Study: Medicare Reimbursement Discourages Same-Day Bundling of Endoscopies

Why perform 2 endoscopies on the same patient within 30 days of each other instead of doing both in a single day? The answer may lie in reimbursement incentives, according to research presented at Digestive Disease Week in Chicago last month.

An analysis on 12,905 Medicare beneficiaries who underwent both a colonoscopy and diagnostic upper endoscopy procedure within about 6 months of each other showed that 37% of the procedures were not bundled on the same day, according to lead researcher Hashem B. El-Serag, MD, chief of gastroenterology and hepatology at Baylor College of Medicine in Houston, Texas.

Among unbundled procedures, 20% were performed with 30 days of each other, and 17% were performed within 31 to 180 days of each other. Nearly 30% of the unbundled procedures were performed within a span of just 4 days, reports Internal Medicine News.

"The lack of bundling was unlikely to be explained by clinical necessity," said Dr. El-Serag when presenting his research at the annual meeting. He added that, particularly in cases where the procedures were performed on separate days within a 30-day period, "you can be quite safe" in assuming that no new indication was discovered between cases.

He suggested that financial incentives were more likely at play in the unbundling of procedures in such a short amount of time, as Medicare reimbursement for bundled endoscopic procedures is less than the sum of the 2 procedures independently. For example, Medicare pays $75 for a bundled esophagogastroduodenoscopy (EGD), but $150 when the procedure is unbundled. Likewise, Medicare pays $88 for a bundled GI endoscopic biopsy, but $177 when it's unbundled.

While physicians and facilities may have a financial incentive to perform endoscopic procedures on separate days, "the financial implications to the health care system and the increased adverse events in patients are likely to be large," warned Dr. El-Serag.

Irene Tsikitas