Does the Varying Rate of Failed Colonoscopy by Provider Create Additional Charges to the Patient?

Background: The failure of an endoscopist to thoroughly visualize the colon during a colonoscopy will often result in a repeat procedure to ensure proper screening, surveillance, and/or treatment. We believe that the rates of failed colonoscopies and subsequent follow-up procedures will vary by individual endoscopist and contribute extra charges to the patient. Out study has two objectives: 1) To determine if endoscopists have varying rates of failed colonoscopies, 2) To determine if endoscopists have varying rates of early repeat follow-up procedures after failed colonoscopies.;Methods: We retrospectively reviewed 6,000 colonoscopies performed from 2009 -- 2011 at Virginia Mason Medical Center. Based on the abstracted information, we determined whether each procedure was a success or failure. For failed procedures, we determined whether a repeat procedure was recommended and how soon after the failed procedure was the repeat procedure recommended. Of failed colonoscopies with a recommended early follow-up procedure, we determined those that contributed extra charges to the patient.;Results: We found one endoscopist with high odds of performing failed colonoscopies, but he or she did not have high odds of recommending a follow-up interval that would contribute to extra charges. We also found one endoscopist with high odds of recommending a follow-up interval that would contribute extra charges, but he or she did not have high odds of performing a failed colonoscopy.;Conclusions: Our results indicate no one individual provider could be held responsible for extra charges assigned to the patient due to failed colonoscopies. While the total burden of extra charges as a result of failed colonoscopies may be deemed excessive by some, any measures aimed to decrease those excess charges should be addressed more broadly to all physicians and patients.