Society News

Creating a legacy of giving is easier than you think. As the new year begins, take some time to start creating your legacy while supporting the AGA Research Foundation. Gifts to charitable organizations, such as the AGA Research Foundation, in your future plans ensure your support for our mission continues even after your lifetime.

Here are two ideas to help you get started.

Name the AGA Research Foundation as a beneficiary. This arrangement is one of the most tax-smart ways to support the AGA Research Foundation after your lifetime. When you leave retirement plan assets to us, we bypass any taxes and receive the full amount.

Include the AGA Research Foundation in your will or living trust. This gift can be made by including as little as one sentence in your will or living trust. Plus, your gift can be modified throughout your lifetime as circumstances change.

Want to learn more about including a gift to the AGA Research Foundation in your future plans? Visit our website at https://gastro.planmylegacy.org or contact Harmony Excellent at 301-272-1602 or [email protected].
 

[email protected]

Creating a legacy of giving is easier than you think. As the new year begins, take some time to start creating your legacy while supporting the AGA Research Foundation. Gifts to charitable organizations, such as the AGA Research Foundation, in your future plans ensure your support for our mission continues even after your lifetime.

Here are two ideas to help you get started.

Name the AGA Research Foundation as a beneficiary. This arrangement is one of the most tax-smart ways to support the AGA Research Foundation after your lifetime. When you leave retirement plan assets to us, we bypass any taxes and receive the full amount.

Include the AGA Research Foundation in your will or living trust. This gift can be made by including as little as one sentence in your will or living trust. Plus, your gift can be modified throughout your lifetime as circumstances change.

Want to learn more about including a gift to the AGA Research Foundation in your future plans? Visit our website at https://gastro.planmylegacy.org or contact Harmony Excellent at 301-272-1602 or [email protected].
 

[email protected]

Creating a legacy of giving is easier than you think. As the new year begins, take some time to start creating your legacy while supporting the AGA Research Foundation. Gifts to charitable organizations, such as the AGA Research Foundation, in your future plans ensure your support for our mission continues even after your lifetime.

Here are two ideas to help you get started.

Name the AGA Research Foundation as a beneficiary. This arrangement is one of the most tax-smart ways to support the AGA Research Foundation after your lifetime. When you leave retirement plan assets to us, we bypass any taxes and receive the full amount.

Include the AGA Research Foundation in your will or living trust. This gift can be made by including as little as one sentence in your will or living trust. Plus, your gift can be modified throughout your lifetime as circumstances change.

Want to learn more about including a gift to the AGA Research Foundation in your future plans? Visit our website at https://gastro.planmylegacy.org or contact Harmony Excellent at 301-272-1602 or [email protected].
 

[email protected]

Bridgette Wilson, PhD, RD, postdoctoral research associate in nutritional sciences, and Kevin Whelan, PhD, RD, professor of dietetics, King’s College London, England, share talking points to help your patients understand what is currently known about the use of prebiotics for GI disorders.

Explaining prebiotics for GI disorders

Different prebiotic supplements have different effects on gut symptoms. For example, lower doses of noninulin type fructans (e.g., beta-galacto-oligosaccharides [GOS], pectin, partially hydrolyzed guar gum) are likely to be better tolerated in patients with functional gut symptoms, including irritable bowel syndrome (IBS).

Though prebiotic-containing foods are thought to benefit gut health in general, some prebiotics are FODMAPs that have been associated with symptoms in IBS patients. Individual patients on restrictive diets should systematically introduce prebiotic foods to identify the type and quantity they can tolerate.

[email protected]

Bridgette Wilson, PhD, RD, postdoctoral research associate in nutritional sciences, and Kevin Whelan, PhD, RD, professor of dietetics, King’s College London, England, share talking points to help your patients understand what is currently known about the use of prebiotics for GI disorders.

Explaining prebiotics for GI disorders

Different prebiotic supplements have different effects on gut symptoms. For example, lower doses of noninulin type fructans (e.g., beta-galacto-oligosaccharides [GOS], pectin, partially hydrolyzed guar gum) are likely to be better tolerated in patients with functional gut symptoms, including irritable bowel syndrome (IBS).

Though prebiotic-containing foods are thought to benefit gut health in general, some prebiotics are FODMAPs that have been associated with symptoms in IBS patients. Individual patients on restrictive diets should systematically introduce prebiotic foods to identify the type and quantity they can tolerate.

[email protected]

Bridgette Wilson, PhD, RD, postdoctoral research associate in nutritional sciences, and Kevin Whelan, PhD, RD, professor of dietetics, King’s College London, England, share talking points to help your patients understand what is currently known about the use of prebiotics for GI disorders.

Explaining prebiotics for GI disorders

Different prebiotic supplements have different effects on gut symptoms. For example, lower doses of noninulin type fructans (e.g., beta-galacto-oligosaccharides [GOS], pectin, partially hydrolyzed guar gum) are likely to be better tolerated in patients with functional gut symptoms, including irritable bowel syndrome (IBS).

Though prebiotic-containing foods are thought to benefit gut health in general, some prebiotics are FODMAPs that have been associated with symptoms in IBS patients. Individual patients on restrictive diets should systematically introduce prebiotic foods to identify the type and quantity they can tolerate.

[email protected]

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.

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.
 

[email protected]

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.
 

[email protected]

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.
 

[email protected]

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.

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 there is radiographic evidence of a complete fissure and anatomic isolation of the treatment target, a bronchoscopy assessment will be made on the patient. A bronchial blocking balloon and flow detection system is used to confirm that the patient has little to no collateral ventilation.

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 there is radiographic evidence of a complete fissure and anatomic isolation of the treatment target, a bronchoscopy assessment will be made on the patient. A bronchial blocking balloon and flow detection system is used to confirm that the patient has little to no collateral ventilation.

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 there is radiographic evidence of a complete fissure and anatomic isolation of the treatment target, a bronchoscopy assessment will be made on the patient. A bronchial blocking balloon and flow detection system is used to confirm that the patient has little to no collateral ventilation.

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.


 

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.

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.

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.

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 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 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 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.