The recent New York Times article, “The $2.7 Trillion Medical Bill,” observed a more significant factor in the nation’s $2.7 trillion annual health care bill may not be the use of extraordinary services, but the high price tag of ordinary ones. The article goes on to highlight colonoscopies as a compelling case study, noting they are the most expensive screening test healthy Americans routinely undergo.
In my role as medical director of the Gastroenterology and Hepatology Unit in the Department of Medicine, I would like to make some observations about our practice at the UVM Medical Center compared to information presented in the article.
As is so often the case, looking at health care issues through a national lens doesn’t necessarily translate well to Vermont, in general, and the UVM Medical Center, in particular.
The article focuses on the private practice setting, describing the change in venue for the procedure from the physician office to newly-constructed physician-owned surgery centers to take advantage of reimbursement charges and facility fees for the procedure. at the UVM Medical Center, our gastroenterologists have performed colonoscopies in rooms equipped to support gastroenterology procedures for more than 20 years and continue to do so. This is common practice among academic medical centers.
Unlike the colonoscopy procedure described in the article, where anesthesiologists are routinely involved to administer an anesthetic agent, propofol, the UVM Medical Center gastroenterologists employ conscious sedation with Versed and Demerol in approximately 90 percent of the procedures. Anesthesiologists assist in only a small percentage of the cases where there are special circumstances.
We have recently tracked colonoscopy in patients over 75 years of age as part of our Choosing Wisely campaign and have found colonoscopy in 75-year-olds was rarely performed here. The Choosing Wisely campaign helps providers reduce unnecessary testing in specific clinical areas.
The article also presents a graphic that lists the highest amount paid for a colonoscopy in 17 metropolitan locations across the country, using data from an organization called Healthcare Blue Book. This is a consumer-focused online medical price guide that bases prices it says a consumer should pay on the typical fee providers in a specific area accept as payment from insurance companies. The payments ranged from $2,100 to $8,500. at the UVM Medical Center, our screening colonoscopy charge is $5,260. This includes the physician and facility fees. We are typically reimbursed at about 55 percent ($2,893) of that charge by insurance companies, about 21 percent ($1,105) by Medicare, and 15 percent by Medicaid ($789), the last being below our cost to provide this care.
Since 1998, the time at which screening colonoscopy became an accepted form of colon cancer screening, the incidence of colon cancer has declined. This may be due to performing colonoscopy and the removal of precancerous polyps. As well, it should be noted a recent New England Journal of Medicine article quoted in the New York Times showed a 53 percent decline in deaths from colon cancer from patients who underwent colonoscopy and removal of precancerous polyps. The omission of these benefits of colon cancer screening with colonoscopy from the New York Times article is unfortunate. As with anything, it is not appropriate to only look at “costs” on one side of the equation without looking at significant benefits on the other side of the equation.
Because of the manner in which individual hospitals set their charges for services, there is no meaningful comparison to be made in comparing charges between hospital “A” and hospital “B.”
However, you should know a patient’s ability to pay for services should not prevent that person from receiving medically emergent and necessary care, and at the UVM Medical Center, it does not.
As a non-profit, we are mission driven and responsive to community need. In 2011, our community benefits totaled $155.1 million, almost 18% of net revenues, and included $7.1 million in free care.
The UVM Medical Center’s Patient Financial Assistance Program is comprehensive. We are committed to providing financial assistance to persons who have essential health care needs and are uninsured, underinsured, ineligible for a government program or otherwise unable to pay for medically necessary care.
James Vecchio, MD, is Medical Director of Gastroenterology and Hepatology at the University of Vermont Medical Center.