Ancillary Services: Enhancing Revenue and Patient...
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2/14/2018 1 1 Reed B. Hogan, II M.D. www.gi.md [email protected] Ancillary Services: Enhancing Revenue and Patient Care Surviving the Perfect Storm 2 • VISION – GIA to be the leader for GI care in Mississippi. • FOCUS/OBJECTIVE – Maintain independence – one umbrella of services – Comprehensive care model of consolidated services & ancillaries. – Enhance best practices, protect income, market share, and to expand boundaries as the market drives expansion. – Maximize size and depth of services – Proactively position GIA to capitalize on opportunities / changes in the market. 2018
Transcript of Ancillary Services: Enhancing Revenue and Patient...
2/14/2018
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Reed B. Hogan, II M.D. [email protected]
Ancillary Services:Enhancing Revenue and Patient Care
Surviving the Perfect Storm
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• VISION– GIA to be the leader for GI care in Mississippi.
• FOCUS/OBJECTIVE– Maintain independence – one umbrella of services– Comprehensive care model of consolidated services &ancillaries.
– Enhance best practices, protect income, market share, andto expand boundaries as the market drives expansion.
– Maximize size and depth of services– Proactively position GIA to capitalize on opportunities /changes in the market.
2018
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31 MDs3 Pediatric GI3 Pathologists 8 Nurse practitioners 13 CRNAs (6 full time)
363 Employees3 AECs 32,000 cases / yr Independent Practice
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Pick up prep here
Get Endo here !!
No Here !!
here for infusion !!
We valet park
Come across townFor your CT and US
Best Doctors!This
location
Transform fragmented SILOs into……
CHANGE THE PARADIGM
… Convenient, efficient, cost effectiveCONNECTED EXPERIENCE
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31 MDs3 Pediatric GI3 Pathologists 8 Nurse practitioners 13 CRNAs (6 full time)
363 Employees3 AECs 32,000 cases / yr Independent Practice
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2018
• Where are we now…
– 3 AECs (Flowood, Madison, & Vicksburg)
– 8 Travel Locations (Magee, Hazlehurst, Carthage, Forest, Morton, Yazoo City, Kosciusko, Tupelo
– 31 physicians
– 32,643 endoscopy procedures on 27,544 patients
– 32,112 clinic visits.
– 363 total staff
– Gross Revenues of $75,126,900 21% growth /1 yr
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A Perfect Storm
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GI Website PresenceGI Website Presence
Go Viral
Ancillary Services
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• Endoscopy Center• Sedation• Pathology• Dietary / Weight Loss• Sponsored Research• Rx / Tx Development• Diagnostics• Scrub Shop
Ancillary Services
• In House Pharmacy• Radiology / CT / US• Infusion• Clinical Blood Lab• HyGieacare• Specialty Service Lines• Reference Labs• Medical Linen Services
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Always asking the question: when can we add Ancillary Services to help us grow, even in the middle of the storm?
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Change your mindset
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Endoscopy Center
• Alignment• Advantage• Assessment• Accountability• Achievement
Value $ $ $
Endoscopy CenterCases Cases Cases per
Year Rooms MDs Per Per Room
Month Year Per Year
1999 4 10 750 9,027 2,256
2004 5 11 1,472 17,660 3,532
2005 7 13 1,671 20,952 2,993
2006 7 13 1,846 22,155 3,165
2007** 6 15 1,556 22,448 3,206
2010 6 17 1,418 17,021 2,836
2011 6 17 1,427 17,131 2,855
3000 cases / room / year18
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Endoscopy Center
3000 cases / room / year
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The Efficiency TriangleLabor intensive 16+ employee contacts per patient
InitiateSedation
Procedure
DictationForm
completion
Pre-opEval
One roomOne MD
PatientFrom Pre‐op
Patient in recovery
New patient in room3‐5 Minutes
Dictation complete
Scope in – scope outEGD 5‐10 minColon 10‐20 min
Discharge Patient !!!!
MD evaluationPatient ready to sedate
5‐10 minEvaluation and
discharge
Proprofol
THE PATIENT DICTATES THE FLOW
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Revenue AugmentationThrough Ancillary Services
Endoscopy Center
Take Home Message:
Study processesMaximize efficiencyFill the rooms, all dayDo not overbuild
Expect physician pushback
3000 cases / room / year
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AncillaryServices
Pathology
Ancillary Services
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• Alignment• Advantage• Assessment• Accountability• Achievement
Value $ $ $ $
Pathology
Revenue AugmentationThrough Ancillary Services
GI Practice
Tissue
Acquisition
GI Lab
Technical
( TC)
GI Lab
Diagnosis
( PC )
GI Lab
Signs out
report
Physician – Owned Model
Great for larger practices, 4‐6,000 specimens per year.Stark law Anti‐markup Rule restrictions applyLab may be in separate building if leased full time.
Pathology ServicesPathology
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Pathology
GIA PathologyAncillary Dashboard 2016 Estimate 2017 2017 2017
Annual % of Jan‐June Annualized Projected
Actual Revenue Actual Estimate Increase
Revenue $ 3,494,707 100% $ 1,716,850 $ 3,433,700
Salaries & Benefits $ 464,945 13% $ 236,962 $ 473,924
Clinical Expenses 1,144,442 33% 414,309 828,619 13%
$ 1,609,387 46% $ 651,271 $ 1,302,543
Net income (loss) $ 1,885,319 53% $ 1,065,579 $ 2,131,157 $245,838
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• Alignment• Advantage• Assessment• Accountability• Achievement
Value $ $ $
Sedation
Revenue AugmentationThrough Ancillary Services
The Sedation CompanyHelp you provide optimal care
for your patient.Rapid turnoverTake care of schedulingHiring and Firing
Joint venture if you would likea piece of the action.
Sedation ServicesSedation
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Revenue AugmentationThrough Ancillary Services
GI Physician
Performs
Procedure
Sedation CompanyContractsSedation
Both Providers
Bill &Collect fees
Sedation Company Model
Company’s Anesthesia
ProviderSedates
Sedation
JOINT VENTURE
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Infusion
Ancillary Services
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Infusion
2 Chairs 3 Chairs
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IBD “Center of Excellence”
Infusion
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AncillaryServices
Ancillary Services Ancillary
Services
Dietary / Weight Loss
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• Alignment• Advantage• Assessment• Accountability• Achievement
Value $
Dietary / Weight Loss
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AncillaryServicesAncill
ary Services
Diagnostic CenterSmart pill, Pill Cam, Bravo, Motility, Fibroscan
Ancillary Services
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• Alignment• Advantage• Assessment• Accountability• Achievement
Value $
Diagnostic CenterSmart pill, Pill Cam, Bravo, Motility, Fibroscan
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Diagnostic CenterSmart pill, Pill Cam, Bravo, Motility, Fibroscan
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• Alignment• Advantage• Assessment• Accountability• Achievement
Value $ $
Radiology / CT / US
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Radiology / CT / US
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Radiology / CT / US
ACTION STEPS 2018:2ND CT tech 12 ‐> 20 cases/d
Staff Education – cost and convienence
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• Alignment• Advantage• Assessment• Accountability• Achievement
Value $ $
Sponsored Research
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In Office Pharmaceutical Dispensing
• Alignment• Advantage• Assessment• Accountability• Achievement
Value $ $
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In Office Pharmaceutical Dispensing
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In Office Pharmaceutical Dispensing
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• Alignment• Advantage• Assessment• Accountability• Achievement
Value $ $ $ $ $
Pharmaceutical and Device Development
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• Alignment• Advantage• Assessment• Accountability• Achievement
Value $ $
Clinical Blood Lab
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Revenue AugmentationThrough Ancillary Services
Clinical Blood Lab
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Clinical Blood Lab
ACTION STEPS 2018:For send out tests: patient billing
New studies: stool analysis
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In Office Pharmaceutical Dispensing
• Alignment• Advantage• Assessment• Accountability• Achievement
Value $ $
HyGIeaCare
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In Office Pharmaceutical Dispensing
• Alignment• Advantage• Assessment• Accountability• Achievement
Value $ $
HyGIeaCare
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Medical Linen Services
• Alignment• Advantage• Assessment• Accountability• Achievement
Value $
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Scrub / Accessory Retail
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• Alignment• Advantage• Assessment• Accountability• Achievement
$ Value $ $ $ $ $
Complex Medical Reference Lab
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Complex Medical Reference Lab
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TelemedicineNASH / Fatty liverHome Clinic SettingNational Registry
Commercial Research
The “Nash” Project
Ancillary Services
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Revenue AugmentationThrough Ancillary Services
10,500 13,100
37,60035,600
2,000
3,900
9,4008,900
50,000
45,000
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
2016 2017 2018 2019
• Among patients who biopsied, there is a 5:1 screening vs. trial inclusion ratio, requiring large patient pools to support the current & upcoming PH3 NASH trials.
• Over the 2016-2020, ~ 130,000 NASH patients will need to be biopsied in order to support Phase 3 trial accruals.
• Additional screening will be needed to support compounds in Phase 2 programs (over 23 active trials)
• NASH PH3 Trial Accruals• (based on patients who receivebiopsies)
Pts. Excluded Pts. Entering trials Cumulatie Pts in trials
12.5K screened17K screened
47K screened44.5K screened
12.5K screened
47K screened44.5K screened
The “Nash” Project
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Nash Project
What Our Program Is: Health management Lifestyle coaching Progress monitoring Patient education Motivation Accountability Complimentary to the
services of the physician Pathway to engage with
NAFLD remotely Prelude to a more traditional
telehealth platform
What Our Program Is NOT: Complex clinical protocols Replacing the role of the
nurse or physician “Medical treatment” in the
traditional sense
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Expensive, outside our box.Stakeholders would rather own restaurant.
Complex Medical Reference Lab
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Expensive, outside our box.Stakeholders would rather own restaurant.
Complex Medical Reference LabQuestions ?Questions ?
An Experiment
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