Roundtables

enterology Associates of North Texas, Fort Worth: If you complete the endoscopy reports correctly, the information will be pretty reliable. However, if you don't document cor- rectly and don't indi- cate polyps are found, the reported data won't be ac- curate. We've found our system quite reliable and once you are in the habit of getting all information put into the report, it's easy to see the benefits. We've actually seen a steady im- provement by all group physicians in ade- noma detection, prep quality and other measures by tracking and bench- marking outcomes. Knowing this information allows you to make changes and become better. It's not unlike similar practices in athletics. Runners time themselves and want to improve on their personal best. Physicians want to improve in the same way. Q: how can gastroenterologists tell whether their process improvement makes a difference? Dr. Deas: ey can continue to benchmark. One example is with ad- enoma detection rate: there is a broad range of performance levels there. Some phy- sicians have a 45 percent to 50 percent adenoma detection rate. ey have good visualization skills and identify small polyps with a skill set that others don't have. At the other end of the spectrum, you have physicians that have an ADR of 15 percent. ey need to find ways to improve that. One way to improve adenoma detec- tion is by taking longer to examine the colon, but that doesn't always solve the problem. Sometimes better bowel preparations are necessary. ey can learn better technique by watching oth- er physicians and see- ing how they examine behind folds and are more me- ticulous in examin- ing the colon mucosa for polyps. You aren't going to spend time to do that if you don't have a measure showing you are substandard. We all want to get better, but we need the feedback that tells us when we need to improve. Q: Do you expect the demand for colonoscopy to grow or de- cline over the next five years? What are the biggest factors im- pacting colo- noscopy volume? William R. Stern, MD, American College of Gastroenterology's Practice Management Committee, Associates in Gastroenterology, Rockville, Md.: I will have insurance and screening colonoscopies are mandated as a preven- tive screening measure. Also, GI societies are trying to make people more aware and in- crease publicity. Dr. Cohen: I believe that demand for optical colonoscopy will continue to increase during the next five years. is belief is based upon evidence that supports the efficacy of colonos- copy in the prevention of colorectal cancer. No other modality currently "In colonoscopy, quality has become second nature. We are using quality benchmarks and documenting our withdrawal time and adenoma detection rates. This data can be used to present to insurance companies and neogotiate savings." -Dr. Edwin Levine GI Centers of the Future 3 Q: Do you expect the demand for colonoscopy to grow or de- cline over the next five years? What are the biggest factors im- pacting colonoscopy volume? William R. Stern, MD, American College of Gastroenterology's Practice Management Committee, Associates in Gastroenterology, Rockville, Md.: I think they'll probably grow. Because of the Affordable Care Act, more people will have insurance and screening colonoscopies are mandated as a preven- tive screening measure. Also, GI societies are trying to make people more aware and increase publicity. Dr. Cohen: I believe that demand for optical colonoscopy will continue to increase during the next five years. This belief is based upon evidence that supports the efficacy of colonoscopy in the prevention of colorectal cancer. No other modality currently in use for colorectal cancer screening, including fecal immunochemical testing, CT colonography and fecal DNA has been demonstrated in randomized trials to be as effective as colonoscopy in reduc- ing both the frequency and the mortality rate of colorectal cancer. Notwithstanding the above, however, I believe that optical colonoscopy will be challenged by other screening modalities when more data examining the cost effectiveness of various testing strategies are available. For example, a large [Veterans Affairs] cooperative study is currently under way comparing colonoscopy with FIT. While the results of this study will not be available for many years, there are some individuals who feel that FIT may come out on top when both effectiveness and cost are factored into the equation. Approximately 60 percent of eligible Americans have now undergone some form of screening for colorectal cancer. This number is up at least 10 percent in the last decade, due to increased efforts to educate the public about the im- portance of colorectal cancer screening and improved methods of sedation that have increased patient compliance with screening recommendations. Q: Do you think that the Gi physician workforce will also in- crease? Colleen M. Schmitt, MD, President-Elect of the American Society for Gas- trointestinal Endoscopy, Galen Medical Group, Chattanooga, Tenn.: A number of factors contribute to the increased demand for colonoscopies, such as the aging and growth of our population. However, it has been pro- jected that there will be a shortfall of GI physicians by 2020. Q: how will you adapt your practice as colonoscopy volume shifts? Are there any preemptive measures you are planning to take? Dr. Deas: We have added new physicians to our practice over the past few years. This is part of the adaptation. The ambulatory surgery center is co- located with our office so that improves our time efficiency and we also have nurse practitioners to help with seeing patients in the office, scheduling and preparing patients for colonoscopy. Some practices provide open access colonoscopy, which means that the pa- tient is not evaluated in the GI endoscopist's office before the colonoscopy. Patients are referred directly from their primary care provider for the proce- dure only, eliminating the office visit time. Q: Where do you see the biggest opportunities for gastroenter- ologists focused on colonoscopy? Dr. Deas: The most important thing we can do is work to improve the quality of the colonoscopy. That includes spending more time examining the colon and improving bowel preparation, to improve the quality of the exam. These are two main issues that the endoscopists can focus on to make the colonos- copy more effective at reducing cancer rates and interval cancers. The ASGE Institute for Training and Technology also has a lot of hands-on training options for physicians to improve their skills and to learn more ad- vanced techniques in polyp removal as well as other endoscopic techniques. Dr. Stern: Just to streamline the care, GI physicians should try and get block time at surgery centers so doing the procedure becomes more efficient. We are also recognizing genetic or familial reasons that might lead to colon cancer and as we are getting better about that, we can screen patients at a younger age. Dr. Schmitt: Within GI industry, we understand the importance of quality measures such as the adenoma detection rate. We need to make sure that all quality measures translate into value for our patients and make sure that our patients and referring physicians understand that value. When they look for an endoscopist, they should ask about those quality measures. The other area where we have opportunity is augmenting our basic skill set. We have GI physicians who want to expand their skills and the ASGE has an assessment-based certificate program to help endoscopists do that. Dr. Cohen: Once again, the core principles are efficacy and efficiency. In oth- er words, we need to do what we're doing well and at a cost that is competitive with other modalities. n Olympus Medical Systems Group, a division of global technology leader Olympus, develops solutions for healthcare professionals that help improve clinical outcomes, reduce overall costs and enhance quality of life for their patients. By enabling less invasive procedures and innovative diagnostic and therapeutic endoscopy, Olympus is transforming the future of healthcare. For more information visit Olympus at www.medical.olympusamerica.com. We need to make sure that all quality measures translate into value for our patients and make sure that our patients and referring physicians understand that value." — Dr. Colleen Schmitt

• Cover