Gastroenterology's reimbursement problem

Low reimbursement rates have plagued gastroenterology for years. Here's what gastroenterologists have to say about how it's affecting the field.

Note: These responses have been lightly edited for length and clarity.

Vivek Kaul, MD. Segal-Watson Professor of Medicine in the Gastroenterology and Hepatology Division at the University of Rochester (N.Y.) Medical Center: 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. 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. 

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Benjamin Levy III, MD. Gastroenterologist at University of Chicago Medicine: [Decreased reimbursements are] concerning because GI practices and endoscopy centers and hospitals require so many staff to take care of our patients. There's a cost to have nurses, anesthesiologists, nurse anesthetists or CRNAs, and people that process insurance. So anytime we talk about decreased reimbursements, that puts a squeeze on the amount of money that's coming in to pay for all this required staff in order to do our job the best possible way that we can.

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Pankaj Vashi, MD. Department Head of Gastroenterology and Nutrition at City of Hope Chicago (Zion, Ill.): My major concern regarding procedure reimbursement is continued increase in costs of doing procedures and denials from payers with decreasing payments, especially by government payers. The only way ASCs can survive is by increasing efficiency and volume and maintaining quality care.

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