Kim-Deobald J, Kozarek R A, Ball T J, Patterson D J, Brandabur J J, Raltz S
Department of Internal Medicine, Virginia Mason Medical Center, Seattle, Washington.
Gastrointest Endosc. 1993 Nov-Dec;39(6):763-5. doi: 10.1016/s0016-5107(93)70260-6.
Procedural (room fee) reimbursement from insurance payers is usually fixed for individual endoscopic procedures and may not include the costs of disposable equipment. This study estimated costs of disposable items used in ERCP procedures and calculated the percentage of total reimbursement spent on such equipment. A total of 248 ERCPs were performed in a 5-month study period, 192 (77%) of which were therapeutic. Total reimbursement was estimated to be $112,262 ($452 per procedure) and total disposable equipment costs were $47,195 ($190 per procedure), or 42% of total reimbursement. Disposable instrument costs in diagnostic ERCP approximated 13% of those associated with therapeutic ERCP, and the latter costs in turn utilized more than 60% of Medicare/Medicaid room fee reimbursement. This reimbursement may be inadequate to cover both disposable instrument costs and other procedural expenses, such as admit-recovery costs, nursing assistance, expenses related to endoscope purchase and capitalization, and equipment cleaning or sterilization. Our data suggest the need for either re-usable endoscopic accessories or adequate compensation to cover disposable instrument costs.
保险公司对手术（手术室费用）的报销通常针对单个内镜手术是固定的，且可能不包括一次性设备的费用。本研究估算了内镜逆行胰胆管造影（ERCP）手术中使用的一次性物品的成本，并计算了此类设备在总报销费用中所占的百分比。在为期5个月的研究期间共进行了248例ERCP手术，其中192例（77%）为治疗性手术。总报销费用估计为112,262美元（每次手术452美元），一次性设备总成本为47,195美元（每次手术190美元），占总报销费用的42%。诊断性ERCP中的一次性器械成本约为治疗性ERCP相关成本的13%，而后者的成本又占医疗保险/医疗补助手术室费用报销的60%以上。这种报销可能不足以支付一次性器械成本和其他手术费用，如入院-恢复成本、护理协助、与内镜采购和资本化相关的费用以及设备清洁或消毒费用。我们的数据表明需要可重复使用的内镜附件或足够的补偿来支付一次性器械成本。
