In August, Illinois Gov. J.B. Pritzker signed new legislation mandating insurance coverage for all colonoscopies for patients who present symptoms of colon cancer or have a preexisting colon condition.
But how will this policy shift impact ASCs, particularly as they grapple with reimbursement challenges and increasing operational costs?
Manish Bhuva, MD, a gastroenterologist at Chicago-based GI Partners of Illinois, joined Becker’s to discuss the potential effects of the legislation.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How do you think the new colonoscopy legislation will impact patient access, particularly among uninsured populations?
Dr. Manish Bhuva: I think it will definitely help. Any law that decreases patient costs will encourage people to get screened and follow up for symptoms or any prior colon history. The law definitely reduces financial barriers, but we’ll have to see how it really affects underinsured or especially uninsured patients. With the upcoming Medicaid cuts being proposed, many of these patients may be sent to hospital outpatient departments and kept away from ASCs, since margins are already so thin with Medicaid patients.
Q: Do you think GI practices and ASCs are equipped to handle increased demand? How are you seeing the strategy shift?
MB: I think they are. There are many ASCs that aren’t completely full, for whatever reason. There’s space to do the cases. Most cases in ASC or office-based settings are healthy patients coming for screenings or with a history of colon polyps. These folks aren’t symptomatic, so scheduling them a month or two out doesn’t really affect them. Also, there are stool-based tests now — Cologuard and Guardant have lab tests — and many patients are opting for those, which could reduce some of the demand generated by the law.
Q: Is there anything you’re worried about with the new types of tests, like the rise in blood tests?
MB: Not really. When Cologuard first came out, there was concern our workload would diminish, but we found most patients and doctors still want the gold standard: colonoscopy. There’s more awareness now about false negatives and false positives. These tests have limitations. They’re better than nothing and helpful in rural settings, but colonoscopy is still the best, and patients understand that. So our workload hasn’t been significantly affected.
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