Two GIs on the biggest threats to gastroenterology

Misunderstandings of Cologuard and shifts in reimbursement are some concerns gastroenterologists have for the field. Two GIs told Becker's ASC Review what they feel are the biggest threats to gastroenterology.

Note: Responses were lightly edited for style.

Brian Dooreck, MD. Gastroenterologist at Memorial Hospital Pembroke (Pembroke Pines, Fla.): I see one of the greatest threats to gastroenterology is through a very well-calculated and well-funded marketing campaign and a great degree of misinterpretation of what Cologuard actually "detects." What is the true role in colorectal cancer "prevention" versus its role in colon cancer "detection"?

What I recommend to myself and my family is to prevent colorectal cancer, not detect it.

Joe Feuerstein, MD. Gastroenterologist at Beth Israel Deaconess Medical Center (Boston): I think in many ways the biggest threats to GI are both changes in reimbursements and evolving with medical advances.

On a nearly yearly basis, gastroenterologists need to deal with the concerns of reduced reimbursements for the same work. While this may provide short-term cost savings for insurers, it shifts an increasing burden on practitioners to increase their volume to maintain stable revenue. Ideally this process should be more sustainable and changing with inflation as opposed to a yearly debate on whether or not reimbursements should be decreased.

Another concerning threat is the need to evolve with changes to clinical practice. Telemedicine is something that practices need to adopt, as patients may prefer the ability to forgo traveling into a clinic/hospital setting. Similarly, with the increasing options for colon cancer screening, gastroenterologists need to embrace these changes and develop pathways for which they can provide patients with shared decision-making about these tests and utilize noninvasive tests when appropriate and recommend for colonoscopy when appropriate.

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