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Faced with cuts in Medicare reimbursement for colonoscopy, some gastroenterologists say they might reduce the number of procedures they do and retire earlier than they had intended, according to a recent survey. Although hypothetical, a shrinking GI workforce could hinder the ongoing initiative of extending screening for colorectal cancer to more of the eligible population.

“Medicare, which often sets a model for private payors, is planning to reduce reimbursement for lower endoscopy next year. This is happening at the same time the U.S. government and the National Colorectal Cancer Roundtable are trying to raise the screening rate to 80% by 2018,” said Matthew McNeill, MD, a third-year resident in internal medicine at New York University School of Medicine, in New York City. “We wanted to take a look at the effect decreases in colonoscopy reimbursement might have on the practice behaviors of gastroenterologists.”

Although it is difficult to quantify how much revenue GIs derive from performing colonoscopies, according to some estimates screening, therapeutic and diagnostic colonoscopies make up at least two-thirds of an endoscopy unit’s procedures. The American Society for Gastrointestinal Endoscopy (ASGE), American Gastroenterological Association (AGA) and American College of Gastroenterology (ACG) fought the proposed reimbursement cuts, as did members of Congress in letters to the Centers for Medicare & Medicaid Services (CMS).

For the study, Dr. McNeill and his colleagues sent a survey to 2,009 physicians in the ACG’s database, asking them to describe their response to reimbursement reductions of 10%, 20%, 30% and 40%. Of the total GIs surveyed, 327 (16.3%) responded to the survey in full, and their baseline characteristics confirmed “what we already know and suspect about gastroenterologists,” Dr. McNeill said. “They are working at almost near capacity: 95% are working over 40 hours a week and 42% are working over 60 hours a week.”

Many of a GI’s working hours are spent performing procedures, and 85% of the respondents indicated that more than half of their procedures are colonoscopies, according to the researchers. But clinicians predicted they would reduce procedure volume if their reimbursements were cut.
“We found that across the range of reimbursement, there was a significant change in procedure volume, and the change was greater with every 10% decrease in reimbursement,” Dr. McNeill said.

Although 72% of GIs indicated that a 10% decrease in reimbursement would not change their procedure volume, 32% said they would decrease volume with a 20% cut, while 21% would increase volume. At reductions of 30% and 40%, respondents indicated they would cut procedure volume by about half. Changes in plans for retirement reflected a similar change in attitude. At their current rate of reimbursement, 5%, 9% and 19% said they planned to retire three, five and 10 years from now, respectively. But even at the lowest potential reimbursement cut (10%), those proportions shifted to 7.6%, 12.5% and nearly 38%, respectively.

With a 30% reduction, 16%, 23% and 46% of GIs said they would retire at three, five and 10 years. Facing a 40% reduction, these proportions grew to 20%, 29% and 47%, respectively. To meet the goal of 80% screening by 2018 set by the National Colorectal Cancer Roundtable, “we need to have a workforce available to do those screenings,” Dr. McNeill said. “I think reining in health care expenditures is a realistic [approach to fixing] the U.S. health care system, but should it be done suddenly or gradually in a stepwise approach, to lessen decreases in the workforce that might have lingering effects down the line?”

He noted that the study was limited by being a survey. “But I think it paints a picture of potential decreases in the gastroenterology workforce if reimbursement decreases significantly,” Dr. McNeill said. GI fellowships have increased in recent years, “but it is yet unclear if this will adequately account for potential decreases in the GI workforce.”

The study was presented as a poster at the 2015 Digestive Disease Week (abstract Tu1076).

For Further Information
More on the gastrointestinal endoscope market in the U.S. can be found in the report published by iData entitled U.S. Market for Gastrointestinal Endoscopic Devices. This report covers the U.S. market segments for gastrointestinal endoscopic devices, capsule endoscopy, virtual colonoscopy, stenting and dilation devices, endoscopic retrograde cholangiopancreatography devices, biopsy forceps, polypectomy snares, fine aspiration needles, specimen and foreign-body removal devices, hemostasis devices, anti-reflux devices, enteral feeding devices, and Barret’s esophagus ablation devices.

The iData series on the market for gastrointestinal endoscopic devices covers the U.S., Brazil, China, Canada, India, Japan, and 15 countries in Europe. Full reports also provide a comprehensive analysis including units sold, procedure numbers, market value, forecasts, as well as detailed competitive market shares and analysis of major players’ success strategies in each market and segment.

Register online or email us at [email protected] for a U.S. Market for Gastrointestinal Endoscopic Devices report brochure and synopsis.

About Procedure Tracker
Procedure number data is available from iData’s Procedure Tracker service, which allows subscribers to define and analyze procedure data segmented by state, region, hospital, surgery centre, and physician. A customizable dashboard sorts procedure data for further analysis and research.

About Reimbursement Tracker
iData Research’s Reimbursement Policy Tracker enables medical device, dental, pharmaceutical and healthcare professionals to receive real-time policy updates from hundreds of insurance companies and 60,000+ policies across all therapeutic areas in the United States.

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