Becker's ASC Review

39 Gastroenterology Q: How can gastroenterologists improve profitability at their endoscopy centers? DG: Gastroenterologists can improve profitability at endoscopy centers by focusing on high-quality practices. Such practices ensure that all procedures are done for indicated reasons, and are completed in a way that aligns with accepted quality metrics. BB: Quality measurement and its codification through utilizing registries such as GIQuIC in conjunction with patient satisfaction surveys can successfully be utilized to negotiate with in- surance carriers. Demonstrating high patient satisfaction and compliance with screening and surveillance intervals can translate into enhanced reimbursement when put in the proper context. BC: Employee costs can be controlled by proper staffing models. One such model utilizes very few full-time employees that are supplemented by part-time and PRN staff. This model reduces em- ployee benefit costs. Efficient staffing in the pro- cedure room, either with a CRNA supplemented by a medical assistant or a single RN monitoring the patient's vital signs with a shared medical as- sistant between two rooms, decreases the overall number of employees and therefore the cost. Disposable equipment costs can be mitigated by large yearly purchases whose sale price can be deeply discounted. MC: Increase volume to offset any [reimburse- ment] reduction. Try to recruit new physicians or bring more volume into the center. In-service primary care physicians to make them aware of appropriate testing and community awareness programs, such as colon cancer screening. Aware- ness programs for primary care and GYN physi- cians should be considered. Communicate with office schedulers the importance of early notice of planned time off that might leave blocks open in the future. Patients should be asked if they wish to be placed on a priority list if availability in the physician's schedule arises. Patients on the prior- ity list are contacted until one fills the gap. Utilization rates must be evaluated. In the morn- ing, utilization is greater than the afternoon. It is very important to examine whether one is run- ning rooms at lower utilization. It may be wise to take the less-profitable cases to the hospital or another venue and have the option to fill that slot with more profitable cases. Sometimes slightly overbooking the schedule may be helpful since one can usually count on one or two patients ei- ther canceling or not showing. Customize physi- cians' blocks to enhance utilization. Some physi- cians are faster at the same level of quality than others. Of course the two most important objec- tives are patient safety and quality medicine. They must not be sacrificed for profitability. DJ: Practices will have to fully understand their costs and carefully evaluate implications of in- volvement in any integrated care delivery system. It will be extremely important to analyze referral lines and the potential impact if the practice was to be involved or chose to not be involved. Em- phasis on marketing high quality, low cost, safety and patient satisfaction will be extremely impor- tant as payment models are developed around value based purchasing. Developing systems to track these within the endoscopy centers will be key. Additionally, programmatic analysis to gain efficiency and eliminate waste will be essential for improvements in profitability. Q: How can ASCs work with insurance companies for better reimbursement rates? MC: Approach carriers for ways to enhance re- imbursement. Examine the contracts with third party payers. Any rate increases that can be ne- gotiated will help offset increases in expenses and decreases in governmental reimbursement. BC: Reimbursement rates can actually go up if endoscopy centers negotiate from a position of strength documenting quality with a robust qual- ity registry such as GIQuIC and using the cur- rent difference between ASC and HOPD rates to your advantage. Our center recently received an increase in its facility fee from a major national insurer by demonstrating an increase in the per- centage of their insured patients who had proce- dures in the ASC, rather than the HOPD. Q: How can gastroenterologists address market competition and give their endos- copy centers a competitive edge? BC: In the current landscape, endoscopy has increasingly become a commodity. In order to distinguish yourself and your endoscopy center from others, you will need to demonstrate the highest quality as measured by an independent entity (for instance the GIQuIC registry) while at the same time improving patient satisfaction and outcomes. Personal attention, ease of scheduling, and pre-and post-op experience go a long way in distinguishing your center. Meeting quality measures and making them avail- able publicly to both your patients and your refer- ring physicians can also distinguish your endos- copy center from its competition. It is important to find opportunities to optimize and publicize the benefits that your center offers patients, refer- ring physicians and third party payers. MC: High quality improves endoscopy through better performance and patient satisfaction. Per- formance data can be used as a bargaining chip with insurers to get reimbursement increases for meeting specific targets. Quality tracking to detect inefficiencies and devise methods for im- provement will produce savings. Quality indica- tors such as arrival to patient in room, patient in room to time-out, time-out to scope-in, scope- in to scope-out, scope-out to recovery start, re- covery start to discharge, and polypectomy de- tection rate can be evaluated and addressed to improve both quality and efficiency. DJ: With full understanding of the costs for pro- viding services and maximizing endoscopy cen- ter efficiency, physicians are in a position to bet- ter address where they can participate in various healthcare markets. Developing a high quality reputation with emphasis on low cost, as well as high levels of patient satisfaction will be key. There will be an increased demand for transparency in all aspects of the care delivery. This will ultimately mean sharing specific outcome data with payers and the public alike. Participation in national reg- istries (e.g. GIQuIC) will be key for comparative benchmarking in value and outcomes. Q: Are there any under-utilized services that endoscopy centers can add to boost case volume and improve profitability? BB: Some procedures that centers may not realize are profitable include endoscopic ul- trasound. While slightly more labor intensive Surgery Center Development and Management The Trusted Partner of Physicians and Hospitals For over 15 years Constitution Surgery Centers has operated efficient, convenient ambulatory surgery centers that provide exceptional quality in patient care while delivering robust financial returns and practice benefits for our physician and hospital partners. In today's challenging marketplace, Constitution's expertise can make a real difference in your center's success. 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