Becker's ASC Review

31 Executive Briefing: Sponsored by: T wo years ago, when Mississippi-based gastroenterologist Dr. Reed Hogan, M.D. suggested adding nonalcoholic fatty liver disease (NAFLD) as a comprehensive ancillary service to the physicians at his practice, they nearly laughed him out of the room. Now, Dr. Hogan and his colleagues at GI Associates and Endoscopy Center (GIA) — comprised of three locations in Flowood, Madison and Vicksburg — have added services to treat a disease that has a $103 billion economic impact and affects 100 million Americans. When Dr. Hogan made his proposal to establish a NAFLD/ metabolic syndrome comprehensive ancillary, why were his GIA partners laughing? It comes down to reimbursement and the scope of practice because GI docs think about endoscopy first as their backbone to financial survival. A FibroScan examination to find a patient with fatty liver made GIA approximately $33 each. The low margin is unattractive to primary and specialty care providers throughout our country. The disease is care-intensive and offers little monetary incentive at face value. When left unaddressed, NAFLD leads to increased complication rates, more severe chronic conditions and is an underlying factor in liver-related fatalities. The low reimbursement rate for NAFLD services had created a treatment desert for the condition in the US healthcare system and intense demand for care. Today, Hogan and his colleagues have discovered far better treatment for their patients and a very profitable revenue source by embracing a comprehensive approach for NAFLD. "It's just an unbelievable ancillary," says Dr. Hogan. "It wouldn't have been possible if it wasn't for the Chronic Liver Disease Foundation (CLDF). The Foundation approached the practice looking for help to screen high-risk patients, identify those at risk for nonalcoholic steatohepatitis (NASH) and fill the CLDF registry database to help fill the current FDA NASH studies. The Foundation provided a FibroScan for GIA to use and the patients soon followed. The big catch was that the practice would be providing the care for free, in exchange for the temporary use of the FibroScan." In the first month, GIA screened 180 patients. Demand remained strong through the second and third months, and Dr. Hogan realized the practice would see 500 patients within the first few months, easily blowing past the goal of the entire campaign before the year was over. Dr. Hogan projected what the potential earnings would be if the organization could charge for the services with the current demand and decided to return the machine early. The Foundation was devastated, but Dr. Hogan didn't let them stew for long. GIA purchased a FibroScan and began seeing NAFLD patients, billing for services on a permanent basis and filling up the CLDF registry. "At first, my CEO and all partners thought I was crazy," Dr. Hogan said. "But that changed in the first year." After designing an algorithm for NAFLD screening, GIA performed 1,800 examinations with FibroScan in the first year of the program and 2,800 in the second year. Now, two years into offering the scans, the practice has an annual profit margin of more than $100,000 from the FibroScan piece of their ancillary. No one is laughing now. In fact, GIA recently acquired a second FibroScan. Once that machine becomes operational, with the added influx of patients to Chronic Care Management (CCM), NAFLD clinic, and research, Hogan estimates the practice will make $500,000 in profits, and eventually surpass more than $1 million. Not only is GIA experiencing fiscal benefits from its NAFLD program, but the organization is also providing a valuable service to its community where viable treatment options for the chronic condition have traditionally been scarce. "I never wanted to fill my clinics up with fatty liver patients, and now I'll take any fatty liver patient you find because I want to give them better care than they could otherwise find in our community," Dr. Hogan said. FibroScan's role in CCM NAFLD's reach stretches far beyond the borders of Mississippi. An estimated 100 million Americans have NAFLD. There is no simple treatment available. When left unaddressed NAFLD patients can develop NASH, which currently affects 25 million Americans. NASH is rapidly becoming the leading cause of liver transplants and hepatocellular carcinoma. As NASH case rates have increased, liver transplant rates have risen 68 percent over the last decade. FibroScan measures the fibrosis and steatosis of the liver and provides simplified readings that can be used to track changes in a patient's liver and inform future treatments. While finding fibrotic NASH is important to address liver disease, patients with steatosis alone are at greater risk of cardiovascular mortality and morbidity. For these patients, FibroScan has become the centerpiece of the GIA CCM plan, which is subsidized by Medicare and has been shown to reduce costs and improve outcomes in this population. Unfortunately, CCM is vastly underutilized in our population by our primary care providers. In the GI setting, where the volume of NAFLD / metabolic syndrome patients is overwhelming, the profitability of CCM really drives this ancillary. The most profitable ancillary you've never heard of — Why NAFLD is the income repair solution your practice needs

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