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    Resource-intensive endoscopy: revenue source or cash drain?

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    Authors
    Harewood, Gavin C
    Stemmer, Wayne
    Roth, Joel
    Waxman, Irving
    Affiliation
    Department of Gastroenterology and Hepatology, Beaumont Hospital, Dublin, Ireland. harewood.gavin@gmail.com
    Issue Date
    2009-08
    MeSH
    Cholangiopancreatography, Endoscopic Retrograde
    Endoscopy, Gastrointestinal
    Endosonography
    Health Resources
    Humans
    Retrospective Studies
    
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    Citation
    Resource-intensive endoscopy: revenue source or cash drain? 2009, 70 (2):272-7 Gastrointest. Endosc.
    Journal
    Gastrointestinal endoscopy
    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
    ISSN
    1097-6779
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.gie.2008.11.008
    Scopus Count
    Collections
    Beaumont Hospital

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