5 key takeaways
1. Larger independent GI groups command 12.5% higher prices than smaller practices.
Larger independent GI groups post prices 12.5% above smaller practices for comparable procedures. However, the difference narrows to approximately 8–10% when looking at actual paid claims. GI ranks 18th among 56 specialties for this scale advantage. (Pages 2–3)
2. Smaller GI practices lose approximately $5,900 per physician annually.
The pricing gap translates into an estimated $5,894 annual payment shortfall per physician compared with larger local independent practices. For a three-physician practice, that amounts to approximately $17,681 annually. (Page 4)
3. Nearly 1 in 3 GI visits involve multiple procedures, exposing practices to reimbursement cuts.
28.4% of GI visits involve two or more procedures. This makes GI particularly vulnerable to reductions in reimbursement for additional procedures performed during the same visit. (Page 5)
4. GI has the highest measured share of second procedures receiving less than 25% of their normal payment.
Only 20.7% of paid second procedures in gastroenterology retain less than one-quarter of their normal price, compared with 6.8% in the next-highest specialty, plastic surgery. Typically, GI physicians retain approximately 32–38% of a second procedure’s normal price. (Page 5)
5. Payer policies, not practice size or ownership, determine second-procedure payment reductions.
The report finds that independent and private-equity-backed practices experience similar reductions. The median difference between small and large practices across 20 specialties is effectively zero. Instead, payer-specific policies and reimbursement rules drive these reductions. (Page 6)