Endoscopy center success in turbulent times: 9 imperative lessons

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Reimbursement cuts. Regulatory demands. Consolidation. Is there still room for independent gastroenterology practices and endoscopy centers to flourish in a healthcare world rife with challenges?

This content is sponsored by FUJIFILM Medical Systems USA, Inc.

GI Specialists of Georgia — an integrated practice including physicians, an endoscopy center, anesthesia and pathology services — has managed to do just that. Gastroenterologist Arif Aziz, MD, Managing Partner at GI Specialists of GA, reveals nine core commitments the practice has made in its continued efforts to stay ahead of the curve.

1. Entrepreneurship. The key to good business is adaptability and healthcare is no different. The changes in healthcare loom large and move quickly; the winners will be those that have the flexibility to respond in time. "I am an entrepreneur at heart. It is a matter of being willing to adapt to the new environment," says Dr. Aziz. "There will always be patients. The key is to bring them to the ASC." Business-driven physicians and endoscopy center leaders will be well-equipped to embrace the key lessons and incorporate necessary knowledge to evolve.  

2. Service. Customer service may have been a foreign term in healthcare a few years ago, but it is rapidly on its way to becoming one of the most important phrases in the medical lexicon. "Service is the most important thing in our practice. It's what gets the patient in the door," says Dr. Aziz.

At GI Specialists of Georgia, physicians and staff alike are held accountable for the level of service provided. The phone system is constantly monitored to ensure patients are not left waiting. Regardless of call volume, all patients who call before 3 p.m. will receive a call back the same day. The office manager's and managing partner's phone numbers are left on the practice's voicemail and patients are encouraged to call if they do not receive a prompt response. "This gives a very strong message," he says. For patients scheduling a screening colonoscopy, the wait time is consistently less than a month.

Once a patient arrives at the endoscopy center for the procedure, service continues to be closely monitored. From prep time to discharge, each physician and staff member is expected to stay on time and perform cases as efficiently as possible, while always adhering to the highest quality expectations.

3. Quality. Though all physicians entered their respective fields with a desire to produce only the highest quality outcomes, just that desire is no longer enough. Quality must be documented and proven. The GI Specialists of Georgia monitor patient satisfaction, withdrawal time, preparation quality, adenoma detection rate, among many other quality indicators. "We make sure our physicians are performing at least to the benchmarks, if not beyond," says Dr. Aziz.

4. Negotiation. Reimbursement cuts are one of the largest concerns for independent providers. How will the doors stay open as costs continue to rise and payment steadily dwindles?  Data is its own form of currency, one with a premium value. "Never go to a payer if you don't know what you want," says Dr. Aziz. Cost per case, current contract rates and rate comparison are all essential negotiating tools. The more data at hand, the more leverage physicians have.

Dr. Aziz found that as his practice worked to establish itself in the community for more than three decades it gained a significant foothold in the market. "Maintain dominant market share, that improves negotiating ability above anything else," he says. "Payers have more to lose if they don't work with you." Carve out a niche in the community and strive to maintain it.

5. Commitment to growth. CMS and private payers are hunting for cost savings. Negotiation and superior quality are essential, but cannot hold back the entire tide of inevitable downward pressure. To balance the scales, GI practices and endoscopy centers must continually look for ways to grow patient volume.

GI Specialists of Georgia employs a robust follow-up system to ensure no patient slips through the cracks. All patients due for a recall colonoscopy are contacted at the proper time to ensure they are not dismissing the procedure or switching to a different provider.

The most important growth strategy revolves around a practice's referral base. "Continuously reach out to and increase your referral base," says Dr. Aziz. "That is the main driver of volume. Never underestimate the importance of referring physicians."

6. Waste reduction. Growth is a necessary strategy for improving profitability, but has finite potential. It can be a slow process and eventually a practice will reach the limit of volume it can handle. But, internal strategy can also help combat payment reduction. Cost-cutting, especially in the narrow-margin environment of an ASC, is a crucial maneuver.

From scopes to accessories, GI Specialists of Georgia have been working to minimize variation. "We don't need six types of snares, just two," says Dr. Aziz. "Those expenses add up quickly." As variation is reduced and the number of vendors working with the center narrowed, physicians can gain more favorable contracts. "Give more [business] to one vendor and get better rates. We moved to FUJIFILM for our endoscopy equipment and this saved us a lot of money without compromising quality," he says. "We get quality scopes at a much better price."

Trimming the excess may seem like a simple process, but in a center or practice with multiple physicians, preference becomes an issue. Multiple different preferences for scopes, snares and endoclips are inevitable, but unsustainable. "Get physicians on board. It can be challenging, but if it is done in the right way they will be receptive and agreeable to change," says Dr. Aziz.

7. Partnerships. Health systems are not the enemy. Dr. Aziz's practice developed a strategy to engage with the local health system a decade ago and now it has cultivated a mutually beneficial partnership with WellStar Health System, the dominant system in the area.

"I don't see an endoscopy center as an isolated unit. The drive for business comes from the physicians and their relationships with health systems and other groups," says Dr. Aziz. Physicians are encouraged to participate in medical staff activities and work to build open lines of communication with health system executives. The practice's partners have served on multiple hospital committees and have served in leadership position such as Chief of GI, Chairman Dept. of Medicine and President of Medical Staff.

"These positions have given us the opportunity to build personal relationships with the health system," he says. "I can pick up the phone and talk to the CEO. We have some competing interests, but there are many areas that we can work together on that are mutually beneficial."

WellStar is in the process of forming a clinically integrated network, and GI Specialists of Georgia are well-positioned; it is unlikely to be shut out in the market. While independence is highly prized, Dr. Aziz has not eliminated the possibility of a joint venture. "We aren't opposed to anything, as long as it doesn't harm our volume," he says. "Those that adapt will survive and thrive."

8. Technology. Too much or too little, technology can be a helpful aid or a stumbling block when it comes to healthcare. GI Specialists of Georgia was an early adopter of EMR and has managed to strike the right balance. The physicians' office switched to EMR 10 years ago and the practice's ASC transitioned eight years ago. The EMR, gGastro, is designed specifically for gastroenterology practices. It also interfaces with the practice's pathology department and its clinical software, eClinicalWorks. Dr. Aziz says that once fully integrated into the practice, the technology helped save on labor time and eliminate errors.

The practice also has software in place to handle patient collections. "All money that is expected to be paid before the patient comes to the center is collected," says Dr. Aziz. "It has greatly helped our cash flow." Additionally, the software has helped eliminate any financial misunderstandings the day of the procedure and reduced the number of patient cancellations.

9. Reputation. Build and maintain a brand in the community. Patient, physician and staff perception shape a practice and endoscopy center's image; and image is instrumental in maintaining and growing business. Satisfied patients will spread the word throughout the community and recommend the practice. Satisfied physicians will continue to bring cases to an endoscopy center, and referring physicians will continue to send patients. "Finally, continually work to maintain a positive and healthy culture at the endoscopy center. If the employees are happy and satisfied with their jobs, it shows in their interactions with the patient," Dr. Aziz says.

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