EndoEconomics Summer 2016

A Journal Dedicated to Economic Issues Impacting GI ASCs and Practices

SUMMER 2016

Augusta Endoscopy Center Opens New Facility Page 5

Early Age Onset Colorectal Cancer Page 10

Online Reputation Page 16

The GI Journal of:

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

SUMMER 2016 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.

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Content 4 Message from the President 5 When It’s Time to Open a New Endo Center 8 Going Solo After 20 Years 10 Understanding Early Age Onset Colorectal Cancer 14 Why Employee Engagement Is So Important 16 Online Reputation: Your First Impression, Not Your Second 19 Business Briefs 20 Front and Center 21 Current GI Opportunities

Find out more at endocenters.com or find us on SU M M E R 2 0 1 6 EndoEconomics

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Message from

the President The benefits of care provided in freestanding ambulatory surgical centers (ASCs) is well-known and well documented by those of us who participate in the BARRY TANNER President and CEO, ASC industry. The Physicians Endoscopy knowledge gap for patients and legislators remains difficult to overcome. There is a broad-based concern regarding the steady rise of healthcare costs. The resulting impact of those costs affects our nation’s economy as well as local governments and employers. However, little seems to change to encourage increased utilization of ASCs versus the higher cost setting of hospital outpatient departments (HOPDs).

Back in 2013, Drs. Brent Fulton, Assistant Adjunct Professor and Research Economist, and Sue Lim, Research Scientist, from the University of California, Berkeley, published a study entitled Medicare Cost Savings Tied to Ambulatory Surgery Centers1. This particular study, which focused exclusively on costs to the Medicare Program, concluded that ASCs could perform many of the same surgical procedures as HOPDs. ASCs can do these procedures with greater efficiency and without the higher overhead costs.

Today Medicare reimburses ASCs approximately 53% of the rate it reimburses HOPDs (on average) for the same procedures.

According to the UC Berkeley study, ASCs reduce Medicare costs by about $2.3 billion annually. This pricing disparity continues to exacerbate due to Medicare’s reimbursement update policies which utilize a “Market Basket” of related healthcare costs to update HOPD rates annually while using a much broader based CPI to update ASC payments.

Very recently, a new study was published 4 |

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that focused entirely on commercial insurance reimbursement. This study entitled Commercial Insurance Cost Savings in Ambulatory Surgery Centers, conducted by Healthcare Bluebook in partnership with HealthSmart2, included technical assistance and expertise from the Ambulatory Surgical Center Association (ASCA). Both Healthcare Bluebook and HealthSmart have access to significant quality and claims data from third-party payers and employer self-funded health plans.

and continues to widen. The study concluded that “while the efficiency inherent in the ASC model explains why ASCs can continue to exist when receiving significantly lower payments, it is the market power of hospitals that widens these price disparities2.”

This study found that ASCs currently (based upon 2014 data) save approximately $38 billion in outpatient surgical costs compared to HOPDs (excluding Medicare savings). The study also found that patients realized more than $5 billion in annual savings from lower deductible and co-pays by utilizing ASCs versus HOPDs. Also of significance, only 48% of those procedures commonly performed in ASCs were actually conducted in an ASC setting. It concluded that an additional $42 billion in savings could be realized annually if the remaining 52% of those procedures migrated to the ASC setting. These are staggering numbers, and there were clear strategies one could gather from the study that could lead to even greater annual savings.

In 2016 Physicians Endoscopy changed the healthcare benefits provided to our employees. While we did not choose a high-deductible plan, our plan does provide a clear incentive to utilize ASCs for eligible surgical procedures by burdening the patient/employee with a substantial out-of-pocket cost for choosing an HOPD setting versus an ASC. This type of plan is clearly becoming more common and will influence insureds to consider their choices.

Clearly, there is a growing body of evidence to support a continuing migration of ASC eligible surgical procedures from the HOPD to the ASC setting. There are currently approximately 5,400 Medicarecertified ASCs in the U.S., and estimates are that nearly percent 65% of those are entirely physician-owned. While many ASCs offer strong advocacy, those that have an active industry partner, such as a corporate or hospital partner or both, tend to put substantial resources to work toward legislative advocacy and consumer education. This effort is to spread the word about the many benefits of ASCs whether economic, quality or patient convenience.

Still, the gap in reimbursement persists

As we continue to experience a pervasive increase in high-deductible health plans, we as consumers of healthcare services have an even greater incentive to utilize the care offered by ASCs.

Led by William Prentice, the ASCA has done a terrific job of promoting education, leadership, and advocacy to our industry. Among the many initiatives, the annual ASCA Capital Fly-in (that took place in June) provides a tremendous opportunity to ASC representatives from across the country to meet with members of Congress and their staff and to help educate them about the benefits that ASCs’ offer. I want to encourage all of our readers to mark your calendars for the 2017 Capital Fly-in and help us to spread the benefits of ASC utilization to the broadest possible audience.

Please enjoy this edition of EndoEconomics.

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Fulton, Brent, MD, and Sue Kim, MD. “Study: Medicare Cost Savings Tied to ASCs.” Study: Medicare Cost Savings Tied to ASCs. Nicholas C. Petris Center on Health Care Markets and Consumer Welfare, School of Public Health, University of California-Berkeley, 10 Sept. 2013. Web. 20 June 2016. <http://www.ascassociation.org/advancingsurgicalcare/reducinghealthcarecosts/costsavings/medicarecostsavingstiedtoascs>.

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“Study: Commercial Insurance Cost Savings in Ambulatory Surgery Centers.” Study: Commercial Insurance Cost Savings in Ambulatory Surgery Centers. Healthcare Bluebook and HealthSmart, 14 June 2016. Web. 18 June 2016. <http://www.ascassociation.org/advancingsurgicalcare/reducinghealthcarecosts/costsavings/healthcarebluebookstudy>.

When It’s Time to Open a New Endo Center: Augusta Endoscopy Center Case Study

By Jeff Meyer, Center Administrator Frank Principati, COO; Mary Ann Gellenbeck, VP, Implementation Services; Lara Jordan, VP, Operations The writing was on the wall. Gastroenterology Consultants of Augusta in Evans, GA had grown from four physicians to 11 over the span of just a few years. What had not grown was the physical space of Augusta Endoscopy Center, the practice’s two-room ASC located in the same building.

“We had an endoscopy center built for four physicians, so it naturally became a challenge as our practice grew,” says Jeff Meyer, administrator of the practice and ASC. “When we added two physicians in 2015 and couldn’t schedule them for cases in the ASC, it was quite evident that it was time for a new center.”

the amazing presence they have in the market. They’re well known and well respected.”

To continue to effectively serve its market required moving forward on building a new center — a decision that was not taken lightly, Meyer says. “It’s always hard to pull the trigger on such a project in this climate and environment. But in our first center, we were on top of ourselves. We had so many needs that required our moving into a new building. We knew it was going to be a challenge, but everyone sensed the vision and the reason. We were in a position where it made sense.”

Choosing a Location

The need for the new ASC is a testament to the practice’s success, says Frank Principati, chief operating officer of Physicians Endoscopy, which became a minority owner of the endoscopy center at the end of 2010.

Perhaps the easiest part of the project was selecting the location for the new endoscopy center. The physicians who owned the practice and existing ASC also owned the adjacent, undeveloped lot.

“Their growth each year has been phenomenal,” he says. “They have been able to attract physicians because of

“We’re in a very high-traffic area in the community that is undergoing its own expansion,” Meyer says. “That made

the decision to move right next door an obvious one.”

While building a new center from ground up takes more time than renovating an existing space, there are significant benefits of owning the land upon which one develops a new facility, says Mary Ann Gellenbeck, vice president of implementation services for Physicians Endoscopy.

“When the physicians who own the ASC and the landlords are the same people, that’s helpful in any situation,” she says.

Obtaining Approval Choosing the location was a fast decision; receiving approval to build the facility was not. “That process was rather lengthy,” Gellenbeck says.

There were several important considerations that needed to be addressed, including expanding the size of the center, she says. “They had to put in a request to the Georgia Department of Community Health, which oversees the certificate of need process for the state, SU M M E R 2 0 1 6 EndoEconomics

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PHOTOS BY STEVE BRACCI PHOTOGRAPHY WITH CONSTRUCTION DONE BY ALLEN+BATCHLEOR CONSTRUCTION

for a letter of determination. This would allow the existing August Endoscopy Center to relocate to the new building and then open a third procedure room — one more than the two dedicated endoscopy rooms in the existing facility.”

Every state has a different set of rules, regulations and construction guidelines that must be followed. Georgia has particularly strict guidelines, Gellenbeck notes. “The team had to make sure the project fell within all of the guidelines from not only a regulatory standpoint but from a cost standpoint for the development of a new center. Under the state regulations, capital costs associated with the construction and development of the project were limited. When you build bricks and mortar up, the limitation gave the team a tight budget to work within.”

The practice received the letter of determination that provided the project’s approval, which was an exciting development for everyone involved, 6 |

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says Principati. “The Augusta Endoscopy Center was one of the first true acquisitions for Physicians Endoscopy.

The approval gave us a chance to take an acquisition and essentially start over as a de novo project by building a new center.”

Moving Ahead with the Build As the project moved forward, Meyer says it was important for the project’s team members to spend time on planning the design for the new center.

“One of the first things we did was visit another build Physicians Endoscopy was involved with at that time. We all took a field trip, which included our contractor, to go look at the build, take pictures and discuss what we needed, liked and thought worked well.”

He continues, “That road trip gave us the opportunity to get on the same page from the beginning. The contractor was involved from the start. That was important, as was the investment each

team member made. In the end, it all really paid off for us.”

Gellenbeck says such teamwork is vital to a project’s success. “You want to make sure you have a good team — that includes a good design partner, engineer and contractor. For this project, the team worked well together and listened to each other’s ideas and suggestions.

Everyone looked out for the best interests of the center. The project really flowed.”

The importance of good organization, keeping timelines and meeting deadlines cannot be understated, says Lara Jordan, vice president of operations for Physicians Endoscopy. “As long as you set up the project appropriately, involve all the necessary people, stay on task, stay organized and make sure everyone is communicating effectively, a project will typically run very smoothly.”

For a project like the new Augusta Endoscopy Center which was work-

ing within its tight, required budget, a smooth process is key to success. The biggest challenge Gellenbeck says she faces on a day-to-day basis is managing cost. “Anytime you have a change that happens after the design drawings are submitted and sent out to bid, you have cost associated with the revision. Trying to minimize those additional costs is key for any project. Working with a well-experienced architect and engineer that is very familiar with state and local regulations, and then a construction team that works together to minimize any of the changes during the building process is critical.”

She notes that the Augusta build went extremely well, aside from some uncontrollable issues with soil conditions and rain that resulted in minor delays and added some cost.

Relocating ... in Four Days After construction of the new endoscopy center was completed, the state visited and approved the facility. Now it was a matter of moving operations over from the old facility — a task which is not easy, Gellenbeck notes.

“Relocations are tricky because you have an existing center that is running, operating, licensed and seeing patients, and now you have a new center,” she says.

“When the state gives you the green light that you’re good to see patients in that new building, it’s like flipping a light switch. Once you have the approvals to move, you can’t start winding down and continue seeing some patients in one center, some in the other.”

This means the existing contents of the operating entity must shift entirely over to the new entity. “Once you start, there’s no turning back,” Gellenbeck says. “It is very tricky working with the state to try to communicate how this is all going to work. The team has to prove they have a safe and compliant building, and also prove from a functional standpoint that

the equipment is going to be installed correctly and validated prior to seeing patients in the new building.”

The plan was to close operations in the old center at the end of a Thursday and then start seeing patients in the new center on the upcoming Monday. “It is difficult to try to do a move that fast unless it is well coordinated by the entire team,” Gellenbeck says.

Fortunately, the Augusta Endoscopy Center staff was up for the task.

“We had our ‘army’ ready to go with singular purpose and expectation that we would be functional and ready to go on that Monday,” Meyer says. “That meant whatever it took is whatever it took. We outlined what we thought we needed the staff to do, and they were excited, so that helped. They understood what we had to accomplish. It was chaotic, but everyone pitched in.”

Vendors need to have a similar attitude, Gellenbeck says. “You’re not just coordinating with staff to assist, but you need to coordinate multiple vendors who must be willing to work over the weekend. The team needs to not only coordinate with the movers but also IT vendors who connect servers and are able to get all of the IT systems up and running; plumbers, who need to get the reprocessing equipment connected to the water lines; and the biomedical company to perform all the biomed checks for all of the equipment. Relocations are, in a way, much more complicated than a de novo project.” She continues, “It’s quite an ordeal, but for this project, the staff really gave 110% and the vendors stepped up. Everybody pitched in, worked through the weekend and made it work.”

Celebrating Success Plans called for completion of the project in June. The relocation was finished in May.

“The team did a great job,” Meyer says.

“They got behind us, got in front of us and did whatever they needed to do to make it happen. The other keys to success were working with Physicians Endoscopy and particularly Mary Ann (Gellenbeck), who was the ‘Mary Poppins’ of the project and made sure everything went according to plan, as well as our group of physicians. They could collectively see the vision for the new center.

These are physicians who were eager, cohesive in moving forward and very accommodating to getting the job done.”

The ability for so many physicians to work so well together was an essential component to the success of the project and the ongoing success of the practice, Principati says.

“It’s not easy to take on more practice partners and expand within a market and still provide that level of service they do,” he says. “As new physicians came in, the coordination and collaboration were impressive. All of the physicians participate and contribute, and they really do work well together. They took the time to get to know each other before they jumped into this together.”

Gellenbeck tipped her hat to everyone involved in the project. “The entire team was great to work with. They did well maintaining construction costs and listening to each other’s needs. They were successful with not only their architectural surveys but also the state department of health surveys. The process went smoothly.”

With the new Augusta Endoscopy Center up and running, the old center will be converted into more clinic space for the practice. This is the next step in practice’s ongoing efforts to deliver the best care possible to its patient population.

“We’re always doing something to grow,” Meyer says. “You have to remain focused on your core competencies while finding new ways to bring value to the market. By doing so, you’re positioning yourself for the future.”

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Going Solo After 20 Years:

Q&A With Dr. James Cremins

By Robert Kurtz In early March, gastroenterologist James E. Cremins, MD, FACP, opened Gastroenterology Solutions, his own private practice in Hagerstown, MD. He previously spent nearly 20 years in a larger group practice in the area, and prior to which he served in the U.S. Army for nine years as a military physician.

Dr. Cremins, who performs procedures at Endoscopy Center at Robinwood in Hagerstown, spoke with EndoEconomics about his decision, the challenges of “going on his own,” and why he is confident this was the right choice.

James Cremins, MD recently opened up his new solo GI practice, Gastroenterology Solutions, in March 2016.

He has been practicing in the Hagerstown, MD community since 1996, and prior to his move to Hagerstown, JAMES CREMINS, MD he served his country in the United States Army for nine years as a military physician. Dr. Cremins provides a variety of diagnostic and therapeutic endoscopic procedures, which are performed primarily at The Endoscopy Center at Robinwood. He also performs procedures at Meritus Medical Center for his hospitalized patients when needed. Dr. Cremins received his undergraduate degree from Harvard University, medical degree from New York Medical College, completed his residency in Internal Medicine at Fitzsimons Army Medical Center and his fellowship training in Gastroenterology at Walter Reed Army Medical Center. For more information, visit gastrosolutionsmd.com.

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Q: At a time when practices are typically growing and consolidating, you went the opposite direction. Why were you comfortable with making this decision?

Dr. James Cremins (JC): I chose to remain in the same neighborhood where I practiced before establishing my own practice. I was fortunate enough to have the endocenter, so I didn’t need to go elsewhere to perform my procedures. That was critical. I was able to locate extremely close to it, which has allowed me to initiate this effort without a huge initial overhead.

The biggest currency I had to bankroll this endeavor was an extremely loyal patient base. I was confident that they were going to find me after I left my previous practice. They are doing just that, every day. More and more are coming back to me when it’s time for an appointment or follow-up.

I knew that patients coming to the practice and establishing the patient flow would be the least of my problems, and that’s clearly been the case. Such an expectation made it much easier to take the initials steps.

Q: How have you been able to attract patients to the new practice?

JC: In this part of Maryland, once you’re well known, a lot of your business is driven by reputation. What I did that I think helped a lot was a blitz in the local paper. In every issue I had an ad in the back of the paper about the new practice, and then every Sunday there was a picture of me with the name of the new practice. This is a smallish town, and the people in it actually still read the local paper, even if it’s just for 15-20 minutes while they have their morning coffee.

I set up a website as well, which certainly helps, and is not hugely expensive. I’ll be developing the website further going forward, but establishing a strong web presence from the start wasn’t a top priority as some of my older patients aren’t too keen on electronic stuff, and some don’t even have a computer.

I personally did a grassroots letter campaign to all of my colleagues letting them know about my decision to open a new practice, which built more awareness.

Business is continuing to roll in, so that’s a good sign so far.

Q: How do you think you will be able to build on this early success going forward?

JC: My success — and survival — will depend upon keeping the practice lean and mean. My wife is managing the practice. She’s not taking a salary yet, and neither am I. I had to make some investments. I’m paying my nurse, and we had to purchase laptops and tablets. I needed to find an EMR with which I was comfortable. I was able to do so, and now I’m learning it. I have some experience

with coding and billing, and I’m doing a lot of that on my own.

on getting your insurance contracts up and running.

I think the keys are keeping your eye on the prize, keeping overhead as low as possible and affiliating yourself with people who can help you. It’s scary to put up some money to start and not get paid for awhile, but you typically need to do that in any business. I am fortunate to have people who started their own practice helping guide me along the way.

Q: Are you pleased with the decision to open your own practice thus far?

Making a decision like this takes some fortitude. I’m not sure what I would do if I was just coming out of fellowship and didn’t have a little bit of money behind me.

I also don’t think I would have made this change if I didn’t have the commitment of my former partners to crosscover me call-wise. I don’t believe that 24-7 call is compatible with mental health. I am still in a similar, reasonably large net call group for coverage. That allows me to have some mental health.

Q: What has been the biggest challenge you have faced thus far?

JC: The biggest difficulty I have faced is dotting every ‘I’ and crossing every ‘T’ in regard to getting insurance contracts. It’s inconceivable to me that, one day, I’m one of the more experienced examiners in the tri-state area, and the next day I’m completely meaningless to the insurance companies. I had to start from the beginning with them. They are making me wait quite a bit of time for contracts, and I have had to work hard to negotiate fair rates. I’m finally getting on board with a good number of them.

If I was to give anyone advice, I would suggest paying whatever is necessary to bring in somebody who is an expert on contracting and who can focus only

JC: I never thought about joining a competing group or another group up the road. My youngest child will graduate high school next year, so I didn’t want to move before that happened.

After I left the military for the civilian sector, we ended up here and have stayed here. We have developed roots.

So far, I’m maybe 75% as busy as I was at my previous practice. I’ve come to accept that this is not unacceptable. I knew I may slow down a bit because of the need to pick up some of the business side of running the practice. It’s quid pro quo; there had to be some tradeoffs. I knew this was going to be a new challenge.

Fortunately, I have a very supportive office manager, who is also my wife. She was very excited to do this with me. I also had the good fortune of a nurse I worked with for 15 years coming with me.

If nothing else, I hope to leave somewhat of a legacy here of a good gastroenterology practice as well as a great endocenter that will hopefully exist for years and years to come.

Q: What do you think is the key to starting one’s own practice?

JC: To me, the key is finding good people to surround you with, which is not always easy.

I have received tremendous support, whether it be simply encouragement from colleagues, who are also in private practice, to my wife and nurse when I ultimately decided to move ahead.

If you can surround yourself with good people, that’s definitely a strong way to start.

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Understanding Early Age Onset

Colorectal Cancer

In March, the Colon Cancer Challenge Foundation hosted the second annual Early Age Onset Colorectal Cancer Summit. The program brought together cancer survivors, healthcare professionals and researchers from across the country to learn about and discuss the rapidly increasing incidence of rectal and colon cancer among young adults under 50 years of age in the U.S. and abroad.

Following the event, EndoEconomics interviewed three physicians involved in the event about early age onset (EAO) colorectal cancer (CRC). They are as follows (listed in alphabetical order by last name):

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DENNIS AHNEN, MD, AGAF, FACG

PAUL C. SCHROY III, MD, MPH

THOMAS WEBER, MD, FACS

Dr. Ahnen is a co-chair of the National Colorectal Cancer Roundtable (NCCRT) Family History and Early Onset Colorectal Cancer Task Group.

He is a professor of medicine at the University of Colorado School of Medicine as well as the clinical lead of the Genetics Clinic at Gastroenterology of the Rockies.

Dr. Schroy is a co-chair of the NCCRT Family History and Early Onset Colorectal Cancer Task Group. He is a professor of medicine at the Boston University School of Medicine and director of clinical research of the GI section at Boston Medical Center.

Dr. Weber was course director and host of the Summit. He is a co-chair of the NCCRT Family History and Early Onset Colorectal Cancer Task Group.

He is a professor of surgery at the State University of New York Health Sciences Center as well as the president and founder of the Colon Cancer Challenge Foundation.

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Q: What is the significance of the rapid rise in EAO CRC? Dr. Paul Schroy (PS): Historically, we have known that most patients who develop CRC are over the age of 50.

Consequently, screening rates among this age group have markedly increased during the past decade due to both increased patient and provider awareness. This increase in screening has resulted in a 30% decrease in CRC incidence and a significant decrease in CRC mortality.

More recently, however, we have seen an alarming rise of CRC in individuals under the age of 50 who really are not candidates for screening in the absence of known familial or genetic risk factors. This is a group that’s harder to identify at a pre-symptomatic state, which makes it more difficult to either prevent or detect cancer early enough to optimize the likelihood of a good outcome.

Dr. Dennis Ahnen (DA): The success story of the steady decrease in both the incidence and mortality of CRC in the United States doesn’t apply to people under the age of 50. They are the only demographic where the incidence and mortality from CRC is increasing rather than decreasing. It’s a stark contrast to the success we have had in reducing incidence in older individuals.

With about 140,000 of new CRCs in the United States each year, EAO represents a bit more than 10% of CRC. EAO CRC incidence is approaching 15,000 people a year; that’s more than cervical cancer incidence and close to esophageal and gastric cancer incidence in the United States. If you just consider the EAO CRC group alone, it’s worth paying attention to and trying to figure out what causes it and what we can do to prevent it.

Dr. Thomas Weber (TW): It certainly underscores that consumers as well as healthcare providers really do need to be more aware of these trends because the vast majority of these people are not likely to be screened. It is sometimes difficult for both patients and providers to appreciate that a young person presenting with symptoms and signs may have a malignancy.

It’s also important to acknowledge that when you are looking at a population under 50, these are young people in the prime of life; people who are looking to partner and have families.

This issue of an increasing incidence of EAO CRC raises a lot of concerns about optimal treatment, aggressiveness of those treatments and how it’s going to impact future quality of life, including fertility.

Q: What challenges do providers face in identifying EAO CRC? TW: One of the biggest challenges is that providers may not think of cancer as the cause for presenting symptoms because the patient is so young. In addition, the evidence we have so far suggests that the majority of these patients do not have known risk factors in their history. Specifically, they may not have a family history of the disease.

Separately, there are the issues of interpreting their presenting symptoms.

People may present with vague symptoms, such as abdominal pain, which is difficult to interpret as it is a very common problem. But when young people, like any other patient, present with rectal bleeding, this is a significant and serious symptom that needs to be addressed.

PS: It’s currently difficult to identify most individuals under the age of 50 who might potentially benefit from early screening or surveillance. The fact is we don’t have a handle on risk factors

for many of these EAO cancers short of those that occur in the setting of a positive family history of CRC. Hence, the most reliable method at present relies on taking an accurate family history beginning before age 20 in hopes of identifying those at the highest risk due to a genetic predisposition.

One of the other challenges is risk stratifying patients with recurrent rectal bleeding under the age of 50. As Dr. Weber noted, this should be a red flag.

Oftentimes, a younger patient may have some of the other GI symptoms that can be associated with CRC, but because these symptoms are relatively common, such as abdominal pain or a change in bowel habits, they are often attributed to conditions like irritable bowel syndrome (IBS) and thus not viewed the same way as someone who is over 50 with similar symptoms.

DA: The most common challenge is recognizing that CRC is in the differential of GI symptoms of the young, particularly rectal bleeding and recent onset persistent abdominal pain, as opposed to longstanding intermittent pain you may see in IBS. To echo what has been stated, rectal bleeding shouldn’t be ignored and attributed to hemorrhoids without an examination. I think the single most common error made that leads to a delay in the diagnosis of EAO CRC is attributing rectal bleeding to hemorrhoids or some other benign source without endoscopic confirmation of the source.

The delay in diagnosing and recognizing the symptoms that can occur from EAO cancer and including cancer in the differential diagnosis of lower GI symptoms in young adults are important challenges providers must recognize.

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Q: What challenges do patients face in identifying they are at higher risk of EAO CRC? DA: They generally parallel the providers’ challenges. Young people need to not ignore symptoms themselves.

Studies that have looked at what specific factors contributed to delayed diagnosis of EAO CRC found that about half of the delay is on the provider side, about half is due to delays on the patient side in reporting symptoms to their providers.

Young people should not attribute rectal bleeding to hemorrhoids without an evaluation to determine the source.

Similarly, persistent or progressive

symptoms such as recent onset abdominal pain or a change in bowel pattern (constipation or diarrhea) should be evaluated as they can be caused by CRC in the young.

on their providers about conducting more diagnostic testing. There’s a tension concerning over-testing of a group that has not been historically at high risk of CRC.

TW: Another major challenge is patients and families being aware of their cancer family history in general, specifically CRC. Up to 15% of Americans have a first-degree relative with CRC. That means these people are at increased risk, and should be on more diligent screening and surveillance protocols. But people will not know if they are not aware.

Q: What are some short- and long-term strategies to build awareness of, identify and treat EAO CRC?

In my mind, the primary responsibility is for the providers to take family histories. We need to be training them to take family histories. We know from the published literature that this is often not the case.

Also, for people who have inflammatory bowel disease, they are certainly at increased risk, and should be receiving council from providers that they need increased surveillance.

PS: Patients need to be resolute in trying to encourage their doctors not to dismiss symptoms. The plight of many of these younger individuals is they keep getting written off for having hemorrhoids as the cause of bleeding or IBS as the cause of their abdominal pain or change in bowel habits. Patients need to speak with the providers when symptoms persist or, in the case of rectal bleeding, when no further workup is ordered.

It is difficult to know when patients should push hard

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DA: As noted by Dr. Weber, family history is critically important in risk assessment for CRC. So for providers, one of the first things they should do is develop a tool or system within their practice that ensures they routinely obtain the relevant family history needed to care for the patient. In the case of CRC prevention, that includes the family history of cancers. You need to have some way of doing that routinely and updating it regularly, preferably by the patient.

In the short term, it’s important to have educational efforts that reinforce the concept that providers should talk about CRC screening and cancer family history with their patients well before the age of 50. We’ve done so well and put so much effort into average risk screening that there is sometimes a link in our minds that colon cancer screening starts for everyone at age 50. But we really need to talk about colon cancer screening before that age, otherwise we’ll miss important groups, such as those with a family history of CRC who should start screening earlier.

PS: The NCCRT Family History Task Group is developing tools that can be built into EMRs to prompt providers to ask the right questions about family history, facilitate accurate documentation and receive real-time information to guide appropriate patient management.

The medical community has been at fault for not educating patients on the

familial risks associated with both colon cancer and advanced adenomas, which are pre-cancerous polyps. We’re hoping these tools in the EMR will not only enable providers to take an accurate family history for both cancers and advanced adenomas but also foster patient and intra-family communication for those at increased risk. As a longer-term strategy, we need to see if we can come up with a reliable risk index for EAO CRC. Ideally, the index will prompt providers to ask the right questions about a specific constellation of relevant symptoms, together with other risk factors (e.g., family history, obesity, smoking, alcohol use, diet), and, in so doing, facilitate the identification of a young person at increased risk, even in the absence of a family history.

We also need to recognize and address the fact that our primary care colleagues need effective, efficient tools to record and update family history information. Further, positive family history information should be linked to evidence-based screening and surveillance recommendations and reminders; and providing clinical decision support to busy healthcare providers. This is probably best done, in the 21st century, using EHR systems. Currently, few, if any, of the commercially produced EHRs provide family history functionality. Constructive engagement on this issue with our EHR vendor colleagues is a critical piece of the overall strategy required to build awareness, secure earliest possible stage diagnosis and optimally treat EAO CRC.

TW: If we are going to identify young people who are at increased risk, we really need to be taking family histories, which primary care medicine needs to embrace. We call it the “forgotten question.” Published literature strongly suggests or documents that in many instances, family history is not being secured. That’s unfortunate, because positive family history contributes significantly to the level of risk, and that level of risk impacts screening and surveillance programs. This is true not just for CRC, but breast cancer and other possible malignancies.

There’s been an over 50% increase in CRC for people age 20-49 since 1994, and that the trend is increasing. Also, 18% of all rectal cancers take place in people under the age of 50. Over the next 10-12 years, that is projected to rise to 25% — a dramatic statistic. This means one-quarter of all rectal cancers will occur in people below the age in which we screen for rectal cancers.

We need to identify people at increased risk, and we need to pay attention to symptoms and signs that might be a warning of a person harboring a malignant disease. We need to invest

in giving providers clinical decision support, information and tools that will facilitate securing family history information and identifying people who are at increased risk of CRC at a young age.

DA: For gastroenterologists and endoscopists, there’s a bigger opportunity to make a difference. We are the ones who identify most patients with CRC, so we have an opportunity to identify high-risk families: those that have a history of CRC and advanced adenomas. We need to develop a process whereby all our patients with CRC or advanced adenomas are told that this finding not only affects their own future risk of colonic neoplasia but also that of their family members.

We should implement a process to reach out to family members that they are at an increased risk and provide then with evidence-based screening recommendations For more on the Early Age Onset Summit, including presentation slides, visit www.coloncancerchallenge.org.

To learn more about the National Colorectal Cancer Roundtable and the work of the Family History and Early Onset Colorectal Cancer Task Group, visit www.nccrt.org.

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with their jobs and company? Over the last few years, a trendy concept has arisen in the human resources world. It’s the idea of employee engagement. But what exactly does it mean?

What is Engagement?

Why Employee Engagement Is So Important

By Tricia Pickford, SPHR, SHRM-SCP, SVP, Human Resources It’s Sunday, the day we all love. Sundays are known for slow mornings, coffee, big breakfasts, reading the newspaper, walks in the park, football and just enjoying the day. Yet as the day happens, some of us progressively feel a sense of dread that the weekend is TRICIA PICKFORD coming to an end, and we have to go to work in the morning. Back to the daily grind, working for a living and doing what we can to support our families, pay our bills and live the proverbial dream. Let’s face it, even if we love our jobs, we still love our free time even more.

Imagine the world where people are excited to go to work every day and feel they have a purpose. Imagine everyone is charged up for Monday mornings and every other workday.

Hopefully, you are reading this and thinking you’re absolutely passionate about what you do and although being happy at work 100% of the time isn’t realistic, most days you’re satisfied with your job and believe you make a difference. You feel as if you’re engrossed in the work you do and not only living for the weekends.

For the longest time, we heard the term “employee satisfaction.” What can we do to make our employees satisfied

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According to Kevin Kruse, author of Employee Engagement 2.0, the definition of employee engagement is the “emotional commitment the employee has to the organization and its goals. This emotional commitment means engaged employees actually care about their work and their company.” That’s a very powerful definition. Think about it. It goes beyond being satisfied. It’s a feeling of being connected to the work you do and your organization. When you care about your job and your organization, you’re going to put in your best effort and go above and beyond.

For employers, making sure your employees are engaged can be a formula of multiple factors. It’s not always as simple as paying people competitively, offering generous benefits and doing things like bringing in lunch and sponsoring holiday parties. Although every organization can be very different and dependent upon its makeup of employees, a combination of things promote engagement.

According to a study done by Dale Carnegie1, the top 3 drivers of engagement on a basic level are: 1) Immediate supervisor 2) Belief in senior leadership 3) Pride in working for the company First, a personal and professional relationship with an employee’s immediate supervisor is critical. The number one reason people leave companies is their immediate supervisor. It’s largely based on the environment a supervisor creates and how employees perceive they’re treated. According to a poll conducted by Gallup2, at least 75% of voluntary turnover can be influenced by managers. Make sure those you place in management roles are equipped and have the tools needed to be successful.

Secondly, belief in senior leadership. If senior leadership makes employees feel valued, openly and transparently communicates and shares the company’s mission, vision, values, and goals, employees will feel a sense of belonging.

Lastly, pride in working for a company is how people intrinsically feel about the organization where they work. Last year at Physicians Endoscopy, we focused on trying to connect the work we do every day with a purpose. Our team supports our partnered centers so that the physicians, management, and staff can focus on providing high-level patient care, efficiently and safely while promoting an excellent patient experience.

Due to the nature of our business and the support contributed to our centers, our employees impact prevention of colon cancer. We indirectly affect prevention and treatment of colon (and other possible) cancers, but we provide a valuable service that enables our centers to focus on patient care. When we shared this message at a company-wide meeting, it was astonishing! Our people felt very connected to our purpose; I think for the first time. Something like this creates pride.

How Do You Measure Engagement?

The big question is, how do you know if your employees are engaged? There are ways you can look at this. One is to talk with them directly. Ask them regularly how they are, how they like their work and get to know them a bit on a personal level. Yes, that’s a fine line, and you want to make sure you balance that line, not delving into information that’s too personal for legal reasons.

However, I recently attended an HR conference, and one of the messages was an incredible reminder that we need to connect with our employees on an emotional level, not just a practical level3. People feel good about their jobs and company when they feel as if people care about them.

Asking people if they’re engaged, by simply talking, is not entirely practical and may not give you the information you need. What if they’re not engaged, are they really going to admit it? Chances are they will not always be forthcoming out of fear of reprisal. No matter how open an environment you try to create, they won’t be completely honest.

Another way to measure engagement is through a formal survey. Last fall, Physicians Endoscopy completed an employee engagement survey using an outside talent management company, CCI Consulting. Although we have done

surveys before, this was our first formal analysis.

When you’re ready to do an engagement survey, you have to be “all in” to look at results and examine your organization’s strengths and weaknesses. In other words, you have to be willing to address the areas where your employees feel you fall short. Think about it, if you take the time to provide feedback and nothing changes, it’s disappointing.

Employees will feel as if their opinions fall on deaf ears and what’s the point?

What To Do with the Results?

What we learned going through the process are the areas where we do very well as an organization. We also learned about areas we should focus on improving. Results were communicated to our employees shortly after the survey closed, and we came up with ways to improve.

Sometimes there are areas where a company may decide they don’t want to pursue making changes or improving. And that’s OK! It all comes down to transparent, open communication and not keeping things too close to the vest.

Trust your employees with knowing “why.” There may be requests and feedback that are nearly impossible to implement, sometimes based on business needs and priorities. But the key is explaining why and including your employees in the process. Whether we’re talking about survey results, business changes, vision, industry outlook or simply daily communication, employees crave information. They want to feel valued and in the know. They want to know how what they do each day impacts the business.

They also want to feel connected.

Why Focus on Engagement?

When people are disengaged, they put in less effort. They are emotionally disconnected from the work and the organization. They’re likely not nearly as

productive; they cut corners. When that starts to happen, it impacts the business and in a healthcare setting can directly affect patient care. If up to 70% of US workers are not engaged, and that impacts productivity, then it also affects the bottom line. Gallup estimates the nationwide cost of lost productivity due to low engagement is $450 billion.4 When it comes to disengagement or the reality of employees not caring, that can have an incredibly detrimental impact on the success of your organization.

Solicit the feedback, give it credit and come through with solid resolutions to fix your workplace where needed. Most of all, connect with your people. They will continue to be your single greatest asset. Hear what they have to say, what’s important to them and why. And communicate. Be transparent. Put yourself in their shoes. Listen and respond. And say thank you – often! These are simple reminders that can make a major difference in your employees’ level of engagement.

Ms. Pickford, SPHR, SHRM-SCP, is the senior vice president of human resources at Physicians Endoscopy and has over 15 years progressive HR experience. Ms. Pickford’s oversight of human resources includes talent acquisition and full-cycle recruitment; compensation and payroll management; performance management and employee relations; employee engagement; employee benefits management, design, implementation and administration; policies and procedures; employee and organizational development; and compliance. Ms. Pickford earned her BA in Labor and Industrial Relations from Penn State University and her SPHR (Senior Professional in Human Resources) certification and SHRM-SCP (Senior Certified Professional) through the Society for Human Resource Management.

1

What Drives Employee Engagement and Why it Matters, Dale Carnegie White Paper, 2012 2

Turning Around Employee Turnover by Jennifer Robison, Gallup Business Journal, 2008 3

HR on Purpose! Five Ways to Own, Lead and Integrate HR Throughout Your Organization by Steve Browne, SPHR, SHRM-SCP, Executive HR Director, LaRosa’s, Inc., June 2016 4

The Type B Manager: Leading Successfully in a Type B world by Victor Lipman via Forbes.com

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Marketing

Buzz

Your First Impression,

Not Your Second.

By Lori Trzcinski, Marketing Communications Specialist

There is a new era of consumerism in the healthcare space that simply cannot be ignored. Dwindling are the days of finding your physician from a listing you saw in the phonebook or an ad posted in the local newspaper.

The shift from print to digital media LORI TRZCINSKI has long since been underway, and change in access to healthcare has moved along with it. There are new ways to access care, tools that offer patients choices, and programs designed to focus on the patient and caregiver experience. With all of these new options, are you paying attention to what your patients are saying about you?

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When Bright Local surveyed local businesses for what ‘reputation’ matters most when choosing a business, a doctor’s reputation came in second, right behind restaurants at number one1. With consumers having the freedom to research and find just about anything with the click of a button, your public, digital reputation to consumers should be your priority. 92% of internet users read reviews, 89% of people say that reviews influence their purchasing decisions, and 79% of consumers trust online reviews as much as they rely on personal recommendations2.

When was the last time you took a look at how you are rated on review sites such as Google, Yelp, RateMDs, Vitals or Healthgrades? How about your practice or center’s social media page ratings? Just because you don’t look at them doesn’t mean that reviews and information aren’t there— positive or negative, accurate or inaccurate. Search engines heavily weigh online review sites and the reviews of physicians and practices because people strongly consider

Marketing

Buzz and use them. You may feel that the work you put into your career is fulfilling and life-saving to the community, but do the community and the patients you serve feel the same?

Is that the ideal first impression you want to give them?

Figure 1

According to The New York Times book review of Kevin Pho, MD and Susan Gay’s Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices, the Internet is quickly becoming the resource of choice for patients to connect with, learn more about and even rate their doctors. And while many have used Facebook, Twitter, LinkedIn or online medical community sites to engage with friends and colleagues, few have communicated with patients.

Most abstain for one simple reason: they aren’t sure how to be a doctor online3.

According to the book authors themselves, the biggest risk of social media in healthcare is not using it at all.

The Internet has profoundly changed the patient-doctor relationship, and doctors must embrace its effects on patient care—or risk losing their own influence4. Opting to ignore rather than support and empower the age of digital search, is a much harder job when you need to resolve inaccuracies and soothe patients’ qualms. Patients will move onto the competing practice who adapted with change and molded their participation and messaging to fit their needs. Give regard to what resonates with them.

In a 2013 Price Waterhouse Coopers study, approximately 150 million Americans said that they had read healthcare reviews about their physicians5. In a Pew Research Center study from that same year, nearly 80 million Americans claimed that they follow someone else’s health experience online6. Knowing how your information appears online and what others are saying about it is important.

This example (Figure 1) shows the page-one Google search results of Brett Bernstein, MD, clinical associate professor of medicine, director of clinical integration for gastroenterology and endoscopy for the Digestive Disease Institute of the Mount Sinai Health System, and medical director of East Side Endoscopy and Pain

GOOGLE RESULT FROM 8/2/16

Management Center. Out of the ten results, those with the highest presence are the online review sites, making up half of the results (5); followed by (2) news-related, (2) medical practice, and (1) social media page. With around 95% of all web visitors not going beyond the first page for their search result7, what shows up on this page for you as a physician is crucial to the success of your reputation.

So, how do you start taking control?

1. Acknowledge that online presence, ratings and reviews are increasingly becoming that first impression and interaction between you and the potential new patient. Reviews do matter, and they are here to stay.

2. Take 30 minutes and search for your name on Google—start with the largest search engine first and work your way onto others, such as Bing, Yahoo, Ask, etc. Try this practice at least once a month to familiarize yourself with how you and your practice appear on searches.

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Marketing

Buzz 3. Complete your information online. Create a LinkedIn profile, claim your auto-generated physician profile listings by registering yourself on each of them, verify your personal digital identity. Taking those initial steps will put you ahead of the game—raising your profile ranking and pushing down any irrelevant listings in the search results.

4. Bolster your positive reviews to outweigh the negatives. The vast majority of patients do not leave online reviews, so each bit of feedback weighs more heavily than you would assume. A small review sample can skew results. A difference of one “star” in rating can lead to a 5-9% difference in expected revenue8.

5. Take it a step further and set aside time to engage with patients on your social feeds and review profiles— boosting your visible online presence and personal connections. Understand (and keep in mind) what you can and cannot say in your responses based on HIPAA regulations.

Quality online maintenance is the key to success in claiming (or reclaiming) your reputation. Within your professional marketing, you should typically discuss your talents as a physician, technology used, and the services provided, but you must also make the inward push focused on the patients and families that you serve. At the end of the day, patients and their loved ones being able to find the best quality care via online search is a step in the right direction towards healthcare efficiency and transparency.

Source: 1 “Local Consumer Review Survey.” Bright Local, 2015. Web. 26 July 2016. https://

www.brightlocal.com/learn/local-consumer-review-survey/ 2 “2013 Study: 79% of Consumers Trust Online Reviews As Much As Personal Recom-

mendations.” Search Engine Land, 26 June 2013. Web. 26 July 2016. http://searchengineland.com/2013-study-79-of-consumers-trust-online-reviews-as-much-aspersonal-recommendations-164565 3 “Doctors and Their Online Reputation.” New York Times, 21 March 2013. Web.

26 July 2013. http://well.blogs.nytimes.com/2013/03/21/doctors-and-their-onlinereputation/ 4 Pho, Kevin, MD, and Susan Gay. Establishing, Managing, and Protecting Your On-

line Reputation: A Social Media Guide for Physicians and Medical Practices. 1st ed. N.p.: Greenbranch, 2013. Print.

5 “Consumer ratings becoming a matter of dollars and cents on Healthcare’s bot-

6. Create content that can be published online to help reinforce your overall digital impression and presence. Did you recently win an award? Did you start accepting new patients or performing new procedures? Make sure that any positive information is readily accessible to the public to discover when they are searching for their next doctor.

Not every physician may find the time to take over full control of his or her digital reputation, but that does not mean you should overrule the importance of listening and being proactive when it comes to your name. Hire a professional to help you manage it or outsource that role to a company who offers those services. Various businesses provide reputation management that can help you find the level of coverage that you need. There are even a growing number of healthcare employers who are starting to create internal physician rating systems that are published online as a way to strengthen both their digital image as well as their physician employees.

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tom line, finds PwC’s Health Research Institute.” Price Waterhouse Coopers, 9 April 2013. Web. 26 July 2016. http://www.pwc.com/us/en/press-releases/2013/ consumer-ratings-becoming-a-matter-of-dollars.html 6 “Health Online 2013.” Pew Research Center, 15 January 2013. Web. 26 July 2016.

http://www.pewinternet.org/2013/01/15/health-online-2013/ 7 “No. 1 Position in Google Gets 33% of Search Traffic.” Search Engine Watch, 20 June

2013. Web. 26 July 2016. https://searchenginewatch.com/sew/study/2276184/no1-position-in-google-gets-33-of-search-traffic-study 8 Luca, Michael. “Reviews, Reputation, and Revenue: The Case of Yelp.com.”

Harvard Business School Working Paper, No. 12-016, September 2011. (Revised March 2016. Revise and Resubmit at the American Economic Journal - Applied Economics.)

Lori Trzcinski is the marketing communications specialist at Physicians Endoscopy and the managing editor of EndoEconomics. With over seven years of marketing experience, 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.

Business

Briefs Physicians Endoscopy collaborates with The Joint Commission and CDC on an Ambulatory Infection Prevention Project Physicians Endoscopy will be collaborating with The Joint Commission and the Centers for Disease Control and Prevention (CDC) on an initiative designed to adapt, enhance and disseminate CDC guidance related to infection prevention and control in ambulatory healthcare settings. The goal of this effort, which is supported through a CDC contract, is to create model infection control plans and expand the reach, uptake and adoption of these and other infection prevention and control guidance materials to prevent infections in outpatient settings.

The project, called ADOPT (Adaptation and Dissemination Outpatient Infection PrevenTion) Guidance, is a three year project that will focus on a variety of free-standing ambulatory settings and services. Physicians Endoscopy is one of 12 outpatient-focused professional organizations

(e.g., medical specialties that primarily serve ambulatory patient populations) and 10 ambulatory healthcare systems selected by the CDC and The Joint Commission to participate. PE will be providing information about the current use of infection prevention guidance materials and input into new or adapted model infection controls plans, helping to ensure applicability and ease of implementation in ambulatory care environments.

Physicians Endoscopy is excited to be working with the CDC and The Joint Commission on this important initiative to improve infection prevention and control in ambulatory settings. To read more about this project, please visit here: www.jointcommission.org/joint_ commission_cdc_collaborating_on_ambulatory_ infection_prevention_project/

Patients Like to See Physicians Wearing White Coats Patients prefer doctors who wear ‘professional’ attire, survey finds Most patients prefer that physicians wear white coats, according to research published online June 1, 2016, in JAMA Dermatology.

In a survey of 255 patients, Robert Kirsner, M.D., Ph.D., of the University of Miami Miller School of Medicine, and colleagues showed participants photos of dermatologists wearing either a suit, a white coat (professional attire), surgical scrubs, or casual clothing, and asked which they favored.

The researchers found that a white coat was the most preferred (73 percent), followed by surgical

scrubs (19 percent), a suit (6 percent), and casual clothing (2 percent).

“In this study, most patients preferred professional attire for their dermatologists in most settings,” the authors write. “It is possible that patients’ perceptions of their physicians’ knowledge and skill is influenced by the physicians’ appearance, and these perceptions may affect outcomes.”

Full Text: http://archderm.jamanetwork. com/article.aspx?articleid=2525547 Article Originally Published: Thursday, June 2, 2016. Copyright © 2016 HealthDay. All rights reserved.

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Front and

Center Growth & Expansion The physicians and staff of Burlington County Endoscopy Center (Lumberton, NJ) and their strategic partner, Physicians Endoscopy, recently completed of a joint venture with Virtua Health in June. Built in 2008, the Center was initially a partnership between Gastroenterology Consultants of South Jersey and Physicians Endoscopy. The expanded partnership with Virtua offers each party increased value – providing a large guiding hand through continued healthcare challenges, stronger negotiating power with payors and a lower cost outpatient strategy to provide the highest quality endoscopic services to patients in the greater Burlington County area.

conveniently located next door to the previous location. The new center, relocated to 393 N. Belair Road, Building 2, Evans, GA, opened one month ahead of its planned schedule.

Physicians Endoscopy recently completed two acquisition partnerships - Surgical Center of Michigan (Troy, MI) and Atlantic Gastro Surgery Center (Egg Harbor Township, NJ). With the addition of these two successful centers, PE is now in partnership with 42 ASCs across the country. PE has several transactions in their pipeline with an estimated completion date before the end of the year.

Recently re-named East Side Endoscopy and Pain Management Center (Lower Manhattan, NYC), the Center now offers pain management services to patients.

Daniel Hanono, MD, Daniel Hanono, MD pain management physician and Director of Comprehensive Pain & Wellness Center, provides a variety of treatment options to help alleviate chronic and acute pain, including epidurals, nerve blocks, radiofrequency ablation, and advanced minimally invasive treatments. North American Partners in Anesthesia (NAPA) is the center’s selected anesthesia provider.

Physicians Endoscopy, an affiliate of the Center, continues to provide ongoing management services.

2016 National ASC Week is August 8-12.

The week, which has been recognized and celebrated by the Ambulatory Surgery Center Association (ASCA) for the last decade, is meant to raise awareness of the benefits of ASCs. Centers are encouraged to market their facility within their communities by hosting an event or open house to educate key policy and decision makers about the benefits of ASCs and to promote public awareness. For more information, visit ascassociation.org.

With growing demand and a need for expanded GI services in the area, Augusta Endoscopy Center (Evans, GA) outgrew its tworoom facility originally built in 2002. On May 23, 2016, Augusta Endoscopy Center opened its brand new, state-of-theart threeroom facility

Upcoming Industry Shows

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EndoEconomics SU MMER 2016

Austin Osemeka, MD, from Greater Gaston Endoscopy Center in Gastonia, NC, presented on Hepatitis C screening for Nigerians traveling to the United States at the Association of Nigerian Physicians in the Americas (ANPA) conference held in Las Vegas, NV. Dr. Osemeka serves on the ANPA Medical Specialties Committee.

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• American College of Gastroenterology (ACG) 2016 October 14-19, 2016 Las Vegas, NV n

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• Becker’s ASC Review 2016 Chicago, IL

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October 27-29,

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• Washington Ambulatory Surgery Center Association (WASCA) November 17-18, 2016 Tulalip, WA n

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• New York Society for Gastrointestinal Endoscopy (NYSGE) December 15-16, 2016 New York, NY n

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Giving Back to the Community

Important Dates & Events

• GI Outlook (GO) 2016 2016 Washington, DC

• Pennsylvania Society of Gastroenterology (PSG) September 23-25, 2016 Pocono Manor, PA

Physicians Endoscopy (PE) participated in numerous give-back programs for the summer season. In honor of Mother’s Day, PE supported Cradles to Crayons—a non-profit organization that works with local partner agencies to disperse necessities to over 56,000 children living in low-income and homeless situations in the Philadelphia region.

The company’s annual food drive, typically held at the end of the year, was rescheduled to July accommodating the most critical time for the community’s local food pantry— the Bucks County Housing Group Pantry at Doylestown. PE employees donated over 320 lbs. of food.

August 5-7,

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• Florida Gastroenterology Society (FGS) Annual Meeting September 9-11, 2016 Orlando, FL n

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• NY Metro ASC Symposium September 14, 2016 New York, NY n

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• Ohio Gastroenterology Society (OGS) September 17, 2016 Columbus, OH n

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Awards & Recognition Congratulations to Sarah Malaniak, CASC, administrator at Ambulatory Center for Endoscopy (North Bergen, NJ). She was named one of Becker’s ASC Review’s “152

Front and

Center ASC administrators to know” for 2016. Those chosen were awarded for being efficient and skillful leaders—overseeing every aspect of their ASC’s business and tasked with navigating their ASC through the rapidly changing healthcare landscape.

Congratulations to Steve Housberg of Advanced Endoscopy Center (Bronx, NY) for his seventh year serving as administrator!

South Broward Endoscopy has been named as one of Modern Healthcare’s Best Place to Work in Healthcare for 2016. This is the fourth year in a row and sixth time the center has been nominated and chosen in seven years.

Physicians Endoscopy’s Senior Vice President Tricia Pickford, SPHR, SHRM-SCP, was honored as HR Person of the Year for a medium-sized organization at the 16th Annual Delaware Valley HR Person of the Year Award dinner on Thursday, May 19, 2016. The award celebrates the Human Resources industry and recognizes those in the profession who exemplify outstanding achievement within the local community. Tricia has been with Physicians Endoscopy for nine years and leads a team of six exceptionally skilled professionals who provide a full suite of HR services to PE’s 42 ASCs. Congrats Tricia!

Current

GI Opportunities Submit your CV online at www2.endocenters.com/opportunities

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 a single office and covers one hospital. Outpatient endoscopy is performed at a 2 room ASC with maximum efficiency and quality of care.

Enjoy sunshine and a great lifestyle in the metro Phoenix area.

Candidate should contact: Britannia Blanchard, Office Manager CamaBBlanchard@Virmedice.com 480-834-0771 480-834-1136 (fax)

Rochester Hills, MI Troy Gastroenterology

The Center for Digestive Health (Troy Gastroenterology) is a well-established, highly respected private practice looking for two 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, ERCP and EUS. • 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) Interested candidates please contact: Angela Johnson, Chief Operating Officer (248) 243-0570 ajohnson@troygastro.com

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Current

GI Opportunities Submit your CV online at www2.endocenters.com/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: 1:6 • 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!

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 speciality, 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.

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

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 benefit package.

For more information, contact: Lisa Burcroff at LMBurcroff@hinet.org

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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: Lara Jordan, VP, Operations (215) 589-9038 • ljordan@endocenters.com

Central New Jersey

Garden State Digestive Disease Specialists, LLC Garden State Digestive Disease Specialists, LLC is seeing a BC/BE Gastroenterologist to join our three physician practice in Central Jersey for a full-time position. 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 Surgi-Center is a state-of-the art Endo Center presently being expanded into a 3 room facility. We are affiliated with 4 local hospitals, 2 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.

Interested gastroenterologists may submit CV/or inquiries to: Ms Liza Macalincag, Practice Administrator Lmmac@comcast.net

Current

GI Opportunities Submit your CV online at www2.endocenters.com/opportunities

Lima, OH

Lumberton, NJ

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 three-room endoscopy center. The center, built in 2008, is AAAHC and ASGE certified. In the area are two local hospitals with state-of-the-art facilities.

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

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

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Located within 30 minutes of Philadelphia and within 1 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

Please contact Monica Awsare, MD at 215-718-6085 or monicaawsare@gmail.com

For more information, contact: Robert Neidich, MD, President of Gastro-Intestinal Associates Phone: (419) 227-8209 ext. 100 Fax: (419) 222-6007

On-Site Endoscopy

Northern CA Central CA

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.

For more information, contact: Amy Fasti • afasti@securemdca.com Toll Free: 1-877-613-3494

Cleveland, OH UHMP Gastroenterology Associates

Williamsville, NY

Gastroenterology Associates, LLP

An 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 eleven 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 dietitian 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

The physicians of UHMP Gastroenterology Associates, a private gastroenterology group affiliated with University Hospitals of Cleveland and CWRU School of Medicine, are seeking a gastroenterologist to expand the practice. This candidate will have ownership opportunity in their two thriving endoscopic ambulatory surgery centers. These freestanding, state-of-the-art ambulatory procedure centers are located in Chagrin Falls and South Euclid, Ohio (suburban Cleveland).

This Opportunity Offers: • Physician owned and controlled centers.

• State-of-the-art endoscopic equipment.

• Medicare licensed and AAAHC approved.

• Physician efficiency and optimal patient quality of care.

• Nursing staff has extensive experience in GI endoscopy.

• All physicians and nurses are advanced cardiac care life support certified.

• An outstanding benefit package is offered.

• Professionally operated and managed.

For more information, Michael Koehler, MD • UHMP Gastroenterology Associates contact: (216) 691-3602 • michaelkkoehlermd@gmail.com SU M M E R 2 0 1 6 EndoEconomics

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