characteristics of best gastroenterology practices

Characteristics of Best Gastroenterology PracticesJohn F. Johanson, M.D., M.Sc. Epid., F.A.C.G., Bergein F. Overholt, M.D., M.A.C.G., andJames T. Frakes, M.D., M.S., F.A.C.G.Rockford Gastroenterology Associates, Ltd, Rockford, Illinois; and Gastrointestinal Associates, P.C.,Knoxville, Tennessee

OBJECTIVE: As health care costs continue to rise, competi-tion among providers is increasing. Although this competi-tion is currently based on price, quality of care will becomean increasingly important issue. One popular method toassess quality is by comparing physicians’ performancewith that of a representative group of physicians, in a pro-cess called benchmarking. The purpose of this study was tosurvey private practice gastroenterologists to identify thepractice characteristics, so-called “best practices,” associ-ated with high-quality health care delivery to provide datafor use as benchmarks.

METHODS: Three hundred randomly selected gastroenterol-ogy practices were surveyed regarding practice demograph-ics, administration, financial management, and use of out-comes techniques by mail questionnaire. Analogousquestionnaires were completed by representatives of thegastroenterology practices comprising the GastroenterologyPractice Management Group, LLC (GMPG).

RESULTS: One hundred and eighty-two (61%) of the 300eligible practices responded to the questionnaire. Increasingdifferences between survey and benchmark GPMG prac-tices were observed as the complexity of quality measuresincreased. Among structure measures, the groups were sim-ilar. By contrast, significant differences were observed be-tween survey and benchmark groups with regards to out-comes measures such as the use of practice guidelines,continuous quality improvement, and outcomes assessment.

CONCLUSIONS: These results provide a snapshot of gastro-enterology practices across the country and can be used asa benchmark for quality assessment purposes to comparewith one’s practice, suggesting areas for change or improve-ment. It seems clear that the defining characteristic of bestgastroenterology practices is the demonstration of qualitypatient care. It also appears that many practices’ efforts inthis regard could be increased. (Am J Gastroenterol 1999;94:2519–2530. © 1999 by Am. Coll. of Gastroenterology)

INTRODUCTION

Since the 1960’s health care expenditures as a percentage ofgross national product have risen from 4% to.14%, a levelfar greater than that of any other developed nation (1).

Despite the significantly higher expenditures, the UnitedStates does not rank at the top of any global measures ofhealth (2, 3). As health care costs continue to rise, compe-tition among managed care organizations (MCOs) as well asindividual providers is increasing. Until now, this competi-tion has been based predominantly on price: whoever hasbeen able to more effectively reduce costs has prevailed.This trend cannot continue indefinitely. When costs reach apoint where they can no longer be reduced, competition willbe based on other factors, the most important of which isquality.

As health care providers, a greater emphasis on qualityshould be welcome, as our primary goal is to provide thebest possible care for our patients. Before quality can bemaximized, however, we must understand what denotesquality health care. In 1990, the Institute of Medicine de-fined quality to be “the degree to which health services forindividuals and populations increase the likelihood of de-sired health outcomes and are consistent with current pro-fessional knowledge” (4). In this regard, there are actuallytwo dimensions of quality: the appropriateness of servicesprovided (high-quality decisionmaking) and the skill withwhich the appropriate care is performed (high-quality per-formance). Stated another way, the delivery of high-qualityhealth care consists of “doing the right things right.” On apopulation basis, quality of care also includes the timeliness,appropriateness, and inappropriateness of diagnostic andmanagement strategies (5).

Quality can be maintained or improved in many ways.One widely utilized method is to compare actual patientoutcomes with national or regional standards. This process,known as benchmarking or profiling, is simply the compar-ison of one physician’s performance with that of a repre-sentative group of other physicians (6). Comparing endo-scopic utilization or complications of endoscopy withnational standards, for example, may lead to improved qual-ity of care by identifying individual physicians who mightbenefit from additional endoscopic training. Using the sameprocess, benchmarking of physician groups may identifypractice operations that could be improved, likewise in-creasing the quality of care. An example of improved prac-tice function might be the implementation of standard op-erating principles to coordinate the use of antibioticprophylaxis before endoscopic procedures. Benchmarking

THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 94, No. 9, 1999© 1999 by Am. Coll. of Gastroenterology ISSN 0002-9270/99/$20.00Published by Elsevier Science Inc. PII S0002-9270(99)00443-8

is being performed on an increasingly frequent basis byMCOs to identify quality providers to include or maintain intheir plans. At the present time, however, the specific phy-sician and practice characteristics that indicate quality havenot been validated.

The purpose of this study was to survey a random sampleof private practice gastroenterologists in an attempt to iden-tify physician or group practice characteristics, or best prac-tices, which are associated with high-quality health caredelivery. Elucidation of these attributes would providemeaningful data to be used as a benchmark, facilitatingcomparison of individual physician groups with a nationalstandard. Clinical gastroenterologists should be the onesidentifying and selecting appropriate measures of qualityrather than allowing others to perform this important task.The term “best practices” can be confusing because it maybe defined on various levels. Best practices may indicategroups of physicians who are recognized as outstanding.Alternatively, the term may represent activities that areperformed by physician groups, continuous quality im-provement representing one example. For purposes of thisstudy, both of these interpretations were considered, al-though more significance was afforded the latter because itis difficult, if not impossible, to assess the clinical judge-ment of individual physicians or their practices based upontheir response to a survey.

MATERIALS AND METHODS

A 10-page questionnaire was developed to assess a widerange of practice variables (see Appendix). Specific data ofinterest included practice demographics, physician charac-teristics such as board certification and teaching activities,the number and duties of support staff, practice managementprograms, use of consultants, experience with contracting(including capitation), performance of outcomes assess-ment, and accreditation. Many of these measures are used byMCOs when determining which providers they want in theirprovider panels.

The survey was sent to 300 randomly selected gastroen-terology practices. Of the 300 surveys, 100 were sent tosmall practices (groups of one to three gastroenterologists),100 were mailed to medium-sized practices (four to six

gastroenterologists), and 100 were sent to large groups (sev-en or more gastroenterologists). Questionnaires were alsocompleted by members of each of the gastroenterologypractices that comprise the Gastroenterology Practice Man-agement Group, LLC (GPMG) (Table 1) to provide data forbenchmarking purposes. Because the specific characteristicsthat constitute best practices are unknown, there are noobjective standards to use for comparison. Although theselection of these groups for comparison may be open tobias, these groups undeniably include some of the largestand best-known gastroenterology practices around the coun-try, practices that are believed to be on the cutting edge ofhealth care delivery, practice management, and outcomesassessment.

Upon completion of the surveys, they were mailed toRockford, Illinois for data analysis. The data were enteredinto a Microsoft Excel spreadsheet and 109 distinct vari-ables were analyzed. Prevalence rates for each of the vari-ables were calculated. Comparisons between membergroups of the GPMG and all other respondents were per-formed usingt tests andx2 analyses for continuous andcategorical data, respectively (7).

RESULTS

DemographicsOf the 300 questionnaires, 182 were returned, providing aresponse rate of 61%. When stratified by practice size,smaller and medium-sized groups demonstrated signifi-cantly higher response rates than did the larger groups, withrates of 87%, 75%, and 17%, respectively. The reason forthe large discrepancy in response rates is unknown. Thebetter response rate among smaller groups may have beendue to an increased desire for knowledge and assistance withpractice management issues. Results of this survey mayprovide more benefits for small and medium-sized groupsthan for larger groups. When stratified by geographic re-gion, the highest response rate was from the Southeast,comprising 22.2% of all participants. The Mideast was next,with 18.2%, followed by the Midwest with 13.1% and theSouthwest with 11.4%. The remaining regions were similar,each contributing approximately 6%.

The 182 surveys represented 673 physicians, the majority

Table 1. Members of the Gastroenterology Practice Management Group (GPMG)

Practice Name Location Physician Representative(s)

Gastrointestinal Associates Knoxville, TN Bergein OverholtRockford Gastroenterology Associates Rockford, IL James Frakes, John JohansonGastroenterology Consultants Milwaukee, WI Joseph Geenen, Mike SchmalzDigestive Health Care Minneapolis, MN Robert GanzMetropolitan Gastroenterology Group Washington, DC Michael WeinsteinConsultants in Gastroenterology Kansas City, MO Gregory BarberAsheville Gastroenterology Associates Asheville, NC James MorganGastroenterology Associates of Fort Worth Fort Worth, TX Thomas DeasAtlanta Gastroenterology Associates Atlanta, GA Alan SunshineSouthern California Gastroenterology Group Santa Monica, CA Richard Corlin

2520 Johanson et al. AJG – Vol. 94, No. 9, 1999

of whom practice in medium-sized groups. Of the total, only31 (4.6%) were women. The distribution of female gastro-enterologists was similar among the three sizes of groups,demonstrating rates of 4.6%, 4.8%, and 3.9% for small,medium, and large groups, respectively. The majority ofrespondents practiced only gastroenterology (83%) andmost groups were single-specialty practices (82%) ratherthan part of multispecialty groups. More than half of thegroups surveyed (58%) added a new physician within thepast 3 yr, with most of these being within the last year.Utilization of midlevel providers such as nurse practitionersor physician assistants remains relatively uncommon amonggastroenterology practices, as only 12% of practices employnonphysician providers.

Structure DataStructure data refers to characteristics of the individualphysicians making up each of the participating groups.Table 2 illustrates a number of specific characteristics sur-veyed, along with comparisons to responses from theGPMG. In most instances the two groups were similar. Ofparticular interest is the fact that similar numbers of respon-dents within each of the two survey populations were in-volved in teaching. However, more of the gastroenterolo-gists from the GPMG were involved in research and hadpublications in peer-reviewed journals within the past 2 yr.There are no data to suggest that publications influenceclinical judgement. Nevertheless, ongoing scholarly effortindicates a commitment to the science of gastroenterology.The continuous accumulation of knowledge necessary topublish in peer-reviewed journals certainly contributes tomaintaining, if not improving, clinical judgement. The twogroups were quite similar with respect to the other physiciancharacteristics.

When analyzing the scope of endoscopic procedures pro-vided, the two groups were also comparable in most in-stances (Fig. 1). Notable exceptions included endoscopicultrasound, laparoscopy, and photodynamic therapy. Only15% of the practices surveyed, for example, provide endo-scopic ultrasound services, in contrast to a significantlygreater number of the comparison GPMG practices whooffered this service. These differences are not unexpectedbecause endoscopic ultrasound and laparoscopy require sig-nificant training and capital expenditures. It is more difficultfor small groups to have the financial resources to providethese services.

Process DataIn this study we chose to define process data to includecomponents of the routine delivery of medical care. Severalkey aspects are outlined in Tables 3 and 4, with results forthe survey population as well as the comparison GPMGgroups. In contrast to results observed among structure data,a more obvious distinction between the two groups wasapparent. With respect to financial management, significantdifferences were observed regarding the use of a budget,negotiations with vendors, and membership in purchasinggroups to reduce the cost of supplies. The number of prac-tices that calculated the cost of providing various endo-scopic services or the cost of services by individual physi-cian was low in both groups and not significantly different.

The differences between the two groups of practices wereeven greater when issues of practice management wereexamined. In particular, significant differences were ob-served with respect to the existence of a mission statementand strategic plan, the use of consultants, and the presenceof a physician chief executive officer (CEO). Again, factorssuch as a physician CEO or use of consultants may be tooexpensive for a small group. This hypothesis, however,cannot explain the lack of a mission statement, strategicplan, or standard operating procedures among a large num-ber of practices, regardless of size.

Outcomes DataPatient-centered outcomes data are the most important databecause the information reflects directly upon the quality ofpatient care. Unlike structure or even process data, which

Table 2. Structure Data: Individual Physician Characteristics

Physician Characteristics General Survey, Number (%) Benchmark Group, Number (%) p Value

Board certification (all members) 151/179 (84) 7/9 (78) NSTeaching activities 128/178 (72) 7/9 (78) NSCommunity service 110/179 (61) 7/9 (78) NSCommunity education 117/179 (65) 6/9 (67) NSClinical research 90/179 (50) 9/9 (100) 0.002Recent publications (within 2 yr) 48/179 (27) 5/9 (56) 0.03

Figure 1. Comparison of endoscopic services provided among thesurvey and Gastroenterology Practice Management Group, LLC(GPMG) practices. *p , 0.05.

2521AJG – September, 1999 Best Gastroenterology Practices

provide an indication of a physician’s credentials or thequality of the practice environment, outcomes assessmentexamines what actually happens to patients.

Analysis of outcomes assessment techniques demon-strates the most dramatic differences among the two groups(Fig. 2). Statistically significant differences were observedfor all of the variables surveyed. That is, significantly moreGPMG practices performed patient satisfaction surveys, hadfunctioning continuous quality management programs andactually made improvements based on the data collectedutilized practice guidelines, and routinely tracked endo-scopic outcomes including such measures as indications,complications, and technical success rates.

One method to objectively assess whether ongoing qual-ity assessment is occurring is to analyze the number ofpractices that have been accredited by an independentagency such as the Joint Commission for Accreditation ofHealth Care Organizations (JCAHO). Of the practices re-sponding to this survey, only 60 were affiliated with anambulatory endoscopy center (AEC), of which 70% wereaccredited. However, both the practice and AEC were ac-credited in the vast majority. As with other measures, ac-creditation was clearly linked to practice size. Only 25% ofsmall groups achieved accreditation, compared with 32% ofmedium and 59% of large groups. This is in striking contrastto the GPMG groups, where 90% of practices have receivedaccreditation.

DISCUSSION

Traditionally, quality has been measured on the basis ofstructure, process, and outcomes of medical care (8). Thesecategories can also be applied to physician groups whenattempting to identify characteristics that denote quality. Inthis survey we applied these terms to classify practice char-

acteristics. Structure data were defined to include qualifica-tions of the physicians comprising each of the groups sur-veyed. Examples included board certification, teachingactivities, and recent publications. The scope of endoscopicservices provided was also described under structure data.Process data, when applied to physician practices, consistedof components of the delivery of medical care includingfinancial and practice management activities. Outcomes dataencompassed a variety of activities, including continuousquality improvement strategies, surveys of patient satisfac-tion, and routine tracking of endoscopic outcomes.

Although there was little difference among groups withregard to structure data, the scope of endoscopic servicesprovided by the various practices was interesting. As mightbe expected, all groups offered sigmoidoscopy, colonos-copy, and upper endoscopy. Significantly fewer practicesoffered laparoscopy, photodynamic therapy, and endoscopicultrasound (EUS). The finding that only 15% of practicesoffer EUS is disconcerting, as endoscopic ultrasound isincreasingly being incorporated into practice guidelines,particularly for tumor staging before curative surgery. Basedon the results of this survey, it is unlikely that practiceguidelines advocating the use of EUS will be strictly fol-lowed because this service is difficult to find among groupsin private practice. Patients may be unwilling to travel longdistances to the nearest endoscopic ultrasound center. Prac-ticing gastroenterologists may likewise be reluctant to refertheir patients to another gastroenterologist for fear of a lossof patients. The limited availability of EUS in routine clin-ical practice suggests caution should be exercised whenincluding it in practice guidelines.

The results of this survey illustrate increasing differencesbetween gastroenterology and the GPMG groups as thecomplexity of quality assessment increased from structureto process and finally to outcomes data. For nearly all the

Table 3. Process Data: Financial Management

General Survey, Number (%) Benchmark Group, Number (%) p Value

Budget 80/178 (45) 8/9 (89) 0.01Cost reduction strategies 72/179 (40) 4/9 (44) NSNegotiates price 98/178 (55) 8/9 (89) 0.05Purchase group 71/179 (40) 7/9 (78) 0.02Cost per service 43/179 (24) 4/9 (44) NSCost per physician 24/179 (13) 1/9 (11) NS

Table 4. Process Data: Practice Management

General Survey, Number (%) Benchmark Group, Number (%) p Value

Mission statement 71/178 (40) 7/9 (89) 0.01Standard operating procedures 131/178 (74) 9/9 (100) 0.06Strategic plan 84/178 (47) 8/9 (89) 0.01Compare against goals 54/178 (30) 5/9 (56) NSPhysician CEO 95/178 (53) 9/9 (100) 0.01Consultant review 89/178 (50) 9/9 (100) 0.003Physician Practice Mgmt Corp 13/178 (7) 1/9 (11) NSAdministrator with MBA 28/169 (17) 3/9 (33) NS

CEO 5 chief executive officer; MBA5 Masters of Business Administration.


variables analyzed, there was also a striking progression inparticipation rates from small to medium to large groups. Itclearly requires time and resources to incorporate many ofthese functions into routine practice. Groups of two or threegastroenterologists may not have the financial resources toemploy a physician CEO or MBA-level administrator. How-ever, many of the practice characteristics that were signifi-cantly different between survey and benchmark groups werenot associated with substantial costs. It does not require agreat deal of money, for example, to develop a missionstatement or strategic business goals, yet fewer than half ofthe practices surveyed had accomplished these fundamentaltasks. With regard to financial management, it is remarkablethat 55% of the groups surveyed did not utilize a budget. Itis less surprising that the majority of practices have notdetermined their costs for providing various services norhave they broken down utilization and costs by individualphysician for specific gastrointestinal disorders. However,these data are extremely valuable when negotiating pay-ment, particularly under capitated contracts (9).

It is clear from the results of this survey that most prac-tices are not routinely engaging in outcomes assessmentactivities. There are three possible explanations for whyprivate practice gastroenterologists are not routinely collect-ing outcomes data. First, they may not be convinced thatcollecting these data provides any benefit to them or to theirpractice. Expending the effort to incorporate outcomes anal-ysis into an already busy practice, however, may providesubstantial benefit. Analysis of one’s practice outcomes mayprovide an important edge when competing for managedcare or corporate contracts. Tracking patient outcomes canbe used to demonstrate quality, thereby fulfilling some re-quirements for accreditation. A second possible reason fornot routinely assessing practice outcomes may be a lack ofresources. But perhaps the most compelling reason whyphysicians may not be routinely collecting outcomes data isa lack of experience or training in this area. There are fewpracticing gastroenterologists who are formally trained inoutcomes assessment. Without sufficient training or expe-rience, it may be unrealistic to expect busy physicians toroutinely track the outcomes of their practices. The key to

successfully implementing an outcomes assessment pro-gram is to identify individuals who can provide the neces-sary support. Assistance may be found by working withhospital-based resource groups, measuring outcomes as partof endoscopic procedure tracking, networking with othermembers of endoscopic database groups, or working withMCOs or other payers.

Although it is difficult to define quality and even harderto measure it, one goal of health care providers should be tomaximize the quality of care. To improve quality, one mustbe able to measure the impact of the health care delivered(10). Gastroenterologists should take an active role in thisprocess. One easy way to start the process of quality im-provement is to use the results of this survey as a benchmarkto identify practice characteristics or activities that might beimplemented or improved. Another method to enhance qual-ity is to incorporate routine outcomes assessment into one’spractice. Measuring the outcomes of individual patientsprovides the ability to identify areas for improvement. Theincorporation of clinical guidelines into routine practice,when combined with feedback on performance as well aseducation, has also been shown to increase quality in ran-domized controlled trials (11). If gastroenterologists are notactively involved in outcomes measurement, analysis, andchange to improve the quality and thus value of their ownwork, someone else will assume this role.

In summary, it is not possible to assess the clinical judge-ment of individual physicians or their practices based on aquestionnaire. In the age of outcomes and quality assess-ment, however, physician practices are increasingly beingjudged by managed care and accrediting agencies based onmany of the practice criteria included in this survey. Theseresults provide a snapshot of current gastroenterology prac-tices across the country. Although only a snapshot, the datacan be used as a benchmark to compare with one’s practiceto suggest areas for change or improvement. It seems clear,however, that the defining characteristic of best gastroen-terology practices is the demonstration of quality patientcare. It also appears that many practices’ efforts in thisactivity could be increased. If we are not actively involvedin activities to improve the quality of our own work, some-one with interests in mind other than those of the patients’will undoubtedly assume this role.

ACKNOWLEDGMENT

This study was supported in part by an unrestricted grantfrom Astra Pharmaceuticals.

Reprint requests and correspondence:John F. Johanson, M.D.,Rockford Gastroenterology Associates, 401 Roxbury Road, Rock-ford, IL 61107-5078.

Received Oct. 29, 1998; accepted Apr. 2, 1999.

Figure 2. Utilization of specific outcomes methods by survey andGastroenterology Practice Management Group, LLC (GPMG)practices. *p , 0.05.


REFERENCES

1. Fries JF, Koop CE, Beadle CE, et al. Reducing health carecosts by reducing the need and demand for medical services.N Engl J Med 1994;329:321.

2. McGinnis M. The state of the nation. U.S. Department ofHealth and Human Services, Office of Disease Prevention andHealth Promotion, 1989.

3. Scheiber GJ, Pollier JP. International health spending: Issuesand trends. Health Affairs 1991:109.

4. Lohr KN, ed. Medicare: A strategy for quality assurance.Washington, DC: National Academy Press, 1990.

5. Starfield B. Quality of care research: Internal elegance andexternal relevance. JAMA 1998;280:1006–8.

6. Frakes JT. Glossary of managed care terms. In: Frakes JT, ed.Managed care issues for the gastroenterologist. Gastroenterol

Clin N Am 1997;26:923–43.7. Kahn HA, Sempos CT. Statistical methods in epidemiology.

New York: Oxford University Press, 1989.8. Brook RH, McGlynn EA, Cleary PD. Measuring quality of

care. N Engl J Med 1996;335:966–70.9. Weinstein ML. Capitation: Theory, practice and evaluating

rates for gastroenterology. In: Frakes JT, ed. Managed careissues for the gastroenterologist. Gastroenterol Clin N Am1997;26:773–84.

10. Nelson EC, Splaine ME, Batalden PB, et al. Building mea-surement and data collection into medical practice. Ann InternMed 1998;128:460–6.

11. Chassin MR. Quality of health care—Part 3: Improving thequality of care. N Engl J Med 1996;335:1060.

(See Appendix on following pp. 2525–2530)


APPENDIXGASTROENTEROLOGY PRACTICE SURVEY

We would like a copy of the results of this survey

Yes: Name (Print)

Address

City, State, Zip

PLEASE CHECK/ANSWER ALL THAT ARE APPROPRIATE

I. DEMOGRAPHICS OF YOUR GI GROUPSize of your group: 1–3 Physicians

4–67–910–20.20

# Male gastroenterologists# Female gastroenterologists# Pediatric gastroenterologists

Single specialtyPart of a multispecialty groupPractice limited to gastroenterologyRegion of country (refer to map and insert # please)

We have added a new physician within the last:1 year2 years3 years

Time to full partnership for new MD:1 yr2 yr3 yr4–5 yr.5 yr

A physician has left our practice within the last 5 years:NoYes: for retirement

other reasons(continued)


We have a nurse practitioner/physician assistant:NoYes How many? 1 3

2 4

We provide GI services at satellite sitesWe are part of a GI networkWe have merged with 1 or more GI groupsWe are discussing merger with other GI groups

We cover (number please) hospitals

Our physicians serve on committees for:hospital(s)serve as medical director of GI labMCOs/insurance companiesnational medical societieslocal medical societiesstate medical societies

Our physicians participate in community services/functions:United WayChamber of CommerceArtsSchool Board/School Councils (governance)School parent organizations (PTO/PTA, etc.)City or County governing bodiesChurch teaching, governance

Our practice offers:EGD colonoscopyERCP flexible sigmoidoscopyendoscopic ultrasound laparoscopyliver biopsy hepatologynutrition flex sig training for PCPsesophageal motility esophageal pH studiesphotodynamic therapy

II. GOVERNANCEOur group is governed by:

Physician Executive CommitteePhysician BoardOther (please explain)

the Board is the entire GI physician groupthe Board is part of the GI physician group

Our group:has a clearly defined mission statementutilizes strategic planning to guide the practicemeasures its achievements against its established goalshas a physician who serves as the leader (day-to-day CEO, managing partner)pays the physician leader

salary if so, $protected time

Our group has had a consultant review at least some aspect of the practice:NoYes within the last 1–2 years

within the last 2–4 years.4 years

Our practice is contractually connected with a Physician Practice Management Company (PPMC):Noinvestigatingplan to within 1–2 yearsYes

(continued)


III. STAFFThe administrator/office manager of our practice is an:

MBABARNOther (describe)

Number (full time equivalents) ofpractice staff (not endoscopy ASC)

Our practice:has a detailed procedure and policy manualhas a formal staff evaluation at least annuallyfunds educational meetings for our:

RNsLPNsNAs, endoscopic assistantsother staff (receptionist, insurance, etc.)

bonuses staff based on:annual bonus (e.g., Christmas bonus)performance and achievement of goalspatient satisfaction surveysother (describe)

Staff benefits include:health insurancedisability insurancelife insuranceretirement planincentive bonusfree parkinguniform allowancesick leavepaid vacationlunchother (describe)

IV. PHYSICIANSOur physicians are all board certified in GI (excluding those within 1 year of completing their training):

No ( is/are not)Yes

The basic method of reimbursement for our physicians is:equal salarysalary1 productivityproductivity

Our practice:has a formal physician performance evaluation at least annuallybonuses physicians based on achieving pre-established goalsbonuses our physicians based on patient satisfaction surveysbonuses our physicians based on referring physician satisfaction surveysprofiles our physicians at least annually (e.g., cost of services per physician or utilization per physician)

Our physicians:participate in a teaching program

medical students/residentsGI fellowship

lecture/train PCPs in GI subjectslecture/train GI Physiciansprovide community education programsconduct clinical research studieshas a dedicated research nurse

(continued)


attend on average at least weeks of CME annually,11–22–4.4

One or more of our physicians has published in a peer reviewed journal within the last:2 years4 years

Our physicians receive time off for:vacation ( # weeks)education ( # weeks)presentations at meetingsprofessional society activitiesclinical research (protected time)administrative activities

V. MANAGED CARE/CONTRACTINGMost contracts are accepted without revision:

NoYes

Contracts are reviewed:in-house by physiciansin-house by staffin-house by both

Our practice uses outside advisors for contract evaluations,25% of contracts25–50% of contracts.50%

Our practice has accepted acommercial capitation contract:NoYes

If Yes,# of covered lives

$ per member per month (PMPM)the endoscopic ASC is included in this fee

The following services have been excluded:screening flexible sigmoidoscopydiagnostic ERCPtherapeutic ERCPPediatric GItransplantsout of area services

Capitated revenue is distributed to physiciansdivided according to our regular practice methodsdivided according to a different method specifically designed for capitationother (please describe)

Our practice has accepted a Medicare risk contract:NoYes

If Yes,# of covered lives

$ per member per month (PMPM)the endoscopic ASC is included in this fee

(continued)


The following services have been excluded:screening flexible sigmoidoscopydiagnostic ERCPtherapeutic ERCPPediatric GItransplantsout of area services

VI. PRACTICE COSTSOur practice:

has a budgethas a clearly defined program to reduce costs (beyond “we want staff to reduce costs”)negotiates prices with vendorsare part of a purchasing grouphas determined a “cost per service”bonuses staff based on cost reductionshas determined the cost of providing services by individual physician

Our practice funds major practice expenses by:loansmonthly practice revenue (cash flow)combination of loans and monthly practice revenue (cash flow)cash set aside in advance for the purpose

Electronic Medical Record:Our practice:

has implemented an EMRis considering an EMRis waiting for further technological advances before considering an EMR

Our office space is sq. Ft.

Our practice:rents its office spaceowns its office space

VII. MARKETINGOur practice:

has a clearly defined marketing planhas staff designated part/full time to marketingtargets the following for specific marketing:

patientshospitalsbusinesssPCPsMCOs/Insurance companiesyour staff

surveys ourpatientsto measure satisfactionquarterlysemi-annuallyannuallyimplements changes based on patient satisfaction surveybonuses our physicians based on patient satisfaction surveys

surveys ourreferring physiciansquarterlysemi-annuallyannuallyimplements changes based on referring physician satisfaction surveysbonuses our physicians based on referring physician satisfaction surveys

VIII. PRACTICE MANAGEMENT INFORMATION SYSTEM (MIS)Our practice has upgraded (more than minor) our MIS within:

the last 2 yearsthe last 2–4 yearshas not upgraded within the last 4 years

(continued)


Electronic Medical Record:Our practice:

has implemented an EMRis considering an EMRis waiting for further technological advances before considering an EMR

IX. CONTINUOUS QUALITY IMPROVEMENT (CQI)Our Practice has a CQI programin place at this time

EASC has a CQI programin place at this time

If Yes,the CQI program is actually operational and has produced results

X. GUIDELINES AND OUTCOMESOur Practice utilizes clinical guidelines

EASC utilizes clinical guidelines:

If Yes,We measure performance based on the guidelines

Our Practice performs outcome measurementsEASC performs outcome measurements

If Yes,We introduce change based on outcomes

XI. ENDOSCOPIC AMBULATORY SURGERY CENTER (EASC)Our practice does EGDs and colons in the office

Our practice utilizes an EASC:No (If No, skip to the end)Yes

primarily single specialtymultispecialty

The EASC is owned by:Our physiciansOther physiciansOur physicians and an ASC corporate partner (e.g., AmSurg, Columbia HCA; National Surgery Centers)HospitalA PPMC (physician practice management company)An ASC corporation (e.g.)

Our group performs what estimated % of its procedures in the EASC:,50%50–75%.75%

Our group performs approximately the following # of procedures annually in the EASC:,10001000–20002000–30003000–40004000–50005000–6000.6000

# full time Staff in the EASC

JCAHO/AAAHC accreditation:NoYes

EASCEASC and office

THANK YOU FOR YOUR TIME AND ASSISTANCE!!


characteristics of best gastroenterology practices

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