EndoEconomics Spring 2019 Issue

SPRING 2019

A journal dedicated to advancing GI ASCs and practices

8 Sharing the vision

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6 12 16

INVESTOR INTEREST IN PRACTICES BUILDING A GI SUPER GROUP ONLINE REVIEWS

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

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EDITORIAL STAFF

Carol Stopa Editor in Chief cstopa@endocenters.com

CONTENTS

SPRING 2019

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Publishing services are provided by GLC, 9855 Woods Drive, Skokie, IL 60077, (847) 205.3000, glcdelivers.com.

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

3 New PE partners,

6

Message from the President

Top Docs, and more

The new frontier

8

Sharing the vision

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

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

EXCELLENCE

INSIGHTS

All rights reserved

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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.

Power in numbers

MARKETING Everyone is a critic

18 MARKETING

What’s your story?

ENDO OPPORTUNITIES 24

GI physician opportunities at partnered practices

20

HR Making a deal

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.

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1 endoeconomics SPRING 2019

letter

{Message from the President}

THE LONG VIEW A strong plan for the future is important when considering private equity investment

David Young, President, Physicians Endoscopy

THERE IS THE POTENTIAL TO LIMIT GROWTH AND OPPORTUNITY FOR YOUNGER DOCTORS WHO ARE THE FUTURE OF INDEPENDENT GI.

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WHEN YOU LOOK AROUND THE GASTROENTEROLOGY (GI) MARKETPLACE, THERE IS A LOT OF WHAT I WILL DESCRIBE AS “DISTRACTION.” This distraction comes in the form of a rapidly growing movement of private equity investment. Private equity companies, recognizing the growing value of GI as part of managing the cost of healthcare, are working to position themselves to buy into the practice side of GI. We have witnessed several large groups being at least partially acquired by private equity companies, and other transactions are on the horizon. In these transactions, a management services organization (MSO) is created, and the private equity company becomes a part owner in it.

While we are highly supportive of the role of private equity in healthcare, it is important to ensure that all these transactions balance between the short- and long-term effects on the GI marketplace.

A typical transaction will involve physicians selling a sizable portion of their future practice income to a private equity company in addition to the creation of the MSO. This commercializes the historical investment in the MSO and opens the MSO platform to growth by providing services to additional GIs. For example, let’s say a private equity company acquires 30 percent of a physician’s future practice compensation. That can be a sizable check.

We also know private equity deals tend to last around five years. Then the private

equity company typically sells its equity interest to another private equity firm or investor creating a liquidity event for all the investors. Everyone seems to win. Yet there is the potential to limit growth and opportunity for younger doctors who are the future of independent GI. The doctors selling can often be the senior leaders with a shorter view of approaching retirement and consider the sale part of their exit strategy. If the impact on the younger physicians is not considered, this approach can limit the ability to attract the future generations of GI providers to the practice. When that 30 percent is sold to a private equity company, it is income gone for good. If you are a young physician, you likely benefit less from the sale, and being able to generate income replacement through alternative growth strategies is of high importance.

A good income replacement plan needs to be in place.

Why does this matter to Physicians Endoscopy (PE)? We believe that independent GI is vital to the success of the marketplace. To achieve such success, there must be a vision not focused just on the transactions (distractions) of today.

Rather, we must work to ensure there is a solid, long-term platform that takes care of all generations of physicians, and these transactions must take all aspects of every physician into account. This is the role of a strategic partner, which we at PE strive to be.

noteworthy

{News and events}

Physicians Endoscopy Partners with Peninsula Regional Medical Center on Maryland-based GI Surgery Center Delmarva Endoscopy Center, LLC (DEC), located in Berlin, MD, is a strategic joint venture between Physicians Endoscopy (PE) and Peninsula Regional Medical Center (PRMC). Berlin is known as one of America’s coolest small towns and only a few miles from shore points and Ocean City beaches.

The two-room center is currently under construction and expected to be open later this summer. PRMC’s premier board-certified gastroenterologists will be performing procedures at the center. The physician leadership group includes Jerrold Canakis, MD; Daniel Daniels, MD; and Pushpjeet Kanwar, MD. The hospital is also looking for additional providers to join the GI medical staff.

PE and PRMC’s team have worked diligently to develop this much-needed facility for the community which will provide high-quality services in a lower-cost setting. DEC represents PE’s second center in Maryland.

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Esophageal Cancer Awareness The Esophageal Cancer Action Network (ECAN) designated April as the official Esophageal Cancer Awareness Month in the majority of U.S. states. Increasing awareness about the risk factors and symptoms of esophageal cancer will help boost detection rates, which will help save numerous lives. ECAN is dedicated to raising awareness about the risk factors that can lead to esophageal cancer, as well as supporting development of effective treatments and a cure for the disease. Join ECAN to help stress the crucial link between reflux disease and esophageal cancer, foster prevention and early detection among those at risk, and support medical research into prevention, early detection, and treatment. Their goal is to connect patients and caregivers with resources for information, encouragement, and compassionate support.

For more information or to request awareness materials in English and Spanish, visit ecan.org/how-to-help

Celebrating Our New York Top Docs Physicians Endoscopy (PE) congratulates their affiliated GI physician partners from New York who have been named Top Doc for 2018 and/or 2019! These physicians were selected as the most outstanding healthcare providers in the field of gastroenterology from review sources such as Castle Connolly. Look for PE’s other Top Doc partners in the next edition of EndoEconomics.

Adam Steinlauf Albert Harary Andrew Blank Anthony Borcich Arnon Lambroza Arthur Vogelman Asher Kornbluth Barry Jaffin Blair S. Lewis Bradley A. Connor Brett B. Bernstein Carl McDougall Cary Schneebaum Charles Saha

Christopher Bartolone Daniel J. Adler David H. Robbins David Stein Gary Schwartz Gregory Haber Henry J. Katz Indira Kairam Ioannis Oikonomou Ira D. Breite Isadore P. Gutwein James George James Lax James Rand

Jan Shim Jeffrey M. Loria Jennifer Bonheur Jonathan Rieber Julie Foont Jusuf Zlatanic Leon Kavaler Michael Blechman Michael Krumholz Michael Kushner Moshe Rubin Myron Goldberg Naima Mian Paul Basuk Paul Miskovitz Paulo Pacheco Perry Gould Peter Baiocco Peter Distler Peter E. Legnani Peter K. Chang Prospere Remy

Raymond Tuoti Ricardo E. Pou Richard Whelan Robert A. Sable Robert B. Cooper Robert Bartolomeo Ron Palmon Ruvan R. Shein Siddhartha S. Shah Steven Fochios Susan Lucak Todd Linden Vicenta DeLopez Wendy Aronson William Cohn

Note: Care has been taken in collecting this information. If any errors or omissions are found, kindly email info@endocenters.com with details.

Every reasonable effort is made to present accurate information.

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noteworthy

{News and events}

Physicians Endoscopy Broadens Their Strategic Partnership with University Hospitals in Cleveland, Ohio Physicians Endoscopy (PE) and University Hospitals (UH) have enjoyed a long-standing relationship dating back to 2006. The partnership grew over the years with the development of two joint ventured ambulatory surgery centers (ASCs), one in Chagrin Falls and one in South Euclid, that include eight University Hospitals physician partners. As part of the systems’ strategic plan, they have been working collaboratively with PE to develop additional ASC sites in extended markets. In late 2018 and early 2019, PE and UH finalized two new GI surgery centers located in Canton and North Ridgeville.

UH Canton Endoscopy (UHCE) completed the development process in January 2019. UHCE is a two-room center expected to perform close to 3,000 procedures annually. University Hospitals’ affiliated GI Physicians, Edward Schirack, DO, and Mona Shay, DO, are proud owners of the center. UHCE received its license in late February.

UH North Ridgeville Endoscopy Center (UHNR) is scheduled to open in early 2019. UHNR is also a three-way joint venture between PE, UH, and four UH GI physicians—Shaffer Mok, MD; Brian Putka, MD; Dany Raad, MD; and Sapna Thomas, MD. UHNR is a hospital outpatient facility conversion to a freestanding licensed ASC. The three-room facility is expected to perform nearly 4,500 procedures annually.

The successful planning and execution of these GI-focused ASCs has paved the way for further development as UH continues to broaden their strategic approach in providing high-quality, low-cost, and patient-friendly GI-focused surgery centers for communities and patients.

To learn more about PE hospital partners, visit endocenters.com

Dr. Eric Shapiro Recognized

by Becker’s ASC Review Eric J. Shapiro, MD, was named by Becker’s ASC Review as one of the “127 GI Physicians to know in 2018.”

Dr. Shapiro, who is associated with The Endoscopy Center at Bainbridge, LLC, is a gastroenterologist at University Hospitals of Cleveland. Dr. Shapiro has over 33 years of experience and is a board-certified physician who specializes in internal medicine and gastroenterology. He practices general gastroenterology with a special interest in the interactions between food, nutrition, and health.

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GI’s Best Doctors in 2018 Physicians Endoscopy (PE) would like to congratulate Robert Bruce Cameron, MD; Michael Koehler, MD; and Eric Shapiro, MD, on being named Cleveland Magazine’s Best Doctors in 2018! All three physicians have shown exemplary dedication, hard work, and persistence in providing excellent care to their patients every day. These doctors are affiliated with The Endoscopy Center at Bainbridge, LLC in Chagrin Falls, OH—a three-room ambulatory surgery center that has partnered with PE since 2006.

Find PE at These Upcoming Tradeshows ACG/FGS Annual Spring Symposium Date: March 1–3, 2019 Location: Naples, FL GI Roundtable (GIRT) Date: April 5–6, 2019 Location: Seattle, WA ACG Eastern Regional Date: June 8–9, 2019 Location: Washington, DC GI Outlook (GO) Date: August 2–4, 2019 Location: Hollywood, CA

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

Brett Bernstein, MD, FASGE, Named to AHMI Expert Panel The American Society for Gastrointestinal Endoscopy (ASGE) nominated Brett Bernstein, MD, MBA, FASGE, to serve on an expert panel to provide a voice for practicing gastroenterologists. The panel will specifically focus on quality measurement in ambulatory surgery centers (ASCs) and hospital outpatient departments.

Through the Ambulatory Surgery Center and Hospital Outpatient Measurement Information Gathering (AHMI) Project, Centers for Medicare & Medicaid Services (CMS) will gather stakeholder input to develop new measurement concepts in several ambulatory and outpatient healthcare settings. CMS is committed to expanding the perspectives that inform their quality measurement initiatives.

Dr. Bernstein is a Clinical Associate Professor of Medicine, Chief of Gastroenterology at Mount Sinai Beth Israel, and the Director of Clinical Integration for Gastroenterology and Endoscopy for the Digestive Disease Institute of the Mount Sinai Health System.

At the Institute, he is responsible for streamlining and integrating gastroenterology and endoscopy operations across five hospital-based departments and four ASCs. Dr. Bernstein, an affiliated Physicians Endoscopy partner, currently serves on the ASGE Quality Assurance in Endoscopy Committee and GIQuIC Board of Directors, as well as the Board of Directors of the ASC Quality Collaboration. We congratulate Dr. Bernstein on his selection to serve on the AHMI expert panel.

To read more, please visit asge.informz.net/asge/pages/ November_2018_Brett_Bernstein

GASTRO MANAGEMENT SERVICES Focus on clinical care, not administrative duties.

Revenue Cycle Finance Operations Leadership Human Resources Information Technology

TO LEARN MORE: info@pegastro.com

strategies

{Business strategy and the bottom line}

The new frontier

Is gastroenterology the next big thing for private equity and other investors?

By Anna Timmerman and Jonathan E. Steinberg

Historically, GI physicians’ practices have followed a traditional model.1 However, as the economics of healthcare increase in complexity, so do the number of business models. Beyond traditional models, gastroenterologists now have other practice options, including partnership with private equity firms and other strategic investors. These investors are interested in gastroenterology practices for numerous reasons that are likely to continue investment in this space for the foreseeable future.

Historical Practices Gastroenterology has remained a rather fragmented field in comparison to some other medical specialties.2 The medical world generally has consolidated, with many physician practices being acquired by hospitals and health systems and others merging into larger practices.

In 2018, almost 6,000 gastroenterologists were practicing in private practices.3 The benefits of a private practice include the ability to take a leadership role early in a provider’s career, and the likelihood of earning more than their employed colleagues, among others.4 However, handling all of the administrative aspects of a medical practice, as well as the clinical work, can be more than a solo practitioner or small physician group wants to juggle.

What Is Private Equity?

While there are various options for a physician who wants to cease running an independent private practice, one intriguing option is partnering with an investor.

Private equity firms “raise funds from institutions and wealthy individuals and then invest that money in buying and selling businesses.”5 They invest in companies directly, instead of purchasing stock, and typically purchase a company with the goal of growing its value.6

would be structured. Under this doctrine, non-licensed persons cannot directly own a medical practice or directly employ licensed healthcare providers. State law needs to be carefully reviewed to determine how the transaction will need to be structured to ensure compliance.

One way private equity or other non-licensed persons can participate in a gastroenterology practice involves the investors forming an administrative services company, which can be owned by non-licensed individuals. That company then contracts with the gastroenterology practice to provide non-clinical administrative support.

However, any structuring decision and other relationships or service lines should be carefully reviewed for compliance with laws.

What Are Some Other Private Equity Considerations?

Why Are Investors Interested in Gastroenterology?

When investing in healthcare, private equity firms must always keep regulatory considerations front of mind. For example, most states have corporate practice of medicine prohibitions that affect how investment in a GI practice

There are several reasons why gastroenterology is poised to be an area of growth and potential investment by private equity firms and other big investors, including the following:

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or nutrition counseling, which offer added profit lines.

However, there are crucial regulatory issues to address any time a practice adds or maintains an ancillary service, including fraud and abuse considerations.

Future Opportunities The first private equity investment in gastroenterology occurred in 2016, and additional interest has only just begun.11 Further, Physicians Endoscopy just purchased its first interest in a gastroenterology physician practice in 2018, and other similar strategic investors may be considering comparable moves. Private equity and other investors’ interest in gastroenterology is likely to increase, as opportunities continue to exist for investment.

REFERENCES “ New Models of Gastroenterology Practice,” John I. Allen, MD, MBA, AGAF & Neal Kaushal, MD, MBA, GI & Hepatology News, June 4, 2018, available at https://www. mdedge.com/authors/john-i-allen-md-mba-agaf.

2 “Why Private Equity is Turning its Attention to Gastroenterology,” Alex Sauter, April 19, 2018, available at https://www.mhtpartners.com/why-private-equity-isturning-its-attention-to-gastroenterology.

3 “Private Practice GI Models Aren’t Disappearing – Dr. Fred Rosenberg Explains Why,” Eric Oliver, Becker’s GI & Endoscopy, November 27, 2018, available at https://www.beckersasc.com/gastroenterology-and-endoscopy/private-practicegi-models-aren-t-disappearing-dr-fred-rosenberg-explains-why.html.

4 Id.; Medscape Gastroenterologist Compensation Report 2018, Slide 6, Carol Peckham, April 18, 2018, available at https://www.medscape.com/ slideshow/2018-compensation-gastroenterologist-6009656#1.

5 “The Strategic Secret of Private Equity,” Felix Barber and Michael Gold, HARVARD BUSINESS REVIEW, September 2007, available at https://hbr.org/2007/09/thestrategic-secret-of-private-equity.

6 “What Exactly Is Private-Equity?,” Jill Schlesinger, CBS News Moneywatch, January 24, 2012, available at https://www.cbsnews.com/news/what-exactly-isprivate-equity.

7 Sauter, supra.

8 “By 2030, all baby boomers will be older than age 65. This will expand the size of the older population so that 1 in every 5 residents will be retirement age.” “Older People Projected to Outnumber Children for First Time in U.S. History,” United States Census Bureau, March 13, 2018, available at https://www.census.gov/ newsroom/press-releases/2018/cb18-41-population-projections.html.

9 Insurance companies and Medicare, for example, generally cover colonoscopies. “Growth and Efficiency in Gastroenterology,” Jacqueline Fellows, HEALTHLEADERS, June 2015, available at https://www.healthleadersmedia.com/ strategy/growth-and-efficiency-gastroenterology.

10 Sauter, supra.

11 Allen & Kaushal, supra.

1

➊ | A Fragmented Industry. Many gastroenterologists ➋ ➌

➍

➎

practice in smaller practices. There is an ability to consolidate and centralize administrative functions.7 | Aging Population. The demand for services is likely to continue as the U.S. population ages and the need for preventative services grows.8 | Related Ambulatory Surgery Centers (ASCs). It is not uncommon for gastroenterologists to own ASCs where they can perform various GI procedures. This investment opportunity presents an additional area for cost containment and patient satisfaction. | Reimbursement. Gastroenterological practices often see an advantage in terms of reimbursement, as common procedures are generally reimbursed by insurers.9 Further, while some reimbursement amounts have decreased over time, the volume and growth in other services is attractive to investors.10 | Ancillary Services. There are ancillary services that practices can expand into, such as pathology services

ANNA TIMMERMAN is a Partner practicing in the healthcare group at McGuireWoods LLP. Her practice focuses on regulatory matters for a variety of healthcare providers, including hospitals and ASCs. She can be reached at atimmerman@mcguirewoods.com.

JONATHAN E. STEINBERG is an Associate at McGuireWoods LLP. He practices within the firm’s healthcare department and advises clients on a broad range of regulatory, compliance, transactional, and corporate matters. He can be reached at jsteinberg@mcguirewoods.com.

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strategies

{Business strategy and the bottom line}

g

a h S rin th

e

vision

Illustration by Roy Scott

The most effective leaders combine strong management skills with the ability to inspire teams to work toward their goals.

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One of the goals of Physicians Endoscopy (PE) is to support gastroenterology practices and encourage physicians to take on leadership roles in their organizations. We want to help our partners learn how to grow their practices and how they can mentor the next generation of leaders.

Joseph Vicari, MD, MBA, FASGE, former Managing Partner of Rockford Gastroenterology Associates, recently spoke to PE Senior Vice President of Business Development and Marketing Carol Stopa. He shared how a gastroenterology practice can create a culture of leadership and a succession plan.

Carol Stopa (CS): Tell me about your group’s history, and how you have scaled the size of your practice.

Joseph Vicari, MD, MBA, FASGE (JV): Rockford Gastroenterology Associates (RGA) is a single-specialty GI group. We are located in Rockford, Illinois, which is about 65 miles northwest of Chicago. We have a clinic and an endoscopy center in a building that is about 25,000 square feet. There are currently 13 physicians and eight nurse practitioners.

We started as a solo gastroenterology practice in 1975 with Dr. Roger Greenlaw working as a hospital-based physician. In 1980, we became an independent group practice and continued to expand. I am proud to say that today all of our physicians are also on the faculty of the University of Illinois College of Medicine at Rockford.

CS: What has been your role in the practice?

JV: I joined RGA in 1997 and became managing partner in 2004. I was in this position for 13 years but decided to step down in 2017. This was a planned and elective exit for me as I enter the last phase of my career.

CS: How does such a large practice make decisions, and is everyone involved in the process?

JV: Our group’s philosophy is that we put patients first, organization second, and our staff and physicians third.

Our leadership team includes a business administrator who is not a physician, a managing partner who is a physician, a CFO who really focuses on the business aspects, and a president. We also have a clinical administrator who works with the leadership team on clinical-related topics.

This leadership team handles many of the daily decisions that do not need to go to the physician board for approval. We are a horizontally integrated group and have many committees that play an important role in decision-making. Even the managing partner ultimately

reports to the physician partners. Currently, our physician partners meet once a month to discuss different matters, such as clinical, business, and economic topics. We give our supervisors a lot of autonomy because the managing partner cannot make every decision, or he would never work. In general, we need a 75 percent majority to make a decision.

CS: How would you define your leadership style?

JV: There are many different leadership styles. There is the classic autocratic style, which is dictatorial and extreme. Then, on the opposite end of the spectrum, there is the laissez-faire leadership style, which is very ineffective and leads to chaos. Many leadership styles fall in between these two extremes.

My style is a blend of servant leadership and participative leadership. Servant leadership is based on service first. Servant leadership means the primary goal is to serve the patients, organization, and staff. Participative leadership means that you invite input from others, and I am a big believer in delegating. By blending the two leadership styles, you can delegate and keep your finger on the pulse of the organization.

Expand your hospital outpatient capability with a strategic partnership!

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Experienced in building GI ASCs with hospitals and physicians

strategies

{Business strategy and the bottom line}

CS: What do you consider important personal characteristics of an effective leader?

JV: They need to have integrity. Integrity means having the quality of being honest and acting in a moral fashion.

They have to be good communicators and good listeners.

Effective leaders also need to know when to compromise.

They cannot be daunted by the loudest negative voice, and they need to keep in mind that this is a business process and not personal. The best leaders have thick skin.

Effective leaders have to be fair and kind. They have to care about people, especially the patients and employees.

Finally, they have to recognize when someone goes beyond their duties, and be willing to say thank you. We are quick to tell people when they do a poor job, but we need to remember to praise people when they do a good job.

CS: How important is team building in leadership?

JV: I think team building is very important unless you plan to be an autocratic leader and make all the decisions alone. You need a team of smart people who are creative and visionary. You also need people who will think differently than you do to have balance.

One way to build a team is to show you trust them by delegating tasks. We have many teams, or committees, within our practice. We involve them in decision-making, and they take more ownership in the practice.

CS: What is the difference between a manager and a leader?

JV: I think the main difference is that leaders bring people together to follow their vision. Leaders also set an example for others to follow. Managers are going to implement the leader’s plan and help execute it. Good leaders have some management skills because they are getting people to do work, but it is not enough. Leaders must have a vision to change and to challenge the organization.

CS: Regarding physician retirements, what key concepts and business terms are part of your organization’s plan?

JV: Our current plan states that if you want to retire, you can work full-time to the end of your practice life. We prefer that you give us a year or two of notice prior to retiring.

For people who want to work part-time and buy out of on-call before retiring, it is more complicated. If they want to work less, there is a five-year period of time that will allow a physician to phase out.

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During this five-year period, you cannot work less than 75 percent of full-time, and you get a reduction in your salary and a reduction in your on-call schedule. However, you can only buy out of on-call for two years maximum.

This protects our group and ensures we have enough physicians on-call.

CS: How important is it to have a succession plan?

JV: I think every organization needs a succession plan to prevent chaos. If you have a void in leadership, then you will end up with an ineffective organization. I think having a succession plan helps avoid disasters. If something happens to the leader, your group is ready for any challenges.

For instance, when I was managing partner, I had vacations scheduled during my last year. The group knew they could go to the person who would be our future managing partner for help while I was away. We always have a backup plan.

CS: Can you discuss the essential components of a succession plan?

JV: A succession plan is just a strategic process for identifying your future leaders. It is a replacement process. I recommend starting early and creating a plan at least two to three years before a leader retires. It has to be a proactive process. It is best for the organization to identify leaders from within. These potential leaders have a good understanding of the organization’s culture.

The next leaders need to have integrity and good communication. They must be team players. Another important aspect is education. We look for leaders who

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I THINK EVERY ORGANIZATION NEEDS A SUCCESSION PLAN TO PREVENT CHAOS. IF YOU HAVE A VOID IN LEADERSHIP, THEN YOU WILL END UP WITH AN INEFFECTIVE ORGANIZATION.

I think some overlapping for a year in a succession plan is helpful. As the outgoing managing partner, I was available to answer questions and mentor the next managing partner. However, when I left the position, I made it clear that I would not meddle. I have no desire to undermine the position of the new managing partner.

I am happy to act as an advisor for him, but only if he comes to me with questions. This is how you make a succession plan work for your practice.

–Joseph Vicari

have an MBA, but it is not required. However, we do want them to take courses and to take leadership roles in the ASGE, AGA, ACG, or local hospitals. This helps them learn how to work with others and understand how practice management works.

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.

JOSEPH VICARI, MD, MBA, FASGE was the Managing Partner of Rockford Gastroenterology Associates, Ltd., for 13 years and is board-certified in Gastroenterology. He is a Clinical Assistant Professor of Medicine at the University of Illinois College of Medicine at Rockford.

He also serves as chair of the Practice Operations Committee of ASGE.

excellence

{Success stories}

Power in numbers

How Texas Digestive Disease Consultants built a successful GI super group.

By James Weber, MD

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This past November, Texas Digestive Disease Consultants (TDDC) achieved a major milestone in gastroenterology. With an investment partner, we formed The GI Alliance, a practice management company that aims to build a physician-led network of regional platform practices. These platforms will operate independently dayto-day but are unified in their values and share a single, best-in-class operational infrastructure. TDDC is the first regional platform to affiliate with The GI Alliance—with more to follow quickly.

The GI Alliance is our answer to the question: “How are GI practices going to survive in the increasingly complex healthcare landscape?” GI practices are facing more market disruptors than ever, including political mandates, government regulations, competition from health systems, payer pressures, new players in the market, regulatory changes, and consolidation. If GI practices want to have a seat at the table, we have to get bigger— and better.

TOGETHER WE ESTABLISHED A STRONGER INFRASTRUCTURE THAN ANY ONE OF US COULD HAVE ACHIEVED INDEPENDENTLY.

Laying the Foundation for a Super Group When I started my own practice in 1992, no one had yet dreamed up the term “super group.” But early on, I recognized the benefits of working as a group.

In 1993, I formed Texas GI. This was an independent physician association that took on capitation—a payment system where insurance companies pay doctors a fixed amount per patient for a set period of time. Though we did not know it at the time, we were laying the groundwork for The GI Alliance: We realized that good doctors working together could accomplish more than smaller groups could achieve by themselves.

In 1995, we founded TDDC by bringing together 12 physicians from three different groups in the Dallas area.

We grew organically, through word of mouth, as doctors and other groups asked to join us. Working together allowed us to create efficiencies as well as improve our negotiating position in the market. We created a central business office that handled billing and collections, saving us time and resources. Together we established a stronger infrastructure than any one of us could have achieved independently. Over the next 15 years, we continued to grow organically to about 60 physicians.

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excellence

{Success stories}

Creating an Expansion Plan By this point, we felt we should move beyond the Dallas area. We believed that a Texas-wide expansion initiative would help us negotiate larger statewide contracts with payers and give us an opportunity to become even more efficient. We continued to grow to about 100 doctors by adding groups in Fort Worth, San Antonio and Austin.

We worked hard to boost TDDC’s visibility through our involvement in organizations such as the Digestive Health Physicians Association (DHPA), American College of Gastroenterology (ACG), American Society for Gastrointestinal Endoscopy (ASGE), and the Crohn’s and Colitis Foundation. I serve as the vice president of the DHPA, have sat on the practice management boards for the ASGE, delivered presentations at ACG meetings, and hosted Crohn’s and colitis events. I attended multiple national and regional meetings to discuss with my colleagues how to grow and run large GI practices most effectively. Participation in these events allowed us to meet other industry groups and thought leaders who were interested in joining TDDC. Several GI practices in Louisiana reached out to me for help because they saw our success at TDDC and wanted to do something similar on a statewide basis.

Ultimately, we decided it would be best for our colleagues in Louisiana to join TDDC. At the same time, the largest independent group in Houston joined our growing family.

Finding Private Equity With the expansion throughout Texas and the addition of the Louisiana groups—as well as a growing interest from other quality groups to expand and consider joining us— we believed TDDC would benefit from greater resources to execute our vision of scaling the practice. We realized we didn’t have the financial capital, talent, time, or energy to reach our full potential without a significant business partner. So we began our exploration for an investment partner, and private equity appeared to be our best option.

After months turned into years of searching for the right group, we were fortunate enough to partner with Waud Capital Partners (WCP) in November 2018 to form The GI Alliance. The relationship we have established with WCP allows us to bolster our infrastructure, expand our service lines, and scale our practice by incorporating other quality groups into The GI Alliance.

While WCP provides significant support to the business, they appreciate the importance of physicians having autonomy over their clinical practice and patient care.

Partnering with Physicians Endoscopy Throughout our history, we have had the good fortune to work with a number of business partners who have helped us succeed. One of our first and most successful

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partnerships was with Physicians Endoscopy (PE), which helped us along our path to becoming a super group. We worked with PE at our Lonestar Endoscopy Centers in Keller, Flower Mound and Southlake, and we collaborated with hospital systems in these areas. We believe our partnership with PE helped us obtain and manage these hospital contracts in a manner that provided the highest quality of care while keeping costs contained.

I developed a great relationship with the CEO of PE, Barry Tanner. Barry and PE helped us realize the benefits of a strong business partner and how they can improve our medical practice. They provided information and access to other practices, which opened our eyes to new possibilities. We were also able to get better contracts from our vendors, create better processes, and increase our overall efficiency in the endoscopy centers.

Predicting the Future for GI Physicians and Value-Based Care When we formed TDDC in 1995, small GI groups were the norm. Our industry has seen a progressive change to form larger groups to remain viable as other healthcare entities continue consolidating.

Today, if GI practices do not consolidate, they will struggle in all areas of their business, including payer

endocenters.com

Putting It All Together

The truth is that it took us more than

25 years

to get our practice to where it is today.

contracts, regulatory requirements and competition from hospital systems. Smaller groups and individual doctors simply lack the infrastructure to remain competitive in this changing healthcare environment. Larger groups will have a much better opportunity to have a voice and have that voice heard.

From the beginning, TDDC focused on providing the highest quality of care at the best price for our patients.

Today, we call this value-based care, and all areas of healthcare are headed toward it. We need to be prepared to successfully manage our practices under this model.

For instance, GI groups can continue providing valuebased care at a reasonable cost by doing things such as moving patients from higher-cost hospital settings to outpatient settings including self-standing ambulatory surgery centers.

One reason we have been successful with value-based care is that we have had the efficiencies that can only be achieved at scale. Because smaller groups lack these efficiencies, they will have a hard time competing as value-based care becomes the norm. Smaller groups often lack the personnel and financial capital to accomplish these goals. When fee-based care switches to value-based care, many practices will not be able to compete and will find it difficult to survive.

Physicians understand that the future for GI will include larger groups. We talk to many practices that want to learn how to become a super group quickly. The truth is that it took us more than 25 years to get our practice to where it is today.

Although we are a super group, we have always had physician leadership at the top. We also allow every doctor and center to have autonomy in how they see and care for their patients, and how they run their local practice. All of these things have set us apart from other groups and helped us grow.

Our partnership with WCP will allow us to continue on this path at a national scale. The GI Alliance will be able to partner with groups throughout the country while continuing to make quality patient care a top priority. We JAMES WEBER, MD, is the Founder, will be able to support President, and CEO of Texas Digestive smaller groups that Disease Consultants, the largest lack resources to grow gastroenterology group in the U.S. He on their own, providing is also the CEO of The GI Alliance. He them with infrastructure is board-certified in gastroenterology and specializes in inflammatory bowel like technology, human disease. He has been recognized in “Best resources, and revenue Doctors in Dallas” by D Magazine, “Top cycle management, so Doctors in Tarrant County” by Fort Worth doctors can do what they Magazine, and won “Doctor of the Year” do best—focus on the from the Crohn’s and Colitis Foundation patients who put their of North Texas. trust in their hands.

The Three P’s of Success

For Texas Digestive Disease Consultants, staying true to the core principles of the “three P’s” allowed us to be successful. Keeping these three principles on our minds has helped us reach the super-group status we have today: >P atients first – Every decision we face, we ask ourselves how it benefits the patient. If we don’t have a good answer, we adjust course. >P ractice second – We also take into consideration how we’re enhancing the practice and ensuring that physicians are well-equipped to provide the best care. >P rofits third – This is the most self-explanatory “P”: You have to make a profit for the business to survive and grow.

15 endoeconomics SPRING 2019

insights

{Marketing strategies and tips}

Everyone is a critic How to get control of bad online reviews and inspire good reviews.

By Meredith Jayne

Bad online reviews are a fact of life for any business, regardless of how good of a service or product it provides.

And ambulatory surgery centers (ASCs) are no different. Even if you consistently deliver great care with terrific outcomes, bad reviews will happen. Looking at recent trends, online reviews are of growing significance to ASCs. Here are some tips for what you can do to proactively deal with reviews and reduce the likelihood of bad reviews posted about your facility and its staff.

Importance of Online Reviews Patients are increasingly turning to the internet to research their health as well as their healthcare options. A 2018 survey of more than 1,700 U.S. adults by Doctor.com found that 63 percent of respondents

16 endoeconomics SPRING 2019

63 percent

of respondents would choose one provider over another because of a strong online presence and

81 percent

said they read reviews about a provider even after a referral.

would choose one provider over another because of a strong online presence, and 81 percent said they read reviews about a provider even after a referral.

It is apparent that online reviews have become an important source of information that patients rely on to help them select a physician and facility. If your ASC does not have a positive online reputation—or any reputation—you could be losing patients to other facilities.

To begin strengthening your online reputation and securing more positive reviews, it’s important to know where to start. While there are numerous review websites, only a few carry significant weight. These include Google (with reviews appearing in several Google products), Facebook, Yelp, Healthgrades, and Vitals. If the option is available, claim

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your ASC’s page on these sites. Depending on the platform, doing so may allow you to update information about your center, respond to reviews, post pictures, and take advantage of other features to help with reputation management and marketing.

Once you have claimed your pages, encourage patients to post reviews on these platforms. You can do so in your literature, signs in your waiting area, with your patient satisfaction survey, and in follow-up communications. On platforms that accept comments in addition to ratings, encourage patients to share a few words about their experience. Platforms will often place reviews with comments above those without.

was posted, it’s better to avoid taking an offensive position. If a patient shares personal health information, do not speak specifically to that information.

While it’s acceptable for a patient to share such information, your doing so could violate HIPAA. Take time to craft a well-written response that speaks specifically to the issue raised so the individual posting the review feels like you took their concern to heart. You may want a practice leader to review and sign off on any response that will be visible to the public. Also, consider responding to positive reviews in addition to bad reviews.

Not only will reviewers appreciate knowing that you read their reviews, but you’ll also demonstrate gratitude.

Responding to Bad Reviews Patients write negative reviews for many reasons. Sometimes it’s because of a bad outcome, but even great outcomes may not keep patients from negatively reviewing your facility. Patients will evaluate all aspects of their experience, from billing to communications with your staff to time spent waiting.

The moment you learn of a bad review that seems genuine, it’s time to act. You may be able to identify the patient who posted the review by their user or account name. If you can, pull up their contact information and reach out directly.

Tell them you saw their review and want to discuss their experience further.

Explain what you will do to try to address their issues.

Regardless of whether you can or can’t identify the person posting the review, posting a reply will often be worthwhile.

A 2018 BrightLocal survey found that 89 percent of consumers read businesses’ responses to reviews. In your reply, express regret that the individual had an unsatisfactory experience and provide a name and direct number so they can contact your facility. Speak about your commitment to patient satisfaction and your ASC’s ongoing efforts to improve upon the overall experience.

When responding, be careful with your language. Even if you disagree with what

To Diminish the Effects of Bad, Be Good Even if you do have to deal with bad reviews, the good news is that as you secure more positive reviews, the significance of an occasional bad review declines. Let’s say your ASC has 100 reviews with 93 positive, five neutral, and two negative. Consumers may look at the two negative reviews, but if they see such a strong percentage of positive reviews, the takeaway will more likely be that you typically deliver an exceptional experience.

Concerns about negative reviews may be lessened if consumers can see how you responded. Furthermore, some platforms list reviews by date, so new positive reviews can push the occasional bad one down quickly.

Keeping up with online reviews— especially if you’re in a busy ASC—can be difficult but may be made easier with careful planning. Implement processes for monitoring these platforms and keeping the information on them current. Take advantage of alerts that will inform you when someone posts a review. Develop policies and procedures for how staff should respond to all types of reviews.

With some upfront work and an ongoing commitment to managing your online reputation, you can ensure that the image of your ASC that you want the public to see is what they actually see.

Fighting Fake Reviews

Unfortunately, some reviews posted online are disingenuous. They may come from competitors, former employees, or staff and physician family members and friends.

Here are some ways to combat fake bad reviews: >K now the platform.

What you can do about fake reviews varies by the service they’re posted on. Platforms typically spell out in some detail how to flag or report questionable reviews, and some allow you to remove them. >K eep up. Make sure you have someone tasked with reviewing comments on a regular basis, and make sure they know how to flag fake reviews. >G et serious. Taking legal action is an option. You may want to get an attorney’s opinion if the situation is extreme.

MEREDITH JAYNE is the Physician Engagement Specialist at Physicians Endoscopy. She is an experienced communications strategist who plays an integral role working with physicians to promote their practice and providers within the community. She can be reached at mjayne@endocenters.com.

17 endoeconomics SPRING 2019

insights

{Marketing strategies and tips}

What’s your story?

Make a lasting impression with patients by building and enhancing your digital presence.

By Janet Liao Kornas If you are looking to promote your practice or ambulatory surgery center (ASC) online—whether through a website, social media, or even sponsored content—there are several principles that can help you make sure that your message gets through to your audiences and spurs action. A proven way to achieve this is by adopting a storytelling approach to your content. As you are planning new content, think about the primary audiences you are trying to reach. This can include patients or consumers and referring physicians. From there, try to craft stories that will appeal to the interests and needs of those audiences.

By providing your viewers with a message that has a story arc (a beginning, middle, and end), they will have a context through which they can understand the importance of their treatment or referral choices. This is especially true if you are offering any statistics about your practice. It is more intellectually and emotionally satisfying to learn that Mary Jones (who happens to be the 1,000th patient you’ve treated) is happy and healthy again thanks to your intervention, as opposed to a dry recitation of “1,000 patients served since June.”

Engagement Find a way to capture the attention of visitors to your website or social media page. You can do this with

18 endoeconomics SPRING 2019

photography or an intriguing headline, but the important thing is to get the reader engaged. Your content should lead with the “why” (why our ASC is a great choice) instead of the “ask” (please choose us). This will set the groundwork for why the reader should spend more time with your message. Focus on the impact your practice or surgery center is having and demonstrate why choosing your practice serves the viewer’s interests.

This can be accomplished with patient success stories.

On your homepage, you can lead with a main story and tease additional stories targeted to different types of readers. Potential patients might enjoy hearing about how a neighbor was treated successfully just in time for a long-awaited vacation, while a referring physician would respond to a story that highlights the ease of patient handoff and thorough follow-up. If possible, develop hooks that appeal to both consumers and physicians.

When you build your portfolio of stories, mix up the presentation styles. A question-and-answer format is particularly useful for social media posts where you want to get a big hit with fewer words. A photo gallery or a first-person account from a patient or referring physician will be unexpected and offer a change of pace.

Telling your stories through videos also can help get people’s attention. Showcasing your providers’ expertise or positive experiences your patients have had in a short

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video will also help consumers or physicians understand what your practice has to offer.

Authenticity Don’t shy away from showing physicians and other staff in your messaging. Present stories and the faces of the people making the impact (doctors, nurses, administrators, etc.). Most users will want to feel that they can form a connection with real people—after all, they will be trusting you with their health. A brief story about your administrator receiving a community service award, for example, does not have any clinical import, but it serves to humanize the practice and offers some inside information about the people delivering their care.

Resourcefulness Use your website and social media outlets to emphasize your practice’s expertise and ability. Positioning your practice as a knowledge center and a supportive partner— whether that’s for patients, doctors, hospitals, or other organizations—gives viewers/visitors more information about why you would be a good choice. If you have made

Invest in Good Photography

Website and social media users are becoming more and more savvy about imagery. Even if they have never seen the photo of the impossibly attractive “physician” or perfectly coiffed “patient” before, they will undoubtedly spot use of stock photography if it is used too prominently. This brings down your authenticity quotient.

If you are using stock images to enhance your messaging, use them in a secondary role. For example, hands sharing a file folder, or an over-the-shoulder shot of someone using a tablet to sign in. For your primary messaging, get well-lit photography of patients (with their permission, of course) either in your facility or at a location locals will recognize.

Additionally, many photographers are also capable of shooting video. Take advantage of this by preparing a few questions for your subject and having the photographer shoot their answers. Video is popular on sites like Facebook or Instagram, and this can be an easy way to get more engagement with people on those platforms.

a patient success story involves a teacher, that would be a good tie-in to the back-to-school months.

Of course, some of your messages will be evergreen.

A carefully curated calendar will show you when to take those stories out of rotation for a while. They can be refreshed and reposted after a hiatus. This not only keeps your messaging up-to-date, it will conserve your marketing budget. Just because a piece was written two years ago doesn’t mean that it’s no longer relevant.

Utility and Clarity

presentations or lectures, particularly in the community itself, share a quick rundown of the key points and invite the public to the next appropriate event.

Timing and Platform Choice Think strategically about how you tell your story, when to tell it and the mediums you use to tell it. While there is no seasonality for endoscopic care (with the exception of Colorectal Cancer Awareness Month in March), certain seasons present thematic opportunities. Once you have a slate of stories available, make an editorial calendar so you can launch them appropriately. For instance, if

Keep the user’s experience in mind when thinking about usability. Even though stories will be a central feature of your site, don’t sacrifice navigability or ease of use. Whenever possible, convert PDFs into text (or HTML) for ease of viewing on mobile devices.

With some good lead JANET LIAO KORNAS time and careful planning, is Senior Managing Editor at GLC, a your digital presence can marketing communications agency. She provide an experience that is an experienced content strategist speaks to your customers’ who provides insight and solutions to interests and health organizations seeking to build audience challenges. engagement through news and information. She can be reached at jkornas@glcdelivers.com.

19 endoeconomics SPRING 2019

insights

{Human resources and personnel issues}

Making a deal Your questions about physician and medical provider employment contracts answered.

By Richard E. Moses, DO, JD One of the most common topics that I am asked about when I mentor or speak with young healthcare professionals across all medical disciplines—residents, fellows, nurses at all levels of training, and work and physician assistants—is how to approach an employment contract.

Contracts can be a confusing topic, particularly for people who don’t have a lot of experience with them. To get a hold on the basics of employment contracts, it’s important to understand contractual terms generally, but also to realize that there is more to it than the “four corners of the contract.”

20 endoeconomics SPRING 2019

endocenters.com

What Is an Employment Contract?

Is the Employment Contract Set in Stone or Is It Negotiable?

An employment contract is a legally binding obligation between the employer (the person offering the job) and the employee (the person taking the job—you).

The employer and the employee are the “parties” to the contract. The employment contract should delineate all of the terms and conditions of employment. Both sides promise to do certain things and perform so as to meet specific standards. The more detailed the agreement, the more informed the parties will be about what is expected.

Who Provides the Employment Contract?

The employer will usually have its attorney draft the contract after the main terms have been negotiated. Depending on market conditions, the group is usually willing to negotiate some, or even many, of the terms. (Contract negotiation is a separate topic in and of itself.) The job market at the time of hire determines which party has greater bargaining power.

Bargaining power is commensurate with the existing job market.

How Do I Determine My Bargaining Power?

You need to research the landscape of the position offered. For example, if a group wants to add a radiologist, and many local training programs are producing a single graduate each, the group holds the bargaining chips. These days, because there are fewer medical trainees than in the recent past, and fewer practicing physicians in general, young doctors are often in a good bargaining position.

In other words, the current demand for physicians or other healthcare professionals often outstrips the supply.

THE CURRENT DEMAND FOR PHYSICIANS OR OTHER HEALTHCARE PROFESSIONALS OFTEN OUTSTRIPS THE SUPPLY.

Consider the initial contract offered to you as a rough draft or a starting point for your negotiations. I have heard occasional stories of medical groups offering a job to young physicians completing their training being given a contract to sign within 48 hours. That job is not for you!

Both sides have needs and the employer probably wants you as much as you need the job. Reviewing and digesting the terms of the offered contract takes time, at least a few days. Do not try to negotiate every term; concentrate on those that have the most impact on you and your life. Identify what is important to you and your family.

Usually the prospective employee then retains an attorney to review the group’s initial draft.

Are There Other Documents I Need to Review?

In addition to reviewing a proposed employment agreement, read through copies of all other practice paperwork.

This includes corporate by-laws, employee manuals, and partnership agreements.

Those documents should be referenced in the contract itself and copies should be attached to the main employment contract. You want to know as much as possible about your prospective employer and position. You also need to understand all of the practice details before you sign.

What if I Have Outside Income?

Today, many physicians in training have dual degrees. There are situations where the contracting doctor has an outside business that is unrelated to the medical practice offering the employment position. This is most common when the physician has a Master in Business

21 endoeconomics SPRING 2019

insights

{Human resources and personnel issues}

healthcare provider they are seeking.

The normal contract includes a description of salary, malpractice insurance, health insurance benefits, automobile expense reimbursement, dues and professional subscriptions, conference benefits, bonus arrangements, CME reimbursement, expenses, sick leave, and vacation/paid-time off (PTO). However, call schedule responsibilities, a requirement that the associate comply with the rules of the practice, the Administration (MBA), a law degree (JD), or a Master in Health Insurance Portability and Accountability Act (a Public Health (MPH), among others. For example, if the law that provides data privacy and security provisions physician applicant has an infusion company, a medical for safeguarding medical information), and privacy IT consulting business, an app development business, or rules in general, adherence to all state and federal laws, an educational consulting business, the ancillary income adherence to hospital and other facility policies, hours, received needs to be “carved out” or opted out in an non-solicitation, restrictive covenants (non-compete exclusion clause. clauses), and termination policies are also addressed in The same issues arise when the doctor the contract. If the contract is for a partner, routinely receives payment for lecturing goodwill, disability, and retirement issues or writing books or articles, income from will also be discussed. You will be required expert witness testimony or intellectual to agree in writing to accept the terms of property (copyrights, patents and the like), any existing practice employee procedure or has other outside income sources. The manual as part of the employment employment contract must clearly state contract.

RICHARD E. MOSES, DO, JD, has who is entitled to payment for any extra practiced gastroenterology and work that is done outside of the normal How Do I Find the Right Fit? hepatology in the Philadelphia area since physician work practice.

You need to consider your personal and 1984. He is also a risk management and educational consultant in patient safety, professional lives as two separate planes, medical professional liability, healthcare What Are Typical Terms of and only when you are happy with both compliance, the state of the healthcare Associate Contracts? will you be comfortable with your new system, medical provider well-being, and Many of the issues raised in the employment employment. The associate contract medical ethics. He is a national speaker contract are financial in nature. They may should set forth all of the terms and and author of articles and books. For an seem complicated but the reality is that the conditions that will govern your being in-depth explanation of contract terms other issues raised are more complicated part of the group and ensure your goals. and other issues, find his most recent and potentially more important. In an ideal Figure out what is important to you and book, Transitioning from Medical Training to world, a young healthcare professional make these conditions your minimum Professional Life: Preparing for Your Future as a Medical Professional, on Amazon. starting with an existing group gets the requirements. You should retain an attorney Follow him on moon and stars, including getting paid the knowledgeable in healthcare employment Facebook @mosesmedlawcompliance same or more than the partners of contracts. (This is not usually a relative or and @therealGIdoc, the group, no call, short-term partnership a college friend.) Take your time and reflect Instagram @therealGIdoc, track, and no buy-in. While no groups on making a detailed summary of what Twitter@mosesmedlaw, and will give an associate everything, many you deem most significant before signing LinkedIn @richardmosesdojd. will “give in” to some extent to get the the contract.

22 endoeconomics SPRING 2019

endo opportunities

West Mesa, AZ Central Arizona Medical Associates

Midwest Bloomington-Normal, IL Digestive Disease Consultants

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.

Reputed 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.

Scottsdale, AZ

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.

Portage, MI Bronson Gastroenterology Practice

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.

Rochester, MI Bellingham, WA NW Gastroenterology & Endoscopy 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.

Northern & Central, CA 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 SPRING 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.

South 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.

Submit your CV online at endocenters.com/services/ physician-recruiting 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.

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 the 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.

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

2500 York Road, Suite 300 Jamison, PA 18929

PHE-006

PAID

PERMIT NO 29 MADISON WI