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David Young, President & CEO
December 22, 2021

David Young details state of the GI industry, ASC growth trends and system automation and more.

PE GI Solutions President and CEO David Young once again sat on a panel at the Becker’s ASC Annual Meeting in October 2021. Young and other panelist met to discuss the topic of “Top ASC Growth Strategies: Investments, Expansions and Partnerships.”

The group discussed ASC growth, recovering from the COVID-19 pandemic, reimbursement trends, higher patient deductibles, and more.

Current ASC growth

When asked about his thoughts on the growth of ASCs and the GI community, Young stated that the impact of the COVID-19 pandemic caused many, including PE GI Solutions to reconsider what growth means. This included the company’s goals surrounding overall growth of partnered ASCs.

“Before COVID it was that you had to have x-percent growth per year. You needed to have more cases, more volume and a little extra to account for inflation,” Young said.

Like many businesses across the world, PE GI Solutions felt the impact of the pandemic. Young said that the company was effectively shut down, as patient volume saw significant dips. This was because more and more Americans sheltered in place and quarantined, opting to not pursue care.

“One week we went from 100-percent volume to four-percent volume,” he said.

As a result, Young detailed his broad three-point plan to help the company recover. This included stabilization, reengaging patients, and finding a way to effectively “restart” the business.  According to Young, another impact of the pandemic was a loss of knowledge. This knowledge was not clinical knowledge, but a loss of knowledge in the ASCs themselves.

Rebuilding Relationships

With the long departure from the centers, Young explained that the knowledge of processes, certain team tasks, and the relationships between ASCs and referring primary care doctors was damaged and needed to be repaired.

“During COVID so many people were laid off, lost their jobs, or were furloughed,” Young said. “That relationship between practices and ASCs, where patient lists were sent every day, those relationships were damaged. We have to work to rebuild those relationships.”

Some of the major keys to repairing this relationship and simultaneously stimulating business included patient recall, patient navigation, and management of the referrals coming from primary care doctors. Young added that it was critical to manage when patients were brought back into ASCs. However, he noted that it was important to bring in the right patients at the right time.

With the recent age change regarding colonoscopies dropping from 55 to 45, it was imperative to ensure that patients were engaged in the process. However, they must also have total access to the procedure.

Rebounding from COVID-19

The topic of COVID’s impact on businesses and ASCs was an often-discussed topic as expected. With over 60 centers nationwide, PE GI Solutions partners are approaching the recovery of their business in different ways and situations.

Young explained that some physicians are okay with seeing less patients daily in comparison to a pre-COVID world. Others find themselves in a state where local major employers have yet to return to in-office settings, hurting nearby centers. However, some are back at 100% volume, and some have even exceeded full volume statistics.

The GI industry took longer to recover in comparison to other specialties. However, the return to normal numbers is well underway. Young reported that in comparison to 2019 numbers, PE GI Solutions is only slightly behind in most major statistics.

“It just means that we have some centers that are ahead, some that are on track and others that are behind. Overall, we are in a good state,” he said.

Industry-wide reimbursement trends

When asked about reimbursement trends between government and commercial sectors, Young said that PE GI Solutions was “holding our own” in relation to commercial payors but doing well in the government sector.

He added that he had noticed a shift in how commercial payors were classifying procedures and their costs.

“We’re getting some pressure (from payors,” he said. “Generally it’s sneaky pricing pressure and undisclosed pricing pressure, but otherwise we are combating that and chasing it back.”

He added that these undisclosed changes were not always malicious. He noted that at times communication may not properly reach PE GI Solutions, leading to confusion on price increases.

Stability was the keyword when speaking of the government side of things. Young has noticed that there has been an increase in discussion regarding value-based site care. This is especially as he works to increase PE GI Solutions force in practice solutions.

The impact of higher patient deductibles

Happily, Young reported that only a very small percentage of patients seen at PE GI Solutions affiliated centers were paying totally out of pocket.

“In GI we are in a fortunate position, and it’s getting better, where the ASC world is being recognized by employers putting pressure on payors to redesign their benefit plans,” Young said. “For instance, if you go to an ASC you have no deductible and no co-pay. Whereas if you go to a hospital environment you will have to deal with a deductible and a co-pay.”

The these changes has been beneficial to the GI community. They have led to the lowered cost of care for employers and patients. It has also caused hospitals to begin rethinking the role of traditional surgery center locations, opting them to consider changing them to ASCs.

Hospital/ASC competition & cooperation

Young explained that recently, hospital systems that would have never considered working with independent doctors are now open to partnerships. Similarly, independent positions who have seen a slow downturn of patient volume are now more open to partnering with hospitals to help increase the number of potential patients.

ASCs in Large Markets

In large markets where multiple hospitals are competing to become the dominant force. Therefore, some hospitals are electing to work with ASCs.

“You have to look at it in a very ZIP code basis,” Young explained. “If you are the dominant hospital in a system in a large population you’re not facing that pressure. You’ve already got the employers tied to your health system, the payors, etcetera. If there are two or three hospitals competing, particularly if they are the second or third in size, they want to be competitive. They are more aligned and keener to bring their patients to ASC’s. They can create that opportunity for the payor to go to the employer to create an attractive offering, and then get the patients through that.”

It is an important distinction to make that this circumstance is typically not happening to dominant hospitals in these areas. Hospitals ranking second or third, not in terms of quality but size, are looking to bring their patients to ASCs.

Boston is an area recognized as beginning to see these moves. Area hospitals are beginning to see the importance and benefits of making the switch to ASCs. Young believes that as time moves on, more and more larger systems will also make the move.

At the moment, larger systems are marketing their brand to payors in order to secure higher paying employers. However, through this plan they are losing considerable capital. Young believes that in time, these systems will begin to look to recoup these losses through ASC partnerships, or simply by the savings in care they will see.

“They are balancing the ways you move money from one bucket to another,” Young said. “Some of them are doing quite well.”

System automation

The panel was then asked about the future of system automatization, and how it will effect the healthcare landscape in coming years.

“As you look at an organization like PE GI Solutions, our job is to take that work off of the centers,” Young explained. “We are continually looking at investments in systems technology, interfacing, process improvement, and process standardization. There’s still a ways to go in some of our centers.”

Patient marketing and patient engagement were identified by Young as areas that were “severely underinvested” in the healthcare industry. He added that the situation is not that healthcare has slowed in creating these new technologies, but that it was slow in implementation of those systems. He then referenced how this technology can not only impact ASCs, but practices as well.

“I think there is work to be done in the practice that will help make the lives of the doctors better to make them more efficient and working on their relationship with the centers,” he explained. “If we work that one well, the practices have a lot more opportunity, because many of the ASC’s already have corporate partners, specialist or consultants that come in and optimize them in many ways. For me that’s the area where there is room for improvement”

Expectations for the future

Lastly, each member of the panel was asked what they were most looking forward to in regard to the end of 2021 and the beginning of 2022. Young’s answer was one that he admitted seemed simple. However, it would make a large impact on how we see the world moving forward.

“What I’m focused on, and it sounds simple, is not every day having a conversation about COVID,” he said. “It sounds like a very obvious thing to say, but in the last six months every conversation, whether you read about it online, digitally, whether it’s on paper, or in the street, you’re being made to judge, you’re being made to pass a positive or negative perspective on an individual or a comment. It’s polarizing the conversation.


We’re really having to get our heads around ‘Are we going to require vaccinations or not?’ ‘Will we require masks or not?’ ‘Is remote here to stay or not?’ ‘Are my privacy rules getting taken away or not?’ and ‘Do I have an independence of choice?’ None of those discussion come to a healthy outcome whenever two people talk about it.

So what we’re really focusing on is ‘this is what it is.’ It is what it is. We’re clarifying what our policies are at the moment, we’re being flexible to make it work in a safe environment, and were establishing ways to take away the fear of most employees, which ironically is not about vaccines or masks, but ‘can I definitely still work from home?’

Really what I want to focus on is getting everyone focused back on the conversation ‘Why are we doing this?’ It’s the doctors, the patients, and the patient care. If we get that conversation right and get everyone’s mind around that we get everyone focused on why we’re doing this. That’s my main focus.”

To hear the full panel discussion including David Young please click here.

To learn more about PE GI Solutions and our Center Solutions and Practice Solutions platforms please click here.