EndoEconomics Summer 2015

A Journal Dedicated to Economic Issues Impacting GI ASCs and Practices

Promoting Success and Awareness Page 5

SUMMER 2015

Changes in the Payer Contracting World

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An Innovative New Device for Ostomy Patients

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The GI Journal of:

“Improving the landscape of healthcare one surgery center at a time.�

SUMMER 2015

SUMMER 2015 ISSUE EndoEconomics

by Physicians Endoscopy Editorial Staff Carol Stopa Editor in Chief cstopa@endocenters.com

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Lori Trzcinski Managing Editor ltrzcinski@endocenters.com EndoEconomics™, a free quarterly publication, is published by Physicians Endoscopy, 2500 York Road, Suite 300, Jamison, PA 18929.

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

POSTMASTER: Send address changes to: Physicians Endoscopy, Attn: EndoEconomics, 2500 York Road, Suite 300, Jamison, PA 18929. Periodical postage paid at Merrill, WI. 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.

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

Printed in the U.S.A. Copyright © 2015 by Physicians Endoscopy.

All rights reserved.

5 CONTENT 4 MESSAGE FROM THE PRESIDENT 5 PROMOTING SUCCESS AND AWARENESS 6 PAYER CONTRACTING UPDATE: TRENDS, DEVELOPMENTS AND TIPS 9 TECHNOLOGIES AND TRENDS: CAPITALIZING ON NEW OPPORTUNITIES 12 DEVELOPMENT OF THE OSTOM-I ALERT SENSOR: Q&A WITH INVENTOR MICHAEL SERES

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 the Physicians Endoscopy. Reproduction in whole or in part of the contents without expressed permission is prohibitied.

15 GLUTEN-FREE DIET: AN EPIDEMIC?

To request reprints or the rights to reprintsuch as copying for general distribution, advertising, promotional purposes-- should be submitted in writing by mail or sent via email to info@endocenters.com.

20 BUSINESS BRIEFS: MOBILE HEALTH APPS TO CONSIDER

16 EXPANDING THE FIGHT AGAINST COLORECTAL CANCER 18 MARKETING BUZZ: OBTAINING REFERRALS AS A NEW PRIVATE PRACTICE PHYSICIAN 21 FRONT AND CENTER 22 CURRENT GI OPPORTUNITIES Find out more at endocenters.com or find us on SU M M E R 2 0 1 5 EndoEconomics

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Message from the

Barry Tanner

President and CEO, Physicians Endoscopy

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would like to take this one time to recognize and applaud all of the men and women who make up the Physicians Endoscopy (PE) family. Our team - approximately 110 strong - works very hard day-in and day-out to support the physicians and staff of the centers with whom we are partnered. While this journal is not intended to be about PE, it is the very efforts of our team that even make this publication possible.

PE has remained dedicated to the single specialty of gastroenterology for over 16 years, growing from two ASCs in 1998 to now 40 partnered facilities. We have made substantial investments in centers, support systems, personnel and in our physical plant to host all our services.

We have learned so much from our physician and industry partners and each other. But the most important things we have clung tightly to are the integrity, values and vision that comprise the core of who we are as people working together as a team.

After many years and so much growth, we decided last year to hit the pause button briefly to re-examine who we are as a company and what it is we want to represent both to ourselves and to the constituents that we serve. We made the purposeful decision to hire a professional organization to provide both leader4 |

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President

ship training and to guide us through a process of self-examination and introspection. Our goals were to improve our abilities to function at the highest level as a team and to re-examine, reset, if necessary, and to rededicate ourselves, holding each other accountable to the core values that have carried us to this point. In hindsight, it may well be the best investment of time and financial resources that we’ve ever made.

I would like to share with you just a few takeaways that resonated with all of us.

The first is that any great organization, large or small, shares a widely embraced bond through the team that is emotional in origin. It may be characterized as a belief or recognition that the organization is doing something that is valuable and honest to contribute to the greater good. It is a shared vision, a belief, an emotional connection that somehow transcends the daily grind that we all face. We invested the time to identify the team guiding principles that we share, many of which had been unstated and undocumented, but we quickly learned that there was a broad based agreement and little, if any, deviation among us.

Last month, we assembled for a company-wide off-site meeting to share with the team our guiding principles and to embrace the entire organization with that emotional and spiritual commitment that drives us forward. As a group, we reviewed the progress that has been achieved in preventing colon cancer over the past decade, but also how much has yet to be accomplished.

Our meeting wrapped up discussing the supporting role that PE plays in helping gastroenterologists to deliver quality care in a cost-effective and convenient setting. Although it was an emotional

meeting, there was also a shared joy and a coalescing of emotions surrounding what we can do as a team to continue to help gastroenterologists improve the health of so many people. This is something that the entire PE team shares and takes tremendous pride in.

I hope that you will enjoy this edition of EndoEconomics!

Physicians Endoscopy Team Guiding Principles • Inspiring Passion – Foster an environment of contribution, creativity and risktaking; unleash the potential and passion in everyone; cultivate a highly engaged, motivated and committed organization.

• Honest and Trustworthy – Be vulnerable and admit our mistakes; directly address concerns with others; communicate openly and candidly.

• Approachable – Invite collaboration; generously share our ideas; engage in constructive conflict to promptly address differences; continuously improve the quality of our relationships and interactions.

• Accountable – Take ownership; be clear on our responsibilities and commitments; hold ourselves and one another accountable to deliver on expectations.

• Selfless Leader – Put others first; promote a spirit of collaboration; recognize and celebrate others’ achievements; take personal risks for the benefit of the team.

• Respectful – Provide constructive feedback; genuinely acknowledge others; recognize, appreciate and leverage differences among team members.

• Caring and Compassionate – Put ourselves in others’ shoes; seek first to understand and then to be understood; demonstrate a strong personal commitment to others’ success.

• Fair Minded – Have the courage to do what’s right even when unpopular; make decisions with a team-wide orientation; be transparent in our motivations and reasoning.

David Dubin I Am Alive And Kickn

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Promoting Successes and Awareness

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n early June, Physicians Endoscopy (PE) brought the entire company together to acknowledge the organization’s recent and longstanding growth – both internally as well as among new partnered centers. Achieving the Becker’s Hospital Review’s “150 Great Places to Work in Healthcare” award, PE strives to improve the landscape of healthcare one surgery center at a time – and it all starts with great employees.

Physicians Endoscopy has grown from just a handful of people and a few acquired GI centers back in 1998 to now over 100 employees. PE developed its first new GI surgery center in 2001 and currently operates over 40 centers across the country. With their commitment to the field of gastroenterology, PE continues to hold steadfast in being the only GI single-specialty management company in the industry.

While many achievements can be attributed to members of the senior management team under the leadership of Barry Tanner, President and CEO, PE’s real secret to success is the remarkable

team members who make up the PE family. Mr. Tanner’s vision has remained unwavering to doing one thing and doing it really well, and everyone at PE rises to this challenge each and every day.

The meeting honored many employees who have accomplished milestones in terms of achievements and tenure and also highlighted guest speaker, Dave Dubin, a three-time cancer survivor. Mr. Dubin shared his experience with being a colon cancer survivor and living a “maintenance lifestyle.”

Mr. Dubin expressed his appreciation to the PE team for all their work and dedication in the fight against colon cancer, and emphasized that every employee is important to patients who are struggling. His story and positive attitude are an inspiration to many.

avid Dubin is a three time cancer survivor. He was first diagnosed with colon cancer at age 29, and again at 40. About two years later, doctors removed a third cancer from his kidney. In response to his life struggles in fighting cancer and his history of being a soccer player, Dave founded “AliveAndKickn”, a foundation for colon cancer and genetic colon cancer. The foundation uses soccer games as a method for awareness and fundraising.

David was the keynote speaker at Physicians Endoscopy’s annual team meeting. He shared his experience with being a colon cancer survivor stating, “Early detection is the key to survival. Going into an examination is not something people should dread.

It’s unfortunate the word colonoscopy is a punchline. It’s not that bad.”

Mr. Dubin is a long-time patient of Blair Lewis, MD, and is seen regularly for screenings at Carnegie Hill Endoscopy in Manhattan, NY. His story and positive attitude is an inspiration to many.

In addition to raising colon cancer awareness, David is Director of Genetics and Genomics at Icahn School of Medicine at Mount Sinai.

For more information, visit AliveAndKickn.org or visit this YouTube link https://youtu.be/yg12ArTKH6o to watch Dave’s story which won best documentary at the 2013 Northeast Film Festival.

The PE Team is individually and collectively committed to fighting colon cancer and promoting awareness. “We all have to go to work every day, but we get to choose how well we do our job,” stated Mr. Tanner. “I’m truly fortunate to work with such a great team.”

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Payer Contracting Update: Trends, Developments and Tips

BY SHARON HOHLFELD, VP PAYER CONTRACTING, PHYSICIANS ENDOSCOPY

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here are always changes taking place in the world of payer contracting. Some are the result of the Affordable Care Act (ACA) — either directly or indirectly. Others are tied to the nationwide consolidation of payers, which is likely to continue. And some others are simply the result of changing practices of payers, employers and patients.

With so much activity surrounding payer contracting, it is important for ASCs to understand what is happening throughout the country so they can be prepared for changes in their market.

Here are some trends and developments I have seen through my work with Physicians Endoscopy’s 40-plus ASCs, and some tips to help you overcome new challenges as you navigate your ASC through the process.

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CREDENTIALING TIPS While credentialing will never be a quick process, there are a number of steps you can take to make it easier and faster.

Sharon Hohlfeld

It’s always best to contact each payer early so that you can obtain a copy of the credentialing application. Review the list of documents that are required, and complete the application as soon as you receive it. Make sure you understand their process. For example, is there a committee that meets on a monthly basis, or are applications processed as they are submitted? Most payers review credentials on an ongoing basis, and typically it takes 30-45 days. Check in with your rep about halfway through the process to make sure everything is on track.

Always give payers exactly what they ask for — no more, no less. You create the potential for questions and confusion if you do not provide them the information they want or give documents they haven’t asked for. It is also helpful to deliver information in the order it is requested. If a payer requests a copy of your Medicare certification, accreditation certificate, insurance declaration sheet and license, in that order, then organize them exactly so after the application. If no formal list is included, you may want to label each of these documents and their corresponding section of the application. The easier you make finding the documents payers are requiring, the faster you are going to get through the credentialing process.

Note: We are seeing some Medicaid HMOs requesting social security numbers and dates of birth for owners,

officers and administrators. They believe they are required to obtain this to perform background checks and ensure the ASC’s owners/officers/administrators are not listed on the OIG’s List of Excluded Individuals/Entities. However, the federal requirements do not require an ASC to disclose this information to anyone but Medicare and Medicaid directly. Considering the increase in security breaches, the less voluntary information you can provide, the better.

If Medicaid HMOs request this information, understand that all they should need to perform this verification is the person’s name. If the owner/officer/administrator has a common name, you may need to provide additional details, but rather than providing those details in writing, work to get a representative on the phone and perform the verification verbally.

So far, I have encountered Medicaid HMOs in four different states telling me this information is required. After multiple discussions and some pushback, all four have backed off and moved forward with contracting.

CONTRACTS NEGOTIATION TIPS Negotiating reimbursement rates high enough to keep an ASC viable and profitable isn’t easy and requires a good deal of analysis and persistence when it comes to dealing with payers. But, equally important in the process is negotiating the contract language. No matter how hard you’ve worked to get great rates, if the payers can send you an amendment at any time changing the terms you’ve agreed to, then your great rates are in jeopardy the moment you sign the agreement.

When I review a contract, I flag everything that makes the hair on the back of my neck stand up, because it’s something I need to change, like a 180-day termination clause, or an amendment section that doesn’t require signatures

for all non-regulatory changes, or I simply don’t like how something reads. I constantly hear from payers when I raise concerns about specific language that “no one has ever asked to change that particular section before.” If you hear something similar, that’s okay. It’s better to be the first person to ask a question than to ignore something you are uncomfortable with or don’t completely understand.

My suggestion is to send alternate language for all sections you wish to change or delete those that don’t apply to your situation. Don’t expect that the payer will agree to all of your requests, so it’s important to determine which changes you’ve requested are “deal breakers” and which you can afford not to fight.

The changes you are willing to concede can be offered up in order to keep the really important changes on track. If a section includes regulatory statues by number, look them up. They may not pertain to your facility, or it may add additional requirements to your operation which could dilute the revenue.

Make sure you track your requests, either by sending them electronically or creating a list of the changes you’ve asked for. On a rare occasion, I’ve received agreements where items that were changed early in the process were not changed on the final document. On each occasion, the document was easily fixed, but without the list of items, I may not have caught it.

I have always operated under the auspice that if you’re reasonable, you can usually convince the other side to be reasonable. Sometimes it requires a great deal of persistence. Remember that there is always someone above the person you are working with that may have the ability to make the changes you are requesting, don’t allow payers to force contract language on your ASC that may hurt you significantly in the future.

CHANGES: VERIFICATION OF BENEFITS Not long ago, insurance plans were pretty clearly defined. We had indemnity, HMO and PPO, and we all understood the benefits and limitation offered by each category. But several years ago, those lines started to blur. Soon payers started coming out with “cafeteria plans,” which offered employer groups a host of options to maximize their benefits for their employees and still maintain reasonable premiums.

In addition, we now have self-funded plans, which can restrict the network of providers permitted to provide care as well as being exempt from many of the changes associated with the ACA. What does this all mean to ASCs? It is no longer safe to assume that just because a patient comes in with an insurance ID card from a contracted payer, you will be reimbursed at your contracted rate.

It is critical for ASCs to confirm benefits of all patients directly with their payer before proceeding with surgery. To do so requires asking the patient’s insurance carrier the “right” questions. In addition to asking for their in-network benefits, we also need to ask whether there are any restrictions on that patient, and does the patient have any capitated language in his or her benefits (i.e., are they capitated to a certain hospital system, lab or group of providers)? It is critical that you call for every patient, and do not assume patients understand their coverage.

In addition, it is important to note that payers are now constantly evolving their product lines and working to develop new plans to fit the needs of the various employer groups in your community. Never assume that just because businesses contract with the same payer that they are following the same plans with the same rules.

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TRENDS: PAYER REPRESENTATIVES If your center has been open for several years and you’ve negotiated all of your agreements, you likely have a contact person at each of the payers. This insurance representative was your point person for initial negotiations, rate increases and any issues you encountered throughout the years. You developed relationships with “your rep” and worked well together to get issues resolved.

We’ve seen a change at two of the national commercial carriers that eliminates this direct contact and the benefits that go along with it. With these two carriers, all direct phone lines and emails have been disconnected or deleted. Now we are required to send a fax with our issue to a central office location.

That office’s sole responsibility is to determine the best department to address the issue and forwards the fax to that department. Within 30 days of your fax

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submission, someone from that department should reach out and work with you until the issue is resolved, even if that requires multiple conversations. But next time you have a concern or question, you need to start the fax process all over again, and you may or may not end up speaking with the same person. With every new process there are bugs and times when it doesn’t work as designed.

When you encounter such a situation, it is critical to be persistent and never expect your fax is going to the right person in the right department. Keep calling and following up. Make sure you obtain and document the reference number for your call so that you can show multiple inquiries for the same issues. Also, write down who you spoke with, when you spoke with them and the details of your conversation. Never assume the representative will document all of the information you feel is critical to addressing your request or resolving your problem.

In addition, don’t be afraid to escalate the issue.

SUMMARY Everything you do is a step toward finalizing a contract for the center or improving the ones you have in place.

By utilizing these tips and understanding the trends and developments in the market, you can reach your goal of getting “good” contracts in place for your ASC. Sharon Hohlfeld, Vice President of Payer Contracting at Physicians Endoscopy, has been with PE since 2005 and has over 25 years of experience in healthcare. Sharon oversees the payer contracting department which is responsible for obtaining network agreements between Physicians Endoscopy partnered centers and the insurance companies, renegotiating current agreements for existing centers to increase revenue on an annual basis, and credentialing the facility with each carrier.

Her team works closely with the finance, billing, and operations departments to support the ASCs and remains on top of the changing healthcare insurance industry to provide support and education to the center physicians and staff. For more information, Sharon may be reached at shohlfeld@endocenters.com

Technologies and Trends:

Capitalizing on New Opportunities

BY CHRIS STANLEY, VP, BUSINESS DEVELOPMENT, PHYSICIANS ENDOSCOPY

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here is considerable conversation taking place in and around the GI community about adenoma detection rates (ADR) and the quality of colonoscopy for cancer screening. While these are certainly important issues, there have been a number of developments in GI over the past few years, specifically in the ASC and practice settings, that are frequently overlooked. These developments — coming in the form of new technologies and techniques — have the potential to impact a GI practice and ASC by building value and creating marketing opportunities.

My knowledge of these developments stems from 16 years as a medical device representative, with the last eight of those years at Boston Scientific Endoscopy. While each of these developments is worthy of a much lengthier

discussion, it is helpful for practices and ASCs to revisit or gain an initial, broad understanding of them. This knowledge can serve as a springboard for Chris Stanley informed internal discussions about how these technologies may potentially — and positively — affect the future of the organization.

The column will begin with a discussion on upper endoscopy developments (reflux, motility, capsule endoscopy and Barrett’s esophagus), followed by lower endoscopy developments (hemorrhoid banding) and end with discussion about the role of imaging technologies in building a stronger market presence.

UPPER ENDOSCOPY Reflux monitoring — Since gastroesophageal reflux disease (GERD) and other esophageal conditions can be hard to diagnose from symptoms alone, newer reflux monitoring technologies may provide the means to evaluate these symptoms. They can help a physician identify reflux frequency and duration, therefore providing data for a more educated decision on treatment.

Medtronic GI’s Bravo pH monitoring capsule-based system is used to evaluate patients who experience symptoms of chronic esophageal reflux at least twice per week. These symptoms include frequent heartburn, indigestion or chest pain, which can all be associated with GERD.

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As a catheter-free, wireless-based testing device, patients can maintain normal daily habits, which should provide for more realistic monitoring of symptoms. The capsule is placed following either the esophagogastroduodenoscopy (EGD) or manometry procedure.

The reimbursement is global, and can be excellent. Investment in the technology is fairly well reported to be around $20,000.

Motility monitoring — Motility monitoring is used to help aid in the evaluation of motility disorders, such as gastroparesis and constipation. There are several technologies for motility monitoring, including three from Medtronic GI. ManoScan ESO is for manometry of the esophagus, assessing pressure and motor function for patients with symptoms including gastric reflux, chest pain, hiatal hernia, difficulty swallowing or achalasia. It can also be used in a pre-operative evaluation of those patients considering more elaborate esophageal reflux surgeries.

ManoScan AR is used to evaluate the function and coordination of the anal sphincter and pelvic floor muscles for patients with chronic constipation, fecal incontinence and rectal prolapse.

Both ManoScans are often nurseadministered, physician-interpreted studies that are typically performed in offices rather than the ASC. Their hi-resolution technology allows for a 10-15 minute procedure versus conventional procedures that can take upwards of 45 minutes. The investment in the technology can be more substantial than traditional systems.

Medtronic GI’s SmartPill is an ingestible pill. It is the only technology that assesses delayed gastric emptying, small bowel transit, large bowel transit and total gut transit. It is helpful for

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studying chronic constipation, bloating, nausea, vomiting or unexplained GI symptoms, and measures pressure, pH and temperature of the GI tract as it records motility. This test is performed in the GI practice, not the ASC. SmartPill offers two major benefits: the elimination of radiation exposure, which is necessary when performed in the hospital setting, and the ability to interpret images outside of the hospital.

While the reimbursement for this motility monitoring test can be a challenge, in the cases where payers honor coverage, payment can be quite good. The investment for SmartPill is approximately $25,000.

Capsule endoscopy — This procedure involves the use of a tiny wireless camera to take pictures of a patient’s digestive tract. There are a number of technology options for providers to choose from if they want to offer this service. Medtronic GI’s PillCam SB is used for visualizing the small bowel, the PillCam ESO is used for visualizing the esophagus and PillCam COLON is used to visualize the colon. Other options include the ENDOCAPSULE System EC 10 from Olympus and the MiroCam capsule endoscope from Medivators which can both visualize the small bowel.

Capsule endoscopy is typically administered by a nurse in either a practice, ASC or hospital setting. The PillCam technology, for example, takes approximately 50,000 pictures over an eighthour period. The images are then streamed together, creating a movielike projection of the studied area. This investment can be expensive but may still be worth evaluation.

Barrett’s esophagus — There is a new technology gaining some interest in the diagnosis of Barrett’s esophagus.

CDx Diagnostics, a pathology company, has developed a proprietary brush technology called WATS3D Biopsy.

The WATS3D Biopsy technology was conceived to provide endoscopists with a comprehensive biopsy system covering 5cm in circumference within the tubular esophagus. It is an adjunct to standard forceps biopsy protocol.

The WATS3D biopsy captures approximately 100,000 cells from the lamina propia (where pre-cancerous cells reside). Total procedural time adds approximately 90 seconds to the EGD. The tissue samples are sent to the CDx laboratory for computer analysis.

Simply put, the proprietary computer program reads every cell captured in three dimensions and identifies the 200 most abnormal ones. The specificity of the test does not diminish the sensitivity. There are academic- and community-based studies showing 40%-60% increased detection of Barrett’s esophagus and dysplasia when using WATS3D and focal biopsy. This technology may substantially increase the identification of Barrett’s esophagus and the early diagnosis of pre-cancerous cells.

There is no cost to the center for the sampling kit or in shipping of the specimens, as each kit has a self-paid United Parcel Service overnight label. The company simply bills insurance for the test as esophageal pathology.

LOWER ENDOSCOPY Hemorrhoidal banding — My discussions with providers and experience in the industry suggest that the treatment of hemorrhoids is still an underserved and provided therapy. There is probably considerable research needed behind the barriers that prevent or discourage gastroenterologists from performing hemorrhoid treatment in either the hospital or the ASC. Perhaps it is

comfort of patient selection or not truly understanding the financial benefits and risks behind performing the treatment in the ASC, for example. With that said, hemorrhoidal banding is a service that may be of great benefit to providers and patients.

As with any procedure, proper patient selection, knowledge of the anatomy being treated and a plan for managing post-procedure and delayed adverse events will be essential for developing a successful hemorrhoid banding service for patients.

A number of years ago, I had the privilege of assisting a GI physician develop a hemorrhoid banding program at his center. He has become well known for providing this treatment in the communities he serves and has now treated a few hundred patients. As a result, he has managed to build a nice name for himself by providing the treatment in a financially responsible way and ultimately has improved the quality of life for many of his patients.

LEVERAGING YOUR TECHNOLOGY INVESTMENTS

There are currently only a handful of companies that offer devices with an indication for the endoscopic ligation of anorectal hemorrhoids. Of them, Boston Scientific’s Speedband Superview Super 7 Multiple Band Ligator and Wilson Cook’s 6 Shooter Saeed Multi-Band Ligator are the most familiar to gastroenterologists because of their more prominent use in the hospital setting for banding esophageal varices. A number of other devices and techniques are available; however, they are not typically used by gastroenterologists.

While reimbursement for hemorrhoid banding is well-established in the hospital, I am aware of some cases where positive reimbursement was also found in the ASC setting. In addition, as manufacturers observe the movement of patients to the ASC setting, they are increasingly adopting financial programs consistent with this movement.

As such, it would be advisable to have discussions with those manufacturers, openly review your objectives to building out your service and request assistance in the cost of those devices.

After reviewing hundreds of GI practice and ASC websites across the country, it seems almost all include mention of using the latest scope technologies.

What is not as apparent is whether they are really marketing those investments and the benefits (advantage) they offer to patients through quality and value.

Whether you choose to adopt and implement one of the technologies discussed in this column, the Narrow Band Imaging feature from Olympus, i-scan from Pentax, FICE from Fuji, the FUSE technology from Endochoice, or others, they should become part of your everyday discussion with patients.

Patients want to know if you are utilizing the latest and greatest imaging technologies available, and how that investment will assist you in delivering the best GI study and procedural outcome.

build trust and confidence in the care you deliver will only make it easier for patients to become your best marketing resource.

Disclaimer: This article discusses specific companies, products, services and medical procedures. The author does not endorse or recommend any companies, products, services or procedures mentioned herein, nor is the author receiving compensation for mention of any companies, products, services or procedures.

There are other GI companies, products, services and procedures not discussed in this column that may be worth considering for your organization and patients.

Chris Stanley is a vice president of business development at Physicians Endoscopy. Prior to joining PE, he served as a medical device representative for 16 years, with the last eight of those years as a Territory Manager and Field Sales Trainer for Boston Scientific Endoscopy, a major medical device manufacturer, specializing in GI diseases through technique and technology delivery. Centered by his physician customers and their patients, he remains entirely focused on creating unique opportunities to develop strong strategic partnerships through value optimization, financial responsibility and growth generation. Chris received his BS in Healthcare Management from the University of Alabama and an MBA in Finance from the University of North Florida. Chris can be reached at cstanley@endocenters.com.

At the end of the day, marketing one’s GI practice and ASC does not need to be a daunting task. Procuring and utilizing the best technologies available will not supersede the value of spending a few extra minutes to review an educational pamphlet with a patient for example. If incorporated into your daily practice; however, the technology you invest in can enhance that patient discussion and overall perception of the services you provide.

Ideally, you want your center to begin to market itself through patients’ word of mouth to family, friends and others.

Anything your organization can do to

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Development of the

Ostom-i Alert Sensor: Q&A WITH INVENTOR MICHAEL SERES

BY CAROL STOPA, VP, BUSINESS DEVELOPMENT, PHYSICIANS ENDOSCOPY

I HAD THE GOOD FORTUNE OF MEETING MICHAEL SERES AT THIS YEAR’S GI ROUNDTABLE IN BOSTON. MICHAEL IS THE INVENTOR OF THE OSTOM-I ALERT SENSOR, AN INNOVATIVE NEW DEVICE FOR OSTOMY PATIENTS. A FEW MONTHS LATER, HE WAS KIND ENOUGH TO SET ASIDE SOME TIME TO SHARE THE STORY BEHIND THE OSTOM-I, WHICH IS AS MUCH ABOUT THE DEVICE AS IT IS ABOUT ONE PERSON’S DESIRE

Carol Stopa

Michael Seres

TO IMPROVE HIS QUALITY OF LIFE AND THE QUALITY OF LIFE FOR PATIENTS WORLDWIDE. Carol Stopa (CS): It’s great to have the opportunity to speak with you again.

Could you begin by explaining what exactly is the Ostom-i device?

Michael Seres (MS): The Ostom-i primarily does two things centered on improving the quality of life for ostomy patients. It is a device that, in very simple terms, clips to the outside of a patient’s ostomy pouch and uses Bluetooth technology to send a signal to an app on an Android or Apple smartphone that alerts the patient 12 |

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through an alarm-type system that the pouch is filling up.

So at nighttime, you can put your smartphone by the bed. The sensor recalibrates depending on what position you’re in so it won’t give you a false reading. If an alarm goes off, you can get out of bed, empty your pouch and there won’t be any accidents. If you’re going out, you keep your smartphone in your pocket. You receive an alarm on your smartphone that tells you when the pouch is a certain percentage full. You

can then decide whether to wait for it to fill more or empty it. The sensor is designed to essentially enable you to conduct as normal of a life as you possibly can as an ostomy patient and help avoid the leaks and spills associated with ostomy pouches. That is the primary focus of the device from a patient’s perspective.

From a clinical perspective, what the Ostom-i does is every time there is a change of movement in the pouch caused by output, it plots the change of movement and converts that into

volume. It plots that volume over a time and allows clinicians to remotely monitor volume output. The data is automatically captured and stored in the cloud, enabling physicians to have secure, remote access. Alternatively, the patient can choose to have that output data automatically sent via email to the clinician’s email. Therefore, it doesn’t require the clinician to have any technology on their end. This automates the process and eliminates the need for patients to empty their pouch into a jug, measure the output, enter the data into a spreadsheet and phone it in to their provider.

When patients use the Ostom-i, it can help clinicians predict when a patient is going to suffer from dehydration or blockage — the things that lead to readmissions or ongoing treatment that the vast majority of ostomy patients take for granted.

You essentially must have a smartphone with the free Ostom-i Android or iPhone app on it to use the device. The only time you wouldn’t need a smartphone is if you are in a hospital or other healthcare setting. The Ostom-i can be connected via Bluetooth to a tablet that would sit at a nurse’s station.

CS: What motivated you to invent the Ostom-i and found your company, 11 Health?

MS: I had Crohn’s disease from the age of 12. I required multiple surgeries, which left me with no more than 40 cm of small bowel. This eventually resulted in intestinal failure. In October 2011, I became the 11th person to undergo a small bowel transplant in the U.K. Part of that transplant required my having an ostomy. Learning to cope as an ostomy patient was difficult and challenging. I love gadgets, so I just assumed I would go online and buy a device that would help me. But it didn’t exist. I reached out to thousands of other patients throughout the world primarily through social media to ask them how

this vision to the next level. We launched our first cobbled-together device on the backend of 2013. We recognized that the biggest barrier to entry was regulatory, so rather than try to just sell the Ostom-i, we worked to crack the regulatory side. We did nothing with the device for nine months while we went through FDA approval and European regulatory approval.

they managed being an ostomy patient.

They essentially said they do what I was doing: just cope.

The transplant required me to spend seven months in the hospital, so I had a lot of time doing nothing. I bought a few tools off of eBay, watched some YouTube videos and built a very crude, very basic sensor. That was 2012, and that was the start of 11 Health.

In the beginning, I would affix this sensor to my pouch and then walk around the hospital and at home to see if it would effectively send the signal as I moved around, and it did. I was then fortunate enough to be introduced to Adam Bloom, an entrepreneur and pharmacist by training, who was willing to provide me with some money to see if I could take this crude, hand-built prototype and turn it into a device.

At that point, I went from being a patient in a bed and a desk in the front room of my home, to starting a business. Since I was the 11th small bowel transplant patient in the U.K., 11 Health became the name of the company.

CS: With the business formed, what happened next?

MS: We gained momentum when we had a bit of money and were able to engage some experts who could help take

We received full FDA 510(k) clearance in October 2014. We then spent quite a bit of time working with Medicare and other payers on getting insurance coverage.

We secured reimbursement around January of this year, so that’s when we really launched the device and took on some proper investments in the company.

CS: Is the Ostom-i available for purchase now?

MS: You can buy it now on the 11 Health website — www.11health.com — and we will fulfill it. Our back-end fulfillment is essentially done through Amazon. You buy it online and get a delivery as if you are ordering through Amazon. It is available in the U.S. and the U.K. We also have some physicians and hospitals going through the procurement process. They will buy it and provide it to patients. We have other hospitals advising their patients who are coming in for surgery to buy it and bring it with them.

Each device lasts about 3-4 months based on average use, and then patients would be expected to purchase another one. Since it is constantly sweeping for Bluetooth, it has a limited battery life, and at the moment you can’t change the battery as the Ostom-i is a sealed unit. If a patient decided not to use the Ostom-i around the clock, perhaps because they decided only to use it when they went out, it will inevitably extend the battery life. You pair it and unpair it as you do any Bluetooth device.

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market, so it’s accurate within 7-8%. As we go through different versions of the device, I suspect we will be able to improve the functionality and battery life.

CS: What sort of response have you received from clinicians and patients?

MS: We have had a wonderful response thus far. The patients say, “We love it, does our clinician know about it?” The clinicians say, “We understand what this does, now we need to tell our patients about it.”

Patients want a bit of validation from their clinicians, which is why we are spending more time at the moment clinician- and nurse-focused than patient-focused, but we have just appointed our first patient advocate because our intention is to also build a program around patients.

We have essentially secured a number of beta testing, user trials and clinical trials with major healthcare centers, including a clinical trial at Massachusetts General Hospital, beta testing with Mayo Clinic, patient testing with Stanford, and we are doing some work with Kaiser and Cedars Sinai. Everyone has a slightly different twist on why they want the device, and we are working to accommodate their needs. We took a view that if we were privileged enough to have these major organizations wanting to engage with us, we would go through the early adopter testing phase, prove the efficacy and then start rolling out sales. We just hired a vice president of sales and we are about to open a very small office

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in Palo Alto, CA. We’re in a situation now where we need to get the word out to more people.

We’re still in the early stages, but I feel we are going in the right direction.

CS: Many believe that out of personal struggles and difficulties comes greatness and strength. You have been able to turn your challenging life experience into something extremely positive, not only for yourself but hundreds of thousands of patients everywhere.

MS: This has quickly gone from being me on my own, then I had a company and now it’s a company with some shareholders. We’re not a big entity, but we’re growing. But what is most important to me is I want to make sure we remain focused on how this device serves to help the lives of patients. If we do that well, the company will be successful.

CS: What does the future hold for 11 Health?

MS: We have a next generation version of the device and some app-related projects under development, which will probably come together in 2016. But we know we have to get the Ostom-i right first before we launch anything else.

Besides that, my real passion is promoting the role patients can play in healthcare. This work is my life — this is all I do.

I really believe there are many patients who are like me and working to solve the problems they face every single day. I’m lucky that my solution was able to gain a bit of traction, and through some gen-

erous investments I have been able to carry it forward.

Hopefully through the success we have had and hopefully will continue to have going forward, that will encourage others to pursue their visions and work to make a difference in the lives of other patients. That’s what I really care most about.

Learn more about 11 Health and the Ostom-i Alert Sensor at www.11health.com.

Carol Stopa is a vice president of business development at Physicians Endoscopy. Carol is responsible for developing new market initiatives as well as identifying and generating qualified business opportunities within the physician community in regards to new partnerships, acquisitions and hospital/health system joint ventures. She is also the editorin-chief for EndoEconomics. Prior to joining the PE team, Ms. Stopa worked in clinical and administrative healthcare including mental health centers, correctional facilities, and psychiatric healthcare management companies. She may be reached at cstopa@ endocenters.com.

Michael Seres was diagnosed aged 12 with the incurable bowel condition Crohn’s Disease. In late 2011 he became the 11th person to undergo a small bowel transplant in the UK at The Churchill Hospital in Oxford.

Recently he was diagnosed with Lymphoma.

He started blogging about his journey through Bowel Transplant and his blog has over 100,000 followers. Michael uses social media to develop global on line peer to peer communities covering over 20,000 patients and devises social media strategies around patient engagement. He is a published author & professional speaker.

He is the patient lead for the main UK health twitterchat #NHSSM, a member of the NHS England Digital Services user council & digital strategy advisor to The Oxford Transplant Foundation where he helped implement the first skype clinics. In 2013 Michael founded health tech start up 11Health having developed sensor technology for ostomy patients. For more information contact Michael@11Health.com.

showed that NCGS patients’ symptoms resolved when they eliminated FODMAPs, even when reintroducing gluten in their diet.

Gluten-free Diet: AN EPIDEMIC?

BY RAMI ABBASS, MD, MBA

A

s a gastroenterologist, I find myself discussing the utility of a gluten-free diet almost daily with patients who have dyspepsia or bloating and who have decided on this lifestyle change. They inform me that they are now “gluten-free� after reading about the benefits online or talking to a friend.

Is this a fad, or are we having a celiac disease epidemic? Do nonceliac patients feel better by eliminating gluten?

A headline study in the American Journal of Gastroenterology recently reported on the celiac serologic markers in old blood samples. Its findings support the notion that celiac disease has increased in prevalence in the past 20 years. Possible explanations for the increase include changes in hygiene, viral infections, alterations in the microbiome from antibiotic use and increased consumption of gluten in baked products.

Still, if celiac disease remains relatively uncommon (about 1 in 133 Americans), why are 10 times that number choosing to be gluten-free?

The new notion is described as nonceliac gluten sensitivity (NCGS). These patients frequently describe abdominal pain, bloating, diarrhea, mood changes Rami Abbass, MD, MBA and fatigue. Celiac duodenal biopsies are normal, and serologic and wheat allergy tests are negative.

Recent studies have led many celiac specialists to believe that true gluten sensitivity is relatively rare. That said, some of these patients may be in the early stages of celiac disease, even when symptoms or serologies are negative. Others may have the uncommon wheat allergy.

There is growing evidence that many of these patients may be sensitive to FODMAPs (fermentable oligo, di-, and monosaccharides and polyols), a group of carbohydrates common in lentils and wheats. FODMAPs draw water in the intestine and may ferment and cause gastrointestinal symptoms. A 2013 study

The irony of the soaring popularity of the gluten-free diet is that a significant number of true celiac patients remain undiagnosed. Why is this? We may not be asking the right questions or testing the right people. Celiac disease has a strong genetic component and affects more than 6 percent of patients with type 1 diabetes. How often do we ask our asymptomatic patients if they have a family history of celiac disease or consider the condition for our diabetic patients? We also need to consider testing for celiac disease in patients with autoimmune disease, chronic iron deficiency anemia and chronic diarrhea. Symptoms we may not typically associate with celiac disease include chronic headaches, joint pains and skin rashes.

The next time you encounter a patient with dyspepsia and bloating, consider the individual situation carefully. Advising patients to eliminate gluten without celiac testing will make future diagnostic testing for celiac disease less accurate and sensitive. If celiac testing is negative, a low-FODMAP diet may be a more evidence-based recommendation.

This article first appeared in June 2015 edition of Physician Update, a publication of University Hospitals of Cleveland, Ohio.

Dr. Rami Abbass practices as part of University Hospitals Medical Practices with Gastroenterology Associates. He has admitting privileges at UH Case Medical Center, UH Richmond Medical Center, UH Ahuja Medical Center and UH Geauga Medical Center (where he serves as Medical Director of Gastroenterology). Dr. Abbass is the Assistant Medical Director of both The Endoscopy Center of Bainbridge and University Suburban Endoscopy Center. Board certified in internal medicine and gastroenterology, Dr. Abbass received his medical degree from Case Western Reserve University. He completed his internal medicine residency at University Hospitals of Cleveland and his fellowship at Georgetown University Hospital.

He is also the Clinical Instructor of Medicine at Case Western Reserve University School of Medicine. Dr. Abbass is a Fellow of the American College of Gastroenterology.

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Expanding the Fight

Against Colorectal Cancer

BY KRISTIN MURPHY, ASSISTANT DIRECTOR OF LEGISLATIVE AFFAIRS, ASCA

C

olorectal cancer, according to the National Cancer Institute, is now the fourth most commonly diagnosed cancer in the US, behind only breast, lung and prostate cancer. The disease affects more than 137,000 Americans, and in 2013, killed

more than 50,000 individuals. The Centers for Disease Control and Prevention (CDC) recently released research indicating that if all precancerous polyps were identified and removed before becoming cancerous, the number of new colorectal cancer

cases could be reduced by 76 to 90 percent. Given how easily preventable colon cancer could be, the number of families torn apart each year by this Kristin Murphy deadly disease is even more heartbreaking.

TRENDS As Americans have become more aware of the benefits of preventive screening, the number of deaths from colorectal cancer has fallen steadily (see the graph below). Despite these encouraging numbers, much work needs to be done to keep this trend moving in the right direction.

Image source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6411a6.htm?s_cid=mm6411a6_e

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The US Preventive Services Task Force recommends that all Americans ages

50 and older undergo regular colonoscopies in accordance with their doctor’s recommendations. This simple and painless procedure has the potential to virtually eliminate colorectal cancer. If a polyp is found, a doctor quickly and easily removes it. The patient’s risk of cancer is reduced to nearly zero, and the need for painful and costly cancer treatments is eliminated.

The colonoscopy was revolutionized in the 1960s by Dr. William I. Wolff, who invented the colonoscope. This instrument enabled doctors to navigate the large intestine and see polyps easily.

This tool was instrumental in identifying, and ultimately decreasing, the occurrences of colorectal cancer in the United States.1 Ambulatory surgery centers (ASCs) play a vital role in preventing cancer, particularly among patients over the age of 65. According to an Ambulatory Surgery Center Association (ASCA) analysis (see www.advancingsurgicalcare.org), ASCs perform more than 40% of the colonoscopies that are reimbursed by Medicare. These preventive procedures are performed at a fraction of the cost of the same procedure performed in a hospital outpatient department (HOPD).

FEDERAL LEGISLATION In most cases, Medicare waives coinsurance and deductibles for screening colonoscopies (meaning patients pay nothing out of pocket) because the procedure is classified as preventive care. When a polyp is discovered and removed, however, the procedure is reclassified as therapeutic for Medicare billing purposes, and patients are required to pay the coinsurance. This is particularly problematic for many seniors who are on a fixed income. These Americans cannot afford a surprise medical bill, and anticipating such an expense could discourage

them from pursuing additional preventive care.

ASCA also encourages everyone to take the following steps:

To help Medicare patients access the preventive care they need, ASCA endorsed and advocates for the Removing Barriers to Colorectal Cancer Screening Act. This legislation would eliminate unexpected costs for Medicare beneficiaries when a polyp is discovered and removed, ensuring that unexpected copays do not deter a patient from undergoing a colonoscopy.

By eliminating financial barriers, this legislation could attain higher screening rates and reduce the incidence of colorectal cancer.

• If you are 50 or older, undergo regular colonoscopies as directed by your doctor.

ASCA encourages all gastrointestinal professionals (both doctors and nurses) to take a moment to send a letter to your members of Congress asking them to cosponsor the Removing Barriers to Colorectal Cancer Screening Act. This legislation would go a long way toward ensuring our nation’s seniors have access to the preventive care they need. To reach your elected officials, go to http://www.ascassociation.org/takeaction.

OTHER WAYS TO JOIN THE FIGHT Colon cancer destroys lives and devastates families despite being easily preventable. The only way to end this is to work together with patients and other key stakeholders to raise awareness and screening rates.

Each March, ASCA actively participates in National Colorectal Cancer Awareness Month. During this time, the association works with other stakeholders to raise awareness both on Capitol Hill and with the public on the importance of early detection. I encourage you to join in these efforts. Advocacy and prevention, of course, must continue to happen throughout the year, as colorectal cancer can devastate families at any time.

• Talk to your friends and families about the importance of early screenings.

You can learn more about the work that ASCA and others are doing at www.advancingsurgicalcare.com/ fightagainstcrc.

The American Cancer Society is working to raise awareness about the benefits of colonoscopies through its “80% by 2018” campaign. Through that campaign, dozens of organizations have committed to eliminating colorectal cancer as a major public health concern by working toward the shared goal of reaching an 80% screening rate for individuals who are at risk by 2018.

You can learn more at http://nccrt.org/ wp-content/uploads/80by18-WebinarPresentation1.pdf.

While colorectal cancer is deadly, it is no longer a death sentence if caught early. ASCA will continue to be an active partner in raising awareness about this tragic disease by participating in others’ awareness campaigns, engaging Congress and publicly supporting the importance of screening.

1 http://www.nytimes.com/2011/09/02/nyregion/dr-william-wolff-94-colonoscopy-co-developer-dies.html?_r=0

Kristin Murphy is the Assistant Director of Legislative Affairs at the Ambulatory Surgery Center Association. She received her Bachelor’s degree in Political Science from the University of South Dakota and currently resides in Washington, D.C.

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Marketing Buzz

Finding Your Patients

will providers refer to you if they don’t know about you?

When sources such as these are not immediately feasible, the fundamental next step to success is direct physician/ practice networking. However outdated or conventional the task may seem, it is a crucial plan for a new physician that will lay the ground-work for a continuous referral base.

Here are 6 ways to build physician referrals:

OBTAINING REFERRALS AS A NEW PRIVATE PRACTICE PHYSICIAN

1. BUILD A LIST What is the total number of potential referring physicians?

Get to know the network of medical practices in your area, and keep track of any potential new practices being established in the region. Purchasing a list from a database company may be possible, but also consider that local hospitals, community directories, etc. may have this information readily available online or in print.

BY LORI TRZCINSKI, MARKETING COORDINATOR, PHYSICIANS ENDOSCOPY

2. KNOW YOUR VALUE AND EXPRESS IT What makes you unique from the other potential physicians being referred to? Like any other promotion in business, you must distinguish yourself from the others around you and establish your own brand in the market. How can what you offer be of value to a referring physician?

T

he difference between success and failure of a new medical practice can be attributed to how quickly the physician can build a referral base. For those doctors who are new to the world of private practice or establishing their own practice, building a referral base can be overwhelming. With a Lori Trzcinski projected national shortage of primary care physicians of more than 90,000 by 2020 and 130,000 by 20251, in addition to a U.S. population that is outgrowing the rate of new physicians entering the field by 16%2, establishing a solid referral base is more important than ever.

Referral sources such as word-of-mouth and various marketing initiatives may work for a community established physician, but will present a challenge for a new private practice physician who may not already have an existing patient base or the financial requirements needed to drive an effective and sustainable marketing program. How else

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3. FAMILIARIZE YOURSELF WITH THE OFFICE STAFF AND BE A RESOURCE TO THEM You may not always have the opportunity to have faceto-face communication with the referring physicians themselves. Their office staff are the front-facing representatives of the practice and the extra set of eyes and ears of the physician. Providing them with referring materials, brochures, business cards, etc. will (likely) help you get your information to the physician even if he or she is unavailable to meet face-to-face. Leaving something concrete will increase the likelihood of the referring doctor actually contacting you. Don’t overlook the power of building trust and rapport with the office staff.

4. COMMUNICATE WELL (AND REGULARLY) Follow-up on any interaction you may have with a referring physician or their practice. Be yourself and be

Marketing Buzz reliable. Consistent, open lines of communication with a referring physician will likely mean an increase in referrals over time by establishing trust with referring physicians, especially with face-to-face interactions.

5. HIRE A PHYSICIAN LIAISON OR CONTACT A CONSULTING COMPANY TO FIND ONE FOR YOU Physician liaisons support the practice by representing and promoting its clinical services, physician(s) and programs in order to increase referrals from existing providers and obtain new referrals from current low volume and non-referring physicians. They are a vehicle to carry your message into the field and gain new referrals without a physician having to always develop a plan of action, put in the face time with physicians’ offices, and facilitate follow-ups or opportunities for the practice. If you’re hiring the candidate on your own, your physician liaison will need the successful traits and abilities that are specific to the needs of your current and future growth. If you’re looking to outsource that search, some consulting organizations provide the option of finding a person that suits the role for you. In either case, tracking the goals of the liaison will help to show how referrals have changed over time.

6. JUST ASK Sometimes all it may take for a referring physician to send patients your way is simply asking. Don’t be afraid to be valiant in your efforts. A provider may not be aware that you are a potential source to send referrals to or aware that you currently have openings.

Sources: 1: http://www.bartonassociates.com/2014/01/06/get-the-facts-the-physicianshortage/ 2: O’Reilly KB. New medical schools open but physician shortage concerns persist. American Medical News. March 29, 2010. http://www.merritthawkins.com/Clients/BlogPostDetail.aspx?PostId=38718

Lori Trzcinski is the marketing coordinator at Physicians Endoscopy and the managing editor of EndoEconomics. Ms. Trzcinski leads the corporate and center marketing initiatives of PE and its affiliated centers. Ms. Trzcinski earned a B.A. in Business & Economics and Media & Communications from Ursinus College. For more information, she can be reached at ltrzcinski@endocenters.com.

Case Study: Carnegie Hill Endoscopy (CHE), New York, recently initiated a Marketing Rep Program in late April 2015 and started personally visiting referring physician offices to provide information about the Center, the services offered and information on the affiliated physicians. Over a period of about eight weeks, the Center received 15 referrals from the offices visited of which 13 referrals occurred directly after the rep made a personal visit. The rep visited offices of practices that had not previously referred to the center or the center’s physicians, and some visits were to those practices that haven’t made a referral in a while.

Due to the immediate success of the marketing program, the rep will be begin a second round of visits to those referring offices who have expressed interest in the Center and/or individual physicians. The Center administrator will also start to attend some of these office visits in an effort to develop a center level relationship with the office staff and in order to continue to encourage and maintain referrals.

If you would like more information on CHE and their marketing program, please contact: Scott Williams, MPH, CASC Administrator, Carnegie Hill Endoscopy (Phone) 646-432-6681 swilliams@carnegiehillendoscopy.com

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Business Briefs Mobile Health App Use on the Rise: Medical Apps to Consider According to a Jackson & Coker Industry Report, 4 out of every 5 doctors are using smartphones and medical apps in everyday medical practice, with 30% of gastroenterologists using this technology to their advantage. There is an “app” for nearly everything medical – from health trackers, medical journals, and prescription history to exam findings, disease management, and lab test results. With nearly two-thirds (64%) of Americans owning a smartphone, up from 35% in the spring of 2011 and with 75% of American physicians owning an iPad, iPhone, or iPod, it is no surprise that the use of digital devices and apps has slowly but surely engrained itself into the health industry1.

Here are some of the top medical and GI-related apps available today on the AppStore or GooglePlay*: 1. Calculate by QxMD: a clinical calculator focused on highlighting tools which are actually useful in clinical practice and serve to impact diagnosis, treatment or determining prognosis.

2. Doximity: the professional network for physicians, Doximity instantly connects physicians with other healthcare professionals, securely collaborating on patient treatment, growing their practices and discovering new career opportunities.

3. Epocrates: review drug prescribing and safety information for thousands of brand, generic and OTC drugs. Upgrade to Epocrates Plus for even more critical, decision-making information.

4. Epocrates CME: offers more than 100 CME/CE activities for a variety of topics and specialties in the palm of your hand. Earn credits through real world, case-based learning.

5. Miniatlas Gastroenterology: doctors can use the app to effectively communicate with their patients, showing them illustrations to help explain the anatomy and pathology related to their digestive disorder. All relevant aspects of the specialty are included in great detail.

6. JWatch Gastroenterology: published by the New England Journal of Medicine, this app delivers medical news, research, and patient care guidelines for gastroenterologists.

7. Medscape: professional medical content, including review articles, journal commentary, expert columns, patient education articles, book reviews, and more.

8. Medibabble: a robust history-taking, examination translation tool designed to improve the safety, efficiency, and overall quality of care for non-English speaking patients by being able to communicate with them in their native language through the app. For deaf or hearingimpaired patients, the app can be used in landscape, full-screen display to show the words in large text.

9. drawMD Gastroenterology: developed by ASGE, drawMD Gastroenterology allows physicians and clinical practitioners to show and discuss common GI conditions and procedures using sketch and annotation tools with relevant medical images or by uploading their own. This is especially useful for physicians who would like to engage with patients in a meaningful way.

10. Omnio: gain access to important and relevant medical information with a comprehensive reference suite of 2,600+ brands and generics drug guide, a disease guide that includes access to medical textbooks, more than 500 essential medical calculators, free specialty resources, etc.

1: http://industryreport.jacksoncoker.com//physician-career-resources/newsletters/Monthlymain/Jul/2011.aspx * Reference in this article to any specific mobile app or company name is for the information and convenience of the readers, and does not constitute endorsement, recommendation, or favoring by EndoEconomics or Physicians Endoscopy.

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Front and Center Dr. Brett Bernstein, Manhattan, NY Congratulations on his new role as Director for Clinical Integration in Gastroenterology and Endoscopy for Mount Sinai Health System. Currently Medical Director of East Side Endoscopy and Director of Endoscopy in the Division of Digestive Diseases at Mount Sinai Beth Israel, Dr. Bernstein will play a crucial role in helping to create the foundation for the soon to be established Digestive Disease Institute. This will entail the creation of patient-focused Centers for Digestive Disease particular to therapeutic areas within GI, and to create, and ultimately standardize and improve, quality and performance metrics for each center.

To achieve this mission, Dr. Bernstein will be working closely with members of the newly created Institute for Health Care Delivery Science, the division chiefs at Mount Sinai Medical Center, Mount Sinai Beth Israel, Mount Sinai St. Luke’s/Roosevelt, and directors of endoscopy at Mount Sinai Beth Israel Brooklyn, Mount Sinai Queens, and the allied ambulatory endoscopy centers of the former CHP group.

Carnegie Hill Endoscopy (CHE), Manhattan, NY • Achieved a 3 year Joint Commission (JCAHO) accreditation with Medicare deemed status.

• Recipient of the 2015 Flame Award for Unit Excellence, awarded by the Society of Gastroenterology Nurses and Associates, Inc. (SGNA). The Flame Award for Unit Excellence recognizes GI/Endosco-

py units who have shown a commitment to infection prevention, a supportive and educational work environment and positive patient outcomes. This award provides a roadmap for what is considered an exceptional work environment in a GI/Endoscopy nursing unit.

• At SGNA’s 42nd Annual Course, Director of Nursing, Melinda Lugay, RN, MS, and GI nurse, Marla Sabuda, RN, BSN, AGTS, of CHE presented their “Strategy to Successfully Implement Endoscopes Testing Using Adenosine Triphosphate (ATP)” research during the SGNA poster sessions.

Presentation abstracts are hand-selected

by SGNA to present at the conference.

practiced in the United States. Each of these centers is one of more than 400 endoscopy units to be granted the recognition since 2009. The ASGE Endoscopy Unit Recognition Program honors endoscopy units that have demonstrated a commitment to patient safety and quality in endoscopy as evidenced by meeting the program’s rigorous criteria, which includes following the ASGE guidelines on privileging, quality assurance, endoscope reprocessing, CDC infection control guidelines and ensuring endoscopy staff competency.

• Burlington County Endoscopy Center, Lumberton, NJ • East Side Endoscopy, Manhattan, NY • Endoscopy Center of Robinwood, Hagerstown, MD • Long Island Center for Digestive Health, Long Island, NY

Successful IPO

Greater Gaston Endoscopy Center, Gastonia, NC Hosted the Montcross Area Chamber of Commerce for a Networking After Work.

Chamber members and friends made business contacts and toured the new Greater Gaston Endoscopy Center at 920 Cox Road in Gastonia during a Networking After Work reception.

(Photo courtesy of Montcross Area Chamber of Commerce Facebook page: Greater Gaston Endoscopy Center physicians and staff in front with a few of the many Chamber members and friends attending the event. On the front row, from left are Chamber Board Chair Melia Lyerly of Lyerly Agency, Dr. Sam Drake, Jessica Mooney, Dr. Neville Forbes, Lara Jordan (PE), Dr. Bill Watkins, Administrator Susan Ordway and Colleen Ferrell. Dr. Austin Osemeka attended but was not present for the photo.)

For more information, visit http://www.montcrossareachamber.com/news/2015/06/11/network-after-work/ greater-gaston-endoscopy-hosts-chamber/

ASGE Endoscopy Unit Recognition Program: Center Congratulations!

The American Society for Gastrointestinal Endoscopy (ASGE) has recognized each of the following centers as part of its program specifically dedicated to promoting quality in endoscopy in all settings where it is

Congratulations to Mark Gilreath, CEO of EndoChoice and his entire team for a very successful IPO in June of this year (NYSE – GI). Mark has done an amazing job of shepherding EndoChoice from inception through several years of very rapid growth and now a successful IPO. Congratulations to Mark and everyone at EndoChoice!

Well Done, ASC Administrators!

Included in ‘ASC Administrators to Know for 2015’ by Becker’s ASC Review are Physicians Endoscopy partnered-center administrators.

These administrators manage a full staff, understand a center’s costs down to the case, work with new and existing physicians and more, all while keeping up with the demands of a rapidly shifting healthcare environment: • Brien Fausone, Michigan Endoscopy Center and Michigan Endoscopy Center at Providence Park in Farmington Hills and Novi, MI, respectively • Helen Lowenwirth, MBA, CASC, East Side Endoscopy in Manhattan, NY • Sarah Malaniak, CASC, Ambulatory Center for Endoscopy in North Bergen, NJ • Penny Nicarry, Endoscopy Center of Robinwood in Hagerstown, MD • Donna Tweed, Endoscopy Center of Bucks County in Newtown, PA • Scott Williams, CASC, Carnegie Hill Endoscopy in Manhattan, NY S U MME R 2 0 1 5 EndoEconomics

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Current GI Opportunities Cortlandt Manor, NY An opportunity in Northern Westchester with a two-physician practice.

• Full-time or part-time: perfect for young families • State-of-the-art endoscopic equipment • Physician efficiency and optimal patient quality of care • Light call schedule: 1:3 • One hour to New York City • Beautiful scenic area For more information, contact: Annie Sariego, CASC, VP, Operations (215) 589-9008 • asariego@endocenters.com

North Bergen, NJ

An outstanding opportunity for a gastroenterologist!

Laredo, TX

Gastroenterology Consultants of Laredo – Laredo Digestive Health Center

The physicians of Gastroenterology Consultants of Laredo, a private gastroenterology group, are seeking a gastroenterologist to expand the practice. This candidate will have ownership opportunity in the affiliated endoscopic ambulatory surgery center.

This two-room facility is located in Laredo, Texas in the Northtown Professional Plaza on McPherson Avenue.

• 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 • Nursing staff has extensive experience in GI endoscopy • An outstanding benefits package is offered • Professionally operated and managed • Group participates in research • High population to GI Doctor ratio 60,000:1 • 2 Nurse Practitioners with over 11 years of GI experience

For more information, contact: Monte Allen, DO - Medical Director (956) 795-4776 • mallen@gastrolaredo.com Ambulatory Center for Endoscopy, LLC 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 GI center is the perfect environment for you and your patients.

ASCs provide physicians the predictability and efficiency in scheduling that most hospitals do not. Specialized focus by nurses and other support staff further increases efficiency. 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.

The nine physicians at Advanced Center for Endoscopy are partnered with Physicians Endoscopy (PE) in their state-of-the art endoscopy center. This is an excellent opportunity for a motivated physician.

For more information, contact: Annie Sariego, CASC, VP, Operations (215) 589-9008 • asariego@endocenters.com

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Garden City, NY

Gastroenterology Associates – Long Island Center for Digestive Disease

The physicians of Gastroenterology Associates, a large single specialty private gastroenterology group, are seeking a BC/BE physician to start immediately or July 2015.

This candidate will have partnership/ownership opportunity in the affiliated endoscopic ambulatory surgery center. This three-room facility, located in Garden City, NY offers: • Physician-owned and controlled center • State-of-the-art endoscopic equipment • Physician efficiency and optimal patient quality of care • Professionally operated and managed Gastroenterology Associates, one of the oldest and most respected GI practices on Long Island, has always prided themselves on being leaders in delivering the highest quality of specialized patient care.

For more information, contact: Kathy Harren, Office Manager (576) 248-3737 • gastrophysicians8@gmail.com

Current GI Opportunities Southeastern PA

Digestive Disease Associates, LLP

Seeking a GASTROENTEROLOGY ASSOCIATE Digestive Disease Associates, LTD is located in southeastern Pennsylvania and seeks a board-certified/board-eligible gastroenterologist to join our 15 physician practice. ERCP and EUS experience is welcomed but not required. DDA is a well-established and highly respected group with a solid referral base in the area. Patients are seen in a comfortable, newlybuilt office with a very pleasant working environment. The physicians are affiliated with two community hospitals within 15 minutes of the office which have a solid reputation for providing quality medical care.

The opportunity includes: • Partnership track in a premier quality driven group; opportunity for ownership in the endoscopy center; • Income potential in the top 5% of GI practices; • Association with independent and entrepreneurial colleagues; • One centrally located office and a physician owned and controlled state-of-the-art endoscopy center; • Competitive compensation and benefits package; • Beneficial call schedule shared equally amongst the providers; • 6 mid-level providers; • A fully integrated EMR environment. Meaningful Use attested; • Professional management staff; and • Well trained nursing and technical staff in our office and center with extensive GI experience.

Southeastern PA offers four beautiful seasons, a wide variety of cultural and recreational opportunities and tremendous housing values. The community features close proximity to excellent public and private colleges and universities, cultural events, and a mix of urban and rural attractions. We are located within easy driving distance of NYC, Philly and Washington DC, the Poconos, the Jersey Shore, etc. Visit our website at www.ddaberks.com to learn more about the practice. Send letters of interest and CV to cyoder@dda-bcdh.com.

Lumberton, NJ

Gastroenterology Consultants of South Jersey Gastroenterology Consultants of South Jersey (GCSJ) is a privately owned, eight physician practice located in Lumberton, NJ. GCSJ is a well-established practice located among several growing communities in southern New Jersey.

• Located within thirty minutes of Philadelphia and within one

hour of New York City.

• We are affiliated with Burlington County Endoscopy Center, a three room Ambulatory Surgical Center • The ASC is physician owned and operated.

• Our practice is seeking to add a full or part time gastroenterologist.

• Our large practice offers an attractive call schedule of 1:7 and an opportunity to perform ERCP and EUS (not required).

• Partnership will be offered in the practice and endoscopy center.

For more information, contact: Monica Awsare, MD • monicaawsare@gmail.com

Williamsville, NY

Gastroenterology Associates, LLP

A well-established practice with a solid referral base, Gastroenterology Associates, LLP, located in western New York, seeks a board-certified/board-eligible gastroenterologist to join our growing 11 physician practice. ERCP experience is a plus.

With two clinical sites and two physician - owned state-of-the-art endoscopy centers, this opportunity includes: • Partnership track in a premier quality driven group • Competitive compensation and benefits package • Nursing staff in our Centers with extensive GI experience • Fully integrated EMR environment. Meaningful Use attested • Professional management staff • 9 mid-level providers including registered dietician Western New York offers four beautiful seasons, a wide variety of cultural and recreational opportunities and tremendous housing values. The area has many public and private colleges and universities, museums, galleries and major league professional sports teams. We are located within easy driving distance of The Finger Lakes Region, The Adirondack Mountains, The Great Lakes and Toronto.

For more information, contact: Peg Centola, Human Resources Manager hr@gastrowny.com • Phone: 716-626-5250 • Fax: 716-565-0665

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