Practice Mgmt Update

Practice Management Update Optimization and Collaboration

R. Fraser Stokes, MD. PSG Practice Management Task Force Chair. August 2020

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“You don’t get paid for the hour. You get paid for the value you bring to the hour.”

—Jim Rohn, American entrepreneur, @FraserStokes author, and motivational speaker he PSG is committed to helping to T optimize GI practice management. Many gastroenterologists provide a wide variety of ancillary services at their practice, including on-site endoscopy, pathology, anesthesia services, infusions, etc. Increasingly, practices are also adding a nutritionist to their team to directly collaborate with GI providers to optimize treatment success for many digestive diseases.

Examples of conditions that benefit from dietary therapy are many. Patients with celiac sprue and other gluten sensitivities are treated by going on a gluten free diet. Having a dedicated expert in this diet teach the patient and his / her family various healthy and tasty eating strategies while avoiding gluten – can be invaluable. We are seeing an increasing number of patients with various symptoms of gastroparesis, dietary changes (e.g. six small meals per day, foods that are softer, more liquid, etc). Eosinophilic esophagitis is an increasingly recognized cause of dysphagia and meat impactions. Various elimination diets can be tremendously useful to reduce esophageal eosinophilia and improve

In addition, it has become apparent in the past three to five years that many patients with irritable bowel syndrome can benefit from a low fodmap diet. Other examples of GI diseases that can benefit from dietary therapy include gastroesophageal reflux disease, cirrhosis with ascites, and lactose / fructose intolerance.

Perhaps the greatest longterm challenge facing medicine today is the obesity epidemic. Obesity often leads to the metabolic syndrome that includes the comorbidities of hypertension, diabetes, hypercholesterolemia, sleep apnea, and fatty liver disease. Fatty liver is the most common liver disorder in Western industrialized countries. We recently began doing in-office elastography to determine if NAFLD patients are developing significant fibrosis. The primary treatments for Nash are vitamin E, exercise, and weight loss. A GI based dietician can be a key resource for patients trying to lose weight. Our nutritionist offers a variety of diets to help patients lose weight, but has had great success with the Ideal Protein program. This is a low carbohydrate diet that is highly structured whereby patients meet with our dietician weekly for dietary advice / coaching and the purchase of medical foods. The program is dedicated to both short term weight loss and long-term maintenance of the new healthy weight.

which often respond to specific that our gastroenterologists and physician assistants have limited time to review specific diet instructions, answer nutrition questions, review patient meal diaries, and provide food related psychological counseling. A dedicated nutritionist in your practice can do a most thorough job handling these important issues.

There are a few hurdles to consider when hiring a dietician. One is financial, as some insurers do not cover dietician consultation. For those patients, we require a patient to pay a modest fee for a medical nutrition consultation. Weight loss programs, such as Ideal Protein, can be somewhat profitable, helping to make the addition of a dietician more affordable. Smaller practices may want to consider hiring a GI dietician as a part-time employee to start.