Several factors point to room for growth for gastrointestinal practices: the mandated age for colonoscopies is now 45 instead of 50, new colorectal cancer screenings are being developed and the prevalence of GI issues are on the rise.
However, concerns remain among some GI leaders about the state of the industry.
"My biggest concern is people moving away from getting colon screening due to shift in payment from certain commercial insurances and CMS. Before, if a patient was to have a colonoscopy for screening, no matter what the findings were, the cost would be [100%] covered," Raquel Hernandez, Administrator of Laredo (Texas) Digestive Health Center, told Becker's.
However, if a colonoscopy becomes diagnostic, patients can expect to pay 15% of the Medicare-approved amount for a physicians' services. In the outpatient setting, patients may also pay a 15% coinsurance amount.
"The GI industry may see a decline in colon screenings with a possible increase in colon cancer findings in the future," Ms. Hernandez said.
Additionally, the uptick in the need for GI care could be an issue for facilities struggling to keep pace with inflation, lower reimbursement rates and staffing issues.
"This could strain resources and drive up healthcare costs," said Haydee Padilla, administrator of Mountain View Surgery Center in Redlands, Calif.
Ms. Padilla also noted that GI centers are juggling advancements in technology, including AI and telemedicine, alongside the daily flow of operations.
"Balancing these evolving needs with maintaining high-quality patient care and managing costs will likely be a significant challenge," she said.