What leaders are saying about colonoscopies

In wake of lowering recommended age for colonoscopies from 50 to 45, increased demand for colonoscopies and rising rates of colon cancer among people younger than 55, colonoscopies have become hot topic in healthcare — regardless of care setting.

Here are three leaders' thoughts on the state of colonoscopies in 2024:

Shakeel Ahmed, MD. Gastroenterologist and CEO of Atlas Surgical Group (St. Louis). 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.

Nathan Merriman, MD. Medical Director of Gastroenterology and Digestive Health at Intermountain Health (Salt Lake City). [O]ur central screening colonoscopy program has been very impactful. We started it about a year and a half ago. We were continuously seeing that there were a lot of open scheduled spots on people's schedules across the Salt Lake Valley, and there were a lot of patients waiting after the backlog of COVID-19. However, the age change to 45 has led to a huge increase in patients. We wanted to make it easier for patients to schedule their screening colonoscopy online, so we started up an online form. I know some people have gone direct to scheduling — which is great — and eventually, we hope to get there as well. 

We started an online form for requests for screening colonoscopy because patients actually don't need a referral, and patients have loved it. It helped with our central scheduling program, allowing patients to see availability across sites in the Salt Lake Valley and to look for open time blocks across sites, and empower them to choose which of our four sites they want to go to, and on what day and at what time, with which physician. Patients have really loved that, 

Jerry Tillinger. CEO at U.S. Digestive Health.  [T]he one that I think is actually going to drive the most change for us is the rapid growth and the demand for outpatient procedures as we've moved the bar for colonoscopy screening from 50 to 45.

And honestly, I don't think we're that far from moving it down to 40. In the conversations we have around the market, the public is very interested in not dying of colon cancer. And every time you have an announcement of someone they've heard of who dies of colon cancer because they weren't diagnosed till they were 38 and they were already at stage 4, they start to wonder why they're waiting till they're 45 or 50. So as I find more and more patients have gone and gotten screened early, I think we're gonna continue to see this demand for screening access. And I don't think the liquid biopsy of stool testing is good enough yet, so I think that we're still gonna see what we're seeing is the demand for us to provide outpatient procedures at our endoscopy centers is driving faster than I can recruit and build.

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