July 01, 2010
AGA eDigest AGA eDigest
Renew Your Membership Now! print iconPrint Page email iconEmail Page view online iconView Online


Clinical Practice

Education & Training



Eugene Chang, MD, AGAF
Basic Research Councillor

F. Taylor Wootton III,
Private Practice Councillor

CMS Releases 2011 Physician Fee Schedule Proposed Rule

CMS released its proposed rule for policy changes to the 2011 physician fee schedule effective Jan. 1, 2011, and its implementation of key provisions under recently enacted health-reform legislation, the Affordable Care Act.


Lead Story, continued

The proposed rule will be published in the Federal Register on July 13. CMS will accept public comments on the rule until Aug. 24. AGA will also submit comments for CMS' consideration prior to release of the final rule by Nov. 1, 2010.

Read more about the components of the proposed rule as well as a detailed summary. Stay tuned to AGA eDigest and the AGA Washington Insider for a more comprehensive analysis of this proposed rule.

Download the fact sheets released by CMS:

  print email top

CGH Image of the Month

Tension Hemothorax: A Dreaded Complication of Percutaneous Liver Biopsy
Ka-Ho Lok, Hon-Da Au, Kin-Kong Li

A 52-year-old man was admitted to a hospital for percutaneous liver biopsy. The indication was to assess his fibrosis stage to determine his treatment for genotype 1b chronic hepatitis C. Prebiopsy preparation was performed in accordance with recent guidelines. The optimal position for needle puncture was marked with ultrasound guidance. The patient was taught to hold his breath in full expiration immediately before biopsy. The patient developed hypovolemic shock two hours after the procedure. He did not complain of any abdominal pain or shortness of breath. Immediate assessment with bedside abdominal ultrasound did not reveal any free intra-abdominal fluid. An urgent CT scan showed a massive right hemothorax with tension effect. The liver biopsy result was a stage two liver fibrosis compatible with chronic hepatitis C. A small piece of normal lung tissue was also included in the liver biopsy specimen (figure).

Read more.



Grants Available for Fellows, Junior Faculty & Experienced Investigators

Investigators at all stages of their careers are invited to apply for research funding from the AGA Foundation for Digestive Health and Nutrition (FDHN).

For fellows:
GI fellows who are interested in independent research careers are invited to apply for the Fellowship to Faculty Transition Award, which provides salary support to further research training in gastrointestinal, liver function or related diseases. The additional two years of research training provided by this award should broaden and expand the scope of investigative tools available to the recipient, generally in basic disciplines such as cell or molecular biology or immunology.

Applicants must be MDs or MD/PhDs currently in a gastroenterology-related fellowship, clinically active at a North American institution and committed to an academic career. They will have completed at least two years of research training at the start of this award.

For junior faculty:
The AGA-General Mills Bell Institute of Health and Nutrition Research Scholar Award in Gut Physiology and Health provides $75,000 per year for three years ($225,000 total) to a young investigator working toward an independent research career. Seventy percent or more of the applicant's research must be on the relationship of gut microflora to physiology and immune function. The award's intent is to foster the scientific independence of junior investigators by ensuring that they have protected time for research.

The award is intended to support young faculty (not fellows) who have demonstrated promise and have a record of accomplishment in research. Candidates should be in the beginning years of their careers; no more than five years shall have elapsed following the completion of the applicant's clinical or postdoctoral training and the start date of this award.

For established investigators:
Established investigators may apply for the Funderburg Research Scholar Award in Gastric Biology Related to Cancer. Investigators working in the fields of gastric mucosal cell biology, regeneration and regulation of cell growth (not as they relate to peptic ulcer disease or repair), inflammation (including Helicobacter pylori) as precancerous lesions, genetics of gastric carcinoma, oncogenes in gastric epithelial malignancies, epidemiology of gastric cancer, etiology of gastric epithelial malignancies, or clinical research in the diagnosis or treatment of gastric carcinoma are eligible.

Applicants must hold faculty positions at accredited North American institutions, must be AGA members at the time of application and must have established themselves as independent investigators in the field of gastric biology.

Applications for all awards are due Sept. 3. Complete eligibility requirements and application information are available on FDHN's Web site.

  print email top

Doctors Identify Predictors of Response in Pediatric Ulcerative Colitis

Doctors performed a prospective study of children with severe ulcerative colitis, assessing outcomes and identifying predictors of nonresponse to intravenous corticosteroids. According to their study results, which were published in Gastroenterology, the pediatric ulcerative colitis activity index, calculated on days three and five of steroid therapy, can identify patients requiring salvage therapy. Infliximab is an effective therapy in steroid-refractory pediatric ulcerative colitis.

  print email top

What Determines Gastroesophageal Varices in Chronic Hep C?

In a study appearing in Gastroenterology, doctors identified the incidence and predictors of de novo gastroesophageal variceal formation and progression in a large cohort of patients with chronic hepatitis C and advanced fibrosis. They found that development of varices in patients with chronic hepatitis C is associated with patient race/ethnicity and laboratory markers of disease severity. Prolonged low-dose peginterferon-α2a therapy and ß-blockers do not reduce the risk of variceal development or progression.

  print email top

Early Use of TIPS Improves Mortality in Cirrhosis

Patients with cirrhosis in Child-Pugh class C or those in class B who have persistent bleeding at endoscopy are at high risk for treatment failure and a poor prognosis, even if they have undergone rescue treatment with a transjugular intrahepatic portosystemic shunt (TIPS). According to data published in the New England Journal of Medicine, in patients with cirrhosis who were hospitalized for acute variceal bleeding and at high risk for treatment failure, the early use of TIPS was associated with significant reductions in treatment failure and in mortality.

  print email top

Early Laparoscopic Cholecystectomy Improves Outcomes After Endoscopic Sphincterotomy

Patients with choledochocystolithiasis generally undergo endoscopic sphincterotomy followed by laparoscopic cholecystectomy. However, many patients receive this surgery six to eight weeks after endoscopic sphincterotomy. There is a high conversion rate of elective laparoscopic cholecystectomy after endoscopic sphincterotomy, and patients can develop recurrent biliary events during the waiting period. In a randomized trial to evaluate timing of laparoscopic cholecystectomy after endoscopic sphincterotomy, recurrent biliary events occurred in 36 percent of patients whose laparoscopic cholecystectomy was delayed for six to eight weeks; study results were published in Gastroenterology. Early laparoscopic cholecystectomy appears to be safe and might prevent the majority of biliary events in this period following sphincterotomy.

  print email top


Medicare Physician Payment Cuts Overturned

After months of fighting against Medicare physician payment cuts, AGA is glad to announce that the president has signed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act into law. It provides a 2.2 percent update in payment rates, retroactive from June 1 through Nov. 30, 2010. CMS has instructed its carriers to process claims at the 2.2 percent rate and will reprocess any claims at the negative 21.3 percent rate as soon as possible to reflect the new rate. CMS has indicated that providers do not need to resubmit claims that were already submitted to their contractors. AGA will continue to provide any new information on this issue from CMS.

  print email top

AGA Policy Blog

Learn more about these cuts and other happenings in DC through the AGA's policy blog.


OIG Issues Statement on Waiving Beneficiary Cost-Sharing Amounts

The Office of Inspector General (OIG) has released a policy statement to assure providers, practitioners and suppliers affected by retroactive increases in payment rates resulting from the operation of new federal statutes or regulations that they will not be subject to OIG administrative sanctions if they waive retroactive beneficiary liability provisions. Read the full statement.

Occasionally, the operation of new federal statutes or regulations will result in payment rate increases that apply retroactively during the period from the effective date of those payment rate increases until the date on which CMS (or the relevant Medicare administrative contractor, fiscal intermediary or carrier) implements the new, increased payment rates (the "retroactive period").

  print email top


How Does Prior Authorization Impact Your Practice?

The AGA invites you to participate in a 10-minute survey on your experience with health insurer prior authorization and prior notification programs. This survey is open to physicians and their practice staff and will help the AMA determine how they can best equip your practice to effectively address prior authorization and prior notification program issues.

Take the survey.

  print email top

Opportunity for Nonparticipating Physicians/Practitioners to Become Participating

In consideration of the recent enactment of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which established a 2.2 percent update to the Medicare physician fee schedule (MPFS), CMS is offering physicians and other practitioners (whose current participation status is non-participating) the opportunity to become participating. This opportunity is available through July 16, 2010.

Non-participating physicians/practitioners who would like to become a participating physician/practitioner should download and complete the Medicare participating physician or supplier agreement form (CMS-460).

Any new CMS-460 form received during this limited enrollment period will be retroactive for claims with dates of service of Jan. 1, 2010, and later. However, the change in participation status will only apply to new MPFS claims submitted after your new status as a participating physician/practitioner is processed. Claims previously submitted and processed will not be adjusted for only a change in participation status.

Medicare claims administration contractors will accept and process requests to become a participating physician/practitioner that are submitted on the CMS-460 form and are postmarked on or before July 16, 2010.

  print email top

It Is Not Too Late to Participate in PQRI

Join the growing number of eligible professionals who are participating and receiving a Physician Quality Reporting Initiative (PQRI) bonus of up to 2 percent of their total Medicare Part B allowed charges for the applicable reporting period.

There are multiple reporting methods available for providers who wish to report through claims or registries for the July 1, 2010, through December 31, 2010, PQRI reporting period. We would suggest going to page 17 of the 2010 PQRI implementation guide.

You can earn the full 12-month payment by submitting your quality data to CMS through the use of the registry or electronic health record (EHR) reporting option. Check out the qualified registries or EHR software for 2010 PQRI reporting.

If you have questions, contact the QualityNet help desk at 866-288-8912 from 7 a.m. to 7 p.m. CT or via e-mail at qnetsupport@sdps.org.

  print email top

AGA Registry Qualifies for PQRI Reporting

The AGA Digestive Health Outcomes Registry™ has qualified to submit data to CMS on behalf of its eligible professionals for the 2010 PQRI reporting of the hepatitis C measures group (available Fall 2010). This is just one of many practice benefits of the registry. Learn more about how the AGA Registry can help your practice.


You Can Still Participate in 2010 eRx Incentive Program

It's not too late to start participating in the 2010 electronic prescribing (eRx) incentive program and potentially qualify to receive a full-year incentive payment. To successfully meet reporting criteria and be considered incentive eligible, individual eligible professionals must report the eRx measure at least 25 times (for eligible patient encounters) and the Medicare Part B physician-fee-schedule allowed charges for services in the eRx measure's denominator should comprise 10 percent or more of the eligible professional's total 2010 estimated allowed charges.

For the 2010 reporting period, eligible professionals who successfully report the eRx measure will be eligible to receive an eRx incentive equal to 2 percent of their total Medicare Part B physician-fee-schedule allowed charges for services performed.

Eligible professionals must have adopted a “qualified” eRx system as defined in the eRx measure specifications. Check if your system meets those requirements (go to the downloads section and select the entry marked “2010 eRx Measure Specification and Release Notes.”)

Eligible professionals do not need to sign up or pre-register to participate in the 2010 eRx effort. Reporting the quality data code (G8553) for the eRx measure to CMS through claims or submission of data via a qualified registry or from a qualified electronic health record is all that is necessary to participate in the program.

Eligible professionals should review the educational products CMS has created on how to get started with eRx reporting.

Additional resources

Questions? Contact the QualityNet Help Desk at 866-288-8912 from 7 a.m. to 7 p.m. CT or via e-mail at qnetsupport@sdps.org.

  print email top

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.

  print email top


Help Us Plan DDW® 2011 Programming

Thank you for helping to make the 41st annual Digestive Disease Week® (DDW) 2010 a success! We are now beginning the process of planning for DDW 2011 in Chicago, IL from Saturday, May 7 to Tuesday, May 10, 2011, and your help is wanted.

The AGA Institute Council has 12 sections whose leaders guide the programming for DDW invited speaker lectures and abstract-based sessions. The council section leaders want your feedback to make DDW 2011 the best yet.

All members are encouraged to get involved with their sections:

  • Review descriptor categories (see links below) and recommend revisions to reflect your needs.
  • Recommend speakers for State-of-the-Art Lectures as well as topics and speakers for symposia.
  • Volunteer to review abstracts.

The council sections have provided an overview of their highlights from DDW 2010. You can view these highlights by visiting the links below:

  print email top

Valuable Resources Available from the 2010 AGA Spring Postgraduate Course

The AGA Institute's 2010 Spring Postgraduate course, Managing Digestive Diseases in the Next Decade: Controversies and New Developments, presented attendees with a look at what is on the horizon for the diagnosis and treatment of digestive diseases and how these latest advances can be incorporated into practice. If you could not attend the course or did attend and want to enhance your learning experience, take advantage of these valuable course resources, including a CD-ROM, online sessions and a course syllabus.

The CD-ROM and online sessions contain the complete audio track of all general and clinical challenge sessions as well as corresponding slides. The CD-ROM also includes the luncheon breakout sessions. The online sessions and the CD-ROM are fully searchable by topic or author, and the online sessions offer CME credit. Buyers can save with a special offer that gives them access to the online sessions for just $10 — $25 in savings — with purchase of the CD-ROM.

The course syllabus contains comprehensive details of all sessions, including abstracts, key points, references, slides, graphs, charts and tables. Learning objectives and complete reference lists are also included.

While supplies last, the CD-ROM for the 2009 Spring Postgraduate course, Applying New Evidence to Clinical Practice, is available at a discounted price.

Obtain more information and order today.

  print email top

Valuable Resources Available from the 2010 AGA Clinical Congress

Managing GI Conditions: Integrating Scientific Evidence with Clinical Experience

Have easy access to the most up-to-date clinical information in the field.

Online Sessions – available for free to AGA members.



AGA Represents at AMA House of Delegates Specialty Showcase

youtbeOn June 12, 2010, a specialty showcase was held in conjunction with the AMA House of Delegates annual meeting in Chicago, IL. The showcase provides an opportunity for the more than 600 medical students who attend the meeting to learn about a variety of different career choices.

Ikuo Hirano, MD, program director at Northwestern University, and one of his second-year fellows, John Paul Norvell, MD, staffed the exhibit table with AGA materials. They spoke with a number of students on the range of practice and research opportunities in gastroenterology, and the role of the AGA as their society home. The AGA was the only GI society represented at the showcase.

View more photographs from the event.

  print email top

Apply for AGA Fellowship

Application Deadline: July 19, 2010

The AGA is now accepting applications for fellowship. Fellowship honors superior achievement in clinical private or academic practice and in basic or clinical research. AGA members must meet specific criteria in order to apply.

View details and apply.



Gastro & CGH Video Abstracts of the Month


Watch Douglas Corley, MD, discuss his recently published Gastroenterology article, “Proton Pump Inhibitors and Histamine-2 Receptor Antagonists Are Associated with Hip Fractures Among At-Risk Patients.” Provide your thoughts and comments on this important study via the YouTube comments tool.

Watch Dario Sorrentino, MD, discuss his recently published Clinical Gastroenterology and Hepatology article, “Low-Dose Maintenance Therapy With Infliximab Prevents Postsurgical Recurrence of Crohn's Disease.” Provide your thoughts and comments on this important study via the YouTube comments tool.

  print email top

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 12.9, 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.

  print email top


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.

BC/BE GI wanted for busy practice with five other gastroenterologists in a beautiful coastal community. 100 percent GI practice with physician-owned endoscopy center onsite. Practice services one nearby hospital. Call rotation 1/7, ERCP optional. Excellent compensation. Benefits include malpractice insurance, paid vacation, pension profit sharing, CME and relocation allowance. Fast track to partnership. Please fax CV to 860-442-2136 or e-mail to jsullivan@coastaldigestive.com.

Jobs. Talent. Better Connections.

Visit the career center today.

  print email top

Copyright © American Gastroenterological Association
4930 Del Ray Avenue, Bethesda, MD 20814 301.654.2055 (p) 301.654.5920 (f)

To opt out of AGA e-mails, log in to your account and select Email Opt Outs.