Becker's ASC Review

14 GASTROENTEROLOGY The obstacles in GI migration from the HOPD to ASC By Patsy Newitt ere are several obstacles slowing the migration of gastroenterology procedures from the hospital outpatient departments to ASCs. James Leavitt, MD, director of clinical quality and outcomes of Miami-based Gastro Health, joined Becker's to discuss these obstacles. Editor's note: is response was edited lightly for clarity and length. Question: What obstacles are halting outpatient migration for GI procedures? Dr. James Leavitt: According to a study from Johns Hopkins Bloomberg School of Public Health, endoscopic procedures cost on average 55% more at hospitals compared to ASCs. e economic driver should be to move more of these procedures to the lower cost ASC setting especially since outcomes are equal in either setting. However, there remain several issues preventing more widespread migration to the lower-cost setting. First, there are still some insurers who will only pay for procedures to be done in a hospital setting. Secondly, there are some higher risk patients where the hospital setting would be more appropriate. Patients with a significantly elevated BMI or with poor airways, for example, are more appropriate for a hospital setting. However, there are still patients who could be done in an ASC and are not. Two major drivers here are access issues (not enough ASC endoscopy slots to accommodate demand) and hospital employed physicians who are required to do their procedures in the HOPD setting. n The best decision this Hawaii gastroenterologist made this year By Paige Haeffele B ecker's connected with Mel Ona, MD, chair and medical director of gastroenterology at Pali Momi Medical Center in Aiea, Hawaii, to find out what recent decision has paid off the most at his ASC. Note: Response has been lightly edited for length and clarity. Question: What is the smartest decision you've made recently that has positively impacted your practice? Dr. Mel Ona: The smartest decision we made was implementing an artificial intelligence-assisted polyp detection device during screening colonoscopy. We were the first private practice in Hawaii to use an AI module in July 2022. Since then, my adenoma detection rate increased from mid-40% to over 50%. We have also diagnosed over 60 colorectal cancers at our ASC since October 2020, many of which have occurred in younger patients (ages 20 to 45). We look forward to more innovations in the field of gastroenterology to assist in the detection and prevention of colorectal cancer. n The most impactful recent change at Intermountain gastroenterology By Paige Haeffele B ecker's connected with Nathan Merriman, MD, medical director of gastroenterology and digestive health at Salt Lake City- based Intermountain Health, to find out what recent change at Intermountain has had the biggest effect on his practice. Note: Response has been lightly edited for length and clarity. Question: What change in the last year has been the most impactful? Dr. Nathan Merriman: Starting up our central screening colonoscopy program has been very impactful. We started it about a year and a half ago. We were continuously seeing that there were a lot of open scheduled spots on people's schedules across the Salt Lake Valley, and there were a lot of patients waiting aer the backlog of COVID-19. However, the age change to 45 has led to a huge increase in patients. We wanted to make it easier for patients to schedule their screening colonoscopy online, so we started up an online form. I know some people have gone direct to scheduling — which is great — and eventually, we hope to get there as well. We started an online form for requests for screening colonoscopy because patients actually don't need a referral, and patients have loved it. It helped with our central scheduling program, allowing patients to see availability across sites in the Salt Lake Valley and to look for open time blocks across sites, and empower them to choose which of our four sites they want to go to, and on what day and at what time, with which physician. Patients have really loved that, We're seeing younger onset of colon cancer, and for every gastroenterologist I've talked to over the last couple of years, we've all seen an increase in precancerous polyps in young patients in their 20s, 30s and 40s as well — making the ability to easily schedule even more important. n

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