News from the Literature | Practice | Journals & Publications
LEADING THE NEWS
Opposition Mounts on Proposed ACO Regulation
The proposed rule for the Medicare Shared Savings Program/accountable care organizations (ACOs) has suffered some recent blows. Ten major multi-specialty organizations wrote to HHS Secretary Sebelius and CMS Administrator Don Berwick voicing their collective concerns with the proposed rule and stating that if major changes were not made, they would not participate — and would oppose implementation. This is a setback for the administration since all 10 groups, including Geisenger Clinic and the Marshfield Clinic, have participated in the Physician Group Practice Demonstration, which was one of the shared savings models.
Additionally, seven Republican senators wrote to Sebelius urging the administration to withdraw its proposal since so many large integrated health systems, such as the Mayo Clinic, have expressed strong reservations on the current proposal and believe it is currently unworkable.
AGA is finalizing its comments on the proposed ACO rule, which are due on June 6, with a team of members who have been instrumental in helping to deconstruct the proposal and its impact on gastroenterologists and patients with chronic GI conditions. We share many of the sentiments expressed by the large multi-specialty organizations.
AGA will continue to update members on the progression of the ACO rule as the comment period comes to a close and what types of changes CMS makes to the proposal. Learn more.
NEWS FROM THE LITERATURE
SVR Reduces Risk of All-Cause Mortality in Hep C Patients
The effectiveness of hepatitis C virus (HCV) treatment with pegylated interferon and ribavirin is usually evaluated by the surrogate endpoint of sustained virologic response (SVR), although the ultimate goal of antiviral treatment is to reduce mortality. The impact of SVR on all-cause mortality is not well documented by HCV genotype or in populations in routine medical practice with substantial comorbidities. According to data appearing in Clinical Gastroenterology and Hepatology, doctors found that an SVR reduced mortality among patients infected with HCV of genotypes 1, 2 or 3 who were being treated by routine medical practice and had substantial comorbidities.
Clinical Gastroenterology and Hepatology 2011: 9(6): 509-516.e1
Doctors Examine Cellular Changes in Gastroparesis
Cellular changes associated with diabetic and idiopathic gastroparesis are not well described. A study in Gastroenterology suggests that on full-thickness biopsy specimens, cellular abnormalities are found in the majority of patients with gastroparesis. The most common findings were loss of Kit expression, suggesting loss of interstitial cells of Cajal, and an increase in CD45 and CD68 immunoreactivity. These findings suggest that examination of tissue can lead to valuable insights into the pathophysiology of these disorders and offer hope that new therapeutic targets can be found.
Gastroenterology 2011: 140(5): 1575-1585.e8
PPIs Associated with Adverse Cardiovascular Events
In a study published in the British Medical Journal, doctors examined the effect of PPIs on adverse cardiovascular events in aspirin-treated patients with first-time myocardial infarction. They concluded that in these patients, treatment with PPIs was associated with an increased risk of adverse cardiovascular events.
British Medical Journal 2011: 342(7807): d2690
Mucosal Healing Predicts Late Outcomes for Newly Diagnosed UC
It is uncertain whether mucosal healing after the first course of corticosteroids therapy predicts outcome in patients with ulcerative colitis (UC). Study results in Clinical Gastroenterology and Hepatology suggest that no mucosal healing after corticosteroid therapy is associated with a more aggressive disease course.
Clinical Gastroenterology and Hepatology 2011: 9(6): 483-489.e3
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PRACTICE
Proposed Rule Would Modify e-Prescribing Quality Measure
On May 26, 2011, CMS issued a proposed rule that makes significant changes to the e-prescribing penalty program by adding more exemption categories. This will help physicians who may have been unfairly penalized for failing to meet the requirements under the 2012 e-prescribing penalty program. Physicians are still required to e-prescribe using a qualifying e-prescribing system and report the G8553 code on at least 10 Medicare Part B claims from Jan.1, 2011, through June 30, 2011, to avoid the 2012 e-prescribing penalty.
In order to avoid the 2012 penalty of 1 percent of their part B earnings, physicians will have an opportunity to attest — through an online Web portal — that they should be eligible for one of the following exemptions:
- Physician’s practice is located in a rural area without high-speed Internet access.
- Physician’s practice is located in an area without sufficient available pharmacies for e-prescribing.
- Physician is registered to participate in the Medicare or Medicaid electronic health record (EHR) incentive program and has adopted certified EHR technology.
- Physician is unable to e-prescribe due to local, state or federal law or regulation (e.g., prescribes controlled substances).
- Physician infrequently prescribes (e.g., prescribes fewer than 10 prescriptions between Jan. 1, 2011, and June 30, 2011).
- There are insufficient opportunities to report the e-prescribing measure due to program limitations.
Physicians will have to apply for an exemption from the 2012 e-prescribing penalty via the Web portal tool by Oct. 1, 2011.
Learn more about the regulations for the e-prescribing program, and read the proposed rule on these changes.
The comment period for this rule will close on July 25, 2011.
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CGH Image of the Month
Giant Duodenal Ectasia
Douglas H. Weinstein, Richard Childs, Theo Heller
A 42-year-old man presented with acute hematochezia and orthostasis. His past medical history included paroxysmal nocturnal hemoglobinuria associated with portal vein thrombosis for which he underwent a stem cell transplant. Several years later, endoscopy revealed nonbleeding esophageal and gastric varices, portal hypertensive gastropathy, and colopathy. A liver biopsy for chronically increased alkaline phosphatase levels revealed nodular regenerative hyperplasia. Ten years after transplant, he developed iron-deficiency anemia and intermittent melena requiring frequent transfusions. Follow-up endoscopies were unrevealing, and a capsule endoscopy showed small angiodysplasias throughout the small bowel.
During evaluation for a distal splenorenal shunt to treat his portal hypertension, he presented with hematochezia and a 3-g/dL hemoglobin decrease over 24 hours. Upper endoscopy revealed an actively bleeding hemicircumferential angiodysplasia on the anterior wall of the duodenal bulb (figure).
Read more in Clinical Gastroenterology and Hepatology.
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:
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.
JOURNALS & PUBLICATIONS
Gastroenterology and CGH Launch IBD Resource Center
The latest research about IBD published in Gastroenterology and Clinical Gastroenterology and Hepatology is now accessible in a single location on the journals’ recently launched IBD Resource Center. The center is packed full of IBD-related content, including original research, reviews, AGA position statements and multimedia. Additionally, a focus of the center is Gastroenterology’s special 2011 issue “Inflammatory Bowel Disease: An Update on Fundamental Biology and Clinical Management.” Guest associate editors of the special issue include Richard Blumberg, MD, AGAF; Judy Cho, MD; James Lewis, MD, MSCE, AGAF; and Gary Wu, MD.
Check out the IBD Resource Center today to read articles on topics such as using infliximab to prevent postsurgical recurrence of Crohn's disease and the development of the human gastrointestinal microbiota. The center’s series of podcasts offer several interviews with experts in IBD, including a discussion with Francis A. Farraye, MD, AGAF, from Boston University School of Medicine, about the development of the AGA’s guidelines on colorectal neoplasia in IBD. Several video abstracts offer unique perspectives from authors about their research in IBD, and striking images accompanied by clinical cases provide readers the opportunity to test their knowledge.
Also included in the IBD Resource Center is a link to active clinical trials in IBD, as well as a link to the AGA researchers directory, a service that can help connect investigators interested in IBD.
Editors-in-Chief Anil K. Rustgi, MD, AGAF, and C. Mel Wilcox, MD, and Journals Online Editor John F. Kuemmerle, MD, AGAF, are interested in receiving your feedback about the resource center. Please e-mail comments to edubnansky@gastro.org.
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.
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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.
Central Pennsylvania
Excellent opportunity for BC/BE gastroenterologist. Well-established, seven-physician practice with state-of-the-art ASC, fully operational EMR and soon-to-open new office with growth potential. Outstanding salary, benefits and incentive compensation plan. Learn more about our practice at www.gicare.com. Fax curriculum vitae to 717-761-0465, attention: Lisa Scicchitano or e-mail lscicchitano@gicare.com.
Ohio
Gastroenterologist needed to join a busy, growing practice in Ohio. Physicians must be graduates of an accredited U.S. gastroenterology fellowship. ERCP and EUS training/experience a plus.
Chance to be part of a physician-owned endoscopy center with strong referral basis. Some call required, 401k, competitive compensation and partnership track available.
Please submit cover letter and CV for consideration.
E-mail: andrea.monier@xenonhealth.com
Fax: 646-304-1681
Washington
Pediatric Gastroenterology Opportunity at Swedish in Seattle, WA: Swedish, the largest non-profit health-care system in the Pacific Northwest, is seeking a board-certified pediatric gastroenterologist to join an existing, well-established physician practice. The Pediatric Gastroenterology Program at Swedish is part of a multi-specialty, hospital-based, non-academic group with a successful outreach program in place.
The ideal candidate will have fellowship training in pediatric gastroenterology, strong communication and interpersonal skills, outstanding clinical expertise, and leadership potential. You will work closely with highly qualified and respected pediatric specialist physicians, pediatric hospitalists, nurses and MAs.
Seattle boasts a diverse community with economic stability and the beauty of the Olympic and Cascade mountain ranges, Puget Sound and Mt. Rainier. A mild climate encourages year-round outdoor activities. It also offers an impressive and eclectic mix of arts-related entertainment, including theatres, museums and performing art centers. If you are a sports fan, Seattle is home to collegiate athletics and professional sports, including football, baseball and soccer.
Swedish offers an excellent compensation and benefits package. If you are interested, or for more information, please e-mail your CV to Sheila Sampatacos, at sheila.sampatacos@swedish.org.
