Role of the AGA Practice Councillor and current priorities: AGA sits down with John Garrett

We were thrilled to have you join our governing board last year as practice councillor – what led you to this role?

When asked by a close colleague why I would consider applying for an AGA clinical councillor position, I stated that there was no better way to give back to AGA than to volunteer time and talent as an AGA board member. While gifts to the AGA Legacy Society are always welcome, our talented members have many ways to give. Given my interests, applying for consideration as an AGA practice councillor was a great opportunity to learn more from other experts while sharing what I love to do.

Tell us more about your background and interests in the delivery of GI care.

As a physician in private practice, I served as president of my mid-sized group (18-20 MDs) in Asheville, North Carolina and became more involved with AGA, working for several terms on the practice management and economics committee, advocacy and government affairs, as well as on the nominating committee. Our group received the first Certificate of Need (CON) for endoscopy in North Carolina, and I coordinated the building of our center and served as medical director of our endoscopy center for 15 years prior to serving as president of the organization. I became involved in hospital board work and now serve as vice chair of our seven-hospital system board as well as chair of the Board Quality, Credentials and Physician Affairs committees. I also have an interest in population health and still sit on the initial governing board for the largest accountable care organization (ACO) in North Carolina.

What is involved in the role of practice councillor?

The AGA Governing Board has 12 members, six councillors in addition to the AGA president, president-elect, vice president, past president, foundation chair and secretary/treasurer. Practice councillors are clinicians from either private practice or an employed physician model. With the support of our exemplary staff, all AGA board members are responsible for advancing the AGA Strategic Plan by oversight of the vision, mission and policy of the organization. Typical decisions requiring board approval include: changes to the strategic plan, resource allocation, advocacy agenda, policy and bylaws, position statements and governance issues. AGA practice councillors are elected to three-year terms, and often serve as board liaisons for Practice Management and Economics Committee, Quality Measures Committee, Research and Innovation, and Government Affairs. AGA councillors are also asked to “get outside their comfort zone” and actively participate in all discussions. For example, practice councillors are encouraged to learn about research initiatives and grant processes while basic scientists are urged to participate in clinical issues. However, scientists are generally not offended if clinicians own MACRA/MIPS! In general, board meetings and teleconferences are lively strategic discussions. It’s always a delight to problem solve with smart people working towards common goals. In summary, the position of AGA practice councillor has been a new challenge for me, but one filled with good times and new friends, all while working to advance our field. What could be better?

AGA has been committed to helping members participate in the Quality Payment Program. Why?

AGA provides resources to aid member participation in the Medicare Quality Payment Program (QPP) to help members maximize rewards and avoid payment penalties. Although participation in the QPP is not required, it is necessary to avoid payment penalties in future years. In 2018, the penalty for opting out of the QPP is a Medicare payment cut of five percent in 2020. Moreover, in every subsequent year, the penalty for opting out increases by 2 percent until the maximum penalty amount (9 percent) is reached. Although payment penalties provide a strong incentive for gastroenterologists and other physicians and clinicians to participate in the QPP, participation may also yield rewards through higher Medicare payments. AGA strives to help members not only survive, but thrive under the QPP.

What does AGA offer to help members participate in the QPP?

AGA helps members survive and thrive under the QPP in many ways. There are two program tracks under the QPP – (1) the Merit-based Incentive Payment System (MIPS) and (2) the Advanced Alternative Payment Models (APMs). Education materials and resources teach members about the QPP and MIPS and provide practical information and advice on how to participate in MIPS. Materials include infographics, webinars, video resources and print material.

AGA also helps members participate in the QPP by engaging in legislative and regulatory activities that shape QPP implementation. Most recently, AGA in conjunction with all of organized medicine, succeeded in advocating for legislative changes to the QPP to:

1. Exclude Medicare Part B drug payments (e.g., payments for Remicade and other infused biologic products) from MIPS payment adjustments.

2. Eliminate requirements for electronic health record (EHR) meaningful use standards to become more stringent.

3. Allow the Centers for Medicare & Medicaid Services (CMS) more time to fully implement the program, including flexibility in how the cost performance category and performance threshold affect MIPS scoring and performance.

AGA, and our member representatives, also engage directly with CMS to ensure that gastroenterology has appropriate quality and cost measures and improvement activities. And although there are no gastroenterology-specific APMs available, AGA also works to ensure policies related to APMs support the future development of such models.

5. Why is it a priority for AGA to create specific GI measures?

AGA has had a long history in creating quality measures for gastroenterology for the Medicare quality reporting programs and for private payors. AGA recognizes that gastroenterologists should be the ones determining how our members should be measured and are in the best position to identify the gaps in care in our specialty and what areas could be improved. If AGA does not define what makes a quality gastroenterologist, the government or payors will define what those measures should be and that would not serve our community. By creating ways to measure quality via measures, AGA defines that path on behalf of the GI community.

Dr. Garrett has no conflicts to disclose. Dr. Garrett serves on the AGA Institute Governing Board as a practice councillor.

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