Issue link: https://beckershealthcare.uberflip.com/i/274954
10 f ive gastroenterologists discuss the current trends and challenges in gastroenterology and where the demand for colonoscopy and value- added services will head in the future. Q: What can Gi physicians do to ensure stability in the face healthcare reform changes? Lawrence B. Cohen, MD, Clinical Professor, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York: Gastroenterologists have become overly dependent upon colonoscopy for a disproportionate fraction of their revenue. We need to become more diversified in our prac- tices so that we are not as vulnerable to dramatic reductions in revenue if demand for colonoscopy is reduced by 50 percent or more. Other areas where there is significant room for growth by gastroenterologists include nutrition and bariatric services, women's GI health and GI oncology. Furthermore, gastroenterologists need to focus on the three core elements that are vital to any health service: quality, cost and access. We need to im- prove the overall quality of colonoscopic services and to demonstrate that quality through performance measurement. In addition to assessing the well- recognized measures of quality such as adenoma detection and cecal intuba- tion rate, appropriate recommendations for screening and surveillance must be captured in order to reduce overutilization. Cost constraints will certainly be felt as payers develop new models of pay- ment to rein in the costs of healthcare. Practices that provide endoscopic services cost-effectively will be the most successful in the next few years. Cost savings within endoscopy can be achieved through the increased uti- lization of mid-level providers for pre- and post-procedure patient man- agement, replacement of MD anesthetists with certified registered nurse anesthetists for the provision of sedation or reverting to conventional seda- tion using an opioid and midazolam to eliminate the cost of an anesthesia specialist altogether. Q: What do you think gastroenterologists need to be successful in the current healthcare environment? Edwin Levine, MD, GI Health Specialists/PriMed Physicians, Trumbull, Conn.: We are not controlling a large part of the healthcare dollar like ortho- pedics or cardiology, but gastroenterologists are an important part of pre- ventative medicine. Colonoscopy is a high volume test and it can save lives. We need continue to do it well but we also need to learn how to do it more efficiently. Bundled payments — where facility fees, gastroenterologist fees, pathology and anesthesia fees are all lumped into one payment — will be a large step forward. The most successful GI physicians will be those that figure out how to do their high volume procedures in a cost-efficient, high-quality manner. Q: What has your practice done over the past few years to keep up with the evolving healthcare environment? Dr. Levine: We have an endoscopy center and are able to control our costs there. We work closely with a pathologist and have discussed partnering with an anesthesiologist. We are working towards bundling payments. We are also working on quality initiatives. In colonoscopy, quality has be- come second nature. We are using quality benchmarks and documenting our withdrawal time and adenoma detection rates. This data can be used to pres- ent to insurance companies and negotiate savings. Q: Benchmarking can sometimes be a challenge for gastroenter- ologists. Are endoscopy benchmarks reliable? Thomas M. Deas Jr., MD, Gastroenterology Associates of North Texas, Fort Worth: If you complete the endoscopy reports correctly, the information will be pretty reliable. However, if you don't document correctly and don't indi- cate polyps are found, the reported data won't be accurate. We've found our system quite reliable and once you are in the habit of getting all information put into the report, it's easy to see the benefits. We've actually seen a steady improvement by all group physicians in ade- noma detection, prep quality and other measures by tracking and bench- marking outcomes. Knowing this information allows you to make changes and become better. It's not unlike similar practices in athletics. Runners time themselves and want to improve on their personal best. Physicians want to improve in the same way. Q: how can gastroenterologists tell whether their process im- provement makes a difference? Dr. Deas: They can continue to benchmark. One example is with adenoma detection rate: there is a broad range of performance levels there. Some phy- sicians have a 45 percent to 50 percent adenoma detection rate. They have good visualization skills and identify small polyps with a skill set that others don't have. At the other end of the spectrum, you have physicians that have an ADR of 15 percent. They need to find ways to improve that. One way to improve adenoma detection is by taking longer to examine the colon, but that doesn't always solve the problem. Sometimes better bowel preparations are necessary. They can learn better technique by watching oth- er physicians and seeing how they examine behind folds and are more me- ticulous in examining the colon mucosa for polyps. You aren't going to spend time to do that if you don't have a measure showing you are substandard. We all want to get better, but we need the feedback that tells us when we need to improve. GI Centers of the Future: Forecasting Colonoscopy Demand, Value-Added Services By Anuja Vaidya and Carrie Pallardy "in colonoscopy, quality has become second nature. We are using quality benchmarks and documenting our withdrawal time and adenoma detec- tion rates. This data can be used to present to insurance companies and negotiate savings." — Dr. Edwin Levine