8 insights from Brigham and Women's Dr. Linda Lee for GI practice success in 2021


Linda Lee, MD, Medical Director of Endoscopy at Boston-based Brigham and Women's Hospital, shared eight things Brigham and Women's Hospital is executing in 2021 to have a successful year.

Note: Responses were edited for style and content.

Question: What will make or break your practice in 2021?

Dr. Linda Lee: As no one could predict we would be living through a historic once-in-a-century pandemic, none of us knows what 2021 will bring, although we all hope for a reprieve. Some factors that will be important for allowing academic GI practices to thrive include the following:

1. Protect patients: Patients have expressed a reluctance to step into hospitals because they are concerned about COVID-19. Vaccinations will help with this, as well as emphasizing [your] hospital's safe care commitment. This should be messaged to patients through multiple methods including text messages, online patient portals, websites, and signs posted in the clinics and endoscopy units outlining steps being taken to ensure the safety of all staff and patients. COVID-19 testing should be performed in close proximity to procedures, especially in areas with high COVID-19 prevalence. Patient entry to hospitals should be controlled and monitored, with everyone masked at all times except during procedures, and visitors [should be] kept to a minimum except when essential for care of the patient. Waiting rooms should be kept pristine, with plastic shields and appropriate social distancing.

2. Protect and support staff: Staff similarly need to be protected. Vaccination and availability of proper personal protective equipment will be essential for protecting all staff. Reminding staff to be vigilant about social distancing when eating with masks removed is also critical. All staff also need to remain mindful when outside the hospital. Staff absences due to illness/need to quarantine can quickly decimate an endoscopy unit's ability to keep functioning. Even if all staff within GI clinics and endoscopy units remain healthy, if there is need in the rest of the hospital due to loss of staff, the hospital will redeploy GI staff to support other areas of the hospital.

3. Ambulatory endoscopy centers: Due to many patients' preference to avoid entering hospitals, academic GI practices should leverage any ambulatory endoscopy centers associated with the hospital and shift as many procedures as possible to these locations outside the hospital.

4. Home hospital: Many hospitals are struggling with inpatient capacity. A novel approach to this is beginning a home hospital program where appropriate inpatients are transferred to their homes for ongoing inpatient-level care by physicians and nurses. Many GI diseases can be managed in this setting, including [inflammatory bowel disease] flares, mild acute pancreatitis, painless jaundice and [also for] patients who require additional assistance for colonoscopy preparations.

5. Protect parity reimbursement for telemedicine: Virtual medicine is here to stay, and insurances and our state and federal governments must understand and support this. Ongoing parity of payment for telemedicine visits is critical even beyond the pandemic, and we must lobby for this to continue. Telemedicine can also help address healthcare inequities, with many disadvantaged patients unable to access healthcare easily due to transportation issues.

6. Streamline care: GI clinics and endoscopy units must make it easier for patients to access care by leveraging online portals for exchange of information, preoperative questionnaires and instructions and communication. The tendency in large institutions is to separate into silos where patients need to call a separate number to register, schedule a preoperative anesthesia appointment, book their procedure and book a clinic visit, etc. Inefficiencies must be reduced to help retain patients who need to return for follow-up visits and procedures.

7. Contain costs: This is self-evident, however, overhead costs may not be as transparent in academic practices, and every cost must be examined by leadership to determine what can be eliminated or reduced. Some examples include payment for parking with many working remotely predominantly, [continuing medical education] monies with virtual courses, and, of course, scope contracts and equipment used in endoscopy.

8. Celebrate successes: This past year has presented unprecedented challenges and difficulties for everyone, and we need to remember to support everyone positively on the GI team. Even little gestures such as sharing a patient's positive feedback about staff with all, not only within the GI group, but also with hospital leadership, will be uplifting.

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