EndoEconomics Fall 2019 Issue

FALL 2019

A journal dedicated to advancing GI ASCs and practices

10 Collaborative culture

6 14 20

PHYSICIAN LEADERSHIP RWANDA ENDOSCOPY WEEK DIGITAL HEALTH

ASC DEVELOPMENT SERVICES

Building GI Surgery Centers of Excellence!

Feasibility Study Site Selection Facility Design Project Financing Vendor Negotiations Equipment Purchasing Construction Management Staff Recruitment and Training License and Certificate of Occupancy Medicare & Accreditation Surveys

TO LEARN MORE: info@endocenters.com

EDITORIAL STAFF

Carol Stopa Editor in Chief cstopa@endocenters.com

CONTENTS

FALL 2019

6

8

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EndoEconomics™, a free quarterly publication, is published by Physicians Endoscopy, 2500 York Road, Suite 300, Jamison, PA 18929.

The views expressed in this publication are not necessarily those of Physicians Endoscopy, EndoEconomics or the editorial staff.

POSTMASTER: Send address changes to: Physicians Endoscopy, Attn: EndoEconomics, 2500 York Road, Suite 300, Jamison, PA 18929.

While every effort has been made to ensure the accuracy of EndoEconomics contents, neither the editor nor staff can be held responsible for the accuracy of information herein, or any consequences arising from it.

LETTER

NOTEWORTHY

STRATEGIES

2 Message from the President

4 Welcoming PE

6 Lead the way

Market Presidents, giving back and more

10

8 Blocking a breach

20

Advertisers assume liability and responsibility for all content (including text, illustrations and representations) of their advertisements published.

Printed in the U.S.A. Copyright Š 2019 by Physicians Endoscopy

EXCELLENCE

INSIGHTS

All rights reserved

10 Collaborative

18 CLINICAL

All copyright for material appearing in EndoEconomics belongs to Physicians Endoscopy, and/or the individual contributor/ clients, and may not be reproduced without the written consent of Physicians Endoscopy.

Reproduction in whole or in part of the contents without express permission is prohibited.

To request reprints or the rights to reprint such as copying for general distribution, advertising or promotional purposes: Submit in writing by mail or send via email to info@endocenters.com.

culture

14 A calling to serve

The value proposition

20 MARKETING

Embracing digital health

ENDO OPPORTUNITIES 24 GI physician opportunities at partnered practices

22 MARKETING Elevate your presence

Cover photo: Warchi via iStock.com

Find out more at endocenters.com or find us on

1 endoeconomics FALL 2019

letter

{Message from the President}

A PERIOD OF CHANGE As we make significant and exciting changes, we strengthen our ability to serve GIs.

David Young, President & CEO, Physicians Endoscopy

WE ARE MAINTAINING OUR UNWAVERING COMMITMENT TO THE MISSION OF SUPPORTING AND HELPING GROW INDEPENDENT GASTROENTEROLOGY, WHICH WE CONSIDER VITAL TO THE DELIVERY OF HIGHQUALITY PATIENT CARE.

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EVERYWHERE YOU LOOK, there’s evidence that healthcare is going through significant changes. We’re seeing such disruption take many forms, including increased consolidation, penetration by private equity, new obstacles to and avenues for patient access, remarkable advances in technology, reimbursement fluctuations, complex regulatory pressures and threats to the independent practice of medicine. Many of these changes are affecting GI, bringing with them new challenges and opportunities.

As you may have noticed, Physicians Endoscopy (PE) has also been a hotbed of activity as of late. We recently announced a major initiative: the launch of our new practice management services organization (MSO). PE formed this MSO through a joint venture partnership with Capital Digestive Care (CDC), one of the largest GI groups in the country. To say we’re excited about the MSO would be an understatement. It’s a solution that’s been in the works for a very long time. The model encourages growth via strategic alignment between the platform and partnering GI organizations and is designed to help support and improve the performance of gastroenterologists, their practices and their affiliated ASCs nationwide. I strongly encourage you to read the cover story of the summer 2019 edition of EndoEconomics to learn more.

We also underwent a leadership transition, with my being named Chief Executive Officer. A little more than a year

after I joined PE as President, I was honored to succeed PE Co-Founder Barry Tanner, who has been named our Chairman.

These and other company developments reflect PE’s ongoing efforts to respond to changes in the healthcare and GI markets as well as support the evolving financial, clinical and operational needs of gastroenterologists. PE has long prided itself as the go-to solution for GIs concerning any aspects of their business.

To continue to do so in a manner that meets and hopefully exceeds client expectations, we recognized the need to evolve as a company and expand our services.

While our company is experiencing some significant changes, I want to emphasize a few key points. First and foremost, GI remains PE’s passion. We are maintaining our unwavering commitment to the mission of supporting and helping grow independent gastroenterology, which we consider vital to the delivery of high-quality patient care. Furthermore, the expansion of our services will allow us to strengthen our ability to deliver long-term support for GIs. Finally, PE is now an even more flexible organization—one set up to cater more effectively to the varying needs of the many different types of GIs we serve. It’s a stressful, yet exciting time in GI. Through the increased depth of our offerings, we are better positioned to respond efficiently to the obstacles confronting GI and help doctors take advantage of new opportunities as they arise.

Experience World Class Hospital JVs Strategic planning is at the forefront for many hospitals with an emphasis on improving quality and lowering costs. The movement of hospitals toward licensed ambulatory surgery centers has accelerated based on a shift to value-based care, population health, and transparency.

Combining Physician Endoscopy’s expertise with a progressive hospital will ensure the most successful joint venture!

Let’s Work Together to Develop World Class: Patient Care ● ∙ Physician Engagement ● ∙ Market Position

(866) 240-9496 www.endocenters.com

noteworthy

{News and events}

PE Introduces Market Presidents to Its Lineup The new Market President role will help Physicians Endoscopy (PE) focus on critical initiatives through the collaboration between centers and practices, along with other key relationships and opportunities in the community, including health systems, third-party payers, GI groups and key strategic partnerships. The Market President will lead the collaboration across internal departments to assess and implement new and expanded services that improve operational and financial outcomes and, ultimately, the patient experience.

Join us in welcoming our first-ever PE Market Presidents!

Annie Sariego joined the PE team in November 2011 and has helped lead many center and company growth initiatives. She has been responsible for the growth and success in key PE partnerships in New York and New Jersey, and she will continue to lead the PE growth strategy for this market.

Jackie Tillinger brings 30 years’ experience as a healthcare manager, including 20 years in gastroenterology. She was previously the CEO/CFO at Digestive Health Specialists in Winston Salem, North Carolina. This group had 125 employees in five locations, along with five ambulatory centers. Jackie’s previous roles included various GI leadership positions in hospitals and ASCs.

PSG Names Ravi K. Ghanta, MD, New President

This October, Manhattan Endoscopy participated in the New York Get Your Rear in Gear 5K Run. The run took place at Riverside Park on Manhattan’s Upper West Side. Funds raised by the run went to the Colon Cancer Coalition, a charity dedicated to funding programs that increase colon cancer screenings and awareness.

The Manhattan Endo Crew were the second-highest fundraisers to participate, raising over $5,000 for the cause.

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Image: iStock.com/Pavel1964 and D3Damon

Raising for Rears

The Pennsylvania Society of Gastroenterology has announced Ravi K. Ghanta, MD, as the new president of the society. Dr. Ghanta is the society’s 20th president since its founding in 1980. The announcement was made at the society’s 2019 Annual Scientific Meeting on October 12. Dr. Ghanta is a partner of Digestive Disease Associates in Wyomissing, Pennsylvania.

Send us your community stories. Email us at info@endocenters.com.

EndoEconomics at the APEX The 31st Annual APEX Awards for Publication Excellence recently recognized the Summer 2018 issue of EndoEconomics with its Award of Excellence in the category of One-Of-A-Kind Publications (Health & Medical). The APEX Awards include submissions from corporate and nonprofit publishers and choose winners based on excellence in graphic design, editorial content and the ability to achieve overall communications excellence.

Read the award-winning issue, and more, at endocenters.com.

Sapna Thomas, MD, Named President of OGS

PE President on ASC Growth

At the Ohio Gastroenterology Society’s (OGS) recent annual meeting, Sapna Thomas, MD, of UH North Ridgeville Center in North Ridgeville, Ohio, was named the new president. OGS works on behalf of gastroenterologists to advance legislative and practice management issues in Ohio.

“We were excited to celebrate the 10th anniversary of OGS at our annual meeting,” says Dr. Thomas. “I am honored to be a part of it. I hope to increase the membership of the society to include the various practice models. This will give us a stronger voice in promoting legislative issues that affect gastroenterologists across the state.”

In October, David Young, President and CEO of Physicians Endoscopy (PE), participated in a keynote address with other ambulatory surgery centers (ASC) leaders at the Becker’s ASC Review 26th Annual Meeting in Chicago. Young discussed the future of ASCs, particularly in the GI industry, and how GI ASCs are growing.

“We’re seeing growth on the GI side organically and good growth from the right demographics, from the right parent companies, and from the right screening [populations],” Young told Becker’s ASC Review. “But we’re also seeing more growth coming through on the M&A side, mostly more in de novo, than buying in. The new de novo growth is coming from the payers and hospitals that are opening joint ventures and partnering with physicians.”

Read more about the keynote address Young participated in at beckersasc.com.

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strategies

{Business strategy and the bottom line}

Lead the way Physician-led healthcare systems are consistently linked to better healthcare quality, efficiency and outcomes.

By Rajiv Sharma, MD You wouldn’t hire your car mechanic to handle a plumbing problem. And your roofer probably isn’t the best resource to update your home’s electrical system. Following a similar train of thought, one would assume that hospitals would be best led by physicians and clinicians—rather than managers with a business or administrative background.

Despite the logic, healthcare systems traditionally put professional administrators at the helm, with medical staff looking after patients and management taking care of business. This has to change. Only the physician knows how the patient’s healthcare should flow, what’s best for the patient and why it’s actually good business to always put the patient before profit. That’s why we need physicians to pursue leadership roles in our hospitals. We need more physician executives—CEOs, CMOs and CFOs.

Physician Leadership Produces Better Performance

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Hospital-Columbia and Cornell—all have physician CEOs and/or presidents. It’s strong evidence that physicianled hospitals rise to the top. So why isn’t everyone following the leaders? More importantly, why does physician leadership matter?

Physician Leaders Understand Healthcare Goals The American Medical Association (AMA) has also noted the advantages of a physician-led, team-based care team, explaining it can provide a better patient experience, better population health, lower overall costs and improved professional satisfaction. And beyond their support, the AMA says, “patients also support physician-led team-based care. A 2012 survey found that patients overwhelmingly want a coordinated approach to healthcare, with a physician leading the healthcare team.”

The thorn in this statement is that it’s difficult to build a physician-led team without a physician-led C-suite.

With a business administrator leading a hospital, it feels

Image: iStock.com/SDI Productions

A recent study, published in Health Care Management Review tested the traditional viewpoint of administrators as healthcare organization leaders and reinforced the value of physician leaders. The study’s aim was to determine if hospital systems led by physicians were associated with better U.S. News and World Report (USNWR) quality ratings, financial performance and operating efficiency as compared with those led by non-physician leaders. The conclusion suggests the answer is yes: “Large hospital systems led by physicians in 2015 received higher USNWR ratings and bed usage rates than did hospitals led by non-physicians, with no differences in financial performance … [P]hysician leaders may possess skills, qualities or management approaches that positively affect hospital quality and the value of care delivered.”

The study’s deduction carries over into USNWR’s 2019–2020 results. The five top-ranked hospitals—Mayo Clinic, Massachusetts General Hospital, Johns Hopkins Hospital, Cleveland Clinic, and New York-Presbyterian

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increases, an “us vs. them” mentality can evolve. In a physician-led hospital, however, everyone is on the same team. Everyone talks to each other. It’s a far more collaborative environment, which greatly benefits the patient. It’s also a warmer, collegial culture, which benefits everyone.

The Path to Physician Leadership Presenting a solid argument in favor of physician-led hospitals is a good start, but physicians need to take action to realize a change. The next step is for physicians to put themselves on a path that heads directly into the C-suite.

That means joining organizations and associations that act as physician advocates. These groups have doctors onboard who have already traversed the pathway toward becoming hospital CEOs. They guide more physicians to do likewise. They’ll open doors. But not enough physicians are asking for help.

For physicians who want to take this next step but are unsure of how to go about it, there are a number of potential paths:

PHYSICIANS HAVE AN OPPORTUNITY TO FUNDAMENTALLY CHANGE THE LEADERSHIP CULTURE OF MEDICINE. like someone is trying to sell you tea but has no idea how to make tea. They’re schooled to put profit first. But it doesn’t have to be that way. Money follows when doctors and nurses are free to perform quality work. Patients are happy, they receive the best care and the hospital prospers.

Physician Leaders Are Better Equipped to Control Physician Burnout A 2018 Survey of America’s Physicians, conducted by Merritt Hawkins, painted a grim picture in terms of physician burnout. It found that 78% of physicians “sometimes, often or always experience feelings of burnout,” and 80% of physicians feel they “are at full capacity or are overextended.”

The cause for physician burnout is complicated, but a major contributor is a hospital administration with an MBA and no MD. C-suite physicians understand how far you can stretch another physician before care becomes rote and impersonal. And as physician burnout

> J oining the American College of Healthcare Executives (ache.org/learning-center). It is an international professional society of physician executives who lead hospitals, healthcare systems and other healthcare organizations. > Earning an Executive MBA. > Fundraising for local senators and congressmen who can help give the physician a voice. > Networking with private equity firms, as they can give the physician leverage to work with hospitals and gain freedom from financial captivity. > Networking with community leaders and other business owners to expand your horizons.

Physicians have an opportunity to fundamentally change the leadership culture of medicine and improve patient health, reduce physician burnout and increase clinical camaraderie. I hope that we can start a positive chain reaction. The first step is to make sure every physician understands that he or she can be a hospital executive. Then, when RAJIV SHARMA, MD, is boardyou’re running a hospital, certified in internal medicine and you can build a team with gastroenterology. He is the founder more physician leaders. If of Digestive Health Associates, LLC we keep the momentum and Gut Happiness, LLC. Learn more going, the right people will about Dr. Sharma at his website, be leading our hospitals DrGutHappiness.com. and everyone wins.

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strategies

{Business strategy and the bottom line}

Addressing one of the largest risks in healthcare: cybersecurity.

By Billy von Grossen

8 endoeconomics FALL 2019

Cyberattacks on the healthcare industry have been an unfortunate reality for decades; however, in the last few years the frequency and breadth of these attacks has reached almost epidemic levels. In 2018, the Department of Health and Human Services (HHS) Office of Civil Rights (OCR) alone levied $28 million in fines for security breaches, and that is just the tip of the iceberg.

Some experts estimate these breaches cost the industry $5 billion annually, including the cost to fix the breach, the lost revenue due to lack of access to information during a breach and the negative impact on patients’ perception of the organization affected.

The healthcare industry is a prime target for cybercriminals because of the value of healthcare data. In particular this includes the personal health information (PHI) of patients, which can be extremely valuable for identity theft and other types of fraud. However, in addition to PHI, healthcare industry clinical research and intellectual property are valuable to cybercriminals.

Ransomware and Other Types of Breaches One of the most discussed types of cyberattacks is ransomware. This refers to a situation where a cybercriminal gets access to your network and then encrypts

Image: iStock.com/Sezeryadigar and voyager624

Blocking a breach

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files or otherwise restricts access to your own data or networked equipment until your organization pays a ransom. As with many data breaches, this often occurs when a worker mistakenly clicks a link in an email or interacts with something malicious online that gives the criminal access to your system.

This practice of sending emails or messages intended to get employees to click on malicious links—which are usually disguised as something innocuous such as a document from a coworker or photos from a friend—is called phishing. In a 2018 breach that resulted from a phishing attack, health insurance company Anthem, Inc., agreed to pay $16 million to OCR, establishing a new record as the single largest HIPAA fine for a security breach.

In addition to phishing, other common ways healthcare organization data is breached include: > Loss or inadvertent disclosure of sensitive information. For example, if an employee misplaces his or her work phone or leaves a laptop unattended. > Stolen information. Similarly, if an employee’s phone or computer with sensitive information or login and password access to secure networks is stolen. > Insider breach. An employee of your organization who has access to secure information maliciously provides that access to criminals. > Third-party breach. Another organization or vendor you work with and has access to your sensitive data is breached. > Unsecure data. Data, including PHI, that should be secured is inadvertently left discoverable by the public.

Image: iStock.com/BeeBright

Addressing Cybersecurity in Your Organization It may seem obvious, but one of the most important ways to protect your organization from cyberattacks is to have a well-defined cybersecurity plan and procedure. This can include, but isn’t limited to: clearly stated employee

duties with regard to cybersecurity, properly-defined software upgrade procedures, regular audits of networks and other technology used such as cloud computing, and an emergency protocol in the event a breach occurs.

Additionally, if you don’t have an IT officer with experience in your organization, consider hiring one or working with a consultant or vendor. While the healthcare industry is a target because of the value of its data, experts also note that many healthcare organizations lack adequate resources to address cybersecurity, and this can compound the severity and financial impact of breaches.

Training Your Team With a well-defined cybersecurity procedure comes training. A 2016 review of cybersecurity literature in Technology and Health Care found that the “most stressed security technique in the literature is proper employee training.” Many of the common types of cybersecurity breaches involve a human component that could be prevented with regular and comprehensive employee training.

When developing training, look to your IT experts for guidance. You can also find resources and guidance online, particularly from HHS. Last year, HHS released a publication that it developed in partnership with the healthcare industry titled Health Industry Cybersecurity Practices (HICP): Managing Threats and Protecting Patients. This publication provides guidance on “voluntary cybersecurity practices to healthcare organizations of all types and sizes.”

As technology develops and medical devices and equipment, as well as patients’ PHI, become more and more accessible over the internet, cybersecurity concerns will only increase. Currently, many practices, hospitals and health systems are not prepared for cyberattacks, and a single breach could end up costing an organization millions of dollars. Examining cybersecurity readiness is extremely important for organizations of all sizes, and even small steps in the right direction can make a difference.

BREACHES COST THE INDUSTRY

$5 billion ANNUALLY.

Billy von Grossen is a Network Administrator at Physicians Endoscopy (PE) and can be reached at bvongrossen@endocenters.com.

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excellence

{Success stories}

Collabora culture

A collaborative culture has helped Gastroenterology Associates of Fredericksburg (GAF) succeed as a team. The GAF team includes (starting at left): Peter Wong, MD, FACP, FACG; Jayme Tishon, MD; Dong Lee, MD; Narayan Dharel, MD, Ph.D; Chetan Pai, DO; Radha Menon, MD; and Frank DeTrane, MD, FACG. Find them at gastrofbg.com.

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Image: iStock.com/Warchi

Creating success with attentive care and a dynamic management style.

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tive Founding partner Dr. John Spivey left a multispecialty practice to begin Gastroenterology Associates of Fredericksburg (GAF) in 1990. With an unusually attentive style of patient care, the new practice soon outgrew its original 700-square-foot rental unit with three staffers to its current 20,000-square-foot location with eight physicians, five midlevel providers and numerous staff. They are now the largest practice in Fredericksburg, Virginia. GAF entered into a partnership with Physicians Endoscopy (PE) in 2018. PE Senior Vice President Carol Stopa spoke with three of the key players in the group: Chet Pai, DO, Managing Partner; Frank DeTrane, MD, Senior Partner; and Cheryl Leite, Practice Administrator, to learn how they have been able to maintain and grow a thriving GI practice.

Carol Stopa (CS): How would you define your leadership style?

Dr. Chet Pai (CP): I believe in adaptive leadership. I want people to have a similar vision for the practice and similar goals—staff, partners and board members—to make the work environment better.

Dr. Frank DeTrane (FD): Historically, I always strived to have a positive outlook and be very inclusive of all of the partners and associates, promoting mutual respect and appreciation for what each individual had to contribute to the success of the practice. GAF still has weekly physician meetings to promote open communication and to try to solve problems before they fester. It is also very important to remain focused and see every challenge as a potential opportunity to improve the quality of care and access for our patients. I would not hesitate to seek professional guidance, either locally or at national meetings, for the more complicated issues such as developing ancillary services.

Cheryl Leite (CL): A key element to my leadership style and what I think makes us successful is communication.

I know it sounds a little cliché, but effective communication skills are essential to any leadership role. Over the years of my career, working with different providers, I’ve learned that people have different ways of delivering and receiving messages. Being the person who makes sure

CAROL STOPA is Senior Vice President of Business Development and Marketing for Physicians Endoscopy (PE). She has more than 18 years’ experience in acquisitions, de novo and hospital/system joint ventures. She can be reached at cstopa@endocenters.com.

important messages are delivered and received is a key part of my role.

In addition to managing communication with and between the providers, it is important to keep the staff informed about what is going on, so I send out regular updates to the team.

They appreciate that someone is cluing them in as to what is going on with the practice. I would also say I’m extremely collaborative. Staff on every level have great insights and good opinions, so I solicit input from people and ask them, “What do you see? What do you think we should be doing differently?” Our culture supports this.

People are very respectful of your questions or suggestions, even if they don’t agree.

CS: What challenges have you successfully overcome when it comes to ongoing growth? Have you faced hurdles in staffing, equipment, facilities or management?

CP: We are working on all of those challenges. In terms of staff, finding the right providers is one big challenge.

We are very selective about who will join our practice; we are trying to find the right partners and associates who have the same vision for the practice.

It’s not hard to attract people—but attracting the right person is hard. Each has to go through our vetting process, which involves all board members. We start with a phone call from one of the senior members of the practice to see if we should invite them for an interview. If that goes well, we invite them to visit the practice, along with their significant other. We don’t present an offer until everyone is comfortable. It’s a rather drawn-out engagement!

CL: Staff recruitment and retention is a challenge for our group, as with many practices. Most resumes I receive are from people who change jobs roughly every two years. Finding the right candidate who is the right fit for the practice but who is also prepared to commit for years to come is very difficult. I think we offer a very good, supportive, collegial work environment and

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excellence

{Success stories}

competitive compensation and benefits. When recruiting, we really try to focus on fit and not just rush to fill a position with the first seemingly qualified candidate.

FD: Over the last 25 years, GAF has successfully overcome many challenges. We outgrew our office space twice, and in 2008 made a major investment in our future by building and owning our current 20,000-squarefoot digestive center, which houses our two-room AAAHC-certified office endoscopy center and 21 exam rooms, allowing the physicians to be more efficient and productive. Our staff has grown exponentially as well, so we successfully recruited Cheryl in 2015 as our Practice Administrator.

With her vast experience, she was able to restructure our outdated management system Gastroenterology Associates of Fredericksburg has and assumed many accomplished all of its growth within a single facility of the responsibilities on the campus of Mary Washington Hospital, above. that the managing partner did not have time to address while working clinically full-time.

Subsequently, we now rotate the managing partner position to interested partners to provide new energy and different perspectives to the future growth of GAF.

CS: As managing partner, what is your vision for the practice over the next several years?

CP: As a provider, I recently did my MBA at George Washington University, and I focused on healthcare in the U.S., and how to curtail the extraordinary costs.

Traditionally, we have looked at healthcare through three prisms, one each belonging to the payer, the hospital and the provider. There has always been a struggle between hospital and payer, the provider and the payer, and so forth. I’m hoping we can all work together to create a system that could decrease costs while providing excellent service at the same time.

CS: What do you feel is important as you look to the immediate future?

CP: Internally, I want the staff to better themselves. The board of trustees has created an educational trust fund for any staff member who wants to further themselves in the practice without having to pay that money back. Of course, the person must be in good standing with the practice. Our external goal is to grow into the surrounding areas like Stafford, Culpepper and King

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George while making sure our quality is still No. 1. We’ve talked about having satellite offices and ambulatory surgery centers (ASCs) in different regions of Virginia.

CL: The practice has been very entrepreneurial and takes intelligent risks, and I think that positions us for long-term success. We have added ancillary services and anesthesia, for example. When you read articles that say, “private practice is a thing of the past,” and “you can’t survive on your own”—I don’t believe that’s true. If you make smart decisions and do what you do well, you can survive in private practice, especially if you enter strategic partnerships.

FD: To date, GAF has accomplished all of our growth within a single facility, which is on the campus of Mary Washington Hospital. This allows us to be very efficient in providing hospital coverage as well as performing office procedures. As we continue to grow, we will need to explore the possibility of and challenges to expanding into the surrounding community.

It is important to keep up to date with the latest developments in GI and give patients the service they are looking for. I now use a scribe to help document office visits in the EMR so I can focus on listening to the patient’s concerns and maintaining eye contact to reassure the patient. If the patient needs a timely procedure and our schedules are full, we give the patient the option to get it done as soon as possible with the first available provider. GAF has worked hard to achieve this level of service for the community of Fredericksburg, which allows patients to feel comfortable getting their care locally and only being referred to tertiary hospitals on rare occasions.

CS: What is the secret sauce to the practice’s success in attracting new physicians and providers?

CP: We are a very dynamic practice. Our practice has younger physicians; most are in their 30s and 40s.

Lifestyle is a priority for the providers—we don’t mandate a specific schedule for them. We can accommodate someone who needs a part-time position, either temporarily or permanently, or someone who prefers to work three, four or all five days per week. We want to make sure that our doctors don’t get burned out so they can provide the best patient care.

CL: One of our barriers to recruitment is geography.

Many physicians want to be closer to D.C. or another big city, so attracting great physicians to Fredericksburg can be difficult. But once we engage with a candidate, I think they enjoy the collegiality and humor that becomes evident during the interview process. Plus, our stability and success are draws, as is our size. With eight physicians and strong midlevel provider support, we are large enough that call is not overly burdensome, and we

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are small enough that we all see one another every day. difficult to make any changes. Having PE as a minority The fact that we offer a pretty short track to partnerpartner allows us the autonomy to meet the community ship has also been a strong selling point to most of the needs while using the benefit of PE’s national experience. physicians who have joined our group in the past several CL: We are the largest, most diverse GI group in the years. The latest physicians to make partner were able area and this appeals to patients. We also have two to do so within a year of coming on board. And unlike female physicians in the group currently, which appeals some other practices, the requirements for partner elito many female patients. Patients love our in-office gibility are very transparent and don’t change once you endoscopy center, and our modern, attractive facility. are on the track. This practice is the most We also have two physicians with cohesive group of physicians I’ve ever advanced endoscopy training and one worked with—they are cordial, collegial with advanced fellowship training in and respectful. transplant hepatology.

FD: Dr. Spivey set the culture of having FD: Giving the new partners opportunity a “can-do” attitude from an early stage, so for buy-in into the building and the we always try to look for solutions instead ancillaries makes a huge difference.

FRANK DETRANE, MD, FACG, is of just bringing up problems. We have I’ve always said, if you make your new one of the founding members of heard of other practices that have a tier partner successful, then everybody’s Gastroenterology Associates of system, where associates aren’t allowed successful. If you just use a new person to Fredericksburg. He is board-certified in to be in meetings with the partners. I squeeze more profit out of them, it’s going internal medicine and gastroenterology, think that having mutual respect, posito hurt them, and it’s going to hurt the and is a Fellow of the American College tive attitude and professionalism, where practice.

We also make a point of sharing of Gastroenterology. Dr. DeTrane can be you are trying to be inclusive and provide success with the staff as well. reached at fdetrane@gmail.com. free expression of ideas, is essential.

CS: What is an example of something that you were able to put in place so that you could capitalize on a coming trend?

CS: What makes your practice unique and sets you apart from your competitors?

CP: We offer traditional services and also specialty GI services, including endoscopic ultrasound, ERCP with advanced training, as well as a board-certified transplant hepatologist. We plan to soon hire a gastroenterologist with a subspecialty of esophageal motility and gastric motility.

Also, we always look to the future. We are never content with where we are and are always looking to better ourselves.

We try to predict what our practice will look like in two to three years. We examine opportunities and efforts that we should do now so we will be appropriately positioned in a few years. We have always done that over the years; most times, we have done well with our planning.

FD: Our growth has been an amazing journey. We can focus on patient care and have control over the practice.

We can make decisions and look for entrepreneurial opportunities instead of being bought out by a hospital system. It also allows us to respond to the patient; once you become corporate, it becomes

CHET PAI, DO, MBA, is Managing Partner of Gastroenterology Associates of Fredericksburg. He is board-certified in internal medicine and gastroenterology, and received a Master’s of Business Administration from George Washington University. Dr. Pai can be reached at chetpai@gmail.com.

CHERYL LEITE, MBA, is the Practice Administrator of Gastroenterology Associates of Fredericksburg. She has 20 years of experience managing large, multispecialty medical groups in New York, Philadelphia and Virginia.

She has experience working with both private and hospital-owned groups. She joined GAF in June of 2015. She can be reached at cleite@gastrofbg.com.

CP: Getting PE to become partners with us is a perfect example. We recognize that we need to continue to grow and diversify, and their expertise in the development and management of freestanding endoscopy centers will help us tremendously in this journey.

FD: GAF was the first in Fredericksburg to have office-based endoscopy, which we introduced in 2008. We have added anesthesia, pathology and infusion services to the practice. We were the first GI group in Fredericksburg to have midlevel providers, and in 2012 recruited the first female GI physicians to Fredericksburg to give our female patients an option to discuss sensitive issues in a way that felt more comfortable for them.

GAF started a GI hospitalist program dedicating a physician and midlevel to the hospital seven days a week. Most recently, GAF has partnered with PE to explore the possibilities of joint venture opportunities for the development of a freestanding endoscopy center.

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excellence

{Success stories}

A calling to serve Gastroenterologists join forces during Rwanda Endoscopy Week.

Image: iStock.com/Avalon_Studio

By Eric S. Teitel, MD, FACG

14 endoeconomics FALL 2019

endocenters.com

In October 2018, I had the opportunity to participate in Rwanda Endoscopy Week, a program established by an international coalition of gastroenterologists eager to advance endoscopy in Rwanda. Participating in Endoscopy Week was certainly among the highlights of my years as a practicing gastroenterologist. I have been in practice for 35 years—a practice that I have enjoyed and that has provided for my family. I have always felt that medicine is nothing if not a calling to serve, and the chance to help an underserved community was irresistible.

A Team of Experts I had participated in other overseas medical missions, mostly in South America, but because these trips focused on surgery, I rarely had the opportunity to share my expertise as a gastroenterologist. When I read an article about Rwanda Endoscopy Week, I quickly sent an email to Steven Bensen, MD, a founding member of the program, and joined in. I found a team of kindred spirits who were anxious to help make a difference in a place that had suffered unspeakable hardships.

Our team consisted of attending gastroenterologists, fellows, endoscopy techs, anesthesiologists and

biomedical engineers. We participated in rounds, taught endoscopic techniques and immersed ourselves in Rwandan culture and history.

We conducted procedures at four different sites, performing 448 procedures, including 66 colonoscopies, 379 EGDs (esophagogastroduodenoscopies) and 3 ERCPs (endoscopic retrograde cholangiopancreatographies), one of which included stenting of a malignant stricture.

Fulfilling a Need There is a desperate need for endoscopic services in Rwanda, as the burden of GI disease is considerable.

One young woman who had large esophageal varices, which bled due to non-cirrhotic hypertension due to schistosomiasis, had a parasitic infection of the liver.

We were able to place bands around the varices to prevent further bleeding. We also saw an 18-year-old boy who had a gastric cancer, which, of course, was very rare for someone of that age. There appears to be a large presence of H. pylori, which can be easily treated with the appropriate medications early on to prevent this kind of complication.

In this, the second year of the program, we had more

Genesis of a Program

Image: iStock.com/Meinzahn

In 1994, interethnic rivalry exploded into genocide in Rwanda, an East African nation of about 12 million people. Estimates are that around 800,000 citizens were killed in the violence, and among them were great numbers of the country’s physicians, nurses and healthcare professionals.

A great deal of rebuilding has been done on many fronts in Rwanda. Assistance from outside the country

has been welcomed, and one such program was the Human Resources for Health Program (HRH), which sent healthcare professionals to help restore the medical profession, as well as provide care alongside Rwandan physicians.

Steven Bensen, MD, was the first gastroenterologist to work with HRH, traveling to Rwanda for months at a time. Frederick Makrauer, MD, was approached by a Rwandan nongovernmental agency that focused on cardiac surgery to see if he could help develop a similar program in gastroenterology. He was happy to accept a faculty position at the University of Rwanda School of Medicine to help guide the nascent GI fellowship program. After years of visiting the country, Drs. Bensen and Makrauer worked with local internists/gastroenterologists Vincent Dusabejambo, MD, and Eric Rutaganda, MD, to establish the Rwanda Endoscopy Week program, which began in 2017.

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excellence

{Success stories}

doctors and nurses participating— both from the U.S. and Rwandan medical teams—but the lack of infrastructure was a challenge.

Even though we had certain instruments, if anything broke, there were no facilities, no biotech industry to repair it. This is a frequent problem with older equipment.

Certainly, we could have treated more people, but the lack of working equipment was the limiting factor.

Impacting the Future Rwanda has come a long way from the horrific period of the 1994 genocide, but there is still a lack of equipment and infrastructure to serve its populace. In addition to providing care, the goal of the program is to assist Rwandans in their gastroenterology education and clinical expertise. We were able to visit the medical school and accompany the fellows on grand rounds. I found both their academic training and their dedication to improving medical care in Rwanda to be very impressive. They were excited to work with us and

Looking for the right business partner?

We offer flexible minority or majority ASC acquisition options!

866.240.9496

Eric Teitel, MD, FACG, (Above: second from left; Left: second from right) teamed up with other gastroenterologists to visit Rwanda and provide muchneeded services and equipment to an underserved population.

enjoyed the interchange with the American doctors.

The students and prospective fellows, welltrained in the academic aspects of medicine, ERIC S. TEITEL, MD, FACG, is a desperately need the board-certified gastroenterologist equipment to further their specializing in the diagnosis, treatment training. Certainly, an and prevention of diseases and disorders exchange program where of the digestive tract. He practices at their fellows can train New York-Presbyterian Medical Group here in the U.S. is a step Hudson Valley. in the right direction, but ultimately, the goal is to have resources available in Rwanda, where they can be put to immediate use.

The exchange of ideas and taking care of people who really needed help in Rwanda was a wonderful reminder of why I wanted to be a physician in the first place—the nobility of the practice of medicine.

THE NEED IS GREAT. Those wishing to participate in or contribute to this program can contact Dr. Teitel at ericteitel@gmail.com.

Donations of unused equipment, such as scopes, snares, biopsy forceps or balloons, will be gratefully accepted.

What We Do We partner with gastroenterologists in private practice, providing resources to improve operations, drive growth and enhance patient, physician ph and staff experiences—all while maintaining their independence.

Our strategy is aligned with your interests in tackling the following challenges: • • • • • • •

Career security and stability Succession and recruitment strategies Growing administrative costs and burdens Shifting regulatory and reporting requirements Preparation to move from fee-for-service to value-based care Competition from hospital and other physician practice models, and Declining reimbursements paired with a need to invest in technology, security, marketing and patient engagement.

Get In Touch We’d love to share more details about how we can help you stay independent and thrive in the changing healthcare environment.

Kevin Harlen, President E: Kevin.Harlen@capitaldigestivecare.com P: 240-485-5201

insights

{Clinical updates}

The value proposition Growing numbers of hospital system-employed physicians are driving higher Medicare costs.

By Scott Leggett Medicare costs for certain common procedures have risen sharply as hospitals employ more physicians, according to new research observers say highlights the benefits of doctors working independently in outpatient centers unaffiliated with large healthcare systems.

The study, commissioned by the nonprofit Physicians Advocacy Institute (PAI) and conducted by Washington, D.C.-based consultancy Avalere Health, showed that a 49% increase in hospital employment of physicians between 2012 and 2015 coincided with an increase of $2.7 billion spent on services for four specific cardiology, orthopedic and gastroenterology services.

Meanwhile, costs to Medicare patients rose by $411 million, or 21%, the study found.

Higher Costs with HospitalEmployed Physicians Many hospitals indirectly employ doctors through a pseudo-independent foundation model. Avalere found physicians working under this kind of arrangement tended to order and bill for more services than those

$2.7 billion

spent on services for four specific cardiology, orthopedic and gastroenterology services.

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Image: iStock.com/Lashkhidzetim

A 49% increase in hospital employment of physicians between 2012 and 2015 coincided with an increase of

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providing services independently in unaffiliated outpatient centers.

“Hospital consolidation pushes healthcare costs upward,” PAI President Robert Seligson said.

Kelly Kenney, PAI’s Executive Vice President and CEO, added that the study “underscores the fact that independent physicians continue to provide patients with affordable, quality care every day.”

The hospital-affiliated outpatient centers Avalere’s researchers focused on are allowed to bill Medicare at a higher rate than independent surgery centers— even though there is no clear evidence hospital outpatient centers deliver higher quality care.

“Medicare is paying hospitals more for the same services because [the federal healthcare program] thinks it costs [physicians] more to provide the same service due to higher overheads,” said Bhagwan Satiani, MD, Professor of Clinical Surgery at Ohio State University’s College of Medicine. He added that doctors working in such settings seem to have an incentive to do more medical procedures.

Independent Physicians: A Better Deal Independent physicians, on the other hand, tend to be more efficient and have greater throughput, Dr. Satiani said. A better model, he said, would be a system in which hospital-affiliated and independent physicians alike compete “for the same quality, matched services, and then the winner will be the lowercost entity.”

Kristof Stremiki, Director of Market Analysis and Insight at the California Health Care Foundation, said that although he had not reviewed the Avalere study, its conclusions seem to be very consistent with earlier, peer-to-peer studies concluding that “the cost per patient absolutely increases” in healthcare settings where the physician is employed by a hospital system.

He referred to a study published in 2014 showing that hospital-owned physician organizations incurred costs per patient that were 10.3% greater than those billed by physician-owned organizations.

Key Takeaways

Growing costs resulting from an increase in hospital-employed physicians are shifting more attention to the independent physician and ambulatory surgery center (ASC) model. Key factors influencing this shift are: ➊ A 49% increase in employed physicians that translates to a $2.7 billion increase in costs. ➋ The cost per patient increases in healthcare settings where the physician is employed by a hospital system. ➌ Independent physicians working in unaffiliated outpatient centers are more efficient. ➍ Cost increases are bringing more attention to the benefits of ASCs combined with bundled payment models.

Stremiki noted it has been difficult to compare the two approaches in terms of quality because they are regulated differently by distinct government agencies. But in cost measures, the comparison is clear, he said: Independent physicians are the better deal.

Implications for ASCs The Avalere study is likely to shift attention to a competing model in which independent physicians working in non-hospital-affiliated ambulatory surgery centers (ASCs) package treatments under what is known as a “bundled payment” system.

With bundled payments, teams of physicians and other medical providers treat patients from pre-operative work all the way through rehabilitation or their final home-health visit. Together these collaborations compete against other programs in their region on the basis of cost, medical outcomes and patient satisfaction.

Stremiki said bundled payments create a powerful incentive in that they typically come with a kind of “30-day warranty” giving patients access to post-op care that’s part of the total price.

Although he hesitated to declare ASCs superior overall, simply because the data is lacking, he said it wouldn’t surprise him if these independent settings are more efficient generally. That’s because these facilities generally specialize in and rack up a higher volume in certain procedures.

“Their quality for that particular procedure goes up,” he said.

SCOTT LEGGETT is Co-Principal, Global 1 and Managing Director, Convergent SameDay Orthopedic Strategies.

With more than two decades working in orthopedics, Leggett’s experience includes founding a network of independent, physician-owned outpatient surgery centers. He also served as the President and board member of the California Ambulatory Surgery Association (CASA). Learn more about Global 1 at surgerybetter.com.

19 endoeconomics FALL 2019

insights

{Marketing strategies and tips}

Embracing digital health In recent years in the U.S., the volume and complexity of endoscopic procedures have increased dramatically.

An increasingly aging patient population, an emphasis on preventative care and surveillance, and new technologies for both diagnostic and interventional procedures have contributed to a growing demand for endoscopy.

In any setting, whether in a large-scale, tertiary-care hospital or a community ambulatory surgery center

20 endoeconomics FALL 2019

(ASC), there are significant challenges in operating endoscopy units. As we have seen in peer-reviewed GI journals such as GI Endoscopy and from private companies on the forefront of endoscopy center management, efficiency and optimizing workflow is crucial to practice growth and sustainability in the current GI landscape.

At the same time, the growth of the electronic health record (EHR) has allowed patients to access their healthcare

Image: iStock.com/AlonzoDesign

The future of healthcare is digital, and mobile technology is an essential component. By Neal Kaushal, MD, MBA

endocenters.com

alike can, and should, look to leverage at never-before-seen speeds and in unprecinformation technology to elevate edented ways. This has created a force for IN 2017, THE ON-DEMAND performance to new levels. innovation that is transforming patient ECONOMY REPRESENTED care into not just a medical necessity, but also a consumer product. Simply put, Reaching Patients Where They patients are still patients, but now they Are—Online IN SPENDING, AN INCREASE are also customers. They can shop around As important as operational performance OF 58% OVER 2016. for their healthcare needs. They want in the endoscopy center is, perhaps of even Rockbridge Associates, 2018. price transparency. They want access to greater significance is the industrywide their healthcare providers. They want to emphasis on the Patient Experience. The consume health-related content at their Patient Experience can be thought of as convenience, and not just take direction the range of interactions that patients from their physician during a 15-minute appointment. have with the healthcare system, including their doctors, All of these forces have combined to create a new nurses and healthcare facilities. With increasing financial healthcare industry: Digital Health. The key concept of reimbursement tied to Hospital Consumer Assessment of Digital Health is that the delivery of healthcare can be Healthcare Providers and Systems (HCAHPS) scores, patient captured, measured, quantified and implemented in real satisfaction and engagement are more crucial than ever. time using the power of information technology. The field The growing availability of digital media and content of gastroenterology has been greatly impacted by new has impacted GI care delivery tremendously. Patients advances in Digital Health mainly in two arenas: endosoften research their gastrointestinal disorders extencopy center management and the patient experience. sively online even before referral to a GI specialist.

Digital media outlets such as YouTube are becoming increasingly popular among GI practices in communicatUsing Data to Improve Operational Performance ing essential information, such as endoscopic procedure When it comes to the management of endoscopy centers, animations and physician delivered tips for effective several peer-reviewed studies have searched for metrics bowel preparation prior to the day of colonoscopy. for evaluating the efficiency of endoscopy units. These Just as Digital Health can be utilized to improve endoscopy have included room turnover time, room-per-endoscopist center performance and create better outcomes on the ratio, usage of propofol anesthesia versus moderate day of procedure, mobile app engagement tools can be sedation and True Completion Time (TCT). leveraged to create a customized experience tailor-made One of the biggest challenges to developing lasting for each patient from the time of initial office visit all operational solutions, however, is obtaining actionable the way through discharge after procedure. Automated data that can be used for real-time analytics. Traditionreminders for appointment confirmation, bowel ally, administrative and clinical leaders have monthly or preparation compliance and educational content can put quarterly operations meetings to review performance and the patient at the forefront efficiency metrics as described above. In this approach, of GI care delivery, with data from the previous time period (i.e., month or quarter) access to their healthcare is collected and reviewed, and operational solutions are right at their fingertips. then implemented based on collective decision making.

As we move forward in Sometimes, budget projections for the following fiscal year our quest to deliver high are even made on projections from prior data analysis. quality care to our patients What is fundamentally lacking in this approach, howNEAL KAUSHAL, MD, MBA, is a gaswith GI disorders, Digital ever, is the ability to analyze data and make decisions in troenterologist in Sonora, California. He Health is the next frontier. real time. Our next great challenge as leaders is to ask, is Chief of GI at Adventist Health Sonora Whether it is in optimizing “How do we learn from yesterday’s performance so that and also serves as Medical Director of workflow and operational we can improve our unit workflow tomorrow?”

Ambulatory Care Services. Dr. Kaushal efficiency in the endoscopy This is where the power of Digital Health can truly is also a well-recognized expert in unit or providing patients be harnessed. To date, mainstream EHRs have yet to endoscopy center efficiency and management. He is Chief Medical Officer of with a bespoke experience develop tools such as mobile apps with user-friendly Core Mobile, Inc, a startup specializing in their GI care delivery, interfaces that can automatically capture operational in optimizing perioperative services and leveraging information data, communicate across the entire care team and enhancing the patient experience via technology is an essential produce customizable reports at the tap of an icon. mobile technology. He can be reached tool for the success of the By exploring partnerships with clinical and software at neal@coremobileinc.com. gastroenterology practice. innovators, gastroenterologists and practice managers

$75.7 billion

21 endoeconomics FALL 2019

insights

{Marketing strategies and tips}

Elevate your presence

Tips to grow your practice or center’s website traffic organically, and make a great first impression with patients.

When it comes to finding a healthcare provider online, patients want the process to be as simple as possible. From discovering your office location to learning more about the physicians in a practice, your website should be the premier destination for all of this information and more.

Growing your practice’s website is a lot different from growing its social media following, but it is crucial to improving engagement with patients. In the Summer 2019 issue of EndoEconomics, you can find tips for how to best optimize the content on your website.

To organically increase the flow of traffic to your center’s website, you want to make sure to focus on the type of content displayed. In addition, focus on how you are communicating with current and future patients, and properly maintaining communication on a weekly or monthly basis.

Here are a few tips on how to improve online visibility for your business, and set an excellent first impression of your facility and your providers.

Content Is King A website’s primary function is to provide useful information that is accessible and easy to digest. For GI centers, patients will want to know

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how they can make appointments and find information about the physicians and the services you provide. Before setting up an appointment, patients want to feel as though they can have a personal connection with the doctors and staff.

They want to know who the physicians are and what they specialize in. Patients want to feel confident that your practice can solve their problems.

To ensure that patients know what they can expect, it’s vital to provide up-to-date bios of all doctors, nurses and other staff members to help put a face with a name. Patients are more likely to book an appointment if they can see who they will be interacting with. It’s also a good idea to make sure that your center’s location, phone number and business hours are highly visible on your homepage. A 2017 Think with Google study notes “local convenience is key,” pointing out that “‘near me’ searches for health-related services” doubled in the previous two years.

To take advantage of local convenience, you need to make finding your practice easy. Locating your office and determining where to park (and whether or not parking is free) should be quick and painless. Sharing photos of the exterior of your

Image: iStock.com/enisaksoy/sefa ozel/CostinT

By Deven Stopa

endocenters.com

center, and photos of your doctors and other staff, can ease vulnerability or anxiety that a patient may feel upon their first visit.

It’s also important to ensure that your website works great on mobile and tablet devices. A Super Monitoring survey reports that 57% of users said they would not recommend a business with a poorly designed mobile site. So, if you take the trouble to make this information easy to access, but it’s difficult to read on mobile, you aren’t reaching everyone you can.

Talk the Talk

Finding Feedback

When researching your center on the internet, it is highly likely that patients are going to look at reviews from individuals who have experienced your services.

These three (free) platforms are great for being proactive in managing your center’s online reputation and encouraging past and present patients to share reviews.

Google Business — Once you verify your business on Google, you can post updates, offers and success stories from patients in order to increase your online rating.

While it is important to communicate with your patients, you don’t want to overwhelm them with too many emails, calls or text alerts. When directly communicating with patients, keep correspondence short and sweet. Ideally, direct communication should only be related to an upcoming procedure or appointment.

If you want to connect with patients more informally, social media is a great outlet to share general information, build credibility and spotlight current events.

As an example, one of our centers recently shared a social media post related to Hispanic Heritage Month and tied it back into how certain ethnicities are more susceptible to GI diseases. When there isn’t a notable holiday or observance, it’s always good to post about common GI issues or health tips, such as foods to eat to avoid acid reflux. The best patient is a well-educated one—you want to empower them to learn more.

According to a report by the Health Research Institute (HRI) at PricewaterhouseCoopers (PwC), one-third of consumers use social media platforms like Facebook, Twitter and other online forums to find health-related information.

These social media sites also have free analytics reporting so that you’re able

Yelp — This platform isn’t just for restaurants. Driving patients to your Yelp profile can help increase visibility to audiences outside of your community.

to measure how well your content is performing online. On Facebook, you can do a promotional post and set a threshold of $30—something as small as that can make an impact, particularly if you specify demographics to target. Remember, it’s not always about selling the doctors upfront; it’s about showing that you’re dedicated to building a relationship with the patient.

After a procedure, you always want to send out a patient survey and remind them to review you. Most patients will automatically go that route if they have an especially good (or bad) experience.

It’s also a great idea to post testimonials to your website often. If you receive a bad review, make sure to address it. By addressing it, you’re showing your community that you’re making changes so that it doesn’t happen again, which ultimately builds credibility and trust.

If you haven’t been thinking about your center or practice’s web presence, these tips should help you get started. With more and more patients using the internet to find healthcare services, you’re losing business if you’re not online. Patients won’t hesitate to find your competitors and book appointments with them.

HealthGrades — This platform is specifically designed to help consumers find physicians, hospitals and caregivers, and includes an opportunity for patients to review their experiences.

DEVEN STOPA is Director of Digital Marketing at Physicians Endoscopy (PE). She can be reached at dstopa@endocenters.com.

23 endoeconomics FALL 2019

endo opportunities

West Mesa, AZ Central Arizona Medical Associates Seeking a full-time gastroenterologist. Physician can expect to step into a busy practice while replacing a retiring partner. Anticipate a short track to practice partnership and ASC ownership. Practice operates out of a single office and covers one hospital. Outpatient endoscopy performed at a physician-owned, two-room ASC. Enjoy sunshine and a great lifestyle in the metro Phoenix area.

Scottsdale, AZ Digestive Health Specialists Arizona Full-time gastroenterologist with partnership potential needed for small practice of four MDs, NP and PA. Outpatient-based with low inpatient volume and only one hospital round. No ERCP or EUS training needed. Physician office includes an infusion center, pathology lab and state-of-the-art endoscopy center, all within the same building.

Bellingham, WA NW Gastroenterology & Endoscopy

Midwest Bloomington-Normal, IL Digestive Disease Consultants Reputable single-specialty practice for more than 30 years seeks physician. Multiple revenue sources including endoscopy center, strong support from local hospital and guaranteed salary for two years. Low turnover and high retention rate.

Portage, MI Bronson Gastroenterology Practice Seeking a BC/BE gastroenterologist to join a well-established and respected group of outpatient and hospitalist gastroenterologists, and mid-levels. Employed position includes competitive salary, paid malpractice and full benefits. Kalamazoo, located midway between Detroit and Chicago, offers highly rated public schools, affordable real estate, and many activities for the whole family. Lake Michigan is less than an hour’s drive away.

Physician needed to join a nine-person single-specialty practice.

Freestanding AEC and pathology lab, EUS optional, ERCP optional.

Outstanding benefits package offered. Progressive coastal community offers ocean and lake recreation, skiing, and miles of hiking and biking trails. Small college town atmosphere with proximity to Seattle and Vancouver, Canada, and a great place to raise a family.

Rochester, MI

Northern & Central, CA

Lima, OH

SecureMD Board-certified gastroenterologists needed for mobile endoscopy practice in Northern CA (Sacramento/Stockton/Tracy) and Central CA (Fresno/Tulare/San Luis Obispo). Flexible schedules allow you to work as many as 2–3 days per week or as few as 1–2 days per month.

24 endoeconomics FALL 2019

Troy Gastroenterology Two gastroenterologists skilled in general endoscopy and ERCP needed for private practice with two state-of-the-art, AAAHCaccredited ASCs. Competitive base salary with productivity incentive, retirement plan, discretionary allowance, insurance, and eligibility for member status after two years.

Gastro-Intestinal Associates, Inc. BE/BC gastroenterologist needed for six-physician, four-CNP single-specialty practice. Practice is physician-owned and includes an 18,000-square-foot combined office and three-room endoscopy center. Opportunity offers 1:7 call rotation, first-year salary guarantee and outstanding earning potential.

Submit your CV online at endocenters.com/recruiting.

South

Hillsborough, NJ Digestive Healthcare Center PA

Gastonia, NC Carolina Digestive Diseases Seeking a BE/BC gastroenterologist to expand coverage in community of Gastonia, NC. Physician can expect to step into a busy practice while replacing a retiring partner. Anticipate a short track to practice partnership and ASC ownership. Practice operates out of a single office and covers one hospital. Outpatient endoscopy is performed at a two-room ASC.

Northeast New York, NY Gastroenterology on Gramercy Park Seeking a gastroenterologist to join two-physician private group.

Expect to step into a busy practice while replacing a retiring partner. Opportunity offers a primarily outpatient experience with a reasonable call burden. Candidate will have ownership opportunity in affiliated endoscopic ambulatory surgery center.

Uniondale, NY Gastroenterology Associates PC Seeking a full-time/part-time, board-certified/board-eligible GI physician to join large single-specialty gastroenterology group.

Compensation package includes an option for partnership in practice and ownership in affiliated Ambulatory Surgery Center.

North Bergen, NJ Advanced Center for Endoscopy GI physician needed to join a single-specialty, nine-physician GI center. The center can help the physician drive patient volume through the ASC, allowing the physician to increase procedure volume in an environment that is more convenient. Ideally located in North Bergen, the “gold coast” of Northern New Jersey, with a spectacular view of the NYC skyline.

Lumberton, NJ Gastroenterology Consultants of South Jersey Seeking full- or part-time gastroenterologist to join a privately owned, seven-physician practice. Well-established practice of 25 years, located among several growing communities in Southern New Jersey. We offer a 1:7 call schedule and an opportunity to perform ERCP/EUS (not required). Affiliated with Burlington County Endoscopy Center, a three-room ASC that is physician-owned and operated.

Central, NJ Garden State Digestive Disease Specialists, LLC Seeking full-time BC/BE gastroenterologist to join threephysician practice. The job offers an excellent salary, competitive benefits package, reasonable call schedule (which includes other gastroenterology colleagues in the rotation), and an opportunity for full partnership track in 2–3 years. EUS/ERCP training preferred.

Seeking a BE/BC gastroenterologist skilled in general endoscopy and ECRP to join busy, seven-person, single-specialty, 30-year established practice located in Central New Jersey. Excellent salary, competitive benefits package.

Jenkintown, PA Gastrointestinal Associates, Inc. Seventeen-physician practice is seeking a board-certified gastroenterologist preferably with an investment in IBD or advanced therapeutic training. Full-time position with shared clinical and administrative responsibilities. The job offers a competitive salary and benefits that include bonus potential and partnership track.

Limerick, PA Endoscopy Associates of Valley Forge Board Certified. US Gastroenterology Fellowship. ERCP- or EUStrained preferred. Full-time, rotating call dispersed evenly with three other physicians. One hospital with endo suite, hospital is within 15 minutes driving distance of center. GI center has three procedure rooms. GI practice is in the same building as the GI center. Located one hour outside of Philadelphia.

PRSRT STD US POSTAGE

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