Becker's ASC Review

15 GASTROENTEROLOGY The biggest misconceptions about gastroenterology By Riz Hatton Gastroenterology is a very common medical specialty, but it is not without its misconceptions. Benjamin Levy III, MD, a gastroenterologist and clinical associate of medicine at the University of Chicago Medicine, connected with Becker's to discuss the biggest misconceptions about gastroenterology. Note: is response has been lightly edited for length and clarity. Dr. Benjamin Levy III: While most people think of gastroenterology as a diagnosing specialty (finding polyps and colon cancers via colonoscopies), another main goal is to prevent colon cancer. We prevent colon cancer by removing polyps with snares and biopsy forceps before polyps can turn into a cancer. I love gastroenterology because of our ability to prevent cancer. We also prevent esophageal cancer by treating dysplasia in patients with Barrett's esophagus from chronic GERD/reflux. Many people think that gastroenterologists just focus on the stomach and colon. However, we're not just poop doctors. Gastroenterologists treat every part of digestion, including the liver, gallbladder, pancreas, stomach, small bowel and colon. We treat patients with hepatitis and manage cirrhosis. We have the ability to remove stones stuck in the common bile duct with endoscopic retrograde cholangiopancreatography procedures. We manage patients with pancreatitis. e term "endoscopy" can refer to both esophagogastroduodenoscopy (EGD) and colonoscopy procedures (not just EGD/upper scope). Endoscopy is a general term for procedures where gastroenterologists use a flexible tube with a light and camera to examine the gastrointestinal tract. Many patients fear that colonoscopies are going to be painful; however, most patients are super comfortable, sleepy and unaware of the procedure. We very carefully sedate patients for their EGD and colonoscopy procedures. Many patients are sedated for colonoscopies with the help of anesthesiologists using a fantastic medication called propofol, which wears off super quickly aer procedures. We very carefully make sure that each patient is comfortable throughout their colonoscopy procedure. Many patients think that colonoscopy is the only way to get screened for colon cancer. Colonoscopies are great procedures because gastroenterologists can remove polyps to prevent cancer. However, some patients (especially patients who are very sick with other serious illnesses such as heart failure or a recent stroke) choose to be screened for colon cancer with FIT (fecal immunochemical testing) or Cologuard testing, which are stool-based tests. Patients with a positive FIT or Cologuard test result will need a follow-up diagnostic colonoscopy to try to figure out why the stool-based test turned positive. n Why gastroenterologists 'breathed a sigh of relief' when UHC rolled back prior authorization plans By Claire Wallace I n June, UnitedHealthcare announced its new advanced notification for patients undergoing esophagogastroduodenoscopies, capsule endoscopies, diagnostic colonoscopies and surveillance colonoscopies. While gastroenterologists were happy to see that the originally proposed prior authorization rules would no longer take effect, several gastroenterology groups still expressed concern and distrust of the advanced notification and gold carding process. Benjamin Levy, MD, a gastroenterologist at University of Chicago Medicine, told Becker's that while advanced notification is a much better option than prior authorization, gastroenterologists are still anxiously watching to see how the program unfolds. "Many gastroenterologists are concerned about prior authorization and advanced notification processes causing delays in cancer diagnosis for patients with alarm symptoms and medical management in general. As a physician community, we breathed a sigh of relief when the proposed new prior authorization requirements were changed to advanced notification. "The advance notification process increases administrative responsibilities for physicians and gastroenterology practices, where instead, we should be focused on expediting care. Gastroenterologists want the best possible and most efficient care for our patients. Prior authorization changes have the potential to cause 1) delays in care; 2) cause some patients to potentially abandon important colonoscopy procedures due to authorization difficulties; 3) increase the need for additional medical staff to process administrative requirements. "Gastroenterologists are curious to learn more about the previously-announced gold card program and the potential to eliminate prior authorization requirements. However, we are concerned that gastroenterologists who do not participate in the UnitedHealthcare 'advance notification' period might not be eligible for the gold card program, which could lead to more administrative work and delays in care. "We hope that UnitedHealthcare will work closely with the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy leaders to improve the delivery of gastroenterology care and to get their input." n

• Cover