The time and financial impact of training fellows in endoscopy. CORI Research Project. Clinical Outcomes Research Initiative.
OBJECTIVE
To use a national endoscopy database (Clinical Outcomes Research Initiative, CORI) to determine 1) if fellow involvement increases procedure time; and 2) the financial impact of fellow participation for academic centers compared to private practice.


METHODS
CORI database from 4/1/97 to 4/1/99 was used to compare endoscopists from private practices, academic medical centers, and Veterans Administration hospitals, with or without fellows-in-training. Data were captured in a computer-generated endoscopy report and transmitted to a central database for analysis. Duration of procedure (minutes) was recorded for diagnostic esophagogastroduodenoscopy (EGD), EGD with biopsy, diagnostic colonoscopy, and colonoscopy with biopsy, in ASA 1 patients. Financial outcomes used 1999 Medicare reimbursement rates for respective procedures and were calculated as procedures per hour on a theoretical practice of 4000 procedures.


RESULTS
Teaching fellows endoscopy added 2-5 min for EGD, with or without biopsy, and 3-16 min for colonoscopy, with or without biopsy. Calculating the number of procedures/h of endoscopy, the reimbursement loss resulting from using fellows-in-training in a university setting would be half a procedure/h. In Veterans Administration hospitals, training of fellows would lose a full procedure/h. In a model of 1000 procedures each of EGD, EGD with biopsy, colonoscopy, and colonoscopy with biopsy, the reimbursement difference between private practice physicians or academic attending physicians and procedures involving fellows-in-training would be $500,000 to $1,000,000/yr.


CONCLUSIONS
Fellow involvement prolonged procedure time by 10-37%. Thus, per-hour reimbursement is reduced at teaching institutions, causing financial strain related to these time commitments.
McCashland
T
T
Department of Medicine, University of Nebraska Medical Center, Omaha, USA.
Brand
R
R
Lyden
E
E
de Garmo
P
P
D000046:Academic Medical Centers / Q000191:economics; D003113:Colonoscopy / Q000191:economics; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D004502:Education, Medical, Continuing; D016145:Endoscopy, Digestive System / Q000191:economics; D005257:Fellowships and Scholarships; D006801:Humans; D007318:Inservice Training; D007349:Insurance, Health, Reimbursement; D011331:Private Practice / Q000191:economics; D013997:Time Factors