Business is getting back to pre-pandemic levels at many GI endoscopy centers across the United States, with concerns about a surge in endoscopy cases and long waiting times for appointments as practices fully reopen proving largely unfounded so far, according to clinicians and industry experts.

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In a survey of U.K. endoscopy clinicians, conducted by the global clinical network SERMO on behalf of Fujifilm and released in March, 79% of respondents said COVID-19 has significantly increased waiting times in endoscopy, and 74% expressed the worry that there is likely to be a “ticking time bomb” of cancer patients waiting for diagnosis and treatment as a result of COVID-19.

Schedules Filling Up

But, the return to near normal volume has remained manageable for most U.S. centers with some adjustments made to catch up. “The last quarter of 2020 was very busy around the country,” said Scott Fraser, the founding partner of the consultancy Fraser Healthcare and a board member for Michigan-based Pinnacle GI Partners. “It was a combination of rebookings [of] all of the cases that were canceled during the elective surgery shutdowns, and the fact that it was year-end deductible season for health care coverage. Many ambulatory surgery centers [ASCs] did add hours, opening on Saturdays and extending weekday hours to get through backlogs of patients.”

That’s what clinicians at Austin Gastroenterology are considering, said Harish Gagneja, MD. “We have definitely seen more people who had deferred their procedures coming back now, and our schedules are filling up. I am booked up at least three to four weeks out and most of my partners’ schedules are the same, while in January and February, I was only booked a week out,” Dr. Gagneja said. “We used to have a half-hour slot between the morning and the afternoon procedures in our center, but we are now scheduling procedures during that time as well, and we are considering opening half an hour earlier in the morning and later in the afternoon, as well as on Saturdays.”

While schedules are filling up, wait times aren’t any longer than the wait for screening colonoscopies typically was before the pandemic, noted Rob Puglisi, the vice president of operations for Physicians Endoscopy GI Solutions (PE GI), which provides management for approximately 65 centers across the country. “A number of our centers had appointments booked out for weeks and weeks prior to the pandemic, and the wait we have seen so far isn’t any more dramatic than normal. I’ve seen a steady filling of our daily schedules, but it’s not like a dam burst; instead, [it’s] more of a steady, consistent flow.”

Staff Shortages Play a Role

“If any centers are feeling overwhelmed, it’s more because of a lack of staff as opposed to too many patients,” said Amiee Mingus, the vice president of clinical operations for PE GI. “COVID was tough on health care workers, so some staff elected not to continue working in the field, and many of our centers are experiencing shortages.”

Pinnacle GI Partners was the only endoscopy center in the Detroit area that continued to offer GI endoscopy procedures throughout the pandemic. “We have two units, and we closed one from the end of March through late May [2020], but kept the other open because we wanted to ensure that emergent patients were able to get care,” said Partha Nandi, MD, the president and chief medical officer. “We began reopening in May and fully reopened in June with strict COVID protocols, including COVID testing for all patients 48 hours prior to their appointments. That allowed us to get our volume back almost to normal by the end of June. When we compare our week-by-week volume now to the same periods in 2019, we’re almost always within 5%.”

Rajiv Sharma, MD, who practices at Digestive Health Associates in Terre Haute, Ind., expected a flood of patients at the end of 2020 and in early 2021, but traffic levels didn’t match those expectations. “I thought we would do something like 120% of the procedures we did in the last quarter of 2019, but it was only about 90%, and things were similar in the first quarter of 2021,” Dr. Sharma said. “I attribute a lot of that to financial distress. If people have lost their jobs and their health insurance and are dipping into savings to survive, they aren’t going to schedule an endoscopic procedure.”

Mr. Fraser observed a correlation between COVID-19 vaccine availability in an area and patients’ willingness to go in for elective procedures. “I live in Philadelphia, but I had to get my vaccination in New Jersey because the vaccine rollout in Pennsylvania has been so poorly executed,” he said. “I know that one of the big GI groups here, US Digestive, has been very aggressive in trying to keep their volume flowing, but some of their ASCs in the region have been hit pretty hard.”

Dr. Gagneja agreed. “When I talk to my returning patients, most of them say they were waiting to be vaccinated. With the vaccine, people are feeling much more secure than they were before.”

Recovery of patient volume also is related to how well a practice has adjusted to the post-pandemic world, Mr. Fraser said. “The groups that have made things process-driven for their staff and patients are the ones that are recovered,” he said. “They did a lot of early preplanning for reopening; they had stockpiles of PPE; and they had a plan and are now executing it. Groups that are struggling have either been affected by patterns in their state or locality that are out of their control, or they didn’t methodically put together a plan for reopening.”

—Gina Shaw

The sources reported no relevant financial disclosures. Dr. Gagneja is a member of the editorial board of Gastroenterology & Endoscopy News.

As endoscopy units reopen, many are dealing with an overwhelming backlog of endoscopy procedures due to last year’s monthslong shutdowns across the country. Klaus Mergener, MD, PhD, MBA, the immediate past-president of the American Society for Gastrointestinal Endoscopy, asked Vivek Kaul, MD, the Segal-Watson Professor of Medicine at the University of Rochester Medical Center, in New York, how endoscopy units can optimize their operations during this challenging recovery phase.

Dr. Mergener: How do endoscopy procedure volumes now compare with pre-pandemic levels?

Dr. Kaul: In conversations with colleagues across the country, it seems that as of May 2021, the majority of endoscopy units are back to about 80% to 90% of pre-pandemic volume. It’s important to keep objective measures that you can track and improve upon. Procedure volumes will vary depending on geographic location; local, hospital and state policy; staffing issues; and multiple local factors.

Dr. Mergener: What about office/clinic volumes and backlog (i.e., wait times for appointments in clinic)?

Dr. Kaul: Again, it’s helpful to know the metrics so that you can compare where you are now with where you were before COVID-19. Although many offices are approaching normal volumes, social distancing–restricted waiting room capacity—limiting in-person visits—remains a challenge, one that many offices are addressing by relying on telemedicine. Patients and providers want in-person visits, but right now, it’s safe to say telemedicine isn’t going away. So, practices should think about how to develop a long-term telemedicine platform.

Dr. Mergener: What are your thoughts on maximizing capacity for endoscopy?

Dr. Kaul: Reaching pre-pandemic endoscopy capacity is a multifactorial issue taking into account the availability of procedure rooms and personal protective equipment, workforce, and patient willingness to enter medical establishments. Although some hospital-based units may be well positioned in terms of equipment and manpower, institutional policies may limit capacity. Smaller practices may have easier-to-control environments with fewer variables and more flexibility to direct procedure volumes.

Dr. Mergener: How are you managing no-shows?

Dr. Kaul: No-shows are the bane of practices at any time, but they may be especially problematic now due to issues around COVID-19 testing and patient reluctance. Now, more than ever, it’s especially important for scheduling teams and office managers to not only do a daily check but perhaps a twice-a-day check on scheduled patients and managing last-minute cancellations and no-shows. I advise that units confirm patients at least a week ahead of time, ensure that they have accurate instructions and COVID-19 testing information, and answer any questions they have regarding COVID-19–related policies.

There is a potential advantage to well-managed no-shows. They present an opportunity to make a dent in your backlog by filling in canceled appointments.

Dr. Mergener: Can you add evening and weekend hours? Can you find and pay providers, nurses and staff, and develop a viable business plan for extended hours?

Dr. Kaul: Everyone has to be paid, sometimes at time-and-a-half (for after-hours), so the volume of clinical activity in the evening and weekend hours needs to be in alignment with total expenses. Traveling nurses and endoscopy technicians may offer a solution to staffing issues. The locum tenens market is available to any practice, but again, at a cost.

Dr. Mergener: Are there any ways to avoid marginally indicated procedures to prioritize more urgent cases and work down your backlog?

Dr. Kaul: Take a close look at currently scheduled procedures to check if any can be deferred to a later date to facilitate scheduling of more urgent cases. Consider alternative diagnostic testing prior to endoscopy, if appropriate and feasible—MRI instead of endoscopic ultrasound, for example. Deferring truly elective cases may create an opportunity to see more urgent, actively ill patients and those with a known or suspected cancer diagnosis.

—Monica J. Smith

Drs. Kaul and Mergener are members of the editorial board of Gastroenterology & Endoscopy News.

This article is from the June 2021 print issue.