Beckersasc: Surviving and thriving through healthcare reform — Gastro Health’s Dr. James Leavitt on consolidating markets

Beckersasc: Surviving and thriving through healthcare reform — Gastro Health’s Dr. James Leavitt on consolidating marketsMiami-based Gastro Health has been able to expand over the past 11 years due to its willingness to adapt, especially as new legislation continually comes into the mix. Founded in 2006, Gastro Health is Florida’s largest gastroenterology provider, with a network of more than 90 physicians staffing 27 Florida locations.

James Leavitt, MD, president of Gastro Health, shared his thoughts on the evolving legislative environment and the company’s rapid expansion, through acquisitions, recruitment of talented physicians, organic growth and new business development deals.

Already taxed by the demands of their caseloads, small practices may struggle to compete in the move toward value-based reimbursement. The enormous amount of legwork and resources required to meet the many reporting requirements at play is the biggest challenge in small gastroenterology practices face, according to Dr. Leavitt.

“How can groups of five or less gastroenterologists, afford the resources, time and professional management needed to meet all those [reporting] requirements?” says Dr. Leavitt.

Value-based care reporting requirements are going to be a part of the healthcare landscape for the near future. And, to “survive and thrive in this regulatory environment,” Dr. Leavitt believes the market needs to go through a consolidation period.

GI groups act as if they are in competition with each other. However, in general, Dr. Leavitt said practices are all so busy that if the competing group disappeared, the remaining group would not have the resources to take over the new patient load without hiring a similar number of care providers.

Therefore, he says practices have to understand who the real competition is and band together through consolidation thus combining a number of groups into a single more effective coherent whole.

A large part of Gastro Health’s business model is tied to acquisitions, partly because of Gastro Health’s private equity firm partner. However, a strategy focused on acquisition is also a way to adapt to the market.

Gastro Health purchases and takes over management of gastroenterology practices and provides the necessary infrastructure to survive in the value based healthcare environment of the future. This strategy increases Gastro Health’s negotiating influence with health insurance companies and maintains reasonable reimbursement rates. It also allows practices to continue serving their patients without making additional costly investments into infrastructure, thus keeping the cost of care delivery in check.

Before Gastro Health associated with its private equity partner, the company was growing, doubling its profile after five years. After Gastro Health brought in the private equity partner, Gastro Health doubled its portfolio again within the first year and is still expanding through both acquisitions and organic growth.

“With the backing of an equity partner, we are able to merge practices under the Gastro Health name,” Dr. Leavitt says. “They don’t have to spend money to join us. We buy them. … [then] we use the increased revenue created by the acquisition to fund the growth of the company and provide better overall patient care.”

With the revenue, Gastro Health can add more physicians and make necessary infrastructure investments to handle the growth. Gastro Health acquired its most recent location in August 2017, and Dr. Leavitt says it’s not stopping there.

Private equity investors have been following the consolidation trend for years and are recognizing an opportunity to affect consolidation and deliver many of the benefits of scale to the independent physician market.

The administrative resources of a large group could become a valuable asset with ability to attract outside investment and participate in capital markets.

For many high quality physician groups today, that arm of the business simply represents a necessary expense. Management service organizations take the administrative capabilities and turn them into a highly valuable company.

By affiliating with a management service organization, in addition to an ongoing earnings stream, a partner physician can receive a multiple of the practice’s future earnings upfront at the time the relationship is formed.

In this way, physicians can treat their practices as more than just an ATM. They can be part of a structure that creates real value and equity above and beyond the revenue they withdraw as salary from the practice.

Gastro Health has been so successful because it’s been able to narrow the market. Instead of creating partnerships, Gastro Health’s private equity partner gives Dr. Leavitt the power to purchase practices, supplement the practices with needed infrastructure and together they both flourish.

Miami Herald: How a scrawny girl conquered her Crohn’s disease and now runs half marathons

At age 16, Esther Hirsch wasn’t developing as fast as other girls her age.

“I was 90 pounds,” Hirsch said. “I was skin and bones.”

At age 12, she was diagnosed with a growth deficiency and prescribed medication. But her symptoms persisted. She had a loss of appetite, couldn’t gain weight and suffered from diarrhea.

Originally from Honduras, Hirsch was previously diagnosed with gastritis, stress and bulimia. She began visiting medical centers in Houston and Miami to seek treatment.

“It was tiring, emotionally and physically,” Hirsch said. “I was missing school going to the hospital. I was missing out on things girls my age do. It was a tough journey.”

Her journey became easier after Dr. Jesse Reeves-Garcia, a pediatric gastroenterologist at Gastro Health Pediatrics, diagnosed her with Crohn’s disease, an inflammatory bowel disease characterized by symptoms that include abdominal pain, weight loss and diarrhea.

An estimated 1.3 percent or 3 million U.S. adults reported being diagnosed with Crohn’s or ulcerative colitis in 2015, a large increase from 1999 when 0.9 percent or 2 million adults were diagnosed, according to the Centers for Disease Control and Prevention.

Most people are diagnosed after age 15. IBD can be diagnosed at a younger age, although it is rare in children younger than 8, according to the Crohn’s & Colitis Foundation.

After an initial steroid treatment, Hirsch was placed on Remicade, a biological therapy used to treat moderate to severe Crohn’s in children and adults. Administered through infusion, Hirsch undergoes the outpatient procedure every 8-10 weeks.

“A common form of treatment is biological therapy, which stops inflammation before it starts destroying tissue,” Reeves-Garcia said. “The gut is a tube and inflammation is just like rust in a pipe. It can cause leaks, causing infectious pockets of pus in the body and leaking into the abdomen.’’

Hirsch saw immediate results. Her symptoms went into remission. She gained an appetite and 20 pounds in one month.

“I was finally happy with my weight,” Hirsch said. “The cook ran away from me because she said I was going to eat her next.”

She also began modeling, which she continued until college, and was featured on the cover of a publication in Honduras.

“I was looking and feeling better,” Hirsch said. “I no longer looked sick and unhealthy.”

With sustained remission, children are able to participate in any activities they choose, said Dr. Alisa Muniz Crim, pediatric gastroenterologist and medical director of the Inflammatory Bowel Disease Center at Nicklaus Children’s Hospital.

“Most patients are able to go to work, school and other activities,” Muniz Crim said. “They can live a normal life with medical management.”

The causes of Crohn’s disease are not well understood, according to the Crohn’s & Colitis Foundation. Diet and stress may aggravate the condition, but do not cause the disease.

Most patients have minimal diet modifications such as avoiding fast and processed foods, Muniz Crim said. Some patients have stricter diet restrictions such as liquid or specific carb diets. Diet modifications can help reduce inflammation.

Hirsch said she avoids things that upset her stomach like alcohol, greens, granola, fried foods and coffee.

Hereditary, genetics and/or environmental factors contribute to the development of the disease, according to the Crohn’s & Colitis Foundation. Studies have shown that 5 to 20 percent of affected individuals have a first-degree relative such as a parent, child or sibling with one of the diseases. The risk is greater for Crohn’s than ulcerative colitis.

Physicians should be aware of family history so they can watch for symptoms, including short stature, abdominal pain and weight loss. Children should be examined yearly by a pediatrician, said Dr. Edgardo D. Rivera-Rivera, pediatric gastroenterology expert with UHealth — the University of Miami Health System.

“We help them go through the hurdles,” Rivera-Rivera said. “We teach them how to fish so they can sustain themselves and give them the resources to be successful.”

Now 25, Hirsch is treated by an adult gastroenterologist in Dallas, where she has lived for the past seven years. In May, she graduated with a master’s of science in management from Southern Methodist University.

She started a mentorship program at the Crohn’s & Colitis Foundation of America, and she runs four or five times weekly. She has run in three half marathons in Austin, Woodlands and Dallas.

“There have been ups and downs along the way, but since I was 16, I’ve been living a healthy life,” Hirsch said.

Although Reeves-Garcia is no longer her physician, they still keep in touch through texts and Facebook.

“He is more than a doctor,” Hirsch said. “He is a father figure.”

Reeves-Garcia returns her sentiment.

“I watched a skinny little girl turn into a beautiful, articulate model,” Reeves-Garcia said.

Meanwhile, Hirsch is pleasantly surprised by an ongoing problem.

“Can you believe I have to watch what I eat?” Hirsch said.

To Eat or Not to Eat? Living with Diverticulitis

Richard Hernandez, MD

Gastro Health acquires first GI practice outside of South Florida

Acquisition of Digestive Health Physicians in Fort Myers, Florida solidifies Gastro Health’s growth into new markets


(Miami, Florida – July 15, 2017) – Gastro Health, LLC has acquired the practice of Digestive Health Physicians and Outpatient Anesthesia Specialists, LLC in Fort Myers, Florida. The acquisition marks Gastro Health’s first office outside of South Florida and poises the company for growth in new geographic markets.

Digestive Health Physicians currently serves patients in two locations within Fort Myers, Florida: 7152 Coca Sabal Lane and 9400 Gladiolus Drive, Suite 250. The practice is comprised of four physicians, as well as two physician assistants. The office will become Gastro Health’s 25th location and the company’s first in Southwest Florida.

Led by James W. Penuel, Jr. MD., providers for this practice include Andree A. Dadrat, Mark S. O’Konski and Paul L. Yudelman. All four physicians have had board certifications with the American Board of Internal Medicine as well as the ABIM/Gastroenterology and many hold leadership roles at the hospitals for which they provide service

Physicians at Digestive Health will continue to provide high quality outpatient consultative care for the broad range of digestive disorders as well as procedures such as colonoscopies and upper GI endoscopies in our convenient outpatient endoscopy center.

By joining Gastro Health’s network, the group will be able to offer even more patients the safe and affordable gastrointestinal care they need. All of Gastro Health’s care centers are equipped with the latest state-of-the-art technology to ensure the best outcomes possible for each individual patient as well as an in-house pharmacy which can dispense medications at a fraction of the cost.

“At Digestive Health Physicians, we take great pride in offering our patients outstanding care,” said Dr. James Penuel. “By becoming part of Gastro Health, one of the most recognized gastroenterology groups in the country with an outstanding reputation, our patients will now benefit from the additional resources we will be able to provide.”

“Being able to bring the talented doctors from Digestive Health Physicians on board with Gastro Health is yet another in a long list of our recent accomplishments,” said Gastro Health CEO, Alejandro Fernandez.  “This is our first acquisition outside of South Florida which poises us for tremendous growth throughout the state, and the country.”

For more information about Gastro Health, visit

# # #

Press Contact:

Joanna Palmer

(786) 456-8677

About Gastro Health

Gastro Health, founded in 2006, is South Florida’s largest, private gastroenterology network comprised of over 90 physicians in 26 locations. Gastro Health provides patients access to some of the nation’s premier gastroenterologists, pediatric gastroenterologists, colorectal surgeons, and allied health professionals. In addition to delivering gastrointestinal care, providers offer a wide range of additional services including: anesthesia, infusion, imaging, pathology, specialty pharmacy and in-office RX dispensing. Gastro Health takes pride in providing outstanding medical care and an exceptional healthcare experience for patients.