Clinical research

The ambulatory endoscopy center (AEC): what it can do for your gastroenterology practice

Endoscopy accounts for most of the gastroenterologist's professional time and revenue. The thoughtful gastroenterologist in practice must understand the potential sites of service for endoscopy, including either the hospital endoscopy unit or an ambulatory endoscopy center (whether an office endoscopy suite or a licensed, certified, and accredited ambulatory surgery center). Out-of-hospital endoscopy centers have advantages for patients, including convenience, efficiency, economy, and more pleasant surroundings than the hospital. Payers appreciate improved access and reduced costs. For gastrointestinal practices, ambulatory endoscopy centers, particularly ambulatory surgery centers, provide significant advantages, including enhanced reimbursement and cost management, control, efficiency and convenience, quality control, opportunities for clinical research, and marketing and competitive strengths.

Research in clinical practice

Clinical research in the practice setting can be a rewarding experience. The atmosphere of research is changing, however, with tighter budgets, more oversight, increasing litigation risks, financial pressures, and increased competition. Sites must be increasingly careful to negotiate appropriate study budgets and contract language that is not overly burdensome or risky for the site. The focus on investigator training and use of qualifies personnel is paramount to preserve and improve the quality of clinical research in the United STates. The future may find certification examinations necessary for all research staff, including investigators. Eventually, the number of clinical research sites in the community will decrease, and academic sites, along with international sites, will once again fill the void.

Revenue enhancement for the practice and the endoscopic ambulatory surgery center

Gastroenterologists, like all physicians, are attempting to control more of the services they provide by developing programs that enhance quality of care and practice revenues, reduce physician stress, and improve the physician's quality of life. Many opportunities exist to accomplish these goals, including those discussed in this article. The overriding feature of any such activity, however, must always meet the criteria of improving patient care.

Outpatient endoscopy. The case for the ambulatory surgery center

Since the late 1970s, there has been a dramatic shift of GI endoscopy services from the inpatient to the outpatient setting. Outpatient GI endoscopy has migrated from the hospital endoscopy unit to the office and then on to the EASC. This evolution has been brought about by many forces, including the drive for health care cost containment, a desire for enhanced service, cost pressure on physicians, and demands for quality assurance. Although there are advantages and disadvantages to each of the outpatient settings (see Tables 5 and 6), the EASC seems to offer the most value to patients, payers, and physician owners. That value is defined as good outcomes, excellent service, and reasonable cost. Those attributes of the EASC that are most important in guaranteeing this value are physician control, time efficiency, convenience, and adequate reimbursement. The endoscopic ambulatory surgery center seems to be the best environment for delivering endoscopic services. The office AEC can only approach the attractiveness of an EASC when restrictive certificate-of-need laws prevent the development of an EASC; when groups lack a critical number of endoscopists to support an EASC (at least three endoscopists with a potential procedure volume of 1200 to 1800 procedures per year [11]); when excess office capacity and personnel can be used for the office AEC; and, perhaps most importantly, when there is an ability to secure favorable contracts for facility payment from private health plans to the office endoscopy center. The evolution of EASCs over three decades has demonstrated many advantages to patients, physicians, and payers. Although further questions and challenges are inevitable, EASCs can adapt quickly and deliver value. The author believes the future is deservedly bright for such facilities.