American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

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

LEADING THE NEWS

NEWS FROM THE LITERATURE

Mutant Kras Alters Differentiation in Colon Epithelium

Adenomatous polyps are precursors to colorectal cancer (CRC), whereas hyperplastic polyps (HPPs) have low risk of progression to CRC. Mutations in KRAS are found in approximately 40 percent of CRCs and large adenomas, and a subset of HPPs. Study results appearing in Gastroenterology suggest that although Kras/KRAS mutation promotes serrated and hyperplastic morphologic features in colon epithelium, it is not able to initiate adenoma development, perhaps in part because activated Kras/KRAS signaling does not increase the number of presumptive stem cells in affected crypts.

Gastroenterology 2011; 141(3): 1003-1013.e10

Diarrhea, Fatigue Most Common Symptoms Among IBD Patients

In a study published in Clinical Gastroenterology and Hepatology, doctors evaluated symptoms and stressful life events over a one-year period in a population-based sample of persons with IBD. They found that diarrhea and fatigue are the two most common symptoms of individuals with IBD. Those with inactive disease still report symptoms. Almost 50 percent of participants reported significant stress in any three-month period, but the primary types were everyday life stressors more so than health-related stress.

Clinical Gastroenterology and Hepatology 2011; 9(9): 769-775
 

Do Predictor Models Improve Prognosis Estimation?

Doctors from the U.K. aimed to develop a novel prognostic indicator for use in patients with advanced cancer that is significantly better than clinicians’ estimates of survival. They evaluated 1,018 patients with locally advanced or metastatic cancer, no longer being treated for cancer, and recently referred to palliative care services. According to data published in the British Medical Journal, in patients with advanced cancer no longer being treated, a combination of clinical and laboratory variables can reliably predict two-week and two-month survival.

British Medical Journal 2011; 343:d4920 doi: 10.1136/bmj.d4920

Submit Your Abstract for GI Cancers Symposium
There are only a few days left to submit an abstract for the 2012 Gastrointestinal Cancers Symposium, which will be held Jan. 19–21, 2012; abstract deadline: Sept. 20.

E. Faecalis Metalloprotease Compromises Epithelial Barrier

Matrix metalloproteases mediate pathogenesis of chronic intestinal inflammation. In a study in Gastroenterology, doctors found that the metalloprotease gelatinase, produced by commensal strains of Enterococcus faecalis, contributes to development of chronic intestinal inflammation in mice that are susceptible to intestinal inflammation by impairing epithelial barrier integrity.

Gastroenterology 2011; 141(3): 959-971

POLICY

Did I Go to Medical School so I Could Be Sequestered?

As part of the debt ceiling agreement that was enacted in August, Democrats and Republicans agreed to the creation of the Joint Select Committee on Deficit Reduction or the “super committee,” which is charged with reducing spending. By Nov. 23, 2011, the super committee must produce detailed legislation that would achieve at least $1.5 trillion in additional deficit reductions over the period of 2012 to 2021.

So, as the super committee meets and negotiates on how to achieve these savings, the question for doctors is whether an agreement or sequestration is better. Read a new post by Joel Brill, MD, AGAF, on the AGA Washington Insider, a policy blog for GIs, that summarizes the potential effects of the super committee and budget cuts on gastroenterology and the care of patients.

We want to hear from you. Use the comments section of the policy blog to share your thoughts on how expected budget cuts may impact your practice and care of patients.

PRACTICE

CMS Delays Implementation of Automated MSP Adjustments

On July 1, CMS implemented change request (CR) 6625 that created a systematic process in which Medicare automatically reopens/adjusts certain Medicare secondary payor (MSP) claims when a beneficiary’s MSP claims record was deleted or an end date was applied to an open beneficiary MSP record. This automated process no longer required physicians, providers and suppliers to contact their Medicare contractors to adjust or reprocess these types of MSP claims.

However, due to system issues currently affecting CR 6625, CMS directed its A/B Medicare administrative contractors, durable medical equipment Medicare administrative contractors and legacy contractors to immediately suspend all actions on this CR. This means that Medicare contractors are unable to automatically reopen/adjust claims when Medicare takes action to delete or terminate a previously existing MSP record.

Physicians, providers and suppliers must revert to the pre-July 1 process and contact their Medicare contractor to request re-openings/adjustments of claims that were previously considered MSP. Therefore, if you have claims that were processed since July 1 that need to be reopened/ adjusted due to Medicare now being the primary payor, you should contact your local Medicare contractor to request that action.

CMS will alert physicians, providers and suppliers once the current issues tied to the implementation of CR 6625 have been resolved.

PQRI Incentive Payment Distribution Has Begun

Incentive payments for the 2010 Medicare Physician Quality Reporting Initiative (PQRI) has begun for eligible professionals who met the criteria for successful reporting. Distribution of payments is scheduled to be completed by Sept. 30, 2011. (Please note, the program name changed to Physician Quality Reporting System in 2011.)

Effective January 2010, CMS revised the manner in which incentive payment information is communicated to eligible professionals receiving electronic remittance advices. CMS has instructed Medicare contractors to use a new indicator of LE to indicate incentive payments instead of LS. LE will appear on the electronic remit.

In an effort to further clarify the type of incentive payment issued (either PQRI or electronic prescribing incentive), CMS created a four-digit code to indicate the type of incentive and reporting year. For the 2010 PQRI incentive payments, the four-digit code is PQ10. This code will be displayed on the electronic remittance advice along with the LE indicator. Additionally, the paper remittance advice will read, “This is a PQRI incentive payment.” The year will not be included in the paper remittance.

If you have questions about the status of your incentive payment (during the distribution timeframe), please contact your provider contact center. Also, the QualityNet Help Desk is available Monday through Friday, 7 a.m. to 7 p.m. CT at 866-288-8912 or via qnetsupport@sdps.org. The help desk can assist with program and measure-specific questions.

In addition, CMS has posted a guide to help eligible professionals understand their 2010 PQRI incentive payments.

Gastroenterology Image of the Month

Unusual Cause of GI Obstruction

Question: An 82-year-old woman was referred for enteroscopic examination because of persistent vomiting with a 10-kg weight loss over three months. Previous CT of the abdomen suggested an inflammatory change of the jejunum. Her medical history was significant for atrial fibrillation. An oral route enteroscopy revealed an annular ulcerative area with severe luminal stenosis at 60 cm from the Treitz ligament (figure). The endoscopy was unable to pass through the area and an enterography was performed. Biopsy from the ulcer showed no malignancy. What is the endoscopic diagnosis of the lesions found?

Answer.

Access AGA Guidelines on Your Mobile Device

AGA guidelines provide preferred approaches to specific GI disorders and are developed through an evidence-based, multi-specialty and multi-stakeholder process. Access to AGA’s guidelines is now available, free of charge, on any Internet-capable mobile device as part of the AGA Mobile Tools application.

Empowering GI professionals on the move, AGA Mobile Tools streamlines vital information and services of importance to the GI community. Point-of-care resources that enhance practice and provide quality patient care such as AGA guidelines are conveniently accessible in this easy-to-navigate mobile application.

In addition, Mobile Tools features hot topics in news and policy, the latest peer-reviewed journal articles from Gastroenterology and Clinical Gastroenterology and Hepatology and sources for funding opportunities in medical academia. It is simply easier than ever to get the AGA resources you need.

Add AGA Mobile Tools to your mobile device today:

• IPhone/Blackberry/Other Devices — visit www.gastro.org/mobiletools using your mobile browser. Upon accessing the site for the first time, you will be asked to bookmark this page. Set a bookmark by using your in-browser menu.
• Android — download AGA Mobile Tools from the Android Marketplace.

RESEARCH

Your AGA Research Foundation Gifts Support ...

 … Karen Edelblum, PhD, University of Chicago, IL, who received a 2011 AGA Research Scholar Award.

“During my postdoctoral research, I have developed live in vivo imaging techniques to visualize the migration of y8 intraepithelial lymphocytes (lELs) within the small intestine epithelium. The purpose of the current study is to understand the molecular interactions by which y8 IELs and epithelial cells directly interact via occluding, and determine how these interactions affect disease initiation and progression in a celiac-like mouse model of disease. I am proud to be a recipient of the research scholar award and would like to thank all of those who made AGA support of this project possible, as it will be invaluable as I begin my independent research program."

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

Deadline Extended — New Research Scholar Award in GERD

The deadline to apply for the AGA-Takeda Research Scholar Award in GERD has been extended to Friday, Oct. 14.

This research award funds research relevant to GERD and provides $60,000 per year for two years (total $120,000) to young investigators working toward independent careers in gastroenterology, hepatology or related areas.

The award’s objective is to enable young investigators to develop independent and productive research careers in digestive diseases by ensuring that a major portion of their time is protected for research.

To be eligible, applicants must meet the following criteria:

• Hold an MD, PhD or equivalent degree.
• Hold a full-time faculty position at a North American university or professional institute by July 1, 2012.
• Be an AGA member at the time of application.
• Have a record of accomplishment in research.
• Be in the early years of a research career (i.e., no more than five years have elapsed since the completion of clinical or postdoctoral training).

Apply now — complete eligibility requirements and application information are available online.

EDUCATION & MEETINGS

Workshop Offers Tools for Building a Successful GI Career

Advance your career and network with your peers at the AGA Practice Skills Workshop, which will be held on Sunday, Jan. 22 immediately following the AGA Clinical Congress. This free one-day workshop for GI fellows in training will provide practical advice for building a successful career in academic or clinical practice in gastroenterology. You will take away strategies to help you critically and accurately assess your clinical practice options and career choices, and can earn up to 6.5 AMA PRA Category 1 Credits™.

The workshop brings together young and experienced faculty who will share their expertise on issues ranging from finding and negotiating job opportunities to evaluating different practice options and understanding the changes facing gastroenterologists in the next decade.

Topical highlights include:

• Your Curriculum Vitae and Interviewing Successfully.
• How Practices View Applicants Who Come to Interview.
• Becoming a Medicare or Commercial Provider.
• When Your Practice Changes: You Started Small and Your Practice Is Merging.
• Gastroenterologists and Accountable Care Organizations.

There will also be an informal mentoring lunch where you can meet and connect with the faculty and network with AGA leadership.

You must apply to attend this free workshop and you must also register for the AGA Clinical Congress. Selected applicants will receive a trainee scholarship in the amount of $500. Trainee scholarships will be awarded on a first-come, first-served basis and will be distributed on site at the workshop. You must be an AGA member in order to apply.

Space is limited to 75 attendees; register early to reserve your space.

Attracting MD/PhD Students into GI Workshop
Do you know an MD/PhD student who is interested in GI or hepatology? Tell them about this highly rated workshop for MD/PhD students, held in conjunction with the Academic Skills Workshop.

ANNOUNCEMENTS

Submit Your Leadership Nominations; Deadline is Oct. 1

The AGA Nominating Committee, chaired by Gail A. Hecht, MD, MS, AGAF, is in the midst of identifying candidates for the offices of vice president, clinical research councillor, community private practice councillor and eight nominees for the 2012–2013 nominating committee ballot.

AGA members are encouraged to submit nominations to ensure that the most qualified and committed candidates are selected to serve next year. Nominations must be submitted by Oct. 1.

Each member may nominate only one person per available position. (Each member may submit one nomination each for vice president, clinical research councillor and community private practice councillor, and up to eight nominations for members of the nominating committee.)

Officers and councillors on the AGA Institute Governing Board and members of the current nominating committee are prohibited from proposing, supporting or endorsing candidates for nomination.

Only full members may be considered for vice president and councillor.

Only full members or senior members may be considered for the nominating committee.

Current and prior nominating committee members are not eligible to serve on the committee again for five years.

Letters of support from members are limited to two per nominee. The letters should not summarize the nominee’s curriculum vitae (CV), but should address the nominee’s personal qualities, strengths and weaknesses.

Nominate yourself or one of your colleagues. Nominations will only be accepted electronically. Nominations must be made via the AGA National Office’s website by Oct. 1, 2011. You may navigate here, or log in to www.gastro.org, select “My AGA,” go to “My Committees,” select “Manage My Committees” and access the leadership nomination form.

The deadline for receipt of nominations is Oct. 1, 2011. The committee chair will contact nominees to request CVs and determine interest and willingness to serve.

Learn more.

Request for Applications: Online Education Editor

The AGA Institute is soliciting applications from interested members for the position of editor for online education. The selected individual will serve on the AGA Web Advisory Board to represent the AGA Institute Education & Training Committee’s online education initiatives.

The editor for online education will lead the innovative and prospective planning of online AGA Institute educational content. These activities, under the umbrella of GI LEARN^®, range from Web-delivered content to mobile applications. Responsibilities include: continuously evaluating current offerings, proposing new programs, assessing new technology in relation to AGA Institute program needs, and maintaining an effective process for the design, adoption and assessment of online educational activities.

All applicants must be AGA members with a terminal degree. Strong candidates will have an active, engaged interest in shaping the future of education in gastroenterology and hepatology. He or she should be well-grounded in practical knowledge of what digital technology can do to support this mission.

This tenured position receives an honorarium.

Learn more and apply.

Last Week's Twitter Buzz

Some of our favorite and popular news items of interest featured via Twitter last week include:

• Networks and Email Dominate Physician Sharing 33charts.com/2011/09/networ… #med2 (via @Doctor_V).
• Folate tied to lower colon cancer risk | Reuters bit.ly/oLQIjn via @Reuters.
• RT @gastromom: Parents rank Obesity low on list of Medical conditions warranting attention. http://ow.ly/6n0N0.
• Higher vitamin D intake & blood levels of the vitamin's active form are linked to lower risk of colon, rectal cancers http://ow.ly/6jOsM (via @Reuters).

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.

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.

Colorado
GASTROENTEROLOGIST: Denver Health Medical Center, nationally recognized as the premier safety net provider in the country, is actively recruiting faculty with clinical interests in luminal gastroenterology who will be using the strengths of our integrated delivery and information systems to provide, understand, evaluate and improve the delivery of digestive health care to all who live in the Denver metro area. Our program is fully integrated with the University of Colorado School of Medicine GI division, including appropriate academic rank and a combined fellowship. Please contact Joel Levine, MD, GI chief at Joel.Levine@dhha.org for further information.

GASTROENTEROLOGISTS/CLINICAL HEAD OF GI: The division of gastroenterology and hepatology at the University of Colorado Denver is seeking talented and energetic clinical academicians. The university serves as a tertiary referral center for the Rocky Mountain region, and the division has outstanding programs in endoscopy, transplantation, early detection and chemoprevention of colon cancer, and other clinical research. Applications are sought from individuals with strong clinical academic and leadership skills. Salary is based on the academic level of entry and individual qualifications and responsibilities. The Denver area provides a beautiful outdoor-oriented environment to complement the opportunities provided through the university. CVs and applications will be processed via www.jobsatcu.com, position number 811902.

Maryland
Large multi-specialty practice serving Montgomery County, MD seeks a BE/BC gastroenterologist. Excellent opportunity to join a large private practice with an integrated referral system. Please forward your CV to elliotrgoldstein@yahoo.com.

New York
Assistant professor of medicine in the department of medicine medical service group at SUNY-HSC at Syracuse, Inc., NY. Engage in clinical care, research and teaching in the area of gastroenterology. Requirements: MD or foreign equivalent, completion of gastroenterology fellowship, eligibility to sit for the gastroenterology boards through completion of fellowship, and license/permit to practice medicine in the state of New York. Qualified applicants: Please send resume and cover letter to Deborah J. Tuttle, SUNY Upstate Medical University, Department of Medicine, 550 East Genesee Street, Syracuse, NY 13202.

North Dakota
Procedure-Oriented Practice

Sanford Health Fargo has immediate openings for BC/BE gastroenterologists in a procedure-oriented practice. Call 1:8. 100 percent hospitalist coverage; hospital consults only. Procedures performed include: ERCP, EUS and capsule endoscopy. ERCP and EUS skills are desirable, but not necessary. Opportunity to teach medical students and IM residents. Level II 583-bed trauma center with electronic medical records and PACS. Sanford Health Fargo consists of 585+ physicians located in Fargo and 32 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 Physician Placement
Phone: 701-280-4853
E-mail: jean.keller@sanfordhealth.org
www.sanfordhealth.org

Virginia
Hospital-employed group practice seeking gastroenterologist with ERCP skills. This is an established four-person group located at the campus of Augusta Health. This entity is part of a larger 50-physician multi-specialty group affiliated with Augusta Health, Inc. This is a dynamic physician-driven organization serving the cities of Staunton and Waynesboro, and a large surrounding area consisting of a population of approximately 200,000. August Health is a sole community provider and holds the majority market share position for many services. Very competitive salary and benefits. No J-1 available. Contact: Arlene Macellaro, director, physician recruitment/practice development, 540-332-4462.