17 Sep 2020

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

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

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

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

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

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

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


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

Headlines for GI

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

Newsletter:

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

ICYMI:

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

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

 

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

 


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

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

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


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

Headlines for GI

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Headlines for GI

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

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

Reducing the backlog of patients (AGA)

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

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

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

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

Hong Kong Researchers Report First Documented Coronavirus Reinfection  (Medscape)

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

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

Perspective: Are Aging Physicians a Burden? (Medscape)

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

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

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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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31 Aug 2020

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

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

 


Originally published on KevinMD

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21 Aug 2020

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


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

Headlines for GI

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

Newsletter:

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

 

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

 

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

 

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

 

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

ICYMI:

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

 

Ear Stimulation Eases IBS Pain in Teens (MedPage Today)

 

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

 

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

 

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

 

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

 

Five no-regret strategies health systems are employing for sustainable results (Becker’s Hospital CFO Report)
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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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19 Aug 2020

Want to be a physician-entrepreneur? Get these insights from Dr. Don Lazas

 

In this video, Dr. Don Lazas shares his insights on how GI physicians can take the spirit of entrepreneurship beyond private practice. 

 

The Transcribed Interview:
Praveen Suthrum: You are a physician entrepreneur involved in many different companies. And there are a lot of physicians out there, gastroenterologists particularly, who want to go through perhaps what you’ve gone through. So, I have a twofold question here – What has been your journey like? And what advice do you have for physicians who want to follow your path?
Dr. Don Lazas: Well, a very interesting question and you know, I don’t really think of myself as a pioneer, but I guess in some ways I have been as a gastroenterologist. I look at great innovative thinking inside of practices around the country and there are some really smart, business-oriented gastroenterologists. I met a lot of them that are really leveraging their business knowledge and their calculated risk tolerance to develop important new ventures inside their practice and I think that’s spectacular. I really applaud that and love that entrepreneurial spirit. But I think, the same spirit can extend beyond the practice, you know.
One of the things that I’ve learned, when we started our investment company several years ago, I knew what I brought to the table. So, I knew clinical medicine, I knew gastroenterology, I knew the doctor-patient relationship and I had a sense where technology was going to take the field of healthcare in terms of digital health. And all that excited me a lot. But what I didn’t know, I made a very calculated decision, to partner with other individuals who brought other skills to the table. So, those could be business skills, healthcare operator skills, banking and legal skills, deal skills – how do you construct a deal? How do you negotiate with an entrepreneur to invest in their company? People who had been in venture capital learned a lot through partnering with smart individuals.
So, I think the most important thing that I could share is – If you’re interested, start reaching out to folks in the community that you know and respect. And begin talking to them about your interests and entrepreneurial activities. There’s two ways to go. You starting your own venture. I think there are a lot of resources out there that can help healthcare entrepreneurs learn about the mechanics of how to start a company. Then there is investing in early-stage companies which I’ve done quite a bit as well and it’s not for the faint of heart. Don’t make it a large part of your portfolio, right? 10% or less. But it’s very exciting, invigorating and I think you win some and you lose some. But I think what you learn is – you learn how to have a mindset of innovation.
You have to take risk. If you’re going to learn anything in life but specifically in entrepreneurial endeavors, you have to be in it. You have to have your hands in it. You have to be doing it. You have to be writing cheques. You have to be investing your time and resources. And until you have your skin in the game, it is really hard to create opportunities and success. I think those are just some general themes that hopefully will be helpful. I always enjoy talking to the entrepreneurs about their interests and I have been quite busy these days with ObjectiveGI, growing the company. So, yeah, that’s just some of my insights.
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By Praveen Suthrum, President & Co-Founder, NextServices. 

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

Interview Trends Influencing Gastroenterology and all of Healthcare

In this interview on RamaOnHealthcare, you’ll learn about trends that impact not just gastroenterology but all of healthcare. The interview is based on the upcoming book on the future of gastroenterology: Scope Forward – The Future of Gastroenterology Is Now in Your Hands.
Actively read by individuals like John Halamka, President of Mayo Clinic Platform, RamaOnHealthcare is an expertly curated newsletter on industry trends and insights.
Trends influencing gastroenterology and all of healthcare

 

Featured in

 

 


 

Excerpt from the interview
RamaOnHealthcare: You’ve explored many trends in the book from technology to business. Let’s talk about exponential technologies first. How is it affecting gastroenterology
Praveen Suthrum: Yes, the trends we discuss in Scope Forward cut across technological, business, and societal areas.
Consider the impact of exponential technologies such as DNA testing, artificial intelligence, and the microbiome. In last couple of decades, gastroenterologists have largely relied on screening colonoscopy to detect colon cancer. But now DNA testing services offer tests that screen for colon cancer via a stool sample. There is plenty of research underway to detect not just cancer of the colon but fifteen types of cancers using a blood sample. That field is called liquid biopsy. Consider the business disruption that this may cause to gastroenterologists who do not adapt.
Artificial intelligence in endoscopy is now able to point to polyps (growths in the gut) and even classify them. If an AI is able to show and tell you what’s cancerous, consider how that might impact the training and role of an endoscopist. Also think about what would happen if insurances link reimbursements to quality and count of polyp detection and removal. Everyone would be compelled to rely on AI.
The important thing to remember about exponential technologies is that they are not developing in isolation. The growth of one field affects the other. Advances in sensors improves robotics. Advances in robotics makes advanced endoscopic surgery possible. In the coming years, we will see a rapid multiplication of these technologies. That will result in an exponential change in gastroenterology and all of healthcare.
RamaOnHealthcare: What about business consolidation? Has there been a lot of private equity activity in gastroenterology?
Praveen Suthrum: Yes, private equity (PE) has fueled consolidation within gastroenterology and many other specialties in healthcare. When I wrote my earlier book Private Equity in Gastroenterology, there were five PE transactions in gastroenterology. Not surprisingly, my predictions about consolidation played out throughout 2019. There were 16 transactions during the year. In 2020, there are already four or more, including a PE platform that went live in the middle of COVID-19.
[Read the rest of the interview here]
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By Praveen Suthrum, President & Co-Founder, NextServices. 

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