Becker's ASC Review

73 GASTROENTEROLOGY How much revenue do GIs generate for hospitals? 3 report details By Rachel Popa G astroenterologists generate more net revenue for hospitals than general surgeons, internal medicine physicians and oncologists, on average, according to Merritt Hawkins' 2019 Physician Inpatient/Outpatient Revenue Survey. Merritt Hawkins emailed a survey to 3,000 hospital CFOs and other financial managers across the U.S. from October 2018 to December 2018. Hospital CFOs and financial managers reported the combined net inpatient and outpatient revenue generated by a full-time equiva- lent physician employed by the hospital or in independent practice. Primary care physicians determined revenue from direct hospital admissions, lab tests and procedures performed. The survey was completed by 62 respondents, representing 93 separate hospitals. Three things to know: 1. Survey respondents said gastroenterologists generated an aver- age net revenue of $2,965,277 in 2019, up from $1,422,677 report- ed in the 2016 survey. 2. Specialties such as orthopedic surgery ($3,286,764), invasive cardiol- ogy ($3,484,375) and cardiovascular surgery ($3,697,916) generated more average net revenue for hospitals than gastroenterologists did. 3. Increasing revenues across specialties shows value-based delivery models have not reduced the volume or cost of physician specialty care, the report noted. n Colonoscopy the gold standard in US, despite alternatives — 7 insights By Eric Oliver M edscape reviewed current colorectal cancer screening tests options as well as research surrounding them to quantify which was the most effective. What you should know: 1. Medscape examined colonoscopy, fecal immuno- chemical tests and flexible sigmoidoscopy. 2. Colonoscopy is viewed as the gold standard in the U.S. but has a reputation as an overly invasive option in the rest of the world. For example, the Netherlands had the lowest colonoscopy opt-in rate with only 23 percent undergoing the procedure. 3. National Cancer Institute's Paul Pinsky, PhD, said the impact of colonoscopy on CRC rates has been second only to cervical cancer in terms of effects on incidence and mortality rate, and that while colonos- copy is resource intensive, the U.S. medical commu- nity views colonoscopy as the gold standard. 4. Researchers are conducting randomized clinical trials to provide evidence of the effectiveness of colo- noscopy. One trial is comparing colonoscopy to fecal immunochemical testing. FIT is a highly accurate noninvasive stool test; however, clinical recommen- dations encourage people to take a FIT test more frequently than a colonoscopy. 5. FIT has other drawbacks. In an interim report from a study with 26,000 men and women, FIT found fewer non-advanced — possibly clinically insignifi- cant — adenomas than colonoscopy. However, FIT's early CRC detection rate is still strong and European countries prefer FIT to colonoscopy. 6. Flexible sigmoidoscopy is a screening option. While it has fallen out of favor in the U.S., flexible sig- moidoscopy is, "still one of the most effective proven screening [methods] for CRC that we have," accord- ing to Dr. Pinsky and NCI's Eric Miller, PhD. One of the biggest drawbacks to flexible sigmoidoscopy is it's much more effective in men than women. 7. Despite the array of options, Medscape predicts colonoscopy will remain the gold standard in the U.S. followed by the emerging FIT test. e publication of randomized trial data could confirm the effectiveness of one over the other. n 3 study insights into the best bowel preparation solutions By Eric Oliver A study published in the American Journal of Gastroenterology compared what bowel preparations were best tolerated and most effective. Researchers reviewed 4,339 outpatient colonoscopies from a large medical center. They measured bowel cleansing quality using the Boston Bowel Preparation Scale. What they found: 1. Magnesium citrate, MiraLAX with Gatorade, MoviPrep, OsmoPrep, Prepopik/Clenpiq and Suprep all had higher tolerability scores than GoLytely. 2. Suprep, MoviPrep and MiraLax with Gatorade had higher Boston Bowel Preparation Scores than GoLytely. The other preps were all similar. 3. Spilt-prep dosing led to better cleansing, but men, opioid and tricyclic antidepressant users, diabetes and cirrhosis patients all had worse cleansing scores. Researchers concluded, "In this prospective, real-world comparative effectiveness study of available bowel preps, we found that MiraLax with Gatorade, MoviPrep, and Suprep were prospectively associated with superior tolerability and bowel cleansing." n

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