22 Sep 2020

Interview with Dr. John Allen (Michigan): “[Expect] pretty stiff headwinds for many years to come”

John Allen, M.D is the Chief Clinical Officer of the University of Michigan Medical Group and is also on the board of Allina Health. In 2019, AGA presented its highest honor, the Julius Friedenwald Medal for his contributions to gastroenterology. Previously, he was the chief of Digestive Diseases at Yale and helped build Minnesota Gastroenterology (now MNGI), one of the largest GI practices in the country.
This interview is so insightful that it’ll help you make several business and personal decisions for the long haul. Here’s specifically what you’ll take away:
1)  What does it take to lead calmly and steadily through a crisis? Especially a large health system like Michigan
2)  Planning for another pandemic (or another wave) should it occur
3)  Fundamental shifts in GI and US healthcare economics that we are not yet recognizing
4)  Weighing pros and cons of private equity
5)  Future of gastroenterology – technology, consolidation, ethics and morals
Watch this thought-provoking interview (45+min).
Do not miss this one – watch it end to end.
◘  Dr. Allen’s professional journey so far
◘  The complexity of handling COVID in a large health system: “It was brutal”
◘ “We were mandated to reduce costs by $400M (laying off over 500 people)”
◘  As a leader, how to navigate emotions and views calmly?
“This is a time to come together and show the most empathy we can”
“This is the chronic phase. We’ll have to adapt our care to exist with this monster virus”
◘  Are you planning for another pandemic?
◘  How do you disseminate learnings from the large system level to smaller practices?
“When you have high fixed costs, it’s like 80% of your home mortgaged”
“We are going to see Medicaid enrollees go up from 70 million to 80 million”
◘  “At Michigan, every 1% switch from commercial to government payors is $8 million less in revenue for the same service. Multiply that with what’s coming up with the payor-mix shift.”
◘  “[Expect] pretty stiff headwinds for many years to come”
◘  What’s the future of gastroenterology?
◘  Risks of private equity
◘  How do you put checks and balances in a way that doesn’t hurt patient care?
“Academic centers that don’t morph into a true integrated healthcare systems are going to have a tough time”
◘  “You aren’t going to be able to fight Humanas, CVSes, Aetnas, Optums in primary care”
◘  How do you re-imagine healthcare truly into a force for good? (“inequities are intolerable, immoral, and unethical”)
◘  The future of GI has to reflect that (“We have to re-establish our credentials as physicians”)
◘  “At some point, we have to level the playing field. We have an obligation to take care of people”
“It’s a time of reflection, a pandemic that hits like this really brings out how weak our safety net in this country was. A lot of people are interested in changing that”


The Transcribed Interview:
Praveen Suthrum: Dr. John Allen, I welcome you to our conversation. Thank you so much for joining me today.
Dr. John Allen: Well, thank you very much. I appreciate it.
Praveen Suthrum: So, I want to begin by asking you Dr. Allen, on what your role entails in a large system as Michigan Medicine?
Dr. John Allen: Let me give a little background on my journey first. I’m a trained gastroenterologist obviously and I think I’ve worked in almost every practice setting there is from the VA to a hospital setting to a small practice to a mega practice which was Minnesota Gastroenterology and now to academic healthcare systems first at Yale as Clinical Chief there and now at Michigan first as Clinical Chief of gastroenterology and now as Chief Clinical Officer and I also sit on the board of directors and chair the quality and population health committee for Allina Health which is a large integrated healthcare system in Minnesota. I’ve gained a lot of perspective on academics non-academics and other aspects of GI practice which has been really quite interesting. And so now I go back and forth between Michigan and Allina and can compare a non-academic, consumer-oriented healthcare system with an academic system like Michigan. It’s fascinating.
What I actually do at Michigan. So, I’m the Chief Clinical Officer of the University of Michigan medical group. And so that entails all of the faculty and all of the professionals that basically bill. All of those revenues come up through the UMMG – the medical group. We also manage the facilities for all ambulatory services. We have 40 different clinical sites. We have radiology, pathology, laboratory services, outpatient ORs. We have about 23 ambulatory ORs and an equal number of ambulatory endoscopy centers. And all those roll up to the executive leadership, which is the person I report to Dr. Mulholland who was the ex-chief of surgery and he’s the executive director and I’m the Chief Clinical Officer. I work directly with the Chief Operating Officer and Chief Nursing Officer. So, we basically manage the operations of the ambulatory part of Michigan. What’s interesting is that Michigan Medicine and Allina Health are about the same size. About 4.3 to 4.4 billion dollars in annual revenue. And so, again it’s really quite interesting to go back and forth between those two systems.
Praveen Suthrum: So, on a day-to-day basis what does your role look like is it more clinical, or is it more on the business side of medicine?
Dr. John Allen: No it’s completely administration now. I stopped scoping last September, a year ago, and have been staffing fellows clinics and things like that. But it’s really completely administration. So, I’ve switched into the administrative role completely. And on a day-to-day basis like for example this week we’re figuring out where, how often, and how to give flu vaccines to the 230,000 patients that are within our primary care catchment. And how to deliver those, and safely within COVID and social distancing and things like that. So, the operations of the clinics are our main focus. And I directly oversee 22 physician leaders and then they oversee another probably 60 physician leaders paired with administrative and nursing leaders as well. So, it’s basically that type of day-to-day activity.
Praveen Suthrum: Which world is more fun? The clinical side or the administrative side of medicine?
Dr. John Allen: They’re both fun. I practiced for 40 years and at that point, I felt I had completed that phase of my life and I was fine getting out of direct clinical care. When I was 50 actually I went back and got my MBA. Got into the business side of medicine and health economics and payors and negotiation and organization. And I find that just fascinating and in some ways, you can really make an impact on many people. When you’re providing clinical care it’s really one on one whereas if you’re really doing an administration coming from a patient-centric viewpoint you can really make a difference in terms of how we deliver care in a lot of people’s lives.
Praveen Suthrum:  Was that transition easy for you moving over from the clinical side to the administrative side?
Dr. John Allen: Well it was slow and iterative. It was not sudden. I started out at Minnesota Gastroenterology in the mid-90s and got into a leadership position there in the late 90s and began to take on more of an administrative role and it was a learning process. This is not easy and it’s not something you can learn from a book. It’s learning by experience and sitting through innumerable meetings and having to deal with all the different aspects of practice, in different practice settings. So, it’s a slow process. But, you know, I’m now toward the end of my career and you know I’ve gained a lot of knowledge there and so it’s a lot easier to make those kinds of system connections and I find that very interesting. So, it was a long process, a long learning process basically.
Praveen Suthrum: Even though we are several months into COVID now you know, I want to revisit the complexity of handling COVID you know in a system like Michigan. There were several months that you spent in handling it doing different things as its leader. So, I want to ask you how was it? How did you go about you and your team how did you go about handling the situation you know in the health system?
Dr. John Allen: Well, I mean frankly it was brutal. It’s brutal for the entire world it’s brutal for Americans and it’s brutal for healthcare workers. As you know January 20th was the first diagnosis of COVID in the United States in Seattle. In early March basically, we began to shut down elected procedures. And so, we had to shut down an ambulatory operation that sees two and a half million people a year (visits a year) within literally 72 to 96 hours. So, we had to consolidate clinics, we had to figure out what patients could have deferred care, what patients needed to come in still for an emergency, how to handle them. Everybody was short of personal protective equipment. So, it was a disaster frankly for a while. But the way we handled it in Michigan was very rapidly ramp up our infrastructure which had been there before. So, we have tiered huddles that started the unit and go all the way up to the health system in the first two hours of every day. So, we developed a command center that handled every aspect of the healthcare system. Met twice a day with the top-most leaders and the frontline workers as well. And really managed it that way in terms of communication.
We instantly converted many of the rooms in the hospital into a respiratory isolation floor with negative pressure. We got to the point where we could turn a hospital room into a negative pressure room in four hours. And we expanded in anticipation of hospitalizations, intensive care units, ventilators, and ECMO. So, we had to create an admitting officer the day that had complete control over transfers, and admissions. He was a transplant surgeon who was just superb. We identified two ex-military physicians to develop plans for a field hospital. So, we were ready to open up a 500-bed field hospital in the Michigan indoor tennis courts basically. So, we had all of these things and it really showed just the phenomenal preparation for the unknown that we had here. And I’m sure other systems had the same thing. But it was just incredible, the infrastructure that we could and the expertise that we could rely on to ramp up that quickly.
So, we basically ramped down and over the first three and a half months we obviously closed down elective procedures and ended up going from a projected operating margin of 175 million dollars per year to a little bit over 300 million dollar loss just in that period of time. And interestingly, the ramping back up has been even more difficult with the unknowns that we’re dealing with, and with all the different clinical service lines that had to go from a consolidated delivery to expanded delivery.
So, it’s just been really challenging. The second or third week of the ramp down the regents of the university and the financial people at the university level basically mandated that we reduce costs on a long-term basis by 400 million dollars. Reflecting an anticipated 300 million dollar loss plus the 100 million dollars that we send to the medical school each year we had to buffer that. Reduction in overhead basically. Which of course means personnel. So, we had to go through a very complex system of reduction in force and ended up laying off over 500 people in selected areas much less in direct patient care and more in support and administration. That on top of the COVID itself and what we’re having to do in terms of our own family was just emotionally brutal.
Praveen Suthrum: A large system like Michigan is like a mini-country. Wide variety of opinions, a lot of diversity, and many emotions that you have to navigate. Not just yours or your immediate team, but of staff, of patients at different levels. How did you go about handling all that as a leader?
Dr. John Allen: Well as a leader you don’t do it by yourself obviously. You have a lot of people around. Before 2019 we did not have the structured leadership, the infrastructure that we have now. It was very thin. So, Dr. Mulholland and I and our administrative and nursing partners have basically hired an infrastructure for leadership, tiered leadership over the last year and a half and that had nothing to do with COVID but had we not had that it would have been a disaster. So, from our standpoint as the top leadership, we have to convey a sense of calm and planning to that next layer of leadership. And also teach them how to convey that to the next layer of leadership down and then the frontline staff. But the anxiety about catching COVID, the anxiety about what to do with family, and now with schools being virtual and how do you handle home-care has been very tough.
But as a leader you just you have to not react. You have to not react from an emotional standpoint and really try to empathize and understand what other people are going through when you get those brutal emails in the middle of the night, and you basically have to learn to live with that, step back, take a couple of deep breaths, and then engage them as best you can.
We’ve been going around to the departments and answering questions from faculty, and then from staff that are you know, really quite angry and upset. Sometimes there are no answers. I mean we’re having a terrible problem hiring at the medical assistant level or the call center level for a lot of different reasons, it’s a low-paying job, and it’s very difficult to hire. So, our call centers right now are really in difficult shape. And we get emails daily about you know what are you doing about this and you just really have to present the calmest face that you can and keep trying to think through this and anticipate what’s needed.
Praveen Suthrum: At an individual level what steps do you take on a daily basis or what your routine looks like that helps you present yourself calmly as a leader to your staff and patients and the wider community?
Dr. John Allen:  Well, you have to realize that you’re on 24/7. You just cannot let down. So, the first thing is those of us in administration or in non-clinical areas, the President of the university basically said do not come on campus and don’t come on campus until the end of the year. So, I’m actually in Minnesota and I’m managing Michigan. Minnesota is my home I’ve been commuting back and forth for many years, but you know I came home to Minnesota and it’s basically eight-plus hours of zoom conferencing and managing. But it’s really a day-to-day interaction, making sure that you’re touching base with the correct people, reassuring them that they have your back or you have their back, and going on like that. So, it’s completely changed how we manage them. Most of the top leaders that again don’t have day-to-day staff interactions or face-to-face interactions are working remotely and that’s really changed things a lot. We expect to continue that well into the first quarter of the next year.
From myself personally, daily exercise, making sure I get some sleep, taking care of myself and family my kids are grown so, it’s my wife and our three dogs. Basically, you know focusing on what we need is a foundation and then again being able to project that to other people and trying to help them. This is a time when we have to come together and show the most empathy we can and a giving spirit and the more you can do that, really the better it feels internally.
Praveen Suthrum: Thank you for sharing that. I want to go back to a point that you made earlier about last week or this week you know where you are discussing internally about how do you administer 200,000 plus flu vaccines across the board in the system. I’m interested to know what kind of tools do you use? How do you go about making these decisions? How do you ensure that it gets done? What kind of a rhythm or project planning do you have in place that you see it rolls out in the coming weeks and months?
Dr. John Allen: We have a really incredible Chief Operating Officer and Chief Nursing Officer. We have project managers assigned specifically to this. Flu is very interesting. We manage the same problems every year. If you look at flu vaccinations from a straight revenue standpoint it’s really a money-losing operation. We get about three dollars in net revenue for administering a flu vaccine but that doesn’t really count all the back stuff that you have to do to prepare it. So, it’s really you know not something that you make revenue off of. However, it is an incredible emotional tie for primary care and their patients they really want to provide this to their patients. So, we have tried to say you know utilize Walgreens, CVS, and retail pharmacies to administer flu. And we have gotten pushback – they don’t administer flu for kids under eight for example so our pediatricians absolutely insist on providing that. So, then what you say is how do you do that and socially distance.
You can’t have a lot of people coming in for just flu shots to our big clinics because that literally takes the place of somebody that’s coming in for you know, care of their diabetes or hypertension because of social distancing, because of PPE restrictions. So, then we’ve popped up tents which we of course did for COVID but you know come November or October that’s not a viable option in Michigan. So, we’re now scrambling to find other areas where we can administer flu vaccines and testing in an indoor basis. And you’d be surprised at the pushback from a lot of landlords they simply don’t want that there. So, it’s been a real challenge we have people scanning the facilities that are available in our county and state to try to identify this. But it’s a process of identifying facilities, identifying staff, and identifying the cadence of bringing people in the midst of COVID that has been challenging but really incredibly interesting. And we will succeed that’s the other thing we will make it happen and I’m quite confident with that.
Praveen Suthrum: In which wave of COVID are we in? You know are we still in the first wave? Have we rolled into the second or you know is this an ongoing thing? The reason I’m asking is how do you account for it internally, when you have internal planning meetings saying are you expecting things to return? I’m curious to know about your planning process actually.
Dr. John Allen:  Sure yeah it’s really fascinating. Well first of all the wave that we’re in now whether it’s the first or second wave or whatever this is the chronic phase. This is the wave where we have to adapt our lives and adapt our care to exist with this monster virus for quite some time. Whether we get a vaccine in the next month or two, there won’t be mass vaccinations, and there won’t be enough immunity within the community to really dampen this down for a long time. I mean we’re really anticipating a year to 18 months. That being said when COVID first hit, nobody knew what to do. We didn’t quite know what personal protective equipment we needed, we didn’t have enough supplies, we didn’t really know about the aerosol transmission, and the importance of crowds and masking and all of that.
So, that initial wave hit us very hard. A lot of times it hit vulnerable people like nursing homes or people in some sort of community living. Those are vulnerable people with multiple co-morbidities and they got very sick. So, they had to be hospitalized, they had to have ICU beds, they had to have ventilators, a few had to have ECMO. And the death rate was just incredible. Now the increase in COVID is in people that don’t necessarily need those you know end-stage resources. It’s more in young people who don’t get quite as sick they obviously do get sick but the demand for beds, ICUs, and ventilators is not as much.
That being said we’ve got a four-tier program depending on the wave of COVID. You get about a two-week notice when COVID infection starts and when the need for hospitalizations occur. So, we are ready at a moment’s notice to reconvert rooms that we sent back to general medicine and surgery. We have everything ready depending on what COVID is in the community. We can predict incredibly accurately how many beds are needed what ICU beds are needed. So, we’re ready for that. And it turns out that there’s a big difference between summer and winter because negative pressure rooms require incredible demand on your HVAC system. So, in summer where you’re running air conditioning and you add negative pressure rooms, you are limited with the number that you can do because of your HVAC requirements. In winter that’s a little bit different. So, we actually have seasonally targeted plans for expansion to 15 beds to 30 beds to 60 beds. And of course, we always have the field hospital in our back pocket. I don’t see that happening. And in fact, we’re learning to live with this, and we do not anticipate ramping down ambulatory care at all. No matter what happens in the community. And I think we’ll see isolated hot spots that come up you know, around parties, or sororities or things like that but I don’t think we’re going to see the mass that we did originally frankly. But we’re not going to ramp down ambulatory short of an executive order from the governor.
Praveen Suthrum: In your internal discussions are you planning for another pandemic? You know not COVID but in the future, in case something else strikes?
Dr. John Allen:  Some of it depends on the infection routes for example Ebola is quite different from an aerosolized route like Influenza and COVID. But we went through Ebola planning and we did all the things necessary in case Ebola hit. We went through for MERS and SARS and things like that. And obviously, we did this through COVID. We’ve documented everything, we have a very specific playbook that we could activate really on a dime. So, whatever hits and whatever in infection source that pandemic rests on, we would be ready for it because we’ve done this kind of planning.
Praveen Suthrum: Now you’ve held, and continued to hold leadership roles in societies and which are at the national level. What kind of learning can you take from what you already do at the large health systems and enable that and what kind of learning can be disseminated to the smaller practices you know that are spread across the country who may not have the kind of resources that you may have at Michigan?
Dr. John Allen:  It’s a really interesting question and it particularly hits gastroenterology and some it relates to the history of gastroenterology. Traditionally in the late 70s and early 80s, you had small practices or solo practices where a gastroenterologist would have a clinic and then go to the hospital to use their equipment to scope. So, those practices had a very low fixed overhead, right? They’re asset-based, that they needed to support was relatively small. In the mid-early 80s, leaders like Gene Overholt and Cecil Chally, and Mike Weinstein realized that we could develop ambulatory endoscopy centers. Then it became infusion centers, and anesthesia, and radiology. And we were able to do that to provide a much better patient experience, much cheaper. But the downside of that is it put a tremendously high fixed cost within practices. Obviously, you know this you’re a Ross School of Business graduate. So, when you have those high fixed costs it’s like having a mortgage, where 80 percent of your home is mortgaged. If you have a down-turning monthly cash flow it can be annihilating and that’s what’s happened during COVID.
Practices depend on monthly cash flow from colonoscopy and seeing patients and when that’s cut off, you have to turn around and say ‘where’s my capital coming from?’ and there are only a limited number of capital sources – you can borrow from the bank, you can connect with a health system that has deep pockets, you can connect with a private equity group, or you can connect with a strategic partner like Physicians Endoscopy for example or Optum. You need somebody that can carry cash year to year which practices don’t do because of tax consequences. So, practices now are in the position where their cash flow is devastated and they need capital infusion. And so we’re seeing a tremendous shift in practices with consolidation, with sales to private equity, with sales to health systems all you know all based on the fact that the monthly cash flow due to COVID has stopped and the fact that the median age of gastroenterologists like a lot of other specialists is pretty high, it’s in the high 50s. So, there are a lot of people that are approaching retirement and saying “I’m out this is too much.” So, those things are going to really change the face of GI coming up.
And that’s not even thinking about the economic impact on the United States. We’re going to see Medicaid rolls go from about 70 million to over 80 million which is going to stress state budgets like we have not seen ever. We’re going to have a lot of people out of work and of course, half the country gets insurance by their employer. So, even if the economy recovers fairly well on a day-to-day basis or the equity markets recover that infrastructure is going to drive patients into either government payors or being uninsured. And that for a health system or practice is a real problem that we’re not going to see resolution for two or three years. At Michigan, every one percent switch from commercial to government payors is eight million dollars less in revenue for doing the same service. So, you multiply that times what’s coming up in terms of the payor mix shift that’s going to be really difficult to handle frankly.
Praveen Suthrum: Yeah it’s going to be a very complicated and interesting problem to solve. You know one thing that I wonder about you know, the big entities and the small entities not just in medicine but you know, we saw through COVID that large companies which we would have never thought you know would file for Chapter 11 file like Hertz or J. C. Penney or and there was an ophthalmology private equity platform that also filed for Chapter 11. So, there must be some determining factor here that might drive this. Though, I agree with what you’re saying that the smaller practices for them to handle the impact is more difficult than for larger entities which may have a cash position like you know they may have money in the bank more than smaller practices do. But I’m wondering if you know even a large entity is safe anymore and I’m talking purely from an economic standpoint.
Dr. John Allen: I don’t think it is without changing their business practice and I’m particularly worried about academic centers that have very high fixed overhead and are much less efficient than non-academic health systems for example. It is very difficult to turn the ship in a big academic center like this. You know, typically health systems carry anywhere from 230 to 290 days cash on hand that’s their bank account, right? Well, that has really diminished. If you look at the annual revenue for an organization like ours it’s about 11 million dollars so everyday cash on hand times 11 million dollars is what we have in the piggy bank.
And most of that is in liquid money but a lot of the endowments, a lot of the cash that we have, is in illiquid funds or it’s in dedicated funds for professorships or things like that. So, again from a cash flow problem, it becomes really acute. So, we’ve really had to scale back. We’ve canceled planned facility expansion of two very big multi-specialty clinics, we’ve delayed a planned new hospital build and those all have ramifications. We have you know, canceled the retirement match for all the clinical faculty for example. The leadership has taken pay cuts and I mean those are temporary things to help in cash flow but they’re not sustainable. And I still don’t think that we have fully appreciated the change in economics for the United States in healthcare because of things that I talked about a few moments ago so this is going to be pretty stiff headwinds for many years to come
Praveen Suthrum: So, that naturally takes us to my next question which is on the future of gastroenterology and healthcare in general actually. And I want to thank you first for giving a testimonial for my book Scope Forward which is on the future of GI. My question is you know what aspects of the book resonated you know, with you like what do you think is likely to happen and what then? And in your own view what is the future of gastroenterology?
Dr. John Allen: So, I appreciate both of your books actually and the Scope Forward book was very good and the things that resonated with me is your continued warning about being dependent on a single service line which is screening colonoscopy and surveillance colonoscopy. And you know we’re seeing the results of that in COVID as well, right? You perceived very well the increased dependence on technology at many levels. Whether it’s remote patient monitoring, artificial intelligence, and screening colonoscopy, all the different types of programs like SonarMD to monitor inflammatory bowel disease patients. There will be more and more of that. And we’re going to separate and I think you were right on that. And the danger of that is that those all cost practices. And the ability to handle what’s going to become routine gastroenterology or cardiology or neurology care it’s going to be more and more expensive and regulations as well.
Those expenses have reached a point in a small practice or medium-sized practices for sure that are really tough. If you’re a very small practice in a rural community, for example, I actually think you’re in pretty good shape because your overhead is low and you have a patient base that is dedicated to you and the ability to hand to deliver really high-quality GI care. I think we’ll continue with that model. We’re seeing consolidation and it’s sort of that middle spot where you have a mid-sized practice that is going to be really stressed to have the capital to handle these innovations. And I think you hit that really well in your book. You also have a lot of emphasis on private equity, both in your first book and some in this book as well. And I’d just like to speak a moment if you wouldn’t mind about some of the risks that I see in private equity.
The basic business model of private equity is to do a leveraged buyout where you basically accumulate whatever you’re accumulating, whether it’s a manufacturing plant or a practice. Strip out costs as best you can consolidate to achieve some sort of economies of scale but you have to hit about a 20 percent annual return and correct me if I’m wrong but you know if you’re an investor in a private equity company you expect that it’s high risk but otherwise you just put your com your money in mutual funds. You expect that kind of annual return. And private equity goes in with the cash influx at first, which is good if you’re a more senior partner and you know are thinking about retiring in the next few years. But it’s really that second bite when the private equity sells to a bigger private equity where the second cash infusion comes in, where you get that much of a return. Because in between that you’re basically discounting your salary because you’re investing in the private equity whether it’s a management company or whatever it is. So, it’s a little bit tough, and private equity does not come in to really improve healthcare as their primary goal. You know, they are very much in it for profit.
A side effect can be better patient care, accumulation of big data, things like negotiating power. But I’m skeptical that this is going to really play out and maybe a repeat of the 1990s where you know we saw those kind of management companies come and then get really stressed in terms of assets down the road. That’s different than hooking up with a company whose business is delivering care and again I go back to Physicians Endoscopy and Capital Digestive as an example. That’s a long-term strategic play they’re not bound by a three to five-year window. So, I think practices have to be very careful about who they’re going to give their autonomy and particularly their financial autonomy to.
Praveen Suthrum: So, how does one balance whether at an individual level we agree or disagree with private equity but this is a wave and it seems to be happening. Regardless of what a practice might opine or feel, right? How do you make it better if it is going to happen anyways you know how do you put you know checks and balances in place in such a way that it doesn’t hurt patient care?
Dr. John Allen: I think there are ways. And first of all, as you know better than I there are probably 200 private equity companies that are targeting medical practices GI things like that and there are a lot of differences between those companies. If you have a company that’s going in with a really financial dent that’s just absolutely brutal I would be a little bit hesitant. But there are some really good private equity companies that are coming in and taking practices that have multiple EMRs for example and combining them into one and then planning to use those big data to give real patient outcomes. And you can almost accumulate enough patients to target a big payor and say “We will look at your patients and show that we can deliver better care.” When you go in with that dent whether it’s private equity or a strategic partner I think managing populations again whether it’s gastroenterology, or cardiology or what can improve care a lot. There are a lot of inefficiencies and those inefficiencies are going to be definitely stripped out.
Praveen Suthrum: What kind of advice do you have for an early stage gastroenterologist who might be watching this? How should they plan their career over the next five-ten years?
Dr. John Allen: Well, I think there’s a great opportunity I think you have to be very careful about where you end up being employed whether it’s a health system or a practice. It goes back to the very basics. If the primary purpose of that practice or health system is to deliver good patient care then that’s going to come out in your interviews, it’s going to come out and how the contracts are structured, it’s going to come out in talking with the partners of the health system. You’re going to be able to tell the difference between that and a practice or health system that is financially driven. Obviously, I would choose the former. I do think that the consolidation trend will definitely continue I think that going into a small practice right now except in some of those niche areas that I mentioned is very difficult and challenging. But you want a practice that is well run, that is patient-focused, and also is embracing the new technologies that we have – AI, remote patient monitoring, basically using technology to get rid of all of the routine stuff and strip out costs from what we do. Whether it’s colonoscopy preps delivered by bots or anything like that. You have to be thinking along those lines to really be successful.
I do think you have to have a more consolidated large practice whether it’s multi-state or single state depends on the region. You also have to have a capital partner and professional management that is really good and can anticipate changes. But I do see the practice of gastroenterology really consolidating like that. I think in the academic realm, it’s going to be very tough. And academic centers that don’t morph into a true integrated healthcare system are going to have a very tough time competing with the integrated healthcare systems that are out there. And there are some really good ones. You cannot live on high tertiary quaternary care alone you have to be able to deliver that secondary care and primary care. And then also, you know, offloading the most routine care. I think at the primary care level, a health system that can partner with some of the retail pharmacies or some of the, now technology companies that are coming into you know, the lowest level routine care. I think you’ve got to partner with them. We’re not going to be able to fight you know the Humanas, the CVSs the Aetnas the Optums in terms of routine primary care so let’s partner with them and use that as a win-win and really deliver the care that we need to.
Praveen Suthrum: My final question Dr. Allen, I want to go back to this whole COVID period right. Like so to a lot of people especially in healthcare it’s also been a time for reflection. And people have reflected on their own careers at an individual level but also overall at a larger healthcare industry or at a systemic level. Now if you go back to our healthcare system, whichever part of the world, to a pre-COVID world there’s been increasing patient and physician distrust like you know with each other, then there is this whole business of healthcare aspect. The fact that there have been several articles about the evils of the corporatization of medicine and so on. Now this reflective period of this lockdown, COVID, and everything else surrounding it presents also an opportunity to re-imagine a newer healthcare system you know, that’s more geared toward doing good and being really a force for good for patient care. So, I want to ask you if you were to reflect on something like that. What would a healthcare system look like in your view?
Dr. John Allen: Well, the first thing is we have to acknowledge that this is not only COVID but the racial and economic inequities in this country are I think, simply intolerable, immoral, and unethical. When George Floyd was murdered in Minneapolis I was sitting about nine miles from that corner. And what happened in Minneapolis and now is spread across the country, has demonstrated that we still have some really tough problems to solve. With COVID coming along no matter what your politics, all you have to do is look at the statistics of who is most affected by this and it is people that have that are suffering from health disparities. So, the future in terms of healthcare or gastroenterology really has to reflect that. We can’t be in this for profit. We have to re-establish our credentials as the physician who not only says “do no harm” but feels a responsibility for the individual patient for our community and for society at large. And I think that means moving toward an infrastructure where we have healthcare for everybody however that’s delivered remains to be seen.
But to have uninsured Americans or to have Americans that simply cannot access healthcare at a fundamental level again I just think is an immoral place for this country to be. And I think we have to step up with that and decide how we want to use our resources. It gets into the whole wealth redistribution it gets into the entire economy and tax situation but at some point, we have to level the playing field and I think we have an obligation to take care of people. So, we go on from this I think really reflecting on what our individual and what our society responsibilities are is going to be very important.
Praveen Suthrum: You know we know being inside the system that preventative care will probably result in fewer procedures but then the system gets compensated by more procedures because that’s what we’ve built so far. And we keep talking about you know value-based care, but you know the evolution of that is very slow in what whatever we can see. So, how does one balance that? Because if a hospital does not do procedures then it can’t survive at you know, at an economic level? But if it goes and invests in say getting people in shape for example, right like you know, reversing their conditions that’s probably the right thing to do because then they don’t end up you know needing the procedures but then if they end up doing who pays for that? And how does one balance in both these worlds?
Dr. John Allen: Well, you’re right we’re paid a lot for the complications that we cause. I mean that’s basically what you’re saying and for illness. I do see a movement. So, for example, a line of health just signed a six-year contract with Blue Cross Blue Shield of Minnesota that switches to a value-based system with a basically a ten percent, two-sided risk in terms of reimbursement. But coming with a partnership around the reduction in pre-authorization and administrative costs, and opening up of data systems. So, Michigan is doing a similar program not quite that robust with Blue Cross Blue Shield of Michigan. So, I think both the payors and health systems are realizing that we have to put real money on the table to partner and not be at odds with each other. So, I see that movement actually happening faster. And that will have some tremendous benefits. I think there’s going to have to be an investment in health disparities because that’s where a lot of these costs come from and that’s going to have to come at either a state or federal level. We have to admit that there is a role for both the state and federal governments in supporting those kinds of health disparities.
You’re talking really hard economics we can get into a discussion about wealth consolidation in this country and what it means, but I think this is a time of reflection and a pandemic that hits like this really brings out how weak our safety net in this country was. I think there are a lot of people that are interested in changing that. So, we’ll see what happens but I mean there is no way I mean, I remember hearing Uwe Reinhardt many years ago saying, “Look however it works people that are earning more than 75,000 dollars have to shift some of their wealth to those that are earning less than 75,000 dollars to provide healthcare there’s just no other way to do it.” There are some hard questions that we have simply kicked down the road that I don’t think we can do that anymore. I know that’s not a great answer to your question but it’s you know it’s the best that I can do.
Praveen Suthrum: I don’t think I was even looking for an answer because there is really no straight answer here. Just a reflection which I was seeking and you know which you gave and I really appreciate that. Dr. Allen, thank you so much for sharing all your perspective. It was very insightful. And yeah thank you also for being so candid with everything. I really appreciate that. Was there anything else that you wish to share before we close?
Dr. John Allen: No I don’t think so I think these forums that you put together are really interesting and keep doing them basically. I really appreciate the opportunity to talk with you and to reflect on this and to really think about the future.
Praveen Suthrum: Thank you.

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

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

Curated GI articles Sept 17th, 2020: CMS to cover new colon cancer test. 10 Takeaways on first and only FDA approved liquid biopsy test + more

Curated GI articles Sept 17th, 2020: CMS to cover new colon cancer test. 10 Takeaways on first and only FDA approved liquid biopsy test + more
PE-backed GI procedure documentation software company makes acquisition (Becker’s GI & Endoscopy)
GI software company Provation acquired ePreop, a perioperative software as a service solution.
Video: Interview with Dr. Fourment, CEO of Precision Research: “Clinical research will be very different in five years”  (NextServices)
Watch this insightful interview in full to learn what it takes to create a clinical trials ancillary in gastroenterology.
CMS soon to cover new colon cancer DNA test. 10 takeaways on the first and only FDA approved liquid biopsy test (NextServices)
Epi proColon detects colon cancer through a specific DNA called Septin9. The company expects CMS approval anytime now and is due to launch nationwide.
Capital Digestive Care partners with Peninsula Gastroenterology Associates (Becker’s GI & Endoscopy)
Silver Spring, Md.-based Capital Digestive Care partnered with Delmar, Md.-based Peninsula Gastroenterology Associates.
The great acceleration in healthcare: Six trends to heed (McKinsey & Company)
Next generation care management, health for all, consolidated care delivery, and reform efforts are among the trends that may shape healthcare in the years ahead.
Video: What if you had a crystal ball to navigate to the future? (Scope Forward)
See this presentation/talk based on the book Scope Forward: The Future of Gastroenterology Is Now in Your Hands. Originally presented at DHPA.
Asian, lean patients with NAFLD have lower prevalence of cirrhosis, CVD  (Healio)
Lean Asian patients with nonalcoholic fatty liver disease had significantly lower prevalence of cirrhosis, cardiovascular disease and metabolic abnormalities than lean non-Asian patients.
Googling for Gut Symptoms Predicts Covid Hot Spots, Study Finds  (Bloomberg)
Using Google Trends online tool, they found the volume of searches correlated most strongly with cases in states with high disease burden — three to four weeks later.
Medscape US and International Physicians’ COVID-19 Experience Report: Risk, Burnout, Loneliness  (Medscape)
“More than half of US physicians have personally treated patients with COVID-19.” This survey from Medscape includes over 5,000 US physicians.
Screening delays due to SARS-CoV-2 could increase advanced CRC cases  (Healio)
Delays in colorectal cancer screening due to the cessation of colonoscopies during the COVID-19 pandemic could increase advanced cases and even mortality if the delay stretches beyond 1 year, according to study results.
Can Machine Learning Make Fecal Testing Part of CVD Screening? (MedPage Today)
Early study suggests role for initial routine cardiovascular health monitoring.
Video: ASGE campaign highlights ‘The Value of Colonoscopy’ (Healio)
In this exclusive video, Jennifer Christie, MD, and Douglas K. Rex, MD, discuss “The Value of Colonoscopy,” a new campaign from the ASGE.
Benefit from a tax-savvy investment portfolio (Healio)
Physicians of all specialties want to reduce taxes wherever possible. While most doctors typically focus on active professional income, spending some time and effort on how one’s investments are taxed is also crucial.
Readers Predict Biggest Medical Breakthroughs by 2045 (Medscape)
When Medscape’s readers were asked to predict medical breakthroughs in the next quarter century, the most common responses zeroed in on the human genome.

Headlines for GI

See Gastroenterology’s curated colorectal cancer research collection (AGA)
The future of gastroenterology and other excerpts on industry-changing trends (Becker’s GI & Endoscopy)
Newsletter: Telehealth and the new choreography of ‘anywhere care’  (RamaOnHealthcare)
5 most-read stories in GI this week — Independent practice consolidates & more (Becker’s GI & Endoscopy News)
Sinusitis Linked to Later IBD, Study Finds (Gastroenterology & Endoscopy News)
ICYMI: Nonalcoholic Fatty Liver Disease and Fibrosis Associated With Increased Risk of Cardiovascular Events in a Prospective Study (AGA)
Food Delivery Startup Helps Physicians Treat IBS Patients (Gastroenterology & Endoscopy News)
Interview: Trends Influencing Gastroenterology and all of Healthcare (NextServices)
Infectious COVID-19 Can Persist in Gut for Weeks (Medscape)
5 recent studies exploring AI in healthcare (Becker’s Health IT)
A gastroenterologist’s COVID musings from behind the mask (KevinMD)
How Coronavirus Is Helping Drive The Digitalization Of Healthcare (Forbes)
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.
17 Sep 2020

CMS soon to cover a new colon cancer DNA test. Plus, 10 takeaways on the first and only FDA approved liquid biopsy test.

Epigenomics is a liquid biopsy company listed on the Frankfurt Stock Exchange. Epi proColon detects colon cancer through a specific DNA called Septin9 (altered in colorectal cancer tumor cells). The company expects CMS approval anytime now and is due to launch nationwide in US this year.
These takeaways are based on their Q2 2020 Earnings Call. Frederic Hilke, the Investor Relations Manager for Epigenomics, and Greg Hamilton, the CEO of Epigenomics AG made these remarks.
1. The operational highlights for Epigenomics include:
◘ CMS’ initiation of the National Coverage Determination (NDC) process for Epi proColon in late February.
◘ Inclusion of Epi proColon in the 2020 NCCN guidelines.
◘ Publication in the Journal of the National Cancer Institute (JNCI) which concludes that Epi proColon is the test of choice for patients who are not willing to participate in FIT or colonoscopy screening.
2. Epigenomics believe that the test is necessary as there are an estimated 9 million Medicare beneficiaries who are not willing to participate in FIT or colonoscopy screening.
3. They believe that as the only FDA-approved blood-based test available, Epi proColon has the opportunity to save over 225,000 Medicare lives.
4. Epigenomics also reckoned that the annual Epi proColon testing was found to be clinically more effective than Cologuard (every 3 years) and (annual) FIT testing.
5. The company indicated that it is interesting to note the clinical benefits of Septin9 (Epi proColon) testing vs. an annual stool DNA test.
◘ Despite 92% sensitivity versus 68% sensitivity, the incidence of Colorectal Cancer is nearly identical, and the mortality is equivalent between the two tests.
◘ The implication of this is that even if future blood tests have increased sensitivity, their impact to clinical outcomes will be negligible.
6. The company feels that nearly all future blood-based test and development are going to be next-generation sequencing-based.
7. The company reckoned that annual stool DNA testing is extremely cost-ineffective. Which is why Epigenomics believes that Epi proColon is well-positioned to be the test of choice for an extended period of time.
8. The revenue for Epigenomics in the first half of 2020 was EUR 322,000. According to the company, the decrease between the first half of 2019 and 2020 was due to the effects of COVID-19 during Q2.
9. They feel that there is significant growth potential in 2021. Gregory Hamilton, Epigenomics AG – CEO & Member of the Executive Board commented, “I mean if you just think of the unscreened market alone, there’s 35 million patients who haven’t been screened.”
10. Post reimbursement, one of the key projects that the company is set to work on is expanding the label of Epi proColon from 50 to 75.
Note: The company feels that CMS will issue a positive coverage determination. As Epi proColon has met the required standards and now with the publication in JNCI, there is a published peer-reviewed evidence that Epi proColon is cost-effective and the test of choice for patients unwilling to participate in FIT or colonoscopy screening.
Edited Transcript of ECXn.DE earnings conference call or presentation
Epigenomics Annual Report 2019
Epigenomics AG: CMS Still Actively Working On Proposed Decision Memo with Goal to Publish As Soon As Possible
Related Links:
1) What has colon cancer screening got to do with self-driving cars?
2) Exact Sciences: COVID-19 will accelerate the adoption of Cologuard by one to two years toward ‘40% market share’ goal
3) 20 Takeaways from Exact Sciences call: “Cologuard fits seamlessly into a permanently changed healthcare environment”
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 Sep 2020

Interview with Dr. Fourment, CEO of Precision Research: “Clinical research will be very different in five years”

Christopher Fourment, M.D is the President and CEO of Clinical Research Strategy Group and Precision Research (Texas).
In this interview, you’ll learn why Dr. Fourment chose to focus on clinical research as a career path. Dr. Fourment also walks us through the various aspects involved in clinical research and how CRSG and Precision Research are helping GI physicians build a sustainable ancillary for their practice. He also reflects on the role of the future of clinical research in a digital world.
Watch this insightful interview in full to learn what it takes to create a clinical trials ancillary in gastroenterology (14+min). 
◘  The difference between CRSG and Precision Research
◘ “We do a lot of the heavy-lifting which allows the sites to do what they do best”
◘  How and why Dr. Fourment built a career focused on research
◘  “Doing research as an ancillary helps everyone”
◘  “…an average patient visit generating $1,700 to $1,800 per visit”
◘  Profitability in clinical research
◘  Steps practices can take to engage with CRSG and Precision Research
◘  Playing the role of a co-director
◘ “The end goal is that I want to build research in their practice that is sustainable for them (the practice)”
◘  What GI research is getting sponsored right now
◘  “The research landscape in five years is going to be very different”

The Transcribed Interview:
Praveen Suthrum: Dr. Chris Fourment, thank you so much for joining me in today for this conversation on clinical research. You are the President and CEO of Clinical Research Strategy Group as well as Precision Research. So glad that we’re speaking finally and happy to get started.
Dr. Chris Fourment: Thanks for having me on, Praveen.
Praveen Suthrum: I wanted to start by asking you that what is the difference between the two companies that you run, CRSG and Precision Research?
Dr. Chris Fourment: It’s kind of how they conduct business is the main difference. So, for Clinical Research Strategy Group, the customers for CRSG are – one site that really wants to build research but doesn’t know how to get started. Doesn’t want to take the time to build or to figure out how to build infrastructure. The second customer for CRSG is the site that is already built and already running research but maybe wants to take it to the next level whether it’s just increasing profitability, increasing the geographic size, and scalability. But the key with that group is to really provide to groups that want to do good research the tools to build the infrastructure and allow them to be sustainable long-term on their own.
With Precision research, it is called a Centrally Integrated Research Network or CIRN and what this is… it is a network of really good GI clinical research sites around the country, who have shown a lot of performance in the past, who already do good research, and what Precision does is… it contracts with pharmaceutical companies to bring studies and once we bring the study to the research network, then we handle a lot of the pain points for the sites. We handle a lot of things like the startup, we handle the contracting, and all the budgeting, the regulatory for instance is all done for them. We build out the source documentation we build out the study in the CTMS – Clinical Trials Management System. So, we do a lot of the heavy-lifting, which allows the sites that are part of Precision to do what they do the best… which is to identify patients for trials, and get them in and see the patients.
Praveen Suthrum: How did you personally choose to focus on clinical research versus doing what everybody does – either going into private practice or academic medicine?
Dr. Chris Fourment: Yeah. Great question. So, after medical school, I got an offer from a pharmaceutical company to come into their medical affairs division. And I worked there for seven years in IBD at the pharmaceutical level as a medical science liaison and then a liaison between clinical operations and medical affairs. One of the things that it allowed me to do is see a bunch of clinical research happening across the country. And I saw sites both academic and community practice and worked with those sites in clinical trials. And what I noticed was there were a lot of sites that were probably destined for failure in the next five years. In other words, the burden of doing research at their site was becoming so much that they weren’t going to be able to kind of keep it going. And because of the burden and because of the pull of their regular practice, the doctors were probably at some point going to have to make a choice and decide whether or not they wanted to devote more time to this research effort. Or whether they just wanted to continue their practice.
I then went to work for TDDC in the GI Alliance and worked with a great partner, Dr. Tim Ritter over there. Where we for five years, built that program to one of the premier clinical research programs in the US. And after that, I really decided to continue to do what I think I love doing which is helping sites become really good. Whether or not it is going to be a true ancillary for the practice or whether they just want to improve the clinical resource or be able to offer clinical research to patients.
Praveen Suthrum: Why should GI practices consider research as an ancillary?
Dr. Chris Fourment: Reasons to… I think to do research as an ancillary or to create an ancillary out of it is that it helps everyone. You look at it from the patient’s standpoint, the patients have access to those therapeutic advancements that most won’t have access to for the next 10 years and they have access to them today through clinical research. So, it is a great way to bring those things to the patient sooner. It is a great way to be able to see the patient more. You take IBD as an example; I think all of us believe that in the ideal world we would be able to see our patients sooner than let’s say six months for a visit. And with clinical research, you are able to do that. You are able to see your patience on a graduated scale to make sure that their disease is being aided by the approach that you’re using.
To the practice, to our point, it can certainly be an ancillary. We look at these research visits, and I think ideal to me in my mind is an average patient visit in research generating around $1700 to $1800 per visit. And a coordinator… when I look at how many visits a coordinator ought to have over the course of a month generally speaking what rate looks like to me is somewhere between 20 to 30. So, if you multiply, let’s say 20 visits by about $1800 per visit you can see that if you have the patients in your practice, and you bring research into the practice, it doesn’t take long to really grow into a point where it can become a good ancillary.
So, that’s the direct value for the practice. The indirect value is that not every practice has research going on. And so the way you’re viewed in the community if you have a research program going on at your clinic may be much different than the gastroenterology practice down the street and that could impact things like referrals. As you get referrals from the primary care. That could impact the way the patients sort of view your practice (if you have research). And then the last part is profit. So, if it helps the patient, if it helps the practice, does it help the bottom line? And you know the way that research runs in a lot of cases in practice is it is kind of a break-even type of prospect. But there’s a way to… And a method to really make research become profitable. So, if you like the first two pieces, if you believe that it helps the patient, if you believe that it helps both, directly and indirectly, the practice, there is a way to get profitability.
Praveen Suthrum:  Now, when a practice decides to engage you or work with you, what are the exact steps that they can take?
Dr. Chris Fourment: Well, it depends. In Clinical Research Strategy Group, I mean the best thing to do is reach out. And then, what Clinical Research Strategy Group will do is take a look at where the research is currently in the practice. So, in other words, do they already have a foundation for research? Or are we building a research from scratch? And either one is okay but there are different strategies that go into both of those. One of the things that we rely on heavily is a Clinical Trials Management System. It is sort of like an EMR for research and it allows a lot of transparency into the program. It also allows us to draw metrics on the program.
The other things that we do to get started are – we create as SOPs – standard operating procedures that represent what our sponsors want to see out of the research, and what the FDA wants to see out of the research. We create a corrective and preventative action plan or a CAPA plan. A CAPA plan is what we use when something goes wrong in research and we have a protocol deviation to make sure it doesn’t happen again. The other thing we do is start to establish a budget for the sites based on upon the actual value of the time that they will spend in studies. And we put together the justification letter so that when the sponsor comes back, and says “Well we can’t really give you X number for this particular procedure” you say, “Hey look that’s my policy here at the site.”
With Precision, again we’re looking for sites that already have good research programs going on; they are already doing fantastic research. And what they can do is getting contact, if they have it already and we can look at sort of what that model would look like for them. And the types of studies and studies that we have to offer, that we could bring in, with full Precision services. And we do that at no charge with Precision. So, the sponsor pays us. The site does not. But again, they need to have the CTMS system in place. That is the most important piece because that allows us in the Precision model to be able to build the regulatory file for them, and manage that regulatory file. It allows us to build the source documentation so that they don’t have to (that’s about a 10-hour job for a coordinator). It allows us to build the study into the CTMS system properly to make sure that they are able to run the reports and go through the financial aspects that they need.
Praveen Suthrum: What is your business model in both these companies? How do they pay you? Like, the way you have narrated CRSG seems to be more of a consulting angle, and Precision maybe a little bit different. If you can clarify that, I think it will be helpful for practices to know.
Dr. Chris Fourment: You’re exactly right. So, CRSG is more of a consulting model. The role that we play at the site is more of a co-directorship, right? So, we really partner with that site. And I’m on calls multiple times a week with each of the sites that we work with to make sure that things are going in the right direction. Once you are in the Precision network, short of the cost of the CTMS system, which is nominal…, it is a few $100 a month or something. So, that is the only cost to the site.
Praveen Suthrum: What kind of a budget should they outline? And when they work with you, does it involve costs associated with building a site, if they don’t have one because it requires space.
Dr. Chris Fourment: It’s a great question. So, there is a cost involved obviously, as with any other ancillary. If you build an infusion center, you are going to have to buy infusion pumps, you’re going to have to buy chairs, and you’re going to have to do all that. So, the equipment cost…  what you need to do research – refrigerators, freezers, the centrifuge, things like that. The cost for all those is around $15,000 per site. If you want to do multiple sites, it is going to be sort of amplified there. Again, the cost of the CTMS system is nominal. And it is important to do it individually. So, rather than having just… sort of one-size-fits-all program, we’re able to look at what the site’s needs are, and what the site’s desires are.
Praveen Suthrum: So, I’m guessing it depends on contract to contract?
Dr. Chris Fourment:  Absolutely it does. But you know, the end result or the end goal is that I want to build research in their practice that is sustainable for them. There are a lot of other models and things like that… that would build research in the practice and continue to take it and give the practice a little bit. I want to be able to have this be a sustainable ancillary for the practice.
Praveen Suthrum: What kind of research in GI is going on with the sponsors that you are connected with?
Dr. Chris Fourment: So, there’s a lot of IBD research. Crohn’s and Ulcerative colitis in both phase two and phase three. Phase two is the shorter-term studies and phase three are the longer-term studies. There’s also work on the luminal side in Eosinophilic esophagitis (EoE) and celiac disease and many others. On the hepatology side, there are NASH trials. I think it is a great idea to sort of broaden out our scope and take on IBD studies and also NASH trials. There’s a lot of work going on in both of those spaces and should one sort of ebb and flow, the other one will perhaps be the opposite. In other words, if we cure Inflammatory Bowel Disease, which would be wonderful, then you still have a productive NASH program going on.
Praveen Suthrum: One final question Chris on technology and clinical research. There seems to be a big role for artificial intelligence and more advanced technology in clinical research. Could you share your thoughts on that?
Dr. Chris Fourment:  So, one of the things that COVID has taught us and it was actually a conversation going on prior to COVID was – could we sort of build virtual clinical research? So, could we reach more patients by having a virtual clinical research platform so that we can do informed consents online or via telemedicine, something like that? Could we conduct a visit virtually? So, that’s one side of that. A company that does a great job of that is Rx.Health, with the trial-engage platform they are working on exactly that. Another piece of that puzzle – How do we get patients for our studies easier? So, how do we identify those patients that already exist in our EMR system, without having to do it completely manually? And a company called DAYCAP is invested in that space and really working hard as is Rx.Health. So, I think there are a number of different options that if we look at the research landscape in five years, I think it’s going to be very different. I think all of the aspects of clinical research are not going to be held in a brick and mortar office, I think many of them will be done virtually.
Praveen Suthrum: Thank you very much for all the insights and perspectives. It’s definitely very educational for me and I’m sure it’ll be the same for everybody who’s watching it.
Dr. Chris Fourment:  It was a great discussion this morning. So, I appreciate you for having me on and I appreciate all that you’re doing.
Praveen Suthrum: Thank you so much.

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

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

Curated GI articles Sept 9th, 2020: Google quietly announces AI algorithm for colonoscopy screening + more

Curated GI articles Sept 9th, 2020:
Google quietly announces AI algorithm for colonoscopy screening + more
Chadwick Boseman’s death shed a much needed light on colorectal cancer (CNN)
African Americans also must recognize their elevated risk. Incidence of colorectal cancer is 20% higher in Blacks than in Whites, and Blacks are 40% more likely to die from the disease than Whites.
Video: Interview with GB Pratt, CEO of ModifyHealth: We are a 100% aligned to where healthcare is heading  (NextServices)
In this interview, you’ll learn more about ModifyHealth’s business model. A big question GB reflects on is whether ModifyHealth goes against the grain of today’s healthcare model.
Google quietly announces AI for colonoscopy screening (Google AI Blog)
“The C2D2 algorithm promises to lead to the discovery of more adenomas, thereby increasing the ADR.”
What has colon cancer screening got to do with self-driving cars? (KevinMD)
Read an excerpt from the first chapter of Scope Forward: The Future of Gastroenterology Is Now in Your Hands.
Tools Emerging to Predict Liver Failure in Cirrhosis (Medscape)
“Before this, we never had any patient signatures to identify ACLF,” said Jonel Trebicka, MD, PhD, from the University of Frankfurt in Germany.
Baseline Disease Activity and Steroid Therapy Stratify Risk of COVID-19 in Patients with Inflammatory Bowel Disease (NCBI)
Study on COVID-19 patients with/without IBD. Lukin, Kumar, Hajifathalian, Sharaiha, Scherl and Longman.
7 Recent reports in interventional endoscopy (Healio)
Recent developments on balloon-assisted enteroscopy, state of endoscopic education and reopening their endoscopy centers in the wake of the COVID-19.
ASGE launches campaign to promote safe colonoscopy screening (Becker’s GI & Endoscopy)
The American Society for Gastrointestinal Endoscopy launched its “Value of Colonoscopy” campaign to remind patients about the importance of regular preventative screenings.
The Battle Against Growing Burden of “Silent” Liver Disease Begins with Early Detection (HCPLive)
NAFLD is gaining more attention as a chronic medical condition, affecting approximately 25% of the worldwide population and 100 million individuals in the United States.
AGA recommends bidirectional endoscopy for most patients with iron deficiency anemia (AGA)
New AGA guideline outlines steps for early GI evaluation, which can lead to the identification and treatment of underlying digestive conditions.
5 most-read stories in GI this week — A spotlight on early-onset CRC & more (Becker’s GI & Endoscopy News)
Here are the five most-read Becker’s ASC Review articles for gastroenterologists.
Why Walmart Health’s chief just left the ‘dream job’ to lead a testing company you’ve never heard of (Fierce Healthcare)
“BioIQ is sitting here with nearly 500,000 COVID test capacity per day.”
Video: Gastro Ex: Video Game for Gastroenterologists (Level Ex)
Perform surgical procedures on virtual patients, diagnose diseases and conditions of the gastrointestinal (GI) tract, and earn CME with this video game!
Who’s Better Off: Employed or Self-Employed Physicians? (Medscape)
Self-employed physicians have the highest salaries, largest homes, and greatest wealth – yet they feel the least fairly compensated, according to an analysis of data from over 17,000 physicians.

Headlines for GI

The Regueiro Report: From the Virtual ECCO 2020 (Gastroenterology & Endoscopy News)
The future of gastroenterology and other excerpts on industry-changing trends (Becker’s GI & Endoscopy)


Telehealth and the new choreography of ‘anywhere care’  (RamaOnHealthcare)
Many Advanced Countries Missing Targets for HCV Elimination (Medscape)
Probiotics Reduce Mortality and Morbidity in Preterm, Low-Birth-Weight Infants (AGA)
NASHNET Announces the Publication of a Cost-Effectiveness Analysis Study in the Leading Journal “Gastroenterology “ (PR Newswire)
Older With IBD: Long-Term Outcomes After IPAA (Gastroenterology & Endoscopy News)


Interview: Trends Influencing Gastroenterology and all of Healthcare (NextServices)
3 Malpractice Risks of Video Visits (Medscape)
A practical approach to utilizing cannabis as adjuvant therapy in inflammatory bowel disease (GI & Hepatology News)
Medical Errors Jump After ‘Spring Forward’ to Daylight Saving Time (Medscape)
Covid-19: UK studies find gastrointestinal symptoms are common in children (The BMJ)
Expert Picks From DDW: Esophageal Disorders (Gastroenterology & Endoscopy News)
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.
03 Sep 2020

Interview with GB Pratt, CEO of ModifyHealth: We are a 100% aligned to where healthcare is heading


George “G.B.” Pratt is the Founder and CEO of ModifyHealth. The company recently raised $2 million in Series A funding – right in the middle of the pandemic. 
As a “food as medicine” company, ModifyHealth provides fresh, Low-FODMAP and Gluten-free meals to patients suffering from GI conditions. GI practices partner with the company to benefit from a dietary ancillary. 
In this interview, you’ll learn more about ModifyHealth’s business model. A big question GB reflects on is whether ModifyHealth goes against the grain of today’s healthcare model. 
Watch this thought-provoking interview in full (15min.47sec).
◘  GB’s background
◘  How ModifyHealth raised $2M in Series A funding in the middle of COVID-19
◘  “It was probably one of the first ‘zoom only’ fund-raising events”
◘ “We make it simple, effective and profitable for GI practices”
◘  The big picture that VCs are looking for
◘  Operating model of ModifyHealth
◘  Benefits patients get after using ModifyHealth
◘  “79% of patients report life-changing relief”
◘  The economic model of ModifyHealth
◘  “For most of our patients it’s cost-neutral” 
◘  Benefit for GI practices referring to ModifyHealth
◘ “We’re a 100% aligned to where healthcare is heading”



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

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

Curated Business/Tech GI Resources: September 2nd, 2020

Curated Business/Tech GI Resources: September 2nd, 2020
Podcast: Author hour with Praveen Suthrum (NextServices)
“There is disruption coming. It is not going to stop based on how we feel about it. If I end up getting worried about disruption, then I am not going to inspire action, neither in myself nor in my business or organization – let alone the industry.”
CRH Medical Corporation Announces Majority Purchase of Orange County Anesthesia Associates (Yahoo News)
Tushar Ramani, CEO of CRH, commented on the transaction, “We are pleased to announce this partnership with Orange County. The transaction deepens our presence in Florida to nine ambulatory surgery centers.”
Is the Doctor’s Office Dead? Practice of Primary Care Goes Virtual (RevCycle Intelligence)
The office-based business model has led to massive financial losses during COVID-19, while virtual primary care providers have been able to remain operational.
The future of gastroenterology and other excerpts on industry-changing trends (Becker’s GI & Endoscopy)
Ten years from now, gastroenterology will be completely unrecognizable from what it is today.
AMA Releases 2021 Overhaul of E/M Services Codes (Medscape)
The American Medical Association says 2021 CPT changes include steps intended to reduce “irrelevant administrative burdens that led to time-wasting note bloat and box checking.”
The future of telehealth: When are regulations returning? (Medical Economics)
Joseph Kvedar, MD, president of the American Telemedicine Association, breaks down what physicians can expect for future telehealth payments and regulations.
Anthem: Shifting certain GI procedures to ASCs could create $12B in savings  (Becker’s ASC Review)
Colonoscopies and upper gastrointestinal procedures cost an average of 1.7 times more in a hospital outpatient department than they cost in an ASC.
Moneyball for Health Care: Why Hasn’t It Happened? (Gastroenterology & Endoscopy News)
If you can measure something, it can be improved. But if something is not being measured, it can’t be improved—and we’re not measuring the value of care in health care, in any organization, in any health care system in the world.
Gut Bacteria Linked to Cardiovascular, Other Health Conditions (Medscape)
Microorganisms in the human digestive tract are linked to 29 specific health conditions.
Calculator to determine impact of Medicare cuts (AGA)
Use this AGA member exclusive tool to estimate the potential impact of the 2021 proposed payment changes to your practice.
Do Liver Conditions Up Risk of Severe COVID-19? It Depends (MedPage Today)
No higher risk of death in liver transplant, but more severe disease in patients with cirrhosis, NAFLD.
Asymptomatic CRC screening population has findings of IBD (Becker’s GI & Endoscopy)
Researchers examined 4,640 patients who underwent a colonoscopy between Sept. 1, 2013, and Aug. 31, 2019. They looked for endoscopic findings suggestive of IBD.
No COVID-19 deaths among Los Angeles IBD patients: 5 key insights for GIs (Becker’s GI & Endoscopy News)
Researchers from Cedars-Sinai Medical Center found that no COVID-19 fatalities have been reported in patients with inflammatory bowel disease in Los Angeles County, Calif.
Machine learning outperforms noninvasive tests in NAFLD (Healio)
Machine learning may be a reasonable solution for screening for fatty liver in the general population in areas where more niche noninvasive tests are unavailable, according to a presenter at the Digital International Liver Congress.
Mayo Clinic, NASA testing CRC-detecting AI algorithm (Becker’s GI & Endoscopy)
Mayo Clinic researchers and NASA Frontier Development Lab scientists are working to fine-tune an artificial intelligence algorithm that detects spatio-temporal patterns related to colorectal cancer progression.
Medscape Residents Lifestyle & Happiness Report 2020 (Medscape)
More than 1600 residents in 30-plus specialties were surveyed by Medscape to understand their physical and mental well-being and the impact of covid-19 on the learning environment.
Video: Younger people with NAFLD, COVID-19 at double risk for mortality (Healio)
In this video, Thomas Berg, MD, discusses data presented at The Digital International Liver Congress on the role of non-alcoholic fatty liver disease in COVID-19 mortality risk.
Video: No ‘hard-to-reach’ patients in HCV, just ‘hardly reached’ (Healio)
In this video, Joss O’Loan, MBBS, from the Hepatitis C Kombi Clinic, Australia, discusses two studies presented at The Digital International Liver Congress on HCV elimination programs using Epclusa.

Headlines for GI

What has colon cancer screening got to do with self-driving cars? (KevinMD)

Newsletter: Telehealth and the new choreography of ‘anywhere care’  (RamaOnHealthcare)

Prioritization by FIT Could Prevent CRC Deaths Amid COVID-19 Disruptions (MedPage Today)

5 Questions on NAFLD, Type 2 Diabetes, and Obesity (Gastroenterology Consultant)

Study of secondary COVID-19 cases underscores importance of physical distancing (Healio)

Colon and rectal cancer cases are going up among people younger than 50, researchers say (CNN Health)

ICYMI: Interview: Trends Influencing Gastroenterology and all of Healthcare (NextServices)

E-Consult Program Saves Time, Resources for GI Clinics (Gastroenterology & Endoscopy News)

Top in GI: Famotidine, Barrett’s esophagus, IBD (Healio)

Actor Chadwick Boseman’s death puts spotlight on early onset colon cancer (Becker’s GI & Endoscopy)

Expert guidance on screening for colorectal and pancreatic cancer in BRCA1 and BRCA2 carriers (AGA)

5 most-read stories in GI this week — Florida network grows even larger & more (Becker’s GI & Endoscopy)

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

Curated Business/Tech GI Resources: August 27th, 2020

Curated Business/Tech GI Resources: August 27th, 2020
Florida GI networks opens 25th location (Becker’s GI & Endoscopy)
Prolonged suspension of elective endoscopic procedures and outpatient consults could “compromise patient care and result in poor outcomes.”
What has colon cancer screening got to do with self-driving cars? (KevinMD)
Here’s an excerpt from Scope Forward: The Future of Gastroenterology Is Now in Your Hands that just got published in KevinMD.
Freenome secures $270M to boost its colorectal cancer blood test, expand trial nationwide (FierceBiotech)
The company’s main goal is to make it easier to screen the 45 million or so people who are behind on recommended colorectal cancer exams, such as a colonoscopy, with a front-line blood test.
The future of gastroenterology and other excerpts on industry-changing trends (Becker’s GI & Endoscopy)
Ten years from now, gastroenterology will be completely unrecognizable from what it is today.
Covenant Physician Partners teams up with 3 practices (Becker’s ASC Review)
Nashville, Tenn.-based Covenant Physician Partners partnered with two practices in California and a practice in Hawaii.
Mazen Noureddin, MD, on Why He Recommends Screening All U.S. T2D Patients for NAFLD (MedPage Today)
Economic analysis model suggests noninvasive screening for fibrosis could be more cost-effective than no screening.
Staying financially well in the time of COVID-19 (GI & Hepatology News)
“Luckily, the financial best practices that I share in “good” times ring true even in today’s world, with a few additions given the health and economic risks created by COVID-19.” – Jonathan Tudor.
GI ASC market not deterred by COVID-19, could hit $10.27B by 2027 (Becker’s GI & Endoscopy)
The U.S. gastroenterology ASC market was worth $7.21 billion in 2019 and is expected to grow at a compound annual growth rate of 5.8 percent through 2027 to hit $10.27 billion.
The gradual return of gastroenterology practice: 5 considerations (Becker’s GI & Endoscopy)
Prolonged suspension of elective endoscopic procedures and outpatient consults could “compromise patient care and result in poor outcomes.”
Siddharth Singh, MD, on How Frailty Can Affect Outcomes in Older Adults With IBD (MedPage Today)
The incidence of inflammatory bowel disease (IBD) among older adults is rising, and thus old age should be considered when weighing the risks and benefits of treatments for patients with IBD.
Non-Alcoholic Steatohepatitis: Identifying High-Risk Patients (Gastroenterology & Endoscopy News)
NASH is the second-leading indication for liver transplantation in the United States and likely will become the main indication in the future.
National economic factors associated with liver-related mortality trends (Healio)
Factors such as national health expenditure and gross domestic product were associated with increased liver-related mortality, according to reports.
COVID-19 linked to pancreatitis  (Becker’s Hospital Review)
Researchers conducted an observational study of 48,012 adult patients. On admission, 189 patients were identified with pancreatitis, of which 32 patients (17 percent) were diagnosed with COVID-19.
The ‘new normal’ for endoscopic education during the COVID-19 pandemic (Healio)
The lockdown period was devastating for our gastroenterology fellows, especially the advanced endoscopy fellow who only has 1 year of training to attain competency in a broad range of therapeutic procedures.
Is Precision Medicine for IBD Ready for Prime Time? (Gastroenterology Consultant)
“Precision medicine is developing in the diagnosis and treatment of IBD, as genetic testing and assessment of prognostic factors are being used to guide treatment decisions.” – Millie Long, MD.
AGA Releases Iron-Deficiency Anemia Guideline (Medscape)
The seven recommendations aim to improve quality of care and reduce practice variability, according to lead author Cynthia W. Ko, MD.
Webinar: Gastroenterology in a post COVID-19 world (The Hippocratic Post)
Webinar on Tuesday 1st Sep, 2020 from 6:00pm to 7:00pm. Speakers include Consultant Gastroenterologist Dr. Peter Irving and Specialist Clinical Psychologist Dr. Alexa Duff.
Why Biliary Atresia Demands Our Respect (Medscape)
“In contrast to newborns with physiologic unconjugated hyperbilirubinemia, which is common and benign, biliary atresia (conjugated hyperbilirubinemia) deserves great respect.” A commentary by William F. Balistreri, MD.

Headlines for GI

What do DNA tests have to do with self-driving cars? (NextServices)

Newsletter: Telehealth and the new choreography of ‘anywhere care’  (RamaOnHealthcare)

Reducing the backlog of patients (AGA)

Two platforms appoint new leaders & more: 5 GI industry key notes (Becker’s GI & Endoscopy)

Stop the PPI to Lower COVID-19 Risk? (Medscape)

Diabetes plus weight loss equals increased risk of pancreatic cancer (GI & Hepatology News)

Walmart pivots to online wellness event as it continues to expand healthcare initiatives (The Business Journals)

Hong Kong Researchers Report First Documented Coronavirus Reinfection  (Medscape)

Vast majority of specialists increased use of telehealth tech during COVID-19 pandemic (Healthcare IT News)

‘Food is your medicine’: Advocating for nutrition policies (Healio)

Perspective: Are Aging Physicians a Burden? (Medscape)

The Post-Covid World: 16 Ways Telehealth Could Transform Healthcare (CB Insights)

Hospitals That Don’t Report COVID Data to HHS to Be Penalized (Medscape)

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

What has colon cancer screening got to do with self-driving cars?

What has colon cancer screening got to do with self-driving cars? An excerpt from Scope Forward: The Future of Gastroenterology Is Now in Your Hands.
Over a decade ago, many of us still used landline phones, watched cable TV, rented DVDs, called for taxis, took photos using cameras, and drove over to Borders to browse and buy books. During the past 10 years, we watched each of these fields permanently getting altered. Today, we stream movies on Netflix, call Uber to get somewhere, and we keep buying new phones to take better photos. We can’t think of what not to use Amazon for. It’s true—our life has turned digital. Most of us are so hooked to a device that to disconnect digitally is considered being mindful now.
Whether we realize it or not, we are living in exponential times. We are part of a grander, digital game.
How does a field become digitized? By finding a way to convert itself into zeros and ones, the basic language of computers. When music became digitized, we could more easily transmit a song as zeros and ones through the internet. When photography became digitized, we could convert pixels into zeros and ones. When books became digitized, we could access it via Amazon Kindle, a digital device. Industries and companies failing to recognize that shift are inevitably disrupted.
With $16 billion in annual revenues, Kodak’s leadership position was unquestionable in 1996. Maybe that’s why its executives didn’t see (or didn’t want to see) the wave of digital photography. When photography became digital, it moved from a physical setup of bulky cameras with film rolls to a more virtual environment—a smartphone in your pocket. Moving to digital, photography became cheaper and cheaper to the point where it became virtually free. You could distribute your photos infinitely. Companies like Instagram built apps that made average people take cool photographs. Meanwhile, Kodak went bankrupt in less than 20 years from its peak in mid-1990s.
Stool DNA tests and self-driving cars
Back in 2012, I sat in a very different-looking Lexus—it was one of Google’s early self-driving cars. Wires ran from a laptop to the steering wheel and into the mechanics of the vehicle. A gray-looking device called the LIDAR scanner sat on top of the car. It rotated all the time and scanned the entire environment. The LIDAR served as the eyes of the self-driving car. From what I gathered, it cost $200,000 to convert the Lexus into a self-driving unit. The LIDAR itself cost $75,000. The automotive industry dismissed Google’s effort as a research project. Well, it was one.
The Google Self Driving Car Project started in 2009. A decade later, Google’s self-driving car, called Waymo, is a Chrysler Pacifica minivan. On their website, the company says that they are “building the World’s Most Experienced Driver.” They can make that claim because when one Waymo car drives a mile, the entire Waymo system learns.
We can clearly see that exponential technologies are disrupting cars and phones. So why wouldn’t these technologies find their way into healthcare and gastroenterology?
What do stool tests have to do with self-driving cars? We’ll soon find out. But let’s first go back to the discussion we had earlier on the shift to digital. Screening for cancer through colonoscopy, while a gold standard, reminds me of a field that’s at the crossroads of disruption—much like music or photography was before iTunes or smartphones.
If you consider the argument for a moment, a colonoscopy is largely limited to one doctor and one patient at a time. When a doctor performs a colonoscopy, he or she can’t scale beyond the procedure. With each procedure, the learning happens within the capacity of that one doctor. To put that into context, only a very small percentage of doctors become endoscopists. And an even smaller percentage achieve mastery in endoscopy. Statistically speaking, we are talking of a very few highly qualified individuals who can reliably screen for cancer using sophisticated methods.
Ask yourself what could make the field of cancer screening go digital? Something that can accelerate cancer screening and give control to the nonexperts. I’m sure you might have arrived at DNA testing or artificial intelligence.
Now ask yourself these five questions:
1. Can stool DNA testing be ultimately represented in zeros and ones, the language of computers?
2. iTunes allows musicians to reach millions of people. With DNA testing, is it technically possible to screen millions of people for colon cancer?
3. The more Google’s self-driving car drives, the more it learns as a system. Could it be technically feasible to reduce screening error rates with more screening data?
4. Smartphones made the average user into a photographer. Could a DNA testing kit (backed by a sophisticated lab) simplify screening to a point where the patient has more control?
5. Amazon made it easier for people to buy books. Could DNA testing make cancer screening dramatically more convenient?
By going digital, we would take a physical environment (endoscopy room to detect cancer) and convert it into a virtual, information-enabled, machine-driven environment (DNA testing to detect cancer).
Looking at it differently, the demand for early cancer screening will continue to rise. According to the World Cancer Research Fund, colorectal cancer is the third most commonly occurring cancer in men and the second most in women. It’s an expanding need. By taking advantage of exponential tools, gastroenterologists can screen more patients than they have in the past.
We must find ways to ride and harness this digital wave to scope forward. Not fight or escape it.


Originally published on KevinMD



21 Aug 2020

Curated Business/Tech GI Resources: August 20th, 2020

Curated Business/Tech GI Resources: August 20th, 2020
NextServices partners with Gastrologix to launch GastroInfuse, a program to help GI practices develop infusion as an ancillary (NextServices)
We are excited to announce our new collaboration with Gastrologix in the launch of GastroInfuse, a new program that helps independent gastroenterology practices develop in-office infusion services.
United Digestive Announces Dr. John Suh as new CMO Celebrates Dr. Steven Morris’ Four Decades of Leadership (PRNewswire)
United Digestive announced John Suh, MD, MPH as its new chief medical officer (CMO). Founding CMO, Steven J. Morris, MD, will remain on the organization’s board of directors.
Who leads the PE-backed GI platforms? (Becker’s GI & Endoscopy)
Seven gastroenterology platforms have been established in the specialty since May 2016. Here are the main leaders behind each one.
Interview: Trends Influencing Gastroenterology and all of Healthcare  (NextServices)
In this interview on RamaOnHealthcare, you’ll learn about trends that impact not just gastroenterology but all of healthcare. The interview is based on the upcoming book on the future of gastroenterology: Scope Forward – The Future of Gastroenterology Is Now in Your Hands.
EHRs May Hold Keys to Practice Survival In the COVID Era  (Gastroenterology & Endoscopy News)
The development of ancillary services is a crucial consideration for gastroenterology practices, particularly in the trying times of the COVID-19 pandemic. What service line should you develop? The answer may lie in the contents of your EHRs.
Telemedicine Success in Gastro Surgery Practice (MedPage Today)
Experience at a large endoscopy clinic in Dallas showed that telemedicine boosted numbers of new patients scheduled and seen — and this was well before the COVID-19 pandemic struck, researchers said.
Tailored Messaging Needed to Get Cancer Screening Back on Track  (Medscape)
Lisa Richardson, MD, emerged from Atlanta, Georgia’s initial COVID-19 lockdown, and “got back out there” for some overdue doctor’s appointments, including a mammogram.
Q&A: Patients who refuse FIT, colonoscopy prefer blood test for CRC screening (Healio)
A study published in the Journal of the National Cancer Institute concludes that Epi proColon is the test of choice for individuals not willing to participate in fecal immunochemical tests or colonoscopy screening.
Want to be a physician-entrepreneur? Get these insights from Dr. Don Lazas (ObjectiveGI) (Nextservices)
In this video, Dr. Don Lazas shares his insights on how GI physicians can take the spirit of entrepreneurship beyond private practice.
Meet the leadership team tasked with growing PE-backed Gastro Care Partners (Becker’s GI & Endoscopy)
Denver-based Gastro Care Partners appointed an executive leadership team with experience in building and scaling physician practices.
How we managed our GI practice during COVID-19 in San Francisco (AGA)
Aparajita Singh, MD, MPH, and Lukejohn Day, MD, share their approaches to caring for patients in GI clinics and endoscopy centers during this pandemic.
Top in GI: COVID-19 and colorectal cancer screening, duodenoscopes  (Healio)
Colorectal cancer screening rates have significantly decreased in recent years among at-risk populations, and COVID-19 has exacerbated this decline, according to a recent analysis.
Web-based fellowship interviews in the era of COVID 19: Tips and tricks (GI & Hepatology News)
Until recently, most programs relied exclusively on on-site face-to face interviews. Since the appearance of the COVID-19 pandemic, the medical field has utilized web-based platforms.
HHS extends application deadlines for financial assistance programs (Healio)
HHS announced that Medicaid, Medicaid managed care, Children’s Health Insurance Program and dental providers as well as certain Medicare providers experiencing financial difficulty stemming from COVID-19 now have until Aug. 28 to apply for funding relief.
Mount Sinai expands GI services — 3 insights (Becker’s GI & Endoscopy)
New York City-based Mount Sinai Health System leased space in Scarsdale, N.Y., to open Mount Sinai Doctors Westchester, which will expand physician services in the region.
With More Fed COVID Aid in Doubt, Practices Struggle to Survive (Medscape)
Despite a rebound in face-to-face office visits since May, the cumulative effect of all the lost business is dragging down many practices, reports from a variety of sources reveal.
Video: Erica Brenner, MD: Returning to Normal in Gastroenterology (HCP Live)
Brenner explained why it was important for doctors and researchers to consistently update the community and patients on guidelines and best practices regarding safety in order to maintain health care services without sacrificing much.
Video: Stephen Hanauer, MD: Gastrointestinal Symptoms Mild in COVID-19  (HCPLive)
A gastroenterologist discusses how gastrointestinal symptoms are manifesting in patients with COVID-19.

Headlines for GI

How real is Virtual/Augmented Reality in healthcare? (Exponential Tech Part 4) (NextServices)


Telehealth and the new choreography of ‘anywhere care’  (RamaOnHealthcare)


Gastrointestinal and liver involvement in patients with COVID-19 (The Lancet)


Flatus: An aerosol generating concern during the COVID‐19 pandemic (BJS)


EHR Add-on Could Help Predict Advanced Fibrosis (Gastroenterology & Endoscopy News)


Crossover Health: The Amazon Deal, Primary Care & The Rise of the ‘Health Activist’ Employer (The Healthcare Blog)


Early Colonoscopy Does Not Improve Outcomes of Patients With Lower Gastrointestinal Bleeding: Systematic Review of Randomized Trials (AGA)


Ear Stimulation Eases IBS Pain in Teens (MedPage Today)


Patients with IBD discontinue methotrexate at higher rate than thiopurines (Healio)


Comparison of Mask Types Finds Key Differences in Filtration (Medscape)


5 top-read stories in GI this week — Best hospitals for GI & more (Becker’s GI & Endoscopy)


AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia (AGA)


Five no-regret strategies health systems are employing for sustainable results (Becker’s Hospital CFO Report)
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.