Making the most of 2015: New Year’s resolutions in GI

What New Year’s resolutions are gastroenterologists making for 2015?

Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses.

Next week's question: How prepared are gastroenterologists for the ICD-10 transition?

Please submit responses to Carrie Pallardy at cpallardy@beckershealthcare.com by Thursday, January 15, at 5 p.m. CST.

Dr. Benjamin LebwohlBenjamin Lebwohl, MD, MS, ColumbiaDoctors (New York): An appropriate New Year's Resolution for gastroenterologists in 2015 is "I will measure my adenoma detection rate." This quality indicator has been in use for over a decade, but only recently has it been convincingly shown to be linked to important clinical outcomes, in particular the degree of protection against colorectal cancer. As the public has become more aware of quality indicators in general, more patients are now asking their gastroenterologist about his or her personal adenoma detection rate.  We should know the answer.

There are certainly limitations of the adenoma detection rate, including 1) differences in underlying patient risk factors for adenomas; 2) practical difficulties of incorporating pathology results into an EMR, allowing for automated reporting; and 3) having enough average-risk screening examinations to formulate a meaningful statistic. But at the present time, this quality indicator is the best metric we have to offer when a patient is looking for confidence that a high-quality colonoscopy will be performed.

Cynthia Rudert, MD, Celiac Disease Foundation (Atlanta): This year, we should all make the resolution to get more of our patients screened for colon cancer. Twenty-three million Americans aged 50 and over are not getting screened as recommended by the CDC. As a result, this very preventable cancer often is not caught early enough for treatment to be most effective. In fact, 60 percent of cases are not diagnosed until the late stages when the five-year survival rate is a mere 12 percent—that’s why colon cancer remains the second leading cause of cancer-related death in the United States. On the other hand, for those whose cancer is detected at an earlier stage, the five-year survival rate can be greater than 90 percent.  

We all know that getting regular screenings is the key to early detection, but convincing our patients to actually get their colonoscopy remains a challenge.

The good news is that while colonoscopy remains the gold standard, there are now noninvasive options for colon cancer screening that could motivate more people to get screened on a regular basis. So in addition to educating our patients about the risks of non-compliance, we can now offer them screening options.

One example is Cologuard, which was approved by the FDA in August. In addition to being patient friendly and easy-to-use, the test is also effective in identifying cancer and precancerous polyps. In a prospective, 90-site, 10,000-patient pivotal study, Cologuard detected 92 percent of cancers with 87 percent specificity. The test also detected 69 percent of the most advanced precancerous polyps in average risk patients. These results were published in New England Journal of Medicine’s, “Multi-target Stool DNA Testing for Colorectal-Cancer Screening.” The test, which can be taken at home without any bowel prep or dietary restrictions, is designed to detect both blood and DNA shed by cancer and pre-cancers in the stool.

The process is also simple. The patient is prescribed Cologuard by their physician and receives the kit in the mail. After depositing a sample in the collection container, they simply ship it back to the lab for testing. A positive Cologuard test means that altered DNA and/or blood that could be caused by advanced adenomas or cancer in the colon or rectum were detected and the patient is then referred for colonoscopy.

The simple fact is that the best test is one that gets done, so if noninvasive options like Cologuard can help get more patients screened, leading to early detection and better outcomes, we should all resolve to inform our patients about their choices. For patients who otherwise would not have been screened, new options like this are critical to the treatment and prevention of colon cancer.

Patrick TakahashiPatrick Takahashi, MD, CMIO and Chief of Gastroenterology Section of St. Vincent Medical Center (Los Angeles): A New Year’s resolution that should be on every gastroenterologist's list is to study the concepts of value-based medicine so that they will be cognizant and prepared for future changes, which could potentially impact their bottom line from a financial standpoint.

Multiple agencies from the federal and state level, as well as insurance payees will stipulate meeting certain minimum requirements on both procedure and office based reports to qualify for reimbursement. Uniform reporting will prove to be a critical point going forward in this new era of medicine. Multiple resources such as the AGA, ACG and ASGE are available to help transition physicians to this new model.

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