Practice Management

In the ever-evolving landscape of health care, the need for diversifying income streams in gastroenterology practices has never been clearer. Relying solely on traditional revenue sources may no longer suffice in today's dynamic environment. By exploring alternative avenues to supplement your practice's income, you not only bolster financial stability but also open doors to innovative patient care and professional growth. In this issue of Practical Solutions, we delve into strategies and actionable steps to diversify your practice's income.

Why Diversify?

Before delving into the “how,” let’s discuss the “why.” There are several reasons why you should diversify your income streams:

1. Financial Resilience

An overreliance on one income stream can make a practice resistant to market changes or reimbursement policy modifications. This situation is addressed by diversifying your practice’s income.

2. Improved Patient Care

Many new income opportunities come with new services or technologies that can help a practice improve patient experience and outcomes.

3. Professional Fulfillment

Diversifying income is a competency that can help you rediscover your passion, innovation and satisfaction.

Strategies for Diversification:

1. Pathology Services

Adding pathology services to your practice offers excellent benefits to your gastroenterology patients while simultaneously providing a lucrative approach to care delivery.

Revenue Streams:

• Billing for Pathology Procedures: Every performed pathology test adds to revenue, including gastrointestinal biopsies and histopathology evaluations.
• Consultation Fees: Charge a fee for expert consultations on pathology reports, attracting referrals and generating additional income.
• Outpatient Pathology Clinics: Establishing on-site clinics allows for direct patient consultations and testing, benefiting patients and the practice financially.

Implementation Steps:

• Investment in Equipment: Acquire necessary pathology equipment tailored to anticipated test volumes. Consider space requirements, initial investment and regulatory compliance needs.
• Certification and Licensing: Obtain the necessary certifications (e.g., CLIA certification) and state licenses to operate a pathology lab. Compliance with HIPAA and other patient privacy regulations is also crucial.
• Hiring Pathologists or Partnerships: Employ board-certified pathologists or partner with reputable labs for specimen processing.
• Marketing and Education: Promote the benefits of in-house pathology to patients and referring physicians.
• Integration into Workflow: Ensure seamless communication between gastroenterologists, pathologists and staff for efficient specimen handling.
• Coding and Billing Compliance: Stay updated with coding guidelines to ensure accurate reimbursement.¹

2. Infusion Services:

Infusion services for the treatment of inflammatory bowel disease (IBD) and other gastrointestinal conditions within gastroenterology practices is a valuable avenue for both patient care and revenue generation. By incorporating this service, practices can offer convenient and comprehensive care to patients while tapping into a significant revenue stream.

Revenue Streams:

• Medication Reimbursements: Gastroenterology practices can bill for both the medication administered during the infusion and the infusion procedure. Each infusion session becomes a billable event, contributing to revenue generation.
• Facility Fees: Practices can charge facility fees for the use of the infusion suite, covering overhead costs and generating additional income.
• Nursing and Physician Fees: Professional fees for nursing and physician oversight during the infusion process are billable, further adding to the revenue stream.

Steps to Implement:

• Facility Setup: Designate and equip a dedicated infusion suite within the practice. This area should meet regulatory standards and be comfortable for patients receiving treatment.
• Staff Training and Certification: Ensure that nursing staff are trained and certified in infusion therapy. This includes proper administration techniques, monitoring for adverse reactions and emergency protocols.
• Medication Management: Establish relationships with pharmaceutical suppliers to procure medications for infusion. Develop protocols for medication storage, handling and disposal in compliance with regulations.
• Scheduling and Workflow: Implement an efficient scheduling system for infusion appointments. Coordinate patient visits to minimize wait times and optimize the use of the infusion suite.
• Patient Education: Educate patients about the benefits of infusion therapy and what to expect during their sessions. Provide materials on the medications being administered and potential side effects.
• Billing and Coding Compliance: Ensure accurate coding for both the medication and the infusion procedure. Stay updated with reimbursement guidelines and billing regulations specific to infusion services.²

3. Nutrition Counseling:

Offering nutrition counseling for gastrointestinal health can attract patients seeking dietary management. 

Steps to implement:

• Certified Nutritionists: Hire or partner with certified nutritionists.
• Patient Education: Develop materials and resources to educate patients on the importance of nutrition in gastrointestinal health.³

4. Pharmacy Services:

Revenue Streams:

• Medication Sales: Direct sale of prescription medications generates revenue for the practice.
• Medication Therapy Management : Billing for comprehensive medication reviews, adherence assessments and patient counseling sessions adds to revenue through billing codes.
• Compounding Services: Customized medication preparation tailored to individual patient needs generates additional revenue.

Steps to Implement:

• Licensing and Compliance: Obtain necessary licenses and permits, ensuring adherence to state pharmacy laws and regulations.
• Facility Setup: Designate and equip a pharmacy space within the practice with the necessary infrastructure and technology.
• Pharmacist Recruitment and Training: Hire licensed pharmacists with expertise in GI medications and provide ongoing training.
• Medication Procurement and Inventory Management: Establish relationships with wholesalers and implement inventory management systems.
• Patient Education and Counseling: Develop education materials and schedule counseling sessions with pharmacists.
• Billing and Coding Compliance: Ensure accurate coding and documentation for reimbursement.⁴

5. Research and Clinical Trials:

Research and clinical trials are essential for advancing gastroenterology care while offering revenue opportunities within practices. By participating in studies, gastroenterologists contribute to medical knowledge, improve patient care and boost practice revenue. This not only provides financial benefits but also positions the practice as a leader in the field, attracting patients interested in cutting-edge treatments and contributing to the advancement of gastrointestinal medicine.

Revenue Streams:

• Funding: Practices secure grants and funding for research participation.
• Enrollment Fees: Compensation for enrolling patients in trials adds to revenue.
• Publication Fees: Fees for publishing research findings enhance practice revenue.

Steps to Implement:

• Identify Opportunities: Stay informed about research studies in gastroenterology.
• Partnerships: Collaborate with research institutions and pharmaceutical companies.
• Ethics and Compliance: Ensure adherence to ethical guidelines, patient privacy regulations and institutional review board approvals for all research activities.
• Patient Recruitment and Informed Consent: Recruit eligible patients for participation in clinical trials, ensuring informed consent and compliance with study protocols.
• Data Collection and Management: Collect and manage data according to study protocols, maintaining accuracy, confidentiality and integrity throughout the research process.
• Publication and Dissemination: Publish research findings in peer-reviewed journals, present at conferences and disseminate results to the medical community through various channels.⁵

Conclusion

Implementing ancillary services within a GI practice requires careful planning, investment and compliance with regulatory standards. Each service not only offers the potential to increase revenue but also significantly enhances patient care by providing comprehensive, integrated treatment options under one roof. By taking a strategic approach to the implementation of these services, GI practices can diversify their revenue streams and strengthen their position in the health care market.

In a future issue of Practical Solutions, we will highlight in-office procedures that can add revenue to your practice. Stay tuned!

References

1. Sarles H. Gastrointestinal pathology incorporating a GI pathology laboratory into your practice. Gastroenterology and Endoscopy News. June 30, 2011. Accessed May 7, 2024. https://www.gastroendonews.com/Review-Articles/Article/06-11/Gastrointestinal-Pathology/18437
2. Ancowitz B, Shah SA. Infusion services in the gastroenterology practice. Gastrointest Endosc Clin N Am. 2006;16:727-742. doi: 10.1016/j.giec.2006.08.016
3. Gut Health Resources. Dietitian Connection. 2024. https://dietitianconnection.com/category/patient-resources/gut-health-resources/
4. Zuckerman AD, Carver A, Cooper K, et al. An integrated health-system specialty pharmacy model for coordinating transitions of care: specialty medication challenges and specialty pharmacist opportunities. Pharmacy (Basel). 2019;7:163. doi: 10.3390/pharmacy7040163
5. Schmitt CM. Establishing a clinical research practice. J Clin Gastroenterol. 2000;31:205-212. doi: 10.1097/00004836-200010000-00004

Pavan Patel, MD, is a practicing gastroenterologist with Northeast Digestive in North Carolina and a member of the ASGE Practice Operations Committee.