Today's SurgiCenter - The Freestanding Endoscopy Center Boom

The Freestanding Endoscopy Center Boom

By John Roark

Industry estimates show 300 to 400 single-specialty endoscopy centers in the United States, as well as a fair number of ASCs that are doing endoscopy, says Barry Tanner, president and CEO of Physicians Endoscopy. “Physician procedure professional fee reimbursement is down about 60 percent in the last decade,” he says. “The continuous pressure being put on GI in particular is probably causing even those physicians who have yet to get into an endoscopy center to consider it — they’ve got to figure out how to replace their income somewhere. We’re seeing as much interest if not more than ever in development of endoscopy centers.”

Increased demand for freestanding endoscopy has been fueled by an aging population coupled with an increased awareness of endoscopy, colonoscopy and colon cancer.

“There is presently, on average, a six-month wait to have a colonoscopy, and it is only going to get worse,” says Randy Jones, president of Clinical Solutions, LLC. “The baby boomer population continues to age. The relative number of physicians with a specialization in GI is not growing, which means that processing capacity is not growing. Therefore, the output of trained gastroenterologists is not increasing sufficiently to keep up with the escalation and evolvement of baby boomers into the age brackets that have greater needs for endoscopy and esophagogastroduodenoscopy (EGD) procedures and services. Therefore, demand is projected to increase without an equivalent increase in processing capacity. Without increases in capacity and without a true pharmaceutical solution to all forms of GI related cancers, movement out of hospitals and into ASCs — where there is greater efficiency and quality control — may be the only realistic way to increase processing capacity sufficient to meet the growing public need, though even these kinds of improvements will likely not be able to meet the burgeoning demand.”

“All of the practices that I’m familiar with are inundated with work and trying to recruit more physicians,” says Tanner. “Certainly, one of the big recruiting attractions for a physician is having your own endoscopy center. It’s always ‘work hard or work smart.’ I won’t say this is true 100 percent of the time, but clearly the physicians who have their own ambulatory surgery centers are finding that they can be much more efficient because they’ve got fixed block times. They’re not getting bumped, the staff is under their control, and the time that it takes them to get procedures done is, generally speaking, half what it is in a hospital environment. Patient satisfaction is significantly higher. All of those things are contributing to the GI physicians almost needing to have their own place to work.”

Jones senses that the physician demand to participate in the ASC environment is holding strong and is rising, and cites three motivating factors for physician interest. “Physician income continues to be squeezed downward year after year, and they are looking for relatively safe ways to increase their income by investing in a growth industry they know well — the medical industry — and it is an investment in themselves through the ownership and operation of their own ASC,” says Jones. “As the baby boomers continue to age, demand for specialized physician services continues to grow at extremely rapid rates. For many physicians, investing in their own ASC is the clearest, least risky way to invest in the high-growth medical industry. They tend to feel they have more control over this type of investment than other typical investment opportunities that come to their attention, as long as the physicians retain majority ownership and control. There is still plenty of upside in medical, and especially ASC ownership, as compared to other investments that physicians make outside the medical industry.”

Second, says Jones, physicians are almost uniformly looking for ways to control their daily schedules and have more personal time, work the same hours, be more efficient, reduce idle waiting times and see more patients. “Again, ownership and control of their own ASC allows physicians to achieve these goals by managing scheduled surgery times and suite turnaround times much better,” he says. “In addition, the opportunity to reduce travel time between office and hospital surgery suite by having their office in the same building as the ASC is also inviting, and increases efficiency and availability of personal time.”

Third, continues Jones, physicians see ownership and control of their own ASC as a way to overcome much of the apathy that they face from some hospital administrations with respect to customer service and accessibility issues. “Again, control of the ASC means they can have greater control and influence over the level of customer service they can give their patients. Some of this again is also influenced by better control over their schedule, meaning patients will receive their services on a timelier basis.”

Just as there is significant patient benefit in a multi-service ASC, specialty centers provide an even greater advantage. “Just like anything else, if you do something consistently, over and over again, you get better at it,” says Tanner.

“In the freestanding specialty centers, you don’t have a clinical staff that’s doing ENT one day, orthopedic surgery the next day, and colonoscopy the next. These people are doing endoscopy all day every day, and therefore the overall quality of care is just going to be better and more efficient.”