Orlando Health is a private, not-for-profit network of community and specialty hospitals based in Orlando, Florida. Orlando Health is Central Florida’s fourth largest employer with nearly 23,000 employees and more than 4,500 affiliated physicians..
Breast MRI is routinely considered at initial diagnosis to evaluate extent of disease, multicentricity, and contralateral disease in the non-metastatic setting, despite randomized data (e.g., COMICE & MONET) showing little impact on re-excision rates or long-term outcomes. In addition to time delays, each scan may expose patients to out-of-pocket expenses that compound “financial toxicity,” a quality-of-life domain now tracked by ASCO and NCCN. We audited all first-episode breast MRIs at a large community system during 2024 to clarify the economic burden. Retrospective billing data of all breast cancer MRI scans (ICD-10 C50.x code present in at least 1 of the first 5 diagnosis fields) performed in calendar-year 2024 at a community hospital system was analyzed in this IRB approved study. Cases were included if they had both Hospital (HB) and Professional Billing (PB) available. Only the “initial episode” MRI for each patient, defined as the earliest service date, was used. Primary endpoint was the posted “Patient Payment Amount”. Descriptive statistics including Spearman, Kruskal-Wallis and chi2 were performed using Python 3.11 (pandas, scipy) A total of 630 patients underwent a breast MRI in 2024. There was no difference in MRI distribution by service month. CPT code 77049 was billed in 95.4% of scans. Payer grouping included 53.0% Commercial, 32.7% Medicare, 11.7% ACA Marketplace, and 2.7% Military / Self-Paid / Other. Of all “Net Charges”, patients were liable for 13.4 %, insurers covered 75.4 %, and the hospital system had a gap of 11.2 %. For PB, 98.3 % of patients had a $0 copay, and among the 1.7% who did owe, median out-of-pocket responsibility was $94 (IQR $34-$100). The upper 10% of payers owed >$135, and the highest bill was $177 (skew = 0.46). For HB, 63.2% had $0 copay, and among the 36.8% who did owe, median out-of-pocket responsibility was $327 (IQR $171-$648). Ten percent of payers owed >$1,300, and the highest bill was $4,878 (skew = 2.8). For the combined PB + HB exposure, 64.0% of patients had a net $0 copay (including 1.3 % with small credits). Among the 36.0 % who owed anything, median out-of-pocket responsibility was $326 (IQR $174-$645). The upper 10 % of payers owed >$1,290, and the highest total bill was $4,878 (skew = 2.8). Patient responsibility did not show a consistent deductible effect: the proportion of $0 visits rose from 46% in January to 70% in December (Spearman p = 0.07), yet mean liability among paying patients fluctuated throughout the year (p = 0.32). Patient cost sharing with $0 co-pay by Payer class varied from 33.8% for ACA Marketplace, 49.7% for Commercial, 50% Military, 93.2% Medicare, and 100% for Medicaid, Self-Paid, and Other. Among patients who incurred >$0 liability, median responsibility was highest in Commercial plans ($453.09), followed by ACA Marketplace ($184.67), Medicare ($70.81), and Military ($30.50). Patient-level "financial toxicity" from an initial staging breast MRI is relatively minimal in our system—63 % of patients paid nothing and the remainder faced a median $327, almost entirely from the technical fee. These findings reassure clinicians that ordering a breast MRI seldom imposes a direct out-of-pocket burden on patients, though up-front cost counselling is important to prevent the rare but substantial financial surprises we identified. Cost-sharing burden fell mainly on ACA Marketplace and Commercially insured patients; Medicare and Medicaid beneficiaries were largely shielded. In a value-based oncology landscape, the decision to order a staging breast MRI should weigh its uncertain clinical benefit against not merely the patient’s copay at the point of care, but also system-level costs of both the hospitals that absorb charity-care write-offs and occasional under-collections, and the payers that cover the bulk of charges. C. Dvorak, H. Saunders, T. Dvorak, J. Smith. Patient Out-of-Pocket Exposure from Initial Staging Breast MRI: Quantifying Financial Toxicity in Breast Cancer Care [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-11-04.
BACKGROUND:Simulation is increasingly being used in trauma care to improve provider confidence, teamwork, and leadership skills in trauma situations. Additionally, the use of modern technology has introduced virtual reality simulation. However, simulations impact on trauma education, clinical practice, and cost effectiveness remain unclear. This review aims to synthesize current literature on the impact of simulation in trauma care education and clinical practice. METHODS:This concise review was performed utilizing five major databases: Cochrane, ProQuest, Google Scholar, PubMed, and Embase to identify relevant studies regarding the role of simulation modalities on team performance, medical education, patient outcomes, provider wellbeing, and cost-effectiveness. RESULTS:This concise review analyzed 1091 articles; 21 studies met inclusion criteria. Simulations demonstrated improved team performance by decreased communication response times (21 to 15 s) and increased teamwork (4.06/5 to 4.40/5). Leadership behavior significantly improved (11.29 vs. 7.23; d = 0.92). Studies demonstrated virtual reality (VR) was non-inferior to mannequins for trauma scores (163.1 vs. 163.2), higher VR assessment scores (158.4 vs. 134.2), and AI serious games reducing under-triage by ∼18%. VR was 40% cheaper than mannequins and reduced per-participant costs ($296 vs $149). Simulation improved completion times (251 vs. 497 s), success rates (100% vs. 64%), and diagnostic accuracy (P = .01) in education. Indirect patient outcomes included faster secondary surveys (14 min vs 6 min) and CT prep times (23 min vs 16 min). CONCLUSION:Simulation-based training is an effective tool in improving trauma care as evidence throughout the studies showed vast improvements in leadership, communication, efficiency in care, and provider confidence. The findings from this study demonstrate that the implementation of VR, in particular, showed tremendous educational benefits and can be a viable strategy to conventional simulation modalities due to its cost effectiveness.
