2017 · CGH · Podcast · Study

GI Pearls Episode 5 – Last two weeks of June 2017

Show Notes for 2017 Second two weeks of June 005
  1. Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis – CGH
  2. Incidence and Prevalence of Crohn’s Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010 – CGH
  3. Fecal Immunochemical Test Detects Sessile Serrated Adenomas and Polyps With a Low Level of Sensitivity – CGH
  4. Comparison of Two Intensive Bowel Cleansing Regimens in Patients With Previous Poor Bowel Preparation: A Randomized Controlled Study. – GIE
  5. Acute Fatty Liver Disease of Pregnancy: Updates in Pathogenesis, Diagnosis, and Management – ACG
  6. Disentangling the Association between Statins, Cholesterol, and Colorectal Cancer: A Nested Case-Control Study – PLOS Medicine
  7. Association of Gastric Acid Suppression With Recurrent Clostridium difficile InfectionA Systematic Review and Meta-analysis – JAMA Internal Med
  8. Amanita phalloides Mushroom Poisonings — Northern California, December 2016 – MMWR June 2017
  9. Wild Mushrooms: An Exclusive Delicacy or Last Meal – ACG
  10. Treatment of NASH: What Helps Beyond Weight Loss? – ACG
  11. Small intestinal bacterial overgrowth and Celiac disease: A systematic review with pooled-data analysis – Neurogastro & Motility

New Approaches to Controlling Health Care Costs

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?