New Study Identifies Upstream and Downstream EUS Revenue
Initial study evaluates pre- and post-care relating to hospital establish-based GI EUS practice
CENTER VALLEY, Pa., (December 19, 2019) – Olympus announced the publication of the research study, “Upstream and downstream revenue of upper gastrointestinal endoscopic ultrasound determined with an episode-of-care approach,” by Daniel Maeng, Phd, Beth Wall, RN, MS, Dina Hassen, MPP, and David L. Diehl, MD FACP, FASGE, in the journal Endoscopy International Open (2019; 07: E1316–E1321). The study offers retrospective economic claims analysis of Upper Gastrointestinal Endoscopic Ultrasound (UGI EUS) commercial and Medicare Advantage cases performed at Geisinger Medical Center, part of a large health system in the U.S. The study identifies financial revenues associated with a pre- and post-upper GI EUS index procedures to help justify a hospital purchase decision for EUS.
The study found that the financial value of UGI EUS is substantial in terms of associated upstream and downstream care. Key findings include:
- 81% of cases had further follow-up care after EUS;
- Average EUS upstream and downstream revenues totaled ,604 per case;
- The total episode-of-care revenues for cancer patients were more than three times higher than those of non-cancer patients.
Accordingly, the study supports the benefit of earlier diagnosis with EUS, leading to more specific individualized treatment for cancer patients. Co-author Dr. David Diehl, Clinical Professor of Medicine and Pathology at Geisinger Commonwealth School of Medicine and Director of Interventional Endoscopy at Geisinger Health System, offers an example: “Pancreatic imaging and biopsy is the most dramatic example of how EUS is efficient in cancer diagnosis and treatment. Lesions on the pancreas are sometimes very small and can’t be seen using other imaging modalities. EUS can dive to the heart of diagnosis. With EUS, we can see the entire pancreas, from the head to the tail, and we can very precisely direct a needle into the lesion for a biopsy. EUS can provide a diagnosis rapidly, which saves hospital costs and, more importantly, moves the patient more quickly to a treatment path.”
In the study, EUS cases with a procedural indication of malignancy had service and procedural profiles that were substantially different from cases without cancer. The frequency of upstream radiology and downstream consults for chemotherapy and radiation therapy was much higher for cancer cases (p<0.0001). Additionally, following EUS inpatient surgical and medical admission rates were 22-25% for cancer cases compared to 2% for those without cancer. Cancer-related, per-case upstream revenues were $11,432 and downstream revenues were $79,053, approximately three to four times higher than non-cancer cases.
“Cancer is sadly a costly disease, and for patients seeking the best in care, it can also mean long travel times to cancer centers that have the advantage of leading-edge diagnostic equipment. Once a patient is referred out of its system, the community hospital is unlikely to regain the patient,” said Kurt Heine, Group Vice President, Endoscopy at Olympus America, Inc. “As more community hospitals invest in EUS, they are advancing healthcare for their patient populations.”
Using electronic health records, the co-authors were able to capture relevant financial data for all applicable procedures. The study team identified a set of CPT (current procedural terminology) and MS (medical severity) DRG (diagnosis-related group) codes that appear to be related to EUS. “Using objective validated data such as the claims data is a very significant contribution to the field,” said co-author Dr. Daniel Maeng, Assistant Professor, Department of Psychiatry, University of Rochester Medical Center.
Olympus is helping to further the availability of EUS as a diagnostic tool for use in local community hospitals by supporting an Diagnostic EUS training program for physicians who are 5 or more years out of fellowship and wish to train in EUS. Offered in partnership with the American Society of Gastroenterology (ASGE), this comprehensive training program focuses on competencies that include online learning modules, hands-on training, webinars and proctorship, exposing each student to more than 200 EUS procedures to meet the ASGE guidelines.
See the full study for more information.
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