Richa Shukla, MD

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The hospital is often the intersection between a patient’s medical illness and their social and financial issues. As physicians, it is important to recognize that patient care encompasses not only prescribing medications and performing procedures but also practicing systems-based medicine; ensuring social and financial barriers do not impede access to, and delivery of, care. Some of these barriers cannot be eliminated by one individual practitioner; they can only be improved by working with government representatives and policy makers to make systemic changes. For gastroenterologists, advocacy involves educating patients, practitioners, and our government representatives about issues related to GI illnesses and the importance of ensuring access to GI specialty care and treatment for all patients who require it.

AGA, via the Government Affairs Department, facilitates advocacy by providing policy briefs and position statements to facilitate informed discussions with government representatives. The AGA Young Delegates program has recently taken this one step further and arranged for GI fellows and young faculty to meet members of Congress in their districts to discuss important policy matters. On Aug. 22, 2017, we had the opportunity to host Congressman Gene Green (D-Tex., District 29) at Baylor College of Medicine, Houston. Congressman Green serves on the Committee on Energy and Commerce and is the Ranking Member for its Subcommittee on Health; he also serves on several other subcommittees including Energy and Power, Environment and Economy, and Oversight and Investigations. During our visit, we discussed topics, including protecting National Institutes of Health funding, increasing access to specialty care, and needing coverage for preventive services like cancer screening and colonoscopy reimbursement.

Academic institutions share the aim of conducting high-quality research to further advances in medicine. These research projects are often funded through NIH grant programs. Unfortunately, these programs are often the target of budget cuts, which can affect not only primary research but also downstream economic growth. An analysis by United for Medical Research found that, for every $1 spent in NIH grants, $2 of economic output is generated.1 In 2016, these programs led to 379,000 jobs and $64 billion in economic activity nationally. AGA calls for increased NIH funding to maintain pace with inflation.2 We discussed how projects funded by the NIH have led to important advances in gastroenterology at our own institution. For example, NIH-funded research by Hashem B. El-Serag, MD, MPH, and Fasiha Kanwal, MD, MSHS, has produced studies to evaluate biomarkers and improving screening techniques in hepatocellular carcinoma.3,4

Health care cost sharing and delivery have been a focus of the current session of Congress. Attempts have been made to repeal the Affordable Care Act; and while none have passed so far, this will continue to be a contentious topic of debate. AGA advocates that any future health care bills ensure patient access and coverage of specialty care, ensure coverage/access to evidence-based preventive screening tests, maintaining of current laws that prohibit discrimination based on pre-existing conditions and sex, and maintaining a ban on lifetime caps. With Congressman Green, we discussed the burden of digestive disease nationally and the need to maintain access and coverage for our patients. We shared the difficulties some of our patients face with access to preventive care services and the differences across the three pavilions we serve (private tertiary care center, county hospital, and VA hospital). Congressman Green, an important advocate for colorectal cancer prevention, discussed his personal experiences with affected friends and family and expressed commitment to the importance of making health care, especially cancer-screening, accessible and available to all.

Pictured from left to right: Dr. Jordan Shapiro, Rep. Gene Green, Dr. Richa Shukla, and Dr. Yamini Natarajan.

Notably, Congressman Green has also sponsored the Removing Barriers for Colorectal Cancer Screening Act. After the passage of the ACA, deductibles and coinsurance fees are waived for colon cancer screening tests. However, once a polyp is removed on a screening colonoscopy, the procedure becomes reclassified as a therapeutic procedure, meaning the patient will have to pay coinsurance.5 Coinsurance costs can be 20%-25% of the Medicare-approved amount. In essence, a patient may go into a procedure with the expectation that it is free, only to find out that they will receive a significant bill because polyps were removed. It puts the gastroenterologist in a difficult position, knowing that removal of polyps would increase cost to the patient, however, waiting for a repeat procedure would be redundant and lead to possible loss of follow-up. The Removing Barriers to Colorectal Cancer Screening Act would correct this by waiving the coinsurance for a screening colonoscopy even if polyps were removed.

As physicians, we are uniquely positioned to represent the needs of our patients. We appreciate the AGA facilitating that voice by providing updates on legislation and coordinating meetings between senators and members of Congress and practicing gastroenterologists and GI fellows. These meetings are an important opportunity to network and share our experiences. Congressman Green was very interested to hear our perspectives as health care providers. It was enlightening to hear about his experiences on the Health Subcommittee and learn about its procedures. We would strongly encourage other AGA members to take advantage of this important program. n

Dr. Natarajan is assistant professor, Dr. Shukla is assistant professor, and Dr. Shapiro is a second-year fellow; all are in the section of gastroenterology and hepatology, Baylor College of Medicine, Houston.

References

1. Ehrlich E. (2017). NIH’S Role in Sustaining the U.S. Economy. United for Medical Research. Accessed at http://www.unitedformedicalresearch.com/wp-content/uploads/2017/03/NIH-Role-in-the-Economy-FY2016.

2. AGA Position Statement on Research Funding. Accessed at http://www.gastro.org/take-action/top-issues/research-funding.

3. El-Serag H.B., Kanwal F., Davila J.A., Kramer J., Richardson P. A new laboratory-based algorithm to predict development of hepatocellular carcinoma in patients with hepatitis C and cirrhosis. Gastroenterology. 2014;May146(5):1249-55.

4. White D.L., Richardson P., Tayoub N., Davila J.A., Kanwal F., El-Serag H.B. The updated model: An adjusted serum alpha-fetoprotein-based algorithm for hepatocellular carcinoma detection with hepatitis C virus-related cirrhosis. Gastroenterology. 2015;Dec 149(7):1986-7.

5. AGA Position Statement on Patient Cost-Sharing for Screening Colonoscopy. Accessed a: http://www.gastro.org/take-action/top-issues/patient-cost-sharing-for-screening-colonoscopy.

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The hospital is often the intersection between a patient’s medical illness and their social and financial issues. As physicians, it is important to recognize that patient care encompasses not only prescribing medications and performing procedures but also practicing systems-based medicine; ensuring social and financial barriers do not impede access to, and delivery of, care. Some of these barriers cannot be eliminated by one individual practitioner; they can only be improved by working with government representatives and policy makers to make systemic changes. For gastroenterologists, advocacy involves educating patients, practitioners, and our government representatives about issues related to GI illnesses and the importance of ensuring access to GI specialty care and treatment for all patients who require it.

AGA, via the Government Affairs Department, facilitates advocacy by providing policy briefs and position statements to facilitate informed discussions with government representatives. The AGA Young Delegates program has recently taken this one step further and arranged for GI fellows and young faculty to meet members of Congress in their districts to discuss important policy matters. On Aug. 22, 2017, we had the opportunity to host Congressman Gene Green (D-Tex., District 29) at Baylor College of Medicine, Houston. Congressman Green serves on the Committee on Energy and Commerce and is the Ranking Member for its Subcommittee on Health; he also serves on several other subcommittees including Energy and Power, Environment and Economy, and Oversight and Investigations. During our visit, we discussed topics, including protecting National Institutes of Health funding, increasing access to specialty care, and needing coverage for preventive services like cancer screening and colonoscopy reimbursement.

Academic institutions share the aim of conducting high-quality research to further advances in medicine. These research projects are often funded through NIH grant programs. Unfortunately, these programs are often the target of budget cuts, which can affect not only primary research but also downstream economic growth. An analysis by United for Medical Research found that, for every $1 spent in NIH grants, $2 of economic output is generated.1 In 2016, these programs led to 379,000 jobs and $64 billion in economic activity nationally. AGA calls for increased NIH funding to maintain pace with inflation.2 We discussed how projects funded by the NIH have led to important advances in gastroenterology at our own institution. For example, NIH-funded research by Hashem B. El-Serag, MD, MPH, and Fasiha Kanwal, MD, MSHS, has produced studies to evaluate biomarkers and improving screening techniques in hepatocellular carcinoma.3,4

Health care cost sharing and delivery have been a focus of the current session of Congress. Attempts have been made to repeal the Affordable Care Act; and while none have passed so far, this will continue to be a contentious topic of debate. AGA advocates that any future health care bills ensure patient access and coverage of specialty care, ensure coverage/access to evidence-based preventive screening tests, maintaining of current laws that prohibit discrimination based on pre-existing conditions and sex, and maintaining a ban on lifetime caps. With Congressman Green, we discussed the burden of digestive disease nationally and the need to maintain access and coverage for our patients. We shared the difficulties some of our patients face with access to preventive care services and the differences across the three pavilions we serve (private tertiary care center, county hospital, and VA hospital). Congressman Green, an important advocate for colorectal cancer prevention, discussed his personal experiences with affected friends and family and expressed commitment to the importance of making health care, especially cancer-screening, accessible and available to all.

Notably, Congressman Green has also sponsored the Removing Barriers for Colorectal Cancer Screening Act. After the passage of the ACA, deductibles and coinsurance fees are waived for colon cancer screening tests. However, once a polyp is removed on a screening colonoscopy, the procedure becomes reclassified as a therapeutic procedure, meaning the patient will have to pay coinsurance.5 Coinsurance costs can be 20%-25% of the Medicare-approved amount. In essence, a patient may go into a procedure with the expectation that it is free, only to find out that they will receive a significant bill because polyps were removed. It puts the gastroenterologist in a difficult position, knowing that removal of polyps would increase cost to the patient, however, waiting for a repeat procedure would be redundant and lead to possible loss of follow-up. The Removing Barriers to Colorectal Cancer Screening Act would correct this by waiving the coinsurance for a screening colonoscopy even if polyps were removed.

As physicians, we are uniquely positioned to represent the needs of our patients. We appreciate the AGA facilitating that voice by providing updates on legislation and coordinating meetings between senators and members of Congress and practicing gastroenterologists and GI fellows. These meetings are an important opportunity to network and share our experiences. Congressman Green was very interested to hear our perspectives as health care providers. It was enlightening to hear about his experiences on the Health Subcommittee and learn about its procedures. We would strongly encourage other AGA members to take advantage of this important program. n

Dr. Natarajan is assistant professor, Dr. Shukla is assistant professor, and Dr. Shapiro is a second-year fellow; all are in the section of gastroenterology and hepatology, Baylor College of Medicine, Houston.

References

1. Ehrlich E. (2017). NIH’S Role in Sustaining the U.S. Economy. United for Medical Research. Accessed at http://www.unitedformedicalresearch.com/wp-content/uploads/2017/03/NIH-Role-in-the-Economy-FY2016.

2. AGA Position Statement on Research Funding. Accessed at http://www.gastro.org/take-action/top-issues/research-funding.

3. El-Serag H.B., Kanwal F., Davila J.A., Kramer J., Richardson P. A new laboratory-based algorithm to predict development of hepatocellular carcinoma in patients with hepatitis C and cirrhosis. Gastroenterology. 2014;May146(5):1249-55.

4. White D.L., Richardson P., Tayoub N., Davila J.A., Kanwal F., El-Serag H.B. The updated model: An adjusted serum alpha-fetoprotein-based algorithm for hepatocellular carcinoma detection with hepatitis C virus-related cirrhosis. Gastroenterology. 2015;Dec 149(7):1986-7.

5. AGA Position Statement on Patient Cost-Sharing for Screening Colonoscopy. Accessed a: http://www.gastro.org/take-action/top-issues/patient-cost-sharing-for-screening-colonoscopy.

The hospital is often the intersection between a patient’s medical illness and their social and financial issues. As physicians, it is important to recognize that patient care encompasses not only prescribing medications and performing procedures but also practicing systems-based medicine; ensuring social and financial barriers do not impede access to, and delivery of, care. Some of these barriers cannot be eliminated by one individual practitioner; they can only be improved by working with government representatives and policy makers to make systemic changes. For gastroenterologists, advocacy involves educating patients, practitioners, and our government representatives about issues related to GI illnesses and the importance of ensuring access to GI specialty care and treatment for all patients who require it.

AGA, via the Government Affairs Department, facilitates advocacy by providing policy briefs and position statements to facilitate informed discussions with government representatives. The AGA Young Delegates program has recently taken this one step further and arranged for GI fellows and young faculty to meet members of Congress in their districts to discuss important policy matters. On Aug. 22, 2017, we had the opportunity to host Congressman Gene Green (D-Tex., District 29) at Baylor College of Medicine, Houston. Congressman Green serves on the Committee on Energy and Commerce and is the Ranking Member for its Subcommittee on Health; he also serves on several other subcommittees including Energy and Power, Environment and Economy, and Oversight and Investigations. During our visit, we discussed topics, including protecting National Institutes of Health funding, increasing access to specialty care, and needing coverage for preventive services like cancer screening and colonoscopy reimbursement.

Academic institutions share the aim of conducting high-quality research to further advances in medicine. These research projects are often funded through NIH grant programs. Unfortunately, these programs are often the target of budget cuts, which can affect not only primary research but also downstream economic growth. An analysis by United for Medical Research found that, for every $1 spent in NIH grants, $2 of economic output is generated.1 In 2016, these programs led to 379,000 jobs and $64 billion in economic activity nationally. AGA calls for increased NIH funding to maintain pace with inflation.2 We discussed how projects funded by the NIH have led to important advances in gastroenterology at our own institution. For example, NIH-funded research by Hashem B. El-Serag, MD, MPH, and Fasiha Kanwal, MD, MSHS, has produced studies to evaluate biomarkers and improving screening techniques in hepatocellular carcinoma.3,4

Health care cost sharing and delivery have been a focus of the current session of Congress. Attempts have been made to repeal the Affordable Care Act; and while none have passed so far, this will continue to be a contentious topic of debate. AGA advocates that any future health care bills ensure patient access and coverage of specialty care, ensure coverage/access to evidence-based preventive screening tests, maintaining of current laws that prohibit discrimination based on pre-existing conditions and sex, and maintaining a ban on lifetime caps. With Congressman Green, we discussed the burden of digestive disease nationally and the need to maintain access and coverage for our patients. We shared the difficulties some of our patients face with access to preventive care services and the differences across the three pavilions we serve (private tertiary care center, county hospital, and VA hospital). Congressman Green, an important advocate for colorectal cancer prevention, discussed his personal experiences with affected friends and family and expressed commitment to the importance of making health care, especially cancer-screening, accessible and available to all.

Notably, Congressman Green has also sponsored the Removing Barriers for Colorectal Cancer Screening Act. After the passage of the ACA, deductibles and coinsurance fees are waived for colon cancer screening tests. However, once a polyp is removed on a screening colonoscopy, the procedure becomes reclassified as a therapeutic procedure, meaning the patient will have to pay coinsurance.5 Coinsurance costs can be 20%-25% of the Medicare-approved amount. In essence, a patient may go into a procedure with the expectation that it is free, only to find out that they will receive a significant bill because polyps were removed. It puts the gastroenterologist in a difficult position, knowing that removal of polyps would increase cost to the patient, however, waiting for a repeat procedure would be redundant and lead to possible loss of follow-up. The Removing Barriers to Colorectal Cancer Screening Act would correct this by waiving the coinsurance for a screening colonoscopy even if polyps were removed.

As physicians, we are uniquely positioned to represent the needs of our patients. We appreciate the AGA facilitating that voice by providing updates on legislation and coordinating meetings between senators and members of Congress and practicing gastroenterologists and GI fellows. These meetings are an important opportunity to network and share our experiences. Congressman Green was very interested to hear our perspectives as health care providers. It was enlightening to hear about his experiences on the Health Subcommittee and learn about its procedures. We would strongly encourage other AGA members to take advantage of this important program. n

Dr. Natarajan is assistant professor, Dr. Shukla is assistant professor, and Dr. Shapiro is a second-year fellow; all are in the section of gastroenterology and hepatology, Baylor College of Medicine, Houston.

References

1. Ehrlich E. (2017). NIH’S Role in Sustaining the U.S. Economy. United for Medical Research. Accessed at http://www.unitedformedicalresearch.com/wp-content/uploads/2017/03/NIH-Role-in-the-Economy-FY2016.

2. AGA Position Statement on Research Funding. Accessed at http://www.gastro.org/take-action/top-issues/research-funding.

3. El-Serag H.B., Kanwal F., Davila J.A., Kramer J., Richardson P. A new laboratory-based algorithm to predict development of hepatocellular carcinoma in patients with hepatitis C and cirrhosis. Gastroenterology. 2014;May146(5):1249-55.

4. White D.L., Richardson P., Tayoub N., Davila J.A., Kanwal F., El-Serag H.B. The updated model: An adjusted serum alpha-fetoprotein-based algorithm for hepatocellular carcinoma detection with hepatitis C virus-related cirrhosis. Gastroenterology. 2015;Dec 149(7):1986-7.

5. AGA Position Statement on Patient Cost-Sharing for Screening Colonoscopy. Accessed a: http://www.gastro.org/take-action/top-issues/patient-cost-sharing-for-screening-colonoscopy.

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