The Impact of the Affordable Care Act on Colonoscopy Cancellation Rates

Abstract

Introduction: Last minute colonoscopy cancellations have a negative impact on the efficiency and productivity of surgery centers. A common perception is that health insurance status has an influence on colonoscopy cancellation rates. The Affordable Care Act (ACA) has provided colonoscopy access to a broader range of the population in the USA.Did this broader access to care have an impact on the colonoscopy cancellation rates at an outpatient endoscopy center? Methods: Retrospective study from a community-based gastroenterology practice that performs colonoscopies at Sierra Endoscopy Center, an outpatient surgery center in Grass Valley, California. Electronic Medical Records were reviewed from January 2016 through December 2017. Patients were seen by a physician in a prior office visit where all colonoscopy issues were addressed. A reminder phone call was made 48 hours prior to the procedure. Cancelled colonoscopies within 24 hours of the procedure were included in this study. Data that was collected from 2009-11 (Am J Gastroenterol Supp 2012;107: S584) were compared to current data to see if there were any significant factors that influenced colonoscopy cancellation rates. Results: 421 patients from a total of 9049 (4.6%) cancelled their colonoscopies within 24 hours of their scheduled procedure time. The following tables provide details of the results: Conclusion: Colonoscopy cancellation rate of 4.6% is twice the 2% observed from our previous study (Am J Gastroenterol Supp 2012;107: S584). The major reason for cancellations were due to personal issues, an increase from 39% to 61%. The number of patients with Medicaid insurance increased from 5% to 24%, an almost 5-fold increase.Except for the type of insurance, all other demographic data remained essentially unchanged between the two time periods. CONCLUSIONS The Affordable Care Act has dramatically increased the number of patients with Medicaid which is correlated with the increased colonoscopy cancellation rates. Personal issues were the most frequent cause for last minute cancellations. Addressing these issues at the time of scheduling may reduce the colonoscopy cancellation rates. It is important to continue to provide access to colonoscopy for all patients, regardless of insurance status. Awareness of these potential factors may influence strategies on how to schedule patients to maintain a more efficient endoscopy center schedule.485_A Figure 1. Demographics485_B Figure 2. Indications and Insurance485_C Figure 3. Reasons for Cancellation