EndoEconomics Winter 2018 Issue

WINTER 2018 ISSUE

EndoEconomics

by Physicians Endoscopy

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

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

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

POSTMASTER: Send address changes to: Physicians Endoscopy, Attn: EndoEconomics, 2500 York Road, Suite 300, Jamison, PA 18929. Periodical postage paid at Merrill, WI. While every effort has been made to ensure the accuracy of EndoEconomics contents, neither the editor nor staff can be held responsible for the accuracy of information herein, or any consequences arising from it.

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Content 4 Message from the President: PE Turns 20 5 Physician/Hospital Relationships: Reflecting Back, Looking Forward

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9 Building Stronger Physician Relationships

Printed in the U.S.A.

14 Shared Savings Payment Model: Making It Work for You

Copyright © 2018 by Physicians Endoscopy.

16 Goal Setting: Make 2018 Your Best Year Yet

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All copyright for material appearing in EndoEconomics belongs to Physicians Endoscopy, and/or the individual contributor/clients and may not be reproduced without the written consent of the Physicians Endoscopy. Reproduction in whole or in part of the contents without expressed permission is prohibitied.

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

11 The Leap to Corporate Partnership: The Advantages May Surprise You

18 Helping Raise Awareness 20 10 FAQs About Credentialing 23 A Winning Concept: Center-to-Center Transactions 25 Understanding and Achieving PCI Compliance 28 Financial Terms to Know: Credit Application and Personal Guarantee 30 Front & Center 32 Current GI Opportunities 35 Dr. Robert Moses Discusses the Pennsylvania Society of Gastroenterology

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Message from

the President Dear Friends, This year marks a special time in the history of our company—Physicians Endoscopy’s 20th anniversary.

Going from start-up to scale-up calls for celebration. It also calls for forward thinking as our greatest accomplishments still lie ahead.

BARRY TANNER Founded in 1998, PE’s journey President and CEO, started as a little company sitting in Physicians Endoscopy a small office writing a business plan with one critical mission—to be the leader in supporting the single specialty of gastroenterology.

It was a bold idea to dedicate an entire organization to only one specialty, but it was our strategic vision to do one thing and do it really, really, really well.

When companies think about growth, it typically centers around people and space. PE started with a handful of people in about 700 square feet of sub-leased space, most of which was empty waiting for the next new hire. Eventually, we graduated to our own office space. However, in ten years we found ourselves suffering through crammed conditions with staff doubling and tripling up in offices, one small lunchroom table and only three bathrooms. They were the good old days. Then in 2010, we again relocated our headquarters to a sleepy little town in Bucks County Pennsylvania where we moved into a building with so much more space—or so we thought. PE’s growth continues and has been exciting.

However, when I truly think about growth, I don’t particularly think in terms of office space, employees or revenue. Instead, I think back to our core mission and the celebration of each center we built and each partnership we achieved, and with that ultimately how it all translates to saving lives. Each center, each physician, each staff member has impacted patients across the country—saving hundreds of lives and loved ones.

We have accomplished so much together during our first 20 years. As a company, we have empowered people to realize their full potential and helped partners reach lifetime goals.

Together, we have all witnessed and been an integral part of the changes in healthcare that are far too numerous to list.

Throughout this time, PE has continued to expand and hone our service offerings, grow our dedicated support team and 4 |

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provide on-going support to the GI specialty.

With all that has transpired over the past 20 years, it is hard to believe we still face transformational change in the practice of gastroenterology. In an effort to meet the challenges, PE is again investing in our ability to support and protect the independent practice of gastroenterology. The drumbeat of more cost-effective and efficient health care is forcing GI practices to at least consider consolidating, and in so doing, to take on a deeper and broader skill set of management expertise that ultimately leads to exceptional data and improved patient access to care.

To our partners, who have known PE all these years to provide quality service to your critically important ancillary business lines, we have expanded and are dedicated to meet your professional practice management needs. Many of you have requested practice assistance, experiencing first-hand the efficiencies and financial growth we have brought to your centers. In response, PE has made the investment that is necessary which is well worth the effort and expense.

When I pause to reflect upon all that we have achieved here at PE, my sense of pride in the team is overwhelming. My thoughts quickly turn to the reality that we are still at the very beginning of what can and must be accomplished, and I am filled with adrenaline of embracing the challenge.

I’m asked how we stayed so motivated through the last 20 years in an industry constantly changing and very often challenging. It’s because we care deeply about the patient experience and the physicians who value our help. We believe we can offer something vastly superior since we are so dedicated to just one specialty.

Today, I think more about the future and what we can accomplish together. Please join me in celebrating a very special anniversary in the history of Physicians Endoscopy.

Our ability to positively impact the GI service line continues to grow and remain an ongoing goal of the organization.

Thank you.

Physician/Hospital Relationships:

Reflecting Back, Looking Forward

LARRY R. KAISER, MD, FACS

MICHAEL K. KOEHLER, MD, FACG

JAMES SAXTON, ESQ.

AMBER WALSH, JD

With the new year upon us, we interviewed four industry influencers to share their thoughts on top issues facing physicians and hospitals, and the opportunities for their collaboration.

Larry R. Kaiser, MD, FACS Dr. Larry Kaiser is the leading health sciences executive at Temple University in Philadelphia. He serves as president and chief executive officer of the Temple University Health System, Senior Executive Vice-President for Health Affairs and The Lewis Katz Dean of the Lewis Katz School of Medicine at Temple University.

James Saxton, ESQ. James Saxton, CEO of Saxton & Stump, has sustained an active health law and healthcare litigation practice for more than 30 years. Jim is a nationally known speaker on healthcare issues and has presented to many prominent healthcare organizations including the Society of American Gastrointestinal and Endoscopic Surgeons and American College of Surgeons.

Michael K. Koehler MD, FACG Dr. Michael K. Koehler practices as part of University Hospitals Medical practices with Gastroenterology Associates. Board certified in internal medicine and gastroenterology, he performs procedures at The Endoscopy Center at Bainbridge and University Suburban Endoscopy Center.

Amber Walsh, JD Amber McGraw Walsh is a partner at McGuireWoods in Chicago. She is the chair of the firm’s healthcare department. Named to “Illinois Rising Stars,” Healthcare, Super Lawyers, by Thomson Reuters, Amber focuses on corporate healthcare transactional work and regulatory matters.

Q: What are the most significant challenges physicians and hospitals faced in 2017?

premiums, certainly in the individual market and perhaps in their other products. There will also likely be an increase in the number of those previously insured who will now again be uninsured, thus putting more pressure on providers, especially safety net hospitals.

Larry Kaiser (LK): There are many challenges that we have faced and will continue to face as we move forward through 2018. It remains unclear what will happen in Washington, D.C., especially with the further dismantling of the Affordable Care Act through the elimination of the individual mandate. The lack of the individual mandate will likely result in insurance companies increasing

The proposed cuts to the 340B Drug Discount Program will have a major effect on safety net hospitals, which depend on the revenue that accrues from this program to partially fund their efforts in providing care of the

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underserved. All hospitals continue to come to grips with increasing expenses, primarily for pharmaceuticals and supplies in addition to increased cost for personnel.

With the continued push from payers, including the federal government, to move care out of the inpatient setting, revenues will continue to decline, thus making expense control that much more critical.

Physicians have had to contend with the implementation of the electronic health record (EHR) that has increased the amount of time spent entering data while they are also being pushed to see more patients. This, as much

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as any other factor, has contributed significantly to physician burnout, a problem becoming much more prevalent. In addition, physicians continue to face increasing regulatory burdens while seeing reimbursement decline.

Michael Koehler (MK): The biggest challenges facing both physicians and hospitals concern the changing landscape of health care. There is tremendous uncertainty with the future of reimbursements to providers and health systems with the Affordable Care Act. Physician offices and hospitals are under pressure to

it also creates new and innovative opportunities. The key to effectively navigating these new risks and opportunities lies in creating, managing and deploying an individual “value story.” Simply put, GI practices that can make a credible argument that they are high value in terms of quality, safety and patient engagement will be the most attractive and financially successful.

The days of simply boasting about value without showing proof are gone.

Your story must be backed up by data.

Amber Walsh (AW): I believe that the most significant challenge is

practice cost-effective medicine while maintaining the highest quality level of care. Tightening reimbursement strains the practitioner in the office setting to see more people in less time in order to be more productive and maintain their practice revenue at the status quo. Hospitals are trying to find ways to achieve the leanest operation from an overhead standpoint. Everyone is being pushed to deliver more for less without sacrificing quality—which is easier said than done.

the present environment created

James Saxton (JS): One of the most significant challenges we have seen are market forces leading to consolidation—not only in the provider market but also in the payer market. Concurrently with GI practices feeling financial pressure to join a hospital or health system, there is a changing landscape in the payer market. In December, CVS announced its plan to buy Aetna. Locally and regionally, health systems are creating dual roles as both payer and provider.

This can be a daunting collective of phenomena for many providers, but it also presents an opportunity for hospitals and physicians who have invested in quality innovation to address patient demands, minimize costs and guard against such threats to distinguish themselves from their fellow providers.

While this adds an unprecedented level of complexity for GI providers,

JS: Understanding new kinds of opportunities for collaboration and

by several converging phenomena.

This includes the much-discussed reimbursement pressure coupled with service to a patient population that is more informed, has higher expectations, views their health care from more of a consumer standpoint, and is more empowered to openly express their satisfaction—or lack thereof—on social media and in other forums. And this confluence exists in a world where cyber security threats are greater than ever.

Q: What strategies should hospitals consider as they plan for the future of their GI services line?

innovation will be key. Being first to the market with a robust, credible, third-party-validated value story will create a competitive advantage in the market place.

GI institute, where physicians from multiple specialties who deal with GI problems are co-located, is a concept whose time has come. A major part of this initiative needs to be access to clinical trials where important questions may be answered. We need to be focused on the needs of patients more so than the convenience of our physicians.

Patients need to be seen at times that

The creation of a value story starts with measurement and quantifying of certain GI-specific value metrics.

In the past, practices had to rely on payer measurements of quality, cost and value. With the adoption of EHRs and innovative measuring tools, some providers gained the capacity to oversee additional “Close measures.

Measurement is becoming a key contributing factor to the success of GI practices. This goes beyond the traditional focus on age-old metrics and requires a new focus on the patient experience and on patient engagement.

infusion centers or other ancillaries, would be optimal.

The bottom line is that well-run GI service lines through a collaborative effort would benefit all parties.

Physician leaders and hospital leadership know how to be costeffective, meet quality benchmarks and deliver the best quality care. If they work together, it would be a win-win for everyone.

alignment between

physicians and hospitals is perhaps more important now than ever.”

LK: There will be increasing pressure by payers to move outpatient endoscopic procedures out of the inpatient setting because of the very significant differential in reimbursement between the settings. Hospitals will need to consider how to increase access to

LAR RY KAISER , MD

work for them and be able to make appointments online as seamlessly as we use a service like OpenTable to make restaurant reservations.

MK: The biggest opportunity, which is essential is for stronger collaboration between hospitals and physician, is to develop and make available the best GI service line at the highest quality and cost-effective means.

outpatient GI procedures, specifically for a procedure like a screening colonoscopy by not requiring a preprocedure visit. Patients should be able to schedule their colonoscopy, have the prep procedure sent to them and then present for the procedure.

Historically, there has been an “us

Looking at GI service lines, patients are concerned with their individual complaint and need to be directed to the physician best suited to deal with the problem. The concept of a

Q: How should hospitals and physicians work more cohesively to manage the patient population in their markets?

MK: In working together, there must be a model where you consider bringing hospital-based employed GI physicians with communitybased GI physicians who share the same goal. This can frequently be done with joint-venture opportunities in endoscopy. This way, you are not setting up a competition between the hospital-based and community-based physicians. Rather, you are creating one team, so to speak, with the shared goal of offering what is best for patients in terms of an ancillary service such as endoscopy.

against them” mentality—i.e., when

Further collaboration is often seen in a

the hospital makes money, the

digestive health institute model where

doctor does not, and vice versa. In

both hospital-based and community

the current environment, this should

GI physicians participate together to

change for the better of all (i.e.,

provide the highest quality care at

patients, physicians and hospitals).

the lowest cost. Such a model, which

Collaboration from a leadership

benefits all parties, should be led

standpoint between hospitals and GI

by people who have expertise and

physician leaders in terms of running

knowledge of quality and GI care

efficient GI service lines, including

paths, which is frequently a physician leader. Within that institute model,

endoscopy centers, liver clinics,

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you have different service lines such as cancer prevention centers of excellence and procedure-related centers focusing on colonoscopy and endoscopy. There is a centralized medical record where everyone is communicating, which eliminates duplication of services. It is all about great care, great customer service and instant access in a patient-centered model. When executed effectively, there are quality and monetary benefits to all.

agreements allow hospitals to retain sole ownership of their outpatient GI service lines but secure much-needed efficiency and quality improvement leadership from private physicians.

patients by using very specific tools and strategies.

Finally, many hospitals and physicians have successfully established clinically integrated networks. These essentially allow physicians to stay private but integrate certain clinical systems to establish collaboration for the sharing of data and to improve quality and performance in an efficient manner.

toward quality care and hold

AW: There are several collaboration strategies that allow physicians to remain in private practice and that allow effective population health

All three techniques involve different types of relationships from a financial standpoint and have different legal requirements for proper establishment, but all are alternatives to traditional employment relationships geared toward improving care to the hospital’s and physicians’ GI patient population.

management. In the GI sector, traditional joint ventures for ASCs continue to provide a consistent, reliable method of cohesively investing in service to a specific market.

Beyond a traditional ASC joint venture, professional service

JS: This all goes back to engagement, which means different things to different people, but what I am referencing here is patients’ understanding their treatment plan, including their role and responsibilities in managing their health. Do they understand endoscopy prep instructions? Is there clear follow up when a return visit is necessary?

Making patients partners in their care and creating accountability on their part has multiple benefits to the provider and patient. This partnership does not just happen. It requires time and sincere effort. Providers must take initiative and work toward developing a true partnership with their

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By taking targeted actions, providers can truly engage and inspire their patients to work collaboratively themselves accountable. Each of these actions should be measured, as should the engagement level of the patient. The data uncovered through these efforts can provide actionable insights to help guide positive change and can be a true differentiator.

LK: Close alignment between physicians and hospitals is perhaps more important now than ever. Over 40 percent of physicians are fully employed by hospitals or health systems, and many others have at least some employment relationship.

If we are to reduce clinical variation, provide more timely and efficient care and do so at lower cost, physicians will have to be engaged with hospitals.

This is particularly important as we see the further implementation of alternative payment models, such as bundled payments, shared savings or fully capitated models.

Accurate and complete documentation with optimal coding will allow hospitals and physicians to be appropriately compensated for the level of care provided and specifically for the level of patient complexity.

Physicians will need to work closely with other health professionals, including nurses, physician assistants, dieticians, physical therapists and pharmacists, to proactively manage patients to promote wellness and anticipate problems in certain patient populations.

Building Stronger

Physician Relationships

By Alexandra Reyes

ASCs looking for worthwhile goals for 2018 can’t go wrong with working to improve physician relationships.

In fact, there are probably few other ways to more effectively bring about organization-wide improvements. When an ASC’s ALEXANDRA REYES relationship with physicians is strengthened, the center can see substantial boosts in its clinical and financial performance.

I’ve witnessed these benefits firsthand during my work at ASCs and with ASC management and development companies. Here are some of my observations along with guidance on how you can improve your ASC’s physician relationships.

Trust is Vital Efforts to build stronger relationships will fall short if physicians do not trust their ASC’s leadership. This is trust that leadership will always have the physicians’—and their patients’—best interests in mind. If the physician is an owner of the ASC, that trust will likely extend to include the performance of the ASC and its bottom line, if doing so does not come at the expense of quality or compliance.

When physicians develop trust in leadership, they are more likely to become willing and engaged partners. When physicians feel engaged, their satisfaction will increase, and they are likely to work more enthusiastically and keep performance improvement of the center at top of mind.

While an ASC’s culture should focus on the delivery of high-quality care, a case can be made to achieve that goal, the culture should revolve around physician engagement.

Don’t Just Talk About Engagement.

“Physician engagement” has been a buzzword for many years. But it needs to be more than just a phrase thrown around. For physician engagement to succeed, physicians must actually be engaged. The manner and extent in which physicians will want to be engaged is likely to vary, so ASC leadership should determine what works best for each individual physician. That’s where communication comes in.

Speak with each physician to learn about their interests and priorities. Do they want a greater role concerning clinical or administrative policy making? Are they interested in helping to support recruitment efforts? Do they feel like they can contribute further to marketing efforts or community outreach? When you identify an interest, find some way— even if it’s small to start—to get the physician involved and go from there. Make sure physicians know that the ASC’s team is available to support them, and ensure the time they spend helping the center through their engagement is maximized.

Be an Active Listener Perhaps the fastest way to kill efforts to improve physician relationships and engagement is to speak with physicians but not truly listen to what is said. When physicians share their thoughts on a matter, offer suggestions or make requests to ASC leadership, they are expecting a response and, if warranted, the taking of an action. Make sure to always close the loop on the conversation. Explain what was done and the reason(s) why.

You can also harm efforts to improve relationships by not seeking input from physicians on matters that will affect them. Even if physicians are not likely to have many thoughts on an issue, you’re better off asking for input. If you don’t, you may end up hearing a physician say, “Why wasn’t I asked about this?” There won’t be many answers you can give that will prove satisfactory. If physicians feel like their input does not matter, they are likely to tune out engagement efforts. Removing this roadblock once it’s in place can prove quite difficult.

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Transparency is Key While physicians don’t need to know every detail about an ASC’s operations and performance, sharing critical details that directly affect physicians can go a long way to building closer relationships and engagement. These details can include surgical outcomes, costs and patient satisfaction survey results.

When physicians gain a greater understanding of their personal performance and its impact on the center, this can motivate them to improve.

Provide Leadership Support If you have physicians interested in taking a more active role in helping lead their center, but they lack a strong leadership background, explore ways to help them develop these skills. Research leadership education opportunities, including online courses, webinars and conferences. You can also consider bringing in executive coaches to provide on-site training.

Start Early The best time to plant the seed of engagement is when a physician starts at your ASC. When you introduce this new physician to the center’s leadership team, share the organization’s history, vision, culture and values. This would go together with reviewing strategic priorities, challenges and expectations.

Such efforts help build trust in leadership through transparency—two elements we noted are vital to building strong relationships.

with primary care physicians (PCPs) in the community. Messaging should focus around expressing appreciation for referrals and exploring how the ASC can help PCPs improve patient satisfaction and scheduling and reduce cancellations and no-shows.

relationships and securing greater engagement of peers, leverage this individual’s willingness. Involve them in your efforts to plan ways to improve engagement and conduct outreach to their peers.

For PCPs who are not yet referral sources, messaging can focus on whether there is an opportunity to change this relationship. Even if a PCP is not in a place to be a referral source at the time, you are planting the seed for a possible future relationship.

Building strong physician relationships must be an ongoing process, so don’t try to do everything discussed here—and your other ideas—all at once. Start slowly, reaching out to your physicians to begin a dialogue about ways your ASC can help them and ways they can help the ASC (possibly to their benefit). Act on the feedback you receive, and go from there. Your efforts should pay off.

Bring Physicians Together While an ASC is required to have a governing board with physician representation that meets on a quarterly basis, you are not precluded from organizing additional committees comprised of physicians. If your ASC is large enough, includes representation from many practices and/or is part of a network of ASCs, such as those under management by a company, explore opportunities to bring groups of physicians together periodically.

These committees could provide an opportunity for physicians to discuss issues affecting healthcare broadly, the ASC industry, their specialty and/ or their practice. Such discussions provide a way for physicians to network and share observations, best practices and ideas for improvement (clinical and financial). If organized effectively

by ASC leadership, the meetings will strengthen relationships between the participating physicians and organizing facility.

Look Outside Your Walls

Identify a Physician Engagement Champion

When it comes to strengthening physician relationships, don’t just focus on the physicians at your ASC. Consider ways to strengthen the ASC’s and its physicians’ relationships

Efforts to improve physician relationships can go smoother if there’s a physician helping lead the charge.

If your ASC has a well-respected physician interested in strengthening

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Every Little Bit Helps

Make sure not to let your efforts fall by the wayside; you won’t want to lose the momentum you gain. As a relationship with one physician grows stronger, this may influence other physicians as well. In time, you will likely see measurable improvements in your ASC’s performance, which will further energize your physicians. If physician engagement can become a core element of your ASC’s culture, strong physician relationships will come more naturally, ultimately for the benefit of patients as well as staff and the physicians themselves.

Alexandra Reyes, RN, BSN, MHA, Vice President of Operations, joined Physicians Endoscopy (PE) in 2017, and has over 24 years of experience in the healthcare industry. Ms. Reyes earned a Master’s degree in Healthcare Administration from Walden University and is a licensed Registered Nurse in New York State. She is an active member of Ambulatory Surgery Center Association (ASCA) and Association of Peri-Operative Registered Nurses (AORN). For more information, she can be reached at areyes@endocenters.com.

The Leap to Corporate Partnership: The Advantages May Surprise You

“Physicians often don’t realize what having a partner can do for them. We bring economy of scale, buying opportunities, contract negotiations—ACCESS started seeing benefits from day one.”

Physicians are experts at patient care, but their medical training doesn’t include the financial aspects of running a profitable clinic. Even with excellent outcomes and above average patient satisfaction, the bottom line can be flat or even follow a discouraging downward trend.

The eight physician owners at Atlantic Gastro Surgicenter, LLC, better known as ACCESS, felt that their ASC could be doing better and took steps to make that happen.

“The medical-economic environment was changing, and we thought positioning ourselves with a strong partner would enable us to better grow the center,” says John Santoro, DO, FACG, AGAF, a gastroenterologist at ACCESS, located in Egg Harbor Township, New Jersey.

Santoro and his partners did their research before choosing Physicians Endoscopy (PE). “We entertained a number of other partners, but PE was the clear winner. While others

— Lara Jordan, VP Operations, Physicians Endoscopy

were just in acquisition mode, PE looked at us individually and had a clear vision of what they could do going forward,” he says.

In November of 2016, ACCESS and PE finalized their corporate partnership. The outcome has been outstanding, with updated equipment, better contracts, an improved organizational framework, and a brighter bottom line—all within the first year of business.

Pro Tip: A business that has been getting by for many years is doing just that—getting by. Instead, your goal should be to excel.

A Well-Established ASC ACCESS was founded in 1996 as a physician-owned

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and operated GI ASC. They later branched out to include additional specialties such as pain management, orthopedics, podiatry, plastic surgery, infusion services and general surgery.

With two procedure rooms and two ORs, they perform over 12,500 procedures a year.

Playing Catch Up Over the years, though, capital improvement updates have lagged.

Their equipment was well maintained, but some items, such as their scopes, were beginning to age.

“Their focus had been on delivering terrific patient care, not always in investing in capital equipment,” says Lara Jordan, VP Operations at PE. “Like many centers, they’d just make things work for another year.”

Payer contracts were also an issue since some hadn’t been renegotiated in many years. According to Jordan, that’s typical for independent centers where owners may not be focused on the process. “When you don’t go to the payers and say, ‘We want an increase,’ they’re not going to come to you and offer one,” she says.

Equipment service contracts also needed to be renegotiated. The group hadn’t looked at budgeting or forecasting that could help them excel financially.

Staffing Challenges Payroll at ACCESS was not wellaligned with productivity or patient volume. Without tracking the center’s financial situation, it was hard to find money for staff raises.

“We’d have evaluations and tell people they were doing a great job, but we couldn’t offer them additional pay,” says Maria Mesiano, Administrator at ACCESS. 12 |

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Without access to the knowledge or training, Mesiano wasn’t able to propose changes to staff scheduling, budgeting or other operational issues.

Also, the facility did not have a human resources department to consult. As a result, these challenges persisted for many years.

Pro Tip: Administrators with limited resources can often make things work anyway. A better plan is to give them what they need to help the organization succeed.

Starting Off Right “The transition has been smooth overall, and getting smoother every minute. I know that Lara manages multiple centers, but it feels like we always have her personal attention.”

– John Santoro, DO, FACG, AGAF

and have budgeted for a new C-Arm as well as scope reprocessing machines in 2018.

“There’s a standard of care the physicians and staff aspire to,” says Jordan. “When you’re telling the world what you can do, you want state-of-theart equipment.”

Better Deals Jordan and her team looked at all of ACCESS’s contracts and agreements with an eye toward saving money. PE has 58 centers, which translates into significant negotiating power. “Within the first few months we were able to save them close to $65,000 a year just on service agreements,” she says.

PE’s experience and nationwide range also helped with payer contracts. With partnerships in most states, they have a good handle on who to talk to and how to make the best deal. That took some extra effort with ACCESS, since it’s a multi-specialty center.

Even before the corporate partnership was finalized, PE representatives were on the phone or onsite talking with staff, reviewing agreements and contracts and otherwise assessing the center. After the acquisition was completed, Jordan spent time getting to know the physician partners, management and staff. Establishing these relationships helped her understand the culture of ACCESS and start prioritizing and implementing needed changes.

“We spent a tremendous amount of time looking at their procedures, looking at different insurance groups and negotiating better contracts,” Jordan says. That involved separate negotiations for the various specialty areas as well as requesting additional coverage. For example, they made sure procedures such as implanting devices for pain management were covered.

Updated Equipment

While the staff at ACCESS had high hopes for the future with PE, they were initially a little apprehensive. “Some of us had been through hospital mergers that involved downsizing, and they were worried about losing their jobs,” says Mesiano. “But that didn’t happen with PE.”

PE surveyed the equipment and replaced the cardiac monitors along with the washer/sterilizer. They also replaced the GI department’s obsolete Olympus EMR system with ProVation and added new computers at all patient bedsides. They are in the process of replacing all the scopes,

A More Productive and Happier Staff

Instead, PE conducted a meeting to

listen to employees’ concerns and answer questions—a process that reassured the staff. In addition, Jordan worked with Mesiano to improve her skills at analyzing service contracts, interpreting financial information and managing the payroll to make sure staffing is appropriate.

“If I had to grade how things were, I’d give some processes a ‘C,’ Mesiano says. “With PE’s guidance, we’ve come up to an ‘A.’ I’ve grown a lot as an administrator.”

With more realistic staff schedules, along with better pricing on contracts and other changes, ACCESS was ready to offer raises for the first time in many years.

A Fresh Coat of Paint With the infrastructure of ACCESS updated, it was time to make the face of the center reflect the changes. Old wallpaper was removed and all areas were repainted. Curtains and carpet were replaced, and the front lobby got new furniture.

“A fresh coat of paint goes a long way,” Jordan says. “Making the place look more inviting helps patients feel more confident and comfortable.”

Pro Tip: Older equipment may function just as well as when it was new. But updating to new gives you the advanced capabilities that have been developed over time.

In addition, the PE-ACCESS partnership will include these ongoing benefits: • A knowledgeable human resources department. ACCESS operated without one before the acquisition. Now they can turn to HR at PE for help with payroll, benefits, retirement planning, employee relations and more.

• Health insurance choices.

PE brought ACCESS employees onto their health plan, which saves them money in their annual premiums and also provides more plan options.

• A dependable process for rewarding employees. The new structure will use evaluations on a regular basis and provide raises for staff who qualify.

• Help with accreditation inspections. Experts at PE consult with ACCESS to ensure they are following state guidelines and are prepared for AAAHC inspections.

In the past, Mesiano was on her own with these processes.

• Strategic planning. According to Santoro, among the biggest advantages of partnering with PE are their management and planning skills. “PE’s methods and metrics are very good. When you see all the data assembled, it’s very useful and meaningful. You know not only where you’ve been, but also where you’re going,” he says.

Pro Tip: Communication is essential to make any partnership work. Look for a corporate partner that is committed to listening and sharing information.

The Bottom Line Managing an ASC can be a balancing act. While it’s essential to budget for equipment, payroll and other expenses, paying for those components depends on the center remaining profitable.

“One of the biggest advantages we brought to them was financial stability.

The bottom line is to always deliver the highest quality of care and to do so in a financially viable way, and we’re very mindful of that,” Jordan says.

Santoro agrees. “We’re looking forward to an exciting future with a significant phase of growth, and that’s because of PE,” he says.

“We didn’t know a lot of the advantages PE would bring until we got into the partnership. It made me wish we had made the move sooner.”

– John Santoro, DO, FACG, AGAF

Long Term Outlook PE’s negotiating skills and economy of scale will continue to benefit ACCESS, providing the best possible deals with contracts and agreements. Updating the equipment is also an ongoing process.

“I’m looking forward to our next inspection because PE has us right on target. They’re here at least once a month, and otherwise they’re just a phone call away.”

– Maria Mesiano, RN, CGRN W I NTE R 2 0 1 8 EndoEconomics

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helped inch the overall payment up. Payers have effectively determined the average cost of many surgeries and bundles to help avoid the line item billing.

Shared Savings Payment Model:

Making It Work for You

GI doesn’t have the same variables during each procedure, so bundles become less interesting to payers. The mindset of both physicians and payers has been to increase the volume of screenings in hopes of preventing many incidents of cancer and reducing overall costs in the long run. In addition, the spend by payers in the GI endoscopy space wasn’t large enough to draw much attention, although that’s changing.

PE is having discussions with payers on value-based contracting, but payers are just starting to pull together the data components available to work through this model, so it’s not available on a large scale.

The Better Fit While bundled payments are not likely a strong fit for GI, we have seen a steady growing number of payers interested in approaching payments that tie into where their money is spent for preventative services (e.g., colonoscopy). More specifically, they want to pay for the provision of these services in an ASC as opposed to a hospital.

By Sharon Hohlfeld

Alternative payment models are garnering significant attention these days, and justifiably so. When executed effectively, they can improve—or at least maintain—the delivery of high-quality care while reducing costs. This is true for GI, but perhaps not with the model that first comes to mind.

SHARON HOHLFELD

Not the Perfect Fit When physicians meet with the Physicians Endoscopy payer contracting team, they usually ask about bundled payments and value-based contracting, and our familiarity with them. Likely due to the attention given to them in the insurance world, these alternative payment models are overarching for most physicians.

At PE, we have had a few opportunities to negotiate bundled payments. However, for the most part, payers are not pushing for this kind of reimbursement model in the GI space. Bundled payments are very effective with orthopedic surgeries where billing for each gauze pad

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Why? It’s likely because of the vast differential between those two facility types in their reimbursement. We also know ASCs typically deliver very good outcomes and can offer several benefits over the performing of these procedures in the hospital. These benefits typically include lower wait times and higher patient satisfaction, to scratch the surface.

It is for these reasons that payers are taking a greater interest in pursuing a shared savings payment model.

Example Scenario How does the model work? From their databases, payers can pull information about where physicians in their network are directing patients for procedures. If a gastroenterologist is directing a notable portion of colonoscopy patients to a hospital, the payer may examine whether it is paying substantially more for those procedures than it would if the physician directed these patients (when appropriate) to an ASC. Each colonoscopy performed includes the physician’s, anesthesiologist’s and pathologists’ professional fees, the

lab fee and technical fee (facility).

When added together, the cost of a screening colonoscopy can vary widely.

For demonstration purposes, let’s suppose if the screening was performed in a hospital, the total payment for these services was $5,000, and if the procedure was performed in an ASC, the total payment was $3,200.

That is about a 48% difference between the two venues.

Using these example reimbursement rates, for 10 colonoscopy patients, an optimal scenario for a payer would be to spend $32,000 for 10 ASC

• Payers win by saving money.

like PE behind them. Without systems

• Physicians and their practices benefit by earning additional income for effectively managing the patient load.

such as the ones we have in place, it can be a time-consuming undertaking to gather the data and then put it in the format payers require.

• Patients benefit by receiving high-quality care in the most appropriate setting, along with the potential benefits of the ASC experience.

Getting Started

• ASCs benefit by receiving more patient volume.

If negotiated correctly, there is no downside to this kind of arrangement.

Need for Quality Metrics

procedures rather than as high as

The other component of a shared

$50,000 for 10 hospital procedures.

savings model is the requirement for

What payers are increasingly willing to

physicians to meet quality metrics.

do is establish a benchmark somewhere

After all, if the delivery of care is

in the middle that considers those

poor, patients are more likely to need

patients who are not clinically

additional care, which increases payer

appropriate for an ASC. The payer

costs. We are seeing payers target

may set a reimbursement benchmark

practices that have demonstrated

of $37,400 for 10 patients (seven to the

years of quality services, meaning

ASC, three to the hospital)—a potential

low incidence of additional

savings of up to $12,600 over the

hospitalizations or repeat services.

cost of these 10 patients going to the

We expect that the future of these

hospital. Under a shared savings model, if the physician comes in below this reimbursement benchmark (reducing the payer’s expenses further) and meets the additional quality benchmarks, the payer shares some of this savings with the physician.

types of reimbursement models will include additional quality metrics and require providing payers with

If a shared savings model sounds appealing to you, your first order of business should be to reach out to your payers and find out if they offer such an arrangement. Assuming they do, and assuming you’re a highperforming group that effectively captures and can produce quality data, ask how you can get involved in shared savings.

You may be hesitant to approach your payers about negotiating a new contract which includes a shared savings component. When negotiations begin, it is possible that payers will try to lower your reimbursement. That’s always a risk when negotiating pay, but if you come to the table armed with data about the quality of your care and an understanding of how your practice and affiliated ASC can help the payer reduce its costs while maintaining high quality, exploring the shared savings model can truly be a win-win.

additional data. While I can’t speak to other ASCs and physicians, I know that PE’s affiliated ASCs and physicians can provide that data and do so with a

To summarize, the shared savings model is a way for payers to motivate physicians—through a payment incentive—to direct appropriate patients to the least costly facility.

short turnaround time. As such, we’re

Across-the-Board Benefits

entering into a shared savings model

There are many winners from the shared savings model:

more difficult for a small group with

confident in our ability to help our partners meet the quality information deadlines and expectations of payers.

This requirement will likely make

Sharon Hohlfeld, Vice President of Payer Contracting, joined Physicians Endoscopy (PE) in 2005 and has over 25 years of experience in healthcare.

Sharon oversees the payer contracting department which is responsible for obtaining network agreements between Physicians Endoscopy partnered centers and the insurance companies, renegotiating current agreements for existing centers to increase revenue on an annual basis, and credentialing the facility with each carrier.

For more information, you can reach her at shohlfeld@endocenters.com.

an affiliated ASC that lacks a company

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Goal Setting:

Make 2018 Your Best Year Yet

By Rodger Baca

Yes, the calendar is correct. It is 2018. Where did the time go? It seems like only yesterday that we were ringing in 2017. What did you accomplish last year? Are you thrilled with the results, or did 2017 leave you feeling you could have achieved more?

and ultimately achieving goals. Let’s examine how such an approach can help with personal and professional goal setting.

The beauty of the calendar is that every January there’s an opportunity to begin anew. The old can be wiped away, and 2018 can be your best year yet, both personally and professionally.

One of the goals that many people RODGER BACA tackle in a New Year is to lose weight. They start out motivated, but before January ends, old habits of eating poorly return.

So why do people fail each year to achieve the goals that seemed important when they were set?

Goal setting is a critical activity each New Year providing the opportunity to break out and establish a new standard. It is something that is often talked about, but few do well. People set goals in a variety of ways. Some create them in their head; I call these good intentions vs. goals. Some take the time to actually write down what they want to accomplish. Others may have attended a business seminar and know that written goals should be SMART: specific, measurable, achievable, realistic and time-bound. While others don’t set any goals finding it easier to take the world as it comes.

I propose that defining SMART goals is a good start and creates a strong foundation from which to begin setting

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Paths to Failure or Success

This phenomenon is not limited to individuals. Most corporations experience the same results. Companies set annual goals, but by February the daily grind interferes with achieving their objectives. The grind has the potential to limit success no matter how well-intentioned executives are when they set lofty goals for their organizations.

Some goals are fundamentally flawed from the outset.

Focusing on personal goals for a moment, a good strategy would be to understand where an individual is today. If someone weighs 210 pounds and wants to weigh 175 pounds, they have determined that they are 35 pounds

overweight. Now we have a starting and ending point and can clearly develop a defined goal: “Go from 210 pounds to 175 pounds by December 15, 2018.” A well-defined goal that is measurable helps you realize what progress is being achieved.

Now to the most important step— establish leading indicators to ensure goals are being achieved.

Just stating “I am going to lose weight” will likely result in no improvement whatsoever. One can’t reach a goal by focusing solely on the end result. The goal, in this case, is a lagging indicator. It reflects the behavior that took place in the past.

This may seem to be an obvious point, but how many businesses, such as ASCs and practices, set goals the same way? While targets are established, new behaviors have not been implemented to improve results. For example, a center wants to grow revenue or patient base; however, every month the results don’t reflect progress toward the stated goals. The reasons? There was no change in behaviors. Focusing on the actions (leading indicators) will drive the results, and measuring progress regularly will gauge if the objective, critical to success, is being achieved. It is also helpful to have milestones along the way. A scoreboard can help track progress and allow for regular wins while working towards the larger goal.

For example, the leading indicator of the goal to lose weight could be caloric intake or workouts. Instead of stepping on the scale every day and being disappointed, monitor and measure caloric intake and workouts. Eating less and exercising regularly ensures a higher likelihood of success. Even more specific, target eating 2,000 calories

per day and five workouts per week.

Focusing on these behaviors will help achieve the intended results, and the scale will ultimately reward the efforts.

Sounds like a simple concept; however, it’s more of a structured approach than what many individuals and businesses take with goal setting. You

achieved before. Set goals that might even scare you a little. We are in the business of preventing cancer which gives us the opportunity to impact peoples’ lives in a way that few are able to do.

Here are a couple of specific goals that might be relevant for your ASC: • Increase adenoma detection rates from 20% to 30% for males by 6/1/2018.

• Increase ADR from 10% to 20% for females by 7/4/2018.

• Increase referrals from Dr. Smith’s practice from 10 to 50 patients by 11/15/2018.

Focus on Success • Set goals that will have a tremendous impact on your organization.

• Make sure goals are SMART: specific, measurable, achievable, realistic and time-bound.

• Don’t focus on the result.

Instead, work on the leading indicators.

• Measure your progress on the leading indicators.

• Celebrate your success!

can “believe” you are doing well, but you need to track progress based on leading indicators to ensure successful achievement of a predetermined goal.

It is the specific measurement of the leading indicator that will help ensure the goal is achieved which has been deemed as essential to success. Many organizations fail to meet their goals, year in and year out, due to lack of focus on what is truly important.

This concept has the same applications in your ASC and practice. As you consider your 2018 goals, commit to making an impact that you have never

Now, with clear goals, what are some leading indicators that will help achieve the goals? Perhaps focus on withdrawal time, as we know that withdrawal times over six minutes help decrease missed polyps.

Concerning referrals, establish marketing efforts to increase education for primary care practices to recognize the high-quality care provided by your ASC. Meet regularly with primary care physicians to improve this relationship. Establish a regular cadence to monitor the leading indicators and watch the results. Have fun with it.

Here’s to 2018! I wish you great success as we improve health care and prevent cancer in this great country.

Rodger Baca, Chief Development Officer, has been with Physicians Endoscopy (PE) since 2014, and is responsible for driving and executing PE’s strategic growth plan of building and acquiring 50 centers over the next five years. Under his leadership, the business development team has successfully achieved a 40% center growth rate in de novo and acquisition transactions, which include hospital and health system joint ventures.

Rodger has more than 25 years of leadership experience, with the last 6 years in the ASC healthcare industry. For more information, he can be reached at rbaca@endocenters.com.

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Helping

Raise Awareness

By Lori Trzcinski There are few better feelings than helping one’s community.

About one in every four people in the United States volunteer every year, spending a median of 52 hours on volunteer activities, according to 2015 data from the Bureau of Labor Statistics.

For small businesses like ASCs and physician practices, volunteering as a team has positive internal benefits. It can boost employee morale, build stronger relationships between staff and improve communication and interpersonal skills.

Community service is also an effective marketing mechanism. A widely sourced statistic, from a study conducted by the Reputation Institute on 47,000 consumers, found that 42 percent of people’s feelings about a company is based on perceptions of the company’s social responsibility. The association that comes with supporting nonprofits and participating in their events can help raise awareness of an ASC and practice and its services to prospective consumers (i.e., patients), physicians and staff— and do so while casting the organization in a positive light.

This is magnified when an event is covered by local news and highlighted on social media.

With Colorectal Cancer Awareness Month coming up

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in March, consider this is a great opportunity to get your ASC and practice out into the community (if you’re not already). Don’t think you have enough time to organize such a team LORI TRZCINSKI effort? That’s okay. March isn’t the only month when volunteering can help you make a difference in the lives of your patient population and bottom line.

Making an Impact Maria Grasso has witnessed the benefits of business involvement in volunteering firsthand. She’s the executive director of Get Your Rear in Gear Philadelphia. Founded in 2009 and supported by the Colon Cancer Coalition, Get Your Rear in Gear Philadelphia organizes an annual walk/run every March to raise money to fight colon cancer. To date, the organization has raised more than $2 million, all of which stays in the tri-state region (Pennsylvania, New York, and New Jersey) to support research, education, advocacy and screening programs.

“Raising awareness of the importance of undergoing screenings is paramount, and colonoscopy screening is the gold standard,” says Grasso, who lost her father and grandfather to colon cancer. “One in 20 people will be

diagnosed with colon cancer, which means everyone is likely to know somebody touched by it. Get Your Rear in Gear Philadelphia elevates personal stories and helps spread the word that screenings save lives.”

Through its fundraising, the organization has funded navigator programs at the University of Pennsylvania and Jefferson University Hospitals. “These navigators are focused on helping ensure people come in for their screening,” Grasso says. “If a patient goes through one of those health systems and is provided a script for a colonoscopy but chooses not to fill it, the navigators go to work.

They’re armed to help that person overcome any barriers to undergoing the screening. They will call the patient up to seven times, offering resources that can cover the cost of the prep, provide transportation and arrange for company following the screening.”

Get Your Rear in Gear Philadelphia has achieved so much success in a relatively short period of time through support from many individuals and organizations. The event draws more than 4,000 participants every year.

“Most people come because of a specific cause,” Grasso says. “They are there to support a loved one who has or had colon cancer.”

importance of screenings. We always welcome sponsorships to help with our expenses, but that’s not the only way to contribute. Organizations can form a team to walk together, and physicians can come on site to talk about what it is they do at the ASC or within their specialty.”

Year-Round Opportunities Does the prospect of your ASC or practice supporting an organization like Get Your Rear in Gear Philadelphia sound appealing? There’s good news:

quick and easy it is to get a screening, which can convince others to get one.

Screenings can be a matter of life or death. The more we can do to build awareness, the better.”

Lori Trzcinski, Marketing Manager, joined Physicians Endoscopy (PE) in 2012 and leads the corporate and center marketing initiatives of PE and its affiliated centers. Miss Trzcinski has a strong background in marketing operations, writing and digital marketing, and is currently pursuing an MBA. Lori is also the managing editor of EndoEconomics.

For more information, she can be reached at ltrzcinski@endocenters.com.

It’s easy. There are dozens of Get Your Rear in Gear races scheduled nationwide. There is a multitude of other types of events centered around colon cancer awareness.

While some events are held in March in conjunction with Colorectal Cancer Awareness Month, ASCs and practices can look for opportunities throughout the year to volunteer in their communities or hold their own events to raise awareness. After all, new cases of colorectal cancer are diagnosed every day of the year—370 cases on average, according to American Cancer Society estimates.

To help you plan community service

Colon Cancer Awareness Events and Days • Get Your Rear in Gear (year-round) • Undy Run/Walk (year-round)

activities, there is a list of colon

• Tour de Tush Bike Ride (year-round)

cancer awareness-related events and

• World Cancer Day (February 4)

Hundreds of volunteers help ensure each event goes smoothly, and sponsorships from organizations including Physicians Endoscopy and large health systems in the region help cover costs and boost fundraising.

important dates (see sidebar). When your ASC or practice decides to participate in or plan an event, take time to promote your involvement.

Doing so will help spread awareness of the event and its mission, while also helping to raise your profile.

• Colorectal Cancer Awareness Month (March)

When ASCs and practices get involved with Get Your Rear in Gear Philadelphia, they connect with a very captive audience, Grasso says.

“These are people who understand the

When an activity encourages people to undergo screenings, everyone wins, Grasso says. “On the patient side, they’re not only helping themselves, but they will often talk about how

• National Dress in Blue Day (first Friday of March) • National Screening Day (March 3) • World Health Day (April 7) • Global Wellness Day (second Saturday in June) • National ASC Week • Open House (up to you!)

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10 FAQs

About Credentialing

By Bruce Bardall

Credentialing is the process of collecting, verifying and assessing the credentials and qualifications of a practitioner to provide care, treatment or services at the surgery center. The purpose of credentialing is to ensure that only qualified licensed practitioners are appointed to the medical staff, and to ensure patient safety and delivery of quality care. Credentialing also helps protect the center from potential liability issues and helps the center meet accreditation and regulatory requirements.

To assist center leaders perform proper credentialing, here are 10 of the most common questions.

1

What is the difference between appointment and reappointment?

Appointment of a licensed independent practitioner, such as a physician or CRNA, is required so that the individual can start treating patients and performing procedures at the center.

For the initial appointment, since you lack background knowledge about the individual, you must reach out to past organizations (e.g., hospitals, health systems, ASCs) where the practitioner has provided services to

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learn about their practice and whether they are in good standing or if they have had reprimands or bad outcomes. You must also verify education; medical license and other qualifications, such as certifications; and documents like malpractice BRUCE BARDALL insurance and Drug Enforcement Administration license; and any previous malpractice cases.

These documents require primary source verification (more on this later). You must query the National Practitioner Data Bank (NPDB) and the American Medical Association (AMA).

When you have completed the collection of documents and have verified the information, the appointment file then requires an assessment by the governing body of the practitioner’s credentials and qualifications before a decision is made to allow the applicant to provide patient services at your center.

You might find the reappointment process goes quicker once you have more information about the practitioner’s practice since the individual has been working at your center. You still need to go through the same processes as appointment, including verification of medical license and

other credentials. With reappointment, you will incorporate peer review from procedures performed at your center in place of peer references you obtained for initial appointment.

How does peer review tie into appointment and reappointment?

2

During appointment, the center should obtain peer references and hospital or other facility confirmation of approved procedures, and determine if the

You need to perform primary source verification, as it is a regulatory requirement. Doing so also protects your center and its patients from risks.

Can a practitioner start doing cases before the entire appointment process is complete?

4

No. All required documents must be completed and primary source verified before the board approves privileges.

of the quality of care a practitioner

The rationale behind this is that it’s a huge liability to grant approval prior to completion of the process. Let’s say a practitioner comes into a center

provides within the center. Note: Peer

and requests privileges. If the center

review documentation must be kept in

fails to do its due diligence on

a file separate from other information

that practitioner and later learns

about a practitioner (e.g., credentialing,

the individual has lost privileges

health records) and is considered to be

elsewhere or is not the type of person

under the center’s quality program, and

wanted at the facility for another

is non-discoverable.

reason, that’s a risk for patient safety

individual is in good standing. Peer review is a center’s ongoing evaluation

3 What is primary source verification and why do I need to do it?

and the center. It’s critical that you check everything about a candidate and gather all the necessary background

6

How should we keep credentialing files?

They must be kept current, organized, secured and under lock and key, with just a few individuals having access. The rationale: there is very confidential and sensitive information in these files. You don’t want unauthorized individuals to view them and/or potentially alter the information.

Can we store practitioner health records with credentialing files?

7

No. They must be kept separate from credentialing and peer review files.

Health records are very confidential.

They are kept separate so that when a governing body reviews a practitioner’s credentialing file for privileges, the decision is not influenced by information in the health record.

Do we need to keep all credentialing information in a practitioner’s file?

8

Primary source verification is the

body to make an educated decision

No. You must keep the original appointment documents, delineation

process of going directly to a source

on whether they want the individual

of privileges, and the most recent

to obtain background information

providing services at the center.

reappointment documents in

information. This allows the governing

about a practitioner.

For example, let’s say a practitioner stated that they graduated from a certain medical school. Perhaps they have a diploma to support this claim.

But since records—even diplomas— can be falsified, primary source verification requires you to contact the medical school directly to request proof of graduation.

As another example, a practitioner may state that there are no reports of misconduct on their record. Primary source verification requires you to contact NPDB and AMA to determine the legitimacy of this claim.

5

What is the process to add new privileges?

Privileges are granted by a center’s governing body for a specific period, which is usually a two- to three-year cycle based upon state requirements.

If a practitioner learns how to perform a new procedure during this cycle, the practitioner does not need to wait for the cycle to end to request additional privileges. The practitioner can request an addendum to the existing delineation of privileges in a written statement to the governing body, which will determine whether to grant the additional privilege.

the file. Documents concerning reappointments which fell between the original appointment and most recent reappointment must be preserved.

However, they do not need to be in the file. You can send them to storage or scan them. They still must be placed in a secured physical or digital location.

When it comes to credentialing, what is the difference between bylaws, policies and the center employee handbook?

9

Bylaws are to credentialing as the employee handbook is to human resources. Practitioners must follow the

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bylaws as employees must follow the human resources handbook. Policies are guidelines for all to follow, regardless of position at the center.

Do we need to provide orientation to credentialed practitioners? If so, how and what should we include?

10

Individuals credentialed should receive an orientation by the facility. This typically falls upon a clinical leader— usually the nurse manager or director of nursing. The orientation should cover a wide range of topics.

It should include the center’s emergency codes, drills and expectation of the individual to participate in emergency drills and activities the center is required to perform. If there is an emergency, practitioners should participate in the response with staff. Practitioners are, after all, part of the center staff, and centers need their help in the event of an emergency.

Orientation should include review of the center’s emergency codes, available emergency equipment, computer systems, infection control, quality program, participation in committees, state-specific requirements and how and when documentation is to be completed.

It should include review of the general layout of the center, including exits and locker rooms.

It should include review of hours of operation.

Practitioners need to know when the first procedure starts.

For most centers, if there is a 7:30 case, that does not mean 7:30 is when the practitioner should arrive at the center. Rather, that is when the practitioner should be in the operating or procedure room ready to start providing treatment.

I recommend putting together an educational binder or packets of information—electronic or in paper form—to assist practitioners with orientation. That helps organize the orientation and provides a means for practitioners to review what is covered during the orientation.

Bruce Bardall, BSN, MS, RN, CNOR joined Physicians Endoscopy in July 2017. He has operating room and critical care experience in both ASC and large academic medical centers. Bruce started up his first ASC in 1999 and has held Administrator, Regional Director, Vice President and Director of Clinical Operations roles for national surgery center management companies. Bruce has been a board member on the Ohio Ambulatory Surgery Center Association for multiple terms. For more information, you can him at bbardall@ endocenters.com.

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A Winning Concept:

Center-to-Center Transactions

By Rob Kurtz

Roy Bejarano is Physicians Endoscopy’s (PE) Chief Strategy Officer. In this interview, he discusses the concept of “center-to-center transactions” and why they represent a potential winning scenario for all parties involved.

What are center-to-center transactions?

They are an exciting concept, but we have seen few examples of them in the marketplace.

Before I further discuss this specific model, I want to note that there are some examples of what we call a “centralized ASC.” In this model, a parent ASC develops facilities in other locations with new ownership. The benefits of this model are additional capacity, establishing

is also an opportunity for an ASC partnered with a good management company to look at a neighboring ASC as a target of that ASC, and not just independently by a management company. In this scenario, the acquirer approaching the ASC is the neighboring ASC.

ROY BEJARANO

a geographic presence in a new market and accelerated

Why would one ASC want to acquire another?

regulatory approval since the existing parent facility is

An ASC acquiring another ASC would gain expanded capacity and grow its physician member base. One scenario where this can be helpful is if you have a group of aging physicians in one center, they can be complemented by acquiring a center with younger physicians.

sponsoring the fledgling facility.

Center-to-center transactions are a derivation of this model, and one which I think is more exciting, practical and applicable to many ASCs in today’s marketplace.

The concept is ASCs acquiring—or merging—with other ASCs. ASC acquisitions are usually associated with management companies or hospitals looking to expand their portfolio. This is something PE enjoys doing. There

There are numerous other benefits. You gain access to a different market. You have real synergistic opportunities through expense management, purchasing, technology and potentially payer contracting.

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Branding and marketing can be another huge benefit. Let’s say your center has a weak brand—maybe something happened with a rogue physician, or you encountered a regulatory issue. As a result, you may be struggling to recruit physicians.

You look across the street at a center that’s bringing in doctors all day long.

An acquisition can essentially provide a marketing and branding reset.

Management companies do well when their partners do well. If there is

Physicians can be credentialed at more than one ASC, so an acquisition would provide more flexibility. Now physicians are building their book of patients between centers. We know of many physicians interested in seeing cases at more than one ASC.

the physician acquirers. Everyone

There’s also the sharing of best practices. For example, if one center is managed by a professional organization and the other is not, the second center could now benefit from those management skills and services.

consolidation in the immediate market

Why would the acquiree be interested in an acquisition as opposed to a partial liquidity event?

If physicians are looking for improved performance and are unsure where to find it, an acquisition may be the solution. There could be a partial liquidity aspect to this — some cash, some equity. There are typically physicians at any target ASC looking for liquidity, usually the retiring or older physicians. Some ASCs are interested in best practices and expanding their patient base through physician mass. There could be a shortage of other options.

Why would a company like PE find center-to-center transactions an attractive approach?

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a good deal for one of our partnered ASCs to engage in, and everybody— the target ASC plus the acquirer—is happy about it, we would be happy

them and asking, “What if?” What if we were to all practice under one roof—not physically, but legally, under one tax identity? If that sounds like an appealing prospect, it may be worth taking the initiative.

as well. It is important to realize that assuming the managing company has ownership in the acquiring ASC, the new owner of the acquiree is the management company plus would benefit from the improved performance of the new asset.

What also makes this appealing is that PE is not typically interested in partnerships with one-room centers unless there is an opportunity for area. For example, New Jersey, due to an old regulation, has numerous oneroom GI ASCs. Today, these one-room centers represent a tremendous opportunity for the physician owners of these facilities to consolidate with physician owners of like facilities. In a center-to-center transaction strategy, a one- or two-room ASC becomes a very interesting opportunity for all parties.

We would love to bring at least one ASC acquisition to every one of our ASCs. We would look to our physician partners to help us identify targets, as they know their marketplace well and can identify ideal target ASCs.

What piece of advice would you give to a physician who likes the idea of a center-to-center transaction?

If you’re a physician at an ASC and know of a neighboring ASC that you never approached and always just labeled as arms-length competition, consider if it’s worth reaching out to

Mr. Roy Bejarano joined the Company in April 2017 and serves as Chief Strategy Officer where he primarily focuses on PE’s New York ASC market. In his previous role, Mr. Bejarano served as President of Frontier Healthcare, where he acted as the strategic advisor during Frontier’s founding and was directly responsible for all operations as well as strategic development. Mr. Bejarano was an active member of the Entrepreneurs’ Organization (EO), New York Chapter, as well as an active board member and senior consultant to the Chabad House Bowery.

Mr. Bejarano graduated with an MBA from Columbia School of Business. He also provides over 12 years of investment banking, private equity, corporate development, strategic consulting, and asset management experience. For more information, you can reach him at rbejarano@endocenters.com.

Understanding and Achieving

PCI Compliance

By Gene Goroschko

Often misunderstood is that meeting PCI compliance standards is a responsibility of all businesses that accept credit card transactions.

Payment card industry (PCI) compliance is an area often overlooked by ASCs — and many other small businesses, for that matter. The PCI Data Security Standard is a set of regulations put forth by the credit card companies to offer a level of security to consumers who use credit cards for transactions in any business, including healthcare organizations.

How this typically plays out in an ASC is a patient presents their credit card to the front desk which is run through a merchant services system. The patient’s co-pay or balance is put on the credit card and applied to their account.

If people think about compliance with credit card use, it is often related to the retail environment. For example, when consumers go to a Home Depot and use their credit card, they expect Home Depot’s system has met the requirements to accept credit cards and therefore be PCI compliant, which is likely since that is a big part of their business.

Often misunderstood is that meeting PCI compliance standards is a responsibility of all businesses that accept credit card transactions. That can include in-person transactions with a physical card, via phone or online, which can all apply to ASCs. GENE GOROSCHKO For online payments, some ASCs have an Internet portal where patients click on a link, and it takes them to a credit card processor through which they enter their credit card information.

The Importance The purpose of PCI compliance standards is to provide consumers with an understanding that when they offer their credit card to a business, that business is delivering a specific, achieved level of security. The broader intent is to help ensure credit card fraud does not run rampant.

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If you follow the news, you are likely aware of the constant reports of major data breaches within and outside of healthcare. Those businesses were all likely PCI compliant and yet were still hacked into and had their information stolen. PCI compliance standards are not a guarantee against intrusion.

Intrusion prevention and information theft cannot be guaranteed. Rather, PCI compliance standards establish a minimum threshold for how difficult it will be for a criminal to gain access and obtain that information.

PCI compliance also provides a level of guarantee to the merchant and consumer. By entering into an agreement with credit card companies to accept their cards and achieve PCI compliance, these companies will work with you as a partner to address the breach. Should you suffer a breach, they will help ensure the breach is mitigated, provide customers with resources and return monies that may have been taken as a result of the breach.

Failing to be PCI compliant increases your level of risk. Should you suffer a breach and are found to be non-PCI compliant, the credit card companies do not have an obligation to work with you. You will likely be on your own, responsible for taking care of notifications and may be responsible for refunding money illegally removed from a patient’s account.

The reason? Without PCI compliance, you are essentially in breach of your agreement with the payment card companies. They are not likely to provide their assistance and support during times when that assistance and support is most needed. Understand that by signing up as a business which accepts credit cards, you are entering

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an agreement with a credit card provider. In that agreement the credit card provider requires you to be PCI compliant.

the process of PCI compliance. That’s 80 pages of very specific questions, with a large majority of them being technical or IT related.

Note: If you accept credit cards and want to purchase cyber-liability insurance, the cyber-liability insurance company will likely ask you to attest to being PCI compliant. If you state you are not PCI compliant, you will not qualify for cyber-liability insurance or will end up paying much more for the insurance than is necessary.

Why is the questionnaire so long? The PCI Security Standards Council puts companies into categories based on the type of system they use to process credits cards rather than the type of business. This means that while you may only conduct 500 credit card transactions a year, you are answering the same questionnaire as a company that does 500,000 transactions.

Administrators running an ASC— particularly a busy center—will likely not have the time, knowledge and/or resources available to answer most of those questions.

Confronting the Challenges Why is PCI compliance a challenge for some ASCs? Managers may not consider their center is a point of contact for a credit card transaction, and therefore required to achieve and maintain PCI compliance for as long as they accept credit card payments.

Since ASCs are not thought of as a retail organization, managers may feel their center is not required to be PCI compliant. Some managers may lack awareness of PCI compliance because they do not oversee a payment-focused business like a retail organization.

Understanding PCI compliance is just one small step toward meeting requirements. Unfortunately, once managers start moving down the path toward PCI compliance, they usually find it difficult to navigate. Like most rules and regulations, PCI compliance is complicated in terms of technology requirements and the financial aspect.

This can include items such as the number of transactions performed by a business and how the business handles credit card information.

Some of the initial questionnaires for the PCI compliance system are 80 pages. That’s 80 pages just to start

If administrators hit roadblock after roadblock and do not see a pathway to move forward, the PCI compliance project may get put on the shelf in favor of other achievable projects. In some cases, ASCs never get back to PCI compliance.

Path to Success The good news is there is likely a way to move forward, often unknown to most facilities. You are probably already paying for a service that can help you obtain PCI compliance and may not even know it.

Many merchant services companies, as part of their offerings, include a service that provides a resource which can help or, in some cases, go as far as work with and guide a business through the PCI compliance process.

It’s not usually a service openly advertised when a business signs a merchant services agreement.

The merchant services company used by our centers grants access to an online portal that provides guides and

instructions on how to fill out the PCI compliance questionnaire.

Questions are asked of center administration, with answers moving them through other questions in a much easier to understand format.

This process essentially breaks down the 80-page questionnaire to about 20 questions. With those answers, the merchant service company provides the center with a roadmap on how to achieve compliance: steps to take, attestations to make and what (and where) the center needs to submit in order to receive the PCI compliance certificate, which, in this case, is also supplied by the merchant services company.

If a center chose not to work with a merchant services company on PCI compliance, administration would likely visit the PCI compliance website (www.pcisecuritystandards.org). There they would find a helpful set of pages addressing the importance of PCI compliance and how to move through the compliance path. Unfortunately, following those steps would take them to the longer questionnaire.

The reason for the broad chasm between what you see on the PCI compliance website and the experience of working with a merchant services company is primarily related to audience. A merchant services company, which should understand your business, is able to direct you to focus on those areas that apply to your business. The PCI Security Standards Council created a tiered system so a small business like an ASC does not have the same burden of compliance as a large clearinghouse conducting millions of transactions a day.

Getting It Done When it comes to achieving PCI compliance, Physicians Endoscopy advises its centers to take four steps:

1 2

Do not to try to achieve PCI compliance on your own because you will need help. Start by reaching out to your merchant services company and finding out what resources are already available to you.

3

Ensure the process is completed.

PCI compliance is not likely something you will pass off to a third party for completion. You can pay a fee to a PCI compliance company to do most of the legwork for you, but such companies are usually focused on much larger clients. An ASC is probably going to be astounded by the fees a company like that would charge, so it’s likely not a practical option.

4

Treat PCI compliance, like all compliance issues, as a living document. There are multiple reasons why an ASC will need to reapply for compliance. Changing your technology is one of them; changing your merchant services company is another. We suggest that centers conduct at least annual reviews of their PCI compliance to see if anything has changed that would require them to reapply.

Merchant services companies are required to perform a lot of heavy lifting concerning their own PCI compliance. Their PCI compliance burden is much greater than that of an ASC using a portal through a merchant services company to process transactions.

Remember, the intent of PCI compliance is to ensure credit card fraud does not run rampant. PCI compliance provides a level of guarantee to the merchant and consumer, and failing to be PCI compliant increases your level of risk. Understanding PCI compliance is just one small step toward meeting requirements; however, there are ways to move forward.

Gene Goroschko, Senior Vice President of Information Systems, is responsible for designing and deploying the information systems in use at Physicians Endoscopy (PE) and PE affiliated centers. He has been an active participant in the rapidly changing world of computers and information systems from their formative years right up to today’s current cutting-edge technology. Gene has been the architect of network and information systems all across the country. He has designed, installed and maintained systems for clients as varied as the United States Military to the United Way. For more information, you can reach him at ggoroschko@endocenters.com.

Commit to becoming PCI compliant.

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Financial Terms to Know

Credit Application and Personal Guarantee

By Brianna Martinez and Tammie Tilson Finance is a challenging area, with even the smallest misstep or misunderstanding having the potential to create significant problems for an ASC or practice down the road. Finance is also a critical area for an ASC’s or practice’s success. After all, it’s the availability of money—or lack thereof—which ultimately drives many decisions of any business. That’s just one of the reasons why Physicians Endoscopy (PE) has a division dedicated to helping ensure our partners make sound financial decisions.

To help keep your organization on the right financial path, we’ll be defining two very important and related terms—“credit application” and “personal guarantee.”

We’ll also provide guidance to aid in your decisions concerning these concepts.

Credit Application Every facility needs to purchase medical supplies and equipment. Some are relatively inexpensive, such as gauze and surgical gloves, while others can be quite expensive, such as scopes and surgical tables. When a facility wants to acquire these goods, a vendor typically requires them to complete a credit application to establish payment terms.

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A credit application has many elements.

In addition to information about the applicant, it may include the credit terms (e.g., credit requested, interest rate); when payments are due (e.g., net 30, annual); late fees, including those associated with potential legal expenses; penalties associated with defaulting on payment; business references; and personal guarantor (more on this later).

Here are some quick tips to remember when reviewing and filling out a credit application:

TAMMIE TILSON

BRIANNA MARTINEZ

• Review the fine print. You want to clearly understand what you are applying for and agreeing to.

• Review any attachments referenced in the credit application which may include significant payment terms.

• Don’t agree with something you see on the application? Don’t sign it. Mark up the document with changes you request. In many cases, you can negotiate

and adjust terms before an agreement is finalized. If a vendor is unwilling to negotiate or make the changes you believe are necessary, you may want to find another vendor.

• Choose your business references carefully. These should be companies with which your organization has a longstanding, positive (i.e., on-time) payment history.

signs an application with language concerning a personal guarantee, they may be on the hook for thousands of dollars (or much more if there are lawsuits) if the organization fails, to cover its financial responsibility.

Here are few tips regarding personal guarantees: • As stated earlier, always read the fine print. Make sure to closely review any financial application or agreement to see if there is

Personal Guarantee

language concerning personal

When a vendor requires a credit application, there is an expectation

guarantees.

that the business will cover the payments until the debt is repaid.

But what if the business defaults on its payments, closes or files for bankruptcy—issues that occur every day? That’s why vendors want personal guarantees.

• Share the risk. If a vendor requires a personal guarantee, it’s not unreasonable for some or all owners of a business to share on responsibility vs. one individual.

How Physicians Endoscopy Adds Value

between an individual and the vendor

When PE centers are interested in purchasing equipment and supplies,

that states the individual will cover

we support them through a carefully

the payment if the business cannot.

planned and executed process:

A personal guarantee is an agreement

A personal guarantee is designed to ensure the vendor recoups money owed from the customer.

Sounds straightforward, right?

Where personal guarantees become problematic is when an individual agrees to become the guarantor without realizing it. Anyone at a business can be the guarantor. Let’s say a credit application includes language indicating that the individual signing the application will serve as the guarantor. Many documents in ASCs and practices are not reviewed and approved by owners. They may be handled by an administrator, business office manager or another staff member. If one of these individuals

5. Once we receive the completed and signed application back from the CFO, it is forwarded onto the vendor if no additional information is required. Or the application is sent back to the center administrator to complete by noting the amount of credit the center is requesting and the terms the center is looking for.

Proceed with Caution Some final words of advice: Don’t rush the review of any credit application or agreement. Even the most wellintentioned vendors can make mistakes on documentation. Once you agree to contract language, revising it can prove difficult, maybe even impossible.

If you don’t have a finance department like the one at PE to lean on for guidance, consider requesting that your accountant and/or legal counsel review language before you proceed.

This expense may protect you from making a much costlier mistake.

1. We receive the credit application from the center’s operations team or administrator.

2. We complete the credit application and review payment information, personal guarantor information and all other important agreement details.

3. We remove any language related to a personal guarantee as well as any language related to the provision of the center’s financial information.

4. The credit application is submitted to PE’s Chief Financial Officer (CFO) for further review and approval.

Tammie Tilson, Contract Administrator, joined Physicians Endoscopy in 2014 and manages Novatus, a Contract Management Software. Ms. Tilson is responsible for reviewing and monitoring service and vendor agreements for PE and its affiliated centers. Ms. Tilson has a paralegal certificate, a M.S. in Criminal Justice, and a background that includes various areas of law.

Brianna Martinez, Lead Accounts Payable Coordinator joined Physicians Endoscopy in 2015 and is responsible for processing center invoices, reconciling vendor accounts, and completing vendor credit applications. Miss Martinez is currently pursuing a BA in Accounting.

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Front and

Center Community Outreach & Events The Endoscopy Center of New York (ECNY) ECNY (New York, NY) participated in “Get Your Rear in Gear,” a 5K Run/Walk & Kids Fun Run on Sunday, October 22, 2017. The event was hosted by the Colon Cancer Coalition and took place at Riverside Park in New York, NY. Center leadership, physicians, and staff not

physician at the center, placed first in her age category and won a medal for her performance. The event raised over $80k to promote education for early-onset colon cancer awareness. Anne Carlson, the National Executive Director for the Colon Cancer Coalition, as well as Dave Dubin of AliveAndKickn, were both in attendance.

Nurses took attendees’ blood pressure to help raise a consciousness of general health. In November, ECN attended the 8th Annual Western New York Heroes Red White and Blue Gala. This event raises funds to support local veterans in the community. ECN also participated in the Volunteers of America program called “Adopt-A-Family” for the Christmas holiday. The program matches families in need with corporate sponsors who then collect toys, clothing, grocery store gift cards and other needed items for the family.

Adopt-A-Family

The Endoscopy Center of Niagara (ECN)

only participated in the activities but were also sponsors. Laura Frado, MD, a

ECN (Niagara Falls, NY) center staff was at the Annual Harvest Festival hosted by the Niagara River Region Chamber of Commerce September 23-24, 2017, to promote colon cancer screenings.

PE participated in is the Adopt-A-Family drive for children of local members of the armed forces killed in action.

Through Liberty USO’s Survivor Outreach Program, PE was able to sponsor and fulfill all of the gifts on the wish lists of a total of eight local families of service members who were killed in action.

Awards and Celebrations West Side GI and Queens Boulevard

and maintains an exemplary level of

The Endoscopy Center of Western

ASC (New York)

personalized care in their digestive

New York (ECWNY)

Becker’s ASC Review highlighted two PE center employees in their article

health and endoscopy services. Kahre

“Rising Stars: 23 ASC leaders under 40” published December

14th.

Salima

Abdin of West Side GI, LLC (New York, NY) is the administrator of the center, a position she has held for five years.

Salima oversees all center activities

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EndoEconomics WINTER 2018

Sandoval of Queens Boulevard ASC, LLC (Rego Park, NY) serves as their business office manager. Kahre oversees the various physicians across 15 subspecialties, and she is dedicated to providing patients with gentle care and state-of-the-art treatment technology.

ECWNY (Williamsville, NY) was approved as a Center of Excellence by the American Society for Gastrointestinal Endoscopy. The ASGE Endoscopy Unit Recognition Program (EURP) honors units that have demonstrated a commitment to delivering quality and safety. The

Front and

Center Center holds high standards and

College of Gastroenterology to their

continually strives to provide superior

Fellows. Fellows are a special group

AEC (Bronx, New York) held a celebration in honor of their 10-year

care to the patients of Western New

of physicians who are dedicated to

anniversary. Thanks to the hard work of

York—distinguishing themselves as

continuing education in medical

Administrator, Steven Housberg and

leaders in service.

practice, teaching, or research.

Director of Nursing, Marianne Catapano.

Fellowship is an honorary designation

Great success!

In other news, ECWNY has opened a fifth procedure room in December 2017 and added two new physicians: Craig Kelled, MD and Benjamin Schaus, DO. Island Digestive Health Center (IDHC) IDHC (West Islip, NY) is proud to announce that Kim Koos, the Center’s Administrator and Director of Nursing, has passed her CASC credential. The Certified Administrator Surgery Center credential is earned by those in the ASC industry that have proved they have a comprehensive understanding of the industry and skills that an ASC administrator requires.

given to recognize ongoing individual service and contributions to the

The Endoscopy Center at Robinwood

practice of medicine.

(ECR) 15 Year Anniversary Open

Physicians Endoscopy (PE) PE (Jamison, PA) has formally been approved

by Certified Administrator Surgery Center (CASC) as a provider for Administrator Education Units (AEUs).

This credential is for organizations with a comprehensive understanding of the skills and knowledge that the role of an ASC administrator requires. Individuals who have earned their CASC credential

Garden State Endoscopy Center

include ASC professionals in a wide

(GSEC)

variety of roles. This provider status

GSEC (Kenilworth, NJ) is proud to announce Wendolyn Littlejohn, RN has obtained her SGNA certification.

Northern New Jersey Center for Advanced Endoscopy, LLC (NNJC) NNJC (Englewood

House

will be helpful to internal PE staff that are CASC certified, and also to center administrators, medical directors, directors of nursing, and clinical staff.

Advanced Endoscopy Center (AEC) 10 Year Anniversary Celebration Party

ECR (Hagerstown, MD) opened their doors to the public on October 23, 2017, by celebrating 15 years of service to the community. The staff gave guided tours of their state-of-the-art facility

Cliffs, NJ) is

and educated guests on the services

pleased that Dr.

and quality of care that the Center

Kenneth Rubin,

provides. Guests enjoyed goodie bags,

MD, FACG has

refreshments, and door prizes.

obtained his Advancement to Fellowship, FACG as of last October. This honor is presented by the American

(L-R) Marianne Catapano, RN; Robert Sable, MD; Steven Housberg

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Current

GI Opportunities Submit your CV online at www.endocenters.com/recruiting

Laredo, TX

Central New Jersey

Gastroenterology Consultants of Laredo – Laredo Digestive Health Center

Garden State Digestive Disease Specialists, LLC

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

Garden State Digestive Disease Specialists, LLC is seeing a BC/BE Gastroenterologist to join our three-physician practice in Central Jersey for a full-time position. The job offers an excellent salary, competitive benefits package, a reasonable call schedule (which includes other gastroenterology colleagues in the rotation), and an opportunity for full partnership track in 2- 3 years. EUS/ERCP training is preferred.

We serve culturally rich and diverse communities; our patients reside primarily in the Union and Middlesex counties of Central Jersey. Our SurgiCenter is a state-of-the art endo center presently being expanded into a 3 room facility. We are affiliated with 4 local hospitals, 2 of which are teaching hospitals with residency programs. We are in the NYC metropolitan area, 45 minutes from Manhattan, conveniently located near an international airport, and in close proximity to many cultural centers and the Jersey Shore.

Lima, OH

Mesa, AZ

Gastro-Intestinal Associates, Inc.

Central Arizona Medical Associates

The physicians of Central Arizona Medical Associates (CAMA) are seeking a full-time Gastroenterologist to join their practice. Physician can expect to step into a busy practice while replacing a retiring partner. Anticipate a short track to practice partnership and ASC ownership. Practice operates out a single office and covers one hospital. Outpatient endoscopy is performed at a 2 room ASC with maximum efficiency and quality of care.

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

Northern Louisiana Hospitalists opportunity with GastroIntestinal Specialists A.M.C.

The physicians of Gastro-Intestinal Associates are seeking a BE/BC gastroenterologist to join our sixphysician, four-CNP single-specialty practice.

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

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

GastroIntestinal Specialists (GIS), a well known and very established specialty group of 13 physicians located in Northern Louisiana, seeks its fourth Hospitalist for our network. We partner with the premier hospital systems offering inpatient and outpatient care services. GIS is the provider of choice in our served market when specialized GI care is required.

• • • •

• • • • • •

7 on 7 off schedule Competitive base salary with bonus metrics opportunity Additional compensation for extra shift work Benefits include 100% healthcare coverage, med-mal coverage, 401K & profit sharing CME allowance EMR and IT support Internal billing department to manage charge capture Practice manages all Meaningful Use and MIPS filing responsibilities All licensing and credentialing functions are provided Collaborative team approach with peers, owners and extender support group

To apply, contact: Angela Burcham, HR Director 318-631-9121 | hr@gis.md

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EndoEconomics WINTER 2018

Bellingham, WA NW Gastroenterology & Endoscopy

Exciting opportunity to join a nine-person single specialty GI practice in Bellingham, Washington. This progressive coastal community offers ocean and lake recreation, skiing, and miles of hiking and biking trails. Small college town atmosphere with proximity to Seattle and Vancouver, Canada. Great place to raise a family! This collegial group has a freestanding AEC and pathology lab. EUS optional, ERCP strongly preferred. Outstanding benefit package.

Current

GI Opportunities Submit your CV online at www.endocenters.com/recruiting

Rochester Hills, MI

Lumberton, NJ

Troy Gastroenterology

Gastroenterology Consultants of South Jersey

The Center for Digestive Health (Troy Gastroenterology) is a well-established, highly respected private practice looking for two Gastroenterologists to join our growing practice. We have several offices across Metro Detroit with two state-of-the-art AAAHC accredited ambulatory surgery centers. We’re looking for an enthusiastic physician skilled in general endoscopy, ERCP.

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

• • • • • •

• Affiliated with Burlington County Endoscopy Center, a three room ASC which is physician owned and operated

Competitive base salary with productivity incentive Incentive bonus Retirement plan Discretionary allowance Eligibility for member status, after two years Insurance (malpractice, health, dental, vision, life, supplemental & dependent life, short & long-term disability)

• Located within 30 minutes of Philadelphia and within 1 hour of New York City

• We are seeking to add a full- or part-time gastroenterologist • We offer a 1:7 call schedule and an opportunity to perform ERCP/EUS (not required) • Partnership will be offered in both the practice and ASC

North Bergen, NJ An outstanding opportunity for a gastroenterologist!

Advanced Center for Endoscopy (ACE) has an immediate opportunity available for GI physicians looking for an outstanding ASC in which to perform procedures. Our single specialty, nine physician GI center is the perfect environment for you and your patients.

Our center can help drive additional patient volume to you through the ASC, allowing you to increase your procedure volume in the environment that is more convenient. Our center can provide your patients a better outcome, and you will have satisfied and loyal patients.

ACE is ideally located in North Bergen along the banks of the Hudson River—the “gold coast” of Northern NJ, with a spectacular view of the NYC skyline. This is an excellent opportunity for a motivated physician.

On-Site Endoscopy

Northern CA Central CA

GI physicians: are you looking for flexibility and supplemental income?

Our mobile endoscopy practice is seeking board-certified gastroenterologists in Northern CA (Sacramento/Stockton/Tracy) and Central CA (Fresno/Tulare/San Luis Obispo)!

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

New York, NY Gastroenterology of Gramercy Park

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

This opportunity offers: • • • • • • • •

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

Carolina Digestive Diseases

Four established gastroenterologists located in central North Carolina, are seeking a BE/BC gastroenterologist to join our physicians to expand the coverage in our community of Gastonia, NC. The physician candidate can expect to step into a busy practice while replacing a retiring partner. Anticipate a short track to practice partnership and ASC ownership. Practice currently operates out of a single office and covers one hospital. Outpatient endoscopy is performed at a 2 room ASC with maximum efficiency and quality of care.

Located 2 hours to the Smoky Mountains and 4 hours to the Atlantic beaches. Enjoy sunshine and a great lifestyle in the metro Charlotte area.

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Physician Partners Physicians Endoscopy thanks all of our physician partners.

We have accomplished so much together during our first 20 years!

Elizabeth Cruz (AZ) Dana N. Freeman (AZ) Mansur Khan (AZ) Patrick Lam (AZ) David B. Leff (AZ) Jonathan Mellen (AZ) Kandarp Patel (AZ) Hector Rodriguez (AZ) Amy Soloman (AZ) David A. Tessler (AZ) Ioannis Oikonomou (CT) Jeffrey B. Kaner (FL) Alix Lanoue (FL) Adam Chad Lessne (FL) Leon Maratchi (FL) Barry L. Migicovsky (FL) Baaz Mishiev (FL) Enrique Molina (FL) Joel Stengel (FL) David Weiss (FL) Anthony Balistreri (GA) Matthew Cranford (GA) W. David Curtis (GA) Dennis DiSantis (GA) Keith Fincher (GA) Temitope Foster (GA) Eric High (GA) John R. Hodges Jr. (GA) Lawrence Lahatte (GA) Timothy Mecredy (GA) Matthew Pantsari (GA) Marcus Pitts Jr. (GA) Curtis Ray (GA) Paul Schwartz (GA) Andrew Simpson (GA) Mark Stern (GA) Adam Waller (GA) Robert E. Clark (IL) Thomas DeWeert (IL) Jennifer Dorfmeister (IL) Darryl Fernandes (IL) Gregory R. Gambla (IL) Sonia S. Godambe (IL) Sunil T. Joseph (IL) Lawrence Kosinski (IL) Philip Koszyk (IL) William Levis (IL) Joseph Losurdo (IL) Vijaya Misra (IL) Rajesh S. Pillai (IL) Kenneth Schoenig (IL) James Stinneford (IL) Wei M. Sun (IL) Fehmida Chipty (MA) David Fefferman (MA) Sanjay R. Hegde (MA) Eric Libby (MA) Jose Marcal (MA) Robert “Al” Muggia (MA) Xi Na (MA) David Siegenberg (MA) William Vanneman (MA) C. Choudari (MD) Louis Cohen (MD) James Cremins (MD) Pear Enam (MD) Nelson Ferreira (MD) Rashid Hanif (MD) Christine Lewis (MD) Juan Tayler (MD) William Silber (ME)

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Amir Abadir (MI) Sami Akkary (MI) Anezi Bakken (MI) David L. Benkoff (MI) Kerri A. Bewick (MI) Sante Bologna (MI) Alan F. Cutler (MI) Amir Damadi (MI) Mark S. DeVore (MI) Emin M. Donat (MI) Janice Fields (MI) Roberto Gamara (MI) Heidi Gjersoe (MI) Phillip A. Goldmeier (MI) Julia Greer (MI) Randall Jacobs (MI) Jean A. Jaffke (MI) Chethana Kanaparthi (MI) Jay R. Levinson (MI) Partha S. Nandi (MI) Ralph Pearlman (MI) Michael Piper (MI) Gregg Polidori (MI) Leonard Quallich III (MI) Michael Raphael (MI) Wael Refai (MI) Laurence E. Stawick (MI) Bradley J. Warren (MI) John R. Weber (MI) Richard Wille (MI) Ryan J. Wong (MI) Edward A. Yousif (MI) Samuel T. Drake (NC) Neville Forbes (NC) Austin Osemeka (NC) William S. Watkins (NC) Steven Weston (NC) Martini Absin (NJ) Charles Accurso (NJ) Monica Awsare (NJ) Claudia Barghash (NJ) Kristin L. Brill (NJ) Karen Callaghan (NJ) Minh Cao (NJ) Eugene Carroccia (NJ) S. Channapragada (NJ) Robert Chapdelaine (NJ) Richard Chessler (NJ) Gary F. Ciambotti (NJ) Frederick Coville (NJ) John A. Cristini (NJ) Michael Del Rosario (NJ) Lee deLacy (NJ) Paul DeMarco (NJ) Rajesh Dhirmalani (NJ) Ramon Ledon (NJ) Marc A. Fiorillo (NJ) Ivan Freidrich (NJ) Raffaele Gibilisco (NJ) Alan R. Gingold (NJ) Mark Greaves (NJ) Robert I. Greenblatt (NJ) Kunal Grover (NJ) Jay Harmelin (NJ) Anthony Holvick (NJ) Stuart Honick (NJ) Gary Hymes (NJ) Sandarsh Kancherla (NJ) Irina Kaplounov (NJ) Barry Kaufman (NJ) Amber M. Khan (NJ)

EndoEconomics WINTER 2018

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Dr. Richard Moses Discusses the

Present and Future of the Pennsylvania Society of Gastroenterology In September 2017, Richard E. Moses, DO, JD, gastroenterologist at Philadelphia Gastroenterology Consultants, LTD, and partner of Physicians Endoscopy, became the 19th president of the Pennsylvania Society of Gastroenterology (PSG). He shares insight into what he hopes PSG will accomplish during his two-year term and the value of becoming a PSG member.

On Growing Membership One of our major goals is to increase membership across a broad age group, particularly in the younger physician segment—Gen Xers and Millennials. We want to reach as many gastroenterologists in all stages of their careers and get them involved in the organization.

We hope to involve advanced practice providers, nurse practitioners and physician assistants who are involved in gastroenterology and hepatology and to ultimately involve gastroenterology technicians, office managers, gastroenterology nurses and gastroenterology nurse administrators.

In the process of growing membership, we are hoping to increase attendance at our annual scientific meeting, taking place this year from September 14–16 in Hershey, PA. As a member, attendance at our annual meeting is complimentary.

On Developing a Stronger Online Presence Over the past few months, thanks to efforts initiated by our Immediate Past President Ralph McKibbin, MD, we have been successful in launching our social media presence on Facebook and Twitter.

As part of our expanded online presence, we recently rolled out a new website (www.pasg.org). It is refreshed, easier to navigate and we plan to keep it up to date and interactive.

On Engaging Young Leaders There are four fellows in training (FITs) on our board of directors. Our goal is to get them more active in leadership. They are the lifeblood of the organization as it continues to develop.

Working with PSG Association Executive Robbi Cook, we developed a document of responsibility for our FIT board members. They will have tasks throughout the year to help PSG, particularly concerning social media engagement, providing website feedback and growing membership for FITs.

ON MEMBERSHIP BENEFITS Annual Meeting: One of the biggest benefits is attendance at our annual meeting. If you are a member, registration is free, and we take care of the continuing medical education paperwork. The event is Richard E. Moses, DO, JD a great educational and networking opportunity.

Mark your calendar: Sept 14-16, Hershey, PA Newsletter: Rumblings comes out a few times a year.

It is a timely report about what is going on in healthcare across the state and nationally and focuses on issues directly affecting gastroenterology.

Advocate: PSG serves as an advocate for gastroenterologists. One current area of focus is the two-step process some health insurance providers are mandating for obtaining medication for patients. This process essentially requires patients to fail one particular medicine before they can move to a more appropriate treatment program. PSG was approached by members who expressed concern with this process as it can delay effective treatment. We contacted pharmaceutical companies and have communicated our concerns over this policy with insurance providers.

PSG was successful in changing one insurance providers’ policy, and we are hopeful we can effectuate appropriate changes with other providers.

Networking: One new benefit involves PSG’s increased effort to network with the American College of Gastroenterology. The partnership will provide PSG an opportunity to better communicate on a national level about what is happening with other state gastroenterology organizations. We believe this new relationship will help us and our members tackle upcoming or developing issues that will impact the practice of gastroenterology, hepatology and patient care.

On the committee front, we have some new, young physicians taking on chair positions.

On Revising Bylaws Early this year, we plan to take a serious look at our bylaws and undertake a major rewrite. We want to reevaluate our mission statement and goals and have a broader interpretation of who should be involved in the organization and what PSG has to offer to those individuals. Medicine is changing, and we need to change with it.

Learn more about PSG by visiting pasg.org. Interested in becoming a member or have questions about PSG? Contact Dr. Moses at remoses@mosesmedlaw.com or Robbi Cook at rcook@pamedsoc.org.

W I NTE R 2 0 1 8 EndoEconomics

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