Demand for GI procedures is climbing, but more patients are canceling at the last minute, and some center leaders can’t say why.
GI case volume per ASC rose 19% from 2023 to 2024, from 349 to 416 cases, according to HST Pathway benchmarking data. Last-minute cancellations at the three GI centers overseen by Nirav Shah, MD, have risen over the past two years for reasons his team hasn’t pinned down.
“We can’t put a finger on it,” said Dr. Shah, president of the DDA division and chief medical officer of U.S. Digestive Health, Oct. 29 at Becker’s 32nd Annual Meeting: The Business and Operations of ASCs in Chicago. His centers perform more than 30,000 procedures a year.
How common it is
At Cleveland Clinic, nearly a third of outpatient endoscopies at its academic center fall through. A retrospective study looked at more than 45,000 procedures scheduled from January 2024 through October 2025. It counted any procedure canceled within seven days of the appointment, or missed entirely, as a last-minute cancellation. It found:
- Academic center: 30.2% of procedures were canceled late or missed (10,308 of 34,129).
- Community site: 18% were canceled late or missed (2,119 of 11,772).
- Medicaid: Patients had 82% higher odds of a late cancellation at the academic center and 44% higher odds at the community site than patients with other insurance.
- Colonoscopy: Colonoscopies had 42% higher odds of cancellation than upper endoscopies at the academic center and 21% higher at the community site.
- Neighborhood deprivation: Each 10-point increase on the Area Deprivation Index raised the odds by 33% at the academic center and 7% at the community site.
“As deprivation increases, so does the likelihood of a late cancellation or no-show,” said Brian Baggott, MD, a Cleveland Clinic gastroenterologist and one of the study’s researchers. He pointed to barriers such as getting time off work and finding a ride.
Smaller units are seeing increases too. One endoscopy unit featured by the American Society for Gastrointestinal Endoscopy said its date-of-service cancellation rate held steady at 3% to 4%, then climbed to 6% in 2024. The unit traced the rise partly to scheduling more open-access patients. It also cited call center breakdowns and the lack of a dedicated scheduling line. Staff began calling patients not on the portal a week before their procedure and sending automated portal reminders a week out. That brought the rate back to about 4%.
There is no widely used national benchmark, and published rates vary widely by setting. Patients missed 6.1% of procedures before a Brigham and Women’s Hospital texting pilot and 14% before a University of Chicago Medicine trial. At a VA Greater Los Angeles endoscopy clinic, quarterly no-show and late cancellation rates ranged from 19% to 38%.
Why each cancellation costs more now
Anesthesia coverage already limits how many rooms Dr. Shah’s centers can run, and he said a partially used room “no longer pays for itself.”
The math is tight elsewhere too. At Spartan Health Surgicenter in Monongahela, Pa., one CRNA covers about 15 GI cases on a typical day, executive administrator Patrick Garman said at the conference.
Stipends are adding to the pressure. In 2024, 28% of ASC leaders expected to pay anesthesia stipends. In 2025, 44% did, according to VMG Health’s ASC leader expectations survey.
The revenue at stake per slot is also shrinking. CMS’ final 2027 Medicare payment rules will cut physician payments for GI endoscopy performed in ASCs and hospital outpatient departments by an average of 2%, according to a Nov. 6 alert from The American Gastroenterological Association.
Possible drivers
- Bowel prep: In March 2025, the U.S. Multi-Society Task Force on Colorectal Cancer raised its benchmark. At least 90% of colonoscopies should now have adequate prep, up from 85% in its 2014 guidance.
- GLP-1s: A Cedars-Sinai study published Oct. 1, 2024, in JAMA Network Open found inadequate bowel prep in 21.3% of GLP-1 users vs. 6.5% of nonusers among 140 colonoscopy patients. The full study included 209 patients.
- Illness: Benjamin Levy, MD, a gastroenterologist at the University of Chicago, spoke on a separate conference panel. He said cases get canceled when patients arrive sick. Anesthesia may cancel a patient who had an upper respiratory infection days earlier, or one with recent diverticulitis.
- Direct scheduling: Dr. Levy said direct-scheduled patients, whom no gastroenterologist or advanced practice provider has seen, can take five to 10 minutes of chart prep before a procedure.
What centers are trying
Dr. Shah’s fix is staffing: hire a dedicated same-day scheduler and overbook to absorb cancellations. Overbooking has some data behind it. A model built at a VA endoscopy clinic projected that predictive overbooking could raise use of clinic capacity from 62% to 97%. The model was not put into practice.
Others are turning to technology:
AI screening: Dr. Levy said AI could flag patients who should be scoped in a hospital rather than an ASC, or who should wait. It could also help patients through prep. “There’s just so many different uses to improve the efficiency and decrease cancellations,” he said.
Texting: Bipan Chand, MD, chair of surgery at Ascension Saint Joseph-Chicago, said patients now receive and complete pre-procedure orders by text. In a 2019 University of Chicago Medicine randomized trial of 1,625 colonoscopy patients, timed prep texts cut no-shows from 14% to 8%.
Lean fixes: A VA endoscopy unit cut its no-show rate from 16% to 7.8% in six months, according to a study published in Gastroenterology. The unit made it easier for patients to cancel in advance and improved its phone systems.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
