PE GI Journal - October 2021

GI A publication dedicated to advancing GI practices and ASCs

Enhancing Information Infrastructure | pg. 6

Taking on Telehealth | pg. 10

Scaling Your Center | pg. 10 GI Industry COVID Support | pg. 6 Improving Digital Patient Engagement | pg. During 12 Building Morale a Crisis | pg. 14 The Colonoscopy “Gold Spotlight | pg. 16 Colon Cancer Survivor Standard” | pg. 16 OCTOBER 2021

WHAT WE DO We partner with gastroenterologists in private practice, providing resources to improve operations, drive growth, and enhance patient, physician, and staff experiences—all while maintaining their independence.

Our strategy is aligned with your interests in tackling the following challenges: • Career security and stability • Succession and recruitment strategies • Growing administrative costs and burdens • Shifting regulatory and reporting requirements • Preparation to move from fee-for-service to value-based care • Competition from hospital and other physician practice models • Declining reimbursements paired with a need to invest in technology, security, marketing, and patient engagement

GET IN TOUCH We’d love to share more details about how we can help you stay independent and thrive in the changing healthcare environment.

Kevin Harlen, President kharlen@pegisolutions.com 240-485-5201

GI Editorial Staff Suzette Sison Editor in Chief ssison@pegisolutions.com

Contents OCTOBER 2021

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Kelly McCormick Digital/Managing Editor kmccormick@pegisolutions.com Contributing Writers: Lynn Hetzler, Jake Keator, Robert Kurtz, and Rachael Samonski

Publishing services are provided by GLC, 9855 Woods Drive, Skokie, IL 60077, (847) 205–3000, glcdelivers.com.

Letter 2 Message From the President Noteworthy 4 Accreditation for PE-partnered centers, expanding the PE team, and more

Strategies 6 Enhancing Information Infrastructure 10 Scaling Your Center

PE GI Journal™, a free publication, is published

by PE GI Solutions, 2500 York Road, Suite 300, Jamison, PA 18929.

The views expressed in this publication are not necessarily those of PE GI Solutions, PE GI Journal or the editorial staff.

POSTMASTER: Send address changes to: PE GI Solutions, Attn: PE GI Journal, 2500 York Road, Suite 300, Jamison, PA 18929.

While every effort has been made to ensure the accuracy of PE GI Journal contents, neither the editor nor staff can be held responsible for the accuracy of information herein, or any consequences arising from it.

Advertisers assume liability and responsibility for all content (including text, illustrations, and representations) of their advertisements published.

Printed in the U.S.A.

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Insights 12 Marketing Tech Toolbox

18 Innovation The AI Revolution

16 Clinical Go for the Gold

PE Opportunities 20 GI physician opportunities at partnered practices

Cover image: iStock.com/monkeybusinessimages

Copyright © 2021 by PE GI Solutions All rights reserved.

All copyright for material appearing in PE GI Journal belongs to PE GI Solutions, and/or the individual contributor/clients, and may not be reproduced without the written consent of PE GI Solutions.

Reproduction in whole or in part of the contents without expressed permission is prohibited.

To request reprints or the rights to reprint such as copying for general distribution, advertising, or promotional purposes: Submit in writing by mail or send via email to info@pegisolutions.com.

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Letter | Message From the President |

Thinking Vertically Supporting and fostering integration across the GI industry

A

t PE GI Solutions, a key part of the company’s continuing evolution centers on achieving better clinical alignment around what I refer to as the “vertical model of care” for GI. In such a model, gastroenterologists delivering care to patients work off medical records and other electronic documentation shared with and used by the other providers involved in the GI care journey of those patients, such as an ASC, anesthesia, pathology, infusion and pharmacy.

To achieve this vertical model requires a combination of clinical and patient experience integration, supported by business integration. We have made progress toward achieving such cohesiveness through our ongoing work around improving patient access and care coordination. We are also benefiting from an acceleration in information sharing through the development of more integrated technology solutions, such as advances in EMRs and revenue cycle platforms, and solutions focused on the patient experience.

While we are proud of what we have accomplished on this voyage thus far, we recognize there is still considerable work to do around determining how to best achieve integration across settings and technologies. Our company’s commitment to this long-term goal is not just about business efficiency. It is more about our priorities around improving clinical delivery, access to care, timeliness of the delivery of care, and integration of patient care decision-making.

We know that, as these areas are strengthened, it means GI patients will be supported by a better care model—one that sees a practice, ASC, and the other areas I highlighted better aligned. This will also extend to health systems, so when patients require care at a hospital, a bridge exists that extends the care link between providers.

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Our business model is still developing, and we are working toward providing consistent GI services market by market. This will take time as our markets are developing at different paces. A shorter-term goal of the PE GI Solutions team is to encourage gastroenterologists and providers of GI support services to be educated on and thinking about the vertical model. This is as much an effort around informing our clients as it is communicating with providers with whom we are not yet engaged.

Why is the latter important to us? Consider When providers get a GI practice lacking an better, patient care effective way to digitally engage with patients. gets better.

We would like to talk to this practice about the options and opportunities that exist.

This will hopefully open a door to a relationship where we can deliver support in a more formal manner. Even if it does not, we will still share that guidance because our company’s model is about supporting GI. When providers get better, patient care gets better. And if we want to maximize the benefits of the vertical model of care for GI, we need as many people David Young, President & CEO, on board as possible.

PE GI Solutions

THE HOLISTIC TITLE GI SOLUTION We help physicians Deck grow and thrive

Practice Management

Expanded Solutions for Practices and Centers With 20+ years of expertise, PE GI Solutions partners exclusively with GI specialists to help streamline and manage practice and ASC operations. We help physicians preserve independence and improve clinical and financial outcomes to drive quality patient care and safety.

Marketing

Billing & Collections

Information Technology

Clinical & Operations

Human Resources

Contact PE GI Solutions today.

Finance

(866) 240-9496 | pegisolutions.com

Payer Contracting

Noteworthy | News and events | Showcasing Our Standards Three PE-partnered centers receive AAAHC accreditation

The Accreditation Association for Ambulatory Health Care (AAAHC) advocates for the provision of high-quality healthcare through the development and adoption of nationally recognized standards, according to their website. As part of its advocacy, the AAAHC provides accreditation for more than 6,000 medical organizations across the country, including ambulatory surgery centers, endoscopy centers, and office-based surgical facilities.

This year, PE GI Solutions congratulates three partnering endoscopy centers that have received AAAHC accreditation: • Digestive Disease and Endoscopy Center • South Broward Endoscopy • Access Surgery Center AAAHC explains that having accreditation demonstrates an organization’s commitment to providing safe and high-quality services to its patients.

Happy Anniversary!

David Young Speaks at Becker’s Meeting

Recently, PE-partnered practice Fredericksburg Endoscopy Center, LLC, in Fredericksburg, Virginia, held an open house to mark their first year of successful service. The center The Fredericksburg Endoscopy Center team celebrates their first year physicians celebrated of providing high-quality patient care. one year of providing quality GI care and having successful patient outcomes for their community in Fredericksburg, as well as their Medicare certification as a GI center.

PE GI Solutions, the physician owners of Fredericksburg Endoscopy Center, and Mary Washington Healthcare are proud of the great work the center has been able to accomplish in the past year. Congratulations to the physicians and staff at the center!

To learn more about Fredericksburg Endoscopy Center, visit fbgendo.com.

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See David Young, President & CEO of PE GI Solutions, at Becker’s ASC Review 27th Annual Meeting David Young will be participating in the hybrid live and virtual Becker’s ASC Review 27th Annual Meeting, taking place in Chicago from October 21–23 and virtually from October 27–29. David will speak on the topic of “Top ASC Growth Strategies: Investments, Expansions, and Partnerships.”

Find out more about Becker’s ASC Review 27th Annual Meeting at beckershospitalreview.com/ conferences-and-events.

iStock.com/shapecharge, Marat Musabirov

Fredericksburg Endoscopy Center celebrates its first year of service

Expanding Our Partners GLST marks PE and Capital Digestive Care’s first partnership in Virginia

iStock.com/opolja

As part of PE GI Solutions April 2021 partnership with Capital Digestive Care (CDC), the largest private gastroenterology practice in the MidAtlantic region, Gastrointestinal & Liver Specialists of Tidewater, PLLC (GLST), also came on board. CDC recently partnered with GLST, which is a leading gastroenterology practice in southeastern Virginia.

The addition of GLST marks CDC’s first partnership in Virginia and adds on eight practice locations within southeastern Virginia. This brings CDC to a total of 128 specialized GI providers serving the Mid-Atlantic region.

Find out more about the latest PE and CDC partnerships at pegisolutions.com.

GI PRACTICE MANAGEMENT SOLUTIONS Focus on clinical care, not administrative duties.

Revenue Cycle Accounting Operations Leadership Human Resources Information Technology

TO LEARN MORE: CALL (866) 240-9496

Strategies | Business strategy and the bottom line |

Enhancing

Information Infrastructure Keeping current with IT opportunities and challenges

I

nformation technology (IT) is playing an increasingly pivotal role in helping gastroenterologists manage and operate their practices and ASCs. But as reliance on IT has grown, so have the risks with which gastroenterologists must contend.

“These days, discussions around advancing GI usually include discussion of advancing technology,” says John Westby, Vice President of IT for PE GI Solutions. “To bring about improvements in your clinical, operational, and financial performance, you will typically need to support those efforts with technology. However, if you want your company to stay healthy as you pursue and leverage IT advancements, you do not want to be sidetracked by disruptive events.”

To best support its partners, PE GI Solutions is proactive in how it approaches providing IT support and services, Westby says. “Technologies are advancing and maturing in this space as rapidly as any other sector I have worked in. Providers are embracing the evolution in technology to drive their business to a new level, and we’re happy to help them. At the same time, security and regulatory needs are increasing, and we’re dedicated to addressing those as well.”

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Strategies | Business strategy and the bottom line | 8 Areas of IT Focus

1. Cloud migration The applications that run providers’ core business operations are increasingly moving to the cloud. This is not just a fad, Westby explains, which is why it is important for providers to understand the reasoning behind the shift and what it will mean for their operations.

“Software developers have very good reasons for migrating toward cloud technology,” Westby says. “They’re increasingly focused on integration across applications to remove errors and better streamline work. The cloud allows them to provide greater scale and more rapid turnaround of functionality improvements to their customer base.”

Westby continues, “The good news for our partners is that, as they move to cloud solutions, they are achieving improvements in their business operations. They are also benefiting from vendors investing in resiliency—which is the preparation for planned and unplanned disruptions—in their hosting capabilities.”

2. Healthcare data interoperability This is an area seeing rapid advancements.

“Vendors that provide clinical capabilities are achieving improvements in the integration of the electronic medical record (EMR) with GI procedural equipment, such as scopes and monitors,” says Westby. “Such integration is starting to allow providers to take the data they capture and run it through more advanced analytics to extract even more value out of the data to strengthen outcomes and the patient experience.”

As providers gain a better appreciation of the value of this integration and the data interoperability it provides, there is an increased desire to achieve integration in other areas, such as scheduling and clinical results. The GI industry is increasingly looking to improve the flow of information across systems from different providers. “Doctors

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want to be able to move from their practice to the ASC and get as seamless of a technology experience as possible,” says Westby.

“This functionality is not very pervasive, and achieving it will be complicated. Since that’s where the industry is heading, we’re working to figure out how to bring these capabilities to our partners.”

3. Patient engagement Another area receiving increased attention is the use of patient engagement technologies. This encompasses a wide range of solutions, from patient portals to kiosks for checking in and completing consents to communication tools like text messaging and apps. “These and other electronic platforms can help GI practices and ASCs digitally engage with patients in nearly all aspects of their visits,” Westby says. “While not all patients are eager to use these tools, we’re seeing a growing number embrace them and appreciate how they can improve their care experience.”

4. Security policies PE GI Solutions continues to adopt industry best practices around security policies and supports its partners in doing the same. “You need controls to ward off the rapidly growing number of cyberthreats,” says Westby.

“Examples of controls include multifactor authentication, password management, and ongoing monitoring and logging of the events happening in your environment. Some of these policies are required by HIPAA, and all are just good defense mechanisms.”

5. Phishing One of the top security challenges facing providers today is phishing. That’s why the PE GI Solutions team is investing in proactive campaigns, overseen by a company called KnowBe4, designed to train and educate its partners about this form of social engineering. Phishing is a technique used by cybercriminals to trick computer users into clicking links that can deploy malicious software like ransomware onto a computer or network. Phishing can also be used to

iStock.com/bearsky23, fonikum, limeart

The following are eight of the areas PE GI Solutions is focusing on to help its partners maximize the opportunities to use new and emerging technologies while meeting the evolving challenges associated with IT.

convince users to share sensitive personal information, like a login or password.

“Many data breaches can be tied back to somebody clicking something they shouldn’t have, such as a link in an email or an attachment,” Westby says. “We’re giving our partners advanced education on phishing and running campaigns to simulate phishing events. We can see who is tricked into clicking a link and then provide them further training to help reduce the likelihood that they will make the same mistake again. We’re also working to make it easier for staff to report suspected malicious emails and files.”

6. Business continuity Despite one’s best efforts, it is impossible to ensure that an IT disaster event, like a successful ransomware attack, will never happen. This makes business continuity— which includes resiliency and the ability to restore technology infrastructure and data—essential to IT planning.

“You need good industry practices that can help you recover and ‘get well’ in case you experience a bad event,” says Westby.

“Security is part of this, but it also includes the ability to effectively manage your data backup and executive disaster recovery so you can be up and running like normal as quickly as possible. This is an area we are very much focused on in our planning with our partners.”

7. Security information and event management (SIEM) A fundamental IT security best practice concerns fortifying an organization’s network perimeter through a combination of the design of the network, configuration of the firewalls, and usage of advanced filtering capability, among other defensive tactics.

PE GI Solutions is now complementing these strategies with next-generation detection, analytics and response software called SIEM. “Using advanced analytics,” Westby says, “SIEM constantly assesses the traffic coming in and out of a network to flag concerning data and create corresponding alerts. This is another

level of protection against the ever-increasing threats facing providers today.”

8. Artificial intelligence (AI) AI is an emerging facet of IT that Westby says seems largely untapped but has incredible potential to help the GI industry. “AI has the capability to find patterns and meaning in data that providers could not possibly identify on their own. Our partners are collecting some incredibly rich data about their patients and outcomes. AI may allow us to look more closely at that data—and do it across practices and ASCs—in ways I believe could make our data an even greater asset in improving outcomes.”

Westby acknowledges that little about AI is assured, but he is optimistic about the future it will play in the delivery of GI care. “It’s always hit or miss on whether the algorithms that data scientists can build in the software will provide meaningful value.

However, I believe that when you couple the richness of our data with the right algorithms, this could certainly be a game changer.” Read more about AI in the GI industry in “The AI Revolution” on page 18.

One Eye on the Present, One on the Future In developing and maintaining its multifaceted IT plan, PE GI Solutions is as focused on the current needs of its partners as it is on preparing for what’s coming down the road. This balance helps facilities take advantage of the systems and solutions available on the market today while better ensuring that emerging technologies and risks are identified and adequately prepared for.

“The plan is equal parts around the technology our partners are using, the processes needed to manage and respond to events, and the security policies required to help protect the IT environment,” says Westby. “We see how advances in technology are making a notable impact on health outcomes, efficiency, and sometimes profitability. If we want to continue to take full advantage of the ways IT is helping take the GI industry John Westby is forward, we must always Vice President of IT for PE GI Solutions. be prepared to confront He can be reached and overcome the threats at jwestby@ that could force us to take pegisolutions.com. steps back.”

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Strategies | Business strategy and the bottom line |

Scaling Your Center T

he opportunity to grow your practice is an exciting time in your career. The advantages and opportunities for scaling are endless, but there are some steps that need to be taken before you begin to expand.

The first and most important factor that needs to be considered is “knowing your why.”

Knowing Your Why “Knowing your why” means knowing your goals for expanding your practice. A key

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consideration when defining your goals is creating benchmarks to make sure the data you collect is aligned with strategic priorities. Not only does it help reach your goals but also measures your growth.

Tracy Belsan, Market President of PE GI Solutions, emphasizes the importance of defining your goals through the benchmarking method. Ask yourself, “What is the current state of our practice? What is the future state and how do we back into that?”

This allows you to have a realistic look into

iStock.com/simonkr

A comprehensive guide to growing your practice or center

what you want for your practice and how to get there.

After defining goals, physicians need to look at other assets that play a role when expanding and operating a practice on a larger scale than before. Belsan offers some additional questions physicians and leaders should ask once they identify their goals: • Whatever the goal is, are you in a financial position to execute?

• Are you in the position with enough physicians to execute?

• Do you have the right leadership on board from an administrative perspective?

These questions address assets that are often overlooked when a practice is trying to expand. Without developing these assets along with the expansion, it can harm the actual scaling of the practice or impact patient access strategies.

Assess Your Financial Position Beyond “knowing your why,” there are a number of factors you should take into consideration when thinking about scaling your practice. One key factor is your financial health. The idea of having substantial finances can be obvious, but it is one of the most overlooked assets when a practice is beginning to expand. Scaling your practice has many benefits, but practices need to be mindful of growing at a pace that the practice can support. The benchmarking method should be applied here as well.

Human Capital Concerns With expansion comes the growth of your staff. From front office employees to administrators to nurses, the more patients you take on, the more staff you are going to need to keep an efficient and effective office.

An important and often overlooked aspect when you are scaling is patient interaction. The larger your practice becomes, the less personal and more routine patient interaction becomes. A recent study by IT service management company Avtex suggests that there is “room for growth” in patient interaction. They found 68% of patients reported feeling that

providers needed to improve how they interact with patients.

To address this, Belsan suggests hiring staff for the front office who are patientfocused. “Practices and centers alike should be in search of someone who is 100% patient-focused, has a strong sense of customer service, the ability to be passionate and empathetic, and the ability to be a good teammate,” she explains.

Making sure you are hiring people who are focused on the patients bridges the gap when you are expanding your practice. Your patients will still feel heard, while also receiving more resources and care.

68

%

Room for Improvement

In a recent study, 68% of patients reported feeling that providers need to improve patient interaction skills.

Examine Leadership and Partnerships Strong leaderships and partnerships are essential when expanding—without them, it is nearly impossible to scale. Partnering with PE GI Solutions is partnering with experts in the GI industry.

“PE GI Solutions helps evaluate the opportunity; we help the physicians understand what they want to do and the ‘why’ behind it,” says Belsan. “We bring an executive team, we bring data, we bring infrastructure, and we bring industry best practices to scale to what the physician wants to do.”

A strong leadership and partnership can make a huge difference and enhance the scaling of your practice with great success. PE GI Solutions makes sure all assets are being maximized and benchmarks are being completed.

Identifying your “why” and determining your goals are the most important aspects of scaling your practice. However, it’s important to not overlook vital assets such as your financial position and human capital. As you expand, it is critical to form strong partnerships as a means to help expand. PE GI Solutions is one such partner that can play a vital role in helping you manage your growth through expertise and industryleading advice, while allowing you to do what you do best: care for your patients.

To learn more about PE GI Solutions offerings, visit pegisolutions.com.

Tracy Belsan is Market President of PE GI Solutions.

She can be reached at tbelsan@ pegisolutions.com.

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Insights | Marketing strategies and tips |

Tech Toolbox

10 digital best practices for patient engagement

K

eeping patients engaged has changed significantly just over the past 10 years. With advances in technology and forms of communication, the traditional practices of engagement are not as effective with patients now. According to Health Affairs, “disengaged patients are 3x as likely to have unmet medical needs and 2x as likely to delay medical care.”

This increases the risk of poor health outcomes for disengaged patients compared to those who are engaged. Keeping current with different technological engagement practices can be difficult, but with small changes, the engagement rates can change drastically, which will lead to a healthier patient.

Here are 10 tips for increasing engagement with your patients.

Use QR codes From ordering food to connecting directly to a particular website, QR codes have become a staple of daily life. However, QR codes are not just for restaurant menus. They can also be used to expedite the form-filling process. Send patients to your website to fill out forms prior to their appointment. Another option is to send the patients to a direct landing page to make an appointment with your office.

It is no secret that social media is a main contact point for most people today. If you do not have social media accounts, create them now. If you do currently have social media accounts, make sure you are posting the most accurate and necessary information.

Creating a social media schedule allows you to keep track of important dates and forms of communication that need to go out to your patients.

Social media not only helps communicate vital information but gives your practice verification. Using social media platforms helps retain trust with patients by communicating transparent information.

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iStock.com/ Chainarong Prasertthai, Zinkevych, Михаил Руденко

Be social

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In-product messaging is important

Tune your web experience

Reminders are beneficial to anyone— if your practice is on an app or uses a text messaging system. Providing an in-product messaging system for your patients can be extremely helpful. MGMA found that “57% of patients who missed an appointment said a text message or email reminder would have helped them attend it.”

This type of system can prevent no shows or schedule changes, as well as let your patient know that the office knows they are coming in. In-product messaging systems are both a practical and considerate engagement practice.

Put yourself in your patients’ shoes. Go to your website and ask yourself: Is this user friendly? If your answer is “no,” there is a good chance that your patients have a hard time navigating your website as well.

This can deter not only new patients but also existing patients who need a follow-up or have an initial health concern. Creating a seamless website to optimize the experience for patients will help create more appointments, more forms filled out, and more patients seen in a timely manner.

Survey your patients

Consider a chatbot

Learning about your patients before they come in can make them engage with you more and allow them to feel comfortable opening up once at the appointment.

A pre-chat survey can be conducted on your website, app, or even via text message. Asking simple questions such as “How did you learn about our office?” and “What are you visiting our office for?” is beneficial for both patients and doctors.

57

Respond to Reminder

%

Of patients who missed appointments, 57% say a text message or email reminder would have helped them make the appointment.

By the end of the workday, many people are not able to call the doctors office to make an appointment, and some offices do not even allow voicemails to be left. This creates frustration with the patient and the office. Having a chatbot on your website can help alleviate that frustration. Chatbots will take necessary information requested from the patient and record it for a coordinator to follow up. It is fast and easy, and can be done virtually anywhere.

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60

%

Comfortable Sharing

Digital formats are becoming more accepted. 60% of patients report being comfortable with digitally sharing their healthcare information.

Deven Stopa is Director of Marketing at PE GI Solutions.

She can be reached at dstopa@ pegisolutions.com.

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Visit virtually

Show, don’t tell

COVID-19 has changed the way we work and live.

Many people went from a bustling work environment with in-person meetings and office lunches to being at home and communicating through a computer screen. We have found as a society that we can work and accomplish tasks in our own spaces—so why not apply that to patient appointments? Offering telehealth as an initial option can save time for both the doctor and patient, and also give patients the personal attention they want. Telehealth allows personal engagement in a time-efficient manner.

Word-of-mouth marketing is still a vital tool, and it comes in different formats.

Video testimonials are an excellent way to convey patient experience.

Video testimonials have a higher retention rate than traditional text. The human brain is particularly attuned to storytelling, and that’s exactly what video testimonials are about. They provide a story for an experience, which can be impactful when shared with other patients.

Have a chat

Be current

When a patient is having a medical problem and cannot get off work or otherwise can’t make it into the office, a confidential virtual chat is an excellent option. According to Deloitte, “60% of patients are comfortable sharing their healthcare through a digital format.” It is fast and can determine if the question or medical issue can be solved quickly or needs further follow-up. This method also engages with the patient and gets them answers directly and quickly without a middleman.

Another route to engage your patients is to share industry-specific news. Your patients will appreciate knowing any changes or developments in the industry and how it might affect them the next time they visit your office.

Engaging with your patients is essential. It is what brings them in and keeps them coming back. It can be as simple as sharing an article about changes in gastroenterology or creating a QR code that can bring them directly to your website to make an appointment. The best way to identify the engagement your office needs is to step into your patients’ shoes. Small changes to convert to digital engagement with patients will not only increase the retention rate of your current patients but also provide an opportunity to bring in new patients. An engaged patient is a healthy patient.

iStock.com/insta_photos, Tero Vesalainen, izusek, Rawf8

Insights | Marketing strategies and tips |

HELPING PHYSICIAN PARTNERS GROW AND THRIVE PE Practice Solutions is a unique, physician-oriented management service organization aligned with the interests of gastroenterologists in independent practice.

A collaboration between PE and Capital Digestive Care, we are committed to preserving the independence of gastroenterologists and advancing digestive healthcare.

LET’S WORK TOGETHER TO ACHIEVE YOUR PRACTICE MANAGEMENT GOALS: Strategic Guidance Financial Revenue Cycle Management Clinical & Operations Payor Contracting Human Resources Information Technology Marketing Kevin Harlen, President kharlen@pegisolutions.com 240-485-5201 capitaldigestivecare.com/joinus

Insights | Clinical updates |

Go for the

Gold

iStock.com/Andrey Shevchuk

Why the colonoscopy is the “gold standard” for CRC screening

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T

he colonoscopy has long been regarded as the “gold standard” for colorectal cancer (CRC) screenings due to its ability to identify and remove precancerous polyps in one procedure. While patients may see the necessity for anesthesia, a designated driver, time off from work, and required fasting prior to the procedure as a hassle, there remains no other option that can provide as much insight and clarity as the standard colonoscopy.

The Impact of the Colonoscopy Goshen Health states that “colonoscopies have shown an 89% reduction in cancer incidences” and have led to a “90% survival rate when the colorectal cancer is found and treated early.” The procedure is also 100% covered by insurance as a preventive screening. Colonoscopies are recommended for patients every 10 years, now beginning at age 45. This age was lowered from age 50 following a May 2021 guideline update by the United States Preventive Services Task Force.

According to the University of Chicago, it is recommended that adults at average risk continue regular CRC screenings up to age 75. Any screening decisions after age 75 should be made jointly with clinicians based on patient preferences, health status, and life expectancy. Patients over age 85 are discouraged from continued screenings. Patients with a family history of colorectal cancer or at an increased risk for the disease should consult with their clinician to determine an appropriate starting time for initial screenings.

Considerations for African American Patients While family history plays a role in increased risk for colorectal cancer, African Americans as a population group also find themselves at higher risk. Here are some findings from a July 2017 report by the American Society of Gastrointestinal Endoscopy regarding increased risk for the African American population: • The incidences of CRC are higher in African Americans than any other population group in the United States.

90

Screening Impact

%

Colonoscopies have led to a 90% survival rate when the colorectal cancer is found and treated early.

• Death rates from CRC are higher among African Americans than any other population group in the United States.

• There is evidence that African Americans are less likely than Caucasians to get screening tests for CRC. • There may be genetic factors that contribute to the higher incidence of CRC among some African Americans.

• African American women have the same chance of getting CRC as men and are more likely to die of CRC than women of any other racial or ethnic group.

Analyzing Other Options Patients may see colonoscopy alternatives as the ideal way to avoid undergoing a full preventative procedure. However, these alternatives leave some patients at risk of incurring increased costs in the future should tests come back positive.

The fecal immunochemical test, or FIT, may be able to help patients avoid the struggles that come along with a traditional colonoscopy, but, according to Goshen Health, the FIT also has drawbacks: “FIT is considered a less effective cancer detection tool. It detects colon cancer once it’s already present, which may mean the disease is in a later stage. FIT detects precancerous polyps only 42.4% of the time, on average.”

Similarly, a virtual colonoscopy, or CT colonoscopy, is less invasive than its traditional counterpart but lacks the ability to remove identified polyps. According to Johns Hopkins Medicine, a CT colonoscopy may also miss polyps smaller than 10mm, which may be identifiable via traditional colonoscopy. Should polyps be identified, a traditional colonoscopy may be required.

Finally, Jay Alamar, MD, of Blanchard Valley Health Systems, identified key areas of the Cologuard© test, which was approved by the Food and Drug Administration in 2014 for patients ages 50–85. Dr. Alamar explains how the Cologuard© test will not diagnose polyps, and should the test come back positive, a colonoscopy will still be required. He adds that like the FIT, Cologuard© only identifies roughly 42% of polyps, with the specificity of results decreasing as patient age increases.

While colonoscopy alternatives provide convenience and ease of use for patients, they fail to provide preventative and early removal of precancerous polyps. This may also cause an increased financial burden on patients whose tests return with a positive result, leading to no preventative Amiee Mingus treatment options covered is Vice President of Clinical by insurance. The traditional Operations at colonoscopy provides an allPE GI Solutions. in-one style of treatment and She can be remains the “gold standard” reached at for colorectal care. amingus@pegisolutions.com.

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Insights | Industry innovations |

The AI

Revolution How the presence of artificial intelligence is changing GI

What is AI currently doing for healthcare?

AI provides unmatched benefits when it comes to supporting physicians and patients in nearly every aspect of healthcare.

This is particularly true when it comes to developing medicine: It costs about $2.6 billion to develop a single drug, and 9 out of 10 candidate treatments never make it to regulatory approval, according to Nature.com. AI is making the search for medicines faster and cheaper. Pfizer has been using the

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new machine learning system IBM Watson to aid in their search and development of immune-oncology drugs, for example, which reduces wasted time and money between the development and approval phases.

AI is also improving patient experience. A 2016 study published in the Journal of Medical Practice Management revealed that 96% of patient complaints related to lack of customer service, paperwork mistakes, and poor front-desk experiences. AI can help automate many administrative tasks to improve efficiency and accuracy behind the scenes, thereby improving customer experience at the front desk and beyond.

AI can also help physicians provide a more personalized treatment experience, as evidenced by the Cleveland Clinic’s partnership with Watson. It also aids in clinical judgment and diagnosis using algorithms as a preventative measure, something that is quickly growing within the GI sector.

iStock.com/FatCamera, Boba

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rtificial intelligence (AI) is changing the landscape in nearly every specialty, including gastroenterology. AI has improved early detection of cancer and other diseases by speeding up review and analysis of mammograms and other scans, for example.

AI, which is defined by Oxford Languages as “the theory and development of computer systems able to perform tasks normally requiring human intelligence,” has been around for decades. Professor John McCarthy first introduced the concept in 1956, and in the years since, AI has evolved into an extremely powerful technology, especially in healthcare.

Artificial intelligence will likely have a significant effect among gastroenterologists.

What AI currently exists in GI? AI is already proving itself invaluable in cancer screening by improving detection and diagnosis, particularly in early stages of cancer. As many as 6% of esophageal cancers are missed on endoscopy, for example, often due to less-experienced endoscopists and smaller lesions. Using AI can improve esophageal cancer screenings by using technology to detect smaller lesions and by overcoming variability and learning curve issues between endoscopists.

With almost 1 million cases each year, gastric adenocarcinoma is the third leading cause of cancer mortality globally, according to research published in the Chinese Medical Journal. Colorectal cancers are the second most commonly diagnosed cancers and the second most deadly. The manual techniques currently used for screening and examinations for these types of cancers are time consuming and meticulous, and inter-operator variability can be significant. Automated detection systems of EGD-related mucosal abnormalities can overcome some of these diagnostic obstacles to improve cancer detection and diagnosis. Dedicated AI systems can also help clinicians determine the best treatment strategy by predicting cancer stage and can even offer therapeutic assistance, resulting in fewer missed EGD diagnoses and better therapeutic outcomes.

What healthcare advancements are currently being made in Artificial Intelligence in the GI sector?

The use and development of AI is growing at a rapid pace in almost every industry and medical specialty, and its use within GI is no different. In April 2021, the Food and Drug Administration (FDA) approved the marketing of the first AI device to aid in the detection of colon cancer in real time.

Known as GI Genius, the device includes hardware and soft-

ware that use AI algorithms to identify regions of interest that may need further assessment. The approach has resulted in a 13% increase in the number of lab-identified adenomas or carcinomas, which signifies a huge advancement for GI. In March 2021, software companies Iterative Scopes and Provation partnered to link documentation software with existing data and insights. Becker’s Healthcare says the partnership will provide AI solutions for healthcare providers and researchers, and initially focus on patients with irritable bowel disease (IBD). If all goes as planned, the AI solution will increase efficiency and accuracy within GI and improve patient outcomes.

AI faces many barriers to adoption, such as fear of AI, choosing the right algorithms, and finding personnel knowledgeable in the use of AI. One of the most prominent barriers for AI’s entrance into the world of GI, however, is that the sluggish regulatory process is often greatly outpaced by the blistering speed of technology development. Fortunately, the FDA is making efforts to speed up the regulation process in order to keep up with the rapid pace of AI technologies.

What does all of this mean for GI physicians and patients?

The increase in availability of AI within the GI sector will have a monumental impact on both patients’ lives and physicians’ ability to improve their patients’ lives. AI can help compensate for physician errors due to inexperience, fatigue, stress, or lack of attention. It can also help improve the accuracy of test results, diagnoses, and treatment outcomes for patients.

While physicians should not become too heavily reliant on AI, the current technology has the ability to match and sometimes surpass human skill level when it comes to the detection and diagnosis of certain diseases. Studies suggest that AI will likely exceed human skills as the technology continues to develop.

AI can also help reduce the cost of GI healthcare by increasing the number of procedures and tests performed each day. For example, the average colonoscopy in the U.S. can cost upwards of $5,500, according to Health IT Outcomes. AI can speed up the process of colonoscopies, thereby reducing patient costs and making GI healthcare more affordable overall.

While AI is making an impact on the GI industry right now, it has the potential to augment and improve patient care in big ways. Understanding the technology Kelly McCormick is Digital/Managing Editor and what it can offer is vital to providing the of PE GI Journal and Director of Marketing at PE highest level of care GI Solutions. She can be for your patients now reached at kmccormick@ and in the future. pegisolutions.com.

19 PE GI Journal pegisolutions.com

Opportunities Submit your CV online at pegisolutions.com/physician-recruitment.

West Scottsdale, AZ

West

Digestive Health Specialists Arizona Full-time gastroenterologist with partnership potential needed for small practice of four MDs, NP, and PA. Outpatient-based with low inpatient volume and only one hospital round. No ERCP or EUS training needed.

Physician office includes an infusion center, pathology lab and state-ofthe-art endoscopy center, all within the same building.

Bellingham, WA Northwest Gastroenterology Exciting opportunity for BC/BE gastroenterologists, preferably with advanced therapeutic, ERCP, and/or EUS skills, to join a growing physicianowned, single-specialty GI practice in beautiful Bellingham, Washington.

Established in 1979 and growing with nine physicians and four advanced practice providers, multiple ancillary service lines, and a new five-room endoscopy center. Offering a two-year partnership track, equal limited call rotation, competitive salary with excellent benefits, and work-life balance in a progressive community close to both Seattle and Vancouver.

Midwest Bloomington-Normal, IL Digestive Disease Consultants Reputable single-specialty practice for more than 30 years seeks physician.

Multiple revenue sources, including endoscopy center, strong support from local hospital, and guaranteed salary for two years. Low turnover and high retention rate.

Bronson, MI Bronson Gastroenterology Practice Seeking a BC/BE gastroenterologist to join a well-established and respected group of outpatient and hospitalist gastroenterologists and mid-levels. Employed position includes competitive salary, paid malpractice, and full benefits. Kalamazoo, located midway between Detroit and Chicago, offers highly rated public schools, affordable real estate, and many activities for the whole family. Lake Michigan is less than an hour’s drive away.

Rochester, MI

Lima, OH Gastro-Intestinal Associates, Inc. Seeking a board-certified full-time gastroenterologist to join a sixphysician, seven-CNP practice—the northwest Ohio area’s largest gastroenterology practice of more than 30 years. ERCP experience is preferred. Partnership track in 18,000-square-foot practice-owned office and ASC after one year. Competitive salary and benefits with paid malpractice, productivity bonus, and 1:7 call rotation. Signing, relocation, and loan forgiveness packages available.

South Laredo, TX Laredo Digestive Health Center Seeking a BC/BE gastroenterologist to join a well-established group of gastroenterologists at this single-specialty ASC in southern Texas. Position includes competitive salary, paid malpractice, equal call rotation, and full benefits. Full-time position includes partnership track with ownership in the ASC. Live in the growing city of Laredo, Texas, which retains a small-town, suburban feel and offers excellent cost of living.

Mid-Atlantic

Troy Gastroenterology Two gastroenterologists skilled in general endoscopy and ERCP needed for private practice with two state-of-the-art, AAAHC-accredited ASCs. Competitive base salary with productivity incentive, retirement plan, discretionary allowance, insurance, and eligibility for member status after two years.

20 PE GI Journal October 2021

Delmar, MD Peninsula Gastroenterology Associates Seeking full-time gastroenterologist to join a three-physician practice.

Well-established practice of more than 40 years, treating the digestive

Northeast Midwest Mid-Atlantic

Gastroenterology Consultants in Northeast Philadelphia. Partnership track available for ownership in adjoining three-room endoscopy center, Philadelphia Gastroenterology Endoscopy Center for Excellence. Competitive salary—first year guaranteed, productivity bonuses, benefits, PTO match, ½ day off per week, paid malpractice, flexible schedule with limited equal call rotation. EUS and/or ERCP skills helpful but not required.

Northeast Stoneham, MA Digestive Health Associates, PC Seeking full-time gastroenterologist to join well-established, seven-physician, single-specialty practice group with an ASC in the Boston area. 1:9 call schedule. Competitive salary and benefits. Full partner track at two years.

South

Central NJ Garden State Digestive Disease Specialists, LLC Seeking full-time BC/BE gastroenterologist to join three-physician practice. The job offers an excellent salary, competitive benefits package, reasonable call schedule (which includes other gastroenterology colleagues in the rotation), and an opportunity for full partnership track in 2–3 years. EUS/ERCP training preferred.

Hillsborough, NJ Digestive Healthcare Center PA health conditions of patients in Southern Delaware and Southern Maryland.

Located adjacent to the affiliated Peninsula Endoscopy Center, a two-room ASC that is physician-owned and -operated. Offering a partnership track, flexible schedule, and limited call rotation.

Seeking a BE/BC gastroenterologist skilled in general endoscopy and ECRP to join busy, seven-person, single-specialty, 30-year established practice located in Central New Jersey. Excellent salary, competitive benefits package.

Lumbertown, NJ Hagerstown, MD Gastroenterology Associates Immediate opening for a gastroenterologist to join a well-established practice. Weekend call 1:8. One-year partnership track for ownership in practice and endoscopy center. Multiple revenue sources, including endoscopy center and ancillary services. One hospital with endoscopy suite next to the office in the same complex as the hospital. Live in Frederick—one hour from Washington, D.C., and Baltimore.

Gastroenterology Consultants of South Jersey Gastroenterology Consultants of South Jersey is a privately owned, eightphysician practice located in Lumberton, NJ. It is a well-established practice of 30 years that is located among several growing communities in southern NJ. Gastroenterology Consultants of South Jersey is seeking to add a fullor part-time gastroenterologist, offering an attractive call schedule and potential partnership in both the practice and ASC.

North Bergen, NJ Limerick, PA Endoscopy Associates of Valley Forge Opening for a full-time, board-certified gastroenterologist to join a practice one hour outside Philadelphia. Partnership track available for ownership in adjoining ASC, Endoscopy Associates of Valley Forge. Competitive salary— first-year guaranteed, productivity bonuses, benefits, PTO match, ½ day off per week, paid malpractice, flexible schedule with limited call rotation. Any experience with EUS and/or ERCP would be a plus.

Advanced Center for Endoscopy GI physician needed to join a single-specialty, nine-physician GI center.

The center can help the physician drive patient volume through the ASC, allowing the physician to increase procedure volume in an environment that is more convenient. Ideally located in North Bergen, the “gold coast” of Northern New Jersey, with a spectacular view of the NYC skyline.

Uniondale, NY Gastroenterology Associates PC

Philadelphia, PA Philadelphia Gastroenterology Consultants Immediate opening for a full-time, board-certified, or board-eligible gastroenterologist to join four-physician and four-physician assistant Philadelphia

Seeking a full-time/part-time, board-certified/board-eligible GI physician to join large single-specialty gastroenterology group. Compensation package includes an option for partnership in practice and ownership in affiliated ambulatory surgery center.

21 PE GI Journal pegisolutions.com

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