Why sinking colonoscopy pay is a growing threat

Gastroenterologists across the country are facing low reimbursement rates for colonoscopy demand.

From 2007 to 2022, unadjusted and adjusted average reimbursement for GI procedures dropped by 7% and 33%, respectively, according to a study published in the American Journal of Gastroenterology

George Dickstein, MD, vice president of clinical affairs of Gastro Health Massachusetts, joined Becker's to discuss the danger of these colonoscopy reimbursement declines. 

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

Question: What are the long-term dangers of declining colonoscopy reimbursements paired with rising CRC cases & colonoscopy demand?

Dr. George Dickstein: Clearly for Medicare, colonoscopy reimbursements are not keeping up with inflation and costs of doing business at practices and ASCs. The reality on the ground for the commercial market is more nuanced and harder to get at as rates are not easily shared and vary tremendously by geography. Gastroenterologists have invested a great deal of time, training and strategic planning around providing safe colonoscopies in high-quality, time-efficient settings. Ultimately, the rapidly increasing market of blood and stool-based screening tests will have an impact on screening colonoscopy demand. As the false positive, true positive, negative predictive value and positive predictive value of each of these emerging technologies is yet to be compared in well-done trials, we will better be able to strategize their impact on diagnostic colonoscopy demand.

Q: What key strategies to approach declining colonoscopy reimbursements?

GD: Every provider and endoscopy suite needs to become as time efficient as possible. Each site of service needs to optimize wheels in/wheels out time and room turnover time, while maintaining best-in-class polyp detection rates and patient safety. Endoscopy suites need to invest in technologies and endoscopy platforms that optimize physician workload. Fifteen cases a day should be manageable in an 8-hour day everywhere, whether a site is offering moderate sedation or deep sedation. 


Some sites still struggle to get 9-10 cases done. Accomplishing all of this requires stable staffing, updated equipment and, increasingly, AI-assisted image analysis to optimize polyp detection. In some parts of the country, there is also a push to train lower-cost providers — NPs and PAs — to do colonoscopies. This, even if palatable to patients and ultimately proved safe, will take an enormous amount of time, effort and money to accomplish. In the end, the solution for Medicare also involves fixing the sustainable pricing model so that physicians continue to willingly perform this critical procedure.

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