Top GI procedures and office/inpatient visits were identified. The Physician Fee Schedule Look-Up Tool from Centers for Medicare & Medicaid Services was queried to extract reimbursement data. Reimbursement trends were analyzed, accounting for inflation. RESULTS:GI procedures exhibited an average decrease in unadjusted and adjusted reimbursement of 7.0% and 33.0%, respectively. Reimbursement for patient visits exhibited an inflation-adjusted decrease of 4.9%.

Background Although validated patient-reported outcome (PRO) measurements can categorize patients with inflammatory bowel disease (IBD) into clinical remission or active disease, patients may have different definitions of remission. The purpose of this study was to compare patient-defined remission to remission based on PRO measures and physician global assessment (PGA) and to understand the clinical and demographic factors associated with disagreements. Methods We retrospectively analyzed 3257 de-identified surveys from 2004 IBD patients who consented to participate in the Crohn’s and Colitis Foundation’s IBD Qorus Learning Health System between September 2019 and February 2021. We used logistic regression models with generalized estimating equations to analyze the clinical and demographic factors (eg, age, disease duration, health confidence) associated with discordance between patient-defined remission (yes/no) and PRO-defined remission for ulcerative colitis (UC; PRO2: stool frequency, rectal bleeding) and Crohn’s disease (CD; PRO-3: average number of liquid stools, abdominal pain, well-being). Results Among patients with UC, overall concordance was 79% between patient self-report and PRO2-defined remission and 49% between patient self-report and PGA-defined remission. Among patients with CD, overall concordance was 69% between patient self-report and PRO3-defined remission and 54% between patient self-report and PGA-defined remission. Patients in PRO-defined remission were more likely to report active disease if they had IBD <5 years and low health confidence. Patients with PRO-defined active disease were more likely to report remission if they were not using prednisone and had high health confidence. Conclusion Discordance exists between how remission is defined by patients, PRO measures, and PGA.

Figure 1. A: Index endoscopy showing fistula in the bulb of the duodenum. B: Subsequent endoscopy with bleeding fistula. C: Fistula closure and successful hemostasis with over the scope clip. D: CT scan showing clip with close approximation to the hepatic artery infusion catheter tip.