#United States #Austin #Gastroenterology #Healthcare Economics #Jiro Health

Gastroenterology Practices Face Financial Pressures on Second Procedures

In a groundbreaking analysis by Jiro Health, the financial challenges encountered by gastroenterology (GI) practices have been brought to light, revealing stark discrepancies in reimbursement rates for second procedures. According to the recently published Gastroenterology Practice Economics Benchmark 2026, the findings specifically address how various factors, including practice size, payer contracts, and payment rules, shape the financial ecosystem of these medical facilities.

Key Insights from the Benchmark

The analysis uncovers two primary factors affecting gastroenterology practices. The first issue, termed a scale gap, shows that larger independent GI groups charge on average 12.5% more for comparable services than their smaller counterparts. However, the actual compensation varies, with paid claims reporting a discrepancy of approximately 8% to 10%. This contrast raises questions about the financial viability of smaller practices in a competitive market.

The second issue is more specific to gastroenterology, namely the frequency and depth of payment reductions for additional same-visit procedures. The data reveals that more than 20% of these added procedures receive compensation of less than 25% of their standard rate, which is significantly higher than the 6.8% seen in the next highest specialty, plastic surgery.

Relevance of Multiple Procedures in Gastroenterology

The nature of GI visits often involves multiple procedures; data indicates that over 28% of patient visits include two or more procedures. As such, the reimbursement structure directly influences the financial health of practices across the board. Many of these reductions in payment stem from Medicare's same-scope rule, which pays for only the additional work performed when multiple related procedures are conducted in a single session. This guideline often leads to varying applications by commercial insurers, complicating the issue further.

Noteworthy Statistics:

• - 20.7% of second procedures in GI earn less than 25% of the standard rate if billed independently.
• - Gastroenterologists typically receive 32% to 38% of the standard rate for a second procedure.
• - 64.1% of additional procedures in the same visit are impacted by the CMS same-scope rule.

As Greg Field, the CEO of Jiro Health, states,