Becker's ASC Review

30 GASTROENTEROLOGY Private practice at- tracts physicians with an 'appetite for risk,' gastroen- terologist says By Patsy Newitt I n the current healthcare climate, only physicians who are willing to risk the comforts of employment will turn to private practice, according to Gabriel Ionescu, MD. Dr. Ionescu, a gastroenterologist at Wyckoff Heights Medical Center in New York City, spoke with Becker's ASC Review about what is drawing physicians to private practice. Question: What needs to change so more physicians can open private practice? Dr. Gabriel Ionescu: e current employment model will drive the talented physicians with a bit of appetite for risk to private practices. e challenge is that each physician is trad- ing in a comfortable [employed] position, albeit with limited autonomy, for potential financial risk. Keeping a practice open will take more effort to comply with government regulations and reporting, so reducing the burden may help. Unlike employment, an independent physician will have to take more charge of the customer service and management aspects. is may affect work-life balance in the short term; long-term survival will depend upon creation of avenues for passive income, although this may be challenging in certain states in which regulations may empower hospitals over smaller practices on building ancillaries such as ASCs. Ultimately, insurers may need to step in, as care in an ASC is cheaper than in the hospital for the majority of private prac- tice patients. Eventually, building and monetizing the equity of the practice should be enough to incentivize physicians to seek alternatives to employment. Q: What is physicians' biggest enemy in providing great patient care? GI: Burnout is a problem interfering with patient care. e largest contributor to burnout likely is the EMR. Although quick data-gathering is great, the order entry and execution at the team level must be flawless to ensure patient satisfac- tion and great clinical outcomes. It rarely works out in the big systems where the executing teams are overstretched and not always knowledgeable about the care coordination pro- cess and the customer service and communication aspects. In addition, the countless hours spent on managing the EMR correspondence, which has to do more with liability manage- ment than patient care, will drive the employed physicians out. e administrators come in a close second, by way of completely ignoring physicians' need for flexibility in patient and time management, thus driving physician burnout. Physicians will look for more autonomy, and if the hospital systems are unwilling to reduce micromanaging, the talent will migrate to private practice or exit medicine altogether. n The financial burden of colonoscopies amid rising CRC cases By Patsy Newitt R ising labor and supply costs paired with declining re- imbursements are making colonoscopy unattractive for many gastroenterologists, drawing concern from many amid a rise of advanced stage colorectal cancer. There was a significant increase in advanced stage colorectal cancer and precancerous growths in adults of all ages in 2021, according to recent data from Nashville, Tenn.-based AmSurg. The company attributed the increase to patients delaying care during the COVID-19 pandemic. More than 200,000 Ameri- cans are reported to have missed colonoscopy appointments since the pandemic began. But this increase in colorectal cancer diagnosis comes as many gastroenterologists are encountering declines in reimburse- ments for colonoscopies, particularly for Medicare and Medic- aid patients. "Especially if the procedure is complex and prolonged, we are left with a situation where [the reimbursement] just about covers the overhead costs, " Curuchi Anand, MD, a gastroen- terologist affiliated with UMass Memorial Health in Worcester, Mass., told Becker's. "I still continue to provide care as a ser- vice to the patients, but in the future may need to stop or limit access to these patients. " While the volume of commercial patients is enough to sustain his practice financially, Dr. Anand said he has to work 60 hours a week because the 20 extra hours is worth more than what he gets paid by CMS. Colorectal cancer is the second leading cause of cancer- related death in the U.S. in men and women combined, and gastroenterologists say a decline in reimbursements will cost payers more in the long run. "CMS needs to realize that early endoscopy is valuable in preventing downstream morbidity to the patient and down- stream cost to the overall healthcare system if diagnoses are made at later stages, " Omar Khokhar, MD, gastroenterologist in Bloomington, Ill., told Becker's. There's another danger to gastroenterology practices as well — noninvasive procedures. Gastrointestinal practices rely heavily on colonoscopies, and new devices could bring down those volumes. "There is concern that the option of noninvasive tests will reduce the volumes, " said Aasma Shaukat, MD, director of outcomes research in NYU Langone Health's division of gas- troenterology and hepatology in New York City. "However, the other side is that it may overall improve CRC screening and bring more people for diagnostic colonoscopy, and expand the pool of surveillance colonoscopy over time. " n

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