Rising labor and supply costs paired with declining reimbursements are making colonoscopy unattractive for many gastroenterologists, drawing concern from many amid a rise of advanced stage colorectal cancer.
There was a significant increase in advanced stage colorectal cancer and precancerous growths in adults of all ages in 2021, according to recent data from Nashville, Tenn.-based AmSurg.
The company attributed the increase to patients delaying care during the COVID-19 pandemic. More than 200,000 Americans are reported to have missed colonoscopy appointments since the pandemic began.
But this increase in colorectal cancer diagnosis comes as many gastroenterologists are encountering declines in reimbursements for colonoscopies, particularly for Medicare and Medicaid patients.
"Especially if the procedure is complex and prolonged, we are left with a situation where [the reimbursement] just about covers the overhead costs," Curuchi Anand, MD, a gastroenterologist affiliated with UMass Memorial Health in Worcester, Mass., told Becker's. "I still continue to provide care as a service to the patients, but in the future may need to stop or limit access to these patients."
While the volume of commercial patients is enough to sustain his practice financially, Dr. Anand said he has to work 60 hours a week because the 20 extra hours is worth more than what he gets paid by CMS.
Colorectal cancer is the second leading cause of cancer-related death in the U.S. in men and women combined, and gastroenterologists say a decline in reimbursements will cost payers more in the long run.
"CMS needs to realize that early endoscopy is valuable in preventing downstream morbidity to the patient and downstream cost to the overall healthcare system if diagnoses are made at later stages," Omar Khokhar, MD, gastroenterologist in Bloomington, Ill., told Becker's.
There's another danger to gastroenterology practices as well — noninvasive procedures. Gastrointestinal practices rely heavily on colonoscopies, and new devices could bring down those volumes.
"There is concern that the option of noninvasive tests will reduce the volumes," said Aasma Shaukat, MD, director of outcomes research in NYU Langone Health's division of gastroenterology and hepatology in New York City. "However, the other side is that it may overall improve CRC screening and bring more people for diagnostic colonoscopy, and expand the pool of surveillance colonoscopy over time."