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Comment & Response
March 2014

The Efficacy of Screening Colonoscopy

Author Affiliations
  • 1Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 2President, American Gastroenterological Association Institute, Bethesda, Maryland
  • 3Division of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
  • 4Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
JAMA Intern Med. 2014;174(3):483. doi:10.1001/jamainternmed.2013.13741

To the EditorJAMA Internal Medicine published an article noting that Medicare reimbursement rates per hour for procedures (specifically screening colonoscopy and cataract extraction) are higher than reimbursement rates for cognitive care by primary care providers (evaluation and management [E&M] codes).1

We suggest a better way to frame the discussion as follows: there is a gap between cognitive and procedural services. We believe that the valuable cognitive services of primary care providers may well be underpaid, accounting for the gap. At a rate of $220, screening colonoscopy is certainly not overpaid; it requires special education, expertise, and training; carries greater risk; and provides great value.

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