Becker's ASC Review

32 GASTROENTEROLOGY How to protect physician autonomy as GI consolidates By Patsy Newitt B enjamin Levy III, MD, a gastroenterologist at University of Chicago Medicine, joined Becker's to discuss strategies to safeguard physician autonomy as gastroenterology practices undergo increasing consolidation. Editor's note: This interview was edited lightly for clarity and length. Question: What are the biggest challenges in preserving physician autonomy and leadership within GI practices as consolidation accelerates? Dr. Benjamin Levy: The biggest challenge to preserve physician autonomy is to make sure that several Gastroenterologists are placed in advisory leadership positions – and that companies listen and implement their GI advice. It's important for vertically integrated payer- provider organizations and private equity owned groups to maintain leadership with a diverse representation of Gastroenterologists, each with a different strength: years of experience, public health background, business background (perhaps someone with a MD, MBA), interest in cutting-edge technology, artificial intelligence, data science, and ethics. Including input from Gastroenterologists is the most ideal way to lead an organization together with the company's business and management leaders. When Gastroenterology practices increase in size, physicians may start to feel like a number – especially when they aren't well-represented on management committees. Consolidation could place physicians at risk for feeling constrained by cost-containment strategies and requirements to hit productivity benchmarks. Vertically integrated payer-provider organizations might dictate specific referral pathways within their own network. Furthermore, physicians may feel at risk-for feeling rushed if organizations start prioritizing productivity in a cookie-cutter manner by overscheduling. It's important to note that some physicians are slower due to keyboarding skills or being thorough – and shouldn't be rushed; instead organizations should appreciate the exceptional care they are providing. Physicians should feel like they are a contributing decision maker – and not just an employee in a group. There is a potential risk for Gastroenterologists to feel burned out when they become the worker-bees and don't have a leadership voice. n How consolidation is reshaping GI practices By Patsy Newitt As healthcare giants like Optum move to acquire gastroenterology groups, the landscape of GI care is rapidly evolving. Benjamin Levy III, MD, a gastroenterologist at University of Chicago Medicine, joined Becker's to discuss how consolidation is reshaping practice operations. Question: How do you see acquisitions like Optum's shaping the future of gastroenterology practices, particularly in terms of integration with larger health insurance and ASC ecosystems? Dr. Benjamin Levy: When organizations like Optum acquire gastroenterology practices, there is potential to make medical care and business more efficient. Vertically integrated payer-providers can accelerate the prior-authorization process for endoscopy procedures at ASCs and hospitals. Acquisitions can streamline referrals from primary care physicians too. ere is potential to direct procedural volume towards ASCs that are owned by the parent organization. When insurance-owned companies or private equity purchases gastroenterology groups, practice sizes tend to increase with goals to maximize procedural volume too. Consolidation may enable better data analytics with the goal of making medicine more efficient. Claims and databases can be used to help compete and benchmark against peers. For ASCs, organizations like Optum can better negotiate bulk purchase of endoscopy equipment including scopes, snares, forceps, and endoscopy reprocessing products. However, physicians have the potential to lose autonomy if they are not well represented on the administrative leadership teams. Gastroenterologists in small markets might feel pressure to join these consolidated umbrella groups/networks to avoid being excluded from primary care referrals. ere is also a potential for vertically integrated payer-provider organizations to reduce physician compensation in these tightly controlled businesses where stockholders are an important part of the equation. It's unclear what effect consolidation will have on quality of care — I think that depends on how involved gastroenterologists remain in leadership positions for the practice. Physician input is critical to make sure that Gastroenterologists can practice unhurried and are not being rushed to see more patients in clinic and on procedure days. For instance, we are now encouraging gastroenterologists to maintain an 8-9 minute withdrawal time instead of 6 minutes to improve adenoma detection rates, especially since we are encountering more polyps in patients at earlier ages. Consolidation may allow organizations like Optum to better leverage lower pricing for purchasing artificial intelligence technologies for use during endoscopy such as natural language processing (using AI to document polyp location, size, and descriptions in real-time during procedures). Consolidation may help gastroenterology practices and ASCs obtain better purchasing power for artificial intelligence like GI Genius that uses computer-aided detection to highlight potentially harder to see polyps with a box. I predict that the accuracy of these AI technologies is going to improve substantially over the next few years. n

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