5 thoughts on Cologuard, gastroenterology's future & the tax threatening Connecticut ASCs from Dr. Charles Adelmann

Charles Adelmann, MD, of Norwalk, Conn.--based Soundview Medical Associates spoke with Becker's ASC Review about the biggest issues in gastroenterology today.

Note: Responses have been lightly edited for style and clarity.

Question: There are now more colorectal cancer options than going in for a traditional colonoscopy. If your patients are weary about going in for a colonoscopy, do you recommend tests like Cologuard or other alternatives?

Dr. Charles Adelmann: The best screening test is the one that gets done well. If patients don't want a colonoscopy, see what you think is the next best they will have done and explain to them the pros and cons of each exam. The fact is colonoscopy is the only test that can detect and remove lesions in one setting. You can't force someone to do something, though, so recommend the next best screening test, and make sure it's done well and appropriately.

Q: What are your thoughts on the 6 percent revenue tax on ASCs in Connecticut?

CA: In the state of Connecticut, we've been fighting this tax. There are a few other states that have had taxes on ASCs, and one of my concerns is that with so many state governments in financial peril, my physician brethren and surgeons who operate will have their surgical center be taxed. In Connecticut, there are a few smaller surgical centers this ASC tax has closed because they couldn't afford it.

If you're in private practice and you own an ASC and run a business, the tax is something to stay on top of legislatively. It has hurt the ASCs in the state of Connecticut, put some of them in peril, caused significant downward pressure on physician revenue and may cause a loss in surgical centers performing high quality care better than what can be delivered in a hospital.

Q: How do you see gastroenterology changing over the next five to 10 years?

CA: The biggest concern I have is the development of narrow networks, or limited networks. One of the most important things you want is to have control or security regarding your referral base. Now that lots of hospitals are employing primary care docs, they're beginning to direct where consultation goes. Depending on where you are and who you're tied to, financially or by employment, or contractually through arrangements as a private practice, the control of your referral base is probably the most important thing.

I'm a partner in a large multispecialty group with a huge primary care base, and that's how my partners and I have a consistent referral process, because we're one big practice.

In our area of the country, we have not seen a lot of private equity play — what we've seen is more consolidation in the industry via insurance companies and/or hospital systems taking control of practices.

Q: As a gastroenterologist, what makes you the most excited to come to work and treat patients?

CA: As a gastroenterologist, like any operative physician, you like to be in the lab and do procedures. Gastroenterology deals with multiple organs and diseases that are specific to the esophagus, liver, gallbladder and colon. I have a specific interest in esophageal disorders, while I have colleagues who have a specific interest in inflammatory bowel disease. You can find a niche due to GI relating to a much bigger group of organs. I like the variability in the disease processes I see, and I like being in a lab and the technical aspect of my job.

Q: What is your view on the American Cancer Society lowering the colorectal cancer screening age to 45? How do you encourage your patients to get screened?

CA: We're seeing an increased risk of colorectal cancer in younger individuals. There's been a trend [among] average-risk individuals to screen earlier, and if you have an excellent prep and a negative exam, to drag the screening out to a later time. A lot of people are scared to have colonoscopies, so I see people who first show up in their 50s or even their 60s for their first screening. So, I think lowering it to 45 will help capture more people earlier.

The most important thing to tell people is that they're doing this for their life, their future and their loved ones. To find and prevent disease in its earliest state regarding any screening is the most important thing you can do. People always want to know what they can do to take care of themselves, and one of the best things you can do is to go for your screening test.

There are illnesses and diseases you have no control over, but screenings are something patients can control. Go for the test, and move forward if something is found.

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