Attention ACG Members: Two Important FDA Safety Alerts in GI

From ACG FDA Related Matters Committee Chair Stephen Hanauer, MD, FACG

On Tuesday, January 14th, the FDA sent out a safety alert to the public that "results from a clinical trial assessing safety show a possible increased risk of cancer with the weight management medicine Belviq, Belviq XR (lorcaserin)." The FDA is recommending that patients currently taking lorcaserin talk to their doctors about the potential risks that might be associated with the drug, which might include increased risk of cancer.

Read the January 14th alert regarding lorcaserin here.

On Friday January 17th, the FDA sent out another safety alert – this time dealing with duodenoscopes, and how failure to correctly reprocess a duodenoscope could possibly result in tissue or fluid from one patient remaining in a duodenoscope when it is used in a subsequent patient – and warning that this can lead to patient-to-patient disease transmission. The FDA recommends that hospitals and endoscopy facilities transition away from fixed endcap duodenoscopes to those with newer design features that facilitate or eliminate the need for reprocessing. FDA continues to work with manufacturers to increase the supply of disposable cap duodenoscopes and the development of other new and innovative device designs that will further minimize or eliminate the risk of patient infection.

Read the January 17th alert regarding duodenoscopes here.

MACRA Update: CMS Releases 2018 Performance Data

From ACG Legislative and Public Policy Council Chair, Whitfield L. Knapple, MD, FACG

In the 2019 ACG “MACRA Tidbit for the Week,” we discussed how 2017 MIPS data impacted the 2019 Medicare payments. The tidbit was called "CMS Releases CY 2017 MIPS Participation Data Impacting 2019 Medicare Payments." The recent data confirmed a problem ACG highlighted back in 2016, where we must have clinicians who “fail,” or be subject to reimbursement cuts, in order to provide bonuses to others.

This week, CMS released participation and payment adjustment rates for 2018. CMS also provided some data comparing 2017 vs. 2018. What does the latest data say? The data also confirms ACG’s concern that MIPS is a “fail-first system” and may impact smaller/rural practices more than others. Also, participating in MIPS can be burdensome but the financial reward to the GI practice is insignificant. Thus, ACG has focused on increasing the exemptions from MIPS, as well as educating members on avoiding a payment cut rather than planning for those bonuses promoted by Congress and CMS. As the cuts in MIPS get higher, however, ACG members should be ready to not only avoid these cuts, but also should be prepared to capture the bonuses provided by others’ payment cuts. ACG continues to educate and advocate on behalf of small and independent GI practices. Some charts that highlight the 2017 vs. 2018 data:


  2017 2018
Total number of clinicians participating in MIPS 1,057,824 916,058
Total number of “qualified participant” clinicians in an alternative payment model 99,076 183,306
Total number of partial “qualified participant” clinicians 52 139


Scoring and payment data comparison

  2017 2018
Performance threshold score 3 15
Exceptional Performance threshold 70 70


Percentage of clinicians receiving a MIPS payment cut, were held neutral, or received a payment bonus

  2017 2018
Percentage of clinicians who received a payment cut 5% 2%
Maximum payment cut for these clinicians -4% -5%
Percentage of clinicians who received a neutral MIPS payment adjustment 2% 0%
Payment  adjustment for these clinicians 0% 0%
Percentage of clinicians who received a positive received a positive adjustment 22% 13%
Payment bonus for these clinicians .2% .2%
Percentage of clinicians who received a positive adjustment and met exceptional performance threshold 71% 84%
Payment bonus for these clinicians 1.88% 1.68%


Small and rural practices 2017 vs. 2018

  2017 2018
Small Practices    
Percentage receiving a payment cut 19% 13%
Percentage held neutral 8% 3%
Percentage receiving a positive adjustment 30% 26%
Percentage receiving a positive adjustment and met exceptional performance threshold 44% 58%
  2017 2018
Rural Practices    
Percentage receiving a payment cut 6% 2%
Percentage held neutral 1% 1%
Percentage receiving a positive adjustment 28% 14%
Percentage receiving a positive adjustment and met exceptional performance threshold 65% 83%

ACG is currently updating its educational material for the CY 2020 reporting year. Stay tuned and please continue to use ACG as your clinical home for MACRA and other practice management resources.

Professional Service Agreements: Perfect Solutions to Affiliations? By Ann Bittinger, Esq.

ACG recently commissioned Ann Bittinger, Esq. to draft a white paper on Professional Services Agreements (PSA) as a resource for our members. In addition to guidance and perspective, Ms. Bittinger also provides template legal contract language that will be helpful to ACG members negotiating a PSA with a health system. Download this language for your use!

Click here to read the article in the most recent edition of the ACG Magazine.

Click here read the article and access the template contract language.

ACG Governors to Meet Next Week: Representing Your Interests

From ACG Board of Governors Chair Neil Stollman, MD, FACG and Vice Chair Patrick Young, MD, FACG

The ACG Governors are planning to meet in Las Vegas over the ACG IBD School and ASGE Best Practices Course 1/24 to 1/26. Please use the button below to reach out to them with any concerns you may have!

The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows that are elected from the membership of a particular 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.