Analysis quantifies the scale gap in gastroenterology and the frequency and depth of payment reductions on additional same-visit procedures.

AUSTIN, Texas, Oct. 14, 2026 /PRNewswire/ — Jiro Health today released the Gastroenterology Practice Economics Benchmark 2026, a national analysis of how practice size, payer contract rates and payment rules shape the economics of gastroenterology practices.

The analysis identifies two separate pressures. The first is a scale gap seen across medicine: larger independent GI groups post prices 12.5% above small independent practices for comparable work, while the difference in actual paid claims is approximately 8% to 10%.

The second is more distinctive to gastroenterology: the frequency and depth of payment reductions on additional same-visit procedures.

The benchmark found that more than one in five additional procedures performed during the same GI visit is paid less than a quarter of its standard rate. That is three times the share of the next-highest specialty, plastic surgery, at 6.8%. Multiple procedures are routine in GI, with more than a quarter of visits including two or more, so how payers price the second one shapes the economics of nearly every practice.

Much of the reduction follows Medicare’s same-scope rule. When related endoscopic procedures are performed in a single session, the rule pays only for the additional work, since the scope is already in place. Many commercial insurers apply similar logic, but not all apply it the same way.

Among the findings:

• 20.7% of paid GI second procedures receive less than 25% of the rate they would if billed alone, the highest share measured
• Gastroenterologists typically receive approximately 32% to 38% of a second procedure’s standard rate
• 28.4% of GI visits include two or more procedures
• 64.1% of additional same-visit GI work is affected by the CMS same-scope rule

“GI practices already know that scale can affect contracting and that second procedures may be reduced. What they have not had is a clear view of the magnitude, how GI compares with other specialties and which issues warrant a closer look,” said Greg Field, CEO of Jiro Health. “A below-market contract rate, an incorrect payment, a denial and a correctly applied payer rule are different problems. They call for different responses.”

The analysis also models the financial effect of the scale gap. Across the claims included in the analysis, the paid shortfall compared with larger local independent practices was approximately $5,894 per physician annually, or $17,681 for a representative three-physician practice. Because Jiro does not observe every claim, these estimates should be treated as floors rather than guaranteed recoveries.

“This is exactly the issue that deserves its own spotlight. It is relevant to every private practice GI group,” said Matthew Fasullo, DO, an interventional endoscopist and member of Jiro Health’s Clinician Advisory Board. “The benchmark is both interesting and eye-opening.”

The new benchmark gives GI practice leaders a clearer view of how their economics compare, where reimbursement pressure may be concentrated and which questions warrant closer examination. For practices, visibility is the starting point: understanding what is happening across contracts, procedures and payments before deciding what, if anything, to do next. The Gastroenterology Practice Economics Benchmark 2026 is available at https://jirohealth.com/gi-practice-economics.

About the analysis

Jiro analyzed 2025 medical claims and insurer remits alongside 2025 and 2026 insurer price-transparency data. Contract-price comparisons held the procedure, insurer and city constant. Paid-claims comparisons also matched the care setting.

The independent-practice scale analysis includes 56 specialties that met the required screening criteria. All figures reflect professional fees and exclude facility fees. The analysis identifies patterns, not insurer intent or causation.

About Jiro Health

Jiro Health is a public benefit corporation building practice intelligence for clinicians and their practices. Its mission is to improve the quality and accessibility of clinical care and research in the United States by returning insights from clinical practice to the clinicians who help create them.

Learn more at jirohealth.com.

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SOURCE Jiro Health