Consolidation of health care dollars


Research shows the ocean’s cod population is diminishing to dangerously low levels. In response, several countries (the United States, Iceland, and others) have instituted a resource allocation system termed “catch share,” where each fisherman is allotted an annual number of fish. Shares can be leased, bought, and traded. Consequently, there has been horizontal and vertical consolidation within the industry and huge fishing corporations have emerged while independent small-boat fishermen have virtually disappeared. Once consolidation occurred, venture capital entered the market. Parallels to what is happening to independent medical practices should not be ignored.

We have closed the book on DDW® 2018. Researchers presented new and innovative studies that will directly affect our practices. I was honored to give the “Best of AGA – DDW” lecture where I chose only seven of hundreds of abstracts to present. All DDW lectures are located at GI & Hepatology News will highlight several high-impact presentations in this and subsequent issues.

This month, our cover stories include a new ACS recommendation to drop the age of first colon cancer screening to 45 (see perspective by John M. Inadomi, MD, AGAF). Two of our most intractable disorders (NAFLD and IBS) have new therapies in the pipeline. From the AGA journals we have articles on Barrett’s surveillance, diet, cognitive-behavioral therapy for IBS, and better monitoring methods for Crohn’s disease.

July begins a new fiscal year for many of us. For many health systems, this last year saw diminishing clinical margins, increased regulations, dramatic alterations in pharmaceutical funds flow, and price pressures that are increasing. I sit on the board of a large nonprofit (nonacademic) Minnesota health system, and I am a member of key financial committees within Michigan Medicine. The learnings and contrasts from each are immense. Health care delivery in both systems is based on high fixed costs and margins that require cost reductions in the 3%-5% range per year to remain viable. Implications for physicians in all settings are immense. That said, there are solutions as you will see in coming issues.

John I. Allen, MD, MBA, AGAF

Editor in Chief

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