News from the Literature | Practice | Research | Education & Meetings | Journals & Publications | Announcements
LEADING THE NEWS
AGA Responds to CMS’ Proposed Rule on ACOs
AGA responded to the proposed accountable care organization (ACO) rule with a letter drafted in coordination 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.
The letter focused on three key areas of the proposal:
- Changes requested to provide more appropriate patient-centered care.
- Recommendations related to the quality reporting requirements.
- Observations regarding the overall ACO structure.
The AGA does not believe that this currently proposed model is “ready for prime time” and urged CMS to delay its implementation. We are extremely concerned about how this proposal will impact patients’ ability to continue to access quality specialty care services, especially those patients who have chronic conditions that GIs treat, such as IBD, malnutrition, chronic liver disease and hepatitis. We agree with other large medical organizations on their structural concerns with establishing an ACO and the financial resources it will require, which are underestimated by CMS.
The current model, as proposed, focuses on primary care, and therefore could limit appropriate referrals to specialists. Therefore, our major concern is for those patients with complex, chronic conditions who often see multiple providers in various settings and rely on a team of specialists to coordinate their care.
CMS issued the proposed regulations on March 31, 2011, to guide the development of ACOs — a key part of the Medicare Shared Savings Program enacted in the 2010 Patient Protection and Affordable Care Act. Along with the proposed rule, the Federal Trade Commission, Department of Justice and IRS issued accompanying guidance to facilitate the development of ACOs. The ACO program is scheduled to go into effect on Jan. 1, 2012.
AGA will continue to update our members on the progression of the ACO rule and what types of changes CMS makes to the proposal. Look for more updates in AGA eDigest and on the AGA Washington Insider.
NEWS FROM THE LITERATURE
GIs Find Variable Reliability of Endoscopic Findings
Endoscopic findings have been used to support a diagnosis of eosinophilic esophagitis (EoE) and to assess response to therapy, but their reliability is unknown. Using white light endoscopy and narrow band imaging (NBI) to analyze EoE, gastroenterologists identified rings and furrows with fair to good reliability, but did not reliably identify plaques or normal images. Intraobserver agreement varied. In the study — appearing in Clinical Gastroenterology and Hepatology — they concluded that endoscopic findings might not be reliable for supporting a diagnosis of EoE or for making treatment decisions.
Clinical Gastroenterology and Hepatology 2011: 9(6): 475-480
NAFLD to Contribute to Liver Disease Burden
Chronic liver diseases are major causes of morbidity and mortality worldwide. National Health and Nutrition Examination Surveys data collected from 1988 to 2008 show that the prevalence of major causes of chronic liver diseases remained stable, except for NAFLD, which increased steadily, along with the prevalence of metabolic conditions. Given the increasing rates of obesity, NAFLD prevalence is expected to contribute substantially to the burden of chronic liver diseases in the U.S., according to data published in Clinical Gastroenterology and Hepatology.
Clinical Gastroenterology and Hepatology 2011: 9(6): 524-530
MSH6 Mutations Associated with Lower Cancer Risks
Providing accurate estimates of cancer risks is a major challenge in the clinical management of Lynch syndrome. Study results appearing in the Journal of the American Medical Association suggest that MSH6 mutations are associated with markedly lower cancer risks than MLH1 or MSH2 mutations. Lifetime ovarian and endometrial cancer risks associated with MLH1 or MSH2 mutations are high, but do not increase appreciably until after the age of 40 years.
Journal of the American Medical Association 2011; 305(22): 2304-2310
Frequency of Capsule Endoscopy Indications Varies in Pediatric, Adult Patients
In a study published in Clinical Gastroenterology and Hepatology, doctors systematically reviewed compiled data on indications and outcomes, and evaluated the effectiveness of capsule endoscopy on patient management using meta-analyses. They concluded that the relative frequency of capsule endoscopy indications varies among pediatric and adult patients. In pediatric patients, capsule endoscopy is used primarily to evaluate patients with celiac disease — to aid in diagnosis, monitor disease severity and assist patient management. Retention rates appear to be related to indication, rather than patient age. Capsule retention is relatively infrequent for adults and children.
Clinical Gastroenterology and Hepatology 2011: 9(6): 490-96
PRACTICE
GastroSlides Featured Image
Topic: Pancreatic Physiology and Pancreatitis
These images illustrate the physiology and pathophysiology of pancreatic function as well as the causes, diagnosis and management of acute and chronic pancreatitis.
Order these slides individually as you need them or purchase a one-year subscription and have access to the entire GastroSlides library of more than 4,000 images. Preview and order slides.
CMS to Provide Overview of eRx Proposed Rule
On June 21, from 1:30 to 3 p.m. ET, CMS will host a national provider teleconference on the Physician Quality Reporting System and electronic prescribing (eRx) incentive program. Subject-matter experts will provide an overview of the proposed rule, CMS-3248-P, released on May 26, 2011, which addresses the proposed changes to the Medicare eRx incentive program. A question and answer session will follow the presentation.
To register for this informative session, please go to http://www.cms.gov/PQRI/04_CMSSponsoredCalls.asp. Registration will close at 1:30 p.m. ET on June 20, or when available space has been filled.
RESEARCH
Your AGA Research Foundation Gifts Support ...
Andres Roig, MD, who received a research scholar award in 2010.
"It is an honor to have been selected as a recipient of the AGA Research Scholar Award, and I sincerely thank the AGA Research Foundation and the Linscheer Memorial Fund for supporting my research in colorectal cancer (CRC) progression. Over the last three years, I developed a cell culture model of immortalized normal human colonic epithelial cells to study in vitro CRC progression. Recent bioinformatics data has confirmed previously well-known CRC driving mutations and has identified many new candidate genes that, when altered, can provide a significant driving force in CRC progression. My goal is to use the immortalized colonic cells to validate, via biological assays, which combinations of specific candidate genetic alterations confer the greatest survival advantage to experimentally progressed (but not fully malignant) human colonic epithelial cells. With the support of the AGA Research Foundation and the Linscheer fund, I will continue to have the protected time necessary to perform these experiments."
To make a donation, visit http://www.gastro.org/contribute.
EDUCATION & MEETINGS
Toolkit Offers Valuable Information on Nutrition, Obesity
With obesity rates in the U.S. quickly rising, and increasing reports and studies identifying a link between obesity and GI diseases, it is critical that health-care providers understand the role of nutrition and obesity in treating and managing patients with digestive disorders. The AGA’s nutrition toolkit series, a collection of online self-assessment modules, covers the latest information for the effective management of nutrition and obesity in the GI practice.
The latest module from the series, Nutrition in Short Bowel Syndrome, offers expert insight into understanding the process of intestinal adaptation; recognizing the role of diet, glutamine, growth hormones and GLP-II; and when to consider surgery. Participants can earn up to 0.75 AMA PRA Category 1 CreditsTM.
Additional modules in the toolkit series include:
- Nutritional Management of Celiac Disease.
- Nutrition Therapy in Acute Pancreatitis.
- Nutrition and IBD.
- Obesity for the Gastroenterologist.
- Nutrition in the Patient with Liver Disease.
Each online module includes slides with corresponding audio delivered by subject-matter experts as well as pre- and post-test questions. A score report will be provided upon completion.
The nutrition toolkit series is an online education component of the AGA Institute's nutrition and obesity initiative. The initiative includes access to AGA Institute obesity-related educational materials located under the nutrition and obesity topic area of the practice resource library of the AGA website. Additional modules on obesity- and nutrition-related issues are in development and will be made available throughout the year.
Nutritional Management of Celiac Disease is sponsored by the General Mills Bell Institute of Health and Nutrition.
Popular Course Focuses on Unique Needs of NPs, PAs
GI nurse practitioners (NPs) and physician assistants (PAs) are an integral part of the GI clinical team. Like physicians, it is essential to maintain a comprehensive, up-to-date knowledge of gastroenterology principles and practices. The AGA’s annual course, Principles of Gastroenterology for the Nurse Practitioner and Physician Assistant, provides in-depth information on GI-specific clinical and practice management issues. The course is designed specifically with the diverse needs of the NP and PA in mind, allowing immediate application in both office and hospital settings.
An expert faculty comprised of physicians, NPs and PAs will present valuable information on topics such as the diagnosis and treatment of liver failure, gastroparesis and small bowel dysmotility, GERD, eosinophilic esophagitis, screening for colorectal cancer, managing nutritional issues, and more.
Two special luncheon symposia will be offered this year. On day one, Salix Pharmaceuticals is hosting a special luncheon and session titled, A Practical Approach to the Diagnosis and Management of IBS. Day two’s luncheon on accountable care organizations will provide an overview of what role NPs and PAs may play under this new care model and how this may affect reimbursement for services rendered.
One of the most unique aspects of this course is the opportunity for networking among GI colleagues. Several companies will also be exhibiting to provide you with the latest information they have to offer. This year’s course will take place at the Crowne Plaza Avenue Chicago Hotel in Chicago, IL, Aug. 15 to 17, 2011.
CME accreditation is pending. Conference organizers plan to request 19 hours of American Academy of Physician Assistants category 1 CME credit from the Physician Assistant Review Panel. The luncheon symposium will offer separate accreditation of approximately 1.5 credit hours.
This program is pending approval by the American Academy of Nurse Practitioners.
Learn more and register.
JOURNALS & PUBLICATIONS
AGA Journal Covers Get New Look
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Do not be surprised next month when your issues of Gastroenterology and Clinical Gastroenterology and Hepatology look different. Starting in July, the covers of the AGA’s journals will have a new and fresh design. You can expect the same expert content within the pages of the journals, but the covers now closely mirror the association’s other products and publications, ensuring that readers across the world instantly recognize the journals as publications from the AGA. In addition, the covers will prominently feature imagery from select articles published within each issue — these striking images will test your knowledge and peak your interest. In keeping with the journals’ current practice, the covers will also include brief highlights of the top articles published in each issue. Keep your eye out for these exciting new covers arriving soon in your mailbox. |
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Brief Reports to Debut in July Gastroenterology
The July issue of Gastroenterology will contain several changes, including a new board of editors, cover and section entitled “Brief Reports.” Editor-in-Chief M. Bishr Omary, PhD, MD, sees this section as a valuable new venue to publish unique basic and clinical reports that will be highly cited and broaden the journal’s scope.
Topics of brief reports may include — but are not limited to — identification of the genetic basis of a disease, a description of a unique case series, novel techniques, new animal models of human disease or mechanistic insights.
Brief reports will be unsolicited content, and authors interested in submitting a report should adhere closely to the section guidelines. There is a limit of 1,000 words (including figure legends, but excluding abstract and references), 15 abbreviated references and up to two figures or tables. A 100-word abstract not divided into sections, and ending with a concluding statement is required. In addition, six supplemental documents consisting of figures, tables and one required document of detailed materials and methods may be included. Abstracts must be formatted correctly (introductory paragraph, results, conclusion/discussion), and reports must not contain section headers. Further specifications will be included in Gastroenterology’s July instructions for authors.
To submit a report for consideration after July 1, please upload your manuscript at www.editorialmanager.com/gastro and choose the article type “Brief Reports.”
ANNOUNCEMENTS
Applications Being Accepted for AGA Fellowship
The AGA is accepting applications for fellowship, the organization’s highest level of membership. The prestigious designation of fellow is awarded to members based on their superior personal and professional achievements in either clinical practice or basic/clinical research. To date, 1,694 members have been honored as AGA fellows.
Fellowship in the AGA is by application only and applicants must meet certain criteria in order to apply. One such criterion is membership in the AGA for at least seven years.
As an AGA fellow, you will have the use of the letters “AGAF” in your professional activities. You will also receive a recognition pin and certificate upon acceptance and be listed as a fellow on the AGA website. During DDW® 2012, you will be recognized with a ribbon denoting your fellowship status and your name will be printed in the recognition and research awards booklet.
The review and selection process for this program falls under the oversight of the Fellowship Recognition Committee, with final approval by the AGA Institute Governing Board. Fellows will be selected based on superior achievements in clinical practice or in research. Applicants will be notified of their acceptance by Jan. 31, 2012. Fellowship will commence upon notification of acceptance.
The application deadline for 2012 is July 18, 2011. Learn more about the eligibility requirements and apply online.
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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.
