March 10-12, 2016 - GI Roundtable 2020

March 10-12, 2016

DALLAS/FORT WORTH 2016

u CMS update on value-based purchasing models and reim-bursement changes

u The employer's perspective on healthcare reform

u Healthcare transparency - implications and opportunities for the GI practice

u Physician Burnout

u Current practice strategies and operations - learning from each other's successes (and failures)

u How independent practices can stay relevant in an era of rapid change

u Social media boot camp

u Optimizing provider and staff incentives and benefits

KEYNOTE SPEAKERSPatrick Conway, M.D.Acting Principal Deputy AdministratorDeputy Administrator for Innovation & QualityChief Medical OfficerCenter for Medicare & Medicaid ServicesBaltimore, MD

Tom Morris, Ph.D.Founder and Chairman, Morris InstituteWilmington, NC

SYLLABUS

Worthington Renaissance Hotel, Fort Worth, TX

GI Roundtable 2016 • Worthington Renaissance Hotel, Fort Worth, TX • www.giroundtable.com • [email protected] • p2

AgendaTHURSDAY, MARCH 10, 20165:00 pmREGISTRATION OPENS

5:00–6:30 pmNETWORKING RECEPTION(Snacks and drinks served)

FRIDAY, MARCH 11, 20167:00-7:45 amREGISTRATION,BREAKFAST, EXHIBITS

7:45-8:00 amWELCOME & PROGRAM REVIEWKlaus Mergener, Tom Deas

8:00-9:00 amBERGEIN F. OVERHOLT KEYNOTE LECTURE:INNOVATION AND HEALTH SYSTEM TRANSFORMATIONPatrick ConwayAs the single largest payer for healthcare in the U.S., CMS is well positioned to study innovative healthcare payment and service delivery models that improve the experience of care, improve the health of populations, and reduce per capita healthcare costs. In his keynote address, Dr. Patrick Conway, CMS Acting Principal Deputy Administrator, Deputy Administrator for Innovation and Quality, and Chief Medical Officer, will provide his unique insight on current CMS initiatives and discuss his vision for improving healthcare delivery by creating a patient-centric and value-based system of care.

9:00-9:30 amMACRA & CMS INITIATIVES: HOW ARE GI PRACTICES AFFECTED?Glenn LittenbergThe Medicare Access and CHIP Reauthorization Act (MACRA) permanently repeals the SGR formula and puts Medicare on a path towards “value-based” payments with an ambitious timeline and a number of Merit-based Incentive- and Alternative Payment Models many of which are yet to be defined. Dr. Littenberg will review the key issues related to MACRA and various other CMS initiatives, and discuss their impact on everyday GI practice. The presentation will also address the anticipated massive payment cuts for

colonoscopy and provide a forecast for other reim-bursement changes that may be looming for GI services.

9:30-10:00 am THE EMPLOYER PERSPECTIVE ON HEALTHCARE REFORMMarianne FazenFaced with continued increases in healthcare costs, ACA compliance headaches, and employee indiffer-ence and confusion, employers are rethinking their health benefits strategies and are looking beyond traditional solutions. This session will focus on how employers view and think about emerging healthcare trends, and will review models and technologies that are transforming the health benefits landscape and enabling employers to offer competitive benefits, control costs, and provide quality healthcare for their employees.

10:00-10:30 amSIESTA – REFRESHMENT BREAK & EXHIBITS

10:30-11:00 amLIKE BUTCH CASSIDY AND THE SUNDANCE KID - PHYSICIAN GROUPS MUST RELENTLESSLY PURSUE INNOVATIVE APPROACHES IN THE PURSUIT OF VALUEMichael DeeganDriven by new payment incentives, risk models, and the transparency of quality and cost, physician groups must pursue new methodologies to manage care transitions, avoid readmissions, and improve popula-tion health. Gastroenterology groups will achieve greater success if they provide these high value services for their referral base who are evolving to the medical home and medical neighborhood models of care. Improved physician-to-physician communication is an essential element of care coordination for patients with complex, high-risk conditions. The specialist medical neighborhoods must prove their quality, safety, and cost-efficiency to maintain their status as a "preferred" provider. This presentation will review the steps and preparation needed for a GI practice to transform and be successful in the new healthcare environment.


11:00-12:00 pmTHE FUTURE OF SPECIALTY MEDICINE: 20/20 VISIONModerator: Tom DeasPanelists: Patrick Conway, Marianne Fazen, Glenn Littenberg, Michael Deegan

What will the post-healthcare reform world look like from the perspective of specialty medical providers? Will there be a resurgence of a gatekeeper model and who will (and who should) be the keeper of the keys? What will it take for gastroenterologists to be success-ful in this new world? – This panel discussion will go beyond the buzzwords of “value”, “transparency” and “population management” and will identify specific steps GI practices can take to overcome current challenges and position their organization for success.

12:00-1:00 pmHIGH NOON – LUNCH & EXHIBITS

1:00-1:45 pmDO I HOLD ’EM OR FOLD ’EM – KEY STRATEGIC CHALLENGES IN 2016, AND PRACTICAL SOLUTIONSModerators: Gene Overholt & Jim Weber The content of this session will be determined by GIRT conference participants! Registered attendees will receive an invitation to submit their most pressing strategic issues for discussion. Drs Overholt and Weber will review and present these issues, and faculty and the GIRT audience will provide timely and practical solutions for these challenges. Topics considered for discussion might include: how to structure the relationship between practice and the local health system, how to best set up pilot bundling projects with payers and employers, what kinds of metrics and analytics to hardwire into the GI practice in anticipa-tion of value-based contracts, how much risk can I take, and many more. GIRT participants will decide!

1:45-2:15 pmCIRCLING THE WAGONS[Sponsor presentations]

2:15-3:00 pmSHIFTING TO WARP 10 – PUTTING PRACTICE OPERATIONS INTO PONY EXPRESS MODEModerator: Reed Hogan & Arnold LevyThe content of this session will be determined by GIRT conference participants! Registered attendees will receive an invitation to submit their most pressing

operational issues for discussion. – No matter the outcome of delivery system and payment reform, GI practices will be best positioned if they are able to optimize their efficiencies and minimize costs. After many years of such efforts, opportunities for further improvement of cost-efficiencies are increasingly difficult to identify. Topics considered for discussion in this session might include: how to optimize endoscopy center efficiencies, minimizing no-shows, training and utilizing non-physician providers, how to optimize hospital coverage and call schedules, what practice operations to outsource, and many more. GIRT partici-pants will decide!

3:00-3:30 pmSIESTA – REFRESHMENT BREAK & EXHIBITS

3:30-4:00 pmTHINKING ‘BIG’ IN PURSUIT OF ‘SMALL’- ESTABLISHING A WEIGHT MANAGEMENT PROGRAM IN YOUR PRACTICEGene Overholt Will balloons become an endoscopic bonanza or just hot air? – Endoscopic therapies for obesity manage-ment are reaching a tipping point with several balloon-based treatments recently receiving FDA clearance. A number of other endoscopic techniques are likely to follow soon. Dr. Overholt will review the use of intra-gastric balloons and present a comprehen-sive weight management program and business model for GI practices to consider if they want to get involved in this field.


4:00-5:00 pmDECISIONS AT SUNDOWN (AND SUNSET) - GI GUNSLINGERS DISCUSS CRITICAL PRACTICE TRANSITIONSModerator: Klaus MergenerPanelists: Tom Deas, Reed Hogan, Chal Nunn, Gene Overholt, Jim Weber

A successful GI practice must endure many difficult transitions in its lifetime. These may include transitions related to recruiting and retirement, but also owner-ship and scope of services, leadership and governance, IT systems and EMRs, community affiliations, and the list goes on. In this session, we will pose questions to a panel of GI gunslingers of great reputation drawing from their vast experience on the challenges and best solutions to many of these practice transitions. Know-ing the best course of action may save you from the quicksand, ambush, or showdown that others have experienced. The audience will have the opportunity to weigh in as well with both questions and solutions to these universal challenges of leadership and man-agement.

5:00 pmADJOURN DAY #1

5:00-6:00 pmWINE TASTING SOCIAL – DIGESTING DAY #1Sponsored by Texas Digestive Disease Consultants & Dr. James Weber

SATURDAY, MARCH 12, 20167:00-7:30 amBREAKFAST, EXHIBITS

7:30-8:30 amBREAKFAST BREAKOUTS

BREAKOUT #1 : ADMINISTRATORS/MANAGERSTHE WILD WEST OF PRACTICE ADMINISTRATION – CHALLENGES AND SOLUTIONSModerator: Rachel ToddGrab breakfast and participate in this networking opportunity for administrators and practice managers (and anyone else who is interested). Bring your specific challenges, obtain input from your peers and compare notes on possible solutions

BREAKOUT #2: PHYSICIANSUPPER GI ENDOSCOPY INNOVATIONS – COMING TO A GI PRACTICE NEAR YOUAmitabh ChakNew screening tools for Barrett’s esophagus are being developed and some providers are broadening the indications for ablative therapies. New imaging modalities may help identify early gastric cancers and other subtle abnormalities. Minimally invasive dissec-tion and suturing techniques are increasingly used to treat achalasia, remove early tumors, and close refrac-tory fistulas. – In this presentation, Dr. Chak will review some of these developments and suggest how they may fit into ambulatory and hospital-based GI practices.

8:40-8:45 amANNOUNCEMENTS DAY #2Klaus Mergener

8:45-10:00 amKEYNOTE ADDRESS:ACHIEVING TRUE SUCCESS IN TIMES OF CHANGETom Morris Performance. Leadership. Success. Change. Commit-ment. Imagine the wisdom of Yoda, Gandalf, and Dumbledore, rolled together and linked to the spirit and energy of the world’s most winning athletic coaches. Stir in the unexpected humor of a Seinfeld or Fallon, and you have an idea of a Tom Morris presen-tation. Tom is one of the world’s top motivators, pioneering business thinkers and strategic advisor to several Fortune 100 companies. As a best-selling book author and a sought-after speaker, his electrifying


talks reengage people around their deepest values and reignite their passion for work and life.

10:00-10:30 amSIESTA – REFRESHMENT BREAK & EXHIBITS

10:30-11:00 amTHE LONE RANGER RIDES NO MORE – MOTIVATING AND INCENTIVIZING TEAM PERFORMANCEDan O’Connell CMS and others use pay-for-performance programs with the goal of incentivizing providers to improve healthcare processes and, ultimately, outcomes. Practices are using internal incentive programs to motivate provider and staff performance. There is, however, evidence that financial incentives have both their limits as well as their unintended consequences when it comes to motivating healthcare providers and staff. In this talk, Dr. O’Connell will review recent relevant research and suggest additional and alterna-tive motivators for practices to consider.

11:00-11:30 am“MONEY CAN’T BUY ME LOVE,” OR CAN IT? – COMPENSATION MODELS AND INCENTIVES IN THE GI PRACTICEModerator: Joe VicariPanelists: Larry Kim, Jeffry Nestler, Michael WeinsteinBuilding on the previous presentation, the panel will discuss a variety of current benefits and performance incentives used in GI practices, their pros and cons, and how they might be optimized to be more effective in motivating the desired physician and staff behav-iors. This discussion will also address how practices are planning to revise physician payment formulas to better align with the anticipated transition to a value-based payment system.

11:30-12:15 pmPHYSICIAN BURNOUT – WHAT TO DO WHEN YOU SMELL SMOKEDan O’Connell Provider stress and burnout are worrisome phenomena that show up in practice effectiveness, collegiality, risk management, and in recruitment and retention arenas. The pace of change in healthcare along with the day-to-day demands of treating patients safely and efficiently, and dealing with the endless adminis-trative tasks that come with each encounter are

starting to feel unmanageable to many providers. In this talk we will look at how this stress can be under-stood and coped with differently so that providers are more able to feel that they are thriving in practice rather than simply surviving.

12:15-1:15 pmHIGH NOON – LUNCH & EXHIBITS

12:30-1:00 pmLUNCH PRESENTATIONGOING SOCIAL – A CRASH COURSE FOR THE UNINITIATEDKrista NeherHaving trouble keeping up with your kids and grand-kids, with your friends and with your patients? Social media is taking the world by storm and many of us are having a hard time keeping track. This entertaining presentation by one of the best-selling authors on social media will review some of the top social networks, provide a crash-course on how they work, and tell you why you should care.

1:15-1:45pmGI PATIENT EXPERIENCE 3.0 – REDUCING RISK…ENHANCING ECONOMICSJim SaxtonThe environment will continue to change, but one constant remains: the patient experience impacts both professional liability exposure and practice economics. Jim Saxton explains how healthcare reform has changed the risk profile of a practice in regards to patient experience, and he discusses “5 Star” strate-gies that help reduce risk while simultaneously enhancing practice economics. The importance of specific measurements and of pursuing a proactive, consistent and pervasive approach is emphasized.

1:45-2:15 pmCIRCLING THE WAGONS[Sponsor presentations]

2:15-2:45 pmTRUE GRIT – EVOLVING PRACTICE MODELS AND STRATEGIES TO HELP SMALL AND LARGE GI GROUPS REMAIN RELEVANT AND SUCCESSFULModerator: Jim LeavittPanelists: Jim Saxton, Barry Tanner, Glenn LittenbergHealthcare reform is triggering a variety of coopera-tive GI practice models to include single specialty


FacultyAmitabh Chak, MDDivision of GastroenterologyCase Western Reserve UniversityCleveland, OH

Patrick H. Conway, MD, MScActing Principal Deputy AdministratorDeputy Administrator for Innovation andQuality & CMS Chief Medical OfficerCenter for Medicare and Medicaid ServicesBaltimore, MD

Thomas M. Deas, Jr., MD, MMMNorth Texas Specialty PhysiciansFort Worth, TX

Michael J. Deegan, MDNaveen Jindal School of ManagementUT DallasDallas, TX

Marianne Fazen, PhDExecutive Director, Dallas/Fort Worth Business Group on HealthPresident & CEO, Texas Business Group on HealthDallas, TX

Reed B. Hogan III, MDGI Associates & Endoscopy CenterJackson, MS

Lawrence S. Kim, MDSouth Denver Gastroenterology PCDenver, CO

James S. Leavitt, MDGastroHealthMiami, FL

Arnold G. Levy, MDCapital Digestive Care, LLCSilver Spring, MD

Glenn Littenberg, MDSouthern California Gastroenterology AssociatesPasadena, CA

Klaus Mergener, MD, PhD, MBADigestive Health SpecialistsTacoma, WA

Thomas V. Morris, PhDChairman, Morris InstituteWilmington, NC

Krista NeherCEO, Boot Camp DigitalCincinnati, OH

Jeffry L. Nestler, MDConnecticut GI, PCHartford, CT

Chalmers M. Nunn, Jr., MD, MMMChal Nunn Executive CoachingLynchburg, VA

Daniel O’Connell, PhDTraining, Coaching & ConsultationSeattle, WA

Bergein F. Overholt, MDGastrointestinal AssociatesKnoxville, TN

James W. Saxton, EsqCEO, Saxton & Stump LLCLeola, PA

Rachel Todd, MBACEO, Puget Sound GastroenterologySeattle, WA

Joseph J. Vicari, MD, MBARockford Gastroenterology AssociatesRockford, IL

James J. Weber, MDTexas Digestive Disease ConsultantsDallas, TX

Michael L. Weinstein, MDCapital Digestive CareBethesda, MD

independent provider associations (IPAs), clinically integrated networks (CINs), virtual integration, and others. This session will review these models, discuss their pros and cons, and consider what GI practices, large or small, need to do to remain relevant and successful in their local environments.

2:45-3:30pmSOCIAL MEDIA 3.0: ONLINE MARKETING REBOOTEDKrista NeherMost people today make decisions based on informa-tion they find online. They use search engines, social media and review sites to inform their decisions. Despite online sources being one of the top factors in healthcare decision-making, some practices still view their online presence as an afterthought or a lower strategic priority. The office used to be the “front door” to the GI practice. Now, the front door is what people find on Google, and they are making judg-

ments before they even walk into the office and meet their physician. – Practices of all sizes can benefit from giving their online presence a fresh look and more attention. In this session, Krista Neher will review how online marketing has evolved and is influencing decisions, and what you can do to improve your current online presence and create an even stronger first impression for your practice.

3:30 pmWRAP IT UP, HIT THE TRAIL AND TAKE IT HOMETom Deas3:30-4:00 pmCONFERENCE ADJOURNS – HAVE A DRINK ON THE HOUSE: WINE AND CHEESE RECEPTION* (EXHIBITS STILL OPEN!)*This reception will also serve as the Welcome Reception for the “Basics of Practice Management” companion course which will follow immediately – see website and separate program.

GI Roundtable • 1917 Warren Avenue North, Seattle, WA 98109 Phone: (403) 244-4998 • Fax: (206) 299-3623 • [email protected] • www.giroundtable.com

GI Roundtable 2016 - Participant List

First Name Last Name Degree Company City State Sanjay Agrawal MD Digestive Health Specialists Tacoma WA Steve Alabaster MD Digestive Health Specialists Tacoma WA Mark Angel

Olympus America Inc Center Valley PA

Skip Ashmore MOTUS GI Marietta GA Richard Aycock MD Memphis Gastroenterology Group Cordova TN Rodger Baca

Physicians Endoscopy Jamison PA

Skip Baldino EndoGastric Solutions Redmond WA Bryan Baucom Miraca Life Sciences Irving TX Robert Be MD Gastroenterology Associates Baton Rouge LA Jed Bell Pentax Medical Montvale NJ Joseph Bennett

Invendo Medical Inc Garden City NY

Scott Berger MD Suburban Gastroenterology Naperville IL Paul Berggreen MD Arizona Digestive Health, PC Phoenix AZ Brian Bernhardt Ferring Pharmaceuticals Chesterfield MD Raymond Berrios Digestive Health Care Center Hillsborough NJ David Berryhill

ERBE USA Marietta GA

Gerald Bertiger MD Hillmont GI, PC Spring House PA Candy Bigham Texas Digestive Disease Consultants Dallas TX Richard Bone MD Advocate Medical Group Oak Lawn IL Laura Boothby RN Gastroenterology Associates, LLC Baton Rouge LA Dana Booze

Digestive Health Associates Winston-Salem NC

Stephen Brackbill MD Gastroenterology Associates Greenville SC Sylvie Bradesi PhD Ferring Pharmaceuticals Los Angeles CA Scott Brady GI Pathology Memphis TN Thomas Brophey Olympus America Inc Center Valley PA Paul Bruggeman

Sedasys, Division of Ethicon Cincinnati OH

Joseph Bruno MD Gastrointestinal Associates, Inc Rydal PA Joel Bryers Main Line Gastroenterology Associates Malvern PA Waseem Butt MD Geisinger Medical Center Danville PA Eric Callan LifeLinc Memphis TN Joseph Cappa MD Connecticut GI, PC Glastonbury CT Marc Carp MD Gastro Health Miami FL Steve Carpenter MD The Center for Digestive & Liver Health Savannah GA Ben Carr AbbVie Seattle WA Tina Casillo

Fayetteville Gastroenterology Associates Fayetteville NC

Mark Casner CRH Medical Vancouver Canada Amitabh Chak MD University Hospitals Case Medical Center Cleveland OH Santhosh Cheela MD Old Bridge NJ Victor Chen MD GI Consultants Reno NV Joe Chickerillo Officite Downers Grove IL Delbert Chumley MD Gastroenterology Consultants San Antonio TX John Cifarelli Invendo Medical Inc Garden City NY Scott Clark MD Gastroenterology Associates Gainesville GA


Brian Cochrane Pentax Medical Montvale NJ Aaron Cohn MD University of Vermont Medical Center Burlington VT Maureen Collins Boston Scientific Corporation Marlborough MA Gregg Costantino

EndoChoice Alpharetta GA

Patrick Conway MD Center for Medicare and Medicaid Services Baltimore MD Vanessa Costilla MD University of Texas Health Science Center San Antonio TX Jim Cox MD Texas Digestive Disease Consultants Plano TX Eimile Dalton-Fitzgerald MD UT Southwestern Dallas TX William Daniels Ferring Pharmaceuticals Chesterfield MD Margaret Davis

gMed, a Modernizing Medicine company Boca Raton FL

John Day ERBE USA Marietta GA Tom Deas MD North Texas Specialty Physicians Fort Worth TX Michael Deegan MD UT Dallas Dallas TX Timothy Dement

Janssen Biotech Horsham PA

Thomas Dewar MD Texas Digestive Disease Consultants Fort Worth TX Jessica Diduch

CRH Medical Vancouver Canada

Leslie Diehl Medtronic Atlanta GA Cristian Dominguez MD UTHSCSA San Antonio TX Alan Donner

Gastroenterology Associates Baton Rouge LA

Michael Dragutsky MD Gastroenterology Center Germantown TN Joyce Duell


Brad Duff Medtronic Overland Park KS John Dugan MD University of Texas Health Science Center Houston TX Angela Duncan AMSURG Nashville TN Joe Dunlop EndoChoice Alpharetta GA Kate Emminger

pMD San Francisco CA

Heath Evans Pentax Medical Montvale NJ Brett Faucett


Marianne Fazen PhD Dallas Fort Worth Business Group Dallas TX Neville Fernandes MD Texas Digestive Disease Consultants Irving TX Alejandro Fernandez MBA Gastro Health Miami FL Keith Fiman MD Gastroenterology Consultants Southwest Sugar Land TX Mark Finnicum Abbvie Wake Forest NC Gerald Flouhouse

Carolina Digestive Health Associates Charlotte NC

Jeff Fox Physicians Endoscopy Jamison PA Chris Fourment Texas Digestive Disease Consultants Southlake TX Kathy Frank RN NorthShore University Health System Evanston IL Scott Fraser EndoChoice Alpharetta GA Ravi Ganeshappa MD Camden Medical Center San Antonio TX Peter Garcia Meza C2 Therapeutics Redwood City CA David Granstaff

Fujifilm Medical Systems Wayne NJ

Nick Goralsky Gastroenterology of the Rockies Louisville CO Navakanth Gorrepati MD UNT Health Science Center Southlake TX Miles Gresham MD Gastroenterology Assoc. of North Central AL Birmingham AL Shawn Grubb

Anderson Products Haw River NC

Kumar Gutta MD Gastroenterology Associates of North Texas Fort Worth TX Mitch Guttenplan MD CRH Medical Vancouver Canada Harvey Guttmann MD Gastrointestinal Associates, Inc. Rydal PA


Molly Haislip

LifeLinc Memphis TN Barbara Hanania AMSURG Nashville TN Justin Hankins

Boston Scientific Corporation Marlborough MA

David Harano MBA, MHA Gastro One Germantown TN Tess Harper


Karissa Hartman AbbVie Seattle WA W.Mark Hassig MD Digestive Health Specialists Tacoma WA Vicki Hawkins Miraca Life Sciences Irving TX Neil Herbsman MD Gastroenterology of The Bronx Bronx NY Timo Hercegfi Invendo Medical Inc Garden City NY Larry Hightower

Vxtra Partners Atlanta GA

Matt Hoenecke Ferring Pharmaceuticals Chesterfield MD Reed Hogan MD GI Associates And Endoscopy Center Jackson MS Annie Hsu Greenbelt Endoscopy Center Lanham MD John Hong United Gastroenterologists Murrieta GA Craig Hunter

Coker Group Alpharetta GA

Joseph Ianello MD Connecticut GI, PC Hartford CT Mary Igo MBA Digestive Health Specialists Tacoma WA Dinesh Jain MD Suburban Gastroenterology, Ltd. Naperville IL Laura Jeffcoat

AbbVie Seattle WA

Rohit Jindal MD Gastroenterology Associates York PA Rajkamal Jit MD Digestive Specialists, Inc. Kettering OH Rodney Joe MD Gastroenterology Associates Olympia WA Mark Johnson

Gastroenterology Associates Birmingham AL

David Jones MD Gastroenterol Consultants of San Antonio Bulverde TX Preston Allen Jones MD Gastroenterology Associates Greenville SC Adam Kenney pMD San Francisco CA Lawrence Kim MD South Denver Gastroenterology Lone Tree CO Darla King Ferring Chesterfield MD Greg Kirby

Digestive Health Associates of Texas Dallas TX

Alan Kittner Captify Health Lenexa KS Mark Kleczewski

Pentax Medical Montvale NJ

Brandon Klein Olympus America Inc Center Valley PA Tom Klim MBA Gastroenterology Consultants Reno NV Michael Koff Gastroenterology Center of Connecticut Hamden CT John Korney


Kimberly Krivacis Takeda Pharmaceuticals Fountain Hills AZ Mike Lachey

Fujifilm Medical Systems Wayne NJ

Doug Ladd EndoChoice Alpharetta GA Gregory Lam MD St. Elizabeth Physicians Crestview Hills KY Jim Leavitt Gastro Health Miami FL Joseph LeBel MD Gastroenterology Associates Greenville SC Dave Lee Med-SN Murfreesboro TN Erica Lee MD Gut Feelings Denver CO T.J. Lee Reshape Medical Frisco TX Arnold Levy MD Capital Digestive Care, LLC Silver Spring MD Steven Lewis MD Puget Sound Gastroenterology Seattle WA Ze'ev Lichtenstein MD GI-View Ramat-Gan Israel


Lee Linton HyGIeaCare Inc Austin TX Branden Lish

South Denver Gastroenterology Englewood CO

Glenn Littenberg MD Southern California Gastro. Associates Pasadena CA Luis Lizardo MD Baylor University Medical Center Dallas TX Atena Lodhi MD Medical College of Wisconsin Wauwatosa WI Michelle Luker

AbbVie Seattle WA

Brian Lynch EndoChoice Alpharetta GA Daryl Malachowski

Epix Anesthesia Peachtree Corners GA

Steve Marshall AMSURG Nashville TN Ted May

Anderson Products Haw River NC

Shaibal Mazumdar MD Advanced Healthcare Brookfield WI

Marsha McKenna-Feldmann


Debby McMillin AMSURG Nashville TN Giancarlo Mercogliano MD Main Line GI Associates Malvern PA Klaus Mergener MD, PhD Digestive Health Specialists Tacoma WA Gavriel Merton HyGIeaCare INC Dallas TX Alannah Miller gMed, a Modernizing Medicine Company Boca Raton FL Cameron Milller

Captify Health Lenexa KS

Fazia Mir MD University of Missouri Columbia MO William Mitchell MD Gastroenterology Associates Olympia WA Alexandra Modiri MD Medical College of Wisconsin Milwaukee WI Christos Monovoukas


Justin Morris Takeda Pharmaceuticals Fountain Hills AZ Marcia Morris

Genii, Inc St. Paul MN

Tom Morris PhD The Morris Institute Wilmington NC Arvind Movva MD Gastroenterology Consultants Moline IL Guy Neff MD Florida Digestive Health Specialists Lakewood Ranch FL Krista Neher

Boot Camp Digital Cincinnati OH

Jeffry Nestler MD Connecticut GI, PC Hartford CT Kofi Nuako MD Advanced Gastro Martin TN Michael Nunez MD Texas Digestive Disease Consultants Dallas TX Chalmers Nunn MD Gastroenterology Associates Lynchburg VA Dan O'Connell PhD Training , Coaching and Consultation Seattle WA Mark O'Neill Vxtra Partners Atlanta GA Scott Okland

Boston Scientific Corporation Marlborough MA

Gene Overholt MD Honorary Conference Chair Knoxville TN Charles Owen MD Texas Digestive Disease Consultants Arlington TX Nishita Patel MD Drexel University Philadelphia PA Craig Penno CEO Dayton Gastroenterology Beavercreek OH Steve Peterson MBA Wilmington Gastroenterology Wilmington NC Hunter Phillips

PRSM Healthcare Nashville TN

Patrice Pickering Braintree Laboratories,Inc Braintree MA Patrick Quinn MD Northern New Mexico Gastroenterology Santa Fe NM Razia Qureshi Janssen Biotech Horsham PA Karla Ramirez

Greenbelt Endoscopy Center Lanham MD

Alex Reynolds Surgical Care Affiliates Deerfield IL Bryan Rhodes

Texas Digestive Disease Consultants Southlake TX


Al Roach PharmD. Ironwood Pharmaceuticals Nashville TN Patricia Robinson

Gastroenterology Assoc, PC Gainesville VA

Omelio Rodriquez AMSURG Nashville TN Scott Rogers

Pentax Medical Montvale NJ

Cathleen Rohling GI Associates Wausau WI Richard Roman MD South Denver Gastro Englewood CO Joe Rubinsztain MD gMed,a Modernizing Medicine company Boca Raton FL Samuel Rubinsztain

gMed,a Modernizing Medicine company Boca Raton FL

Craig Sande MD Gastroenterology Consultants Reno NV Sanjay Sandhir MD Dayton Gastroenterology Beavercreek OH Craig Sarrett Miraca Life Sciences Irving TX Tom Sanders

Captify Health Lenexa KS

James Saxton Esq Saxton & Stump LLC Lancaster, PA Ted Schaffer


Matt Schreiber gMed,a Modernizing Medicine company Boca Raton FL Mitchal Schreiner MD Southwest Gastroenterology Albuquerque NM Steve Schuster JD Innovative Anesthesia Ashburn VA Shane Schweda MBA Austin Gastroenterology Austin TX Ryan Sciacca pMD San Francisco CA Andrew Scoular

Ferring Pharmaceuticals Chesterfield MD

March Seabrook MD Consultants in Gastroenterology West Columbia SC Peggy Seiler COO Texas Digestive Disease Consultants Dallas TX Asad Shalami InVentiv Health/Janssen Horsham PA Sam Shekier Admin Connecticut GI PC Hartford CT Brian Shields Fujifilm Medical Systems Wayne NJ Jennifer Sin Greenbelt Endoscopy Center Lanham MD Jay Sykes

Ideal Protein Safety Harbour FL

Tal Simchony MD GI-View Ramat Gan Israel Jennifer Sin RN Greenbelt Endoscopy Center Lanham MD William Slavin Captify Health Lenexa KS Monica Smith

Gastroenterology & Endoscopy News Brooklyn NY

Cari Sorrell MD University of Texas, HSC San Antonio TX Paul Sowell


Laurie Stafford Texas Digestive Disease Consultants Arlington TX Chris Stanley

Physicians Endoscopy Jamison PA

Jennifer Stano Greater Houston Gastroenterology Houston TX Jan Stivers

Surgical Care Affiliates Deerfield IL

Carol Stopa Physicians Endoscopy Jamison PA Jason Sugar MD Digestive Health Specialists Tacoma WA Lisa Swize MD South Denver Gastroenterology Englewood CO Rebecca Swoyer

Gastroenterology Associates, PA Greenville SC

Barry Tanner Physicians Endoscopy Jamison PA Patricia Tappan

Gastroenterology Assoc of Colorado Springs Colorado Springs CO

James Taterka MD Hillmont GI Spring House PA Barbara Tauscher MHA The Oregon Clinic Oregon City OR Kimberly Teichmann AMSURG Nashville TN Neviana Terzieva

gMed,a Modernizing Medicine company Boca Raton FL

Jackie Tillinger Digestive Health Specialists Winston Salem NC


Rachel Todd MBA Puget Sound Gastroenterology Bothell WA Michelle Toungette AMSURG Nashville TN Loretta Tracy

NorthShore University Health System Evanston, IL

Suzanne Turzillo Asheville Gastroenterology Associates Asheville NC Vance Rodgers MD Central Coast Gastroenterology San Luis Obispo CA Cory Vergilio MD Digestive Health Care Center Hillsborough NJ Nathan Vestal

Digestive Health Specialists Winston Salem NC

Joe Vicari MD, MBA Rockford Gastroenterology Associates Rockford IL Scott Wagner

Ironwood Pharmaceuticals Rosemont IN

Andy Waldo Gastroenterology Clinic APMC Monroe LA Thomas Waldron

MIdwest Gastrointestinal Assoc Omaha NE

Anne Hutson Walker PhD Ferring Pharmaceuticals Houston TX Dan Walker MBA Ohio Gastroenterology & Liver Institute Cincinnati OH Elizabeth Walters Carolina Digestive Health Assoc Charlotte NC James Weber MD Texas Digestive Disease Consultants Dallas TX Michael Weinstein MD Capital Digestive Care Chevy Chase MD Matthew Wilder

11 Health and Technologies London UK

Dennis Williams Digestive Care Endoscopy Johns Creek GA Amanda Willoughby

Ferring Pharmaceuticals Chesterfield MD

Donna Wright Texas Digestive Disease Consultants Southlake TX Edward Wright CRH Medical Vancouver Canada Claude S Yarborough MD Gastroenterology Associates Greenville SC Christopher Young MD GI Associates Wausau WI Steve Young

Pathgroup Brentwood TN

Michael Yuan Greenbelt Endoscopy Center Lanham MD Mike Zagger EndoGastric Solutions Redmond WA Liam Zakko MD Mayo Clinic Rochester MN

Thank you to our 2016 Industry Partner Sponsors:

Thank you to our 2016 Industry Media Partner:


March 10-12, 2016Worthington Renaissance, Fort Worth, TX

Thank you to our 2016 Industry Partner Exhibitors:



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Thank you to our 2016 Industry Partner Exhibitors:




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Screening Colonoscopy Adenoma Detection Rate Measure.

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Contact Information Dr. Patrick Conway, M.D., M.Sc.

Acting Principal Deputy Administrator and CMS Chief Medical Officer

[email protected]

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MACRA & CMS Initiatives: How Are GI Practices Affected?

Glenn Littenberg, M.D., MACP

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MACRA & CMS INITIATIVES:HOW ARE GI PRACTICS AFFECTED?

Glenn Littenberg, MD, FASGE, MACPChief Medical Officer, inSite Digestive Health Care

Chair, Reimbursement Comm. & CPT Advisor, ASGE• .

[email protected]

(no relevant conflicts to disclose, thanks much)

Agenda• The GREAT LEAP: will it be YUGE?• Payment for GI services, 2016 • The next cut: moderate sedation• The new federal mandate: pay for value,

not quantity…MIPS, APMs and other new acronyms

• Yet more initiatives • Implications for GI practices

In the next five years …• Cost reduction will be job # 1, 2 , 3…

• Massive Consolidation of Health Systems, mandated tightly managed referral networks and Enterprise EMR

• GI will be a build or buy decision; you can be swapped out…

• Health-care becomes retail

• Five types of patients • Medicaid• Exchange Marketplace• Medicare• Employer• Self pay

• Shift from Volume to Value Reimbursement

• Practices that demonstrate value (quality/cost) will win

GI procedure MD reimbursement• CMS/ACA “misvalued services” revaluations• All GI endoscopy codes revalued by AMA Relativity

Update Comm.� CMS 2012-2016• UGI endo, ERCP, EUS new values 2014 6-36%

reductions• Lower intraservice time, devaluation of moderate

sedation, “misunderstanding”

• Colonoscopy 11-20% cuts 2016 after 1 year delay

GI procedure facility reimbursement• Facility: 40% drop ASC fees phased in through

2012 over 4 years, slight increases since• Hospital outpatient (HOPD) 45% more on average • Many procedures not feasible economically in ASC• But sufficient margin to maintain an efficient high

quality center within GI groups “FILL THE SCHEDULE!!”

Year eRx EMR (MU) PQRS Total Penalty

2013-1.5% No penalty No penalty -1.5%

2014 -2.0% No penalty No penalty -2.0%

2015 No penalty -1.0% -1.5% -2.5%

2016 No penalty -2.0% -2.0% -4.0%

2017 No penalty -3.0% -2.0% -5.0%

2018 -4.0% -2.0% -6.0%2019 -5.0% -2.0% -7.0%

CMS Penalties Adjustments for Non-participation in Quality Programs:

And your -2.0% sequester “bonus”ADDED TO VB modifier ? -4%

Value-Based Modifier Scoring Clinical care

Patient experience

Efficiency

Patient Safety

Care Coordination

Total overall costs

Total costs for beneficiaries with specific conditions

Quality of Care

Composite Score

Cost Composite

Score

VALUE-BASEDPAYMENT MODIFIER AMOUNT

2017 ADJUSTMENTS +4% vs zero vs -4% based on 2015 reporting2016: groups of 10+ 2017: all of us

Next: moderate sedation

• Propofol providers for >40% of GI endoscopy• We asked CMS in 2011 to remove moderate sedation from the endoscopy

“bundle” and to separately value…..”no thank you”• 2014 after review of all GI endo codes including MS value:

• NOW we intend to remove MS value when NOT performed• Pay separately for it when performed• “Budget neutral”

• 2015 CPT codes, RUC valuation recommended to CMS• DECISIONS PENDING $5-10 ? $30-40? And how is budget neutrality

applied? Our proposal: G codes, 2 codes, GI endoscopy and “the rest”

MACRA (HR 2) SGR repeal 2015 (YEAH!)

� Where we’ve been: Essentially no Medicare MD payment updates past 12 years…& commercial plan rates have moved to Medicare plus or minus…..

� ”Positive” physician fee updates 0.5% 2015 - 2019;

� 0 % 2020 -2025� Beyond 2025:0.75 % for eligible alternative payment model

(APM) participants, 0.25% for others.

2019

OPTION 1: Merit Based

Incentive Payment System

(MIPS)

OPTION 2:Alternative

Payment Models (APM)

2019-2025 . . .By 2019 There will be 2 Options to Satisfy Value Based Reimbursement Mandates

5%BonusMaybe4 years 0.5%

+9 to -9%

MMACRA programs will be….• Single consolidated quality program that rewards physicians who meet

performance (quality, cost) thresholds;

• MIPS path is the default, APM the option…�

• Merit-Based Incentive Payment System or MIPS, penalty risks for lowest performance quartile capped at 9%

• OR if you receive a significant share of revenues through participation in Alternate Payment Models (APMs) that involve financial risk and a quality reporting component will receive

5% bonus each year between 2019-2024

• Also incentivizes participation in private-payer APMs.

Two pathways: MIPS versus APMs• Point scale, threshold ?mean or median, penalty funds feed high

performers• Measurement categories:

• Clinical quality (by year 3 will be 30% of total composite score)

• Meaningful use (25%--but could be adjusted down to 15% if 75% of eligible professionals are meaningful users)

• Resource Use (10% in year 1, 15% in year 2, and 30% in year 3 and subsequent years

• Practice improvement (15%)• Additional weighting will be applied based on achievement,

improvement, and the applicability of each category to the type of EP

MIPS

Two pathways: MIPS versus APMs

• 5% annual bonus FFS payments for physicians with substantial revenue from alternative payment models that

• Involve upside and downside financial risk, e.g. ACOs or bundled payments

OR• Primary Care Medical Homes (PCMH), if shown to

improve quality w/o increasing costs, or lower costs w/o decreasing quality <no financial risk>

APM

APMs: required revenue thresholds• Two options available for eligible professionals to

qualify for the annual 5% FFS bonus:• First option: 2019-2020, 25% of Medicare payments must be

attributable to the APM; increasing to 50% in 2021• Second option: starting in 2021, 50% of combined payments

from Medicare and other payers must be attributable to the APM

What qualifies as an APM?• ACO is a “shared savings” model involving

hospital/medical groups/others…projected vs actual expenditures, margin shared with payor

• First generation ACOs: small % achieved saving $$$-�little or no trickle down to specialists

• What else will qualify? • RULES PENDING

Payment methods in ACO’s• Graduates toward capitation

• Flexibility how to spend funds• 2-sided risk, payor and ACO• Specialists downstream from funding source• Unless risk for specific patient populations or bundles/episodes of care (e.g.

colonoscopy, IBD care, chronic liver disease….)

• Form & leadership of the ACO is critical to understand & participate

PPham HH et al. N Engl J Med 2015;373:987-990.

Growth in the Number of Medicare Accountable Care Organizations (ACOs), 2012–2015.

Further concerns about ACO’s• Your quality reporting becomes the ACO’s quality measures• Your cost measures? Do you live in an expensive medical

neighborhood?• GI as “small provider” can become a buy-or-build decision for the

system, your PCP referral source may be aggregated and switched off if…..

• WOEFUL limitations of EHRs and lack of HIE’s, cost & capabilities of data analytics

APMs for GastroenterologistsWhat, me worry?• Colonoscopy bundled payment• Financial risk subcontracting within

ACOs?• ?What if our current contracts are with

capitated organizations (IPAs, contracting medical groups, PHOs etc)…is this a form of APM

• GI subcapitation• Episodes of care eg

• IBD• Chronic hepatitis, cirrhosis

• Specialty medical homes /garages

Consolidating quality measures: small ray of hope?

• CORE QUALITY MEASURES COLLABORATIVE just published (2/16) list of standard measures for primary care & 6 specialties including GI

• CMS, private payers, employer coalitions….• Must incorporate into CMS regs, programs; must incorporate in

private contracts• For GI: colon cancer & HCV measures familiar & in our registries now

• AND MAYBE MU3 will die a crib death

DO HOSPITALSOR PAYERSKNOW HOWTO LEADPHYSICIANS TO DELIVERHIGH QUALITYVALUE BASED HEALH CARE?

Can hospital-”owned” healthcare be effective in delivering value?• James Robinson (UC Berkeley) analysis 2014:• Expenditures for equivalent populations in managed care in

California• Care via independent docs (IPAs) 10% lower than systems oriented

around hospitals; • 20% further lower than systems integrated with hospitals• No better outcomes

Evolving choices

• Independent solo/small group? MANY challenges of management, compliance, integrated delivery, IT If can’t provide the data or work in high cost neighborhoods…

• Independent larger medical groups (single, multispecialty)• Hospital integration (“employed”): building empires arguably

focused on ‘feeding the mother ship’ more than on tightly managed integrated care

WHAT ELSE?• Value-based pharma? Contracting for value in its infancy in US

(look to Brits & Europe)• Equipment / devices

• Hurdles to innovation numerous FDA, CPT, RUC, CMS, payor coverage

• Specialty trained NPs, MA’s, “coaches”…cost & availability

Harold D Miller Sandra S Marks (AMA)

http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page

Episode groups development• Some of these episode groups have been used in feedback reports on resource

use to physician group practices, and been used to support bundled payment and hospital quality reporting programs. Comments to [email protected] by February 15, 2016.

• Care episode groups; patient condition groups: developing methods to describe or classify patient conditions, diagnoses; to describe relationship of physician to patient;

• Claims submitted as of Jan 1 2018 shall include the applicable codes established for care episode groups, patient condition groups, and patient relationship categories

GI Episodes under development

MODEL CATEGORY

3 days prior to 90 or 120 day global

Getting from here to there• Input on the future rules being collected now• Data for MIPS based on 2017…APMs will still use quality data• GI episodes of care need form & substance ASAP…with

low financial risk or financial support to re invent our practices• Eg PROJECT SONAR…roll out via DHPA groups• Eg Lili Brillstein MD, MPH Horizon BCBS initiatives

QQUESTIONS?• [email protected]

SELECTED MACRA PROVISIONS

Clinical Practice Improvement Activities. Professionals will beassessed on their effort to engage in clinical practice improvementactivities. The subcategories for these activities shall include atleast the following:· Expanded practice access· Population management· Care coordination· Beneficiary engagement· Patient safety and practice assessment· Participation in an APM

Clinical practice improvement activities. The clinical practice improvementactivities would be specified by the Secretary and would include at least thefollowing subcategories:a. expanded practice access, such as same day appointments for urgent needsand after-hours access to clinician advice;b. population management, such as monitoring health conditions of individualsto provide timely health care or participation in a qualified clinical dataregistry;c. care coordination, such as timely communication of test results, timelyexchange of clinical information to patients and other providers, and use ofremote monitoring or telehealth;d. beneficiary engagement, such as the establishment of care plans forindividuals with complex care needs and beneficiary self-managementassessment and training, and using shared decision-making mechanisms;e. patient safety and practice assessment, such as thorough use of clinical orsurgical checklists and practice assessments related to maintainingcertification; andf. participation in an alternative payment model.

AN APM IS DEFINED:• A model under the Center for Medicaid and Medicare Innovation (other than ahealth care innovation award);• Medicare shared savings program accountable care organization;• A demonstration under section 1866C of the SSA;• A demonstration required by Federal law.The term “eligible alternative payment entity” would mean an entity that (i) participates in an APM that requires participants to use certified EHR technology and provides for payment for covered professional services based on quality measures comparable to measures under the performance category described in the MIPS program established above, and (ii) bears financial risk for monetary losses under the APM that are in excess of a nominal amount, or is a medical home expanded under section 1115(c) of the SSA.

CARE EPISODES the bill would require the development of (1) care episode and patient condition groups and classification codes,(2) patient relationship categories and codes to facilitate the attribution of patients and episodes to physicians or applicable practitioners, (3) expanded claims to gather more information for resource use measurement, and (4) a methodology for resource use analysis.In order to classify similar patients into care episode groups and patient condition groups, the Secretary would be required to develop new classification codes. No later than 180 days after enactment, the Secretary would post a list of episode groups and related descriptive information as developed pursuant to the episode grouper (under current law). For 120 days after such posting, the Secretary would accept suggestions from physician specialty societies, applicable practitioner organizations, and other stakeholders for episode groups in addition to those posted as well as specific clinical criteria and patient characteristics in order to classify patients into (1) care episode groups and (2) patient condition groups. Taking into account this information, the Secretary would (a) establish care episode groups and patient condition groups that account for a target of an estimated one-half of Part A and Part B expenditures (with the target increasing over time as appropriate), and (b) assign codes to the groups.These patient relationship categories would include different relationships of the physician or practitioner to the patient (and the codes could reflect combinations of such categories). Examples of such relationship categories might include a physician or practitioner who1. considers himself or herself to have the primary responsibility for the general and ongoing care for the patient over extended periods of time;2. considers himself or herself to be the lead physician or practitioner and who furnishes items and services and coordinates care furnished by other physicians or practitioners for the patient during an acute episode;3. furnishes items and services to the patient on a continuing basis during an acute episode of care, but in a supportive rather than a lead role;4. furnishes items and services to the patient on an occasional basis, usually at the request of another physician or practitioner; or5. furnishes items and services only as ordered by another physician or practitioner.No later than one year after enactment, the Secretary would post a draft list of the patient relationship categories and codes on the CMS website. For 120 days after posting the list, the Secretary would seek comments from physician specialty societies, applicable practitioner organizations, and other stakeholders, including representatives of Medicare beneficiaries, regarding the patient relationship categories and codes To gather more information for resource use measurement, the Secretary would require that Medicare claims submitted on or after January 1, 2018 include the applicable codes as established above,

Sec 106 b Gainsharing This provision of H.R. 2 would require the Secretary, within six months of enactment and in consultation with the HHS Inspector General, to report to Congress with recommendations on amending existing anti-fraud and abuse laws (e.g., Civil Monetary Penalty and anti-kickback statutes) to permit physician-hospital gainsharing. The report must (1) consider what types of ownership interests, compensation arrangement, or other relationships should be covered; (2) describe how the recommendations address accountability, transparency, and quality, including how best to limit inducements to limit medically necessary care; and (3) consider whether any savings generated by gainsharing should accrue to Medicare.

Prepared by Hart Health Strategies, Inc. www.hhs.com, 03/19/15 (Updated 03/25/15)

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The Employer Perspective On Healthcare Reform

Marianne Fazen, Ph.D.

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Employers’ Post-Reform Challenges and Strategies

Marianne Fazen, PhDDFWBGH Executive Director

TBGH President & CEOMarch 11, 2016

2016 GI Roundtable

2

Today’s Discussion

� Key challenges facing employers

� Benefit design strategies

� Provider network strategies

� Employee engagement & empowerment strategies

GI Roundtable – DFW 2016

3

Employers’ Key Challenges

� Controlling healthcare costs� High cost claims

� Specialty Rx

� ACA compliance

� Employee confusion and/or indifference


4

Rising Healthcare Costs

� Caps on govt. reimbursements shifting costs to private payers

� Health plans raising premiums to compensate for losses on public exchanges

� Aging baby-boomers staying in workforce longer and using more healthcare

� Higher out-of-pocket costs for employees


5

High Cost Claims

� No annual or lifetime limits on medical benefits (ACA)

� Catastrophic claims over $175,000 are increasing dramatically � Heart transplant: avg. cost = $550,000

� Bone marrow-stem cell transplant: avg. cost = $475,000

� Cancer care and muskuloskeletal claims among highest costs and prevalence for private payers


6

Specialty Pharmacy

� Est. 50%-60 % of employers’ total healthcare spend in 2016

� Impacts only 2% of employee population

� Pipeline if full of new high-priced specialty drugs

� Oncology drugs are most expensive� $1,200 - $12,000 a month� Avg. cost of new cancer drugs is $100,000/yr.

� Threat of strong govt. action may drive changes in pharmacy business models


7

Benefit Design Strategies to Control Costs

� High deductible/consumer-directed health plans

� Defined contribution models

� Monitor spousal & dependent eligibility; impose spousal surcharge

� Restrictive pharmacy policies

� Precision medicine/genomic testing


8

Provider Network Strategies to Control Costs

� Narrow provider networks

� High performance networks/Centers of Excellence

� Direct contracting with IDNs & ACOs

� “Pay-for-value” replacing fee-for-service� Bundled payments/ Flat fees for selected procedures

� Reference-based pricing

� Capitation for managing population health (e.g. diabetes)


9

ACA Compliance

� Employer insurance mandate in 2015

� Compliant benefit design: � Affordable (no more than 9.5% of pay)

� Required coverage: free preventive services, prenatal care, mental health parity, etc.

� Out-of-pocket cap: $6,600

� New reporting rules

� “Cadillac Tax” in 2020 (or repealed)


10

Strategies to Engage & Empower Employees

� Concierge & Navigator services

� Price & quality transparency tools

� Financial incentives/disincentives

� Technology-enabled digital and mobile tools

� Education in healthcare & health benefits literacy


11

Strategies to Improve Employee Health

� Worksite Wellness Programs

� Biometrics/health improvement accountability

� Telemedicine and “Convenience care” in lower cost settings using non-physicians

� Big Data & data analytics to identify and manage high cost conditions for better outcomes

� Mobile medical apps & digital technologies (personal tracking devices, personal health information “vaults”, diabetes monitoring)


12

Thank You!

Contact:Marianne Fazen, PhD

Dallas-Fort Worth Business Group on HealthPhone: 214-382-3036

Email: [email protected]

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Like Butch Cassidy And The Sundance Kid - Physician

Groups Must Relentlessly Pursue Innovative Approaches In The

Pursuit Of Value

Michael Deegan, M.D.

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GI Roundtable Fort Worth March 10 – 12, 2016 Specialty Care in a Value-Based World Michael J. Deegan, M.D.,D.M. Clinical Professor; Healthcare Leadership & Innovation Naveen Jindal School of Management The University of Texas at Dallas

Macro-Trends as Drivers of Change

•  US health care costs not sustainable •  Changing demographics •  Changing consumer expectations •  Advances in science & technology •  Ubiquity of information & communication technology

Old & New Healthcare Paradigms OLD NEW ·Locus of control Provider Person ·Emphasis Disease Health ·Access By Appointment 24 / 7 ·Data collection Episodic Real time; continuous ·Analytic tools Limited Many ·Information Limited; highly Ubiquitous controlled ·Peer connectivity No Yes ________________________________________________ Adapted from Terini P: Fitting Together Videogames & Health; Robert Wood Johnson Foundation 2011.

Financial Drivers: Current vs. Future

Current – Volume Based ·low accountability for cost of care ·population defined as patients who seek care ·infrastructure limits ·culture rewards more care �

Future – Risk-Based ·high accountability for cost of care ·population defined as every patient in panel ·infrastructure supports full panel management ·culture rewards value

AMGA – ACOs & Population Health Management

Provider Risk Under Alternate Payment Systems*

Cost # Conditions # EOC # / Type Services # Processes Cost = X X X X Person Person Condition EOC Service Process

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CMS – HHS National Quality Strategy

THREE AIMS �  Better Care: improve the overall quality of care by making healthcare more person- centered, reliable, accessible and safe �  Healthier People, Healthier Communities: improve the health of Americans by supporting proven interventions to address behavioral, social and environmental determinants of health and deliver higher-quality care �  Smarter Spending: reduce the cost of quality healthcare for individuals, government and communities

The Reimbursement Tsunami

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Business Model Typology*

�  Solution Shop �  Value-Added Process Business �  Facilitated Network Business

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Solution Shop · Organizations designed to identify [diagnose] and recommend solutions to unusual or unique challenges [problems] · Deliver value to customers using expertise resident in their expert staff – most problems unique and require customized solutions · Examples: consulting firms, advertising agencies, R & D firms, legal firms, general hospitals, SPECIALTY PHYSICIAN PRACTICES

Value Added Process Business · Transforms resource inputs – people, materials, energy, equipment, information, capital – into outputs of higher value · Work is often repetitive and the ability to deliver value rests in the work processes, staff, equipment and other operating functionality · Examples: restaurants, auto manufacturing, smart phones – many medical events or procedures are value-adding process activities [cataract surgery, joint replacement surgery, colonoscopy]

Map of Common Medical Conditions*

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Migraine Depression

IBD MS

AAA Appendicitis

Asthma

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Strep Throat Fractures

MI CVA

Pulmonary Embolism

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ACCOUNTABLE CARE

Accountable Care Organization DEFINITION *

“An ACO is a group of providers who have organized themselves in a way that enables them to take ACCOUNTABILITY for the overall quality of care and total cost to payers of all or most of the health care services needed by a group of patients over a period of time.”

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ACO Prevalence & Cluster Types *

· > 700 in US [at time of data collection] · 55% - 1 Contract · 50% Commercial payer contracts · 36% Medicare only contract · 16% Medicare + commercial contracts Cluster Types Larger IDS Smaller physician-led Hybrid jointly-led

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Physician Practice ACO Participation - California vs. All Other States *

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Early ACOs Not Focused on Specialists*

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Specialists & ACOs *

“A lesson learned in the 1990s�.is that specialist incentives and behavior play a much larger role in care redesign than is currently accounted for by most ACOs. Specialists, not PCPs, are responsible for the majority of spending in medicine�..as ACOs begin to form they must address the challenge of managing the cost of specialty care through a combination of disease prevention and reduction of specialist utilization.”

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ACO Specialty Providers · Selective participation · frequent patient contact · infrequent patient contact · Full member or contract provider? · Develop PCP relationships thru shared goals and priorities · Provide guidelines to primary care physician practices for common conditions

Bundled Payments

· A single payment for a condition, treatment or procedure · Includes a pre-defined set of services from multiple providers and sites · Improves health care value by: · controlling costs · improving provider communication & collaboration · Improving patient outcomes while reducing mal-occurrences

Benefits of Bundled Colonoscopy

· Informs and aligns patient expectations · Coordinates care among providers · Improves procedure quality and results: ·prep ·complete exam ·adenoma detection rate ·complications / post-procedure care · Encourages adoption of evidence-based guidelines · Consolidates costs into a single fee

Colonoscopy Bundle*

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Value Added Process Business · Transforms resource inputs – people, materials, energy, equipment, information, capital – into outputs of higher value · Work is often repetitive and the ability to deliver value rests in the work processes, staff, equipment and other operating functionality · Examples: restaurants, auto manufacturing, smart phones – many medical events or procedures are value-adding process activities [cataract surgery, joint replacement surgery, colonoscopy]

Changing PCP – Specialist Relations

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�  Enrollment size really matters [25 – 50K lives] �  Care management systems and processes for high risk – high cost patients are key > Effective EHR and HIE capability essential �  ALL PAYERS agree on COMMON, FOCUSED set of Quality Metrics �  Providers ability to develop COC alliances �  Enhanced Patient – Family care engagement

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“One of Thomas Kuhn’s most prominent conclusions was that when a new paradigm was emerging from the work of scientists, the experts in the old paradigm, remained convinced, even to their dying days, the new paradigm cannot possibly be true. The reason is the old paradigm has so powerfully shaped their beliefs�their minds literally cannot see the phenomena leading to the new paradigm.” [pg. 412]*

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QUESTIONS – COMMENTS

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ROUNDTABLE DISCUSSION

The Future Of Specialty Medicine: 20/20 Vision

Moderator: Tom Deas, M.D.

[no syllabus materials]


Thomas M. Deas, Jr., M.D. Tom Deas is board certified by the American Board of Internal Medicine in both Internal Medicine (1981) and Gastroenterology (1989). He began his gastroenterology medical practice in Fort Worth in 1991 after serving 20 years in the U.S. Air Force, retiring as Colonel. After 23 years of GI practice in Fort Worth he retired from Gastroenterology Associates of North Texas in December 2014. His education includes a B.S. and M. S. in Chemistry from Baylor University 1970, 1971. While serving in the USAF, he received his M.D. from Louisiana State University School of Medicine in Shreveport graduating with honors (1978). Postgraduate medical training at Wilford Hall USAF Medical Center in San Antonio included an internal medicine residency (1978-‐-‐81) and gastroenterology fellowship (1986-‐-‐88). In 2001 he earned a Masters of Science in Medical Management from the University of Texas Dallas Business School and UT Southwestern Medical School. He served as Medical Director of the Fort Worth Endoscopy Center and the SW Fort Worth Endoscopy Center from 1995-‐-‐2012. He is also a member of the Physician Advisory Board for Surgical Care Affiliates, corporate partner for the ambulatory endoscopy centers. In 2014 he was appointed to Ambulatory Surgery Center Association (ASCA) Board and the ABIM Gastroenterology Subspecialty Board. He has served in leadership positions with ASGE as committee chair, board member, treasurer, and as president, May 2012-‐-‐13. From 2008-‐-‐2012 he served on the Advisory Board for the GI Quality Improvement Coalition (GIQuIC), the first gastroenterology quality registry established in 2008. He was President of North Texas Specialty Physicians (NTSP) from 2002-‐-‐2008 and has served on NTSP’s physician board 1998-‐-‐2013. NTSP is an


independent practice association (IPA) that has successfully managed the following innovations:

• 1996-‐-‐successful management of 60,000 Medicare Advantage patients • 2006-‐-‐developed SandlotConnect, north Texas’ first health information exchange • 2008-‐-‐formed Care N Care (CNC), Medicare Advantage PPO, wholly owned by NTSP

(10,000 members) • 2012-‐-‐formed PLUS, Medicare Pioneer ACO in partnership with Texas Health

Resources As Chief Medical Officer for SandlotConnect and President of CNC, Dr. Deas has been an outspoken advocate for improving patient care through health information technology which provides point of care clinical information, analytics, and facilitates care coordination and population health.

��



Do I Hold 'Em Or Fold 'Em - Key Strategic Challenges In 2016,

And Practical Solutions

Moderators: Gene Overholt, M.D. & Jim Weber, M.D.



Bergein F. Overholt, M.D., MACP, MACG Dr. Overholt is a graduate of the University of Tennessee Medical School. He did his internship, residency and gastroenterology fellowship at University Hospital in Ann Arbor, Michigan and additional gastroenterology fellowship training at New York Hospital-‐Cornell Medical Center. He is Managing Partner of Gastrointestinal Associates (GIA) in Knoxville, TN. His efforts led his group in the development of the first licensed and accredited endoscopic ambulatory surgery center in the USA. He is now leading the development of an innovative Quality and Value program for GIA. Dr Overholt has been involved with technology development his entire professional career and received the prestigious Schindler Award from the American Society for Gastrointestinal Endoscopy and the William Beaumont Award of the American Medical Association for the development of flexible fiberoptic sigmoidoscopy. Dr. Overholt served as the Medical Director of the Laser Center of the Thompson Cancer Survival Center until 2011 where he pioneered the development of photodynamic therapy and radiofrequency ablation (BARRx) of precancerous esophageal disease. He is a past president of the American Society for Gastrointestinal Endoscopy and the American Association of Ambulatory Surgery Centers and is widely published in the field of gastroenterology.


James J. Weber, M.D.

Jim Weber is the President and Managing Partner of Texas Digestive Disease Consultants; a professional association of 60 gastroenterologists in the Dallas Fort Worth area. He is the Medical Director of two exceptional endoscopy centers, Lonestar Endoscopy in Keller, TX and the newly opened Lonestar Endoscopy in Flower Mound, TX. He is currently working to build a large regional gastroenterology association in Texas, to be called SAGE, Specialists in Advanced Gastroenterology and Endoscopy, which will be the largest gastroenterology group in the country.

Academic achievements include:

• Undergraduate degree in Biomedical Science from Texas A&M University • Medical Degree from UT Southwestern Medical School in Dallas • Internal Medicine Residency at Parkland Memorial Hospital in Dallas • GI Fellowship at Baylor University Medical Center in Dallas • GI Board certified in 1993, 2003 and 2013

He is currently associated with the:

• American Gastroenterology Association (AGA) • American College of Gastroenterology (ACG) • American Society for Gastrointestinal Endoscopy (ASGE) • Texas Society for Gastroenterology and Endoscopy (TSGE) • Crohn’s and Colitis Foundation of America (CCFA)

��



Shifting To Warp 10 - Putting Practice Operations

Into Pony Express Mode

Moderators: Reed Hogan, M.D. & Arnold Levy, M.D.



Reed B. Hogan, M.D. Reed B. Hogan is one of the gastroenterologists at the Jackson GI Associates and Endoscopy Center and the Madison GI Associates and Endoscopy Center. He received his Bachelor of Science in Biochemistry at Delta State University and went on to pursue a Doctor of Medicine at the University of Mississippi School of Medicine. He fulfilled his residency and internship requirements in Internal Medicine at the University of Mississippi Medical Center and completed a fellowship in Gastroenterology at Baylor University Medical Center. He is board certified in Internal Medicine and Gastroenterology. Dr. Hogan was elected by his peers for inclusion in Best Doctors in America®: 1996-‐-‐2013. He has an extensive list of research experience and has authored numerous scientific publications. In addition to working at the GI Associates, he is Clinical Assistant Professor of Medicine at the University of Mississippi School of Medicine and is Chairman of the American Society of Gastrointestinal Endoscopy (ASGE) special interest group for Ambulatory Endoscopy Centers and also serves on the Practice Management Committee for ASGE. Dr. Hogan is president of Maregade Rx and has also been listed in the 2012 Beckers’ “The 125 Gastroenterologists to Know.” Personal interests include sports photography and tennis.


Arnold G. Levy, M.D. Arnold G. Levy is the President and CEO of Capital Digestive Care LLC, a 57 physician practice in the Washington, D.C. and metro Maryland region. He is one of the two founding members of Capital Digestive Care, which since its inception by merger of 7 GI practices in January of 2009, has become the largest GI practice in the Mid-‐Atlantic and the Northeast part of the country. He received his BA degree (valedictorian) and MD degree (with distinction) in 1968 and 1971 from The George Washington University, did his internal medicine training at Strong Memorial Hospital (University of Rochester – NY), served in the United States Public Health Service as a Clinical Associate in GI at the NIH, and returned to GWU for additional GI fellowship training and service as Chief Medical Resident prior to entering private practice in 1977. He has served on the National Digestive Diseases Advisory Board and as a member of the Board of the National Digestive Disease Information Clearinghouse. He is boarded in internal medicine and gastroenterology, and is an Associate Clinical Professor of Medicine at GWU. He is a FACP and a member of ACG, AGA, ASGE, CCFA, and the Maryland State Medical Society. He is active in medical politics in the state of Maryland, with the focus of protecting the integrative model of medical private practice. In this role he serves at the President of the Maryland Patient Care and Access Coalition (and its PAC) representing many large subspecialty private practice groups with over 300 physician members. Voted by his peers as a Washington “Top Doctor,” he has worked to assist other practices develop strong practice management techniques.

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Thinking 'Big' In Pursuit Of 'Small' - Establishing A Weight Management

Program In Your Practice

Gene Overholt, M.D.

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THINKING 'BIG' IN PURSUIT OF 'SMALL' __

ESTABLISHING A WEIGHT MANAGEMENT PROGRAM IN

YOUR PRACTICE

Bergein F Overholt, MD �

GI Roundtable, 2016 Gastrointestinal Associates Knoxville, TN

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No relevant disclosures

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DEFINITION OF OBESITY

Obesity: Body Mass Index (BMI) of 30 or higher. BMI Weight Status

Below 18.5 Underweight

18.5—24.9 Normal

25.0—29.9 Overweight

30.0 and Above

Obese

Obesity Classification I

BMI

30.00 - 34.99

II 35.00 - 39.99 III ≥40.00

FACTS:

- More than one-third (35.7 percent) of adults are

considered to be obese.

- More than 1 in 20 (6.3 percent) have extreme

obesity.

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Does your state have an obesity problem?

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2012

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2013

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2014

Does your community have an obesity problem?

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If there were an endoscopic technology that provides an

advantage for a Weight Management Program in your

practice -

- then what ?

- would you develop your GI WMP?

What endoscopic technologies are available?

Orbera Intragastric Balloon

Reshape Duo Intragastric Balloon

Spatz Adjustible Balloon System

Obalong Gastric Balloon

BARONova Transpyloric Shuttle

Full Sense Device

Aspire Bariatrics Aspiration Therapy

Endoscopic Sleeve Gastroplasty w/Overstitch Sewing Device

Primary Obesity Surgery Endoluminal (POSE)

Now, let’s look at the data

ASGE Preservation and Incorporation of Valuable

Endoscopic Innovations document

- PIVI –

An approved device/method that meets PIVI thresholds is

appropriate for consideration for clinical adoption

(subject to safety, training, etc)

PIVI threshold (ASGE; ASMBS):

1. Minimum of 25% EWL @ 12 months in pts with

BMI >35

2. EWL > 15% over control group

3. Risk is <5% SAE

Orbera IGB

: 25.44 % EWL @12 months

(n = 1638; 17 studies)

: mean difference in % EWL over

controls of 26.9%

(n = 131 IGB; n = 95 control)

Orbera IGB meets PIVI thresholds for clinical

adoption

GIE. 2015. 82:425-38

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Reshape Duo : 18.8% % EWL @12 months

(n = 136; pivotal study)

: at 24 weeks, twice the weight

loss compared to

controls

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REDUCE Pivotal Trial

Is there an opportunity for a Weight Management

Program in your practice?

Is there an opportunity for a Weight Management

Program in your practice?

- YES -

- if done for the right reasons and in the right way -

Done for making $$$$ NO!

Done to help patients YES

Done to make the practice better YES

Treatments:

-lifestyle changes:

-exercise

-diet

-behavioral modification

-pharmacotherapy

-surgery

Prescription Medications:

Malabsorption: Orlistat (Xenical)

Serotonin Antagonist: Lorcaserin (Belviq)

Sympathomimetic: Phentermine (Adipex-P, Suprenza)

Phentermine-topiramate (Qsymia)

Antidepressants: Bupropion (Welbutrin)

Antiepilectics: Topiramate, Zonisamic

Combination drugs: Bupropion/naltrexone (Contrave)

Diabetic drugs: Metformin

Pramlintide

Exenatide

Liraglutide

Apovian et al. J Clin Endocrinol Metab 2015;100:342-62

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Surgical Procedures

- Rou-en-Y Gastric Bypass

- Laparoscopic Adjustable Gastric Banding

- Sleeve gastrectomy

- Biliopancreatic Diversion with Duodenal Switch

Treatments:

-lifestyle changes:

-exercise

-diet

-behavioral modification

-pharmacotherapy

-surgery

Do they work?

YES, but ��.

The question for gastroenterologists:

If there is an effective endoscopic approach for

weight management,

- is there an opportunity in your practice

for an endoscopic assisted Weight

Management Program?

YES

but ��.

Do it for the right reasons:

Done for making $$$$ NO!

Done to help patients YES

Done to make the practice better YES

What is required?

A WMP for a GI Practice requires:

- leadership

- long term commitment

- resources

- training

- technology

First Major Step: THE PRACTICE DECISION:

Whether to develop a comprehensive,

multidisciplinary, long term (12-24 month)

WMP with the ultimate goal being to change

the patient’s attitudes and practices toward

lifestyle, diet and exercise

What is required?

1. Lead physician(s)

: be the champion, the leader, the “do-er”

: takes the personal training and education

: in turn, trains the WMP team, practice, ASC

: participates in developing the business plan

: participates in marketing

: makes it happen

What is required?

1. Lead physician(s)

2. Approval and Support of the physicians

(board approval)

What is required?

1. Lead physician (champion)

2. Approval and Support of the physician (board)

3. Administrative support

- CEO: Business Plan;

Practice Infrastructure

- RCM: Cash Payment

Billing and Collection

What is required?

1. Lead physician (champion) 2. Approval and Support of the physician (board) 3. Administrative support

4. Endoscopy Center procedure approval credentialing physicians (training) education team equipment (including the intra-gastric balloon)

What is required?

1. Approval and Support of the physician (board) 2. Lead physician (champion) 3. Administrative support 4. Endoscopy Center 5. Anesthesia

What is required? 1. Approval and Support of the physician (board) 2. Lead physician (champion) 3 Administrative support 4. Endoscopy Center: 5. Anesthesia

6. Staff: Physician leader (champion)

Program Director (cheerleader)

Dietician (cheerleader)

Contracted or Employed: - exercise physiologist - psychologist Others: - RCM: billing and collection

What is required?

1. Approval and Support of the physician (board) 2. Lead physician (champion) 3. Administrative support 4. Endoscopy Center: 5. Anesthesia 6. Staff

7. Equipment - Balloon - Scales - Phone App (My Fitness Pal) - Exercise monitor (Fitbit)

What is required?

1. Approval and Support of the physician (board) 2. Lead physician (champion) 3. Administrative support 4. Endoscopy Center: 5. Anesthesia 6. Staff 7. Equipment

8. Marketing

What is required?

8. Marketing:

- Name, logo

- Web site

- Printed materials

- Referring MDs

- Practice MDs

- Practice staff

- Existing patients

- News Media

- Social Media : Twitter, Facebook

- Health fairs

Marketing budget:

Enrollment

- Relationships and Accountability

- Patient Education : Realistic expectations : Procedures : Diet and Nutrition : Exercise : Electronic communication (phone app; exercise monitor) : Finance

- Weight and measurements. Photos.

- Physician assessment (H/P)

“I definitely want to be convinced that each patient whom I take is dedicated to weight loss and a lifetime of fitness. I also want to be sure that they are not completely crazy.”

CMO, 1-28-16

Financial

: Bundled pricing (all inclusive)

- Cash

- Financing option

Monitoring

- FREQUENT

- face to face

- phone

- use technology to assist ***

- track (graphing)

- ENCOURAGEMENT

Malpractice Insurance

Developing a WMP

: the right way

: for the right reasons

- helping patients

- building the practice

- improving revenues

ESTABLISHING A WEIGHT MANAGEMENT PROGRAM IN YOUR PRACTICE

Requires:

1. Approval and Support of the physician (board) 2. Lead physician (champion) 3. Administrative support 4. Endoscopy Center: 5. Anesthesia 6. Staff 7. Equipment 8. Marketing 9. Enrollment 10. Financial 11. Monitoring 12. Malpractice Insurance

2 Months – 35#

Thank

you!

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Decisions At Sundown (And Sunset) - GI Gunslingers

Discuss Critical Practice Transitions

Moderator: Klaus Mergener, M.D.



Klaus Mergener, M.D., Ph.D., M.B.A. Dr. Klaus Mergener attended medical school in Frankfurt and Heidelberg, Germany, and at Duke University and Harvard University in the U.S. He completed his MD/PhD-‐thesis summa cum laude with 2008 Nobel Prize Laureate Dr. Harald zur Hausen at the German Cancer Research Center in Heidelberg before returning to Duke University for his residency in internal medicine and his fellowship training in gastroenterology and interventional endoscopy. He received his MBA from the University of Massachusetts at Amherst. A diplomat in several national medical organizations, Dr. Mergener is board-‐certified in Gastroenterology, Medical Management, and Healthcare Quality Management. He is a Partner at Digestive Health Specialists and currently serves as the Director for Interventional Endoscopy at Tacoma General Hospital in Tacoma, WA. He is an Affiliate Professor of Medicine at the University of Washington in Seattle, WA. Dr. Mergener is a recent member of the Governing Board of the American Society for Gastrointestinal Endoscopy (ASGE) and the current Vice-‐Chair of the ASGE Foundation Board of Trustees. He served as Associate Editor for Gastrointestinal Endoscopy from 2009 until 2014. Dr. Mergener’s areas of clinical expertise include cancer prevention, interventional endoscopy, biliary and pancreatic diseases. He has authored approximately 100 articles and book chapters, and has presented invited lectures at regional, national, and international conferences. In addition to his clinical and administrative activities, Dr. Mergener enjoys volunteer medical service. He has worked for extended periods of time at hospitals in various developing countries including Sri Lanka and Tanzania. Dr. Mergener is fortunate to be supported by his wife, Dr. Sabine Endrigkeit, and their children Johanna and Philipp who share his passion for volunteerism and community service.

Invites You to a Winetasting from Hawley Winery

Friday, 5:00-6:30 PM, The Terrace, Mezzanine Level

Bradford Mountain perches above Dry Creek Valley at over 1,000 feet above sea level. On the rocky Eastern slopes, Hawley Vineyard and Winery sits well above the fog that blankets the valley floor most mornings. The hillside soil is rocky and weak; the topsoil washed down to the valley floor centuries ago. Our vines have to toil for water and nutrients and it is through this struggle that great grapes are born.

Ten acres of the estate are plated to grapes: Merlot, Cabernet, Cabernet Franc, Zinfandel, Petite Sirah and Viognier. From the steep trellised rows at the top of the vineyard, you can see from one end of the valley to the other.

ESTATE VINEYARD FACTS First Hawley Vintage: 1995 Annual Case Production: 3500 Hawley Vineyard Elevation: 1000ft Soil Type: Boomer Loam Climate Classification: Region II Estate Vineyard Acreage: 9.5

Please enjoy tasting:

2014 Viognier, 2014 Chardonnay, 2011 Meritage, 2011 Cabernet


James J. Weber, M.D.

Jim Weber is the President and Managing Partner of Texas Digestive Disease Consultants; a professional association of 60 gastroenterologists in the Dallas Fort Worth area. He is the Medical Director of two exceptional endoscopy centers, Lonestar Endoscopy in Keller, TX and the newly opened Lonestar Endoscopy in Flower Mound, TX. He is currently working to build a large regional gastroenterology association in Texas, to be called SAGE, Specialists in Advanced Gastroenterology and Endoscopy, which will be the largest gastroenterology group in the country.

Academic achievements include:

• Undergraduate degree in Biomedical Science from Texas A&M University • Medical Degree from UT Southwestern Medical School in Dallas • Internal Medicine Residency at Parkland Memorial Hospital in Dallas • GI Fellowship at Baylor University Medical Center in Dallas • GI Board certified in 1993, 2003 and 2013

He is currently associated with the:

• American Gastroenterology Association (AGA) • American College of Gastroenterology (ACG) • American Society for Gastrointestinal Endoscopy (ASGE) • Texas Society for Gastroenterology and Endoscopy (TSGE) • Crohn’s and Colitis Foundation of America (CCFA)

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BREAKOUT #1: ADMINISTRATORS/MANAGERS

The Wild West Of

Practice Administration - Challenges And Solutions

Moderator: Rachel Todd, MBA


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BREAKOUT #2: PHYSICIANS

Upper GI Endoscopy Innovations - Coming To A Practice Near You

Amitabh Chak, M.D.

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Upper GI Endoscopy Innovations:

Coming to a Practice Near You

Amitabh Chak, MD University Hospitals Case Medical Center

Case Western Reserve University Cleveland, OH

Disclosure

�  CWRU and Amitabh Chak have patents on device and biomarkers for BE screening

Objectives

�  Innovations in BE Screening

�  Innovations in BE Surveillance

�  Innovations in BE Therapy

�  Innovations in Achalasia Therapy

�  Innovations in Resection of Neoplasia

Chak’s Criteria For Adoption of Innovations - PEACE

�  Performance - adequate sensitivity and specificity (PPV and NPV) for desired clinical indication

�  Ease - interpretable by endoscopists; shallow learning curve; high inter-observer agreement

�  Adoption - easily incorporated into clinical practice

�  Cost(reimbursement) – not overly expensive for specific clinical indication; CMS Code goes a long way

�  Effective – leads to improved outcomes

CHALLENGES – BE Screening

•  Though Barrett’s esophagus (BE) is the precursor of esophageal adenocarcinoma (EAC), screening of general population is not recommended

•  Less than 10% of EACs occur in previously diagnosed BE;

•  40% of subjects with EAC have no prior history of GERD

•  Approaches that can detect BE more easily and at less expense than EGD and biopsy need to be developed

Alternative Strategies for Screening

� Unsedated transnasal esophagoscopy

� Video capsule

� Balloon/brush cytology

Sensitivity is 60 – 70%

Cytosponge (Kadri et al., BMJ 2010)

©2010 by British Medical Journal Publishing Group

Sensitivity = 73%; Specificity = 94% in over 500 screened subjects

VIM Methylation has 90% sensitivity in esophageal brushings

for detection -CEBP

PEACE – Innovations for BE Screening

�  P – TNE as good as EGD; Video Capsule not so good; Capsule/molecular marker still developing

�  E – TNE requires skill; capsules easier

�  A – TNE not widely adopted; video capsule no uptake; capsules unknown

�  C – TNE less expensive than EGD; video capsule expensive; capsule/molecular marker less so

�  E – remains to be seen

CHALLENGES – BE Surveillance

•  Endoscopic surveillance based on identifying

dysplasia is ineffective. •  Depends on Pathology Interpretation •  Sampling errors •  Over surveillance •  Under surveillance

•  Approaches that can improve diagnosis and

detection of dysplasia would make surveillance more effective

Advanced Imaging Strategies

� Global (“red flag”) Techniques �  High Definition Endoscopy �  Chromoendoscopy (methylene blue, indigo carmine, Lugol’s) �  Virtual Chromoendoscopy (NBI, FICE, I-scan) �  Fluorescence Endoscopy

� Focal Techniques �  High Magnification Endoscopy �  Optical Coherence Tomography �  Confocal Microscopy

Sharma et al. (GIE 2006, 51 pts, 8 LGD, 7 HGD) Kara et al. (GIE 2006, 63 pts)

Regular villus/gyri patterns Flat w/ long vessels

Irregular disrupted patterns Irregular or abnormal vessels

Randomized Study of HD-WLE vs. NBI Surveillance (Sharma et al., Gut, 2013)

�  123 pts surveyed at 3 centers. 4 quad random biopsies done with HD-WLE; targeted biopsies with NBI

�  Both modalities detected IM in 92% of pts; NBI required fewer biopsies

�  NBI targeted bx detected a higher proportion of areas with dysplasia but no difference in proportion of patients with dysplasia

AF - Kara et al. (EGD vs. AFI in 60 pts, GIE 2005)

Dysplastic tissue is biochemically (collagen, FAD, NAD) different and fluoresces differently Excite at 370-470 nm; detect at 500-630 nm; display fluorescence in false color; green is normal; purple is dysplastic 21 pts with endoscopically detectable HGD/Ca – six detectable only with AFE; however, 40% false positive rate

Trimodal Endoscopy – Combines High Res, AFI and NBI (Kara et al., GIE 2006)

Trimodal – BE Surveillance

�  Curvers et al. GIE 2011 - SE vs TMI in 99 BE pts with LGD; �  TMI had higher targeted biopsy yield and detected 22

additional lesions �  TMI was no better than standard endoscopy for overall

yield

�  Curvers et al., Gastro 2010 – SE vs TMI in 87 BE pts; 3 institutions �  TMI had higher targeted yield but not overall yield �  NBI reduced false positives from 71% to 48% but misclassified

17% HGD/Ca as not being suspicious

�  TMI cannot be recommended for BE surveillance

PEACE for BE Surveillance Global Techniques--VCE/AFI

�  P – BE surveillance not yet improved

�  E – interpretation of histology needs training; But NBI is easy

�  A – High Res/NBI have been partially adopted

�  C – expense of HR/NBI built in to newer systems

�  E – no studies yet that they improve outcome

Focal - Optical Coherence Tomography

�  Processes coherent back scattered light providing near microscopic resolution.

BroadbandOptical Source

EnvelopeDetector Frame

Grabber ComputerDisplay/Recording

50/50

OpticalCirculator

III

I II

-

+Σ

DifferentialDetector Module

Operator Controls

Probe Control

Unit

DelayLine

CatheterProbe

BLOCK DIAGRAM OF EOCT SYSTEM

NORMAL SQUAMOUS BARRETT S

HIGH GRADE DYSPLASIA CANCER

Isenberg et al. (314 paired OCT streams and biopsies in 33 pts) �  Sens for dysplasia =

68%; Spec = 82%; PPV = 53%

�  OCT has not yet been proven useful for identifying dysplasia

�  3-D OCT (VLE) reported to identify buried glands post RFA

Confocal Imaging Probe

Kiesslich et al. Clin Gastro Hep 2006

HGD

Early Cancer

156 areas in 63 patients

BE Sens/Spec/PPV = 98%/94%/97% Neop Sens/Spec/PPV = 93%/98%/93%

CLE Trials in BE

�  Dunbar et al. GIE2009 (Tandem MCT in 46 high risk BE patients) – CLE increased proportion of biopsies that showed dysplasia and decreased number of biopsies. No increase in number of patients detected.

�  Sharma et al. GIE2011 (Tandem MCT in 101 high risk pts) – pCLE had a better sens/spec (88%/84%) than NBI/WLE (45%/88%) but did not increase number of pts detected with dysplasia

Focal Techniques-- High Mag/OCT/Confocal

�  P - limited ability to survey wide areas

�  E – interpretation not always easy; CLE requires injection of fluorescein

�  A - Endoscopist might not be willing to become pathologists; hard to replace biopsy

�  C – expense doesn’t yet justify the benefit

�  E – no studies yet that they improve outcome

Innovations in BE Therapy

Barrett’s Therapy

Innovations in BE Therapy

�  Endoscopic Mucosal Resection (EMR)

�  Radiofrequency Ablation (RFA)

�  Cryotherapy

Indications for EMR

�  High Grade Dysplasia in a short segment of BE

�  Nodular HGD

�  Early Cancer �  Moderately or well differentiated cancer �  No ulceration or depression �  T1a cancer (< 5% mets) w/o lymphovascular invasion �  ??T1b < 100um??

Barrett’s and Esophageal Cancer

Ell, et al. GE 2007;65:3-10

• 100 patients •  36.7 month (mean)

follow up

80%

91%

11% 12%

0%

20%

40%

60%

80%

100%

Intention to Treat Per Protocol

RFASham

* p<0.001

*

*

Complete Response Dysplasia (CR-D) HGD Cohort (n=43)

NEJM 2009 Aim Dysplasia Trial – Shaheen et al.

Efficacy of Nitrogen Cryo Multicenter Case Series (n=66) (Shaheen et al. GIE, 2010)

Indications For Ablation

�  Flat high grade dsyplasia

�  Ablation of remaining BE after mucosal resection

�  Low Grade Dysplasia �  Confirmed by two expert pathologists �  Multifocal LGD �  Persistent LGD

PEACE Criteria – Innovations in BE Therapy

�  P – EMR and RFA both prevent progression of HGD to Cancer; cryo data more limited

�  E – all therapies require additional training

�  A – adopted at tertiary centers and many practices

�  C – endoscopic therapy cost effective compared to esophageal surgery

�  E – No reduction in esophageal cancer to date

Innovations in Achalasia Therapy

Challenges in Achalasia

�  Although effective, pneumatic dilation for achalasia is limited to select centers because of risk of perforation.

�  Botulinum toxin injection is easy but not durable. Has gone out of favor.

�  Peroral endoscopic myotomy (POEM) is a rapidly developing endoscopic technique that is nearly equivalent to a surgical Heller procedure (without a wrap).

Per-Oral Endoscopic Myotomy (POEM) �  Prospective, international, multicenter trial (n=70)

�  Three months after POEM, 97% of patients were in symptom remission (95% confidence interval, 89%-99%)

�  Symptom scores were reduced from 7 to 1 (P < .001) and LES pressures were reduced from 28 to 9 mm Hg (P < .001).

�  Patients in symptom remission at 6 and 12 months was 89% and 82%, respectively.

�  POEM was found to be an effective treatment for achalasia after a mean follow-up period of 10 months

Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Von Renteln D, Fuchs KH, Fockens P, Bauerfeind P, Vassiliou MC, Werner YB, Fried G, Breithaupt W, Heinrich H, Bredenoord AJ, Kersten JF, Verlaan T, Trevisonno M, Rösch T Gastroenterology. 2013 Aug;145(2):

PEACE - POEM

�  P – Effectiveness similar to Heller myotomy without an anti-reflux procedure

�  E – Requires training; learning curve not yet defined but easier than ESD

�  A – Spreading rapidly; therapeutic endoscopists and thoracic surgeons eager to adopt

�  C – very favorable; much less expensive than Heller

�  E – Long-term data not yet available

Challenges in Resection of GI Neoplasms

� EMR can resect mucosal lesions and provide pathological specimens to evaluate tumor grade and deep submucosal margin

� EMR cannot tackle circumferential lesions and wide area neoplasms �  Piecemeal resection implies risk of recurrence �  Inability to evaluate lateral margins effectively

� EMR cannot tackle tumors involving the deep submucosa or muscular layers

Innovations in Resecting Neoplasia

�  Endoscopic Submucosal Dissection

�  Endoscopic Full Thickness Resection

ESD In The United States

�  Steep Learning Curve – Perforation rates as high as 10%. Higher in the first 100 cases.

�  US Endoscopists have learned by hands on practice in explant and porcine models followed by observation/training in Japan.

�  Number of cases requiring ESD are limited. ESD will likely be limited to selected centers.

Endoscopic Full Thickness Resection (EFTR)

“Closed“ technique:

1. GI tract wall plication

2. Lesion resetion

“Open“ technique:

1. Lesion resection

2. Defect closure

“Tunneling“ technique:

1. Submucosal tunnel creation

2. Lesion resection

3. Entrance closure

Plicate then Resect

Institute for Digestive Health and Liver Disease at Mercy, Baltimore, USA

PEACE – ESD/EFTR

�  P – ESD prevents recurrence; EFTR still under development

�  E – Major barrier is long learning curve

�  A – ESD widely adopted in Asia, not so in US

�  C – Cost of ESD accessories is minimal

�  E – ESD appears to be effective for early gastric cancer; role in BE still not defined; EFTR still very much a research technique

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KEYNOTE ADDRESS

Achieving True Success In Times Of Change

Tom Morris, Ph.D.

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True Success

The Art of Achievement in Times of Change

Tom Morris

The 7 Cs of Success For True Success, we need:

C1 A clear CONCEPTION of what we want, a vivid vision, a goal clearly imagined.

The Greatest Advice Ever Given

for Powerful Goal

Setting:

The Greatest Advice Ever Given

for Powerful Goal

Setting:

Know Thyself

The Second Greatest Advice for Powerful Goal Setting:

Do not allow what is very good to keep you from what is best.

You Hill A

Hill B

C2 A strong CONFIDENCE that we can attain that goal.

William James

Precursive Faith

We need 2 kinds of confidence:

(1) Initial Confidence

(2) Resilient Confidence

C3 A focused CONCENTRATION on what it takes to reach that goal.

Zeno

Start __:__:__:__Goal

Divide then

Conquer

C4 A stubborn CONSISTENCY in pursuing our vision, a determined persistence.

The 3 Causes of Persistent Inconsistency:

Ignorance

Indifference

Inertia

C5 An emotional COMMITMENT to the importance of what we are doing.

The Dual Significance Principle

Every job productive of any good can be given either

(1) A trivial description

Ultimate motivation requires that we have, in our own minds, a noble description of what we do.

or (2) A noble description

C6 A good CHARACTER to guide us and keep us on a proper course.

Aristotle on Masterful Persuasion and Salesmanship

Logos

Pathos

Ethos

C7 A CAPACITY TO ENJOY the process along the way.

ENJOY THYSELF

The 7 Cs of Success 1. A clear CONCEPTION

2. A strong CONFIDENCE

3. A focused CONCENTRATION

4. A stubborn CONSISTENCY

5. An emotional COMMITMENT

6. A good CHARACTER

7. A CAPACITY TO ENJOY

If there were An 8th Condition for Success,

it would be:

C8

CONTACT ME anytime at:

www.TomVMorris.com

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The Lone Ranger Rides No More - Motivating And Incentivizing

Team Performance

Dan O'Connell, Ph.D.

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The Lone Ranger Rides No More:

Motivating and Incentivizing Team Performance

Daniel O’Connell, PhD [email protected]

206 282-1007

Objectives

�  Understand intrinsic and extrinsic motivators �  Where they enhance practice behavior �  Where they have unintended consequences

�  Consider the implications for encouraging desired practice behaviors

Motivation

�  Motivation 1.0: 50 thousand years ago �  Survival, biological drive for food, reproduction, safety

�  Motivation 2.0: 100 years ago �  Reward what you want, punish/discourage what you don’t

want, an assumption that tasks themselves are not interesting or motivating

�  Motivation 3.0: 50 Years �  Autonomy, purpose, mastery, and relatedness (Deci&Ryan,

Deming, Ariely, Pink) �  Many desirable behaviors do not respond in straightforward

manner to extrinsic motivators

Extrinsic Reward

�  “Not forming an essential part of a thing or arising or originating from the outside”

�  “Any tangible benefit of a particular job or activity which is external to the job itself, e.g., vacation, promotion, friendship, compensation”

Extrinsic Motivation

�  Extrinsic rewards delivered a short term boost (like a jolt of caffeine) but effect wears off and interest and effort are reduced. �  Studying to get a good grade �  Earning a commission on sales �  Being paid “piecemeal” for each widget/activity

�  Fee for service

Intrinsic motivation

�  Engaging in a behavior or activity because it is personally rewarding

�  Performing an activity for its own sake rather than the desire for some external reward. �  E.g., my efforts at golf, guitar playing, learning Spanish,

etc., = hours of “uncompensated” time

�  Intrinsic motivation asks us to reflect on the meaning of compensation

Motivation 3.0 Profit Maximizes vs. Purpose Maximizers

�  Microsoft Encarta fails despite enormous investment, corporate structure and support, talented people

�  Wikipedia thrives despite volunteer contributors and minimal funding

Carrots & Sticks: Unintended Consequences

�  Offering reward signals task is undesirable �  Paying for chores at home

�  Rewards are addictive – dopamine in nucleus accumbens

�  Less creativity on task, more scheming on compensation

�  More cheating – Wall Street, mortgage crisis, sports, educational testing

More Unintended Consequences of Extrinsic Motivators

�  Narrows focus of interest and motivation �  Compensation formula becomes overshadowing focus of

group’s latent and manifest agreements and resentments �  Only compensated activities have value �  Resentment of the “extra work” in caring for patients

�  Competitiveness fuels conflict and undermines group cohesiveness

Extrinsic Rewards and Unintended Consequences

�  Blood donors gave less when compensated

�  Parents coming to daycare even later when “fine” for lateness was introduced

�  Cheating �  VW emissions scandal �  Wall Street investment and housing market crash �  Athletes doping, university athletic recruting �  Teaching giving out test questoins

When do incentives help? �  When task is

�  Routine, not particularly satisfying �  Path is obvious, �  Little feeling of mastery/accomplishment �  Primarily mechanical skill involved

�  Bonus for more/faster production, more accurate, fewer accidents

�  Even then better to “Pay enough to take money off the table” and focus on these things: �  offering autonomy and involvement in designing work processses

(vs. compliance), linking to purpose/value, making it fun, a nurturing workplace, effective management, removal/mitigation of obstacles

Ah, but in the real world…

�  Extrinsic reinforcers have been given almost mythological importance. �  Correlation between $ and life satisfaction is .13 beyond

$75K in the US �  Yet money (and its psychological cache in terms of self

esteem, status, equity, etc.) is manifestly and latently offered up as measure of all that is “good, true and beautiful”. �  The Greeks, and almost every spiritual path since then has

admonished us to guard against this illusion of money and material gain beyond the useful baseline as a distorting force to recognize and grapple with if there is to be hope for a wise and meaningful life.

Courageous Conversations About $

�  Consider: �  “Paying enough to take money off the table” for all your

“employees” �  Extra compensation for truly extra work (overtime, additional

clinic, more call).

�  Talk about equity/fairness directly, rather solely through the lens of $.

�  Raise the concern that $ might be intruding in a destructive way in the discussion of an issue.

�  Talking maturely (not cynically or facetiously) about the deeper value of providing safe, effective and satisfying healthcare to real people who need our help.

�  Thinking more comprehensively about stewardship of limited financial resources for provision of health to population

Data to Fuel Constructive Self Reflection on Practice and Role in Group

�  Quality data (providing safe effective care)

�  Productivity Data (doing fare share)

�  Patient Experience Data (humanity, communication, shared decision making)

�  360 Degree feedback(collegiality, civility, ethics, involvement, emotional intelligence) �  Staff, referring docs, colleagues, admin

��



"Money Can't Buy Me Love" - Or Can It? - Compensation Models And Incentives In The GI Practice

Moderator: Joe Vicari, M.D.



Joseph J. Vicari, M.D., M.B.A. Dr. Vicari joined Rockford Gastroenterology Associates, Ltd. in 1997 and has held a faculty appointment at the University of Illinois College of Medicine at Rockford since that time. He currently holds the academic rank of Clinical Assistant Professor of Medicine at the University of Illinois College of Medicine at Rockford. Dr. Vicari is now Managing Partner of Rockford Gastroenterology Associates, Ltd. He is Board Certified in Gastroenterology. He currently serves on the Practice Management Committee of the American Society for Gastrointestinal Endoscopy and is a journal reviewer for the American Journal of Gastroenterology. Dr. Vicari attended medical school at Creighton University where he received the Golden Apple Award for Excellence in Teaching for 3 consecutive years. He completed his residency and chief residency in Internal Medicine at Creighton University and also completed his GI Fellowship in gastroenterology at the Cleveland Clinic Foundation where he became Chief Fellow in Gastroenterology from 1996-‐1997. While completing his fellowship his interests were in esophageal and liver diseases. Dr. Vicari has presented numerous lectures and presentations to students, and residents and physicians both locally and nationally.


Lawrence S. Kim, M.D. Dr. Lawrence Kim is a partner at South Denver Gastroenterology, an independent GI practice in Colorado. He attended Princeton University for his undergraduate studies and graduated cum laude from the Woodrow Wilson School for Public and International Affairs. He received his medical degree from The Johns Hopkins University and went on to internship and residency in internal medicine at Beth Israel Hospital in Boston, MA. He completed his gastroenterology fellowship at the University of California, San Francisco where he pursued additional training in outcomes and clinical research. During fellowship, he also received advanced training in endoscopic ultrasound, which remains an area of special interest. In addition to various roles within his 18 physician practice, Dr. Kim has been a leader in organized medicine throughout his career. He was the first gastroenterologist to join the Board of Directors of the Accreditation Association for Ambulatory Health Care, the leading accreditor of ambulatory endoscopy centers. He has served in several positions for the American Gastroenterological Association, including as Clinical Practice Councilor on the Governing Board. In addition, he currently serves on the Executive Committee of the Digestive Health Physicians Association, an advocacy group for independent GI practice. Dr. Kim is committed to improving the quality of digestive care worldwide and has led or served on multiple medical missions to Vietnam, Cambodia, and Peru. Beyond his professional activities, Dr. Kim is first and foremost a dedicated husband and father. An avid skier and outdoors enthusiast, he loves nothing better than spending a day in the Colorado mountains with his family.


Jeffry L. Nestler, M.D. Jeffry L. Nestler, MD is a partner and president of Connecticut GI (CTGI), as well as the Chief of Gastroenterology at Hartford Hospital. He is a senior attending physician at Hartford Hospital and Clinical Assistant Professor at the University of Connecticut in Farmington, CT. Dr. Nestler’s areas of clinical expertise include interventional endoscopy and pancreaticobiliary disease He is Governor for the state of Connecticut with the American College of Gastroenterology (ACG) and is a member of the Board of Directors at Hartford Hospital. He has served on committee on the Practice Management and the National Affairs Committee for the ACG as well the Connecticut chapter of Medicare Carrier Advisory Committee. He is a member of the American College of Physician Executives, Connecticut State Medical Society, Hartford County Medical Association, American College of Gastroenterology and American Gastroenterology Association. In addition, he is CEO/Medical Director of the Glastonbury Endoscopy Center and Managing Partner/Medical Director of Connecticut GI Endoscopy Center. He is a past President of the Medical staff at Hartford Hospital. Dr. Nestler attended medical school at New York Medical College in Vallhala, New York. He completed both his internship and residency at The New York Hospital, New York. Dr. Nestler resides in West Hartford, Connecticut.


Michael L. Weinstein, M.D. A graduate of Northwestern University and the Northwestern University Feinberg School of Medicine, Michael Weinstein, MD enjoys a busy clinical practice while continuing his academic pursuits as Assistant Clinical Professor of Medicine at the George Washington University School of Medicine and Health Sciences. He is active in his community and his specialty through numerous medical society memberships. He is a founder of the Digestive Health Physician Association and currently serves as Chair of Health Policy. He has served on the American Gastroenterological Association Board of Trustees and as the American Society for Gastrointestinal Endoscopy representative to the American Medical Association’s CPT Advisory Panel. Dr. Weinstein is the Vice President of Capital Digestive Care, an independent, 57 physician practice in the metro Washington, DC region. He has been consistently recognized by his peers as a “Top Doctor” in Washingtonian magazine.

��


Physician Burnout - What To Do When You Smell Smoke

Dan O'Connell, Ph.D.

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Coping Well with

Stress at Work

Dan O’Connell, PhD

• Seattle, WA• [email protected]• 206 282-1007

What we hope to accomplish

today:

•  Identify stress/distress, its multiple sources and how they interact

•  Identify good coping in its behavioral, emotional, social and cognitive forms

•  Assess our own level of distress/burnout and its expression at work and away from work

•  Apply steps of intentional change to make needed adjustments

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Stress arises in the interaction

between person and environment

•  Psych meaning of stress comes from Fr. estrecier meaning to tighten/make narrow

•  Stress is the interaction between:

–  Appraisal One: Is this a threat/challenge to usual capabilities, preferences or status quo?

•  “What is at stake?”

–  Appraisal Two: Do I have the coping resources needed to manage this?

•  “What can I do about it?”;�

Hans Selye (1956)

The Stress of Life

•  Three stages in response to stress

–  Alarm – triggers sympathetic nervous system –HPA -hormones with their immediate physical/psychological effects

–  Resistance – coping with chronic stress creates ongoing cycle of alarm responses alternating with attempts at repair and recovery

–  Exhaustion – depletion of resources without sufficient recovery leading to health effects and lost psychological resilience (learned helplessness, depression)

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Maslach’s Burnout Scale

•  Emotional exhaustion

•  Depersonalization/cynicism/alienation

•  Feeling ineffective/low sense of personal accomplishment

•  “Energy turns into exhaustion, involvement turns into cynicism and efficacy turns into ineffectiveness.”

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Physician Burnout

•  In numerous studies, 35%-60% of physicians report recurring symptoms of burnout across specialties (increasing over time)

•  In 2012, 47% of U.S. physicians reported symptoms of burnout, highest among ER docs and 50% among general internists

–  T.D. Shanafelt, S. Boone, L. Tan, et al., “Burnout and Satisfaction with Work-Life Balance among U.S. Physicians Relative to the General U.S. Population,” Arch Int Med 2012;172(18):1377-1385.

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Specific Sources of Stress

•  Daily stress events

•  Life changes

•  Positive events (planning a vacation or a wedding) can create stress by requiring adaptation/deviation from the status quo

•  Workplace stressors

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Predisposing Sources of Stress

•  Personality

•  Lifestyle and health

•  Work-related

•  Enculturation and expectations

•  Environmental

•  Societal forces@�

Personality

•  5 Factor Model (CANOE or OCEAN):

–  Conscientiousness (careful-lackadaisical)

–  Agreeableness (easy going-high maintenance)

–  Neuroticism (resilient-prone to distress)

–  Openness (curious/flexible-conservative/rigid)

–  Extraversion (out-going/friendly-reserved/loner)

AB�

Lifestyle and Health

•  Sleep

•  Exercise

•  Health problems

•  Alcohol/drug use

•  Financial situation (needs/desires/debts)

•  Commitments and encumbrancesAA�

Work-related•  Hours

–  length of day, commute, breaks?

•  Tasks–  technical, consequential, automatic/demanding, repetitive, boring,

multi-tasking/managing interruptions?

•  Pace, breaks, nurturing/depleting?

•  Emotional labor–  projecting warmth, empathy, absorbing distress in face of difficult

behavior/distress/suffering of “customers” and “co-workers”

•  Social interactions –  supportive/warm, conflict, critical, isolating, competitive? AC�

Enculturation and Expectations

•  Medicine–  High expectations and consequential actions–  Perfectionism/guilt/compulsivity–  Subordination of everything personal–  Encouragement of detachment

•  Ethnic styles of interaction, language, expectations

•  SES and hierarchy of health care setting

•  Gender-based expectations at work and homeA:�

Environmental

•  Noise

•  Distractions

•  Space

•  Ergonomics

•  Aesthetics

•  Temperature

•  Lighting

A;�

Societal Forces

•  Economic downturns

•  Technology at work and home

•  Vulnerability caused by political disruption, war, terrorism, etc. (background/foreground)

•  Biases/prejudices based on gender, race, religion, sexual orientation

•  Changing structure of health care provision and financing A<�

Coping

•  Expending conscious effort in order to master, minimize or tolerate stressful situations (acute, protracted and recurrent)

A=�

Ways We Can Cope

•  Primary control: Change the environment

•  Secondary control: Adapt better to the environment

–  Adjust our behavior in the situation–  Adjust our behavior away from the situation to renew,

restore, compensate, build skills –  Adjust our thinking

–  to affect our appraisal of situation, correct distortions that increase distress or obscure potential solutions

–  Adjust our mood/arousal levels–  Meditation, mindfulness, relaxation, mood-altering medications/substances

A>�

Adjusting our thinking:

A psychological perspective

William James, Ph.D.

•  "The greatest weapon against stress is our ability to choose one thought over another."

•  "The greatest discovery of my generation is that a human being can alter his life by altering his attitudes."

•  "If you want a quality, act as if you already had it."

A?�


•  "To enjoy good health, to bring true happiness to one's family, to bring peace to all, one must first discipline and control one's own mind. If a man can control his mind, he can find a way to enlightenment, and all wisdom and virtue will naturally come to him."

•  "The mind is everything. What you think, you become.”

Buddha

A@�


Cognitive behavioral therapy

•  Events—actual, remembered and anticipated—all stimulate thoughts.

•  Thoughts (ideas, expectations) stimulate emotions.

•  Thoughts and emotions combine to trigger behaviors.

•  Those behaviors have consequences.

Those consequences become or contribute to the next events to which we will have to respond.

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Principal findings of cognitive

behavioral therapy

•  People create unnecessary distress by maladaptive/distorted thinking without realizing it.

–  Catastrophizing

–  “All or nothing” thinking (good/bad)

–  Emotional reasoning

–  Overgeneralizing (always, never)

–  Mistaking preferences for “shoulds”

CA�

Examples of maladaptive

thoughts common in health care•  Patients should comply with my recommendations (vs. adhere to

commitments they have made).

•  Patients should not come with self-diagnoses or specific expectations about work-ups and treatments.

•  Even though our recommendations change, patients should accept what I said last as the truth.

•  Patients should always be on time even if I am not (and graciously accept my lateness).

•  If I don’t give patients everything they want, then my satisfaction scores will be abysmal.

•  Administrators (of all stripes) don’t care about us at all.

CC�

More maladaptive thoughts in

health care

•  I don’t need to follow the advice I give my patients about a healthy lifestyle.

•  A single frustrating patient encounter discounts 10 satisfying ones.

•  The world (health care system) is broken and I cannot experience equanimity and satisfaction until it is fixed (to my liking).

•  Even though I defend my right to practice autonomy, I get upset when patients ask me to be flexible in considering their ideas and preferences.

C:�

Coping Thoughts and Practices

•  The patient is not the problem. You are not the problem. The patient is the person with whom your are trying to solve the problem.

–  So focus on the problem is the problem. –  Be soft on the people and focus your and their attention on the specific problem.

•  Be often curious and never furious

•  Expressing concern is much more effective than criticizing.

•  There is a normal human tendency to overpersonalize conflict and disappointment (fundamental attribution error).

–  Focus on all the aspects of the situation that may have contributed to the difficulty. –  Be slow to make assumptions about intentions or personality.

•  Think about patients and families as partners in problem solving –  Rather than yourself as the one who must “find it and fix it and sell the solution.”

C;�

More Coping Thoughts and

Practices•  Mindfulness is the nonjudgmental focus on the present moment.

In patient care it is necessary to move from room to room, clearing one’s mind of past and future and listening deeply to the concerns of eachconversation.

•  Try the following as a way of clearing your mind and centering yourself on the present.

1.  Take three deeper breaths and say the phrase “relax and let go” as you slowly breathe out.

2.  Relax your muscles and slow your pace. 3.  Let go of all thoughts and concerns that are not directly relevant to the

moment at hand. 4.  Then enter the activity mindfully and notice how much more capacity

you have to be calmly attentive while also centered with equanimity.

C<�

I want to change, but how do I do it? Conviction, Confidence, Importance and Commitment

•  People are most willing to try a change when:

–  They are reasonably convinced it is necessary•  and reasonably convinced ________could help

–  Are reasonably confident they can do itfit it in, pay for it, get approval from others, tolerate discomfort

–  Believe it is important enough to take on (in light of existing commitments and demands)

–  Are willing to commit themselves for a sufficient period to develop proficiency and assess results

C=�

What should I do if I feel burnt out?

•  Initiate your own 360 degree appraisal and listen to what you are being told and sensing.

–  Am I irritable, frazzled, cynical, exhausted, depersonalized, feeling ineffective, hurrying too often, dreading work or family life.

•  (Take the online Maslach Burnout Scale – free version and score and reflect on what you see)

•  Go to therapy!!–  This is not normal, even if you are telling yourself it is.–  You need a skilled listener, one who understands doctors to

hear you out and help you take stock.–  Then make the changes that you and your therapist think

are likely to build a more satisfying life and stick with it!!!

Questions?

C?�

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LUNCH PRESENTATION:

Going Social - A Crash Course For The Uninitiated

Krista Neher

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Krista NeherCEO – Boot Camp Digital

[email protected]@kristaneher

Copyright Boot Camp Digital - All Rights Reserved @KristaNeher @BootCampDigital Copyright Boot Camp Digital - All Rights Reserved @KristaNeher @BootCampDigital 2

About Me.....

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Diggggigigiggigiggiiiiiiiiigggiiiigggiigigigigigggggggggggigggiggggigiigggigggiiigggg tataattatatatatatattatatataatatatataataaatatattatattattatttatatttaatattaataaatataatataatattaataatataaaataaataatattaaallllllllllllllllllll ------------------- AlAlAAAAAAAAAAAAAAAAAAAAAAlllAAAAlAllAAllllAAlAAllAlAlAAlllAAllAlAAlAlAlAAAAlAlAAlAlAAAAlAAAlAAAlAlAAAAAlAlAAAAAAAAAAAAAAllAAAlAAllllllllllllllllll RRRRRRRiRiRRRRiRiRiRRRRRiRRRRRRRRiRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR ghghghghghghghghghghghghghghghghhhhhggghhhhghhghghhhhhgghhhhhghhhhhhhhhhhhhghhhhhhhhghhhhhghghhhhgg tsststststtstststttsststtsststsststssststssststsststtstsssttssttttststssttsssssstttsttssstsssstststtssttstttts RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRReservedddddd @@@@@@@@@@@@K@K@@@@@@@@@@K@K@K@@K@K@K@K@@@@@@@@@@@@@@@@@K@KKK@KK@KKKKKK@K@@@@@@@@@@@K@@KKK@KKK@K@KKKKKK@K@@@@@@@@@KKKK@K@K@KK@K@@@@@@@@@@@K@KKK@K@K@K@K@@@@@@@@@@@KKKK@KK@@@@K@K@@@KK@K@K@K@@KKKK@K@K@K@K@K@K@@@@@K@@@@K@@@@@@K@@K@K@@@@K@K@@K@@@@K@K@@@K@@@K@@@@@@@K@@@@@K@@KK@@@@@KKKK@K@@@@@@@@KKKK@@@@K@@@@@K@K@KKKK@K@K@K@@@@@@@@@KKKKKKK@K@@K@@@@@@@@@KKKKKKK@K@K@@@@@@@@K@@KKKKK@KK@@@@@@@@@@@KKKKK@KK@@@@@@@@@K@K@@@KKKK@KKKKK@@@@@@@@@@@K@K@K@KKKKKKK@@@@@@@K@K@@@@KKKKKKKKK@@@@@@@@@@K@@KKKKKKKKK@KKK@@@@@@@@@@@KKKKKKKKKKKK@@@@@@@@@@K@@@@@KKKKKKK@KK@KK@KKK@K@@@@@@@@@@@@KKKKKKKKKKK@KK@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ rriririrrrrriiririiiriiririiiiriririiririiiririiriririrrriririrrriiirirrriirirrririririrrrrririrrrrririrrrrririrrrrrrrrrriririrrrrrrrrrrirrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr 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Copyright Boot Camp Digital - All Rights Reserved @KristaNeher @BootCampDigital Copyright Boot Camp Digital 2013 - All Rights Reserved @KristaNeher @BootCampDigital

Skittles.com had

23,000 visitors Their Facebook page had

320,000 urce: ComScore

Test Your Knowledge

Do more people SHOWER every day or check

FACEBOOK?

FACEBOOK SHOWER

What do more people do

EVERY DAY?

Check Facebook

Read the Newspaper

Listen to the Radio

Which Social Network is OLDER?

FACEBOOK LINKEDIN

What percent of GLOBAL Business Professionals

use LinkedIn?

Over 50% Under 50%

What percent of

BUSINESSES use social

media?

Over 70% Under 70%

What percent of internet

users OVER 65 use

Facebook?

Over 50% Under 50%

What is the SECOND

BIGGEST social network

(based on # of users)?

LinkedIn TwitterPinterest

Which social network

sends the most TRAFFIC

to websites?

Twitter YouTubePinterest

Copyright Boot Camp Digital - All Rights Reserved @KristaNeher @BootCampDigital 13

Copyright Boot Camp Digital - All Rights Reserved @KristaNeher @BootCampDigital 14

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36

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Copyright Boot Camp Digital - All Rights Reserved @KristaNeher @BootCampDigital

A picture is actually

worth 60,000 words.

38

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What’s Next?!?!?!?

What People Want�  Visual  Privacy  Efficient  Public/Private

49

Copyright Boot Camp Digital - All Rights Reserved @KristaNeher @BootCampDigital Copyright Boot Camp Digital - All Rights Reserved @KristaNeher @BootCampDigital

THANK YOU Connect with me online!

LinkedIn - Krista Neher @KristaNeher

[email protected]

50

��


GI Patient Experience 3.0 - Reducing Risk...Enhancing

Economics

Jim Saxton, Esq.

��


��

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�� 8�� &��&�� 9�� 8�� &��)��)��(��'��%��:��&��&��&��)��#��#��&�� )�� +�.+�� *�� !�� "$��$��8��;��(��,��*�+�.�� !��%��,��&��)�� &��&��8��)��&�� 8��(��'��&��)��&��<'&&�8��)��<'&&�(��5��)��(��'��&��&��

�� “Getting Serious” is the

��

��

The lines have crossed

(for the first time in history) · Specific tasks to enhance economics

· Specific tasks to reduce liability exposure

!

serious

"

It’s just about getting

#1 drivers of frequency and severity of malpractice claims are:

� Communication� Listening � Being on-time� “Relationship” � What we call “Five-Star”

#

This is what is being referred to as the“ Patient Experience” - HCAHPS, CGCAHPS, Patient Satisfaction

Some facts:

$

Some facts:

$

� Every pay-for-performance, value-based contract, ACO metric, and shared savings arrangement will have some form of “patient experience” score

� Patient experience drives bad debt

� Patient experience drives your business

Any doubt…

%

� 744 ACOs, and continuing to grow� 23.5 million lives covered by ACOs � 132 participating payers (including

Cigna, UnitedHealth & Aetna)� Projected that the number of U.S.

patients receiving care from an ACO from will expand to over 72 million by 2020…

more than 150 million by 2025!Growth and Dispersion of Accountable Care Organizations in 2015, HealthAffairs Blog, March 2015. David Muhlestein. http://healthaffairs.org/blog/2015/03/31/growth-and-dispersion-of-accountable-care-organizations-in-2015-2/

Creating… for gastroenterologistsThere are new opportunities

Be &attractive' to the

new &neighborhood'

(

This could be: · An ACO or Virtual ACO

· Patient-Centered Medical Specialty Neighborhood

· Second Generation Clinically Integrated Network

· An Employer Coalition

)

Gastroenterologists can mitigate risk and enhance economics through patient satisfaction and engagement!

*

+

Let’s talk about some practical specific examples:

Claims are more likely to result when an unexpected outcome is coupled with an aggravating factor such as poor communication or a lack of engagement documentation.

1. Service lapses & communication failures

So lay the foundation for a great relationship!

Five-Star service has always been important, but has become even more so in light of health care and payment reform

!

"

pervasive and consistent

A culture which is both…

2. Greeting, waiting experience

3. Experience in the procedure room

4. Informed consent

5. Examination

6. Use of EMR

7. Service Recovery

8. Even billing!

Each point of contact is important

#

1. First interaction (telephone call, office visit,

website or portal)

How?

� Leadership buy-in… what is five-star?

� Set up a committee of champions

� Get a baseline assessment

� Measure� Role out to staff

� Keep it alive!!

� Pervasive & consistent

� Should be part of (everyone’s) pay $

Simple 5 Point Plan:� Survey patients

� Make a personal commitment

� Invest 10 seconds

� Be cognitive of body language

� Be and lead by example %

(

So to really get serious…

What progressive gastroenterologists around the country are doing

)

Measure factors that impact the GI patient experience

Use GI patient experience survey tools:

*

Measure your locations, physicians, advanced practice professionals –even the front desk!

Five-Star Key Issues

!+

Teachings from 1,000,000 visits…

Burn the Busy Card!slow down – do not appearrushed to patients or staff

!

Put on a smile(even when it hurts)

!!

Don’t look at your watch

!"

Let the patient speak for 15 seconds

!#

Don’t let the EMR get between you & your patient

…make sure the patient is there.!$

2. In the new world…document engagement

� At-Risk letters� Patient history forms � Gastroenterology-specific 2nd generation

informed consent forms

!%

!(

At-Risk letter� Identifies the non-compliance

� Describes the implications

� Provides a plan to get “back on track”

So when patients fail to follow instructions…

!)

At-Risk letter exampleDear Ms. Jones:Our practice views the physician-patient relationship as critical to our ability to provide you with appropriate care and treatment. This includes the need for you to keep your scheduled appointment…

It has come to my attention that you have missed at least 4 of your last scheduled appointments with our practice, and you specifically failed to notify us that you would not be showing up for these appointments. Specifically, you failed to show for your scheduled appointments on January 1, 2016 and March 1, 2016. You have a history of Gastrointestinal Bleeding (GI Bleeding), and keeping these appointments is critical to your ongoing health.

So that we can get your treatment back on track for important reasons related to your health, including preventative medical treatment, it is necessary for you to show for your next scheduled appointment…

We are committed to providing you with quality healthcare, and to do so, we must count on you to follow your prescribed treatment. You are a critical part of the healthcare team… If you have any questions about what you must do, please call our office.

Identify the

e non-compliance

Provide a plan to get back on track

Describe the implications

� Introductory language

� Verification

� Advises patients of the importance of the information THEY provide

“The following information is very important to your health. Please take time to fully and completely fill out this important information. We are counting on you.”

Patient History Form:

“The information that I provided on this form is true and correct to the best of my belief.

Patient signature date

Beginning of the form:

End of the form:

!*

Specific language on patient history forms

Procedure-specific2nd generation informed consent

“It is very important to Dr. Smith that you understand and consent to the treatment your doctor is providing for you and any procedure your doctor may perform… sign this form only after you understand the procedure, the anticipated benefits, the risks, the alternatives...”

Sample Informed Consent for Gastrointestinal Endoscopy:

“The doctor has explained the benefits of gastrointestinal endoscopy to me… I understand there is no certainty that I will achieve these benefits and no guarantee has been made to me… risks include, but are not limited to, blood loss, transfusion reactions, infection, heart complications, blood clots, loss of or loss of use of a body part…

“reasonable alternative(s) to gastrointestinal endoscopy, as well as the risks to the alternatives, have been explained to me…

“the risks of the alternatives include, but are not limited to, …

"+

“to

1

“t

2

Witness attestation confirms that the patient:

� Read the form

� Understands the information, and

� Has no unanswered questions

� The Patient/Authorized Representative has read this form or had it read to him/her.

� The Patient/Authorized Representative states that he/she understands this information.

� The Patient/Authorized Representative has no further questions.

______/______/__________________________________Date Time Signature of Witness

"

3

Sample Informed Consent for Gastrointestinal Endoscopy:

3. Post-Event communication –

"!

Patients and their families Patients and their familieexpect and deserve to expect and deserve to know what happened know what happened during the procedure as during the proceduresoon as possible, soon as possible, whatever the outcome

� Time is of the essence

� Describe calmly, professionally

� Link back to the informed consent process

� OK to express disappointment with the outcome, but choose words with care

� Responsibility to communicate continues even after transfer

How you handle post-event communication is paramount

""

Diffusing anger� Listen – allow time to vent

� Empathize – OK to apologize, without admitting liability

� Discuss plan to move forward with treatment and future communication "#

Putting it all together

"$

� Developing the relationship

� Engaging the patient (make them as responsible as in reality

they should be)

� Measure� Use GI-specific consent forms

� Handling post-adverse event communication thoughtfully

Reducing liability

"%

Concurrently positioning for enhanced economics -

You can now do both!

James W. Saxton, Esq.CEEO and Shareholder, Saxton & Stump, LLC

� Active litigation practice for over 30 years, representing hospitals and physicians before State and Federal courts in professional liability and complex litigation matters.

� Advisor to physicians throughout the United States to aid in understanding and reducing their professional liability risk, as well as helped to create innovative risk reduction tools and safety programs.

� Fellow of the Litigation Counsel of America – a position reserved for less than one-half of 1% of attorneys in the country.

� Fellow of the College of Physicians of Philadelphia, past Board member of the Surgical Review Corporation, and Board Director of SE Healthcare Quality Consulting, LLC.

� Past Chair, American Health Lawyers Association’s Healthcare Liability and Litigation Practice Group and was named to the American Health Lawyers Association’s Accountable Care Organization Task Force.

� Jim has published over 200 articles, 7 textbooks, and several handbooks and also presents frequently to nationally prominent healthcare organizations.

� In addition to his legal pursuits, Jim believes strongly in giving back to the community, volunteering in leadership roles and lending his experience to many health care and community nonprofits. He is a recent recipient of the Excellence in Philanthropy Award presented by the Lancaster General Health Foundation’s Board of Trustees. In 2003, he was awarded Philanthropist of the Year by the Central Pennsylvania Chapter of the Association of Fundraising Professionals. Additionally, Jim was the Founding Board Member of the Lancaster Community Health Plan, Chairman of the Lancaster Family YMCA Foundation, and prior to that, President of the YMCA Board of Directors. He is also a past Board Member of the American Heart Association. "(

38

JJames W. Saxton, Esq.717-399-6639

[email protected]

Based in Central Pennsylvania, Saxton & Stump, LLC is a full service health care litigation firm focused on defending doctors, hospitals and nursing homes in medical professional liability claims and providing risk mitigation and safety

consulting services to health care professionals. The firm also provides litigation representation in medical staff matters including credentialing and peer review, licensing and professional board matters and insurance bad faith

counseling and litigation. In addition to a team of lawyers and paralegals, the firm employs physicians, nurses, psychologists, physician reimbursement specialists, as well as health policy thought leaders.

In conjunction with SE Healthcare Quality Consulting, LLC (www.sehqc.com), its quality and safety partner, Saxton & Stump develops specialty-specific quality/safety/risk reduction tools, services and strategies focused

on improving quality and enhancing economics. Some of those programs include clinical quality benchmarks and data-driven assessment tools, education programs that include “Five-Star Service Excellence” and Disclosure Training, as well as the new EMR risk reduction program. Specialty specific programs are available as well. All

programs combine education, training, communication, as well as documentation services.

Thank You!

��



True Grit - Evolving Practice Models And Strategies To Help

Small And Large GI Groups Remain Relevant And Successful

Moderator: Jim Leavitt, M.D.



James S. Leavitt, M.D. Dr. James Leavitt has been in practice since 1980. He is a graduate of Dartmouth College, Magna Cum Laude, and the State University of New York Downstate Medical School. He completed his medical internship and residency at Jackson Memorial Hospital in Miami, as well as his Gastroenterology fellowship. Dr. Leavitt is board certified in Gastroenterology and Internal Medicine, and has been named one of the top 28 Gastroenterologists in America by Becker’s ASC Review.


James W. Saxton, Esq. Jim has sustained an active litigation practice for over 30 years, representing hospitals and physicians before state and federal courts in professional liability and complex litigation matters. His practice includes health care litigation, licensing and medical staff and professional board matters. Leveraging his extensive experience as a litigator, Jim advises gastroenterologists throughout the United States with understanding and reducing their professional liability risk by promoting excellence in patient satisfaction and incorporating certain specific loss control and safety protocols. He has helped create innovative risk reduction tools, including specialty–specific diagnostic clinical effectiveness dashboards as well as patient experience and engagement tools. Jim has also created innovative safety programs for captive insurers, many national in scope. Jim is a nationally known speaker on health care issues, including liability mitigation and patient safety in gastroenterology. He presents to many prominent health care organizations including the Society of American Gastrointestinal and Endoscopic Surgeons, American College of Surgeons, the American Society for Metabolic and Bariatric Surgery, the American Urological Association and the Physicians Insurers Association of America. Additionally, he has published more than 200 articles, several handbooks and seven textbooks in his field, including most recently, Operation Five-‐Star: Service excellence in the medical practice – Cultural Competency, Post-‐Adverse Events, and Patient Engagement. Selected Publications

• The ASMBS Textbook of Bariatric Surgery. Vol. 1, Chapter on Medical Liability in Bariatric Surgery, Contributing Author

• Minimizing Endoscopic Complications: Gastrointestinal Endoscopy Clinics of North America. Vol 17, Contributing Author

• The Taking Bariatric Safety to the Next Level, James W. Saxton, Esq., Philip R. Schauer, MD, and Amanda R. Budak, RN, CBN, PhD, Bariatric Times. October 2014


Barry Tanner Mr. Tanner (“Barry”), who joined the company in July 1999, is considered to be a founder of Physicians Endoscopy, co-‐writing the business plan with Karen Sablyak for the company that has evolved and grown into what exists as Physicians Endoscopy today. Today, Barry shares responsibility for the company’s partnership development activities, as well as being primarily responsible for the company’s strategic direction, and services development while also sharing in the day-‐to-‐day management and governance of several of the company’s partnered facilities. Prior to joining PE, Mr. Tanner served as chief financial officer of Navix Radiology Systems, Inc., a physician practice management company based in Miami, Florida. Mr. Tanner co-‐founded Navix Radiology Systems, Inc. (a venture capital backed company) and was primarily responsible for the development of that company’s business plan. Over a period of four years, Mr. Tanner contributed to building the company from zero to over $75 million in revenues, including the acquisition of seven professional radiology practices and orchestrating the acquisition and financing of a major diagnostics company. Functioning as the chief financial officer and chief operating officer of Navix, Mr. Tanner was also responsible for all day-‐to-‐day operations of the company. Prior to founding Navix, Mr. Tanner served as chief operating officer of HealthInfusion, Inc. (NASDAQ – HINF), a Miami based provider of home intravenous therapy services. Before joining HealthInfusion, Mr. Tanner was primarily involved in the financial services industry. Mr. Tanner successfully orchestrated the financial and operational turn-‐around of two publicly traded companies within that industry having previously co-‐founded (in 1977) and successfully operated another publicly traded financial services company, Scientific Leasing, Inc., for over ten years. Prior to Scientific Leasing Mr. Tanner, who is also a CPA, spent nearly seven years working for KPMG.


Glenn D. Littenberg, M.D., MACP A bachelor’s degree in literature from Reed College preceded his MD in 1973 from Keck University of Southern California and internal medicine training at Los Angeles County-‐USC Medical Center. This was followed by GI fellowship training at UCLA and the Wadsworth VA Medical Center 1976-‐1978. Dr Littenberg established a solo private practice in Pasadena, CA in 1978 which grew gradually to a group of 4, working out of Huntington Memorial Hospital where he was President of the Medical Staff and won Best Teaching awards from the Medical Housestaff. Largely in pursuit of answers to practice management problems, he became involved in coding, billing , regulatory and political advocacy efforts in the 1980s, schooling himself in health policy and health administration. This led to long-‐standing involvement in the California Medical Association, California’s Internal Medicine Societies and the national counterparts, American Society of Internal Medicine and the American College of Physicians. After terms as president of the Calif. SIM and chair of the ASIM/ACP’s coding and reimbursement committee, and serving as ACP’s advisor to the AMA CPT Editorial Panel, he then served 8 years (1998-‐2006) as an Editorial Panel member. He was then asked to join ASGE’s Practice Management Committee and chaired the PMC 2008-‐2015; he also serves as ASGE’s CPT Advisor and was a course director for 3 years for ASGE/AGA Gastroenterology Outlook (GO) national course. He received much-‐appreciated recognition with distinguished service awards from the California Chapter of the ACP, a Crystal Service Award from the ASGE and was recognized as a Master of the ACP.


He was a founding board member of the Southern California Gastroenterology Associates (SCGA) medical group, as of its founding in 2012 consisting of 32 gastroenterologists originating in 12 separate practices that merged, now the largest GI group in California, which (as InSite Digestive HealthCare) projects to have 50 physicians by the end of 2015 and offices from San Francisco to Irvine in California. In his (rare) time off, he pursues photography and travels widely in photography workshops in pursuit of the dramatic image. He continues activity in teaching, writes and speaks widely on issues of healthcare reform, physician reimbursement and GI practice administration. As of 2015 he will chair ASGE’s Reimbursement Committee and serves on the Excellence in Practice Taskforce. He is most pleased to return to the GI Roundtable as a speaker and to continue working with his predecessor/mentor in the ASGE Practice Management Committee, Dr Klaus Mergener.


Jim is an active member of many professional associations, including being chosen as a Fellow of the Litigation Counsel of America, a prestigious nomination reserved for less than one-‐half of one percent of the lawyers in the country, a Fellow of the College of Physicians of Philadelphia and a Board Member for SE Healthcare Quality Consulting, LLC. As published in Philadelphia magazine, Jim has been recognized annually in the Commonwealth as a Pennsylvania Super Lawyer since 2012 by being selected by his peers as among the top five percent of lawyers. In addition to his legal pursuits, Jim believes strongly in giving back to the community, volunteering in leadership roles and lending his expertise to many health care and community nonprofits. He is a recent recipient of the Excellence in Philanthropy Award presented by the Lancaster General Health Foundation’s Board of Trustees. In 2013 he was awarded Philanthropist of the Year by The Central Pennsylvania Chapter of the Association of Fundraising Professionals. Additionally, Jim was the Founding Board Member of the Lancaster Community Health Plan, Chairman of the Lancaster YMCA Foundation and prior to that, President of the YMCA Board of Directors. He is also a Past Board Member of the American Heart Association.

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Social Media 3.0 - Online Marketing Rebooted

Krista Neher

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Krista NeherCEO – Boot Camp Digital

[email protected]@kristaneher

KEY ASSETS  Search

 Search Engine Optimization  Search Engine Ads  Reputation Management

 Website  Professional  Converts

Getting Results  Get People Talking

  Recommendations and word of mouth!!!

 Facebook/Social Networks   Build trust and stay top of mind

 Video   Connect in a meaningful way

28

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What’s Next?!?!?!?

Copyright Boot Camp Digital - All Rights Reserved @KristaNeher @BootCampDigital Copyright Boot Camp Digital - All Rights Reserved @KristaNeher @BootCampDigital

THANK YOU Connect with me online!

LinkedIn - Krista Neher @KristaNeher

[email protected]

30

��


CIRCLING THE WAGONS

Sponsor Presentations

Friday:

Captify Health/Colon Prep Center gMed/Modernizing Medicine

CRH Medical Physicians Endoscopy

Saturday: Janssen

Boston Scientific Pentax Medical

Takeda [not presenting]

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CIRCLING THE WAGONS

SPONSOR PRESENTATION

CAPTIFY HEALTH /Colon Prep Center

Predictive Analytics for

Practice Efficiency

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New in 2016

We met many of you as CPC . . .

. . . And we look forward to serving you as Captify Health

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Last Week in Your Practice

Your practice scheduled and managed a full roster of patients.

But how many procedures did you complete for all scheduled

patients?

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Understanding Schedule Gaps

1.   Poor prep: repeat appointment required 2. No-shows: patients cancelled very late, slots not filled 3. Schedule churn: patients cancelled without

rescheduling, but slots were backfilled in time, burning staff time and your referral pipeline

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The Right Data Makes Your Patients Predictable

Scheduled “Surprise”: Patient no-shows

Typical Process Permits Unwanted Surprises

Prep Directions

Issued

Best Patient Management Predicts and Inflects Patient Behavior

Your schedule is optimized

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Scheduled Two-way Communication

�  Patient intent revealed early

�  Practice alerted to

cancellation risk

New Performance Standards

No-Show Rate Cancellation Rate Poor Prep Rate

-70%

Typical

-90%

Best Typical Best Typical Best

-25%

Leading practices have reset the bar

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Captify Elevates Practice Efficiency

Patient Management at Scale

Predictive Analytics for Financial Improvement

Comprehensive and customized pre-procedure patient management reduces the burden on your staff

Patient-generated data triggers easy practice steps to fill the schedule and increase revenue

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Captify Health supports GI practices with complete pre-procedure patient management. We use responsive marketing techniques and robust patient analytics to help all patients complete successful appointments, with less effort from you and your staff.

� Personalized information given to patients online, in print, by text message or call, and by prep experts at a 24/7 call center, according to patient preferences

� Scheduled patients enter a communication flow sent on behalf of your practice

� Patients at-risk of cancelling are flagged for you before appointment time

Practice revenue, costs, and quality performance in colonoscopy all hinge on successful prep completed by engaged and educated patients. Even top-performing GI practices can improve both cancellation rates and prep quality. Too many practices accept underperformance as “routine” – but unimproved performance means sacrificing revenue, inflating practice costs and administrative burdens, and missing quality targets.

Executive Summary

Extended Impact from GI Patient Management

Practices Struggle to Improve

How Captify Health Helps

Too many GI practices suffer from inefficiency and staff frustration without identifying the root cause – under-managed prep. Frontline staff, practice managers, and physicians all struggle to solve the prep challenge on their own. Most practices still rely on mass-mailings and zero-interaction phone reminders to guide patients through the complex at-home prep steps. Unfortunately, many patients still fail to adhere to their physician’s prep regimen, and cancel or skip their appointment.

Practices have little insight into their own performance, and only discover patient communication breakdowns when the patient fails to appear for their appointment. Even when the problem is known, practice staff do not have “extra” time or bandwidth to devote to an expanded patient engagement process.

Captify Health Capabilities:

� Analytics track performance at every step across all scheduled patients, finding fixable causes for missed or cancelled appointments

Physicians and practice management at a large GI practice realized that Captify Health improves the bottom line but also front-office efficiency and patient satisfaction. This practice saw significant drops in cancellations and no-shows but the most noticeable impact has been on the phone lines. Patient questions about prep now go to Captify Health instead of the schedulers for the practice, and that change benefits both staff and patients.

Supporting Staff

Impact at a 22-Physician Practice

“We hired Captify Health to handle patient communication for two of our [high-volume] endoscopy centers . . . and the change has been unbelievable. Fewer appointments are cancelled, no-shows have been reduced by half, and we’re saving on postage and administrative work“

“From many angles, there has been a very positive financial impact. But the biggest impact has been in our scheduling department, since patients with questions about the prep now call Captify Health, not our office. Patients no longer complain that they’ve been on hold for too long, because our call volume is very manageable now. Thanks to Captify Health, our scheduling department is operating much more efficiently.“

- Chief Operating Officer of the practice

7,166 patients managed during a 6-month measurement period

In Their Own Words

Documented Improvement

Cancellations

Decrease

-15%14%12%

BeforeWith Captify Health

No-Shows per Month

Decrease

-67%12

4

BeforeWith Captify Health

195+ cases retained over six months

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CIRCLING THE WAGONS


gMed /Modernizing Medicine

GI ROUNDTABLE 2016

Modernizing Medicine Acquired gMed

Closed on the acquisition September 1, 2015

gMed now operates as a subsidiary of Modernizing Medicine

gMed, a Modernizing Medicine company

Our Specialty-specific Strategy Drives Its Value Engine

•  EHR •  ERW •  Practice Management •  Analytics

• Revenue Cycle Management • Pathology Partnerships • Telemedicine

•  Population Health •  Retrospective / Prospective studies •  Dashboards •  Clinical trials

• EH• ER• Pr•• AnSoftware�

• R• P• TPractice

Integration�

dies Data & Access�

What This Means •  Combining expertise and resources to accomplish even

bigger things together as one team •  Developing the most-advanced gastroenterology-specific

products in the industry •  Making a bigger impact on transforming how healthcare

information is created, consumed and utilized to increase efficiency and improve outcomes

Our Flagship Product

•  gGastro™ is a server or cloud-based, GI specialty-specific, electronic medical records (EMR) system

•  Customizable for any size practice and scalable for large enterprises

•  Comprehensive GI and ASC Suite integrated with population analytics and Practice Management

Black Book Rankings

6

#1 Four Years in a Row!

The Power of Our Network

™

®

™

You chose to focus on gastroenterology as your specialty.

Learn more I www.gmed.com

As an Olympus® preferred partner chosen to be a replacement solution for EndoWorks®, gMed™, a Modernizing Medicine® company, can have extra endoscopy rooms up and running live in as little as two weeks. Designed to supplement your current EndoWorks rooms, Fast Track can help alleviate the burden of room shortages and dispel your wait as Olympus sunsets their software.

Extra Endoscopy Rooms Up and Running in Just Two Weeks*

Learn more I www.gmed.com or sign up for a personalized demo.

Olympus

Preferred Partner

About gMedA leader in gastroenterology software, gMed has developed intuitive solutions that include:

• On-premise server and cloud options

• Robust data analytics and benchmarking capabilities

• Google-style searching through both EndoWorks and gGastro™ data

• Data conversion from EndoWorks to gGastro

gMed is honored to have been selected by Olympus as an alternative to an outstanding product. See how it works.

* Subject to resource availability. Implementation times may vary.

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CIRCLING THE WAGONS


CRH Medical

Partnering with GIs to deliver the

highest quality care possible

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Private and Confidential 2

CRH Medical Corp.

Background

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Incorporating Hemorrhoid Care

Into Your Practice �

The Technology

  The CRH O’Regan System® - The “gold standard” disposable hemorrhoid treatment technology

  Developed “GI Partnership Program” in 2008

  Trained approximately 2,200 physicians at 800 practices in 48

states

  > 800,000 procedures performed in North America

  Comprehensive, no-cost training, support and marketing

The Technique

  Requires no prep, no sedation

  Quick (1 minute), Effective (99%), Painless

  Safe – complication rate 1%

  Proven safe and effective with 1000’s of cases reported

  Performed in office or ASC setting

  Excellent reimbursement

  No capital expenditures required

The Training

  No cost for comprehensive training and support

  Training session at your office or ASC

  Didactic presentation

  “Hands-on” banding session led by a CRH surgeon

  Complimentary CME-granting video access

  Complimentary follow-up and “advanced” training sessions

  “24/7” consultative support and backup – all physician to

physician

The Procedure

Financial Impact on Your Practice

National Average, Medicare Reimbursements



* Includes procedural and ASC fees

National Average Medicare Reimbursements

Patient material Referring physician material Advertising templates

Marketing Materials & Web Presence

CRH offers a wealth of materials to help educate your patients and promote awareness within your practice and to your local community.

CRH O’Regan System

Learn more about how CRH can support your ASC

Visit our website at www.crhmedicalproducts.com for more information & to contact us directly.

Helping address anesthesia service

needs at GI surgical centers nationwide

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What We Have Done

Executive Summary

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Partnership Models


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Partnership Models


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reimbursements�

Additional Benefits


What Physicians Have to Say

Current CRH Anesthesia Partners

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For More Information

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Adding painless,non-surgical hemorrhoid

treatment to yourGI practice is easy.

(Almost as easy as the procedure itself.)

Half of your patients will experience symptomatic hemorrhoids by age 50. Why not start treating them?

It’s also now being performed by more than 2,000 physicians at 800 practices across the country.

Join your colleagues and get started today by scheduling a free physician-physician training session at your practice.

For more information, call 800.660.2153 x 1023 or visit www.crhmedicalproducts.com

Your patients will thank you.

We’re GI anesthesia service specialists.

Because specialists deserve specialists.

Whether you’re looking to monetize your current business or transition to deep

sedation, our flexible partnership models allow our anesthesia services to integrate

seamlessly into your center. At CRH, we are dedicated to working together with you

to deliver only the highest quality of services to both your patients and your facility.

Contact us today to learn more about the opportunities available to your center.

1.800.660.2153 x 1035 | [email protected] | www.crhanesthesia.com

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CIRCLING THE WAGONS


Physicians Endoscopy

Rodger Baca Chief Development Officer

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What Makes PE Different?

Single-specialty focused in GI Hands-on management 110+ dedicated employees supporting over 40 centers Partnered with 17 hospitals in 14 states that collectively perform 300,000+ procedures.

PE Corporate Jamison, PA

Our Partnerships

GI physicians

40+ centers

300,000+ procedures

300+ satisfied

Our Hospital JVs

•  De Novo Partnerships

•  Acquisition Partnerships

•  Minority Ownership

•  Majority Ownership

•  Hospital Partners

•  Attractive Business Terms

•  Professional Management Services

What Makes PE Different?

FLEXIBIILITY PE Ownership

Physician Ownership

Hospital Ownership

Finance

Billing

Payor Contracting

Human Resources

Marketing

Clinical IT

Development

Acquired and/or developed 7 surgery centers in 5 states

that collectively perform over 30,000 procedures.

Partnered with 5 new hospitals who hold an equity stake in the surgery centers.

Completed a successful year by partnering with 50 new GI physicians. 6 surgery centers currently under development and/or

expansion scheduled to open in 2016.

2015 Growth & Beyond

2015 Growth & Beyond

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Partner to the GI Industry!

“Improving the landscape of healthcare one surgery center at a time.”

www.endocenters.com

NEW PARTNERS

Advanced Endoscopy Center

Ambulatory Center for Endoscopy

Augusta Endoscopy Center

AZ West Endoscopy Center

Berks Center for Digestive Health

Burlington County Endoscopy Center

Carnegie Hill Endoscopy

Central Arizona Endoscopy

Dekalb Endoscopy Center

DHA Endoscopy Center

Digestive Disease Endoscopy Center

East Side Endoscopy

Eastside Endoscopy Center

Eastside Endoscopy Center-Issaquah

Eastside Surgery Center

Elgin Gastroenterology Endoscopy Center

Endoscopy Center at Robinwood

Endoscopy Center of Bucks County

Endoscopy Center of Niagara

Endoscopy Center of Western New York

Garden State Endoscopy & Surgery Center

Greater Gaston Endoscopy Center

Hudson Valley Center for Digestive Health

Island Digestive Health Center

Kalamazoo Endo Center

Laredo Digestive Health Center

Lone Star Endoscopy

Lone Star Endoscopy Flower Mound

Long Island Center for Digestive Health

Michigan Endoscopy Center

Michigan Endoscopy Center at Providence Park

Mid-Bronx Endoscopy Center

Northern New Jersey Center for Advanced Endoscopy

Northwest Endoscopy Center

PGC Endoscopy Center for Excellence

Secure MD

South Broward Endoscopy

The Endoscopy Center at Bainbridge

The Endoscopy Center of West Central Ohio

University Suburban Endoscopy Center

... and more under development!

Join the Roundup of Partnered Centers:

2500 York Road ∙ Suite 300 ∙ Jamison, PA 18929(866) 240-9496 ∙ [email protected]

www.endocenters.com

Visit us at our booth!

40 surgery centers in 14 states that perform over 300,000 procedures.

Partnered with 17 new hospitals who hold an equity stake in the surgery centers.

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CIRCLING THE WAGONS


Janssen



CIRCLING THE WAGONS


Boston Scientific

1

Global Collaboration

Winning Spirit

Caring

Diversity

Meaningful Innovation

Living Our Mission and Values

High Performance

Boston Scientific is dedicated to transforming lives through innovative medical solutions that improve

the health of patients around the world.

2

Compete in Large, Growing Disease Markets

2 2

GI & Lung Cancer

15% of all asthma patients have severe symptoms

6-8 million patients not well controlled by medication

55% of all cancer-related deaths worldwide

4 million lung/GI deaths annually

Refractory Asthma

Pancreatico-Biliary Disease GI Bleeding Nutritional

Support

GI Disease Base Vast BSC Endo devices assist in the diagnosis and treatment of over 115 GI and Airway Disease

Primary Call Point Gastroenterology, Colorectal Surgeon, General Surgeon, Interventional Radiologist, Pulmonologist and Interventional Pulmonologist

14% of adults are affected by gallstone disease

1.5 million patients have large stones requiring clinical intervention

10% mortality rate with Upper and Lower GI bleeds

2.1 million patients are treated for gastrointestinal bleeding annually

7% of adults over age 65 require enteral feeding support

4 million initial and replacement procedures worldwide

3

GI & Pulmonary Vast Disease List

3 3

Polypectomy •  Colorectal Cancer •  Gardner’s Syndrome •  Lynch Syndrome •  Familial Adenomatous Polyposis Biopsy •  Esophagitis •  Barrett’s Esophagus •  Gastritis •  Crohn’s Disease •  Ulcerative Colitis •  Celiac Disease •  Gastroesophageal reflux disease (GERD) •  Viral Esophagitis •  Gastritis •  Gastric Ulcers / Peptic Ulcers •  Esophageal Cancer •  Stomach Cancer •  Ampulary Cancer

Esophageal Stent •  Esophageal Cancer: Squamous Cell &

Adenocarcinoma •  Esophago-respiratory Fistula •  Extrinsic Esophageal Compression from

Adjacent Lung Cancer •  Refractory Benign Esophageal Strictures

–  Peptic –  Anastomotic –  Radiation –  Caustic (Poison Ingestion)

Enteral Stent •  Bowel Obstruction •  Small Bowel Obstruction (SBO) •  Large Bowel Obstruction (LBO) •  Malignant Gastric Outlet Obstruction (GOO) •  Small Intestine Cancer •  Adenocarcinoma •  Carcinoid Tumor •  Lymphoma Tumors •  Sarcoma •  Colorectal Cancer •  Small Bowel Obstruction (SBO) •  Small Intestine Cancer •  Large Bowel Obstruction (LBO) •  Colon Cancer

Enteral Feeding •  Neurological Disorders •  Chronic Illnesses •  Mental Illness •  Critical Injuries •  Dysmotility •  Gastrointestinal Obstructions •  Gastrointestinal Decompression •  Trauma

Dilation •  Benign Esophageal Strictures •  Peptic Esophagitis •  Barrett’s Esophagus •  Gastroesophageal Reflux Disease (GERD) •  Schatzki’s ring •  Esophageal Webs •  Achalasia •  Peristalsis •  Anastomotic Stricture •  Malignant Esophageal Strictures: Squamous

Carcinoma or Adenocarcinoma •  Benign Pyloric Strictures •  Gastric Outlet Obstruction (GOO) •  Peptic Ulcers •  Gastric Ulcers •  Fibrotic Tissue •  Anastomotic Strictures •  Malignant Pyloric Strictures - Gastric cancer •  Benign Colonic Strictures - Inflammatory Bowel

Disease (IBD) •  Ulcerative Colitis •  Crohn's Disease •  Intestinal Obstruction •  Anastomotic Stricture •  Malignant Colorectal Strictures

Biliary Stone Disease •  Cholelithiasis •  Biliary Colic •  Acute Cholecystitis •  Cholangitis •  Choledocholithiasis •  Pancreatitis •  Cholangitis •  Cholecystitis •  Primary Sclerosing Cholangitis (PSC) •  Pancreatitis: Acute and Chronic

Pulmonary •  Ganulomatosis •  Granuloma •  Fibrotic Strictures •  Tracheomalacia •  Non-Small Cell Lung Cancer (NSCLC): •  Squamous Cell Carcinoma •  Adenocarcinoma •  Large Cell Carcinoma •  Small Cell Lung Cancer (SCLC) •  Anastomotic Strictures •  Extrinsic Tumors •  Cystic Fibrosis •  Tracheal-esophageal Fistula (TE fistula) •  Foreign Body Aspiration •  Asthma

RFA •  Jaundice •  Cholesthasis •  Hepatomegaly •  Portal Hypertension •  Ascites •  Liver Encephalopathy •  Cirrhosis •  Hepatitis •  Hepatocellular Carcinoma •  Cholangiocarcinomas •  Colorectal Cancer •  Ocular Melanoma

SpyGlass Direct Visualization System •  Biliary System Cancer •  Pancreatic Cancer •  Bile Duct Cancer •  Gallbladder Cancer •  Intraductal Pancreatic Mucinous Tumor (IPMT) •  Intraductal Papillary Mucinous Neoplasms of the

Pancreas (IPMN) •  Choledocholithiasis and Cholelithiasis

(Gallstones) •  Primary Sclerosing Cholangitis (PSC) •  Pancreatitis •  Indeterminate Pancreatic Strictures/Masses •  Pancreatic Stones/Debris •  Intraductal Papillary Mucinous Tumors of the

Pancreas (IPMT) •  Biliary Papillomatosis

Hemostasis •  Upper GI Bleeding •  Variceal or Non-variceal

–  Bleeding –  Lower GI Bleeding

•  Bleeding Varix •  Peptic Ulcer •  Gastric Ulcer •  Duodenal Ulcer •  Esophagitis •  Mallory-Weiss Syndrome •  Gastritis •  Dieulafoy’s Lesions •  Watermelon Stomach •  Gastric Antral Vascular Ectasia (GAVE) •  Ulcerative Colitis •  Crohn's Disease •  Diverticular •  Angiodysplasia of the Colon •  Angiomata Syndromes •  Post-polypectomy Bleeds

Biliary Metal Stents •  Cholangiocarcinoma •  Klatskin’s Tumor •  Extrahepatic Bile Duct Cancer •  Gallbladder Cancer •  Ampullary Cancer •  Pancreatic Cancer /Adenocarcinoma of the

Pancreas •  Intraductal Papillary-mucinous Tumors (IPMT) •  Intraductal Pancreatic-mucinous Tumors (IPMT)

4

•  Fortune 500 company with $7.4 billion in sales and seven operating divisions

•  23,000+ employees worldwide •  Representation in 110 countries, 40 facilities •  Portfolio of more than 13,000 products •  Over 16,000 patents, and 6,000 pending •  Shipping product throughout the world every

two seconds1

•  21 Million patients treated with Boston Scientific devices in 20141

•  Annual R&D and Clinical Science investment over $800 million

Who We Are…by the numbers

1 BSX internal estimates

5

Early Intervention Awareness Diagnosis

Monitoring Discharge Behavior

Solutions Across the Care Continuum

Health Economics and Reimbursement Services

Supply Chain and Workflow Optimization Benchmarking

Education & Training

Treatment Behavioral Medical Interventional

Portfolio Breadth & Product Value

Patient Monitoring Awareness & Access to Care

Patient management

Awareness and early detection patient education Scope Repair

Disease Management patient education

Procedural patient education

To learn more about Close the Gap, visit preventcrc.com. For inquiries regarding

Close the Gap opportunities, contact your local Boston Scientific Endoscopy representative

or email our Close the Gap program manager at [email protected].

Ways to Outreach and Serve

Close the Gap promotes educational activities, supports fundraising initiatives, and helps improve access to preventative

services through partnerships with health professionals and patient advocacy groups. Partnership opportunities include:

• Product Donations for Free Screenings — Online

Boston Scientific application process to support hospital

free screening events.

• Nationwide Screening Assistance — Boston Scientific

is the founding sponsor of the Colon Cancer Alliance’s

Blue Hope Prevention Program that improves access to

colonoscopies for uninsured and underinsured patients.

• Event Sponsorships — Online Boston Scientific grants

and charitable donation application process to support

community awareness and patient outreach events.

• Patient Education Materials — Access to educational

brochures and wallet cards to distribute at health fairs

or doctors’ offices.

Project Spotlight

Helping to Improve Screenings:

Addressing a Region’s Historically High Mortality

Rate from Colon Cancer1

Boston Scientific and the Kentucky Colon Cancer

Prevention Project worked to generate awareness about

colorectal cancer and encourage patients to get their

screening colonoscopies. The goal was to achieve 80%

screening rates in Kentucky by 2018 to improve patient

outcomes and reduce the overall cost of care.

Working with the Colon Cancer Alliance, Boston Scientific established

the Blue Hope Prevention Award that provides financial scholarships for

colonoscopies to underserved patients.

(Continued)

Close the Gap is a Boston Scientific health equity program dedicated

to raising awareness and helping to increase access to care for

underserved patient communities across the U.S. at high risk of

suffering from gastrointestinal and pulmonary diseases.

HEALTH DISPARITY PROGRAMS: CLOSE THE GAP

Boston Scientific is a sponsor of Project Innovation,

a new grant program that provides funding for

innovation ideas in Kentucky and Southern Indiana

that raise awareness about colon cancer prevention.

Why Boston Scientific?

For more than three decades, Boston Scientific has partnered with leading healthcare

providers to help improve patient outcomes through minimally invasive devices. Today,

as healthcare provider needs change, we are working collaboratively with our customers

to help optimize patient care and manage costs through our services and solutions.

To learn more, visit bostonscientific.com/gastroservices.

Boston Scientific works with its customers to address four areas critical to

an organization’s ability to create greater value.

Improving Financial Health

Enhancing Patient Experience

Greater Quality Outcomes

Increasing Operational Efficiencies

Project Spotlight (cont.)

Outcomes to date:

• More than 1,200 people reached through community

education in Louisville, Kentucky

• More than 600 pledges to get screened, and growing,

with 1,800 people educated to date, primarily in the

African American community

• 250 volunteers being trained as community educators

• 14,000 people educated and receiving assistance to

get screened at Community Health Centers

“ Close the Gap is making a huge impact in

our community, and ensuring more people

are getting screened, including the areas

of our city and state where the most health

disparities exist.”

— Andrea Uhde Shepherd, the Executive Director

of the Kentucky Colon Cancer Prevention Project

1 Kentucky had the highest incidence and fourth highest mortality rates of colorectal cancer from 2004-2008 in the United States, http://chfs.ky.gov/nr/rdonlyres/e6377a50-5c2e-4405-b237-48b26957c67a/0/2011annualreportfinal.pdf

All trademarks are the property of their respective owners.

Boston Scientific Corporation

300 Boston Scientific Way

Marlborough, MA 01752-1234

www.bostonscientific.com

Ordering Information 1.888.272.1001

©2015 Boston Scientific Corporation

or its affiliates. All rights reserved.

ENDO-357410-AA December 2015

HEALTH DISPARITY PROGRAMS: CLOSE THE GAP

��


CIRCLING THE WAGONS


Pentax Medical

GI Round Table | Forth Worth 2016 Worthington Renaissance Hotel, Fort Worth, TX

Brian Cochrane, VP, Sales March 11, 2016

What does it take to be innovative?

What is desirable to users?

What is viable in the marketplace?

What is possible with technology?

INNOVATION

GI Roundtable | March 2016

Our Mission and Vision


Safety & Incident Management

Training & Education Partnerships with Regulatory Agencies & Professional Organizations

Quality Care

Clinically Relevant Technology Filling the Therapy Gap Clinical Initiatives Standardization of Care

Cost Efficiency

Flexibility, right scope, right procedure Inpatient versus outpatient care Trend analysis Process management

FleproInpTrePro

gement

logy

Our focus is on developing clinically relevant, meaningful technology to improve patient care and reduce costs in healthcare delivery. �  Advanced imaging technologies designed to

improve disease detection rates and made easier to use and clean by healthcare providers.

�  Endoscope and video processing technology that seamlessly integrates procedural quality indicator data points to monitor and measure hospital and provider productivity.

�  New technology material selection designed to improve equipment sustainability, cleaning and disinfection capabilities.

Clinically Relevant Technology

Quality Care Caree


Standardization of Care

Key Imperatives

�  Maximizing operating efficiency – taking “cost out”

�  Intensifying the clinical portfolio – rationalize / prioritize service lines

�  Reducing fixed costs – hospital / academic

�  Increasing scale of the “right” service lines and outsourcing the “wrong”

�  Benchmarking and best practices

Integrated Care

Reimbursement Changes

Healthcare Reform

Competitive Pressures

$$$ for healthcare quality, not

quantity


Cost Efficiency




Quality Care


Cost Efficiency


FleproInpTrePro

gement

logy

Operational Partners

�  Utilization analytics based on shared goals and facility type

�  Service cost per procedure analytics per scope, procedure type, facility and clinician

�  Preventive versus non preventable repairs

�  Preventative Maintenance Inspections

�  Risk sharing


Cost Efficiency CostC

Safety and Incident Management




Quality Care


Cost Efficiency


FleproInpTrePro

gement

logy

Training and Educational Programs

�  Technician safety program �  Secure customer Infection

Prevention portal �  Specialty-specific community

education dinners �  Fellow Enrichment Program �  GI Nurse Continuing

Education �  Website CNE training �  Nurse care and maintenance

regional meetings

GI Roundtable | March 2016 Safety & Incident Management nagement

& Incident tt

Partnering with Regulatory Agencies and Professional Organizations

PENTAX Medical is continuously engaged with the FDA, CDC, and other professional medical societies to help us improve technology and develop enhancements to service and cleaning protocols.

Educational Partnerships

�  Video Editing Sponsorship Program (VESP) — co-hosted by ASGE, this program trains 3rd and 4th year Fellows on how to capture, edit, and produce procedural videos of high educational and technical quality.

�  DAVE Project — a free online atlas of peer-reviewed procedure video clips and physician presentations accessible to physicians worldwide.

�  Institute for Training & Technology — unites American Society for Gastrointestinal Endoscopy (ASGE) thought leaders and corporate visionaries, enabling endoscopic research and hands-on education and training.

�  Ambassador Program — initiative that exports endoscopic medical care and training to areas of the world in need.

Safety & Incident Management nagement

& Incident tt


New modules increase operational efficiency and facilitate clinical improvement

The next generation endoPRO iQ, version 7.7, features:Physician Favorites for creating and saving frequently used procedure

report templates and documentation selections

Tracking capability for pending pathology results

Automated Withdrawal Calculations to report withdrawal time based on

timestamps associated with Cecum photo documentation

Need help converting to endoPRO iQ 7.7? We have extensive experience

converting from existing EndoWorks® databases. Learn more and schedule a

demo at ConvertToiQ.com

Visit us at: us.PENTAXMedical.com

endoPRO iQ® Informatics SolutionsBetter Support for Better Patient Care

©201 PENTAX America, Inc. All Rights Reserved. All company and product names and marks contained within are federally registered trademarks, trademarks or service marks of PENTAX of America, Inc.

MK-762 Rev: A

��


CIRCLING THE WAGONS

SPONSOR

Takeda

[no presentation]

There is more that we can do to help improve people’s lives. Driven by passion to realize this goal, Takeda has been providing society with innovative medicines since our foundation in 1781.

Today, we tackle diverse healthcare issues around the world, from prevention to care and cure, but our ambition remains the same: to find new solutions that make a positive difference, and deliver better medicines that help as many people as we can, as soon as we can.

With our breadth of expertise and our collective wisdom and experience, Takeda will always be committed to improving the future of healthcare.

��


EXHIBITOR

AbbVie

��)55067�6�� )�� !��"��"��#��"�� $��)��%��&��#��'��(��"��"��(��)��"��"��(��# (www.facebook.com/abbviecareers) ��#�*��+��#��,��,��"�-��

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EXHIBITOR

AMSURG

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EXHIBITOR

Andersen Products

Disinfec on is no longer good enough. Sterilize your endoscopes with EtO using the next-genera on EOGas 4. High E ciency Flexible Chamber Technology provides the assurance of EtO steriliza on in a compact, tabletop package that uses only 17.5 grams of gas per cycle. EOGas sterilizes without a vacuum or steam injec on cycle. Ideal for your most sensi ve instruments. Easy installa on does not require water or vacuum lines.

4 Tabletop Ethylene Oxide Steriliza on for Endoscopes

100% Ethylene Oxide Steriliza on

Ac ve Aera on:Bag & Cartridge System:Unlike tradi onal Ethylene oxide sterilizers which involve rigid metal chambers and large external tanks of gas, the EOGas 4 system uses gas impermeable steriliza on bags and unit dose 100% EtO cartridges. By elimina ng chamber dead space, EOGas employs only a ny frac on of the EtO used in other systems.

With EOGas, steriliza on and aera on occurs in the same chamber. There is no need to transfer products to a separate aera on area.

The EOGas 4 sterilizer provides the proven relability of 100% ethylene oxide (EtO) steriliza on

in an easy to install tabletop package.

the future of gas sterilization

re

4

Speci\ca ons:

FRONT

BACK

SIDE

InnerDimensions

18"W x14" H x

25.25" D

Wal

l19"

28"

1.25"

24.25"

28.25"29.5"

51.75"

50.5"

28"

28"

22"

22"

6"

clearance

23.25"

Andersen Products has been a leader in 100% ethylene oxide steriliza on for over forty years. Our founder, Dr. H.W. Andersen, patented the ¶rst EtO ¸exible chamber sterilizer in 1969. Andersen systems are now in use in over ¶ y countrys around the world. Andersen sterilizers have always been the most gas e cient on the market, using less than 18cc of EtO per cycle. Please visit our website at www.anpro.com for more informa on about our products.

Total Weight:76.2 kg

Power Supply:230 ± 10%, 50-60 Hz

FDA & Valida on Informa on

Free Key Operator TrainingAndersen provides free training for as many operators as required, for the

life me of the cabinet.

Version_021616

www.anpro.comAndersen Products, Inc.Health Science Park • 3202 Caroline DriveHaw River, NC 27258-9564 USA800-523-1276 • fax 336-376-8153

www.andcal.comH. W. Andersen Products of California, Inc.Health Science Park • 3151 Caroline DriveHaw River, NC 27258-9575 USA800-524-3455 • fax 336-376-3088

H.W. Andersen Products, Ltd.Davy Road • Clacton-on-SeaEssex CO15 4XA UK1255-428-328

Manufactured by:Andersen Sterilizers, Inc.3154 Caroline DriveHaw River, NC 27258 USA

the future of gas sterilizationthe future of gas sterilization

The EOGas 4 has been fully validated and approved by FDA for the steriliza on of the following types of ¸exible endoscopes:

Device Type Maximum Load Device Examples Required Aera on

Validated and FDA Approved

One (1)

2.0 mm internal diameter

1100 mm (3.6’) length

Gastrovideoscopes, gastrointes nal videoscopes

12 hours at 50°C; Following manufacturer’s instruc ons

Four (4)

1.2 mm internal diameter

700 mm (2.3’) length

Bronchoscopes, bronchovideoscopes, cystoscopes, ureteroscopes, choledocoscopes

Andersen sterilizers are 100% US made. Proudly designed and manufactured at our headquarters in Haw River, North Carolina.

Items to be sterilized are prepared and placed inside a steriliza on bag along with an EtO cartridge and a Humidichip® to insure an appropriate humidity level . The bag is cinched with a Velcro® strap and loaded into the steriliza on cabinet. For each load the sterilizer prints two tracking labels, one for the bag and one for a steriliza on log book. Once inside the cabinet the EtO cartridge is ac vated inside the sealed steriliza on bag. The steriliza on cycle lasts 3.5 hours including a 30 minute gas purge cycle. The gas is then evacuated from the bag via a purge probe and vented directly to the outside via a 1” exhaust line. Emission abatement system is available for demanding air quality districts.

EOGas 4 Process

About us

��


EXHIBITOR

C2 Therapeutics

C2 CryoBalloon™ FOCAL ABLATION SYSTEMA better choice for patients with unwanted esophageal tissue

BETTER FOR PATIENNTS

The C2 CryoBalloon™ Ablation System provides you with another option for treating unwanted tissue in the esophagus, while offering inherentpatient benefits of cryyotherapy:

• Reduced potential forr stricture and scarring1,2

• Less post-procedure ppain1,3-5

• Safe ablative approacch4,6-8

• Psychological preference to that of burning tissue3

BETTER FOR CLINICIAANS

C2’s patented design delivers nitrous oxide (N20) cryogen from the diffusser through a conformable balloon, providing conttrolled depth of ablation but with the versatility tto address tortuous anatomy, advanced diseease and other characteristics or conditions that would otherwise preclude ablative therapy.5,7,8

Cryoablation reaches thhe submucosa without damagingunderlying healthy tissue.7

Expanded patient use and a favorable safety and efficacy profile allows nd a favorable safety and efficacy profile allows cryotherapy to be considered a first line therapy for esophageal disease.dered a first line th f 9

BETTER FOR HEALTH ECONOMICS

The C2 CryoBalloon™ Ablation System is a therapy enabled through a handheldcontroller in combination with self-sizing balloon catheters,without the need for large capital investment or substantial inventory of disposable items.7

C2 CryoBaB llolloon™on™ FFoF lcala CaCathetheter, Standard (FG-1009)

Insert through working channel

(866) 515-3861 www.c2therapeutics.com

THE PROCEDURE*

• C2 CryoBalloon™ Focal Ablation System is inserted into the working channel of a 3.7mm therapeutic endoscope (diagnostic endoscopes may also be used with the addition of a C2 CryoBalloon™ Sidecar device).

• A pre-puff of N20 is delivered to inflate the balloon and orient cryogen diffuser.

• Set dosing and hold trigger of the C2 CryoBalloon™ Controller to deliver cryotherapy.

• Reposition diffuser by tilting Controller left or right. Repeat energy delivery as needed.

• Deflate C2 CryoBalloon™ and withdraw catheter.

*See Instructions For Use (IFU) for complete procedural information.

PART NUMBER DESCRIPTION

SYSTEMS (Includes Controller and Catheter)

SYS-1035 C2 CryoBalloon™ Focal Ablation System

ACCESSORIES

FG-1010 C2 CryoBalloon™ Nitrous Oxide Cartridges, Regular (Box of 5)

FG-1011 C2 CryoBalloon™ Sidecar (Box of 5)

FG-1016 C2 CryoBalloon™ Boa (Box of 5)

Portable system with no capital investment

C2 Therapeutics, Inc.303 Convention Way, Suite 1 Redwood City, CA 94063(866) 515-3861 – Toll Free(650) 556-1145 – Faxwww.c2therapeutics.com

® Copyright C2 Therapeutics, Inc. 2016.

NOTE: The C2 CryoBalloon™ Focal Ablation System is intended to be used as a cryosurgical tool for the destruction of unwanted tissue in the field of general surgery, specifically for endoscopic applications.

REFERENCES 1 Schölvinck DW, Künzli HT, Kestens C, et al. Treatment of Barrett’s esophagus with a novel focal cryoablation device: a safety and feasibility study. Endoscopy. 2015 Dec;

47(12):1106-12.

2 Vikingstad EM, de Ridder GG, Glisson RR, et al. Comparison of Acute Histologic and Biomechanical Effects of Radiofrequency Ablation and Cryoablation on Periarticular Structures in a Swine Model. JVIR. 26:1221-1228,2015.

3 Timmermans C, Ayers GM, Crijns HJ, Rod\riguez LM. Randomized Study Comparing Radiofrequency Ablation with Cryoablation for the Treatment of Atrial Flutter with Emphasis on Pain Perception. Circulation. 107:1250-1252,2003.

4 Deisenhofer I, Zrenner B, Yin Y, et al. Cryoablation Versus Radiofrequency Energy for the Ablation of Atrioventricular Nodal Reentrant Tachycardia (the CYRANO Study). Circulation. 2010;122:2239-2245.

5 Johnston et al. Cryoablation of Barrett’s esophagus: a pilot study. Gastrointest Endosc 2005: Vol. 62, p842-848.

6 Evonich RF, Nori DM, Haines DE. A Randomized Trial Comparing Effects of Radiofrequency and Cryoablation on the Structural Integrity of Esophageal Tissue. J Interv Card Electrophysiol. 2007 Aug;19(2):77-83.

7 Friedland S, Triadafilopoulos G. A novel device for ablation of abnormal esophageal mucosa. Gastrointest Endosc. 2011 Jul;74(1):182-8.

8 Sengupta, et al. Salvage cryotherapy after failed radiofrequency ablation for Barrett’s esophagus-related dysplasia is safe and effective. Gastrointest Endosc. 2015 Apr 14.

9 Dumot J. The Use of Cryotherapy for Treatment of Barrett’s Esophagus. Gastro & Hep. 2013: Vol. 9, Issue 12, p811-813.

MKTG 1002 Rev A.

1st Ablation

2nd Ablation

Left over ice field from 1st ablation

��


EXHIBITOR

Coker Group

��


EXHIBITOR

EndoChoice

Imaging Devices Diagnostics Infection Control

EndoChoice.com/Fuse | FuseColonoscopy.org | FuseCases.com

To schedule a Fuse demo, please email [email protected] or call 888.682.3636 x5.

A new generation has arrived.Introducing Fuse® Generation 2FuseView® 4K Ultra HD Viewing Experience | FuseBox® Advancements | C38s Slim Colonoscope | StrataFlex™ Technology

Experience Fuse® at EndoChoice Booth #16

032M-END GI Roundtable_2016.qxp_EndoChoice 2/25/16 11:50 AM Page 1

Intuitive.Reliable.ALL NEW Neptune® Injection NeedleSmart design allows for easy, single-handed operation

Spring-assisted catheter facilitates smooth catheter advancement andreliable needle deployment even in tortuous anatomy

One click, push button needle retraction

For more information, please call

888.682.ENDO

ControlInnovation.

ALL NEW Boa® Polypectomy Snare

through

OmniLoop™ 3-in-1 variable loop sizing (10, 20 & 30 mm)

Provides flat loop deployment and retraction whilemaintaining shape through multiple deployments

Maximizes loop diameter while minimizing length

30mm

20mm

10mm

Imaging Devices Diagnostics Infection Control

EndoChoice.com

EndoChoice Booth #16

032M-END GI Roundtable_2016.qxp_EndoChoice 2/25/16 11:50 AM Page 2


EXHIBITOR

EndoGastric Solutions

��


EXHIBITOR

EPIX Anesthesia

��

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EPIX ANESTHESIA T: 855-888-EPIX (3749) | O: 678.580.1349 | F: 770.559.1231 | 3949 Holcomb Bridge Rd., Ste. 300 Peachtree Corners, GA 30092�

COMPREHENSIVE ANESTHESIA SOLUTIONS Epix Anesthesia, an independent anesthesia management company with a collective 50+ years of experience, is the industry leader in delivering flexible, adaptable, anesthesia solutions that result in exceptional patient care and superior client productivity and satisfaction. The Epix Anesthesia team establishes and manages anesthesia practices at ambulatory endoscopy centers across the country. Epix partners with its clients through a transparent structure that empowers its clients to fully understand the anesthesia business. Our seasoned management team establishes and leads anesthesia departments focused on service and quality and works with your center to achieve its objectives through our commitment to service and our comprehensive management program.

CAPITALIZE ON OUR EXPERTISE Epix Anesthesia works hand-in-hand with our clients to map a long-term course for meeting current and future needs, including maximizing margins and attaining productivity goals. As a result of our attention to detail, our comprehensive management program and strong relationships, our clients are able to capitalize on our expertise. Our industry leading services include, among other things:

Superior patient care and client satisfaction Clinical and non-clinical management to support day-to-day operations of

the anesthesia department Proficiency with anesthesia managed care contracting by leveraging well-

established relationships with insurance carrier representatives cultivated through years of experience

Dedicated anesthesia billing services Recruiting and staffing services utilizing well-established relationships

with anesthesiologists and CRNAs Credentialing and enrollment services ensuring each clinician’s ability to

provide anesthesia services and to participate in your various payer contracts

Total Quality Management system using data analysis achieved through technology and compliance training processes

Anesthesia documentation and forms MAXIMIZE MARGINS Epix Anesthesia helps you increase your profitability. Epix Anesthesia’s devoted team helps increase revenue and decrease costs by managing the business aspects of the

��

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EPIX ANESTHESIA T: 855-888-EPIX (3749) | O: 678.580.1349 | F: 770.559.1231 | 3949 Holcomb Bridge Rd., Ste. 300 Peachtree Corners, GA 30092�

anesthesia department while Epix’s billing team maximizes collections in this difficult environment. Through our dedicated anesthesia billing services, we offer:

In-depth anesthesia revenue analysis and management via our experienced financial and operations team

Billing-related compliance and training programs for all personnel Robust and fully transparent reporting system

� Ability to create and view hundreds of customizable reports � Access to real-time reporting

Checks and balances system for managed care contracting, credentialing and enrollment to ensure that anesthesia dollars are maximized and collected

Epix Anesthesia supports this process by auditing and tracking revenue performance to ensure every anesthesia dollar is collected. Along with our anesthesia billing department, our financial team utilizes a robust reporting system to effectively manage the economic performance of your anesthesia department. PARTNERING WITH A COMPANY THAT KNOWS ANESTHESIA Epix Anesthesia provides clinical and non-clinical solutions to proficiently manage the anesthesia department at our clients’ sites. By partnering with the Epix Anesthesia team, your anesthesia services will benefit from our focused knowledge and experience. Our clinical expertise and proven practices provide a solution for your current and future anesthesia needs. With an honest and direct approach, you can confidently develop your anesthesia department and continually know that your needs and expectations are being met. A PROGRAM TO MEET YOUR NEEDS Honest and direct communications with our clients has been key to Epix Anesthesia’s success. With the complexities of structuring, organizing, developing and managing an anesthesia department, Epix asks all of the right questions and advises you on the effects of your decisions. Understanding the financial and operational aspects of the anesthesia business empowers you to make decisions to meet your needs and to better understand the impact those decisions will have from a business and clinical perspective. Once you make those critical business decisions, Epix Anesthesia’s management team will help implement those decisions.

��


EXHIBITOR

ERBE

��#�)#�� !�� #�;�� !��"��#��##�� $##;��!��#;�� %� ��&�!��&��'��!!��#�)#��"��#�)#$��!��%��%(��&��(�&��!�)�&��!��!�&��&��#�)#�$��)��!�&��&��!��*%��%+��&��!��'��#�� # ��,�� "�-��- �*../0�1..%001%*0�*��'��%��'&��

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EXHIBITOR

Exact Sciences

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EXHIBITOR

Ferring Pharmaceuticals

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EXHIBITOR

FujiFilm

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EXHIBITOR

Genii

� Is the only generator that can perform all GI procedures (from simple polypectomy to argon coagulation to ESD – with lavage) in one unit so compact that it can fit anywhere. This makes standardization easy – a hallmark of efficiency.

� The gi4000 is only for flexible endoscopy. Every output is perfect for GI and perfectly matched to GI specific accessories. Exclusive FDA cleared default settings for physician confidence.

� A revolution in ease of use! Touch, confirm, treat! Simpler to be safer and more efficient. True touch screen is intuitive and has easy set up instructions on every screen.

� Best argon beam. Robust arc length without sacrificing limited tissue depth.

� Hundreds of units are in use all across the country. Genii customers include university, government and community hospitals as well as free standing / physician owned centers—large and small!

� Made in the USA

855-501-4810 www.genii-gi.com [email protected]

��


EXHIBITOR

HyGIeaCare

�HyGIeaCare® provides unique services and solutions to gastroenterologists to deliver better GI outcomes for their patients and their practice.

About Us In 2014 Gavriel D. Meron, founder and former CEO of Given Imaging, the Company that successfully brought the PillCam to the world, partnered with Texas-based Lifestream Purification Systems to form HyGIeaCare, Inc. to bring the HyGIeaCare FDA-cleared Prep System and Prep procedure exclusively to the GI world. The goal of HyGIeaCare is to provide unique services and solutions to gastroenterologists to deliver better GI outcomes for their patients and their practice through a chain of HyGIeaCare Centers to be established in the US and throughout the world. In the US, 14.5M screening colonoscopies are performed each year, and this number is growing annually. According to the recently released US Multi-Society Task Force Consensus Statement on Adequate Bowel Cleansing for Colonoscopy, up to 20 - 25 percent of all colonoscopies are reported to have an inadequate bowel preparation. An incomplete standard prep makes it difficult to detect precancerous lesions. Current prep is also burdensome. There is clearly a need for a better way to prep colons.

Same Day Prep™ Providing Same Day Prep for Endoscopic Procedures

What?�� Gentle bowel prep for colon cleansing, RX based - such as before radiological or endoscopic examination (FDA-cleared)

How? Through a gentle infusion of warm, gravity-flow, filtered water

Why? To effectively cleanse the colon

Where?�� At HyGIeaCare Centers GI Practice Advantages: • Expands and differentiates practice • Expand patient base by reaching out to patients

who: • Proactive marketing and PR � Do not want to do the traditional prep

� Are contraindicated for a traditional prep � May have side effects from traditional prep � Are diabetic

• Improved patient satisfaction – “viral marketing”

Expanded Patient Base: Patient populations that find the standard prep difficult to perform, such as: • Diabetics with difficulty going on a

liquid diet • Dementia patients • Nursing home residents • Other hygienic-impaired patients

• Patients who cannot “run to the bathroom”

• Patients who cannot drink huge quantities of water

• Patients contraindicated for traditional prep

�

Patients Choose HyGIeacare® Prep: • Prep requires less burdensome diet restrictions • Same day as procedure - No additional time away from work • Safe, fast, easy and convenient (usually less than an hour) • Private, modest and odorless • Hygienic • Personal sterile disposable kit • Stringent disinfection protocol for the System

Potential Improvements in GI Office Operations: • Improving ADRs • Time to reach cecum • Efficiency of extraction • Fewer repeat procedures due to poor prep • Fewer failed procedures due to • poor prep compliance • Fewer cancellations by patients due to non-compliance • Salvage colonoscopies for unprepped patients

The System:

FDA-cleared Class II RX ONLY Medical Device

Conforms to AAMI Std ES60601-1 & IEC Std 60601-1 (3rd Edition compliant)

Indications for Use: When medically indicated, such as before radiological or endoscopic examination.

Contraindications: Congestive heart failure, intestinal perforation, carcinoma of the rectum, fissures or fistula, severe hemorrhoids, abdominal hernia, renal insufficiency, recent colon or rectal surgery, recent abdominal surgery, first and last trimester of pregnancy, cirrhosis

Safety Features of the HyGIeaCare Prep System:

• Gently arched rectal nozzle, with a diameter of less than 1 cm. • Water flows through a sediment and UV filter. • Water flows gently, driven only by gravity. • Temperature of the water is steadily maintained. • Water automatically stops flowing into the patient if temperature of the water exceeds

the safe range of 99° - 103°F (37° - 39° C).

Infection prevention is high priority in HyGIeaCare Centers. Our centers implement and strictly follow the guidelines produced by the Centers for Disease Control (CDC) titled “Guide to Infection Prevention in Outpatient Settings”. The guide covers recommendations for issues such as healthcare-associated infection surveillance and reporting as well as the proper cleaning and disinfection of both environmental surfaces and medical equipment. The water used in HyGIeaCare System is periodically tested to ensure it meets the EPA National Primary Drinking Water Regulations (NPDWR) for drinking water.

HyGIeaCare® is HIPPA compliant

��


EXHIBITOR

Ideal Protein

OOUR WEIGHT LOSS PROTOCOL IS… PREDICTABLE, REPEATABLE AND MEASURABLE

Ideal Protein is a supervised, four-phase VLCD weight loss method utilizing foods of highly bio-available amino acids combined with lowered carbohydrate and fat intake. This is not a high

protein diet. Rather, it is a medically sound, balanced diet wherein the dieter receives the ideal amount of protein as recommended by the FDA (.8gékg of body weight), as well as vegetables,

carbohydrates and other vitamins. The goal is to support and coach the dieter and then give the education to maintain their weight loss for the long-term.

��


EXHIBITOR

Invendo Medical

invendo medical is a global leader in sterile, single-use and light-weight HD endoscopy products in the field of gastroenterology and GI surgery. invendo medical’s first product is a sterile single-use colonoscope with advanced ergonomics.

21st Century Ergonomics

Traditional endoscopes utilize an old-fashioned 2-wheel cable-bound system for deflection of the endoscope’s tip. GI endoscopes are one of the very few medical devices not to have undergone any real ergonomic improvements in 40+ years.

The new invendoscopy E200 system incorporates an advanced detachable control body for all scope functions – the invendo ScopeControl. The ScopeControl gives the endoscopist the options to either use it attached to the proximal end of the scope - like traditional endoscopes - or detached from the scope permitting free movement for the endoscopist and effectively providing greater comfort.

The ScopeControl will be made available in different standard sizes to properly fit the different hand sizes of different endoscopists.

The sterile single-use invendoscope SC200 colonoscope deflects 180° in all directions with a very tight radius (35 mm vs. 52 mm of most conventional colonoscopes), permitting retroflection throughout the colon. The tip can also rotate with a single button activation on the ScopeControl (“Diagnostic Mode”) to increase the effective field of view beyond conventional systems, allowing the endoscopist to fully concentrate on the view and not be distracted by his/her hand movements. A 3.1 mm working channel allows for biopsies and polypectomies using standard-sized endotherapy instruments.

The invendoscopy processor (invendo SPU E200) is designed for ease of use by the endoscopy staff. All set-up functions are properly displayed on the graphic user interface and activation is simplified with a modern touchscreen. The invendoscope single use aspect eliminates the high start-up cost associated with adding an additional room or opening a new satellite center.

Always New

Single-use product solutions also eliminate the issue of technology obsolescence, as newest technology upgrades are typically available upon the next shipment without the need to re-invest significant amounts of money. Therefore a single-use endoscope will permit your institution to always have the newest technology available, while at the same time eliminate expensive scope repairs.

No Reprocessing

According to the CDC contamination of endoscopes has been linked to more healthcare associated infections than any other medical device. ECRI ranks endoscopes as the number 1 healthcare hazard in their latest report.

Additionally the current means of reprocessing endoscopes with high-level disinfectants are typically either oxidizing agents or aldehydes. These aldehydes are effective disinfectants, but may potentially cause occupational health issues for healthcare workers.

invendo medical is addressing all these issues with sterile single-use GI endoscopes. Difficulties associated with the proper cleaning and disinfecting of reusable flexible endoscopes are completely eliminated. invendo ensures a sterile new scope for every patient every time – avoiding any potential risk of cross-contamination.

*The product described in this document has not yet been submitted for 510(k) clearance with the Food and Drug Administration or any other equivalent clearance pathway with other regulatory agencies worldwide. While it is intended to file a 510(k) submission with the Food and Drug Administration the product is not available for sales in the United States or in any other country. The company is therefore not soliciting or even taking any orders

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EXHIBITOR

LifeLinc Anesthesia

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EXHIBITOR

Miraca Life Sciences

Excellence in GI Anatomic Pathology

© 2015 Miraca Life Sciences, Inc. All rights reserved. GI0162 5.15

To order Miraca Life Sciences GI Pathology Services

or to speak with a Miraca Life Sciences representative, call

1 . 8 6 6 . 5 8 8 . 3 2 8 0 or visit us online at MiracaLifeSciences.com

Miraca Life Sciences Delivers E X P E R T G I PAT H O LO G Y

TECHNOLOGY SOLUTIONS • CONSULTING SER VICES

IMPECCABLE SER VICE

Serving more than 5,500 patients every day, Miraca is the largest U.S. anatomic pathology laboratory, with our

primary facilities in Dallas, Phoenix, Boston and Union, N.J. Our team of nearly 90 academic-caliber pathologists are

all fellowship-trained subspecialists, including more than 40 GI pathologists. We continuously improve diagnostic

precision through a commitment to research and publishing in peer-reviewed journals, our consensus approach

to terminology and criteria, rigorous quality assurance, daily consensus conferences, extensive educational and

training activities, and close relationships with clinical partners. Additionally, Miraca Life Sciences has a nearly perfect

concordance rate with outside academic institutions. Beyond our labs, we also serve clients with technology solutions

and consulting services for Meaningful Use, ASC reporting, quality reporting, workflow efficiency and more.

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EXHIBITOR

Officite

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EXHIBITOR

Olympus

Olympus technology continues to advance the art of

endoscopy. As the world leader in endoscopy, Olympus

provides cutting-edge medical technology to healthcare

professionals around the globe.

Our commitment to research and development and our

collaborative efforts with the medical community work

to improve both the underlying technology and the quality

of patient care it helps deliver. It is a continuous evolution,

aimed at improving the health of people around the world.

These innovative technologies help facilitate more accurate

diagnosis and treatment, simplify setup and reprocessing,

and improve workflow.

The EVIS EXERA III endoscopy system

is setting the standards for technologies

focusing on:

Advancing Visualization

Advancing Control

Advancing Workflow

Advancing the Art of Endoscopy

Advancing Visualization

EVIS EXERA III provides superior image quality

to commercially available products, which enables

observation with greater detail.

In a recent large study from Mayo Clinic Jacksonville,

the adenoma detection rate reported using the Olympus

190-series colonoscope was 50%.

Advancing Control

Using Olympus ScopeGuide technology (see image above)

in conjunction with Olympus 190-series colonoscopes can

be a valuable combination to achieve a complete exam in

difficult anatomy and to improve endoscopic success rates.

The Olympus forward-viewing ultrasound gastrovideoscope

sets a new standard with its straight channel port. Reduced

resistance provides greater puncture force and increased

device control.

A recent multi-site study using 190-series colonoscopes

showed reduced cecal intubation time compared

to previous generation scopes.

1 Rastogi A, Kaltenbach T, Soetikno R, Bansal A, Wallace M. Cecal Intubation

Times with Colonoscopes Incorporating Passive Bending and High-Force

Transmission Technology: A Multicenter Randomized Controlled Trial.

The American Journal of Gastroenterology. 2013 October 1;108 (Supplement).

Advancing Workflow

Achieve greater operating efficiency by standardizing

equipment, training, service and biomed support, plus

cost-saving backward compatibility with over 100 flexible

and rigid scopes, and camera heads.

The EVIS EXERA III Universal Video Platform provides an

economical upgrade path from simple to complex

procedural specialties providing advanced imaging options

in HD, Narrow Band Imaging, 2D and 3D.

Conventional convex type

OLYMPUS GF-UCT180

TGF-UC180J

3500 Corporate Parkway, PO Box 610, Center Valley, PA 18034

Olympus is a registered trademark of Olympus Corporation, Olympus America Inc., and/or their affiliates.

For more information, contact your local Olympus

sales representative, or call 800-848-9024.

www.medical.olympusamerica.com

©2016 Olympus America Inc. All rights reserved.

Printed in the USA OAIGI0116BRO17988

ScopeGuide technology:

Real-time, 3D visualization of the scope configuration

Increased procedural efficiency1

Total cecal intubation time (hours) per 100 procedures

Shorter bar indicates reduced procedure time

60 65 70 75 80 85

CF-HQ190

CF-H180

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EXHIBITOR

Ostom-i Alert/11-Health

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EXHIBITOR

PathGroup

Gastrointestinal Pathology

Our comprehensive gastrointestinal pathology testing menu includes the latest in:

With personalized attention and the fastest turnaround times in the industry, we offer the most comprehensive

anatomic, clinical, and molecular pathology services from a single point of contact. As your partner, we share

in your focus on high quality patient care and service. This is why our pathology testing menu is built on a

core offering of the latest and most accurate in diagnostics.

Our Advantage

PathGroup is privately held and physician-centric. Our diagnostic staff is made up of more than 75 board-certified

pathologists and includes a dedicated, fellowship-trained GI Pathology team, as well as on-site hematopathologists,

ready to assist physicians in the diagnosis of a broad spectrum of gastroenterological disorders.

Diagnostic Expertise

One source for all of your anatomic, clinical, and molecular pathology needs;

comprehensive sub-specialty expertise

Every case signed out by a fellowship-trained GI Pathologist

Definitive diagnosis on GI Pathology cases; Questions? Speak directly

to a pathologist

Industry leading turnaround times and responsive customer service

KRAS and BRAF gene testing

Microsatellite Instability / Lynch Syndrome Testing

HER-2neu Fluorescent In-Situ Hybridization

Flow Cytometry

Immunohistochemistry

Cytochemical Histologic Stains

For more information, visit pathgroup.com or call 1-888-410-4618.

Quality diagnostic services create a vital link in the cycle of patient

relationships. As an industry leader, PathGroup’s mission is to provide

the highest quality anatomic, clinical, and molecular pathology services,

consistently exceeding the expectations of our clients, physicians,

employees, payers and most importantly, patients.

PathGroup makes it easy for your medical practice to provide the fastest, most accurate, diagnostic services for

your patients with the operational benefits of working with a single pathology company. We offer customized

quality assurance measures to meet customer specifications, and compared to the industry standard of 2% we

review a minimum of 5% and up to 15% of cases retrospectively. We are proud to deliver life changing advances

in healthcare technology and diagnostics, every day.

Fast and Accurate

PathGroup uses the latest in proprietary and industry-standard technology to deliver fast, accurate results.

Reporting and Connectivity

Over 400 live interfaces with

more than 100 EHR/EMR providers

PathGroup Mobile™, the latest in

iPhone and iPad apps for clinicians

Customizable reports, including

photographic and document

telephone reporting

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EXHIBITOR

pMD

Mobile Software ThatMAKES DOCTORS HAPPY ®

pMD provides intuitive, elegant mobile software that improves patient care and makes doctors happy. Our mobile communication and data capture platform vastly increases efficiency, improves compliance, and allows you to capture more accurate information right at the point of care.

GASTROENTEROLOGY • CARDIOLOGY • HOSPITALIST • INFECTIOUS DISEASE NEPHROLOGY • NEUROLOGY • GERIATRIC • PULMONOLOGY • UROLOGY

We also work with many other hospital-based specialties!

ABOUT USpMD provides intuitive, elegant mobile software that improves patient care and makes doctors happy. pMD’s mobile patient management and billing platform increases your efficiency and streamlines the entire practice from point-of-care through reimbursement.

pMD’s customers include individual physicians, physician practice groups, managed care organizations, hospitals, billing companies, and myriad specialists located across the country. The pMD team is committed to developing the best solution on the market and providing superior customer service.

CHARGE CAPTUREpMD’s mobile charge capture app allows doctors to record billing information on their services right into their mobile devices - anytime, anywhere. The advanced, customized ICD-10 code search gives providers a convenient and intuitive way to select the most accurate codes during charge capture. In addition to charge capture, pMD also gives providers an easy way to capture lightweight clinical data right at the point of patient care. The clinical information can then be exported or interfaced with other systems and databases.

SECURE MESSAGINGpMD’s HIPAA-compliant secure text messaging platform allows you to communicate about sensitive patient information securely and in real-time. The messaging functionality is integrated directly into the mobile app and works even in areas with poor data signal. Keep everyone on the same page using secure group conversations and automated clinical alerts and reminders. pMD helps you strengthen relations with physicians outside your group with on-the-fly messaging invites and creates a secure communication channel with your medical community.

HEALTH INFORMATION EXCHANGEpMD excels in interoperability. pMD’s health information exchange services filter and route different types of data and clinical information to automate and eliminate manual processes. Health care professionals and patients can securely access and share pertinent medical information in real-time, reducing data entry and improving provider workflows. Leverage pMD’s interface expertise to reduce the amount of time you spent on interface projects. pMD works with most major hospital information systems, electronic medical records, medical billing and practice management systems.

CARE COORDINATIONpMD provides the technology to track and manage the care that patients receive across various health care specialists and transitions of care. Improve cross-directional information sharing between specialists and with external care teams with pMD’s secure platform and custom, shareable patient templates. Providers can easily and compliantly share clinical information across an entire care team and within different organizations.

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EXHIBITOR

PRSM Healthcare

HOWmany patients are you missing with your current recall efforts?

much revenue has your practice missed?

often are you exposed to liability from missed patients?

It’s time to rethink recalls.CHALLENGE: Gastroenterology (GI) practices face

significant barriers to procedure recalls, including a multi-year

gap between visits, inaccurate data and competing priorities.

The result? At many practices across the country, only 15-20%

of patients return for their recall procedure at the right time.

SOLUTION: PRSM Healthcare solves the GI practice challenge

of patients who fail to return for follow-up endoscopy visits by providing

complete patient recall solutions proven to:

• Improve patient care

• Increase revenue

• Ensure compliance

• Seamlessly support the GI practice through the entire recall process

Snapshot – More RecallsA GI practice in Knoxville, TN

increased their recalls by almost

2,000 patients in their first full calendar

year using PRSM, significantly increasing

their revenues.

800.341.5839 | www.PRSMhealthcare.com

“PRSM has helped us streamline our workflow around recalls and increase our volume. Prior to PRSM we were backlogged on our recalls, but PRSM has helped us schedule additional patients and catch up.”

GI Associates and Endoscopy Center, Jackson, MS

Before PRSM:

patientpresented

unknown/ no response

19%$

81%

After PRSM:

patient declined/unable to engage

patient presented/ currently scheduled or patient in contact with practice

ongoing engagement/ patient deferred

51% 41% 9% $ $ $ $ $ $ $

IncreasingREVENUESNo patient = no payment to PRSM.

It’s that easy.

PRSM sets the new standard for procedure recalls, yet is

remarkably cost effective. Once recall patients that have been

contacted and scheduled by PRSM present for their procedure

appointment, you pay PRSM – it’s that easy. No patient = no

payment to PRSM.

PRSM’s services have been shown to dramatically increase the presentation rate of procedure recall patients, and therefore the revenues of GI practices. The math is simple: a physician attempting to recall 1,000

patients a year typically only has 20% – or less – that actually

present. During the first year, PRSM has a proven history of

increasing procedure recall presentations by 30% or more.

There are additional benefits to the practice based upon related

patient visits and increased practice productivity.

The PRSM ProcessPRSM’s advanced approach to procedure recalls begins with

gaining an understanding of the practice’s recall process to

ensure the timely recall of all eligible patients while documenting

each patient’s status in the process. From there, PRSM’s highly

skilled staff begins the recall of non-compliant patients. Patients

appreciate the convenience offered by PRSM’s team, which is

available days, nights and weekends.

PRSM can also provide other services, such as performing a

historic review to evaluate past recall non-compliance for a period

of up to 10 years and reengage any patients that need to come

back. Additionally, many practices engage PRSM to examine their

existing patient base to ensure all patients are being notified

when they reach the appropriate age for a colonoscopy, further

enhancing patient engagement and increasing practice revenues.

800.341.5839 | www.PRSMhealthcare.com

Ensuring Compliance and Reducing LiabilityThe proper and timely recall of patients is not just a revenue

issue, it is also a quality and a liability issue. If your practice did

not make a sufficient effort to recall a patient, doesn’t have the

documentation to prove it made the effort, or doesn’t know how

to improve its process, the costs could be significant.

Snapshot – Database MiningPRSM was asked to help a practice bring in

new patients. Rather than looking outside

the practice’s walls, PRSM looked inside,

and was able to identify previously

seen patients who were now at

the right age for colonoscopies.

The Time for PRSM Is NowPRSM has developed the new standard for

procedure recalls that improves patient care,

increases practice revenues, ensures

patient compliance and reduces liability.

Contact PRSM today and see how we can help your practice.

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EXHIBITOR

Sedasys/Ethicon Endosurgery

EES Meetings & Conventions Company Description - Sedasys.doc

COMPANY DESCRIPTION Sedasys, a Division of Ethicon US, LLC 4545 Creek Road Cincinnati, OH 45242 Phone: 1-877-ETHICON (384-4266) Website: www.sedasys.com Description:

Sedasys, a Division of Ethicon US, LLC, established the foundation for a transformative new medical device category in patient sedation- computer-assisted personalized sedation (CAPS). The Sedasys division is committed to redefining the practice of sedation by developing and facilitating access to innovative solutions that enable health care systems to deliver greater value. The SEDASYS® Computer-Assisted Personalized Sedation (CAPS) System is the first-to-market product in the U.S. in this new category. The SEDASYS® System is designed to enable trained physician-led teams to administer minimal-to-moderate propofol sedation for healthy patients undergoing sedation during routine colonoscopy and esophagogastroduodenoscopy (EGD) procedures. The System will only be used in healthcare facilities where an anesthesia professional is immediately available for assistance or consultation as needed.

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EXHIBITOR

Surgical Care Affiliates

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EXHIBITOR

Vxtra

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March 10-12, 2016 - GI Roundtable 2020

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