Here are six gastroenterologists discussing how they are evolving to meet the numerous challenges presented by today's healthcare environment. Sign up for our FREE E-Weekly for more coverage like this sent to your inbox!
William Katkov, MD, Saint John's Health Center, Santa Monica, Calif.: There is a great deal of fear and the only way to address that anxiety is to have a game plan. No one knows how changes to healthcare will play out, but for some people their current practice model will survive or even thrive. Many with ownership in ambulatory endoscopy centers will do well by taking advantage of strategic opportunities.
There is ample evidence that across all medical specialties, very few new physicians or specialists emerging from training programs look at traditional private practice as a viable option. These young doctors are filling the ranks of health systems across the country.
In general, realignment and consolidation makes the practice of medicine much more corporate. At the same time, it is premature to assume that private practice will be universally obsolete. Alignment will take many forms. Physicians must be cautious and maintain an individual stake in their work and business.
Lawrence Kim, MD, South Denver Endoscopy: We are positioning ourselves to move away from fee-for-service medicine and to complete that transition, we need data. ASCs are investing in
electronic medical records to collect hard data on their procedures. The AGA has been very forward-thinking in this regard; they have two registry programs to help practices report on quality measures. Both registries are still in the early stages, but as they mature, they will allow participants to submit data to quality incentive programs, such as PQRS and Bridges to Excellence, as well as to meet requirements for recertification.
AGA is also helping gastroenterologists to move from fee-for-service to new reimbursement structures. One example is the colonoscopy bundled payment model. This model provides a framework for gastroenterologists to negotiate a single price for screening colonoscopy. It is important to emphasize that the model does not set a fixed price. Instead, it identifies the critical variables that should be considered as practices determine their own costs and outcomes; this will allow them to negotiate more effectively with payers. Effective use of such tools will be critical as pressure builds on gastroenterologists to move toward population-based payment for healthcare services.
Lawrence Kosinski, MD, MBA, Illinois Gastroenterology Group, Elgin: As chair of the AGA Practice Management and Economics committee , we have been focusing on non-procedural business lines. Gastroenterologists have to focus on other areas where payers are searching for input from providers. Our initial three business lines are Nutrition, Geriatric GI and Woman's GI Health. Those are the things we can focus on to be part of the solution.
As for ASCs, with everything moving from expensive to less expensive settings, ASCs are more attractive than Hospital Outpatient departments. On the other side, office endoscopy centers are growing competition to ASCs as they are appealing to payers because they are even less expensive.
Blair Lewis, MD, Mount Sinai Hospital, New York: We are seeing a trend of gastroenterologists using report cards to look at infection rates and intubation rates to change physician behavior. For internal medicine, similar report card information is publicly published. I think that type of arrangement will come to the world of gastroenterology, and we need to be prepared for these reports to be published.
Quality reports also allow ASCs to benchmark themselves against their competitors and use that information during negotiations with third party payers. There are different quality measurements
dealing with accountable care organizations as well. Many gastroenterologists are trying to figure out whether they want to be part of the ACO or externally contracted with the ACO. If they externally contract, they can show their report cards for how quickly they are able to see patients and then notify them of abnormal results, which is what the ACO is looking for.
Harry Sarles, MD, President-Elect of American College of Gastroenterology, Digestive Health Associates, Rockwall, Texas: The overriding power that an ASC has is it's the lowest cost setting for care delivery for gastroenterology procedures. There is an emphasis now at insurance companies to drive business to the ASC setting because it's far less expensive than providing the same service at a hospital outpatient setting. Physicians are also recognizing that when you can provide the 
services in the ASC setting, you are looking at market forces in the best possible location.
Richard Zelner, MD, Orange Coast Memorial Medical Center, Fountain Valley, Calif.: We are evolving to figure out how to improve efficiency and lower our costs while not impairing quality. There will be parameters set up monitoring the physician's ability to provide quality care. They will include the physician's time spent with patients, patient office experience and other key clinical measures.
It will be difficult to fairly compare the monitored parameters as there is significant variability amongst patients that could dramatically bias the parameters. Monitoring parameters are going to be 
helpful, but humans are not machines and patient variability such as age, underlying illnesses, compliance and many other factors will be a significant challenge to reliable monitoring. One should be cautious of any current monitoring data that attempts to pigeon-hole physicians or medical facilities.
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