Resurgent Inflation and Its Impact on Medicare Reimbursements for Outpatient Gastroenterology Procedures

Abstract

Introduction: Rising healthcare costs have led to decreasing reimbursements for various procedures and providers. We chose to analyze Medicare reimbursement trends for 26 esophagogastroduodenoscopy (EGD) and 31 colonoscopy current procedural terminology (CPT) codes from 2018 to 2023 for hospital outpatient centers, ambulatory surgical centers and gastroenterologists. We also wanted to look at the effects of inflation on these Medicare reimbursements. Methods: We calculated the nominal percentage change from 2018 to 2023 for each CPT code. We then took inflation data provided by the U.S. Bureau of Labor Statistics and calculated the real change in reimbursements from 2018 to 2023 for each of the 31 colonoscopy and 26 EGD CPT codes. Results: Our results show that while nominal reimbursements to physicians have been steadily declining for performing gastrointestinal procedures, nominal reimbursements to hospital outpatient and ambulatory surgical centers have been increasing from 2018 to 2023. After taking into account inflation, physicians saw significant decreases in real purchasing power for performing EGD and colonoscopies. Ambulatory surgical centers and hospital outpatient centers saw reimbursements keep up with inflation. Discussion: Physician reimbursements by Medicare for gastroenterology procedures make up a small portion of the reimbursements by Medicare to facilities like ambulatory surgical centers and hospital outpatient centers. However physicians have seen significant reimbursement cuts while facilities have not. Moreover, higher inflation leads to increased expenses for gastroenterology practices. It remains to be seen how these reimbursement changes will affect patients access to care as well as physicians practice sustainability.