25 YEARS OF QUALITY CARE AND COST EFFICIENCY OF OFFICE GASTROENTEROLOGY PROCEDURES

Abstract

Purpose: Outpatient facility fee makes up 75% to 85% of the cost of endoscopy and colonoscopy examinations. Hospital facility fees range from $1000 to $1500 for outpatient endoscopy and $1500 to $2500 for colonoscopy. To cut health care costs and for patient convenience and preference, office endoscopy was initiated in 1979, followed by colonoscopy in 1980. Methods: Patient with significant pulmonary or cardiovascular diseases were excluded from office procedures. The patient is put on a pulse oximeter and EKG monitor. Conscious sedation is given with IV Demerol or Fentanyl and IV Versed or Valium. Nasal oxygen was available as needed. Results: 9,460 patients had endoscopy with or without esophageal dilatation; 7,155 patients had colonoscopy with or without polypectomy. Average total yearly savings per 378 patients for office endoscopy was $567,000, compared to outpatient facility fees; Average total yearly savings per 298 patients for office colonoscopy was $596,000. Total yearly savings $1,163,000.00; Overhead cost of equipment and nursing personnel was $110.00 per procedure or $74,360.00 per year. The author was rated in the top 1% for cost efficiency in gastroenterology in Virginia. Conclusions: There were 16,615 office procedures performed with no anesthesia complications, two colon perforations due to diverticula disease and electrocautery with no deaths. By avoiding outpatient facility fees, there was a savings of 29 million dollars over 25 years by insurance carriers. More third party payors should recognize these savings and encourage experienced gastroenterologists to do office procedures by paying overhead costs. Office gastroenterology procedures improve cost efficiency substantially without affecting quality care.