Resource-intensive endoscopic procedures: do the dollars make sense?

Background

The rapid development of endoscopic technologies over the past decade has led to an increased utilization of resource-intensive endoscopic procedures in clinical practice. These procedures are technically challenging, time consuming, and typically involve major equipment-related costs.

Objective

To determine the economics associated with performing resource-intensive endoscopic procedures in a tertiary-referral center

Design

A retrospective practice database review.

Setting

A single, North American tertiary-referral medical center.

Patients

All the patients whose initial contacts with the medical center were as outpatients for an EUS, EMR, or ERCP between July and November 2004.

Main Outcome Measurements

Hospital charges, the cost of providing services, revenue, and net income from all services provided through June 2006.

Results

Seventy patients were tracked. During the review period, these 70 patients generated a total of $2.9 million, or $42,126 per patient, in hospital charges. The net profit was $407,263 ($5790 per patient). Endoscopic services alone resulted in a loss of $424 per patient. Surgical services generated just over $300,000 in net profit.

Conclusions

Economics for only resource-intensive endoscopic procedures are not financially viable under the current health care reimbursement system. The first step to removing disincentives to performing these cost-effective procedures would appear to be an insistence that reimbursement be weighted equitably to ensure reasonable profitability.