Screening colonoscopy for a healthy patient in a hospital should be malpractice, CEO says

The demand for colonoscopies is skyrocketing as reimbursements sink, and many leaders feel ASCs are in a perfect position to mitigate that demand. 

Shakeel Ahmed, MD, gastroenterologist and CEO of Atlas Surgical Group in St. Louis, joined Becker's to discuss how he approaches this dynamic. 

Editor note: This interview was edited lightly for clarity and length. 

Question: What advice would you give ASCs to mitigate potentially bad relationships with hospitals?

Dr. Shakeel Ahmed: ASCs are good for healthcare. We have almost a $30 trillion federal deficit and 30% of our GDP goes to healthcare. The vast chunk of that expenditure is hospital fees. The powers that be know that. The way you play with this power dynamic is to focus on the savings. Also, you have to engage the hospitals. I don't want to demonize the hospitals, we need them. When your child is sick, you rush them to the hospital. But we need to think about the consumer, the healthcare system and the government. 

First, before you think of personal interests, we at least need to move elective surgery into the ASC. I'm a gastroenterologist, so I speak from my field, but I think that screening a colonoscopy in a healthy patient in an inpatient hospital setting should be malpractice. Over time this will become mainstream. People will realize what a huge expenditure we're wasting by keeping simpler electives — and I'm not talking about necessary procedures – but I'm talking about colonoscopies and other minor surgeries on healthy patients. These need to 100% move to the outpatient setting. 

A screening colonoscopy in the hospital setting is about 65% more expensive than an ASC. Same standards often apply for orthopedic and spine. At my ASC in South Illinois, we charge $150 for self-pay colonoscopy, which basically includes the professional fee for the gastroenterologist, the facility fee, the anesthesia fee and the pathology fee. I personally had a colonoscopy at a local hospital, which is close to my house, and the hospital got paid $10,000 for that colonoscopy. Additionally, in the ASC, according to CDC data, it's oftentimes safer to get a colonoscopy [at an ASC] compared to the hospital setting. The convenience is more effective. The cost is half as much.

We are destroying the system for our children. That's the biggest loss. As the federal deficit keeps growing, patients lose. What they don't realize is that if it doesn't come out of your pocket, you tend to feel that that's none of your business. But it's reflected back through a higher premium. The expenses are passed to somebody you love. 

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