June 03, 2010
AGA eDigest AGA eDigest
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Clinical Practice



Eugene Chang, MD, AGAF
Basic Research Councillor

F. Taylor Wootton III,
Private Practice Councillor

Congress Fails to Fix SGR

For the third time this year, Congress has failed to address the sustainable growth rate (SGR) payment formula. With Congress leaving town for the Memorial Day recess, the 21.3 percent cut is effective June 1.


Lead Story, continued

This is unacceptable. Congress has been struggling this year to even pass short-term temporary fixes to halt the payment cut, which further exacerbate the underlying problems of the SGR and make the cost of a permanent fix more problematic. The longer Congress fails to address enacting a permanent fix, the more patients' access to specialty care is put at risk.

Last Friday, the House passed H.R. 4213, which would prevent the 21.3 percent cut, replace it with a 2.2 percent increase for the remainder of 2010 and provide a 1 percent update for 2011. Because the legislation would not repeal the SGR, beginning in 2012, the SGR would go back into effect and physicians would be faced with cuts of nearly 33 percent. The Senate was unable to address this legislation and recessed for the week, which resulted in the 21.3 percent cut going into effect. However, once again, CMS has alerted providers and carriers that they will hold all claims for 10 business days to give Congress time to address the cut.

In the interim, Congress needs to hear that enough is enough and they must provide a permanent solution to the Medicare physician payment crisis. The AGA and the Alliance of Specialty Medicine have a toll-free hotline through which physicians can call their senators and representatives and urge them to enact a permanent solution to the SGR that fairly and accurately reimburses physicians for the services that they provide to Medicare beneficiaries. Your call is necessary to help urge Congress to repeal this flawed formula once and for all.

Call the toll free number, 866-899-4088, to connect with your legislators; when prompted, press 4242 or bypass the introduction by pressing 1, then 4242.

The AGA will continue to fight with all of organized medicine to urge Congress to fix the broken formula once and for all, and will continue to provide timely updates in the AGA Washington Insider.

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Dyspepsia Symptoms After Gastroenteritis More Prevalent in Exposed Individuals

Symptoms of dyspepsia may occur following an episode of acute gastroenteritis, but data are conflicting. In a study published in Gastroenterology, doctors found that symptoms of dyspepsia eight years after an outbreak of acute gastroenteritis were significantly more prevalent in exposed compared with non-exposed individuals.

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IBS Patients May Have Exocrine Pancreatic Insufficiency

Patients with IBS might have other underlying pathologies. Pancreatic disease can be elusive — especially in the early stages — and some symptoms overlap with those of IBS. According to study results appearing in Clinical Gastroenterology and Hepatology, pancreatic exocrine insufficiency was detected in 6.1 percent of patients who fulfilled the Rome II criteria for diarrhea-predominant IBS (D-IBS). In these patients, pancreatic enzyme therapy might reduce diarrhea and abdominal pain. Pancreatic exocrine insufficiency should be considered in patients with D-IBS.

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IBS Resource

The "Computer-Based Learning Program," endorsed by the AGA Institute, offers more than 750 images covering functional GI disorders. View complete list and purchase slides individually or as a complete set.


Risk Index Category Can Predict Surgical Site Infection

The risk index category is a tool to predict and compare surgical site infection rates among surgeons and hospitals. However, the accuracy of the index in colorectal surgery has been questioned because the index was validated in a patient population with lower surgical site infection rates than recently reported in the literature. In a study appearing in Diseases of the Colon Rectum, doctors concluded that the risk index category is a strong predictor for the development of surgical site infection in colorectal surgery patients when infections are prospectively collected and should be used to stratify patients when reporting infection rates in elective colorectal surgery.

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Gastric Bypass Increases Energy Expenditure in Rats

Mechanisms underlying weight loss maintenance after gastric bypass are poorly understood. Data published in Gastroenterology suggests that gastric bypass in rats prevented a decrease in energy expenditure after weight loss. Diet-induced thermogenesis was higher after gastric bypass, compared with body weight-matched controls. Raised energy expenditure may be a mechanism explaining the physiologic basis of weight loss after gastric bypass.

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Obesity Resource for Your Patients

"The No-Diet Obesity Solution for Kids"

Written by a pediatric GI, this patient resource provides parents of overweight and obese children with practical advice, stories and examples from other families and children.

Learn more and order today.



What Are Specialty Physicians Doing About Medicare?

As you know, Medicare reimbursement to physicians continues to be in jeopardy since Congress has enacted three temporary measures to prevent a scheduled 21.3 cut and needs to act again to prevent this cut from being implemented. In an effort to better understand the implications for Medicare beneficiaries should this 21.3 percent cut go into effect, the Alliance of Specialty Medicine, of which AGA is a member, is conducting a brief survey on specialists' plans for Medicare participation.

The survey, which is designed to help determine how these threatened pay cuts and instability in the program are affecting specialty physicians, will guide the alliance's messages regarding Medicare's current physician payment formula.

Please participate in this brief survey to ensure gastroenterology is included in the results. The survey needs to be completed by June 30. Should you have any questions, please contact Kathleen Teixeira at kteixeira@gastro.org. Thank you for helping us make a difference for you.

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FTC Delays Enforcement of Red Flags Rule

The FTC has announced that it will be delaying enforcement of its red flags rule through Dec. 31, 2010, while Congress considers legislation that would exempt physician, attorney and accounting offices with fewer than 20 employees from having to comply with the regulation that calls for banks and creditors to have written plans in place to prevent, identify and mitigate identity theft. Originally, there was a June 1 deadline for compliance. The AGA, along with the AMA and organized medicine, continues to advocate that physicians should be exempt from the red flags rule. In fact, the AMA, the American Osteopathic Association and the Medical Society of DC recently filed a lawsuit challenging the red flags rule.

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Joint Commission Modifies Deemed Status Process for ASCs

The Joint Commission has added some new requirements and an additional survey day for larger facilities to its CMS ambulatory surgery center (ASC) deemed status process.

The changes were made to accommodate the new conditions for coverage and interpretive guidelines that CMS issued for ASCs last year. Changes to the commission's deemed status survey process for ASCs include:

  • Additional reviews of credential files for physicians and personnel files for licensed non-physician practitioners.
  • Completion of the CMS infection control worksheet.
  • Review of closed medical records.
  • Observation of one full surgery or procedure.
  • Addition of one survey day for ASCs that perform more than 600 cases annually.

The Joint Commission conducted pilot surveys and participated in CMS surveyor training last year to come up with a process that would comply with CMS' new directives without disrupting the commission's patient tracer approach to ASC observations.

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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 Web site. 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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June 23: GI Quarterly Update Audio Conference

New changes in billing and reimbursement issues can significantly impact your practice. Understanding modifiers, CMS policy changes and a laundry list of other issues can help ensure the financial success of your practice.

McVey Associates, along with the AGA Center for Practice Management, is offering a series of four audio conferences. You can register for each audio conference separately or register for all four and save $175.

Dates of upcoming audio conferences:

  • June 23, 2010
  • Sept. 22, 2010
  • Dec. 29, 2010
  • March 23, 2011

Download the registration form to learn more or to register.

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FDA Drug Safety Updates

Hospira Expands Nationwide Liposyn™ & Propofol Recall
Hospira, Inc., a global specialty pharmaceutical and medication delivery company, announced that it is voluntarily expanding its March 31, 2010, recall of propofol injectable emulsion 1 percent and Liposyn™ (intravenous fat emulsion) products to the consumer or user level. Hospira is conducting the recall because some of the containers may contain particulate matter.

Learn more.

Claris Lifesciences Recalls All Lots of Ciprofloxacin Inj.
Claris Lifesciences announced the voluntary nationwide recall of all lots of Ciprofloxacin Inj. USP 200 mg/100 mL (NDC 36000-008-24), Ciprofloxacin Inj. USP 400 mg/200 mL (NDC 36000-009-24), Metronidazole Inj. USP 500 mg/100 ml (NDC 36000-001-24) and Ondansetron in 5 percent Dextrose Inj. 32 mg/50 mL (36000-014-06). The lots were distributed to hospitals, wholesalers and distributors nationwide.

Claris has initiated this recall as a precautionary measure against possible contamination due to packaging integrity of the product. The company has received reports of floating matter, which may pose risk if administered to patients. Health-care professionals should NOT use these products and should immediately remove them from their pharmacy inventories.

Learn more.

Orlistat Labeling Change
FDA notified health-care professionals and patients that it has approved a revised label for Xenical to include new safety information about cases of severe liver injury that have been reported rarely with the use of this medication. The agency is also adding a new warning about rare reports of severe liver injury to the over-the-counter drug facts label for Alli.

Xenical and Alli are medications used for weight loss that contain different strengths of the same active ingredient, orlistat. Xenical (orlistat 120 mg) is available by prescription and Alli (orlistat 60 mg) is sold over the counter without a prescription. This new safety information, originally announced in August 2009, is based on FDA's completed review of orlistat.

Health-care professionals should weigh the benefits of weight loss with the potential risks associated with Xenical and Alli before prescribing or recommending these medications to their patients. Patients should stop use of orlistat and contact their health-care professional if they develop the signs and symptoms of liver injury, including itching, yellow eyes or skin, dark urine, light-colored stools, or loss of appetite.

Learn more.

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Don't Be the Last to Know About Important Drug Alerts

Instead of waiting for late-breaking FDA-required alerts to arrive through the mail, receive them instantly in your inbox. Visit the AGA Institute/Health Care Notification Network Web site to complete the short registration process.


Free Webinar Highlights Practice Benefits of AGA Registry

AGA members are encouraged to participate in a free one-hour live Webinar to learn how the AGA Digestive Health Outcomes Registry™ can help them monitor and improve patient care while also generating data to evaluate the efficacy of treatments, manage patient populations and, potentially, increase reimbursement. The Webinar will be held on Wednesday, June 16, noon to 1 p.m. ET.

Presenters include both the chair and the chief medical officer of the AGA Registry Executive Management Board, John I. Allen, MD, MBA, AGAF, and Joel V. Brill, MD, AGAF, respectively. Also presenting will be Joseph Lynch, RN, CPHQ, representing AGA's registry partner, MedAssurant, Inc.

A Q&A session will follow the presentations, providing an opportunity for participants to ask questions specific to their practices.

Register now for this free Webinar.

Have you requested information about the AGA Registry? Enrollment packages have been mailed. If you have not received your enrollment material, or if you have any questions, contact an enrollment advisor at info@agaregistry.org or 877-809-9559.

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Call for Papers on Clinical Trials: Gastroenterology

Gastroenterology is committed to advancing clinical practice in the field of digestive disease. Recognizing that clinical trials generally have the greatest impact of all studies on clinical practice, Editor Anil K. Rustgi, MD, and his associate editors strongly encourage authors to submit their manuscripts on clinical trials (diagnostic validation, therapeutic efficacy) of drugs, biological materials and devices in digestive, liver and pancreatic diseases, including studies at phases I, II and especially III, to Gastroenterology for consideration. The journal is also interested in publishing trials in endoscopic and imaging modalities.

There are several important reasons to submit clinical trial research for publication in Gastroenterology:

  • With an impact factor of 12.6, Gastroenterology is the premier journal in the field.
  • Gastroenterology is the journal that will directly reach the largest portion of physicians who care for and make treatment decisions for patients with GI or liver disease.
  • Authors who submit their manuscripts to Gastroenterology typically will receive decisions within three weeks or fewer.
  • Accepted manuscripts will be published online and indexed on PubMed within 10 days of acceptance.

To submit your manuscript to Gastroenterology, go to www.editorialmanager.com/gastro. For important information on how to report clinical trials, go to www.gastrojournal.org/authorinfo. To review the current and past issues of the journal, go to www.gastrojournal.org.

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Place GI position listings and activity announcements in AGA eDigest.

For only $82.50, you can place an ad of 100 words or less in two consecutive issues and for $165 in four consecutive issues. Ads can also be placed in AGA Perspectives, AGA's bi-monthly magazine. If you place ads in both AGA Perspectives and AGA eDigest, you will receive a 10 percent discount. For more information, contact Alissa Cruz at acruz@gastro.org or 301-272-1603.

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Visit our newly redesigned career center today.

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