Irving Pike, MD, FACG, is Chief Medical Officer of Walnut Creek, Calif.-based John Muir Health and the Secretary of the American College of Gastroenterology. He provides executive staffing to John Muir's CMS shared-savings accountable care organization and is working closely with John Muir’s commercial ACO. The initial strategy surrounding the creation of these ACOs was the organization of primary care physicians. "Subsequently, the ACO clinical medical director and its Board of Directors identified specialties that they would work most closely with. There are 13 such specialties and GI is one of them," says Dr. Pike. After these specialties were identified, the main focus became coordination of care.
ACOs offer gastroenterologists the opportunity to provide coordinated care without tying them to just one ACO . While gastroenterologists can actually become participating providers of an ACO, they would have to commit to only working within that network; instead, they can be associated with several ACOs while maintaining their independence. GI physicians poised to benefit from working with ACOs will focus on:
• Evidence-based medicine
• High quality care
• Affordable care
GI physicians already track a number of quality indicators, such as adenoma detection rate. As quality data collection progresses, the infrastructure to track indicators for complex diseases, like inflammatory bowel disease, will begin to form. This data will be used to create a strong foundation of evidence-based care that will benefit patient populations of ACOs.
Gastroenterologists stand to not only enhance patient care through data-sharing with ACOs, but to also become a valued resource. "If you become known as a high-quality, affordable physician with good patient satisfaction you will likely receive more patient referrals from primary care physicians who are participating physicians with the ACO for their ACO and non-ACO patients," says Dr. Pike.
Though gastroenterologists may not be directly linked to a single ACO, CMS views active physician interaction with ACOs as an important part of the clinical integration process. GI physicians could receive benefits such as discounted access to EHR through the ACO based on their level of association.
While coordinated care with primary care physicians may mean more referrals, successful GI physicians will continue to seek ways to capture more patients and reduce costs. "Compensation in an era of accountable care will be more limited," says Dr. Pike. Strategies include:
• Finding new approaches to alter workflow and limit expenses.
• Bringing cases to an endoscopy center with the most affordable rates.
• Integrating pathology services and other practice related activity, while remaining aware of all compliance issues.
"Broadening your portfolio like this provides a practice with a broader source of revenue. This is the business of healthcare. You can then complete the mission of providing the highest level of care possible if you have the revenue to support that mission," says Dr. Pike. "Gastroenterologists need to stay at the forefront of providing high quality care at affordable rates. As long as we can do that, we will be important to the overall maintenance of health and the management of disease."
More Articles on Gastroenterology:
6 Updates on Medicare &GI Reimbursement for Gastroenterologists to Know
Looking Beyond the Scope: Integrated Care & Women's Health in Gastroenterology
Dr. Caroll Koscheski of ACG: Value-Based Care in Gastroenterology