Inside the AGA Practice Management and Economics Committee

Imagine that most of us involved in the practice of clinical gastroenterology feel like an unsought quest has been thrust upon us. In the history of health care in America, there has never been as great an alteration in the practice of medicine as the shift that is taking place beneath our feet.

The paradigm of health care is being transformed from a fee-for-service model into one in which value will be defined by patient satisfaction, outcomes and cost. In many journeys, the protagonist does not choose the voyage, it chooses them. All great quests involve uncertainty and risk. Opportunity and progress are the motivators to persevere; they are also the rewards.


The charge of AGA’s Practice Management and Economics Committee, in concert with the AGA Institute Roadmap Task Force, is to provide clinicians with a survival kit to succeed in navigating health-care reform.


In the face of these seismic changes, the charge of AGA’s Practice Management and Economics Committee, in concert with the AGA Institute Roadmap Task Force, is to provide clinicians with a survival kit to succeed in navigating health-care reform. The tools that we have developed and will continue to develop fall into three categories: tools to expand the scope of GI practices, tools to help deliver high-value patient care and tools to help us maximize our revenue.

Opportunities for GI practices to expand are being developed in non-procedural service lines. Our current focus is on the epidemic of obesity, which represents one of modern health care’s greatest challenges. Comprehensive care of the obese patient is an area well suited for gastroenterology. Not only are many common GI conditions a consequence of obesity, but also the integral relationship of diet to digestive diseases has historically linked nutrition to gastroenterology.

Two endoscopically placed bariatric devices have been approved in the past several months, and more will undoubtedly follow. These will be potentially important interventions to augment obesity treatment. In order to be the providers of these new technologies and incorporate them into GI practice, comprehensive weight management programs are required to support both patient safety and device efficacy. Our committee, as part of a larger AGA initiative, is developing a multidisciplinary user’s guide on how to safely and effectively implement these new advances of endoscopic bariatric therapy into practice. AGA has taken a collaborative approach in this multi-disciplinary space, and this initiative will be a multi-society effort in conjunction with our colleagues in SAGES, the Obesity Society and NASPGHAN. Another tool our committee created to help practices move forward is the Benchmark Database project. GI practices that participate in the AGA Benchmark survey will be able to compare themselves with other groups both regionally and nationally. In addition to basic practice characteristics of size, composition and affiliation, data will be available on reimbursement patterns, Medicare participation, services offered and quality reporting. This resource will be incorporated into a dynamic, easily searchable tool that will allow GI practices to evaluate themselves alongside their peers in order to be informed of current practice trends.

Communication is a vital part of providing high quality patient care and achieving successful outcomes. We are developing a tool for specialist-to-specialist communication for the management of anti-coagulation at the time of endoscopy. This will be endorsed by both AGA and the American Heart Association. We are also considering similar provider-to-provider communication tools for the management of diabetes and for recommending health-maintenance care for patients with chronic IBD and liver disease. Lastly, we are developing an infographic and video to help patients understand what constitutes a high-value colonoscopy, available on the AGA website.

As reimbursement transitions to value-based care, alternative payment models that allow us to be rewarded for demonstrating high quality, efficiency gains and effective care coordination are needed. The AGA Roadmap Oversight and Practice Management groups have developed tools to navigate this transition. In the AGA Roadmap Toolbox, a timeline to value-based care serves as a guide for key transitions ahead. A bundled framework for colonoscopy was published for implementation and supported by an AGA colonoscopy bundled payment discussion forum on LinkedIn. Currently, a GERD bundle framework is awaiting publication. Notably, behind the scenes, the coverage and reimbursement subcommittee of our committee has been instrumental in advocating for the value of our clinical work. They tirelessly lobby and proactively support the evolution of fair and thoughtful payor policies related to all aspects of GI practice.

In order for tools to be useful, they need to be rapidly accessible, flexible and well designed. Going forward, a new focus will be placed on the impact of the Medicare Access and CHIP Reauthorization Act of 2015, and on the needs of the growing number of employed physicians, young gastroenterologists and, importantly, the patients that we care for. The AGA Practice Management and Economics Committee is excited to develop tools that will help AGA members survive and thrive as we navigate the rapidly changing health-care environment.

Dr. Streett is a member of the Crohn’s and Colitis Medical Advisory Board of Northern California.

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