Becker's ASC Review

May/June Issue of Becker's ASC Review

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80 GASTROENTEROLOGY How COVID-19 upended a practice's 35-year-old business model in 2 weeks By Eric Oliver T he COVID-19 pandemic is devastating private practice gastroenterologists, resulting in layoffs, reduced hours and decreased salaries to try and stay afloat, MDedge reports. Will Bulsiewicz, MD, a Charleston, S.C.-based gastroenterologist, said the pandemic upended his 35-year-old practice in two weeks. Dr. Bulsiewicz used to see 22 patients a day or performed around 16 daily procedures. Now he sees between zero and six patients daily via telemedicine, and endoscopy volume has dropped by more than 90 percent across his three-physician practice. It's not only hurting private, independent practices either. James Leavitt, MD, is a gastroenterologist with private equity-backed Miami-based Gastro Health. Dr. Leavitt told MDedge his 17-clini- cian group has furloughed half of its staff. The practice went from seeing 150 patients daily to five or fewer. Endoscopy volume, too, has dropped from 100 procedures a day to around five proce- dures a day. And while these practices are turning to telemedicine to attempt to fill the void, gastroenterology doesn't lend itself to the platform as easily as other specialties do because of the internal nature of the diseases gastroenterologists treat. Independent practices are on life support, said Rajeev Jain, MD, a Dallas-based gastroenterologist. Dr. Jain said if government fi- nancial assistance programs don't roll out fast enough, he fears "a death to small, independent practices because they're not going to have the financial wherewithal to tolerate this for too long." n More early-onset CRC cases could be caught by examining family history By Eric Oliver C linicians can help catch early-onset colorectal cancer by consistently screening and recording a patient's family history and proceeding with preventive screening when appropriate, according to a new set of international cancer registries, Medpage Today reports. What you should know: 1. About a quarter of CRC cases in the 40- to 49-year- old age group would have qualified for early preventive screening based on family history, according to findings published in Cancer. 2. If clinicians followed the family history-based screen- ing criteria, most of the early-onset cases could've been diagnosed earlier or prevented. 3. About 44 percent of the early-onset CRC cases were diagnosed at the same age as the patient's youngest first- degree relative with CRC. e finding suggests patients didn't make their clinician aware of a family history of CRC until they reached the age of the youngest person in their family who was diagnosed with CRC. 4. Several CRC-related task forces have recommended early screening for patients who have first- or second- degree relatives with CRC. 5. Researchers noted the study could have been limited by spectrum bias, and the number of patients with family members who had CRC in the study may not be reflective of the same number of people in the general population. n AGA updates guidance for outpatient ulcerative colitis treatment By Angie Stewart T he American Gastroenterology As- sociation unveiled new guidelines for patients with ulcerative colitis, accord- ing to HCPLive. Five takeaways: 1. Joseph Feuerstein, MD, and his gastroen- terology team at Beth Israel Deaconess Medi- cal Center in Boston released the guidelines on AGA's behalf. 2. e guidance focuses on immunomodu- lators, biologics and small molecules for inducing and maintaining remission in patients with moderate to severe ulcerative colitis. ey also address decreasing the risk for colectomy patients with severe ulcerative colitis. 3. For adult outpatients with moderate to severe cases, the AGA said using infliximab, adalimumab, golimumab, vedolizumab, tofacitinib or ustekinumab is superior to providing no treatment at all. 4. Adult outpatients previously exposed to infliximab should be treated with ustekinum- ab or tofacitinib instead of vedolizumab or adalimumab. 5. e AGA recommends against using thiopurine monotherapy to induce remission in adult outpatients with moderate to severe ulcerative colitis. In these same patients, the society also does not recommend using methotrexate monotherapy to induce or maintain remission. n

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