understand where you are what's acceptable for a cost per piece in the industry may not work for you because of your payer contracts.
00:27:02
Speaker
You could be upside down when someone else is getting three times to the rate. So you need to understand where you need to like cut costs and really spend that time and energy into getting that great contract, looking at your GPOs and making sure you're not overpaying.
00:27:19
Speaker
These are awesome suggestions. Thank you both. Have a good day. Thank you.
Medicare and Payment Reform Updates
00:27:32
Speaker
As always, it's been a busy week in healthcare, so let's jump right into the highlights. First up, from Becker's ASC News, a quick update on the Medicare rules. CMS released its 2026 physician fee schedule on October 31st, but the rest of the outpatient rules ASCs care about, quality reporting updates, and the expanded covered procedures list did not come out at the same time.
00:27:55
Speaker
That staggered timing isn't unheard of, but the gap is usually only a day or two. With the federal shutdown slowing other health policy moves, ASC leaders had worried about a longer delay, and as of last week, the rule still hadn't cleared its final OMB review.
00:28:09
Speaker
ASCUS Cara Newberry told Beckers they expect CMS to finalize a large addition to the ASC-covered procedures list for 2026, but warned reimbursement has to keep up with rising staffing and anesthesia costs or the migration to ASCs will stall.
00:28:24
Speaker
In other policy news, CMS is moving ahead with site-neutral payment reform in its proposed 2026 hospital outpatient rule, a change that would pay the same rate for a service regardless of whether it's done in a hospital outpatient department or a physician's office.
00:28:38
Speaker
The agency says hospitals currently get roughly 60% more than physician offices for similar services because of how professional and facility fees are structured. If this is finalized, expect hospital margins to compress and ASCs to gain relative strength as lower cost providers.
00:28:55
Speaker
Becker's reports some leaders see this as a catalyst for new partnerships, think co-branded strategies or joint ventures, especially as hospitals rebuild trust with independent physicians and as rural markets look for ways to stay viable.
00:29:09
Speaker
Site neutrality could reset pricing power and push more care to ambulatory settings, but it'll also force hospitals and ASCs to rethink how they work together.
Healthcare Payment Discrepancies and Debates
00:29:19
Speaker
UnitedHealthcare is drawing fresh scrutiny after a health affairs analysis found it pays doctors employed by its sister company, Optum, more than other physicians for common, high-cost services.
00:29:30
Speaker
As Healthcare Dive and Fierce Healthcare care reported last week, using 2024 price transparency data, The researchers estimated UnitedHealthcare paid Optum practices about 17% more than non-optum peers in the same markets.
00:29:44
Speaker
And in places where UHC holds at least a quarter of the insurance market, the gap rose to roughly 61%. The authors of the analysis argue that this kind of vertical integration can keep more premium dollars inside a single enterprise while still needing medical loss ratio requirements, which helps explain why policymakers are paying attention.
00:30:05
Speaker
UnitedHealthcare pushed back hard in statements to reporters calling the analysis flat-out wrong, saying cherry-picks data and maintaining that UnitedHealthcare pays opt-in rates consistent with the broader market to remain competitive and actuarially sound.
00:30:21
Speaker
Regardless of where you land, this adds fuel to the debate over insurer-owned physician groups, how ownership might shape prices, referrals, and reported medical spend. And it does come amid broader scrutiny of UnitedHealthcare's business practices.
Innovations in Cancer Detection Tests
00:30:36
Speaker
And finally, some genuinely hopeful cancer detection news. A blood test called Gallery looks for tiny fragments of tumor DNA circulating in the blood, and new data suggest it can spot a meaningful share of cancers, often with clues about where they started, from just a single vial.
00:30:53
Speaker
In a large 2025 study known as Pathfinder 2, the test correctly flagged about 40% of cancers overall and about 74% across a set of 12 of the deadliest cancers while staying highly specific, meaning very few false alarms.
00:31:09
Speaker
When the test was positive, roughly 62% of people did in fact have cancer, and the test pointed to the likely tissue of origin about 92% of the time, helping doctors streamline the workup.
00:31:22
Speaker
This isn't a replacement for mammograms, colonoscopies, or lung CTs. It's intended to sit alongside standard screening and it won't catch every cancer, especially some early stage tumors that shed little DNA, but it's progressing fast.
00:31:35
Speaker
A massive randomized trial with the UK National Health Service has finished three annual screening rounds and is tracking outcomes now, but with results expected in 2026 on the most important question, does this approach shift cancers to earlier stages and ultimately save lives.
00:31:52
Speaker
And that's all for our episode today. i hope you enjoyed the conversation with Grant, Vanessa, and Nancy. And if you did find this content helpful, leave a rating a a review for us on your favorite podcast platform so others could find our show.
00:32:05
Speaker
As always, we appreciate you taking a few minutes out of your week to spend with us, and we hope to see you again next time.