03 Dec 2022

Curated GI articles December 2nd, 2022: One GI continues expansion | AGA’s venture capital fund makes first investment in Virgo | A $615M endobariatric deal

Curated GI articles December 2nd, 2022:
One GI continues expansion | AGA’s venture capital fund makes first investment in Virgo | A $615M endobariatric deal
What the election results mean for GI (AGA)
The majorities in both chambers are razor thin and compromises will need to be made to pass funding bills and other priorities.
One GI Continues Eastern US Expansion (PR Newswire)
One GI®, a gastroenterology management services organization, has partnered with The Colon, Stomach, and Liver Center (CSL) and Loudoun Endoscopy Group in Lansdowne, VA.
AI-Fueled Endoscopy Capture and Clinical Trials Platform, Virgo Surgical Video Solutions, Receives Support From American Gastroenterological Association Venture Fund (Newswire)
Virgo is the fund’s first investment. Through the venture fund, GIs can join AGA to invest in fast-growing, early-stage companies that are transforming care for patients with digestive disease.
Boston Scientific to buy Apollo Endosurgery for $615M as entry into endobariatric market (Medtech Dive)
The acquisition may complement Boston Scientific’s endoscopy business as it targets GI endoscopists while allowing the company to enter the endobariatric market.
What gastroenterology leaders are most excited about (Becker’s GI & Endoscopy)
Gastroenterology leaders are keeping their eyes on technological innovations as the field continues to evolve.
With FDA nod for its fecal microbiome therapy, Ferring becomes No. 1 in No. 2 (Fierce Pharma)
U.S. officials have approved the first pharmaceutical-grade version of fecal transplant procedures that doctors have increasingly used against hard-to-treat intestinal infections.
Debating the Clinical Trial Upending Colonoscopy Practices (Medscape)
Dr. David Johnson and Dr. Kenny Lin discuss colon cancer screening, the controversial NEJM colonoscopy study, and more.
$15M malpractice suit brought against Virginia GI center alleging medical negligence (Becker’s GI & Endoscopy)
The lawsuit alleges that the hospital was negligent by failing to provide a GI specialist, failing to implement a contingency plan.
Novel Liquid Biopsy Found More Reliable For Diagnosing NASH Than Current Strategies (GI & Endoscopy News)
A novel liquid biopsy has proven to be accurate, sensitive and specific in diagnosing the presence and severity of nonalcoholic steatohepatitis/liver fibrosis and is more reliable than currently used biomarkers.
Could Gut-Directed Hypnotherapy Be The Answer To Irritable Bowel Syndrome? (Women’s Health)
According to some experts, gut-directed hypnotherapy is worth looking into for patients dealing with irritable bowel syndrome or other gastrointestinal woes.
Navigating the Therapeutic Landscape for IBD (ReachMD)
Dr. Peter Buch speaks with Dr. Aline Charabaty from the Sibley Memorial Hospital on available medications, and the development of new therapeutics for IBD.
Diversity, Equity, and Inclusion in Gastroenterology and Hepatology: A Survey of Where We Stand (AJG)
The survey aimed to assess current perspectives of racial and ethnic workforce diversity and healthcare disparities among gastroenterology (GI) and hepatology professionals in the United States.
New study provides evidence for three-year interval for multi-target stool DNA screening for those at average risk of colon cancer (Regenstrief Institute)
The results suggest that at least a three-year interval between screenings using this method is clinically appropriate.
Most patients say their healthcare provider’s digital tools are underwhelming, survey finds (MM+M)
Patients are struggling with their healthcare provider’s digital tools despite increased investment in the technology, according to a new notable survey.
The EMR/ESD Hybrid or Precutting EMR Endoscopic Resection Technique (GI & Endoscopy News)
The article shows a technique of advanced endoscopic resection to improve complete entrapment and resection of colorectal, esophageal and stomach lesions.
Weird Theory Suggests IBS Caused by Body’s Inability to Manage Gravity (Newsweek)
A new theory about the underlying causes of irritable bowel syndrome (IBS) suggests that the condition could result from the body’s inability to withstand gravity.

More Hot headlines in GI

Dr. Jonathan Ng, CEO of Iterative Health: Not using computer vision is a barrier to health equity. But will it replace GIs? (NextServices)

ASGE to collaborate on endoscopy simulation training (Becker’s GI & Endoscopy)

2 gastroenterologists making headlines (Becker’s GI & Endoscopy)

Phenotype-tailored diets ‘set patients up for success’ in weight loss, health outcomes (Healio)

Personalis and UCSF to Study Clinical Utility of ctDNA for Treatment Response in Colorectal Cancer (Business Wire)

All Physicians Are Leaders: American Association for Physician Leadership to Debut Annual Conference in Chicago, Illinois June 9-11, 2023 (PR Newswire)

CRO start­up Vial scores $67M Se­ries B led by General Catalyst (Endpoints News)

Salix Pharmaceuticals Culminates Year-Long Constipation Awareness Campaign with New Social Media and Digital Initiatives Empowering Patients to Discuss Their Symptoms with a Health Care Provider (Investing News)

The TikTok Trend That Triggered a Diabetes Drug Shortage (Medscape)

HHS Moving into 2023 with Eyes on Health Equity, Public-Private Partnerships in Value-Based Programs (Hospice News)

Videos: Interviews with GI Leaders  (Scope Forward Show/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.
19 Nov 2022

Curated GI articles November 18th, 2022: New virtual GI startup raises $4.6M | The next 5 years of GI | 28% drop in physician income

Curated GI articles November 18th, 2022:
New virtual GI startup raises $4.6M | The next 5 years of GI | 28% drop in physician income
Ayble seeded $4.6M for virtual digestive care (Axios)
Ayble is a clinically-backed digital health platform that provides holistic care for people with GI conditions.
Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties (KHN)
Private equity firms have shelled out almost $1 trillion to acquire nearly 8,000 healthcare businesses, which has led to higher prices, lawsuits, and complaints about care.
First “Global State of Digital Health Report” Tapping into 200 Million Data Points Examining over 12,000 Digital Health Ventures Released At HLTH (PR Newswire)
Among the top 5 most invested therapeutic areas, gastroenterology was the only one that saw an increase in funding (2%) from 2021 to 2022.
The next 5 years of gastroenterology (Becker’s GI & Endoscopy)
Neal Kaushal, MD, a gastroenterologist at Adventist Health’s Foothill Specialty Group connected with Becker’s to discuss how he sees the gastroenterology industry evolving over the next five years.
A coup for poo: why the world’s first faecal transplant approval matters (The Guardian)
In a world first for fecal transplants, a company in Australia has been given the go-ahead to syringe a treatment derived from a donor’s stool into a recipient’s colon as a way of kicking a certain type of bowel infection.
Artificial intelligence-aided colonoscopy does not increase cancer detection (Medical Xpress)
Adenoma and polyp detection rates (ADR/PDR) are lower with use of artificial intelligence-aided colonoscopy (AIAC), according to a study published in the November issue of The American Journal of Gastroenterology.
VIDEO: Patient compliance with vibrating capsule linked to improved constipation outcomes (Healio)
In a Healio video exclusive, Eamonn Quigley, MD, reported increased compliance to an orally ingested vibrating capsule predicted positive outcomes among patients with chronic idiopathic constipation.
Amazon launches virtual health service with Amazon Clinic (MobiHealthNews)
The clinic will operate in 32 states in the U.S. Costs of the consultations will vary, though patients will be provided up-front pricing.
IBD specialists, and nonphysician practitioners have a greater EHR burden in gastroenterology (Healio)
Understanding the EHR burden of gastroenterologists is crucial to maintaining a strong workforce.
New guidance: managing subepithelial lesions during endoscopies (AGA)
Experts share 10 pieces of best practice advice.
28% of physicians’ income has dropped in the last year (Becker’s ASC)
Twenty-eight percent of physicians have reported a drop in income in the last year, according to the Physicians Foundation’s “2022 Survey of America’s Physicians”.
AGA releases 10 best practice statements for management of refractory celiac disease (Healio)
In an expert review published in Gastroenterology, AGA provided updated guidance for the diagnosis and management of refractory celiac disease, including supportive and therapeutic treatment options and recommendations for monitoring.
IBD and Ulcerative Colitis Resources for Clinicians (ACG)
The 5-part clinician education video series provides key takeaways on managing IBD informed by the ACG Crohn’s Disease & Ulcerative Colitis Guidelines.
Mandeep Sawhney, MD, MS, FASGE, Discusses ASGE Guidelines on Pancreatic Cancer Screening (GI & Endoscopy News)
Lead author Mandeep S. Sawhney, MD a gastroenterologist at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School, speaks about forming the new evidence-based guidelines and clinical implications for GIs.
National Database Results: Upper GI Bleeding Rates Are Rising (GI & Endoscopy News)
Recent trends in gastrointestinal bleeding rates derived from the Nationwide Emergency Department Sample present both bad and good news.
HLTH 2022: What is the potential of value-based care? (Medical Economics)
Despite its challenges, value-based care has shown great promise in improving health outcomes and access to care, particularly among traditionally underserved or high-risk patient populations.
Finding Community Through Girls With Guts (how its network works to empower women with IBD and ostomy) (Gastro Broadcast)
Dr. Rosenberg interviews Jenny Harrison, who is the director of communications of Girls with Guts, a non-profit organization that supports and empowers women with inflammatory bowel disease and/or ostomies.
Doctors urge screening for autoimmune disorders for patients with celiac disease (MDedge)
CD specialists differ on the need for universal cross-screening but agree that, at least in some cases, people with one autoimmune disorder should be tested for others.

More Hot headlines in GI

ICYMI: SF Interview- Dr. Jonathan Ng, CEO of Iterative Health: Not using computer vision is a barrier to health equity. But will it replace GIs? (NextServices)

Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis (The Lancet GI & Hepatology)

Olympus applauds CMS move to expand access to colonoscopies (Mass Device)

What SonarMD Heard at HLTH: Day 1 (SonarMD)

Oracle is ‘jumping in the water’ in healthcare | HLTH Conference (Chief Healthcare Executive)

IBD Tied to Increased Risk for Malnutrition And Micronutrient Deficiency (GI & Endoscopy News)

More Weight Loss With Surgery Than New Obesity Meds: Meta-Analysis (Medscape)

Hoag Welcomes Dr. Catherine Ngo to Head Digestive Health Institute Motility Program (PR Newswire)

AMA chief: Stop the harassment and threats against doctors (Medical Economics)

New York GI practice to become part of UVM Health Network (Becker’s GI & Endoscopy)

Mayo Clinic launches digital referee for spotting potential bias in healthcare AI programs (Fierce Biotech)

Videos: Interviews with GI Leaders  (Scope Forward Show/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.
12 Nov 2022

Curated GI articles November 11th, 2022: Specialty Networks acquires Gastrologix | One GI expands in Ohio | Cash for colonoscopies

Curated GI articles November 11th, 2022:
Specialty Networks acquires Gastrologix | One GI expands in Ohio | Cash for colonoscopies
Specialty Networks Acquires Gastrologix, a Gastroenterology Group Purchasing Organization (GPO) (PR Newswire)
The acquisition of Gastrologix allows Specialty Networks to help GI physicians deliver exceptional patient care, and remain independent.
One GI® Expands Ohio Presence through a New Partnership with Gastroenterology and Hepatology Specialists in Canton, Ohio (PR Newswire)
One GI, the Home for Independent Gastroenterology, announced a new partnership with Gastroenterology and Hepatology Specialists (GHS). GHS has been providing high-quality, patient-centric GI care since 1998.
SF Interview- Dr. Jonathan Ng, CEO of Iterative Health: Not using computer vision is a barrier to health equity. But will it replace GIs? (NextServices)
In this episode, Dr. Jonathan Ng discusses why failure to embrace computer vision technologies can be a barrier to health equity. Tune in to find out how Dr. Ng landed in the gastrointestinal space, AI in GI, and more in this exclusive interview.
Downward Trend in Medicare Payments for GI Services (Medscape)
There has been a steady decline in Medicare reimbursement for common gastrointestinal (GI) services and patient office visits over the past 15 years, which could have a direct impact on patients.
Meet the leaders of 16 top-ranked GI residency, fellowship programs (Becker’s GI & Endoscopy)
Meet the leaders of 16 top-ranked gastroenterology residency and fellowship programs in the U.S., based on Doximity’s regional rankings of the country’s best internal medicine residencies.
Capital Digestive Care Laboratory Opens; First GI Specialty Practice Recognized as Roche Diagnostics Center of Excellence (PR Newswire)
As part of Capital Digestive Care’s integrated GI health network, the expanded laboratory completes an end-to-end continuum of care for patients from diagnosis and treatment through ongoing screening and future research.
The impact of private equity ownership in health care: A research roundup and explainer (The Journalist’s Resource)
Private equity firms argue they bring value to health care. Critics of private equity’s approach say the intense drive for quick profit puts patients at risk. The article takes a look at the research.
Self-employed Physicians Report: Is It Worth It to Be Your Own Boss? (Medscape)
Medscape’s 2022 “Self-Employed Physicians Report” lays out the pros and cons of being a self-employed physician.
Walgreens Unit to Buy Summit Health (The Wall Street Journal)
Walgreens shares rose after its primary-care-center subsidiary agreed to acquire Summit Health, the parent company of CityMD urgent-care centers. The transaction is worth roughly $9 billion including debt.
Medical groups close Q3 in tough financial position with expenses outpacing patient volumes (Fierce Healthcare)
Medical groups and physician practices continue to feel the financial pinch of higher expenses in 2022 even as patient volumes help to drive revenue growth.
Cash for Colonoscopies: Colorado Tries to Lower Health Costs Through Incentives (Medscape)
It’s part of an initiative known as the Colorado Purchasing Alliance, through which employers in the state are banding together to negotiate lower prices for health care services.
Dr. Ali Keshavarzian and Chronobiology of the Gut (The Scope with Dr. K)
Dr. K and Dr. Keshavarzian follow the thread connecting environment, diet, circadian rhythm, GI disorders, and other chronic diseases like Parkinson’s and multiple sclerosis.
November issue of The American Journal of Gastroenterology (AJG)
This issue of the AJG includes expert recommendations for occasional constipation and quality indicators for capsule endoscopy and deep enteroscopy.
Closing the gender gap in gastroenterology leadership: the need for effective and comprehensive allyship (The Lancet)
Increasing female representation in the academic pipeline is not sufficient on its own to close the gender gap in leadership positions.
Noninvasive tests may provide prognostic value in NAFLD (MDedge)
Noninvasive ultrasound- and serum-based fibrosis biomarkers have similar prognostic performance to histology for nonalcoholic fatty liver disease (NAFLD), according to new findings.
Updated AGA Guidelines: Managing IBS with Diarrhea (ReachMD)
Peter Buch is joined by Dr. Eamonn Quigley, the David M Underwood Chair of Medicine in Digestive Disorders and Professor of Medicine at the Academic Institute to discuss the new recommendations and medications.
Dr. Regueiro’s Top IBD Therapeutics Abstracts From ACG 2022 (GI & Endoscopy News)
Dr. Regueiro discussed six abstracts highlighting new approaches for Crohn’s disease and ulcerative colitis.
Don’t Wait for Patients to Bring Up Their GI Symptoms (Medscape)
Nearly three-quarters of Americans would wait before discussing GI symptoms with a healthcare provider if their bowel frequency or symptoms changed, according to a new survey from the AGA.

More Hot headlines in GI

ICYMI: Dr. Michael Owens: “What would I do with my time if I’m not doing as many colonoscopies?” (NextServices)

5 gastroenterologists to know (Becker’s GI & Endoscopy)

The Worldwide Colorectal Procedure Industry is Expected to Reach $29.5 Billion by 2028 (Tullahoma News)

USPI vs. Surgery Partners vs. SCA Health in Q3: 9 financial notes (Becker’s ASC Review)

RosmanSearch Introduces Gastroenterology Recruitment Service (RosmanSearch)

Brigham and Women’s gastroenterologist honored by American Liver Foundation (Becker’s GI & Endoscopy)

Researchers Identify Cells Responsible for Colon Cancer Relapse (Inside Precision Medicine)

Intermountain Healthcare Bringing New Artificial Intelligence Technology to Patients in Heber Valley and Wasatch Back to Help Fight Colon Cancer (Intermountain Healthcare)

Multidisciplinary Program for Fatty Liver Disease Helps Patients Lose Weight
(GI & Endoscopy News)

Videos: Interviews with GI Leaders  (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.
11 Nov 2022

Dr. Jonathan Ng, CEO of Iterative Health: “Not using computer vision is a barrier to health equity. But will it replace GIs?”

Dr. Jonathan Ng, CEO of Iterative Health:
“Not using computer vision is a barrier to health equity. But will it replace GIs?”
I asked Jonathan Ng, founder and CEO of Iterative Health (formerly known as Iterative Scopes, an AI in GI startup) why investors recently gave them $150 million in funding. We didn’t exactly get to the answer but I can fathom a thesis.
Iterative Health’s investors include the founders of Flatiron: Nat Turner and Zach Weinberg. A digital health company that advances cancer research. Pharma company Roche acquired Flatiron for $1.9 billion in 2018. Other investors of Iterative Health include Johnson & Johnson and Eli Lilly amongst others. Further key team members from Flatiron have been joining Iterative.
My reading of the play here is straightforward. It’s possible that investors want to repeat their thesis of Flatiron for Iterative but in gastroenterology. Big Pharma is funding AI in healthcare to develop more targeted therapy for the drugs they develop. Therefore the central premise of Iterative’s offerings today seem to be on better recruitment for clinical trials. Physicians get an ancillary. Pharma automates patient recruitment.
I came away super impressed with Jon’s unwavering vision for AI in GI: equitable healthcare. When I asked how Iterative is different from Medtronic or others who were also working AI in GI. He repeated his vision – he said the desire for equitable healthcare differentiated them.
While on a medical mission in Cambodia, it occurred to him that not all doctors are made equal. And that means patients can’t get fair access to healthcare. Computer vision and AI could change that. He took action.
Jon moved to MIT to study MBA and build on this idea. In a very short period, he developed the foundation for Iterative that went onto pave the way for AI in GI.
Here’s Jon changing gastroenterology for good. It’s reasonable to say that the future of GI hinges on the execution of his vision.
◘  The fascinating story behind starting up Iterative Health
◘  “Not using computer vision is a barrier to health equity”
◘  Why did Iterative Health enter the field of gastroenterology?
◘  How does Iterative Health differ from the other AI companies in GI?
◘  Iterative Health raised $150 million. What attracted investors?
◘  What is their next milestone?
◘  “Right now today there’s an unacceptable level of disparity in (health) outcomes”
◘  “Being able to minimize the barrier for GIs is to be able to access information”
◘  Will AI replace GIs?
◘  How sophisticated is computer vision in the endoscopy room right now?
◘  “For healthcare, it just takes way too long to understand our impact on patients”
◘  Future of AI in GI
◘  “Even our colonoscopy screening recommendations are generic for the population”
◘  Iterative Health’s operational model
◘  Partnership with One GI
◘  Jonathan’s views on the controversial NordICC colonoscopy study

The Transcribed Interview:
Praveen Suthrum: Dr. Jonathan NG, CEO, and founder of Iterative Scopes. Thank you so much for joining me on The Scope Forward Show. I’ve been waiting to have this chat for many months now, so I’m glad that we scheduled it. So let me first introduce you to our audience. So you’re the CEO and founder of Iterative Scopes, a pioneer in the application of AI-based precision medicine to gastroenterology with the aim of establishing a new standard of care for the detection and ultimate treatment of GI diseases. The company is a start-up that’s fun out of MIT, and you’ve recently raised $150M in Series B financing to accelerate the development of your core algorithmic innovations. So that’s exciting and it’s really wonderful. So anyway, John, welcome to The Scope Forward Show.
Dr. Jonathan Ng: Yeah, thanks for having me, Praveen. I’m excited to be here and sorry it took us so long to get here.
Praveen Suthrum: No, you’ve been busy raising the money that you did. So, first of all, congratulations to your team. I think it’s very exciting, not just for you as a company and as a start-up, but for the industry itself, because it’s very telling on the interest that GI as a space is attracting and the direction of where investments are flowing. So it’s very telling. So congratulations to all of you. But John, I want to ask you first about the backstory here. So now you got the idea. I learned while you were on a trip in Cambodia and you were looking at doctors there trying to detect tumours and their inability to find it. And then the idea germinated. I think at that time you were doing your MBBS in Singapore. So please tell us all about it.
Dr. Jonathan Ng: Happy to share that one. It’s quite an interesting story. So I think since I got my start in healthcare pretty early on, just by chance, I happened to visit Cambodia for context. Pretty much first generation college, no one else and family had doctors. But I was fortunate to receive mentorship from a friend’s dad who was a doctor. And he said, John, can you come to Cambodia and carry my bag? Go around. Medical mission happened to be on that trip. And that was my first experience of healthcare outside of Singapore, which is very much a first of all healthcare system. And frankly, it was pretty shocking how the state of health care was back then. It was back then emerging from the Khmer Rouge, from the Pol Pot regime and it was feeling at a very fundamental stage of like. After the Pol Pot regime there were basically two doctors left in the country serving patients and for a population of 12 million people because Khmer Rouge decided that the best way to prevent an uprising against them was to kill off all the intellectual people. And so I arrived in the country that observed how kids were not making it through for really basic reasons. And back then, the under five mortality rate was about 20%, 25%. And I was like, this is totally unacceptable. You can’t know this and not do anything about it. Long story short, I end up in a deep rabbit hole, end up spending about 14years in Cambodia, building all kinds of facilities, open its first paediatric cardiothoracic surgery units, unit awards, for instance, reconstructive units, getting involved in a couple of establishments, establishing a couple paediatric hospitals in rural Cambodia. But as part of this process, we were trying to train Cambodia’s first generation of surgeons. And I would frequently bring in my best tutors from Singapore, from the US. From places like the Brigham Boston group of hospital, and bring them to try and impart knowledge. And frequently we would struggle with this thing where and this thing plays on my mind over and over again, where I would be sending in the operating theatre. My mentor would be standing next to me, and you’d be like, look at this huge tumour. You would describe all the details to me and all the ways in which we could treat it. I’d be like, yeah, that’s a massive tumour. Obviously, I’m lacking all these other details because I’m not as experienced, I’m not as good. And then there was a session with trying to train, and he would be like, where’s the tumour? And we were like, oh, then if you’re not even seeing it, if you’re not even identifying it, you can’t treat it, right? And that sets off then series cascade of decisions that essentially ends up with the patient receiving a very different outcome. There are many ways to go wrong, only one way, pretty much one way to go right in, and the patient would essentially receive a very different outcome. So when I reach kind of like my 12 13 hours by then doing a lot of regional work, and it got pretty frustrating, to be frank, in terms of my inability to feel like I was moving the needle. I felt like I was spinning in circles, right, constantly trying to move this needle. And so I said, yeah, I’m going to take some time off. I’m going to go back to grad school. By then, I had my immediate I was go to a place which essentially was very forward thinking and very a hub for innovation. And that updates MIT.
Praveen Suthrum: Sorry. Just to time this a little bit, you were doing your MBBS, and you were in Cambodia at the same time, so it was happening.
Dr. Jonathan Ng: Yeah. So I started working in Cambodia when I was pretty much 15 years old. So this is the way that yes. And then I continued through military service, continued through med school, continued through medical training. So I was working in Cambodia throughout this period.
Praveen Suthrum: Fascinating. Okay. Yeah, please continue. So now you’re in MIT, and then?
Dr. Jonathan Ng: In MIT, I come there with an open mind, trying to explore all the labs. And one of the first few technologies that I see is the use of computer vision and autonomous vehicles. And I look at it, I’m like, this is fascinating. This technology can identify cats, dogs, humans, cars. And even at the point of time, they were like, we can integrate. If a human is walking in a certain way, we can kind of predict whether the person’s going to turn left and right, dodge it, start running all these complex intuition. And I was like, that’s super cool. But also, why don’t we have this in medicine? Why can’t we have this in healthcare? Because to me, that represented a major barrier to patients receiving equitable health care, right? As equitable in outcome as possible. And that’s, in a nutshell, what I’ve been working through towards for the past, I’d say now, 20 years now. And I was like, this feels like a big one. This feels like a big knowledge gap that back then, we were in today. Still, we’re trying to move medical knowledge. Sure. Medical textbooks. We know that doesn’t really work. It doesn’t represent real world, because we did then we wouldn’t need residency. We do residency, which is essentially apprenticeship, which is nearly a one to one teaching model, which is not scalable and doesn’t really fulfil what the world needs in terms of better health care, more scalable health care. And then we also do conferences, which, unfortunately, I’ve been to a number of these, and for a good number of them, I think, with the ability to educate once a year, the feedback loop isn’t short enough. The examples we use aren’t real world enough, and they’re not really geared towards, like, very fundamental, like, questions like, is this a tumour? Is this not a tumour? Right. People expect for it to be covered in medical school, but it’s also that gap exists very much in a real world today. And I kept thinking to myself, damn, this is awesome technology that we can use. Now, I’m not a gastroenterologist by training. In fact, I was training to be a surgeon, but I kind of landed, worked my way backwards into fascinating technology. Where can we use this? And so they started looking at places which I’m more familiar with and plastic surgery and orthopaedics and cardiology. But I did landed in GI really, because I think for a few reasons. Number one, I think GI doctors are just awesome to work with. I think when you deal with poop and stool all day, I think he just can’t take himself too seriously and it’s just straight out. We all know start-up as a grind. We all know that you try to innovate the grind and you really want to go through that grind with people you enjoy working with. There are set of specialties which I will not name on this record, that I will not try to innovate with. Right. Like they will bite your head off before you try to move and change anything. I think beyond that understanding that GI isa very visually based disease, naturally it’s like surgery but with a natural camera already. Whereas most surgeons don’t operate with a camera or don’t have a primary view of a camera. All these factors played into it and I said why don’t we try it in GI? I think from the very get go and still today I have a broad mandate, I have a broad vision, but in terms of using this technology to close in on disparities and health care outcomes and I think that accounts for what you alluded to a lot of our successes. I think many people see this potential as well.
Praveen Suthrum: If I may ask, how does it differ from the AI solutions that are already there in GI? For example, there’s GI genius from Medtronic, there’s Satisfai Health and there are a lot of start-ups waiting at the gate of FDA from what I learned. And there are newer and newer publications all the time. Even Google has got its interests, they’ve written a paper on computer vision and detecting polyps. So how does your solution actually differ and what part of it is similar to what’s out there?
Dr. Jonathan Ng: Yeah, great question. Sorry. I won’t claim to know every single solution out there. I think the biggest differentiator we have is really the vision behind and why we’re doing this. I think that will eventually we keep doubling on why and we’re doing this in terms of reducing health disparities and health care outcomes. We have a very practical role take on the application of the AI and GI and I think eventually that just leads us into more differentiated space, slightly different angle than say someone who is trying to just sell more snares or trying to do it for maybe sell most products. I’m not sure. I think for us the fundamental reason is very critical and it’s what drives every single decision we make here at Iterative.
Praveen Suthrum: Let’s go back to the name, Iterative Scopes itself. How did you come up with it and get a story here?
Dr. Jonathan Ng: Yeah, essentially I was having too many drinks of my professors at MIT, you know, and trust us to come up with overly complicated names, but I think why ‘Iterative’ firstly, I saw it as a very much a learning journey in the practical sense of, I don’t have it all done today. I expect to have an Iterative process. Iterative learning around this. I think the other part is also the whole machine learning aspect of this. It’s like it’s not one algorithm at this point in time, tens, hundreds of algorithms that are all learning on repeat. And the more times you iterate, the better you become. And so that word really stuck in my head now, the ‘scopes’ part. Here’s some news on this. I think by the time this podcast is out, you’ll get the news that’s what the change? I think to me, it was defining a narrow initial path of GI. First, and to be very clear, the flip side did not realize that would do is I think 80% of the market thinks we manufacture hardware and like, okay, I probably made the mistake. Everyone’s asking me, so where’s the scope you manufacture? I’m like, I don’t know, man. We don’t manufacture anything. But we’re about to fix that. And stay tuned for some news. It’ll be pretty fun.
Praveen Suthrum: I’m looking forward to that news, but I can guess what it might be based on what you just said. But somewhere, John, the message seems to have resonated with investors, with digital health investors. So somewhere the community seems to have taken to your vision. Can you talk a little bit about that? You’ve raised a huge sum of money. I’ve not seen $150M plus being raised in digital GI.I think your start-up is leading that game. What attracted investors to your company?
Dr. Jonathan Ng: Honestly, I wish I knew. I think the breadth of the vision in terms of and I think we have such a strong team in place right now. And I keep saying this since early days. It’s easy to mistake. Everyone has to enter the market at some point. But I think the quality of talent and the vision behind the company will eventually, you know, define where each company goes. And I think for clarity first, I think the market, the GI market is big enough to host multiple AI companies. So I always tell my folks that the competition is not really, say, GI genius or Satisfai or any of that. It’s really ourselves. It’s really making sure that we do what’s best for our doctors and making sure that we understand our customers as well as we should and doing the best for our patients. We’re only fighting ourselves with this one. And so I think what’s the quality of people that we have internally, depth of which we have bottomed out our vision in terms of putting together a comprehensive strategy and our initial successes and being able to execute against them, I think that has all attracted quite a decent amount of money.
Praveen Suthrum: Did you plan to raise this amount when you were at the end of Series A or did it just happen? What is the story here? How did that come about?
Dr. Jonathan Ng: I think it’s a bit of both serendipity and I also acknowledge that a lot of it’s been a huge privilege in terms of this whole entire journey myself. I arrived in the US only four and a half years ago and two years to spend it in school. So it’s been incredible the past four years, three years running this company. I think everyone has plans. It was certainly, I think, a mix of serendipity in terms of meeting the right folks who understood the vision, also hitting milestones, and also being able to show that we were bringing in the right folks. And with bit more money, we could basically strap on some rockets and take it to where we wanted to.
Praveen Suthrum: And where would that be? So what is the Holy Grail for the company? What is the next milestone or the next big milestone from here?
Dr. Jonathan Ng: I think the Holy Grail is if we basically are able to use AI to analytics to basically provide every single doctor with the information they need, and they deserve to be able to treat their patients somewhat equally. Right. I think right now, today, there’s an unacceptable level of disparity in outcomes, whether you choose to accept it or not. Whether you choose to acknowledge it or not. Right. I’ve worked in countries where we struggle to even get basic calls into place. We don’t even talk about identification of serial polyps or any of the store or the level of severity of the IBD right. And so being able to push this information into every single endoscopy suite, being able to minimize the barrier and the activation energy for GIs to be able to access this information and be consistent about it across the board, I hope that this will be a great equalizer in terms of outcomes.
Praveen Suthrum: That’s fantastic for patient outcomes, but there may be gastroenterologists out there who might be thinking, hey, if a technology like this is going to do the job that I do currently, what would I do? So how would you respond to that or any thoughts there?
Dr. Jonathan Ng: Personally, I don’t think we’re trying to replace anybody here. I think we’re providing information so that folks can do what they do best, which is treat all of us, sign up to medicine, to healthcare, to treat our patients, to help someone. Right. And why would you turn down being able to knowledge and data that is able to help you to drive better outcomes? We’re not saying we’re taking over, for example, the mechanics of driving a scope. We’re not intercepting the polyp for you. We’re simply making recommendations, making it easier to have a common identification of polyps, common identification of certain procedures, common assessment of certain diseases, so that we have good understanding of how these patients should be treated. That’s the way we see it. We’re not going to take away what GIs do today. I think that’s impossible.
Praveen Suthrum: But let’s go back to that analogy of self driving cars that actually prompted you in this direction. You may be familiar with the five levels of self driving or autonomous vehicles. Somebody’s given this classification. I find it quite interesting. I even wrote about it in Scope Forward. So the thinking on my question to you is that what if that were to be applied to computer vision in the endoscopy room? So if you were to apply from level 1 2 3 4 5, which has increasing levels of sophistication where would you land when you apply computer vision to endoscopy?
Dr. Jonathan Ng: We’re right at the start right now. It’s very rudimentary what we’re doing. And I think for healthcare, it just takes way too long to understand our impact on patients. Like, imagine this early to put cars, these cars on the roads. We’re just barely standardized. And roads are pretty straight. Roads have, like, standardized stop signs. Roads have crosswalk. So people actually go across. Now think about anatomy. There’s no crosswalk. Everyone’s anatomy is different. If you had bowel surgery before this, it’s completely different. I think it’s going to take us tens of years to get there. The totally autonomous situation. Everything told them is an identification of patents. And just being able to support.
Praveen Suthrum: That’s interesting to know. I usually ask this question towards the end, but I think I want to ask it now. So if you were to throw a stone and that way to land, let’s say five years from now, and then three years from now and then next year, one year from now, where would it land in terms of AI, in gastroenterology? Let’s start with five. Let’s start with the distant future. I’m saying five is not even too far out, but how far would we go in terms of AI and GI? Five years from now? And then I just want to follow that up with three years and then one year.
Dr. Jonathan Ng: I think five years is pretty short term for us. There’s a pace of change in healthcare is pretty short. Okay, we might have certain great polyp detection algorithms, certain features being detected, certain historic being predicted, for example, and use in certain clinical decision making. But I suspect that’s where we’re going to be here in five years time. And that’s it. I’m pretty conservative with how fast technology moves. I know there’s some visionaries out there that are like, oh, we’re going to be self driving these scopes through a colon in five years time. I think no.
Praveen Suthrum: Then let’s extend the horizon. Like, five years is short term, and that’s what you’re seeing, what is increased sophistication from that point of time, let’s push forward to ten years.
Dr. Jonathan Ng: I think being able to, for example, ingest multiple data sources that are now becoming more and more available. So, for example, we’ve got all these like Guardant or Freenome and all these liquid biopsies, for example, right? You know, being able to ingest from various tests and being able to risk adjust, being able to take a comprehensive view of a patient, being able to ingest various multi model data sets to then come up with a more balanced view of a patient more comprehensive view of patient will be an incredible outcome if we can get to in ten years time. Right? And I think that would be a great application to be able to have personalized recommendations right now. Even our colonoscopy screening recommendations are generic for the population. Folks who ask me every time, like, what age should I start scoping? And I’m like, as soon as you can afford it, you should scope. Because I have friends who have had stage four cancer at 35 years old, right? And I’m like, I don’t know if it’s not going to be you, but I certainly hope not. And the only way that it’s not you is if you get a colonoscopy. So if you can afford it, go scope. Peace. I’m going to get my first colonoscopy next year at age 35. But instead of generic recommendations to come up with true risk predictors, to come up with a comprehensive view of the patient so that we are able to confidently and individually make these recommendations, because right now, also the way we do healthcare, because the guidance is so broad, seething, it just becomes so expensive. And so there’s a sweet spot where we can understand each patient, we can customize our recommendations for each patient, and then we can in between that apply preventative measures to just keep monitoring in between.
Praveen Suthrum:  So currently, what is the operational model? You’re not yet selling in the US, are you?
Dr. Jonathan Ng: So we do have a product in the US. It’s a bit of a patient identification algorithm which basically identifies the right patients for the right clinical trials. It’s currently in working in inflammatory bowel disease. It’s a pretty cool piece of technology. We’ve got quite a few sites deployed right now, and it’s been a tremendous year for us in terms of that site deployment, and we’re really excited to see what it brings for the next 20 years.
Praveen Suthrum: But you’re not using the polyp detection tool in the US.
Dr. Jonathan Ng: That’s not available in the US. So we just got cleared with the agency and it should be commercially available pretty soon.
Praveen Suthrum: Okay. And I’m assuming that would be next year.
Dr. Jonathan Ng: I believe it’s very early today.
Praveen Suthrum: Now, you’ve raised all this money. Other than building up the leadership team, how are you deploying it? What happens over the next, let’s say100 days and twelve month period?
Dr. Jonathan Ng: I mean, 100 days pretty much it’s too short. Again, we don’t think in that short term. Right. Again, the capital we have raised upwards and allows us to do that. So we’re very, very privileged here, I think. We think very much in terms of years where we want to go, I’d say we’re doubling down on GI. We’re not going anywhere. Right. We remain extremely focused and we’re excited to engage more with a broader swath of the community. For example, we’ve got great partners. We just announced a partnership with One GI, the One GI platform, which is, you know, they’re really, really awesome people. And Robbie and Zia, we love working with them, and we want to find more partners like that. Right? We want to find ways in which clinicians, who are even CEOs and administrators who are interested in moving the needle forward, not just for themselves, but for many others in the world, to engage with us and to be able to help us understand what would make a difference to the practice and allow us to create tools against those. I think that’s very much on our roadmap.
Praveen Suthrum: Got it. And these partnerships with GI practices, it’s primarily for recruiting patients for clinical trials. Is that the scope of the partnership or is it beyond that?
Dr. Jonathan Ng: We’ve got a number of other programs as well, R&D programs. We’re exploring a good number of novel endpoint and novel ways of measuring disease severity and such that.
Praveen Suthrum: So, John, the last few days there’s been a flurry of news in GI as a result of the Nordic study that was published by NEJM. And as you know, the study questioned the effectiveness of colonoscopy and linked it to deaths associated with colon cancer. What did you think of it and what did you think of the reaction on both sides of the continent? There were people on the European side who commented. There were GI societies on the US side that commented. So I’m curious to know what your take was when you read all that first-year. is your product currently commercial or when is it going to launch?
Dr. Jonathan Ng: I applaud the office for putting in all this effort, and it’s a ten year study. It’s incredible how much effort has gone into it. I think it’s a much-needed study. Unfortunately, I think the title was pretty much dictate. I think there are many ways in which we could have framed the title more responsibly so that the general population who reads it actually goes beyond the title to understand what’s in the study and what the actual recommendation or findings were. I think certain things spread out, and we’ve known this for a while around, say, for example, certain GI populations having lower detection rates. And that is the key thing we’re trying to address here in terms of, yeah, maybe everyone maybe if you have lower area rates, either we should do some population studies in your population or perhaps they just have a lower propensity to get cholesterol cancer, which I don’t think is true in Norwegian population. Or we should help them with polyp detection algorithms, perhaps, and maybe start deploying some of these tools into their systems. But this is an biological  difference that we have known for some time I mean, we’ve seen other studies, for example, done in Italy, where the devices approved from Italy for Italian studies, for example, that have a completely different patient population. You know, we tend to be aware that these differences do present themselves. I think historically we try to have more balanced view of studies. I know studies are how you design them, essentially, right? But essentially for ourselves, we tried to personally stay away from the design of the study and had more clinical advisors, more balanced advisors come in and help us to design it. So, for example, in our most recent publication in Gastroenterology and the foundation in September, it was a five century RCT that was done across, you know, it was MGH, it was midsized academic hospital. Below that, there was a large PE practice based, large PE rollout type practice as well as a community GI type practice. And we saw a fascinating range of outcomes. I’m sure there are reasons for that, but we want to be truthful of ourselves. We want to make sure that representative against population we’re deploying against.
Praveen Suthrum: One of the comments that came out on the US. Side was about the ADRs, and that the ADR of the endoscopy was lower. When I did that, I was thinking, shouldn’t we actually mandate using AI tools for endoscopy so that the ADR across the board reaches a certain baseline? Do you think that should happen or is it likely to happen? Any comments?
Dr. Jonathan Ng: I wish it happened. It’s why we are here. It’s why we’re present. I think it’s a two way street. I think as much as regulators and insurers and payers should regulate it into existence and to broader assistance, I think the other side of this is engaging us and for us to minimize the barrier to adoption. I think a lot of AI right now is current for would be infeasible or overly expensive for most of GI practices to adopt. And I think we as a company have a responsibility to try and in the spirit of our mission, trying to reduce or minimize this barrier to adoption. And that’s what we’ve been working towards having again.
Praveen Suthrum: John, this is great to have this conversation. I think it gave me a great perspective on how you’re thinking and how the company is thinking. Is there anything else that you wanted to share?
Dr. Jonathan Ng: No, we were just really excited to keep innovating. We’re always looking for good partners. So let us know. Hit us up if you’re keen to work with us and we’re keen to understand our products and yeah, pretty much, we’ll keep going.
Praveen Suthrum: Congratulations once again to you and your team, and I look forward to catching up again.
Dr. Jonathan Ng: Yeah. Thank you. Bye.


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08 Nov 2022

Dr. Michael Owens: “What would I do with my time if I am not doing as many colonoscopies? It’s an interesting thought experiment”.

Dr. Michael Owens:
“What would I do with my time if I am not doing as many colonoscopies? It’s an interesting thought experiment”.
Gastroenterologist Dr. Michael Owens did a thought experiment during the pandemic period. He asked himself, what would I do with my time if I’m not doing as many colonoscopies?
That question led him to leave his large GI group to start up a multi-specialty GI group that takes advantage of the trends shaping the future of GI. For example, trends such as value based care, the microbiome, AI, colonics, single-use devices, genomic tests, liquid biopsy and so on. As he implies, Mike literally implemented the central premise of the book Scope Forward to build future on his own terms. He stands as a great example for GI 2.0.
We often limit our choices to what’s prevalent in the market. Join a hospital. Join PE. Merge with a large independent group. Kudos to Mike and his partners at Pearl Health Partners for having the courage to go against the grain and take a different, innovative approach.
He says in the interview: if not now then when?
◘  Backstory on how he got started
◘  “I think the Northwest has been somewhat excluded from a lot of the M&A and a lot of the PE involvement, but it’s happening”
◘  The larger the organizations, greater the complexity
◘  “Seeing what was happening in the surrounding states with PE and not knowing where that was headed, the desire to take control of your own situation sometimes kind of bubbles up”
◘  “We’re watching Cologuard and we’re watching a lot of the world shift”
◘  “I felt like there were more opportunities here to look outside. What would I do with my time if I’m not doing as many colonoscopies?”
◘  Why did Pearl Health Partners choose the multi-specialty route?
◘  “We are able to bring in investors at a pretty low EBITDA”
◘  Is the multi-specialty model better than a single specialty GI model?
◘  Innovations
◘  “We don’t have a group of 60 doctors with 3 committees taking 6 months to pick which prep we use”
◘  “I think we have a lot of incentive to not do fewer colonoscopies out there”
◘  What changes will private practices or GI as a space see in the next 5 years?
◘  “AI is going to be just sorting a lot of the complexity for us”

The Transcribed Interview:
Praveen Suthrum: Dr. Michael Owens from Pearl Health Partners. Thank you so much for joining me on The Scope Forward Show. I’m really looking forward to our chat today.
Dr. Michael Owens: Good to see you, Praveen. Thanks.
Praveen Suthrum: Mike as we get started, I want to first introduce you briefly and I’m taking this off from your LinkedIn profile. So you’re now the co-founder of Pearl Health Partners and you’re also the director of Digestive Health for this new company. But by way of background, you’ve had a long career in interventional gastroenterology and now you’ve built this new organization. It’s an independent health organization that’s focused on value-based care. You’ve got two surgery centers and you’re working with multidisciplinary specialists. And you say you have a novel model for the business of medicine, which I’m really looking forward to learning. And then you’re expanding in the Portland metro area. What is fascinating for me from your profile is that now this is your former private practice GI and now you’re part of this whole multispecialty GI entity. So I’m looking forward to learning all about it. But as we get started Mike, what is the backstory here? How did all this happen?
Dr. Michael Owens: Thanks for giving me a chance to talk to you again. I think that we have a lot in common and I think we shared some conversations that were pretty interesting so far. After reading your book Scope Forward, there were other people out there that pre-pandemic who had similar thoughts to me. And I wasn’t really aware of that until very recently, but that’s a part of it. I think that there’s obviously been pressure the past four or five years in many regions. I think the Northwest has been somewhat excluded from a lot of the MnA that’s been going on and a lot of the PE involvement. But it’s happening especially up north of us in Washington, what used to be how do we kind of build out our indoor lab and how do we get in our ancillaries and how do we look at our service lines and how do we bring some of the tertiary care into smaller places? The conversation started changing. It was a lot more pressure from outside institutions that they were aligned with. But things were changing in the employment models in hospitals wanting to joint venture more and more and a lot of money exchanging hands in different arrangements. And along with that, I noticed that there were pressures on the revenue models that we’d all expected. And I think we’ve all thought about this for a long time. And I’ve always been a look down the road, two to five years kind of person. It’s maybe my sweet spot. And thinking the larger organizations were getting, the more complexity was coming into what the doctors wanted to do every day. And it’s what we’ve all felt, we can’t get the extra nurse that we need, we can’t get that extra amount of time to do the other thing. And so we all feel like the glory days maybe of independent practice started to make us feel a little bit of anxiety about where things were headed. And I realized there are so many physicians coming out of training who are really kind of embracing the employment model because on the surface, it appears easy. A lot of the headaches are not there, a lot of the worry isn’t there. It’s secure. And if there’s anything the past couple of years have taught us, the securities of employment and salary seem wonderful, especially when there’s so much upheaval. So I had been a therapeutic endoscopist for almost 20 years. I’d spent three days at the hospital and really enjoyed that world to the point that I did a lot of extra work in different aspects of interventional. Throughout the year, we helped work on service lines, building an advanced endoscopy center. We became one of the 30 pancreas centers in the country. Our ripple volumes were doubling. We brought in more surgeons. So I really wasn’t sitting in the normal space, I think, for gastroenterologists during this time. So 2021 or so, I have an opportunity to join some other docs in buying into a surgery center and seeing what was happening in the surrounding states with PE and not knowing with my position previously where all that was headed. The desire to take control of your own situation sometimes kind of bubbles up. You hear a lot of people coming out of the pandemic have said, I just wanted to try this, and if it doesn’t work, it doesn’t work. But if you don’t do it now, when are you going to do it? And so we spent about six months playing with the idea, making an offer on a surgery center that had not really got up and running before the pandemic hit, and it was sitting unused. We had a small plan at first about how we might turn this into an interesting opportunity, and it grew fast. We ended up bringing in a number of different people who were very similar in their experience and age, but were surgeons, many of whom I’d worked with for a long time. And these are relationships maybe because I was doing interventional work. I think interventional and therapeutics may be a different world a little bit for many people and maybe that’s where the outbreak came from. All of these ideas when you start to put yourself into how would I do things different, how would I do things better? What do I think the risks are? Your whole book is in my head as I’m looking at, okay, colonoscopy 2021 probably is going to impact, who knows, 20% to 30% of our recall cases when the new USPSTF guidelines come out. We’re hearing alternative ideas anyways. We’re watching Cologuard and we’re watching a lot of the world shift in all of the genomics that are happening. And I really thought there’s a good chance that we’re over utilizing Colonoscopy, that the world is coming together to probably impact that in the next how many years on a two-to-five-year thinker kind of. And it seemed like it was going to hit in that window because of that and because it did not been like the mainstay of my day to work, I felt like there were more opportunities here to look outside. What would I do with my time if I’m not doing as many colonoscopies? And it was refreshing. It’s like a thought experiment, right? So I really was excited about what was happening with the microbiome. I was very interested in weight loss and our failures as GI doctors to really spend time on it. I think a lot of people thought that that was a primary care diagnosis and treatment algorithm, right? I was very interested in how I can work on service lines with these other doctors that I used to have to send patients to and it would take them forever to get seen and they were in a different institution. So we started looking at pelvic floor, pelvic floor dysfunction. We started looking at women’s centers and what are their needs and all these overlap ideas started to happen. There were some business thoughts there too. When you have a primary care market that’s a bit controlled by health systems, some of the women’s clinics are kind of a backdoor. They have tens of thousands of patients, but they’re really being asked to provide the primary care. And I think that there was overlap with a lot of the surgeons working with who I’ve worked with for years, who do endoscopy. And we started looking at what else can we do in helping our ENC docs and our folks that have issues with sleep apnea and hydro hernia and they need weight loss. Again, it kept coming back to what if this all was kind of a new way of working together. We had the benefit of, OK, let’s build this around a surgery center. We saw the problems with the hospitals being able to provide access to care and we thought, okay, we could be the last man or woman standing in this ASC if we build this right? So that more procedures move to that space, everyone wins.
The co-founder of Pearl Health Partners is a dominant named Richard Rosenfield. He’s a GYN surgeon who pioneered outpatient Laparoscopic Hysterectomy same day discharge. He’s worked on other aspects of medicine for a long time relating to the business of medicine and a lot of it repairs, bundles, ERISA plans, things that I didn’t know much about. But as we started looking at how value-based care is or isn’t really value based care, and we saw people bantering about transparency, we saw hospitals not complying, we saw payers that kind of wanted to comply. We started entering relationships with some of the organizations that are doing deep data mining and cleaning of the data and they’re doing different market analysis now. And we all realized we kind of know our numbers and we think we know what our price targets could be to be cheaper for the patient and the payers, even if it’s just a high deductible situation and colonoscopy is a little different, it’s a high-volume situation. But some of the other things we’re doing in weight loss aren’t they’re kind of a little more surgical and putting together a bundle that is going to be something that is either a cash pays or you’re going to build it into new things. We’re going to find a way to get to payers and say, look at what we’ve done. We now have long term results that are worth us considering some of those things. So we had a component here of the business that was 15 years into the process of trying to deliver care in a more affordable fashion with high quality. And we were right at the peak of when transparency was finally starting to get to some real hooks, I think. So all that kind of came together into these big ideas of what if we took the best folks we know that we’re kind of aligned and we work together and we had a very easy entry into a surgery center. Can we make something like this happen? We then went to a bunch of consultants, and we started kind of getting an idea about who we might want to talk to, who would be a corporate partner that was thinking a little different in the space. We are intending to use our existing business to build out as a business service, all under a tax ID, slowly assimilate the practices as much as we can. You want consultants that have done this a lot. You want people that can guide you and not down the wrong path and pivot if you need to. And I think that’s been very key. We would like to see that. At the end of the day, we’ve executed our steps and our business model has exit ramps. We thought long and hard about this and we do think that you get a target on your back for acquisition when you do this. No matter who you are. Maybe because the way that PEs approach different specialties they’ve gotten through Derm and Opto and Ortho, you know, and their GI was the hot girl at the dance for a while here and it’s going to move on. I mean, I think that there’s going to be other things. So multi-specialty care, there are other areas in the multi-specialty space. When you look at who would you want to bring in like cardiology, there are definitely some things that are changing a little bit and you want to have enough autonomy to continue that path, enough ownership and equity to allow it to be a rewarding independent group. And then you’re going to have to figure out on the corporate side that there will be some ownership, there will be capital, there will be other things that come in for growth purposes and eventually you might end up looking a little more like another existing organization out there. But not GI single specialty probably.
Praveen Suthrum: Let me clarify a few things. So first things first. You didn’t go for a single GI specialty type expansion. You went the multi-specialty route. And I do not know of any other Gastroenterologists in the country who has dropped out of private practice and started up another entity with multispecialty group with the intent of focusing on value-based care. So congratulations on that. Now my question is how is this all funded? Is it all self-funded by the physicians? Did you have to raise money?
Dr. Michael Owens: So we were in this enviable position that our cofounder had an ASC that did mostly GYN, plastics and had done a number of other pain and a few other specialties over the years. It was already capitalized, it was already just went through recertification and contracts were already established. Now maybe contracts need to be renegotiated because we have a bunch of new things and that’s in the works. But we’re able to bring in investors at a pretty low EBITDA because the goal here is to allow more people to become involved because the end result is the key. So you don’t want like a high barrier to entry if you don’t need it and to immediately start work, you get credentialed there wasn’t a ton more capital in the or needed and immediately start generating revenue. We have our banking relationships; we have our next round of syndication closings will be round two. And so the physicians are basically funding the practice and then the remodel of a second center with their equity shares essentially. So this was tailored just to our specific instance. Would it work like copy and paste around the country? It will be very different. I mean, I think if you said let’s do this from a de novo pad out in the middle of a suburb and you were going to put 5 million into an ASC, you’re going to have a lot of different capital needs, right? We are in a situation. We’ve got confirmation today we’re going to be able to expand to our second center with the same tax ID under Medicare. So we have our contracts and it will really not slow us down as much as it might some other situations. So it’s kind of an expansion that is de novo situation. But we did go through a very lengthy process on articles of incorporation and the operating agreement to set up this particular version, I guess, of how you would model it.
Praveen Suthrum: Got it. And I’m assuming your partners I’m asking this because I’m sure other people will have similar questions. So the partners in this venture, I’m sure they were already part of other practices. There are other specialties, other practices. They might have been part of other surgery centers. So have they left that and come on full time this venture or are they still doing that and then this is part time? How does that work?
Dr. Michael Owens: They are all independent practices. So they each have, I think we have nine different practices now. And so they each have all the components of their practice. They each are very interested in the benefits of us taking over time, all those practices under one roof for reasons everyone can imagine, right? And I think that’s where more opportunity has presented itself. So we had these steps of one surgery center cranking you’re there. It’s not big enough for all of us. We’re going to have our expansion coming. We have the business putting our practices together. How is that going to benefit? As you can imagine, things that people really want. They want to get that network effect for leverage, for contracting. But we’re bringing in the transparency data. We’re going to try and look at this from a number of different angles because of our timing. We may try to align sooner than we bought on some of those things. But it’s been almost entirely group dynamics, opportunity, the people involved, and I think for innovative thinkers, but I think it made it easier for us to convince people to come together around this. And the pressure about that independent practice is not an insignificant part. I think the ability to say we all feel the same, many of us have been through similar kinds of things and see the opportunity to try, like it or not, to maintain an independent practice as long as possible is worth it.
Praveen Suthrum: Like you, your other partners also did not want to join private equity groups or the hospital or larger groups. They do not do that. Okay.
Dr. Michael Owens: No, they’re very much aligned around the idea that maintaining your autonomy and independent practices it is and how they’ve done things.
Praveen Suthrum: Now Mike, other than the business aspect or the business arrangement itself of coming together in a multi-specialty environment, are there any correlations that you’re seeing in terms of patient care itself? Are there any links that you’re seeing from GI to some other specialties or it’s too early to say all that.
Dr. Michael Owens: That’s been very clear with the women’s clinic and women’s care, whether there’s in total amongst a couple of the practices and there’s some things in development might be 10,000 patient lives and fatty liver is a giant issue, as you know. And that was an immediate alignment amongst four or five of us, the pelvic floor, endometriosis and our colorectal surgeon, our pain specialist GYN, GI, the way that our work in the microbiome overlaps in a lot of this care. But what’s missing, we are not yet looking at complex IBD, some complex liver disease. We’ve not built around those ideas because we really were required, and I think it was an intentional choice to build around outpatient procedural and surgical care first because that’s kind of where the business model evolved from. It is a little more surprising how much the clinical care aligned. It happens. I mean, our GYN surgeon just the other night was in late at the hospital taking care of a patient and just happened to bump into one of our foregut surgeons and was like, well, what do we think about this? And she’s like, Let me have a look. That’s like any good group, I think any larger multi-specialty group employed situations, you would see those interactions and alignment. I think the difference is we’re in control and I think when it comes to price points, we all can look at each other and say what makes sense? Because you have three hats on when you’re sitting there thinking about this, right? You want to deliver that value-based proposition. You got to support the centre so that it’s functional and you don’t lose money. So you’re trying to figure out where is that sweet spot? And we keep sort of finding it. I think that there is when you look at it from a procedural aspect, it’s easy to wrap your head around the costs and it’s easy to figure out how to bundle things together. It’s a little harder when you’re looking at it from a payer’s perspective or a hostel’s perspective and looking at the total service line as a silo. I just think there’s different inputs and outputs from those thought processes.
Praveen Suthrum: So you’ve talked about pricing transparency and negotiating with insurance companies and so on. So is this model lending itself better than let’s say a single specialty GI model to negotiate better with insurance companies. Or is it again.
Dr. Michael Owens: But I can say that the sessions that we’ve had on a system level with different people who are not physicians. Who are in administrative roles and financial roles. It’s very attractive when people are looking at strategy for their health systems and their health plans. They found this type of innovative thinking to be very attractive as it materialized in a way that I can give you numbers and like, everyone should do this. Of course not. And we’re aware that those are moving pieces and it’s very difficult right now because I think everyone’s trying to sort out what is the future and what do we do and if there’s any criticisms of what we’ve taken on. It’s like, okay, well, what about your Crohn’s patients? And it’s like, well, we’re just not yet building the program, but we’ll get there. What about other specialties that are not proceduralist? You know, well, that might be difficult because we’ve had to build this around the ASC space. Where will we bring those in? So, for example, Endocrinology makes a lot of sense in our comprehensive weight loss program. How do we bring them in? We’re going to have to wrestle with some of that piece by piece. If you’re an existing multi-specialty group, which there are many, you’ve seen how they run their ASC, how things move around in the financial pieces. So there’s some trade-offs and ideally there’s a different delivery system of healthcare in the US. And it’s not fee for services and a lot of this gets solved. But in the meantime, here’s what we can do. And so that’s what we’re putting our efforts into.
Praveen Suthrum: Can you outline what innovations are happening in your business that are different from other multispecialty or other private practice companies and so on.
Dr. Michael Owens: Other than, you know, bringing together all these specialists under one tax ID, working together to deliver care at lower cost, which is part of the biggest innovation. The GI related areas, I think that have changed because I got to rethink colonoscopy from the ground up. We decided to do things a little different. We don’t have like a group of 60 doctors with like three committees taking six months to pick which prep we use. So there’s benefits, right? We rejiggered our day around our ASC because there’s not as many people needing to get in to get their cases done from the physician like productivity side. We’re doing mostly same day preps and we’re doing that 5 hour before the two-hour NPO window. And it’s been going great. And patients love it. I love it. I’m not having people up all night. They’re not calling me all night; they’re not suffering all night. That has been wonderful. Now in the morning we’re doing uppers, we’re doing our diabetics, we’re doing our constipation patients, right? So we just kind of like piece that together a little bit different and then we’ve been able to move a little bit faster. We just saw and are going to do a little pilot with the happy colon, low residue food prep for people that don’t necessarily want to have clear liquid and then a morning day of prep high GI care, which is finally like a little bit more accepted. I know there’s some variability in the data of hydrotherapy for colon preps. We have people that are touted to be experts at colonics in Portland, Oregon. And so I’ve been learning all about that world and it’s fascinating that we were so against the idea of clinics and danger, and these are real concerns. But there are people who’ve been doing things in a way that, like, doctors in medicine just haven’t thought. And so will that become like, another great area of care while we’re getting data? Now we’re getting it from large PE firms and GI groups that are building centers for IG Fair. And it may not take off, but it’s starting. But what’s more interesting in our microbiome work, if you take the Effluent from a colonic and you study it with a spontaneously passed stool, the diversity of organisms is not the same. So we really kind of thought more about what can we do different for the patients, for their procedure. We looked at all the single use devices that are out there. We are waiting, really for the prototypes and then pricing to decide. Is that where we’ll head? But here’s an opportunity as we’re going from one to two to three to four rooms. What if we don’t want to drop three to $400,000 a room when colonoscopy volumes may go down 30, 40% in three or four years? Doesn’t make any sense.
The quality programs we’ve done all the ASGE basically level quality programs to maintain our data. However, I think that we’re being clear with patients already. Why do you want to have your colonoscopy 45, 55, 60 that first colonoscopy, and we’re seeing Cologuard. Now they’re doing 750,000 tests a quarter. You kind of know where that’s headed. There’s how many hundred? Some companies, 150 working on these approaches. Right. You’ve had people on talking about the RNA based approach and there’s folks looking at the microbiome and poly detection, which is insane, but it’s not bad. And we know these things will slot, and I think we have a lot of incentive to not do fewer colonoscopies out there. And, I mean, the PE world has brought that to the table and their arbitrage events and second bites and how that will look. And I think some of the folks that are national societies and point out, like, the flaws and some of the data which are real, but they’re not assimilating at all. I mean, there’s really no reason to think that someone who is put into a low-risk category with their first colonoscopy, which is like 90% right. AI altering like, 3% of the patients into like, a high risk scenario is not going to save us in colonoscopy. Right. And what’s even funnier about that, if you think about it, colonoscopy has a certain performance characteristic that it was only able to do so well at seeing so many polyps. And if that lower performance test saw three small polyps, that was high risk. Well, if you have a new test with AI that can double the ability to detect those little things, it doesn’t mean that person is high risk. When they get to three, it might be ten, it could be twelve. Because now you’re seeing the things that you didn’t know were there before. And with the old test, you knew you could now wait seven to ten years. You can’t say, well, I’m going to go find a few more with AI now I can say they’re high risk, right? It’s a different test. So I think that a lot of this is going to end up in two to three years people becoming more and more cognizant of alternatives. I think that if you read Exact Sciences quarterly reports and you listen to their earnings calls, you kind of get a hint on where they’re headed. They’re already saying, the Blue-C trial, they could stop today and probably use that data, but they’re going to keep going until next year. I think we should all be honest, really going to want to look at what we’re going to spend our time on. And so there’s a bunch of thinkers out there think, you know, are like me. They have the time. They don’t have that pressure to meet their RVU in an employee position or whatever their partners in their large group want them or their PE firm wants them to do. You’re bringing all these people together to think, okay, what do you do with your time? What are you going to do with the specialty? And it’s like, oh, my God, why have we not paid attention? The microbiome is enormously interesting. It’s like our world, and we’ve not yet really accomplished what we need to.
I just finished watching today, the Illumina Genomics conference. One of my colleagues from WashU, J. Wilson, at his CMO at Quest Diagnostics and just talking about where they’re headed, looking at Pharmacokinetics. And he said the problem is everything has been built for the provider in the hospital, but not the patient. So they’re basically getting pharmacogenetics to the patient, who then takes it to the pharmacist, who then says, here’s the drug issues, here’s the dose, here’s what you need. And then they’re calling the doctor to let them know, here’s what we found. They’re like in running around that to bring genomics to the masses. If we’re going to be doing Cologuard, you know, eventually if this is a part of the primary career world, we’re going to get cut out from the decision making and then think about how they’re delivering panels. So you may not really like the Cologuards out there or the next epiphy propoline, but it’s a panel now with 15 other common cancers. So parent care not going to do that. And maybe they still believe in colonoscopy, but now you have this result from the genomics test, and the patient wants that, where are we going to fit? And I think it’s going to be patient risk stratification. There was a recent study from Asia where they tried to kind of do a little bit of high risk, low risk. Where stool testing with entity A go into the algorithm? And it was 75% accurate for advanced polyps in low-risk people, right? So I love the idea of thinking about these combination strategies, risk stratification as the performance characteristics of these nonvisual tests go up, which they will because the science is real, the cost goes down and all of a sudden your compliance goes up and then it’s a win for the disease management and it’s a win for the patient. And I think GI docs is going to have to think about this is win for you. This is time for you to like, let’s look at the bigger picture of what else can we do.
Praveen Suthrum: It’s concerning. It’s amazing. It’s all these things together, right. Final question, Mike is, and you’ve been talking about it, I think you dropped enough clues throughout this conversation. But if you look ahead, not just two to three years, but let’s pick a number like five years from now, okay. What changes do you see in private practice, Gastroenterology or GI as a space as a whole?
Dr. Michael Owens: Well, if I were I don’t think he was pessimistic, but when Larry was on recently and he pointed out, you know, people have their head in the sand and the colonoscopy factories, et cetera, I would wonder about five years, I think for sure. I would wonder what are we going to do with all those GI rooms and what are half of my partners going to be doing all day? And I think that one thing that maybe a little cynically makes me feel like this model we’re building is interesting. I have seven people doing endoscopy and colonoscopy, but half of them do surgery. And we used to look at that as competition. We used to look at it as turf battles. The training is different, but it’s changing a little bit over time in big centers. And the trainees coming out are really somewhat very talented endoscopists, but they can do a lot more than I can do as a GI doc, too. They have this whole other area that I don’t have now, probably that’s complimentary because I’m going to have a GI team that is way down the road on the microbiome and Chrons. We’re not going to be ignoring it anymore, as you pointed out, I think in your newsletter right, there’s already almost a $2 million raise for the Gusto the probiotic like proprietary mix and the mouse model benefits are all that we have. But the data is kind of sound. It’s been there. That will probably get there. Therapies and monitoring are going to finally address weight loss, right. And it’s not just genomic, right. We know that there’s these phenotype variants that are happening somewhere between nature and nurture that we’re going to need to figure out and we’re starting to sort out some of those different phenotypes, right?
I think that there’s going to be areas of therapeutic endoscopy that are very specialized and are really going to continue to move towards working more and more with a lot of people that are not really just gastroenterologists of the old version. Like we mentioned, I think once in our last talk, AI is going to be just sorting a lot of the complexity for us. I don’t think we’re going to be finding a lot of little polyps that really aren’t going to make a difference. It will be this person doesn’t need a colonoscopy because these panels from the microbiome are telling us this person is okay and we changed their diet and they got more bacterias and the thermophilities is lower. Right. I think those are probably the angles we should look at and maybe we’re spending a little more time with the patients. We’re going to be comfortable with a little less revenue because our quality life and our intellectual stimulation is going to be so high. We’ll have less repetitive motion injuries. I think those are all very possible. Will there be independent practices still? I don’t know. We’re going to try.
Praveen Suthrum: No, I’ll reserve my thoughts for later on whether there would be independent GI practice, but just very quickly. Yeah, that would be there will always be the old with the new because there will be some aspects of any industry that will not change or that will take a really long time to change. But in closing, Mike, any final words of wisdom, like in a minute or two to people who are out there who might be in your shoes from, let’s say, 2020, from a couple of years ago when you were contemplating reflecting and you were at crossroads deciding what to do, what would your advice be to them?
Dr. Michael Owens: Because I think I’ve had these conversations lately. I think if you’re bringing on capital, if you’re going to bring on a liquidity, you’re going to bring on other people that are non-clinical. Think hard about that because you really can and maybe should maintain ownership amongst people who are providing the care and generating. And you really have to think carefully about the value of large sales where you’re losing autonomy and what the value really is. And I think that the PE firms and VC that’s coming behind them are thinking that way. And I think that if you’re in a situation where your group does still decide to go down that path for maybe the typical reasons of exit strategies for some of the older docs we’ve seen down the road, what kind of happens. Start thinking about these other models where you maybe two or three of your other aligned physicians in your doctor group start looking at what else could we do here? Right? So try and maybe not give away the whole boat. And if you’re in a group where you do start talking to your folks that you think are aligned about what are we going to do next?
Praveen Suthrum: Mike, this was fantastic. I really enjoyed listening to your views again and some of these conversations we’ve had before. But the way you’ve outlined and connected the dots, I’m sure many in the audience would benefit from it. Thank you so much for coming on The Scope Forward Show.
Dr. Michael Owens: Thank you so much. It was a pleasure. Thank You.
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.
05 Nov 2022

Curated GI articles November 4th, 2022: 2023 Medicare fees – Mixed news for GI | At-home gut test for babies raises $4.5M | FDA okays implant for GERD

Curated GI articles November 4th, 2022:
2023 Medicare fees – Mixed news for GI | At-home gut test for babies raises $4.5M | FDA okays implant for GERD
SF Interview- Dr. Michael Owens: “What would I do with my time if I’m not doing as many colonoscopies?” (NextServices)
In this episode, Praveen Suthrum interviews Dr. Michael Owens (Physician & Co-founder, Pearl Health Partners). Find out what led Dr. Owens to leave a large GI group to start up a multi-specialty GI group and more in the latest interview.
2023 Medicare Payment Policies Are Mixed News for GI (Joint statement by ACG, AGA, ASGE)
The 2023 Physician Fee Schedule conversion factor — which calculates how much a physician is reimbursed by Medicare for services — changed to $33.06, a $1.55 decrease from 2022 at $34.61.
The evolution of gastroenterologist pay (Becker’s GI & Endoscopy)
Gastroenterologist compensation has increased by $111,000 on average since 2012. It took a dive between 2019 and 2020, but has continued to rise since.
The Different Facets of GI Leadership with Amy Oxentenko, MD (Healio)
In this podcast episode, Amy Oxentenko, MD, discusses the importance of adapting in her leadership roles and shares her thoughts on creating transparent, inclusive spaces in practice, and more.
Innovation in GI: What’s the next big thing? (MDedge)
Innovation is driving major advances in endoscopy and attracting many to Gastroenterology. In this issue of Perspectives, two experts present their thoughts on current hot topics in GI.
Tiny Health, an at-home gut test for babies and moms, raises $4.5M (Vator News)
Tiny Health works by sending customers a non-invasive, at-home test kit with simple instructions for a stool sample. The test takes no more than five minutes.
‘Every day there is a new player in the ASC space’: 5 leaders weigh in on private equity (Becker’s ASC)
Neal Kaushal, MD (Chief of Gastroenterology and Chair of the Department of Medicine at Adventist Health) and four leaders joined Becker’s to discuss private equity’s influence in the ASC industry.
Exact Sciences Announces Third Quarter 2022 Results (PR Newswire)
The molecular diagnostics company posted revenue of $523.1 million and a loss of $148.8 million in its third quarter.
Considerations for physician practice mergers (Physicians Practice)
The decision to buy, sell, or merge a medical practice is more complicated than ever, and determining a medical practice’s worth is just one element crucial to this process.
13 Highlights From the American College of Gastroenterology’s 2022 Meeting (Medscape)
David Johnson, MD (professor of medicine and chief of gastroenterology at Eastern Virginia Medical School) on the most provocative highlights from ACG 2022.
How this Georgia doctor is helping IBD patients outside the office (11 Alive)
Dr. Aja McCutchen created a create a “whole patient approach” support group to educated underrepresented communities when it comes to IBD diagnoses. Dr. McCutchen discussed the importance of paying attention to diversity and inclusion in GI on The Scope Forward show.
FDA backs EndoStim’s neurostimulation implant for GERD control (Healio)
The device is implanted laparoscopically and designed to provide long-term reflux control via automatically delivered mild electrical signals to the lower esophageal sphincter throughout the day.
Adventist Health Sonora launches fundraising efforts for new $14 million digestive health center
(The Union Democrat)
The fundraising aims to expand the ability to provide gastroenterology services, including colon cancer screenings and treatments.
Legal and Malpractice Risks When Taking Call (Medscape)
Physicians who violate the bylaws may have their privileges restricted or removed. They could also be sued for malpractice, even if they never treated the patient.
The GastroIntestinal Research Foundation Launches New Multi-Million Dollar Funding Initiative Aimed at Curing Cancers of the Digestive System (Globe Newswire)
Despite its prevalence, colon cancer research is grossly underfunded. CA CURE will quickly put vital research dollars in the hands of leading scientists.
Improving Bowel Preparation For Inpatient Colonoscopy: A Proactive Approach (GI & Endoscopy News)
Achieving adequate bowel preparation is challenging but critical to achieve a good-quality colonoscopy. Inadequate bowel prep is responsible for up to one-third of all incomplete colonoscopies.
Comparison of focal cryoballoon ablation with 10- and 8-second doses for treatment of Barrett’s esophagus–related neoplasia: results from a prospective European multicenter study (with video) (GIE)
The current study aimed to compare the efficacy and safety of a single FCBA treatment session with 10 seconds versus 8 seconds.
Distal cap-assisted endoscopic mucosal resection safe, effective for fibrotic polyps (Healio)
Distal cap-assisted endoscopic mucosal resection is safe and effective for managing non-lifting and fibrotic colorectal polyps, according to a multicenter study.

More Hot headlines in GI

How to Infuse Joy in Your Practice: Our Journey to Sustainable Well-Being (American Journal of Gastroenterology)

First-Degree Relatives Of Patients With NAFLD At Risk Of Developing Liver Disease (Medical Dialogues)

Omnivision and AdaptivEndo partner on hybrid and single-use endoscopes (Medtech News)

COVID Infection Disrupts the Gut’s Microbiome (WebMD)

Heather Armstrong on How Some Dietary Fibers Worsen IBD (Medpage Today)

Alimentiv, Summit Clinical Research Announce Collaboration to drive Non-Alcoholic Steatohepatitis (NASH) Clinical Trials (PR Newswire)

Acute Massive Gastrointestinal Bleeding Caused by Ascaris lumbricoides Infection: A Case Report (Cureus)

Gut Microbiome Studied for Effect On Weight Loss After Physical Activity (GI & Endoscopy News)

Mauna Kea Technologies Announces Success of Clinical Trial on Prediction of Remission in Patients with Inflammatory Bowel Disease (IBD) and its Publication in Gastroenterology (Business Wire)

Endoscopic Sleeve Gastroplasty For Weight Loss Impressive in Trial (GI & Endoscopy News)

Videos: Interviews with GI Leaders  (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.
29 Oct 2022

Curated GI articles October 28th, 2022: Gorilla in the room – Even experts miss polyps | DOJ to scrutinize PE | Gut app for “whole self”

Curated GI articles October 28th, 2022:
Gorilla in the room – Even experts miss polyps | DOJ to scrutinize PE | Gut app for “whole self”
COVID Lawsuits Have Arrived: Which Doctors Are at Risk? (Medscape)
New data reflect the grim news: COVID claims have arrived. Complaints of delayed care associated with the pandemic are also on the rise. Are GIs at risk?
Gorilla in the room: Even experts can miss polyps at colonoscopy and how AI helps complex visual perception tasks (Science Direct)
Is there a gorilla in the endoscopy room? Some educated hypotheses on how AI can support endoscopists in detecting colon polyps.
An App for Gut Health Using “Whole Self Science” – Jeff Glueck, CEO and Co-Founder at Salvo Health (Osmosis)
Tune in to find out about Salvo’s “Whole Self Science” approach that incorporates diet, mind, movement, sleep, labs, and more for people suffering from chronic GI conditions.
Clinical Practice Update: How to manage refractory celiac disease (AGA)
AGA has released a new Clinical Practice Update providing best practice advice on the diagnosis and management of refractory celiac disease.
Gastroenterologists’ top priorities before the end of the year (Becker’s GI & Endoscopy)
From increased colorectal cancer screenings to improving care access, four gastroenterologists joined Becker’s to discuss their top priorities to close out the year.
The FTC and DOJ have vowed to scrutinize private equity deals. Here’s what it means for healthcare (Fierce Healthcare)
Austin Ownbey, an antitrust attorney, suspects those being targeted will include verticals with promising returns from consolidation, namely outpatient services like gastroenterology, ambulatory and wound care centers.
Exact Sciences Expands Leadership in CRC Screening with New Data Presented at the ACG 2022 Annual Meeting (PR Newswire)
Data presentations include positive impact of eliminating patient cost for follow-up colonoscopies, shifting to non-invasive colorectal cancer testing, and increasing overall screening.
Independent physicians struggle as hospitals get larger and larger (Modern Healthcare)
The loss of independent physician practices threatens to fundamentally reshape the historical relationship between doctors and patients as more doctors become beholden to their employers instead of the people they treat.
Neurogastroenterology: What is it and what does it have to do with endoscopy? (GIE)
Dr Doug Adler, GIE Editor-in-Chief, chats with Dr Laura Pace in this Special Edition podcast, “Neurogastroenterology: What is it and what does it have to do with endoscopy?”
Noninvasive Tests for NASH Reducing Need for Biopsies (GI & Endoscopy News)
An approach that uses the FIB-4 score along with the results of noninvasive tests can identify high-risk patients with nonalcoholic steatohepatitis without requiring liver biopsies.
Prior authorization: Burden on physicians and recommendations for change (Healthcare Economist)
In a recent survey of 1004 physicians, 88% reported that the burden associated with prior authorization requirements was high or extremely high.
Computer-Assisted Diagnosis Brings Gastroenterology into the Future (Mayo Clinic Platform)
Despite some skepticism about the usefulness of AI in clinical medicine, there’s ample evidence to show CAD-assisted colonoscopy can save lives.
Lumea Partners with Granite Peaks to Advance Gastrointestinal Digital Pathology (Newswires)
Granite Peaks is the first GI group to implement Lumea’s game changing AI-enabled digital pathology solution throughout its practice.
Aasma Shaukat, MD, MPH: The Current State of Colorectal Cancer Screenings (HCP Live)
In an interview, Aasma Shaukat, MD, MPH, explained how damaging the pandemic was toward the goal of 80% CRC screenings for individuals aged 45 years and older.
Gastro Health’s Dr. Daniel J. Pambianco Elected President of the American College of Gastroenterology (Gastro Health)
Dr. Pambianco is a practicing gastroenterologist and managing partner of Gastro Health in Charlottesville and the founder of Charlottesville Medical Research.
Virtual reality may improve symptoms, quality of life in functional dyspepsia (Healio)
Virtual reality significantly improved symptoms and quality of life in a small subset of patients with functional dyspepsia, a presenter said at the ACG Annual Scientific Meeting.
Risk Factors ID’d for Acute Pancreatitis From Weight-Loss Drugs (Medscape)
Several factors appear to influence the risk for acute pancreatitis among patients who start taking glucagon-like peptide (GLP-1) receptor agonist medications for weight management, a new study has found.
FMT in IBS: ‘We’ve been targeting the wrong part of the intestine’ (MDedge)
FMT into the small intestine led to a better response rate of longer duration in patients with irritable bowel syndrome (IBS), vs. it being administered into the large intestine, according to a new study.
The unhealthy state of parental leave policies in gastroenterology: A call to action (Healio)
Despite strong evidence of the mental and physical health benefits of paid parental leave on parents, children and the community, the Unites States is one of only six countries that does not offer it.
$3.6 million grant backs effort to better treat Crohn’s disease (EurekAlert)
Researchers plan to build a sophisticated computer model to interpret the internal workings of cells in the ileum, a section of the small intestine often stricken by Crohn’s.

More Hot headlines in GI

Iterative Health Expands Team with New Senior Vice President of Technology, Jeremy Freeman, and Vice President of Sales, Scott Lish (Business Wire)

Only two-thirds of patients with young-onset CRC receive referrals for genetic counseling (Healio)

4 United Digestive moves in 2022 (Becker’s GI & Endoscopy)

Jordan Axelrad, MD, MPH: The State of IBD Care at ACG (HCP Live)

Patients with HIV and NAFLD at an Increased Risk of Cardiovascular Disease (HCP Live)

Exploring Four Practice Models for Today’s GI Physician (ASGE)

Motus GI Announces Positive Clinical Data for Pure-Vu EVS in Three Poster Presentations at the American College of Gastroenterology (ACG) 2022 Annual Scientific Meeting (Globe Newswire)

Digestive and mental health are closely connected and thanks to our gut microbes, scientists may know why (Gut Microbiota For Health)

10 physician memoirs that offer inspiring accounts of life in medicine (AMA)

Report from ACG ’22: Study Assesses Learning Curve for Transition to Disposable Duodenoscopes (GI & Endoscopy News)

Better outcomes achieved with cap-assisted endoscopic removal for esophageal impaction (Healio)

Walmart opening 16 primary care health centers by fall 2023 (Medical Economics)

Risk Factors ID’d for Acute Pancreatitis From Weight-Loss Drugs (Medscape)

Videos: Interviews with GI Leaders  (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.
22 Oct 2022

Curated GI articles October 21st, 2022: Is FIT an effective alternative to costly screening tests? (ACS) | Future of microbiome therapeutics

Curated GI articles October 21st, 2022:
Is FIT an effective alternative to costly screening tests? (ACS) | Future of microbiome therapeutics
Where GI execs are seeing the greatest opportunity (Becker’s GI & Endoscopy)
U.S. Digestive Health CEO Jerry Tillinger and Latha Alaparthi, MD, president and chair of the board of directors of the Digestive Health Physicians Association on three key areas within GI where opportunity is ripe.
Study finds less expensive noninvasive test is an effective alternative to a more costly test for colorectal cancer screening (American College of Surgeons)
About 60% of patients taking both tests at home had early-stage cancer, but a fecal immunochemical test detected it at one-fifth the cost according to a large claims database analysis.
New Ways to Prevent Esophageal Cancer (make screening for Barrett’s more accessible, less expensive) (Gastro Broadcast)
Dr. Michael Weinstein interviews Dr. Prasad Iyer about new approaches to screening patients and detecting earlier stages of Barrett’s esophagus and associated dysplasia that can prevent esophageal cancer.
Gastroenterologists’ secrets to success (Becker’s GI & Endoscopy)
Three gastroenterologists joined Becker’s to discuss their secrets to success.
AGA releases first guideline ranking most effective anti-obesity medications (Healio)
The AGA has released its first guideline endorsing the use of four medications for obesity management, when paired with lifestyle interventions, for patients who have failed to lose weight with diet and exercise alone.
Updated ACG-CAG Guideline on Management of Periprocedural Bleeding (GI & Endoscopy News)
Lead author Neena S. Abraham, MD, a professor of medicine and consultant in the Division of Gastroenterology and Hepatology at Mayo Clinic in Scottsdale, Ariz., about the impetus for the guideline and what it means to GI practice.
AI in GI: Diagnosis, Detection and Improved Efficiency (GI & Endoscopy News)
At the ACG’s 2022 Global Gastroenterology and AI Summit, experts discussed various ways in which AI can be deployed in the endoscopy suite to improve GI practice.
For stomach pain and other IBS symptoms, new apps can bring relief (NPR)
A new treatment approach helps people with IBS symptoms like stomach pain, bloating and diarrhea find relief through a combination of dietary and stress management strategies.
10 statistics on gastroenterologists’ wealth, debt (Becker’s GI & Endoscopy)
The article summarizes statistics on gastroenterologist salary, wealth and debt.
Closing the Gaps in CRC Screening: Shared Decision-Making in Practice (ReachMD)
Dr. Charles Turck interviews gastroenterologist Dr. Harish Gagneja and primary care physician Dr. Robert Baldor on how to work with patients to select the best screening option and coordinate the patient’s care with other providers.
The Future of Microbiome-based Therapeutics (Medscape)
The review summarises the current developments in microbiome-based medicines and provides insight into the next steps required for therapeutic development.
Newer Endoscopic Bariatric Technique Helps Control NAFLD (GI & Endoscopy News)
The recently developed minimally invasive anti-obesity procedure, primary obesity surgery endoluminal 2.0, can reverse nonalcoholic fatty liver disease, according to a controlled trial.
Apple Will Launch Health Insurance In 2024, Says Analyst (Forbes)
Apple will start to offer health insurance in 2024 as it looks to build on the health data it has acquired from the Apple Watch, an analyst has predicted.
Will Physician Practices Survive? (Healthcare IT Today)
The podcast dives into the challenges that physician practices face, which technology will have the most impact, and organizations to look out for when it comes to physician practices.
Iterative Health Redefines Approach to Precision GI Care (Business Wire)
Iterative Health, formerly known as Iterative Scopes, has announced a rebrand to reflect the company’s success in utilizing AI to strengthen clinical research and augment clinical decision making within gastroenterology.
New AGA course to help GIs increase CRC screenings (AGA)
AGA’s Colorectal Cancer: Screening to Save Lives is designed to help gastroenterologists increase screening among newly recommended age groups and high-risk populations.
GI OnDEMAND Announces Partnership with Trellus Health Enabling Gastroenterology Practices Nationwide to Provide Coordinated and Personalized Psychosocial and Nutritional Support for all Patients with IBD (PR Newswire)
GI OnDEMAND, a joint venture between the ACG and Gastro Girl, Inc., will now offer access to the Trellus scientifically validated resilience training and self-management program.
GI OnDEMAND Partnership with Mindset Health/Nerva Makes It Easy for Gastroenterology Practices Nationwide to Deliver Gut-Directed Hypnotherapy to Their IBS Patients (PR Newswire)
Nerva is a 6-week gut-directed hypnotherapy program, delivered through a mobile app to help patients with IBS better manage their symptoms.
CliniOps Announces Strategic Partnership With My Total Health (Newswire)
The collaboration will accelerate and streamline gastroenterology (GI) clinical trials with an end-to-end platform for patient recruitment, enrollment, and management.
Medtronic, MNGI bring artificial intelligence to Twin Cities colonoscopy exams (Star Tribune)
Earlier this year, MNGI conducted a three-month pilot trial with four GI Genius machines at its Plymouth location. During its trial, MNGI saw its ADR increase 17%.

More Hot headlines in GI

Media campaigns improve bowel cancer screening rates (Healio)

Do Crohn’s Patients Do Better With Early Surgery? (Medpage Today)

VA Study Assesses CRC Risk 20 Years After Baseline Screen (GI & Endoscopy News)

Fujifilm in GI: 5 updates this year (Becker’s GI and Endoscopy)

Machine Learning Model Predicts Inpatient Mortality for IBD Patients (HCP Live)

9 Meters Biopharma to Present at the American College of Gastroenterology (ACG) 2022 Annual Scientific Meeting (Market Wire News)

BGL Announces the Real Estate Sale of Gastroenterology Health Partners (PR Newswire)

Preparing for the Inevitable: Protecting Hospitals and Physician Groups From Cybercrimes (Lexology)

MedStar Health welcomes gastroenterologist Mark Real to MedStar Southern Maryland Hospital Center (The Southern Maryland Chronicle)

2023 Gastroenterology Reimbursement and Coding Update Course (ASGE)

Artificial Intelligence in medicine: what it means for primary care (Medical Economics)

6 ways to defeat physician fatigue (MedCity News)

Videos: Interviews with GI Leaders  (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.
15 Oct 2022

Curated GI articles October 14th, 2022: Controversial study questions effectiveness of colonoscopy – US docs push back

Curated GI articles October 14th, 2022:
Controversial study questions effectiveness of colonoscopy – US docs push back
Colonoscopies save lives. Doctors push back against European study that casts doubt (NPR)
A new European study grabbed headlines this week, as it seemed to question the efficacy of colonoscopies as a cancer screening tool. But U.S. physicians say there were big limits to that study. The AGA also released a statement on the controversial data.
Why consolidation doesn’t work for ASCs (Becker’s ASC)
As an industry built on independent centers, the ASC market has remained fragmented amid increasing healthcare consolidation.
Dr. James Leavitt – Private Equity (The Scope with Dr. K)
In this exclusive, host Dr. Lawrence Kosinski sits down with Dr. James Leavitt, the founder of Gastro Health and the “father of private equity in gastroenterology”.
Iterative Scopes Partners with One GI® to Advance Gastrointestinal Care Through AI (Business Wire)
The partnership between the two organizations will allow One GI® physicians to standardize the endoscopic scoring process for patients and identify eligible patients to enroll in IBD clinical trials.
New CPU alert: Endoscopic approach to recurrent acute and chronic pancreatitis (AGA)
Eight best practice advice statements plus a quick video from one of the authors, Dr. Dennis Yang.
Eli Lilly Bets Nearly $500M on Metabolic Disease Pact with Nimbus (BioSpace)
Eli Lilly is forecasting that Nimbus Therapeutics will discover new therapies for treating diabetes, obesity, and related disorders.
One in 4 clinicians want to leave healthcare, citing burnout. Here’s what providers can do to stem the tide (Fierce Healthcare)
Research also shows that around half of clinicians surveyed report their mental health has declined since the start of the pandemic.
Expert Perspectives on PPI Prescribing & Monitoring Patterns (GI Insights)
Dr. David Leiman, Assistant Professor of Medicine at Duke University School of Medicine, joins Dr. Peter Buch to discuss how PPIs can be utilized with patients.
SonarMD Chief Medical Officer Develops eNose Technology to Promote Gut Health (SonarMD)
The VOCnomics device, called an eNose, detects volatile organic compounds (VOCs) emitted from fermentation of resistant starch by the fecal microbiome. Dr. Kosinski spoke about the origin of VOCnomics on The Scope Forward Show.
GI Genius™ named to FORTUNE 2022 ‘Change the World’ list (Medtronic)
The GI Genius module is the first commercially available computer-aided detection system using AI. This is the second time Medtronic has been named to FORTUNE’s annual ‘Change the World’ list.
Negative hospital experience for IBD linked to development of posttraumatic stress (Healio)
Patients with poorly managed anxiety and pain during hospitalization had the highest risk for developing inflammatory bowel disease-related posttraumatic stress.
Mentorship Key to Improving GI, Hepatology Workforce Diversity (Medscape)
Five gastroenterology and hepatology societies partnered with investigators at UCLA to develop a 33-question electronic survey “to determine perspectives of current racial, ethnic, and gender diversity within GI and hepatology.
Will AI affect the burden of patient surveillance after polyp removal? (MDedge)
While the use of AI during colonoscopy may contribute to improved cancer prevention, it may also add to patient burden in terms of increased colonoscopy frequency and, in turn, health care costs.
MGMA survey: New good faith estimates causing extreme burdens for physician practices (Fierce Healthcare)
A new requirement of the No Surprises Act for physicians to offer good faith estimates of charges is creating substantial administrative burden.
“Breath testing from the comfort of your home.” Craig Strasnick, on CDI, functional GI disorders, breath testing, digital health and decentralization of medical testing (GI Startup Podcast)
Listen to the podcast as Craig Strasnick speaks on the origins of CDI, their products from breath tests, blood tests to digital health, clinical trials and strategic investments.
Endoscopy device company inks deal to sell products to 1,200+ VA facilities (Becker’s GI & Endoscopy)
Through the partnership, UroViu will be able to provide endoscopy equipment to U.S. government facilities, including more than 1,200 Defense Department and Veterans Affairs healthcare facilities.
Walmart steps into clinical trials, joining rivals Walgreens, CVS (Healthcare Dive)
Walmart said the venture is meant to improve diversity in clinical trials, focusing on interventions and medications that can make an impact in underrepresented communities.
World-renowned Gastroenterologist to Livestream Milestone Weight Loss Procedure (Business Wire)
Dr. Christopher McGowan will live stream his 2,000th Endoscopic Sleeve Gastroplasty on October 15th, allowing prospective patients and physician colleagues to see how the procedure is performed and to ask questions in real-time.
VIDEO: Bowel urgency ‘dominates burden, fear of incontinence’ in UC (Healio)
Simon Travis, DPhil, FRCP, consultant gastroenterologist the University of Oxford, highlighted the unmet need to treat bowel urgency among patients with ulcerative colitis.
5 gastroenterologists to know (Becker’s GI & Endoscopy)
The list compiled by Becker’s Healthcare highlights five physicians to know who specialize in gastroenterology.

More Hot headlines in GI

2023 Gastroenterology Reimbursement and Coding Update Course (ASGE)

Experts refine nomenclature for eosinophilic GI disorders (MDedge)

Transitions from pediatric to adult IBD care: Incorporating lessons from psychogastroenterology (Frontiers in GI)

Stelara Study Shows Efficacy for Ulcerative Colitis (Drug Topics)

Abivax enrolls first patient in phase 3 ulcerative colitis drug trial (Becker’s GI & Endoscopy)

Seres Therapeutics to Present Clinical Results at IDWeek and American College of Gastroenterology (ACG) 2022 Annual Meeting (Business Wire)

More than half of young gastroenterologists have student debt (Becker’s GI & Endoscopy)

New Albany gastroenterology center under new owners (News and Tribune)

Gastroenterology Market to Touch Valuation of $79.01 Billion by 2028 | Top 4 Players Hold 67% Market Share – SkyQuest Technology (Globe Newswire)

7 gastroenterology tech innovations (Becker’s GI & Endoscopy)

Videos: Interviews with GI Leaders  (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.
08 Oct 2022

Curated GI articles October 7th, 2022: US Digestive Health expands into Delaware | Gastro Health’s 4th acquisition in Ohio

Curated GI articles October 7th, 2022:
US Digestive Health expands into Delaware | Gastro Health’s 4th acquisition in Ohio
Gastro Health Finalizes Partnership with Springfield Gastroenterology (Gastro Health)
This will be Gastro Health’s fourth partnership within the state since late 2020. Springfield Gastroenterology is joining with three physicians and one advanced practice provider (APP).
US Digestive Health Expands Presence into Delaware Through Partnership with Delaware Center for Digestive Care (News Direct)
The partnership with DCDC will bring an additional three locations, two ambulatory surgery centers, over 35 providers, and more than 140 employees to the US Digestive Health Management network.
Alimentiv, Satisfai Health, and Virgo Announce Partnership to use AI-driven technology to Enhance Clinical Trials in IBD and other GI Diseases (PR Newswire)
The partnership enables advanced AI-fueled HD video capture, decision support, and clinical research tools for Alimentiv’s global clinical trial investigator site network.
Gastroenterologist suing Mount Sinai for allegedly refusing to leave building he plans to convert to ASC (Becker’s GI & Endoscopy)
Gastroenterologist Shawn Khodadadian, MD, owner of a three-story building housing Mount Sinai’s Heart Institute in New York City, is suing the health system for $596,000 in alleged unpaid rent.
Demystifying AI and Computer Vision for GIs (GI & Endoscopy News)
Dr. Ashish Atreja speaks with Jason Samarasena, MD, MBA, an interventional gastroenterologist about demystifying AI and computer vision for gastroenterologists.
10 highest-paying cities for mid-career, late-career gastroenterologists (Becker’s GI & Endoscopy)
Dallas is the highest-paying U.S. city for mid-career (eight to 14 years) GIs, while Atlanta is the highest-paying city for late-career (22 to 28 years) GIs.
4 numbers pointing to gastroenterology consolidation (Becker’s GI & Endoscopy)
Healthcare is increasingly consolidating, and gastroenterology is one of the many specialties with physicians migrating to employed models.
AI and the future of endoscopy – how training holds the key (FUJIFILM Healthcare EMEA)
AI can make endoscopy not only more efficient and of higher quality, but can also improve the detection rate of abnormalities.
Medtronic to install 115 GI Genius modules across VA facilities (Mass Device)
Medtronic has announced that its Gastrointestinal Business received a contract to install GI Genius systems at some Veterans Affairs (VA) facilities.
Discovery of a New Liquid Biopsy to Detect Early-Onset Colorectal Cancer (Oncology Times)
The test might be used as part of a routine physical exam for adults who do not have a non-invasive and accurate way to detect the presence of nonhereditary form of CRC.
4 Key Areas of Value-Based Care Transformation (RevCycleIntelligence)
With healthcare spending at an all-time high, value-based care transformation can solve the cost problem while shifting healthcare dollars so providers can focus on population health outcomes.
Barriers physicians face when seeking help for burnout (Medical Economics)
Finding, providing and paying for the best mental health services for physicians is a complicated topic, but there is an easy way to help.
Risk-Adapted Screening Strategy Could Reduce Colonoscopy Use (Medscape)
The Asia-Pacific Colorectal Screening (APCS) scoring system, combined with a stool DNA test, could improve the detection of advanced colorectal neoplasms and limit colonoscopy use, according to a new study.
How to Approach the Silent Epidemic of NAFLD and NASH (Objective Health)
While the medical research being conducted by integrated research providers is inching us closer to medical therapy, there is still a need for awareness to help identify high-risk patients.
October 2022 issue of the American Journal of Gastroenterology (AJG)
The current issue of the American Journal of Gastroenterology includes articles on IBD, dietary interventions, endoscopy, PPIs, Barrett’s Esophagus, liver disease & more, PLUS the new ACG Pregnancy Monograph supplement.
Telemedicine’s current status in Gastroenterology and Hepatology (Medtech Outlook)
Though the COVID-19 public health emergency enabled a rapid large-scale innovation in telehealth, it took some time to gain widespread acceptance in GI & Hepatology.
Four vaccine recommendations for your patients with IBD (AGA)
AGA recommends patients with IBD maintain up-to-date vaccinations, like the flu shot, to protect the body from infections.
Infliximab retreatment results in remission in 35% of patients with Crohn’s disease (Healio)
After previously discontinuing infliximab, 35% of patients with Crohn’s disease achieved remission at 26 weeks with drug retreatment, according to a study.

More Hot headlines in GI

2023 Gastroenterology Reimbursement and Coding Update Course (ASGE)

Air pollution linked to increased IBS incidence (MDedge)

UH Cleveland facility to receive additional GI Genius endoscopy modules (Becker’s GI & Endoscopy)

Q&A: Updated ACG monograph provides guidance for GI care during pregnancy, postpartum (Healio)

Patients Give Thumbs Up to Better-Tasting Bowel Prep in Randomized Trial (GI & Endoscopy News)

AbbVie Highlights Robust Gastroenterology Portfolio with New Data in Crohn’s Disease and Ulcerative Colitis at the UEG Week 2022 (Abbvie)

HHS: Specialty drug costs up more than $300 billion since 2016 (Healio)

Norovirus link to Crohn’s disease may point to new therapies (Science Daily)

Bariatric Surgery May Up Risk for Epilepsy (Medscape)

Women in endoscopy: leading the way (Nature Reviews)

WHO and partners launch the world’s most extensive freely accessible AI health worker (WHO)

2 gastroenterologists making headlines (Becker’s GI & Endoscopy)

Videos: Interviews with GI Leaders  (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.