There are several huge challenges for gastroenterologists with the implementation of the Patient Protection and Affordable Care Act, and physicians are making significant changes in their practice to prepare.
A few of the biggest challenges include:
• Transition from fee-for-service to a value-based model for reimbursement;
• Electronic medical record implementation;
• Rising price of technology and equipment;
• ICD-10 coding transition;
• Patient volume increases and access to care issues.
Robert Stoler, MD, a gastroenterologist at St. Joseph Mercy Ann Arbor in Ypsilanti, Mich., discusses how his practice is changing to meet their needs in this new healthcare environment.
1. Proving quality. Payers and patients are looking more closely at cost and quality data before undergoing treatment. The ACA encourages a transition away from fee-for-service to pay-for-performance models, which take quality of care into account.
"The challenge is to get gastroenterologists to show compelling measures of quality in a way people can understand," says Dr. Stoler. "Physicians with that data can communicate the value of colonoscopy better to referring physicians, health plans and patients. A good and safe experience with a complete colonoscopy will ultimately detect adenoma polyps and save lives."
GI practices are now taking advantage of electronic medical records and other information systems more frequently to collect and track accurate information about the services provided. They can tell whether they are reaching the cecum and optimal evaluation of the entire bowel with good documentation and adenoma detection rates that exceed benchmarks.
"With the cost of doing business exceeding the rate of reimbursement, it's challenging to cut costs and provide the kind of quality and excellence that will make you successful," says Dr. Stoler. "Take advantage of IT available to track your quality and there will be an opportunity to thrive."
2. Communicate with staff. Keeping costs down begins with good staff communication. Clinical nurse managers, administrative staff and surgeons working together in the endoscopy center or unit can keep costs down while still providing good quality care.
"You have to have strong communication with your staff and make sure the small things don't add up," says Dr. Stoler. "Keep everything in line so you don't reduce comfort or quality of care. Whether it's the type of device you use or the number of blankets patients have, you need adequate staff to provide that care without purchasing excessive overhead."
3. Enlist a strong hospital partner. GI centers and groups can leverage a good relationship with hospital partners for managed care contracting and supply purchases. "You have to have a strong hospital partner," says Dr. Stoler. "If you can take advantage of economies of scale where you work together on projects to lower prices or achieve HOPD reimbursement rates, you'll be able to provide better value in the ambulatory endoscopy center."
There is an opportunity for endoscopy centers to participate in the hospital's clinically integrated networks, especially as the individual mandate will expand coverage to more Americans.
"If your goal is to get as many people into the gold standard of colon cancer prevention, it would be good for business to create the opportunity to have these patients seen and fill your rooms at the endoscopy centers," says Dr. Stoler. "Endoscopy centers have something to bring to the table for the clinically integrated networks. Those that have the best patient satisfaction, access to care and highest detection rates will succeed in that type of environment where contracts depend on those metrics and benchmarks."
4. Invest in IT for coding changes. ICD-10 will be in full effect on Oct. 1, 2014. Many gastroenterologists and billers across the country are already preparing for the change. Investing in software to begin the evolution to ICD-10 codes can put your group ahead of the game.
"Begin to form a game plan that's well spelled out between your and your coders and IT staff, and be aware of the possibility that there may be some delays in reimbursement temporarily when this actually goes live," says Dr. Stoler. "This could pose challenges to the center's business."
Some experts in the field have suggested keeping three month's cash on hand in case of delays and ensuring a good line of credit will be available if the situation turns dire.
5. Update scheduling practices. Clinically integrated networks are growing in many markets, consolidating specialists and referring physicians. Independent centers may experience a drop in patient volume or referrals from physicians joining other networks. However, there are ways to make scheduling at the ASC/AEC more attractive.
"Most schedules are somewhat archaic and basically don't optimize access," says Dr. Stoler. "They are working the backlog of patients scheduled for different procedures. You have to have space available for appointments on short notice because otherwise you are going to lose market share. You have to have the capacity to meet the demand for endoscopy as well as office-based care."
This might mean opening more rooms or scheduling additional hours—such as evenings or weekends—that are more convenient times for patients.
"Really analyze the information that's times from practice management software," says Dr. Stoler. "You can also manage and modify the schedule for variations during the year. There will be more patients with large deductibles coming at the end of the year; there are teachers who are more likely to schedule during the summer or holiday breaks. Modify you vacations and schedules to meet those demands."
More Articles on GI Centers:
10 Statistics on GI/Endoscopy Revenue Per Case in Surgery Centers Across the Country
5 Key Trends in GI/Endoscopy
The Latest in GI Cancer: Q&A With Dr. Neville Bamji of New York Gastroenterology Associates
A few of the biggest challenges include:
• Transition from fee-for-service to a value-based model for reimbursement;
• Electronic medical record implementation;
• Rising price of technology and equipment;
• ICD-10 coding transition;
• Patient volume increases and access to care issues.
Robert Stoler, MD, a gastroenterologist at St. Joseph Mercy Ann Arbor in Ypsilanti, Mich., discusses how his practice is changing to meet their needs in this new healthcare environment.
1. Proving quality. Payers and patients are looking more closely at cost and quality data before undergoing treatment. The ACA encourages a transition away from fee-for-service to pay-for-performance models, which take quality of care into account.
"The challenge is to get gastroenterologists to show compelling measures of quality in a way people can understand," says Dr. Stoler. "Physicians with that data can communicate the value of colonoscopy better to referring physicians, health plans and patients. A good and safe experience with a complete colonoscopy will ultimately detect adenoma polyps and save lives."
GI practices are now taking advantage of electronic medical records and other information systems more frequently to collect and track accurate information about the services provided. They can tell whether they are reaching the cecum and optimal evaluation of the entire bowel with good documentation and adenoma detection rates that exceed benchmarks.
"With the cost of doing business exceeding the rate of reimbursement, it's challenging to cut costs and provide the kind of quality and excellence that will make you successful," says Dr. Stoler. "Take advantage of IT available to track your quality and there will be an opportunity to thrive."
2. Communicate with staff. Keeping costs down begins with good staff communication. Clinical nurse managers, administrative staff and surgeons working together in the endoscopy center or unit can keep costs down while still providing good quality care.
"You have to have strong communication with your staff and make sure the small things don't add up," says Dr. Stoler. "Keep everything in line so you don't reduce comfort or quality of care. Whether it's the type of device you use or the number of blankets patients have, you need adequate staff to provide that care without purchasing excessive overhead."
3. Enlist a strong hospital partner. GI centers and groups can leverage a good relationship with hospital partners for managed care contracting and supply purchases. "You have to have a strong hospital partner," says Dr. Stoler. "If you can take advantage of economies of scale where you work together on projects to lower prices or achieve HOPD reimbursement rates, you'll be able to provide better value in the ambulatory endoscopy center."
There is an opportunity for endoscopy centers to participate in the hospital's clinically integrated networks, especially as the individual mandate will expand coverage to more Americans.
"If your goal is to get as many people into the gold standard of colon cancer prevention, it would be good for business to create the opportunity to have these patients seen and fill your rooms at the endoscopy centers," says Dr. Stoler. "Endoscopy centers have something to bring to the table for the clinically integrated networks. Those that have the best patient satisfaction, access to care and highest detection rates will succeed in that type of environment where contracts depend on those metrics and benchmarks."
4. Invest in IT for coding changes. ICD-10 will be in full effect on Oct. 1, 2014. Many gastroenterologists and billers across the country are already preparing for the change. Investing in software to begin the evolution to ICD-10 codes can put your group ahead of the game.
"Begin to form a game plan that's well spelled out between your and your coders and IT staff, and be aware of the possibility that there may be some delays in reimbursement temporarily when this actually goes live," says Dr. Stoler. "This could pose challenges to the center's business."
Some experts in the field have suggested keeping three month's cash on hand in case of delays and ensuring a good line of credit will be available if the situation turns dire.
5. Update scheduling practices. Clinically integrated networks are growing in many markets, consolidating specialists and referring physicians. Independent centers may experience a drop in patient volume or referrals from physicians joining other networks. However, there are ways to make scheduling at the ASC/AEC more attractive.
"Most schedules are somewhat archaic and basically don't optimize access," says Dr. Stoler. "They are working the backlog of patients scheduled for different procedures. You have to have space available for appointments on short notice because otherwise you are going to lose market share. You have to have the capacity to meet the demand for endoscopy as well as office-based care."
This might mean opening more rooms or scheduling additional hours—such as evenings or weekends—that are more convenient times for patients.
"Really analyze the information that's times from practice management software," says Dr. Stoler. "You can also manage and modify the schedule for variations during the year. There will be more patients with large deductibles coming at the end of the year; there are teachers who are more likely to schedule during the summer or holiday breaks. Modify you vacations and schedules to meet those demands."
More Articles on GI Centers:
10 Statistics on GI/Endoscopy Revenue Per Case in Surgery Centers Across the Country
5 Key Trends in GI/Endoscopy
The Latest in GI Cancer: Q&A With Dr. Neville Bamji of New York Gastroenterology Associates