Abstract
Background and study aims Upper gastrointestinal endoscopic ultrasound (EUS) has clinical advantages that can
lead to improved patient outcome. This study seeks to characterize and quantify the
upstream and downstream healthcare utilizations and revenues.
Patients and methods A retrospective claims data analysis of upper gastrointestinal EUS procedures was
conducted at a large health system. Types of care and total revenues associated with
each episode of care were characterized by descriptive statistics. Comparisons were
made between patients who had Medicare Advantage and commercial plans as well as those
with and without cancer diagnoses during the downstream period.
Results A total of 436 cases were identified. The most frequent downstream healthcare utilizations
consisted of radiology (31 %), pathology services (28 %), and high-revenue services
including chemotherapy and inpatient admissions. The most common upstream utilizations
included radiology (18 %) and lab services (22 %). Average total downstream revenue
was $ 34 231 (95 %CI: $ 28 561 – $ 39 901) per case, and average total upstream revenue
was $4373 (95 %CI: $3227 – $ 5519). Average total revenue per case did not differ
significantly between Medicare Advantage and commercial plan members. However, patients
who were diagnosed with cancer at or immediately following EUS (20 %) were associated
with significantly higher total revenue compared to those without cancer diagnosis
(P < 0.0001).
Conclusions This episode-of-care approach to quantifying the revenue impact of upper gastrointestinal
EUS to the providers suggests there are substantial downstream as well as upstream
revenues associated with upper gastrointestinal EUS procedures, driven by patients
who are diagnosed with cancer by the EUS procedures and subsequently require oncologic
care.
