What are GI's biggest disruptors?

Seven gastroenterology leaders spoke with Becker's ASC Review on what they see as the biggest disruptor in the GI industry.  

Here are their responses:

Editor's note: These responses were edited lightly for clarity and brevity. 

Sheldon Taub, MD. GI specialist in Jupiter, Fla.: The biggest disrupter in the GI industry, as well as in the healthcare industry as a whole, is the insurance companies. As long as they're allowed to dictate healthcare to the general population without medical input, our healthcare system will be in shambles. Presently, healthcare administration is lopsided — with the insurance companies controlling the administration of care. The system has to be changed with significant medical input to administer the best healthcare to the population as a whole. Until that happens, our healthcare will be compromised.

Scott Ketover, MD. President and CEO of MNGI Digestive Health (Minneapolis): The development of digital smartphone apps which assist patients in communicating directly with providers and receiving care is the biggest disrupter. Once these pathways to care are supported by third-party payment, there will be 24/7 access to cognitive, diagnostic and therapeutic care. This will lead to change in the need for brick-and-mortar clinics. ASCs can benefit from establishing referral relationships with the digital platforms.

Ari Grinspan, MD. Associate Professor of Medicine in the Dr. Henry D. Janowitz Division of Gastroenterology at Icahn School of Medicine at Mount Sinai (New York City): From a "disruption" perspective, it is still COVID-19. We continue to alter our preprocedural protocols to address the COVID-19 pandemic. With each new wave of infections, we have to reevaluate the safest and most efficient way to perform procedures. Are COVID-19 tests necessary before procedure in vaccinated patients? ASCs and hospitals have different protocols which lead to cancellations, patient and provider frustration and further delays to procedure time. We still have not caught up with the tremendous backlog of patients over the past 18 months.

James Leavitt, MD. President and Chief Clinical Officer of Gastro Health (Miami): The GI delivery systems will continue to consolidate and hopefully become more efficient "focus factories." The cost of developing sophisticated data platforms and aggregating large data will, therefore, be more affordable since it can be amortized over many providers. We will see an explosion of these large datasets being leveraged using sophisticated data tools supported by AI and machine learning. Real-time clinical decision support, predictive analytics and outcomes data will drive improved care and lower cost with better patient engagement and patient satisfaction. This will not only be a huge disruptor in the way we care for patients but will have the potential to totally change the way we negotiate with payers and the way we as physicians get compensated. Our entire business model will be affected. 

Linda Lee, MD, Medical Director of Endoscopy for Brigham and Women's Hospital (Boston): I would say AI may be the biggest disrupter in GI because it has the potential to change everything about how we practice and care for our patients in clinics as well as endoscopy. The lowest-hanging fruit with AI has been assisting gastroenterologists in identifying and characterizing colon polyps to help battle the second leading cause of cancer-related death in the U.S.: colorectal cancer. However, there is so much more potential for AI to help us in GI. This includes health bots to answer straightforward prep-related and other clinical questions for patients, assisting with intelligent scheduling in clinic and endoscopy by accounting for disease, patient and procedure complexity in scheduling appointments, supply management, and training and assessing competency of fellows and staff.

Paul Dambowy, MD. CMO of MNGI Digestive Health: The biggest disruption of medical care in GI (and likely most of medicine) would be insurance coverage of patient medications. Unfortunately, it seems coverage of specific therapies change annually, which leads to unnecessary changing of treatments that may have been effective for many years. Treatment regimens need to change simply because they become cost prohibitive when an insurance plan no longer "covers" specific medications. This can also lead to hours of correspondence between the provider and insurance company before treatment can be continued or ultimately declined.

Kenneth Wang, MD. Director of Mayo Clinic's Advanced Endoscopy Group and Esophageal Neoplasia Clinic (Rochester, Minn.): Endoscopic surgery. Essentially, GI is acquiring all of the components of open/laparoscopic surgery with resection and closure techniques. This is constantly expanding with the advent of endoscopic robotics that may further enhance our capabilities.

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