-

June 9th, 2009

Can We Justify Performing Upper and Lower Endoscopies on Consecutive Days?

I recently saw a patient who was referred after upper and lower endoscopies had not revealed the cause of his abdominal discomfort. What struck me was that the patient had these two exams on consecutive days. That meant two days lost from work, two days with altered diet, two trips to the endoscopy center, two days with a driver commitment, two anesthetic administrations, etc. I am not naïve to the fact that most insurers discount heavily for endoscopy procedures performed on the same day. But how do we justify the additional risk, costs, inconvenience, and impact on a patient’s quality of life by not performing needed procedures at the same time?

Perhaps I am missing something here, so I would really like to better understand the rationale for this practice. Please weigh in on the practice of same-day versus consecutive-day endoscopies.

10 Responses to “Can We Justify Performing Upper and Lower Endoscopies on Consecutive Days?”

  1. luc terriere says:

    on of the(scarse )reasons could be that you hope to find the diagnose with one exam in casu the upper endo. while the pt has not eaten but is not prepared for a colo

  2. Tom says:

    It is primarily due to insurance. I would like to do them both the same day in many patients, BUT I don’t get and and the hospital doesn’t get paid. Simple economic.

  3. Nancy Merbitz, Ph.D. says:

    Come on, guys – that’s pitiful!

  4. Gary says:

    In addition to possible insurance payment reasons and from a layman patient’s perspective, is it possible that performing both tests on the same day is more physically stressful and risky to the patient’s general health and wellbeing??

  5. richard kradel says:

    There is NO REASON to do EGD and COLONOSCOPY on separate procedure days if both are indicated. To justify it by blaming the payment mechanism totally misses the issue of competent professional patient service. Victimize the payor (by not working for them)-not the patients.

  6. richard kradel says:

    Penalize payors (don’t work for them)-not patients.

  7. Quinn Minar says:

    Bless you for discussing with me. Your post are really helping me to inquire about the reality about insurance quotes. I have got to stick to this website. Thanks and well done again.

  8. Honestly speaking, I find it absolutely unethical to perform Upper and Lower Endoscopies on consecutive days rather than the same time. You are not entitled to put the patient at avoidable risk just for the sake of insurance benefit. Can we ?

  9. FreakonomicsMedicine says:

    If (patient AND insurer) have established the routine: not to pay for the second scope and expect it to be done on the basis that it is the right thing to do for the GI doctor, then why pay for the first endoscopy as well:

    Once it has been established that the doctor need not get paid and no rational reasoning is involved, then why bother paying at all?

    Is the effort and risk associated with the second scope reduced, if they are done the same day?

    Is the payment to the doctor a mere inconvenience that we are slowly getting away from!?

    If it is clearly to the benefit of the patient to have them done the same day, then logically should that not be paid MORE, rather than less, to the endoscopist?

    Generally, more sedation may be required in one sitting and particularly with sleep apnea patients it is a higher risk. Should the endoscopist not be compensated for handling that?

    It is easy to say that don’t work for them(insurance companies): these rules are universal and include Medicare. Only time this would not happen if the patient is paying directly, and in that case, I give a discount for each of services and more so if there is hardship.

    We already provide uncompensated care all the time. If a referring physician asks for a patient to be seen, regardless of the patient’s ability to pay, I and most of the doctors provide the care and accept the fact that the self pay patient would feel no compulsion to pay specially if they got better in one episode of care that they do not have to come back.

    If the patient buys 2 packs of cigarettes, is the second pack discounted because of same date of service?

    I encourage people to read Freakonomics and SuperFreakonomics. Where we put incentives is what shapes the events.

  10. Cathy Lloyd says:

    FreakonomicsMedicine is confused. The insurers do pay for the second procedure, only at a 50% rate. The time to perform and EGD (usually 5 min or less) takes much less physician time when bundled (no pre-op, IV consent, time out, anesthesia induction, etc. Even if it is down to average of $100 for the 5 min test- that is $1200/hr. Even the lawyers who will come after us for the abuse of the patients by unbundling make less!! Also, according to the Joan Rivers case, one in 10,000 die from complications of the anesthesia. So many will be seeing lawyers, especially if the patient dies during the second procedure. More that 60% of deaths from endoscopy are anesthesia related. We as physicians need to do the right thing and not expose patients to dangers of anesthesia twice just to make a few bucks.

Leave a Reply

Note: This is a moderated forum. By clicking on the "Submit Comment" button below, you agree to abide by the NEJM Journal Watch Terms of Use.

Our physician bloggers cannot respond to requests for personal medical advice, and recommend patients discuss health issues with their individual physicians.

Gastroenterology Research: Author M. Brian Fennerty, M.D.

M. Brian Fennerty, MD

Editor-in-Chief

NEJM Journal Watch Gastroenterology

Biography | Disclosures | Summaries

Learn more about Gut Check on Gastroenterology.