January 23rd, 2009

Ambulatory Endoscopy Centers: No Seniors Allowed!

Ambulatory endoscopy centers (AECs) have proven so successful in providing convenient, efficient, low-cost, high-quality endoscopy services to outpatients that they are now ubiquitous around the country. Given this success, you might assume that payers would steer business their way. However, that’s not the case with the Centers for Medicare & Medicaid Services (CMS). In fact, Medicare beneficiaries are now being priced out of AECs.

CMS recently announced that it is changing reimbursements to AECs so that they receive only 59% of what hospitals receive for doing the exact same endoscopic procedures. Although the proportion paid to AECs versus hospitals has been inching downward for years now, this latest change is really the tipping point — what AECs will now receive for reimbursement ($312) is less than what it actually costs them to do the procedure (~$365). 

What does this mean for seniors who need screening colonoscopy, diagnostic colonoscopy, or upper endoscopy exams? Local, convenient, efficient, and high-quality AEC service will probably not be available to them, and they will instead be forced to have their procedure done in a hospital. Granted, they’ll still receive a high-quality exam there, but they won’t have had the same choices in their care.
This stinks. CMS is potentially making colon cancer screening a difficult decision for seniors. This abuse by our own government agencies must stop. If you agree, let your Senators and U.S. Representatives know.

And if you have ideas on how to remedy this problem, by all means, let me know!

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

M. Brian Fennerty, MD


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