title: The Impact on Endoscopic Resource Utilization After a Targeted Intervention for Cost-Minimization of EGD and Colonoscopy.
abstract: OBJECTIVE
  The need to define the cost of endoscopic procedures becomes increasingly important in an era of providing low-cost, high-quality care. We examined the impact of informing endoscopists of the cost of accessories and pathology specimens as a cost-minimization strategy.
  
  
  METHODS
  We conducted a prospective observational cohort study of therapeutic outpatient esophagogastroduodenoscopy (EGD) and colonoscopy. During the pre-intervention phase (phase 1), the endoscopists were not briefed on the cost of accessories or pathology specimens obtained during the procedure. During a 3-week intervention phase and the post-intervention phase (phase 2) endoscopists were informed of the dollar value of accessories and pathology specimens after the completion of all procedures. In all cases the institutional costs (not charges) were used. The endoscopists were blinded to their observation.
  
  
  RESULTS
  A total of 969 EGD, colonoscopy, and EGD+colonoscopy performed by 6 endoscopists were reviewed, 456 procedures in phase 1 and 513 procedures in phase 2. There was no significant difference between phases 1 and 2 in total device and pathology cost in dollars (188.8±151.4 vs. 188.9±151.8, P=0.99), total device cost (36.2±107.9 vs. 39.0±95.96, P=0.67) and total pathology cost (152.6±101.3 vs. 149.9±112.5, P=0.70). There was not a significant difference in total device and pathology cost when examined by specific procedures performed, or for any of the endoscopists between phases 1 and 2.
  
  
  CONCLUSIONS
  Making endoscopists more cost conscious by informing them of the costs of each procedure during EGD and colonoscopy does not result in lower procedural costs. Analysis of cost-minimization strategies involving procedures in other health-care settings and procedures using high-cost accessories are warranted.
authors: Department of Internal Medicine, Section of Digestive Diseases, University of Oklahoma Health Sciences Center, OUHSC, Oklahoma City, Oklahoma, USA.
authors: Sindhu R
authors: SR
authors: Kaitha
authors: Department of Internal Medicine, University of Oklahoma Health Sciences Center, OUHSC, Oklahoma City, Oklahoma, USA.
authors: George
authors: G
authors: Salem
authors: Department of Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
authors: Yan D
authors: YD
authors: Zhao
authors: Department of Internal Medicine, Section of Digestive Diseases, University of Oklahoma Health Sciences Center, OUHSC, Oklahoma City, Oklahoma, USA.
authors: Mohammad F
authors: MF
authors: Madhoun
authors: Department of Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
authors: Allshine
authors: A
authors: Chen
authors: Department of Internal Medicine, Section of Digestive Diseases, University of Oklahoma Health Sciences Center, OUHSC, Oklahoma City, Oklahoma, USA.
authors: William M
authors: WM
authors: Tierney
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003113:Colonoscopy / Q000191:economics* / Q000295:instrumentation; D003107:Colorectal Surgery / Q000193:education; D017046:Cost Savings; D003365:Costs and Cost Analysis; D016145:Endoscopy, Digestive System / Q000191:economics / Q000295:instrumentation; D004864:Equipment and Supplies / Q000191:economics*; D005260:Female; D000072102:Gastroenterologists / Q000193:education*; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000601:surgery; D006295:Health Resources; D006801:Humans; D008297:Male; D008875:Middle Aged; D010338:Pathology, Clinical / Q000191:economics