Resident Loma Linda University Medical Center Loma Linda, CA
Mohamed Azab, MD1, Kelli Kam, MD2, Emily Lin, MD1, Jonathan Pham3, Nathan Oh3, Andrew Wright, MD1; 1Loma Linda University Medical Center, Loma Linda, CA; 2VA Loma Linda Healthcare System, Redlands, CA; 3Loma Linda University School of Medicine, Redlands, CA
Introduction: Cold forceps polypectomy technique is frequently utilized for the removal of diminutive colon polyps. However, recent US MSTF guidelines have recommended snare technique for removal of all colon polyps. Snare removal of diminutive polyps has been associated with higher rates of complete resection as compared to forceps, which directly benefits patients. As these techniques are associated with different rates of physician reimbursement and equipment costs, we aimed to assess the financial impact on providers and facilities of adopting these new guidelines in a retrospective cohort. Methods: We performed a retrospective chart review of patients with age greater than 40 that underwent screening colonoscopy at Loma Linda University Medical Center in the fiscal year of July 2018 to June 2019. We categorized patients that underwent any polypectomy by technique into groups (A) forceps alone, (B) snare alone, and (C) both snare and forceps. We estimated the economic impact of adopting a practice of exclusive snare polypectomy technique for removal of all polyps in two ways. First, we determined the difference in actual vs. projected provider reimbursement (wRVU, estimated payment in US $ using Medicare rates) for adopting a snare only practice pattern. Second, we determined the difference in actual vs. projected disposable equipment costs for adopting a snare only practice pattern to understand the economic impact on facilities. Results: Out of 940 outpatient screening colonoscopies, polypectomy was performed in 583 procedures (PDR=62%). The mean age was 62.5 years with 45.5% of patients being women. Polypectomy technique was cold forceps alone in 180 procedures (19.1%, group A), snare alone in 281 procedures (29.9%, group B), and cold forceps + snare in 122 procedures (12.9%, Group C). By practicing snare only technique the annual estimated physician wRVU and reimbursement increased by 5.0% (3828 vs. 3646 wRVU; $223,704 vs. $213,397). Annual estimated disposable equipment cost (forceps, snare, specimen trap) increased by 8.1% with adopting snare only technique ($15,216 vs. $14,066). Discussion: Based on our retrospective cohort in an academic medical center, adopting a snare only polypectomy technique for removal of all colon polyps increased projected annual physician reimbursement by 5% while increasing disposable equipment costs by 8.1%. These findings may assist providers and institutions in projecting the economic impact of adopting the most recent polypectomy guidelines in their practice.
Disclosures: Mohamed Azab indicated no relevant financial relationships. Kelli Kam indicated no relevant financial relationships. Emily Lin indicated no relevant financial relationships. Jonathan Pham indicated no relevant financial relationships. Nathan Oh indicated no relevant financial relationships. Andrew Wright indicated no relevant financial relationships.