Three gastroenterologists share their thoughts on the biggest challenges in reimbursement and their strategies for combating these pressures.

Ask Gastroenterologists is a weekly series of questions posed to gastroenterologists and colorectal surgeons around the country on business and clinical issues affecting the field of gastroenterology. We invite all GI physicians to submit responses. Next week’s question: What are the best opportunities for GI practice expansion in 2014?
 
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Question: What are a few of the biggest reimbursement challenges in the field of gastroenterology?

Shawn Khodadadian, MD, Manhattan (N.Y.) Gastroenterology: The Affordable Care Act will obviously have many ramifications for physicians in all fields, including gastroenterology, which remain to be seen. Further, there have also been changes on behalf of many of the major insurers with regard to aspects of the insurance plans that are offered. Many of these plans have higher deductibles and overall higher out of pocket expenses for patients. These high deductible plans may affect the desire of patients to see physicians because of these expenses in the first place and secondly, collection may be a more difficult endeavor affecting reimbursement for gastroenterology.

Practices will have to have systems in place in order to address these increasingly common scenarios. There has also been an increasing trend of utilizing ambulatory surgery centers for outpatient procedures which has been occurring for many years. As physician compensation continues to shift, gastroenterologists may be more interested in seeing if participation with ambulatory surgery centers can increase their efficiency and ultimately compensation.

Nizam Meah, MD, Your GI Center, Houston: While the challenges are many, there are a few main issues; these are things like progressive reduction in the procedure reimbursements that we are seeing every year, elimination of “consult” codes from government insurances both in inpatient and outpatient arena which is effectively a big reduction on reimbursement, and finally the persistent problems of “multiple procedure discounts” which reduces payment for a second or third procedure done on the same day, a rather unique way to reduce payment to the GIs.

Try to become more efficient in seeing patients and documentation, streamline the office staff, reduce supply costs from vendors, hold down expansions and keep our patients first in our minds.

Patrick Takahashi, MD, Chief Medical Information Officer, Chief of Gastroenterology Section, St. Vincent Medical Center, Los Angeles: Reimbursement issues in gastroenterology are similar whether one is in private practice or in the academic arena. Challenges are multiple, but include increasing demands for services, outside/internal pressure to curtail expenditures, advancement of technology which makes the former difficult and dropping reimbursement for procedures in the face of increasing expectations.  

Medicare physician fee schedules have failed to keep up with inflation in physician practice expense. Rising costs include institution and maintenance of electronic health records/health institution technology. It has been proposed that complex procedures will be subject to significant reimbursement reductions, disregarding the technical training and skill required to perform these procedures. The most egregious cuts will affect those procedures performed on unscheduled/emergent patients who are oftentimes the most sick with complex issues. It would be unfortunate if physicians began to gravitate away from those complex cases due to reimbursement, especially considering the risk involved with these types of cases.

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