Becker's ASC Review

31 GASTROENTEROLOGY The newest driver of the GI boom: 5 things to know By Sophie Eydis A dramatic rise in colorectal cancer among adults under 50 — especially those ages 45–49 — is driving a major shift across gastroenterology and ASCs. Screening guidelines dropped to age 45 in 2021, and early uptake is rising fast, even as providers grapple with reimbursement declines, capacity constraints and workforce pressure. Colorectal cancer has become the leading cause of cancer deaths for men under 50 and the second-leading cause for women under 50, according to the American Cancer Society's 2024 data. Here are five key ways the rise in younger colorectal cancer cases could reshape GI practice and ASC operations: 1. Rising colonoscopy demand Screening rates in 45-49-year-olds increased 62% from 2019 to 2023, with colonoscopy volumes rising 43% and stool-based testing jumps more than fivefold. 2. Need for expanded ASC capacity Gastrointestinal procedures already make up more than a quarter of Medicare ASC volume, with eight GI-related procedures — including colonoscopies, CRC screenings and endoscopies — accounting for 28.3% of all billed services in 2023, according to MedPAC. With millions of newly eligible patients, ASCs may need to add procedure slots, anesthesia coverage and recovery space to meet demand. 3. Shifting payer dynamics Coverage expansion for younger patients creates new billing opportunities, but adjusted reimbursement for GI procedures has dropped 7% to 33% since 2007, with colonoscopy and biopsy payments down 38%. Without rate stabilization, rising volumes may not translate into proportional revenue growth. 4. Heightened workforce pressure Gastroenterology is projected to face a shortage of more than 1,600 physicians nationwide by the end of 2025. Rising demand from younger screening guidelines could amplify appointment delays, provider burnout and reliance on advanced practice providers. 5. Equity and access gaps Despite expanded guidelines, nearly 4 in 10 adults older than 45 have not undergone a colonoscopy. Many cite fear, lack of awareness, or cost as barriers, and 79% of Americans do not know the recommended screening age. Programs that partner with community health groups to provide free or low-cost screenings show promise in reaching underserved populations, but disparities persist. n GI private equity deals are fewer — but bigger By Sophie Eydis P rivate equity activity in gastroenterology is slowing in frequency, even as deal sizes and consolidation momentum grow. is shi is redefining the field — and what independent GI groups and ASCs need to anticipate. 1. Deal volume is falling fast GI PE transactions fell by 50% over 2022 to 2023, from 26 to 13, respectively. is mirrors a broader healthcare slowdown, where overall PE deals dropped 16.2% in 2023. 2. Deals are bigger and more strategic ough transaction volume has slowed, consolidation is increasingly driven by large platforms such as Southlake, Texas-based GI Alliance, Miami-based Gastro Health and Atlanta-based United Digestive, which continue to expand nationally. Recent activity includes add-on acquisitions of individual sites, as well as recapitalizations such as GI Alliance's $785 million deal with Apollo Global Management. 3. Mega-deals are reshaping the market Major consolidations continue to shake up the GI landscape. In early 2025, Optum subsidiary SCA Health acquired Exton, Pa.-based U.S. Digestive Health, which includes more than 250 providers across 40 practice sites and 24 ASCs. e deal drew strong reactions from physicians and executives, with some citing expanded resources and others raising concerns about clinician autonomy. "Optum's acquisition of U.S. Digestive Health is important because it's an example of how companies can quickly consolidate gastroenterology practices and integrate care within a health insurance ecosystem. … Unfortunately, physicians might lose some autonomy during the acquisition," Benjamin Levy III, MD, gastroenterologist at University of Chicago Medicine, told Becker's earlier this month. 4. Reimbursement pressure adds urgency Gastroenterologists' compensation is under strain — average pay fell 3% from 2023 to 2024, even before adjusting for inflation. is erosion, combined with fewer but larger PE exits, creates both risk and opportunity for practices. 5. Policy and regulatory scrutiny intensify New legislation in 2025 is adding hurdles to PE-driven GI consolidation. Oregon enacted the nation's strictest limits on corporate and private equity ownership of medical groups, requiring physicians to retain majority control. Pennsylvania passed a bill expanding the attorney general's authority to review and block healthcare M&A. With GI among the most PE-consolidated specialties, these moves could directly impact the structure and pace of future gastroenterology transactions. n

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