The gastroenterology practice of the future will little resemble the practices of a few years ago, or even today. Joel V. Brill, MD, AGAF, AGA, CPT Advisor; Dawn L. Francis, MD, AGA RUC Advisor and Shivan J. Mehta, MD, AGA, RUC Advisor Alternate, offer insight into practice models and actions to take now to pave the way for a gastroenterologist success in the new healthcare world.
Question: What do you think are the largest threats to sustainability in the GI field?
Dr. Joel Brill, Dr. Dawn Francis and Dr. Shivan Mehta: Myopic focus on screening colonoscopy blinds GI physicians to our other cognitive and procedural expertise that could ensure our sustainability. With more patients moving into high deductible health plans and narrow networks, GI practices must recognize and adapt to these changes by understanding the value of the total care we provide for patients in addition to our endoscopic services.
The threat of legislative attempts to eliminate the ancillary services exception could hinder the integrated model (pathology, anesthesia, infusion, ASC, nutrition, etc.) of providing coordinated GI services under one roof.
Q: What are some of the best ways to overcome these challenges?
JB, DF and SM: As a specialty we must define our role as, not only endoscopists, but as physicians who lead a team of professionals focused on meeting patient needs, addressing their symptoms and improving their health. There is an opportunity for practices to restructure care delivery around service lines and multidisciplinary care (e.g. GERD, viral hepatitis, IBD, IBS, CRC screening, obesity, etc.).
Ultimately, our success may be similar to an Amazon.com model in which we function as a GI "store" within a healthcare system "store," rather than just an endoscopy-focused factory.
The successful GI practice of the future will likely cross-train mid-level providers and primary care colleagues to address common GI problems and will build teams — e.g. dieticians, psychologists, social worker, kinesiologists, surgeons, etc. — who can be efficiently leveraged across service lines.
Q: What alternative practice models can gastroenterologists look at to build a sustainable future?
JB, DF and SM: Prepare for a future where Medicare rates are your dominant payer. Practices should be planning for demonstrating value to payers. They should position themselves to play an integral role in the care of a population, driven by hospitals, payers and/or other healthcare professionals, where you provide a wide range of services and collaborate closely with your referring providers.
Q: What do you think are the biggest opportunities for gastroenterologists to succeed in the current healthcare environment?
JB, DF and SM: Know your numbers. Be prepared to demonstrate meaningful information to external stakeholders (patients, purchasers, payers) that can shift the discussion from solely price to price and quality. Think about bundled payment for common GI procedures and services.
The next year could be extremely critical towards success of GI practices as we anticipate a number of reimbursement challenges in 2016 and payment model shifts, so stay tuned.