News From CHEST Physician®

In anticipation of the 2019 CHEST Foundation grants cycle, opening in late February, CHEST Foundation staff sat down with 2017 CHEST Foundation Community Service grant winner, Sharon Armstead, RRT, Director of Clinical Education & Clinical Assistant Professor for the Department of Respiratory Care at Texas State University, to learn more about her project supporting respiratory asthma clinics in Guyana.

Ms. Armstead’s program takes respiratory care students from her institution on a study abroad trip to Guyana with aims to educate Guyanese student populations about asthma and teach them self-management skills. Additionally, she and her students work alongside clinicians at Georgetown Public Hospital to host a mobile asthma clinic that provides asthma screenings and education for Guyanese students, the first of its kind at Texas State University.

This passion for supporting clinics in Guyana stems from a deeply personal place. “Guyana is my country of birth. I left when I was 14. I came back many years later realizing that I can give back to the county that gave me so much.” Ms. Armstead shared.

“The CHEST Foundation grant opened doors for me that had never been opened before. Members of the community were very open to hearing what we had to say and receptive to the changes we suggested they make in their daily lives. The financial portion of the award allowed me to purchase additional spirometers for the asthma clinic, allowing for a whole new level of outpatient testing and outreach in the community.”

In addition to the impact she and her students have in Georgetown, Ms. Armstead says opportunity provided to her students was life-changing for them. “To watch my students communicate with people in a different country really helps build their confidence as future clinicians.” Her study program received a significant growth in attendance over the past few years. “When we first started doing this study abroad in Guyana, I only had 2 students interested… We took 14 respiratory care students to Guyana in 2017. It’s really elevated this study abroad program at my institution.”

The CHEST Foundation’s grants cycle opens in late February. Visit our grants page to view the RFPs for our 2019 offerings and see a step-by-step walkthrough of how simple it is to apply for funding! Be a champion of lung health, and secure your research award today!

In anticipation of the 2019 CHEST Foundation grants cycle, opening in late February, CHEST Foundation staff sat down with 2017 CHEST Foundation Community Service grant winner, Sharon Armstead, RRT, Director of Clinical Education & Clinical Assistant Professor for the Department of Respiratory Care at Texas State University, to learn more about her project supporting respiratory asthma clinics in Guyana.

Ms. Armstead’s program takes respiratory care students from her institution on a study abroad trip to Guyana with aims to educate Guyanese student populations about asthma and teach them self-management skills. Additionally, she and her students work alongside clinicians at Georgetown Public Hospital to host a mobile asthma clinic that provides asthma screenings and education for Guyanese students, the first of its kind at Texas State University.

This passion for supporting clinics in Guyana stems from a deeply personal place. “Guyana is my country of birth. I left when I was 14. I came back many years later realizing that I can give back to the county that gave me so much.” Ms. Armstead shared.

“The CHEST Foundation grant opened doors for me that had never been opened before. Members of the community were very open to hearing what we had to say and receptive to the changes we suggested they make in their daily lives. The financial portion of the award allowed me to purchase additional spirometers for the asthma clinic, allowing for a whole new level of outpatient testing and outreach in the community.”

In addition to the impact she and her students have in Georgetown, Ms. Armstead says opportunity provided to her students was life-changing for them. “To watch my students communicate with people in a different country really helps build their confidence as future clinicians.” Her study program received a significant growth in attendance over the past few years. “When we first started doing this study abroad in Guyana, I only had 2 students interested… We took 14 respiratory care students to Guyana in 2017. It’s really elevated this study abroad program at my institution.”

The CHEST Foundation’s grants cycle opens in late February. Visit our grants page to view the RFPs for our 2019 offerings and see a step-by-step walkthrough of how simple it is to apply for funding! Be a champion of lung health, and secure your research award today!

In anticipation of the 2019 CHEST Foundation grants cycle, opening in late February, CHEST Foundation staff sat down with 2017 CHEST Foundation Community Service grant winner, Sharon Armstead, RRT, Director of Clinical Education & Clinical Assistant Professor for the Department of Respiratory Care at Texas State University, to learn more about her project supporting respiratory asthma clinics in Guyana.

Ms. Armstead’s program takes respiratory care students from her institution on a study abroad trip to Guyana with aims to educate Guyanese student populations about asthma and teach them self-management skills. Additionally, she and her students work alongside clinicians at Georgetown Public Hospital to host a mobile asthma clinic that provides asthma screenings and education for Guyanese students, the first of its kind at Texas State University.

This passion for supporting clinics in Guyana stems from a deeply personal place. “Guyana is my country of birth. I left when I was 14. I came back many years later realizing that I can give back to the county that gave me so much.” Ms. Armstead shared.

“The CHEST Foundation grant opened doors for me that had never been opened before. Members of the community were very open to hearing what we had to say and receptive to the changes we suggested they make in their daily lives. The financial portion of the award allowed me to purchase additional spirometers for the asthma clinic, allowing for a whole new level of outpatient testing and outreach in the community.”

In addition to the impact she and her students have in Georgetown, Ms. Armstead says opportunity provided to her students was life-changing for them. “To watch my students communicate with people in a different country really helps build their confidence as future clinicians.” Her study program received a significant growth in attendance over the past few years. “When we first started doing this study abroad in Guyana, I only had 2 students interested… We took 14 respiratory care students to Guyana in 2017. It’s really elevated this study abroad program at my institution.”

The CHEST Foundation’s grants cycle opens in late February. Visit our grants page to view the RFPs for our 2019 offerings and see a step-by-step walkthrough of how simple it is to apply for funding! Be a champion of lung health, and secure your research award today!

One year ago, I wrote in these pages with regard to my two main goals for CHEST Physician for 2018, namely allowing more space in our pages for leaders and members to express their views, and improving interactivity between the staff here and our readership to help us better craft a publication that met your needs.

While I think we’ve met the first goal quite well, with a greater number of educational write-ups from our NetWork leadership and high-quality editorials and commentaries from other CHEST dignitaries, we have not yet heard much from the most important resource we have, our readers. So for the coming year, I would welcome you to drop us a line every now and then. See something in our pages that you like, or with which you disagree? Is there something in the news relevant to pulmonary, critical care, or sleep medicine that you think we should have covered but did not? Send us an email at [email protected]

I look forward to closer contact with you over the coming year. Let’s make CHEST Physician even better together!

David

One year ago, I wrote in these pages with regard to my two main goals for CHEST Physician for 2018, namely allowing more space in our pages for leaders and members to express their views, and improving interactivity between the staff here and our readership to help us better craft a publication that met your needs.

While I think we’ve met the first goal quite well, with a greater number of educational write-ups from our NetWork leadership and high-quality editorials and commentaries from other CHEST dignitaries, we have not yet heard much from the most important resource we have, our readers. So for the coming year, I would welcome you to drop us a line every now and then. See something in our pages that you like, or with which you disagree? Is there something in the news relevant to pulmonary, critical care, or sleep medicine that you think we should have covered but did not? Send us an email at [email protected]

I look forward to closer contact with you over the coming year. Let’s make CHEST Physician even better together!

David

One year ago, I wrote in these pages with regard to my two main goals for CHEST Physician for 2018, namely allowing more space in our pages for leaders and members to express their views, and improving interactivity between the staff here and our readership to help us better craft a publication that met your needs.

While I think we’ve met the first goal quite well, with a greater number of educational write-ups from our NetWork leadership and high-quality editorials and commentaries from other CHEST dignitaries, we have not yet heard much from the most important resource we have, our readers. So for the coming year, I would welcome you to drop us a line every now and then. See something in our pages that you like, or with which you disagree? Is there something in the news relevant to pulmonary, critical care, or sleep medicine that you think we should have covered but did not? Send us an email at [email protected]

I look forward to closer contact with you over the coming year. Let’s make CHEST Physician even better together!

David

Editor’s Picks

Giants in Chest Medicine – Atul C. Mehta, MBBS, FCCP
By Dr. J. K. Stoller

Screening Heroin Smokers Attending Community Drug Services for COPD.
By Dr. H. Burhan, et al.

The NHLBI LAM Registry: Prognostic Physiologic and Radiologic Biomarkers Emerge
From a 15-Year Prospective Longitudinal Analysis.
By Dr. N. Gupta, et al.

Indwelling Pleural Catheters in Hepatic Hydrothorax: A Single-Center Series of Outcomes and Complications.
By Dr. C. Kniese, et al.

Implications of the Revised Common Rule for Human Participant Research.
By Dr. E. G. DeRenzo, et al.






 

Editor’s Picks

Giants in Chest Medicine – Atul C. Mehta, MBBS, FCCP
By Dr. J. K. Stoller

Screening Heroin Smokers Attending Community Drug Services for COPD.
By Dr. H. Burhan, et al.

The NHLBI LAM Registry: Prognostic Physiologic and Radiologic Biomarkers Emerge
From a 15-Year Prospective Longitudinal Analysis.
By Dr. N. Gupta, et al.

Indwelling Pleural Catheters in Hepatic Hydrothorax: A Single-Center Series of Outcomes and Complications.
By Dr. C. Kniese, et al.

Implications of the Revised Common Rule for Human Participant Research.
By Dr. E. G. DeRenzo, et al.






 

Editor’s Picks

Giants in Chest Medicine – Atul C. Mehta, MBBS, FCCP
By Dr. J. K. Stoller

Screening Heroin Smokers Attending Community Drug Services for COPD.
By Dr. H. Burhan, et al.

The NHLBI LAM Registry: Prognostic Physiologic and Radiologic Biomarkers Emerge
From a 15-Year Prospective Longitudinal Analysis.
By Dr. N. Gupta, et al.

Indwelling Pleural Catheters in Hepatic Hydrothorax: A Single-Center Series of Outcomes and Complications.
By Dr. C. Kniese, et al.

Implications of the Revised Common Rule for Human Participant Research.
By Dr. E. G. DeRenzo, et al.






 

Giants in Chest Medicine

Emeritus Professor Peter D. Wagner, MD

By Dr. Tatum S. Simonson



State of the Journal Editorial

Spread the Word About CHEST in 2019: Innovations, Introductions,

and Farewells. By Dr. R. S. Irwin, et al.



Original Research

Meta-analysis of Gastroesophageal Reflux Disease and Idiopathic Pulmonary Fibrosis. By Dr. D. Bedard, et al.



Surgical Disparities Among Patients With Stage I Lung Cancer in the National Lung

Screening Trial. By Dr. A. A. Balekian, et al.



Evidence-Based Medicine

Clinically Diagnosing Pertussis-Associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report. By Dr. A. Moore, et al.



Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report. By Dr. A. T. Hill, et al.

Giants in Chest Medicine

Emeritus Professor Peter D. Wagner, MD

By Dr. Tatum S. Simonson



State of the Journal Editorial

Spread the Word About CHEST in 2019: Innovations, Introductions,

and Farewells. By Dr. R. S. Irwin, et al.



Original Research

Meta-analysis of Gastroesophageal Reflux Disease and Idiopathic Pulmonary Fibrosis. By Dr. D. Bedard, et al.



Surgical Disparities Among Patients With Stage I Lung Cancer in the National Lung

Screening Trial. By Dr. A. A. Balekian, et al.



Evidence-Based Medicine

Clinically Diagnosing Pertussis-Associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report. By Dr. A. Moore, et al.



Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report. By Dr. A. T. Hill, et al.

Giants in Chest Medicine

Emeritus Professor Peter D. Wagner, MD

By Dr. Tatum S. Simonson



State of the Journal Editorial

Spread the Word About CHEST in 2019: Innovations, Introductions,

and Farewells. By Dr. R. S. Irwin, et al.



Original Research

Meta-analysis of Gastroesophageal Reflux Disease and Idiopathic Pulmonary Fibrosis. By Dr. D. Bedard, et al.



Surgical Disparities Among Patients With Stage I Lung Cancer in the National Lung

Screening Trial. By Dr. A. A. Balekian, et al.



Evidence-Based Medicine

Clinically Diagnosing Pertussis-Associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report. By Dr. A. Moore, et al.



Adult Outpatients With Acute Cough Due to Suspected Pneumonia or Influenza: CHEST Guideline and Expert Panel Report. By Dr. A. T. Hill, et al.

While in San Antonio for CHEST 2018, CHEST Foundation caught up with the recipient of our 2017 CHEST Foundation Research Grant in Asthma, Drew Harris, MD, to learn about the impact of winning a CHEST Foundation Research grant had on his community and career. Dr. Harris’ project created a medical-legal partnership to target many of the social determinants of asthma and help address them beyond the typical scope a provider can offer in a traditional visit.

“Currently, we have a full-time lawyer, two social workers, and people in Public Health Sciences program as well as law students at The University of Virginia (UVA) all working together to address the needs of the community,” Harris stated. “Public health students conduct asthma screenings in any of the four clinics we partner with within the UVA system and bring their findings to the larger group. From there, we figure out how to best intervene for these people and connect them with our lawyer if there are housing or workplace discrimination concerns.”

Dr. Harris recently received NIH funding for his approach and has since expanded this medical-legal partnership at the University of Virginia. “The grant I received last year from the CHEST Foundation funded a pilot version of my project that I then was able to share with a larger audience and ultimately secure federal funding for,” Dr. Harris shared.

“The NIH grant was awarded through the lens of implementation science. We know what works in asthma medication and environmental and social factors that help improve patients’ lives. But we do a poor job on actually DOING it. Our project addresses barriers to fixing these social needs and brings a team together to help fix these other problems that are hard for just a medical provider to address.” Dr. Harris continued, “Social needs and determinants of health are starting to receive more attention in pulmonary medicine, so we are really hitting the ground at the right time. Everyone understands that these are important determinants of health, but they lack the tools to help improve patients’ lives. We are creating those.”

Your donations support clinical research projects like this grant for Dr.Harris. Please consider making a donation to support next year’s grants. https://foundation.chestnet.org/donate/

“A middle-aged textile worker who entered Charlottesville as a Syrian refugee several years ago had been unable to work much in Charlottesville due to work-related asthma. She was denied disability due to insufficient work time. Without a network of friends or family to turn to, this family was struggling in poverty with housing and food insecurity. By connecting with this CHEST Foundation-supported program, this patient received needed advocacy and support of doctors, social workers, and legal aid attorneys. She is now supported in an application for a monthly subsidy to help her immediate social needs while we work towards a more permanent solution. Our program has also helped patients with health-harming social needs, including lack of access to care (by helping patients apply for and enroll in Medicaid, for example), housing issues (such as mold and unresponsive landlords), and intimate partner violence. Working together as a team, we are able to provide advocacy to improve the health and well-being of our vulnerable community members. This program addresses issues that are important to my community. Without the hard work and dedication of my colleagues, the community at large, and all those committed to confronting these problems, many families would not get what they need to thrive. I am proud and feel lucky to dedicate my time to support my patients and my community. Thank you to the CHEST Foundation and all those who support it to ensure that ALL patients receive the care they deserve.”

—Drew Harris, MD

While in San Antonio for CHEST 2018, CHEST Foundation caught up with the recipient of our 2017 CHEST Foundation Research Grant in Asthma, Drew Harris, MD, to learn about the impact of winning a CHEST Foundation Research grant had on his community and career. Dr. Harris’ project created a medical-legal partnership to target many of the social determinants of asthma and help address them beyond the typical scope a provider can offer in a traditional visit.

“Currently, we have a full-time lawyer, two social workers, and people in Public Health Sciences program as well as law students at The University of Virginia (UVA) all working together to address the needs of the community,” Harris stated. “Public health students conduct asthma screenings in any of the four clinics we partner with within the UVA system and bring their findings to the larger group. From there, we figure out how to best intervene for these people and connect them with our lawyer if there are housing or workplace discrimination concerns.”

Dr. Harris recently received NIH funding for his approach and has since expanded this medical-legal partnership at the University of Virginia. “The grant I received last year from the CHEST Foundation funded a pilot version of my project that I then was able to share with a larger audience and ultimately secure federal funding for,” Dr. Harris shared.

“The NIH grant was awarded through the lens of implementation science. We know what works in asthma medication and environmental and social factors that help improve patients’ lives. But we do a poor job on actually DOING it. Our project addresses barriers to fixing these social needs and brings a team together to help fix these other problems that are hard for just a medical provider to address.” Dr. Harris continued, “Social needs and determinants of health are starting to receive more attention in pulmonary medicine, so we are really hitting the ground at the right time. Everyone understands that these are important determinants of health, but they lack the tools to help improve patients’ lives. We are creating those.”

Your donations support clinical research projects like this grant for Dr.Harris. Please consider making a donation to support next year’s grants. https://foundation.chestnet.org/donate/

“A middle-aged textile worker who entered Charlottesville as a Syrian refugee several years ago had been unable to work much in Charlottesville due to work-related asthma. She was denied disability due to insufficient work time. Without a network of friends or family to turn to, this family was struggling in poverty with housing and food insecurity. By connecting with this CHEST Foundation-supported program, this patient received needed advocacy and support of doctors, social workers, and legal aid attorneys. She is now supported in an application for a monthly subsidy to help her immediate social needs while we work towards a more permanent solution. Our program has also helped patients with health-harming social needs, including lack of access to care (by helping patients apply for and enroll in Medicaid, for example), housing issues (such as mold and unresponsive landlords), and intimate partner violence. Working together as a team, we are able to provide advocacy to improve the health and well-being of our vulnerable community members. This program addresses issues that are important to my community. Without the hard work and dedication of my colleagues, the community at large, and all those committed to confronting these problems, many families would not get what they need to thrive. I am proud and feel lucky to dedicate my time to support my patients and my community. Thank you to the CHEST Foundation and all those who support it to ensure that ALL patients receive the care they deserve.”

—Drew Harris, MD

While in San Antonio for CHEST 2018, CHEST Foundation caught up with the recipient of our 2017 CHEST Foundation Research Grant in Asthma, Drew Harris, MD, to learn about the impact of winning a CHEST Foundation Research grant had on his community and career. Dr. Harris’ project created a medical-legal partnership to target many of the social determinants of asthma and help address them beyond the typical scope a provider can offer in a traditional visit.

“Currently, we have a full-time lawyer, two social workers, and people in Public Health Sciences program as well as law students at The University of Virginia (UVA) all working together to address the needs of the community,” Harris stated. “Public health students conduct asthma screenings in any of the four clinics we partner with within the UVA system and bring their findings to the larger group. From there, we figure out how to best intervene for these people and connect them with our lawyer if there are housing or workplace discrimination concerns.”

Dr. Harris recently received NIH funding for his approach and has since expanded this medical-legal partnership at the University of Virginia. “The grant I received last year from the CHEST Foundation funded a pilot version of my project that I then was able to share with a larger audience and ultimately secure federal funding for,” Dr. Harris shared.

“The NIH grant was awarded through the lens of implementation science. We know what works in asthma medication and environmental and social factors that help improve patients’ lives. But we do a poor job on actually DOING it. Our project addresses barriers to fixing these social needs and brings a team together to help fix these other problems that are hard for just a medical provider to address.” Dr. Harris continued, “Social needs and determinants of health are starting to receive more attention in pulmonary medicine, so we are really hitting the ground at the right time. Everyone understands that these are important determinants of health, but they lack the tools to help improve patients’ lives. We are creating those.”

Your donations support clinical research projects like this grant for Dr.Harris. Please consider making a donation to support next year’s grants. https://foundation.chestnet.org/donate/

“A middle-aged textile worker who entered Charlottesville as a Syrian refugee several years ago had been unable to work much in Charlottesville due to work-related asthma. She was denied disability due to insufficient work time. Without a network of friends or family to turn to, this family was struggling in poverty with housing and food insecurity. By connecting with this CHEST Foundation-supported program, this patient received needed advocacy and support of doctors, social workers, and legal aid attorneys. She is now supported in an application for a monthly subsidy to help her immediate social needs while we work towards a more permanent solution. Our program has also helped patients with health-harming social needs, including lack of access to care (by helping patients apply for and enroll in Medicaid, for example), housing issues (such as mold and unresponsive landlords), and intimate partner violence. Working together as a team, we are able to provide advocacy to improve the health and well-being of our vulnerable community members. This program addresses issues that are important to my community. Without the hard work and dedication of my colleagues, the community at large, and all those committed to confronting these problems, many families would not get what they need to thrive. I am proud and feel lucky to dedicate my time to support my patients and my community. Thank you to the CHEST Foundation and all those who support it to ensure that ALL patients receive the care they deserve.”

—Drew Harris, MD

Cardiovascular Medicine and Surgery

PIONEER-HF trial: Changing practice in patients hospitalized for heart failure

Renin-angiotensin system (RAS) inhibition forms a pivotal part of guideline-recommended therapy for patients with heart failure with reduced ejection fraction (HFrEF).¹ Inhibition of the neutral endopeptidase neprilysin increases levels of several vasoactive peptides that inhibit progression of HF.² The randomized PARADIGM HF trial compared sacubitril/valsartan (angiotensin receptor neprilysin inhibition, ARNI) to enalapril in 8,434 patients with HFrEF and demonstrated a 20% reduction in the primary outcome of cardiovascular death or HF hospitalization (HR 0.80; CI 0.73– 0.87; P <.001) in patients treated with ARNI; mortality and rehospitalization were decreased significantly, as well.³ Importantly, patients had to be clinically stable and complete a sequential run-in period to be eligible for randomization. On this basis, the 2017 HF guideline update recommended transition from RAS inhibition to ARNI in trial-eligible patients.⁴

The recent PIONEER-HF trial now provides important evidence to support safety of careful initiation of sacubitril-valsartan for hospitalized patients with and without prior exposure to RAS.⁵ Hemodynamically stable patients were started on a regimen of sacubitril-valsartan, usually at doses half of those used in PARADIGM-HF. The primary endpoint of a decrease in BNP levels was improved significantly with sacubitril-valsartan (ratio 0.71, CI 0.63–0.81; P<.001), and this translated into a significant decrease in the important patient-centered secondary endpoint of rehospitalization.5 ARNI are underutilized in eligible patients; complexity of outpatient drug initiation may contribute.⁶

Data from this important trial suggest that clinicians should consider initiation of ARNI during hospitalization for acute heart failure. This could increase the number of patients receiving a guideline-recommended therapy that improves outcomes.

Steven M. Hollenberg, MD, FCCP
Steering Committee Chair

References:

1. Yancy CW et al. 2013 ACCF/ AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147.

2. Vardeny O et al. Combined neprilysin and renin-angiotensin system inhibition for the treatment of heart failure. JACC Heart Fail. 2014;2:663.

3. McMurray JJ, et al. Angiotensin– neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993.

4. Yancy CW, et al. 2017 ACC/ AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70:776.

5. Velasquez EJ, et al. Angiotensin-neprilysin inhibition in acute decompensated heart failure. N Engl J Med. 2018 Nov 11. doi: 10.1056/NEJMoa1812851. Epub ahead of print.

6. Luo N, et al. Early adoption of sacubitril/valsartan for patients with heart failure with reduced ejection fraction: insights from get with the guidelines-heart failure (GWTG-HF). JACC Heart Fail. 2017; 5:305.
 

 

 

Chest Infections

Pneumonia: It is NOW time to act!

The upper part of the globe is going through another winter season and this brings large numbers of patients visiting emergency departments and requiring admission to the hospital due to pneumonia and influenza. It is concerning to see that despite our knowledge that these events will occur during this season every year, there are no significant improvements in place compared to the prior year. But the most concerning aspect of all is lack of perception that pneumonia and influenza remain among the most important diseases resulting in morbidity and mortality to both children and adults (GBD 2016 Lower Respiratory Infections Collaborators. Lancet Infect Dis 2018; S1473-3099[18]30310).

Every year we read, listen or watch the alarming news regarding the increasing number of cases of influenza and pneumonia, the number of deaths, the lack of vaccine protection, the concerns about human-to-human transmission, the development of resistance, and the lack of resources to deal with this problem. We wonder why we tolerate this difficult situation over and over again? What can we do as a society to help fight this problem? What else needs to happen so we take this issue seriously? Why can we not improve the care of patients who suffer from pneumonia? We as part of the Chest Infections NetWork would like to raise the awareness of the pneumonia and influenza problem and unite with our communities to address this calamity once and for all! A recent editorial proposes a series of strategic solutions to address this situation that include increasing the overall resources, more funding for research, and the development of advocacy groups and education programs (Aliberti S, et al. Lancet Respir Med. 2018;S2213-2600(18):30470).

Marcos I. Restrepo, MD, MSc, PhD.
Steering Committee Vice-Chair

 

 

Clinical Research

Guidelines for the management of malignant pleural effusion

A multisociety multidisciplinary panel developed recommendations for management of malignant pleural effusions (MPE) by using the PICO (Population, Intervention, Comparator, and Outcomes) format. As per these guidelines, definitive therapy is aimed at

minimizing symptoms, re-accumulation and repeated pleural interventions, and risk of interventions in asymptomatic MPE outweighing benefits. Pleural interventions were suggested for indications such as clinical staging, obtaining molecular markers, etc. (Tremblay A. J Bronchology Interv Pulmonol. 2007;14:98). Large-volume thoracentesis is suggested for symptomatic patients and for those where lung entrapment is a concern (Lan RS. Ann Intern Med. 1997;126:768). In light of available evidence, the panel noted that the outcomes of definitive therapy for symptomatic MPE are equivocal between indwelling pleural catheter (IPC) and pleurodesis. IPC, which was restricted to un-expandable lungs in the previous guidelines, are now suggested for both expandable and un-expandable lungs (Feller-Kopman, et al. Am J Respir Crit Care Med. 2018;198[7]:839). Talc, being the most effective and widely use pleurodesis agent, is suggested to be delivered by poudrage or slurry. Higher treatment failure rates with chemical pleurodesis, as well as low Incidence rates of IPC-related cellulitis and pleural space infections, led the panel to suggest IPC for un-expanded lungs, treatment failures, and residual symptomatic loculated effusions. In patients with IPC-related infections, treatment of the infection rather than removal of the catheter was suggested unless in events where the infection failed to respond (Feller-Kopman, et al. Am J Respir Crit Care Med. 2018;198[7]:839). In view of evidence suggesting improved safety outcomes with ultrasound-guided pleural interventions (Abusedera M, et al. J Bronchology Interv Pulmonol. 2016;23:138), ultrasound guidance was recommended.

Bharat Bajantri, MD
Steering Committee Fellow-in-Training
 

Interprofessional Team

Difficult-to-control asthma, defined as: uncontrolled asthma despite use of maximum dose inhaled corticosteroids or chronic oral corticosteroids with daily asthma symptoms, frequent exacerbations, and/or hospitalization results in a substantial medical and financial burden with a resultant decrease in quality-of-life. Extrapulmonary co-morbidities, such as obesity, nicotine use, GERD, allergic rhinitis, chronic rhinosinusitis, sleep apnea, anxiety/depression, females of older age, vocal cord dysfunction (VCD), and type 2 diabetes mellitus (T2DM) have been shown to increase exacerbation frequency, missed days of school/work, and lessened quality-of life. Of these comorbidities, that latter has garnered recent attention as a focal point for asthma management.

Cardiovascular Medicine and Surgery

PIONEER-HF trial: Changing practice in patients hospitalized for heart failure

Renin-angiotensin system (RAS) inhibition forms a pivotal part of guideline-recommended therapy for patients with heart failure with reduced ejection fraction (HFrEF).¹ Inhibition of the neutral endopeptidase neprilysin increases levels of several vasoactive peptides that inhibit progression of HF.² The randomized PARADIGM HF trial compared sacubitril/valsartan (angiotensin receptor neprilysin inhibition, ARNI) to enalapril in 8,434 patients with HFrEF and demonstrated a 20% reduction in the primary outcome of cardiovascular death or HF hospitalization (HR 0.80; CI 0.73– 0.87; P <.001) in patients treated with ARNI; mortality and rehospitalization were decreased significantly, as well.³ Importantly, patients had to be clinically stable and complete a sequential run-in period to be eligible for randomization. On this basis, the 2017 HF guideline update recommended transition from RAS inhibition to ARNI in trial-eligible patients.⁴

The recent PIONEER-HF trial now provides important evidence to support safety of careful initiation of sacubitril-valsartan for hospitalized patients with and without prior exposure to RAS.⁵ Hemodynamically stable patients were started on a regimen of sacubitril-valsartan, usually at doses half of those used in PARADIGM-HF. The primary endpoint of a decrease in BNP levels was improved significantly with sacubitril-valsartan (ratio 0.71, CI 0.63–0.81; P<.001), and this translated into a significant decrease in the important patient-centered secondary endpoint of rehospitalization.5 ARNI are underutilized in eligible patients; complexity of outpatient drug initiation may contribute.⁶

Data from this important trial suggest that clinicians should consider initiation of ARNI during hospitalization for acute heart failure. This could increase the number of patients receiving a guideline-recommended therapy that improves outcomes.

Steven M. Hollenberg, MD, FCCP
Steering Committee Chair

References:

1. Yancy CW et al. 2013 ACCF/ AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147.

2. Vardeny O et al. Combined neprilysin and renin-angiotensin system inhibition for the treatment of heart failure. JACC Heart Fail. 2014;2:663.

3. McMurray JJ, et al. Angiotensin– neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993.

4. Yancy CW, et al. 2017 ACC/ AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70:776.

5. Velasquez EJ, et al. Angiotensin-neprilysin inhibition in acute decompensated heart failure. N Engl J Med. 2018 Nov 11. doi: 10.1056/NEJMoa1812851. Epub ahead of print.

6. Luo N, et al. Early adoption of sacubitril/valsartan for patients with heart failure with reduced ejection fraction: insights from get with the guidelines-heart failure (GWTG-HF). JACC Heart Fail. 2017; 5:305.
 

 

 

Chest Infections

Pneumonia: It is NOW time to act!

The upper part of the globe is going through another winter season and this brings large numbers of patients visiting emergency departments and requiring admission to the hospital due to pneumonia and influenza. It is concerning to see that despite our knowledge that these events will occur during this season every year, there are no significant improvements in place compared to the prior year. But the most concerning aspect of all is lack of perception that pneumonia and influenza remain among the most important diseases resulting in morbidity and mortality to both children and adults (GBD 2016 Lower Respiratory Infections Collaborators. Lancet Infect Dis 2018; S1473-3099[18]30310).

Every year we read, listen or watch the alarming news regarding the increasing number of cases of influenza and pneumonia, the number of deaths, the lack of vaccine protection, the concerns about human-to-human transmission, the development of resistance, and the lack of resources to deal with this problem. We wonder why we tolerate this difficult situation over and over again? What can we do as a society to help fight this problem? What else needs to happen so we take this issue seriously? Why can we not improve the care of patients who suffer from pneumonia? We as part of the Chest Infections NetWork would like to raise the awareness of the pneumonia and influenza problem and unite with our communities to address this calamity once and for all! A recent editorial proposes a series of strategic solutions to address this situation that include increasing the overall resources, more funding for research, and the development of advocacy groups and education programs (Aliberti S, et al. Lancet Respir Med. 2018;S2213-2600(18):30470).

Marcos I. Restrepo, MD, MSc, PhD.
Steering Committee Vice-Chair

 

 

Clinical Research

Guidelines for the management of malignant pleural effusion

A multisociety multidisciplinary panel developed recommendations for management of malignant pleural effusions (MPE) by using the PICO (Population, Intervention, Comparator, and Outcomes) format. As per these guidelines, definitive therapy is aimed at

minimizing symptoms, re-accumulation and repeated pleural interventions, and risk of interventions in asymptomatic MPE outweighing benefits. Pleural interventions were suggested for indications such as clinical staging, obtaining molecular markers, etc. (Tremblay A. J Bronchology Interv Pulmonol. 2007;14:98). Large-volume thoracentesis is suggested for symptomatic patients and for those where lung entrapment is a concern (Lan RS. Ann Intern Med. 1997;126:768). In light of available evidence, the panel noted that the outcomes of definitive therapy for symptomatic MPE are equivocal between indwelling pleural catheter (IPC) and pleurodesis. IPC, which was restricted to un-expandable lungs in the previous guidelines, are now suggested for both expandable and un-expandable lungs (Feller-Kopman, et al. Am J Respir Crit Care Med. 2018;198[7]:839). Talc, being the most effective and widely use pleurodesis agent, is suggested to be delivered by poudrage or slurry. Higher treatment failure rates with chemical pleurodesis, as well as low Incidence rates of IPC-related cellulitis and pleural space infections, led the panel to suggest IPC for un-expanded lungs, treatment failures, and residual symptomatic loculated effusions. In patients with IPC-related infections, treatment of the infection rather than removal of the catheter was suggested unless in events where the infection failed to respond (Feller-Kopman, et al. Am J Respir Crit Care Med. 2018;198[7]:839). In view of evidence suggesting improved safety outcomes with ultrasound-guided pleural interventions (Abusedera M, et al. J Bronchology Interv Pulmonol. 2016;23:138), ultrasound guidance was recommended.

Bharat Bajantri, MD
Steering Committee Fellow-in-Training
 

Interprofessional Team

Difficult-to-control asthma, defined as: uncontrolled asthma despite use of maximum dose inhaled corticosteroids or chronic oral corticosteroids with daily asthma symptoms, frequent exacerbations, and/or hospitalization results in a substantial medical and financial burden with a resultant decrease in quality-of-life. Extrapulmonary co-morbidities, such as obesity, nicotine use, GERD, allergic rhinitis, chronic rhinosinusitis, sleep apnea, anxiety/depression, females of older age, vocal cord dysfunction (VCD), and type 2 diabetes mellitus (T2DM) have been shown to increase exacerbation frequency, missed days of school/work, and lessened quality-of life. Of these comorbidities, that latter has garnered recent attention as a focal point for asthma management.

Cardiovascular Medicine and Surgery

PIONEER-HF trial: Changing practice in patients hospitalized for heart failure

Renin-angiotensin system (RAS) inhibition forms a pivotal part of guideline-recommended therapy for patients with heart failure with reduced ejection fraction (HFrEF).¹ Inhibition of the neutral endopeptidase neprilysin increases levels of several vasoactive peptides that inhibit progression of HF.² The randomized PARADIGM HF trial compared sacubitril/valsartan (angiotensin receptor neprilysin inhibition, ARNI) to enalapril in 8,434 patients with HFrEF and demonstrated a 20% reduction in the primary outcome of cardiovascular death or HF hospitalization (HR 0.80; CI 0.73– 0.87; P <.001) in patients treated with ARNI; mortality and rehospitalization were decreased significantly, as well.³ Importantly, patients had to be clinically stable and complete a sequential run-in period to be eligible for randomization. On this basis, the 2017 HF guideline update recommended transition from RAS inhibition to ARNI in trial-eligible patients.⁴

The recent PIONEER-HF trial now provides important evidence to support safety of careful initiation of sacubitril-valsartan for hospitalized patients with and without prior exposure to RAS.⁵ Hemodynamically stable patients were started on a regimen of sacubitril-valsartan, usually at doses half of those used in PARADIGM-HF. The primary endpoint of a decrease in BNP levels was improved significantly with sacubitril-valsartan (ratio 0.71, CI 0.63–0.81; P<.001), and this translated into a significant decrease in the important patient-centered secondary endpoint of rehospitalization.5 ARNI are underutilized in eligible patients; complexity of outpatient drug initiation may contribute.⁶

Data from this important trial suggest that clinicians should consider initiation of ARNI during hospitalization for acute heart failure. This could increase the number of patients receiving a guideline-recommended therapy that improves outcomes.

Steven M. Hollenberg, MD, FCCP
Steering Committee Chair

References:

1. Yancy CW et al. 2013 ACCF/ AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147.

2. Vardeny O et al. Combined neprilysin and renin-angiotensin system inhibition for the treatment of heart failure. JACC Heart Fail. 2014;2:663.

3. McMurray JJ, et al. Angiotensin– neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993.

4. Yancy CW, et al. 2017 ACC/ AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70:776.

5. Velasquez EJ, et al. Angiotensin-neprilysin inhibition in acute decompensated heart failure. N Engl J Med. 2018 Nov 11. doi: 10.1056/NEJMoa1812851. Epub ahead of print.

6. Luo N, et al. Early adoption of sacubitril/valsartan for patients with heart failure with reduced ejection fraction: insights from get with the guidelines-heart failure (GWTG-HF). JACC Heart Fail. 2017; 5:305.
 

 

 

Chest Infections

Pneumonia: It is NOW time to act!

The upper part of the globe is going through another winter season and this brings large numbers of patients visiting emergency departments and requiring admission to the hospital due to pneumonia and influenza. It is concerning to see that despite our knowledge that these events will occur during this season every year, there are no significant improvements in place compared to the prior year. But the most concerning aspect of all is lack of perception that pneumonia and influenza remain among the most important diseases resulting in morbidity and mortality to both children and adults (GBD 2016 Lower Respiratory Infections Collaborators. Lancet Infect Dis 2018; S1473-3099[18]30310).

Every year we read, listen or watch the alarming news regarding the increasing number of cases of influenza and pneumonia, the number of deaths, the lack of vaccine protection, the concerns about human-to-human transmission, the development of resistance, and the lack of resources to deal with this problem. We wonder why we tolerate this difficult situation over and over again? What can we do as a society to help fight this problem? What else needs to happen so we take this issue seriously? Why can we not improve the care of patients who suffer from pneumonia? We as part of the Chest Infections NetWork would like to raise the awareness of the pneumonia and influenza problem and unite with our communities to address this calamity once and for all! A recent editorial proposes a series of strategic solutions to address this situation that include increasing the overall resources, more funding for research, and the development of advocacy groups and education programs (Aliberti S, et al. Lancet Respir Med. 2018;S2213-2600(18):30470).

Marcos I. Restrepo, MD, MSc, PhD.
Steering Committee Vice-Chair

 

 

Clinical Research

Guidelines for the management of malignant pleural effusion

A multisociety multidisciplinary panel developed recommendations for management of malignant pleural effusions (MPE) by using the PICO (Population, Intervention, Comparator, and Outcomes) format. As per these guidelines, definitive therapy is aimed at

minimizing symptoms, re-accumulation and repeated pleural interventions, and risk of interventions in asymptomatic MPE outweighing benefits. Pleural interventions were suggested for indications such as clinical staging, obtaining molecular markers, etc. (Tremblay A. J Bronchology Interv Pulmonol. 2007;14:98). Large-volume thoracentesis is suggested for symptomatic patients and for those where lung entrapment is a concern (Lan RS. Ann Intern Med. 1997;126:768). In light of available evidence, the panel noted that the outcomes of definitive therapy for symptomatic MPE are equivocal between indwelling pleural catheter (IPC) and pleurodesis. IPC, which was restricted to un-expandable lungs in the previous guidelines, are now suggested for both expandable and un-expandable lungs (Feller-Kopman, et al. Am J Respir Crit Care Med. 2018;198[7]:839). Talc, being the most effective and widely use pleurodesis agent, is suggested to be delivered by poudrage or slurry. Higher treatment failure rates with chemical pleurodesis, as well as low Incidence rates of IPC-related cellulitis and pleural space infections, led the panel to suggest IPC for un-expanded lungs, treatment failures, and residual symptomatic loculated effusions. In patients with IPC-related infections, treatment of the infection rather than removal of the catheter was suggested unless in events where the infection failed to respond (Feller-Kopman, et al. Am J Respir Crit Care Med. 2018;198[7]:839). In view of evidence suggesting improved safety outcomes with ultrasound-guided pleural interventions (Abusedera M, et al. J Bronchology Interv Pulmonol. 2016;23:138), ultrasound guidance was recommended.

Bharat Bajantri, MD
Steering Committee Fellow-in-Training
 

Interprofessional Team

Difficult-to-control asthma, defined as: uncontrolled asthma despite use of maximum dose inhaled corticosteroids or chronic oral corticosteroids with daily asthma symptoms, frequent exacerbations, and/or hospitalization results in a substantial medical and financial burden with a resultant decrease in quality-of-life. Extrapulmonary co-morbidities, such as obesity, nicotine use, GERD, allergic rhinitis, chronic rhinosinusitis, sleep apnea, anxiety/depression, females of older age, vocal cord dysfunction (VCD), and type 2 diabetes mellitus (T2DM) have been shown to increase exacerbation frequency, missed days of school/work, and lessened quality-of life. Of these comorbidities, that latter has garnered recent attention as a focal point for asthma management.

NAMDRC focuses on keeping its members informed on legislative and regulatory issues impacting their practices.

Today, those agreements have been replaced by employment contracts or simply disappeared entirely, replaced by various business models that have invariably shifted the focus of coverage and payment issues away from the group practice into significantly different financial incentives. The challenge for NAMDRC is to keep its members informed about structural changes in coverage and payment rules that could impact their decision making. In November 2018, CMS published three distinctly separate sets of rules slated to take effect in 2019, all of which affect physicians in the pulmonary, critical care, and sleep landscapes. Through the monthly membership publication, the Washington Watchline, members get timely information that impact their practices. Excerpts from a recent Watchline include:

Physician fee schedule: As most physicians know, CMS had proposed dramatic changes to payment for Level 4 and Level 5 E&M codes, but due to strong reaction from many within the medical community, CMS is withdrawing that specific proposal, at least in the short term. Related provisions include:

• For CY 2019 and 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits,



• Effective January 1, 2019, for new and established patients for E/M office/outpatient visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information.



• For 2021, CMS is finalizing a significant reduction in the current payment variation in office/outpatient E/M visit levels by paying a single rate for E/M office/outpatient visit levels 2, 3, and 4 (one for established and another for new patients) beginning in 2021. However, CMS is not finalizing the inclusion of E/M office/outpatient level 5 visits in the single payment rate, to better account for the care and needs of particularly complex patients.



• CMS policy for 2021 will adopt add-on codes that describe the additional resources inherent in visits for primary care and particular kinds of specialized medical care. As discussed further below, these codes will only be reportable with E/M office/outpatient level 2 through 4 visits, and their use generally will not impose new per-visit documentation requirements.



Hospital outpatient rules: There are two particularly relevant issues addressed in this final regulation. The payment rates for pulmonary rehab are:

Pulmonary Rehab via G0424 – APC 5733, $55.90 with co-pay of $11.18

Pulmonary Rehab via G0237, 38, 39 – APC 5732, $32.12 with co-pay of $6.43

This regulation is also the vehicle for CMS addressing issues related to Section 603/site of service payment issues. As physicians know, CMS enacted Section 603 of the 23015 Budget Act that puts notable restrictions on payment for certain hospital outpatient services provided off campus (more than 250 yards from main campus of the hospital). NAMDRC is most concerned about the impact on pulmonary rehab – under the rules, off-campus programs that are grandfathered (“excepted” is the CMS term) as long as they were billing for those services at that location November 2015. However, if a hospital chooses to open a new program, or relocate an existing program to a different location, the payment principles that apply are physician fee schedule rates rather than hospital outpatient rates. In the proposed rule posted this past July, CMS had proposed that even a new service provided in an excepted (grandfathered) setting would be subject to PFS payment rates rather than hospital outpatient rates. CMS has withdrawn that proposal for the coming year, so new services in excepted settings will be covered. “Excepted” is actually CMS’ terminology, which is used to refer to off-campus outpatient facilities that were offering services in November 2015. Services that do not meet that singular criterion are considered nonexcepted (not grandfathered), and those services are paid at the physician fee schedule rate.



DME: In its proposed rule this past summer, CMS actually acknowledged flaws in the structure of the competitive bidding system for DME (including oxygen, CPAP, and certain ventilators referred to by CMS as respiratory assist devices). Specifically, related to oxygen, there is also acknowledgement of reductions in liquid oxygen utilization, a story we have been pushing for years. The CMS proposed rule would have tied liquid portable payment rates to portable concentrator and transfill system payment rates, a genuine bump in actual $$. More than a dozen societies joined to respond to the proposed rule, including NAMDRC, CHEST, and ATS.

In the final rule, CMS is moving forward with its proposal, acknowledging that it will need to monitor shifts in the oxygen marketplace and adjust their payment policies accordingly.
 

NAMDRC focuses on keeping its members informed on legislative and regulatory issues impacting their practices.

Today, those agreements have been replaced by employment contracts or simply disappeared entirely, replaced by various business models that have invariably shifted the focus of coverage and payment issues away from the group practice into significantly different financial incentives. The challenge for NAMDRC is to keep its members informed about structural changes in coverage and payment rules that could impact their decision making. In November 2018, CMS published three distinctly separate sets of rules slated to take effect in 2019, all of which affect physicians in the pulmonary, critical care, and sleep landscapes. Through the monthly membership publication, the Washington Watchline, members get timely information that impact their practices. Excerpts from a recent Watchline include:

Physician fee schedule: As most physicians know, CMS had proposed dramatic changes to payment for Level 4 and Level 5 E&M codes, but due to strong reaction from many within the medical community, CMS is withdrawing that specific proposal, at least in the short term. Related provisions include:

• For CY 2019 and 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits,



• Effective January 1, 2019, for new and established patients for E/M office/outpatient visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information.



• For 2021, CMS is finalizing a significant reduction in the current payment variation in office/outpatient E/M visit levels by paying a single rate for E/M office/outpatient visit levels 2, 3, and 4 (one for established and another for new patients) beginning in 2021. However, CMS is not finalizing the inclusion of E/M office/outpatient level 5 visits in the single payment rate, to better account for the care and needs of particularly complex patients.



• CMS policy for 2021 will adopt add-on codes that describe the additional resources inherent in visits for primary care and particular kinds of specialized medical care. As discussed further below, these codes will only be reportable with E/M office/outpatient level 2 through 4 visits, and their use generally will not impose new per-visit documentation requirements.



Hospital outpatient rules: There are two particularly relevant issues addressed in this final regulation. The payment rates for pulmonary rehab are:

Pulmonary Rehab via G0424 – APC 5733, $55.90 with co-pay of $11.18

Pulmonary Rehab via G0237, 38, 39 – APC 5732, $32.12 with co-pay of $6.43

This regulation is also the vehicle for CMS addressing issues related to Section 603/site of service payment issues. As physicians know, CMS enacted Section 603 of the 23015 Budget Act that puts notable restrictions on payment for certain hospital outpatient services provided off campus (more than 250 yards from main campus of the hospital). NAMDRC is most concerned about the impact on pulmonary rehab – under the rules, off-campus programs that are grandfathered (“excepted” is the CMS term) as long as they were billing for those services at that location November 2015. However, if a hospital chooses to open a new program, or relocate an existing program to a different location, the payment principles that apply are physician fee schedule rates rather than hospital outpatient rates. In the proposed rule posted this past July, CMS had proposed that even a new service provided in an excepted (grandfathered) setting would be subject to PFS payment rates rather than hospital outpatient rates. CMS has withdrawn that proposal for the coming year, so new services in excepted settings will be covered. “Excepted” is actually CMS’ terminology, which is used to refer to off-campus outpatient facilities that were offering services in November 2015. Services that do not meet that singular criterion are considered nonexcepted (not grandfathered), and those services are paid at the physician fee schedule rate.



DME: In its proposed rule this past summer, CMS actually acknowledged flaws in the structure of the competitive bidding system for DME (including oxygen, CPAP, and certain ventilators referred to by CMS as respiratory assist devices). Specifically, related to oxygen, there is also acknowledgement of reductions in liquid oxygen utilization, a story we have been pushing for years. The CMS proposed rule would have tied liquid portable payment rates to portable concentrator and transfill system payment rates, a genuine bump in actual $$. More than a dozen societies joined to respond to the proposed rule, including NAMDRC, CHEST, and ATS.

In the final rule, CMS is moving forward with its proposal, acknowledging that it will need to monitor shifts in the oxygen marketplace and adjust their payment policies accordingly.
 

NAMDRC focuses on keeping its members informed on legislative and regulatory issues impacting their practices.

Today, those agreements have been replaced by employment contracts or simply disappeared entirely, replaced by various business models that have invariably shifted the focus of coverage and payment issues away from the group practice into significantly different financial incentives. The challenge for NAMDRC is to keep its members informed about structural changes in coverage and payment rules that could impact their decision making. In November 2018, CMS published three distinctly separate sets of rules slated to take effect in 2019, all of which affect physicians in the pulmonary, critical care, and sleep landscapes. Through the monthly membership publication, the Washington Watchline, members get timely information that impact their practices. Excerpts from a recent Watchline include:

Physician fee schedule: As most physicians know, CMS had proposed dramatic changes to payment for Level 4 and Level 5 E&M codes, but due to strong reaction from many within the medical community, CMS is withdrawing that specific proposal, at least in the short term. Related provisions include:

• For CY 2019 and 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits,



• Effective January 1, 2019, for new and established patients for E/M office/outpatient visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information.



• For 2021, CMS is finalizing a significant reduction in the current payment variation in office/outpatient E/M visit levels by paying a single rate for E/M office/outpatient visit levels 2, 3, and 4 (one for established and another for new patients) beginning in 2021. However, CMS is not finalizing the inclusion of E/M office/outpatient level 5 visits in the single payment rate, to better account for the care and needs of particularly complex patients.



• CMS policy for 2021 will adopt add-on codes that describe the additional resources inherent in visits for primary care and particular kinds of specialized medical care. As discussed further below, these codes will only be reportable with E/M office/outpatient level 2 through 4 visits, and their use generally will not impose new per-visit documentation requirements.



Hospital outpatient rules: There are two particularly relevant issues addressed in this final regulation. The payment rates for pulmonary rehab are:

Pulmonary Rehab via G0424 – APC 5733, $55.90 with co-pay of $11.18

Pulmonary Rehab via G0237, 38, 39 – APC 5732, $32.12 with co-pay of $6.43

This regulation is also the vehicle for CMS addressing issues related to Section 603/site of service payment issues. As physicians know, CMS enacted Section 603 of the 23015 Budget Act that puts notable restrictions on payment for certain hospital outpatient services provided off campus (more than 250 yards from main campus of the hospital). NAMDRC is most concerned about the impact on pulmonary rehab – under the rules, off-campus programs that are grandfathered (“excepted” is the CMS term) as long as they were billing for those services at that location November 2015. However, if a hospital chooses to open a new program, or relocate an existing program to a different location, the payment principles that apply are physician fee schedule rates rather than hospital outpatient rates. In the proposed rule posted this past July, CMS had proposed that even a new service provided in an excepted (grandfathered) setting would be subject to PFS payment rates rather than hospital outpatient rates. CMS has withdrawn that proposal for the coming year, so new services in excepted settings will be covered. “Excepted” is actually CMS’ terminology, which is used to refer to off-campus outpatient facilities that were offering services in November 2015. Services that do not meet that singular criterion are considered nonexcepted (not grandfathered), and those services are paid at the physician fee schedule rate.



DME: In its proposed rule this past summer, CMS actually acknowledged flaws in the structure of the competitive bidding system for DME (including oxygen, CPAP, and certain ventilators referred to by CMS as respiratory assist devices). Specifically, related to oxygen, there is also acknowledgement of reductions in liquid oxygen utilization, a story we have been pushing for years. The CMS proposed rule would have tied liquid portable payment rates to portable concentrator and transfill system payment rates, a genuine bump in actual $$. More than a dozen societies joined to respond to the proposed rule, including NAMDRC, CHEST, and ATS.

In the final rule, CMS is moving forward with its proposal, acknowledging that it will need to monitor shifts in the oxygen marketplace and adjust their payment policies accordingly.
 

In 2013, CHEST began work with the Chinese Ministry of Health and the Chinese Medical Doctor Association to establish the specialty of Pulmonary and Critical Care Medicine in China. CHEST members, among them Drs. Renli Qiao, Jack Buckley, Darcy Marciniuk, Mark Rosen, and Stephanie Levine, helped to establish a curriculum and a board exam and have now seen the first class of fellows complete their training. At our October Board meeting, Dr. Buckley reported at this meeting that the Chinese PCCM program, the first medical subspecialty to be established in China, is prepared to stand on its own, without further support from CHEST. This is a huge accomplishment for both the Chinese Medical Doctor Association and for CHEST, and the Board heartily congratulated everyone who contributed to this impressive project.

Another important function at this October meeting is to approve the Governance Committee’s recommendations for a new slate of board members and a new President-Designate. The board bid farewell to four valued members at the end of their terms: Drs. Robert Aranson (Freeport, ME), Subhakar Kandi (Hyderabad, India), Janet Maurer (Desert Hills, AZ), and Hassan Bencheqroun (San Diego, CA). All contributed immensely to the success of CHEST, and the remaining board members expressed their gratitude. The Board also approved Drs. Vera De Palo (Providence, RI), Neil Freedman (Evanston, IL), Francesco DeBlasio (Napoli, Italy), and Lynn Tanoue (New Haven, CT) as at-large regents, and Dr. Steven Simpson (Kansas City, KS) as the new President-Designate. The Board is committed to ensuring that its makeup be representative of the entirety of our membership base. As CHEST continues to grow internationally and as we gain more members who are women and historically underrepresented minorities, we are dedicated to ensuring that there is no glass ceiling in our organization and that all have the opportunity to contribute to the full extent of their ability. We are, likewise, dedicated to providing mentorship and leadership opportunities for members of groups who are under-represented.

Following the resignation of CHEST’s CEO during the summer, the Chief Operating Officer, Dr. Robert Musacchio, became interim CEO. Dr. Musacchio is a PhD economist who joined CHEST in 2015 after a 35-year stint at the American Medical Association and who has broad and deep experience in the business of running a nonprofit medical organization. He brings an extraordinary skill set in both business and staff development to the role, and we very much look forward to working with him in this new position! Dr. Musacchio gave an update on educational efforts, domestic and international growth in membership, changes in the structure of the professional staff, and the state of our flagship journal, CHEST®.

In 2013, CHEST began work with the Chinese Ministry of Health and the Chinese Medical Doctor Association to establish the specialty of Pulmonary and Critical Care Medicine in China. CHEST members, among them Drs. Renli Qiao, Jack Buckley, Darcy Marciniuk, Mark Rosen, and Stephanie Levine, helped to establish a curriculum and a board exam and have now seen the first class of fellows complete their training. At our October Board meeting, Dr. Buckley reported at this meeting that the Chinese PCCM program, the first medical subspecialty to be established in China, is prepared to stand on its own, without further support from CHEST. This is a huge accomplishment for both the Chinese Medical Doctor Association and for CHEST, and the Board heartily congratulated everyone who contributed to this impressive project.

Another important function at this October meeting is to approve the Governance Committee’s recommendations for a new slate of board members and a new President-Designate. The board bid farewell to four valued members at the end of their terms: Drs. Robert Aranson (Freeport, ME), Subhakar Kandi (Hyderabad, India), Janet Maurer (Desert Hills, AZ), and Hassan Bencheqroun (San Diego, CA). All contributed immensely to the success of CHEST, and the remaining board members expressed their gratitude. The Board also approved Drs. Vera De Palo (Providence, RI), Neil Freedman (Evanston, IL), Francesco DeBlasio (Napoli, Italy), and Lynn Tanoue (New Haven, CT) as at-large regents, and Dr. Steven Simpson (Kansas City, KS) as the new President-Designate. The Board is committed to ensuring that its makeup be representative of the entirety of our membership base. As CHEST continues to grow internationally and as we gain more members who are women and historically underrepresented minorities, we are dedicated to ensuring that there is no glass ceiling in our organization and that all have the opportunity to contribute to the full extent of their ability. We are, likewise, dedicated to providing mentorship and leadership opportunities for members of groups who are under-represented.

Following the resignation of CHEST’s CEO during the summer, the Chief Operating Officer, Dr. Robert Musacchio, became interim CEO. Dr. Musacchio is a PhD economist who joined CHEST in 2015 after a 35-year stint at the American Medical Association and who has broad and deep experience in the business of running a nonprofit medical organization. He brings an extraordinary skill set in both business and staff development to the role, and we very much look forward to working with him in this new position! Dr. Musacchio gave an update on educational efforts, domestic and international growth in membership, changes in the structure of the professional staff, and the state of our flagship journal, CHEST®.

In 2013, CHEST began work with the Chinese Ministry of Health and the Chinese Medical Doctor Association to establish the specialty of Pulmonary and Critical Care Medicine in China. CHEST members, among them Drs. Renli Qiao, Jack Buckley, Darcy Marciniuk, Mark Rosen, and Stephanie Levine, helped to establish a curriculum and a board exam and have now seen the first class of fellows complete their training. At our October Board meeting, Dr. Buckley reported at this meeting that the Chinese PCCM program, the first medical subspecialty to be established in China, is prepared to stand on its own, without further support from CHEST. This is a huge accomplishment for both the Chinese Medical Doctor Association and for CHEST, and the Board heartily congratulated everyone who contributed to this impressive project.

Another important function at this October meeting is to approve the Governance Committee’s recommendations for a new slate of board members and a new President-Designate. The board bid farewell to four valued members at the end of their terms: Drs. Robert Aranson (Freeport, ME), Subhakar Kandi (Hyderabad, India), Janet Maurer (Desert Hills, AZ), and Hassan Bencheqroun (San Diego, CA). All contributed immensely to the success of CHEST, and the remaining board members expressed their gratitude. The Board also approved Drs. Vera De Palo (Providence, RI), Neil Freedman (Evanston, IL), Francesco DeBlasio (Napoli, Italy), and Lynn Tanoue (New Haven, CT) as at-large regents, and Dr. Steven Simpson (Kansas City, KS) as the new President-Designate. The Board is committed to ensuring that its makeup be representative of the entirety of our membership base. As CHEST continues to grow internationally and as we gain more members who are women and historically underrepresented minorities, we are dedicated to ensuring that there is no glass ceiling in our organization and that all have the opportunity to contribute to the full extent of their ability. We are, likewise, dedicated to providing mentorship and leadership opportunities for members of groups who are under-represented.

Following the resignation of CHEST’s CEO during the summer, the Chief Operating Officer, Dr. Robert Musacchio, became interim CEO. Dr. Musacchio is a PhD economist who joined CHEST in 2015 after a 35-year stint at the American Medical Association and who has broad and deep experience in the business of running a nonprofit medical organization. He brings an extraordinary skill set in both business and staff development to the role, and we very much look forward to working with him in this new position! Dr. Musacchio gave an update on educational efforts, domestic and international growth in membership, changes in the structure of the professional staff, and the state of our flagship journal, CHEST®.

NAMDRC focuses on keeping its members informed on legislative and regulatory issues impacting their practices

NAMDRC’s mission statement clearly signals its commitment to improve access to quality care for patients with respiratory disease by removing regulatory and legislative barriers to appropriate treatment. Adhering to that commitment presents challenges in the rapidly changing structure of the delivery of health care. For example, 10 years ago, the majority of NAMDRC members were private practitioners/group practices, many with contracts to provide a range of services to institutions. While those agreements varied, the underlying principles were relatively constant – structure your agreements that were mutually beneficial to physician and hospital.

Today, those agreements have been replaced by employment contracts or simply disappeared entirely, replaced by various business models that have invariably shifted the focus of coverage and payment issues away from the group practice into significantly different financial incentives. The challenge for NAMDRC is to keep its members informed about structural changes in coverage and payment rules that could impact their decision making. In November 2018, CMS published three distinctly separate sets of rules slated to take effect in 2019, all of which affect physicians in the pulmonary, critical care, and sleep landscapes. Through the monthly membership publication, the Washington Watchline, members get timely information that impact their practices. Excerpts from a recent Watchline include:

Physician fee schedule: As most physicians know, CMS had proposed dramatic changes to payment for Level 4 and Level % E&M codes, but due to strong reaction from man within the medical community, CMS is withdrawing that specific proposal, at least in the short term. Related provisions include:

• For CY 2019 and 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits,

• Effective January 1, 2019, for new and established patients for E/M office/outpatient visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information.

• For 2021, CMS is finalizing a significant reduction in the current payment variation in office/outpatient E/M visit levels by paying a single rate for E/M office/outpatient visit levels 2, 3, and 4 (one for established and another for new patients) beginning in 2021. However, CMS is not finalizing the inclusion of E/M office/outpatient level 5 visits in the single payment rate, to better account for the care and needs of particularly complex patients.

• CMS policy for 2021 will adopt add-on codes that describe the additional resources inherent in visits for primary care and particular kinds of specialized medical care. As discussed further below, these codes will only be reportable with E/M office/outpatient level 2 through 4 visits, and their use generally will not impose new per-visit documentation requirements.



Hospital outpatient rules: There are two particularly relevant issues addressed in this final regulation. The payment rates for pulmonary rehab are:

• Pulmonary Rehab via G0424 – APC 5733, $55.90 with co-pay of $11.18

• Pulmonary Rehab via G0237, 38, 39 – APC 5732, $32.12 with co-pay of $6.43



This regulation is also the vehicle for CMS addressing issues related to Section 603/site of service payment issues. As physicians know, CMS enacted Section 603 of the 23015 Budget Act that puts notable restrictions on payment for certain hospital outpatient services provided off campus (more than 250 yards from main campus of the hospital). NAMDRC is most concerned about the impact on pulmonary rehab – under the rules, off-campus programs that are grandfathered (“excepted” is the CMS term) as long as they were billing for those services at that location November 2015. However, if a hospital chooses to open a new program, or relocate an existing program to a different location, the payment principles that apply are physician fee schedule rates rather than hospital outpatient rates. In the proposed rule posted this past July, CMS had proposed that even a new service provided in an excepted setting would be subject to PFS payment rates rather than hospital outpatient rates. CMS has withdrawn that proposal for the coming year, so new services in excepted settings will be covered.

DME: In its proposed rule this past summer, CMS actually acknowledged flaws in the structure of the competitive bidding system for DME (including oxygen, CPAP, and certain ventilators referred to by CMS as respiratory assist devices). Specifically, related to oxygen, there is also acknowledgement of reductions in liquid oxygen utilization, a story we have been pushing for years. The CMS proposed rule would have tied liquid portable payment rates to portable concentrator and transfill system payment rates, a genuine bump in actual $$. More than a dozen societies joined to respond to the proposed rule, including NAMDRC, CHEST, and ATS.

In the final rule, CMS is moving forward with its proposal, acknowledging that it will need to monitor shifts in the oxygen marketplace and adjust their payment policies accordingly.
 

NAMDRC focuses on keeping its members informed on legislative and regulatory issues impacting their practices

NAMDRC’s mission statement clearly signals its commitment to improve access to quality care for patients with respiratory disease by removing regulatory and legislative barriers to appropriate treatment. Adhering to that commitment presents challenges in the rapidly changing structure of the delivery of health care. For example, 10 years ago, the majority of NAMDRC members were private practitioners/group practices, many with contracts to provide a range of services to institutions. While those agreements varied, the underlying principles were relatively constant – structure your agreements that were mutually beneficial to physician and hospital.

Today, those agreements have been replaced by employment contracts or simply disappeared entirely, replaced by various business models that have invariably shifted the focus of coverage and payment issues away from the group practice into significantly different financial incentives. The challenge for NAMDRC is to keep its members informed about structural changes in coverage and payment rules that could impact their decision making. In November 2018, CMS published three distinctly separate sets of rules slated to take effect in 2019, all of which affect physicians in the pulmonary, critical care, and sleep landscapes. Through the monthly membership publication, the Washington Watchline, members get timely information that impact their practices. Excerpts from a recent Watchline include:

Physician fee schedule: As most physicians know, CMS had proposed dramatic changes to payment for Level 4 and Level % E&M codes, but due to strong reaction from man within the medical community, CMS is withdrawing that specific proposal, at least in the short term. Related provisions include:

• For CY 2019 and 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits,

• Effective January 1, 2019, for new and established patients for E/M office/outpatient visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information.

• For 2021, CMS is finalizing a significant reduction in the current payment variation in office/outpatient E/M visit levels by paying a single rate for E/M office/outpatient visit levels 2, 3, and 4 (one for established and another for new patients) beginning in 2021. However, CMS is not finalizing the inclusion of E/M office/outpatient level 5 visits in the single payment rate, to better account for the care and needs of particularly complex patients.

• CMS policy for 2021 will adopt add-on codes that describe the additional resources inherent in visits for primary care and particular kinds of specialized medical care. As discussed further below, these codes will only be reportable with E/M office/outpatient level 2 through 4 visits, and their use generally will not impose new per-visit documentation requirements.



Hospital outpatient rules: There are two particularly relevant issues addressed in this final regulation. The payment rates for pulmonary rehab are:

• Pulmonary Rehab via G0424 – APC 5733, $55.90 with co-pay of $11.18

• Pulmonary Rehab via G0237, 38, 39 – APC 5732, $32.12 with co-pay of $6.43



This regulation is also the vehicle for CMS addressing issues related to Section 603/site of service payment issues. As physicians know, CMS enacted Section 603 of the 23015 Budget Act that puts notable restrictions on payment for certain hospital outpatient services provided off campus (more than 250 yards from main campus of the hospital). NAMDRC is most concerned about the impact on pulmonary rehab – under the rules, off-campus programs that are grandfathered (“excepted” is the CMS term) as long as they were billing for those services at that location November 2015. However, if a hospital chooses to open a new program, or relocate an existing program to a different location, the payment principles that apply are physician fee schedule rates rather than hospital outpatient rates. In the proposed rule posted this past July, CMS had proposed that even a new service provided in an excepted setting would be subject to PFS payment rates rather than hospital outpatient rates. CMS has withdrawn that proposal for the coming year, so new services in excepted settings will be covered.

DME: In its proposed rule this past summer, CMS actually acknowledged flaws in the structure of the competitive bidding system for DME (including oxygen, CPAP, and certain ventilators referred to by CMS as respiratory assist devices). Specifically, related to oxygen, there is also acknowledgement of reductions in liquid oxygen utilization, a story we have been pushing for years. The CMS proposed rule would have tied liquid portable payment rates to portable concentrator and transfill system payment rates, a genuine bump in actual $$. More than a dozen societies joined to respond to the proposed rule, including NAMDRC, CHEST, and ATS.

In the final rule, CMS is moving forward with its proposal, acknowledging that it will need to monitor shifts in the oxygen marketplace and adjust their payment policies accordingly.
 

NAMDRC focuses on keeping its members informed on legislative and regulatory issues impacting their practices

NAMDRC’s mission statement clearly signals its commitment to improve access to quality care for patients with respiratory disease by removing regulatory and legislative barriers to appropriate treatment. Adhering to that commitment presents challenges in the rapidly changing structure of the delivery of health care. For example, 10 years ago, the majority of NAMDRC members were private practitioners/group practices, many with contracts to provide a range of services to institutions. While those agreements varied, the underlying principles were relatively constant – structure your agreements that were mutually beneficial to physician and hospital.

Today, those agreements have been replaced by employment contracts or simply disappeared entirely, replaced by various business models that have invariably shifted the focus of coverage and payment issues away from the group practice into significantly different financial incentives. The challenge for NAMDRC is to keep its members informed about structural changes in coverage and payment rules that could impact their decision making. In November 2018, CMS published three distinctly separate sets of rules slated to take effect in 2019, all of which affect physicians in the pulmonary, critical care, and sleep landscapes. Through the monthly membership publication, the Washington Watchline, members get timely information that impact their practices. Excerpts from a recent Watchline include:

Physician fee schedule: As most physicians know, CMS had proposed dramatic changes to payment for Level 4 and Level % E&M codes, but due to strong reaction from man within the medical community, CMS is withdrawing that specific proposal, at least in the short term. Related provisions include:

• For CY 2019 and 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits,

• Effective January 1, 2019, for new and established patients for E/M office/outpatient visits, practitioners need not re-enter in the medical record information on the patient’s chief complaint and history that has already been entered by ancillary staff or the beneficiary. The practitioner may simply indicate in the medical record that he or she reviewed and verified this information.

• For 2021, CMS is finalizing a significant reduction in the current payment variation in office/outpatient E/M visit levels by paying a single rate for E/M office/outpatient visit levels 2, 3, and 4 (one for established and another for new patients) beginning in 2021. However, CMS is not finalizing the inclusion of E/M office/outpatient level 5 visits in the single payment rate, to better account for the care and needs of particularly complex patients.

• CMS policy for 2021 will adopt add-on codes that describe the additional resources inherent in visits for primary care and particular kinds of specialized medical care. As discussed further below, these codes will only be reportable with E/M office/outpatient level 2 through 4 visits, and their use generally will not impose new per-visit documentation requirements.



Hospital outpatient rules: There are two particularly relevant issues addressed in this final regulation. The payment rates for pulmonary rehab are:

• Pulmonary Rehab via G0424 – APC 5733, $55.90 with co-pay of $11.18

• Pulmonary Rehab via G0237, 38, 39 – APC 5732, $32.12 with co-pay of $6.43



This regulation is also the vehicle for CMS addressing issues related to Section 603/site of service payment issues. As physicians know, CMS enacted Section 603 of the 23015 Budget Act that puts notable restrictions on payment for certain hospital outpatient services provided off campus (more than 250 yards from main campus of the hospital). NAMDRC is most concerned about the impact on pulmonary rehab – under the rules, off-campus programs that are grandfathered (“excepted” is the CMS term) as long as they were billing for those services at that location November 2015. However, if a hospital chooses to open a new program, or relocate an existing program to a different location, the payment principles that apply are physician fee schedule rates rather than hospital outpatient rates. In the proposed rule posted this past July, CMS had proposed that even a new service provided in an excepted setting would be subject to PFS payment rates rather than hospital outpatient rates. CMS has withdrawn that proposal for the coming year, so new services in excepted settings will be covered.

DME: In its proposed rule this past summer, CMS actually acknowledged flaws in the structure of the competitive bidding system for DME (including oxygen, CPAP, and certain ventilators referred to by CMS as respiratory assist devices). Specifically, related to oxygen, there is also acknowledgement of reductions in liquid oxygen utilization, a story we have been pushing for years. The CMS proposed rule would have tied liquid portable payment rates to portable concentrator and transfill system payment rates, a genuine bump in actual $$. More than a dozen societies joined to respond to the proposed rule, including NAMDRC, CHEST, and ATS.

In the final rule, CMS is moving forward with its proposal, acknowledging that it will need to monitor shifts in the oxygen marketplace and adjust their payment policies accordingly.
 

As the CHEST Foundation continues to grow, so does our ability to impact the careers of early career clinicians. What began as a small travel grants program for the 2015 winners of the NetWorks Challenge to help offset their trainee members’ travel to CHEST 2015 in Montreal, was quickly identified as opportunity for the CHEST Foundation to deepen their engagement with early career clinicians. The CHEST Foundation travel grants program has grown immensely since then, but the core tenants of the program remain unchanged – to provide excellent trainees, medical students, and all other members of the care team with the fiscal support they need to become successful clinicians and faithfully treat their patients and community. Some of the ways our travel grants are put to good use is to attend the CHEST Annual Meeting and to further engage them as active members of CHEST. In addition to travel grant support to offset the costs of attending the annual meeting, recipients of these competitive grants receive free registration to the meeting; individualized mentorship from a CHEST member who is currently or has been part of CHEST leadership (ie, served on one of the boards, as faculty, on committees, as well as chairs and vice-chairs of the NetWorks); learn best practices for applying for research and community service grants from previous grant winners; invitations to exclusive receptions to network with peers and potential employers; and access to several sessions at the annual meeting intended to strengthen their clinical skill set. All of these programmatic pieces come together to help propel these young leaders’ careers and invest in the future of our discipline as CHEST clinicians.

Due to your overwhelming philanthropic support, CHEST Foundation’s travel grant programs continue to flourish. In 2017, the CHEST Foundation supported

a total of 43 early career clinicians’ travel to attend the CHEST Annual Meeting in Toronto. Through continued donor support, a successful NetWorks Challenge

fundraiser, and an overwhelming number of qualified early career applicants for the travel grants, that number swelled to 72 clinicians for the 2018 CHEST Annual Meeting in San Antonio. In total, the CHEST Foundation dispensed over $70,000 in travel grants for CHEST 2018. We can’t thank you enough for the impact you have made in these early career clinicians’ professional lives, and we urge you to increase your gifts, so we can advance these important professional development opportunities for clinicians by CHEST 2019!



“I’m so thankful to be a recipient of the CHEST travel grant! It enabled me to connect with such a wide array of health-care professionals and learn from my peers. It was wonderful to discover that there are many ways for me as a respiratory therapist to become involved in CHEST! Thank you to all the donors who made these awards a reality!”

- Maya Jenkins, RRT

“As an international medical graduate fellow, I experience challenges spanning from economic (inability to moonlight), professional (scarce funding and sponsorship opportunities, mentorship) to immigration-related difficulties. The CHEST Foundation grant is a superbly structured and implemented opportunity that allowed me a chance to address most of these challenges as I advance in my academic career. The grant itinerary permitted me to network with mentors and, subsequently, resulted in critical leads: A collaborative research project, offers to write letters in support of my visa situation, interest from a journal for one my manuscripts, plans to submit proposals for #CHEST2019, and, most importantly, support from leaders in our field who offered guidance and sponsorship (huge shout out to Dr. Chris Carroll)! I would like to thank the Foundation for awarding this grant as it isn’t just the grant but the slew of opportunities that came along with it that can, and, in my case, catapult fledgling careers in the field of pulmonary and critical care medicine.”

-Viren Kaul, MD

“CHEST education is the cornerstone of pulmonary medicine and delivering world-class health care. CHEST and the CHEST Foundation care about me and the importance of being the best practitioner I can be for my patients. Having impactful conversations with other clinicians, seeing new innovations, and learning through a diverse number of ways while at CHEST 2018 gave me meaningful lessons to apply in my daily practice. The travel grant made this possible!”

- Sarah Brundidge, MSc, RRT
 

As the CHEST Foundation continues to grow, so does our ability to impact the careers of early career clinicians. What began as a small travel grants program for the 2015 winners of the NetWorks Challenge to help offset their trainee members’ travel to CHEST 2015 in Montreal, was quickly identified as opportunity for the CHEST Foundation to deepen their engagement with early career clinicians. The CHEST Foundation travel grants program has grown immensely since then, but the core tenants of the program remain unchanged – to provide excellent trainees, medical students, and all other members of the care team with the fiscal support they need to become successful clinicians and faithfully treat their patients and community. Some of the ways our travel grants are put to good use is to attend the CHEST Annual Meeting and to further engage them as active members of CHEST. In addition to travel grant support to offset the costs of attending the annual meeting, recipients of these competitive grants receive free registration to the meeting; individualized mentorship from a CHEST member who is currently or has been part of CHEST leadership (ie, served on one of the boards, as faculty, on committees, as well as chairs and vice-chairs of the NetWorks); learn best practices for applying for research and community service grants from previous grant winners; invitations to exclusive receptions to network with peers and potential employers; and access to several sessions at the annual meeting intended to strengthen their clinical skill set. All of these programmatic pieces come together to help propel these young leaders’ careers and invest in the future of our discipline as CHEST clinicians.

Due to your overwhelming philanthropic support, CHEST Foundation’s travel grant programs continue to flourish. In 2017, the CHEST Foundation supported

a total of 43 early career clinicians’ travel to attend the CHEST Annual Meeting in Toronto. Through continued donor support, a successful NetWorks Challenge

fundraiser, and an overwhelming number of qualified early career applicants for the travel grants, that number swelled to 72 clinicians for the 2018 CHEST Annual Meeting in San Antonio. In total, the CHEST Foundation dispensed over $70,000 in travel grants for CHEST 2018. We can’t thank you enough for the impact you have made in these early career clinicians’ professional lives, and we urge you to increase your gifts, so we can advance these important professional development opportunities for clinicians by CHEST 2019!



“I’m so thankful to be a recipient of the CHEST travel grant! It enabled me to connect with such a wide array of health-care professionals and learn from my peers. It was wonderful to discover that there are many ways for me as a respiratory therapist to become involved in CHEST! Thank you to all the donors who made these awards a reality!”

- Maya Jenkins, RRT

“As an international medical graduate fellow, I experience challenges spanning from economic (inability to moonlight), professional (scarce funding and sponsorship opportunities, mentorship) to immigration-related difficulties. The CHEST Foundation grant is a superbly structured and implemented opportunity that allowed me a chance to address most of these challenges as I advance in my academic career. The grant itinerary permitted me to network with mentors and, subsequently, resulted in critical leads: A collaborative research project, offers to write letters in support of my visa situation, interest from a journal for one my manuscripts, plans to submit proposals for #CHEST2019, and, most importantly, support from leaders in our field who offered guidance and sponsorship (huge shout out to Dr. Chris Carroll)! I would like to thank the Foundation for awarding this grant as it isn’t just the grant but the slew of opportunities that came along with it that can, and, in my case, catapult fledgling careers in the field of pulmonary and critical care medicine.”

-Viren Kaul, MD

“CHEST education is the cornerstone of pulmonary medicine and delivering world-class health care. CHEST and the CHEST Foundation care about me and the importance of being the best practitioner I can be for my patients. Having impactful conversations with other clinicians, seeing new innovations, and learning through a diverse number of ways while at CHEST 2018 gave me meaningful lessons to apply in my daily practice. The travel grant made this possible!”

- Sarah Brundidge, MSc, RRT
 

As the CHEST Foundation continues to grow, so does our ability to impact the careers of early career clinicians. What began as a small travel grants program for the 2015 winners of the NetWorks Challenge to help offset their trainee members’ travel to CHEST 2015 in Montreal, was quickly identified as opportunity for the CHEST Foundation to deepen their engagement with early career clinicians. The CHEST Foundation travel grants program has grown immensely since then, but the core tenants of the program remain unchanged – to provide excellent trainees, medical students, and all other members of the care team with the fiscal support they need to become successful clinicians and faithfully treat their patients and community. Some of the ways our travel grants are put to good use is to attend the CHEST Annual Meeting and to further engage them as active members of CHEST. In addition to travel grant support to offset the costs of attending the annual meeting, recipients of these competitive grants receive free registration to the meeting; individualized mentorship from a CHEST member who is currently or has been part of CHEST leadership (ie, served on one of the boards, as faculty, on committees, as well as chairs and vice-chairs of the NetWorks); learn best practices for applying for research and community service grants from previous grant winners; invitations to exclusive receptions to network with peers and potential employers; and access to several sessions at the annual meeting intended to strengthen their clinical skill set. All of these programmatic pieces come together to help propel these young leaders’ careers and invest in the future of our discipline as CHEST clinicians.

Due to your overwhelming philanthropic support, CHEST Foundation’s travel grant programs continue to flourish. In 2017, the CHEST Foundation supported

a total of 43 early career clinicians’ travel to attend the CHEST Annual Meeting in Toronto. Through continued donor support, a successful NetWorks Challenge

fundraiser, and an overwhelming number of qualified early career applicants for the travel grants, that number swelled to 72 clinicians for the 2018 CHEST Annual Meeting in San Antonio. In total, the CHEST Foundation dispensed over $70,000 in travel grants for CHEST 2018. We can’t thank you enough for the impact you have made in these early career clinicians’ professional lives, and we urge you to increase your gifts, so we can advance these important professional development opportunities for clinicians by CHEST 2019!



“I’m so thankful to be a recipient of the CHEST travel grant! It enabled me to connect with such a wide array of health-care professionals and learn from my peers. It was wonderful to discover that there are many ways for me as a respiratory therapist to become involved in CHEST! Thank you to all the donors who made these awards a reality!”

- Maya Jenkins, RRT

“As an international medical graduate fellow, I experience challenges spanning from economic (inability to moonlight), professional (scarce funding and sponsorship opportunities, mentorship) to immigration-related difficulties. The CHEST Foundation grant is a superbly structured and implemented opportunity that allowed me a chance to address most of these challenges as I advance in my academic career. The grant itinerary permitted me to network with mentors and, subsequently, resulted in critical leads: A collaborative research project, offers to write letters in support of my visa situation, interest from a journal for one my manuscripts, plans to submit proposals for #CHEST2019, and, most importantly, support from leaders in our field who offered guidance and sponsorship (huge shout out to Dr. Chris Carroll)! I would like to thank the Foundation for awarding this grant as it isn’t just the grant but the slew of opportunities that came along with it that can, and, in my case, catapult fledgling careers in the field of pulmonary and critical care medicine.”

-Viren Kaul, MD

“CHEST education is the cornerstone of pulmonary medicine and delivering world-class health care. CHEST and the CHEST Foundation care about me and the importance of being the best practitioner I can be for my patients. Having impactful conversations with other clinicians, seeing new innovations, and learning through a diverse number of ways while at CHEST 2018 gave me meaningful lessons to apply in my daily practice. The travel grant made this possible!”

- Sarah Brundidge, MSc, RRT