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Announcing new Crohn’s & colitis congress
AGA and the Crohn’s & Colitis Foundation are partnering to cosponsor a new annual conference for health care professionals and researchers. By joining the nation’s leading IBD patient organization with the premier GI professional organization, this will be the must-attend IBD conference, bringing state-of-the-art comprehensive care together with the latest research to advance prevention, treatment, and cures for IBD patients.
Save the date – Jan. 18-20, 2018, in Las Vegas. Get ready to expand your knowledge, network with other leaders, and be inspired! Stay tuned for our website launch and more details coming this spring.
AGA and the Crohn’s & Colitis Foundation are partnering to cosponsor a new annual conference for health care professionals and researchers. By joining the nation’s leading IBD patient organization with the premier GI professional organization, this will be the must-attend IBD conference, bringing state-of-the-art comprehensive care together with the latest research to advance prevention, treatment, and cures for IBD patients.
Save the date – Jan. 18-20, 2018, in Las Vegas. Get ready to expand your knowledge, network with other leaders, and be inspired! Stay tuned for our website launch and more details coming this spring.
AGA and the Crohn’s & Colitis Foundation are partnering to cosponsor a new annual conference for health care professionals and researchers. By joining the nation’s leading IBD patient organization with the premier GI professional organization, this will be the must-attend IBD conference, bringing state-of-the-art comprehensive care together with the latest research to advance prevention, treatment, and cures for IBD patients.
Save the date – Jan. 18-20, 2018, in Las Vegas. Get ready to expand your knowledge, network with other leaders, and be inspired! Stay tuned for our website launch and more details coming this spring.
Education: Register Now for the 2017 VAM
The topic is vascular care. The subjects to be covered are nearly too numerous to count. And the clock is ticking for signing up.
Registration and housing will open in early March for the 2017 Vascular Annual Meeting, set for May 31 to June 3 in San Diego, Calif., with plenaries and exhibits from June 1 to 3. This premier meeting of vascular specialists will be held at the San Diego Convention Center. The headquarters hotel, the Marriott Marquis San Diego Marina Hotel, adjoins the center.
There is plenty going on.
Additional programming: Expanded programming begins Wednesday and continues through Saturday. Be sure to plan your travel to attend these informative sessions. This year’s meeting includes more concurrent sessions, and the number of joint society programs has doubled from last year.
Free postgraduate courses for SVS members: Once again, all SVS member-registrants receive free admittance to the six Wednesday postgraduate courses, a savings of $300. Non-members plus anyone registering only for the postgraduate courses must pay the appropriate registration fee. Self-assessment credit is available to all physician attendees.
SVS/STS Aortic Summit: New this year, and a highlight for Saturday, is the SVS/STS Summit: Advances and Controversies in the Management of Complex Thoracoabdominal Aneurysmal Diseases and Type B Aortic Dissection. This program will take place from 1 to 5 p.m. and is co-sponsored by the Society of Thoracic Surgeons. An additional fee is required. 
Revamped workshops: Wednesday’s workshops will feature a new format, with four separate two-hour timeslots, and the opportunity to rotate between sessions in each time period. Cost is $100 for each timeslot and registration is required. Attendance is limited to 25 registrants per workshop; register early for the best selection.
Expanded international programming: A new session has been added to Wednesday’s International program: “International Consortium of Vascular Registries: Quality Improvement in Vascular Surgery Goes Global.” This presentation will be held from 8 to 10 a.m. and kicks off a full day of international events.
VQI @ VAM – VQI’s Second Annual Meeting: Vascular Quality Initiative’s second Annual Meeting has expanded to 1 ½ days, beginning Tuesday afternoon, May 30, and continuing all day Wednesday. Also new this year are a poster session and networking reception. Registration and a separate $200 fee are required.
Exhibit Hall: Learn first-hand from our industry partners about the latest devices, products and services. The Exhibit Hall also hosts the Opening Reception, box lunches and coffee breaks Thursday through Saturday. Industry participation in the exhibits underwrites a signification portion of VAM – allowing us to keep registration fees at lower rates than other industry meetings – so please support our industry partners.
And more: VAM also will include: breakfast sessions; a discount for the On-Demand Library; texting of questions; Interactive Poster Session, programming for fellows, residents and students; the Physician Vascular Interpretation Examination Review course; SVS Member Business Luncheon, with the election of officers plus the presentation of SVS and SVS Foundation awards; Vascular Live sessions highlighting the latest products and developments; plus socializing, with alumni receptions and other events.
For information and to register, visit vsweb.org/VAM17.
The topic is vascular care. The subjects to be covered are nearly too numerous to count. And the clock is ticking for signing up.
Registration and housing will open in early March for the 2017 Vascular Annual Meeting, set for May 31 to June 3 in San Diego, Calif., with plenaries and exhibits from June 1 to 3. This premier meeting of vascular specialists will be held at the San Diego Convention Center. The headquarters hotel, the Marriott Marquis San Diego Marina Hotel, adjoins the center.
There is plenty going on.
Additional programming: Expanded programming begins Wednesday and continues through Saturday. Be sure to plan your travel to attend these informative sessions. This year’s meeting includes more concurrent sessions, and the number of joint society programs has doubled from last year.
Free postgraduate courses for SVS members: Once again, all SVS member-registrants receive free admittance to the six Wednesday postgraduate courses, a savings of $300. Non-members plus anyone registering only for the postgraduate courses must pay the appropriate registration fee. Self-assessment credit is available to all physician attendees.
SVS/STS Aortic Summit: New this year, and a highlight for Saturday, is the SVS/STS Summit: Advances and Controversies in the Management of Complex Thoracoabdominal Aneurysmal Diseases and Type B Aortic Dissection. This program will take place from 1 to 5 p.m. and is co-sponsored by the Society of Thoracic Surgeons. An additional fee is required.
Revamped workshops: Wednesday’s workshops will feature a new format, with four separate two-hour timeslots, and the opportunity to rotate between sessions in each time period. Cost is $100 for each timeslot and registration is required. Attendance is limited to 25 registrants per workshop; register early for the best selection.
Expanded international programming: A new session has been added to Wednesday’s International program: “International Consortium of Vascular Registries: Quality Improvement in Vascular Surgery Goes Global.” This presentation will be held from 8 to 10 a.m. and kicks off a full day of international events.
VQI @ VAM – VQI’s Second Annual Meeting: Vascular Quality Initiative’s second Annual Meeting has expanded to 1 ½ days, beginning Tuesday afternoon, May 30, and continuing all day Wednesday. Also new this year are a poster session and networking reception. Registration and a separate $200 fee are required.
Exhibit Hall: Learn first-hand from our industry partners about the latest devices, products and services. The Exhibit Hall also hosts the Opening Reception, box lunches and coffee breaks Thursday through Saturday. Industry participation in the exhibits underwrites a signification portion of VAM – allowing us to keep registration fees at lower rates than other industry meetings – so please support our industry partners.
And more: VAM also will include: breakfast sessions; a discount for the On-Demand Library; texting of questions; Interactive Poster Session, programming for fellows, residents and students; the Physician Vascular Interpretation Examination Review course; SVS Member Business Luncheon, with the election of officers plus the presentation of SVS and SVS Foundation awards; Vascular Live sessions highlighting the latest products and developments; plus socializing, with alumni receptions and other events.
For information and to register, visit vsweb.org/VAM17.
The topic is vascular care. The subjects to be covered are nearly too numerous to count. And the clock is ticking for signing up.
Registration and housing will open in early March for the 2017 Vascular Annual Meeting, set for May 31 to June 3 in San Diego, Calif., with plenaries and exhibits from June 1 to 3. This premier meeting of vascular specialists will be held at the San Diego Convention Center. The headquarters hotel, the Marriott Marquis San Diego Marina Hotel, adjoins the center.
There is plenty going on.
Additional programming: Expanded programming begins Wednesday and continues through Saturday. Be sure to plan your travel to attend these informative sessions. This year’s meeting includes more concurrent sessions, and the number of joint society programs has doubled from last year.
Free postgraduate courses for SVS members: Once again, all SVS member-registrants receive free admittance to the six Wednesday postgraduate courses, a savings of $300. Non-members plus anyone registering only for the postgraduate courses must pay the appropriate registration fee. Self-assessment credit is available to all physician attendees.
SVS/STS Aortic Summit: New this year, and a highlight for Saturday, is the SVS/STS Summit: Advances and Controversies in the Management of Complex Thoracoabdominal Aneurysmal Diseases and Type B Aortic Dissection. This program will take place from 1 to 5 p.m. and is co-sponsored by the Society of Thoracic Surgeons. An additional fee is required.
Revamped workshops: Wednesday’s workshops will feature a new format, with four separate two-hour timeslots, and the opportunity to rotate between sessions in each time period. Cost is $100 for each timeslot and registration is required. Attendance is limited to 25 registrants per workshop; register early for the best selection.
Expanded international programming: A new session has been added to Wednesday’s International program: “International Consortium of Vascular Registries: Quality Improvement in Vascular Surgery Goes Global.” This presentation will be held from 8 to 10 a.m. and kicks off a full day of international events.
VQI @ VAM – VQI’s Second Annual Meeting: Vascular Quality Initiative’s second Annual Meeting has expanded to 1 ½ days, beginning Tuesday afternoon, May 30, and continuing all day Wednesday. Also new this year are a poster session and networking reception. Registration and a separate $200 fee are required.
Exhibit Hall: Learn first-hand from our industry partners about the latest devices, products and services. The Exhibit Hall also hosts the Opening Reception, box lunches and coffee breaks Thursday through Saturday. Industry participation in the exhibits underwrites a signification portion of VAM – allowing us to keep registration fees at lower rates than other industry meetings – so please support our industry partners.
And more: VAM also will include: breakfast sessions; a discount for the On-Demand Library; texting of questions; Interactive Poster Session, programming for fellows, residents and students; the Physician Vascular Interpretation Examination Review course; SVS Member Business Luncheon, with the election of officers plus the presentation of SVS and SVS Foundation awards; Vascular Live sessions highlighting the latest products and developments; plus socializing, with alumni receptions and other events.
For information and to register, visit vsweb.org/VAM17.
Bipartisan Budget Act (BBA) of 2015 threatens growth of pulmonary rehab
In late 2015, Congress passed the Bipartisan Budget Act (BBA) to address numerous wide-ranging budget concerns, including issues related to agriculture, pensions, the strategic petroleum reserve, along with some Medicare issues. Section 603 of BBA is now coming back to haunt pulmonary rehabilitation services.
The intent of Section 603 is reasonable – to address the phenomenon of hospitals purchasing physician practices to take advantage of payment differentials between identical or virtually identical services when comparing the hospital outpatient prospective payment system (HOPPS) and the physician fee schedule (PFS). For example, an orthopedic practice might own its own MRI and related support services. It will bill for those services under the PFS. However, if the practice sells that segment of the revenue stream (the MRI assets, etc) to a hospital, the hospital can bill Medicare for those same services under the hospital outpatient prospective payment system at an amount notably higher than the PFS payment.
To address this payment aberration, Congress instructed the Centers for Medicare & Medicaid Services to craft a system to preclude a hospital from such behavior. If a hospital offers new or expanded outpatient services, it could NOT bill Medicare under the hospital outpatient services methodology and would be required to bill under the PFS payment methodology. Importantly, a few exemptions exist. If the new or expanded service is within 250 yards of the main hospital campus, the outpatient billing methodology is permitted. Likewise, if expansion of a current off-campus service occurs at the same location of the current off-site service, the hospital may continue to bill under the outpatient rules. Several other technical exceptions are permitted, for example construction planned prior to passage of BBA.
The implications for pulmonary rehabilitation are critical to its growth. A hospital that wishes to expand its current program and bill under the hospital outpatient methodology MUST do so by expanding at its current location. An expansion at a new location that is not within 250 yards of the main hospital campus triggers Section 603 provisions, and the hospital will bill at the physician fee schedule rate. Because the PFS payment rate is just over half of the payment rate for HOPPS payment, it is unlikely that a hospital would expand an existing program or establish a new one if it would be forced to bill under the lower rate.
While congressional logic may be relatively understandable, for pulmonary medicine, it is based on the premise that a hospital would purchase a pulmonary practice because that practice had a lucrative pulmonary rehabilitation services cash flow. NAMDRC and other societies were able to document major flaws in the basic premise, resulting in very problematic unintended consequences. A detailed review of Medicare claims data provides strong evidence that pulmonary practices simply do not provide pulmonary rehab services.
These data strongly indicate that G0424 pulmonary practice physician office billing for the most recent year data are available ($230K), compared with hospital outpatient allowed charges ($119M), is less than two-tenths of 1% of billing through the hospital setting. To argue that hospitals are purchasing pulmonary practices for financial gain tied to pulmonary rehab services defies Medicare data, as well as financial logic. If the CMS premise was valid, one would expect the aggregate physician office billing to be much greater than $535K. In discussions with CMS, the Agency did agree that there are likely to be unintended consequences related to Section 603 implementation. The Agency also emphasizes that it does not have the statutory authority for a “carve out” exemption. CMS stated that even if it agreed with us, it simply lacked the authority to exempt pulmonary rehab services. CMS also agreed that there is growing evidence that pulmonary rehab is a underutilized service that may very well save the program money through reduced hospitalizations and rehospitalizations, but it has little choice to implement the statute as Congress so mandated.
Therefore, the only solution is a legislative one. NAMDRC and other societies are seriously considering approaching Congress for such resolution.
In late 2015, Congress passed the Bipartisan Budget Act (BBA) to address numerous wide-ranging budget concerns, including issues related to agriculture, pensions, the strategic petroleum reserve, along with some Medicare issues. Section 603 of BBA is now coming back to haunt pulmonary rehabilitation services.
The intent of Section 603 is reasonable – to address the phenomenon of hospitals purchasing physician practices to take advantage of payment differentials between identical or virtually identical services when comparing the hospital outpatient prospective payment system (HOPPS) and the physician fee schedule (PFS). For example, an orthopedic practice might own its own MRI and related support services. It will bill for those services under the PFS. However, if the practice sells that segment of the revenue stream (the MRI assets, etc) to a hospital, the hospital can bill Medicare for those same services under the hospital outpatient prospective payment system at an amount notably higher than the PFS payment.
To address this payment aberration, Congress instructed the Centers for Medicare & Medicaid Services to craft a system to preclude a hospital from such behavior. If a hospital offers new or expanded outpatient services, it could NOT bill Medicare under the hospital outpatient services methodology and would be required to bill under the PFS payment methodology. Importantly, a few exemptions exist. If the new or expanded service is within 250 yards of the main hospital campus, the outpatient billing methodology is permitted. Likewise, if expansion of a current off-campus service occurs at the same location of the current off-site service, the hospital may continue to bill under the outpatient rules. Several other technical exceptions are permitted, for example construction planned prior to passage of BBA.
The implications for pulmonary rehabilitation are critical to its growth. A hospital that wishes to expand its current program and bill under the hospital outpatient methodology MUST do so by expanding at its current location. An expansion at a new location that is not within 250 yards of the main hospital campus triggers Section 603 provisions, and the hospital will bill at the physician fee schedule rate. Because the PFS payment rate is just over half of the payment rate for HOPPS payment, it is unlikely that a hospital would expand an existing program or establish a new one if it would be forced to bill under the lower rate.
While congressional logic may be relatively understandable, for pulmonary medicine, it is based on the premise that a hospital would purchase a pulmonary practice because that practice had a lucrative pulmonary rehabilitation services cash flow. NAMDRC and other societies were able to document major flaws in the basic premise, resulting in very problematic unintended consequences. A detailed review of Medicare claims data provides strong evidence that pulmonary practices simply do not provide pulmonary rehab services.
These data strongly indicate that G0424 pulmonary practice physician office billing for the most recent year data are available ($230K), compared with hospital outpatient allowed charges ($119M), is less than two-tenths of 1% of billing through the hospital setting. To argue that hospitals are purchasing pulmonary practices for financial gain tied to pulmonary rehab services defies Medicare data, as well as financial logic. If the CMS premise was valid, one would expect the aggregate physician office billing to be much greater than $535K. In discussions with CMS, the Agency did agree that there are likely to be unintended consequences related to Section 603 implementation. The Agency also emphasizes that it does not have the statutory authority for a “carve out” exemption. CMS stated that even if it agreed with us, it simply lacked the authority to exempt pulmonary rehab services. CMS also agreed that there is growing evidence that pulmonary rehab is a underutilized service that may very well save the program money through reduced hospitalizations and rehospitalizations, but it has little choice to implement the statute as Congress so mandated.
Therefore, the only solution is a legislative one. NAMDRC and other societies are seriously considering approaching Congress for such resolution.
In late 2015, Congress passed the Bipartisan Budget Act (BBA) to address numerous wide-ranging budget concerns, including issues related to agriculture, pensions, the strategic petroleum reserve, along with some Medicare issues. Section 603 of BBA is now coming back to haunt pulmonary rehabilitation services.
The intent of Section 603 is reasonable – to address the phenomenon of hospitals purchasing physician practices to take advantage of payment differentials between identical or virtually identical services when comparing the hospital outpatient prospective payment system (HOPPS) and the physician fee schedule (PFS). For example, an orthopedic practice might own its own MRI and related support services. It will bill for those services under the PFS. However, if the practice sells that segment of the revenue stream (the MRI assets, etc) to a hospital, the hospital can bill Medicare for those same services under the hospital outpatient prospective payment system at an amount notably higher than the PFS payment.
To address this payment aberration, Congress instructed the Centers for Medicare & Medicaid Services to craft a system to preclude a hospital from such behavior. If a hospital offers new or expanded outpatient services, it could NOT bill Medicare under the hospital outpatient services methodology and would be required to bill under the PFS payment methodology. Importantly, a few exemptions exist. If the new or expanded service is within 250 yards of the main hospital campus, the outpatient billing methodology is permitted. Likewise, if expansion of a current off-campus service occurs at the same location of the current off-site service, the hospital may continue to bill under the outpatient rules. Several other technical exceptions are permitted, for example construction planned prior to passage of BBA.
The implications for pulmonary rehabilitation are critical to its growth. A hospital that wishes to expand its current program and bill under the hospital outpatient methodology MUST do so by expanding at its current location. An expansion at a new location that is not within 250 yards of the main hospital campus triggers Section 603 provisions, and the hospital will bill at the physician fee schedule rate. Because the PFS payment rate is just over half of the payment rate for HOPPS payment, it is unlikely that a hospital would expand an existing program or establish a new one if it would be forced to bill under the lower rate.
While congressional logic may be relatively understandable, for pulmonary medicine, it is based on the premise that a hospital would purchase a pulmonary practice because that practice had a lucrative pulmonary rehabilitation services cash flow. NAMDRC and other societies were able to document major flaws in the basic premise, resulting in very problematic unintended consequences. A detailed review of Medicare claims data provides strong evidence that pulmonary practices simply do not provide pulmonary rehab services.
These data strongly indicate that G0424 pulmonary practice physician office billing for the most recent year data are available ($230K), compared with hospital outpatient allowed charges ($119M), is less than two-tenths of 1% of billing through the hospital setting. To argue that hospitals are purchasing pulmonary practices for financial gain tied to pulmonary rehab services defies Medicare data, as well as financial logic. If the CMS premise was valid, one would expect the aggregate physician office billing to be much greater than $535K. In discussions with CMS, the Agency did agree that there are likely to be unintended consequences related to Section 603 implementation. The Agency also emphasizes that it does not have the statutory authority for a “carve out” exemption. CMS stated that even if it agreed with us, it simply lacked the authority to exempt pulmonary rehab services. CMS also agreed that there is growing evidence that pulmonary rehab is a underutilized service that may very well save the program money through reduced hospitalizations and rehospitalizations, but it has little choice to implement the statute as Congress so mandated.
Therefore, the only solution is a legislative one. NAMDRC and other societies are seriously considering approaching Congress for such resolution.
Registration is now open for CHEST Board Review 2017
Looking for in-person board review prep? Join us in Orlando, August 18 to 27, for the best live review of pulmonary, critical care, and sleep medicine.
Register by March 31 and save $100. Registration can be done at http://boardreview.chestnet.org.
Looking for in-person board review prep? Join us in Orlando, August 18 to 27, for the best live review of pulmonary, critical care, and sleep medicine.
Register by March 31 and save $100. Registration can be done at http://boardreview.chestnet.org.
Looking for in-person board review prep? Join us in Orlando, August 18 to 27, for the best live review of pulmonary, critical care, and sleep medicine.
Register by March 31 and save $100. Registration can be done at http://boardreview.chestnet.org.
NetWorks: Mass shootings, MACRA, asthma in pregnancy Disaster Response Practice Operations Transplant Women’s Health
Mass shootings
There are multiple definitions for a mass shooting. Some definitions require a certain number of people be killed. Some definitions require a certain number of people be shot. Some definitions do not include gang violence. Regardless of the definition used, the number of mass shootings in the United States is increasing.
There are also multiple definitions of what qualifies as a medical disaster. These definitions can be summarized with the statement that a medical disaster is an event that produces a number of casualties that overwhelms the local health system.
Most mass shootings fit the definition of a medical disaster. When a mass shooting occurs, medical resources are diverted from current patients to those injured in the shooting. Patients with acute medical problems unrelated to the shooting must endure a prolonged wait for medical care.
The CHEST Disaster Response NetWork feels that it is necessary to take action to reduce the number of mass shootings. Unlike natural disasters, mass shootings are man-made. As such, we should proactively work to prevent them. Prevention is a large part of medicine. Working together with community leaders, law enforcement, and government officials, we can and should work to eliminate mass shootings so that we can minimize gun-related injury and death.
MACRA: Reincarnation of Medicare physician reimbursement model
In April 2015, President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) eradicating the detested sustainable growth rate (SGR) formula. If this is your first dive into MACRA as an eligible professional (EP), it may be a bit baffling trying to understand its impact on your practice. 
Under MIPS, rules are divided into four categories. During the first year, each category will make up a certain percentage to the physician’s overall score, which will result in a penalty or payment as a lump sum in 2019. If you are an Advanced APM in 2017 and receive 25% of Medicare payments or see 20% of your Medicare patients through this model, you can earn up to a 5% incentive payment in 2019.
The performance period started on January 1, 2017. Submission of performance data is due by March 31, 2018. MACRA is complicated and here to stay. Learn and educate yourself to avoid downward payment adjustment. For full details, please visit https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf.
References
1. CMS MACRA Proposed Rule. http://1.usa.gov/1PpBpMt
2. CMS MACRA Executive Summary. https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf
3. American Medical Association. http://bit.ly/1miEtBD
4. Policy and Medicine. MACRA http://bit.ly/1PTLkKa. MIPS http://bit.ly/20RoMzZ. APMs http://bit.ly/1OlxoxH
Frailty in lung transplantation
Two of the greatest challenges in lung transplantation are to identify optimal transplant candidates and to help those transplant recipients thrive in the years following surgery. Frailty is emerging as a marker of increased posttransplant morbidity and may represent an area where both the recipient selection process and posttransplant outcomes can be optimized. Described by some as “biologic age” rather than “chronologic age,” frailty is a syndrome of functional impairment and weakness that predisposes to adverse health outcomes. The adverse effects of frailty have been described in multiple clinical scenarios, including the ICU, chronic lung diseases, heart failure, liver transplant, kidney transplant, geriatrics, and others.
Remaining challenges include determining which clinical assessments best define frailty in the lung transplant population, documenting the adverse effects of frailty in well-designed multicenter prospective studies, and developing interventions to mitigate the adverse effects of frailty.
Asthma treatment during pregnancy
Asthma is common in pregnancy, occurring in 3% to 8% of pregnant women. While the course of asthma during pregnancy is variable, the objectives of asthma treatment do not change and aim to prevent acute exacerbations and optimize management. Uncontrolled asthma is associated with an increased risk of perinatal morbidity. Published guidelines on pharmacologic therapies during pregnancy recommend the same step-wise approach as in nonpregnant women. 
The diagnosis of asthma, the use of other concurrent medications, and medication compliance may all be potential confounders. ICS use in pregnancy was associated with endocrine and metabolic disturbances in the offspring in a national cohort (Tegethoff M et al. Am J Respir Crit Care Med. 2012;185[5]:557-63). However, this study did not report on systemic steroid use, asthma severity, or details of these disturbances. 
Mass shootings
There are multiple definitions for a mass shooting. Some definitions require a certain number of people be killed. Some definitions require a certain number of people be shot. Some definitions do not include gang violence. Regardless of the definition used, the number of mass shootings in the United States is increasing.
There are also multiple definitions of what qualifies as a medical disaster. These definitions can be summarized with the statement that a medical disaster is an event that produces a number of casualties that overwhelms the local health system.
Most mass shootings fit the definition of a medical disaster. When a mass shooting occurs, medical resources are diverted from current patients to those injured in the shooting. Patients with acute medical problems unrelated to the shooting must endure a prolonged wait for medical care.
The CHEST Disaster Response NetWork feels that it is necessary to take action to reduce the number of mass shootings. Unlike natural disasters, mass shootings are man-made. As such, we should proactively work to prevent them. Prevention is a large part of medicine. Working together with community leaders, law enforcement, and government officials, we can and should work to eliminate mass shootings so that we can minimize gun-related injury and death.
MACRA: Reincarnation of Medicare physician reimbursement model
In April 2015, President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) eradicating the detested sustainable growth rate (SGR) formula. If this is your first dive into MACRA as an eligible professional (EP), it may be a bit baffling trying to understand its impact on your practice.
Under MIPS, rules are divided into four categories. During the first year, each category will make up a certain percentage to the physician’s overall score, which will result in a penalty or payment as a lump sum in 2019. If you are an Advanced APM in 2017 and receive 25% of Medicare payments or see 20% of your Medicare patients through this model, you can earn up to a 5% incentive payment in 2019.
The performance period started on January 1, 2017. Submission of performance data is due by March 31, 2018. MACRA is complicated and here to stay. Learn and educate yourself to avoid downward payment adjustment. For full details, please visit https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf.
References
1. CMS MACRA Proposed Rule. http://1.usa.gov/1PpBpMt
2. CMS MACRA Executive Summary. https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf
3. American Medical Association. http://bit.ly/1miEtBD
4. Policy and Medicine. MACRA http://bit.ly/1PTLkKa. MIPS http://bit.ly/20RoMzZ. APMs http://bit.ly/1OlxoxH
Frailty in lung transplantation
Two of the greatest challenges in lung transplantation are to identify optimal transplant candidates and to help those transplant recipients thrive in the years following surgery. Frailty is emerging as a marker of increased posttransplant morbidity and may represent an area where both the recipient selection process and posttransplant outcomes can be optimized. Described by some as “biologic age” rather than “chronologic age,” frailty is a syndrome of functional impairment and weakness that predisposes to adverse health outcomes. The adverse effects of frailty have been described in multiple clinical scenarios, including the ICU, chronic lung diseases, heart failure, liver transplant, kidney transplant, geriatrics, and others.
Remaining challenges include determining which clinical assessments best define frailty in the lung transplant population, documenting the adverse effects of frailty in well-designed multicenter prospective studies, and developing interventions to mitigate the adverse effects of frailty.
Asthma treatment during pregnancy
Asthma is common in pregnancy, occurring in 3% to 8% of pregnant women. While the course of asthma during pregnancy is variable, the objectives of asthma treatment do not change and aim to prevent acute exacerbations and optimize management. Uncontrolled asthma is associated with an increased risk of perinatal morbidity. Published guidelines on pharmacologic therapies during pregnancy recommend the same step-wise approach as in nonpregnant women.
The diagnosis of asthma, the use of other concurrent medications, and medication compliance may all be potential confounders. ICS use in pregnancy was associated with endocrine and metabolic disturbances in the offspring in a national cohort (Tegethoff M et al. Am J Respir Crit Care Med. 2012;185[5]:557-63). However, this study did not report on systemic steroid use, asthma severity, or details of these disturbances.
Mass shootings
There are multiple definitions for a mass shooting. Some definitions require a certain number of people be killed. Some definitions require a certain number of people be shot. Some definitions do not include gang violence. Regardless of the definition used, the number of mass shootings in the United States is increasing.
There are also multiple definitions of what qualifies as a medical disaster. These definitions can be summarized with the statement that a medical disaster is an event that produces a number of casualties that overwhelms the local health system.
Most mass shootings fit the definition of a medical disaster. When a mass shooting occurs, medical resources are diverted from current patients to those injured in the shooting. Patients with acute medical problems unrelated to the shooting must endure a prolonged wait for medical care.
The CHEST Disaster Response NetWork feels that it is necessary to take action to reduce the number of mass shootings. Unlike natural disasters, mass shootings are man-made. As such, we should proactively work to prevent them. Prevention is a large part of medicine. Working together with community leaders, law enforcement, and government officials, we can and should work to eliminate mass shootings so that we can minimize gun-related injury and death.
MACRA: Reincarnation of Medicare physician reimbursement model
In April 2015, President Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) eradicating the detested sustainable growth rate (SGR) formula. If this is your first dive into MACRA as an eligible professional (EP), it may be a bit baffling trying to understand its impact on your practice.
Under MIPS, rules are divided into four categories. During the first year, each category will make up a certain percentage to the physician’s overall score, which will result in a penalty or payment as a lump sum in 2019. If you are an Advanced APM in 2017 and receive 25% of Medicare payments or see 20% of your Medicare patients through this model, you can earn up to a 5% incentive payment in 2019.
The performance period started on January 1, 2017. Submission of performance data is due by March 31, 2018. MACRA is complicated and here to stay. Learn and educate yourself to avoid downward payment adjustment. For full details, please visit https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf.
References
1. CMS MACRA Proposed Rule. http://1.usa.gov/1PpBpMt
2. CMS MACRA Executive Summary. https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf
3. American Medical Association. http://bit.ly/1miEtBD
4. Policy and Medicine. MACRA http://bit.ly/1PTLkKa. MIPS http://bit.ly/20RoMzZ. APMs http://bit.ly/1OlxoxH
Frailty in lung transplantation
Two of the greatest challenges in lung transplantation are to identify optimal transplant candidates and to help those transplant recipients thrive in the years following surgery. Frailty is emerging as a marker of increased posttransplant morbidity and may represent an area where both the recipient selection process and posttransplant outcomes can be optimized. Described by some as “biologic age” rather than “chronologic age,” frailty is a syndrome of functional impairment and weakness that predisposes to adverse health outcomes. The adverse effects of frailty have been described in multiple clinical scenarios, including the ICU, chronic lung diseases, heart failure, liver transplant, kidney transplant, geriatrics, and others.
Remaining challenges include determining which clinical assessments best define frailty in the lung transplant population, documenting the adverse effects of frailty in well-designed multicenter prospective studies, and developing interventions to mitigate the adverse effects of frailty.
Asthma treatment during pregnancy
Asthma is common in pregnancy, occurring in 3% to 8% of pregnant women. While the course of asthma during pregnancy is variable, the objectives of asthma treatment do not change and aim to prevent acute exacerbations and optimize management. Uncontrolled asthma is associated with an increased risk of perinatal morbidity. Published guidelines on pharmacologic therapies during pregnancy recommend the same step-wise approach as in nonpregnant women.
The diagnosis of asthma, the use of other concurrent medications, and medication compliance may all be potential confounders. ICS use in pregnancy was associated with endocrine and metabolic disturbances in the offspring in a national cohort (Tegethoff M et al. Am J Respir Crit Care Med. 2012;185[5]:557-63). However, this study did not report on systemic steroid use, asthma severity, or details of these disturbances.
Connect to CHEST members and leaders
Build your network and access the CHEST Member and Leader Directory. Use the directory to search for members and leaders. Easily search by name, specialty, location, or CHEST committee name to find others in the CHEST community. All members current in their dues are included in the directory.
Access to the directory is an exclusive CHEST member benefit. To view the directory, visit the following address: https://www.chestnet.org/Get-Involved/Membership/Member-Directory.
Build your network and access the CHEST Member and Leader Directory. Use the directory to search for members and leaders. Easily search by name, specialty, location, or CHEST committee name to find others in the CHEST community. All members current in their dues are included in the directory.
Access to the directory is an exclusive CHEST member benefit. To view the directory, visit the following address: https://www.chestnet.org/Get-Involved/Membership/Member-Directory.
Build your network and access the CHEST Member and Leader Directory. Use the directory to search for members and leaders. Easily search by name, specialty, location, or CHEST committee name to find others in the CHEST community. All members current in their dues are included in the directory.
Access to the directory is an exclusive CHEST member benefit. To view the directory, visit the following address: https://www.chestnet.org/Get-Involved/Membership/Member-Directory.
In memoriam
Sylvan Lee Weinberg, MD, FCCP, MACC, a Past President of the American College of Chest Physicians (1983-1984), died Jan 17, 2017, in Dayton, Ohio. Dr. Weinberg was born in Nashville, TN, and received both his bachelor of science and doctor of medicine degrees from Northwestern University in Evanston, IL. He spent his time as an intern, medical resident, and fellow in cardiology at the Michael Reese Hospital in Chicago and went on to serve as a physician at Good Samaritan Hospital in Dayton, Ohio, for more than 40 years, ultimately becoming chief of cardiology and founder of the first coronary care unit in Ohio. Dr. Weinberg was also a clinical professor of medicine at the Wright State University School of Medicine in Dayton, and led a group cardiology practice until his retirement in 2000.
CHEST extends its heartfelt condolences to Dr. Weinberg’s family and friends.
Sylvan Lee Weinberg, MD, FCCP, MACC, a Past President of the American College of Chest Physicians (1983-1984), died Jan 17, 2017, in Dayton, Ohio. Dr. Weinberg was born in Nashville, TN, and received both his bachelor of science and doctor of medicine degrees from Northwestern University in Evanston, IL. He spent his time as an intern, medical resident, and fellow in cardiology at the Michael Reese Hospital in Chicago and went on to serve as a physician at Good Samaritan Hospital in Dayton, Ohio, for more than 40 years, ultimately becoming chief of cardiology and founder of the first coronary care unit in Ohio. Dr. Weinberg was also a clinical professor of medicine at the Wright State University School of Medicine in Dayton, and led a group cardiology practice until his retirement in 2000.
CHEST extends its heartfelt condolences to Dr. Weinberg’s family and friends.
Sylvan Lee Weinberg, MD, FCCP, MACC, a Past President of the American College of Chest Physicians (1983-1984), died Jan 17, 2017, in Dayton, Ohio. Dr. Weinberg was born in Nashville, TN, and received both his bachelor of science and doctor of medicine degrees from Northwestern University in Evanston, IL. He spent his time as an intern, medical resident, and fellow in cardiology at the Michael Reese Hospital in Chicago and went on to serve as a physician at Good Samaritan Hospital in Dayton, Ohio, for more than 40 years, ultimately becoming chief of cardiology and founder of the first coronary care unit in Ohio. Dr. Weinberg was also a clinical professor of medicine at the Wright State University School of Medicine in Dayton, and led a group cardiology practice until his retirement in 2000.
CHEST extends its heartfelt condolences to Dr. Weinberg’s family and friends.
Calls for faculty participation in the CHEST PREP program
About PREP
The CHEST PREP Clinical Immersion program is an unbranded, disease-state program that educates industry members and partners to advance their knowledge into understanding that builds their confidence for engagement in clinical
conversations with health-care teams. We are seeking faculty for the following initiatives:
1. The CHEST PREP program is embarking on a curriculum and content development initiative and is seeking interested faculty members to consider participating in the development of content in the areas of CTEPH, Alpha-1 Antitrypsin, and Bronchiectasis.
2. The CHEST PREP program is seeking interested CHEST members in Chicago-based institutions to consider participating as faculty presenters in the following disease areas: COPD, Asthma, PAH, CTEPH, IPF, SCLC, and NSCLC.
Requirements for participation
1. PREP welcomes faculty who would be interested in creating two or more presentations and/or cases on an assigned topic using a flipped classroom, interactive design. A minimum of four faculty experts will be needed per disease state indicated previously. Honorarium provided.
2. PREP welcomes faculty from Chicago-based institutions who would be interested in participating as faculty presenters in the disease states indicated previously. Honorarium provided.
Selection criteria
To be considered, please indicate the disease area in which you are interested in participating as content developer or faculty presenter, as well as providing the best way to contact you. For the asthma curriculum, we have a specific need for expertise/interest in moderate to severe asthma and the use of biologics in treatment.
If you are interested in participating in this initiative, please contact Jasmine Turner ([email protected]). Thank you.
About PREP
The CHEST PREP Clinical Immersion program is an unbranded, disease-state program that educates industry members and partners to advance their knowledge into understanding that builds their confidence for engagement in clinical
conversations with health-care teams. We are seeking faculty for the following initiatives:
1. The CHEST PREP program is embarking on a curriculum and content development initiative and is seeking interested faculty members to consider participating in the development of content in the areas of CTEPH, Alpha-1 Antitrypsin, and Bronchiectasis.
2. The CHEST PREP program is seeking interested CHEST members in Chicago-based institutions to consider participating as faculty presenters in the following disease areas: COPD, Asthma, PAH, CTEPH, IPF, SCLC, and NSCLC.
Requirements for participation
1. PREP welcomes faculty who would be interested in creating two or more presentations and/or cases on an assigned topic using a flipped classroom, interactive design. A minimum of four faculty experts will be needed per disease state indicated previously. Honorarium provided.
2. PREP welcomes faculty from Chicago-based institutions who would be interested in participating as faculty presenters in the disease states indicated previously. Honorarium provided.
Selection criteria
To be considered, please indicate the disease area in which you are interested in participating as content developer or faculty presenter, as well as providing the best way to contact you. For the asthma curriculum, we have a specific need for expertise/interest in moderate to severe asthma and the use of biologics in treatment.
If you are interested in participating in this initiative, please contact Jasmine Turner ([email protected]). Thank you.
About PREP
The CHEST PREP Clinical Immersion program is an unbranded, disease-state program that educates industry members and partners to advance their knowledge into understanding that builds their confidence for engagement in clinical
conversations with health-care teams. We are seeking faculty for the following initiatives:
1. The CHEST PREP program is embarking on a curriculum and content development initiative and is seeking interested faculty members to consider participating in the development of content in the areas of CTEPH, Alpha-1 Antitrypsin, and Bronchiectasis.
2. The CHEST PREP program is seeking interested CHEST members in Chicago-based institutions to consider participating as faculty presenters in the following disease areas: COPD, Asthma, PAH, CTEPH, IPF, SCLC, and NSCLC.
Requirements for participation
1. PREP welcomes faculty who would be interested in creating two or more presentations and/or cases on an assigned topic using a flipped classroom, interactive design. A minimum of four faculty experts will be needed per disease state indicated previously. Honorarium provided.
2. PREP welcomes faculty from Chicago-based institutions who would be interested in participating as faculty presenters in the disease states indicated previously. Honorarium provided.
Selection criteria
To be considered, please indicate the disease area in which you are interested in participating as content developer or faculty presenter, as well as providing the best way to contact you. For the asthma curriculum, we have a specific need for expertise/interest in moderate to severe asthma and the use of biologics in treatment.
If you are interested in participating in this initiative, please contact Jasmine Turner ([email protected]). Thank you.
Pulmonary Hypertension Care Center initiative moves forward
The Pulmonary Hypertension Association (PHA) launched its Pulmonary Hypertension Care Center (PHCC) initiative 2 years ago. This initiative was designed to raise the quality of care, as well as long-term outcomes for this disease that is often misdiagnosed and progressive. The PHCC program has designated 41 adult and 6 pediatric sites as Comprehensive Care Centers with ongoing accreditation of new sites. As part of this program, the PHA Registry was established to provide input to improve the care of PH patients. The PHA Registry (PHAR) is a multicenter, prospective observational registry of newly evaluated patients with pulmonary arterial hypertension (PAH) and has enrolled 200 patients to date. PHAR participation is open to any PHCC-accredited center.
PHCC accreditation has two pathways: Comprehensive Care Centers and Regional Care Centers. Accreditation is based on adherence “to consensus guidelines for the diagnosis and treatment of PH, the scope of PH-related services provided at the center, and the expertise of the center’s PH Care Team members.” PHCC accreditation is potentially available to all PH centers that meet the established criteria that can be found at the PHCC website.
Additional information may be found at the PHCC website (https://phassociation.org/PHCareCenters).
The Pulmonary Hypertension Association (PHA) launched its Pulmonary Hypertension Care Center (PHCC) initiative 2 years ago. This initiative was designed to raise the quality of care, as well as long-term outcomes for this disease that is often misdiagnosed and progressive. The PHCC program has designated 41 adult and 6 pediatric sites as Comprehensive Care Centers with ongoing accreditation of new sites. As part of this program, the PHA Registry was established to provide input to improve the care of PH patients. The PHA Registry (PHAR) is a multicenter, prospective observational registry of newly evaluated patients with pulmonary arterial hypertension (PAH) and has enrolled 200 patients to date. PHAR participation is open to any PHCC-accredited center.
PHCC accreditation has two pathways: Comprehensive Care Centers and Regional Care Centers. Accreditation is based on adherence “to consensus guidelines for the diagnosis and treatment of PH, the scope of PH-related services provided at the center, and the expertise of the center’s PH Care Team members.” PHCC accreditation is potentially available to all PH centers that meet the established criteria that can be found at the PHCC website.
Additional information may be found at the PHCC website (https://phassociation.org/PHCareCenters).
The Pulmonary Hypertension Association (PHA) launched its Pulmonary Hypertension Care Center (PHCC) initiative 2 years ago. This initiative was designed to raise the quality of care, as well as long-term outcomes for this disease that is often misdiagnosed and progressive. The PHCC program has designated 41 adult and 6 pediatric sites as Comprehensive Care Centers with ongoing accreditation of new sites. As part of this program, the PHA Registry was established to provide input to improve the care of PH patients. The PHA Registry (PHAR) is a multicenter, prospective observational registry of newly evaluated patients with pulmonary arterial hypertension (PAH) and has enrolled 200 patients to date. PHAR participation is open to any PHCC-accredited center.
PHCC accreditation has two pathways: Comprehensive Care Centers and Regional Care Centers. Accreditation is based on adherence “to consensus guidelines for the diagnosis and treatment of PH, the scope of PH-related services provided at the center, and the expertise of the center’s PH Care Team members.” PHCC accreditation is potentially available to all PH centers that meet the established criteria that can be found at the PHCC website.
Additional information may be found at the PHCC website (https://phassociation.org/PHCareCenters).
Alternative to 10-year ABIM exam starts 2018
On December 14, the American Board of Internal Medicine (ABIM) announced an alternative to the 10-year Internal Medicine recertification exam, effective 2018. Currently, ABIM board–certified physicians can participate in Maintenance of Certification (MOC) by earning 100 MOC points every 5 years and passing a maintenance of certification exam every 10 years.
Beginning in 2018, physicians who are certified by the ABIM in Internal Medicine will have the option to take a lower-stakes exam every 2 years, rather than taking the current high-stakes exam every 10 years. The low-stakes exam option provides greater flexibility to the diplomate by allowing one to complete the examination at a convenient time set by the physician at home or in the office. While this new option will initially be available only to Internal Medicine diplomates, the ABIM intends to extend this alternative recertification model to subspecialties in the future.
CHEST is exploring how our education will evolve to address these key changes. For additional information, please visit ABIM’s website.
On December 14, the American Board of Internal Medicine (ABIM) announced an alternative to the 10-year Internal Medicine recertification exam, effective 2018. Currently, ABIM board–certified physicians can participate in Maintenance of Certification (MOC) by earning 100 MOC points every 5 years and passing a maintenance of certification exam every 10 years.
Beginning in 2018, physicians who are certified by the ABIM in Internal Medicine will have the option to take a lower-stakes exam every 2 years, rather than taking the current high-stakes exam every 10 years. The low-stakes exam option provides greater flexibility to the diplomate by allowing one to complete the examination at a convenient time set by the physician at home or in the office. While this new option will initially be available only to Internal Medicine diplomates, the ABIM intends to extend this alternative recertification model to subspecialties in the future.
CHEST is exploring how our education will evolve to address these key changes. For additional information, please visit ABIM’s website.
On December 14, the American Board of Internal Medicine (ABIM) announced an alternative to the 10-year Internal Medicine recertification exam, effective 2018. Currently, ABIM board–certified physicians can participate in Maintenance of Certification (MOC) by earning 100 MOC points every 5 years and passing a maintenance of certification exam every 10 years.
Beginning in 2018, physicians who are certified by the ABIM in Internal Medicine will have the option to take a lower-stakes exam every 2 years, rather than taking the current high-stakes exam every 10 years. The low-stakes exam option provides greater flexibility to the diplomate by allowing one to complete the examination at a convenient time set by the physician at home or in the office. While this new option will initially be available only to Internal Medicine diplomates, the ABIM intends to extend this alternative recertification model to subspecialties in the future.
CHEST is exploring how our education will evolve to address these key changes. For additional information, please visit ABIM’s website.