Resource-intensive endoscopy: revenue source or cash drain?

Hdl Handle:
http://hdl.handle.net/10147/127610
Title:
Resource-intensive endoscopy: revenue source or cash drain?
Authors:
Harewood, Gavin C; Stemmer, Wayne; Roth, Joel; Waxman, Irving
Affiliation:
Department of Gastroenterology and Hepatology, Beaumont Hospital, Dublin, Ireland. harewood.gavin@gmail.com
Citation:
Resource-intensive endoscopy: revenue source or cash drain? 2009, 70 (2):272-7 Gastrointest. Endosc.
Journal:
Gastrointestinal endoscopy
Issue Date:
Aug-2009
URI:
http://hdl.handle.net/10147/127610
DOI:
10.1016/j.gie.2008.11.008
PubMed ID:
19386305
Abstract:
Recent research has demonstrated that resource-intensive endoscopic procedures are not financially viable if performed without the need for further clinical care.; To determine whether the net income from downstream clinical activities makes resource-intensive endoscopy a financially viable activity.; Retrospective database review.; Tertiary-referral medical center.; Patients whose initial contacts with the medical center were as outpatients who underwent EUS, EMR, or ERCP in 2004.; Hospital charges, the cost of providing services, revenue, and net income from all services provided through June 2006.; A total of 120 patients were reviewed whose initial procedure was EUS (48), ERCP (53), or EMR (19). Although income was lost by performing the endoscopic procedures, revenue was generated by the subsequent clinical care derived from EUS (mean $7093 per patient, standard deviation [SD] $23,686, range $12,316-$117,984 per patient); a loss of revenue was incurred in the clinical care of both patients who underwent ERCP (mean -$5028 per patient, SD $12,565, range -$33,648-$47,481) and patients who underwent EMR (mean -$931 per patient, SD $6515, range -$11,245-$12,196). The most lucrative activity arising from initial endoscopic referral was surgery. Revenue was lost for these procedures in Medicare patients compared with non-Medicare patients.; Indirect costs are institution specific and may not be generalizable to other centers.; EUS is the most remunerative resource-intensive endoscopic procedure. Centralizing these resource-intensive procedures into multispecialty practice sites that provide surgical and oncologic care allows downstream revenue from patient treatment to offset procedural losses. Even taking account of downstream revenues, performing these procedures on Medicare patients is not financially viable. Any future cuts in Medicare physician payment rates will further increase this Medicare/non-Medicare reimbursement imbalance and likely have consequences on the performance of these procedures.
Item Type:
Article
Language:
en
MeSH:
Cholangiopancreatography, Endoscopic Retrograde; Endoscopy, Gastrointestinal; Endosonography; Health Resources; Humans; Retrospective Studies
ISSN:
1097-6779

Full metadata record

DC FieldValue Language
dc.contributor.authorHarewood, Gavin Cen
dc.contributor.authorStemmer, Wayneen
dc.contributor.authorRoth, Joelen
dc.contributor.authorWaxman, Irvingen
dc.date.accessioned2011-04-07T08:22:42Z-
dc.date.available2011-04-07T08:22:42Z-
dc.date.issued2009-08-
dc.identifier.citationResource-intensive endoscopy: revenue source or cash drain? 2009, 70 (2):272-7 Gastrointest. Endosc.en
dc.identifier.issn1097-6779-
dc.identifier.pmid19386305-
dc.identifier.doi10.1016/j.gie.2008.11.008-
dc.identifier.urihttp://hdl.handle.net/10147/127610-
dc.description.abstractRecent research has demonstrated that resource-intensive endoscopic procedures are not financially viable if performed without the need for further clinical care.-
dc.description.abstractTo determine whether the net income from downstream clinical activities makes resource-intensive endoscopy a financially viable activity.-
dc.description.abstractRetrospective database review.-
dc.description.abstractTertiary-referral medical center.-
dc.description.abstractPatients whose initial contacts with the medical center were as outpatients who underwent EUS, EMR, or ERCP in 2004.-
dc.description.abstractHospital charges, the cost of providing services, revenue, and net income from all services provided through June 2006.-
dc.description.abstractA total of 120 patients were reviewed whose initial procedure was EUS (48), ERCP (53), or EMR (19). Although income was lost by performing the endoscopic procedures, revenue was generated by the subsequent clinical care derived from EUS (mean $7093 per patient, standard deviation [SD] $23,686, range $12,316-$117,984 per patient); a loss of revenue was incurred in the clinical care of both patients who underwent ERCP (mean -$5028 per patient, SD $12,565, range -$33,648-$47,481) and patients who underwent EMR (mean -$931 per patient, SD $6515, range -$11,245-$12,196). The most lucrative activity arising from initial endoscopic referral was surgery. Revenue was lost for these procedures in Medicare patients compared with non-Medicare patients.-
dc.description.abstractIndirect costs are institution specific and may not be generalizable to other centers.-
dc.description.abstractEUS is the most remunerative resource-intensive endoscopic procedure. Centralizing these resource-intensive procedures into multispecialty practice sites that provide surgical and oncologic care allows downstream revenue from patient treatment to offset procedural losses. Even taking account of downstream revenues, performing these procedures on Medicare patients is not financially viable. Any future cuts in Medicare physician payment rates will further increase this Medicare/non-Medicare reimbursement imbalance and likely have consequences on the performance of these procedures.-
dc.language.isoenen
dc.subject.meshCholangiopancreatography, Endoscopic Retrograde-
dc.subject.meshEndoscopy, Gastrointestinal-
dc.subject.meshEndosonography-
dc.subject.meshHealth Resources-
dc.subject.meshHumans-
dc.subject.meshRetrospective Studies-
dc.titleResource-intensive endoscopy: revenue source or cash drain?en
dc.typeArticleen
dc.contributor.departmentDepartment of Gastroenterology and Hepatology, Beaumont Hospital, Dublin, Ireland. harewood.gavin@gmail.comen
dc.identifier.journalGastrointestinal endoscopyen
dc.description.provinceLeinster-

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