The biggest challenges for GI in 2016: 3 gastroenterologists weigh in

What obstacles will gastroenterologists face next year?

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 piece of advice do you think has most impacted your career?

Please submit responses to Carrie Pallardy at by Thursday, October 29, at 5 p.m. CST.

Charles Accurso, MD, FACG, Medical Director, Digestive Healthcare Center, Hillsborough, N.J.: The biggest challenge in gastroenterology for 2016 and beyond is the transformation from fee-for-service to value-based contracts. Digestive Healthcare Center developed the first episode of care model for colonoscopy in our state with Blue Cross/Blue Shield of New Jersey. This innovative contract "bundles" services around the provision of colonoscopy and is tied to quality measures and patient satisfaction.
This new payment methodology and new working relationship with a large payer is innovative in the country. Value-based contracts around procedures, such as colonoscopy and chronic disease management strategies, are central to the U.S. healthcare system moving away from fee-for-service to patient-centered, quality-driven, accountable healthcare.
CMS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality and value through alternative payment models, such as ACOs or bundled payment arrangements by the end of 2016 and tying 50 percent of payments to these models by the end of 2018.     
CMS' push to value-based contracts will spur the private sector to do the same. The challenge is to get your organization ready for this.

Razvan Arsenescu, MD, PhD, division chief of the Atlantic Digestive Institute at Morristown Medical Center: The two biggest challenges I see facing gastroenterologists will be the adoption of pay-for-performance quality measures and the establishment of measures to achieve patient satisfaction. Physicians should be using scales to document the quality of their procedures, which will ultimately be used for reimbursement, but also need to find ways to measure the satisfaction of their patients to yield both better clinical results and repeat customers/positive word of mouth referrals. Accurate and frequent documentation allows physicians to identify issues in real-time and implement protocols to better manage them.

Maxwell Chait, MD, FACP, FACG, FASGE, AGAF, ColumbiaDoctors Medical Group (Hartsdale, N.Y.): There are significant challenges for gastroenterologists in 2016. One of the biggest challenges for us is how to deal with the uncertainty. Our landscape is changing. We don't know what our health systems are actually going to be and whether more people will be covered or not. The challenge to prove the value of our services to the payers who are paying for health care despite the uncertainty of our future is a significant challenge.

Consolidation of the health care networks where large hospital groups are behaving more as insurance companies and consolidating all physician practices including gastroenterology practices as multigroup practices across regions will have a major impact. GI practices need to work better, smarter and more efficiently to provide high-quality care in a cost-effective manner to get the outcomes we need. We are being pushed toward the accountable care organization concept that will require significant reengineering in how we approach individual patients and how we stay profitable whether we are independent or part of hospital systems or large health care systems.

We must concentrate on what we do best and prove our outcomes are better and that we can do it cheaper. As we see further pricing pressure on gastroenterology procedures, there is the possibility that there will be more non-gastroenterology providers performing gastroenterology-type procedures. The gastroenterologist's practice may shift from the high percentage of procedures that are done today to more cognitive clinical work. We as practicing gastroenterologists feel that we are better endoscopists than others, but this quality approach may fall short against the cost cutting approach. The outpatient procedures we do are a commodity and we may face pressures that they will be performed by the lowest cost providers in the future.

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