June 7, 2023

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THIS WEEK'S ARTICLES

What GI Centers Can Learn from Ryan Reynolds’ Live Colonoscopy

UHC Backs Off From Prior Authorization for GI Procedures

Addressing the Colonoscopy Boom with Technology - Sponsored Content

Efficiency Is Key for GI Surgery Planning

Break Down Colonoscopy Transportation Barriers

 

What GI Centers Can Learn from Ryan Reynolds’ Live Colonoscopy

Viral video was viewed 16 million times and bolstered screenings by 36%.

ReynoldsSTAR POWER Actors Ryan Reynolds and Rob McElhenney put their influence to good use in order to raise public awareness of the vital importance of colonoscopies.

When Ryan Reynolds, star of the popular Deadpool movies and perennial rom-com leading man, agreed to have his first colonoscopy filmed for public release, it wasn’t a zany social media stunt. It was to send a sincere message about the importance of these screenings.

At 46 years old, Mr. Reynolds is in the age group now recommended to get initial colorectal screenings. After losing a bet with friend and fellow Wrexham AFC co-owner Rob McElhenney of It’s Always Sunny in Philadelphia fame, Mr. Reynolds agreed to a “public” colonoscopy, and Mr. McElhenney, 45, magnanimously agreed to join him to raise awareness about the lifesaving capabilities of regular screenings. The actors’ procedures were effective. Mr. Reynolds’ doctor found and removed a potentially precancerous polyp, while Mr. McElhenney had three polyps removed.

Mr. Reynolds’ creative agency Maximum Effort teamed with the Colorectal Cancer Alliance’s LEAD FROM BEHIND initiative to create a sleek, humorous and well-produced video featuring interviews with the celebrities along with footage of their colonoscopies. The video was viewed 16 million times, but more impressive were its follow-on effects. The Colorectal Cancer Alliance reported that online booking platform Zocdoc reported a 36% increase in daily colonoscopy bookings after the launch, social media posts talking about #colonoscopy increased by 244%, and Google searches for “colonoscopy” and “colon cancer” rose by 129% and 113%, respectively.

Your ASC may not have the pull and resources of Hollywood stars and the Colorectal Cancer Alliance when it comes to marketing colonoscopies to prospective patients, but this project’s effectiveness reinforces how a little creativity can go a long way. Case in point: Robert Fusco, MD, gastroenterologist and regular colonoscopy patient, who sends hilarious holiday greeting cards to around 25,000 potential patients each year to encourage them to get their screenings. He says his efforts garner attention — and a lot of visits.

UHC Backs Off From Prior Authorization for GI Procedures

Its replacement, however, could prove just as controversial.

ColonoscopyLIVES IN THE BALANCE GI physicians and associations warn that UnitedHealthcare’s new requirements could limit patient access to colonoscopies.

The American Gastroenterological Association (AGA) has announced that UnitedHealthcare (UHC), the country’s largest commercial health insurer, has backed down from implementing its controversial prior authorization policy. The aborted policy, which was slated to launch on June 1 and drew heated protest from AGA and many other parties in the larger GI community, would have required prior authorizations for colonoscopies and other endoscopic procedures.

However, gastroenterologists and GI centers are not out of the woods, as UHC replaced its planned prior authorization policy with something AGA describes as “nebulous”: the Gastroenterology Endoscopy Advance Notification program. According to reporting from Axios, this program requires clinicians to collect and submit patient data to UHC before performing a procedure.

“This program requires you to provide even more data on top of the current burdensome paperwork requirements,” writes AGA on its website. “It is a temporary patch. Patients will not be denied care immediately, but the downstream effects of the program could be as bad or worse for patient access. This misguided program involves a poorly defined and complicated administrative process that will ultimately impact millions of Americans who require colonoscopies or endoscopies and exacerbate administrative burdens.”

Adds AGA President Barbara H. Jung, MD, AGAF, “UHC’s slap-dash approach to rolling out a policy that will ultimately control patient access to critical, often lifesaving, medical procedures flies in the face of common sense and responsible medical practice. It also indicates that UHC does not currently have data that shows any significant overutilization of critical endoscopy and colonoscopy procedures that would ostensibly justify this program or prior authorization.”

According to Axios, UHC claims its desire for more information up front is to prevent procedures such as colonoscopies being performed unnecessarily according to clinical guidelines. AGA, many physicians and other GI-focused associations respond that this problem does not actually exist, and that in fact too few of these potentially lifesaving procedures are being performed. The publication also reports that providers who wish to qualify for UHC’s upcoming gold card program, which will allow physicians to bypass the prior authorization process after six months if they have a high percentage of approvals, are required to participate in the Advance Notification program.

“AGA is in this battle for the long haul, and we’re prepared to continue fighting for you and your patients,” writes AGA to its members. “This is not the end of the road.”

 

Addressing the Colonoscopy Boom with Technology
Sponsored Content

Learn how your GI facility can navigate the current colonoscopy boom

StrykerPhoto by Maestro
A nurse manually searches through a canister of GI waste, trying to find a lost polyp.

Colonoscopy and colorectal cancer screening procedures are on the rise in facilities across the country. With the U.S. Preventive Services Task Force lowering the recommended initial screening age from 50 to 45, and patients rescheduling colonoscopies they postponed at the height of the pandemic, healthcare professionals in the GI space are busy.1

There are five procedure rooms where Connie Hall, RN, a certified gastroenterology nurse, works.2 Lately, 500 to 600 colonoscopies per month are performed with at least 1,000 patients waiting to be scheduled. “We’re on a trajectory to break any record we would have thought about setting,” says Hall.

What’s made a difference for Hall in efficiency and staff safety was switching from using canisters to a constantly closed waste management system. Previously, canisters had to be changed during a procedure – occasionally two to three times – and a lost polyp** meant manually searching through the GI waste.

“It was labor intensive to change out those canisters. The way you had to go through them to find a missing polyp, now that’s a day you don’t want to repeat very often,” Hall recalls. When Hall was on the design team at her new facility, purchasing Stryker’s Neptune Waste Management System was non-negotiable.

The Neptune System helps protect staff from biohazardous fluid exposure and streamlines the colonoscopy process because it reduces the need to empty canisters during a procedure. Hall said a recent nationwide shortage of canister liners was also a challenge for some facilities. Having a constantly closed waste management system can help combat that issue because GI waste is disposed through a hands-free docking station.

While upgrading a waste management system is a monetary investment, it's also an investment in safety for everyone in the room. Hall encourages pulling the safety card and getting infection control and employee health team members on board.

“It’s only going to take one splash in the face or contamination of a staff member to put everyone through the cleanup of biohazards, potential blood work and treatment for those affected,” Hall concludes. “Safety is a bigger commitment than it’s ever been in healthcare.”

Is your facility equipped to address the current colonoscopy boom? Stryker’s Neptune S Waste Management System was specifically designed for the GI space. Join us on our Journey to Zero* splashes and spills at safeor.com

Notes:
*Zero splash and spills, zero airborne contaminants, zero smoke, zero retained surgical sponges, zero blind spots, zero trips and falls, zero drug diversion, zero maternal harm, zero lost polyps, zero exposure, and zero doubt messages are not guarantees and are aspirational in nature.

**Polyps 2 mm or larger.

References:
1. Shaukat A, Church T. Colorectal cancer screening in the USA in the wake of COVID-19. Lancet Gastroenterol Hepatol. 2020 Aug;5(8):726-727. doi: 10.1016/S2468-1253(20)30191-6. Epub 2020 Jun 19. PMID: 32569576; PMCID: PMC7304951.

2. This is a paid interview with a Stryker nurse consultant, conducted March 22, 2023, on behalf of Stryker.

 

Efficiency Is Key for GI Surgery Planning

Data-driven analysis and initiatives can make your center’s procedural machine purr profitably.

There are many factors to consider when running a gastroenterology (GI) line: patient safety, endoscope reprocessing, supply management and infection prevention among them. But perhaps the most important factor that determines whether your GI center is profitable and successful is its efficiency.

Klaus Mergener, MD, PhD, MBA, MASGE, immediate past president of the American Society for Gastrointestinal Endoscopy and affiliate professor of medicine at the University of Washington in Seattle, describes outpatient GI care as a high fixed cost/low variable cost business once all your capital equipment has been purchased. As such, volume is key and marginal profits are high.

To maintain a full schedule, Dr. Mergener suggests calling patients the day before their scheduled procedures to not only remind them of their appointments, but also to confirm if they will be there on time. Patients also should be suitably educated on how to prep for their visits; he suggests providing clear printed or digital instructions on how to properly take bowel preps before colonoscopies to prevent aborted exams and, thus, idle procedure rooms.

With those basics out of the way, data analysis is your friend when it comes to deriving the most profit you can each day. Gastroenterologist Lukejohn Day, MD, FASGE, chief medical officer at the Zuckerberg San Francisco General Hospital and Trauma Center and professor of medicine at the University of California, San Francisco, says high-volume GI centers succeed when the entire team is committed to improving efficiency, and that leaders should support that effort by encouraging data-driven actions. “Look at what metrics have been published and linked to improving efficiencies, and then make sure to choose metrics you can validate, track, monitor and share,” he says.

Dr. Day suggests analyzing three data points in particular:

Turnover times. These can provide an accurate measure of efficiency across multiple phases of patient care, according to Dr. Day, who has used room turnover times to identify quality improvement opportunities, such as having staff communicate through a digital tracking board that tells them when procedures begin and end. “It provides a clear visual cue to let staff know key procedural steps, so they can plan ahead accordingly in preparation to turn over rooms and get patients ready for the next case,” he says.

Duration of care. Regularly monitor how much time your patients spend at your facility. Dr. Day says recording and tracking patients’ door-to-door delta will provide a clear indication of how well your efforts to streamline processes are working. Patients will benefit as well. “Time is valuable for patients,” he says. “You increase their satisfaction and operational efficiencies by limiting how long they spend in your facility.”

On-time starts. Track this metric to gain better insight on when and why delays occur each day and how they impact your schedule. If patients are late or unprepared, revisit your pre-procedure instructions to make them clearer or easier to digest. “Identify two to three key pieces of information to share with patients prior to their procedures to help reduce delays and no-shows,” suggests Dr. Day.

One thing is certain: every lost minute in your procedure rooms costs your center money. Armed with the right data, you can fine-tune your operations not only to maximize profitability, but also patient and staff satisfaction. After all, their time is just as valuable as yours.

 

Break Down Colonoscopy Transportation Barriers

A rideshare pilot program in Seattle shows the power of making it easier for some patients to get to your facility.

Availability of transportation to your GI center often determines whether or not a patient receives a needed colonoscopy. A new, first-of-its-kind rideshare study co-led by Seattle’s UW Medicine and Fred Hutchinson Cancer Center finds that, if provided a way to get home from a colonoscopy after sedation, many patients will seek out this potentially lifesaving procedure that they would otherwise put off.

The study, recently presented at the Digestive Disease Week conference in Chicago and slated for publication in a forthcoming issue of the journal Gastroenterology, shows just how powerful the simple act of providing a ride for many patients’ health.

“Lack of patient transportation or a chaperone are frequently cited barriers to colorectal cancer screening,” the report notes, “leading to missed or delayed colonoscopies for initial screening or follow-up of abnormal non-invasive tests.”

The details of establishing the rideshare pilot program were published in January in the journal Frontiers in Health Services. Recruitment of patients for the study is ongoing. The 22 patients recruited to date say they typically traveled by public transportation or on foot to attend appointments at Harborview Medical Center in Seattle. All but one reported a positive experience with the rideshare program, and even that one patient said they would use rideshare again or recommend it to a friend who needed a colonoscopy, according to their survey response.

“We found that transportation costs were very modest, generally about $20 to $25 dollars per ride, so we are also interested in exploring analyses that would encourage insurance companies to cover this service for patients who receive procedural sedation in the future,” says Rachel Issaka, MD, MAS, who directs the UW Medicine/Fred Hutch Population Health Colorectal Cancer Screening Program and is an assistant professor of medicine, Division of Gastroenterology, at the University of Washington School of Medicine.

“Colon cancer is one of the most preventable cancers, and one in three people who are due for screening have not completed it,” she says. “Improving screening and follow-up of non-invasive tests will help us find cancer earlier, when it’s easier to treat. Our study shows that there are practical solutions to these challenges, and they are necessary for those who experience the most disparities.”

UW Medicine posted a video about the program, which you can view here. OSM

 

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