AMSURG Joins in the 80% in Every Community Colorectal Cancer Screening Initiative

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AMSURG has joined in the national initiative with the Colorectal Cancer Roundtable to increase awareness of colon cancer and to work to ensure that 80% of adults take advantage of potentially life-saving colorectal cancer screening. AMSURG is a leader in ambulatory surgery center management and partners with more than 160 endoscopy centers. In 2019, our centers performed more than 600,000 colonoscopies, responding to the increase in cancer-related deaths among people.

By joining the 80% in Every Community effort, AMSURG pledges our resources and time to make certain that every community we serve benefits from increased colorectal cancer screening rates. Colorectal cancer is the second leading cause of cancer deaths in the U.S., when men and women are combined, and causes considerable suffering among more than 145,000 adults diagnosed with colorectal cancer each year. Additionally, over 50,000 people are expected to die from the disease this year alone.

When adults get screened for colorectal cancer, it can be detected early at a stage when treatment is most likely to be successful, and in some cases, it can be prevented through the detection and removal of precancerous polyps. Colonoscopy is considered the gold standard in colon cancer screening as it is the only screening that can both detect and prevent colorectal cancer.

To date, more than 1,700 organizations have committed to the shared goal of increasing colorectal screening rates to 80% and higher for adults aged 50 and older. By partnering together, we will reduce barriers to screening in our community and save more lives.

For more information about colorectal cancer, visit AMSURG’s education-focused website stopcoloncancernow.com.

AMSURG Leverages Its Size in the Fight Against Early-Onset Colorectal Cancer

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Colorectal cancer has shown a dramatic increase among younger and middle-aged populations in the United States, becoming the third most diagnosed form of cancer among Americans.

The numbers tell the story. In 2020, the American Cancer Society (ACS) estimates there are approximately 104,000 new cases of colon cancer and 43,000 new cases of rectal cancer. Combined, colorectal cancer may lead to 53,000 deaths this year alone.

Because of these numbers, AMSURG, an Envision Healthcare solution, and its nearly 200 gastroenterology partner centers are working tirelessly to advance the fight against colorectal cancer. Last year alone, AMSURG performed more than 600,000 colonoscopies and is responding to the two percent annual increase in colon cancer related deaths in people under age 55.

The increase in deaths in this younger population prompted the ACS to update its screening guidelines and recommend screening begin at 45 for people who are at average risk. “As a physician, I agree that 45 is the new 50,” said John Popp, M.D., Medical Director for AMSURG. “When you look at the last decade or so, incidence of CRC has dropped because we are screening people 50 and older. But at the same time, we have to do something when we see that the rates of CRC in people under 50 have doubled in that same period.”

AMSURG has leveraged its national scope as an early advocate of GIQuIC, the Gastroenterology Quality Improvement Consortium. AMSURG partners began utilizing the registry in 2013 and the company’s impact has been significant, providing more than 2.5 million colonoscopy reports in the GIQuIC registry – accounting for nearly 25 percent of entrants. “We have an obligation to advance colon cancer research, and GIQuIC has allowed us to add to the science by our research capabilities,” Dr. Popp said.

“Because of our scale, we have such a significant amount of quality and demographic data to draw from,” Dr. Popp said. “We have patients in that 45-50 age range with a symptom that warranted a colonoscopy and the instances of colon cancer are there. This is not an anomaly, and the people studying early-onset colon cancer are very interested in that data.”

Diagnosed early, colorectal cancer is easier to treat, and patients have an increased chance of survival. Colorectal cancer affects people of all genders, races and ethnicities, and it often has no warning signs or symptoms until it becomes advanced. Risk factors can include a family history of colorectal cancer, inflammatory bowel disease and certain lifestyle habits.

Depending on a person’s age and health insurance policy, a screening colonoscopy may be provided free of cost.

To learn more about colorectal cancer and find a gastroenterologist, visit www.StopColonCancerNow.com.

Americans Are Waiting Too Long To Start Colorectal Cancer Screening

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NASHVILLE, Tenn. – Last year, the American Cancer Society updated its colorectal cancer screening guidelines to recommend screening begin at 45 for people who are at average risk. Yet according to new data from AMSURG, a leader in the detection, prevention and treatment of colorectal cancer, most people wait until the age of 58 for an initial screening – 13 years after the recommended guidelines.

In recognition of National Colorectal Cancer Awareness Month, AMSURG today released proprietary data from approximately 1 million patient encounters during the past five years showing that more work is needed to encourage Americans to get screened at the recommended age. This year, more than 140,000 people in the U.S. are expected to be diagnosed with colorectal cancer. While research shows that younger adults are increasingly diagnosed, they do not start regular screenings until their late 50s when cancer is often more advanced.

“Colorectal cancer is the third most commonly diagnosed cancer and the second deadliest form in the U.S.,” said John Popp, M.D., Medical Director for AMSURG. “Having a screening during those 13 years can be life-changing. Screening is the most effective way to detect, prevent and treat colorectal cancer. These cancers typically develop during a 10- to 15-year period, and with early and regular screenings, growths can be removed before they become cancerous.”

If cancer is diagnosed early, it is easier to treat, and patients often have a shorter recovery time as well as an increased chance of survival. Colorectal cancer affects people of all genders, races and ethnicities and it often has no warning signs or symptoms until it becomes advanced. Risk factors can include a family history of colorectal cancer, inflammatory bowel disease, Crohn’s disease, diabetes and certain lifestyle habits.

“A screening colonoscopy is considered the gold standard,” said Colleen Schmitt, M.D., MHS, FASGE, FACG, Past President of the American Society for Gastrointestinal Endoscopy, Trustee and Vice Chair of the ASGE Foundation and a gastroenterologist at Chattanooga Endoscopy Center in Tennessee. “It is the most comprehensive because we can both detect and remove precancerous polyps during the procedure. In addition to being safe, colonoscopies enable us to evaluate the overall health of the colon and help patients treat any underlying conditions.”

People can decrease their chances of developing colorectal cancer by maintaining a healthy weight, eating a balanced diet, exercising regularly and having routine screenings.

Depending on a person’s age and health insurance policy, a screening colonoscopy may be provided free of cost.

AMSURG, an Envision Healthcare solution, provides nearly 1 million colonoscopies a year and is committed to helping patients develop appropriate care plans to prevent and treat colorectal cancer. To learn more about colorectal cancer and find a gastroenterologist, visit www.stopcoloncancernow.com.

AMSURG Partner Discusses Increase in Colon Cancer in Young Adults

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Antonio Serna, M.D., gastroenterologist at San Antonio Gastroenterology Associates and Endoscopy Center, recently appeared on FOX San Antonio to discuss the increase of colon cancer in young adults. According to a 2017 study, people born in 1990 are twice as likely as those born in 1950 to be diagnosed with colon cancer and four times as likely to be diagnosed with rectal cancer. The cause isn’t known, but physicians suspect diet and sedentary lifestyles may be to blame.

In the video, Dr. Serna urges young adults not to ignore symptoms and to talk to family members to learn whether they have a family history of colorectal cancer. Symptoms include blood in the stool, a change in bowel pattern, abdominal discomfort and unintentional weight loss.

Dr. Serna stresses that a referral from a primary care physician is not needed to be screened for colorectal cancer and early detection is often a lifesaver. The full video can be viewed here.

Kendall Endoscopy Center’s Creative Cake Promotes Colonoscopy Screenings

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In honor of National Colorectal Cancer Awareness Month, Kendall Endoscopy and Surgery Center in Miami, Florida created a cake to encourage colon screenings. The cake features multiple tools used to perform routine home repairs and urges patients to “know when to call an expert.” The pamphlet featured on the cake then directs patients to StopColonCancerNow.com. The cake can be seen here.

AMSURG Research to Focus on Colonoscopy Screening Rates and Community Costs

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As an early advocate of GIQuIC, AMSURG has anticipated the many benefits that better data about GI procedures and screening can bring to physicians, payors and patients. At a March GI Research Summit, leaders from AMSURG, Evolution Health and other industry-leading organizations collaborated on how best to study and leverage GIQuIC data in pursuit of the Healthcare Quadruple Aim.

Dr. Gerald Maccioli, chief quality officer of Envision Healthcare, said, "I believe we have a moral obligation to investigate our exceptional database and convert it to useful hypotheses and, ultimately, meaningful action." AMSURG's contributions to the GIQuIC database surpassed one million procedures earlier this year.

The group of industry leaders, which gathered at Envision Healthcare's Nashville headquarters on March 2, also included AMSURG President Phillip Clendenin, Evolution Health Chief Quality Officer Daniel Castillo, and Dr. Ashish Atreja, chief innovation and engagement officer at The Mount Sinai Hospital. A full day of collaboration yielded several hypotheses that could be pursued with AMSURG's current GIQuIC data and supplemental demographic information.

The three potential hypotheses focus on socioeconomic factors related to colon cancer screening rates and risk, social determinants that contribute to community screening rates and average screening ages, and the community cost impact of colon cancer screening.

"For physicians, this analysis would be difficult or impossible at the individual or group level, but at the AMSURG level we can provide real insight into what is happening and how to make improvements in colon cancer screenings," said Eric Thrailkill, chief information officer for AMSURG and Evolution Health.

"In response to some of the literature that has recently appeared on this topic, we kept coming back to the topic of age-appropriate screening recommendations," said Kathy Wilson, vice president of quality for AMSURG. "We believe this is a meaningful opportunity to support our physician partners and positively impact patients and communities."

Fecal transplants in an outpatient endoscopy setting offer big reward with little risk

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Patients often go to hospitals for fecal transplants, but according to Paul Allegretti, M.D., many patients are healthy enough to have the procedure performed in endoscopy center or ambulatory surgery center (ASC).

“AMSURG was great because they had had some preliminary research, preliminary data on how to put something like that in an endoscopy center,” Allegretti said. “I had written a protocol with the help of another physician who sort of pioneered fecal transplant from a physician end of it. So that protocol was in place, they reviewed it. [They] really were great. No significant interference. Everything they had to say was really additional info that was helpful in getting it on board.”

Allegretti, an AMSURG physician partner at Lancaster Gastroenterology Procedure Center in Lancaster, Pa., has been a long-time proponent of using probiotics to treat gastrointestinal diseases, but the increase of Clostridium difficile (also known as C. difficile or C. diff) infections over the last several years has caused him to focus particularly on fecal transplants.

“The reason I started doing fecal transplants was, I always had kind of an interest in the microbiome and the bacterial contribution to gastrointestinal disease,” Allegretti said. “More and more, as time is going on, you see C. diff throughout the hospital becoming much more common than it was even when I was a medical resident, even more common in the community than it was 5 to 10 years ago. So in the short time I’ve been practicing, it’s become really a difficult disease to manage with what we had, which were just antibiotics. So seeing this becoming a new way to treat something and having the success rates that it had really kind of pushed me to work towards getting this procedure locally.”

Anyone can become infected with C. diff, but those who have been recently treated with antibiotics are most vulnerable. When antibiotics fight off harmful bacteria, they also destroy the healthy bacteria that protect the body against infection, leaving the body susceptible to C. diff. Once a C. diff infection is established, the bacteria release toxins that attack the lining of the intestine. C. diff infections can range from mild to life-threatening.

Fecal transplants are a highly successful way to treat the increasing number of patients infected with C. diff. According to a new review, infusion of healthy bacteria through donor stool helped 55 percent of patients heal who did not respond to standard drug treatments. Fecal transplant helps break the cycle of recurrence for C. difficile. With a fecal transplant, 90 percent of people improve.

In July of 2013, the U.S. Food and Drug Administration (FDA) dropped the regulation that required doctors to complete an investigational drug application before performing fecal transplants. According to Allegretti, this decision greatly contributed to making fecal transplants more accessible to interested practitioners.

“That really opened it up to people who were interested in doing it that maybe didn’t have a full university staffing behind them to do all the paperwork that’s sometimes involved," said Allegretti. "So, less paperwork allowed it to be done.”

Overall, Allegretti said that the reaction from patients has been quite positive. Most patients turn to the internet to do their own research, and they come into the office well-informed and asking good questions.

“They ask about our own success rates. They ask about success rates nationally. They want to reiterate what the positive research has shown. They ask a lot of questions about the donor – who is an appropriate donor – and they ask a lot of questions about cost, because that’s something you can’t really find on the internet necessarily," said Allegretti.

Allegretti added that many patients have concerns about the cost of the procedure, but it typically turns out to be quite affordable with insurance coverage.

For physicians who are interested in offering fecal transplants, Allegretti offered these recommendations.

“The best advice to give other gastroenterologists who might be considering this procedure is to make sure you, obviously, review literature, have your protocol in place before you present, make sure you’re well-read so you can answer any questions that an advisory board or a safety board or your nurses will have," said Allegretti. "A lot of questions pop up in the process, and generally these questions are answered by prior research, prior protocols that are available. So if you’re able to be well-read in those, it’s pretty straightforward, very rewarding and worth it once you’re able to do those things.”

Click here to watch the complete interview with Dr. Allegretti. Be sure to subscribe to our YouTube channel and be notified when AMSURG physician partners discuss surgery center insights and their experiences with an AMSURG partnership.