A gift to the AGA Foundation research awards program by Dec. 31, 2010, qualifies as a tax-deductible charitable donation for the 2010 tax year. Your entire donation — 100 percent — will go to support our research endowment to provide stable, secure award funding for young researchers in GI.

Make a secure online donation to the AGA Foundation research awards program or postmark your check today to qualify for 2010 tax benefits.

Celiac disease is characterized by an inflammatory response to wheat gluten, rye and barley proteins. Fermentation of wheat flour with sourdough lactobacilli and fungal proteases decreases the concentration of gluten. In a study published in Clinical Gastroenterology and Hepatology, doctors found that a 60-day diet of baked goods made from hydrolyzed wheat flour, manufactured with sourdough lactobacilli and fungal proteases, was not toxic to patients with celiac disease. A combined analysis of serologic, morphometric and immunohistochemical parameters is the most accurate method to assess new therapies for this disorder.

Prevalence of NAFLD has not been well established. Data appearing in Gastroenterology suggest that the prevalence of NAFLD and NASH is higher than estimated previously. Hispanics and patients with diabetes are at greatest risk for both NAFLD and NASH.

Most quality indicators for colonoscopy measure processes; little is known about their relationship to patient outcomes. According to study results in Gastroenterology, endoscopist characteristics derived from administrative data are associated with development of post-colonoscopy colorectal cancer and have potential use as quality indicators.

The importance of histologic analysis of biopsy samples in the diagnosis and management of patients with autoimmune hepatitis (AIH) is unclear. Most patients with features of AIH, based on laboratory analyses, are likely to have a compatible liver histology, according to a study in Clinical Gastroenterology and Hepatology. Few patients have atypical histology and these findings have little impact on patient management. These results indicate biopsy samples might not need to be collected from patients who meet other clinical criteria for AIH.

To be eligible for Medicare program meaningful use incentives, eligible providers (EPs) must meet a number of criteria set forth in final rules issued by CMS and the Office of the National Coordinator (ONC). HHS has established that ambulatory surgery centers (ASCs) are not eligible for meaningful use incentives. Can patient encounters in the ASC setting be used in the calculations for EPs to become eligible for meaningful use incentive payments? That depends.

The AGA has posed this question to HHS and CMS staff, who have responded as follows: EPs must demonstrate meaningful use of the electronic health record (EHR) for 50 percent of their patient encounters, and any EHR being utilized must be certified by one of the ONC-authorized testing and certification bodies (ONC-ATCBs). If certified EHR technology is available in the ASC, then the encounters at the ASC would be included in the meaningful use calculations and towards the 50 percent threshold for eligibility. If certified EHR technology is unavailable at the ASC, and the EP had more than 50 percent of their patient encounters at the ASC, then they would not be eligible for the EHR incentives.

It has also been clarified by CMS staff that hospital care/encounters do not apply. Therefore, any hospital services do not count towards the meaningful use calculation.

The following examples demonstrate when an EP would or would not be eligible under the 50 percent rule for meaningful use incentives:

Example 1
A gastroenterologist practices:

• 30 percent in office A with certified EHR technology.
• 20 percent in office B with certified EHR technology.
• 10 percent in hospital with or without certified EHR technology.
• 40 percent in ASC without certified EHR technology.

This GI is eligible for meaningful use incentives.

Example 2
A gastroenterologist practices:

• 30 percent in office with certified EHR technology.
• 10 percent in hospital with or without certified EHR technology.
• 60 percent in ASC without certified EHR technology.

This GI is not eligible for meaningful use incentives.

Example 3
A gastroenterologist practices:

• 30 percent in office A without certified EHR technology.
• 30 percent in office B with certified EHR technology.
• 40 percent in ASC with certified EHR technology

This GI is eligible for meaningful use incentives.

Although every physician's practice pattern is different, if you encounter a large number of patients in the ASC setting, it may be beneficial to ensure that the EHR system you use while seeing patients in the ASC is certified. A current list of ONC-ATCB-approved EHR systems and modules can be found here. This list is updated as more EHRs become certified.

CMS has provided guidance that ambulatory surgical centers (ASCs) may perform a history and physical (H&P) on a patient the same day that patient is scheduled for surgery. The guidelines outlined in the letter are effective immediately.

The existing H&P requirement for ASCs, as written, had been causing confusion among state surveyors, who reportedly did not know whether the requirement that H&Ps be performed "not more than 30 days before the date of the scheduled surgery" allowed the assessments to be conducted on the actual day of surgery. The ASC Association says it brought this concern to the attention of CMS, which responded by issuing a letter to state survey agencies late last week clarifying the requirement. The letter clarifies three major points:

• "The comprehensive H&P may be performed on the same day as the surgical procedure, and may be performed in the ASC." However, the H&P must be performed before the patient is prepped and brought into the operating room.
• "If the H&P is performed on the day of the surgical procedure in the ASC, the H&P assessment may be combined with some, but not all, of the elements of the pre-surgical assessments." Specifically, it cannot be combined with the anesthesia/procedure risk assessment, which must be performed after the H&P by a physician.
• "A comprehensive medical H&P assessment is required regardless of the type of surgical procedure."

CMS will delay for 90 days the implementation of a requirement, made as part of its most recent physician fee schedule final rule, that a physician's or qualified nonphysician practitioner's (NPP) signature must be included on requisitions for clinical diagnostic laboratory tests paid under the clinical laboratory fee schedule effective Jan. 1, 2011. On its website, CMS states:

"Although many physicians, NPPs and clinical diagnostic laboratories may be aware of, and are able to comply with, this policy, CMS is concerned that some physicians, NPPs and clinical diagnostic laboratories are not aware of, or do not understand, this policy. As such, CMS will focus in the first calendar quarter of 2011 on developing educational and outreach materials to educate those affected by this policy. As they become available, we will post this information on our website and use the other channels we have to communicate with providers to ensure this information is widely distributed. Once our first quarter of 2011 educational campaign is fully underway, CMS will expect requisitions to be signed."

Clinical data registries have been around since the 1980s. The ophthalmologists and thoracic surgeons were some of the first specialists to use registries to track outcomes for quality purposes, and others followed later. Fast forward several decades, and registries have moved to the forefront of quality of care. In its second edition of Registries for Evaluating Patient Outcomes: A User's Guide, the Agency for Healthcare Research and Quality defines a patient registry as an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. 

A growing number of federal government quality initiatives now rely on registries, including the CMS Physician Quality Reporting System. CMS qualifies registries to submit quality data to CMS on behalf of eligible professionals for the system. The AGA Digestive Health Outcomes Registry^® is a CMS-qualified registry for reporting on the hepatitis C measures group for 2010. 

The private payors are also incorporating registries as a means of documenting the quality of care and clinical outcomes for physician recognition programs. These are also expected to link to maintenance of certification physician improvement activities. 

At the practice level, registries provide an important quality management tool facilitating the individual physician and the practice to measure a wide range of metrics. The individual provider can compare and contrast their personal performance to that of their peers, identify areas for improvement and develop a personalized plan for improving performance.

The AGA Registry enables eligible professionals to still report for 2010 using the hepatitis C measures group and potentially earn a 2 percent bonus, provided they act quickly and follow these three steps:

• Enroll in the AGA Registry by Jan. 15, 2011.
• Identify 30 unique patients who qualify for the hepatitis C measures group.
• Submit patient data by Jan. 31, 2011, using the registry's physician quality reporting module.

Details about the Physician Quality Reporting System, including measure specifications, can be accessed on the CMS website.

Nominations will close this Monday, Jan. 3 for the AGA Institute Council new vice chair and sections' Nominating Committee members. Please visit the AGA Institute Council nomination page to nominate individuals for these leadership positions.

AGA is soliciting applications from interested members for three Journal Club associate editors to work with the AGA Editorial Board for Online Education. Every month, the Journal Club associate editors will each provide three concise reviews of timely and important articles published in Gastroenterology and Clinical Gastroenterology and Hepatology. Articles reviewed have clinical relevance to members and fellows in training.

For additional information about the position, application requirements and honoraria, contact:

Mark Goetz, eLearning Manager
301-654-2055, ext. 673
education@gastro.org

AGA seeks applications for editor-in-chief of its official clinical practice journal Clinical Gastroenterology and Hepatology (CGH) from qualified members. CGH is the go-to resource on a broad spectrum of themes in clinical gastroenterology and hepatology, providing the best, most actionable information in the field.

This exciting and challenging position requires an energetic and passionate individual to direct the intellectual content of the journal, ensuring its quality and relevancy to clinical investigators and practicing physicians. To keep pace with the rapidly evolving field of medical publishing, candidates must be forward thinking, creative and open to change. Interested candidates must be AGA members and board certified in gastroenterology and hepatology; past experience on a journal editorial board is desirable.

The term of this position is five years and begins July 1, 2012. Completed applications are due April 1, 2011.

For additional information, contact Thoba Khumalo at tkhumalo@gastro.org or 301-941-9780.