Don't Count on Colonoscopies

The Medical University of South Carolina has made strides by reorganizing the administration and structure of digestive health services. Before restructuring, fragmentation plagued the department; patients were shuffled from a gastroenterologist for diagnosis to a radiologist for an image to a surgeon for an intervention, with little coordination among the various providers.

DeLegge was able to solve the problem in the same way that leaders in other service lines have improved coordination—through centralization of services as well as the reporting structure.

"We realized that gastroenterologists and GI surgeons are very dependent on one another. With that the idea that came up is, Why not house everybody in one location so that their patients and their clinics and their offices are together?" says DeLegge. "When you look at how patients are scheduled or how clinics are run, how the endoscopy suite is run, or how the OR is run, it's all through one reporting system. You don't have to repeat things on both sides."

Service Line Success Key No. 3: Incorporate bariatrics
With the service line structure also comes a more strategic and deliberate approach to developing the services. Leaders at the Medical University of South Carolina perform an annual assessment of where the service line is heading in order to make strategic adjustments and investment decisions. Beginning about three years ago, they started to view obesity treatment as a major growth area.

With two-thirds of Americans overweight or obese and nearly $150 billion spent on obesity-related treatments each year, weight-loss programs may be the next frontier for gastroenterologists. Although bariatric surgery is typically handled by general or specialized surgeons, gastroenterologists often see patients before and after surgery and intervene when complications arise.

The problem at the Medical Center of the University of South Carolina was that the surgeons and gastroenterologists operated in silos before the service line was centralized, so there was a disconnect between the medical and surgical aspects of treatment.

"We have a pretty elaborate gastric bypass program here and some medical weight-loss management, but the two programs have operated separately and in different parts of the facility without a lot of give and take between the two. Patients didn't flow freely between the two centers, medical and surgical weight loss," DeLegge says.

The hospital brought the two together so that patients entered a centralized digestive disease center and were funneled to the appropriate treatment—medical or surgical—for weight loss. Initially the approach involved bringing in a bariatrician to evaluate patients for proper treatment and follow up after an intervention, but DeLegge is now recruiting a physician with endoscopic, as well as bariatric, expertise to prepare for a shifting market.

"We've evolved over last 18 months to realize the writing is on wall with regard to a limited number of new endoscopic technologies coming on board for weight loss," he says. "As we looked at that it made sense to us that the bariatrician we were referring to as a specialist would have to be someone who had a specialty in endoscopy, too. We felt that would be the best person to deal with surgeons, the endoscopic aspects, and the medical side."