July 22, 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

Survey Finds Many GIs Have Reduced Time Spent with Patients

Elimination of Medicare's consultation codes has negative impact on docs

The elimination of Medicare's consultation codes has had a negative impact on physician efforts to improve care coordination and reduced the treatment options available to Medicare patients, according to a new survey released by AMA, AGA and other medical specialty societies.


Lead Story, continued
Consultation codes are used most frequently by specialists after a patient referral from a primary care physician. In April 2010, AGA, ASGE and ACG participated in this AMA-sponsored survey. View a topline report on GI results.

After analyzing survey data, AGA, AMA and representatives of these specialties identified several technical improvements that would make the policy more equitable. We, along with AMA, joined numerous other specialties in a letter outlining our concerns and asking CMS to review and modify its current policy to prevent further deterioration of care coordination between physicians.

"AGA members surveyed indicated that their total revenue stream has decreased as a result of Medicare's decision to eliminate the use of consultation codes," said Robert Burakoff, MD. "Many GI physicians have had to modify their practices as a result, reducing the time spent with Medicare patients, deferring the purchase of new equipment and technology, and eliminating office staff."

The survey indicates that the approximately 5,500 physicians who completed the survey have been forced to take a number of cost-cutting steps to offset revenue losses associated with the elimination of these codes. Highlights from the survey include:

  • Three out of every 10 have already reduced their services to Medicare patients or are contemplating cost-cutting steps that will impact care.
  • One-fifth have already eliminated or reduced appointments for new Medicare patients.
  • Nearly two-fifths will defer the purchase of new equipment and/or information technology.
  • More than one-third are eliminating staff, including physicians in some cases.
  • Following CMS' suggestions that they no longer need to provide primary care physicians with a written report, about 6 percent have stopped providing these reports, while nearly another 19 percent plan to stop providing them.

These are real-world examples of the impact of this policy change on Medicare patients and physician offices in the medical specialties that participated in the survey.

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NIH Expands Food Allergy Research Program

The Consortium of Food Allergy Research (CoFAR) will be funded for five more years with a $29.9 million grant. CoFAR will continue to foster new approaches to prevent and treat food allergies and also expand in scope to include research on the genetic causes underlying food allergy and studies of food allergy-associated eosinophilic gastrointestinal diseases (EGIDs).

EGIDs are a group of recently recognized allergic diseases that are associated with production of immunoglobulin E antibodies as well as other immune responses to food. The most common EGID is eosinophilic esophagitis (EoE), which is characterized by inflammation and accumulation of eosinophils, a subset of immune cells, in the esophagus. The primary symptoms of EoE in children include nausea, vomiting and abdominal pain after eating. In adults, the primary symptom is difficulty swallowing.

When the National Institute of Allergy and Infectious Diseases established CoFAR in 2005 with five clinical sites, the goal was to help improve understanding of why food allergies develop and how they can be treated or prevented. CoFAR will add a new clinical trial to treat peanut allergy, using peanut protein that will be applied on the skin. As part of the program expansion, there will be two new research sites looking for genes associated with food allergies and three consulting sites conducting studies to understand EoE.

Learn more.

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HAE: Learn About It, Talk About It

Find out how to diagnose hereditary angioedema (HAE) and when to refer patients to an allergist or immunologist. Learn about HAE.


Your AGA Foundation Gifts at Work

altYour AGA Foundation gifts support ...
Rohit Loomba, MD, at the University of California San Diego, who received the AGA Foundation Research Scholar Award (RSA) in 2009. “AGA RSA is the oasis that young investigators like me need to survive in the current funding environment ... It’s the AGA RSA that triggered all the grants and research support that I got in the last year, including the extra stimulus support from my own department to expand my research in liver epidemiology.”

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Lactose Intolerance Symptoms Unrelated to Malabsorption

Symptomatic lactose intolerance is common; however, abdominal symptoms that patients experience after ingestion of lactose-containing foods can have causes beyond lactose malabsorption. According to study results published in Clinical Gastroenterology and Hepatology, daily life symptoms that patients associate with lactose intolerance are often unrelated to lactose malabsorption. Even among true lactose malabsorbers, symptom recall tends to be amplified by the patient. Thus, conventional anamnesis is a highly unreliable tool to establish symptomatic lactose malabsorption.

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Study Suggests Small Polyps Rarely Contain High-Grade Dysplasia

In patients with polyps detected at CT colonography (CTC) screening, management decisions are influenced by the likelihood of important polyp histology. Data published in Clinical Gastroenterology and Hepatology suggests that small polyps rarely contain high-grade dysplasia; none was malignant. The malignancy rate for large colorectal polyps was less than 1 percent. These findings indicate the potential for less aggressive management of lesions detected by CTC.

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Doctors Report Novel Approach to Antibiotic Prophylaxis in PEG

In a study appearing in the British Medical Journal, doctors evaluated a new and simpler strategy of antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG). They commented that 20 ml of co-trimoxazole solution deposited in a newly inserted PEG catheter is at least as effective as cefuroxime prophylaxis given intravenously before PEG at preventing wound infections in patients undergoing PEG.

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Bacterial Peritonitis Before Transplantation Does Not Affect Patient Survival

Spontaneous bacterial peritonitis (SBP) is a devastating complication of cirrhosis with high mortality. The impact of a prior episode of SBP on the outcome of liver transplantation (LT) is not well known. Despite higher Child-Pugh and model for end-stage liver disease score at the time of LT, survival times of patients with SBP before LT are similar to those patients without SBP, according to data published in Clinical Gastroenterology and Hepatology.

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Appropriations Committees Approve Increase in VA Research Program

The House Appropriations Committee approved the fiscal year (FY) 2011 Military Construction, Veterans Affairs and Related Agencies appropriations bill that includes $590 million for the VA's Medical and Prosthetic Research Program, which supports the biomedical research done at the VA. This represents a $9 million increase over last year's levels and is consistent with funding levels supported by the Friends of VA, of which AGA is a member.

Last week, the Senate Appropriations Committee approved their version of the FY 2011 Military Construction-VA appropriations bill, which also included $580 million for the research program. Both bills are now ready to be voted on by the House and Senate and could be taken up prior to the August recess.

The VA's Medical and Prosthetic Research Program is critical in addressing the health-care needs of our nation's veterans from Iraq and Afghanistan, and has helped doctors make significant progress in treating spinal cord injuries, traumatic brain injury, eye injuries and post-traumatic stress disorder. These investments made by the VA continue to help improve the quality of life for our veterans and also benefit the civilian population.

The AGA will continue to monitor the appropriations process and advocate for increased research funding through the VA and other agencies like the NIH and NIDDK.

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ASCs to Receive Payment Updates of 2.2 Percent

The recent enactment of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, §101, resulted in a positive 2.2 percent update in the 2010 Medicare physician fee schedule (MPFS), effective June 1, 2010, through Nov. 30, 2010.

Many payment rates under the ambulatory surgical center (ASC) payment system are controlled by payment rate information in the MPFS. In order to fully comply with this legislation, it is necessary to implement revised MPFS payment rates in the ASC payment system. Therefore, CMS has provided the updated fees to its contractors for testing and implementation. One set of files is for ASC services furnished on or after July 1, 2010, and the second set of files is for ASC services furnished June 1, 2010, through June 30, 2010. Once installed, Medicare contractors will use these updated payment files to process new ASC claims and adjust previously processed ASC claims for dates of service on or after June 1, 2010, that are brought to their attention. This only affects office-based codes, so it has little impact on GI.

Contractors will make July 2010 ASC fee schedule data for their ASC payment localities available on their Web sites. The payment rates in the July 2010 ASCFS fee data files mirror the 2.2 percent update payment rates for services June 1, 2010, to June 30, 2010, and also contain payment rates for newly established services identified in change request (CR) 7008, effective July 1, 2010. Read an explanation of the requirements.

CMS is aware that contractors were unable to implement the revised payment rates by the July 6, 2010, implementation date contained in CR7008 because these files have just become available to contractors for download and testing. Contractors have been directed to have all these ASC update files in production no later than July 28, 2010. This implementation date supersedes the implementation date specified in CR7008.

ASCs who may have received an incorrect payment determination for certain services furnished on or after June 1, 2010, through the implementation of the July 2010 ASCFS may request contractor adjustment of the previously processed claims.

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Answer Clinical Questions Quickly with UpToDate®

Free trial available to AGA members

The demands that we face as gastroenterologists mean that frequently, we have very little free time. Maximizing our time means being able to quickly find reliable answers to the clinical questions that arise in practice. However, doing so can often be a challenge.

UpToDate® helps overcome this challenge. With a searchable database of more than 8,300 practice-oriented, evidence-based topics, UpToDate provides answers to clinical questions quickly and easily. In addition, with 24-hour online access through your computer or mobile device, you can find those answers whenever and wherever you need them.

UpToDate authors and editors are leaders in gastroenterology, who not only provide detailed subject reviews, but also offer their expert recommendations. Moreover, as new information becomes available, topics are updated, so that you can easily remain current in this constantly evolving, multifaceted specialty.

Topics in UpToDate cover both common and rare conditions in gastroenterology, with a focus on clinical manifestations, diagnosis and treatment. View UpToDate's sample topics in gastroenterology. In addition, UpToDate includes topics in the areas of routine endoscopy, advanced endoscopy and cutting-edge endoscopic technology. View UpToDate's gastroenterology and hepatology table of contents.

UpToDate not only provides in-depth gastroenterology content, but also serves as a clinical resource across 16 medical specialties. In addition to reviewing topics on your patient's gastroenterological issues, you can access information about their other medical conditions — knowledge that can be crucial in determining the best approach to patient management.

More than 400,000 of your colleagues throughout the world rely on UpToDate to help answer questions quickly and provide better patient care. See for yourself what a difference UpToDate can make to your practice. Try it out by registering for your free trial today.

To sign up for the 30-day free trial available to AGA members, go to learn.uptodate.com/AGA.

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Registration Now Open for the 2011 AGA Clinical Congress

Registration is now open for the AGA Clinical Congress of Gastroenterology and Hepatology: Best Practices in 2011, which will be held Jan. 14 and 15, 2011, at the Loews Miami Beach Hotel, FL. This year's congress will provide clinicians with an evidence-based approach to GI clinical care based on the most recent and best available research.

Course director, Prateek Sharma, MD, and course co-director, Marcia R. Cruz-Correa, MD, PhD, AGAF, have developed a cutting-edge program that explores the full spectrum of GI and hepatic disorders. In addition to a review of the latest clinical information, this year's congress will incorporate lectures that explore key data from the major clinical trials that took place over the last year. Experts will evaluate new therapies and management strategies and provide attendees with an understanding of how they may work in a clinical setting. Topical highlights include:

  • Immunomodulators and biologics to treat IBD.
  • Novel endoscopic techniques to remove large polyps and early cancer.
  • New guidelines for patients undergoing endoscopy while on anti-platelet agents.
  • Effective therapies for hepatitis B and C.
  • Endoscopic ablation for patients with dysplastic Barrett's esophagus.

GI fellows in training are encouraged to submit an abstract to this year's congress and present their research. Selected abstracts will be published in the February issue of Clinical Gastroenterology and Hepatology. The abstract submission deadline is Oct. 1.

The following events will be held in conjunction with the congress:

  • AGA Practice Management Course
  • AGA Practice Skills Workshop
  • Hands-on Course: Endoscopic Techniques for Barrett's Esophagus

Congress attendees may register for one or more of these optional add-on programs at a discount.

Learn more and register.

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

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Registration Now Open

AGA Practice Management Course: From Surviving to Thriving in a New World

Jan. 13 & 14
Miami, FL

Held alongside the AGA Clinical Congress.

Attend this 1.5-day course and obtain essential information for successful practice management in a demanding health-care environment.

Learn more.


AGA Accepting Applications for Train the Trainers Program

Applications are now being accepted for the 2011 Train the Trainers Program. This exciting program will bring two trainers to Chennai, India, April 10 to 15, 2011, to attend intensive and interactive sessions dedicated to the development of teaching and training skills. Sponsored by the World Gastroenterology Organization (WGO), the program offers a unique forum for educational leaders to share experiences and discuss common problems. View more detailed information on the WGO Web site.

Eligibility requires that applicants be responsible for endoscopic teaching and training in a GI unit and must be AGA members. Nonmembers may submit a membership application with their application form. Applicants also must commit to implementing the workshop lessons in their own teaching environment upon return.
Selected individuals will be responsible for the cost of air transportation; accommodations and meals for five days will be provided by the organizers of the workshop.

Applications must be submitted to the AGA by Aug. 11, 2010. The AGA International Committee will select two trainers from the pool of applicants and will submit their nominations to the WGO for final consideration and selection. 

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Webinars Offer the Latest Information 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.


2010 Dates for GI Coding Two-Day In-Depth Training & Exam

The AGA has partnered with the Professional Association of Healthcare Coding Specialists (PAHCS) to provide a certification program for GI coders. This program is attached to a series of in-depth, two-day training courses, provided by McVey Associates, Inc., and reviews the latest coding guidelines for the GI practice. Upon successful completion of the exam, participants are jointly certified by the AGA Institute and PAHCS. Registrants may participate in the course only (and not take the exam).

"For the practice, a certified GI coder ensures a high level of competency in GI coding. For the coder, certification acknowledges that you possess specific skills that set you apart as a professional, dedicated to both your employer and your profession," said Cecile M. Katzoff, MGA, CGCS, director of the AGA Center for Practice Management.

Program dates and locations are as follows:

Location Course Dates Exam Date
Branson, MO Aug. 4 & 5 Aug. 6
Baltimore, MD Aug. 18 & 19 Aug. 20
Atlanta, GA Sept. 15 & 16 Sept. 17
Las Vegas, NV Oct. 6 & 7 Oct. 8

To qualify to sit for the exam, applicants must have a specific level of education and experience, including:

  • Active employment as a health-care coder for a minimum of two years.
  • Formal education in courses pertinent to health-care coding that can be fulfilled by attending the McVey seminars.
  • Two professional references.

Coders may attend the training sessions even if they have not yet qualified to sit for the exam.

The course provides a strong foundation for gastroenterology coding and billing. Retention of certification requires 24 hours of continuing education units every two years, which can be accumulated by attending AGA Institute and McVey programs, as well as other programs focusing on coding.

Visit our GI coding certification Web site for more information and to register.

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Basics of GI Coding & Billing Webinar — Free

Aug. 19
Noon–1 p.m. ET

Register for this free, one-hour Webinar for a review of basic GI coding and billing principles.



IVFE Shortage Update

The American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) has been in ongoing communications with U.S. suppliers of IV fat emulsion (IVFE). Currently, it is uncertain as to when the shortage will be resolved and IVFE purchase supplies return to normal. It is possible that this shortage may last anywhere from six weeks to six months.

A.S.P.E.N. recommends that all facilities and practitioners review and implement the information to use in the event of an IVFE shortage available on the A.S.P.E.N. Web site. Best estimates suggest that if all facilities implement the shortage guidelines, the national supply will remain commensurate with national demand.

During the period of shortage, wastage of IVFE is a concern. Any manipulation of IVFE from its original container and preparation of IVFE for infusion may potentially increase risk of contamination and product instability. Facilities and practitioners need to observe and be compliant with the IVFE product labeling for storage and use, the U.S. Pharmacopeia's general chapter <797> pharmaceutical compounding-sterile preparations, and state boards of pharmacy rules and regulations. Practices outside of these sources should not be implemented.

Baxter Healthcare Corporation continues to allocate its national supply on a direct purchase basis. Should you have any questions, please contact your Baxter sales representative or Baxter's center for service at 888-229-0001.

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The Bell Institute Becomes AGA Foundation Partner

The General Mills Bell Institute of Health and Nutrition has become the first AGA Foundation Digestive Health Partner Program, which recognizes companies that support digestive health research through the AGA Foundation.

"We are pleased that the General Mills Bell Institute of Health and Nutrition has become the AGA Foundation's first partner in the Digestive Health Partner Program," said Nicholas F. LaRusso, MD, AGAF, chair of the AGA Foundation. "The Bell Institute is dedicated to advancing the research and knowledge needed to better manage digestive health and nutrition, which will lead to a greater understanding of gastrointestinal diseases. We hope they will soon be joined by other like-minded corporations."

Central to the AGA's efforts is the continued funding of critical research in digestive health to ensure that patients receive the most advanced care and treatments possible. Among its initiatives, the AGA has created the Digestive Health Partner Program to recognize companies that are committed to advancing research and public education into the causes, diagnosis, treatment and cure of digestive illnesses.

"The Bell Institute is proud to be the first corporation to partner with the AGA Foundation's Digestive Health Partner Program. Together, we will advance the science that can improve and promote good digestive health," said Susan Crockett, PhD, RD, vice president, senior technology officer, the General Mills Bell Institute of Health and Nutrition.

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Research Grant from General Mills & AGA

The AGA-General Mills Bell Institute of Health and Nutrition Research Scholar Award in Gut Physiology and Health supports a young investigator working toward an independent research career. The deadline is Sept. 3 apply now.


AGA Web site Offers Instant Access to News & Resources

The new AGA Web site includes RSS feeds and resource libraries to make it easier for members to stay informed and navigate to the information they need.

RSS Feeds
The site's RSS feeds are designed to keep members up to date by retrieving the latest news in the field of GI from one location. The content areas of the feeds focus on research, practice, advocacy, fellowship and international relations. Subscribe today.

Resource Libraries
The site's resource libraries, one focused on practice and one on research, include the latest news, guidelines, courses and more, based on topic. Members can choose their area of interest and view all of AGA's resources on that topic on one page.

Additional features of the new Web site include:

  • My AGA, where members can find and update their contact information, sections and committees, as well as connect to GI LEARN® to track CME credits and organize educational activities in My Library.
  • A community section that allows members to connect with the AGA and their colleagues. The section provides access to AGA's Facebook page, Twitter feed, Linked In group and YouTube page. In addition, members can join in on a lively online discussion of recent journal articles through the Journal Club.

Visit www.gastro.org today.

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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.

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.

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