PE GI Journal July 2020 Issue

GI A publication dedicated to advancing GI practices and ASCs

Taking on Telehealth | pg. 10 GI Industry COVID Support | pg. 6 Building Morale During a Crisis | pg. 14 Colon Cancer Survivor Spotlight | pg. 16

JUNE 2020

ASC

DEVELOPMENT SERVICES Building GI Surgery Centers of Excellence Feasibility Study Site Selection Facility Design Project Financing Vendor Negotiations Equipment Purchasing Construction Management Staff Recruitment and Training License and Certificate of Occupancy Medicare and Accreditation Surveys

TO LEARN MORE: INFO@ENDOCENTERS.COM

GI Editorial Staff Suzette Sison Editor in Chief ssison@endocenters.com

Contents JUNE 2020

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Meredith Jayne Managing Editor mjayne@endocenters.com

Publishing services are provided by GLC, 9855 Woods Drive, Skokie, IL 60077, (847) 205.3000, glcdelivers.com.

PE GI Journal™, a free publication, is published

by Physicians Endoscopy, 2500 York Road, Suite 300, Jamison, PA 18929.

Letter 2 Message From the President

Strategies 6 In It Together

Noteworthy 4 Introducing PE GI Journal, the GI industry gives back and more

Excellence 8 Filling the Gap

The views expressed in this publication are not necessarily those of Physicians Endoscopy, PE GI Journal or the editorial staff.

POSTMASTER: Send address changes to: Physicians Endoscopy, Attn: PE GI Journal, 2500 York Road, Suite 300, Jamison, PA 18929.

While every effort has been made to ensure the accuracy of PE GI Journal contents, neither the editor nor staff can be held responsible for the accuracy of information herein, or any consequences arising from it.

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

Printed in the U.S.A. Copyright Š 2020 by Physicians Endoscopy

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Insights 10 Clinical Taking on Telehealth

Spotlight 16 Inspirational Stories Show of Strength

14 HR Inspiring Your Team

PE Opportunities 20 GI physician opportunities at partnered practices

Cover image: iStock.com/Jean-philippe WALLET

All rights reserved All copyright for material appearing in PE GI Journal belongs to Physicians Endoscopy, and/or the individual contributor/clients, and may not be reproduced without the written consent of Physicians Endoscopy.

Reproduction in whole or in part of the contents without expressed permission is prohibited.

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

Find out more at endocenters.com or find us on

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Letter | Message From the President |

Meeting the Need GI centers and ASCs are well-positioned to help coming out of the COVID-19 crisis

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hen looking at the effects of COVID-19 on GI practices and ambulatory surgery centers (ASCs), we can break our assessment down into three phases. Phase one was the initial responses to the presence and spread of the novel coronavirus. Organizations were forced to take drastic and often difficult actions, such as closing or dramatically reducing operations, furloughing staff, adjusting contracts, and seeking other ways to diminish the financial impact of shutting down.

We are experiencing phase two now. This concerns gradually reopening and operating in an environment where the threat remains at levels that vary by zip code. For GI practices, this initially means leveraging telehealth to maintain patient relationships while delivering in-person care to those with the most intense needs. For ASCs, it means prioritizing essential surgeries and treatment for those patients needing long-term care management. In both settings, safety remains the highest priority.

Phase three comes next. While the GI industry has been hit hard by the pandemic, there is a very bright light at the end of this dark tunnel. The role of GI doctors, practices, and ASCs in delivering patient care in nonhospital settings will become even more critical in a post-COVID environment.

As regulations continue to ease, patient volume will steadily increase. We have an opportunity—and responsibility—to ensure our facilities are sources of the safest and highest quality care. This will allow hospitals to remain focused on treating COVID-19 patients and others requiring emergency services. GI practices and ASCs are well positioned to meet the needs of greater numbers of patients going forward.

To achieve such success and build patient confidence with and through our great patient care model, ensure you understand your business model and community’s specific situation as you work to reopen. Closely monitor your clinical, financial and operational data. Make educated decisions that allow you to safely build up services (and community confidence in those services), fund them appropriately, and return to the same strong level of operations as before this health crisis.

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The good news is that we are on this path. Proper management and coordination among the entire GI industry will get us to the finish line. This is what we are focusing on at Physicians Endoscopy (PE). As you may have noticed over the past year, PE has been repositioning itself. While we remain fully committed to supporting gastroenterologists in ASCs, we are looking beyond endoscopy to meet the broader needs of GI specialists and their healthcare partners to help practices, ASCs, and ancillary services coordinate, grow, and thrive.

Part of this effort includes rebranding EndoEconomics We have an and changing its name to opportunity—and the PE GI Journal. From the time we launched our responsibility—to first publication in 2006, ensure our facilities we shared GI trends solely focused on the economic are sources of the state of endoscopy centers. safest and highest And, through the years, our content has expanded to share quality care. not only financial insights but now provide business and operational strategies, trends, and solutions for the GI community. Our goal continues to focus on sharing ways to improve financial and clinical outcomes as well as supporting both positive physician and patient experiences. Stay tuned to learn more about our PE GI Journal and the additional digital content we will be sharing to support your efforts in delivering quality David Young, President & CEO, Physicians Endoscopy patient care.

EXPERIENCE WORLD-CLASS HOSPITAL JVs

Strategic planning is at the forefront for many hospitals with an emphasis on improving quality and lowering costs.

The movement of hospitals toward licensed ambulatory surgery centers has accelerated based on a shift to value-based care, population health, and transparency.

Combining Physician Endoscopy’s expertise with a progressive hospital will ensure the most successful joint venture. PE has years of experience building successful three-way joint ventures and long-term relationships between hospitals and physicians.

LET’S WORK TOGETHER TO DEVELOP WORLD-CLASS: PATIENT CARE • PHYSICIAN ENGAGEMENT • MARKET POSITION

(866) 240-9496 endocenters.com/partner-opportunities-withphysicians-endoscopy/hospital-joint-venture

Noteworthy | News and events | Rosemary Zimmer Named President of ABCGN

A new look and an expanded focus on the GI industry

Physicians Endoscopy (PE) is excited to announce that EndoEconomics is now PE GI Journal. In addition to the name change, we’ve also refreshed the design of the magazine and expanded our focus. You’ll still find the thought leadership and GI industry expertise that PE is known for with an increased focus on trends and best practices in the GI industry and a fresh, modern feel.

We’ll also be delivering the PE GI Journal newsletter directly to your inbox, with regular content updates from the magazine, as well as web exclusive posts from PE. To ensure you receive these updates, please sign up at marketing.pegisolutions.com/pegijournal.

This is just a step in the evolution of PE. Stay tuned for more information about the exciting plans we have in the works for the future!

To learn more about PE and PE GI Journal, and to sign up for our newsletter, visit endocenters.com.

Physicians Endoscopy (PE) congratulates Rosemary Zimmer, BSN, RN, CGRN, of Endoscopy Center of Western New York on her installation as President of the American Board of Certification for GI Nurses and Associates (ABCGN). ABCGN is an independent board established in 1986 and is the only organization that awards professional certification for gastroenterology nurses.

“I am excited to serve as the new president of ABCGN,” said Zimmer. “I’m passionate about GI certification and infection prevention, and my goal over the next year is to increase the number of certified GI professionals. I hope to accomplish this by promoting certification within PE’s 60 centers.”

Zimmer also noted the importance of professional standards and certification in light of the COVID-19 pandemic.

“I feel that at this time, it is more important than ever to demonstrate to our patients that the nursing professionals at PE have attained the knowledge, skills, and attitudes to provide excellence in patient care through certification,” she said.

“GI certification validates nurses’ knowledge and expertise and demonstrates dedication to nursing as a profession.”

Source: abcgn.org

Introducing PE GI Journal

Zimmer plans to increase GI nurse professional certifications

Supporting Our Own

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donating $5,000.

He has seen firsthand how important this kind of support is during a crisis.

“I’ve had the good fortune of spending my entire career at Beth Israel, including my internship, residency, and fellowship,” wrote Dr. Bernstein. “I recall the fear I experienced when I was a housestaff officer at Beth Israel over three decades ago at the beginning of the AIDS epidemic. The current situation pales in comparison.”

Source: gofundme.com and crainsnewyork.com

Fundraiser collects over $50,000 for physicians fighting COVID-19

“There has never been a time any of us can recall when so many need the care and expertise of those in our profession simultaneously,” wrote Brett Bernstein, MD, medical director of Eastside Endoscopy and Director of Endoscopy in the Division of Digestive Diseases and the Department of Medicine at Mount Sinai Beth Israel (MSBI) in New York, NY. This message introduces a GoFundMe fundraiser Dr. Bernstein created to support the physicians and staff at MSBI as they met the overwhelming challenge the novel coronavirus created in New York City.

At the time of print, the fundraiser had collected more than $52,000, which will be distributed to MSBI staff to pay for lodging and food for anyone that was forced to separate from their loved ones due to their work on the front lines of the COVID-19 pandemic. Among almost 250 other donors, Dr. Bernstein kicked off the fundraiser by personally

Expanding Our Reach

PE GI Journal recognized with a gold award

On March 1, Physicians Endoscopy (PE) entered into a partnership with Digestive Disease and Endoscopy Center, PLLC in Silverdale, WA. The three-room ambulatory surgery center with five physicians is AAAHC accredited and specializes in the care and treatment of a variety of gastroenterological issues and assists in providing patients with the highest level of wellness and care. The center opened for operation in 2011, and currently performs over Get the latest updates on new 6,500 procedures annually. partners and other PE news at PE welcomes this new member of our family! endocenters.com.

Earlier this year, the winners of the 37th annual Healthcare Advertising Awards were announced. We are proud to say that the Winter 2019 issue of PE GI Journal (then known as EndoEconomics) received a gold award in the “Physician Referral” publications category.

The Healthcare Advertising Awards are presented by the Healthcare Marketing Report, which reviewed more than 4,200 entries for this year’s awards. PE GI Journal was recognized for its excellence in creativity, quality, message effectiveness, consumer appeal, graphic design, and overall impact.

Celebrating our latest PE partnership with Digestive Disease & Endoscopy Center, PLLC

Source: ddecenter.com

Source: healthcare-advertising-awards.com

Getting the Gold

Runway for a Cure Charity fashion show raises money for Colon Cancer Coalition

In February, only a few weeks before the spread of COVID-19 shut down many public gatherings, the Philadelphia chapter of Get Your Rear in Gear hosted its annual Runway for a Cure charity fashion show. This is the sixth year of the fashion show, which raises funds for the Colon Cancer Coalition (CCC), a nonprofit organization that encourages colorectal cancer screening and awareness.

Get Your Rear in Gear – Philadelphia, which along with Runway for a Cure also hosts an annual 5K run, has raised more than $3 million for the CCC since its founding in 2009. Its founder, Maria Grasso, explained its mission to The Philadelphia Inquirer: “Our primary goal is to talk about awareness, and the money we raise goes to our communication around colon cancer screening, Source: facebook.com/getyourrearingear/posts/get-yoursaving lives, and funding rear-in-gear-philadelphia-hosted-a-special-on-the-runway-for-a-cure-fas/10154097171779711 research,” said Grasso.

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Strategies | Business strategy and the bottom line |

Together

Physicians Endoscopy participates in the New York readiness efforts during COVID-19

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ike other large-scale public health emergencies, the COVID-19 outbreak almost immediately resulted in an overwhelming demand for healthcare resources, such as medical staff, personal protective equipment, and care centers. The demand surge threatened to wipe out medical supply stockpiles, stretch hospitals beyond capacity, and leave healthcare workers exhausted and vulnerable to infection. Resource allocation and willingness to share are the only ways to ensure that healthcare workers have the resources they need to outlast the virus.

Resource allocation plays an important role in mitigating demand surge; protecting healthcare workers; and controlling the spread of coronavirus by providing access to the healthcare professionals, tools, testing, medicines, and facilities necessary to provide advanced care to very large numbers of very sick people.

Allocating large numbers of these resources swiftly and efficiently can help mitigate the resulting demand surge.

Allocating resources effectively can prevent millions of infections and save tens of thousands of lives. Resource allocation also ensures that other essential health services, such as cancer care, have the resources they need to continue operating during a public health emergency.

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Teresa Chaisson RN, BSN, CNOR, is the Director of Clinical Support at Physicians Endoscopy (PE). She can be reached at tchaisson@ endocenters.com.

To work well, though, resource allocation requires out-of-the-box thinking and willingness to share.

To slow the torrent of new Andrew Castaldi, CPA, COVID-19 cases in New MBA, is the York, Gov. Andrew Cuomo Vice President issued a number of executive of Operations orders that allowed medical for the New professionals and practices York and New Jersey Market to provide care and medical at Physicians Endoscopy (PE). services/supplies in new and He can be reached at acastaldi@ innovative ways. The orders endocenters.com. allowed doctors and nurses from other states or Canada to practice in New York without fear of penalties related to licensure, for example, and relaxed some of the rules about moving medical supplies and drugs to alleviate temporary shortages.

At about the same time, the Centers for Medicare & Medicaid Services (CMS) announced its “CMS Hospitals without Walls� initiative that allows hospitals to provide hospital services in other healthcare facilities and locations not typically used to provide patient care. This policy makes it

Image: iStock.com/Juanmonino

In It

possible to send recovering COVID-19 patients to other facilities, such as ambulatory surgery centers (ASCs), to create more room at hospitals for patients who need acute care.

Taking these unprecedented steps helps the medical professionals, leaders, and people of New York allocate the resources they need to manage the flood of existing COVID19 patients and stem the tide of new cases.

to the New York State Department of Health and is making its stock at PE centers available for hospitals in need.

Anticipating the Unexpected

Cooperation and coordination are the cornerstones of resource allocation—and of medicine—during a pandemic. As with most public health emergencies of this magnitude, it has required a team effort to resolve unexpected and complicated Physicians Endoscopy Joins the Fight situations that came with the coronavirus outbreak. Chaisson Physicians Endoscopy (PE) joined the massive resource presented two examples of how PE has stepped in and offered allocation effort to fight the novel coronavirus. PE provides its services to contribute to this effort: integrated business strategies and insights to GI specialists “In New York, we were getting news that COVID-positive and healthcare partners to help practices, ASCs, and patients were going to be readmitted into nursing homes, ancillary services grow and thrive. PE specializes in the which would obviously be increasing the risk for those in development and management of free-standing, singlethe facilities who weren’t infected. We wanted to help, so specialty endoscopic ASCs through strategic partnerships we reached out and stated that we had 15-plus ASCs [then and aligned investments with practicing physicians, health closed for business due to coronavirus] in New York that we systems, and hospitals. could use in some fashion so that the patients didn’t go back Like many others in healthcare, PE offered its services into the nursing homes. They wound up finding another place to the battle against COVID-19. Teresa Chaisson, Director to take these patients, but that’s one example of where Physicians Endoscopy has been ready to help the cause. of Clinical Support Implementation at PE, and Andrew “Another example is that we had an email from the Castaldi, Vice President of Operations at PE, served on the Ambulatory Surgery Center Association saying a hospital in front lines. The pair has since been working diligently to help Yonkers was in dire need of Propofol for PE-partnered hospitals, centers, and patients who needed to be intubated. If center employees prepare for the worst “No matter what this pandemic they didn’t have this medication, it would in the face of this pandemic. They have throws at us, we’ll figure out a set off a cascade of negative effects. also been contributing to the overall effort to keep New York hospitals solution—that’s what we do on The troops got together, and people were even willing to drive to Yonkers above water as patients flood in. a daily basis, and we’ve carried themselves to deliver it. It turned out New York State was one of the world’s hot spots for COVID-19. In that the shipment came in two hours it through this difficult time.” fact, the state claimed the unfortunate later, so the crisis was averted, but the – Andrew Castaldi, Vice President of distinction of having more cases of offer was there, and it was amazing to Operations at Physicians Endoscopy coronavirus than any other country see such collaboration in such a short outside of the United States on April amount of time.”

8, 2020. The influx of patients bombarded hospitals at While the effort the PE team is making is not necessarily unprecedented levels and stretched hospital staffing to its glamorous, they have met their goals to facilitate the care prolimit. PE is working toward supporting its partnered hospitals vided to COVID-19 patients and to ensure that their centers are with the staff they need to continue providing care. as fully prepared as possible under the current circumstances.

PE is also working hard to get hospitals the personal “If I could describe in one word what we’re striving for, it’s protective equipment (PPE) essential to control the spread facilitation, being the person who can be called in case someof coronavirus. PPE includes gowns and masks, such as the thing comes up. No matter what this pandemic throws at us, N-95 masks that filter 95% of airborne particles. CBS News we’ll figure out a solution—that’s what we do on a daily basis, calls N-95 masks “the coin of the realm in this crisis,” but and we’ve carried it through this difficult time,” said Castaldi. notes that “gloves, gowns, goggles, face shields, [and] In response to the COVID-19 pandemic, PE stepped surgical masks [are] all PPE designed to be discarded after up and stood out as a contributing member of the medical every encounter with an infected patient.” community. “Physicians Endoscopy has put forth every Because they are treating a huge number of patients and effort to support this national crisis, and I’m very proud throwing away their protective gear in between cases, many of the work that’s been done here. I won’t lie; this has been hospitals are running short of PPE. A number of PE-partnered an experience that I’ll be glad to have as a distant memory, centers donated PPE to help keep healthcare workers and but we’re managing, we’re in it, and we’ll get through it,” patients safe. PE also submitted an updated list of inventories said Chaisson.

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Excellence | Success stories |

Filling the Gap

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very year the Blue Sky Surgical Team provides outpatient general surgical services at the Double Harvest Clinic in Haiti, where many members have served every year since 2007. The team includes general surgeons, pediatric surgeons, anesthesiologists, and CRNAs. March 2019 was their fourth year at the Double Harvest Clinic, a wonderful facility with Haitian staff, including a primary care physician and nurses.

Blue Sky Surgical Team founder and leader, Anthony V. Coletta, MD, MBA, also serves as the Executive Chairman of the Board at Tandigm Health, LLC, a Population Health and Physicians Management Services Organization headquartered in Conshohocken, Pennsylvania.

The Blue Sky Surgical Team’s purpose is to conduct medical missions through Double Harvest Clinic outside of Port-au-Prince, Haiti, to help “fill the gap” in a nation that has

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no formal healthcare system or infrastructure—even seven years after its catastrophic earthquake.

Since 2007, Dr. Coletta, a board-certified general surgeon, has volunteered as a surgical missionary to Haiti, performing surgical procedures alongside others looking to help. Following the earthquake of 2010, Dr. Coletta has led a team of doctors, nurses, and medical professionals on these annual missions (sometimes twice annually), traveling to the island with medical supplies and performing general and pediatric surgery on hundreds of patients through the years.

On January 12, 2010, Haiti was devastated by an enormous 7.0 magnitude earthquake that occurred just 16 miles from Port-au-Prince. According to history.com, all of the capital’s hospitals, along with three facilities run by Doctors Without Borders, sustained severe damage. The toll on the people of Haiti remains incalculable. It is estimated that 316,000 people

Image: iStock.com/001nights

Blue Sky Surgical provides muchneeded GI services in Haiti

Source: .buckscountycouriertimes.com

died, but authorities acknowledge that the exact number will remain unknown; about 1 million people were also displaced.

With an outpouring of help for Haiti from around the globe, the nation has yet to recover fully. Seismic activity and a history of settlement, occupation, and extortion by other countries have contributed to Haiti’s status as the poorest country in the Western Hemisphere.

“I’ve had the privilege of traveling to Haiti to perform surgery on some of the poorest and most underserved citizens of this country, which is one of the most povertystricken in the Western Hemisphere,” said Dr. Coletta. “First, as an individual working with another group, and now as part of a team I founded, Blue Sky Surgical. We travel up to two times a year Above: The Blue Sky Surgical team doing what we can to help, always with the intent unpacks supplies and prepares the operating rooms. of establishing strong, country-based relationships Left: Anthony Coletta, MD, with that will someday hopefully lead to a self-sustaining one of his patients at a medical healthcare system in Haiti. Working through the clinic in Port-au-Prince, Haiti.

Double Harvest Clinic outside of Port-au-Prince, our team of medical professionals spends 7–10 days experience never onsite, often conducting 70–80 surgeries during ceases to remind me that time. While the difficulties of this country of how lucky I am and our work sometimes seem overwhelming, we to be a healthcare continue to go by the motto: ‘One patient at a time.’” professional in the Medical missionaries, mostly Philadelphia-based, United States. Too have quietly worked to aid Haiti as much as possible. often we forget what They have volunteered their time, talent, and resources great talent, innovation, and resources we have available and committed to making these highly valued visits. At a to us.” time when the United States healthcare system is in a state Unfortunately, this year the medical mission trip was cut of uncertainty, this humanitarian work is a stark reminder of short due to the COVID-19 pandemic. After the U.S. State what a nation without real healthcare options can—and does— Department raised its travel advisory for Haiti to Level 4 look like.

“Do Not Travel,” the decision was made to return to the This year, Dr. Coletta’s team reached out to the GI United States. Dr. Coletta assured patients and partners community to obtain supplies for an upcoming trip. Items that they would be back as soon as possible. After the travel they regularly need include benign prostatic hyperplasia advisory for Haiti has lifted, the Blue Sky Surgical Team (BPH)/prostate medication such as Flomax or Proscar, will once again be looking to the medical community for hemorrhoid ointments, and stool softeners. Although they donations and volunteers and planning their next journey were not seeking high quantities, these needed medications in serving the medical needs of the people of Haiti. point to the kind of medical issues patients suffer from THE NEED IS GREAT. The team at Blue Sky without treatment options. Dr. Coletta’s goal is to help Haitian patients feel connected to care, but in the process, Surgical needs the help of he has humbled and inspired many healthcare workers who our medical community.

Anthony make the trip with him or hear of his efforts.

V. Coletta, Small donations, as well MD, MBA, In collaboration with the Blue Sky Surgical Team mission, as sample-size supplies, is Executive Physicians Endoscopy (PE) reached out to its vendor partners are a huge contribution Chairman of to aid in the effort. Henry Schein made a significant donation the Board of and an excellent of medical supplies, including Proscar tablets, hemorrhoidal Tandigm Health, option for travel and ointment, and docusate sodium soft gel capsules. PE also made LLC. A boardcertified general surgeon and an a personal donation of materials, including electrosurgical pads, shipping. Those wishing experienced healthcare business to contribute to this cases of dextrose and sodium chloride, as well as Medivators leader, Dr. Coletta brings an program can contact Endogator endoscopy irrigation tubing. exceptional depth of executive and Dr. Anthony Coletta at “A good number of our team’s patients are children under clinical expertise to Tandigm. Learn age 10, including many orphans,” said Dr. Coletta. “This dravcoletta@gmail.com. more at tandigmhealth.com.

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Insights | Clinical updates |

TakingTelehealth on

Developing and implementing a successful telemedicine strategy

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he coronavirus pandemic has changed the way doctors, nurses, and other healthcare professionals interact with patients and one another. During the pandemic, every face-to-face encounter between healthcare professionals and patients presents an opportunity to spread the virus that causes COVID-19, or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To safely treat patients and stop the spread of COVID-19, a growing number of hospitals, clinics, and doctor’s offices are turning to telehealth as a means of social distancing while providing care. Capital Digestive Care, the largest independent GI group in the mid-Atlantic states and a Physicians Endoscopy partner, made a quick transition to telehealth, stabilizing office volumes via “virtual visits” for their 56 physicians. We sat down with Cara Reymann, CMO and Director of Practice Development for Capital Digestive Care, to discuss their telehealth strategy and what they have learned while implementing it.

Meredith Jayne (MJ): What caused the integration of telehealth, and how has Capital Digestive Care incorporated it into their overall strategy?

Cara Reymann (CR): We had been evaluating telehealth solutions since 2019, but the crisis with COVID-19 necessitated an accelerated implementation to maintain the safest environment possible. We not only canceled all the elective procedures in our endoscopy centers, we also canceled all the elective appointments across our 13 office locations.

We had already chosen a platform that was HIPAA compliant and were in the midst of integrating that platform with our electronic medical record (EMR) system. We had not planned on launching telehealth until May to give everyone ample time to go through training and learn all of the capabilities available through the program. Instead, we hit the hyperspeed button in March and were able to finish our integration, get everyone loaded into the system, and train users in about 8–10 days. It was a massive effort on everybody’s part.

MJ: Can you tell me about the transition to digital medicine and any hiccups?

CR: With every new technology comes technical challenges, and we definitely had those. Our first week was a bumpy one. However, I think that had more to do with the fact that the entire country was moving every business, every school, every communication onto these digital platforms, so that overload on the technology ecosystems across the country was

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Insights | Clinical updates |

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problematic as a whole. It a computer or a telephone, didn’t matter what digital if there’s a particular app that healthcare platform you they should download—those were using; everybody kinds of things. If you can experienced some disruption. address these items during Our platform had to spend scheduling, then it will Capital Digestive Care sees about 220 patients a day via several days of very intense help you connect with that telehealth across its 13 office locations. work with Microsoft to patient more seamlessly for expand the bandwidth of their system, so that was one big their appointment, and you won’t have to waste time trying snag that we had to overcome. Then we saw a considerable to troubleshoot. improvement as we were heading into week three.

The second and third things we did were create virtual The other hurdle is that each patient’s ability to engage with check-in and check-out processes. After a patient is schedtechnology is going to be different. We have had problems uled, there’s some information that needs to be collected and where people can’t get their video to work, or they can’t get populated so that the doctor has it for their visit. If you’re in the their audio to turn on, or the technology is just not working office, this is done by the medical assistant. Now, we can comin general. Fortunately, because the Centers for Medicare plete that process in a virtual environment so that when the doc& Medicaid Services regulations have been so dramatically tor logs into that patient’s visit, the information has already been relaxed, our doctors have been able to fall back on a regular populated in advance. Similarly, the virtual check-out process phone call, or even a FaceTime call, in order to complete that is where the physician is going to have some recommendations appointment. We always try to use our telehealth platform for the patient as a result of the visit, and all of that information first, but if it’s not working, we still have a backup so that we needs to be transitioned after the appointment is complete. can always complete the visit. It has its hiccups, for sure, but Again, our team will do this in the virtual environment. For examI think everybody has done a phenomenal job of being ple, if they need to send a prescription to the pharmacy for them, adaptable, including the doctors and the staff. they do that virtually after the appointment is complete.

Patients Seen Daily

MJ: What are some key tips or steps companies switching to digital healthcare should know?

MJ: What has patient feedback looked like so far?

CR: It’s been pretty amazing. We’re seeing about 220 patients CR: First and foremost, they should understand all of a day via telehealth, and I think patients are embracing that the changes in the regulations that have come out due to technology. I think everybody has been pleasantly surprised by COVID-19; that will help them understand what technology how comprehensive the visit can be, even though you’re doing platforms are acceptable during the crisis it over an electronic device. We’ve seen a lot Cara Reymann and how to educate patients on accessing of very seamless activity, and a lot of adoption serves as Senior the technology. The second thing I would of technology. We plan to conduct a survey in Vice President recommend is to be aware of the changes to the very near future to identify areas that we of Practice Operations the coding that have been released. It allows can improve upon. and Marketing a physician to understand what type of for PE Practice visit they can conduct using telehealth and MJ: Do you think this will be a longSolutions what documentation is required to support term transition to digital healthcare, or and oversees Capital Digestive their coding. For the most part, a telehealth will patients want to be seen in person Care, the largest independent GI practice in the mid-Atlantic states. visit is reimbursed at the same level as an again moving forward?

She is a member of the Board of in-office visit, which is a huge advantage Directors of the Maryland Medical for practices that are struggling right now.

CR: I think when we get back to work after Group Management Association.

Finally, they need to think about what needs COVID-19, we will need to be prepared to to be completed before and after the visit. deliver medicine differently. I believe that Meredith Our group did three things to improve we will need the regulatory bodies to Jayne is the workflow as we introduced telehealth.

Marketing embrace telehealth and keep some of these Manager at First, we created a process for our waivers of the rules in place to encourage Physicians scheduling team so that they are coaching people to continue using the technology.

Endoscopy patients on the technology as part of the Hopefully, this experience will help prove (PE). She can scheduling process. They let them know what how telehealth is a benefit to patients, be reached at browser works best, whether to use mjayne@endocenters.com. doctors, and the system as well.

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WHAT WE DO We partner with gastroenterologists in private practice, providing resources to improve operations, drive growth, and enhance patient, physician, and staff experiences—all while maintaining their independence.

Our strategy is aligned with your interests in tackling the following challenges: • Career security and stability • Succession and recruitment strategies • Growing administrative costs and burdens • Shifting regulatory and reporting requirements • Preparation to move from fee-for-service to value-based care • Competition from hospital and other physician practice models • Declining reimbursements paired with a need to invest in technology, security, marketing, and patient engagement

GET IN TOUCH We’d love to share more details about how we can help you stay independent and thrive in the changing healthcare environment.

Kevin Harlen, President kevin.harlen@capitaldigestivecare.com 240-485-5201

Insights | Human resources and personnel issues |

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mployee morale affects the productivity of any organization, but it’s especially important in organizations that provide patient care. Low morale is associated with poor performance, conflicts that can disrupt patient care, and loss of revenue for your organization. In healthcare situations, these negative effects can lead to poor patient experiences due to unmotivated staff not treating or supporting patients with the highest standards of quality of care.

This is especially relevant during this time as the COVID-19 pandemic has spread a feeling of uncertainty and anxiety within the medical community. As a physician or practice manager, it’s vital to the success of your practice that leadership openly communicate and address opportunities to positively impact the morale and well-being of the staff.

How to build morale during a crisis

By Dana Pietras, PHR, SHRM-CP

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When staff morale is high, productivity increases. Satisfied healthcare workers are cheerful, attentive to the needs of their patients, willing to go the extra mile, and display a positive attitude. This will improve the overall patient experience, which is key. When it is low, staff members are less motivated to work. Healthcare workers with low morale have decreased productivity and increased insubordination, conflicts with co-workers, disorganized work methods, routine complaints about seemingly insignificant work-related issues, and an uptick in patient complaints regarding the employee’s behavior.

Low morale increases turnover rates, too, and the constant flow of workers can drastically reduce overall productivity as new employees tend to complete tasks more slowly. The national nurse turnover rate was 17.2% in 2018, and CNA turnover rate was nearly 32% that year.

According to Forbes Media, LLC, 46% of American businesses have implemented

Image: iStock.com/AaronAmat and LueratSatichob

Inspiring Your Team

Why Morale Is Important to Your Practice

remote-work policies as of mid-February. Staff new to working from home are struggling to stay engaged, focused, and productive, which leads to a decrease in employee morale. Staff will often look to leadership for guidance during a time of ambiguity and need guidance to keep from falling into patterns that can lead to low morale.

How to Improve Morale Among Your Staff Discover and empathize with the needs of your staff According to BusinessSolver, 90% of employees are more likely to stay with an organization that empathizes with their needs.

Being flexible and working to incorporate questions about what’s working and what needs to be improved is invaluable to staff when delivered with sincerity. It is unavoidable that staff working from home will experience distractions, but employees who feel appreciated will work to make up for those moments of disruption.

Prioritize employee health and mental well-being Happy, healthy employees are more productive, but many healthcare workers are vulnerable to job-related illness, injury, and significant stress. While employees continue to work remotely, encourage time outdoors, frequent breaks from the computer screen, and even suggest a fitness app to help employees stay active, avoid burnout, and prevent illness and injury. Always strive to provide an outlet for staff. Carve out time at the beginning of a meeting to have a social conversation to reconnect with each other for a few minutes before getting to essential content, especially when the meeting is done virtually.

Adjust workload and support your employees A study by Southern Methodist University shows that when the overall workload is low, increasing the workload may motivate workers to work harder. However, when the workload is high, increasing the workload can actually reduce worker productivity. Check in with staff frequently to see how they are handling the amount of work they have on their plate. Make it a point to schedule one-onone meetings with your staff, and don’t cancel them unless

absolutely necessary. If you had an open-door policy at the physical office, be as responsive as possible on your instant messaging platform to maintain that feeling of open communication with employees.

A softer approach In a March 2020 article, “How to Boost Telecommuters’ Morale During the COVID-19 Pandemic,” Moira Alexander suggested that working in an online environment doesn’t have to affect employee morale negatively.

Providing company-wide updates to keep staff up to date about organizational tactics in the face of COVID19, or hosting team wellness check-ins, can make a huge difference in employee morale. Use dialogue and feedback to understand and clarify what employees do, reassess task alignment, and optimize the working environment. Dialogue and shared purpose between employees can help individuals work as a cohesive team to increase productivity and morale. Use this opportunity to capitalize on team members’ strengths and encourage them to expand upon, or even provide online training options for, skill sets that they may have begun developing while in the office.

During work from home periods, it is especially important to publicly recognize individual work and affirm staff’s value.

“In a crisis, the only asset you have is your credibility,” said Paul Volcker, the late former Federal Reserve Chairman and Chairman of President Obama’s Economic Recovery Advisory Board throughout the 2008–2009 economic crisis.

Identify and address other factors that may be reducing productivity Organizational culture, work environment, leadership, peer support, stress, wages, and other factors contribute to employee morale.

Identify and address any of these factors affecting your organization’s productivity. Morale is one of the most essential components of a company’s Dana Pietras, culture and success, and staff PHR, SHRM-CP, will reflect leadership’s value is the Senior of their morale in daily effort.

Human Resources Improve productivity at Business Partner your practice by boosting at Physicians morale among your most Endoscopy (PE). valuable asset—your She can be reached at healthcare workers. dpietras@endocenters.com.

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Spotlight | Inspirational stories |

16 PE GI Journal June 2020

Show of

Strength

A

ccording to the latest edition of Colorectal Cancer Statistics 2020, the American Cancer Society announced that a heavy burden is shifting to younger individuals. Colon cancer is now the third leading cause of cancer deaths in young adults, and it is on the rise as 1 in 5 colorectal cancer patients are between the age of 20 and 54. In 2020, there will be about 18,000 cases of CRC (12%) diagnosed in people under 50, the equivalent of 49 new cases per day. Because younger adults do not fall under the recommended screening age umbrella, they are frequently diagnosed with late-stage colorectal cancer, and therefore have a tougher battle to fight. Lauren Ricottone is a mother of two children, a wife, and a rock for her family.

Despite no history of colon cancer in her family, she is now in an ongoing fight for her life and is showing her strength in incredible ways.

Deven Stopa (DS): When did you discover you had cancer?

Lauren Ricottone (LR): I had mild intermittent bleeding when I went to the bathroom. I did schedule a colonoscopy, but then I found out I was pregnant minutes before I went in for my procedure.

In January of 2016, I had my daughter, and at the end of that month was when I really got sick and was bleeding vaginally and rectally, so I scheduled a colonoscopy. When I woke up from the colonoscopy, I thought it was a little odd because the nurse was hugging me. The doctor called my husband in and told us that I had cancer.

Lauren Ricottone faces colon cancer head-on with perseverance and determination

DS: Can you tell me about receiving your diagnosis and how it made you feel?

LR: I didn’t know what to think; I was in a complete fog. It didn’t fully click for me that I had cancer until I had to start chemotherapy, which was after my first surgery to remove the cancer.

In my mind, I thought they would cut it out during the surgery, and everything would be fine. Once they told me it had metastasized, and I would have to do chemotherapy…I think that’s when it really sunk in and I realized it was way worse than I thought.

DS: Can you walk me through your treatment and any obstacles that you encountered?

LR: After my first surgery, I recovered and then did six months of chemotherapy. I didn’t take off of work [as a nurse in a hospital Emergency Room] during that entire period. I would get to the hospital and into chemotherapy by 7:30 a.m. after my night shift, and then be in chemotherapy for six hours, go home for a little bit to see the baby, and then go back to work by 7:00 p.m.

I knew chemotherapy was bad, but it got worse as time went on. At my job, they use fingerprints for everything, and toward the end of my chemotherapy, I had such bad swelling that the machine couldn’t pick up my fingerprints.

DS: Where are you now in your journey with cancer?

LR: In May of last year, I started getting abdominal pain, so I went in for an ultrasound, and they told me I had an ovarian

17 PE GI Journal endocenters.com

Spotlight | Inspirational stories | cyst. The cyst ruptured, and I had internal bleeding, so they took me back for surgery. They took both of my ovaries, and there was colon cancer in them. I had to go back on chemotherapy and just finished at the end of December 2019. Since then, I’ve been back at work [as an Emergency Room nurse] once a week to start.

DS: Who or what did you turn to in order to make it through your treatment? It sounds like your work helps a lot.

LR: It does. It helps me feel normal. For example, I may not look the same as I did last year, but patients don’t know that.

I can take my mind off cancer and focus on my work.

I also have great support from my family and friends. My one friend went with me to a majority of my chemotherapy, and my in-laws offered to watch the kids while I was there.

It got so bad toward the end of this chemotherapy that they would take the kids overnight so that they didn’t have to see me sick. Everyone has been wonderful.

DS: What has your journey meant to you and your family?

LR: It has brought our family so much closer, even cousins. It has brought all of our families much closer. It didn’t have to be cancer that caused it, but it’s still a good thing.

My priorities in life have changed, as well. I always used to be a workaholic, but when the kids came, and I got sick at the same time, everything changed. But I’m okay with that. I’d much rather be home and see them grow.

DS: What would you want other men and women of screening age, who are hesitant to get a colonoscopy, to know?

LR: It’s very important to realize that it does not have to be genetic. It can happen to anyone at any time; it’s happening in younger people more and more. Yes, the prep sucks, but it’s getting better; if you’re young, and you can handle it, do it.

DS: What are some words of advice that you would give to someone who just received their cancer diagnosis today?

LR: I’ve actually had this conversation frequently. There have been times where the physician I work with will ask me to come into the room if he’s giving a cancer diagnosis so that I can talk to the patients after he leaves.

Sometimes people who are newly diagnosed get into a mindset of ‘Okay, I’m going to do A, B, and C, and then I will be cured.’ But that’s rarely the case. You are going to take one

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“It’s very important to realize that [colon cancer] does not have to be genetic. It can happen to anyone at any time; it’s happening in younger people more and more.”

— Lauren Ricottone, colon cancer survivor step forward and two steps back. You might get redirected onto another path, but you just need to keep moving forward, and sometimes it’s really hard to do.

Lauren is still battling her colon cancer. Her hopes for the future change by the day, but one thing remains the same. “I honestly hope I can see my kids grow up…that’s the biggest thing. I would love to see them be teenagers,” she said. Lauren’s perseverance and determination to not only survive her cancer but not let it hinder her career, motherhood, or daily routine is nothing short of astonishing.

It is increasingly important for people under the typical screening age to be aware of their risk for developing colon cancer and know the signs and symptoms that may Deven Stopa point to a developing issue. is Director Visit coloncancercoalition. of Digital Marketing org/get-educated to find at Physicians out how on-time screenings Endoscopy and timely evaluation (PE). She can of symptoms can help be reached at eradicate this disease. dstopa@endocenters.com.

HELPING PHYSICIAN PARTNERS GROW AND THRIVE PE Practice Solutions is a unique, physician-oriented management service organization aligned with the interests of gastroenterologists in independent practice.

A collaboration between PE and Capital Digestive Care, we are committed to preserving the independence of gastroenterologists and advancing digestive healthcare.

LET’S WORK TOGETHER TO ACHIEVE YOUR PRACTICE MANAGEMENT GOALS: Strategic Guidance Financial Revenue Cycle Management Clinical & Operations Payor Contracting Human Resources Information Technology Marketing Kevin Harlen, President kevin.harlen@capitaldigestivecare.com 240-485-5201 capitaldigestivecare.com/joinus

Opportunities

Northeast West

Midwest

South West Mesa, AZ Central Arizona Medical Associates Seeking a full-time gastroenterologist. Physician can expect to step into a busy practice while replacing a retiring partner. Anticipate a short track to practice partnership and ASC ownership. Practice operates out of a single office and covers one hospital. Outpatient endoscopy performed at a physician-owned, two-room ASC. Enjoy sunshine and a great lifestyle in the Phoenix metro area.

Outstanding benefits package offered. 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, and a great place to raise a family.

Scottsdale, AZ Digestive Health Specialists Arizona Full-time gastroenterologist with partnership potential needed for small practice of four MDs, NP, and PA. Outpatient-based with low inpatient volume and only one hospital round. No ERCP or EUS training needed.

Physician office includes an infusion center, pathology lab, and state-of-theart endoscopy center, all within the same building.

Northern & Central, CA SecureMD Board-certified gastroenterologists needed for mobile endoscopy practice in Northern CA (Sacramento/Stockton/Tracy) and Central CA (Fresno/ Tulare/San Luis Obispo). Flexible schedules allow you to work as many as 2–3 days per week or as few as 1–2 days per month.

Bellingham, WA NW Gastroenterology & Endoscopy Physician needed to join a nine-person, single-specialty practice.

Freestanding AEC and pathology lab, EUS optional, ERCP optional.

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Midwest Bloomington-Normal, IL Digestive Disease Consultants Reputable single-specialty practice for more than 30 years seeks physician.

Multiple revenue sources including endoscopy center, strong support from local hospital, and guaranteed salary for two years. Low turnover and high retention rate.

Portage, MI Bronson Gastroenterology Practice Seeking a BC/BE gastroenterologist to join a well-established and respected group of outpatient and hospitalist gastroenterologists, and mid-levels.

Employed position includes competitive salary, paid malpractice and full benefits. Kalamazoo, located midway between Detroit and Chicago, offers highly rated public schools, affordable real estate, and many activities for the whole family. Lake Michigan is less than an hour’s drive away.

Rochester, MI Troy Gastroenterology Two gastroenterologists skilled in general endoscopy and ERCP needed for private practice with two state-of-the-art, AAAHC-accredited ASCs. Competitive base salary with productivity incentive, retirement plan, discretionary allowance, insurance, and eligibility for member status after two years.

Lima, OH Gastro-Intestinal Associates, Inc. BE/BC gastroenterologist needed for six-physician, four-CNP single-specialty practice. Practice is physician-owned and includes an 18,000-square-foot combined office and three-room endoscopy center.

Opportunity offers 1:7 call rotation, first-year salary guarantee, and outstanding earning potential.

Northeast Stoneham, MA Digestive Health Associates, PC Seeking full-time gastroenterologist to join well-established, seven-physician, single-specialty practice group with an ASC in the Boston area. 1:9 call schedule. Competitive salary and benefits. Full partner track at two years.

Affiliated with Burlington County Endoscopy Center, a three-room ASC that is physician-owned and operated.

North Bergen, NJ Advanced Center for Endoscopy GI physician needed to join a single-specialty, nine-physician GI center.

The center can help the physician drive patient volume through the ASC, allowing the physician to increase procedure volume in an environment that is more convenient. Ideally located in North Bergen, the “gold coast” of Northern New Jersey, with a spectacular view of the NYC skyline.

New York, NY Gastroenterology on Gramercy Park Seeking a gastroenterologist to join two-physician private group. Expect to step into a busy practice while replacing a retiring partner. Opportunity offers a primarily outpatient experience with a reasonable call burden. Candidate will have ownership opportunity in affiliated endoscopic ambulatory surgery center.

Uniondale, NY Gastroenterology Associates PC Seeking a full-time/part-time, board-certified/board-eligible GI physician to join large single-specialty gastroenterology group. Compensation package includes an option for partnership in practice and ownership in affiliated ambulatory surgery center.

Hagerstown, MD Gastroenterology Associates

Jenkintown, PA Gastrointestinal Associates, Inc.

Immediate opening for a gastroenterologist to join a well-established practice.

Weekend call 1:8. One-year partnership track for ownership in practice and endoscopy center. Offer includes competitive salary, attractive bonus, comprehensive benefit package, and income from endoscopy center and ancillary services. Hagerstown merges the best of small-town friendliness with easy access to metropolitan areas like Washington, DC, and Baltimore.

Seventeen-physician practice is seeking a board-certified gastroenterologist, preferably with an investment in IBD or advanced therapeutic training. Fulltime position with shared clinical and administrative responsibilities. The job offers a competitive salary and benefits that include bonus potential and partnership track.

Central, NJ

Limerick, PA

Garden State Digestive Disease Specialists, LLC

Endoscopy Associates of Valley Forge

Seeking full-time BC/BE gastroenterologist to join three-physician practice.

The job offers an excellent salary, competitive benefits package, 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 preferred.

Board certified. U.S. Gastroenterology Fellowship. ERCP- or EUS-trained preferred. Full-time, rotating call dispersed evenly with three other physicians.

One hospital with endo suite. Hospital is within 15 minutes driving distance of center. GI center has three procedure rooms. GI practice is in the same building as the GI center. Located one hour outside of Philadelphia.

Hillsborough, NJ

Philadelphia, PA

Digestive Healthcare Center PA Seeking a BE/BC gastroenterologist skilled in general endoscopy and ECRP to join busy, seven-person, single-specialty, 30-year established practice located in Central New Jersey. Excellent salary, competitive benefits package.

Lumberton, NJ

Philadelphia Gastroenterology Consultants Four-physician and four-physician assistant GI practice located in Northeast Philadelphia seeking board-certified or board-eligible gastroenterologist. ERCP skills helpful but not required. Full-time position. Competitive salary and benefits with productivity bonus and partnership track. Mostly outpatient GI practice with adjacent three-room endoscopy center. Very limited equal call schedule.

Gastroenterology Consultants of South Jersey Seeking full- or part-time gastroenterologist to join a privately owned, seven-physician practice. Well-established practice of 25 years, located among several growing communities in Southern New Jersey. We offer a 1:7 call schedule and an opportunity to perform ERCP/EUS (not required).

Submit your CV online at endocenters.com/recruiting.

21 PE GI Journal endocenters.com