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News From The Literature Diaphragm and Esophageal Sphincter Separation Increases Reflux According to a report in this month's Gastroenterology, intermittent spatial separation of the diaphragm and lower esophageal sphincter in the non-reduced state results in a two-fold increase in acidic and weakly acidic reflux. In small hiatal hernias, the size of the hernia is variable and intermittent complete reduction can be observed with high-resolution manometry as a transition from a double-peak to a single-peak high-pressure zone. Researchers from the Netherlands performed prolonged high-resolution manometry in 16 patients who presented with a small hiatal hernia of about 3 cm. The team investigated whether intermittent separation of the diaphragm and lower esophageal sphincter favors the occurrence of gastroesophageal reflux disease. Acidic and weakly acidic reflux episodes were detected with pH-impedance monitoring. The researchers presented the single pressure peak profile, or reduced hernia, for 814 minutes. The double peak profile, or unreduced hernia, was present for 626 minutes. In all patients, both pressure profiles were observed. The transition rate between the two profiles was eight per hour. The team noted that more reflux occurred when the lower esophageal sphincter and diaphragm were separated versus the reduced hernia state. The researchers found that the proportions of acidic reflux episodes during the single and double pressure peaks were similar. In the two-pressure-zone state, there was an increase in all reflux mechanisms except transient lower esophageal sphincter relaxation. - Newsfeed from GastroHep.com Gastroenterology ; 2006: 130(2): 334-340
Calcium plus Vitamin D Supplements Do Not Reduce Colorectal Cancer A study in last week's New England Journal of Medicine finds that daily supplementation of calcium with vitamin D for seven years has no effect on the incidence of colorectal cancer among postmenopausal women. Higher intake of calcium and vitamin D has been associated with a reduced risk of colorectal cancer in epidemiologic studies and with a reduced risk of polyp recurrence in polyp-prevention trials. However, there was a lack of randomized-trial evidence that calcium with vitamin D supplementation is beneficial in the primary prevention of colorectal cancer. Investigators conducted a randomized, double-blind, placebo-controlled trial. The team included 36,282 postmenopausal women from 40 Women's Health Initiative centers over a seven-year period. Out of these, 18,176 women received 500 mg of elemental calcium as calcium carbonate with 200 IU of vitamin D3 twice daily. The researchers gave 18,106 women a matching placebo. The incidence of pathologically confirmed colorectal cancer was the designated secondary outcome. Baseline levels of serum 25-hydroxyvitamin D were assessed in a nested case-control study. The team found that the incidence of invasive colorectal cancer did not differ between women assigned to the supplementation or placebo. The researchers also found that the tumor characteristics were similar in the two groups. The frequency of colorectal-cancer screening and abdominal symptoms was also similar in both groups. The team observed no significant treatment interactions with baseline characteristics. - Newsfeed from GastroHep.com New England Journal of Medicine ; 2006: 354(7): 684-696
Anti-viral Hep C Therapy Associated with Reduced Quality of Life Anti-viral therapy for hepatitis C is associated with diminished health-related quality of life - influenced by both anemia and depression - although depression is the most consistent predictor, according to findings in the latest Journal of Hepatology. Hepatitis C infected patients have significant health-related quality of life impairment which worsens during anti-viral therapy. Researchers examined the association of health-related quality of life with treatment-induced depression and anemia. The team included 271 hepatitis C patients who received pegylated interferon alfa 2b and ribavirin. Data on health-related quality of life, depressive symptoms, laboratory values and socio-demographic characteristics were collected. The mean age of the patients was 47 years, 69 percent were male and 73 percent were white. The researchers found that the patients' health-related quality of life declined during anti-viral therapy. However, the health-related quality of life returned to or exceeded baseline levels within 24 weeks of completion. The team noted that anemia and depression were both associated with health-related quality of life impairment and the effects of depression were strong. Once the team included depression scores, other factors were no longer significant. Patients' depressive symptoms tended to increase during the initial half of treatment regimen. The team observed that those with higher body mass index, cirrhosis and women reported more health-related quality of life impairments. Health-related quality of life scales were generally not associated with alcohol abuse, age, race, alanine aminotransferase and hepatitis C RNA levels. - Newsfeed from GastroHep.com Journal of Hepatology ; 2006: 44(3): 491-8
New Surveillance Program Needed for Esophageal Cancer A report in this month's issue of Endoscopy finds that surveillance programs based on current concepts of risk do not have an impact on mortality from esophageal adenocarcinoma, and more precise methods are needed to identify those most at risk. The incidence of esophageal adenocarcinoma has increased significantly in recent years and surveillance of people with Barrett's esophagus has been advocated in order to detect dysplasia, and early cancer in those considered to be at greatest risk. However, the impact of such a strategy on survival from esophageal adenocarcinoma is unclear. Researchers from Ireland determined the effect of surveillance on mortality from esophageal adenocarcinoma, performing a Medline search of the literature published between 1985 and 2004. The team searched for studies on gastroesophageal reflux disease, Barrett's esophagus and adenocarcinoma. The analysis included 100 male patients considered to be at high risk of developing adenocarcinoma. The patients were aged over 50 with Barrett's esophagus but without high-grade dysplasia at entry. The researchers found that four patients in this high-risk group developed adenocarcinoma during surveillance, with survival rates of 79 percent at two years and also a 79 percent survival at five years. Meanwhile, between 515 and 2,060 patients with Barrett's esophagus were not detected or surveyed by this strategy. Between 16 and 61 of these developed adenocarcinoma, with much lower survival rates of 37 percent at two years and 17 percent at five years. The team noted that surveillance in the high-risk group resulted in the long-term survival of three patients who would not otherwise have survived. This gain was dramatically offset by the 13 to 51 patients, excluded from surveillance by this strategy, who died from esophageal adenocarcinoma. - Newsfeed from GastroHep.com Endoscopy; 2006: 38: 162-9
Genetic Basis for Increased Intestinal Permeability in Families with Crohn's In healthy first-degree relatives of patients with Crohn's disease, high mucosal permeability is associated with the presence of a CARD 15 3020insC mutation, reports a study in this month's Gut. A genetically impaired intestinal barrier function has long been suspected to be a predisposing factor for Crohn's disease. Recently, mutations of the capsase recruitment domain family, member 15 ( CARD 15) gene have been identified and associated with Crohn's disease. German researchers hypothesized that a CARD 15 mutation may be associated with an impaired intestinal barrier. The team studied 128 patients with quiescent Crohn's disease, also assessing 129 first-degree relatives, 66 non-related household members and 96 healthy controls. The three most common CARD 15 polymorphisms of R702W, G908R and 3020insC were analyzed. The research team determined intestinal permeability by the lactulose/mannitol ratio. Intestinal permeability was significantly increased in Crohn's disease patients and the relatives compared with household members and controls. Values above the normal range were seen in 44 percent of Crohn's disease patients and 26 percent of relatives. However, the team observed above-normal-range values in only 6 percent of household members, and in none of the controls. A household community with Crohn's patients was not associated with increased intestinal permeability in family members. The team noted that 40 percent of Crohn's disease first-degree relatives carried a CARD 15 3020insC mutation. The researchers also found that 75 percent of those relatives with combined 3020insC and R702W mutations had increased intestinal permeability. This was compared with only 15 percent of wild-types, indicating a genetic influence on barrier function. The team found that R702W and G908R mutations were not associated with high permeability. - Newsfeed from GastroHep.com Gut ; 2006: 55: 342-7
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Policy Update MedPAC To Congress: Fix the Reimbursement System The Medicare Payment Advisory Commission (MedPAC), and advisory body to Congress, has released its March report, which focuses on payment adequacy and policies for physicians, hospitals and other health care providers. Throughout the report, MedPAC points out inadequacies with the current sustainable growth rate formula (SGR), which sets physician reimbursement rates. Under the SGR, 5 percent rate cuts are planned yearly through 2011. The Commission recommended approximately a 2.8 percent physician fee update for 2007, and used the Medicare Economic Index instead of the SGR to estimate costs. The AGA and MedPAC oppose sustained fee cuts planned under the SGR because the cuts could result in reduced beneficiary access to physician services. The March report specified that per capita volume for imaging, tests and non-major procedures grew the most over 2004. Volume grew 6.2 percent per beneficiary and in 2004, spending on physician services grew by 11.5 percent, resulting in substantial increases in Part B spending. The SGR formula includes the growth in input costs, growth in fee-for-service enrollment, and growth in the volume of physician services relative to growth in the national economy. The Commission indicates in the report that it considers the SGR formula a flawed, inequitable mechanism for volume control and plans to examine alternative approaches to the SGR over the coming year. As previously reported in AGA eDigest, Congress overrode the scheduled payment cuts under the SGR formula by freezing 2006 Medicare fees at 2005 levels. The AGA aggressively advocated against payment cuts. The MedPAC report also contained a chapter on the review of work relative values of the physician fee schedule. The Commission is concerned that the current system does a poor job of identifying services paid too high relative to others and that inaccurate payment rates can distort the market for physician services. MedPAC recommended that the Secretary of Health and Human Services establish a standing panel of experts to help CMS identify overvalued physician services and to review recommendations from the AMA’s Relative Value Scale Update Committee (RUC). The panel should be given the resources it needs to independently collect data and develop evidence. The panel should initiate a five-year review of services that have experienced substantial changes in length of stay, site of service, volume, practice expense and other factors that may indicate changes in physician work. New services likely to experience reductions in value should be referred to the RUC for review. Lastly, to ensure the validity of the physician fee schedule, the Secretary should review all services periodically. At this time, MedPAC reported that beneficiary access to physicians remains strong and that the number of physicians providing services to Medicare beneficiaries has kept pace with the growth in the beneficiary population. MedPAC also reported that 2004 Medicare rates were 83 percent of extrapolated private payer rates, a slight increase from 81 percent in 2003. MedPAC is an advisory body to Congress and, as such, Congress is not bound to accept the commission’s recommendations. Stay tuned to next week’s AGAeDigest, however, to read about the Health Subcommittee of the Ways and Means Committee’s hearing on MedPAC’s March report. To review the complete report, see www.Medpac.gov.
Competitive Acquisition Program Election for Physicians Announced Beginning in April 2006, Medicare physicians will be given the opportunity to elect to participate in the Competitive Acquisition Program ( CAP ) for claims paid on or after July 1, 2006. Participating CAP physicians will obtain Medicare Part B covered drugs from selected drug categories through the CAP . Until further notice, there is only one drug category in the CAP . The exact dates of the physician election period will be announced in AGA eDigest once released by the Centers for Medicare & Medicaid Services ( CMS ). Under the voluntary CAP program, physicians will have the option of obtaining many physician-administered drugs from vendors selected by Medicare through competitive contracting. The vendors are then responsible for billing the Medicare program for the drugs and billing the patients for any coinsurance or deductibles or a third-party insurer such as Medigap after the drugs have been administered. An advantage of the CAP program is that it will free physicians from the administrative work of purchasing and procuring drugs in their offices. Physicians will continue to bill Medicare for the drug administration portion and Medicare will pay the same amount whether the physician obtains the drugs directly from a vendor or through the CAP program. Physicians who do not wish to participate in the program may continue to purchase their drugs through the vendors and be paid directly by Medicare at the rate of 106 percent of the manufacturers' average sales price. As previously announced in AGAeDigest, CMS suspended the CAP vendor bidding process last fall in order to address a number of concerns and operational issues. CMS also delayed the implementation of the CAP program from Jan. 1, 2006, to July 1, 2006. The CAP program is only available for physician-injectable drugs covered under Medicare's Supplemental Medical Insurance (or Part B) program that are commonly provided incident to the physician's service. For gastroenterologists, this will include the administration of infliximab (Remicade) for Medicare beneficiaries with Crohn's disease. The CAP program will not apply to drugs included in the new Prescription Drug Benefit (Medicare Part D) or to drugs that are self-administered by the patient. Physicians will elect whether to participate in the CAP on a yearly basis and choose a vendor. More information
CMS Announces National Colorectal Cancer Awareness Month March is National Colorectal Cancer Awareness Month and the Centers for Medicare & Medicaid Services ( CMS ) is encouraging all providers to screen eligible patients for colorectal cancer. CMS has a comprehensive Medlearn Matters Special Edition issue that reviews Medicare coverage and billing processes for colorectal cancer screening. Colorectal cancer is the second-leading cause of cancer death in the U.S., and the third-most-common type of cancer. Although colorectal cancer screening has been a Medicare benefit since 1998, the remains underutilized. Claims data from 1998-2002 indicate that less than half of Medicare beneficiaries had any screening test during this five-year period, and less than one-third were tested according to recommended intervals. There are a variety of methods available for colorectal cancer screening, including fecal occult blood testing, flexible sigmoidoscopy, colonoscopy and screening barium enema. The Medlearn article provides detailed information on Medicare coverage guidelines and time intervals for these screening tests. It is important that practitioners follow the practice guidelines for screening and follow-up. The Medlearn article includes information on who is considered to be at high risk for colorectal cancer and detailed information on how to bill Medicare with the correct HCPCS codes. CMS has also developed a comprehensive prevention Web site that provides information and resources for all Medicare preventive benefits.
Medicare To Cover Bariatric Surgery The Centers for Medicare and Medicaid Services ( CMS ) issued a final decision memorandum on Feb. 21 stating that Medicare will begin covering obesity surgeries for beneficiaries 65 and older under certain conditions. Coverage of the obesity surgery will be confined to those beneficiaries with another medical condition such as hypertension, type-2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory surgery and certain types of cancer. CMS originally issued a proposed decision memorandum in November 2005 that restricted coverage of obesity surgery to those under 65, since the data indicated those over 65 had higher death rates after bariatric surgery. However, CMS reviewed new data that indicates experienced surgeons have similar outcomes for patients despite age. CMS has also stated that it will only cover the procedures in facilities certified by the American College of Surgeons and the American Society for Bariatric Surgery.
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News For Clinicians AGA Convenes Panel on Polyp Surveillance Performance Measures The AGA Center for Quality in Practice has convened a panel of technical experts to develop performance measures for polyp surveillance. This is the first topic chosen by the AGA for developing measures using our performance measurement process. Although the panel's work is not yet finalized, the measures will focus on surveillance intervals and processes that are measurable and manageable by the gastroenterologist. The panel used several seminal guidelines for the development of the measures, including Colorectal cancer screening and surveillance: Clinical guidelines and rationale-Update based on new evidence. The Center for Quality in Practice technical expert panel on polyp surveillance is comprised of GI experts representing diverse practice settings, training and experience. The criteria for panel composition included:
After the measures have been finalized, the Center for Quality in Practice will develop data abstraction and reporting tools, which will be beta tested in a variety of practice settings. Based on the beta test results, the data collection tools and related resources will be refined and made available to members. For more information regarding this project, please contact Debbie Robin at drobin@gastro.org.
Attend a Free Interactive CME Café Workshop Join us at an upcoming breakfast workshop in the following cities:
The workshops are a series of cutting-edge educational programs featuring leading experts who explore clinically relevant and emerging topics using actual clinical examples. Past attendees have praised the program as an "excellent interactive learning experience" that helped them "to improve their clinical knowledge" and "gain new insights into GI diseases." Physicians can earn CME credit for attending. Additional workshops are being scheduled at locations across the country. Click here for more information and to register for an upcoming workshop. AGA developed this program in cooperation with Healthology. GERD (Barrett's Esophagus), Evolving Aspects of Colorectal Carcinoma, and Innovations in Endoscopy are sponsored through an educational grant from TAP Pharmaceutical Products, Inc. This activity has been approved for AMA PRA Category 1 Credit.
Let GICareerSearch.com Work for You Let GICareerSearch.com do your recruiting and job placement work for you. AGA 's online physician placement service, GICareerSearch.com, is the leading recruitment resource for jobs in gastroenterology. Launched in March 2000, GICareerSearch.com has successfully matched many gastroenterologists with jobs throughout the U.S. If you are a candidate looking for a job, sign up for Job Alerts to receive instant e-mail notifications as new jobs are posted to the discipline and geographic location you have specified. In addition, you can search the GICareerSearch.com database 24-hours-a-day to find open listings, create an online profile and post your résumé. You can also send your résumé with a cover letter directly to employers in the GICareerSearch.com database. Employers with job postings on GICareerSearch.com can sign up for Résumé Alerts - instant e-mail notifications of new résumé postings that meet the criteria for your job. You can also find candidates directly by searching the posted résumé database. GICareerSearch.com is a cost-effective way to reach potential candidates by allowing you simultaneously to post an online ad as well as a print ad in an AGA Journal. In addition to the listings of open positions, the site includes an online tool called Conference Connection which allows both candidates and employers to facilitate face-to-face meetings at industry conferences and upcoming AGA events such as Digestive Disease Week. GICareerSearch.com is a member of the HEALTHeCAREERS Network of association career programs. Sign up today by visiting www.GICareerSearch.com, by calling (888) 884-8242 or by e-mailing info@healthecareers.com.
AGA Offers GI Coding & Reimbursement Seminars The AGA is a proud sponsor of gastroenterology coding and reimbursement seminars presented by McVey Associates. Read an online brochure for more information. Following are dates and locations of the one-day seminars to be held this month.
AGA members can register for these workshops at the reduced fee of $250 ($230 for each additional registrant from a physician's office). If you are interested in attending a seminar, click on the city name above for a registration form.
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News For Academic Clinicians & Researchers Attend a Free Interactive CME Café Workshop Join us at an upcoming breakfast workshop in the following cities:
The workshops are a series of cutting-edge educational programs featuring leading experts who explore clinically relevant and emerging topics using actual clinical examples. Past attendees have praised the program as an "excellent interactive learning experience" that helped them "to improve their clinical knowledge" and "gain new insights into GI diseases." Physicians can earn CME credit for attending. Additional workshops are being scheduled at locations across the country. Click here for more information and to register for an upcoming workshop. AGA developed this program in cooperation with Healthology. GERD (Barrett's Esophagus), Evolving Aspects of Colorectal Carcinoma, and Innovations in Endoscopy are sponsored through an educational grant from TAP Pharmaceutical Products, Inc. This activity has been approved for AMA PRA Category 1 Credit.
Sign up today for Job and Résumé Alerts Let GICareerSearch.com do your recruiting and job placement work for you. AGA 's online physician placement service, GICareerSearch.com, is the leading recruitment resource for jobs in gastroenterology. Launched in March 2000, GICareerSearch.com has successfully matched many gastroenterologists with jobs throughout the U.S. If you are a candidate looking for a job, sign up for Job Alerts to receive instant e-mail notifications as new jobs are posted to the discipline and geographic location you have specified. In addition, you can search the GICareerSearch.com database 24-hours-a-day to find open listings, create an online profile and post your résumé. You can also send your résumé with a cover letter directly to employers in the GICareerSearch.com database. Employers with job postings on GICareerSearch.com can sign up for Résumé Alerts - instant e-mail notifications of new résumé postings that meet the criteria for your job. You can also find candidates directly by searching the posted résumé database. GICareerSearch.com is a cost-effective way to reach potential candidates by allowing you simultaneously to post an online ad as well as a print ad in an AGA Journal. In addition to the listings of open positions, the site includes an online tool called Conference Connection which allows both candidates and employers to facilitate face-to-face meetings at industry conferences and upcoming AGA events such as Digestive Disease Week. GICareerSearch.com is a member of the HEALTHeCAREERS Network of association career programs. Sign up today by visiting www.GICareerSearch.com, by calling (888) 884-8242 or by e-mailing info@healthecareers.com.
Work Begins on Polyp Surveillance Performance Measures The AGA Center for Quality in Practice has convened a panel of technical experts to develop performance measures for polyp surveillance. This is the first topic chosen by the AGA for developing measures using our performance measurement process. Although the panel's work is not yet finalized, the measures will focus on surveillance intervals and processes that are measurable and manageable by the gastroenterologist. The panel used several seminal guidelines for the development of the measures, including Colorectal cancer screening and surveillance: Clinical guidelines and rationale-Update based on new evidence. The Center for Quality in Practice technical expert panel on polyp surveillance is comprised of GI experts representing diverse practice settings, training and experience. The criteria for panel composition included:
After the measures have been finalized, the Center for Quality in Practice will develop data abstraction and reporting tools, which will be beta tested in a variety of practice settings. Based on the beta test results, the data collection tools and related resources will be refined and made available to members. For more information regarding this project, please contact Debbie Robin at drobin@gastro.org.
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News for Trainees Expand Your Career Opportunities GICareerSearch.com, the official job bank of AGA , is the place to go, whether you're actively searching for a job or just curious about the opportunities available. Job openings are updated regularly and targeted specifically to the field of gastroenterology. Launched in March 2000, GICareerSearch.com offers positions in academia and research, gastroenterological surgery, general gastroenterology, hepatology, pediatric gastroenterology and GI nursing. By allowing you to create an online profile and post your résumé, GICareerSearch.com doubles your chances both for being seen and getting the job. You can post your information confidentially, reply directly to online job postings and submit a cover letter with your résumé. If you've already created a profile, go online and make sure that it is up-to-date and confirm that your résumé is posted. GICareerSearch.com offers free access, 24-hours-a-day, to over 200 active jobs and offerings can be searched either by discipline or location The site also offers Job Alerts with e-mail notification as new jobs are posted to the discipline and geographic location you specify. In addition to the listings of open positions, GICareerSearch.com includes an online tool called Conference Connection which allows both job seekers and employers to flag their online profiles to facilitate face-to-face meetings at upcoming AGA events such as Digestive Disease Week. GICareerSearch.com is a member of the HEALTHeCAREERS network of association career programs. Find out more by visiting www.GICareerSearch.com, by calling (888) 884-8242 or by e-mailing info@healthecareers.com.
Polyp Surveillance Performance Measures Expert Technical Panel Meets The AGA Center for Quality in Practice has convened a panel of technical experts to develop performance measures for polyp surveillance. This is the first topic chosen by the AGA for developing measures using our performance measurement process. Although the panel's work is not yet finalized, the measures will focus on surveillance intervals and processes that are measurable and manageable by the gastroenterologist. The panel used several seminal guidelines for the development of the measures, including Colorectal cancer screening and surveillance: Clinical guidelines and rationale-Update based on new evidence. The Center for Quality in Practice technical expert panel on polyp surveillance is comprised of GI experts representing diverse practice settings, training and experience. The criteria for panel composition included:
After the measures have been finalized, the Center for Quality in Practice will develop data abstraction and reporting tools, which will be beta tested in a variety of practice settings. Based on the beta test results, the data collection tools and related resources will be refined and made available to members. For more information regarding this project, please contact Debbie Robin at drobin@gastro.org.
Attend a Free Interactive CME Café Workshop Join us at an upcoming breakfast workshop in the following cities:
The workshops are a series of cutting-edge educational programs featuring leading experts who explore clinically relevant and emerging topics using actual clinical examples. Past attendees have praised the program as an "excellent interactive learning experience" that helped them "to improve their clinical knowledge" and "gain new insights into GI diseases." Physicians can earn CME credit for attending. Additional workshops are being scheduled at locations across the country. Click here for more information and to register for an upcoming workshop. AGA developed this program in cooperation with Healthology. GERD (Barrett's Esophagus), Evolving Aspects of Colorectal Carcinoma, and Innovations in Endoscopy are sponsored through an educational grant from TAP Pharmaceutical Products, Inc. This activity has been approved for AMA PRA Category 1 Credit.
Place GI position listings and activity announcements in 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 ¹s 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 Vivian Hayward at vhayward@gastro.org or (301) 654-2055 . Activity Announcement California District of Columbia Oklahoma Oregon Virginia
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