A recent analysis indicates that Medicare reimbursements to physicians for common gastrointestinal procedures have decreased in recent years. Meanwhile, ambulatory surgical centers and hospital outpatient departments have seen their reimbursements either increase or remain stable.

These trends could intensify concerns that current federal payment policies are promoting consolidation within the healthcare industry. This also places increased financial strain on clinicians working in smaller, independent practices.

In a study published in the American Journal of Gastroenterology, dipen Patel, MD, of Northwestern Memorial Hospital, CHICAGO, and his colleagues examined Medicare reimbursement trends from 2018 to 2023 for colonoscopy and esophagogastroduodenoscopy (EGD) procedures. The study, available on PubMed, compared changes in Medicare’s compensation for physicians with changes in facility reimbursements for the same procedures. Key findings include:

Physician Fee Schedule (Adjusted for Inflation):

• Colonoscopy: Reimbursement decreased by 22.6%. Nominal (unadjusted): 6.12% decline.
• EGD: Reimbursement decreased by 22.7%. Nominal: 6.2% decline.

Ambulatory Surgical Centers (Adjusted for Inflation):

• Colonoscopy: Reimbursement saw a slight increase of 0.27%. nominal (unadjusted): 21.7% increase.
• EGD: Reimbursement increased by 6.23%. Nominal: 28.9% increase.

Hospital Outpatient Departments (Adjusted for Inflation):

• Colonoscopy: Reimbursement saw a slight decrease of 0.65%. Nominal (unadjusted): 20.6% increase.
• EGD: Reimbursement increased slightly by 0.82%. Nominal (unadjusted): 22.3% increase.

The researchers analyzed 31 current procedural terminology codes for colonoscopy and 26 for EGD procedures.

Patel, a 2019 graduate of the University of Texas Medical Branch School of Medicine, GALVESTON, Texas, stated that a primary goal of the study was to increase awareness among younger physicians who may not closely monitor Medicare policy.

“for my generation of physicians who are coming out of training, we don’t really know much about these trends,” Patel told Medscape Medical News. “We don’t really know what the policies are or how they are playing out.”

Similar patterns have been observed in other recent studies. These studies indicate that professional fees have declined while facility reimbursement either increased or declined to a lesser extent for common orthopedic procedures, such as shoulder surgeries and knee and hip arthroplasty.

The Policy implications

Patel and his coauthors emphasized Medicare’s significant impact on the U.S.healthcare system. As the largest purchaser of healthcare services, Medicare’s total annual spending exceeds $1 trillion. Commercial insurers also consider Medicare’s payment rates when determining their own reimbursement rates for services.

“For my generation of physicians who are coming out of training, we don’t really know much about these trends.” – Dipen Patel,MD

The American Medical Association (AMA) has connected cuts to the physician fee schedule with a decrease in independent practice ownership. In May, the AMA released findings from its biennial Physician Practice Benchmark Survey, available on the AMA website. The survey revealed that:

• Approximately 58% of physicians were employees in 2024, an increase from 42% in 2012, the survey’s initial year.

Efforts to Update for Inflation

Lawmakers from both parties in Congress have supported proposals to implement automatic updates to the base rate for the Medicare physician fee schedule to account for rising costs. As an example, over 170 members of the House supported a bipartisan bill in 2023 that would have established automatic annual updates to the base rate of the physician fee schedule to keep pace with inflation.

The proposed bill aimed to fully reflect the Medicare Economic Index (MEI), which measures changes in practice costs for clinicians. However, the bill was stalled when the 119th session of Congress commenced in January.

A budget package led by Republicans includes a similar, though more limited, proposal. It would increase the base rate of the Medicare physician fee schedule, but by an amount less than the anticipated increase in inflation.

The House-passed version of this bill would create an initial annual increase equal to 75% of the expected