A Commentary in JAMA:Internal Medicine

David Lieberman and John Allen discuss what is probably going to happen to the colonoscopy payment system: – bundling: fixed fee for the anesthesia, pathological analysis, and repeated procedures due to poor bowel preparation.

Currently Centers for Medicare and Medicaid Services waive patient costs associated with anesthesia services (i.e. propofol for all). Some think it is not a great idea from a cost perspective. The authors point out that given focus on quality and patient satisfaction, anesthesia for all cases may not be a bad idea, especially if we enter the bundled payment system.

These are good points, but from a clinical perspective, the quality and patient satisfaction are not exactly two major parameters that enter my mind when it comes to what’s best for patient. Quality is slowly becoming a nebulous term which includes anything from access, cost, etc, and the contribution of clinical indication is rapidly declining in that formula.

And bundled payments may in the end not be so bad, as long as we all share in the costs of this, from primary care to the specialist.

One more thing -“…costly, cost-effective, and well accepted. In some areas, however, charges can vary more than 10-fold for the same services, from approximately $500 to more than $8000.” $8000 for a colonoscopy?  – Where? What kind of a colonoscopy does one get for that much money?