As the healthcare landscape changes, gastroenterology groups are looking for enhancements to keep their practices competitive. "There are several changes in healthcare we can anticipate, but the challenge is to adapt and really understand what the landscape will look like in the near and long term," says William Katkov, MD, of Saint John's Health Center in Santa Monica, Calif. "One of the important factors that affects strategic planning and priorities is understanding where gastroenterologists are in their careers and how that may determine goals for the future. You have to decide on the goals and overall strategy first and then determine what the most effective tactics are achieve those aims."
Dr. Katkov discusses multiple options available to gastroenterologists to enhance their practice revenue stream and build a competitive business.
1. Expand ancillary services. Many gastroenterology practices and endoscopy centers are adding ancillary services, such as pathology labs, to enhance their revenue stream. While there is some uncertainty about the regulatory future and reimbursement for physician-owned pathology services, this remains an important ancillary opportunity.
"With pathology services, physicians can capture the technical and/or professional component of care," says Dr. Katkov. "We are also seeing a proliferation of diagnostic tests in the office that can include breath tests for bacterial overgrowth and helicobacter pylori infection as well as capsule endoscopy and even dietary counseling. These are just a few examples of the kinds of services that can be used to increase income."
2. Incorporate endoscopic ultrasonogrophy. Dr. Katkov also sees endoscopic ultrasonography playing an important role in expanding gastroenterology services in the future. "The demand for EUS is growing and it certainly increases the number of patients being drawn to a practice," he says. "As a service line, interventional endoscopy (EUS and ERCP) definitely fits as an enhancement for GI groups."
3. Utilize non-interventional expertise. Gastroenterology groups are also expanding their services in non-interventional treatment by adding and marketing expertise in hepatology including the treatment of viral hepatitis as well as programs for the care of patients with irritable bowel syndrome. "These enhanced services are a draw for practices," says Dr. Katkov. "They can help GI groups stay competitive in their markets."
4. Adding new physicians or specialists. To grow patient volume, gastroenterology groups can add practitioners. "Many groups are looking to expand their market share," says Dr. Katkov. "This can be done through enlarging your group and tapping into new markets geographically."
However, the long-term strategy of bringing on a new physician incurs steep costs and the potential for added revenue may be delayed. "The cost of bringing a new physician into the group can be prohibitively high in the current environment," says Dr. Katkov. "Expansion can be especially challenging for smaller groups, which is driving physicians to consider other growth options including merging with other GI groups and alignment with hospitals or health systems."
5. Align with a hospital and/or health system. The motivation to align is a response to real and perceived challenges in the new healthcare landscape. In the end, these decisions are driven by financial realities and the uncertainties about access to patients in the future. Affiliations come in many shapes and sizes ranging from overhead and infrastructure support, to multispecialty groups or foundation models, to straightforward employment by a large entity.
"The overarching decision facing most gastroenterology practices today is trying to understand if they need to align with a health system and if so, what the best approach would be," says Dr. Katkov. "Many physicians are considering alignment to share the burden and costs of growth, such as bringing new physicians into the community and to achieve sustainability in the future."