EndoEconomics Fall 2018 Issue

FALL 2018

A journal dedicated to advancing GI ASCs and practices

8 Cultivating a leading practice

6

HOW TO BOOST THE BOTTOM LINE

14

DELIVERING POSITIVE PATIENT EXPERIENCES

22

COACH YOUR STAFF TO MAKE IMPROVEMENTS

CENTER DEVELOPMENT “From a vacant lot or empty building through the construction of a new facility—PE has the expertise to ensure your center is on time, on budget and fully licensed.”

- Frank Principati, COO, Physicians Endoscopy

“Teamwork is vital to a project’s success. Choosing the right architects, engineers and contractors is critical, and PE manages every step looking out for the center’s best interest.”

- MaryAnn Gellenbeck, Senior VP, Implementation Services, Physicians Endoscopy

“Everything is done collaboratively. We share the same goals, quality focus and vision to drive the business forward in a way that will truly benefit patients.”

- Bob Estes, Senior VP, Operations, Physicians Endoscopy

Let the experts manage your new center build, visit endocenters.com or call (866) 240-9496.

EDITORIAL STAFF

Carol Stopa Editor in Chief cstopa@endocenters.com

CONTENTS 8

Lori Trzcinski Managing Editor ltrzcinski@endocenters.com

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, (877) 442.3687, endocenters.com/endoeconomics.

NOTEWORTHY

STRATEGIES

2

4

6

Message from the President

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.

Printed in the U.S.A. Copyright Š 2018 by Physicians Endoscopy.

All rights reserved.

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.

14

LETTER

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

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

FALL 2018

16

PE welcomes two new partnered centers, CMS proposed pay increase and more

22

EXCELLENCE

INSIGHTS

8

14

Cultivating a leading practice

Hidden opportunities

MARKETING The new-era consumer

16

CLINICAL Your next move

ENDO OPPORTUNITIES 24

GI physician opportunities at partnered practices

20 IT

Information exchange

22

HR Put me in, coach

Find out more at endocenters.com or find us on

1 endoeconomics FALL 2018

letter

{Message from the President}

OUR SHARED PASSION PE supports doctors’ vision to ensure quality care while serving as a solution to today’s healthcare challenges.

David Young, President, Physicians Endoscopy

THE PE APPROACH TO THIS CHALLENGE IS TO KEEP CARE DECISIONS IN THE HANDS OF THE EXPERTS: PHYSICIANS.

2 endoeconomics FALL 2018

AS THIS IS MY FIRST MESSAGE AS PRESIDENT OF PHYSICIANS ENDOSCOPY (PE), I want to begin by thanking the PE leadership team for such a tremendous opportunity. I’m fortunate to have joined a company that is already established as the leader in GI development and management of ambulatory surgery centers (ASCs), with an impressive 20-year track record of success. Not a bad set of cards to be dealt.

While PE’s achievements were a significant factor in making this position so attractive, the company’s mission is what ultimately sealed the deal. Before further diving into this discussion, I’d like to share a little about my professional history.

I’m a financial person with an accounting background. Finance work eventually led me into operations and management, specifically within healthcare. As my career evolved, I took on leadership positions at companies such as US Oncology, McKesson Corp., Smile Brands and, most recently, Privia Health, an independent medical group and practice management services provider. I learned through these experiences that what really excites me is how the successful operation of healthcare can help physicians remain strong, independent and at the leading edge of clinical decision-making.

The healthcare industry is brimming with passionate people. You must be passionate, as there are no easy roles

anywhere. It doesn’t matter if you spend most of your time in an operating room, front office, back office or anywhere else within a practice or ASC: The work is consistently challenging and requires individuals to remain dedicated— playing a part in helping people get well.

That universal passion has inspired me throughout my career.

That brings me to why I joined PE in June 2018. PE is a company committed to developing solutions that allow physicians to maintain independence and be economically aligned with the goals of healthcare. The business of healthcare is quite complex; we must find ways to simplify it. The PE approach to this challenge—and one I believe is the most effective—is to keep care decisions in the hands of the experts: physicians.

Physician success can be measured in several ways. There’s clinical and business success, but both are predicated on being active participants in the greater good of managing patients and the cost of care. PE’s model supports the passion and vision of doctors to ensure quality care in GI while serving as a solution to the healthcare challenges facing our country today.

This role provides a wonderful opportunity to effectuate positive change within the GI community and this organization.

I look forward to continuing this mission and supporting our partners in achieving theirs as well.

GASTRO MANAGEMENT SERVICES

Focus on clinical care, not administrative duties.

Revenue Cycle Finance Operations Leadership Human Resources Information Technology

The leader in GI practice management solutions—helping you reach maximum potential in clinical, operational, and financial outcomes!

TO LEARN MORE: info@pegastro.com

noteworthy

{News and events}

PARTNERS

Physicians Endoscopy Partners With Two GI ASCs in Pennsylvania!

PE is pleased to announce the addition of two new partnerships with physicians from the practices of Endoscopy Associates of Valley Forge, located in Limerick, Pennsylvania, and Gastrointestinal Associates Inc., located in Rydal, Pennsylvania.

About Our New Partners Endoscopy Associates of Valley Forge is an existing ambulatory surgery center (ASC) that opened in 2007. The GI physician owners include Elizabeth Rock, MD; Kellen Kovalovich, MD; and Annapurna Korimilli, MD. PE and the physicians executed a letter of intent in April 2018 and finalized their partnership July 31st. It was evident from the outset that this relationship would be a win-win as each party recognized the value both organizations bring to the joint venture. Dr. Rock serves as the center’s Medical Director. This ASC is PE’s 56th partnered center.

Gastrointestinal Associates is a long-established practice consisting of 20 GI physicians. In a collaborative effort, the physicians along with PE recently opened their brand-new endoscopy center located in Chalfont, Pennsylvania—Gastrointestinal Endoscopy Center—taking less than one year to complete. The facility is scheduled to receive its licensure in late September 2018. This strategic partnership will also include Abington-Jefferson Health, which will become a hospital partner in the near future. Stuart Lubinski, MD, serves as the center’s Medical Director. This ASC is PE’s 57th partnered center.

Learn more about these centers as well as all of our partnered centers at endocenters.com/partnered-centers

Sen. Sepúlveda Visits Mid-Bronx Endoscopy Center On Friday, June 22nd, Mid-Bronx Endoscopy Center (MBEC) opened its doors to welcome New York State Sen. Luis Sepúlveda. Administrator Angelo Wong; Mohamad Erfani, MD; and Annie Sariego, Senior Vice President of Operations for Physicians Endoscopy, provided a tour of the facility. The tour was given from a patient’s point of view, offering Sen. Sepúlveda the opportunity to experience the patient flow process of a typical procedure. They discussed patient security using life and safety codes, as well as construction requirements, to emphasize ambulatory surgery center (ASC) regulations and similarities to hospital procedure rooms. The visit focused on the role ASCs can play in lowering costs and expanding access to quality care.

Read more about Sen. Sepúlveda at nysenate.gov/ senators/luis-r-sepulveda/about

4 endoeconomics FALL 2018

(L-R): Mohamad Erfani, MD; Ibrahim Shatara, Chief of Staff & Counsel for Sen. Luis Sepúlveda; Angelo Wong; and Annie Sariego; (front) Ryan Erfani, son of Dr. Erfani

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

endocenters.com

CMS Proposes 2% Pay Increase

Physicians Help Boost Aid for Puerto Rico, U.S. Virgin Islands The American Medical Association Interim Meeting of the House of Delegates (HOD), held in 2017, sparked government action that would have a great effect on Medicaid programs in the U.S. Virgin Islands and Puerto Rico.

The HOD adopted a policy advocating to “adequately fund” and provide emergency federal funding for the Medicaid programs above, which are subject to an annual cap. This Bipartisan Budget Act of 2018 included $4.8 billion federal Medicaid funding for Puerto Rico and $143 million for the U.S. Virgin Islands to help recover from recent Hurricanes Maria and Irma. The American College of Gastroenterology (ACG) proposed the original resolution on behalf of ACG Board of Governors’ Wilmer Rodriguez, MD. Dr. Rodriguez credits ACG delegates Bruce Cameron, MD, and March Seabrook, MD, with the success of the policy.

For the original article, visit bit.ly/Puerto_Rico_Aid

On July 26th, the Centers for Medicare & Medicaid Services released a proposed payment rule for ambulatory surgery centers (ASCs) and hospital outpatient departments for 2019. The proposal addresses payment factors and potential changes in the quality reporting system and sheds light on a number of long-requested Ambulatory Surgery Center Association (ASCA) priorities. Under this proposal, ASCs would have payments updated for the five-year period of 2019–2023. If the proposed rule is finalized as drafted, ASCs would see, on average, an increased payment per covered procedure of 2 percent. This is based on a combination of a 2.8 percent inflation rate based on the hospital market basket, and a productivity reduction of 0.8 percentage points, mandated by the Affordable Care Act. The update is code-specific, so not all procedures would see this increase. ASCA’s continued advocacy efforts are directly responsible for the proposed changes.

Learn about the rule at bit.ly/Proposed_Medical_ Payment_Rule

ASC Payment Transparency Act to Be Introduced in the Senate The U.S. House of Representatives passed the Ambulatory Surgical Center Payment Transparency Act of 2018.

HR 6128 comprises half of the ASC Quality and Access Act (HR 1838) that the Ambulatory Surgery Center Association regularly advocates on behalf of. The next step is to introduce it to the Senate. Two provisions are included in HR 6128: > Add at least one ambulatory surgery center (ASC) industry representative to the Centers for Medicare & Medicaid Services’ (CMS) advisory panel on Hospital Outpatient Payment (HOP),which helps determine payment policies for hospital outpatient departments and ASCs. Currently, the statute requires all HOP members to be employed by a hospital or health system. > Require CMS to disclose criteria used to determine the ASC procedure list. Adding procedures that can be performed safely in an ASC to this list saves money for Medicare and its beneficiaries.

ASC Community Takes Part in Congressional Meetings Day Wednesday, September 5th was Congressional Meetings Day at The Liaison Capitol Hill in Washington, DC. The Ambulatory Surgery Center Association (ASCA) provided an opportunity for attendees to learn to conduct a successful congressional meeting and meet their representatives face-to-face.

This was a great way for attendees to network with ASCA colleagues and learn to become a voice for the ASC community in Congress.

Congressional meetings were held in coordination with National Advocacy Day on Tuesday, September 4th.

For more information, visit bit.ly/Congressional_ Meetings_Day

To read more, visit bit.ly/ASCA_Transparency_Act_2018

5 endoeconomics FALL 2018

strategies

{Business strategy and the bottom line}

Hidden opportunities Boost your bottom line by turning your attention to missed potential.

by Brian Cochrane

Physician owners of ambulatory surgery centers (ASCs) have a lot on their plate. First and foremost is the delivery of safe, high-quality care that achieves optimal patient outcomes and satisfaction.

On top of that are numerous responsibilities that come with running an ASC and practice, as well as expanding regulatory requirements. It is not surprising to see an ASC’s business performance receive decreased attention.

An ASC might appear to be in good shape financially: bills are paid on time, staff salaries are competitive and

6 endoeconomics FALL 2018

physicians receive regular distributions. But looks can be deceiving.

A deeper dive might reveal that the facility has been stagnant in growth and operating on the lower end of financial security.

Such a scenario is concerning. It may indicate the ASC is not adequately prepared for the ebbs and flows of business that can quickly create financial challenges.

Even if there is some money set aside for rainy days, a lack of attention to an ASC’s business could lead to missed opportunities, including expanding revenue-generating

services, reducing costs and improving efficiency.

Physician owners can focus on these five areas to boost the bottom line.

➊ | New Ancillary Services Opportunities exist within the GI marketplace for physicians to capture incremental revenue within their surgery centers in addition to professional and facility fees. There may be the potential to incorporate a new service line such as anesthesia, or add a second specialty such as pain management to improve volume and

utilization if your center has excess capacity.

➋ | Existing Ancillary Services It’s not unusual to find a mature ASC that contracted for ancillary services— often at the time of its opening—having never revisited agreements.

Much has likely changed since initial agreements.

Perhaps the ASC has significantly grown its volume, which in turn grew the volume for its contracted ancillary service provider. Perhaps the contract was signed when the market was particularly hot,

Learn how Physicians Endoscopy helps its centers benchmark and presents economies of scale: endocenters.com/contact-us

endocenters.com

AMBULATORY SURGERY CENTERS WOULD BE WISE TO EXPLORE OPPORTUNITIES TO RENEGOTIATE ANCILLARY SERVICE CONTRACTS BASED ON VOLUME POWER AND/OR MARKET RATE CHANGES.

➍ | Revenue Cycle Management

with the ASC paying what might now be considered a premium for this service.

ASCs would be wise to explore opportunities to renegotiate ancillary service contracts based on volume power and/or market rate changes, or determine a more costeffective option that does not compromise quality.

If an ASC stopped making money or began losing money on these services, it should consider making a change.

➌ | Contracted Services ASCs should consider who is providing services, such

as laundry and linens, pharmacy, information technology and human resources, and when contracts were last reviewed.

If the ASC has grown, the business for these vendors and what they are paid for services have likely grown as well. ASCs should ask these questions:

One of the simplest ways ASCs can improve revenue cycle management, and financial upside in the process, is through a coding audit. Such an audit reviews whether an ASC is billing properly and if there are additional CPT codes the ASC could bill for that are being omitted on claims.

While a coding audit can be performed internally, it is advisable to consider using a third-party auditor.

There are companies that will perform an impartial audit of the procedures an ASC performs and then identify whether the ASC is capturing all the deserved reimbursement for these procedures. It’s a small investment, but one that could lead to a sustained increase in revenue.

routinely revisit and renegotiate payments.

As time passes, ASCs typically undergo changes, such as performing more and new procedures, and even delivering better outcomes. Yet these qualities may not be effectively leveraged to secure stronger reimbursement rates.

As a result, there’s the potential to leave revenue on the table just because an ASC lacks someone watching this aspect of the business.

With a little refocusing of priorities, an ASC could significantly enhance its financial stability while giving owners a stronger return on investment.

➎ | Payer Contracting > Are you receiving a discount tied to growth? > Have you solicited offers from other service providers to determine if you are paying too much for these services?

When preparing to open a new ASC, one of the most significant steps is securing third-party payer contracts. While these contracts receive great attention early on, ASCs may lack a system to

BRIAN COCHRANE is Vice President of Business Development for Physicians Endoscopy (PE). He joined PE in 2017 and brings 30 years of experience in the healthcare industry to the company.

He can be reached by email at bcochrane@endocenters.com.

7 endoeconomics FALL 2018

excellence

{Success stories}

Cultivating a leading practice A Q&A with Kevin Harlen, Chief Operating Officer of Capital Digestive Care.

by Scott Fraser As president of PE Gastro Management, one of the activities I find most valuable is the opportunity to spend time with other thought leaders in the GI community. I recently had the good fortune of getting to know Kevin Harlen, Chief Operating Officer of Capital Digestive Care (CDC). CDC stands out as a success story in independent GI practice management. In our discussion here, Kevin and I talk about how CDC evolved from laptops on folding tables to the largest independent GI practice in the Mid-Atlantic states, in no small part due to some smart investments in scaling the operation through the development of a central business office (CBO).

Tell me about your professional background and how you made the transition from a hospital executive to COO of a private medical group.

8 endoeconomics FALL 2018

Kevin Harlen: I’m one of these healthcare administrators who thought seriously about attending medical school and decided not to for various reasons. But healthcare has always been my passion and being involved with improving patient care is very rewarding, both professionally and personally.

After earning a Master of Science degree in public health from the University of North Carolina, Chapel Hill, I started my career in Florida as a member of the executive team in a 500-bed hospital. In 1994, I began a 12-year tenure at MedStar Washington Hospital Center, a 900-bed academic medical center with major trauma, burn, cancer and heart centers in Washington, D.C. It was a truly wonderful opportunity to work with world-class administrative leaders with exposure to many areas of responsibility, including their flight program, emergency medicine services, trauma services and other similar emergency preparedness and response work.

I stepped away from MedStar to continue work in emergency preparedness as Executive Director of the Northern Virginia Hospital Alliance, formed in the wake of 9/11 to coordinate emergency preparedness, response and recovery activities for its member hospitals and healthcare systems. In 2008, a friend and former MedStar colleague reached out to me, explaining that his GI group and six others in the D.C./Maryland region were merging and looking for someone to serve as the group’s COO. I put my hat in the ring and was hired in February 2008.

endocenters.com

Photography by Carol Clayton

HEALTHCARE HAS ALWAYS BEEN MY PASSION AND BEING INVOLVED WITH PATIENT CARE IS VERY REWARDING, BOTH PROFESSIONALLY AND PERSONALLY.

Kevin Harlen, Chief Operating Officer of Capital Digestive Care

9 endoeconomics FALL 2018

excellence

{Success stories}

What are the key facts and figures about CDC? KH: Our focus is on quality, expertise and accessibility. That is not marketing lip service; it is something we all feel very strongly about and around which have built a culture. These qualities are reflected in our size and in the scope and diversity of our clinical and administrative services.

Size matters when you are talking about covering a large geographic area.

When the practices merged, we had about 50 physicians and 14 clinical offices.

We now stand at 65 physicians and 17 clinical offices, making us the largest independent GI group in the mid-Atlantic and Northeast and the fifth or sixth largest in the country.

We see more than 75,000 patients annually—a number that has grown over time, in part due to our increasing number of physicians but also patients searching us out. We cover the spectrum of digestive health services, including GI and liver disease as well as infusion therapy, clinical laboratory services and pathology. CDC is increasingly the go-to group from a basic consumer

standpoint, a fact in which we take tremendous pride.

Our pathology lab is a real jewel in our crown. It is a world-class, high-complexity laboratory managed by a top-notch physician who serves as medical director and supported by a team of nine other pathologists trained in the areas of anatomic and clinical pathology, cytopathology and hematopathology.

Our executive board realized that being the leader in our region brings certain responsibility from a community support standpoint. We have a close affiliation with Chevy Chase Clinical Research, an independent research organization performing more digestive disease-related clinical trials than even the academic medical centers in the region. And we are very involved with the Crohn’s & Colitis Foundation where I have served on the Board of Directors for the National Capital Area Chapter and as Chair of the annual Take Steps event. As an organization, we have directed more than $500,000 through sponsorships and fundraising to the Crohn’s & Colitis Foundation since our founding.

KH: From the start, we set up the infrastructure to centralize finance, accounting, accounts payable, patient financial services and HR. In a second phase we added centralized IT and marketing efforts. Including the management team, we have approximately 45 employees in our CBO supporting our 17 offices and pathology laboratory.

Achieving that level of integration made it possible for us to pursue other efficiencies that had an immediate impact on our bottom line, such as the management of malpractice insurance, payer contracting, recruiting and hiring, and health insurance contracting.

One opportunity worth considering for any organization of size is a self-funded health plan, which we were able to transition to about two years ago.

We’re very proud of what we’ve built.

It’s a scalable operation, and we have seen it grow over time. As evidence, we provide facility billing services for six of the eight affiliated ambulatory surgery centers (ASCs) as if we were a billing and collections company.

You can see how central infrastructure provides the support so our physicians can focus on taking care of patients. The budget is supported by what we liken to a federated model. The CBO is the federal government, and the local care centers (i.e., practices) within our group are the states.

Much like the U.S. government, the states have a fair amount of autonomy in terms of managing their own operational budget.

The day-to-day clinical workflow and operational responsibilities reside at the local level within the care centers.

What should our readers know about CDC’s CBO?

10 endoeconomics FALL 2018

Demand more.

Because we’re ready to deliver more.

Your dedicated team deserves our dedicated support.

As the healthcare industry continues to change, we expect you to demand more from Boston Scientific.

With a team focused solely on the Ambulatory Surgical Centers, we want to help you optimize your business performance while you continue to deliver high-quality patient care. Challenge us. We’re ready.

ASC SOLUTIONS

GI Lab Optimization

Single-Use Devices

Community Wellness

©2018 Boston Scientific Corporation or its affiliates. All rights reserved.

ENDO-554109-AA June 2018

Infection Prevention

Scope Repair and Certified Pre-owned Equipment

GI Specialized Pathology

excellence

Photography by Carol Clayton

CDC has made substantial investments in the CBO. What were some of these investments and why were they made?

12 endoeconomics FALL 2018

{Success stories}

The care centers pay a fee as a percentage of collections to defray the cost of the centralized overhead and infrastructure that varies mainly by provider work productivity. To the degree that it is not enough to cover expenses at the “federal level,” we are an LLC, so the partners of the company

—most of our physicians are equal members—pay the remainder equally on a per-member basis because there is central overhead that is more proportionate to head count. Overall, our management services overhead percentage is less than industry standards.

KH: Our most significant investment, and the one that makes it all work so smoothly, has been our people. The commitment to building a core team of leaders in the areas of finance, HR, patient financial services, IT and marketing has been crucial to our success. Our President and CEO, Michael Weinstein, MD, continues with his busy clinical practice and devotes significant time to administrative responsibilities.

Many of our physicians volunteer their time after hours to serve on our board and advisory committees, such as our pension and quality management committees.

Changing gears to comment on operational departments, IT performance and security is something that should be a priority for anyone in healthcare. Under the direction of our chief information and security officer, we have developed a highly sophisticated platform that supports not only our network, but those of some of our affiliated partners. That serves as a revenue stream to CDC under a shared-services agreement.

Marketing, branding and reputation management is another area where we have devoted significant energy, which may come as a surprise. But the bigger you are, the higher the stakes and the more people expect from you. Our marketing budget supports activities that expand our influence in the region and includes tools to monitor and respond to reviews that patients post online, improvements to our website and a robust digital presence, including engagement across social media channels and programmatic investments in search engine optimization and content syndication. Being able to control your own narrative is an advantage in a landscape where consumerism has driven such significant change in the way physicians practice medicine.

Thinking about the regulatory environment, Medicare’s move toward value-based payment systems, including MACRA/MIPS, requires measuring outcomes and identifying gaps in care. We take quality assessment and outcomes management seriously and decided some time ago to add a dedicated quality management coordinator.

endocenters.com

What do you see as the future of private practice GI groups?

KH: I firmly believe the future for private in solving the complex problem of cost GI practices, specifically larger groups, of care. is bright. The demographics are clear: Large groups should remain physicianWe have an aging population, and the led but partner with executive teams to prevalence of colon cancer and other manage the administrative functions of digestive health issues are either increasa medical practice, allowing physicians ing or growing in complexity. Group to focus on delivering world-class patient consolidation can meet these needs and care. Our desire is to provide excellent result in a stronger regional density, service to our patients; we need the depth positioning the group to thrive during and breadth of administrative services that and after the migration to value-based only growth and consolidation can bring in payments. While we still predominantly today’s healthcare environment. rely upon a fee-for-service mechanism for reimbursement, we are rapidly moving towards a value-based approach. It’s going to be about outcomes in terms of clinical effectiveness SCOTT FRASER, MBA, is President of PE KEVIN J. HARLEN, MSPH, FACHE, is and cost effectiveness.

Gastro Management, Physicians Endoscopy's the Chief Operating Officer for Capital CDC firmly believes that Practice Management Division. He can be Digestive Care. He can be reached at kevin. the independent medical reached at sfraser@endocenters.com. harlen@capitaldigestivecare.com. practice has a role to play

Half Page Horiztonal_EE_ACG_print.pdf 2 8/17/2018 11:34:17 AM

insights

{Marketing strategies and tips}

The new-era consumer

How to deliver a positive patient experience when consumers are more informed and engaged than ever before.

by Meredith Jayne In most markets, patients have multiple options for where they can receive treatment. In this era of the informed, engaged consumer, loyalty must be earned. To ensure patients return for future care, they should leave your facility with a positive impression that covers their outcome and overall experience.

Come up short, and you risk a patient sharing his or her negative perception (accurate or not) with family members and friends, on social media and on review websites. If this happens, you may lose future visits by that patient and potential visits from anyone who learns about the perceived experience. Take a proactive approach to reputation management to ensure patients leave with the impression you want, which will positively shape messaging they share about their experience.

14 endoeconomics FALL 2018

Initial Impressions When patients walk in your door for the first time, these early experiences can set the tone for the rest of their time in your facility. After all, this is when they formulate initial and potentially long-lasting impressions of your facility and staff. Periodically assess how patients likely perceive your facility upon entry: ➊ | What do they see in the lobby and waiting area? ➋ | Does the furniture look old? ➌ | Is paint chipping? ➍ | Are there stains on the rug?

Learn about the marketing support Physicians Endoscopy provides for our partners: endocenters.com/contact-us Consider perceptions of staff as well: ➊ | Are staff members in uniform? ➋ | Are they looking at their smartphones? ➌ | Are they aware when patients come in, and do they deliver an appropriate greeting?

If your assessment casts doubt on whether a patient’s initial experience is welcoming and comforting, take steps to rectify the situation. For example, you can establish cell phone use rules or have a meeting with staff to reinforce how to treat patients when they come in the door.

Online Perceptions Patients increasingly research their care options. If what they find paints your organization negatively, they are likely to look elsewhere. Closely monitor internet results that come up when someone searches for your facility: ➊ | Does your organization appear as one of the first results? ➋ | Do search results represent your facility the way you desire? ➌ | Do search results include nice pictures of your building and staff? ➍ | Is it clear through searches how patients can learn more about your facility, including location?

Monitor reviews and discussions published about your facility on platforms such as Yelp, Google and your social media pages. While you typically cannot remove negative reviews, you can work to counter them by providing an exceptional, complete experience that patients will feel compelled to share. Have a plan to promptly and politely respond to criticism, and determine whether feedback warrants an internal review and improvement efforts.

Social Media If you use social media to market your facility, consistently update your platform(s) or your presence will feel outdated. Some people now rely on social media to conduct research. If they come across a page with old content, they may believe your facility is no longer in business.

endocenters.com

Watch for “tagging” of your facility in posts (separate from monitoring your profile). It’s common for people to take pictures of the places they visit and post them on social media, which can be problematic if images of other patients or sensitive information are shared in pictures. Even text-only posts that tag your facility can be questionable if the individual sharing the information identifies or describes another patient.

Establish clear rules for staff to follow when posting to their social media accounts or any company platforms to avoid jeopardizing patient privacy.

Staff Training Critical to improving the patient experience is effective staff training. Training should cover more than just what’s required for staff members to complete their tasks. It needs to address the personal components of their job: ➊ | Help staff appreciate the importance of friendliness and understand how to treat patients like people, not an account number or chart. ➋ | Teach them to appropriately communicate with patients and with other staff in front of patients, highlighting the potential for lasting impressions even from seemingly mundane conversations. ➌ | Educate staff about the power of body language as well as positioning (for example, perceived aggressiveness when someone is standing while speaking to a person sitting). ➍ | Train staff to respond to complaints so patients can walk away feeling like they have been heard and their problem was at least acknowledged, if not solved.

When you make the patient experience a consistent area of focus for staff education, internal improvement projects and external outreach efforts, your organization will boost its reputation and help ensure patients continue to view your setting as a preferred site for care.

QUICK TIP

Encourage patients who seem happy with their care to leave a review on your website, social media or business listing pages.

MEREDITH JAYNE is the Marketing Coordinator at Physicians Endoscopy.

She can be reached by email at mjayne@endocenters.com.

15 endoeconomics FALL 2018

insights

{Clinical updates}

Your next move Tips to help you successfully transition from medical training to real-world job opportunities.

by Richard E. Moses, DO, JD

16 endoeconomics FALL 2018

I am frequently asked by residents and fellows how to look for a job and review and negotiate an employment contract as their long years of formal medical training come to a close. This is not a unique concern for physician house staff—it also applies to physician assistants and nurse practitioners, among others. The job and employment contract are the last and easier problems to address and analyze. First, there are important questions that need to be recognized and answered outside of a vacuum prior to entering into contract negotiations and accepting job offers.

Do You Have a Significant Other to Consider?

Do you have a significant other, spouse or partner?

Although it is your life, your significant other’s desires and preferences are also important. The two of you need to discuss these issues together and come to a consensus. If you have children, consider the impact of a move on them.

Are you planning a family if you do not currently have children? Lifestyle and education are major areas for discussion. Are you married? Are you planning to get married? Is marriage an issue? Are you a U.S. citizen? Is your significant other a U.S. citizen? If you

have elderly parents or other family members, be mindful of their needs and expectations as well.

The discussion becomes more complicated if your significant other is also a physician or other professional with a career.

It is common today for both partners to practice in different disciplines of medicine, or for one to work as an attorney, accountant, engineer or other professional. Does your significant other have commitments to fulfill before launching his or her professional career or otherwise? These issues may limit your job mobility unless the other person is

able to find a satisfactory job in the same general geographic area as the one you want.

Ultimately, although it is your choice alone, you ideally want decisions to be consensual.

Where Do You Want to Live?

The next set of queries involves where you want to live. Do you want to move back home, or is the presence of family and old friends not a significant issue for you? Do you want to live in a small town, a larger city or a giant metropolis? Are you better suited to urban or rural life? Do you want to live on

Looking for the right business partner?

We offer flexible minority or majority ASC acquisition options!

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insights

{Clinical updates}

AFTER YOU DECIDE ON A CAREER PATH, THE LAST STEP IS UNDERSTANDING YOUR EMPLOYMENT CONTRACT AND RELATED ISSUES. THESE TOPICS WILL BE ADDRESSED IN FURTHER DETAIL IN THE FORTHCOMING BOOK, TRANSITIONING FROM MEDICAL TRAINING TO PRACTICE: EMPLOYMENT CONTRACTS AND OTHER CONSIDERATIONS THAT SHAPE YOUR FUTURE.

a large plot of land, or will a housing development suffice?

Climate is extremely important to many people.

Do you have a preference as to climate? Do you or your significant other have allergies to pollen or other allergens? Pollen counts at different times of the year should be checked in that regard. What weather pattern do you prefer? Is it important to live in an area with four seasons or two seasons?

Do you have any hobbies such as hiking, camping, skiing, fishing, water sports or other activities?

This is important if you desire these activities be close to your home or within a reasonable traveling distance.

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If you are from another country, do you want to stay in the United States or return home? Is your family willing to relocate?

How many times a year would you plan to return to your native land for a visit, thereby requiring a multiple-day travel stint?

Depending on your religion or ethnicity, do you want to be in an area with professionals and others with like demographics? Do you want to live in an area with like politics?

If you plan to raise a family, what educational options, religious facilities and activities are available for children? Is there a good public transportation system? Is commute time to work important?

Many physicians get dual degrees after they complete or even while they are finishing their clinical training. Do you plan to continue your education and get an additional degree? Do you want to be in an academic center? Do you prefer to be in an area that offers medically related business opportunities?

short-term financial needs and long-term goals.

Answer questions such as: > What do you owe in school and other loans? > What are your current living expenses? > Do you plan to start a family any time soon?

What Do Your Finances Look Like?

> Will the amount you make in a salaried position cover your expenses?

Before you decide to take a given job, open a solo practice or find a nonmedical employer, evaluate your finances. Be sure your anticipated salary or the amount you expect to make from your practice will be sufficient to live. This analysis includes your

Other important factors include the cost to open or buy into a practice, as well as your life goals and aspirations.

If you cannot afford to go into practice, you may need to change your plans. You may consider the following:

> Change the geographic area where you want to start your practice because salary and solo income expectations vary widely depending on the need and insurance company control in the marketplace. Certain rural communities may permit your practice to be subsidized. > Stay in a training program to extend your loan repayment and gain additional training, which may entitle you to additional salary or solo practice opportunities in the future.

> Join the military or other governmental healthcare position or go into teaching, since both often afford the opportunity to have your loans paid for you while you work. > Make some other path-altering decision before you accept a job or start out on your own.

Once you have considered these important issues, deciding on your professional career path— clinical versus academic practice, private practice versus employment, etc.— becomes easier.

RICHARD E. MOSES, DO, JD, has practiced gastroenterology and hepatology in the Philadelphia area since 1984. He is also a risk management and educational consultant in patient safety, medical professional liability, healthcare compliance, the state of the healthcare system, medical provider well-being and medical ethics. He is a national speaker and author of articles and books, the most recent of which, Medical Malpractice & Other Lawsuits: A Healthcare Provider’s Guide, became a No. 1 best seller on Amazon. Follow him on Facebook @mosesmedlawcompliance, on Twitter @mosesmedlaw and on LinkedIn @richardmosesdojd.

Join Physicians Endoscopy at these upcoming shows!

American College of Gastroenterology (ACG) 2018

ACG Southern Regional Postgraduate Course 2018

October 7-9, 2018 Philadelphia, PA Booth #707

December 1-2, 2018 Nashville, TN

NY Metro ASC Symposium 2018

NYSGE 42nd Annual NY Course

November 2, 2018 New York, NY

December 13-14, 2018 New York, NY

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insights

{IT insights}

Information exchange A brand-new mobile app allows patients and doctors to track GI symptoms.

by Rajiv Sharma, MD One aspect of the doctor/patient relationship that can be frustrating is getting a complete patient history and full description of the patient’s complaint. Patients can forget—or might not ever have known—key details in their medical history or that of family members. It could also be that when they experience seemingly minor symptoms, patients might forget their frequency, duration or exact nature.

A development team created a solution to fill this gap.

A collaboration among the American Gastroenterology Association (AGA), Cedars-Sinai, the University of Michigan and UCLA have launched a smartphone app, MyGiHealth, that will allow patients to enter their medical histories and track GI symptoms so they can later easily share the information with their physician.

The app does not offer diagnoses but rather provides authoritative yet easy-to-understand health information, which helps patients steer clear of potentially misleading information on the internet. MyGiHealth gives medically vetted guidance about symptoms, self-care and what tests the physician might request. Patients can download the app to their Apple devices from the App Store; non-iOS users can use the app website, which is mobile-friendly and works on any desktop, laptop or mobile device.

How MyGiHealth Came to Be In times of technological transition, users often encounter pain points that prevent complete adoption of new systems. MyGiHealth co-founders Brennan Spiegel, MD, and William D. Chey, MD, felt this was the case with electronic medical records (EMR). To them, it didn’t feel like these tools improved efficiency or quality of care.

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On the contrary, they believed that patients felt rushed with their doctors, and that doctors’ attention was forced away from patients as a result of an endless cascade of clicks and drop-down menus. They believed that the right technology could address this disconnect and created the MyGiHealth app accordingly.

MyGiHealth has advantages for both patient and physician. Patients can record information at their leisure in the comfort of their home, where there is less embarrassment. The app asks clear questions about symptoms and collects data in a way that the physician can use. Once this information is shared with the physician’s office, the doctor can review it ahead of the appointment and does not have to spend valuable time asking the same questions repeatedly. Instead, he or she can focus on what to do next, which enhances both patient and physician satisfaction.

Making the Connection In addition to tracking symptoms and medical history, MyGiHealth uses the AGA member directory to help users find a gastroenterologist. Once the patient is set up with a practice, he or she can send information from

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The Inventors

Brennan Spiegel, MD, Co-Founder/ Co-Chief Medical Officer, MyGiHealth Dr. Spiegel is a Professor of Medicine, Public Health and Digestive Diseases, and runs UCLA’s public health curriculum on big data science, digital health science and health analytics.

He is also Director of Health Services Research for Cedars-Sinai Health System and Co-Editor-in-Chief of the American Journal of Gastroenterology.

William D. Chey, MD, Co-Founder/ Co-Chief Medical Officer, MyGiHealth Dr. Chey is a Professor of Medicine, Director of the GI Physiology Lab, Director of the Digestive Diseases Center for Nutrition & Lifestyle and Co-Director of the Michigan Bowel Control Program at the University of Michigan. He is former Co-Editorin-Chief of the American Journal of Gastroenterology.

the app to the physician’s office, where it can be incorporated into an EMR. Because the patient is voluntarily sending the information, there is no HIPAA exposure for the practice. If the patient prefers, a personalized report can be emailed to the doctor in advance of an appointment; clinicians can copy and paste the pertinent information directly into their clinic notes.

“This report enables the doctor to quickly understand the patient’s goals for the visit along with a detailed description of his or her GI symptoms,” explains Dr. Chey.

The app development team worked closely with clinicians to refine the report so data is presented in a form that is easy to understand and clinically relevant.

For example, the report includes a GI symptom “heat map” that allows the doctor to quickly see which symptoms the patient is experiencing along with their severity.

Patients can continue to use MyGiHealth throughout their course of treatment. “The app uses validated NIH GI PROMIS questionnaires, allowing users to receive a score that shows how severe their symptoms are compared to others who have the same symptoms,” says Dr. Spiegel. “The app then lets users track and see whether their symptoms are objectively improving after starting a medicine for treatment of their symptoms.”

The developers plan to update the app as needed, says Duncan McLaren, CEO of MyGiHealth. As new treatments become available, they will be incorporated into the app so patients can track progress with the specific new therapy. “We’ll be adding tools to help doctors promote their clinic to our audience and also have the opportunity to participate in revenue share if they help find us patients for clinical trials,” he says.

Visit MyGi.Health to learn how the app can be integrated into systems at your clinic or practice.

Email duncan@mytotalhealthinc.com with inquires.

RAJIV SHARMA, MD, is a gastroenterologist who completed his post-graduate training at the Loma Linda University Medical Center and was fellowship-trained in gastroenterology and hepatology at the University of Rochester Medical Center. He continues to draw interest in gut health through his book, Pursuit of Gut Happiness. He is an adviser and test site for MyGiHealth and currently has a private practice in Indiana.

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insights

{Human resources and personnel issues}

Put me in, coach Use these six steps to improve staff performance at your center or practice through coaching.

by Heather A. Howard

Do team members struggle to achieve their full potential? Do staff members have problems with one another? Are individuals not concerned with the organization’s overall success?

If you answered yes to these questions, coaching may be the answer.

Coaching is a collaborative relationship that supports individuals in achieving their personal and professional development goals. It is vital to develop talent, address issues and ensure a successful organization.

22 endoeconomics FALL 2018

Coaching uses education and action to help individuals become more self-aware, increase their personal satisfaction and achieve their desired outcomes—all leading to greater professional success.

Coaching is a shared responsibility among physicians, managers and supervisors, and should be applied to all employees, from individual contributors to supervisors who report to a medical director.

But coaching for effective change doesn’t happen in a vacuum; it thrives through careful planning

and execution. Follow these six steps to ensure a positive outcome from coaching efforts.

➊ | Identify Areas for Change The coaching process begins when you, as a leader or manager, recognize that a team member needs to improve. Typically there is a repetitive behavior or action you find concerning or at least not ideal.

Once you identify this behavior or action, share

it with the individual.

Anticipate one of three responses: acceptance, confusion or denial.

Regardless of the response, sharing your observation starts the ongoing dialogue you will have with this individual during the coaching process, which can ultimately lead to improvement.

➋ | Quantify Impact of Current Choices To help the individual understand why it is

Learn about the HR support we provide for our partners: endocenters.com/contact-us necessary to change behavior, provide a quantifiable example of how their behavior negatively affects the organization. Explain the short- and long-term effects on the areas of the organization most likely affected by the behavior, such as business operations, coworker relationships, patient satisfaction or professional advancement.

Through this discussion, aim to put to rest any doubt in the individual’s mind about why a change is necessary.

➌ | Define New Choices To encourage people to change, help them make that change by explaining the behaviors you want them to exhibit. Provide specific examples and model those behaviors so they better understand their deficiencies and how to improve. This is commonly referred to as leading by example.

➍ | Watch for Commitment When you explain the ramifications of problematic behavior and outline ways to improve, the individual will be more likely to embrace the change. After all, it is in their best interest to change if they want to continue in their current position. If you value the individual’s contributions to your organization, you

will want to convince that person of the importance of adjusting their behavior or actions so that you do not need to consider punitive actions.

An individual can agree with everything you state, but talk is cheap. Actions must prove they are committed to improving.

If you do not witness commitment, hold the individual accountable.

Revisit previous discussions and ask whether anything you reviewed was unclear. If you still do not notice a change, you may be faced with a difficult decision: Is your organization willing to tolerate the behavior? If not, you’ll need to consider other options, including requesting that the individual exit the organization.

➎ | P rovide Support Behavior changes aren’t easy. Be prepared to provide ongoing support and feedback as the individual works to change.

Check in on progress.

You may want to allow the individual to choose the frequency for such discussions to empower them in their improvement efforts.

Some people want frequent check-ins to receive regular positive feedback as well as constructive criticism.

Others may prefer only an email to touch base.

Feedback doesn’t just need to come from the employee’s manager.

Encourage colleagues who

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are aware of the change effort to show support.

Educational courses, webinars, books and other external resources, including Physicians Endoscopy’s human resources department, can provide additional guidance.

➏ | Evaluate Results Once a change appears complete, your work as a coach is not done. In fact, once you assume a coaching role, you will likely never leave it. Old habits die hard, so there’s always the chance that the individual who made the change could have prior behaviors resurface.

It’s critical to monitor this individual going forward. If you observe regression, remind the individual of the hard work they completed to correct the behavior. On the flipside, if you notice sustained improvement and even growth, praise the individual by letting them know the specific ways their improvements have benefited the organization.

It may initially seem challenging to evaluate results. Behavior change can be difficult to quantify.

But the individual—and you through observation— should experience the changes, such as increased positivity and socialization from coworkers. Changes may be subtle, but keep your eyes and ears open: They’ll be there.

TO HELP THE INDIVIDUAL UNDERSTAND WHY IT IS NECESSARY TO CHANGE BEHAVIOR, PROVIDE A QUANTIFIABLE EXAMPLE OF HOW THEIR BEHAVIOR NEGATIVELY AFFECTS THE ORGANIZATION.

HEATHER A. HOWARD, SHRM-SCP, SPHR, is Director of Human Resources at Physicians Endoscopy (PE). She and her team provide day-to-day HR support including payroll and benefits administration to PE centers and affiliated partners.

She can be reached by email at hhoward@endocenters.com.

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endo opportunities WEST Mesa, AZ Central Arizona Medical Associates

Submit your CV online at endocenters.com/recruiting

The physicians of Central Arizona Medical Associates (CAMA) are seeking a full-time gastroenterologist to join their practice.

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 physicianowned, two-room ASC with maximum efficiency and quality of care. Enjoy sunshine and a great lifestyle in the metro Phoenix area.

Bellingham, WA NW Gastroenterology & Endoscopy Exciting opportunity to join a nine-person single-specialty GI practice in Bellingham, WA. This 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. Great place to raise a family! This collegial group has a freestanding AEC and pathology lab. EUS optional, ERCP strongly preferred.

Outstanding benefits package.

SOUTH Gastonia, NC Carolina Digestive Diseases

Northern & Central CA SecureMD GI physicians: Are you looking for flexibility and supplemental income? Our mobile endoscopy practice is seeking boardcertified gastroenterologists in Northern CA (Sacramento/ Stockton/Tracy) and Central CA (Fresno/Tulare/San Luis Obispo)!

Flexible schedules allow you to work as many as 1–2 days per week or as few as 1–2 days per month. Position offers competitive pay.

Three established gastroenterologists in central North Carolina are seeking a BE/BC gastroenterologist to join our physicians to expand the coverage in our community of Gastonia, NC. The physician candidate can expect to step into a busy practice while replacing a retiring partner. Anticipate a short track to practice partnership and ASC ownership. Practice currently operates out of a single office and covers one hospital. Outpatient endoscopy is performed at a two-room ASC with maximum efficiency and quality of care. Located two hours from the Smoky Mountains and four hours from the Atlantic beaches. Enjoy sunshine and a great lifestyle in the metro Charlotte area.

MIDWEST Lima, OH Gastro-Intestinal Associates, Inc. The physicians of Gastro-Intestinal Associates are seeking a BE/BC gastroenterologist to join our six-physician, four-CNP single-specialty practice.

Established in 1977, the practice has an outstanding reputation with the local Lima community. This is an opportunity to join a GI physician-owned, 18,000-square-foot combined office and threeroom endoscopy center. The center, built in 2008, is AAAHC- and ASGE-certified. In the area are two local hospitals with state-of-theart facilities.

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This opportunity offers: • 1:7 call rotation • First-year salary guarantee • Outstanding earning potential • Professionally operated and managed

Rochester Hills, MI Troy Gastroenterology The Center for Digestive Health (Troy Gastroenterology) is a wellestablished, highly respected private practice looking for two

NORTHEAST New York, NY

Lumberton, NJ

Gastroenterology on Gramercy Park

Gastroenterology Consultants of South Jersey

Gastroenterology on Gramercy Park, a two-physician private group, is seeking a gastroenterologist to expand the private practice. Physician can expect to step into a busy practice while replacing a retiring partner. The opportunity offers a primarily outpatient experience with a reasonable call burden. This candidate will have an ownership opportunity in the affiliated endoscopic ambulatory surgery center.

Gastroenterology Consultants of South Jersey is a privately owned, seven-physician practice located in Lumberton, NJ. We are a well-established practice of 25 years, located among several growing communities in Southern New Jersey.

This opportunity offers: • Physician-owned and controlled center • State-of-the-art endoscopic equipment • Medicare-licensed and AAAHC-accredited • Anesthesia services for patient comfort • Physician efficiency and optimal patient quality of care • First-year salary guarantee • Retirement benefits • Desirable location in downtown Manhattan

• Located within 30 minutes of Philadelphia and within one hour of New York City • Affiliated with Burlington County Endoscopy Center, a threeroom ASC that is physician-owned and operated • We are seeking to add a full- or part-time gastroenterologist • We offer a 1:7 call schedule and an opportunity to perform ERCP/EUS (not required) • Partnership will be offered in both the practice and ASC

Central NJ North Bergen, NJ

Garden State Digestive Disease Specialists, LLC

Advanced Center for Endoscopy Advanced Center for Endoscopy (ACE) has an immediate opportunity available for GI physicians looking for an outstanding ASC in which to perform procedures.

Our single-specialty, nine-physician GI center is the perfect environment for you and your patients. Our center can help drive additional patient volume to you through the ASC, allowing you to increase your procedure volume in the environment that is more convenient. Our center can provide your patients a better outcome, and you will have satisfied and loyal patients. ACE is ideally located in North Bergen along the banks of the Hudson River—the “gold coast” of Northern NJ—with a spectacular view of the NYC skyline.

This is an excellent opportunity for a motivated physician.

gastroenterologists to join our growing practice. We have several offices across Metro Detroit with two state-of-the-art, AAAHCaccredited ambulatory surgery centers. We’re looking for an enthusiastic physician skilled in general endoscopy and ERCP. • Competitive base salary with productivity incentive • Incentive bonus • Retirement plan • Discretionary allowance • Eligibility for member status after two years • I nsurance (malpractice, health, dental, vision, life, supplemental and dependent life, short- and long-term disability)

Garden State Digestive Disease Specialists, LLC, is seeking a full-time BC/BE gastroenterologist to join our three-physician practice in Central Jersey. The job offers an excellent salary, competitive benefits package, a 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 is preferred.

We serve culturally rich and diverse communities; our patients reside primarily in the Union and Middlesex counties of Central Jersey. Our center is a state-of-the-art endo center.

We are affiliated with four local hospitals, two of which are teaching hospitals with residency programs. We are in the NYC metropolitan area, 45 minutes from Manhattan, conveniently located near an international airport and in close proximity to many cultural centers and the Jersey Shore.

Jenkintown, PA Gastrointestinal Associates, Inc. A busy 17-physician practice, located in Jenkintown, PA, is seeking a board-certified and highly motivated gastroenterologist preferably with an investment in IBD or advanced therapeutic training to join our group. You would provide a full range of care to patients both in hospital and through outpatient procedures. This is a full-time position with shared clinical and administrative responsibilities, and a competitive salary and benefits to include bonus potential and a partnership track.

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