Roundtables

EL: Just as the Affordable Care Act presents challenges, it also creates oppor- tunities. e ex- changes are going to be looking for centers that provide cost effec- tive, efficient care with excellent outcomes. Centers that not only provide this type of care, but just as importantly, those that have the data to prove it, will be the ones with potential to benefit from the likely big numbers of new patients with insurance for the first time who need medical care. MN: I think we have to begin by looking at the missed oppor- tunities. Every- one has been very busy with colorectal cancer screening; there is no death of colonoscopy patients. But this isn't everything that can be of- fered. Internal marketing is an import- ant tool for boosting volume without bring- ing in more phy- sicians. Internal marketing has become a kind of mantra. Many physicians don't listen, but it is a key to success. You don't need to bring in new resources to main- tain this strategy. We empower our staff and teach them about the signs of other diseases. If a patient comes in for a colo- noscopy screening but mentions oand re- flux symptoms our staff can recognize this and bring it up with a physician. Frankly, this is just good patient care. If a patient comes in and mentions a family member has a problem, pay attention. Opportunities for further evaluation can be missed if you don't. Q: What are a few of the best value-added services for gastro- en- terologists to consider? Vera Denmark, MD, Medical Director of Inflammatory Bow- el Disease Re- search, Newton (Mass.) Wellesley Hospital: A lot of patients are looking for com- plementary and team approaches to care, such as care provided by case navigators, nutritionists or psychiatrists. We are starting to work closely with these providers. We have created a virtual center and regularly refer patients to nutritionists and psychiatrists. We regularly communicate with these pro- viders and discuss common patient goals. But, it would be great to bring all of these provid- ers under one roof. JG: e main thing that endosco- py centers can provide is adequate access for patients who require endoscopy services. is should be available in a timely fashion and at the lowest possible cost to the patient and the health- care system. Shawn Khodadadian, MD, Manhattan Gastroenterology, New York: Many gastroenterol- ogists have observed the field's shi towards procedural- ism. Some of the intricacies of the field are waning. Colonoscopy screen- ing awareness and demand has grown; though an important issue, physi- cians have focused more on procedures and less on functional issues. Functional gastroenterology includes service lines such as nutrition, irritable bowel disease management and women's GI health. We need to revisit the overall wellbeing of patients. e different specialties within GI are trying to clarify and expand their roles. EL: Pathology and anesthesiolo- gy services are still the best val- ue-added ser- vices for endoscopy centers. ere are many potential arrangements that are seen in- cluding direct employment of these physicians by the center and contracts with larger companies that supply these services. e endoscopy equipment sup- pliers are oen offering deep discounts in all kinds of ancil- lary equipment from cleaning machines to polyp snares when "If a patient comes in for a colonoscopy screening but mentions offhand reflux symptoms, our staff can recognize this and bring it up with a physician. Frankly, this is just good patient care." -Dr. Mark Noar Expanding GI Centers 3 reimbursement. These Stretta, practices and valu- number fructose. Phy- assistants and for safe, environ- patient as the Quality resources to single spe- efficiency. patients 48 to instructions, pre- keeping presched- slots by endoscopies are trying have dif- such as endoscopy cen- medication will doesn't even boost to func- to work satisfaction and EL: Clearly the best way for an endoscopy center to attract new physicians is, if possible, to offer them equity in the center. Nothing incentivizes physicians to draw volume to a center like financial ones. Outside of financial incentives, endoscopy centers should stress the increased efficiency that they offer. Most physicians not using endoscopy centers are doing their procedures in hospitals which are much less efficient in general. The number of cases which can be done in a given amount of time is far greater in an endoscopy center than in a hospital. In our current fee-for- service system where time is money, this is a huge incentive MN: Look at allied and compatible specialties. Pulmonologists and ENT phy- sicians are often treating symptoms of GERD, such as chronic cough and sinusitis. Many of these physicians do not have centers outside of a hospital. When putting together a coordinated approach to the diagnosis and treat- ment of reflux, it can be quite successful to partner with these physicians. They can perform procedures at the endoscopy center that will boost volume and revenue. For example, an ENT physician could perform transnasal en- doscopy, which generally takes five to 10 minutes to complete and does not require sedation. ES: High quality and efficient healthcare services, patient care, and opera- tions, including databases, will attract physicians. Q: What are a few ways endoscopy center physicians boost case volume without concentrating on physician recruitment? JG: Some novel approaches that we are doing here at The Ohio State Univer- sity Wexner Medical Center to boost physician case volume include; utiliza- tion of additional "swing rooms," having a queue of standby patients to back fill no-shows and cancellations, creative nurse workflow schemes to reduce room turnover time and Saturday endoscopy blocks for screening colonos- copies. EL: Obviously the work generated at endoscopy centers comes from patient office visits. Any single physician can generate only so much volume. Physi- cian extenders, both nurse practitioners and physician assistants, can really boost case volume. By seeing patients in the office, they directly generate cases for the supervising physician as well as free up office time for him/her allowing more time in the endoscopy center. Many centers are now opening earlier, closing later and working some week- ends. Patients are demanding these changes to better fit their busy schedules. In our evolving new world of efficiency, these are the type of patient-friendly changes that payers are going to want to see. n 35 Endoscopy Division of FUJIFILM Medical Systems U.S.A., Inc. is much more than a leading provider of state-of-the-art endoscopic technology for the gastroenterology and pulmonology markets. We offer affordable repair service and preventative maintenance agreements for effective and efficient operations. In addition, our Financial Services can create the perfect solution for any equipment, facility or expansion requirement regardless of the vendor you choose. FUJIFILM is dedicated to providing innovative endoscopic solutions in the medical field. www.fujifilmendoscopy.com

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