Colonoscopy by a family physician: a case series demonstrating health care savings.

Army community hospitals (ACHs) without gastroenterologists require civilian referrals for colonoscopy. The purpose of this study was to determine whether a colonoscopy-trained, military family physician (FP) saved health care dollars at an ACH by decreasing outside referrals. We present a chart review of all 182 colonoscopies performed by a FP at an ACH from September 2003 to May 2005. The total facility cost was determined using the cost of personnel, lost clinic hours, equipment, supplies, medications, continuing medical education, missed diagnoses, procedure complications, and need for additional studies. The potential referral cost was determined using local civilian colonoscopy billing codes and TRICARE reimbursement rates for 2004. The total facility cost was $53,517.14 ($294.05 per colonoscopy). The total referral cost would have been $156,197.60 ($858.23 per colonoscopy). Using a FP saved the hospital $102,680.46 ($564.18 per colonoscopy). A colonoscopy-trained FP saved significant health care dollars at an ACH.