Oct. 07, 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

Call on Your Legislators to Commemorate NIDDK's 60th Anniversary

As you may know, the AGA is supporting legislation introduced by Reps. Frank Pallone, D-NJ, and John Shimkus, R-IL, that would commemorate the 60th anniversary of NIDDK. H. Res. 1444 not only recognizes the anniversary of NIDDK, but also the organization's leadership and achievements of supporting biomedical research and improving the quality of life for countless individuals.


Lead Story, continued
The AGA, along with AASLD, the Digestive Diseases National Coalition and the American Urological Association, is supporting this resolution and working to secure co-sponsors so that this legislation can pass before the end of the 111th Congress. Reps. Pallone and Shimkus would like to move the legislation before the end of this congressional session, but need at least 100 co-sponsors to do so. Please contact your legislators and ask them to consider signing on to this resolution, which recognizes the achievements of this premier research institute that has contributed to research, research training, science education and improvement of overall health.

You can use the AGA's legislative tool, CapWiz, to contact your legislators and urge them to support this effort. If you have any questions, please feel free to contact Lauren DePutter at ldeputter@gastro.org or 240-482-3221.

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CGH Image of the Month

Infliximab-Induced Psoriaform Rash
Jonathan Goldstein, Joel Levine

A 25-year-old woman with ileal Crohn's disease presented with alopecia and a diffuse rash. The patient had inflammation and stricturing in her ileum and was treated initially with 6-mercaptopurine, but had abnormal liver function test results and a limited clinical response. Therapy was changed to infliximab and her pain, diarrhea and blood in the stool improved. However, after the fourth intravenous infusion (16 weeks) of infliximab, the patient developed a diffuse erythematous anular rash over her palms (figure) and soles, torso, extremities, and in her scalp, causing alopecia.

Read more.



Your AGA foundation gifts support ...

altMomo Nakagawa, an undergraduate at the University of Pennsylvania who received an AGA Student Research Fellowship Award in 2009 and an AGA Student Abstract Prize this year.

“The entire research process has been a truly inspirational experience, deepening my interest and broadening my understanding of scientific research … The scientists and doctors who I interacted with daily also helped me develop new critical thinking skills, which I found to be an essential aspect in scientific research. Through this, I hope to continue my research to expand my knowledge about molecular and cellular biology, particularly through studying more about the role of EGFR and p53 in esophageal epithelial differentiation and the tumor microenvironment.” 

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Research Subjects Needed

The NIH-funded randomized trial of sphincterotomy in patients with suspected sphincter of Oddi dysfunction seeks more subjects with troublesome post-cholecystectomy pain.

Details are available at www.clinicaltrials.gov or www.episod.org.

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Budesonide Induces Remission More Effectively than Prednisone

Autoimmune hepatitis (AIH) is a chronic liver disease associated with cirrhosis and liver failure. Corticosteroid therapy induces long-term remission, but has many side effects. Data appearing in Gastroenterology suggest that oral budesonide, in combination with azathioprine, induces and maintains remission in patients with noncirrhotic AIH, with a low rate of steroid-specific side effects.

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Male Gender, Smoking Have Large Impact on Colorectal Neoplasia Prevalence

Screening recommendations for colorectal cancer commonly take family history, but no other risk factors, into account. According to data published in Clinical Gastroenterology and Hepatology, male gender and smoking have a larger impact on the prevalence of colorectal neoplasia than family history, suggesting an extensive evaluation of additional risk stratification in population-based screening, particularly by gender.

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H2-Receptor Antagonists Are an Alternative to PPIs

Previous observational studies reported that concomitant use of clopidogrel and PPIs in patients with prior acute coronary syndrome (ACS) was associated with adverse cardiovascular outcomes. In a study published in Gastroenterology, doctors report that concomitant use of clopidogrel and H2-receptor antagonist or PPI after hospital discharge for ACS is associated with increased risk of adverse outcomes.

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People with Advanced Chronic Liver Disease Have Greater Risk of Complications

Although percutaneous liver biopsy is a standard diagnostic procedure, it has drawbacks, including risk of serious complications. It is not known whether persons with advanced chronic liver disease have a greater risk of complications from liver biopsy than patients with more mild, chronic liver disease. Study results in Clinical Gastroenterology and Hepatology showed that approximately 0.5 percent of persons with hepatitis C and advanced fibrosis experienced potentially serious bleeding after liver biopsy; risk increased significantly in patients with platelet counts of 60,000/mm3 or less.

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Get the Facts on EHR

Incentive payments totaling as much as $27 billion may be made under the Medicare and Medicaid electronic health record (EHR) incentive programs beginning in 2011. What are the key dates for these programs? Read the program timeline.

Are you eligible for an incentive? How much can an eligible professional earn? Get the facts through CMS' tip sheets for eligible professionals. Select the Medicare and Medicaid eligible professional tab on the left, then scroll to downloads:

  • Medicare EHR Incentive Programs, Physician Quality Reporting Initiative and E-Prescribing Comparison — learn what opportunities are available to Medicare eligible professionals to receive incentive payments for participating in important Medicare initiatives. This fact sheet provides information on eligibility, timeframes and maximum payments for each program.
  • Flow Chart to Determine Eligibility for Medicare and Medicaid EHR Incentive Programs — unsure if you are eligible to participate in the Medicare or Medicaid EHR incentive programs? Use this handy flow chart to find out.
  • Medicare EHR Incentive Payments for Eligible Professionals — which types of individual practitioners can participate in the Medicare EHR incentive program? This easy tip sheet provides information about incentive payment amounts and describes how payments are calculated for fee-for-service and Medicare Advantage providers. It also describes payment adjustments beginning in 2015 for eligible professionals who are not meaningful users of certified EHR technology.
  • Medicaid EHR Incentive Payments for Eligible Professionals — which types of individual practitioners can participate in the Medicaid EHR incentive program? Learn about Medicaid patient volume requirements, payment amounts and the timeframes for the Medicaid EHR incentive program.
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On-Demand Webinar on the EHR Incentive Program

Now that CMS has released its final rule, learn what you need to know about the incentive program, the initial electronic health record certification rules and what they mean for your practice.

View Webinar.


Access 2009 E-Prescribing Incentive Program Feedback Reports

Important information about accessing 2009 electronic prescribing (eRx) incentive program feedback reports is posted to the eRx Web page on the CMS Web site.

These feedback reports will be available in November 2010 after the 2009 eRx incentive payments are distributed. Feedback reports are compiled at the taxpayer identification number (TIN) level, with individual-level reporting (by national provider identifier level) information for each eligible professional who reported at least one valid eRx quality data code on a claim submitted under that TIN for services furnished during the reporting period.

Several new and updated educational resource documents about accessing 2009 eRx incentive program feedback reports are now available on the "Spotlight, 2009 Physician Quality Reporting Initiative (PQRI) Program and eRx Overview" links of the eRx Web site, and include the following:

  • Downloadable document on accessing 2009 eRx incentive program feedback reports.
  • 2009 PQRI feedback report user guide.
  • 2009 eRx feedback report user guide.
  • Guide for understanding 2009 PQRI incentive payments.
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On-Demand Webinar Features GI Coding and Billing Basics

Accurate coding and understanding the billing process is critical to maximizing reimbursement, minimizing audit liability and ensuring the financial success of the practice. View this one-hour, on-demand Webinar, offering a comprehensive review of basic coding and billing principles. The Webinar covers:

  • How to select a current procedural terminology/health-care 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.

You can also hear answers to your colleagues' questions that were addressed during the Webinar's Q-and-A session.

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UpToDate® Free Topic of the Month

Produced in cooperation with the AGA Institute, UpToDate® is a subscription-based clinical information resource available on the Web, CD-ROM and pocket PC handheld devices. Each month, a free topic is made available on the AGA Web site. This month's free topic is:

Nearly 232 physicians write more than 673 topic reviews for UpToDate in gastroenterology and hepatology alone. UpToDate provides gastroenterologists with access to more than 60,000 pages of original, peer-reviewed text, 160,000 MEDLINE abstracts, drug information and drug interactions databases, and hundreds of patient information handouts across 12 specialties. Moreover, UpToDate is used by tens of thousands of clinicians in more than 110 countries and by hundreds of premier medical institutions worldwide.

Order your subscription to UpToDate.

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AGA Course Prepares You for Changes in Health-Care Environment

The time is now to prepare your practice for the challenges faced in today's health-care environment. If you are unsure if your practice is ready, ask yourself these questions:

  • Do I have alternative revenue streams set up to help supplement the decline in reimbursements?
  • Am I using my staff efficiently, including nurse practitioners and physician assistants?
  • Can I document outcomes to demonstrate a value-based practice to purchasers, payors and my patients?

Find answers to these questions and more by attending this year's AGA practice manager's/administrator's course, From Surviving to Thriving in a New World, which will be held alongside the AGA Clinical Congress on Jan. 13 and 14, 2011, at the Loews Miami Beach Hotel, FL. This one-and-a-half day course provides an excellent opportunity for physicians and practice managers/administrators to examine their current strategies for successful practice management, update their skills and enhance their knowledge about the future of GI. Physicians can earn up to 10.5 AMA PRA Category 1 Credits™.

Led by a faculty of experienced physicians and practice management experts, the program will address a variety of 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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Register Now

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.


DDSEP® 6 Marks Return of Popular Educational Resource

This December, the AGA Institute will launch the sixth edition of its popular self-assessment activity, the Digestive Diseases Self-Education Program® or DDSEP. Based on the GI core curriculum, DDSEP provides a current and comprehensive review of gastroenterology, hepatology and nutrition.

Under the direction of Editor-in-Chief, John F. Kuemmerle Jr., MD, AGAF, DDSEP 6 features revised and expanded content written by the field's leading experts. It also includes new information on digestive disease in women, nutrition, obesity and eating disorders, as well as all new questions and critiques. The program offers more CME than in previous editions — up to 64 CME credits — with greater flexibility. Users can now claim CME for each chapter, allowing them to focus on specific areas of interest.

"The return of DDSEP fills a void in our field for a current, comprehensive textbook and board-review reference," said Dr. Kuemmerle. "Written and published in the same year, DDSEP avoids the obsolescence often seen with traditional textbooks, providing users with current, reliable information that addresses the latest advances in GI clinical care."

DDSEP has long been used by gastroenterologists to update and assess their knowledge, enhance clinical decision-making skills, prepare for GI board and American Board of Internal Medicine maintenance of certification exams, and earn CME. One of DDSEP's most popular features is that users can work through the program at their own pace and in their preferred format. DDSEP 6 is offered in a combined print/online format, which includes a syllabus, question book and answer/critique book, and online access to the questions.

DDSEP 6 can be pre-ordered through Nov. 30 at a $50 discount. Learn more and order now.

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Earn MOC Points and CME with GI SAM®

Assess your current knowledge of gastroenterology- and hepatology-related topics with GI SAM®, an interactive, intuitive series of online self-assessments modules.

Now Available:


Prepare for the Board Exams

After initial stabilization and resuscitation of the patient, each of the following options should be considered in the management of upper GI bleeding except:

A. Determine the source of bleeding.
B. Stop acute bleeding.
C. Treat the underlying abnormality.
D. Prevent rebleeding.
E. Emergency surgery.

Find the answer to this question in the gastrointestinal bleeding chapter and more than 400 board-like questions and answers from the Digestive Diseases Self-Education Program® (DDSEP) 5.0, the fifth edition of the AGA Institute's popular self-education program.

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AGA Names New Leaders

The AGA Governing Board is pleased to announce the appointment of Lynn P. Robinson, JD, and Thomas J. Serena, MBA, CPA, as co-executive vice presidents.

Since joining the AGA in the mid 1990s when the organization had only a handful of staff members, Robinson and Serena helped shape the AGA into a powerful and respected medical specialty society with more than 85 staff members and a budget of $35 million.

"Tom and Lynn's experience and complementary skills have helped build the AGA as the trusted voice of the GI community," said Ian L. Taylor, MD, PhD, AGAF, president of the AGA Institute. "They have been integral to AGA's many successes in the past 16 years, which include creating respected divisions for public policy, professional affairs, quality and practice management; launching a robust political action committee; developing the AGA Digestive Health Outcomes Registry™; and solidifying Digestive Disease Week® as the gold-standard GI meeting."

Read the full announcement.

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The Puzzle of IBS

IBS is challenging to patients and health-care providers because the causes of the symptoms are not well understood and treatment options are not consistently effective. In a recent article featured in an independent supplement to the Los Angeles Times, AGA member Margaret Heitkemper, PhD, RN, offers her thoughts on several non-drug approaches that are effective. These include relaxation, hypnotherapy and short-term psychodynamic psychotherapy, which can be used in combination with drug therapy, if needed. Thus, the good news is that IBS symptoms can be successfully managed with self-awareness strategies.

Dr. Heitkemper’s article is part of a comprehensive guide exploring the ways in which people can gain control of their digestive health. The report provides information on not only the products available to treat digestive illnesses, but also on just how important diet and nutrition is in aiding and preventing digestive ailments.

Read the full digestive wellness report and share it with your patients.

Dr. Heitkemper is an author of AGA's book, "Master Your IBS: An 8-Week Plan to Control the Symptoms of IBS."

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New Journal Podcasts Available for Download

Listen in each month as the AGA Institute presents thought-provoking podcasts on popular articles from Gastroenterology and Clinical Gastroenterology and Hepatology (CGH). Each podcast lasts approximately 10 to 15 minutes and can be downloaded to an iPod or any other media player. Podcasts are available through iTunes. Subscription to the podcasts is free and you will receive automatic updates on your iPod as new podcasts are added.

Recent podcasts from Gastroenterology include:

Recent podcasts from CGH include:

Podcasts are hosted by the journals' online editor, John F. Kuemmerle, MD, AGAF, professor of medicine and physiology at the Medical College of Virginia Campus at Virginia Commonwealth University. Each month, he will present a mix of author interviews and expert opinion based on articles from the latest issues of Gastroenterology and CGH.

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New Blog Post

Read the latest post on The AGA Journals Blog: Who Has the Greatest Risk for Colorectal Cancer?


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.

Outstanding Opportunities
The Digestive Disease Institute at Thomas Jefferson University Hospitals is seeking two board-certified/eligible gastroenterologists and one hepatologist. This is an exciting opportunity to join one of the largest academic groups (ranked in the top 25 in U.S. News and World Report) on the east coast that is also part of the oldest and second largest liver transplant programs in Philadelphia. This 25-plus physician group provides the opportunity to teach medical students, residents and fellows, be part of an active research program with over 35 active clinical trials and NIH grants, utilize state-of-the-art facilities and technology, while maintaining an excellent work/life balance. Candidates with clinical research experience preferred. Competitive salary and excellent benefit package. To discuss this opportunity, contact:

Anthony DiMarino Jr., MD
Chief of Gastroenterology and Hepatology
Thomas Jefferson University
132 South 10th Street
Suite 480
Main Building
Philadelphia, PA 19107

Phone: 215-955-2728
Fax: 215-955-0872
E-mail to Anthony.DiMarino@jefferson.edu

Jobs. Talent. Better Connections.

Visit the career center today.

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