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Showing content from https://pubmed.ncbi.nlm.nih.gov/24980877/ below:

Colorectal testing utilization and payments in a large cohort of commercially insured US adults

Observational Study

. 2014 Oct;109(10):1513-25. doi: 10.1038/ajg.2014.64. Epub 2014 Jul 1. Colorectal testing utilization and payments in a large cohort of commercially insured US adults

Affiliations

¹ 1] Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA [2] Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
² Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA.
³ Predictive Health, Paradise Valley, Arizona, USA.
⁴ 1] Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA [2] National Bureau of Economic Research, Cambridge, Massachusetts, USA.

PMID: 24980877
DOI: 10.1038/ajg.2014.64

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Observational Study

Colorectal testing utilization and payments in a large cohort of commercially insured US adults

Uri Ladabaum et al. Am J Gastroenterol. 2014 Oct.

. 2014 Oct;109(10):1513-25. doi: 10.1038/ajg.2014.64. Epub 2014 Jul 1. Affiliations

¹ 1] Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA [2] Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
² Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA.
³ Predictive Health, Paradise Valley, Arizona, USA.
⁴ 1] Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA [2] National Bureau of Economic Research, Cambridge, Massachusetts, USA.

PMID: 24980877
DOI: 10.1038/ajg.2014.64

Item in Clipboard

Abstract

Objectives: Screening decreases colorectal cancer (CRC) mortality. The national press has scrutinized colonoscopy charges. Little systematic evidence exists on colorectal testing and payments among commercially insured persons. Our aim was to characterize outpatient colorectal testing utilization and payments among commercially insured US adults.

Methods: We conducted an observational cohort study of outpatient colorectal test utilization rates, indications, and payments among 21 million 18-64-year-old employees and dependants with noncapitated group health insurance provided by 160 self-insured employers in the 2009 Truven MarketScan Databases.

Results: Colonoscopy was the predominant colorectal test. Among 50-64-year olds, 12% underwent colonoscopy in 1 year. Most fecal tests and colonoscopies were associated with screening/surveillance indications. Testing rates were higher in women, and increased with age. Mean payments for fecal occult blood and immunochemical tests were $5 and $21, respectively. Colonoscopy payments varied between and within sites of service. Mean payments for diagnostic colonoscopy in an office, outpatient hospital facility, and ambulatory surgical center were $586 (s.d. $259), $1,400 (s.d. $681), and $1,074 (s.d. $549), respectively. Anesthesia and pathology services accompanied 35 and 52% of colonoscopies, with mean payments of $494 (s.d. $354) and $272 (s.d. $284), respectively. Mean payments for the most prevalent colonoscopy codes were 1.4- to 1.9-fold the average Medicare payments.

Conclusions: Most outpatient colorectal testing among commercially insured adults was associated with screening or surveillance. Payments varied widely across sites of service, and payments for anesthesia and pathology services contributed substantially to total payments. Cost-effectiveness analyses of CRC screening have relied on Medicare payments as proxies for costs, but cost-effectiveness may differ when analyzed from the perspectives of Medicare or commercial insurers.

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