Costly pre-colonoscopy gastroenterologist visits unnecessary, Johns Hopkins internist says
Primary care doctors are generally in a good position to alert their patients that they should be screened, study says.
Nearly a third of patients who get colonoscopies to screen for cancer visit a gastroenterologist before having the procedure, at an average cost of $124, even though such visits may be unnecessary, a new study found.
Primary care doctors are generally in a good position to alert their patients that they should be screened, discuss the risks and benefits of the procedure with them and order the test, said Dr. Kevin Riggs, an internist at Johns Hopkins University School of Medicine who co-authored the study, which appeared this week in the Journal of the American Medical Association. Such "open access" programs, which allow providers and sometimes patients to schedule the screening test without first sitting down with a gastroenterologist for a consultation, are becoming routine.
The gastroenterologist's office can then contact the patient to discuss how to take the bowel preparation mix to clean out the colon before the test. The patient can simply show up for the colonoscopy on the scheduled day, without taking more time off work and saving the cost of a specialist office visit.
[Also: Medicare payment changes lead more men to get screening colonoscopies]
"These are things that streamline the care processes and lead to a better patient experience," Riggs said. "We should be thinking about ways to make the process more efficient."
Colorectal cancer screening is recommended by the U.S. Preventive Services Task Force for most people beginning at age 50. Under the health law, insurers are required to cover preventive services without charging consumers. But although the federal government has clarified that insurers can't charge people for anesthesia received during a colonoscopy, the rules don't state how insurers should handle other services, including office visits and facility fees.
The study analyzed the claims data of 843,000 patients between the ages of 50 and 64 between 2010 and 2013 who had a screening colonoscopy. They all had employer-sponsored coverage.
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Twenty-nine percent of patients visited a gastroenterologist in the six weeks prior to a screening colonoscopy, the study found. It wasn't possible to determine the precise reason for the office visits, and some may have been clinically necessary, said Riggs.
The average office visit payment was $124, including both patient and insurer portions. Across all patients, the office visits added an average $36 to the total cost of a colonoscopy.
"It's nickels and dimes, but when you add it up over 7 million colonoscopies annually, it's a pretty significant cost," said Riggs.
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