Dr. Lyndon Hernandez: Uniting the voices in GI & demonstrating quality

Lyndon HernandezLyndon Hernandez, MD, MPH is a partner of the Wisconsin practice GI Associates, LLC. Dr. Hernandez offers insight into his start in medicine and the state of gastroenterology today.

Question: Why did you decide to become a gastroenterologist?

Dr. Lyndon Hernandez: I've always wanted to be in a specialty that involves hand-eye coordination. I initially considered cardiology, but the lifestyle of interventional cardiology was too intense. When I rotated to GI during my residency, the GI staff matched my personality. Typically, GI’s do not take themselves too seriously. We have the right mix of performing interventional procedures, office time, and emergency calls. It offered the right balance for me.

Q: How has the GI field changed since you first began to practice?

LH: I joined GI Associates in 2001. Our group, then led by Dr Joseph Geenen, was one of the first in the country to build an ASC in the mid 1990s. The ASC was still in its infancy when I joined. We weren't busy at all at first, but at the same time we were being compensated much higher for each procedure.

The volume at our ASCs then began to pick up in the mid-2000s and has remained steady since, and we now have five ASC’s serving Southeastern Wisconsin. Our practice has grown to 22 partners.  Our volume has remained consistent, which has served as buffer against declining reimbursement.

Q: What do you think are the biggest challenges in the GI field today?

LH: Staying independent is the biggest challenge, but we've remained independent and intend to remain so.  Despite facing competition from employed gastroenterologists in our market, so far we have managed to weather each storm, perhaps due to our dedication to quality, and continued engagement with hospital systems. Fortunately, our business model remains on a path towards further growth.

Younger physicians who choose the employment model are a concern. They look at the upfront salary offered by hospital systems, but they don't realize the downside. They have little control over their schedule, income, and support. At least in our market, a lot of these young MD’s who opt for employment get disillusioned and don't stay very long. If they do stay, they aren't happy but feel they have no other choice.  Recruiting talented physicians with complementary skill sets has been a bit challenging, because frankly many do not realize the advantages of joining a thriving, independent GI group.

Q: What do you think are the biggest opportunities?

LH: Providing high-value ancillary services in ASC settings remain the biggest opportunities. Also, advanced procedures such as interventional EUS and ERCP, despite the long procedural times, help to differentiate your group from competitors.

One of next big opportunities is to continue to work with other independent groups throughout the nation. We are fortunate to be a part of the Gastroenterology Practice Management Group, which now includes more than 300 members. We share best practices and information on quality metrics. In fact, we have published in Gastrointestinal Endoscopy journal the quality metrics we've collected in our ASCs over a six-year period. It is a nationwide study of adenoma detection rate from more than 370 gastroenterologists. We have demonstrated that ASCs across the nation can collaborate on comparing quality metrics despite our limited resources and health information technologies.

Q: Are you planning to take on any new practice or payment models in 2015?

LH: Our market isn't ready to work on bundled payments with commercial insurers, but we have executed a few bundled payment contracts with self-employed insurers. We are expanding those contracts next year. So far the model has worked very well.

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