Now, let's dive into our day. I would like to start with a few polling questions. So the first question is, have you noticed any recent changes in the GI practice structures? The way people are practicing and all the practices are structured. Yes. So I expected that. And we're gonna go briefly about these changes and the structure of the GI practices as well, because GI practice throughout the country has been going through waves of changes, the way they are structured. All right, so we'll go to our next question now. How would you describe your practice? Interesting. So I was expecting somewhat of a different take here, but I'm glad to see a lot of single speciality participant here. All right, it's time to go to the next question. Did you have more than usual employee turnover in your practice? Yeah, it goes exactly along the lines of the surveys we have seen recently. All right, we're gonna go ahead. Reinforcing the structure integrity in GI practice. Our goal today is to highlight some of the major challenges faced by GI practices today. Some of these challenges were there already present in one shape or the other before the pandemic. However, COVID-19 pandemic made these challenges even worse and also created its own new challenges that since has persisted. So in next 15 to 20 minutes, I'm going to give an overview of some of the issues faced these days by the GI practices. And then with our talks, we are trying to present some solutions or a guidance what to do about these issues. First of all, the financial challenges, as you can see here is a data collected last year after the COVID-19 pandemic. And almost 97% of the practices that responded to MGMA survey reported a negative impact on their finances due to the pandemic. Similarly, 55% of the practices reported that they had a decline in their revenue and about the same number of practices reported a decline in the number of the patients coming to these practices. Although some of these issues have resolved since with the aid packages offered by the government and with the improvement in the COVID-19 pandemic and so on, with the improvement in the COVID-19 pandemic and especially with the vaccination, number of patients have actually improved since then, but financial issues, some of the financial issues are still there. Similarly, there have been some other financial challenges that will be part of the issues in coming next few years and that have nothing to do with COVID-19. That includes the reimbursement changes, especially for GI practices, overall change in the reimbursement for the procedures and also the clinic visits. Some of these changes were put on hold last year due to the pandemic, but it appears that they will be implemented in next year. Actually, a few days ago, CMS released its guidance according to which the conversion factor has been changed to a lower dollar value unless Congress makes some changes, the sequestration will be implemented as well. With the MIPS, which has been in force, has increased penalties when you don't meet those quality indicators. And similarly, in the MIPS matrix, the cost is going to be a bigger factor as well. Another challenge that has been forthcoming and especially is being felt in the GI practices recently is the change in the practice landscape. It was interesting that the AMA did a survey in 2020 to look at how many physicians are working as private physicians or working on their own compared to employed physicians. And there have been a drastic increase in number of employed physicians compared to the physician that works in a physician-owned practice. And for the first time, actually more than half of the physicians who responded to the survey were employed. Similarly, even the doctors who were working in the private practices, majority of them were working in larger groups, be it single speciality or multi-speciality groups, indicating that there has been more consolidation in the practices. This picture is an interesting visualization of how the GI practices are changing. And you can see the top circles represent the traditional mode of GI practices that includes the single speciality physicians, the multi-speciality physician-owned practices, the hospital-based practices, and then the academic practices. However, there has been a mushrooming of a new type of GI practices recently that includes the professional service agreements, then there are employed physician in a large single specialty practices, and a new kid on the block is the private equity-backed multi-state practices. These are single specialty practices that have been partially, or in some cases, completely owned by private equities. And in my opinion, this is going to be a big factor in how GI is being practiced in the United States in the next few years. Workforce burnout has been a major issue even prior to COVID-19 pandemic that was made worse by the pandemic, actually. There was a national survey done even prior to COVID-19 that showed about 35 to 45% of the clinicians were having high occupational burnout. And even among gastroenterologists, there was a significant number of physicians that were feeling this pinch or excessive work causing them to burn out. So Yerkes-Dodson curve or Yerkes-Dodson law is an interesting concept that can be found in many psychiatric discussions and books. Basically, it graphs the performance against the stress. So you can see as the stress increases, the performance also increases, but there is a point of optimal stress where you can get maximum performance. But once you increase the stress, the performance tends to decline across the plane and it goes considerably down as seen in this graph. So what COVID-19 pandemic has done, it has tipped a number of workers over that optimal stress point, resulting in significant decrease in performance where they feel exhausted and they're burned out. So this is a graph that is a little bit old from last year. When MGMA survey actually looked at healthcare workers and how many were furloughed or how many were laid off. And you can see that initially with the reduced patient inflow, decrease in revenues, there were a lot of layoffs as well as a lot of workers were actually furloughed for obvious reasons. And that started an avalanche of that stress, which I showed earlier, because initially people were stressed out because there was no work. And then it resulted in something much bigger than what it started from. And that's why I'm showing this graph, which is an older one. And then we're gonna look at some of the data available recently, what has happened to the workforce. So this is more recent data that was published in JAMA in August, 2021. And they looked at full-time employees and their emotional exhaustion and depersonalization. And you can see both of these issues were becoming more frequent. And almost every day, people were having more exhaustion emotionally. And that has obviously would result in dissatisfaction and that was more obvious. And we can project that all of this would result in people either leaving the jobs or just changing their professions altogether because they were dissatisfied, they were more exhausted. And this effect has resulted in extreme shortage of workforce overall in healthcare. Another survey that was published recently looked at the workforce in healthcare and the reason for shortages. And you can see since mid-February, 2020, there is a consistent theme that almost 20% of the workforce in healthcare decided or wanted to quit the jobs for various reasons. Then in the same survey, they looked at the reasons and you can look at the top four reasons are the COVID-19 pandemic, they wanted more money, better wages, they found some better opportunities somewhere else or they were overworked. So we are seeing the same pattern all across that with the COVID-19, there has been increased stress, increase in burnout and that resulted in number of these workers to leave the workforce from healthcare. Similarly, the inflation has resulted in increased demand for worker pay, which is available at times in different situations. Looking at all these challenges briefly, we can say that the business is not as usual. This code was quite apt in this situation that it is not necessary to change, but survival is not mandatory as well. So if we are not going to change, if we are not going to mend our ways, we won't be there anymore. So this presents us with this challenge, what to do about these issues, how to tackle these issues. New challenges require new solutions and to do that, you have to look at them in a different light. That exactly what we intend to do today by discussing these issues that are faced by GI practices and to come up with suggestions and solutions and then we can discuss them, how to implement the solutions in our practices. So what to expect today? We are going through these staffing dilemmas faced by the practices. We are going through the infrastructure issues, financial issues that the practices are facing and as well as the communication that has always been the backbone of any practice and with new emerging technologies, it has become even more important to communicate with the society, with the patients in new ways and make it more easier for them. As I mentioned earlier, that what we intend to do is to go through these issues, come up with some suggestions and solutions and what we expect you to do is answer the poll questions, share your experiences about these issues and ask questions. This can help to create a collective wealth of knowledge that can be used by all of us and we can use for the betterment of our practices and to help our patients more.

gastrointestinal practices

financial challenges

COVID-19 pandemic

workforce burnout

changing landscape