Here are six gastroenterologists talking about big challenges in the field today in ambulatory surgery centers.
This roundtable is sponsored by the American Gastroenterological Association.
William Katkov, MD, Saint John's Health Center, Santa Monica, Calif.: I think gastroenterology as a specialty is facing the same sort of tectonic shifts that the rest of medicine is coming to grips with. Some of this is due to the Affordable Care Act; however many equally powerful changes have been underway for years. Gastroenterologists must become well-versed in the economic and policy changes that aren't strictly related to patient care.
The changes are most profound for the individual physician who wonders if he/she can survive in traditional private practice. On a very basic level, the gastroenterologist is asking herself or himself whether their future requires employment by a hospital and/or health system to move forward.
Lawrence Kim, MD, South Denver Endoscopy: There are immediate threats and long-term challenges on the horizon. The biggest issue right now is the negative publicity, starting with the New York Times article about colonoscopy charges and spreading to the Washington Post and other news outlets. This really has shone a spotlight on the way colonoscopy is reimbursed under the current U.S. healthcare system. Unfortunately, this information has been presented in an extremely negative light.
What hasn't been brought out in these reports is the true value of colonoscopy. Gastroenterologists are out there preventing colon cancer and our patients put their trust in us. We try to live up to that trust. Colonoscopy saves lives and does so in a very cost-effective fashion when compared with other preventative tests. What we need to do now is focus on the value we provide patients through high-quality colon screening.
Long-term, we all know that fee-for-service is a dinosaur. The ground is shifting under our feet; it's been a slow transition so far but I think the changes are going to come at us faster in the future. Gastroenterologists increasingly will be pushed to demonstrate the value they provide for CMS and other payers, and to move to alternative reimbursement models
Lawrence Kosinski, MD, MBA, Illinois Gastroenterology Group, Elgin: This year, the RUC is reevaluating the entire set of endoscopy codes and reassessing the wRVU. It is likely that there will be a decrease in reimbursement on the professional side. The other opportunity where gastroenterologists have been generating revenue is in their pathology labs, and that reimbursement has been cut. It's in danger of being taken away completely. This makes owning an ASC right now even more important because if your professional revenue and outside revenue generation are being cut, you really want to make sure you own an ASC and receive fair compensation for it.
The second big concern for us is healthcare reform, where we are going to see bundled payments. In order to compete in a value-based model, you have to control all aspects of treatment, including anesthesia and pathology. We need to provide focused services for our patients instead of an a la carte menu of items where patients must choose what they want.
Blair Lewis, MD, Mount Sinai Hospital, New York: The number one issue driving me today is building quality. In the world of gastroenterology, quality is very measurable. There are a lot of quality measures that are used and centers can set themselves apart by creating value. I think that's a primary focus of the future. Specifically, I think the quality measure of adenoma detection rate is a quintessential metric and there are vendors creating reports to help you collect data there. We also have two national registries allowing you to collect and benchmark data from across the country.
Harry Sarles, MD, President-Elect of American College of Gastroenterology, Digestive Health Associates, Rockwall, Texas: The overriding concern is a general decline in reimbursement for our work. Since I went into practice in 1984, there has been a steady retreat in reimbursement levels. There has been a complete disregard from a reimbursement perspective for consulting or cognitive services under the new coding guidelines. When you go see a new or established patient for a consult at the hospital, you aren't reimbursed for your time or effort.
The number two problem has been the prohibition of physician ownership in healthcare facilities with ObamaCare. ASCs have been exempt but there is a fear that they won't be in the future. We are also seeing declines in procedural reimbursement and a decrease in access to care especially for Medicare and Medicaid patients.
Richard Zelner, MD, Orange Coast Memorial Medical Center, Fountain Valley, Calif.: Healthcare costs are skyrocketing and everyone is looking for ways to lower costs. Surgery centers have shown to have had a big impact on lowering the total cost of care. Some studies suggest that there are 25 to 50 percent cost reduction when doing endoscopic procedures in an ambulatory surgery center due to their efficiency. Endoscopic procedures are more cost-effective in the outpatient setting. As the physician's reimbursement is diminishing, I think we'll see more gastroenterologists interested in surgery center involvement and investment.
A significant challenge to every gastroenterologist is making sure we don't sacrifice quality for efficiency. The surgery centers are designed to be very efficient, but if physicians feel too much pressure to move quickly they might not provide the best quality of care. Patients will need to be vigilant in choosing a high-quality physician.
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