Proctology's operating environment should be read with the FY2026 fee revision as an inflection point.
1. Macro environment — policy pushing short-stay surgery outpatient
The revision raised base fees 3.09% against a 0.87% drug price cut, for +2.22% overall — the first base increase above 3% in three decades. Note that implementation split from the usual pattern: drug prices from April 1, base fees from June 1, which matters for filing and billing preparation schedules.
Return visit fees rose from 75 to 76 points, a 2-point inflation response fee was added to first and return visits, and the outpatient and home base-up evaluation fee (I) was raised. These support baseline revenue for outpatient-focused clinics, but all are small — fee changes alone will not materially improve the revenue structure.
Most important for proctology is policy direction on day surgery. MHLW has indicated it will promote moving short-stay surgery that does not require admission into outpatient settings, with consideration advancing toward narrowing the point differential between inpatient and outpatient delivery.
Hemorrhoid and fistula surgery already aligns well with outpatient day delivery, so this direction can be a tailwind for bed-free day surgery clinics while exerting revenue pressure on facilities with beds that have depended on short-stay surgery base fees. Whether to operate with or without beds, and whether to retain admission or lean into day surgery, becomes the basic design question determining profitability under the revision.
On demand, hemorrhoids, fissures, and fistulas maintain high prevalence while psychological barriers — embarrassment and anxiety — strongly suppress care-seeking. That every clinic website foregrounds consideration for patients who hesitate out of embarrassment itself indicates the scale of latent demand and how directly the pathway that surfaces it connects to competitive advantage.
2. Characteristics of newly opened clinics
Recent openings favor combined "gastrointestinal, endoscopy, and proctology" clinics over standalone proctology. The names of top-ranking new clinics themselves reflect this — "endoscopy and day surgery clinic for stomach, colon, and anus."
Opening guides describe the combination of general outpatient care, upper and lower endoscopy, and health screening as the establishing mainstream pattern, with three growing practice types: community-focused, endoscopy-focused, and day-surgery-focused.
Capital and location
Capital swings widely by model: ¥50–80 million for outpatient and procedure-focused practices, ¥60–100 million with endoscopy, ¥80–150 million for day surgery, and ¥100–200 million+ with beds. Endoscopy equipment alone runs ¥20–35 million, with interior construction at ¥500,000–900,000 per tsubo. Average income for independent physicians is cited around ¥30 million, with cases exceeding that where self-pay and visiting care are introduced.
Location strategy has distinctive features. Opening guides note many successes on roadside sites near core community hospitals rather than prime station-front locations — yet proctology and endoscopy specialists frequently choose urban locations immediately adjacent to stations in areas like Shinjuku, Akasaka, Akihabara, and Kawasaki, promoting "X minutes from the station." Strategy polarizes according to whether the target is working-age single households or families traveling by car.
On acquisition, symptom-plus-location search optimization, Google Business Profile management, and condition-specific pages are repeatedly cited as early priorities. Real clinic sites design condition explanation, pricing, surgical process, women physician staffing, and web booking as one continuous path — content SEO and end-to-end booking are now standard equipment. Differentiators typically combine attached internal medicine for primary care function, evening and weekend hours, and women physicians and women's clinics.
3. Revenue areas specific to proctology
Day surgery for hemorrhoids, fistulas, and fissures
This remains the revenue core. Leading day-surgery specialists foreground performance figures — over 30,000 cumulative group cases, over 1,700 annually, 100% same-day discharge, 99.7% able to work the next day — building their message around speed of return to normal life. One publishes ¥30,000–60,000 for insured procedures and ¥250,000–380,000 for proprietary techniques as self-pay, illustrating a two-layer revenue structure.
Non-surgical treatment — ALTA sclerotherapy
An insured technique injecting a sclerosing agent into internal hemorrhoids in four stages, treatable same-day without a scalpel. Because the internal hemorrhoid region lacks sensory nerves, injection is nearly painless, and patients go home after about 30 minutes of recovery in a private room. Cost is cited at roughly ¥28,000 at 30% coinsurance (¥10,000 at 10%), making it a technique that lowers both psychological and physical barriers.
At the same time, clinics state clearly that roughly 80% of hemorrhoid and fistula cases can improve with conservative treatment — medication and lifestyle guidance. Offering a staged menu from conservative care through surgery, rather than weighting toward surgery, is described as important for both trust and return rates.
Combining with colonoscopy and colorectal cancer screening
Clinics emphasize that symptoms assumed to be hemorrhoids not infrequently turn out to be colorectal cancer, making the case for delivering anal examination and colonoscopy together. Endoscopy is positioned as the high-margin revenue source in gastrointestinal practice, and the pathway from anal symptoms into endoscopy, polypectomy, screening, and comprehensive health checks raises both unit price and reasons to visit.
From the proctology side, attaching endoscopy lowers the threshold for visiting compared with a standalone anal specialty, simultaneously preventing missed diagnoses and diversifying revenue.
Privacy routing and women's clinics
Lowering psychological barriers and designing privacy-conscious patient flow is itself a competitive arena. Clinics state explicitly that declaring multiple specialties so patients need not announce they came for proctology, private rooms, time-slot booking, women physicians and women-only clinics, and weekend hours all connect directly to surfacing patients who defer care out of embarrassment.
This is not merely patient service — it is acquisition infrastructure that converts latent demand into actual visits. Women physicians, women-only clinics, and women-only time slots have established themselves as the mechanism for reaching patients who avoided male physicians out of embarrassment.
4. Self-pay services
Self-pay in proctology is not a large market like aesthetic dermatology, but has steady presence at the periphery of insured care.
First, excision of anal skin tags for cosmetic purposes. Skin tags are benign redundant skin without pain, bleeding, or malignancy risk. They may be treated when they cause functional problems such as friction during defecation or difficulty with hygiene, but purely cosmetic removal is self-pay. Clinics draw the line between medical indication and cosmetic purpose, and that boundary design determines actual self-pay revenue.
Second, monetizing proprietary techniques and added services. The day-surgery specialist cited above offers proprietary laser techniques as self-pay (¥250,000–380,000) alongside insured procedures, pricing added value in early return, low invasiveness, and cosmetic outcome.
Third, sexually transmitted infection-related anal conditions such as condyloma acuminatum are primarily insured, but urban clinics offer self-pay menus for patients seeking anonymity and same-day service, combined with STI screening.
Fourth, self-pay options on colonoscopy and health screening — preparation-free examination, painless sedated procedures, same-day upper and lower endoscopy — raise unit price as value-added services.
Overall, proctology self-pay organizes into three directions: cosmetic needs outside insurance, proprietary techniques as premium alternatives to insured procedures, and comfort options on endoscopy and screening. All are secondary revenue arising alongside the core business. Rather than building a pillar from self-pay alone, self-pay accumulates as a result of the breadth of insured care and the quality of patient routing.
5. Management implications
First, the combined gastroenterology-endoscopy-proctology model outperforms standalone proctology on demand routing, revenue diversification, and preventing missed diagnoses.
Second, the FY2026 policy direction — promoting outpatient migration of short-stay surgery and narrowing the point differential — can be a tailwind for bed-free day surgery models and a headwind for inpatient-dependent ones, making basic bed/no-bed design and dependence on short-stay surgery base fees a required review item.
Third, privacy routing and women's clinics are acquisition infrastructure, not courtesies — the largest lever converting latent demand into actual visits. Combining multi-specialty declaration so patients need not announce their reason, private rooms, women physicians and women-only slots, and weekend and evening hours delivers high return.
Fourth, web acquisition (symptom-plus-location SEO, map optimization, condition pages, end-to-end web booking) is the de facto standard, making content development from opening a precondition.
Fifth, position self-pay as secondary revenue alongside the core business, incorporating cosmetic needs such as skin tags, proprietary techniques, and examination comfort options without strain.
6. How an AI EMR addresses these problems — feature by feature
Patient acquisition in proctology depends on converting people who hesitate out of embarrassment or anxiety into actual visits — while running day surgery and endoscopy at high throughput. Here is how Pottech's AI Karte supports that, feature by feature.
Feature 1: Booking and reception — build the "no need to announce it" pathway into the system
In-person and online bookings are managed together, searchable instantly by name, phone number, or card number, with segmented slot management.
The dominant acquisition problem here is avoidance driven by embarrassment. Since a pathway that spares patients from announcing they came for proctology functions as acquisition infrastructure, web booking that does not require selecting a specialty, time-slot booking that avoids crowded waiting rooms, and women-only time slots are simultaneously patient service and revenue.
Because the model also runs day surgery and endoscopy at high throughput, managing surgery, endoscopy, and outpatient slots by duration is necessary.
Feature 2: Charting and orders — lower the pre-visit barrier through questionnaires
AI generates SOAP notes from consultation audio, and web and paper questionnaires are digitized by camera.
Online pre-visit questionnaires and symptom self-checks align with the "no need to announce it" pathway and can raise conversion to actual visits. Precisely because verbal description of symptoms carries strong resistance in this area, being able to enter them in writing beforehand matters. It also shortens explanation time in the consultation room, redirecting limited time toward examination and discussion.
Feature 3: Billing and claims — encode the insured/self-pay boundary
An automated calculation engine checks bundling conflicts, exclusions, and frequency limits, and determines eligibility automatically.
Self-pay here divides from insurance on medical indication versus cosmetic purpose: skin tags, proprietary techniques, endoscopy options. The same procedure can be insured or self-pay depending on the patient's condition, touching the prohibition on mixed billing directly. Encoding the distinction in the system protects both compliance and against lost opportunity.
As short-stay surgery base fee treatment shifts with the revision, keeping pace with rule changes is itself an operational burden.
Feature 4: Document generation — standardize surgical explanation and consent
AI generates medical documents from patient data, with registered templates preserving the clinic's format.
At facilities performing over 1,000 day surgeries annually, pre-operative explanation and consent documents scale with case volume. Hemorrhoidectomy, ALTA therapy, and fistula surgery each require different explanation, and self-pay proprietary techniques demand additional discussion of risks, costs, and alternatives. Standardizing surgical explanation, consent, and post-operative follow-up connects directly to revenue in this model.
Feature 5: Patient PHR app integration ("Pote-kun") — keep screening and surveillance cycles unbroken
OCR capture of prescriptions with medication reminders, appointment booking, and LINE login with push notifications.
Recall for colorectal cancer screening and polyp management is the core of recurring revenue here. Post-polypectomy surveillance runs on one- to three-year intervals, and relying on patient memory guarantees losses. A mechanism that keeps the screening → endoscopy → surveillance sequence unbroken stabilizes revenue.
In conservative hemorrhoid treatment, where lifestyle guidance and medication continuity determine outcomes, reminders also carry clinical meaning.
Feature 6: Integrations and APIs — connect endoscopy reports to the record
An OAuth2 gateway, MCP server, and HAPI FHIR enable integration with external systems.
Since preventing the missed diagnosis — "symptoms assumed to be hemorrhoids that turned out to be colorectal cancer" — is a core value of this specialty, unifying endoscopy findings with the clinical record so progression can be tracked bears on care quality itself. Holding polyp site, count, and pathology results in structured form also enables automatic calculation of the next surveillance date.
Primary sources
- Doctor Vision, "Summary of the FY2026 fee schedule revision" https://www.doctor-vision.com/dv-plus/column/trend/healthcarefee-point.php
- PRRISM, "Direction of the FY2026 revision on short-stay surgery base fee 3" https://www.prrism.com/newscolumns/10560/
- CLIUS, "Complete guide to opening a surgical or gastroenterological surgery clinic" https://clius.jp/mag/2026/07/01/geka-kaigyo-guide/
- CLINICS, "Is opening a surgical clinic difficult? Capital, income, and success factors" https://clinics-cloud.com/column/437
- CUC, "Opening a gastroenterology practice: revenue and income" https://www.cuc-jpn.com/cucap/24177/
- Hachioji Clinic Shinjuku (hemorrhoid day surgery: volumes, insured and self-pay pricing) https://hachicli.or.jp/shinjuku/
- Ivy Colorectal and Anal Clinic (women physicians, day surgery process, colonoscopy coordination) https://www.ivyclinic.jp/proctology/
- Hiroshima DS Endoscopy and Day Surgery Clinic (ALTA therapy and costs) https://www.touge-geka.jp/alta/