In the Journals

Gastroenterologist office visits prior to screening colonoscopy may lead to unnecessary costs

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February 2, 2016

Precolonoscopy office visits to a gastroenterologist may increase unnecessary costs associated with the procedure, according to an analysis of billing data.

The high costs associated with colonoscopy in the U.S. have been criticized, according to study background. However, the impact of gastroenterology office visits prior to screening has not been adequately studied.

Kevin R. Riggs, MD, MPH

Kevin R. Riggs, MD, MPH

“Widely accepted guidelines for colon cancer screening and polyp surveillance and the generally low risk of colonoscopy may obviate the need for many of these visits,” Kevin R. Riggs, MD, MPH, instructor in medicine at Johns Hopkins University in Baltimore, and colleagues wrote. “Open-access endoscopy, which allows patients to be referred for endoscopies without a prior gastroenterology office visit, began in the United States in the 1990s, though recent estimates of the prevalence of the practice are lacking.”

Riggs and colleagues used the MarketScan Commercial Claims and Encounters database — which contains use and expenditure data for individuals with employer-sponsored private health insurance — to analyze billing data to determine the proportion of colonoscopies for colon cancer screening and polyp surveillance that were preceded by office visits and the associated payments for those visits.

The analysis included data from 842,849 individuals aged 50 to 64 years who underwent a colonoscopy between 2010 and 2013.

Overall, 29.4% (95% CI, 29.3-29.5) of the cohort had a precolonoscopy office visit.

Patients who had a precolonoscopy office visit had a higher Charlson Comorbidity Index (CCI; CCI of 1, 21.1% vs. 17.8%; CCI of ≥ 2, 12.5% vs. 9.8) and were more likely to reside in the South (50.5% vs. 31.4%) than patients who did not have a prior office visit.

Of precolonoscopy office visits, 77.4% were associated with a diagnosis of screening or preoperative evaluation.

The mean cost of these office visits were $123.83. When distributed across all patients, a precolonoscopy office visit added a mean cost of $36.37 per office visit.

The researchers acknowledged limitations of the analysis, including that they were unable to determine the reason for each of these office visits or if they were necessary or appropriate. The researchers also were unable to determine if these office visits prevented any unnecessary colonoscopies or improved the clinical value or safety of a colonoscopy that was performed. Additionally, no patients aged older than 64 years were included, so these results may not be generalizable outside of the population studied.

“Although the precolonoscopy office visits added a modest $36 per colonoscopy in this population, there are an estimated 7 million screening colonoscopies performed in the U.S. annually,” Riggs and colleagues wrote. “So the cumulative costs are significant.”

The researchers concluded that identifying patients who can benefit from a precolonoscopy office visit and targeting them could increase the overall value of colon cancer screening. – by Anthony SanFilippo

Disclosure: Riggs reports no relevant financial disclosures. One other researcher reports stock ownership in the Advisory Board Company.

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