Reimbursement for endoscopic procedures is decreasing in the face of increasing demand, especially for GI procedures. To help you counter this trend, we've compiled financial and operating benchmarking data so you can see how your GI service stacks up.

Financial benchmarks
This first group of numbers comes from the single-specialty endoscopy centers and multi-specialty ASCs that participated in InforMed Healthcare Media's Endoscopy Intellimarker benchmarking study, representing more than 300,000 GI cases.

1. $1,471 Average gross charges per case. Average net revenue per case is $552. NRPC for facilities with one OR, between two and three ORs, and four or more ORs is $747, $535 and $530, respectively.[1]

2. 3,437 Median case volume per year, or nearly 14 cases per day. Multi-specialty surgery centers did 19.3 cases per day, compared to 13.7 cases per day in single-specialty endoscopy centers.[1]

3. $4.5 million and $2.2 million Median gross charges and net revenue, respectively, of single-specialty endoscopy centers. Net revenue for facilities with fewer than 3,000 cases per year, between 3,000 and 6,000, and more than 6,000 is $1.3 million, $2.8 million and $5.0 million, respectively.[1]

4. $591,000 Median annual personnel costs, including salaries, wages, taxes and benefits. Personnel costs are the single largest expense, representing more than 26 percent of net revenue. Surgical supplies accounted for about 8 percent of net revenue.[1]

5. $332,000 Median total accounts receivable. A/R turns over nearly seven times per year, or every 50 days. About 72 percent of all A/R are fewer than 60 days old.[1]

6. 26 percent Percentage of cases the highest volume-producing physician accounts for in the typical endo center. Top two account for 45 percent and the top three account for 73 percent of all cases.[1]

7. 70-30 Ratio of commercial payers to payments received from Medicare or Medicaid.[1]

8. $31.42 Median hourly wage for endoscopy nurses in single-specialty facilities, or about $65,000 per year. Median wage rate for nurses in multi-specialty facilities is $25.26.[1]

9. $18.01 Median hourly wage for endoscopy techs in single-specialty facilities, or about $37,000 per year. Median wage rate for techs in multi-specialty facilities is $16.48.[1]

10. $18.37 Median hourly wage for administrative staff in single-specialty facilities, or about $38,000 per year. Median wage rate for administrative staff in multi-specialty facilities is $15.72.[1]

11. 5.6 hours Average staff hours per case (2.8 hours per nurse, 1.5 hours per tech).[1]

12. $623,500 Operating expenses per operating room or about $412 per case.[1]

13. 2.42 Average number of ORs in single-specialty endoscopy centers compared to 5.74 ORs in multi-specialty facilities.[1]

Disease detection
14. 6 minutes or more GIs with a mean withdraw time of six minutes or more had significantly higher rates of detection for any form of neoplasia (28.3 percent versus 11.8 percent) and advanced neoplasia (6.4 percent versus 2.6 percent) than those with lower mean withdraw times, says a study in the Dec. 14 New England Journal of Medicine. The study suggests that a colonoscopy's effectiveness may depend on how much time is allotted to the procedure: The quicker you are, the more likely you are to miss polyps. Specifically, the study found a large difference in how often adenomas were detected that correlated with the time spent withdrawing the colonoscope from the cecum to the anus.

15. 12 p.m. Afternoon colonoscopies have higher failure rates than morning colonoscopies, finds a study in the American Journal of Gastroenterology that reviewed 1,084 patients who received colonoscopies between 8 a.m. and 11:59 a.m., and 999 colonoscopies performed after 12 p.m. A significantly higher number of patients had inadequate bowel preparation in the afternoon compared to the morning and were therefore unable to complete their colonoscopies. "Every effort possible should be made to not only improve colonoscopy completion rates but also to improve the adequacy of bowel preparation," says the author of the study.

16. 5mm Consider colonoscopy adequate if it allows (within the technical limitations of the procedure) detection of polyps 5mm or larger, according to the ASGE/ACG Taskforce on Quality in Endoscopy.

17. > 90 percent Effective colonoscopists should be able to intubate the cecum in >90 percent of all cases and in >95 percent of cases when the indication is screening in a healthy adult.[2]

18. > 25 percent Among healthy asymptomatic patients undergoing screening colonoscopy, adenomas should be detected in >25 percent of men and >15 percent of women older than 50.[2]

19. 1 in 500 Perforation rates greater than one in 500 overall or greater than one in 1,000 in screening patients should raise concerns as to whether inappropriate practices are the cause of the perforations. About 5 percent of colonoscopic perforations are fatal.[2]

Appropriate colonoscopy intervals
Here are appropriate intervals for performing colonoscopy.

20. 10 years Average risk, beginning at age 50 years.[3]

21. 10 years Single first-degree relative (FDR) with cancer (or adenomas) at age >60, beginning at age 40.[3]

22. 5 years Two or fewer FDRs with cancer (or adenomas) or one FDR diagnosed at age <60 years, beginning at age 40 years or of 10 years younger, whichever is earlier.[3]

23. 5 years Prior endometrial or ovarian cancer diagnosed at age <50 years.[3]

24. 1-2 years Hereditary nonpolyposis colorectal cancer, beginning at age 20 to 25 years.[3]

25. 5-10 years One or two tubular adenomas of <1cm during postadenoma resection.[3]

26. 3 years Three to 10 adenomas or adenoma with villous features, > 1cm or with high-grade dysplasia.[3]

27. 2-3 years Ulcerative colitis, Crohn's colitis surveillance after eight years of pancolitis or 15 years of left-sided colitis, until 20 years after onset of symptoms, then yearly.[3]

References:
1. InforMed's Endoscopy Intellimarker 2006
2. ASGE. Appropriate use of gastrointestinal endoscopy. Gastrointest Endosc 2000;52:831-7.
3. American Society For Gastrointestinal Endoscopy/American College of Gastroenterology Taskforce on Quality in Endoscopy. Gastrointestinal Endoscopy, Volume 63, No. 4 : 2006 writeOutLink("www.giejournal.org",1).