title: The Effect of Colonoscopy Reimbursement Reductions on Gastroenterologist Practice Behavior.
abstract: The purpose of this study was to assess the effect of decreased colonoscopy reimbursement on gastroenterologist practice behavior, including time to retirement and procedure volume.
  
  
  
  In 2015, the Centers for Medicare and Medicaid Services proposed reductions in colonoscopy reimbursements. With new initiatives for increased colorectal cancer screening, it is crucial to understand how reimbursement changes could affect these efforts.
  
  
  
  Randomly selected respondents from the American College of Gastroenterology membership database were surveyed on incremental changes in practice behavior if colonoscopy reimbursement were to decrease by 10, 20, 30, or 40 %. Data were analyzed using both Pearson's Chi-square and analysis of variance.
  
  
  
  Two thousand and nine gastroenterologists received the survey with a 16.3 % response rate. Procedure volume significantly decreased with degree of reimbursement reductions (p < 0.001). With a 10 % decrease, 72 % of respondents reported no change in the number of colonoscopies performed. With a 20 % decrease, 39 % would decrease their procedure volume, while 21 % of respondents would increase their procedure volume. With a 30 and 40 % decrease, procedure volume decreased by 48 and 50 %, respectively. In terms of retirement, current plans predict a cumulative retirement rate of 29.4 % at 10 years. More than 42 % of respondents plan to retire after 2030. In the 2014-2023 retirement subgroup (N = 74 responses), there was a significant hastening of retirement year at 20 % (p = 0.016), 30 % (p < 0.001), and 40 % (p < 0.001) reimbursement reductions as compared to baseline responses.
  
  
  
  Decreasing colonoscopy reimbursements may have a significant effect on the effective gastroenterology work force.
authors.affiliation: Department of Medicine, New York University School of Medicine, 550 First Avenue, 15-1539, New York, NY, 10016, USA. matthew.mcneill@nyumc.org.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: McNeill
authors.affiliation: Division of Gastroenterology, New York University School of Medicine, New York, NY, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Chang
authors.affiliation: Division of Gastroenterology, New York University School of Medicine, New York, NY, USA.
authors.forename: Farhad
authors.initials: F
authors.lastname: Sahebjam
authors.affiliation: Division of Gastroenterology, New York University School of Medicine, New York, NY, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Goodman
authors.affiliation: Division of Gastroenterology, New York University School of Medicine, New York, NY, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Gross
authors.affiliation: Division of Gastroenterology, New York University School of Medicine, New York, NY, USA.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Sigal
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000191:economics*; D003625:Data Collection; D000072102:Gastroenterologists / Q000191:economics*; D006301:Health Services Needs and Demand / Q000639:trends*; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012051:Reimbursement Mechanisms; D011795:Surveys and Questionnaires
keywords: Colonoscopy; Colorectal neoplasm; Early detection of cancer; Endoscopy; Health insurance reimbursement; Medicare