Gastroenterology

The researchers at Johns Hopkins Medicine shows similar benefits from “bundling” upper and lower gastrointestinal endoscopies on the same day to remedy what they say is the “disturbingly” large number of older Americans currently being schedule for the procedures on two different days.

Measure quality health care

The research is describe in a study in the journal JAMA Internal Medicine. “Studies of medical procedures look mostly at complication rates to measure quality health care ; but they also measure the appropriateness of that care whether the procedure is overuse or altogether unnecessary;” says Martin A. Makary, M.D., M.P.H., senior author of the study; professor of surgery at the Johns Hopkins University School of Medicine and an authority on health care quality.

He also serves as principal investigator of Improving Wisely; therefore a national project to lower medical costs in the United States by implementing measures of appropriateness in health care. “Measuring appropriateness is one of the three underappreciate means of fixing health care; along with addressing pricing failures and improving care coordination;” he adds.

Lower medical costs

Endoscopy is a procedure in which the gastrointestinal (GI) tract is view through a fiber-optic camera know as an endoscope; insert either through the mouth (upper) to scan the esophagus; stomach and small intestines; or through the anus (lower) to examine the large intestine; colon and rectum.

Where safe and appropriate; it has been shown that same-day scheduling of elective upper and lower endoscopic procedures can help reduce health care costs and avoid potential harm from repeated sedation and blood-drawing. However; the Hopkins Medicine research showed that some physicians routinely split the one-day procedure into two; a pattern that was more common when they have a stake in the endoscopy facility.

The second booking of an endoscopy suite results in higher costs from additional physician and facilities fees. Despite the recognized advantages of same-day scheduling, the Johns Hopkins researchers identified patterns of different-day overuse. This was least common in hospital outpatient departments (HOPDs) while more often seen in ambulatory surgery centers (ASCs, which are free-standing centers focused on providing same-day surgical care) and physician offices.

Ambulatory surgery centers

In a bid to document the scope of the problem, the researchers used Medicare claims data to identify slightly more than 4 million paired procedures (upper and lower endoscopies done on different days for the same patient) performed within 90 days of each other from 2011 to 2018. Of the total different-day endoscopies performed, 52.5% (approximately 2.1 million) were done in hospitals; 43.3% (approximately 1.7 million) in surgery centers and 4.2% (approximately 167,000) in physician offices.
Physicians at HOPDs conducted the lowest overall % of different-day procedures at 13.6%, while those at ASCs and offices did significantly more at 22.2% and 47.7%t, respectively. Therefore, compared to physicians at HOPDs, those at ASCs were 1.6 times more likely to schedule different-day procedures and those at physician offices were 3.5 times more likely.