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Control of the volume of gastrointestinal endoscopy

1993; Elsevier BV; Volume: 39; Issue: 1 Linguagem: Inglês

10.1016/s0016-5107(93)70028-0

1097-6779

J H Bond,

Diverticular Disease and Complications

From the Rostrum Control of the volume of gastrointestinal endoscopyA key objective of virtually every current health care reform proposal is control of the growth of medical expenditures.Uncertainty as to how to limit growth, however, has given rise to arbitrary means of reducing the increasing use of tests and procedures that benefit patients with digestive disorders.Gastrointestinal endoscopy, for a variety of compelling, scientifically valid reasons, is in a period of sustained volume growth.Examples of these reasons include the increasing use of endoscopic techniques to effectively treat gastrointestinal bleeding, colonoscopic surveillance for persons at high risk for colorectal cancer, percutaneous endoscopic placement of feeding tubes, and diagnostic and therapeutic ERCP associated with the meteoric growth of laparoscopic cholecystectomy.These highly beneficial developments prevent lethal disease and often obviate the need for more costly and morbid surgical alternatives.However, their impact on the steady growth of endoscopic volume has been largely ignored by health reform "bean counters."Even before the implementation of the new resourcebased Medicare fee schedule, the Health Care Financing Agency (HCFA) imposed arbitrary selective reductions in physician reimbursement for esophagogastroduodenoscopy and colonoscopy because these procedures appeared on the top list of medical services according to total volume and expenditures.Then, although directed by law to be "budget neutral," the HCFA further imposed an arbitrary reduction in the conversion factor for the new fee schedule as a "behavioral offset" as the result of their cynical prediction that physicians would counter reductions in fees with medically unnecessary (and therefore unethical) increases in the volume of services prescribed for their patients.Further arbitrary reduction in Medicare fees are antici-