How GI will overcome declining reimbursement, combat early onset CRC

Declining reimbursement and increasing early onset colorectal cancer rates are among the biggest topics in healthcare that will influence gastroenterology in the future.

These issues were explored in a June 5 webinar hosted by Becker's ASC Review and sponsored by Modernizing Medicine Gastroenterology. Becker's Publisher Scott Becker led a panel discussion featuring:

  • David E. Rivadeneira, MD, MBA, FACS, FASCRS, professor of surgery at Zucker School of Medicine at Hofstra/Northwell in Hempstead, N.Y.; vice chair of surgical strategic initiatives at Northwell Health in New York City; director of colorectal surgery and surgical services at Huntington (N.Y.) Hospital
  • Imran Sheikh, MD, gastroenterology, hepatology and advanced endoscopy at Baylor Scott & White Digestive Diseases Group in Garland, Texas
  • Barry Tanner, CEO of Physicians Endoscopy in Jamison, Pa.
  • Arnold Levy, MD, adviser to Modernizing Medicine Gastroenterology

Industrywide decreasing reimbursement rates have made their mark on every aspect of the specialty. From the medical student who's just graduated to the 35-year independent gastroenterologist, declining reimbursement will change gastroenterology itself.

Mr. Tanner noted that payer reimbursement rates are getting to a point where they're almost "too low to sustain growth and to invest in the technology and human capital necessary to sustain a practice."

"Because of this, gastroenterologists have been too reliant on ancillary revenue streams for survival," Mr. Tanner said.

Despite this, declining reimbursement rates aren't a death sentence to independent practices. Mr. Tanner said the decreasing rates will likely lead to consolidation and partnership as well as shifts in the gastroenterologists' role in care delivery.

"You're going to see more collaboration between gastroenterologists, hospitals, health systems and payers, especially in these larger more regionalized practices," he said. "I predict there's going to be a gradual shift toward more therapeutic procedures with gastroenterologists doing more therapeutic and less diagnostic procedures ... as screening technologies begin to improve exponentially."

Early onset colorectal cancer
Emerging CRC screening technologies are of the utmost importance for another reason as well. Early onset CRC rates are increasing and befuddling researchers.

"We've made strides in [screening the] over 50-year-old population," Dr. Rivadeneira said. "We've seen a decrease in mortality in regard to CRC, but what we have seen is a significant increase — a doubling or an even four-times increase — of CRC in patients under 50, [a population that] traditionally has not been screened."

Researchers and professional societies alike are debating whether to lower the universal screening age to 45 and are pondering whether to rely on colonoscopy screening alternatives to screen this possible newly eligible portion of the population.

The American Cancer Society issued a guideline to begin universal screening at 45 years, and while some other international medical societies have followed suit, American societies are fiercely debating it.

While Dr. Sheikh hopes more patients begin to get screened at 45, he said payer adaptation rates may stymie progress on this front. "Unfortunately what we see on the ground is payers don't typically cover CRC screening for folks that are 45-50 years old. Hopefully over the next few years we start seeing more third party payers picking that up, more patients getting screened and more CRC cases being prevented."

Dr. Sheikh added that shifting gastroenterology procedures from hospital outpatient departments to ASCs or endoscopy centers could go a long way to reduce the payer's financial commitments.

How technology can help
Gastroenterologists need to fight both declining reimbursement and increasing early onset CRC rates to be successful. One way they can aid that is by implementing a comprehensive technology solution.

"Whether you're in the hospital with an endo unit, in private practice, small practice, big practice, you have to survive," Dr. Levy said. "You have to have an IT partner, not a vendor, that's in the field of gastroenterology that can provide all of these services because we should all be about patient care first."

The solution should work for both providers and clinical support staff, because a practice can only be wholly successful if both halves work together.

"You need a system that has an EHR, a report writer, that can handle the practice management aspect and the business aspects," Dr. Levy said. "[The system should] offer medical management, analytics, [financial billing], patient engagement and ideally, it should have mobility features that can integrate with hospital EHR systems."

Dr. Levy urged practices to ensure they adopt a platform that will work with the practice to achieve joint success.

To view a recording of this webinar, click here.

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