The time and financial impact of training fellows in endoscopy

Timothy M McCashland, Randall Brand, Elizabeth Lyden, Pat De Garmo

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

OBJECTIVE: To use a national endoscopy database (Clinical Outcomes Research Initiative, CORD to determine 1) if fellow involvement increases procedure time; and 2) the financial impact of fellow participation for academic centers compared to private practice. METHODS: CORI database from 4/1/97 to 4/1/99 was used to compare endoscopists from private practices, academic medical centers, and Veterans Administration hospitals, with or without fellows-in-training. Data were captured in a computer-generated endoscopy report and transmitted to a central database for analysis. Duration of procedure (minutes) was recorded for diagnostic esophagogastroduodenoscopy (EGD), EGD with biopsy, diagnostic colonoscopy, and colonoscopy with biopsy, in ASA 1 patients. Financial outcomes used 1999 Medicare reimbursement rates for respective procedures and were calculated as procedures per hour on a theoretical practice of 4000 procedures. RESULTS: Teaching fellows endoscopy added 2-5 min for EGD, with or without biopsy, and 3-16 min for colonoscopy, with or without biopsy. Calculating the number of procedures/h of endoscopy, the reimbursement loss resulting from using fellows-in-training in a university setting would be half a procedure/h. In Veterans Administration hospitals, training of fellows would lose a full procedure/h. In a model of 1000 procedures each of EGD, EGD with biopsy, colonoscopy, and colonoscopy with biopsy, the reimbursement difference between private practice physicians or academic attending physicians and procedures involving fellows-in-training would be $500,000 to $1,000,000/yr. CONCLUSIONS: Fellow involvement prolonged procedure time by 10-37%. Thus, per-hour reimbursement is reduced at teaching institutions, causing financial strain related to these time commitments. (C) 2000 by Am. Coll. of Gastroenterology.

Original languageEnglish (US)
Pages (from-to)3129-3132
Number of pages4
JournalAmerican Journal of Gastroenterology
Volume95
Issue number11
DOIs
StatePublished - Nov 20 2000

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Endoscopy
Digestive System Endoscopy
Colonoscopy
Biopsy
Private Practice
Veterans Hospitals
United States Department of Veterans Affairs
Databases
Teaching
Physicians
Gastroenterology
Medicare
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

The time and financial impact of training fellows in endoscopy. / McCashland, Timothy M; Brand, Randall; Lyden, Elizabeth; Garmo, Pat De.

In: American Journal of Gastroenterology, Vol. 95, No. 11, 20.11.2000, p. 3129-3132.

Research output: Contribution to journalArticle

McCashland, Timothy M ; Brand, Randall ; Lyden, Elizabeth ; Garmo, Pat De. / The time and financial impact of training fellows in endoscopy. In: American Journal of Gastroenterology. 2000 ; Vol. 95, No. 11. pp. 3129-3132.
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