July 29, 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

Enlist Patients as Advocates for Your Practice

Thanks to a groundswell of physicians and their professional societies — like AGA — protesting against a slash in Medicare practice reimbursements, Congress recently prevented a 21.3 cut. But it’s only a temporary reprieve. The problem will resurface this fall when the flawed sustainable growth rate formula, which sets Medicare practice reimbursements, once again triggers a 23 percent cut on Dec. 1, 2010.


Lead Story, continued

While Congress has heard loud and clear from physicians about the need for stable reimbursements in order to run practices, they have not yet heard from Medicare patients — the ones who are in danger of losing access to specialty care.

Patients need to understand that the current instability of the Medicare payment system impacts physician practices as viable businesses, which must pay employees, provide health insurance, manage rent and purchase equipment, among many other things.

The Alliance of Specialty Medicine, of which AGA is a member, has created a toll-free hotline for patients to use (877-373-3517) to contact their representatives and senators to express their support for reforming the Medicare physician reimbursement system.

Encourage your patients to reach out to Congress and tell them to act now to provide a long-term solution to the reimbursement formula.

The physician payment cuts are not just about paying doctors. A viable reimbursement system is essential for physicians to be able to make the necessary investments to continue to provide the quality of care that our seniors deserve.

Print this article and post or hand out to patients in your office or on your Web site to outline the potential impact of the flawed Medicare reimbursement formula on specialty care.

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Research Scholar Awards Fund Specialized Areas of GI Research

Upcoming research scholar awards from the AGA Foundation provide financial support to investigators studying gut microflora, GI cancer or hepatitis C.

GI Cancer
Established investigators may apply for the Funderburg Research Scholar Award in Gastric Biology Related to Cancer. Investigators working in the following fields are eligible: 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.

Applicants must hold faculty positions at accredited North American institutions and must have established themselves as independent investigators in the field of gastric biology. Applications are due Sept. 3, 2010.

Gut Microflora
The AGA-General Mills Bell Institute of Health and Nutrition Research Scholar Award in Gut Physiology and Health is available to young faculty (not fellows) who intend to spend 70 percent or more of their research time 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. 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. Applications are due Sept. 3, 2010.

Hepatitis C
The AGA-Vertex Pharmaceuticals Research Scholar Award in Hepatitis C Translational Research is a new award available to young faculty (not fellows) interested in translational research. This award is intended to support research involving the application of a basic science finding in hepatocellular function, hepatitis C virus biology, or other genetic or biological processes to the prevention, diagnosis or treatment of viral hepatitis C or its sequelae.

Candidates must hold full-time faculty positions at a North American institution, have a commitment to clinical translational research and plan to devote at least 70 percent of their efforts to research related to the digestive system. Applications are due Jan. 28, 2011.

AGA membership is required for all awards. Visit AGA’s Web site for more information and to join. Visit the Foundation Web site for complete eligibility criteria and downloadable applications.

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Your AGA Foundation Gifts at Work

altYour AGA Foundation gifts support ...
Anamika Chaudhuri, MD, at Yale University, who received the Fellowship-to-Faculty Transition Award this year. "My studies investigate the mechanisms through which acidosis sensitize to acute pancreatitis, focusing on changes in calcium signaling. This generous award will provide the protected time that is essential to achieving my ultimate goal of becoming an independent investigator and academic physician. I would like to thank the AGA Foundation for selecting me to receive the Fellowship-to-Faculty Transition Award."

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UK Audit Reveals Underutilization of Endoscopic Therapy

In a study appearing in Gut, researchers examined the use of endoscopy in the U.K. for acute upper GI bleeding and compared with published standards. Their audit found continuing delays in performing endoscopy after acute upper gastrointestinal bleeding and underutilization of standard endoscopic therapy, particularly for variceal bleeding. In hospitals with a formal out-of-hours endoscopy rota, patients received earlier endoscopy, were more likely to receive endoscopic therapy and may have a lower mortality.

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CHE-EUS Improves Accuracy in Diagnosis of Pancreatic Masses

Contrast harmonic echo (CHE) has been developed for endoscopic ultrasound (EUS). This new technique detects echo signals from microbubbles in vessels with very slow flow, without artifacts. According to a study in Clinical Gastroenterology and Hepatology, detection of a hypo-enhancing and inhomogeneous mass accurately identified patients with pancreatic adenocarcinoma. CHE-EUS increased the detection of malignant lesions in difficult cases (patients with chronic pancreatitis or biliary stents) and helped guide EUS-fine needle aspiration. A hyperenhancing pattern could be used to rule out adenocarcinoma.

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Sessile Serrated Adenomas Are High-Risk Lesions

Sessile serrated adenomas are associated with colorectal carcinomas that demonstrate high microsatellite instability. Currently, sessile serrated adenomas are managed clinically in a similar fashion to adenomatous polyps. According to data published in the American Journal of Surgical Pathology, sessile serrated adenomas are high-risk lesions, with 15 percent of the sessile serrated adenomas patients developing subsequent colorectal carcinomas or adenomatous polyps with high-grade dysplasia. This incidence is higher than that of the control hyperplastic polyps and adenomatous polyps patients, and would support close endoscopic follow-up in patients harboring sessile serrated adenomas.

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Krüppel-Like Factor 4 Essential for Epithelial Differentiation

Krüppel-like factor (Klf) 4 is a DNA-binding transcriptional regulator highly expressed in skin and gastrointestinal epithelia, specifically in regions of cellular differentiation. Homozygous null mice for Klf4 die shortly after birth from skin defects, precluding their analysis at later stages. Results published in Gastroenterology indicate that Klf4 is essential for squamous epithelial differentiation in vivo, and interacts with Klf5 to maintain normal epithelial homeostasis.

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CMS Announces Medicare Imaging Demonstration

CMS has announced that it is soliciting proposals for participation in the Medicare imaging demonstration (MID). Applications are due to CMS by Sept. 21, 2010. The MID will test whether the use of decision support systems (DSSs) can improve quality of care and reduce unnecessary radiation exposure and utilization by promoting appropriate ordering of advanced imaging services. It will also assess the impact that DSSs used by physician practices have on the appropriateness and utilization of advanced medical imaging services ordered for the Medicare fee-for-service population. The demonstration will focus on MRI, CT and nuclear medicine advanced imaging diagnostic services.

All current Medicare coverage and payment policies are unaffected under this demonstration. Prior authorization processes, which can be used to deny coverage for tests, are not part of the demonstration.

CMS will use conveners to reach eligible physicians interested in participating in the demonstration. Conveners will be responsible for recruiting physician practices, deploying a DSS that incorporates medical specialty society guidelines for the selected procedures, ensuring the DSS remains current with those guidelines, collecting and transmitting data, and distributing payments to practices for reporting data. A wide variety of interested parties may be eligible to apply as conveners or in collaboration with other organizations to perform the responsibilities specified in the demonstration.

CMS is particularly interested in proposals from conveners that involve a diverse mix of physician practice sizes and types, medical specialties and geographic areas. CMS will consider the characteristics of the physician practices and the ability of the convener to perform the functions identified in the solicitation when selecting demonstration areas.

Read additional information, including how to apply. Questions may be submitted to CMS at: ImagingDemo135b@cms.hhs.gov.

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CMS to Consolidate J2 & J3 Medicare Administrative Contracts

On July 21, 2010, CMS notified Noridian Administrative Services (NAS) that it would consolidate the jurisdiction 2 and 3 (J2 and J3) workloads and Medicare Administrative Contractor (MAC) contracts and issue a new request for proposal (RFP). Timelines for this have not been announced.

In a letter to NAS, CMS wrote that the consolidation of J2 and J3 would lead to "the development of innovative initiatives and process improvements, thereby further lowering the operational costs for the administration of the Medicare program."

The letter continued, "We have spent some time reevaluating the initial approach, which assumed 15 A/B MAC jurisdictions. As an initial step in this effort, starting with the impending re-procurement of the original J3 MAC, CMS has decided to cancel the J2 A/B MAC procurement and consolidate the J2 and J3 workloads into a new RFP that will be completed in the near future."

NAS holds the legacy Medicare contracts for the states of Washington, Oregon, Idaho (Part A) and Alaska, which compose the J2 contract. NAS is also the current contractor for J3, which includes North Dakota, South Dakota, Montana, Wyoming, Utah and Arizona, and is the legacy Medicare Part A contractor for Minnesota.

NAS will continue to administer the legacy states of Washington, Oregon, Idaho (Part A) and Alaska, and will continue as the J3 MAC contractor until the new combined J2/J3 is implemented. NAS will also continue as the Minnesota legacy Part A contractor.

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Free Webinar on Basics of GI Coding & Billing

On Aug. 19 from noon to 1 p.m. ET, the AGA Institute will be holding a free member-only Webinar on the basics of coding and billing for the GI practice. Accurate coding and understanding the billing process is a critical component of GI clinical practice, and essential to minimizing audit liability and maximizing reimbursement. Join Cecile M. Katzoff, MGA, CGCS, as she reviews basic coding and billing principles, including:

  • How to select a current procedural terminology/healthcare common procedure coding system code to define the service provided.
  • The importance of accurate International Classification of Diseases-9 code selection.
  • Categories of evaluation and management services (visits).
  • Coding multiple procedures during an endoscopy.
  • Using modifiers to maximize reimbursement.
  • Coding screenings.

A Q&A session will follow. Be prepared to ask your most pressing coding and billing questions.

Register now for this free Webinar.

Additional Coding & Billing Resources for the Success of Your Practice

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Important Drug Warning Released

An important FDA-mandated drug warning pertaining to all AGA clinician members is scheduled to be communicated this week via the Health Care Notification Network (HCNN). If you are not registered yet, immediately ensure there is no future delay in receiving these urgent notifications by registering for the HCNN. You will also avoid extraneous paper clutter. If you are registered already, log in to view the alert now.

The HCNN is free to AGA members and fulfills the new FDA guidance promoting electronic delivery of drug warnings. It is supported by the AGA and medical liability carriers because it eliminates delay and reduces your professional liability. Register today.

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Webcast Explores Lessons Learned in Management of Nonresponders

A new Webcast, Management of Nonresponders to Previous Hepatitis C Virus (HCV) Therapy: What Lessons Have We Learned? has been added to the AGA Institute and Medscape Hepatitis C Resource Center. This center is designed to provide health-care providers with data that has been translated into practical information and can help in diagnosing and treating patients with hepatitis C. Resources from the center will fill knowledge gaps and address:

  • Effective use of standard of care.
  • Management of difficult-to-treat patients.
  • Strategies for increasing awareness of new agents in HCV management.

Additional resources include:

This program has been approved for AMA PRA Category 1 CME Credit(s)™.

This program is supported in part through an independent educational grant from Genentech and Vertex Pharmaceuticals.

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Trainee Abstracts Being Accepted for Clinical Congress

GI fellows, interns and residents may submit an abstract to present at this year’s 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. The deadline for submission is Oct. 1, 2010.

Selected abstracts will be presented during the wine and cheese reception on Jan. 14 and published in the February issue of Clinical Gastroenterology and Hepatology. This is a great opportunity for GI fellows to present their research in a small, intimate forum and obtain valuable feedback from the expert faculty and attendees.

Authors may submit abstracts in one of the following categories:

  • Clinical Trials
  • Endoscopy & Screening/Surveillance
  • Epidemiology
  • Outcomes Research
  • Pharmacotherapy
  • Clinical Practice: Other

All abstracts must be submitted online. Authors may submit more than one abstract. Only interns, residents and fellows may submit and present abstracts. There is a $30 fee due upon submission. Authors of selected abstracts will be notified by Oct. 18.

View more information, including abstract submission guidelines, rules and instructions.

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AGA Practice Skills Workshop

Free for AGA member trainees.

Jan. 16
Miami, FL

Held in conjunction with the AGA Clinical Congress.

Learn the necessary skills and information needed to build a successful clinical practice career.

View details.


Practice Management Course to be Held at Clinical Congress

This year’s AGA practice manager’s/administrator’s course, From Surviving to Thriving in a New World, will be held in conjunction with the AGA Clinical Congress on Jan. 13 and 14, 2011, at the Loews Miami Beach Hotel, FL. Usually held in conjunction with DDW®, this exciting one-and-a-half day course was moved to coincide with the congress to allow physicians to attend the course with their practice managers/administrators. The course provides an excellent opportunity for both physicians and practice managers/administrators to learn the essential information for successful practice management in a demanding health-care environment.

Led by a faculty of experienced physicians and experts, the program will address today's most pressing topics, including:

  • Managing practice transformation, including retirement, recruitment and slow downs.
  • Joining an accountable care organization.
  • Spotting trends in commercial payors.
  • Adding ancillary services such as pathology, imaging, capsules and infusion to grow your practice.
  • Selecting the right electronic medical record.
  • Learning how the AGA Digestive Health Outcomes Registry™ can help physicians monitor and improve patient care while also generating data to compare the efficacy of treatments and potentially increase reimbursement.

Physicians who also register for the congress will receive a discount on this course and will have the flexibility to go back and forth between the Friday sessions at both events.

Learn more and register.

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

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Registration Now Open

AGA Clinical Congress of Gastroenterology and Hepatology: Best Practices in 2011

Jan. 14 & 15, 2011
Miami, FL

Join the field's top experts as they present an evidence-based approach to GI clinical care based on the most recent and best available research.

Learn more.



Leadership Nominations Due Oct. 1

The AGA Nominating Committee, chaired by Robert S. Sandler, MD, MPH, AGAF, is in the midst of identifying candidates for the offices of vice president, basic research councillor, community private practice councillor and eight nominees for the 2011–2012 Nominating Committee ballot.

AGA members are encouraged to submit nominations to ensure that the most qualified and committed candidates are selected to serve next year. Nominations must be submitted by Oct. 1.

  • Each member may nominate only one person per available position. (Each member may submit one nomination each for vice president, basic research councillor, community private practice councillor and up to eight nominations for members of the Nominating Committee.)
  • Officers and councillors on the Governing Board and members of the current Nominating Committee are prohibited from proposing, supporting or endorsing candidates for nomination.
  • Only full members may be considered for vice president and councillor.
  • Only full members or senior members may be considered for the Nominating Committee.
  • Current and prior Nominating Committee members are not eligible to serve on the committee again for five years.
  • Letters of support from members are limited to two per nominee, specified in advance by the prospective nominee. The letters should not summarize the nominee’s curriculum vitae (CV), but should address the nominee’s personal qualities, strengths and weaknesses.

Nominate yourself or one of your colleagues. Nominations will only be accepted electronically. You must have your member ID number in order to submit your nominations electronically. To get your member number, call AGA Member Services at 301-941-2651 or e-mail member@gastro.org.

The deadline for receipt of nominations is Oct. 1, 2010. The committee chair will contact nominees to request CVs and determine interest and willingness to serve.

Vice President. The AGA Institute vice president is elected for a one-year term and succeeds automatically to the office of president-elect, the office of president and then to past president, serving one year in each office. In the absence of both the president and president-elect, the vice president would preside at meetings of the Governing Board and Executive Committee. The vice president serves as a member of the Executive Committee (throughout the four-year tenure) and as liaison between the International Committee and the Governing Board. The vice president also serves as a member of the Finance & Operations and the Executive Compensation Committees, and as an ex officio member of the AGA Governing Board.

Councillors. AGA Institute councillors are elected from the membership for a three-year term. Councillors are directors of the AGA Institute and hence are responsible for managing and overseeing the activities of the AGA Institute. Further, the basic research councillor shall be actively engaged in basic research in a health-care institution and be responsible for representing the views of this constituency at Governing Board meetings. The basic research councillor also serves as liaison between the Research Policy Committee and the Governing Board. The community private practice councillor shall be actively engaged in community private practice and be responsible for representing the views of this constituency at Governing Board meetings. The community private practice councillor also serves as an editor for AGA eDigest, as a member of the E-Communications Advisory Board, and as liaison between the Practice Management & Economics Committee and the Governing Board.

Nominating Committee. Nominating Committee members serve for one year and are responsible for selecting future officers and councillors for the AGA Institute as well as the members who are placed on the ballot for election to the AGA Nominating Committee for the following year. The AGA Nominating Committee is comprised of nine members: the chair (past chair of the AGA Governing Board), four members elected from a ballot of eight candidates and four members appointed by the AGA Governing Board.

The Nominating Committee will hold two teleconferences in the fall and a face-to-face meeting in January.

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Apply Now for the 2011 Train the Trainers Program

Application deadline: Aug. 11

This exciting program will bring two educators to Chennai, India, April 10–15, 2011, to attend intensive and interactive sessions dedicated to the development of teaching and training skills.

Learn more.



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.

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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.

Washington, D.C., Suburb/Northern Virginia — Outstanding opportunity for BC/BE gastroenterologist to join prestigious and very busy GI group with two physicians, a PA and NP on staff. 100 percent GI practice with office endoscopy center on site. Associated with premier university affiliated teaching hospital with house staff and medical students. Please e-mail CV to ofcmgr.gidoc@gmail.com.

Jobs. Talent. Better Connections.

Visit the career center today.

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