It may be time for GI practices to step out of the procedure-heavy comfort zone to prepare for value-based reimbursement and an aging population.
This article first appeared in the June 2015 issue of HealthLeaders magazine.
When Katie Couric underwent a colonoscopy on live television in 2000 as host of the Today show, she not only heightened awareness of the important role colonoscopies play in detecting colon cancer, but she actually boosted the rate of colonoscopies among men and women. Jay Monahan, Couric's husband, died from colon cancer at age 42, and the experience led to Couric's efforts to raise awareness about screening for the disease. The strategy worked and subsequently ushered in a boon to GI practices.
While there are other less-invasive screening tests available for colon cancer, such as the fecal occult blood test (FOBT) or fecal immunochemical test (FIT), which can be done at home annually, colonoscopies are regarded as the gold standard and are the most commonly used screening test to detect polyps that can turn into colon cancer.
"Gastroenterology started gaining traction because of the volumes from the 'Couric effect,' " says Yousif A-Rahim, MD, PhD, chief medical officer for Nashville-based Covenant Surgical Partners, owner and operator of 28 ambulatory surgical centers, most of which are GI-focused, across the country. "We've enjoyed a relatively sanguine era since 2000."
Insurance coverage for colonoscopies, from private payers and Medicare, also helped improve colonoscopy volumes at GI practices. A-Rahim says that at the GI ASCs that Covenant runs, colonoscopies and endoscopies are the "bread and butter" of its revenue streams. Still, technological advances, a mature market—after all, Couric's TV colonoscopy was 15 years ago—and reimbursement reductions are pressures that all GI practices are
Some providers, such as Covenant, remain focused on the procedural mainstays of their specialty, but other gastroenterology providers are preparing for a fee-for-value transition by partnering with insurance companies and focusing on specific populations to improve readmission rates.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.