 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
16 March 1999 | Volume 130 Issue 6 | Pages 525-530
Screening with flexible sigmoidoscopy may reduce mortality rates from colorectal cancer. Primary care physicians are able to provide this screening procedure, but many have been reluctant to do so, partly because of the impression that reimbursement rates are inadequate to cover physician costs. This study examines the cost of performing flexible sigmoidoscopy in a primary care practice and compares this cost with the new Medicare reimbursement rate for flexible sigmoidoscopy. Fixed and variable costs associated with the performance of office-based flexible sigmoidoscopy were derived from the published literature. The principal assumption in the analyses is that the time required to perform flexible sigmoidoscopy represents an opportunity cost because the physician could use that time to see additional patients during routine office hours. Sensitivity analyses were done across a range of estimates for the cost variables. When Medicare reimbursement rates were used, the physician's total cost for flexible sigmoidoscopy without biopsy was $86.86, which is similar to the Medicare reimbursement rate for screening flexible sigmoidoscopy (code 45330, $87.84). The calculations were most sensitive to estimates of equipment cost, procedure time, number of procedures performed per year, additional malpractice coverage, and revenue generated per hour of outpatient care. The estimated cost per procedure in a screening program that includes the ability to perform biopsy is $152.93, which exceeds Medicare reimbursement rates across the range of all variables included in the sensitivity analyses. Thus, low reimbursement may limit the adoption of screening flexible sigmoidoscopy with or without biopsy in primary care practices.
Author and Article Information
From Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania, Philadelphia, Pennsylvania.
Acknowledgments: The authors thank Daniel Polsky, PhD; Sankey V. Williams, MD; and Michael L. Kochman, MD, for their thoughtful review of earlier versions of the manuscript.
Grant Support: In part by National Institutes of Health training grant 1-T32-DK07740-0 (Dr. Lewis) and an Outcomes Research Training Award from the American Digestive Health Foundation (Dr. Lewis). Dr. Asch is a Department of Veterans Affairs Health Services Research and Development Senior Research Associate.
Requests for Reprints: James D. Lewis, MD, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Eighth Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021; e-mail, jlewis{at}cceb.med.upenn.edu.
Current Author Addresses: Dr. Lewis: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Eighth Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021.
Dr. Asch: Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104-6218. MEDICINE AND PUBLIC ISSUES
Barriers to Office-Based Screening Sigmoidoscopy: Does Reimbursement Cover Costs?
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  B. Levin, D. A. Lieberman, B. McFarland, R. A. Smith, D. Brooks, K. S. Andrews, C. Dash, F. M. Giardiello, S. Glick, T. R. Levin, et al. Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology CA Cancer J Clin, May 1, 2008; 58(3): 130 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. F. Imperiale, D. R. Wagner, C. Y. Lin, G. N. Larkin, J. D. Rogge, and D. F. Ransohoff Using Risk for Advanced Proximal Colonic Neoplasia To Tailor Endoscopic Screening for Colorectal Cancer Ann Intern Med, December 16, 2003; 139(12): 959 - 965. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H. Fletcher Screening Sigmoidoscopy-- How Often and How Good? JAMA, July 2, 2003; 290(1): 106 - 108. [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Lewis, K. Ng, K. E. Hung, W. B. Bilker, J. A. Berlin, C. Brensinger, and A. K. Rustgi Detection of Proximal Adenomatous Polyps With Screening Sigmoidoscopy: A Systematic Review and Meta-analysis of Screening Colonoscopy Arch Intern Med, February 24, 2003; 163(4): 413 - 420. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. S. Frame Screening for Cancer: Progress, but More Can Be Done J Natl Cancer Inst, November 21, 2001; 93(22): 1676 - 1677. [Full Text] [PDF]
|
|
|
|
 |
|
 Practice Expense Costs in Pulmonary and Critical Care Practices . Is Providing Patient Care Still Economically Feasible? Am. J. Respir. Crit. Care Med., June 1, 2001; 163(7): 1524 - 1527. [Full Text] [PDF]
|
|
|
|
|
|
J. D. Lewis Prevention and Treatment of Colorectal Cancer: Pay Now or Pay Later Ann Intern Med, October 17, 2000; 133(8): 647 - 649. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Glick Double-Contrast Barium Enema for Colorectal Cancer Screening: A Review of the Issues and a Comparison with Other Screening Alternatives Am. J. Roentgenol., June 1, 2000; 174(6): 1529 - 1537. [Full Text]
|
|
|
|
 |
|
 J. D. Lewis, G. G. Ginsberg, T. C. Hoops, M. L. Kochman, W. B. Bilker, and B. L. Strom Flexible Sigmoidoscopy Training and Its Impact on Colorectal Cancer Screening by Primary Care Physicians Arch Fam Med, May 1, 2000; 9(5): 420 - 425. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Loeve, M. L. Brown, R. Boer, M. van Ballegooijen, G. J. van Oortmarssen, and J. D. F. Habbema Endoscopic Colorectal Cancer Screening: a Cost-Saving Analysis J Natl Cancer Inst, April 5, 2000; 92(7): 557 - 563. [Abstract] [Full Text] [PDF]
|
|
Article
