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Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA), when performed by skilled physicians, reduces the need for mediastinoscopy and unnecessary thoracotomies with their associated morbidity, and is poised to permanently alter the landscape of lung cancer diagnosis and staging.
Prior to 2008, Medicare seemed to recognize the potential value of EBUS by paying hospitals about $2,000 per EBUS-TBNA, but 2010 payments were slashed to the same level as an ordinary bronchoscopy with transbronchial needle aspiration ($723).
Since EBUS-TBNA requires the purchase of a new machine that costs about $100,000 (or more), hospitals haven't rushed to embrace EBUS, and the technology has failed to disseminate widely.
In the February 2012 Chest, Nicholas Pastis, Suzanne Simkovich and Gerard Silvestri of the Medical University of South Carolina provide an accounting from 97 new patients referred to MUSC for EBUS-TBNA. Although the procedures themselves generated only pocket change, authors calculate the "downstream revenue" from chemotherapy, surgery and radiation therapy for new cancer diagnoses, additional procedures, hospitalizations, and consults to other services to have totaled $2.4 million -- about $25,000 per new patient referred for EBUS-TBNA.
These were collections, i.e., actual dollars the medical center put in the bank. About 80% of patients were Medicare or privately insured; collection rate was about average at 25%.
Slide a copy of this article under your hospital CEO's door if you're building a case for EBUS at your institution. Of course, as Kevin Kovitz points out in an associated editorial, the slow spread of EBUS into community pulmonology practice may be a good thing, since it increases the caseloads at centers that do provide EBUS, increasing their proficiency, and prevents rampant overuse motivated by payment incentives. Maybe Medicare isn't so clueless, after all.
Pastis NJ et al. Understanding the Economic Impact of Introducing a New Procedure. Calculating Downstream Revenue of Endobronchial Ultrasound With Transbronchial Needle Aspiration as a Model. Chest 2012;141:506-512.