Rumblings Summer Edition 2018

Summer 2018

www.pasg.org

PSG

INSIDE

President’s Message

PSG Has Been Active On All Fronts Richard E. Moses, DO, JD PSG President Summer is here! I am approaching the end of my first term as your President. We have accomplished a lot but there is much to be done. With the help of our great staff, I continue to maintain an open dialogue with PSG members and nonmembers to highlight issues affecting the gastroenterology arena. The President eMessages have gotten positive feedback. We appreciate your phone calls and e-mails. This open line of communication keeps us on top of what our membership needs.

Restructuring Officer” to help determine how to maintain fiscal solvency so it might continue its mission as a safety net for indigent patients.

Since my Spring President’s Message, the healthcare arena has been active as usual in Pennsylvania and nationally.

The proposed healthcare venture between Amazon, Berkshire Hathaway, and JPMorgan is moving forward. Atul Gawande, MD, MPH, from Harvard has been tapped to be the CEO. We can “chat” offline if you are not aware of his writings and position on physicians and healthcare delivery. Locally, there have been more mergers and affiliations between major health systems and smaller institutions around the state.

BRANDING, BRANDING, BRANDING! One of our major teaching hospital systems in Philadelphia hired a “Chief

Your PSG Board met on Saturday, May 12th. We discussed a number of GI practice issues, and Dr. Nandi updated us on his excellent academic agenda for our September Scientific meeting. We also “brainstormed” some family events for the meeting weekend. In addition, recommendations were made regarding the PSG website by our FITs under the leadership of Dr. Navabi. Changes were implemented immediately thanks to Brian Raybin, our IT guru.

As I have mentioned in previous messages, we need your support and involvement in the PSG efforts to regain control of our profession nationally and in Pennsylvania. We are in the process of developing a plan to meet with members throughout Pennsylvania to let you know we are in the trenches advocating on your behalf and that joining the PSG strengthens our presence. We are exploring acceptable funding options with some of our corporate sponsors and others to help accomplish this goal.

On May 31st, I had the honor of addressing the attendees of the Delaware Valley Society for Gastrointestinal continued on page 14

MCAC Update DDNC Update Task Force Recommendations Legislative Update FIT Update Licensure Renewal JUA Update Annual Meeting Recruitment Campaign PRESIDENT Richard E. Moses, DO, JD Phila.Gastroenterology Consultants, Ltd. 700 Cottman Ave., Suite 201 Philadelphia, PA 19111-3062 remoses@mosesmedlaw.com PRESIDENT-ELECT Ravi Ghanta, MD Digestive Disease Associates, Ltd. 1011 Reed Ave., 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 Manish Thapar, MD Manish.Thapar@jefferson.edu

2 Medicare Contractor Advisory Committee Update F. Wilson Jackson, MD The CAC met in Baltimore on June 13. Patrick Hamilton from CMS provided an update on the new Medicare cards being distributed to members over the next few months. Members covered through the Railroad Retirement Board will also be receiving new cards after June 1. Members should begin using the new Medicare cards upon receipt, however, healthcare providers and suppliers can use either the former Society Security based HICN or the new alpha-numeric Medicare Beneficiary Identifier through December 31, 2019.

The Medicare Administrative Contractor (MAC) secure portal Medicare Beneficiary Identifier (MBI) look-up tools is ready for use. If you do not have access, sign up for your MAC’s portal to use the tools. New membership cards are being mailed in phases. Pennsylvania members were included in the Wave I mailing.

If you submitted 2017 MIPS data through the Quality Payment Program website, you can review your final scores and feedback after July 1 through the QPP website. Access to preliminary and final feedback can be obtained using the same Enterprise Identify Management (EIDM) credentials used to submit and view your data during the submission period. For additional information and to create an EIDM account, review the Quality Payment Program.

Those participating in a MIPS Alternative Payment Model (APM) in 2017 for Medicare Shared Savings Program or Next Generation Accountable Care Organization (ACOs) can view your preliminary MIPS feedback via the Quality Payment Program website. Under this program, preliminary performance feedback is based on the APM Entity score and applicable to all MIPS eligible clinicians within the APM Entity group. Next Generation ACOs will need to request feedback from a representative within their APM Entity. Feedback and scores do not have an impact on the Shared Savings Program or Next Generation ACOs’ quality assessment.

If you have questions on your performance feedback, contact the Quality Payment Program or call 1-866-288-8292.

CMS has re-named the MIPS Advancing Care Information performance category to Promoting Interoperability performance category. The new name better reflects the focus of CMS on promoting interoperability and sharing of health care data between providers and patients.

The Meaningful Use program has also been re-named Promoting Interoperability. Providers are reminded to use the 2015 Edition of certified electronic health record technology in 2019 as part of demonstrating meaningful use to qualify for incentive payments and avoid reductions to Medicare payments.

CMS is initiating an Annual Call for Measures process to allow stakeholders to be involved in the focus on and ongoing evolution of Medicare Promoting Interoperability (PI) Program measures. If submitted proposals are finalized, measure implementation would be required beginning with calendar year 2021 but would be optional in 2020.

The process reinforces CMS’ commitment to engaging stakeholders to further advance meaningful use of certified electronic health record technology (CEHRT) by Medicare eligible hospitals and critical access hospitals (CASHs) participating in the Medicare PI Program. For additional information, visit the Medicare PI Program Annual Call for Measures Fact Sheet.

Two draft LCDs were discussed during the June meeting.

DL37796 deals with sclerotherapy and endovernous nonthermal treatment of varicose veins and DL37792 related to 4Kscore testing. Tasha Bishop from Provider Outreach and Education provided updates on the MBI implementation and the Targeted Probe and Educate (TPE) program.

Ms. Bishop also presented Novitas initiatives, including Novitasphere and educational symposiums and provided information on how to join the electronic mailing lists.

The updated JL Comprehensive Error Rate Testing (CERT) Final Report for November 2017 was provided for claims sampled between July 2015 and June 2016.

The next CAC meeting will be held October 17 in Newark, DE.

3 Digestive Disease National Coalition Update Ralph D. McKibbin, MD, FACP, FACG, AGAF PSG Representative and DDNC President The Digestive Disease National Coalition (DDNC) continues to represent the interests of the gastroenterology community in Washington, DC. As the PSG representative, I voice the concerns of Pennsylvania’s providers to both the constituent members of the organization and our elected Federal legislators.

The DDNC also has a voice with federal agencies and meets with FDA, CMS, and HHS agencies on important issues.

The DDNC has adopted a consensus priority agenda which pushes for equal access to care, preservation of benefits for those with chronic diseases, and continued NIH research as an investment aimed to improve the understanding and care of gastrointestinal diseases. Election years often change congressional and agency action plans. Here is a mid-summer update.

Washington Update Legislators returned to Washington following the July 4th recess with a busy agenda. The Senate was gearing up for hearings and a confirmation process for Brett Kavanaugh, recently nominated by President Trump to fill the Supreme Court vacancy of Judge Anthony Kennedy. Battle lines were being drawn on social policy issues, including health care access. The House of Representatives continued to grind through appropriations bills and other timely issues.

Budget and Appropriations The push to make progress on the Fiscal Year 2019 appropriations bills continues. Conferees have been appointed for the 3-bill minibus appropriations package for VA, Energy & Water, and Legislative Branch. The House Appropriations Committee held a marathon mark-up of the FY 2019 Labor-HHS Appropriations bill and adopted 18 of 49 amendments. Most of the adopted amendments were not funding-related and were more focused on separation of families and immigration policy (which is handled in part by the Department of Health and Human Services).

View the US House of Representatives Committee on Appropriations press release.

HEALTH RE FORM

Health Reform • The Centers for Medicare and Medicaid Services announced recently it would suspend risk adjustment payments to health insurers. The payments are intended to help stabilize health insurance markets by compensating insurers that covered sicker, more expensive enrollees. Patient-based organizations weighed in on the topic, raising concerns that the move “undermines the ability of people with pre-existing health conditions to enroll in affordable, comprehensive insurance coverage.”

• The Department of Health & Human Services announced it is severely reducing funding for patient navigator organizations – grassroots groups that help Americans access health insurance coverage offered through the Affordable Care Act (ACA). For the ACA enrollment period starting in November, the funding will be reduced to $10 million from the previous year’s funding level of $36.8 million. An article by Kaiser Health News on the ACA can be read here.

• Many patient-based organizations are preparing comments or preparing to sign on to comments related to the HHS – released Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs. Most patient organizations are highlighting patient access issues rather than focusing on the intricacies of drug prices.

The Federal Register Notice can be read here. continued on page 15

4 2018 ACG Board of Governors Medication and Utilization Task Force Recommendations James C. Reynolds, MD, FACG ACG Governor for Eastern Pennsylvania I wanted to update you on recent developments from the ACG Board of Governors and ACG leadership.

As part of its recent meeting, the ACG Board of Trustees approved a set of position statements recommended by the ACG Governors earlier this year: • The ACG Board of Governors endorses the notion that patients who are stable on an existing biologic may be best treated by remaining on that agent. Patients should not be switched to a different biologic without first informing the treating physician and the patient and giving them a chance to confer, consent to, or disagree with, this action.

• The ACG Board of Governors endorses the notion that patients who are stable on an existing biologic not be switched to a biosimilar for that biologic (or vice-versa) without first informing the treating physician and the patient and giving them a chance to confer, consent to, or disagree with, this action.

• The ACG Board of Governors endorses the notion that all health care providers who administer Propofol should have specialized training in the safe delivery of sedation.

• Propofol is now widely accepted, used, and often preferred for endoscopic procedures and the ACG should continue to promote policies that oppose restrictive payment models by insurance providers (for both medications and procedures).

• Governors are encouraged to contact ACG public policy staff as soon as they become aware of regional or state-wide insurance coverage issues, so that the College, often in coordination with the state medical association and/or the state GI society (if one exists) can mount an effective response.

These recommendations came from the 2017 ACG Board of Governors Medication and Utilization Task Force, chaired

by Douglas G. Adler, MD, FACG.

The Task Force was charged with the following objectives: •

• •

Define and send out a survey to all U.S. ACG Governors regarding biosimilars, Propofol, and insurance denials of medications, radiology testing, etc.

Review and interpret the survey results.

Generate recommendations and next steps for consideration, by the ACG Board of Governors, relevant ACG Committees, and other appropriate ACG groups.

The Task Force presented its draft recommendations to the Board of Governors in early 2018 and incorporated the feedback and edits from the Governors at-large. The ACG Board of Trustees then approved these position statements of the College. I hope these statements help clarify where the College stands on important clinical issues impacting our practices and patients.

I encourage you to reach out to the College or me with any regional or state-wide insurance coverage issues, or other questions.

The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology.

Governors are ACG Fellows elected from the membership of a state or region. There are currently 77 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps the College make certain it is meeting the evolving needs of the membership.

5

PSG Membership Recruitment Campaign Underway for 2018-2019

Become a Member and Enjoy the Benefits PSG

Not a member of PSG? Do you find value in the content of the Rumblings newsletter, the monthly eMessages from President, Richard E. Moses, DO, JD, or the email updates on what is happening in the GI community? Have you attended the PSG Annual Scientific Meeting in the past and found value in the speakers and topics and the opportunity to network with your colleagues and peers?

Now is the time to become a member!! New members joining PSG will pay 2019 membership rates and receive the balance of 2018 for FREE. As a bonus, you will be able to register for the September 14 – 16 Annual Scientific Meeting as a member and your registration fee is waived!

Take advantage of this opportunity to join and become part of the PSG family. We are the PSG, your organization and your professional family. We look forward to welcoming you and working with you.

JOIN US ‌ See following pages for benefits and membership application.

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 4-16 at the Hotel Hershey in Hershey, PA. • The annual 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 actively voices concerns affecting gastroenterology and patient care to the PA legislature and insurers.

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

Become a Member and Enjoy the Benefits

• Contains reimbursement news and updates • Alerts members of pending issues and problems relative to gastroenterology • Informs members of state and federal legislative issues effecting 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.

9 Legislative Update F. Wilson Jackson, MD The General Assembly has recessed for the summer with a budget completed before the June 30 deadline. The Senate and House will return in midSeptember for a limited number of session days as they gear up for the November election.

Governor Wolf signed the 2018 – 2019 budget June 22 marking the first time in four years Pennsylvania has had a budget completed on time!

The $32.7 billion spending plan is the first budget Governor Wolf has signed since taking office in 2015. Previous budgets were passed without his signature due to his objections to what it contained or how it was financed.

The budget does not include the proposed 3% tax on net revenue from ambulatory surgical or endoscopy centers.

Your voices were heard loud and clear on this proposed tax and the communications with our legislative body were successful in killing the proposed tax. The budget does include a 34% increase of $75 million in an assessment on hospitals. Understandably, the Hospital Association of Pennsylvania opposed this component of the budget.

Prior Authorization A call to action from PAMED to physicians across the state took place in April, with follow-up emails to the House Insurance Committee Members urging them to address prior authorization. HB 1293 was introduced by Rep. Marguerite Quinn (R-Bucks) in May 2017 and is supported by more than 50 patient and medical advocacy groups.

Informed Consent A ruling in June 2017 stipulates a physician cannot delegate his/her duty to obtain a patient’s informed consent prior to conducting a procedure. PAMED’s legal and government relations team continue working with HAP to draft legislation aimed to address concerns with the informed consent ruling. A co-sponsorship memo has been drafted and is under review by Speaker Turzai.

Team-Based Care & Scope of Practice SB 25 was passed in the Senate in April 2017 and currently is awaiting consideration in the House Professional Licensure Committee (HB 100). Both bills would grant independent practice to CRNPs. PAMED strongly opposes any legislation that interferes with the physician as the leader of the healthcare team. The PAMED government relations team continues to educate legislators in the House Professional Licensure Committee and the public regarding concerns with this legislation.

Telemedicine SB 780 and HB 1648 would establish a statutory definition for telemedicine, mandate reimbursement for telemedicine services and prohibit “audio only” services (video must be available if requested by the patient or physician). SB 780 recently was approved unanimously in the Senate. We will update members as the legislation moves through the House.

Opioid Crisis Twenty-five pieces of legislation have been introduced ranging from PDMP requirements to prescription limitations. One bill, SB 655, would mandate physicians follow guidelines such as the current voluntary guidelines when prescribing opioids. The legislation could potentially saddle physicians with a “no win” decision whereby they would be required to follow the mandated guidelines knowing it may not be the best course of treatment for their patient or break the law in the interest of appropriate care for their patient. SB 655 unfortunately passed the Senate unanimously and will move to the House for deliberation.

We will keep PSG members updated on this issue.

Drug Formularies Insurers, under current law, are not required to provide practitioners with drug alternatives when a drug prescribed is denied due to not being included in the patient’s drug formulary. This creates a burden on the practitioner and their staff to expend time and resources to determine an appropriate treatment that would be covered under the patient’s insurance coverage. PAMED is working to address this issue to make the process more transparent. We will keep PSG membership updated if potential legislation is introduced to reform the drug formulary process.

10 FIT Update Seyedehsan Navabi, MD The Pennsylvania Society of Gastroenterology (PSG) focuses on engagement of academia and over the past few years has provided opportunities to achieve this goal. Involving the second and third year Fellows-in-Training (FITs) as board members is one of the opportunities I find meaningful.

Four FITs sit on the PSG board and are actively involved in board decisions. The FITs participate in the promotion of PSG’s value to many gastroenterology training programs in Pennsylvania. PSG’s current President, Dr. Richard E. Moses, has evolved the role and responsibilities of the FITs to provide additional leadership opportunities. FIT members participate in quarterly meetings with Dr. Moses and these meetings have been very productive. For FIT members, it provides a unique opportunity to improve their leadership role and experience real life aspects of the GI practice. Within the last year, FIT members have been more engaged in promoting PSG through social media outreach within the GI community, participated in the re-branding of the PSG website and having a presence on social media

including Facebook and Twitter. PSG is working to increase engagement of our members and provide a resource for our patients.

For the first time, FIT members have an opportunity to participate in the academic presentation at the PSG annual meeting. PSG values the involvement of future gastroenterologists. FIT board members are also working in collaboration with Dr. Neil Nandi, Program Chair, on coordinating the September 15th annual GI jeopardy competition.

One important role for the FIT board members is to serve as a bridge between the PSG and the academic institutions.

We are active representatives promoting the values of the Society among our fellows, residents, the attending physicians, and other members of the GI care team in our institutions. We have been successful in recruiting new members for PSG and hope they will remain members for many years to come. This year FIT board members played an important role introducing the benefits of PSG membership to our counterparts and residents resulting in an increased involvement of many new residents and fellows submitting for the PSG annual meeting’s academic poster presentation competition.

Active involvement of FIT board members and PSG’s commitment to GI trainees, especially under new leadership, has resulted in an increase in value for the GI specialty. Serving as a FIT board member is not only a great experience but has also been a great opportunity to promote our GI society among future gastroenterologists who will likely remain in practice in PA. Serving as a FIT on the board provides us the opportunity to be a resource and offer networking opportunities for fellows and residents to find opportunities for their future career among GI practices in Pennsylvania.

Stay tuned for more great news from FIT corner.

11 2018 is a Licensure T ’ N DO GET! FOR

Renewal Year

To qualify to renew your license, all physicians must meet the following requirements: • A total of 100 credit hours of CME is required for each two-year license cycle. o A minimum of 20 credit hours must be in Category 1 o 12 credit hours must be in the areas of patient safety or risk management (Category 1 or Category 2) o 2 credits must be from a Department of Human Services (DHS) approved course on the topic of mandated child abuse recognition and reporting (for a list of approved providers visit the PA Department of State website. o NEW 2 credit hours of education in pain management, identification of addiction, or the practices of prescribing of opioids.

All physicians, dentists and advanced practice practitioners who prescribe and dispense controlled substances are required to complete at least two hours of education in pain management, identification of addiction or safe opioid prescribing.

• 2 hours of education may be in either Category 1 or Category 2.

• Must be taken after January 1, 2017 (education prior to January 1, 2017 will not be considered).

• The requirement is not a one-time requirement. This will be required in each future licensure period for license renewal.

• There are no mandated courses but the title of the course on the documentation/certificate must be clear that the content addressed Board-required subject matter.

If you are a member of Pennsylvania Medical Society (PAMED), additional information can be found on the PAMED website.

PAMED also offers courses that will satisfy the State requirement on their website: • • • • • •

Opioid Prescribing Guidelines for Non-Cancer Pain Prescribing Naloxone w/Opioids Identifying Addiction & Referral to Treatment Opioid Prescribing & the PA-PDMP Opioid Prescribing Red Flags – Be Smart, Safe, Sure Pain Management & Alternative to Opioid Therapy

1.0 AM PRA Category 1 Credit 1.0 AM PRA Category 1 Credit 1.0 AM PRA Category 1 Credit 1.0 AM PRA Category 1 Credit 0.5 AM PRA Category 1 Credit 1.0 AM PRA Category 1 Credit

DO’s Must Complete Renewal by 10/31/18 MD’s Must Complete Renewal by 12/31/18

12 Pennsylvania Professional Liability Joint Underwriting Association (JUA) Update Richard E. Moses, D.O., J.D. For the past two years, Governor Tom Wolf has been determined to transfer hundreds of millions of dollars from the JUA to the Commonwealth General Fund so that the Commonwealth of Pennsylvania can use that money for its own purposes, in an effort to balance the budget.

The JUA was created to provide medical professional liability insurance for various Pennsylvania health care providers, especially those practicing in high-risk specialties. The JUA is funded in small part by applicant administrative fees and in large part by policy premiums and surcharges paid by policyholders (healthcare providers, i.e., us!). The JUA is not funded by the Governor or the Commonwealth, and never has been. The $200,000,000 is physician money.

Neither Governor Wolf nor anyone else should be allowed to take it to subsidize the state budget.

In 2016, the Pennsylvania legislature passed a bill directing that $200,000,000 would be transferred from the JUA to the General Fund. In May 2017, the JUA filed a lawsuit in federal court, seeking an injunction to prevent the bill’s enforcement. While that lawsuit was pending, in July 2017, the Pennsylvania House Appropriations Committee passed a bill declaring that the funds in the JUA’s control do not belong to the JUA, that the JUA is an instrumentality of Pennsylvania, and that those funds belong to Pennsylvania.

The House bill was amended to say that if the JUA did not pay the money to the Pennsylvania Department of Treasury by November 1, 2017, the JUA would be abolished. This was followed by two more House bills passed in late October, again requiring the JUA to pay the money or be abolished.

On November 22, 2017, the federal court granted the JUA’s request for a preliminary injunction and the court temporarily blocked Pennsylvania’s ability to take the money. On May 17, 2018, Judge Christopher Connor declared that the 2017 law violated the federal

Constitution, because the funds are “private property” and accordingly, cannot be seized by the government without fair compensation. Governor Wolf and the General Assembly have appealed the decision to the Third Circuit Court of Appeals.

While that appellate court case is still winding its way through the court system, Governor Wolf signed HB 1851 into law on June 22, 2018. This is his most recent attempt to appropriate the JUA’s money. The latest law, now known as Act 41, places the JUA under the “control, direction and oversight” of the Pennsylvania Department of Insurance (PID). The law becomes effective July 28, 2018. At that time, Act 41 will transfer all of the JUA’s assets to the PID and will transfer the authority to act on behalf of the JUA to an executive director. The PID will hire staff for the JUA. The legislation vests a Board, appointed by the Governor and the leaders of the General Assembly, with governance of the JUA. Board members would serve a four (4) year term.

Act 41 also provides additional powers and duties to the Board, which includes, subject to the Commissioner’s approval, the ability to place a portion of the JUA’s funds in a restricted receipt account in the Treasury. Funds placed in the Treasury account would be appropriated for the purposes required by law and as may otherwise be directed by the Board, thereby allowing them to take the money we have been paying into the JUA over the years.

The legislation prohibits JUA members and health care providers insured by the JUA from bringing claims against the current or future funds, profits, investments or losses of the association, including upon dissolution.

In response, the JUA once again sued the legislature on June 29th, seeking a temporary restraining order and preliminary injunction so that Act 41 will not be enforced.

Middle District Judge Christopher Conner ruled in favor of the JUA’s preliminary injunction the week of July 17th.

In his opinion, Judge Conner referred back to his first decision, reiterating his belief the JUA is a private fund and indicating the JUA’s case had enough merit to warrant intervention. Judge Conner noted in his latest opinion, the continued on page 15

13

ONLINE N REGISTRATIO NOW OPEN

Sessions Include: • “Celiac: Management of Today and Tomorrow” – Stephanie Moleski, MD, Thomas Jefferson University Hospital • “Successful Dietary Reintroduction in Eosinophilic Esophagitis” – Octavia Pickett-Blakely, MD, University of Pennsylvania • “Dysplastic Barrett’s Management” - Christopher Hibbard, DO, Einstein • “Magnetic Sphincter Augmentation for Chronic GERD” – Francesco Palazzo, MD, Thomas Jefferson University Hospital • “Biosimilars in IBD” – Andrew Tinsley, MD, Penn State Hershey Medical Center • “Post-Operative Crohn’s Management” – Adam Ehrlich, MD, Temple University • “Proactive Therapeutic Drug Monitoring in IBD” – Mark Osterman, MD, University of Pennsylvania

• “Today’s IBD Toolbox vs the Promise of Precision Medicine” – David Binion, MD, University of Pittsburgh • “Achalasia: Diagnostics and Treatment” – Stacey Zavala, MD, Einstein • “Cyclic Vomiting Syndrome” – David Levinthal, MD, PhD, University of Pittsburgh • “Gastroparesis”, Zubair Malik, MD, Temple University • “Practical Management of Fecal Incontinence” – Asyia Ahmad, MD, Drexel University • “Endoscopic Drainage of Abdominal Collections & Beyond” – Anand Kumar, MD, Drexel University • “Fatty Liver: Practical Management” – Karen Krok, MD, Penn State Hershey Medical Center • “Eyeopeners in Ethanol Induced Hepatitis” – Andres Riera, MD, Drexel University

PSG will be offering AMA PRA Category 1 Credits™, as well as Nursing credits for this year’s event.

Annual GI Jeopardy Tournament Register Your Teams for this spirited competition.

Prizes awarded to the top team.

Annual Fellows’ Lecture

BRING THE FAMILY TO PSG’S FAMILY-FRIENDLY EVENT

FAMILY

FUN

Family Excursion to Indian Echo Caverns Family-Fun Night at Hotel Hershey Discounted Tickets to HersheyPark & ZooAmerica

Social Media Engagement for the GI Seyedehsan Navabi, MD Penn State Hershey Medical Center

Special Welcome Gift for the Kids

14 Welcome

N EW

Members (April 4 through August 1, 2018)

Active Puneet S. Basi, MD James S. Blake, DO Norman M. Callahan, III, DO Scott A. Fink, MD Adam B. Kaufman, MD Keith R. Kearny, DO Rupal Kothari, DO Keith J. Laskin, MD Giancarlo Mercogliano, MD Anil K. Sharma, MD Michael B. Wolfson, MD Patricia Wong, MD Stacey R. Zavala, MD Marc A. Zitin, MD

Associate Mahesh Cheryala, MD Rodrigo Durate-Chavez, MD Andrew C. Elden, MD Daniel Gaballa, MD Daniil Gekhman, DO Venkata S. Gorrepati, MD, MPH Amir Gougol, MD Sarina Kapoor, MD Nihaal P. Karnik, MD Brian Kim, DO S. Vikas Kumar, MD Andrew E. Lee, MD Travis Magdaleno, DO Ana Martinez-Tapia, MD Elana B. Mitchel, MD Nelson O. Onyango, MD Meet Parikh, DO Nihit Shah, MD Erik F. Soto, MD Benjamin Stern, DO Hesham Tayel, MD Hussam Tayel, MD

Non-Physician Clinician Emily Hill, RN Abby Rathman, PA-C Joshua B. Teach, RN

President’s Message from page 1

Endoscopy (DVSGE) during its annual Spring Academic dinner meeting, held at the historic College of Physicians in Philadelphia. I discussed the importance and benefits of being an active member of the PSG and detailed the various issues the PSG has been pursuing. Executive Director Robbi Cook was at the PSG information booth to help DVSGE members, including fellows and residents, complete membership applications and answer questions. As always, Robbi did a fabulous job organizing the PSG booth and organizing our presence. We have a number of new members because of our efforts.

WELCOME TO THE PSG! My personal thanks to my friends and colleagues, Drs. Jeff Tokar (FCCC) and Jennifer Maranki (Penn State Hershey Medical Center) for allowing me the time to speak prior to the excellent DVSGE educational program.

WE ARE STILL ACCEPTING DUES RENEWAL! Remember that membership includes complimentary registration for the September 14 – 16 annual scientific educational meeting as a member benefit. Encourage your partners, associates, and other GI colleagues outside your practice to join our organization. Membership is also open to Advanced Practice Providers (our Nurse Practitioner and Physician Assistant colleagues). My practice’s two new PAs just joined – welcome Michaela Breski and Dana Campetti!

Practice office administrators, GI techs, ASC and AEC nurses, and others who are part of the GI care team will be able to join as well in the coming months.

Please join me in welcoming Dawn Losiewicz to the PSG team and family! She is our new Assistant Association Executive. She has extensive experience and is well acquainted with the Pennsylvania healthcare environment. She attended our May 12th Board Meeting in Harrisburg with her sleeves rolled up and ready to go!

On the legislative front, your PSG remains active and engaged. Your calls and emails to our Pennsylvania legislators were heard loud and clear. The PA State Budget signed by Governor Wolf on June 22nd did not include his proposed 3% tax on ambulatory surgical and endoscopy centers. This shows that we need all of you to continue to reach out and express our opposition to issues that threaten our delivery of quality care to our patients.

I want to personally thank all of you, the PSG staff, and our corporate partner, Physicians Endoscopy, for taking the time to e-mail and call legislators. Since this is an election year, I do not think much will happen on the legislative front until after November.

For our members on the eastern side of our state who care for IBC-insured patients, IBC continues to restrict them from our high quality in-office GI Pathology services.

The Board discussed a number of options to pursue this matter further. Recall that IBC refused to meet or speak with us, or our national GI organizations, to discuss their draconian decision. I have been in discussion with a few entities who might be interested in helping us reach out to IBC once again. I am personally saddened that IBC puts PROFITS BEFORE PATIENTS and refuses the input of the GI physicians responsible for the excellent service our PSG members provide. However, despite the ultimate outcome, I remain vigilant. In the interim, we are forced to use IBC’s contracted pathology labs that are essentially LabCorp.

Reserve Friday, September 14th through Sunday, September 16th to join us for a wonderful weekend of education and fun. As I noted, Dr. Nandi has a fantastic slate of

15 topics and speakers confirmed for our September 14 – 16 scientific meeting. There are many family-friendly events planned for the weekend in “Chocolate Town” (Hershey).

PSG is striving to make our annual meeting a familyinclusive event, so you can attend the educational sessions and spend quality time with your family. Friday evening’s Welcome Reception has been extended to accommodate your travel time to Hershey. Throughout the weekend, we have special food and events planned to entertain your children, grandchildren and the kid in all of us! Who would not have a great time enjoying the Sweetest Place on Earth®? Discounted tickets to Hersheypark and Zoo America will be available. We will also have an optional excursion available to explore the caves at Indian Echo Caverns. We look forward to meeting your family in September.

The ACG meeting is coming to Philadelphia this year! The PSG will be sponsoring a networking event on Saturday, October 6, 2018, at Maggiano’s (Philadelphia) in the Palumbo South Room. Drinks and food are provided.

All PSG members, fellows, non-members, and significant others are invited! Make it a night in Philly after we eat and chat. The Philadelphia area PSG members can give you DOZENS of ideas on what to do on a Saturday night in the city.

We need you to join our social media groups if you have not already done so. Visit the updated PSG website. If you are engaged, we are engaged! Post and tweet information about what is going on from a GI and/or medical standpoint in Pennsylvania, in your geographic area, in your practices, and at your institutions. Thanks to those of you have done so already…KEEP IT UP! Continue to forward your information on upcoming conferences and meetings so we can post the material on our website and social media platforms. If you are unsure how to share your information, just email the PSG staff team for their assistance. They want to help you become engaged.

Enjoy the rest of your summer. Take time out to have some fun with your family and friends. Please reach out to us if we may help you in any way.

Richard

DDNC Update from page 3

VA Secretary Nominee The Senate Veterans Affairs Committee approved the nomination of Robert Wilkie as Secretary of the Department of Veterans Affairs. The nomination will soon be voted on by the Senate, which is nearly sure to confirm Wilkie as VA Secretary. The website The Hill posted an article on the Senate confirmation.

Opioid Legislation Both the House & Senate continue to push forward on opioid-related legislation. The Senate is gearing up for consideration of its package similar to the Housepassed bill, HR 6. Both House & Senate FY 2019 L-HHS appropriations bills include funding for many of the initiatives contained in the pending legislative package, and various agencies are announcing the availability of funding.

Additional information on the SAMHSA grants process can be viewed here.

Pennsylvania Professional Liability Update from page 12

claim the legislature can make certain private funds public is “offered with no jurisprudential support.”

Your PSG plans to continue to keep the membership updated as this issue continues through the court system.

In addition, PAMED has continued to support the JUA through its filing of multiple amicus curiae briefs over the past two years.

PSG

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