Should we pay doctors less for colonoscopy?

Colonoscopy reimbursements highlight some of the challenges in balancing the goals of maximizing public health while carefully allocating limited resources. Colonoscopy is an important modality in screening for colorectal cancer, a common malignancy that is both preventable and treatable at an early stage. However, colonoscopy has highly variable costs within the United States, and these costs are purportedly excessive compared to those of other countries. Public concerns about the cost of colonoscopy have promulgated suggestions to reduce endoscopist reimbursement. However, relying on a strategy of just reducing professional fee payment to the performing endoscopist may be problematic. First, endoscopist reimbursement is only a small proportion of the overall cost for colonoscopy. Second, endoscopists in different practice settings may respond differentially to reimbursement reductions. Finally, the blunt tool of reducing endoscopist reimbursement for all colonoscopies may incur the unintended consequence of reducing access to high-quality colonoscopy for screening and surveillance of colorectal cancer. Alternative approaches are warranted to ensure appropriate utilization of colonoscopy for maximal societal benefit.