Roundtables

new contracts come due with the centers. ese discounts can have a big impact on the bottom line. MN: ere are a number of areas that you can look to for adding ancillary in- come. Ancillary procedures also have the benefit of providing more compre- hensive patient care. For example, hem- orrhoidal banding is very inex- pensive and effective. is proce- dure can be brought to ASCs and practices. Reflux is another important area. ere is an excess of 50 million people in the U.S. that have GERD. is is a huge patient base. ere are many tests that a practice or endoscopy center can add for the diagnosis of reflux. For example, there is esophageal manometry, pH testing and Restech. ese tests are reimbursed well and you do not need to fight for reimburse- ment. ese tests allow physicians to recommend a surgical proce- dure, such as Stretta, medication, LINX or a number of other treat- ments for GERD. Irritable bowel syndrome and inflammatory bowel disease offer practices and endoscopy centers the opportunity to add a number of simple and valu- able services. Hydrogen breath testing is a simple way to diagnosis a num- ber of GI issues, such as bacterial overgrowth or inability to digest fructose. Phy- sicians do not even need to perform this procedure. Physician assistants and nurses can perform this ancillary testing, decreasing the cost. ES: High-quality endoscopy in an ambulatory care setting provides for safe, effective and efficient procedures within a comfortable, friendly environ- ment. Person- able and highly skilled staff will improve practice and patient outcomes. is will establish quality improvement initiatives such as the American College of Gastroenterology's GIQuIC (Gas- trointestinal Quality Improvement Consortium). Q: how can endoscopy centers maximize time and resources to boost revenue? BB: As the director of Eastside Endoscopy, a Manhattan-based single spe- cialty endoscopy center, we are always looking for ways to enhance efficiency. During down time, nurses are utilized to make pre-calls to patients 48 to 72 hours in advance of procedures to review preparation instructions, pre- pop- ulate the EHR with historical data and ensure patients plan on keep- ing appointments. If patients are identified who are not planning on coming to their presched- uled appointment, our manager aggressively attempts to fill those slots by reaching out to other physicians by phone and electronically. MN: We consign hours, general- ly a three-hour period when no endoscopies are being performed, in the aernoon for infusion work. Payers are trying to drive this kind of procedure out of the hospital so oen patients have dif- ficulty finding an infusion center. An ASC already has the beds and IV pumps needed for infusions, such as Remicade or infusions for multiple sclerosis patients. If your endoscopy cen- ter becomes an infusion center, the companies making the medication will place you on a list of centers posted on their websites. e center doesn't even need to spend time market- ing directly. Q: how can endoscopy centers attract new physicians to boost case volume? JG: e best way to attract new physicians is for endoscopy center to func- tion in an operationally efficient manner. is allows the physicians to work at their opti- Expanding GI Centers 5 are reimbursed well and you do not need to fight for reimbursement. These tests allow physicians to recommend a surgical procedure, such as Stretta, medication, LINX or a number of other treatments for GERD. Irritable bowel syndrome and inflammatory bowel disease offer practices and endoscopy centers the opportunity to add a number of simple and valu- able services. Hydrogen breath testing is a simple way to diagnosis a number of GI issues, such as bacterial overgrowth or inability to digest fructose. Phy- sicians do not even need to perform this procedure. Physician assistants and nurses can perform this ancillary testing, decreasing the cost. ES: High-quality endoscopy in an ambulatory care setting provides for safe, effective and efficient procedures within a comfortable, friendly environ- ment. Personable and highly skilled staff will improve practice and patient outcomes. This will establish quality improvement initiatives such as the American College of Gastroenterology's GIQuIC (Gastrointestinal Quality Improvement Consortium). Q: how can endoscopy centers maximize time and resources to boost revenue? BB: As the director of Eastside Endoscopy, a Manhattan-based single spe- cialty endoscopy center, we are always looking for ways to enhance efficiency. During down time, nurses are utilized to make pre-calls to patients 48 to 72 hours in advance of procedures to review preparation instructions, pre- populate the EHR with historical data and ensure patients plan on keeping appointments. If patients are identified who are not planning on coming to their presched- uled appointment, our manager aggressively attempts to fill those slots by reaching out to other physicians by phone and electronically. MN: We consign hours, generally a three-hour period when no endoscopies are being performed, in the afternoon for infusion work. Payers are trying to drive this kind of procedure out of the hospital so often patients have dif- ficulty finding an infusion center. An ASC already has the beds and IV pumps needed for infusions, such as Remicade or infusions for multiple sclerosis patients. If your endoscopy cen- ter becomes an infusion center, the companies making the medication will place you on a list of centers posted on their websites. The center doesn't even need to spend time marketing directly. Q: how can endoscopy centers attract new physicians to boost case volume? JG: The best way to attract new physicians is for endoscopy center to func- tion in an operationally efficient manner. This allows the physicians to work at their optimum capacity, increases physician and patient satisfaction and allows for improved case volumes. EL: Clearly the best way for an endoscopy center to attract new physicians 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 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 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 The 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 Team 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 "Many centers are now opening earlier, closing later and working some weekends. 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." -Dr. Ellen Scherl

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