Are physicians overpaid for performing colonoscopies?

Last year the New York Times created quite a media storm with an article in which it reported on colonoscopies that ranged in price--depending on the location--from $7,563.56 to $19,438 (including a polyp removal).

With costs like these in mind, the Centers for Medicare and Medicaid Services (CMS) is more than justified in carefully reviewing Medicare and Medicaid payment policies. The question is whether cutting reimbursements is the best way to go about controlling these costs, FierceMedicalImaging recently reported.

The evidence seems to suggest the answer is no. Shivan Mehta, M.D., and Scott Manaker, M.D., of the University of Pennsylvania, in that article, argue that despite the fact Medicare in 2014 reduced reimbursement for upper endoscopy as a misvalued service (and they believe colonoscopy reimbursement will meet the same fate in 2015), reimbursement rates for performing colonoscopies are so low that they won't have much of an effect on cost containment efforts.

More importantly, however, is the possibility that threats to reimbursements could end up stalling public health efforts to increase colorectal cancer screening and prevention efforts.

As Mehta and Manaker noted, simple economics suggest that reduced reimbursements could result in physicians who perform colonoscopies directing their activities elsewhere. Or they could restrict patient access to their services if those patients carry insurance coverage--such as that provided by Medicare--that reimburses less.

"While it is hard to predict exactly how physicians would respond to the reduction of colonoscopy professional fees, potential responses such as de-emphasizing screening colonoscopy or performing shorter exams would reduce the societal benefit of CRC screening," Mehta and Manaker pointed out.

And those benefits can be substantial. According to the American Cancer Society, 136,383 Americans will be diagnosed with colorectal cancer, and 50,310 will die of the disease in 2014. And caring for those individuals with advanced colorectal cancer is expensive--some studies have determined that the treatment costs for late stage colorectal cancer can top $200,000.

On the other hand, according to the American Gastroenterological Association, the professional fee from Medicare for performing a colonoscopy is only about $220. One could easily argue that considering the education, training and expertise required to perform the procedure, as well as the value gained with the early diagnosis of colorectal cancer, that screening colonoscopy is not overpaid and that there are probably better ways to go about controlling costs. - Mike (@FierceHealthIT)