Another attendee asked whether physician factors such as years in practice or type of facility may have influenced the use of bundling. Dr. El-Serag said that he and his associates have not done such an analysis and are limited by the nature of the database. It was noted during the discussion, however, that some ambulatory care centers have almost a standing policy against bundling, and that large institutions have been known to get around the thorny issue of reimbursement by having two providers at the same institution bill for procedures performed on the same day.
Session cochair Dr. James M. Scheiman, professor of internal medicine at the University of Michigan Health System in Ann Arbor, said, "I was surprised it [non-bundling] was only a third, I expected it to be much higher."
Dr. El-Serag said in an interview after the presentation that he too was surprised by the results, but he expected more physicians to bundle the two procedures because patients with suspected GI disorders often need both colonoscopy and upper endoscopy.
"It begs the question that the indication was the same one and that it was just a matter of convenience, patient request, or financial disincentive," he said. "Removing the financial disincentive for physicians to bundle procedures is likely to reduce the overall costs to the health care system by saving the facility fees, anesthesia, and work days lost."
Dr. El-Serag disclosed research support and other financial relationships with Astra-Zeneca and Onyx Pharmaceuticals and consulting for Vertex Pharmaceuticals. Coauthor Dr. Gregory S. Cooper reported consulting for and serving on advisory committees/review panels for Medtronic.