Roundtables

GI Centers of the Future: Forecasting Colonoscopy Demand, Value-Added Services By Anuja Vaidya and Carrie Pallardy F ive gastroenterologists discuss the current trends and challenges in gastroenterology and where the de- mand for colonoscopy and value-add- ed services will head in the future. Q: What can GI physicians do to en- sure stability in the face healthcare reform changes? Lawrence B. Cohen, MD, Clinical Professor, Department of Medicine, e Icahn School of Medicine at Mount Sinai, New York: Gastro- enterologists 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 gas- troenterologists 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 qual- ity of colonoscopic services and to demonstrate that quality through performance measurement. In addi- tion 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 overutili- zation. Cost constraints will certainly be felt as payers develop new models of pay- ment to rein in the costs of health- care. Practices that provide endoscop- ic 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 conven- tional seda- tion using an opioid and midazolam to eliminate the cost of an anesthesia specialist altogether. Q: What do you think gastroenter- ologists need to be successful in the current healthcare environment? Edwin Levine, MD, GI Health Spe- cialists/PriMed Physicians, Trum- bull, Conn.: We are not controlling a large part of the healthcare dollar like ortho- pedics or cardiology, but gas- troenterologists are an important part of preventative medicine. Colonos- copy 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 pathology and anesthesia fees are all lumped into one payment — will be a large step forward. e most successful GI physicians will be those that figure out how to do their high volume procedures in a cost-effi- cient, high-quality manner. Q: What has your practice done over the past few years to keep up with the evolving healthcare environ- ment? 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 ini- tiatives. In colonoscopy, quality has be- come second nature. We are using quality benchmarks and documenting our withdrawal time and adenoma detection rates. is data can be used to pres- ent to insurance companies and negotiate savings. Q: Benchmarking can sometimes be a challenge for gastroenter- ol- ogists. Are endoscopy benchmarks reliable? omas M. Deas Jr., MD, Gastro- GI Centers of the Future 2 "We need to make sure that all quality measures translate into value for our patients and referring physicians understsand that value." -Dr. Colleen Schmitt

• Cover