Resurgent Inflation and Its Impact on Medicare Reimbursements for Outpatient Gastroenterology Procedures

Rising healthcare costs have led to decreasing reimbursements for various procedures and providers. We chose to analyze Medicare reimbursement trends for 26 esophagogastroduodenoscopy (EGD) and 31 colonoscopy current procedural terminology (CPT) codes from 2018 to 2023 for hospital outpatient centers, ambulatory surgical centers (ASC), and gastroenterologists. We also wanted to look at the effects of inflation on these Medicare reimbursements.

We calculated the nominal percentage change from 2018 to 2023 for each CPT code. We then took inflation data provided by the US Bureau of Labor Statistics and calculated the real change in reimbursements from 2018 to 2023 for each of the 31 colonoscopy and 26 EGD CPT codes.

Our results show that although nominal reimbursements to physicians have been steadily declining for performing gastrointestinal procedures, nominal reimbursements to hospital outpatient and ASC have been increasing from 2018 to 2023. After taking into account inflation, physicians saw significant decreases in real purchasing power for performing EGD and colonoscopies. ASC and hospital outpatient centers saw reimbursements keep up with inflation.

Physician reimbursements for gastroenterology procedures make up a small portion of reimbursements by Medicare compared to Medicare reimbursements to facilities such as ASC and hospital outpatient centers. However, physicians have seen significant reimbursement cuts, whereas facilities have not. Moreover, higher inflation leads to increased expenses for gastroenterology practices. It remains to be seen how these reimbursement changes will affect patients access to care and physicians practice sustainability.