Roundtables

Seven Gastroenterologists Discuss How to Expand GI Centers By Carrie Pallardy Seven gastroenterologists discuss the biggest challenges and oppor- tunities in GI field expansion. Question: What is the biggest challenge for gastroenterologists working to expand their prac- tices or endoscopy centers this year? J. Royce Groce, MD, Medical Director of Endoscopy, e Ohio State Uni- versity Wexner Medical Center, Columbus: e biggest challenge for gastroenter- ologists working on expanding an endoscopy center this year is navigating the changing climate of healthcare reimbursement. As we are moving from a pay-for-service to a pay-for-performance model, there is vast uncertainty about how this will impact endoscopy practices. is will be a difficult time for hospital-based endoscopy centers, as they will have to adapt to provide the same excellent medical care at a lower cost to the healthcare system. Edwin Levine, MD, GI Health Specialists/PriMed Physicians, Trumbull, Conn.: As always reimbursement cuts from Medi- care and commercial insurers will remain big challenges. Both are expecting and demanding im- provement in efficiencies and endoscopy centers need to prepare for this. In addition, regulations continue to increase. Benchmarks and quality measures are becom- ing mandatory. Finally, with the implementation of the Affordable Care Act comes a lot of unknowns including unknown reimburse- ment rates and unknown effects on volume. Mark Noar, MD, Director of e Endoscopy Center, Towson, Md.: I think the answer to that is reimbursement. Gastroenterology is one of the few spe- cialties that has recently been listed as having increasing income. is is a red flag for a government looking to save money. It is clear that cuts are taking place. Rather than external expansion, gastroenterologists should look internally for ways to better use overhead time we are already paying for. Ellen Scherl, MD, Director of e Roberts Center for Inflam- matory Bowel Disease, Weill Cornell Medical College, New York: e biggest challenge is re- imbursement and adequate space. Q: What are a few of the biggest opportunities for Gi practice and endoscopy center expansion? Brett Bernstein, MD, Director of East Side Endoscopy, Manhattan, N.Y: With regard to expansion I believe that there is ample oppor- tunity to continue ramping up screening rates for colon cancer. Screening colonoscopy is widely regarded as the gold standard for prevention and early detection. Utilization of trained patient nav- igators in the private practice set- ting or ASC is an efficient, cost-ef- fective way of driving additional colonoscopies into your practice through ensuring adequate edu- cation and patient engagement is performed prior to the procedure. e major GI societies including the ASGE, AGA and ACG also have excellent marketing and edu- cational resourc- es for physicians to successfully recruit screening exams into their practices. JG: Because ambulatory endosco- py centers can generally run more efficient- ly and at a lower cost, there will be a push to perform most of the routine screening en- doscopies in this setting. In addi- tion, the fact that reimburse- ment will be contingent on the quality of the service that is performed should allow for greater oversight and improvement of endoscopy quality. Expanding GI Centers 2 are reimbursed well and you do not need to fight for reimbursement. tests allow physicians to recommend a surgical procedure, such as Stretta, medication, LINX or a number of other treatments for GERD. Irritable bowel syndrome and inflammatory bowel disease offer practices and endoscopy centers the opportunity to add a number of simple and able services. Hydrogen breath testing is a simple way to diagnosis a number of GI issues, such as bacterial overgrowth or inability to digest fructose. sicians do not even need to perform this procedure. Physician assistants nurses can perform this ancillary testing, decreasing the cost. ES: High-quality endoscopy in an ambulatory care setting provides for effective and efficient procedures within a comfortable, friendly environ- ment. Personable and highly skilled staff will improve practice and outcomes. This will establish quality improvement initiatives such American College of Gastroenterology's GIQuIC (Gastrointestinal Quality Improvement Consortium). Q: how can endoscopy centers maximize time and resources boost revenue? BB: As the director of Eastside Endoscopy, a Manhattan-based single cialty endoscopy center, we are always looking for ways to enhance efficiency. During down time, nurses are utilized to make pre-calls to patients 72 hours in advance of procedures to review preparation instructions, populate the EHR with historical data and ensure patients plan on keeping appointments. If patients are identified who are not planning on coming to their presched- uled appointment, our manager aggressively attempts to fill those slots reaching out to other physicians by phone and electronically. MN: We consign hours, generally a three-hour period when no endoscopies are being performed, in the afternoon for infusion work. Payers are to drive this kind of procedure out of the hospital so often patients have ficulty finding an infusion center. An ASC already has the beds and IV pumps needed for infusions, such Remicade or infusions for multiple sclerosis patients. If your endoscopy ter becomes an infusion center, the companies making the medication place you on a list of centers posted on their websites. The center doesn't need to spend time marketing directly. Q: how can endoscopy centers attract new physicians to case volume? JG: The best way to attract new physicians is for endoscopy center to tion in an operationally efficient manner. This allows the physicians to at their optimum capacity, increases physician and patient satisfaction allows for improved case volumes. The Endoscopy leading pulmonology agreements Team can regardless endoscopic

• Cover