The obstacles in GI migration from the HOPD to ASC

There are several obstacles slowing the migration of gastroenterology procedures from the hospital outpatient departments to ASCs.  

James Leavitt, MD, director of clinical quality and outcomes of Miami-based Gastro Health, joined Becker's to discuss these obstacles. 

Editor's note: This response was edited lightly for clarity and length. 

Question: What obstacles are halting outpatient migration for GI procedures?

Dr. James Leavitt: According to a study from Johns Hopkins Bloomberg School of Public Health, endoscopic procedures cost on average 55% more at hospitals compared to ASCs. The economic driver should be to move more of these procedures to the lower cost ASC setting especially since outcomes are equal in either setting.  

However, there remain several issues preventing more widespread migration to the lower-cost setting. First, there are still some insurers who will only pay for procedures to be done in a hospital setting. Secondly, there are some higher risk patients where the hospital setting would be more appropriate. Patients with a significantly elevated BMI or with poor airways, for example, are more appropriate for a hospital setting. 

However, there are still patients who could be done in an ASC and are not. Two major drivers here are access issues (not enough ASC endoscopy slots to accommodate demand) and hospital employed physicians who are required to do their procedures in the HOPD setting. 

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