Kevin R. Riggs, M.D., M.P.H., of the Johns Hopkins University School of Medicine, Baltimore, and colleagues analyzed billing data to determine the proportion of colonoscopies for colon cancer screening and polyp surveillance that were preceded by office visits and the associated payments for those visits. The study appears in JAMA.
Widely accepted guidelines for colon cancer screening and polyp surveillance and the generally low risk of colonoscopy may obviate the need for many of the gastroenterology office visits before colonoscopy. Open-access endoscopy, which allows patients to be referred for endoscopies without a prior gastroenterology office visit, began in the United States in the 1990s, though recent estimates of the prevalence of the practice have been lacking. The researchers used a database that contains use and expenditure data for individuals with employer-sponsored private health insurance from several hundred U.S. employers and health plans and includes approximately 43 to 55 million beneficiaries each year from all 50 states. The authors included patients age 50 to 64 years with continuous insurance coverage for 12 months prior to an outpatient colonoscopy performed in the gastroenterology setting that included a diagnosis for screening or polyp surveillance, for 2010 through 2013.
Of 842,849 patients who underwent colonoscopy, 247,542 (29 percent) had a precolonoscopy office visit. Patients with office visits had a higher Charlson Comorbidity Index (CCI; a score based on health conditions of the patient). Of patients with office visits, 66 percent had a CCI of 0. Of the office visits, 77 percent were associated with a diagnosis of either screening or preoperative evaluation. Average payment for office visits was $124. Distributed across all patients, precolonoscopy office visits added an average of $36 per colonoscopy.
"Although the precolonoscopy office visits added a modest $36 per colonoscopy in this population, there are an estimated 7 million screening colonoscopies performed in the United States annually, so the cumulative costs are significant. Identifying which patients benefit from a precolonoscopy office visit and targeting those patients could increase the value of colon cancer screening," the authors write.