Gastroenterology in 2012: Q&A With Dr. Glenn Littenberg of ASGE

Glenn Littenberg, MD, chair, ASGE Practice Management Committee, future recipient of ASGE’s Distinguished Service Award at Digestive Disease Week 2012 and gastroenterologist at Huntington Hospital in Pasadena, Calif., shares his thoughts on the future of gastroenterology.

Q: Do you see yourself or your group participating in an ACO-like arrangement now or in the future?

Dr. Glenn Littenberg: In California, these arrangements are not new concepts. Regional medical groups like the one I participate in, HealthCare Partners, has a very substantial and effective experience in the type of managed care envisioned for ACOs, and will be participating in a CMS Pioneer ACO as well as an ACO with a private payer.

The challenge is to see if patients in non-restricted — Medicare fee for service — or wide-network PPO systems will find enough value in the ACO to participate. In markets like California, patient satisfaction and care access are both quite good and clinical outcomes seem no worse than for patients in traditional fee for service.

Q: How does your practice ensure patient satisfaction?

GL: Trying hard to give patients access when they want and need it, including being accessible by phone and through online methods when efficient and appropriate; giving them sufficient time and particularly attention to what they feel their needs are — not just what we think is medically most appropriate — and understandable advice that they're likely to remember and treatment plans that are practical and affordable, so that they work. And most importantly, performing their procedures safely, effectively and communicating the results and implications of their diagnosis clearly and quickly.   

Q: What procedure has been most helpful to the patients in your practice?

GL: The greatest benefit to the patient lies in the face-to-face assessment of the individual and the advice we can render in consultations and office follow up visits. However, patients probably value the skillfully done colonoscopy most, since it is the most broadly performed procedure with the greatest potential impact on future lives saved, extended and suffering avoided. With colonoscopy, there is also the satisfaction patients get from knowing that they're okay.  

Q: What changes do you see in terms of technology?

GL: We must find more cost-effective methods of dealing with obesity to bring the results of gastric bypass down to the level of an endoscopic procedure or a medication. We may soon have reliable technologies to allow for resect or discard or view or ignore for many colon polyps, which we now send for traditional pathology. If we get a low-toxicity oral program for hepatitis C, the implications will be huge.

Q: What treatments are you having the most difficulty receiving pre-approval from payors for?

GL: Medication authorization and reauthorization, for both routine medications and high-expense medications such as for hepatitis C and biologics for IBD, take up a lot of time. Approvals of advanced imaging and of capsule endoscopy would be more difficult if we weren't well-organized to provide rationale up front. In terms of my staff's time, the pre-certification process is often onerous as we have to use both phone and log-in online methods.

Related Articles on Gastroenterology:

Obese Patients Less Likely to Have Genetic Mutation Associated With Better Colorectal Cancer Outcomes
Dr. Santiago Horgan Performs First Single-Incision Gallbladder Removal in U.S.
Patients who Develop Esophageal Dilatation After Gastric Banding Often Require Conversion to Different Bariatric Procedure

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