North American Society for Pediatric Gastroenterology, Hepatology & Nutrition

President’s Perspectives . . . . . . . . .B UK Li, MD • President, North American Society for Pediatric Gastroenterology, Hepatology & Nutrition

SUMMER 2009

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DDW– It was good to see a good many of you at the NASPGHANreception at DDW in early June. The energ y and collegiality ofNASPGHANees never ceases to amaze me. I heard about new babies,grumpy teenagers, graduations, weddings, anniversaries, and unexpectedsurgeries, all a part of life. At DDW, we had a great display of pediatric GIpresentations throughout the meeting in basic science, eosinophilicesophagitis, IBD, pediatric endoscopy, FGID and hepatitis sessions.

Summer –It has finally come upon most of you, but here in Milwaukee itis but a brief window in July–August bracketed between snow showers.What have I been doing? As one of the ‘sandwich’ generation, after getting our two kids out of the house and off the payroll, we just movedmy 89-year-old father from Kansas to a small condo down the hall. He reminisces with remarkable clarity about a life that spanned the earlychaotic years of the Chinese republic, just missing the Nanjing massacre, attending Nanjing University displaced to the far west of China, sailing to the U.S. to graduate school, watching Mao’s revolution force relatives to flee, and returning to China starting in 1972. A remarkable life that paralleled the political cataclysms of the 20th century. Me, I grew up inIowa.

The Economy– A lot has happened since I began my term as your President in San Diego in November 2008. At that time, it was easy towax poetically about ‘change’. Now many of us have experienced real‘painge’ within our practice and academic environments. Fortunately,most of us still have a job.

NASPGHAN– Looking on the bright side, we still have a healthy, leaner, and meaner fighting NASPGHAN organization and CDHNFfoundation with Margaret, Sandy and Kim. The essential core is you, our members who continue to make this organization better. This year,our Annual Meeting seeks to once again join learning with networking,perhaps never as important as it will be this year.

Annual Meeting –Kathy Schwarz and the organizing committee haveplanned a comprehensive meeting with educational innovation and endoscopy simulation. In a survey of training directors, we determined that our meeting attendance will be maintained within 10% of last year’s attendance. We will have a Postgraduate Course and two-day Annual Meeting. This year, it will be followed by a unique Sunday single topic symposium on GI Disorders in Autism sponsored by Autism Speaks. We will begin to integrate maintenance of certification activities into ourmeeting to help demystify part IV of the recertification process that willapply to many of us in 2011.

Conflictof Interest–The extensive revision of the Conflict of Interest Policy was led by Steve Schwarz, Kay Motil, Ivor Hill and David Gremse.The main tenet of the revised policy is full disclosure on a 6x 4 grid of financial activities and dollar ranges from < $1K to ≥ $25K adapted from the Duke University policy. No dollar amount automatically disqualifies members but any amount ≥$10K must be reviewed by a smallCOI committee. For guidelines committee members, the majority of thecommittee must have no conflict. This grid approach will be implementedfor all officers, chairs and committee members, speakers and nominees.

Practitioner’s Focus Group – Ian Leibowitz chairs the newly establishedPractitioners’ Focus Group. The group is comprised of proactive private,hospital-based and academic practitioners and serves as an advisory group to help the NASPGHAN and Annual Meeting better meet the specific practice and educational needs. If you have ideas or issues that should bebrought to the leadership, the designated path is through the Practitioner’sFocus Group (Ian) and Clinical Care and Quality Committee (SteveSchwarz).

VOL. 9, NO.2

“In the depth of winter, I finally learned that within me lay an invincible summer.” ~ Albert Camus

“Ah, summer, what power you have to make us suffer and like it.” ~ Russell Baker

“Being a child at home alone in the summer is a high-risk occupation. If you call your mother at work thirteen times an hour, she can hurt you.” ~ Erma Bombeck

N E W S

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Secretary-Treasurer’s Report . . . . . . . . 2

CDHNF Report . . . . . . . . . . . . . . . . . 3

2009 Annual Meeting Update . . . . . . 4

2nd Year Fellows Conference . . . . . . . . . 4

Committee Reports . . . . . . . . . . . . . . . 5

AAP Corner . . . . . . . . . . . . . . . . . . . . 6

Important Dates & Deadlines . . . . . . . 7

Meetings of Interest . . . . . . . . . . . . . . 7

Billing and Coding . . . . . . . . . . . . . . . 8

3rd Year Fellows Conference . . . . . . . . . 9

Advocacy Update . . . . . . . . . . . . . . . 10

Classifieds . . . . . . . . . . . . . . . . . . . . 11

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Secretary–Treasurer’s Report Dear Friends and Colleagues:Concerns about the economy and finances seem to be on everyone’s mind as we enter 2009. As I reported in the last newsletter, most ofNASPGHAN’s investments have been in money market accounts or other cash equivalents allalong, leaving us with more than 12 monthsof operating funds in reserve. However, our reserve fund holdings are notenough insurance to shelter us from the current economic realities.I had the privilege to participate with a talented group of dedicated NASPGHAN members in a Finance Strategic Planning Task Force atthis year’s leadership retreat. Our objectives were to develop a financial strategy that will continue to fund our core missions of education,research, and quality. We developed a survey that was distributed to all of the attendees at the retreat to gather input on services thatNASPGHAN could offer to provide opportunities for additional revenue to support our core missions. We also received responses fromthe group on budget priorities that NASPGHAN should continue to fund. Many ideas arose from this survey for programs that NASPGHAN members may find of interest. The top suggestion was to develop guidelines for NASPGHAN-designated “Centers of Excellence” to recognize institutions and divisions that provide outstanding clinicalcare in specific fields, e.g., Transplantation Medicine, Motility, IBD, Liver disease, Nutrition, etc. The second rated suggestion was to investigate the interest for an International Program to invite sponsorship through grant support to pediatric gastroenterologists aroundthe world to attend our Annual Meeting. The next highest rated proposal was to establish criteria to offer a “Master” designation programto recognize individuals who have made outstanding contributions to our specialty. Also recommended were developing programs for Maintenance of Certification.The top funding priorities from the survey results were continued funding of grants to support the future of our subspecialty–ouryoung investigators. Also highly endorsed was the continued funding of Clinical Practice Guidelines. Implementing any or all of these ideas would involve a great deal of dedication and effort from the membership. I would welcome input from all of you on your interest in these strategic planning ideas.

Best regards,

David Gremse, MDSecretary-Treasurer, NASPGHANLas Vegas, Nevada

2009 NASPGHAN Annual Meeting RegistrationIn NASPGHAN’s quest to be environmentally friendly, registration forms and details for the 2009 Annual Meeting in November will be available on-line, only. A registration brochure will not be mailed prior to the meeting this year. You will be able to register on-line or download and print the registration form and fax or mail the completed form to theNASPGHAN National Office. The materials will be posted soon.

Subsubspecialization Task Force –There is an increasing trend towardssubsubspecialization in transplant hepatology (i.e. Certificate of Added Qualification) that is spreading to motility and functional GI disorders, inflammatory bowel disease and therapeutic endoscopy. On the one hand,added expertise promotes specialized clinical care as well as clinical and research niches that potentially open more doors to new jobs and careers.On the other, how do we balance this potential against the few fellows who are willing to incur a fourth year? Hepatology (adult) wants to spawna separate training path and certification entirely separate from GI. ChrisDickinson, Estella Alonso, Karen Murray and Alan Leichtner will tacklethis sticky wicket.

What can I do in these challenging times? 1) Keep the faith, baby, and do what you do best . . . pediatric GI,

hepatology and nutrition.

2) Keep NASPGHAN going with your ideas, proactivity and collegiality.

3) And, come to the Annual Meeting! Uncle SPGHAN needs you!

I look forward to seeing you all in Washington in November.

Best Regards,

B UK Li, MDPresident, NASPGHANMilwaukee, WI

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CDHNF President’s ReportPresident CDHNF: William Balistreri, MD

DIGESTIVE HEALTH FOR LIFE CAMPAIGNS©

The Digestive Health for Life Campaigns© continue to develop new resources for our members, primary care providers, as well as family members and patients. Here is a look at what is new this summer:

FOR YOUR PATIENTS AND FAMILIES

IBD Family WebcastCDHNF hosted an IBD family webcast on Thursday, June 18 from12:30pm–2pm EST, during which a panel of healthcare professionalsand families affected by IBD gathered to stimulate conversation.Key issues related to Crohn’s disease and ulcerative colitis, includingsymptoms and diagnosis, treatment options, diet and its role in IBD,tips for working with healthcare providers and personal experiences were discussed. Dr. Maria Oliva-Hemker, co-chair of the CDHNF IBD Campaign and chief of the Division of Pediatric Gastroenterology and Nutrition at Johns Hopkins University School of Medicine, served as moderator.Dr. Joshua Korzenik, assistant professor of medicine at Harvard Medical School and director of the school’s Crohn’s and Colitis Centerfocused on adult IBD issues. Jenifer Hampsey, MS, RD, CSP, a pediatric nutritionist at the Johns Hopkins Children’s Center discussedthe importance of diet and nutrition in the overall management of patients with IBD.Support for this program was provided by Shire.

New Website for IBD Independent-Aged Patients Goes LiveWe are proud and excited to share our new website IBDU: Graduatingto Independence (www.ibdu.org). CDHNF and the Starlight Children’s Foundation joined forces tolaunch a new interactive resource for young adults with InflammatoryBowel Disease (IBD) who are preparing for college, vocational training,entrance into the workforce, or living independently. The four featured sections include: Education, Healthcare, Lifestyleand Self-Help with tips for employers, friends, parents and resourcesfor medical professionals.

Polling takes place on an ongoing basis with immediate results as towhat others are saying. Video segments highlighting real patient testimonials and advice dealing with work, school, family and friendswill be available this summer.The site provides answers for older teens and young adults to real lifechallenges and educational resources.Please feel free to use this flyer to direct your patients to the website.(http://www.cdhnf.org/user-assets/Documents/PDF/IBDUflier3.pdf )

Support for this program was provided by UCB Inc.

FOR YOU AND YOUR PEERS

New Eosinophilic Esophagitis Grand Rounds

A 20-city grand rounds program highlighting the EoE slide set will be launched this summer targeting specialists and primary care as well as physician extenders. Although our first phase provides supportfor 20 speakers, we hope to expand the grand rounds program next year. In the meantime, please feel free to use the slide set(http://www.cdhnf.org/wmspage.cfm?parm1=116) for presentationsin your local areas.Support for this program was provided by Ception Therapeutics and Meritage Pharma.

CME IBD Newsletter on IBD Classification (www.cdhnf.org)

The first CME IBD newsletter is now available.“Making the Right Diagnosis: Differentiating between Crohn’s Disease and Ulcerative Colitis in Children and Young Adults” will helppracticing physicians accurately classify their patients. Faculty includes: Chair–Athos Bousvaros, MD; Jennifer Strople, MD;Melanie Griefer, MD; Jeffrey Goldsmith, MD, and LeAnne Vitito, MS, RN, FNP-BC, CGRN. We are targeting pediatric and adultgastroenterologists as well as nurse practitioners and physicianassistants. An adaptation of the module is being prepared for the Journal of Gastrointestinal Nursing.

NASPGHAN and APGNN members will receive a copy of thenewsletter.

Support for this program was provided by Shire and Centocor.

William Balistreri Receives Distinguished Educator AwardCDHNF President, William F. Balistreri, MD, was awarded the American Gastroenterological Association (AGA) Distinguished Educator Award for his achievement as an outstanding educator over a lifelong career. Dr. Balistreri, also editor-in-chief of the Journal of Pediatrics, is the first pediatrician to receive this award.Dr. Balistreri is the Dorothy M.M. Kersten Professor of Pediatrics and associate chair, subspecialty education in the departmentof pediatrics at the University of Cincinnati College of Medicine, Ohio. He also is the director of the pediatric liver care center, the medical director of liver transplantation, and the program director of the fellowship in transplant hepatology inthe division of pediatric gastroenterology, hepatology and nutrition at the Cincinnati Children's Hospital Medical Center.

In presenting the award, Dr. Balistreri was recognized as follows: Dr. Balistreri’s efforts at the levels of medical school, residency programs, fellowship programs and CME activities reflect both a breadth anddepth of commitment to education that is unique. Through his leadership on the American Board of Pediatrics, he has had a major role in de-termining how pediatric gastroenterologists are trained, evaluated and certified since the process began in 1990. He has trained more than 50fellows in his program, many of whom are division chiefs, department chairs and hold full-time positions in academic pediatrics.

CONGRATULATIONS, BILL!

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During my first tutorial on “how to be President” meeting with B Li, John Barnard, and Margaret Stallings, I asked the three of them what they thought was the Number One strength of the organization. The response was unanimous: it’s the people in it! And during my first few very busy months as President-Elect I have found that to be so true: enthusiasm, brains, highstandards, energy, humor–it’s been such a pleasure and honor to be involved.One of the major highlights has been planning the Annual Meeting. At theLeadership Retreat this winter, there were many wonderful ideas thatsurfaced. We put the program together and I went back to Baltimore and sent out a series of email invitations to possible participants. The response was overwhelmingly positive and rapid. Many thanks to all those who said yes and did it so quickly.

Highlights of the Annual Meeting are many, including two distinguished invited speakers, Dr. Preston Campbell of the Cystic Fibrosis Foundation andDr. Steve James, Director of NIDDK. An outstanding and diverse faculty of NASPGHAN members has been assembled for the meeting. Programs include state-of-the-art, year-in-review formats for both clinical and basic science, 6 research abstract oral presentations and 3 poster sessions (covering basic science, clinical investigation, and clinical practice vignettes with oralpresentations of 6 Posters of Distinction on Friday and Saturday). In addition

there will be four concurrent clinical modules, including two new initiatives:a “virtual” Hepatitis B session with 5 small discussion groups and a multi- disciplinary team approach to the management of intestinal failure. The clinical modules have been redesigned to include a 30-minute case-based panel and audience discussion. And I’m delighted to report that there will betwo days of hands-on endoscopy sessions as well. It promises to be a fabulousmeeting at a lovely new venue – the Gaylord National Convention Center on the Potomac River in our nation’s capital. Your attendance is strongly encouraged!Another very active arm of NASPGHAN in which I’ve been involved is theAdvocacy Committee, headed by John Udall. We’ve made the bold decision togive CapWhiz a trial with the hope that this state-of-the-art tool will facilitatethe input of all NASPGHAN members into legislative priorities. As I think weall know, health care is changing at warp speed (or at least that’s the hope of thelegislators) and the Advocacy Committee believes that the time is ripe to speakup for important priorities such as manpower issues, pediatric GI researchfunding, and payor coverage of specialized nutritionals for our patients.In conclusion, I am honored to be the NASPGHAN President-elect and look forward to working with you to encourage the growth and development of this very wonderful organization!

Update on the 2009 Annual Meeting President-Elect, NASPGHAN: Kathy Schwarz, MD

NASPGHAN 2nd Year Pediatric Gastroenterology Fellows Conference

Tradition and Innovation: The 2nd Year Fellows’ Conference

Supported by a grant from Abbott Nutrition, the annual Second YearFellows’ Conference was held March 12–15 in Scottsdale, Arizona.Building on the themes of the first-year conference, the primary goalsof this conference were to promote continued scholarship and assistthe fellows in the difficult task of choosing a career pathway and finding a job. Sixty two fellows from across North America had the opportunity to interact with 12 faculty members representing the diverse community of NASPGHAN. Faculty members provided tips on running a lab, setting up a practice, designing multidisciplinaryprograms, crafting clinical practice guidelines, pursuing a career as amedical educator, directing multidisciplinary studies, performing clinical and translational research, and developing leadership skills.Small group sessions included in-depth discussions of individual careerplans and a new initiative focusing on ethical issues in pediatric gastroenterology. A highlight of the meeting was the presentationworkshop led by John Pohl who assigned fellows the task of presentingresearch findings to the “2009 Personal Obstipation in Observant Pediatricians Conference” in West Duck, Oklahoma. Based on the evaluations, the fellow participants greatly benefited by interacting withfaculty members and with each other, and the faculty appreciated this unique forum for teaching. Not only is the second-year conferencean invaluable experience for fellows, but it is also an opportunity formedical educators in NASPGHAN to bring innovation to fellow education.

H A N D S – O N E N D O S C O P Y C O U R S E TO B E O F F E R E D

A Pediatric Hands-On Endoscopy Course will be offered againon Friday October 2 and 3, 2009 in Oak Brook, Illinois. Theadvance registration deadline is August 25, 2009. The class islimited to 60 individuals and will be on a first-come, first-servedbasis. A waiting list will be maintained.

The course will be co-directed by Petar Mamula and JeniferLightdale and will feature a faculty of nine senior pediatric andtwo leading adult endoscopists. Course content will address theneeds of established pediatric endoscopists who are interested in improving their knowledge of familiar and new proceduraltechniques.

Emphasis will be placed on the specialized use of therapeutic endoscopy in infants and children, including both the limitationsand potential applications of advanced or unique techniques in pediatric patients. In particular, attendees will learn about various hemostasis techniques: including heater/bipolar probes,clipping techniques, argon plasma coagulation, variceal bandingand sclerotherapy. In addition, saline assisted polypectomy, balloon dilation, video capsule deployment, wireless pH probeplacement, and foreign body removal will also be covered.

This unique pediatric GI course will feature some presentationsand roundtable discussions, as well as extensive hands-on instruction at the Interactive Technology and Training (IT&T)Center at the Chicago headquarters of the American Societyof Gastrointestinal Endoscopy (ASGE).

Additional information can be found at www.naspghan.org

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Committee Reports

CLINICAL CARE AND QUALITY COMMITTEE

Chair: Steven M. Schwarz, MDOver the past year, the Clinical Care and Quality Committee (CCQ)has continued to seek ways of addressing pertinent issues that affect pediatric GI practice in both institution and community-based settings.As NASPGHAN membership has become increasingly clinically focused, our goal has been to assure that our society remains unified andcontinues to vigorously respond to the needs and concerns of a diversemembership. In this regard, CCQ has been actively involved in the following key areas:

Clinical Practice GuidelinesAs indicated in last summer’s newsletter, CCQ now serves as the primary review committee for both practice guideline and clinicalreport proposals. Any committee or NASPGHAN member seekingto propose a new clinical topic can obtain an application form from the National Office. Based upon the terrific response to ourNew Clinical Practice Guidelines session in San Diego, we will beholding a similar symposium at the upcoming annual meeting in National Harbor, MD. Topics to be presented for discussion include Probiotics in Pediatrics (David Mack), Nutritional Care of the Neurodevelopmentally Challenged Child (Kay Motil) and Skeletal Health in IBD (Helen Pappa). We look forward to anotherenergetic, standing room only crowd.Issues in Clinical Practice Based upon recent bulletin board postings, concerns regarding practice benchmarks (i.e. WRVUs) and other measures of performanceremain top-of-mind for many NASPGHAN members. At the Annual Meeting, CCQ has arranged a number of important presentations to address these critical concerns. Our Clinical PracticeForum will discuss issues of enhancing productivity and performancefor clinical practitioners in academic, hospital and group practice settings. Our speakers for this important symposium will be KathyMueller (of Billing and Coding fame), Mike Hart and Rob Squires.Kathy, in addition to her ever-popular B & C program, will also beavailable throughout one day of the meeting for one-to-one sessions.Professional-Pharma Relationships As the subject of industry influences on clinical practice have becomethe subject of intense debate in the literature and with recent, controversial articles in both NEJM and JAMA, our society has become increasingly concerned with the public’s perception of conflicts of interest within the biomedical community. Workingclosely with the NASPGHAN Council and Ethics Committee, we have developed a conflict of interest policy. The key element embodied in this document is the principle of full disclosure of all fiduciary relationships with commercial entities. This disclosure willbe required and posted for all candidates for NASPGHAN office aswell as for all committee chairs and committee members as we seekto achieve total transparency with respect to these associations.After three years, this is my final newsletter to membership as CCQChair. I have truly enjoyed leading this energetic and committedgroup as we have, hopefully, responded appropriately to the needsand concerns of our constituents. I would like to personally thankPhil Sherman, John Barnard and B Li who, as Presidents ofNASPGHAN, have demonstrated a real commitment to our clinically-focused membership. And, of course, none of our accomplishments would have been possible without the tireless support of Sandy Fasold and Margaret Stallings from the NationalOffice. I hope to see you all in National Harbor, MD!

NEUROGASTROENTEROLOGY ANDMOTILITY COMMITTEE

Chair: Samuel Nurko, MDThe vision of NASPGHAN leadership allowed the recent creation of the Neurogastroenterology and Motility Committee. This is an exciting time for the field as there have been many recent advances, bothin the area of functional bowel disorders and motility techniques. The Committee is acutely aware of the need to increase professionaleducation for our members, something that will translate into betterquality of care for the patients we serve. Therefore the Committee isworking on a) the development of educational modules for the betterunderstanding of functional gastrointestinal disorders, b) establishingguidelines and minimum standards for the performance of motility procedures, and c) developing educational and web based modules forthe membership to be able to understand and learn about differentmotility procedures. We are also exploring mechanisms to providehands-on training.The Committee is also participating with the Training Committee inthe development of training guidelines in functional and motility bothfor the general gastroenterology fellow, or the fellow that wants to obtain advanced training in the field. Another important area that we are trying to develop is related to public education, and we are exploring the possibility of launching some educational campaigns to increase public awareness and understanding of functional and motility disorders. Given the multidisciplinary nature of functional and motility disordersthe committee is trying to expand NASPGHAN’s reach by planningjoint symposia with our sisters societies during their respective AnnualMeetings, or during our annual meeting. This will allow for the crossfertilization that will be necessary for the advancement of the field. Finally, the Committee’s action plans are also focusing on trying to findmechanisms to support research efforts in Functional and Motility disorders.FELLOWS COMMITTEE

PUBLIC EDUCATION COMMITTEE

Chair: Philip L. Rogers, MDThe Public Education Committee continues to pursue an ambitiousagenda for NASPGHAN’s “public face” for patients and their families.Our brochures serve a worthwhile role in providing pediatric-focusedmaterial for our patients. There is no other website that carries as many topics on pediatric gastrointestinal disorders and procedures. Allbrochures are now reviewed on a yearly basis with major revisions performed on a three-year cycle. Many of the brochures now have linksto reputable websites with complementary disease information. In thenext year we hope to have all brochures appropriately “linked” to othersites that we have previewed and find useful. In this way we can provideguidance to our patients and their families as they research pediatric GI issues.Brochures are written in English, Spanish, French, and Portuguese. In the past year, efforts have been made to increase utilization of thesebrochures. To that end we have worked with the International Committee to promote our non-English teaching aids. Clearly, the marketing of our website needs to begin in earnest. This will start

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with the designation of an easy to remember “alias” so that families can readily access our published information. Unfortunately, the(www.naspghan.org) is not easy to remember or at all intuitive. Oncewe have the alias identified, this will be advertised through the mediato our membership, as well as, to pediatricians and to parents. Over the past year we have worked with the Digestive Diseases Information Clearinghouse and had several of our brochures and information sites linked to pamphlets already published by the DDIC.We are continuing to work closely with the Clearinghouse to exploreother collaborations particularly in the area of brochure creation.The process by which brochures are reviewed, revised, translated, andapproved remains a time-consuming process. This procedure is beingstreamlined to get changes published quickly and new brochures produced in a more timely fashion than is currently done. Our committee welcomes input from the membership on new brochuretopics, as well as, interesting and effective materials that could be linked to our website. If you have information you think should be posted, please email me at: dadthedoc@gmail.com

American Academy of Pediatrics CornerIt is my pleasure to announce that Leo Heitlingerhas been elected as incoming Chairperson, AAP Section on Gastroenterology, Hepatology andNutrition, effective November 1, 2009. Leo has served as a member of the SOGHN Executive Committeesince 2004 and will undoubtedly provide excellent leadership!

The SOGHN continues to work closely with NASPGHANand CDHNF to complete an eQIPP course on GER &GERD. The goal of this Web-based CME course is to provide tools and resources to help pediatric health careproviders recognize, differentiate, and manage GER &GERD. Furthermore, the eQIPP module will help satisfy aportion of our CME requirements. In addition, we continuein our efforts to “translate” several existing evidence-basedpolicies, including constipation and GER, into condensed,summary formats to disseminate to pediatricians. We welcomethe input and expertise of any NASPGHAN member whowishes to contribute to these important initiatives. Pleasecontact me if interested!

This year’s National Conference and Exhibition (NCE), the Annual Meeting for AAP members with over 11,000 attendees, will take place October 17-20, 2009, in Washington,D.C. This year, our Section’s program is titled, “All You Want to Know about Pediatric Obesity,” and will include prevention, co-morbidities, medical therapy, and surgicaltherapy. Sessions will also be presented on GER and GERD(to tie in with impending release of the eQIPP module),autism and the gastrointestinal tract, functional abdominalcomplaints, and infant formulas. The SOGHN has played a significant role in recommending topics specific to our specialty. Special thanks to Ivor Hill who serves as our NCEPlanning Group liaison.

Over the past 78 years, the AAP has become a powerful voicefor children’s health through education, research, advocacy,and expert advice. The AAP has demonstrated a continuingcommitment to working with medical facilities, includinghospitals and clinics, communities, and with state and federal governments to protect the well-being of children.Pediatricians with the drive to make a difference in child andadolescent health through Congress and/or state and federalagencies can become effective child advocates, from meetingwith local officials, participating in community action, offering testimony at local, state or national venues, or meeting with a representative or senator. If you have not already done so, please join the SOGHN in our efforts to enhance the visibility and role of experts in pediatric gastroenterology, hepatology, and nutrition to help educatethe pediatric community on issues pertinent to our field.

Have a great summer!

Mel Heyman, MDChair, AAP Section on Gastroenterology, Hepatology andNutritionE-Mail: mheyman@peds.ucsf.edu

�AASLD / NASPGHAN

Pediatric Symposium 2009October 30, 2009 ◆ Hynes Convention Center

The AASLD/NASPGHAN Pediatric Symposium 2009 willbe held on Friday, October 30, 2009 from 12:00pm–3:00pmduring the The Liver Meeting 2009 at the Hynes ConventionCenter in Boston. Registration for the event opens in July2009 and will be available at (www.aasld.org).

Directors for this year’s course, Iron and the Liver, are Drs.Kathleen Loomes and Karan Emerick. The symposium, designed for pediatric hepatologists, will review recent advances in iron homeostasis and metabolism and the liver’scentral role in these processes. Topics include current recommendations for screening and therapy in HFE-relatedhemochromatosis; genes in the iron metabolic pathways thathave now been identified as causing variants of juvenile onsethemochromatosis; neonatal hemochromatosis; managementof acquired overload in patients with thalessemia and sicklecell disease; novel modalities for non-invasive measurement of iron, and current literature on iron as a co-factor for otherliver diseases.

The Liver Meeting is AASLD’s 60th

Annual Meeting & Postgraduate Course.

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4 AUGUST 1, 2009Early Bird Deadline for NASPGHAN Annual Meeting and Postgraduate Course• Register online at (www.naspghan.org)

4 AUGUST 25, 2009Advance registration deadline for Hands-On Endoscopy Course• October 2–3, 2009 / Oak Brook, IL• Register online at (www.naspghan.org)

4 SEPTEMBER 14, 2009Advanced Deadline for NASPGHAN Annual Meeting and Postgraduate Course• Register online at (www.naspghan.org)

4 OCTOBER 17–18, 2009Collaborative Group of the Americas on Inherited Colorectal Cancer (CGA-ICA) 13th Annual Meeting• Hawaiian Hilton Village, Honolulu, Hawaii• Register online at (www.cgaicc.com)• Abstract deadline July 15, 2009

Contact: steve.erdman@nationwidechildrens.org

4 NOVEMBER 12–14, 2009NASPGHAN Annual Meeting andPostgraduate Course 2009• Gaylord National / National Harbor, MD

4 NOVEMBER 16, 20092009 Certifying Examination in Pediatric Gastroenterology• For further details, refer to American Board of

Pediatrics website (www.abp.org)

NASPGHAN Meetings &Important Deadlines

Meetings of Interest31st Annual Aspen Conference on Pediatric Gastrointestinal Disease

• Date: July 12–17, 2009• Location: Aspen, Colorado• Contact: Cincinnati Children’s Medical Center• Phone: 513.636.6732

ESPGHAN Translational Medicine Symposium

• Date: September 4–6, 2009• Location: Kings Health Partners / London, England

International Symposium on Pediatric Inflammatory Bowel Disease

• Date: September 9–12, 2009• Location: Paris, France• Contact: www.consensus.nih.gov

Hands-On Endoscopy Course

• Date: October 2–3, 2009• Location: Oak Brook, Il

AAP Annual Meeting National Conference & Exhibition

• Date: October 17–20, 2009• Location: Washington, DC

AASLD: The Liver Meeting 2009

• Date: October 30–November 3• Location: Hynes Convention Center, Boston

AASLD/NASPGHAN Pediatric Symposium 2009

• Date: Friday, October 30 / 12:00pm–3:00pm• Location: Hynes Convention Center, Boston• Topic: Iron and the Liver

1st Year Fellows Conference

• Date: January 14–27, 2010• Location: Fort Lauderdale, FL

2nd Year Fellows Conference

• Date: March 25–28, 2010• Location: Scottsdale, AZ

3rd Year Fellows Conference

• Date: April 15–18, 2010• Location: Scottsdale, AZ

Welcome New NASPGHAN Members

JAY FONG, MD

TANJA V.E. KRAL, PHD

SYLVIE CAYER, MD, FRCPC

ANDERS DAHLSTROM, MD, PHD

PRANAVKUMAR SHIVAKUMAR, PHD

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Billing &CodingProvided by Kathleen A. Mueller, RN, CPC, CCS–P, CCC Healthcare Consultant in association with McVey Associates, Inc.

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RED FLAG

This proposed rule, which was initially to become effective on November 1, 2008, has now been delayed until August 1, 2009.There has been an effort by the AGA as well as other medical societies to release physician offices from this mandate. Under theRed Flags Rules, financial institutions and creditors (Yes, physiciansare considered creditors) must develop a written program that identifies and detects the relevant warning signs – or “red flags”– ofidentity theft. These may include, for example, unusual account activity, fraud alerts on a consumer report, or attempted use of suspicious account application documents. The program must alsodescribe appropriate responses that would prevent and mitigate the crime and detail a plan to update the program. The program must be managed by the Board of Directors or senior employees of the financial institution or creditor, include appropriate staff training, and provide for oversight of any service providers. For moreinformation, type in “red flag” in your web browser.

MODIFIER 25 UPDATE

Due to the change in CCI policy, as previously mentioned in thewinter newsletter, there has been an increased denial for visits whenbilled with a procedure on the same date despite the use of modifier25 on the visit. There are some carriers that will not pay for a visiton the same date of a procedure as outlined in that particular payer’spolicies. Listed below are some tips to avoid denials:

When billing a visit on the same day of a procedure, the documentation for the visit should be separate from the procedure/endoscopy note.

Know each one of your payer/carriers policies on visits on thesame date as procedures.

Do monthly or quarterly E/M reviews on each provider and include visits billed with the 25 modifier. Utilize this data to educate/train your providers.

Even though the diagnosis code doesn’t have to differ for the visit and the procedure, it is recommended to use the symptom/condition for the visit and the significant finding for the procedure. If no finding during the procedure, the indication should be billed.

Just because you saw the patient before a scheduled proceduredoesn’t mean that you can bill a visit unless there is a change orcompletely unrelated problem.

Update all reimbursement staff in your office of any change inpolicy when it occurs. For example, some Cigna regional carriersare now requiring that progress notes be submitted at the time ofinitial claim submission when a visit is billed on the same date of a procedure. That information was sent to all the participationproviders in that region and should have been forwarded to theappropriate staff, including physicians and non-physician practitioners, in each one of the offices.

QUESTIONS AND ANSWERS

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Question: I was looking at the reports for our department and I noticed that we have very few nurse visits 99211 billed for our entire department. Upon further research, we have a large numberof patients who come in for weight checks for failure to thrive,weight checks for eating disorders, visits for specimen collection(breath tests) and these patients are not registered nor charged. In my mind this is money left on the table that does not recognizethe work nor expertise of the nurses who provide these services. If we were to begin to charge for these services, it is my understandingthat this must be a licensed provider (RN). What are the stipulationsfor supervision (i.e., must the MD be on site?) and documentation(RN or MD? If RN, must MD co-sign?)?

Answer: There are several issues addressed in that question. Any information or instructions given to the patient should be documented in the medical record for quality of care and medical/legal issues. This means that the patient should be registered. Evenif a charge can’t be entered on a patient because it is not a billablecharge, there should be some record that the patient was seen in theoffice that date. A nurse visit can be billed as 99211 if there is a faceto face with a patient and the documentation supports it. Thismeans that the visit has to be done incident to the physician’s ordersor treatment plan. The nurse needs to document what was done,instructed, etc. For example, constipation clinics, inflammatorybowel clinics, etc. This should be cosigned by the physician on sitethat date. In order to bill, there has to be a physician on site and thatis who it is billed under. If the patient came in to have their blooddrawn, to get kits for stool or for instructions prior to breath tests,that is just considered part of the technical reimbursement of the testand not separately reimbursable.

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Question: We have a patient that has come in several times to haveher port for a feeding tube replaced during office visits. We get theports from the GI Lab in the hospital. Can we bill something otherthan office visit?

Answer: Unfortunately, the answer to that is question is no. Thereis no code for this so it would be considered part of a visit. The levelof that visit would be based on the documentation.

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Question: One of my physicians did an EGD and then placed a pHprobe. It’s the hospital’s equipment, but my doctor will also interpretthe results. Any suggestions for the pH probe modifiers? -52 and -26?

Answer: When the hospital owns the equipment and your doctorplaces the probe, the only reimbursement you will receive would befor the interpretation of the study unless you endoscopically placethe probe. You would bill either 43200 or 43235 plus the pH studyperformed with a 26 modifier. The studies would be 91034 for thestandard pH, 91035 for the Bravo study and 91037 or 91038 fora combined pH and impedance study.

(continued)

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Question: If a patient had Ulcerative Colitis and had a total colectomy some time ago and now is admitted with pouchitis, is that still a part of the ulcerative colitis or is it complication997.4 ? I'm having a time trying to figure out the appropriate dx.The doctors are using 556.9 and pouchitis interchangeably. Ithought once you've had a total colectomy for UC, you know longerhad the disease but now have a history of UC.

Answer: You are right. Once the colon is removed, ulcerative colitis usually is considered taken care of and it becomes personalhistory. There is no specific code for pouchitis but would be 558.9(Other and unspecified noninfectious gastroenteritis and colitis).

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Question: My doctor did a procedure that I am not familiar with.How would you code this? "A 1 centimeter horizontal incision ismade after anesthesia with 1% Lidocaine. Then placed a Cookcatheter and needle apparatus into the gastric lumen. Through this was then placed a wire which was grasped with a snare and withdrawn out through the patient's mouth. To this we attached a

24 French traction removable percutaneous gastrostomy. Utilizinggeneral steady traction, this was withdrawn out through the gastrostomy tube site and secured in place. Next, the jejunal tube isopened. The guiding wire is then introduced per the percutaneousendoscopic gastrostomy and drug down into the fourth portion ofthe duodenum. Fluoroscopically, the jejunal tube is then placedover this wire and watched to go clearly within the fourth portionof the duodenum. This flushes easily."

Answer: Your doctor placed a PEG (percutaneous gastrostomytube) and then the tube is guided into the jejunum with the use ofendoscopy and fluoroscopy. The correct codes would be: 43246.Upper gastrointestinal endoscopy including esophagus, stomach,and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube 44373. Smallintestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneousgastrostomy tube to percutaneous jejunostomy tube 76000-26.Fluoroscopy (separate procedure), up to 1 hour physician time.

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NASPGHAN 3rd Year Pediatric Gastroenterology Fellows ConferenceThe annual NASPGHAN– Mead Johnson Research Forum for Pediatric Gastroenterologists was held in Scottsdale, Arizona from March 19–22,2009. This year’s program, which is annually organized by the NASPGHAN Research Committee and supported by Mead Johnson Nutrition, included 32 fellows from 26 training programs across the United States and Canada. Once again, the theme of the conference was focused on career development in pediatric gastroenterology. In addition to outstanding scientific presentations highlighting the research accomplishments ofparticipating senior fellows, the program also featured faculty presentations on strategic career planning, research funding options, academic careerdevelopment, and research opportunities outside academic medical centers. In addition to giving a presentation to the group on NIH supportfor career development, Dr. Judy Podskalny from NIH/NIDDK met individually with many fellows to provide advice on funding opportunities.Based on written reviews provided by the trainee participants, this popular conference continues to be a highly valuable experience for senior fellows in pediatric gastroenterology.

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The new Administration and Congresshave wrestled with a heavy agenda sinceJanuary, focused on economic recoveryand military issues. The President con-tinues to fill in the blanks on his Cabinet,with the recent confirmation of formerKansas Governor Kathleen Sebelius asSecretary of Health and Human Servicesbeing an important step in completing theteam that will handle the health reformdebate. Former HCFA Administrator(before the agency became CMS) Nancy-Ann DeParle has taken the health reformczar position in the White House.

The Senate approved the appointment of Margaret Hamburg, MDto be FDA Commissioner. The President appointed Thomas Frieden,MD, Commissioner of the New York City Health Department, to be head of the Centers for Disease Control. No one has been namedto run the Centers for Medicare and Medicaid Services. Also open isthe position of Director of NIH.

Despite the distractions of the economy (and the rest of the world,which does not always behave as Uncle Sam might like), Congresscontinues to work on health reform. Earlier action on health issues included extension of the Children's Health Insurance Program, additional funds for Medicaid in the stimulus package, expansion offederal support for health information technology and creation of aprogram of comparative effectiveness to begin evaluating the value ofhigh volume, big ticket health care services. The Medicaid money isalready going to states, but HIT and comparative effectiveness willtake longer to roll out.

On the health reform front, the Senate Finance Committee has takenthe lead, releasing three policy option documents. The first focusedon improving patient care and reducing health care costs. Much ofthis deals with various changes in the way Medicare pays for healthcare services, but the Committee Chairman Max Baucus (D-MT)sees Medicare as a lever to influence the private sector going forward.The second paper addressed issues of insurance coverage, suggestingways to reach universal coverage through a mix of public and privateprograms. The third piece addresses the challenge of financing all ofthese other proposals.

The Committee has held three roundtable discussions, one on each ofthe topics, with presentations to the members by a number of expertsin each of the topic areas. This has been followed by private meetingsof the Committee members focusing on option papers derived from the public roundtable sessions. While this public process hasbeen reasonably inclusive of the major stakeholders, it is not clear howpublic the tough negotiations among members will be. There are significant areas of agreement as well as disagreement. The latter couldtorpedo progress at any point.

The Senate process is bifurcated with the Health, Education, Labor andPensions Committee also having a major role in developing the finallegislation in the Senate. Nothing has emerged from this committee'sdiscussions to date, although a draft proposal is expected soon.

The House is following a much different process, which involves only the key Democratic leadership of the three committees that have a role in developing a bill. This secrecy has lead to a great dealof criticism from within the party as significant groups feel closed out.Of course, Republicans are really closed out, so there is even more unhappiness there. Committee and House leadership has had topromise that they will reach out to all elements of the DemocraticCaucus before final decisions are made, but fears remain that a product will simply be presented as a done deal without much inputfrom many interested Democrats who might have views somewhatdifferent from those espoused by the committee leadership. Basicallythe conservative and moderate wings of the party feel somewhat disenfranchised since the committee leadership is decidedly to the leftof them.

Very little information has leaked out of the House leadership discussions, and what has lacks detail. A key issue in Congress is the creation of a public plan to compete with private plans. As onemoves from the left to right on the political spectrum, the idea raisesmore and more concerns. This is guaranteed to be one of the mostdifficult parts of solving the health reform puzzle.

Both the House and Senate have set ambitious timelines for completing work on health reform, promising to have legislation before the President in the fall. Given the many other issues that areoccupying legislative time and energy, it is hard to see how timetableswill be met. Interestingly, the various stakeholders have been relativelymuted in their criticism of the ideas that are being broached. Ofcourse, the lack of detail makes it hard to decide whether or not an issue is a real problem. Opposition could increase once detailedlegislation becomes available. Also, many groups may feel that healthreform will actually pass and they do not want to lose their seat at thetable by being overtly and publicly critical.

House and Senate Republicans are just beginning to articulate detailed alternatives to the Democratic view of health reform. Philosophically they favor less government intervention, more creative use of the tax code to create the right incentives and market-based solutions to many problems. It is not that the Republicans seemto have fundamental disagreements with Democrats on the problemsin the health system, it is just that their approach to addressing themdiffers in many respects. It will be interesting to see how many of theirideas get incorporated as the process moves forward and conservativeand moderate elements in Congress push back against some of theideas of their progressive colleagues.

While the end is still far off (or maybe not if you accept the timetablecommitments that Congressional leaders have made), there is alwaysthe fallback of "taking the first step" toward universal coverage andhealth reform. If the spinmeisters get control, the simplest Medicarechange could be called the first step to universal coverage. Perceptionis everything and reality is in the eye of the beholder.

In any event, it promises to be an eventful summer around healthcareissues, with potentially significant changes affecting NASPGHANmembers and their patients. Hopefully, any changes will be positivefor all.

RANDOLPH FENNINGERHolland & Knight

Advocacy UpdateProvided by Randolph Fenninger, Senior Policy Advisor, Holland & Knight

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Classifieds . . . .

• Alaska –Providence Health & Services is seeking aBE/BC pediatric GI to join a busy practiceat The Children’s Hospital at Providence(TCHAP), housed within ProvidenceAlaska Medical Center in Anchorage.

Practice covers full range of pediatric gastroenterology, so candidates must becomfortable with virtually all relevant procedures. As part of TCHAP, new physician will enjoy broad pediatric subspecialty support, including pediatricsurgery, anesthesia and radiology, as well as endoscopy block time with anesthesia and excellent air ambulance services.

Additional facility/opportunity features:• 44-bed Level III NICU• 10-bed PICU and outpatient subspecialty

clinics• Draws from population base of entire state

of Alaska• Academic and clinical research available• Opportunities for consultative practice

with other facilities in the area• Hospital-employed model offers highly

competitive compensation with cost-of-living adjustment, generous benefits

• Private practice model also available• Open to J-1 Visa candidates• Possible loan assistance

Anchorage, with 285,000 residents, is a modern American city surrounded byspectacular scenery and boundless outdoorrecreation. Within the city limits are moose,bears, glaciers, miles of trails for hiking, biking and skiing, a ski resort, golf coursesand major dogsled race starts. There are also

shopping malls, world-class restaurants,brewpubs, two universities, a sports arenaand a performing arts center.

Providence Alaska Medical Center is part of Providence Health & Services, a not-for-profit network of hospitals, clinics andphysician partners in Alaska, California,Montana, Oregon and Washington. Providence has a proud 152-year history inthe West, and we continue to grow with thecommunities we serve. With more than 300 physician opportunities in virtually all specialties, we offer physicians diverselifestyle choices, flexible work arrangementsand robust practice support.

Contact: Jon CheneyPhone: 907.212.7941E-Mail: jon.cheney@providence.orgOr visit us at www.providence.org/physicianopportunities

• Arizona –The University of Arizona Department of Pediatrics is recruiting two additional positionsat the assistant or associate professor level toserve as pediatric gastroenterologists attendingin the Section of Pediatric Gastroenterology.Job duties include patient care at UniversityMedical Center and at Tucson Medical Center.

One position is for a clinically-oriented physician, the second position is for research-oriented clinician/scientist. State-of-the-art core facilities and support to establish research careers are available.Required: MD or DO and Pediatrics Board Certified or Eligible with BC/BE inPediatric Gastroenterology. Physicians onJ1-visa will be considered.

Review of application materials will continue until the positions are filled. For more information on the Department of Pediatrics and the Steele Memorial Children’s Research Center, see(http://www.peds.arizona.edu).

The University of Arizona, located in central Tucson, is one of the top ranked research universities in the nation. A moderately-sized city of 750,000 inhabitants, Tucson is a growing economicand recreational center with a multiculturalpopulation that reflects the richness of theSouthwest. Forty-five miles from the U.S.border of Mexico, the city shares common

borders with the Tohono O’odham and the Pasqua Yaqui Indian Nations, and is surrounded by majestic desert and ruggedmountains rising to more than 9,000 feet.Southern Arizona has more than 300 days of sunshine per year, more than any other region in the U.S.

Please reference Job # 991561 and submitCV along with a letter of interest to:Dr. Hesham A-Kader Hassan, MD, M.Sc.Professor and Chief Division of GastroenterologyThe University of Arizona1501 N Campbell Ave.PO Box 245073Tucson, AZ 85724-5073Phone: 520.626.4140Fax: 520.626.4141 E-Mail: hassan@peds.arizona.edu

• California –A medical professional corporation is seeking a pediatric gastroenterologist to join a thriving private practice. Located inthe East Bay just outside of San Franciscoand Napa Valley, this unique area offers agreat quality of life and a chance to explorethe many attractions of California. As partof a growing pediatric gastroenterology practice, you will be an integral part of ateam that works to ensure each patient receives individualized, high quality care.

• Excellent Financial Package• Signing Bonus• Student Loan Assistance• Paid Relocation• Home Loan Assistance• Well-Respected Colleagues

If you are looking for an exciting and gratifying opportunity and a chance to contribute your expertise to a thriving pediatric gastroenterology practice in a community setting, while enjoying tremendous quality of life, considerjoining our practice.

For more information about this positionand to be considered for this opportunity,please contact:Lindsey StewartPhone: 925.952.2933Fax: 925.952.2908E-Mail:lindsey.stewart@johnmuirhealth.comPlease reference – Pediatric GI

• To post your ad, contact Kim Rose at:krose@naspghan.org or 215.233.0808. The deadline for the next newsletter isAugust 1, 2009

QUARTERLY EMPLOYMENT ADS =$200 per quarter. This includes one printad in one quarterly newsletter and oneonline ad (NASPGHAN website) for 3 months.

ANNUAL EMPLOYMENT ADS =$750 for 12 months. This includes one printad in four quarterly newsletters and oneonline ad (NASPGHAN website) for12 months.

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• California –The Department of Pediatrics at Loma Linda University Health Care seeks BC/BE candidates specializing in pediatricgastroenterology and nutrition, to join ourfour-member division at the assistant or associate professor level. Additionally, we havea Pediatric Hospitalist on staff. The candidatewill participate in teaching of residents andmedical students. Research is encouraged and our division is committed to supportingthe successful candidate with funding andprotected time to conduct studies.

Loma Linda University’s Medical Center andChildren’s Hospital is the only Level I traumacenter serving a four-county area that coversapproximately 25 percent of the state. TheMedical Center and Children’s Hospital are equipped with over 850 licensed beds. The Children's Hospital is one of the largest children’s hospitals in the country; it is theonly tertiary care facility serving the vast population east of Los Angeles, to the bordersof Arizona, Nevada and Mexico. The total bed count at our children’s hospital is 256. We have an active pediatric liver transplantprogram with a dedicated and fully equippedpediatric endoscopy and manometry laboratory, which performs invasive and non-invasive procedures. Our procedures are in excess of 3,000 per year.

Loma Linda University is located in the center of Southern California in an areaknown as the “Inland Empire”— with a population of over 3.3 million and increasingat a rate of nearly 100,000 residents per year.There are opportunities for many outdoor activities such as mountain biking, snowboarding, skiing, surfing, and fishing. In addition, with Los Angeles and OrangeCounty in close proximity, the arts and culture are endless.

If you are interested in being a part of thisexperience, please contact:Barbara J. SharpPhone: 800.328.1163E-Mail: recruitmd@llu.eduTo view a list of current opportunities, visit:(www.llu.edu/recruitmd)

• California –The Division of Pediatric Gastroenterologyat Children’s Hospital Los Angeles and theDepartment of Pediatrics of the KeckSchool of Medicine of the University of

Southern California is recruiting a pediatricgastroenterologist at the assistant/associateprofessor level.

Requirements for the position include amedical license in California and certificationor active candidate status in the Sub-Boardof Pediatric Gastroenterology.

The Gastroenterology Division serves a 280-bed tertiary care children's hospital with all surgical and medical disciplinesactive. A new 317- bed in-patient facility ispresently under construction. The Division iscurrently ranked number 24 in the nation inU.S. News & World Report’s annual rankingof pediatric digestive disease programs. TheDivision takes a comprehensive approach to the care of patients with gastrointestinal,liver and nutritional disorders and is a majorreferral center in the greater Los Angelesarea. Clinical services include a complete nutrition support service. The Division operates a three-year clinical fellowshipprogram. The candidate will participate infellow, resident and medical student teachingand ongoing clinical research projects. Basicand clinical research opportunities are available within the Division and hospital(for qualified candidates). Protected time forclinical or basic research can be negotiated forindividuals interested in a clinical investigatorcareer. The professional development of its faculty is a priority of the Division. Compensation will be commensurate withexperience and qualifications.

The Keck School of Medicine of the University of California and the Children’sHospital Los Angeles are equal opportunity/affirmative action employers.

Interested applicants should submit theirCV to:Dan W. Thomas, MDHead, Division of GastroenterologyPhone: 323.361.5924E-Mail: dthomas@chla.usc.edu

• Illinois –The Division of Gastroenterology, Hepatology, and Nutrition in the Departmentof Pediatrics at Northwestern University’sFeinberg School of Medicine and Children’sMemorial Hospital in Chicago is seeking afull-time qualified individual at the associateor professor level, interested in providingleadership in targeted programs including

IBD, EoE, motility, short gut, and/or advanced endoscopy. The individual mustbe an MD or MD, PhD and board certified.Candidates must have demonstrable experience in both clinical care and administration. Salary is commensuratewith experience and will be competitive.Starting date is flexible.

Northwestern University is an AffirmativeAction/Equal Opportunity Employer.Women and minorities are encouraged toapply. Hiring is contingent upon eligibilityto work in the United States.

Applications will be accepted until the position is filled.

Contact person is:Barry K. Wershil, MDChildren’s Memorial Hospital2300 Children’s Plaza (#65)Chicago, IL 60614Phone: 773.880.8368

• Iowa –The Children’s Center Pediatric SubspecialtyClinic and Dr. Daniel Di Meo at MercyMedical Center-Des Moines seek a BC/BEpediatric gastroenterologist for a thriving established practice in the nation’s heartland.We can offer you an excellent compensationpackage with flexible practice options andtremendous upside potential.

Mercy Medical Center-Des Moines, the largest“system” in the Catholic Health Initiativesfamily, has over 900 beds in our 3 metro Hospitals. Our flagship Mercy features:• 24/7 Children’s emergency center• 40-bed level-three NICU six full-time

neonatologists• 24-bed pediatric medical/surgical unit • 8-bed PICU• Full-time complement of pediatric sub

specialists including pediatric surgery, pediatric intensivist, pediatric hospitalists

• Residency programs in general surgery andfamily practice

• Iowa’s busiest birthing center (set state record three years in a row!)

• Level-two trauma with over 67,000 visits last year

• Home of the Iowa Inflammatory Bowel Disease Center

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Mercy’s affiliate network includes:• 16 rural hospitals• 17 metro area FP and urgent Care clinics• 6 metro area pediatric clinics

The Des Moines metropolitan area is home toover 500,000 and offers affordable housing,safe neighborhoods, nationally ranked schoolsand abundant recreational opportunities. Tolearn more about the area, try the followingweb sites: (www.seedesmoines.com) or(www.desmoinesmetro.com).

We invite you to take a closer look at Mercy byviewing our website (www.mercydesmoines.org)or contact me for more information.

J-1 and H1-B applicants encouraged to apply.

Contact: Roger McMahonDirector, Physician Employment ServicesMercy Medical Center-Des MoinesPhone: 515.643.8323Fax: 515.643.831?E-Mail: rmcmahon@mercydesmoines.org

• Louisiana –Ochsner Health System in New Orleans isseeking a BC/BE pediatric gastroenterologistto join an existing division. Experience in inflammatory bowel disease, common GI disorders, and nutrition is desirable. The position involves teaching medical studentsand residents from the combined programwith Tulane University School of Medicine in New Orleans. Referrals are from active pediatric tertiary care subspecialty group practices as well as from physicians throughout the Gulf South.

Ochsner Children’s Health Center is a large,multi-specialty group practice with a strongcommitment to state-of-the-art tertiary careas well as primary care. The Center includes60 pediatric specialists and 40 general pediatricians, integrated into OchsnerHealth System, an academic medical center.We have a 40,000-square-foot freestandingpediatric ambulatory facility that includesgeneral academic pediatrics, medical and sur-gical subspecialty pediatrics with pediatric ra-diology, laboratory, and pharmacy facilities.In addition, we have a state-of-the-art, 18-bedPICU, three new pediatric wards, and a 36-bed NICU. We are dedicating a totallycomputerized pediatric emergency room.

Ochsner Health System (www.ochsner.org) is a non-profit, academic, multi-specialty,

healthcare delivery system dedicated to patient care, research, and education. The system includes 7 hospitals and 40 health centers throughout Southeast Louisiana.Ochsner employs over 600 physicians in 80medical specialties and subspecialties and conducts over 300 ongoing clinical researchtrials annually. We offer a generous and comprehensive benefits package. We alsoenjoy the advantage of practicing in a favorable malpractice environment inLouisiana. EOE.

Phone: 800.488.2240 Fax: 225.761.5441E-Mail CV: profrecruiting@ochsner.orgRef #APGA3

• Louisiana –Our Lady of the Lake Children’s Hospital,located in sunny Baton Rouge, Louisiana, is adding two BC/BE pediatric gastroen-terologists to its current division. Our focusis excellent evidence-based clinical care and developing a new pediatric residencyprogram for 2010. Research opportunitiesare available through Pennington BiomedicalResearch Center, the largest in the world devoted to obesity and its complications.OLOL has 70 pediatric beds, including 24/7pediatric ER and 14 bed PICU.

Baton Rouge has a warm climate, strongeconomy, and endless outdoor and culturalactivities (except snow shoveling). There is ahigh degree of physician autonomy withoutthe worries of private practice. Louisiana enjoys a favorable malpractice environment.Compensation is production-based andhighly competitive. J-1 and H-1B visas areconsidered.

Contact:Brannon Alberty, MDMedical Director of Pediatric GastroenterologyOur Lady of the Lake Children’s HospitalPhone: 225.765.6834Fax: 225.765.3342 Email: john.alberty@ololrmc.com

• Michigan –The University of Michigan is seeking a CAQcertified or eligible hepatologist to join ourdivision. The University of Michigan is theonly pediatric liver transplant program in

the state and performs approximately 15 transplants each year with a busy non-transplant hepatology practice. Theprogram has one hepatologist currently andseeks to expand. The Ann Arbor campushosts the S.R.T.R. U.N.O.S. database andserves as the data coordinating center for thebiliary atresia research consortium (BARC).Persons interested in outcomes, health services, adherence or transitioning of care to adult providers, viral hepatitis, and NASHwill find on-going excellent collaborations.

Please contact: Chris J Dickinson, Director Phone: 734.763.9650 E-Mail: chrisjd@umich.edu

• Missouri –Saint Louis University is seeking faculty candidates to join an active division of Pediatric Gastroenterologists, clinical PNP,dedicated GI clinical nurses and dedicatedprocedure staff. The division has busy outpatient and inpatient services based at Cardinal Glennon Children’s Medical Center, a 165-bed, free-standing children’shospital affiliated with the Saint Louis University School of Medicine. The divisionserves an active liver transplant program, a nutritional support team, a multidisciplinaryobesity clinic, and interacts with the CF center. Pediatric gastroenterology and hepatology also has ongoing, NIH-fundedclinical and basic science research projectswithin the division, and a working relationshipwith the St. Louis University School of Public Health. Close clinical and research tiesare maintained with the St. Louis UniversityLiver Center. Excellent opportunities forteaching in both didactic and clinical settings are available at the medical studentand postgraduate levels. Candidates must be BC/BE in Pediatric Gastroenterology. The institution is open to working withmany types of foreign visa holders, as well as green card holders and US citizens.

Saint Louis University is a Catholic, Jesuit institution dedicated to student learning, research, health care, and service. Saint LouisUniversity is an Affirmative Action, EqualOpportunity Employer, and encourages nominations of, and applications from women and minorities.

Interested candidates must submit a cover letter, application, and current CV to:

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(http:/jobs.slu.edu)Other correspondence regarding this position can be sent to:Jeffrey Teckman, MDDirector, Division of Gastroenterology Department of PediatricsSaint Louis University School of Medicine1465 S. Grand BlvdSaint Louis, MO 63104Phone: 314.577.5647Fax: 314.268.2775E-Mail: teckmanj@slu.edu

• Missouri –St John’s Mercy Children’s Hospital, a member of Sister’s of Mercy Health System, isseeking a BC/BE Pediatric Gastroenterologistto expand an existing and thriving practicein St. Louis, Missouri.

St. John’s Mercy Medical Center offers: • 859-bed, fully accredited not- for-profit

teaching hospital• Children’s Hospital new patient tower

under construction, which will have 71 beds including 16 PICU beds and 98 NICU beds

• Associate member of NACHRI• Level 1 Trauma Center with 21,000

pediatric emergency visits annually• Currently a 54-bed pediatric unit, 10-bed

PICU and a 70- bed Level III NICU • More than 300 pediatric providers on staff

with over 70 fellowship-trained pediatric specialists and Child Life Specialists

• Excellent 24-hour in-house neonatology and pediatric coverage

The successful candidate will: • Work in a comprehensive Gastrointestinal

Endoscopy Laboratory with the latest in advanced diagnostic equipment including a new PH Impendance

• Have practice management services• Share call with the other gastroenterologists

on staff• Be employed by the hospital with a highly

competitive income guarantee• Receive benefits including health, dental,

vacation and CME• Receive relocation assistance and malpractice

insurance

St. Louis offers urban amenities in an attractive and affordable living environment.The four-season climate and abundance ofcultural and outdoor activities, along with

five-star restaurants, major league sportingattractions, outstanding schools, and a diverseeconomy make St. Louis an attractive placeto live, work and play!

The successful candidate will be BE/BC in pediatric gastroenterology. For more information, visit our website at(www.stjohnsmercy.org).

If you are interested in learning more aboutthis opportunity with St John’s MercyHealth Care, please contact:Lisa Kues Phone: 800.851.2382 or 314.364.3840E-Mail: lisa.kues@mercy.net

• Nebraska –A pediatric affiliation between Children'sHospital and the University of NebraskaMedical Center College of Medicine has created an opportunity for a pediatric gastroenterologist. This professional environment offers attractive compensationand benefits. Design your own practice to include the level of clinical practice, researchand teaching that you desire.

Children’s is the only full-service, pediatrichealth care center in Nebraska. We provideexpertise in more than 30 pediatric specialtyservices to children across a five-state regionand beyond. The 144-bed, non-profit hospital houses the only dedicated pediatricemergency department in the region and offers 24-hour, in-house services by pediatriccritical care specialists and neonatologists.Children’s has achieved the Magnet designation for nursing excellence and is anInfoWorld 100 award winner for innovationin information technology. For more information on Children’s Hospital, visit(www.ChildrensOmaha.org).

Omaha is a vibrant city with a metropolitanpopulation of 800,000. Offering excellentschools, Omaha is a safe, family-orientedtown. Entertainment options are nearlyendless with a new large convention center,which attracts the biggest names in music andsports. Omaha has become a major center forNCAA events including Volleyball FinalFour, Regional Division I Basketball, 2008Olympic Swimming Trials and the CollegeWorld Series. The CWS, an Omaha eventfor over 50 years, will continue in Omahawith the construction of a new downtownstadium. Omaha, the home of the largestcommunity theater in the country, has an

excellent symphony and opera and hosts numerous visiting Broadway plays. Propertyvalues are among the most affordable in thecountry for a city of this size. Omaha is consistently ranked as one of the most livable and family-friendly cities in theUnited States.

Contact:Brenda KrullPhone: 402.955.6971E-Mail: bkrull@childrensomaha.org

• New Jersey –Join five adult gastroenterologists in New Jersey for an immediate pediatric gastroenterology opportunity with partnership in central New Jersey.

Includes:• Attractive base salary• Early partnership track• Paid malpractice insurance• Excellent call schedule

Benefits: • Full family benefits• Relocation assistance• Life insurance• 401K• CME allowance• Phone and Auto allowance

Forward CV to:Raymond BerriosExecutive Director, Digestive Healthcare511 Courtyard DriveHillsborough, NJ 08844E-Mail: rayberrios@gmail.com

• Ohio –The Division of Gastroenterology, Hepatology and Nutrition of CincinnatiChildren’s Hospital Medical Center(CCHMC) is continuing to expand to meetour goal to improve child health through better diagnosis, treatments and outcomes.

We are recruiting a faculty member tojoin our Inflammatory Bowel Disease(IBD) Program. The division currentlyparticipates in the International PediatricIBD Genetics Consortium, the PediatricIBD Collaborative Registry, the PediatricIBD North American Collaborative Research Group and the Trailblazers Quality Improvement Initiative. The

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successful candidate will join a strong multidisciplinary team led by Ted Denson, MD and will take a major role in leading clinical trials.

The Division is ranked 3rd nationally in Digestive Disorders by U.S. News and World Report. Clinical and research teamswith national leaders and outstanding mentors are in place to help advance newknowledge. It is important to have healthcare providers as part of our team who cantranslate this new knowledge into patientcare. These opportunities, combined withour commitment to and support of junior faculty, make this is a great place to launchyour career and change the outcome for children.

CCHMC and Children’s Hospital ResearchFoundation is one of the largest pediatric research programs in the nation and rankssecond among pediatric institutions in direct funding from the National Institutesof Health. The Division has an NIH-fundedtraining program, participates in 6 NIH-funded Translational Research Consortiaand is home to an NIH-funded DigestiveDisease Research Core Center (DigestiveHealth Center) devoted to pediatric digestive diseases. Women and minoritiesare encouraged to apply. CCHMC is an Affirmative Action/Equal Opportunity employer.

Interested candidates should contact:Mitchell B. Cohen, MD Director, Division of Gastroenterology, Hepatology and NutritionCincinnati Children’s Hospital Medical Center3333 Burnet Avenue, ML 2010Cincinnati, Ohio 45229–3039Phone: 513.636.4953E-Mail: mitchell.cohen@cchmc.org

• Ohio –The Division of Pediatric Gastroenterology,Hepatology and Nutrition at Rainbow Babiesand Children’s Hospital in conjunction withCWRU School of Medicine in Cleveland,Ohio is recruiting faculty members at theassistant, associate or full professor level tojoin our group of five fulltime pediatricgastroenterologists. We are primarily seeking an individual with clinical expertisein hepatology and/or a clinically oriented

pediatric gastroenterologist. The facultymember will be responsible for clinical careof both inpatients and outpatients as well as teaching fellows, housestaff and medicalstudents. The division has an active ACGME-accredited Pediatric Gastroenterology Fellowship Program. All candidates should beboard certified in pediatrics and board certifiedor eligible in pediatric gastroenterology. Thesuccessful applicant must hold or be eligiblefor Ohio Medical Licensure. Candidatesjust completing training in pediatricgastroenterology are welcome to apply. Pediatric intensivists supply sedation forprocedures and the GI procedures unit isfully staffed. We provide full state-of-the-art GI services, including manometry, pH, impedence and capsule endoscopy. TheDepartment of Pediatrics enjoys a wonderfulacademic reputation for excellent care andresearch and all of the support services thatare needed to meet the needs of our pediatricgastroenterology patients including pediatricpathology, radiology and surgery.

The combination of Cleveland’s downtownskyline, fine restaurants, entertainment options, excellent public schools and affordable housing, makes Northeast Ohio a desirable place to live. Investigatethe Greater Cleveland Area attractions at(www.Cleveland.com). Come and grow your professional expertise with us.

In employment, as in education, Case WesternReserve University is committed to EqualOpportunity and World Class Diversity.Applications from qualified women, minorities, veterans and individuals with disabilities are encouraged.

Interested individuals should feel free to contact: Jeffrey Blummer, MD, PhD Rainbow Babies and Children’s Hospital 11100 Euclid AvenueCleveland, OH 44160Phone: 216.844.6006 E-Mail: jeffrey.blummer@uhhospitals.org

• Pennsylvania –The Division of Pediatric Gastroenterologyand Nutrition at the Penn State Milton S.Hershey Medical Center, Penn State HersheyChildren's Hospital seeks two additional faculty members at the assistant/associateprofessor level. These positions involve primarily outpatient clinics, performing

endoscopic procedures and teaching medicalstudents and residents. The majority of ourinpatient service is covered by one of ourphysicians. As part of the Penn State Collegeof Medicine, there is ample opportunity forteaching and clinical and basic science research.Interests in nutrition and hepatology are desirable.

Our division consists of five physicians, twovery experienced nurse practitioners, oneRN, one LPN, a behavioral psychologist and an administrative assistant. Divisional interests include inflammatory bowel disease, feeding problems and liver stem cell research. We house a nationally and internationally recognized feeding program.

We have 24/7 pediatric hospitalist coverage,endoscopy block-time with all proceduresperformed with pediatric anesthesiology andclose working relationships with excellentpediatric surgery, pediatric radiology,pathology and adult GI divisions.

Hershey, located in beautiful central Pennsylvania, is a wonderful place to raise a family and has excellent "Blue Ribbon"schools. We are located within 15 minutes of the State Capitol, 90 minutes from Baltimore and Philadelphia and 3 hoursfrom the New Jersey shore.

Penn State Milton S. Hershey Medical Center is an equal opportunity/AffirmativeAction employer and encourages applicationsfrom women and members of minoritygroups.

Interested candidates should contact:Douglas Field, M.D.Chief, Division of Pediatric GI/Nutrition500 University DriveHershey, PA 17033Phone: 717.531.5901E-Mail: dfield@psu.edu

• Texas –This intellectual and clinically satisfying position has the support of a full complimentof pediatric subspecialists and the appealinglife-style practice you are seeking.

Call is every other week. This is consultativecall, normally completed each evening by 6 pm and only telephone calls at night. (You may go into the hospital once or twicea year.) The week you are not on call you are home by 4:30 or 5 pm.

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You will enjoy both clinical and didacticteaching with the Driscoll Children's Hospital Residency Program, obtaining anacademic appointment with Texas A&MUniversity. They have 40 pediatric residentsin their program. Driscoll Children's Hospital is a 180-bed not-for-profit tertiarycare regional referral center offering themost complex and comprehensive medicaland surgical care of children.

In Corpus Christi, located on the Gulf ofMexico about halfway between Houstonand the U.S. Mexico border, you will findsmooth sea breezes and endless blue skiesyear-round. Nestled on a bay and surroundedby islands and hundreds of miles of beaches,Corpus Christi provides endless recreationalopportunities.

Corpus Christi is the eighth largest city inTexas with a census of approximately380,000. The seven-county Bay Area population is over 500,000. Corpus Christineighbors Padre Island, the longest barrierisland in the nation. The average CorpusChristi temperature is 71.2 degrees. Thereare approximately 255 days of CorpusChristi sunshine a year!

This "progressive city" offers higher education options for its residents –a branch of Texas A&M University, TexasA&M-Corpus Christi, Del Mar Jr. College,and Texas A&M-Kingsville are all located in the Corpus Christi area.

Contact:Germaine LorbertPhone: 800.678.7858 (Extension 63704) E-Mail: glorbert@cejkasearch.com(www.cejkasearch.com)ID#31597QX

• Washington –Providence Health & Services is seeking aBC/BE Pediatric Gastroenterologist to joinits team at Sacred Heart Medical Center &Children's Hospital in Spokane, Washington.The new physician will join another pediatricgastroenterologist with an established pediatric gastroenterology and nutritionteam.

• 161-bed Children's Hospital serving population of 1.5 million

• Excellent subspecialty support including Peds Hospitalists

• Procedural sedation provided by Peds Intensivists

• World-class research department• Competitive compensation and benefits

Sacred Heart Medical Center & Children'sHospital has 623 beds, a medical staff ofmore than 900 and a service area populationof about 1.5 million. The children's hospitalalone includes more than 90 pediatric sub-specialists. Sacred Heart has a world-class research department and offers some of the Northwest's most advanced services,including minimally invasive cardiac surgeryprocedures and robotic surgery.

Spokane, about halfway between the Rockyand Cascade Mountain Ranges, is a regionalmedical hub with an abundance of quality of life features: • Four seasons with 250-plus days of sun• Strong, diversified economy• Excellent K-12 & higher education,

including Gonzaga University• Close to prime skiing, hiking, rafting

and more

Sacred Heart is part of Providence Health & Services, a not-for-profit networkof hospitals, clinics and physician partners in Alaska, California, Montana, Oregon and Washington. Providence has a proud152-year history in the West and continues togrow with the communities we serve. Withmore than 300 physician opportunities in virtually all specialties, we offer physiciansdiverse lifestyle choices, flexible workarrangements and robust practice support.

For details, contact:Pat Isakson Phone: 509.474.6604E-Mail: Isaksop@psew.orgOr visit our Web site:(www.providence.org/physicianopportunities)

• West Virginia –West Virginia University School of Medicine, Department of Pediatrics is seeking an academic physician to join thesection of Pediatric Gastroenterology. Applicants must be fellowship trained and Board Certified/Eligible in PediatricGastroenterology. The ideal candidate willbe primarily involved with clinical servicesand teaching of medical students and

residents, but ample opportunities exist inboth clinical and basic research.

The Pediatrics department maintains a stellar outreach program supporting pediatric gastroenterology services as well as collaboration with the adult digestive disease section. Faculty physiciansalso have direct access to highly advancedtechnological resources and comprehensivepediatric services.

WVU faculty enjoy the benefits of a premier tertiary referral center for the stateof West Virginia, affiliation with WVUHospitals, Inc., cutting edge technology, and acollaborative academic atmosphere conducive to professional growth.

Morgantown, West Virginia, recently rankedby Forbes as one of the Best Small Metros inAmerica, is located just over an hour southof Pittsburgh, PA and just three and one-halfhours from Washington, DC and Baltimore,MD. Morgantown offers culturally diverse,large-city amenities in a safe, family setting.There is an excellent school system and anabundance of recreational opportunities.

Title and academic rank will be commensuratewith experience. The position will remainopen until filled.

West Virginia University is an AffirmativeAction/Equal Opportunity employer.

If you are interested in more details regardingthis opening, please contact:Larry Rhodes, MD Search Committee Chairc/o Laura Blake Director, Physician RecruitmentPhone: 304.293.6135Fax: 304.293.0230E-Mail: blakel@wvuh.com(http://www.wvukids.com)

• Wisconsin –Marshfield Clinic has an immediate opening for a fourth BC/BE pediatric gastroenterologist to expand the service. You will join over 30 pediatric generalistsand subspecialists who are dedicated to providing quality health care at our tertiaryfacility in Marshfield, Wisconsin. Opportunities for teaching residents andmedical students is available through ouraccredited pediatric residency program,

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as well as the ability to perform researchthrough the Marshfield Medical ResearchFoundation. Care for your patients is second to none at St. Joseph’s Children’sHospital, a fully accredited children’s hospital physically connected to the Clinic.To find out more about Marshfield Clinic or St. Joseph’s Children’s Hospital, check out the following websites –(http://www.marshfieldclinic.org/recruit)and (http://www.ministryhealth.org/display/router.aspx).

Benefits and Compensation:Includes a competitive $200,000 two year guaranteed salary plus bonus/loan repayment options -- followed by no capRVU production based income;

a fully-funded retirement plan; a matching401(k) plan; malpractice, health, dental, life and disability insurance; four weeks paidvacation to start; two weeks CME time and$5,800 CME allowance; generous relocationand more.

Community Information:Marshfield, Wisconsin is truly the city in the center. Its location in the state providesproximity to metro areas and plentiful outdoor recreation (right in your own backyard or a short drive away). Golf, biking, boating, swimming, cross countryskiing, and much, much more. Schools areamong the best in the country. Wisconsinranks near the top in ACT and SAT scores.No long commutes. Housing is affordable.

Marshfield Clinic is an Affirmative Action/Equal Opportunity Employer that values diversity. Minorities, females, individualswith disabilities and veterans are encouragedto apply.

For more information:Mary Treichel, Physician RecruiterPhone: 715.221.9774E-Mail: treichel.mary@marshfieldclinic.org