As screening guidelines evolve and GI care increasingly shifts to outpatient settings, ASCs are seeing significant growth in colonoscopy volume.
Here are ten developments shaping that trend:
- Lower screening age expands the patient pool.
Updated screening guidelines lowering the starting age from 50 to 45 have added millions of newly eligible patients, driving a steady rise in screening demand. Practices report noticeable increases in patient inquiries and referrals following the guideline change. - Early-onset colorectal cancer is fueling urgency: Colorectal cancer diagnoses among adults under age 50 continue to climb, prompting more proactive screening from primary care providers and GI specialists. This trend is pushing younger cohorts into screening pathways earlier.
- ASCs are absorbing more GI volume, including colonoscopies: GI procedures represent one of the largest categories of ASC volume, and eight GI-related services accounted for 28.3% of all Medicare ASC procedures in 2023. As demand rises, particularly after guideline changes expanding screening eligibility, ASCs are performing an increasing share of screening and diagnostic colonoscopies.
- Site-of-service cost differences are driving outpatient migration: Colonoscopies conducted in ASCs remain significantly less expensive than those performed in hospital outpatient departments, a factor increasingly emphasized by payers and employers seeking cost-efficient care.
- Reimbursement pressure persists despite volume growth: Even as colonoscopy demand accelerates, driven by younger screening cohorts and higher overall CRC incidence, reimbursement continues to lag. Between 2007 and 2022, average GI reimbursement fell 7%, unadjusted, and 33% when adjusted for inflation, with colonoscopy and biopsy reimbursement dropping 38%. ASC leaders say stagnant rates, rising staffing and supply costs, and tighter medical-necessity reviews are putting continued pressure on GI margins.
“Decreased reimbursements put a squeeze on the money needed to cover staff and resources to deliver high-quality care,” Benjamin Levy III, MD, gastroenterologist at University of Chicago Medicine, told Becker’s.
- Workforce and capacity constraints are increasing: Higher screening volume is straining capacity in many markets, with centers citing staff shortages, anesthesia availability issues and bottlenecks in recovery and procedure scheduling as barriers to scaling colonoscopy services.
- Technology is enabling faster and more accurate colonoscopies: New tools are improving both detection and efficiency in GI care.
Gastroenterologists are beginning to use AI-assisted endoscopic systems to help identify precancerous lesions during colonoscopy, and AI dictation to streamline documentation and increase clinic capacity.
Dr. Levy also noted a growing role for intestinal ultrasound, which allows clinicians to assess inflammatory bowel disease activity in clinic without fasting or bowel prep.
- Screening access gaps remain: Even with the screening age lowered to 45, nearly 40% of eligible adults have not undergone a colonoscopy. Gastroenterologists say lack of awareness, fear of the procedure and cost barriers continue to limit uptake, and many patients still do not know the recommended screening age. Providers are ramping up education and outreach efforts to close these gaps as colorectal cancer rates rise.
- Operational strategy is becoming increasingly important: As colonoscopy demand grows, ASCs are refining operations to keep pace. GI procedures now make up 28.3% of all Medicare ASC volume, putting added pressure on scheduling, anesthesia coverage and staffing.
Leaders say the anesthesia shortage is a major bottleneck, worsened by the influx of roughly 19 million newly eligible patients after screening guidelines shifted from age 50 to 45. ASCs are responding by optimizing scheduling workflows, expanding pre-procedure education and strengthening recovery-area efficiency to maintain throughput while managing rising complexity and resource strain.
- Strategic implications for ASC platforms continue to grow: With GI procedures accounting for 28.3% of all Medicare ASC volume, centers are moving beyond day-to-day capacity management and toward long-term operational planning.
ASCs are redesigning scheduling workflows, standardizing pre-procedure education and reevaluating anesthesia coverage models to support rising colonoscopy volume.
