The costs and reimbursements associated with gastroenterology procedures are not keeping up with the increase in patient diagnoses.
"There is the well-known issue of decreasing reimbursement over time for procedures that already have existing CPT codes, and that too in the face of the post-pandemic increased demand, higher costs of doing business and staffing issues," Vivek Kaul, MD, a professor at the University of Rochester (N.Y.) Medical Center, told Becker's. "In addition, a real challenge we are facing is the inability to get reimbursed for a host of relatively newer (but well established) endoscopic procedures that have emerged in the last decade or so. Oftentimes, these are minimally invasive, transformational interventions for our patients that help reduce morbidity, length of stay and overall healthcare costs but are poorly reimbursed or not reimbursed at all, in some cases."
Here are five numbers illustrating the GI reimbursement conundrum:
33%. The percent decline of adjusted average reimbursement for GI procedures from 2007 to 2022, according to a study published in the American Journal of Gastroenterology.
38%. The decrease in reimbursements for colonoscopy and biopsy, according to the same study.
55%. How much higher U.S. hospitals' facility fees for colonoscopy procedures covered by private health insurance are than those at ASCs, according to a JAMA Health Forum study.
10%. The increase in the cost of a diagnostic colonoscopy at ASCs, compared to 17% at HOPDs, according to the JAMA study.
153,020. The estimated number of people who were diagnosed with colorectal cancer in the U.S. in 2023, according to the American Cancer Society.