American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

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LEADING THE NEWS

NEWS FROM THE LITERATURE

NMDA Channels Link Ammonia, Epithelial Cell Death Mechanisms

Helicobacter pylori (H. pylori) infection is a risk factor for gastric cancer. Ammonia/ammonium (A/A) is a cytotoxin generated by H. pylori that kills gastric epithelial cells. According to data published in Gastroenterology, A/A affects gastric epithelial cell viability by allowing excessive Ca2+ permeation through N-methyl D-aspartate (NMDA) channels. NMDA channels might thereby regulate cell survival and death pathways during development of gastric cancers associated with H. pylori infection.

Gastroenterology 2011: 141(6): 2064-2075

Treatment of Neuroendocrine Tumors Associated with Carcinoid Syndrome

Everolimus, an oral inhibitor of the mammalian target of rapamycin, has shown antitumor activity in patients with advanced pancreatic neuroendocrine tumors. According to a study appearing in The Lancet, everolimus plus octreotide long-acting repeatable, compared with placebo plus octreotide long-acting repeatable, improved progression-free survival in patients with advanced neuroendocrine tumors associated with carcinoid syndrome.

The Lancet 2011: 378(9808): 2005-2012

Celiac Disease Increases Renal Disease Risk

The prevalence of end-stage renal disease is increasing worldwide. Although increased levels of celiac disease auto-antibodies are often seen in renal disease, the importance of biopsy-verified celiac disease for the risk of future end-stage renal disease is unclear. A study published in Gut indicates that individuals with biopsy-verified celiac disease suffer increased risk of subsequent end-stage renal disease.

Gut 2012; 61: 64-68

Serum Ferritin Concentration Predicts Liver Transplantation Mortality

Serum ferritin concentration is a widely available parameter used to assess iron homeostasis. It has been described as a marker to identify high-risk patients awaiting liver transplantation, but is also elevated in systemic immune-mediated diseases, metabolic syndrome and in hemodialysis, where it is associated with an inferior prognosis.

Serum ferritin concentration 365 μg/L or more in combination with transferrin saturation less than 55 percent before liver transplantation is an independent risk factor for mortality following liver transplantation, stated doctors in a study in Hepatology. Lower transferrin saturation combined with elevated serum ferritin concentrations indicate that acute-phase mechanisms beyond iron overload may play a prognostic role. Serum ferritin concentration therefore not only predicts pre-liver transplantation mortality, but also death following liver transplantation.

Hepatology 2011: 54(6): 2114–2124

PRACTICE

Gastroenterology Image of the Month

An Unusual Interpretation of “Blind Drunk”

Question: A 53-year-old man was admitted with a week-long history of painless jaundice, pruritis, dark urine and malaise. Examination revealed icterus, 1-cm hepatomegaly, gynecomastia and shifting dullness. His blood tests were significant for markedly elevated liver function tests, low albumin and prolonged prothrombin time. Abdominal computed tomography reported mild portal hypertension and ascites.

The patient admitted to an approximately two-year history of alcohol abuse. A diagnosis of acute-on-chronic liver disease secondary to alcohol dependence syndrome was made. He also reported a recent two-month history of night blindness with difficulty reading in low light and adjusting to the dark in the evening time. Visual acuity and visual field examinations were normal bilaterally. Examination of the sclera revealed the corresponding picture (figure).

What is the next most appropriate blood test to explain these symptoms and signs?

Answer.

Earning a Medicare Bonus Made Easier with AGA Registry

The CMS-qualified AGA Digestive Health Outcomes Registry™ provides clinicians with a new, easy and inexpensive way to report on the hepatitis C measures group as part of the CMS Physician Quality Reporting System (PQRS). Using the registry's simple online forms, a physician can potentially earn a 1.5 percent bonus on all Medicare Part B allowable charges for calendar year 2011.

Providers wanting to use the AGA Registry to submit to CMS for the 2011 PQRS have until Jan. 13, 2012, to enroll,  and until Jan. 31 to enter their patient data. Both full- and half-year reporting options are available for 2011.

"For many physicians, a Medicare incentive payment can be substantial, and to not submit data or submit data and not qualify, can be a costly mistake,” said John Allen, MD, MBA, AGAF, chair of the AGA Registry Executive Management Board. Physicians can estimate their potential bonus payment using the registry's online Medicare bonus calculator.

Earning the 2011 physician quality reporting bonus through the AGA Registry is much easier than using claims-based physician reporting, which requires billing codes and submitting data for 80 percent of eligible patients. Physicians who use the registry need only to successfully report on 30 unique patients aged 18 and over with chronic hepatitis C. Additionally, physicians who do not see at least 30 chronic hepatitis C patients per year can report on at least 80 percent of their patients, provided that they have seen at least 16 patients with chronic hepatitis C within 2011, or at least eight patients during either half of the year.

Additional benefits of using the registry for submission of data include:

• Real-time, easy-to-understand status reports to let physicians see the data they have entered.
• Separation of the reporting of PQRS data from the claims-reporting process, allowing for retrospective entry of data and preventing the physician reporting process from delaying physician claims.
• Built-in quality checks that reduce errors, improving the likelihood of qualifying for the 1.5 percent bonus payment.

Learn more at www.gastro.org/agaregistry.

Find Clinical Answers More Quickly

Like most specialists, gastroenterologists and hepatologists face increasing challenges in their efforts to keep up with the latest clinical developments. However, in order to provide patients with the best possible care, physicians must be able to access current, comprehensive clinical information — especially when dealing with complex or controversial cases. UpToDate is an evidence-based clinical information resource that can help you find the answers you need quickly.

Gastroenterologists turn to UpToDate because of its high-quality content.
UpToDate authors and editors are true leaders in gastroenterology — the team you would want to turn to when seeking clinical expertise. When writing a topic, UpToDate authors not only provide detailed subject reviews, they offer recommendations based on their extensive knowledge and collective clinical experience. UpToDate gastroenterology content covers both common and rare conditions, with a focus on clinical manifestations, diagnosis and treatment. View UpToDate gastroenterology and hepatology sample topics.

A single resource for treatment of multiple conditions and disciplines.
UpToDate’s extensive gastroenterology content is augmented by equally in-depth coverage of 18 other specialties, including newly launched surgery and geriatric sections. In addition to reviewing topics on your patients’ gastroenterological issues, you can access information about their other medical conditions as well — knowledge that can be crucial in making or confirming management decisions. View sample topics in all UpToDate specialties.

UpToDate also offers a new graphics search feature that provides quick and easy access to more than 23,000 authoritative graphics, including pictures, tables, illustrations, diagrams, graphs, algorithms and movies. With UpToDate’s graphics search, you can quickly find trusted graphics without having to use other search engines.

To sign up for a 14-day free trial — available to AGA members only — go to learn.uptodate.com/AGA and select the orange free trial button. Try it for yourself and see what a difference UpToDate can make in your practice.

POLICY

MedPAC Sets Payment Recommendations for 2013

The Medicare Payment Advisory Commission (MedPAC) met to discuss its annual assessment of payment adequacy for hospital inpatient and outpatient services, physician fee schedule, and ambulatory surgical center (ASC) services. The commission will vote on the following recommendations at its January meeting:

Physician fee schedule update. The commission did not provide specific recommendations for Medicare Part B physician payments, but continues to support recommendations provided in its October letter to Congress that the sustainable growth rate (SGR) formula be repealed and paid for through reimbursement cuts for specialists and a freeze for primary care doctors.

While the AGA agrees that the current SGR needs to be fixed, we strongly oppose MedPAC’s proposal. AGA does not believe that specialty physicians should be penalized for a broken SGR system that has been made worse by congressional inaction over the past decade.

ASC update. MedPAC is considering implementing a 0.5 percent increase in payment rates for ASC services in 2013, along with required cost reporting, and requiring a value-based purchasing program for ASCs no later than 2016.

Hospital inpatient and outpatient update. Medicare payments for evaluation and management (E&M) visits provided in hospital outpatient departments in fiscal year 2013 would be reduced to align with the rates paid for patient visits in freestanding physician offices. MedPAC believes this will equalize Medicare payment rates for E&M services in the two settings and help stem hospital acquisition of physician practices. MedPAC also recommended that the payment update for all inpatient and outpatient services be 1 percent in 2013 in contrast to the 2.9 percent under current law.

CMS Issues Framework for Essential Health Benefits

The CMS Center for Consumer Information and Insurance Oversight issued a bulletin providing guidance on how the agency intends to propose, in rulemaking, the essential health benefits defined in the Patient Protection and Affordable Care Act. This act ensures that health insurance plans offered in the individual and small-group markets, both inside and outside of insurance exchanges, offer a comprehensive package of items and services, known as essential health benefits.

The guidance indicates that each state would be able to establish essential benefit benchmarks from among one of the following:

• One of the three largest small-group plans in the state.
• One of the three largest state employee health plans.
• One of the three largest federal employee health plan options.
• The largest health maintenance organization offered in the state’s commercial market.

Plans would be allowed to modify coverage within a benefit category as long as they do not reduce the value of coverage. States and insurers would also have the flexibility to change the benefits package as innovative plan designs are developed and advancements in care become available.

CMS did not indicate a timeframe for when final regulations will be promulgated. CMS is accepting comments on the bulletin until Jan. 31, 2012. Review the fact sheet on the essential health benefits bulletin.

RESEARCH

What Is the NIH Secret Code for Grants?

In the December issue of Gastroenterology, Judy Podskalny breaks the code. She describes early career NIH funding opportunities and takes readers in orderly fashion from early career grants to the awards for which newly independent investigators compete.

Your AGA Research Foundation Gifts Support ...

… Sanders Chang, of Lynbrook High School in San Jose, CA, who received a 2011 AGA-Eli & Edythe L. Broad Student Research Fellowship Award.

"Thanks to the guidance of my mentors, Hiroshi Nakagawa, MD, and Mistuteru Natsuizaka, MD, I have become acquainted with fascinating topics in gastroenterology that I would not have encountered on my own or in my classes. Working in their lab has shown me the many rewards of performing biomedical research, from the personal growth that I can experience to the amazing impact that can be made on other people's lives. I thereby look forward to using this award to support and continue my research experience in their lab."

"Ultimately, I highly anticipate that this research experience will be transformed into an endeavor extending beyond my college years. Thank you to the AGA Research Foundation and the Eli & Edythe L. Broad Foundation for providing me with this generous opportunity."

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

Reduce Your Taxes by Giving to AGA Foundation

As the end of the year quickly approaches, remember your charitable contributions can help reduce your taxes. Gifts in support of the AGA Research Foundation are tax deductible to the full extent of U.S. law. Gifts must be made prior to Dec. 31, 2011, to be eligible for 2011 tax benefits.

Make a secure online donation to the AGA Research Foundation Research Awards Program or call foundation staff at 301-222-4002.

ANNOUNCEMENTS

CMS Selects 32 Organizations to Participate in ACO Model

Thirty two health-care organizations from across the country were selected to participate in the new pioneer accountable care organization (ACO) model. Operated by the CMS Innovation Center, the initiative will test the effectiveness of several innovative payment models and how they can help experienced organizations provide better care for beneficiaries, work in coordination with private payors and reduce Medicare cost growth.

The pioneer ACO model requires ACOs to engage other payors in similar efforts to reward health-care providers who deliver high-quality care. The pioneer ACO model also includes strict beneficiary protections, including the ability for patients to seek care from any Medicare provider they wish.

Selected pioneer ACOs include physician-led organizations and health systems, urban and rural organizations, and organizations in various geographic regions of the country, representing 18 states and the opportunity to improve care for about 860,000 Medicare beneficiaries. The first performance period of the pioneer ACO model will begin Jan. 1, 2012. CMS posted a fact sheet with the final list of participating pioneer ACOs, as well as frequently asked questions detailing information about the pioneer ACO model.

The pioneer ACO initiative is one of a menu of options for providers wishing to participate in an ACO. Pioneer ACOs are designed specifically for groups of providers with experience working together to coordinate care for patients. The Medicare Shared Savings Program and the advance payment ACO model, both announced in October 2011, are also ACO options for providers.

Special IRA Opportunity Expires Dec. 31

The individual retirement account (IRA) charitable rollover legislation allows individuals age 70½ and older to make tax-free gifts up to $100,000 to charities such as the AGA Research Foundation using funds from their IRA. This opportunity is only available through Dec. 31, 2011. Read more.

In Case You Missed It ...

Check out what our followers retweeted most often last week. Then, spread the word by retweeting to your followers.

• Senate Unlikely to Pass House’s Two Year “Doc Fix” ow.ly/80l2b.
• Diabetes remission rate is 75% in gastric bypass patients after 6 years vs 1% in controls. GI & Hep News: ow.ly/7Zrtc.
• We are proud to partner w/@ABIMFoundation in Choosing Wisely. Learn more in today’s AGA eDigest: ow.ly/80Nyr. #choosingwisely.

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.

AGA Office Closed Until Jan. 3

The AGA national office will be closed from Dec. 26, 2011, to Jan. 2, 2012, and will reopen on Jan. 3. If you are a member with an urgent inquiry, e-mail member@gastro.org.

We wish you a great holiday and happy New Year.

EDUCATION & MEETINGS

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 to 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:

• Virtual and Mobile Meeting 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 2012 Gastrointestinal Cancers Symposium proceedings on an e-tote USB device.

For additional details and to register, visit www.gicasymposium.org.

Start Your New Year Off Right

Congratulations to Sherif Shabana, MD, for winning the December clinical question of the month.

Make a new year’s resolution to win the AGA clinical question of the month. Like old acquaintances, your knowledge gained from the Digestive Disease Self-Education Program^® 6 should not be forgotten. By correctly answering the question, you earn a chance to win a $25 gift card from either iTunes or Amazon.

Look for the next question on Monday, Jan. 9 on the AGA Facebook page. Entering is quick and easy. Simply join/sign in to your Facebook account and “like” the AGA page. Select the link and answer the question.

For more information on game rules and prizes, visit www.gastro.org/cqom. Happy New Year and good luck.

Don't Miss Early Bird Registration for Clinical Congress

Register now and save up to $150 on your 2012 AGA Clinical Congress registration. Early bird registration for the congress and all add-on events closes Friday, Jan. 6, 2012.

Make your hotel reservations today.

The clinical congress is an excellent opportunity for you to explore the latest in the detection, management and treatment of GI and liver disorders. Designed by your peers, the congress combines didactic lectures with small-group breakout sessions that provide immediately applicable information to enhance clinical knowledge, improve patient care and build/maintain a successful practice — all while earning American Board of Internal Medicine maintenance of certification (MOC) to help fulfill licensing requirements.

Tour the exhibit hall and shop the most recent products and services from a variety of vendors. Enjoy several networking opportunities and expand your professional network while connecting with colleagues.

Challenge the faculty — e-mail your toughest cases to education@gastro.org by Dec. 31. If your case is selected to “challenge” our expert panel, you will receive one free hotel night (room plus tax).

Early bird registration also ends for the clinical congress add-on events:

• AGA Practice Management Course: New Strategies for Changing Times — Jan. 19 and 20, 2012. Get the information needed to develop strategies and implement best practices for building and maintaining a successful GI practice in a demanding health-care environment.
• AGA Practice Skills Workshop: Pathways to Success — Jan. 22, 2012 (free registration and scholarships for AGA member trainees). Practical strategies to help fellows in training critically assess their clinical practice options and career choices.
• AGA MOC Course — Jan. 22, 2012. Earn up to 20 out of the required 100 points of self-evaluation toward MOC.

Space is limited. Register today.

Attend Symposium on Crohn’s Disease at the 2012 Congress
Sponsored by Given Imaging, Inc., Advances in Small Bowel Imaging: Visualizing and Monitoring Crohn's Disease focuses on the utility of capsule endoscopy in the visualization and monitoring of Crohn’s disease through review of unique case studies.

JOURNALS & PUBLICATIONS

Call for Papers on Clinical Trials: Gastroenterology

Gastroenterology is committed to advancing clinical practice in the field of digestive disease. Recognizing that clinical trials generally have the greatest impact of all studies on clinical practice, Editor Anil K. Rustgi, MD, and his associate editors strongly encourage authors to submit their manuscripts on clinical trials (diagnostic validation, therapeutic efficacy) of drugs, biological materials and devices in digestive, liver and pancreatic diseases, including studies at Phases I, II and especially III, to Gastroenterology for consideration. The journal is also interested in publishing trials in endoscopic and imaging modalities.

There are several important reasons to submit clinical trial research for publication in Gastroenterology:

• With an impact factor of 12.9, Gastroenterology is the premier journal in the field.
• Gastroenterology is the journal that will directly reach the largest portion of physicians who care for and make treatment decisions for patients with GI or liver disease.
• Authors who submit their manuscripts to Gastroenterology typically will receive decisions within three weeks or fewer.
• Accepted manuscripts will be published online and indexed on PubMed within 10 days of acceptance.

To submit your manuscript to Gastroenterology, go to www.editorialmanager.com/gastro.

For important information on how to report clinical trials, go to www.gastrojournal.org/authorinfo. To review the current and past issues of the journal, go to www.gastrojournal.org.

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.

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 performed 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.