2015-05-20 18:32:52 UTC

Extra Effort Will Move Medicine Forward, John Allen Says at Joint Presidential Plenary

May 19, 2015

Highlights from the annual AGA/ASGE Joint Presidential Plenary at DDW® 2015.

This post originally appeared in DDW® Daily News.

Medical providers and medical societies must keep moving forward just to stay where they are. Moving ahead, advancing clinical goals, advancing outcomes and advancing provider satisfaction takes far more effort.

“There is a ‘Red Queen’ effect in gastroenterology,” said AGA Institute President John I. Allen, MD, MBA, AGAF, during the joint AGA/ASGE Presidential Plenary. “The Red Queen told Alice that it takes all the running you can do just to keep in the same place. If you want to get somewhere else, you must run at least twice as fast. If I asked the physicians in this audience if they could relate to that quote, 95 percent would say yes. The other five percent are retired.”

Despite the challenges, gastroenterology has advanced. The SGR is gone, replaced by reimbursement systems that reward quality care rather than quantity care. New research, new drugs and new devices are advancing the fight against obesity and GI disease.

But significant challenges remain.

Medicare turns 50 this year. The revolution in medical payment and decision-making continues. Federal or state health-care programs cover 43 percent of Americans and control $1 trillion of the nation’s annual $2.1 trillion in health-care spending.

“Gastroenterology has benefited from 50 years of procedural reimbursement, but we are now in the crosshairs,” Dr. Allen said. “We are seeing a re-evaluation of all 106 of our endoscopy codes. There will soon be a reduction in site-of-service differentials and likely further restrictions on ancillary revenue streams.”

CMS and most commercial insurers are moving to quality- and value-based payments.

Dr. Allen opened Sunday’s plenary, which also included remarks from ASGE President Colleen Schmitt, MD, MHS and top science presentations from the societies.

Lee M. Kaplan, MD, PhD, director of the Massachusetts General Hospital Weight Center, said that understanding and treating obesity was key to providing quality care for the GI tract. He called obesity “a complex issue that can be daunting.”

Obesity causes or exacerbates at least 160 diseases, including 15 GI disorders. Obesity is now understood as dysfunction in the complex regulatory system intended to maintain a stable fat mass, stable liver mass and stable red blood cell mass. Obesity is a failure of regulatory mechanisms, and the GI tract is heavily involved.

“There is a wide heterogeneity in causes of obesity that leads to a wide variability in response to diet, drugs, devices and bariatric surgery,” he said. “The goal is to match the patient to the most effective treatment or combination of treatments for that patient.”

IBD shares similar complexities. It is not a single disease, said session presenter Maria T. Abreu, MD, AGAF, chief of gastroenterology and professor of medicine, microbiology and immunology at the University of Miami Health System, FL, but early indications show that common mechanisms and pathogens exist that can be manipulated to turn off IBD and perhaps cure it.

Ulcerative colitis and Crohn’s disease represent the two extremes of IBD, but recent research has found 110 genetic loci shared by both. Autologous hematopoietic stem cell treatment has been successful in a subgroup of Crohn’s patients, which suggests similar therapy for other forms of IBD.

Anti-TNF therapies do help with IBD, Dr. Abreu said, but blocking TNF is like blocking bullets while ignoring the shooters. Existing biologic agents may be effective in preventing T cells from moving from the circulation into the gut where they cause disease. Other agents may be able to sequester T cells to achieve the same goal. 

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