Colonoscopies are booming, but the economics are getting complicated.
As colorectal cancer rates climb and updated screening guidelines add millions of newly eligible patients, ASCs are racing to meet demand. But reimbursements are falling even as procedure volumes rise, forcing GI groups to think carefully about where and how they operate.
The strength of GI procedures
GI procedures represent one of the largest categories of ASC volume; eight GI-related services accounted for 28.3% of all Medicare ASC procedures in 2023. As demand rises, particularly following guideline changes that expanded screening eligibility, ASCs are performing a growing share of screening and diagnostic colonoscopies. As more procedures shift to outpatient settings, GI ASCs have grown into a $6.2 billion market projected to expand nearly 7% annually through 2030, according to Grand View Research.
Colonoscopies conducted in ASCs also remain less expensive than those performed in hospital outpatient departments, a factor increasingly emphasized by payers and employers seeking cost-efficient care.
Neal Kaushal, MD, a gastroenterologist from Sonora, Calif., highlighted colon cancer screening as the most promising growth area for ASCs.
“The demand for endoscopic services nationwide has reached an all-time high,” he said. “Furthermore, cost pressures are increasingly — and almost exclusively — pushing elective screening procedures to the outpatient ASC setting.”
The migration presents a “significant opportunity — both clinical and commercial — for GI groups and institutions to capitalize on providing quality patient care in a manner that is both cost efficient and profitable,” he said.
This is also true for health systems and hospitals. Health systems are responding by building specialized GI hubs designed to streamline care and increase accessibility. For patients, these centers offer more convenient, targeted services with fewer hospital visits. For providers, they support value-based models, chronic disease management and long-term financial growth.
Recently, Chicago-based Northwestern Medicine opened a $15 million Center for Advanced Endoscopy at its Central DuPage Hospital in Winfield, Ill. Additionally, Sacramento, Calif.-based UC Davis Health opened the region’s first dedicated adult congenital colorectal clinic May 12.
What’s driving the colonoscopy surge
ASCs are seeing a surge in colonoscopy demand as colorectal cancer rates rise, particularly among adults younger than 50.
Updated screening guidelines lowered the recommended starting age from 50 to 45, adding millions of newly eligible patients. Practices have reported noticeable jumps in patient inquiries and referrals since the change took effect.
Colorectal cancer rates among U.S. adults have hit record highs in recent years. The expected growth rate among men is 8%, and 7% among women.
The reimbursement roadblock
Reimbursements for gastroenterologists have steadily declined. Between 2007 and 2022, unadjusted and adjusted average reimbursement for GI procedures dropped 7% and 33%, respectively, according to a study published in The American Journal of Gastroenterology. Reimbursements for colonoscopy and biopsy specifically fell 38% during that period.
The 2026 payment landscape adds another wrinkle: Office-based endoscopy procedures will see an average 16% Medicare payment increase, while ASCs and hospital outpatient departments face an average 8% cut, according to the American College of Gastroenterology.
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.