GI A publication dedicated to advancing GI practices and ASCs
The Year That Was in GI Reviewing lessons learned in 2021 and supporting GI through 2022 and beyond
SPECIAL ISSUE
DECEMBER 2021
Letter | Message From the President |
Aligning for Success PE GI Solutions supports GI through the new year and beyond
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his issue of the PE GI Journal recaps another unusual year. You can read my thoughts on key takeaways from the year on page 4 of this issue. In this article, I highlight the impressive resilience of the GI industry in the face of continued uncertainty and disruption. I draw attention to the extraordinary efforts around patient engagement and expanded access. I note some of the most significant challenges facing the industry and share ideas on what I feel must happen to help overcome these obstacles, such as using clinical and information technology. I talk about the ongoing consolidation in the industry and what will be required for these efforts to deliver on their promise. Finally, I touch on the importance of prioritizing support for gastroenterologists. I’d like to elaborate a bit further on the work I feel is necessary to best position the industry going forward. The first step concerns the role of companies like PE GI Solutions supporting and aligning practices and ambulatory surgery centers (ASCs). We’ve done a lot of good work around caring for the other areas of the doctor’s business. Now, through proper consolidation, we can help gastroenterologists better care for themselves. Which brings me to the second step: helping doctors make sound decisions for their future. This means providing guidance so they can effectively plan for different compensation models, different succession plans and the employment versus independent route. The third step concerns increasing collaboration and alignment of gastroenterologists and their facilities with industry partners, such as primary care networks and health systems. A key here will be the use of technology and data through improved inte-
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GI Editorial Staff Suzette Sison Editor in Chief ssison@pegisolutions.com Kelly McCormick Digital/Managing Editor kmccormick@pegisolutions.com Contributing Writers: Lynn Hetzler, Jake Keator, Robert Kurtz, and Rachael Samonski
gration. This should support more effective incorporation of the doctors’ and patients’ roles into the healthcare system, which will eventually lead to something similar to value-based care. In terms of PE GI Solutions’ role in these efforts, we’ll continue to focus on the core principles of the company: We’re here to work for and with doctors, invest for and with doctors, and find alignment on their success. When we do well for our doctors, the company does well. This is not a new philosophy. It’s what we eat, sleep, and breathe. And it’s what motivated us to launch a practice management services organization in 2019, which eventually led to our company name change at the beginning of 2021. What we have always done and will continue to do in this business is make investments in the future focusing on careers and longevity of young doctors that allows older doctors to have a proper succession plan and transition. When we do well These investments are not for our doctors, the and will never company does well. be around executing transactions. They reflect our unwavering commitment to enter into long-term partnerships that ultimately bring success to everyone David Young, President & CEO, PE GI Solutions involved.
Publishing services are provided by GLC, 9911 Woods Drive, Skokie, IL 60077, (847) 205–3000, glcdelivers.com. PE GI Journal™, a free publication, is published by PE GI Solutions, 2500 York Road, Suite 300, Jamison, PA 18929. The views expressed in this publication are not necessarily those of PE GI Solutions, PE GI Journal or the editorial staff. POSTMASTER: Send address changes to: PE GI Solutions, 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 © 2021 by PE GI Solutions. All rights reserved. All copyright for material appearing in PE GI Journal belongs to PE GI Solutions, and/or the individual contributor/clients, and may not be reproduced without the written consent of PE GI Solutions. 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, or promotional purposes: Submit in writing by mail or send via email to info@pegisolutions.com.
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| News and events |
Noteworthy
Looking Back at 2021
Cover: iStock.com/XiXinXing, This page: iStock.com/Chris Curry, sturti
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hile 2021 offered many challenges for the GI industry, it also offered plenty of opportunities, and there was no lack of moments to celebrate. PE GI Solutions launched its new brand, brought in more partners, and watched proudly as many partnered centers hit important milestones. Here are a few highlights from 2021. Physicians Endoscopy announced their brand expansion to PE GI Solutions (PE), which includes a holistic service model offering to GI specialists. To continue advancing the business of digestive care, PE expanded their brand to recognize the already successful move into practice management and development from their existing services in ambulatory surgery center (ASC) management and development. PE GI Solutions and the physicians of Gastroenterology Associates of Fredericksburg and Mary Washington Healthcare announced their three-way joint venture partnership and the opening of Fredericksburg Endoscopy Center, LLC, in Fredericksburg, Virginia. David Greenwald, MD, was appointed president of the American College of Gastroenterology (ACG). Dr. Greenwald is the Director of Clinical Gastroenterology and Endoscopy at Mount Sinai Hospital in New York City and is a partnering physician of PE at The Endoscopy Center of New York. Capital Digestive Care (CDC) created a partnership with Gastrointestinal & Liver Specialists of Tidewater.
The GI news and events from the past year
This partnership is the first CDC has in the state of Virginia, as well the largest in the Mid-Atlantic region. PE GI Solutions and Ambulatory Center for Endoscopy, LLC, acquired Hudson Bergen Medical Center, LLC. The surgical center has become a second location for the existing Ambulatory Center for Endoscopy. The center has been formally renamed to Hudson Bergen Endoscopy and Surgical Center. Three PE GI Solutions partnering endoscopy centers received their AAAHC Accreditation. The Digestive Disease and Endoscopy Center in Silverdale, WA; South Broward Endoscopy in Cooper City, FL; and Access Surgery Center in Egg Harbor Township, NJ, have successfully passed the AAAHC Accreditation survey.
Learn more about how PE GI Solutions can help your practice achieve its goals at pegisolutions.com. 3 PE GI Journal pegisolutions.com
Excellence | The year in review |
The Year That Was in GI 6 key takeaways from a roller-coaster year
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s we approach the end of 2021, it’s an apt time to look back at the year. And what a year it was. It’s safe to say that 2021 did not go the way anyone likely expected. David Young, President and Chief Executive Officer of PE GI Solutions, puts himself in this bucket. He recalls feeling optimistic over the summer that the end of pandemic was nearing. This was before the Delta variant hit with full force and slowed down the momentum that was building thanks to the rollout of vaccines and improved COVID-19 testing and treatments. While it’s looking like the year will end with the pandemic still a significant presence in our lives, that doesn’t mean 2021 was a bad year. In fact, for the GI industry, Young sees many positives and remains greatly optimistic about the future of the specialty. But he also recognizes that there is significant work that must be done for GI to emerge from this time with the positive momentum that will help further solidify the specialty’s critical role in our healthcare delivery system. Here are six of Young’s key takeaways for the GI industry from 2021.
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The industry showed its resilience
While 2020 was undoubtedly one of the most challenging years for healthcare and the GI industry, Young says 2021 wasn’t that far behind. “Consider how we came through the worst of COVID-19, then how we responded from a period of no vaccine to vaccine to the decisions we’ve needed to make concerning vaccinated and unvaccinated staff and patients. We’ve had to figure out how to live with Delta and hotspots. We’re continuing to adjust to the experiences and developments that have changed the way practices and surgery centers have operated, such as telehealth, testing, and masking. Then there are all the things we’ve learned and needed to consider during these periods.” The fact that GI remains strong is quite a testament, Young says. “I’m particularly proud of the way the industry has learned how to deal with COVID-19 and become more sophisticated with decision-making around it. When cases rise, we don’t panic and race to shut down. We apply what we have learned from our experiences and help ensure we can keep moving forward.”
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Efforts around patient engagement have been commendable
During a time when coordinating care has proved difficult at best due to factors including disruption in patient job status, housing, and insurance coverage, Young says the GI industry has still managed to achieve high levels of engagement. “Whether via telehealth, recall programs, or triaging, the ability to get patients to the appropriate care environment has been really impressive,” he says. “The focus on patients has been incredible during this period. That’s not just around delivering care but getting patients to the right place at the right time for the right service and for the right payer. This hasn’t been an easy feat, and yet this is an area where the industry has excelled.”
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Providers continue to face and respond strongly to pressure
The fact that the GI industry is performing as well as it is speaks volumes when you consider the ongoing challenges facing gastroenterologists and their practices and ASCs, Young says. This includes backlogged patients who still require GI care and services, overworked physicians and staff, a tougher safety and personal protective equipment environment, and the ever-lingering uncertainty that COVID-19 has introduced into day-to-day operations. “Unfortunately, we have the same number of GIs trying to fit in all these patients and prioritize and catch up on the more critical patients,” he says. “You’re working harder than ever, and it’s tiring.” This makes the U.S. Preventive Services Task Force’s recently updated guidelines on colorectal cancer screenings, which dropped the recommended age for screening from 50 to 45, a bit of a mixed bag for the GI industry. While this is certainly a positive for patient care, Young says, and payers are beginning to implement coverage for this younger age, the revised guidelines expand the patient population that should be receiving GI care at a time when gastroenterologists are already struggling to support patients.
“This development and our current situation make it all the more important that we continue finding ways to keep engaging with patients, dealing with mental challenges for our doctors and staff, and identifying opportunities to improve access, experience, and the diagnosis of issues,” he says.
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Technology is helping and positioned to do even more
Technology is taking on greater importance in the delivery and coordination of care, and Young says that will only continue to grow. Clinical and information technology advancements—everything from computer-aided polyp detection systems to reputation management tools to cloud solutions—are helping GI practices and ASCs improve their operations and performance across the board. There’s also the emergence of telehealth, a topic that now feels synonymous with the pandemic. Telehealth is here to stay, Young says, bringing with it many pros and cons. “We’re still learning how to effectively incorporate and leverage telehealth. We know it can enhance patient access and provide gastroenterologists with even greater control over their practice. On the other hand, it brings some challenges around patient engagement, and there remain barriers to access for some of our most vulnerable populations. It will take some time until we fully understand how telehealth will affect GI.”
iStock.com/Jacob Ammentorp Lund
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leveraging of services and solutions, and strengthen our value proposition—not just become bigger for the sake of becoming bigger. That’s the next test for the piece of the consolidation play.”
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Improving the care of gastroenterologists should be a priority
With so much attention on patient care, often followed by the wellness of staff, the needs of doctors are often overlooked or not given the attention they deserve. It’s imperative, Young says, that this changes. “We’re seeing organizations trying to find solutions to deal with succession problems and transition planning to the evolving needs of doctors in this post-COVID environment,” he says. “These efforts have been good, but they must be even better if we want to ensure a strong path forward for the industry and successful transition into future generations of GI.”
Read more of Young’s reflections on the year and thoughts on the future of the GI industry in this issue’s “Message From the President” on page 2.
Consolidation shows no signs of slowing down
Even with all the disruption in the GI industry during 2021, consolidation is proceeding at a rapid pace, Young says. “The business of GI is hard at work across the country, and that’s leading to more consolidation to support practices, which have generally been under-supported. We are now seeing second deals and financings completed and a lot of new consolidation underway.” For consolidation to be successful and beneficial to the industry, it requires a focus on creating value through operational delivery versus simply growing in size, Young says. “We must be able to repair income, improve scaling and
5 PE GI Journal pegisolutions.com
Insights | Highlights from PE GI Journal | One of the key missions of PE GI Solutions is supporting our partners and the GI industry at large. Our publication, PE GI Journal, helps achieve this goal by covering important topics affecting the GI industry, from clinical insights to marketing
tips. Below are a few brief highlights from the last year of PE GI Journal. To read extended versions of these articles and get the latest GI industry updates, visit pegijournal.com and sign up for our enewsletter.
immunochemical testing or stool DNA can be considered. Identify and address factors likely to slow patient throughput. Increasing throughput may involve scheduling patients in groups, then taking patients on a firstcome-first-serve basis, keeping procedure times to a minimum, asking patients to send in their paperwork earlier and having ancillary staff available to process it, and calling patients to confirm appointment times and answering questions.
Colonoscopy Care
Tips for reducing your patient backlog
gastroenterology clinic. Gastroenterologists can take steps to avoid a backlog of patients.
olonoscopy is often considered the “bread and butter” of a GI practice, but too much of a good thing might choke an unprepared
Create or add to staff dedicated to colonoscopy. A well-rounded colonoscopy team includes staff dedicated to scheduling the procedure, providing patient informa-
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Change in Policy
Gastroenterologists have shaped their practices around providing colorectal cancer screenings to patients over the age of 50. However, a growing number of younger adults are developing colorectal cancer; under the old recommendations, younger patients may not be receiving the colon cancer screenings they need. To address this, the U.S. Preventive Services Task Force has recently updated its guidelines on colorectal screenings to include younger patients. The new recommended age to begin getting screened is 45 years old.
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tion,and managing workups, intake forms, and patient records. Implement a triage. Establishing colonoscopy triage priorities can ensure that the patients at highest risk receive screening promptly. Offer alternatives for average-risk patients. Clinics inundated with colonoscopy requests may benefit from developing a tiered approach to recommending colonoscopy, one that is based on assessing each patient’s individual risk for developing colorectal cancer. While colonoscopy is the recommended best practice and gold standard for screening, other alternatives like fecal
Beef up the business office. While healthcare organizations are encouraging payers to update their policies quickly, it may take some time for insurance companies to update their policies. Adding temporary staff to the Billing & Insurance office can help GI clinics avoid a backlog of paperwork and payments. Use a “Direct Endoscopy Referral System” for eligible patients. Direct endoscopy referral system (DERS), sometimes called “open access,” allows nurse practitioners and other care providers to medically clear and refer patients directly for colonoscopy. READ MORE
iStock.com/romaset
Expand
Measure, Survey &
Communicate T
Getting patients back into your office
iStock.com/Drazen Zigic, FatCamera
he balance between relying on the healthcare world for information and patients’ reluctance to come into appointments requires walking a fine line. Bringing patients back into the office has been a struggle for physicians all over the country. How do you recall patients to make sure their healthcare isn’t put on hold? – Measure: A common theme during this time of COVID-19 is knowing the efforts made by healthcare offices to keep the public safe. Being able to measure the efforts going on within your office, then providing that information to your patients will go a long way.
Positive Outlook
Building a culture of optimism
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fter the year that employees and employers alike have had, it is no surprise that everyone is hungry for a company culture that has
a positive outlook for future growth. Employers can choose to build a culture around various positive values, but the most important to meet this moment
– Survey: While COVID-19 seems to be the common denominator for why most patients are not coming back into the office, there is still room to run a more specific survey to address other issues patients may experience as well. – Communicate: While you can survey the concern of your patients and measure the safety efforts in your office, patients will not know about these efforts unless you communicate with them. The mode of communication can vary depending on the office. READ MORE
is optimism. Here are some strategic actions you can take to encourage a longterm workforce with a positive outlook: Value human connections above all. Building, maintaining, and valuing personal connections in your workplace is the simplest avenue to achieving an optimistic workforce. Remember that titles are subjective. Many employees, of all levels, place too much significance on titles and levels within a workplace. While levels can provide clear definition of day-to-day responsibilities, they should not define who is responsible for inspiring optimism. Feed off people’s desire for normalcy. Renewed hope from vaccines is bringing reopening and a desire to get out into the world safely.
Use this to your advantage and have face-to-face (or mask-to-mask) interactions. Don’t try to buy optimism. Strive for long-term recognition and appreciation of your staff by compensating them fairly and offering competitive benefits every day, not just on a special day. Define the type of engagement you are looking for. Set a higher, more specific target for your workplace by encouraging people to share their positive outlooks. For example, instead of asking for comments on work experience, start asking what someone’s favorite part of their position is, or if they have specific growth goals you can help them achieve. READ MORE
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