PE GI Journal October 2020

GI A publication dedicated to advancing GI practices and ASCs

Making Nutrition Services Effective | pg. 8 Tips for 1099 Reporting | pg. 6 Lisa Issa’s Empowering Advice for Patients | pg. 14 Addressing Online Reviews | pg. 16

OCTOBER 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 OCTOBER 2020

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Deven Stopa Digital/Managing Editor dstopa@endocenters.com

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

PE GI Journal™, a free quarterly publication, is published by Physicians Endoscopy, 2500 York Road, Suite 300, Jamison, PA 18929.

Letter

Strategies

2 Message from the President

6 Tackling 1099s

Noteworthy

8 Making Nutrition Services Effective

4 The new PE blog, celebrating a new partnership, and more

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.

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

Excellence

Insights

12 The Personal Connection

16 Marketing Critical Thinking

Printed in the U.S.A.

Spotlight

PE Opportunities

14 Inspirational Stories Battle of a Lifetime

20 GI physician opportunities at partnered practices

Copyright Š 2020 by Physicians Endoscopy

Cover image: iStock.com/Cecilie_Arcurs

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

1 PE GI Journal endocenters.com

Letter | Message From the President |

Confidence Building How lessons learned from the pandemic can help guide the way forward

T

o say COVID-19 came quickly would be an understatement. The first U.S. case was in the latter half of January; the U.S. declared a public health emergency in early February. On March 11, COVID-19 was declared a pandemic; just two days later, it was declared a national emergency.

GI practices and ASCs, like all businesses, were forced to respond fast. Plans for the coming weeks, months and, in some cases, years were discarded as organizations worked to reinvent how to manage themselves according to a new set of rules. Many steps were taken, and many difficult decisions were made, including those concerning staffing levels and partner contracts.

Once the necessary steps were completed, businesses hunkered down, tightened their belts, and worked to make it through a challenging period of time. Attention was paid to providing care that could not be safely postponed and efforts began in working with government programs and lenders to secure financial support.

Time passed, and now businesses are reopening. GI practices and ASCs have focused on further building patient and provider confidence, with the goal of coming out of this health crisis feeling like there is still a positive short-term future for GI and a strong role for the specialty in the long term. But we can’t look too far ahead, as we still must travel a significant part of the journey.

While we may be feeling like we are slowly getting back to normal as we approach pre-pandemic patient visits and case volumes, there remains the ever-present threat of hotspots.

We must stay nimble, flexible, and ready to respond quickly and effectively so we can continue to treat patients in a safe environment—one that takes into account the lessons learned from COVID-19 thus far.

Momentum is building across GI practices and ASCs because of the aforementioned patient and provider

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confidence. By ably responding to speed bumps, we can continue this progression. When there is a better understanding on immunization and vaccination opportunities, we will further evaluate our situation and determine the best way to move forward, including how we can further enhance the pivotal role of GI. In the months ahead, continue to focus on the safety of your patients, employees, and yourselves, as well as the reputation of your business. Work closely with the partners that can provide financial, clinical, and operational support to help you best navigate these challenging times.

Physicians Endoscopy’s primary focus is to lead practices and ASCs to longterm success. We remain committed to supporting the GI industry and all physicians, regardless of whether they are our partners. The future for GI is bright—we look forward to playing a part in helping the industry make the most of this potential.

We must stay nimble, flexible, and ready to respond quickly and effectively so we can continue to treat patients in a safe environment— one that takes into account the lessons learned from COVID-19 thus far.

David Young, President & CEO, Physicians Endoscopy

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 | Community Support

PE awarded Largest Corporate Team at Get Your Rear in Gear – Philadelphia

Actor Chadwick Boseman’s passing at age 43 put a spotlight on colorectal cancer trends in younger people.

Source: facebook.com/ColorectalCancerAlliance

The 12th annual Get Your Rear in Gear – Philadelphia looked a little different than usual when it took place on July 19. This year, the event was virtual with a theme that challenged participants to complete at least 24 minutes of activity on that day (or whenever they could). Why 24 minutes? It represents the one in 24 people that develop colorectal cancer.

Participants were encouraged to share their photos and videos from their 24 minutes on social media, using the hashtag #GYRIGMyWay. Physicians Endoscopy proudly participated in the event, and even won the award for Largest Corporate Team. In all, the event raised over $140,000 for the Colon Cancer Coalition, a nonprofit organization dedicated to raising screening rates and increasing awareness about colorectal cancer.

Advancing Awareness

Source: facebook.com

GI Content Where and When You Need It Read the new PE GI Journal blog

If you enjoy the articles in PE GI Journal, you should check out its online home: The PE GI Journal blog. You’ll find the articles and insight you’ve come to expect from the Journal, as well as the latest industry news and updates.

Check out the blog at endocenters.com, and sign up for our emails so you’ll never miss an update: marketing.pegisolutions.com/pegijournal.

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In late August, colorectal cancer surged to the forefront of the news cycle due to the death of actor and Black Panther star Chadwick Boseman. At 43, Boseman is a monitory case of a growing trend of young adults being diagnosed with colon cancer. Although this brought attention to the cause, as Colorectal Cancer Alliance (CCA) CEO Michael Sapienza pointed out, the news blitz slowed down quickly and within days interest in the disease was back to its normal levels.

To help keep this conversation in the public dialogue, the CCA is promoting awareness in many ways. They are developing the first-ever screening navigation tool that can fully integrate with health systems. Additionally, CCA is launching a national screening campaign as well as a coordinated public relations effort, which will have significant focus on reaching out to those that are disproportionately affected by colorectal cancer. The campaign will target the general public as well as primary care providers.

Learn more about the CCA’s efforts to promote colorectal cancer awareness at ccalliance.org.

iStock.com/vasabii

CCA is creating a new screening navigation tool and more

Joining GI Forces

Capital Digestive Care (CDC) recently partnered with Peninsula Gastroenterology Associates (PGA) and its four gastroenterologists and two advanced care practitioners.

This exciting partnership was supported by CDC’s private equity-backed arm, PE Practice Solutions (a strategic platform created by a partnership between Physicians

Endoscopy and CDC). PE Practice Solutions expanded PGA’s strategic services, including IT infrastructure, EHR system, and added staff for charge entry.

Combining forces will allow for advanced patient care in the Washington, D.C., Maryland, and Virginia area, representing more than 80 physicians with the new partnership.

Source: capitaldigestivecare.com

PE Practice Solutions supports partnership

GI PRACTICE MANAGEMENT SOLUTIONS Focus on clinical care, not administrative duties.

Revenue Cycle Accounting Operations Leadership Human Resources Information Technology

TO LEARN MORE: CALL (866) 240-9496

Tackling How preparation makes 1099 reporting for vendor payments run smoother

By Kelly Smola

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1099s

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very January, the IRS requires all companies, including GI practices and ambulatory surgery centers (ASCs), to report certain types of vendor payments that were made in the company’s course of business. Reporting is accomplished by filing either IRS Form 1099-MISC or (starting with

iStock.com/Iamstocker

Strategies | Business strategy and the bottom line |

Tip: Collecting W-9s

Collecting W-9s should be part of your new vendor approval or onboarding process throughout the year. This will minimize the need to go back to vendors and gather this data during the filing process.

the 2021 filing season for the 2020 year) new IRS Form 1099-NEC (non-employee compensation). The process includes providing the proper 1099 form to the vendor, as well as filing the 1099 forms with the IRS by January 31 for the previous year.

The IRS facilitates this process by requiring companies to collect a completed IRS form W-9 from each vendor when the company starts doing business with that vendor.

How and When to Prepare Although 1099-MISC and 1099-NEC forms are not due for distribution to the vendor or filing with the IRS until the end of January, fall is the best time to start preparing for the upcoming deadline. Here are some suggested activities to perform in the fall to ensure you have accurate vendor information as you approach the filing deadline: 1. Review your vendors and determine that you have a W-9 on file for each one.

2. Verify that every W-9 includes the vendor’s name (as shown on their income tax return), their Tax ID Number, and their federal tax classification.

3. Confirm that you have a current address for each vendor.

4. Ensure that you have updated all the above information into your accounting software, since most software systems have a function to help print the 1099 forms.

Choosing the Right Form Next, you need to determine which vendor payments require a 1099 form and which 1099 form to use—1099-MISC or 1099NEC. GI practices and ASCs previously used form 1099-MISC box 7 to report

non-employee-compensation that met the following criteria. Starting in reporting year 2021 (for payments made in 2020), those payments are now reported on the new 1099-NEC. If the following conditions are met, the vendor payment should be reported on 1099-NEC: 1. Payment is made for services in the course of your trade or business.

2. Payments for the year are at least $600.

3. Payment is to a vendor that is not your employee.

4. Payment is made to a vendor with the following tax classifications: individual/ sole-proprietor or single-member LLC, partnership, trust/estate. Note: All legal services over $600 should be reported regardless of tax classification (i.e., C-corporations and S-corporations would also be reported for legal services paid).

Kelly Smola is Tax Manager at Physicians Endoscopy (PE).

She can be reached at ksmola@ endocenters.com.

GI practices and ASCs will still use 1099-MISCs to report the following vendor payments: 1. Payments for rent from vendors whose tax identification status is either a partnership or individual that total $600 or more. (1099-MISC box 1) 2. Payments for medical services regardless of the vendor’s tax identification status that total $600 or more. For example, if you use an outside company to provide anesthesia services. (1099-MISC box 6) The IRS provides instructions and guidelines to assist with the annual filing requirements. You can find those instructions, as well as the IRS forms mentioned in this article, at irs.gov/forms-instructions.

You should consult your accountant if you have specific questions about your business transactions and filings.

Remember, a little prep work every fall will simplify your reporting process each January.

Additionally, it will make for a smoother transition this year to the new 1099-NEC form for 2021 reporting.

Have other tax or administrative questions? Physicians Endoscopy can help. Find us at endocenters.com.

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Strategies | Business strategy and the bottom line |

Making Nutrition Services Effective

How to remove the complexity in treating patients requiring medical nutrition therapy

iStock.com/RossHelen

By Michael L. Weinstein, MD, and Hagan Jordan

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N

utrition is becoming an increasingly critical form of therapy and an intriguing service line for GI practices across the country. A recent global study published by the Rome Foundation indicated that four in 10 adults have a functional gastrointestinal disorder (FGID)1 and, for most FGIDs, medical nutrition therapy (MNT) is a critical element of the treatment protocol.

GI societies recommend nutrition therapy (i.e., specific dietary protocols) as first-line therapies and complementary treatments in the management of multiple GI disease states, including IBS, IBD, celiac, NAFLD, EoE, GERD, gastroparesis, and general weight loss. These disease states represent a significant percentage of a GI provider’s patient population, which makes adopting an efficient, clinically effective and, ideally, profitable nutrition program important.

Options now exist that enable GI practices to offer nutrition therapy in a way that is clinically effective, operationally efficient, and profitable.

Challenges with Nutrition Services While most acknowledge the important role of nutrition in GI disease state management, nutrition therapies have historically been challenging for GI practices to adopt. Even as great technological advancements have been made in creating systems to make prescribing pharmaceutical drugs and/or performing surgical procedures simpler for physicians, a streamlined, efficient system for managing and achieving positive outcomes for patients with nutrition therapies has been more elusive.

For private practice gastroenterologists in particular, there have been consistent challenges with managing patients that could benefit from nutrition therapy: 1. Time: Most gastroenterologists and mid-level providers don’t have the time to manage these patients, as medical nutrition therapies require ongoing coaching and counseling.2 Furthermore, providers aren’t reimbursed adequately to spend the time it would take to “food journal,” find trigger foods, and interface on a regular basis to ensure patient compliance and outcomes.

2. Training: As a general rule, most physicians and midlevel providers don’t have in-depth training on nutrition therapies and specific dietary protocols.3 In a recent survey of 1,500 gastroenterologists, only 56% were “comfortable” to “very comfortable” with providing dietary counseling to their patients.4 Due to this, and the limited time they have with patients, many GI providers offer information and educational materials to help patients adopt recommended diets on their own. Unfortunately, patient compliance is low, and the overall experience is impacted under this self-guided model.

3. Access to a trained dietitian: While data shows GI-trained dietitians significantly improve outcomes for patients needing nutrition therapy and can provide the focused attention and guidance patients need, many GI practices don’t have an established relationship with a local GI-trained dietitian, leading to only 21% of gastroenterologists saying they “usually” or “always” refer their patients to a dietitian.5 4. Economics: The majority of GI practices that have tried to bring nutrition services in-house or hire a dietitian directly have found the economic challenges to be at the forefront, creating a break-even service line, at best. There are multiple reasons for this but, primarily, lack of insurance coverage, low reimbursement, and low patient willingness to pay out-of-pocket for these services top the list.

These challenges beg a very important question that the GI community has been asking for quite some time: “How can a GI practice offer a nutrition service line that is clinically effective, efficient, and profitable?”

Let’s start first with a specific disease state/diet example to illustrate the problem and then, of course, a solution.

Case Study: IBS/Low FODMAP IBS patients present unique challenges for gastroenterologists.

The global prevalence of IBS is 10–20% of the population6; however, most GI providers attest to the fact that a much larger percentage of their patient population experiences varying degrees of chronic IBS-like symptoms, such as abdominal pain, gas, bloating, diarrhea, and/or constipation.

Dietary modification, specifically the Low FODMAP diet, is considered a first-line therapy for IBS.7 The Low FODMAP diet is a powerful diagnostic tool to help patients and their providers understand the role that certain foods are playing in their IBS symptoms and, most importantly, identify those specific trigger foods. The protocol significantly decreases and then systematically reintroduces FODMAP subgroups, a collection of short-chain carbohydrates (such as some sugar and fibers), back into the patient’s diet. These foods may not be absorbed properly in the gut and can trigger symptoms in people with IBS. FODMAPs are found naturally in many common foods, even highly nutritious foods, such as wheat, apples, pears, onion, garlic, honey, agave syrup, sugar-free gum, mints, and some medicines.

The goal is to identify the specific FODMAPs that are triggering a patient’s IBS symptoms. Most patients aren’t sensitive to all categories of FODMAPs, so when they identify their specific FODMAP triggers, they can actually expand or liberalize their diet and better manage their symptoms long-term.

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Strategies | Business strategy and the bottom line | During this protocol, which typically runs six to eight weeks and is not a long-term “diet,” patients go through three specific phases—Elimination, Reintroduction, and Personalization—to identify their specific trigger foods and manage symptoms long-term. Most patients start to experience symptomatic relief in as few as two to three weeks.8 The Low FODMAP diet has been shown to be effective in improving chronic symptoms in up to 86% of patients with IBS.9 Low FODMAP is now the most commonly recommended dietary protocol by gastroenterologists for IBS patients, and 85% of gastroenterologist report Low FODMAP to be somewhat to very effective.10

1. Connected with an expert dietitian or healthcare provider to coach/counsel them through the Low FODMAP process. Compliance also improves.13 2. Provided food in some manner to make food sourcing, preparation, and cooking easier.

So, What’s the Challenge?

A Solution to Improve Both Outcomes and Profitability

Like many dietary protocols, the Low FODMAP diet can be challenging for a patient to successfully implement and complete without the support of a trained dietitian or healthcare provider and a system to make food preparation and cooking easier or less stressful for the patient.

In cases where a healthcare provider simply gives the patient a pamphlet or brochure and recommends the Low FODMAP diet, a very small percentage of patients successfully completes Elimination and Reintroduction, and never identifies their specific trigger foods. In fact, a recent study showed only 41% of patients who were recommended the Low FODMAP diet were able to adhere to it through the elimination phase.11 This is a primary reason why only 11% of IBS patients report a positive relationship with their provider and will, on average, visit 5.2 physicians as they seek answers.12 However, clinical data shows outcomes are improved when a patient is:

IBS and Low FODMAP are just one example of a disease state and corresponding nutrition therapy that illustrate the challenges that GI providers face. We could extend these examples into many other disease states requiring medical nutrition therapy, such as NAFLD and Eosinophilic Esophagitis, and see similar challenges.

In early 2019, ModifyHealth launched a new service to make nutrition services more efficient and effective for GI providers and their patients. By partnering with ModifyHealth, GI practices get access to all of the necessary resources needed to provide a world-class nutrition service for their patients without having to build an internal program from scratch and hire a full-time dietitian(s). The GI practice is able to offer a nutrition service program to their patients while also accessing an ancillary revenue stream, if desired.

Starting first with IBS/Low FODMAP, ModifyHealth’s service enables a GI provider to refer their patients directly to ModifyHealth as an extension of their practice. All referred patients have access to a free, initial virtual consult with a GI-trained dietitian, where they receive focused time and attention as well as education, resources, and recipes. The free

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is now the most commonly recommended dietary protocol by gastroenterologists for IBS patients and 85% of gastroenterologists report Low FODMAP to be somewhat to very effective.

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iStock.com/FG Trade

Low FODMAP

%

Additional Resources

Nutrition therapy can be an effective option for many patients. Have questions or want to learn more about how these programs work? Here are some Low FODMAP and nutrition therapy resources: • Download ModifyHealth’s Low FODMAP Patient Education Handout and Brochure for Patients • Check out the Monash University Low FODMAP App (iOS, Android) • Find a Monash Low FODMAP and/or GI trained dietitian • Visit the International Foundation for Gastrointestinal Disorders (IFFGD.org)

consult encourages patients to engage with a dietitian to get the support they need. On average, 86% of referred patients participate in the free, initial consult while 40–50% sign-up for the full service with dietitian support and meals.14 The fact that the initial consult is both free and virtual removes barriers to patients getting the help they need.

The full service from ModifyHealth helps to simplify the Low FODMAP protocol and improves compliance. All referred patients receive: • A free, initial virtual consultation with a GI-trained dietitian • Three additional virtual dietitian consults and ongoing on-demand dietitian support • Medically-tailored, Low FODMAP meals delivered directly to the patient’s door • A patient-friendly app (iOS, Android) to track progress and connect with their dietitian • At the end of the program, the GI provider receives a summary report from the ModifyHealth dietitian The program is a weekly subscription where the patient purchases affordable, medically-tailored, home-delivered meals (with free shipping) and pays a one-time $99 fee for all three dietitian consults and on-demand access. For practices that already have a GI dietitian, their patients can simply purchase the meals from ModifyHealth and continue working with their in-house dietitian. The program is very affordable and similar to what a patient is already budgeting and spending on food today, but with the benefit of medically-tailored meals and support.

The clinical results have been encouraging: • 85% of patients who sign up for the program complete the Elimination Phase.

• 79% of patients report significant relief as defined by at least a 50-point improvement in their IBS-SSS (Symptom Severity Score).

• The average patient reports a 120-point improvement in their IBS-SSS score.15

In addition to being clinically impactful, ModifyHealth offers an attractive ancillary revenue opportunity where a GI practice can benefit financially. The ancillary program is upon request and not required to refer patients to the service.

This ancillary program enables GI practices to add another, new ancillary revenue stream to their practice that is passive in nature and requires no additional infrastructure or new employees. The risk is also minimal for the practice due to no to low upfront costs.

For more information on the ModifyHealth service and how to add this service line to your practice, please contact providers@modifyhealth.com. Learn more about ModifyHealth at modifyhealth.com.

Note: The ModifyHealth service and meals are not reimbursed by any third-party, including any federal or state healthcare programs and therefore the sale of the meals is not subject to the United States Federal Anti-Kickback Statute. ModifyHealth and any physician practices entering into an ancillary service agreement intend to comply with all applicable laws and will modify or terminate the agreement upon any change in the laws which may impact the agreed-upon structure.

FOOTNOTES

AD Sperber, et al., Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study, Gastroenterology (2020), doi: https://doi.org/10.1053/ j.gastro.2020.04.014.

2 https://www.gastroendonews.com/In-the-News/Article/04-18/Role-of-Dietitians-Expands-as-DietsFor-IBS-Gain-Favor/48360?sub=81257C76C3B6DD78A83F75D86BCE5DE4F102F921FF83CA23 B58F26C6161435A 3 Crowley, Jennifer et al. “Nutrition in medical education: a systematic review.” The Lancet. Planetary health vol. 3,9 (2019): e379-e389. doi:10.1016/S2542-5196(19)30171-8.

4 Lenhart, et al. Use of dietary management in irritable bowel syndrome: results of a survey of over 1500 United States Gastroenterologists. J Neurogastroenterol Motil. 2018;24:437–451.

5 Lenhart, et al. 437-451.

6 Endo, et al. “Epidemiology of irritable bowel syndrome.” Annals of gastroenterology vol. 28,2 (2015): 158-159.

7 Halmos et al. “A diet low in FODMAPs reduces symptoms of irritable bowel syndrome.” Gastroenterology vol. 146,1 (2014): 67-75.e5. doi:10.1053/j.gastro.2013.09.046.

8 Nanayakkara, et al. “Efficacy of the low FODMAP diet for treating irritable bowel Michael L. syndrome: the evidence to date.” Clinical and Weinstein, MD, experimental gastroenterology vol. 9 131-42. is President and 17 Jun. 2016, doi:10.2147/CEG.S86798.

9 Nanayakkara, et al. 131-142.

CEO of Capital 10 Lenhart, et al. 437-451.

Digestive Care 11 Mari, et al. “Adherence with a low-FODMAP and the Managing diet in irritable bowel syndrome: are eating Partner for the disorders the missing link?.” European journal of gastroenterology & hepatology Metropolitan vol. 31,2 (2019): 178-182. doi:10.1097/ Gastroenterology Group division.

MEG.0000000000001317.

12 Drossman, et al. “International survey of patients with IBS: symptom features and Hagan Jordan is their severity, health status, treatments, and risk taking to achieve clinical benefit.” the Chief CommerJournal of clinical gastroenterology cial Officer at Modvol. 43,6 (2009): 541-50. doi:10.1097/ MCG.0b013e318189a7f9. ifyHealth. Prior 13 PR Gibson. “The evidence base for efficacy to ModifyHealth, of the low FODMAP diet in irritable bowel Jordan helped syndrome: is it ready for prime time as a firstline therapy?.” Journal of gastroenterology launch EndoChoice and hepatology vol. 32 Suppl 1 (2017): from a startup in 32-35. doi:10.1111/jgh.13693.

14 2008 through its eventual sale to ModifyHeath Internal Data, April 2020.

15 ModifyHealth Internal Data, April 2020.

Boston Scientific in 2016.

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Excellence | Success stories |

The Personal Connection Strong workplace relationships lay the groundwork for business to get done By Ryan Gaymon

I

read somewhere that in order to have a good relationship, you must have great social skills. While you might think about your relationships with friends and family when you think about social skills, the workplace is also one of the main spaces where we build relationships. Naturally, coworkers socialize and look forward to spending time with one another while they do their jobs. In many cases, they become your new family—the people you spend a significant portion of your day with.

Strong Relationships Start with Strong Leadership The growth of good relationships in the workplace is connected to increased employee morale. So, how can we harness our social skills to help build great relationships with our teams? The right leadership is vital to the growth of the team. Companies that invest in their leadership development tend to build stronger organizations compared to those that don’t. Looking at Physicians Endoscopy (PE), we compared our leadership structure to that of another a successful company—Google—and we can see a lot of similarities.

Google’s establishment is overseen by a board of directors, which passes instructions down through an executive management group. This group oversees several departments, such as Engineering, Products, Legal, Finance, and Sales. Each of these departments is divided into smaller units. Physicians Endoscopy is systemized in a similar way—we, too, have a board of directors as our top chain of command that guides our company community. Google gives perks and bonuses to their employees to show their appreciation—at PE, we also have perks and bonuses for employees’ commitment to the company.

Lessons Learned at Physicians Endoscopy Although we are structured to promote good relationship building, it’s the daily work everyone at PE does that keeps these bonds strong. I have had the pleasure of working at PE now for seven years, and within my time, I was able to

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Ryan Gaymon, CBCS, is Contract Coordinator at Physicians Endoscopy (PE). She can be reached at rgaymon@endocenters.com.

advance into several positions all within our CBO department. Starting out as a billing representative at our then-new location in Jamison, I remember when we were a lot smaller and could all fit on one floor. When I started, I was given a tour and introduced to all the departments and department heads. At that time, I was overwhelmed meeting so many people whose names I couldn’t possibly remember, but, in turn, it was a great first step toward building relationships with those I would collaborate with in the future. Since those days, our company has grown more than double in size, so things are done differently now, but that first experience was the start of building strong relationships with my peers.

The importance of building these long-term relationships is just as true with people outside your organization. Often in our daily tasks, we have to outsource to other companies to conduct business. Those relationships are also very important—having a reliable contact can make your job a lot smoother. However, these relationships may take a little more work. Creating strong connections with people outside your organization is always more difficult than with those inside it. Properly introducing yourself and your position is important, just as is applying proper email etiquette, ensuring you use an appropriate tone, and taking part in light personal conversation topics, such as birthdays, vacation and wedding plans, to help the person feel like they know a part of you and trust can be built.

iStock.com/DjelicS

The Benefits of Building Strong Relationships In my previous work as a representative, I was someone who was on the phone 90% of my day dealing with patients and insurance carriers. I was constantly utilizing the relationships I had built to complete my daily tasks. In my work as a supervisor, the relationships expanded more to physicians, BOMs, EVPs, directors, and supervisors. Having those strong relationships helped in tackling new projects and issues that came about.

During PE’s restructure in 2017, there were a lot of transitions and changing of processes that took place. I strongly believe if it hadn’t been for those resilient relationships I already built, it would have been almost impossible to keep up with the change.

I felt I had to rely on every connection I created to get through some of the many challenges we faced.

It was only then that I realized if I hadn’t connected so well and invested the time I did in those relationships, I wouldn’t have been successful. In my work today in payer contracting, I still rely on all of my personal and professional relationships to help get me through. What I’ve learned is we need to focus on building relationships not only with internal coworkers, but also with outside individuals. This will benefit our own personal growth, as well as the growth and perception of our company.

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Spotlight | Inspirational stories |

Source: coloncancercoalition.org

Battle of a Lifetime Lisa Issa discusses what she learned from her experience with colon cancer

L

isa Issa—yes it rhymes, she says jokingly—is a 34-yearold school aide, mother to her 9-year-old son, Carter, and wife to her high school sweetheart, Chris. She grew up as the oldest in a family of five and still lives near many of her family members, seeing them often. In April 2012, her life was just as she expected, caring for her young son. That changed when she was diagnosed with cancer in her colon, lymph nodes, and liver, despite a lack of family history of the disease. Over the next two years, Lisa fought an exhausting battle against cancer; however, she came out the other side in remission as a survivor. In this interview with PE GI Journal, Lisa opens up about the experience, her feelings, what advice she has for others in a similar position, and more.

Melissa Landis (ML): Can you tell me a little bit about your overall journey with colon cancer?

Lisa Issa (LI): Overall, I can say it was successful. I made it.

The journey itself was long and exhausting, but there were some pretty magical moments along the way. A cancer diag-

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nosis can bring out the best in the people around you, and I can’t explain the love I felt coming at me from all directions.

I felt scared a lot, too, though. It was like staring down the barrel of a gun for two years, and then, slowly the gun was put down. I don’t feel free of the fear entirely, but I’m much more at peace with my new normal.

ML: How was the cancer initially detected? Were there any signs that alerted you to the issue? What made you go to the doctor?

LI: I skipped over my family doctor and went straight to a gastroenterologist to talk about my concerns. I was having a lot of bleeding when I went to the bathroom, was going more than normal, and was extremely fatigued. These symptoms had been going on for a few years, but really accelerated after I had my son. When we decided to start trying for another baby, I wanted to just get myself checked out to make sure I was healthy. It’s funny how you suddenly start caring more about your health when you have people depending on you.

break you down. This experience taught me gratitude more than anything else.

Source: coloncancercoalition.org

Long story short, my doctor didn’t mess around and ordered a colonoscopy right away. When I woke up from the procedure, she told me the that she found a tumor and was 99% sure it was cancer. After further testing, it was confirmed stage IV CRC.

ML: What would you tell someone who just got their cancer diagnosis today?

LI: To just think about shortterm goals—thinking about the whole journey and everything that lies ahead is so overwhelming, and worry doesn’t serve a LI: Numb. I felt like my feet were purpose. Come up with a plan; stuck in cement, and everyone meet your short-term goals; else was running forward. Then, learn to swerve when things hope kicked in, and I started don’t go in the direction you Lisa Issa, with her husband Chris, holds the Maude Daniel award she making small steps. planned; and take one day at received at the Get Your Rear in Gear – Philadelphia event in 2014. a time. And, of course, now I ML: Were you seen in a GI ambulatory surgery share a special bond with other people diagnosed—reminding them that they aren’t dying today, so they should try to live center or a hospital? Can you tell me about your each day to the fullest. experience there?

ML: How did you feel when you first received the diagnosis?

LI: I went to Jefferson for all of my surgeries and Comprehensive Care for chemo and radiation. I felt extremely taken care of at both places. My doctors were amazing, and I always felt like I was in good hands. I also felt like they believed in my case. There were doctors who put a time stamp on me, so I decided I’d never see them again. It was crucial for me to know that my doctors believed they could cure me.

ML: Tell me a little bit about your treatment process.

Did you face any unforeseen obstacles? If so, how did you overcome these obstacles?

LI: Oh, yes. Towards the end, I just started to assume that there would always be something unforeseen. It’s the nature of the beast, I guess. I don’t feel like I did anything special to overcome them—I just did what I had to do.

ML: Can you describe how sharing your story with others has affected your journey with cancer?

LI: It feels wonderful to be able to shed some hope onto those who otherwise feel like they just received a death sentence. Stories of hope mean the world to those newly diagnosed—I know that I couldn’t get enough of them when I was just starting out.

ML: What would you want other people of screening age, who are hesitant to get a colonoscopy, to know?

LI: That it isn’t as bad as they think. They’ll be surprised at how simple the whole process is once it’s over. For younger men and women, I would also say: Watch for signs and always listen to your body—I wish I listened to my body earlier.

ML: What did you do to meet and overcome the challenges of your treatment?

LI: We planned things to look forward to. There was a day toward the end of year two where I told my husband that I didn’t think I could finish my chemo regimen. He convinced me to finish by booking a vacation as a finish line—It worked!

ML: What has this experience taught you?

LI: Life is fragile and growing old is a privilege denied to many.

Hard times can make you stronger while at the same time

Visit the Colon Cancer Coalition at coloncancercoalition.org/get-educated/ what-you-need-toMelissa Landis is know/colon-cancerDigital Marketing facts to find out how Coordinator at Physicians on-time screenings Endoscopy (PE). and timely evaluation She can be reached of symptoms can help at mlandis@ eradicate this disease. endocenters.com.

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Insights | Marketing strategies and tips |

Critical

Thinking How to address negative or false online reviews

iStock.com/SDI Productions

By Deven Stopa

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O

nline reviews are great when they are positive, but negative or erroneous reviews can have terrible consequences for gastroenterologists and other medical practices.

For doctors and other professionals, online reputation matters: A good reputation builds trust between physicians and the patients they treat, while a bad reputation can erode a practice’s bottom line. The importance of managing one’s online reputation has become increasingly apparent in the last decade or so, as a growing number of patients turn to the internet for information about their health and their chosen healthcare professional. Prior to the internet, medical practices relied on personal recommendations and professional referrals to attract new patients. While wordof-mouth still draws new patients, reputation management through online ratings and reviews is increasingly important.

When a practice has a solid reputation in the local community, patients will remain loyal to that practice even if other organizations offer similar services at lower costs.

A good reputation can help a practice differentiate its services in a highly competitive market while maintaining premium pricing. However, maintaining a good reputation in the age of digital communication requires a careful strategy and a plan for responding to any negative reviews that may affect a practice’s online reputation.

The Effect of a Bad Review Despite the best efforts of the practitioners and staff, patients do not always have the best experiences. They may feel frustrated about scheduling difficulties, for example, or feel they did not get enough time with the doctor. This frustration may cause them to leave negative reviews. In some cases, patients leave exaggerated or inaccurate reviews about their experience; at other times, online trolls who have never visited a practice leave bad reviews.

These poor reviews can take a toll on a practice. If seen— and believed—by enough people, the bad review could cause potential patients to look elsewhere, drive away existing patients, and cause a downward turn in revenue. In the worst scenarios, the local community may turn against the practitioner. The smaller the location and practice, the greater the potential effect of a single bad review.

Patients believe what they read in online reviews, especially when it comes to health. In fact, medicine is in the top three industries for online reviews. According to research cited by Search Engine Journal (SEJ), 91% of young consumers trust online reviews as much as personal recommendations. In another poll, 95% of all respondents and 97% of millennials said they found online ratings and reviews of doctors to be reliable. In the survey, 70% said online ratings and reviews influenced their choice of

physician, and 41% said they check a doctor out online even if they were a physician referral.

A 2018 study published in Mayo Clinic Proceedings found that online reviews typically reflect things beyond a doctor’s control, such as the friendliness of the staff and appointment wait times. The authors of the study note that, while 90% of ratings are positive, negative reviews can harm physician reputation, online prestige, and even the physician-patient relationship.

Strategies for Dealing with Negative or False Online Reviews It’s clear that false or negative ratings and reviews have a detrimental effect on practices. If you or your practice are having issues with online reviews, it’s important to take action. Here are some ways you can prevent, mitigate, and fix bad or false online reviews: 1. Always reply. Ignoring online reviews is a dangerous proposition, as it allows the negative reviews to go unanswered and the positive reviews to go unrewarded.

The better approach is to thank people who leave positive reviews, and reply to those who leave negative feedback.

Even a simple “Thanks!” demonstrates your engagement and investment in their health. It also shows your patients that you want them to have the best experience possible at your office.

2. Choose your words carefully. The desire to protect oneself from unfair or unwarranted criticism is natural, but medical professionals must be cautious in their response.

Avoid ad hominem engagements, of course, and resist engaging in battles or lengthy discussions. The first rule of reputation management is “do no harm.”

3. Develop a standard reply to fake accounts that leave fake reviews. While most people are able to spot a fake review, addressing the phony review demonstrates your commitment to making the situation right. It also provides an opportunity to give readers your name contact information.

A good reply might be, “Sorry, but we are unable to find you in our system as a patient. Please call our office at [office number] and ask for our administrator. We

95

One study found 95% of people find online ratings and reviews of doctors to be reliable, and 70% are influenced by online ratings and reviews when making their choice of physician.

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iStock.com/katleho Seisa

Insights | Marketing strategies and tips |

would like the opportunity to address your issue, as your healthcare experience is very important to us.�

4. Invite patients to leave reviews after their office visit.

Maintaining a fresh supply of reviews is a powerful tool against unflattering online reviews. When evaluating a medical office or other organization, consumers will typically look at the top reviews first. If the first reviews they see are negative, potential patients may just stop reading and look for another doctor, even if several positive reviews appear immediately below the negative ones. Generating new reviews allows positive reviews to push negative posts further down the page.

An impressive 70% of consumers will leave a review if asked. Gastroenterology staff can ask for reviews via email if they have the technology to do so, or even utilize their patient recall system.

5. Embrace the occasional negative review. Consumers are skeptical of near-perfect ratings. In fact, SEJ notes that consumers spend five times as long on a website when they interact with negative reviews and that these sites experience an 85% increase in conversion rates.

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If asked, 70% of consumers will leave an online review. Leverage email marketing or patient recall systems to encourage happy customers to review your practice.

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6. Consider using a reputation management system.

While it is always tempting to manage your online reputation personally, dealing with online reviews can be time consuming—handled poorly, it can also hurt a practice. In many cases, busy gastroenterologists and other medical professionals turn to reputation management systems, such as Binary Fountain, to handle the tedious work of replying to every review. Reputation management systems can offer a variety of ways to manage reviews, such as automating replies based on ratings. A partnership with a reputation management professional can help build a clinician’s professional profile through specialized services, such as the creation of landing pages that contain helpful and accurate information about you as a physician or your practice.

Reputation management systems can help GI Fellows present their gastroenterology practice in the best light possible to attract more patients.

Dealing with negative or erroneous online reviews is essential to maintaining a good reputation, expanding patient base, and solid bottom line. It is time for gastroenterologists and other healthcare proDeven Stopa fessionals to think of online is Director reputation management in of Digital Marketing the same way they view the latest billing software or state- at Physicians Endoscopy of-the-art equipment: as a (PE). She can requirement of doing business be reached at in the healthcare industry. dstopa@endocenters.com.

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

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-ofthe-art 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. Multiple revenue sources including endoscopy center and ancillary services. One hospital with endoscopy suite next to the office in the same complex as the hospital. Live in Frederick—one hour from Washington, D.C. 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.

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