Issue link: https://beckershealthcare.uberflip.com/i/1208835
40 GASTROENTEROLOGY Finally, as vast amounts of data are collected on patients, research- ers will be able to aggregate and analyze this information to derive population-based insights in a more timely and efficient way. Luke Mitchell, partner and managing director of Edgemont Part- ners: When it comes to [predicting what GI will look like in 2030], there is only one certainty: It will look very different than it does today. Major changes in reimbursement models, evolving approaches to care delivery, variations in ownership structures and increasing consolidation among GI groups ensure that the only certain change will be change itself. Some changes will be positive for practitioners, some will be negative, but most will be both challenges and opportu- nities for those physicians and groups that are forward-thinking and willing to make the investments and adaptations necessary to remain leaders in their fields. Delivery of care, and how physicians get paid for that care, is not going to get any easier or less complex over the next 10 years. e demographic trends driving the growth in GI, namely the aging U.S. population and increasing incidence of GI disease, will remain strong for many years to come, providing a stable founda- tion for the entire specialty. Also, the endoscopy center model does not seem to be at risk given the lower relative cost compared to inpatient alternatives. While GIs have taken some lumps over the past several years in terms of reimbursement cuts, that doesn't necessarily mean that the pain is over. Most investors believe the future reimbursement land- scape will be heavily focused on bundled payments and outcomes- based reimbursement, beyond [the Merit-based Incentive Payment System]. It is rare that a GI group can report outcomes data that would allow it to meaningfully differentiate their quality of care for payers, and bundled payments have the potential to significantly dis- rupt the current ownership models that rely heavily on distinct but separate entities providing ancillary services such as pathology, anes- thesia, infusion and facility services. Finally, as investors continue to pour capital and expertise into the specialty, the chasm between the haves and have nots will become even more meaningful. With their increased ability to fund growth, infrastructure and sophisticated systems, the large consolidators will make it harder for solo practitioners and small groups to thrive in many geographies. Louis Wilson, MD, Wichita Falls (Texas) Gastroenterology Associ- ates: My opinions about the future of the practice of GI are shaped by my work as the chairman of the American College of Gastroen- terology practice management committee, as president-elect of the Texas Society of Gastrointestinal Endoscopy, and most importantly as the managing partner of a decidedly independent private practice GI group in a small- to medium-size market. A mixture of forces is coming together right now, shaping the state of affairs in our prac- tice, as well as the future for the next decade. Colonoscopy and endoscopy will continue to thrive as a screening and diagnostic tool, aided by new technologies such as AI. New tech- nologies will improve our endoscopy capabilities rather than replace them. On a day-to-day basis, however, by 2030 or sooner, GIs will see their workflow and revenue sources evolve from traditional fee-for- service and endoscopy-focused work to more of a fee-for-value and chronic disease management type of practice. Some of the disease states that will consume our workflow include fatty liver disease, cryptogenic cirrhosis, autoimmune diseases, inflammatory bowel disease, Barrett's esophagus and eosinophilic esophagitis. Ancillary service lines will be critical to both the business of GI and care delivery. ASCs will remain central, as well as the ancillary ser- vice lines ASCs support easily. Ancillary service lines, however, will need to prove themselves as clearly cost-effective for patients and im- prove the value patients receive to survive. erefore, the service line I think is most at risk is anesthesia assistance for routine endoscopy. I don't see [it being] as relevant 10 years from now. Instead, pathology services, infusion services and pharmaceutical research will be better opportunities over the next decade. Each of these provides value to patients and complements clinical practices. e business processes of hospital consolidation and private equity capitalization of private practices will certainly impact the practice settings and opportunities for GIs, but these forces will not be dis- tributed geographically. I also don't think these processes will have the effect others predict. Independent medical practice will prob- ably remain the best setting for physicians, while the availability and viability of that setting will vary from one market to another. As the current PE-backed management service organizations sell to larger entities, the advantages of independent private practice will increase in some areas. Hospital-based systems will continue to be under significant stress over the next 10 years, and many of them will perform poorly as delivery systems for cost-effective care. ey will need to take advantage of joint ventures with independent practices and provide excellent professional service agreements to physicians to remain profitable. Physician employment will peak but not deliver the type of stability and profits hospitals are hoping for. e demand for GIs will remain high. Markets where hospitals fail to effectively develop joint ventures and professional services agreements will have a dif- ficult time attracting and keeping high-quality GIs. n References 1 Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin 2018;68:250-281.