Commercial Hospital Versus Ambulatory Surgery Center Facility Fees for Colonoscopy
Douglas K. Rex, MD, MASGE, reviewing Wang Y, et al. JAMA Health Forum 2023 Dec 15.
This study used new Transparency in Coverage (TIC) data to assess commercial facility fees nationwide for 3 colonoscopy Current Procedural Terminology (CPT) codes (45378, 45380, and 45385). The investigators acquired TIC data for May 2023 from Anthem, Cigna Group, Healthcare Service Corporation (HCSC), and UnitedHealthcare.
There were 13,287 colonoscopy commercial facility fees from 3582 hospitals and 17,052 facility fees from 3899 ambulatory surgery centers (ASCs) across the U.S. Anthem accounted for 22.9% of data provided on facility fees, Cigna 25.9%, HCSC 11.9%, and UnitedHealthcare 39.3%.
The hospitals’ mean facility fees for the 3 codes were $1530, $1760, and $1761, respectively. For ASCs, the fees were $989, $1034, and $1030. For the 3 CPT codes, after controlling for insurer and other variables, commercial facility fees at hospitals were 154%, 156%, and 161% higher than fees at the ASCs.
COMMENT
These updated data on differences between hospitals and ASCs in commercial fees, which are not as widely understood or recognized as the differences paid by Medicare for hospitals versus ASCs, demonstrate the incentive for moving routine endoscopic procedures to ASCs.
Douglas K. Rex, MD, MASGE
CITATION
Wang Y, Wang Y, Plummer E, Chernew ME, Anderson G, Bai G. Facility fees for colonoscopy procedures at hospitals and ambulatory surgery centers. JAMA Health Forum 2023;4:e234025. (https://doi.org/10.1001/jamahealthforum.2023.4025)
COMMENT
This study affirms important principles for FIT screening. First, cancers detected by FIT remain in an early stage during subsequent screening rounds. Further, increasing the cutoff level of hemoglobin for positive test results reduces sensitivity but does not shift the fraction of detected cancers substantially toward later-stage CRC. Thus, programs can adjust the cutoff to levels appropriate for their colonoscopy resources, and the detected cancers will be in an early stage across a range of hemoglobin thresholds for positive tests.