Commentary

Tectonic shift


 

Every community practice gastroenterologist knows that private equity is making an aggressive push into our specialty. This is a tectonic shift in GI practice and the implications for private practice, academic training programs, and our GI societies are substantial. Gastro Health (Florida), Atlanta Gastro (Georgia), and GI Alliance (Texas) all closed deals with private equity in 2018 and there are reported to be 16-20 deals completed or in process currently. The three “first movers” formed practice management companies that now have acquired numerous large and small practices around the country. We have one practice with more than 200 physicians and we will see single groups of 500-1000 in the near future.

Dr. John I. Allen

Imagine what a digestive health multi-state practice of 500 physicians (gastroenterologists, pathologists, surgeons), 200 advance practice providers (APPs) plus other ancillary professionals (psychology, nutrition) could accomplish. Gross revenues could top $1 billion. All back-office operations would be consolidated and managed professionally. Each provider would work top of license so much routine care would be shifted away from MDs. Negotiating power with payers, vendors, hospital systems, and referring providers would be immense (care would be taken to avoid the appearance of a monopoly, but Department of Justice scrutiny has already been evident). Referral sources (CVS, Optum, health systems, and a few remaining independent practices) would be secured by contract or favored reimbursement rates. Academic health systems will find competition challenging save for high tertiary and quaternary care, but even these complex procedures often will have been consolidated (and contained within risk-bundles) to a half dozen health systems by direct-to-employer contracting. Current society offerings such as meetings, journals, and clinical guidelines will become obsolete because of practice-distributed virtual education, open publishing, and internal outcomes measurement. The vast provider network will be on a single data platform so it can generate true outcomes based on a payer’s patient base (not guideline-restricted process measures), and these outcomes will be used for negotiating restricted networks.

I hope these trends will be a clarion call for our societies and training programs to awaken to a new world order and adapt their efforts to meet demands from our patients and the critical (and changing) needs of current and future digestive health professionals.

John I. Allen, MD, MBA, AGAF
Editor in Chief

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