As colonoscopy reimbursement declines and GI practices see more patients with functional disorders, obesity, MASLD, and nutrition-related concerns, two gastroenterologists describe how they have expanded beyond procedure-based care into metabolic, lifestyle, and gut-health services. Their models differ: one uses shared medical appointments within an insurance-based practice, while the other combines reimbursed nutrition services with a direct-pay integrative medicine arm.
The article highlights the practical requirements behind these programs: team-based staffing, dietitians, structured group visits, appropriate payer models, and physician expertise. The physicians argue that current fee-for-service reimbursement still favors procedures, making nonendoscopic care difficult to sustain on physician time alone, while value-based models and broader reimbursement for nutrition and lifestyle services could make these programs more viable.