Category: Covid19

16 Jan 2021

Curated GI articles Jan 15th, 2021: NY Times – A colonoscopy alternative comes home

Curated GI articles Jan 15th, 2021:
NY Times – A colonoscopy alternative comes home
New blood test detects CRC advanced adenomas, study says (Becker’s GI & Endoscopy)
Freenome’s novel multiomics blood test for colorectal cancer detected advanced adenomas with a 41 percent sensitivity at 90 percent specificity, according to results from its Ai-Emerge study.
Scope Forward podcast – Dr. John Allen (Michigan) (Episode 11)
Listen to the interviews while on the move! Praveen Suthrum’s conversations with GI leaders are now available via the Scope Forward podcast on Apple PodcastsSpotify and elsewhere.
Recap 2020: Gastroenterologists reflect on building a new future (NextServices)
Through the ups and downs of COVID-19, 25+ GI leaders shared their fears, triumphs, ideas and insights through the SF podcast. Don’t miss this video.
8th PE deal: NJ’s largest GI group Allied Digestive Health forms PE partnership (Becker’s GI & Endoscopy)
Allied has more than 65 physicians providing care across 35 locations and several ancillary services. ADH employs 200 employees in its MSO.
Toll of pandemic’s first surge on health plan colonoscopies (Becker’s GI & Endoscopy)
COVID-19-related delays devastated the gastroenterology sector at the height of the initial surge.
Pinnacle GI Partners makes 1st transactions a month after formation (Becker’s GI & Endoscopy)
Pinnacle GI Partners partnered with Michigan Gastroenterology Institute and Capitol Colorectal Surgery on Jan. 8, just slightly over a month after its formation.
The Emerging Subspecialty of Cardiogastroenterology  (Gastroenterology & Endoscopy News)
Neena S. Abraham, MD, MSc, discussed an area of study that evolved from an unmet need to a clinically relevant field: cardiogastroenterology.
NEC releases new AI diagnosis-support medical device software for colonoscopies  (Healthcare IT News)
The software can automatically mark potential lesions based on the use of AI to learn from endoscopic images of more than 10,000 lesions as well as learning from the observations of expert physicians.
22 states where COVID-19 is spreading fastest, slowest (Becker’s Hospital Review)
Washington has the highest COVID-19 reproduction rate, while New Hampshire and Montana have the lowest.
Physician growth slowing as demand climbs: 8 things to know (Becker’s ASC Review)
The number of physicians practicing in the U.S. is growing slowly compared to the population growth projections over the next decade-plus.
Color-Imaging Endoscopy Improves Detection of Upper GI Cancer  (Medscape)
Use of linked color imaging for upper gastrointestinal tract endoscopy improves the detection of neoplasms in comparison with conventional white-light imaging.
Children have high rates of undiagnosed celiac disease (Becker’s GI & Endoscopy)
Children in Colorado had high rates of undiagnosed celiac disease, according to initial results from a mass screening program published in The American Journal of Gastroenterology.
10 changes CMS made in 2021 (Becker’s ASC Review)
With the new calendar year, several CMS changes took effect, with more on the way. Here’s a roundup of changes CMS made or will make in 2021.
Gut Microbiota May Influence COVID-19 Severity, Immune Response  (Medscape)
The gut microbiome may influence the severity of COVID-19 as well as the magnitude of the immune response to the infection, according to new research.
A Colonoscopy Alternative Comes Home (The New York Times)
An at-home test for colon cancer is as reliable as the traditional screening, health experts say, and more agreeable.
Federal government advances collusion charges against ASC management company & more (Becker’s ASC Review)
Here are 12 updates on ASC companies and industry-relevant companies to note.
Haven Healthcare Shuts Down But Disruption Thrives (Yahoo Finance)
Haven, the healthcare joint venture created by Amazon, Berkshire Hathaway and JP Morgan to disrupt healthcare in the U.S., announced early last week that it will shut down by the end of February.
Podcast: Women in GI Innovation (AGA)
Drs. Amrita Sethi and Mythili Prabhu Pathipati are on the podcast to discuss how to bring innovation into your clinical practice.

More Hot headlines in GI
CRC blood tests, partnerships and more (Becker’s GI & Endoscopy)

Fecal Transplants Safe Long Term for Recurrent C. Diff (MedPage Today)

Ellen Scherl, MD, Wins Humanitarian Award From CCF’s Greater N.Y. Chapter (Gastroenterology & Endoscopy News)

Mass screening program finds high prevalence of undiagnosed pediatric celiac disease (Healio)

Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England (The Lancet)

Webinar: ACG Special Virtual Grand Rounds 2021 – COVID-19 Surge: Updated Task Force Recommendations (ACG)

20 healthcare moves from Amazon, Google, Microsoft & Apple in 2020 (Becker’s Health IT)

The future of gastroenterology and other excerpts on industry-changing trends (Becker’s GI & Endoscopy)

Videos: Interviews with GI Leaders  (NextServices)

More frequent bowel movements may be risk factor for diverticulitis (Healio)

US Cancer Death Rates Drop for Second Year in a Row (Medscape)

Anti-reflux lifestyle leads to decreased risk for GERD symptoms in women (Healio)

Moderna CEO says the world will have to live with Covid ‘forever’ (CNBC)

Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders (AGA)

COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
06 Jan 2021

Will AI replace GIs? President of Medtronic GI responds (interview)

Recently, Medtronic released a video showing how Pillcam (in partnership with Amazon) will enable home-based colonoscopy screening. Watch Giovanni Di Napoli, President of Medtronic GI sharing that vision.
Naturally, I was curious to find out more and interviewed Giovanni few days ago. In this interview, he walks us through how Pillcam and GI Genius will evolve in the coming years. GI Genius is already approved in Europe and helps endoscopists use AI in detecting polyps. Further, he reflects on whether he sees Cologuard as competition or not and if insurances would mandate payment on adenoma detection rate (ADR).
We also talked about how these developments will change the role of gastroenterologists. Do not miss this one (18+ mins) – get a glimpse into the near-future of GI.
◘  Giovanni’s journey: From a basketball coach to senior executive at a Fortune 500 med-tech company
◘  What is Medtronic up to in gastroenterology?
◘  “Alexa is going to remind you: ‘you’re 45, Happy Birthday, but you should also go for a CRC screening'”
◘  Giovanni on the role of physicians: “AI is going to support the decisions but it won’t be taking the decisions”
◘  “Cologuard is going to detect cancer but PillCam will detect early cancer or pre-cancerous lesions”
◘  “For endoscopists, being able to visualize,  size and localize the lesion is critical”
◘  “I also see a future where patients can have an ask”
◘  Will we reach a point where the AI is going to handhold and guide the endoscopists?
◘  “If I’m a gastroenterologist, I will give more attention to beat the machine or be as fast as the machine to identify this lesion”
◘  “I don’t think AI will replace the need for a gastroenterologist. But there will be a performance matrix that you want to hit”
◘  Vision for GI: Do you see PillCam talking to GI Genius?

The Transcribed Interview:
Praveen Suthrum: Giovanni Di Napoli, president of Medtronic Gastrointestinal. Thank you so much for coming on board today. I look forward to our conversation, but first, I want to welcome you.
Giovanni Di Napoli: Thank you very much for having me. I’m looking forward to this conversation as well Praveen.
Praveen Suthrum: Great. Giovanni, you’ve recently been named the president of Medtronic Gastrointestinal, and congratulations on that. So, I wanted to first walk back on your career. I’ve learned that you were a basketball coach once upon a time. So, I wanted to understand how that journey has been? From that point of time to being a senior executive at a Fortune 500 medical devices company.
Giovanni Di Napoli: Yeah, thank you for the question. Actually, I’m very passionate about sports in general, but with a particular interest in basketball. That was my place to be since I was four years old. And I kept playing and playing until I was 15 or 16. And then I started to coach. At the same time, I was finishing my economics degree and the moment I finished my economics degree, I just wanted to check out and see what this would mean for me in terms of a business opportunity, just because I was curious. And I clicked on a link of J&J Medical Ethicon Endo-surgery. I applied for a job in Rome, and they called me. I went for the interview and I fell in love with the vision of the company and what they were doing. Also, my dad is a nurse and so I actually appreciate his work in helping patients throughout my young age. So I felt like, “you know what? I think I like this job and I want to try to give the shot”. I was not looking for a job at all. It just was a coincidence and also my father’s background that pushed me to apply for this. And I’m here now.
Praveen Suthrum: That’s awesome. And let’s talk about that some more. So what is Medtronic up to in gastroenterology?
Giovanni Di Napoli: So a little bit of history here. Covidien, which is the company that Medtronic acquired three years ago, bought a company called Barrx, I’m sure you know this radiofrequency technology to prevent esophageal cancer. And I was working for this company actually at that time. And so, I was acquired by Covidien from Barrx. And clearly, Covidien was going to invest a lot in GI as a space where procedures that could go earlier in the care continuum from surgery. And Barrx was the first acquisition. A couple of years after we acquired Given Imaging. So we acquired scale across the globe because at that time PillCam was already well-established technology in the US and also beyond the US.
With Barrx and the combination of this new technology, we were able to get out from just being one device company at that time with Barrx to become a little bit more present in endoscopy and GI markets. So the long story short is that we kept moving into BD, acquisitions… EndoFlip (Crospon) for example, one more. And now I mean, we are also in a position with this new portfolio that I’m sure today we will touch base upon the video…to be a really strong leader, not only in GI but in endoscopy in general because that’s the goal of the company.
Praveen Suthrum: Excellent. So, Giovanni, let’s talk about that video that you just referred to and that prompted this whole interview. It’s amazing. The vision for PillCam is quite amazing… you talked about a patient receiving or buying it online and receiving it at home maybe and swallowing it like a vitamin capsule. And by the end of the day, getting a notification on a mobile app about whether she has polyps or not. That’s an amazing vision for how screening for polyps can happen compared to what we do today. Can you talk about this a little bit more? And then I have follow-up questions.
Giovanni Di Napoli: So the idea was how can we disrupt this market? One of the things that I always remember when we acquired Given Imaging at the time of the Covidien was the future of PillCam COLON and how this technology could reach millions of patients that today don’t want to go through a colonoscopy and they are not compliant. So we started from there and we understood that the technology as it is today, is not ready for prime time, is not patient-friendly. And it doesn’t allow the GI to be able to really leverage this innovational technology to accelerate diagnoses and also potentially even diagnose more patients in the future. And one of these partnerships that we were able to establish with the teams in Seattle, where we spent a couple of weeks, two and a half years ago, we sat down together with them.
We painted a picture of the perfect world, which is what you saw in the video. I’m home, I’m 45. Alexa is going to remind you that you are 45, Happy Birthday but you should also go for a CRC screening because CRC is the most preventable cancer, but still, the least prevented. So and then we thought why not ship the device at home and just go through this technology like would take a normal capsule, a vitamin pill, and then through AI and through also additional innovation that we are bringing to market it connects this with a gastroenterologist and in case of any positive finding, have the opportunity in the same day to also perform a therapy. So we want to go from start to finish. And that’s the reason why we believe this technology can really impact our patients across the globe. I mean, it’s one more weapon that we have on top of the other screening tests.
So we are currently in development and we are willing to start a pivotal trial early in 2022 where I’m pretty sure we need to go through to get FDA approval. But I would say the work we have done in the last 18 months tells us and tells me also that we are on the right track to stick with the timeline and also with the promises we have with this technology.
Praveen Suthrum: So in this vision, what is the role of the physician?
Giovanni Di Napoli: Oh, it’s critical because AI is going to support decisions, but it won’t be making decisions. So AI is going to provide the most meaningful images and videos to the GI to make a sound decision about that patient eventually the GI is also going to decide whether the patient needs to come for a colonoscopy, a follow-up, or doesn’t need to come for a follow-up. We actually believe this technology is going to enable them to see more patients in the endoscopy suite and treat them earlier in this stage of cancer development.
Praveen Suthrum: So let me ask you a different kind of question here and bring up liquid biopsy and other alternative ways of detecting cancer, which are coming up. So from that standpoint, let’s assume that the vision for liquid biopsy, which is taking a blood test and screening for cancer, does come true. And as we know, the holy grail, there is not to detect just one, but 15 different types of cancers with one sample. So let’s say that does come true then of what your vision is for PillCam would it go along with that or would it compete? Any thoughts that you have there?
Giovanni Di Napoli: I think our position is going to be different than liquid biopsy. Liquid biopsy, as far as I know now can detect cancer or Cologuard can detect cancer. But you know, PillCam Genius is going to detect early cancer or precancerous lesion. So which is where actually the most impactful therapy can be made. So polyps and adenomas. So if liquid biopsy won’t be able to have a high level of sensitivity for these precancerous lesions, I think is going to be positioned in a very different way. Also, if you think about it PillCam Genius would be the only test that can visualize the lesion, could be the only test that can localize the lesion. It could be the only test that can size also the lesion. And I think for endoscopy, being able to see visualize, size, and localize the region is critical if you need to have a follow-up colonoscopy to remove that lesion, I think that our value proposition is going to be different than liquid biopsy.
We respect what they’re doing. I know there is a lot of investment there. I think is going to add that one more component in the armamentarium of tests available for those patients who need to get screened. And I think now with the age going from 50 to 45 eligible for screening, even more patients will need to get screened. So even in terms of capacity, I think we can also be one of the options. Plus, I believe our technology is going to be attractive on the technology side and I think is going to be very patient-friendly and that these also will be, in our opinion, a good plus to have into our technology.
Praveen Suthrum: Very good. Let’s talk about GI Genius now. It has been approved in Europe, and from what I understand, you are going through FDA approval in the US. Can you share a little bit more about GI Genius as a product and what stage is it in right now?
Giovanni Di Napoli: Yes, so we are very proud of GI Genius. We were the first to be in the market with artificial intelligence to have detection during colonoscopy. And the partnership with Cosmo Pharmaceutical in Italy is working really well. So the European approval came last year just before UGW, and we were very happy to be able to showcase our technology. And the technology is ticking off. We have many units already placed in different markets. Clearly, it is not as fast as we were expecting because COVID-19 had a very huge impact. As you know, the number of colonoscopies and patients going to the hospital from last February, especially in Europe, went really down. And this also impacted many opportunities that we were working with our team in Europe.
So I can tell that before the second wave, which happened just a month ago in Europe, things were getting much better. So we are patient, we are focusing on clinical outcomes and we are focusing on a center that actually can also support education. And I don’t know if you know, but also we have partnered with the ESGE, which is the European society in Europe, and we provide a very important grant for clinical investment on the AI during colonoscopy, I think is about 1.5 million dollars investment. And also we are going to provide the technology to generate this data, especially these days because going for a colonoscopy is very important, can prevent cancer. So we hope this will accelerate the recovery of the backlog.
Praveen Suthrum: So let’s talk a little bit about the gastroenterologist’s private practice standpoint. So they rely on reimbursement from insurance, now with the technology like AI in the endoscopy room coming, their ability or people using the technology, their ability to detect polyps goes up because the AI is going to help them do that. But there are several people out there who may not adapt soon enough and then maybe using old technology. So do you see at some point insurances mandating a certain base level of Adenoma Detection Rate so that endoscopists do not have a choice but to advance in the use of technology? Do these conversations come up in your discussions internally?
Giovanni Di Napoli: Yeah, I think you got the point. I mean, GI Genius and AI in general for colonoscopy is going to have gastroenterologists to be somehow more precise where it actually is not possible to be precise. You know, I always make this analogy. Do you want to be patient number one of 15 that day or you want to be the last one to be seen by the gastroenterologist? I’m sure, you know, fatigue plays an important role in detection. If you have AI technology helping you throughout the day, you can keep your level of performance the same. And I think this is also shown by multiple studies. And I think this has to be taken into account also for payors as well as from society.
I know there is a task force looking at the ADR, and if this is going to be possible to be over a certain percentage. I think with AI it is going to be possible. If the insurance is going to pay on top of what they are already paying, I don’t know yet. I think I also see a future where also patients can have ask. And not because I don’t trust the gastroenterologist because he or she will make the final decision. But again, performance is going to be critical. And you want to get the performance anywhere in the US in any place you go for a colonoscopy. And I think these technologies will help to get there.
Praveen Suthrum: If you examine how technology moves, let’s take the example of Google Maps as an app, or let’s take the example of Siri or Netflix. At the early stages of these technologies, I remember clearly when I used to drive before how much I used to the member streets and how less I remember now or my need to remember streets has steadily declined. So I’m wondering if all of this will get to the point where the endoscopist will be completely guided by the AI? You know, if we advance forward enough, will we reach a point where the AI is going to do pretty much handhold and guide the endoscopists on what he or she needs to do?
Giovanni Di Napoli: You know, I actually see this on the opposite side, If I’m a gastroenterologist supported by artificial intelligence, GI Genius in this case, during my procedure, I’m actually going to pay more attention to somehow beat the machine or be as fast as the machine to identify the lesion. And I was in a couple of cases in the UK last year when we launched the device, and I could tell that the feedback was, “Oh my God, I want to be faster. This is going to give so much training opportunity for our GI fellows because they will learn quicker.” So I think if you know how to utilize it, the technology is going to improve your performance and keep it stable.
I don’t think AI going to replace the need for a gastroenterologist and an endoscopist to perform colonoscopy. Not at all. But yes, for sure there would be performance metrics that you want to hit. And if the performance metric is to find a certain amount of polyps in 10 patients, you want to be at that standard. It’s almost like a benchmark. And so I think it’s going to give you more motivation to stay attentive, to stay focused during the procedure together with the machine. So that’s the way we see AI working, especially in colonoscopy.
Praveen Suthrum: Do you work with the insurance industry at all related to the financial aspects of the technology that you launch?
Giovanni Di Napoli: Yes, we do. And our leader is working very close to them to understand also needs and opportunities.
Praveen Suthrum: Giovanni, my final question, trying to connect all these dots is do you see PillCam talking to GI Genius internally? And if you have to fast forward five years or even beyond, what are we going to see? What is the vision for GI?
Giovanni Di Napoli: So we have technologies in our portfolio that can be genius powered, which means we’re going to offer more and more solutions to our customers with artificial intelligence. GI Genius is the first of this solution. You mentioned, are we going to be able to connect the dots with GI Genius and PillCam? I would say the answer is yes. There are multiple solutions. Think about EndoFlip for Motility disorders. Think about Manometry. Think about pH impedance and all of these technologies that can be Genius powered. And we have a huge investment in place with over 30 plus engineers in Israel. And also the partnership with Cosmo is really strategic and important. So we believe that we can go faster and we can bring disruptive innovation, genius powered into the Endo-suite.
Praveen Suthrum: And from the lens of an endoscopist or a gastroenterologist, how would that vision play out? What would they be doing differently five years from now?
Giovanni Di Napoli: I would say data is going to support the decisions. And I also would say that we’ve simplified the workload of our customers in order to be able to perform more procedures on the same day and see more patients and prevent more cancer.
Praveen Suthrum:  Giovanni, thank you so much for spending time today and sharing what Medtronic is up to in the space of GI. Was there anything else that you wanted to share before we close?
Giovanni Di Napoli: No, thank you very much. And I’m very happy to be in this business. I promise Medtronic is in GI to stay and also to invest. And you will see more and more coming from our company.
Praveen Suthrum:  Thank you so much. Giovanni.
Giovanni Di Napoli: Thank you.


By Praveen Suthrum, President & Co-Founder, NextServices. 

COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
04 Jan 2021

Curated GI articles Jan 2nd, 2021: 2020: A year like no other

Curated GI articles Jan 2nd, 2021:
2020: A year like no other
8 predictions for GI in 2021 (Becker’s GI & Endoscopy)
Chris Shaver, MD, is the CEO at Birmingham (Ala.) Gastroenterology Associates. Here, he offers eight predictions on the future of the specialty in 2021.
GI in 2021 — What 6 gastroenterologists think is in store for the specialty  (Becker’s GI & Endoscopy)
As a year unlike any other comes to a close, several trends emerged in gastroenterology over the past year that will continue to emerge in 2021.Gets a Bad Rap … From Primary Care Providers  (Gastroenterology & Endoscopy News)
Exact Sciences: 2020 in review (Becker’s GI & Endoscopy)
The company planned to build on its 2019 acquisition of Genomic Health to create a multifaceted diagnostic testing company in 2020, but COVID-19-related disruptions altered the plan for the year.
Gastroenterology Articles That Provide Essential Guidance (Medscape)
These 10 articles (presented in no particular order) represent the key reviews for those involved in the delivery of gastrointestinal (GI) care.
10 global health issues to track in 2021 (WHO)
Speed up access to COVID-19 tests, medicines and vaccines, Provide global leadership on science and data and more.
Why 2 analysts think big things are in store for GI M&A in 2021 (Becker’s ASC Review)
Bill Bolding, senior analyst at Provident and Eric Major, director at Provident, offered insights on the current state of PE investment in GI and made predictions about what 2021 could look like.
Top in GI: New IBS guidelines, investigational eosinophilic esophagitis therapy (Healio)
The American College of Gastroenterology released new guidelines for the treatment of patients with irritable bowel syndrome. It was the top story in gastroenterology last week.
In FIT-Positive Population, Diverticular Disease Means More Adenomas  (Gastroenterology & Endoscopy News)
“Gastroenterologists who perform screening colonoscopy should be aware of this association, which should prompt extra vigilance during colonoscopy.”
Micro-Tech, Interscope partner to distribute EndoRoter System (Becker’s GI & Endoscopy)
Micro-Tech Endoscopy and Interscope have partnered to collaborate and distribute the EndoRoter System for interventional gastroenterology.
Healthcare digital transformation: 5 predictions for 2021 (CIO)
The market now favors “digital-first” companies, i.e., those who deliver healthcare primarily as online experiences, especially for ambulatory and low-acuity care needs.
aScope™ Duodeno Coding and Payment Guide (Ambu)
George Catinis, MD, medical director at the New Orleans Research Institute, discusses an RNA-FIT colorectal cancer screening test developed by Geneoscopy.
Video: Benefit of COVID-19 vaccine outweighs risks in IBD patients (Healio)
Freddy Caldera, DO, MS, speaks about the two recent COVID-19 vaccines that have been authorized for emergency use.

ICYMI: Hot headlines in GI
The future of gastroenterology and other excerpts on industry-changing trends (Becker’s GI & Endoscopy)

10 Strategic Technology Trends Businesses Should Plan for in 2021 (Hackernoon)

Geneoscopy RNA-FIT has high sensitivity for colorectal cancer (Healio)

Blood test can diagnose celiac disease without biopsy with 95% accuracy (Becker’s GI & Endoscopy)

2021 predictions, compensation and more (Becker’s GI & Endoscopy)

GI Bleeds Tied to Worse Prognosis for COVID-19 Inpatients (Medpage Today)

4 High-Growth Trends You’ll Want to Invest in for 2021 (The Motley Fool)

A look back at the top 20 high-impact clinical research articles (AGA)

5 trends that will shape healthcare in 2021 (MedCity News)

Effective leadership in times of crisis (AGA)

A newly designed over-the-scope-clip device to prevent fully covered metal stents migration: A pilot study (TIGE)

COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
31 Dec 2020

Evaluation and Management Code Changes for 2021

Over past several years medical practices have found the documentation for accurately coding E/M services to be lengthy and complicated. Hence, the American Medical Association has revised E/M coding guidelines for 2021. These changes would reduce administrative burden, improve payment accuracy and make it relevant to current medical practice. 
Effective Date: The changes will be applicable from Jan 1, 2021. 
Key Highlights of changes:
◘  Code 99201 is deleted
◘  Code 99211 do not require time component
◘  E/M level can be selected based on MDM or Time
◘  Time ranges for each code have changed
◘  The code selection and documentation will now be dependent only on problem pertinent history and exam
◘  99417 is used to report prolonged services (only when primary coding is based on time) in office or other outpatient services. However, CMS considered that 99417 lacked clarity in code descriptor and the potential for double counting time and created a HCPC code G2212 to report prolonged service for Medicare.

(Use G2212 to bill prolonged service for Medicare)
(Some private payers may require to use 99417 for prolonged services) 
(Use 99417/G2212 in conjunction with 99205, 99215) 
(Do not report 99417/G2212 in conjunction with 99354, 99355, 99358, 99359, 99415, 99416) 
(Do not report 99417/G2212 for any time unit less than 15 minutes) 

E/M Coding Changes Snapshot: 

Recommendations to the providers:
◘  Documentation: It is very important to have a standard documentation available for the services performed. The documentation will have to be concise and appropriate to derive the exact code.
◘  Time calculation: If the coding is based on time factor all the elements in the time factor should be considered and the total time should be summed up.
◘  Precision in Medical decision making: Analyze the service provided before assigning a code based on MDM.
◘  Training: The physician and staff should attend webinars with respect to 2021 changes to understand it thoroughly.
◘  Workflow and protocol changes: The practice might require to change the workflow and protocols to align to the changes. For eg: provision to document various services provided by clinical staff.
◘  E&M calculators: Use of in-built E&M calculators will help the practice to implement this change effortlessly.
◘  Periodical Audits: In-house periodical coding audits are advised to make sure that the standard coding process is been followed.
◘  Changes in Electronic Health Record systems: Check your current EMR and make sure the required templates are available to document the MDM changes. Assign specific roles and check provision to calculate the time factor for each service.
◘  Changes in billing: Make sure to implement the updated Medicare fees schedule and new codes in the system.
◘  Analytics on reimbursement: The practice can estimate the reimbursements for 2021 based on proposed changes in reimbursements and wRVU.


AAPC Evaluation and Management changes 2021  

CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99XXX) Code and Guideline Changes 


COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
22 Dec 2020

Interview with Dr. Kosinski (SonarMD): “We are not practicing on an island. You can’t build a wall around colonoscopy”

Dr. Lawrence Kosinski is the Founder and Chief Medical Officer at SonarMD. In this exclusive interview, Dr. Kosinski said what needs to be said. It’s an urgent wake-up call to the GI industry. The topics we cover range from starting up a GI-tech venture to private equity, valuation concerns and what in the end has value in life.
If you have time for just one insight, let it be this one: risks of basing PE valuations on vulnerable assets. The right thing to do would be to make time to watch the entire interview. Each minute of this interview has insights that would save the industry enormous time and money.
Do not miss this one (25+ mins).
◘  Being in private practice vs. running a GI-tech startup
◘  “I’m still helping people. Except I’m not helping one person at a time, I’m helping a lot of people at one time”
◘  The story behind SonarMD
◘  “My first ‘aha’ moment for SonarMD was….”
◘  Why aren’t more GI doctors starting entrepreneurial ventures?
◘  Are GI practices “colonoscopy factories?
◘  “The market is screaming for solutions!”
◘   “No one would build a business and be a one trick pony and ride that pony till it turned into a nag”
◘   “Take a look at cancer registries…”
◘   “If our passion is to eliminate colon cancer, then let’s figure out more ways to do it”
◘  Dr. Kosinski reflects on private equity in gastroenterology
◘  “There may be seven platforms but they’re all not the same”
◘  “There are no second-bite of the apples yet in GI”
◘   Are we basing valuations on EBITDA multiples that hinge on vulnerable assets?
◘  “We’re not practicing on an island. You can’t build a wall around colonoscopy”
◘  What would a future-oriented GI practice look like?
◘  Dr. Kosinski’s advice for younger gastroenterologists

The Transcribed Interview:
Praveen Suthrum: Dr. Larry Kosinski, thank you so much for coming to this conversation and having this chat with me. I want to welcome you first.
Dr. Lawrence Kosinski: Thank you very much for asking me to be part of this interview. I look forward to it.
Praveen Suthrum: So, Dr. Kosinski I want to start by asking you how your life has been in a full-time or near full-time in a digital health startup as the Chief Medical Officer of SonarMD and how does that differ from being in private practice GI?
Dr. Lawrence Kosinski: Night and day! It’s a totally different experience. I love being a gastroenterologist. I spent my entire adult career as a practicing gastroenterologist. I loved the patient interaction I loved the interaction with all my colleagues. I felt so good that I was doing something meaningful for people and helping people in their everyday lives. But I always had this burning desire to do something more. I’ve always been a problem solver so it was an easy transition into this. But my transition from clinical practice to Chief Medical Officer of a startup company was a very easy one for me to take. That move was not difficult at all and I transitioned through it over the course of a few years. And last year when I finally ceased practicing, it was almost anticlimactic. I finished my last procedure which had 15 polyps! Supposed to be an easy procedure but the last procedure I did as a gastroenterologist had 15 polyps! And since then I’ve been extremely happy in my role. I’m still helping people except I’m not helping one person at a time; I’m helping a lot of people at the same time.
Praveen Suthrum: So, I want to ask you to go back a little bit in the history of SonarMD. Why did you start the company? What was the trigger?
Dr. Lawrence Kosinski: Well, I have been starting companies for 30 years, but this one specifically has a unique story. I was involved heavily at the AGA and have been involved since… Oh god! For 15 years now! And I had sat on the practice management and economics committee for three years and they asked me to chair the committee. So, I came on as chairman of the practice management and economics committee for the AGA back in the fall of 2011. And something that I had always struggled with in GI is the lack of diversity in revenue streams of gastroenterology. So much of it comes from CPT codes that surround colonoscopy and so when I took over the committee I said, you know, I want to do something more than just put in my three years. I’d like to accomplish something. And if I could help my colleagues diversify their revenue stream and build new lines of business, I would accomplish something. And since value-based care is something that’s in vogue, I said okay, “What are the most significant illnesses we take care of as gastroenterologists? It’s inflammatory bowel disease those are our sickest patients, our most expensive patients, the ones that wind up having the most morbidity. So, I went to Blue Cross Blue Shield, Illinois, and used every chip I possibly could to get in the door. Because all I wanted from them was – What does it cost to take care of Crohn’s disease? That was my question.
So, it took a few meetings of begging before they realized this guy’s crazy. He doesn’t want more money, he just wants data. So, they gave me an enormous data set – every claim on 21,000 patients with Crohn’s disease for two years. It was an enormous file! Excel crashed, I had to build a SQL database out of it which took some time. And we analyzed it and in the analysis, I got my first ‘aha’ moment for SonarMD. Because there was a 17% hospitalization rate in this patient population which is consistent. We’re seeing around 14% in our BHI database analysis today. So, 17% and the doctor may say, “Well geez! What could have been done to avoid those hospital admissions?” And so, I went into the 30-day period before each of these hospital admissions, created a query so we could see what CPT codes came out in those 30 days, and in over two-thirds of the patients there wasn’t a CPT code. That was my first ‘aha’ moment because I thought these are symptomatic patients that have relationships with their doctors and they go over the cliff without realizing it.
And then the light bulb went on in my head and I thought… it’s true! I’ve stood next to the bedside of patients for years in the emergency room and I would ask them, “Why didn’t you call me? And what the patients will tell you is…” ah doc I have this all the time” “oh I thought I had the flu” “oh I thought I ate something wrong” or they’ll tell you that “I’m busy with my kids or my job or my family” whatever. The bottom line is patients with Inflammatory Bowel Disease… we look upon them as Crohn’s patients or Ulcerative Colitis patients. They’re human beings who have lives and this illness is just one component of their life. So, I said I’m going to see if I can do something to help people present earlier in their deterioration. And I was home that night and I was watching the Hunt for Red October. And as Sean Connery says, “Send him one ping, captain” I said I need a Sonar system! I need a way to ping these people in between their face-to-face visits. So, a medical professional can decide when they need an intervention that was the beginning of SonarMD. After our first year success where we showed we could lower hospitalization costs by over 50% and lower emergency room costs by over 70% Blue Cross then said, can you put this in other practices? And that’s when I needed to form a company and that’s when I formed SonarMD so that was in 2016.
Praveen Suthrum: That’s an amazing journey. I’m curious whether Blue Cross paid you that first year? Or did they want you to show success before?
Dr. Lawrence Kosinski: No. I have to give Blue Cross Blue Shield, Illinois a lot of credit. They paid us they gave us upfront per member per month, we had to bill it, and they created a code. The Blue Venture Fund which is the investment fund of all of the Blue Cross plants… they pool their money together and they gave it to a company that at the time was called Sandbox industries in the Fulton Market district here in Chicago. And so, Sandbox came in… to Matter and did a Shark Tank. And so I said, “I can do this!” So, I was the oldest person there. The only one in a suit and tie and I pitched SonarMD. They liked it especially because I had revenue, I had a contract, I was a business, and I wasn’t just a concept, I was a business that was generating money and building and it was in their space. So, they agreed to invest. March 1st, 2018 when we closed on this thing, I think it was March 6th; I was the only employee of SonarMD. I had the investment money, I was the sole employee of this company, and we had to build it and now we have 20 employees and we’ve gone through Series A and you know we’re rolling.
Praveen Suthrum: Yeah. Congratulations on the success so far. It beats me why more GI doctors aren’t starting entrepreneurial ventures like you have?
Dr. Lawrence Kosinski: It is myopia and blindness, we get myopic. If you talk to gastroenterologists, and I love my colleagues and I was doing this myself, you get pigeonholed into colonoscopy. You’ve got your endocenters; you’ve got all your revenue streams coming out of the endocenters; you live and die over those cases. You have myopia. You have blinders. You can only see this… you can’t do this.
Praveen Suthrum: In your interview in the book Scope Forward, you had referred to GI practices as “colonoscopy factories” and some thought it was harsh, but for some… you know, it woke them up. And I know for a fact that it changed people’s mindset… that single interview. So, I want to ask you, what you were referring to when you said that? And I want to tie it also to your recent article where you call for a dramatic change in gastroenterology?
Dr. Lawrence Kosinski: Well, it referred to the same myopia I just spoke about. It’s wonderful to be able to go to your endocenter that you own, work with employees that you employ, and basically do the same thing over and over and over again and you get really good at it, and everybody tells you how good you are at it and it brings you a wonderful income. So, then there’s this crazy guy, Larry Kosinski, telling you that you know, you should be doing something else. Well, it’s like buying a stock. The day you buy a stock… that decision can be made but when do you sell it? Or it’s like with retirement. When do you retire? When do you bring in a new product line? Do you wait till the product you currently have has fallen apart? Or do you take the profits that you have from your successful product and reinvest them to expand so that by the time your current product starts declining you already have one to take over or two or three but you’ve diversified yourself.
So, the reason I said that, is because we have created factories! We make widgets! We do the same thing over and over and over and over again. My point is I think we should invest some of the money that we’re profiting from on making these widgets to do something else that the market needs. And the market is screaming for solutions, patients are screaming for solutions. And why don’t we give them to them why don’t we use this intelligence we have and why don’t we create them? And so you know the entrepreneurial side of me is always looking for something else. It’s just this itch. But from a business point of view, no one would build a business, be a one-trick pony and ride that pony till it turned into a nag. We have to invest so we can diversify.
Praveen Suthrum: But wouldn’t your colleagues argue saying that it is the gold standard and there are so many people out there who still aren’t screen and you know there’s only more need for GI care so you know why shouldn’t we be serving all of these millions of people who need GI care, stomach cancer or GI-related cancers are on the rise so shouldn’t we be doing, in fact, more colonoscopy? And you’re suggesting to do less, why?
Dr. Lawrence Kosinski: I’m not suggesting to do less. That’s not what I was saying what I was saying was diversifying and build. But take a look at cancer registries I’ve done this. I looked at the cancer registry data in Illinois from 2006 and compared it to the cancer registry data from 2016. Now what this cancer registry data tells you is what stage patients are presenting with colon cancer. It hasn’t changed despite the thousands and thousands of colonoscopies done in Illinois in the 10 years between 2006 and 2016. The Illinois cancer registry data is unchanged. So, yes it would be great if every human being came in for a colonoscopy, that would be great but human nature is not that. Human nature is telling us that at least a third if not more of our patient population doesn’t want to have anything to do with a colonoscopy and has their head in the sand and those people are getting colon cancer. And like my Crohn’s patients in SonarMD, they’re not presenting early.
So, what we can do if we really did care about our patient population we would be looking at what other mechanisms we can use to screen patients. And the big fear everybody has… “Oh well if we have them do FIT or something like that then they’re not going to have colonoscopies and we’re not going to make money and it’s going to be bad for our business.” I would contend you’re actually going to build your business because and I’ve run spreadsheets that show that if you could get that 32 to 35% of the population that isn’t being screened to come in for a screening of any kind you will capture the patients in there that have the positive screening tests and they’re not only going to be screening colonoscopies they’re going to be surveillance colonoscopies that you’re going to be able to survey over the years. So, let’s not be pennywise in dollar-foolish here, and let’s do things for the right reason. If our passion is that we want to eliminate colon cancer then let’s figure out more ways to do it. You know that’s the way I look at it.
Praveen Suthrum:  Excellent! I want to switch gears and move to private equity. Now you successfully transitioned your practice to a PE platform and then you retired from private practice, you moved on, and during the course of our interview, this was last year in 2019, I asked you – What are your concerns about private equity? And you said, “LOTS!” and that ‘lots’ was in caps in the book. And you started with culture.  So, now fast forward to almost the end of 2020, we have seven GI platforms and maybe one more I hear before the end of the year. So, how have these concerns played out?
Dr. Lawrence Kosinski: Well, you have this little thing called COVID-19 that was overlaid on top of it, and probably the worst thing any of these platforms could have feared to happen to them was to initiate and then get slapped with a pandemic that cut the revenue stream out of that one procedure they do and 80% of their revenue depends on and it’s an elective procedure that people don’t necessarily have to come in and get. So, this has been challenging for the private-equity-owned practices and most of my colleagues have done their best, they’ve really worked diligently to try to maintain their staffs, the viability of their endocenters, to continue to get a return on their assets, and the investors are equally probably suffering as well. We’ll see…we’ll see how they come out. I think that’s yet to be determined. Now, there may be seven platforms but they’re not all the same.
And I like some of the newer models that are being deployed. My big problem with private equity… and I was part of the process that caused IGG to sell to the GI alliance and you know we went through this laborious process where we interviewed 20 different companies. We had multiple rounds of interviews, and we chose the GI alliance and I would do the same thing again with the way the process went through I’m not second-guessing what we did. But as a senior guy in the leadership of IGG who stayed on an extra year of practice just to help them do this, I was going to retire from practice in 2018, I put off my retirement to 2019 so that I can help the group make the final decision and go through all the legal ramifications it took. And just for the record, I retired ahead of the closure. I received no funds from that purchase. I retired with zero from that. I had altruistic reasons for why I helped my partners with the process but I was not doing it for any personal gain because I knew I was destined to run SonarMD.
So, anyway, my biggest challenge in the current private equity structure is that this is an LBO buying perpetuity. They’re using other people’s money largely to purchase the assets of the practices in hopes that they can build that business and then get out in several years. The practice, on the other hand, you could be a 40-year-old doctor; you are giving up a percentage of your income forever. That’s been my struggle is that you’ve got a short-term investor using somebody else’s money, buying perpetuity of your income forever and the only way it turns out as a positive for the doctors is if it allows them to continue to practice as doctor putting the patient number one in their focus and that’s a challenge. And secondly, they continue to get payouts from the transfer of this ownership to other entities, over the years. It’s not been done before in GI. There are no second bites of the apples yet in GI. We don’t know how that’s going to turn out. That’s the thing I struggle with – Can you maintain that culture? Can you maintain the fact that you are still a doctor and that your major focus is helping patients and generating an income in the process but you’re a doctor taking care of patients? Can that be preserved? Or is all the other noise involved in the financial aspects of this investment going to interfere with your ability to do that? That’s what I was referring to when I said culture. That’s the culture I hope we don’t lose.
Praveen Suthrum:  Yeah. So, there’s a PE question that I’ve always wondered and I’ve asked this to a bunch of people and I want to ask you the same. Now all the valuations have been based on adjusted EBITDA and the adjusted EBITDA is based off of physician productivity or rather future physician productivity, normalized compensation of physicians, and so on. Now that future productivity and I’m connecting the dots to your earlier point today which is that productivity currently is tied largely to certain procedures and going back to that point on procedures…that procedure itself or the revenues from that is a vulnerability rather than an asset. So, if I have to connect those two dots, we’re actually basing a valuation on a vulnerable asset and I’m probably making broad assumptions and connecting the dots here but you know this question I do have. So, you know, what happens when those EBITDA assumptions don’t come true? Am I thinking correctly?
Dr. Lawrence Kosinski: You are. You are thinking exactly the way I’m thinking because it would be better I mean if I was an investor I’d look at that and say, “Oh it’s a single revenue stream, and oh that colonoscopy reference revenue streams driving the pathology revenue stream, it’s driving the ASC revenue stream, it’s driving the anesthesia revenue stream.” So, if something happens to that colonoscopy procedure the other revenue streams fall off too and it’s vulnerable, it’s a significant vulnerability plus it’s an elective procedure it’s not like people are clamoring to get in. We have to send them their reminders and you know I’ve looked at the data across the country and a lot of the practices and I don’t know that some of the best practices are getting 50% of their patients to actually come back for the repeat colonoscopies.
So, it is vulnerable and I’m concerned about what’s going to happen a few years down the line here. We saw a five percent cut in colonoscopy professional revenue this year with the new Medicare fee schedule. It has cut five percent! So, you know I don’t think we’re going to see that stop. I think that’s going to continue over time. And it’s clear that the Robin Hood concept that’s happening inside CMS taking from the rich and giving it to the poor… they’re taking money out of procedural services and moving it into cognitive services and I don’t see that stopping. I also don’t see the payors stopping to find less expensive ways so that they can maintain their star ratings for screenings without overpaying for certain procedures. We’re not practicing on an island. You can’t build a wall around colonoscopy. Colonoscopy has to be able to handle the competition that’s coming from Exact Sciences, other technologies, we now have the liquid biopsy, and we have all this technology that’s being developed to identify who is at risk for colon cancer. And so that goes back to my initial thought – you’ve got to have a diversified revenue stream
Praveen Suthrum: Yeah. If you were to get a bunch of practices together or a bunch of doctors together and start over and build a future-oriented GI practice what would that look like?
Dr. Lawrence Kosinski: I’ve given this a lot of thought. I do believe that we are at a point in time where we can virtually integrate GI practices based upon acceptance of risk and provision of value. If we’re given the data from the payors, if we have that data, we can change…that’s mandatory. We can’t do it without the data. I have learned so much over the course of the last five or six years about where the costs of care lie. I have access to claims data all the time and claims data that my colleagues do not have access to and I can tell where the drivers are for the cost of care and look at the levers that can be moved. So, well-run gastroenterology practices that are factories, that’s a good thing, okay? They’ve got the process down. I think there’s value-based care revenue streams that are there for the taking if we construct it the appropriate way. Just think about this in a medical practice, not just a GI practice but any practice patients call with symptoms, with needs, and you have a human being taking care of that. Means answering the phone if they can’t deal with it, it gets sent to a billing person, if that can’t be done it gets sent to a clinical person, if it’s really serious it gets to a nurse, and if it’s really bad it gets to the doctor. It’s repetitive, there are hundreds of calls coming in every day in a practice… those are automatable processes. Those are places where you build an automation platform and you allow AI to refine it and make it better.
Praveen Suthrum: Yeah. I want to conclude our conversation with the final question, Dr. Kosinski. A couple of weeks ago I was in a conversation with somebody and then you came into the conversation and I think the context was being successful in gastroenterology and you know doing investments or building technology and so on. And this individual said you are one of the most successful gastroenterologists in the world and he meant every bit of it. And it was amazing. So, my question is you know let’s roll back the clock a little bit at the same time bring it to the present. If you were starting over today as a young gastroenterologist seeing everything that’s happening, and seeing the risks, seeing the opportunities, what would you do? And I would translate also that to what advice would you give the younger GI community that is coming out to practice in this field?
Dr. Lawrence Kosinski: Well that’s a complicated question, multiple moving parts to that. Given where I was in the development of technology for the course of my career I don’t know if I could have done it much differently. I embraced technology at every stage it was presented to me. I think, first… embrace technology. Number two, follow your passions. Don’t give up your passions but the only way this works is if you master what you are doing. So, you better learn to do that colonoscopy, learn to do it really well. Maybe you don’t need to do an ERCP, maybe you don’t need to be the guy that’s doing barracks master something and master maybe more than one thing but master it so that you can now say, “I know that… I’m going to go follow my passion for this.”
Build yourself time to be able to follow your passions and stay ahead of the rapidly advancing core of knowledge that becomes so challenging for all of us. Keep your personal life in order, okay? Don’t get divorced. I mean, keep your personal life in order. Keep everything in line so that you have the time, the intellectual space, and the energy to pursue things. You know, a career is a long thing. I’m 68 years old I’ll be 69 in February and every stage of my career has given me something that the previous stage didn’t give me and I lose something in each one. So, be willing to change, adapt to change, embrace technology, follow your passions. I’m not the wealthiest gastroenterologist. So, whoever gave you this praise of me…. The one thing I can tell you… I’m doing exactly what I want to do at this stage of my life and that has value.
Praveen Suthrum: Awesome. Dr. Kosinski, thank you so much for sharing your wisdom. I’ve really benefited, I’m sure people listening or watching would tremendously benefit from this. Were there any final words or anything that you wanted to say?
Dr. Lawrence Kosinski: Stay well. We’re almost there. This is like a marathon. We’ve hit the wall at mile 21 we just got to get to the end!
Praveen Suthrum:  Thank you so much.
Dr. Lawrence Kosinski:  Thank you.


By Praveen Suthrum, President & Co-Founder, NextServices. 

COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
18 Dec 2020

Curated GI articles Dec 17th, 2020: GI physicians urge COVID-19 vaccines for IBD | Hospital volumes fall again

Curated GI articles Dec 17th, 2020:
GI physicians urge COVID-19 vaccines for IBD | Hospital volumes fall again
Hospital Volumes Start to Fall Again, Even as COVID-19 Soars (Medscape)
Strata’s report, based on data from about 275 client hospitals, notes that what kept the volumes up was the increasing number of COVID-19 cases.
The Scope Forward podcast – Interview with Dr. Joe Rubinsztain, CEO & Co-Founder of ChronWell (Episode 8)
Now, listen to the interviews while you workout! Praveen Suthrum’s conversations with GI leaders are now available via the Scope Forward podcast on Apple PodcastsSpotify and elsewhere.
Colonoscopy Gets a Bad Rap … From Primary Care Providers  (Gastroenterology & Endoscopy News)
You know your patients would rather avoid colonoscopies, but did you know their primary care providers may be shaping their perceptions and behaviors?
GI Physicians Urge COVID-19 Vaccines for All IBD Patients (Medscape)
Miguel Regueiro, MD, chair of Gastroenterology & Hepatology at Cleveland Clinic in Ohio, said, “We’re uniformly recommending this to all our patients.”
Is Your Practice Ready for a COVID-19 Vaccine? (Medscape)
The US Food and Drug Administration on Friday authorized the nation’s first COVID-19 vaccine, one developed by Pfizer and BioNTech. Here’s a survey by Medscape.
FDA approves ointment for esophageal inflammation of EoE (EndPoints News)
“For too long, healthcare professionals have been without approved treatments developed specifically to target the chronic, localized esophageal inflammation of EoE,” said Asit Parikh, MD.
Avoiding and Managing Medical-Legal Risk in Colonoscopy (Gastroenterology & Endoscopy News)
This report reviews the medical-legal risk of colonoscopy and methods to limit potential malpractice suits.
Virtual Reality Augmenting Therapy in Gastroenterology and Beyond  (Medscape)
“There are now over 200 hospitals around the US using VR in some way, shape, or form. We hope that will grow significantly in time.”
New Medicare pass-through code supports adoption of single-use duodenoscopes (Becker’s GI & Endoscopy)
The pass-through code makes single-use duodenoscopes a financially viable alternative to reusable duodenoscopes.
Endoscopists Often Ignore Polypectomy Guidelines (Gastroenterology & Endoscopy News)
“The selection of polypectomy technique is affected by several factors, and it’s not clear whether the participation of GI fellows affects the quality of polypectomy,” Nehme said.
Most Favored Nation Regulation Could Upend The Rx Market (Life Science Leader)
Many providers are expected to be upside down, as the costs of acquiring the biologicals they seek to administer will greatly exceed Medicare reimbursement.
Congressional Committee Leaders Announce Surprise Billing Agreement  (Energy & Commerce House)
Legislation Will Protect Patients from Surprise Medical Bills and Establish Fair Framework to Resolve Disputes Between Providers and Insurers.
Partnering With Dietitians Can Bridge Gaps in IBD Care (Medscape)
Working with a registered dietitian (RD) can help ensure that changing the way patients with inflammatory bowel disease (IBD) eat won’t deprive them of the nutrients they need.
USPSTF publishes HBV recommendation amid declines in screening, vaccination (Healio)
Experts said the recommendation is inadequate as it excludes patients who would benefit from HBV screening, which has declined amid the COVID-19 pandemic.
Podcast: “Influencing” GI through social media (AGA)
In this episode of Small Talk, Big Topics, Dr. Austin Chiang shares tips for using social media to enhance your career.
Video: Early detection difficult in pancreatic cancer (Healio)
In this video, Monique van Leerdam, MD, and Matthias Löhr, MD, PhD, discuss the need for better early detection of pancreatic cancer.

Headlines for GI
From a consolidation boom to telehealth, here are 5 predictions for the hospital industry in 2021 (Fierce Healthcare)

Money, Patients, Romance: Physician Ethics 2020 (Medscape)

Florida GI practice to open $6M surgery center (Becker’s GI & Endoscopy)

Endoscopic Accessory Disposal: Too Conservative, Too Costly? (Gastroenterology & Endoscopy News)

Tissue-Sparing Surgery Safe in Early Rectal Cancer (MedPage Today)

7 predictions for what lies ahead for health tech in 2021 (Fierce Healthcare)

COVID-19 & the 5 trends that defined GI in 2020 (Becker’s GI & Endoscopy)

The future of gastroenterology and other excerpts on industry-changing trends (Becker’s GI & Endoscopy)

IBD: Fecal Calprotectin’s Role in Guiding Treatment Debated (Medscape)

Videos: Interviews with GI Leaders  (NextServices)

ACG Issues Its First Clinical Guideline on Management of Irritable Bowel Syndrome (News Wise)

AGA publishes recommendations for managing IBD in elderly patients (GI & Hepatology News)

COVID-19 vaccine distribution: How 4 systems are deciding who gets first shots (Becker’s Hospital Review)

The ‘Wondrous Map’: Charting of the Human Genome, 20 Years Later (Medscape)

COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
11 Dec 2020

Interview with Dr. Nandi (Pinnacle GI): “We are clearly in the third inning of private equity investments in GI” (not eighth)

On November 30th, 2020, Troy Gastroenterology (Michigan) announced its partnership with H.I.G. Growth Partners to launch the seventh private equity platform in GI: Pinnacle GI Partners.  
Dr. Partha Nandi is the President, Practice CEO and Executive Chair of the Board of the new platform. In this insightful interview, he shares why it’s still an early inning for private equity in gastroenterology, how they chose their PE partner and discusses challenges with EBITDA expectations.
My company NextServices recently partnered with Gastrologix and other partners to help launch GastroInfuse, an infusion ancillary.
Watch this exclusive deep dive into GI’s latest PE platform. Do not miss this one (20+ mins)
◘  How did you decide that you do want to do PE and eventually partner with H.I.G.?
◘  “Our two key goals: a) Continue to give the care that we’re giving b) Replicate the environment for our providers”
◘  “I’m not going to be naive and say this isn’t a financial transaction”
◘  Troy GI’s journey on selecting H.I.G Growth Partners
◘  Why didn’t they join an existing PE platform?
“Delivery of excellence in healthcare is regional and local”
◘  Their agenda for the first 90-days and beyond
◘  “It’s not about adding two tea spoons of groups, add water, mix and voila!”
◘  “The one thing that anybody listening should be aware of…” 
◘  Dr. Nandi reflects on the conflict between clinical goals and business goals
◘  Not all private equity (firms) are made equal
◘  “I want my junior partner to be able to say in 20 years that this was a great decision”
◘  What happens if physician productivity does not match EBITDA expectations?
◘  “Having myopic vision is not a recipe for success”
◘  “We are clearly in the third inning of private equity investments in GI” (not eighth)

The Transcribed Interview:
Praveen Suthrum: So, Dr. Nandi, thank you so much for joining me today on this conversation. Before we get started I want to congratulate you on being the seventh private equity platform in gastroenterology, you just made the announcement. So, congratulations to you and your team.
Dr. Partha Nandi: Well, thank you so much Praveen for having me. We’re excited and it’s my honor to be able to represent our organization and thank you for giving us the opportunity to talk about a little bit.
Praveen Suthrum: Excellent. So, I want to first start by asking you, how did you arrive at this decision? First to decide that you want to do PE and after that arriving at this decision with H.I.G.
Dr. Partha Nandi: You know when as a gastroenterologist and as an independent gastroenterologist our practice began in 1992 Praveen. So, we’ve been, you know, working and doing well. We started off as a group of two back in 1992 and we’ve now grown to over 19 providers in our practice and with multiple locations. So, for us, the decision was how are we going to be able to give the kind of care that we’re giving and being able to extend that and to other groups? And then second is providing the environment that we have for our providers and how do we replicate that, right? So, those are our two goals. And we felt like organically within our group we’ve grown sufficiently but the next step would require professionalization. Meaning that if we want to get other groups to be involved and really have some of our strengths and strengths of other groups come into the vote. We need to professionalize our organization and we thought how are we going to do that? Now we can do the traditional merging of groups in gastroenterology you know all of us are pretty independent so we said, “Well maybe that may not work.” It could, but it may not work. The second option would be, should we partner with a hospital partner? We have great relationships with our hospitals. So, should we then partner with the hospital? One of the other options, the third option that we picked was private equity.
So, this management services organization concept was attractive because you’re part of an organization and this organization is your common thread with all these other groups that we will be partnering with and yet you’re still maintaining independent practice. That was critically important for us. The most exciting conversations we had about this are – can we develop an IBD center of excellence? Can we finally effectively do obesity management? Can we revolutionize how our endoscopy centers deliver care? Listen I’m not going to be naive and say this is not also a financial transaction. Of course, it is because we could do other things as well. But this to be to me was the best way and our partners at the center for digestive health, we felt this is the right way. So, we began I would say 18 to 20 months ago Praveen, and we started with about 150 private equity firms, and with my partners at KPMG I personally met with 67 of those firms. And then over a course of several meetings in New York, Chicago, Dallas, and Detroit we narrowed it down to a dozen and then to five. And then we did an LOI in the middle of the pandemic in the summertime. So, with that’s how we picked our partners at H.I.G. They’ve been extremely successful in what they do you know their return is tremendous right so that’s a baseline financial but what’s also important is in all the management meetings you know, for me I always said… we have a very simple litmus test for our practice you know if we do something… my mom or any of my partners’ mothers’ or parents should be able to come and get it done, right? So, it may sound very basic but it’s very fundamental. The whole idea that quality standards and being able to do the right thing is important… resonated with H.I.G. tremendously. And they’re extremely conservative and they want to be able to do things right. It was extremely important and they wanted us to be able to practice in the way we have been and to accentuate what we’ve been doing.
Praveen Suthrum: Okay. So, I’ll ask something that I’m sure many in the audience you know would want to know. Why didn’t you join an existing PE platform because largely if you talk to them they would say that these are their goals too: to take care of the patient, keep up with quality, and also financially benefit… so and there were plenty of options. So, why didn’t you go that route?
Dr. Partha Nandi: That’s an excellent question. So, I met with all the platforms early on. Gastro Health, GI Alliance, US Digestive, I think I met every single one that existed at the time. And here’s the fundamental reason why healthcare and the delivery of excellence in healthcare is regional and local. That’s what we want. We want to be able to have folks that understand what the geography means. Michigan is a different environment in California, which is a different environment than Florida, which is a different environment than Texas, which is clearly a different environment than Pennsylvania. There are some national payors and there are some national environments that are common but the regional density and regional focus is critical in this. My goal is to be able to do this you know talk to my colleagues in Michigan and in the Midwest to be able to really do something that we want to. For example, we would like to contract directly with employers. How do you do that? You can’t do that if you have a center in Oregon, a center in Illinois, a center in Massachusetts, and then you say well you know we’d like this practice in Michigan with 19 providers to really be able to give you the employer who has 52,000 employees in Michigan, we’d like to be able to deliver care for you… that doesn’t work. can you please share some growth numbers that you experienced leading up to the transaction itself in 2019?
I can show you that my ASC with the triple AHC survey had zero citations that we were commended for an award from the AAAC. I can say that from a physician’s perspective, right? And then we have partners who can then show the spreadsheets and the financial analysis that show that this can be something that can work and be financially successful for them. So, that… plus payors. You know, there are some dominant payors in Michigan. Could we contract with them? With the national company, with a couple of practices in Michigan? Maybe. But I think it’s much more likely if we have the entire market in Michigan, the majority of physicians that are in gastroenterology and we come with common concerns and a common theme of efficiency I think we’ll be more successful.
Praveen Suthrum: It’s been about a week or so since your announcement. So, what is your agenda for the first 90 days?
Dr. Partha Nandi: As you know as many of the folks even listening may know the first literally first six months two years is one of transition, right? You’re trying to get everything organized and it’s a completely different organization. So, there are two answers… one is organizationally from Pinnacle GI, the management services organization and I serve on the board, so I have a different role for the MSO than from the practice. So, the practice continues on, right? From the patient perspective, there really is no difference. We continue to provide the best care we’re not changing that. We’re not going to dramatically change what we do, because we’ve done it well. However on the MSO side here’s what we’re doing is getting ready to make sure that the organization can run smoothly. Number one…what do we do from all the… so it’s overlooked but all the nitty-gritty… where do the accounts go to, who are the non-clinical entities versus clinical entities, and what are we going to do with our partnerships. We’re blessed that we have a partnership coming on by the end of this year we have another group of physicians that are going to be our partners coming up.
So, we’re planning on how we’re going to integrate with that group so that we can have our common strengths be accentuated, right? So, they can help us, we can help them, immediately. The key to this is it’s not about just you know add two teaspoons of groups, add water, mix, and voila! The critical part of the success of a gastrointestinal platform is integration and how you integrate effectively and that involves planning that involves finding out: What you’re going to do for revenue cycle management? What are you going to do for financial management? Who are your GPOs going to be for your traditional payors? Who’s your CFO going to be? How are you going to be able to manage a completely different organization that’s almost separate from the practice entity in our state? So, we’re doing all that. We’re developing targets for growth… meaningful targets, right?
The one thing that can happen and this is one of the things that that anybody who’s listening knows…hopefully or if they don’t know they should be aware of that you can grow but you can grow in a way that’s not meaningful, right? You can just keep adding people on without any real plan for integration that will fail because all you’re doing is adding layers of bureaucracy and overhead without really having to understand what you can do. So, you know, we have a pipeline of folks that we’re talking to for physician groups that are going to be our partners and finding out what ancillary lines do they have? What can they help us with? Is there a group that does infusion better than the platform group (which is us)? And how can we integrate with them? And what’s the plan for that? And in 2021 first quarter what’s our plan for doing that, right? So, we’ve got to get those things settled. You know if there’s a pathology lab that these folks use, do they use it do they not use it? You know, we were very interested in obesity management. Is there a strategy for obesity management? How can we plan that out? And looking at it from an organizational structure to see how much we need to grow but also from a financial perspective to see what kind of capital expenditures, those CapEx costs are going to be you know important to plan… and in this transaction, I didn’t go through with it but you’ve done that before is that you know part of this is… you have lenders that are involved in this and you have to have the lenders understand that what is going to be the trajectory of your group? What are going to be your financial needs? Those are critical to understand now so that when we get there we have dry powder to be able to accomplish those. But it’s exciting to be able to form an organization that is really going to be able to serve the under-served market in Michigan. I think that’s going to be exciting.
Praveen Suthrum: Got it. So, you know one of the aspects of private equity not just in gastroenterology but all of medicine or the concern is the conflict between clinical aspirations and business aspirations. And even in the book Scope Forward some of the interviews that I’ve done, when I ask people what are your concerns? They bring this up and they talk a lot about keeping the clinical side separate, clinical goals separate from the business goals, and so on. But as we know sometimes this can come in conflict. I’m wondering as you’re getting started with your PE partner, what you’re doing to lay this in place?
Dr. Partha Nandi:  That’s a great question and I think that the traditional view that people are petrified for and I think and they should is that there is an inherent conflict between financial goals and clinical goals, right? This is why I spent almost 20 months finding the right private equity partner. Not all private equity is made equally. You have to understand that and you have to let folks know what your goals are. To us clinical excellence, clinical quality supersedes everything. There’s nothing nice about the COVID-19 pandemic, let me assure you… but what was great to find is you had a situation that tested that philosophy, right? Did you have a private equity firm that tried to force things? To continue to go ramp up? Or do things that are unsafe during the pandemic? You heard I’m sure you’ve heard of instances where physicians were asked to practice unsafely because private equity firms were leveraged and they really didn’t do the right thing. Well, what was nice about us is in the top five of all of our choices for private equity, every single one of those firms shut down all their clinical activity during COVID. But again remember what I said before… we have a pretty simple criterion if it’s good enough for my mom, and it’s good for the practice with all of our practitioners, and it’s good for the bottom line, we do it. But if all those three criteria are not met we just don’t do it. But if something is bad for clinical success, but it makes more money, we won’t do it, we won’t, we haven’t and we will not in the future.
In the first quarter of 2020 one of our junior partners, we’re going to have him on the partnership track to be able to be part of this MSO. I want him in 20 years to be able to say, “Wow that was a great decision that really changed our trajectory,” right? So, in your question though, you said, what about some of the expectations? So, here’s why I think the 90-day plan is extremely important as you know you’re…in all of the work that you do, you’re very thoughtful in letting folks know economically how to be realistic in their expectations. You want to be bullish I mean you want to be like… you want to go for it and not say that you’re going to be stymied up but you have to be realistic. You don’t want to make growth such an important part that you forget about what it is that you’re supposed to do we’re physicians, we’re healers and caregivers, right? I’m still excited about taking care of patients and being able to help them. So, our goals for growth are great. We have tremendous goals but when you have a practice that becomes a partner, we want them to continue to do what they feel is best for their practice because we’re choosing these partners carefully.
The criterion is not that, “Do you have a pulse, then come on in.” We’re going to be choosy. First of all, we’re going to pick our partners to be practicing good quality medicine, and then we’re going to say you know we’re not here to impose upon you manners in which you should practice, right? Michigan is a practice medicine state the practice is separate from the MSO their relationships of course. However, nobody’s going to tell us how to practice. Here’s the different stuff if somebody you know knows that they can have a better revenue cycle management so that they can actually collect a few percentages higher than they do and spend a few percent less why wouldn’t they do it, right? Why wouldn’t they do it? If they can they can buy an infusion drug for a few percentages less because the fact that they belong to a GPO that you know that a buyer group that can actually help them why wouldn’t they do that right if they have a financial management system that shows them that this is where you have duplicity and this is where we feel you can actually grow. If you feel like there’s an ancillary line, let’s say you don’t do infusion and you don’t have to metaphorically stub your toe and learn by mistakes that people who’ve already done it and done it successfully can show you as part of this MSO.
Praveen Suthrum: The question around valuation in general which is as I understand, it’s a measure of adjusted EBITDA and when you adjust EBITDA, one of the important factors is physician productivity or physician future productivity. Now just going based on historicals, one big driver for physician productivity is screening colonoscopies and procedures because that is very much tied in and given some of the technologies which are coming and are already here let’s say the trajectory of GI takes a ship and somehow those productivity assumptions are not met so what happens in terms of your relationship with the PE partner if those EBITDA assumptions don’t come true?
Dr. Partha Nandi: Here’s the truth of this, right? So, private equity does not go in with just blinders on saying that, “We’re not going to look and we’re going to just you know be blind everything” that’s going on. They’re making an investment, an investment that’s not without risk, right? So, I mean this is part of the reason why we need partners that are adept financially and are experienced. So, there is no crystal ball saying that you’re absolutely going to be successful is there a chance of failure. Of course in any of these transactions, that’s present in any kind of private equity or other financial transactions there are risks, right? Of industry disruptions that are not only here but can come in the future. That’s in every field that you have.
I mean today Amazon is a dominant market player in consumer products, right? But it’s not to say that there could not be a player that’s coming in three years that’s going to take them off trajectory. So, what I’m suggesting is that are there going to be challenges in gastroenterology, in dermatology, in anesthesiology in every specialty that private equity is investing in, absolutely. Here’s where the challenges can be overcome… as you suggested in many of your writings that you have to be prepared for it, right? It doesn’t mean that you stop investing in endoscopy centers or ASCs you want to be able to invest in all kinds of patient care modalities that really help the patient, right? And of course, endoscopy is a big part of it. But you also want to be able to diversify it so that if liquid biopsies are a huge part of what’s happening in healthcare in five years, if it’s dominant, you have to understand how to incorporate that into your practice. You have to also be able to be flexible enough to say that… Could we add radiology services to our practice? Could we add obesity management to our practice? Could we add revenue lines and ancillary lines that help patients that we’re not doing now, right? Some of this can be an IBD center of excellence managing the entire experience for the patients.
We understand and we feel that the future is bright for patients and how can we be part of that future? Being part of the future is by listening to visionaries like yourself who talk about this every week, every day. About looking at the future and paying attention, listening, and then adjusting your organization accordingly. So, you’ll be able to handle those challenges and thrive not just survive in the future. That’s not a pipe dream it can actually happen you can pivot. If we remember one thing all of those so-called challenges are incredible opportunities for patients and as a consequence, there are opportunities for us, if we have the vision and also the ability to look beyond what’s right in front of us, right?
Having a myopic vision is not a recipe for success in anything especially in these kinds of endeavors. There’s a famous hockey player… Wayne Gretzky. Wayne Gretzky’s always asked, “Wayne, how come you’re so good and you’re always being able to score goals?” He said, “I’m not better than anybody else I just happen to know where the puck is going to be before it gets there and so, I’m there before the puck gets there.” I would offer to you that’s what Pinnacle GI is going to do. We’re going to be able to try to understand where the puck is going to be, where the technology is going to be, where the care is going so we’re there. And so, we’re not only meeting the challenges, we’re exceeding them and our expectations are not actually dampened but they’re exceeding.
Praveen Suthrum: On that note Partha, I want to thank you for sharing your thoughts it was fantastic. So, I wish you all the best and your partners at Pinnacle GI as well as you lay the foundation for this future. Was there anything that you wish to share before we close?
Dr. Partha Nandi: Absolutely, you know, thank you for the opportunity. The one thing I wanted to say was that… some people fear that the seventh platform, are we plateauing? Are there enough opportunities? Here’s what I would offer… in dermatology, there are 17 DMGs or dermatology management groups. And even with those 17 Praveen, it’s still a fragmented dermatology market. We’re incredibly fragmented in gastroenterology and I think there are many ways to be able to do this both regionally and nationally. And I think what this allows us to do is maintain independent gastroenterology practices in the United States, giving this excellent care that we know we can. So, to me, we’re just beginning. Using a baseball analogy, we’re probably in about the third inning of gastrointestinal PE-based investments. We’re not in the eighth inning we’re clearly in the third inning. So, I think that the future is bright and folks who are looking at this and listening to this you know if you think that your practice can really benefit from it I encourage you to look at Pinnacle GI and others to see if it’s a good fit for you.
Praveen Suthrum:  Thank you so much.
Dr. Partha Nandi: Thank you.


By Praveen Suthrum, President & Co-Founder, NextServices. 

COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
10 Dec 2020

Curated GI articles Dec 9th, 2020: GI goes digital with IBS digital therapeutic receiving FDA clearance

Curated GI articles Dec 9th, 2020:
GI goes digital with IBS digital therapeutic receiving FDA clearance
The story behind the Pinnacle GI Partners deal (Becker’s GI & Endoscopy)
H.I.G. Growth Partners partnered with Rochester Hills, Mich.-based The Center for Digestive Health Dec. 1 to create Pinnacle GI Partners, a new investment platform in Michigan.
The Scope Forward podcast – (All Episodes)
Now, listen to the interviews while you workout! Praveen Suthrum’s conversations with GI leaders are now available via the Scope Forward podcast on Apple PodcastsSpotify and elsewhere.
Deloitte’s 2021 predictions  (VentureBeat)
Deloitte has announced its predictions for tech, media, and communications in 2021. Prognostications include that the number of online video visits to doctors will rise to 400 million next year.
Video Capsule Endoscopy for GI Bleeding Reduces Need for Invasive Procedures (Gastroenterology & Endoscopy News)
“In the COVID era, one advantage of video capsule endoscopy is that it requires very little patient contact.”
VRx by gastroenterologist Dr. Spiegel: How VR is changing therapeutic medicine  (MedGadget)
Dr. Brennan Spiegel, a gastroenterologist and Director of Health Services Research at Cedars-Sinai Medical Center, goes into detail about how virtual reality is playing an increasing role in therapeutic medicine.
GI goes digital with IBS digital therapeutic receiving FDA clearance  (mobihealthnews)
The three-month digital treatment logs a patient’s symptoms and uses them to deliver relevant guidance. In addition, the digital CBT teaches patients skills and habits to help them manage their condition.
Healthcare Spending in 2020 May Drop, Reversing Longtime Growth Trend: Study (Medscape)
In a stunning reversal of a decades-long trend, healthcare spending in 2020 is on course to be lower than in 2019.
New survey shows clinician confidence in AI for improving patient outcomes – as endoscopy demand continues to grow (PR Newswire)
European survey shows 70% of polled gastroenterology clinicians say Artificial Intelligence (AI) will reduce the number of missed lesions.
Clinical perceptions of AI in endoscopy (Health Europa)
Mat Tallis, European Business Manager at Fujifilm Europe discusses the clinical perceptions of Artificial Intelligence (AI) in endoscopy.
Options to Make Medicare More Affordable For Beneficiaries Amid the COVID-19 Pandemic and Beyond (KFF)
The pandemic has exposed long-standing gaps in the U.S. health care system and brought fresh reminders of the health care affordability challenges.
Colorectal Cancer Screenings: A 2020 Success Story (HCPLive)
Despite the difficult circumstances, experts believe colorectal cancer rates will not decrease in the coming years due to delays in screenings.
NASH drug helps reduce liver fat with good tolerability (Healio)
Patients with non-alcoholic steatohepatitis treated with BIO89-100 experienced clinically meaningful reduction in liver fat, according to research presented at The Liver Meeting Digital Experience.
Virginia GI group joins hospital-affiliated physicians group (Becker’s GI & Endoscopy)
Dong Lee, MD, a gastroenterologist with Gastroenterology Associates of Fredericksburg, said the partnership builds on the groups’ “long-standing relationship” in caring for patients.
AGA Updates Best Practices for Colonic Diverticulitis (MedPage Today)
The AGA has issued updated advice for clinicians on the management of colonic diverticulitis, a painful, unpredictable, and increasingly common disease affecting 180 in 100,000 Americans a year.
Podcast: Practical Considerations for IBD Management, Telehealth, and COVID Vaccination (Healio)
Gil Y. Melmed, MD, MS, discusses the evidence regarding COVID-19 risk among patients with IBD, the future of telehealth for gastroenterologists and the importance of vaccination.
Cancer Rates on the Rise in Adolescents and Young Adults (Medscape)
“Clinicians should be on the lookout for these cancers in their adolescent and young adult patients,” said senior investigator Nicholas Zaorsky, MD.
Video: The Business of Gastroenterology (Spherix Global Insights)
Jennifer Robinson from Spherix Global Insights, and Scott Fraser from Fraser Healthcare, discuss a partnership that examines the evolving landscape of management services organizations in the gastroenterology space.
A GI-Fellow Who Followed His Dream From Zimbabwe to MSK: Josh’s Story  (MSK)
Josh Foromera was born in a small village in Zimbabwe and recently began a fellowship in the Gastroenterology, Hepatology, and Nutrition Service at Memorial Sloan Kettering Cancer Center (MSK).

Headlines for GI
6 Big Changes Coming for Office-Visit Coding (Medscape)

Study Shows Future of Healthcare is Shaped by Hybrid Cloud (BusinessWire)

New treatment in development for irritable bowel syndrome (EurekAlert)

Medicare Payments Could Get Tougher for Docs (Medscape)

Complete remission at 8 weeks with high-dose adrenomedullin in UC (Healio)

Universal Nutrition Screening Urged for COVID-19 Patients (Gastroenterology & Endoscopy News)

Top in GI: Entyvio, coagulopathy of COVID-19 (Healio)

The future of gastroenterology and other excerpts on industry-changing trends (Becker’s GI & Endoscopy)

Videos: Interviews with GI Leaders  (NextServices)

Abivax completes enrollment for study of ulcerative colitis candidate (Healio)

ICYMI: A Quality Systems Approach To Scope Reprocessing (Gastroenterology & Endoscopy News)

Lower socioeconomic status linked with worse outcomes in IBD (Healio)

In the news: Takeda Partners With Universities on Research Into GI and Liver Disorders (IBD News Today)

COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
04 Dec 2020

Curated GI articles Dec 3rd, 2020: Medicare Finalizes 2021 Physician Pay Rule With E/M Changes (Medscape)

Curated GI articles Dec 3rd, 2020:
Medicare Finalizes 2021 Physician Pay Rule With E/M Changes (Medscape)
WEO Webinar Series: Impact of COVID-19 on Endoscopy Services (WEO)
Webinar by World Endoscopy Organization. Date: December 5, 2020. Time: 8 am EST. Catch Dr. Mark B. Pochapin’s talk on – ‘The role of GI Societies to maintain safe practice and support physicians.’
Scope Forward podcast – Interview with Scott Fraser (Senior Advisor, Private Equity at HIG Capital) (Episode 7)
Now, listen to the interviews while you workout! Praveen Suthrum’s conversations with GI leaders are now available via the Scope Forward podcast on Apple PodcastsSpotify and elsewhere.
Physician employment: The path forward in the COVID-19 era (McKinsey & Company)
The COVID-19 pandemic has led many providers and physicians to consider how to maintain clinical quality standards and financial stability. McKinsey launched a national survey of general and specialty physicians six weeks into the pandemic.
PE firm invests in Michigan GI practice, creates new platform (Becker’s GI & Endoscopy)
Partha Nandi, MD, of The Center for Digestive Health, will serve as president and practice CEO. Scott Fraser, former president of practice management of Physicians Endoscopy, will join the platform’s board of directors.
CRC prevention can’t wait — 2 gastroenterologists on precautions needed to continue screening during the pandemic (Becker’s GI & Endoscopy)
American Society for Gastrointestinal Endoscopy Value of Colonoscopy co-chairs Joseph Vicari, MD, and Jonathan Cohen, talked about COVID-19’s effect on CRC.
DHPA Opposes Most Favored Nation Rule Announced by CMS (DHPA)
“The effects of this rule could be seriously detrimental to our healthcare system, especially during the COVID-19 pandemic,” said Glenn Littenberg, DHPA chair of health policy.
Motus GI partners with Texas hospital to improve colonoscopy efficiency  (Becker’s GI & Endoscopy)
Physicians can use the Pure-Vu system to improve inadequately prepared bowels. The system helps the hospital lower length of stay and allow for colonoscopies to proceed as usual.
Despite COVID-19 disruption, PE investments running rampant (Becker’s ASC Review)
Here are eight updates on ASC companies and industry-relevant companies to note.
Medicare Finalizes 2021 Physician Pay Rule With E/M Changes (Medscape)
“This finalized policy marks the most significant updates to E/M codes in 30 years, reducing burden on doctors imposed by the coding system and rewarding time spent evaluating and managing their patients’ care,”  Verma said.
10 hot spots for GI development over the last 3 years (Becker’s GI & Endoscopy)
Over the last three years, Becker’s ASC Review reported on 98 new gastroenterology developments. There have been 41 new developments with GI services in 2020 so far.
Will You Fight Flu? A Vaccine Education Initiative for GI Patients and Physicians  (ACG)
Dr. Francis A. Farraye and Dr. Freddy Caldera are spearheading an ACG initiative to promulgate patient and physician education.
Ink Masters: The Art and Science of Colonic Tattooing (Gastroenterology & Endoscopy News)
The use of endoscopic tattooing to localize a suspected or known malignant lesion in the colon is widespread.
Tiny cameras inside pills to help treat Scottish bowel cancer patients (The Scotsman)
Scottish bowel cancer patients are going to be fed pills with tiny cameras inside as an alternative to intrusive examinations.
AGA Registry Analysis Confirms Utility of FMT for Recurrent C. difficile  (Gastroenterology & Endoscopy News)
“This is the largest prospective study to date of effectiveness and safety outcomes after FMT,” Colleen Kelly, MD.
Helmsley awards $4.7 million for Crohn’s diet therapy research (Healio)
The Leona M. and Harry B. Helmsley Charitable Trust awarded nearly $4.7 million to fund three studies designed to explore dietary interventions for Crohn’s disease.
Endoscopists Often Ignore Polypectomy Guidelines (Gastroenterology & Endoscopy News)
The analysis found that roughly half of small polyps were removed using hot snare polypectomy, not cold snare as recommended by the U.S. Multi-Society Task Force on Colorectal Cancer (USMSTF).
Podcast: Curiosity and Persistence: The Discovery of H. pylori with Dr. Barry Marshall (Healio)
In this podcast catch Barry Marshall, AC, FRACP, FRS, FAA, the legendary Nobel Laureate who discovered that peptic ulcer disease was caused by the bacteria Helicobacter pylori, not excess acid.
Podcast: What will the world look like after COVID-19? (GatesNotes)
Bill Gates: “Dr. Fauci and I are both optimistic that a vaccine will bring an end to the pandemic at some point in the near future. But what the world looks like after that is a lot less clear.”

Headlines for GI
It’s Crohn’s and Colitis Awareness Week 2020 (AGA)

AASLD 2020: A Clinical News Roundup (Medscape)

Endoscopy Insights With Dr. Prateek Sharma: COVID-19 (Gastroenterology & Endoscopy News)

Frailty linked with mortality after liver transplantation (Healio)

A new measure in the fight against choking deaths with LifeVac (Health Europa)

Year in Review: Ulcerative Colitis (MedPage Today)

The future of gastroenterology and other excerpts on industry-changing trends (Becker’s GI & Endoscopy)

Videos: Interviews with GI Leaders  (NextServices)

Video: Atopy allergy patch tests link with improvements in EoE (Healio)

ICYMI: Cannabis in Gastroenterology: Watch Your Head! (Springer Link)

What I see in my practice (AGA)

Study Defines Geographic Hot Spots of Early-Onset CRC Morality Among Women (Cancer Network)

5 Things We Learnt About Investments in Digital Health (TMF)

Video: Dr. Neil Stollman on C. difficile and Fecal Microbiota Transplant: The Beginnings of Microbiome Therapy (ACG)

From cold robot to lifeline: How perception of the virtual physician has shifted during the pandemic (Becker’s Health IT)

COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
28 Nov 2020

Curated GI articles Nov 27th, 2020: 370 MD GI Alliance expands into Oklahoma with Adult Gastroenterology

Curated GI articles Nov 27th, 2020:
370 MD GI Alliance expands into Oklahoma with Adult Gastroenterology
A closer look at AMSURG CRC prevention, screening efforts (Becker’s GI & Endoscopy)
Jay Popp, MD, AMSURG’s medical staff lead, spoke to Becker’s ASC Review about the proposed new guideline and the importance of early detection to CRC prevention.
Scope Forward podcast – Interview with Dr. Alaparthi: PACT GI Center joins Hartford HealthCare (Episode 6)
Now, listen to the interviews while you workout! Praveen Suthrum’s conversations with GI leaders are now available via the Scope Forward podcast on Apple PodcastsSpotify and elsewhere.
Why now is the time for dramatic change (LinkedIn)
Dr. Lawrence Kosinski, Chief Medical Officer at SonarMD writes – Resilience isn’t about being tough, standing still and bracing yourself; it’s about adapting and transforming as the situation calls for it.
The 5 Biggest Healthcare Trends In 2021 Everyone Should Be Ready For Today  (Forbes)
While the biggest drivers of change are still AI, the internet of things, and other fourth industrial revolution fields, their impact was felt in different ways than we may have anticipated.
GI Alliance Expands Operations into Oklahoma with Addition of Adult Gastroenterology Associates (PR Newswire)
“We are excited to welcome AGA to GI Alliance and our expanding network of physicians.” said Dr. Jim Weber, CEO of GI Alliance.
PE activity resumes as year winds down – 8 GI deals in 2020 (Becker’s GI & Endoscopy)
After a banner year for activity in 2019, COVID-19 disrupted private equity investment in the gastroenterology space. Yet activity has resumed as the year winds down to a close.
This Massive Sector Is The Next Market Amazon Will Disrupt (IBD)
But now, as it collects more revenue of all types due to the Covid-19 pandemic, Amazon faces a health care industry that’s primed for disruption once the coronavirus passes.
US Digestive Health acquires Pennsylvania practice in 2nd move this month (Becker’s GI & Endoscopy)
US Digestive Health has signed on 22 affiliate locations over the past 18 months, with the Royersford location being the first new practice for the  organization.
And your 2020 Healio Disruptive Innovators are … (Healio)
Each of the awardees in the eight categories has changed the face of gastroenterology and pushed the status quo toward the betterment of the field.
41 GI centers opened or announced so far in 2020 (Becker’s GI & Endoscopy)
Forty-one surgery centers or practices with gastroenterology services opened or were announced so far in 2020.
New Phase of Microbiome Research  (Harvard Medical School)
“I think microbiome research is entering an exciting new phase where we can start tying things together to get a firmer grasp on the mechanisms of what’s happening to microbes in humans over time and how it relates to disease,” said Georg Gerber.
10 highest-paying cities for physicians in 2020 (Becker’s GI & Endoscopy)
Doximity surveyed about 44,000 full-time U.S. physicians on compensation growth from 2019 to 2020 and found that overall compensation was up 1.5 percent.
The future of healthcare payments: Predictions for 2021 (Modern Healthcare)
Companies navigating the disruption raised record-breaking funding rounds and experienced unprecedented levels of M&A activity as the pandemic accelerated the adoption of digital health tech.
“Scope Forward”: An Excerpt  (Gastroenterology & Endoscopy News)
The majority of the gastroenterology space is moving toward consolidation. But does being large guarantee safety from disruption? – Read a free excerpt from Scope Forward.
Triple FIT Beats Single Sigmoidoscopy in CRC Screening in Norway (Medpage Today)
Repeat biennial fecal immunochemical testing detected more advanced adenomas and colorectal cancers.
The Regueiro Report: Focus on CRC  (Gastroenterology & Endoscopy News)
The increased uptake of screening for colorectal cancer has led to improvements in the incidence of and mortality from the disease.
Video: Interview with Gastrologix GPO: “We create companies that physicians can have ownership in” (NextServices)
What if you could own companies you spend money on? What if you could save money on routine purchases by getting bulk rates? Watch this video to find out.
Video: Will Smith Films First Colonoscopy (People)
“I’m 50, so people need to look up my stuff,” he shared in this video from 2019.

Headlines for GI
FDA Clears First Rapid At-Home COVID Test (Medscape)

Flipped Classroom Approach Enhanced Learning About C. difficile Infection  (Gastroenterology & Endoscopy News)

Entyvio shows high patient persistence after dose frequency reduction (Healio)

The future of gastroenterology and other excerpts on industry-changing trends (Becker’s GI & Endoscopy)

Videos: Interviews with GI Leaders  (NextServices)

Top in GI: Magnetic sphincter augmentation, the evolution of IBD (Healio)

ICYMI: Personalizing Polypectomy Techniques Based on Polyp Characteristics (AGA)

C. difficile May Colonize Colon’s Mucus Layer (Gastroenterology & Endoscopy News)

Two Independent Peer-Reviewed Studies Validate Cernostics’ TissueCypher® Barrett’s Esophagus Assay (TissueCypher®) (StreetInsider)

Sanford Health launches cybersecurity health innovation hub (Becker’s Health IT)

How Enteral Nutrition Restores Healthy Gut Microbiome in Crohn’s Patients  (Gastroenterology & Endoscopy News)

Do GIs still need to prescribe a clear-liquid diet before a colonoscopy? (Becker’s GI & Endoscopy)

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