EndoEconomics Winter 2015

A Journal Dedicated to the Economic Issues Impacting GI Practices

WINTER 2015

Overcoming the Odds to Open Gastonia Center

Page 6

Making a Difference in New York ASCs Page 9

Preparing for Colon Cancer Awareness Month Page 18 The GI Journal of:

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

WINTER 2015

WINTER 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.

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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.

CONTENT

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9 NEW YORK ENDOSCOPY CENTERS MAKING A DIFFERENCE

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RIGHT DIRECTION?

Copyright © 2015 by Physicians Endoscopy.

13 THE BRAIN-GUT CONNECTION: IBS THERAPY

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4 MESSAGE FROM THE PRESIDENT 6 NORTH CAROLINA GASTROENTEROLOGISTS OVERCOME THE ODDS TO OPEN ENDOSCOPY CENTER 12 SELF-REGISTRATION KIOSKS: IS YOUR ASC MOVING IN THE

15 TURNING LOW VOLUME DAYS INTO HIGH PRODUCTIVITY OPPORTUNITIES 18 COLON CANCER AWARENESS MONTH: STEPS TO PREPARE 21 POSITIONING THE GI PRACTICE FOR FUTURE SUCCESS 22 MARKETING BUZZ: FIVE WAYS TO FACILITATE PATIENT ADVOCATES 24 BUSINESS BRIEFS 26 CURRENT GI OPPORTUNITIES Find out more at endocenters.com or find us on W I NTE R 2 0 1 5 EndoEconomics

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Message from the Barry Tanner

President and CEO, Physicians Endoscopy

H

appy New Year! 2015 has arrived and we are greeted with both challenges and opportunities. I continue to be excited about the trends and changes that are taking place within our healthcare delivery system, and I am glad that the PE team continues to play a leadership role in developing innovative, strategic solutions to the challenges that are faced by gastroenterologists.

This past year, we continued to expand the number of Physicians Endoscopy (PE) partnered facilities. In fact, in 2014 the PE team successfully opened six new ASCs across the U.S. This is the very first time that we have opened so many new ASCs in a single year! So when you hear that the de novo market for ASCs is dead, we can show evidence to the contrary.

Here at PE, there were several other important accomplishments achieved during 2014 and even more on tap for 2015. First, PE’s billing and IT teams conducted initial testing with a patient registration kiosk. This new technology allows patients entering one of our partnered facilities to walk up to the kiosk and register entirely on their own. At the kiosk, the patient can get verification of eligibility and benefits and even make a payment, all very privately and HIPAA compliant. In the days of healthcare 4 |

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President

delivery where we are challenged to do more for less cost, this important technological advancement could be a part of the answer.

ing to HHS Secretary Sylvia Mathews Burwell. These numbers do not include those individuals who enrolled for plans through the state run exchanges.

Also, in keeping with the theme of trying to do more with less, PE added some terrific in-house IT programming capabilities. We were able to automate the monthly billing reports that go out to every one of our partnered facilities on a monthly basis. Thanks to the internally developed automated process, the reports are prepared and e-mailed to each of our facilities in less than a minute per facility. The team has identified several more projects where we hope to achieve similar results during 2015.

A key driver of the ACA was to reduce the number of uninsured people, and that clearly seems to have happened.

However, making healthcare insurance accessible and affordable doesn’t automatically translate to making health “care” affordable. Many people cite the impact of high-deductible health insurance plans as playing a critical role in holding growth in healthcare spending to 3.6% in 2013 – the lowest since the government started measuring it in 1960.

Looking back, 2014 also marked the inaugural year of implementing The Affordable Care Act. While the implementation of this important legislation met with several challenges early on, it has slowly settled down, and so far, the annual renewal process appears to be going smoothly. Overall, 6.7 million Americans have obtained and paid for private coverage on the insurance marketplaces in 2014. Nearly 10 million more people qualified for Medicaid due to the expansion of coverage by many states. The percentage of uninsured Americans dropped from 17.7% prior to the ACA to an estimated 12.4% now, according to the Urban Institute. As of December 15th, second year enrollment shows that almost 6.4 million people selected a health plan through the Federal marketplace or were automatically re-enrolled, accord-

Today, nearly everyone in the U.S. at least has access to affordable healthcare insurance. That is indeed great news. However, one unfortunate aspect of the ACA is that on January 1, 2015, Medicaid payments to physicians for services provided were reduced by an average of 43%. The ACA included increases in Medicaid payments for physician services, both in 2013 and 2014, in an effort to encourage physicians to provide coverage for the swelling Medicaid roles in many states. Now, in what seems to be a bit of a bait and switch, physicians find themselves seeing far more Medicaid patients; however, their fees for services provided will be reduced by nearly half.

President Obama has proposed a 1-year extension of the current Medicaid fee schedules, a proposal that does not seem likely to get any

traction in Congress. While not all aspects of the ACA legislation have yet been implemented, it seems clear that this legislation has sparked a new era of innovation for our healthcare delivery system.

There are several trends that are beginning to materialize as a result of the Affordable Care Act. One of the most positive trends/developments is the increased focus on pricing transparency and quality reporting that has emerged. CMS has implemented PQRS (Physician Quality Reporting System), which until 2015 was rolled out without penalty to all physician providers. The PQRS program provides an incentive payment to practices with eligible physician providers who chose to report certain quality data. For the past two years, physicians who satisfactorily reported data on quality measures for covered services furnished to Medicare Part B beneficiaries received a small incentive payment. This year, however, the failure by physicians to report PQRS quality data results in an escalating payment penalty. So far, it has been reported that only approximately 25% of physicians have begun complying with PQRS, however, that may change with the 2015 financial penalties.

a steadily growing portion of the cost of healthcare gets shifted to us via the growing prevalence of high-deductible health plans.

On the negative side, although again not necessarily a direct result of the ACA, is the continuing trend of hospital physician employment. A recent Physicians Foundation survey of some 20,000 U.S. physicians found that 35% described themselves as independent, down from 49% in 2012 and 62% in 2008. While I will concede that physician employment could be a part of the long-term solution, I definitely fear that putting more power and control in the purview of hospitals is a very slippery slope. Physicians are being driven toward employment for many reasons, not the least of which include growing uncertainty about the future of healthcare and the escalating expense of trying to maintain a small independent practice. Still, I believe that physician independence is vitally important within the balancing act of healthcare delivery.

At PE, we will continue to find ways to help gastroenterologists remain viable and successful in independent practice, and to explore new ways in which GI specialists can band together to gain access to the various resources necessary to protect their independent practice of medicine.

Two of the most common themes in healthcare right now are pricing transparency and data interoperability. Both are squarely aimed at dramatically reducing healthcare costs and increasing patient safety/health outcomes. In a fairly rapid sequence of events, pricing transparency is gaining momentum on a steep trajectory. While I can’t tie this advancement directly to the Affordable Care Act, it is welcome and important to progress nonetheless. Also In 2013, CMS for the very first time released data revealing hospital charges, which represented almost 7 million discharges or 60 percent of total Medicare IPPS discharges. Then in April 2014, CMS took a major step forward in making Medicare cost data even more transparent and accessible, by announcing the release of data on medical services and procedures furnished to Medicare beneficiaries by physicians and other healthcare professionals.

For many years, the only information on physicians that was readily available to consumers was physician name, address and phone number. The data that CMS released marked the first time that the cost of physicians’ services was ever made available to patients as consumers of healthcare, providing key information on the provision of services by physicians, and how much they are being paid for those services. I believe that this trend toward more transparency, in both pricing and quality reporting, will continue. It will even accelerate, fueled by the fact that we as patients are being forced into the role of retail healthcare consumers as W I NTE R 2 0 1 5 EndoEconomics

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North Carolina Gastroenterologists OVERCOME THE ODDS TO OPEN ENDOSCOPY CENTER

BY LARA JORDAN

IT BEGAN AS A SLOW TRICKLE, RECALLS GASTROEN-

economic standpoint. Considering their insurance, they were able to get their indicated procedure done financially better than what we could do.”

TEROLOGIST AUSTIN OSEMEKA, MD, OF CAROLINA DIGESTIVE DISEASES IN GASTONIA, N.C. HE WATCHED AS A FEW OF HIS PATIENTS LEFT GASTONIA AND TRAVELED TO THE NEIGHBORING CITY OF CHARLOTTE TO UNDERGO THEIR SCREENING COLONOSCOPY.

This was in the mid-2000s. Several endoscopy centers had opened in Charlotte, but Gastonia — located in Gaston County — had none. “Patients would go get their screening done in Charlotte and then come back to Gastonia for the rest of their care,” Dr. Osemeka recalls.

“Initially there were just a few patients doing this, but it soon became a pattern. They were getting their screening done at these endoscopy centers be-

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Lara Jordan

cause they could have the procedure at a lower cost than what we could provide to them by performing the procedure at the local hospital.”

Gastroenterologist Sam Drake, MD, of Gaston Digestive Disease Clinic in Gastonia, recalls a similar change happening with his practice. “We started seeing patients leaving our county and going to Charlotte. It was strictly from an

Over the years, the number of patients leaving Gaston County for their procedures grew significantly, says gastroenterologist William Watkins, MD, of Gaston Gastroenterology in Gastonia.

“We were losing about 1,400 colonoscopies a year to endoscopy centers in Charlotte because patients could get their procedure for a co-pay, which was lower than what they needed to pay at the hospital.”

Dr. Osemeka adds, “Many patients are unwilling to pay what the hospital charges, especially those with no medical problems, a high deductible and private

insurance. They are being asked to pay a lot out-ofpocket for a preventive procedure at a time when many cannot afford the expense.”

PURSUING A SOLUTION

“Not only was opening the center about providing better access to care to our local patients, but we thought that it might help all of us who are in separate practices,” Dr. Drake says. “We really felt like this partnership might allow us to become more of a functioning group than individual physicians. My hope was that if we were able to do this project and do it effectively, it would really serve as our unification.”

As soon as they observed patients leaving Gastonia County for treatment elsewhere, a group of gastroenterologists approached the local hospital about the need for the county to develop its own endoscopy center, says gastroenterologist Neville The Physicians of Greater Gaston Endoscopy Center: (left to right) Forbes, MD, of Gaston MedNeville Forbes, MD; Co-Medical Director, Sam Drake, MD; Co-Medical ical Associates in Gastonia.

Director, William Watkins, MD; Austin Osemeka, MD “We thought we could open THE GOAL ACHIEVED a center through a joint venture with the hospital. This Greater Gaston Endoswould help prevent further exodus of In late October 2010, a group of Gas- copy Center (GGEC) opened and bepatients and hopefully allow us to recap- tonia gastroenterologists successfully gan seeing patients in early February. ture our patients that were leaving.” petitioned the state to open the center. GGEC features two procedure rooms.

“We just got tired of waiting,” says Dr. Drs. Drake and Watkins serve as coGaston County was the largest county Osemeka. “We decided that if the hos- medical directors, with Drs. Osemeka in North Carolina without a dedicated pital wouldn’t do it, we would try to do and Forbes also performing procedures endoscopy center, Dr. Drake notes. “We it ourselves. If we wanted to practice for at the center. Physicians Endoscopy proapproached the hospital about opening another 10-20 years in this area, we knew vides management of the facility, with an endoscopy center because we were we needed to be able to keep up with Lara Jordan, a vice president of operatrying to get the people who wanted the times by opening a center rather tions for Physicians Endoscopy, assisting to stay here for their care back. Most of than just keep doing the same thing at the center with ongoing operations. these were people we had seen for years the hospital. If we just continued doing and had done their procedures before, It’s been a long, difficult process, but what we were doing, we would end up but now with the way things were beJordan says she is not surprised that this losing too many patients.” ing designated by the insurance, it was group of physicians stayed true to their more advantageous for them to get But the hospital did not view this action vision. “It just shows they have a trementheir care across the river. Opening a positively, and took legal action to try to dous commitment to the community. center in Gastonia was truly about pro- block the center from opening. After a What I’ve heard, time and time again viding economic access to the residents three-year legal battle, the court struck from all of them, is they just want betof our community.” down the hospital’s claims. Even after ter for their patients. They want their pathe ruling, the physicians approached tients to have options, and to see them The hospital applied for a certificate of the hospital about partnering on a cen- persevere through the legal battle and need to build an endoscopy center and ter, but the hospital declined. “We re- all the time that’s passed, it’s apparent received it in late 2008. But over the next ally tried to do a joint venture, but it just they really just want this project to be two years, little progress on the center successful for the patients.” didn’t materialize,” Dr. Drake says. was made. “They said that, economically, it wasn’t the right time for the proj- So the group of gastroenterologists, Dr. Forbes says the alternative to not ect,” Dr. Drake recalls. “But we knew working with Physicians Endoscopy, be- opening an endoscopy center was one there was an alternative to the joint ven- gan building the Greater Gaston Endos- that he wasn’t willing to accept. “We ture model, and that was complete phy- copy Center in Gastonia. had to stick with the center, otherwise sician ownership.” the cost to receive care here would be-

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come so prohibitive for patients. Once that happened, there would no patients for us. The other option to opening the center was closing up and leaving, and we weren’t willing to do that.”

For patients who have never been to a surgery center of any type, the experience they will have at the endoscopy center will likely change their perception of what it can mean to receive exceptional care, Jordan says.

“In this county, specifically, many patients don’t have the knowledge of surgery centers,” she says. “If you go to a hospital, it can be an all-day process for an endoscopy-type procedure.

But at an endoscopy center, everything is meant to be easy. There’s the ease of the scheduling process; the ease of parking right in front of the building, walking in and being exactly where you need to be; the ease of being in and out of the building in just a few hours.

It’s such a drastically different experience for patients.”

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It’s also a different experience for the physicians, Dr. Watkins notes. “It’s difficult to get things scheduled at the hospital in a timely fashion because you have about eight gastroenterologist plus the surgeons all trying to get their procedures done there. The hospital recently told me I could no longer schedule procedures on Tuesday mornings. We were at the whims of the hospital, but at the center we will control our own scheduling. The center makes us more independent, and allow us to make our own decisions about what we feel are the best ways to meet the needs of our patients.”

Ultimately it’s the residents of Gastonia and Gaston County that Dr. Osemeka hopes will benefit the most from the new facility. “We are finally able to provide our patients with the care they need at a very cost-effective rate, and do so right here. These are our patients. These are people who have come to us and asked us to take care

of them. I think we have an obligation to do just that.”

Dr. Drake adds, “To stay the course the way we have and finally see our efforts come together is a real statement to people trying to do what’s right for patients. We hope that we will do things in such a way that this will be an extremely positive step for healthcare within our county.”

Lara Jordan, RN, BA, CNOR, CASC, is a VP of Operations at Physicians Endoscopy with over 26 years of experience in surgical services administration and operations.

Lara has experience in improving operations and financial performance as well as knowledge of state, federal and accreditation agency regulatory and compliance standards.

She is CNOR certified since 1996 and CASC certified since 2008. Ms. Jordan has 19 years of hospital experience, starting as an OR nurse at Hahnemann University in Philadelphia and finishing her hospital career as the perioperative director at Lehigh Valley Hospital and Health Network, in Bethlehem, PA.

New York Endoscopy Centers

Making a Difference

BY ROBERT KURTZ

T

hroughout New York, endoscopy centers are making a significant impact on the lives of the uninsured and underserved, and in some cases even helping save those lives. They’re having this effect by providing residents all over the state with free screening colonoscopies.

The second reason concerns the desire to remain open to be able to provide that care.

CERTIFICATION REQUIREMENT

Robert Kurtz

Their reason for providing charitable care is two-fold. The first is a natural desire by physicians and healthcare workers to provide care to those who need it, says gastroenterologist Brett Bernstein, medical director of Eastside Endoscopy in New York and director of clinical integration for endoscopy and gastroenterology at Mount Sinai Health System in New York.

“As individual doctors and those of us working in endoscopy centers, we all are obligated and naturally want to provide care that’s high quality, safe and also equitable, which means providing care to everybody regardless of their ability to a fford the care,” he says. “There are many imperatives when you’re providing care in this type of setting. There’s the quality imperative, economic imperative, operational imperatives, and then there’s the moral and ethical imperative, which is what charity care is all about.”

New York, like many states, is a certificate of need state. Up until 2009, endoscopy and other ambulatory surgery centers (ASCs) were granted certification (a higher form of quality than licensure), referred to as an Article 28 Facility in New York.

Following an extensive process, the facility received a permanent certification—at least what they thought was permanent.

As a component of receiving the certification, these centers needed to commit to providing charity care, but it was not a requirement. In 2009, that changed.

The New York State Department of Health (DOH) and its related body, the Public Health and Health Planning Council, continued granting certifications for new ASCs but began placing a “limited life” on the certification for five years.

This limited life certification has certain contingencies attached to it. One of the contingencies is a certain percentage of an ASC’s case volume has to be charity care cases with data reported to the DOH. Failure to meet this requirement, amongst others, could result in the DOH not granting renewal of a facility’s certification.

While Eastside Endoscopy had a longstanding commitment

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to providing charity care, establishing a program that documented these cases and would ensure the center met this requirement was easier said than done, Dr. Bernstein recalls.

“Charity was important to us from day one, but the ability to take the concept of charity care and turn it into a practical, successful program turned out to be a more laborious task than we expected,” he says.

Health Organizations that some of NY ASCs work with for their Charitable Care/Free Screening Colonoscopy Program: • Charles B. Wang Health Center • Community Healthcare Network (11 Center Network) • Cornell Community Clinic • Gouveneur Hospital • Institute for Family Health (10 Center Network including Hillman & Phillips Family Clinic and NYU Free Clinic) • Hudson River Health Clinic • Hudson River Health Center (HRHC) and the Cancer Service Program • Renaissance Health Center • Rockaway Free Clinic • Rufuah Health Center • The Nena Ryan Center • William F. Ryan Health Center Network (5 Center Network)

Ann Sariego, Physicians Endoscopy’s vice president of operations for New York and New Jersey partnered centers, says the first step in launching formal charity care programs for Physician Endoscopy’s centers was to determine how to locate appropriate patients.

“We had to come up with a way to find people who were uninsured,” she says. “We also wanted to make sure we helped the underserved population. Many people may have insurance, but that doesn’t mean they can afford testing or treatment.”

LAUNCHING THE PROGRAM These efforts took off after Sariego says she was introduced to a contact at the New York City Department of Health and Mental Hygiene (DOHMH). “Through this relationship we were connected with other departments within the DOHMH who were charged with trying to prevent colon cancer and improve access to screening for everybody. We also connected with the American Cancer Society and the Citywide Colon Cancer Control Coalition.”

Dr. Bernstein notes, “That enabled us to develop relationships with federally qualified health centers (FQHCs). These health centers generally provide care to patients who are indigent, often below the poverty line and don’t have the means to receive regular care in any other way.”

While the FQHCs represented great sources to identify patients in need of screening colonoscopies, some facilities lacked the infrastructure necessary to ensure the patients arrived at Eastside Endoscopy for their screening. So the center made an investment.

“We took it upon ourselves to hire a navigator,” Dr. Bernstein says. “This navigator functions as a liaison both to the centers we work with but also to patients these centers refer to us.

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The navigator is responsible for doing an intake on patients, reaching out to them to ensure they understand their preparation before the procedure is done, where to go for their procedure and if they have any questions. The decision to invest in a navigator was a crucial step in making this program successful.”

Dr. Moushumi Sanghavi, a physician at Eastside Endoscopy, was chosen to serve as assistant medical director for the program. “Our assistant medical director works with the navigator to make sure the patients who are referred are appropriate candidates for screening colonoscopy exams,” Dr. Bernstein says. “The assistant medical director is responsible for following up if there’s any significant pathology obtained as a result of the examination.”

He says the success of the program requires a collaborative effort involving a team consisting of the navigator, nurse manager, center administrator and clinical leadership. “Our center manager, Helen Lowenwirth, has made the grassroots efforts to visit the leadership of these FQHCs onsite and develop the relationships that have been key to the success of the program. Our Director of Nursing, Fran Glennon, has methodically developed a scheduling system that has lead to broad participation by our physicians in this important initiative.”

Physician Endoscopy centers all over the state follow a similar model to identify the uninsured and underserved in need of screenings, Sariego says. “It took us quite some time to develop a program where we would feel comfortable knowing that these patients would be seen at FQHCs by a primary physician, screened appropriately at that level and then referred to one of our centers.”

Critical to the success of these efforts has been the providing of services free of charge by the participants in the program, she says. This includes the physicians, anesthesia providers, pathology companies to perform biopsies and many other individuals. It also includes Braintree Laboratories, a pharmaceutical company based in Braintree, Mass.

“Braintree donates the bowel prep for these patients,” Sariego says. “They didn’t hesitate to commit to supporting

the program when we asked. They will donate the prep in whatever way is necessary to get it to the patients in need.

They will provide coupons patients can use to pick up a free prep at a pharmacy, or if patients don’t have this access, Braintree will deliver the prep. They have been excellent partners.”

With a strong framework in place, Dr. Bernstein says the program has been a tremendous success at Eastside Endoscopy. “Over the past two years, we’ve had 750 qualified referrals that resulted in more than 350 free screening procedures performed at the center. The ability to give back to the community in this way is very gratifying.”

Physician Endoscopy centers now work with more than a dozen FQHCs. “Physician Endoscopy and its partner centers are not only providing charity care, but we’ve established a program that we feel can be replicated nationwide or outside of our centers,” Sariego says. “This may have started with a requirement which we had to meet, but I think it’s developed into something that’s even more significant.

It’s about developing the means to screen the nation.”

ADVOCATING FOR ASCS The success of the charity care programs at endoscopy centers throughout New York provide further support for the value and need of ASCs throughout the country.

Sariego is looking forward to helping make a difference on the national level through her new position on the board of ASCAPAC, the Ambulatory Surgery Center Association’s (ASCA) nonpartisan political action committee (PAC).

ASCAPAC is a critical piece of ASCA’s federal advocacy strategy, says Heather Ashby, ASCA’s deputy director of advocacy. “As the only national PAC representing all ASCs, ASCAPAC allows members of the ASC community to strengthen their voice in Washington, D.C., by pooling individual contributions into a unified war chest of resources.”

ASCAPAC works on all ASCA priority legislative issues, which includes preventing barriers for patients to receive screening colonoscopies. “In the last session of Congress, ASCAPAC coordinated within the ASC community to host

an event with Rep. Charlie Dent (R-PA), a colon cancer screening champion,” Ashby says.

In addition, ASCAPAC has worked with ASCA-member GI/endoscopy centers across the country to host similar events for ASC-supportive members of Congress, she says.

“ASCAPAC plans, schedules and hosts these events to provide local ASC leaders the opportunity to build relationships with their members of Congress and ensure they have the support they need to keep fighting for ASCs in Washington, D.C.” Sariego says serving on the ASCAPAC board will provide her with the opportunity to play a more significant role in helping surgery centers receive state and national support.

“My goal is to try to keep elected officials in office that are committed to keeping surgery centers viable. Without them, at the end of the day, we’re not going to be able to provide the access to care needed to provide screenings and prevent colon cancer.”

Robert Kurtz is the founder of Kurtz Creative, a provider of writing, editing and consulting services primarily for the healthcare industry.

He is the former editor of Becker’s ASC Review and Becker’s Hospital Review. For more information, visit www.kurtzcreative.com.

Annie Sariego, CASC, VP, Operations, joined Physicians Endoscopy in 2011 and has over 30 years of healthcare industry experience focused in the hospital and outpatient surgery center setting.

She has a strong background in business and clinical operations in ambulatory surgery center arena, including ASC/hospital joint ventures, and has extensive knowledge of state, federal and accrediting agency regulatory and compliance standards. She holds the CASC credential, Certified Administrator Surgery Center, and oversees operations for PE’s New York and New Jersey Centers.

Brett Bernstein, MD, is the medical director of Eastside Endoscopy, LLC in Manhattan, NY. He is also the director of clinical integration for gastroenterology and endoscopy at Mount Sinai Health System and the director of endoscopy at Mount Sinai Beth Israel in New York. He is a member of the American Society for Gastrointestinal Endoscopy Quality Assurance Committee. Dr. Bernstein is the program director of gastroenterology fellowship at Mount Sinai Beth Israel and a clinical associate professor of medicine at Icahn School of Medicine Mount Sinai.

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Self-Service Registration Kiosks: Is Your ASC Moving in the Right Direction?

BY AMY FASTI

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atients arriving at physician offices, ambulatory surgery centers, and even hospitals usually expect the customary steering to the registration desk where a staff member will review information and collect patient liabilities. However, there is a growing demand and availability to integrate technology into these settings. In a world where privacy concerns are at an all-time high, patients desire improved and safer ways to share their personal information.

In conjunction with that, many medical providers seek cost saving measures in operations without jeopardizing quality or results. Self-service kiosks may be a solution to the need for improved front office processes and efficiencies, as well as heightened patient privacy.

groups, its use in the healthcare setting is expanding.

On a daily basis, the general population interfaces with self-service kiosks.

Pumping gas, self-serve checkout at the grocery store, and self-serve check-in at the airport are all examples of the same technology used in different industries. As this technology crosses all age

Some kiosk technology provides automated verification of benefits. There is already software available outside of the kiosk that automates verification of benefits, but often the software is faulty, creating double the work for the medical staff.

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Dig a little deeper and many benefits can be discovered.

Does your ASC Amy Fasti struggle to collect up to date information, or even error free information? Do you have staff who spend countless hours on the phone or pulling up websites manually to verify patient benefits? When front office staff are absent due to sickness or vacation, do you scramble to find ample coverage without sacrificing key clinical staff?

Self-service kiosks may be the answer to these dilemmas too.

There have been improvements in the automation of verification of benefits, and these can be exponentially beneficial when built into the kiosk platform.

Prior to the patient arriving for an appointment, the software will flag the case if patient information is incorrect or if there is no coverage. Quality kiosk technology can drill down the information so that it is customized for a specific specialty or setting, like an ambulatory surgery center. Imagine staff no longer logging on and scrolling through payer websites. Even better, staff can reduce or eliminate phone calls that take an eternity just to verify benefits. There still can be shortcomings in this area, but not necessarily at the fault of the software. Specifically, if a patient requires an authorization, the payer website will provide the need for the authorization through the kiosk software, but it will not give the actual authorization number. In those cases, staff will have to revert to customary processes to obtain the authorization; however, the information to get to that point could be more efficient through use of the kiosk software. The automation of retrieving the benefits information is extremely valuable, and when married with a kiosk, it allows the patients to view their individual benefits during the self-registration process, allowing them to pay copays directly at the kiosk with an easy swipe of a credit card.

Consider another common quandary for an ASC: how do you handle front office staff absences with a full day of scheduled patients? All providers have been faced with this issue, and there are often a couple of different outcomes. First, maybe a medical technician is pulled to help with the shortage at the front desk. No one wants patients to wait longer than usual during the registration process. This makes perfect sense, but the technician’s duties would then fall behind. Some-

where along the chain, something is going to feel the tension when reliance is based solely on staff. Another common solution is to manage the front with whatever staff are still available, which could cause bottlenecks and unhappy patients.

Envision using a kiosk in the front office to offer the balance between direct human interaction and automation. A kiosk will never eliminate human interaction 100%, and nor should it in a medical setting. However, if you use both, the results could be an increase in efficiencies and customer service.

This can be correlated to a setting such as the self-service check-in at an airline. There are still staff available who interact with customers, but the kiosks allow them to check-in quickly and efficiently to keep everything running smoothly. This same type of logic can be used in an ASC or other medical providers. Use of the technology certainly makes staff shortages a minimal issue. If an ASC is looking to scale back on labor cost, this can offer that advantage as well. In terms of efficiencies, checking in at a kiosk can take 2-3 minutes compared to the 10-15 minutes experienced during face-toface registration.

Technology is a partial solution to inefficient processes related to verification of benefits and registration. Understanding procedures and results is key to identifying important changes that will create increased efficiencies. Coupling smart changes in processes with sound technology will likely add to your bottom line, reduce stress of staff, and hopefully result in a better patient experience.

Amy Fasti, VP, is the Ops & Revenue Cycle Manager at Physicians Endoscopy. Ms. Fasti has led the billing team since August 2004. She has over 15 years experience in the healthcare industry. Ms. Fasti currently works with ASCs to improve cash collections by analyzing and implementing changes related to the full cycle of scheduling, registration, billing, and collections. She remains on top of healthcare reimbursement changes to provide continued support and education to center staff and physicians. Ms. Fasti has earned a B.S. in Economics and a Masters in Business Administration.

THE BRAIN-GUT CONNECTION:

Media-delivered bowel-centered mindfulness meditation as an adjuvant therapy for irritable bowel syndrome

BY DR. MISSALE SOLOMON, DR. CONSTANTINE FISHER, DR. MARCI LAUDENSLAGER & DR. OLEG GRAPP

I

rritable Bowel Syndrome (IBS) is a familiar, yet enigmatic, disease process. Despite our general familiarity with IBS, we as physicians are often unable to help our patients achieve remission.

Instead, IBS has become a chronic disease with patients reporting persistent or relapsing/remitting symptomatology that is often refractory to current medical therapy. While conventional pharmacologic therapies may be potentially effective in patients with mild to moderate symptoms, they frequently fail to provide consistent symptomatic relief in patients with severe disease. As such, IBS patients (and particularly those with more severe disease pathology) report an associated decrease in health-related quality of life as compared to the general population.

The refractory nature of IBS stems from the fact that the etiology of this syndrome remains unclear. We are (therefore) able to treat symptoms of the disease without addressing the precise etiologic factors which govern disease progression. Though the brain-gut axis is undoubtedly involved in the development of IBS, progression of the disease is very likely a multifactorial process involving a complex meshwork of genetic, psychologic and environmental factors. It is this profound complexity that has persistently thwarted efforts to establish effective treatment plans, thereby frustrating both patient and practitioner.

Dr. Missale Solomon

Dr. Constantine Fisher

Dr. Marci Laudenslager

It is this frustration, perhaps, that has led to the generation of novel, alternative therapeutic approaches to the treatment of IBS. Though these modalities are not new to medicine (most have roots in Theravada Dr. Oleg Grapp Buddhism), they have most certainly increased in popularity over the past decade. Alternative modalities include Cognitive Behavioral Therapy (CBT), mindfulness meditation/relaxation and psychoeducation, as well as many others. CBT remains the most widely studied alternative treatment approach for IBS. Though CBT-based approaches, including mindfulness and meditative practices, have been W I NTE R 2 0 1 5 EndoEconomics

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shown to improve IBS symptom severity in some patients, utilization of this form of therapy is limited by time and cost to both provider and patient. Internetbased approaches have been developed with the aim of providing the benefits of cognitive behavioral therapy and mindfulness practices to patients who are unable to adhere to weekly sessions with a physician or therapist. These approaches, though generally more accessible than traditional CBT, remain equally as intensive. Patients engage in hours of weekly practice, homework assignments and remote conversations with therapists via email or telephone.

As practitioners in an urban environment, we found a number of limitations with even the most simplistic of cognitive behavioral therapy regimens.

The patient population of Center City Philadelphia is, like that of many urban centers, highly diverse. Our patients display a unique ethnic, racial, educational and economic heterogeneity.

Our clinic patients, in particular, represent a specialized subset of the Philadelphia urban community. Patients are generally of a lower economic status with the majority of patients displaying poor health literacy. They are a working class people who are markedly distinct from those represented in the present body of IBS literature. It is not uncommon for patients to travel on several different bus and train lines to arrive at their clinic appointments. Even on the best of days, it may take several hours for patients to meet with their health care providers. During poor weather conditions, many are unable to obtain any form of medical care outside of ur-

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disease process purely be seeking out routine medical care.

Physicians Endoscopy is a long-time supporter of the Pennsylvania Society of Gastroenterology (PSG). At the 2014 annual meeting, Carol Stopa, vp business development, spoke with several of the poster candidates who were displaying their clinical studies during the conference. Each year selected GI fellows and internal medicine students display their research posters and are judged by the PSG leadership. “It’s impressive the amount of time and dedication these young physicians and specialists put into their research. Every candidate is so eager to discuss their studies and overall results. Drs. Fisher and Grapp were very proud of the rewarding work they have accomplished.”

gent care centers and the emergency department. Patients often risk losing their jobs in order to make clinic appointments, as most are employed in the service industry and are not often granted time off from work. If, through all aforementioned obstacles, patients are able to arrive safely to clinic, they do so with a significant burden of great stress and anxiety. In the setting of IBS, patients effectively worsen their

It was this treatment catch-22 which led to the development of our media-delivered, bowelcentered mindfulness meditation program. We aimed to create alternative medicine audio aids for our unique subset of patients with IBS. The program itself consists of a simple, two minute audio file that walks patients through a series of deep abdominal breathing and mindfulness meditative exercises. Patients are able to upload files onto their computers, tablets, smartphones and mp3 players. If patients do not possess mp3 compatible devices, files are made available by CD. Patients were asked to listen to the provided files several times per week and record a log of their symptoms in a diary. Diaries contained questionnaires with components of the GSRS-IBS – a well-studied symptom rating scale for patients with IBS. Preliminary data suggests that patients may experience improvement in symptoms by participating in this abbreviated, “mobile medicine,” mindfulness meditative approach. We additionally found, anecdotally, that patients reported increased compliance with the protocol given the ease of accessibility.

Though these data are indeed preliminary and have a number of limitations (sample size being perhaps the most significant), we are hopeful that the approach itself suggests a new facet to modern medicine.

In developing a media-delivered method, we hope to increase both accessibility and adherence to medical care while minimizing cost to patients. Through the development of a “mobile medicine” modality, we seek

to incorporate traditional mindfulness practices with familiar, easily accessible technology. By studying the urban patient, we aim to provide an effective, novel form of therapy to patients who are otherwise not represented in the IBS literature.

Most importantly, it is our most sincere hope that this approach may serve to empower patients in their path to wellness. Via mobile medicine, all patients are invited to plug in, breathe in and be well.

Dr. Missale Solomon is a gastroenterologist and provides consultation in the field of Gastroenterology and Hepatology. Her special interests include clinical nutrition and small bowel disorders in addition to general gastrointestinal disorders. She has a strong focus in improving patient awareness and education in managing obesity.

Dr. Constantine Fisher is a resident physician of the Drexel University College of Medicine Internal Medicine. He graduated from the City University of New York City College BS/MD Program with Honors and completed his clinical training at New York Medical College. He will be a Fellow of Hepatology this year at Rutgers New Jersey Medical School University Hospital.

His interests include enhancing patient education, improving communication between physicians and patients, and studying general gastrointestinal disorders.

Dr. Marci Laudenslager is presently an internal medicine resident at the North Shore LIJ Hofstra School of Medicine. She received her bachelor’s degree from the Pennsylvania State University and subsequently became a research scientist at the Children’s Hospital of Philadelphia, where she and her team worked to identify ALK as the major neuroblastoma predisposition gene. Dr Laudenslager reveived her medical degree from Drexel Univeristy College of Medicine, and now has a strong interest in the genomics of gastrointestinal disorders.

Dr. Oleg Grapp is a resident physician in his second year at the Drexel University College of Medicine. He received a bachelor of Science in Biology from Temple University, graduating magna cum laude, and then attended the Drexel University College of Medicine. His research and interests include irritable bowel syndrome, hepatitis C virus, and the role of peritoneal dialysis in patients with concomitant end stage renal disease and cirrhosis with refractory ascites.

Turning Low Volume Days

Into High Productivity Opportunities

BY LARA JORDAN, ROB PUGLISI & BOB ESTES

MOST SURGERY CENTERS SEE THEIR VOLUME INCREASE AND DECREASE THROUGHOUT THE YEAR. IT IS RARE FOR AN ASC TO EXPERIENCE A CONSISTENT NUMBER OF CASES DAY IN AND OUT. There are many reasons why a center’s volume may change. At the beginning of the year, the number of cases will often decline from the end of the year because many deductibles reset at the start of a new year.

This leads patients to put off elective procedures until their deductibles are met. When physicians take vacations, volume will naturally decline, as it likely will be during periods of time when schools are closed and families go on vacation.

For ASCs to remain financially viable, it is critical to adjust staffing for volume whenever possible, advises Bob Estes, MSPT, CASC, vice president of center development and implementation for Physicians Endoscopy.

“In those times when there is lower volume, it is important to flex the staff W I NTE R 2 0 1 5 EndoEconomics

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as much as you can,” he says. “If we anticipate low volume, we are going to adjust the staff schedule because we will likely be busier and need staff to stay longer another day. We always recommend informing staff, during recruitment and hiring, that as an outpatient surgery center, we don’t have call and typically are without weekend scheduling. This is an upside for qualified staff as we schedule for cases and not for shifts. Our goal is to stay busy and productive enough so everybody is gainfully employed and getting a full schedule.”

Cancellations can also create time in the schedule. While cancellations can be expected, should work to reduce them as as possible.

open some ASCs much

“For many years it seemed to be understood that a 10% cancellation and no-show rate across outpatient services was the norm,” Estes says. “It doesn’t need to be that high, but a productive center can be so busy that oftentimes trying to reduce that rate is one of the last projects undertaken when it should be one of the first. It’s a quality improvement and operational flow project.”

ASC staff should emphasize to patients the importance of keeping the appointment and the value of the care they will receive.

“It’s all about improving communication with your patients, beginning with the first contact you have with patients: at the time you are scheduling their procedure,” Estes says. “Make the scheduling process as easy as possible. Get patients fully informed and engaged. Make sure they have the preps they need. Provide good directions to the center. Educate them on their financial responsibility. Through

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that first contact and subsequent contacts made when providing reminders, therein lies your best opportunity to make sure patients keep their appointment.”

BE PREPARED FOR SLOWER DAYS Through efforts such as flexing staff and working to reduce cancellations, surgery centers can be proactive in trying to optimize staffing. But ASCs will inevitably encounter days when there are gaps in the schedule and flexing is not an option. Rather than view this development negatively, surgery centers can put a positive spin on it by using this available time to tackle a wide range of important projects, says Robert Puglisi, CASC, vice president of operations for Physicians Endoscopy.

“First thing I would do with this available time would be to look at all of the center’s policies and procedures, and have the staff walk through them,” he says. “They should work to determine whether each policy and procedure represents what actually happens in the center. If it doesn’t, this presents an opportunity to either update the policy and procedure to reflect the current practice or provide training on the existing policy and procedure.”

In addition to reviewing policies and procedures, downtime presents an opportunity for staff to review instructions for using supplies and devices, says Lara Jordan, vice president of operations for Physicians Endoscopy.

“Let’s say you recently installed a new scope washer,” she says. “Training on how to use it should have been conducted when it was installed, but if training was provided a month or two ago, and you have now been using this piece of equipment for a little while, take a step back and retrain on its use.

Pull out the manual and instructions,

reread it and make sure everyone is using the equipment correctly. This is also particularly helpful with new staff members, who likely received a lot of training all at once when they started and could perhaps use some refresher training.”

Any time a surgery center encounters a slow period is a good time to work on a quality improvement project, Estes says. “That’s a project which lends itself to either an individual or group of people. Get together, conceive of a topic, gather data, analyze that data and put together a worthwhile quality project.”

When multiple staff members have free time, this presents a terrific opportunity for group discussion and brainstorming, Jordan says.

“If it’s close to the beginning of the year, this is a great time to gather staff together and have them discuss what really worked and didn’t work last year; what did we implement that was new that we liked; what did we implement that didn’t work so well,” she says.

“Come up with a list of suggestions to management about process changes that could be made. This is all about getting the staff involved and committed to the success of the center.”

Estes says he has witnessed the value of bringing staff members together to discuss marketing ideas for a center.

“There were lots of folks at one facility that had a great deal of enthusiasm for participating on a marketing committee,” he says. “They came up with many ideas for different marketing strategies, from participating in health fairs to developing content for a new website. All we had to do was plant a seed, use the time that was available to meet and the staff ran with it.”

Not all projects will be received with such open arms, but that does not mean you should not use downtime to tackle them. “One thing centers could always use is some cleaning up,” Puglisi says. “Go room by room. Clean anything with dust on it. Bring any equipment that’s been sitting around back to where it belongs. Clean the vents.

Wipe the bottom of gurneys down.”

He continues, “People may not want to do this kind of work, but patients notice dust, cobwebs and clutter. If a patient looks up at the ceiling and sees a dirty vent, that makes an impression, and not a good one. Going around cleaning not only helps support the perception that the surgery center is clean and sterile, but this process may also help you identify facility issues that need to be maintained, such as walls in need of painting.”

VALUABLE TIME FOR ADMINISTRATORS While administrators may want to participate in many of these projects, it is important they take advantage of downtime for their own projects, Puglisi says.

“This is a good time for administrators to go out to their affiliated physicians’ offices,” he says. “Meet with the schedulers, and maybe have lunch with them. Talk with them and find out if there are any issues they have experienced that is hindering their ability to work well with the center.”

Downtime also presents administrators with an opportunity to do some “grassroots-type marketing,” Estes says.

“I’ve gone out with administrators and brought a clinician along with us at times,” he says. “If an afternoon is slow, gather up your marketing collaterals and visit your referral sources

—not only your partners’ practices, but go to see their referral sources.

Let them know you’re there on behalf of the surgery center that takes care of some of their patients. Provide information on the ASC and answer any questions they have about the center.”

If administrators want to tackle work during downtime that does not involve staff, it is imperative that they learn how to assign projects, Jordan says.

“Sometimes when the volume and patient care load is low, that doesn’t mean the administrator is not busy,” she says. “In so many centers, administrators feel like they need to do everything, but they really need to know how to delegate. During staff meetings, they should be telling the staff about the types of projects they will need to do during downtime and then have them report back on those projects.”

She continues, “You can run a center and do all the work yourself, but the minute you ask the staff for their input, they are usually more than willing to give it to you. Assigning projects to staff members and having them take the lead give staff the feeling of empowerment.”

With a little bit of planning, ASCs can quickly make unproductive downtime a concept of the past.

“It’s imperative for an administrator to have a variety of projects ready for staff to tackle when there is an opening in the schedule,” Puglisi says. “There’s always something to be done in a center.”

Lara Jordan, RN, BA, CNOR, CASC, is a VP of Operations at Physicians Endoscopy with over 26 years of experience in surgi-

cal services administration and operations.

Lara has experience in improving operations and financial performance as well as knowledge of state, federal and accreditation agency regulatory and compliance standards.

She is CNOR certified since 1996 and CASC certified since 2008. Ms. Jordan has 19 years of hospital experience, starting as an OR nurse at Hahnemann University in Philadelphia and finishing her hospital career as the perioperative director at Lehigh Valley Hospital and Health Network, in Bethlehem, PA. Rob Puglisi, CASC, is a VP of Operations at Physicians Endoscopy with over 22 years healthcare experience. He holds an MBA in Health and Medical Services Administration and is a member of CASC (Certified Administrator Surgery Center). Mr. Puglisi has experience in hospital administration, healthcare consulting specializing in private practice acquisition, management and development, and has been employed by one of the largest Blue Cross franchisee as a Sr. Project Manager.

The past twelve years have been spent on the front lines of the Ambulatory Surgery Center business. Six of these years were spent running a single site, multi-specialty surgery center. The balance has been as a Vice President of Operations with responsibility over multiple, single and multi-specialty centers. In addition, Mr. Puglisi has been involved with the ASC industry at the state level with various state associations as well as having testified before numerous state department agencies regarding the ambulatory surgery industry.

Bob Estes, MSPT, CASC, is the VP of Center Development and Implementation at Physicians Endoscopy with over 25 years of broad-spectrum healthcare experience.

His combined clinical and business education, professional credentials and multiple business management roles add hands-on value to each PE partnered center.

Over his career, Mr. Estes has specialized in ambulatory services, developing and managing multiple centers across the United States. He holds the CASC credential, (Certified Administrator Surgery Center), demonstrating his commitment to the ASC industry with single and multispecialty surgery center expertise. At PE, Mr. Estes serves to provide oversight and support for all aspects of implementation, operations, and development opportunities as well as serving as PE board member for multiple centers.

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Front and Center 2014 Top Docs Congratulations to Dr. Christopher Bartolone and Dr. Michael Kozower who are once again honored to be among 2014’s Top Doctors. Drs. Bartolone and Kozower are part of Gastroenterology Associates, LLP and provide colonoscopy and endoscopy services in their two state-of-the-art ASCs: Endoscopy Center of Western New York (ECWNY), as well as recently opened, Endoscopy Center of Niagara (ECNI).

Carnegie Hill Endoscopy (CHE) Held an Open House Showcasing New, State-of-the-Art Fuse Technology On December 4, 2014, Carnegie Hill Endoscopy (CHE) held an open house with over 150 guests from the local medical community. Along with their guests and local officials, they were introduced to the undeniable benefits of FUSE technology.

Attendees were able to see the new technology for themselves and were able to speak with the physicians using this new scope. CHE is the only ASC in New York to offer this revolutionary tool in colonoscopy to its patients.

Digestive Disease Endoscopy Center (DDEC) has received AAAHC

accreditation in December 2014 for a three year term. DDEC, an acquisition partnership with Physicians Endoscopy since August 2012, is also licensed by the State of Illinois and is Medicare Certified. Congratulations to DDEC for their initial accreditation with AAAHC!

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Colon Cancer Awareness Month GEARING UP FOR NATIONAL COLORECTAL CANCER AWARENESS MONTH In February 2000, President Bill Clinton officially dedicated the month of March as National Colorectal Cancer Awareness Month. Since then, it has grown to be a true rallying point for the colon cancer community.

Every year, thousands of patients, survivors, caregivers and advocates throughout the community join together to spread colon cancer awareness by wearing blue, holding fundraising and educational events, talking to friends and family about screening and so much more.

March presents two important opportunities for everyone in the business of healthcare: 1) to provide information to the community regarding colon cancer; 2) to promote awareness of our roles with regard to colorectal cancer screening, prevention and treatment. Physicians Endoscopy (PE) encourages all of its partnered physicians to get their practices involved in Colon Cancer Awareness initiatives.

Here are (additional) ways to get involved and plan activities in observance of Colon Cancer Awareness Month: 1. TALK ABOUT IT Encourage people in your community to talk about the risks of colon cancer and discuss the importance of getting screened for colorectal cancer starting at age 50.

Send out newsletters or postcards to those in your area. Place flyers in areas that will attract attention: doctor’s office, local hospitals, grocery stores, banks, community centers, health clubs, etc. Be active in community groups—join a chamber of commerce or disease awareness groups where you can promote the message of awareness. Send out press releases to the local media or place ads in various publications that will hit your target audience. Use local television, radio, newspapers, community calendars, even your own website or blog to promote awareness.

Each year, more and more celebrities are coming forward to advocate colon cancer awareness—from Katie Couric and Terrance Howard to Morgan Freeman and Meryl Streep. Advocating the message: Colorectal cancer is the second leading cancer killer in the U.S., but it is largely preventable. Encourage the use of colorectal cancer screening conversation starters and distribute questions to ask your doctor— talking points between a patient and his or her physician that may help to ease the patients fears of not knowing what to ask or where to begin. Questions such as: What screening test(s) do you recommend for me? How do I prepare?

What’s involved in the test? Is there any risk involved?

2. DISTRIBUTE COLON CANCER AWARENESS MATERIALS Various organizations supporting Colon Cancer Awareness have free materials available for use—helping to spread the

importance of colorectal screening at any age.

The Centers for Disease Control and Prevention (CDC) has numerous materials available free of charge at http:// www.cdc.gov/cancer/dcpc/resources/ features/colorectalawareness/ as a part of its ‘CDC’s Screen for Life: National Colorectal Cancer Action’ campaign.

Resources include print materials (fact sheets, brochures, and posters) and television and radio public service announcements.

The National Colorectal Cancer Roundtable (NCCRT) developed the Blue Star/ March Marketing Kit for use by its members to help promote National Colorectal Cancer Awareness Month and the Blue Star, the universal symbol for colon cancer awareness. The kit, which includes templates for pins, magnets, postcards, banners, and radio public service announcements, can be found at http://nccrt.org/about/ public-education/bluestar-marketing-kit/.

The National Colorectal Cancer Research Alliance (NCCRA) is dedicated to the eradication of colorectal cancer by promoting the importance of early medical screening and funding research to develop better tests, treatments, and ultimately a cure. The initiative was co-founded in March 2000 by Katie Couric, Lilly Tartikoff, and the Entertainment Industry Foundation (EIF). Various GI industry resources and links can be found at http://www.eifoundation.org/programs/59/ resources.

Want materials more specific to your practice or center? Create your own.

For 2015, Physicians Endoscopy developed a new Colon Cancer Awareness marketing initiative for each of their centers to be handed out to patients and patient caregivers. The main goal of the piece is to help patients develop a better understanding of the difference of a screening colonoscopy and a diagnostic colonoscopy.

3. GO SOCIAL Tweet about it to your peers! Post articles and informative videos on your center’s Facebook page. Use social media platforms as a means of sharing your knowledge of ways to prevent colon cancer and why others should screen for it. Share facts, recipes, fitness ideas, health tips, health insurance coverage information to those you know. Do your part to spread the word.

4. PARTICIPATE IN COLON CANCER AWARENESS EVENTS Dress in Blue Day: This year, national Dress in Blue Day is Friday, March 5, 2015. Encourage others to do the same to show their support. For example, businesses can allow their employees to wear jeans and a blue t-shirt instead of their usual uniforms. Some people both raise awareness and show support for friends or family members who have suffered or are suffering from colon cancer by wearing a shirt that says simply, “I’m blue for my son” or, “I’m blue for Mike”.

Visit http://support.ccalliance.org/ for more information.

The Undy 5000: Created by the Colon Cancer Alliance, the Undy 500 is a 5k run/walk where participants are encouraged to run in their boxers to bring attention to the area affected by colon cancer. Events can be found across the U.S. Visit https://www.facebook.com/ UndyRunWalk for more information.

Get Your Rear in Gear: In part with the Colon Cancer Coalition, the Get Your Rear in Gear (GYRIG) 5K Run/Walk

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events can be found in communities across America. Celebrating 10 years of achievement in 2014, Get Your Rear in Gear is a grassroots movement with the purpose of driving home the importance of colorectal screening. “Get educated. Get screened” is their motto. To find a race in your area, visit http://www.coloncancercoalition.org/.

Take Steps, Be Heard for Crohn’s & Colitis: The Crohn’s and Colitis Foundation of America’s (CCFA) ‘Take Steps, Be Heard for Crohn’s & Colitis’ event is the largest fundraising event— raising awareness for the more than 1.4 million American adults and children affected by digestive diseases like Crohn’s disease and ulcerative colitis.

Find out where the next walk will be at http://www.ccfa.org/get-involved/ take-steps.html.

5. CREATE YOUR OWN Don’t see a colon cancer awareness event in your area? Host your own! In part with the Colon Cancer Coalition, Get Your Rear in Gear has the option of starting your own race. Organizers can submit their request at http:// www.coloncancercoalition.org/get-involved/start-your-own-race/.

daily food and activity diary, using a fiber calculator, using physical activity/fitness assessment tools (such as Fitbit or FuelBand), using phone apps that track diet and fitness (such as Diet Assistant or My Fitness Pal), or using the Colorectal Cancer Assessment risk calculator at http://www.cancer.gov/ colorectalcancerrisk/.

Have a Colorectal Cancer Awareness Month event at your center. Hold a center open house or a general community health fair. Give out information about screenings, and talk about the importance of getting screened.

Organizing and planning the event is crucial. It is important to identify your audience, plan your program, send out invitations inviting people to the event and marketing it accordingly, as well as reaching out to media to spread word of the event prior to the day. Identify public policy officials that help support the cause—everyone from state and local departments to the governor and state legislature to members of Congress. The more widespread the support—the greater the outreach of awareness.

7. OFFER A FREE SCREENING Dr. Moushumi Sanghavi of East Side Endoscopy (ESE), a PE-partnered center, has developed a robust charitable care program with the mission of providing free colorectal care screening and surveillance to uninsured individuals. Since its launch in 2012, the goal of the program has been to perform at least 300 colonoscopies per year to uninsured patients—covering the entire service fee from anesthesia to pathology. “I hope to expand this program in the near future by increasing our referral base and performing non-screening (i.e. diagnostic) procedures for uninsured patients,” she says.

Ad for Gastroenterology Associates, PC and Long Island Center for Digestive Health as a part of their 2015 Colon Cancer Awareness campaign.

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6. ENCOURAGE A HEALTHY LIFESTYLE Encourage families to get active together—exercise may help reduce the risk of colorectal cancer.

Offer a healthy cookbook to patients as a giveaway or center promotion.

Direct them towards personal health tools such as keeping a

For insured patients, discuss health coverage. Patients may qualify for a free screening colonoscopy under their health insurance plan and may not even know it. As deductibles and overall patient liability rise, patients determine what healthcare needs are most important and balance this with financial realities. The Patient Protection and Affordable Care Act (PPACA) requires healthcare insurance plans to cover preventative services (without any cost sharing) for patients between the ages of 50 and 75. Medicare, however, does not follow the same guidelines, but does cover a screening colonoscopy in full when the procedure does not result with a diagnostic maneuver. In either case, verification of benefits plays a crucial role in screening. Screening colonoscopies may save patients cash and potentially their lives.

Positioning the GI Practice for Future Success THOUGHTS FROM THE FIFTH BEATLE

BY KLAUS MERGENER, MD & THOMAS DEAS, JR, MD

R

emember “Abbey Road”, the Beatles’ last studio album? The iconic photo on the cover with the zebra crossing and the four Beatles advancing in single file? - The album got its name from the location of the recording studio just to the right of that photo.

The owner of the studio, George Martin, became a legend in his own right and ended up producing each of the Fab Four’s original albums. “The Fifth Beatle”, as he is affectionately known to his legions of fans, turned 89 last month.

Happy Birthday, Sir George!

How did the Beatles do it? In less than a decade of working together, they created some of the most enduring music of our time. Speaking of their work Martin says, “They were eternally

curious. They wanted to find new ways of doing what they were doing – new harmonies, new endings to songs.

They would always want to look beyond the horizon, not just at it.”1 George Martin worked his magic in the hyper-pressurized environment created by the collaboration and conflict between artists like John Lennon and Paul McCartney. And to what does he attribute the Beatles’ longevity and success? They didn’t get bogged down by the daily challenges of an increasingly competitive, market-driven pop music industry. Instead, they remained inquisitive, tried to anticipate change, and “looked beyond the horizon!”

At the eve of the fifth anniversary of the Affordable Care Act, this quote from the fifth Beatle is worth considering. The GI Roundtable conference in Boston, March 26-28, 2015, will take participants beyond the horizon to explore many of the most important strategic issues currently faced by gastroenterologists and their practices: • How to improve care delivery models and succeed in a more qualitytransparent, value-based payment environment through local efforts to engage, align, and collaborate with

other healthcare stakeholders in our communities with which we have not been previously aligned.

• How to better engage patients in their care, increase patient satisfaction, and how to use these strategies to differentiate your practice.

• In comparing your own strategies and obstacles, what to learn from the successes and failures of others, and how to avoid common pitfalls in transforming the GI practice in this era of rapid change.

• How we may reduce costs for employers without creating financial problems for physicians and hospitals, and how to reduce utilization of services without denying patients the care they need.

• and many more equally important topics...

Consider joining your colleagues at GIRT 2015 for two days of networking and an exchange of knowledge in a relaxed and stimulating atmosphere Let’s jointly figure out what lies beyond the horizon for our providers, our patients, and our practices!

Go to www.giroundtable.com for more information about this Physicians Endoscopy sponsored CME event, and to register for the conference.

Reference: 1. http://somethingelsereviews.com/2015/01/03/ george-martin-the-beatles-appreciation/ (accessed January 26, 2015) Klaus Mergener, MD, is the GI Medical Director at MultiCare Health System and a partner with Digestive Health Specialists in Tacoma, WA. He serves as an Affiliate Professor of Medicine at the University of Washington in Seattle, WA, and is a Trustee on the Foundation Board of the American Society for Gastrointestinal Endoscopy (ASGE). Dr. Mergener co-founded the GI Roundtable and will serve as the Co-Director for GIRT 2015.

Thomas M. Deas, Jr, MD, is the Director of Physician Development for North Texas Specialty Physicians in Fort Worth, TX. After two decades of service in the U.S. Air Force and a 24-year career as gastroenterologist, Dr. Deas recently retired from clinical practice. He is a past-president of ASGE and a current member of the ASGE Governing Board. Dr. Deas will serve as Co-Director for GIRT 2015.

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Marketing Buzz

Brand Awareness: FIVE WAYS TO FACILITATE PATIENT ADVOCATES

BY LORI TRZCINSKI THE LAST TIME A NEW PATIENT CAME INTO YOUR

your content and offerings with their peers. Brand advocates are 83% more likely to share information and 70% more likely to been seen as a reliable source of information than the average person1.

OFFICE AS A RESULT OF A RECOMMENDATION FROM

A FRIEND, FAMILY MEMBER OR COLLEAGUE, WAS THE RECOMMENDER PAID FOR SENDING A NEW PATIENT

YOUR WAY? OF COURSE NOT. WITHOUT CONSCIOUSLY KNOWING IT, THE FRIEND OR FAMILY MEMBER PLAYED A ROLE IN BEING AN ADVOCATE FOR YOUR BRAND. WHAT

MARKETING DOLLARS DID IT COST YOU TO SPREAD THAT

Lori Trzcinski

WORD-OF-MOUTH MESSAGE? ZERO.

Deeply motivated by a natural affinity for the brand, advocates such as the one who recommended your new patient are known as “brand advocates”—enticed to make decisions, to solve problems, and to contribute a wealth of information with little to no incentives or recognition for doing so.

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HOW CAN YOU TURN YOUR PATIENTS INTO BRAND ADVOCATES? 1. Foster patient engagement

are absolutely essential to the long-term success of your practice and your ASC. These brand advocates go beyond your logo, your website, your visual identity.

They play a key role in differentiating your services and patient care from a nearby, competing health organization.

They are a source of referrals, positive reviews and feedback—answering potential patients’ questions and sharing

Spend time getting to know your target patient. Engage with current and potential patients online through your practice’s digital platforms—whether it be Facebook, Twitter, LinkedIn, Google+, your website, your blog. Listen and respond, to encourage interaction online and to increase patient engagement. Further facilitate those connections in person the next time he or she stops by

Marketing Buzz for an appointment. Encourage staff such as nurses or an administrator to be involved as well. You are who you hire. Staff can play a huge role—directly and indirectly—in sharing news about the organization and promoting public health. With digital media, every patient or staff member related to your practice or center has a far-reaching and instant platform to share and advocate on your behalf whether you realize it or not.

2. Create emotional bonds Emotional bonds and connections help to deepen the relationship of the story.

Take an opportunity to further your connection with your patients by reflecting on the history of the practice or the history of the ASC and how you arrived there. What struggles or challenges did you face? What inspired you along the way? Where do you see your role in healthcare going in the somewhat soon or distant future? Encourage them to also share their stories—to engage online on their own social network pages or on your practices’ pages regarding their personal encounters with you, your staff, whomever they may come in contact with that represents your practice or center. A 2014 study from BrightLocal revealed that 88% of consumers trust online reviews as much as personal recommendations—up from 79% in 2013 and 72% in 2012.

3. Strive for consistency and reliability Follow up with your patients. Encourage them to return both to participate on your social or web pages online and to come back for office visits. With 1.0 billion physician office visits per year and 3322 visits per 100 persons, a new or

existing patient is guaranteed to eventually return for another visit3. Through community engagement and maintenance of your practice’s social media and other digital platforms, you are identifying yourself and your practice as a reliable resource that patients will return to in the future.

4. Demonstrate inspirational leadership Both online and offline, share with your patients the passion and drive that brought you into the practice of medicine in the first place. Motivate your patients to do the same. Odds are your patients are aware of who you are and why you are so passionate about your practice—even after only their initial appointment with you. Motivating your patients to share that same passion about things in their life may inspire them to promote you to others.

5. Evoke a positive patient experience The doctor-patient relationship is one that must be nurtured over time. With more patients and less time spent with each one during a visit, every patient encounter needs to be treated like it’s the only one that counts. According to a 2013 multi-city study of over 3,600 online reviews of 300 physicians from “rate-your-doctor” websites, published

by Vanguard Communications, the top two review complaints made by patients were poor bedside manner (43.1%) and poor customer service (35.3%)4—two outcomes that are largely shaped by the overall experience a patient has with your practice and not necessarily reflective of your actual medical skills.

From the moment they schedule an appointment to the moment they return

home after an office visit or a procedure, to the follow-up communications they receive post-visit, every touch-point with a patient is as crucial as the next.

A brand advocate will praise your services to those around them—overlooking even the occasional minor bad experience because of the overall personal satisfaction that interactions with your practice were still well worth their time.

The typical path of creating a brand advocate starts at awareness, advancing to satisfaction, then loyalty—leading to your ultimate goal: advocacy.

Incorporating these five approaches into your daily medical practice will help you to facilitate some of your patients into becoming your very own walking marketing billboard—your brand advocates.

References: 1. Phil Mershon, “9 Reasons Your Company Should Use Brand Advocates: New Research”, http:// www.socialmediaexaminer.com/9-reasons-yourcompany-should-use-brand-advocates-new-research/ 2. Myles Anderson, “88% Of Consumers Trust Online Reviews As Much As Personal Recommendations”, http://searchengineland.com/88consumers-trust-online-reviews-much-personalrecommendations-195803 3. CDC/National Center for Health Statistics, “Ambulatory Care Use and Physician office visits”, http://www.cdc.gov/nchs/fastats/physician-visits.htm 4.

Vanguard Communications, “Online Doctor Reviews: Four Times as Many Patients Peeved About Service & Bedside Manner Than Medical Skills”, http://vanguardcommunications.net/ doctor-online-review-study/

Lori Trzcinski is the marketing coordinator at Physicians Endoscopy and the managing editor of EndoEconomics. Ms. Trzcinski aids in 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.

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Business Briefs Six Tech Trends Physicians Should Watch in 2015

BY DIVAN DAVE

As we near the close of 2014, it’s time for physicians and their medical practices to look ahead to 2015.

Here are six of the biggest technology-related trends on the horizon and what they mean for physicians.

Calls for meaningful use extensions from both industry and federal leaders will continue, and may need to be addressed in order for the entire EHR community to be successful.

1. Industry Consolidation. In 2014, it was difficult for many small- to medium-sized EHR vendors to keep up with the pace of change. Other vendors saw this as an opportunity to gain market share. The EHR industry continues to see high levels of consolidation activity in order to support these market dynamics.

4. Compliance. Giving roaming clinicians the freedom to use a variety of devices during the course of their day is critical.

However, if healthcare IT personnel do not have strict control over the security of patient data, especially on mobile devices, there can be issues with HIPAA and healthcare IT compliance.

What this means for physicians:

Privacy and security issues may prove to be the biggest stumbling block to interoperability, and these issues may ultimately scare off a large percentage of providers from fully embracing information exchange. Still, this remains to be seen.

• Those who have not yet purchased EHRs need to make

long-time viability of the EHR vendor a top consideration when evaluating options.

• Those who have already purchased EHRs should review their vendors to make sure that they are established companies with successful business models.

2. Interoperability. The majority of providers and physicians have acknowledged lack of EHR interoperability and exchange infrastructure as major barriers to health information exchange. They have also identified the cost of creating and maintaining interfaces and exchanges as a major barrier.

What this means for physicians: In addition to the usability challenges surrounding the use of EHRs, physicians face a nascent and often uncertain health information exchange environment, including interoperability challenges associated with the ability of different EHR systems to share patient information with one another. Interoperability of EHRs will become more of an issue as physicians attempt to successfully participate in advanced stages of meaningful use. Providers not using interoperable EHR systems should evaluate different systems that offer interoperability by facilitating data exchange with other HIT systems and devices.

3. Meaningful use requirements and beyond. One of the overall objectives of meaningful use is to have common interoperable data, but the vast array of standards to support the various stages of meaningful use is mind-boggling.

Reprint from: http://www.physicianspractice.com/blog/six-tech-trends-physicians-should-watch-2015

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What this means for physicians:

EndoEconomics WINTER 2015

What this means for physicians:

5. Work flow. In a recent study focusing on challenges associated with implementing EHRs, several hospital executives pointed to work flow issues as the most difficult to overcome.

There’s a powerful force working against the spread of health IT: Physician resistance, as doctors resist adopting work flows that can feel to them more like manufacturing than traditional treatment.

What this means for physicians: While health IT is advancing and enhancing care, challenges related to work flow must be met.

6. Data encryption. Many hospitals and health systems have enacted extensive security and privacy measures to become HIPAA compliant and protect their patients’ personal information. However, even with encryption, passwords, and protocols, data breaches are still occurring.

What this means for physicians: The use of data encryption with necessary security precautions is the only way to ensure the security of protected health information and avoid having to report a data breach. Practices will need to invest in these systems and be sure they are implemented correctly to remain in adherence to the strict healthcare regulations.

Business Briefs Skyscape Releases New Version Skyscape is one of the big three apps, other than Epocrates, and Medscape. Originally released over 20 years ago as a first mHealth tool of its kind, it has released the 2.0.42 version with new features.

The free Skyscape app comes loaded with a valuable package of medical resources, including drug information, medical calculators and clinical information on over 850 topics.

• More than 600 premium resources in 35 medical special-

ties are available for purchase from within this one convenient app.

• Robust features include SmartLink™, Skyscape’s propri-

etary cross-reference functionality; medical calculators; algorithms; interactive images; flowcharts; and frequent content updates.

• Ideal for students and trainees as a part of their curricu-

lum, clinical rotations, certification exam prep or training programs.

• Perfect for advanced practitioners to get authoritative and evi-

dence-based treatment strategies & drug information on the go

Included in the new version: • Skyscape Rx: Comprehensive information on thousands of brands and generics, with interactions (including multi-drug analyzer tool) and over 400 integrated dosing calculators.

• Skyscape Clinical Calculator: Medical calculator with more

than 200 interactive tools, organized by specialty.

• Skyscape Clinical Consult: Evidence-based clinical infor-

mation on hundreds of diseases and symptom-related topics, presented in convenient outline format.

• Skyscape MedBeats™: In-context and specialty-focused jour-

nal summaries, trial results, breaking clinical news, drug alerts and other information, fully integrated with the app’s global search and SmartLink.

For more information, visit www.skyscape.com

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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: Carol Stopa, VP, New Business Development (215) 589-9018 • cstopa@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 • asariego@endocenters.com

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Hagerstown, MD Digestive The physicians of Digestive Disorders Consultants Disorders seeking to expand their Consultants are practice due to growth Located in historic Washington County, MD, Digestive Disorders Consultants offers: • Physician-owned and controlled center • Beneficial call schedule • State-of-the-art endoscopic equipment • Growing clinical research program that allows physicians opportunities to pursue clinical research studies • Location on the same campus and within walking distance of Meritus Medical Center, the local hospital • An easy driving distance to Washington, DC; Baltimore, MD; and Pittsburgh, PA Interested physicians should contact Meritus Health’s Physician Recruiter, Sid Gale at (301) 665-4508, Sid.Gale@MeritusHealth.com or by fax at (301) 733-5653.

Or contact Daniel A. Elyard, Practice Manager at (301) 665-4539.

Current GI Opportunities Garden City, NY

Bucks County, PA

Gastroenterology Associates – Long Island Center for Digestive Disease

The beautiful northern suburbs of Philadelphia

GASTROENTEROLOGY ASSOCIATE – Full or Part Time Excellent opportunity to join a 100% clinical GI practice with an ambulatory endoscopy center in a beautiful suburb north of Philadelphia. The practice is well-established with a solid referral base which continues to grow. The physicians are universitytrained, board certified, and enjoy an excellent reputation in the community.

Patients are seen in a comfortable newly-built office with a very pleasant working environment. Endoscopic procedures are performed in an ambulatory endoscopy center in which the physicians have an ownership stake. 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 successful candidate will be board-eligible/board-certified in GI and proficient in performing endoscopic procedures and consultations. ERCP and EUS experience are not necessary. Call will be shared equally. The daily schedule is reasonable with regularly scheduled time off in addition to a competitive salary, benefits, and vacation.

Partnership will be offered in the practice and endoscopy center. The position´s starting date is flexible.

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

For more information, contact: Carol Stopa, VP, New Business Development (215) 589-9018 • cstopa@endocenters.com

Be

the Know!

Follow PE on LinkedIn® for more GI opportunities and news in-between issues.

Go to: www.linkedin.com/ company/physicians-endoscopy

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