Don't Count on Colonoscopies

In fact, endoscopic treatments are where the real growth lies for gastroenterologists, who could expand beyond their traditional pre- and postintervention roles and actually offer endoscopic procedures for dealing with weight issues.

There are currently more than 10 different devices and procedures being researched or introduced that would allow physicians (in many cases gastroenterologists) to treat patients endoscopically, by either shrinking the stomach, controlling hunger, or otherwise affecting weight loss, says Joel Brill, MD, chair of the Practice Management and Economics Committee for the American Gastroenterological Association (AGA).

"If a gastroenterology practice isn't set up to treat and manage these patients preoperatively and postoperatively, they need to start asking what they need to do to prepare," he says.

Service Line Success Key No. 4: Focus on physician recruitment
In some markets, joint ventures and other formalized partnerships may not be that feasible, and many of the stronger alignment tactics available for other service lines—physician employment and integration—are harder to pull off in gastroenterology. But even in a tough market, hospitals and gastroenterologists can develop relationships by partnering on physician recruitment.

Like many other specialties, gastroenterology is facing a potential physician shortage—a study by The Lewin Group projects a shortfall of about 1,000 gastroenterologists by 2020, and as many as 1,500 if colorectal cancer screening rates are increased by 10%.

It may not seem as strategically elaborate as other partnership approaches, but its importance shouldn't be underestimated, says Mitch Weinberg, MD, PhD, vice president of medical affairs for Evergreen Hospital and Medical Center, a 227-staffed-bed hospital in Kirkland, WA.

"Physician recruitment and retention is going to be a dominant opportunity that hospitals can help with," he says. "As hospitals own their regions' physician needs assessment, they can legally help recruit new GI doctors and help assist with succession planning."

Elyas Bakhtiari is senior editor for service lines for HealthLeaders Media. He may be contacted at ebakhtiari@healthleadersmedia.com.

Gastroenterologists won what may have been the first of many upcoming turf battles earlier this year when CMS announced that Medicare would not pay for CT colono-graphies—commonly known as virtual colonoscopies.

Some GI physicians were concerned that the less invasive alternative to colorectal cancer screenings—performed by radiologists—would cut into the number of colonoscopies performed by gastroenterologists. Patients, after all, typically prefer a scan to sedation and a probe. But the long-term effect isn't easy to gauge.

Only about half of Americans over 50 get the recommended colonoscopy screening every 10 years, and if a virtual alternative increased the number of screenings, it could help gastroenterology practices. When a polyp is detected virtually, the patient then must follow up with a GI specialist for an intervention, and better detection rates could lead to more referrals.

For now, CMS concluded there wasn't enough evidence that the noninvasive alternative—which can be performed by radiologists—screens for cancer as effectively as a colonoscopy.

But with some private insurers already paying for CT colonography and other detection methods in the pipeline, many gastroenterologists are revamping their practices for what may be an inevitable change.

—Elyas Bakhtiari

Quite a few technologies are currently being researched that could shake up the gastroenterology service line in the next few years. Here are a few to keep an eye on:

COLORECTAL CANCER SCREENING

• Self-propelling colonoscope. Propelled by balloons or sticky films and used for diagnosis only.
• Colon retroscope. Provides retrograde view of the colon for more accurate screenings.
• Fecal DNA analysis. A noninvasive method to detect colorectal cancer.
• CT colonography. Virtual colonoscopies; are not currently reimbursed by Medicare.
• Capsule colonoscopy. Wireless capsule swallowed by patient to detect polyps.
• Personalized medicine. Recognizes specific gene expression patterns that may help predict cancer likelihood.

OBESITY AND WEIGHT LOSS

• Gastric luminal reduction. Method of endoscopically reducing the size of the stomach.
• Duodenal bypass. Limits food absorption and the amount that can by eaten by decreasing stomach size and bypassing a portion of the small intestine.
• Stoma reduction. Minimally invasive approach to reducing stomach size.
• Vagal nerve disruption. Disrupts or disables the nerve that sends signals hunger signals to the brain.
• Gastric pacing. Implant similar to a heart pacemaker that uses electronic pulses to create "full" feeling.