Becker's ASC Review

46 GASTROENTEROLOGY From virtual visits to cost cutting, 6 experts predict what's in store for gastroenterology in 2021 By Eric Oliver S ix gastroenterologists share their pre- dictions on the future of the specialty: Note: Responses were edited for style and content and presented alphabetically. Fred Askari, MD, PhD, director of the Wil- son Disease Program at Ann Arbor-based Michigan Medicine: COVID-19 has ac- celerated the move toward virtual visits for our clinic. Virtual visits have been favorably received by many patients, particularly those who drive long distances for appointments. I anticipate virtual visits will make up at least 50 percent of office visits going forward based on patient demand. Caregivers and educators will have to adapt to the pandemic and patient-driven change to vir- tual practice. ere will be more virtual caregiv- ing, teaching and learning for medical students, residents and fellows anticipated in 2021 which was virtually unheard of prior to 2020. 2021 will also bring further cost cutting initiatives with reductions in non-essential support staff and a move toward a seven-day-a-week active outpa- tient and hospital practice. ese management initiatives will likely lead to further unionization of the healthcare workforce in 2021. Challenges with organ availability will fuel the growth of living-donor liver transplan- tation in 2021, and sadly, we will likely see greater numbers of people presenting with alcohol-induced liver disease given the well documented uptick in alcohol use in 2020. Novel treatments driven by advances in biotechnology will lead to clinical trials of artificial intelligence-developed nucleic acid treatments and gene therapies in 2021 for Wilson disease, as well as ongoing studies with novel copper reduction treatments. Anil Dev, MD, gastroenterologist at New York City-based BronxCare Health System: GI is well poised to maintain strong growth in coming years. New technology and procedural armamentarium will help fuel specialty growth. However, the cost of new technology and accessories is prohibi- tive in early adaptation. More competitive pricing for scopes and accessories is needed to contain cost curves and retain an edge in care coordination. Sam Giordano, MD, gastroenterologist at Camden, N.J.-based Cooper University Health Care: It was a tough year for gastro- enterology, as it was for many medical spe- cialties, but there is much to look forward to in 2021. It will be refreshing to embrace COVID-19 vaccinations and turn the corner on a return to normalcy following a year of disruption and hardship. Many patients delayed medical care during a time when elective procedures were put on hold, and this resulted in many diagnoses that may have been made later than ideal. I look forward to getting back to helping pa- tients in a timely-fashion, and I am still trying to unload my patient backlog from that time. Secondly, I look forward to the implemen- tation of the new U.S. Multi-Society Task Force Guidelines with the recommended screening age being reduced to 45 years of age for all. is is long overdue, and it is certainly a balancing act trying to keep in mind public policy as a population, with an individual experience. I personally have seen too many young persons unfortunately well under 50 fall victim to advanced-stage colon cancer. ere is nothing more heart- breaking than to break this news to a young family, and the hope is that this monumen- tal change in policy lowering the screening age to 45 will allow us as clinicians to have less of those conversations. Lastly, I am looking very much forward to new endoscope technology and the imple- mentation of AI to aid in polyp detection. As someone who takes great pride in my personal adenoma detection rate, I realize that none of us are perfect and the hope is this improved technology will take us a step closer to achieving that goal. Wishing everyone a happy and healthy 2021. Steve Morris, MD, gastroenterologist at Atlanta Gastroenterology Associates: [2020] was the annus horribilis in GI and healthcare in general. Any view toward 2021 has to take into account what has transpired and longer term implications. It is the first time that physicians have seen societal events dramatically alter their ability to work and earn an income. As a consequence, I believe 2021 will see acceleration of a trend towards perceived safety and stability with employment of GIs by hospital systems and managed care consortiums, and [2021 will see] the continued consolidation of private practices into large GI platforms. ese changes already had momentum and the COVID-19 crisis will prove a tipping point. GIs will continue to expand into the outpatient setting by owning and partnering to provide [care in] an ASC setting for an in- creasing number of procedures. Insurers will finally resist the much more expensive alter- native of doing elective cases in a hospital. GI physicians will need to offer in-office infu- sion services for patient cost and convenience as more biologics and biosimilars are avail- able for therapy. Telemedicine will be part of everyday practice as will social distancing in offices and ASCs for years to come. Finally, I believe we will see GI practices start to take on more risk as part of a value proposition; this was in its nascency but derailed as part of the crisis. GI practices that are truly forward thinking will expand to include colorectal and laparoscopic sur- geons, and even GI oncology expertise to be able to fully serve all their patients' needs as part of a risk sharing model. Chris Shaver, MD, CEO at Birmingham (Ala.) Gastroenterology Associates: Our medium-sized, single-specialty GI practice experienced the very real challenges and uncertainties characteristic of the coronavi- rus pandemic. Our general approach to this unprecedented event included staying open for business through consolidating provider schedules in our clinics and hospitals, [of- fering] telemedicine, [making] appropriate adjustments in office staffing and institut- ing protocols to protect our patients and employees. Along the way, we learned a lot about our business and our people. is in- formation enabled us to make some positive clinical and operational adjustments that We will see GI practices start to take on more risk as part of a value proposition. - Steven Morris, MD

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