Demand for GI/endoscopy procedures and care is projected to rise and innovative technology continues to reshape the specialty, yet gastroenterologists face a mounting set of obstacles. From declining reimbursement to dwindling time for patient care, practice as it is today is becoming increasing untenable. Change is inevitable, but how can gastroenterologists take control of that change and carve out a viable future in medicine?
Reimbursement tops the list of concerns for any physician. In the private practice world, gastroenterologists are reimbursed directly for their time and any procedures performed. Any cuts to reimbursement rates directly impact a practice's ability to keep the doors open. This has become a large enough concern that many physicians are turning away from independence and choosing the relative safety of employment. But, employment is no longer the promise of stability it once was.
Though hospital and health system gastroenterologists are salaried, they often work for a base salary plus bonuses. The RVU-based bonus model is on the rise, even as RVUs continue to decline. And, as across all medicine, compensation is quickly becoming aligned with value. Whether employed or independent, gastroenterologists must take action or allow their compensation, and future, to be shaped for them.
"Society is asking us to have accountability. As much as physicians bristle at that because of our independent nature, it is a demand that we need to respond to," says Sarah Streett, MD, American Gastroenterological Institute Practice Management and Economics Committee member and Kaiser Permanente Medical Center physician. "The quicker GI physicians can own that, the better off we will be." The best way to control how compensation is doled out is to have a hand in defining the value by which it is measured.
Quality reporting measures will only grow in number. Practicing gastroenterologists are in the best position to set these quality measures. "We need to be proactive and become involved in the process of designing quality measures," says Dr. Streett. "Otherwise other people are going to make decisions for us and our patients."
As reporting requirements through the Physician Quality Reporting System and Qualified Clinical Data Registries increase, so will the potential incentives and penalties. "Work to keep incentives positive. Keep policy so physicians are rewarded for meeting benchmarks, rather than docked for not meeting them," she says. Gastroenterologists can get involved in local legislative efforts or step onto the national scene through involvement with any of the three sister GI societies' advocacy efforts.
Reimbursement, though essential, is not the only piece of the puzzle. Time has become an invaluable and scarce commodity. "In the overall scheme of healthcare reform, I feel that physicians have been targeted with a disproportionate amount of accountability. We face increasingly demanding requirements for documentation, maintenance of certification and diminishing time to provide vital complex patient care," says Dr. Streett. "We need mid-level support so we are spending time doing things that require our expertise."Physician extenders, whether nurse practitioners or physician assistants, could play a vital role in balancing the demands of volume and quality.
Gastroenterology, for many physicians, has been a procedural specialty. But, shifting patterns of reimbursement, referrals, technology and models of care make pure proceduralism a risky path going forward. Exploration of new services lines is a key strategy for the forward-thinking GI physician. "No one owns obesity management and gastroenterologists could claim that," says Dr. Streett. "Some practices are developing nutrition and obesity service lines." Other practices are focusing on areas such as chronic illness management in inflammatory bowel diseases, geriatric care and women's health service lines.