PSG Rumblings Newsletter Winter 2023 by TEAM

PSG

Rumblings WINTER 2024

WINTER 2023

PENNSYLVANIA SOCIETY OF GASTROENTEROLOGY / NEWSLETTER

President’s Message / Karen Krok, MD President’s Message / David L. Diehl, MD, FACP, FASGE

@Kkrok @DavidDiehlMD

www.pasg.org

As the new President of the Pennsylvania Society of Gastroenterology, this is my inaugural piece for our newsletter. As this is a time in which we celebrate being The Importance grateful and thankful, I thinkof it isMentoring prudent to use this opportunity to thank some amazing people for all of their hard work! attending physicians at one’s The PSG is launching a own training program work very mentorship for GIour outgoing First I would like program to start by thanking President, Dr. David Diehl. hard to train GI fellows, but this is Under Dr. and Diehl’searly leadership we have had successful webinars, continued to Fellows career generally different from a mentoring grow our membership include West Virginia gastroenterologists, worked GI physicians. Wetowill relationship. towards developing a mentorship program for the gastroenterology fellows, be reaching out to those had our first research grant RFA and returned to in person annual meetings! I have been lucky enough to have of whoto would to leadership Hisyou dedication the PSGlike and his were very valuable as we some important mentors in my participate in thisworld! project. navigated a post-COVID medical career. The first was assigned to me when I was a firstMany usDiehl’s have benefitted UnderofDr. leadership,from we had returned to the Pittsburgh area after a year medical student. His name mentors. some usannual have meeting many yearPerhaps hiatus and hadof our September 8-10. This brings me was Eugene “Skip” Felmar, MD and suffered forperson the lacktoof a mentor to the next thank – Dr. Gursimran Kochhar from the Alleghany Health he was a Family Practice attending during ourAlleghany educationGeneral or training. Network’s Hospital; Dr. Kochhar was the program director for in the San Fernando Valley area of Mentors can have a and lifelong the annual meeting by allimpact accounts we had a very successful meeting! This Southern California. I enjoyed going on their trainees, butcourse, the relationship included a hands on research abstract awards for 3 fellows, 17 fantastic out to his office and shadowing him does not go in only one direction. and relevant lectures, time to meet with Representative Arvind Venkat, MD, of the while he saw outpatients, Mentors can get as much benefit and andclosely Pennsylvania House of Representatives of course the opportunity to network rounded on inpatients, and did office satisfaction their menteesthroughout can. and socializeaswith colleagues the State. We had over 20 poster procedures. Beyond gaining valuable Gastroenterology, other of presentations and like more thanareas 100 participants at the meeting. Dr. Kochhar did insight into the practice of medicine, medical training akinsotoalla of “guild”, not do this alone,isand the members of the program committee need to I found out why his nickname was where the experienced the Chaput, Ravi Ghanta, Harshit be recognized - Doctors take Kimberly Khara, Harrison “Skip” after he took me out on his novice under their wing to train Malcom, Shyam Thakkar, and Zubair Malik. And I extremely grateful for Jessica sailboat which he kept docked at them in the their chosen Winger, whoarts hasof been our Meeting Manager for many years – she brings a the Los Angeles harbor. Skip Felmar field. All GIknowledge fellows, including us historical of the conferences as well as insight into great locations in became a role model for me, and way back when, trainersMeeting and Pennsylvania forhad the Annual and her organization skills allow for us to the mentor-mentee relationship was coaches that typically were staffyear after year! have these successful meetings mutually rewarding. gastroenterologists at our program. Many medical schools provide forput on your calendar our next annual meeting: Speaking of conferences…. Please Another highly impactful mentor mentor relationships, but at thisThe is less September 13-15, 2024 Hershey Hotel in Hershey, Pennsylvania that I had was someone that I chose common in GI training. Certainly, myself. Dick Kozarek, MD was (and I like to say that I have “drunk the hot cocoa” as I am a resident of Hershey – it is known as the “Sweetest Place on Earth”. You could go to the amusement park,

PSG/SOCIAL: @PAGastroSoc

INSIDE:

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PSG/SOCIAL: @PAGastroSoc

INSIDE

1 President’s Message

1 President’s Message 3 Practice Management 2 Announcement 4 GI Supergroups 4 Lifetime Achievement

6 Venue Shopping 6 Legislative Update 8 EMR or ESD? 7 Top Ten List 11 Roulette 8 FIT Update

13 Jeopardy Winners 10 Governor’s Update 14 Annual Meeting Highlights 12 Annual Meeting Wrap-up 16 Board and Staff 16 Board and Staff

President’s Message continued from page 1

take a trolley ride around the city to learn about Milton Hershey and his innovative vision to become a chocolate company, visit Chocolate World or get a massage at the Spa. We would love to see a great turn out for 2024! Up next… I would like to thank the other members of the Executive Board of the PSG who will be their roles for the next two years – Dr. Manish Thapar (Chair of the Division of Hepatology and Medical Director of the Liver Transplant Program at the Einstein Medical Center in Philadelphia) who will be serving as Vice President, Dr. Neil Nandi (Inflammatory Bowel Disease expert at Penn Presbyterian Hospital in Philadelphia) who will be serving as Secretary, and Dr. Kim Chaput (Program Director of the Gi Fellowship at St. Luke’s University Heath System) who will be serving as Treasurer. As a team we look forward to working with the rest of the Board and continuing to grow this organization. I would like to introduce myself to you as well. I am a Pennsylvania native and grew up in West Philadelphia (“In West Philadelphia born and raised, On the playground was where I spent most of my days” – for those Fresh Prince fans) and attended Franklin and Marshall College – Go Dips! When I went to college in Lancaster it did not have all of the great restaurants and cultural scene that it does now…

I would suggest spending a weekend there sometime and you can see a show at The Fulton, visit an Amish farm, and great some great meals! I went to medical school at the University of Pennsylvania and it was there that I remember rounding with a hepatologist – Dr. Kellen Kovalovich – who inspired me to want a career in Transplant Hepatology (he is another person that I am grateful for). I continued that interest in Gastroenterology and Hepatology during my residency at the University of Pennsylvania and attended Johns Hopkins for my 3-year GI fellowship and an additional 1 year in transplant hepatology (this was pre-match days and looking back it was sort of like the old Wild West with finding a spot for fellowship). Funny story – this was at a time basically precell phones and I received a page from Dr. Frank Giardiello at Johns Hopkins while I was in my residency continuity clinic that I was being offered a spot in their fellowship (that was probably the best residency continuity clinic that I ever had!). And I then come home and earlier in the day a PD from another institution had called and left me a message on my answering machine that I was offered a spot at their institution… it often makes you wonder how life takes these turns. What if I had gotten that phone message first before the page??

Because if I had gone to this other institution in a different city who knows what may have happened in my career – who would have inspired me? Would I still be a hepatologist? It was also during my time in Baltimore that I met my husband and we now have two daughters that keep us busy between soccer games, theatre productions, dance classes, and basketball games. I am so thankful for my family who bring me great joy and remind me everyday of how wonderful life is. So – over the next two years I look forward to working with the Board to support Gastroenterology and Hepatology in Pennsylvania and West Virginia. My goals include the following: 1) To strive to have 100% of all GI fellows as members of the society 2) T o increase our membership and grow into Southern New Jersey and Delaware 3) To work with you all and the PAMED Society to continue to advocate for gastroenterologists and patients 4) To have at least one additional education session a year My ask of you is that you reach out to me with any ideas or concerns that you have that as a Pennsylvania Society of Gastroenterology can work to address! I am grateful for this opportunity to work with the PSG!

Announcement: Dr David A. Sass, FACP, FACG, AGAF, FAASLD (our former PSG President from 2013-2015) has just been named the next Rorer Professor of Medicine in the Division of Gastroenterology and Hepatology at the Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia. Dr Sass has been at Jefferson since 2013 where he serves as the Medical Director of Liver Transplantation. He is honored to assume this new endowed Professor title as a distinguished leader, educator, researcher, and clinician in the field of liver disease and transplantation.

The WVU School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dr. Harvey Lefton recipient of special PSG Lifetime Achievement Award distinguished former presidents. His activity in the Pennsylvania Society of Gastroenterology spans decades as he has remained steadfast and true to our mission.

David Sass, MD, FACP, FACG, AGAF, FAASLD. Former PSG President 2013-2015 Rorer Professor of Medicine Sidney Kimmel Medical College of Thomas Jefferson University It is my distinct privilege to introduce Dr. Harvey Lefton as the recipient of this very special PSG Lifetime Achievement Award. As you’ll see, Dr Lefton is truly deserving of this special honor. Harvey did his college years at the University of Pittsburgh, and then he went to medical school at Jefferson Medical College. He then did his postgraduate training in Internal Medicine and gastroenterology at the Cleveland Clinic. He served in the United States Air Force at Scott Air Force Base, where he served as chief of Gastroenterology. He then came to Philadelphia in 1976, and started Gastrointestinal Specialists which became the largest and most successful GI practice in Northeast Philadelphia. Harvey is an active member of multiple GI societies, including the ACG, the AGA, and the ASGE and has a fellowship distinction in all of those societies. He was a founder of the Pennsylvania Society of Gastroenterology and has been an active member of the society for the past 40 years. In 1999 when serving as a program chair, the PSG was facing financial difficulties and only had about $30,000 in the bank. Due to his efforts, he was able to raise over $120,000 which really set the society back to fiscal good health, and it has been in good financial standing ever since then. In 2002 Harvey again served as program director of the PSG postgraduate course and he’s being a board member for over 20 years. Harvey was named the PSG President in 2005 and during his two-year term introduced the fellow-in-training (FIT)

position to the PSG board, and this has been part of the board since then. In addition, the diverse nature of the board and PSG in general is a true reflection of Harvey’s leadership. Beyond his presidency over the last 15 years Harvey has remained the very active board member, and as many of the of the former PSG presidents can attest to, he has been a source of great counsel to all of the former PSG presidents, given his vast experience with organized medicine. Harvey has a very strong interest in teaching and was actually the youngest full clinical professor at the Medical College of Pennsylvania. Finally, as a past president of the Philadelphia County Medical Society, Harvey initiated and leads the annual update in gastroenterology that is up to its 12th year. So once again it’s my distinct privilege and pleasure to introduce Harvey Lefton as this year’s recipient of the special lifetime achievement award. Thank you. Wilson Jackson, MD F. Former PSG President President PA Medical Society Our Pennsylvania Society of Gastroenterology is a better, stronger and more meaningful society because of the great work and effort of Dr. Harvey Lefton, one of our

I had the pleasure of meeting Harvey early in my career. It was a relationship that I grew to value in the subsequent years. In addition to core excellence in patient care, he continues to distinguish himself as a champion of gastroenterologists throughout our Commonwealth. A notable illustration was the aftermath of the attacks of September 11, 2001. Like many like organizations, our society has sustained itself through a combination of membership dues and generous support of bio-pharma companies. Up to 2001, we had largely lived on a thin year-to-year budget margin. In 2001, our annual meeting was scheduled to occur shortly after the events of 9/11. Naturally, the meeting was canceled and industry support was understandably withdrawn. Unfortunately, contractual obligations to meeting expenses were not forgiven. As a result, PSG incurred significant debt that jeopardized our fiscal sustainability. Dr. Lefton’s leadership and engagement in the following years brought the Society from the literal brink of bankruptcy, to the robust and financially sound organization that it is today.

Hathaway stock at $15 dollars a share and I wouldn’t be in medicine, but here we are! I appreciate the honor you’re giving me.

He never shies to right a wrong. As a steady presence on the PSG board, we regularly wrestle with insurance policies or legislative activity that would adversely impact our patients or members. His experience and perspectives remain valued and essential to mapping out any number of strategies to lead PSG forward and remain a critical voice amongst legislatures or insurance medical directors. He sees the road ahead. He was an early advocate for physicians to come together as a singular voice to challenge any number of administrative or bureaucratic challenges or obstacles that confronted physicians. With the consolidation in health care, the collective physician voice has become more important. Harvey recognizes the value or PSG and other groups within organized medicine to advocate for physicians. Importantly, Harvey has been a mentor and friend, and someone whose counsel I have grown to respect and value. He has remained true to his family, his profession, our PSG and his friends. Congratulations, Harvey, on this well-deserved lifetime achievement award from the PSG. Comments of Harvey Lefton, MD Thank you for this honor, colleagues. I do appreciate it. I can’t believe you’re giving this to me at age 34! I came to the University of Pittsburgh in 1962. If I knew then what I know now, I would have bought Berkshire

In the spring of 1981, a group of Gastroenterologists met at the Museum of the University of Pennsylvania to discuss the need for statewide representation. As the song from Hamilton goes, “I was in the room where it happened “. We decided to form this society and to set as our goals the need for more research, education and more interaction among gastroenterologists. Since then, we have seen the radical change in the treatment of ulcer disease. We’ve seen advances and endoscopic treatment of various diseases and we’ve seen a cure of hepatitis C. In the 1980s I gave a lecture on inflammatory bowel disease I showed a picture of the inflammatory cascade. I said wouldn’t it be nice if we could treat this disease at various points in the inflammatory cascade and it looks like that’s where we’re headed now. Let me conclude with a cautionary observation. we are in an era now where practice is changing dramatically. We are seeing solo practices vanish, larger groups merging, and institutions getting together to form megagroups. While this may help from negotiating and monetary perspectives, we should not ever forget that we are the keepers of our patients. We are their safeguard. We have taken the Hippocratic oath; not venture capitalists or money managers, but Physicians. We should not let our craft be taken over by others who are not of a medical background. I think it was the Greek dramatist Euripides who said “Nothing new comes into the realm of man without a curse”. Do not let the negative aspects of these changes influence you, and keep your mind open for change, but also be there to protect your patients. Thank you again for this great honor I’m sorry I couldn’t be there in person, but I want to give you my heartfelt thanks.

Pennsylvania Legislative Update: “Venue shopping” for malpractice claims is now again the law of the land F. Wilson Jackson, MD Prior to August 2022, a malpractice case could only be filed in the county where the alleged medical error occurred. Underreported in the news was the August 25, 2022 ruling by the Pennsylvania Supreme Court that changed their 2003 venue ruling. The new ruling expands the counties where a claim may be filed; it does not any longer need to be filed in the county where the alleged medical error occurred. The ruling returns us to the practice of “venue shopping.” By background (and for those of you who were practicing in Pennsylvania at that time will remember), through the late 1990s and into the early 2000’s our state had an evolving malpractice crisis that crested in 2003. Over that time, we saw a steady and unsustainable rise in malpractice premiums. A major driver of this trend was the fact that alleged malpractice cases could be moved to jurisdictions with historically more favorable jury verdicts. As jury verdicts rose, premiums for physician rose. This in turn drove many physicians to leave the state, pushed some towards early retirement, and induced others to limit their scope of work. In addition, this situation disincentived young physicians to begin their careers in Pennsylvania.

Much historically relevant information can be found in a report that followed a Senate resolution passed in 2019 that directed the Pennsylvania Legislative Budget and Finance Committee to study the impact of venue on medical liability actions. This study was released in February 2020. https://lbfc.legis. state.pa.us/Resources/Documents/ Reports/656.pdf Unfortunately, the current venue ruling in August 2022 by the Pennsylvania Supreme Court threatens to reverse the market correction that has been state law for 19 years. As currently written, plaintiffs and their counsel can now shop their case to venues that have little to no connection to the county where the alleged action took place. It is well known that certain counties routinely offer more favorable verdicts than others. As a result of this action, physicians may again see rising professional liability insurance

In concert with these trends, malpractice premiums rose significantly from 1996 to 2003. As a result, many underwriters stopped writing policies in Pennsylvania. Major legislation relief arrived with a change in state law regarding limiting venue shopping. After the Supreme Court’s procedural ruling, subsequently improved in the periods between 2000-2002 and 2015 – 2017.

premiums. Physicians may see a greater impact on their professional and personal lives, as they would need to travel to these county courts far from their homes. Finally, Pennsylvania may again become a less attractive locale for new physicians to begin their careers. The change has the potential to impact physicians regardless of their employment status, whether independent, part of a private equity structure, or academic. The cost of higher premiums will need to come some from somewhere. This may ultimately lead to patients again having reduced access to care. The road to challenge this Pennsylvania Supreme Court ruling would not be an easy one. Effectively, there would need to be a constitutional amendment to shift the authority over venue shopping from the Supreme Court to our legislature. In the interim, I strongly encourage you to take the time to meet and educate your state representative to the General Assembly and help them to understand the negative effects of the recent venue change legislation.

Top Ten list —for GI fellows Kimberly Jegel Chaput, DO St., Luke’s University Health Network Program Director of the GI Fellowship

1. Be ready to work hard! 2. Enjoy and be engaged in the experience. 3.Learn, teach, be humble, be kind, be sincere. 4. C ommunicate effectively and respectfully, and work efficiently as a team player. 5. T ransition into your role as a consultant without sacrificing your Internal Medicine knowledge; convey your assessment and recommendations logically, methodically and succinctly. 6. Ask questions if unsure. 7. S how appreciation to staff, nurses, AP’s, residents, fellows, and attendings. 8. Practice self-care 9. B e proactive regarding timely communication, anticipation of add- ons, assess optimization of patients, blood thinning agents and prep issues prior to endoscopy, timely triage of patients, diet orders and post procedure recommendations. 10. Don’t screw over your co-fellows!

PSG

Endoscopic education: A Fellow’s Perspective After the First Year Muhammed “Areeb” Alikhan, MD Coming into gastroenterology fellowship, I kept hearing about the “steep learning curve”. I felt relatively comfortable with basic medical management of common inpatient gastrointestinal problems, but endoscopy represented uncharted waters. I remember thinking to myself, “Will I even be able to do this? How do I even know if I’m good at this?” When I eventually started my first year of fellowship, I remember these thoughts constantly swirling in my head. Intubation of the esophagus was the first challenge I was faced with, and I clearly remember the sense of accomplishment I felt after being able to perform this consistently. Then came another anxiety-filled challenge anxiety of navigating the duodenal sweep. This too, was followed with pride in competency after consistent application in the endoscopy suite. This pattern continued throughout the first year, and still does. Looking back, I am thankful to my mentors for facilitating an immense period of growth in my procedural skillset along the way. Now midway through my second year in training, I continue to reflect about my path through endoscopic education. How do we optimize procedural learning for the trainee? Is there always a right way to teach something? How do we negotiate all of the stimuli and pressures of a normal workday with training? Certainly, these are not easy questions but perhaps some guidance can be found in personal reflection and the experiences of others.

Endoscopic simulators have been discussed for years but remain not widely available. The literature of their use in endoscopic education is certainly a mixed bag. Perhaps the greatest benefit early in training is developing a familiarity with the endoscope. There is value in understanding how to maneuver the tip of the scope and the functions of each button. Despite advances in the audiovisual specifications of simulator software, however, the navigational experience just cannot compare to that of an in vivo procedure. “Real time” attending feedback is paramount in the procedural development of the trainee. Naturally, different personalities afford different feedback styles. Some prefer initiating with verbal coaching while others prefer manual demonstration, and almost always a combination of the two is employed eventually. I believe a tailored approach to the level of the fellow is best, all while focusing feedback on a pre-stated endoscopic goal. For example, the attending can focus their feedback on loop reduction for a given procedure. This can provide a targeted, point-of-care instruction which will hopefully make it a “high yield” endoscopic day. Extraneous stimuli throughout the day can be a cognitive burden that can hinder development of a new skill. For example, the ongoing stream of telephone calls and pages as part of a simultaneous inpatient responsibility can quickly overwhelm. While it is impossible to completely eliminate these stimuli, perhaps this would be an ideal scenario in which to shift the focus of education. When there is agreement that an unstable patient is not the right case on which to practice esophageal intubation, the focus

could instead shift to a discussion on a certain device used in the procedure. From personal experience, even if I did not personally manipulate the scope for most of a procedure, I still feel a sense of fulfillment in that I left the procedure with a greater knowledge on an endoscopic device I otherwise knew little about. There are so many other facets to endoscopic education, some of which I may not even realize at my current level of training. I hope that sharing my experience with a few aspects of my education was helpful and I welcome commentary from the experience of others. Ultimately, I think a vast majority, if not all, graduating gastroenterology fellows leave their training period competent in most diagnostic and therapeutic procedures. However, I believe optimizing education within the training period will allow for a more enriching experience and translate into a more satisfying professional growth even after fellowship.

PSG

PSG Mentorship Program

e are looking for PSG members who are interested in serving as mentors to trainees and early-stage GI W practitioners. This promises to be a mutually rewarding activity. Time commitment is variable, but interaction between mentor and mentee should be at least quarterly. In addition, the mentor should be willing to have contact (by email, text, telephone call) on an as needed basis. Please contact Dr, Karen Krok (kkrok@pennstatehealth.psu.edu) or David Diehl (dldiehl@geisinger.edu) if you are interested in becoming a PSG Mentor or for any questions. Thanks for your participation in this! Disease specific categories

Other categories

Barrett’s esophagus

Women’s GI Health

Eosinophilic esophagitis

Diversity and Inclusivity in GI

Inflammatory bowel disease

Private practice issues and early practice

Gastrointestinal Motility

Advocacy

Functional bowel diseases / GI Psychology

Clinical trials

Pancreaticobiliary diseases

Clinical research

Bariatrics and Nutrition / Endobariatrics

Invention and Innovation in GI

Hepatology

Work/Life Integration

Interventional endoscopy

Save the date for PSG Meeting—September 13-15, 2024 BOARD&STAFF Hershey Hotel, Hershey, PA PRESIDENT

David L. Diehl, MD Geisinger Medical Center Gastroenterology/Nutrition 570-271-6856 dldiehl@geisinger.edu

@DavidDiehlMD

1st Vice-President

Karen Krok, MD Penn State Hershey Gastroenterology (717) 531-4950 kkrok@pennstatehealth.psu.edu

TREASURER

Neilanjan Nandi, MD, FACP University of Pennsylvania 215-662-8900 Neilanjan.Nandi@pennmedicine.upenn.edu

@fitwitmd

EDITOR

David L. Diehl, MD Geisinger Medical Center Gastroenterology/Nutrition 570-271-6856 9 dldiehl@geisinger.edu

STAF

Cindy Mark

Jessic Meet

Tom Desig

DDNC and ACG Governor’s Update Ralph D McKibbin, MD, FACP, FACG, AGAF ACG Governor, Western PA DDNC Representative Each fall medical practices are faced with significant challenges. Federal, State, University, Insurance carrier and office practice budgets are being looked at for the coming year. CMS pushes out its regulatory and payment changes for the coming year and sets the tone for all carriers. This year, there are additional challenges. Decreasing reimbursement and growing administrative burdens are threats to the current practice model but artificial intelligence (AI) will permanently transform the entire healthcare industry and may provide real opportunity. Shrinking payments Medical provider reimbursement is a budget neutral item for CMS so total expenditures cannot rise. The rising volume of all medical services leads to incremental decreases in payments for services. There has been a steady decline in Medicare reimbursement for common gastrointestinal (GI) services and patient office visits over the past 15 years. From 2007 to 2022, unadjusted and adjusted reimbursement for GI procedures declined by 7% and 33%, respectively, on average. This is in addition to the devaluation from inflation and increased cost of living. CMS is proposing a further 3.36% cut to the 2024 Medicare physician payment schedule conversion factor. Inflation and budget constraints are making a more competitive financial environment, so it is important that medical professionals in all settings participate in the budget process. Private practitioners, department heads, division leaders all need to engage in the process. As the saying goes, “if you are not at the table, you are on the menu!”

The PSG, ACG and other professional societies understand this and are pushing for adequate reimbursement. Individuals also need to engage decision makers such as your congressional representatives, insurance carrier liaisons and regulatory bodies. Your voice is needed to maximize our leverage. Look at our society websites to get contact details and sample letters to send. Administrative burdens Administrative burdens are growing. Prior authorization (PA) for procedures and medications is a tool for carriers to limit the volume of services to hold down their costs. While PA helps carriers and may be lowering total healthcare spending, the CAQH estimates that the cost to providers for manually generating a single prior authorization request is close to $11. This can cost the average medical practice over $70,000 a year in actual expenses and opportunity. PA is becoming universal and providers are unable to pass on these additional costs, so our margins are shrinking. Federal and state legislators are working to pass legislation, but this will only be as good as the implementation. We need to monitor this with true measures of time and expense to the practice as well as the cost and outcome burdens for our patients. We must adopt best practices in documentation and push for such measures as gold card status to facilitate timely care.

Artificial intelligence (AI) The challenges of an aging population, shifting patient expectations, and lifestyle changes are pushing healthcare systems to evolve from episodic care to proactive, long-term care management. AI, characterized as the ability of a computer program to perform tasks associated with human intelligence, may provide a solution to address these challenges. Because AI transformation is new, questions regarding its impact on patients, practitioners, health systems, and ethical concerns about data usage will need to be addressed. This transformation affects private practitioners, university-based providers, and employed providers alike, offering opportunities and challenges that demand attention. Like the growth of the internet, AI will grow rapidly. Many of the changes haven’t been imagined yet. Here are three anticipated early changes, three threats to practices, and three opportunities for practices to capture financial and time benefits.

Anticipated Early Changes from AI Enhanced Diagnosis and Decision Making: AI-based systems are rapidly becoming invaluable tools for gastroenterologists. They can analyze vast patient datasets to assist in early diagnosis, risk assessment, and personalized treatment plans. By providing more accurate and timely insights, AI-driven diagnostic tools will enable practitioners to deliver higherquality care and improve patient outcomes.

Streamlined Office Operations: AI solutions can optimize general office functions. For instance, AIpowered appointment scheduling systems can reduce no-shows, and AI-driven chatbots can handle routine patient inquiries, freeing up staff for more critical tasks. Moreover, AI can help streamline mdical billing and coding, reducing errors and accelerating the revenue cycle. Efficient Insurance Claim Processing and Authorization: AI can significantly improve the insurance claim and authorization process, which is often a source of frustration for gastroenterology practices. AI-driven software can quickly and accurately process claims, reducing reimbursement delays and claim denials. Additionally, predictive modeling can assist in determining patient eligibility, minimizing the hassle of prior authorizations.

Potential Threats to Practices from AI Data Privacy and Security Concerns: With the integration of AI systems, the volume of sensitive patient data stored electronically increases. This exposes practices to greater risks of data breaches and cyberattacks. Safeguarding patient information becomes even more critical, requiring investments in robust cybersecurity measures and compliance with evolving regulations.

Physician-Patient Relationship: As AI becomes more prominent in healthcare, there is a concern that the traditional doctor-patient relationship may erode. Patients might become overly reliant on AI for advice and information, potentially leading to misunderstandings or mistrust between patients and healthcare providers. It’s essential to maintain a balance between technology and human interaction. Integration Challenges: Implementing AI solutions in existing practices can be complex and timeconsuming. Ensuring that AI systems seamlessly integrate with electronic health records (EHRs) and other existing technology can be a daunting task. Poor integration can lead to operational inefficiencies and patient dissatisfaction. Potential Benefits of AI for Medical Practices Cost Savings and Revenue Enhancement: AI can reduce operational costs through automation, improved billing processes, and optimized resource allocation. By minimizing claim denials, practices can capture additional revenue. The financial benefits of AI can help practices thrive in an increasingly competitive healthcare landscape.

Improved Patient Care: AI-driven diagnostic and decision support tools can enhance patient care by providing more accurate and timely insights. This not only improves patient outcomes but also boosts patient satisfaction, potentially attracting more referrals and boosting the practice’s reputation. Time Efficiency and Work-Life Balance: By automating routine tasks and streamlining office operations, AI allows healthcare providers to focus on patient care. This can lead to improved work-life balance, reduced burnout, and higher job satisfaction. Additionally, it can help practices meet the growing demand for gastroenterology services. AI is poised to make nearterm transformative changes in Pennsylvania gastroenterology practices. While there are potential threats, including data security concerns and the risk of dehumanizing patient interactions, the opportunities for cost savings, revenue enhancement, and improved patient care are substantial. Gastroenterologists should embrace AI as a tool that can not only streamline their practices but also elevate the quality of care they provide. Being proactive in adopting AI solutions while addressing associated challenges will be key to success in this evolving healthcare landscape.

PSG Meeting Recap:

The annual meeting of the PSG was held in Pittsburgh September 8-10 and it was a huge success! Dr. Gursimran Kochhar from Allegheny Health System was the program director, and he did a wonderful job organizing a program and selecting the topics and the speakers. Many thanks are also due to the Education Committee of the PSG, who participated in monthly meetings to work with Dr. Kochhar to hone the speaker line-up. Dr. David Whitcomb was our Keynote speaker and delivered a cutting edge talk on prevention of chronic pancreatitis in the modern era. Another highlight was presentation of a Lifetime Achievement Award to Dr. Harvey Lefton, one of the original founders of the PSG. Please look elsewhere in this issue of Rumblings for more information about Harvey.

29 exhibitors 110 attendees

Drs. Harshit Khara and David Diehl.

Arvind Venkat, MD, PA State Representative, district 30.

Dr. Neil Nandi interacting with a vendor.

Dr. Kochhar had the concept of having a hands-on session this year, something that we haven’t done in a few years. This also was a wild success. Practicing gastroenterologists and GI fellows had the opportunity to “test drive” a wide variety of endoscopic technologies and devices. We are very grateful to all the companies that helped set this up and generously contributed equipment, supplies, and personnel to make it a success. There was a tremendous amount of behind-the-scenes planning that was required, but in the end, everything came together perfectly.

Program Director Dr. Gursimran Kochhar and PSG President Dr. David Diehl.

Drs. Khara and Kochhar in the hands-on section.

Drs. Rocky Schoen, Austin Chiang, Piyush Mathur and Shyam Thakker.

PSG Meeting Recap:

There was an outstanding turnout at the Friday evening reception.

A hands-on station being led by Dr. Hadie Razjouyan. Drs. Randy Brand, Neil Nandi, and our keynote speaker David Whitcomb.

There were 110 attendees, with representation from long standing members, trainees, physician assistants, and nurses form all across the state. The venue for the meeting, the Wyndham Grand Pittsburgh Downtown, was well suited for our group, and it was really exciting being back in the Western part of the Commonwealth again for the annual meeting. We had a full line-up of exhibitors and had to turn away some because the space was full. Altogether, there were 29 exhibitors and the feedback that we have received from them was that this was a very worthwhile and successful meeting for them. “There were outstanding abstract submissions this year, as usual, and the top three submissions won generous cash prizes. ”Shivani Desai, MD won first prize with her submission, “ Outcomes of ERCP in prone versus supine position: a large multi-center study”; “Dr. Muhammad Waleed won second prize for “A randomized control trial comparing the migration rate of covered esophageal stents with and without endoscopic suture fixation.” “Dr. Danial Nadeem won third prize for his submission, “Effect of Glucagon-like Peptide-1 Receptor Agonists on Upper Endoscopy in Diabetic and Non-Diabetic Patients”.

Outgoing PSG President David Diehl, MD with incoming President Karen Krok, MD.

PSG

PRSRT STD U.S. POSTAGE PAID HARRISBURG PA PERMIT NO. 922

BOARD&STAFF BOARD&STAFF PRESIDENT PRESIDENT David L.Krok, Diehl,MD MD Karen Geisinger Medical Center Penn State Hershey Gastroenterology/Nutrition Gastroenterology 570-271-6856 (717) 531-4950 dldiehl@geisinger.edu kkrok@pennstatehealth.psu.edu @DavidDiehlMD @klkrok 1st Vice-President 1st Vice-President Manish Thapar, Karen Krok, MD MD Thomas Jefferson Penn State Hershey University Hospital Gastroenterology (215) 955-8900 (717) 531-4950 manishthapar@yahoo.com kkrok@pennstatehealth.psu.edu

TREASURER TREASURER

Neilanjan Kim Nandi, MD, FACP Chaput, DO University St. of Pennsylvania Luke’s Gastroenterology 215-662-8900 484-526-6545 Neilanjan.Nandi@pennmedicine.upenn.edu kimberly.chaput@sluhn.org @fitwitmd EDITOR David L. Diehl, MD EDITOR Geisinger Medical Center David L. Diehl, MD Gastroenterology/Nutrition Geisinger Medical Center 570-271-6856 Gastroenterology/Nutrition dldiehl@geisinger.edu 570-271-6856 @DavidDiehlMD dldiehl@geisinger.edu

@DavidDiehlMD @klkrok ADMINISTRATIVE OFFICE SECRETARY ASSOCIATION EXECUTIVE ADMINISTRATIVE OFFICE Neilanjan Nandi, MD, FACP Dawn Swartz ASSOCIATION EXECUTIVE SECRETARY University of Pennsylvania (717) 909-2584 Audrey Dean Manish Thapar, MD 215-662-8900 info@pasg.org (717) 909-2633 Thomas Jefferson Neilanjan.Nandi@pennmedicine.upenn.edu info@pasg.org University Hospital @fitwitmd (215) 955-8900 manishthapar@yahoo.com

STAFF STAFF

Cindy Warren Jessica Winger Marketing Coordinator Meeting Manager Jessica Winger Tom Notarangelo Meeting Manager Design Manager Tom Notarangelo Design Manager