Fighting the decline: 3 gastroenterologists on standing up to reimbursement pressure

From turning to alternative payment models to maximizing value-based payments, three gastroenterologists share strategies to fight the decline in reimbursement and maintain revenue.


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: What is the most important quality of a successful gastroenterologist?

Please submit responses to Carrie Pallardy at by Thursday, April 9, at 5 p.m. CST.

Dr. Larry Good Larry Good, MD, FACG, founder, CEO Good Pharmaceutical Development, CEO, Compassionate Care Center of New York: Strategies to combat declining reimbursement are diverse. Some well-established physicians can opt out of insurance all together, reduce the volume of their practice, set fair and reasonable private fees and maintain or increase their practice incomes. For younger physicians or those with weaker practices, the only options are a paradigm shift in practice management.

Some practices can coalesce into Independent Practice Associations to attempt to negotiate better fees or reimbursements. Investment in surgery or endoscopy has helped many gastroenterologists in the past, but those fees are being reduced as well. Institutional practice as an employed physician will be the inevitable choice for many. Some may use this crisis as a stimulus to reinvent themselves and change careers, not always a negative outcome.                

Timothy Miller, MD, Lubbock Digestive Disease Associates, South Plains Endoscopy Center, St. Joseph HoagDr. Timothy Miller Health at Covenant Medical Center (Lubbock, Texas): Reimbursement across all medical specialties is declining. Just last year, reimbursement for upper endoscopy was significantly cut. Payment rates for colonoscopy are up for review by CMS in the next year and may face cuts as well.  

In the short term, our excellent GI societies, including the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy are continually meeting with political leaders and policy makers to reinforce the message that colonoscopies are proven to prevent colon cancer and thus, save lives.  If anything, further emphasis on colorectal cancer screening should be placed, and higher reimbursement for colonoscopy should be considered in order to decrease the financial burden of colon cancer treatment down the line.  

In the long term, GI physicians will have some control over our individual reimbursement, based on the quality of our work. Payers, starting with the government, will reimburse at lower rates when certain quality measures are not met. Specific examples of quality measures for screening colonoscopy include adenoma detection rate, cecal intubation rate, cecal withdrawal time and documentation of bowel prep quality. It will also be important to perform screening colonoscopies at the appropriate interval, as set forth by our society guidelines. Meeting and exceeding these quality measures will not only benefit our patients, but likely will result in higher reimbursement rates as well.
Dr. Julie Servoss Julie Servoss, MD, MPH, medical director, EMA Gastroenterology: The best way for GI physicians to combat declining reimbursement is to not only think of your medical practice as a place you treat patients, but also as a business. We successfully completed medical school and post-graduate training, but in most cases how to operate a profitable business was not included in the curriculum. Certainly part of having a thriving medical practice is treating your patients well, but it's not everything these days. It's important to market your business to not only sustain the number of current patients but also increase your patient base to help maximize reimbursement.

But, probably the most important item to really understand is how the regulatory and compliance changes have the ability to significantly affect your bottom line. ICD-10, Meaningful Use, PQRS and the recent shift from paying for quantity to paying for quality aren't items to be delegated to your office manager or front office staff. The best option you have is to invest in an electronic health record system that automates all of these requirements, and accurately captures the work you do without under or over billing. Paper just isn't an option any more. Period. And most EHR systems on the market aren't equipped to handle PQRS, ICD-10, Meaningful Use and quality reporting with ease. Capturing structured patient data at the point of care will eliminate most if not all of the headaches associated with the multitude of changes that are getting ready to hit our practices.

Ask your EHR system vendors what their solutions are, how easy they are to use, how much time each will take how much it will cost to upgrade the system. If you're not satisfied with the answer, do some research, and don't let the fear of changing systems get in the way of running your practice efficiently. Don't let sunk costs sink your business.

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