I appreciate Dr. Boharski’s thoughts (Daily Inter Lake, Dec. 9) on the high cost of health care and the changing local landscape. Being relatively new to medical practice in the Flathead Valley, I can only imagine what medical practice was like 25 years ago and can certainly understand the concerns of some who have watched it evolve into its current form.
I’ve had the opportunity to practice gastroenterology for nearly 30 years in private practice, at academic centers and as an employed physician of a hospital system prior to coming to Kalispell in 2016 and have been fortunate to experience medical practice from many different perspectives.
Unquestionably, the charges and insurance payments for office-based endoscopy are significantly less than those for the same procedures performed in ambulatory surgical centers and hospital-based outpatient centers. Unfortunately, it is neither safe nor practical to perform certain types of procedures in this setting since many patients require a higher level of sedation, monitoring, specialty equipment and technical assistance to safely and effectively care for them. In addition, there are many patients with complex medical conditions such as chronic lung and heart disease, who are not good candidates for office-based endoscopy and are best cared for within the walls of a hospital, even for their outpatient care.
In my experience here in Kalispell, about 40 percent of the patients we see fall into this category and are best served by having sedation provided by an anesthesiologist or require that their testing be performed in a hospital setting, due to the complexity of their procedure and their other medical conditions.
For the other approximately 60 percent, we offer conscious sedation (without an anesthesiologist) and generally perform their procedures in the ambulatory setting of the Digestive Health Institute of Montana. The Digestive Health Institute was designed to provide the highest possible quality gastrointestinal endoscopy care for patients in a modern, comfortable setting. The notion that this was planned to “appease the people while they wait for their loved ones” is at the very least, an unfortunate way to describe our objective.
If you put local medical economics aside for the moment and consider changes that have taken place in medicine and GI practice over the last 15 to 20 years, it becomes clearer why costs have risen and we have seen a substantial decline in office-based endoscopy services around the country. New and improved expensive endoscopic equipment becomes available every few years, standards for reporting make practice without expensive electronic medical records difficult, newer and more expensive disposable devices such as clips and balloons have entered into standard practice and an increase in oversight over virtually every aspect of endoscopic services creates an ever-increasing financial burden for those trying to practice this way.
I credit Dr. Boharski with being able to operate such a business for as long as he has in this environment. To imply that we are not offering office-based endoscopy services due to other overriding financial concerns is simply inaccurate.
The nine providers at the Digestive Health Institute strive to provide a wide variety of consultative and endoscopic services to serve the needs of our population as well as those from the surrounding communities referred here for management of complex medical conditions. To accomplish this goal, we insist upon having the best high-definition, high-resolution endoscopy equipment, other specialty equipment not routinely available in office-based endoscopy centers, modern electronic medical records systems to accurately and completely document all facets of procedures and office services performed. We are extremely fortunate to have a state-of-the-art facility to house these services and the support of Kalispell Regional Healthcare to provide this level of care. This is becoming the standard of care throughout the country, and I would contend that our patients and community deserve nothing less.
— Dr. Philip E. Jaffe is director of the Digestive Health Institute of Montana at Kalispell Regional Healthcare