Preserving the integrated model of care

Bending the cost curve in healthcare is no small feat, and lately there has been a lot of talk about physician reimbursement and the costs of certain medical procedures.

In the midst of these heated – and often politicized – debates over compensation and pricing, it’s important to focus on cost-cutting measures that maintain, if not improve, the quality of healthcare. One such example is the integrated model of care.

ADVERTISEMENT
With this model, patients are able to seek various diagnostic and therapeutic services in one setting rather than traveling to multiple locations or to the more expensive hospital setting. At a time when quality of care and cost-effectiveness are more important than ever, integrated, independent GI practices that bring physicians of different specialties together are consistently providing better care at a lower cost to patients.

The benefits of this approach are reflected in a new study by an independent, integrated gastroenterological (GI) practice in Minnesota. The study, published in the journal “Gastrointestinal Endoscopy,” found Barrett's esophagus (BE) – a condition in which the cells of the lower esophagus are damaged, typically due to repeated exposure to stomach acid – is commonly overdiagnosed in clinical practice.

It is important to accurately diagnose BE because the condition can increase a patient’s risk of developing esophageal cancer. When the criteria for the diagnosis of BE are accurately used, prevalence decreases, while the risk of malignancy in BE increases simultaneously. Moreover, misdiagnosis wastes resources and induces unnecessary psychological stress for the patient. Through a better definition of the gastroesophageal junction, stricter accountability for BE diagnosis and improved endoscopic education for physicians, we can decrease utilization of biopsies and pathology, streamline resources and ultimately lower healthcare costs – and there is no setting more ideal for this than the integrated, independent GI practice.

Unfortunately, the integrated care model is consistently under attack by threats on Capitol Hill, in regulatory agencies and in statehouses across the country. Some members of Congress are pushing for the elimination of protections for diagnostic imaging, pathology and other medical services under the in-office ancillary services exception (IOASE) to the federal Stark Law. If the IOASE were to be eliminated, patients would lose access to these integrated services in their own doctors’ offices and be forced to seek the same care in less coordinated, disparate hospital outpatient settings where, ironically, reimbursement costs are significantly higher.

The evidence is clear. Digestive care – like many other aspects of healthcare – is most optimally delivered in comprehensive and integrated settings where decision-making is enhanced by patient exposure to providers with different expertise who provide viewpoints based on their clinical experience. Protecting the IOASE is critical not only to maintaining the high quality, coordinated, cost-effective treatments that patients deserve, but to facilitating important research that can lead to significant cost savings down the road. 

Ketover is president & CEO of Minnesota Gastroenterology, P.A., and president and chairman of the Board of the Digestive Health Physicians Association (DHPA).