Dr. George Dickstein on old challenges, new trends shaping gastroenterology

From the emergence of artificial intelligence to declining reimbursements, some of the biggest challenges for gastroenterology were discussed by George Dickstein, MD, a gastroenterologist at Greater Boston Gastroenterology, in an interview with Becker's ASC Review

Editor's note: This interview was edited lightly for clarity and brevity. 

Question: What are the biggest threats and trends in gastroenterology?

Dr. George Dickstein: Many of the threats to gastroenterology are not new:

  • A push toward finding clinically relevant and financially secure ways to participate in bundled payments or pay-for-performance models of care, while taking care not to sacrifice quality for efficiency.
  • The annual and sometimes erratic pressures of rate reduction from CMS and commercial plans [with some draconian and sudden reductions by some large regional commercial plans being a more important driver of risk this year than usual].
  • A continued lack of integration of many electronic health systems, which still leads to fragmented and suboptimally coordinated care.
  • The proliferation of blood and stool tests for colorectal cancer screening as opposed to colonoscopy. These are now covered by many federal and commercial payers. What financial impact will this have on practices? More importantly, what is the societal cost of false positive exams and missed cancers that are more common with these tests?

We have yet to succeed in meeting these challenges in a way that really provides security to the profession.

However, some of the challenges are new:

  • What role can, should and will telemedicine play in new, existing and chronic GI care? How will services be reimbursed once the healthcare emergency finally ends? How do we make the case that virtual care is the same or better than in-person care for many problems we treat?
  • What role should artificial intelligence play in screening colonoscopy? The new data is clear that adenoma detection rate has improved. Will patient outcomes also improve? Will these be affordable add-ons at our ASCs and hospital endoscopy suites? At what price and outcome point do they become cost-effective?
  • Are there enough endoscopy rooms, anesthesiologists, CRNAs and gastroenterologists to meet current and future endoscopy demand? Where is the coordinated, multisociety, multispecialty plan to be sure that there are?
  • Can we finally get people back to work? Many markets are struggling with a drop-off of available clerical staff, medical assistant staff, nursing staff and techs for scope reprocessing and procedures. What will finally entice new and former employees back to the workforce?

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