Patients who have unexplained anemia due to blood loss or other reasons often undergo two diagnostic endoscopic procedures: esophagogastroduodenoscopy (EGD) and colonoscopy. These two procedures can be safely performed together on the same day. Performing these endoscopic procedures on the same day offers several important advantages to our members: Safety. Patients are only administered one dose of anesthesia, rather than two. Convenience. For patients who are actively employed, they will only need to miss one day of work rather than two. In addition, they only need to arrange once for help with transportation to and from the office and with child care, if applicable. Finally, patients will only have to prepare once for the procedures. Cost-savings. Members who have these two procedures on the same day are only required to pay cost-sharing (i.e., copayment, deductible, or coinsurance) once. Members who get these procedures on separate dates of service will pay cost-sharing twice. In addition to affording advantages to our members, performing these endoscopic procedures on the same day also helps reduce health care costs, as the procedures performed on the same day are paid as one facility charge and one anesthesia charge. Hashem B. El-Serag, MD, chief of gastroenterology and hepatology at Baylor College of Medicine, led a research effort to analyze nearly 13,000 Medicare beneficiaries who underwent both a colonoscopy and EGD within 180 days of one another.¹ Sixty-three percent of the procedures were performed on the same day, or "bundled." However, procedure bundling was not used for 37 percent of the beneficiaries. Among these unbundled procedures, 20 percent were performed within 30 days of each other. Even more notable, nearly 30 percent of the unbundled procedures were performed within four days of one another. There were no significant differences with regard to gender or age between the three groups of patients (i.e., those who had bundled procedures, those who had them within 30 days, and those who had them within 31- 180 days). Dr. El-Serag concluded that performing these procedures on the same day "is likely to reduce the overall costs to the health care system by saving the facility fees, anesthesia, and work days lost."² The majority of AmeriHealth-participating providers are correctly performing these procedures; however, there is a concern with those providers who regularly perform these services on different dates of service. In most cases, this behavior will present an unnecessary safety risk, as well as additional inconvenience and cost, to our members. Whenever medically appropriate, we encourage our network providers to perform these endoscopic procedures on the same date of service for those patients with indications for both procedures.

¹ El-Serag, H. (May 2011). Bundling in Medicare Patients Undergoing Both Colonoscopy and EGD. How Often Does It Happen? Presented at Digestive Disease Week, Chicago, IL.

² Wendling, P. Financial Incentives Discourage Bundling of Endoscopic Procedures. Internal Medicine News. Accessed June 3, 2011. www.internalmedicinenews.com/specialty-focus/gastroenterology/single-article-pag e/financial-incentives-discourage-bundling-of-endoscopic-procedures.html