June 17, 2010
AGA eDigest AGA eDigest
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Clinical Practice

Education & Training



Eugene Chang, MD, AGAF
Basic Research Councillor

F. Taylor Wootton III,
Private Practice Councillor

Tomorrow — CMS to Begin Processing Claims at 21.3 Percent Cut Rate

As you know, last month the House passed H.R. 4213, legislation that included tax extensions and a 19-month physician payment fix. Unfortunately, the Senate failed to garner the necessary votes and this legislation failed yesterday.


Lead Story, continued
The Senate plans to vote today on a scaled back bill that would provide a six-month physician fix with an update at 2.2 percent. If the Senate passes this temporary fix, the legislation would still need to go back to the House for passage. Because the Senate has not acted on this legislation, technically, a 21.3 percent cut in Medicare physician payments went into effect on June 1. CMS has been holding claims for 13 business days to give Congress time to enact legislation to reverse this cut.

However, today is the last day that CMS will hold claims before having to begin processing claims at the reduced rate tomorrow.

The Senate needs to feel pressure from physicians that this cut must be reversed. AGA members are encouraged to contact their senators using the Alliance of Specialty Medicine's legislative hotline to urge them to prevent the cuts. 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.

If you would prefer to send a letter, you can use AGA's online advocacy system.

What Can Gastroenterologists Do About the Cuts?

Beginning Friday, physicians will have two choices for how to handle their Medicare claims.

  • Physicians can hold their claims until the pay rate is fixed and be reimbursed the correct amount the first time. However, this may cause difficulty for many smaller practices in meeting payroll and other overhead expenses with no revenue received from Medicare reimbursement.
  • Physicians can submit claims right away and get reimbursed one-fifth less, leaving Medicare to settle the difference retroactively once a bill has passed Congress.

Upcoming Congressional Action

The Senate plans to vote today on a scaled back version of H.R. 4213, which, if it passes, must go back to the House for a vote. AGA has been assured that once Congress passes H.R. 4213, any claims processed at the 21.3 percent reduction rate will be fixed retroactively. However, given the difficulty that the Senate has had passing even a 19-month fix, Senators need to hear from physicians that enough is enough — this cut must be fixed to provide physicians and beneficiaries some stability.

The AGA will continue to urge the Senate to move forward and prevent the 21.3 percent cut. We will provide timely updates on this critical issue via AGA eDigest and the AGA Washington Insider.

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CGH Image of the Month

Verrucous Squamous Cell Carcinoma: A Rare Esophageal Malignancy
Gregory W. Munson, Yvonne Romero and Dawn L. Francis

A 63-year-old woman with a history of osteoporosis presented with dysphagia, cough and chest pain.  She had a distant history of odynophagia after swallowing several medications without water. She felt well until early 2008 when she developed a paroxysmal cough so violent that she broke ribs and occasionally vomited, including hematemesis.  Five esophagogastroduodenoscopies for worsening symptoms showed severe reflux esophagitis, a Mallory-Weiss tear and thickened, friable mucosa in the mid and/or distal esophagus. She was treated for acid reflux and eosinophilic esophagitis. She underwent two endoscopic ultrasounds (EUS) to assess for possible malignancy. The first EUS showed intramucosal nodularity over 12 cm without suspicious lymphadenopathy; the other EUS showed a 13-cm segment with  submucosal involvement and one 4.5-mm periesophageal lymph node. On subsequent EUS, the lesion involved the edge of the muscularis propria and there were multiple suspicious peritumoral nodes up to 1 cm (figure).

Read more.



Surveillance Colonoscopy Is Cost-Effective for High-Risk Patients

Guidelines recommend that patients with colon adenomas undergo periodic surveillance colonoscopy. In a study published in Gastroenterology, doctors concluded that surveillance colonoscopy is cost-effective for patients who are at high risk for developing colorectal cancer. Aggressive surveillance can be expensive or even harmful; efforts should be made to improve risk models for colonic neoplasia.

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NSAIDs, Statins, PPIs May Reduce Esophageal Adenocarcinoma Risk

Limited evidence suggests that PPIs, NSAIDs/aspirin and statins may be associated with a low risk of esophageal neoplasia. However, the possible effect these medications may have on the risk of esophageal adenocarcinoma (EAC) in patients with existing Barrett's esophagus (BE) is unclear. An observational study in Gastroenterology indicates that in patients with BE, using PPI, NSAID/aspirin or statin therapy might reduce the risk of developing EAC.

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NSAID Resources

Connect to Protect, an online resource, is designed to help physicians and patients alike better understand and reduce the risks associated with NSAIDs. Resources include a Webcast, fact sheet and discussion guides.


Paris Criteria Are Effective in Diagnosing Primary Biliary Cirrhosis

Primary biliary cirrhosis (PBC) and autoimmune hepatitis (AIH) differ in clinical, laboratory and histologic features as well as in response to therapy. A small subgroup of patients has an overlap syndrome with features of both diseases, although there is no consensus on its definition or diagnostic criteria. Results appearing in Clinical Gastroenterology and Hepatology indicate that the Paris diagnostic criteria detect overlap syndrome with high levels of sensitivity and specificity. The clinical value of the revised and simplified AIH scoring system is not as reliable. Patients with PBC-AIH overlap syndrome have a 92 percent rate of 10-year, transplantation-free survival.

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Replicated Association Between IL28B Gene Variant & Sustained Response to PEG-IFN/RBV

Patients with chronic hepatitis C virus (HCV) infections are treated with pegylated interferon and ribavirin (PEG-IFN/RBV), which is effective in less than 50 percent of those infected with HCV genotype 1. Genome-wide association studies have linked response to PEG-IFN/RBV with common single nucleotide polymorphisms in the vicinity of interferon (IFN)-γ genes on chromosome 19. According to data published in Gastroenterology, rs12979860 genotype is a significant independent predictor of response to PEG-IFN/RBV in patients with chronic HCV infection; tests for this genotype might be used to determine the best course of treatment for patients considering antiviral therapy.

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HHS Announces Patient Safety & Medical Liability Initiative

On Sept. 9, 2009, President Obama addressed a joint session of Congress on health insurance reform and, in his speech, stated that he was asking HHS to launch an initiative to invest in new ways to address medical liability claims.

As a result, in October 2009, HHS launched a patient safety and medical liability initiative and announced the availability of $25 million in funding to address four goals:

  • Put patient safety first and work to reduce preventable injuries.
  • Foster better communication between doctors and their patients.
  • Ensure that patients are compensated in a fair and timely manner for medical injuries, while also reducing the incidence of frivolous lawsuits.
  • Reduce liability premiums.

On June 11, HHS announced the awarding of the $25 million in grants to meet these goals, including $19.7 million for seven demonstration grants, $3.5 million for 13 planning grants and $2 million for an evaluation grant.

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PECOS Enrollment Required for Medicare EHR Incentive Program

CMS announced that provider enrollment, chain and ownership system (PECOS) records will be used to verify Medicare enrollment prior to making Medicare electronic health record (EHR) incentive payments. Your enrollment information must be in PECOS, so act now if you do not have an enrollment record in this system.

If you are a physician who enrolled in Medicare before November 2003 and have not updated your Medicare enrollment information since then, you do NOT have an enrollment record in PECOS. Act now to establish your enrollment record in PECOS. Access instructions.

If you enrolled in Medicare after November 2003, or if you enrolled before November 2003 and have updated your Medicare enrollment information since November 2003, no further action is required.

If you are unsure:

  • Check the ordering referring report on the CMS Web site. If you are on that report, you have a current enrollment record in PECOS.
  • Use Internet-based PECOS to look for your PECOS enrollment record. (You will need to first set up your access to Internet-based PECOS.) If no record is displayed, you do not have an enrollment record in PECOS.
  • Contact your designated Medicare enrollment contractor and ask if you have an enrollment record in PECOS.

If you have submitted an enrollment application within the last 90 days and your enrollment application has been accepted for processing by the carrier or A/B MAC, you need not take any additional actions.

Note for physicians who reassign all their Medicare benefits to a group/clinic: the group/clinic must have an enrollment record in PECOS in order for you to enroll using Internet-based PECOS. You should check with the officials of the group/clinic or with your designated Medicare enrollment contractor if you are not sure if the group/clinic has an enrollment record in PECOS. If the group/clinic does not have an enrollment record in PECOS, you will not be able to use Internet-based PECOS to submit your enrollment application to Medicare. You will need to submit a paper enrollment application (CMS-855).

Learn how to establish an enrollment record in PECOS.

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Order Today

"EMR Field Guide for Gastroenterology" — find step-by-step instructions for selecting and implementing an EMR. This book is a must have for every GI practice.

Learn more.


NQF Releases Endoscopy/Polyp Surveillance Measures for Public Comment

The National Quality Forum (NQF) is conducting a public comment period for three endoscopy and polyp surveillance measures. The measures were jointly developed by the AGA, ASGE and the Physician Consortium for Performance Improvement® in 2008. One of those measures, Endoscopy & Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps — Avoidance of Inappropriate Use, is included in the CMS 2010 Physician Quality Reporting Initiative program.

All three measures were recently reviewed by an NQF Steering Committee and have been recommended for endorsement. As part of the endorsement process, the measures are now out for public comment. Public comments must be submitted no later than 6 p.m. ET, June 29, 2010. Learn more and submit comments.

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Enroll in the AGA Registry

This national, outcomes-driven registry can help you monitor and improve patient care while generating data to evaluate efficacy of treatments, manage patient populations and potentially increase reimbursement.

Learn more.



View Webinars on Prebiotics & Probiotics

The AGA Institute hosted a series of four Webinars that were designed to address the rapidly advancing field of human microbiota and their relationship to health and disease. The Webinars are now archived on GI LEARN® as an online educational resource to help clinicians better understand the evidence behind using probiotics and prebiotics in the prevention and treatment of GI disorders. The series also provides practical information on how to navigate the complex marketplace containing probiotic and prebiotic products, and guidelines on recommendations and use.

The series consists of four segments:

The Webinars are sponsored by the AGA Institute in conjunction with the International Scientific Association for Probiotics and Prebiotics and the International Life Sciences Institute North America, Committee on Gut Microbes and Health. This program is supported by educational grants from Danone Research, Institut Rosell, BioGaia and Yakult.

This activity has been approved for AMA PRA Category 1 CME Credit™.

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Patient Resources on Probiotics

View an online patient guide or listen to a podcast on what probiotics are and their health benefits.



Gastro.org — New Look, Enhanced Features

AGA has launched a newly designed Web site, offering users enhanced navigation and search capabilities. Based on member feedback, the new Web site was updated to include a cleaner look and feel as well as:

  • RSS feeds to keep you up to date on news in the field of GI. Sign up to receive information in the areas of practice, research, advocacy, fellowship and international relations.
  • Resource libraries, a one-stop shop to find the latest news, guidelines, courses and more, on topics related to AGA's sections. View the practice resource library and the research resource library.
  • My AGA, where you can find and update your contact information, sections and committees. You will also be able to connect to GI LEARN to track CME credits and organize educational activities in My Library.
  • Connect with AGA and your colleagues in the community section of the Web site. Here you can find AGA's Facebook page, Twitter feed, LinkedIn group and YouTube page. In addition, you can join a lively online discussion of recent journal articles through the Journal Club.

Keep an eye out for additional updates to the AGA Web site, including discussion boards. Visit the new www.gastro.org today.

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Applications Being Accepted for AGA Fellowship

The AGA is accepting applications for fellowship, the organization's highest level of membership. The prestigious designation of fellowship is awarded to members based on their superior personal and professional achievements in either clinical practice or basic/clinical research. To date, 1,560 members have been honored as AGA fellows.

As an AGA fellow, you will have use of the letters "AGAF" in your professional activities. The AGA will recognize your fellowship with a pin and certificate upon acceptance. During DDW® 2011, you will be acknowledged with a ribbon denoting your fellowship status, and your name will be listed in the president's dinner program. You will also be included in the listing of fellows on the AGA Web site.

Fellowship in the AGA is by application only and applicants must meet certain criteria in order to apply. One such criterion is membership in the AGA for at least seven years. Additional criteria can be found at www.gastro.org/fellowship.

The review and selection process for this program falls under the oversight of the Fellowship Recognition Committee, with final approval by the AGA Governing Board. Applicants will be notified of the status of their fellowship applications by Jan. 31, 2011. Fellowship will commence upon notification of acceptance.

The application deadline for 2011 is July 19, 2010. Eligibility requirements and an application can be found online at www.gastro.org/fellowship.

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Gastroenterology, CGH Podcasts: Voice Your Opinion

Gastroenterology and Clinical Gastroenterology and Hepatology request your feedback on our journal podcasts via a new online survey. Since launching in 2009, the goal of each podcast has been to present an engaging and informative discussion with experts or authors of articles from the latest issues of the journals. Please take a moment to complete a brief online survey rating the quality and content of the podcasts. Your feedback is highly constructive and will help us improve your future listening experience. To listen first, please visit the Gastroenterology or Clinical Gastroenterology and Hepatology podcast sites.

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Gastro & CGH Video Abstracts of the Month

Watch W. Ray Kim, MD, discuss his recently published Gastroenterology article, "Donor Race Does Not Predict Graft Failure After Liver Transplantation." Provide your thoughts and comments on this important study via the YouTube comments tool.


Watch Guido Costamagna, MD, Cristiano Spada, MD, and Cesare Hassan, MD, discuss their recently published Clinical Gastroenterology and Hepatology article, "Meta-Analysis Shows Colon Capsule Endoscopy Is Effective in Detecting Colorectal Polyps."  Provide your thoughts and comments on this important study via the YouTube comments tool.

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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.

Jobs. Talent. Better Connections.

Visit the career center today.

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