The “Orphan” Condition Costing the Healthcare Industry $Billions per year

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Why Value-Based Care Practices Could Help Gastroenterologists Tackle This Issue

By Dr. Harry Sarles, MD, Medical Director, Digestive Health Research Institute and Dr. Mitchel Guttenplan, MD, FACS, CRH Medical Director

While “value-based healthcare” has become a hot topic and a major initiative to advance the U.S. healthcare system, it’s implementation and development of associated guidelines has been slow for a variety of reasons. Despite an overall interest in the concept and desire to move toward a value-based model that focuses on cost-effective patient care and positive outcomes, lack of clarity surrounding new billing models, challenges around standardization and data sharing, and an infrastructure that unfortunately does not often facilitate the adoption of innovative new methods have posed barriers to value-based care across the industry.

One issue in particular that has flown under the radar – despite the need and potential for more effective treatment methods – is one most people are very familiar with: hemorrhoids. Currently the cost of diagnosis, prescription medications, physician encounters and facility costs for this condition for the employer insured population alone (a small percentage of the US population at large) – have cost the healthcare system a whopping $2.5 billion per year.  This condition is placing a significant financial burden on the industry, not to mention the impact it’s having on the quality of life for the estimated 10.4 million patients across the U.S. who are diagnosed with hemorrhoids every year. Many more that suffer from hemorrhoids unfortunately go untreated or under-treated, a situation that has had a trickle-down effect on both patients and the healthcare system overall. 

For patients, half of those with a hemorrhoid-related claim are prescribed medications such as hydrocortisone creams, suppositories or other temporary treatments that may provide short-term relief, but haven’t demonstrated long-term effectiveness and in some cases, make matters worse. They often deal with the condition for years, requiring repeat diagnostic procedures and receiving the same ineffective prescriptions time and again. Many more suffer recurrent symptoms such as pain, itching, irritation, and bleeding – desperate for relief, but ultimately suffering in silence from embarrassment or hopelessness to find a real cure. In addition to dealing with these symptoms longer term, they become more likely to develop more advanced hemorrhoidal disease, which might not be amenable to more conservative treatment measures. This can result in the need for surgery, which can be incredibly painful, requires substantial recovery time, and requires time off from work. 

For the healthcare system, hemorrhoids ultimately cost significantly more than they would if treated effectively upfront. In fact, diagnosis without treatment accounts for 60% of the cost of hemorrhoid-related claims. Repeat office visits, colonoscopies, prescriptions, facility costs, and expensive surgeries are all contributing factors to an increasing economic burden. 

Fortunately, an effective and simple treatment method exists that physicians across the country are using to cure, not just treat, hemorrhoids. “Rubber band ligation” is an office-based procedure, which places a small band around a portion of the hemorrhoid, causing the involved tissue to scar into place, and by doing so, eliminate hemorrhoidal symptoms.  This technique has existed since the 1960s, and it used to be associated with the risk of significant pain.  New developments in banding technology have all but eliminated this issue, offering a quick, painless cure after an average of three office visits. Banding requires no recovery time, and is proven to be 99% effective. Many gastroenterologists that provide banding to patients view this as an opportunity to provide true value-based care to patients.  It not only meets a previously unmet need, but also provides preventative care, reducing the need for colonoscopy, and other costly surgical procedures. 

Gastroenterologists are in a unique position to effectively diagnose and provide quality, economical hemorrhoid care. By doing so, they can lead the efforts in reducing the financial burden of these conditions, and improve the quality of life and real outcomes for their patients. 

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