SUMMER 2018
A journal dedicated to advancing GI ASCs and practices
14 Center questions answered
6 12 20
SEPARATING FINANCIALS HEMORRHOID BANDING PEER REVIEWS
CENTER DEVELOPMENT “From a vacant lot or empty building through the construction of a new facility—PE has the expertise to ensure your center is on time, on budget and fully licensed.” - Frank Principati, COO, Physicians Endoscopy
“Teamwork is vital to a project’s success. Choosing the right architects, engineers and contractors is critical, and PE manages every step looking out for the center’s best interest.” - MaryAnn Gellenbeck, Senior VP, Implementation Services, Physicians Endoscopy
“Everything is done collaboratively. We share the same goals, quality focus and vision to drive the business forward in a way that will truly benefit patients.” - Bob Estes, Senior VP, Operations, Physicians Endoscopy
Let the experts manage your new center build, visit endocenters.com or call (866) 240-9496.
EDITORIAL STAFF
Carol Stopa Editor in Chief cstopa@endocenters.com
CONTENTS
SUMMER 2018
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Lori Trzcinski Managing Editor ltrzcinski@endocenters.com
Publishing services are provided by GLC, 9855 Woods Drive, Skokie, IL 60077, (847) 205.3000, glcdelivers.com. EndoEconomics™, a free quarterly publication, is published by Physicians Endoscopy, 2500 York Road, Suite 300, Jamison, PA 18929, (877) 442.3687, endocenters.com/endoeconomics.
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LETTER
NOTEWORTHY
STRATEGIES
2
3
6
Message from the President
The views expressed in this publication are not necessarily those of Physicians Endoscopy, EndoEconomics or the editorial staff. POSTMASTER: Send address changes to: Physicians Endoscopy, Attn: EndoEconomics, 2500 York Road, Suite 300, Jamison, PA 18929. While every effort has been made to ensure the accuracy of EndoEconomics contents, neither the editor nor staff can be held responsible for the accuracy of information herein, or any consequences arising from it. Advertisers assume liability and responsibility for all content (including text, illustrations and representations) of their advertisements published. Printed in the U.S.A. Copyright Š 2018 by Physicians Endoscopy. All rights reserved. All copyright for material appearing in EndoEconomics belongs to Physicians Endoscopy, and/or the individual contributor/ clients, and may not be reproduced without the written consent of Physicians Endoscopy. Reproduction in whole or in part of the contents without express permission is prohibited. To request reprints or the rights to reprint such as copying for general distribution, advertising or promotional purposes: Submit in writing by mail or send via email to info@endocenters.com.
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New President welcome, center news, celebratory anniversaries and more
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Maximizing value
12
Striking a balance
20
EXCELLENCE
INSIGHTS
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18
Questions answered
Draw the line
MARKETING Timing is everything
20
CLINICAL Peer reviews with purpose
ENDO OPPORTUNITES 24
GI physician opportunities at partnered practices
22 IT
The team behind your technology
Find out more at endocenters.com or find us on
1 endoeconomics SUMMER 2018
letter
{Message from the President}
WITH SUCCESS COMES CHANGE Physicians Endoscopy welcomes two new team members to help bring additional opportunity for growth.
Barry Tanner, CEO, Physicians Endoscopy
IF WE CONTINUE TO EMBRACE OUR SHARED VISION AND UNSHAKABLE DEDICATION TO OUR CORE VALUES, EVERY CHALLENGE WE FACE WILL BE SHORT-LIVED AND OVERCOME.
2 endoeconomics SUMMER 2018
I WANT TO BEGIN THIS EDITION BY WELCOMING TWO NEW AND VERY IMPORTANT TEAM MEMBERS TO THE PHYSICIANS ENDOSCOPY (PE) FAMILY. First, Christina Morrison has joined as our Chief Financial Officer. Christina brings deep experience having held senior financial positions with Wyeth Pharmaceuticals and Aramark, among others. Christina not only fits the character and profile of our company, but she also has the organizational skills we need to continue our pursuit of becoming the most trusted and reliable partner to gastroenterologists nationwide. Many of you may wonder what happened to our long-time CFO Karen Sablyak. Karen is still with PE, and she and I will work closely together as we move forward on a host of strategic initiatives designed to help our GI partners grow and improve in all aspects of delivery of GI care. I also want to welcome David Young as President of PE. I will remain as PE’s Chief Executive Officer. David comes to us from Privia Health where he served as Chief Operating Officer (see page 3). His experience and knowledge of practice management, financial expertise and amazing leadership skills will help catapult PE to become the full-service GI company that we have long envisioned. Starting with the Fall 2018 issue, you will have the opportunity to hear directly from David as he delivers his inaugural Message from the President to the GI community. With success comes change, and change always brings new challenges and the opportunity for growth. If we continue to embrace our shared vision and unshakable dedication to our core
values, every challenge we face will be short-lived and overcome. Turning to other matters, we continue to see an unusually high level of activity in GI practice consolidation and monetization. Many GI physicians are choosing to explore new professional practice model alternatives. Fueling this activity is continued interest from investors such as private equity firms in healthcare generally and physician services specifically. In addition, the largest owner/operator of GI ambulatory surgery centers (ASCs) in the U.S., Envision/Amsurg, is being sold to KKR. There are approximately a dozen sales offering memorandums for GI practices on the market around the country. We are assessing the business models being deployed and attempting to determine how, if and when to enter into this segment. We see enormous potential to protect and grow independent GI practices, and see equal potential for major problems if the models, compensation structures and incentives for growth are misaligned. Caution is the operative word here. Another important trend emerging after years of being fairly stagnant is the de novo development of new ASCs. Much of this development appears to be driven by hospitals and health systems taking steps toward increased collaboration with physicians. They recognize the need to move certain outpatient procedures, such as GI procedures, away from hospital outpatient departments to ASCs where the cost of care is lower. This movement is not exactly a tsunami yet, but it definitely is building. Please enjoy this Summer edition of EndoEconomics.
noteworthy
{News and events}
endocenters.com
WELCOME
PE WELCOMES A NEW PRESIDENT
To better support our partners—and to support even more partners in the future—Physicians Endoscopy (PE) has brought additional skills and talent into the company. After a thorough and thoughtful search process, as of June 4th, David Young joined the PE team as President. David is responsible for driving PE to the next level, building on the solid foundation and momentum achieved by PE for the past 20 years. David is an accomplished executive and brings a great mix of leadership, inspiration, operational experience and passion for customer care. He has a proven record of more than 20 years’ experience in applying a strong financial and operational skill set to deliver on strategic and tactical objectives across multiple industry sectors. David’s appointment is a clear reflection of the company’s current state: ready to take on the future and fired up after a healthy year of growth. PE is now poised for a major evolution in the market, and we are excited about David’s unique experience of nurturing companies of our size into the next generation. Barry Tanner will continue to serve as Chief Executive Officer, spending the majority of his time focusing on growing the business using his talents and expertise within the GI healthcare sector as PE continues its work toward practice management and management services organization (MSO) successes. In addition, earlier this year, Christina Morrison joined the PE team to serve as Chief Financial Officer. In 2017, PE also added two important positions to the executive team by hiring Scott Fraser, Co-President, PE Gastro Management, and Roy Bejarano, Chief Strategy Officer and Co-President, PE Gastro Management, to lead the company’s efforts in expanding into physician practice management. There is enormous opportunity for PE in the years that lie ahead, and we couldn’t be happier to have David join the PE family.
David Young, President, Physicians Endoscopy > COO, Privia Health For the past three years, David served as COO at Privia Health, the fastest growing, largest independent medical group and practice management services provider. Under his leadership, the company scaled from $200 million and 200 providers to $1 billion and 2,000+ providers. > CFO, Smile Brands, Inc. Before Privia, David served as CFO of Smile Brands, Inc., one of the largest dental service organizations in the country with 5,500+ providers and employees in approximately 400 locations across the U.S. > SVP, Operations, McKesson Specialty Health David served as SVP, Operations with McKesson Specialty Health, a division of McKesson Corporation, designed as an MSO with ancillary services to pharmaceutical, biotech, payer and patient customer segments. > CFO, US Oncology David’s career includes serving as the CFO of US Oncology, which operates a network of integrated community-based oncology practices that provide cancer care services.
3 endoeconomics SUMMER 2018
noteworthy
{News and events}
AliveAndKickn Celebrated Annual Blue Genes Bash in New York City Every year AliveAndKickn brings together physicians, survivors and administrators from GI, oncology, OB/GYN and genetics from throughout the New York metro area. On May 8th, the fundraising event celebrated the accomplishments of 2018 Blue Genes honorees Heather Hampel, MS, LCG; Tara Kiri; and Jill DeSimone. AliveAndKickn promotes awareness and improves the lives of individuals and families affected by Lynch syndrome and associated cancers through research, education and screening. Since 2016, Physicians Endoscopy (PE) has been a proud corporate sponsor of AliveAndKickn.
Celebratory Anniversaries Congratulations to the following centers that have been consistently committed to serving their respective communities. We are proud to have them as part of the PE family! >A ugusta Endoscopy Center Evans, Georgia (February 2003) >M ichigan Endoscopy Center Farmington Hills, Michigan (February 2003)
> The Endoscopy Center of New York New York, New York (February 2013) > Queens Boulevard Endoscopy Center Rego Park, New York (March 2013) > University Suburban Endoscopy Center South Euclid, Ohio (April 2013) > Queens Endoscopy ASC Fresh Meadows, New York (April 2013) > Flushing Endoscopy Center Flushing, New York (May 2013)
(L-R): Marla Sabuda, RN (Carnegie Hill Endoscopy); Angelo Wong (Administrator for Mid-Bronx Endoscopy); Scott Williams, MPH, CASC (Administrator for Carnegie Hill Endoscopy); Jennifer Zimmerman, MD, and James George, MD (Carnegie Hill Endoscopy)
To learn more about Lynch syndrome and AliveAndKickn, visit aliveandkickn.org or call 201-694-8282
4 endoeconomics SUMMER 2018
South Broward Endoscopy Recognized as a Best Place to Work South Broward Endoscopy in Cooper City, Florida, was selected as one of Modern Healthcare’s “Best Places to Work in Healthcare” for 2018. SBE received the award eight times in the past nine years. The recognition program lists workplaces throughout the healthcare industry that empower employees to provide patients and customers with the best possible care, products and services.
Raqhel Laurence and Kat Bockhorst of Physicians Endoscopy
For more information, visit southbrowardendo.com or call 954-435-0101
Send us your community stories. Email us at info@endocenters.com
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National Advocacy Day 2018
BASC to Offer CAIP Certification The Board of Ambulatory Surgery Certification (BASC) will offer the Certified Ambulatory Infection Preventionist (CAIP) certification starting this fall. The first exam for the new certification program will be offered October 1st–31st in testing centers around the country. Electronic applications for the October testing period will be accepted August 1st–31st. Licensed healthcare professionals with specialized knowledge and skills in infection prevention can now demonstrate their expertise through this new CAIP program. The program also provides an opportunity for infection preventionists (IP) working in the ambulatory surgery center (ASC) setting to distinguish themselves from IPs who work in other settings and to demonstrate their commitment to best practices in infection prevention and control.
For more information, download the handbook at aboutcaip.org
June 5th was National Advocacy Day in Washington, DC. The Ambulatory Surgery Center Association (ASCA) provided an opportunity for attendees to speak faceto-face with members of Congress. This was a great way for ASCA members to convey important, lasting messages to key decision-makers. Learn about what is going on in Congress, what ASC legislation is being discussed and how to ask your representative to support your ASC.
For more information, visit ascassociation.org
World Digestive Health Day
Laredo Digestive Health Center Attends SGNA Conference On April 7th, Laredo Digestive Health Center (LDHC) attended the South Central Texas Society of Gastroenterology Nurses and Associates (SGNA) 2018 Conference in San Antonio, Texas. The event was organized by Janice Balentine and featured several educational sessions by physician speakers that helped attendees improve patient care. LDHC found great value in the event, and two of its staff members won prizes including a fully paid registration fee for the 45th National SGNA Annual Conference (held May 20th–22nd near Orlando, Florida). SGNA is an organization of nurses and associates dedicated to the safe and effective practice of gastroenterology and endoscopy nursing, as well as the advancement of the science and practice of these fields.
For more information, visit sgna.org or call 800-245-7462
May 29th marked World Digestive Health Day 2018. The World Gastroenterology Organisation has established this awareness day to focus on a new digestive disorder each year. 2018’s theme is “Viral Hepatitis, B and C: Lifting the Global Burden.” The organization’s goal is to increase public awareness of the viral infection, as well as its causes, prevention and therapy. It provides gastroenterologists and the general public with the latest research within the field, so they can understand the effects and repercussions of this contractible virus. To support this endeavor, the World Gastroenterology Organisation has released a year-long, multifaceted campaign featuring digital and print collateral available for use in multiple languages. The campaign is expected to reach more than 50,000 individuals worldwide.
To learn more about the campaign, visit worldgastroenterology.org/ wgo-foundation/wdhd
5 endoeconomics SUMMER 2018
strategies
{Business strategy and the bottom line}
Draw the line Separating the financials of your ambulatory surgery center (ASC) and your practice is key to a successful acquisition. By Cheryl Costella
One of the most exciting moments when considering to sell your ambulatory surgery center (ASC) is learning what it’s worth to a possible acquisition partner. A surefire way to throw a wrench into the valuation process before it even begins is having to merge the financials of the ASC and practice. This accounting method is common when an ASC and practice operate out of the same building and share the same owners. In what is likely an effort to reduce the financial management workload, owners track revenue and expenses for both operations together. On the surface there seems to be some logic to this method. After all, money coming in and out belongs to the same owners. Why complicate matters by separating them out by facility? Unfortunately, when it comes time to consider selling the ASC (or practice), such an approach makes it difficult to determine the facility’s true profitability. If the operations jointly earn a net revenue of $1 million annually and spend $500,000, how much is attributable to the ASC and how much to the practice?
6 endoeconomics SUMMER 2018
SEPARATE YOUR FINANCIALS WELL IN ADVANCE OF STARTING THE SELLING PROCESS.
When a company like Physicians Endoscopy (PE) is approached as a prospective ASC acquisition partner, one of our first requests is to view the facility’s financials. When they are merged with the financials of a practice, this creates a significant challenge. Work must be done to separate the two sets of financials. This can lead to a much lengthier and tedious valuation and purchase process, and may even negatively affect the price offered to a center. When entities are merged in this manner, it can also raise ownership and/or tax issues concerning operations and entity types (e.g., corporation, LLC) that may require further discussions and arrangements before a sale is possible. If your ASC’s financials are merged with that of the practice, and you intend to eventually sell part or all of your ASC (or at least consider it), separate your financials well in advance of starting the selling process. Doing so will save you and a prospective acquisition partner significant time and effort, and will help you receive a more accurate and fair purchase price.
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In addition, keeping financials separate is beneficial from a performance improvement perspective (see “Another Compelling Reason to Separate,” page 9).
Areas of Focus Separating your financials may seem daunting, but while it will take some work up front, there are simple setups for many areas. Once you establish processes for tracking revenue and expenses, much of it will happen naturally and become second nature. Here are six tips to get started breaking apart your businesses. ➊ | Revenue. This may be as simple as looking at the data produced by your billing systems. Most should automatically separate services rendered by CPT code and break out where and for what services cash was collected. ➋ | Payroll. Many payroll companies will set up your timekeeping system and break out payroll by department, with departments defined as you choose. A simple tracking approach is to set up your timekeeping for two different departments, with departments defined as your two operations. You can even assign departments within operations (e.g., business office, clinical, administration). Many payroll reports will separate all your expenses, such as payroll taxes, the same way. If you share staff between operations, you’ll want to require these team members to clock in and out from each operation. These are good solutions to track payroll, including benefits, and expenses going forward. If you’re looking to calculate these figures for previous years, you can break them down either by employee or hours worked if an employee is shared by both operations. For example, a technician probably only works at the center, so all payroll and associated expenses for this
individual would be assigned to the center. For a front desk team member or nurse who works at both the practice and ASC, split figures based on an average percentage of hours worked. Don’t stress about calculating an exact percentage. Get as close as you can within reason. Whole numbers should suffice. ➌|S upplies. Supplies can get a little tricky. It should be fairly straightforward to separate supplies used in only one operation. For example, you would assign disposables associated with performing colonoscopies to the ASC. Where matters become complicated is when an item such as alcohol swabs is used at both the ASC and practice.
ONE WAY TO DIVIDE THE COST BETWEEN OPERATIONS IS TO BASE IT ON A PERCENTAGE OF CASE VOLUME OR NUMBER OF PATIENTS IN A MONTH.
One way to divide the cost between operations is to base it on a percentage of case volume or number of patients in a month. Track these figures for a few months and determine the monthly average. Then divide accordingly. If you average 70 percent of your volume on patients at the practice and 30 percent at the center, divide the cost of alcohol swabs by those percentages. Any supply expense that’s shared probably won’t be a high-dollar item, so approximating the percentages should be acceptable.
Contact us if you are considering private equity funding or consolidation: endocenters.com/contact-us
7 endoeconomics SUMMER 2018
strategies
{Business strategy and the bottom line}
➍|B uilding expenses. The easiest way to divide costs related to the building (e.g., rent, utilities, business insurance, property insurance, real estate taxes, landscaping) is by a percentage of square footage each operation occupies. ➎ | I nsurances. Evaluate your non-building insurances on a case-by-case basis. Many insurances cannot be shared between facilities, so separating these expenses should be easy. If you’re unsure of the breakdown, your insurance broker may be able to offer some suggestions. For insurances that are shared, such as workers’ compensation, this is another scenario where percentage of hours worked can help divide costs appropriately. Professional liability should be expensebased on the policyholder: physician policies to the practice and ASC policies to the ASC.
WHEN FINANCIALS ARE SEPARATED YOU WILL BE ABLE TO DETERMINE THE SOURCE OF THE ISSUE.
8 endoeconomics SUMMER 2018
➏|O ther shared expenses. There are numerous other shared expenses to consider. For expenses related to patient services, divide by case volume or number of patients. For fees concerning business operations, such as equipment rentals (e.g., photocopiers), accounting, legal and consulting, determine a reasonable estimate of the split based on usage or square footage (if this seems applicable). If you think usage is close to even, dividing the expense 50/50 would likely be appropriate. The same would be true for the cost of a company party or charitable donation, for example, where the expense is essentially from the joint entity.
Getting Started These tips should help you begin to understand how much work will be required to separate your financials. Lean on your bookkeeper and/or accountant for assistance and guidance. You may want to focus your initial efforts on this year’s revenue and expenses to gain a sense of the breakdown, then estimate figures from prior years. Throughout this process, maintain documentation on the division and rationale behind how you split financials. That way, if an acquisition partner is interested in learning about your financials, you can provide a resource that serves as an effective roadmap. Once you establish percentages for the division of financials, there’s no need to revisit these figures every month. Consider re-evaluating every quarter or twice a year to see if the split still makes sense. If a development has shifted a figure heavily toward one operation, update your figures accordingly. Otherwise, minor developments are not likely to alter your percentages enough to warrant a change in your tracking methodology.
Another Compelling Reason to Separate Clearly separating your financials is key for the purpose of selling your ambulatory surgery center (ASC). But there’s another significant reason to do so. If you merge your financials, you potentially sacrifice the ability to effectively assess your performance. Let’s say your organization—the combined ASC and practice—begins to experience a downturn in revenue or increase in staff-associated expenses. When you examine your financials, there will likely be no fast way to determine in which operation the problem lies. When financials are separated, you should be able to determine the source of the issue. If ASC revenue is down, you know to look at areas such as individual physician procedure volume changes. If practice salaries are on the rise, you can assess changes specific to the practice staff. In both scenarios, you can quickly focus on what area needs to be investigated closely and targeted for improvement. And if you eventually decide to pursue a sale, your ability to achieve improvements will help attract buyers and should ultimately earn your ASC a higher sale price.
CHERYL COSTELLA, MBA, is Director of Financial Analysis at Physicians Endoscopy. She prepares financial information for acquisition valuations and works with acquired centers during the transition to PE ownership and services. She can be reached at ccostella@endocenters.com.
9 endoeconomics SUMMER 2018
strategies
{Business strategy and the bottom line}
Maximizing value By Jonathan C. Vick I recently spoke with ambulatory surgery center (ASC) leaders from across the country on how to maximize the value of ASC/medical office building (MOB) real estate through sales/leasebacks and defer capital gains taxes with a 1031 exchange. ASC/ MOB real estate expert and broker Jason Winokur and I presented at Becker’s ASC Review 24th Annual Meeting on this critical, timely topic. It’s a topic that physicians should pay attention to: Many physicians who own their ASC real estate do not realize how much value their real estate represents. These physicians have significant capital locked up in real estate that could be deployed in higher-yielding investments (see “Leaseback in Action,” page 11).
10 endoeconomics SUMMER 2018
Real estate sales and leasebacks can help ASC owners opt for higher-yielding investments.
endocenters.com
How Does a Sale/Leaseback Work? An ASC broker with a network of national buyers will create a marketing package to send to 20 or more qualified buyers (private investors, family trusts, investment funds, REITS, etc.). This typically generates six to 10 competitive offers for a property. The sellers select the buyer that offers the best price and terms, and receive cash on closing. The ASC will continue to pay the same rent as before, but to the new owner instead of to itself. The sellers will either pay a capital gains tax on the profits from the sale—which will be significantly less than the income tax they were paying for the rent they received—or they will defer the capital gains tax by buying one or more income-generating properties in a 1031 exchange. This also diversifies the sellers’ investments. Most sales/leasebacks are executed with a triple-net lease, which maximizes value for the sellers while leaving the ASC in control of the property. After the sale, the ASC continues to be responsible for the ongoing expenses of the property, including real estate taxes, building insurance, maintenance, rent and utilities.
Common Mistakes Made by Sellers To maximize the value of your ASC through a sale/leaseback, avoid these mistakes: > Rent is too low. Rent should be market rate ($30–$40 per square foot for an ASC). Higher rent means a higher selling price. > Leases are too short. Leases should be 10–15 years and include several five-year renewal options to get the best price and most offers. > Selling at the wrong time. Sales should occur when interest rates are relatively low to yield the highest selling price. > Selecting a local broker with no buyers. Pick a broker with national buyers who will be interested in your property. > Having only one offer to consider. Sellers will always get a better price when there
Leaseback in Action Consider this example of a successful sale/leaseback. 10 Years Ago A group of five surgeons in Ohio developed an ASC for $3 million using a $2 million loan. Today The ASC pays an annual rent of $400,000. The debt is paid off.
With the rent they are paying themselves, the real estate is worth $5.7 million. The real estate is appreciating at a rate of only 3 percent
a year through rent increases. This may be offset by interest rate increases that cause commercial real estate to decline in value. The ASC owners pay income tax on the rent.
Future After paying off the loan, the physicians could sell and lease back the real estate and gain $5.7 million in cash to invest in higher-yielding investments. The owners would no longer pay income tax on the rent. is competition among buyers and several offers from qualified buyers. > Not taking advantage of a 1031 exchange. This defers taxes and gives you tax-free use of the sales proceeds to reinvest in one or more incomegenerating properties. If you avoid these mistakes, a sale/ leaseback can be a great way to maximize the value of your real estate while eliminating income tax on rental income and giving you the opportunity to put your money to work in higher-yielding investments. The time for a sale/leaseback of your ASC real estate may be prime: Interest rates remain relatively low, and it’s a seller’s market with many buyers competing to invest in medical properties.
JONATHAN C. VICK, the founder and President of ASCs Inc., has extensive experience in ASC real estate sales, leasebacks and valuations. He can be reached at 760-751-0250 or jonvick2@ ascs-inc.com.
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strategies
{Business strategy and the bottom line}
39 percent
of screening colonoscopies revealed significant hemorrhoids, with
Striking a balance Incorporating hemorrhoid banding into your practice can help you offset declining reimbursements. By Shaun Gerrits In an effort to offset declining reimbursements, many gastroenterologists are now considering the introduction of new ancillary revenue streams. While ancillary services such as anesthesia, imaging, infusion, pharmacy, research and pathology require a critical mass of procedures—in addition to expertise and financial resources to establish—hemorrhoid banding can involve no capital expense and be implemented by a GI practice of any size.
Tapping in to the Market for Hemorrhoid Banding Seventy-five percent of people will experience hemorrhoid symptoms at some point in their lives, according to data published in 2006 in The Gale Encyclopedia of Medicine (3rd edition).i A 2011 study published in Colorectal Disease demonstrated that 39 percent of screening
12 endoeconomics SUMMER 2018
45 percent
of those patients suffering from hemorrhoidal symptoms.
colonoscopies revealed significant hemorrhoids, with 45 percent of those patients suffering from hemorrhoidal symptoms.ii With an aging population, the number of patients with symptomatic hemorrhoids will continue to grow. In many GI practices, hemorrhoids are underdiagnosed for a few common reasons: > Patients are often embarrassed to bring up hemorrhoid symptoms to their provider. If they do, many providers tell patients they are “just hemorrhoids” and limit them to conservative treatment options. > Most patients have hemorrhoid symptoms that are episodic in nature and therefore not acutely symptomatic at the time of their visit. > Because definitive hemorrhoid treatment has historically been more problematic than the disease itself, many patients have opted for treatments that target hemorrhoid symptoms but not the underlying disease. Patients become accustomed to living with hemorrhoids not realizing there are painless, nonsurgical options available.
endocenters.com
Reimbursements for Banding Procedure
CPT Code
Procedure Time
Revenue Per Hour
Hemorrhoid Ligation
46221
Office
12 minutes
$1,369.80
Hemorrhoid Ligation
46221
ASC
12 minutes
$1,888.20*
Upper Endoscopy
43235
ASC
30 minutes
$1,015.80*
Colonoscopy
45378
ASC
30 minutes
$1,112.40*
Location
*Includes procedural and facility fees Revenue for rubber band ligation, upper endoscopy and colonoscopy as compared per unit of time. Rates based on 2018 Medicare national averages.
To overcome these factors, implement processes around the diagnosis and scheduling of hemorrhoid patients: > Incorporate hemorrhoid symptoms as part of your intake process, and be proactive in discussing treatment options with anyone suffering from symptoms. > Explain to patients that you offer a procedure that is quick, safe and effective, and does not require prep or sedation. > Don’t just consider your most severely symptomatic patients. Even patients with mild to moderate disease can significantly benefit from a definitive treatment option. > Look for patients with itching, swelling, soiling, prolapse and rectal bleeding. > Consider patients complaining of what they believe are external symptoms. The majority of patients’ symptoms are a result of internal disease of which they are unaware. > If your practice faces capacity issues, train advanced practitioners to provide this service.
Understanding the Financial Impact of Hemorrhoid Banding Given the prevalence of symptomatic
About the CRH O’Regan System
46 percent of hemorrhoid diagnoses are missed during colonoscopy in retroflexion.
hemorrhoids as well as favorable reimbursement, hemorrhoid banding can have a significant financial impact. On an hourly basis, hemorrhoid banding reimburses higher than endoscopic procedures including colonoscopy. When you consider the abundance of hemorrhoid patients, the diagnosis rate through screening colonoscopy (18 percent, according to the 2011 study published in Colorectal Disease) and the hemorrhoid diagnoses missed during colonoscopy in retroflexion (46 percent, according to a study in the Journal of Clinical Gastroenterologyiii), a conservative measure of potential patients for hemorrhoid treatment in a GI practice is 20 percent of colonoscopy volume. Many patients will come from sources outside of colonoscopy, but 20 percent provides a guide to gauge the financial impact that hemorrhoid banding can have. The average GI practice is already seeing a large number of symptomatic hemorrhoid patients, and implementing processes to identify and educate suitable patients will benefit patients and the bottom line. Baker H. Hemorrhoids. In: Longe JL, ed. Gale Encyclopedia of Medicine, 3rd ed. Detroit: Gale; 2006: 1766–1769 ii Riss S, Weiser FA, Riss T, Schwameis K, Mittlbock M, Stift, A. Haemorrhoids and quality of life. Colorectal Disease, 2011 Apr;13(4):48-52 iii Kelly SM, Sanowski RA, Foutch PG, et al. A Prospective Comparison of Anoscopy and Fiberendoscopy in Detecting Anal Lesions. Journal of Clinical Gastroenterology, Vol. 8, No. 6, 1989 i
The CRH O’Regan System for hemorrhoid banding can be performed in the office or the ambulatory surgery center (ASC). There are no special tables, monitoring equipment or capital expenditures; all materials required for the procedure are disposable. Appointments are typically 10–15 minutes. The complication rate for the system is less than 1 percent and includes pain and bleeding. CRH Medical provides free physician-to-physician training at the GI practice on the technical aspect of utilizing the technology as well as on the diagnosis and treatment of anorectal health issues.
SHAUN GERRITS is the Vice President of Business Development for CRH Medical Corporation. CRH is dedicated to bringing innovative solutions to GI practices across the country and delivering the highest level of service. To schedule training or to learn more, visit physicians.crhsystem.com or call 800-660-2153 x2.
13 endoeconomics SUMMER 2018
CASE STUDY
excellence
{Success stories}
ENDOSCOPY CENTER AT ST. MARY AND ENDOSCOPY CENTER AT ROBINWOOD
Questions What is it really like to partner with Physicians Endoscopy? Two partnered center administrators reveal their initial apprehensions—and how those fears have been eliminated. Partnering with a management and development company like Physicians Endoscopy (PE) can afford a long list of benefits, from leveraging rich expertise in building and acquiring ambulatory surgery centers (ASCs) to accessing a comprehensive team that works exclusively on the business and operational components of ASCs. But it’s natural for a center to initially come to the table with concerns about the partnership and the future of the center and its staff. Two PE partnered center administrators—Darlene Buddendorf of Endoscopy Center at St. Mary and Penny Nicarry of Endoscopy Center at Robinwood—spoke with PE Senior Vice President of Business Development and Marketing Carol Stopa about their initial concerns and how those concerns were quickly alleviated.
Carol Stopa (CS): Tell me a little about your centers and when they partnered with PE.
Darlene Buddendorf (DB): We have served the southeastern Pennsylvania, central New Jersey and greater Philadelphia communities since 2006. Our center was affiliated with a hospital, with staff employed by the hospital. Our partnership with PE began in 2016. The hospital remains an owner, but staff transitioned to become employees of the center.
Penny Nicarry (PN): We opened in 2002 and serve a tri-state area that includes Maryland, Pennsylvania and West Virginia. We were part of a health system for 10 years, with our staff employed by the system. We exited that relationship and partnered with PE in 2012.
14 endoeconomics SUMMER 2018
answer
endocenters.com CS: What were your concerns about entering into a partnership with a company like PE?
DB: The biggest concern was probably preservation—preservation of my staff and even myself. In the early planning stages, we didn’t know what to tell the staff as we lacked information about PE and their approach to partnerships. What would happen to our benefits? Will they still need me, the administrator, or our clinical director? Would they tell us we weren’t completing enough cases and needed to downsize? Are they going to advise us of the need to change staffing structure to reduce costs? I was stressing so much that I practically had a resignation letter drafted in my inbox.
ed
PN: My apprehensions were similar. What changes were forthcoming? A lot of our employees had been with the center for 10 years, and turnover was minimal. Would there be staff retention? Would our benefits change? Would seniority carry over?
CS: Those concerns were justified. After all, Penny, you were a part of the center before it even opened. You brought the staff over and developed it from scratch. Now there’s this big change coming, and it’s daunting. How did PE help alleviate your concerns?
IT’S NATURAL FOR A CENTER TO INITIALLY COME TO THE TABLE WITH CONCERNS ABOUT THE PARTNERSHIP AND THE FUTURE OF THE CENTER AND ITS STAFF.
Illustration by Roy Scott
PN: The first question we asked was whether staff would keep their jobs. It was imperative to get that uncertainty out of the way. We learned everyone would keep their jobs, which relieved some apprehension. Then our minds shifted toward how our center would operate going forward. It felt like we were starting essentially at ground zero, knowing nothing except that our jobs were safe. But would we even want to stay in our positions? To further alleviate our concerns, we held multiple meetings where we sat down with PE representatives and got answers. PE stepped up, with their representatives listening to us and treating us very well. They maintained our seniority
15 endoeconomics SUMMER 2018
excellence
{Success stories}
and initially carried over the same benefits. We did have to get used to some changes. For example, as part of the health system, we had a mail machine downstairs from the center that we used to send out mail. We no longer had use of the machine following the ownership change. It seems small, but we had to figure a new way to get mail out. Little issues like this popped up for a while, and we just had to be prepared to come up with solutions.
DB: PE has helped us improve quality anal-
ysis and benchmarking by continuously updating us on new developments. They’ve helped us achieve significant cost savings through securing reduced pricing on equipment purchases. PE takes care of our billing, which helps ensure accounts receivable and payable THE BIGGEST FACTOR turn around in a timely manner. IN ALLEVIATING MY As an administrator, this CONCERNS ABOUT THE NEW PARTNERSHIP WAS support allows me to focus on BEING ABLE TO MEET other critical matters, such as PE STAFF IN PERSON. maintaining better communi—Darlene Buddendorf cation with staff and physicians, DB: The biggest factor in allevireviewing and filling operating ating my concerns about the new room schedules and marketing the partnership was being able to meet center for continued growth. It has PE staff in person. It really helps to get to allowed me to tackle projects I didn’t have know your new partner and teammates. time to do before. Early in the process, I was able to tour PE headquarters The ongoing collaboration with PE is wonderful. in Jamison, Pennsylvania, and meet the PE team faceI regularly work with Rob Puglisi, Vice President of to-face. We were able to see how they work together Operations. He is like my own PE partner. I can pick and gain a better sense of the kind of partner we were up the phone and speak with him anytime to discuss getting. This provided some insight into how they would matters involving the center. likely respond to us. It also helped to get to know individual team members. When we picked up the phone to PN: For us, PE’s negotiating power with payor contracting call PE, we could then put a face to a name and know to and supplies may be the most beneficial. They’re also whom we were speaking. We were happy to discover that great at helping us keep up with regulatory developments PE has the same family-oriented camaraderie as our staff. and updates. Running the day-to-day operations is a fulltime job itself. It’s great to have PE’s assistance in keeping CS: It’s great when a partner can visit us in our office. us up-to-date on changing regulations. It certainly helped that Endoscopy Center at St. Mary is I may have been skeptical of the partnership at the close to us. When the distance grows, it can be a bit more start, but it really has been a blessing in disguise. It seems difficult for physicians and center leadership to make the like at least once a day someone on my team tells me trip, but we always encourage and welcome it. they’re glad not to be with the health system anymore. When we were with the system, there were regular layoffs DB: The transition also was made easier through my and tremendous uncertainty about professional futures. ongoing communication with you and PE’s human Now we have stability, a level of job security and a thriving resources department. When the time came for us to loop center to boot. in our staff, PE’s team didn’t work from afar; they were hands-on right away. They visited our center several times CS: What steps would you recommend a center considerand sat down with every member of my staff, answering ing a partnership take to improve the process? all questions and providing comfort when necessary. They even brought pizza. DB: I believe the process should include a means of comThe entire experience was a bit overwhelming for municating key elements of the partnership transition to my staff. After all, lots of them were long-term hospital the administrator early on so that they can better comemployees and hesitant to embrace the change. PE gave prehend what will be expected of them and help alleviate them the time to vent, listened to their concerns and misconceptions for the future. The physicians may know alleviated fears of the unknown. this partnership will be successful because they have dealt with the anticipated partners behind the scenes, CS: How has the partnership with PE helped you so this communication can help the administrator have and your center? a better feel for the expected relationship.
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Learn more about our center partnerships: endocenters.com/asc-acquisition I think there would be great value in scheduling regular communications, perhaps weekly calls between the administrator, physicians and partner. These calls could serve to provide updates on the transition and give an opportunity to address questions or concerns, including those from staff, sooner than later.
CS: We encourage physicians to inform their administrators about what is going on. They don’t need to share all the details, such as purchase price, but the more about the potential partnership that is a mystery, the more undue fears will build up.
endocenters.com
Management can help calm these fears by offering some direction sooner than later. Having physicians and the new partner address staff questions and clarify that a partnership is not a takeover may relieve many of the pressures and fears. I would also recommend an ASC visit its partner to see their headquarters and meet their staff. An administrator can gain a better understanding of how the partner is ready to assist and ultimately help make the center even better than it already is. Embrace the change.
DB: Once the staff feels like they know changes are coming, they will want to know the who, what, when, where and why of the potential change.
CAROL STOPA is Senior Vice President of Business Development and Marketing for Physicians Endoscopy. She has more than 15 years’ experience in acquisitions, de novo and hospital/system joint ventures. She can be reached at cstopa@endocenters.com.
DARLENE BUDDENDORF is Administrator of Endoscopy Center at St. Mary in Langhorne, Pennsylvania. The center is about 7,500 square feet with four procedure rooms, three of which are licensed for operation. Physicians perform about 5,600 procedures annually.
PENNY NICARRY is Administrator of Endoscopy Center at Robinwood in Hagerstown, Maryland. The center is about 6,000 square feet with four procedure rooms, three of which are presently operational. Physicians perform about 9,500 procedures annually.
Looking for the right business partner? We offer flexible minority or majority ASC acquisition options!
17 (866) 240-9496 ∙ info@endocenters.com ∙ www.endocenters.com
endoeconomics SUMMER 2018
insights
{Marketing strategies and tips}
Timing is everything Motivate people ages 50–74 to get screened for colorectal cancer to improve their health, and increase procedure volumes in the process. By Nadine Clark
to the CDC. However, early screening may be indicated in some cases such as: > Patient is AfricanAmerican (screening should begin at age 45) > Colorectal polyps or colorectal cancer were detected in the past
> Patient has inflammatory bowel disease, Crohn’s disease or ulcerative colitis > Patient history shows a genetic condition such as familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer (Lynch syndrome)
Colorectal cancer is one of the most detectable and treatable forms of cancer, and regular screening tests can effectively reduce risk. Unfortunately, 37 percent of the eligible population in the U.S. is not getting screened for colorectal cancer, according to the National Health Interview Survey from the Centers for Disease Control and Prevention (CDC). Take advantage of the opportunity to motivate this population of 30 million people ages 50–74 to improve their overall health and, in turn, increase procedure volumes. At the lowest Medicare rate, the potential patient base represents $6 billion in reimbursement.
> Close family members to the patient have a history of colorectal polyps or colorectal cancer
Screening Guidelines
Strategies to Activate Patients
People age 50 or older should undergo recommended screening for colorectal cancer until the age of 75, according
In addition to simply talking to patients sooner, other measures can help you reach patients at the right time.
The key is to attract the best patient mix to your practice. Patients closer to 50 typically have private insurance, making them more attractive than those with public insurance. CDC data shows that screening compliance is lowest in the 50–54 age range. Starting the conversation earlier—around age 45—could result in screening compliance by 50.
37%
of the eligible population is not getting screened for colorectal cancer in the U.S.
18 endoeconomics SUMMER 2018
endocenters.com
➊M ake it easy for your referral base. Provide patient
New Guidelines From the American Cancer Society
education materials to hand out with referral slips. Communicate why screening is important in addition to explaining the procedure and pre-procedure paperwork. Provide the patient with reasons to select your practice. Spend time with your referral base to ensure they continue to support your practice.
The American Cancer Society lowered its colorectal cancer screening recommended starting age to 45 for people of average risk. The change was based in part on new data that shows rates of colorectal cancer are increasing in younger populations. This change is a great first step in fighting colon cancer, but at the time of publication, it has not yet been adopted by the CDC, Centers for Medicare & Medicaid or private insurers.
➋ I mplement a targeted marketing campaign in your community. Social media advertising allows you to target by location, age, interests and more. Offering something like a quiz to assess colon cancer risk draws patients to your website at minimal expense. Time your campaign to even out patient demand for screening procedures. Everyone tries to squeeze in exams in December before the New Year starts and they face another deductible. Marketing campaigns in the spring and summer can more evenly load your schedule. March is Colon Cancer Awareness month and a great time to start a campaign.
➌ T est your website. Does your website work well on a smartphone, tablet and computer? If not, it’s time to update to a responsive website. Websites should convince potential patients that you are the best choice. This is often an emotional versus logical choice, so even reassuring design elements like a welcoming bio picture and waiting room images are important. Also ensure that the website offers patient education articles that provide all of the relevant information without being too technical.
If Marketing Is Not Your Strong Suit Many resources are available to support your marketing
needs. For colon cancer specifically, the following may be helpful: > CDC Screen for Life Toolkit: cdc.gov/cancer/colorectal/ sfl/toolkit > National Colorectal Cancer Roundtable Resource Center: nccrt.org/resource-center > Industry partner resources such as Olympus America, which provides marketing materials for colon cancer screening: colonoscopytoday.com Marketing a practice to the right audience at the right time can help you bring in patients, preferred procedures and an optimal payor mix. At the same time, it can help you balance your schedule to avoid the endof-year rush.
Colorectal Cancer Screening by the Numbers
58%
Adults ages 50–64 were less likely to have been screened than those 65+.
Screening prevalence amongst races
White
Black
65% American Indians / Alaska Natives
62% Hispanic
50%
54%
Asian
50%
NADINE CLARK is Director of Marketing, GI Scopes & Procedures, at Olympus America. In addition to product marketing, she is passionate about patient education and marketing focused on colon cancer. She can be reached at Nadine.Clark@olympus.com.
Source: CDC National Health Survey
19 endoeconomics SUMMER 2018
insights
{Clinical updates}
Peer reviews with purpose How to develop a successful peer review process that can deliver meaningful results. By Doria Cipriani The peer review process is an essential and significant component of any quality program in an ambulatory surgery center (ASC). Peer review provides ASCs with an internal audit of the clinical practices of their physicians. When executed properly, evaluations of physicians by fellow physicians help identify practices that could impact patient safety and show an ASC’s commitment to meeting the highest quality standards of care. The peer review process can also serve as the first step toward identifying improvements and executing positive changes. While these reasons alone support the value of peer review, it is a process required for maintaining regulatory and accreditation compliance. Peer review in an ASC is the evaluation of the practices of any physician who is credentialed in the center (e.g., gastroenterologists, anesthesiologists) by a peer physician using a pre-established set of criteria. The reviewing physician compares the medical charts of the physician under review against these criteria. Here are seven critical steps for an effective ASC peer review process that can deliver meaningful results.
➊M atch process to policy. Your peer review process must reflect your center policy. This policy should include: > The criteria for peer review and its goals > How physicians are expected to perform the auditing of their peers, including the number of charts to review (often a percentage of a provider’s total monthly volume) > The manner in which the ASC will review, assess and act upon information gathered during the peer review process If your process changes, your policy should reflect that. Failure to follow your policy, by omitting or adding actions, will likely draw the scrutiny of surveyors.
20 endoeconomics SUMMER 2018
➋ E nsure auditing tool provides value. To perform peer review, your ASC should provide physicians with an auditing tool to follow. This tool should include the patient chart identifier, often the patient medical record or account number, the identifier of the physician being reviewed and the month of the audit or the date of service. The criteria for the review should be a clear part of the tool. These criteria typically take the form of questions to be answered, with often around six to eight questions total. The exact number is less important than ensuring a variety of well-rounded questions that can deliver meaningful, measurable results. If over time you see answers to a particular question come back consistently positive, consider replacing the question. The question has likely lost its value, as it fails to provide new insight and represents an area that does not need improvement. By changing questions, you will more likely find new ways to assess and improve your quality care.
➌ E ngage reviewers. The peer reviews are more likely to be performed if the process is simple for physicians to complete. Engage physicians in discussion on what method of performing the reviews works best for them. For example, some physicians may request printed copies of medical charts rather than digital versions. Providing documentation in the format desired may make the difference between a positive and negative reviewing experience.
➍K eep audits random. When choosing which medical charts you will provide to reviewers, select charts randomly. This will help you capture a variety of cases. Randomness can increase the likelihood that the review process will identify possible weaknesses.
Learn more about the clinical and operations support we provide for our partners: endocenters.com/contact-us
endocenters.com
WHEN EXECUTED PROPERLY, EVALUATION OF PHYSICIANS BY FELLOW PHYSICIANS HELPS IDENTIFY PRACTICES THAT COULD IMPACT PATIENT SAFETY AND SHOWS AN ASC’S COMMITMENT TO MEETING THE HIGHEST QUALITY STANDARDS OF CARE.
DORIA CIPRIANI, BSN, RNBC, joined Physicians Endoscopy in 2017 as Director, Clinical Support. She has ambulatory surgery experience in both an ASC and hospital setting and has a certification in Ambulatory Care Nursing. She can be reached at dcipriani@ endocenters.com.
Make sure charts from all cases that resulted in transfers to a hospital undergo peer review, as well as any case requiring further discussion. Surveyors will expect to see their inclusion with the randomly chosen charts.
➎A ssess review findings by committee. Following the completion of reviews, all results should undergo analysis and discussion by a peer review or quality assurance performance improvement (QAPI) committee. The reviewing committee should summarize findings and provide recommendations to the governing board for further review and discussion, as needed, including whether or not the standard of care was met. All findings and recommendations should be well documented in committee meeting minutes. In addition, committee findings should be reviewed and discussed at board meetings and included in board meeting minutes.
➏ T rack results. Treat the peer review process as more than just an exercise. Use the findings and recommendations to make changes in your provision of care. As you implement what you hope will be improvements, track trends and results to ensure you are meeting goals. If you observe trends of goals not met, investigate to determine the reasons why, and implement corrective action. Often opportunities to document a continuous quality improvement study arise from trends identified in peer review. The identification of trends and practices requiring modification should be an ongoing process and discussion with the providers.
➐ I nclude findings during reappointment. When a physician is up for reappointment, include the individual’s peer review results in the reappointment process. If a physician is credentialed for two years, the reappointment process should include all cumulative peer review findings for those two years.
21 endoeconomics SUMMER 2018
insights
{IT insights}
The team behind your technology The PE Help Desk works day in and day out to keep centers’ technologies performing so they can provide the care their patients need. By Andrew LoPresti
There was a time not long ago when using a computer in an ambulatory surgery center (ASC) was optional. The first personal computers introduced in the mid-1970s came as kits that required assembly and programming. Fast-forward 40-plus years to 2018, and every ASC relies on numerous computers to support software applications and technologies to power their organization. Even facilities that still use paper medical charts count on computers to support aspects such as registration, billing and communications. As ASC reliance on technology has grown, so has the need to support these tools. When technology in an ASC fails, it has the potential to halt operations. At minimum, it’s likely to slow down workflow and require short-term workarounds such as paper documentation. I joined Physicians Endoscopy (PE) in 2012 as the company’s first desktop support technician. My job was to provide all technical support for both local and remote users of desktops, laptops, applications and related technology. Now I’m the information technology (IT) support manager overseeing PE’s IT Help Desk. Four technicians and I comprise the Help Desk team.
22 endoeconomics SUMMER 2018
Our primary responsibility: Keep our technologies and partnered centers performing the way they need to so patients receive the best care and experience possible, and center operations can run smoothly.
How Our Help Desk Works The IT Help Desk provides IT support for all of our partnered centers—regardless of what technology or how much of it they use—and the PE team. We act as the main support line for any center or PE staff member experiencing an IT issue. Centers communicate IT issues to the Help Desk in three ways.
➊M ost of the time, centers call a support phone number to convey information. The Help Desk team member who answers the phone creates a service ticket, which allows the center and us to track progress.
endocenters.com
➋C enters can email the Help Desk. When we receive an email, a system automatically creates a service ticket, which is provided to the center via auto-response.
The Life of a Ticket When a ticket arrives, the Help Desk determines the tier level of support and directs it accordingly.
➌W e offer a self-service portal, a link
IT Help Desk receives ticket and determines support tier.
living on a computer’s desktop where centers can personally submit tickets. The Help Desk is operational for all centers from 6 am to 7 pm ET. We maintain an emergency help line for incidents that require immediate attention, such as a center’s server room flooding overnight. We provide support at some level to every one of PE’s centers. Some we support entirely; others that opt to employ an IT staff member(s) receive support relating to specific issues. Our model for delivering support is built around our ability to do so remotely. We can tackle nearly any issue from the PE office. Rarely do we need to send someone on-site, but if that’s necessary, we will do so. All IT services are included in a center’s managed service agreement, so the work of the Help Desk delivers a nice value-add. We take satisfaction in knowing our IT services can deliver significant cost savings for centers in need of increased support over outsourcing to a vendor likely to charge for every small task.
A Focus on Customer Service (L-R): Kevin Roche, Greg Laurie, Andrew LoPresti, Thaddeus Trybus, Justin Hornung
TIER ➊
TIER ➋
Basic IT Support Networking (network access, (back-end support) scanning, Help Desk directs printing) the ticket to the Individual appropriate team. reviewing the ticket typically handles the issue.
The Help Desk is like an emergency room. Based on the situation, we triage its priority and the most logical path toward resolution. If an incident will impact the delivery of patient care, we immediately elevate it to high priority. Everyone who works at the Help Desk is prepared and eager to do whatever is necessary to take care of our centers. We pride ourselves in how we treat the people who come to us. There are no silly questions, just challenges requiring solutions. We’ve all experienced the frustration of technology failures and shortcomings. When we can alleviate stress associated with technology and help centers devote their time to patient care rather than IT, we’ve done our job.
Contact Physicians Endoscopy to learn more about the IT support we provide our centers: endocenters.com/contact-us
TIER ➌
Development Work Help Desk directs the ticket to the appropriate team.
ANDREW LOPRESTI, who joined Physicians Endoscopy in May 2012 as a Desktop Support Technician, is the IT Support Manager. In his current position, he has shifted to a proactive role to resolve issues before they occur. He can be reached at alopresti@endocenters.com.
23 endoeconomics SUMMER 2018
endo opportunities WEST Mesa, AZ Central Arizona Medical Associates The physicians of Central Arizona Medical Associates (CAMA) are seeking a full-time gastroenterologist to join their practice. Physician can expect to step into a busy practice while replacing a retiring partner. Anticipate a short track to practice partnership and ASC ownership. Practice operates out of a single office and covers one hospital. Outpatient endoscopy is performed at a physician-owned, two-room ASC with maximum efficiency and quality of care. Enjoy sunshine and a great lifestyle in the metro Phoenix area.
Bellingham, WA NW Gastroenterology & Endoscopy Exciting opportunity to join a nine-person single-specialty GI practice in Bellingham, Washington. This progressive coastal community offers ocean and lake recreation, skiing, and miles of hiking and biking trails. Small college town atmosphere with proximity to Seattle and Vancouver, Canada. Great place to raise a family! This collegial group has a freestanding AEC and pathology lab. EUS optional, ERCP strongly preferred. Outstanding benefits package.
Northern & Central CA SecureMD GI physicians: Are you looking for flexibility and supplemental income? Our mobile endoscopy practice is seeking board-certified gastroenterologists in Northern CA (Sacramento/Stockton/Tracy) and Central CA (Fresno/Tulare/San Luis Obispo)! Flexible schedules allow you to work as many as 1-2 days per week or as few as 1-2 days per month. Position offers competitive pay.
NORTHEAST New York, NY Gastroenterology on Gramercy Park Gastroenterology on Gramercy Park, a two-physician private group, is seeking a gastroenterologist to expand the private practice. Physician can expect to step into a busy practice while replacing a retiring partner. The opportunity offers a primarily outpatient experience with a reasonable call burden. This candidate will have an ownership opportunity in the affiliated endoscopic ambulatory surgery center. This opportunity offers: • Physician-owned and controlled center • State-of-the-art endoscopic equipment • Medicare-licensed and AAAHC-accredited • Anesthesia services for patient comfort • Physician efficiency and optimal patient quality of care • First-year salary guarantee • Retirement benefits • Desirable location in downtown Manhattan
North Bergen, NJ Advanced Center for Endoscopy Advanced Center for Endoscopy (ACE) has an immediate opportunity available for GI physicians looking for an outstanding ASC in which to perform procedures. Our single-specialty, nine-physician GI center is the perfect environment for you and your patients. Our center can help drive additional patient volume to you through the ASC, allowing you to increase your procedure volume in the environment that is more convenient. Our center can provide your patients a better outcome, and you will have satisfied and loyal patients. ACE is ideally located in North Bergen along the banks of the Hudson River—the “gold coast” of Northern NJ—with a spectacular view of the NYC skyline. This is an excellent opportunity for a motivated physician.
MIDWEST Lima, OH Gastro-Intestinal Associates, Inc. The physicians of Gastro-Intestinal Associates are seeking a BE/BC gastroenterologist to join our six-physician, four-CNP single-specialty practice. Established in 1977, the practice has an outstanding reputation with the local Lima community. This is an opportunity to join a GI physician-owned, 18,000-square-foot combined office and threeroom endoscopy center. The center, built in 2008, is AAAHC- and ASGE-certified. In the area are two local hospitals with state-of-theart facilities.
24 endoeconomics SUMMER 2018
This opportunity offers: • 1:7 call rotation • First-year salary guarantee • Outstanding earning potential • Professionally operated and managed
Rochester Hills, MI Troy Gastroenterology The Center for Digestive Health (Troy Gastroenterology) is a wellestablished, highly respected private practice looking for two
Submit your CV online at endocenters.com/recruiting
Lumberton, NJ Gastroenterology Consultants of South Jersey Gastroenterology Consultants of South Jersey is a privately owned, seven-physician practice located in Lumberton, New Jersey. We are a well-established practice of 25 years located among several growing communities in Southern New Jersey. • Located within 30 minutes of Philadelphia and within one hour of New York City • Affiliated with Burlington County Endoscopy Center, a three-room ASC that is physician-owned and operated • We are seeking to add a full- or part-time gastroenterologist • We offer a 1:7 call schedule and an opportunity to perform ERCP/ EUS (not required) • Partnership will be offered in both the practice and ASC
Central NJ Garden State Digestive Disease Specialists, LLC Garden State Digestive Disease Specialists, LLC, is seeking a fulltime BC/BE gastroenterologist to join our three-physician practice in Central Jersey. The job offers an excellent salary, competitive benefits package, a reasonable call schedule (which includes other gastroenterology colleagues in the rotation), and an opportunity for full partnership track in 2-3 years. EUS/ERCP training is preferred. We serve culturally rich and diverse communities; our patients reside primarily in the Union and Middlesex counties of Central Jersey. Our center is a state-of-the-art endo center. We are affiliated with four local hospitals, two of which are teaching hospitals with residency programs. We are in the NYC metropolitan area, 45 minutes from Manhattan, conveniently located near an international airport, and in close proximity to many cultural centers and the Jersey Shore.
gastroenterologists to join our growing practice. We have several offices across Metro Detroit with two state-of-the-art, AAAHCaccredited ambulatory surgery centers. We’re looking for an enthusiastic physician skilled in general endoscopy and ERCP. • Competitive base salary with productivity incentive • Incentive bonus • Retirement plan • Discretionary allowance • Eligibility for member status after two years • Insurance (malpractice, health, dental, vision, life, supplemental & dependent life, short & long-term disability)
SOUTH Gastonia, NC Carolina Digestive Diseases Four established gastroenterologists in central North Carolina are seeking a BE/BC gastroenterologist to join our physicians to expand the coverage in our community of Gastonia, North Carolina. The physician candidate can expect to step into a busy practice while replacing a retiring partner. Anticipate a short track to practice partnership and ASC ownership. Practice currently operates out of a single office and covers one hospital. Outpatient endoscopy is performed at a two-room ASC with maximum efficiency and quality of care. Located two hours from the Smoky Mountains and four hours from the Atlantic beaches. Enjoy sunshine and a great lifestyle in the metro Charlotte area.
GASTRO MANAGEMENT SERVICES Focus on clinical care, not administrative duties.
Revenue Cycle Finance Operations Leadership Human Resources Information Technology
TO LEARN MORE: info@pegastro.com
Y
PRSRT STD US POSTAGE
PAID
2500 York Road, Suite 300 Jamison, PA 18929
PERMIT NO 29 MADISON WI
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