Krishan Patel, MD, Meeki Lad, BS, Emaad Siddiqui, MD, Sushil Ahlawat, MD; Rutgers New Jersey Medical School, Newark, NJ
Introduction: Advanced endoscopy is a valuable option for providing minimally invasive treatment and reducing morbidity and mortality for older patients with high surgical risk. We assessed trends in case volume and reimbursement for three common advanced procedures in the Medicare population. Methods: The Centers for Medicare and Medicaid Services (CMS) Medicare part B database was accessed to determine case volume and inflation adjusted reimbursement for endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), and endoscopic mucosal resection (EMR) from 2009-2018 using current procedure terminology (CPT) codes. Trends were plotted for total case volume, per-procedure reimbursement, and procedures per 100,000 Medicare enrollees. Results: There was a steady rise in total case volume for all procedure types with variable trends for each CPT code. While most performed cases for ERCP were for diagnostic, coding revision and consolidation in 2014 created a shift to primarily therapeutic procedures led by stone removal, destruction of bile duct lesion, and stent exchange/removal (Fig 1). While overall ERCP case volume increased, per procedure reimbursement decreased by 7-21% per CPT code and led to a decline in total annual reimbursement (data not shown). The majority of EUS procedures was comprised of upper diagnostic endoscopy and fine needle aspiration/biopsy (FNA/b). The utilization of these procedures rose markedly per 100,000 enrollees during the study period, particularly for upper diagnostic (29%), upper FNA/b (39%), and pseudocyst drainage (158%) (Fig 2). Finally, performance of EMR increased, driven primarily by colonic EMR, while reimbursement stayed constant (Fig 3). Discussion: These results reveal an overall growth in the performance of advanced endoscopy in the Medicare population, albeit with declining reimbursement. Given the vital role of these procedures, physicians and policy makers should be aware of these trends and determine equitable compensation in order to promote continued innovation and success for advanced endoscopy.
Figure 1. Annual trends for ERCP demonstrating showing increasing total case volume (top panel), relatively constant utilization per 100,000 enrollees (middle panel), and decreasing per procedure reimbursement (bottom panel) for individual procedure codes. Dashed line represents implementation of revised procedure codes. ERCP: Endoscopic retrograde cholangiopancreatography, SO: sphincter of Oddi.
Figure 2: Annual trends for EUS demonstrating increasing total case volume (top panel) and per 100,000 enrollee utilization (middle panel) over time, with slightly decreasing per procedure reimbursements (bottom panel). EUS: Endoscopic ultrasound, EGD: Esophagogastroduodenoscopy, FNA/b: Fine needle aspiration or biopsy
Figure 3: Annual trends for EMR demonstrating increasing total case volume (top panel), with relatively constant per 100,000 enrollee utilization (middle panel) and per procedure reimbursement (bottom panel). EMR: Endoscopic mucosal resection, EGD: Esophagogastroduodenoscopy.
Disclosures: Krishan Patel indicated no relevant financial relationships. Meeki Lad indicated no relevant financial relationships. Emaad Siddiqui indicated no relevant financial relationships. Sushil Ahlawat indicated no relevant financial relationships.