3 key issues in gastroenterology

Colonoscopy backlogs could take "years to recover from," according to the CFO of Minneapolis-based MNGI Digestive Health. 

Here are three GI leaders on some of the biggest issues in the industry:

1. Colonoscopy backlogs

David Silvernale. CFO of MNGI Digestive Health (Minneapolis): The deferment of elective procedures such as screening colonoscopy that occurred during COVID-19 has created a backlog of procedures that could take years to recover from. This, combined with the lowering of the CRC screening age and attention to site-of-service to lower the total cost of care, has created confidence for the organization to continue to grow through additional physicians and the ASC space for them to work. In addition, as we design new facilities we are paying strong attention to the learnings of infection control, air quality and patient flow that will become part of the new normal post-COVID-19.

2. Private-equity influx

Larry Schiller, MD. Digestive Health Associates of Texas (Dallas): Private equity organizations will continue to vacuum up private practices throughout the country as older gastroenterologists see the potential to cash out. The challenge for PE organizations will be to use their scale to build value, but expenses can only be cut so far without impacting the quality of services. Competition from hospital or medical school-based practice groups eventually will limit the growth of PE organizations in larger communities. Consolidation of PE organizations will be the next stage of growth for these businesses with disposition of these larger entities uncertain at present. Possible outcomes include going public with an initial public offering of shares once a critical size is reached or sale to health care systems or private insurance companies. For gastroenterologists individually, salaries should be stable for the near term, but opportunities to profit from ancillary services may be limited.

3. Challenges in hospital contracting

Vivek Kaul, MD. Gastroenterologist at University of Rochester (N.Y.) Medical Center & Strong Memorial Hospital (Rochester): The most important principles to keep in mind when evaluating a contractual relationship with a hospital are as follows:

1. Seek and provide transparency throughout the process.

2. Aim for a "win-win" negotiation when discussing terms of a contract/employment.

3. What role will you play in the system or at the hospital, and does the system provide resources for you to be successful in that role? 

4. Is the compensation package fair, and what benefits are included beyond salary and incentive?

5. Understand the nature and scope of any "noncompete" clauses (and/or any other restrictive covenants) as well as the penalties involved if such an agreement is breached. 

6. Have a clearly defined exit strategy in place, should things not work out. 

7. Be prepared to walk away if there are fundamental disagreements on overarching goals, vision and philosophy.​

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