News from AGA

One of the most devastating complications in any endoscopic procedure is a perforation that may result in a life-threatening situation for the patient and abrupt termination of the intended procedure. The new AGA Clinical Practice Update on Endoscopic Management of Perforations in Gastrointestinal Tract: Expert Review offers a practical approach to prevent GI perforations, as well as detect subtle signs of and endoscopically manage them.

Best practice advice

• The area of perforation should be kept clean to prevent any spillage of gastrointestinal contents into the perforation by aspirating liquids and, if necessary, changing the patient position to bring the perforation into a nondependent location while minimizing insufflation of carbon dioxide to avoid compartment syndrome.
• Use of carbon dioxide for insufflation is encouraged for all endoscopic procedures, especially any endoscopic procedure with increased risk of perforation. If available, carbon dioxide should be used for all endoscopic procedures.
• All endoscopists should be aware of the procedures that carry an increased risk for perforation such as any dilation, foreign body removal, any per oral endoscopic myotomy (Zenker’s, esophageal, pyloric), stricture incision, thermal coagulation for hemostasis or tumor ablation, percutaneous endoscopic gastrostomy, ampullectomy, endoscopic mucosal resectio, endoscopic submucosal dissection, endoluminal stenting with self-expanding metal stent, full-thickness endoscopic resection, endoscopic retrograde cholangiopancreatography in surgically altered anatomy, endoscopic ultrasound (EUS)–guided biliary and pancreatic access, EUS-guided cystogastrostomy, and endoscopic gastroenterostomy using a lumen apposing metal stent.
• Urgent surgical consultation should be highly considered in all cases with perforation even when endoscopic repair is technically successful.

One of the most devastating complications in any endoscopic procedure is a perforation that may result in a life-threatening situation for the patient and abrupt termination of the intended procedure. The new AGA Clinical Practice Update on Endoscopic Management of Perforations in Gastrointestinal Tract: Expert Review offers a practical approach to prevent GI perforations, as well as detect subtle signs of and endoscopically manage them.

Best practice advice

• The area of perforation should be kept clean to prevent any spillage of gastrointestinal contents into the perforation by aspirating liquids and, if necessary, changing the patient position to bring the perforation into a nondependent location while minimizing insufflation of carbon dioxide to avoid compartment syndrome.
• Use of carbon dioxide for insufflation is encouraged for all endoscopic procedures, especially any endoscopic procedure with increased risk of perforation. If available, carbon dioxide should be used for all endoscopic procedures.
• All endoscopists should be aware of the procedures that carry an increased risk for perforation such as any dilation, foreign body removal, any per oral endoscopic myotomy (Zenker’s, esophageal, pyloric), stricture incision, thermal coagulation for hemostasis or tumor ablation, percutaneous endoscopic gastrostomy, ampullectomy, endoscopic mucosal resectio, endoscopic submucosal dissection, endoluminal stenting with self-expanding metal stent, full-thickness endoscopic resection, endoscopic retrograde cholangiopancreatography in surgically altered anatomy, endoscopic ultrasound (EUS)–guided biliary and pancreatic access, EUS-guided cystogastrostomy, and endoscopic gastroenterostomy using a lumen apposing metal stent.
• Urgent surgical consultation should be highly considered in all cases with perforation even when endoscopic repair is technically successful.

One of the most devastating complications in any endoscopic procedure is a perforation that may result in a life-threatening situation for the patient and abrupt termination of the intended procedure. The new AGA Clinical Practice Update on Endoscopic Management of Perforations in Gastrointestinal Tract: Expert Review offers a practical approach to prevent GI perforations, as well as detect subtle signs of and endoscopically manage them.

Best practice advice

• The area of perforation should be kept clean to prevent any spillage of gastrointestinal contents into the perforation by aspirating liquids and, if necessary, changing the patient position to bring the perforation into a nondependent location while minimizing insufflation of carbon dioxide to avoid compartment syndrome.
• Use of carbon dioxide for insufflation is encouraged for all endoscopic procedures, especially any endoscopic procedure with increased risk of perforation. If available, carbon dioxide should be used for all endoscopic procedures.
• All endoscopists should be aware of the procedures that carry an increased risk for perforation such as any dilation, foreign body removal, any per oral endoscopic myotomy (Zenker’s, esophageal, pyloric), stricture incision, thermal coagulation for hemostasis or tumor ablation, percutaneous endoscopic gastrostomy, ampullectomy, endoscopic mucosal resectio, endoscopic submucosal dissection, endoluminal stenting with self-expanding metal stent, full-thickness endoscopic resection, endoscopic retrograde cholangiopancreatography in surgically altered anatomy, endoscopic ultrasound (EUS)–guided biliary and pancreatic access, EUS-guided cystogastrostomy, and endoscopic gastroenterostomy using a lumen apposing metal stent.
• Urgent surgical consultation should be highly considered in all cases with perforation even when endoscopic repair is technically successful.

After an unexpected and challenging year and as the new year begins, there are some ways you can make a difference, without giving up assets you may need today.

• Beneficiary designation. Adding the AGA Research Foundation as a beneficiary of your retirement plan or other assets is simple and you don’t need to leave your home to complete the gift. Since the funds are granted after your lifetime, you can maintain your family budget today.
• Gift in your will. With as little as one sentence, you can create a brighter tomorrow at the AGA Research Foundation without parting with assets today. You can designate the AGA Research Foundation as the beneficiary of a specific asset or, as many of our donors do to ensure that their family is protected, as the recipient of a percentage of the total estate.
• Grant from your donor advised fund (DAF). This popular one-stop giving solution lets you care for multiple causes and organizations with minimal paperwork. Consider it a charitable savings account where money waits until you’re ready to distribute it. And when you use your existing DAF to recommend a grant, it means you can invest in our future without impacting your budget today.
• Distribution from your IRA. If you are 70½ years or older, you can use your IRA to make a gift directly to the AGA Research Foundation without having to pay income tax on the distribution. Beginning in the year you turn 72, you must take your required minimum distribution (RMD). You can use a gift from your IRA to satisfy all or part of your RMD.

Learn more at https://gastro.planmylegacy.org.

After an unexpected and challenging year and as the new year begins, there are some ways you can make a difference, without giving up assets you may need today.

• Beneficiary designation. Adding the AGA Research Foundation as a beneficiary of your retirement plan or other assets is simple and you don’t need to leave your home to complete the gift. Since the funds are granted after your lifetime, you can maintain your family budget today.
• Gift in your will. With as little as one sentence, you can create a brighter tomorrow at the AGA Research Foundation without parting with assets today. You can designate the AGA Research Foundation as the beneficiary of a specific asset or, as many of our donors do to ensure that their family is protected, as the recipient of a percentage of the total estate.
• Grant from your donor advised fund (DAF). This popular one-stop giving solution lets you care for multiple causes and organizations with minimal paperwork. Consider it a charitable savings account where money waits until you’re ready to distribute it. And when you use your existing DAF to recommend a grant, it means you can invest in our future without impacting your budget today.
• Distribution from your IRA. If you are 70½ years or older, you can use your IRA to make a gift directly to the AGA Research Foundation without having to pay income tax on the distribution. Beginning in the year you turn 72, you must take your required minimum distribution (RMD). You can use a gift from your IRA to satisfy all or part of your RMD.

Learn more at https://gastro.planmylegacy.org.

After an unexpected and challenging year and as the new year begins, there are some ways you can make a difference, without giving up assets you may need today.

• Beneficiary designation. Adding the AGA Research Foundation as a beneficiary of your retirement plan or other assets is simple and you don’t need to leave your home to complete the gift. Since the funds are granted after your lifetime, you can maintain your family budget today.
• Gift in your will. With as little as one sentence, you can create a brighter tomorrow at the AGA Research Foundation without parting with assets today. You can designate the AGA Research Foundation as the beneficiary of a specific asset or, as many of our donors do to ensure that their family is protected, as the recipient of a percentage of the total estate.
• Grant from your donor advised fund (DAF). This popular one-stop giving solution lets you care for multiple causes and organizations with minimal paperwork. Consider it a charitable savings account where money waits until you’re ready to distribute it. And when you use your existing DAF to recommend a grant, it means you can invest in our future without impacting your budget today.
• Distribution from your IRA. If you are 70½ years or older, you can use your IRA to make a gift directly to the AGA Research Foundation without having to pay income tax on the distribution. Beginning in the year you turn 72, you must take your required minimum distribution (RMD). You can use a gift from your IRA to satisfy all or part of your RMD.

Learn more at https://gastro.planmylegacy.org.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion:  

Robert Herman, MD, wrote in “Rectal lesion”:

A 42-year-old healthy female was seen by me for symptoms of non-ulcer dyspepsia that was unresponsive to H2 Blockers and for assessment for screening colonoscopy. Her father had developed colon cancer at the age of 50. She denied changes in bowel habits, pattern, rectal bleeding, or melena. An EGD revealed a medium sized hiatal hernia and LA Grade B esophagitis that responded well to an OTC PPI qd.

A colonoscopy was performed and revealed a 4-cm anterior rectal “bulge” just above the hemorrhoidal plexus, appearing somewhat firm and mobile on probing the lesion with a closed biopsy forceps, and a 1 cm sessile IC valve adenomatous polyp.

And then the endoscopic medical assistant made a comment that changed everything. Read the full case discussion: https://community.gastro.org/posts/25568.
 

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion:  

Robert Herman, MD, wrote in “Rectal lesion”:

A 42-year-old healthy female was seen by me for symptoms of non-ulcer dyspepsia that was unresponsive to H2 Blockers and for assessment for screening colonoscopy. Her father had developed colon cancer at the age of 50. She denied changes in bowel habits, pattern, rectal bleeding, or melena. An EGD revealed a medium sized hiatal hernia and LA Grade B esophagitis that responded well to an OTC PPI qd.

A colonoscopy was performed and revealed a 4-cm anterior rectal “bulge” just above the hemorrhoidal plexus, appearing somewhat firm and mobile on probing the lesion with a closed biopsy forceps, and a 1 cm sessile IC valve adenomatous polyp.

And then the endoscopic medical assistant made a comment that changed everything. Read the full case discussion: https://community.gastro.org/posts/25568.
 

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion:  

Robert Herman, MD, wrote in “Rectal lesion”:

A 42-year-old healthy female was seen by me for symptoms of non-ulcer dyspepsia that was unresponsive to H2 Blockers and for assessment for screening colonoscopy. Her father had developed colon cancer at the age of 50. She denied changes in bowel habits, pattern, rectal bleeding, or melena. An EGD revealed a medium sized hiatal hernia and LA Grade B esophagitis that responded well to an OTC PPI qd.

A colonoscopy was performed and revealed a 4-cm anterior rectal “bulge” just above the hemorrhoidal plexus, appearing somewhat firm and mobile on probing the lesion with a closed biopsy forceps, and a 1 cm sessile IC valve adenomatous polyp.

And then the endoscopic medical assistant made a comment that changed everything. Read the full case discussion: https://community.gastro.org/posts/25568.
 

Patients with cirrhosis, or permanent liver damage, are at higher risk for coagulation disorders, which impact your body’s ability to control blood clotting. This puts cirrhosis patients at increased risk of morbidity and mortality when undergoing diagnostic or therapeutic invasive procedures. AGA has released new clinical guidelines to change how you identify and treat coagulation disorders in patients with cirrhosis. In this new guidance, AGA recommends against the use of extensive preprocedural testing to estimate clotting in patients with cirrhosis. These guidelines, which were developed after a detailed review of available literature, are published in Gastroenterology, AGA’s official journal.

Key guideline recommendations:

• Extensive preprocedural testing, including measurements of prothrombin time/international normalized ratio or platelet count, should not routinely be performed in patients with stable cirrhosis undergoing common GI procedures.
• Blood products, including fresh frozen plasma or platelet transfusion, should not routinely be used for bleeding prophylaxis in patients with stable cirrhosis undergoing common GI procedures.
• Standard pharmacologic venous thromboembolism prophylaxis should be given to hospitalized patients with cirrhosis like other medical patients.
• Anticoagulation should be used to treat acute or subacute nontumoral portal vein thrombosis in patients with cirrhosis to improve patient outcomes.

Learn more in the AGA GI Patient Center. Read the AGA Clinical Practice Guidelines on the Management of Coagulation Disorders in Patients with Cirrhosis to review the complete recommendations.

Patients with cirrhosis, or permanent liver damage, are at higher risk for coagulation disorders, which impact your body’s ability to control blood clotting. This puts cirrhosis patients at increased risk of morbidity and mortality when undergoing diagnostic or therapeutic invasive procedures. AGA has released new clinical guidelines to change how you identify and treat coagulation disorders in patients with cirrhosis. In this new guidance, AGA recommends against the use of extensive preprocedural testing to estimate clotting in patients with cirrhosis. These guidelines, which were developed after a detailed review of available literature, are published in Gastroenterology, AGA’s official journal.

Key guideline recommendations:

• Extensive preprocedural testing, including measurements of prothrombin time/international normalized ratio or platelet count, should not routinely be performed in patients with stable cirrhosis undergoing common GI procedures.
• Blood products, including fresh frozen plasma or platelet transfusion, should not routinely be used for bleeding prophylaxis in patients with stable cirrhosis undergoing common GI procedures.
• Standard pharmacologic venous thromboembolism prophylaxis should be given to hospitalized patients with cirrhosis like other medical patients.
• Anticoagulation should be used to treat acute or subacute nontumoral portal vein thrombosis in patients with cirrhosis to improve patient outcomes.

Learn more in the AGA GI Patient Center. Read the AGA Clinical Practice Guidelines on the Management of Coagulation Disorders in Patients with Cirrhosis to review the complete recommendations.

Patients with cirrhosis, or permanent liver damage, are at higher risk for coagulation disorders, which impact your body’s ability to control blood clotting. This puts cirrhosis patients at increased risk of morbidity and mortality when undergoing diagnostic or therapeutic invasive procedures. AGA has released new clinical guidelines to change how you identify and treat coagulation disorders in patients with cirrhosis. In this new guidance, AGA recommends against the use of extensive preprocedural testing to estimate clotting in patients with cirrhosis. These guidelines, which were developed after a detailed review of available literature, are published in Gastroenterology, AGA’s official journal.

Key guideline recommendations:

• Extensive preprocedural testing, including measurements of prothrombin time/international normalized ratio or platelet count, should not routinely be performed in patients with stable cirrhosis undergoing common GI procedures.
• Blood products, including fresh frozen plasma or platelet transfusion, should not routinely be used for bleeding prophylaxis in patients with stable cirrhosis undergoing common GI procedures.
• Standard pharmacologic venous thromboembolism prophylaxis should be given to hospitalized patients with cirrhosis like other medical patients.
• Anticoagulation should be used to treat acute or subacute nontumoral portal vein thrombosis in patients with cirrhosis to improve patient outcomes.

Learn more in the AGA GI Patient Center. Read the AGA Clinical Practice Guidelines on the Management of Coagulation Disorders in Patients with Cirrhosis to review the complete recommendations.

2022 Medicare payment rules contain both good and bad news for GI. First the bad news: GIs and other specialties face millions of dollars in cuts as Medicare finalized a 3.71% cut to the Physician Fee Schedule conversion factor, which could increase to near 9% if Congress doesn’t act.

Here are highlights from the 2022 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Department (HOPD)/Ambulatory Surgery Center (ASC) final rules.

Good news

• Telehealth reimbursement continues through December 2023.
• Medicare coverage changes from the Removing Barriers to Colorectal Cancer Screening Act were finalized and coinsurance reduction will start Jan. 1, 2022, with full phase out by 2030.

Bad news

• A 3.71% cut to MPFS 2022 conversion factor, which could result in a up to 9% cut to our practices. Email your lawmaker now.
• HOPD and ASC conversion factors will increase 2% for those that meet applicable quality reporting requirements.
• New MPFS payments for peroral endoscopic myotomy (POEM) and some capsule endoscopy CPT codes not as high as expected.

2022 Medicare payment rules contain both good and bad news for GI. First the bad news: GIs and other specialties face millions of dollars in cuts as Medicare finalized a 3.71% cut to the Physician Fee Schedule conversion factor, which could increase to near 9% if Congress doesn’t act.

Here are highlights from the 2022 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Department (HOPD)/Ambulatory Surgery Center (ASC) final rules.

Good news

• Telehealth reimbursement continues through December 2023.
• Medicare coverage changes from the Removing Barriers to Colorectal Cancer Screening Act were finalized and coinsurance reduction will start Jan. 1, 2022, with full phase out by 2030.

Bad news

• A 3.71% cut to MPFS 2022 conversion factor, which could result in a up to 9% cut to our practices. Email your lawmaker now.
• HOPD and ASC conversion factors will increase 2% for those that meet applicable quality reporting requirements.
• New MPFS payments for peroral endoscopic myotomy (POEM) and some capsule endoscopy CPT codes not as high as expected.

2022 Medicare payment rules contain both good and bad news for GI. First the bad news: GIs and other specialties face millions of dollars in cuts as Medicare finalized a 3.71% cut to the Physician Fee Schedule conversion factor, which could increase to near 9% if Congress doesn’t act.

Here are highlights from the 2022 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Department (HOPD)/Ambulatory Surgery Center (ASC) final rules.

Good news

• Telehealth reimbursement continues through December 2023.
• Medicare coverage changes from the Removing Barriers to Colorectal Cancer Screening Act were finalized and coinsurance reduction will start Jan. 1, 2022, with full phase out by 2030.

Bad news

• A 3.71% cut to MPFS 2022 conversion factor, which could result in a up to 9% cut to our practices. Email your lawmaker now.
• HOPD and ASC conversion factors will increase 2% for those that meet applicable quality reporting requirements.
• New MPFS payments for peroral endoscopic myotomy (POEM) and some capsule endoscopy CPT codes not as high as expected.

As COVID-19 cases rise in the United States due to the Delta variant, there is renewed concern about infection and transmission of SARS-CoV-2 during endoscopy. In May 2021, AGA released updated recommendations on preprocedure testing post vaccination in the setting of ongoing population-wide vaccination programs for the prevention of COVID-19–related morbidity. In vaccinated individuals, breakthrough infections occurred very infrequently. Weighing the evidence demonstrating extremely low rates of rates of infection and transmission with vaccination and PPE, and considering the downsides of routine testing (burden, cost, false test results, increased disparities), AGA made a conditional recommendation against routine preprocedure testing for elective cases. The highly contagious Delta variant has now emerged as the predominant SARS-CoV2 virus in the U.S. and some data suggests that it may cause more severe illness than previous strains.  While more breakthrough infections may develop in fully vaccinated individuals, the greatest risk of infection, transmission and hospitalizations is among those who are unvaccinated.

• AGA suggests against reinstituting routine preprocedure testing prior to elective endoscopy. The downsides (delays in patient care, burden, inaccurate results) outweigh potential benefits. Infection and transmission of SARS-CoV-2 from asymptomatic individuals is rare especially among vaccinated health care workers using personal protective equipment (PPE), even with the emergence of the Delta variant.
• If PPE is available, AGA recommends using N95 for upper endoscopy and suggests using N95 or surgical masks for lower endoscopy (acknowledging that upper endoscopy is more aerosolizing than lower endoscopy) and continuation of elective and nonelective endoscopy.
• Based on local prevalence rates, PPE, and test availability, in intermediate- and high-prevalence settings, preprocedure testing may be used to inform PPE decisions (N95 versus surgical mask). Additional benefits to testing are small and include deferring elective endoscopy in individuals testing positive and reducing anxiety among staff and patients.

As COVID-19 cases rise in the United States due to the Delta variant, there is renewed concern about infection and transmission of SARS-CoV-2 during endoscopy. In May 2021, AGA released updated recommendations on preprocedure testing post vaccination in the setting of ongoing population-wide vaccination programs for the prevention of COVID-19–related morbidity. In vaccinated individuals, breakthrough infections occurred very infrequently. Weighing the evidence demonstrating extremely low rates of rates of infection and transmission with vaccination and PPE, and considering the downsides of routine testing (burden, cost, false test results, increased disparities), AGA made a conditional recommendation against routine preprocedure testing for elective cases. The highly contagious Delta variant has now emerged as the predominant SARS-CoV2 virus in the U.S. and some data suggests that it may cause more severe illness than previous strains.  While more breakthrough infections may develop in fully vaccinated individuals, the greatest risk of infection, transmission and hospitalizations is among those who are unvaccinated.

• AGA suggests against reinstituting routine preprocedure testing prior to elective endoscopy. The downsides (delays in patient care, burden, inaccurate results) outweigh potential benefits. Infection and transmission of SARS-CoV-2 from asymptomatic individuals is rare especially among vaccinated health care workers using personal protective equipment (PPE), even with the emergence of the Delta variant.
• If PPE is available, AGA recommends using N95 for upper endoscopy and suggests using N95 or surgical masks for lower endoscopy (acknowledging that upper endoscopy is more aerosolizing than lower endoscopy) and continuation of elective and nonelective endoscopy.
• Based on local prevalence rates, PPE, and test availability, in intermediate- and high-prevalence settings, preprocedure testing may be used to inform PPE decisions (N95 versus surgical mask). Additional benefits to testing are small and include deferring elective endoscopy in individuals testing positive and reducing anxiety among staff and patients.

As COVID-19 cases rise in the United States due to the Delta variant, there is renewed concern about infection and transmission of SARS-CoV-2 during endoscopy. In May 2021, AGA released updated recommendations on preprocedure testing post vaccination in the setting of ongoing population-wide vaccination programs for the prevention of COVID-19–related morbidity. In vaccinated individuals, breakthrough infections occurred very infrequently. Weighing the evidence demonstrating extremely low rates of rates of infection and transmission with vaccination and PPE, and considering the downsides of routine testing (burden, cost, false test results, increased disparities), AGA made a conditional recommendation against routine preprocedure testing for elective cases. The highly contagious Delta variant has now emerged as the predominant SARS-CoV2 virus in the U.S. and some data suggests that it may cause more severe illness than previous strains.  While more breakthrough infections may develop in fully vaccinated individuals, the greatest risk of infection, transmission and hospitalizations is among those who are unvaccinated.

• AGA suggests against reinstituting routine preprocedure testing prior to elective endoscopy. The downsides (delays in patient care, burden, inaccurate results) outweigh potential benefits. Infection and transmission of SARS-CoV-2 from asymptomatic individuals is rare especially among vaccinated health care workers using personal protective equipment (PPE), even with the emergence of the Delta variant.
• If PPE is available, AGA recommends using N95 for upper endoscopy and suggests using N95 or surgical masks for lower endoscopy (acknowledging that upper endoscopy is more aerosolizing than lower endoscopy) and continuation of elective and nonelective endoscopy.
• Based on local prevalence rates, PPE, and test availability, in intermediate- and high-prevalence settings, preprocedure testing may be used to inform PPE decisions (N95 versus surgical mask). Additional benefits to testing are small and include deferring elective endoscopy in individuals testing positive and reducing anxiety among staff and patients.

AGA President John Inadomi, MD, and former AGA President David Lieberman, MD, along with American Cancer Society Cancer Action Network and Fight CRC, met with Assistant Secretary of Labor, Ali Khawar, and representatives from the U.S. Department of Health & Human Services and U.S. Department of Treasury to request they direct private health plans to cover colonoscopy after a positive noninvasive colorectal cancer (CRC) screening test.

The meeting was in response to an appeal sent to the three agencies, which provided guidance to health plans to ensure that workers have the benefits that have been agreed upon by their employers. As part of the Affordable Care Act, plans are mandated to cover colorectal cancer screening without cost sharing.

In May 2021, when the United States Preventive Services Task Force (USPFTF) lowered the recommended CRC screening age to 45, it also stated that “positive results on stool-based screening tests require follow-up with colonoscopy for the screening benefits to be achieved.”

To ensure that privately insured Americans receive proper CRC screening, AGA, ACS, and Fight CRC are pushing the government to provide written guidance to private plans clarifying that follow-up colonoscopies conducted after a positive noninvasive screening test are part of the colorectal cancer screening process and, therefore, patients should not face out-of-pocket costs when completing colorectal cancer screening.

Colorectal cancer remains the second leading killer in cancer in the United States despite the availability of preventive screening options. In 2018, just 68.8% of those eligible were screened for colorectal cancer. The challenge of getting people screened was exacerbated in 2020 when it is estimated that colorectal cancer screening declined by 86% during the first few months of the COVID-19 pandemic.

AGA President John Inadomi, MD, and former AGA President David Lieberman, MD, along with American Cancer Society Cancer Action Network and Fight CRC, met with Assistant Secretary of Labor, Ali Khawar, and representatives from the U.S. Department of Health & Human Services and U.S. Department of Treasury to request they direct private health plans to cover colonoscopy after a positive noninvasive colorectal cancer (CRC) screening test.

The meeting was in response to an appeal sent to the three agencies, which provided guidance to health plans to ensure that workers have the benefits that have been agreed upon by their employers. As part of the Affordable Care Act, plans are mandated to cover colorectal cancer screening without cost sharing.

In May 2021, when the United States Preventive Services Task Force (USPFTF) lowered the recommended CRC screening age to 45, it also stated that “positive results on stool-based screening tests require follow-up with colonoscopy for the screening benefits to be achieved.”

To ensure that privately insured Americans receive proper CRC screening, AGA, ACS, and Fight CRC are pushing the government to provide written guidance to private plans clarifying that follow-up colonoscopies conducted after a positive noninvasive screening test are part of the colorectal cancer screening process and, therefore, patients should not face out-of-pocket costs when completing colorectal cancer screening.

Colorectal cancer remains the second leading killer in cancer in the United States despite the availability of preventive screening options. In 2018, just 68.8% of those eligible were screened for colorectal cancer. The challenge of getting people screened was exacerbated in 2020 when it is estimated that colorectal cancer screening declined by 86% during the first few months of the COVID-19 pandemic.

AGA President John Inadomi, MD, and former AGA President David Lieberman, MD, along with American Cancer Society Cancer Action Network and Fight CRC, met with Assistant Secretary of Labor, Ali Khawar, and representatives from the U.S. Department of Health & Human Services and U.S. Department of Treasury to request they direct private health plans to cover colonoscopy after a positive noninvasive colorectal cancer (CRC) screening test.

The meeting was in response to an appeal sent to the three agencies, which provided guidance to health plans to ensure that workers have the benefits that have been agreed upon by their employers. As part of the Affordable Care Act, plans are mandated to cover colorectal cancer screening without cost sharing.

In May 2021, when the United States Preventive Services Task Force (USPFTF) lowered the recommended CRC screening age to 45, it also stated that “positive results on stool-based screening tests require follow-up with colonoscopy for the screening benefits to be achieved.”

To ensure that privately insured Americans receive proper CRC screening, AGA, ACS, and Fight CRC are pushing the government to provide written guidance to private plans clarifying that follow-up colonoscopies conducted after a positive noninvasive screening test are part of the colorectal cancer screening process and, therefore, patients should not face out-of-pocket costs when completing colorectal cancer screening.

Colorectal cancer remains the second leading killer in cancer in the United States despite the availability of preventive screening options. In 2018, just 68.8% of those eligible were screened for colorectal cancer. The challenge of getting people screened was exacerbated in 2020 when it is estimated that colorectal cancer screening declined by 86% during the first few months of the COVID-19 pandemic.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion: 

Vikrant Parihar, MD, wrote the following in “COVID-19 and UC”:

A 43-year-old man with an index presentation of distal colitis (Montreal E2) (Mayo endoscopic score 2-3) was discharged home on tapering doses of oral steroids. He was being worked up to commence anti-TNF likely initially as combo therapy. Fully vaccinated against COVID – had both doses of vaccine way back in May. Attended a match and looks to have got mild symptoms and on testing turned out to be COVID+. Rx himself by self-quarantine.

What would be the optimal strategy?

1. Stop steroids completely and immediately given the adverse signal in registry data?

2. When can anti-TNF’s be safely started?

3. How to manage him in the interim?

See how AGA members responded and join the discussion: https://community.gastro.org/posts/25172.
 

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion: 

Vikrant Parihar, MD, wrote the following in “COVID-19 and UC”:

A 43-year-old man with an index presentation of distal colitis (Montreal E2) (Mayo endoscopic score 2-3) was discharged home on tapering doses of oral steroids. He was being worked up to commence anti-TNF likely initially as combo therapy. Fully vaccinated against COVID – had both doses of vaccine way back in May. Attended a match and looks to have got mild symptoms and on testing turned out to be COVID+. Rx himself by self-quarantine.

What would be the optimal strategy?

1. Stop steroids completely and immediately given the adverse signal in registry data?

2. When can anti-TNF’s be safely started?

3. How to manage him in the interim?

See how AGA members responded and join the discussion: https://community.gastro.org/posts/25172.
 

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion: 

Vikrant Parihar, MD, wrote the following in “COVID-19 and UC”:

A 43-year-old man with an index presentation of distal colitis (Montreal E2) (Mayo endoscopic score 2-3) was discharged home on tapering doses of oral steroids. He was being worked up to commence anti-TNF likely initially as combo therapy. Fully vaccinated against COVID – had both doses of vaccine way back in May. Attended a match and looks to have got mild symptoms and on testing turned out to be COVID+. Rx himself by self-quarantine.

What would be the optimal strategy?

1. Stop steroids completely and immediately given the adverse signal in registry data?

2. When can anti-TNF’s be safely started?

3. How to manage him in the interim?

See how AGA members responded and join the discussion: https://community.gastro.org/posts/25172.
 

New patient care resource: NASH Clinical Care Pathway

The American Gastroenterological Association – in collaboration with seven professional associations – assembled a multidisciplinary taskforce of 15 experts to develop an action plan to develop a nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) Clinical Care Pathway providing practical guidance across multiple disciplines of care. The guidance ranges from screening and diagnosis to management of individuals with NAFLD and NASH, as well as facilitating value-based, efficient, and safe care that is consistent with evidence-based guidelines. 

This clinical care pathway is intended to be applicable in any setting in which care for patients with NAFLD is provided, including primary care, endocrine, obesity medicine, and gastroenterology practices. 

Read the special report: Clinical Care Pathway for the Risk Stratification and Management of Patients with Nonalcoholic Fatty Liver Disease. 

To learn more about the development of this publication, visit NASH.gastro.org. 
 

GI societies push CMS for payment rules favorable for practices 

As part of our longstanding collaboration and ongoing efforts on critical policy and payment issues impacting GI clinicians, AGA, the American College of Gastroenterology, and American Society for Gastrointestinal Endoscopy submitted comments on proposed 2022 Medicare payments to physicians, ambulatory surgery centers (ASCs), and hospital outpatient departments to the CMS. We advocated for the following: 

Increased and more accurate valuation for peroral endoscopic myotomy (POEM) and capsule endoscopy services. 

Continued flexibility and payment parity for telehealth and telephone services. 

Elimination of the secondary scalar for ASCs, which contributes to the widening differential in payments to ASCs compared to the hospital outpatient department. 

You can access our letter here. 

New patient care resource: NASH Clinical Care Pathway

The American Gastroenterological Association – in collaboration with seven professional associations – assembled a multidisciplinary taskforce of 15 experts to develop an action plan to develop a nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) Clinical Care Pathway providing practical guidance across multiple disciplines of care. The guidance ranges from screening and diagnosis to management of individuals with NAFLD and NASH, as well as facilitating value-based, efficient, and safe care that is consistent with evidence-based guidelines. 

This clinical care pathway is intended to be applicable in any setting in which care for patients with NAFLD is provided, including primary care, endocrine, obesity medicine, and gastroenterology practices. 

Read the special report: Clinical Care Pathway for the Risk Stratification and Management of Patients with Nonalcoholic Fatty Liver Disease. 

To learn more about the development of this publication, visit NASH.gastro.org. 
 

GI societies push CMS for payment rules favorable for practices 

As part of our longstanding collaboration and ongoing efforts on critical policy and payment issues impacting GI clinicians, AGA, the American College of Gastroenterology, and American Society for Gastrointestinal Endoscopy submitted comments on proposed 2022 Medicare payments to physicians, ambulatory surgery centers (ASCs), and hospital outpatient departments to the CMS. We advocated for the following: 

Increased and more accurate valuation for peroral endoscopic myotomy (POEM) and capsule endoscopy services. 

Continued flexibility and payment parity for telehealth and telephone services. 

Elimination of the secondary scalar for ASCs, which contributes to the widening differential in payments to ASCs compared to the hospital outpatient department. 

You can access our letter here. 

New patient care resource: NASH Clinical Care Pathway

The American Gastroenterological Association – in collaboration with seven professional associations – assembled a multidisciplinary taskforce of 15 experts to develop an action plan to develop a nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) Clinical Care Pathway providing practical guidance across multiple disciplines of care. The guidance ranges from screening and diagnosis to management of individuals with NAFLD and NASH, as well as facilitating value-based, efficient, and safe care that is consistent with evidence-based guidelines. 

This clinical care pathway is intended to be applicable in any setting in which care for patients with NAFLD is provided, including primary care, endocrine, obesity medicine, and gastroenterology practices. 

Read the special report: Clinical Care Pathway for the Risk Stratification and Management of Patients with Nonalcoholic Fatty Liver Disease. 

To learn more about the development of this publication, visit NASH.gastro.org. 
 

GI societies push CMS for payment rules favorable for practices 

As part of our longstanding collaboration and ongoing efforts on critical policy and payment issues impacting GI clinicians, AGA, the American College of Gastroenterology, and American Society for Gastrointestinal Endoscopy submitted comments on proposed 2022 Medicare payments to physicians, ambulatory surgery centers (ASCs), and hospital outpatient departments to the CMS. We advocated for the following: 

Increased and more accurate valuation for peroral endoscopic myotomy (POEM) and capsule endoscopy services. 

Continued flexibility and payment parity for telehealth and telephone services. 

Elimination of the secondary scalar for ASCs, which contributes to the widening differential in payments to ASCs compared to the hospital outpatient department. 

You can access our letter here. 

We’ve launched a new app designed to help AGA trainees and early career members navigate each step along their GI career path. Once users get started by setting up their professional profile, AGA Career Compass offers curated resources on topics like career planning, clinical education, and leadership skills.

The Connections Corner section hosts experienced mentors and matches them with users based on profile compatibility and shared topics of interest, such as grant writing, setting up a lab, navigating career options in academic medicine, managing burnout, and more. Download the app today to branch out from your institution or practice and receive personalized career guidance.

Now available in Apple and Google Play stores.

We’ve launched a new app designed to help AGA trainees and early career members navigate each step along their GI career path. Once users get started by setting up their professional profile, AGA Career Compass offers curated resources on topics like career planning, clinical education, and leadership skills.

The Connections Corner section hosts experienced mentors and matches them with users based on profile compatibility and shared topics of interest, such as grant writing, setting up a lab, navigating career options in academic medicine, managing burnout, and more. Download the app today to branch out from your institution or practice and receive personalized career guidance.

Now available in Apple and Google Play stores.

We’ve launched a new app designed to help AGA trainees and early career members navigate each step along their GI career path. Once users get started by setting up their professional profile, AGA Career Compass offers curated resources on topics like career planning, clinical education, and leadership skills.

The Connections Corner section hosts experienced mentors and matches them with users based on profile compatibility and shared topics of interest, such as grant writing, setting up a lab, navigating career options in academic medicine, managing burnout, and more. Download the app today to branch out from your institution or practice and receive personalized career guidance.

Now available in Apple and Google Play stores.