Jiro Health | Practice Economics
GI’s Scale Gap Is Common. Its Second-Procedure Economics Are Not.
Larger independent GI groups post prices 12.5% above small practices, a familiar scale advantage across medicine. What makes gastroenterology different is how often additional same-visit procedures are reduced, and how deeply their value is discounted.
28.4%
of GI visits include two or more procedures
The question
Two distinct pressures on GI economics.
GI leaders already know that size can influence contracting and that second procedures may be reduced. What has been harder to see is the magnitude, how GI compares with other specialties, and which parts of the economics are structural versus payer-specific.
Jiro analyzed insurer contract prices and paid claims while holding the procedure, insurer and market constant. The findings reveal two distinct pressures: a scale gap that is widespread across specialties, and a same-scope payment dynamic that is unusually consequential in GI.
The scale gap is real, but not exceptional
GI sits in the middle tier of 56 specialties.
Across 56 screened specialties, the median posted-price gap between larger and small independent practices is 8.8%. GI ranks 18th, placing it in the middle tier rather than among the largest gaps. Health systems remain a useful additional comparator, but the more important GI story is not that scale exists. It is what happens when that common scale pressure meets GI's procedure mix.
12.5%
posted-price gap
The difference between larger and small independent GI practices. On paid claims, the gap is approximately 8% to 10%.
The contract price is the larger financial lever
Dollars per $100 of approved value
Small-practice gap observed in the GI analysis. Price gap reflects lower contract prices. Denial gap reflects fewer denied claims later paid.
What makes GI different
Second procedures are common, and deeply discounted.
Nearly two-thirds of additional same-visit GI work is affected by the CMS same-scope rule, and 20.7% of paid second procedures retain less than one-quarter of their normal price, the highest share measured. Commercial policies vary, making payer mix and contract language central to understanding the impact.
28.4%
of visits
The share of GI visits with two or more procedures. Gastroenterologists retain approximately 32% to 38% of a second procedure's normal price.
The full benchmark
Explore the Gastroenterology Practice Economics Benchmark 2026
Unlock the complete analysis, including the 56-specialty scale comparison, the cross-specialty map of second-procedure exposure, payer-specific findings, modeled practice impact, an action framework, and methodology and limitations.
What’s included
- Posted-price and paid-claims gaps within independent GI
- How GI's scale gap compares across 56 specialties
- Modeled annual impact for a representative three-doctor practice
- Payer-level second-procedure findings, including severe reduction patterns
- Cross-specialty comparison of procedure frequency and payment depth
- Practice action framework, methodology and limitations
Benchmark preview
GI practice economics at a glance. Two separate pressures: a common scale gap and distinctive second-procedure exposure.
12.5%
Posted-price gap
Larger vs. small independent GI
8%–10%
Paid-claims gap
Larger vs. small independent GI
28.4%
Multi-procedure visits
GI visits with two or more procedures
32%–38%
Second price retained
Typical share of a second procedure's normal price
20.7%
Severely reduced
Paid second procedures retaining less than 25%
Scale versus second procedures
GI’s scale gap is common. Its severe second-procedure reductions are not.
Posted-price gap: larger vs. small independent practices
Percent higher
Paid second procedures retaining less than 25%
Share of paid second procedures
Source: Jiro analysis. Scale comparison includes 56 screened specialties. Measures use different eligible cohorts.
What can a GI practice do?
The answer depends on which problem the data reveals.
Practices cannot change market structure or payer policy on their own, but they can identify where their economics diverge, quantify what is material and take the right next step:
01
Benchmark high-volume procedures against relevant local peers, payer by payer.
02
Separate below-market base rates from denials and policy-based reductions.
03
Compare actual remits with the written contract and payer policy; escalate discrepancies.
04
Quantify the annual dollars and wRVUs at stake so the largest opportunities come first.
05
Use the finding to choose the action: contract strategy, payment correction, operational improvement or planning around a valid rule.
Private practice economics briefing
See how your GI practice compares
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