American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

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LEADING THE NEWS

NEWS FROM THE LITERATURE

Prevalence and Indicators of Portal Hypertension in NAFLD

Little is known about the prevalence and severity of portal hypertension in patients with NAFLD. In a study appearing in Clinical Gastroenterology and Hepatology, signs of portal hypertension were present in 25 percent of patients at the time of diagnosis of NAFLD; most had advanced fibrosis or cirrhosis. Portal hypertension can occur in a small proportion of patients with mild or no fibrosis and is associated with the extent of steatosis. Features of advanced liver disease and insulin resistance might identify patients with NAFLD and portal hypertension, and those expected to derive the most benefit from endoscopic screening for esophageal varices.

Clinical Gastroenterology and Hepatology 2012: 10(9): 1028-1033.e2

Operating Characteristics of Endoscopic Findings Inadequate for EoE Diagnosis

Endoscopic findings such as esophageal rings, strictures, narrow-caliber esophagus, linear furrows, white plaques, and pallor or decreased vasculature might indicate the presence of eosinophilic esophagitis (EoE). According to data published in Clinical Gastroenterology and Hepatology, there is heterogeneity among studies in the reported prevalence of endoscopic findings in patients with EoE. However, in prospective studies, at least one abnormality was detected by endoscopy in 93 percent of patients. The operating characteristics of endoscopic findings alone are inadequate for diagnosis of EoE. Esophageal biopsy specimens should be obtained from all patients with clinical features of EoE, regardless of the endoscopic appearance of the esophagus.

Clinical Gastroenterology and Hepatology 2012; 10(9): 988-996.e5

Gastroesophageal Reflux Symptoms Have Increased Substantially

Changes in the occurrence of gastroesophageal reflux symptoms in the population remain uncertain. A study in Gut suggests that between 1995–1997 and 2006–2009, the prevalence of gastroesophageal reflux symptoms increased substantially. At least weekly gastroesophageal reflux symptoms increased by 47 percent. The average annual incidence of severe gastroesophageal reflux symptoms was 0.23 percent, and the corresponding spontaneous loss was 1.2 percent. The incidence and spontaneous loss of gastroesophageal reflux symptoms were influenced by gender and age.

Gut 2012; 61: 1390-1397

Analysis of Bile Duct Biopsies Is Important in Patient Management

Evaluation of indeterminate biliary strictures typically involves collection and analysis of tissue or cells. Single-operator, peroral, cholangioscopic techniques have been developed that allow for a biopsy sample to be obtained from a specific area of the visualized stricture. In a study in Clinical Gastroenterology and Hepatology researchers concluded that analysis of bile duct biopsies is important in management of patients with indeterminate biliary strictures. Use of a special handling protocol for these small biopsies could reduce the number of cases with insufficient material for diagnosis. Increasing the sample size (either by using larger biopsy forceps or obtaining more biopsy bites) could improve the sensitivity of the SpyGlass technique. As endoscopists and pathologists gain more experience in collecting and handling small biopsies, the diagnostic efficacy of intraductal biopsies will continue to improve.

Clinical Gastroenterology and Hepatology 2012: 10(9): 1042-1046

PRACTICE

Are You Using an EHR to Advance Patient Care?

By Carla H. Ginsburg, MD, MPH, AGAF; chair, AGA Public Affairs & Advocacy Committee

AGA and the Alliance of Specialty Medicine are working with CMS and Congress to improve Medicare's current electronic health record (EHR) incentive program. To make sure we are meeting the needs of members, the alliance has created a survey to help us gather information about your experience with EHRs. By completing the survey, you will help us gather data about how specialists are using this technology to advance patient care. By better understanding your needs, we will be able to advocate that CMS make changes important to your practice.

Take the survey.

Under the EHR incentive program, beginning in 2015, physicians who did not demonstrate meaningful use criteria in 2013 will face reductions in their Medicare payments. This means payments will be reduced by 1 percent in 2015 for those who do not participate, and the reductions will increase each year — 2 percent in 2016 and 3 percent for 2017 and each subsequent year. These penalties are on top of other requirements in the Patient Protection and Affordable Care Act, such as the Physician Quality Reporting Program and the new value-based payment modifier.  

We hope to use the data to better understand the utilization of EHRs by our members since it serves as a foundation for other quality reporting initiatives. The data will be analyzed and shared with Congress and CMS, and may be the basis for advocating for modifications and/or delays in the meaningful use requirements. Additionally, this data will help us better understand the adoption of EHRs by gastroenterologists compared with our other specialty colleagues and whether there are cross-specialty commonalities for which we can advocate.   

We realize you are busy and appreciate your assistance in providing information about your experience with EHRs, which will assist us in our advocacy efforts.

Take the survey to help ensure the needs of GI are being met.

Should Endoscopy Reporting Be Standardized?

In this month’s Clinical Gastroenterology and Hepatology column “Practice Management: The Road Ahead,” Louis Y. Korman, MD, Metropolitan Gastroenterology Group, Chevy Chase, MD, discusses the vital need for standardized endoscopy reporting. While physicians often prefer the use of natural language reporting, Dr. Korman argues that there needs to be balance between GIs’ desire to define the information in their endoscopy reports with the controlled vocabulary needed for electronic health records.

With both government and commercial payors transitioning to value-based reimbursements that will link health outcomes with payments, there is a heightened need to collect specific performance measures derived from standardized data elements. Endoscopic findings need to be recorded in a manner that everyone involved in a patient’s care can understand. Dr. Korman believes that the GI community must work together to create standardized reporting that ensures endoscopy records and reports become models for achieving the goal of effective patient care and rational clinical practice. This cooperation is needed to create and maintain the common ground for a sustainable clinical and business model.

Read more.

Is Your ASC Prepared for 2012 Quality Reporting?

Between Oct. 1 and Dec. 31, 2012, CMS will require all Medicare-certified ambulatory surgical centers (ASCs) to report on five facility quality measures or otherwise face a 2 percent Medicare payment penalty in 2014.

Are you prepared? Do you still have questions regarding how this program will work?

Participate in a free webinar, hosted by AGA, ACG and ASGE, during which you will have an opportunity to ask questions about the new Medicare ASC Quality Reporting Program. Submit your questions in advance of the webinar.

During the webinar on Monday, Oct. 1, noon ET, you will hear an overview of the quality reporting program and be able to have your questions answered by a CMS representative. You will also learn about submitting quality data codes from GI physicians familiar with the ASC quality measures and reporting requirements.

This webinar is the last in a series of three education opportunities on the ASC Quality Reporting Program presented by the three societies. Did you miss the first two webinars? Review the content online.

Register today. Space is limited and available on a first-come, first-served basis. Submit your questions to marketing@gastro.org in advance of the webinar.

Presenters:

• Anita Bhatia, PhD, MPH, CMS program lead, Outpatient Hospital and ASC Quality Reporting Program
• Lawrence B. Cohen, MD, AGAF, FACG, FASGE, New York Gastroenterology Associates LLP
• James Leavitt, MD, Gastroenterology Care Center, Miami, FL
• Lawrence R. Kosinski, MD, MBA, AGAF, FACG, chair, AGA Institute Practice Management & Economics Committee; Elgin Gastroenterology

Stay Up To Date with Meaningful Use Requirements

CMS posted the final rule on the Electronic Health Record Incentive (EHR) Program — stage two — in the Federal Register. Joel Brill, MD, AGAF, and Lawrence Kosinski, MD, MBA, AGAF, have been actively engaged with CMS officials to prepare an in-depth summary of the final rule and help you plan for stage two.

The rule specifies the stage two criteria that eligible professionals, eligible hospitals and critical access hospitals must meet in order to qualify for Medicare and/or Medicaid EHR incentive payments. What does this rule mean for gastroenterologists?

• New Criteria — Starting in 2014, providers participating in the EHR incentive programs who have met stage one for two or three years will need to meet new meaningful use stage two criteria.
• Improvements in Patient Care — Stage two includes new objectives designed to improve patient care through better clinical decision support, care coordination and patient engagement.
• Saving Money, Time, Lives — With this next stage, CMS hopes EHRs will further save our health-care system money, save time for doctors and hospitals, and save lives.

Read more.

Please contact Deborah Robin, AGA senior director for quality, or Elizabeth Wolf, AGA director of regulatory affairs, if you have any questions about the requirements. For additional information on the stage two rule, review the CMS tip sheet.

ANNOUNCEMENTS

FDA Approves Qsymia™ for Chronic Weight Management

The FDA approved Qsymia™ (phentermine and topiramate extended release) capsule CIV with a risk evaluation and mitigation strategy (REMS) to ensure that the benefits of Qsymia outweigh the increased risk of teratogenicity. As part of the REMS, a letter to health-care providers as well as a  training program are available to present important information about the safe use of the drug.

Qsymia is indicated as an adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adult patients with an initial BMI of either of the following:

• 30 kg/m2 or greater (obese).
• 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbidity such as hypertension, type 2 diabetes mellitus or dyslipidemia.

Once available, Qsymia will be dispensed only through certified mail-order pharmacies that provide a medication guide and risk-of-birth-defects patient brochure with every prescription and refill, as required by the REMS. A list of these mail-order pharmacies will be available through the website www.QsymiaREMS.com once Qsymia is available.

Read more information about the REMS for Qsymia or call VIVUS Medical Information at 888-998-4887.

Leadership Nominations Due Oct. 1

The AGA Nominating Committee, chaired by C. Richard Boland, MD, AGAF, is in the midst of identifying candidates for the offices of vice president, secretary/treasurer, at-large councillor, education and training councillor, and eight nominees for the 2013–2014 AGA Nominating Committee.

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.  Learn more about nominating yourself or one of your colleagues.

AGA Needs You: Join Our Committees

AGA and AGA Institute committees recommend and oversee new and existing policies and programs. Committee service offers members several benefits — networking with other physicians and scientists, pursuing a special interest, or making an impact in an area that is important to you. The following committees will have open positions for members:

• AGA Digestive Health Outcomes Registry® Executive Management Board (eight positions open)
• Center for GI Innovation and Technology Executive Management Board
• Clinical Practice & Quality Management Committee (PDF) (one position open)
• Education & Training Committee (PDF) (one position open)
• Ethics Committee (PDF) (two positions open)
• International Committee (PDF) (two positions open)
• Practice Management & Economics Committee (PDF) (two positions open)
• Public Affairs & Advocacy Committee (PDF) (two positions open)
• Publications Committee (PDF) (one position open)
• Research Awards Panel (11 positions open)
• Research Policy Committee (PDF) (one position open)
• Underrepresented Minorities Committee (PDF) (three positions open)
• Women's Committee (PDF) (two positions open)

If you would like to nominate yourself and/or another AGA member, please visit the AGA website and log in. Go to My AGA and select the “Submit Committee Nomination” link in the My Committee section to submit your nomination(s). Nominations must be received no later than Nov. 1, 2012. If you should encounter any difficulties with the online nomination process, please contact Diane Field (dfield@gastro.org) at the AGA national office.

Nominees will be contacted to confirm their interest and to obtain their curriculum vitae. The AGA Institute Appointments Committee will consider applications and select appointees for each committee. These selections will then be brought before the AGA Institute Governing Board for ratification. The appointees will begin serving their term June 1, 2013.

AWARDS

Deadline Approaching for Liver Disease Award

The application deadline is Oct. 24 for the AGA-Emmet B. Keeffe Award in Translational or Clinical Research in Liver Disease. This $85,000 award, in memory of Emmet B. Keeffe, MD, will allow the recipient to pursue an independent, productive research career in translational or clinical research related to liver disease. The award is designed for an assistant professor or junior faculty member appointed to this position within two years or less from the time of application, or a senior fellow in a hepatology training program.

The award recipient will be selected based on the novelty, feasibility and significance of the proposed research. The research environment and the attributes of the candidate will also be considered.

This award is funded by Vertex Pharmaceuticals and donations from the friends and family of Dr. Keeffe.

Applications are also due in October for AGA Research Scholar Awards, which provide $90,000 per year for two years to young faculty working toward independent careers in gastroenterology, hepatology or related areas. Applications are due Oct. 19.

Candidates for both awards must be AGA members at the time of application submission. Complete eligibility requirements and application information for these and other research awards are available on the AGA website.

Check Out AGA's New Research Funding Opportunities

As part of its mission to create opportunities for young GIs to advance careers in research, the AGA Research Foundation offers funding to junior investigators working toward independent careers. The foundation recently announced the availability of two new research awards:

• The AGA-Caroline Craig Augustyn and Damian Augustyn Award in Digestive Cancer will support young investigators conducting research relevant to the pathogenesis, prevention, diagnosis or treatment of digestive cancer. The award will provide $40,000 in supplementary funding to an investigator who currently holds a federal or non-federal career development award (NIH K-series or similar award) devoted to digestive cancer research.
• The AGA-Elsevier Gut Microbiome Pilot Research Award will provide $25,000 to support pilot research projects pertaining to the gut microbiome. Both early stage and established investigators are eligible to apply for this award.

Applications for both awards are due Jan. 13. AGA membership is required at the time of application submission; membership information and complete application information are available on the AGA website.

DOD Announces Research Funding Opportunities

The following pre-announcement on a postdoctoral fellowship award may be of interest to those working on colon cancer/breast cancer or pancreatic cancer/breast cancer (BRCA2 mutations) research.

The fiscal year 2012 (FY12) Defense Appropriations Act provides $120 million to the Department of Defense Breast Cancer Research Program (BCRP) to support innovative, high-impact breast cancer research. The BCRP is administered by the U.S. Army Medical Research and Materiel Command through the Office of Congressionally Directed Medical Research Programs (CDMRP).

The FY12 BCRP program announcement and general application instructions for the following award are anticipated to be posted on grants.gov in October.

Eligibility

• Principal Investigator: doctoral graduates (PhD or MD). Clinical investigators are eligible to apply. Must have no more than two years experience in the proposed research setting and no more than four years of postdoctoral research experience as of the application deadline.
• Mentor or formal co-mentor must have breast cancer research experience, including current funding and publications.

Key Mechanism Elements

• Supports the training of exceptionally talented recent doctoral or medical graduates who have demonstrated that they are the "best and brightest" of their peers.
• Individualized training program and mentorship should prepare the principal investigator for an independent career at the forefront of breast cancer research.
• Proposed research should address a critical problem in breast cancer.

Funding

• Maximum funding of $300,000 for direct costs ($100,000 per year, plus indirect costs).
• Period of performance not to exceed three years.

A pre-application is required and must be submitted through the CDMRP eReceipt website (http://cdmrp.org) prior to the pre-application deadline. Applications must be submitted through the federal government’s single-entry portal, grants.gov. Submission deadlines are not available until the program announcement is released. Requests for email notification of the program announcement release may be sent to help@cdmrp.org. For more information about the BCRP or other CDMRP-administered programs, please visit the CDMRP website.

RESEARCH

Emmet Keeffe’s Legacy Lives On

Mina Rakoski, MD, at the University of Michigan, received the 2012 Emmet B. Keeffe Award in Translational or Clinical Research in Liver Disease.

“It is a great honor to have been chosen by the AGA Research Foundation as the first recipient of the Emmet B. Keeffe Award in Translational or Clinical Research in Liver Disease. I hope to carry on his legacy with reverence and enthusiasm.”

“The goal of my research proposal is to determine predictors of liver- and non-liver-related mortality among elderly patients with cirrhosis and to assess the validity of the model for end-stage liver disease score for predicting mortality in this population. This information is critical to help balance decisions regarding goals of care and aggressiveness of liver-related therapies in the elderly.”

“The Emmet B. Keeffe Award will provide protected time and support so that I can build a solid foundation in aging-related research, develop meaningful and productive collaborations with geriatric and palliative care investigators, and pursue my goal of becoming an independently successful researcher.”

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EDUCATION & MEETINGS

Submit Your Abstract to the 2013 GI Cancers Symposium

The 2013 Gastrointestinal Cancers Symposium (Jan. 24–26 in San Francisco, CA) is a specialized conference designed for the exchange of research and science in the field of gastrointestinal oncology. Join us for three days of focused, high-impact education and scientific innovation that maximizes learning and networking opportunities for attendees.

This year’s meeting marks the 10th anniversary of the symposium, offering attendees the opportunity to reflect upon ten years of advancements in GI oncology and discuss new approaches for the future. Submit an abstract and participate in this milestone meeting by visiting gicasym.org. The abstract submission deadline is Sept. 25, 2012, at 11:59 PM ET.

Only 10 Days Left to Join AGA Academy of Educators for Free

The deadline to apply to the AGA Academy of Educators for free is approaching. After Sept. 30, there will be a $25 application fee.

Join the academy today to enhance your teaching skills, gain recognition and advance your career as an academic medical professional. As a member, you will be able to access members-only educational resources, share scholarly work, discover new teaching tips, view sample CVs and join the Academy of Educators LinkedIn Group.

All AGA members who are involved in education are invited to join. View the criteria for membership and join today.

This activity is supported in part by a grant from Pfizer, Inc.

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 email 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.

District of Columbia

Gastroenterology Division
Department of Medicine, Washington Hospital Center
Washington, D.C.

Announcing the availability of a staff position in the division of gastroenterology and hepatology at the Washington Hospital Center. Letters of inquiry or recommendations are invited.

The MedStar Washington Hospital Center (WHC) is an 850-bed acute care academic medical center located in midtown Washington, D.C. Along with the MedStar Georgetown University Medical Center, the WHC is part of the MedStar Health System and is the largest not-for-profit hospital in D.C., serving as a major tertiary care hospital to the Washington metropolitan area and local community with a focus on subspecialty care, and maintains its own research institute.

The attending physician staff of the department of medicine includes 110 full-time teaching faculty and 450 voluntary staff. The gastroenterology division enjoys clinical, research and education programs, including a fully accredited gastroenterology fellowship program. Staff physicians manage hospitalized and ambulatory patients in an interdisciplinary setting and take an active role in the implementation of clinical research protocols and practice guidelines. Currently, the Gastroenterology Center of Excellence at Washington Hospital Center is developing initiatives in hepatology, advanced therapeutic endoscopy and endoscopic ultrasound, a clinical research consortium, and our endoscopy unit is performing 10,000 procedures annually. We are now recruiting experienced subspecialists with expertise in hepatology, inflammatory bowel diseases and GI motility for further expanding the clinical and research centers of excellence within our gastroenterology division. The immediately adjacent Veterans Administration Hospital and National Childrens Medical Center provide opportunities for collaboration. The gastroenterology faculty provide clinical consultation, resident and fellow education, clinical research, and clinical trials. Significant collaborative and academic opportunities have developed with Georgetown University since the acquisition by MedStar Health of the Georgetown University Hospital; full-time faculty at the WHC are eligible for academic faculty positions with the Georgetown University School of Medicine, equivalent to full-time faculty at Georgetown Hospital.

Interested candidates should send CV to: Leonard Wartofsky, MD, MACP; Chairman, Department of Medicine, Washington Hospital Center; 110 Irving Street, NW, Suite 2A-62, Washington, D.C. 20010; fax to 202-877-6292; or email to: leonard.wartofsky@medstar.net.

Georgia

Sensational practice with state-of-the-art endoscopy center in a beautiful location.

Gastroenterologist to join our extremely busy practice and ASC in beautiful Savannah, GA.

• Partnership opportunity after two years with the practice.
• Highly competitive base salary.
• A very productive practice with an endoscopy center.
• Located in the heart of the medical area in gorgeous Savannah, GA.
• Call schedule is 1/8.
• This is a single-specialty practice with solid reputation.
• Outpatient procedures performed at our endoscopy center or three area hospitals.
• Moving expenses are provided.
• Full family medical benefits.
• Malpractice coverage.
• Great vacation time paid with CME.

Our Mission Statement
To provide our patients with a comfortable and pleasant setting for receiving the best quality endoscopic care in southeast Georgia.

Applicant should possess strong clinical and endoscopic skills. Therapeutic ERCP and EUS would be a strong plus. Board certification is required, but we will help you reach that status if you are not there already. Applicant should also be personable, flexible, energetic and a hard-working individual.

Our physicians participate in continuing education by serving as part-time professors at our largest local health system.

Lynne Marini, CEO
lm@savannahgi.com
912-790-2696
Fax: 912-790-2702

New Jersey

Well-established GI practice in northern New Jersey looking for a part-time gastroenterology associate. Long-term position. Two to three days per week. No night or weekend call. Malpractice, health and pension.

Contact Cathy Shanahan at 973-633-1484. Fax: 973-633-7980. Email: cshanahan999@hotmail.com.

New York

Looking for GI associate to join three-person, well-established, busy GI group in New York City with two locations in Manhattan and Brooklyn. Must be fluent in Chinese. Competitive salary, benefits and partner track. Email CV to: lichixin@yahoo.com.