S1254 Impact of COVID-19 on a Large, Vertically Integrated Gastroenterology Community Practice

Abstract

INTRODUCTION: The COVID-19 pandemic has led to immediate, profound, and potentially permanent changes to the practice of gastroenterology. Here, we describe the progression of change in a large community practice gastroenterology clinic resulting from COVID-19. Additionally, we examine implications on staffing, requirements for personal protection equipment and the use of telemedicine. METHODS: We looked at practice data from a vertically integrated community-based gastroenterology practice of 30 physicians, and 16 non-physician providers (NPPs) based in the Puget Sound Region of the Pacific Northwest. The practice operates 9 clinics, 7 endoscopy centers and 2 ambulatory infusion centers. In 2019 collectively, the practice performed approximately 3800 endoscopic procedures, 350 infusions and 4300 clinic visits per month. We examined data in the immediate months before March 19, 2020 state mandated closure for Covid-19 and two months following. RESULTS: At the height of its impact in April, we saw an approximate decrease of 75% in RVU's, 45% in clinic visits, and 100% reduction in endoscopic procedures. Telemedicine, which previously was not utilized in our practice, evolved rapidly within less than a week to approximately 90% of clinical visits and was embraced by both physicians and patients. There was an increase in clinic visits per MD as clinical contact increased and procedure volume was reduced. With the reopening of the endoscopy centers in May, we noted a 15.25% increase in costs per procedure, secondary to utilization of PPE, increasing staffing per procedure and a reduction of the average number of cases per physician per month from 130 to 50. Infusion volumes were minimally impacted by the epidemic and stay at home orders. CONCLUSION: The COVID-19 pandemic has led to immediate and profound changes on the practice and delivery of gastroenterology care. Many of these changes will be temporary as we embrace efficiencies. However, there will be fundamental alterations to the practice of gastroenterology that will remain even after a vaccine or very effective treatment for COVID-19 has been secured such as the use of PPE, requirements for clinical space and the use of telemedicine. We anticipate PPE cost will decrease over time, with efficiency of AEC throughput, and testing/ screening requirements Future studies will be valuable to look at those trends and changes in practice patterns as this epidemic evolves.