P0843 - Single Use Duodenoscopes Are Financially Viable for ERCP: A Real-World Study Within a Community Setting

Robert Dean, MD, Buffa Salvatore, FACG, Peter Varunok, FACG, Khuram Ashraf, FACG
Premier Medical Group, Poughkeepsie, NY

Introduction: : Duodenoscope associated bacterial infections have been identified by the US FDA as a cause of morbidity and mortality for patients undergoing ERCP. A solution to the concern for device transmitted infections is the development of sterile, single use duodenoscopes (SUD). Our aim was to identify the impact to medical centers that choose SUD for ERCP, as it relates to recent insurance reimbursement schedules.

Methods: We examined the financial viability of ERCPs utilizing SUD during the period from January 01, 2022, to April 20, 2023. We included in the analysis the instrument costs of the SUD and device-specific reimbursement from Medicare, Medicaid, and commercial insurance. Only outpatient procedures were included, as inpatient reimbursement was provided as a bundled payment and does not allow examination of device-specific reimbursement. The newly created device C-code was submitted for payment for these outpatient procedures in addition to the traditional CPT codes used for ERCP reimbursement.

Results: 155 ERCPs were completed using the EXALT Model-D SUD. Of these 155 procedures, 68 were outpatient cases and included in the analysis. 55 outpatient cases were reimbursed(81%), while 13 outpatient cases were denied reimbursement(19%) . Among the 55 reimbursed cases, average reimbursement was $3,985 per case. When the 13 nonreimbursed cases were included in the analysis, the average reimbursement was $3,223 per case. Overall, additional device-specific reimbursement fully addressed the additional costs of SUD and provided an additional $293.13 of net impact margin to each ERCP case. [Table 1]

Discussion: Prior studies have estimated the economic impact of SUD versus reusable duodenoscopes. A lack of initial capital investment, absence of reprocessing and instrument maintenance, and elimination of potential institutional costs of infection-related complications were cited in these studies as benefits of SUD [1]. Estimates of an economic “break-even” point for SUD fell in the range of 150-250 ERCP/year, assuming a 0.4% infection rate. These estimates assume no device reimbursement at all. Therefore, if device reimbursement were to be included, SUD may prove to be a viable option for ERCP in not only less-efficient lower volume centers, but also more efficient higher-volume institutions as well.





Disclosures:


Robert Dean, MD, Buffa Salvatore, FACG, Peter Varunok, FACG, Khuram Ashraf, FACG. P0843 - Single Use Duodenoscopes Are Financially Viable for ERCP: A Real-World Study Within a Community Setting, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.