The demand for colonoscopies is rising, alongisde the consistent migration of GI procedures to the outpatient setting. Here’s 10 things to know about ASCs and colonoscopies:
1. Lower recommended age for colonoscopies has increased demand. In 2023, CMS expanded its coverage to meet the updated recommendation that people at average risk for colorectal cancer get their first colonoscopy at age 45, as opposed to 50 previously. This has led to an increased demand for colonoscopies, and an increased pressure on ASCs to meet that demand.
2. An increase in colorectal cancer in younger populations is also driving demand. Colon cancer diagnoses among people younger than 55 increased from 11% in 1995 to 20% in 2019, according to a report from the American Cancer Society. Additionally, colon and rectal cancer rates are expected to grow 8% among men and 7% among women in 2024.
“Now, to see someone in their 20s and 30s [being diagnosed with cancer], it doesn’t wow us anymore,” Nancy You, MD, a professor of colon and rectal surgery at the University of Texas MD Anderson Cancer Center in Houston, told Becker’s. “Even when I was a fellow in 2008 at Mayo Clinic, we were already seeing young patients with colorectal cancer, and even then we were writing about the increased rates.”
3. Many outpatient procedures are migrating to ASCs. But some believe colonoscopies should be moved to the outpatient setting entirely. The cost of a diagnostic colonoscopy at ASCs increased by 10% between 2017 and 2022, compared to 17% at HOPDs, according to the Blue Health analysis. Colonoscopy screenings cost 32% more in HOPDs than at ASCs and double than when performed in a physician’s office. Diagnostic colonoscopies cost 58% more in an HOPD than in an ASC.
“I’m a gastroenterologist, so I speak from my field, but I think that screening a colonoscopy in a healthy patient in an inpatient hospital setting should be malpractice,” Shakeel Ahmed, MD, gastroenterologist and CEO of Atlas Surgical Group in St. Louis told Beckers. “Over time this will become mainstream. People will realize what a huge expenditure we’re wasting by keeping simpler electives — and I’m not talking about necessary procedures – but I’m talking about colonoscopies and other minor surgeries on healthy patients. These need to 100% move to the outpatient setting.”
4. Lower reimbursement rates from payers make it challenging for ASCs to meet demand. Lower reimbursement rates have been a problem in gastroenterology for years, but this disparity has hit harder with increased demand for colonoscopies. From 2007 to 2022, unadjusted and adjusted average reimbursement for GI procedures dropped by 7% and 33%, respectively, according to a study published in the American Journal of Gastroenterology.
5. Prior authorization also puts a squeeze on ASCs working with high demand for colonoscopies. In a recent AMA survey, Around 88% of physicians reported that prior authorizations put a high or extremely high burden on their practice. “The most challenging payer trends affecting ASCs right now are the policies that require prior authorization or advanced notification for colonoscopies and other relatively routine endoscopic procedures,” Eugenio Hernandez, MD, senior vice president of clinical affairs for Miami-based Gastro Health, told Becker’s. “While these policies place an additional administrative burden on ASCs, the bigger issue is that they could potentially harm patients because of limited, delayed or denied care.”
6. Inflation continues to complicate the financial picture. Reimbursement rates aren’t meeting the cost of doing business for many ASCs and gastroenterology practices who are also fighting the impact of inflation on labor and supply costs, stretching ASCs bandwidth even thinner.
7. While the rise in demand is still overall good for business, labor shortages persist in gastroenterology. The U.S. is expected to see a shortage of 1,630 gastroenterologists in 2025, making it more difficult for patients to get in for these procedures. While new alternatives to in-office colonoscopies, like GI cancer blood tests, are being developed, the American Gastroenterological Association has warned that these tests are not yet ready to fully substitute a colonoscopy.
8. AI could provide some relief. Efficiency could prove to be key in the success of ASCs amidst the surge in colonoscopy demand. For some, the ability of AI and other advanced imaging technologies to more accurately detect polyps and adenomas is a powerful tool in that success –– for both ASCs and their patients.
“Every provider and endoscopy suite needs to become as time efficient as possible. Each site of service needs to optimize wheels in/wheels out time and room turnover time, while maintaining best-in-class polyp detection rates and patient safety,” George Dickstein, MD, vice president of clinical affairs of Gastro Health Massachusetts told Becker’s. Endoscopy suites need to invest in technologies and endoscopy platforms that optimize physician workload. Fifteen cases a day should be manageable in an 8-hour day everywhere, whether a site is offering moderate sedation or deep sedation.
9. Other new technology advancements, like Cologuard and blood tests, could also ease demand. While none of these technologies are a replacement for colonoscopies entirely, they can act as effective screenings in determining patients who may need a diagnostic colonoscopy. Cologuard is also noninvasive and can be performed at home, further lifting the burden on the outpatient setting.
10. Gastroenterology is driving the growth of ASC chains. Dallas-based USPI, the largest ASC chain in the U.S owned by healthcare giant Tenet, saw significant growth in their gastroenterology care in 2023. In the second quarter of 2023, USPI same-facility cases grew 6.6% and net revenue per case improved nearly 3%. As of November 2023, USPI added 12 ASCs to its portfolio, three of which were single specialty GI centers.
