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CHEST introduces five core organizational values

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Changed
Mon, 01/08/2024 - 13:45

Looking ahead to 2024, one notable accomplishment of the past 12 months that will guide our organization for years to come was to establish CHEST organizational values. The result of a collaborative process that was led by the Value-Setting Work Group and informed by CHEST leaders, members, and staff, the CHEST values are Community, Inclusivity, Innovation, Advocacy, and Integrity.

The process to arrive at these values was intentionally designed to ensure input from all corners of the organization. Over the course of 5 months, CHEST members had the opportunity to participate in focus groups or submit written feedback about the proposed values. The feedback shaped subsequent iterations of the values that the work group produced, finally arriving at these five.

“These values are meant to be reflective of the CHEST organization and all of its leaders, members, and staff,” said Co-Chair of the Value-Setting Work Group and CHEST Board of Regents Member Nneka Sederstrom, PhD, FCCP. “As a society, we’ve come to a point where we can’t pretend that real life issues don’t matter to our patients and to our members. It’s become a pivotal point in our world for our systems to be clear on who they are. All too often, the question of, ‘Is this our lane?’ comes up. These values are a succinct way to show not only what falls into our ‘lane,’ but that we celebrate where we stand. It was a big undertaking, but seeing the collaboration and passion was exceptional.”

The work group was co-chaired by Dr. Sederstrom and Elizabeth Stigler, PhD, and was supported by David Zielinski, MD, FCCP; Bravein Amalakuhan, MD; Alisha Young, MD; Steven Simpson, MD, FCCP; Nehan Sher, MD; and CHEST staff members, Teresa Rodriguez, Manager, CHEST Annual Meeting; Terri Horton-O’Connell, MSW, Director, Grant and Proposal Development; and Vanessa Rancine, Recruiting Specialist.

Beyond solidifying the five succinct values, the work group strategically defined each value to clarify its intent.
 

  • Community: We invest in the support, growth, and development of everyone involved with CHEST, both individually and collectively, and are tireless champions for one another.
  • Inclusivity: We cherish the diverse perspectives and experiences of our community members and amplify their unique voices.
  • Innovation: We strive for excellence in all that we do with an adaptable and ever-evolving perspective. We pursue bold, future-oriented possibilities for constant improvement and continual growth.
  • Advocacy: We courageously and intentionally create and foster positive changes for our patients and their families, our members and staff, and the next generation of CHEST clinicians.
  • Integrity: We take pride in acting responsibly with respect, honesty, and accountability that engenders trust.


“With the new values in place, hopefully, our members will feel a shift in how we, as an organization, show up when anything occurs,” Dr. Sederstrom said. “The values will be reflected through community engagement and support and will be deeply integrated into the CHEST Annual Meeting. When someone asks CHEST, ‘Who are you?’ -we can now answer it with certitude.”

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Looking ahead to 2024, one notable accomplishment of the past 12 months that will guide our organization for years to come was to establish CHEST organizational values. The result of a collaborative process that was led by the Value-Setting Work Group and informed by CHEST leaders, members, and staff, the CHEST values are Community, Inclusivity, Innovation, Advocacy, and Integrity.

The process to arrive at these values was intentionally designed to ensure input from all corners of the organization. Over the course of 5 months, CHEST members had the opportunity to participate in focus groups or submit written feedback about the proposed values. The feedback shaped subsequent iterations of the values that the work group produced, finally arriving at these five.

“These values are meant to be reflective of the CHEST organization and all of its leaders, members, and staff,” said Co-Chair of the Value-Setting Work Group and CHEST Board of Regents Member Nneka Sederstrom, PhD, FCCP. “As a society, we’ve come to a point where we can’t pretend that real life issues don’t matter to our patients and to our members. It’s become a pivotal point in our world for our systems to be clear on who they are. All too often, the question of, ‘Is this our lane?’ comes up. These values are a succinct way to show not only what falls into our ‘lane,’ but that we celebrate where we stand. It was a big undertaking, but seeing the collaboration and passion was exceptional.”

The work group was co-chaired by Dr. Sederstrom and Elizabeth Stigler, PhD, and was supported by David Zielinski, MD, FCCP; Bravein Amalakuhan, MD; Alisha Young, MD; Steven Simpson, MD, FCCP; Nehan Sher, MD; and CHEST staff members, Teresa Rodriguez, Manager, CHEST Annual Meeting; Terri Horton-O’Connell, MSW, Director, Grant and Proposal Development; and Vanessa Rancine, Recruiting Specialist.

Beyond solidifying the five succinct values, the work group strategically defined each value to clarify its intent.
 

  • Community: We invest in the support, growth, and development of everyone involved with CHEST, both individually and collectively, and are tireless champions for one another.
  • Inclusivity: We cherish the diverse perspectives and experiences of our community members and amplify their unique voices.
  • Innovation: We strive for excellence in all that we do with an adaptable and ever-evolving perspective. We pursue bold, future-oriented possibilities for constant improvement and continual growth.
  • Advocacy: We courageously and intentionally create and foster positive changes for our patients and their families, our members and staff, and the next generation of CHEST clinicians.
  • Integrity: We take pride in acting responsibly with respect, honesty, and accountability that engenders trust.


“With the new values in place, hopefully, our members will feel a shift in how we, as an organization, show up when anything occurs,” Dr. Sederstrom said. “The values will be reflected through community engagement and support and will be deeply integrated into the CHEST Annual Meeting. When someone asks CHEST, ‘Who are you?’ -we can now answer it with certitude.”

Looking ahead to 2024, one notable accomplishment of the past 12 months that will guide our organization for years to come was to establish CHEST organizational values. The result of a collaborative process that was led by the Value-Setting Work Group and informed by CHEST leaders, members, and staff, the CHEST values are Community, Inclusivity, Innovation, Advocacy, and Integrity.

The process to arrive at these values was intentionally designed to ensure input from all corners of the organization. Over the course of 5 months, CHEST members had the opportunity to participate in focus groups or submit written feedback about the proposed values. The feedback shaped subsequent iterations of the values that the work group produced, finally arriving at these five.

“These values are meant to be reflective of the CHEST organization and all of its leaders, members, and staff,” said Co-Chair of the Value-Setting Work Group and CHEST Board of Regents Member Nneka Sederstrom, PhD, FCCP. “As a society, we’ve come to a point where we can’t pretend that real life issues don’t matter to our patients and to our members. It’s become a pivotal point in our world for our systems to be clear on who they are. All too often, the question of, ‘Is this our lane?’ comes up. These values are a succinct way to show not only what falls into our ‘lane,’ but that we celebrate where we stand. It was a big undertaking, but seeing the collaboration and passion was exceptional.”

The work group was co-chaired by Dr. Sederstrom and Elizabeth Stigler, PhD, and was supported by David Zielinski, MD, FCCP; Bravein Amalakuhan, MD; Alisha Young, MD; Steven Simpson, MD, FCCP; Nehan Sher, MD; and CHEST staff members, Teresa Rodriguez, Manager, CHEST Annual Meeting; Terri Horton-O’Connell, MSW, Director, Grant and Proposal Development; and Vanessa Rancine, Recruiting Specialist.

Beyond solidifying the five succinct values, the work group strategically defined each value to clarify its intent.
 

  • Community: We invest in the support, growth, and development of everyone involved with CHEST, both individually and collectively, and are tireless champions for one another.
  • Inclusivity: We cherish the diverse perspectives and experiences of our community members and amplify their unique voices.
  • Innovation: We strive for excellence in all that we do with an adaptable and ever-evolving perspective. We pursue bold, future-oriented possibilities for constant improvement and continual growth.
  • Advocacy: We courageously and intentionally create and foster positive changes for our patients and their families, our members and staff, and the next generation of CHEST clinicians.
  • Integrity: We take pride in acting responsibly with respect, honesty, and accountability that engenders trust.


“With the new values in place, hopefully, our members will feel a shift in how we, as an organization, show up when anything occurs,” Dr. Sederstrom said. “The values will be reflected through community engagement and support and will be deeply integrated into the CHEST Annual Meeting. When someone asks CHEST, ‘Who are you?’ -we can now answer it with certitude.”

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University of Washington Fellowship director announced as mentor for Medical Educator Fellowship

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Thu, 12/07/2023 - 16:38

It wasn’t until Başak Çoruh, MD, FCCP, was a mentee herself that she realized the value of structured mentoring. And now, she has more to give.

Dr. Çoruh, Associate Professor of Pulmonary, Critical Care, and Sleep Medicine and Director of the Pulmonary and Critical Care Medicine fellowship program at the University of Washington, was named as the mentor for the Medical Educator Diversity Scholarship Fellowship.

This mentorship opportunity is part of a joint program sponsored by CHEST and the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD). It was created to support a fellow who intends to pursue a career in medical education but who may have limited resources to train in teaching, formal medical education curricula, and medical education research.

“The fellowship is an incredible opportunity to increase the diversity of our medical education community,” Dr. Çoruh said.

The fellowship also closely aligns with CHEST’s newly established philanthropic pillar of “Support of the profession.” CHEST is devoted to elevating the field of chest medicine through top-notch clinical education and empowering early career clinicians from diverse backgrounds with the latest knowledge.

“I’m particularly excited to serve as a mentor for an aspiring medical educator without access to resources for coursework, teaching activities, or scholarship at their home institution,” Dr. Çoruh said. “I am fortunate to be a part of a large and welcoming education community at the University of Washington that I’m excited to share with my mentee.”

The importance of mentorship cannot be overstated, as it can shape the rest of a clinician’s career. There is immense value in not only the funding and research aspect but in the wisdom-sharing and motivational side, as well.

“It wasn’t until my own fellowship that I experienced the value of structured mentoring, and the mentoring I have received has impacted my career in countless ways. I look forward to helping [the fellow] achieve their goals.”

The fellowship recipient will be announced in early 2024.

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It wasn’t until Başak Çoruh, MD, FCCP, was a mentee herself that she realized the value of structured mentoring. And now, she has more to give.

Dr. Çoruh, Associate Professor of Pulmonary, Critical Care, and Sleep Medicine and Director of the Pulmonary and Critical Care Medicine fellowship program at the University of Washington, was named as the mentor for the Medical Educator Diversity Scholarship Fellowship.

This mentorship opportunity is part of a joint program sponsored by CHEST and the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD). It was created to support a fellow who intends to pursue a career in medical education but who may have limited resources to train in teaching, formal medical education curricula, and medical education research.

“The fellowship is an incredible opportunity to increase the diversity of our medical education community,” Dr. Çoruh said.

The fellowship also closely aligns with CHEST’s newly established philanthropic pillar of “Support of the profession.” CHEST is devoted to elevating the field of chest medicine through top-notch clinical education and empowering early career clinicians from diverse backgrounds with the latest knowledge.

“I’m particularly excited to serve as a mentor for an aspiring medical educator without access to resources for coursework, teaching activities, or scholarship at their home institution,” Dr. Çoruh said. “I am fortunate to be a part of a large and welcoming education community at the University of Washington that I’m excited to share with my mentee.”

The importance of mentorship cannot be overstated, as it can shape the rest of a clinician’s career. There is immense value in not only the funding and research aspect but in the wisdom-sharing and motivational side, as well.

“It wasn’t until my own fellowship that I experienced the value of structured mentoring, and the mentoring I have received has impacted my career in countless ways. I look forward to helping [the fellow] achieve their goals.”

The fellowship recipient will be announced in early 2024.

It wasn’t until Başak Çoruh, MD, FCCP, was a mentee herself that she realized the value of structured mentoring. And now, she has more to give.

Dr. Çoruh, Associate Professor of Pulmonary, Critical Care, and Sleep Medicine and Director of the Pulmonary and Critical Care Medicine fellowship program at the University of Washington, was named as the mentor for the Medical Educator Diversity Scholarship Fellowship.

This mentorship opportunity is part of a joint program sponsored by CHEST and the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD). It was created to support a fellow who intends to pursue a career in medical education but who may have limited resources to train in teaching, formal medical education curricula, and medical education research.

“The fellowship is an incredible opportunity to increase the diversity of our medical education community,” Dr. Çoruh said.

The fellowship also closely aligns with CHEST’s newly established philanthropic pillar of “Support of the profession.” CHEST is devoted to elevating the field of chest medicine through top-notch clinical education and empowering early career clinicians from diverse backgrounds with the latest knowledge.

“I’m particularly excited to serve as a mentor for an aspiring medical educator without access to resources for coursework, teaching activities, or scholarship at their home institution,” Dr. Çoruh said. “I am fortunate to be a part of a large and welcoming education community at the University of Washington that I’m excited to share with my mentee.”

The importance of mentorship cannot be overstated, as it can shape the rest of a clinician’s career. There is immense value in not only the funding and research aspect but in the wisdom-sharing and motivational side, as well.

“It wasn’t until my own fellowship that I experienced the value of structured mentoring, and the mentoring I have received has impacted my career in countless ways. I look forward to helping [the fellow] achieve their goals.”

The fellowship recipient will be announced in early 2024.

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Get to know incoming CHEST President John “Jack” D. Buckley, MD, MPH, FCCP

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Thu, 11/30/2023 - 16:10

Starting January 1, 2024, current President-Elect John “Jack” D. Buckley, MD, MPH, FCCP, will become the new President of CHEST. Dr. Buckley is a pulmonologist and critical care physician with an extensive background in education, and he has served on the Board of Regents for the College for 8 years collectively.

Before Dr. Buckley steps into the role of President, he spoke with CHEST for a glimpse into what he is looking to bring to the organization.



What would you like to accomplish as President of CHEST?

I mentioned this in my address during the CHEST Annual Meeting in Honolulu, but the role of President is to guide the Board of Regents as we provide governance and direct the organization to fulfill our mission. With that in mind, my job is to advance CHEST by following our strategic plan, continuing the great work already being done, and preparing for what comes next.

As our world changes around us, we must not only adapt to the current environment but anticipate the future and take the lead by influencing the direction we believe to be important. This is the role of the Board of Regents, and we need input from CHEST’s members.

In 2023, with the guidance of an advisory board, and a tremendous amount of time and effort encompassing input from a wide range of CHEST members, leaders and staff, the organization defined its core values. The values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.

While looking forward, it’s also important to reflect on the past. CHEST started as an organization centered on preventing and treating tuberculosis. As progress was made, the entire pulmonary field evolved from tuberculosis experts and, from there, critical care emerged and continues to evolve. Now we’re seeing tremendous growth in the roles of advanced practice providers in our ICUs and, most recently, a resurgence of cardiology-critical care. We are excited to welcome these colleagues into CHEST as we move forward.



What do you consider to be CHEST’s greatest strength, and how will you build upon this during your presidency?

The strength of CHEST is in our community and our educational programs. Our emphasis is on delivering relevant information to our members in ways that are immediately clinically applicable – something I think we do better than anyone – to improve the care we’re able to provide to our patients. Through expanding our community and continuing to produce quality medical education, this will continue to be a focus for years to come.



What are some challenges facing CHEST, and how will you address them?

The challenges facing CHEST are the same challenges facing the whole of health care. Predominantly, providers and patients are both caught navigating complex health systems and insurance programs, costs of care, and access. The latter is particularly concerning for us as the burnout of health care providers has worsened, and people are leaving the clinical setting.

While there is no simple solution, CHEST has demonstrated commitments to making an impact through initiatives like First 5 Minutes®, which was created to address implicit bias, establish trust, and form a stronger connection between patients and their clinicians more quickly.

This will be a growing focus for CHEST, and it is reflected in the formal addition of social responsibility to our organizational pillars. The work being done in philanthropy and through our diversity, equity, inclusion, and belonging efforts will continue to develop and are now a core element of the organization.



And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I cannot stress enough that every person reading this should join the conversation. Meant to represent the whole of pulmonary, critical care, and sleep medicine clinicians, CHEST is stronger with every voice. Conveniently, an email address exists for this very purpose. The address president@chestnet.org is a direct way to communicate with me, and I very much encourage you to take me up on this.

Let me know what you would like to see change in 2024 or what you think we’re doing well. I’d also like to hear if there is something neat you’re doing for the field; beyond my personal interest, CHEST loves to celebrate the accomplishments of members.

I look forward to elevating your voice and am truly elated to serve as the next President of CHEST.

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Starting January 1, 2024, current President-Elect John “Jack” D. Buckley, MD, MPH, FCCP, will become the new President of CHEST. Dr. Buckley is a pulmonologist and critical care physician with an extensive background in education, and he has served on the Board of Regents for the College for 8 years collectively.

Before Dr. Buckley steps into the role of President, he spoke with CHEST for a glimpse into what he is looking to bring to the organization.



What would you like to accomplish as President of CHEST?

I mentioned this in my address during the CHEST Annual Meeting in Honolulu, but the role of President is to guide the Board of Regents as we provide governance and direct the organization to fulfill our mission. With that in mind, my job is to advance CHEST by following our strategic plan, continuing the great work already being done, and preparing for what comes next.

As our world changes around us, we must not only adapt to the current environment but anticipate the future and take the lead by influencing the direction we believe to be important. This is the role of the Board of Regents, and we need input from CHEST’s members.

In 2023, with the guidance of an advisory board, and a tremendous amount of time and effort encompassing input from a wide range of CHEST members, leaders and staff, the organization defined its core values. The values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.

While looking forward, it’s also important to reflect on the past. CHEST started as an organization centered on preventing and treating tuberculosis. As progress was made, the entire pulmonary field evolved from tuberculosis experts and, from there, critical care emerged and continues to evolve. Now we’re seeing tremendous growth in the roles of advanced practice providers in our ICUs and, most recently, a resurgence of cardiology-critical care. We are excited to welcome these colleagues into CHEST as we move forward.



What do you consider to be CHEST’s greatest strength, and how will you build upon this during your presidency?

The strength of CHEST is in our community and our educational programs. Our emphasis is on delivering relevant information to our members in ways that are immediately clinically applicable – something I think we do better than anyone – to improve the care we’re able to provide to our patients. Through expanding our community and continuing to produce quality medical education, this will continue to be a focus for years to come.



What are some challenges facing CHEST, and how will you address them?

The challenges facing CHEST are the same challenges facing the whole of health care. Predominantly, providers and patients are both caught navigating complex health systems and insurance programs, costs of care, and access. The latter is particularly concerning for us as the burnout of health care providers has worsened, and people are leaving the clinical setting.

While there is no simple solution, CHEST has demonstrated commitments to making an impact through initiatives like First 5 Minutes®, which was created to address implicit bias, establish trust, and form a stronger connection between patients and their clinicians more quickly.

This will be a growing focus for CHEST, and it is reflected in the formal addition of social responsibility to our organizational pillars. The work being done in philanthropy and through our diversity, equity, inclusion, and belonging efforts will continue to develop and are now a core element of the organization.



And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I cannot stress enough that every person reading this should join the conversation. Meant to represent the whole of pulmonary, critical care, and sleep medicine clinicians, CHEST is stronger with every voice. Conveniently, an email address exists for this very purpose. The address president@chestnet.org is a direct way to communicate with me, and I very much encourage you to take me up on this.

Let me know what you would like to see change in 2024 or what you think we’re doing well. I’d also like to hear if there is something neat you’re doing for the field; beyond my personal interest, CHEST loves to celebrate the accomplishments of members.

I look forward to elevating your voice and am truly elated to serve as the next President of CHEST.

Starting January 1, 2024, current President-Elect John “Jack” D. Buckley, MD, MPH, FCCP, will become the new President of CHEST. Dr. Buckley is a pulmonologist and critical care physician with an extensive background in education, and he has served on the Board of Regents for the College for 8 years collectively.

Before Dr. Buckley steps into the role of President, he spoke with CHEST for a glimpse into what he is looking to bring to the organization.



What would you like to accomplish as President of CHEST?

I mentioned this in my address during the CHEST Annual Meeting in Honolulu, but the role of President is to guide the Board of Regents as we provide governance and direct the organization to fulfill our mission. With that in mind, my job is to advance CHEST by following our strategic plan, continuing the great work already being done, and preparing for what comes next.

As our world changes around us, we must not only adapt to the current environment but anticipate the future and take the lead by influencing the direction we believe to be important. This is the role of the Board of Regents, and we need input from CHEST’s members.

In 2023, with the guidance of an advisory board, and a tremendous amount of time and effort encompassing input from a wide range of CHEST members, leaders and staff, the organization defined its core values. The values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.

While looking forward, it’s also important to reflect on the past. CHEST started as an organization centered on preventing and treating tuberculosis. As progress was made, the entire pulmonary field evolved from tuberculosis experts and, from there, critical care emerged and continues to evolve. Now we’re seeing tremendous growth in the roles of advanced practice providers in our ICUs and, most recently, a resurgence of cardiology-critical care. We are excited to welcome these colleagues into CHEST as we move forward.



What do you consider to be CHEST’s greatest strength, and how will you build upon this during your presidency?

The strength of CHEST is in our community and our educational programs. Our emphasis is on delivering relevant information to our members in ways that are immediately clinically applicable – something I think we do better than anyone – to improve the care we’re able to provide to our patients. Through expanding our community and continuing to produce quality medical education, this will continue to be a focus for years to come.



What are some challenges facing CHEST, and how will you address them?

The challenges facing CHEST are the same challenges facing the whole of health care. Predominantly, providers and patients are both caught navigating complex health systems and insurance programs, costs of care, and access. The latter is particularly concerning for us as the burnout of health care providers has worsened, and people are leaving the clinical setting.

While there is no simple solution, CHEST has demonstrated commitments to making an impact through initiatives like First 5 Minutes®, which was created to address implicit bias, establish trust, and form a stronger connection between patients and their clinicians more quickly.

This will be a growing focus for CHEST, and it is reflected in the formal addition of social responsibility to our organizational pillars. The work being done in philanthropy and through our diversity, equity, inclusion, and belonging efforts will continue to develop and are now a core element of the organization.



And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I cannot stress enough that every person reading this should join the conversation. Meant to represent the whole of pulmonary, critical care, and sleep medicine clinicians, CHEST is stronger with every voice. Conveniently, an email address exists for this very purpose. The address president@chestnet.org is a direct way to communicate with me, and I very much encourage you to take me up on this.

Let me know what you would like to see change in 2024 or what you think we’re doing well. I’d also like to hear if there is something neat you’re doing for the field; beyond my personal interest, CHEST loves to celebrate the accomplishments of members.

I look forward to elevating your voice and am truly elated to serve as the next President of CHEST.

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“A physician’s secret weapon”: Why the world needs more RTs

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Thu, 12/07/2023 - 16:44

CHEST and the National Board for Respiratory Care (NBRC) are continuing their longstanding partnership to raise awareness about the More RTs initiative, which addresses the alarming shortage of respiratory therapists (RTs) in the United States.

The COVID-19 pandemic intensified the shortage of RTs, but the problem predated the 2020 crisis. A survey from the American Association for Respiratory Care showed several factors driving the need for more RTs, including an aging U.S. population, growing incidences of respiratory disorders, and advances in pulmonary medical devices.

But the squeeze is coming from both internal and external forces. Retirements of RTs are outpacing new growth, while, at the same time, the need for quality respiratory care is increasing. Simply put, demand for RTs is high but the supply of RTs is dangerously low.

Lori Tinkler, Executive Officer of the NBRC, said physicians can make a difference in increasing the number of RTs and championing their success on the clinical care team. Tinkler recently shared her insights on the initiative and how physicians can get involved.


CHEST: Respiratory therapists are extremely valuable members of the clinical care team. Can you share why RTs are so important?

Lori Tinkler: I like to say respiratory therapists are a physician’s secret weapon. Respiratory therapists work under the direction of a medical director.

They really carry out the orders of physicians and help the physician determine the best pathway for patients using protocols. They [serve as] experts when it comes to ventilators and treating the patients for their pulmonary issues under the physician’s orders.


CHEST: How can physicians get more done with more RTs on the clinical team?

Tinkler: By working with protocols and relying on their respiratory therapists. Listen to what they’re saying when it comes to patient care since respiratory therapists are spending much more time with the patients than the physicians are.

It’s really the whole health care team working together with the patient. What [physicians can] keep in mind is, how are they going treat that patient the best and utilize the expertise that respiratory therapists bring to the table? They probably have the most diverse skillset, but they are highly trained and specialized in lung diseases and treatment of asthma and COPD.


CHEST: How can physicians help integrate RTs into the clinical team?

Tinkler: It’s really ensuring that their institutions recognize the value of respiratory therapists and what they bring to the table. Ensuring that their departments are adequately staffed and championing that effort, speaking up, and being a voice for the respiratory therapist and what they bring to the bedside.


CHEST: How else can physicians get involved?

Tinkler: We’re always looking for physician stories about how they utilize and champion their respiratory therapist. And, of course, we’re always looking for physicians to get involved in the credentialing process by being a consultant or board member, or by being a content expert and helping write the test questions for the respiratory therapy credentialing exams.

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CHEST and the National Board for Respiratory Care (NBRC) are continuing their longstanding partnership to raise awareness about the More RTs initiative, which addresses the alarming shortage of respiratory therapists (RTs) in the United States.

The COVID-19 pandemic intensified the shortage of RTs, but the problem predated the 2020 crisis. A survey from the American Association for Respiratory Care showed several factors driving the need for more RTs, including an aging U.S. population, growing incidences of respiratory disorders, and advances in pulmonary medical devices.

But the squeeze is coming from both internal and external forces. Retirements of RTs are outpacing new growth, while, at the same time, the need for quality respiratory care is increasing. Simply put, demand for RTs is high but the supply of RTs is dangerously low.

Lori Tinkler, Executive Officer of the NBRC, said physicians can make a difference in increasing the number of RTs and championing their success on the clinical care team. Tinkler recently shared her insights on the initiative and how physicians can get involved.


CHEST: Respiratory therapists are extremely valuable members of the clinical care team. Can you share why RTs are so important?

Lori Tinkler: I like to say respiratory therapists are a physician’s secret weapon. Respiratory therapists work under the direction of a medical director.

They really carry out the orders of physicians and help the physician determine the best pathway for patients using protocols. They [serve as] experts when it comes to ventilators and treating the patients for their pulmonary issues under the physician’s orders.


CHEST: How can physicians get more done with more RTs on the clinical team?

Tinkler: By working with protocols and relying on their respiratory therapists. Listen to what they’re saying when it comes to patient care since respiratory therapists are spending much more time with the patients than the physicians are.

It’s really the whole health care team working together with the patient. What [physicians can] keep in mind is, how are they going treat that patient the best and utilize the expertise that respiratory therapists bring to the table? They probably have the most diverse skillset, but they are highly trained and specialized in lung diseases and treatment of asthma and COPD.


CHEST: How can physicians help integrate RTs into the clinical team?

Tinkler: It’s really ensuring that their institutions recognize the value of respiratory therapists and what they bring to the table. Ensuring that their departments are adequately staffed and championing that effort, speaking up, and being a voice for the respiratory therapist and what they bring to the bedside.


CHEST: How else can physicians get involved?

Tinkler: We’re always looking for physician stories about how they utilize and champion their respiratory therapist. And, of course, we’re always looking for physicians to get involved in the credentialing process by being a consultant or board member, or by being a content expert and helping write the test questions for the respiratory therapy credentialing exams.

CHEST and the National Board for Respiratory Care (NBRC) are continuing their longstanding partnership to raise awareness about the More RTs initiative, which addresses the alarming shortage of respiratory therapists (RTs) in the United States.

The COVID-19 pandemic intensified the shortage of RTs, but the problem predated the 2020 crisis. A survey from the American Association for Respiratory Care showed several factors driving the need for more RTs, including an aging U.S. population, growing incidences of respiratory disorders, and advances in pulmonary medical devices.

But the squeeze is coming from both internal and external forces. Retirements of RTs are outpacing new growth, while, at the same time, the need for quality respiratory care is increasing. Simply put, demand for RTs is high but the supply of RTs is dangerously low.

Lori Tinkler, Executive Officer of the NBRC, said physicians can make a difference in increasing the number of RTs and championing their success on the clinical care team. Tinkler recently shared her insights on the initiative and how physicians can get involved.


CHEST: Respiratory therapists are extremely valuable members of the clinical care team. Can you share why RTs are so important?

Lori Tinkler: I like to say respiratory therapists are a physician’s secret weapon. Respiratory therapists work under the direction of a medical director.

They really carry out the orders of physicians and help the physician determine the best pathway for patients using protocols. They [serve as] experts when it comes to ventilators and treating the patients for their pulmonary issues under the physician’s orders.


CHEST: How can physicians get more done with more RTs on the clinical team?

Tinkler: By working with protocols and relying on their respiratory therapists. Listen to what they’re saying when it comes to patient care since respiratory therapists are spending much more time with the patients than the physicians are.

It’s really the whole health care team working together with the patient. What [physicians can] keep in mind is, how are they going treat that patient the best and utilize the expertise that respiratory therapists bring to the table? They probably have the most diverse skillset, but they are highly trained and specialized in lung diseases and treatment of asthma and COPD.


CHEST: How can physicians help integrate RTs into the clinical team?

Tinkler: It’s really ensuring that their institutions recognize the value of respiratory therapists and what they bring to the table. Ensuring that their departments are adequately staffed and championing that effort, speaking up, and being a voice for the respiratory therapist and what they bring to the bedside.


CHEST: How else can physicians get involved?

Tinkler: We’re always looking for physician stories about how they utilize and champion their respiratory therapist. And, of course, we’re always looking for physicians to get involved in the credentialing process by being a consultant or board member, or by being a content expert and helping write the test questions for the respiratory therapy credentialing exams.

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CHEST 2023 award winners

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Thu, 12/07/2023 - 16:41

Each year, CHEST recognizes members who make an impact – through dedication to the organization, by contributions to research and practice, through their commitment to educating the next generation, and so much more.

MASTER FELLOW AWARD

John E. Studdard, MD, FCCP

Masters of CHEST are national or international Fellows of CHEST who have distinguished themselves by attaining professional preeminence. Because of their personal character and leadership; extraordinary contributions to medical research, clinical practice, quality improvement, or medical education; and years of enduring and outstanding service to CHEST, they have advanced chest medicine

DISTINGUISHED SERVICE AWARD

Victor J. Test, MD, FCCP

This award is conferred to a CHEST Fellow (FCCP) who has held a CHEST leadership position; has led significant society achievements; and/or has donated time, leadership, and service to CHEST.

COLLEGE MEDALIST AWARD

Steven D. Nathan, MBBCh, FCCP

The College Medalist Award is a long-standing CHEST tradition. This award is given for meritorious service in furthering progress in the field of diseases of the chest.


EARLY CAREER CLINICIAN EDUCATOR AWARD

Viren Kaul, MD, FCCP

The Early Career Clinician Educator Award recognizes the achievements of a clinician educator who has already made significant contributions to CHEST educational activities and is committed to continuing to grow as CHEST faculty.


MASTER CLINICIAN EDUCATOR AWARD

Christopher L. Carroll, MD, FCCP

The Master Clinician Educator Award recognizes long-term achievements of one clinician educator who has made significant contributions to CHEST activities and has demonstrated a strong commitment to medical education throughout their career.


ALFRED SOFFER AWARD FOR EDITORIAL EXCELLENCE

Laura Riordan

This award honors Alfred Soffer, MD, Master FCCP, Editor-in-Chief of the journal CHEST® from 1968 to 1993, and Executive Director of CHEST from 1969 to 1992. Recipients have made significant contributions to CHEST and are often world experts in their fields, have written numerous papers and abstracts, have served as primary investigators, and/or have served as a department editor for the journal CHEST.


PRESIDENTIAL CITATION

Scott Manaker, MD, PhD, FCCP

The Presidential Citation is awarded on behalf of the CHEST President to individuals who have shown their dedication to the chest medicine field and for their contributions to CHEST.


For a comprehensive list of Distinguished CHEST Educators, new FCCP designees, and scientific abstract award winners, visit chestnet.org/awards.

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Each year, CHEST recognizes members who make an impact – through dedication to the organization, by contributions to research and practice, through their commitment to educating the next generation, and so much more.

MASTER FELLOW AWARD

John E. Studdard, MD, FCCP

Masters of CHEST are national or international Fellows of CHEST who have distinguished themselves by attaining professional preeminence. Because of their personal character and leadership; extraordinary contributions to medical research, clinical practice, quality improvement, or medical education; and years of enduring and outstanding service to CHEST, they have advanced chest medicine

DISTINGUISHED SERVICE AWARD

Victor J. Test, MD, FCCP

This award is conferred to a CHEST Fellow (FCCP) who has held a CHEST leadership position; has led significant society achievements; and/or has donated time, leadership, and service to CHEST.

COLLEGE MEDALIST AWARD

Steven D. Nathan, MBBCh, FCCP

The College Medalist Award is a long-standing CHEST tradition. This award is given for meritorious service in furthering progress in the field of diseases of the chest.


EARLY CAREER CLINICIAN EDUCATOR AWARD

Viren Kaul, MD, FCCP

The Early Career Clinician Educator Award recognizes the achievements of a clinician educator who has already made significant contributions to CHEST educational activities and is committed to continuing to grow as CHEST faculty.


MASTER CLINICIAN EDUCATOR AWARD

Christopher L. Carroll, MD, FCCP

The Master Clinician Educator Award recognizes long-term achievements of one clinician educator who has made significant contributions to CHEST activities and has demonstrated a strong commitment to medical education throughout their career.


ALFRED SOFFER AWARD FOR EDITORIAL EXCELLENCE

Laura Riordan

This award honors Alfred Soffer, MD, Master FCCP, Editor-in-Chief of the journal CHEST® from 1968 to 1993, and Executive Director of CHEST from 1969 to 1992. Recipients have made significant contributions to CHEST and are often world experts in their fields, have written numerous papers and abstracts, have served as primary investigators, and/or have served as a department editor for the journal CHEST.


PRESIDENTIAL CITATION

Scott Manaker, MD, PhD, FCCP

The Presidential Citation is awarded on behalf of the CHEST President to individuals who have shown their dedication to the chest medicine field and for their contributions to CHEST.


For a comprehensive list of Distinguished CHEST Educators, new FCCP designees, and scientific abstract award winners, visit chestnet.org/awards.

Each year, CHEST recognizes members who make an impact – through dedication to the organization, by contributions to research and practice, through their commitment to educating the next generation, and so much more.

MASTER FELLOW AWARD

John E. Studdard, MD, FCCP

Masters of CHEST are national or international Fellows of CHEST who have distinguished themselves by attaining professional preeminence. Because of their personal character and leadership; extraordinary contributions to medical research, clinical practice, quality improvement, or medical education; and years of enduring and outstanding service to CHEST, they have advanced chest medicine

DISTINGUISHED SERVICE AWARD

Victor J. Test, MD, FCCP

This award is conferred to a CHEST Fellow (FCCP) who has held a CHEST leadership position; has led significant society achievements; and/or has donated time, leadership, and service to CHEST.

COLLEGE MEDALIST AWARD

Steven D. Nathan, MBBCh, FCCP

The College Medalist Award is a long-standing CHEST tradition. This award is given for meritorious service in furthering progress in the field of diseases of the chest.


EARLY CAREER CLINICIAN EDUCATOR AWARD

Viren Kaul, MD, FCCP

The Early Career Clinician Educator Award recognizes the achievements of a clinician educator who has already made significant contributions to CHEST educational activities and is committed to continuing to grow as CHEST faculty.


MASTER CLINICIAN EDUCATOR AWARD

Christopher L. Carroll, MD, FCCP

The Master Clinician Educator Award recognizes long-term achievements of one clinician educator who has made significant contributions to CHEST activities and has demonstrated a strong commitment to medical education throughout their career.


ALFRED SOFFER AWARD FOR EDITORIAL EXCELLENCE

Laura Riordan

This award honors Alfred Soffer, MD, Master FCCP, Editor-in-Chief of the journal CHEST® from 1968 to 1993, and Executive Director of CHEST from 1969 to 1992. Recipients have made significant contributions to CHEST and are often world experts in their fields, have written numerous papers and abstracts, have served as primary investigators, and/or have served as a department editor for the journal CHEST.


PRESIDENTIAL CITATION

Scott Manaker, MD, PhD, FCCP

The Presidential Citation is awarded on behalf of the CHEST President to individuals who have shown their dedication to the chest medicine field and for their contributions to CHEST.


For a comprehensive list of Distinguished CHEST Educators, new FCCP designees, and scientific abstract award winners, visit chestnet.org/awards.

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ILD: Time lost is lung lost

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Fri, 11/03/2023 - 17:35

First launched in 2022 in partnership with Three Lakes Foundation, Bridging Specialties™: Timely Diagnosis for ILD is a collaborative initiative hinged on bringing together pulmonary and primary care experts. To shorten the time to diagnosis for interstitial lung diseases (ILDs) like pulmonary fibrosis, the initiative illustrates that there is a need for clinicians to work collaboratively, utilizing the unique strengths of all involved. The steering committee of experts from both fields created a clinician-facing toolkit that, with support of two quality improvement grants, will be introduced into health care institutions in 2024.

Kavitha Selvan, MD, Pulmonary and Critical Care Fellow at the University of Chicago School of Medicine, and Amirahwaty Abdullah, MBBS, Assistant Professor & Critical Care Medicine Associate Program Director at the West Virginia University School of Medicine, are the recipients of the grants. Each recipient will receive funding to implement strategic quality improvement projects designed to work closely with primary care partners and address the needs of their communities to shorten the time to diagnosis for patients with ILD.

Dr. Selvan’s project leverages the diverse population of Chicago and will engage primary care physicians by working closely with the Medical Director of the Primary Care Group within the University of Chicago. “There is a growing body of research that illustrates vast racial and ethnic disparities in ILD outcomes, including time to diagnosis and survival. The diverse community we serve in Chicago provided the inspiration for our project, which we hope will enable us to take a meaningful step toward achieving equity in health care,” Dr. Selvan said. “Through close collaboration with the dedicated physicians in our Primary Care Group, we aim to increase recognition of signs and symptoms suggestive of ILD earlier in the course of disease and streamline the thoughtful, multidisciplinary care our patients need.”

Affecting 400,000 people in the United States, ILDs are often overlooked as a potential diagnosis given their rarity. A proper diagnosis for this disease is further complicated by ubiquitous presenting symptoms that are common in many other diseases, including asthma, COPD, and cardiac conditions, and often leads to a misdiagnosis. This delay in diagnosis, or an outright misdiagnosis, leads to additional delays in receiving proper treatment and, subsequently, a degradation in the patient’s quality of life. For Dr. Abdullah, the rarity of the disease is not the issue; rather, there is an access issue. Because of this, their project will focus on telemedicine implementation to meet the needs of their area. “While ILD is a rare disease, the state of West Virginia has a disproportionately increased prevalence due to a variety of societal factors,” Dr. Abdullah said. “Despite this prevalence, there is one ILD clinic in the state of West Virginia in comparison to 1,253 primary care providers throughout the state. To address this gap, the project will focus on expanding telemedicine capabilities in order to reach these patients virtually through their primary care physicians who would help us to facilitate the video-assisted visits.”

To learn more about the toolkit they will be implementing, visit the CHEST website.

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First launched in 2022 in partnership with Three Lakes Foundation, Bridging Specialties™: Timely Diagnosis for ILD is a collaborative initiative hinged on bringing together pulmonary and primary care experts. To shorten the time to diagnosis for interstitial lung diseases (ILDs) like pulmonary fibrosis, the initiative illustrates that there is a need for clinicians to work collaboratively, utilizing the unique strengths of all involved. The steering committee of experts from both fields created a clinician-facing toolkit that, with support of two quality improvement grants, will be introduced into health care institutions in 2024.

Kavitha Selvan, MD, Pulmonary and Critical Care Fellow at the University of Chicago School of Medicine, and Amirahwaty Abdullah, MBBS, Assistant Professor & Critical Care Medicine Associate Program Director at the West Virginia University School of Medicine, are the recipients of the grants. Each recipient will receive funding to implement strategic quality improvement projects designed to work closely with primary care partners and address the needs of their communities to shorten the time to diagnosis for patients with ILD.

Dr. Selvan’s project leverages the diverse population of Chicago and will engage primary care physicians by working closely with the Medical Director of the Primary Care Group within the University of Chicago. “There is a growing body of research that illustrates vast racial and ethnic disparities in ILD outcomes, including time to diagnosis and survival. The diverse community we serve in Chicago provided the inspiration for our project, which we hope will enable us to take a meaningful step toward achieving equity in health care,” Dr. Selvan said. “Through close collaboration with the dedicated physicians in our Primary Care Group, we aim to increase recognition of signs and symptoms suggestive of ILD earlier in the course of disease and streamline the thoughtful, multidisciplinary care our patients need.”

Affecting 400,000 people in the United States, ILDs are often overlooked as a potential diagnosis given their rarity. A proper diagnosis for this disease is further complicated by ubiquitous presenting symptoms that are common in many other diseases, including asthma, COPD, and cardiac conditions, and often leads to a misdiagnosis. This delay in diagnosis, or an outright misdiagnosis, leads to additional delays in receiving proper treatment and, subsequently, a degradation in the patient’s quality of life. For Dr. Abdullah, the rarity of the disease is not the issue; rather, there is an access issue. Because of this, their project will focus on telemedicine implementation to meet the needs of their area. “While ILD is a rare disease, the state of West Virginia has a disproportionately increased prevalence due to a variety of societal factors,” Dr. Abdullah said. “Despite this prevalence, there is one ILD clinic in the state of West Virginia in comparison to 1,253 primary care providers throughout the state. To address this gap, the project will focus on expanding telemedicine capabilities in order to reach these patients virtually through their primary care physicians who would help us to facilitate the video-assisted visits.”

To learn more about the toolkit they will be implementing, visit the CHEST website.

First launched in 2022 in partnership with Three Lakes Foundation, Bridging Specialties™: Timely Diagnosis for ILD is a collaborative initiative hinged on bringing together pulmonary and primary care experts. To shorten the time to diagnosis for interstitial lung diseases (ILDs) like pulmonary fibrosis, the initiative illustrates that there is a need for clinicians to work collaboratively, utilizing the unique strengths of all involved. The steering committee of experts from both fields created a clinician-facing toolkit that, with support of two quality improvement grants, will be introduced into health care institutions in 2024.

Kavitha Selvan, MD, Pulmonary and Critical Care Fellow at the University of Chicago School of Medicine, and Amirahwaty Abdullah, MBBS, Assistant Professor & Critical Care Medicine Associate Program Director at the West Virginia University School of Medicine, are the recipients of the grants. Each recipient will receive funding to implement strategic quality improvement projects designed to work closely with primary care partners and address the needs of their communities to shorten the time to diagnosis for patients with ILD.

Dr. Selvan’s project leverages the diverse population of Chicago and will engage primary care physicians by working closely with the Medical Director of the Primary Care Group within the University of Chicago. “There is a growing body of research that illustrates vast racial and ethnic disparities in ILD outcomes, including time to diagnosis and survival. The diverse community we serve in Chicago provided the inspiration for our project, which we hope will enable us to take a meaningful step toward achieving equity in health care,” Dr. Selvan said. “Through close collaboration with the dedicated physicians in our Primary Care Group, we aim to increase recognition of signs and symptoms suggestive of ILD earlier in the course of disease and streamline the thoughtful, multidisciplinary care our patients need.”

Affecting 400,000 people in the United States, ILDs are often overlooked as a potential diagnosis given their rarity. A proper diagnosis for this disease is further complicated by ubiquitous presenting symptoms that are common in many other diseases, including asthma, COPD, and cardiac conditions, and often leads to a misdiagnosis. This delay in diagnosis, or an outright misdiagnosis, leads to additional delays in receiving proper treatment and, subsequently, a degradation in the patient’s quality of life. For Dr. Abdullah, the rarity of the disease is not the issue; rather, there is an access issue. Because of this, their project will focus on telemedicine implementation to meet the needs of their area. “While ILD is a rare disease, the state of West Virginia has a disproportionately increased prevalence due to a variety of societal factors,” Dr. Abdullah said. “Despite this prevalence, there is one ILD clinic in the state of West Virginia in comparison to 1,253 primary care providers throughout the state. To address this gap, the project will focus on expanding telemedicine capabilities in order to reach these patients virtually through their primary care physicians who would help us to facilitate the video-assisted visits.”

To learn more about the toolkit they will be implementing, visit the CHEST website.

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Gen Z is hooked on vaping

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Changed
Fri, 11/03/2023 - 17:29

Exploring the obstacles to nicotine cessation among teens

Pulmonologist Evan Stepp, MD, FCCP, has a teenage daughter who doesn’t smoke or vape – as far as he knows, Stepp will admit – but the statistics on youth smoking are alarming enough to have him worried.

On one hand, fewer Americans are smoking today than ever before. Since 1992, the percentage of people who told Gallup that they’d had a cigarette in the past week has dropped from 28% to 11%. Meanwhile, the rate of new lung cancer cases declined from 65 per every 100,000 people in 1992 to 34 per 100,000 in 2020, according to the National Cancer Institute.

While those statistics are worth celebrating, they hide an alarming reality: A disproportionate number of teens and young adults today are addicted to nicotine.

According to a November 2022 report from the Centers for Disease Control and Prevention (CDC), 1 in 6 high school students and 1 in 20 middle schoolers are using a nicotine product at least once every day.

“It’s a completely different picture for nicotine cessation in youth,” Dr. Stepp, who is an associate professor at National Jewish Health in Denver, said. “Because of the fact that the nicotine addiction is occurring in a developing brain, which raises many other nicotine-related harms.”
 

Why teens vape

Today’s teens are smoking less actual tobacco, and, instead, overwhelmingly prefer e-cigarettes or vaping. In fact, 85% of high school–aged smokers and 72% of middle school smokers reach for a vape over regular cigarettes or smokeless tobacco, according to the CDC.

It’s not hard to understand why: e-cigarettes use a heating element to turn a nicotine-infused liquid into an aerosol, with no open flame, ash, or lingering smoke. The vapes themselves are easy to conceal, and if someone needed to hide an e-cigarette from particularly perceptive parents or teachers, they can find vapes built into hoodies, fake smartwatches, and USB drives.

Plus, the liquids often come in flavors like fruit, bubble gum, mint, and vanilla, because unflavored nicotine isn’t exactly appealing. “Huge concentrations of nicotine salts are just miserable to breathe in,” Dr. Stepp said. “Flavors are necessary to make these products palatable, and those flavors end up being a huge draw for youth users to get exposed to nicotine addiction.”
 

Challenges surrounding smoking cessation in youth

The powerful effect of nicotine in youth means the need for effective cessation strategies is both more urgent and more difficult. But while physicians can prescribe to adults the antidepressants varenicline and bupropion, along with nicotine replacement therapy, to help ease withdrawal symptoms, the US Food and Drug Administration (FDA) has not approved those medications for anyone under the age of 18.

Research on cessation medications in young people is limited: A recent meta-analysis found only four studies on people between the ages of 12 and 21. In teens, antidepressants seem to help quitting for the first few weeks but are unproven as a long-term solution.

“That really has been a challenge for the 1 in 6 high school students who are current users of tobacco products,” said pediatrician, Susan Walley, MD, a co-author of the American Academy of Pediatrics’ recent position papers on children and smoking.

“One of the things that is important to keep at the forefront of the conversation is that nicotine addiction is a chronic medical disease, and it’s a form of substance abuse,” Dr. Walley said. “We know that we need more research in adolescent tobacco cessation, and it really is about the funding, about research dollars.”

Without medications, smoking cessation in teens relies largely on counseling strategies. A 2017 review published by Cochrane Library found that group counseling was the most effective quitting method, with teens participating in group sessions 35% more likely to stop using nicotine products up to a year later, compared with teens who did not receive any counseling.

Counseling can help educate teens (and parents) on some of the realities of e-cigarettes, bridging the gap between well-established anti-smoking campaigns and the anti-vape campaigns that have yet to catch up.

“We have done a great job promoting cigarette use as dangerous,” Dr. Walley said. “[But] many teens who would never pick up a cigarette –because they know the health risks – are vaping.”
 

 

 

How to get a teen to quit

Cessation and prevention strategies are closely linked, and interventions can start in middle school-aged children up through high school and young adults. Simply asking a 12-year-old, “Do you know anyone who smokes?” can help start a conversation that leads to an attempt to quit.

Teens may be compelled to smoke through digital advertising and influencer endorsements on social media platforms, but Gen Z is turned off by the idea that it’s being manipulated by the tobacco industry. Juul, for example, is partially owned by Altria, which makes Marlboros, and Vuse is wholly owned by R.J. Reynolds, which makes Camel cigarettes.

“If you can get somebody to understand that Big Tobacco is trying to manipulate you as a young person to want to illegally obtain and use their products, which are incredibly addictive, thus ensuring you will remain a loyal customer, that could be the thing that pushes them over the hump,” Dr. Stepp said. “You push it away like you would push away a parent trying to tell you how to park a car in the driveway.”

And just because a smoker relapses, it doesn’t mean the cessation was a complete failure. The younger someone is when they stop smoking, the less likely they are to suffer from the long-term health consequences of smoking, according to a 2021 study in the Journal of the American Medical Association. “With the right counseling,” Dr. Walley said, “each relapse is an opportunity for losing the habit permanently.”


This article was adapted from the Summer 2023 online issue of CHEST Advocates. For the full article – and to engage with the other content from this issue – visit https://chestnet.org/chest-­advocates.

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Exploring the obstacles to nicotine cessation among teens

Exploring the obstacles to nicotine cessation among teens

Pulmonologist Evan Stepp, MD, FCCP, has a teenage daughter who doesn’t smoke or vape – as far as he knows, Stepp will admit – but the statistics on youth smoking are alarming enough to have him worried.

On one hand, fewer Americans are smoking today than ever before. Since 1992, the percentage of people who told Gallup that they’d had a cigarette in the past week has dropped from 28% to 11%. Meanwhile, the rate of new lung cancer cases declined from 65 per every 100,000 people in 1992 to 34 per 100,000 in 2020, according to the National Cancer Institute.

While those statistics are worth celebrating, they hide an alarming reality: A disproportionate number of teens and young adults today are addicted to nicotine.

According to a November 2022 report from the Centers for Disease Control and Prevention (CDC), 1 in 6 high school students and 1 in 20 middle schoolers are using a nicotine product at least once every day.

“It’s a completely different picture for nicotine cessation in youth,” Dr. Stepp, who is an associate professor at National Jewish Health in Denver, said. “Because of the fact that the nicotine addiction is occurring in a developing brain, which raises many other nicotine-related harms.”
 

Why teens vape

Today’s teens are smoking less actual tobacco, and, instead, overwhelmingly prefer e-cigarettes or vaping. In fact, 85% of high school–aged smokers and 72% of middle school smokers reach for a vape over regular cigarettes or smokeless tobacco, according to the CDC.

It’s not hard to understand why: e-cigarettes use a heating element to turn a nicotine-infused liquid into an aerosol, with no open flame, ash, or lingering smoke. The vapes themselves are easy to conceal, and if someone needed to hide an e-cigarette from particularly perceptive parents or teachers, they can find vapes built into hoodies, fake smartwatches, and USB drives.

Plus, the liquids often come in flavors like fruit, bubble gum, mint, and vanilla, because unflavored nicotine isn’t exactly appealing. “Huge concentrations of nicotine salts are just miserable to breathe in,” Dr. Stepp said. “Flavors are necessary to make these products palatable, and those flavors end up being a huge draw for youth users to get exposed to nicotine addiction.”
 

Challenges surrounding smoking cessation in youth

The powerful effect of nicotine in youth means the need for effective cessation strategies is both more urgent and more difficult. But while physicians can prescribe to adults the antidepressants varenicline and bupropion, along with nicotine replacement therapy, to help ease withdrawal symptoms, the US Food and Drug Administration (FDA) has not approved those medications for anyone under the age of 18.

Research on cessation medications in young people is limited: A recent meta-analysis found only four studies on people between the ages of 12 and 21. In teens, antidepressants seem to help quitting for the first few weeks but are unproven as a long-term solution.

“That really has been a challenge for the 1 in 6 high school students who are current users of tobacco products,” said pediatrician, Susan Walley, MD, a co-author of the American Academy of Pediatrics’ recent position papers on children and smoking.

“One of the things that is important to keep at the forefront of the conversation is that nicotine addiction is a chronic medical disease, and it’s a form of substance abuse,” Dr. Walley said. “We know that we need more research in adolescent tobacco cessation, and it really is about the funding, about research dollars.”

Without medications, smoking cessation in teens relies largely on counseling strategies. A 2017 review published by Cochrane Library found that group counseling was the most effective quitting method, with teens participating in group sessions 35% more likely to stop using nicotine products up to a year later, compared with teens who did not receive any counseling.

Counseling can help educate teens (and parents) on some of the realities of e-cigarettes, bridging the gap between well-established anti-smoking campaigns and the anti-vape campaigns that have yet to catch up.

“We have done a great job promoting cigarette use as dangerous,” Dr. Walley said. “[But] many teens who would never pick up a cigarette –because they know the health risks – are vaping.”
 

 

 

How to get a teen to quit

Cessation and prevention strategies are closely linked, and interventions can start in middle school-aged children up through high school and young adults. Simply asking a 12-year-old, “Do you know anyone who smokes?” can help start a conversation that leads to an attempt to quit.

Teens may be compelled to smoke through digital advertising and influencer endorsements on social media platforms, but Gen Z is turned off by the idea that it’s being manipulated by the tobacco industry. Juul, for example, is partially owned by Altria, which makes Marlboros, and Vuse is wholly owned by R.J. Reynolds, which makes Camel cigarettes.

“If you can get somebody to understand that Big Tobacco is trying to manipulate you as a young person to want to illegally obtain and use their products, which are incredibly addictive, thus ensuring you will remain a loyal customer, that could be the thing that pushes them over the hump,” Dr. Stepp said. “You push it away like you would push away a parent trying to tell you how to park a car in the driveway.”

And just because a smoker relapses, it doesn’t mean the cessation was a complete failure. The younger someone is when they stop smoking, the less likely they are to suffer from the long-term health consequences of smoking, according to a 2021 study in the Journal of the American Medical Association. “With the right counseling,” Dr. Walley said, “each relapse is an opportunity for losing the habit permanently.”


This article was adapted from the Summer 2023 online issue of CHEST Advocates. For the full article – and to engage with the other content from this issue – visit https://chestnet.org/chest-­advocates.

Pulmonologist Evan Stepp, MD, FCCP, has a teenage daughter who doesn’t smoke or vape – as far as he knows, Stepp will admit – but the statistics on youth smoking are alarming enough to have him worried.

On one hand, fewer Americans are smoking today than ever before. Since 1992, the percentage of people who told Gallup that they’d had a cigarette in the past week has dropped from 28% to 11%. Meanwhile, the rate of new lung cancer cases declined from 65 per every 100,000 people in 1992 to 34 per 100,000 in 2020, according to the National Cancer Institute.

While those statistics are worth celebrating, they hide an alarming reality: A disproportionate number of teens and young adults today are addicted to nicotine.

According to a November 2022 report from the Centers for Disease Control and Prevention (CDC), 1 in 6 high school students and 1 in 20 middle schoolers are using a nicotine product at least once every day.

“It’s a completely different picture for nicotine cessation in youth,” Dr. Stepp, who is an associate professor at National Jewish Health in Denver, said. “Because of the fact that the nicotine addiction is occurring in a developing brain, which raises many other nicotine-related harms.”
 

Why teens vape

Today’s teens are smoking less actual tobacco, and, instead, overwhelmingly prefer e-cigarettes or vaping. In fact, 85% of high school–aged smokers and 72% of middle school smokers reach for a vape over regular cigarettes or smokeless tobacco, according to the CDC.

It’s not hard to understand why: e-cigarettes use a heating element to turn a nicotine-infused liquid into an aerosol, with no open flame, ash, or lingering smoke. The vapes themselves are easy to conceal, and if someone needed to hide an e-cigarette from particularly perceptive parents or teachers, they can find vapes built into hoodies, fake smartwatches, and USB drives.

Plus, the liquids often come in flavors like fruit, bubble gum, mint, and vanilla, because unflavored nicotine isn’t exactly appealing. “Huge concentrations of nicotine salts are just miserable to breathe in,” Dr. Stepp said. “Flavors are necessary to make these products palatable, and those flavors end up being a huge draw for youth users to get exposed to nicotine addiction.”
 

Challenges surrounding smoking cessation in youth

The powerful effect of nicotine in youth means the need for effective cessation strategies is both more urgent and more difficult. But while physicians can prescribe to adults the antidepressants varenicline and bupropion, along with nicotine replacement therapy, to help ease withdrawal symptoms, the US Food and Drug Administration (FDA) has not approved those medications for anyone under the age of 18.

Research on cessation medications in young people is limited: A recent meta-analysis found only four studies on people between the ages of 12 and 21. In teens, antidepressants seem to help quitting for the first few weeks but are unproven as a long-term solution.

“That really has been a challenge for the 1 in 6 high school students who are current users of tobacco products,” said pediatrician, Susan Walley, MD, a co-author of the American Academy of Pediatrics’ recent position papers on children and smoking.

“One of the things that is important to keep at the forefront of the conversation is that nicotine addiction is a chronic medical disease, and it’s a form of substance abuse,” Dr. Walley said. “We know that we need more research in adolescent tobacco cessation, and it really is about the funding, about research dollars.”

Without medications, smoking cessation in teens relies largely on counseling strategies. A 2017 review published by Cochrane Library found that group counseling was the most effective quitting method, with teens participating in group sessions 35% more likely to stop using nicotine products up to a year later, compared with teens who did not receive any counseling.

Counseling can help educate teens (and parents) on some of the realities of e-cigarettes, bridging the gap between well-established anti-smoking campaigns and the anti-vape campaigns that have yet to catch up.

“We have done a great job promoting cigarette use as dangerous,” Dr. Walley said. “[But] many teens who would never pick up a cigarette –because they know the health risks – are vaping.”
 

 

 

How to get a teen to quit

Cessation and prevention strategies are closely linked, and interventions can start in middle school-aged children up through high school and young adults. Simply asking a 12-year-old, “Do you know anyone who smokes?” can help start a conversation that leads to an attempt to quit.

Teens may be compelled to smoke through digital advertising and influencer endorsements on social media platforms, but Gen Z is turned off by the idea that it’s being manipulated by the tobacco industry. Juul, for example, is partially owned by Altria, which makes Marlboros, and Vuse is wholly owned by R.J. Reynolds, which makes Camel cigarettes.

“If you can get somebody to understand that Big Tobacco is trying to manipulate you as a young person to want to illegally obtain and use their products, which are incredibly addictive, thus ensuring you will remain a loyal customer, that could be the thing that pushes them over the hump,” Dr. Stepp said. “You push it away like you would push away a parent trying to tell you how to park a car in the driveway.”

And just because a smoker relapses, it doesn’t mean the cessation was a complete failure. The younger someone is when they stop smoking, the less likely they are to suffer from the long-term health consequences of smoking, according to a 2021 study in the Journal of the American Medical Association. “With the right counseling,” Dr. Walley said, “each relapse is an opportunity for losing the habit permanently.”


This article was adapted from the Summer 2023 online issue of CHEST Advocates. For the full article – and to engage with the other content from this issue – visit https://chestnet.org/chest-­advocates.

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525,600 minutes ... how does one measure a year as President?

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Fri, 11/03/2023 - 17:00

As we find ourselves in November, on the heels of yet another exceptional CHEST Annual Meeting, I cannot help but use my last column as CHEST President to reflect on a year well spent.

For the first time since CHEST 2011, when I was the Scientific Program Committee Vice Chair, I was able to return to beautiful Hawaiʻi as the organization’s President, which was such a big coincidence that it felt almost like fate.

Dr. Doreen Addrizzo-Harris

During my time on stage at the CHEST 2023 Opening Session, I reflected on the last (at the time) 9 months and shared how truly humbled I have been to lead such a group of leaders and doers. I’m continually amazed at the energy of our members and our staff. In my 25 years as a member, I thought I knew all that CHEST did, but there is so much more happening than any one person realizes. From creating and implementing patient care initiatives to drafting and endorsing statements advocating for better access to health care, there is a tremendous amount accomplished by this organization every year.
 

One notable accomplishment of this particular year is that not only was CHEST 2023 our largest meeting ever, but I’m proud to share that we also had more medical students, residents, and fellows than any other year, with over 2,000 attendees in-training.

This is a great reflection of the work we’ve been doing to expand the CHEST community – both to physicians earlier in their careers and also to the whole care team. We are putting a dedicated focus toward welcoming and creating a sense of belonging for every clinician. The first step toward this inclusion is the creation of the new CHEST interest groups – Respiratory Care, which is dedicated to the field, and Women in Chest Medicine, which is a more inclusive evolution of the previous Women & Pulmonary group.

This year, we also established CHEST organizational values. The result of a tremendous effort from an advisory committee, CHEST leaders, members, and staff, these values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.

They also serve to elevate the work we are doing in social responsibility and health equity, within both of which we’ve made great strides. CHEST philanthropy evolved from what was known as the CHEST Foundation, with a new strategic focus, and we continue working to create opportunities to expand diversity within health care, including the new CHEST mentor/mentee sponsorship fellowship in partnership with the Association of Pulmonary and Critical Care Medicine Program Directors.

Though I could go on for eternity describing all we did at CHEST this year, the reality is that at the end of the next month, as we ring in the new year, I will cede the presidency to the incredibly accomplished and capable Jack Buckley, MD, MPH, FCCP, who will take the reins of our great organization.

For now, in my parting words to you, I encourage everyone to stay in touch. I am always reachable by email and would love to hear your thoughts on CHEST – reflections on this past year, ideas about where we’re going, and suggestions for what we’re missing. The role of the President (and, to some extent, the Immediate Past President) is to be a steward of the needs of the CHEST members, and it’s been a true honor being your 2023 CHEST President.

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As we find ourselves in November, on the heels of yet another exceptional CHEST Annual Meeting, I cannot help but use my last column as CHEST President to reflect on a year well spent.

For the first time since CHEST 2011, when I was the Scientific Program Committee Vice Chair, I was able to return to beautiful Hawaiʻi as the organization’s President, which was such a big coincidence that it felt almost like fate.

Dr. Doreen Addrizzo-Harris

During my time on stage at the CHEST 2023 Opening Session, I reflected on the last (at the time) 9 months and shared how truly humbled I have been to lead such a group of leaders and doers. I’m continually amazed at the energy of our members and our staff. In my 25 years as a member, I thought I knew all that CHEST did, but there is so much more happening than any one person realizes. From creating and implementing patient care initiatives to drafting and endorsing statements advocating for better access to health care, there is a tremendous amount accomplished by this organization every year.
 

One notable accomplishment of this particular year is that not only was CHEST 2023 our largest meeting ever, but I’m proud to share that we also had more medical students, residents, and fellows than any other year, with over 2,000 attendees in-training.

This is a great reflection of the work we’ve been doing to expand the CHEST community – both to physicians earlier in their careers and also to the whole care team. We are putting a dedicated focus toward welcoming and creating a sense of belonging for every clinician. The first step toward this inclusion is the creation of the new CHEST interest groups – Respiratory Care, which is dedicated to the field, and Women in Chest Medicine, which is a more inclusive evolution of the previous Women & Pulmonary group.

This year, we also established CHEST organizational values. The result of a tremendous effort from an advisory committee, CHEST leaders, members, and staff, these values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.

They also serve to elevate the work we are doing in social responsibility and health equity, within both of which we’ve made great strides. CHEST philanthropy evolved from what was known as the CHEST Foundation, with a new strategic focus, and we continue working to create opportunities to expand diversity within health care, including the new CHEST mentor/mentee sponsorship fellowship in partnership with the Association of Pulmonary and Critical Care Medicine Program Directors.

Though I could go on for eternity describing all we did at CHEST this year, the reality is that at the end of the next month, as we ring in the new year, I will cede the presidency to the incredibly accomplished and capable Jack Buckley, MD, MPH, FCCP, who will take the reins of our great organization.

For now, in my parting words to you, I encourage everyone to stay in touch. I am always reachable by email and would love to hear your thoughts on CHEST – reflections on this past year, ideas about where we’re going, and suggestions for what we’re missing. The role of the President (and, to some extent, the Immediate Past President) is to be a steward of the needs of the CHEST members, and it’s been a true honor being your 2023 CHEST President.

As we find ourselves in November, on the heels of yet another exceptional CHEST Annual Meeting, I cannot help but use my last column as CHEST President to reflect on a year well spent.

For the first time since CHEST 2011, when I was the Scientific Program Committee Vice Chair, I was able to return to beautiful Hawaiʻi as the organization’s President, which was such a big coincidence that it felt almost like fate.

Dr. Doreen Addrizzo-Harris

During my time on stage at the CHEST 2023 Opening Session, I reflected on the last (at the time) 9 months and shared how truly humbled I have been to lead such a group of leaders and doers. I’m continually amazed at the energy of our members and our staff. In my 25 years as a member, I thought I knew all that CHEST did, but there is so much more happening than any one person realizes. From creating and implementing patient care initiatives to drafting and endorsing statements advocating for better access to health care, there is a tremendous amount accomplished by this organization every year.
 

One notable accomplishment of this particular year is that not only was CHEST 2023 our largest meeting ever, but I’m proud to share that we also had more medical students, residents, and fellows than any other year, with over 2,000 attendees in-training.

This is a great reflection of the work we’ve been doing to expand the CHEST community – both to physicians earlier in their careers and also to the whole care team. We are putting a dedicated focus toward welcoming and creating a sense of belonging for every clinician. The first step toward this inclusion is the creation of the new CHEST interest groups – Respiratory Care, which is dedicated to the field, and Women in Chest Medicine, which is a more inclusive evolution of the previous Women & Pulmonary group.

This year, we also established CHEST organizational values. The result of a tremendous effort from an advisory committee, CHEST leaders, members, and staff, these values – Community, Inclusivity, Innovation, Advocacy, and Integrity – are reflective of the CHEST organization and will guide decisions for years to come.

They also serve to elevate the work we are doing in social responsibility and health equity, within both of which we’ve made great strides. CHEST philanthropy evolved from what was known as the CHEST Foundation, with a new strategic focus, and we continue working to create opportunities to expand diversity within health care, including the new CHEST mentor/mentee sponsorship fellowship in partnership with the Association of Pulmonary and Critical Care Medicine Program Directors.

Though I could go on for eternity describing all we did at CHEST this year, the reality is that at the end of the next month, as we ring in the new year, I will cede the presidency to the incredibly accomplished and capable Jack Buckley, MD, MPH, FCCP, who will take the reins of our great organization.

For now, in my parting words to you, I encourage everyone to stay in touch. I am always reachable by email and would love to hear your thoughts on CHEST – reflections on this past year, ideas about where we’re going, and suggestions for what we’re missing. The role of the President (and, to some extent, the Immediate Past President) is to be a steward of the needs of the CHEST members, and it’s been a true honor being your 2023 CHEST President.

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Highlights of the 2024 Medicare Physician Fee Schedule proposed rule

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Fri, 10/20/2023 - 14:02

The suggested Medicare Physician Fee Schedule for calendar year (CY) 2024 was announced by the Centers for Medicare & Medicaid Services (CMS) in July 2023. Physicians who specialize in pulmonary, critical care, and sleep medicine will be impacted by a number of policy and payment changes. Additionally, keep in mind that this is the proposed rule. Following are some of the key points for our readers:

1. The conversion factor that CMS is suggesting for 2024 is $32.75, which represents a $1.14 (–3.34%) reduction. The current conversion factor is $33.89. This is specifically meant to lower total Medicare spending.

2. It is forecast that pulmonary specialists will experience an estimated 1.09% reduction in Medicare reimbursements if the proposed changes are approved. Medicare reimbursements for critical care specialists will be reduced by 2.51%, and sleep medicine specialists will be seeing a 0.75% increase.

3. Interestingly, CMS is proposing a Healthcare Common Procedure Coding System (HCPCS) code G2211 that will have a distinct add-on payment starting on January 1, 2024. With the help of this add-on code, the resource costs of evaluation and management visits for primary care and long-term treatment of difficult patients will be more accurately recognized. In general, it will be used as an additional payment for outpatient office visits in recognition of the potential expenditures that doctors may face when treating a patient’s single, significant, or complex chronic condition over time. Payment for this add-on code would have a redistributive impact on all other CY 2024 payments, which are still lower than what was previously predicted for this policy in CY 2021 under the Medicare Physician Fee Schedule, which was not implemented at the request of various surgical specialties.

4. As you all are aware, split (or shared) E/M visits in hospitals and other institutional settings are those that are provided in part by doctors and in part by other practitioners of the same specialty but billed under a single provider. Thankfully CMS is recommending delaying the application of the “substantive portion” definition of more than 50% of the total period to at least December 31, 2024. Instead, they are going to keep the present definition of the “substantive portion” for CY 2024, which permits use of either more than half of the visit’s total time or one of the three major components (history, exam, or MDM) to determine who bills the visit. Please remember that Critical Care services (99291/99292) may also be shared or split; however, in this case, billing is based only on time.

5. According to CMS’s current regulatory stance, teaching physicians have to be physically present to charge for services involving residents at the end of the COVID-19 Public Health Emergency. Congress, on the other hand, stepped in and passed legislation to expand Medicare coverage of a number of telehealth services. In accordance with the expanded telehealth policies adopted by Congress, CMS is recommending that teaching physicians be permitted to employ audio/video real-time communications technology when the resident physician provides telehealth services to Medicare beneficiaries for CY 2024.

The CMS’s document is fairly comprehensive, so please visit this link for more information

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The suggested Medicare Physician Fee Schedule for calendar year (CY) 2024 was announced by the Centers for Medicare & Medicaid Services (CMS) in July 2023. Physicians who specialize in pulmonary, critical care, and sleep medicine will be impacted by a number of policy and payment changes. Additionally, keep in mind that this is the proposed rule. Following are some of the key points for our readers:

1. The conversion factor that CMS is suggesting for 2024 is $32.75, which represents a $1.14 (–3.34%) reduction. The current conversion factor is $33.89. This is specifically meant to lower total Medicare spending.

2. It is forecast that pulmonary specialists will experience an estimated 1.09% reduction in Medicare reimbursements if the proposed changes are approved. Medicare reimbursements for critical care specialists will be reduced by 2.51%, and sleep medicine specialists will be seeing a 0.75% increase.

3. Interestingly, CMS is proposing a Healthcare Common Procedure Coding System (HCPCS) code G2211 that will have a distinct add-on payment starting on January 1, 2024. With the help of this add-on code, the resource costs of evaluation and management visits for primary care and long-term treatment of difficult patients will be more accurately recognized. In general, it will be used as an additional payment for outpatient office visits in recognition of the potential expenditures that doctors may face when treating a patient’s single, significant, or complex chronic condition over time. Payment for this add-on code would have a redistributive impact on all other CY 2024 payments, which are still lower than what was previously predicted for this policy in CY 2021 under the Medicare Physician Fee Schedule, which was not implemented at the request of various surgical specialties.

4. As you all are aware, split (or shared) E/M visits in hospitals and other institutional settings are those that are provided in part by doctors and in part by other practitioners of the same specialty but billed under a single provider. Thankfully CMS is recommending delaying the application of the “substantive portion” definition of more than 50% of the total period to at least December 31, 2024. Instead, they are going to keep the present definition of the “substantive portion” for CY 2024, which permits use of either more than half of the visit’s total time or one of the three major components (history, exam, or MDM) to determine who bills the visit. Please remember that Critical Care services (99291/99292) may also be shared or split; however, in this case, billing is based only on time.

5. According to CMS’s current regulatory stance, teaching physicians have to be physically present to charge for services involving residents at the end of the COVID-19 Public Health Emergency. Congress, on the other hand, stepped in and passed legislation to expand Medicare coverage of a number of telehealth services. In accordance with the expanded telehealth policies adopted by Congress, CMS is recommending that teaching physicians be permitted to employ audio/video real-time communications technology when the resident physician provides telehealth services to Medicare beneficiaries for CY 2024.

The CMS’s document is fairly comprehensive, so please visit this link for more information

The suggested Medicare Physician Fee Schedule for calendar year (CY) 2024 was announced by the Centers for Medicare & Medicaid Services (CMS) in July 2023. Physicians who specialize in pulmonary, critical care, and sleep medicine will be impacted by a number of policy and payment changes. Additionally, keep in mind that this is the proposed rule. Following are some of the key points for our readers:

1. The conversion factor that CMS is suggesting for 2024 is $32.75, which represents a $1.14 (–3.34%) reduction. The current conversion factor is $33.89. This is specifically meant to lower total Medicare spending.

2. It is forecast that pulmonary specialists will experience an estimated 1.09% reduction in Medicare reimbursements if the proposed changes are approved. Medicare reimbursements for critical care specialists will be reduced by 2.51%, and sleep medicine specialists will be seeing a 0.75% increase.

3. Interestingly, CMS is proposing a Healthcare Common Procedure Coding System (HCPCS) code G2211 that will have a distinct add-on payment starting on January 1, 2024. With the help of this add-on code, the resource costs of evaluation and management visits for primary care and long-term treatment of difficult patients will be more accurately recognized. In general, it will be used as an additional payment for outpatient office visits in recognition of the potential expenditures that doctors may face when treating a patient’s single, significant, or complex chronic condition over time. Payment for this add-on code would have a redistributive impact on all other CY 2024 payments, which are still lower than what was previously predicted for this policy in CY 2021 under the Medicare Physician Fee Schedule, which was not implemented at the request of various surgical specialties.

4. As you all are aware, split (or shared) E/M visits in hospitals and other institutional settings are those that are provided in part by doctors and in part by other practitioners of the same specialty but billed under a single provider. Thankfully CMS is recommending delaying the application of the “substantive portion” definition of more than 50% of the total period to at least December 31, 2024. Instead, they are going to keep the present definition of the “substantive portion” for CY 2024, which permits use of either more than half of the visit’s total time or one of the three major components (history, exam, or MDM) to determine who bills the visit. Please remember that Critical Care services (99291/99292) may also be shared or split; however, in this case, billing is based only on time.

5. According to CMS’s current regulatory stance, teaching physicians have to be physically present to charge for services involving residents at the end of the COVID-19 Public Health Emergency. Congress, on the other hand, stepped in and passed legislation to expand Medicare coverage of a number of telehealth services. In accordance with the expanded telehealth policies adopted by Congress, CMS is recommending that teaching physicians be permitted to employ audio/video real-time communications technology when the resident physician provides telehealth services to Medicare beneficiaries for CY 2024.

The CMS’s document is fairly comprehensive, so please visit this link for more information

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CHEST launches sepsis resources in partnership with the CDC

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Thu, 10/12/2023 - 16:38

Earlier this year, CHEST released new clinical resources on sepsis and antibiotic stewardship developed by the Sepsis Resources Steering Committee with grant support from the US Centers for Disease Control and Prevention (CDC).

The resources – including infographics, videos, podcasts, and research commentaries – aim to help clinicians increase their knowledge of sepsis prevention and treatment, especially when considering the use of antibiotics.

According to CHEST Past President, Steven Q. Simpson, MD, FCCP, who serves as Chair of the Sepsis Resources Steering Committee, sepsis is the number one cause of death in U.S. hospitals . It’s also the most expensive condition treated in those hospitals.

“Perhaps the single most important tool we have to fight sepsis is our array of antimicrobial therapies, including antibacterial, antifungal, and antiviral agents,” Dr. Simpson said. “It is vital that we use the antibiotics we have wisely and preserve them for future use.”

He pointed to the apparent tension between the need to administer broad-spectrum antimicrobials quickly to patients with sepsis and the need to limit the use of broad-spectrum agents as much as possible. But these concepts aren’t at odds with each another, he said. They’re allies in the sepsis war.

CHEST’s new resources can help clinicians practice good antimicrobial stewardship as they balance these needs. Included in the collection is a two-part video discussion exploring conservative and aggressive approaches to antibiotic use in suspected sepsis. A series of podcasts delves into complex sepsis cases, and easy-reference infographics outline key components of an antimicrobial stewardship program, rapid diagnostics for infectious diseases in the ICU, and sepsis mimics.

Steering committee members were chosen from CHEST’s membership for their clinical expertise in sepsis, infectious diseases, and antimicrobial stewardship. The committee selected topics based on current practice and knowledge gaps where education is most needed.

Working with the CDC increases CHEST’s impact in this area. Much of the care of patients with sepsis happens before they reach the ICU. The CDC’s broad reach with general and specialty medical audiences allows CHEST to share these resources with a wide array of clinicians who practice inside and outside of the ICU.

“Cooperation with the CDC gives us an opportunity to spread CHEST’s knowledge and expertise to a much broader audience, making the CDC a powerful partner and allowing us to serve the nation and beyond in a way that we cannot do by ourselves,” Dr. Simpson said.

Access the full collection of sepsis resources at chestnet.org/topic-collections/sepsis.

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Earlier this year, CHEST released new clinical resources on sepsis and antibiotic stewardship developed by the Sepsis Resources Steering Committee with grant support from the US Centers for Disease Control and Prevention (CDC).

The resources – including infographics, videos, podcasts, and research commentaries – aim to help clinicians increase their knowledge of sepsis prevention and treatment, especially when considering the use of antibiotics.

According to CHEST Past President, Steven Q. Simpson, MD, FCCP, who serves as Chair of the Sepsis Resources Steering Committee, sepsis is the number one cause of death in U.S. hospitals . It’s also the most expensive condition treated in those hospitals.

“Perhaps the single most important tool we have to fight sepsis is our array of antimicrobial therapies, including antibacterial, antifungal, and antiviral agents,” Dr. Simpson said. “It is vital that we use the antibiotics we have wisely and preserve them for future use.”

He pointed to the apparent tension between the need to administer broad-spectrum antimicrobials quickly to patients with sepsis and the need to limit the use of broad-spectrum agents as much as possible. But these concepts aren’t at odds with each another, he said. They’re allies in the sepsis war.

CHEST’s new resources can help clinicians practice good antimicrobial stewardship as they balance these needs. Included in the collection is a two-part video discussion exploring conservative and aggressive approaches to antibiotic use in suspected sepsis. A series of podcasts delves into complex sepsis cases, and easy-reference infographics outline key components of an antimicrobial stewardship program, rapid diagnostics for infectious diseases in the ICU, and sepsis mimics.

Steering committee members were chosen from CHEST’s membership for their clinical expertise in sepsis, infectious diseases, and antimicrobial stewardship. The committee selected topics based on current practice and knowledge gaps where education is most needed.

Working with the CDC increases CHEST’s impact in this area. Much of the care of patients with sepsis happens before they reach the ICU. The CDC’s broad reach with general and specialty medical audiences allows CHEST to share these resources with a wide array of clinicians who practice inside and outside of the ICU.

“Cooperation with the CDC gives us an opportunity to spread CHEST’s knowledge and expertise to a much broader audience, making the CDC a powerful partner and allowing us to serve the nation and beyond in a way that we cannot do by ourselves,” Dr. Simpson said.

Access the full collection of sepsis resources at chestnet.org/topic-collections/sepsis.

Earlier this year, CHEST released new clinical resources on sepsis and antibiotic stewardship developed by the Sepsis Resources Steering Committee with grant support from the US Centers for Disease Control and Prevention (CDC).

The resources – including infographics, videos, podcasts, and research commentaries – aim to help clinicians increase their knowledge of sepsis prevention and treatment, especially when considering the use of antibiotics.

According to CHEST Past President, Steven Q. Simpson, MD, FCCP, who serves as Chair of the Sepsis Resources Steering Committee, sepsis is the number one cause of death in U.S. hospitals . It’s also the most expensive condition treated in those hospitals.

“Perhaps the single most important tool we have to fight sepsis is our array of antimicrobial therapies, including antibacterial, antifungal, and antiviral agents,” Dr. Simpson said. “It is vital that we use the antibiotics we have wisely and preserve them for future use.”

He pointed to the apparent tension between the need to administer broad-spectrum antimicrobials quickly to patients with sepsis and the need to limit the use of broad-spectrum agents as much as possible. But these concepts aren’t at odds with each another, he said. They’re allies in the sepsis war.

CHEST’s new resources can help clinicians practice good antimicrobial stewardship as they balance these needs. Included in the collection is a two-part video discussion exploring conservative and aggressive approaches to antibiotic use in suspected sepsis. A series of podcasts delves into complex sepsis cases, and easy-reference infographics outline key components of an antimicrobial stewardship program, rapid diagnostics for infectious diseases in the ICU, and sepsis mimics.

Steering committee members were chosen from CHEST’s membership for their clinical expertise in sepsis, infectious diseases, and antimicrobial stewardship. The committee selected topics based on current practice and knowledge gaps where education is most needed.

Working with the CDC increases CHEST’s impact in this area. Much of the care of patients with sepsis happens before they reach the ICU. The CDC’s broad reach with general and specialty medical audiences allows CHEST to share these resources with a wide array of clinicians who practice inside and outside of the ICU.

“Cooperation with the CDC gives us an opportunity to spread CHEST’s knowledge and expertise to a much broader audience, making the CDC a powerful partner and allowing us to serve the nation and beyond in a way that we cannot do by ourselves,” Dr. Simpson said.

Access the full collection of sepsis resources at chestnet.org/topic-collections/sepsis.

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