EndoEconomics Spring 2018 Issue

SPRING 2018

A journal dedicated to advancing GI ASCs and practices

8 The search for capital 1 endoeconomics SPRING 2018

12 16 20

THE PATIENT EXPERIENCE REFERRAL MARKETING STRATEGIES INFORMATION TECHNOLOGY RECOVERY PLAN

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 5

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.

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

Printed in the U.S.A. Copyright Š 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 expressed permission is prohibited.

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

6

LETTER

NOTEWORTHY

STRATEGIES

2

4

6

Message from the President

Colon Cancer Awareness Month, awards and more

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.

SPRING 2018

12

Raising the bar

8

The search for capital

16

EXCELLENCE

INSIGHTS

12

16

The ultimate patient experience

MARKETING Referral game plan

18

CLINICAL Culture shift

ENDO OPPORTUNITES 24

GI physician opportunities at partnered practices

20 IT

The risk is real

22

HR The feedback loop

Find out more at endocenters.com or find us on

1 endoeconomics SPRING 2018

letter

{Message from the President}

WINDS OF CHANGE As practice aggregation promises to evolve the GI specialty, we must maintain a balance between profits and patient care.

Barry Tanner, President and CEO, Physicians Endoscopy

WE MUST SUPPORT THE MEDICAL PRACTITIONER WITHOUT UNDULY INFLUENCING THE PRACTICE OF MEDICINE.

2 endoeconomics SPRING 2018

THE WINDS OF CHANGE in the GI specialty are starting to blow at gale force.

In that spirit, you will notice changes with this issue of EndoEconomics. We redesigned the magazine with you in mind: We have incorporated dynamic imagery to inspire you, and we have created targeted departments to help you find what you are looking for. We hope you like the changes and welcome feedback.

Among the GI specialty’s most significant changes is the growing trend of practice aggregation. I applaud the initiative, yet I worry about the pressure independent GI practices are experiencing to invest in their practice in an effort to remain independent.

I worry the pressure will divert physicians’ attention away from patient care, and the business of managing the business will take center stage.

It is understandable that physician attention can be diverted toward money.

For many years, GI physicians have had to fight just to get paid. With the potential of a more viable practice model on the horizon, who among us wouldn’t at least consider boarding that train?

Practice aggregation is potentially good.

Most physicians I know would rather focus their attention on clinical and patient care issues than the business of running the business. For more mature GI physicians, the prospect of selling a percentage of their practice income at a nice price—and off-loading the headaches of running an independent practice—may be close to nirvana. For younger GI physicians and

those entering into the specialty, this model grants them a stable, well-paying job that allows them to have a personal life while offering an opportunity for growth and advancement. Practice aggregation models can hold all of this promise and more. Why worry?

My concern is the risk of commoditization of physicians. For years, companies like Physicians Endoscopy have helped GI physicians develop and manage important service lines such as ambulatory surgery centers (ASCs). But these are ancillary businesses, and we do not influence how physicians practice medicine.

Today, we see the business of independent medical practice being turned into an ancillary service line. We must support the medical practitioner without unduly influencing the practice of medicine.

We must begin with awareness of the risk, then focus on the metrics of the practice of gastroenterology. We use those metrics to arm the GI physician with vital clinical and operational data from which they alone make time management and clinical care decisions that will improve efficiency or outcomes, or otherwise alter patient care.

This is possible through practice aggregation provided the primary focus is improving patient care—not driving growth and profitability with one eye firmly fixed on the exit sign. While profits will always be a yardstick by which we measure success, we must maintain an appropriate balance.

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}

AWARENESS

PE-AFFILIATED CENTERS CELEBRATE COLON CANCER AWARENESS MONTH

Each March marks the start of National Colorectal Cancer Awareness Month (CCA). Also referred to as colon cancer, colorectal cancer is the third most common cancer in the U.S. and the second leading cause of death from cancer. Here’s a sampling of awareness events among PE centers: > The Endoscopy Center of New York participated in the Colorectal Cancer Awareness Fair held March 7th at Mount Sinai Hospital. Participants received giveaways and educational Staff from The Endoscopy Center of New literature, and walked through York participated in the Colorectal Cancer a 20-foot-long inflatable colon.

Awareness Fair held at Mount Sinai Hospital. > The Endoscopy Center of Niagara staff participated in a morning radio show in the Niagara, NY area to promote colon cancer

OPPORTUNITY TO ENCOURAGE MORE COLORECTAL CANCER SCREENINGS 24%

Uninsured

65%

28%

Up-todate CRC testing

Never tested

7%

Testing status of adults aged 50-75 years

76% Insured

Tested but not up-todate

Source: CDC Vital Signs, November 2016

4 endoeconomics SPRING 2018

awareness and discuss their Charitable Care Program. On April 28th, they participated in the Buffalo, NY Undy Run/Walk. > The Endoscopy Center of West Central Ohio held a “Wipe out Colorectal Cancer” campaign the entire month handing out patient information, awareness bracelets and rolls of toilet paper to patients and visitors. > Greater Gaston Endoscopy Center hosted the traveling inflatable colon at the center on March 10th where visitors learned about the importance of colorectal cancer screening and got an up-close look at various stages of colorectal cancer. > Laredo Digestive Health Center staff distributed colon cancer materials at the Mall del Norte where they educated community members on the benefits of screening. Informative posters were displayed around the mall for the entire month. > Long Island Center for Digestive Health held a CCA event in which Congresswoman Kathleen Rice, Rep. Rose Marie Walker and over 100 people attended. Patients provided heartfelt testimonies of their experiences with colon cancer. > Michigan Endoscopy Center and Michigan Endoscopy Center Providence Park held their annual “Strike Out Colon Cancer” employee bowling event, a fundraiser through the Colon Cancer Alliance. > Island Digestive Health Center staff participated in Dress in Blue Day on March 2nd to promote awareness of and honor those affected by colorectal cancer. > Physicians Endoscopy sponsored and participated in the Colon Cancer Coalition’s Get Your Rear in Gear Philadelphia, a 4-mile run and 2-mile walk.

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

endocenters.com

PE Partner Centers Receive APEX Quality Award Physicians Endoscopy congratulates its partnered centers that received the SPH Analytics APEX Quality Award: > Elgin Gastroenterology Endoscopy Center > Endoscopy Center of Niagara > Hudson Valley Center for Digestive Health > Laredo Digestive Health Center > Long Island Center for Digestive Health > PGC Endoscopy Center for Excellence > South Broward Endoscopy Center > Westside GI

To view 2016/ 2017 winners, visit sphanalytics.com

Each year SPH Analytics recognizes its highestperforming healthcare entities with the APEX Quality Award. The award recognizes outstanding healthcare organizations that demonstrate the highest levels of excellence in patient satisfaction and overall care over 12 months. Key performance indicators tied to clinical, operational and interpersonal measures are paramount to the overall evaluation process. The award is patient-centric, with scoring provided solely from each entity’s patients.

Esophageal Cancer Awareness Month Gains Ground

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

Periwinkle is the newly designated color for esophageal cancer awareness month. Through its efforts, Esophageal Cancer Action Network (ECAN)—which was founded in 2009—was able to designate April as the official Esophageal Cancer Awareness Month in the majority of U.S. states. The designated month hopes to increase awareness and increase screenings.

Symptoms of esophageal cancer include heartburn and gastroesophageal reflux disease (GERD), also known as chronic acid reflux. Finding the cancer early is very important. Only one in five patients diagnosed with esophageal cancer will survive five years because it is most often caught at late stages. Though considered a rare disease, esophageal cancer takes more American lives each year than melanoma skin cancer or cervical cancer.

Provider Tax on PA Surgery Centers On Feb. 21, 2018, the Pennsylvania Ambulatory Surgery Association (PASA) communicated news on a proposed new tax on all PA ambulatory surgery centers. Pennsylvania Gov. Tom Wolf’s 2018–2019 state budget proposes a new provider tax on all PA ASCs. The budget plan assumes a 2.81 percent tax on profitability (net patient revenue) to generate $25 million annually. The tax is proposed as part of the Human Services Code to provide additional dollars for medical assistance. It has the potential to result in decreased access to high-quality, cost-efficient, community-based surgical care as well as increased costs for patients, insurers, employers and the state. Data suggests that more than 25 percent of PA ASCs will operate at a loss if the provider tax is enacted.

For information on how to communicate your concerns to your representative, visit pasa-asf.org/advocacy

5 endoeconomics SPRING 2018

strategies

{Business strategy and the bottom line}

Raising the bar An effective expense management strategy can help your center achieve long-term financial gains.

By Jason Schifman When an ambulatory surgery center (ASC) is exploring adding new physicians and procedures, there is usually great excitement. Growth means increased revenue, and increased revenue can mean increased profitability and owner distributions.

What usually does not bring the same level of energy is implementing prudent expense management. But effective expense management can have a similar impact on the bottom line as adding physicians and procedures.

Learning where an ASC can save money is hard work and requires a certain skill set and approach. Executing on savings initiatives requires analyzing data, and once you find areas of potential savings, implementing change is rarely easy. As a result, expense management is often pushed to the back burner, with growth projects receiving the headline attention.

When expense management is not properly executed, ASCs miss out on the potential for long-term financial gains. Fortunately, there’s no bad time to make expense management a higher priority.

Key Tenants of Expense Management

Small, recurring wins = bigger wins.

You may occasionally find ways to achieve significant, immediate savings. These are great. Who doesn’t want a quick windfall?

But worthwhile savings come in many sizes and forms.

Consider the following: Your ASC finds a way to realize an annual recurring $30,000 in savings. This recurring $30,000 adds up over time and should, therefore, be treated with higher priority than a one-time $30,000 savings. Managers may find it helpful to view and present a recurring $30,000 savings booked today as a much larger $150,000 savings achieved over five years.

Keep in mind several key points to develop an effective expense management system:

Quality remains No. 1.

Maintaining high quality is the top priority in building a strong, sustainable healthcare business. Avoid saving dollars by cutting corners and negatively impacting quality, which will likely cost you exponentially down the road.

ASCs are long-term businesses; prudent expense management requires a similarly long-term perspective.

Relative spend counts as much as nominal spend.

A spending cut that results in a tangible adverse impact on quality is not a truly realizable savings.

6 endoeconomics SPRING 2018

When assessing spend, there is a tendency among leadership to focus primarily on nominal expenses for a given period. This is important, but equally important is looking at which expense line items are growing the fastest.

endocenters.com Your center may be able to learn from a neighboring center striving to achieve similar outcomes. In turn, your center may offer unique insights to other centers.

Do not inhibit your own success.

ASC leadership tends to love the topic of cost analytics, but when it comes to truly embracing and utilizing data to influence operational decisions, the love often fades. When a potential savings is uncovered, avoid a few common reactions: Avoid blaming others if you are faced with an implication that you have failed in your fiscal or operational responsibility. Also, avoid dismissing analytical findings and rushing to rationalize the status quo costs as fully justified with little room for alternative action.

Defensive reactions can stand in the way of positive change. With operating expense budgets in the millions of dollars—even with the best managers in place—some level of realizable savings is likely available at any given time. If you find opportunities for savings, regardless of how long those opportunities have existed, at least you found them and can act upon them.

Even though payor contracts may include reimbursement escalators—and with the right strategic approach, your center may be able to periodically negotiate higher rates—your center is not likely to achieve significant reimbursement increases. Expenses need to be managed accordingly. If an expense item is growing at 10 percent annually while annual top-line growth is in the 2–3 percent range, the numbers do not bode well over the long term.

Analyze expenses not just on a nominal basis, but also from a percentage growth perspective with a keen eye toward negative outlier line items.

Facilitate sharing lessons learned.

At Physicians Endoscopy, our network of approximately 60 centers provides a platform of highly comparable data and lessons learned concerning expense management (among other statistics and disciplines). We also offer an accompanying team of end-to-end operations professionals who can put these lessons learned in their appropriate contexts and provide guidance on practical implementation.

It is a sign of good management when managers constantly look at the business through fresh, open-minded and critical eyes.

Ongoing Expense Management Efforts Unless expense management is a core component of your recurring operational program, you will hinder the likelihood of success. Consider making expense management a regular agenda item at board meetings.

You can also form a financial committee that focuses on expense management and reports to the board on the status of previously agreed upon savings initiatives.

Finally, consider JASON SCHIFMAN joined Physicians rewarding your managers Endoscopy in April 2017 and serves as when their hard work Vice President of Finance. Before joining yields results. Doing so PE, he was Vice President of Finance at Frontier Healthcare, an ambulatory within appropriate surgery center management company bounds will help yield with a network of 15 surgery centers. efficient, cost-effective He can be reached at jschifman@ operations for your endocenters.com. practice or ACS.

Learn more about the benchmarking information that can be provided by Physicians Endoscopy: endocenters.com/contact-us

7 endoeconomics SPRING 2018

strategies

{Business strategy and the bottom line}

The search for capital As private equity sets its sight on GI practices, is this funding option right for you?

8 endoeconomics SPRING 2018

By Scott Fraser 2017 was a banner year for private equity funds. Industry tracker Preqin reported that the global private equity industry raised a record-breaking $453 billion from investors last year, with investment reserves of more than $1 trillion. And you can be certain that these funds are looking for investment opportunities.

endocenters.com

Generally speaking, the objective of a private equity firm, in its efforts to make money for its investors (typically large pension funds, wealthy investors and major institutions), is to outpace the market. To do so, firms look for strategic market areas that present unique opportunities, such as those experiencing significant pricing changes and new technology developments.

These firms also look for high levels of market fragmentation. That is why GI practices are starting to find themselves in the private equity spotlight.

Why GI? Why Now? Over the past several years, healthcare has experienced massive consolidation in areas including payors, hospital systems and suppliers (pharmacy chains and pharmaceutical and medical device companies). Providers have experienced little or no consolidation other than large hospital systems buying their practices to secure referrals.

Tremendous fragmentation in GI groups exists today. Less than 5 percent of all gastroenterologists work in a group of 20 or more physicians, according to publicly available information. This presents an opportunity to aggregate physician practices to achieve economies of scale and market density, which private equity firms find appealing.

Also appealing are ambulatory surgery centers (ASCs), which have been a tremendous boon for the private practice of GI. When gastroenterologists invest in themselves in the form of opening and owning ASCs, they gain access to a model for providing better clinical care in a more efficient manner while saving money for the healthcare system. Private equity firms recognize the current and likely future value of ASCs and the importance they will serve in the efforts to provide more effective healthcare delivery.

While private equity firms, as non-healthcare entities, may seem like odd bedfellows for GI groups, a private equity investment in GI is possible under a management service organization (MSO).

An MSO is essentially an investment

vehicle that allows a non-provider to invest in a medical practice in a manner compliant with the corporate practice of medicine.

The Appeal of Private Equity Why do private equity firms believe GI groups are interested in investments?

GI groups are experiencing the growing administrative burden every medical practice faces. Couple this with increased costs in all areas of a practice operation, investment in electronic medical records, complexity with contracting, operational and financial challenges with new technology implementation, regulatory and reporting requirements, and physicians are being asked to do more administrative work unrelated to delivering patient care than ever.

Organic practice growth in GI is possible but difficult. It takes strong leadership, but more importantly, it takes time and capital.

It is not surprising that most practicing gastroenterologists lack the time and willingness to invest the capital needed to merge entities.

Enter private equity and the MSO vehicle, which not only provide the capital needed to accomplish successful mergers but also accelerate the process. The MSO structure allows GI groups to pursue forming a consolidated practice under a single tax identification number, with the ability to grow and prosper. Other areas of medicine, including dentistry, dermatology, urology, primary care and women’s health, have widely adopted the MSO model. It is a model GI groups may find appealing as they continue to face mounting internal and external pressures, including the continued focus on consolidation within healthcare.

Private Equity by the Numbers

$453 billion

The record-breaking amount the global private equity industry raised from investors in 2017

$414 billion

The previous record amount raised by the global private equity industry in 2007

$1 trillion+

The amount of “dry powder” (money raised but not invested) in private equity funds in 2017

Less than 5%

of all gastroenterologists work in a group of 20 or more physicians

Sources: industry tracker Preqin; publicly available information

Potential Risks of Private Equity Like any investment, private equity investments carry risks. Private equity firms invest in strategic assets. Medical groups are financial assets—just like factories or retail chain stores—that are meant to grow in value and be sold.

Before you move ahead with agreeing to a private equity investment, understand

Contact Physicians Endoscopy if you are considering private equity funding or consolidation: endocenters.com/contact-us

9 endoeconomics SPRING 2018

strategies

{Business strategy and the bottom line}

that the firm you partner with today will not be your partner in the future. The typical investment window for a private equity firm is 3–5 years. Eventually, the firm will look to sell your practice. You can fall in love with one private equity firm, only to be later sold to another firm or strategic buyer you dislike.

While you might be eager to secure a private equity investment, do not rush into a deal without the appropriate support. These are complex transactions. Private equity firms are extremely savvy investors with every resource, from personnel to data, needed to secure the best financial terms possible for them as the acquirer of your practice.

You will want to surround yourself with an experienced MSO legal counsel, accountant and perhaps an investment banker (note: investment bankers tend to charge very high fees for these transactions). If you try to make this deal without an experienced “deal team,” the results are not likely to be in your favor.

It is very easy to be swept off your feet with the terms of the transaction. By securing a private equity investment, you will likely earn a significant initial cash payout. But placing too much importance on this figure can hurt your practice long term. Rather, focus on what happens to your group post-transaction—specifically, what the influx of capital will mean to your group and how it

will allow you to grow and deliver better clinical care, enhance ancillary service lines and secure better payor contracts.

That is why selecting the right partner is so critical.

Choosing a Private Equity Partner As you vet potential private equity firms or strategic buyers like Physicians Endoscopy (PE), keep in mind these questions: > Does this firm have experience in the GI space or other sub-specialties like dermatology or urology that have substantial ancillary lines of income in their respective practices? The value of an experienced buyer should far outweigh the cash transaction in your decision, as an experienced buyer focuses on proven strategic growth initiatives post-transaction. > Does this partner truly understand and appreciate the uniqueness of the GI subspecialty? This concerns the sources of revenue that help drive a group beyond practice revenue, including investments in endocenters, additional ancillary service lines and skilled management that will help position your group for the future.

Looking for the right business partner?

We offer flexible minority or majority ASC acquisition options!

(866) 240-9496 ∙ info@endocenters.com ∙ www.endocenters.com

endocenters.com

> How will this firm help my practice grow both in my local market and regionally? > Does the firm understand alternative payment models (e.g., episode of care bundles, shared savings/risk arrangements) and have experience with self-insured employer contracting? > Ultimately, can this firm offer my group anything other than a cash transaction?

Look for a private equity firm that avoids shortterm decisions to drive investment value and jeopardize long-term goals of providing better GI care.

If your group approaches private equity investments in this way, you are more likely to maximize the benefits of the partnership and deliver the private equity firm a strong return.

SCOTT FRASER is President of PE Gastro Management, Physicians Endoscopy’s new practice management division. He joined the company in 2017.

Prior to PE, he was part of the founding executive team at EndoChoice, Inc. and served as the Global Vice President of Commercialization. He can be reached at sfraser@endocenters.com.

Our Philosophy on Private Equity Since 2003, Physicians Endoscopy (PE) has had five turns (i.e., investments) with private equity, beginning with Navigation Capital Partners through our most recent turn, the acquisition of PE by Kelso & Co. in August 2016.

PE’s sole focus is on GI operational excellence.

Through private equity investments, we secure capital that allows us to provide and scale our expertise in GI operations and administrative services for the benefit of our partner practices and endocenters.

There is one noteworthy consistency through all our private equity turns: PE has always maintained its steadfast commitment to serving as a steward for the interests of our partner gastroenterologists. Staying the course is vital to achieving our mission and creating value for our partners. PE has not allowed short-term decisions to drive investment value and jeopardize long-term goals of providing better GI care. As a result, PE essentially serves as the vehicle through which private equity invests in GI—and does so successfully.

CASE STUDY

excellence

{Success stories}

SOUTH BROWARD ENDOSCOPY CENTER

The ultimate patient experience Discover how partner centers such as South Broward Endoscopy leverage patient satisfaction surveys to deliver the highest level of care.

By Frank Principati Physicians Endoscopy’s (PE) first issue of EndoEconomics debuted in fall 2003 with the tagline, “Journal Dedicated to the Economic Issues Impacting GI Practices” (since updated to “A Journal Dedicated to Advancing GI ASCs and Practices”). One column in the inaugural issue stood out in particular, despite being the least economics-focused piece in the entire lineup. It hit at the very foundation of the PE patient-centered business model.

12 endoeconomics SPRING 2018

endocenters.com

The column—titled “Patient Satisfaction–The Key” and written by attorney James Saxton—offered a plan for developing a service culture and incorporating service excellence strategies.

Fast-forward 15 years, and we at PE are reminded every day that the focus of our business, and that of our partners, is the patient experience. More than 8,000 patients on average visit PE partner centers every week.

From the moment patients and their escorts walk in the door through the moment they leave, there are numerous opportunities to obtain feedback on efforts to make them feel like the highest priority.

Each patient encounter, whether with a front desk representative, nurse, physician or even other patients, is critical to gauging our performance.

Not all patients who come into our centers are happy to be there. Some can prove difficult. This can be magnified further if staff members allow their personal challenges to influence the way they provide care. Staff and physicians must remember that each patient experience is a reference for the next patient experience.

Saxton wrote: “We must develop a certain service culture that is truly woven into your practice or facility. It is having the confidence that on a rainy Monday morning, even when the weekend did not go well, every individual in your organization is still turning it on to even the most unreasonable patient. It has to do with greetings, body language and demeanor, and it must be a consistent practice throughout your entire organization.”

But many patients viewed as “unreasonable” are being seen because they have experienced a change in their health. “They are seeking treatment or a diagnostic test that may belay fears or deliver devastating news.

This is a heavy emotional burden for them, so a degree of anxiety and anxiety-related behavior can be expected,” says Robert Puglisi, PE Vice President of Operations. “Our response should always strive to be positive and focused on quality of care to everyone.”

TRULY INCORPORATING SERVICE EXCELLENCE STRATEGIES INTO YOUR ORGANIZATION IS HARD WORK BUT IS EXTRAORDINARILY WORTHWHILE.

For South Broward Endoscopy in Cooper City, FL, engaging patients is top of mind even before they walk in the door.

13 endoeconomics SPRING 2018

excellence

{Success stories}

A Model for Excellence The groups that excel in this regard are those committed to activities focused on the patient experience, including ongoing physician and staff training, finding new initiatives to promote service offerings and using feedback to drive quality improvement. For South Broward Endoscopy in Cooper City, Florida, engaging patients is top of mind even before they walk in the door.

“We want patients to be informed and serve as active participants in their healthcare,” says Executive Director of Operations Shelly Daduk. “When patients are scheduled for their procedure, they are provided a brochure titled ‘What to Expect.’” This simple initiative helps prepare patients for the experience at the center, hopefully alleviating fears and building comfort.

South Broward Endoscopy also texts reminders to patients about their upcoming procedures and prep instructions. Staff members call patients to review their medical history and medications, review how to take their preps and answer questions.

“We have a very friendly and well-educated staff,” Daduk says. “Our front office staff are educated in customer service skills and delivery. On the day of the procedure, patients and escorts are warmly greeted. Staff focus on communicating effectively with patients and practice active listening. They take pride in providing excellent patient care and buy into its importance.”

Harnessing the Power of Data We want to help our centers make information-driven decisions based on quality data and metrics, cost metrics, center utilization, and physician and staff performance.

To that end, we’ve dispatched tools that help our partners compare their performance internally and to the performance of peers and the broader healthcare industry.

Puglisi works with partner centers to maximize the value of these tools, one of which is a patient satisfaction survey. “This survey, which is uniform across all PE centers that have chosen to implement it, measures our care to patients from a clinical and operational standpoint,” he says. “It gives us meaningful data to analyze.”

On a monthly and quarterly basis, Puglisi, the PE operations team and center administrators receive reports on center performance and compare them to previous findings.

“If there is a result lower than anticipated, the center administrator and I will work to pinpoint the issue.

Based on what we determine, the administrator will share the information during staff meetings, reviewing what changed, what we think was the cause and what education will be provided to improve performance. The information is also shared with the center’s board of directors,” Puglisi says.

14 endoeconomics SPRING 2018

Patient satisfaction survey results help South Broward Endoscopy make positive changes. “Staff is incentivized to achieve exceptional patient satisfaction through a quarterly bonus program,” Daduk says. “Recently, after reviewing patient feedback, we set an internal benchmark and achieved shorter wait times.”

In addition to rating a center’s performance, patients can freely share thoughts on their overall experience and ideas for improvements. “We want to know if patients feel they received personalized, quality care or if they were treated like an item on an assembly line,” Puglisi says. “If someone had a bad experience, we want to know about it. If patients identify themselves on their surveys, we will reach out. The more we can learn, the better we can improve ourselves and their experience.”

But measuring and improving patient satisfaction must be more than a monthly or quarterly exercise.

Satisfaction rates and perceptions of centers can change quickly. One bad experience can harm a center, especially if the individual takes to public forums to express their displeasure.

endocenters.com

How to Address Patient Reviews Our satisfaction surveys aren’t the only place patients comment on their care. Through platforms such as Healthgrades, Facebook, Yelp and other mediums, patients and their escorts can share their feelings— good or bad—about their experience with a physician, individual staff members or the entire center. Monitoring these mediums and responding to comments requires work, but it is imperative to put processes in place to do so.

Responding to compliments is easy, if the means exist to express your appreciation: > Avoid using canned responses; respond directly to what was written. > If the person identifies him or herself, and he or she was a previous patient, reach out directly to say thanks.

Responding to criticism is a bit more difficult but, if approached appropriately, can help turn a negative into a positive: > If you post a reply, apologize for the negative experience and acknowledge that you take their concerns seriously. > Ask the individual to contact you to discuss their concerns further (offline). > Don’t dispute or argue with the individual on the platform. > Keep responses direct and sympathetic. > If you come to an understanding with the individual, consider asking if they will update their post. > If the poster is identifiable as a previous patient, you can reach out directly. Consider sending an email or physical letter, as a phone call can catch the patient off-guard.

I frequently say, “Everything is a learning experience.”

When we see something that does not represent the best of us, we must find out how to do it differently or better. For providers, that attitude should carry over to every encounter.

What Truly Matters People are not typically excited about coming to our business. Right off the bat, we’re fighting an uphill battle to provide an enjoyable experience. That’s why, when someone chooses to come to us, we must make it the best experience we can, taking into consideration his or her preconceived notions.

As patients leave the facility, the best question we can ask them is, “Now that you’ve been through the experience yourself and know it’s maybe not as bad as you expected, who is the next person you would recommend to our center?”

Much of our business is driven by word of mouth. With a large portion of the population skipping colorectal cancer screening, there’s a lot of potential untapped business.

The best way to capture the population not coming in is by referral, and you earn referrals by making sure patients are willing to recommend your center.

This is an area I think our FRANK PRINCIPATI joined Physicians centers do well.

Endoscopy in June 2010 and serves as Let’s conclude with a Chief Operating Officer, responsible for final thought from Saxton all operational aspects of PE’s current that rang true in 2003 and operating centers as well as several still applies today: “Truly projects under development. He and his incorporating service team also concentrate on opportunities excellence strategies into to enhance the overall success and financial growth of each partner center. your organization is hard He can be reached at fprincipati@ work but is extraordinarily endocenters.com. worthwhile.”

∙∙ PSG PSG MEMBER MEMBER BENEFITS BENEFITS ∙∙ ∙ Free attendance to the annual meeting ∙ Free attendance to the annual meeting September 14-16, 2018 at Hershey Hotel September 14-16, 2018 at Hershey Hotel ∙ Interaction with other state and national ∙ Interaction with other state and national medical societies medical societies ∙ Representation by GI fellows in training ∙ Representation by GI fellows in training ∙ Assistance with healthcare issues ∙ Assistance with healthcare issues ∙ Rumblings newsletter ∙ Rumblings newsletter QUESTIONS ABOUT PSG MEMBERSHIP? QUESTIONS ABOUT PSG MEMBERSHIP? Call (717) 558-7750 x1584 or visit www.pasg.org Call (717) 558-7750 x1584 or visit www.pasg.org

insights

{Marketing strategies and tips}

Referral game plan Marshal your resources to acquire even more patients through physician referrals.

By Lori Trzcinski

It is a question most physicians in private practice face: How are we going to acquire more patients?

The best answer is by generating more referrals from physicians in your market. That’s where a solid referral marketing game plan comes into play.

Building relationships with potential referring physicians will form the basis of your marketing efforts. If physicians and other healthcare providers in your area do not know of you, your partners or your ambulatory surgery center (ASC), how will they know you can be a resource for them and their patients?

Consider these critical pieces of your referral marketing game plan.

➋N eeds a Push. These doctors should get a lot of your attention. They refer patients occasionally but have the potential to send more. They just need a little cultivation to improve their numbers.

➌ L ess than Stellar. These physicians might send you a few patients now and then or have never referred to you. Do they need more education about your practice or services? With a little effort, you might find out if they have concerns that could be mitigated or if they are contractually obligated to send patients elsewhere.

If your practice is fairly well established, divide your current pool of referring physicians into categories based on their referral history with you:

If you do not already have a directory of physicians in your area, learn which doctors are affiliated with hospitals that are pushing procedures to outside GI ASCs. Look for a local medical society where you can network with other physicians, particularly general practitioners, family practitioners and OB/GYNs.

➊ T ried and True. These are the doctors with whom you

Craft Your Marketing Message

Prioritize Your Contact List

have a good relationship. They refer often and only need acknowledgment a few times a year to keep sending patients your way.

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Once you identify the people you will speak to, make sure you can give them accurate, helpful information about your practice. Your talking points should be clear about

Leverage your staff. Build a rapport with your staff and encourage them to spread the word about your practice. They are a critical support system for reaching out to care providers and generating referrals. what your center can and cannot do. Information should be concise and consistent in every communication medium, whether in talking points and brochures, or on web pages and social media channels.

Focus on services that set your center apart. Maybe you have a competitive or technical advantage over others (see “What Is In Your Service Playbook?”). Stress the service aspect of your center. For instance, let people know that your team can make the patient hand-off easier for the referring physician’s office.

Remember you are trying to foster a relationship, not just make a sales pitch. Be sincere. Talk about how the relationship benefits the referring practice and their patients. Do not randomly contact people without trying to facilitate a true relationship. If you show loyalty to providers, that loyalty will come back to you.

Get Your Staff Involved in Referral Marketing As you develop each step in your plan, think about which staff members could take on a particular task. Someone who is cheerful and outgoing might make a great ambassador from your practice to other clinicians’ offices, while a quiet, diligent employee might welcome the opportunity to do research or schedule networking appointments.

During staff meetings, present a plan to talk to a certain number of providers within a set time period and assign staff members to the practices you have identified. Or put it on the schedule that once a week a staffer will visit target providers. This is another reason to make sure staff members care enough about your business to extend themselves in this way.

(Check out “Culture shift” on page 18.) If generating new leads is not a good match for staff members, consider hiring an outside consultant to go out on your behalf. Just be sure they are well-informed about your practice and services and can make you look good.

These marketing visits don’t have to be a chore. Consider having a partner or staffer take lunch to their offices. Better still, host an event at your center. This could be an open house, a lunch-and-learn or a networking meeting that involves different specialties. Take time to introduce your visitors to your practice’s offerings, and everybody wins.

And when referrals come in, take time to send a thank-you message to the referring physician.

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What Is In Your Service Playbook?

No one ambulatory surgery center (ASC) offers all GI procedures or has access to all the latest devices. Look at your menu of services and focus your pitch on the ones you excel in or that are frequently needed in your market. Don’t forget to highlight your providers’ training and skill sets.

Board-Certified Gastroenterologists Pediatric Gastroenterologists Advanced Cardiac Life Support (ACLS) Trained Physicians and Nurses pH Probe Testing Colonoscopy Capsule Endoscopy CT or CAT scan Virtual Colonoscopy

EGD Enteroscopy ERCP Endoscopic Ultrasound Esophageal Motility Flexible Sigmoidoscopy Hemorrhoid Banding Weight Loss Procedures Infusion Therapy InterStim Procedures Sigmoidoscopy Liver Biopsy

AS YOU DEVELOP EACH STEP IN YOUR PLAN, THINK ABOUT WHICH STAFF MEMBERS COULD TAKE ON A PARTICULAR TASK.

Acting on your referral marketing game plan will no doubt take time—first in research and preparation, then in communication and follow-up. But when your schedule fills up, and you have satisfied patients and providers who can generate even more word-of-mouth referrals for you, the time and effort will be well worth it.

LORI TRZCINSKI, Marketing Manager, joined Physicians Endoscopy in 2012 and leads the corporate and center marketing initiatives of PE and its affiliated centers. She is also the managing editor of EndoEconomics. She can be reached at ltrzcinski@endocenters.com.

17 endoeconomics SPRING 2018

insights

{Clinical updates}

Culture shift

We must work toward changing a workplace culture where medical errors are accepted as a cost of doing business.

By Teresa Chaisson Take a moment and consider the following questions: What is your expectation regarding center patient safety? Do staff have a shared goal of zero patient harm? What does leadership do to support a safe workplace culture?

Research published in the Journal of Patient Safety puts the number of annual deaths associated with preventable harm in healthcare to between 210,000 and 440,000 patients. On the low end, that is the equivalent of 10 airplane crashes every week. Would the aviation industry accept these numbers? Why are these numbers accepted in healthcare?

Thankfully, in recent years these figures have not gone unnoticed. Organizations such as The Joint Commission, National Patient Safety Foundation and Children’s Hospitals’ Solutions for Patient Safety have stated the importance of striving for zero patient harm.

As an organization leader, you are responsible for creating and supporting a safe patient culture. You must

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openly embrace its need and value. If you do not demonstrate an unwavering commitment to a safe workplace culture, you cannot expect your staff to follow suit.

Areas of Focus to Transform Your Culture To obtain staff buy-in, focus your efforts on these areas.

> Equality. When it comes to a safe workplace culture, everyone is an important part of the team and everyone’s voice matters: physician, technician, nurse and housekeeper alike. No one’s concerns should be dismissed because of their position or lack of seniority. If staff see leadership building relationships and trust with everyone who works in the facility—even workers from outside agencies—this will create a tighter-knit community within your walls. > Responsibility. Your patients must always be the top priority. Their safety and well-being take center stage,

L earn more about the clinical and operations support we provide for our partners: endocenters.com/contact-us day in and day out. If anyone on your team is unwilling or unable to give patients complete attention, working in healthcare is probably not the right career choice. > Openness. A sign of strong safety culture is when anyone working at a facility feels comfortable speaking up—without hesitation or fear of retribution—when they believe something isn’t right. Work to promote such an environment. When concerns are brought to you, take them seriously and respond in a timely manner that recognizes their significance. > Systems. Errors in healthcare were historically addressed by punishing the individual who made the error as opposed to blaming the system that allowed this individual to fail. When errors occur, conduct a comprehensive root-cause analysis and fix issues that contributed to the error. > Accountability. When you provide education and training that promotes your safe environment, staff should be expected to follow what is taught. If anyone resists, they must be held accountable. A single person unwilling to fully support the safe workplace culture can weaken the entire effort. > Privacy. When staff admit they made an error or confide in you about the inappropriate actions of another team member, keep your discussion private and this individual’s identity confidential. If staff believe word of their actions will leak out, they are much less likely to come forward.

Walking the Walk At Physicians Endoscopy (PE), we take pride in achieving growth and success through embracing a patientcentered management model rather than a bottom-line management model. We are always looking to raise the standards and what it means to deliver safe, highquality, efficient care.

Currently, we are working with a partner facility, East Side Endoscopy in New York (ESNY), on a quality initiative from the Agency for Healthcare Research and Quality (AHRQ). AHRQ developed an ambulatory surgery center survey on patient safety culture, which we distributed to all physicians, anesthesia providers, nurses, technicians and other staff members at ESNY. Once we complete analyzing the data, we will gain a better understanding of where ESNY excels with patient safety culture and where improvement opportunities exist. Using an action planning tool provided by AHRQ, we will begin to implement changes to address lowerperforming areas.

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Safe Workplace Culture Checklist This checklist can help you assess opportunities for improvement in your efforts to achieve a safe workplace culture.

❑ My staff is trained on all the ways to report safety concerns.

❑ I support my people when they report a safety concern.

❑ I act upon all reported safety concerns. ❑ I provide clear, written expectations to my staff. ❑ I treat employees’ safety concerns with respect. ❑ I enforce safety rules. ❑ I encourage everyone to do their part to create

a safe and healthy work environment.

I model safety and “walk the walk.”

I use “management by walking around” to be seen by, listen to and share information with staff. ❑ I get involved when something doesn’t look right. ❑ I treat staff fairly when they make mistakes. ❑ I address patient safety concerns in real time. ❑ I encourage the sharing of errors to help improve education and performance. ❑ I provide resources to improve patient safety. ❑ I acknowledge that we can always do better.

❑ ❑

It is important to note that PE knows that ESNY delivers exceptional care. On the surface, it may seem like undertaking this exercise is unnecessary. Rather, it is paramount to the PE philosophy and what distinguishes us from other management companies. All clinical directors continuously work with their centers toward improving patient care.

We constantly evaluate opportunities to foster more positive patient outcomes and improve patient safety.

We encourage all our partners to take this type TERESA CHAISSON, RN, BSN, CNOR, of deep dive into their joined Physicians Endoscopy in May 2017 cultures and find even the and has more than 25 years of healthcare smallest ways to change experience. She oversees the clinical operations for PE’s New York and New care to better protect Jersey centers, holds the CNOR credential patients. As improvements and is a member of the Association of are made, a facility’s staff Peri-Operative Registered Nurses (AORN). will be in a better position She can be reached at tchaisson@ to support the critical goal endocenters.com. of zero patient harm.

19 endoeconomics SPRING 2018

insights

{IT insights}

The risk is real

Develop a thoughtful IT recovery plan today to protect yourself from a potential disaster tomorrow..

By Rick Schmidt

If your organization is fortunate to remain in business long enough, you will undoubtedly face some form of disaster. This could be a natural disaster (earthquake, flood, hurricane or winter storm) or a man-made disaster (chemical spill, cyber attack or power service disruption and blackout).

Regardless of the type of disaster your practice or ambulatory surgery center (ASC) encounters, you need a plan to recover from it. Without an effective recovery plan, business continuity efforts could be significantly hindered, stalling the return to normal operations or, in the worstcase scenario, leading to the closing of a business.

A vital component of disaster recovery planning is an organization’s information technology (IT). While practices and ASCs rely on IT to different degrees, all organizations count on some form of IT to support operations. To improve your organization’s IT recovery planning efforts, address these key considerations.

Develop an All-Encompassing Recovery Strategy Make sure your recovery plan considers every critical component of your IT infrastructure. This includes your

20 endoeconomics SPRING 2018

hardware systems (e.g., desktops, laptops, servers), software applications, data and connectivity (i.e., the means through which your systems connect to one another and the internet). Overlooking any area will complicate restoring functionality.

Address Disaster Recovery Priorities When disaster hits, every minute spent focusing on a noncritical area to your operation is a minute poorly utilized.

Make sure your plan identifies an order of IT recovery priorities that will best ensure the return of vital business functions and processes:

➊A ddress the IT functions and processes your organization requires to remain open or reopen safely.

➋M ove to areas that help your organization function effectively (e.g., allow you

Learn more about the IT support we provide our partners: endocenters.com/contact-us

to move from paper back to electronic documentation).

➌A ddress the areas that enhance productivity and the work environment but are not necessary for efficient business operations.

Determine Your Financial Pain Level If IT recovery efforts require outside vendor support, the faster you want to recover, the more you are likely to pay for services.

Reduce expenses by identifying areas where you can afford to move more slowly.

Speak with vendors about different options for restoring IT infrastructure following varying degrees of damage.

Match allocated resources to recovery time objectives for your business functions.

While it will likely make sense to budget (i.e., pay a premium) for an expedited recovery of your time-sensitive business functions, you can likely push other areas down the list.

Identify Internal Capabilities Your plan should consider the IT abilities of individuals on your staff, particularly designated IT specialists. Understand what recovery skills these team members bring to the table.

These individuals must be honest about their abilities. They may feel comfortable setting up a new desktop, but installing a server could put their skill limits to the test. For areas of high priority, the risk of placing a task in the hands of an uncertain staff member may not be worth the potential savings, as any shortcomings will require external support. Keep in mind there is no guarantee your in-house IT specialists will be available when a disaster hits. Include a backup plan in your recovery plan.

Consider IT Options Smart investments can potentially help improve recovery capabilities. There are numerous options from which to choose, with different functionality and cost. For example, some organizations maintain

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Comprehensive Disaster Planning two servers onsite When it comes to protecting your organization in case that are essentially of disaster, consider the full spectrum of planning. clones of each other. If one server fails, the other can Business continue to supContinuity Plan port operations.

Focuses on Another option Disaster defining the is to use cloud Recovery Plan threats and backup solutions Focuses on scenarios that can that capture and determining adversely impact sync copies of data, consistent, an organization applications and/ pre-planned and on making or servers to offactions in decisions about site locations. response to how to mitigate These and other a disaster these risks. choices can feel scenario after overwhelming. the damage has It is essential to been done. have support from someone knowledgeable about the pros and cons of such solutions.

Physicians Endoscopy (PE) provides this support to its centers, as well as helps with budgeting for IT upgrades and considering opportunities to build in redundancies when replacing existing systems. If you do not have an organization like PE in your corner, consider bringing in an outside IT consultant. This expertise can help ensure that your organization makes the most appropriate decisions about where to invest.

Keep Your Plan Current Treat your IT disaster recovery plan as a living document. Regularly update it to reflect your current operations.

Update your IT disaster recovery plan when there are new IT investments, staff turnover that would affect its execution and changes to your IT vendors. Even if none of these events happen during the year, an annual review is worthwhile to make sure the plan remains viable.

If inconsistencies develop between the plan and your current operations, this will impede your efforts for a timely, effective recovery.

As Director, Information Systems, at Physicians Endoscopy, RICK SCHMIDT plans for growth and ensures information systems continue to function efficiently.

With 18 years of IT experience, he is responsible for designing and deploying the information systems in use at PE and PE-affiliated centers. He can be reached at rschmidt@endocenters.com.

21 endoeconomics SPRING 2018

insights

{Human resources and personnel issues}

The feedback loop Leverage these tips for delivering regular employee feedback to help your team members perform at their highest levels.

By Tricia Pickford Like all businesses, ambulatory surgery centers (ASCs) invest heavily in recruiting and retaining staff.

With unemployment around 4 percent1, it is critical to hire the right people and provide them with development, opportunity and support to ensure they want to remain employed at your center or practice.

Include regular, candid feedback—both positive and negative—to ensure team members have tools to improve their performance and become better employees.

Many leaders cringe at the thought of sharing constructive feedback because it can be perceived as conflict. In reality, people typically crave feedback. They want to know when they have done well and when they need to improve.

Leaders and managers have a responsibility to give feedback in a manner that is productive and beneficial.

feedback within 24 to 48 hours of the matter. Pull the person aside, tell them what you observed and share the specific facts.

➍ Focus on facts. Avoid sharing opinions and provide details to support your feedback. It is more impactful to tell someone they have been late 10 times in a month versus saying they have been late “a lot lately,” for example. It is also good to explain why you are making the request (e.g., the importance of being punctual to work).

➎ Provide a heads-up. Before you provide feedback, tell the person you would like to give them feedback and ask if doing so is acceptable. This gives the employee an opportunity to prepare himself or herself mentally for what is coming, and he or she will likely be more receptive to your message.

Ten Tips to Improve Employee Feedback

➊ Get to know your people. Work to connect professionally, and at times personally, with your staff. When you invest in getting to know team members as people rather than subordinates, it builds trust and comfort.

Even simple questions like, “How are you doing?” and “How was your weekend?” can make a difference.

When people feel like you support them and have a vested interest in them, providing feedback can be more valuable for them and easier for you.

➋ Be specific when providing feedback. For example,

➏ Do not overlook the positive. Most people need some positive feedback to maintain a successful job performance. They want to feel good about their work and appreciate kind words from leaders and managers. A simple “thank you” can help boost morale, but you will get more bang for the buck with specifics.

➐ Do not let busy days stand in the way of feedback.

When you take on a leadership position, you agree to manage a team. Part of management requires assessing staff performance and helping improve it.

While downtime in an ASC or physician practice is rare, you still must find time to provide feedback so your people feel valued and understand how they can improve themselves to do more of what you praise.

instead of saying, “You did a great job today,” say, “Your presentation was tremendous. You put a lot of effort into it, and your real-world examples were spot-on.”

This helps team members understand exactly where they excel or need improvement.

➌ Give constructive criticism right away. Do not wait until a performance evaluation to discuss an issue. The longer you wait to provide feedback, the more the feedback will lose its effectiveness, as the matter you are discussing will not be as fresh. Whenever possible, give

22 endoeconomics SPRING 2018

➑ Practice. When you must deliver an uncomfortable message, practice what you want to say in front of a mirror or with a colleague. You can also call your human resources department for support. You do not need to

1

Bureau of Labor Statistics: bls.gov/news.release/pdf/empsit.pdf

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Do’s and Don’ts of Providing Employee Feedback script what you want to say, but ensure your words accurately reflect the message you want to convey.

Do: Make eye contact during discussions to show you’re paying attention.

➒ Combine positive and negative. Consider combining constructive criticism on a staff member’s performance with a positive comment or two. If a team member is frequently tardy, share the facts (e.g., number of times in a month) and explain how this affects operations. Couple that with praise for the team member’s work ethic (if applicable), then make your request for improvement.

Don’t: Cross your arms while speaking to avoid seeming closed off.

Do: Speak at a table rather than a desk to avoid being perceived as a projection of power.

➓ Allow a response. When sharing constructive criticism, do not talk at the team member; talk with them. Ask what they feel about the feedback and if they agree. This will allow you to see if you are on the same page. If not, engage in a thoughtful discussion on where you differ.

You may learn something about them you did not know, and they will feel supported.

Be Consistent With Feedback All team members should receive ongoing feedback presented in the same manner. Providing more constructive criticism to some team members and praise for others could create frustration and a rift between staff. Every team member can improve, and each brings something positive to the table. Strive to consistently highlight a little of both. When feedback does not improve performance or behaviors, leaders have to make tough decisions.

Don’t: Stand when the employee is sitting to avoid a feeling of intimidation.

TRICIA PICKFORD, SPHR, SHRM-SCP, is Senior VP, Human Resources, at Physicians Endoscopy. She has more than 15 years of progressive HR experience including talent acquisition, compensation and payroll management, and performance management. She can be reached at tpickford@ endocenters.com.

Learn more about the HR support we provide for our partners: endocenters.com/contact-us

Do: Pick up nonverbal cues that could show nervousness or comprehension.

Don’t: Provide constructive criticism in public; find a private area.

23 endoeconomics SPRING 2018

endo opportunities WEST Mesa, AZ Central Arizona Medical Associates 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 physician-owned, 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, Washington. 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.

Northern & Central CA SecureMD GI physicians: Are you looking for flexibility and supplemental income?

Our mobile endoscopy practice is seeking board-certified 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.

NORTHEAST New York, NY Gastroenterology on Gramercy Park 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.

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

North Bergen, NJ 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.

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.

24 endoeconomics SPRING 2018

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

Submit your CV online at endocenters.com/recruiting

Lumberton, NJ Gastroenterology Consultants of South Jersey Gastroenterology Consultants of South Jersey is a privately owned, seven-physician practice located in Lumberton, NJ. We are a wellestablished practice of 25 years located among several growing communities in Southern NJ. • Located within 30 minutes of Philadelphia and within one hour of New York City • Affiliated with Burlington County Endoscopy Center, a three-room ASC which 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 New Jersey Garden State Digestive Disease Specialists, LLC Garden State Digestive Disease Specialists, LLC, is seeking a fulltime 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.

SOUTH Gastonia, NC Carolina Digestive Diseases Four established gastroenterologists located 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 to the Smoky Mountains and four hours to the Atlantic beaches. Enjoy sunshine and a great lifestyle in the metro Charlotte area.

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BOOTH BOOTH 2411 2411 Gastroenterologists to join our growing practice. We have several offices across Metro Detroit with two state-of-the-art, AAAHC accredited 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 • Insurance (malpractice, health, dental, vision, life, supplemental & dependent life, short & long-term disability)

June June3-5, 3-5,2018 2018 Washington, Washington,DC DC

DDW DDWCareer CareerFair Fair

Accepting AcceptingGI GIApplications Applications

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