Gastroenterologists are facing more and more demands on their time, while striving to maintain excellence. Four gastroenterologists share tips on improving GI practice efficiency without affecting quality of care.
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: How has healthcare reform affected the field of gastroenterology thus far? Please submit responses to Carrie Pallardy at cpallardy@beckershealthcare.com by Thursday, October 16, at 5 p.m. CST.
Maxwell Chait MD FACP, FACG, AGAF, FASGE, ColumbiaDoctors Medical Group (Hartsdale, N.Y.): Gastroenterologists need to improve efficiency in their practices without sacrificing quality to reduce healthcare costs, retain quality and maintain patient satisfaction. To develop these goals the gastroenterologist must assign responsibility and measure and report progress. The gastroenterologist must contend with changing healthcare demands, reimbursement rate cuts, EHR mandates and limitations of existing facilities. These issues require reliable data to support decisions regarding optimal physician mix, projected revenues and expenses, and future real estate requirements to gain efficiencies and improve staff interaction. Gastroenterologists must satisfy patient expectations and reduce expenses to ensure long-term viability of their practices. The ASC team responsible for this should include an administrator, a physician, a clinician, information technology (IT) and administrative support. To reduce capital requirements one must establish a consistent model of care and optimize its delivery to create a quality patient experience. The team must develop efficient flow patterns, set purchasing standards, try to develop a recognizable brand identity, implement and integrate technology, improve staff interaction and develop a flexible, adaptable environment with easy access by patients to physicians and diagnostic services. The team and leadership must create a model that can deal with both the operational challenges of today and the challenges of the future.
David Robbins, MD, MSc, gastroenterologist (New York): There is no question that we are now in the era getting paid for performance, and the traditional fee-for-service model will soon be going the way of the dodo bird (once endemic to the island of Mauritius). The expectation is that healthcare providers, once upon a time referred to as doctors, deliver higher "quality" care, however that is defined, at a lesser cost. Yet as office rents, overhead expenses and equipment cost continue to soar in many parts of the country this may rightly seem like an impossible calculus.
The only thing that will save us is enhancements in our own efficiency.
When I think of the major opportunities to improve my efficiency, one of the major concerns is the transition between where I practice endoscopy and where I see patients in the office. This becomes especially critical when faced with unexpected same-day cancellations or delays in the endoscopy unit that are beyond my control. Being able to see patients in between cases is a luxury that few have, but being able to maximize downtime by bringing the office with you (e.g., in the form of an EHR-equipped laptop or a list of patient callbacks) can be a slick alternative. I actually anticipate that there will be delays and downtime and I'm prepared to work on other tasks when they inevitably arrive. And don't forget that disconnecting oneself from social media (Twitter, Facebook, Instagram) will probably do more to enhance your efficiency than other single intervention. Now get back to work!
Patrick Takahashi, MD, CMIO and Chief of Gastroenterology Section of St. Vincent Medical Center (Los Angeles): The question of improving efficiency without sacrificing quality is an age old question which is gaining more traction considering the current climate of healthcare. Gastroenterologists are strained as is in trying to maintain a sufficient workflow to help take care of their overhead costs. With decreasing reimbursements being the driving force, physicians have taken on more and more patients both in the office as well as in the endoscopic setting. This has inevitably led to a decrease in quality as physicians have been strained in multiple ways. With increasing requirements for quality metrics on the horizon, I believe it is a good opportunity for physicians to think out of the box when it comes to a traditional practice.
Utilizing resources such as Physician Assistants and Medical Assistants may help physicians to see patients effectively, while also maintaining quality of care. Utilizing an electronic health record can help physicians document the required metrics that payers will require in the near future as well. This can also help with the efficiency part while maintaining quality. The days of the practitioner "doing everything" are quickly moving to extinction, similar to the dinosaurs in the Creataceous period. Having additional support staff to maintain good rapport with patients and their families will be paramount to the success of practices in the future, while allowing for personal sanity.
Pankaj Vashi, MD, Lead National Medical Director, National Clinical Director of Gastroenterology/Nutrition, Metabolic Support and Gastroenterology, Cancer Treatment Centers of America at Midwestern Regional
Medical Center (Zion, Ill.): I’ve identified seven areas that gastroenterologists can focus on to improve efficiency in their practices without sacrificing quality:
Streamline flow. Create an environment that allows for the optimal flow and relationship between patient and physician, taking into consideration the time needed to build a meaningful rapport for each face to face patient interaction. Going as far as creating a patient flow map can be helpful to see where improvements can be implemented.
Be proactive. Be proactive in identifying high risk patients and be prepared to address their needs. As physicians, we are taught to access the situation and then act. It’s important to keep in mind that patients come to us seeking answers. The more information we can share with our patients regarding diagnosis, treatment and follow up care, the greater the chance for compliance. And patient compliance can definitely help create an efficient practice.
Welcome communication. Create an environment that welcomes communication between patients, staff and colleagues. All three of these audiences are vital to an efficient and successful practice. Furthermore, accessibility to clinicians, key support staff and information regarding the patient’s medical condition is important. The greater the back and forth dialogue between the patient and the care provider, the less likely the chance of miscommunications.
Mindful recruiting. Recruit high quality nursing and endoscopy room staff to assure good quality care while maintaining optimal efficiency. When bringing on new team members, it is important to find the right balance between experience/knowledge and a patient centered care mentality. Always put your patient and the center of his or her care.
Review quality measures. Periodic review quality measures like polyp detection rate, cecal intubation rate and complication rates help to identify gap, which can then be addressed as needed.
Incorporate health records. Incorporate user friendly endoscopic specific electronic health records (EHR) to reduce redundancy in documentation, which can save time for the staff without compromising quality.
Welcome innovation. Always look for new and innovative ideas and technology to advance the field of Gastroenterology and incorporate them into the practice as appropriate.
More articles on gastroenterology:
Colorectal cancer screening in 2015: Achievements to date & hurdles ahead
3 gastroenterologists & internal medicine physicians in the headlines
10 statistics on gastroenterologist salary by subspecialty
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: How has healthcare reform affected the field of gastroenterology thus far? Please submit responses to Carrie Pallardy at cpallardy@beckershealthcare.com by Thursday, October 16, at 5 p.m. CST.
Maxwell Chait MD FACP, FACG, AGAF, FASGE, ColumbiaDoctors Medical Group (Hartsdale, N.Y.): Gastroenterologists need to improve efficiency in their practices without sacrificing quality to reduce healthcare costs, retain quality and maintain patient satisfaction. To develop these goals the gastroenterologist must assign responsibility and measure and report progress. The gastroenterologist must contend with changing healthcare demands, reimbursement rate cuts, EHR mandates and limitations of existing facilities. These issues require reliable data to support decisions regarding optimal physician mix, projected revenues and expenses, and future real estate requirements to gain efficiencies and improve staff interaction. Gastroenterologists must satisfy patient expectations and reduce expenses to ensure long-term viability of their practices. The ASC team responsible for this should include an administrator, a physician, a clinician, information technology (IT) and administrative support. To reduce capital requirements one must establish a consistent model of care and optimize its delivery to create a quality patient experience. The team must develop efficient flow patterns, set purchasing standards, try to develop a recognizable brand identity, implement and integrate technology, improve staff interaction and develop a flexible, adaptable environment with easy access by patients to physicians and diagnostic services. The team and leadership must create a model that can deal with both the operational challenges of today and the challenges of the future.David Robbins, MD, MSc, gastroenterologist (New York): There is no question that we are now in the era getting paid for performance, and the traditional fee-for-service model will soon be going the way of the dodo bird (once endemic to the island of Mauritius). The expectation is that healthcare providers, once upon a time referred to as doctors, deliver higher "quality" care, however that is defined, at a lesser cost. Yet as office rents, overhead expenses and equipment cost continue to soar in many parts of the country this may rightly seem like an impossible calculus.The only thing that will save us is enhancements in our own efficiency.
When I think of the major opportunities to improve my efficiency, one of the major concerns is the transition between where I practice endoscopy and where I see patients in the office. This becomes especially critical when faced with unexpected same-day cancellations or delays in the endoscopy unit that are beyond my control. Being able to see patients in between cases is a luxury that few have, but being able to maximize downtime by bringing the office with you (e.g., in the form of an EHR-equipped laptop or a list of patient callbacks) can be a slick alternative. I actually anticipate that there will be delays and downtime and I'm prepared to work on other tasks when they inevitably arrive. And don't forget that disconnecting oneself from social media (Twitter, Facebook, Instagram) will probably do more to enhance your efficiency than other single intervention. Now get back to work!
Patrick Takahashi, MD, CMIO and Chief of Gastroenterology Section of St. Vincent Medical Center (Los Angeles): The question of improving efficiency without sacrificing quality is an age old question which is gaining more traction considering the current climate of healthcare. Gastroenterologists are strained as is in trying to maintain a sufficient workflow to help take care of their overhead costs. With decreasing reimbursements being the driving force, physicians have taken on more and more patients both in the office as well as in the endoscopic setting. This has inevitably led to a decrease in quality as physicians have been strained in multiple ways. With increasing requirements for quality metrics on the horizon, I believe it is a good opportunity for physicians to think out of the box when it comes to a traditional practice. Utilizing resources such as Physician Assistants and Medical Assistants may help physicians to see patients effectively, while also maintaining quality of care. Utilizing an electronic health record can help physicians document the required metrics that payers will require in the near future as well. This can also help with the efficiency part while maintaining quality. The days of the practitioner "doing everything" are quickly moving to extinction, similar to the dinosaurs in the Creataceous period. Having additional support staff to maintain good rapport with patients and their families will be paramount to the success of practices in the future, while allowing for personal sanity.
Pankaj Vashi, MD, Lead National Medical Director, National Clinical Director of Gastroenterology/Nutrition, Metabolic Support and Gastroenterology, Cancer Treatment Centers of America at Midwestern Regional
Medical Center (Zion, Ill.): I’ve identified seven areas that gastroenterologists can focus on to improve efficiency in their practices without sacrificing quality:Streamline flow. Create an environment that allows for the optimal flow and relationship between patient and physician, taking into consideration the time needed to build a meaningful rapport for each face to face patient interaction. Going as far as creating a patient flow map can be helpful to see where improvements can be implemented.
Be proactive. Be proactive in identifying high risk patients and be prepared to address their needs. As physicians, we are taught to access the situation and then act. It’s important to keep in mind that patients come to us seeking answers. The more information we can share with our patients regarding diagnosis, treatment and follow up care, the greater the chance for compliance. And patient compliance can definitely help create an efficient practice.
Welcome communication. Create an environment that welcomes communication between patients, staff and colleagues. All three of these audiences are vital to an efficient and successful practice. Furthermore, accessibility to clinicians, key support staff and information regarding the patient’s medical condition is important. The greater the back and forth dialogue between the patient and the care provider, the less likely the chance of miscommunications.
Mindful recruiting. Recruit high quality nursing and endoscopy room staff to assure good quality care while maintaining optimal efficiency. When bringing on new team members, it is important to find the right balance between experience/knowledge and a patient centered care mentality. Always put your patient and the center of his or her care.
Review quality measures. Periodic review quality measures like polyp detection rate, cecal intubation rate and complication rates help to identify gap, which can then be addressed as needed.
Incorporate health records. Incorporate user friendly endoscopic specific electronic health records (EHR) to reduce redundancy in documentation, which can save time for the staff without compromising quality.
Welcome innovation. Always look for new and innovative ideas and technology to advance the field of Gastroenterology and incorporate them into the practice as appropriate.
More articles on gastroenterology:
Colorectal cancer screening in 2015: Achievements to date & hurdles ahead
3 gastroenterologists & internal medicine physicians in the headlines
10 statistics on gastroenterologist salary by subspecialty