Becker's ASC Review

21 GASTROENTEROLOGY The colonoscopy conundrum By Patsy Newitt G astroenterology physicians and practices are facing a major challenge: increased demand for colonoscopies amid declining reimbursements. Gastroenterologists are facing low reimbursement rates, affecting the financial stability of their practices as procedure demand continues to grow. 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. Reimbursements for colonoscopy and biopsy decreased 38% during that period. "ere is the well-known issue of decreasing reimbursement over time for procedures that already have existing CPT codes, and that too in the face of the post-pandemic increased demand, higher costs of doing business and staffing issues," Vivek Kaul, MD, gastroenterology professor at the University of Rochester (N.Y.) Medical Center, told Becker's last year. "In addition, a real challenge we are facing is the inability to get reimbursed for a host of relatively newer (but well-established) endoscopic procedures that have emerged in the last decade or so. Oentimes, these are minimally invasive, transformational interventions for our patients that help reduce morbidity, length of stay and overall healthcare costs but are poorly reimbursed or not reimbursed at all, in some cases." Prior authorizations can be another obstacle for gastroenterologists looking to secure reimbursements. "e most challenging payer trends affecting ASCs right now are the policies that require prior authorization or advanced notification for colonoscopies and other relatively routine endoscopic procedures," Eugenio Hernandez, MD, senior vice president of clinical affairs for Miami-based Gastro Health, told Becker's. "While these policies place an additional administrative burden on ASCs, the bigger issue is that they could potentially harm patients because of limited, delayed or denied care." While reimbursements are declining, demand for colonoscopies is on the rise. In 2021, an advisory panel lowered the recommended age for when people should begin colon cancer screenings from 50 to 45, and CMS said Nov. 1 it is expanding Medicare coverage for certain colorectal cancer screening tests by reducing the minimum age payment and coverage limitation from 50 to 45. Colon cancer diagnoses among people younger than 55 increased from 11% in 1995 to 20% in 2019, according to a report from the American Cancer Society. Additionally, colon and rectal cancer rates are expected to grow 8% among men and 7% among women in 2024. "Now, to see someone in their 20s and 30s [being diagnosed with cancer], it doesn't wow us anymore," Nancy You, MD, a professor of colon and rectal surgery at the University of Texas MD Anderson Cancer Center in Houston, told Becker's. "Even when I was a fellow in 2008 at Mayo Clinic, we were already seeing young patients with colorectal cancer, and even then we were writing about the increased rates." Omar Khokhar, MD, a gastroenterologist at Illinois GastroHealth in Bloomington, told Becker's he is holding out hope that 2024 might see more successful payer negotiations. "I would love to see payers and clinicians sit down at a table and have a conversation about the benefit of early endoscopy for diagnosis and screening," he said. "In particular, how EGD/colonoscopy can potentially prevent patient morbidity and decrease downstream cost to the healthcare system. Yes, endoscopy isn't cheap, but cancer is a bad diagnosis and is more expensive." n ASC leaders turn to gastroenterology for growth By Riz Hatton Healthcare leaders are turning to gastroenterology to unlock growth opportunities. Here are how three leaders are using gastroenterology to grow their facilities: Dean Lehmkuhler. Administrator at Northside Gastroenterology Endoscopy Center (Indianapolis): The growth of our ASC will be significant after two years as we are planning to build a new endoscopy center with a projected opening of Jan. 31, 2026. The new center will allow for 50 percent growth over the next five years as we are increasing the size of the center and increasing from four procedure rooms to five procedure rooms with an ability to add a sixth room. We will also be programming a more efficient patient flow along with technological advances that we currently do not have in the center today. Alex Pham, MD. Chronic Pain Physician at SEVA Med Care (Tulsa, Okla.): We plan on expanding our surgical volume by implementing marketing strategies and expanding our services. This includes the addition of gastroenterology, otolaryngology, cardiovascular and orthopedic specialities, among others. Within the next 12 to 24 months, we hope to optimize operational efficiency while creating an intimate and individualized environment for our patients. Sap Sinha. COO at Allied Digestive Health. Our focus is on continuing to grow aggressively in our ASCs. There is an increase in colonoscopies in general because of the change in the age for mandatory colon checks for colon cancer from 50 to 45. Furthermore, we are also seeing an increase in chronic diseases such as IBD and IBS that also require procedures in the ASC. n

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