News from AGA

The AGA Research Foundation plays an important role in medical research by providing grants to young scientists at a critical time in their career. AGA’s flagship award is the Research Scholar Award (RSA), which provides career development support for young investigators in gastroenterology and hepatology research. In the last 9 years, the AGA Research Foundation has funded 57 young scientists through an RSA grant.

In a recent survey conducted of RSA recipients from 2000 to 2009, the findings illustrate the research award program’s significant impact on digestive disease research.

• Over 90% of the RSA recipients surveyed remained in academic research.

• 85% of AGA RSA recipients in the past 10 years received NIH funding subsequent to their AGA award.

• Over 50% received $1 million or more in NIH grant support.

• Nearly 80% of the RSA cohort has received other federal or non-federal funding subsequent to receiving the AGA award.

• Over 80% of the RSA cohort currently holds a research grant.

"The AGA Research Scholar Award served as my first stepping stone to developing a serious career in basic science. The RSA paved the way for me to gain independence and transition seamlessly from postdoctoral fellow to a tenure-track assistant professorship. Receiving the grant from the AGA provided me with confidence and peace of mind, setting me up for a better candidacy when it came to receiving further awards and open tenure positions," said Dr. Pradipta Ghosh, 2008 AGA Foundation Research Scholar Award Recipient.

Funded by the generosity of donors, the AGA Research Foundation’s research award program ensures that we are building a community of researchers whose work serves the greater community and benefits all our patients.

By joining others in supporting the AGA Research Foundation, you will ensure that young researchers have opportunities to continue their life-saving work. Your tax-deductible contribution supports the foundation’s research award program, including the RSA, which ensures that studies are funded, discoveries are made, and patients are treated. Learn more or make a contribution at www.gastro.org/foundation.

The AGA Research Foundation plays an important role in medical research by providing grants to young scientists at a critical time in their career. AGA’s flagship award is the Research Scholar Award (RSA), which provides career development support for young investigators in gastroenterology and hepatology research. In the last 9 years, the AGA Research Foundation has funded 57 young scientists through an RSA grant.

In a recent survey conducted of RSA recipients from 2000 to 2009, the findings illustrate the research award program’s significant impact on digestive disease research.

• Over 90% of the RSA recipients surveyed remained in academic research.

• 85% of AGA RSA recipients in the past 10 years received NIH funding subsequent to their AGA award.

• Over 50% received $1 million or more in NIH grant support.

• Nearly 80% of the RSA cohort has received other federal or non-federal funding subsequent to receiving the AGA award.

• Over 80% of the RSA cohort currently holds a research grant.

"The AGA Research Scholar Award served as my first stepping stone to developing a serious career in basic science. The RSA paved the way for me to gain independence and transition seamlessly from postdoctoral fellow to a tenure-track assistant professorship. Receiving the grant from the AGA provided me with confidence and peace of mind, setting me up for a better candidacy when it came to receiving further awards and open tenure positions," said Dr. Pradipta Ghosh, 2008 AGA Foundation Research Scholar Award Recipient.

Funded by the generosity of donors, the AGA Research Foundation’s research award program ensures that we are building a community of researchers whose work serves the greater community and benefits all our patients.

By joining others in supporting the AGA Research Foundation, you will ensure that young researchers have opportunities to continue their life-saving work. Your tax-deductible contribution supports the foundation’s research award program, including the RSA, which ensures that studies are funded, discoveries are made, and patients are treated. Learn more or make a contribution at www.gastro.org/foundation.

The AGA Research Foundation plays an important role in medical research by providing grants to young scientists at a critical time in their career. AGA’s flagship award is the Research Scholar Award (RSA), which provides career development support for young investigators in gastroenterology and hepatology research. In the last 9 years, the AGA Research Foundation has funded 57 young scientists through an RSA grant.

In a recent survey conducted of RSA recipients from 2000 to 2009, the findings illustrate the research award program’s significant impact on digestive disease research.

• Over 90% of the RSA recipients surveyed remained in academic research.

• 85% of AGA RSA recipients in the past 10 years received NIH funding subsequent to their AGA award.

• Over 50% received $1 million or more in NIH grant support.

• Nearly 80% of the RSA cohort has received other federal or non-federal funding subsequent to receiving the AGA award.

• Over 80% of the RSA cohort currently holds a research grant.

"The AGA Research Scholar Award served as my first stepping stone to developing a serious career in basic science. The RSA paved the way for me to gain independence and transition seamlessly from postdoctoral fellow to a tenure-track assistant professorship. Receiving the grant from the AGA provided me with confidence and peace of mind, setting me up for a better candidacy when it came to receiving further awards and open tenure positions," said Dr. Pradipta Ghosh, 2008 AGA Foundation Research Scholar Award Recipient.

Funded by the generosity of donors, the AGA Research Foundation’s research award program ensures that we are building a community of researchers whose work serves the greater community and benefits all our patients.

By joining others in supporting the AGA Research Foundation, you will ensure that young researchers have opportunities to continue their life-saving work. Your tax-deductible contribution supports the foundation’s research award program, including the RSA, which ensures that studies are funded, discoveries are made, and patients are treated. Learn more or make a contribution at www.gastro.org/foundation.

The AGA is proud to announce the first BTE recognized physicians:

Mark J. Allen, Kansas City, MO

Charles Barish, Raleigh, NC

Brian W. Behm, Charlottesville, VA

Jennifer M. Choi, Los Angeles, CA

Nicholas V. Costrini, Richmond Hill, GA

Bulent Ender, Raleigh, NC

Edward Tze Wong, Lancaster, CA

Marc A. Herschelman, Raleigh, NC

Jeffrey S. Hyams, Hartford, CT

Seth Kaplan, Raleigh, NC

Nirmal Kaur, Highland Park, MI

Matthew T. Nichols, Lone Tree, CO

Michael B. Jones, Omaha, NE

Bruce A. Salzberg, Atlanta, GA

Janine Purcell, Rapid City, SD

Shahriar Sedghi, Macon, GA

Melinda J. Miller, Deltaville, VA

Emmanuelle Williams, Hershey, PA

Ira Shafran, Winter Park, FL

BTE is a program designed to recognize and reward physicians who demonstrate outstanding patient care. BTE measures the quality of care delivered in practices and rewards those clinicians who meet performance standards with multiple benefits.

The AGA has recognized 18 clinicians so far with Dr. Bruce Salzberg as the first physicians to have achieved BTE IBD recognition.

"I am honored to have received the acknowledgment of the AGA for my efforts in providing the best quality of care for my IBD patients. I take great pride in caring for these individuals and will continue to strive to maintain this level of care for the future. This recognition is a great step forward by our national organization in ensuring that IBD patients have access to state of the art therapy," said Dr. Salzberg.

You too can participate in Bridges to Excellence through the AGA’s Digestive Health Recognition Program (DHRP). The DHRP was designed by AGA in conjunction with the Health Care Incentives Improvement Institute (HCI3) to provide quality reporting familiar to payers. AGA has the only BTE program for gastroenterology. Applicants who achieve BTE recognition may be eligible to earn a fixed annual bonus payment for each patient, preferred network tiering and fee schedule increases. Contact your health plans to determine your eligibility. The status is valid for 1 year from recognition date.

In addition to BTE recognition, the DHRP offers eligible physicians the ability to qualify for CMS PQRS incentives and avoid penalties, as well as complete ABIM maintenance of certification requirements.

For more information or to get started visit www.agarecognition.org.

The AGA is proud to announce the first BTE recognized physicians:

Mark J. Allen, Kansas City, MO

Charles Barish, Raleigh, NC

Brian W. Behm, Charlottesville, VA

Jennifer M. Choi, Los Angeles, CA

Nicholas V. Costrini, Richmond Hill, GA

Bulent Ender, Raleigh, NC

Edward Tze Wong, Lancaster, CA

Marc A. Herschelman, Raleigh, NC

Jeffrey S. Hyams, Hartford, CT

Seth Kaplan, Raleigh, NC

Nirmal Kaur, Highland Park, MI

Matthew T. Nichols, Lone Tree, CO

Michael B. Jones, Omaha, NE

Bruce A. Salzberg, Atlanta, GA

Janine Purcell, Rapid City, SD

Shahriar Sedghi, Macon, GA

Melinda J. Miller, Deltaville, VA

Emmanuelle Williams, Hershey, PA

Ira Shafran, Winter Park, FL

BTE is a program designed to recognize and reward physicians who demonstrate outstanding patient care. BTE measures the quality of care delivered in practices and rewards those clinicians who meet performance standards with multiple benefits.

The AGA has recognized 18 clinicians so far with Dr. Bruce Salzberg as the first physicians to have achieved BTE IBD recognition.

"I am honored to have received the acknowledgment of the AGA for my efforts in providing the best quality of care for my IBD patients. I take great pride in caring for these individuals and will continue to strive to maintain this level of care for the future. This recognition is a great step forward by our national organization in ensuring that IBD patients have access to state of the art therapy," said Dr. Salzberg.

You too can participate in Bridges to Excellence through the AGA’s Digestive Health Recognition Program (DHRP). The DHRP was designed by AGA in conjunction with the Health Care Incentives Improvement Institute (HCI3) to provide quality reporting familiar to payers. AGA has the only BTE program for gastroenterology. Applicants who achieve BTE recognition may be eligible to earn a fixed annual bonus payment for each patient, preferred network tiering and fee schedule increases. Contact your health plans to determine your eligibility. The status is valid for 1 year from recognition date.

In addition to BTE recognition, the DHRP offers eligible physicians the ability to qualify for CMS PQRS incentives and avoid penalties, as well as complete ABIM maintenance of certification requirements.

For more information or to get started visit www.agarecognition.org.

The AGA is proud to announce the first BTE recognized physicians:

Mark J. Allen, Kansas City, MO

Charles Barish, Raleigh, NC

Brian W. Behm, Charlottesville, VA

Jennifer M. Choi, Los Angeles, CA

Nicholas V. Costrini, Richmond Hill, GA

Bulent Ender, Raleigh, NC

Edward Tze Wong, Lancaster, CA

Marc A. Herschelman, Raleigh, NC

Jeffrey S. Hyams, Hartford, CT

Seth Kaplan, Raleigh, NC

Nirmal Kaur, Highland Park, MI

Matthew T. Nichols, Lone Tree, CO

Michael B. Jones, Omaha, NE

Bruce A. Salzberg, Atlanta, GA

Janine Purcell, Rapid City, SD

Shahriar Sedghi, Macon, GA

Melinda J. Miller, Deltaville, VA

Emmanuelle Williams, Hershey, PA

Ira Shafran, Winter Park, FL

BTE is a program designed to recognize and reward physicians who demonstrate outstanding patient care. BTE measures the quality of care delivered in practices and rewards those clinicians who meet performance standards with multiple benefits.

The AGA has recognized 18 clinicians so far with Dr. Bruce Salzberg as the first physicians to have achieved BTE IBD recognition.

"I am honored to have received the acknowledgment of the AGA for my efforts in providing the best quality of care for my IBD patients. I take great pride in caring for these individuals and will continue to strive to maintain this level of care for the future. This recognition is a great step forward by our national organization in ensuring that IBD patients have access to state of the art therapy," said Dr. Salzberg.

You too can participate in Bridges to Excellence through the AGA’s Digestive Health Recognition Program (DHRP). The DHRP was designed by AGA in conjunction with the Health Care Incentives Improvement Institute (HCI3) to provide quality reporting familiar to payers. AGA has the only BTE program for gastroenterology. Applicants who achieve BTE recognition may be eligible to earn a fixed annual bonus payment for each patient, preferred network tiering and fee schedule increases. Contact your health plans to determine your eligibility. The status is valid for 1 year from recognition date.

In addition to BTE recognition, the DHRP offers eligible physicians the ability to qualify for CMS PQRS incentives and avoid penalties, as well as complete ABIM maintenance of certification requirements.

For more information or to get started visit www.agarecognition.org.

Media outlets have recently published articles critical of physician payments. The national GI societies are working to set the record straight and help reporters, patients, and policymakers understand the complexities of the system and the value of gastroenterologists and tests like colonoscopy.

Do I even need a colonoscopy? Is there a cheaper test that would be just as good for colon cancer screening?

Colonoscopy is a safe, well-tolerated and potentially life-saving exam. The GI societies recommend colonoscopy for colorectal cancer screening beginning at age 50 for all average risk people due to its ability to examine the entire colon and find and remove polyps (growths in the colon) during the same procedure. There are cheaper screening tests, but if the screening test is positive, the patient must return to the doctor for a colonoscopy to check for cancers and remove any polyps. Some tests only find cancer once it has developed, while colonoscopy is a preventive exam that identifies precancerous polyps and removes them before they turn into cancer. A 2012 study in the New England Journal of Medicine showed a 53% decline in deaths for patients who underwent colonoscopy and had precancerous polyps removed.

If a patient is considered average risk and no polyps are found during a colonoscopy, the exam does not need to be repeated for 10 years while other screening tests need to be repeated more often, some of them yearly.

How much does a colonoscopy cost? What charges are included in my colonoscopy bill?

The cost of a colonoscopy varies based on a number of factors including the individual health of the patient and their needs, which informs the decision as to where the procedure is performed, and whether the procedure is a screening exam for colon cancer or diagnostic (to evaluate symptoms such as bleeding) and if a lesion is removed or a biopsy (tissue sample) is taken.

A billed charge is the amount that a physician, hospital or other healthcare entity charges for the specific procedures or services provided to the patient. Reimbursement is the amount paid to the physician, hospital or other entity by an insurance company and/or the patient for a particular procedure or service provided to the patient. For example, with a patient covered by Medicare, on average, Medicare reimburses physicians about $220 for conducting a screening colonoscopy. (The New York Times article was inaccurate in the $531 figure they quoted and issued a correction on June 30, 2013.)

Reimbursement depends on the patient’s insurance provider and the provider contract. Patients should review their health insurance plan for specific details including if the doctor is within their insurance company’s list of "in-network" providers. If they are not and are considered "out of network," the cost to the patient may be significantly higher.

Following is a list of charges that are typically included when colonoscopy is performed. Patients may receive one or multiple bills for different elements of the procedure from different practice and hospital providers.

• Bowel or colon prep kit

• Colonoscopy – There are different classifications for the procedure based on the patient’s health:

Screening colonoscopy (patient has no symptoms, no biopsy or lesion removal)

Diagnostic colonoscopy (the patient has symptoms)

Colonoscopy and biopsy (tissue sample is taken)

• Lesion removal colonoscopy (lesion/polyp is removed)

• Sedation

Whether sedation is used or not

Type of sedation used

Administration – with or without an anesthesiologist or nurse anesthetist

• Pathology (tissue/lesion examination by a pathologist after the procedure)

• Facility (where the procedure is performed)

Hospital

Ambulatory surgery center

Doctor’s office

Why is a colonoscopy more expensive at a hospital than when it is performed in a doctor’s office or ambulatory surgery center (ASC)?

A colonoscopy can be performed in a number of settings including a hospital, ASC or a doctor’s office. Where a colonoscopy is performed is typically determined by the individual health of the patient, the type of procedure, and where the physician asked to provide the service practices.

A patient considered high risk, may need the additional resources available in a hospital setting where procedure costs are typically higher. A lower-cost ASC or doctor’s office is appropriate for the majority of patients who are otherwise in overall good health.

Why does a colonoscopy cost less in one state versus in another state? Is colonoscopy less expensive in other countries?

Health care, like other expenses, is more costly in some parts of the country. This regional price variation also determines what a physician is paid. Medicare and private insurance carriers adjust payment rates based on regional price variations in areas such as salaries, supplies and building expenses necessary for maintaining practice operations and performing physician services. For example, it will cost more to run a practice in New York City than in a small town in Nebraska.

The cost of health care and all medical services (not just GI procedures and colonoscopy) vary widely between countries, therefore direct cost comparisons between the U.S. and other countries are very difficult. There are many factors that contribute to the cost variance including different insurance systems, different approaches to facility charges and reimbursements, different ways to control costs, the complexity of the health care systems, and differences in cost of living.

What costs will my insurance provider/Medicare cover? Why do I still have to pay for some costs of the colonoscopy?

Reimbursement depends on the patient’s insurance provider and the provider contract. Patients should review their health insurance plan for specific details including if the doctor is within their insurance company’s list of "in-network" providers. If they are not and are considered "out of network," the cost to the patient may be significantly higher.

In 2000, Medicare started paying for colonoscopy for people age 50 and older. The Patient Protection and Affordable Care Act, passed in 2010, waives the coinsurance and deductible for many colorectal cancer screening tests, including colonoscopy. An oversight in the 2010 law still held patients financially responsible for a 20% copay for a screening colonoscopy if a polyp was removed because polyp removal changed the procedure from a "screening" test (which is covered under the Affordable Care Act) to a "therapeutic" exam (polyp removal). Patients with Medicare coverage must still pay a coinsurance (but not a deductible) when a polyp is removed as a result of a screening colonoscopy. The GI societies are working on changing cost sharing for screening colonoscopy for Medicare beneficiaries.

In 2013, the federal government issued an important clarification on preventive screening benefits under the Affordable Care Act. Patients with certain private insurance plans will no longer be liable for cost sharing when a precancerous colon polyp is removed during a screening colonoscopy. This ensures that colorectal cancer screening is available to privately insured patients at no additional cost, as intended by the new health care law. Patients should review their health insurance plan for specific details, including whether their plan falls under this guidance.

Finally, colonoscopies that are performed to evaluate specific problems, such as intestinal bleeding or anemia, are not classified by private insurers and Medicare as screening procedures, and may not be eligible for waiver of deductible and copay requirements.

Can I have a colonoscopy without sedation since anesthesia costs so much?

In many cases, colonoscopy can be done without sedation. However, sedation is used to make patients comfortable during the procedure. Having a colonoscopy with or without sedation may also depend on the individual health of the patient and should be discussed with your doctor. Many patients prefer to be sedated during the exam. Depending on the type of sedation used, there may or may not be an extra charge for this portion of the service. Patients should discuss the available options with their physician and specifically ask about the cost of the various sedation options.

[email protected]

Media outlets have recently published articles critical of physician payments. The national GI societies are working to set the record straight and help reporters, patients, and policymakers understand the complexities of the system and the value of gastroenterologists and tests like colonoscopy.

Do I even need a colonoscopy? Is there a cheaper test that would be just as good for colon cancer screening?

Colonoscopy is a safe, well-tolerated and potentially life-saving exam. The GI societies recommend colonoscopy for colorectal cancer screening beginning at age 50 for all average risk people due to its ability to examine the entire colon and find and remove polyps (growths in the colon) during the same procedure. There are cheaper screening tests, but if the screening test is positive, the patient must return to the doctor for a colonoscopy to check for cancers and remove any polyps. Some tests only find cancer once it has developed, while colonoscopy is a preventive exam that identifies precancerous polyps and removes them before they turn into cancer. A 2012 study in the New England Journal of Medicine showed a 53% decline in deaths for patients who underwent colonoscopy and had precancerous polyps removed.

If a patient is considered average risk and no polyps are found during a colonoscopy, the exam does not need to be repeated for 10 years while other screening tests need to be repeated more often, some of them yearly.

How much does a colonoscopy cost? What charges are included in my colonoscopy bill?

The cost of a colonoscopy varies based on a number of factors including the individual health of the patient and their needs, which informs the decision as to where the procedure is performed, and whether the procedure is a screening exam for colon cancer or diagnostic (to evaluate symptoms such as bleeding) and if a lesion is removed or a biopsy (tissue sample) is taken.

A billed charge is the amount that a physician, hospital or other healthcare entity charges for the specific procedures or services provided to the patient. Reimbursement is the amount paid to the physician, hospital or other entity by an insurance company and/or the patient for a particular procedure or service provided to the patient. For example, with a patient covered by Medicare, on average, Medicare reimburses physicians about $220 for conducting a screening colonoscopy. (The New York Times article was inaccurate in the $531 figure they quoted and issued a correction on June 30, 2013.)

Reimbursement depends on the patient’s insurance provider and the provider contract. Patients should review their health insurance plan for specific details including if the doctor is within their insurance company’s list of "in-network" providers. If they are not and are considered "out of network," the cost to the patient may be significantly higher.

Following is a list of charges that are typically included when colonoscopy is performed. Patients may receive one or multiple bills for different elements of the procedure from different practice and hospital providers.

• Bowel or colon prep kit

• Colonoscopy – There are different classifications for the procedure based on the patient’s health:

Screening colonoscopy (patient has no symptoms, no biopsy or lesion removal)

Diagnostic colonoscopy (the patient has symptoms)

Colonoscopy and biopsy (tissue sample is taken)

• Lesion removal colonoscopy (lesion/polyp is removed)

• Sedation

Whether sedation is used or not

Type of sedation used

Administration – with or without an anesthesiologist or nurse anesthetist

• Pathology (tissue/lesion examination by a pathologist after the procedure)

• Facility (where the procedure is performed)

Hospital

Ambulatory surgery center

Doctor’s office

Why is a colonoscopy more expensive at a hospital than when it is performed in a doctor’s office or ambulatory surgery center (ASC)?

A colonoscopy can be performed in a number of settings including a hospital, ASC or a doctor’s office. Where a colonoscopy is performed is typically determined by the individual health of the patient, the type of procedure, and where the physician asked to provide the service practices.

A patient considered high risk, may need the additional resources available in a hospital setting where procedure costs are typically higher. A lower-cost ASC or doctor’s office is appropriate for the majority of patients who are otherwise in overall good health.

Why does a colonoscopy cost less in one state versus in another state? Is colonoscopy less expensive in other countries?

Health care, like other expenses, is more costly in some parts of the country. This regional price variation also determines what a physician is paid. Medicare and private insurance carriers adjust payment rates based on regional price variations in areas such as salaries, supplies and building expenses necessary for maintaining practice operations and performing physician services. For example, it will cost more to run a practice in New York City than in a small town in Nebraska.

The cost of health care and all medical services (not just GI procedures and colonoscopy) vary widely between countries, therefore direct cost comparisons between the U.S. and other countries are very difficult. There are many factors that contribute to the cost variance including different insurance systems, different approaches to facility charges and reimbursements, different ways to control costs, the complexity of the health care systems, and differences in cost of living.

What costs will my insurance provider/Medicare cover? Why do I still have to pay for some costs of the colonoscopy?

Reimbursement depends on the patient’s insurance provider and the provider contract. Patients should review their health insurance plan for specific details including if the doctor is within their insurance company’s list of "in-network" providers. If they are not and are considered "out of network," the cost to the patient may be significantly higher.

In 2000, Medicare started paying for colonoscopy for people age 50 and older. The Patient Protection and Affordable Care Act, passed in 2010, waives the coinsurance and deductible for many colorectal cancer screening tests, including colonoscopy. An oversight in the 2010 law still held patients financially responsible for a 20% copay for a screening colonoscopy if a polyp was removed because polyp removal changed the procedure from a "screening" test (which is covered under the Affordable Care Act) to a "therapeutic" exam (polyp removal). Patients with Medicare coverage must still pay a coinsurance (but not a deductible) when a polyp is removed as a result of a screening colonoscopy. The GI societies are working on changing cost sharing for screening colonoscopy for Medicare beneficiaries.

In 2013, the federal government issued an important clarification on preventive screening benefits under the Affordable Care Act. Patients with certain private insurance plans will no longer be liable for cost sharing when a precancerous colon polyp is removed during a screening colonoscopy. This ensures that colorectal cancer screening is available to privately insured patients at no additional cost, as intended by the new health care law. Patients should review their health insurance plan for specific details, including whether their plan falls under this guidance.

Finally, colonoscopies that are performed to evaluate specific problems, such as intestinal bleeding or anemia, are not classified by private insurers and Medicare as screening procedures, and may not be eligible for waiver of deductible and copay requirements.

Can I have a colonoscopy without sedation since anesthesia costs so much?

In many cases, colonoscopy can be done without sedation. However, sedation is used to make patients comfortable during the procedure. Having a colonoscopy with or without sedation may also depend on the individual health of the patient and should be discussed with your doctor. Many patients prefer to be sedated during the exam. Depending on the type of sedation used, there may or may not be an extra charge for this portion of the service. Patients should discuss the available options with their physician and specifically ask about the cost of the various sedation options.

[email protected]

Media outlets have recently published articles critical of physician payments. The national GI societies are working to set the record straight and help reporters, patients, and policymakers understand the complexities of the system and the value of gastroenterologists and tests like colonoscopy.

Do I even need a colonoscopy? Is there a cheaper test that would be just as good for colon cancer screening?

Colonoscopy is a safe, well-tolerated and potentially life-saving exam. The GI societies recommend colonoscopy for colorectal cancer screening beginning at age 50 for all average risk people due to its ability to examine the entire colon and find and remove polyps (growths in the colon) during the same procedure. There are cheaper screening tests, but if the screening test is positive, the patient must return to the doctor for a colonoscopy to check for cancers and remove any polyps. Some tests only find cancer once it has developed, while colonoscopy is a preventive exam that identifies precancerous polyps and removes them before they turn into cancer. A 2012 study in the New England Journal of Medicine showed a 53% decline in deaths for patients who underwent colonoscopy and had precancerous polyps removed.

If a patient is considered average risk and no polyps are found during a colonoscopy, the exam does not need to be repeated for 10 years while other screening tests need to be repeated more often, some of them yearly.

How much does a colonoscopy cost? What charges are included in my colonoscopy bill?

The cost of a colonoscopy varies based on a number of factors including the individual health of the patient and their needs, which informs the decision as to where the procedure is performed, and whether the procedure is a screening exam for colon cancer or diagnostic (to evaluate symptoms such as bleeding) and if a lesion is removed or a biopsy (tissue sample) is taken.

A billed charge is the amount that a physician, hospital or other healthcare entity charges for the specific procedures or services provided to the patient. Reimbursement is the amount paid to the physician, hospital or other entity by an insurance company and/or the patient for a particular procedure or service provided to the patient. For example, with a patient covered by Medicare, on average, Medicare reimburses physicians about $220 for conducting a screening colonoscopy. (The New York Times article was inaccurate in the $531 figure they quoted and issued a correction on June 30, 2013.)

Reimbursement depends on the patient’s insurance provider and the provider contract. Patients should review their health insurance plan for specific details including if the doctor is within their insurance company’s list of "in-network" providers. If they are not and are considered "out of network," the cost to the patient may be significantly higher.

Following is a list of charges that are typically included when colonoscopy is performed. Patients may receive one or multiple bills for different elements of the procedure from different practice and hospital providers.

• Bowel or colon prep kit

• Colonoscopy – There are different classifications for the procedure based on the patient’s health:

Screening colonoscopy (patient has no symptoms, no biopsy or lesion removal)

Diagnostic colonoscopy (the patient has symptoms)

Colonoscopy and biopsy (tissue sample is taken)

• Lesion removal colonoscopy (lesion/polyp is removed)

• Sedation

Whether sedation is used or not

Type of sedation used

Administration – with or without an anesthesiologist or nurse anesthetist

• Pathology (tissue/lesion examination by a pathologist after the procedure)

• Facility (where the procedure is performed)

Hospital

Ambulatory surgery center

Doctor’s office

Why is a colonoscopy more expensive at a hospital than when it is performed in a doctor’s office or ambulatory surgery center (ASC)?

A colonoscopy can be performed in a number of settings including a hospital, ASC or a doctor’s office. Where a colonoscopy is performed is typically determined by the individual health of the patient, the type of procedure, and where the physician asked to provide the service practices.

A patient considered high risk, may need the additional resources available in a hospital setting where procedure costs are typically higher. A lower-cost ASC or doctor’s office is appropriate for the majority of patients who are otherwise in overall good health.

Why does a colonoscopy cost less in one state versus in another state? Is colonoscopy less expensive in other countries?

Health care, like other expenses, is more costly in some parts of the country. This regional price variation also determines what a physician is paid. Medicare and private insurance carriers adjust payment rates based on regional price variations in areas such as salaries, supplies and building expenses necessary for maintaining practice operations and performing physician services. For example, it will cost more to run a practice in New York City than in a small town in Nebraska.

The cost of health care and all medical services (not just GI procedures and colonoscopy) vary widely between countries, therefore direct cost comparisons between the U.S. and other countries are very difficult. There are many factors that contribute to the cost variance including different insurance systems, different approaches to facility charges and reimbursements, different ways to control costs, the complexity of the health care systems, and differences in cost of living.

What costs will my insurance provider/Medicare cover? Why do I still have to pay for some costs of the colonoscopy?

Reimbursement depends on the patient’s insurance provider and the provider contract. Patients should review their health insurance plan for specific details including if the doctor is within their insurance company’s list of "in-network" providers. If they are not and are considered "out of network," the cost to the patient may be significantly higher.

In 2000, Medicare started paying for colonoscopy for people age 50 and older. The Patient Protection and Affordable Care Act, passed in 2010, waives the coinsurance and deductible for many colorectal cancer screening tests, including colonoscopy. An oversight in the 2010 law still held patients financially responsible for a 20% copay for a screening colonoscopy if a polyp was removed because polyp removal changed the procedure from a "screening" test (which is covered under the Affordable Care Act) to a "therapeutic" exam (polyp removal). Patients with Medicare coverage must still pay a coinsurance (but not a deductible) when a polyp is removed as a result of a screening colonoscopy. The GI societies are working on changing cost sharing for screening colonoscopy for Medicare beneficiaries.

In 2013, the federal government issued an important clarification on preventive screening benefits under the Affordable Care Act. Patients with certain private insurance plans will no longer be liable for cost sharing when a precancerous colon polyp is removed during a screening colonoscopy. This ensures that colorectal cancer screening is available to privately insured patients at no additional cost, as intended by the new health care law. Patients should review their health insurance plan for specific details, including whether their plan falls under this guidance.

Finally, colonoscopies that are performed to evaluate specific problems, such as intestinal bleeding or anemia, are not classified by private insurers and Medicare as screening procedures, and may not be eligible for waiver of deductible and copay requirements.

Can I have a colonoscopy without sedation since anesthesia costs so much?

In many cases, colonoscopy can be done without sedation. However, sedation is used to make patients comfortable during the procedure. Having a colonoscopy with or without sedation may also depend on the individual health of the patient and should be discussed with your doctor. Many patients prefer to be sedated during the exam. Depending on the type of sedation used, there may or may not be an extra charge for this portion of the service. Patients should discuss the available options with their physician and specifically ask about the cost of the various sedation options.

[email protected]

Having attended the now annual July Alliance of Specialty Medicine Advocacy "Fly-In" in Washington DC over the past couple of years, I noticed a change (although subtle) this year. Besides the fact that the attendance was greater, more representatives and senators came to tell us their viewpoints (mostly Republicans), and DC seemed hotter than ever – this year there was a sense of urgency and an engagement among the attendees for action and solutions now.

The Alliance is a coalition of 13 national specialty societies whose collective goal is the preservation of a quality health care policy that supports access to specialty care for patients. Each year, physicians from these different societies, including AGA, gather in Washington to go to the offices of their senators and representatives to speak in a collective voice for specialty medicine.

As a gastroenterologist, I, along with ophthalmologists, spine surgeons, dermatologists and others, pleaded our case to our respective representatives for our shared concerns. While some of the issues remained the same – the constant fight for fair Medicare reimbursement, repealing the Sustainable Growth Rate formula and the Independent Payment Advisory Board, and tackling medical liability reform – there were some new issues that came to the forefront.

I learned that that United States will face an overall shortage of more than 130,000 physicians by 2025. One-half of this shortage will come from specialty physicians. Growth in future demand for physicians will be highest among specialties that predominately serve the elderly. With 10,000 seniors aging into Medicare every day for the next 18 years, along with the influx of patients seeking access to care as a result of the Affordable Care Act, the need for our services will increase significantly. We need to ensure that we have enough gastroenterologists for the future.

On my Hill visits, I urged my Massachusetts representative and senators to address the workforce shortages in many specialties that will jeopardize access to care for our patients. Both the "Resident Physician Shortage Reduction Act" and the "Training Tomorrow’s Doctors Today Act" will improve the nation’s graduate medical education system and help preserve access to specialty care by increasing the residency slots by 15,000 over the next 5 years, with half of the positions going to training specialists.

While we all have been made aware of the crisis in primary care and the changes ahead to increase the number of primary care physicians, we need to make Congress aware that access to specialists is also threatened by an equal shortage of specialists. To ensure a fully trained specialty workforce for the future, it is apparent that we need to take steps now. We are all in agreement that the proposed legislation will begin to help improve the acute shortage of specialty physicians.

Our marathon for a sound federal health care policy fostering patient access to the highest quality specialty care continues. Yet this year, I believe the crowds were cheering us on and there was a passion in the air. Practicing quality medicine is not the issue (we all agree to that). How to do it best is still the challenge and on all fronts, I felt we were getting closer to the finish line.

Having attended the now annual July Alliance of Specialty Medicine Advocacy "Fly-In" in Washington DC over the past couple of years, I noticed a change (although subtle) this year. Besides the fact that the attendance was greater, more representatives and senators came to tell us their viewpoints (mostly Republicans), and DC seemed hotter than ever – this year there was a sense of urgency and an engagement among the attendees for action and solutions now.

The Alliance is a coalition of 13 national specialty societies whose collective goal is the preservation of a quality health care policy that supports access to specialty care for patients. Each year, physicians from these different societies, including AGA, gather in Washington to go to the offices of their senators and representatives to speak in a collective voice for specialty medicine.

As a gastroenterologist, I, along with ophthalmologists, spine surgeons, dermatologists and others, pleaded our case to our respective representatives for our shared concerns. While some of the issues remained the same – the constant fight for fair Medicare reimbursement, repealing the Sustainable Growth Rate formula and the Independent Payment Advisory Board, and tackling medical liability reform – there were some new issues that came to the forefront.

I learned that that United States will face an overall shortage of more than 130,000 physicians by 2025. One-half of this shortage will come from specialty physicians. Growth in future demand for physicians will be highest among specialties that predominately serve the elderly. With 10,000 seniors aging into Medicare every day for the next 18 years, along with the influx of patients seeking access to care as a result of the Affordable Care Act, the need for our services will increase significantly. We need to ensure that we have enough gastroenterologists for the future.

On my Hill visits, I urged my Massachusetts representative and senators to address the workforce shortages in many specialties that will jeopardize access to care for our patients. Both the "Resident Physician Shortage Reduction Act" and the "Training Tomorrow’s Doctors Today Act" will improve the nation’s graduate medical education system and help preserve access to specialty care by increasing the residency slots by 15,000 over the next 5 years, with half of the positions going to training specialists.

While we all have been made aware of the crisis in primary care and the changes ahead to increase the number of primary care physicians, we need to make Congress aware that access to specialists is also threatened by an equal shortage of specialists. To ensure a fully trained specialty workforce for the future, it is apparent that we need to take steps now. We are all in agreement that the proposed legislation will begin to help improve the acute shortage of specialty physicians.

Our marathon for a sound federal health care policy fostering patient access to the highest quality specialty care continues. Yet this year, I believe the crowds were cheering us on and there was a passion in the air. Practicing quality medicine is not the issue (we all agree to that). How to do it best is still the challenge and on all fronts, I felt we were getting closer to the finish line.

Having attended the now annual July Alliance of Specialty Medicine Advocacy "Fly-In" in Washington DC over the past couple of years, I noticed a change (although subtle) this year. Besides the fact that the attendance was greater, more representatives and senators came to tell us their viewpoints (mostly Republicans), and DC seemed hotter than ever – this year there was a sense of urgency and an engagement among the attendees for action and solutions now.

The Alliance is a coalition of 13 national specialty societies whose collective goal is the preservation of a quality health care policy that supports access to specialty care for patients. Each year, physicians from these different societies, including AGA, gather in Washington to go to the offices of their senators and representatives to speak in a collective voice for specialty medicine.

As a gastroenterologist, I, along with ophthalmologists, spine surgeons, dermatologists and others, pleaded our case to our respective representatives for our shared concerns. While some of the issues remained the same – the constant fight for fair Medicare reimbursement, repealing the Sustainable Growth Rate formula and the Independent Payment Advisory Board, and tackling medical liability reform – there were some new issues that came to the forefront.

I learned that that United States will face an overall shortage of more than 130,000 physicians by 2025. One-half of this shortage will come from specialty physicians. Growth in future demand for physicians will be highest among specialties that predominately serve the elderly. With 10,000 seniors aging into Medicare every day for the next 18 years, along with the influx of patients seeking access to care as a result of the Affordable Care Act, the need for our services will increase significantly. We need to ensure that we have enough gastroenterologists for the future.

On my Hill visits, I urged my Massachusetts representative and senators to address the workforce shortages in many specialties that will jeopardize access to care for our patients. Both the "Resident Physician Shortage Reduction Act" and the "Training Tomorrow’s Doctors Today Act" will improve the nation’s graduate medical education system and help preserve access to specialty care by increasing the residency slots by 15,000 over the next 5 years, with half of the positions going to training specialists.

While we all have been made aware of the crisis in primary care and the changes ahead to increase the number of primary care physicians, we need to make Congress aware that access to specialists is also threatened by an equal shortage of specialists. To ensure a fully trained specialty workforce for the future, it is apparent that we need to take steps now. We are all in agreement that the proposed legislation will begin to help improve the acute shortage of specialty physicians.

Our marathon for a sound federal health care policy fostering patient access to the highest quality specialty care continues. Yet this year, I believe the crowds were cheering us on and there was a passion in the air. Practicing quality medicine is not the issue (we all agree to that). How to do it best is still the challenge and on all fronts, I felt we were getting closer to the finish line.

The AGA Research Foundation has announced the 2013 Student Research Fellowship Award recipients. The awards are intended to stimulate interest in research careers in digestive diseases among high school, undergraduate, graduate, and medical school students. The high school recipients are funded by The Eli and Edythe Broad Foundation.

"The AGA Institute remains committed to providing young researchers with unprecedented research opportunities," said Martin Brotman, M.D., AGAF, chair of the AGA Research Foundation. "We are extremely impressed by the caliber of nominations we received for the 2013 Student Research Fellowship Awards, and we look forward to watching these gifted students as they work to advance the understanding of digestive diseases through their novel research objectives."

A total of eight awards of $2,500 each were given to support high school students interested in performing digestive disease or nutrition research for a minimum of 10 weeks. Virtually all have indicated an intention to continue their studies in medically related fields. This year’s Broad Scholars are:

• Alexander R. Cohen, Newton South High School, MA

• Ayesha Godil, Granite Bay High School, CA

• Chimdi V. Obinero, Commack High School, NY

• Jordan M. Poles, Horace Greeley High School, Chappaqua, NY

• Naryan L. Rustgi, Haverford School for Boys, PA

• Prateeti P. Sarker, Dulaney High School, Timonium, MD

• Henry N. Senkfor, Hawken School, Gates Mills, OH

• Jordan L. Widom, Ransom Everglades, Miami, FL

The AGA Research Foundation also awarded 22 AGA Student Research Fellowship Awards to undergrad, graduate, and medical students looking to further their research careers. These promising students will receive up to $3,000 each to perform research in digestive diseases over a 10-week period.

The Student Research Fellowship Awards program was created by the AGA more than a decade ago to stimulate interest in gastroenterological research careers in high school, college, and medical school students. To date, the program has identified nearly 253 high school, undergraduate, graduate, and medical students to participate in the program. Selected through a rigorous national application process, the students have participated in research at such distinguished institutions as Perelman School of Medicine at the University of Pennsylvania, Philadelphia; University of Maryland School of Medicine, Baltimore; Mayo Clinic, Rochester, MN; Rush University Medical Center, Chicago, IL; and others.

The Eli and Edythe Broad Foundation is a national venture philanthropy established by entrepreneur Eli Broad to advance entrepreneurship for the public good in education, science and the arts. The Broad Foundation invests in scientific and medical research in the areas of human genomics, stem cell research, and inflammatory bowel disease.

Learn more about the AGA Research Foundation or make a contribution at www.gastro.org/aga-foundation.

[email protected]

The AGA Research Foundation has announced the 2013 Student Research Fellowship Award recipients. The awards are intended to stimulate interest in research careers in digestive diseases among high school, undergraduate, graduate, and medical school students. The high school recipients are funded by The Eli and Edythe Broad Foundation.

"The AGA Institute remains committed to providing young researchers with unprecedented research opportunities," said Martin Brotman, M.D., AGAF, chair of the AGA Research Foundation. "We are extremely impressed by the caliber of nominations we received for the 2013 Student Research Fellowship Awards, and we look forward to watching these gifted students as they work to advance the understanding of digestive diseases through their novel research objectives."

A total of eight awards of $2,500 each were given to support high school students interested in performing digestive disease or nutrition research for a minimum of 10 weeks. Virtually all have indicated an intention to continue their studies in medically related fields. This year’s Broad Scholars are:

• Alexander R. Cohen, Newton South High School, MA

• Ayesha Godil, Granite Bay High School, CA

• Chimdi V. Obinero, Commack High School, NY

• Jordan M. Poles, Horace Greeley High School, Chappaqua, NY

• Naryan L. Rustgi, Haverford School for Boys, PA

• Prateeti P. Sarker, Dulaney High School, Timonium, MD

• Henry N. Senkfor, Hawken School, Gates Mills, OH

• Jordan L. Widom, Ransom Everglades, Miami, FL

The AGA Research Foundation also awarded 22 AGA Student Research Fellowship Awards to undergrad, graduate, and medical students looking to further their research careers. These promising students will receive up to $3,000 each to perform research in digestive diseases over a 10-week period.

The Student Research Fellowship Awards program was created by the AGA more than a decade ago to stimulate interest in gastroenterological research careers in high school, college, and medical school students. To date, the program has identified nearly 253 high school, undergraduate, graduate, and medical students to participate in the program. Selected through a rigorous national application process, the students have participated in research at such distinguished institutions as Perelman School of Medicine at the University of Pennsylvania, Philadelphia; University of Maryland School of Medicine, Baltimore; Mayo Clinic, Rochester, MN; Rush University Medical Center, Chicago, IL; and others.

The Eli and Edythe Broad Foundation is a national venture philanthropy established by entrepreneur Eli Broad to advance entrepreneurship for the public good in education, science and the arts. The Broad Foundation invests in scientific and medical research in the areas of human genomics, stem cell research, and inflammatory bowel disease.

Learn more about the AGA Research Foundation or make a contribution at www.gastro.org/aga-foundation.

[email protected]

The AGA Research Foundation has announced the 2013 Student Research Fellowship Award recipients. The awards are intended to stimulate interest in research careers in digestive diseases among high school, undergraduate, graduate, and medical school students. The high school recipients are funded by The Eli and Edythe Broad Foundation.

"The AGA Institute remains committed to providing young researchers with unprecedented research opportunities," said Martin Brotman, M.D., AGAF, chair of the AGA Research Foundation. "We are extremely impressed by the caliber of nominations we received for the 2013 Student Research Fellowship Awards, and we look forward to watching these gifted students as they work to advance the understanding of digestive diseases through their novel research objectives."

A total of eight awards of $2,500 each were given to support high school students interested in performing digestive disease or nutrition research for a minimum of 10 weeks. Virtually all have indicated an intention to continue their studies in medically related fields. This year’s Broad Scholars are:

• Alexander R. Cohen, Newton South High School, MA

• Ayesha Godil, Granite Bay High School, CA

• Chimdi V. Obinero, Commack High School, NY

• Jordan M. Poles, Horace Greeley High School, Chappaqua, NY

• Naryan L. Rustgi, Haverford School for Boys, PA

• Prateeti P. Sarker, Dulaney High School, Timonium, MD

• Henry N. Senkfor, Hawken School, Gates Mills, OH

• Jordan L. Widom, Ransom Everglades, Miami, FL

The AGA Research Foundation also awarded 22 AGA Student Research Fellowship Awards to undergrad, graduate, and medical students looking to further their research careers. These promising students will receive up to $3,000 each to perform research in digestive diseases over a 10-week period.

The Student Research Fellowship Awards program was created by the AGA more than a decade ago to stimulate interest in gastroenterological research careers in high school, college, and medical school students. To date, the program has identified nearly 253 high school, undergraduate, graduate, and medical students to participate in the program. Selected through a rigorous national application process, the students have participated in research at such distinguished institutions as Perelman School of Medicine at the University of Pennsylvania, Philadelphia; University of Maryland School of Medicine, Baltimore; Mayo Clinic, Rochester, MN; Rush University Medical Center, Chicago, IL; and others.

The Eli and Edythe Broad Foundation is a national venture philanthropy established by entrepreneur Eli Broad to advance entrepreneurship for the public good in education, science and the arts. The Broad Foundation invests in scientific and medical research in the areas of human genomics, stem cell research, and inflammatory bowel disease.

Learn more about the AGA Research Foundation or make a contribution at www.gastro.org/aga-foundation.

[email protected]

The AGA Research Foundation has released a video highlighting a seminal colorectal cancer research discovery made possible through a grant from the foundation.

In the video, C. Richard Boland, M.D., AGAF, past president, AGA Institute and chief of gastroenterology services at Baylor University Medical Center at Dallas, shares his very personal story of how this research project into the genetics of colorectal cancer saved his family.

He is joined by Rajeev Jain, MD, AGAF, chair-elect, AGA Institute Practice Management and Economics Committee and partner, Texas Digestive Disease Consultants, Dallas , who reflects on what Dr. Boland’s discovery means to the GI community and how it has improved patient care.

"Research is a critical component to advancing the practice of gastroenterology and improving patient care," said Dr. Boland. "The research highlighted in this video was pivotal not only to my career, but also to my family’s private struggle with cancer. I am honored to share my personal story and reflect on how far our field has come thanks to research funded by the AGA Research Foundation."

To watch the video, visit www.gastro.org/Foundation.

Look forward to learning about more GI research successes in the AGA Research Foundation series, "The Stories Behind the Science," in which researchers and those benefitting from their discoveries tell the stories behind the science that have shaped how we care for patients.

What is the AGA Research Foundation?

The AGA Research Foundation serves the physicians and scientists who research, diagnose, prevent and treat diseases of the gastrointestinal tract and liver and serves the patients who depend on AGA’s members. The foundation awards nearly $1.2 million each year to young researchers in gastroenterology and hepatology. Learn more on our website, www.gastro.org/foundation.

The AGA Research Foundation has released a video highlighting a seminal colorectal cancer research discovery made possible through a grant from the foundation.

In the video, C. Richard Boland, M.D., AGAF, past president, AGA Institute and chief of gastroenterology services at Baylor University Medical Center at Dallas, shares his very personal story of how this research project into the genetics of colorectal cancer saved his family.

He is joined by Rajeev Jain, MD, AGAF, chair-elect, AGA Institute Practice Management and Economics Committee and partner, Texas Digestive Disease Consultants, Dallas , who reflects on what Dr. Boland’s discovery means to the GI community and how it has improved patient care.

"Research is a critical component to advancing the practice of gastroenterology and improving patient care," said Dr. Boland. "The research highlighted in this video was pivotal not only to my career, but also to my family’s private struggle with cancer. I am honored to share my personal story and reflect on how far our field has come thanks to research funded by the AGA Research Foundation."

To watch the video, visit www.gastro.org/Foundation.

Look forward to learning about more GI research successes in the AGA Research Foundation series, "The Stories Behind the Science," in which researchers and those benefitting from their discoveries tell the stories behind the science that have shaped how we care for patients.

What is the AGA Research Foundation?

The AGA Research Foundation serves the physicians and scientists who research, diagnose, prevent and treat diseases of the gastrointestinal tract and liver and serves the patients who depend on AGA’s members. The foundation awards nearly $1.2 million each year to young researchers in gastroenterology and hepatology. Learn more on our website, www.gastro.org/foundation.

The AGA Research Foundation has released a video highlighting a seminal colorectal cancer research discovery made possible through a grant from the foundation.

In the video, C. Richard Boland, M.D., AGAF, past president, AGA Institute and chief of gastroenterology services at Baylor University Medical Center at Dallas, shares his very personal story of how this research project into the genetics of colorectal cancer saved his family.

He is joined by Rajeev Jain, MD, AGAF, chair-elect, AGA Institute Practice Management and Economics Committee and partner, Texas Digestive Disease Consultants, Dallas , who reflects on what Dr. Boland’s discovery means to the GI community and how it has improved patient care.

"Research is a critical component to advancing the practice of gastroenterology and improving patient care," said Dr. Boland. "The research highlighted in this video was pivotal not only to my career, but also to my family’s private struggle with cancer. I am honored to share my personal story and reflect on how far our field has come thanks to research funded by the AGA Research Foundation."

To watch the video, visit www.gastro.org/Foundation.

Look forward to learning about more GI research successes in the AGA Research Foundation series, "The Stories Behind the Science," in which researchers and those benefitting from their discoveries tell the stories behind the science that have shaped how we care for patients.

What is the AGA Research Foundation?

The AGA Research Foundation serves the physicians and scientists who research, diagnose, prevent and treat diseases of the gastrointestinal tract and liver and serves the patients who depend on AGA’s members. The foundation awards nearly $1.2 million each year to young researchers in gastroenterology and hepatology. Learn more on our website, www.gastro.org/foundation.

Imagine my colleague’s surprise when a patient was reluctant to undergo a colonoscopy at our endoscopy center based on a total of three online reviews, which were all negative. Patients are researching their medical conditions, doctors and health-care facilities on the Internet. In 2008, a Wall Street Journal/Harris Interactive study found that most people are interested in participating in and using web-based consumer rating tools to rate their doctors.

Physicians must be cognizant of their online professional reputation. AMA and the American College of Physicians both have position statements related to social media. Both position statements recommend that physicians should periodically assess the accuracy of their personal and professional information available online. Recently, Dr. Kevin Pho published an entire book on this subject: "Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices."

A simple first way to assess your online presence is to Google yourself. In addition, Google has a function known as Google Alerts that are e-mail updates of the latest relevant Google search results based on your query. For example, I have created Google Alerts for my name and practice. Additionally, third-party online reputation management companies provide monitoring services. Unflattering reviews, even if inaccurate, cannot be easily removed because of free speech protections and are difficult to respond to online because of privacy concerns. Therefore, savvy physicians and online reputation management companies use the strategy of search engine optimization. Physicians or reputation management companies encourage patients with positive reviews to post their experiences so that negative reviews will be "pushed down" on search results.

A positive online presence reassures established patients and attracts new patients to your practice. Physicians and medical practices should monitor and manage their online reputation.

Imagine my colleague’s surprise when a patient was reluctant to undergo a colonoscopy at our endoscopy center based on a total of three online reviews, which were all negative. Patients are researching their medical conditions, doctors and health-care facilities on the Internet. In 2008, a Wall Street Journal/Harris Interactive study found that most people are interested in participating in and using web-based consumer rating tools to rate their doctors.

Physicians must be cognizant of their online professional reputation. AMA and the American College of Physicians both have position statements related to social media. Both position statements recommend that physicians should periodically assess the accuracy of their personal and professional information available online. Recently, Dr. Kevin Pho published an entire book on this subject: "Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices."

A simple first way to assess your online presence is to Google yourself. In addition, Google has a function known as Google Alerts that are e-mail updates of the latest relevant Google search results based on your query. For example, I have created Google Alerts for my name and practice. Additionally, third-party online reputation management companies provide monitoring services. Unflattering reviews, even if inaccurate, cannot be easily removed because of free speech protections and are difficult to respond to online because of privacy concerns. Therefore, savvy physicians and online reputation management companies use the strategy of search engine optimization. Physicians or reputation management companies encourage patients with positive reviews to post their experiences so that negative reviews will be "pushed down" on search results.

A positive online presence reassures established patients and attracts new patients to your practice. Physicians and medical practices should monitor and manage their online reputation.

Imagine my colleague’s surprise when a patient was reluctant to undergo a colonoscopy at our endoscopy center based on a total of three online reviews, which were all negative. Patients are researching their medical conditions, doctors and health-care facilities on the Internet. In 2008, a Wall Street Journal/Harris Interactive study found that most people are interested in participating in and using web-based consumer rating tools to rate their doctors.

Physicians must be cognizant of their online professional reputation. AMA and the American College of Physicians both have position statements related to social media. Both position statements recommend that physicians should periodically assess the accuracy of their personal and professional information available online. Recently, Dr. Kevin Pho published an entire book on this subject: "Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices."

A simple first way to assess your online presence is to Google yourself. In addition, Google has a function known as Google Alerts that are e-mail updates of the latest relevant Google search results based on your query. For example, I have created Google Alerts for my name and practice. Additionally, third-party online reputation management companies provide monitoring services. Unflattering reviews, even if inaccurate, cannot be easily removed because of free speech protections and are difficult to respond to online because of privacy concerns. Therefore, savvy physicians and online reputation management companies use the strategy of search engine optimization. Physicians or reputation management companies encourage patients with positive reviews to post their experiences so that negative reviews will be "pushed down" on search results.

A positive online presence reassures established patients and attracts new patients to your practice. Physicians and medical practices should monitor and manage their online reputation.

Electronic health record systems have become an essential component of most medical practices. Whether you are working at a hospital, an ASC or in your office, you’re working in a digital world. This will only expand as health information exchanges and patient portals are implemented. In this digital age, practice comes with significant risk of "cyber attack," which could result in a breach of protected health information (PHI) and the associated penalties. As of December 2012, there were almost 500 breaches of more than 21 million patient records. Since July 2011, physician practices have been the most breached organizational type.

Internal processes to prevent breaches of data are imperative for your practice. Do you have a designated HIPAA security professional? Who in your practice is knowledgeable of cyber security? Do you perform background security checks on prospective employees? Are you using cellphones to transmit PHI to other members of your practice?

Physicians are required to develop and maintain a compliance program in their practice under the Affordable Care Act (ACA). While the federal government has yet to release guidelines on what these compliance programs should look like, Section 6401 of the ACA requires that all providers and suppliers institute formal compliance programs. New practices will no longer be able to enroll in Medicare or Medicaid without a compliance program in place, and existing practices also will be expected to institute them.

Even the most technologically advanced practices can be vulnerable to a cyber-breach. As part of your compliance program, do you have cyber insurance to protect your practice from this liability? The basic components of cyber insurance are detailed in this table. Contact your liability/medical malpractice carriers to see if you are covered.

Electronic health record systems have become an essential component of most medical practices. Whether you are working at a hospital, an ASC or in your office, you’re working in a digital world. This will only expand as health information exchanges and patient portals are implemented. In this digital age, practice comes with significant risk of "cyber attack," which could result in a breach of protected health information (PHI) and the associated penalties. As of December 2012, there were almost 500 breaches of more than 21 million patient records. Since July 2011, physician practices have been the most breached organizational type.

Internal processes to prevent breaches of data are imperative for your practice. Do you have a designated HIPAA security professional? Who in your practice is knowledgeable of cyber security? Do you perform background security checks on prospective employees? Are you using cellphones to transmit PHI to other members of your practice?

Physicians are required to develop and maintain a compliance program in their practice under the Affordable Care Act (ACA). While the federal government has yet to release guidelines on what these compliance programs should look like, Section 6401 of the ACA requires that all providers and suppliers institute formal compliance programs. New practices will no longer be able to enroll in Medicare or Medicaid without a compliance program in place, and existing practices also will be expected to institute them.

Even the most technologically advanced practices can be vulnerable to a cyber-breach. As part of your compliance program, do you have cyber insurance to protect your practice from this liability? The basic components of cyber insurance are detailed in this table. Contact your liability/medical malpractice carriers to see if you are covered.

Electronic health record systems have become an essential component of most medical practices. Whether you are working at a hospital, an ASC or in your office, you’re working in a digital world. This will only expand as health information exchanges and patient portals are implemented. In this digital age, practice comes with significant risk of "cyber attack," which could result in a breach of protected health information (PHI) and the associated penalties. As of December 2012, there were almost 500 breaches of more than 21 million patient records. Since July 2011, physician practices have been the most breached organizational type.

Internal processes to prevent breaches of data are imperative for your practice. Do you have a designated HIPAA security professional? Who in your practice is knowledgeable of cyber security? Do you perform background security checks on prospective employees? Are you using cellphones to transmit PHI to other members of your practice?

Physicians are required to develop and maintain a compliance program in their practice under the Affordable Care Act (ACA). While the federal government has yet to release guidelines on what these compliance programs should look like, Section 6401 of the ACA requires that all providers and suppliers institute formal compliance programs. New practices will no longer be able to enroll in Medicare or Medicaid without a compliance program in place, and existing practices also will be expected to institute them.

Even the most technologically advanced practices can be vulnerable to a cyber-breach. As part of your compliance program, do you have cyber insurance to protect your practice from this liability? The basic components of cyber insurance are detailed in this table. Contact your liability/medical malpractice carriers to see if you are covered.

Continuing the important dialogue regarding the use of fecal microbiota transplants (FMT) to treat recurrent C. difficile infection, your colleague, Colleen Kelly, M.D., published a blog in Huffington Post highlighting this life-saving procedure.

In the blog post, Dr. Kelly, AGA expert spokesperson on FMT and clinical assistant professor of medicine at Women’s Medicine Collaborative, Warren Alpert Medical School of Brown University, discusses her experience providing more than 100 FMTs over the past 5 years.

Dr. Kelly also discusses the regulatory challenges she faced in establishing her ongoing NIH-funded, randomized, placebo-controlled clinical trial of FMT for recurrent C. difficile infections.

Read Dr. Kelly’s blog post to learn more about her experience with FMT, regulatory pushback she has encountered, and her thoughts on FDA involvement at http://ow.ly/mQevL.

[email protected]

Continuing the important dialogue regarding the use of fecal microbiota transplants (FMT) to treat recurrent C. difficile infection, your colleague, Colleen Kelly, M.D., published a blog in Huffington Post highlighting this life-saving procedure.

In the blog post, Dr. Kelly, AGA expert spokesperson on FMT and clinical assistant professor of medicine at Women’s Medicine Collaborative, Warren Alpert Medical School of Brown University, discusses her experience providing more than 100 FMTs over the past 5 years.

Dr. Kelly also discusses the regulatory challenges she faced in establishing her ongoing NIH-funded, randomized, placebo-controlled clinical trial of FMT for recurrent C. difficile infections.

Read Dr. Kelly’s blog post to learn more about her experience with FMT, regulatory pushback she has encountered, and her thoughts on FDA involvement at http://ow.ly/mQevL.

[email protected]

Continuing the important dialogue regarding the use of fecal microbiota transplants (FMT) to treat recurrent C. difficile infection, your colleague, Colleen Kelly, M.D., published a blog in Huffington Post highlighting this life-saving procedure.

In the blog post, Dr. Kelly, AGA expert spokesperson on FMT and clinical assistant professor of medicine at Women’s Medicine Collaborative, Warren Alpert Medical School of Brown University, discusses her experience providing more than 100 FMTs over the past 5 years.

Dr. Kelly also discusses the regulatory challenges she faced in establishing her ongoing NIH-funded, randomized, placebo-controlled clinical trial of FMT for recurrent C. difficile infections.

Read Dr. Kelly’s blog post to learn more about her experience with FMT, regulatory pushback she has encountered, and her thoughts on FDA involvement at http://ow.ly/mQevL.

[email protected]

CHICAGO – Coding and computers were among key concerns for physician leaders at the American Medical Association’s annual House of Delegates meeting.

Resolutions from several delegations aimed to delay or scuttle the transition to the newest incarnation of the International Classification of Diseases, ICD-10.

Delegates from the American College of Rheumatology (ACR) introduced a resolution urging the association to keep up its campaign to stop ICD-10 implementation, specifically via federal legislation.

Without a statement supporting delay, there is a "perception out there that the AMA has essentially caved on the issue of ICD-10," said ACR delegate Dr. Gary Bryant . "Now that’s not my perception, but I believe it’s the perception, to some degree, among American physicians."

Alicia Ault/IMNG Medical Media

The House adopted instead a resolution calling for the AMA to support federal legislation to delay ICD-10 implementation for 2 years. During that time, payers would not be allowed to deny payment based on the specificity of the diagnosis, but they would be required to provide feedback in the case of an incorrect diagnosis. The resolution was brought by the Colorado delegation.

Dr. Reid Blackwelder, president-elect of the American Academy of Family Physicians, spoke in favor of the resolution.

"It’s not likely that we’re moving from ICD-9, we are." Instead, the resolution "allows our members to have a period of time to get used to the sticker shock," he said.

Another issue is that "ICD-10 initially came into use in 1994 and was never designed to be computer-savvy. ICD-11 is due in 2015, and will be designed to be easily coded by computer software," said Dr. Peter Kaufman, the AGA’s delegate to AMA. "If we go to ICD-10 in 2014, or even 2016, when will we be able to go to the newer, more appropriate 11th Revision?"

The AMA has estimated that the cost of implementing ICD-10 could range from $83,290 to more than $2.7 million per practice, depending on practice size.

Delegates cited major problems with electronic health record interoperability, and some also sought to slow the adoption of electronic health records.

Karthik Sarmah medical student alternate delegate in the California delegation, cited interoperability as a major concern.

"The lack of interoperability is the primary driver of why so many people in this room hate their EHR system," he said, adding that interoperability standards exist, but that there are no incentives for venders to create ways to allow physicians to share their patient data with each other.

Dr. Melissa Garretson, a delegate from the American Academy of Pediatrics, agreed.

"I can’t tell you the number of times I have to repeat labs," and CT scans because data can’t be accessed from other physicians, Dr. Garretson said. She called the lack of interoperability an unfunded mandate on physicians because the vendors aren’t making it possible. "If we force them to do this through legislation, it will finally happen."

Kaufman testified \"there are strong interoperability standards already out there. They may only cover limited amounts of data but they work between programs well. The problem is that while they were required when EHRs were certified by CCHIT, with the advent of Meaningful Use, that requirement to use the same specific standard was no longer mandatory.\" Kaufman went on to state that the standards committees were woefully short of practicing physicians, and called for doctors to join the process to the standards could be completed and be workable for clinicians.

Other delegates were skeptical.

"I have been waiting now for about 12 years for this interoperability to occur and I think I’ll either be retired or dead before it finally does," said Dr. Arthur E. Palamara, a vascular surgeon with the Florida delegation.

The House approved a resolution "seeking legislation or regulation to require all EHR vendors to utilize standard and interoperable software technology to enable cost efficient use of electronic health records across all health care delivery systems including institutional and community based settings of care delivery."

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On Twitter @aliciaault

CHICAGO – Coding and computers were among key concerns for physician leaders at the American Medical Association’s annual House of Delegates meeting.

Resolutions from several delegations aimed to delay or scuttle the transition to the newest incarnation of the International Classification of Diseases, ICD-10.

Delegates from the American College of Rheumatology (ACR) introduced a resolution urging the association to keep up its campaign to stop ICD-10 implementation, specifically via federal legislation.

Without a statement supporting delay, there is a "perception out there that the AMA has essentially caved on the issue of ICD-10," said ACR delegate Dr. Gary Bryant . "Now that’s not my perception, but I believe it’s the perception, to some degree, among American physicians."

Alicia Ault/IMNG Medical Media

The House adopted instead a resolution calling for the AMA to support federal legislation to delay ICD-10 implementation for 2 years. During that time, payers would not be allowed to deny payment based on the specificity of the diagnosis, but they would be required to provide feedback in the case of an incorrect diagnosis. The resolution was brought by the Colorado delegation.

Dr. Reid Blackwelder, president-elect of the American Academy of Family Physicians, spoke in favor of the resolution.

"It’s not likely that we’re moving from ICD-9, we are." Instead, the resolution "allows our members to have a period of time to get used to the sticker shock," he said.

Another issue is that "ICD-10 initially came into use in 1994 and was never designed to be computer-savvy. ICD-11 is due in 2015, and will be designed to be easily coded by computer software," said Dr. Peter Kaufman, the AGA’s delegate to AMA. "If we go to ICD-10 in 2014, or even 2016, when will we be able to go to the newer, more appropriate 11th Revision?"

The AMA has estimated that the cost of implementing ICD-10 could range from $83,290 to more than $2.7 million per practice, depending on practice size.

Delegates cited major problems with electronic health record interoperability, and some also sought to slow the adoption of electronic health records.

Karthik Sarmah medical student alternate delegate in the California delegation, cited interoperability as a major concern.

"The lack of interoperability is the primary driver of why so many people in this room hate their EHR system," he said, adding that interoperability standards exist, but that there are no incentives for venders to create ways to allow physicians to share their patient data with each other.

Dr. Melissa Garretson, a delegate from the American Academy of Pediatrics, agreed.

"I can’t tell you the number of times I have to repeat labs," and CT scans because data can’t be accessed from other physicians, Dr. Garretson said. She called the lack of interoperability an unfunded mandate on physicians because the vendors aren’t making it possible. "If we force them to do this through legislation, it will finally happen."

Kaufman testified \"there are strong interoperability standards already out there. They may only cover limited amounts of data but they work between programs well. The problem is that while they were required when EHRs were certified by CCHIT, with the advent of Meaningful Use, that requirement to use the same specific standard was no longer mandatory.\" Kaufman went on to state that the standards committees were woefully short of practicing physicians, and called for doctors to join the process to the standards could be completed and be workable for clinicians.

Other delegates were skeptical.

"I have been waiting now for about 12 years for this interoperability to occur and I think I’ll either be retired or dead before it finally does," said Dr. Arthur E. Palamara, a vascular surgeon with the Florida delegation.

The House approved a resolution "seeking legislation or regulation to require all EHR vendors to utilize standard and interoperable software technology to enable cost efficient use of electronic health records across all health care delivery systems including institutional and community based settings of care delivery."

[email protected]

On Twitter @aliciaault

CHICAGO – Coding and computers were among key concerns for physician leaders at the American Medical Association’s annual House of Delegates meeting.

Resolutions from several delegations aimed to delay or scuttle the transition to the newest incarnation of the International Classification of Diseases, ICD-10.

Delegates from the American College of Rheumatology (ACR) introduced a resolution urging the association to keep up its campaign to stop ICD-10 implementation, specifically via federal legislation.

Without a statement supporting delay, there is a "perception out there that the AMA has essentially caved on the issue of ICD-10," said ACR delegate Dr. Gary Bryant . "Now that’s not my perception, but I believe it’s the perception, to some degree, among American physicians."

Alicia Ault/IMNG Medical Media

The House adopted instead a resolution calling for the AMA to support federal legislation to delay ICD-10 implementation for 2 years. During that time, payers would not be allowed to deny payment based on the specificity of the diagnosis, but they would be required to provide feedback in the case of an incorrect diagnosis. The resolution was brought by the Colorado delegation.

Dr. Reid Blackwelder, president-elect of the American Academy of Family Physicians, spoke in favor of the resolution.

"It’s not likely that we’re moving from ICD-9, we are." Instead, the resolution "allows our members to have a period of time to get used to the sticker shock," he said.

Another issue is that "ICD-10 initially came into use in 1994 and was never designed to be computer-savvy. ICD-11 is due in 2015, and will be designed to be easily coded by computer software," said Dr. Peter Kaufman, the AGA’s delegate to AMA. "If we go to ICD-10 in 2014, or even 2016, when will we be able to go to the newer, more appropriate 11th Revision?"

The AMA has estimated that the cost of implementing ICD-10 could range from $83,290 to more than $2.7 million per practice, depending on practice size.

Delegates cited major problems with electronic health record interoperability, and some also sought to slow the adoption of electronic health records.

Karthik Sarmah medical student alternate delegate in the California delegation, cited interoperability as a major concern.

"The lack of interoperability is the primary driver of why so many people in this room hate their EHR system," he said, adding that interoperability standards exist, but that there are no incentives for venders to create ways to allow physicians to share their patient data with each other.

Dr. Melissa Garretson, a delegate from the American Academy of Pediatrics, agreed.

"I can’t tell you the number of times I have to repeat labs," and CT scans because data can’t be accessed from other physicians, Dr. Garretson said. She called the lack of interoperability an unfunded mandate on physicians because the vendors aren’t making it possible. "If we force them to do this through legislation, it will finally happen."

Kaufman testified \"there are strong interoperability standards already out there. They may only cover limited amounts of data but they work between programs well. The problem is that while they were required when EHRs were certified by CCHIT, with the advent of Meaningful Use, that requirement to use the same specific standard was no longer mandatory.\" Kaufman went on to state that the standards committees were woefully short of practicing physicians, and called for doctors to join the process to the standards could be completed and be workable for clinicians.

Other delegates were skeptical.

"I have been waiting now for about 12 years for this interoperability to occur and I think I’ll either be retired or dead before it finally does," said Dr. Arthur E. Palamara, a vascular surgeon with the Florida delegation.

The House approved a resolution "seeking legislation or regulation to require all EHR vendors to utilize standard and interoperable software technology to enable cost efficient use of electronic health records across all health care delivery systems including institutional and community based settings of care delivery."

[email protected]

On Twitter @aliciaault