Under the new HCFA ruling, the teaching Staff Endoscopist (SE) must be present during the entire viewing portion of an endoscopic procedure performed by residents or fellows in institutions receiving monetary support as a teaching institution. Prior to the new HCFA teaching rule, the SE was present during during difficult passage, tissue sampling, therapies, and all withdrawals. For efficiency, the SE coordinated start times for procedures in more than one room once a fellow acquired basic competencies. AIM: To determine the impact of this ruling in an academic institution with a large volume endoscopy practice exceeding 25,000 procedures yearly. METHODS: The impact of the new HCFA ruling on efficiencies was analyzed using procedure times and cost accounted physician productivity pre & post ruling for 14 teaching colonoscopists. Fellows average 300 colonoscopies during training at our institution. The Mayo Rochester endoscopy practice is paper-free; all procedure information (including procedure start and finish times) is recorded in a comprehensive, in-house developed, computer Database. The start time is recorded when a physician enters the room; the finish time is recorded upon extubation. Procedure time includes discussion of risks, answering patient questions, administration of conscious sedation, and the performance of the procedure. RESULTS: There was little difference in the additional procedure time needed for training pre and post ruling (+13.2 min. vs. +14.5 min. respectively) Efficient utilization of personnel, space, and equipment was decreased for teaching both before and after the ruling. Prior to the ruling, the additional procedure time required to train one fellow in colonoscopy cost approximately $2895 in additional paramedical time($.73/min. of paramedical time × 13.2 min. × 300 procedures). After the ruling, the number of procedures performed by a SE per half day decreased 37% (8 pre vs. 5 post) necessitating the addition of a SE assigned to endoscopy. The SE work and practice expense added to the paramedical expense increased the cost per fellow to $22,750 ($5.23/min. × 14.5 min × 300 procedures). SUMMARY: The new HCFA ruling increased the cost of training eight fold. The effects on the quality of training are yet to be determined. CONCLUSIONS: The new HCFA ruling may improve one-on-one teaching but eliminates the independent learning experience during training. Because Federal compensation has not increased, the new ruling will have a negative financial effect on endoscopy training programs.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging