Bundling in medicare patients undergoing bidirectional endoscopy: how often does it happen?

Area of Science:

• Gastroenterology
• Health Services Research

Background:

• Bundling colonoscopy and esophagogastroduodenoscopy (EGD) is convenient, efficient, and cost-saving.
• Medicare reimbursement rates may disincentivize same-day bundling of these procedures.
• Practice patterns for bundled endoscopic procedures are not well understood at a national level.

Purpose of the Study:

• To investigate the practice patterns of same-day bundling for colonoscopy and EGD in a US Medicare population.
• To identify factors influencing the bundling of these endoscopic procedures.

Main Methods:

• Analysis of Medicare claims data (2007-2009) from fee-for-service beneficiaries aged 66+.
• Identification of patients undergoing both colonoscopy and EGD within 180 days.
• Calculation of bundling proportions (same-day, 1-30 days, 31-180 days) and comparison of patient demographics and indications.

Main Results:

• 12,982 Medicare beneficiaries had both procedures within 180 days.
• Approximately 35% of procedures were not bundled on the same day.
• Geographic variations in bundling were observed, with lower rates in the Northeast and higher rates in the West. Bundled procedures were more common for gastrointestinal bleeding indications.

Conclusions:

• Same-day bundling of colonoscopy and EGD, despite its advantages, is not practiced in over one-third of cases among Medicare beneficiaries.
• Further research may be needed to understand and address barriers to same-day bundling.