How GI physicians can thrive despite dwindling reimbursement and massive consolidation

Adhering to the influx of regulations and dealing with EMR connectivity issues cost gastroenterologists energy and time. In 2017, 50 percent of gastroenterologists reported feeling burned out due to increased regulations, working long hours for lower compensation and working with EMR systems, according to Medscape's "2017 Gastroenterologist Lifestyle Report." Medscape asked respondents to rate burnout on a scale of one to seven, in which seven indicated the highest degree of burnout. Overall, gastroenterologists reported their burnout severity was 4.0. Burnout can have a series of consequences, whether that may be reduced empathy toward patients or an uptick in patient care mistakes, indicating the industry should devise solutions to mitigate symptoms of burnout.

This content is sponsored by gMed, a Modernizing Medicine company

Despite this higher rate of burnout and other challenges in healthcare today, GI physicians and practices can and do survive the heavy regulatory burden, as well as reduced reimbursements and consolidation in the healthcare space. The key tactics for GI groups to thrive will include implementing data gathering and reporting technology to meet regulatory compliance, as well as merging independent physicians and groups into a larger practice to leverage economies of scale. In this executive brief, Scott Choi, MD, CEO of Gainesville, Va.- based Gastroenterology Associates and president of Advanced Digestive Care, discusses key challenges for gastroenterology practices and how implementing the technology suite from gMed™, a Modernizing Medicine® company, built a foundation for success at his practice.

Preparing for legislative changes
Over the past seven years, CMS officials have put forth efforts to move healthcare from a fee-for-service payment model to a pay-for-performance payment model. The Trump administration may decide to continue down this path or take healthcare in a new direction.

However, physicians operating in the current healthcare landscape have various reporting requirements to meet and many in the medical community have concerns over the transition to a value-based payment system. KPMG and the American Medical Association released a joint report finding that less than 25 percent of physicians reported being "well prepared" for CMS' Medicare Access and CHIP Reauthorization Act (MACRA), which aims to improve healthcare by tying payments to value. Ninety percent of physicians felt MACRA's reporting requirements were "somewhat" or "very" burdensome. Gastroenterologists will have to allocate both more time and more resources to meet MACRA's future reporting requirements.

"Fulfilling MACRA requirements will increase overhead for gastroenterology groups, as more staffing time will be devoted to measuring quality, clinical improvement and penalty avoidance," Dr. Choi says.

After receiving more than 4,000 public comments on MACRA, CMS released its final rule in October 2016. The agency gave providers the option to report data to the agency at their own pace based on their perceived level of readiness. Providers who felt prepared for the shift to MACRA started collecting data on Jan. 1, 2017, and providers can begin collecting data any time between Jan. 1 and Oct. 2, 2017. CMS will require every provider to report data by March 31, 2018, and the data collected in the first performance year will determine payment adjustments beginning Jan. 1, 2019.

Under MACRA, officials replaced the sustainable growth rate formula with the Quality Payment Program (QPP). GI physicians can opt to participate in either of the following tracks within the Quality Payment Program — the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). Providers qualify for the Quality Payment Program if they participate in an Advanced APM or if they bill Medicare more than $30,000 in Part B allowed charges and provide care for more than 100 Medicare patients annually. Providers including physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists quality for QPP.

Providers have several considerations when weighing which track will better suite their practice. APMs will require providers to take on more risk, and most physicians will report under MIPS as a result. MIPS evaluates clinician performance based on the following categories in 2017: Quality, Improvement Activities and Advancing Care Information, formerly known as Meaningful Use. While CMS will not evaluate cost as a performance indicator in 2017, this will contribute to the overall MIPS score in the future. Gastroenterology Associates is opting to participate in MIPS, as APMs "are still fairly new in the management of digestive and liver disease," explains Dr. Choi.

"My own care center plans to apply for the full-year MIPS program. In this effort, the COO of my group has been communicating with our EHR vendors at gMed to ensure we capture any data to meet these requirements," Dr. Choi adds.

To maximize their workflows and meet reporting requirements in this transition, gastroenterologists need to equip themselves with the appropriate technological solutions. gMed's gGastro™ suite, a healthcare IT suite, aims to achieve both of these goals for GI physicians. The gGastro suite includes an EHR system with a built-in MIPS scorecard to measure the current success of a practice in this age of value-based care. It also boasts an analytical reporting platform and allows gastroenterologists to document key information quickly due to GI-specific workflows.

The wealth of data available at GI physicians' fingertips, as well as the time saved from the relatively seamless documentation process, can help providers succeed in MACRA.

MIPS requires physicians to illustrate that they are performing well relative to other providers, and the ability to prove one's superior performance dictates reimbursement. Aside from the technology offered by gMed, GI physicians can also use gGastro's gAdvisor™ consultative services, which pairs them with an expert well-versed in MIPS requirements, to fare well under MIPS. This advisor helps physicians build a MIPS plan and make adjustments as necessary to ensure providers are maximizing reimbursement.

Can gastroenterologists remain independent?
Facing high overhead costs and declining reimbursement, many practices are forced to forgo their independence and join hospitals or venture capital-backed multispecialty groups to remain profitable. An American Medical Association (AMA) study found 2016 marked the first time in history that the majority of physicians were employed. The AMA survey received responses from 35,000 active physicians and found 47.1 percent of physicians held ownership stakes in a medical practice, down from 53.2 percent in 2012.

"Hospital systems and venture capital-based multispecialty groups acquire doctors who no longer can or want to deal with the increasing burdens and overheads of running a practice," says Dr. Choi.

While many practices are opting for employment models, Gastroenterology Associates is not one of these groups. Nearly four years ago, the strong desire to remain autonomous in a time of significant consolidation drove Gastroenterology Associates to examine alliances with other GI groups in northern Virginia. On Oct. 1, the eight groups officially merged to become Advanced Digestive Care.

"As hospitals and commercial payers try to control the flow of patients, it is extremely important for my practice to retain our patients and patterns of referral. By merging with other GI groups in northern Virginia, we now have leverage with hospitals, commercial payers and vendors," Dr. Choi says. "We can start to collect data and create models of shared savings and episodes of care for digestive care."

To gauge how GI physicians stack up to their peers, many use gInsights™, an advanced analytics platform that allows physicians to analyze their clinical, financial and operational data to identify key performance indicators. Physicians can select measures they want to hone in on and analyze those measures in real time. Through the platform, gastroenterologists seeking to thrive in the consolidating marketplace can learn key ways to boost efficiency, thereby increasing revenue and improving patient outcomes.

How GI practices can benefit from technological investments
Since Gastroenterology Associates finalized its merger to become Advanced Digestive Care, the combined group is eyeing potential new technologies and service lines to stay viable, such as a clinical laboratory and pharmacy.

"Without this ancillary revenue and larger group size, gastroenterologists will have a harder time supporting overhead, and ultimately may have to allow a larger entity to manage them, which is not what we want," Dr. Choi says. "We find that when we control patient care, we can deliver quicker, cheaper and more compassionate care than entities that aren't run by physicians."

The decision to add new service lines requires substantial research, including an analysis to gauge the projected revenue and overhead for one to three years in the future to ensure the total expenses do not surpass total revenues. Dr. Choi says he does this analysis prior to adopting new service lines, adding that a service line should "not only align with the needs of our patients, but [with] the scope of practice and the mission of our group."

GI practices that are well-equipped with data have a great likelihood of adhering to the federal government's reporting requirements. Five years ago, Gastroenterology Associates adopted the gMed EHR system. The practice initially used gMed's Endoscopy Report Writer, which documents information such as nprocedure notes, referring physician letters and discharge notes. gMed's Endoscopy Report Writer updates patient data between office visits, communities and hospital information systems to ensure the data is both current and correct. Gastroenterology Associates added the gScheduler™ in 2015, which allowed the practice to integrate nursing notes and a patient portal into its scheduling system.

"All of these additions have led to a fully integrated EMR that has allowed our group to capture all of the Medicare payments for Meaningful Use," Dr. Choi explains. "By having a fully integrated EMR, our doctors and staff can spend more time focusing on patient care and less time performing duplicate tasks."

Working in tandem with the gScheduler, practices can use gReminder™ to keep providers' schedules updated. gReminder automatically updates appointment status based on patient responses received via phone call or text.

Gastroenterology Associates also improved the revenue cycle process by collecting accurate patient insurance information and correcting improperly coded or incomplete office notes or procedures, expediting collections. For example, gMed's practice management system, gPM™, can help improve billing accuracy and revenue by billing for a variety of professional fees, such as anesthesia, pathology and radiology. Through the platform, practices can optimize their workflows and better navigate highdeductible health plans by automatically deducting payments from patient credit cards or checking accounts.

Equipped with the many solutions embedded in gGastro, providers can bolster their bottom line and offer excellent patient outcomes, both of which are key to succeeding in the value-based healthcare landscape. Gastroenterology Associates' decision to employ various technological tools and merge with seven other groups allowed the practice to maintain something the practice strongly believes in — physician independence. Gastroenterologists spanning the nation have a series of obstacles before them, but they can utilize various resources like gGastro to remain autonomous in 2017 and beyond.

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