According to the studies’ authors, many IBD patients are not being vaccinated appropriately. One thousand gastroenterologists, randomly selected from the membership of the American College of Gastroenterology, were asked to complete a 19-question electronic survey regarding suitable vaccines for the immune-competent and immunosupressed IBD patient and the barriers to recommending the vaccines. The researchers also assessed the perceived role of the gastroenterologist versus the PCP. The researchers analyzed 108 responses and found only 56 (52 percent) of the gastroenterologists took an immunization history most or all of the time. There was no significant difference between gastroenterologists with smaller practices (less than 40 IBD patients) compared with those with larger practices (greater than 40 IBD patients) in how often they asked their patients about immunization history. In contrast, more academic physicians (67.5 percent) asked their patients about immunization history most or all of the time compared to 42.4 percent of private physicians. Sixty-nine (64 percent) of the respondents thought the PCP was responsible for determining which vaccinations to administer to the IBD patient and ninety (83 percent) believed the PCP was responsible for administering the vaccine. Sixteen of the 108 surveyed gastroenterologists did not regularly recommend immunization against influenza. The most common reasons included “too busy/forgot,” “no specific reason,” and “did not know my patient needed it”. In addition, the researchers found 20 to 30 percent of gastroenterologists would erroneously recommend any of the three queried live, attenuated vaccines (MMR, herpes zoster, varicella) to their immune-suppressed IBD patient. In addition, 24 to 35 percent of gastroenterologists would incorrectly not give the three queried live, attenuated vaccinations to their immune-competent patients. Of the inactivated vaccines, knowledge regarding the HPV vaccine was particularly poor, with only 71 (66 percent) recommending the vaccine to their immune-competent patients and only 51 (47 percent) recommending the vaccine to their immune-suppressed patients).
How Gastroenterologists Can Prepare for Healthcare Reform: Q&A With Dr. Patrick Takahashi
PT: Quality reporting will be imperative for gastroenterologists going forward. Attempts to meet certain quality measures during procedural reporting will be key to my practice going forward. I am planning on going with the ICD-10 conversion, and have already instituted an office based EMR, and have already begun to measure certain measures as they pertain to gastroenterology procedural reporting. Q: There have been some predictions of patient volume increases as a result of the individual mandate. How will that impact GI practices? PT: I believe patient volumes will increase, thus potentially necessitating more office staff and overhead. To offset overall costs by the ACA I believe physician reimbursements will drop as mentioned above. This will likely drive independent/solo practitioners to a group/hospital model for gastroenterologists. Q: How can GI physicians prepare for a potential increase in patient volume, especially if many of these patients are on high deductible plans? PT: High deductible plans may dissuade some patients from getting screening procedures done, as there is a thought that patients may see a potential increase in co-payments required for therapeutic procedures, such as when a polyp is removed. Q: Are there any new payment models, such as ACOs, bundled payments, that could be beneficial for GI physicians/groups to explore in the future? PT: Bundled payments may serve as a middle-ground for gastroenterologists trying to reach economic solvency. It is less likely to encourage unnecessary care, and will require coordination between providers to maximize payment. Practices will need to be efficient, as payments will be relatively fixed.