News From CHEST Physician®

Preparation is key for disaster management. It includes identifying heath-care worker capability, surge capacity, disposable medical resources, and expert consultation availability.   

Staff 

In disaster, the hospital transitions to a mass casualty strategy,  repurposing noncritical care staff to a tiered critical care model focusing on disaster triage and mass critical care. The goal is to provide care to minimize mortality.   

Stuff 

Critical care supplies improve survival and are implemented quickly and easily. Essential supplies include personal protective equipment, basic modes of mechanical ventilation, hemodynamic support, antimicrobial therapy or other disease-specific countermeasures, oxygen, and prophylactic treatments. 

Structure 

Disaster critical care can be delivered in noncritical care areas. Hospital policies should establish surge capacity strategies.  

System 

Providing quality lifesaving care to appropriately triaged patients by utilizing minimal qualifications for survival, predetermined ICU admission criteria, and dynamic protocols using the highest level of evidence available scalable to local resources.  
Inappropriate triage results in suboptimal care and can lead to increased mortality. 
Virtual critical care can augment critical care capacity and capability. 
The implementation of mass critical care requires hospitals to rapidly increase its patient volume above its normal capacity. The essential four components are staff, stuff, space, and structure. Effective mass critical care requires a different mindset than critical care in day-to-day operations. 

Patrick Moon, MD; and Alexis MacDonald, MD 
(Drs. Reed and Tripp's Fellows) 
Mary Jane Reed, MD, FCCP, and Michael Tripp, MD, FCCP 
Steering Committee Members 

Practice Operations 

Coding for telemedicine in the COVID-19 era 

Over the years since telemedicine (TM) was developed in the 1960s, it has transformed into more mobile, compact, and interconnected forms. However, its widespread adoption has been limited by the regulatory, compensatory, and licensing status quo. The emergence of the COVID-19 pandemic and its necessity for physical distancing has brought TM into the limelight. With restrictions on TM use lifted by CMS, the scope of TM could extend from outpatient to inpatient care to emergency triaging and management of chronic medical conditions.  

In February 2020, the comprehensive 2020 COVID-19 ICD 10 coding guidelines were released. To date, CMS has approved approximately 80 codes, which can be used with telehealth and non face-face-to-face (NFTF) encounters. They include telephone calls, online digital E/M services, interprofessional telephone/internet/electric health record consultations, digitally stored data services/remote physiologic monitoring, remote reporting of self-measure blood pressure, and remote physiologic monitoring treatment management services. Some of the key "rules of the game" are highlighted below. 

• For telephone visits in the outpatient setting use the codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (21-30 minutes). 
• For interactive real-time audio and video telecommunication (RAVT) in the outpatient setting, use the codes normally used for outpatient E/M: 99201-99215. 
• For using RAVT to perform an initial visit for an inpatient, use the codes that are normally used for inpatient E/M: 99221-99223. 
• For using RAVT to perform a subsequent visit for an inpatient, use the codes that are normally used for subsequent hospital care service E/M: 99231-99233. 
• Seeing a critically ill patient without being in the patient's room is allowed, as a physical exam is not required for either 99291 or 99292. Be sure to use 99292 for each 30 minutes beyond the initial 74 minutes and document the time spent on the patient. 

The details of the coding/billing guidelines are intricate and full of nuances and for a better understanding on how to utilize TM both in an inpatient and outpatient setting, consider the following resources:  
1. CHEST Experience presentation entitled "TELE MEDICINE/TELE HEALTH IN THE ERA OF PANDEMIC" at the CHEST Annual Meeting 2020. 
1. Coding and Billing Guidelines by ATS:  
https://www.thoracic.org/about/newsroom/newsletters/coding-and-billing/resources/2020/mostrecentcbqapril.pdf 
2. Coding specific for management of COVID patients by the AMA: 
https://www.ama-assn.org/system/files/2020-05/covid-19-coding-advice.pdf 
 

Humayun Anjum, MD, FCCP 
Vice-Chair, Practice Operations

Haala Rokadia, MD, FCCP 

Practice Operations NetWork Steering Committee Member

Transplant  

The COVID 19 pandemic led the health-care community to rapidly adopt telecommunication tools allowing provision of care equivalent to in-person visits. Implementation of telemedicine visits demonstrated that providers can simultaneously distance and connect with patients to provide expert care.   
The University of Pennsylvania lung transplant team adapted video communications to provide individualized physical therapy (PT) recommendations for lung transplantation candidates. The evaluation includes a systems review, musculoskeletal screen, submaximal aerobic capacity testing, and performance of the short physical performance battery test (SPPBT), a frequently used frailty evaluation tool focused on lower extremity function and balance. In the era of social distancing, telemedicine capabilities have made this crucial aspect of pretransplant evaluation possible.  
In advance, patients are emailed a document outlining the telemedicine PT assessment, including the SPPBT. Patients receive videos of the SPPBT to ensure they understand the test and can prepare their home to safely perform the tasks. We are able to highlight the patient's functional capabilities and detail accurate assessments of their deficits. Our teleconsultations utilize BlueJeans for connectivity and typically last about 30 minutes. At this time, we are billing for these pretransplant visits but not for posttransplant PT follow-up.  

Patient experiences with the PT teleconsultations have been overwhelmingly positive. Patients and their families appreciate the uninterrupted evaluation time and the individualized recommendations for improving their deficits. The providers can devote their full attention to the patient directly in front of them. Importantly, patients and providers report they have never felt a stronger connection than through these telemedicine encounters. Longitudinal telemedicine PT assessments will enable us to better monitor our patients throughout the lung transplantation process.  
 

Joshua Diamond, MD 
Steering Committee Member 
Derek Zaleski, PT, DPT 
 

Women's Lung Health  

The SARS-COV-2 pandemic has brought on many fears and uncertainties with new information emerging daily, including the effect during pregnancy. At the time of this article,however, data pertaining to COVID-19 and pregnancy remain limited. Pregnant women do not seem to have a higher infection rate than the general population. In a correspondence where pregnant women admitted for delivery underwent universal screening in NY, 1.9% of women were symptomatic and tested positive, and 13.7% of the asymptomatic patients were found to be SARS-COV-2 positive.1  Furthermore, unlike H1NI, data suggest that pregnant women infected with SARS-COV-2 currently do not seem to have worse outcomes than the average person.2,3  As of now, there have not been any reports of maternal fetal vertical transmission from COVID-19 or any other coronavirus variants.4  Postpartum testing of infants has yielded a very small number of babies who have tested positive for virus, but this more likely represents transmission after birth. There are currently no specific FDA-approved medications for the treatment of moderate-severe infections with COVID-19 in pregnant women, although there are several clinical trials underway. Patients with moderate to severe symptoms should seek medical attention, while those with mild symptoms should continue with conservative therapies, as well as maintaining proper hygiene.5  Delivery methods and timing remain unchanged with cesarean delivery as currently indicated per established guidelines.5   
 

Mariam Louis, MD 
Steering Committee Member 
Jorge Trabanco, MD  
 
1. N Engl J Med. 2020 Apr 13;382:2163-4. April 13, 2020, DOI: 10.1056/NEJMc2009316 
2. N Engl J Med. 2020 Jun 18; 382:e100. April 17, 2020 DOI: 10.1056/NEJMc2009226 
3. Acta Obstet Gynecol Scand. 2020 Jul;99(7):823-829. 2020 Apr 7. doi: 10.1111/aogs.13867. [Epub ahead of print] 
4. Arch Pathol Lab Med. 2020 Apr 27. doi: 10.5858/arpa.2020-0211-SA. [Epub ahead of print] 
5. ACOG practice advisory, Novel Coronavirus 2019 (COVID-19) April 23, 2020. 
 

Preparation is key for disaster management. It includes identifying heath-care worker capability, surge capacity, disposable medical resources, and expert consultation availability.   

Staff 

In disaster, the hospital transitions to a mass casualty strategy,  repurposing noncritical care staff to a tiered critical care model focusing on disaster triage and mass critical care. The goal is to provide care to minimize mortality.   

Stuff 

Critical care supplies improve survival and are implemented quickly and easily. Essential supplies include personal protective equipment, basic modes of mechanical ventilation, hemodynamic support, antimicrobial therapy or other disease-specific countermeasures, oxygen, and prophylactic treatments. 

Structure 

Disaster critical care can be delivered in noncritical care areas. Hospital policies should establish surge capacity strategies.  

System 

Providing quality lifesaving care to appropriately triaged patients by utilizing minimal qualifications for survival, predetermined ICU admission criteria, and dynamic protocols using the highest level of evidence available scalable to local resources.  
Inappropriate triage results in suboptimal care and can lead to increased mortality. 
Virtual critical care can augment critical care capacity and capability. 
The implementation of mass critical care requires hospitals to rapidly increase its patient volume above its normal capacity. The essential four components are staff, stuff, space, and structure. Effective mass critical care requires a different mindset than critical care in day-to-day operations. 

Patrick Moon, MD; and Alexis MacDonald, MD 
(Drs. Reed and Tripp's Fellows) 
Mary Jane Reed, MD, FCCP, and Michael Tripp, MD, FCCP 
Steering Committee Members 

Practice Operations 

Coding for telemedicine in the COVID-19 era 

Over the years since telemedicine (TM) was developed in the 1960s, it has transformed into more mobile, compact, and interconnected forms. However, its widespread adoption has been limited by the regulatory, compensatory, and licensing status quo. The emergence of the COVID-19 pandemic and its necessity for physical distancing has brought TM into the limelight. With restrictions on TM use lifted by CMS, the scope of TM could extend from outpatient to inpatient care to emergency triaging and management of chronic medical conditions.  

In February 2020, the comprehensive 2020 COVID-19 ICD 10 coding guidelines were released. To date, CMS has approved approximately 80 codes, which can be used with telehealth and non face-face-to-face (NFTF) encounters. They include telephone calls, online digital E/M services, interprofessional telephone/internet/electric health record consultations, digitally stored data services/remote physiologic monitoring, remote reporting of self-measure blood pressure, and remote physiologic monitoring treatment management services. Some of the key "rules of the game" are highlighted below. 

• For telephone visits in the outpatient setting use the codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (21-30 minutes). 
• For interactive real-time audio and video telecommunication (RAVT) in the outpatient setting, use the codes normally used for outpatient E/M: 99201-99215. 
• For using RAVT to perform an initial visit for an inpatient, use the codes that are normally used for inpatient E/M: 99221-99223. 
• For using RAVT to perform a subsequent visit for an inpatient, use the codes that are normally used for subsequent hospital care service E/M: 99231-99233. 
• Seeing a critically ill patient without being in the patient's room is allowed, as a physical exam is not required for either 99291 or 99292. Be sure to use 99292 for each 30 minutes beyond the initial 74 minutes and document the time spent on the patient. 

The details of the coding/billing guidelines are intricate and full of nuances and for a better understanding on how to utilize TM both in an inpatient and outpatient setting, consider the following resources:  
1. CHEST Experience presentation entitled "TELE MEDICINE/TELE HEALTH IN THE ERA OF PANDEMIC" at the CHEST Annual Meeting 2020. 
1. Coding and Billing Guidelines by ATS:  
https://www.thoracic.org/about/newsroom/newsletters/coding-and-billing/resources/2020/mostrecentcbqapril.pdf 
2. Coding specific for management of COVID patients by the AMA: 
https://www.ama-assn.org/system/files/2020-05/covid-19-coding-advice.pdf 
 

Humayun Anjum, MD, FCCP 
Vice-Chair, Practice Operations

Haala Rokadia, MD, FCCP 

Practice Operations NetWork Steering Committee Member

Transplant  

The COVID 19 pandemic led the health-care community to rapidly adopt telecommunication tools allowing provision of care equivalent to in-person visits. Implementation of telemedicine visits demonstrated that providers can simultaneously distance and connect with patients to provide expert care.   
The University of Pennsylvania lung transplant team adapted video communications to provide individualized physical therapy (PT) recommendations for lung transplantation candidates. The evaluation includes a systems review, musculoskeletal screen, submaximal aerobic capacity testing, and performance of the short physical performance battery test (SPPBT), a frequently used frailty evaluation tool focused on lower extremity function and balance. In the era of social distancing, telemedicine capabilities have made this crucial aspect of pretransplant evaluation possible.  
In advance, patients are emailed a document outlining the telemedicine PT assessment, including the SPPBT. Patients receive videos of the SPPBT to ensure they understand the test and can prepare their home to safely perform the tasks. We are able to highlight the patient's functional capabilities and detail accurate assessments of their deficits. Our teleconsultations utilize BlueJeans for connectivity and typically last about 30 minutes. At this time, we are billing for these pretransplant visits but not for posttransplant PT follow-up.  

Patient experiences with the PT teleconsultations have been overwhelmingly positive. Patients and their families appreciate the uninterrupted evaluation time and the individualized recommendations for improving their deficits. The providers can devote their full attention to the patient directly in front of them. Importantly, patients and providers report they have never felt a stronger connection than through these telemedicine encounters. Longitudinal telemedicine PT assessments will enable us to better monitor our patients throughout the lung transplantation process.  
 

Joshua Diamond, MD 
Steering Committee Member 
Derek Zaleski, PT, DPT 
 

Women's Lung Health  

The SARS-COV-2 pandemic has brought on many fears and uncertainties with new information emerging daily, including the effect during pregnancy. At the time of this article,however, data pertaining to COVID-19 and pregnancy remain limited. Pregnant women do not seem to have a higher infection rate than the general population. In a correspondence where pregnant women admitted for delivery underwent universal screening in NY, 1.9% of women were symptomatic and tested positive, and 13.7% of the asymptomatic patients were found to be SARS-COV-2 positive.1  Furthermore, unlike H1NI, data suggest that pregnant women infected with SARS-COV-2 currently do not seem to have worse outcomes than the average person.2,3  As of now, there have not been any reports of maternal fetal vertical transmission from COVID-19 or any other coronavirus variants.4  Postpartum testing of infants has yielded a very small number of babies who have tested positive for virus, but this more likely represents transmission after birth. There are currently no specific FDA-approved medications for the treatment of moderate-severe infections with COVID-19 in pregnant women, although there are several clinical trials underway. Patients with moderate to severe symptoms should seek medical attention, while those with mild symptoms should continue with conservative therapies, as well as maintaining proper hygiene.5  Delivery methods and timing remain unchanged with cesarean delivery as currently indicated per established guidelines.5   
 

Mariam Louis, MD 
Steering Committee Member 
Jorge Trabanco, MD  
 
1. N Engl J Med. 2020 Apr 13;382:2163-4. April 13, 2020, DOI: 10.1056/NEJMc2009316 
2. N Engl J Med. 2020 Jun 18; 382:e100. April 17, 2020 DOI: 10.1056/NEJMc2009226 
3. Acta Obstet Gynecol Scand. 2020 Jul;99(7):823-829. 2020 Apr 7. doi: 10.1111/aogs.13867. [Epub ahead of print] 
4. Arch Pathol Lab Med. 2020 Apr 27. doi: 10.5858/arpa.2020-0211-SA. [Epub ahead of print] 
5. ACOG practice advisory, Novel Coronavirus 2019 (COVID-19) April 23, 2020. 
 

Preparation is key for disaster management. It includes identifying heath-care worker capability, surge capacity, disposable medical resources, and expert consultation availability.   

Staff 

In disaster, the hospital transitions to a mass casualty strategy,  repurposing noncritical care staff to a tiered critical care model focusing on disaster triage and mass critical care. The goal is to provide care to minimize mortality.   

Stuff 

Critical care supplies improve survival and are implemented quickly and easily. Essential supplies include personal protective equipment, basic modes of mechanical ventilation, hemodynamic support, antimicrobial therapy or other disease-specific countermeasures, oxygen, and prophylactic treatments. 

Structure 

Disaster critical care can be delivered in noncritical care areas. Hospital policies should establish surge capacity strategies.  

System 

Providing quality lifesaving care to appropriately triaged patients by utilizing minimal qualifications for survival, predetermined ICU admission criteria, and dynamic protocols using the highest level of evidence available scalable to local resources.  
Inappropriate triage results in suboptimal care and can lead to increased mortality. 
Virtual critical care can augment critical care capacity and capability. 
The implementation of mass critical care requires hospitals to rapidly increase its patient volume above its normal capacity. The essential four components are staff, stuff, space, and structure. Effective mass critical care requires a different mindset than critical care in day-to-day operations. 

Patrick Moon, MD; and Alexis MacDonald, MD 
(Drs. Reed and Tripp's Fellows) 
Mary Jane Reed, MD, FCCP, and Michael Tripp, MD, FCCP 
Steering Committee Members 

Practice Operations 

Coding for telemedicine in the COVID-19 era 

Over the years since telemedicine (TM) was developed in the 1960s, it has transformed into more mobile, compact, and interconnected forms. However, its widespread adoption has been limited by the regulatory, compensatory, and licensing status quo. The emergence of the COVID-19 pandemic and its necessity for physical distancing has brought TM into the limelight. With restrictions on TM use lifted by CMS, the scope of TM could extend from outpatient to inpatient care to emergency triaging and management of chronic medical conditions.  

In February 2020, the comprehensive 2020 COVID-19 ICD 10 coding guidelines were released. To date, CMS has approved approximately 80 codes, which can be used with telehealth and non face-face-to-face (NFTF) encounters. They include telephone calls, online digital E/M services, interprofessional telephone/internet/electric health record consultations, digitally stored data services/remote physiologic monitoring, remote reporting of self-measure blood pressure, and remote physiologic monitoring treatment management services. Some of the key "rules of the game" are highlighted below. 

• For telephone visits in the outpatient setting use the codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (21-30 minutes). 
• For interactive real-time audio and video telecommunication (RAVT) in the outpatient setting, use the codes normally used for outpatient E/M: 99201-99215. 
• For using RAVT to perform an initial visit for an inpatient, use the codes that are normally used for inpatient E/M: 99221-99223. 
• For using RAVT to perform a subsequent visit for an inpatient, use the codes that are normally used for subsequent hospital care service E/M: 99231-99233. 
• Seeing a critically ill patient without being in the patient's room is allowed, as a physical exam is not required for either 99291 or 99292. Be sure to use 99292 for each 30 minutes beyond the initial 74 minutes and document the time spent on the patient. 

The details of the coding/billing guidelines are intricate and full of nuances and for a better understanding on how to utilize TM both in an inpatient and outpatient setting, consider the following resources:  
1. CHEST Experience presentation entitled "TELE MEDICINE/TELE HEALTH IN THE ERA OF PANDEMIC" at the CHEST Annual Meeting 2020. 
1. Coding and Billing Guidelines by ATS:  
https://www.thoracic.org/about/newsroom/newsletters/coding-and-billing/resources/2020/mostrecentcbqapril.pdf 
2. Coding specific for management of COVID patients by the AMA: 
https://www.ama-assn.org/system/files/2020-05/covid-19-coding-advice.pdf 
 

Humayun Anjum, MD, FCCP 
Vice-Chair, Practice Operations

Haala Rokadia, MD, FCCP 

Practice Operations NetWork Steering Committee Member

Transplant  

The COVID 19 pandemic led the health-care community to rapidly adopt telecommunication tools allowing provision of care equivalent to in-person visits. Implementation of telemedicine visits demonstrated that providers can simultaneously distance and connect with patients to provide expert care.   
The University of Pennsylvania lung transplant team adapted video communications to provide individualized physical therapy (PT) recommendations for lung transplantation candidates. The evaluation includes a systems review, musculoskeletal screen, submaximal aerobic capacity testing, and performance of the short physical performance battery test (SPPBT), a frequently used frailty evaluation tool focused on lower extremity function and balance. In the era of social distancing, telemedicine capabilities have made this crucial aspect of pretransplant evaluation possible.  
In advance, patients are emailed a document outlining the telemedicine PT assessment, including the SPPBT. Patients receive videos of the SPPBT to ensure they understand the test and can prepare their home to safely perform the tasks. We are able to highlight the patient's functional capabilities and detail accurate assessments of their deficits. Our teleconsultations utilize BlueJeans for connectivity and typically last about 30 minutes. At this time, we are billing for these pretransplant visits but not for posttransplant PT follow-up.  

Patient experiences with the PT teleconsultations have been overwhelmingly positive. Patients and their families appreciate the uninterrupted evaluation time and the individualized recommendations for improving their deficits. The providers can devote their full attention to the patient directly in front of them. Importantly, patients and providers report they have never felt a stronger connection than through these telemedicine encounters. Longitudinal telemedicine PT assessments will enable us to better monitor our patients throughout the lung transplantation process.  
 

Joshua Diamond, MD 
Steering Committee Member 
Derek Zaleski, PT, DPT 
 

Women's Lung Health  

The SARS-COV-2 pandemic has brought on many fears and uncertainties with new information emerging daily, including the effect during pregnancy. At the time of this article,however, data pertaining to COVID-19 and pregnancy remain limited. Pregnant women do not seem to have a higher infection rate than the general population. In a correspondence where pregnant women admitted for delivery underwent universal screening in NY, 1.9% of women were symptomatic and tested positive, and 13.7% of the asymptomatic patients were found to be SARS-COV-2 positive.1  Furthermore, unlike H1NI, data suggest that pregnant women infected with SARS-COV-2 currently do not seem to have worse outcomes than the average person.2,3  As of now, there have not been any reports of maternal fetal vertical transmission from COVID-19 or any other coronavirus variants.4  Postpartum testing of infants has yielded a very small number of babies who have tested positive for virus, but this more likely represents transmission after birth. There are currently no specific FDA-approved medications for the treatment of moderate-severe infections with COVID-19 in pregnant women, although there are several clinical trials underway. Patients with moderate to severe symptoms should seek medical attention, while those with mild symptoms should continue with conservative therapies, as well as maintaining proper hygiene.5  Delivery methods and timing remain unchanged with cesarean delivery as currently indicated per established guidelines.5   
 

Mariam Louis, MD 
Steering Committee Member 
Jorge Trabanco, MD  
 
1. N Engl J Med. 2020 Apr 13;382:2163-4. April 13, 2020, DOI: 10.1056/NEJMc2009316 
2. N Engl J Med. 2020 Jun 18; 382:e100. April 17, 2020 DOI: 10.1056/NEJMc2009226 
3. Acta Obstet Gynecol Scand. 2020 Jul;99(7):823-829. 2020 Apr 7. doi: 10.1111/aogs.13867. [Epub ahead of print] 
4. Arch Pathol Lab Med. 2020 Apr 27. doi: 10.5858/arpa.2020-0211-SA. [Epub ahead of print] 
5. ACOG practice advisory, Novel Coronavirus 2019 (COVID-19) April 23, 2020. 
 

Big data scientists and health-care experts have tried preparing physicians and patients for the arrival of telemedicine for years. Health tracking applications are on our smartphones. Compact ambulatory devices diagnose hypertension and atrial fibrillation.  Advanced imaging modalities make the stethoscope more of a neck accessory than a practical tool. Despite these efficient technologic advancements, the idea of making the sacred in-person office visit remote and through a screen appealed to few. In fact, prior to the COVID-19 pandemic, only 15% of medical practices offered telehealth services and 8% of Americans joined in remote visits annually (Mann DM et al. J Am Med Inform Assoc. 2019 Feb 1;26[2]:106-114).

When the COVID-19 pandemic hit New York City and admissions for hypoxemic respiratory failure skyrocketed, ED and in-person clinic visits for other acute and chronic conditions plummeted. Prior to clinics officially closing their doors, doctors in New York City asked their patients to reserve office visits for emergency issues only ,with most patients willingly staying home to avoid exposure to the virus. Suddenly, after years of disinterest in adopting telehealth, hospitals and clinics were catapulted into a full-on need for this technology. Overnight, our division’s secretaries and medical assistants became IT support staff.  We all learned together what worked, what didn’t work, and how to adapt our workflow to meet everyone’s needs.

Previously, longstanding issues with accessibility and reimbursement presented barriers to widespread adoption of telemedicine. Once the pandemic hit, though, many regulatory changes were quickly made to accommodate telehealth. 

Three such changes are worth highlighting (Centers for Medicare and Medicaid Services. COVID-19 emergency declaration blanket waivers for health care providers. March 30, 2020). 

First, patient privacy rules became more lenient.  Prior to the pandemic, HIPAA mandated that both doctor and patient use embedded video interfaces with high levels of security.  Now, health-care providers can use commonplace video chat applications such as FaceTime, Google Hangouts, Zoom, or Skype to provide telehealth without risk of penalty for HIPAA noncompliance.  When connectivity concerns arose with our EMR’s embedded telehealth application, a quick transition to one of these platforms mitigated patient and provider frustration. 

Second, prior to the pandemic, some private insurance providers reimbursed for televisits, but there were stipulations on how the visit could be conducted. Now, many of the commercial insurers plus Medicare and Medicaid in New York State reimburse the same amount for televisits as in-person visits (fee-for-service rate).  Reimbursement rates of audio-only encounters were increased.   If these changes are continued postpandemic, it will have an expansive impact on the future of an outpatient practice.  

Third, restrictive government regulations relaxed with regard to telehealth deployment.  Gone are the demands on providers and patients to be physically face-to-face.  Many colleagues worked from home, safely social distancing. 

Even though remote medical visits were a crucial part of flattening the curve during the peak of the pandemic in New York City, the telehealth experience is not without flaws. 

An informal survey of providers in our own division garnered diverse and spirited viewpoints about seeing patients remotely.  Instead of using a stethoscope to pick up a subtle finding, telehealth visits require the use of our eyes to scan a patient’s home environment for insights explaining their chronic cough (Where is the mold? Where is the water damage? Where is the bird?).  We use our ears to hear the intonation of our patient’s voice to know when he or she is concerned, anxious, or are at their baselines.  We would implore patients to put on their pulse oximeter and perform activities of daily living and/or exertion. On multiple occasions, patients would perform their own, unsolicited walks about their home to show us what they could and couldn’t do, where they place their concentrators, and where they are likely to trip over oxygen tubing. We learned to depend on them to reach the conclusion that they were at their normal state of health.

For straight-forward encounters with existing patients, most of our colleagues appreciated the simplicity and efficiency of telemedicine. But when it came to new patients, some colleagues struggled with whether they should see them for the first time over video. Universally, providers felt feelings of inadequacy without an in-person examination and review of diagnostic information. 

Along those lines, many of our colleagues worried about their ability to perform the most fundamental role of a physician over the phone/internet for all patients: building trust with a patient.  Eye contact, the physical exam, and verbal and nonverbal communication that engenders confidence and displays empathy remain a challenge.  Multiple colleagues commented on the difficulty of communicating a new horrible diagnosis over a spotty internet connection.  Others expressed concern about the inability to review chest imaging in-person with patients as this often enhances patient comprehension and relieves anxiety about diagnostic possibilities. 

Providers also noted that telehealth implementation is not the same for all individuals. Just as COVID-19 disproportionately affects the most vulnerable populations (NYC Health. COVID-19: data. Accessed July 1, 2020. https://www1.nyc.gov/site/doh/covid/covid-19-data.page), practicing telehealth has uncovered more ways in which racial/ethnic minorities, low income communities, and older patients are at a disadvantage (Garg S, et al. MMWR Morb Mortal Wkly Rep. 2020;69[15]:458). The relatively quick transition to telemedicine revealed that many of our patients don’t have emails or home computers to connect with online platforms. Similarly, some do not have smart phones with internet capabilities. Many do not speak English and cannot partake in video visits since translators are not yet embedded into the EMR’s video system. Elderly patients were frequently very anxious with telemedicine because of unfamiliarity with the technology, and many preferred a phone conversation.  Thus, while more fortunate patients get to use a video interface and its association with higher patient understanding and satisfaction, our most vulnerable populations are often denied the same access to such care (Voils CI et al. J Genet Couns. 2018;27[2]:339).  

Telemedicine will continue to have a significant impact on the future of health care long after the COVID-19 pandemic abates.  There will be growing pains, refinement of technology, improvements in policy, and an ongoing general evolution of the system. Patients and providers will grow together as its utilization continues. We suspect patient surveys about their attitudes and preferences for telemedicine will be as varied as the providers surveyed here.  A recent survey of 1000 patients about their telehealth experiences during the pandemic reported that over 75% were very or completely satisfied with their virtual care experiences and over 50% indicated they would be willing to switch providers to have virtual visits on a regular basis (Patient Perspectives on Virtual Care Report, Accessed July 7, 2020, https://www.kyruus.com/2020-virtual-care-report).

One hopes that with time and on-going feedback, the fundamental purpose of the physician-patient relationship can be maintained and both sides can still appreciate the conveniences and power of telehealth technology.  

Dr. Fedyna and Dr. McGroder are affiliated with the Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY.

Big data scientists and health-care experts have tried preparing physicians and patients for the arrival of telemedicine for years. Health tracking applications are on our smartphones. Compact ambulatory devices diagnose hypertension and atrial fibrillation.  Advanced imaging modalities make the stethoscope more of a neck accessory than a practical tool. Despite these efficient technologic advancements, the idea of making the sacred in-person office visit remote and through a screen appealed to few. In fact, prior to the COVID-19 pandemic, only 15% of medical practices offered telehealth services and 8% of Americans joined in remote visits annually (Mann DM et al. J Am Med Inform Assoc. 2019 Feb 1;26[2]:106-114).

When the COVID-19 pandemic hit New York City and admissions for hypoxemic respiratory failure skyrocketed, ED and in-person clinic visits for other acute and chronic conditions plummeted. Prior to clinics officially closing their doors, doctors in New York City asked their patients to reserve office visits for emergency issues only ,with most patients willingly staying home to avoid exposure to the virus. Suddenly, after years of disinterest in adopting telehealth, hospitals and clinics were catapulted into a full-on need for this technology. Overnight, our division’s secretaries and medical assistants became IT support staff.  We all learned together what worked, what didn’t work, and how to adapt our workflow to meet everyone’s needs.

Previously, longstanding issues with accessibility and reimbursement presented barriers to widespread adoption of telemedicine. Once the pandemic hit, though, many regulatory changes were quickly made to accommodate telehealth. 

Three such changes are worth highlighting (Centers for Medicare and Medicaid Services. COVID-19 emergency declaration blanket waivers for health care providers. March 30, 2020). 

First, patient privacy rules became more lenient.  Prior to the pandemic, HIPAA mandated that both doctor and patient use embedded video interfaces with high levels of security.  Now, health-care providers can use commonplace video chat applications such as FaceTime, Google Hangouts, Zoom, or Skype to provide telehealth without risk of penalty for HIPAA noncompliance.  When connectivity concerns arose with our EMR’s embedded telehealth application, a quick transition to one of these platforms mitigated patient and provider frustration. 

Second, prior to the pandemic, some private insurance providers reimbursed for televisits, but there were stipulations on how the visit could be conducted. Now, many of the commercial insurers plus Medicare and Medicaid in New York State reimburse the same amount for televisits as in-person visits (fee-for-service rate).  Reimbursement rates of audio-only encounters were increased.   If these changes are continued postpandemic, it will have an expansive impact on the future of an outpatient practice.  

Third, restrictive government regulations relaxed with regard to telehealth deployment.  Gone are the demands on providers and patients to be physically face-to-face.  Many colleagues worked from home, safely social distancing. 

Even though remote medical visits were a crucial part of flattening the curve during the peak of the pandemic in New York City, the telehealth experience is not without flaws. 

An informal survey of providers in our own division garnered diverse and spirited viewpoints about seeing patients remotely.  Instead of using a stethoscope to pick up a subtle finding, telehealth visits require the use of our eyes to scan a patient’s home environment for insights explaining their chronic cough (Where is the mold? Where is the water damage? Where is the bird?).  We use our ears to hear the intonation of our patient’s voice to know when he or she is concerned, anxious, or are at their baselines.  We would implore patients to put on their pulse oximeter and perform activities of daily living and/or exertion. On multiple occasions, patients would perform their own, unsolicited walks about their home to show us what they could and couldn’t do, where they place their concentrators, and where they are likely to trip over oxygen tubing. We learned to depend on them to reach the conclusion that they were at their normal state of health.

For straight-forward encounters with existing patients, most of our colleagues appreciated the simplicity and efficiency of telemedicine. But when it came to new patients, some colleagues struggled with whether they should see them for the first time over video. Universally, providers felt feelings of inadequacy without an in-person examination and review of diagnostic information. 

Along those lines, many of our colleagues worried about their ability to perform the most fundamental role of a physician over the phone/internet for all patients: building trust with a patient.  Eye contact, the physical exam, and verbal and nonverbal communication that engenders confidence and displays empathy remain a challenge.  Multiple colleagues commented on the difficulty of communicating a new horrible diagnosis over a spotty internet connection.  Others expressed concern about the inability to review chest imaging in-person with patients as this often enhances patient comprehension and relieves anxiety about diagnostic possibilities. 

Providers also noted that telehealth implementation is not the same for all individuals. Just as COVID-19 disproportionately affects the most vulnerable populations (NYC Health. COVID-19: data. Accessed July 1, 2020. https://www1.nyc.gov/site/doh/covid/covid-19-data.page), practicing telehealth has uncovered more ways in which racial/ethnic minorities, low income communities, and older patients are at a disadvantage (Garg S, et al. MMWR Morb Mortal Wkly Rep. 2020;69[15]:458). The relatively quick transition to telemedicine revealed that many of our patients don’t have emails or home computers to connect with online platforms. Similarly, some do not have smart phones with internet capabilities. Many do not speak English and cannot partake in video visits since translators are not yet embedded into the EMR’s video system. Elderly patients were frequently very anxious with telemedicine because of unfamiliarity with the technology, and many preferred a phone conversation.  Thus, while more fortunate patients get to use a video interface and its association with higher patient understanding and satisfaction, our most vulnerable populations are often denied the same access to such care (Voils CI et al. J Genet Couns. 2018;27[2]:339).  

Telemedicine will continue to have a significant impact on the future of health care long after the COVID-19 pandemic abates.  There will be growing pains, refinement of technology, improvements in policy, and an ongoing general evolution of the system. Patients and providers will grow together as its utilization continues. We suspect patient surveys about their attitudes and preferences for telemedicine will be as varied as the providers surveyed here.  A recent survey of 1000 patients about their telehealth experiences during the pandemic reported that over 75% were very or completely satisfied with their virtual care experiences and over 50% indicated they would be willing to switch providers to have virtual visits on a regular basis (Patient Perspectives on Virtual Care Report, Accessed July 7, 2020, https://www.kyruus.com/2020-virtual-care-report).

One hopes that with time and on-going feedback, the fundamental purpose of the physician-patient relationship can be maintained and both sides can still appreciate the conveniences and power of telehealth technology.  

Dr. Fedyna and Dr. McGroder are affiliated with the Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY.

Big data scientists and health-care experts have tried preparing physicians and patients for the arrival of telemedicine for years. Health tracking applications are on our smartphones. Compact ambulatory devices diagnose hypertension and atrial fibrillation.  Advanced imaging modalities make the stethoscope more of a neck accessory than a practical tool. Despite these efficient technologic advancements, the idea of making the sacred in-person office visit remote and through a screen appealed to few. In fact, prior to the COVID-19 pandemic, only 15% of medical practices offered telehealth services and 8% of Americans joined in remote visits annually (Mann DM et al. J Am Med Inform Assoc. 2019 Feb 1;26[2]:106-114).

When the COVID-19 pandemic hit New York City and admissions for hypoxemic respiratory failure skyrocketed, ED and in-person clinic visits for other acute and chronic conditions plummeted. Prior to clinics officially closing their doors, doctors in New York City asked their patients to reserve office visits for emergency issues only ,with most patients willingly staying home to avoid exposure to the virus. Suddenly, after years of disinterest in adopting telehealth, hospitals and clinics were catapulted into a full-on need for this technology. Overnight, our division’s secretaries and medical assistants became IT support staff.  We all learned together what worked, what didn’t work, and how to adapt our workflow to meet everyone’s needs.

Previously, longstanding issues with accessibility and reimbursement presented barriers to widespread adoption of telemedicine. Once the pandemic hit, though, many regulatory changes were quickly made to accommodate telehealth. 

Three such changes are worth highlighting (Centers for Medicare and Medicaid Services. COVID-19 emergency declaration blanket waivers for health care providers. March 30, 2020). 

First, patient privacy rules became more lenient.  Prior to the pandemic, HIPAA mandated that both doctor and patient use embedded video interfaces with high levels of security.  Now, health-care providers can use commonplace video chat applications such as FaceTime, Google Hangouts, Zoom, or Skype to provide telehealth without risk of penalty for HIPAA noncompliance.  When connectivity concerns arose with our EMR’s embedded telehealth application, a quick transition to one of these platforms mitigated patient and provider frustration. 

Second, prior to the pandemic, some private insurance providers reimbursed for televisits, but there were stipulations on how the visit could be conducted. Now, many of the commercial insurers plus Medicare and Medicaid in New York State reimburse the same amount for televisits as in-person visits (fee-for-service rate).  Reimbursement rates of audio-only encounters were increased.   If these changes are continued postpandemic, it will have an expansive impact on the future of an outpatient practice.  

Third, restrictive government regulations relaxed with regard to telehealth deployment.  Gone are the demands on providers and patients to be physically face-to-face.  Many colleagues worked from home, safely social distancing. 

Even though remote medical visits were a crucial part of flattening the curve during the peak of the pandemic in New York City, the telehealth experience is not without flaws. 

An informal survey of providers in our own division garnered diverse and spirited viewpoints about seeing patients remotely.  Instead of using a stethoscope to pick up a subtle finding, telehealth visits require the use of our eyes to scan a patient’s home environment for insights explaining their chronic cough (Where is the mold? Where is the water damage? Where is the bird?).  We use our ears to hear the intonation of our patient’s voice to know when he or she is concerned, anxious, or are at their baselines.  We would implore patients to put on their pulse oximeter and perform activities of daily living and/or exertion. On multiple occasions, patients would perform their own, unsolicited walks about their home to show us what they could and couldn’t do, where they place their concentrators, and where they are likely to trip over oxygen tubing. We learned to depend on them to reach the conclusion that they were at their normal state of health.

For straight-forward encounters with existing patients, most of our colleagues appreciated the simplicity and efficiency of telemedicine. But when it came to new patients, some colleagues struggled with whether they should see them for the first time over video. Universally, providers felt feelings of inadequacy without an in-person examination and review of diagnostic information. 

Along those lines, many of our colleagues worried about their ability to perform the most fundamental role of a physician over the phone/internet for all patients: building trust with a patient.  Eye contact, the physical exam, and verbal and nonverbal communication that engenders confidence and displays empathy remain a challenge.  Multiple colleagues commented on the difficulty of communicating a new horrible diagnosis over a spotty internet connection.  Others expressed concern about the inability to review chest imaging in-person with patients as this often enhances patient comprehension and relieves anxiety about diagnostic possibilities. 

Providers also noted that telehealth implementation is not the same for all individuals. Just as COVID-19 disproportionately affects the most vulnerable populations (NYC Health. COVID-19: data. Accessed July 1, 2020. https://www1.nyc.gov/site/doh/covid/covid-19-data.page), practicing telehealth has uncovered more ways in which racial/ethnic minorities, low income communities, and older patients are at a disadvantage (Garg S, et al. MMWR Morb Mortal Wkly Rep. 2020;69[15]:458). The relatively quick transition to telemedicine revealed that many of our patients don’t have emails or home computers to connect with online platforms. Similarly, some do not have smart phones with internet capabilities. Many do not speak English and cannot partake in video visits since translators are not yet embedded into the EMR’s video system. Elderly patients were frequently very anxious with telemedicine because of unfamiliarity with the technology, and many preferred a phone conversation.  Thus, while more fortunate patients get to use a video interface and its association with higher patient understanding and satisfaction, our most vulnerable populations are often denied the same access to such care (Voils CI et al. J Genet Couns. 2018;27[2]:339).  

Telemedicine will continue to have a significant impact on the future of health care long after the COVID-19 pandemic abates.  There will be growing pains, refinement of technology, improvements in policy, and an ongoing general evolution of the system. Patients and providers will grow together as its utilization continues. We suspect patient surveys about their attitudes and preferences for telemedicine will be as varied as the providers surveyed here.  A recent survey of 1000 patients about their telehealth experiences during the pandemic reported that over 75% were very or completely satisfied with their virtual care experiences and over 50% indicated they would be willing to switch providers to have virtual visits on a regular basis (Patient Perspectives on Virtual Care Report, Accessed July 7, 2020, https://www.kyruus.com/2020-virtual-care-report).

One hopes that with time and on-going feedback, the fundamental purpose of the physician-patient relationship can be maintained and both sides can still appreciate the conveniences and power of telehealth technology.  

Dr. Fedyna and Dr. McGroder are affiliated with the Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY.

The CHEST Foundation is excited to announce that the NetWorks Challenge will be reinvented for 2020! Instead of raising funds to support travel grants to CHEST’s Annual Meeting as in previous years, the NetWorks Challenge will focus on raising funds to support COVID-19 community service grants. With so many people suffering due to the pandemic, we believe this change will make a tangible impact on the lives of people who need it most.

To date, the CHEST Foundation has dispersed over $60,000 in payments for patient support groups that provide services to those living with chronic lung disease, and we hope this year’s efforts will enable us to continue this work. For every $2,500 raised by a NetWork, the CHEST Foundation will provide a grant to a community support group in need.

While providing vulnerable populations with funds to purchase essential items (PPE, cleaning supplies, emergency food purchases, etc), each grant will be named in honor of the NetWork raising the funds, and all stories of impact will be shared with NetWorks’ members, once they are available.

The NetWorks Challenge spans from Monday, July 20, to the end of Board Review on August 22, and members can easily designate their donation to their NetWork on the CHEST Foundation’s donor page.

In addition to receiving named recognition of your NetWork, the NetWork that raises the most funds, along with the NetWork with the highest percentage of participation, will receive additional prizes, including two complimentary registrations to CHEST 2020. These registrations are specifically for early-career clinicians and fellows-in-training, which will be selected by each NetWorks’s steering committee.

For every $5,000 raised by a NetWork, that NetWork will receive one complimentary registration to CHEST 2020, which will be awarded to their early-career and fellows-in-training as selected by that NetWorks’s steering committee.

In addition to directly impacting patients across the United States, NetWorks members will have a chance to test their knowledge against their peers by participating in a NetWork Challenge Game Series, where they will be asked a series of hand-selected board review questions each week through the end of Board Review.

For additional Information about the NetWorks Challenge, visit the CHEST Foundation’s website.

The CHEST Foundation is excited to announce that the NetWorks Challenge will be reinvented for 2020! Instead of raising funds to support travel grants to CHEST’s Annual Meeting as in previous years, the NetWorks Challenge will focus on raising funds to support COVID-19 community service grants. With so many people suffering due to the pandemic, we believe this change will make a tangible impact on the lives of people who need it most.

To date, the CHEST Foundation has dispersed over $60,000 in payments for patient support groups that provide services to those living with chronic lung disease, and we hope this year’s efforts will enable us to continue this work. For every $2,500 raised by a NetWork, the CHEST Foundation will provide a grant to a community support group in need.

While providing vulnerable populations with funds to purchase essential items (PPE, cleaning supplies, emergency food purchases, etc), each grant will be named in honor of the NetWork raising the funds, and all stories of impact will be shared with NetWorks’ members, once they are available.

The NetWorks Challenge spans from Monday, July 20, to the end of Board Review on August 22, and members can easily designate their donation to their NetWork on the CHEST Foundation’s donor page.

In addition to receiving named recognition of your NetWork, the NetWork that raises the most funds, along with the NetWork with the highest percentage of participation, will receive additional prizes, including two complimentary registrations to CHEST 2020. These registrations are specifically for early-career clinicians and fellows-in-training, which will be selected by each NetWorks’s steering committee.

For every $5,000 raised by a NetWork, that NetWork will receive one complimentary registration to CHEST 2020, which will be awarded to their early-career and fellows-in-training as selected by that NetWorks’s steering committee.

In addition to directly impacting patients across the United States, NetWorks members will have a chance to test their knowledge against their peers by participating in a NetWork Challenge Game Series, where they will be asked a series of hand-selected board review questions each week through the end of Board Review.

For additional Information about the NetWorks Challenge, visit the CHEST Foundation’s website.

The CHEST Foundation is excited to announce that the NetWorks Challenge will be reinvented for 2020! Instead of raising funds to support travel grants to CHEST’s Annual Meeting as in previous years, the NetWorks Challenge will focus on raising funds to support COVID-19 community service grants. With so many people suffering due to the pandemic, we believe this change will make a tangible impact on the lives of people who need it most.

To date, the CHEST Foundation has dispersed over $60,000 in payments for patient support groups that provide services to those living with chronic lung disease, and we hope this year’s efforts will enable us to continue this work. For every $2,500 raised by a NetWork, the CHEST Foundation will provide a grant to a community support group in need.

While providing vulnerable populations with funds to purchase essential items (PPE, cleaning supplies, emergency food purchases, etc), each grant will be named in honor of the NetWork raising the funds, and all stories of impact will be shared with NetWorks’ members, once they are available.

The NetWorks Challenge spans from Monday, July 20, to the end of Board Review on August 22, and members can easily designate their donation to their NetWork on the CHEST Foundation’s donor page.

In addition to receiving named recognition of your NetWork, the NetWork that raises the most funds, along with the NetWork with the highest percentage of participation, will receive additional prizes, including two complimentary registrations to CHEST 2020. These registrations are specifically for early-career clinicians and fellows-in-training, which will be selected by each NetWorks’s steering committee.

For every $5,000 raised by a NetWork, that NetWork will receive one complimentary registration to CHEST 2020, which will be awarded to their early-career and fellows-in-training as selected by that NetWorks’s steering committee.

In addition to directly impacting patients across the United States, NetWorks members will have a chance to test their knowledge against their peers by participating in a NetWork Challenge Game Series, where they will be asked a series of hand-selected board review questions each week through the end of Board Review.

For additional Information about the NetWorks Challenge, visit the CHEST Foundation’s website.

The Board of Regents met remotely in June because of ongoing travel restrictions and safety concerns for staff and board members.

• The meeting was opened with Stephanie Levine, President; Steve Simpson, President-Elect; and Robert Musacchio, CEO/EVP discussing the impacts of the COVID-19 pandemic and Business Continuity Planning. The COVID-19 Task Force, chaired by Steve Simpson, continues to meet weekly to identify emerging content needs toward supporting membership and their patients through the pandemic, connecting with the Education Committee and Foundation to ensure robust coverage, drawing on the expertise of the NetWorks for content development, and leveraging the Social Media Workgroup for dissemination. Key activities include: a regular Thursday webinar series at 3:00 pm CDT titled: “Advice From the Front Lines”; clinical resources in the form of infographics and guides are posted in the resource center and circulated through social media; Alex Niven, MD FCCP, led a team to develop a wellness curriculum and series; the CHEST Foundation developed patient education videos and guides, a public service announcement in partnership with the American Thoracic Society, and a pilot partnership with AMITA Health enabling access to telehealth.

• The Finance Committee, chaired by John Howington, reported that CHEST is on track to meet its budget and exceed its debt covenants and operating reserve policy for the current fiscal year. The record attendance at the October 2019 annual meeting, along with strong performance from our digital offerings offset the financial impacts of the global pandemic. Bob Musacchio, CEO/EVP, reminded the Board why CHEST is switching from a fiscal year to calendar year budget. A calendar year budget process creates better alignment with budgets of pharma, other clients, and vendors; facilitates various accruals that are based on the calendar year, such as benefits, vacation, sick, and PTO days; provides for greater continuity for doing business throughout the year, and permits more planning time for staff in setting individual goals related to the annual meeting.

• CHEST’S Digital Transformation strategy that kicked off in 2019 was timely considering the pandemic. With education as one of our main foci, CHEST has hired and onboarded a Chief Learning Officer, Jim Young, to actively examine how we develop and deploy our educational products and services. Our first movement toward remote meetings occurred on June 26 with the Virtual Congress originally slated for Bologna, Italy. Here, we piloted a new platform and brought to life the tenets established in the new learning strategy—providing choice, demonstrating responsiveness, and fostering connection.

• CHEST’s Governance Committee reviewed the College bylaws for revisions, as per the group’s practice every 2-3 years, and the Board approved the revisions to the bylaws as proposed by the committee.

• CHEST’s newly formed Health Policy and Advocacy Committee (HPAC), chaired by Neil Freedman, MD, FCCP, is holding monthly meetings with a goal of making a recommendation to the Board of Regents on CHEST’s regulatory and policy priorities during the August meeting. The HPAC assists CHEST leadership and the BOR in developing and implementing health policy positions, setting chest advocacy agendas in the legislative and regulatory arenas, engaging with policymakers as directed by the BOR, and educating CHEST members of government affairs relevant to CHEST’s mission. The HPAC is currently setting its priorities to bring to the BOR for approval later this summer. Areas of focus include home mechanical ventilation and competitive bidding access to in education four home auction therapy, only rehabilitation and tobacco vaping education,

• Peter Mazzone, MD, FCCP; Editor in Chief, CHEST journal, reviewed his editorial team, which now consists of three Deputy Editors, nine Associate Editors, an Assistant Editor, a Statistical Editor, and three Case Series Editors and the publishing staff and partners.

The Board’s next meetings will be a scheduled teleconference in August, followed by their meeting that will occur concomitantly with the CHEST meeting in October.

The Board of Regents met remotely in June because of ongoing travel restrictions and safety concerns for staff and board members.

• The meeting was opened with Stephanie Levine, President; Steve Simpson, President-Elect; and Robert Musacchio, CEO/EVP discussing the impacts of the COVID-19 pandemic and Business Continuity Planning. The COVID-19 Task Force, chaired by Steve Simpson, continues to meet weekly to identify emerging content needs toward supporting membership and their patients through the pandemic, connecting with the Education Committee and Foundation to ensure robust coverage, drawing on the expertise of the NetWorks for content development, and leveraging the Social Media Workgroup for dissemination. Key activities include: a regular Thursday webinar series at 3:00 pm CDT titled: “Advice From the Front Lines”; clinical resources in the form of infographics and guides are posted in the resource center and circulated through social media; Alex Niven, MD FCCP, led a team to develop a wellness curriculum and series; the CHEST Foundation developed patient education videos and guides, a public service announcement in partnership with the American Thoracic Society, and a pilot partnership with AMITA Health enabling access to telehealth.

• The Finance Committee, chaired by John Howington, reported that CHEST is on track to meet its budget and exceed its debt covenants and operating reserve policy for the current fiscal year. The record attendance at the October 2019 annual meeting, along with strong performance from our digital offerings offset the financial impacts of the global pandemic. Bob Musacchio, CEO/EVP, reminded the Board why CHEST is switching from a fiscal year to calendar year budget. A calendar year budget process creates better alignment with budgets of pharma, other clients, and vendors; facilitates various accruals that are based on the calendar year, such as benefits, vacation, sick, and PTO days; provides for greater continuity for doing business throughout the year, and permits more planning time for staff in setting individual goals related to the annual meeting.

• CHEST’S Digital Transformation strategy that kicked off in 2019 was timely considering the pandemic. With education as one of our main foci, CHEST has hired and onboarded a Chief Learning Officer, Jim Young, to actively examine how we develop and deploy our educational products and services. Our first movement toward remote meetings occurred on June 26 with the Virtual Congress originally slated for Bologna, Italy. Here, we piloted a new platform and brought to life the tenets established in the new learning strategy—providing choice, demonstrating responsiveness, and fostering connection.

• CHEST’s Governance Committee reviewed the College bylaws for revisions, as per the group’s practice every 2-3 years, and the Board approved the revisions to the bylaws as proposed by the committee.

• CHEST’s newly formed Health Policy and Advocacy Committee (HPAC), chaired by Neil Freedman, MD, FCCP, is holding monthly meetings with a goal of making a recommendation to the Board of Regents on CHEST’s regulatory and policy priorities during the August meeting. The HPAC assists CHEST leadership and the BOR in developing and implementing health policy positions, setting chest advocacy agendas in the legislative and regulatory arenas, engaging with policymakers as directed by the BOR, and educating CHEST members of government affairs relevant to CHEST’s mission. The HPAC is currently setting its priorities to bring to the BOR for approval later this summer. Areas of focus include home mechanical ventilation and competitive bidding access to in education four home auction therapy, only rehabilitation and tobacco vaping education,

• Peter Mazzone, MD, FCCP; Editor in Chief, CHEST journal, reviewed his editorial team, which now consists of three Deputy Editors, nine Associate Editors, an Assistant Editor, a Statistical Editor, and three Case Series Editors and the publishing staff and partners.

The Board’s next meetings will be a scheduled teleconference in August, followed by their meeting that will occur concomitantly with the CHEST meeting in October.

The Board of Regents met remotely in June because of ongoing travel restrictions and safety concerns for staff and board members.

• The meeting was opened with Stephanie Levine, President; Steve Simpson, President-Elect; and Robert Musacchio, CEO/EVP discussing the impacts of the COVID-19 pandemic and Business Continuity Planning. The COVID-19 Task Force, chaired by Steve Simpson, continues to meet weekly to identify emerging content needs toward supporting membership and their patients through the pandemic, connecting with the Education Committee and Foundation to ensure robust coverage, drawing on the expertise of the NetWorks for content development, and leveraging the Social Media Workgroup for dissemination. Key activities include: a regular Thursday webinar series at 3:00 pm CDT titled: “Advice From the Front Lines”; clinical resources in the form of infographics and guides are posted in the resource center and circulated through social media; Alex Niven, MD FCCP, led a team to develop a wellness curriculum and series; the CHEST Foundation developed patient education videos and guides, a public service announcement in partnership with the American Thoracic Society, and a pilot partnership with AMITA Health enabling access to telehealth.

• The Finance Committee, chaired by John Howington, reported that CHEST is on track to meet its budget and exceed its debt covenants and operating reserve policy for the current fiscal year. The record attendance at the October 2019 annual meeting, along with strong performance from our digital offerings offset the financial impacts of the global pandemic. Bob Musacchio, CEO/EVP, reminded the Board why CHEST is switching from a fiscal year to calendar year budget. A calendar year budget process creates better alignment with budgets of pharma, other clients, and vendors; facilitates various accruals that are based on the calendar year, such as benefits, vacation, sick, and PTO days; provides for greater continuity for doing business throughout the year, and permits more planning time for staff in setting individual goals related to the annual meeting.

• CHEST’S Digital Transformation strategy that kicked off in 2019 was timely considering the pandemic. With education as one of our main foci, CHEST has hired and onboarded a Chief Learning Officer, Jim Young, to actively examine how we develop and deploy our educational products and services. Our first movement toward remote meetings occurred on June 26 with the Virtual Congress originally slated for Bologna, Italy. Here, we piloted a new platform and brought to life the tenets established in the new learning strategy—providing choice, demonstrating responsiveness, and fostering connection.

• CHEST’s Governance Committee reviewed the College bylaws for revisions, as per the group’s practice every 2-3 years, and the Board approved the revisions to the bylaws as proposed by the committee.

• CHEST’s newly formed Health Policy and Advocacy Committee (HPAC), chaired by Neil Freedman, MD, FCCP, is holding monthly meetings with a goal of making a recommendation to the Board of Regents on CHEST’s regulatory and policy priorities during the August meeting. The HPAC assists CHEST leadership and the BOR in developing and implementing health policy positions, setting chest advocacy agendas in the legislative and regulatory arenas, engaging with policymakers as directed by the BOR, and educating CHEST members of government affairs relevant to CHEST’s mission. The HPAC is currently setting its priorities to bring to the BOR for approval later this summer. Areas of focus include home mechanical ventilation and competitive bidding access to in education four home auction therapy, only rehabilitation and tobacco vaping education,

• Peter Mazzone, MD, FCCP; Editor in Chief, CHEST journal, reviewed his editorial team, which now consists of three Deputy Editors, nine Associate Editors, an Assistant Editor, a Statistical Editor, and three Case Series Editors and the publishing staff and partners.

The Board’s next meetings will be a scheduled teleconference in August, followed by their meeting that will occur concomitantly with the CHEST meeting in October.

After careful consideration, CHEST has decided to cancel the live, in-person CHEST Annual Meeting in Chicago, Illinois, this October and replace it with a 100% virtual event. The COVID-19 pandemic has provided the opportunity to look at different approaches for delivering education, and over the past several months, CHEST has done just that.

Due to the pandemic, we moved the CHEST Congress 2020, originally scheduled to take place in Bologna, Italy, to June 2021. On June 30, in partnership with the Italian Delegation, the CHEST Virtual Congress event took place with over 3,200 people registered, spanning over 100 countries. This event featured a robust program that included an international COVID panel, additional educational sessions, over 300 recorded poster presentations, and live, interactive games that kept attendees engaged throughout the day. There was also a surprise welcome message delivered by Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases. We are excited to use the success of this virtual event as an opportunity to expand our knowledge and expertise, and deliver a fun, memorable CHEST 2020.

This October, CHEST will bring you the premier virtual education event in pulmonary, critical care, and sleep medicine, all from the comfort and safety of your home or institution. This year’s virtual Annual Meeting will include live, interactive education, including panel and case-based discussions, virtual networking opportunities, CHEST GAMES, and the space for you to connect, learn, and recharge with your peers…virtually.

Top faculty from across the field will bring you the latest in clinical developments related to the diagnosis, treatment, and management of pulmonary diseases, critical care complications, and sleep disorders. Nonclinical topics, like cultural diversity and burnout, that feature more prominently than ever in day-to-day practice, will be given equal weight. Sessions like, Being Me: Understanding ‘Otherness’ and Issues of Diversity, will rely on audience interaction to address scenarios involving bias and racism faced by the panel of presenters and members of the audience.

Crucial and quickly evolving information on COVID-19 will be front and center, including complications with COVID-19 recovery, COVID-19 management in complex situations, and additional discussions on updated drug trials, treatment plans, and practice management changes. We will focus on other challenges the pandemic has highlighted, helping educators with sessions such as APCCMPD: Education Lessons During a Pandemic and sharing key reminders to all on the fundamentals of pandemic preparation with When the Theoretical Becomes Real: Lessons from a Pandemic.

It is more important than ever to stay up to date on developments in health and medicine, but CHEST is putting equal weight on ensuring the experience of CHEST 2020 is a respite from the mental and physical exhaustion our community is experiencing during these unprecedented times. As ever, we will ensure you meet your educational needs. But together, we will also focus on supporting you in building resilience and giving you the tools to continue to find joy in medicine, even amidst the chaos of a pandemic. Thank you for your continued trust in CHEST, and we look forward to “seeing” you at CHEST 2020 October 18-21!

After careful consideration, CHEST has decided to cancel the live, in-person CHEST Annual Meeting in Chicago, Illinois, this October and replace it with a 100% virtual event. The COVID-19 pandemic has provided the opportunity to look at different approaches for delivering education, and over the past several months, CHEST has done just that.

Due to the pandemic, we moved the CHEST Congress 2020, originally scheduled to take place in Bologna, Italy, to June 2021. On June 30, in partnership with the Italian Delegation, the CHEST Virtual Congress event took place with over 3,200 people registered, spanning over 100 countries. This event featured a robust program that included an international COVID panel, additional educational sessions, over 300 recorded poster presentations, and live, interactive games that kept attendees engaged throughout the day. There was also a surprise welcome message delivered by Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases. We are excited to use the success of this virtual event as an opportunity to expand our knowledge and expertise, and deliver a fun, memorable CHEST 2020.

This October, CHEST will bring you the premier virtual education event in pulmonary, critical care, and sleep medicine, all from the comfort and safety of your home or institution. This year’s virtual Annual Meeting will include live, interactive education, including panel and case-based discussions, virtual networking opportunities, CHEST GAMES, and the space for you to connect, learn, and recharge with your peers…virtually.

Top faculty from across the field will bring you the latest in clinical developments related to the diagnosis, treatment, and management of pulmonary diseases, critical care complications, and sleep disorders. Nonclinical topics, like cultural diversity and burnout, that feature more prominently than ever in day-to-day practice, will be given equal weight. Sessions like, Being Me: Understanding ‘Otherness’ and Issues of Diversity, will rely on audience interaction to address scenarios involving bias and racism faced by the panel of presenters and members of the audience.

Crucial and quickly evolving information on COVID-19 will be front and center, including complications with COVID-19 recovery, COVID-19 management in complex situations, and additional discussions on updated drug trials, treatment plans, and practice management changes. We will focus on other challenges the pandemic has highlighted, helping educators with sessions such as APCCMPD: Education Lessons During a Pandemic and sharing key reminders to all on the fundamentals of pandemic preparation with When the Theoretical Becomes Real: Lessons from a Pandemic.

It is more important than ever to stay up to date on developments in health and medicine, but CHEST is putting equal weight on ensuring the experience of CHEST 2020 is a respite from the mental and physical exhaustion our community is experiencing during these unprecedented times. As ever, we will ensure you meet your educational needs. But together, we will also focus on supporting you in building resilience and giving you the tools to continue to find joy in medicine, even amidst the chaos of a pandemic. Thank you for your continued trust in CHEST, and we look forward to “seeing” you at CHEST 2020 October 18-21!

After careful consideration, CHEST has decided to cancel the live, in-person CHEST Annual Meeting in Chicago, Illinois, this October and replace it with a 100% virtual event. The COVID-19 pandemic has provided the opportunity to look at different approaches for delivering education, and over the past several months, CHEST has done just that.

Due to the pandemic, we moved the CHEST Congress 2020, originally scheduled to take place in Bologna, Italy, to June 2021. On June 30, in partnership with the Italian Delegation, the CHEST Virtual Congress event took place with over 3,200 people registered, spanning over 100 countries. This event featured a robust program that included an international COVID panel, additional educational sessions, over 300 recorded poster presentations, and live, interactive games that kept attendees engaged throughout the day. There was also a surprise welcome message delivered by Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases. We are excited to use the success of this virtual event as an opportunity to expand our knowledge and expertise, and deliver a fun, memorable CHEST 2020.

This October, CHEST will bring you the premier virtual education event in pulmonary, critical care, and sleep medicine, all from the comfort and safety of your home or institution. This year’s virtual Annual Meeting will include live, interactive education, including panel and case-based discussions, virtual networking opportunities, CHEST GAMES, and the space for you to connect, learn, and recharge with your peers…virtually.

Top faculty from across the field will bring you the latest in clinical developments related to the diagnosis, treatment, and management of pulmonary diseases, critical care complications, and sleep disorders. Nonclinical topics, like cultural diversity and burnout, that feature more prominently than ever in day-to-day practice, will be given equal weight. Sessions like, Being Me: Understanding ‘Otherness’ and Issues of Diversity, will rely on audience interaction to address scenarios involving bias and racism faced by the panel of presenters and members of the audience.

Crucial and quickly evolving information on COVID-19 will be front and center, including complications with COVID-19 recovery, COVID-19 management in complex situations, and additional discussions on updated drug trials, treatment plans, and practice management changes. We will focus on other challenges the pandemic has highlighted, helping educators with sessions such as APCCMPD: Education Lessons During a Pandemic and sharing key reminders to all on the fundamentals of pandemic preparation with When the Theoretical Becomes Real: Lessons from a Pandemic.

It is more important than ever to stay up to date on developments in health and medicine, but CHEST is putting equal weight on ensuring the experience of CHEST 2020 is a respite from the mental and physical exhaustion our community is experiencing during these unprecedented times. As ever, we will ensure you meet your educational needs. But together, we will also focus on supporting you in building resilience and giving you the tools to continue to find joy in medicine, even amidst the chaos of a pandemic. Thank you for your continued trust in CHEST, and we look forward to “seeing” you at CHEST 2020 October 18-21!

Greetings. I hope that you are well and are enjoying the summer as best you can during these challenging times. Since the “CHEST year” has drawn to a close recently, I would like to offer my reflections, which were recently shared with the Board of Regents, as well as a glimpse of what is ahead for CHEST. There is just so much great work I want to share.

This past year has posed a number of challenges. COVID-19 has caused us to interact differently on both a social and a business level. CHEST Headquarters has been closed, and we have not had a live-learning course for more than 4 months. But our work has not faltered. We have been extremely productive during this period and have once again demonstrated our resiliency and innovative spirit; in our vernacular, we “Crushed It.”

While COVID-19 has presented us with a number of obstacles, it has presented us with a number of opportunities, and we have taken advantage of them. During this pandemic, CHEST has truly demonstrated its ability to provide a connection at a critical time, giving this phrase new meaning and urgency. We have created a new resource center for clinicians, developed patient education and awareness campaigns to support the public through this crisis, launched a webinar series, developed scientific guidance statements, and more. At the same time, we have invested in our technology and educational infrastructure to grow our capabilities and position CHEST for long-term success.

Prior to COVID-19, we spent a significant amount of time among the CHEST staff, Presidents, and Boards drafting and reviewing a concise strategy statement for CHEST to provide focus and clarity to its efforts and derive and tie together future strategies specific to learning, technology, and more. From this statement, we derived four key areas requiring our continued and explicit focus to achieve this goal:

• People: Ensure we attract, retain, and incentivize the right people (staff, leaders, and volunteers).

• Products: Foster an environment of innovation and product development resulting in overall revenue growth, as well as revenue from new products and services.

• Education: Ensure that CHEST education products and services are robust, differentiated, and scalable..

• Growth: Meet or exceed revenue and margin targets.

As long as the mission and strategy of the organization does not deviate, these goals should not change. However, how we go about executing on achieving these goals each year will depend on the context of our environment and be shaped by the specific initiatives planned affecting our People, Products, Education, and building toward Growth. This consistency is important to sustain a vibrant, aligned, and productive organization.

Beyond this groundwork, I also would like to list a series of things that, together, CHEST accomplished over the last year.

• Reviewed existing contracts and, where appropriate, renegotiated major contracts to ensure terms more favorable for CHEST.
• Hired and on-boarded a Chief Learning Officer to place greater emphasis on expanding CHEST educational programs. Analyzed current educational products and have begun repositioning our educational efforts to better serve our learners.
• Refined the one CHEST concept, realigned responsibilities throughout the organization in general, and the CHEST Foundation, in particular, to enhance resource readiness and productivity. Clarified relationship with industry by continuing to implement our Industry Partnership Guidelines and streamline efforts with our partners.
• Continued rollout and execution of our international event strategy. Successfully developed and held a program for CHEST Congress 2020 Italy with our CHEST Italian Delegation, in a virtual format, due to COVID, while enabling us to build momentum for a rescheduled meeting in 2021. We had over 2,000 virtual registrants from over 100 countries, and there was a thank you given to all attendees by Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, to start off the program – what a success!
• Accelerated our digital transformation with an educational focus on virtual Board Review, CHEST 2020 Annual Meeting, online simulation.
• Forecasting strong financial outlook and improving financial reporting for FY19-20. Successful 2019 annual meeting:

o Total attendance 8,593—the largest attendance to date.

o Simulation Session Registration 979

o Exhibiting companies 160 SOLD OUT

o CHEST Annual Meeting 2019 delivered largest number of APPs and fellows attending in the last 5 years.

• Reintroduced CHEST into the advocacy and health policy arena through the successful acquisition of NAMDRC.

CHEST’s operating financial performance is solid, and well thought out efforts have kept CHEST on a growth trajectory over the last 7 years. During this same period (since 2011/12), our staff headcount has grown from 85 to a projected 121 this year; the new expertise and capabilities we have brought on board, combined with our highly talented and committed staff team, have contributed to this tremendous growth.

Our future is bright. These 2 two years have been very exciting for me both professionally and personally. I am grateful for the opportunity to work with all of you and serve as your CEO/EVP because together, we truly are making a significant difference in moving CHEST forward and crushing lung disease.

I know you are as proud of CHEST’s efforts this year as I am.

Thank you.

Greetings. I hope that you are well and are enjoying the summer as best you can during these challenging times. Since the “CHEST year” has drawn to a close recently, I would like to offer my reflections, which were recently shared with the Board of Regents, as well as a glimpse of what is ahead for CHEST. There is just so much great work I want to share.

This past year has posed a number of challenges. COVID-19 has caused us to interact differently on both a social and a business level. CHEST Headquarters has been closed, and we have not had a live-learning course for more than 4 months. But our work has not faltered. We have been extremely productive during this period and have once again demonstrated our resiliency and innovative spirit; in our vernacular, we “Crushed It.”

While COVID-19 has presented us with a number of obstacles, it has presented us with a number of opportunities, and we have taken advantage of them. During this pandemic, CHEST has truly demonstrated its ability to provide a connection at a critical time, giving this phrase new meaning and urgency. We have created a new resource center for clinicians, developed patient education and awareness campaigns to support the public through this crisis, launched a webinar series, developed scientific guidance statements, and more. At the same time, we have invested in our technology and educational infrastructure to grow our capabilities and position CHEST for long-term success.

Prior to COVID-19, we spent a significant amount of time among the CHEST staff, Presidents, and Boards drafting and reviewing a concise strategy statement for CHEST to provide focus and clarity to its efforts and derive and tie together future strategies specific to learning, technology, and more. From this statement, we derived four key areas requiring our continued and explicit focus to achieve this goal:

• People: Ensure we attract, retain, and incentivize the right people (staff, leaders, and volunteers).

• Products: Foster an environment of innovation and product development resulting in overall revenue growth, as well as revenue from new products and services.

• Education: Ensure that CHEST education products and services are robust, differentiated, and scalable..

• Growth: Meet or exceed revenue and margin targets.

As long as the mission and strategy of the organization does not deviate, these goals should not change. However, how we go about executing on achieving these goals each year will depend on the context of our environment and be shaped by the specific initiatives planned affecting our People, Products, Education, and building toward Growth. This consistency is important to sustain a vibrant, aligned, and productive organization.

Beyond this groundwork, I also would like to list a series of things that, together, CHEST accomplished over the last year.

• Reviewed existing contracts and, where appropriate, renegotiated major contracts to ensure terms more favorable for CHEST.
• Hired and on-boarded a Chief Learning Officer to place greater emphasis on expanding CHEST educational programs. Analyzed current educational products and have begun repositioning our educational efforts to better serve our learners.
• Refined the one CHEST concept, realigned responsibilities throughout the organization in general, and the CHEST Foundation, in particular, to enhance resource readiness and productivity. Clarified relationship with industry by continuing to implement our Industry Partnership Guidelines and streamline efforts with our partners.
• Continued rollout and execution of our international event strategy. Successfully developed and held a program for CHEST Congress 2020 Italy with our CHEST Italian Delegation, in a virtual format, due to COVID, while enabling us to build momentum for a rescheduled meeting in 2021. We had over 2,000 virtual registrants from over 100 countries, and there was a thank you given to all attendees by Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, to start off the program – what a success!
• Accelerated our digital transformation with an educational focus on virtual Board Review, CHEST 2020 Annual Meeting, online simulation.
• Forecasting strong financial outlook and improving financial reporting for FY19-20. Successful 2019 annual meeting:

o Total attendance 8,593—the largest attendance to date.

o Simulation Session Registration 979

o Exhibiting companies 160 SOLD OUT

o CHEST Annual Meeting 2019 delivered largest number of APPs and fellows attending in the last 5 years.

• Reintroduced CHEST into the advocacy and health policy arena through the successful acquisition of NAMDRC.

CHEST’s operating financial performance is solid, and well thought out efforts have kept CHEST on a growth trajectory over the last 7 years. During this same period (since 2011/12), our staff headcount has grown from 85 to a projected 121 this year; the new expertise and capabilities we have brought on board, combined with our highly talented and committed staff team, have contributed to this tremendous growth.

Our future is bright. These 2 two years have been very exciting for me both professionally and personally. I am grateful for the opportunity to work with all of you and serve as your CEO/EVP because together, we truly are making a significant difference in moving CHEST forward and crushing lung disease.

I know you are as proud of CHEST’s efforts this year as I am.

Thank you.

Greetings. I hope that you are well and are enjoying the summer as best you can during these challenging times. Since the “CHEST year” has drawn to a close recently, I would like to offer my reflections, which were recently shared with the Board of Regents, as well as a glimpse of what is ahead for CHEST. There is just so much great work I want to share.

This past year has posed a number of challenges. COVID-19 has caused us to interact differently on both a social and a business level. CHEST Headquarters has been closed, and we have not had a live-learning course for more than 4 months. But our work has not faltered. We have been extremely productive during this period and have once again demonstrated our resiliency and innovative spirit; in our vernacular, we “Crushed It.”

While COVID-19 has presented us with a number of obstacles, it has presented us with a number of opportunities, and we have taken advantage of them. During this pandemic, CHEST has truly demonstrated its ability to provide a connection at a critical time, giving this phrase new meaning and urgency. We have created a new resource center for clinicians, developed patient education and awareness campaigns to support the public through this crisis, launched a webinar series, developed scientific guidance statements, and more. At the same time, we have invested in our technology and educational infrastructure to grow our capabilities and position CHEST for long-term success.

Prior to COVID-19, we spent a significant amount of time among the CHEST staff, Presidents, and Boards drafting and reviewing a concise strategy statement for CHEST to provide focus and clarity to its efforts and derive and tie together future strategies specific to learning, technology, and more. From this statement, we derived four key areas requiring our continued and explicit focus to achieve this goal:

• People: Ensure we attract, retain, and incentivize the right people (staff, leaders, and volunteers).

• Products: Foster an environment of innovation and product development resulting in overall revenue growth, as well as revenue from new products and services.

• Education: Ensure that CHEST education products and services are robust, differentiated, and scalable..

• Growth: Meet or exceed revenue and margin targets.

As long as the mission and strategy of the organization does not deviate, these goals should not change. However, how we go about executing on achieving these goals each year will depend on the context of our environment and be shaped by the specific initiatives planned affecting our People, Products, Education, and building toward Growth. This consistency is important to sustain a vibrant, aligned, and productive organization.

Beyond this groundwork, I also would like to list a series of things that, together, CHEST accomplished over the last year.

• Reviewed existing contracts and, where appropriate, renegotiated major contracts to ensure terms more favorable for CHEST.
• Hired and on-boarded a Chief Learning Officer to place greater emphasis on expanding CHEST educational programs. Analyzed current educational products and have begun repositioning our educational efforts to better serve our learners.
• Refined the one CHEST concept, realigned responsibilities throughout the organization in general, and the CHEST Foundation, in particular, to enhance resource readiness and productivity. Clarified relationship with industry by continuing to implement our Industry Partnership Guidelines and streamline efforts with our partners.
• Continued rollout and execution of our international event strategy. Successfully developed and held a program for CHEST Congress 2020 Italy with our CHEST Italian Delegation, in a virtual format, due to COVID, while enabling us to build momentum for a rescheduled meeting in 2021. We had over 2,000 virtual registrants from over 100 countries, and there was a thank you given to all attendees by Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, to start off the program – what a success!
• Accelerated our digital transformation with an educational focus on virtual Board Review, CHEST 2020 Annual Meeting, online simulation.
• Forecasting strong financial outlook and improving financial reporting for FY19-20. Successful 2019 annual meeting:

o Total attendance 8,593—the largest attendance to date.

o Simulation Session Registration 979

o Exhibiting companies 160 SOLD OUT

o CHEST Annual Meeting 2019 delivered largest number of APPs and fellows attending in the last 5 years.

• Reintroduced CHEST into the advocacy and health policy arena through the successful acquisition of NAMDRC.

CHEST’s operating financial performance is solid, and well thought out efforts have kept CHEST on a growth trajectory over the last 7 years. During this same period (since 2011/12), our staff headcount has grown from 85 to a projected 121 this year; the new expertise and capabilities we have brought on board, combined with our highly talented and committed staff team, have contributed to this tremendous growth.

Our future is bright. These 2 two years have been very exciting for me both professionally and personally. I am grateful for the opportunity to work with all of you and serve as your CEO/EVP because together, we truly are making a significant difference in moving CHEST forward and crushing lung disease.

I know you are as proud of CHEST’s efforts this year as I am.

Thank you.

Dear Colleagues,

We are now near 6 months into living with COVID-19. In Texas, we are experiencing the surge that much of the Northeast saw in March and April. The COVID-19 Task Force led by Dr. Steve Simpson (CHEST President-Elect) and with representation from the Critical Care, Chest Infections, and Disaster Response and Global Health NetWorks continues to meet regularly to keep our members updated on the latest research and rapidly changing clinical management of COVID-19 illness and the sequelae. COVID-19 has put our medical profession and our subspecialty under considerable stress, and CHEST has launched a new longitudinal Wellness Center led by Dr. Alex Niven, from Mayo Clinic, Rochester. These new resources will feature a wellness webinar series focused on mental health and wellness for clinicians during COVID-19 and beyond. CHEST received overwhelming positive feedback from members and attendees to the Women & Pulmonary Virtual Happy Hour that focused on sharing stories and building community. Many leaders have suggested other such topics and efforts that may be useful to the CHEST community. The CHEST Wellness Center will launch on July 15.

In addition to COVID-19 activities, our nation and the world have compelled a new powerful look at race relations, disparities, and diversity. I represented CHEST at a “White Coats for Black Lives” event in San Antonio. Following our nation’s call for racial equality, CHEST released a Statement of Equity that received overwhelmingly positive feedback and response from members via email and on social media. This statement clearly resonated with the CHEST community. We are asking our leadership and members to consider ways in which CHEST might continue to raise awareness and continue with efforts related to diversity and equity. CHEST also hosted an excellent webinar moderated by Dr. Demondes Haynes and Dr. Nneka Sederstrom in late June that offered a direct and meaningful dialogue on issues facing clinicians and patients of color, and the responsibility of those in leadership positions. CHEST leadership stand firm that racism and inequality are public health issues and are working to define how we further our efforts in this arena.

On June 17, CHEST held a 1-day Virtual CHEST Congress in conjunction with our the CHEST Italian Delegation, as COVID-19 prevented us from safely holding the live Congress in Bologna. We had 3,250 registered attendees. I was so impressed at what a virtual platform can deliver, complete with great educational sessions, including much on COVID-19, as well as capturing the CHEST experience with games, bocce, jeopardy etc! This gave CHEST an opportunity to explore further virtual-based education to reach our wider global audience. CHEST will still be holding an in-person Congress in Bologna, June 24-26, 2021.

CHEST will host three entirely virtual Board Review Courses this August in the areas of Pulmonary, Critical Care, and Pediatric Pulmonary Medicine. These courses will include a combination of pre-recorded lectures and live, interactive sessions. Audience response systems and SEEK questions will still be utilized. There’s still time to register, so don’t miss it! With time being a major commodity at present, all attendees will receive year-long access to all material!

I know you have been wondering about CHEST 2020, and as you have heard by now, CHEST 2020 in Chicago will be a virtual meeting. I am sure that this announcement came as no big surprise, but is certainly disappointing. As you can imagine this was a difficult decision, but one that was necessary based upon our new reality. It was compounded by limitations on the convention center venue under the Illinois reopening plan, and the fact that a large number of our faculty, as well as our attendees, are under a travel ban for the remainder of 2020 that will not allow them to travel to Chicago. The abstract and case report deadline closed June 1, and despite these circumstances, we saw our highest number of submissions to date! Late abstracts were due on July 17. We will be presenting standalone and complementary online offerings to ensure seamless delivery of critical education in formats that cater easily to our newly formed habits.

Thanks to our dedicated Scientific Program Committee Chair, Dr. Victor Test, and staff, we had already begun preparing for virtual CHEST Annual Meeting 2020. Here’s what you can expect:

• A memorable experience

• A highly interactive education program that includes audience Q&A, discussion threads, and audience response systems

• Opportunities for one-on-one discussions, networking, and access to faculty

• Industry-sponsored programs and a virtual exhibit hall

• Access to hundreds of narrated poster presentations, case reports, and research abstracts

• Competitive educational gaming where attendees can participate, win, or watch

• Dedicated COVID-19 update sessions

• CME and MOC credits

If you have already registered for CHEST 2020, you will have the option to transfer your registration to this new model. Our main focus is delivering the virtual program with the highest level of service that you have come to expect from CHEST and respect for our member’s time and current situation. I know Dr. Victor Test and the program committee will deliver a superb educational experience in a virtual meeting setting. Thank you for your support and understanding as we continue to evolve our events to meet the needs of our members while adapting to the best delivery methods.

Since so many fellows were unable to hold their live graduation events, and celebrations, we decided to send them off with a virtual event! On June 30 we held a Joint CHEST/ATS Respiratory Community Graduation Ceremony–for graduating fellows, and to welcome new fellows to our profession. The ceremony consisted of a combination of live and recorded messages from key leaders from both organizations. In addition, there was a keynote address from Dr. Rana Awdish, a critical care physician at Henry Ford Hospital in Detroit, who authored the bestselling book “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” I encourage you to watch the video on the Early Career Professionals page on our Chestnet.org website.

The National Association for Medical Direction of Respiratory Care (NAMDRC) merger with CHEST was finalized at the end of May. Look for more advocacy-related actions coming from CHEST. The newly formed Health Policy and Advocacy Committee is helping to set CHEST’s advocacy agendas in the legislative and regulatory arenas, engaging with policymakers and educating CHEST members on governmental affairs relevant to CHEST’s mission. Did you see the inaugural CHEST published, on-line issue of Washington Watchline, a newsletter that aims to keep CHEST members informed about governmental activities that affect physicians who provide clinical care in respiratory, critical care, and sleep medicine? Follow Washington Watchline to learn more about CHEST’s advocacy around regulatory, legislative, and payment issues that relate to the delivery of health care in support of CHEST’s mission. One of the features was Telemedicine, which many of us are now using and is likely to be a part of many of our practices going forward.

With new COVID-19 surges throughout many parts of the United States, CHEST has continued our volunteer matching program for areas of need, including to the Navaho Nations, where CHEST matched 20 volunteers and has had more than a half-dozen inquiries from our members. In addition, in conjunction with the Foundation, CHEST has partnered with American Mask Rally and started a campaign to distribute masks to frontline essential workers in underserved communities. CHEST received a generous donation from AstraZeneca and Glaxo Smith Kline to help in the global fight against COVID-19 to provide current and accurate information and education to frontline clinicians to allow them to provide the best patient outcomes. CHEST also partnered with the American Thoracic Society to launch a joint PSA/ media campaign entitled For My Lung Health Campaign, to provide credible resources for underserved Black and Latino communities, as these communities are disproportionally affected by COVID-19. At the time of this writing, over a million people have seen the related video, featuring tips for taking control of one’s health in these difficult and uncertain times.

So, in closing, thank you all for what you do in these challenging times. 2020 will certainly be a year to remember! Stay safe and stay well!

Stephanie




 

Dear Colleagues,

We are now near 6 months into living with COVID-19. In Texas, we are experiencing the surge that much of the Northeast saw in March and April. The COVID-19 Task Force led by Dr. Steve Simpson (CHEST President-Elect) and with representation from the Critical Care, Chest Infections, and Disaster Response and Global Health NetWorks continues to meet regularly to keep our members updated on the latest research and rapidly changing clinical management of COVID-19 illness and the sequelae. COVID-19 has put our medical profession and our subspecialty under considerable stress, and CHEST has launched a new longitudinal Wellness Center led by Dr. Alex Niven, from Mayo Clinic, Rochester. These new resources will feature a wellness webinar series focused on mental health and wellness for clinicians during COVID-19 and beyond. CHEST received overwhelming positive feedback from members and attendees to the Women & Pulmonary Virtual Happy Hour that focused on sharing stories and building community. Many leaders have suggested other such topics and efforts that may be useful to the CHEST community. The CHEST Wellness Center will launch on July 15.

In addition to COVID-19 activities, our nation and the world have compelled a new powerful look at race relations, disparities, and diversity. I represented CHEST at a “White Coats for Black Lives” event in San Antonio. Following our nation’s call for racial equality, CHEST released a Statement of Equity that received overwhelmingly positive feedback and response from members via email and on social media. This statement clearly resonated with the CHEST community. We are asking our leadership and members to consider ways in which CHEST might continue to raise awareness and continue with efforts related to diversity and equity. CHEST also hosted an excellent webinar moderated by Dr. Demondes Haynes and Dr. Nneka Sederstrom in late June that offered a direct and meaningful dialogue on issues facing clinicians and patients of color, and the responsibility of those in leadership positions. CHEST leadership stand firm that racism and inequality are public health issues and are working to define how we further our efforts in this arena.

On June 17, CHEST held a 1-day Virtual CHEST Congress in conjunction with our the CHEST Italian Delegation, as COVID-19 prevented us from safely holding the live Congress in Bologna. We had 3,250 registered attendees. I was so impressed at what a virtual platform can deliver, complete with great educational sessions, including much on COVID-19, as well as capturing the CHEST experience with games, bocce, jeopardy etc! This gave CHEST an opportunity to explore further virtual-based education to reach our wider global audience. CHEST will still be holding an in-person Congress in Bologna, June 24-26, 2021.

CHEST will host three entirely virtual Board Review Courses this August in the areas of Pulmonary, Critical Care, and Pediatric Pulmonary Medicine. These courses will include a combination of pre-recorded lectures and live, interactive sessions. Audience response systems and SEEK questions will still be utilized. There’s still time to register, so don’t miss it! With time being a major commodity at present, all attendees will receive year-long access to all material!

I know you have been wondering about CHEST 2020, and as you have heard by now, CHEST 2020 in Chicago will be a virtual meeting. I am sure that this announcement came as no big surprise, but is certainly disappointing. As you can imagine this was a difficult decision, but one that was necessary based upon our new reality. It was compounded by limitations on the convention center venue under the Illinois reopening plan, and the fact that a large number of our faculty, as well as our attendees, are under a travel ban for the remainder of 2020 that will not allow them to travel to Chicago. The abstract and case report deadline closed June 1, and despite these circumstances, we saw our highest number of submissions to date! Late abstracts were due on July 17. We will be presenting standalone and complementary online offerings to ensure seamless delivery of critical education in formats that cater easily to our newly formed habits.

Thanks to our dedicated Scientific Program Committee Chair, Dr. Victor Test, and staff, we had already begun preparing for virtual CHEST Annual Meeting 2020. Here’s what you can expect:

• A memorable experience

• A highly interactive education program that includes audience Q&A, discussion threads, and audience response systems

• Opportunities for one-on-one discussions, networking, and access to faculty

• Industry-sponsored programs and a virtual exhibit hall

• Access to hundreds of narrated poster presentations, case reports, and research abstracts

• Competitive educational gaming where attendees can participate, win, or watch

• Dedicated COVID-19 update sessions

• CME and MOC credits

If you have already registered for CHEST 2020, you will have the option to transfer your registration to this new model. Our main focus is delivering the virtual program with the highest level of service that you have come to expect from CHEST and respect for our member’s time and current situation. I know Dr. Victor Test and the program committee will deliver a superb educational experience in a virtual meeting setting. Thank you for your support and understanding as we continue to evolve our events to meet the needs of our members while adapting to the best delivery methods.

Since so many fellows were unable to hold their live graduation events, and celebrations, we decided to send them off with a virtual event! On June 30 we held a Joint CHEST/ATS Respiratory Community Graduation Ceremony–for graduating fellows, and to welcome new fellows to our profession. The ceremony consisted of a combination of live and recorded messages from key leaders from both organizations. In addition, there was a keynote address from Dr. Rana Awdish, a critical care physician at Henry Ford Hospital in Detroit, who authored the bestselling book “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” I encourage you to watch the video on the Early Career Professionals page on our Chestnet.org website.

The National Association for Medical Direction of Respiratory Care (NAMDRC) merger with CHEST was finalized at the end of May. Look for more advocacy-related actions coming from CHEST. The newly formed Health Policy and Advocacy Committee is helping to set CHEST’s advocacy agendas in the legislative and regulatory arenas, engaging with policymakers and educating CHEST members on governmental affairs relevant to CHEST’s mission. Did you see the inaugural CHEST published, on-line issue of Washington Watchline, a newsletter that aims to keep CHEST members informed about governmental activities that affect physicians who provide clinical care in respiratory, critical care, and sleep medicine? Follow Washington Watchline to learn more about CHEST’s advocacy around regulatory, legislative, and payment issues that relate to the delivery of health care in support of CHEST’s mission. One of the features was Telemedicine, which many of us are now using and is likely to be a part of many of our practices going forward.

With new COVID-19 surges throughout many parts of the United States, CHEST has continued our volunteer matching program for areas of need, including to the Navaho Nations, where CHEST matched 20 volunteers and has had more than a half-dozen inquiries from our members. In addition, in conjunction with the Foundation, CHEST has partnered with American Mask Rally and started a campaign to distribute masks to frontline essential workers in underserved communities. CHEST received a generous donation from AstraZeneca and Glaxo Smith Kline to help in the global fight against COVID-19 to provide current and accurate information and education to frontline clinicians to allow them to provide the best patient outcomes. CHEST also partnered with the American Thoracic Society to launch a joint PSA/ media campaign entitled For My Lung Health Campaign, to provide credible resources for underserved Black and Latino communities, as these communities are disproportionally affected by COVID-19. At the time of this writing, over a million people have seen the related video, featuring tips for taking control of one’s health in these difficult and uncertain times.

So, in closing, thank you all for what you do in these challenging times. 2020 will certainly be a year to remember! Stay safe and stay well!

Stephanie




 

Dear Colleagues,

We are now near 6 months into living with COVID-19. In Texas, we are experiencing the surge that much of the Northeast saw in March and April. The COVID-19 Task Force led by Dr. Steve Simpson (CHEST President-Elect) and with representation from the Critical Care, Chest Infections, and Disaster Response and Global Health NetWorks continues to meet regularly to keep our members updated on the latest research and rapidly changing clinical management of COVID-19 illness and the sequelae. COVID-19 has put our medical profession and our subspecialty under considerable stress, and CHEST has launched a new longitudinal Wellness Center led by Dr. Alex Niven, from Mayo Clinic, Rochester. These new resources will feature a wellness webinar series focused on mental health and wellness for clinicians during COVID-19 and beyond. CHEST received overwhelming positive feedback from members and attendees to the Women & Pulmonary Virtual Happy Hour that focused on sharing stories and building community. Many leaders have suggested other such topics and efforts that may be useful to the CHEST community. The CHEST Wellness Center will launch on July 15.

In addition to COVID-19 activities, our nation and the world have compelled a new powerful look at race relations, disparities, and diversity. I represented CHEST at a “White Coats for Black Lives” event in San Antonio. Following our nation’s call for racial equality, CHEST released a Statement of Equity that received overwhelmingly positive feedback and response from members via email and on social media. This statement clearly resonated with the CHEST community. We are asking our leadership and members to consider ways in which CHEST might continue to raise awareness and continue with efforts related to diversity and equity. CHEST also hosted an excellent webinar moderated by Dr. Demondes Haynes and Dr. Nneka Sederstrom in late June that offered a direct and meaningful dialogue on issues facing clinicians and patients of color, and the responsibility of those in leadership positions. CHEST leadership stand firm that racism and inequality are public health issues and are working to define how we further our efforts in this arena.

On June 17, CHEST held a 1-day Virtual CHEST Congress in conjunction with our the CHEST Italian Delegation, as COVID-19 prevented us from safely holding the live Congress in Bologna. We had 3,250 registered attendees. I was so impressed at what a virtual platform can deliver, complete with great educational sessions, including much on COVID-19, as well as capturing the CHEST experience with games, bocce, jeopardy etc! This gave CHEST an opportunity to explore further virtual-based education to reach our wider global audience. CHEST will still be holding an in-person Congress in Bologna, June 24-26, 2021.

CHEST will host three entirely virtual Board Review Courses this August in the areas of Pulmonary, Critical Care, and Pediatric Pulmonary Medicine. These courses will include a combination of pre-recorded lectures and live, interactive sessions. Audience response systems and SEEK questions will still be utilized. There’s still time to register, so don’t miss it! With time being a major commodity at present, all attendees will receive year-long access to all material!

I know you have been wondering about CHEST 2020, and as you have heard by now, CHEST 2020 in Chicago will be a virtual meeting. I am sure that this announcement came as no big surprise, but is certainly disappointing. As you can imagine this was a difficult decision, but one that was necessary based upon our new reality. It was compounded by limitations on the convention center venue under the Illinois reopening plan, and the fact that a large number of our faculty, as well as our attendees, are under a travel ban for the remainder of 2020 that will not allow them to travel to Chicago. The abstract and case report deadline closed June 1, and despite these circumstances, we saw our highest number of submissions to date! Late abstracts were due on July 17. We will be presenting standalone and complementary online offerings to ensure seamless delivery of critical education in formats that cater easily to our newly formed habits.

Thanks to our dedicated Scientific Program Committee Chair, Dr. Victor Test, and staff, we had already begun preparing for virtual CHEST Annual Meeting 2020. Here’s what you can expect:

• A memorable experience

• A highly interactive education program that includes audience Q&A, discussion threads, and audience response systems

• Opportunities for one-on-one discussions, networking, and access to faculty

• Industry-sponsored programs and a virtual exhibit hall

• Access to hundreds of narrated poster presentations, case reports, and research abstracts

• Competitive educational gaming where attendees can participate, win, or watch

• Dedicated COVID-19 update sessions

• CME and MOC credits

If you have already registered for CHEST 2020, you will have the option to transfer your registration to this new model. Our main focus is delivering the virtual program with the highest level of service that you have come to expect from CHEST and respect for our member’s time and current situation. I know Dr. Victor Test and the program committee will deliver a superb educational experience in a virtual meeting setting. Thank you for your support and understanding as we continue to evolve our events to meet the needs of our members while adapting to the best delivery methods.

Since so many fellows were unable to hold their live graduation events, and celebrations, we decided to send them off with a virtual event! On June 30 we held a Joint CHEST/ATS Respiratory Community Graduation Ceremony–for graduating fellows, and to welcome new fellows to our profession. The ceremony consisted of a combination of live and recorded messages from key leaders from both organizations. In addition, there was a keynote address from Dr. Rana Awdish, a critical care physician at Henry Ford Hospital in Detroit, who authored the bestselling book “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.” I encourage you to watch the video on the Early Career Professionals page on our Chestnet.org website.

The National Association for Medical Direction of Respiratory Care (NAMDRC) merger with CHEST was finalized at the end of May. Look for more advocacy-related actions coming from CHEST. The newly formed Health Policy and Advocacy Committee is helping to set CHEST’s advocacy agendas in the legislative and regulatory arenas, engaging with policymakers and educating CHEST members on governmental affairs relevant to CHEST’s mission. Did you see the inaugural CHEST published, on-line issue of Washington Watchline, a newsletter that aims to keep CHEST members informed about governmental activities that affect physicians who provide clinical care in respiratory, critical care, and sleep medicine? Follow Washington Watchline to learn more about CHEST’s advocacy around regulatory, legislative, and payment issues that relate to the delivery of health care in support of CHEST’s mission. One of the features was Telemedicine, which many of us are now using and is likely to be a part of many of our practices going forward.

With new COVID-19 surges throughout many parts of the United States, CHEST has continued our volunteer matching program for areas of need, including to the Navaho Nations, where CHEST matched 20 volunteers and has had more than a half-dozen inquiries from our members. In addition, in conjunction with the Foundation, CHEST has partnered with American Mask Rally and started a campaign to distribute masks to frontline essential workers in underserved communities. CHEST received a generous donation from AstraZeneca and Glaxo Smith Kline to help in the global fight against COVID-19 to provide current and accurate information and education to frontline clinicians to allow them to provide the best patient outcomes. CHEST also partnered with the American Thoracic Society to launch a joint PSA/ media campaign entitled For My Lung Health Campaign, to provide credible resources for underserved Black and Latino communities, as these communities are disproportionally affected by COVID-19. At the time of this writing, over a million people have seen the related video, featuring tips for taking control of one’s health in these difficult and uncertain times.

So, in closing, thank you all for what you do in these challenging times. 2020 will certainly be a year to remember! Stay safe and stay well!

Stephanie




 

Obstructive sleep apnea (OSA) has been recognized to increase the risk of adverse cardiopulmonary perioperative outcomes for some time now.¹ An ever growing body of literature supports this finding,2 including a large prospective study published in 2019 highlighting the significant risk of poor cardiac-related postoperative outcomes in patients with unrecognized OSA.³ As the majority of patients presenting for elective surgery with OSA will not be diagnosed at the time of presentation,^3,4 many centers have developed preoperative screening programs to identify these patients, though the practice is not universal and a desire for better guidance is needed.⁵ In addition, best practices for patients with suspected or known OSA undergoing surgery have been a matter of debate. Out of these concerns, the Society of Anesthesia and Sleep Medicine (SASM) was formed over 10 years ago to promote interdisciplinary communication, education, and research into matters common to anesthesia and sleep.

Pulmonary and sleep medicine providers are often asked to provide preoperative clearance and recommendations for patients with suspected or known OSA. Recognizing the need for guidance in this area, a task force assembled by SASM obtained input from experts in anesthesiology, sleep medicine, and perioperative medicine to develop and publish an evidence-based / expert consensus guideline on the preoperative assessment and best practices for patients with suspected or known OSA.⁶ While specifics regarding logistics of preoperative screening and optimization of patients will vary based on each medical center’s infrastructure and organization, the recommendations presented should be able to be adapted by most, if not all, institutions. Preoperative evaluation and management is only part of the overall perioperative journey however, and SASM thus followed this document with guidelines for the intraoperative management of patients with OSA.⁷ To complete this set of recommendations, guidelines for the postoperative care of these patients are being planned. Guidelines for pediatric and obstetric perioperative OSA management are also currently being developed by SASM task forces to address these unique areas.

OSA is not the only sleep disorder where the perioperative environment may pose problems for our patients. Sleep disorders such as the hypersomnias and sleep-related movement disorders (including restless legs syndrome) may both impact and be impacted by the perioperative environment and may create safety concerns for some patients.^8,9 These issues are also under active investigation by SASM. In addition, understanding the basic mechanisms determining unconsciousness in both anesthesia and sleep, as well as examination of the interrelationships between sleep disturbance, sedation and their effects on clinical outcomes, are areas of interest that have implications beyond the perioperative arena.

SASM is currently planning to host its 10th anniversary conference in Washington DC on October 1-2, public health issues permitting. The meeting has consistently enlisted expert speakers from anesthesia, sleep medicine, and other relevant fields, and this year will be no different. Given the host city, discussions on important healthcare policy issues will be included, as well. Registration for the meeting, as well as meeting updates, are on the SASM website (sasmhq.org).
 

Dr. Auckley is with the Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Professor of Medicine, Case Western Reserve University, Cleveland, OH. He is the current president of the Society of Anesthesia and Sleep Medicine.

References

1. Gupta RM, et al. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: A case-control study. Mayo Clin Proc. 2001;76(9):897.

2. Opperer M, et al. Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing. Anesth Analg. 2016;122(5):1321.

3. Chan MTV, et al. Association of unrecognized obstructive sleep apnea with postoperative cardiovascular events in patients undergoing major noncardiac surgery. JAMA. 2019;321(18):1788.

4. Finkel KJ, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic center. Sleep Med. 2009;10(7):753.

5. Auckley D, et al. Attitudes regarding perioperative care of patients with OSA: a survey study of four specialties in the United States. Sleep Breath. 2015;19(1):315.

6. Chung F, et al. Society of Anesthesia and Sleep Medicine Guidelines (SASM) on Preoperative Screening and Assessment of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2016;123(2):452.

7. Memtsoudis SG, et al. Society of Anesthesia and Sleep Medicine Guideline (SASM) on Intraoperative Management of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2018;127(4):967.

8. Hershner S, et al. Knowledge gaps in the perioperative management of adults with narcolepsy: A call for further research. Anesth Analg. 2019 Jul;129(1):204.

9. Goldstein C. Management of restless legs syndrome / Willis-Ekbom disease in hospitalized and perioperative patients. Sleep Med Clin. 2015;10(3):303.

Obstructive sleep apnea (OSA) has been recognized to increase the risk of adverse cardiopulmonary perioperative outcomes for some time now.¹ An ever growing body of literature supports this finding,2 including a large prospective study published in 2019 highlighting the significant risk of poor cardiac-related postoperative outcomes in patients with unrecognized OSA.³ As the majority of patients presenting for elective surgery with OSA will not be diagnosed at the time of presentation,^3,4 many centers have developed preoperative screening programs to identify these patients, though the practice is not universal and a desire for better guidance is needed.⁵ In addition, best practices for patients with suspected or known OSA undergoing surgery have been a matter of debate. Out of these concerns, the Society of Anesthesia and Sleep Medicine (SASM) was formed over 10 years ago to promote interdisciplinary communication, education, and research into matters common to anesthesia and sleep.

Pulmonary and sleep medicine providers are often asked to provide preoperative clearance and recommendations for patients with suspected or known OSA. Recognizing the need for guidance in this area, a task force assembled by SASM obtained input from experts in anesthesiology, sleep medicine, and perioperative medicine to develop and publish an evidence-based / expert consensus guideline on the preoperative assessment and best practices for patients with suspected or known OSA.⁶ While specifics regarding logistics of preoperative screening and optimization of patients will vary based on each medical center’s infrastructure and organization, the recommendations presented should be able to be adapted by most, if not all, institutions. Preoperative evaluation and management is only part of the overall perioperative journey however, and SASM thus followed this document with guidelines for the intraoperative management of patients with OSA.⁷ To complete this set of recommendations, guidelines for the postoperative care of these patients are being planned. Guidelines for pediatric and obstetric perioperative OSA management are also currently being developed by SASM task forces to address these unique areas.

OSA is not the only sleep disorder where the perioperative environment may pose problems for our patients. Sleep disorders such as the hypersomnias and sleep-related movement disorders (including restless legs syndrome) may both impact and be impacted by the perioperative environment and may create safety concerns for some patients.^8,9 These issues are also under active investigation by SASM. In addition, understanding the basic mechanisms determining unconsciousness in both anesthesia and sleep, as well as examination of the interrelationships between sleep disturbance, sedation and their effects on clinical outcomes, are areas of interest that have implications beyond the perioperative arena.

SASM is currently planning to host its 10th anniversary conference in Washington DC on October 1-2, public health issues permitting. The meeting has consistently enlisted expert speakers from anesthesia, sleep medicine, and other relevant fields, and this year will be no different. Given the host city, discussions on important healthcare policy issues will be included, as well. Registration for the meeting, as well as meeting updates, are on the SASM website (sasmhq.org).
 

Dr. Auckley is with the Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Professor of Medicine, Case Western Reserve University, Cleveland, OH. He is the current president of the Society of Anesthesia and Sleep Medicine.

References

1. Gupta RM, et al. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: A case-control study. Mayo Clin Proc. 2001;76(9):897.

2. Opperer M, et al. Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing. Anesth Analg. 2016;122(5):1321.

3. Chan MTV, et al. Association of unrecognized obstructive sleep apnea with postoperative cardiovascular events in patients undergoing major noncardiac surgery. JAMA. 2019;321(18):1788.

4. Finkel KJ, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic center. Sleep Med. 2009;10(7):753.

5. Auckley D, et al. Attitudes regarding perioperative care of patients with OSA: a survey study of four specialties in the United States. Sleep Breath. 2015;19(1):315.

6. Chung F, et al. Society of Anesthesia and Sleep Medicine Guidelines (SASM) on Preoperative Screening and Assessment of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2016;123(2):452.

7. Memtsoudis SG, et al. Society of Anesthesia and Sleep Medicine Guideline (SASM) on Intraoperative Management of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2018;127(4):967.

8. Hershner S, et al. Knowledge gaps in the perioperative management of adults with narcolepsy: A call for further research. Anesth Analg. 2019 Jul;129(1):204.

9. Goldstein C. Management of restless legs syndrome / Willis-Ekbom disease in hospitalized and perioperative patients. Sleep Med Clin. 2015;10(3):303.

Obstructive sleep apnea (OSA) has been recognized to increase the risk of adverse cardiopulmonary perioperative outcomes for some time now.¹ An ever growing body of literature supports this finding,2 including a large prospective study published in 2019 highlighting the significant risk of poor cardiac-related postoperative outcomes in patients with unrecognized OSA.³ As the majority of patients presenting for elective surgery with OSA will not be diagnosed at the time of presentation,^3,4 many centers have developed preoperative screening programs to identify these patients, though the practice is not universal and a desire for better guidance is needed.⁵ In addition, best practices for patients with suspected or known OSA undergoing surgery have been a matter of debate. Out of these concerns, the Society of Anesthesia and Sleep Medicine (SASM) was formed over 10 years ago to promote interdisciplinary communication, education, and research into matters common to anesthesia and sleep.

Pulmonary and sleep medicine providers are often asked to provide preoperative clearance and recommendations for patients with suspected or known OSA. Recognizing the need for guidance in this area, a task force assembled by SASM obtained input from experts in anesthesiology, sleep medicine, and perioperative medicine to develop and publish an evidence-based / expert consensus guideline on the preoperative assessment and best practices for patients with suspected or known OSA.⁶ While specifics regarding logistics of preoperative screening and optimization of patients will vary based on each medical center’s infrastructure and organization, the recommendations presented should be able to be adapted by most, if not all, institutions. Preoperative evaluation and management is only part of the overall perioperative journey however, and SASM thus followed this document with guidelines for the intraoperative management of patients with OSA.⁷ To complete this set of recommendations, guidelines for the postoperative care of these patients are being planned. Guidelines for pediatric and obstetric perioperative OSA management are also currently being developed by SASM task forces to address these unique areas.

OSA is not the only sleep disorder where the perioperative environment may pose problems for our patients. Sleep disorders such as the hypersomnias and sleep-related movement disorders (including restless legs syndrome) may both impact and be impacted by the perioperative environment and may create safety concerns for some patients.^8,9 These issues are also under active investigation by SASM. In addition, understanding the basic mechanisms determining unconsciousness in both anesthesia and sleep, as well as examination of the interrelationships between sleep disturbance, sedation and their effects on clinical outcomes, are areas of interest that have implications beyond the perioperative arena.

SASM is currently planning to host its 10th anniversary conference in Washington DC on October 1-2, public health issues permitting. The meeting has consistently enlisted expert speakers from anesthesia, sleep medicine, and other relevant fields, and this year will be no different. Given the host city, discussions on important healthcare policy issues will be included, as well. Registration for the meeting, as well as meeting updates, are on the SASM website (sasmhq.org).
 

Dr. Auckley is with the Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Professor of Medicine, Case Western Reserve University, Cleveland, OH. He is the current president of the Society of Anesthesia and Sleep Medicine.

References

1. Gupta RM, et al. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: A case-control study. Mayo Clin Proc. 2001;76(9):897.

2. Opperer M, et al. Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing. Anesth Analg. 2016;122(5):1321.

3. Chan MTV, et al. Association of unrecognized obstructive sleep apnea with postoperative cardiovascular events in patients undergoing major noncardiac surgery. JAMA. 2019;321(18):1788.

4. Finkel KJ, et al. Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic center. Sleep Med. 2009;10(7):753.

5. Auckley D, et al. Attitudes regarding perioperative care of patients with OSA: a survey study of four specialties in the United States. Sleep Breath. 2015;19(1):315.

6. Chung F, et al. Society of Anesthesia and Sleep Medicine Guidelines (SASM) on Preoperative Screening and Assessment of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2016;123(2):452.

7. Memtsoudis SG, et al. Society of Anesthesia and Sleep Medicine Guideline (SASM) on Intraoperative Management of Adult Patients with Obstructive Sleep Apnea. Anesth Analg. 2018;127(4):967.

8. Hershner S, et al. Knowledge gaps in the perioperative management of adults with narcolepsy: A call for further research. Anesth Analg. 2019 Jul;129(1):204.

9. Goldstein C. Management of restless legs syndrome / Willis-Ekbom disease in hospitalized and perioperative patients. Sleep Med Clin. 2015;10(3):303.

Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China.By Dr. L. Shiyue, et al.

Effect of intermittent or continuous feed on muscle wasting in critical illness a phase II clinical trial. By Dr. A. McNelly, et al.

Triage of scarce critical care resources in COVID-19: An implementation guide for regional allocation: A CHEST and Task Force for Mass Critical Care Expert Panel Report.By Dr. J. Dichter, et al.

Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report. By Dr. A. Chang, et al.

Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China.By Dr. L. Shiyue, et al.

Effect of intermittent or continuous feed on muscle wasting in critical illness a phase II clinical trial. By Dr. A. McNelly, et al.

Triage of scarce critical care resources in COVID-19: An implementation guide for regional allocation: A CHEST and Task Force for Mass Critical Care Expert Panel Report.By Dr. J. Dichter, et al.

Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report. By Dr. A. Chang, et al.

Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China.By Dr. L. Shiyue, et al.

Effect of intermittent or continuous feed on muscle wasting in critical illness a phase II clinical trial. By Dr. A. McNelly, et al.

Triage of scarce critical care resources in COVID-19: An implementation guide for regional allocation: A CHEST and Task Force for Mass Critical Care Expert Panel Report.By Dr. J. Dichter, et al.

Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report. By Dr. A. Chang, et al.

On a Wednesday night in April, CHEST Women and Pulmonary Advisory Board hosted a virtual happy hour that was not just a webinar but also on Facebook Live, entitled Wellness Wednesday. During the 2-hour event, the hosts of the happy hour exchanged experiences during the pandemic, thoughts, hopes, and some very practical ideas on how to stay well in the midst of the pandemic. I was thrilled to co-host this event with Drs. Aneesa Das, Doreen Addrizzo-Harris, Margaret Pisani, Michele Cao, and Rachel Quaney.

We started off toasting with whatever drink people chose to have and each member shared what she was doing during the pandemic. There were many amazing stories of how these women adapted to the changing environment. Dr. Addrizzo-Harris told us how she and her husband literally split their apartment in half since they work in different hospitals and did not want to risk infecting not just one another but also their respective patients. Both she and her husband were working long shifts and most days of the week in the hospital and had not really seen each other since the lockdown started in New York. She also gave us an update on the pandemic and response in New York and reiterated her appreciation for health-care providers who came from elsewhere to help. Drs. Das and Quaney made a point to say that Ohio had done a great job planning for and preventing an onslaught of infected patients and that they were quite thankful to be able to do virtual visits and keep up with their patients.

With regards to work, a few panelists described not only the change in the hospital census and environment but also the impact on education for everyone. We shared ideas for keeping up with pulmonary and critical care that were not related to COVID-19 and ways to not feel overwhelmed by it. I mentioned that we kept our weekly clinical case conference for non-COVID cases and that our fellows and faculty found it refreshing and reinvigorating. Dr. Quaney, who is still in training, mentioned the impact the pandemic had on her education but was also thankful for all that was being done to mitigate that.

While several of us were going into the hospitals and working with COVID-19 patients, others were working from home. It may seem like that would be low stress but think about the challenges of doing virtual visits from home while young children are running around! Dr. Cao gave us a few stories about this and made us all laugh.

So much has changed in our lives and what we must do to care for ourselves, our families, and our patients. On this topic, many of the panelists mentioned that self-care is imperative, as well as all the other things we do. Many shared what they do to remain calm and to relieve stress, such as yoga, hiking, calls with friends and family, etc. Dr. Pisani in particular mentioned the importance of self-care while also lamenting that we have gone backwards with regard to delirium prevention in the ICU due to the isolation needed for COVID 19 patients.

The laughter and camaraderie amongst the panelist extended to the online participants. We had over 2,400 viewers either on Facebook live or via the webinar link! Many people who joined us asked questions or shared stories of how they were coping and what they miss about the pre-pandemic life. Most agreed that the lack of interpersonal interaction, especially with friends and family, has been difficult and that something as simple as this virtual happy hour was a welcome addition to all the other online meetings and patient visits. After the event, many online participants reached out personally and via social media to express how much they enjoyed it and hopes that we continue something like this going forward. I believe we all agreed at least a quarterly Wednesday Wellness event would be great, so I hope you will join us next time!

On a Wednesday night in April, CHEST Women and Pulmonary Advisory Board hosted a virtual happy hour that was not just a webinar but also on Facebook Live, entitled Wellness Wednesday. During the 2-hour event, the hosts of the happy hour exchanged experiences during the pandemic, thoughts, hopes, and some very practical ideas on how to stay well in the midst of the pandemic. I was thrilled to co-host this event with Drs. Aneesa Das, Doreen Addrizzo-Harris, Margaret Pisani, Michele Cao, and Rachel Quaney.

We started off toasting with whatever drink people chose to have and each member shared what she was doing during the pandemic. There were many amazing stories of how these women adapted to the changing environment. Dr. Addrizzo-Harris told us how she and her husband literally split their apartment in half since they work in different hospitals and did not want to risk infecting not just one another but also their respective patients. Both she and her husband were working long shifts and most days of the week in the hospital and had not really seen each other since the lockdown started in New York. She also gave us an update on the pandemic and response in New York and reiterated her appreciation for health-care providers who came from elsewhere to help. Drs. Das and Quaney made a point to say that Ohio had done a great job planning for and preventing an onslaught of infected patients and that they were quite thankful to be able to do virtual visits and keep up with their patients.

With regards to work, a few panelists described not only the change in the hospital census and environment but also the impact on education for everyone. We shared ideas for keeping up with pulmonary and critical care that were not related to COVID-19 and ways to not feel overwhelmed by it. I mentioned that we kept our weekly clinical case conference for non-COVID cases and that our fellows and faculty found it refreshing and reinvigorating. Dr. Quaney, who is still in training, mentioned the impact the pandemic had on her education but was also thankful for all that was being done to mitigate that.

While several of us were going into the hospitals and working with COVID-19 patients, others were working from home. It may seem like that would be low stress but think about the challenges of doing virtual visits from home while young children are running around! Dr. Cao gave us a few stories about this and made us all laugh.

So much has changed in our lives and what we must do to care for ourselves, our families, and our patients. On this topic, many of the panelists mentioned that self-care is imperative, as well as all the other things we do. Many shared what they do to remain calm and to relieve stress, such as yoga, hiking, calls with friends and family, etc. Dr. Pisani in particular mentioned the importance of self-care while also lamenting that we have gone backwards with regard to delirium prevention in the ICU due to the isolation needed for COVID 19 patients.

The laughter and camaraderie amongst the panelist extended to the online participants. We had over 2,400 viewers either on Facebook live or via the webinar link! Many people who joined us asked questions or shared stories of how they were coping and what they miss about the pre-pandemic life. Most agreed that the lack of interpersonal interaction, especially with friends and family, has been difficult and that something as simple as this virtual happy hour was a welcome addition to all the other online meetings and patient visits. After the event, many online participants reached out personally and via social media to express how much they enjoyed it and hopes that we continue something like this going forward. I believe we all agreed at least a quarterly Wednesday Wellness event would be great, so I hope you will join us next time!

On a Wednesday night in April, CHEST Women and Pulmonary Advisory Board hosted a virtual happy hour that was not just a webinar but also on Facebook Live, entitled Wellness Wednesday. During the 2-hour event, the hosts of the happy hour exchanged experiences during the pandemic, thoughts, hopes, and some very practical ideas on how to stay well in the midst of the pandemic. I was thrilled to co-host this event with Drs. Aneesa Das, Doreen Addrizzo-Harris, Margaret Pisani, Michele Cao, and Rachel Quaney.

We started off toasting with whatever drink people chose to have and each member shared what she was doing during the pandemic. There were many amazing stories of how these women adapted to the changing environment. Dr. Addrizzo-Harris told us how she and her husband literally split their apartment in half since they work in different hospitals and did not want to risk infecting not just one another but also their respective patients. Both she and her husband were working long shifts and most days of the week in the hospital and had not really seen each other since the lockdown started in New York. She also gave us an update on the pandemic and response in New York and reiterated her appreciation for health-care providers who came from elsewhere to help. Drs. Das and Quaney made a point to say that Ohio had done a great job planning for and preventing an onslaught of infected patients and that they were quite thankful to be able to do virtual visits and keep up with their patients.

With regards to work, a few panelists described not only the change in the hospital census and environment but also the impact on education for everyone. We shared ideas for keeping up with pulmonary and critical care that were not related to COVID-19 and ways to not feel overwhelmed by it. I mentioned that we kept our weekly clinical case conference for non-COVID cases and that our fellows and faculty found it refreshing and reinvigorating. Dr. Quaney, who is still in training, mentioned the impact the pandemic had on her education but was also thankful for all that was being done to mitigate that.

While several of us were going into the hospitals and working with COVID-19 patients, others were working from home. It may seem like that would be low stress but think about the challenges of doing virtual visits from home while young children are running around! Dr. Cao gave us a few stories about this and made us all laugh.

So much has changed in our lives and what we must do to care for ourselves, our families, and our patients. On this topic, many of the panelists mentioned that self-care is imperative, as well as all the other things we do. Many shared what they do to remain calm and to relieve stress, such as yoga, hiking, calls with friends and family, etc. Dr. Pisani in particular mentioned the importance of self-care while also lamenting that we have gone backwards with regard to delirium prevention in the ICU due to the isolation needed for COVID 19 patients.

The laughter and camaraderie amongst the panelist extended to the online participants. We had over 2,400 viewers either on Facebook live or via the webinar link! Many people who joined us asked questions or shared stories of how they were coping and what they miss about the pre-pandemic life. Most agreed that the lack of interpersonal interaction, especially with friends and family, has been difficult and that something as simple as this virtual happy hour was a welcome addition to all the other online meetings and patient visits. After the event, many online participants reached out personally and via social media to express how much they enjoyed it and hopes that we continue something like this going forward. I believe we all agreed at least a quarterly Wednesday Wellness event would be great, so I hope you will join us next time!