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Did You Know... GI Predictions for 2021

From Becker’s GI & Colonoscopy

Several trends emerged in gastroenterology over the past year that will continue in 2021. Here, six gastroenterologists share their predictions on the future of the specialty:

Fred Askari, MD, PhD, director of the Wilson Disease Program at Ann Arbor-based Michigan Medicine: COVID-19 has accelerated the move toward virtual visits for our clinic. Virtual visits have been favorably received by many patients, particularly those who drive long distances for appointments. I anticipate virtual visits will make up at least 50 percent of office visits going forward based on patient demand.

There will be more virtual caregiving, teaching and learning for medical students, residents and fellows anticipated in 2021 and a move toward a seven-day-a-week active outpatient and hospital practice.

Novel treatments driven by advances in biotechnology will lead to clinical trials of artificial intelligence-developed nucleic acid treatments and gene therapies in 2021 for Wilson disease, as well as ongoing studies with novel copper reduction treatments.

Anil Dev, MD, gastroenterologist at New York City-based BronxCare Health System: GI is well poised to maintain strong growth in coming years. New technology and procedural armamentarium will help fuel specialty growth. However, the cost of new technology and accessories is prohibitive in early adaptation. More competitive pricing for scopes and accessories is needed to contain cost curves and retain an edge in care coordination.

Sam Giordano, MD, gastroenterologist at Camden, N.J.-based Cooper University Health Care: Many patients delayed medical care during a time when elective procedures were put on hold, and this resulted in many diagnoses that may have been made later than ideal. I look forward to getting back to helping patients in a timely-fashion.

Secondly, I look forward to the implementation of the new U.S. Multi-Society Task Force Guidelines with the recommended screening age being reduced to 45 years of age for all. This is long overdue. I personally have seen too many young persons well under 50 fall victim to advanced-stage colon cancer.

Lastly, I am looking very much forward to new endoscope technology and the implementation of AI to aid in polyp detection. As someone who takes great pride in my personal adenoma detection rate, I realize that none of us are perfect and the hope is this improved technology will take us a step closer to achieving that goal.

Steve Morris, MD, gastroenterologist at Atlanta Gastroenterology Associates: GIs will continue to expand into the outpatient setting by owning and partnering to provide [care in] an ASC setting for an increasing number of procedures. Insurers will finally resist the much more expensive alternative of doing elective cases in a hospital.

GI physicians will need to offer in-office infusion services for patient cost and convenience as more biologics and biosimilars are available for therapy. Telemedicine will be part of everyday practice as will social distancing in offices and ASCs for years to come.

GI practices that are truly forward thinking will expand to include colorectal and laparoscopic surgeons, and even GI oncology expertise to be able to fully serve all their patient’s needs as part of a risk sharing model.

Chris Shaver, MD, CEO at Birmingham (Ala.) Gastroenterology Associates: Pulling out my crystal ball, here are some projections regarding the GI landscape in 2021:

1. There will be a COVID-19 endpoint. My hope is that societal shutdowns and unbridled fear will die with the virus.

2. Progressive GI practices will value a holistic and personalized patient experience where GI care points are optimized through replete ancillary service lines.

3. Onerous healthcare regulations and downward revenue pressures will continue to consume enormous amounts of valuable practice resources.

4. Consolidation will follow my No. 2 and No. 3 point above. Independent GI practices will search for the best playbook to consolidate their market. If they do not, existing private equity backed platforms will be more than happy to call the plays.

5. There will be amplified understanding of how to effectively market our practices.

6. Recruiting five-star talent will become more important than ever.

7. Telemedicine will continue as a niche customer service line.

8. If the new colonoscopy pill preparation is effective and safe, it will reshape its market.

Larry Schiller, MD, program director of gastroenterology at Dallas-based Baylor Scott & White Health: I'm no Nostradamus, but here are a few thoughts:

1. Demand for endoscopic services will continue to rebound from pandemic-induced lows, driven by missed screenings and extension of the age range for colonoscopy screening down to age 45.

2. The number of medical residents opting for a career in GI will remain high. The number of fellowship positions may expand modestly.

3. The number of more senior GIs opting for retirement or employment by academic centers will increase as the large cohort of GIs trained in the 1970s and 1980s age.

4. Telemedicine services in GI will continue to expand and will be supplemented by app-based electronic interfaces and novel home-visiting services by mid-level providers to collect vital signs, physical examination data and conduct laboratory tests.

5. Healthcare systems will continue to expand GI services to access a large volume of procedures with generous margins. In more rural areas, regions with one hospital, one GI practice, this process is well-underway and will go on to completion.

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