How to Increase Open Access GI Procedures

Open access GI endoscopy, or endoscopy procedures performed without a full consultation beforehand, can open up time in a busy endoscopist's schedule. Although not all procedures can be done on an open access basis, studies have shown that if done properly, routine procedures — such as screening colonoscopies or occasionally upper endoscopies — are just as safe as those done after a full consultation.

Spokesmen forthe American Society for Gastrointestinal Endoscopy, of Thomas M. Deas Jr., MD, FASGE, president-elect of ASGE, and Joseph J. Vicari, MD, MBA, FASGE, member of ASGE's Practice Management Committee, share their thoughts on how a GI ambulatory surgery center can increase open access procedures.

1. Work with primary care physicians. The most important step to increase open access procedures is working closely with primary care physicians who refer patients to the surgery center, says Dr. Vicari.

"The best thing to do is to communicate with your primary care physicians to let them know that the service is available," says Dr. Vicari.

Dr. Deas goes once step further and suggests that because open access requires sacrificing a full pre-procedure consultation, endoscopists should only work with primary care physicians they trust.

"Practices should allow open access with selected referring physicians that they can depend on to refer the right patients with appropriate indications and complete evaluations prior to the referral for endoscopy," he says. "With full open access, the gastroenterology office is depending on the primary care office to provide all of the instructions for the patient."

Another reason for working with selected physicians is to avoid doing unnecessary procedures, Dr. Deas says.

"One of the problems with open access referrals is that many of those patients may not meet an evidence-based guideline for having an endoscopy," he says. "You are potentially adding additional costs to the system by doing unnecessary procedures."

When a center has decided on which physicians to work with on open access, the best way to increase the number of referrals is to make the process as seamless as possible, Dr. Vicari says. Something that makes the referral process easier on physicians is to make sure the physicians only have one point of contact in the surgery center.

"We have a dedicated scheduler that works for screening colonoscopy patients, and the referring physicians know that," says Dr. Vicari.

2. Decide which patients are eligible for open access. "The other critical factor in open access is defining which patients the practice will allow to be seen in an open access environment," Dr. Deas says. "In general, they need to be healthier patients that are going through routine screenings, not patients with chronic conditions."

In order to make sure the right type of patients are being referred for open access procedures, both Drs. Vicari and Deas recommend creating set criteria for open access patients, sticking to that list and making sure the primary care physicians are aware of and follow the criteria.

Dr. Vicari says that healthy patients between the ages of 50 and 80 could be eligible for open access. Any patient with a chronic health problem — such as diabetes, chronic obstructive pulmonary disease or chronic kidney disease — should have a full consultation before undergoing any procedure.

3. Get the patient in the office before the procedure. While open access means not completing a full consultation before the procedure, it's always beneficial to have the patient come into the center before the procedure for an educational session.

At Dr. Vicari's practice, where almost all of the screening colonoscopy procedures are open access, nurses conduct classes that include a video of a colonoscopy, explanation of the procedure, explanation of consent and a question-and-answer session. The classes are held several times a week in the morning and afternoon to work around patients' schedules. Attending a class insures that patients are fully aware of the procedure details as well as the consent before the day of the procedure.

"The main issue with medical legal exposure is I would be uncomfortable if someone just showed up for a screening colonoscopy without having seen the informed consent," Dr. Vicari says. "They could say it could not be true informed consent. I prefer to have the patients ahead of time hear about the informed consent or to physically have a copy of the informed consent."

A center visit before the procedure also helps with day-of logistics, Dr. Deas says. Patients will already know where the center is and won't have the added stress  on the day of the procedure, he says.

Learn more about the American Society for Gastrointestinal Endoscopy

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