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Step Therapy National Day of Advocacy
AGA and 17 other specialty physician and patient advocacy organizations partnered with the Digestive Disease National Coalition (DDNC) on an advocacy day focused on the need for step therapy reform.
We met with congressional offices to seek support for patient protection guardrails in step therapy and to encourage co-sponsorship of the Safe Step Act. This bipartisan legislation would create a clear process for a patient or physician to request an exception to a step therapy protocol. It also would require insurers to grant exemptions to step therapy in the following situations:
- Patient already tried and failed on a required treatment
- Delayed treatment will cause irreversible damage
- Required treatment will cause harm to the patient
- Required treatment will prevent a patient from working or fulling daily activities
- Patient is stable on their current treatment
AGA representatives and patient advocates met with the congressional offices of these legislators who serve on key committees that have jurisdiction over this issue.
Sen. Chris Van Hollen, D-Md
Sen. Tim Scott, R-S.C.
Sen. Thom Tillis, R-N.C.
Sen. Lamar Alexander, R-N.C.
Rep. Alma Adams, D-N.C.
Rep. Mark Walker, R-N.C.
Rep. Tim Walberg, R-Mich
A special thanks to AGA members who contacted your legislators online. A combination of 344 tweets and emails were sent urging federal legislators to support the Safe Step Act.
Sharing is caring
Legislators and their staff are always asking us for real-life examples from constituents about step therapy burdens to humanize the issue. Contact AGA staff at [email protected] to share your story.
AGA and 17 other specialty physician and patient advocacy organizations partnered with the Digestive Disease National Coalition (DDNC) on an advocacy day focused on the need for step therapy reform.
We met with congressional offices to seek support for patient protection guardrails in step therapy and to encourage co-sponsorship of the Safe Step Act. This bipartisan legislation would create a clear process for a patient or physician to request an exception to a step therapy protocol. It also would require insurers to grant exemptions to step therapy in the following situations:
- Patient already tried and failed on a required treatment
- Delayed treatment will cause irreversible damage
- Required treatment will cause harm to the patient
- Required treatment will prevent a patient from working or fulling daily activities
- Patient is stable on their current treatment
AGA representatives and patient advocates met with the congressional offices of these legislators who serve on key committees that have jurisdiction over this issue.
Sen. Chris Van Hollen, D-Md
Sen. Tim Scott, R-S.C.
Sen. Thom Tillis, R-N.C.
Sen. Lamar Alexander, R-N.C.
Rep. Alma Adams, D-N.C.
Rep. Mark Walker, R-N.C.
Rep. Tim Walberg, R-Mich
A special thanks to AGA members who contacted your legislators online. A combination of 344 tweets and emails were sent urging federal legislators to support the Safe Step Act.
Sharing is caring
Legislators and their staff are always asking us for real-life examples from constituents about step therapy burdens to humanize the issue. Contact AGA staff at [email protected] to share your story.
AGA and 17 other specialty physician and patient advocacy organizations partnered with the Digestive Disease National Coalition (DDNC) on an advocacy day focused on the need for step therapy reform.
We met with congressional offices to seek support for patient protection guardrails in step therapy and to encourage co-sponsorship of the Safe Step Act. This bipartisan legislation would create a clear process for a patient or physician to request an exception to a step therapy protocol. It also would require insurers to grant exemptions to step therapy in the following situations:
- Patient already tried and failed on a required treatment
- Delayed treatment will cause irreversible damage
- Required treatment will cause harm to the patient
- Required treatment will prevent a patient from working or fulling daily activities
- Patient is stable on their current treatment
AGA representatives and patient advocates met with the congressional offices of these legislators who serve on key committees that have jurisdiction over this issue.
Sen. Chris Van Hollen, D-Md
Sen. Tim Scott, R-S.C.
Sen. Thom Tillis, R-N.C.
Sen. Lamar Alexander, R-N.C.
Rep. Alma Adams, D-N.C.
Rep. Mark Walker, R-N.C.
Rep. Tim Walberg, R-Mich
A special thanks to AGA members who contacted your legislators online. A combination of 344 tweets and emails were sent urging federal legislators to support the Safe Step Act.
Sharing is caring
Legislators and their staff are always asking us for real-life examples from constituents about step therapy burdens to humanize the issue. Contact AGA staff at [email protected] to share your story.
GI societies advise FDA on duodenoscope reprocessing
AGA, ACG, ASGE and SAGES were represented by three physicians who made oral remarks to the panel: Michael Kochman, MD, AGAF, Wilmott Professor of Medicine and Surgery at the University of Pennsylvania; Bret Petersen, MD, FASGE, professor of medicine and advanced endoscopist at the Mayo Clinic in Rochester, Minn. and Danielle Walsh, MD, associate professor of surgery at East Carolina University.
The GI societies over-arching goal is to ensure patient safety and ready access to clinically indicated procedures employing duodenoscopes and other elevator-channel endoscopes.
The panel discussed the adequacy/margin of safety for high-level disinfection, as well as the challenges and benefits of sterilization for routine for duodenoscope reprocessing. The panel’s consensus was that cleaning is the most important step in duodenoscope reprocessing. The panel noted that in properly cleaned duodenoscopes, high-level disinfection is appropriate; however, panel members acknowledged that reports indicate that duodenoscopes are not properly cleaned. The panel also discussed the challenges of implementing sterilization of duodenoscopes, such as potential decreased patient access to endoscopic retrograde cholangiopancreatography (ERCP) and increased costs.
On behalf of the GI societies, Dr. Kochman and Dr. Petersen proposed several overarching principles for the future evolution of our clinical practices focusing on patient safety and outcomes:
We encourage embracing multiple solutions, using a measured step-wise approach to the transition with both iterative and novel devices and processes.
We encourage data-based solutions addressing real-world efficacy while incorporating ongoing surveillance of processes and performance to ensure that early trouble signals are detected.
We believe that device or reprocessing transitions can be incorporated over the lifecycle of current instrumentation, to eliminate the potential for gaps in accessibility of care and to ensure that there is adequate efficacy and safety data to support the adoption of new technology.
We accept minimizing extensive premarket studies, while expecting vigilant post-market surveillance, for technologies or device changes made exclusively with intent to convert to conceptually more safe designs without significant changes in mechanism or function.
We support the addition of durability testing for devices undergoing both standard reprocessing and, in particular, those undergoing sterilization.
Our societies are prepared to support and participate in continued discussion regarding:
Mandatory servicing and inspections.
Mandatory device retirement for reusable devices.
Assessment of the role and standards for third-party inspection and repair.
Our societies strongly support the importance and oversight of succinct, practical, reproducible, user-friendly guidance in manufacturers’ instructions for use (IFUs), which should incorporate post-market validation studies and updates.
We recommend that devices that incorporate programmable features (AERs, washers, sterilizers) should have lock-down mechanisms in place to prevent both user and manufacturer from deviating from the FDA-cleared IFU parameters for the device.
Our societies, as well as numerous guidelines, include high-level disinfection as a currently acceptable option for endoscope reprocessing, assuming use of enhanced washing and drying standards of practice.
Finally, we support the FDA in its efforts to convey to companies the necessary endpoints and goals for performance and expectations relative to post-market review and development of new data to ensure efficacy in the community.
Our societies appreciated this opportunity to comment on the complex and critical topic at hand. Our over-arching goal as physicians remains that of ensuring patient safety and ready access to clinically indicated procedures employing duodenoscopes and other elevator-channel endoscopes.
AGA, ACG, ASGE and SAGES were represented by three physicians who made oral remarks to the panel: Michael Kochman, MD, AGAF, Wilmott Professor of Medicine and Surgery at the University of Pennsylvania; Bret Petersen, MD, FASGE, professor of medicine and advanced endoscopist at the Mayo Clinic in Rochester, Minn. and Danielle Walsh, MD, associate professor of surgery at East Carolina University.
The GI societies over-arching goal is to ensure patient safety and ready access to clinically indicated procedures employing duodenoscopes and other elevator-channel endoscopes.
The panel discussed the adequacy/margin of safety for high-level disinfection, as well as the challenges and benefits of sterilization for routine for duodenoscope reprocessing. The panel’s consensus was that cleaning is the most important step in duodenoscope reprocessing. The panel noted that in properly cleaned duodenoscopes, high-level disinfection is appropriate; however, panel members acknowledged that reports indicate that duodenoscopes are not properly cleaned. The panel also discussed the challenges of implementing sterilization of duodenoscopes, such as potential decreased patient access to endoscopic retrograde cholangiopancreatography (ERCP) and increased costs.
On behalf of the GI societies, Dr. Kochman and Dr. Petersen proposed several overarching principles for the future evolution of our clinical practices focusing on patient safety and outcomes:
We encourage embracing multiple solutions, using a measured step-wise approach to the transition with both iterative and novel devices and processes.
We encourage data-based solutions addressing real-world efficacy while incorporating ongoing surveillance of processes and performance to ensure that early trouble signals are detected.
We believe that device or reprocessing transitions can be incorporated over the lifecycle of current instrumentation, to eliminate the potential for gaps in accessibility of care and to ensure that there is adequate efficacy and safety data to support the adoption of new technology.
We accept minimizing extensive premarket studies, while expecting vigilant post-market surveillance, for technologies or device changes made exclusively with intent to convert to conceptually more safe designs without significant changes in mechanism or function.
We support the addition of durability testing for devices undergoing both standard reprocessing and, in particular, those undergoing sterilization.
Our societies are prepared to support and participate in continued discussion regarding:
Mandatory servicing and inspections.
Mandatory device retirement for reusable devices.
Assessment of the role and standards for third-party inspection and repair.
Our societies strongly support the importance and oversight of succinct, practical, reproducible, user-friendly guidance in manufacturers’ instructions for use (IFUs), which should incorporate post-market validation studies and updates.
We recommend that devices that incorporate programmable features (AERs, washers, sterilizers) should have lock-down mechanisms in place to prevent both user and manufacturer from deviating from the FDA-cleared IFU parameters for the device.
Our societies, as well as numerous guidelines, include high-level disinfection as a currently acceptable option for endoscope reprocessing, assuming use of enhanced washing and drying standards of practice.
Finally, we support the FDA in its efforts to convey to companies the necessary endpoints and goals for performance and expectations relative to post-market review and development of new data to ensure efficacy in the community.
Our societies appreciated this opportunity to comment on the complex and critical topic at hand. Our over-arching goal as physicians remains that of ensuring patient safety and ready access to clinically indicated procedures employing duodenoscopes and other elevator-channel endoscopes.
AGA, ACG, ASGE and SAGES were represented by three physicians who made oral remarks to the panel: Michael Kochman, MD, AGAF, Wilmott Professor of Medicine and Surgery at the University of Pennsylvania; Bret Petersen, MD, FASGE, professor of medicine and advanced endoscopist at the Mayo Clinic in Rochester, Minn. and Danielle Walsh, MD, associate professor of surgery at East Carolina University.
The GI societies over-arching goal is to ensure patient safety and ready access to clinically indicated procedures employing duodenoscopes and other elevator-channel endoscopes.
The panel discussed the adequacy/margin of safety for high-level disinfection, as well as the challenges and benefits of sterilization for routine for duodenoscope reprocessing. The panel’s consensus was that cleaning is the most important step in duodenoscope reprocessing. The panel noted that in properly cleaned duodenoscopes, high-level disinfection is appropriate; however, panel members acknowledged that reports indicate that duodenoscopes are not properly cleaned. The panel also discussed the challenges of implementing sterilization of duodenoscopes, such as potential decreased patient access to endoscopic retrograde cholangiopancreatography (ERCP) and increased costs.
On behalf of the GI societies, Dr. Kochman and Dr. Petersen proposed several overarching principles for the future evolution of our clinical practices focusing on patient safety and outcomes:
We encourage embracing multiple solutions, using a measured step-wise approach to the transition with both iterative and novel devices and processes.
We encourage data-based solutions addressing real-world efficacy while incorporating ongoing surveillance of processes and performance to ensure that early trouble signals are detected.
We believe that device or reprocessing transitions can be incorporated over the lifecycle of current instrumentation, to eliminate the potential for gaps in accessibility of care and to ensure that there is adequate efficacy and safety data to support the adoption of new technology.
We accept minimizing extensive premarket studies, while expecting vigilant post-market surveillance, for technologies or device changes made exclusively with intent to convert to conceptually more safe designs without significant changes in mechanism or function.
We support the addition of durability testing for devices undergoing both standard reprocessing and, in particular, those undergoing sterilization.
Our societies are prepared to support and participate in continued discussion regarding:
Mandatory servicing and inspections.
Mandatory device retirement for reusable devices.
Assessment of the role and standards for third-party inspection and repair.
Our societies strongly support the importance and oversight of succinct, practical, reproducible, user-friendly guidance in manufacturers’ instructions for use (IFUs), which should incorporate post-market validation studies and updates.
We recommend that devices that incorporate programmable features (AERs, washers, sterilizers) should have lock-down mechanisms in place to prevent both user and manufacturer from deviating from the FDA-cleared IFU parameters for the device.
Our societies, as well as numerous guidelines, include high-level disinfection as a currently acceptable option for endoscope reprocessing, assuming use of enhanced washing and drying standards of practice.
Finally, we support the FDA in its efforts to convey to companies the necessary endpoints and goals for performance and expectations relative to post-market review and development of new data to ensure efficacy in the community.
Our societies appreciated this opportunity to comment on the complex and critical topic at hand. Our over-arching goal as physicians remains that of ensuring patient safety and ready access to clinically indicated procedures employing duodenoscopes and other elevator-channel endoscopes.
Consider a Donation to the SVS Foundation
The SVS Foundation is a fundamental part of the Society for Vascular Surgery, entrusted with supporting programs that advance our knowledge of vascular disease and improve the care we provide our patients and communities. A little while back the SVS Foundation published its 2019 Annual Report. This year, the report focuses on how past award recipients have used their grants to impact and improve patient care. More than $13 million in grants over the past three decades have given recipients the support they need to impact the lives of patients and those who provide care. Consider a donation today.
The SVS Foundation is a fundamental part of the Society for Vascular Surgery, entrusted with supporting programs that advance our knowledge of vascular disease and improve the care we provide our patients and communities. A little while back the SVS Foundation published its 2019 Annual Report. This year, the report focuses on how past award recipients have used their grants to impact and improve patient care. More than $13 million in grants over the past three decades have given recipients the support they need to impact the lives of patients and those who provide care. Consider a donation today.
The SVS Foundation is a fundamental part of the Society for Vascular Surgery, entrusted with supporting programs that advance our knowledge of vascular disease and improve the care we provide our patients and communities. A little while back the SVS Foundation published its 2019 Annual Report. This year, the report focuses on how past award recipients have used their grants to impact and improve patient care. More than $13 million in grants over the past three decades have given recipients the support they need to impact the lives of patients and those who provide care. Consider a donation today.
CPT® and ICD-10 Coding for Endobronchial Valves
The FDA recently approved endobronchial valves for the bronchoscopic treatment of adult patients with hyperinflation associated with severe emphysema in regions of the lung that have little to no collateral ventilation. There are CPT® and ICD 10 codes that are appropriate to report these new services. CPT® codes typically are not product or device specific and the codes below apply to current and future FDA approved endobronchial valves with similar clinical indications and intent for the treatment of emphysema.
To be a candidate for the currently approved service, patients must have little to no collateral ventilation between the target and adjacent lobes. In some patients, this can be determined by a quantitative CT analysis service to assess emphysematous destruction and fissure completeness.
If the bronchial blocking technique shows evidence of collateral ventilation, the patient would be discharged without valve placement. In that scenario the appropriate CPT® code would be 31634:
INSERT GRAPHIC HERE
If the patient is determined not to have collateral ventilation, the valve procedure would proceed, followed by a minimum three-day inpatient stay to monitor for possible side effects.
The appropriate CPT codes for placing, and removing FDA approved valves are:
INSERT GRAPHIC HERE
The table below identifies potential ICD-10-CM diagnosis codes for emphysema. Applicability and usage of these codes may vary per case. Hospitals and physicians also should check and verify current policies and requirements with the payer for any patient who will be treated with endobronchial valves.
INSERT GRAPHIC HERE
The CHEST/ATS Clinical Practice Committee provided information for this article.
The FDA recently approved endobronchial valves for the bronchoscopic treatment of adult patients with hyperinflation associated with severe emphysema in regions of the lung that have little to no collateral ventilation. There are CPT® and ICD 10 codes that are appropriate to report these new services. CPT® codes typically are not product or device specific and the codes below apply to current and future FDA approved endobronchial valves with similar clinical indications and intent for the treatment of emphysema.
To be a candidate for the currently approved service, patients must have little to no collateral ventilation between the target and adjacent lobes. In some patients, this can be determined by a quantitative CT analysis service to assess emphysematous destruction and fissure completeness.
If the bronchial blocking technique shows evidence of collateral ventilation, the patient would be discharged without valve placement. In that scenario the appropriate CPT® code would be 31634:
INSERT GRAPHIC HERE
If the patient is determined not to have collateral ventilation, the valve procedure would proceed, followed by a minimum three-day inpatient stay to monitor for possible side effects.
The appropriate CPT codes for placing, and removing FDA approved valves are:
INSERT GRAPHIC HERE
The table below identifies potential ICD-10-CM diagnosis codes for emphysema. Applicability and usage of these codes may vary per case. Hospitals and physicians also should check and verify current policies and requirements with the payer for any patient who will be treated with endobronchial valves.
INSERT GRAPHIC HERE
The CHEST/ATS Clinical Practice Committee provided information for this article.
The FDA recently approved endobronchial valves for the bronchoscopic treatment of adult patients with hyperinflation associated with severe emphysema in regions of the lung that have little to no collateral ventilation. There are CPT® and ICD 10 codes that are appropriate to report these new services. CPT® codes typically are not product or device specific and the codes below apply to current and future FDA approved endobronchial valves with similar clinical indications and intent for the treatment of emphysema.
To be a candidate for the currently approved service, patients must have little to no collateral ventilation between the target and adjacent lobes. In some patients, this can be determined by a quantitative CT analysis service to assess emphysematous destruction and fissure completeness.
If the bronchial blocking technique shows evidence of collateral ventilation, the patient would be discharged without valve placement. In that scenario the appropriate CPT® code would be 31634:
INSERT GRAPHIC HERE
If the patient is determined not to have collateral ventilation, the valve procedure would proceed, followed by a minimum three-day inpatient stay to monitor for possible side effects.
The appropriate CPT codes for placing, and removing FDA approved valves are:
INSERT GRAPHIC HERE
The table below identifies potential ICD-10-CM diagnosis codes for emphysema. Applicability and usage of these codes may vary per case. Hospitals and physicians also should check and verify current policies and requirements with the payer for any patient who will be treated with endobronchial valves.
INSERT GRAPHIC HERE
The CHEST/ATS Clinical Practice Committee provided information for this article.
Be Part of VAM Scholarship Program; Apply for VAM Travel Scholarship Today
Are you interested in vascular surgery? Consider applying for a travel scholarship that will help defray costs of attending the 2020 Vascular Annual Meeting June 17 to 20 in Toronto, Canada. The Society for Vascular Surgery offers travel scholarships for medical students or general surgery residents. The Vascular Annual Meeting – June 17 to 20 – includes a dedicated resident/student educational and networking program that will include a mock interview session, mentor program, residency fair and more. Learn more.
Are you interested in vascular surgery? Consider applying for a travel scholarship that will help defray costs of attending the 2020 Vascular Annual Meeting June 17 to 20 in Toronto, Canada. The Society for Vascular Surgery offers travel scholarships for medical students or general surgery residents. The Vascular Annual Meeting – June 17 to 20 – includes a dedicated resident/student educational and networking program that will include a mock interview session, mentor program, residency fair and more. Learn more.
Are you interested in vascular surgery? Consider applying for a travel scholarship that will help defray costs of attending the 2020 Vascular Annual Meeting June 17 to 20 in Toronto, Canada. The Society for Vascular Surgery offers travel scholarships for medical students or general surgery residents. The Vascular Annual Meeting – June 17 to 20 – includes a dedicated resident/student educational and networking program that will include a mock interview session, mentor program, residency fair and more. Learn more.
SVS Members: You Have Options When It Comes to Disability Insurance
The Affinity Program of expanded benefits gives SVS members more options for disability insurance. Many members are part of a group plan in which the employer or group pays the premium. These plans may meet the needs of members, but sometimes they may not. With the options offered through the Affinity Program, members could avoid offsets that reduce tax-free benefits or ones that limit the time period in which they are covered. The program can connect interested members with three companies: Principal Life Insurance Company, Securian and Lloyd’s of London. These group plans are unlike many others, providing tax-free benefits that could potentially protect hundreds of thousands of dollars. Click here for details.
The Affinity Program of expanded benefits gives SVS members more options for disability insurance. Many members are part of a group plan in which the employer or group pays the premium. These plans may meet the needs of members, but sometimes they may not. With the options offered through the Affinity Program, members could avoid offsets that reduce tax-free benefits or ones that limit the time period in which they are covered. The program can connect interested members with three companies: Principal Life Insurance Company, Securian and Lloyd’s of London. These group plans are unlike many others, providing tax-free benefits that could potentially protect hundreds of thousands of dollars. Click here for details.
The Affinity Program of expanded benefits gives SVS members more options for disability insurance. Many members are part of a group plan in which the employer or group pays the premium. These plans may meet the needs of members, but sometimes they may not. With the options offered through the Affinity Program, members could avoid offsets that reduce tax-free benefits or ones that limit the time period in which they are covered. The program can connect interested members with three companies: Principal Life Insurance Company, Securian and Lloyd’s of London. These group plans are unlike many others, providing tax-free benefits that could potentially protect hundreds of thousands of dollars. Click here for details.
NAMDRC legislative initiatives take shape
Two priorities of NAMDRC have moved into the formal congressional arena. The issues focus on access to pulmonary rehabilitation and CMS’s move to include home mechanical ventilation in competitive bidding.
Pulmonary Rehabilitation – The Problem: One of the major concerns to CMS and Congress is the fact that different payment methodologies for the same service result in different payment amounts dependent upon the actual site of service. To address the phenomenon of hospitals purchasing certain physician practices to game the payment system, Congress included in the 2015 Budget Act a provision that would remove incentives for such hospital purchases by stating that new hospital outpatient services must be within 250 yards of the main hospital campus in order to receive payment based on the hospital outpatient prospective payment system methodology. If a hospital opens such services beyond that 250-yard threshold, the hospital would be reimbursed at the physician fee schedule amount for the same service. Likewise, if an off campus program moved its grandfathered location because of expansion, loss of lease, etc, the physician fee schedule would again kick in.
For pulmonary rehabilitation services, this is extremely problematic and is tying the hands of hospitals providing this service. The physician fee schedule payment for pulmonary rehabilitation is less than $30 for 1 hour of service, and it is, therefore, not surprising that the service is simply not provided in physician offices. In fact, Medicare data show that all physician specialties bill less than $1M for code G0424, and we believe that most of that is likely billing error. Pulmonologists bill less than $500K for code G0424, and putting that number in context, the entire Medicare program is approaching $700B in outlays.
Pulmonary Rehabilitation – The Solution: As a solution to this problem, HR 4838 has been introduced in the House of Representatives. There is no specific reference to pulmonary rehabilitation in the bill as our approach is based not only on substance but political considerations, as well. Using CMS’ own acknowledgment of “unintended consequences,” this legislation would exempt all CPT codes from the restrictions imposed by Section 603 of the 2015 Budget Act when the physician billings for that code are under $2M for the most recent year for which data are available. CMS has signaled to us that such a limitation would apply only to pulmonary and cardiac rehab services, but others may be affected, as well. By putting a dollar limit rather than identifying a specific service for such a “carve out,” it is a more politically viable approach.
Bills such as this rarely see the light of day; however, such provisions are often attached to larger, more substantive bills. For nearly 2 decades, the common legislative vehicle for such provisions is a larger Medicare bill, often including “must pass Medicare extender” provisions that are slated to expire on a particular date. Our goal is to include HR 4838 in such a package of extenders some time between now and the end of this Congress in 2020.
Home Mechanical Ventilation – The Problem: CMS has proposed inclusion of home mechanical ventilation in competitive bidding for durable medical equipment. Such a regulatory proposal is fraught with downside risk, most notably that such a policy would follow the history of liquid oxygen. Liquid 02 has virtually disappeared from the marketplace since it was included in competitive bidding as suppliers simply refused to provide liquid oxygen systems as their own bidding dropped the price to prohibitively low levels. Also, because there is a statutory requirement that such payment be made on the basis of “frequent and substantial servicing,” and that stipulation could trigger wide variations in actual bidding because some states require involvement of respiratory therapists in such services, while others do not.
It is critical to understand that the driving force behind all of this is the reality that CMS’ own coverage policies for home mechanical ventilation are seriously flawed and outdated, creating perverse incentives for physicians to order easily accessible systems rather than clinically appropriate ones. NAMDRC and its sister societies have been pushing CMS to revise those policies with no success.
Home Mechanical Ventilation – The Solution: Our solution is twofold. HR 4945 bill was introduced on November 1, 2019. First, the proposed legislation would create a blanket exemption for home mechanical ventilation from competitive bidding. Second, it requires CMS to convene a technical expert panel to craft up-to-date policies for home mechanical ventilation.
The political strategy here is slightly different. While passage of the bill is certainly our first choice, we believe that introduction of the bill is a red flag signal to CMS for the need to revise its coverage policies as those policies are the root cause of the growth of home mechanical ventilation outlays.
Two priorities of NAMDRC have moved into the formal congressional arena. The issues focus on access to pulmonary rehabilitation and CMS’s move to include home mechanical ventilation in competitive bidding.
Pulmonary Rehabilitation – The Problem: One of the major concerns to CMS and Congress is the fact that different payment methodologies for the same service result in different payment amounts dependent upon the actual site of service. To address the phenomenon of hospitals purchasing certain physician practices to game the payment system, Congress included in the 2015 Budget Act a provision that would remove incentives for such hospital purchases by stating that new hospital outpatient services must be within 250 yards of the main hospital campus in order to receive payment based on the hospital outpatient prospective payment system methodology. If a hospital opens such services beyond that 250-yard threshold, the hospital would be reimbursed at the physician fee schedule amount for the same service. Likewise, if an off campus program moved its grandfathered location because of expansion, loss of lease, etc, the physician fee schedule would again kick in.
For pulmonary rehabilitation services, this is extremely problematic and is tying the hands of hospitals providing this service. The physician fee schedule payment for pulmonary rehabilitation is less than $30 for 1 hour of service, and it is, therefore, not surprising that the service is simply not provided in physician offices. In fact, Medicare data show that all physician specialties bill less than $1M for code G0424, and we believe that most of that is likely billing error. Pulmonologists bill less than $500K for code G0424, and putting that number in context, the entire Medicare program is approaching $700B in outlays.
Pulmonary Rehabilitation – The Solution: As a solution to this problem, HR 4838 has been introduced in the House of Representatives. There is no specific reference to pulmonary rehabilitation in the bill as our approach is based not only on substance but political considerations, as well. Using CMS’ own acknowledgment of “unintended consequences,” this legislation would exempt all CPT codes from the restrictions imposed by Section 603 of the 2015 Budget Act when the physician billings for that code are under $2M for the most recent year for which data are available. CMS has signaled to us that such a limitation would apply only to pulmonary and cardiac rehab services, but others may be affected, as well. By putting a dollar limit rather than identifying a specific service for such a “carve out,” it is a more politically viable approach.
Bills such as this rarely see the light of day; however, such provisions are often attached to larger, more substantive bills. For nearly 2 decades, the common legislative vehicle for such provisions is a larger Medicare bill, often including “must pass Medicare extender” provisions that are slated to expire on a particular date. Our goal is to include HR 4838 in such a package of extenders some time between now and the end of this Congress in 2020.
Home Mechanical Ventilation – The Problem: CMS has proposed inclusion of home mechanical ventilation in competitive bidding for durable medical equipment. Such a regulatory proposal is fraught with downside risk, most notably that such a policy would follow the history of liquid oxygen. Liquid 02 has virtually disappeared from the marketplace since it was included in competitive bidding as suppliers simply refused to provide liquid oxygen systems as their own bidding dropped the price to prohibitively low levels. Also, because there is a statutory requirement that such payment be made on the basis of “frequent and substantial servicing,” and that stipulation could trigger wide variations in actual bidding because some states require involvement of respiratory therapists in such services, while others do not.
It is critical to understand that the driving force behind all of this is the reality that CMS’ own coverage policies for home mechanical ventilation are seriously flawed and outdated, creating perverse incentives for physicians to order easily accessible systems rather than clinically appropriate ones. NAMDRC and its sister societies have been pushing CMS to revise those policies with no success.
Home Mechanical Ventilation – The Solution: Our solution is twofold. HR 4945 bill was introduced on November 1, 2019. First, the proposed legislation would create a blanket exemption for home mechanical ventilation from competitive bidding. Second, it requires CMS to convene a technical expert panel to craft up-to-date policies for home mechanical ventilation.
The political strategy here is slightly different. While passage of the bill is certainly our first choice, we believe that introduction of the bill is a red flag signal to CMS for the need to revise its coverage policies as those policies are the root cause of the growth of home mechanical ventilation outlays.
Two priorities of NAMDRC have moved into the formal congressional arena. The issues focus on access to pulmonary rehabilitation and CMS’s move to include home mechanical ventilation in competitive bidding.
Pulmonary Rehabilitation – The Problem: One of the major concerns to CMS and Congress is the fact that different payment methodologies for the same service result in different payment amounts dependent upon the actual site of service. To address the phenomenon of hospitals purchasing certain physician practices to game the payment system, Congress included in the 2015 Budget Act a provision that would remove incentives for such hospital purchases by stating that new hospital outpatient services must be within 250 yards of the main hospital campus in order to receive payment based on the hospital outpatient prospective payment system methodology. If a hospital opens such services beyond that 250-yard threshold, the hospital would be reimbursed at the physician fee schedule amount for the same service. Likewise, if an off campus program moved its grandfathered location because of expansion, loss of lease, etc, the physician fee schedule would again kick in.
For pulmonary rehabilitation services, this is extremely problematic and is tying the hands of hospitals providing this service. The physician fee schedule payment for pulmonary rehabilitation is less than $30 for 1 hour of service, and it is, therefore, not surprising that the service is simply not provided in physician offices. In fact, Medicare data show that all physician specialties bill less than $1M for code G0424, and we believe that most of that is likely billing error. Pulmonologists bill less than $500K for code G0424, and putting that number in context, the entire Medicare program is approaching $700B in outlays.
Pulmonary Rehabilitation – The Solution: As a solution to this problem, HR 4838 has been introduced in the House of Representatives. There is no specific reference to pulmonary rehabilitation in the bill as our approach is based not only on substance but political considerations, as well. Using CMS’ own acknowledgment of “unintended consequences,” this legislation would exempt all CPT codes from the restrictions imposed by Section 603 of the 2015 Budget Act when the physician billings for that code are under $2M for the most recent year for which data are available. CMS has signaled to us that such a limitation would apply only to pulmonary and cardiac rehab services, but others may be affected, as well. By putting a dollar limit rather than identifying a specific service for such a “carve out,” it is a more politically viable approach.
Bills such as this rarely see the light of day; however, such provisions are often attached to larger, more substantive bills. For nearly 2 decades, the common legislative vehicle for such provisions is a larger Medicare bill, often including “must pass Medicare extender” provisions that are slated to expire on a particular date. Our goal is to include HR 4838 in such a package of extenders some time between now and the end of this Congress in 2020.
Home Mechanical Ventilation – The Problem: CMS has proposed inclusion of home mechanical ventilation in competitive bidding for durable medical equipment. Such a regulatory proposal is fraught with downside risk, most notably that such a policy would follow the history of liquid oxygen. Liquid 02 has virtually disappeared from the marketplace since it was included in competitive bidding as suppliers simply refused to provide liquid oxygen systems as their own bidding dropped the price to prohibitively low levels. Also, because there is a statutory requirement that such payment be made on the basis of “frequent and substantial servicing,” and that stipulation could trigger wide variations in actual bidding because some states require involvement of respiratory therapists in such services, while others do not.
It is critical to understand that the driving force behind all of this is the reality that CMS’ own coverage policies for home mechanical ventilation are seriously flawed and outdated, creating perverse incentives for physicians to order easily accessible systems rather than clinically appropriate ones. NAMDRC and its sister societies have been pushing CMS to revise those policies with no success.
Home Mechanical Ventilation – The Solution: Our solution is twofold. HR 4945 bill was introduced on November 1, 2019. First, the proposed legislation would create a blanket exemption for home mechanical ventilation from competitive bidding. Second, it requires CMS to convene a technical expert panel to craft up-to-date policies for home mechanical ventilation.
The political strategy here is slightly different. While passage of the bill is certainly our first choice, we believe that introduction of the bill is a red flag signal to CMS for the need to revise its coverage policies as those policies are the root cause of the growth of home mechanical ventilation outlays.
Mark J. Rosen, MD, Master FCCP Endowment
When most think of Mark J. Rosen, MD, Master FCCP, so many words come to mind: master educator, astute and caring clinician, researcher, mentor, leader. We recall his generosity, kindness, honesty, brilliance, and sense of humor.
Mark loved CHEST. He gave so much to the organization and was happy to do so. He was one of the rare Past Presidents who contributed even more after his presidency than during or before. Mark left an enormous footprint on CHEST’s educational programs, including the CHEST Annual Meeting, Pulmonary Board Review, and SEEK. He was instrumental in building our international educational programs and a key player in empowering our Chinese colleagues in establishing pulmonary fellowships in their country. Much of what we have all accomplished at CHEST and in pulmonary medicine is directly related to the wonderful mentors we have had in the organization, and Mark was certainly one of the most prominent.
Mark introduced many of us to so many friends and mentors. He especially did this for hundreds of trainees and junior faculty throughout his career. What made him most happy was seeing his trainees and mentees succeed – Mark was THE example of an outstanding mentor. After his passing, and in recognition of his work that can and will live on, the CHEST Foundation has established an endowment with a major focus that truly honors Mark’s most memorable traits – the Rosen International Scholarship Fund
Mark always believed the core strength of the college was education. The CHEST Foundation is endowing the Rosen International Scholarship and raising $100,000 to support deserving international clinicians. This endowed fund will directly support international CHEST members’ travel to the CHEST Annual Meeting affording CHEST’s world-class educational and mentorship opportunities to members who could not otherwise attend.
To support the Mark J. Rosen, MD, FCCP Endowment, his legacy, and international CHEST members, visit chestfoundation.org/donate today.
When most think of Mark J. Rosen, MD, Master FCCP, so many words come to mind: master educator, astute and caring clinician, researcher, mentor, leader. We recall his generosity, kindness, honesty, brilliance, and sense of humor.
Mark loved CHEST. He gave so much to the organization and was happy to do so. He was one of the rare Past Presidents who contributed even more after his presidency than during or before. Mark left an enormous footprint on CHEST’s educational programs, including the CHEST Annual Meeting, Pulmonary Board Review, and SEEK. He was instrumental in building our international educational programs and a key player in empowering our Chinese colleagues in establishing pulmonary fellowships in their country. Much of what we have all accomplished at CHEST and in pulmonary medicine is directly related to the wonderful mentors we have had in the organization, and Mark was certainly one of the most prominent.
Mark introduced many of us to so many friends and mentors. He especially did this for hundreds of trainees and junior faculty throughout his career. What made him most happy was seeing his trainees and mentees succeed – Mark was THE example of an outstanding mentor. After his passing, and in recognition of his work that can and will live on, the CHEST Foundation has established an endowment with a major focus that truly honors Mark’s most memorable traits – the Rosen International Scholarship Fund
Mark always believed the core strength of the college was education. The CHEST Foundation is endowing the Rosen International Scholarship and raising $100,000 to support deserving international clinicians. This endowed fund will directly support international CHEST members’ travel to the CHEST Annual Meeting affording CHEST’s world-class educational and mentorship opportunities to members who could not otherwise attend.
To support the Mark J. Rosen, MD, FCCP Endowment, his legacy, and international CHEST members, visit chestfoundation.org/donate today.
When most think of Mark J. Rosen, MD, Master FCCP, so many words come to mind: master educator, astute and caring clinician, researcher, mentor, leader. We recall his generosity, kindness, honesty, brilliance, and sense of humor.
Mark loved CHEST. He gave so much to the organization and was happy to do so. He was one of the rare Past Presidents who contributed even more after his presidency than during or before. Mark left an enormous footprint on CHEST’s educational programs, including the CHEST Annual Meeting, Pulmonary Board Review, and SEEK. He was instrumental in building our international educational programs and a key player in empowering our Chinese colleagues in establishing pulmonary fellowships in their country. Much of what we have all accomplished at CHEST and in pulmonary medicine is directly related to the wonderful mentors we have had in the organization, and Mark was certainly one of the most prominent.
Mark introduced many of us to so many friends and mentors. He especially did this for hundreds of trainees and junior faculty throughout his career. What made him most happy was seeing his trainees and mentees succeed – Mark was THE example of an outstanding mentor. After his passing, and in recognition of his work that can and will live on, the CHEST Foundation has established an endowment with a major focus that truly honors Mark’s most memorable traits – the Rosen International Scholarship Fund
Mark always believed the core strength of the college was education. The CHEST Foundation is endowing the Rosen International Scholarship and raising $100,000 to support deserving international clinicians. This endowed fund will directly support international CHEST members’ travel to the CHEST Annual Meeting affording CHEST’s world-class educational and mentorship opportunities to members who could not otherwise attend.
To support the Mark J. Rosen, MD, FCCP Endowment, his legacy, and international CHEST members, visit chestfoundation.org/donate today.
News From the Board of Regents: Highlights of ongoing successes
CHEST leadership recently met for its fall quarterly face to face meeting prior to the CHEST Annual Meeting in New Orleans this October. Like all of CHEST board meetings, the agenda was packed with important topics and a great deal of meaningful discussion. I left the meeting more energized about CHEST and its current and future offerings for our membership. Below are a few highlights from the meeting.
The meeting was opened with an update from the outgoing CHEST President Clayton Cowl, MD, MS, FCCP. He highlighted some of the organization’s major achievements over the past year, including: Confirming and signing a new contract with our new EVP/CEO Robert Musacchio, PhD; hiring a new Chief Learning Officer, a new Editor in Chief for the CHEST® journal, and a new Chief Legal Counsel; and expansion of the international strategy with CHEST Congress in Bangkok and a CHEST Regional meeting in Athens with plans for CHEST Congress 2020 in Bologna, Italy. In addition, CHEST convened a Digital Strategy Task Force, which made recommendations to improve how members, patients, and staff interact with our organization.
EVP/CEO Robert Musacchio reviewed some additional organizational accomplishments and areas of focus for the future. These included redefining the One CHEST operating model and a continued focus on international business development with plans for CHEST Congress 2020 in Italy and exploration of future meetings in Singapore and The Philippines. CHEST continues to develop an improved membership strategy focused on improving experiences for our membership and improving member engagement to help secure the future of CHEST. Finally, CHEST remains focused on innovation though new experiences for our members, including new games, virtual patient tours, and enduring activities and products. Many of these experiences were highlighted and on display at the recent CHEST annual meeting.
Doreen Addrizzo-Harris, MD, FCCP, the CHEST Foundation outgoing President, recapped a very successful year for the CHEST Foundation with plans for increasing the impact and visibility of the CHEST Foundation going forward.. John Howington, MD, FCCP, Chair of the Finance Committee, updated the board on the financial health of the organization. Overall, CHEST had a solid financial report based on budgeted revenue and strong expense management by our executive leadership team.
John Studdard, MD, FCCP, the immediate Past President and Chair of the Governance Committee, led the Governance Committee report and discussion. The Governance Committee is composed of members of both the College Board of Regents (BOR) and Foundation Board of Trustees (BOT) and is responsible for the overall health of both boards and ensuring that the boards are consistently performing at a high level. Dr. Studdard presented slates for 2019-20 Board of Trustees and Board of Regents for discussion and approval. Five new members for the Board of Regents and four new members for the Board of Trustees were approved for the upcoming year. In addition, David Schulman, MD, MS, FCCP, and Robert De Marco, MD, FCCP, were elected as President-Designate of the BOR and BOT, respectively.
Several committees presented to the Board to review this year’s progress, future plans, and potential barriers to success. The Council of Global Governors continued to see growth in our international membership, though a potential ongoing barrier to future growth will be developing an efficient mode of communication between the Global Governors and our international members. Discussion around using the expertise within the Digital Strategy Task Force was offered as one method to improve international member communication and engagement. The Education Committee continues to be one of CHEST’s most popular committees with an unprecedented 130 nominations with exceptional credentials for the 2019-20 election cycle. The Education Committee has expanded the size of three of its subcommittees to better include and engage these individuals in CHEST education projects. The Training and Transitions Committee continues to see increased engagement from trainees and training programs. CHEST 2019 had an increased number of trainee submissions, as well as the number of accepted submissions to the meeting. The committee will continue to evolve their strategy for engaging trainees and early career professionals. Finally, Christopher Hergott, MD, FCCP, Chair of the Membership Committee, reviewed several strategies and recommendations to expand our membership offerings and improve the value that we bring to our all of our members.
Finally, it was time to say thank you and farewell to out our outgoing Board members. Clayton Cowl, MD, MS, FCCP, and Stephanie Levine, MD, FCCP, recognized the following board members for their service to CHEST over the last several years: Jack Buckley, MD, FCCP; John Studdard, MD, FCCP; David Zielinski, MD, FCCP; and Burt Lesnick, MD, FCCP.
CHEST leadership recently met for its fall quarterly face to face meeting prior to the CHEST Annual Meeting in New Orleans this October. Like all of CHEST board meetings, the agenda was packed with important topics and a great deal of meaningful discussion. I left the meeting more energized about CHEST and its current and future offerings for our membership. Below are a few highlights from the meeting.
The meeting was opened with an update from the outgoing CHEST President Clayton Cowl, MD, MS, FCCP. He highlighted some of the organization’s major achievements over the past year, including: Confirming and signing a new contract with our new EVP/CEO Robert Musacchio, PhD; hiring a new Chief Learning Officer, a new Editor in Chief for the CHEST® journal, and a new Chief Legal Counsel; and expansion of the international strategy with CHEST Congress in Bangkok and a CHEST Regional meeting in Athens with plans for CHEST Congress 2020 in Bologna, Italy. In addition, CHEST convened a Digital Strategy Task Force, which made recommendations to improve how members, patients, and staff interact with our organization.
EVP/CEO Robert Musacchio reviewed some additional organizational accomplishments and areas of focus for the future. These included redefining the One CHEST operating model and a continued focus on international business development with plans for CHEST Congress 2020 in Italy and exploration of future meetings in Singapore and The Philippines. CHEST continues to develop an improved membership strategy focused on improving experiences for our membership and improving member engagement to help secure the future of CHEST. Finally, CHEST remains focused on innovation though new experiences for our members, including new games, virtual patient tours, and enduring activities and products. Many of these experiences were highlighted and on display at the recent CHEST annual meeting.
Doreen Addrizzo-Harris, MD, FCCP, the CHEST Foundation outgoing President, recapped a very successful year for the CHEST Foundation with plans for increasing the impact and visibility of the CHEST Foundation going forward.. John Howington, MD, FCCP, Chair of the Finance Committee, updated the board on the financial health of the organization. Overall, CHEST had a solid financial report based on budgeted revenue and strong expense management by our executive leadership team.
John Studdard, MD, FCCP, the immediate Past President and Chair of the Governance Committee, led the Governance Committee report and discussion. The Governance Committee is composed of members of both the College Board of Regents (BOR) and Foundation Board of Trustees (BOT) and is responsible for the overall health of both boards and ensuring that the boards are consistently performing at a high level. Dr. Studdard presented slates for 2019-20 Board of Trustees and Board of Regents for discussion and approval. Five new members for the Board of Regents and four new members for the Board of Trustees were approved for the upcoming year. In addition, David Schulman, MD, MS, FCCP, and Robert De Marco, MD, FCCP, were elected as President-Designate of the BOR and BOT, respectively.
Several committees presented to the Board to review this year’s progress, future plans, and potential barriers to success. The Council of Global Governors continued to see growth in our international membership, though a potential ongoing barrier to future growth will be developing an efficient mode of communication between the Global Governors and our international members. Discussion around using the expertise within the Digital Strategy Task Force was offered as one method to improve international member communication and engagement. The Education Committee continues to be one of CHEST’s most popular committees with an unprecedented 130 nominations with exceptional credentials for the 2019-20 election cycle. The Education Committee has expanded the size of three of its subcommittees to better include and engage these individuals in CHEST education projects. The Training and Transitions Committee continues to see increased engagement from trainees and training programs. CHEST 2019 had an increased number of trainee submissions, as well as the number of accepted submissions to the meeting. The committee will continue to evolve their strategy for engaging trainees and early career professionals. Finally, Christopher Hergott, MD, FCCP, Chair of the Membership Committee, reviewed several strategies and recommendations to expand our membership offerings and improve the value that we bring to our all of our members.
Finally, it was time to say thank you and farewell to out our outgoing Board members. Clayton Cowl, MD, MS, FCCP, and Stephanie Levine, MD, FCCP, recognized the following board members for their service to CHEST over the last several years: Jack Buckley, MD, FCCP; John Studdard, MD, FCCP; David Zielinski, MD, FCCP; and Burt Lesnick, MD, FCCP.
CHEST leadership recently met for its fall quarterly face to face meeting prior to the CHEST Annual Meeting in New Orleans this October. Like all of CHEST board meetings, the agenda was packed with important topics and a great deal of meaningful discussion. I left the meeting more energized about CHEST and its current and future offerings for our membership. Below are a few highlights from the meeting.
The meeting was opened with an update from the outgoing CHEST President Clayton Cowl, MD, MS, FCCP. He highlighted some of the organization’s major achievements over the past year, including: Confirming and signing a new contract with our new EVP/CEO Robert Musacchio, PhD; hiring a new Chief Learning Officer, a new Editor in Chief for the CHEST® journal, and a new Chief Legal Counsel; and expansion of the international strategy with CHEST Congress in Bangkok and a CHEST Regional meeting in Athens with plans for CHEST Congress 2020 in Bologna, Italy. In addition, CHEST convened a Digital Strategy Task Force, which made recommendations to improve how members, patients, and staff interact with our organization.
EVP/CEO Robert Musacchio reviewed some additional organizational accomplishments and areas of focus for the future. These included redefining the One CHEST operating model and a continued focus on international business development with plans for CHEST Congress 2020 in Italy and exploration of future meetings in Singapore and The Philippines. CHEST continues to develop an improved membership strategy focused on improving experiences for our membership and improving member engagement to help secure the future of CHEST. Finally, CHEST remains focused on innovation though new experiences for our members, including new games, virtual patient tours, and enduring activities and products. Many of these experiences were highlighted and on display at the recent CHEST annual meeting.
Doreen Addrizzo-Harris, MD, FCCP, the CHEST Foundation outgoing President, recapped a very successful year for the CHEST Foundation with plans for increasing the impact and visibility of the CHEST Foundation going forward.. John Howington, MD, FCCP, Chair of the Finance Committee, updated the board on the financial health of the organization. Overall, CHEST had a solid financial report based on budgeted revenue and strong expense management by our executive leadership team.
John Studdard, MD, FCCP, the immediate Past President and Chair of the Governance Committee, led the Governance Committee report and discussion. The Governance Committee is composed of members of both the College Board of Regents (BOR) and Foundation Board of Trustees (BOT) and is responsible for the overall health of both boards and ensuring that the boards are consistently performing at a high level. Dr. Studdard presented slates for 2019-20 Board of Trustees and Board of Regents for discussion and approval. Five new members for the Board of Regents and four new members for the Board of Trustees were approved for the upcoming year. In addition, David Schulman, MD, MS, FCCP, and Robert De Marco, MD, FCCP, were elected as President-Designate of the BOR and BOT, respectively.
Several committees presented to the Board to review this year’s progress, future plans, and potential barriers to success. The Council of Global Governors continued to see growth in our international membership, though a potential ongoing barrier to future growth will be developing an efficient mode of communication between the Global Governors and our international members. Discussion around using the expertise within the Digital Strategy Task Force was offered as one method to improve international member communication and engagement. The Education Committee continues to be one of CHEST’s most popular committees with an unprecedented 130 nominations with exceptional credentials for the 2019-20 election cycle. The Education Committee has expanded the size of three of its subcommittees to better include and engage these individuals in CHEST education projects. The Training and Transitions Committee continues to see increased engagement from trainees and training programs. CHEST 2019 had an increased number of trainee submissions, as well as the number of accepted submissions to the meeting. The committee will continue to evolve their strategy for engaging trainees and early career professionals. Finally, Christopher Hergott, MD, FCCP, Chair of the Membership Committee, reviewed several strategies and recommendations to expand our membership offerings and improve the value that we bring to our all of our members.
Finally, it was time to say thank you and farewell to out our outgoing Board members. Clayton Cowl, MD, MS, FCCP, and Stephanie Levine, MD, FCCP, recognized the following board members for their service to CHEST over the last several years: Jack Buckley, MD, FCCP; John Studdard, MD, FCCP; David Zielinski, MD, FCCP; and Burt Lesnick, MD, FCCP.
This month in the journal CHEST®
Editor’s Picks
Editorials
Pulmonary Embolism Cardiac Arrest: Thrombolysis During Cardiopulmonary Resuscitation and Improved Survival. By Drs. B. W. Bottiger and W. A. Wetsch.
Interstitial Lung Abnormalities: A Word of Caution.
By Drs. V. Tzilas and D. Bouros.
Original Research
Thrombolysis During Resuscitation for Out-of-Hospital Cardiac Arrest Caused by Pulmonary Embolism Increases 30-Day Survival: Findings From the French National Cardiac Arrest Registry.
By Dr. F. Javaudin, et al.Interstitial Lung Abnormalities and Lung Cancer Risk in the National Lung Screening Trial. By Dr. S-A. Whittaker Brown, et al.
Commentary
Publishing a Clinical Research Manuscript: Guidance for Early-Career Researchers With a Focus on Pulmonary and Critical Care Medicine.
By Dr. E. M. Viglianti, et al.
Editor’s Picks
Editor’s Picks
Editorials
Pulmonary Embolism Cardiac Arrest: Thrombolysis During Cardiopulmonary Resuscitation and Improved Survival. By Drs. B. W. Bottiger and W. A. Wetsch.
Interstitial Lung Abnormalities: A Word of Caution.
By Drs. V. Tzilas and D. Bouros.
Original Research
Thrombolysis During Resuscitation for Out-of-Hospital Cardiac Arrest Caused by Pulmonary Embolism Increases 30-Day Survival: Findings From the French National Cardiac Arrest Registry.
By Dr. F. Javaudin, et al.Interstitial Lung Abnormalities and Lung Cancer Risk in the National Lung Screening Trial. By Dr. S-A. Whittaker Brown, et al.
Commentary
Publishing a Clinical Research Manuscript: Guidance for Early-Career Researchers With a Focus on Pulmonary and Critical Care Medicine.
By Dr. E. M. Viglianti, et al.
Editorials
Pulmonary Embolism Cardiac Arrest: Thrombolysis During Cardiopulmonary Resuscitation and Improved Survival. By Drs. B. W. Bottiger and W. A. Wetsch.
Interstitial Lung Abnormalities: A Word of Caution.
By Drs. V. Tzilas and D. Bouros.
Original Research
Thrombolysis During Resuscitation for Out-of-Hospital Cardiac Arrest Caused by Pulmonary Embolism Increases 30-Day Survival: Findings From the French National Cardiac Arrest Registry.
By Dr. F. Javaudin, et al.Interstitial Lung Abnormalities and Lung Cancer Risk in the National Lung Screening Trial. By Dr. S-A. Whittaker Brown, et al.
Commentary
Publishing a Clinical Research Manuscript: Guidance for Early-Career Researchers With a Focus on Pulmonary and Critical Care Medicine.
By Dr. E. M. Viglianti, et al.