Gastroenterology Associates of New Jersey needed to optimize care and capacity: reimbursement becomes stricter every year as patient demand grows. The practice aims to improve access to necessary in-person care and procedures while offering patients complementary, proven interventions ideally suited to telemedicine.
THE PROBLEM
“Gastroenterology is a complex specialty,” says Dr. George N. Pavlou, gastroenterologist and president and CEO of Gastroenterology Associates of New Jersey. “We diagnose and treat dozens of diseases of the digestive tract, liver and pancreas, and also provide essential screening procedures for the early detection of colorectal cancer.
“Like many specialties, GI is facing a huge backlog preventive care and delayed screenings, as well as treating patients to achieve and maintain remission,” he continued. “Our eight advanced practice providers see patients all day long; Our 42 gastroenterologists care for patients throughout the day and after hours.”
Meanwhile, the practice is processing a daily stream of patient messages, insurance and prior authorization requests, and coordinating appointments and follow-ups.
“A large percentage of patients come to us with functional gastrointestinal disorders (FGIDs), also known as gut-brain interaction disorders (DGBIs),” Pavlou explains. “These are cyclical problems caused by atypical functioning of the digestive tract and not by a structural problem or infection. They cause a wide range of symptoms that can be disabling and have a major impact on all aspects of a patient’s life and well-being.
“Treatment of these patients requires a tailored management plan and frequent contact to guide patients through dietary and behavioral changes,” he said. “The reality is that few GI practices, even an advanced, high-quality practice like ours, are structured or staffed to provide high-quality dietary and behavioral interventions.”
Most, if not all, patients with chronic gastrointestinal disease benefit from these conservative but proven interventions, he added.
“Regular contact with a registered dietitian or a GI psychologist is easier deliver via telehealth, to the great convenience of the patient,” Pavlou noted. “The interplay between the brain and the gut is something that needs to be unpacked through dialogue, education and response – to help patients understand and manage the effects of food, stress, anxiety, depression and sleep on their gastrointestinal health This can make a huge difference between flare-up and remission of any chronic gastrointestinal condition.
“Patients come to us for answers, and especially for patients dealing with DGBIs and functional overlap for organic disorders, we need to have more to offer them – especially with complicated diets and behavioral health interventions that are almost impossible to devise without specialist physicians, ” he said.
PROPOSAL
“A virtual multidisciplinary GI care partnership is an extension of our practice – uniquely suited to deliver the interventions that will improve the lives and outcomes of our patients,” said Pavlou. “Hybrid virtual care is also well suited to support iteration and adherence to care plans, answer patient questions as they arise, and coordinate care with providers outside our practice.
“Our goal is to surround our patients with a multidisciplinary care team as they strive for true control of their symptoms,” he continued. “Symptom management can prevent disease escalation, and this model has data to support a reduction in avoidable surgeries use of emergency care. This not only provides a significant benefit to the patient, but also benefits the larger healthcare system and improves the experience for our gastroenterologists.”
Pavlou said staff know their health care system can be difficult to navigate, so they also try to alleviate the feeling that patients have to sacrifice their own care.
“Finally, we also know that an activated, empowered patient is more likely to keep up with preventive screening procedures, creating a virtuous patient referral pipeline to our practice,” he said. “Colorectal and esophageal cancers are treatable with early detection.”
MARKETPLACE
There are many providers of telemedicine technology and services in the healthcare IT market today. Healthcare IT news published a special report highlighting many of these suppliers with detailed descriptions of their products. Click here to read the special report.
MEETING THE CHALLENGE
Dietary interventions are especially suited to digital health, where people can check in more often with a registered dietitian and share analytics on food and symptom tracking, which is very cumbersome to do in person, Pavlou explains.
“Anyone who has tried to change their diet knows how difficult it can be,” he said. “And for people with digestive problems, diets can be incredibly restrictive and difficult to implement and maintain. A common dietary intervention used in gastroenterology is the low FODMAP diet, which eliminates: and then reintroduces – a broad category of foods that are likely to cause gastrointestinal symptoms and can be a difficult diet in itself.
“Working with a registered dietitian can help patients quickly identify triggers and switch to different therapies if this specific diet isn’t working,” he noted.
Gastroenterology Associates of New Jersey also sees patients with significant anxiety related to their gastrointestinal conditions – which of course worsens symptoms.
“Working with psychologists and therapists specially trained in gastrointestinal disorders and gut-brain interventions is critical, but access to these specialists on site is rare – and usually comes at a high out-of-pocket cost for patients,” said Pavlou .
“Providing the best of virtual and in-person care to patients is supported by two-way information exchange,” he continued. “Collaboratively managed patient care is achieved through the exchange of EHR and health information, as well as through more traditional means of collaboration, such as conversations between healthcare providers, where discussion is warranted. This hybrid model has a purpose-built commitment to data sharing and integration. “
RESULTS
The endpoints that the practice measures are aspects that have already been proven: access, patient outcomes and improved care, Pavlou explained.
“In addition to scaling access to care, hybrid virtual care will deliver greater value to our medical group to optimize practice capacity and support operational excellence by focusing on what happens between visits,” he said. “In gastroenterology, where access and cost have become the focus of health plans, hybrid collaboration enables multidisciplinary care, standardized outcome measurement and an exemplary patient experience.
“We will measure all of these metrics and believe the impact on our patients’ lives will differentiate our practice,” he added.
ADVICE FOR OTHERS
“In these times of ever-increasing patient demand and overloaded clinical practices, I advocate that assessing and negotiating the right partnerships with digitally enabled virtual care clinics should be a core competency for the next generation of medical group leaders,” Pavlou advised. “Geography, access to subspecialties, payment models and physician culture are all factors to consider when determining the right model for hybrid partnerships.
“With proper execution, this healthcare team expansion can optimize practice capacity for necessary personalized care, improve and measure outcomes, and provide their physicians with better options for their patients,” he concluded.
Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.