02 Jul 2022

Curated GI articles July 1st, 2022: PE GI Solutions Joins SCA Health (owned by OptumCare) | Alternatives to private equity

Curated GI articles July 1st, 2022:
PE GI Solutions Joins SCA Health (owned by OptumCare) | Alternatives to private equity
PE GI Solutions Joins SCA Health (PE GI Solutions)
PE GI Solutions joins SCA Health (Surgical Care Affiliates), $2.5 billion ASC company. Note that SCA Health is part of OptumCare, which is part of United Healthcare.
Scope Forward Show: “It’s crazy that we record 4K videos with our iPhones but don’t capture data of our most precious asset – our body” (NextServices)
In this interview, Praveen Suthrum interviews Matt Schwartz CEO & Co-Founder at Virgo. If data is the new oil, could it be a new ancillary for GI?
Physician-owned management model: An alternative to private equity (Healio)
Michael Owens, MD, FASGE, physician and the director of digestive health at Pearl Incision shares his opinions on alternatives to private equity.
Private equity’s place in gastroenterology: 3 physicians’ viewpoints (Becker’s GI & Endoscopy)
The amount of private equity gastrointestinal groups grew to 68% last year and is projected to expand throughout 2022. Here is what three GIs said about this trend.
5 statistics making gastroenterologists nervous (Becker’s GI & Endoscopy)
From a rise in colorectal cancer cases to missed colonoscopy appointments, here are five numbers making gastroenterologists nervous.
FIT, Hemoglobin Together Can Rule Out CRC (GI & Endoscopy News)
In a population of almost 5,000 patients followed in a symptomatic patient referral pathway, the use of these two tests in combination correctly identified cancer in 99.96% of cases.
US Digestive Health CEO Jerry Tillinger wants GI leaders to embrace competition (Becker’s GI & Endoscopy)
Jerry Tillinger, CEO of U.S. Digestive Health in Exton discusses how competitors can be gastroenterology leaders’ greatest allies and more.
Health-Care Dealmaking Slows as US Inflation Hits Record High (Bloomberg Law)
Economic trends and supply chain issues point to a slowdown in transaction activity in many areas of the economy. Health-care dealmaking decreased in May under the pressure of record-setting inflation.
Why AI in GI? Why now? (Inside Perspectives)
Dr. Sravanthi Parasa and Dr. Prateek Sharma, M.D., practicing gastroenterologists, discuss how artificial intelligence can be applied in healthcare and why now is the time to learn about the possibilities.
Dr Christopher Thompson Discusses Innovative Treatment for Type 2 Diabetes and Obesity (AJMC)
Christopher Thompson, MD, director of endoscopy and codirector of the Center for Weight Management and Wellness at Brigham & Women’s Hospital, discusses duodenal jejunal bypass liner treatment and future innovations in gastroenterology.
Artificial intelligence in gastroenterology and hepatology: how to advance clinical practice while ensuring health equity (UCLA)
The review adapts a framework for ethical AI/ML development and application to gastroenterology and hepatology such that clinical practice is advanced while minimising bias and optimising health equity.
Singaporean gut microbiome firm AMILI brings home $10.5M in Series A funding (Mobi Health News)
The company is building a huge multi-ethnic repository of microbiome data and samples. They are also developing diagnostics tests, predictive algorithms, and microbiome-modifying interventions.
The ACG Clinical Practice Guideline on Upper Gastrointestinal and Ulcer Bleeding Review (Medscape)
The guideline which offers 16 statements, are consolidated into five recommendations in this guideline update for the generalist.
AGA Presidential Plenary Focused on Eradicating Disparities in Gastroenterology (MedPage Today)
John M. Inadomi, MD, talks about “Don’t Talk — Act: The Relevance of DEI [Diversity, Equity, and Inclusion] to Gastroenterologists and Hepatologists and the Imperative for Action.”
Assessing the Clinical Robustness of Digital Health Startups: Cross-sectional Observational Analysis (JMIR)
The digital health sector has experienced rapid growth over the past decade. However, health care technology stakeholders lack a comprehensive understanding of clinical robustness and claims across the industry.
PreventionGenetics Receives FDA Approval for its Companion Diagnostic Genetic Test as a Class II Medical Device (PR Newswire)
Exact Sciences subsidiary PreventionGenetics announced  that it has received clearance from the U.S. FDA for a companion diagnostic genetic test to identify patients for monogenic obesity therapy.
IBS guideline follow-up: try a low-FODMAP diet first (AGA)
AGA’s patient education can help patients successfully follow a low-FODMAP diet.
A Guide for Deprescribing Proton Pump Inhibitors (GI Insights)
Dr. Peter Buch and Dr. Laura Targownik, who’s the lead author of the American Gastroenterological Association’s Clinical Practice Update discuss about De-Prescribing of Proton Pump Inhibitors.
The urgent unmet need in IBD (Atomic IBD)
Patients have unequal access to expert care, latest medicines, nursing, dietary and psychological support. The article discusses key areas of urgent unmet need for IBD in 2022.
GISTs Mimic Gynecologic Diseases: A Case Series (Rare Disease Disorder)
Gastrointestinal stromal tumors (GISTs) may sometimes manifest as gynecologic diseases in some patients, according to a case series published in Diagnostics.

More Hot headlines in GI
ICYMI- SF Interview: Why GI doc left lucrative practice for startup (NextServices)

4th Global Gastroenterology & Artificial Intelligence Summit (ASGE)

2nd Annual EquityInIBD Hybrid Patient Symposium (COCCI)

ACG 2022 Annual Scientific Meeting & Postgraduate Course (ACG)

Urge CMS to cover follow-up colonoscopies after a positive non-invasive screening test (AGA)

Laura Mantell Joins Iterative Scopes as Vice President of Life Sciences (Business Wire)

Cleveland Clinic hospital in Florida receives $5M for digestive center (Becker’s GI & Endoscopy)

Walgreens Looks to Healthcare and Digital for Growth (PYMNTS)

Microbial link between Western-style diet and incidence of colorectal cancer uncovered (EurekAlert)

Irritable Bowel Syndrome Therapy Removed From Market (Again) (Medscape)

7 gastroenterology practice openings in Q2 (Becker’s GI & Endoscopy)

Gastro Health announces Hygieacare® Center Now Open in Miami, FL to Comfortably Prep Patients for Colonoscopy (EIN Presswire)

Why primary care doctors are leaving revenue on the table (Medical Economics)

Travis Barker reportedly hospitalized with pancreatitis after a colonoscopy. Gastroenterologists say it’s rare (Insider)

Researchers Uncover Factors Associated With NAFLD in Patients With IBD (GI & Endoscopy News)

Videos: Interviews with GI Leaders  (NextServices)

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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.
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30 Jun 2022

Matt Schwartz (CEO of Virgo): “Huge opportunity to add a digital layer to GI and endoscopy” (Interview)

Matt Schwartz (CEO of Virgo): “Huge opportunity to add a digital layer to GI and endoscopy” (Interview)
A few years ago I ran into Matt at one of the GI conferences. At that time, Virgo was taking shape as a storage system for endoscopy videos. With persistence and the right pivoting, it’s amazing what Matt and his team at Virgo have been able to do.
In case you wondered, they’ve captured 400,000 endoscopy videos and that number is growing exponentially. That’s a lot of data.
Virgo smartly partnered with pharmaceutical companies so that they can recruit right candidates for clinical trials. That led to a fund raise of $8 million with FCA Venture Partners and a soon-to-be-announced strategic investor.
Their Northstar goal is to change the standard of care by saving data. You’ve heard of the new adage: data is the new oil. With the advent of AI in GI, it shouldn’t be a surprise then that Virgo will dramatically influence GI care in the coming years.
Watch this one. You might discover a new data ancillary in your own endoscopy room.
What led to the founding of Virgo? Why GI?
Why did they pivot toward clinical trials and pharmaceutical companies?
The business benefit for providers
“The biggest challenge around IBD trials was patient recruitment”
“We’ve captured 400,000 endoscopy videos and that number is growing exponentially”
“It’s crazy that we record 4K videos with our iPhones but don’t capture data of our most precious asset- our bodies”
“We have a lot of runway in the IBD space, but there are other disease areas within GI that we are looking at”
Medical malpractice implications of recording videos
“Video evidence can be a great tool of protection for endoscopists”
“Data is the new oil”
Virgo raised $8 million
“There is a huge opportunity to add a digital layer to 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.
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25 Jun 2022

Curated GI articles June 24th, 2022: PE creates uncertainty | $19M, $7M for GI startups | GI sixth wealthiest

Curated GI articles June 24th, 2022:
PE creates uncertainty | $19M, $7M for GI startups | GI sixth wealthiest
Gemelli Biotech to work on gastrointestinal diseases with new $19M funding (Labiotech)
Funding will accelerate the commercialization of Gemelli’s Trio-smart® and IBS-smart® precision diagnostic tests for IBS and SIBO, and its strategies for gastrointestinal discoveries related to the microbiome.
Private equity creates ‘big uncertainty’ in gastroenterology, physician says (Becker’s GI & Endoscopy)
As private equity’s influence in healthcare continues to grow, its effect on the gastroenterology industry remains murky.
SF Interview: Why GI doc left lucrative practice for startup (NextServices)
In this episode of The Scope Forward Show, Praveen Suthrum interviews Fehmida Chipty, MD, COO of digital health startup NovoLiver on why she left her thriving GI practice.
Gut health platform Cara Care raises $7m (Sifted)
The digital health platform builds a personalised treatment plan, and users can chat with dieticians, track their food and take quizzes to better understand their conditions.
Mergers, policy advocacy, GI fellowships, and more: DDW 2022 (Gastro Broadcast)
Dr. Michael Weinstein interviews Dr. Nadeem Baig, VP and CMO of Allied Digestive Health over various issues affecting independent GI.
Gastroenterologist wealth: 3 report takeaways (Becker’s GI & Endoscopy)
Gastroenterology is the sixth wealthiest specialty, according to Medscape’s Physician Wealth & Debt Report 2022.
2022 Physician Report: Top 10 issues facing physicians this year (Medical Economics)
While the top issues physicians identified remained similar to previous years, new challenges presented by the COVID-19 pandemic and the Great Resignation were felt by practices.
The Risk of PPI Therapy: What’s the Real Story?​ (ACG)
Dr. Paul Moayyedi interpreted the latest evidence vis a vis PPI risks and benefits and discussed best practice recommendations for clinical use.
New AGA guidelines: A targeted approach to IBS-C and IBS-D treatment (AGA)
The newest clinical guidelines by AGA outline when to use which IBS drug based on your patients’ symptoms.
What private practice physicians need to know about prior authorization (Becker’s ASC Review)
“In 36 years, I can only recall one time I could not get the test approved I wanted,” says gastroenterologist Carl Dettwiler, MD, find out why?
New Standards to Reduce Polyp Recurrence (GI & Endoscopy News)
Endoscopic submucosal dissection and endoscopic mucosal resection with margin ablation should be considered standards of care to reduce recurrence after endoscopic resection of large colorectal polyps.
Scrubs & Heels: How an Organization Aims to Close Gender Disparities in GI (Reach MD)
Drs. Aline Charabaty and Anita Afzali join Dr. Neil Nandi to discuss Scrubs & Heels’ mission and how we can close gender disparities and promote women in the field of gastroenterology.
Obesity in GI Care: Coverage and Reimbursement (Inside Scope)
In this episode, hosts Drs. Andres Acosta and Octavia Pickett-Blakely discuss the role of the GIs and hepatologists,  advanced practice providers (APP), and others in a care team for obesity management.
Evidence-based study shows how hypnotherapy provides positive outcomes for IBS patients (News Medical)
Apart from medication, overseas studies have pointed out that a variety of alternative therapies (including hypnotherapy) show their effectiveness on various levels.
Liquid biopsy identifies who can skip chemo after colon cancer surgery (Reuters)
Early colon cancer patients who have circulating tumor DNA detected in blood may need more aggressive treatment, but people who have a negative liquid biopsy appear to be safe in avoiding chemotherapy.
Doctors Prefer Colonoscopy, But Average-Risk Adults Don’t (GI & Endoscopy News)
For CRC screening, physicians prefer colonoscopy, but average-risk adults would likely choose blood tests or at-home stool tests if given the choice.
CapsoVision and Gastrologix Announce Agreement to Provide the World’s Only Capsule Endoscopy System with a 360° Panoramic View for GPO Members (CapsoVision)
CapsoCam Plus® is the only small bowel capsule endoscopy system in the world with a 360° panoramic view, to hundreds of gastroenterology offices and clinical end-users.
MRI index can predict postop recurrence in Crohn disease (Medical Xpress)
A magnetic resonance imaging (MRI) index has been developed and validated for predicting postoperative recurrence (POR) in Crohn disease (CD), according to a study.
COVID-19 shutdown ‘magnified the disparities’ among patients with GI bleeding (Healio)
Although fewer patients visited the emergency department for gastrointestinal bleeding during the pandemic, cases were more severe and disproportionately worse among underrepresented groups, according to a study.
Ditching Pre-Colonoscopy Visits Reaches More for Screening (GI & Endoscopy News)
To capture patients who find the traditional two-visit colonoscopy process too onerous, some practices have implemented “fast-track” colonoscopy programs.

More Hot headlines in GI
ICYMI: Abe M’Bodj on PE valuations during recession and the next “second bite” (NextServices)

4th Global Gastroenterology & Artificial Intelligence Summit (ASGE)

2nd Annual EquityInIBD Hybrid Patient Symposium (COCCI)

ACG 2022 Annual Scientific Meeting & Postgraduate Course (ACG)

PathAI co-founder Khosla carves a new path as CTO of Iterative Scopes (Fierce Healthcare)

Oshi Health Names Dr. John Allen to Medical Advisory Board (PR Web)

Baclofen shows limited role in GERD (MDedge)

GE Healthcare debuts wireless, wearable hospital patient monitor (Fierce Healthcare)

Ustekinumab and adalimumab comparable in safety and efficacy for treatment of Crohn’s disease (2 Minute Medicine)

Study indicates gut microbiome, host gene affect gastrointestinal disorders (Mayo Clinic)

Impact of Eliminating Cost-Sharing on Follow-Up Colonoscopy Mixed (Medscape)

Videos: Interviews with GI Leaders  (NextServices)

_
COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
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24 Jun 2022

Dr. Fehmida Chipty: From GI doc to COO of a digital health startup (Interview)

Dr. Fehmida Chipty: From GI doc to COO of a digital health startup (Interview)
I got to know Dr. Fehmida Chipty because of her involvement in NovoLiver, a fatty liver disease startup I cofounded in US and India. She’s a Boston-based gastroenterologist, and a photographer. As the months rolled by, I observed closely how Fehmida made up her mind to leave private practice GI and take the plunge into the vast unknown. After just a few weeks of exploration, she assumed the role of chief operating officer of NovoLiver transforming the startup’s operations. She brought order to the house.
GI doctors are conditioned to function the way they have for the last 10-15-20-30 years. But the industry is shifting gears. Technology and business forces are disrupting the norm as we know it. Physicians want to change but fear grips them as they do. Most don’t talk about their concerns openly fearing ridicule of their peers.
Watch Dr. Fehmida Chipty’s fascinating narration unfold fundamental issues of gastroenterology. As with Scope Forward interviews, I ask my questions quite directly. Why did she quit GI? What are the problems that we don’t talk about? Why don’t physicians ask for help? What her concerns are with our healthcare system? Is doing colonoscopy after colonoscopy really helping solve for cancer?
Your future self will want you to watch this one.
Why did Dr. Fehmida Chipty quit a thriving GI practice?
Journey from a GI doctor to COO of a digital health startup
What are the unspoken problems faced by GI doctors?
If the end game is to prevent cancer for a GI, are there more effective ways to do that?
“Female colonoscopies are more complex”
“Physicians don’t ask for help”
◘  The looming threat of disruptors like AI, digital biology, consolidation, patient mistrust and its effect on physicians
“If Physicians don’t adapt, they won’t survive”
If GIs and physicians leave the field, who will take care of the patients?
“I am scared about where GI and all of medicine is going”

_
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.
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18 Jun 2022

Curated GI articles June 17th, 2022: Gastro Health expands | PE valuations and upcoming “second bite” | Wearable gut disorder test

Curated GI articles June 17th, 2022:
Gastro Health expands | PE valuations and upcoming “second bite” | Wearable gut disorder test
AGA releases evidence-based principles to guide creation of national colorectal cancer screening approach (AGA)
CRC experts developed eight statements on reducing the burden of CRC.
Gastro Health Signs Partnership with Digestive Disorders Associates in Annapolis (Gastro Health)
Digestive Disorders Associates is joining with 6 physicians and 3 advanced practice providers. The practice has three office locations in Annapolis, Chester, and Gambrills.
SF Interview: Abe M’Bodj on PE valuations during recession and the next “second bite” (NextServices)
In this episode of The Scope Forward Show, Praveen Suthrum interviews Abe M’Bodj, Vice President at Westcove Partners, a leading healthcare-focused investment bank.
Ibex Obtains CE Mark for Galen Gastric, the World’s First AI-powered Solution for Gastric Cancer Detection (PR Newswire)
Galen™ Gastric demonstrated outstanding outcomes in detecting gastric cancer in a multi-site study, supporting quality diagnosis, enhanced lab efficiency and quality control.
Medscape Physician Wealth & Debt Report 2022: How Did a Tough Year Add Up? (Medscape)
The survey was conducted on 13,000 physicians across 29 specialities. The Physicians were questioned on parameters like compensation, savings, investments etc.
The biggest challenges gastroenterologists are facing (Becker’s GI & Endoscopy)
Three GI experts weighed in to answer: “What is the biggest challenge gastroenterologists are facing?”
June issue of The Lancet Medical Journal Gastroenterology & Hepatology (Lancet GI & Hepatology)
The June 2022 issue covers the content on screening, Crohn’s disease, Wilson disease, AMR in chronic liver disease, and much more.
Emergence of digital therapeutics boosts access to GI behavioral resources (Healio)
Research has shown the benefits of tailoring a patient’s treatment team to include a GI psychologist, registered GI dietitian, pelvic floor therapist and more.
GERD Roundtable: Applying the Guidelines to Clinical Practice (GI & Endoscopy News)
Part 2 of the GERD roundtable series highlights the management of refractory GERD, patient monitoring and patients who are misdiagnosed.
New practice resource: Coding guide for CRC screening (AGA)
AGA tips will help your office navigate new regulations to decrease surprise bills for patients.
Johns Hopkins and Microsoft awarded $150K to these startups creating digital solutions (Technical.ly)
SpectralDx is creating a tool that allows patients to use their smartphones to screen their own stool samples for colorectal cancer.
Value-Based Gastroenterology: Removing the Barriers of Care (ChenMed)
Dr. Steven Kaster, ChenMed’s National Director of Gastroenterology talks about the business of providing quality care, healthcare policy solutions, and specialty access through primary care.
20 gastroenterology companies to know (Becker’s GI & Endoscopy)
From device companies to providers, here are 20 gastroenterology-focused companies to know compiled by Becker’s Healthcare.
Cryoballoon Ablation Comparable to RFA For Eradicating Dysplastic Barrett’s (GI & Endoscopy News)
Cryoballoon ablation appears to be just as effective as radiofrequency ablation in treating patients with dysplastic Barrett’s esophagus.
AI-based CADe outperforms high-definition white light in colonoscopy (MDedge)
An AI-based computer-aided polyp detection system missed fewer adenomas, polyps, and sessile serrated lesions and identified more adenomas per colonoscopy than a high-definition white light colonoscopy.
Gut-brain axis dysfunction underlies FODMAP-induced symptom generation in irritable bowel syndrome (Wiley Online Library)
FODMAPs produce similar small bowel water and colonic gas in patients IBS and healthy controls (HCs), despite IBS patients reporting increased GI symptoms.
Private Equity Pass No More: Antitrust Enforcers Look to Increase Scrutiny on “Roll Up” Acquisitions (JD Supra)
Private equity firms that have not encountered strong antitrust scrutiny in the past should be prepared for a very different experience with future acquisitions.
Alimetry gets FDA clearance for wearable gut disorder test (MobiHealth News)
Gastric Alimetry is a non-invasive test for common stomach disorders, including nausea and vomiting, gastroparesis, and functional dyspepsia.
Sick to Our Stomachs​ | Why Does Everyone Have IBS? (The Drift)
IBS symptoms in individuals are reported to have either worsened during the pandemic, or appeared for the first time, according to studies from both pharmaceutical companies and medical research institutes.
VIDEO: Outgoing AGA president highlights race in medicine, AI as key topics from DDW 2022 (Healio)
In a video exclusive, John Inadomi, MD, AGAF, chair of the department of medicine at the University of Utah and immediate past president of the AGA, shares key takeaways from DDW 2022.

More Hot headlines in GI
ICYMI: “More data, better diagnosis” – Founder & CEO of FoodMarble (Interview) (NextServices)

4th Global Gastroenterology & Artificial Intelligence Summit (ASGE)

ACG 2022 Annual Scientific Meeting & Postgraduate Course (ACG)

Boston Scientific offers $230M for Korean maker of gastrointestinal and airway stents (Fierce Biotech)

Best Children’s Hospitals for Gastroenterology & GI Surgery (U.S. News)

6 colonoscopy, endoscopy updates (Becker’s GI & Endoscopy)

Persistent Abdominal Pain: Not Always IBS (Medscape)

Google’s health chief says the company wants to be ‘trusted’ by consumers (Digital Health)

Pre-op Bowel Stimulation Reduces Post-op Ileus (GI & Endoscopy News)

GI Dynamics EndoBarrier meets endpoints in diabetes, obesity study (Mass Device)

Bridging the Gap Between Celiac Disease and Mental Health Care (GI Advisor)

Videos: Interviews with GI Leaders  (NextServices)

_
COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
button_download
16 Jun 2022

Abe M’Bodj: How will PE respond to recession? (Interview)

Abe M’Bodj: How will PE respond to recession? (Interview)
There’s a lot of noise about recession right now. Inflation is high. Job losses are on the horizon. Public markets are brutal. Abe M’Bodj, VP at Westcove Partners an investment bank helps us listen to the signal from the noise.
What I was curious about was the mindset of private equity companies during an economic downturn. Would they continue to invest in GI or hold-off? Or, would they accelerate their investments? (there’s a lot of “dry powder” available).
Talking about gastroenterology specifically, what would happen with upcoming exits? Would they continue to get pre-downturn valuations? What about bankers who gave debt in these transactions? How about the GI practices that didn’t transact?
If there were a crystal ball, what can we expect in the coming months with PE in GI?
This is one of those interviews that unpacks a lot of information and converts that into deeper insights. Listen or watch closely.
The ‘R’ word
What exactly is recession anyways?
“That’s like a textbook outcome of what to expect when you are printing money”
Where does private equity get its money from?
“The longest weekly decline in the stock market since the tech-bubble burst in 2000 was seen in the last month”
What would a PE firm be worried about at the moment
“Healthcare services are a great area for PE investments” 
…will likely see a secondary transaction next year
If Gastro Health were to exit at the peak of the recession, would they get the same valuation?
“10% of 14,000 GIs  are part of PE-backed organizations
“A lot of the slower-moving groups will be acquired by the larger ones”
“Where is GI in terms of PE right now”?
Crystal ball on upcoming announcements in GI?

The Transcribed Interview:
Praveen Suthrum: Abe, it’s really nice to see you again. Welcome back to The Scope Forward Show.
Abe M’Bodj: Likewise. Thank you for having me. For me, it’s good to be back again.
Praveen Suthrum: I want to introduce you to our audience. So Abe M’Bodj is currently a Vice President with Westcove Partners, an investment banking firm that specializes in working with healthcare entrepreneurs and has unique experience advising physician practices and more specifically, GI practices through private equity and or strategic M and A transactions. So Abe this is going to be such a useful conversation for people who are listening, because I’m going to start with the R word, which is recession. So are we in recession? Is this supposed to be recession?
Abe M’Bodj: I have to check the exact I think the specific definition of recession is two consecutive quarters with shrinking or negative GDP growth.  I don’t know if we’ve met the technical definition for a recession yet, but it definitely feels like economic activity is declining, maybe a little bit. I know everyone’s sort of waiting on some updated inflation numbers and data, but I think as a result of some of the kind of monetary and fiscal policies of the last year to pump a lot of money into the economy, you certainly had inflation pick up, which has caused a lot of prices to increase. Gas, grocery store, used goods, all sorts of items have kind of increased in price. And so it’s caused consumers to pull back a little bit on spending and definitely slow down economic activity. And then there’s been obviously a lot of talk of rate increases, which is also hampered a bit of activity as well, which has a direct impact on private equity and their investments into various various companies and organizations. But I don’t know if we’ve hit the technical definition of recession yet, but activities definitely slowed down from an economic standpoint. I think from a deal standpoint, just kind of seeing transactions on a day to day basis. There’s still quite a bit of activity in the market. Private equity firms are still deploying a lot of capital, partially because you look back at prior economic slowdowns or prior true recessions in the same span of time. I was actually looking at this a little bit earlier today. From 2011 to now, the amount of private equity capital that’s available from deployment has increased from about 1.1 trillion to about $2.9 trillion across the industry. So as you think about sure that there may be a little bit of slowdown rates may be increasing, which makes it more expensive to deploy capital and finance deals. There’s also so much more dry powder, as we call it, or capital available for investment in the industry that you’re still going to see quite a bit of activity because the funds have to find ways to put that money to work.
Praveen Suthrum: Okay. So you packed a lot of information in that response. So I want to break that down a little bit. So let’s start with the basics. So we don’t know whether we’re in recession or not, but it smells like one. Technically, we don’t know yet. But if you were to explain to an eight year old what exactly is the problem with recession environment, how would you say it. Like costs are going up, inflation is high. That means that everything is more expensive. But then you’re also saying there is more capital available. But I would think that there’s less money available. But I want to hear from you. How would you explain it? In very simple terms.
Abe M’Bodj: Yeah. So I think in terms of what a recession is, it’s a general again, decrease in economic output or GDP, meaning the value of goods and services in the economy is decreasing. And so when I say how inflation is impacting that as normal day, everyday people like ourselves go to the grocery store or go to fill your car, the gas pump, the price of those things are increasing. And so I’m in Southern California, so gas is easily well over $6 gallon. Many gas stations here. You go to the gas station. And that cause you to think twice about going to that nice dinner you wanted to go to or that elective procedure in relative health care that you may want to have on a micro level. Like these things don’t seem to be correlated, but there is a general correlation with the level of inflation and consumer price increases and the level of consumer spending that goes into the economy. So circling back to what that means for an eight year old, I guess people are spending less money than they have otherwise in the past several years due to the overall state of the economy. So that’s what everyone sort of dealing with you thinking right now. Okay. But just looking back on the COVID period when the pandemic began, people already were spending less money. Right. Thats like a recession. You would think that. But you also had a lot of government subsidization, which has led in some ways to great resignation. A lot of kind of unemployment funding was out there. There was a lot of subsidies that were increasing the level of funding those programs are providing. For the first time in history, you had direct deposits into the bank accounts of Americans to actually kind of subsidize lifestyle. And while some of that was meant to stave off economic hardship. Like you look at, for example, I’m doing a lot of work in plastic surgery right now. Plastic surgery businesses saw some of the greatest increases that they’ve seen historically in terms of their revenue, like throughout COVID. Why was that? Because a lot of people got stimulus checks and used that for elective services. I think that now we’re getting to a point where there’s a bit of equal, like a hangover of all of the money that’s sort of been pumped into the economy through that period. And on one hand, I always kind of joke about this with people, but we pumped a lot of money, trillions of dollars into the economy. And then we woke up one day and we’re confused how prices increased and inflation picked up. And that’s like textbook outcome of what you should expect when you’re printing money and putting it into the economy. So that’s sort of how we got here. So I think common sense would have said that there was a slowdown during COVID. That really wasn’t the case because there was so much money being put into people’s pockets. And I think now that economic reality is setting in maybe a year and a half, 18 months later, you’re seeing that slow down happened a bit later.
Praveen Suthrum: Very well explained. So is the government printing more money now?
Abe M’Bodj: They slowed down a little bit, and that’s kind of part of government policy, in terms of the central bank, in terms of looking at raising interest rates, like by default, them raising interest rates is them buying back money that’s essentially in the economy through open market operations and government programs. So they haven’t been printing as much lately, but we obviously did just print quite a bit over the last couple of years.
Praveen Suthrum: Okay. So now moving on to private equity, which is the crux of this interview of this conversation. So you said that the amount of dry powder or the amount of capital to invest has increased substantially in the last few years, almost maybe over a trillion dollars. You said even more. It’s more than a trillion dollars. Yeah. So where is this money coming from?
Abe M’Bodj: It’s typically institutional investors. So pension funds, endowment funds, ultra high net worth individuals, accredited investors like state pension plans, like California state pension plan is one of the largest investors toppers. So very large endowment funds and investors that have tens of hundreds of millions of dollars to put to work at any given time. And I think what’s caused such a great deal of inflow of capital into private equity has been the outsize returns they’ve been able to generate relative to some of some of the alternatives of these groups, which are mutual funds in public markets and in some cases, hedge funds. And so the success that private equity has not just in healthcare, but kind of across the board, has caused those institutional investors to allocate more and more of their portfolios into kind of these private market investments. And so I think, as I mentioned, as I was looking today, I want to say from 2011 to 2021, it’s increased from about $1.1 trillion in active like capital that was available for deployment to about 2.9 trillion. So quite a bit of increase in capital.
Praveen Suthrum: Yeah. So that’s about $1.8 trillion increase in capital. Yeah, that’s a lot of money. So, again, I just want to break that down as well. So the institutional investors, or let’s call them limited partners, as they’re called. These are endowment funds from universities such as University of Michigan or Harvard or wherever. And so they’re giving money, then there are insurance companies, they’re giving money, then there are ultra high net worth individuals. They made a lot of money in the market. So they’ve given money. And so lot of dry powder has been supplied to private equity. Now, this capital is already there. The agreements between the limited partners and the PE companies or firms are already there and they are executed. So they’ve committed to investing that money and giving back returns. So this money has to, so PE has an agenda now to complete the deployment or whatever agenda that they’re in right now. Now, my question, I want to begin with one question from the limited partners point of view. So now that everybody is going to pull back in the current environment, either the generation of market returns will slow down, it possibly will slow down. We don’t know how long, but I’m assuming based on whatever I’m finding out, the slowdown is here for a while, this correction is here for a while. So if that happens, then my understanding would be that they will not supply more money into the market. Is that a correct understanding or No?
Abe M’Bodj: I can see a scenario where, because you’ve got to separate call it the market from what I would call the private market. So you got public market and private market. Public market doing horrible. I saw a stat last month that it was the longest weekly decline of the stock market since the tech bubble had burst in 2000. So decline was greater than 08 or 09. But the weekly extent in the timeline of the decline was actually longer in the last few weeks than it had been in historical slowdowns in the stock market. And so the general stock market is driven by fear, greed, emotion, that’s all part of the investment. And to some extent, the private markets are too. But these investors are thinking about investments over a much longer time horison, right? Five to seven years, call it the average private equity investment. And I think if I’m sitting there as the head of an endowment or a pension fund and we’re entering a world of potential low returns in the public markets, on one hand, you could make the argument that you’re going to see more capital allocated to alternative investment strategies, of which private equity is one of them to find creative ways to get that return out of the market, even though maybe the return, albeit it’s fair, maybe the return could be a bit less over the coming five years than it has been over the last ten to fifteen. But if it’s still exceeding if you think of it like their competition, competition being public markets as we are wondering, you still may see a greater degree of capital allocation into private equity. And we’re actually talking about this as a team. Earlier this week we were curious to see some of the recent fundraising numbers. They haven’t come out yet, but one article I read today was about every year for the last several years has been a record fundraising for private equity. And when is that going to slow down a little bit? And all indications point to kind of continuing. But I think in the backdrop of as an investor, if your alternatives are getting poor, you’re going to allocate more capital private equity. So I can see them continue to raise a fair amount of money.
Praveen Suthrum: So let’s talk about that a little bit more by getting to the level of the PE firm itself. Let’s say somebody who is heading a private equity firm. What would they be thinking right now? Because let’s consider what must be happening to typical portfolio. Let’s set aside health care for the moment. But in general, in the industry, most employers. So layoffs are on the horizon, if not already. And in the tech space, there is a hiring freeze across the board. It seems to be all the big tech firms they hired excessively, assuming the whole world will go digital during the COVID period, which is true from a long term standpoint. But now they have excess people and they don’t know what to do with them. So either there are lay offs, like from Netflix, laid off people. There are other firms that are either laying off or holding back on the hiring. So if they were part of the portfolio and some of them would be so then your portfolio is not hiring much anymore. So there is lesser economic activity in your portfolio companies, which means that the exit that you were expecting within a three to seven or a five to seven year horizon may or may not happen at the level that you’re expecting. You may have a return, you may not find a buyer. I mean, a whole variety of possibilities. What would the PE firm be worried about at the current moment? And then please also add in the angle of lenders and bankers because they have a huge role to play in the investment activity when they’re giving debt.
Abe M’Bodj: You touched on a good point. Like with a lot of companies that have had sell offs or layoffs recently and a lot of the companies that have the largest sell offs in the stock market, there’s been a huge shift in the market. Generally this is across public market and private market. When I say this from really you think of high flying growth stocks, technology, which usually is a big component of that two more value oriented, cash flow driven profitability type business models and the businesses that are susceptible to layoffs at this point are the companies tend to be technology companies that have really over hired, probably weren’t profitable to begin with or had marginal profitability, and so they couldn’t really sustain their workforce and their valuations. A lot of cases were just driven on kind of continued revenue growth. And now that you’re seeing that slow for several companies use Netflix as an example, that is causing these organizations, after rethink their call structures and profiles and causing their investors to rethink it. It’s really the same within the private market as well. There are certain segments of the healthcare economy. I would not put GI in this category because those deals tend to be more profitability driven. But there are segments that were historically trading on revenue multiples or pretty high valuations that have certainly come down because the market is not as favorable to just growth at any cost at this point in time. So I think as you sit at the head of a portfolio and looking at the investments that you’ve made within that portfolio, whether in health care, otherwise, you’re trying to understand what are the cost structures of my investments. How will ultimately the market evaluate these investments upon exit? I think some of these businesses that may have historically been valued upon revenue multiple growth multiple are now trying to think through how they pivot themselves towards profitability. And I would say the urgency to show profitability from investors or outside parties is greater than it has been over perhaps the last couple of years. And so as you think about that, as a portfolio operator, that may include layoffs or redefining the strategy or spinning off and profitable or segments of the business or businesses that maybe haven’t developed in the way that you would have liked. But I think for companies that are still, and this is why healthcare services tends to be a really great area for private equity investment. Businesses that are stable, have stable cash flow, profitable and continuing to grow, can thrive in this sort of environment. Especially as you look at something like a physician practice, which is a bit more resistant to kind of overall price changes. Right. A GI practice is somewhat impacted by inflation, but not really right. Payer rates don’t necessarily change with the price of gas or the consumer price index. So you’re a little resistant to some of those outside changes, which is why it is still a pretty good area to see that you’re continuously investment appetite for those portfolio companies to exit for other buyers is definitely strong. You had a large deal last year with Gastro Health being exited by Audax Group and trading to OMERS, another very large private equity firm. There’s several of these other platforms I’m certain are going to explore exits in the near future. My guest, GI alliance, will likely see a secondary transaction in the next year or so, as well as some of the others are going to start to explore it. So again, just circling back, if you’re in that position or you have a strong company with strong cash flows, you don’t have to change how you’re thinking about the investment a whole lot as it relates to health care. If you’re in an area of health care where it’s more of a growth oriented play and you’re thinking about how do you exit into the current market, then you’ve got to think a little bit more about what that strategy looks like in your time horizon, because I think it is changing a lot for a lot of people.
Praveen Suthrum: What are the bankers thinking?
Abe M’Bodj: Well, I guess to back up. So from a lender perspective, rates are increasing. So that impacts things in a couple of ways. One, from a banker standpoint, you know that if we tend to work on the sell side, so working with the organizations that are bringing on private equity capital or seeking to be acquired or some type of investment partner. So you know that with rates increase historically and potentially can’t have an impact on valuations. Right. And so as a private equity firm is going through their model and building that out and they’re making their assumptions on their entry investment and what the cost of that capital is going to be from a financing standpoint, the plug in that model, that is the interest rate on their debt gets a bit more expensive. And so as that filters through and ultimately will come back that they can definitely pay a little bit less for their investment. Again, though, going back to the comment around how much capital has been raised. We’ve seen such competition for these as a banker, which is a good thing for us. We’ve seen such competition for our clients in these transaction processes from various private equity firms as well as larger health care strategic organizations that we haven’t seen that impact of that financing actually impact valuations really at all or as much as expected. In fact, we’re pretty consistently exceeding kind of valuation expectations that we set at the outset of the process through the transaction process. So we haven’t seen that yet. It’s definitely a possibility. I will say groups are definitely and this is getting back to lenders. Whereas during COVID there were a lot of businesses that were impacted negatively throughout the course of COVID, whether that was and Phil have in some cases like trouble staffing, like it’s a staffing type of organization, staffing caregivers and providers, and in some instances, nurses in a lot of instances has become more challenging. So that was definitely a struggle for some of those organizations. You were able to make adjustments to the finance or really any business that saw like a downturn as a result of COVID. We were able to explain a lot of that stuff away with investors and lenders and be honest truth that some of that has come back and some of it hasn’t. So there are certain things that people had bought off on that didn’t come to fruition, both lenders and investors. Again, as a banker, our job is to ensure that, ensure we get our clients credit for those things. But the reality is some of those adjustments that people make to EBITDA or revenue or whatever it may be have come to fruition. Some of them haven’t. And the key thing that you focus on in the process is like showing a trend back to normalization. I think that now in the current environment, people are there’s not as much appetite for those types of adjustments. So whereas maybe twelve to eighteen months ago you could get away with some of those things, right now you really can’t. And so people are pretty heavily diligent saying those types of adjustments to the quality range. So I guess to answer a question from a lender perspective, it’s definitely getting a bit more stringent in terms of underwriting requirements.
Praveen Suthrum: If Gastro Health were to exit now or in the coming months, and let’s say we’re in peak recession, would they get the same valuation that they got? First of all, would they find the buyer? And second of all, would they get a similar multiple as they did last year?
Abe M’Bodj: This current environment wouldn’t impact their ability to exit if it was six months later. I don’t think it’s going to be the case for some of these large organizations that are exploring exits. The reason being, again, it’s a fast growing but profitable organization and they’ve kind of established themselves within the market. So there’s very strong economic fundamentals behind those investments. That’s different than a technology investment that could grow a lot and has shown and demonstrated the opportunity to grow quite a bit. But I think they’re in kind of a different category where there still would be a fair amount of appetite. You’re seeing a kind of across physician practice management. There’s been several pretty high profile exits over the last call it six months, not just in GI, but in other specialties. I think you’re still seeing that appetite. And then even I can say there’s still a lot of appetite for private equity firms to find platforms within various areas of physician practice. And we can talk specifically about where GI is at. I think it’s tougher to find a platform investment outside of one of the larger groups that’s already been created as the platform, as a second bite of the Apple. But I’m doing a lot of work in the Cardiology space right now and there’s insane valuations are being paid for these organizations because of the market opportunity exists irrespective of the kind of outside market. Even higher than they were at the peak of some of the GI activities. So you definitely have a lot of appetite from investors to find assets in these spaces. But to your question, I don’t think would impact. Let’s say Gastro health was transacting right now, I don’t think they would be being impacted in their transaction.
Praveen Suthrum: So you’re saying even the valuation would be the same?
Abe M’Bodj: Valuation would be the same, yes.
Praveen Suthrum: Okay, so now talking about second bites of some of the other platforms that got their start in 2018 and after. So one would expect just adding five years to that, so one would expect that they would be exiting next year. So we would see second bites next year, which means that the groundwork for that should have begun already. That would be my take. What’s your take? Is that going to change or based on what you just said? I’m assuming you’d say that no, they’ll find the exit and they’ll find at the valuation that they would normally find.
Abe M’Bodj: The groundwork has definitely been laid. I suspect with a pretty high degree of confidence. Some of them are exploring exits at the current time. However, I think it’s fair to say there’s been varying degrees of success amongst the platforms that have been created in the market. And so the ones that I would place on the spectrum of more successful relative to others, like they’re in good position to exit. The ones that I would place on the farther end of the spectrum in terms of having a successful transaction, they’re probably going to have to hold on to the assets quite a bit longer. My actual suspicion is that you’ll start to see those organizations get acquired by the ones that do have successful exits with their next partner. But the challenge right now in the GI space, I don’t want to say it’s a challenge, but these platforms, namely like Gastro Health and GI alliance and One GI has had so much success in such a short amount of time and in partnering with so many groups. I’ve seen a report the other day that 10% of the 14,000 gastroenterologists in the country are part of these private equity backed organizations. But these groups have had such success that there’s really not entryway for a new platform to come into the space. So you’re pretty set. Like if a new GI group wanted to go and find a platform investment, it would be pretty hard. Look at the current state of the market, but what you do have is this kind of captive pool of investors or buyers that now have intense competition for assets or groups that come available in the market and even for relatively smaller transaction opportunities. So not impossible for sub 10 doctor group to be trading at a double digit multiple because there’s such intense competition to partner with those groups for these larger groups to have a successful outcome within their transactions. But I think that the groups that are I don’t have to say who they are. People know who the more successful groups are. People know who the less successful groups are. I think those groups will have an easy time exiting and the other groups will probably spend a bit more time in the market finding their way. Ultimately, I suspect a lot of the slower growing groups will probably be acquired by some of the other larger ones. And that’s like not unprecedented across physician practice management. For example, one of the largest OBGYN providers is a company called Unified Women’s Healthcare. Unified Women’s Healthcare was a portfolio company of Ares Management wasn’t his from 2013 until very late in 2020. And they did a recapitalization with another private equity firm called Atlas Partners. With Atlas Partners, they actually went and bought the second or third largest OBGYN platform company called Women’s Health USA and brought them into their organization. So it’s not unprecedented for you to start to see some of these larger platforms combined and grow with one another.
Praveen Suthrum: Yeah, very interesting. So now if you look over the shoulders of some other specialties that are ahead in the PE game, how has it played out once these large platforms started acquiring more and started exiting, there’s been a second bite or maybe even a third bite and some. So when those transactions have happened, have they gone multi specialty, have they gone across the board or what is the norm or is there so much room for growth even within specialties that are the transactions just making these companies larger and larger within a single specialty? What have you observed?
Abe M’Bodj: It varies a bit by specialty. I would say for most of the specialties over the course of the last ten years, they’ve all gone through 2nd, 3rd transactions and it’s all been still kind of single specialty with a couple of exceptions. But where sort of the area the playbook came from for multi site investment in position practice was really the model of dental practice management. And many of the dental spaces is so fragmented and there’s so much room for growth that even the largest dental organizations out there in the market, their number one way of still growing today is by partnering with solar practices and solar practitioners. That is different than what you’ll find in the GI market. It’s very fragmented, but it’s not as fragmented as called densely. So I don’t think it would go on forever like it is in dental. Now, what you saw with some of the outsourced, maybe hospital based service type physician practice management businesses, those grew and I’m talking like anesthesia radiology emergency medicine. Those did ultimately end up combining. And you had the creation of the Envision Healthcare, which I know ultimately had some trouble as well as Team Healthcare. But those ultimately became, I think when Team was taken private, it was $18 billion transaction. When Envision was taken private, it was about eleven or $10 billion transactions. So those became extremely large organizations. And then as you think about the Ophthalmology and just going along the timeline here, like pain management, ophthalmology dermatology, most of those businesses have gone to their second bite of the Apple. None of them have started to change specialties quite a bit. All that I would say on the Ophthalmology side, you start to see some of those kind of blend on the more optical side, which is kind of interesting. So continuing to get into the consumer angle on that piece and you’ve continued to see that grow. And then on the women’s health side, interestingly circling back to the Unified example I gave. That’s an example where you’re starting to see a crossing of specialties in a way. So like Unified, shortly after they had bought Women’s Health USA, they also acquired CCRM, which was one of the largest fertility, private equity backed organizations. I think it was 500 or $700 million transaction. So it’s fairly large. And so that’s an example of them. You could view fertility as like an ancillary service of women and women’s health relative to pure OBGYN services, but that’s an example of them kind of crossing into a different specialty. So I don’t know where it ends with GI, just going back to GI, I don’t know where it ends specifically. There’s been some talk of integration amongst Urology platforms and moving into other areas. But I don’t think that within GI you’ll start to see mixing and specialties just yet.
Praveen Suthrum: Where is GI right now in terms of you said 10% of the gastroenterologist are under A private equity platform if you break the whole market down. I remember having this conversation with you several months ago now, but if you think of it as a pyramid at that time, I remember you saying that most of the big groups are gone. There are some still so are they exploring transactions? Have they decided not to do it? What about the middle and what about the huge base of this pyramid that all the different smaller practices have they decided? I mean, those who decided to do a transaction have done. Are people still in the middle or have they decided, hey, this is not for me.
Abe M’Bodj: I maybe over generalizing, but generally, if you’re over generalizing, but generally, if you’re a large group, call it north of 15 doctors, even north of ten, you have the opportunity to transact. Whether it was a banker called you, a private equity firm called you directly or one of the platforms in the market, you likely tried to at least figure out and get educated on whether or not a deal could make sense for your group. And I think the groups that are still independent, like have decided that it’s just not the direction they want to go. That’s completely fine. And those groups will still have the opportunity to transact. I think the challenge some of those groups may have is that the impetus to transact for some of these practices can’t be like that. They want an exit strategy for the senior partnership or the leaders within that group, because then it won’t set them up for a great transaction when they ultimately go through it. I think if these groups change their minds and want to explore transactions, it really needs to be based on some sort of change in thinking that it makes sense to become part of a large organization and join and grow. From an equity standpoint, that’s what I would call the top end of the market, top to middle. I would say that the base of the pyramid for them, the market is actually in a really exciting time because these are the groups that didn’t have a lot of options before. There was this ecosystem of private equity firms that created called sub five doctor practices, right, where there aren’t private equity firms calling them to invest in them as a platform for those shareholders. They’ve now had the opportunity to create liquidity from the practices that didn’t exist for them for the last five years while all these other large practices were doing deals. And so I think it’s an exciting time in the market from that standpoint because that is obviously creating  a lot of opportunity for those gastroenterologists, and it’s also creating a lot of opportunity for the private equity platforms that are invested in the space. Right. Because that’s where they actually create your return. You don’t create your return by going and buying 15-20 largest groups in the country create your return with what you can do after that and because you can expand within all of those markets by partnering with smaller groups. So I think the base / lower middle of that pyramid is where you’re seeing the most activity at the moment.
Praveen Suthrum: Earlier, in the conversation Abe you talked about during the pandemic transactions happened, people, the investors gave transactions a little bit slack. And you said some worked out and some did not. It did not play out as they thought it would. I think we’re talking about deferred income and the growth activity will pick up. And you said for some it did not happen. I want to talk about that for a moment. So what happens in that case? What are the risks that we are dealing with? I know you’re an investment banker, and you would say like, hey, everything is great, but I just want you to step away from that for a moment and help me understand what are the risks that we are dealing with. Risks from the PE standpoint, risks from the portfolio standpoint, from the platform standpoint, from the people who have joined the platform standpoint. And ultimately, if you’re a small practice or medium practice, that’s right in the middle, what are the risks that we are dealing with? What would go wrong?
Abe M’Bodj: The risk ultimately is that the earnings or the EBITDA that you’re basing the transaction on, right. If the deal is based on an adjusted EBITDA, just pick a number of 2 million and you as a buyer paid ten times multiple on that for 20 million. And then you fast forward there were adjustments in there maybe for code, productivity or positions were out or whatever it might have been. And fast forward at twelve months after the deal, if EBITDA is 1.5 instead of 2, what did you buy? Right. You bought something that was worth 15 for 20. That’s the ultimate risk. And then the downstream impact of that is obviously it has a negative impact on the equity value of everyone associated with the organization. What I would say is that’s actually within GI specifically and really most physician practices, that hasn’t been the case. There has been pretty strong normalization of trends post COVID. That comment I had made was somewhat related to what we’ve seen in some of the post acute space like home care providers and home help providers, where some of these businesses have had trouble staffing kind of providers and nurses into care settings. And that market has been a bit more challenging and has not come back in the same way that some of the other areas of health care have. But within the physician space, you can look at the financials and most physician practices and they’re over and above what they were pre COVID. But going back to that, the risk is that there are likely some deals that happened during COVID or shortly after where the earnings didn’t materialize. I think we actually talked about this quite a bit in our last discussion, though. The investors in the private equity firms, they did do a pretty good job of protecting themselves against that profitability or that earnings not coming back. So that’s what everyone was dealing with at that point in time. Like, how do we structure this deal in a manner that gets the practice full value? Go back to our $20 million example, you may get your 20 million. It may take ten upfront five and five over the next two years while we see volumes come back. Those types of structures are gone, nor do sellers want to accept them. But I think it’s also shifted towards just being more thoughtful around adjustments that could be made to the financials. But to answer your question, the downstream impact of that is impacting the equity valuation. If it’s a platform, obviously that could potentially get you into issues with your lenders, which could put you on the path towards bankruptcy. I don’t think anyone’s had that issue at this point. That’s a potential risk. So everyone’s being very thoughtful on that.
Praveen Suthrum: Are we going to see any announcements in Gastroenterology in the coming months, new platforms, any major announcements that you know.
Abe M’Bodj: I don’t think of any new platforms that are being created. I know we knock on wood should be announcing a deal the next couple of months with a group that’s partnering with an existing platform. So there continues to be groups that are doing transactions. If I had a Crystal ball, I don’t know anything for certain, but I would expect by the end of the year you’ll probably see another one of these very large one of the staffers platforms exit to a larger investor.
Praveen Suthrum: On that note, a fantastic insight into what’s happening in the PE world and specific to GI very insightful. I learned a lot from this conversation and thank you for being so open and candid and clear about everything. I always appreciate that once again I thoroughly end up enjoying and learning a lot every time I chat with you. So thank you thank you for coming today and sharing your perspective.
Abe M’Bodj: Thank you very much Praveen for having me. I always enjoy speaking with you and I always enjoy hearing your perspective on these things as well. You have a unique one and I always enjoy whether you’re doing these types of activities podcasts and getting this education to the stakeholders in these industries because I think it’s important and you do a good job of it, but thank you for having me.

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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.
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11 Jun 2022

Curated GI articles June 10th, 2022: Rectal cancer disappears after immunotherapy | “Food as medicine” AJG issue | GIs making headlines

Curated GI articles June 10th, 2022:
Rectal cancer disappears after immunotherapy | “Food as medicine” AJG issue | GIs making headlines
‘An unmet medical need’: Physician weighs in on 1st eosinophilic esophagitis treatment (Becker’s GI & Endoscopy)
Marc Rothenberg, MD, PhD, discusses the approval of the first eosinophilic esophagitis treatment, its significance and the challenges that came with researching the disease.
SF Interview: “More data, better diagnosis” – Founder & CEO of FoodMarble (NextServices)
Praveen Suthrum interviews Aonghus Shortt, Founder & CEO of FoodMarble in the latest episode of The Scope Forward Show. Watch to know why the next phase of GI depends on innovators such as Aonghus and FoodMarble.
Private equity turns to physicians after courting ASCs for years (Becker’s ASC)
Private equity firms have long used ASCs as investment vehicles, but across the market, those institutions are reaching their capacity for such investments.
Rectal Cancer Disappears After Experimental Use of Immunotherapy (Memorial Sloan Kettering Cancer Center)
All participants in the trial saw their tumors disappear using immunotherapy, without surgery, radiation, or chemotherapy.
Dr. Sravanthi Parasa Discusses Digital Therapeutics Used in Gastroenterology (AJMC)
Sravanthi Parasa, MD, gastroenterologist at Swedish Gastroenterology, talks about innovations in gastroenterology technology.
Recommendations based on race, ethnicity should be avoided in GI clinical guidelines
(Healio)
Gastroenterology societies should refrain from incorporating race and ethnicity into clinical guidelines as doing so may exacerbate health inequities.
New technologies could revolutionize colonoscopy effectiveness (MDLinx)
Innovations in colonoscopy technology are progressing rapidly and have the potential to revolutionize colonoscopy effectiveness.
“Food as Medicine” Special Issue (AJG)
The “Food as Medicine” special issue by The American Journal of Gastroenterology acknowledges the intense interest in diet by patients, providers, and researchers.
Groundbreaking mRNA vaccine could help cure pancreatic cancer (NY Post)
A new vaccine using the same mRNA technology as the Pfizer jab against COVID-19 could be a breakthrough in the fight against pancreatic cancer.
World Hepatitis Summit 2022: Day 2 Highlights (World Hepatitis Alliance)
Speakers discussed key issues surrounding the elimination of viral hepatitis worldwide including liver cancer control, fighting stigma and discrimination, prevention, and vaccination.
Rectal expulsion device may predict outcomes in patients with chronic constipation (Healio)
An investigational, point-of-care rectal expulsion device may help determine whether patients with chronic constipation will improve with pelvic floor physical therapy.
The role of AI in Gastroenterology (Patient Safety in Endoscopy)
Prof. Siersema (Radboud University Medical Center) and Prof. Dr. Kiesslich (HELIOS Dr. Horst Schmidt Kliniken) discuss AI applications, addressing challenges in polyp detection and solutions to overcome them.
10 Highlights from Digestive Disease Week 2022 (Medscape)
Dr. David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School highlights 10 abstracts that have potentially practice-changing implications.
5 gastroenterologists making headlines (Becker’s GI & Endoscopy)
From the next editor-in-chief of Gastrointestinal Endoscopy to Gastro Health’s newly appointed COO, here are five gastroenterologists as reported by Becker’s.
Once-only colonoscopy or two rounds of faecal immunochemical testing 2 years apart for CRC screening (The Lancet GI & Hepatology)
The study investigates the effect of screening with once-only colonoscopy or two rounds of faecal immunochemical test screening on colorectal cancer mortality and incidence.
Private practice physicians: How they can focus on their patients & sustain their practice (AMA)
AMA Vice President of Healthcare Quality, Kathleen Blake, MD, MPH, dives into  how physicians can implement these vital resources to improve internal business operations, clinical workflow and team culture.
Oracle, Cerner plan to build national medical records database as Larry Ellison pitches bold vision for healthcare (Fierce Healthcare)
The purchase of Cerner, which marks Oracle’s biggest acquisition, gives the database giant a stronger foothold in healthcare.
AFib History is the quiet beginning of a huge Apple Health revolution (9 to 5 Mac)
Apple Watch is going to play a massive role in helping medical professionals to identify the role that lifestyle factors may have on health.
What GI Doctors Think of the ‘Internal Shower’ Drink That’s All Over TikTok (Health)
The internal shower drink isn’t something that’s regularly prescribed by gastroenterologists, but there is some validity to the claim that it will help you to pass stool.
AGA welcomes new AGA Research Foundation Executive Board members (AGA)
Michael Camilleri, MD, AGAF, will be taking over the AGA Research Foundation chair role beginning this month. He has recruited five members to be part of the 2022-2024 AGA Research Foundation Executive Board.

More Hot headlines in GI
4th Global Gastroenterology & Artificial Intelligence Summit (ASGE)

ACG 2022 Annual Scientific Meeting & Postgraduate Course (ACG)

Crohn’s Disease Biomarker Appears Years Ahead of Diagnosis (Medscape)

Long-Haul Truckers May be at Greater Risk for CRC (education is the key to increasing screening rates) (Gastro Broadcast)

Check-Cap announces initiation of the U.S. Pivotal trial (NS Medical Devices)

Obesity Ups Survival in Esophageal Cancer Patients Undergoing Robotic Surgery (GI & Endoscopy News)

Common Gastrointestinal, Hepatic Symptoms in Patients Hospitalized With COVID-19 (GI Advisor)

Georgia gastroenterology practice cuts ribbon on ASC, office (Becker’s GI & Endoscopy)

Latest In No Surprises Act Litigation And New Guidance (Health Affairs)

Colorectal cancer screening participation among citizens not recommended to be screened: a cohort study (BMC Gastroenterology)

Screening Colonoscopy With Add-On AI Could Save $290 Million a Year (Tissue Pathology)

Bidirectional Risk Seen for Inflammatory Bowel Disease, Depression (Physician’s Weekly)

Additional biopsies after colorectal cancer biopsy not tied to metachronous colorectal cancer (Medical Xpress)

Videos: Interviews with GI Leaders  (NextServices)

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COVID-19: The Way Forward for Gastroenterology Practices
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09 Jun 2022

“More data, better diagnosis” – Founder & CEO of FoodMarble (Interview)

“More data, better diagnosis” – Interview with Founder & CEO of FoodMarble, Aonghus Shortt
We are back with the next season of Scope Forward Show where you’ll get to meet innovators and leaders who are reimagining the healthcare system.
The next phase of GI depends on innovators such as Aonghus and FoodMarble. Why? Because the industry is shifting from under our feet. Four trends are influencing GI: exponential technologies, consolidation, big brothers (such as hospitals, insurances) and changes in patient behavior.
FoodMarble, a tiny device that analyzes digestive disorders such as IBS and SIBO, comes squarely in the middle of these trends. After selling 30,000 devices, what do they know about patients with IBS that a private practice does not? How can this be a new revenue-generating ancillary opportunity?
The story of its growth is also interesting. An engineer gets an idea after seeing his girl friend suffer. Ideates and develops the device in Ireland and China. Raises $6 million and sells globally – more than 2/3rd in the US. It’s indicative of how the next phase of innovation would happen.
Aonghus says, with “more data”, you can come up with a “better diagnosis”. True.
Welcome to the evolving world of data-driven GI.
Don’t miss this one.
How does an engineer/PhD enter GI?
FoodMarble’s journey from Dublin to China to US
Why is Hydrogen used as a primary gas for digestive breath testing?
The secret of listening to breath signals
Demo of the second generation medical device med AIRE 2
“We’ve sold over 30,000 devices so far”
“It can provide a considerable source of revenue for clinicians”
Correlation between stress and digestion? Can the device sense it?
Short term and long term growth plans for FoodMarble
“If you capture more data, you should be able to do a better diagnosis.”
◘  Will FoodMarble consider branching off to diagnose other conditions?
Fundraising?
“Right now there’s not much for patients suffering from functional GI disorders”
Vision for the future of GI


The Transcribed Interview:
Praveen Suthrum: Aonghus you’re the CEO and founder of FoodMarble which is a breath analyzing device that I’m excited to learn about. I warmly welcome you to The Scope Forward Show.
Aonghus Shortt: Thanks very much, Praveen. I’ve always loved Scope Forward Show. Just really informative and just delighted to be invited.
Praveen Suthrum: Aonghus, you are a PhD in engineering in a completely different field, and you’re a data scientist. How does somebody with your background get into a field like gastroenterology?
Aonghus Shortt: It’s a good question. It was actually my wife while my girlfriend at the time. She has IBS, and she was struggling. She was having a really difficult time. She’d been to different types of clinicians between primary care, she’d been to a number of gastroenterologists. She tried enough medications. She, of course, had a number of procedures, and she didn’t find anything they were very worried about. So kind of a really common story where people end up with a diagnosis of IBS. And I just started doing some research to see because I had access to the literature. So at that time, breath analysis had been used for quite some time because of large benchtop devices. But I could see the low FODMAP diet was emerging from the literature. And this was kind of an approach where if you can identify which foods ferment rapidly into gases in the gut and reduced down the consumption of those foods, that you could feel a lot better. And it was remarkable for me because I could see that in those early trials of Low FODMAP diet and as many as three or four people were seeing significant improvement, people at least tend to feel better. So they were using breath analysis in that research. So it kind of triggered me to think, okay, can I build one of these devices for Grace? And when she’d eat it, she’d see sometimes very significant rises in the breath hydrogen be measured. That was quite a good signal in terms of maybe this food should limit in her diet. It’s a pretty cool way if she was able to start personalizing what she could and condition. I guess that was sort of the inspiration for what we’re doing today.
Praveen Suthrum: That’s an amazing backstory. So how did you get started?
Aonghus Shortt: I started working on the original prototypes back in 2014. The accelerator program is at the start of 2016. We spent a couple of years developing the device and just getting it up to a level where it was performing really well because it is really challenging to measure these breath gases at the concentration levels. We need to measure them out on the breath. Yeah, there was a lot of product development that went in and just even learning from users using the device, giving feedback, letting us know and kind of us being able to build up that app guided process as well with their users. That took a while, but it’s really beneficial for us I think.
Praveen Suthrum: From my understanding, why did you choose to focus on hydrogen as a gas, like for the lay man, if you can explain why hydrogen in particular?
Aonghus Shortt: Yeah. There’s a few gases that are relevant on the breath. And so hydrogen is probably the primary gas. So whenever if you eat something, essentially, it’s not absorbed or it’s not fully digested, and it gets as far as microbes that can break it down in the gut. So that might be the small intestine, but usually the large intestine. If you get that undigested food to that point, it starts to be fermented by the bacteria or the different microbes in the gut, and that’s producing hydrogen, carbon dioxide And lots of other different metabolites. Hydrogen is the kind of primary gas that’s produced. Some of the hydrogen can be turned into methane, which is another gas that’s often present on the breath. Some of it can be turned into hydrogen sulfide as well. There is a couple of other gasses on there. For a first generation device, we want you to measure hydrogen because, first of all, it is the main gas of interest. But then also, when it comes to people being able to identify what foods they can and can’t eat, hydrogen is very responsive to the food that people are eating. If you’re not digesting the food effectively, you’ll often see very significant increases in hydrogen levels. And if you’re not seeing it, that’s a good indicator that this food might be actually okay for the person. So that was the first one. But in our second generation device, we are measuring methane, and we should be able to release an update on that device where we’re also measuring hydrogen sulfide on the breath. So in our sensing array, we have the capability to measure all three gasses in our second-generation device.
Praveen Suthrum: What is in the device that listens to the signal of hydrogen? How exactly does it sense?
Aonghus Shortt: Inside the device there’s a sensing canal. So the person is exhaling into the device, and there’s a sensing array inside of there. So multiple sensors which are measuring effectively. There’s a signal that’s generated by the sensors. It’s measuring the electrical resistance of process sensors. So whenever the molecule of interest comes in contact with the sensor, it kind of temporarily attaches to the sensor, and then it kind of detaches it again. So you’re having all of these reactions happening on the surface of the sensors while they’re exposed to the sensors.  So we get a signal. Then, in effect, we’re getting multiple signals that are coming from the sensing array. And then there’s all sorts of different kinds of models we’re using to be able to translate that into concentration levels that we can show to the clinician and show to the patient.
Praveen Suthrum: Aonghus I’d love to see the device if you have it with you. I’d love to see how it looks. And if you can show it to us.
Aonghus Shortt: Yeah, sure. So I’ve actually got this is actually the second generation medical device which is coming up. This is med AIRE 2. So if you can see here. So this is a mouse piece at the front which you can click off, and you can wash the on and off button at the top. And so you can see the canal here. So you’re breathing in here and the breath comes out the other end and you can see as well. There’s a USB Port on the side.  So that’s for charging the battery.
Praveen Suthrum: And it communicates via Bluetooth?
Aonghus Shortt: Yeah, exactly. So it communicates with the phone over Bluetooth and then the readings can be uploaded to our cloud servers. So then the clinician is able to see the results through the dashboard at that point.
Praveen Suthrum: Sounds so fascinating. Now can you share some numbers? How far have you come?
Aonghus Shortt: Yeah. So we’ve sold over 30,000 devices so far, so most of those are direct to consumers. So initially we started offering the device direct to consumer at the end of 2018 through our website. More recently, in the middle of last year, we started selling a medical so our first medical device, it’s an FDA class one device which we call Med AIRE. So that’s now available in the US. In terms of other numbers, we’re 25 people based over in Dublin, but we’re often in the US, we’ve raised over $6 million of VC funding. And yeah, we’ve seen a steady growth. So last year, we saw our sales double compared to the previous year. And again this year, we’re seeing really good growth as well. So there’s certainly a lot of interest from consumers and also from clinicians. And often what happens is a consumer buys a device, they’re gathering data, and they come into their gastroenterologist. And probably many of the people on the show might have had this experience. I guess about a year ago or so we decided, okay, we need to be able to build a system where we can provide a dashboard to the clinicians to see the results. And also we’re making it possible by having a medical device. The clinician can use that. And from a kind of considerable revenue point of view, it’s something that they can add to their practice and it can be a source of revenue as well.
Praveen Suthrum: Can you talk a little bit more about that? How could a clinician earn money by partnering with you? And how could it be a source of revenue for them?
Aonghus Shortt: Yeah. So basically the way we do it is that if a clinician gets set up with us, it’s been possible for them to order devices that get sent to their patients. So we can send them directly or we can send them a bulk number of units that they can have to hand because sometimes the clinician wants to be able to give the device directly to the patient if they’re coming into their office. In this instance, then the clinician is also able to avail reimbursement. So there’s reimbursement for the breath test. For breath tests that have been done traditionally. So it’s the same reimbursement codes. And something we’re also doing more and more is where the device has been used from a remote physiologic monitoring perspective. So that’s an RPM idea is something that’s getting increasingly because these are conditions like IBS, SIBO, functional constipation. These are conditions where it really makes sense to track the patient over a period of time. So clinically, if you’re measuring, for example, for functional constipation, measuring methane levels in the brain is very relevant because constipation tends to correlate with methane levels in a lot of patients. But yes, there’s different models that can be applied, and it really depends on what the clinician wants to do. But fundamentally, there’s a dashboard for the clinician to be able to review the results from the patient, and so we can guide the actual patient through the procedure of doing breath tests. So that could be SIBO breath tests or tests for different food intolerances or as I said, remote monitoring.  So we keep it really easy for the clinician and for staff to be able to set up patients and to be able to interact with the patient. It just makes it a lot easier for a clinician to be able to do breath testing and facilitate that from the home.
Praveen Suthrum: Does this come under the same category as other remote patient monitoring devices, such as blood pressure cuff or you measure diabetes and you send that to the clinician, would it come under the same category?
Aonghus Shortt: Yeah, exactly.  So from a Reimbursement perspective, it’s the exact same code.
Praveen Suthrum: Yes from a Reimbursement standpoint?
Aonghus Shortt: Yeah. Also, it’s a very similar concept as well. So you’re tracking data that’s relevant to the course of treatment. For example, if a patient so initially they might be diagnosed, the GI might diagnose them with SIBO. So if they did conventional SIBO breath test, which is a kind of a fasting morning breath test, and that can be done remotely using our device if they determined that, okay, this patient appears to have SIBO, and in most cases, they proceed to treating with vaxamin, which is an antibiotic, like during the course of treatment and after treatment, you’re able to monitor the levels of hydrogen and methane in the patient. And that’s really relevant because, well, first of all, you want to see, did the treatment work and is in the course required. But then also after the patient has been treated successfully, in about half the cases, SIBO tends to return. So for some clinicians, they might be interested in being able to monitor the patient to see, do the symptoms return, do they need to do another course of treatment, or what’s the best next approach for this patient, because for a lot of these conditions, you need to try different things. So you might like in SIBO, for example, you want to identify what is the underlying cause and what can bring the patient to a resolution, because you might be testing placebo and you clear it with antibiotics. If you don’t identify and resolve under lik cause, they may still continue to have symptoms. So, for example, you might have where a patient has very slow motility, so the food is passing very slowly through the gut, and sometimes maybe using a pro kinetic agent or something like that might be beneficial. But if you’re able to track their fermentation levels in real time over a period of time, that could be really beneficial in terms of treatment.
Praveen Suthrum: I’m really curious about that. So do you write into the EHR? I’m getting into a little bit of detail now, but how does the clinician I think what I’m trying to figure out are two things. One is from your end, one is from a clinicians end. If you’re providing a dashboard, or if you’re writing, let’s say into the EHR, whatever, how can I get a longitudinal view of a patient’s condition? One. Second is how can I get a population view if 30,000 people have used the device? What have you learned from it? These are two questions mixed into one.
Aonghus Shortt: They’re both really good questions. So, first of all, from the perspective of how does the clinician monitor results? So in the dashboard, they can see charts of the patient’s data over time, so they could be looking at their breath readings, they could be looking at their intake of fermentable carbohydrates. So what the patient is eating, they could be looking at their symptom levels. Fuel tracking can be very relevant, especially if you’re talking about functional constipation or IBS. So they can see that data over time and they can look at it just at a specific day, or they can look at over a week or a month or over a longer period of time. And we also try and make it possible.  You can also see the trend in the data. So we try and make it easy for the GI to see whether the levels tend to be going down or maybe they’ve started to go up again. So there are some of the key things that they’re looking for. But it’s something we’re building on all the time. So you mentioned the population level data. So something we want to get into the dashboard is where the gastroenterologist is able to compare the results of this patient against the broader population or different kind of cohorts of patients. So that’s something we’re looking into, because what we found, which is kind of remarkable, is different individuals are in terms of their breath readings. When we’ve done clinical trials or what we’ve been involved in different studies, it’s just a huge range in terms of people’s daily patterns and their longer term patterns. So some people their levels go up and down quite often during the day. Some people it’s a slower progression, and a lot of that seems to link to how quickly or slowly people digest food.
Praveen Suthrum: Is there a role of stress here? I’m just curious. So do you see a correlation? If people are more stressed? Does the condition flare up and do you sense it in your device?
Aonghus Shortt: We do invite the patients and the users to be able to record their stress levels. Certainly stress is a factor in digestion. It’s something that there’s probably a two way correlation there. Your other symptoms can provoke stress and then where stress can provoke your symptoms. We’ve definitely seen a certain amount of that in the data and to provide assistance to people as well, to be able to try and manage that side of things. And in the future, we’re hoping to partner with other app based technologies, for example, which can help from that perspective as well.
Praveen Suthrum: Now you have the benefit of more than one clinical study, isn’t that right?
Aonghus Shortt: Yeah. So we’ve done a number of studies validating the device itself and then more recently, looking at interesting ways of using the data.
Praveen Suthrum: So coming back to the business aspect of it, are you in touch with insurance companies? What are they saying? The US?
Aonghus Shortt: Yeah. From a business point of view, this is something that we want to develop because we haven’t had any discussions so far with payers. But this is an area where you’ve got like, IBS is the number one diagnosis in gastroenterology. You’re looking at different cohorts of patients, like, say, for example, IBSC, which is IBS that’s constipation predominant. I was looking at numbers just before the call where the average was an extra $4,000 per patient per year, which isn’t as much as some other conditions. When you’re looking at the amount of people that are affected, it becomes a very big number. It is a huge cost for payers. And we think of the different drugs that are used. They can be expensive. And so I suppose from a payer perspective, we can offer a tool that you can save a lot of money. And because value based care is coming, and we think we’re very consistent with that as well.
Praveen Suthrum: So you’ve raised $6 million, you’ve sold 30,000 devices, and two thirds of that is in the US. What happens next, short term and long term? What are your growth plans?
Aonghus Shortt: Yeah. So there’s some really interesting things that we’re looking at with some of our research collaborators. We’re doing a clinical trial at the moment, for example, over in Johns Hopkins, and it’s looking at  where you’re using breath readings instead of kind of looking purely at a single snapshot, fast eating morning breath test, if you’re gathering data over a period of time from the home as a patient. So if you’re recording your meals, you’re taking breath tests just during the day. So if you’re taking breath tests after you eat, well, first of all, that’s quite convenient for the person because they’re measuring in the home in a sort of more conventional sort of way. You’re getting to capture how does somebody actually respond to food when it comes to actual diagnosis and guiding the course of treatment becomes especially interesting because what we found in our trial is that we were looking in particular at seeing if somebody would respond well to rifaxman, which is a drug that’s approved for IBSD. We found that this approach seemed to be much more effective than the conventional test. So instead of replacing kind of single snapshot testing with where you’re gathering data over a period of time seems to be very powerful, mainly because the digestive tractors antidepressant trial disk knows there’s a lot of variability. There are a lot of factors that affect your digestion. So if you’re able to capture more data, you should be able to do a better diagnosis.
Praveen Suthrum: Do you see yourself branching off into other disease conditions, or would you stick with IBS and similar conditions?
Aonghus Shortt: Primarily, we’re very much focused on disorders of the gut, and we think that you’re seeing increase in evidence that where the microbiome and the gut is affecting broader health as well. So we will be very focused around the GI tract. That’s a pretty broad scope. So IBS is certainly very important to us. SIBO, functional constipation. These are some of the key kind of target areas. But we do think that what we’re doing could be relevant in other areas as well. So we’re doing a study actually in IBD patients, which is very interesting, and we will probably do more in respect of IBD. But yeah, so there’s a lot more we can do because fundamentally when you’re looking at breath, it’s something that can be gathered very easily. You can gather it over time longitudinally. The actual equipment for doing it is accessible from a cost point of view. So we think there’s a lot of potential. And say, for example, with the trial at Johns Hopkins, we’re applying machine learning to the data, and then it becomes even more exciting. So, yeah, I think that there’s a broad range of things that we can do. But yeah, our focus right now is really on somebody’s kind of really common but hard to manage GI disorders.
Praveen Suthrum: Are you raising more money? What happens from a fundraising standpoint?
Aonghus Shortt: Yes, we’re doing around at the moment. And so you’re very interested to speak to anyone who’s investing at the early stage, really with a focus on US investors as well, because from a healthcare perspective, our complete focus is on the US. And, yeah, we’d love to hear from anyone who might be interested.
Praveen Suthrum: Excellent. Is there anything else that you want to share before we close?
Aonghus Shortt: I think for us we do see a big gap where there’s a lot of people who have some of these functional gastrointestinal disorders. Right now, there’s not that much for those patients. We just want to sit in that gap and to be able to provide something that’s really convenient for the gastroenterologist and their staff and something from a practical perspective can be a revenue generator also taking breath and these measurements combining with machine learning for example, there’s just so much that can be done with that. Looking forward we just want to keep expanding what’s possible using the technology.
Praveen Suthrum: Is there a vision that you have for the future of GI? Everything happens like you think it should? What does that look like? What does such a future look like?
Aonghus Shortt: The way it should be for patients who are coming in and it could be something like half of patients coming into gastroenterology but have conditions that would be relevant to what we’re doing. So for those patients coming in if we can give them the technology where they can go home, gather data over a period of time and use that to manage treatment. For example, if they were to take over the counter supplements like identifying which are helping them if they were to take different medications help the clinician choose which would be most beneficial. It could be just purely food related so deciding whether this patient is a good candidate for example a low FODMAP diet or maybe another type of diet that might be more suitable for the patient. If you’re able to guide the patient over a period of time through that process remotely it’s something that will cost a lot less money it’s something that will be much more effective for the patient and for the clinician as well. Just the satisfaction of being able to treat the patient really effectively because these are really hard to manage patients because they’re really complex conditions.
Praveen Suthrum: Aonghus Shortt thank you so much for joining us today on The Scope Forward Show. I’m excited about what you’re building. Always admire and respect innovators. What you’re doing is fantastic. I wish you great success, you and your team.
Aonghus Shortt: Thank you once again, thanks Praveen.

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COVID-19: The Way Forward for Gastroenterology Practices
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04 Jun 2022

Curated GI articles June 3rd, 2022: Investors bet on the ‘golden age’ of colonoscopies

Curated GI articles June 3rd, 2022:
Investors bet on the ‘golden age’ of colonoscopies
The ACA colonoscopy billing violation that’s all too common (Becker’s GI & Endoscopy)
Preventive colonoscopies, which are usually scheduled every 10 years starting at age 45, are supposed to be free for patients, according to the ACA.
Betting on ‘golden age’ of colonoscopies, investors buy up GI practices (Fortune)
Praveen Suthrum, President, NextServices is quoted in this article. Private equity has invested in GI practices in recent years to tap into the revenue potential in meeting growing demand.
Fast facts about GI Alliance (Becker’s GI & Endoscopy)
Southlake, Texas-based GI Alliance is the largest gastroenterology ‘megagroup’ in the industry, with more than 660 physicians and 400 locations.
A Look at Emerging Virtual Reality Tools in Gastroenterology (GI Insights)
Drs. Peter Buch and Brennan Spiegel discuss the latest advances in artificial intelligence and virtual reality that are aiding both clinical practice and research efforts.
Saneso Novel 360° Colonoscope Receives FDA Clearance (PR Newswire)
In addition to its revolutionary 360° field of view, Saneso endoscopes have innovative tissue wash and multi lens wash systems.
Artificial Intelligence Can Now Accurately Describe Your Poop (Vice)
We don’t have jetpacks, flying cars, or teleportation pods, as futurists of the ‘60s imagined we would, but AI-assisted shit-scanning apps are amongst the many pleasures of the 21st century.
Noninvasive Diagnostics to Detect NASH (GI & Endoscopy News)
In the future, biopsies may not always be needed to diagnose nonalcoholic steatohepatitis, according to a new analysis of real-world data.
‘The Rock’ assumes the presidency of AGA (AGA)
Dr. John Carethers brings decades of experience, a compendium of publications and a true dedication to mentorship.
First Real-World Data Show Stem Cell Treatment Helps Resolve Perianal Fistulas (GI & Endoscopy News)
Nearly two-thirds of patients with Crohn’s perianal fistulas treated with the novel stem cell–based drug darvadstrocel achieved clinical remission and had significantly improved quality of life.
How inflation may affect your practice and finances, steps to take now (Healio)
The article by Healio looks at how inflationary forces may impact the practice of medicine, physician finances and mentions precautions physicians can take now to safeguard their assets.
First-ever severity index for eosinophilic esophagitis published (AGA)
Developed by a multidisciplinary team of experts, the new tool is now available to use as a tool to help assess EoE patients.
Obesity in GI Care: Updates on devices (Inside Scope)
In this episode, Dr. Andres Acosta is joined by Dr. Barham Abu Dayyeh to discuss updates on devices for obesity management and look into what may be available in the future.
New ASGE Guidelines on Pancreatic Cancer Screening (GI & Endoscopy News)
Mandeep S. Sawhney, MD, MS, FASGE, a GI at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School speaks about the impetus for the guidelines and what they mean to GI practice.
Top in GI: Highlights from Digestive Disease Week (Healio)
The article by Healio highlights the top stories from Digestive Disease Week.
Are At-Home Gut Health Tests Worth It? (Everyday Health)
Ranging in price from $49 to nearly $350, these tests claim to inform you on ways to improve your intestinal ecosystem, but are they worth it?
Become a highly effective endoscopy teacher, from start to finish (MDedge)
Navin Kumar MD, explains how you can provide high-quality endoscopy education to your fellows while ensuring the best care for your patients.
Innovation is not Only About Technology (how do we use our resources to care for people effectively?) (Gastro Broadcast)
Hear Kevin and gastroenterologist Dr. Dorn explore how the COVID-19 pandemic forced physicians to deliver care online and how GI Physicians can make sense of that experience and harness virtual care.
How Study Sites Experienced Clinical Trial Changes During Pandemic (Applied Clinical Trials)
In this interview, Aasma Shaukat, MD, MPH, study co-lead, professor of medicine, and director of outcomes research for the Division of Gastroenterology and Hepatology at NYU Langone Health discusses the site perspective.
Gluten-Sensing Tech May Change Fight Against Celiac Disease (Medscape)
The test described in a new paper in the journal Food Control, reveals not just the presence of gluten but also its concentration.
Older-Onset IBD Linked to Antibiotic Use (GI & Endoscopy News)
The researchers found older patients were 2.3 times more likely to be diagnosed with IBD after treatment with five or more antibiotic courses.

More Hot headlines in GI
Eyeing inflation, physician-owned GI clinic spends $1.5M on raises for 165 employees (Becker’s GI & Endoscopy)

Psychological Health Affects Inflammatory Bowel Disease Activity (Medical Bag)

Endoscopists Missed EMDs Nearly 1 in 6 Cases in Japanese Study (GI & Endoscopy News)

Top in GI: Mystery hepatitis outbreak; unexpected medical events after endoscopy (Healio)

Three reasons colorectal cancer screening is more important than ever (University of Michigan Health)

Soft implant monitors brain and gut chemistry (MSU Today)

Low-FODMAP, gluten-free diet improves IBS symptoms (Healio)

Multiple-Target Blood Test Detects Liver Cancer After Cirrhosis (GI & Endoscopy News)

Surge in alcohol-related disease during pandemic reveals unmet need for treatment (Healio)

GI ASC included in $40M New York hospital campus project (Becker’s ASC)

Videos: Interviews with GI Leaders  (NextServices)

_
COVID-19: The Way Forward for Gastroenterology Practices
COVID-19 is a double whammy of both clinical and business disruption. This ebook will help you explore possible scenarios and be a guide in your plans for the future.
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28 May 2022

Curated GI articles May 27th, 2022: GI tech like Netflix | GIs leaving clinical practice | United Digestive expands | App as good as expert GI

Curated GI articles May 27th, 2022:
GI tech like Netflix | GIs leaving clinical practice | United Digestive expands | App as good as expert GI
Use of AI in Gastroenterology Can Move Beyond “Cool Tools” to Improve Practice Efficiency (AJMC)
As AI technology continues to advance, speakers at DDW 2022 discussed how these tools can be put into practice to improve efficiency, reduce physician burnout, and reap cost savings.
How GI tech is becoming more like Netflix (Becker’s GI & Endoscopy)
Bill Snyder, CEO of Vivante Health, a digital health company, speaks on the hyper-personalization of GI tech and the emerging technologies in gastroenterology.
New Research Finds Computer-Assisted Colonoscopy Identifies More Precancerous Polyps Compared to Traditional Colonoscopy (NYU Langone Health)
The overall rate of detection of adenoma, or cancerous and precancerous polyps increased by 27 percent in average-risk patients.
United Digestive Expands GI Therapeutic Center of Excellence Model to Coastal Georgia Region by Partnering with Dr. Daniel K. Mullady (PR Newswire)
Dr. Mullady will merge his practice with UD’s existing member group, the Center for Digestive & Liver Health (CDLH) in Savannah, Ga.
GIs Moving to Industry Cite a Desire to Reach More Patients (GI & Endoscopy News)
The reasons gastroenterologists leave clinical practice for industry vary, but there appears to be a common thread: they potentially can help far more patients than they could ever treat in person.
Innovative app found to be as good as gastroenterologists at characterizing stool samples (News Medical)
An innovative mobile phone application was found to be as good as expert gastroenterologists at characterizing stool specimens, according to a study by Cedars-Sinai.
An inside look at DDW® 2022 (AGA)
From May 21- 24, more than 3,000 oral and abstract presentations showcasing the latest updates and research were shared at Digestive Disease Week® (DDW) 2022 in San Diego.
Is It Time to Broaden Use of Multigene Panel Testing in Patients With Colorectal Cancer? (Medscape)
The article highlights if multigene panel testing can be used more broadly to identify both more precise treatments and cancers earlier in patients and their family members.
Thorne Relaunches Gut Health Test with Microbiome Wipe (Non Wovens)
Wipe makes stool sample collection convenient and simple, while providing users with analyses and personalized results with increased efficacy.
CRC Screening: Blood Test Accuracy Compared to Colonoscopy (Medscape)
The first prospective study to evaluate the accuracy of a blood test for people being screened for CRC revealed a high sensitivity and specificity.
Vibrating Pill Counters Constipation (Medscape)
A swallowable, vibrating capsule improved symptoms among patients with chronic idiopathic constipation in a phase 3 multicenter, randomized, controlled trial.
University Gastroenterology Partners With Virgo Surgical Video Solutions to Reimagine IBD Clinical Trial Recruitment (PharmiWeb)
Virgo leverages AI and endoscopic video data to more easily identify patients who meet the complex inclusion and exclusion criteria set forth by pharmaceutical companies.
Metaverse: Where Are the Medical Ethics? (Medscape)
“Concepts of issues like confidentiality and privacy are going to have to be rethought” says Arthur L. Caplan, Ph.D., director of the Division of Medical Ethics at NYU Langone Medical Center.
Walmart’s latest healthcare moves: 8 things for ASCs to know (Becker’s Healthcare)
Walmart is making moves to boost its healthcare presence. Becker’s Healthcare enlists eight updates for ASC leaders to know.
Disease Surveillance With Every Flush: Introducing the Smart Toilet (GI & Endoscopy News)
The smart toilet prototype is equipped with sensors that can classify stool samples according to the Bristol Stool Form Scale and detect blood in stool.
Serving Patients through GI Psychology (Regent University)
Madison Simons, Psy.D. highlights her experience with GI Psychology, the area that explores the “intersection of psychology and gastroenterology.”
Physician mistreatment emerges as crisis that can ripple through U.S. health care (Science Daily)
In a recent survey of more than 6,500 physicians, nearly 30% of respondents reported experiencing discrimination and mistreatment from patients or patients’ family members or visitors.
DDW22: SonarMD Data Shows Hidden Impact of Mental Health on IBD Costs, Company Expands Access to Support Services (Business Wire)
SonarMD’s platform pinpoints patients in need of mental health support better than claims data alone.
Dr. Fola May Describes Disparities in Colorectal Cancer Diagnosis, Treatment at DDW 2022 (AJMC)
The accumulation of screening and treatment disparities are contributing to colorectal cancer incidence and mortality disparities, said Folasade (Fola) May, MD, Ph.D.
GERD Roundtable: Applying Guidelines to Clinical Practice (GI & Endoscopy News)
In the GERD Roundtable series, a panel of GERD specialists explore some aspects of the ACG guidelines and discuss how they will be implemented in practice.

More Hot headlines in GI
US surgeon general: Confronting burnout ‘must be a top national priority’ (Healio)

Iterative Scopes announces positive data in Skout AI colonoscopy algorithm clinical trial (TMG Pulse)

Micro-Tech Endoscopy Partners with Wision A.I. to Distribute its AI-assisted Polyp Detection Software in the U.S. (Valdosta Daily Times)

ASGE debate pits EMR against ESD in ‘quest for ideal endoscopic resection’ (Healio)

Fujifilm Provides Education Advancement Opportunities for Gastroenterologists and Endoscopists (Globe Newswire)

Black patients ‘not caught up’ to whites in early-onset CRC survival over 20-year period (Healio)

Risk for Advanced Colorectal Neoplasia in Young Adults Tied to Age, Tobacco, and More (Gastroenterology Advisor)

Two COVID-19 vaccine doses ‘highly effective’ in immune-mediated inflammatory disease (Healio)

Blood Biomarker Predicts Complicated Crohn’s Disease Years before Diagnosis (Clinical Lab Manager)

Videos: Interviews with GI Leaders  (NextServices)

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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.
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