15 things to know about gastroenterology for ASCs

One of the three most popular ASC specialties, gastroenterology has seen a number of proposed regulatory changes and challenges this year. Here are 15 things to know about gastroenterology.

1. GI/endoscopy procedures account for 27 percent of overall ASC case volume, according to VMG Health's 2012 Intellimarker Ambulatory Surgical Center Financial & Operational Benchmarking Study.

2. GI/endoscopy cases typically generate net revenues of around $800. Here are three statistics on GI/endoscopy revenue per case.

•    Gross Charges per Case — $3,610
•    Net Revenue per Case — $788
•    Discount To Charges — 75.1 percent

3. The revenue per case for GI/endoscopy procedures varies in accordance with the number of operating rooms in a facility.1
 
One to two ORs
•    Gross charges per case: $2,973
•    Net revenue per case: $668

Three to four ORs
•    Gross charges per case: $3,391
•    Net revenue per case: $790

More than four ORs
•    Gross charges per case: $4,014
•    Net revenue per case: $872  

4. In 2014, gastroenterologists earned an average salary of $370,000, up 7 percent from the previous year, and it the third highest paying specialty, according to the Medscape Gastroenterologist Compensation Report 2015. Hospital-employed gastroenterologists earn an annual average salary of $420,000 while independent gastroenterologists earn $316,000.

5. GI physicians tend to earn the most in the Northwest region of the United States. Here is the breakdown of gastroenterologist pay in accordance with U.S. region.2

•    Northwest — $505,000
•    Southwest — $463,000
•    Southeast — $387,000
•    Northeast — $379,000
•    South Central — $367,000
•    West — $365,000
•    Mid-Atlantic — $357,000
•    Great Lakes — $348,000
•    North Central — $310,000

6. GI physicians typically earn the most in healthcare organizations. Here is gastroenterologist pay by practice setting:2

•    Healthcare organization: $467,000
•    Office-based single-specialty group practice: $415,000
•    Office-based multispecialty group practice: $411,000
•    Office-based solo practices: $382,000
•    Hospital: $284,000
•    Outpatient clinic: $275,000
•    Academic (nonhospital), research, military, government: $226,000

7. However, the Medscape Physician Debt and Net Worth Report 2015 shows 14 percent of GI physicians faced recent financial losses due to practice issues.3   

8. Just more than half of gastroenterologists, 52 percent, expressed overall career satisfaction. But less than half of GI physicians, 46 percent, are satisfied with their income.2

9. Gastroenterologists are also considering a number of payment models. These include:2

•    Accountable care organizations: 31 percent
•    Planning to join an ACO within a year: 8 percent
•    Concierge practice: 3 percent
•    Cash-only practice: 1 percent

10. Gastroenterology was determined one of the least popular healthcare specialties by average online ranking. It earned an average rating of 3.70 out of five stars, according to a Vanguard Communications study. The study of 28,000 online physician reviews identified the specialty physicians that patients rank the highest and lowest.

11. CMS proposed colonoscopy reimbursement cuts with the release of the 2016 Medicare Physician Fee Schedule proposed rule. Proposed changes for 11 lower GI/endoscopy procedures, by RVU percent change, include:

•    Colonoscopy with biopsy (45380): -19 percent
•    Colonoscopy with snare polypectomy (45385): -12 percent
•    Colonoscopy (45378): -11 percent
•    Colorectal cancer screen, high risk (G0105): -2 percent
•    Colorectal cancer screen, low risk (G0121): -2 percent
•    Colonoscopy with hot biopsy (45384): -11 percent
•    Colonoscopy with submucosal injection (45381): -14 percent
•    Colonoscopy, flexible with ablation (45388): -15 percent
•    Flexible sigmoidoscopy with biopsy (45331): -7 percent
•    Flexible sigmoidoscopy (45330): -20 percent
•    Colonoscopy with control of bleeding (45382): -16 percent

12. The American Gastroenterological Association polled its members to see how gastroenterologists expect CMS' proposed colonoscopy cuts to affect their practices.

•    More than half of gastroenterologists plan to limit the number of new Medicare patients they will see
•    55 percent of gastroenterologists plan to limit procedures for Medicare patients
•    43 percent of gastroenterologists plan to refer patients to the hospital for colonoscopy
•    15 percent of gastroenterologists are considering opting out of Medicare entirely

13. In August, UnitedHealthcare also announced significant changes to how GI procedures will be reimbursed. Starting Nov. 15, UnitedHealthcare will use CMS special multiple endoscopic resection rules on specific commercial claims. The payer will pay the full allowable amount for the highest valued endoscopy code in the family when multiple procedures from the same family are reported on the same day.

14. The GI specialty has seen some controversy over the last year. "Superbugs" made national headlines following several outbreaks of infections linked to duodenoscopes used during ERCP. Ronald Reagan UCLA Medical Center in Los Angeles discovered an outbreak in January and began to notify 179 patients who could have been exposed to CRE from October to January. Of seven patients infected, two died. Shortly after the UCLA Medical Center news broke, Cedars-Sinai Medical Center in Los Angles reported four patients had contracted CRE.

15. Management company acquisition of GI-focused ASCs has also been prominent in 2015. Physicians Endoscopy acquired a majority interest in the Philadelphia Gastroenterology Consultants Endoscopy Center of Excellence and formed a new joint venture with Garden State Endoscopy Center in Kenilworth, N.J.

References:

1VMG Health's 2012 Intellimarker Ambulatory Surgical Center Financial & Operational Benchmarking Study
http://www.vmghealth.com/Downloads/VMGIntellimarker2012.pdf

2Medscape Gastroenterologist Compensation Report 2015
http://www.medscape.com/features/slideshow/compensation/2015/gastroenterology

3Medscape Physician Debt and Net Worth Report 2015
http://www.medscape.com/features/slideshow/compensation/2015/debt-and-net-worth#page=14

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