2011 will be a year of change and opportunity for GI physicians. Glenn Littenberg, MD, chair of the American Society for Gastrointestinal Endoscopy's practice management committee, discusses five opportunities for gastroenterologists this year.
1. More physicians should advantage of open access endoscopy. Dr. Littenberg predicts the next few years will see an increase in the number of physicians performing open access endoscopy, or endoscopic procedures requested by referring physicians without a prior full gastrointestinal specialty consult. Dr. Littenberg says that while open access endoscopy is becoming more popular throughout the United States, quite a few practices still fail to take advantage of the opportunity. "If you think about the efficiency loss of patients having to come to the office for a consultation, which they'd rather not even do, where are you best off spending your time?" he says. He says while physicians may not make money on patient consultations, they can use the time usually spent on consultations on more profitable procedures or more medically-necessary patient visits.
He adds that for most practices, setting up an efficient, risk-free open access program is relatively straightforward. He says the biggest barrier to open access endoscopy may be the conflict with traditional practice. "For some physicians, it's simply tradition. They've always done it that way, and they want to meet the patients and believe the patients want to meet them," he says. He adds that while some physicians worry about medical legal risk, a good OAE program involving patient education on procedures, preparation and risk can significantly decrease that concern.
2. More large GI groups will form. Dr. Littenberg says it seems inevitable that many small GI practices will link up in one form or another. He says small practices should be thinking about whether they could benefit from joining other GI groups in their region. "It doesn't necessarily require giving up your independent or small group status, but you certainly need to think about horizontally forming large GI groups in regions or across regions," he says. "There are models being developed in many parts of the country that involve large GI groups and multi-satellite offices." He says the structure of larger GI organizations will differ by region and could include involvement with a hospital or a large multi-specialty group.
In California, Dr. Littenberg says some GI practices have already had luck forming virtual groups through IPOs. "The IPOs that have been doing managed care for a long time already have fairly tightly linked groups of independent doctors, and more of them are getting on the same EHR systems," he says. "Some of the IPOs, like the one I belong to (HealthCare Partners Medical Group), are promoting and paying for a large part of the infrastructure." Dr. Littenberg says joining a larger practice or a hospital can help previously independent physicians implement EHR, which will be increasingly necessary as virtual communication becomes standard.
3. Technology could improve GI practice, though perhaps not reimbursement. Dr. Littenberg says at the ambulatory surgery center level, new GI technologies may improve quality of practice without serving as profit sources. He says researchers are developing better ways to use colonoscopes to miss fewer lesions, allowing physicians a microscopic or backward look at difficult-to-see areas of the colon. "Those technologies that pan out will help us do a better job, but it won't offer a new range of reimbursement opportunities," he says.
He says the next few years may also see evolution in obesity treatment and GERD management. "There are a whole bunch of emerging technologies for gastric restriction procedures and revisions for patients who have had gastric bypass," he says.
He says as these new methods hit the market, physicians may be able to take advantage of a wide market of patients who go outside their insurance or are covered by their insurance for the new procedures. "There will certainly be a lot of opportunities in attracting a variety of surgeons who haven't been involved in a lot of endoscopic procedures or outpatient procedures," he says.
4. Contracts due for renegotiation could be improved. Dr. Littenberg says he frequently sees ASC contracts that could be vastly improved upon renegotiation, especially for GI and endoscopy reimbursement. "If centers don't regularly renegotiate and look at the terms of their contracts, they may be losing money in the way some of the claims get handled," he says. "There are a lot of payors who don't deal with multiple endoscopy claims the same way that CMS does and may not recognize multiple procedures." He says in many cases, centers write off the loss without appealing or looking closely at the language in their contracts. "Facing the cuts in Medicare facility fees, it's more important than ever to look at every operational efficiency possible and benchmark your center against others to see where you stand," he adds.
He says as insurance companies become more aware of the cost savings ASCs offer, centers should use their efficiency as leverage to negotiate better contracts. He says the opportunity to negotiate good contracts is particularly important as out-of-network centers find it more and more difficult to maintain their OON status.
5. More physicians should hold membership in national GI societies. In the coming years, involvement in specialty societies will be even more important, Dr. Littenberg says. "Physicians need to [support and pay attention to] specialty societies because they gather a lot of valuable resources," he says. "They advocate for benefits for our patients and for us, and they serve as important information sources." He says as physicians and ASCs encounter major changes through healthcare reform, physicians must collaborate on adapting to new payment systems and quality regulations. The best way to strengthen that collaboration is to support a specialty society that connects physicians across the country and publishes clinical and operational "best practices."
Read more advice for gastroenterologists:
-Decreasing Patient Discomfort and Pain During GI Procedures: Q&A With Dr. Ralph McKibbin of Allegheny Regional Endoscopy Center
-EndoEconomics: 4 Questions With Scott Becker and Anna Timmerman of McGuireWoods
-5 Proven Strategies to Reduce Costs of Scopes
1. More physicians should advantage of open access endoscopy. Dr. Littenberg predicts the next few years will see an increase in the number of physicians performing open access endoscopy, or endoscopic procedures requested by referring physicians without a prior full gastrointestinal specialty consult. Dr. Littenberg says that while open access endoscopy is becoming more popular throughout the United States, quite a few practices still fail to take advantage of the opportunity. "If you think about the efficiency loss of patients having to come to the office for a consultation, which they'd rather not even do, where are you best off spending your time?" he says. He says while physicians may not make money on patient consultations, they can use the time usually spent on consultations on more profitable procedures or more medically-necessary patient visits.
He adds that for most practices, setting up an efficient, risk-free open access program is relatively straightforward. He says the biggest barrier to open access endoscopy may be the conflict with traditional practice. "For some physicians, it's simply tradition. They've always done it that way, and they want to meet the patients and believe the patients want to meet them," he says. He adds that while some physicians worry about medical legal risk, a good OAE program involving patient education on procedures, preparation and risk can significantly decrease that concern.
2. More large GI groups will form. Dr. Littenberg says it seems inevitable that many small GI practices will link up in one form or another. He says small practices should be thinking about whether they could benefit from joining other GI groups in their region. "It doesn't necessarily require giving up your independent or small group status, but you certainly need to think about horizontally forming large GI groups in regions or across regions," he says. "There are models being developed in many parts of the country that involve large GI groups and multi-satellite offices." He says the structure of larger GI organizations will differ by region and could include involvement with a hospital or a large multi-specialty group.
In California, Dr. Littenberg says some GI practices have already had luck forming virtual groups through IPOs. "The IPOs that have been doing managed care for a long time already have fairly tightly linked groups of independent doctors, and more of them are getting on the same EHR systems," he says. "Some of the IPOs, like the one I belong to (HealthCare Partners Medical Group), are promoting and paying for a large part of the infrastructure." Dr. Littenberg says joining a larger practice or a hospital can help previously independent physicians implement EHR, which will be increasingly necessary as virtual communication becomes standard.
3. Technology could improve GI practice, though perhaps not reimbursement. Dr. Littenberg says at the ambulatory surgery center level, new GI technologies may improve quality of practice without serving as profit sources. He says researchers are developing better ways to use colonoscopes to miss fewer lesions, allowing physicians a microscopic or backward look at difficult-to-see areas of the colon. "Those technologies that pan out will help us do a better job, but it won't offer a new range of reimbursement opportunities," he says.
He says the next few years may also see evolution in obesity treatment and GERD management. "There are a whole bunch of emerging technologies for gastric restriction procedures and revisions for patients who have had gastric bypass," he says.
He says as these new methods hit the market, physicians may be able to take advantage of a wide market of patients who go outside their insurance or are covered by their insurance for the new procedures. "There will certainly be a lot of opportunities in attracting a variety of surgeons who haven't been involved in a lot of endoscopic procedures or outpatient procedures," he says.
4. Contracts due for renegotiation could be improved. Dr. Littenberg says he frequently sees ASC contracts that could be vastly improved upon renegotiation, especially for GI and endoscopy reimbursement. "If centers don't regularly renegotiate and look at the terms of their contracts, they may be losing money in the way some of the claims get handled," he says. "There are a lot of payors who don't deal with multiple endoscopy claims the same way that CMS does and may not recognize multiple procedures." He says in many cases, centers write off the loss without appealing or looking closely at the language in their contracts. "Facing the cuts in Medicare facility fees, it's more important than ever to look at every operational efficiency possible and benchmark your center against others to see where you stand," he adds.
He says as insurance companies become more aware of the cost savings ASCs offer, centers should use their efficiency as leverage to negotiate better contracts. He says the opportunity to negotiate good contracts is particularly important as out-of-network centers find it more and more difficult to maintain their OON status.
5. More physicians should hold membership in national GI societies. In the coming years, involvement in specialty societies will be even more important, Dr. Littenberg says. "Physicians need to [support and pay attention to] specialty societies because they gather a lot of valuable resources," he says. "They advocate for benefits for our patients and for us, and they serve as important information sources." He says as physicians and ASCs encounter major changes through healthcare reform, physicians must collaborate on adapting to new payment systems and quality regulations. The best way to strengthen that collaboration is to support a specialty society that connects physicians across the country and publishes clinical and operational "best practices."
Read more advice for gastroenterologists:
-Decreasing Patient Discomfort and Pain During GI Procedures: Q&A With Dr. Ralph McKibbin of Allegheny Regional Endoscopy Center
-EndoEconomics: 4 Questions With Scott Becker and Anna Timmerman of McGuireWoods
-5 Proven Strategies to Reduce Costs of Scopes