The time and financial impact of training fellows in endoscopy

OBJECTIVE: To use a national endoscopy database (Clinical Outcomes Research Initiative, CORI) to determine 1) if fellow involvement increases procedur e time; and 2) the financial impact of Fellow participation for academic ce nters compared to private practice. METHODS: CORI database from 4/1/97 to 4/1/99 was used to compare endoscopis ts from private practices, academic medical centers, and Veterans Administr ation hospitals, with or without fellows-in-training. Data were captured in a computer-generated endoscopy report and transmitted to a central databas e for analysis. Duration of procedure (minutes) was recorded for diagnostic esophagogastroduodenos copy (EGD), EGD with biopsy, diagnostic colonoscopy , and colonoscopy with biopsy, in ASA 1 patients. Financial outcomes used 1 999 Medicare reimbursement rates for respective procedures and were calcula ted as procedures per hour on a theoretical practice of 4000 procedures. RESULTS: Teaching fellows endoscopy added 2-5 min for EGD, with or without biopsy, and 3-16 min for colonoscopy, with or without biopsy. Calculating t he number of procedures/h of endoscopy, the reimbursement loss resulting fr om using fellows-in-training in a university setting would be half a proced ure/h. In Veterans Administration hospitals, training of fellows would lose a full procedure/h. In a model of 1000 procedures each of EGD, EGD with bi opsy, colonoscopy, and colonoscopy with biopsy, the reimbursement differenc e between private practice physicians or academic attending physicians and procedures involving fellows-in-training would be $500,000 to $1,000,000/yr . CONCLUSIONS: Fellow involvement prolonged procedure time by 10-37%. Thus, p er-hour reimbursement is reduced at teaching institutions, causing financia l strain related to these time commitments. (C) 2000 by Am. Cell. of Gastro enterology).