How Gastroenterologists Can Prepare for Healthcare Reform: Q&A With Dr. Patrick Takahashi
Q: What do you think are the biggest challenges for gastroenterology from healthcare reform?
Dr. Patrick Takahashi: The Affordable Care Act will bring many challenges to the field of gastroenterology. There will be a potentially increased demand on gastroenterologists as more patients will have access to healthcare. However, procedure reimbursement will likely decrease at both the facility and professional level, as there will not be enough funds from the government or elsewhere to offset the increased procedural demand costs.
Simply put, there is tremendous pressure to curb costs in healthcare, and with an increasing demographic trend with aging, there will be a need to care for more individuals at lower reimbursement levels.
Q: How you preparing your practice for the ACA and other changes next year?
PT: Quality reporting will be imperative for gastroenterologists going forward. Attempts to meet certain quality measures during procedural reporting will be key to my practice going forward. I am planning on going with the ICD-10 conversion, and have already instituted an office based EMR, and have already begun to measure certain measures as they pertain to gastroenterology procedural reporting.
Q: There have been some predictions of patient volume increases as a result of the individual mandate. How will that impact GI practices?
PT: I believe patient volumes will increase, thus potentially necessitating more office staff and overhead. To offset overall costs by the ACA I believe physician reimbursements will drop as mentioned above. This will likely drive independent/solo practitioners to a group/hospital model for gastroenterologists.
Q: How can GI physicians prepare for a potential increase in patient volume, especially if many of these patients are on high deductible plans?
PT: High deductible plans may dissuade some patients from getting screening procedures done, as there is a thought that patients may see a potential increase in co-payments required for therapeutic procedures, such as when a polyp is removed.
Q: Are there any new payment models, such as ACOs, bundled payments, that could be beneficial for GI physicians/groups to explore in the future?
PT: Bundled payments may serve as a middle-ground for gastroenterologists trying to reach economic solvency. It is less likely to encourage unnecessary care, and will require coordination between providers to maximize payment. Practices will need to be efficient, as payments will be relatively fixed.
However, I believe that this is a likely model that the government is pursuing. ACOs are an interesting option to explore as well, again relying on cost containment and documenting quality to reward physicians with a share of the savings. It will be interesting to see how physicians will align with hospitals and insurance carriers to get this done. Again, independent practitioners will be forced into partnering with each other and hospitals/insurance companies to maintain solvency.
Q: How will downward pressure on reimbursement rates impact GI groups? Is there anything they can do to mitigate the negative impact?
PT: Decreasing revenue rates will force gastroenterology groups to be more efficient with their day to day activities. I fear that the days of the independent practitioner are numbered. Some of the ways that gastroenterologists can deal with decreased reimbursement will be to consolidate with each other to share overhead, align with hospitals in either an ACO setting, or begin exploring other avenues of payment such as bundled payments.
With EHRs having a major role in quality reporting going forward, costs of EHR maintenance/implementation will be difficult for independent practitioners to offset by themselves. In addition, EHRs generally lead to decreased productivity overall.
Q: Where do you see the biggest opportunities for gastroenterologists and groups to be successful in the future?
PT: The biggest opportunities for gastroenterologists will be to proactively start quality reporting, prepare for alignment with local healthcare systems or ACOs, and being open to the idea of consolidating with other gastroenterologists/hospitals in an attempt to curb overall overhead costs which could serve as an impediment to delivering healthcare.
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