Dinesh Madhok, MD, gastroenterologist CEO of Jacksonville, Fla.-based Borland Groover, joined Becker’s to discuss the three biggest challenges facing gastroenterology practices today.
Dr. Madhok was recently appointed CEO after nearly three decades with Borland Groover.
Question: What do you see as the biggest challenges facing GI practices today, and how is Borland Groover preparing to address them?
Editor’s note: This interview was edited lightly for clarity and length.
Dr. Dinesh Madhok: The first is that a lot of GI care, as you know, revolves around colon cancer — whether it’s screening for it or finding and removing polyps. Colon cancer is the second most common cancer that kills Americans, and I think the screening landscape is shifting because of convenience. We’re seeing more blood-based and stool-based methods, like fecal DNA and RNA testing, coming into the market. These are sometimes sent directly to patients without physician involvement.
I think that’s a disservice to patients and physicians. These tests can give patients a false sense that everything is fine. As we know, polyps lead to colon cancer, and most of these tests don’t pick up polyps; they pick up cancer. Our goal is not to find cancer early, it’s to prevent cancer. Colonoscopy is still the only procedure that can both find and remove polyps, preventing cancer from developing rather than just diagnosing it.
If you already have cancer, yes, you want to catch it early, but in some sense, you’ve already lost the battle. Stool- and blood-based tests have their place, for example, for patients who absolutely refuse colonoscopy, but we need to educate patients about their limitations. Colon cancer screening is an area where we need to make sure both physicians and patients are focused on the best test available, not just the easiest one.
The second challenge is payer cuts. Medicare is reducing rates every year. When I first started, Medicare paid about $500–$600 for a colonoscopy. Now it’s closer to $200, and it keeps dropping. GI is a very Medicare-heavy specialty, because as people age, GI issues become more common. We have to be mindful of that and find ways to stay sustainable even as reimbursement continues to fall.
Finally, I worry about consolidation — hospitals and Wall Street buying more and more medical practices, whether GI, cardiology or others. I don’t think that serves patients well. It might be financially lucrative for certain organizations, but it takes healthcare out of the hands of physicians. That’s a more philosophical concern, but I think it’s detrimental to healthcare in general.
