Nursing Malpractice Newsroom

The Proportion Of These Endoscopes Procedures Performed In Physicians

We also found no evidence to suggest that the resource-based site-of-service payment differential has caused physicians to conduct a greater proportion of gastroente rological or urological endoscopic procedures in their offices for Medicare beneficiaries. Since 1996, the proportion of these endoscopic procedures performed in physicians’ offices for Medicare beneficiaries has not increased. At the same time, practice expense payments in 2002 for these office-based endoscopic procedures have increased to five times greater than payments for the procedures performed in a health care facility. However, because full implementation of the practice expense component did not occur until 2002, it is too early to tell whether that the percentage of these procedures performed in physicians’ offices will increase in the future.

If Medicare coverage for the office procedures in our study were terminated, few access problems would occur in most of the country because physicians perform the vast majority of the procedures that we studied in health care facilities. However, our analysis of CMS data demonstrated that the New York City area has a much higher rate of utilization of physicians’ offices for these procedures than the rest of the nation. As noted by state Medicare carrier directors, health care facility capacity in the New York City area might be initially inadequate because about 35 percent of the gastroenterological procedures in our study were performed in physicians’ offices in this region.

If these gastroenterological procedures could no longer be provided in offices, medical facilities in the area might not be able to absorb all the displaced patients in the short term. The effect on patient access of such a change might be mitigated somewhat over time, however, by a March 1998 New York State Department of Health rule change that is causing the numbers of ASCs in the state to increase. Relatively few of the urological procedures in our study (about 8 percent) are performed in physicians’ offices in the New York City area, so if Medicare coverage for office-based procedures was eliminated, the impact for these procedures would likely be minimal.