Although small medical practices can adapt to change, it is not certain that small practices will survive. The regulatory burden is becoming more expensive, and the reimbursement is decreasing. Reduction in upper endoscopy codes in 2014 is one example of decreased revenue. Most new graduates of GI training programs are looking at hired positions in hospital programs or in large groups. As physician-owners retire, small practices will close or merge into larger groups, depriving patients of a practice style predicated on the personal relationship with the physician, an approach that cannot always be provided by large groups or multispecialty practices.
Take-away points
1. The small practice can adapt and implement mandates for meaningful use. Whether Stage 2 Meaningful Use improves the quality of care that we provide is an arguable assumption. The cost of implementation of Meaningful Use Stage 2 may exceed the penalty for not meeting this goal.
2. ICD-10 coding does not represent a major logistical problem for gastroenterology practices. For most practices, the number of diagnostic codes is limited. The AGA ICD-10 resource is a good starting point for frequently used codes. Published materials and websites should represent an inexpensive option to supplement the AGA information. 3. Reductions in reimbursement represent an existential threat to the small practice. The loss of this style of practice may create access issues for the delivery of GI services in many communities.
References
1. Allen, J.L. The road ahead. Clin Gastroenterol Hepatol. 2012;10:692-696.
2. Sheen, E., Dorn, S.D., Brill, J.V. et al. Health care reform and the road ahead for gastroenterology. Clin. Gastroenterol. Hepatol. 2012;10:1062-65.
3. Allen, J.L. Health care reform 3.0: the road gets bumpy. Clin. Gastroenterol. Hepatol. 2013;11:1527-1528.
4. Kosinski, L. How does a gastroenterologist demonstrate value? Clin Gastroenterol Hepatol. 2014;12:1584-1586.
5. Brill, J.V., Jain, R., Margolis, P.S., et al. A bundled payment framework for colonoscopy performed for colorectal cancer screening or surveillance. Gastroenterology 2014;146:849-853.
6. Kane, S. Establishing an inflammatory bowel disease practice in an accountable world. Clin Gastroenterol Hepatol. 2012;10:1301-1304.
7. Available: www.aspe.hhs.gov/health/report/2014/marketplaceenrollment/April2014/pdf/MI.pdf.
Dr. Fogel is with the Digestive Health Center of Michigan, Chesterfield Township. The author disclosed no conflicts.
