News from the AGA

In a new statement, five professional gastroenterology organizations caution that there are currently no data to support stopping glucagonlike peptide 1 (GLP-1) receptor agonists prior to elective endoscopy

The medications, which include semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro), and liraglutide (Saxenda), among others, are used for the treatment of diabetes or for weight loss and may be associated with delayed gastric emptying.

Penn Medicine

Patients taking GLP-1 receptor agonists for diabetes management “need to be cautious about withholding these medications because doing so can adversely impact blood glucose control,” said Octavia Pickett-Blakely, MD, a gastroenterologist with University of Pennsylvania in Philadelphia and spokesperson for the American Gastroenterological Association (AGA). “In patients undergoing endoscopic procedures, poorly controlled blood glucose could raise the risk of complications.”

In a commentary on Medscape, David Johnson, MD, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, urges clinicians to learn about the topic and inform patients when prescribing GLP-1 receptor agonists.

“These are new and changing issues. In our world as gastroenterologists, we should be considering – very strongly – mitigating strategies to protect the patients on this wonderful class of therapy,” he says. “Sometimes these drugs can have significant side effects that we need to at least be aware of. Nothing is perfect, but let us be better informed.”

“We really don’t know what the risks are yet. With endoscopy, they could be significant, but perhaps they’re not,” Jonathan Leighton, MD, a gastroenterologist with Mayo Clinic Arizona in Phoenix and president-elect of the American College of Gastroenterology (ACG), told this news organization. “There are a lot of factors that go into this, and we just want to proceed cautiously and carefully until we know more.”

The ACG, AGA, the American Association for the Study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition released the statement on Aug. 11.

It was issued in response to recent guidance on the preoperative management of adults and children on GLP-1 receptor agonists put forth by the American Society of Anesthesiologists.

In a separate statement, the AGA stated that there is little, or no data on complications from aspiration.

“While there is anecdotal experience that increased gastroparesis risk may be dose dependent or related to whether it is being used for diabetes control versus weight loss, we also acknowledge that there is little, or no data related to the relative risk of complications from aspiration. As a result, the impact associated with stopping these therapies prior to undergoing upper GI endoscopy (EGD) or other moderate to deep sedated procedures is unknown at this time. 

“As clinical gastroenterologists and hepatologists, we are very familiar with safety issues regarding the performance of endoscopy in our patients suffering from gastroparesis as well as unexplained nausea, vomiting, and epigastric pain, particularly in emergency situations. As patient safety will always be paramount, and in the absence of actionable data, we encourage our members to exercise best practices when performing endoscopy on these patients who are taking GLP-1 receptor agonists. More data are needed to understand if and when these medications should be held prior to elective endoscopy. Given the need for further data regarding the emerging use of these novel compounds, we encourage our anesthesiology, endocrinology, and industry partners to work collaboratively with our members to develop the necessary evidence to appropriately inform medication adjustments prior to elective endoscopy.”

ASA recommendations

The ASA Task Force on Preoperative Fasting reviewed the available literature on GLP-1 receptor agonists and associated gastrointestinal adverse effects, including the consequences of delayed gastric emptying.

The task force acknowledges that the evidence to provide guidance for preoperative management of these drugs to prevent regurgitation and pulmonary aspiration of gastric contents is “sparse, limited only to several case reports.”

Nevertheless, given the concerns of GLP-1 receptor agonist–induced delayed gastric emptying and associated high risk for regurgitation and aspiration of gastric contents, the task force made these recommendations for elective procedures.

The day before the procedure

For patients on daily dosing, consider holding GLP-1 agonists on the day of the procedure/surgery. For patients on weekly dosing, consider holding GLP-1 agonists a week prior to the procedure/surgery.

This suggestion is irrespective of the indication (type 2 diabetes or weight loss), dose, or the type of procedure/surgery.

If GLP-1 agonists prescribed for diabetes are held for longer than the dosing schedule, consider consulting an endocrinologist for bridging the antidiabetic therapy to avoid hyperglycemia.

The day of the procedure

If GI symptoms such as severe nausea/vomiting/retching, abdominal bloating, or abdominal pain are present, consider delaying the elective procedure and discuss the concerns of potential risk of regurgitation and pulmonary aspiration of gastric contents with the proceduralist/surgeon and the patient.

If the patient has no GI symptoms and the GLP-1 agonists have been held as advised, proceed as usual.

If the patient has no GI symptoms but the GLP-1 agonists were not held as advised, proceed with “full stomach” precautions or consider evaluating gastric volume by ultrasound, if possible and if proficient with the technique. If the stomach is empty, proceed as usual. If the stomach is full or if gastric ultrasound is inconclusive or not possible, consider delaying the procedure or treat the patient as “full stomach” and manage accordingly. Discuss the concerns of potential risk of regurgitation and pulmonary aspiration of gastric contents with the proceduralist/surgeon and the patient.

There is no evidence to suggest the optimal duration of fasting for patients on GLP-1 agonists. Therefore, until we have adequate evidence, we suggest following the current ASA fasting guidelines.

For patients on GLP-1 receptor agonists who need urgent or emergent procedures, the ASA advises proceeding and treating the patient as “full stomach” and managing accordingly.

Dr. Leighton has financial relationships with Olympus and Pfizer. Dr. Pickett-Blakely has no relevant disclosures. Dr. Johnson is an adviser to ISOTHRIVE and Johnson & Johnson.

This story was adapted for GI&Hepatology News from Medscape.

In a new statement, five professional gastroenterology organizations caution that there are currently no data to support stopping glucagonlike peptide 1 (GLP-1) receptor agonists prior to elective endoscopy

The medications, which include semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro), and liraglutide (Saxenda), among others, are used for the treatment of diabetes or for weight loss and may be associated with delayed gastric emptying.

Penn Medicine

Patients taking GLP-1 receptor agonists for diabetes management “need to be cautious about withholding these medications because doing so can adversely impact blood glucose control,” said Octavia Pickett-Blakely, MD, a gastroenterologist with University of Pennsylvania in Philadelphia and spokesperson for the American Gastroenterological Association (AGA). “In patients undergoing endoscopic procedures, poorly controlled blood glucose could raise the risk of complications.”

In a commentary on Medscape, David Johnson, MD, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, urges clinicians to learn about the topic and inform patients when prescribing GLP-1 receptor agonists.

“These are new and changing issues. In our world as gastroenterologists, we should be considering – very strongly – mitigating strategies to protect the patients on this wonderful class of therapy,” he says. “Sometimes these drugs can have significant side effects that we need to at least be aware of. Nothing is perfect, but let us be better informed.”

“We really don’t know what the risks are yet. With endoscopy, they could be significant, but perhaps they’re not,” Jonathan Leighton, MD, a gastroenterologist with Mayo Clinic Arizona in Phoenix and president-elect of the American College of Gastroenterology (ACG), told this news organization. “There are a lot of factors that go into this, and we just want to proceed cautiously and carefully until we know more.”

The ACG, AGA, the American Association for the Study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition released the statement on Aug. 11.

It was issued in response to recent guidance on the preoperative management of adults and children on GLP-1 receptor agonists put forth by the American Society of Anesthesiologists.

In a separate statement, the AGA stated that there is little, or no data on complications from aspiration.

“While there is anecdotal experience that increased gastroparesis risk may be dose dependent or related to whether it is being used for diabetes control versus weight loss, we also acknowledge that there is little, or no data related to the relative risk of complications from aspiration. As a result, the impact associated with stopping these therapies prior to undergoing upper GI endoscopy (EGD) or other moderate to deep sedated procedures is unknown at this time. 

“As clinical gastroenterologists and hepatologists, we are very familiar with safety issues regarding the performance of endoscopy in our patients suffering from gastroparesis as well as unexplained nausea, vomiting, and epigastric pain, particularly in emergency situations. As patient safety will always be paramount, and in the absence of actionable data, we encourage our members to exercise best practices when performing endoscopy on these patients who are taking GLP-1 receptor agonists. More data are needed to understand if and when these medications should be held prior to elective endoscopy. Given the need for further data regarding the emerging use of these novel compounds, we encourage our anesthesiology, endocrinology, and industry partners to work collaboratively with our members to develop the necessary evidence to appropriately inform medication adjustments prior to elective endoscopy.”

ASA recommendations

The ASA Task Force on Preoperative Fasting reviewed the available literature on GLP-1 receptor agonists and associated gastrointestinal adverse effects, including the consequences of delayed gastric emptying.

The task force acknowledges that the evidence to provide guidance for preoperative management of these drugs to prevent regurgitation and pulmonary aspiration of gastric contents is “sparse, limited only to several case reports.”

Nevertheless, given the concerns of GLP-1 receptor agonist–induced delayed gastric emptying and associated high risk for regurgitation and aspiration of gastric contents, the task force made these recommendations for elective procedures.

The day before the procedure

For patients on daily dosing, consider holding GLP-1 agonists on the day of the procedure/surgery. For patients on weekly dosing, consider holding GLP-1 agonists a week prior to the procedure/surgery.

This suggestion is irrespective of the indication (type 2 diabetes or weight loss), dose, or the type of procedure/surgery.

If GLP-1 agonists prescribed for diabetes are held for longer than the dosing schedule, consider consulting an endocrinologist for bridging the antidiabetic therapy to avoid hyperglycemia.

The day of the procedure

If GI symptoms such as severe nausea/vomiting/retching, abdominal bloating, or abdominal pain are present, consider delaying the elective procedure and discuss the concerns of potential risk of regurgitation and pulmonary aspiration of gastric contents with the proceduralist/surgeon and the patient.

If the patient has no GI symptoms and the GLP-1 agonists have been held as advised, proceed as usual.

If the patient has no GI symptoms but the GLP-1 agonists were not held as advised, proceed with “full stomach” precautions or consider evaluating gastric volume by ultrasound, if possible and if proficient with the technique. If the stomach is empty, proceed as usual. If the stomach is full or if gastric ultrasound is inconclusive or not possible, consider delaying the procedure or treat the patient as “full stomach” and manage accordingly. Discuss the concerns of potential risk of regurgitation and pulmonary aspiration of gastric contents with the proceduralist/surgeon and the patient.

There is no evidence to suggest the optimal duration of fasting for patients on GLP-1 agonists. Therefore, until we have adequate evidence, we suggest following the current ASA fasting guidelines.

For patients on GLP-1 receptor agonists who need urgent or emergent procedures, the ASA advises proceeding and treating the patient as “full stomach” and managing accordingly.

Dr. Leighton has financial relationships with Olympus and Pfizer. Dr. Pickett-Blakely has no relevant disclosures. Dr. Johnson is an adviser to ISOTHRIVE and Johnson & Johnson.

This story was adapted for GI&Hepatology News from Medscape.

In a new statement, five professional gastroenterology organizations caution that there are currently no data to support stopping glucagonlike peptide 1 (GLP-1) receptor agonists prior to elective endoscopy

The medications, which include semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro), and liraglutide (Saxenda), among others, are used for the treatment of diabetes or for weight loss and may be associated with delayed gastric emptying.

Penn Medicine

Patients taking GLP-1 receptor agonists for diabetes management “need to be cautious about withholding these medications because doing so can adversely impact blood glucose control,” said Octavia Pickett-Blakely, MD, a gastroenterologist with University of Pennsylvania in Philadelphia and spokesperson for the American Gastroenterological Association (AGA). “In patients undergoing endoscopic procedures, poorly controlled blood glucose could raise the risk of complications.”

In a commentary on Medscape, David Johnson, MD, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, urges clinicians to learn about the topic and inform patients when prescribing GLP-1 receptor agonists.

“These are new and changing issues. In our world as gastroenterologists, we should be considering – very strongly – mitigating strategies to protect the patients on this wonderful class of therapy,” he says. “Sometimes these drugs can have significant side effects that we need to at least be aware of. Nothing is perfect, but let us be better informed.”

“We really don’t know what the risks are yet. With endoscopy, they could be significant, but perhaps they’re not,” Jonathan Leighton, MD, a gastroenterologist with Mayo Clinic Arizona in Phoenix and president-elect of the American College of Gastroenterology (ACG), told this news organization. “There are a lot of factors that go into this, and we just want to proceed cautiously and carefully until we know more.”

The ACG, AGA, the American Association for the Study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition released the statement on Aug. 11.

It was issued in response to recent guidance on the preoperative management of adults and children on GLP-1 receptor agonists put forth by the American Society of Anesthesiologists.

In a separate statement, the AGA stated that there is little, or no data on complications from aspiration.

“While there is anecdotal experience that increased gastroparesis risk may be dose dependent or related to whether it is being used for diabetes control versus weight loss, we also acknowledge that there is little, or no data related to the relative risk of complications from aspiration. As a result, the impact associated with stopping these therapies prior to undergoing upper GI endoscopy (EGD) or other moderate to deep sedated procedures is unknown at this time. 

“As clinical gastroenterologists and hepatologists, we are very familiar with safety issues regarding the performance of endoscopy in our patients suffering from gastroparesis as well as unexplained nausea, vomiting, and epigastric pain, particularly in emergency situations. As patient safety will always be paramount, and in the absence of actionable data, we encourage our members to exercise best practices when performing endoscopy on these patients who are taking GLP-1 receptor agonists. More data are needed to understand if and when these medications should be held prior to elective endoscopy. Given the need for further data regarding the emerging use of these novel compounds, we encourage our anesthesiology, endocrinology, and industry partners to work collaboratively with our members to develop the necessary evidence to appropriately inform medication adjustments prior to elective endoscopy.”

ASA recommendations

The ASA Task Force on Preoperative Fasting reviewed the available literature on GLP-1 receptor agonists and associated gastrointestinal adverse effects, including the consequences of delayed gastric emptying.

The task force acknowledges that the evidence to provide guidance for preoperative management of these drugs to prevent regurgitation and pulmonary aspiration of gastric contents is “sparse, limited only to several case reports.”

Nevertheless, given the concerns of GLP-1 receptor agonist–induced delayed gastric emptying and associated high risk for regurgitation and aspiration of gastric contents, the task force made these recommendations for elective procedures.

The day before the procedure

For patients on daily dosing, consider holding GLP-1 agonists on the day of the procedure/surgery. For patients on weekly dosing, consider holding GLP-1 agonists a week prior to the procedure/surgery.

This suggestion is irrespective of the indication (type 2 diabetes or weight loss), dose, or the type of procedure/surgery.

If GLP-1 agonists prescribed for diabetes are held for longer than the dosing schedule, consider consulting an endocrinologist for bridging the antidiabetic therapy to avoid hyperglycemia.

The day of the procedure

If GI symptoms such as severe nausea/vomiting/retching, abdominal bloating, or abdominal pain are present, consider delaying the elective procedure and discuss the concerns of potential risk of regurgitation and pulmonary aspiration of gastric contents with the proceduralist/surgeon and the patient.

If the patient has no GI symptoms and the GLP-1 agonists have been held as advised, proceed as usual.

If the patient has no GI symptoms but the GLP-1 agonists were not held as advised, proceed with “full stomach” precautions or consider evaluating gastric volume by ultrasound, if possible and if proficient with the technique. If the stomach is empty, proceed as usual. If the stomach is full or if gastric ultrasound is inconclusive or not possible, consider delaying the procedure or treat the patient as “full stomach” and manage accordingly. Discuss the concerns of potential risk of regurgitation and pulmonary aspiration of gastric contents with the proceduralist/surgeon and the patient.

There is no evidence to suggest the optimal duration of fasting for patients on GLP-1 agonists. Therefore, until we have adequate evidence, we suggest following the current ASA fasting guidelines.

For patients on GLP-1 receptor agonists who need urgent or emergent procedures, the ASA advises proceeding and treating the patient as “full stomach” and managing accordingly.

Dr. Leighton has financial relationships with Olympus and Pfizer. Dr. Pickett-Blakely has no relevant disclosures. Dr. Johnson is an adviser to ISOTHRIVE and Johnson & Johnson.

This story was adapted for GI&Hepatology News from Medscape.

AGA is excited to announce the new co–editors-in-chief of Cellular and Molecular Gastroenterology and Hepatology (CMGH). Michele A. Battle, PhD, and Jonathan P. Katz, MD, will be taking over their new roles beginning July 1, 2024.

“In my role as co–editor-in-chief of CMGH, I look forward to working with Jonathan Katz to advance its longstanding mission to disseminate rigorous, reproducible, and impactful digestive biology research. I am excited to launch new initiatives including the addition of special topic editors who will cover themes relating to early career investigators and diversity, equity, and inclusion,” said Dr. Battle, who is a professor in the department of cell biology, neurobiology, and anatomy at the Medical College of Wisconsin, Milwaukee.

Jonathan P. Katz, MD

“I am honored to work with Michele Battle and the rest of our new CMGH board of editors. Some of our goals are to expand CMGH outreach and engagement, incorporate more programs and opportunities for junior investigators, and provide rapid advancements and technical reports that drive research in the field. As such, we will strive to ensure that CMGH remains the preeminent journal focused on high-impact, basic, mechanistic research in GI and hepatology,” said Dr. Katz, an associate professor of medicine in the department of medicine gastroenterology division, director of molecular pathology and imaging care, and director of the undergraduate student scholars program at the University of Pennsylvania, Philadelphia. He is also currently an associate editor for CMGH.

Dr. Battle and Dr. Katz are former AGA Research Foundation awardees, with Dr. Battle receiving an AGA Research Scholar Award in 2009 and Dr. Katz receiving the AGA Astra Merck Advanced Research Training Award in 1998.

Over the next year, they will meet with the current editorial board and start to plan and develop new special sections and initiatives to bring to CMGH during their term.

Please join us in congratulating Dr. Battle and Dr. Katz on their new role as incoming co–editors-in chief.
 

AGA is excited to announce the new co–editors-in-chief of Cellular and Molecular Gastroenterology and Hepatology (CMGH). Michele A. Battle, PhD, and Jonathan P. Katz, MD, will be taking over their new roles beginning July 1, 2024.

“In my role as co–editor-in-chief of CMGH, I look forward to working with Jonathan Katz to advance its longstanding mission to disseminate rigorous, reproducible, and impactful digestive biology research. I am excited to launch new initiatives including the addition of special topic editors who will cover themes relating to early career investigators and diversity, equity, and inclusion,” said Dr. Battle, who is a professor in the department of cell biology, neurobiology, and anatomy at the Medical College of Wisconsin, Milwaukee.

Jonathan P. Katz, MD

“I am honored to work with Michele Battle and the rest of our new CMGH board of editors. Some of our goals are to expand CMGH outreach and engagement, incorporate more programs and opportunities for junior investigators, and provide rapid advancements and technical reports that drive research in the field. As such, we will strive to ensure that CMGH remains the preeminent journal focused on high-impact, basic, mechanistic research in GI and hepatology,” said Dr. Katz, an associate professor of medicine in the department of medicine gastroenterology division, director of molecular pathology and imaging care, and director of the undergraduate student scholars program at the University of Pennsylvania, Philadelphia. He is also currently an associate editor for CMGH.

Dr. Battle and Dr. Katz are former AGA Research Foundation awardees, with Dr. Battle receiving an AGA Research Scholar Award in 2009 and Dr. Katz receiving the AGA Astra Merck Advanced Research Training Award in 1998.

Over the next year, they will meet with the current editorial board and start to plan and develop new special sections and initiatives to bring to CMGH during their term.

Please join us in congratulating Dr. Battle and Dr. Katz on their new role as incoming co–editors-in chief.
 

AGA is excited to announce the new co–editors-in-chief of Cellular and Molecular Gastroenterology and Hepatology (CMGH). Michele A. Battle, PhD, and Jonathan P. Katz, MD, will be taking over their new roles beginning July 1, 2024.

“In my role as co–editor-in-chief of CMGH, I look forward to working with Jonathan Katz to advance its longstanding mission to disseminate rigorous, reproducible, and impactful digestive biology research. I am excited to launch new initiatives including the addition of special topic editors who will cover themes relating to early career investigators and diversity, equity, and inclusion,” said Dr. Battle, who is a professor in the department of cell biology, neurobiology, and anatomy at the Medical College of Wisconsin, Milwaukee.

Jonathan P. Katz, MD

“I am honored to work with Michele Battle and the rest of our new CMGH board of editors. Some of our goals are to expand CMGH outreach and engagement, incorporate more programs and opportunities for junior investigators, and provide rapid advancements and technical reports that drive research in the field. As such, we will strive to ensure that CMGH remains the preeminent journal focused on high-impact, basic, mechanistic research in GI and hepatology,” said Dr. Katz, an associate professor of medicine in the department of medicine gastroenterology division, director of molecular pathology and imaging care, and director of the undergraduate student scholars program at the University of Pennsylvania, Philadelphia. He is also currently an associate editor for CMGH.

Dr. Battle and Dr. Katz are former AGA Research Foundation awardees, with Dr. Battle receiving an AGA Research Scholar Award in 2009 and Dr. Katz receiving the AGA Astra Merck Advanced Research Training Award in 1998.

Over the next year, they will meet with the current editorial board and start to plan and develop new special sections and initiatives to bring to CMGH during their term.

Please join us in congratulating Dr. Battle and Dr. Katz on their new role as incoming co–editors-in chief.
 

We are delighted to introduce the Gastro Journal Club in which an author of a study published in Gastroenterology will present their paper followed by a Q&A. The inaugural Gastro Journal Club features Loren Laine, MD, professor of medicine (digestive diseases) at Yale University, New Haven, Conn., and was hosted by the McMaster University gastroenterology division. Dr. Laine presented his article “Vonoprazan Versus Lansoprazole for Healing and Maintenance of Healing of Erosive Esophagitis: A Randomized Trial,” published in the January 2023 issue of Gastroenterology.

The Gastro Journal Club is open to GI units at any institution worldwide. If you are interested in participating, please contact mpogachar@gastro.org.

Watch the inaugural Gastro Journal Club: https://rb.gy/j8mqm

We are delighted to introduce the Gastro Journal Club in which an author of a study published in Gastroenterology will present their paper followed by a Q&A. The inaugural Gastro Journal Club features Loren Laine, MD, professor of medicine (digestive diseases) at Yale University, New Haven, Conn., and was hosted by the McMaster University gastroenterology division. Dr. Laine presented his article “Vonoprazan Versus Lansoprazole for Healing and Maintenance of Healing of Erosive Esophagitis: A Randomized Trial,” published in the January 2023 issue of Gastroenterology.

The Gastro Journal Club is open to GI units at any institution worldwide. If you are interested in participating, please contact mpogachar@gastro.org.

Watch the inaugural Gastro Journal Club: https://rb.gy/j8mqm

We are delighted to introduce the Gastro Journal Club in which an author of a study published in Gastroenterology will present their paper followed by a Q&A. The inaugural Gastro Journal Club features Loren Laine, MD, professor of medicine (digestive diseases) at Yale University, New Haven, Conn., and was hosted by the McMaster University gastroenterology division. Dr. Laine presented his article “Vonoprazan Versus Lansoprazole for Healing and Maintenance of Healing of Erosive Esophagitis: A Randomized Trial,” published in the January 2023 issue of Gastroenterology.

The Gastro Journal Club is open to GI units at any institution worldwide. If you are interested in participating, please contact mpogachar@gastro.org.

Watch the inaugural Gastro Journal Club: https://rb.gy/j8mqm

The AGA Government Affairs Committee is pleased to announce that the Senate and House have reintroduced the bipartisan Treat and Reduce Obesity Act (TROA) (H.R. 4818/S. 2407). This legislation is a vital first step in expanding access to obesity treatment as it would expand Medicare coverage to include screening and treatment of obesity by a diverse range of health care providers who provide obesity care. The bill also includes coverage of behavioral counseling, prescription drugs for long-term weight management, and other prevention and treatment options.

The passage of TROA could lead to improved obesity care options because many private insurance companies model their covered health benefits to reflect Medicare.

You can help lawmakers understand the urgent need for expanded access to affordable, effective obesity treatments and how greater access to these tools will equip you to better care for your patients.

Use the new obesity advocacy toolkit to find the tools and resources you need, including an email template, sample phone script, op-ed template, and more, to assist you in reaching out to your elected officials and urging them to support the passage of TROA.
 

The AGA Government Affairs Committee is pleased to announce that the Senate and House have reintroduced the bipartisan Treat and Reduce Obesity Act (TROA) (H.R. 4818/S. 2407). This legislation is a vital first step in expanding access to obesity treatment as it would expand Medicare coverage to include screening and treatment of obesity by a diverse range of health care providers who provide obesity care. The bill also includes coverage of behavioral counseling, prescription drugs for long-term weight management, and other prevention and treatment options.

The passage of TROA could lead to improved obesity care options because many private insurance companies model their covered health benefits to reflect Medicare.

You can help lawmakers understand the urgent need for expanded access to affordable, effective obesity treatments and how greater access to these tools will equip you to better care for your patients.

Use the new obesity advocacy toolkit to find the tools and resources you need, including an email template, sample phone script, op-ed template, and more, to assist you in reaching out to your elected officials and urging them to support the passage of TROA.
 

The AGA Government Affairs Committee is pleased to announce that the Senate and House have reintroduced the bipartisan Treat and Reduce Obesity Act (TROA) (H.R. 4818/S. 2407). This legislation is a vital first step in expanding access to obesity treatment as it would expand Medicare coverage to include screening and treatment of obesity by a diverse range of health care providers who provide obesity care. The bill also includes coverage of behavioral counseling, prescription drugs for long-term weight management, and other prevention and treatment options.

The passage of TROA could lead to improved obesity care options because many private insurance companies model their covered health benefits to reflect Medicare.

You can help lawmakers understand the urgent need for expanded access to affordable, effective obesity treatments and how greater access to these tools will equip you to better care for your patients.

Use the new obesity advocacy toolkit to find the tools and resources you need, including an email template, sample phone script, op-ed template, and more, to assist you in reaching out to your elected officials and urging them to support the passage of TROA.
 

The AGA Government Affairs Committee is pleased to announce the Senate and House have reintroduced the bipartisan Treat and Reduce Obesity Act (TROA) (H.R. 4818/S. 2407). This legislation is a vital first step in expanding access to obesity treatment. If passed, the bill would expand Medicare coverage to include screening and treatment of obesity by health care providers who provide obesity care. The bill also includes coverage of behavioral counseling, prescription drugs for long-term weight management, and other prevention and treatment options.

The passage of TROA could lead to improved obesity care options for all Americans since many private insurance companies model their covered health benefits to reflect Medicare.

The AGA Government Affairs Committee is pleased to announce the Senate and House have reintroduced the bipartisan Treat and Reduce Obesity Act (TROA) (H.R. 4818/S. 2407). This legislation is a vital first step in expanding access to obesity treatment. If passed, the bill would expand Medicare coverage to include screening and treatment of obesity by health care providers who provide obesity care. The bill also includes coverage of behavioral counseling, prescription drugs for long-term weight management, and other prevention and treatment options.

The passage of TROA could lead to improved obesity care options for all Americans since many private insurance companies model their covered health benefits to reflect Medicare.

The AGA Government Affairs Committee is pleased to announce the Senate and House have reintroduced the bipartisan Treat and Reduce Obesity Act (TROA) (H.R. 4818/S. 2407). This legislation is a vital first step in expanding access to obesity treatment. If passed, the bill would expand Medicare coverage to include screening and treatment of obesity by health care providers who provide obesity care. The bill also includes coverage of behavioral counseling, prescription drugs for long-term weight management, and other prevention and treatment options.

The passage of TROA could lead to improved obesity care options for all Americans since many private insurance companies model their covered health benefits to reflect Medicare.

A new study published in Neurology found an association between long–term proton-pump inhibitors (PPI) use and dementia. This was an observational study and does not prove that acid reflux drugs cause dementia.

“In this study, the authors note that long-term PPI use, defined as more than 4.5 years of use, was associated with dementia. It is important to note, however, that this does not necessarily mean that PPIs cause dementia. With observational studies, there is an inherent risk of bias and confounding, as the authors report. Some of these confounders include Helicobacter pylori status, vitamin B₁₂ deficiency, depression, and socioeconomic status,” said Fouad J. Moawad, MD, graduate of the AGA FORWARD Program and gastroenterologist at Scripps Health in San Diego. A 2017 study led by Andrew T. Chan, MD, MPH, of Mass General Brigham, Boston, examined the association between proton pump inhibitor use and cognitive function in women. The investigators found no “convincing association between PPI use and cognitive function. Our data do not support the suggestion that PPI use increases dementia risk.”

A new article in press in Gastroenterology by Raaj S. Mehta and colleagues also studied this issue and concluded that in adults 65 years of age or older, PPIs were not associated with dementia or decline in cognition over time. These data provide reassurance about the safety of long-term use of PPIs among older adults.

The headlines may be confusing for patients. Here are AGA’s three talking points for communicating with patients about PPIs:

Talk to your doctor, before making any changes to your medication.

You have been prescribed PPIs for a reason, to treat a diagnosed medical condition. We can discuss the reason for your prescription, the dose and the timeframe for treatment.

Consider lifestyle modifications. 

These may reduce or eliminate the need for PPIs for long-term use. These may include weight loss, avoiding tobacco or a change in your eating patterns. We can work together to determine the changes that are right for you.

Keep in touch.

Research continues to be done on PPI use. Current research recommends that patients who have a diagnosed condition that is helped by PPIs should stay on them, as benefits can outweigh risks.

A new study published in Neurology found an association between long–term proton-pump inhibitors (PPI) use and dementia. This was an observational study and does not prove that acid reflux drugs cause dementia.

“In this study, the authors note that long-term PPI use, defined as more than 4.5 years of use, was associated with dementia. It is important to note, however, that this does not necessarily mean that PPIs cause dementia. With observational studies, there is an inherent risk of bias and confounding, as the authors report. Some of these confounders include Helicobacter pylori status, vitamin B₁₂ deficiency, depression, and socioeconomic status,” said Fouad J. Moawad, MD, graduate of the AGA FORWARD Program and gastroenterologist at Scripps Health in San Diego. A 2017 study led by Andrew T. Chan, MD, MPH, of Mass General Brigham, Boston, examined the association between proton pump inhibitor use and cognitive function in women. The investigators found no “convincing association between PPI use and cognitive function. Our data do not support the suggestion that PPI use increases dementia risk.”

A new article in press in Gastroenterology by Raaj S. Mehta and colleagues also studied this issue and concluded that in adults 65 years of age or older, PPIs were not associated with dementia or decline in cognition over time. These data provide reassurance about the safety of long-term use of PPIs among older adults.

The headlines may be confusing for patients. Here are AGA’s three talking points for communicating with patients about PPIs:

Talk to your doctor, before making any changes to your medication.

You have been prescribed PPIs for a reason, to treat a diagnosed medical condition. We can discuss the reason for your prescription, the dose and the timeframe for treatment.

Consider lifestyle modifications. 

These may reduce or eliminate the need for PPIs for long-term use. These may include weight loss, avoiding tobacco or a change in your eating patterns. We can work together to determine the changes that are right for you.

Keep in touch.

Research continues to be done on PPI use. Current research recommends that patients who have a diagnosed condition that is helped by PPIs should stay on them, as benefits can outweigh risks.

A new study published in Neurology found an association between long–term proton-pump inhibitors (PPI) use and dementia. This was an observational study and does not prove that acid reflux drugs cause dementia.

“In this study, the authors note that long-term PPI use, defined as more than 4.5 years of use, was associated with dementia. It is important to note, however, that this does not necessarily mean that PPIs cause dementia. With observational studies, there is an inherent risk of bias and confounding, as the authors report. Some of these confounders include Helicobacter pylori status, vitamin B₁₂ deficiency, depression, and socioeconomic status,” said Fouad J. Moawad, MD, graduate of the AGA FORWARD Program and gastroenterologist at Scripps Health in San Diego. A 2017 study led by Andrew T. Chan, MD, MPH, of Mass General Brigham, Boston, examined the association between proton pump inhibitor use and cognitive function in women. The investigators found no “convincing association between PPI use and cognitive function. Our data do not support the suggestion that PPI use increases dementia risk.”

A new article in press in Gastroenterology by Raaj S. Mehta and colleagues also studied this issue and concluded that in adults 65 years of age or older, PPIs were not associated with dementia or decline in cognition over time. These data provide reassurance about the safety of long-term use of PPIs among older adults.

The headlines may be confusing for patients. Here are AGA’s three talking points for communicating with patients about PPIs:

Talk to your doctor, before making any changes to your medication.

You have been prescribed PPIs for a reason, to treat a diagnosed medical condition. We can discuss the reason for your prescription, the dose and the timeframe for treatment.

Consider lifestyle modifications. 

These may reduce or eliminate the need for PPIs for long-term use. These may include weight loss, avoiding tobacco or a change in your eating patterns. We can work together to determine the changes that are right for you.

Keep in touch.

Research continues to be done on PPI use. Current research recommends that patients who have a diagnosed condition that is helped by PPIs should stay on them, as benefits can outweigh risks.

The American Gastroenterological Association announced in June that is has invested in Oshi Health, a virtual care integrative health care clinic specializing in treating patients with gastrointestinal disorders that has been named a recipient of funding through the AGA Center for GI Innovation & Technology’s GI Opportunity Fund.

Launched in 2020, Oshi Health works with employers, health insurance partners, health systems, and community GI practices to scale access to multidisciplinary care, reduce health care costs, and help improve outcomes for patients.

Research shows that a whole-person, multidisciplinary GI care model – which for Oshi includes nutrition and diet support, health coaching, behavioral and mental health services – is highly effective in mitigating symptoms. For example, a 2020 literature review published in the Journal of the Canadian Association of Gastroenterology documented far more advantages with integrated care models, as compared with the GI specialist model of care. The study found that integrated care teams were better equipped to meet the needs of patients with inflammatory bowel disease (IBD), patient outcomes and satisfaction were better, overall direct and indirect costs were lower, and psychological health needs were better addressed.

The AGA Center for GI Innovation and Technology supports innovation and the development of new technology in gastroenterology, hepatology, nutrition, and obesity by guiding medical device and therapeutics innovators through the technology development and adoption process.

For more information about Oshi Health, visit https://oshihealth.com.

The American Gastroenterological Association announced in June that is has invested in Oshi Health, a virtual care integrative health care clinic specializing in treating patients with gastrointestinal disorders that has been named a recipient of funding through the AGA Center for GI Innovation & Technology’s GI Opportunity Fund.

Launched in 2020, Oshi Health works with employers, health insurance partners, health systems, and community GI practices to scale access to multidisciplinary care, reduce health care costs, and help improve outcomes for patients.

Research shows that a whole-person, multidisciplinary GI care model – which for Oshi includes nutrition and diet support, health coaching, behavioral and mental health services – is highly effective in mitigating symptoms. For example, a 2020 literature review published in the Journal of the Canadian Association of Gastroenterology documented far more advantages with integrated care models, as compared with the GI specialist model of care. The study found that integrated care teams were better equipped to meet the needs of patients with inflammatory bowel disease (IBD), patient outcomes and satisfaction were better, overall direct and indirect costs were lower, and psychological health needs were better addressed.

The AGA Center for GI Innovation and Technology supports innovation and the development of new technology in gastroenterology, hepatology, nutrition, and obesity by guiding medical device and therapeutics innovators through the technology development and adoption process.

For more information about Oshi Health, visit https://oshihealth.com.

The American Gastroenterological Association announced in June that is has invested in Oshi Health, a virtual care integrative health care clinic specializing in treating patients with gastrointestinal disorders that has been named a recipient of funding through the AGA Center for GI Innovation & Technology’s GI Opportunity Fund.

Launched in 2020, Oshi Health works with employers, health insurance partners, health systems, and community GI practices to scale access to multidisciplinary care, reduce health care costs, and help improve outcomes for patients.

Research shows that a whole-person, multidisciplinary GI care model – which for Oshi includes nutrition and diet support, health coaching, behavioral and mental health services – is highly effective in mitigating symptoms. For example, a 2020 literature review published in the Journal of the Canadian Association of Gastroenterology documented far more advantages with integrated care models, as compared with the GI specialist model of care. The study found that integrated care teams were better equipped to meet the needs of patients with inflammatory bowel disease (IBD), patient outcomes and satisfaction were better, overall direct and indirect costs were lower, and psychological health needs were better addressed.

The AGA Center for GI Innovation and Technology supports innovation and the development of new technology in gastroenterology, hepatology, nutrition, and obesity by guiding medical device and therapeutics innovators through the technology development and adoption process.

For more information about Oshi Health, visit https://oshihealth.com.

On Aug. 1, AGA president Barbara H. Jung, MD, AGAF, wrote to UnitedHealthcare’s chief medical officer, Rhonda Randall, DO, to express continued concern about the company’s Advance Notification Program for gastrointestinal endoscopy procedures, which took effect June 1, and UnitedHealthcare’s proposed “Gold Card” prior authorization program planned for 2024.

AGA

Dr. Jung made three requests: A request for UnitedHealthcare’s deidentified aggregate data on which the Advance Notification program is based.

She asked for clarification in regards to gastroenterologists who opt not to participate in the Advance Notification program. Will they be automatically subject to prior authorization when UnitedHealthcare implements the 2024 Gold Card program?

And, how will information gathered through the Advance Notification program shape the GI Gold Card prior authorization program that UnitedHealthcare plans to implement in 2024?

Dr. Jung asked for a written response to each of these three issues and a meeting to discuss concerns and questions.

She stated that the Advance Notification Program was launched without adequate communication to gastroenterologists, plus the AGA, the American College of Gastroenterology, and the American Society of Gastrointestinal Endoscopy have had questions and concerns that haven’t yet been addressed.

“Despite multiple requests, you have not shared any UnitedHealthcare-specific overuse or variation data on a code-by-code basis that would warrant such a burdensome process. Please share the deidentified aggregate data. Absent data, there is no rationale for such a policy. The Advance Notification program directly contradicts UnitedHealthcare’s publicly stated goals of reducing administrative burden and streamlining access to care – goals we support and encourage you to work toward in the gastroenterological specialty. In contrast, Advance Notification is imposing significant administrative burdens on physician practices, which will negatively impact patient access to timely, medically necessary care,” she wrote.
 

Practice burden

“The chaotic rollout of the new data reporting requirements led to widespread confusion throughout the gastroenterological community and has since forced physicians and staff to spend multiple hours every day completing reporting requirements for data that UnitedHealthcare already has through claims forms. This is a serious drain on gastroenterology practices’ time, staff, and resources – which should be entirely focused on patient care, not reams of paperwork,” Dr. Jung wrote.

AGA members have stated that:

• Most local UHC representatives are unaware of the Advance Notification Program for GI endoscopy program and are unable to advise them regarding concerns or problems.
• Local UHC representatives have no information on the Gold Card program and how it might operate.

Many practices report they have not received any follow-up from UHC requesting additional records via the Advance Notification Program.

Some large GI practices report it takes their staff 5-7 minutes per patient to enter the required data. Others quantify the additional work of participating in the advance notification program as 25%-35% more work than before the program was implemented.

Practices with large UHC volume report having to divert multiple staff to work full-time on UHC accounts.

All practices report that they are required to input/upload the same clinical information as other UHC prior authorizations. Some practices additionally take a screenshot of the statement that the procedure does not require precertification and place it in the patient notes as a precaution in case issues arise in the future.

GI practices that have tried to use the telephone number to report a change in procedure report spending an average of an hour on hold per case.

Dr. Jung said that “given these challenges, many practices are not participating” in the advance notification program.

“AGA is troubled by the serious lack of specific details about the Gold Card prior authorization program to date. With less than 6 months until 2024, UnitedHealthcare has not issued any details about eligibility criteria, participation, or what new prior authorization requirements may be implemented for practices that do not qualify for a Gold Card. We resolutely oppose the implementation of any type of preauthorization requirements for colonoscopies and endoscopies. We are medical practitioners who have years of training and experience treating patients. Our medical decisions are evidence-based, which no prior authorization policy can claim.

“As you recognized when announcing UnitedHealthcare will slash prior authorization requirements by 20% earlier this spring, requiring physicians to apply for and receive preapproval before being able to deliver medically necessary care is not just frustrating – it is disruptive and dangerous for patients’ health. This is particularly true when it comes to performing colonoscopies and endoscopies, which are vital for detecting and monitoring diseases such as inflammatory bowel disease and colorectal cancer, the second deadliest form of cancer in the United States.

“AGA stands ready to partner with UnitedHealthcare on mutually beneficial educational initiatives to promote appropriate use of endoscopy procedures. However, we reiterate our call for UnitedHealthcare to halt the confusing and burdensome Advance Notification Program – and scrap plans to implement a Gold Card prior authorization program as planned in 2024. Instead, we invite UnitedHealthcare to work collaboratively with us to develop programs that improve quality of care without creating barriers to treatment for patients and unnecessary and inappropriate administrative burdens for physicians. We urge you to stop the Advance Notification and any prior authorization programs impacting GI endoscopy and directly engage with AGA to ensure patients’ continued access to high-value, patient-centered endoscopy care. Please contact Leslie Narramore at lnarramore@gastro.org at your earliest convenience so we can resume our dialogue.”

Dr. Jung closed the letter urging UHC to stop the advance notification program and planned prior authorization programs and instead engage in a dialogue with AGA about the issues.

To read Dr. Jung’s letter in full, see https://shorturl.at/dhjyH.
For updates on the AGA campaign to stop UHC’s prior authorization plans, visit www.gastro.org/StopUHC.

On Aug. 1, AGA president Barbara H. Jung, MD, AGAF, wrote to UnitedHealthcare’s chief medical officer, Rhonda Randall, DO, to express continued concern about the company’s Advance Notification Program for gastrointestinal endoscopy procedures, which took effect June 1, and UnitedHealthcare’s proposed “Gold Card” prior authorization program planned for 2024.

AGA

Dr. Jung made three requests: A request for UnitedHealthcare’s deidentified aggregate data on which the Advance Notification program is based.

She asked for clarification in regards to gastroenterologists who opt not to participate in the Advance Notification program. Will they be automatically subject to prior authorization when UnitedHealthcare implements the 2024 Gold Card program?

And, how will information gathered through the Advance Notification program shape the GI Gold Card prior authorization program that UnitedHealthcare plans to implement in 2024?

Dr. Jung asked for a written response to each of these three issues and a meeting to discuss concerns and questions.

She stated that the Advance Notification Program was launched without adequate communication to gastroenterologists, plus the AGA, the American College of Gastroenterology, and the American Society of Gastrointestinal Endoscopy have had questions and concerns that haven’t yet been addressed.

“Despite multiple requests, you have not shared any UnitedHealthcare-specific overuse or variation data on a code-by-code basis that would warrant such a burdensome process. Please share the deidentified aggregate data. Absent data, there is no rationale for such a policy. The Advance Notification program directly contradicts UnitedHealthcare’s publicly stated goals of reducing administrative burden and streamlining access to care – goals we support and encourage you to work toward in the gastroenterological specialty. In contrast, Advance Notification is imposing significant administrative burdens on physician practices, which will negatively impact patient access to timely, medically necessary care,” she wrote.
 

Practice burden

“The chaotic rollout of the new data reporting requirements led to widespread confusion throughout the gastroenterological community and has since forced physicians and staff to spend multiple hours every day completing reporting requirements for data that UnitedHealthcare already has through claims forms. This is a serious drain on gastroenterology practices’ time, staff, and resources – which should be entirely focused on patient care, not reams of paperwork,” Dr. Jung wrote.

AGA members have stated that:

• Most local UHC representatives are unaware of the Advance Notification Program for GI endoscopy program and are unable to advise them regarding concerns or problems.
• Local UHC representatives have no information on the Gold Card program and how it might operate.

Many practices report they have not received any follow-up from UHC requesting additional records via the Advance Notification Program.

Some large GI practices report it takes their staff 5-7 minutes per patient to enter the required data. Others quantify the additional work of participating in the advance notification program as 25%-35% more work than before the program was implemented.

Practices with large UHC volume report having to divert multiple staff to work full-time on UHC accounts.

All practices report that they are required to input/upload the same clinical information as other UHC prior authorizations. Some practices additionally take a screenshot of the statement that the procedure does not require precertification and place it in the patient notes as a precaution in case issues arise in the future.

GI practices that have tried to use the telephone number to report a change in procedure report spending an average of an hour on hold per case.

Dr. Jung said that “given these challenges, many practices are not participating” in the advance notification program.

“AGA is troubled by the serious lack of specific details about the Gold Card prior authorization program to date. With less than 6 months until 2024, UnitedHealthcare has not issued any details about eligibility criteria, participation, or what new prior authorization requirements may be implemented for practices that do not qualify for a Gold Card. We resolutely oppose the implementation of any type of preauthorization requirements for colonoscopies and endoscopies. We are medical practitioners who have years of training and experience treating patients. Our medical decisions are evidence-based, which no prior authorization policy can claim.

“As you recognized when announcing UnitedHealthcare will slash prior authorization requirements by 20% earlier this spring, requiring physicians to apply for and receive preapproval before being able to deliver medically necessary care is not just frustrating – it is disruptive and dangerous for patients’ health. This is particularly true when it comes to performing colonoscopies and endoscopies, which are vital for detecting and monitoring diseases such as inflammatory bowel disease and colorectal cancer, the second deadliest form of cancer in the United States.

“AGA stands ready to partner with UnitedHealthcare on mutually beneficial educational initiatives to promote appropriate use of endoscopy procedures. However, we reiterate our call for UnitedHealthcare to halt the confusing and burdensome Advance Notification Program – and scrap plans to implement a Gold Card prior authorization program as planned in 2024. Instead, we invite UnitedHealthcare to work collaboratively with us to develop programs that improve quality of care without creating barriers to treatment for patients and unnecessary and inappropriate administrative burdens for physicians. We urge you to stop the Advance Notification and any prior authorization programs impacting GI endoscopy and directly engage with AGA to ensure patients’ continued access to high-value, patient-centered endoscopy care. Please contact Leslie Narramore at lnarramore@gastro.org at your earliest convenience so we can resume our dialogue.”

Dr. Jung closed the letter urging UHC to stop the advance notification program and planned prior authorization programs and instead engage in a dialogue with AGA about the issues.

To read Dr. Jung’s letter in full, see https://shorturl.at/dhjyH.
For updates on the AGA campaign to stop UHC’s prior authorization plans, visit www.gastro.org/StopUHC.

On Aug. 1, AGA president Barbara H. Jung, MD, AGAF, wrote to UnitedHealthcare’s chief medical officer, Rhonda Randall, DO, to express continued concern about the company’s Advance Notification Program for gastrointestinal endoscopy procedures, which took effect June 1, and UnitedHealthcare’s proposed “Gold Card” prior authorization program planned for 2024.

AGA

Dr. Jung made three requests: A request for UnitedHealthcare’s deidentified aggregate data on which the Advance Notification program is based.

She asked for clarification in regards to gastroenterologists who opt not to participate in the Advance Notification program. Will they be automatically subject to prior authorization when UnitedHealthcare implements the 2024 Gold Card program?

And, how will information gathered through the Advance Notification program shape the GI Gold Card prior authorization program that UnitedHealthcare plans to implement in 2024?

Dr. Jung asked for a written response to each of these three issues and a meeting to discuss concerns and questions.

She stated that the Advance Notification Program was launched without adequate communication to gastroenterologists, plus the AGA, the American College of Gastroenterology, and the American Society of Gastrointestinal Endoscopy have had questions and concerns that haven’t yet been addressed.

“Despite multiple requests, you have not shared any UnitedHealthcare-specific overuse or variation data on a code-by-code basis that would warrant such a burdensome process. Please share the deidentified aggregate data. Absent data, there is no rationale for such a policy. The Advance Notification program directly contradicts UnitedHealthcare’s publicly stated goals of reducing administrative burden and streamlining access to care – goals we support and encourage you to work toward in the gastroenterological specialty. In contrast, Advance Notification is imposing significant administrative burdens on physician practices, which will negatively impact patient access to timely, medically necessary care,” she wrote.
 

Practice burden

“The chaotic rollout of the new data reporting requirements led to widespread confusion throughout the gastroenterological community and has since forced physicians and staff to spend multiple hours every day completing reporting requirements for data that UnitedHealthcare already has through claims forms. This is a serious drain on gastroenterology practices’ time, staff, and resources – which should be entirely focused on patient care, not reams of paperwork,” Dr. Jung wrote.

AGA members have stated that:

• Most local UHC representatives are unaware of the Advance Notification Program for GI endoscopy program and are unable to advise them regarding concerns or problems.
• Local UHC representatives have no information on the Gold Card program and how it might operate.

Many practices report they have not received any follow-up from UHC requesting additional records via the Advance Notification Program.

Some large GI practices report it takes their staff 5-7 minutes per patient to enter the required data. Others quantify the additional work of participating in the advance notification program as 25%-35% more work than before the program was implemented.

Practices with large UHC volume report having to divert multiple staff to work full-time on UHC accounts.

All practices report that they are required to input/upload the same clinical information as other UHC prior authorizations. Some practices additionally take a screenshot of the statement that the procedure does not require precertification and place it in the patient notes as a precaution in case issues arise in the future.

GI practices that have tried to use the telephone number to report a change in procedure report spending an average of an hour on hold per case.

Dr. Jung said that “given these challenges, many practices are not participating” in the advance notification program.

“AGA is troubled by the serious lack of specific details about the Gold Card prior authorization program to date. With less than 6 months until 2024, UnitedHealthcare has not issued any details about eligibility criteria, participation, or what new prior authorization requirements may be implemented for practices that do not qualify for a Gold Card. We resolutely oppose the implementation of any type of preauthorization requirements for colonoscopies and endoscopies. We are medical practitioners who have years of training and experience treating patients. Our medical decisions are evidence-based, which no prior authorization policy can claim.

“As you recognized when announcing UnitedHealthcare will slash prior authorization requirements by 20% earlier this spring, requiring physicians to apply for and receive preapproval before being able to deliver medically necessary care is not just frustrating – it is disruptive and dangerous for patients’ health. This is particularly true when it comes to performing colonoscopies and endoscopies, which are vital for detecting and monitoring diseases such as inflammatory bowel disease and colorectal cancer, the second deadliest form of cancer in the United States.

“AGA stands ready to partner with UnitedHealthcare on mutually beneficial educational initiatives to promote appropriate use of endoscopy procedures. However, we reiterate our call for UnitedHealthcare to halt the confusing and burdensome Advance Notification Program – and scrap plans to implement a Gold Card prior authorization program as planned in 2024. Instead, we invite UnitedHealthcare to work collaboratively with us to develop programs that improve quality of care without creating barriers to treatment for patients and unnecessary and inappropriate administrative burdens for physicians. We urge you to stop the Advance Notification and any prior authorization programs impacting GI endoscopy and directly engage with AGA to ensure patients’ continued access to high-value, patient-centered endoscopy care. Please contact Leslie Narramore at lnarramore@gastro.org at your earliest convenience so we can resume our dialogue.”

Dr. Jung closed the letter urging UHC to stop the advance notification program and planned prior authorization programs and instead engage in a dialogue with AGA about the issues.

To read Dr. Jung’s letter in full, see https://shorturl.at/dhjyH.
For updates on the AGA campaign to stop UHC’s prior authorization plans, visit www.gastro.org/StopUHC.

The AGA Research Foundation plays an important role in medical research by providing grants to young scientists at a critical time in their careers. AGA’s flagship award is the Research Scholar Award (RSA), which provides career development support for young investigators in gastroenterology and hepatology research.

The AGA Research Awards program has a significant impact on digestive disease research.

• More than $58 million has been awarded in research grants.
• More than 1,000 scientists have been awarded grants.
• Over the first 30 years of the Research Scholar Awards program, 57% of RSA recipients subsequently received at least one NIH R01 award, with 5 years on average between the RSA and first R01. Collectively, this group of investigators has secured 280 distinct R01 or equivalent awards.

Funded by the generosity of donors, the AGA Research Foundation’s research award program ensures that we are building a community of researchers whose work serves the greater community and benefits patients.

“In order to produce truly innovative work at the forefront of current discoveries, donations to research in GI are essential and cannot be replaced by other funding sources,” states Kathleen Curtius, PhD, MS, 2022 AGA Foundation Research Scholar Award recipient.

Join others in supporting the AGA Research Foundation. You will ensure that young researchers have opportunities to continue their lifesaving work. Your tax-deductible contribution supports the Foundation’s research award program, including the RSA, which ensures that studies are funded, discoveries are made, and patients are treated.

To learn more or to make a contribution, visit www.foundation.gastro.org.

The AGA Research Foundation plays an important role in medical research by providing grants to young scientists at a critical time in their careers. AGA’s flagship award is the Research Scholar Award (RSA), which provides career development support for young investigators in gastroenterology and hepatology research.

The AGA Research Awards program has a significant impact on digestive disease research.

• More than $58 million has been awarded in research grants.
• More than 1,000 scientists have been awarded grants.
• Over the first 30 years of the Research Scholar Awards program, 57% of RSA recipients subsequently received at least one NIH R01 award, with 5 years on average between the RSA and first R01. Collectively, this group of investigators has secured 280 distinct R01 or equivalent awards.

Funded by the generosity of donors, the AGA Research Foundation’s research award program ensures that we are building a community of researchers whose work serves the greater community and benefits patients.

“In order to produce truly innovative work at the forefront of current discoveries, donations to research in GI are essential and cannot be replaced by other funding sources,” states Kathleen Curtius, PhD, MS, 2022 AGA Foundation Research Scholar Award recipient.

Join others in supporting the AGA Research Foundation. You will ensure that young researchers have opportunities to continue their lifesaving work. Your tax-deductible contribution supports the Foundation’s research award program, including the RSA, which ensures that studies are funded, discoveries are made, and patients are treated.

To learn more or to make a contribution, visit www.foundation.gastro.org.

The AGA Research Foundation plays an important role in medical research by providing grants to young scientists at a critical time in their careers. AGA’s flagship award is the Research Scholar Award (RSA), which provides career development support for young investigators in gastroenterology and hepatology research.

The AGA Research Awards program has a significant impact on digestive disease research.

• More than $58 million has been awarded in research grants.
• More than 1,000 scientists have been awarded grants.
• Over the first 30 years of the Research Scholar Awards program, 57% of RSA recipients subsequently received at least one NIH R01 award, with 5 years on average between the RSA and first R01. Collectively, this group of investigators has secured 280 distinct R01 or equivalent awards.

Funded by the generosity of donors, the AGA Research Foundation’s research award program ensures that we are building a community of researchers whose work serves the greater community and benefits patients.

“In order to produce truly innovative work at the forefront of current discoveries, donations to research in GI are essential and cannot be replaced by other funding sources,” states Kathleen Curtius, PhD, MS, 2022 AGA Foundation Research Scholar Award recipient.

Join others in supporting the AGA Research Foundation. You will ensure that young researchers have opportunities to continue their lifesaving work. Your tax-deductible contribution supports the Foundation’s research award program, including the RSA, which ensures that studies are funded, discoveries are made, and patients are treated.

To learn more or to make a contribution, visit www.foundation.gastro.org.

Without help from other funding sources, talented young investigators struggle to continue their research, build their research portfolios, and obtain future federal funding. This leads to promising investigators walking away from GI research frustrated by a lack of support. Investigators in the early stages of their careers are particularly hard hit.

Decades of research have revolutionized the care of many digestive disease patients. These patients, as well as everyone in the GI field – clinicians and researchers alike – have benefited from discoveries made by dedicated investigators, past and present.

Creative young researchers are poised to make groundbreaking discoveries that will shape the future of gastroenterology. Unfortunately, declining government funding for biomedical research puts this potential in jeopardy. We’re at risk of losing an entire generation of researchers if we don’t act now.

To fill this gap, the AGA Research Foundation invites you to support young investigators’ research careers, allowing them to make discoveries that could ultimately improve patient care and even cure diseases.

“We are at the threshold of key research advances that will cure digestive diseases. We have the manpower, we have trained the people, now we need to have the security that they can stay in research and advance these cures,” said Kim Elaine Barrett, PhD, AGAF, AGA legacy society donor and AGA governing board member.

AGA

Without help from other funding sources, talented young investigators struggle to continue their research, build their research portfolios, and obtain future federal funding. This leads to promising investigators walking away from GI research frustrated by a lack of support. Investigators in the early stages of their careers are particularly hard hit.

Decades of research have revolutionized the care of many digestive disease patients. These patients, as well as everyone in the GI field – clinicians and researchers alike – have benefited from discoveries made by dedicated investigators, past and present.

Creative young researchers are poised to make groundbreaking discoveries that will shape the future of gastroenterology. Unfortunately, declining government funding for biomedical research puts this potential in jeopardy. We’re at risk of losing an entire generation of researchers if we don’t act now.

To fill this gap, the AGA Research Foundation invites you to support young investigators’ research careers, allowing them to make discoveries that could ultimately improve patient care and even cure diseases.

“We are at the threshold of key research advances that will cure digestive diseases. We have the manpower, we have trained the people, now we need to have the security that they can stay in research and advance these cures,” said Kim Elaine Barrett, PhD, AGAF, AGA legacy society donor and AGA governing board member.

AGA

Without help from other funding sources, talented young investigators struggle to continue their research, build their research portfolios, and obtain future federal funding. This leads to promising investigators walking away from GI research frustrated by a lack of support. Investigators in the early stages of their careers are particularly hard hit.

Decades of research have revolutionized the care of many digestive disease patients. These patients, as well as everyone in the GI field – clinicians and researchers alike – have benefited from discoveries made by dedicated investigators, past and present.

Creative young researchers are poised to make groundbreaking discoveries that will shape the future of gastroenterology. Unfortunately, declining government funding for biomedical research puts this potential in jeopardy. We’re at risk of losing an entire generation of researchers if we don’t act now.

To fill this gap, the AGA Research Foundation invites you to support young investigators’ research careers, allowing them to make discoveries that could ultimately improve patient care and even cure diseases.

“We are at the threshold of key research advances that will cure digestive diseases. We have the manpower, we have trained the people, now we need to have the security that they can stay in research and advance these cures,” said Kim Elaine Barrett, PhD, AGAF, AGA legacy society donor and AGA governing board member.

AGA