Best ideas for entrepreneurial gastroenterologists: Public presence, ASC ownership & more

What are the best endeavors for business-minded gastroenterologists to pursue in the current healthcare landscape?

Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses. Next week's question: If given a second chance, would you choose the gastroenterology field or a different specialty?

Please submit responses to Carrie Pallardy at by Thursday, August 14, at 5 p.m. CST.

Dr. Hazan-SteinbergSabine Hazan-Steinberg, MD, CEO of Malibu Specialty Center, miVIP Surgery Centers, physician (Los Angeles, Calif.): The best way for gastroenterologists to start new endeavors is by creating venues to educate the public better in order to avoid all the misinformation gathered from the internet or from television shows.

Gastroenterologists often deal with complex GI symptoms that are not limited only to procedural treatments. We have been conditioned to do colonoscopies because it saves lives, but the mission of a gastroenterologist is also to heal or decrease suffering. Providing patients with accurate information and educational resources is extremely important. The public has various misconceptions on certain products they are told help their conditions when in fact there is no substantial research to back the claims.

Gastroenterologists need to step up and validate the benefits or risks of those products. Too often, people take multiple vitamins thinking they are prolonging their lives when in fact the same vitamins accumulate in the pancreas and can be detrimental. With information overload from the internet, doctors must find ways to educate people outside the clinic environment. Whether it's developing their own talk or radio shows, writing articles, blogging or holding medical seminars on diseases, treatment or new medical tools, patient education is by far one of the most important aspects of healthcare. Education allows patients to cope with their symptoms and disease. Understanding the physiology of the body, the mechanism of the disease and the tools needed to find the disease and how medications work is half the way to recovery.

Patrick TakahashiPatrick Takahashi, MD, CMIO and Chief of Gastroenterology Section of St. Vincent Medical Center (Los Angeles): In this current climate of healthcare, so many changes are occurring that it is difficult to take care of one's patients as a gastroenterologist, while trying to maintain a sound business model that can sustain itself. However, it remains to be said that there are still opportunities for the aspiring gastroenterologist to help supplement their salaries.  

While surgery centers are far from the "cash cows" that they were, the opportunity to build a profitable endoscopy center is still there. Partnering with the right group of physicians is paramount to the success of an ambulatory surgical center. By maintaining similar goals for the future, I believe that ASCs can still serve as a good source of ancillary income, while allowing a gastroenterologist to practice in a setting that is comfortable, efficient and an excellent experience for both the endoscopist and the patient.  
Revenue can still be had by contracting with the proper payers, negotiating fair rates and analyzing cost control within the center itself.  It would be prudent not to perform too many procedures which involve substantial cost due to equipment usage. Similarly, difficult cases that are performed at an endoscopy center will only hurt the "throughput" of a center, thus decreasing revenue due to the number of patients that can be accommodated in a day there.  

Similarly, positioning oneself to be aware of clinical quality measures that will be mandated by regulatory agencies will help in the grand scheme of things. Gastroenterologists who meet these measures will meet the maximum amounts for reimbursement that are allowed, whereas those who do not will be penalized.  
As procedural reimbursement continues to drop, gastroenterologists should also consider expanding nonprocedural lines to expand their services. Such fields as irritable bowel syndrome, nutritional, inflammatory bowel disease and liver disease will continue to grow in scope and need. In essence, gastroenterologists should follow the obvious and go to the areas of need.

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