Fall/Winter 2017 Rumblings

Page 1

Fall/Winter 2017

www.pasg.org

PSG

INSIDE

President’s Message

Pennsylvania Society of Gastroenterology

President’s Message

By Richard E. Moses, DO, JD

Legislative Update

Our Pennsylvania Society of Gastroenterology was founded by the sole initiative of a highly respected clinician, teacher, and Director of Gastroenterology at the then Albert Einstein Hospital in Philadelphia, Edwin Cohn, M.D. in 1980. His efforts culminated after meeting with gastroenterologists throughout Pennsylvania to serve their educational needs, improve the level of care of gastrointestinal disorders, and to advocate for patients and gastroenterologists on socioeconomic issues throughout the state. He served as the first president of the society from 1981 to 1983 and established annual rotating venue meetings offering outstanding presentations on timely topics. Please refer to the PSG website: www.pasg.org, where this history was borrowed, for further information. I am humbled and honored to assume the role as the 19th President of the PSG. I am grateful to our outgoing President, Ralph McKibbin, M.D., for the effort he put into his two-year tenure leading the PSG in advocating for our Pennsylvania gastroenterologists and fellows-intraining, in addition to invigorating the PSG. He has pledged a continued commitment as the Immediate Past

2017 Annual Meeting

President to ensure we continue to thrive and grow as an organization.

PAMED Specialty Leadership Cabinet Update

The September Scientific Meeting at the Nemacolin Woodlands Resort was a major success. Vinay Chandrasekhara, M.D., the program director, did a stellar job developing innovative GI topics presented by top-notch speakers despite his decision to take a new position at the Mayo Clinic in Rochester. We wish Dr. Chandrasekhara all the best with his new academic position and will surely miss his input both educationally and at the Board level.

ACG Governor’s Upate

The change in format from the Saturday evening gathering to an earlier family friendly format was fabulous and another win for our younger members with children in tow! The informal buffet style dinner in an early evening time slot geared towards full family attendance was a major homerun. I personally enjoyed seeing the kids running around fascinated by the animal presentations by the expert Nemacolin Zoo staff. The Conference research poster competition by the fellows-in-training was again impressive as well. Everyone enjoyed the GI Jeopardy tournament. I congratulate our Poster Competition winners: Dr. Amir Rezk (Geisinger) – 1st Place, Dr. Amir Gougol (LVHN) – 2nd Place, and Dr. Kyle Kreitman (LVHN) – continued on page 13

PSG Fellow-in-Training Interview PA Dept. of State Transitioning to New Online Licensure System PRESIDENT Richard E. Moses, DO, JD Phila Gastroenterology Consultants, Ltd 700 Cottman Avenue, Suite 201, Building B Philadelphia, PA 19111-3062 remoses@mosesmedlaw.com PRESIDENT-ELECT Ravi K. Ghanta, MD Digestive Disease Associates, Ltd 1011 Reed Avenue, Suite 300 Wyomissing, PA 19610-2002 rghanta@hotmail.com SECRETARY David L. Diehl, MD 801 Mount Zion Drive Danville, PA 17821-8613 dldiehl@geisinger.edu TREASURER Karen Krok, MD 425 Elm Avenue Hershey, PA 17033-1752 kkrok@pennstatehershey.psu.edu ADMINISTRATIVE OFFICE ASSOCIATION EXECUTIVE Robbi-Ann M. Cook 777 East Park Drive, P.O. Box 8820 Harrisburg, PA 17105-8820 (717) 909-2688 rcook@pamedsoc.org RUMBLINGS EDITOR Ravi K. Ghanta, MD rghanta@hotmail.com


2 Hail and FarewellNemacolin Woodlands Resort Annual Meeting By: Ralph D. McKibbin, MD, FACP, FACG, AGAF Immediate Past President The 2017 Annual Scientific Meeting was held September 8-10 at the Nemacolin Woodlands Resort in western Pennsylvania. The meeting was a great success. The beautiful surroundings and fine weather were a wonderful setting for the annual event and allowed our “off time” to be well spent enjoying the facilities and time with family and friends. The success of meetings like this are the result of advanced preparation and a lot of teamwork.

Pa. Dept. of State Transitioning to New Online Licensure System The Pennsylvania Department of State’s (DOS) Bureau of Professional and Occupational Affairs (BPOA) is transitioning to a new online licensing system. This new system, called the Pennsylvania Licensing System (PALS), will replace MyLicense, the state’s current online licensing system. The State Board of Osteopathic Medicine has already implemented PALS. Applications for unrestricted Osteopathic physicians and surgeons are now available only on the PALS system. The State Board of Medicine is currently transitioning from MyLicense to PALS. However, there is no timetable for when the Board of Medicine will be online with the PALS system.

I first want to thank Dr. Vinay Chandrasekhara for arranging a top-notch scientific program. He did a great job of arranging meaningful updates for each of the speaker sessions. Pennsylvania is blessed to have so many talented faculty upon which to draw. Dr. Chandrasekhara’s efforts were particularly notable as he simultaneously arranged a career change and immediately after the meeting he and his family moved to the Mayo Clinic in Minnesota to advance the next phase of his career. We all wish him the best of luck in the future. Thanks also to each of the speakers for taking the time to share their updates with us. The fellows’ poster competition highlighted the research efforts of the fellows in training across the state. Many fine posters were offered making the competition tight. Three posters were awarded prizes. The winners were: 1st place: Dr. Amir Rezk from Geisinger 2nd place: Dr. Amir Gougol from Lehigh Valley Health Network 3rd place: Dr. Kyle Kreitman from Lehigh Valley Health Network

continued on page 12

What can I expect from PALS? BPOA hopes that PALS will make the online application and renewal process more user-friendly by: streamlining operations, improving processing times, eliminating (to the extent possible) the use of paper records, accepting digital uploads of most documentation, maintaining security and privacy safeguards, and standardizing the collection and maintenance of licensing records and reports. In addition to online application and renewal, the PALS site (available at www.pals.pa.gov) provides access to various other licensing services. Specific features of PALS include: • Online Application Submission and Monitoring Process: Applicants and licensees can submit and check the status of their applications online. The PALS system will also enable the emailing of application discrepancy notices. Once the system is fully implemented, discrepancy notices will no longer be mailed. continued on page 10


3 Legislative Update By Richard E. Moses, DO, JD President, PSG Legislative Committee The PSG, in cooperation with the PAMED and other State Societies, continues to track Health Care Bill Legislation introduced into the Pennsylvania Congress. The PSG has made access to select bills available to members through a portal on the PSG website: www.pasg.org. This list of bills is periodically updated. Since our last update, Pennsylvania Congress has not introduced many Health Care related bills. As I am sure you are aware, budget negotiations on a revenue package to fund the previously enacted 2017-2018 spending plan fell apart. Although the Senate, Governor, and House could not agree, the negotiations consumed much of their attention since we last reported in the Summer RUMBLINGS. Some bills we are watching have moved forward in Committee(s). We will touch on some of the major bills of interest to date. From the healthcare standpoint, the past few months have not been as active as earlier this year. Attention continues to be focused on the opioid crisis. SB 25: An Act amending the act of May 22, 1951 (P.L.317, No.69), known as The Professional Nursing Law, further providing for definitions for the State Board of Nursing, for dietitian-nutritionist license required, for temporary practice permit, for graduates of schools of other states, territories or Dominion of Canada, for certified registered nurse practitioners, for scope of practice for certified registered nurse practitioners, for prescriptive authority for certified registered nurse practitioners, for Drug Review Committee and for professional liability; and providing for the expiration of the State Board of Nursing’s power to license certified registered nurse practitioners. Recall the bill affords Certified Registered Nurse Practitioners independent practice. The bill passed through Committee with a vote of 40-10. The bill went to the Professional Licensure Committee and has not moved since our last report. SB 895: Amending the act of December 20, 1985 (P.L.457, No.112), entitled “An act relating to the right to practice medicine and surgery and the right to practice medically

related acts; reestablishing the State Board of Medical Education and Licensure as the State Board of Medicine and providing for its composition, powers and duties; providing for the issuance of licenses and certificates and the suspension and revocation of licenses and certificates; provided penalties; and making repeals,” further providing for the State Board of Medicine and for Physician Assistants. HB 45: Providing for the use of investigational drugs, biological products and devices by terminally ill patients. On October 13, 2017, this bill was signed into law by Governor Wolf. This is also known as the Right to Try Law. MEGAN L. SHINAL AND ROBERT J. SHINAL, HER HUSBAND, Appellants v. STEVEN A. TOMS, M.D., Appellee. 162 A. 3d 429 (Pa. 2017) On June 20, 2017, in a decision regarding the Medical Care Availability and Reduction of Error (Mcare) Act’s informed consent requirement, the Pennsylvania Supreme Court has ruled that a physician may not delegate to others his or her obligation to provide sufficient information in order to obtain informed consent—the duty to obtain a patient’s informed consent is a non-delegable duty owed by the physician conducting the surgery or treatment. Reversing the trial court and Superior Court’s judgment in favor of the defendant surgeon, the Supreme Court has remanded the case for a new trial.

Welcome New Members (6/21/17-10/31/2017) Active Nina Ahuja, MD Randall Elliot Brand, MD Nadim Mahmud, MD


4 PAMED Specialty Leadership Cabinet Update

ACG Governor’s Update

By Karen Krok, MD and Manish Thapar, MD The PAMED SLC met on Tuesday, August 15. A brief overview of items that were discussed include: • State legislation is deadlock due to the continued work on resolving the budget issue. • Out-of-Network/Surprise Billing update was provided. The multi-specialty collaborative is hoping to meet with key legislators in the upcoming months to discuss the issue of lack of transparency and inadequate networks. • Right-to-Try legislation is currently stalled, again due to the budget negotiations. PSOH expressed concerns about possible uncontrolled use which may lead to further delays in getting adequate medications approved from FDA. • IBC Modifier 25 Policy Change went into effect on August 1. PAMED is still working to negotiate meetings with IBC and potentially the Insurance Commissioner. • Prior Authorization Initiative – PAMED is continuing to work toward educating legislators and the public on the problems surrounding prior authorization. A media campaign is in place using Thunderclap. • Joint Underwriters Association – Governor Wolf and the state legislature is attempting to move $200 million from the Joint Underwriters’ Association (JUA) to offset the revenue shortfall in the budget. PAMED is actively involved in this issue. • Informed Consent changes require the physician performing the procedure to be the individual to explain the procedure to the patient and obtain consent. A resident or other party cannot obtain consent from the patient. PAMED is determining how to address this issue. The Regulatory Update included the following: • Achieving Better Care by Monitoring All Prescriptions Programs (PDMP) – No change from May 2017. Statistical information on the success is being compiled. • Immunization regulations went into effect August 1, 2017.

continued from page 14

Last month the American College of Gastroenterology had a successful joint international meeting with the World Congress of Gastroenterology in Orlando, Florida. During this meeting, the ACG met with representatives of GI State Societies. The meeting was quite successful and the ACG is trying to assist state societies by providing support to highlight issues important to the states at a national level and a guideline on its website on “How to Set-up a State Society.” Our Pennsylvania Society was well represented at this meeting by Drs. Moses and McKibbin as well as our ACG Governors Drs. Reynolds and Brand. At a national level, the ACG continues to focus on major issues that affect gastroenterologists including board recertification efforts, MACRA/Quality Payment Program and MIPS. For those of you who were unable to attend the annual meeting, the ACG will be offering the 2018 Board of Governor/ASGE Best Practices Course and IBD School in Las Vegas, NV from January 26 – 28. 2018 IBD School and BOG/ASGE Best Practices Agenda. Lastly, please do not hesitate to contact either Dr. Reynolds (Eastern Governor) or Dr. Brand (Western Governor) if you wish to serve on an ACG committee or advance to fellowship.


5

Setting Innovation in Motion We’re driven to improve people’s lives. Takeda strives toward better health for people worldwide through leading innovation in medicine. At Takeda, we make a commitment to make a difference. Takeda Pharmaceuticals U.S.A., Inc.

www.takeda.us

Now Enrolling for ELAD Clinical Trial Assessing Survival in Subjects Diagnosed with Acute Alcoholic Hepatitis ®

VTL-308 Study Overview and Enrollment Sites: www.AAHStudy.com VTL-308: A Phase 3, Randomized, Open-Label, Multicenter, Controlled, Pivotal Study to Assess Safety and Efficacy of ELAD® in Subjects with Alcohol-Induced Liver Decompensation (AILD)

The primary objective of the study is to evaluate safety and efficacy of ELAD® with respect to overall survival (OS) of subjects with a clinical diagnosis of alcohol-induced liver decompensation (AILD) through at least Study Day 91. Key Eligibility Criteria*:

• Age 18 to <50 • Bilirubin ≥16 mg/dL (273.6 μmol/L) • INR ≤2.5

• Serum Creatinine <1.3 mg/dL (115.04 μmol/L) • MELD score <30

• Maddrey score ≥32 • Association (6 weeks or less) of alcohol use and hospital admission for this episode of AILD

*Although subjects may meet the criteria above, they may not qualify for VTL-308. Please visit www.clinicaltrials.gov for full inclusion/exclusion criteria and for more information about participation.

For more information, please contact Brian Dempster or Michael Stephens at clinicaltrials@vitaltherapies.com or at 858-673-6840 ELAD is an investigational extracorporeal, human cell-based liver treatment, and is designed to improve survival of subjects with liver failure by providing hepatic support continuously for up to five days. Sponsor: Vital Therapies, Inc.

For more information please visit www.aahstudy.com or www.clinicaltrials.gov. NCT#02612428.

The ELAD System has not been demonstrated to be safe or effective for any indication and is not available for sale in the United States or any other country. CAUTION: Investigational Product. Limited by United States law to investigational use. Copyright ©2008-2017 Vital Therapies, Inc. All rights reserved. AD-000002-0117 v05

(858) 673-6840 | www.vitaltherapies.com


6 The Benefits of Your PSG Membership Annual Meeting • Free to members. The non-member meeting physician registration fee is $175 and $100 for physicians’ assistants and nurses. (Pending members who have a completed application on file are entitled to free registration.) • The 2018 Annual Meeting will be held September 14-16 at The Hotel Hershey in Hershey, PA. • The PSG Annual Scientific Meeting provides an excellent opportunity to earn CME credits.

Interaction with Other State and National Medical Societies • PSG is a member of the Digestive Disease National Coalition and is represented at their meetings. • PSG maintains a regular dialogue with the AGA, ACG, and ASGE on national issues that impact Pennsylvania gastroenterologists. • PSG has a seat on the PA Medical Society (PAMED) Specialty Leadership Cabinet and a vote at their House of Delegates. Together, PSG and PAMED advocate for gastrointestinal issues on a state level. • The two PA regional governors for ACG are now members of the PSG Board and we will closely collaborate with them on matters of common interest

Representation by GI Fellows In Training

• Four FITs sit on the PSG Board. • PSG hosts a FIT poster competition at the annual meeting. Those who submit a poster and attend the meeting receive generous stipends.

Reimbursement and Health Care Issues

• PSG routinely corresponds with carriers to convey gastroenterology concerns and clarify questions. • PSG sends a gastroenterology representative to the PA Medicare Carrier Advisory Committee.

PSG Website The PSG Website (www.pasg.org) has many features that benefit our physician members and their patients. Website features include: • membership information – online join/renew opportunities; • meeting information; • legislative and payor relations updates; • fellows in training details; and • electronic copies of the PSG newsletter, Rumblings.

Rumblings Newsletter • • • •

Contains reimbursement news and updates Alerts members of pending issues and problems relative to gastroenterology Informs members of state and federal legislative issues affecting Pennsylvania gastroenterologists Provides helpful information for GI fellows and new practitioners

If you received this issue of Rumblings as a non-member, PSG invites you to consider membership benefits such as free registration for the PSG Annual Scientific Meeting, representation in physician advocacy activities, and opportunities for dialogue with other GI professionals across Pennsylvania. To learn more about the Society, visit www.pasg.org.

Join us today! A membership application is enclosed in the following pages.

CLICK HERE TO APPLY ONLINE


7


8


9 Nadim Mahmud, MD PSG Fellow-in-Training Hospital of the University of Pennsylvania Q: What made you want to go into the field of medicine? A: My first exposure came from my dad who is a Radiologist at Geisenger. Throughout my childhood, I was always observing whenever I went to visit the hospital. I became very curious about the medical field at such a young age so growing up I never went into this profession blindly. I enjoy the environment of a hospital, helping people in need and knowing that I am making a difference in someone’s life is very rewarding. Going into the medical field, however, is such a huge commitment so when I was making this decision, at the age of 18, I thought very carefully on how I would approach this and what would be my next steps to move forward. Medicine is so vast and interesting so it just seemed like a good fit. Q: What led you to pursue gastroenterology as a specialty? A: Gastroenterology wasn’t something I thought about until the end of my first year of residency. It wasn’t until then I was introduced to Emily Bethea (my senior resident), that I started to feel more passionate about this field. She really opened some doors to thinking about what it would be like to work as a Gastroenterologist and her thirst for knowledge and expertise really just sucked me in. I also came to find that I really liked being around other Gastro residents and doctors. The culture was so relaxed, they were all good humored and seemed very involved in their jobs. I have always enjoyed working with the research side of medicine and I found that Gastroenterology not only worked with procedural work but clinical thinking as well. Q: Can you tell me about where your training is taking place and when it will be completed? A: My fellowship will be done in June 2019 but if I choose to do a Hepatology Transplant fellowship that will bring me to 2020. As of right now I am thinking and starting to apply locally. Q: If you were to choose one doctor who was influential in your life that helped guide you to where you are today, who would that be?

A: I would have to say my dad because he was my first window to medicine. He played a big part in why I went into medicine in the first place. But as I mentioned before Emily Bethea helped me seek specifically what field of medicine I wanted to be in which I am forever grateful for. Q: Why do you think it is important for physicians to be active members of their specialty society? A: I think it’s important for physicians to be active members of their specialty society because it keeps our patients aware in the long run. At least for me thinking about physician engagement and my experience practicing medicine, we are surrounded with many elements not really designed with physicians in mind. There are laws that impact everyone differently and it should be our job to be able to tell our patients why you may have to pay for this and not that as an example. Being engaged broadly allows you to understand what issues are impacting our specialty and to go out and have a voice on the subject. Not just with the government but with corporations and industries as well. We won’t be able to counsel our patients if we do not know what is going on first hand. You really are doing a disservice to your patients if you don’t know what is going on yourself. Q: What prompted you to submit your name for consideration for one of the FIT board positions with PSG? A: I wanted to be more involved and present in the conversations that Gastro doctors were having and I found that being a part of the FIT board it was a perfect time to do so. Everyone’s perspective is so different and that was not something I had great exposure to at the time but being in these meetings, such as the Annual board meeting in Nemacolin, it became a very intimate setting where everyone was able to speak their minds on certain topics and other important issues. Q: Being on the PSG Board, what do you hope to bring to the table that would help other FITs and emerging physicians? A: I hope that I can bring new and exciting knowledge about Gastroenterology to other fellows in training. I’ve been trying to find ways to get FIT’s more involved, how to increase membership attendance at conferences and policy level issues. Things like social media would definitely broaden the interaction from other FIT’s and I think it is important for us to push Twitter and Facebook as a communication tool and not just to catch up on E! News, etc. I truly believe that if we show that this organization is active more interest will arise.


10 Why get involved in PSG? A FITs perspective. Nadim Mahmud, MD Hospital of the University of Pennsylvania As a second-year GI trainee at the Hospital of the University of Pennsylvania, I was fortunate to join the PSG board as a fellow-in-training (FIT) representative this year. At our recent board meeting held prior to the annual scientific conference at Nemacolin resort, one of the identified priorities was to increase fellow engagement and involvement in PSG activities. To that end, I wanted to share my perspective on what PSG offers for FITs like myself. First, PSG provides access to a network of GI practitioners throughout the state. This includes MDs, DOs, advanced practice providers, and nurses, and spans the spectrum from academic institutions to private practice to mixed models in between. For those of us who have been siloed in either highly academic or highly clinical programs, it is invaluable to interact with other providers along the spectrum, as practice concerns vary widely depending on the clinical setting. Second, the intimate nature of PSG allows for realworld networking opportunities. Anecdotally, I made far more connections—and meaningful ones—at the annual scientific conference as compared to large national conferences, where the scale and anonymity may be paradoxically limiting. Third, PSG fosters a sense of community among fellows. For example, the annual scientific meeting brings together fellows through a poster competition and the fellow jeopardy tournament. There were more than 30 poster submissions this year, and all presenters receive a generous stipend in order to attend the conference as well! Finally, through the PSG, a FIT can obtain leadership development opportunities and become engaged in policy issues that affect GI practice. This occurs at both the state and national level, as PSG maintains active dialogue with national GI societies (i.e. AGA, ACG, ASGE) and holds a seat on the PA Medical Society Specialty Leadership Cabinet. I can personally attest to the benefits of PSG, and I hope to meet you at our next scientific conference!

Pa. Dept. of State Transitioning continued from page 2

• Request Documentation of License Verification: Verification/certification of licenses can be requested. Upon completion of the online request form and fee payment, the Board will electronically send the requested document and a secure link to the designated recipient. • Self-Reporting of Disciplinary Actions: Licensees can self-report their arrest, criminal conviction, or disciplinary action in another jurisdiction via a Mandatory Reporting application. • Complaint Filing: A new link to file complaints online. Complaints previously could be filed online via Board websites. • Online License verification: The PALS Online License verification service allows the public to search and verify BPOA-regulated licensees, facilities, providers, and disciplinary actions. • Mcare Report Filing: Physicians can file Mcare Reports, to report medical liability lawsuits. Attorneys, facilities, and other authorized parties may also report on behalf of physicians.

Where Can I Find More Information? Additional information on the PALS system can be found here. The Pennsylvania Medical Society (PAMED) will continue to monitor the implementation of the PALS system and share updates with PAMED members. PAMED has numerous resources on licensure requirements and renewal. A FAQ by PAMED on renewing your medical license can be accessed here. A PAMED member exclusive module on how to maintain your medical license in Pennsylvania can be accessed here. For more information on licensure requirements in Pennsylvania, visit PAMED’s Legal Resource Center at www.pamedsoc.org/LegalResourceCenter. PAMED’s Legal Resource Center provides quality, timely legal advocacy and resources for member physicians who practice in Pennsylvania.

2018 Medicare Physician Fee Schedule Is Final – Here’s What Physicians Should Know The Centers for Medicare and Medicaid Services (CMS) finalized the 2018 Medicare Physician Fee Schedule on Nov.


11 2, 2017. The 2018 Medicare PFS will take effect on Jan. 1, 2018. As expected, physicians and physician practices expecting negative Value-based Payment Modifier (VBPM) payment adjustments in 2018 for quality performance in 2016 would see reduced penalties – or, in certain cases, no VBPM penalties at all – under the 2018 Medicare PFS. CMS recently launched a “Patients Over Paperwork” initiative to reduce administrative burden and enable physicians to spend more time with patients. It says its new Medicare PFS was created with the goals of this initiative in mind. Noteworthy provisions in the 2018 Medicare PFS include: 1. Revised Value-based Payment Modifier (VBPM) Payment Adjustments—CMS is making these changes to previously finalized policies for the 2018 VBPM: • Reducing the automatic downward payment adjustment for not meeting the criteria to avoid the PQRS adjustment from negative four percent to negative two percent for groups of ten or more clinicians; and from negative two percent to negative one percent for physician and non-physician solo practitioners and groups of two to nine clinicians. • Holding all groups and solo practitioners who met 2016 Physician Quality Reporting System (PQRS) criteria harmless from any negative VBPM payment adjustments in 2018. • Aligning the maximum upward adjustment amount to two times the adjustment factor for all physician groups and solo practitioners. 2. Revised Physician Quality Reporting System (PQRS) quality reporting requirements for 2016 performance—To better align with the new Merit-based Incentive Payment System (MIPS), CMS is making PQRS revisions for 2016 performance, including: • Reducing the PQRS reporting requirement of 9 measures across 3 National Quality Strategy domains to only require reporting of 6, with no domain or cross-cutting measure requirement. CMS is also making similar changes to the clinical quality measure reporting requirements under the Medicare Electronic Health Record Incentive Program for eligible professionals who reported electronically through the PQRS portal.

3. Diabetes Prevention Program—The Medicare Diabetes Prevention Program (MDPP) is an expanded, structured intervention with the goal of preventing progression from pre-diabetes to type 2 diabetes for at risk individuals. The Medicare PFS establishes a payment structure for the model in the final rule, CMS has limited ongoing maintenance from the proposed two years to one year. This changes the payment structure and reduces the maximum performance based payment from $810.00 to $670.00. Get more details on the MDPP model here. PAMED has collaborated with the American Medical Association in conjunction with the National Association of Chronic Disease Directors (NACDD) to promote and educate PA physicians on the National Diabetes Prevention Program (NDPP). This initiative focuses on screen, test and referral (STR) of patients with and those who are at risk for pre-diabetes to CDC-recognized lifestyle change programs and the PreventDiabetesSTAT.org website. 4. Appropriate use criteria for advanced diagnostic imaging—CMS’ Appropriate Use Criteria Program was originally set to begin in 2019. Now, per the 2018 Medicare PFS, educational and operations testing will start in January 2020. This delay will enable physicians an extended time for establishing with a qualified clinical decision support mechanism as well as voluntary reporting (July 2018-December 2019). Claims for advanced diagnostic imaging will be paid during the voluntary and educational and operations period regardless of whether they correctly contain information on the required AUC consultation. To incentivize an early adoption, clinicians can attest and earn credit under the MIPS as an improvement activity in 2018. 5. Payment Update—The 2018 PFS conversion factor is $35.99, an increase to the 2017 PFS conversion factor of $35.89. 6. Patient relationship codes—Level II Healthcare Common Procedural Coding System (HCPCS) codes can be reported by clinicians on a voluntary basis, starting Jan. 1, 2018. This is an opportunity for physicians and practices to become familiar with the proper use of these modifiers. 7. Payment rates for non-excepted off-campus providerbased hospital departments (PBDs)—CMS has finalized a 20 percent reduction of these rates, changing PFS payment rates for these services from 50 percent of the Hospital continued on page 14


12 thoroughness. We have been working with a special task force to develop new communication and social media strategies for the PSG. Jennifer Redmond has done a great job developing our strategies but will be stepping down. She will be replaced by Chelsea Dimmig, who I know is ready and willing to take us to the next level. I look forward to the coming changes. I want to also acknowledge that their continuous attention to the business of the society during my whole term as President of the society was an important factor in allowing me to focus my attention on the advocacy agenda needed to represent gastroenterology practitioners in Pennsylvania. Thank you for everything and I am sure that the transition for the new officers will be seamless.

Hail and Farewell continued from page 2

Thanks to the winners for their time and energy. The fellows in training represent the future of our field and it is good to see the high level of enthusiasm. The annual GI Jeopardy tournament was well attended. The competitive nature of physicians is fun to watch and the “old guard” can quietly test their fund of knowledge. This year’s winning team was Dr. Dhruvan Patel of Drexel/Hahnemann, Dr. Eric Nellis of Lehigh Valley Health Network and Dr. Joshua Weston of Geisinger. Secondly, I want to personally thank the administrative staff of the PSG for their logistical expertise in arranging the facilities, activities and support for the meeting. Jessica Winger, Meeting Manager deserves a round of applause. If you have ever arranged a meeting or even a large party, you will appreciate the invisible “ballet” of happenings that she makes look so effortless. Next, I want to recognize the thoroughness of the year-round administrative support headed up by Robbi Cook, Executive Director. The PSG staff team has organized the behind-thescenes business and governance meetings with great care and

Lastly, as I step down as President of the society, I know that Dr. Moses, the incoming President, and the officers and Board of Directors of the Pennsylvania Society of Gastroenterology are well prepared and ready to continue the mission of the society. In the words of Victor Hugo, “The future has several names. For the weak, it is impossible. For the fainthearted, it is unknown. For the thoughtful and valiant, it is ideal.” I know we are in good hands.

We Invest in Your Success Discover how PE partners with GI physicians to positively impact single-specialty ASC’s bottom line. Increase reimbursement, lower cost, share personal risk, gain short-term and long-term success.

To learn more, contact Physicians Endoscopy (866) 240-9496 I info@endocenters.com I www.endocenters.com


13 President’s Message continued from page 1

3rd Place. Finally, I must also commend our GI Jeopardy Competition team winners: 1st Place – Dr. Dhruvan Patel (Drexel/Hahnemann), Dr. Eric Nellis (LVHN), Dr. Joshua Weston (Geisinger), and 2nd Place – Dr. Maria Bergenstock (Geisinger), Dr. Sunny Patel (Geisinger), Dr. Amir Rezk (Geisinger). Our 2018 Annual Scientific Meeting will be held at the Hershey Hotel. It will prove to be another academically rewarding and family friendly event. Neilanjan Nandi, M.D. from the Drexel University College of Medicine will be the program director and has already set the planning into motion. Most importantly, I want to personally thank our PSG professional staff who put in countless hours and make themselves readily available to the PSG leadership, frequently manipulating their schedules around our clinical schedules to make sure the job gets done on deadline. These behind the scene experts are Robbi Cook, our Executive Director, Jessica Winger, the PSG meeting planner, and Jill Bennish, our Member Services Specialist. We all appreciate their dedication. I also recognize the work of Jennifer Redmond, our outgoing Assistant Executive Director, who started the work on revamping the PSG website and directed the launch of our new social media presence. We congratulate her on her promotion, wishing her the best of luck and success, although we will miss her enthusiasm and expertise. We are fortunate however, to welcome Chelsea Dimmig into Jenn’s position. Chelsea brings a wealth of knowledge in the management and utilization of social media for organizations in particular. I am looking forward to working with Robbi and Chelsea to move our web and social media presence to the next level. We welcome and recognize our new FIT Board members, Dr. Nadim Mahmud (University of Pennsylvania) and Seyedehsan Navabi (Penn State). They are joining are current FITs, Dr. C. Andrew Kristler (Jefferson) and Dr. Akash Gadani (WPAHS). I am looking forward to their input and expertise. We all realize that the practice of Medicine in general, and the practice of Gastroenterology and Hepatology in particular, is changing. Private practice Gastroenterology is being threatened by hospital systems, government and third party regulations, decreasing reimbursements with

increasing practice overhead despite the important services we provide, and the interest of venture capitalists who want to own physicians. The PSG needs to continue to evolve and change with the times. Given the above, I ask myself, what do we need to accomplish to continue and further meet the needs of our membership and thrive as an organization? I have a number of goals to move us, the PSG, forward. We are in the process of reorganizing our Committee and Regional chairs. Our vision statement and bylaws need to be refreshed. The PSG must have a strong presence on social media to members and potential members to show what we are doing for our membership, and importantly, connect with our younger current and potential members. Advanced Practice Providers are more important than ever in working with Gastroenterologists in caring for patients. We need to connect and collaborate with these well-trained professionals to achieve the common goal of providing the best care achievable in Pennsylvania. We also cannot ignore our GI techs and office managers. Membership needs to be increased. The PSG needs more of a presence throughout the state beyond our excellent annual scientific meeting. I am confident that the next 2 years will welcome many changes and advancement for the PSG. I am both honored and excited to work with the highly professional PSG support staff and leadership team who give hours of donated time to make the PSG great. We all owe a debt of gratitude to Dr. Cohn, our first president, and all of the members of the PSG who have helped to shape our organization. Now, we need to follow their example and continue to advance forward in these changing times.


14 Pa. Dept. of State Transitioning

PAMED Specialty Leadership Cabinet Update

continued from page 11

continued from page 4

Outpatient Prospective Payment System (OPPS) payment rate to 40 percent of the OPPS rate. This affects outpatient departments that were not billing under the OPPS prior to November 2, 2015, that are not located within 250 yards of hospital provider’s main campus or remote location.

• Medical Marijuana Regulations – Update from May 2017. On June 25, 2016, the Department of Health issued temporary regulations regarding the safe harbor provision contained in the medical marijuana law. The safe harbor provision authorizes parents, legal guardians, caregivers, or spouses of a minor to bring medical marijuana from another state into the Commonwealth without violating the law. • Health Care Worker ID Badge Regulations – No change from May 2017. On June 1, 2015, the remaining provisions of the Photo Identification Tag legislation went into effect, even though the remainder of the law related to titles and their precise placement on the badge did not go into effect. • Hospital Regulations – PAMED has participated in an internal workgroup developed by the Department of Health to revise the Department’s hospital regulations. Major area of concern for PAMED includes medical staff revisions to include practitioners other than physicians and dentists. • Laser Regulations – No change from May 2017. State Board of Medicine plans to issue proposed regulations to clarify the requirements for the use and delegation of the use of medical lasers. The proposed rule will bring the Board’s regulations in line with other states. • Child Abuse Reporting Requirements – No change from May 2017 • Anesthesia Regulations – No change from May 2017 • Compounding regulations – Update from May 2017 • Public Health Dental Hygiene Practitioners – trying to define where they may practice (i.e. nursing homes, care facilities). The next SLC meeting will be held on February 6, 2018.

8. Codes for Telehealth—CMS is eliminating the required reporting of telehealth modifier GT and finalizing separate payment for CPT code 99091, for certain remote patient monitoring. In addition, these new codes have been added: • HCPCS code G0296—For visit to determine low dose computed tomography (LDCT) eligibility • CPT code 90785—For Interactive Complexity • CPT codes 96160 and 96161—For Health Risk Assessment • HCPCS code G0506—For Care Planning for Chronic Care Management • CPT codes 90839 and 90840—For Psychotherapy for Crisis 9. Payment for Office-Based Behavioral Health Services— The final rule will increase payment for these services by recognizing overhead expenses for office-based face-to-face services with a patient. 10. Payment for Tests on the Clinical Laboratory Fee Schedule (CLFS)—CMS says that the payment amount for a test on the CLFS furnished on or after January 1, 2018, generally will be equal to the weighted median of private payer rates determined for the test, based on the data of applicable laboratories. 11. Payment for Biosimilars Under Medicare Part B—CMS will separately code and pay for biological biosimilar products under Medicare Part B. Effective January 1, 2018 newly approved biosimilar biological products with a common reference product will no longer be grouped into the same billing code. Additional Resources For more details on the 2018 Medicare PFS, access CMS’ Fact Sheet online here. A complete copy of the 1,250-page rule is available here. Pennsylvania Medical Society members with questions can also contact our Knowledge Center at 855-PAMED4U (855726-3348) or KnowledgeCenter@pamedsoc.org. Please Log in to comment/rate on this article.


15 PSG’s Staff is Here to Serve Our Members! PSG continues to contract staffing services with the Specialty Society Management Services Division of the Pennsylvania Medical Society. Staff, working from their Harrisburg-based office, are available to answer members’ questions about membership benefits, meeting updates, and assist with our members’ needs.

Leading the PSG staff and working directly with the Executive Committee, Executive Director Robbi Cook has been with PSG since January 2015. She has extensive experience in association management and corporate business. Robbi holds a BS (summa cum laude) in business administration and a Paralegal certification from Penn State University. Prior to joining PSG, Robbi was CEO of a construction association. Contact Information: Email: rcook@pamedsoc.org

Chelsea Dimmig joined the PSG staff as the assistant executive director in August of 2017. Chelsea will focus on communications and marketing for PSG, including social media, website development and the PSG newsletter. Chelsea holds a BA in Journalism and Marketing from Penn State University and has extensive experience in marketing and brand recognition. Contact Information: Email: cdimmig@pamedsoc.org

Meeting Manager, Jessica Winger, has served PSG meeting needs for 10 years and has been with the PA Medical Society for 18 years. Jessica plans educational and social events, negotiating contracts, coordinating exhibitor/ sponsorships and obtaining CME. Jessica loves spending time with her daughter, Lucy, volunteering at her school, going to the gym, and traveling. Contact Information: Email: jwinger@pamedsoc.org

Rounding out the PSG team is Member Service Specialist Jill Bennish. Jill joined the PSG team in August 2017 and previously worked for the County Commissioners Association of Pennsylvania for 15 years. Jill’s administrative support background and experience in association management makes her a great addition to our team. Contact Information: Email: jbennish@pamedsoc.org


PSG

PRSRT STD U.S. POSTAGE PAID HARRISBURG PA PERMIT NO. 922

777 East Park Drive PO Box 8820 Harrisburg, PA 17105-8820

Annual Scientific Meeting 2018