Innovative Care Strategies Around Colorectal Screening Benefit Practices and Patients
Procedures surrounding screening colonoscopy, including where and how they are conducted, are changing. As physicians and health care providers are increasingly responsible for ensuring value as well as quality of care, efficiencies emerge, altering workflows and systems that have been in place for years.
That is the case with colorectal cancer screening. Colonoscopy is increasingly being performed at outpatient centers as opposed to hospitals, and the once-standard pre-operative visit prior to a colonoscopy is slowly disappearing for certain patients. The latter is driven by patient satisfaction surveys that confirm patients are not fans of the pre-operative office visit. After all, it means an extra visit to a doctor’s office. Eliminating this visit for the appropriate patients also contributes to cost reduction, both in actual out-of-pocket expense as well as work time lost by patients. Also, less time seeing straightforward pre-procedure patients in the office translates into more office time to see sick patients and greater access to GI care within the Network.
Open access colorectal screenings can boost compliance
“Moving away from the pre-procedure visit, strictly for patients who are ASA 1 or 2,* has been a national trend for about 10 years,” says Tony Auteri, MD, Chief of the Division of Gastroenterology at Lehigh Valley Health Network (LVHN). His practice, Eastern Pennsylvania Gastroenterology and Liver Specialists (EPGI) has partnered with LVHN to operate the only Joint Venture Ambulatory Endoscopy Center in Lehigh County (Eastern Pennsylvania Endoscopy Center or EPEC), with a new location opening soon in Northampton County (NEC). “Open (or Direct) Access reduces the roadblocks to having a screening colonoscopy. This helps more patients comply with screening recommendations,” he says.
The open access process works like this: A patient visits his or her primary care physician (PCP) for a routine visit. The doctor notes that the patient is in good health and is due for a screening colonoscopy. The doctor faxes the H&P to EPGI, where the patient’s information is reviewed to be certain he or she is appropriate for open access. If confirmed as eligible, EPGI calls the patient, provides the pre-operative preparation instructions and schedules the screening at the JV ambulatory endoscopy center. “We streamline the workload of the PCP related to information review, scheduling, and prep,” says Dr. Auteri.
Outpatient procedures in a freestanding endoscopy center can save money
Continuing the cost perspective, moving the colorectal screening itself away from the hospital to an ambulatory center such as EPEC or NEC, also offer efficiencies. “Screenings completed at the Hospital Outpatient Department (HOPD) are much more expensive,” says Dr. Auteri. Screening colonoscopy in the HOPD costs payers roughly three times the cost of the same exact procedure at EPEC. While that extra expense may be justified for patients with multiple medical problems who are at high risk and require a higher level of care, payers have begun to penalize networks and providers that indiscriminately make these expensive choices by “tiering” them out of their insurance products. Payers are also discouraging patients from utilizing networks and providers that are less cost-efficient by charging those patients a higher co-pay for those encounters. Furthermore, “at-risk” global contracts will require that providers choose more cost-efficient care alternatives.
Regarding access, if healthy patients are going to the hospital for colorectal screenings, they fill the hospital’s GI Lab procedure schedule and make it harder for sicker outpatients as well as inpatients to have more timely GI procedures at that location. “With these new alternatives, we’re redirecting resources to the most appropriate use,” says Dr. Auteri.
These factors have prompted Dr. Auteri and others to visit Lehigh Valley physician practices and speak to physicians about the advantages of both open (direct) access colorectal screening colonoscopy, and of utilizing the freestanding JV ambulatory endoscopy centers. More and more are understanding the value of the new workflows and updated operational path.
“We are sharing the advantages of both the open access model and to moving colorectal screenings away from the hospital,” says Dr. Auteri. “At EPGI, we have been doing multiple open access screenings every day for some time and the numbers are growing. We’re finding the patients do well because they are low risk and they universally claim that the patient experience is superior to that of the busy hospital.”
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