Society News

Valerie W. Rusch, MD, FACS, an esteemed thoracic surgeon who practices in New York, NY, was elected to serve as the 2018−2019 President-Elect of the American College of Surgeons (ACS) at the October 24 Annual Business Meeting of Members. Dr. Rusch is vice-chair, clinical research, department of surgery; Miner Family Chair in Intrathoracic Cancers; attending surgeon, thoracic service, department of surgery, Memorial Sloan-Kettering Cancer Center; and professor of surgery, Weill Cornell Medical College. An ACS Fellow since 1986 and this year’s recipient of the ACS Distinguished Service Award (DSA), Dr. Rusch has led several prominent ACS bodies, including serving as Chair of the Board of Governors (2006−2008), Board of Regents (2015−2016), and several other ACS committees.

Valerie W. Rusch, MD, FACS, an esteemed thoracic surgeon who practices in New York, NY, was elected to serve as the 2018−2019 President-Elect of the American College of Surgeons (ACS) at the October 24 Annual Business Meeting of Members. Dr. Rusch is vice-chair, clinical research, department of surgery; Miner Family Chair in Intrathoracic Cancers; attending surgeon, thoracic service, department of surgery, Memorial Sloan-Kettering Cancer Center; and professor of surgery, Weill Cornell Medical College. An ACS Fellow since 1986 and this year’s recipient of the ACS Distinguished Service Award (DSA), Dr. Rusch has led several prominent ACS bodies, including serving as Chair of the Board of Governors (2006−2008), Board of Regents (2015−2016), and several other ACS committees.

Valerie W. Rusch, MD, FACS, an esteemed thoracic surgeon who practices in New York, NY, was elected to serve as the 2018−2019 President-Elect of the American College of Surgeons (ACS) at the October 24 Annual Business Meeting of Members. Dr. Rusch is vice-chair, clinical research, department of surgery; Miner Family Chair in Intrathoracic Cancers; attending surgeon, thoracic service, department of surgery, Memorial Sloan-Kettering Cancer Center; and professor of surgery, Weill Cornell Medical College. An ACS Fellow since 1986 and this year’s recipient of the ACS Distinguished Service Award (DSA), Dr. Rusch has led several prominent ACS bodies, including serving as Chair of the Board of Governors (2006−2008), Board of Regents (2015−2016), and several other ACS committees.

The abstract submission site for the 2019 Vascular Annual Meeting is now open. Submissions may be considered for the following programs: Scientific Session, Vascular and Endovascular Surgical Society (VESS), International Forum, International Fast Talk, Poster Competition and Interactive Poster. In addition to the International Forum and International Fast Talk, the international community has added two further opportunities to showcase research: The International Young Surgeon Competition and the International Poster Competition. This year the submission site is mobile friendly! Get more information on submission and policy guidelines here.

The abstract submission site for the 2019 Vascular Annual Meeting is now open. Submissions may be considered for the following programs: Scientific Session, Vascular and Endovascular Surgical Society (VESS), International Forum, International Fast Talk, Poster Competition and Interactive Poster. In addition to the International Forum and International Fast Talk, the international community has added two further opportunities to showcase research: The International Young Surgeon Competition and the International Poster Competition. This year the submission site is mobile friendly! Get more information on submission and policy guidelines here.

The abstract submission site for the 2019 Vascular Annual Meeting is now open. Submissions may be considered for the following programs: Scientific Session, Vascular and Endovascular Surgical Society (VESS), International Forum, International Fast Talk, Poster Competition and Interactive Poster. In addition to the International Forum and International Fast Talk, the international community has added two further opportunities to showcase research: The International Young Surgeon Competition and the International Poster Competition. This year the submission site is mobile friendly! Get more information on submission and policy guidelines here.

Anticipation is growing for SVSConnect, a new online community for SVS members. This site will give users an online home for connecting with colleagues on various topics including case complications, techniques, practice management and even work-life balance. A group of “early adopters” has already begun testing the waters, but the site will become open to all members before year’s end. Keep an eye on our Pulse newsletters, emails and the SVS website for an official launch date.
 

Anticipation is growing for SVSConnect, a new online community for SVS members. This site will give users an online home for connecting with colleagues on various topics including case complications, techniques, practice management and even work-life balance. A group of “early adopters” has already begun testing the waters, but the site will become open to all members before year’s end. Keep an eye on our Pulse newsletters, emails and the SVS website for an official launch date.
 

Anticipation is growing for SVSConnect, a new online community for SVS members. This site will give users an online home for connecting with colleagues on various topics including case complications, techniques, practice management and even work-life balance. A group of “early adopters” has already begun testing the waters, but the site will become open to all members before year’s end. Keep an eye on our Pulse newsletters, emails and the SVS website for an official launch date.
 

The SVS Foundation is supporting travel scholarships for trainees to attend the annual Vascular Research Initiatives Conference (VRIC), which will be held on May 13, 2019, in Boston. Recipients of the scholarship will receive complimentary registration to both VRIC and the Vascular Discovery Scientific Sessions, as well as a $1,000 award for conference travel. VRIC is considered a key event for connecting with vascular researchers and the theme this year is Hard Science: Calcification and Vascular Solution. Learn more and apply today. VRIC registration is now open; register today.

The SVS Foundation is supporting travel scholarships for trainees to attend the annual Vascular Research Initiatives Conference (VRIC), which will be held on May 13, 2019, in Boston. Recipients of the scholarship will receive complimentary registration to both VRIC and the Vascular Discovery Scientific Sessions, as well as a $1,000 award for conference travel. VRIC is considered a key event for connecting with vascular researchers and the theme this year is Hard Science: Calcification and Vascular Solution. Learn more and apply today. VRIC registration is now open; register today.

The SVS Foundation is supporting travel scholarships for trainees to attend the annual Vascular Research Initiatives Conference (VRIC), which will be held on May 13, 2019, in Boston. Recipients of the scholarship will receive complimentary registration to both VRIC and the Vascular Discovery Scientific Sessions, as well as a $1,000 award for conference travel. VRIC is considered a key event for connecting with vascular researchers and the theme this year is Hard Science: Calcification and Vascular Solution. Learn more and apply today. VRIC registration is now open; register today.

The SVS Executive Board has announced that all Active SVS members in good standing will now be considered Fellows of the Society for Vascular Surgery™ (FSVS™). The trademarked designation is one of the benefits of SVS membership and is a public acknowledgement that a surgeon has met the high standards required by the SVS of its members and has shown and professional commitment to the field of vascular surgery. Active members in good standing may add the initials FSVS™ after their name in any usage, such as signature lines, letterhead, door signage and so on. Distinguished Fellows also may use the trademarked designation of DFSVS™. Read the official announcement here.

The SVS Executive Board has announced that all Active SVS members in good standing will now be considered Fellows of the Society for Vascular Surgery™ (FSVS™). The trademarked designation is one of the benefits of SVS membership and is a public acknowledgement that a surgeon has met the high standards required by the SVS of its members and has shown and professional commitment to the field of vascular surgery. Active members in good standing may add the initials FSVS™ after their name in any usage, such as signature lines, letterhead, door signage and so on. Distinguished Fellows also may use the trademarked designation of DFSVS™. Read the official announcement here.

The SVS Executive Board has announced that all Active SVS members in good standing will now be considered Fellows of the Society for Vascular Surgery™ (FSVS™). The trademarked designation is one of the benefits of SVS membership and is a public acknowledgement that a surgeon has met the high standards required by the SVS of its members and has shown and professional commitment to the field of vascular surgery. Active members in good standing may add the initials FSVS™ after their name in any usage, such as signature lines, letterhead, door signage and so on. Distinguished Fellows also may use the trademarked designation of DFSVS™. Read the official announcement here.

This final month of the year is the giving season, and many people delay their charitable contributions until then. Please consider making a difference in the world of vascular surgery this holiday season by donating to the SVS Foundation. The mission of the Foundation has expanded, and your dollars are needed now, more than ever. From research, to disaster relief efforts, to patient awareness and disease prevention, all contributions are ultimately aimed at improving patient health. Please give today.

This final month of the year is the giving season, and many people delay their charitable contributions until then. Please consider making a difference in the world of vascular surgery this holiday season by donating to the SVS Foundation. The mission of the Foundation has expanded, and your dollars are needed now, more than ever. From research, to disaster relief efforts, to patient awareness and disease prevention, all contributions are ultimately aimed at improving patient health. Please give today.

This final month of the year is the giving season, and many people delay their charitable contributions until then. Please consider making a difference in the world of vascular surgery this holiday season by donating to the SVS Foundation. The mission of the Foundation has expanded, and your dollars are needed now, more than ever. From research, to disaster relief efforts, to patient awareness and disease prevention, all contributions are ultimately aimed at improving patient health. Please give today.

The SVS Executive Board announced in November that all Active SVS Members in good standing will now be considered Fellows of the Society for Vascular Surgery™ (FSVS™). The trademarked designation is one of the benefits of SVS membership and is a public acknowledgement that a surgeon has met the high standards required by the SVS of its members and has shown and professional commitment to the field of vascular surgery. Active Members in good standing may add the initials FSVS™ after their name in any usage, such as signature lines, letterhead, door signage and so on. Distinguished Fellows of the Society for Vascular Surgery™ also may use the trademarked designation of DFSVS™. Read the official announcement here.

The SVS Executive Board announced in November that all Active SVS Members in good standing will now be considered Fellows of the Society for Vascular Surgery™ (FSVS™). The trademarked designation is one of the benefits of SVS membership and is a public acknowledgement that a surgeon has met the high standards required by the SVS of its members and has shown and professional commitment to the field of vascular surgery. Active Members in good standing may add the initials FSVS™ after their name in any usage, such as signature lines, letterhead, door signage and so on. Distinguished Fellows of the Society for Vascular Surgery™ also may use the trademarked designation of DFSVS™. Read the official announcement here.

The SVS Executive Board announced in November that all Active SVS Members in good standing will now be considered Fellows of the Society for Vascular Surgery™ (FSVS™). The trademarked designation is one of the benefits of SVS membership and is a public acknowledgement that a surgeon has met the high standards required by the SVS of its members and has shown and professional commitment to the field of vascular surgery. Active Members in good standing may add the initials FSVS™ after their name in any usage, such as signature lines, letterhead, door signage and so on. Distinguished Fellows of the Society for Vascular Surgery™ also may use the trademarked designation of DFSVS™. Read the official announcement here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

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

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



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

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

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

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

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

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

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

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

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

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

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



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

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

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



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

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

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

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

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

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

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

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

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

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

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



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

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

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



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

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

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

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

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

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

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



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

- Maya Jenkins, RRT

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

-Viren Kaul, MD

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

- Sarah Brundidge, MSc, RRT
 

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

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

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

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



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

- Maya Jenkins, RRT

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

-Viren Kaul, MD

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

- Sarah Brundidge, MSc, RRT
 

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

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

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

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



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

- Maya Jenkins, RRT

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

-Viren Kaul, MD

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

- Sarah Brundidge, MSc, RRT