Becker's ASC Review

16 GASTROENTEROLOGY 5 ways for GIs to improve colonoscopy performance By Claire Wallace A s major gastroenterology organizations have recently made changes to guidelines regarding the quality indicators surrounding colonoscopy, gastroenterologists are reconsidering how they can keep up with new requirements and best practices. According to a Sept. 19 Medscape report, there are five major ways that gastroenterologists can improve their performance, and therefore improve patient colonoscopies. 1. Addressing poor preparation: To improve bowel preparation rates, physicians should consider identifying those at high risk for inadequate prep, which could include known risk factors such as age, body mass index, inpatient status, constipation, tobacco use and hypertension. e biggest return-on-investment option is to maximize prep for all patients, especially since every patient has at least some risk of poor prep, according to the report. Physicians should offer patients verbal and written instructions for all components of prep, patient navigation with phone or virtual messaging to guide patients through the process, a low-fiber or all-liquid diet on the day before colonoscopy and a split-dose 2-L prep regimen. 2. Improving polyp detection: Adenoma detection rates can be impacted by a number of factors, including different techniques, technical skills, pattern recognition, interpretation and experience. AI tools can help to improve detection rates. Multiple tools and techniques may be needed in real time to interpret a lesion, such as washing, retroflexing and using better lighting, while paying attention to alerts and noting areas for further inspection and resection. 3. Following polyp surveillance intervals: Due to conflicting guidelines, some physicians may be unsure when to instruct patients to come back aer colonoscopy and polypectomy. To improve guideline adherence, GI groups should provide physicians with additional education, implement an automated surveillance calculator, and adhere to guidelines at the point of care. Practitioners should feel comfortable leaning toward longer surveillance intervals. 4. Reducing environmental impacts: In recent waste audits of endoscopy rooms, providers generate 1 to3 kilograms of waste per procedure. Waste comes from procedure-related equipment, administration, medications, travel of patients and staff, and infrastructure with systems such as air conditioning. Taking steps toward a green practice can reduce waste and the carbon footprint of healthcare. Clinicians can take the biggest step toward sustainability by avoiding unneeded colonoscopies. Additionally, they can rethink their approach to resection, such as using a snare first instead of forceps to reduce single-instrument use, using clip closure only when it's truly indicated and implementing AI-assisted optical diagnosis to help with leaving rectosigmoid polyps in place, according to the report. Practices should also reconsider how they sort bins and biohazards and conduct waste audits to understand usage and environmental impact. 5. AI for quality and efficiency: Artificial intelligence can play a major role in quality colonoscopy, from spotting polyps to assisting in documentation. Physicians should beware of a false sense of comfort with AI, and be sure to use a "physician-AI" hybrid model. n Gastroenterologists vs. colonoscopy reimbursements By Francesca Mathewes S creening colonoscopies in the U.S. cost a total of $23.7 billion in 2021, the most recent available data for nationwide cancer screening costs. Colorectal cancer rates among U.S. adults have also hit record highs in recent years. The expected growth rate of CRC among U.S. men is 8%, and 7% for women. In the ASC setting, the average colonoscopy costs $925, compared to $1,224 in the hospital outpatient department. Medicare and private insurers, under the Affordable Care Act, cover a screening colonoscopy, but Medicare patients can expect to pay 15% of the Medicare-approved amount for a physicians' services in a follow-up screening. In the ASC setting, there may also be a 15% coinsurance amount. But reimbursements for gastroenterologists have steadily declined in recent years. Between 2007 to 2022, unadjusted and adjusted average reimbursement for GI procedures dropped by 7% and 33%, respectively, according to a study published in The American Journal of Gastroenterology. Reimbursements for colonoscopy and biopsy decreased 38% during that period. In California, Kentucky, Illinois, Nebraska and Vermont, lawmakers are considering or have passed legislation that would expand insurance coverage of colonoscopies. Additionally, in 2021, the National Cancer Institute's recommended screening age for colonoscopies was lowered from 50 to 45, increasing the overall demand for colonoscopies. "I would love to see payers and clinicians sit down at a table and have a conversation about the benefit of early endoscopy for diagnosis and screening," Omar Khokhar, MD, a gastroenterologist at Illinois GastroHealth in Bloomington, told Becker's. "In particular, how EGD/ colonoscopy can potentially prevent patient morbidity and decrease downstream cost to the healthcare system. Yes, endoscopy isn't cheap, but cancer is a bad diagnosis and is more expensive." n

• Cover