Inappropriate Medicare Incentives Lead to Unnecessary Subspecialty Procedures

doctor with endoscopeSometimes people flat out need cameras shoved down into their stomachs.  A long history of reflux disease, for example, could prompt a gastroenterologist to perform an “upper endoscopy”—to run a thin tube down the patient’s throat in order to view their esophagus and stomach and look for signs of serious illness.  Medicare has correctly decided that such upper endoscopies are valuable medical tests, and reimburse physicians relatively generously for performing them.  But what should Medicare do when gastroenterologists unnecessarily repeat these tests in patients who do not show signs of serious illness on their first exam?

I became aware of this issue after reading an article in the Annals of Internal Medicine by Pohl and colleagues.  Pohl glanced at billing data from a random sample of almost 1 million Medicare enrollees. (I am pleased with myself when I pull together a study of a few hundred patients.  Perhaps I won’t be so pleased in the future.)

Pohl and colleagues analyzed how many patients received more than one upper endoscopy within a three year period.  They then tried to figure out how often these repeat procedures were necessary, because of abnormalities discovered in the initial exam… (Read more and view comments at Forbes)

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