2014 Outlook: 7 Issues for Gastroenterologists to Focus on This Year

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Shawn Khodadadian, MD, of Manhattan Gastroenterology in New York, and Jeffrey Fine, MD, chief of gastroenterology for the Medical and Surgical Clinic of Irving and a gastroenterologist at Star Medical Center in Plano, Texas, share a forecast for the year ahead in the field of gastroenterology.

Dr. KhodadadianExpansion and clarification of roles
Many gastroenterologists have observed the field's shift towards proceduralism. "Some of the intricacies of the field are waning," says Dr. Khodadadian. Colonoscopy screening awareness and demand has grown; though an important issue, physicians have focused more on procedures and less on functional issues.

Functional gastroenterology includes service lines such as nutrition, irritable bowel disease management and women's GI health. "We need to revisit the overall wellbeing of patients," says Dr. Khodadadian. "The different specialties within GI are trying to clarify and expand their roles."

Gastroenterologists will continue to provide colon cancer screenings and perform surveillance Dr. Jeff Finecolonoscopy, but focus on the expansion of personalized care. "GI physicians will help patients improve their overall health through less conventional therapies such as food elimination, nutritional supplements and exercise programs, while treating the underlying reasons for GI problems," says Dr. Fine.

The role of EHR
The switch from paper to electronic health records is a learning process, but an important one. EHR allows physicians the flexibility to schedule on the go and access to patient records at anytime. "As specialists become more comfortable with EHR, efficiency is going to increase. Patients will grow to accept the role of EHR and the health record is going to become stronger," says Dr. Khodadadian.

Hospital employment
Growing hospital employment of physicians affects GI physicians' referral sources and creates concern for the future of physician independence. "It is important for gastroenterologists to be aware of the changes in healthcare, but to be sure those changes do not interfere with our ability to provide the highest quality of care to our patients," says Dr. Khodadadian.

Quality improvement
Quality improvement projects are of growing importance in healthcare. Physicians have a number of quality reporting requirements to meet and strive to improve the care given to patients. Dr. Fine tracks cecal withdrawal time and has tracked adenoma detection rates for years, both of which are important quality markers. "The challenge is identifying these important quality markers and effectively benchmarking," says Dr. Khodadadian.

Changes in reimbursement
The Patient Protection and Affordable Care Act will likely cause shifts in reimbursement. In the field of gastroenterology, Crohn's disease is an expensive condition to treat and payers have often limited reimbursement for treatment. "Many people who were diagnosed with Crohn's disease had to pay for treatment out-of-pocket," says Dr. Fine. "The Affordable Care Act may bridge that gap for some Crohn's disease patients."

The PPACA is also changing coverage for colon cancer screening. Previously, patients had to shoulder the pathology and removal costs if a polyp was found during a colonoscopy screening. "Under the ACA, the removal and pathology costs are supposed to be covered, so it should make colon cancer screenings more affordable for the public," says Dr. Fine.

Advances in hepatitis C treatment  
There has been a number of recent advancements in the GI field, chief among them the development of novel therapies for hepatitis C. "Newer therapies with higher cure rates are now available," says Dr. Fine. "I am anxious to treat patients with them in the very near future."

More Articles on Gastroenterology:
Dr. Caroll Koscheski of ACG: Value-Based Care in Gastroenterology
Study: Longer Colonoscopy Withdrawal Times Associated With Higher Polyp, Adenoma Detection Rates
AGA: 11 Things to Know About Personalized Medicine

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