Downward Trend in Medicare Payments for GI Services
There has been a steady decline in Medicare reimbursement for common gastrointestinal (GI) services and patient office visits over the past 15 years, which could have a direct impact on patients.
“When Medicare reimbursements decrease, health outcomes, healthcare access, and patient satisfaction may be affected, particularly in light of high inflation and increased costs due to staffing shortages, increased staffing salaries, and additional equipment necessary for COVID-19 safety,” researchers write in The American Journal of Gastroenterology.
Samir Shah, MD, with Brown University Warren Albert Medical School, Providence, Rhode Island, and colleagues evaluated trends from 2007 to 2022 in Medicare reimbursement for the top 10 common GI procedures.
These procedures, which included colonoscopies, endoscopies, and gastrostomy tube placement, were identified through a joint list published by the American College of Gastroenterology, the American Society of Gastrointestinal Endoscopy, and the American Gastroenterological Association.
From 2007 to 2022, unadjusted and adjusted reimbursement for GI procedures declined by 7% and 33%, respectively, on average.
The adjusted change in physician reimbursement ranged from a decrease of roughly 29% for esophagus endoscopy to 38% for colonoscopy and biopsy, the study team found.
They also found that the decline in reimbursement of GI procedures was significantly larger after 2015 (P < .001).
From 2007 to 2014, the mean decrease in physician reimbursement for GI services was 6.7%, and the annual growth rate in reimbursement was -1.0%.
In comparison, from 2015 to 2022, the mean decrease in physician reimbursement was 28.2%, and the mean annual growth rate in reimbursement was -4.7%.
To examine trends in reimbursement for office and inpatient visits from 2007 to 2022, the researchers identified the top five current procedural terminology (CPT) codes from outpatient office and inpatient consult visits provided to Medicare Part B beneficiaries by gastroenterologists.
In contrast to the reimbursement trends for GI procedures, the unadjusted physician reimbursement for inpatient and outpatient visits showed an average increase of 32%.
However, after adjusting for inflation, physician reimbursement for patient visits showed an average decline of 4.9%.
Overall, reimbursement for outpatient visits increased by 4.3%, while reimbursement for inpatient visits decreased by 18.8%.
Shah and colleagues say their findings are important, given that Medicare patients make up a substantial and growing proportion of patients with GI problems and because fewer than 1% of gastroenterologists have opted out of Medicare.
They also note that the trends in GI reimbursement they observed mirror trends in other specialties, which have also noted a decrease in adjusted reimbursement for care.
The study had no financial support. The authors have disclosed no relevant financial relationships.
Am J Gastroenterol. Published online October 28, 2022. Abstract
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