OBJECTIVES

Colonoscopy is widely used as a primary screening test for the early detection and prevention of colorectal cancer. Colonoscopies are challenging to prepare for, provoke anxiety, and can be costly, thus leading to high rates of no-shows, wasted capacity and lost revenue. The objective of this study is to estimate the cost benefit of sending timed-release text messages (SMS) to help prepare patients for their endoscopy visits compared with standard paper instructions and phone-calls.

METHODS

This cost-benefit model was established based upon the findings of a recently conducted l performed in an urban academic endoscopy unit¹. During 16 week study period, no-show/same day cancellation rates were lower in the SMS group compared to the controls (10% vs. 16%). No-show/cancellations within 7 days were 18% in the SMS group compared to 26% in the control group. Direct costs were derived from CMS Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment by CPT code.

RESULTS

With a projected number of 2000 colonoscopies conducted in one year, the model estimated total costs of $194,065 due to no-show/same day cancellations in the SMS group compared to $308,540 in the control group, resulting in $114,475 cost savings. . Assuming 25% to 75% cancellations were rescheduled, this translated into additional potential annual cost savings for SMS group ranging from $13,078 to $4,359. The total estimated annual cost savings with the use of timed-release text message program ranged from $118,834 to $127,553 from a hospital perspective (median = $123,194). Estimated median ROI from adopting the timed-release text message program at year one was 2.5.

CONCLUSIONS

Digital navigation with timed-release messages was associated with significant direct cost savings in the endoscopy unit. Further investigation should be performed to evaluate the clinical and economic impact of digital navigation for a variety of outpatient appointment types.

¹Manuscript still in press