Resource-intensive endoscopy: revenue source or cash drain?

Background: Recent research has demonstrated that resource-intensive endoscopic procedures are not financially viable if performed without the need for further clinical care. Objective: To determine whether the net income from downstream clinical activities makes resource-intensive endoscopy a financially viable activity Design: Retrospective database review. Setting: Tertiary-referral medical center. Patients: Patients whose initial contacts with the medical center were as outpatients who underwent EUS, EMR, or ERCP in 2004. Main Outcome Measurements: Hospital charges, the cost of providing services, revenue, and net income from all services provided through June 2006. Results: A total of 120 patients were reviewed whose initial procedure was EUS (48), ERCP (53), or EMR (19). generated by the subsequent Although income was lost by performing the endoscopic procedures, revenue was 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. Limitation: Indirect costs are institution specific and may not be generalizable to other centers. Conclusions: 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. (Gastrointest Endosc 2009;70:272-7.)