Colorectal cancer is the second leading cause of cancer death in the United States. Approximately 140,610 people are expected to be diagnosed with colorectal cancer in 2020. Regular colonoscopies and timely treatment are keys to catching colorectal cancer early and treating potential problems before they become a serious condition. An active colonoscopy patient recall system is a clinically appropriate and necessary tool for a gastroenterology (GI) practice. Despite the clinical importance of colonoscopy patient recall, studies point to low GI patient recall rates, with significant variation between practices.
Beyond the clinical considerations, a colonoscopy patient recall system can generate significant patient volume at a significant return on investment (ROI). A robust patient recall system can be very expensive in terms of labor, systems and services. Patient recall can take place entirely in-house, entirely outsourced or some combination of the two.
Running the Recall Numbers
The first step in analyzing the size of the opportunity is to consider the size of the recall pool. Data that we’ve analyzed from Physicians Endoscopy (PE) partnered centers point to an average colonoscopy recall interval of approximately five years with a range of 1–10 years. Approximately two-thirds of center procedures are colonoscopy procedures. If we consider a physician with 10 years of stable volume, the average annual size of the colonoscopy recall pool may approximate the physician’s average annual volume. When you consider recall for repeat esophagogastroduodenoscopies (EGDs), a physician’s average annual recall pool likely exceeds their annual procedure volume.
The next step in analyzing the size of the opportunity is to calculate how many patients due for a recall come back for a repeat procedure during the active recall process (typically the due date plus 6–12 months). We refer to this calculation as recall conversion rate. In analyzing data from PE partnered centers, we find that recall conversion rates range from 18% to approximately 35% with an average of 28%–30%. Recall conversion rates generally max out around 40%–45%.
From a high level, if the size of a recall pool approximates the annual volume of a long-term physician with stable volume, a 5% increase in recall conversion rate can correspond to a roughly 5% increase in annual volume. We believe that many practices have an opportunity of 5%–15% volume growth from better recall conversion rates. These estimates have been validated based on the results of enhanced recall efforts implemented by practices at partnered PE centers.
Making Recall Part of the Repertoire
We find that the more effort a practice puts into recall, the higher the conversion rate. On the low end, practice efforts may be limited to a physical letter as the patient approaches their recall due date. On the high end, a practice can implement a very robust system of letters, texting, primary care provider communication, multiple rounds of follow-up calls, and tracking and monitoring of results. Depending upon practice, ancillaries and physician ownership, the revenue opportunities from increased procedure volume can include office visit revenue, professional fees, share of center profits (based on any center ownership), and other potential ancillary revenue source such as anesthesia and pathology. Increasing patient recall efforts is an investment that we believe has a significant ROI for both the practices and their centers.
From a practical standpoint, an enhanced recall system can be expensive in terms of cost and practice staff. Simply instructing busy staff to start calling patients for recall when available frequently results in a situation where “free time” becomes “no time.” To increase productivity, practices can use dedicated staff, dedicated blocks of time, and tracking and monitoring of results. If available staff is too limited to properly mine the recall data, components of the patient recall process, such as the follow-up calls, can be outsourced to specialized vendors.
While colonoscopy recall efforts are a clinical necessity, a robust recall process that properly mines the recall pool can generate significant additional volume at a very attractive ROI. It is not only a good financial endeavor but makes for good patient care.