With governmental reimbursements going down for GI procedures and more costs being added, there is a greater premium placed upon expert, efficient management of these businesses. The additional costs can hurt and, if not proactively managed, can add to the cost per case. These new regulations are appropriate for quality of care and can often be somewhat easier to implement for single-specialty ASCs. ASC owners, however, must look to recover and offset these added costs through greater utilization and efficiencies.
Q: How has technology affected the management of GI practices and ASCs?
BT: For GI, technology is constantly changing, but this is more evolutionary than revolutionary, meaning the same products are improving over time. We’ve seen changes in the scopes used, such as narrow-band imaging and high-definition scopes, and this also means changes in costs associated with them. For example, there is no point in using HD scopes if you don’t have HD monitors. This all adds to the overall cost of the procedure.
When it comes to EMR, we’ve used electronic dictation at our centers for years, and many of our facilities have moved to more robust EMRs over the years. This can be a very good investment especially from a quality of care perspective because an EMR system can capture and preserve all information about patient care in one place, and both professional practices and ASCs will see quality improvements as a result of the standardization incorporated into these EMR products.
Q: How have these costs impacted the GI practices? What does this mean for the future of management?
BT: Physician reimbursements continue to experience downward pressure and overhead costs (including rent, billing, staffing, benefits, EMR, etc.) are growing in an environment where reimbursements are not. It has become harder for solo practitioners and small groups to maintain historical cost and revenue structures. As a result, we’ve seen increasing demands on physicians’ time. They have to work harder and put in even more extended hours to see the number of patients needed to maintain reasonable margins. There is also an increasing demand for physicians. Some practices have added physician extenders to meet this need, but there is only so much physicians can do and still maintain the quality of care that they are so committed to.
A large number of GI physicians are approaching retirement and there are not enough fellows coming out of GI fellowship programs to take their places. Increasingly, GI fellows look at the demands associated with a solo or small practice, and many have decided that they want to have a better lifestyle and a family outside of their practices. Employment by a larger group practice or hospital may look more attractive to these fellows, because it is less expensive and demanding upon their time and they can collect a paycheck and have someone else run the business aspect of their practice.
Similar reasons have smaller practices looking to merge with bigger groups or into multi-specialty practices. Larger groups mean overhead costs are shared across a greater number of providers and, therefore, the costs of running a medical practice are not the burden of just one or two physicians. This strategy is more prevalent in larger, urban environments, and it is a trend we believe we will continue to see.
Q: Are there any resources or educational opportunities out there for GI physicians to improve their knowledge on these compliance and business issues?
BT: The professional societies do a good job of providing compliance resources to those who have the time to participate and take full advantage of the resources. Digestive Diseases Week in May and the American College of Gastroenterology conference in October provide many educational offerings on these and many other important topics. The educational offerings that the societies offer provide an excellent way for physicians to become more acquainted with and to formulate strategies to deal with these issues; however, physicians still need to invest the time in continuing education and they need to follow-up to make sure their practices are in full compliance. There is also a host of industry of consultants who will help with compliance for a price.
On the business end, there is some information out there; however, it is much more limited in scope. There are, of course, the standard business courses offered by local colleges and universities, but there is nothing GI-specific. Consultants are also helpful here, especially those who focus on physician practices. We have worked quite extensively with Jim Saxton from Stevens & Lee, and he has a team of colleagues who have helped our centers in this regard.
Mr. Tanner is the president and CEO of Physicians Endoscopy, which specializes in development and management of free-standing, single-specialty ambulatory surgery centers. Learn more about Physicians Endoscopy.
