61.20 Cost Efficiency of a Comprehensive ASC Evaluation for Patients with GERD in a Rural Surgical Clinic.

Posted on January 31, 2019

A. Miller1,2, M. Bempah1, S. Clarke1, C. Cruz Pico1,2, A. Postoev1,2, C. Ibikunle1,2  1Medical College Of Georgia,Surgery,Augusta, GA, USA 2Augusa State University,Surgery,Augusta, GA, USA

Introduction:
An estimated prevalence of GERD is 59% in the US, with more than 7,067,209 annual visits and more than $10 billion of annual treatment cost. GERD has multifactorial pathophysiology requiring several diagnostic procedures as esophagogastroduodenal endoscopy (EGD), Ph probe, Manometry, and Biopsy for correct diagnostics and prevention of Barrett's esophagus and cancer. Objectives of the study is to examine cost efficiency of a comprehensive evaluation for the patient with GERD in one visit by an Ambulatory Surgical Center (ASC) evaluation protocol (EGD, Ph probe, Manometry, Cellvisio) at a rural ambulatory surgical center.

Methods:
We examined retrospectively AthenaHealthNet electronic medical records of patients evaluated by ASC protocol with procedure codes: “43239 EGD Transoral biopsy single/multiple”, “91010 Manometry Esophagus motility study”, “91035 Bravo Esoph/Gastroesoph reflux test”, “43252 Cellvizio w/mucous telemetry Ph electrode place/Rec/Interp” from 08/22/2017 to 08/22/2018.

Results:
We evaluated total 344 patients, with average age 51.47 (range 19-87). The most common diagnostic codes applied were: 120 (34.8%) “K219: Gastroesophageal reflux disease without esophagitis”; 65 (18.9%) “K2270: Barrett's esophagus without dysplasia”; 42 (12.2%) “K635: Polyp of colon”; 38 (11.0%) “E6601: Morbid (severe) obesity due to excess calories”; 29 (8.4 %) “K449: Diaphragmatic hernia without obstruction or gangrene”; 19 (5.5 %) “K2970: Gastritis, unspecified, without bleeding”;13 (3.8 %) “R1310: Dysphagia, unspecified”;12 (3.5 %) “R109: Unspecified abdominal pain”. Total annual cumulative billed chargers for all procedures were $ 807,784, comprising charges for EGD/Biopsy ($ 467,935), EGD Flex Biopsy ($ 126,492), Manometry Motility study ($ 126,492), Bravo Reflux test ($ 156,024). Annual billed charges for total evaluation protocol applied in one visit ranged from $ 3,927 to $ 4,763 in contrast to applied in two visits ranged from $ 6,081 to $ 7,820.   

Conclusion:
ASC evaluation protocol (EGD, Ph probe, Manometry, Cellvizio) is more cost efficient in complex evaluation of patients at one visit.