GI A publication dedicated to advancing GI practices and ASCs
Migration Patterns | pg. 6
Technology and the GI Industry | pg. 2 Embracing Innovation | pg. 9 Tech Trends Affecting GI in 2022 | pg. 10
JUNE 2022
Letter | Message From the President |
Technology and the GI Industry A conversation with PE GI Solutions Market Presidents
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ecently PE GI Solutions President and CEO David Young sat down with Market Presidents Annie Sariego, Tracy Belsan and Cara Reymann to discuss the current state of technology in the industry and new advancements being adapted by physicians. Read their insight on the current technology landscape below.
David Young (DY): How has social media grown within the industry? Are physicians more willing to utilize it as a business tool? Annie Sariego (AS): Personally, I think it’s evolving. Physicians need our support and assistance, and we can help them get where they want to go regarding social media, among other things. In discussions I’ve had they are especially interested in using it for patient reviews. If you have a young millennial looking for a physician, they are going to do their research, and the physicians want to ensure they can manage their digital reputations on social media platforms.
thought about the impact of their online reputation, but now they are understanding that because people are home, that is the primary way to communicate and provide feedback. I think we’re certainly going to continue to see an uptick. Cara Reymann (CR): In Virginia and Maryland there is a very large practice that includes 22 offices and 134 physicians and advanced practitioners, and we have a very heavy social media presence with them since it is a unique aspect of that market. We’ve been assisting them with support for their practice marketing program and have seen that social media has been a great way to engage with the patients. We’re seeing more than 650 engagements per month on Facebook alone, so it has been very successful.
DY: What do you see as the future of telehealth post-pandemic? Will it continue to play a role in healthcare? AS: I believe the future of telehealth lies in reimbursement. It’s going to depend on how payors want to approach that in the current situation. It’s also going to be a competitive edge. If you’re in an urban and densely populated market like New York, you’ll find specific niches where it will stay due to convenience. Overall, it’s going to be practice dependent.
Tracy Belsan (TB): I believe social media has been very successful for physicians and it will be really important in the future. Physicians are interested in reputation management, search engine optimization (SEO) and what they can do for their business. I agree with Annie that patient reviews have become a big factor. Not TB: From what I’ve seen, even five years ago some David Young, President & CEO, telehealth has really trended PE GI Solutions physicians would have never downward. I don’t know of
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GI Editorial Staff Suzette Sison Editor in Chief ssison@pegisolutions.com Kelly McCormick Digital/Managing Editor kmccormick@pegisolutions.com Contributing Writers: Lynn Hetzler, Jake Keator, Robert Kurtz and Rachael Samonski
Publishing services are provided by GLC, part of SPM group, 9911 Woods Drive, Skokie, IL 60077, (847) 205–3000, glcdelivers.com. PE GI Journal™, a free publication, is published by PE GI Solutions, 2500 York Road, Suite 300, Jamison, PA 18929. The views expressed in this publication are not necessarily those of PE GI Solutions, PE GI Journal or the editorial staff. POSTMASTER: Send address changes to: PE GI Solutions, Attn: PE GI Journal, 2500 York Road, Suite 300, Jamison, PA 18929. While every effort has been made to ensure the accuracy of PE GI Journal 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 © 2022 by PE GI Solutions. All rights reserved. All copyright for material appearing in PE GI Journal belongs to PE GI Solutions, and/or the individual contributor/clients, and may not be reproduced without the written consent of PE GI Solutions. Reproduction in whole or in part of the contents without expressed 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@pegisolutions.com.
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Meet the PE Market Presidents
“If you have a young millennial looking for a physician, they are going to do their research, and the physicians want to ensure they can manage their digital reputations on social media platforms.” — Annie Sariego
many locations that are still using it. Telehealth has been around for a while, and COVID-19 really forced us into that modality. I see it being used very often in primary care, but not as much by GI physicians. I don’t believe we should discount it entirely, in case we were to have another severe wave of COVID appear in the future.
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CR: I think we will continue to see the percentage of telehealth visits go up. Like Annie said, I think that some areas will keep it around simply for the convenience for physicians and patients.
DY: What kind of new technology or techniques are you seeing come into practices and centers? AS: I’ve seen more practices and centers focusing on patient experiences. In a similar relationship to online reviews, new physicians and staff are being shown patient survey sheets and trained on how to specifically meet those expectations. It’s improving the quality of care and how patients view their visit. TB: We’re seeing an increased emphasis on cybersecurity technology. Cybersecurity is a highly regulated area of healthcare, as it should be. It’s important to work with centers and practices annually to ensure the security of their systems meets required guidelines. Our physicians care about the safety of patient information.
Ann “Annie” Sariego, RN, BS, CASC, is Market President at PE GI Solutions, overseeing business and clinical operations for PE GI Solutions’ New York and New Jersey Centers. Annie joined PE in 2011 and has over 30 years of healthcare industry experience focused in the hospital and outpatient surgery center setting. She has a strong background in business and clinical operations in the ambulatory surgery center (ASC) arena, including ASC/hospital joint ventures, with extensive knowledge of state, federal and accrediting agency regulatory and compliance standards. Tracy Belsan has over 30 years of healthcare experience in hospital operations, ambulatory operations and graduate medical education. Prior to her role with PE GI Solutions, Tracy served as Chief Operating Officer and Designated Institutional Officer for Dignity Health in the California market. Prior to Dignity Health, Tracy served as Senior Vice President of Operations for Privia Health in Arlington, Virginia. In her role at Privia Health, she also served as the advocacy executive and collaborated with the AMA and AMGA on healthcare policy issues. She is also on the Board of Directors for the AMGA Voice, which focuses on advocacy and advancing healthcare issues in Congress. Market President for the Mid-Atlantic region, Cara Reymann brings more than 20 years of progressive leadership expertise to the team at PE GI Solutions. In her role, she ensures that PE GI Solutions’ partnering physicians are supported in their practices and endoscopy centers and across their ancillary service lines such as laboratory and infusion therapy. Prior to joining PE GI Solutions, Cara was a member of the executive team at Capital Digestive Care, originating the departments of marketing and practice operations after the company’s founding in 2009. Cara has focused her career on healthcare, helping physicians and their practices navigate change, improve processes and adopt new technologies.
CR: Some locations are trialing new AI technology for specific procedures. I believe that it can really improve the quality of care for patients. There is also new technology that can assist in the administration of infusion patients. We should all be excited about the potential of both items and how they can impact patient care.
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Noteworthy | News and events | Partnering for Improved Safety Garden State Endoscopy & Robert Wood Johnson Barnabas announce joint venture partnership PE GI Solutions and Garden State Endoscopy (GSE) officially announced their joint venture partnership with Robert Wood Johnson Barnabas (RWJB) in the beginning of 2022. RWJB is the largest healthcare system in New Jersey. In 2015, PE GI Solutions entered into a strategic partnership with GSE, which is accredited by the Accreditation Association for Ambulatory Health Care, Inc. and located in Mountainside, New Jersey. This new strategic partnership between PE GI Solutions, GSE and RWJB will allow all parties to scale growth planning activities that support the endoscopy center in providing a safe and efficient environment for all patients.
Open for Business PE GI Solutions and Emerson Hospital create strategic partnership PE GI Solutions recently entered a strategic partnership with Emerson Hospital in Concord, Massachusetts, to open Emerson Endoscopy & Digestive Health Center. The facility is equipped with cutting-edge equipment and is the only hospital-owned outpatient endoscopy center in the region. Emerson Hospital entered into the strategic partnership with PE GI Solutions to leverage and utilize their management services. The PE Center Solutions platform offers several opportunities for GI physicians, health systems and hospitals to build, develop and optimize a new or existing GI-specific ASC.
Capital Digestive Care and Gastroenterology, Ltd. partner to leverage PE’s platform PE GI Solution’s strategic partner Capital Digestive Care recently announced a signed transaction with Gastroenterology, Ltd. of Virginia Beach, Virginia, a premier gastroenterology practice in Southeastern Virginia. Capital Digestive Care is the largest private gastroenterology practice in the Mid-Atlantic Region. With this transaction, two new locations are being added, along with an advanced endoscopy center and 15 board-certified providers in Southeastern Virginia. A key factor of this partnership agreement with Gastroenterology, Ltd. of Virginia Beach is the value of leveraging PE Practice Solutions—this platform streamlines operations and enhances revenue streams.
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Congratulations Dr. Brett Bernstein! Dr. Bernstein takes on a new role Dr. Brett Bernstein recently accepted the position of Medical Director of GI Services for the Mount Sinai Health System in New York. Dr. Bernstein is one of the original founding members of The Endoscopy Center of New York and has been Medical Director since 2009. PE GI Solutions congratulates Dr. Bernstein on his new role!
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Insights | Clinical updates |
Migration
Trends in accelerating outpatient migration hospital leaders should know
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Highlighting Current Trends
Lambiasi identifies the following as some of the most significant and more recent outpatient surgical trends and developments. Price transparency laws and penalties. Many hospitals have yet to comply with hospital price transparency requirements. PatientRightsAdvocate.org assessed 1,000 accredited hospitals and found that just slightly more than 14% were complying with the transparency rule, according to a February 2022 report. This figure is likely to increase in the coming years, in part because Centers for Medicare & Medicaid Services (CMS) penalties for noncompliance with requirements have increased. The penalty for a full year of noncompliance currently ranges from $109,500 to about $2 million. “As more prices are published, those consumers interested in shopping for their care and understanding where their copay or deductible may be lower will have more information upon which
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or many years, there has been a steady migration of cases and procedures out of the hospital environment and into outpatient facilities like GI centers and other ambulatory surgery centers (ASCs). Contributing factors have included the development of more advanced clinical technology, improved anesthetics and physicians becoming more comfortable with minimally invasive approaches to care. But over the past few years, there have been several developments that have accelerated and are likely to further hasten this migration, says Ralph Lambiasi, Vice President of Partnership Development for PE GI Solutions. “Hospital and health system leaders—particularly those tasked with overseeing their organization’s outpatient strategy—need to understand these trends so they can better assess the impact on their strategy and formulate a plan to remain competitive in the outpatient space,” he explains.
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Patterns the USPSTF recommendations. “This new case volume will to base their site-of-service decision,” Lambiasi says. “This plays largely go to surgery centers,” Lambiasi says. “If hospitals to one of the core strengths of ASCs: lower costs.” want to see these patients within their service lines, it’s time The “No Surprises Act,” which took effect in 2022, may to start thinking about an ASC strategy.” further spur consumerism, he adds. Commercial payor preference. The pandemic has motiFederal initiatives. When looking at some of the major vated commercial payors to consider and adopt site-of-service federal developments of the past decade, Lambiasi is reminded policies that are more aggressively pushing patients out of of Steven Brill’s Time magazine article, “Bitter Pill: Why Medithe inpatient setting. “Payors are requesting more documencal Bills Are Killing Us.” tation from hospitals to authorize procedures and prove that “Consider recent efforts to push consumerism, such as accountable care organizations, various Affordable Care Act the hospital is an appropriate site of care,” Lambiasi says. “It’s becoming much more difficult for hospitals to receive approval initiatives, the exchanges and transparency laws,” he says. for something like a screening endoscopy for a younger, health- “I think CMS and the federal government are trying to avoid more sticker shock to patients.” ier patient. These cases are going to ASCs.” Lambiasi believes there will be more In 2021, the U.S. Preventive Ser“If hospitals want to see similar initiatives down the road. “We vices Task Force (USPSTF) issued new already have site neutrality for some recommendations for colorectal cancer [patients under age 50] surgical procedures where the hospital and stating that people at average risk should within their service lines, ASC are paid the same rate. Are screening start screening at age 45 instead of the endoscopies or other elective GI cases ripe traditional 50. The Affordable Care Act it’s time to start thinking for site neutrality? If a development like requires most insurers to cover the costs about an ASC strategy. ” this occurs and you’re a hospital lacking of colorectal cancer screening tests as per
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Insights | Clinical updates |
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Compliance
14% of hospitals comply with the ACA transparency rule. The penalty for noncompliance ranges from $109,500 to $2 million.
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private groups, Lambiasi says. “The MSO could be a ‘double whammy’ for the hospitals. They would lose the opportunity to employ the physician looking to leave private practice and would most likely lose case volume to the competing ASC that the MSO-sponsored entity owns or would build.”
Despite Challenges, ASC Opportunities Exist for Hospitals The rapidly-evolving surgical landscape makes it clear: Hospitals and health systems need a strong outpatient portfolio; one that includes ASCs and physician partnerships. “Inpatient-to-outpatient surgical migration shows no signs of slowing down, and with an aging population, the demand for surgery is rising,” Lambiasi says. “Without such a portfolio, a hospital will likely struggle to retain surgical volume and miss out on what’s becoming an even more significant piece of healthcare.” Hospitals uncertain how to best proceed with establishing or growing an ASC portfolio are increasingly looking to experts to help them make intelligent development decisions and facilitate the partnerships with physicians needed for outpatient surgery success. “At PE GI Solutions, we’re engaging in more discussions and entering into more partnerships with hospitals and health systems,” Lambiasi says. “We’re “We’re helping these helping these organizaorganizations overcome tions overcome their pain points and solve the multi- their pain points and tude of challenges they’re solve the multitude of facing today and likely to face in the coming years.” challenges they’re facing Lambiasi expects such today and likely to face collaboration with hospitals to become a more in the coming years.” substantial part of the PE GI Solutions business going forward. Among the ways the company is collaborating with hospitals and health systems: strengthening engagement and relationship with GI physicians and identifying opportunities to add ASCs to their portfolio, whether through HOPD-to-ASC conversions, joint ventures with physicians or building de novo facilities. These initiatives support the creation of endocenters, the cornerstones for gastroenterology service line integration and growth, and Ralph Lambiasi the development of longis Vice President of Partnership term plans to account for the Development continued outmigration of at PE GI care. “We are bringing hospiSolutions. He tals our years of experience can be reached and expertise in the ASC and at rlambiasi@ pegisolutions.com. GI space,” Lambiasi says.
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an ASC strategy, expect to experience difficult financial and operational ramifications.” Additional COVID-19 effects. The pandemic is likely to encourage more migration of care to ASCs—and not just because of commercial payor efforts. During periods of high COVID hospitalizations, hospitals were focused on caring for these patients and providing more emergency and urgent care, which naturally led to non-urgent patient volume going to outpatient settings. It will be difficult for hospitals to slow this momentum. In addition, hospitals have become less appealing sites for care for patients, Lambiasi says. “Whether right or wrong, that’s going to be the perspective and bias of many patients who now associate hospitals with people sick with COVID— especially with the uncertainty around future waves.” Then, there are the financial and personnel effects of COVID, which are being felt in every industry, including healthcare. “Perhaps before the pandemic, hospitals may have had the capital and staffing levels to consider ways to expand their outpatient portfolio and try to capture some of the surgical volume making its way to ASCs,” Lambiasi says. “That may no longer be the case, with hospital efforts more focused on returning to pre-pandemic levels of operation and accepting that some surgical cases, especially lower-acuity procedures, are not a priority with respect to new capital initiatives.” That doesn’t mean hospitals should abandon their pre-pandemic outpatient strategy, he says. Rather, they may need to consider different approaches that will help them achieve their goals. Physician alignment with management services organization (MSO) rollup groups. A rapidly growing trend that could siphon more surgical cases out of hospital operating rooms is physicians deciding to sell to and/or align their practices with MSO rollup groups. Such groups have become the top alternative to hospital employment in the eyes of many
| Business strategy and the bottom line |
Strategies
Embracing Innovation
10 digital initiatives for your practice or center
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igital innovations in the healthcare industry continue to rapidly expand, creating new avenues for improved patient care and efficiencies and better patient experiences. GI practices are well-positioned to take advantage of these innovations. Here are 10 ways your practice or center can incorporate digital and technological initiatives:
1. Maximize your use of social media. Social media is increasingly important for reviews and reputation management, and both patients and physicians are using the technology regularly. 2. Use chatbots on your website. Chatbots provide access to “on-demand” healthcare, a common expectation of today’s patients.
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3. Organize your data for higher quality care. Taking a look at how you organize your practice’s data can pay dividends: It lowers the risk of medication errors, improves preventive care and makes staffing decisions clearer. 4. Be open to artificial intelligence (AI). AI is becoming increasingly integrated into GI processes and technology. Be open to researching AI tech and making it a part of your practice or center. 5. Maintain and update your patient portal. As part of the “on-demand” healthcare trend, an updated and unique patient portal can drastically improve your practice or center’s reputation and patient experience.
6. Continue use of telehealth. While telehealth use is declining nationally, it remains a vital piece of patient interaction and efficiency for physicians. 7. Share your membership in GI organizations/communities. Actively share and promote your inclusion in various associations and groups via social media. This activity can help improve your reputation and boost your online identity. 8. Curate blog and video content. Hosting a blog where you create or curate relevant GI content can help promote your center or practice as a respected thought leader. Outside content should be pulled from and attributed to highly-respected GI organizations, such as Becker’s or PE GI Solutions’ PE GI Journal Blog. 9. Allow for digital navigation (DN) via cellphones. DN improves the patient experience while decreasing the rate of no-show appointments. DN allows patients to receive reminders and important information via text message or calendar reminders. 10. Provide patient feedback opportunities. Send a feedback form to patients following their visits. This can be done via text messaging or email and can help you target areas of improvement or provide recognition to staff members in well performing aspects.
For more in-depth insights into tech trends, the latest GI industry news and more, check out our blog at pegijournal.com. 9 PE GI Journal pegisolutions.com
Insights | Industry innovations | devices in Q4 of 2021. As part of this trend, many patients were on the hunt for mobile “on-demand” healthcare. Research by marketing agency DMN3 adds that 77% of consumers seeking medical information were looking to book their appointment on their phones. “In addition to the trend of providing advanced mobile healthcare management to patients, the industry is equally focused on apps to assist healthcare providers with most of their important tasks, including information and time management as well as health record maintenance and access,” explains PE GI Solutions Vice President of Information Technology John Westby. “In doing so, these mobile capabilities are significantly increasing access to pointof-care tools, which has been shown to support better clinical decision-making and improved patient outcomes. When polled, a vast majority of providers agree that mobile devices enabled better coordinated care among providers across a health system big or small.”
Pulse
The tech trends that will affect GI in 2022
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he evolution of technology has brought about numerous improvements in the way physicians care for patients. Artificial intelligence (AI), the cloud, telehealth and various other advancements have become normal in the age of ever-growing
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technological innovations. The COVID-19 pandemic expedited the need for digital systems, including telehealth services. As the country moves forward, several healthcare trends will continue to grow, while new trends will surely make their impact.
Growth in Mobile “On-Demand” Healthcare According to Statista, 54.4% of all web traffic worldwide came from mobile
Artificial Intelligence in the Exam Room To many the thought of AI conjures the idea of fully automated surgeries—that scenario is likely many years in the future. In reality, AI is already playing a large role in healthcare and patient care
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On the
“Our ultimate goal is colon cancer prevention, and [AI] is something that will help us to achieve that goal.” – Amiee Mingus in the form of online chatbots and precision medicine. PE GI Solutions’ partners are working to improve patient outcomes using AI technology in their practices and centers. Several partners are currently trialing the computer-aided polyp detection tool GI Genius, according to PE GI Solutions Vice President of Clinical Operations Amiee Mingus. “We are very much interested in technology that improves the outcome for the patient,” Mingus says. “Using systems such as AI polyp detection is a way to increase adenoma detection and, therefore, decrease the number of patients who develop colon cancer. Our ultimate goal is colon cancer prevention, and this is something that will help us to achieve that goal.” Physicians, especially those in the GI industry, could potentially see a large influx of AI devices soon. In February, Iterative Scopes
submitted its advanced AI polyp detection software SKOUT to the U.S. Food and Drug Administration (FDA) for approval. The growth in AI technology is sure to continue, and more devices and software will continue to be developed and released throughout the remainder of 2022 and beyond.
Blockchain and EHR Cloud computing, often referred to as “the cloud,” offered healthcare providers access to immense amounts of storage for digital records and other necessary information. This led to the incorporation of commonly used tools like Google Drive and Dropbox. However, physicians around the world are beginning to investigate blockchain to replace the cloud as their preferred storage
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Book Digitally 77% of consumers seeking medical information wanted to book their appointment on their phones.
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center. In short, blockchain provides a more transparent and more secure location for valuable patient data. The system is much more difficult for cybercriminals to hack and would allow physicians and patients to see exactly who has accessed specific files, as there is a clear transcript of the flow of information and data. Digital Authority Partners adds that Australia and the United Kingdom have already begun experimenting with the service for medical records, though legislation in the United States has made it difficult to begin testing blockchain for similar purposes domestically.
The Continuation of Telehealth As COVID19 continues to wane, the growing debate of the future of telehealth services as a primary means of delivering care are coming into question. “I think telehealth will be around for the foreseeable future, but I do think Medicare and commercial payers will start to restrict how it can be used,” says PE GI Solutions Vice President of Payor Contracting Sharon Hohlfield. As Hohlfield explains, payments and reimbursement have become the main topic of discussion surrounding the future of telehealth. Tanya Albert Henry, contributing news writer for the American Medical Associa-
tion, summarized the issue in two questions: • How much are payors willing to reimburse for hands-on services? • How much will the industry adopt valuebased payment? Hohlfield outlined a potential framework for how telehealth may answer these questions and evolve to match the current circumstances of the world, adding that physicians are more inclined to want to personally meet with patients. “Perhaps it will be only for follow-ups, and not for initial visits, or if a new concern is being discussed,” Hohlfield writes. “That will restrict the payment structure, as new patient visits are generally longer, so they pay higher rates. It was a savior during COVID, but I do think physicians would rather ‘see’ people whenever possible, so I don’t see them continuing to use it in high volumes.” The future of these technologies will continue to grow and be molded to match the needs and desires to today’s physicians. While major changes may not be enacted in 2022, it is possible that the foundation for implementing these, and other, advancements can be established by the time 2023 begins.
To learn more about how artificial intelligence can enhance GI services, visit pegijournal.com/ the-ai-revolution. 11 PE GI Journal pegisolutions.com
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