CT, your cost analysis seems incomplete. Making an endoscopy center able to see more patients per hour makes it more efficient in many ways, since lots of the costs (staff, overhead, etc.) accrue by the hour. While you can certainly argue that they make more money for being efficient, that’s far from a completely bad thing. Wacky drug pricing and reimbursement skews this, of course, but there’s much more to it than the price of propofol. In any case I’ve never bothered with sedation for a pouchoscopy, so I (happily!) get out there quicker than the propofol recipients.