American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

News from the Literature | Practice | Policy | Research | Announcements | Education & Meetings | Journals & Publications

LEADING THE NEWS

NEWS FROM THE LITERATURE

Men with CRC Not Offered Treatment for Erectile Dysfunction

Most men treated for colorectal cancer (CRC) experience erectile dysfunction as a consequence. Not all, however, want the same response from health professionals. Erectile dysfunction is profoundly stressful for most men, affecting self image, behavior and relationships; some do not regard it as a health priority. Unlike patients with prostate cancer, men with CRC are not routinely offered information and treatment for erectile dysfunction, stated doctors in a study appearing in the British Medical Journal. Greater coordination of care and consistent strategies are needed to tackle the unmet needs of this widely diverse patient group. Currently, clinicians are inadvertently neglecting, misleading and offending such patients. Better training could improve this situation, as might the reorganization of services. Further research is needed to determine whether trained clinical nurse specialists in CRC units could coordinate ongoing care.

British Medical Journal 2011: 343doi: 10.1136/bmj.d5824

Appendix May Protect Against C. Difficile

Several risk factors have been identified for the development of recurrent Clostridium difficile infection (CDI) that alter host immunity and disrupt colonic flora. Although the function of the appendix has been debated, its active, gut-associated lymphoid tissue and biofilm production indicate potential roles in recovery from initial CDI and protection against recurrent CDI. Data published in Clinical Gastroenterology and Hepatology suggest that the presence of an appendix has a significant and independent, inverse association with CDI recurrence, but this finding requires validation in a prospective study. Assessing the presence or absence of an appendix might be useful in predicting CDI recurrence.

Clinical Gastroenterology and Hepatology 2011: 9(12): 1072-1077

Clinical Prediction Rule, Platelet Count Predict Esophageal Varices

The validation of noninvasive tests to diagnose esophageal varices is a priority in children because repeated endoscopic evaluations are too invasive. A study in Gastroenterology concludes that noninvasive tests such as the clinical prediction rule and platelet count can assist in triaging children for endoscopy to identify esophageal varices.

Gastroenterology 2011: 141(6): 2009-2016

Weight-Loss Counseling Has Long-Term Achievements

Calls for primary care providers to offer obese patients behavioral weight-loss counseling have not been accompanied by adequate guidance on how such care could be delivered. According to a study in the New England Journal of Medicine, enhanced weight-loss counseling helps about one third of obese patients achieve long-term, clinically meaningful weight loss.
 
New England Journal of Medicine 2011; 365: 1969-1979

PRACTICE

It’s Jerry McGuire Time – Show Me the Money

Some of our largest GI groups have successfully attested for meaningful use and have received their first payment of $18,000 per physician. Have you? Where are you in the process? The clock is ticking. The longer you wait, the smaller the incentive. (See details on CMS web site).

There are three essential components to reporting for meaningful use:

 

• Core Measures: these 15 measures are essential and need to be met. There is no margin for variation from the list. Most of your software vendors have tools to help you monitor whether you are compliant with each measure.
• Menu Set Measures: you get to choose five measures from this list of 10.
• Clinical Quality Measures: you must report on three core measures (a, b, c below) and three others from a list of 44. Most of those on the list do not pertain to GI. The three shown below (d, e ,f) were those successfully used by Minnesota Gastroenterology and Illinois Gastroenterology Group:

 

a.    Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record, and if the most recent BMI is outside parameters, a follow-up plan is documented (BMI is calculated on the VS data template, counseling is documented during office visit).
b.    Percentage of patients aged 18 years and older who have been:

 

i.    Seen for at least two office visits and who were queried about tobacco use one or more times within 24 months.

ii.    Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months who have been seen for at least two office visits and who received cessation intervention.

c.    Percentage of patients aged 50 years and older who received an influenza immunization during the flu season.
d.    Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine.
e.    Percentage of adults 50 to 75 years of age who had appropriate screening for colorectal cancer (colonoscopy, flexible sigmoidoscopy or fecal occult blood test).
f.    Percentage of patients 18 years of age and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies.

Although the journey to meaningful use is at times an arduous one, it is not insurmountable. We hope that the information above will help you to successfully negotiate the path to meaningful use.

— Joel Brill, MD, AGAF, and Lawrence R. Kosinski, MD, MBA, AGAF

 

 

 

P.O. Boxes Not Permitted in Billing Provider Address

Do you use a P.O. Box or lock box address as your billing provider address to receive payments? If you submit claims electronically, you will be required to use only a street address or physical location as the billing provider address. Continuing to report a P.O. Box in the billing provider address field will cause your claims to be rejected.
 
Under HIPAA, all physicians and other health-care providers that submit claims electronically are required to transition to the version 5010 transactions by Jan. 1. One of many data reporting changes in the version 5010 transactions is the requirement to report only a street address or physical location as the billing provider address.
 
You may need to work with your practice management system vendor, billing service or clearinghouse to have this address change made for your claims in order to prevent claims rejections and interruptions in cash flow.
 
Practices that wish to continue having payments sent to a P.O. Box or lock box will report this address in the “pay to” address field.

Visit www.ama-assn.org/go/5010 or www.cms.gov/Versions5010andD0 to learn more.

Enforcement of Version 5010 Compliance Delayed

Version 5010, CMS’ revised set of HIPAA transaction standards, will become mandatory on Jan. 1, 2012. Practices still must prepare to ensure that their electronic transactions (claims, eligibility, referral authorizations, etc.) are compliant with this new standard. However, on Nov. 17, 2011, the CMS Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement of compliance with Version 5010 until March 31, 2012.

OESS encourages all covered entities to continue working with their trading partners to become compliant with the new HIPAA standards and to determine their readiness to accept the new standards as of Jan. 1, 2012. While enforcement action will not be taken, OESS will continue to accept complaints associated with compliance with Version 5010 transaction standards during the 90-day period beginning Jan. 1, 2012. If requested by OESS, covered entities that are the subject of complaints (known as filed-against entities) must produce evidence of either compliance or a good faith effort to become compliant with the new HIPAA standards during the 90-day period.

If you are unsure of your practice’s status in terms of compliance with Version 5010, check with your vendors. They should be able to inform you of their, and more importantly your, compliance status with these updated HIPAA standards.

For more information on Version 5010 and the new HIPAA transaction standards, visit the CMS Web page.

EHR, Registry-Based Reporting: What You Need to Know

On Dec. 20, from 1:30–3 p.m. ET, CMS will host a national provider call on the Physician Quality Reporting System and electronic prescribing incentive program. Subject-matter experts will provide an overview on electronic health record and registry-based reporting options that are available for eligible professionals participating or looking to participate.

Medicare fee-for-service providers, medical coders, physician office staff, provider billing staff and vendors are encouraged to participate.

Visit http://www.eventsvc.com/blhtechnologies/ to register. Registration will close at noon ET on Dec. 20 or when available space has been filled. No exceptions will be made. Please register early.

The presentation will be posted at least one day before the call in the downloads section of the CMS website.

Earn Your 2011 Medicare Bonus
The AGA Digestive Health Outcomes Registry provides a quick, easy and inexpensive method for reporting on the Hepatitis C measures. Learn more.

UpToDate^® Free Topic of the Month

Produced in cooperation with the AGA Institute, UpToDate^® is a subscription-based clinical information resource available on the Web, CD-ROM and pocket PC handheld devices. Each month, a free topic is made available on the AGA website. This month's free topic is:

• Treatment of eosinophilic esophagitis.

Nearly 232 physicians write more than 673 topic reviews for UpToDate in gastroenterology and hepatology alone. UpToDate provides gastroenterologists with access to more than 60,000 pages of original, peer-reviewed text, 160,000 MEDLINE abstracts, drug information and drug interactions databases, and hundreds of patient information handouts across 12 specialties. Moreover, UpToDate is used by tens of thousands of clinicians in more than 110 countries and by hundreds of premier medical institutions worldwide.

Order your subscription to UpToDate.

POLICY

Supreme Court to Decide Constitutionality of Health-Care Reform Law

Health-care public policy has always been a significant factor in elections and will continue to be so in the 2012 race for president. Since it was passed, the Patient Protection Affordable Care Act (PPACA), President's Obama's signature legislative achievement, has generated much partisan debate and contention. Recently, the Supreme Court announced that before its present session concludes later next year, the justices will hear arguments and decide the fate of the PPACA.

Read more about the potential impact of the court’s ruling on the outcomes of the 2012 presidential and general elections. AGA will continue to follow this and other issues closely, including the impact on Medicare reimbursement, research funding, and other important issues related to health-care reform and regulation. Look for updates in AGA eDigest and on the AGA Washington Insider, a policy blog for GIs.

Super Committee Fails

The Joint Select Committee on Deficit Reduction, commonly referred to as the “super committee,” failed to reach its deadline to produce a $1.2 trillion package to cut government spending. As part of the debt ceiling legislation deal, if the super committee failed to produce a product by Nov. 23, an automatic trigger, or sequestration, would cut up $1.2 trillion in savings equally divided between defense and non-defense spending.

Read more about the affect of sequestration on gastroenterologists who are already facing a 27 percent cut in Medicare reimbursement beginning January 2012 unless Congress intervenes, as well as the effect on programs like NIH and CDC, which could be cut by 7.8 percent in 2013. The AGA continues to advocate that Congress take action to prevent the 27 percent cut in physician reimbursements and that they enact meaningful payment reform that provides stability to physicians and patients. We also continue to advocate that Congress not make deep cuts to the NIH and CDC, and continue to invest in this important mission.

RESEARCH

Your AGA Research Foundation Gifts Support ...

 … Angela Wiley, Rudolf Steiner High School, who received a 2011 AGA Eli and Edythe Broad Student Research Fellowship Award.

"As a high school student, I am just starting my exposure to research. The AGA Eli & Edythe Broad Student Research Fellowship Award provides a wonderful opportunity to work with an outstanding mentor and investigator, Ellen Zimmermann, MD, to learn about how activation of specific regulators of inflammation play a role in the development of colitis and the perception of pain."

"I have been interested in science for as long as I remember. The AGA-Broad student research award provides the chance to explore one aspect of how nature works. I view this as an exciting and challenging opportunity that will help prepare me for subsequent challenges and opportunities in the future."

"I wish to thank the AGA Research Foundation for creating this award and funding this application, and my primary mentor Dr. Zimmermann for her generous and enthusiastic support"

To make a donation, visit http://www.gastro.org/contribute.

Research Awards Deadlines Are Approaching

The AGA would like to remind you of the upcoming deadlines for the following research awards:

• The inaugural AGA-Emmet B. Keeffe Award in Translational or Clinical Research in Liver Disease will provide a young physician investigator $70,000 for one year to pursue research on viral hepatitis, liver transplantation or other liver disease-themed areas. This award, in memory of Emmet B. Keeffe, MD, will allow physician investigators to pursue independent, productive research careers in translational or clinical research related to liver disease. Applications are due on Feb. 3. Support of this program by Vertex Pharmaceuticals Incorporated is gratefully acknowledged.
• The Elsevier Pilot Research Award will give $25,000 for one year to investigators piloting GI or hepatology projects in different research directions than their prior focus. This provides time for investigators to obtain new data that can eventually lead to subsequent grant applications for a greater funding amount and longer period of time. The application deadline for this grant is Jan. 12.
• The deadline for the AGA-Takeda Research Scholar Award in GERD has been extended to Jan. 13. This award provides $60,000 per year for two years to young investigators working toward independent careers in gastroenterology, hepatology or related areas.
• The 11th annual June & Donald O. Castell, MD, Esophageal Clinical Research Award provides $25,000 for research/salary support to young investigators interested in esophageal disease research. The application deadline is Jan. 20.

All research awards candidates must be AGA members at the time of application submission. Apply online at www.gastro.org/foundation.
 

ANNOUNCEMENTS

FDA Seeks Comments on Prescriber Education on Opioids

The FDA announced the release of its draft outline for physician educational programs as part of the opioid risk evaluation and mitigation strategy (REMS) entitled “Blueprint for Prescriber Education for the Long-Acting/Extended-Release Opioid Class-wide REMS.” Since the REMS blueprint is focused on long-acting opioids, this is an important development for gastroenterologists treating patients with chronic pain (e.g., chronic pancreatitis). Although there is no mandatory requirement that prescribers take the course as a precondition to dispensing the medication to patients, manufacturers will be required to establish goals for the number of prescribers trained, collect the information about the number of prescribers who took the courses, and report the information to FDA as part of periodic required assessments.

The draft blueprint contains core messages intended for use by continuing education providers to develop educational materials to train prescribers (e.g., physicians, nurse practitioners, physician assistants) of long-acting and extended-release opioids under the required REMS for these products. The affected opioid drugs include long-acting and extended-release brand name and generic products that are formulated with the active ingredients buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone, oxymorphone and tapentadol.

The draft is open for comment until Dec. 7, 2011. After comments are received, FDA will revise the blueprint as appropriate, incorporate it into the opioid REMS when it is approved and post it on FDA’s website for use by continuing education providers.

Did You Miss These Tweets Over the Holiday?

Catch up on the latest GI news by taking a look at our most retweeted items from last week.

• Did you eat a lot of fatty food this holiday? Learn how to reduce related gas in the digestive tract: ow.ly/7BXgh.
• What is the correlation between gut microbiota and IBS? Find out in today's post from The AGA Journals Blog. ow.ly/7BLzv.
• Researchers state colon cancer risk incidence is four times higher in female longtime smokers; Pg 8. GI & Hep News: ow.ly/7AABo.
• December Gastro online! Hot topics: Barrett’s, pediatric esophageal varices screening & dependence receptors, CRC. ow.ly/7AzHN.
• ASCs Will Benefit from New Payment Rates for 2012. ow.ly/7yhS7.

Have any news that you would like us to share with our AGA members? Please send them to communications@gastro.org or share them on our social media channels:

• Become an AGA fan on Facebook.
• Join our LinkedIn group.
• Follow us on Twitter @AmerGastroAssn.
• Check out our videos on YouTube.

EDUCATION & MEETINGS

2012 AGA Clinical Congress to Present Latest in Patient Care

The 2012 AGA Clinical Congress of Gastroenterology and Hepatology: Practice, Evidence and Quality in 2012 will review the latest updates on key clinical issues that arise in everyday practice. Congress director, Marcia R. Cruz-Correa, MD, PhD, AGAF, and congress co-director, David A. Lieberman, MD, AGAF, have developed a comprehensive clinically focused program that covers the full spectrum of GI and hepatic disorders, helping attendees to enhance their clinical decision-making skills and improve patient care. The congress will be held on Jan. 20 and 21, at the Loews Miami Beach Hotel, FL.

The in-depth congress program includes six general sessions and nine breakout sessions, allowing attendees to customize their learning experience. Program highlights include:

• Technical and Quality Improvements in Colonoscopy — What Is Likely to Impact Your Practice?
• Update on Treatment Options for Hepatitis C.
• Food Allergies and Eosinophilic Gastroenteritis: Real or Imagined?
• Biliary Dyskinesia: Advances in Diagnosis and Management.
• Gastroparesis: Evolving Tools.
• My IBD Patient: Complications of Treatment with Immune Modulators and Biologics.

The program also incorporates the latest information on how to best manage and treat pediatric patients. One of the most interesting aspects of the program is a review of difficult patient cases, which are submitted by attendees and chosen by the faculty. Attendees are encouraged to submit a case to be considered for review. Prizes will be awarded to those whose cases are selected.

Special incentives are available for AGA member trainees, including free registration for the congress and a corresponding practice skills workshop, which follows the congress on Jan. 22, and eligibility to receive a travel award.

Trainees can also submit an abstract and present their research. This is a valuable opportunity to receive feedback from the faculty and other attendees in a small, relaxed environment. Selected abstracts will be published in Clinical Gastroenterology and Hepatology. Abstract submission will open on Aug. 15.

Other events held alongside the congress include a practice management course, a practice skills workshop for trainees and a maintenance of certification (MOC) review course. Congress registrants can register for the practice management course or the MOC course at a discount. Those who register for the congress on or before Oct. 31 will receive free access to the 2012 congress online sessions.

Learn more and register.

Are You Up for a Clinical Challenge?

Congratulations to Sahil Khanna, MBBS, for winning the Clinical Question of the Month contest for November.

AGA’s Clinical Question of the Month contest has proven to be a fun, new way for GI clinicians and other medical professionals to test their clinical awareness. With more than 350 board-type self-assessment questions to choose from, each month is sure to offer a new and unique challenge to assess your understanding of the Digestive Diseases Self-Education Program^® 6.

The next question will be posted on Monday, Dec. 5 on the AGA Facebook page. Submitting the correct answer qualifies participants to be entered into a raffle drawing for a chance to win a valuable prize.

To ensure that you receive proper access to the question, you must have an active Facebook account and “like” the AGA page. By liking the page, your news feed will display updates from AGA’s page.

For more information on game rules and prizes, visit www.gastro.org/cqom. Good luck!

Explore Multi-Disciplinary Approaches to GI Cancers

The 2012 Gastrointestinal Cancers Symposium: Science and Multidisciplinary Management of GI Malignancies is one of a few educational events that addresses GI cancer diagnosis, treatment and management in a multi-disciplinary forum. For the ninth consecutive year, the AGA Institute, the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, and the Society of Surgical Oncology will co-sponsor this three-day event, which will be held Jan. 19–21, 2012, in San Francisco, CA.

Designed as a discussion-based meeting, the symposium will foster dialogue among oncologists, gastroenterologists and other members of the cancer-care community. It will also provide a unique opportunity to learn the science behind the latest clinical advances related to diagnosis and treatment.

The symposium offers educational sessions and abstract presentations focused on each type of GI cancer, including esophageal, gastric, hepatobiliary, pancreatic, small bowel, colon and rectal.

New symposium highlights include:

• The virtual and mobile meetings have been combined into one product and are included with the registration fee.
• The Pocket Program, the print version of the program agenda, now includes titles, authors and poster board numbers for abstracts presented in general poster sessions.
• Attendees will receive a digital copy of the 2012 Gastrointestinal Cancers Symposium proceedings on an e-tote USB device.

The early bird registration deadline is Dec. 14. Registration fees will increase by $150 after this date. For additional details and to register, visit www.gicasymposium.org.

JOURNALS & PUBLICATIONS

View This Month's Journal Highlights, All in One Place

The editors of Gastroenterology and Clinical Gastroenterology and Hepatology (CGH) would like to bring to your attention highlighted articles from the December issues of the journals.

Gastroenterology

• Efficacy of the Protease Inhibitor BI 201335, Polymerase Inhibitor BI 207127, and Ribavirin in Patients With Chronic HCV Infection; By Stefan Zeuzem, et al.
• Nonsteroidal Anti-Inflammatory Drugs and Statins Have Chemopreventative Effects in Patients With Barrett's Esophagus; By Florine Kastelein, et al.
• Magnifying Narrowband Imaging Versus Conventional White-Light Imaging for Accurate Diagnosis of Gastric Mucosal Cancer; By Yasumasa Ezoe, et al.
• A Clinical Prediction Rule and Platelet Count Predict Esophageal Varices in Children; By Juan Cristóbal Gana, et al.
• N-methyl D-Aspartate Channels Link Ammonia and Epithelial Cell Death Mechanisms in Helicobacter pylori Infection; By Ji Hye Seo, et al.

CGH

• The Appendix May Protect Against Clostridium difficile Recurrence; By Gene Y. Im, et al.
• High Resolution Manometry Studies are Frequently Imperfect but Usually Still Interpretable; By Sabine Roman, et al.
• Twenty-Year Transplant-Free Survival Rate Among Patients With Biliary Atresia; By Willemien de Vries, et al.
• Inflammatory Bowel Disease is Associated With Poor Outcomes of Patients WithPrimary Sclerosing Cholangitis ; By Jing Hieng Ngu, et al.
• Increasing Frequency of Opioid Prescriptions for Chronic Abdominal Pain in U.S. Outpatient Clinics; By Spencer D. Dorn, et al.

Classifieds

Place GI Position Listings and Activity Announcements

For as little as $82.50, you can place a classified ad of 100 words or less in AGA's weekly e-mail newsletter, AGA eDigest, or AGA's bi-monthly magazine, AGA Perspectives. If you place ads in both AGA Perspectives and AGA eDigest, you will receive a 10 percent discount. Advertising in either includes a free online classified listing. Learn more.

Global Probiotics Council — Young Investigator Grant for Probiotics Research
The Global Probiotics Council, a committee established in 2004 by DANONE and YAKULT HONSHA CO., LTD., has announced the fifth annual Young Investigator Grant for Probiotics Research. The purpose of the two annual grants of $50,000 each is to contribute to the advancement of probiotics and gastrointestinal microbiota research in the U.S., and to impact academic and career development of young investigators, attracting them into the field of probiotics and microbiota.

Deadline: Feb. 15, 2012.

The official announcement and description of this opportunity may be found at:
http://www.probioticsresearch.com/.

Kentucky
The division of gastroenterology, hepatology and nutrition at the University of Louisville is seeking to expand its group of 17 academic faculty members in the areas of GI motility, IBD and therapeutic endoscopy. There is tremendous opportunity and support for clinicians, as well as translational and clinical researchers. Louisville is a very dynamic multicultural community. The University of Louisville is an equal opportunity affirmative action employer. Interested candidates are invited to submit a curriculum vitae to Kristine Krueger, MD, professor and chief, academic and clinical affairs, division of gastroenterology, hepatology and nutrition, University of Louisville School of Medicine, Louisville, KY 40292 or kristine.krueger@louisville.edu.

North Dakota
Regional Leaders in Gastroenterology
Immediate openings for BC/BE gastroenterologists interested in practicing in an organization experiencing dynamic growth and development. This procedure-oriented practice with Sanford Health Fargo offers you a great work-life balance with a call schedule of 1:8. Procedures preformed include ERCP, EUS, SpyGlass^® and capsule studies. Consults only in 583-bed level II trauma center with EMR and PACS. Opportunity to teach medical students and IM residents. Sanford Health Fargo consists of 585+ physicians located in Fargo and 34 regional primary care clinics.

Fargo, ND, with a metro population of 190,000, is a diverse, stimulating and family-oriented city with all the amenities that make for a satisfying and fulfilling life. We offer exceptional K-12 and higher education systems, world-class health care, affordable housing, low cost of living, and myriad cultural and entertainment opportunities.

Jean Keller, physician recruiter
Sanford Health Physician Placement
Phone: 701-280-4853
E-mail: Jean.Keller@sanfordhealth.org

J1 candidates accepted.