Gastroenterologist Mark Noar, MD, of Endoscopic Microsurgery Associates in Towson, Md., discusses the biggest challenges and best opportunities for growing GI center case volume over the next few years. Q: Where are the best opportunities for patient volume growth in 2014?
Dr. Mark Noar: I think the best opportunity for growing patient volume is incorporating new procedures and technology that will bring additional patients into the practice. These things should also save time and money in the long run. There are a lot of new technologies available beyond the standard endoscopy; for instance, the Stretta procedure will be a huge way to grow patient volume because it will attract a large and never ending subset of patients.
At the same time, ancillary procedures that are needed when treating these patients will generate a nice income with relatively high return on investment. These procedures are typically performed by a nurse or a technician and have huge earning potential.
Q: In your opinion, is focusing on colon cancer screening still a viable option for GI groups?
MN: Some practices may look and see the writing on the wall for colon cancer screening. There is downward pressure on reimbursements for those procedures. Recent newspaper articles have taken taking aim at costs associated with colon cancer screening. Gastroenterologists and radiologists are looking at alternative detection possibilities such as CT colonoscopy and saying they are just as good at finding early cancers as colonoscopy.
Many practices may look at this as an opportunity rather than a threat to bring in new technology. As patients find out they have issues, they can seek additional treatment with the group. That has significant upstream revenue possibilities.
Q: Are there any other procedures GI groups are incorporating to drive additional patient volume?
MN: One is hemorrhoid treatment. There are several inexpensive hemorrhoid treatment options that don't require extensive instrumentation use, such as the CRH ligator. It's a five minute patient interaction and it could generate enough positive cash flow to change the complexion of an entire practice.
Another possibility that we've lost over the past few decades is neuro-gastroenterology. This is the study of disorders of the function and motility of the gut and how patients respond. One of the many procedures used in this field is Electrogastrography. This is another type of gastric motility study that not only helps us to understand disorders such as nausea and gastroparesis but also pays well. If you consider the population of patients at present with nausea or dyspepsia, only 50 percent of the time the answer is found through endoscopy. In order to help diagnose the problem in these patients, we will be turning more and more to neuro-gastroenterology and its associated testing for answers.
Finally, the new fecal DNA testing is a sensitive way to look for early cancers or advanced polyps, which will help to identify an even larger population of yet undiagnosed patients that will require intervention.
Q: What are a few of the biggest challenges when working to drive patient volume to GI centers?
MN: A huge challenge facing us now is the health insurance system. This year is the first year we saw huge out-of-pocket copays from patients. Traditionally, copays are in the range of $100 to $500 out-of-pocket, but this year we saw more like $2,000 to $4,000 because employers are trying to reduce costs by providing plans with higher copays.
Additionally, we usually see a slow time during the first few weeks or month of the year as patients wait to meet their deductible before undergoing diagnostic or elective procedures. This year, our slow period lasted three months and we are anticipating the same for next year. The smart practices will recognize this as a threat to cash flow.
We're planning to bring in our Medicare patients for the first three months of next year to keep volume up until the patients with private pay insurances have met their deductibles.
Q: How will new standards for colonoscopy impact gastroenterologists?
MN: Up until now, we have only seen guidelines from the societies and the government about when patients should return for their next colonoscopy. Now we are hearing the term "standards" being used. If it's no longer considered a guideline but instead a standard, there will be a significant downward pressure on the number of procedures they are able to perform. The next step will be more careful review of the practice and provider to see whether the standards are followed and if not in compliance, the penalties. could be quite onerous.
Q: Hospitals are new employing specialist physicians in their network. How will this trend impact private practice gastroenterologists?
MN: In the past, you might have seen a hospital employing a therapeutic endoscopist but now we are seeing in the Maryland region that hospitals are hiring multiple gastroenterologists, even just to see the patients in the hospital preferentially and therefore excluding the primary gastroenterology practitioner. That's an important trend for everyone to keep an eye on.
However, if you have a busy outpatient practice, having to see an inpatient becomes a loss because the hospital environment is so inefficient. Having someone else see that patient at the hospital might be a benefit because you can see more patients in the outpatient setting.
Since there is a net shortage of GI physicians in most places, this shift to hospital employment probably doesn't impact the independent gastroenterologists too much. But if you have a strong presence at the hospital, it could have a negative impact, especially if the hospital decides to assign their employed gastroenterologist to patients who come in the emergency room.
Q: What are a few of the best direct-to-patient marketing strategies to boost GI center patient volumes?
MN: I believe there are many avenues you can use to attract patients, but the tried and true methods of word-of-mouth are the most effective and cost-effective ways to market. The reality is you can spend a ton of money advertising on external sources, but your return on investment is usually very small. Instead, educate your employees and patients about what you do, and that internal marketing will be beneficial.
For example, a few years ago, I incorporated hemorrhoid treatment technology into the practice and once patients saw it was painless and worked really well, they recommended their family, friends and co-workers. For every patient that has that procedure, they refer another 10 to the practice within a month. When you start telling patients you can find and fix their disease and make a significant impact on the way they feel, that internal marketing easily pays for itself.
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