Don't Count on Colonoscopies

Even when the hospital doesn't own or manage an HMO in a market, it can bring a lot of clout to payer negotiations and help physicians get higher rates than they would have on their own.

Hospitals, too, are becoming more interested in partnering with physicians. Gastroenterology is a decent revenue generator on its own, but many gastroenterologists are also board certified in internal medicine and can bring in a decent amount of referrals and ancillary revenue. When physicians began breaking away to outpatient facilities, hospitals lost both primary and ancillary revenue streams, such as pathology and imaging referrals and follow-up surgical cases.

"Hospitals have been hit with a triple whammy," says Poisson. "We've seen a resurgence in the number of hospitals that want to develop stronger relationships with GI physicians."

Beth Israel Medical Center in New York City initiated a joint venture with a group of local physicians after watching the slow attrition of endoscopic revenue out of the hospital. Taking a minor ownership interest in a new ambulatory surgical center not only helped the hospital tap back into the revenue stream, but it also opened up communication lines and built relationships with physicians who otherwise weren't affiliated with the hospital, says Brett Bernstein, MD, director of endoscopy in the division of digestive diseases at Beth Israel Medical Center, a 1,106-bed not-for-profit hospital in Manhattan.

Bernstein was aided in his endeavor by New York's CON laws, which make it near impossible for physicians to open up a private ASC that would directly compete with the hospital. But the joint venture wouldn't have happened without some on-the-ground physician championing—he learned of physician candidates through word of mouth and met with each potential owner before gathering together a group of 10 doctors.

"The hope is that by having helped to get us up to speed and build a center like this, there is new loyalty because these doctors will now be on staff at Beth Israel," says Bernstein. "They will hopefully like the way they saw the hospital responding to them and would begin and continue to send patients and pathology and radiology work to the institution."

Service Line Success Key No. 2: Defragment services
Coordinating care among various disciplines and departments is a chief challenge for any service line, but historically, digestive disease services have been particularly fragmented, leaving a long road ahead to integrated care.

The eventual next step for gastroenterology is probably the spread of digestive health centers that resemble the centralization seen in more developed service lines like cardiovascular and oncology, says Poisson. "I'd envision the ASC as part of it, the gastroenterologists' professional practice as part of it, maybe some nutritional counseling that deals with weight loss."

Some are already beginning to create more comprehensive programs that combine colorectal and pancreatic cancer programs with other diseases like irritable bowel syndrome, liver disease, gastroesophageal reflux disease, and obesity programs.