Here are 10 key business trends for gastroenterologists and GI centers today and in the future.
1. Increased patient awareness of colorectal cancer. In 2018, more than 140,000 Americans are expected to receive a colorectal cancer diagnosis, according to the American Cancer Society, a diagnosis that results in around 50,000 deaths nationally. However, preventive screenings are also increasing to detect and treat colorectal cancer early.
"Patient awareness that colorectal cancer is highly preventable coupled with an aging demographic within our society and a trend toward preventative medicine are the biggest economic factors impacting GI facilities," said Barry Tanner, CEO of Physicians Endoscopy. "From a political/regulatory perspective, there is a growing trend toward increasing the screening percentage of the eligible population and toward earlier screening based upon a significant increase in colon cancer in the under 50 years old population."
2. With the updated guidelines, younger patients are undergoing colonoscopies. Earlier this year, the American Cancer Society updated it's guideline, recommending adults with average risk of colorectal cancer begin screening at age 45 instead of 50. According to the organization, the rate of colorectal cancer for people under 55 years old increased 51 percent from 1994 to 2014. The guidelines recommend regular screening for six different tests, including colonoscopy every 10 years.
3. There is an impending gastroenterologist shortage. The population of Americans over the age of 55 years is also expected to increase in the coming years, making it more important than ever for gastroenterologists to take the lead in screening patients. However, there is a shortage of board-certified gastroenterologists heading into the next decade.
"Currently, there are many more gastroenterologists nearing retirement than there are newly trained gastroenterologists entering the profession," said Mr. Tanner. Counter balancing that however is the fact that gastroenterologists in general are extending their working career for a variety of reasons.
4. Independence in many markets may require consolidation. There are opportunities across the country for gastroenterologists to run their practice independently, and many specialists are joining larger groups or organizations to avoid hospital employment. "Preparing to stay independent and vibrant in many markets today may mean consolidation into a larger practice and surrendering some degree of autonomy in favor of being able to provide for the four key elements of success," said Mr. Tanner. The four elements of success include:
• Delivering outstanding patient care
• Maximizing efficiency from both a clinical and cost perspective
• Attracting new GI physicians to the practice
• Ability to meet the needs of new GI physicians from a lifestyle, financial and diversity perspective
"Preparing for this involves both self-examination from a practice perspective and identification of what is truly important about the independent practice of gastroenterology," Mr. Tanner said. "What I mean by that is identifying what is truly important from what would be nice to have. This is likely to be quite different from one physician to the next and therefore compromise will be an important part of preparedness."
5. The reimbursement landscape is relatively stable for GI, but practice costs are steadily on the rise. "For many years GI physicians have been able to overcome significant decreases in professional reimbursements by working harder and smarter — more efficiently," said Mr. Tanner. "Unfortunately, the days of working harder and smarter are to a very large extent, over. What is keeping GI practices comfortable today is access to ancillary revenue streams."
6. Self-pay could be an opportunity for gastroenterologists in the future. Anthony Starpoli, MD, a New York City-based gastroenterology, sees self-pay as an opportunity for the future. He has also obtained board certification in obesity medicine to treat additional patients. "I anticipate less insurance carrier participation and an emerging self-pay model of practice," he said. "Patients are faced with high-deductible insurance coverage that has essentially created this self-pay market. I spend more time with patients, and I am having a positive impact on health by addressing the obesity epidemic."
7. While many gastroenterologists are beginning to collect data and provide value-based care, they aren't necessarily seeing a boost in pay. "GI physicians have very little remaining control over the cost of practice operations, almost no control over what they get paid for their services, and an inability to monetize the investments that they have made in quality reporting because the payers are not yet in a position to broadly implement value-based reimbursement models," said Mr. Tanner.
8. Ancillary revenue streams play a key role in GI physician independence. ASCs and endoscopy centers have been a reliable source of ancillary revenue for gastroenterologists and remain a key opportunity. "While I believe professional revenue is now reasonably stable, I do have a sense that ASC reimbursements will continue to benefit from the very large differential between HOPD and ASC reimbursements and from increasing price transparency," said Mr. Tanner. "The challenges I see on the practice side are more in the area of ancillary revenues outside of the ASC, for example pathology and the increasing utilization of physician extenders."
9. The foundation for providing great patient care remains important for running a successful practice. The practice needs well-trained staff as well as skilled and board-certified gastroenterologists delivering care in a controlled and regulated environment to achieve the right patient experience. According to Mr. Tanner economic success depends on:
• The ability to provide great patient care
• Careful planning and execution of business management skills
• Engaged physicians that play an active role in management and governance of the center
• Dedicated staff who can help make the patient feel important and respected
10. Technology could help ease the administrative burden for gastroenterologists. Across the country, gastroenterologists, as well as other physicians, are faced with redundant documentation related to their EHR, endoscopy writer software and quality measures for CMS, meaning less time for patients. However, technology could help in the future.
"Documentation technology must improve," said William E. Karnes, MD, a gastroenterologist at the University of California, Irvine. "I'm hoping artificial intelligence will play a role toward that goal in the future."