E0624 - Insurance Status Predicts Endoscopy No-Show

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

KG

Keith Garrison, MD

University of Texas Houston Health Sciences Center
Houston, TX

Keith Garrison, MD¹, Tanmay Gaglani, MD², Miller Chase, MD¹, Muhammed Vohra, MD¹, Nina Quirk, BS³, Sean Ngo, BS³, Scott Larson, MD, PhD⁴
¹University of Texas Houston Health Sciences Center, Houston, TX; ²The University of Texas Health Science Center at Houston, Houston, TX; ³McGovern School of Medicine, Houston, TX; ⁴UT Houston McGovern Medical School, Houston, TX

Introduction: Lyndon B. Johnson (LBJ) hospital is a part of the Harris Health System, which provides comprehensive care to the uninsured and underinsured population in Harris County, TX. LBJ serves a population with 55% unemployment and a median household income of $22000. Access to endoscopy is limited by resource availability, and the completion of scheduled endoscopies is essential for public health. We aimed to assess if insurance status was associated with no- show for scheduled endoscopic procedures at the LBJ GI Lab.

Methods: All patients scheduled for outpatient endoscopy during the year 2021 were collected. Included patients must have completed a GI clinic appointment, anesthesia screening, pre-procedural COVID test, confirmed attendance on pre-procedure call, and not showed for scheduled endoscopy. Patient’s insurances statuses were: FAP (county payment assistance), Harris County Prisoners (no costs), Medicare/Medicaid (variable costs), Private Insurance (variable costs), Self-Pay, and Texas Family Planning/HCHD Presumed (temporary FAP).

Results: Comparative analysis of insurance types demonstrated that patients who were Self-Pay were 5.96 times more likely (P< 0.002) not to show up for previously scheduled endoscopic procedures, while patients with the TFP/HCHD insurance were 10.1 times more likely (P< 0.001) to not show when compared to patients who were covered by the county’s FAP.

Discussion: Our analysis demonstrated a statistically significant association between insurance status and the incidence of no-showing for endoscopy. Upon literature review, there was limited data on rates of endoscopy no-shows in relation to the out-of-pocket commitment for individuals. Further investigation into this topic would significantly affect both the academic and private practice of gastroenterologists. We plan to continue this quality assessment by meeting with the patient eligibility department to assess if modifications of benefit profiles could optimize procedural attendance.

Figure: Study selection methodology

Multivariate Logistic Regression	Odds Ratio	95% CI	p-value
Gender
Female	-	-
Male	1.33	0.74, 2.41	0.3
Patient Age (years)	0.98	0.96, 1.01	0.2
Primary Insurance
Harris County Financial Assistance Program (FAP)	-	-
Harris County Prisoner	7.17	0.35, 49.7	0.086
Medicare/Medicaid	1.95	0.66, 5.54	0.2
Private	1.76	0.72, 4.35	0.2
Self-Pay	5.98	1.76, 18.1	0.002
Texas Family Planning Indigent (TFPI)	10.1	4.52, 23.8	< 0.001

Table: When compared to the Harris County Financial Assistance Program (which lowers the out-of-pocket cost of endoscopy to <$50), patients who were Self-Pay were 5.96 (p<0.002) times more likely to not show up for previously scheduled endoscopy. While patients with Texas Family Planning Indigent (TFPI) (a county program that provides 90 days of FAP cost assistance; however, all expenditures are due if not fully approved for FAP) were 10.1 times more likely (p<0.001) not to show when compared to patient's who were covered by FAP.

Disclosures:

Keith Garrison indicated no relevant financial relationships.

Tanmay Gaglani indicated no relevant financial relationships.

Miller Chase indicated no relevant financial relationships.

Muhammed Vohra indicated no relevant financial relationships.

Nina Quirk indicated no relevant financial relationships.

Sean Ngo indicated no relevant financial relationships.

Scott Larson: Motus GI – Consultant.

Keith Garrison, MD¹, Tanmay Gaglani, MD², Miller Chase, MD¹, Muhammed Vohra, MD¹, Nina Quirk, BS³, Sean Ngo, BS³, Scott Larson, MD, PhD⁴. E0624 - Insurance Status Predicts Endoscopy No-Show, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.