PE GI Journal - October 2022

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A publication dedicated to advancing GI practices and ASCs GI OCTOBER 2022 How to Improve Your Financial Reporting | pg. 5 Navigating Supply Chain Disruptions | pg. 9 Patient Financial Pressures | pg. 10 The Reimbursement Crunch | pg. 6

Conversations

Digging Into the Numbers

David Young talks to PE GI Solutions Executive Vice President of Finance Tara Hamburger

GI

Editorial Staff

Suzette Sison Editor in Chief ssison@pegisolutions.com

Kelly McCormick Digital/Managing Editor kmccormick@pegisolutions.com

Contributing Writers: Lynn Hetzler, Jake Keator, Robert Kurtz and Rachael Samonski

Publishing services are provided by GLC, part of SPM group, 9911 Woods Drive, Skokie, IL 60077, (847) 205–3000, glcdelivers.com.

PE GI Journal , a free publication, is published by PE GI Solutions, 2500 York Road, Suite 300, Jamison, PA 18929.

PE GI Solutions Presi dent and CEO David Young sat down with Executive Vice President of Finance Tara Hamburger to discuss financial trends and issues facing GI prac tices and ambulatory surgery centers (ASCs) today. Below, they dig into a number of issues affecting the GI industry, such as the impact of COVID-19, inflation and more.

David Young (DY): How did the COVID-19 pandemic impact the bottom line? Are physicians still feeling the financial ramifications of patients who delayed care?

Tara Hamburger (TH) : Practices and cen ters are certainty still feeling the effects of the pandemic. One of the results of patients delaying care is a big backlog, which is a good thing, since there are so many peo ple searching for care. At the same time, however, you only have so much time in the day to see patients. Locations dealt with staff taking vacations throughout the summer, for example, which can limit how many patients can be helped. It’s so critical that physicians can see patients at a strong volume, because the more patients you can see in a day, the better your bottom line is going to be.

DY: What about patients? How are they impacted?

TH : Patients are impacted by all the rising costs, including gas prices, food, etc. There is a lot of price pressure everywhere, which might prevent a patient from scheduling an elective procedure. This is a very bad side effect of the cost pressures because this could delay lifesaving healthcare. With costs ris ing, it is important to shop around for healthcare options. Patients will find that ASCs have a much lower cost of service, so they are a better alternative to the hospital setting.

DY : How are issues such as supply chain delays and inflation impacting practices and ASCs?

TH : Costs have certainly gone up for everyone across the board. You’re getting squeezed from your vendors because costs have risen, and they pass those raised prices on to purchasers. Compensation costs have also gone up due to the inflation we’re seeing right now, and that stretches all the way from current employees to hiring new ones. The result of these increases is squeezing on profitability and the bottom line, so you must do something to offset those factors. To do that you may need to improve your efficiency by seeing more patients per day or working longer hours. Of course, taking steps like working longer hours, for example, have their own costs associated since you need to pay employees more for the extra work.

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.

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David Young, President & CEO, PE GI Solutions
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| Discussions with the President |

DY : Changes in reimbursements and payor rates are also playing a factor in practice or center profitability. How do those aspects affect the bottom line?

TH : That can be a huge factor when looking at a location from a financial perspective. Here at PE GI Solutions, we have a payor contracting department that is working to con stantly negotiate the best rates for our partners. However, the only way to combat that in the expense department— the bottom line—is to increase productivity—the top line. By working to showcase the need for higher productivity we can work to bring the level of profits back to where they should be.

DY : It seems as if these high levels of inflation may continue. How can practices plan for the future?

TH : With the vendors passing on the increased rates there’s not too much we can do, but we can try to help. We want to help the owners and physicians understand the increase and where they need to be from a revenue perspective. I think it all comes down to productivity because you can’t control the cost of inflation. This is where financial report ing becomes really important.

When we look at these reports, we can say, “Your costs are going to go up 2% next year, so let’s consider adding an extra procedure per day to combat that.” I feel it’s easier to see and explain these changes year-to-year by looking at the numbers on a piece of paper or on a screen versus just talking about it.

Everybody’s costs are going up, and that’s why it’s so important to break things down to a procedure or productivity

level. We will show owners or physicians how each proce dure impacts their business. It can be a valuable tool and help drive the point home: The importance of considering seeing more patients in a day or working longer hours. It may just seem like we need “X” revenue, but when you really look at the numbers, it may come out to only being a couple more procedures a day.

DY : How can patients become best prepared for the higher costs of care?

TH : Patients need to understand their health benefits coverage. They don’t want to be surprised at the visit by the cost (copay, deductible, etc.). If the patient responsible amount is not provided by the facility upfront, the patient should ask so they are aware.

Another tip would be to know when your health benefit coverage renews. All costs are increasing, including insur ance premiums and costs for service, so it might be best to schedule a procedure before the renewal period to avoid cost increases and plan for procedures at the end of your renewal period once deductible limits are satisfied to save on costs.

Learn more about our influential leaders. Turn to page 4 of this issue to read about the backgrounds of Tara Hamburger and the rest of the PE GI Solutions Senior Leadership Team. For more great insight from our industry experts and to learn how PE GI Solutions can help your practice or ASC, visit pegisolutions.com.

“The result of [cost] increases is squeezing on profitability and the bottom line, so you must do something to offset those factors.”
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Noteworthy

Meet Our Senior Leaders

Ann “Annie” Sariego, RN, BS, CASC, is Market President at PE GI Solutions, overseeing business and clinical operations for PE GI Solutions’ New York and New Jersey Centers. Annie joined PE in 2011 and has over 30 years of healthcare industry experience focused on the hospital and outpatient surgery center setting.

John Westby is the Vice President of Information Technology at PE GI Solutions. He joined the organization in December of 2019 with a senior executive background in global information technology. John has over 30 years of demonstrated success in directing all functions within IT, from strategic planning to transformational change to large scale delivery and operations.

With a wealth of experience between them, the PE GI Solutions Senior Leadership Team is united by their shared commitment to improving GI patient care and supporting physicians, care teams, and partners. Combining extensive knowledge in finance, business development, strategy, and management, the team brings together a diverse portfolio of skills to drive business success.

David Young joined PE GI Solutions in June of 2018 and serves as President & Chief Executive Officer. David shares responsibility for PE GI Solutions’ strategic direction and service development, with a primary responsibility of day-to-day management.

Christina Morrison joined PE GI Solutions as Chief Financial Officer in April 2018. Prior to joining the company, Christina served as Senior Vice President of Finance at Aramark where she led Financial Planning & Analysis, Mergers & Acquisitions, Treasury, and Global Shared Services. She was also one of the leaders of Aramark’s 2013 IPO.

Tracy Belsan is Market President at PE GI Solutions. She has over 30 years of healthcare experience in hospital operations, ambulatory operations, and graduate medical education. Prior to her role with PE GI Solutions, Tracy served as Chief Operating Officer and Designated Institutional Officer for Dignity Health in the California market.

Ellen Coffee is the Vice President of Revenue Cycle Management at PE GI Solutions. She joined the company in December 2019 and has over 20 years of experience in healthcare revenue cycle and coding. Ellen’s team is responsible for ensuring successful reimbursement for services provided by PE GI Solutions’ partnered practices and centers. Her focus is on providing successful management of the revenue cycle to help PE GI Solutions’ partners improve profitability and reach their revenue targets to support growth of practices and ASCs and provide a better patient care experience.

Tara Hamburger, CPA, is the Executive Vice President of Finance at PE GI Solutions. She joined the company in April 2002 and has over 15 years of experience in finance and accounting. Tara oversees the entire financial management process and ensures that accounting procedures and reporting conform to Generally Accepted Accounting Principles. Tara provides leadership and coordination of financial reporting, tax compliance, and budget management functions for PE GI Solutions, as well as PE GI Solutions’ partnered practices and centers.

Sharon Hohlfeld is the Vice President of Payor Contracting at PE GI Solutions. She has been with the company since 2005 and has over 25 years of experience in healthcare. Sharon oversees the payor contracting department, which is responsible for obtaining network agreements between PE GI Solutions’ partnered practices and centers and the insurance companies.

Get to know the members of the PE GI Solutions Senior Leadership Team
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Improving

Your Financial Reporting

Financial reporting is one of the biggest business management challenges for independent GI physician practices and ambulatory surgery centers (ASCs). This confusing and time consuming, yet essential, task can leave those unfamiliar with proper reporting processes at risk of reduced insight into practice or ASC financial trends, along with potential fines.

“Financial reporting is one way to really tell how the business is performing,” says PE GI Solutions Executive Vice President of Finance Tara Hamburger. “It’s the best way to gauge profit ability and performance.”

Why Worry About Proper Reporting?

Along with the legal obligation, financial reporting can be a valuable tool to better understand aspects of your practice or ASC, especially when considering creditworthiness and day-to-day decision making. Failing to meet set guidelines can lead to potential litigation from outside sources, such as the IRS, and lead to further complications for your business.

Netsuite.com lays out several ways poor financial report ing can open up your location to potential trouble, including fraud, inadequately trained staff, and poorly integrated finan cial systems, among others. Each of these aspects, whether intentional or otherwise, brings unnecessary risks upon yourself, your staff and your practice or ASC.

How to Improve

One of the best ways to improve financial reporting is to have safeguards, such as a corporate partner like PE GI Solutions

to assist in the process. Our PE Practice Solutions and PE Center Solutions plat forms can assist in helping you better understand the financial health of your practice or center.

Tara Hamburger is Executive Vice President of Finance at PE GI Solutions. She can be reached at thamburger@ pegisolutions.com

“One of the big ways we help our partners is through the financial reporting,” Ham burger says. “I’ve often seen practices and centers using cash statements prior to partnering with us, which is good. However, the thing about cash statements is that it’s hard to understand productivity through these reports.

“When we assist partners, we will use an accrual basis. By gauging things this way, we can really see how a location performed versus when the cash hits the bank later that month. When providing statements, we will share a cash statement and an accrual statement. This way, practice or center leadership can really understand where they were performing best or what changes can be made to improve.”

Financial reporting is a key aspect of any successful business. Understanding the numbers and creating plans for improvement can be difficult to comprehend but taking the time to learn can be a valuable tool for understanding the intricacies of running your practice or ASC.

To learn more about how PE GI Solutions can help your practice or ASC with financial reporting, visit pegisolutions.com.

Practices must be up to date on all reporting measures to ensure compliant and efficient business management
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The Reimbursement

If you’re finding that your practice or ambulatory surgery center (ASC) is getting paid less by commercial insurers or spending much more time trying to collect what you’re contractually owed, you have plenty of company. GI practices and surgery centers nationwide are feeling a reimbursement crunch—and one that’s been building over the past several years. Whether that crunch is caused by reduced payment

What the declining reimbursement trend could mean for your practice or ASC Crunch
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rates or increased expenses associated with collections, the impact is the same: a potentially weaker bottom line.

What Is Contributing to These Trends?

A host of factors are responsible for the declining reimburse ment trends, says Sharon Hohlfeld, Vice President of Payor Contracting, and Ellen Coffee, Vice President of Revenue Cycle Management (RCM), for PE GI Solutions. Much of it boils down to the fact that most commercial payors are forprofit organizations that often use various tactics to increase or at least preserve their profitability.

As of late, there are a few significant developments spurring commercial payors to step up their efforts to protect their own bottom line, often at the expense of their contracted providers, Hohlfeld says. One trend concerns a growing number of employer groups moving to self-funded arrangements in an effort to spend less on claims than what they were spending on pre miums across their employee group.

“For the most part, the strategy works out for these groups, which is why we continue to see this sector grow,” Hohlfeld says. “But this causes a trickle-down effect. Insurance com panies are losing those premiums, so they are focused on ways to maintain the revenue generated from the pre miums that still exist. The best way to do so is slash reimbursement rates to providers or make it incredibly frustrating and difficult for providers to get paid because of the hoops needed to jump through pre- and post-claim submission.”

Another development is the recently revised colorectal can cer screening recommendation that those at average risk should start screening at age 45 instead of the traditional 50. The good news here is that the federal government and commercial insurers are following the recommendation and covering screening at 45, increas ing access to this potentially lifesaving service to millions of additional people.

“From a business perspective, that’s good news for GI physicians since they are in the business of providing screen ings and preventing colon cancer,” Hohlfeld says. “But this expansion of coverage is costing the insurance industry more money, so they’re trying to make it a little more difficult for us to get paid.”

A third noteworthy development concerns staffing. Like most industries, insurance is struggling with staff recruit

ment and retention. It doesn’t help that some payors are mak ing decisions leading to self-inflicted problems in these areas. New hires aren’t getting the type of training they used to, which is leading to lengthy delays in getting issues resolved or issuing responses to rate proposals.

Getting in touch with a live person at a commercial payor these days is a challenge all its own, Coffee says. “We are finding that we often need to wait on the phone for multiple hours to try and get a single or a few claims paid, depending on how many we are allowed to ask about on any given call. Where before we might have waited half an hour to speak with someone, it’s not unusual for us to experience wait times of two hours or more. While our staff can do other work as they wait, it’s still a struggle and a frustrating experience, and one that gets magnified as your number of claims grow.”

Payor Considerations

Payors are also creating more issues for GI providers that need follow-up, such as increasing the number of claims denials. Contributing factors here include requiring authorizations and medical records where they were not mandated before.

“They are making policies stating that if they perform a certain pro cedure code, they now require prior authorization or copies of medical records,” Coffee says. “That’s extra work that must be done; more touches to a claim to get it paid. If you don’t include those documents, now you’re getting denials that cause a lot more work on the back end and often require multiple appeals.”

Unfortunately, payors don’t always make it easy for providers to learn about policy updates. While payors typically send out newsletters highlighting policy changes, these publications do not always cover every change, Hohl feld says. The information on all changes is typically published to payors’ websites, but navigating those aren’t easy either.

“If you miss a policy update that affects one of your codes, you can start seeing a surge in denials,” Coffee says. “That’s how providers often learn of policy changes.”

Finally, Coffee says she’s seeing commercial payors increasingly leverage a simple tactic that’s keeping cash out of providers’ accounts for longer: delaying payments. “Whereas they would previously pay a claim in 15 days, it might now be 20 or 30 days. The delays could be caused by staffing issue, claims volume, new systems—any number of reasons. The result is the same: slower payments.”

“[Commercial payors] would previously pay a claim in 15 days, it might now be 20 or 30 days. The delays could be caused by … any number of reasons. The result is the same: slower payments.”
— Ellen Coffee
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Strategies Business

Countering Payment Pressures

If GI practices and ASCs hope to grow or at least maintain their bottom line, this is no time for inactivity. One of the most important steps providers should take is renegotiat ing their commercial payor contracts at regular intervals, Hohlfeld advises. “That’s probably one of the biggest things that PE GI Solutions does routinely for our partners on the practice and ASC side. We gather information on the facility, the physicians who provide services there, and the area demographics as well as cost and historical quality and performance data. We then put that into a nice package to present to payors and explain why they should continue to want our facility to be part of their network and reimburse the facility more.”

The expectation is that these efforts will lead to higher reimbursement—one that’s rea sonable for the facility and payor, Hohlfeld says. “Does that mean we’re going get an 8% increase on a contract because of infla tion? Probably not, because an 8% increase from a payor is generally not something they’re going to be on board with. But we have received 5% and 6%. We are looking for incremental increases so that we continue to cover the costs of doing business and not lose money. Timely touches for renewal rate increases, and then automatic rate increases over a three- or five-year term, really help a facil ity maintain its revenue.”

Putting all the information together that’s often needed for successful renegotiation is time consuming, Hohlfeld says, but it usually pays off. If a payor indicates it’s still not inter ested in a rate change, she recommends bringing in help. “We will involve our physicians to speak about clinical issues with a payor’s medical director. While this usually isn’t necessary, getting a physician involved in negotiations can help move them forward.”

Securing fair contracts is the beginning of the work that’s needed for practices and centers to achieve financial sol vency. Facilities must also work to ensure they are getting reimbursed consistently and appropriately. “We have staff devoted to getting claims paid, no matter the cost,” Coffee says. “This is incredibly important to our staff because they understand the work they do supports the mission of the physicians. Getting paid is how physicians can continue caring for patients.”

As payments come in, Coffee says it’s imperative that facil ities perform continuous analysis to confirm those payments are equivalent to what’s stated in payor contracts. “When we identify trends indicating we are not being paid as we should be, we work closely with those on the payor contracting side to go back to the payor and get the money we deserve.”

Such collaboration between those tasked with contracting and RCM is essential to success. “We work together to identify those policy pieces that change a facility’s operationalization,” Hohlfeld says. “For example, if someone on my team reads that authorization will soon be required for an EGD for a particular group of patients, we alert those on the RCM side immediately as well as the physicians and center administrators.”

The RCM team has additional ways it supports the con tracting team. “While much of my team’s time is spent on the key steps RCM is supposed to do, like reviewing denials and submitting appeals, we also allocate time to bigger picture trends that go beyond claimby-claim reviews,” Coffee says. “We slice and dice our data to identify trends by payor, by provider, and sometimes by particular plan that point to pay ment issues. We then give this information to contracting so they can work to resolve these issues directly with payors.”

It certainly helps that PE GI Solutions has large teams dedicated to supporting con tracting and RCM for its partner practices and ASCs. “If you’re a single practice or ASC, you likely have people multitasking and handling a combination of coding, billing, collections, deni als, and other work,” Hohlfeld says. “We have staff devoted to these tasks and who have the time to gather data, sit on the phone for hours and do whatever is necessary for our partners to get paid. While it’s not our money, we go after it like it’s coming out of our individual pockets.”

She continues, “Our company was built on the notion that, ‘You take care of patients, we’ll take care of everything else.’ That’s really the differentiator I think PE GI Solutions brings to its partners.”

Sharon Hohlfeld is Vice President of Payor Contracting for PE GI Solutions. She can be reached at shohlfeld@ pegisolutions.com

Ellen Coffee is Vice President of Revenue Cycle Management (RCM) for PE GI Solutions. She can be reached at ecoffee@pegisolutions.com

“We will involve our physicians to speak about clinical issues with a payor’s medical director … getting a physician involved in negotiations can help move them forward.” — Sharon Hohlfeld
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Navigating Supply ChainDisruptions

Combating supply shortages and delays to run a healthy practice

One of the keys to running a successful practice or ambulatory surgery center (ASC) is having the equipment needed to provide essential care to patients. However, supply chain disruptions stemming from the COVID-19 pandemic and international affairs are leaving many locations struggling to procure necessary items.

Physicians have become all too familiar with the concept of shortages and delays. Backlogs formed during the height of the pandemic left many scavenging for personal protective equipment (PPE) and essentials. In today’s world, one where the fears of COVID-19 have somewhat waned in the eyes of the American public, physicians are now facing shortages of a broader range of equipment, leading many to adjust how they operate and deliver care.

“The list of scarce items is long,” a May 2022 Forbes article explains. “It includes latex and vinyl examination gloves, sur gical gowns, laboratory reagents, specimen-collection testing supplies, saline-flush syringes, and dialysis-related products, according to the U.S. Food and Drug Administration.”

According to Abe Eshkenazi, CEO of the Association for Supply Chain Management, items often-used to treat patients previously had fill rates between 96% and 98%. Today, those rates have plummeted to around 80%.

“It used to be that hospitals would deal with 50 to 100 back-ordered items per day,” he told Forbes. “There are many institutions that now are dealing with 800 to 1,000 back orders per day.”

So how can practices and ASCs work to reduce the pres sure of backlogged orders and supply constraints? According to a July article from Becker’s, one solution may be to move to a clinically-integrated supply chain formula.

Clinically integrating your supply chain is not a one-step process. Rather, it involves a cultural change throughout your practice or ASC. Benefits of this switch include reduced waste, lower costs, higher patient satisfaction, and a more informed staff.

How to Clinically Integrate Your Supply Chain

The cultural change begins with practice or center leadership. Leaders should evaluate the costs of items used in their location and consult with supply chain professionals to iden tify relevant alternatives that remain clinically acceptable yet cost efficient.

As the items are identified, practice or center staff should be notified of potential changes, and taught the costs of their supplies and how each change can help save money while continuing to provide high-quality care. Finally, data should be continually reviewed to adjust contracts, monitor compli ance, and find new cost-saving alternatives.

Keep Staff Informed

One of the best ways to limit errors due to shortages is to ensure that each member of your staff is informed on how to prepare should a shortage of a valuable item arise. Prepa ration for shortages will help reduce stress levels within your location and maintain high standards of care. An open line of communication between staff and leadership, while always a valuable asset, can also help avoid bottlenecks while provid ing care and maintaining efficiency.

Supply chain delays will continue to play a role in the healthcare industry for years to come and understanding how to navigate stockpiles and alternatives during this time can help keep your location running smoothly.

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The COVID-19 pandemic has forever changed the way physicians and patients approach healthcare. These changes have impacted the costs and reimbursements presented, including the expectation surrounding patient payment obligations.

According to a study by Commerce Healthcare, 27% of patients over the age of 65 have $500 or less saved to cover medical expenses.

“For many years, the trend in patient expense obligation has marched steadily upward,” the study explains. “Growth

Patient Financial Pressures: A MountingChallenge

of personal outlays is projected to rise 9.9% annually through 2026. Moreover, 10% of adults under 65 were uninsured in the first half of 2021.”

This increased financial burden on patients has led to significant complications surrounding payment processes, especially on the uninsured.

Commonwealth Fund’s study found that one-third of patients, both insured and uninsured, battled some form of medial debt, while another study reported that nearly 18% carry medical debt after receiving care, with the average

Patients are feeling the strain of rising medical costs, though increased transparency may be the solution
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patient owing a mean total of $429.

The study also found that 50% of uninsured participating patients had experienced some form of billing or pay ment difficulty; 40% of uninsured partici pants reported they had trouble paying medical bills or could not do so in any form; and 24% of insured participants also reported having trouble with paying their bills.

84%Kept Appointments

84% of patients who received cost estimates for procedures—an overwhelming majority—did not cancel their appointments.

Only 16% of patients canceled their appoint ments after receiving estimates, while another 16% went in search of lower prices, but ultimately returned for care. Lastly, only 5% of participating patients shopped around for lower costs and booked care at another location.

PE GI Solutions Vice President of Revenue Cycle Manage ment Ellen Coffee explained the reasoning behind the shift.

“There’s been this cost shift to the patient through higher deductibles and higher co-insurance rates, so patients are taking on a larger liability for the care they are receiving,” Coffee says. “It has become extremely important for provid ers to put research into the care they are providing to be able to provide an accurate cost estimate to each patient.”

Physicians Feeling the Struggle

The result of this increased responsibility on patients is also felt by the physicians who provide their care. Patients who struggle or cannot afford to pay medical debt can cause lost profits for physicians, leading to tighter bottom lines.

Those who see others struggling to pay for care may opt to delay or refuse treatment altogether. A mid-2021 affordability survey spoke with patients of varying generations, including Baby Boomers (age 57–74), Gen X (age 42–56), and millennials (age 25–41). Results of the survey showed Gen X participants were the most likely to delay treatment or medication (37%), skip an appointment (29%), or decline treatment (25%).

To avoid lost profits, healthcare providers may choose to offer more financing to patients to incentivize receiving care and meet a growing demand for upfront cost estimates.

Estimates and Patient Volume

Increasingly, physicians are seeing a trend of upfront cost estimate requests from patients in higher and higher numbers to help avoid overwhelming medical bills. A recent survey showed that nearly half of all patients (46%) requested a cost estimate from their provider prior to receiving care.

Results showed that once patients were able to see their potential incurred costs, many felt more comfortable continuing with their procedure or visit. 63% of those surveyed received care after looking over their cost, a promising sign for providers who worry that estimates may deter patients.

As physicians continue to find ways to meet the demands of their patients, simple changes, such as upfront estimates, are proving to be invaluable in not only getting new patients through the door but building the loyalty to make them repeat visitors.

“These expanded financing steps can go beyond improved satisfaction to building patient loyalty,” Commerce Healthcare’s article states. “That effort is critical to long-term provider health and is much needed in an environment in which 36% of con sumers register indifference to health system brands.”

The National Conference of State Legislatures (NCSL) hopes improving transparency between physicians and patients can help implement cost saving measures that benefit both parties, and the healthcare system.

Some states, such as Kentucky, Connecticut, Florida, Maine, and others, offer simple-to-use price comparison tools for patients, in the hopes of speeding up the process and assisting them in completing care previously delayed by the pandemic. Other states, such as New Hampshire and Utah, offer RightTo-Shop programs through employers, incentivizing patients to find high-quality care at a lower cost with successful results.

“Through Right-to-Shop programs, insurers typically share a portion of their cost savings with health plan enrollees to offset any pre-deductible or out-of-pocket expenses,” notes the NCSL. “Proponents of Right-to-Shop programs argue that financial incentive programs prompt healthcare consum ers to utilize public price information and seek cost-effective care. However, some argue that Right-to-Shop programs are not necessarily effective, since patients often defer to phy sician referrals and recommendations when seeking health services rather than shop for services.”

While there is no one correct solution to the issue, mov ing toward increased transparency looks to be a viable way to improve results for patients while reducing lost revenue for physician providers.

Ellen Coffee is Vice President of Revenue Cycle Management (RCM) for PE GI Solutions. She can be reached at ecoffee@pegisolutions.com

For more guidance and strategies for taking advantage of healthcare trends affecting the GI industry, visit our blog at pegijournal.com.

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WHAT WE DO

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

Our strategy is aligned with your interests in tackling the following challenges:

• Career security and stability

• Succession and recruitment strategies

• Growing administrative costs and burdens

• Shifting regulatory and reporting requirements

• Preparation to move from fee-for-service to value-based care

• Competition from hospital and other physician practice models

• Declining reimbursements paired with a need to invest in technology, security, marketing and patient engagement

2500 York Road, Suite 300 Jamison, PA 18929 PRSRT STD US POSTAGE PAID PE GI SOLUTIONS Submit Your CV Join PE GI Solutions’ extensive network of physicians solely focused on the GI community. PHE-022
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. To learn more about PE GI Solutions and PE Practice Solutions, visit pegisolutions.com, or contact us at 877.442.3687 or info@ pegisolutions.com.