Barriers to office-based screening sigmoidoscopy: does reimbursement cover costs?

Area of Science:

• Gastroenterology
• Health Economics
• Preventive Medicine

Background:

• Colorectal cancer (CRC) screening with flexible sigmoidoscopy can decrease mortality rates.
• Primary care physicians' reluctance to offer this screening may stem from perceived inadequate reimbursement.
• Understanding the cost-effectiveness of flexible sigmoidoscopy in primary care is crucial for its adoption.

Purpose of the Study:

• To analyze the cost of performing flexible sigmoidoscopy in a primary care setting.
• To compare these costs with current Medicare reimbursement rates.
• To identify factors influencing the cost-effectiveness of this CRC screening method.

Main Methods:

• Cost analysis using fixed and variable costs from published literature.
• Incorporation of opportunity cost for physician time during procedures.
• Sensitivity analyses were performed on key cost variables.

Main Results:

• The cost of flexible sigmoidoscopy without biopsy was $86.86, closely matching the Medicare reimbursement rate of $87.84.
• The cost for procedures including biopsy was $152.93, exceeding Medicare reimbursement.
• Procedure cost sensitivity was highest for equipment, time, volume, malpractice, and hourly revenue.

Conclusions:

• Medicare reimbursement for screening flexible sigmoidoscopy without biopsy appears adequate for primary care practices.
• Reimbursement rates for flexible sigmoidoscopy with biopsy are insufficient, potentially hindering its implementation.
• Financial considerations related to reimbursement significantly impact the feasibility of offering flexible sigmoidoscopy in primary care.