PE GI Journal June 2021

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GI A publication dedicated to advancing GI practices and ASCs

Staying Strong | pg. 12 Evaluating Corporate Partners | pg. 6 The Pillars of Pandemic Recovery | pg. 8 Building a Culture of Optimism | pg. 16

JUNE 2021


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 kharlen@pegisolutions.com 240-485-5201


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

Contents JUNE 2021

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Kelly McCormick Digital/Managing Editor kmccormick@pegisolutions.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 PE GI Solutions, 2500 York Road, Suite 300, Jamison, PA 18929.

Letter 2 Message From the President

Strategies 6 The Corporate Connection

Noteworthy 4 PE gives back during the pandemic, new partnerships and more

8 The Path Forward

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.

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Excellence 12 Staying Strong

Printed in the U.S.A. Copyright © 2021 by PE GI Solutions All rights reserved.

Cover image: iStock.com/alfexe

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.

Insights 14 Clinical Text Support 16 HR Positive Outlook

Spotlight 18 Inspirational Stories Don’t Delay PE Opportunities 20 GI physician opportunities at partnered practices

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@pegisolutions.com.

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Letter | Message From the President |

Finding theLight

Emerging from the COVID-19 pandemic, lessons learned will inform the future of care

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hile it’s been an extraordinarily challenging past year, we can finally see the light at the end of the pandemic’s tunnel. This makes it an apt time to assess the state of the GI industry, COVID-19’s impact, and what needs to happen to help ensure an even brighter future for gastroenterologists. From a macro perspective, GI maintains strong underlying demographics. The age of the population requiring GI care is declining. People are living longer, which translates to longer-term care. In addition, patients are moving away from considering GI as episodic care and toward viewing the specialty as an integral component of a care management program. These positives for the specialty have not been impacted by the pandemic. On the other hand, telehealth has emerged and is here to stay, bringing with it a host of pros and cons. We’re still learning how to most effectively leverage and incorporate telehealth. We know it can enhance patient access and can provide gastroenterologists with even greater control over their practice. On the other hand, it creates some challenges around patient engagement, and there remain barriers to access for some of the most vulnerable populations. It will be some time until we fully understand how telehealth will affect GI. The pandemic has reminded us that GI is an intensive and important occupation. As we look forward, we must assess how we take care of doctors better, going beyond productivity and efficiency. We must focus on how to improve the doctor’s experience alongside the patient’s experience. We should also examine how changes in the doctor’s experience are affecting decisions about forward career planning. This would seem to point to more alignment with corporate partners. There’s pressure on practices

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to consolidate and share resources to allow for forward transition into future generations of GI. Solo and small GI groups are trying to figure out their succession and transition plans. COVID-19 has made gastroenterologists think more about succession and stop pushing off future planning. As dialogue about transition planning becomes easier, corporate consolidation emerges as an important option. Looking toward the future, the role of companies like PE GI Solutions in supporting and aligning practices The pandemic has and centers becomes more reminded us that GI critical. A vertical model such as ours is important is an intensive and for strengthening patient important occupation. engagement while aligning the provider experience with the patient to improve care delivery. This must be a vital focal point for the industry. Finally, payers had a short-term financial luxury of missing a season of GI preventive care. Now they will hopefully be focused on ensuring support for gastroenterologists managing those issues patients put off that may lead to exacerbated problems. The role of payers and payer-type organizations supporting independent GI David Young, President & CEO, PE GI Solutions is more important than ever.



Noteworthy | News and events | Working Together NY ASCs collaborated to solve problems at the height of COVID-19 Although not in the most ideal circumstances, the COVID-19 pandemic did bring healthcare providers together. In the New York region, ambulatory surgery centers (ASCs), hospitals, and other healthcare organizations worked together to develop partnerships for common issues like COVID-19 testing, access to supplies, and even human resources-related concerns. One participant in this collaboration was PE partner Endoscopy Center of Western New York. The center teamed up with local ambulatory surgery centers to push state legislators, perform more elective procedures in open counties, and secure critical PPE supplies and COVID-19 tests. “If we didn’t have each other, this would have been a much different road,” Patricia Graham, administrator at Endoscopy Center of Western New York told Buffalo Business First. “Yes, they’re our competition, but we all have things we may need. It was great to have someone to lean on and share ideas.”

PE Partners had a successful Colon Cancer Awareness Month

To kick off Colon Cancer Awareness Month, PE partners participated in numerous ways to talk to the public about the importance of colorectal cancer screenings. With the coronavirus pandemic causing reduced rates in screenings for all types of cancer, this year’s Colon Cancer Awareness Month was particularly important. PE Partner C.P. Choudari, MD, of the Endoscopy Center at Robinwood sat down with The Herald Mail to debunk common colonoscopy myths and encourage people to schedule their routine screening. Dr. Choudari explained how preventable colorectal cancer is when caught early and why that makes it important for people to get screened. He also explained that the colonoscopy process is not nearly as difficult as it once

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was: “People are scared of the preparation. People are afraid of having pain. Those two things have been taken care of,” he told the newspaper. Also encouraging people to get screened was William Stern, MD, FACG, of Capital Digestive Care (CDC). Dr. Stern appeared on ABC 7 (WJLA-TV in the Washington, D.C., area) to discuss the new HyGieaCare technology and the CDC HyGieaCare® Center in Rockville, Maryland. The CDC center is just the fifth center in the United States to offer this FDAapproved system. “It allows a patient to avoid taking the usual, standard oral prep, which makes them run to the bathroom all night … [and] instead they come in the morning of the procedure—about an hour and a half before … and just gently wash out their colon,” Dr. Stern told ABC 7 News.

Learn more about how PE participated in Colon Cancer Awareness Month at pegisolutions.com.

iStock.com/Morsa Images, Chinnapong

Time for Screenings


A Growing Impact PE GI Solutions and Capital Digestive Care bring new partners to the team This year has seen a lot of change, and that has been no different for PE GI Solutions and Capital Digestive Care (CDC). Partnering with new practices opens new doors and expands our reach. Here are two notable recent additions to the PE team:

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Capital Digestive Care makes largest transaction yet with Gastrointestinal & Liver Specialists of Tidewater CDC recently announced a partnership with Gastrointestinal & Liver Specialists of Tidewater, PLLC (GLST), a premier gastroenterology practice in Southeastern Virginia. This marks CDC’s first partnership in Virginia and its largest transaction thus far in the mid-Atlantic region. With the addition of GLST, CDC will double its footprint in the mid-Atlantic, bringing the number of GI specialists serving the region to 128. With 34 board-certified physicians, 12 advanced care providers, and eight locations, GLST has been the Hampton Roads region’s leading practice for liver and gastroenterology care for more than 25 years. GLST’s doctors and medical divisions are the preferred gastroenterology consultants for primary care physicians and specialists in the region because of their expertise in the evaluation and treatment of digestive and liver diseases and their commitment to high-quality, compassionate, patient-centered care. “We’re thrilled to welcome GLST’s talented team of providers and staff,” says Michael Weinstein, President and CEO of CDC. “Capital Digestive Care is dedicated to providing best-in-class digestive healthcare to patients and securing the future of independent GI physician groups throughout the mid-Atlantic. We’re proud to partner with highly respected practices like GLST that share our vision and values.” PE acquires Hudson Bergen Medical Center Adding to its repertoire, PE GI Solutions and Ambulatory Center for Endoscopy, LLC (ACE), recently acquired Hudson Bergen Medical Center, LLC. The surgical center has officially become a second location for the existing Ambulatory Center for Endoscopy, LLC, and has formally been renamed Hudson Bergen Endoscopy and Surgical Center, LLC.

PE GI Solutions entered into a strategic partnership with ACE in 2012 and has provided support in delivering clinical and operational excellence for the center over the last nine years. The expansion of the existing partnership with ACE through the acquisition of Hudson Bergen Endoscopy and Surgical Center, LLC, was spearheaded by the six physician partners of ACE’s first location: Jeffrey M. Raskin, MD; Wayne D. Siegel, MD; Harry Snady, MD, PhD, FACG; Paul M. Stoopack, MD; Harold G. Tepler, MD; and Mauricio Zapiach, MD, FACG. This second location accommodates both patients requiring GI care as well as those requiring general surgical procedures, and the partnering physicians of the second location are expected to perform more than 4,000 procedures annually. The partnering physicians of the second ACE location are Peter Caride, MD; Juan Gonzalez, MD; and John Sotiriadis, MD, PhD.

We’re growing. Find out about our latest strategic partnerships at pegisolutions.com. 5 PE GI Journal pegisolutions.com


Strategies | Business strategy and the bottom line |

The Corporate

Connection Use this checklist to evaluate corporate partners By Robert Kurtz

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Reymann says. “It also gives you a foundation for comparison of partnership models. This allows you to better assess the differences between entities and their services and how these align with your approach to patient care.”

4 Essential Checklist Criteria The following are four criteria Reymann recommends gastroenterologists include in their corporate partner evaluation checklist. 1. Personal objectives. Document what you hope to achieve by taking on a corporate partner. “As you begin your research, you’ll find there’s a lot of information to process, and it’s easy to become distracted,” Reymann says. “If you spend time before you engage in discussions to identify what matters to you, you will better set yourself up for success when selecting a partner.”

iStock.com/Goodboy Picture Company

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number of trends are motivating gastroenterologists to consider engaging with a corporate partner. Among them are industry consolidation, increased operating expenses, strenuous regulatory and reporting requirements, contracting complexity, new technology implementation, and, of course, the short- and long-term impact of the pandemic. Even with these factors, proceeding with a corporate partnership is rarely an easy decision, says Cara Reymann, Market President for PE GI Solutions for the mid-Atlantic region. “It can be highly emotional when you have physicians who have been owners and operators of practices and ambulatory surgery centers (ASCs) for many years. Engaging a partner means not only creating a new relationship, but possibly needing to take a different approach to your business—there is a fear of losing control that is very difficult to overcome.” When evaluating corporate partner options, using a checklist can better ensure a more disciplined process. “Having clarity on what you’re looking for and why you’re looking is one of the most valuable reasons to use a checklist,”


Objectives will be different for every gastroenterologist. There are those who have grown their practice value over many years and are now looking to convert that value as they near retirement. Then there are physicians who have many years of practice ahead and want a partner who will allow them to preserve independence. “Objectives will vary depending upon the individual and/or group and their personal and business goals,” Reymann says. 2. Expertise. Expect to find a wide range of expertise during your search. As you learn about firms, work to gain an understanding of the depth and breadth of this expertise, Reymann says. “The type of expertise and how specialized it is matters greatly. Many people can execute on a function. Where I think the value of expertise matters is when you need to adapt to a new circumstance or implement a new ancillary. Understanding how to align all the details to the benefit of the physician group requires deep expertise and true partnership.” For example, she notes that PE GI Solutions is focused on gastroenterology. The company’s depth of knowledge concerns gastroenterology and all the moving parts of being a gastroenterologist, including the practice, ASC, and ancillary services. “That specialized knowledge allows you to have a better understanding of the challenges GI physicians face in their day-to-day operation,” she says. “Since we have this specialized perspective and know those challenges intimately, we can respond more comprehensively.” While Reymann says depth is what tends to set PE GI Solutions apart, the company’s breadth—which includes the experience and expertise in GI practice, ASC, and ancillary services—plays a pivotal role. “We’re able to share our holistic knowledge across all those different areas and have meaningful dialogue about how to drive the business forward because we understand how each piece connects to the whole. Even if you are only engaged with us for center management, you’re still getting the benefits of our expertise in GI practice and ancillary services.” 3. Performance. It’s easy to talk the talk. But can a corporate partner you’re considering walk the walk? “Assessing a potential partner’s performance comes down to whether they’re actually delivering on the expertise they claim to possess and helping physicians work better and grow their business,” Reymann says. This is an area where PE GI Solutions shines, she says, which was particularly apparent over the last year as gastroenterologists worked through the pandemic. For example, PE GI Solutions’ financial team

helped partners navigate the Paycheck Protection Program and CARES Act Provider Relief Fund. “We were able to apply sophisticated financial modeling tools, which contemplated different scenarios,” Reymann says. “This helped our physicians understand what they needed to do for their businesses.” As another example, PE GI Solutions helped source personal protective equipment (PPE) by leveraging relationships with group purchasing organizations. “We were able to deliver significant value by being engaged and understanding where we needed to achieve progress to help physician groups, offices, and centers be successful,” Reymann says. 4. Quality. Without quality, the value of expertise and performance is greatly reduced, Reymann says. “Physicians spend their lives building their reputation. When they engage with a corporate partner, that partner has a responsibility to assist that physician and practice in a way that will honor and grow that reputation.” To evaluate whether a corporate partner checks the box on quality, one area to focus on is support services. “With our managed services organization, we have clinical experts who inform the strategy and services we bring to our physician partners,” Reymann says. “For example, we have a compliance team that helped us navigate the concerns related to COVID-19, including how to appropriately screen patients and maintain staff and patient safety.” When a corporate partner can deliver that quality component, it helps physicians uphold their commitment to safety. “You don’t want a partnership to compromise the reputation you have worked so hard to build in your community,” Reymann says.

Rely on References

Your checklist will help in your research into and discussions with corporate partners. It can take on greater value if you speak with peers about their experiences. Cara Reymann “Talking with someone who has been with serves as Market a corporate partner for at least a year will President for PE provide a valuable perspective,” Reymann Practice Solutions says. “Almost anyone can make something and oversees Capital Digestive successful in the beginning. The ability Care, the largest to sustain alignment and success is where independent GI practice some of these partnership models will start in the mid-Atlantic states. to show their strengths and weaknesses.” The PE GI Solutions model, Reymann says, Robert Kurtz considers physician alignment a long-term is Founder and priority. “A huge part of being a physician President of Kurtz is remaining independent and getting Creative, LLC, and to choose the challenges you want to take former editor in on. When physicians partner with us, they chief of Becker’s ASC Review. maintain control over those decisions.”

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Strategies | Business strategy and the bottom line |

The Path

Forward

The four pillars of recovery from the 2021 pandemic

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hen the COVID-19 pandemic hit, many healthcare practices ground to a halt. Fears about the virus and shifting markets stifled patient and procedure volume, suppressed revenue, and brought workers to the brink of exhaustion. Patient volumes in physician practices dipped as much as 30% to 75% by April 2020. Many patients put off screening tests, such as screening colonoscopy, which are often the bread and butter of endoscopy units. In fact, nearly 200,000 people had missed their colonoscopies by October of last year. Mass vaccinations are providing a glimmer of hope that 2021 will be closer

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to normal. However, after nearly a year of fumbling in the darkness, tribulations, and turmoil, it may be difficult for some practitioners to remember what “normal” looked like, much less navigate back to it. It can also be tough to imagine surviving a second pandemic, if a similar situation should arise in the future. Practices can take four steps to recover from lackluster patient volume and lost revenues associated with COVID-19. Integrating these four strategies into the organization’s overall structure can help a practice maintain operations in the event of another pandemic.

iStock.com/Thomas Kelley

By Lynn Hetzler


People are the backbone of any successful business, of course, but especially in GI practices. Gastroenterology is a complex specialty that requires advanced training and expertise in GI best 1. Human practices. Recruiting and maintaining exceptional team is difficult in any resources an year, much less during a pandemic. Like other healthcare workers, GI professionals experienced COVID-19 fatigue, brought about by long work hours, added shifts, lack of sleep, short staffing, and dealing with the ever-changing guidelines for personal protective equipment (PPE) and COVID-19 testing—all while risking infection to provide care to patients in their hour of need. Stress and fatigue increases the risk for injury, infections, illnesses, and mental health disorders. Recovery begins and ends with human resources. The first step is to recognize the staggering amount of stress, fatigue, and misery the pandemic inflicted on healthcare

workers. The next step is to create a care plan to help your staff navigate the choppy waters back to normalcy. Consider educating staff on self-care strategies and ways to improve sleep quality, for example, or providing healthy food and drinks in the break room. Establish a Fatigue Risk Management Plan, and use tools like the Epworth Sleepiness Scale to help workers quickly rate their fatigue. Create a culture of safety, one in which management and team members feel comfortable talking about their fatigue, challenges, and struggles during recovery. Build a system in which workers can report their own fatigue or signs of fatigue in their co-workers without fear of punishment; use language that stresses team camaraderie. Develop a safety-centric work schedule that features shifts shorter than 12 hours, allows at least 11 hours between shifts, and shorter shifts for those monotonous or physicallyand mentally-demanding tasks. Offer short breaks every two hours and longer breaks for meals, or even naps, as necessary.

The pandemic caused financial chaos in nearly every industry, including healthcare. Economic slowdowns across the various sectors disrupted cash flow throughout the entire supply chain, the effects of which are palpable today. Experts stressed the importance Finances of cash reserves throughout the pandemic, suggesting that those with unstable cash flows and low cash reserves would be particularly vulnerable during the thick of the outbreak. Practices that managed to keep their coffers somewhat full will also stand a better chance at bouncing back during the recovery phase. Cash reserves can fund human resource considerations, PPE, and socially distant workspaces, for example. Maintaining a cash reserve can also help practices prepare for the inevitable increase of patient volumes by subsidizing equipment upgrades to attract new patients and supporting a larger staff to care for all those new patients. Increasing patient volumes increases revenue, of course, but only for those practices that are ready to handle the influx—patients will likely favor practices with short wait times

for appointments and those that provide the services patients are interested in receiving. Practices that know their way around government funding have the upper hand. The newly approved COVID-19 stimulus bill earmarks $3 billion in additional grants to reimburse hospital and healthcare providers for healthcare-related expenses or lost revenue resulting directly from the pandemic, for example. The NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) funds digestive diseases centers and research through Center Core Grants (P30). Other universities and organizations offer grants, such as the American College of Gastroenterology’s (ACG) research awards, to keep research moving forward. The pandemic pressed the pause button on GI training as well, which could affect staffing during the recovery phase. Some organizations provide funding to keep the pipeline of new GI doctors flowing into rebounding practices. For example, ACG’s North American International GI Training Grant provides partial financial support to U.S. and Canadian GI fellows in training or GI doctors who have recently completed their training.

2.

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Strategies | Business strategy and the bottom line |

200K

Missed screenings Nearly 200,000 people had missed their colonoscopies by October 2020..

4.

Marketing will pump new life into patient volume and practice revenues. In a post-pandemic world, patients will look for practices that are safe, staffed well, and ready to go with comfortable surroundings and state-of-the-art equipment. Marketing Now more than ever, patients have learned to be good consumers and educated participants in their own healthcare; many use the internet to research conditions and select doctors. As the pandemic wanes, practices that lean into the digital world and put a stress on patient outreach initiatives will have a better shot at increasing patient volumes after one

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nature of coronavirus has also added a new layer of PPE and rearranged the endoscopy suite to accommodate social distancing. To make compliance with the constantly evolving mandates and guidelines easier, GI practices can sign up for communication updates from their state associations and departments of health. Check updates frequently, and plan to implement changes quickly.

of the toughest years on record. GI practices can offer virtual appointments, for example, or publish online seminars for colon health. In addition to increasing patient engagement, outreach programs can Lynn Hetzler is present practices as safe and a leading writer reliable during the waning in the medical days of the pandemic. field. After By resting their practices on working with these four pillars, gastroenterol- clinicians in hospitals, uniogy clinics can be fully operaversities, and tional and functioning at the medical laboratories for 20 years, “new normal” by this time next she has spent the last 20 years year. Renovating the foundation sharing her wealth of knowledge of a GI practice can also help it of the healthcare landscape through writing. survive the next catastrophe.

iStock.com/Sergi Nunez

3. Safety and compliance

COVID-19 protocols, guidance and recommendations are here to stay for the near future, and compliance may require significant changes in GI practices. At the very least, the pandemic introduced pre-procedure COVID-19 testing to routine protocols, which takes extra time and labor to perform and manage. The highly infectious


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Excellence | success stories |

Staying

Strong

SecureMD persists through COVID-19 and delivers care to vulnerable populations By Raymond Hino

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elivering care safely was a complicated issue for providers during the pandemic. When the population you serve is also incarcerated, that only adds to the complexity. This was the situation SecureMD found itself in in March 2020, and with resilience and support from its GI industry partners, it persevered.

What is SecureMD? SecureMD Professionals (SMD) of California is a unique business model, which delivers GI procedures and FibroScan procedures to the California state prison inmate population. A PE GI Solutions partner since 2013, SecureMD brings a full team of medical professionals, including one board-certified gastroenterologist, one certified registered nurse anesthetist (CRNA), one registered nurse and two GI technicians inside prisons each day. The mobile GI team travels frequently to 15 of the 35 state prisons in California, spanning the Oregon border to the Mexico border, about the distance from New York City to Jacksonville, Florida. The SecureMD team arrives at each prison in a van that is fully stocked with GI scopes, monitors, processor units, and supplies (on mobile carts), and is prepared to perform cases on up to 15 inmates in clinical spaces provided by the prisons. Before COVID-19 interrupted the business model, SecureMD averaged 10–12 GI cases per day and 14–15 FibroScan cases per day. GI volumes were consistently increasing—so much so that the team took the plunge to invest in a second van, stocked with equipment, and increased staff.

A Challenging Year At the onset of the COVID-19 pandemic, SecureMD’s biggest concern was the safety of staff as well as patients. Like PE partner centers and practices across the country, SecureMD had limited access to personal protective equipment (PPE), as it is not considered a hospital, an office, or even a clinic.

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Thankfully, SecureMD leaned on PE GI Solutions’ considerable supply chain strength and resources to obtain N95 masks, goggles, and impervious gowns for the team. Soon after safety concerns were mitigated with increased PPE, a new and more significant obstacle arose: being denied access to most of the prisons. In March 2020, the State Department of Correctional Health issued guidance postponing elective procedures but left the decision to allow necessary diagnostic colonoscopies and alike procedures up to individual prisons. With this news, SecureMD chose to stay open in the most uncertain times of the pandemic last spring. Unfortunately, many individual prisons did choose to cancel GI procedures as the pandemic raged on throughout the state of California. In July, one of the largest COVID outbreaks in the entire U.S. hit San Quentin State Prison, California’s oldest prison. At the time, San Quentin had 2,159 confirmed COVID cases out of the entire inmate population of 3,500. From April through August, SecureMD averaged only 58 GI cases per month, a 66% reduction from its 2019 average of 175 cases per month. Fall 2020 brought more widespread COVID-19 testing and a brief relief in COVID-19 case numbers. Slowly, SecureMD began approaching old volumes, hitting 131 cases in October. However, a new wave drove cases in prisons back up, and the team closed the year in December with only 59 cases for the month. From April 2020 to January 2021, SecureMD averaged 75 cases per month, 43% of pre-pandemic volume.

Back on a Growth Path Like many gastroenterologists across the country, Medical Director Edward Wong, MD, had never seen drops in procedure volume this severe before. Still, the SecureMD team chose to persevere and deliver care for the few prison clients that did remain accessible. “It was an easy decision,” says Dr. Wong, “How could we deny essential preventative care to the inmates in the few prisons that did still allow access?”


“It was an easy decision. How could we deny essential preventative care to the inmates in the few prisons that did still allow access?” — Edward Wong, MD, Medical Director, SecureMD

Employees at SecureMD provided CRC screenings to inmates during the COVID-19 pandemic.

In California, every inmate is required to have a colonoscopy at age 50 and then follow-ups. “We knew the need was still there from this population, and the need will only grow,” adds Dr. Wong. Growth is an understatement. California’s prison population is aging rapidly, with the share of prisoners over 50 having grown from 4% to 23% from 2000 to 2017. “We could not have bounced back so quickly alone,” says Dr. Wong. PE GI Solutions supported SecureMD over the past year’s unstable journey, with PE’s Finance team helping to secure two Paycheck Protection Program (PPP) loans for SecureMD over the course of the pandemic. These sources of income proved critical in keeping SecureMD viable over the past year. Additionally, SecureMD made other bold moves to survive: It recently changed anesthesia companies as a cost-saving measure that has proved very successful. It also increased communication with the state

of California, which provided close guidance on re-entering prisons as soon as possible. Lastly, the team leaned on the prisons themselves, which graciously agreed to vaccinate the SecureMD staff as soon as possible. In the short term, getting volume back on track to begin sending two vans into the field every day is SecureMD’s main priority. RN Leader Theresa Dunaway, who joined the team in January eager to support the care of vulnerable populations, says, “I have always been passionate about inmate healthcare, and feel I joined SecureMD at a challenging, but exciting time. We are on the verge of huge growth.” SecureMD Raymond Hino, already has plans to begin MPA, FACHE, is Vice President servicing two new prisons of Operations it had not previously visited at PE GI to get inmates caught up on Solutions. postponed procedures.

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Insights | Clinical updates |

Text Support

The Colorectal Cancer Provider Outreach Program offers help for patients who need it By Kelly McCormick

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Kelly McCormick is Digital/Managing Editor of PE GI Journal and Director of Marketing at PE GI Solutions.

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iStock.com/Ju Photographer

cancer diagnosis can be a confusing and overwhelming experience for a patient. Gastroenterologist Brian Dooreck, MD, has seen this dynamic firsthand. “When receiving their diagnosis, patients don’t hear anything after ‘cancer.’ It’s a scary, dark place to be,” says Dr. Dooreck. Even after more than 15 years in the field, these difficulties have not been lost on him. It is one of the hardest diagnoses a person can hear. It takes time to process. It takes time to understand what it all means and what the next steps are. It is Dr. Dooreck’s expertise as a gastroenterologist and his drive to help patients post-diagnosis that led him to create the Colorectal Cancer (CRC) Provider Outreach Program, a groundbreaking tool to help patients post-diagnosis.


“There is a big void when patients are diagnosed with colorectal cancer,” says Dr. Dooreck. “The truth of the matter is they are often left with little to no information on what to research or do next to help them better understand their diagnosis. The Colorectal Cancer Provider Outreach Program fills that void.” More specifically, the CRC Provider Outreach Program is a free tool GI physicians can use to provide their patients with easy-to-access, supportive resources at the time of their diagnosis. Patients can simply text “COLON” to 484848 to receive information and links about available resources from several National Colorectal Cancer Roundtable (NCCRT) member organizations, including the American Cancer Society, the Colorectal Cancer Alliance, Fight

“There is a big void when patients are diagnosed with colorectal cancer … The Colorectal Cancer Provider Outreach Program fills that void.” – Brian Dooreck, MD

Colorectal Cancer, the Colon Cancer Coalition, and the Colon Cancer Foundation. Dr. Dooreck’s program not only tells patients the next steps needed (e.g., CT scans, appointments, etc.), but it also provides them with easily accessible resources for emotional support. Colon cancer, Dr. Dooreck explains, is different from other diagnoses. Patients are just coming out of sedation from their colonoscopy when they receive the news. They are still groggy. They have just had a procedure. They hear the word “cancer.” It makes the information that much harder to absorb and process. “Telling a patient already in a moment of crisis that their world is now flipped upside down makes having this program available for them to easily access an actionable step of accountability,” says Dr. Dooreck. “We can tell the patient to simply text this number, and it allows the patient to take control of something when their world seems out of control.” With just one text, the patient receives clear direction. It also helps patients feel less alone and more reassured that they have support in this journey. That one text can unlock a cache of trusted resources and guides. Additionally, this program could not come at a more opportune time. Now, more than ever, young adults are being diagnosed with colorectal cancer. The American Cancer Society estimates that over 150,000 new cases of colorectal cancer will be diagnosed this year. Colorectal cancer is the third-leading cause of cancer-related deaths in men and women in the United States. It is the secondmost common cause of cancer when men and women’s statistics are combined. The CRC Provider Outreach Program has set out to fill the void in the clinical flow between patients and GI physicians. Its ultimate purpose is to help people in their time of need. It is available to any and all physicians dealing with colorectal cancer diagnoses and to support the hundreds of thousands affected each year. “I have always been motivated by patient-driven initiatives, which led to the Colorectal Cancer Provider Outreach Program,” says Dr. Dooreck. “I enjoy providing service and support paired with leveraging technology.”

Give your patients access to the Colorectal Cancer Provider Outreach Program. Patients can text “COLON” to 484848 to receive information about a CRC diagnosis.

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Insights | human resources and personnel issues |

Positive Outlook A

fter the year that employees and employers alike have had, it is no surprise that everyone is hungry for a company culture that has an optimistic outlook for future growth. As humans, employees value hope and are growthoriented by nature. Fatigue from the past year’s health, economic, and personal woes only push people further to look for a more hopeful future—an end to negativity.

16 PE GI Journal June 2021

By Eric Lane

Employers can choose to build a culture around various positive values, but the most important to meet this moment is optimism. Inspiring optimism in a workplace, whether the size of a two-physician practice or a mid-sized management services organization, is easy in theory. The challenge is building long-lasting optimism—a culture that exceeds the life of a small employee appreciation gift. Here are some strategic

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Building a culture of optimism


actions you can take to encourage a longterm, optimistic workforce:

1. Value human connections above all. Building, maintaining, and valuing personal connections in your workplace is the simplest avenue to achieving an optimistic workforce. Luckily, this does not require extensive training or technical skills—it requires you to genuinely show up in your daily interactions. Authenticity cannot be taught, but there are a couple things you can remember while conversing with your staff: • Ask questions to learn more about them and find connections. • Remember details they share to follow up on next time. • Practice active listening, rather than listening with the intent to speak. • Be willing to be vulnerable and share your own personal stories, too. • Leave assumptions at the door. • Reach out and follow up authentically, not because you are forcing a networking connection. • Prioritize resolving any workplace conflicts as they arise, and do not minimize any employee frustrations. • If time is keeping you from maintaining connections, set specific time aside, even if small and infrequent, to connect with employees—perhaps over lunch or coffee.

2. 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. Draw in employees of all levels, and inspire them to value an optimistic outlook. Often, low-level employees will make the most valuable contributions to the culture because they build the foundation. In GI practices and centers, low-level employees typically are the visual representation of your

workplace culture to patients—their positivity is seen at the front desk, in cleaning the areas around patients, and in the quick phone conversations they have with patients. If you are inspiring these workers, the results are two-fold: employee satisfaction and retention and better patient interactions.

3. Feed off people’s desire for normalcy. Renewed hope from vaccines is bringing reopenings and a desire to get out into the world safely. Use this to your advantage, and have faceto-face (or mask-to-mask) interactions.

4. Don’t try to buy optimism. Rewarding employees and buying “appreciation gifts” is only a short-term solution. When employees don’t have a positive outlook in their day-to-day work but are receiving material gifts for “employee appreciation,” they are able to see through the gesture. 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. Even more worthwhile are meaningful connections with your staff, especially in a small practice or center setting.

5. Define the type of engagement you are looking for. “Employee engagement” can be a buzzword that is not very useful. Engagement should not be your goal. Engagement can be forced or negative. 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 Eric Lane is if they have Vice President specific growth of Human Resources at goals you can PE GI Solutions. help them achieve.

17 PE GI Journal pegisolutions.com


Spotlight | Inspirational stories |

Don’t Delay iStock.com/PS3000

After her colorecteal cancer diagnosis, Marlene Patterson urges others to get screened

18 PE GI Journal June 2021


M

arlene Patterson was just 49 years old when she was diagnosed with colon cancer. As a person under the age of 50 with a colorectal cancer diagnosis, she is unfortunately part of a larger trend. What was once widely considered an innocuous threat to young people has become much more prevalent and concerning. According to the National Cancer Institute, the rate of colorectal cancer has more than doubled among adults younger than 50 since the 1990s. This year alone, roughly 18,000 people under the age of 50 will be diagnosed with colorectal cancer. In this interview with PE GI Journal, Marlene shares her journey and the advice she has for others.

Kelly McCormick (KM): When and how did you discover you had colon cancer? Marlene Patterson (MP): I learned I had colon cancer after having a colonoscopy in May of 2019. I had been experiencing pain from, what I thought, were hemorrhoids and this feeling that I didn’t quite empty when I had a bowel movement. When I thought I saw blood in my stool, I contacted my PCP, who gave me a home test to take. It was positive for blood, so I booked a colonoscopy.

KM: Could you walk us through where you are now in your treatment journey?

KM: How has receiving care during the COVID-19 pandemic affected you? MP: It has been very hard to have no one with me as a second set of ears and as a support through all the visits, hospitalizations, and treatments. Even at my home I couldn’t have visitors. It was isolating and depressing when I was trying hard to stay positive.

KM: Who or what have you leaned on for support throughout your journey? MP: Always faith first. My faith has led me to the kindest, most caring, compassionate, and thoughtful people. I have been very blessed with the support I have.

KM: What would you want patients skeptical of getting screened for colon cancer to know? MP: In most of the stories I’ve heard firsthand, including my own, there were either no symptoms, or by the time there were symptoms, the cancer was already very advanced. It is so important that even very mild symptoms should never be ignored. I urge people to please get screened because it could save your life.

“It is so important that even very mild symptoms should never be ignored. I urge people to please get screened because it could save your life.”

MP: My initial treatment was chemo-radiation. So, I received chemotherapy on days 1–5 and 31–35 while receiving 35 days of external beam radiation to the tumor in my rectum/anus. (There is a very slim margin). I was then scanned in January 2020. The initial area of my treatment looked successful—rectum clear, lymph nodes clear—but the physicians were suspicious of metastasis to my liver. A February 2020 liver biopsy confirmed that the cancer had metastasized to my liver. There were tumors in both lobes. From March to August 2020, I received carboplatin and taxol every three weeks, which resulted in a slight positive response. In August 2020, I had colostomy surgery. From October to December 2020, I received Keytruda immunotherapy every three weeks with no success, and my tumor continued to grow. Currently, I receive FOLFOX chemo every other week. I also just had y90 spheres directly planted into the tumors in my liver, and after recovery, I will need to have the same thing done in my other lobe. It’s a two-part procedure. First, they map out where to plant, then two days later, they deploy the radioactive isotopes. It’s been quite a ride!

KM: Are there any words of advice you would have for a patient just receiving their diagnosis?

MP: Breathe. You’ve got this. I would seek several opinions before choosing where to go for treatment. I would read as much as I could about my diagnosis, so I’m informed. Take someone with you to every appointment if you can. If there are still COVID restrictions, FaceTime or conference call someone in on the appointment. Marlene’s story is a reminder that this cancer can no longer be considered an “old person’s” disease. With the rising statistics and patients like Marlene sharing her story, hopefully more people will take heed and begin earlier screenings. Kelly McCorIt is imperative now, more than mick is Digital/ Managing ever, that young adults start Editor of PE screenings at 45 years old, GI Journal and unless there is a family history, Director of in which case earlier screenings Marketing at may be advised. PE GI Solutions.

19 PE GI Journal pegisolutions.com


Opportunities Submit your CV online at pegisolutions.com/physician-recruitment. West 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.

West

Bellingham, WA Northwest Gastroenterology Exciting opportunity for BC/BE gastroenterologists, preferably with advanced therapeutic, ERCP and/or EUS skills, to join a growing physicianowned, single-specialty GI practice in beautiful Bellingham, Washington. Established in 1979 and growing with nine physicians and four advanced practice providers, multiple ancillary service lines, and a new five-room endoscopy center. Offering a two-year partnership track, equal limited call rotation, competitive salary with excellent benefits, and work-life balance in a progressive community close to both Seattle and Vancouver.

Lima, OH Gastro-Intestinal Associates, Inc.

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.

Seeking a board-certified full-time gastroenterologist to join a six-physician, seven-CNP practice—the northwest Ohio area’s largest gastroenterology practice of more than 30 years. ERCP experience is preferred. Partnership track in 18,000-square-foot practiceowned office and ASC after one year. Competitive salary and benefits with paid malpractice, productivity bonus, and 1:7 call rotation. Signing, relocation, and loan forgiveness packages available.

South

Bronson, 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.

20 PE GI Journal June 2021

Laredo, TX Laredo Digestive Health Center Seeking a BC/BE gastroenterologist to join a well-established group of gastroenterologists at this single-specialty ASC in southern Texas. Position includes competitive salary, paid malpractice, equal call rotation, and full benefits. Full-time position includes partnership track with ownership in the ASC. Live in the growing city of Laredo, Texas, which retains a small-town, suburban feel and offers excellent cost of living.

Mid-Atlantic Delmar, MD Peninsula Gastroenterology Associates Seeking full-time gastroenterologist to join a three-physician practice.


per week, paid malpractice, flexible schedule with limited call rotation. Any experience with EUS and/or ERCP would be a plus.

Northeast Midwest Mid-Atlantic

Philadelphia, PA Philadelphia Gastroenterology Consultants Immediate opening for a full-time, board-certified or board-eligible gastroenterologist to join four-physician and four-physician assistant Philadelphia Gastroenterology Consultants in Northeast Philadelphia. Partnership track available for ownership in adjoining three-room endoscopy center, Philadelphia Gastroenterology Endoscopy Center for Excellence. Competitive salary—first year guaranteed, productivity bonuses, benefits, PTO match, ½ day off per week, paid malpractice, flexible schedule with limited equal call rotation. EUS and/or ERCP skills helpful but not required.

Northeast Stoneham, MA

South

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.

Central NJ Garden State Digestive Disease Specialists, LLC 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. Well-established practice of more than 40 years, treating the digestive health conditions of patients in Southern Delaware and Southern Maryland. Located adjacent to the affiliated Peninsula Endoscopy Center, a two-room ASC that is physician-owned and -operated. Offering a partnership track, flexible schedule, and limited call rotation.

Hillsborough, NJ 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.

Hagerstown, MD Gastroenterology Associates

North Bergen, NJ Advanced Center for Endoscopy

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.

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.

Limerick, PA

Uniondale, NY

Endoscopy Associates of Valley Forge Opening for a full-time, board-certified gastroenterologist to join a practice one hour outside Philadelphia. Partnership track available for ownership in adjoining ASC, Endoscopy Associates of Valley Forge. Competitive salary— first-year guaranteed, productivity bonuses, benefits, PTO match, ½ day off

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.

21 PE GI Journal pegisolutions.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 kharlen@pegisolutions.com 240-485-5201 capitaldigestivecare.com/joinus