A Business Opportunity Seen Through a Colonoscope

You could say I got lucky the other day. It was time for my colonoscopy – which bawdy comedians talk about as “the garden hose” (it maybe about the same thickness, but is not actually50 feet long).  

What The Wags Say is Sometimes "An Acute Remunerative Procedure."

This was a routine screening, done at the Surgery Center of Central Virginia (SCCV) by Dr. Waring Trible. I have no complaints about the wonderful service I got – in fact my complaints is rather the opposite.

A Vicious Start

As anyone who’s had this done knows, the whole drama starts the day before with a clear liquid diet (I am amused at how beef broth looks exactly the same going in as coming out). Following this you take some purgative to totally scour your intestine.

I do have a gripe about that.Why did this ‘Suprep’, which consisted of two 6 ounce bottles of sodium/potassium/magnesium sulfate (the cost of which would be “negligible” according to my chemist cousin Ron) and a plastic beaker to drink it from, cost me $108? 

Not to mention how vicious it was.

So I turn up for my colonoscopy, am checked in by the receptionist and passed on to the nurse – not without signing a hundred disclaimers. Put in one of those delightful gowns, given an IV, oxygen by nasal cannula, and continuously monitored with a pulse oximeter and a blood pressure cuff. 

I am visited by a member of the anesthetic team and we discuss what medicines they are going to administer. Then on to the procedure room and the care of a nurse anesthetist, who provides the knock out punch – and the next thing I know is Dr. Trible telling me it’s all over and “you did fine.”

When I get home I find my packet of discharge instructions has a charming “thank you for entrusting us with your care today” card, personally signed by 8 members of the staff. 

They must have thought my colon was something pretty special.

Runaway Train

I had the same thing twenty years ago, also by Dr. Trible. At that time he administered the sedative, and from what I remember there was far less hoopla.

Even though I have not received it yet, I am warned that soon there will be several bills dropped through my letterbox – one for the “facility charge” from SCCV. A bill from Dr. Trible. But also one from the anesthesia team.

 Being somewhat parsimonious (“cheapskate” is the term my daughters use) I was intrigued to know was I really paying for something I needed with the IV, the oxygen, and in particular the anesthetist.

Reverting to the Internet I found a paper in Gastrointestinal Endoscopysaying for low risk patients “use of anesthesia professionals does not appear to bring a safety benefit to patients receiving colonoscopy.”

Also that “Minimal and/or moderate sedation can be delivered safely by endoscopists” (the person doing the scope – Dr. Trible in this case).

And a program on National Public Radio entitled Is Anesthesia A Luxury During Colonoscopy? notes that in 2003, just 14 percent of people getting a colonoscopy had some member of the anesthetic team in attendance. Now it’s somewhere around 50 percent, and “People in the Northeast are much more likely to get anesthesia services” (59 percent of the time versus 13 percent in the Western states - “where insurers have balked at paying the extra cost, saying that almost all people do just fine with sedatives administered by the doctor doing the endoscopy.”)

I couldn’t find it addressed specifically, but I’ll bet it would be difficult to find studies to justify the use of oxygen and IV fluids for routine screening colonoscopies of healthy patients.

So is this just another example of maximizing business. Of the runaway train of healthcare costs?

Forced Purchase

The very helpful SCCV administrator, Kenny Ellinger RN told me “we provide the same high quality service to people getting a colonoscopy as we do to patients getting any kind of surgery in our facility.” That is, you get an anesthetist. 

It is significantly cheaper than at other facilities, he told me. But still, “without the bells and whistles it could be even cheaper “ was my thought. And having to have all that is like being forced to buy a car with leather seats, heated steering wheel, panoramic roof and backup camera, when all you wanted was the base model.

This leads us again to the basic question, “should healthcare be different to any other business?”

And What's Wrong With This?

It is the job of every business to be as profitable as possible isn’t it? Why shouldn’t healthcare companies, doctors, pharmaceutical companies, medical device manufacturers all employ every maneuver they can to maximize profits? 

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