I'm Colleen Schmidt, and it's my pleasure, thanks to Ferga and Klaus, to talk to you about ASGE and the potential role ASGE will play in your future. Here's some key facts. This group was an iteration of what was originally a gastroscopy club that was started right here in Chicago by a few like-minded physicians, including Rudolf Schindler, who immigrated from Germany after his father was arrested during World War II. And when I first joined ASGE back in 1950, it was a very small organization. I'm just kidding. When I joined, there was a very small office in one of these outlying suburbs. The administrative staff was outsourced. The first innovative thing that was started under an earlier president, I think Chris Gestalt's leadership was the first hands-on lab, which could fit in Lyle's closet back there. And you can see how the organization has grown. One of the early dreams back in the 90s and 2000s was that we would have a teaching facility just like this. So, so glad you're here and joining us. So glad we're here and joining it together in person. During that nearly 100 years, the focus of ASGE has been dedicated to advancing patient care and digestive health through excellence and innovation in gastrointestinal endoscopy. And it is truly a profession and a discipline that I think is tremendously fun and rewarding just because of experiences like this. We have now more than 14,000 members worldwide, and this group serves really to create and provide the highest standards for endoscopic training and practice, serve as a resource for endoscopic education and research, and recognize distinguished contributions to endoscopy. And I don't just mean the innovation, the research, the education, the training, but also the other front lines of practice management and other services. I consider this my professional home. I told Klaas I haven't been here in two years, and really when I drove back up to the building yesterday it gave me kind of a warm fuzzy. But we've conducted, as you know, hundreds and hundreds of hands-on and didactic courses here. And the staff live upstairs. This building was meant to be used, and you will see that today as you visit different parts of the building and sit down with faculty in more intimate conversations. The ASGE cultivates this kind of relationship. It's an organization for which all members should feel valued and have access to involvement and opportunities. And that's what you're being invited to do this weekend, is enjoy this organization, this culture, this family, and see where you might fit in the future. We want it to be an organization that's valuable to you at every level and during every stage of your career. So you may remember when you were here as first-year fellows. Now you're more senior fellows. You'll be going into practice or academia or employment. There will be something, many things, about ASGE for which you can take an opportunity regardless of your gender, your age, racial or ethnic group, orientation, or geographical location. So in broad strokes, these are some of the pillars of what ASGE provides to you through your membership. It's really important that you translate that training membership over to a full and active membership and avail yourself of all the educational, clinical, practical resources, the networking, the connections and connectivity, and staying engaged and informed, coming from the health and public policy, practice management area. I'll highlight that at the end of my talk. As you can see, the educational part of this is led by a guy that's extremely enthusiastic but supported by a number of committees who are equally enthusiastic and excited about the concept of education. And the best part of it is that education occurs from the level of residents to fellows all the way up to senior members of the organization. And they realize it's not a one-size-fits-all, certainly not these days. So the education is ready to be delivered to you the way you need it to be delivered. And thank goodness this is a cutting-edge group because they were more than ready to tackle the educational needs of the membership full-on, even when no one could meet together. And now we are back together but have a blended audience with many attending virtually. We are all, I hope, lifelong learners. That's one of the enjoyable things about being a physician. And there are a lot of tools in the ASGE toolbox to help you continue to be a lifelong learner. I've talked to several folks here this weekend about how they learn through podcasts that they listen to in their car or while they're exercising. Some who prefer just watching a video, a webinar, a podcast in between cases. And even moving into the areas of gamification. I've actually not seen that, but I'll look forward to it based on our Jeopardy experience. How many of you do a quick look for a video or a tech talk before you start on a procedure you might not be familiar with? These are things that are available to us all the time. And thank goodness they are really in bite-sized pieces. So they're not only quick references, but they're a library that you can use to build your own portfolio of experience and information. The organization stays on the cutting edge with publications and do that in a variety of creative ways. So the signature journal, GIE, followed a few years ago by Video GIE, which also provides an interesting audiovisual way to learn. Everyone here is familiar with practice guidelines. They were just referenced in the Jeopardy game several times. Those are something that you'll find that you'll download onto your computer laptop, onto your work surfaces in the endoscopy lab, along with technology reviews, and provide really frequently resourced areas of information for us to use every day in our practice. Some of the other ones, again, are just the ASGE's way to create an on-the-spot but very quick reference for you to keep you up to date. A good example of that would be the journal scan, tech talks, and the clinical video tips. One of the newer ones in the portfolio is the Advocate. I think this was started by Klaus this year, actually. And this is to bring timely healthcare-related issues into a discussion that can be highlighted. These are about 30-minute, one-on-one discussions with content experts about issues that impact us day-to-day in practice but don't really lend themselves well, perhaps, to an article or wouldn't seem as timely and as interesting. The first one that he did was with Doug Rex, and it was actually in response to some legislation – we'll talk about how that ties in with it later – that limited prescribing authority for bowel preparations. And that is something, whether or not you know it, that impacts all of us about 20 times a day and creates burdens on practices, burdens on your administrative staff and schedulers. And there's ways we can try to work back to redirect those efforts. Through these publications, you have access to the most current in science and innovation in GI endoscopy. And I like the way we're able to roll these out from everywhere, from peer-reviewed research to reviews. The solutions that we have in place through ASGE that seem more behind the scenes are some of these. And as fellows, you may not be as familiar with these than those who are already in practice or practicing in an academic or employed setting. We have entire teams of physicians on our reimbursement committee, our practice management committee and others that volunteer their time and develop significant, sometimes highly specialized expertise in moving along the needs of our patients and our colleagues through specific coding-related issues, reimbursement-related issues, providing decision tools. AI tools for practices. And although this may be something that wouldn't be on your bedside table, some of the benchmarking data that they've developed over the last 15 years is unique to our areas of practice and are ones that we use whenever we're looking back at some of the benchmarking around our endoscopy units and how our performance compares with normative behaviors. The GI Quick Registry is a partnership with the ACG. It's one of the highest-ranked registries in the world with an extremely high participation rate. I can talk more about that later. Our quality, safety, compliance resources are superb. We now also have onboarding resources for staff and then office-based, web-based solutions for practices called Office Site. These are some of the more practical solutions ASGE has created for practices like mine and Joe's. There are courses, didactic, in-person, combined, blended with webinars, podcasts on just the practical solutions and challenges that we face every day in practice. The benchmarking survey I talked about. The ASGE Endoscopic Recognition Unit Program is one that we actively participate in. And then the two publications, including the benchmarking data and the coding primer that I think is unique to ASGE's work effort. You may have heard of the benchmarking data around the GI Quick Registry. How many of your units where you work now participate in benchmarking, let's say, of any kind around, let's pick colonoscopy quality metrics? So some hands. And of those, do you know if it's the GI Quick Registry? All right. So some of those may be, it is GI Quick Registry. Okay, thank you. I didn't see that. This registry was launched, as you may recall, 10 years ago, around quality metrics in colonoscopy. Now we have over 10 million colonoscopies recorded in that registry. Upper endoscopy was added as the next module. And we will be launching more cognitive modules in the future. That's a work in progress. Having an improved infrastructure is allowing us to expand that registry, and we're really excited about the direction it's going in. As I mentioned earlier, I think this is really the place and time to help you understand translate a trainee membership into a full and active membership in ASGE and and really through your conversations with some of the folks here but also your colleagues, hopefully your faculty and those that you meet in the future and some of the small groups are really where you can connect with ASGE and it is a terrific area to develop learning cohorts, support cohorts, people you can just bounce questions off of. You're a cohort here that probably are developing friendships and relationships that will last the rest of your career so it won't just be the folks that were on the Baylor team but the folks that cross over and meet outside on that patio and that's one of the intents of a program like this. There are any number of places where you can get engaged. The folks that appoint the individuals to committees are the vice the immediate, class I'm blanking on the right word, the president-elect, thank you. The president-elect is the individual that appoints folks to the committee. Once the individual is already president those committee selections are done. If you are interested in participating I would encourage you to go to the website and fill out that application form but be be thoughtful about that. Go ahead and open it up and look at it but you will be asked what are your particular areas of interest so take a look at the committees. Evaluate what you might be interested in. We're always interested in growing our bench in some of these areas and then some of the committees there are many more applicants than there are spots on the committee. Rank those in order of interest and recognize you might not get your first wish, you might not get your second wish, you might need to reapply next year but if you don't put down any wish they really won't understand what it is that you're trying to what you're trying to do. They'll ask for a CV, three page limit to be attached to that and I would I would encourage you to do it and if you don't get on a committee this year try to get into a SIG, a special interest group that you might be interested in and see if that's really an area for potential engagement for you. Learn from that, learn from your own special interests or special skill sets or skill sets that you want to develop and then become involved. That is maybe some of the best advice I could give to you this weekend. If you choose to try to apply for a committee member I would suggest that you not not contact the individual directly but through one of the administrative staff write a letter expressing your interest again and have that sent to the president-elect. He'll collate that and send it all together and if you know someone who might advocate for you please ask them to do so. I'm asking the women especially to ask to do this. We tend to not ask and it it's not going to be done for you so if you are interested ask and and ask for support. There are new and novel programs that we have to develop leadership, to develop practice leadership and you've already heard Ferga talk about the new mentorship programs so a lot of good ways to engage and become involved in ASGE. Let me stop here and see if there are any questions about this. If I don't know Klaus can answer it. Yes. You said basically that the special interest groups are the easiest to get in first as like a stepping. A special interest group is something you basically can subscribe to. Okay. Those are often procedural based or condition based so for example bariatric started out like that. There'll be there's an EUS SIG. It's a practice management SIG. There's a women's SIG. Ferga? Yes. Say that louder. Invention and innovation SIG. Those of you who are entrepreneurial. Anybody else? All right. So as I mentioned this is advocacy is an area that's very dear to my heart. This is something that all of you can get involved in and these are some of the areas that are our articulated advocacy agenda this year. This is something that the committee sits down every year to work through with our excellent staff and then have this approved by the governing board because this really is the front-facing material that represent what ASGE believes is important to our regulatory agencies and our legislature. It's something that that you should familiarize yourself with. It's not terribly dry reading but I I think you need to know what these societies are trying to promote and actively trying to promote and I think you'll feel very comfortable with it. We have a strong voice on Capitol Hill for those who participate. We have good relationships with the health care liaisons and advisory staff for congressmen and women and our senators and it actually is a it is a tremendous amount of fun to sit down with them. If you would like to participate just let LaKeisha know you can do that with something as simple as online advocacy. They have a great supportive materials for that if you sign up to be part of that advocacy group. You'll receive an occasional, not many, an occasional email asking you to to be active and you'll be provided with a template suggestion for a letter that you could send to your congressperson or your senator and their staff. So it will outline the information for you. You can edit it and put it in your own words but remember most importantly these individuals are here to represent you as a constituent and for me I represent 570 Tennesseans. So you really will sit down with a voice that they want to hear and the most important thing is that you convey accurate factual information and are available to them as a resource. So where are we advocating right now during the August recess? The Safe Step Act. This is in response to the prior authorization hurdles that have been put in position over the last couple years. It's been an accelerated process of an insidious behavior that's been going on for decades but is really amped up and we're trying to push back to make sure that the right steps are in place for physician practices to be able to respond to prior authorization requirements and that patients know what to expect as well. The Improving Seniors Timely Access to Care Act relates to the prior authorization behavior. Then there's legislation in progress that's being led by the AMA to help avert 3.75% cut to the Medicare conversion factor and then finally legislation that will help us maintain telehealth flexibilities after the current PHE extension expires. ASG has a strong voice with regulatory agencies, with CMS. We regularly engage. In fact, we're in the process of responding to the proposed physician fee schedule rule. We always respond to the outpatient rule. We have members that have been involved since the beginning with development of the episode-based cost measures and we have full committees that help respond to MIPS in the next iteration, the MVP programs. We have members that work in an advisory capacity and review capacity for NIH, so not just grant recipients but those that help inform those committees. And through the work of some experts, they sit on advisory committees for the FDA. We've addressed as an organization issues such as the drug shortage and, of course, endoscopic reprocessing and disinfection. These are the areas we're currently engaged in, including the surprise billing interim rule, which will impact all of us, and the VA supremacy project, which kind of did an end run around state control over credentialing and scope of practice. We collaborate with a lot of like-minded stakeholders, so very broad issues. Of course, we'll work through AMA, but almost always we'll work together with our sister societies to create, with one voice, a response to advocacy-related issues. And this is what our successes have looked like. We've helped remove barriers to colorectal cancer screening with regard to co-pay, ensure that the ambulatory surgery center's financial update every year is using the same market basket as the hospital's, work to protect physician reimbursement for GI services, increase funding for CDC colorectal cancer control, inclusion of ASGE programming in the CMS-driven quality payment programs, and then, as I mentioned, serve on those working groups with CMS and the FDA. Working with colorectal cancer roundtable and in ASGE, we've created abundant patient awareness resources around this issue. And I will end with that, and thank you for your attention. Does the ASGE have a, like, a philosophy or an approach or a strategy to addressing how novel endoscopic technology, as it's approved by the FDA, is then coded by CMS for reimbursement? Yes, there actually is a very deliberate process. This has actually done that. Would you like to take that question? Sure. So there's a committee structure within ASGE that specifically focuses on reimbursement. It's currently headed by Glenn Littenberg. And we have representatives to all the various bodies. I'll refer to them in my breakout a little bit later, the CPT panel, the RUC. It's a frustratingly long process, and where all you hear your attendings complain about not getting paid for ESD for some of the newer things has to do with a clunky health care system that we have. But yes, we have a dedicated group of individuals who do that. And it's, is that now a separate committee, Joe? Is that correct? That used to be part of what we had as a practice management committee, and now we have it separately. I should be looking towards Ed here, not Joe. So yes, you do have a reimbursement committee dedicated to just what you're talking about as far as our representation with CPT RUC that meets periodically, you know, when hosted by the AMA. And then, and so we have representation on that. The practice operations really is focusing really more in the practical aspects of GI practice management, no matter which are small, medium, or large practices. And I think the value of that, Klaus, is that these really are two very different areas. So I think that allowed the ASG to really focus their expertise in these two different areas. They, it was really too broad a topic. Let's just call it practice management. And the reason I pointed to Joe is he used to be chairing the practice management committee, now practice operations committee, is now sitting on our board. And the other person you heard speaking up is currently chairing our special interest group on innovation, Drew Chambres, so if there's any interest in that area. And Klaus previously was our representative to the RUC, so that's the whole boilerplate. Very good.

American Society for Gastrointestinal Endoscopy

ASGE

patient care

digestive health

endoscopic training

endoscopic education