Resource-intensive endoscopy: revenue source or cash drain?

Area of Science:

• Gastroenterology
• Health Economics

Background:

• Resource-intensive endoscopic procedures often incur losses.
• Financial viability depends on downstream clinical care revenue.

Purpose of the Study:

• To assess the financial viability of resource-intensive endoscopy.
• To determine if downstream clinical activities generate net income.

Main Methods:

• Retrospective database review at a tertiary-referral center.
• Analysis of hospital charges, costs, revenue, and net income for EUS, EMR, and ERCP procedures performed in 2004.
• Inclusion of all services provided through June 2006.

Main Results:

• Endoscopic procedures alone resulted in income loss.
• Endoscopic ultrasound (EUS) generated mean revenue of $7093 per patient from subsequent care.
• Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic mucosal resection (EMR) incurred revenue losses from subsequent care.
• Surgery was the most lucrative downstream activity.
• Medicare patients generated less revenue than non-Medicare patients.

Conclusions:

• EUS is the most financially rewarding resource-intensive endoscopic procedure.
• Integrating EUS with surgical and oncologic services can offset procedural losses.
• Performing these procedures on Medicare patients is not financially viable due to reimbursement imbalances.
• Future Medicare payment cuts may impact the performance of these procedures.