Regional Differences in Medicare Reimbursements and Gastroenterology Workforce Dynamics: Implications for Access to Care

Background: As the U.S. population ages, the need for gastrointestinal (GI) care and procedures grows. Medicare is a significant payer for these procedures, but declining reimbursements raise concerns about the availability of GIs and thus equitable access to care. This study examines the relationship between Medicare reimbursements for GI procedures and the regional supply and demand of GI physicians. Methods: This study analyzed the Medicare facility and non-facility setting physician reimbursements for the top 10 GI procedures for 2003, 2013, and 2023. Facility reimbursements were compared across four regions (Northeast, Midwest, South, and West) and compared to regional GI physician supply and demand data for 2013 and 2025 projections. Linear regression and mixed-effects models were used to evaluate relationships between reimbursements, physician supply, and demand. Results: The national average adjusted facility setting physician reimbursements for the top 10 GI procedures declined by 45.6% from 2003 to 2023. In 2013 and projected for 2025, the South had the highest GI physician supply and demand, but consistently lower facility setting physician reimbursements compared to the Northeast and West. Associations between supply, demand, and reimbursements were observed, though regional patterns showed paradoxical trends, such as similar low reimbursements in the South and Midwest despite differing supply levels. Conclusions: Regional inconsistencies between physician supply and reimbursements highlight the complexity of economic and healthcare dynamics. Declining Medicare reimbursements for GI procedures are multifactorial and, as the aging population grows, these reductions may widen disparities. Further investigation is needed to address barriers and ensure equitable access to GI care.