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May 24, 2014 | By\u00a0Jane Antonio<\/a><\/div>\n<\/div>\n
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Research study results\u00a0raise the question of whether some gastroenterologists do upper endoscopies to make money servicing Medicare beneficiaries who show no signs of illness on their first exam,\u00a0Forbes\u00a0<\/em>reported. Often performed as an outpatient procedure, an upper endoscopy involves running a thin scope with a light and camera at its tip down the throat to check\u00a0inside\u00a0the upper digestive system for signs of serious illness. A study in the\u00a0Annals of Internal Medicine<\/em>\u00a0analyzed data on almost 1 million randomly selected beneficiaries who had upper endoscopies between 2004 and 2006. Fifty-four percent of those who underwent the tests shouldn’t have had them, the study found. With the average cost of the procedure estimated at $3,000, the projected Medicare overpayment is $1.2 billion for 4 million unnecessary\u00a0services performed nationwide during a three-year period,\u00a0Forbes\u00a0<\/em>estimated.<\/div>\n
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http:\/\/www.forbes.com\/sites\/peterubel\/2014\/05\/22\/are-gastroenterologists-scoping-for-dollars-on-medicare-patients\/<\/p>\n
![\"Peter](\"http:\/\/0.gravatar.com\/avatar\/239b4d0d3cdd843692c6608f11de1fad?s=136&d=http%3A%2F%2F0.gravatar.com%2Favatar%2Fad516503a11cd5ca435acc9bb6523536%3Fs%3D136&r=G\")
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Sometimes people flat out need cameras shoved down into their stomachs.\u00a0 A long history of reflux disease, for example, could prompt a gastroenterologist to perform an \u201cupper endoscopy\u201d\u2014to run a thin tube down the patient\u2019s throat in order to view their esophagus and stomach and look for signs of serious illness.\u00a0 Medicare has correctly decided that such upper endoscopies are valuable medical tests, and reimburse physicians relatively generously for performing them.\u00a0 But what should Medicare do when gastroenterologists unnecessarily repeat these tests in patients who do not show signs of serious illness on their first exam?<\/p>\n
I became aware of this issue after reading\u00a0an article<\/a>\u00a0in the\u00a0Annals of Internal Medicine<\/i>\u00a0by Pohl and colleagues.\u00a0 Pohl glanced at billing data from a random sample of almost 1 million Medicare enrollees. (I am pleased with myself when I pull together a study of a few hundred patients.\u00a0 Perhaps I won\u2019t be so pleased in the future.)<\/p>\n![\"repeat](\"http:\/\/blogs-images.forbes.com\/peterubel\/files\/2014\/05\/upper-endoscopy.png\")
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Pohl and colleagues analyzed how many patients received more than one upper endoscopy within a three year period.\u00a0 They then tried to figure out how often these repeat procedures were necessary, because of abnormalities discovered in the initial exam.<\/p>\n
Let\u2019s start with the bad news.\u00a0 Among those patients who should have received repeat tests, only half did so.\u00a0 That means even when doctors found bad things that needed to be followed up, it was practically a flip of a coin whether they would do so.<\/p>\n
Now for the worse news.\u00a0 Among those who should not have received a follow-up test, a full 30% did, for a total of 20,000 such tests in this population.\u00a0 Here is a picture summarizing the results:<\/p>\n
Here is another way to look at these results.\u00a0 Among patients receiving upper endoscopies, the majority \u201354%\u2014should\u00a0not<\/i>\u00a0have received these tests.<\/p>\n
Now for some back-of-the-envelope math.\u00a0 The sample of patients Pohl and colleagues looked at made up 5% of the Medicare population.\u00a0 That means if you take their estimates of how many gastroenterologists performed unnecessary upper endoscopies over the three year period of their study, and multiply that estimate by 20, you end up with 4 million unnecessary endoscopies nationwide.\u00a0 With the average costs of such a procedure being around $3,000, that amounts to $1.2 billion of our tax dollars wasted on an unnecessary and, I should mention, uncomfortable and potentially harmful procedure.\u00a0 (Warning: I don\u2019t know what Medicare pays for this test.\u00a0 But we are still talking hundreds of millions of dollars, in a best case scenario.)<\/p>\n
In\u00a0an editorial<\/a>\u00a0accompanying the\u00a0Annals<\/i>\u00a0study, a gastroenterologist bemoaned these unnecessary procedures and recommended several steps we could take to reduce such testing.\u00a0 First, the editorialist said we should help physicians better understand when they should and should not use such procedures.\u00a0 Second, he said we \u201cmust also educate patients about the modest yield\u201d of such tests.<\/p>\n
I find this last idea\u2026what\u2019s a nice way to put this\u2026highly na\u00efve.\u00a0 (Haive?)<\/p>\n
What we need to do is to stop paying doctors for unnecessary tests.\u00a0 Or alternatively, we need to pay doctors in ways that reduce their incentive to perform unnecessary tests, like lump sums to take care of all of their patients\u2019 needs.<\/p>\n
While some gastroenterologists may be cynically scoping patients for dollars\u2014performing questionable tests because it pays for their kid\u2019s private school tuition\u2014I expect most believe such testing is in their patient\u2019s best interests. \u00a0We need an incentive system that forces them to think more carefully about when\u2014or whether\u2014these expensive tests are necessary.<\/a><\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
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Upper endoscopies may bilk Medicare May 24, 2014 | By\u00a0Jane Antonio Research study results\u00a0raise the question of whether some gastroenterologists do upper endoscopies to make money servicing Medicare beneficiaries who show no signs of illness on their first exam,\u00a0Forbes\u00a0reported. Often performed as an outpatient procedure, an upper endoscopy involves running a thin scope with … Continue reading Endoscopic overservicing<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[26,33,9,22,6],"tags":[],"class_list":["post-2058","post","type-post","status-publish","format-standard","hentry","category-facts-data-points","category-health-market-quality","category-healthcare","category-policy","category-politics"],"_links":{"self":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/2058","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2058"}],"version-history":[{"count":3,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/2058\/revisions"}],"predecessor-version":[{"id":2061,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/2058\/revisions\/2061"}],"wp:attachment":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2058"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2058"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2058"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}