Is the road ahead for the gastroenterology field bright or dark? Lawrence Kosinski, MD, MBA, AGAF, managing partner of Illinois Gastroenterology Group in Elgin, offers insight into four key components on the future of GI.
1. Declining reimbursement. There is no doubt that many specialties across healthcare are facing downward pressure on reimbursement. As a procedurally driven specialty, gastroenterology is particularly impacted by cuts to the professional components of upper and lower GI/endoscopy. "There is no question we are going to be fighting a battle with CMS and the payers to maintain current reimbursement levels, but they are not sustainable," says Dr. Kosinski. "We are going to have to learn to live on significantly less."
2. Population health. Though reimbursement cuts are a challenge, opportunity lies outside the procedural realm. "We have to focus on the entire health system and what the cost of the GI service line entails. Can we increase our own revenue by decreasing the overall cost of care?" asks Dr. Kosinski. "There is an opportunity to counter the decline of procedural reimbursement through blazing the trail in population health."
For example, Illinois Gastroenterology Group partnered with Blue Cross and Blue Shield of Illinois to create an intensive medical home program focused on Crohn's disease. Dr. Kosinski and his team discovered that the practice was seeing only a small fraction of what the payer was spending on Crohn's disease. The largest portion of payer dollars was funneled into complication costs. Through the new intensive medical home program, Illinois Gastroenterology Group's care management tool Project Sonar works to improve patient communication and decrease avoidable complications.
3. Decline of the small practice. Independence is not impossible in gastroenterology, but pressures in healthcare may redefine what it means to practice independently. "The small to midsize practice is going to have a very difficult time surviving. We will see large merged GI practices that can participate in population health on the grand scale," says Dr. Kosinski. On the flip side, a number of gastroenterologists will opt for hospital and health system employment.
4. GI in ASCs. Ambulatory surgery centers have a history of fierce independence, but that is beginning to change. Joint ventures, hospital acquisitions and new partnerships are on the rise. Dr. Kosinski envisions a future in which ASCs are less like standalone entities and more integrated into the overall system of healthcare. "Imagine an ASC that sits on or near a hospital campus," he says. "A virtual ASC would own and manage this ASC and the hospital outpatient department. Staffing could be spread between the two and physicians could have ownership opportunities in this virtual ASC."
Technology in GI is rapidly advancing. This year alone has seen a number of new modalities for colorectal cancer screening. As of now, the greatest proportion of GI revenue in ASCs is driven by colonoscopy, but there is a possibility that new tests and devices will supersede this procedure as the bread and butter of GI. "We are vulnerable. It is imperative that we look to population health and other places to generate revenue and save the system money in the whole process," says Dr. Kosinski.