September 01, 2011 Home|Journals & Publications|  AGA eDigest
AGA eDigest

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

LEADING THE NEWS

AGA Advocates for Fair Medicare Reimbursements

On Aug. 30, 2011, the AGA, along with the ACG and ASGE, submitted comment letters to CMS on both the 2012 Medicare physician fee schedule (MPFS) proposed rule and the 2012 hospital outpatient prospective payment system (HOPPS)/ambulatory surgery center (ASC) proposed rule. AGA also sent a letter to CMS on the quality reporting measures in the Physician Quality Reporting System (PQRS).

MPFS
The joint letter to CMS focused primarily on changes in payment policies and proposals that will impact gastroenterologists and their patients. The overall impact of the policy changes in the proposal for gastroenterologists is 0 percent, although CMS has proposed an overall 29.5 percent cut in the conversion factor. AGA, and all of organized medicine, continues to advocate for a stable and predictable payment formula; Congress will be debating this issue in the fall.

PQRS
AGA submitted a comment letter to CMS on the 2012 PQRS, specific to the quality measures related to gastroenterology. AGA is pleased that the proposal includes some of the AGA-IBD measures, creating an opportunity for GIs to qualify for a bonus payment for quality reporting. Additionally, the measures group is proposed to be reported only via a CMS-qualified registry, which includes the AGA Digestive Health Outcomes Registry™.

HOPPS/ASC Proposed Rule
The joint society letter on the HOPPS/ASC proposed rule addressed payment policies that impact gastroenterologists. We urged CMS to update ASC payment rates using the hospital market basket instead of the current consumer price index-urban, which we believe does not accurately assess the costs associated with providing care in an ASC. The GI societies also urged CMS to eliminate the secondary rescaling process applied to the ASC payment rates since it has a negative impact on updates. The overall payment update for ASC procedures is 0.9 percent, and the overall update for payment rates for procedures in hospital outpatient departments is 1.1 percent.

Our comments also focused on the proposed quality reporting program for ASCs for which ASCs will be required to submit quality measures beginning Jan. 1, 2012, and can be subject to a 2 percent reduction for non-compliance. We recommended that the reporting program be pushed back to begin on Oct. 2, 2012, and that the penalty be scaled down to a 0.4 percent reduction, which is consistent with the initial hospital reporting program.

The AGA will monitor the implementation of both of these proposals and continue to advocate for fair and stable reimbursement policies for gastroenterologists.

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NEWS FROM THE LITERATURE

Cancer Incidence, Mortality Are Not Increased in BE Patients

Barrett's esophagus increases risk for esophageal adenocarcinoma, but it is not clear how it affects risk for other cancers or overall mortality. According to a study in Clinical Gastroenterology and Hepatology, the incidence of esophageal cancer was increased in a population-based cohort of subjects with Barrett's esophagus. However, when esophageal and gastric cancers were excluded, total cancer incidence and overall mortality were not increased among subjects with Barrett's esophagus.

Clinical Gastroenterology and Hepatology 2011; 9(9): 754-761

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Telaprevir Alone or with Peginterferon, Ribavirin Reduces HCV RNA

In a study appearing in Gastroenterology, doctors evaluated antiviral activity of two weeks of therapy with telaprevir alone, peginterferon alfa-2a and ribavirin, or all three drugs in treatment-naïve patients with chronic hepatitis C virus (HCV) genotype 2 or 3 infections. They found that telaprevir monotherapy for two weeks reduces levels of HCV ribonucleic acid in patients with chronic HCV genotype 2 infections, but has limited activity in patients with HCV genotype 3.

Gastroenterology 2011; 141(3): 881-889.e1

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Colchicine, Methotrexate Are Effective After 20 Years

The combination of ursodeoxycholic acid (UDCA), colchicine and methotrexate (MTX) is effective therapy for a subset of patients with primary biliary cirrhosis (PBC) who do not respond to UDCA. However, the durability of the response is unclear. Treatment with the combination of UDCA and MTX or UDCA and colchicine led to sustained clinical remission in a subset of patients with PBC, stated doctors in a study in Clinical Gastroenterology and Hepatology. The response to the combination of UDCA and MTX appeared to be more durable than to UDCA and colchicine.

Clinical Gastroenterology and Hepatology 2011; 9(9): 776-780

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Doctors Analyze Shiga-Toxin-Producing E. Coli

An outbreak caused by Shiga-toxin-producing Escherichia coli (E. coli) O104:H4 occurred in Germany in May and June of 2011, with more than 3,000 persons infected. According to results published in the New England Journal of Medicine, in less than a week, studies revealed that the outbreak strain belonged to an enteroaggregative E. coli lineage that had acquired genes for Shiga toxin 2 and for antibiotic resistance.

New England Journal of Medicine 2011; 365: 718-724

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RESEARCH

Your AGA Research Foundation Gifts Support ...

 … Taeko Noah, PhD, of Cincinnati Children's Medical Center, who received the 2011 AGA-Horizon Pharma Fellow Abstract Prize.

"It is a great honor to be selected by the AGA as a recipient of the AGA-Horizon Pharma Fellow Abstract Prize. I deeply appreciate the effort of the AGA and the generosity of Horizon Pharma in encouraging the development of young investigators in the field of gastroenterology and hepatology research. I would also like to thank my mentor Noah Shroyer, MD, and the department of gastroenterology, hepatology and nutrition at Cincinnati Children's Medical Center for providing me the support for my postdoctoral training. Some of my research goals include understanding the function of a transcriptional factor, SPDEF, in the intestinal epithelium and applying this knowledge to gain insight into its role in the pathogenesis of colon cancer. This award provides personal validation with regard to my efforts, in addition to the opportunity to meet great researchers in the field and to exchange ideas and information that will advance my research.”

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

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PRACTICE

CMS Issues Final Rule on eRx Incentive Program

CMS issued a final rule on changes to the electronic prescribing (eRx) incentive program that seeks to provide greater flexibility for providers to ensure more providers are able to comply.

As part of the Medicare Improvements for Patients and Providers Act of 2008, providers would receive a reduction in payments of 2 percent for not being successful e-prescribers beginning in 2012. However, CMS issued this current final rule to address comments they received from providers who were having trouble complying with the statute. CMS announced they will make two modifications to the Medicare eRx incentive program.

  • CMS will modify the 2011 eRx measure so that a qualified eRx system for the Medicare eRx incentive program will include certified electronic health record (EHR) technology under the Medicare EHR incentive program. 
  • CMS is adding four additional significant hardship exemptions for eligible professionals to be exempt from the 2012 payment reduction, including:
  1. Eligible professionals who register to participate in the EHR program and adopt certified EHR technology.
  2. Eligible professionals who are unable to electronically prescribe due to local, state or federal law.
  3. Eligible professionals who have limited prescribing activity.
  4. Eligible professionals who have insufficient opportunities to report the eRx measure due to limitations of the measure’s denominator.

Currently, there are two hardship exemptions for professionals for the eRx program — eligible professionals or group practices in rural areas with limited access to high-speed Internet and eligible professionals or group practices in an area with limited available pharmacies with eRx capability.

For more information on the final rule, view the CMS fact sheet and read the Federal Register as well as the CMS blog.

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CGH Image of the Month

Caput Medusae
Chia-Hsin Liu, Chin-Hui Hsu

A 44-year-old man with chronic hepatitis B virus infection and alcoholic cirrhosis presented with a two-month history of progressive abdominal fullness. On physical examination he had icteric sclera, shifting dullness, dilated superficial abdominal veins (caput medusae) (figure), Cruveilhier-Baumgarten murmur and splenomegaly.

Read more in Clinical Gastroenterology and Hepatology.

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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.

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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.

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Follow AGA and Share Your Favorite Tweets

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

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:

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EDUCATION & MEETINGS

Trainee Abstracts Now Being Accepted for Clinical Congress

GI fellows in training are encouraged to submit an abstract at this year's clinical congress, which will be held Jan. 20 and 21, 2012, at the Loews Miami Beach Hotel, FL. The abstract submission deadline is Oct. 12.

Authors may submit abstracts in one of the following categories:

  • Clinical Trials
  • Endoscopy & Screening/Surveillance
  • Epidemiology
  • Outcomes Research
  • Pharmacotherapy
  • Clinical Practice: Other

All abstracts must be submitted online. Authors may submit more than one abstract. Only fellows may submit and present abstracts. There is a $30 fee due upon submission. Authors of selected abstracts will be notified by Oct. 31.

Selected abstracts will be presented during a wine and cheese reception on Jan. 20 and published in the February issue of Clinical Gastroenterology and Hepatology. This is a great opportunity for GI fellows to present their research in a small, intimate forum and obtain valuable feedback from the expert faculty and attendees.

View more information, including abstract submission guidelines, rules and instructions.

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2012 Practice Skills Workshop — For GI Fellows in Training

Following the clinical congress on Jan. 22, this free workshop will provide practical advice for building a successful career in academic or clinical practice in gastroenterology. Trainee scholarships are available.

Register for International Hep C Conference in Paris

The fifth annual Paris Hepatitis Conference will be held on Jan. 30 and 31, 2012, and is dedicated to the management of patients with hepatitis C. International experts will be reviewing the most up-to-date information and provide their personal recommendations for the clinical care of these patients.

The aim of the conference is to provide clinicians with state-of-the-art information as well as highly practical and relevant clinical guidance to optimize the management of hepatitis C for the ultimate benefit and cure of as many patients as possible worldwide.

Learn more and view the preliminary program.

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JOURNALS & PUBLICATIONS

Gastro and CGH Video Abstracts of the Month

Watch Graham Foster, MD, discuss his recently published Gastroenterology article, “Telaprevir Alone or with Peginterferon and Ribavirin Reduces Hepatitis C Virus Ribonucleic Acid in Patients with Chronic Genotype 2 But Not Genotype 3 Infections.” Provide your thoughts and comments on this important study via the YouTube comments tool.

 

Also watch Marshall M. Kaplan, MD, discuss his recently published Clinical Gastroenterology and Hepatology article, “Colchicine or Methotrexate, with Ursodiol, Are Effective After 20 Years in a Subset of Patients with Primary Biliary Cirrhosis.” Provide your thoughts and comments on this important study via the YouTube comments tool.

View our comprehensive library of video abstracts and educational videos on the AGA YouTube channel.

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Journal Editors' Picks

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

Gastroenterology

CGH

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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.

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.

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