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Those are the things we can focus on to be part of the solution. As for ASCs, with everything moving from expensive to less expensive settings, ASCs are more attractive than Hospital Outpatient departments. On the other side, office endoscopy centers are growing competition to ASCs as they are appealing to payers because they are even less expensive. Blair Lewis, MD, Mount Sinai Hospital, New York: We are seeing a trend of gastroenterologists using report cards to look at infection rates and intubation rates to change physician behavior. For internal medicine, similar report card information is publicly published. I think that type of arrangement will come to the world of gastroenterology, and we need to be prepared for these reports to be published. Quality reports also allow ASCs to benchmark themselves against their competitors and use that information during negotiations with third party payers. There are different quality measurements dealing with accountable care organizations as well. Many gastroenterologists are trying to figure out whether they want to be part of the ACO or externally contracted with the ACO. If they externally contract, they can show their report cards for how quickly they are able to see patients and then notify them of abnormal results, which is what the ACO is looking for. Harry Sarles, MD, President-Elect of American College of Gastroenterology, Digestive Health Associates, Rockwall, Texas: The overriding power that an ASC has is it’s the lowest cost setting for care delivery for gastroenterology procedures. There is an emphasis now at insurance companies to drive business to the ASC setting because it’s far less expensive than providing the same service at a hospital outpatient setting. Physicians are also recognizing that when you can provide the services in the ASC setting, you are looking at market forces in the best possible location. Richard Zelner, MD, Orange Coast Memorial Medical Center, Fountain Valley, Calif.: We are evolving to figure out how to improve efficiency and lower our costs while not impairing quality. There will be parameters set up monitoring the physician’s ability to provide quality care.
Unfortunately, not all physicians follow these guidelines, and a new study points to one possible reason. The study , performed by U.S.-based clinicians and published by the European Journal of Gastroenterology & Hepatology, used a large national database to identify all adults who had endoscopies and biopsies for celiac disease between 2006 and 2009. The researchers then analyzed those cases, which involved more than 92,000 people, to determine whether gastroenterologists who performed more endoscopies than the average tended to take fewer samples of the intestinal lining during each procedure. As it turned out, gastroenterologists with a higher procedure volume — in other words, who performed lots of endoscopies — did take fewer intestinal samples. Meanwhile, the study also found that gastroenterologists who worked more closely with other members of their medical specialty tended to take more samples, possibly because of peer-to-peer education. The authors note that most cases of celiac remain undiagnosed in the U.S., in part because too few physicians follow the guidelines calling for at least four samples of the intestinal lining. The moral of this story? If you’re undergoing celiac disease testing , try to choose a gastroenterologist who doesn’t perform tons of endoscopies, or one who works in concert with other gastroenterologists. And, stress during your pre-procedure visit that you expect the gastroenterologist to take at least four samples of your small intestine. Keep up with the latest in the celiac disease/gluten sensitivity world — sign up for my newsletter , connect with me on Facebook and Google+ , or follow me on Twitter – @AboutCeliac . Photo Getty Images/Rob Melnychuk
Esophageal adenocarcinoma is now the fastest growing form of cancer in the United States, but gastroenterologists at The Center for Advanced Therapeutic Endoscopy at the University of Rochester Medical Center (URMC) have been using an innovative technology to detect precancerous cells in time to prevent disease progression. The WATS3Dcomputer-assisted brush biopsy takes a wide sample of tissue from the esophagus and then analyzes it using a 3-Dimensionial computer imaging system that is based on an algorithm developed as part of the U.S. Strategic Defense Initiative missile defense program. WATS3D stands for Wide Area Transepithelial Sample. URMC Gastroenterologist Vivek Kaul, M.D. , along with Gastroenterology Fellows Danielle Marino, M.D., and Donald Tsynman, M.D., today in Orlando, Fla., presented new research examining WATS3D at Digestive Disease Week, the worlds largest gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. WATS3D computer-assisted brush biopsy takes a wide sample of tissue from the esophagus. Our study examined patients who have had previous endoscopic therapy for dysplastic Barretts esophagus, a condition that can be a precursor to esophageal cancer, said Marino. In these high-risk patients, the goal is to confirm that all precancerous tissue has been eliminated, in order to prevent recurrence of dysplasia and cancer in the long term. Precancerous changes in patients with Barretts esophagus can be difficult to detect because they are often flat and patchy in distribution. The current standard of care for screening patients involves using multiple forceps biopsies to collect samples from the esophagus, but research has shown that this method is not always accurate or adequate. The WATS3D brush biopsy is designed to overcome the limitations of forceps biopsy by collecting a tissue sample from a wider area within the esophagus, thus potentially increasing the yield during surveillance tissue sampling. In three of the 11 patients included in our study, WATS3D found residual Barretts esophagus after endoscopic therapy that the forceps biopsies had missed, said Kaul, associate professor of Medicine and chief, Division of Gastroenterology and Hepatology at URMC. Weve been waiting for a new technology to help us address this important unmet need the results seen with WATS3D indicate a promising area for further research in the field of Barretts esophagus. A sample of abnormal cells detected with WATS3D. About Digestive Disease Week Digestive Disease Week (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), this year DDW takes place May 18-21, 2013, at the Orange County Convention Center, Orlando, Fla. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. More information can be found at http://www.ddw.org. Vivek Kaul, M.D., serves on the advisory board of Endo-CDx, manufacturer of WATS3D. For Media Inquiries: