title: The economic impact of incorporating flexible endoscopy into a community general surgery practice.
abstract: BACKGROUND
  Flexible endoscopy is a vital component of gastrointestinal surgery. It has and will replace many of the surgical procedures now commonly performed. Flexible endoscopy, unfortunately, is not an integral part of surgical residency training based on resident operative experience as reported by the Residency Review Committee. Moreover, general surgeons have deferred the practice of flexible endoscopy to the gastroenterologists because of concerns over turf battles and referral patterns. The purpose of this study was to assess the overall case load and the economic impact of flexible endoscopy on the practice of general surgery in a community hospital setting.
  
  
  METHODS
  This retrospective review was performed over a 6-month period. The total cases and the total billings of inpatient and outpatient procedures for a group practice of five general surgeons in a community hospital were evaluated. The billings were the actual charges based on current procedural terminology (CPT) codes for these procedures using the Medicare fee schedule.
  
  
  RESULTS
  Of the 2,159 procedures performed, 1,154 involved flexible endoscopy cases accounting for 54% of all cases (1,154 of 2,159) performed from February 1, 2003 to July 31, 2003. Flexible endocopy accounted for 43% of the total charges. A. total of 46 surgical procedures and 216 future endoscopies were generated from the flexible endoscopic procedures. Future endoscopic cases were for surveillance of colonic neoplasia and Barrett's esophagus.
  
  
  CONCLUSIONS
  Flexible endoscopy contributed to a major portion of the caseload and revenue generated by the general surgery group studied. The overall impact of flexible endoscopy is even greater than reported because of the future endoscopic surveillance cases or surgical interventions generated on the basis of endoscopic findings.
authors.affiliation: Department of Surgery, Huron Hospital, Cleveland Clinic Health System and Case Western Reserve University, Cleveland, Ohio 44124, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Nimeri
authors.forename: S A
authors.initials: SA
authors.lastname: Hussein
authors.forename: E
authors.initials: E
authors.lastname: Panzeter
authors.forename: J
authors.initials: J
authors.lastname: McNeill
authors.forename: J
authors.initials: J
authors.lastname: Gusz
authors.forename: P M
authors.initials: PM
authors.lastname: Chen
authors.forename: J N
authors.initials: JN
authors.lastname: Yuh
authors.forename: J M
authors.initials: JM
authors.lastname: Marks
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000191:economics; D013505:Digestive System Surgical Procedures / Q000191:economics; D004180:Direct Service Costs; D016145:Endoscopy, Digestive System / Q000191:economics*; D005249:Fees and Charges; D013502:General Surgery / Q000191:economics*; D006123:Group Practice / Q000191:economics; D017721:Hospital Costs; D006764:Hospitals, Community / Q000191:economics*; D006801:Humans; D007297:Inpatients; D006278:Medicare / Q000191:economics; D011364:Professional Practice / Q000191:economics*; D012189:Retrospective Studies