Techniques in Gastrointestinal Endoscopy RSS feed: Current Issue. The purpose of each issue of Techniques in Gastrointestinal Endoscopy is to provide a comprehensive, current overview of a clinical condition or surgical procedure in gastrointestinal endoscopy, combining the effectiveness of an atlas with the timeliness of a journal. Each issue places a vigorous emphasis on diagnosis, rationale for and against a procedure, actual technique, management, and prevention of complications. The journal features abundant illustrations, line drawings and color artwork to guide readers through even the most complicated procedure. 2011 Topics Vol. 13, Issues 1-4 January EMR and ESD Roy Soetikno and Co Guest-Editor Tonya Kaltenbach April Training and Simulation in Endoscopy Kai Matthes July Ambulatory Endoscopy (Centers) Colleen Schmitt October Quality in Endoscopy Douglas O. Faigel 2010 Topics , Vol. 12, Issues 1-4 January Ablative Therapies Ian Norton April Barrett's Esophagus Gary Falk July Bariatric Endoscopy Chris Thompson and Co Guest-Editor Michele Ryan October Esophageal strictures, Tumors, and Fistulae Peter Siersema 2009 Topics , Vol. 11, Issues 1-4 January Interface of ERCP and EUS for Pancreaticobiliary Pathology Steve Edmundowicz April NOTES in Clincial Application Anthony Kalloo July Management of Pulmonary Complications of GI Disease Dan Sterman October Endoscopic Management of Esophageal Strictures Todd H. Baron http://www.techgiendoscopy.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Techniques in Gastrointestinal Endoscopy1096-2883134October 2011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.techgiendoscopy.com/article/PIIS1096288311001562/abstract?rss=yesCover10.1016/S1096-2883(11)00156-2Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2OFCOFChttp://www.techgiendoscopy.com/article/PIIS1096288311001574/abstract?rss=yesMasthead10.1016/S1096-2883(11)00157-4Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2IFCIFChttp://www.techgiendoscopy.com/article/PIIS1096288311001586/abstract?rss=yesEditorial Board10.1016/S1096-2883(11)00158-6Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2iihttp://www.techgiendoscopy.com/article/PIIS1096288311001598/abstract?rss=yesTable of Contents10.1016/S1096-2883(11)00159-8Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2iiiihttp://www.techgiendoscopy.com/article/PIIS1096288311001367/abstract?rss=yes“Let me have men about me that are fat; sleek-headed men and such as sleep o' nights.” (William Shakespeare, The Tragedy of Julius Caesar) Caesar was alluding to prosperity, wisdom, and ethical calm when he said these lines. Endoscopists who practice in ambulatory endoscopy centers (AECs) face increasing challenges as health care reform unfolds and can use the experienced voices that can bring us opportunities for prosperity, acumen, and calm. It is a privilege to provide an introduction for my colleagues and partners who have offered their formidable experience and opinion to help educate us as we move further down this road.IntroductionColleen M. Schmitt10.1016/j.tgie.2011.08.003Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2209209http://www.techgiendoscopy.com/article/PIIS1096288311000568/abstract?rss=yesOptimizing value in health care delivery is the primary driver of the health care reform initiative. The value proposition in health care requires that the quality of care is maximized whereas excess costs of medical errors, adverse events, redundancy, and overutilization are minimized or eliminated. Ambulatory endoscopy centers (AECs), because of their significant role in care delivery, are compelled to address the primary health care reform objectives to remain competitive in the reform era. One of the earliest demands includes the expansion of efficiency and capacity to accommodate the growing insured population and the influx of baby-boomers into Medicare coverage. Adoption of electronic health records and connectivity through health information exchange will provide an infrastructure required for integration and coordination of care with other health care providers. Health information technology will also facilitate the education and engagement of patients to enhance their participation in disease prevention and the management of chronic diseases. The evolution of value-based payment methodologies will mandate that AECs participate in larger care delivery coalitions to coordinate and deliver high-value health care. The reform era requires that AECs make a renewed effort to assess their operations and efficiencies with a focus on quality of care and concurrent cost efficiencies.Optimizing ambulatory endoscopy center value in the reform eraThomas M. Deas10.1016/j.tgie.2011.03.008Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2210216http://www.techgiendoscopy.com/article/PIIS1096288311001240/abstract?rss=yesInfection related issues are an important concern in ambulatory endoscopy centers. Safety is paramount. Maintenance of effective infection control processes is a crucial component of safety in endoscopy, and proper reprocessing of endoscopic equipment must be viewed as an important part of any procedure. Critical issues in reducing the risk of transmission of infection during endoscopic procedures include general infection control principles, safe injection practices and meticulous endoscope reprocessing.Ambulatory endoscopy centers: infection-related issuesDavid A. Greenwald10.1016/j.tgie.2011.08.001Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2217223http://www.techgiendoscopy.com/article/PIIS1096288311001227/abstract?rss=yesQuality improvement (QI) activities are now key pursuits for clinicians and managers in all medical environments. Demonstration of QI effort is required for accreditation of facilities and board recertification of most medical professionals. Every facility has opportunities for improvement and the most pressing issues are often unique to the local facility. Nevertheless, to limit risks both for the health of the practice and for patients, all endoscopy facilities should ensure satisfactory performance in regard to procedural quality, infection control, equipment reprocessing, sedation and analgesia, and management of pre- and postprocedure medications, including anticoagulants and antibiotics. Because efforts are usually constrained by staff, time, and financial considerations, improvement needs must be prioritized to identify those with the greatest urgency and impact. For units new to QI endeavors, it is useful to focus on single issues at first. Improvement methods are widely varied; many are commonly applied systematically, whereas others are particularly suitable for ad hoc application. This article reviews principles pertaining to defining and selecting improvement goals and the various methodologies often employed in pursuing them. Further reading is encouraged in regard to specific methods for use by improvement teams.Quality in the ambulatory endoscopy centerBret T. Petersen10.1016/j.tgie.2011.07.002Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2224228http://www.techgiendoscopy.com/article/PIIS1096288311001239/abstract?rss=yesSeeking accreditation initiates a process of self-evaluation as an organization measures itself against established national standards related to patient safety and quality of care. There is value in the preparation process in terms of awareness of and the internalizing and operationalization of nationally accepted standards.Preparing for accreditationFrank J. Chapman10.1016/j.tgie.2011.07.003Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2229233http://www.techgiendoscopy.com/article/PIIS1096288311000544/abstract?rss=yesInformation technology holds promise for improving communication, increasing quality, and reducing costs for our health care system. In the ambulatory endoscopy center (AEC), procedure report generating software has evolved over nearly 30 years to fit more closely within this paradigm. Many software systems now allow communication with electronic health record and practice management systems, ancillary service electronic solutions, and regional health information exchanges. The opportunity to use such systems to participate effortlessly with quality reporting programs now exists as well. Automation of procedure-related information including the procedure report, nursing and anesthesia documentation, and endoscopy inventory data has been shown to reduce AEC expense and increase efficiency. The digitization of such health information has become vital in the era of the modern AEC as pressures mount to maximize quality and maintain profitability.Endoscopic reporting systems and integration with the electronic health recordRaj I. Narayani10.1016/j.tgie.2011.03.006Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2234238http://www.techgiendoscopy.com/article/PIIS1096288311001550/abstract?rss=yesAmbulatory surgery centers remain strong sites for physician services in the outpatient setting. The relationship between endoscopists and surgery centers can be complex from a financial and legal standpoint. The interpretation of Stark and Anti-Kickback laws is a dynamic target, constantly being sifted by legal minds, and is the topic of review in this chapter. Other important issues are reviewed within the context of current interpretation and analysis.Key legal issues facing U.S. endoscopy centersScott Becker, David M. Wolff10.1016/j.tgie.2011.08.005Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2239243http://www.techgiendoscopy.com/article/PIIS1096288311001379/abstract?rss=yesThe use of anesthesia provider services in the ambulatory endoscopy setting represents an important collaboration given current guidance. This chapter reviews a unique, personal experience for developing a relationship between providers in this setting from a business model perspective.Ambulatory endoscopic sedation: clinical and fiscal issuesRichard F. Corlin, Rudolph A. Bedford10.1016/j.tgie.2011.08.004Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2244246http://www.techgiendoscopy.com/article/PIIS1096288311000556/abstract?rss=yesProper reimbursement and regulatory compliance for GI endoscopy facility services require understanding of the payment system, how Medicare and other payers determine fees, and the many nuances of how to code and bill effectively. A short review with useful references is presented here.Ambulatory endoscopy centers: payment issues that affect the bottom lineGlenn D. Littenberg10.1016/j.tgie.2011.03.007Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2247253http://www.techgiendoscopy.com/article/PIIS1096288311001252/abstract?rss=yesThe key to improving ambulatory endoscopy center (AEC) performance revolves around implementing certain key activities while at the same time consistently measuring and reporting specific mission-critical metrics throughout the organization. Although many of these key activities could be described as “business fundamentals,” the impact of health care reform will be driven home within the AEC environment as reimbursement transforms from the purely fee-for-service model to other alternate reimbursement arrangements. Although other contributions to this issue focus on potential future reimbursement models in more detail, a focus on quality and cost-effectiveness is a common theme in most potential new reimbursement mechanisms. In the historical AEC environment, procedural volume has always been King; his Queen is room utilization. These factors are undoubtedly the two key drivers of performance within the center today and will remain so in the future. However, all kingdoms need their knights of the round table and this article focuses on those elements that assist in driving financial, operational, and clinical performance. These same elements will prove critical in tomorrow's AEC reimbursement environment that transforms as the result of various health care reform initiatives.Improving ambulatory endoscopy center performanceJohn M. Poisson10.1016/j.tgie.2011.08.002Techniques in Gastrointestinal Endoscopy 13, 4 (2011)2011-10-01Techniques in Gastrointestinal Endoscopy2011-10-01134S1096-2883(11)X0006-2254259