DURING THE CARONAVIRUS PANDEMIC, gastroenterology and other physician groups with in-house medical laboratories—like most medical practices and clinical laboratories in the United States—have seen a sharp drop in patient visits and specimen volume.
That drop occurred at the same time gastroenterologists experienced strong growth in patient visits and in the specimen volume they sent to anatomic pathologists, said Kenneth N. Josovitz, MD, MPH, President of Associates in Gastroenterology (AIG) and Endoscopy Associates in Woodbridge, Va.
“Let’s put it this way: gastroenterology is a field that was flourishing, at least pre-COVID,” he commented. “Then almost overnight, work at our practice went from 100% to 10% of normal volume. It was a devastating drop.”
Normal Volume in January
AIG has a staff of 60 employees in five offices, including 11 physicians, nine of whom are co-owners of the specialty group. Three of the offices have in-office endoscopy centers and the other two do ambulatory surgery.
Josovitz and his AIG co-owners also own Maya Laboratories, a high-complexity lab in Manassas, Va. The 5,000-square-foot, lab is CAP-accredited and CLIA-certified and has 15 employees, including three part-time pathologists.
“In January, patient visits and specimen volume ran at normal levels,” Josovitz said in an interview with The Dark Report. “Each month, our gastroenterologists send an average of about 5,000 jars to Maya Lab. So, if a routine month was 5,000 specimens, that’s 1,250 specimens per week. Our group was on track to send about 60,000 jars or more by the end of the year.”
Patient visits rose sharply in February, when the seven care centers sent 7,065 jars to Maya Lab, Josovitz said. Of that total, AIG accounted for 912 jars, and another care center collected 1,980 jars.
Workload Drops by 90%
Then, routine GI patient visits and AP volume dropped in March, as coronavirus infections spread in Virginia and the mid-Atlantic states, and after Virginia Gov. Ralph Northam implemented a stay-at-home order on March 23. Under that order, Northam ordered the closing of non-essential businesses and public schools and banned public gatherings of more than 10 people.
“On March 18, we were still at 100% of normal patient volume,” Josovitz said. “At AIG, we have two endoscopy rooms in Woodbridge and everyone was fully busy. We have other care centers that have one room each and they were all going strong five days a week.
“But then our patient workload started to drop slightly, and then more until we were down to 10% of our normal volume by the end of the month,” he added. “For all of March, we were down about 20% off our normal volume. In April, workload was down by about 90%.”
Since May 1, when state officials allowed routine screening colonoscopies and other care services to return with restrictions, the number of patient visits started to rise slowly.
50% of January’s Volume
“For the next few weeks, I expect we’ll be at 50% of where we were in January,” Josovitz predicted. “I hope that over the next couple of months, we’ll be fully back to where we were in February. “We still have to be careful, and we can’t use all of our capacity yet,” commented Josevitch. “Plus, we can’t fill up the waiting rooms at our clinics and endoscopy centers due to social distancing and the need for heavy cleaning of the endo rooms.”
To boost revenue and add another level of patient care, Josovitz plans to have Maya Lab add immunology testing. “We’re trying to expand services in our lab, and immunology testing will be useful because patients can see if they’ve been at risk of contracting the virus,” he explained.
New Testing Considered
“Our in-office laboratory primarily does anatomic pathology testing,” he reported. “We could easily expand by adding some clinical lab testing and recently added molecular testing for stool samples for infections. Also, immunology testing could be useful for our practice.”
The drop-off in patient volume and lab test referrals at Associates in Gastroenterology and Endoscopy Associates is similar to what other labs have seen. As Josovitz noted, patients continue to defer chronic care and preventive screening. This is an inauspicious trend for lab directors trying to predict when patient volume and routine lab test referrals will return to pre-pandemic levels.
When Will Patients Want Preventive Care?
“IN OUR FIVE CARE CENTERS, WE GENERATE MORE TISSUE SPECIMENS compared to some hospitals,” said Kenneth N. Josovitz, MD, MPH, President of both Associates in Gastroenterology (AIG) and Endoscopy Associates (EA). “But almost all of our work is preventive screening.
That’s the nature of gastroenterology. “We do certain life-saving procedures—such as bowel obstructions and gastrointestinal bleeding—but those cases represent only about 1% of our patient volume,” he explained. “The other 99% is chronic and preventive care, such as screening colonoscopies.
Preventive Care Deferred
“In the age of COVID, a patient wants to defer his or her screening colonoscopy and similar preventive care,” said Josovitz. “Recently, I was concerned about a patient’s condition, and even he decided to wait until June for his screening procedure. Because of the pandemic, our patient visits and lab test volume have gone down and there aren’t many ways to make that up.”
When the number of patient visits dropped in March and April at AIG and EA, so did the number of specimen jars and revenue. “Our revenue went down in March to about 80% of what it was in January,” noted Josevitz.
To cut costs and retain all 60 employees in the care centers, the nine physician owners took no salary since March, he noted. The groups also applied for and received federal stimulus funds from the Paycheck Protection Program (PPP) and from the Medicare Advance Payment Initiative, as authorized by the CARES Act. The PPP funds came in the form of a loan that Josovitz hopes the federal government will forgive.
Contact Kenneth N. Josovitz, MD, at 703-580-0181 or kjosovitz@hotmail.com.
