How has healthcare reform affected gastroenterology?

Two gastroenterologists weigh in on how the Patient Protection and Affordable Care Act has affected the gastroenterology field thus far.

Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses. Next week's question: What qualities does a CFO in the gastroenterology field need to be successful?

Please submit responses to Carrie Pallardy at cpallardy@beckershealthcare.com by Thursday, October 30, at 5 p.m. CST.

Maxwell M. Chait, MD, FACP, FACG, FASGE, AGAF, ColumbiaDoctors Medical Group (Hartsdale, N.Y.): Gastroenterologists provide many needed services, ranging from colorectal and esophageal cancer prevention to the evaluation and management of a variety of disorders, such as gastroesophageal reflux disease, liver disease and inflammatory bowel disease. The pace of change in the care provided by gastroenterologists has markedly accelerated due to The Affordable Care Act of 2010.  

Ambulatory endoscopy centers provide needed endoscopy services in a safe, efficient, reduced-cost, patient-centered environment. However, the recent modification by the Centers for Medicare and Medicaid Services, has led to a decline in facility fees for endoscopic services of more than 25 percent over the last four years, which poses a significant threat to the viability of these centers. The gap between payments to AECs and hospital outpatient departments for the same endoscopic services widens every year and many AECs now operate at or below cost when performing a colonoscopy on Medicare patients.

The ACA contains 1,083 pages of sweeping changes with the goal of reforming the insurance system as well as the delivery and payment systems of healthcare in the United States to be implemented over many years. Many gastroenterology providers have decided to mitigate the risk associated with the ACA uncertainty by aligning within hospitals and health systems or by selling their practices and becoming employed providers. Many states are expanding their Medicaid programs with the federal government assuming most of the financial burden. Gastroenterology practices will have to decide how to deal with the expected large influx of patients with poorly paying insurance. This means that gastroenterology practices can expect to do more for less and will have to become even more efficient and cost-effective.

The proposed bundling payment approach leaves gastroenterologists and all other providers with the dilemma of having to continue to exist in the current fee-for-service world while simultaneously having to prepare for a new payment paradigm that they cannot predict or fully understand. Gastroenterologists should not ignore the fundamentals of gastroenterology practice management. They should always focus on what is best for the patient and continue to optimize current practice operations.

However, it is important to cut costs, standardize procedures, and explore ways to partner and share resources. Although, quality measurement, provider profiling, and transparency are in their infancy, they are here to stay. Gastroenterology practices should establish quality improvement and incentive programs for providers and staff built around quality and performance parameters. Unfortunately, payment and care decisions will be increasingly based on demonstrated value.

The gastroenterology practice that is able to demonstrate that it establishes, updates, and adheres to the best practice guidelines, implements point-of-care decision tools and benchmarks, and distinguishes itself from competitors will survive in the new arena of assessment and accountability. The healthcare environment is evolving more rapidly than ever. Gastroenterologists need to improve their networking and organizational skills and stay up-to-date to ensure continued success. These are turbulent times in U.S. healthcare and the next few years will be critical for all gastroenterologists.

Patrick Takahashi, MD, CMIO and Chief of Gastroenterology Section of St. Vincent Medical Center (Los Angeles): Healthcare reform is beginning to change the practice pattern for gastroenterologists across the nation. With the Affordable Care Act in full swing, physicians are seeing changes on multiple levels. At the most basic level, physicians are starting to see a shift of patients towards different payer plans. For the gastroenterologist, this means checking with referring physicians to see what types of plans that they are enrolled in so they can also align with the same plans if need be.  Otherwise, this is a potential large loss of revenue for the gastroenterologist. For those gastroenterologists who are currently not in alignment with an ACO or any of the Obama care plans, serious consideration must be made to join depending on the potential loss of revenue by holding the status quo.  

Gastroenterologists will survive in this next phase of healthcare if they maintain a practice based on efficiency, leadership, and integrated care. There will be an increasing reliance on health information technology systems, especially considering the paths that are being carved for physicians in terms of value based care. Performance measurements and quality improvements will be expected of all going forward.  

Gastroenterology practices should be cognizant of their operations at all times, in terms of maintaining efficiency, maximizing patient throughput, and the like, especially since reimbursements continue on a downward spiral with no end in sight. Healthcare reform has made this even more imperative. Consideration must be made to partner with other physicians, multispecialty groups, hospitals, and the like to diversify referral and revenue sources. In addition, this will allow for new opportunities in improvement of one's practice, as fresh ideas can be incorporated as such.  
 
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