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AGA Fellows application period now open
The application period for the 2019 AGA Fellowship is now open. Members whose professional achievements demonstrate personal commitment to the field of gastroenterology and meet the AGA Fellows program criteria are encouraged to apply.
Learn more about joining this community of excellence or to how to apply online at www.gastro.org/fellowship.
AGA Fellows receive:
• The privilege of using the designation “AGAF” in professional activities.
• An official certificate and pin denoting your status.
• A listing on AGA’s website alongside esteemed peers.
• And more.
Apply and gain international recognition for your achievements when you become an AGA Fellow.
The application period for the 2019 AGA Fellowship is now open. Members whose professional achievements demonstrate personal commitment to the field of gastroenterology and meet the AGA Fellows program criteria are encouraged to apply.
Learn more about joining this community of excellence or to how to apply online at www.gastro.org/fellowship.
AGA Fellows receive:
• The privilege of using the designation “AGAF” in professional activities.
• An official certificate and pin denoting your status.
• A listing on AGA’s website alongside esteemed peers.
• And more.
Apply and gain international recognition for your achievements when you become an AGA Fellow.
The application period for the 2019 AGA Fellowship is now open. Members whose professional achievements demonstrate personal commitment to the field of gastroenterology and meet the AGA Fellows program criteria are encouraged to apply.
Learn more about joining this community of excellence or to how to apply online at www.gastro.org/fellowship.
AGA Fellows receive:
• The privilege of using the designation “AGAF” in professional activities.
• An official certificate and pin denoting your status.
• A listing on AGA’s website alongside esteemed peers.
• And more.
Apply and gain international recognition for your achievements when you become an AGA Fellow.
AGA hosted productive Hill meeting advocating for GIs
Chairman Roskam recently took over the chair of the Health Subcommittee, which has prime jurisdiction over Medicare Part B issues when Rep. Pat Tieberi, R-OH, retired. The roundtable focused on regulatory issues that impact physician practices and their ability to provide timely care to patients.
AGA and the Alliance of Specialty Medicine thanked Chairman Roskam and Congress for the technical corrections to the Quality Payment Program (QPP) that were included as part of the bipartisan budget agreement passed earlier this year that will significantly improve physicians’ ability to successfully participate in the Merit-based Incentive Payment System (MIPS) track. Because of the lack of opportunity for specialists like gastroenterologists to participate in advanced alternative payment models (APMs), most physicians will be participating in MIPS. Although Congress provided CMS with more flexibility in scoring for MIPS, we stressed to Chairman Roskam that MIPS reporting and scoring needs to be simplified to make it less administratively burdensome and costly for physicians. We also addressed the ongoing challenges regarding electronic health records (EHR) interoperability and the administrative and financial burdens it has on physician practices. This roundtable is part of one of AGA’s top advocacy issues, urging the Centers for Medicare & Medicaid Services (CMS), other payors, and Congress to provide relief to physicians.
AGA also raised the issue of alternative payment models and gastroenterology’s experience with developing bundles and episodes around common GI conditions. AGA stressed to Roskam the need for CMS to move forward piloting specialty payment models that have been approved by the Physician Technical Advisory Committee (PTAC) to test them in the Medicare population. The need for modernizing the Stark laws to enable physician practices to participate in alternative payment models was also discussed at the roundtable since the current Stark laws prohibit physician referral based on volume or value. AGA supports S. 2051/H.R. 4206, the Medicare Care Coordination Improvement Act, which would provide CMS with the regulatory authority to create exceptions under the Stark law for APMs and to remove barriers in the current law to the development and operation of such arrangements. The legislation would allow CMS to waive the Stark laws for physicians seeking to develop and operate APMs like what Congress allowed for accountable care organizations (ACOs). AGA believes this legislation is necessary for many of the innovative payment models developed by gastroenterologists to be implemented in the Medicare program.
Prior authorization
Prior authorization was also a major topic raised with Roskam and how it impacts all physicians regardless of where they practice. We emphasized how tremendously burdensome prior authorizations is to physicians and physician practices, and gave examples of how it often interrupts and/or delays delivery of patient care.
AGA and the alliance recommended that payors make prior authorization requirements and criteria transparent and easily accessible. We also recommended that CMS standardize and streamline prior authorization processes by Medicare Advantage and Part D plans. We also encouraged the committee to conduct oversight hearings to investigate prior authorization and utilization management practices by Medicare Advantage Organizations and Part D plans.
AGA and the alliance will continue to work with Roskam and the committees of jurisdiction to find solutions to lessen the regulatory burden on physicians that take time away from providing care to patients.
Chairman Roskam recently took over the chair of the Health Subcommittee, which has prime jurisdiction over Medicare Part B issues when Rep. Pat Tieberi, R-OH, retired. The roundtable focused on regulatory issues that impact physician practices and their ability to provide timely care to patients.
AGA and the Alliance of Specialty Medicine thanked Chairman Roskam and Congress for the technical corrections to the Quality Payment Program (QPP) that were included as part of the bipartisan budget agreement passed earlier this year that will significantly improve physicians’ ability to successfully participate in the Merit-based Incentive Payment System (MIPS) track. Because of the lack of opportunity for specialists like gastroenterologists to participate in advanced alternative payment models (APMs), most physicians will be participating in MIPS. Although Congress provided CMS with more flexibility in scoring for MIPS, we stressed to Chairman Roskam that MIPS reporting and scoring needs to be simplified to make it less administratively burdensome and costly for physicians. We also addressed the ongoing challenges regarding electronic health records (EHR) interoperability and the administrative and financial burdens it has on physician practices. This roundtable is part of one of AGA’s top advocacy issues, urging the Centers for Medicare & Medicaid Services (CMS), other payors, and Congress to provide relief to physicians.
AGA also raised the issue of alternative payment models and gastroenterology’s experience with developing bundles and episodes around common GI conditions. AGA stressed to Roskam the need for CMS to move forward piloting specialty payment models that have been approved by the Physician Technical Advisory Committee (PTAC) to test them in the Medicare population. The need for modernizing the Stark laws to enable physician practices to participate in alternative payment models was also discussed at the roundtable since the current Stark laws prohibit physician referral based on volume or value. AGA supports S. 2051/H.R. 4206, the Medicare Care Coordination Improvement Act, which would provide CMS with the regulatory authority to create exceptions under the Stark law for APMs and to remove barriers in the current law to the development and operation of such arrangements. The legislation would allow CMS to waive the Stark laws for physicians seeking to develop and operate APMs like what Congress allowed for accountable care organizations (ACOs). AGA believes this legislation is necessary for many of the innovative payment models developed by gastroenterologists to be implemented in the Medicare program.
Prior authorization
Prior authorization was also a major topic raised with Roskam and how it impacts all physicians regardless of where they practice. We emphasized how tremendously burdensome prior authorizations is to physicians and physician practices, and gave examples of how it often interrupts and/or delays delivery of patient care.
AGA and the alliance recommended that payors make prior authorization requirements and criteria transparent and easily accessible. We also recommended that CMS standardize and streamline prior authorization processes by Medicare Advantage and Part D plans. We also encouraged the committee to conduct oversight hearings to investigate prior authorization and utilization management practices by Medicare Advantage Organizations and Part D plans.
AGA and the alliance will continue to work with Roskam and the committees of jurisdiction to find solutions to lessen the regulatory burden on physicians that take time away from providing care to patients.
Chairman Roskam recently took over the chair of the Health Subcommittee, which has prime jurisdiction over Medicare Part B issues when Rep. Pat Tieberi, R-OH, retired. The roundtable focused on regulatory issues that impact physician practices and their ability to provide timely care to patients.
AGA and the Alliance of Specialty Medicine thanked Chairman Roskam and Congress for the technical corrections to the Quality Payment Program (QPP) that were included as part of the bipartisan budget agreement passed earlier this year that will significantly improve physicians’ ability to successfully participate in the Merit-based Incentive Payment System (MIPS) track. Because of the lack of opportunity for specialists like gastroenterologists to participate in advanced alternative payment models (APMs), most physicians will be participating in MIPS. Although Congress provided CMS with more flexibility in scoring for MIPS, we stressed to Chairman Roskam that MIPS reporting and scoring needs to be simplified to make it less administratively burdensome and costly for physicians. We also addressed the ongoing challenges regarding electronic health records (EHR) interoperability and the administrative and financial burdens it has on physician practices. This roundtable is part of one of AGA’s top advocacy issues, urging the Centers for Medicare & Medicaid Services (CMS), other payors, and Congress to provide relief to physicians.
AGA also raised the issue of alternative payment models and gastroenterology’s experience with developing bundles and episodes around common GI conditions. AGA stressed to Roskam the need for CMS to move forward piloting specialty payment models that have been approved by the Physician Technical Advisory Committee (PTAC) to test them in the Medicare population. The need for modernizing the Stark laws to enable physician practices to participate in alternative payment models was also discussed at the roundtable since the current Stark laws prohibit physician referral based on volume or value. AGA supports S. 2051/H.R. 4206, the Medicare Care Coordination Improvement Act, which would provide CMS with the regulatory authority to create exceptions under the Stark law for APMs and to remove barriers in the current law to the development and operation of such arrangements. The legislation would allow CMS to waive the Stark laws for physicians seeking to develop and operate APMs like what Congress allowed for accountable care organizations (ACOs). AGA believes this legislation is necessary for many of the innovative payment models developed by gastroenterologists to be implemented in the Medicare program.
Prior authorization
Prior authorization was also a major topic raised with Roskam and how it impacts all physicians regardless of where they practice. We emphasized how tremendously burdensome prior authorizations is to physicians and physician practices, and gave examples of how it often interrupts and/or delays delivery of patient care.
AGA and the alliance recommended that payors make prior authorization requirements and criteria transparent and easily accessible. We also recommended that CMS standardize and streamline prior authorization processes by Medicare Advantage and Part D plans. We also encouraged the committee to conduct oversight hearings to investigate prior authorization and utilization management practices by Medicare Advantage Organizations and Part D plans.
AGA and the alliance will continue to work with Roskam and the committees of jurisdiction to find solutions to lessen the regulatory burden on physicians that take time away from providing care to patients.
Federal spending agreement includes wins for medical community
President Trump signed a $1.3 trillion omnibus appropriations package that includes notable increases for the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) last week. This funding and language is a major victory for digestive disease research and patients. AGA thanks everyone who joined our call to Congress to increase funding for research. Your advocacy matters and makes a difference!
NIH
NIH is a big winner in the omnibus and will receive $37.1 billion for fiscal year 2018, an 8.8% increase over the previous year’s funding, which represents the largest increase for NIH since the doubling period over a decade ago.
The omnibus also includes language pushed by AGA to require NIH to provide Congress with an update on the implementation of the recommendations of the National Commission on Digestive Diseases. AGA applauds Congress for including language that will help increase digestive disease research.
Congress also included funding for young researchers and continues to take action to reduce the average age of a new NIH-supported investigator. AGA appreciates the appropriators including this language, which has been a longstanding priority of AGA in supporting young investigators and ensuring that our best and brightest scientists have the support and funding that they need to start their careers.
Language was also included that prohibits the administration from capping administrative and facility fees paid to research institutions.
The All of Us Precision Medicine initiative received an increase of $60 million and antibiotic resistance initiatives received an increase of $50 million.
Opioid funding
The bill includes $4.65 billion to address the opioid epidemic across various government agencies. NIH would receive $1 billion to research opioid addiction and alternative pain management and treatment.
CDC
The CDC would receive $8.3 billion in funding, rejecting President Trump’s call for $900 million in cuts.
President Trump signed a $1.3 trillion omnibus appropriations package that includes notable increases for the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) last week. This funding and language is a major victory for digestive disease research and patients. AGA thanks everyone who joined our call to Congress to increase funding for research. Your advocacy matters and makes a difference!
NIH
NIH is a big winner in the omnibus and will receive $37.1 billion for fiscal year 2018, an 8.8% increase over the previous year’s funding, which represents the largest increase for NIH since the doubling period over a decade ago.
The omnibus also includes language pushed by AGA to require NIH to provide Congress with an update on the implementation of the recommendations of the National Commission on Digestive Diseases. AGA applauds Congress for including language that will help increase digestive disease research.
Congress also included funding for young researchers and continues to take action to reduce the average age of a new NIH-supported investigator. AGA appreciates the appropriators including this language, which has been a longstanding priority of AGA in supporting young investigators and ensuring that our best and brightest scientists have the support and funding that they need to start their careers.
Language was also included that prohibits the administration from capping administrative and facility fees paid to research institutions.
The All of Us Precision Medicine initiative received an increase of $60 million and antibiotic resistance initiatives received an increase of $50 million.
Opioid funding
The bill includes $4.65 billion to address the opioid epidemic across various government agencies. NIH would receive $1 billion to research opioid addiction and alternative pain management and treatment.
CDC
The CDC would receive $8.3 billion in funding, rejecting President Trump’s call for $900 million in cuts.
President Trump signed a $1.3 trillion omnibus appropriations package that includes notable increases for the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) last week. This funding and language is a major victory for digestive disease research and patients. AGA thanks everyone who joined our call to Congress to increase funding for research. Your advocacy matters and makes a difference!
NIH
NIH is a big winner in the omnibus and will receive $37.1 billion for fiscal year 2018, an 8.8% increase over the previous year’s funding, which represents the largest increase for NIH since the doubling period over a decade ago.
The omnibus also includes language pushed by AGA to require NIH to provide Congress with an update on the implementation of the recommendations of the National Commission on Digestive Diseases. AGA applauds Congress for including language that will help increase digestive disease research.
Congress also included funding for young researchers and continues to take action to reduce the average age of a new NIH-supported investigator. AGA appreciates the appropriators including this language, which has been a longstanding priority of AGA in supporting young investigators and ensuring that our best and brightest scientists have the support and funding that they need to start their careers.
Language was also included that prohibits the administration from capping administrative and facility fees paid to research institutions.
The All of Us Precision Medicine initiative received an increase of $60 million and antibiotic resistance initiatives received an increase of $50 million.
Opioid funding
The bill includes $4.65 billion to address the opioid epidemic across various government agencies. NIH would receive $1 billion to research opioid addiction and alternative pain management and treatment.
CDC
The CDC would receive $8.3 billion in funding, rejecting President Trump’s call for $900 million in cuts.
AGA leaders recognized for their contributions to the field
We are proud to announce the 2018 AGA Recognition Award recipients who are honored for their outstanding contributions to the field of gastroenterology and hepatology. The recipients will be formally recognized during Digestive Disease Week® (DDW) 2018 in Washington, D.C., but you can congratulate your colleagues now in the AGA Community.
2018 Recognition Award Recipients
Julius Friedenwald Medal
Loren A. Laine, MD
Distinguished Achievement Award in Basic Science
T. Jake Liang, MD, AGAF
William Beaumont Prize in Gastroenterology
Mary K. Estes, PhD, AGAF
Distinguished Educator Award
James D. Lewis, MD, MSCE, AGAF
Distinguished Clinician Award
Private Practice: Bertha (Nice’) E. Toriz, MD
Clinical Academic Practice: Michael L. Kochman, MD, AGAF
Distinguished Mentor Award
Mary K. Estes, PhD, AGAF
Young Investigator Awards
Clinical Science: David S. Goldberg, MD, MSCE
Basic Science: Andrew D. Rhim, MD
You can read more about each award recipient and the awards themselves at gastro.org/about/awards.
We are proud to announce the 2018 AGA Recognition Award recipients who are honored for their outstanding contributions to the field of gastroenterology and hepatology. The recipients will be formally recognized during Digestive Disease Week® (DDW) 2018 in Washington, D.C., but you can congratulate your colleagues now in the AGA Community.
2018 Recognition Award Recipients
Julius Friedenwald Medal
Loren A. Laine, MD
Distinguished Achievement Award in Basic Science
T. Jake Liang, MD, AGAF
William Beaumont Prize in Gastroenterology
Mary K. Estes, PhD, AGAF
Distinguished Educator Award
James D. Lewis, MD, MSCE, AGAF
Distinguished Clinician Award
Private Practice: Bertha (Nice’) E. Toriz, MD
Clinical Academic Practice: Michael L. Kochman, MD, AGAF
Distinguished Mentor Award
Mary K. Estes, PhD, AGAF
Young Investigator Awards
Clinical Science: David S. Goldberg, MD, MSCE
Basic Science: Andrew D. Rhim, MD
You can read more about each award recipient and the awards themselves at gastro.org/about/awards.
We are proud to announce the 2018 AGA Recognition Award recipients who are honored for their outstanding contributions to the field of gastroenterology and hepatology. The recipients will be formally recognized during Digestive Disease Week® (DDW) 2018 in Washington, D.C., but you can congratulate your colleagues now in the AGA Community.
2018 Recognition Award Recipients
Julius Friedenwald Medal
Loren A. Laine, MD
Distinguished Achievement Award in Basic Science
T. Jake Liang, MD, AGAF
William Beaumont Prize in Gastroenterology
Mary K. Estes, PhD, AGAF
Distinguished Educator Award
James D. Lewis, MD, MSCE, AGAF
Distinguished Clinician Award
Private Practice: Bertha (Nice’) E. Toriz, MD
Clinical Academic Practice: Michael L. Kochman, MD, AGAF
Distinguished Mentor Award
Mary K. Estes, PhD, AGAF
Young Investigator Awards
Clinical Science: David S. Goldberg, MD, MSCE
Basic Science: Andrew D. Rhim, MD
You can read more about each award recipient and the awards themselves at gastro.org/about/awards.
Save the date for the 2019 Crohn’s & Colitis Congress
Building on the success of this year’s inaugural Crohn’s & Colitis Congress™, the Crohn’s & Colitis Foundation and the American Gastroenterological Association (AGA) are pleased to announce the second annual Crohn’s & Colitis Congress. Be sure to save the date: Feb. 7-9, 2019 at the Bellagio in Las Vegas.
The Crohn’s & Colitis Congress is the must-attend meeting for all inflammatory bowel disease (IBD) professionals. It offers a bold, multidisciplinary approach to learning in the IBD space as one care team. All health care professionals and research investigators interested in IBD are invited to attend.
By bringing all audiences together to learn from each other, the Congress embodies how IBD research and patient care needs to be approached – it is not “one-size-fits-all” and it requires collaboration from a variety of health practitioners.
By attending the Crohn’s& Colitis Congress, attendees will:
• Build a powerful network and share solutions with IBD thought leaders.
• Discover cutting-edge basic, translational and clinical research in the IBD space.
• Determine best practices at every stage of the patient’s disease journey.
• Explore new technologies and products from IBD-related exhibitors.
• Earn CME and MOC points.
• Improve skills and patient outcomes.
• Learn together as one multidisciplinary care team.
Get ready to expand your knowledge, network with IBD leaders, and be inspired. Stay tuned at www.crohnscolitiscongress.org for more details coming in later this spring.
Building on the success of this year’s inaugural Crohn’s & Colitis Congress™, the Crohn’s & Colitis Foundation and the American Gastroenterological Association (AGA) are pleased to announce the second annual Crohn’s & Colitis Congress. Be sure to save the date: Feb. 7-9, 2019 at the Bellagio in Las Vegas.
The Crohn’s & Colitis Congress is the must-attend meeting for all inflammatory bowel disease (IBD) professionals. It offers a bold, multidisciplinary approach to learning in the IBD space as one care team. All health care professionals and research investigators interested in IBD are invited to attend.
By bringing all audiences together to learn from each other, the Congress embodies how IBD research and patient care needs to be approached – it is not “one-size-fits-all” and it requires collaboration from a variety of health practitioners.
By attending the Crohn’s& Colitis Congress, attendees will:
• Build a powerful network and share solutions with IBD thought leaders.
• Discover cutting-edge basic, translational and clinical research in the IBD space.
• Determine best practices at every stage of the patient’s disease journey.
• Explore new technologies and products from IBD-related exhibitors.
• Earn CME and MOC points.
• Improve skills and patient outcomes.
• Learn together as one multidisciplinary care team.
Get ready to expand your knowledge, network with IBD leaders, and be inspired. Stay tuned at www.crohnscolitiscongress.org for more details coming in later this spring.
Building on the success of this year’s inaugural Crohn’s & Colitis Congress™, the Crohn’s & Colitis Foundation and the American Gastroenterological Association (AGA) are pleased to announce the second annual Crohn’s & Colitis Congress. Be sure to save the date: Feb. 7-9, 2019 at the Bellagio in Las Vegas.
The Crohn’s & Colitis Congress is the must-attend meeting for all inflammatory bowel disease (IBD) professionals. It offers a bold, multidisciplinary approach to learning in the IBD space as one care team. All health care professionals and research investigators interested in IBD are invited to attend.
By bringing all audiences together to learn from each other, the Congress embodies how IBD research and patient care needs to be approached – it is not “one-size-fits-all” and it requires collaboration from a variety of health practitioners.
By attending the Crohn’s& Colitis Congress, attendees will:
• Build a powerful network and share solutions with IBD thought leaders.
• Discover cutting-edge basic, translational and clinical research in the IBD space.
• Determine best practices at every stage of the patient’s disease journey.
• Explore new technologies and products from IBD-related exhibitors.
• Earn CME and MOC points.
• Improve skills and patient outcomes.
• Learn together as one multidisciplinary care team.
Get ready to expand your knowledge, network with IBD leaders, and be inspired. Stay tuned at www.crohnscolitiscongress.org for more details coming in later this spring.
AGA seeks regulatory relief for GIs
A top priority for AGA this year is to call on the Centers for Medicare & Medicaid Services (CMS), other payors, and Congress to alleviate some of the regulatory burden that currently falls on physicians. Reevaluating prior authorization, step therapy, and Stark reform would allow physicians to devote more time and resources to provide high-quality care. A more comprehensive breakdown of the following key areas is available along with other top issues.
Prior authorization
• AGA urges payors to standardize prior authorization requirements and criteria and make them transparent and easily accessible. The services subject to prior authorization vary by payor, including CMS, as well as by plan type within a given payor. Physicians and physician practices are forced to comply with an increasing and unmanageable number of prior authorization requirements.
• AGA urges payors, including CMS, to develop and implement processes that allow for true “peer-to-peer” dialogues. Gastroenterologists seeking prior authorization for prescription drug or biologic therapy on behalf of a patient should be routed to a physician specialist in the same or similar discipline with expertise in the given condition to discuss the request.
Step therapy
• Step therapy, also known as “fail first,” occurs when an insurer requires patients to try and fail one or more lower-cost prescription drug or biologic therapies before covering the therapy originally prescribed by their health care provider.
• AGA urges insurers to reduce the burden of step therapy on physicians and physician practice. AGA supports The Restoring the Patient’s Voice Act (H.R. 2077), legislation introduced by Rep. Brad Wenstrup, R-Ohio, and Rep. Raul Ruiz, D-Calif., both physicians, that would provide a clear and timely appeals process when a patient has been subjected to step therapy.
Stark reform
• Stark self-referral laws prohibit physicians from referring patients to an entity in which they have a financial interest, which limits their ability to participate in many advanced alternative payment models (APMs). These prohibitions stifle care delivery innovation by inhibiting practices from incentivizing their physicians to deliver patient care more efficiently, because the practices cannot use resources from designated health services in rewarding or penalizing adherence to new clinical care pathways.
• AGA supports S. 2051/H.R. 4206, the Medicare Care Coordination Improvement Act, which would provide CMS with the regulatory authority to create exceptions under the Stark law for APMs and to remove barriers in the current law to the development and operation of such arrangements.
A top priority for AGA this year is to call on the Centers for Medicare & Medicaid Services (CMS), other payors, and Congress to alleviate some of the regulatory burden that currently falls on physicians. Reevaluating prior authorization, step therapy, and Stark reform would allow physicians to devote more time and resources to provide high-quality care. A more comprehensive breakdown of the following key areas is available along with other top issues.
Prior authorization
• AGA urges payors to standardize prior authorization requirements and criteria and make them transparent and easily accessible. The services subject to prior authorization vary by payor, including CMS, as well as by plan type within a given payor. Physicians and physician practices are forced to comply with an increasing and unmanageable number of prior authorization requirements.
• AGA urges payors, including CMS, to develop and implement processes that allow for true “peer-to-peer” dialogues. Gastroenterologists seeking prior authorization for prescription drug or biologic therapy on behalf of a patient should be routed to a physician specialist in the same or similar discipline with expertise in the given condition to discuss the request.
Step therapy
• Step therapy, also known as “fail first,” occurs when an insurer requires patients to try and fail one or more lower-cost prescription drug or biologic therapies before covering the therapy originally prescribed by their health care provider.
• AGA urges insurers to reduce the burden of step therapy on physicians and physician practice. AGA supports The Restoring the Patient’s Voice Act (H.R. 2077), legislation introduced by Rep. Brad Wenstrup, R-Ohio, and Rep. Raul Ruiz, D-Calif., both physicians, that would provide a clear and timely appeals process when a patient has been subjected to step therapy.
Stark reform
• Stark self-referral laws prohibit physicians from referring patients to an entity in which they have a financial interest, which limits their ability to participate in many advanced alternative payment models (APMs). These prohibitions stifle care delivery innovation by inhibiting practices from incentivizing their physicians to deliver patient care more efficiently, because the practices cannot use resources from designated health services in rewarding or penalizing adherence to new clinical care pathways.
• AGA supports S. 2051/H.R. 4206, the Medicare Care Coordination Improvement Act, which would provide CMS with the regulatory authority to create exceptions under the Stark law for APMs and to remove barriers in the current law to the development and operation of such arrangements.
A top priority for AGA this year is to call on the Centers for Medicare & Medicaid Services (CMS), other payors, and Congress to alleviate some of the regulatory burden that currently falls on physicians. Reevaluating prior authorization, step therapy, and Stark reform would allow physicians to devote more time and resources to provide high-quality care. A more comprehensive breakdown of the following key areas is available along with other top issues.
Prior authorization
• AGA urges payors to standardize prior authorization requirements and criteria and make them transparent and easily accessible. The services subject to prior authorization vary by payor, including CMS, as well as by plan type within a given payor. Physicians and physician practices are forced to comply with an increasing and unmanageable number of prior authorization requirements.
• AGA urges payors, including CMS, to develop and implement processes that allow for true “peer-to-peer” dialogues. Gastroenterologists seeking prior authorization for prescription drug or biologic therapy on behalf of a patient should be routed to a physician specialist in the same or similar discipline with expertise in the given condition to discuss the request.
Step therapy
• Step therapy, also known as “fail first,” occurs when an insurer requires patients to try and fail one or more lower-cost prescription drug or biologic therapies before covering the therapy originally prescribed by their health care provider.
• AGA urges insurers to reduce the burden of step therapy on physicians and physician practice. AGA supports The Restoring the Patient’s Voice Act (H.R. 2077), legislation introduced by Rep. Brad Wenstrup, R-Ohio, and Rep. Raul Ruiz, D-Calif., both physicians, that would provide a clear and timely appeals process when a patient has been subjected to step therapy.
Stark reform
• Stark self-referral laws prohibit physicians from referring patients to an entity in which they have a financial interest, which limits their ability to participate in many advanced alternative payment models (APMs). These prohibitions stifle care delivery innovation by inhibiting practices from incentivizing their physicians to deliver patient care more efficiently, because the practices cannot use resources from designated health services in rewarding or penalizing adherence to new clinical care pathways.
• AGA supports S. 2051/H.R. 4206, the Medicare Care Coordination Improvement Act, which would provide CMS with the regulatory authority to create exceptions under the Stark law for APMs and to remove barriers in the current law to the development and operation of such arrangements.
Sessions at DDW® 2018 designed for trainees and early career GIs
Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material.
With the exception of the AGA Postgraduate Course, all of the sessions are free, but you must register for DDW to attend. Registration is open and is complimentary for AGA member trainees, students, medical residents, and postdoctoral fellows until April 18. Visit the AGA website for additional details about these sessions.
Saturday, June 2, and Sunday, June 3
- Difficult Conversations: Navigating People, Negotiations, Promotions, and Complications
Sunday, June 3, 4-5:30 p.m.
- Advancing Clinical Practice: GI Fellow-Directed Quality Improvement Projects
Monday, June 4, 4-5:30 p.m.
- Board Review Course
Tuesday, June 5, 1:30-5:30 p.m.
Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material.
With the exception of the AGA Postgraduate Course, all of the sessions are free, but you must register for DDW to attend. Registration is open and is complimentary for AGA member trainees, students, medical residents, and postdoctoral fellows until April 18. Visit the AGA website for additional details about these sessions.
Saturday, June 2, and Sunday, June 3
- Difficult Conversations: Navigating People, Negotiations, Promotions, and Complications
Sunday, June 3, 4-5:30 p.m.
- Advancing Clinical Practice: GI Fellow-Directed Quality Improvement Projects
Monday, June 4, 4-5:30 p.m.
- Board Review Course
Tuesday, June 5, 1:30-5:30 p.m.
Participants will learn about all aspects of starting a career in clinical practice or research, have the opportunity to network with mentors and peers, and review board material.
With the exception of the AGA Postgraduate Course, all of the sessions are free, but you must register for DDW to attend. Registration is open and is complimentary for AGA member trainees, students, medical residents, and postdoctoral fellows until April 18. Visit the AGA website for additional details about these sessions.
Saturday, June 2, and Sunday, June 3
- Difficult Conversations: Navigating People, Negotiations, Promotions, and Complications
Sunday, June 3, 4-5:30 p.m.
- Advancing Clinical Practice: GI Fellow-Directed Quality Improvement Projects
Monday, June 4, 4-5:30 p.m.
- Board Review Course
Tuesday, June 5, 1:30-5:30 p.m.
Better manage acute pancreatitis to improve patient outcomes
AGA has a new clinical guideline on the initial management of acute pancreatitis, published in Gastroenterology. In the U.S., acute pancreatitis (AP) is a leading cause of inpatient care among gastrointestinal conditions with more than 275,000 patients hospitalized annually, at an aggregate cost of over $2.6 billion per year. The guideline focuses on patient care within the first 48-72 hours of admission when management decisions can alter the course of disease and duration of hospitalization.
Guideline recommendations
AGA’s new guideline aims to reduce practice variation and promote high-quality and high-value care for patients suffering from acute pancreatitis. It addresses questions on the benefits of goal-directed fluid resuscitation, early oral feeding, enteral vs. parenteral nutrition, the routine use of prophylactic antibiotics, and routine ERCP in all patients with AP.
The guideline is accompanied by a technical review, a new spotlight (infographic) and a patient companion infographic, which provides key points and important information directly to patients.
AGA has a new clinical guideline on the initial management of acute pancreatitis, published in Gastroenterology. In the U.S., acute pancreatitis (AP) is a leading cause of inpatient care among gastrointestinal conditions with more than 275,000 patients hospitalized annually, at an aggregate cost of over $2.6 billion per year. The guideline focuses on patient care within the first 48-72 hours of admission when management decisions can alter the course of disease and duration of hospitalization.
Guideline recommendations
AGA’s new guideline aims to reduce practice variation and promote high-quality and high-value care for patients suffering from acute pancreatitis. It addresses questions on the benefits of goal-directed fluid resuscitation, early oral feeding, enteral vs. parenteral nutrition, the routine use of prophylactic antibiotics, and routine ERCP in all patients with AP.
The guideline is accompanied by a technical review, a new spotlight (infographic) and a patient companion infographic, which provides key points and important information directly to patients.
AGA has a new clinical guideline on the initial management of acute pancreatitis, published in Gastroenterology. In the U.S., acute pancreatitis (AP) is a leading cause of inpatient care among gastrointestinal conditions with more than 275,000 patients hospitalized annually, at an aggregate cost of over $2.6 billion per year. The guideline focuses on patient care within the first 48-72 hours of admission when management decisions can alter the course of disease and duration of hospitalization.
Guideline recommendations
AGA’s new guideline aims to reduce practice variation and promote high-quality and high-value care for patients suffering from acute pancreatitis. It addresses questions on the benefits of goal-directed fluid resuscitation, early oral feeding, enteral vs. parenteral nutrition, the routine use of prophylactic antibiotics, and routine ERCP in all patients with AP.
The guideline is accompanied by a technical review, a new spotlight (infographic) and a patient companion infographic, which provides key points and important information directly to patients.
How to talk with your patients about PPIs and cognitive decline
A 2018 study published in Clinical Gastroenterology and Hepatology, “Lack of association between proton pump inhibitor use and cognitive decline,” found no association between PPI use and cognitive decline in analyzing data from two large population-based studies in Denmark. While this data is reassuring, clinicians should continue to anticipate questions from their patients about the risks associated with PPI therapy.
- Reassure patients that you prescribed a PPI for a clear-cut indication, in the lowest possible dose, and for an appropriate period of time (lowest dose, shortest time). This advice echoes that offered by AGA and ABIM in the Choosing Wisely campaign.
- Educate patients not to ask “what side effects do PPIs have?” but rather “is it really indicated?” Reassure patients that, when PPIs are indicated, benefits outweigh risks.
- Keep conversation channels open with patients. When patients require long-term use of PPIs, the medication should not be stopped without a discussion with you about the risks and benefits.
- Recommend that patients also consider life-style modifications that may reduce or eliminate the need for PPIs for long-term use.
A 2018 study published in Clinical Gastroenterology and Hepatology, “Lack of association between proton pump inhibitor use and cognitive decline,” found no association between PPI use and cognitive decline in analyzing data from two large population-based studies in Denmark. While this data is reassuring, clinicians should continue to anticipate questions from their patients about the risks associated with PPI therapy.
- Reassure patients that you prescribed a PPI for a clear-cut indication, in the lowest possible dose, and for an appropriate period of time (lowest dose, shortest time). This advice echoes that offered by AGA and ABIM in the Choosing Wisely campaign.
- Educate patients not to ask “what side effects do PPIs have?” but rather “is it really indicated?” Reassure patients that, when PPIs are indicated, benefits outweigh risks.
- Keep conversation channels open with patients. When patients require long-term use of PPIs, the medication should not be stopped without a discussion with you about the risks and benefits.
- Recommend that patients also consider life-style modifications that may reduce or eliminate the need for PPIs for long-term use.
A 2018 study published in Clinical Gastroenterology and Hepatology, “Lack of association between proton pump inhibitor use and cognitive decline,” found no association between PPI use and cognitive decline in analyzing data from two large population-based studies in Denmark. While this data is reassuring, clinicians should continue to anticipate questions from their patients about the risks associated with PPI therapy.
- Reassure patients that you prescribed a PPI for a clear-cut indication, in the lowest possible dose, and for an appropriate period of time (lowest dose, shortest time). This advice echoes that offered by AGA and ABIM in the Choosing Wisely campaign.
- Educate patients not to ask “what side effects do PPIs have?” but rather “is it really indicated?” Reassure patients that, when PPIs are indicated, benefits outweigh risks.
- Keep conversation channels open with patients. When patients require long-term use of PPIs, the medication should not be stopped without a discussion with you about the risks and benefits.
- Recommend that patients also consider life-style modifications that may reduce or eliminate the need for PPIs for long-term use.
Four new and noteworthy IBD drug studies
Inflammatory bowel disease (IBD) is a vibrant area of clinical research. Many of the 250+ abstracts presented at the inaugural Crohn’s & Colitis Congress — a partnership of the Crohn’s & Colitis Foundation and AGA — looked at the efficacy and safety of IBD therapies. You can review all abstracts presented at the Crohn’s & Colitis Congress in Gastroenterology.
Double-blind, randomized, placebo-controlled, crossover trial to evaluate induction of clinical response in patients with moderate-severe Crohn’s disease treated with rifaximin
By Scott D. Lee, University of Washington Medicine, et al.
Significance: It is now known that the intestinal microbiome is integral to the pathogenesis of IBD. However, antibiotic treatments for IBD have previously shown limited effectiveness. In this 8-week clinical trial, there was a fourfold greater response to the antibiotic rifaximin in Crohn’s disease treatment, compared with placebo. The positive impact on clinical disease activity was seen even in patients with a significant disease burden and prior exposure to one or more biologic therapies. Quality of life and laboratory measurements were numerically improved. No new safety concerns were identified. These results offer renewed hope for the use of antibiotics in treating Crohn’s disease.
Post-hoc analysis of tofacitinib Crohn’s disease phase 2 induction efficacy in subgroups with baseline endoscopic or biomarker evidence of inflammation
By Bruce E. Sands, Icahn School of Medicine at Mount Sinai, et al.
Significance: Tofacitinib, a Janus kinase (JAK) inhibitor, is under investigation for treatment of ulcerative colitis and Crohn’s disease. To date, response rates in ulcerative colitis have been higher than for Crohn’s disease. In this report, investigators performed post-hoc analysis studies using objective baseline criteria of disease activity. Their findings showed a greater proportion of patients with moderate to severe Crohn’s disease were in remission with tofacitinib compared to placebo. These results provide evidence of JAK inhibition for the treatment of Crohn’s disease and support further investigation.
Refined population pharmacokinetic model for infliximab precision dosing in pediatric inflammatory bowel disease
By Laura E. Bauman, Cincinnati Children’s Hospital Medical Center, et al.
Significance: Long-term clinical remission from IBD with anti-TNF therapies has generally been limited to less than half of the treated patients. Improved outcomes are seen with optimal pre-infusion trough drug levels, a measurement of the level of drugs in the patient’s bloodstream. However, standard weight-based dosing for pediatric patients has provided widely varying trough drug levels. The investigators report the development of a multifactorial pharmacokinetic model for predicting infliximab trough levels during maintenance therapy for IBD. Such dynamic approaches to treatment address a specific gap in pediatric IBD therapeutic strategies.
Primary nonresponse to tumor necrosis factor antagonists is associated with inferior response to second-line biologics in patients with inflammatory bowel diseases: A systematic review and meta-analysis
By Siddharth Singh, University of California San Diego Health, et al.
Significance: Primary nonresponse to anti-TNF therapy is seen in 35%-65% of IBD patients and another 40%-60% lose responsiveness during the first year of treatment. Physicians struggle with what treatments to recommend for these patients. The investigators in this study performed a literature search and identified eight randomized controlled trials of biologics in patients with prior exposure to anti-TNF and compared outcomes based on their prior responses to anti-TNF. The analysis reveals a 24% decrease in likelihood to achieve remission in patients who changed medications because of immediate nonresponse compared to loss of responsiveness or intolerance during the treatment. These findings raise important questions about the biology of IBD, including the pharmacology of anti-TNF in a subset of patients.
Inflammatory bowel disease (IBD) is a vibrant area of clinical research. Many of the 250+ abstracts presented at the inaugural Crohn’s & Colitis Congress — a partnership of the Crohn’s & Colitis Foundation and AGA — looked at the efficacy and safety of IBD therapies. You can review all abstracts presented at the Crohn’s & Colitis Congress in Gastroenterology.
Double-blind, randomized, placebo-controlled, crossover trial to evaluate induction of clinical response in patients with moderate-severe Crohn’s disease treated with rifaximin
By Scott D. Lee, University of Washington Medicine, et al.
Significance: It is now known that the intestinal microbiome is integral to the pathogenesis of IBD. However, antibiotic treatments for IBD have previously shown limited effectiveness. In this 8-week clinical trial, there was a fourfold greater response to the antibiotic rifaximin in Crohn’s disease treatment, compared with placebo. The positive impact on clinical disease activity was seen even in patients with a significant disease burden and prior exposure to one or more biologic therapies. Quality of life and laboratory measurements were numerically improved. No new safety concerns were identified. These results offer renewed hope for the use of antibiotics in treating Crohn’s disease.
Post-hoc analysis of tofacitinib Crohn’s disease phase 2 induction efficacy in subgroups with baseline endoscopic or biomarker evidence of inflammation
By Bruce E. Sands, Icahn School of Medicine at Mount Sinai, et al.
Significance: Tofacitinib, a Janus kinase (JAK) inhibitor, is under investigation for treatment of ulcerative colitis and Crohn’s disease. To date, response rates in ulcerative colitis have been higher than for Crohn’s disease. In this report, investigators performed post-hoc analysis studies using objective baseline criteria of disease activity. Their findings showed a greater proportion of patients with moderate to severe Crohn’s disease were in remission with tofacitinib compared to placebo. These results provide evidence of JAK inhibition for the treatment of Crohn’s disease and support further investigation.
Refined population pharmacokinetic model for infliximab precision dosing in pediatric inflammatory bowel disease
By Laura E. Bauman, Cincinnati Children’s Hospital Medical Center, et al.
Significance: Long-term clinical remission from IBD with anti-TNF therapies has generally been limited to less than half of the treated patients. Improved outcomes are seen with optimal pre-infusion trough drug levels, a measurement of the level of drugs in the patient’s bloodstream. However, standard weight-based dosing for pediatric patients has provided widely varying trough drug levels. The investigators report the development of a multifactorial pharmacokinetic model for predicting infliximab trough levels during maintenance therapy for IBD. Such dynamic approaches to treatment address a specific gap in pediatric IBD therapeutic strategies.
Primary nonresponse to tumor necrosis factor antagonists is associated with inferior response to second-line biologics in patients with inflammatory bowel diseases: A systematic review and meta-analysis
By Siddharth Singh, University of California San Diego Health, et al.
Significance: Primary nonresponse to anti-TNF therapy is seen in 35%-65% of IBD patients and another 40%-60% lose responsiveness during the first year of treatment. Physicians struggle with what treatments to recommend for these patients. The investigators in this study performed a literature search and identified eight randomized controlled trials of biologics in patients with prior exposure to anti-TNF and compared outcomes based on their prior responses to anti-TNF. The analysis reveals a 24% decrease in likelihood to achieve remission in patients who changed medications because of immediate nonresponse compared to loss of responsiveness or intolerance during the treatment. These findings raise important questions about the biology of IBD, including the pharmacology of anti-TNF in a subset of patients.
Inflammatory bowel disease (IBD) is a vibrant area of clinical research. Many of the 250+ abstracts presented at the inaugural Crohn’s & Colitis Congress — a partnership of the Crohn’s & Colitis Foundation and AGA — looked at the efficacy and safety of IBD therapies. You can review all abstracts presented at the Crohn’s & Colitis Congress in Gastroenterology.
Double-blind, randomized, placebo-controlled, crossover trial to evaluate induction of clinical response in patients with moderate-severe Crohn’s disease treated with rifaximin
By Scott D. Lee, University of Washington Medicine, et al.
Significance: It is now known that the intestinal microbiome is integral to the pathogenesis of IBD. However, antibiotic treatments for IBD have previously shown limited effectiveness. In this 8-week clinical trial, there was a fourfold greater response to the antibiotic rifaximin in Crohn’s disease treatment, compared with placebo. The positive impact on clinical disease activity was seen even in patients with a significant disease burden and prior exposure to one or more biologic therapies. Quality of life and laboratory measurements were numerically improved. No new safety concerns were identified. These results offer renewed hope for the use of antibiotics in treating Crohn’s disease.
Post-hoc analysis of tofacitinib Crohn’s disease phase 2 induction efficacy in subgroups with baseline endoscopic or biomarker evidence of inflammation
By Bruce E. Sands, Icahn School of Medicine at Mount Sinai, et al.
Significance: Tofacitinib, a Janus kinase (JAK) inhibitor, is under investigation for treatment of ulcerative colitis and Crohn’s disease. To date, response rates in ulcerative colitis have been higher than for Crohn’s disease. In this report, investigators performed post-hoc analysis studies using objective baseline criteria of disease activity. Their findings showed a greater proportion of patients with moderate to severe Crohn’s disease were in remission with tofacitinib compared to placebo. These results provide evidence of JAK inhibition for the treatment of Crohn’s disease and support further investigation.
Refined population pharmacokinetic model for infliximab precision dosing in pediatric inflammatory bowel disease
By Laura E. Bauman, Cincinnati Children’s Hospital Medical Center, et al.
Significance: Long-term clinical remission from IBD with anti-TNF therapies has generally been limited to less than half of the treated patients. Improved outcomes are seen with optimal pre-infusion trough drug levels, a measurement of the level of drugs in the patient’s bloodstream. However, standard weight-based dosing for pediatric patients has provided widely varying trough drug levels. The investigators report the development of a multifactorial pharmacokinetic model for predicting infliximab trough levels during maintenance therapy for IBD. Such dynamic approaches to treatment address a specific gap in pediatric IBD therapeutic strategies.
Primary nonresponse to tumor necrosis factor antagonists is associated with inferior response to second-line biologics in patients with inflammatory bowel diseases: A systematic review and meta-analysis
By Siddharth Singh, University of California San Diego Health, et al.
Significance: Primary nonresponse to anti-TNF therapy is seen in 35%-65% of IBD patients and another 40%-60% lose responsiveness during the first year of treatment. Physicians struggle with what treatments to recommend for these patients. The investigators in this study performed a literature search and identified eight randomized controlled trials of biologics in patients with prior exposure to anti-TNF and compared outcomes based on their prior responses to anti-TNF. The analysis reveals a 24% decrease in likelihood to achieve remission in patients who changed medications because of immediate nonresponse compared to loss of responsiveness or intolerance during the treatment. These findings raise important questions about the biology of IBD, including the pharmacology of anti-TNF in a subset of patients.