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Becker’s Healthcare Podcast
Dr. Benjamin Levy, Gastroenterologist and Clinical Associate of Medicine, University of Chicago Medicine
00:16:43
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- [00:00]
A
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- [00:36]
B
Is Gracelyn Keller with the Becker's Healthcare Podcast and we're recording live at the 31st Annual Business and Operations of ASCS. I'm currently joined by Dr. Benjamin Levy, who is a gastroenterologist and a Clinical Associate of Medicine at the University of Chicago. Thanks for being here. Let's have you kick us off by sharing a little bit more about yourself and your work in the ASC space.
- [00:56]
C
Well, thanks for having me. I'm always excited to come to this conference and learn from my colleagues from around the country and brainstorm about trends and how to just practice medicine better and more efficiently. I am a gastroenterologist at the University of Chicago and I have been involved with the they have ASC called Ingalls Same Day Surgery and I scope there on Fridays and it's been a really amazing experience to help try to make things more efficient and to improve the delivery of healthcare to an even higher level. It's always amazing. At the University of Chicago our system is so well organized, but over the past couple years I've been thinking a lot about trends in GI and I'm excited to talk with you about that today.
- [01:52]
B
Awesome. Well, thanks for being here and let's start our conversation with the ASC market because in the US it's projected to reach $60.8 billion by 2030 and continues to experience strong year over year growth. So from your perspective, what is the most significant trend and market forces driving this expansion and how should ASC leaders be preparing today?
- [02:13]
C
Well, I think there are several things going on. The most exciting thing is that we recently changed the recommended screening age to begin screening colonoscopies based on age and we lowered the age from 50 to 49. Now there are 19 million new Americans that need to be scoped all of a sudden between those ages of 45 and 49 and because of that we're seeing a huge growth in the number of colonoscopies that we're so you add that to the mix of the patients. We're already screening of 50 and older, and there's a huge demand. The advantage of ASCs over performing colonoscopies in a hospital is that many times, not all the time, but many times, we're able to improve the efficiency, the turnaround times ASCs are able, especially if you're building out a new ASC, you're able to think about how to really work on the turnaround time, try to get anesthesia to be able to see the patients really quickly. And while we're writing the notes, have the anesthesiologist working on the next patient. And there are many ways that we're able to get ASC super efficient. And also the use of propofol has allowed us to do more procedures in the day because of the turnaround times, easier sedation, letting the gastroenterologist focus on patient care. So it's super exciting. The reason that we reduced the age from 50 to 49 is that the American Cancer Society first noticed a blip, an increase in the number of early onset of colorectal cancer cases, especially around the age of 49. So the thought was, if we begin screening age 45, we can try to remove the polypus before they turn into a cancer. So I think this is the biggest opportunity, at least in GI for our growth. And, you know, our job is to make sure that we are able to fully schedule at ASCs and to take advantage of the opportunity when a provider goes there, to try to do as many procedures as we can and to try to minimize any patient cancellations, to try to make the patient experience really, really awesome. And a of that has to focus on the care that we do before the patient gets there, make sure that the instructions are super clear, make sure there's really good communication between the ASC and the patient and anesthesia anesthesiology team and the patient. But this is a really exciting time. At the same time, you know, we're always fearful about any kind of reduction in reimbursement for our procedures. So, you know, fortunately, we have our societies that are trying to advocate for patients and make sure that our insurance covers this really important, great care that we're providing to prevent colon cancer. And I'm, I'm involved with American College of Gastrology, and there are a lot of gastroenterologists, you know, who are involved with our national organization. So this is a really, really exciting time as we just try to improve and Prevent colon cancer 100%.
- [05:46]
B
So shifting gears slightly from AI and robotic surgeries to advanced EHR systems. Technology remains both a make or break factor and a critical driver of ASC operations at scale. So how do you see deeper tech integration shaping the way ASCs deliver care and manage their business over the next few years?
- [06:03]
C
So this is a super exciting time for the integration of AI into our workspace. One of the most exciting things that has come down recently is the event of computer assisted detection of colon polyps. And there are several different companies that are creating this software. The first company that really got involved in GI in this particular space was GI Genius. And basically it puts a little box around a potential colon polyp and it's up to the gastroenterologist to decide whether it's actual polyp or not and to remove it. But I like to think of it as an exercise of eyes in the room. So you have the gastronomist looking at the screen looking for polyps. You should be having your tech and nurse at the same time, especially your tech trying to look for polyps. But this is like a third set of eyes in the room. And I kind of think of it as Top Gun, you know, in the flying scenes when you see like a box over the Pl their target that they're trying to, to look for. And this is the same kind of thing. And the technology is probably going to get even better. But this is especially helpful for patients who have polyps that are harder to see. Sometimes they're flat lesions, sometimes if there's a residual stool in the colon, is a really great opportunity to be able to highlight these polyps. And I kind of also think of this as like the iPhone, the first version of the iPhone. So it's a groundbreaking technology, revolutionary. But the technology is going to keep getting better as we feed it more information. And especially since there's some competition in this environment, I feel like the technology is going to get better and better. Another amazing AI created software that we at the University of Chicago have been using for the past year is a bridge, which is basically ambient dictation. So they're now apps and they're a bunch of different companies that have created these apps for doctors to use. And basically it uses AI technology to write notes as a template. We still go back and edit the notes after we've seen the patient. But basically we use this software to be able to facilitate better conversations with the patient. So it will know whose voice is the patient, whose voice is the patient advocate, if they have a family member there and who's the physician, if there's nursing interaction it's able to tease all that out. Now, there's several amazing opportunities when we use the software. First of all, it just allows for more natural conversation between the physician and the patient. Instead of having our heads buried in the computer, we're able to talk with them, have a more natural conversation. It also picks up our little small details. If we're typing, I'm super fast typer. But, you know, when we're listening to patients, we're looking for big things that are like, super important. But occasionally, like a patient will put, you know, mention a date and it'll pick it up more easily. So it kind of like lowers our stress level when we're seeing patients because we know that the software is going to pick up all these dates and we don't have to worry about, like typing them out. If there's ever any question, we can also go back and look at the type version of what the patient said. Word, word for word. And the software kind of summarizes the patient conversation and organizes it in a really incredible way. Me, like a lot of gastroenterologists and physicians naturally, were a little bit hesitant to use the software initially because we have like, you know, we've been trained to write really good notes. But it is amazing what this software is able to do. One of my favorite things is that it summarizes everything that we discuss and helps us with the patient discharge summary with a list of instructions for the patient to do, any important phone numbers for them to reach if we mentioned it during the patient visit, separately from that. So that's frequently used in clinic. But it's really helpful. And the reason I mentioned it's an ASC space is that I think that it better prepares patients for colonoscopies because it picks up on all the information. If we tell patients to avoid eating fruits, vegetables and salads for four days before the procedure, it'll pick that up and put that in so you don't have to just rely on the patient reading the patient handout, which is important that we give to patients to prepare. But they can actually see it in their note. They can see in their patient discharge summary. In addition to that super exciting invention is now there are companies that are developing software where we can, during the middle of a colonoscopy procedure, an EGD procedure, we can actually dictate things that will show up in the report. There's a company called Endosoft that has this Argus software and, you know, it's going to speed up the documentation for our procedures at both ASCs and in the hospital. And I look forward to, you know, in the future having this technology rolled out more on a national level, because I think it's going to improve our day. It's going to make things a lot more accurate so we don't have to recall everything after the procedure. It's in real time. You can describe things, and it's just, it is going to create a situation where you have much more efficient care and accurate information being documented in the note. In real time.
- [11:42]
B
Absolutely. And with 60% of health systems considering ASC joint ventures and many ASCs already partnering with systems in their communities, what opportunities do you see for collaboration, whether with other providers or vendors, to strengthen patient care and operational efficiency?
- [11:58]
C
Well, I will use our system as an example. I think that anytime you have collaboration, it's a really great idea because you can pool knowledge and resources and hopefully make things more efficient and just better for patients overall. So at the ASC that I work at, on Fridays, you know, it's a lot of physicians who are doing procedures from the University of Chicago, but there are also some private practice physicians as well that use the center. And, you know, it's. It's a great opportunity to have the university have another space where you can do procedures, sometimes in a more efficient manner. But it also allows universities to be able to expand quickly into other demographics and other geographic areas in whatever city you live in. So, for instance, you know, my. My main practice is in Hyde park at the University of Chicago. And I love, I love going down there, but it's super cool to go out to the suburbs and to see a totally different patient population. And it allows the ASCs to really be able to maximize their efficiency because you have a pool of doctors that are trying to do more and more and more procedures, especially as we expand. And, you know, any kind of university that's in the same kind of position, you know, nationally, you know, you're able to, to partner with ASCs and to try to increase the volume of the number of procedures and also take care of patients in other geographic areas and outlying areas. Or maybe the other, the other huge advantage is that when we find a cancer or we find some unusual pathology, it also drives patient care to the main campus. And so it allows our colorectal surgeons and oncologists to have even more patients to be able to take care of, because we're identifying cancers and, you know, we're identifying things for our advanced endoscopy team when we need their help. And so it's able to increase the number of kind of specialized procedures that are done on our main campus. And the ASCs in turn, really like it because it really makes sure that their ASCs are full and we're doing procedures every day of the week and we're maximizing the use of all their OR rooms. So it's very beneficial for all parties. And, you know, I encourage ASCs to look at these partnerships and I also encourage the academic centers to try to want to partner with them because it just provides better care and hopefully expedites the time from clinic seeing a patient, whether it's a primary care doctor ordering direct colonoscopy or whether they see us in clinic as a gastroenterologist in clinic, it will expedite the time from clinic to actually doing their procedure?
- [15:00]
B
Absolutely. Well, Dr. Levy, is there anything we didn't touch on today or any final thoughts you'd like to share as we wrap up our conversation?
- [15:07]
C
Yeah. So I think this is an exciting opportunity for growth of ASCs and growth in gastroenterology in general. The other thing that I wanted to point out this morning is that, you know, in order to make things really efficient and to make sure that the patient really understands what's going on, I think it's important for us to slow down in clinic and make sure that we spend an adequate amount of time with patients, preparing them from their prep. Have the nurses also work with the patient in clinic whenever possible. Have really great handouts that are easy to understand on all reading levels whenever possible, to try to have handouts in languages that you're frequently encounter in your patient population. And in addition to that super helpful thing that we have incorporated at the University of Chicago is to have a nursing navigator, especially for patients who have a history of a poor prep. I think that the patients are greatly benefiting from this service. And we, we currently work with three amazing nursing navigators who have all worked in the GI space. They have a lot of experience and we're getting a lot better patient outcomes in terms of better preps because of their assistance and a lot fewer cancellations. So I would encourage everyone to use Nursing Navigators as much as possible. They're a great resource.
- [16:30]
B
Wonderful. Well, thank you so much for joining me today on the Becker's Healthcare Podcast and sharing these thoughts and insights. Again, we are recording live at the 31st annual business and operations of ASCS.