MNGI Digestive Health: Experts in Comprehensive, Complex Subspecialty Care

By Josh Garcia
Wednesday, May 1, 2019

MNGI Digestive Health has built a practice that offers much more than procedures-focused care, with the long-term health and well-being of patients being the main priority across the practice’s many subspecialty clinics.

For almost 25 years, MNGI Digestive Health has focused on providing greater access to quality gastrointestinal (GI) care across the state of Minnesota and the upper Midwest. With the addition of its newest Woodbury location, MNGI Digestive Health now has eight outpatient clinic locations and shows no signs of slowing its expansion efforts.

“Most of our office locations include a clinic and ambulatory surgery centers [ASCs] with four endoscopic procedure rooms in addition to clinic exam rooms,” says Scott Ketover, MD, AGAF, FASGE, President and CEO of MNGI Digestive Health. “We’ve also formed a partnership with Colon & Rectal Surgery Associates and University of Minnesota Physicians to create an additional ASC in Saint Paul.”

In addition to its dedicated outpatient clinics, MNGI Digestive Health also supplies GI coverage to 13 metropolitan area hospitals, including two pediatric hospitals. Physicians from MNGI Digestive Health can provide on-site consultation to doctors, staff, patients and families at these locations with around-the-clock availability.

“We have long-standing relationships with these hospitals,” Dr. Ketover says. “We’re always looking to collaborate and do joint ventures to bring quality services to all patients.”

Collaboration and Optimization

MNGI Digestive Health’s commitment to quality and innovation has been on display for decades. The practice was an early adopter of the Pay for Performance (P4P) model of health care, which provides physicians with funds based on their clinical outcomes and performance.

“Not many organizations had implemented P4P in the early 2000s,” Dr. Ketover says. “We dove in and made internal changes to make sure our physicians could respond to pathology results quickly and relay that information to patients and referring providers.”

Much of this communication was fostered by the early adoption of EHR systems, which MNGI Digestive Health also embraced in the early 2000s, before many of its peers. Whereas the national benchmark for providing patients with pathology results was 14 days at the time, MNGI Digestive Health was able to shorten this period to only three days.

“EHR allowed us to automate and digitize a lot of processes related to communication,” Dr. Ketover says. “We could order tests for patients and get the results interpreted by physicians faster, which allowed us to get information to patients in a much shorter time frame.”

EHR has allowed MNGI Digestive Health to facilitate communication with external providers in the area, too, which helps keep them up to date on their patients and deliver a stronger continuum of care.

MNGI Digestive Health has also formed an affiliation with a clinically excellent local gastrointestinal pathology group, which uses the laboratory at MNGI Digestive Health to interpret patients’ test results and specimens quickly and accurately. This approach allows MNGI Digestive Health to keep its testing and diagnostic services in-house, resulting in accurate results, quicker turnaround times and earlier updates for patients.

“This allows for immediate expert GI pathology interpretation of the pathology specimens for our patients,” says Scott Keeley, MD, gastroenterologist at MNGI Digestive Health.

MNGI Digestive Health’s on-site laboratory, which was specifically designed to meet the needs of a large GI practice, allows specialists to examine test results directly and explain their findings to patients as soon as possible.

“I read all the motility tests myself, such as the SmartPill, which is a motility capsule to assess stomach emptying and intestinal transit” says April Grudell, MD, Director of the Functional and Motility Disorders Clinic at MNGI Digestive Health. “If I get a patient’s motility test result before their next scheduled clinic visit, I’ll call that patient directly rather than waiting to see that patient back in clinic.”

Specialization: The Functional and Motility Disorders Clinic

Dr. Grudell is one of multiple specialists at MNGI Digestive Health whose medical interests revolve around complex GI care. Like her colleagues in the Functional and Motility Disorders Clinic at MNGI Digestive Health, she has completed extra training to specialize in treating conditions such as irritable bowel syndrome (IBS), functional dyspepsia, gastroparesis and pelvic floor dysfunction.

The Functional and Motility Disorders Clinic uses a multidisciplinary approach to care that relies on the expertise of other specialists in addition to gastroenterologists.

“We work with colorectal surgeons, pelvic floor therapists and our psychiatric colleagues in our clinic,” Dr. Grudell says. “We also hold functional and motility meetings every two months to discuss patient cases and larger topics in a group setting.”

Patients with functional and motility disorders often require complex care, which requires more time from their healthcare providers. Because of this, the Functional and Motility Disorders Clinic sets aside at least 45 minutes for each patient visit. This extra time allows providers to discuss what treatment options have and have not worked for patients in the past and discuss options for care. It also allows them to administer a quality of life survey that takes into account multiple aspects of patients’ lives beyond their GI diagnosis, including mental health.

“The quality of life survey is completed every time patients come to the clinic,” Dr. Grudell says. “The survey can tell us how patients are functioning and how frequently they experience abdominal pain and other GI symptoms. It also gives us information about other issues, such as whether or not patients are experiencing depression as a result of their symptoms.”

The Functional and Motility Disorders Clinic is the only functional and motility clinic in the metropolitan area and is currently available at MNGI Digestive Health’s Coon Rapids, Plymouth and Maplewood locations.

Once patients are properly assessed, the Functional and Motility Disorders Clinic can choose the proper course of action, which may include insertion of a gastric pacemaker. Gastric pacemakers are implanted devices that aid in gastric emptying through the use of electricity rather than medication.

Specialization: The Crohn’s and Colitis Clinic

Similar to the Functional and Motility Disorders Clinic, the Crohn’s and Colitis Clinic at MNGI Digestive Health can also address the needs of patients who require advanced care for their GI conditions.

“We’ve embraced the complex patient with all of our subspecialty clinics and especially with our Crohn’s and Colitis Clinic,” Dr. Keeley says. “We provide convenient access to experts that are highly effective in managing complex inflammatory bowel disease (IBD) while also providing the care and empathy that patients deserve.”

The Crohn’s and Colitis Clinic is available at all eight of MNGI Digestive Health’s outpatient office locations and can refer patients to infusion centers for biologic treatments and iron infusions. Biologic treatments are normally reserved for patients with moderate to severe Crohn’s disease or ulcerative colitis.

“Biologic (infusion) treatments are typically administered through an IV over one or two hours,” Dr. Keeley says. “These infusions are monoclonal antibodies that block specific components of the body’s immune response, ultimately suppressing that response and effectively treating Crohn’s disease and ulcerative colitis.”

The Crohn’s and Colitis Clinic is made up of gastroenterologists, physicians, nurses, nurse practitioners, physician assistants and dietitians, all of whom specialize in IBD. Though their expertise is vital in treating patients with IBD, these team members take a compassionate approach to care that helps patients through difficult symptoms and treatments.

“Our locations are convenient for patients, and they also make our patients feel comfortable,” Dr. Keeley says. “We have experienced nurses who administer infusion therapy, which can ease the anxiety that sometimes occurs when receiving infusions. If patients have a comfortable and convenient experience, they are more likely to stay compliant with their treatments.”

Innovation: Research and MAC

As part of MNGI Digestive Health’s commitment to providing the most comprehensive care for patients, many of its specialists engage in research aimed at finding new treatments for GI conditions.

“We often have access to clinical trials for emerging or novel IBD treatments,” Dr. Keeley says. “These options are offered to patients who have failed most or all of the standard, FDA-approved IBD treatments currently available.”

Dozens of staff members at MNGI Digestive Health assist with clinical trials and six members are devoted solely to research functions. MNGI Digestive Health’s research sees patients at its Plymouth, Maplewood and Northeast locations.

“Outside of our core research committee, we have individuals who want to present their own research projects,” Dr. Grudell says. “Those individuals can present their ideas at our committee meetings, where we can approve projects and move them forward.”

A good example of new technology that has stemmed from this research is the LINX treatment — a minimally invasive procedure for treating gastroesophageal reflux disease.

Dr. Grudell is a member of the research committee that helps bring clinical trials to MNGI Digestive Health. MNGI Digestive Health has been involved in trials for the treatment of many conditions, including Crohn’s disease, ulcerative colitis, gastroparesis, primary biliary cholangitis and nonalcoholic steatohepatitis. In addition, she helps lead innovation efforts at MNGI Digestive Health and works to improve gastric pacemakers, Endoflip technology and pyloric therapies.

“The Endoflip assesses pyloric tone,” Dr. Grudell says. “If pyloric tone is elevated, patients may require Botox injections to relax the pylorus.”

The constant drive to improve has resulted in the adoption and expansion of monitored anesthesia care (MAC) at MNGI Digestive Health.

“Prior to creating our own anesthesia department, we did conscious sedation for many of our endoscopic procedures,” Dr. Ketover says. “What we learned is that comorbid conditions — such as obesity, diabetes and heart complications — can make any kind of sedation riskier for patients.”

The addition of MAC and dedicated anesthesia professionals at MNGI Digestive Health have allowed the practice to use faster-acting anesthesia medications that do not cause a lengthy hangover effect after surgery. MAC also allows MNGI Digestive Health to perform more complicated procedures in an outpatient setting. Because these services are provided in-house at MNGI Digestive Health’s ASCs, anesthesia costs are much less than they would be in a hospital setting.

“Providing MAC for patients has been an enormous success,” Dr. Keeley says. “It has relieved much of the anxiety and pain that patients may have experienced with endoscopic procedures in the past.”


To learn more about how MNGI Digestive Health promotes innovation and positive outcomes for patients facing complex GI conditions, visit mngi.com.