Concerns about healthcare costs have led to a lot of discussion about how to spend wisely and efficiently on health programs and procedures.
One of those procedures is colonoscopy, which has received some media attention due its high cost (and variability in price) compared to other countries. For example, according to this article in the New York Times, the average price of a colonoscopy in the U.S. is $1,185, while it is well below $1,000 outside the U.S.
But should efforts to cut down costs associated with colonoscopy include targeting the amount endoscopists should be reimbursed for performing the procedure?
According to a recent article published online in the American Journal of Managed Care, the answer is no.
Authors Shivan Mehta, M.D., and Scott Manaker, M.D., of the University of Pennsylvania, write that Medicare in 2014 reduced reimbursement for upper endoscopy as a misvalued service, and that they expect colonoscopy reimbursement will meet the same fate in 2015.
And while a careful review of payment policies by the Centers for Medicare & Medicaid Services is always warranted, the authors write that "relying on a strategy of just reducing professional fee payment to the performing endoscopist may be problematic" for several reasons.
For starters, they say, those reimbursements are only a small part of the costs associated with colonoscopy--as little as 20 percent.
Second, endoscopists in different practice settings likely will respond differently to those reimbursement reductions. For example, the authors say, few colonoscopies occur in the physician office setting, the site of service that would experience the large impact of a reduced endoscopist fee.
Finally, the authors say, reducing reimbursements could have the unintended consequence of reducing access to high-quality colonoscopies. In order to maintain income, physicians may end up performing more colonoscopies in shorter periods of time, which could potentially impact the quality of the procedure.
"Achieving the goals of reducing costs and overutilization requires a more nuanced understanding of the comprehensive sources of colonoscopy costs, and realignment of physician incentives towards access and quality," the authors say.
Research published in March in CA: A Cancer Journal for Clinicians found that in the decade between 2001 and 2010, overall colon cancer incidence rates decreased by an average of 3.4 percent per year. They credited the drop to the increased availability of colonoscopy.