Becker's ASC Review

32 Executive Briefing: The practice uses FibroScan in screening of high-risk patients with a BMI over 30, Type 2 diabetes, dyslipidemia, hypertension, elevated fatty liver triglycerides or displays fatty liver on imaging, and then, depending on their CAP score, proceeds appropriately. A score under 240 is generally fine unless liver function tests come back abnormal, and these patients generally have no follow-up appointments at GIA. Patients with CAP scores higher than 240 are channeled into two treatment pathways: 1. CAP scores between 240-270 are funneled into a fatty liver disease pathway. The pathway largely centers around implementing a healthy weight loss plan, cutting alcohol and providing education on diet and exercise with the goal to lose one pound per week. In six months, the patient repeats the FibroScan and continues on the weight loss plan. 2. CAP scores over 270 and elevated stiffness are evaluated for the practice's research programs, which are supported by clinical trials. Dr. Hogan believes that despite the value of the GIA CCM program, primary care physicians (PCPs) at-large are reluctant to buy into similar programs. In a Quest Diagnostics survey: 77% of PCPs said they did not try a CCM program at their practice; 43% said reimbursement was too low; 37% said the documentation work was too burdensome; and 23% criticized the reimbursement rate. While some PCPs have bought into the CCM programs, these providers see on average 47 patients, with a median number of 10 patients per PCP. GIA, on the other hand, has put at least 1,000 patients through its CCM program since its inception. Dr. Hogan attributes the high enrollment number to the resources GIA uses for each patient, stating, "Primary care doctors are not being rewarded for CCM programs so there's no way they're going to push for them. They are so busy and overwhelmed, they cannot get their heads around the entire issue. Their care tends to be crisis-to-crisis. While the focus on NAFLD with metabolic syndrome is often outside the usual PCP's practice, this ancillary fits perfectly in the GI physicians' wheelhouse, if the processes are in place to efficiently provide the services." He adds that even GIA needed help with their program, contracting with MetaPhy Health, a physician services group focused on assisting gastroenterologists with their efforts to manage NAFLD patients. Like most other groups, GIA found it impossible to set up a CCM program in house due to the complexity needed for comprehensive care. Working collaboratively with MetaPhy, GIA developed a CCM program that took the cost of development out of their office, rapidly turning it profitable. Without MetaPhy and FibroScan, the GIA CCM program wouldn't have been as successful. Why NAFLD should be the centerpiece of a gastroenterology practice As evidenced by the booming CCM ancillary and the number of enrolled patients, the GIA program for fatty liver patients has been successful to date. Nationwide, CCM programs are also booming. According to research from the Mathematica Policy Research Group, patients that went through CCM programs were: • Hospitalized at lower rates • Used fewer emergency services • Cost CMS $95 less per month • Saved CMS more than $38 million annually "I honestly believe that in the very near future, this may be our best ancillary," Dr. Hogan says. "It may be better than pathology. It may be better than endoscopy." The data backs up that claim. When comparing projected revenues from separate cohorts of 10 patients over a 10- year period that received a colonoscopy or entered the CCM program, the returns are significant. For CCM patients, the 10-year-rolling revenue estimate was $95,110. With respect to profit, the colonoscopy group generated $18,000 in profit to the CCM pathways' $37,000. The bottom line: what would have gotten a gastroenterologist laughed out of a room five years ago is quickly becoming a quintessential aspect of a gastroenterology practice and one that cannot be ignored. While the financial returns are encouraging, patients have the most to gain from this pathway. "If you simply look at patient care, we as GI doctors can change the game for these underserved patients," Dr. Hogan said. "We can provide unavailable healthcare pathways that will improve outcomes and save lives. And in these times of decreasing reimbursements and the desire for income repair, this ancillary is a no-brainer for the GI profession. This is in our wheelhouse." Reed B. Hogan is a practicing gastroenterologist at G.I. Associates and Endoscopy Center in Flowood, Mississippi. Dr. Hogan received his a Doctor of Medicine at the University of Mississippi School of Medicine and completed a fellowship in gastroenterology at Baylor University Medical Center. He is board certified in internal medicine and gastroenterology. Dr. Hogan has been recognized as one of the Best Doctors in America®: 1996-2018. Dr. Hogan has previously served as clinical assistant professor of medicine at the University of Mississippi School Of Medicine and is chairman of the American Society of Gastrointestinal Endoscopy special interest group for Ambulatory Endoscopy Centers and has served on the practice management committee for ASGE. Dr. Hogan has also been listed in the 2012 Beckers' "The 125 Gastroenterologists to Know." Dr. Hogan is a medical consultant for MetaPhy. Echosens, the developer of FibroScan, offers a full range of products and services supporting physicians in their assessment and management of patients with chronic liver diseases. FibroScan is supported by over 2,500 peer reviewed publications and examinations are covered by Medicare, Medicaid and many insurance plans. For more information, please visit http://www.echosens.us and follow us on Twitter (@echosensNA).

• Cover