Like nearly everything else in our lives, the coronavirus pandemic upended gastroenterology.
We saw some GI practices report a 90 percent drop in endoscopy volume during the first wave of the pandemic as elective procedures like colonoscopies — the bread and butter of the average GI practice — were temporarily put on hold. This was a debilitating blow to GI practices around the country, most of which rely on colorectal cancer screening and surveillance colonoscopies for nearly 80 percent of their revenue. More importantly, reduced patient volumes meant some key staff lost their jobs and critical patient care was delayed.
Despite all of this, as we turn the corner on the pandemic, I don't believe we should just seek to return to our old practice models. The future of GI is likely to look different from pre-2020 and we should try to anticipate the necessary practice changes.
In many ways, the last few months have been a trial run for the future of our specialty. With safety precautions in place, practices have resumed endoscopies and colonoscopies at a reduced rate. There is reason to believe colonoscopy volumes may be vulnerable in the future, even if they initially return to the pre-pandemic levels after we have a vaccine. Changing demographics and new, noninvasive cancer screening alternatives mean the volume of colonoscopies may decline in the long term. Returning to our old, procedure-dependent business model is not a sustainable strategy.
Our current model is also failing patients with chronic inflammatory bowel diseases. In my more than 30 years of practice as a gastroenterologist, I developed close working relationships with my patients. Yet patients with chronic disease still showed up in the emergency room unexpectedly. This is because many patients, so accustomed to dealing with chronic disease, lost the ability to discern between normal and worsening symptoms. They didn't realize symptoms were escalating until it was too late.
I believe the future of GI depends on our ability to remotely engage patients proactively, help them track and manage symptoms at home, and intervene and coordinate care when necessary. The pandemic has offered us a unique opportunity to reevaluate, reset and test drive new models of care to diversify revenue streams and better serve our patients.
This model of care is already being tested at forward-thinking practices in New Jersey and Illinois. Most recently, we've seen remote patient engagement in action at three New Jersey-based practices — Allied Digestive Health in West Long Branch, Digestive Healthcare Center in Hillsborough, and Gastroenterology Associates of New Jersey, which has locations throughout the northern part of the state. Beginning in late 2019 and early 2020, those three practices adopted remote engagement via SonarMD, a virtual care coordination program for patients with inflammatory bowel disease (IBD).
By April 2020, more than half of eligible patients from each of the three practices enrolled in the program. By the end of November 2020, 80 percent of eligible patients have enrolled, enabling the practices to remotely track symptom severity for most of their patients with chronic conditions. The program uses patient-reported data and predictive analytics to detect declines in health. It then alerts the practice if they need to intervene and helps to coordinate care. This has enabled physicians at all three practices to connect with patients and help them get symptoms under control before their conditions escalate to an emergency.
This model works incredibly well for patients with difficult-to-manage chronic conditions, like IBD, that are often associated with higher rates of hospitalization and variation in per capita cost. In a yearlong study with Blue Cross and Blue Shield of Illinois, this style of remote patient engagement/monitoring was shown to reduce ER visits for patients with Crohn's disease by 77 percent and their associated hospital admissions by more than 50 percent, driving down annual costs for the average Crohn's patient by $6,500. A focus on remote patient engagement/monitoring and care coordination means GI patients will have better outcomes and a greater sense of wellbeing. It means they won't spend so much time in the hospital, driving down unnecessary healthcare spend. And, when GI practices partner with payers to adopt these care models in a value-based arrangement, it means physicians can get paid to keep people healthy, rather than rely on elective screenings to keep the lights on. That is the future of gastroenterology.
The pandemic has shown us just how vulnerable the traditional GI practice model is to disruption, but it's also shown us that patients are ready for virtual engagement and payers are ready to reimburse for it. I am hopeful the final months of this pandemic can serve as a catalyst for change in our specialty. This will position gastroenterology for what I believe is a stronger, more resilient future under value-based care.
Dr. Lawrence R. Kosinski practiced gastroenterology for more than 30 years and is the founder and chief medical officer of SonarMD, a care coordination and therapeutic optimization solution for chronic conditions with significant variation in cost and clinical outcomes.