Dr Chey, from the University of Michigan Medicine, reviews his presentation from DDW on how bringing a dietitian into a GI practice can ensure patients with disorders of gut-brain interaction receive true integrated multidisciplinary care, and refutes the common belief that dietitians add to costs rather than bringing in revenue to the practice.

William Chey, MD, is the H. Marvin Pollard Professor of Gastroenterology, professor of Nutrition Sciences, and chief, Division of Gastroenterology & Hepatology, at University of Michigan Medicine in Ann Arbor, Michigan.

TRANSCRIPT:

Hi, my name is William Chey, I'm a professor of gastroenterology and nutrition sciences at the University of Michigan in Ann Arbor, Michigan. I'm also the chief of GI and hepatology at University of Michigan. I'd like to tell you about some of the highlights around a symposium that we did that Digestive Diseases Week 2024 on how to incorporate a dietitian into your GI practice.

I think in 2024, one of the big points that I emphasized was that multidisciplinary care and even taking it a step further, integrated multidisciplinary care, is really the standard of care. Now I know that that's a lofty goal and it's not easy to achieve that lofty goal but that's what we should be shooting for, because one size does not fit all for the management of patients with disorders of gut-brain interaction and more specifically irritable bowel syndrome. We really have to understand the patient's experience, the main drivers for their illness, and what is practically achievable for each individual patient.

So coming up with a tailored individualized plan that meets the patient halfway, but yet recommends evidence-based quality treatment options that will hopefully make the patient’s symptoms better, is critically important. Part of that is having a GI dietitian at your disposal. You know, I think every gastroenterologist at this point is aware of the fact that the low FODMAP diet makes at least half of IBS patients better, which is incredible and certainly a wonderful asset to have at your disposal.

But it's also important to remember that the low FODMAP diet isn't just about restricting foods that contain FODMAPs. It's using the restriction phase as a means of finding out if IBS patients are sensitive to FODMAPs, and then going on to the second phase of the low FODMAP program, which is reintroduction, to determine which FODMAPs are driving a patient's illness experience, and then going on to the third phase, which is to use that information you obtained from the reintroduction phase to liberalize, to personalize an IBS patient's diet so that they're not on the full restriction that you started them on at the beginning of this journey.

So I think a couple other key things that I really emphasized during this symposium, as you introduce a dietitian into your practice, it's really important to do so in a way that respects them as part of the team, not as a subordinate. You'll find that things will go a lot more smoothly and the dietitian will feel at home more quickly and also be less hesitant to give you their honest, constructive advice as they see a patient if they feel as if they're a card-carrying member of the team and not somebody that works for your practice.

The other thing that's really important, and I think a huge misconception, is that dietitians lose money. Dietitians don't lose money. Actually their services are billable and largely reimbursable in most parts of the country. Of course, you have to do a little bit of homework depending on where you reside. But for the most part, the dietitian services are absolutely reimbursable. And the other thing is that the advent of group classes completely changes the game financially. Because here's the thing: group classes are accepted by patients. Studies have shown that they lead to equivalent outcomes to face-to-face appointments for many aspects of the nutrition consultation and actually cash flows because the dietician is now seeing 6, 8, 10 patients as opposed to 1 patient face-to-face.

Now, the last bit on this that I'll just say—which is maybe the most important thing—is that for the patient it's cheaper because each individual patient is charged a lower fee, but in aggregate when you see a patient as a group, it generates more income. So this notion that dietitians don't pull their own weight financially is not true. And the value add in terms of having a dietitian, in terms of delivering state-of-the-art care, giving your patient the greatest chance of doing well, you should have — every big GI practice should have — a dietitian or access to a GI dietitian.