News From CHEST Physician®

Two priorities of NAMDRC have moved into the formal congressional arena. The issues focus on access to pulmonary rehabilitation and CMS’s move to include home mechanical ventilation in competitive bidding.

Pulmonary Rehabilitation – The Problem: One of the major concerns to CMS and Congress is the fact that different payment methodologies for the same service result in different payment amounts dependent upon the actual site of service. To address the phenomenon of hospitals purchasing certain physician practices to game the payment system, Congress included in the 2015 Budget Act a provision that would remove incentives for such hospital purchases by stating that new hospital outpatient services must be within 250 yards of the main hospital campus in order to receive payment based on the hospital outpatient prospective payment system methodology. If a hospital opens such services beyond that 250-yard threshold, the hospital would be reimbursed at the physician fee schedule amount for the same service. Likewise, if an off campus program moved its grandfathered location because of expansion, loss of lease, etc, the physician fee schedule would again kick in.

For pulmonary rehabilitation services, this is extremely problematic and is tying the hands of hospitals providing this service. The physician fee schedule payment for pulmonary rehabilitation is less than $30 for 1 hour of service, and it is, therefore, not surprising that the service is simply not provided in physician offices. In fact, Medicare data show that all physician specialties bill less than $1M for code G0424, and we believe that most of that is likely billing error. Pulmonologists bill less than $500K for code G0424, and putting that number in context, the entire Medicare program is approaching $700B in outlays.

Pulmonary Rehabilitation – The Solution: As a solution to this problem, HR 4838 has been introduced in the House of Representatives. There is no specific reference to pulmonary rehabilitation in the bill as our approach is based not only on substance but political considerations, as well. Using CMS’ own acknowledgment of “unintended consequences,” this legislation would exempt all CPT codes from the restrictions imposed by Section 603 of the 2015 Budget Act when the physician billings for that code are under $2M for the most recent year for which data are available. CMS has signaled to us that such a limitation would apply only to pulmonary and cardiac rehab services, but others may be affected, as well. By putting a dollar limit rather than identifying a specific service for such a “carve out,” it is a more politically viable approach.

Bills such as this rarely see the light of day; however, such provisions are often attached to larger, more substantive bills. For nearly 2 decades, the common legislative vehicle for such provisions is a larger Medicare bill, often including “must pass Medicare extender” provisions that are slated to expire on a particular date. Our goal is to include HR 4838 in such a package of extenders some time between now and the end of this Congress in 2020.

Home Mechanical Ventilation – The Problem: CMS has proposed inclusion of home mechanical ventilation in competitive bidding for durable medical equipment. Such a regulatory proposal is fraught with downside risk, most notably that such a policy would follow the history of liquid oxygen. Liquid 02 has virtually disappeared from the marketplace since it was included in competitive bidding as suppliers simply refused to provide liquid oxygen systems as their own bidding dropped the price to prohibitively low levels. Also, because there is a statutory requirement that such payment be made on the basis of “frequent and substantial servicing,” and that stipulation could trigger wide variations in actual bidding because some states require involvement of respiratory therapists in such services, while others do not.

It is critical to understand that the driving force behind all of this is the reality that CMS’ own coverage policies for home mechanical ventilation are seriously flawed and outdated, creating perverse incentives for physicians to order easily accessible systems rather than clinically appropriate ones. NAMDRC and its sister societies have been pushing CMS to revise those policies with no success.

Home Mechanical Ventilation – The Solution: Our solution is twofold. HR 4945 bill was introduced on November 1, 2019. First, the proposed legislation would create a blanket exemption for home mechanical ventilation from competitive bidding. Second, it requires CMS to convene a technical expert panel to craft up-to-date policies for home mechanical ventilation.

The political strategy here is slightly different. While passage of the bill is certainly our first choice, we believe that introduction of the bill is a red flag signal to CMS for the need to revise its coverage policies as those policies are the root cause of the growth of home mechanical ventilation outlays.

Two priorities of NAMDRC have moved into the formal congressional arena. The issues focus on access to pulmonary rehabilitation and CMS’s move to include home mechanical ventilation in competitive bidding.

Pulmonary Rehabilitation – The Problem: One of the major concerns to CMS and Congress is the fact that different payment methodologies for the same service result in different payment amounts dependent upon the actual site of service. To address the phenomenon of hospitals purchasing certain physician practices to game the payment system, Congress included in the 2015 Budget Act a provision that would remove incentives for such hospital purchases by stating that new hospital outpatient services must be within 250 yards of the main hospital campus in order to receive payment based on the hospital outpatient prospective payment system methodology. If a hospital opens such services beyond that 250-yard threshold, the hospital would be reimbursed at the physician fee schedule amount for the same service. Likewise, if an off campus program moved its grandfathered location because of expansion, loss of lease, etc, the physician fee schedule would again kick in.

For pulmonary rehabilitation services, this is extremely problematic and is tying the hands of hospitals providing this service. The physician fee schedule payment for pulmonary rehabilitation is less than $30 for 1 hour of service, and it is, therefore, not surprising that the service is simply not provided in physician offices. In fact, Medicare data show that all physician specialties bill less than $1M for code G0424, and we believe that most of that is likely billing error. Pulmonologists bill less than $500K for code G0424, and putting that number in context, the entire Medicare program is approaching $700B in outlays.

Pulmonary Rehabilitation – The Solution: As a solution to this problem, HR 4838 has been introduced in the House of Representatives. There is no specific reference to pulmonary rehabilitation in the bill as our approach is based not only on substance but political considerations, as well. Using CMS’ own acknowledgment of “unintended consequences,” this legislation would exempt all CPT codes from the restrictions imposed by Section 603 of the 2015 Budget Act when the physician billings for that code are under $2M for the most recent year for which data are available. CMS has signaled to us that such a limitation would apply only to pulmonary and cardiac rehab services, but others may be affected, as well. By putting a dollar limit rather than identifying a specific service for such a “carve out,” it is a more politically viable approach.

Bills such as this rarely see the light of day; however, such provisions are often attached to larger, more substantive bills. For nearly 2 decades, the common legislative vehicle for such provisions is a larger Medicare bill, often including “must pass Medicare extender” provisions that are slated to expire on a particular date. Our goal is to include HR 4838 in such a package of extenders some time between now and the end of this Congress in 2020.

Home Mechanical Ventilation – The Problem: CMS has proposed inclusion of home mechanical ventilation in competitive bidding for durable medical equipment. Such a regulatory proposal is fraught with downside risk, most notably that such a policy would follow the history of liquid oxygen. Liquid 02 has virtually disappeared from the marketplace since it was included in competitive bidding as suppliers simply refused to provide liquid oxygen systems as their own bidding dropped the price to prohibitively low levels. Also, because there is a statutory requirement that such payment be made on the basis of “frequent and substantial servicing,” and that stipulation could trigger wide variations in actual bidding because some states require involvement of respiratory therapists in such services, while others do not.

It is critical to understand that the driving force behind all of this is the reality that CMS’ own coverage policies for home mechanical ventilation are seriously flawed and outdated, creating perverse incentives for physicians to order easily accessible systems rather than clinically appropriate ones. NAMDRC and its sister societies have been pushing CMS to revise those policies with no success.

Home Mechanical Ventilation – The Solution: Our solution is twofold. HR 4945 bill was introduced on November 1, 2019. First, the proposed legislation would create a blanket exemption for home mechanical ventilation from competitive bidding. Second, it requires CMS to convene a technical expert panel to craft up-to-date policies for home mechanical ventilation.

The political strategy here is slightly different. While passage of the bill is certainly our first choice, we believe that introduction of the bill is a red flag signal to CMS for the need to revise its coverage policies as those policies are the root cause of the growth of home mechanical ventilation outlays.

Two priorities of NAMDRC have moved into the formal congressional arena. The issues focus on access to pulmonary rehabilitation and CMS’s move to include home mechanical ventilation in competitive bidding.

Pulmonary Rehabilitation – The Problem: One of the major concerns to CMS and Congress is the fact that different payment methodologies for the same service result in different payment amounts dependent upon the actual site of service. To address the phenomenon of hospitals purchasing certain physician practices to game the payment system, Congress included in the 2015 Budget Act a provision that would remove incentives for such hospital purchases by stating that new hospital outpatient services must be within 250 yards of the main hospital campus in order to receive payment based on the hospital outpatient prospective payment system methodology. If a hospital opens such services beyond that 250-yard threshold, the hospital would be reimbursed at the physician fee schedule amount for the same service. Likewise, if an off campus program moved its grandfathered location because of expansion, loss of lease, etc, the physician fee schedule would again kick in.

For pulmonary rehabilitation services, this is extremely problematic and is tying the hands of hospitals providing this service. The physician fee schedule payment for pulmonary rehabilitation is less than $30 for 1 hour of service, and it is, therefore, not surprising that the service is simply not provided in physician offices. In fact, Medicare data show that all physician specialties bill less than $1M for code G0424, and we believe that most of that is likely billing error. Pulmonologists bill less than $500K for code G0424, and putting that number in context, the entire Medicare program is approaching $700B in outlays.

Pulmonary Rehabilitation – The Solution: As a solution to this problem, HR 4838 has been introduced in the House of Representatives. There is no specific reference to pulmonary rehabilitation in the bill as our approach is based not only on substance but political considerations, as well. Using CMS’ own acknowledgment of “unintended consequences,” this legislation would exempt all CPT codes from the restrictions imposed by Section 603 of the 2015 Budget Act when the physician billings for that code are under $2M for the most recent year for which data are available. CMS has signaled to us that such a limitation would apply only to pulmonary and cardiac rehab services, but others may be affected, as well. By putting a dollar limit rather than identifying a specific service for such a “carve out,” it is a more politically viable approach.

Bills such as this rarely see the light of day; however, such provisions are often attached to larger, more substantive bills. For nearly 2 decades, the common legislative vehicle for such provisions is a larger Medicare bill, often including “must pass Medicare extender” provisions that are slated to expire on a particular date. Our goal is to include HR 4838 in such a package of extenders some time between now and the end of this Congress in 2020.

Home Mechanical Ventilation – The Problem: CMS has proposed inclusion of home mechanical ventilation in competitive bidding for durable medical equipment. Such a regulatory proposal is fraught with downside risk, most notably that such a policy would follow the history of liquid oxygen. Liquid 02 has virtually disappeared from the marketplace since it was included in competitive bidding as suppliers simply refused to provide liquid oxygen systems as their own bidding dropped the price to prohibitively low levels. Also, because there is a statutory requirement that such payment be made on the basis of “frequent and substantial servicing,” and that stipulation could trigger wide variations in actual bidding because some states require involvement of respiratory therapists in such services, while others do not.

It is critical to understand that the driving force behind all of this is the reality that CMS’ own coverage policies for home mechanical ventilation are seriously flawed and outdated, creating perverse incentives for physicians to order easily accessible systems rather than clinically appropriate ones. NAMDRC and its sister societies have been pushing CMS to revise those policies with no success.

Home Mechanical Ventilation – The Solution: Our solution is twofold. HR 4945 bill was introduced on November 1, 2019. First, the proposed legislation would create a blanket exemption for home mechanical ventilation from competitive bidding. Second, it requires CMS to convene a technical expert panel to craft up-to-date policies for home mechanical ventilation.

The political strategy here is slightly different. While passage of the bill is certainly our first choice, we believe that introduction of the bill is a red flag signal to CMS for the need to revise its coverage policies as those policies are the root cause of the growth of home mechanical ventilation outlays.

When most think of Mark J. Rosen, MD, Master FCCP, so many words come to mind: master educator, astute and caring clinician, researcher, mentor, leader. We recall his generosity, kindness, honesty, brilliance, and sense of humor.

Mark loved CHEST. He gave so much to the organization and was happy to do so. He was one of the rare Past Presidents who contributed even more after his presidency than during or before. Mark left an enormous footprint on CHEST’s educational programs, including the CHEST Annual Meeting, Pulmonary Board Review, and SEEK. He was instrumental in building our international educational programs and a key player in empowering our Chinese colleagues in establishing pulmonary fellowships in their country. Much of what we have all accomplished at CHEST and in pulmonary medicine is directly related to the wonderful mentors we have had in the organization, and Mark was certainly one of the most prominent.

Mark always believed the core strength of the college was education. The CHEST Foundation is endowing the Rosen International Scholarship and raising $100,000 to support deserving international clinicians. This endowed fund will directly support international CHEST members’ travel to the CHEST Annual Meeting affording CHEST’s world-class educational and mentorship opportunities to members who could not otherwise attend.

To support the Mark J. Rosen, MD, FCCP Endowment, his legacy, and international CHEST members, visit chestfoundation.org/donate today.

When most think of Mark J. Rosen, MD, Master FCCP, so many words come to mind: master educator, astute and caring clinician, researcher, mentor, leader. We recall his generosity, kindness, honesty, brilliance, and sense of humor.

Mark loved CHEST. He gave so much to the organization and was happy to do so. He was one of the rare Past Presidents who contributed even more after his presidency than during or before. Mark left an enormous footprint on CHEST’s educational programs, including the CHEST Annual Meeting, Pulmonary Board Review, and SEEK. He was instrumental in building our international educational programs and a key player in empowering our Chinese colleagues in establishing pulmonary fellowships in their country. Much of what we have all accomplished at CHEST and in pulmonary medicine is directly related to the wonderful mentors we have had in the organization, and Mark was certainly one of the most prominent.

Mark always believed the core strength of the college was education. The CHEST Foundation is endowing the Rosen International Scholarship and raising $100,000 to support deserving international clinicians. This endowed fund will directly support international CHEST members’ travel to the CHEST Annual Meeting affording CHEST’s world-class educational and mentorship opportunities to members who could not otherwise attend.

To support the Mark J. Rosen, MD, FCCP Endowment, his legacy, and international CHEST members, visit chestfoundation.org/donate today.

When most think of Mark J. Rosen, MD, Master FCCP, so many words come to mind: master educator, astute and caring clinician, researcher, mentor, leader. We recall his generosity, kindness, honesty, brilliance, and sense of humor.

Mark loved CHEST. He gave so much to the organization and was happy to do so. He was one of the rare Past Presidents who contributed even more after his presidency than during or before. Mark left an enormous footprint on CHEST’s educational programs, including the CHEST Annual Meeting, Pulmonary Board Review, and SEEK. He was instrumental in building our international educational programs and a key player in empowering our Chinese colleagues in establishing pulmonary fellowships in their country. Much of what we have all accomplished at CHEST and in pulmonary medicine is directly related to the wonderful mentors we have had in the organization, and Mark was certainly one of the most prominent.

Mark always believed the core strength of the college was education. The CHEST Foundation is endowing the Rosen International Scholarship and raising $100,000 to support deserving international clinicians. This endowed fund will directly support international CHEST members’ travel to the CHEST Annual Meeting affording CHEST’s world-class educational and mentorship opportunities to members who could not otherwise attend.

To support the Mark J. Rosen, MD, FCCP Endowment, his legacy, and international CHEST members, visit chestfoundation.org/donate today.

CHEST leadership recently met for its fall quarterly face to face meeting prior to the CHEST Annual Meeting in New Orleans this October. Like all of CHEST board meetings, the agenda was packed with important topics and a great deal of meaningful discussion. I left the meeting more energized about CHEST and its current and future offerings for our membership. Below are a few highlights from the meeting.

The meeting was opened with an update from the outgoing CHEST President Clayton Cowl, MD, MS, FCCP. He highlighted some of the organization’s major achievements over the past year, including: Confirming and signing a new contract with our new EVP/CEO Robert Musacchio, PhD; hiring a new Chief Learning Officer, a new Editor in Chief for the CHEST® journal, and a new Chief Legal Counsel; and expansion of the international strategy with CHEST Congress in Bangkok and a CHEST Regional meeting in Athens with plans for CHEST Congress 2020 in Bologna, Italy. In addition, CHEST convened a Digital Strategy Task Force, which made recommendations to improve how members, patients, and staff interact with our organization.

EVP/CEO Robert Musacchio reviewed some additional organizational accomplishments and areas of focus for the future. These included redefining the One CHEST operating model and a continued focus on international business development with plans for CHEST Congress 2020 in Italy and exploration of future meetings in Singapore and The Philippines. CHEST continues to develop an improved membership strategy focused on improving experiences for our membership and improving member engagement to help secure the future of CHEST. Finally, CHEST remains focused on innovation though new experiences for our members, including new games, virtual patient tours, and enduring activities and products. Many of these experiences were highlighted and on display at the recent CHEST annual meeting.

Doreen Addrizzo-Harris, MD, FCCP, the CHEST Foundation outgoing President, recapped a very successful year for the CHEST Foundation with plans for increasing the impact and visibility of the CHEST Foundation going forward.. John Howington, MD, FCCP, Chair of the Finance Committee, updated the board on the financial health of the organization. Overall, CHEST had a solid financial report based on budgeted revenue and strong expense management by our executive leadership team.

John Studdard, MD, FCCP, the immediate Past President and Chair of the Governance Committee, led the Governance Committee report and discussion. The Governance Committee is composed of members of both the College Board of Regents (BOR) and Foundation Board of Trustees (BOT) and is responsible for the overall health of both boards and ensuring that the boards are consistently performing at a high level. Dr. Studdard presented slates for 2019-20 Board of Trustees and Board of Regents for discussion and approval. Five new members for the Board of Regents and four new members for the Board of Trustees were approved for the upcoming year. In addition, David Schulman, MD, MS, FCCP, and Robert De Marco, MD, FCCP, were elected as President-Designate of the BOR and BOT, respectively.

Several committees presented to the Board to review this year’s progress, future plans, and potential barriers to success. The Council of Global Governors continued to see growth in our international membership, though a potential ongoing barrier to future growth will be developing an efficient mode of communication between the Global Governors and our international members. Discussion around using the expertise within the Digital Strategy Task Force was offered as one method to improve international member communication and engagement. The Education Committee continues to be one of CHEST’s most popular committees with an unprecedented 130 nominations with exceptional credentials for the 2019-20 election cycle. The Education Committee has expanded the size of three of its subcommittees to better include and engage these individuals in CHEST education projects. The Training and Transitions Committee continues to see increased engagement from trainees and training programs. CHEST 2019 had an increased number of trainee submissions, as well as the number of accepted submissions to the meeting. The committee will continue to evolve their strategy for engaging trainees and early career professionals. Finally, Christopher Hergott, MD, FCCP, Chair of the Membership Committee, reviewed several strategies and recommendations to expand our membership offerings and improve the value that we bring to our all of our members.

Finally, it was time to say thank you and farewell to out our outgoing Board members. Clayton Cowl, MD, MS, FCCP, and Stephanie Levine, MD, FCCP, recognized the following board members for their service to CHEST over the last several years: Jack Buckley, MD, FCCP; John Studdard, MD, FCCP; David Zielinski, MD, FCCP; and Burt Lesnick, MD, FCCP.

CHEST leadership recently met for its fall quarterly face to face meeting prior to the CHEST Annual Meeting in New Orleans this October. Like all of CHEST board meetings, the agenda was packed with important topics and a great deal of meaningful discussion. I left the meeting more energized about CHEST and its current and future offerings for our membership. Below are a few highlights from the meeting.

The meeting was opened with an update from the outgoing CHEST President Clayton Cowl, MD, MS, FCCP. He highlighted some of the organization’s major achievements over the past year, including: Confirming and signing a new contract with our new EVP/CEO Robert Musacchio, PhD; hiring a new Chief Learning Officer, a new Editor in Chief for the CHEST® journal, and a new Chief Legal Counsel; and expansion of the international strategy with CHEST Congress in Bangkok and a CHEST Regional meeting in Athens with plans for CHEST Congress 2020 in Bologna, Italy. In addition, CHEST convened a Digital Strategy Task Force, which made recommendations to improve how members, patients, and staff interact with our organization.

EVP/CEO Robert Musacchio reviewed some additional organizational accomplishments and areas of focus for the future. These included redefining the One CHEST operating model and a continued focus on international business development with plans for CHEST Congress 2020 in Italy and exploration of future meetings in Singapore and The Philippines. CHEST continues to develop an improved membership strategy focused on improving experiences for our membership and improving member engagement to help secure the future of CHEST. Finally, CHEST remains focused on innovation though new experiences for our members, including new games, virtual patient tours, and enduring activities and products. Many of these experiences were highlighted and on display at the recent CHEST annual meeting.

Doreen Addrizzo-Harris, MD, FCCP, the CHEST Foundation outgoing President, recapped a very successful year for the CHEST Foundation with plans for increasing the impact and visibility of the CHEST Foundation going forward.. John Howington, MD, FCCP, Chair of the Finance Committee, updated the board on the financial health of the organization. Overall, CHEST had a solid financial report based on budgeted revenue and strong expense management by our executive leadership team.

John Studdard, MD, FCCP, the immediate Past President and Chair of the Governance Committee, led the Governance Committee report and discussion. The Governance Committee is composed of members of both the College Board of Regents (BOR) and Foundation Board of Trustees (BOT) and is responsible for the overall health of both boards and ensuring that the boards are consistently performing at a high level. Dr. Studdard presented slates for 2019-20 Board of Trustees and Board of Regents for discussion and approval. Five new members for the Board of Regents and four new members for the Board of Trustees were approved for the upcoming year. In addition, David Schulman, MD, MS, FCCP, and Robert De Marco, MD, FCCP, were elected as President-Designate of the BOR and BOT, respectively.

Several committees presented to the Board to review this year’s progress, future plans, and potential barriers to success. The Council of Global Governors continued to see growth in our international membership, though a potential ongoing barrier to future growth will be developing an efficient mode of communication between the Global Governors and our international members. Discussion around using the expertise within the Digital Strategy Task Force was offered as one method to improve international member communication and engagement. The Education Committee continues to be one of CHEST’s most popular committees with an unprecedented 130 nominations with exceptional credentials for the 2019-20 election cycle. The Education Committee has expanded the size of three of its subcommittees to better include and engage these individuals in CHEST education projects. The Training and Transitions Committee continues to see increased engagement from trainees and training programs. CHEST 2019 had an increased number of trainee submissions, as well as the number of accepted submissions to the meeting. The committee will continue to evolve their strategy for engaging trainees and early career professionals. Finally, Christopher Hergott, MD, FCCP, Chair of the Membership Committee, reviewed several strategies and recommendations to expand our membership offerings and improve the value that we bring to our all of our members.

Finally, it was time to say thank you and farewell to out our outgoing Board members. Clayton Cowl, MD, MS, FCCP, and Stephanie Levine, MD, FCCP, recognized the following board members for their service to CHEST over the last several years: Jack Buckley, MD, FCCP; John Studdard, MD, FCCP; David Zielinski, MD, FCCP; and Burt Lesnick, MD, FCCP.

CHEST leadership recently met for its fall quarterly face to face meeting prior to the CHEST Annual Meeting in New Orleans this October. Like all of CHEST board meetings, the agenda was packed with important topics and a great deal of meaningful discussion. I left the meeting more energized about CHEST and its current and future offerings for our membership. Below are a few highlights from the meeting.

The meeting was opened with an update from the outgoing CHEST President Clayton Cowl, MD, MS, FCCP. He highlighted some of the organization’s major achievements over the past year, including: Confirming and signing a new contract with our new EVP/CEO Robert Musacchio, PhD; hiring a new Chief Learning Officer, a new Editor in Chief for the CHEST® journal, and a new Chief Legal Counsel; and expansion of the international strategy with CHEST Congress in Bangkok and a CHEST Regional meeting in Athens with plans for CHEST Congress 2020 in Bologna, Italy. In addition, CHEST convened a Digital Strategy Task Force, which made recommendations to improve how members, patients, and staff interact with our organization.

EVP/CEO Robert Musacchio reviewed some additional organizational accomplishments and areas of focus for the future. These included redefining the One CHEST operating model and a continued focus on international business development with plans for CHEST Congress 2020 in Italy and exploration of future meetings in Singapore and The Philippines. CHEST continues to develop an improved membership strategy focused on improving experiences for our membership and improving member engagement to help secure the future of CHEST. Finally, CHEST remains focused on innovation though new experiences for our members, including new games, virtual patient tours, and enduring activities and products. Many of these experiences were highlighted and on display at the recent CHEST annual meeting.

Doreen Addrizzo-Harris, MD, FCCP, the CHEST Foundation outgoing President, recapped a very successful year for the CHEST Foundation with plans for increasing the impact and visibility of the CHEST Foundation going forward.. John Howington, MD, FCCP, Chair of the Finance Committee, updated the board on the financial health of the organization. Overall, CHEST had a solid financial report based on budgeted revenue and strong expense management by our executive leadership team.

John Studdard, MD, FCCP, the immediate Past President and Chair of the Governance Committee, led the Governance Committee report and discussion. The Governance Committee is composed of members of both the College Board of Regents (BOR) and Foundation Board of Trustees (BOT) and is responsible for the overall health of both boards and ensuring that the boards are consistently performing at a high level. Dr. Studdard presented slates for 2019-20 Board of Trustees and Board of Regents for discussion and approval. Five new members for the Board of Regents and four new members for the Board of Trustees were approved for the upcoming year. In addition, David Schulman, MD, MS, FCCP, and Robert De Marco, MD, FCCP, were elected as President-Designate of the BOR and BOT, respectively.

Several committees presented to the Board to review this year’s progress, future plans, and potential barriers to success. The Council of Global Governors continued to see growth in our international membership, though a potential ongoing barrier to future growth will be developing an efficient mode of communication between the Global Governors and our international members. Discussion around using the expertise within the Digital Strategy Task Force was offered as one method to improve international member communication and engagement. The Education Committee continues to be one of CHEST’s most popular committees with an unprecedented 130 nominations with exceptional credentials for the 2019-20 election cycle. The Education Committee has expanded the size of three of its subcommittees to better include and engage these individuals in CHEST education projects. The Training and Transitions Committee continues to see increased engagement from trainees and training programs. CHEST 2019 had an increased number of trainee submissions, as well as the number of accepted submissions to the meeting. The committee will continue to evolve their strategy for engaging trainees and early career professionals. Finally, Christopher Hergott, MD, FCCP, Chair of the Membership Committee, reviewed several strategies and recommendations to expand our membership offerings and improve the value that we bring to our all of our members.

Finally, it was time to say thank you and farewell to out our outgoing Board members. Clayton Cowl, MD, MS, FCCP, and Stephanie Levine, MD, FCCP, recognized the following board members for their service to CHEST over the last several years: Jack Buckley, MD, FCCP; John Studdard, MD, FCCP; David Zielinski, MD, FCCP; and Burt Lesnick, MD, FCCP.

Editorials

Pulmonary Embolism Cardiac Arrest: Thrombolysis During Cardiopulmonary Resuscitation and Improved Survival. By Drs. B. W. Bottiger and W. A. Wetsch.

Interstitial Lung Abnormalities: A Word of Caution.

By Drs. V. Tzilas and D. Bouros.
 

Original Research

Thrombolysis During Resuscitation for Out-of-Hospital Cardiac Arrest Caused by Pulmonary Embolism Increases 30-Day Survival: Findings From the French National Cardiac Arrest Registry.

By Dr. F. Javaudin, et al.Interstitial Lung Abnormalities and Lung Cancer Risk in the National Lung Screening Trial. By Dr. S-A. Whittaker Brown, et al.
 

Commentary

Publishing a Clinical Research Manuscript: Guidance for Early-Career Researchers With a Focus on Pulmonary and Critical Care Medicine.

By Dr. E. M. Viglianti, et al.

Editorials

Pulmonary Embolism Cardiac Arrest: Thrombolysis During Cardiopulmonary Resuscitation and Improved Survival. By Drs. B. W. Bottiger and W. A. Wetsch.

Interstitial Lung Abnormalities: A Word of Caution.

By Drs. V. Tzilas and D. Bouros.
 

Original Research

Thrombolysis During Resuscitation for Out-of-Hospital Cardiac Arrest Caused by Pulmonary Embolism Increases 30-Day Survival: Findings From the French National Cardiac Arrest Registry.

By Dr. F. Javaudin, et al.Interstitial Lung Abnormalities and Lung Cancer Risk in the National Lung Screening Trial. By Dr. S-A. Whittaker Brown, et al.
 

Commentary

Publishing a Clinical Research Manuscript: Guidance for Early-Career Researchers With a Focus on Pulmonary and Critical Care Medicine.

By Dr. E. M. Viglianti, et al.

Editorials

Pulmonary Embolism Cardiac Arrest: Thrombolysis During Cardiopulmonary Resuscitation and Improved Survival. By Drs. B. W. Bottiger and W. A. Wetsch.

Interstitial Lung Abnormalities: A Word of Caution.

By Drs. V. Tzilas and D. Bouros.
 

Original Research

Thrombolysis During Resuscitation for Out-of-Hospital Cardiac Arrest Caused by Pulmonary Embolism Increases 30-Day Survival: Findings From the French National Cardiac Arrest Registry.

By Dr. F. Javaudin, et al.Interstitial Lung Abnormalities and Lung Cancer Risk in the National Lung Screening Trial. By Dr. S-A. Whittaker Brown, et al.
 

Commentary

Publishing a Clinical Research Manuscript: Guidance for Early-Career Researchers With a Focus on Pulmonary and Critical Care Medicine.

By Dr. E. M. Viglianti, et al.

Philanthropy is a driving force supporting and promoting pioneering research and programs in many fields of medicine. Charitable giving, foundation support, and grants touch the lives of millions of patients and also have an impact across all fields of practice of medical practice. But philanthropy is being transformed by changing technology, interests of the giving public, and demands for accountability and transparency. Understanding where these trends are going will give physicians insights into what they can expect from philanthropy and what it might mean for their own institutions and interests.

Impact investing, transparency, and trust

The demand for increased accountability in philanthropy is growing. Today’s donors want to know their contributions will have a real impact in causes they believe in. As donors become more focused on results, organizations will need to demonstrate their ability to achieve short-term goals that bring them closer to accomplishing their mission and vision. This sentiment may be strongest among Millennials. Nonprofit organizations should expect an increased level of due diligence and a higher level of personal involvement by donors. At least 41% of donors have changed their giving because of increased knowledge about nonprofit effectiveness. Foundations and corporations donate to medical centers and research institutions, but recipients are have an expectation of close involvement of donors, the need for detailed accounts of how funds are spent, and a responsibility to show progress or measurable outcomes.²

Health care–related issues

Two of the top three issues identified by donors as a challenge to be addressed are related to health care, according to Fidelity Charitable. Thirty-nine percent identified “developing treatment or cures for a disease” and 33% cited “access to basic health services” as priority issues. A study by Giving USA estimated that charitable giving to health care organizations rose a strong 7.3% (5.5% adjusted for inflation) in 2017, but giving that year was fueled by a booming stock market and a favorable tax environment. Charitable donations to hospitals tend to reflect the economic health of the community in which the institution is located. Donations to rural hospitals in depressed communities are likely to be far less than to urban institutions in economically strong areas.³

Tax reform

The Tax Cuts and Jobs Act of 2017 will likely affect donations to charitable organizations in 2019. Specifically, the 2017 Tax Act doubled the standard tax deduction, thereby reducing the number of households having to itemize their deductions and eliminating many tax benefits for charitable donations. Middle-class families are expected to opt for the standard deduction while wealthier taxpayers will likely continue itemizing their deductions. As a result, some predict that donors may switch from giving annually to giving every third year so they can itemize in their giving years to get the deduction. Estimates that charitable donations from individuals may decrease as much as $4 billion to $11 billion because of the increase in standard deductions and $0.9 billion to $2.1 billion because of the decrease in the marginal tax rate.⁴

Technology and peer-to-peer giving

Technological advances that make researching and giving easier and more convenient are likely to have a significant impact on many charitable organizations in 2019. Online donations are likely to increase as organizations make it simple to donate from mobile devices, social media platforms and their websites. Although charitable organizations will continue to directly ask individuals for a donation, many are expanding their efforts to include online social campaigns that leverage peer-to-peer giving. Other technological advancements likely to affect donations in the future include the ability for organizations to incorporate contactless payment programs and blockchain technology. Online giving grew by 12.1% over 2018-2019 with monthly automatic giving increasing by 40% over 2016 to 2017.⁵

Generational differences in giving

Although the trends identified above are likely to affect the decision to give in 2019, there are some meaningful differences in how different generations embrace these changes. Technological advances, the rise of alternative forms of giving, and increased opportunities to connect with peers about giving influence Millennials significantly more than Baby Boomers. Millennials are more likely to say that they give to make a meaningful difference while Boomers are likely to say that giving is part of their values. Millennials also are more likely to say their giving is more spontaneous while Boomers say their giving is more planned. As many as 49% of Millennials cite technological advances influencing their giving, compared with only 23% of Baby Boomers. This trend continues for the rise of alternative forms of giving (32% of Millennials, compared with 14% of Boomers) and increased opportunities to connect with peers about giving (30%, compared with 11%).

Twenty-nine percent of Millennials are very optimistic about philanthropy’s ability to solve the issues most important to them, compared with only 15% of Baby Boomers.²

One thing they have in common is their priorities. Both generations prioritize challenges related to health, hunger, and the environment.⁶

Today, foundations need to focus on impact, not just education programs or scholarships. New tech-driven trends in giving, such as the emergence of digital peer-to-peer giving and crowdfunding campaigns, make it possible to tap into high-volume, small-amount donations. To recruit new donors, organizations will need to target their messages based on the audience segment.
 

References:

1. Giving USA 2019: Annual report for philanthropy for 2018. Accessed Nov. 14, 2019.

2. Fidelity Charitable (2019) Future of philanthropy. Accessed Nov. 10, 2019.3. Betbeze, Philip (2018) Charitable giving to health giving to health organizations rose 7.3% last year. Health Leaders. July 11.

4. Martis & Landy/Indiana University Lilly Family School of Philanthropy (2018) The Philanthropy Outlook 2018 & 2019.

5. M&R Benchmarks 2019.

6. Nonprofit Source (2019) The ultimate list of charitable giving statistics for 2018. Accessed Nov. 10, 2019.

Note: Background research performed by Avenue M Group.

CHEST Inspiration is a collection of programmatic initiatives developed by the American College of Chest Physicians leadership and aimed at stimulating and encouraging innovation within the association. One of the components of CHEST Inspiration is the Environmental Scan, a series of articles focusing on the internal and external environmental factors that bear on success currently and in the future. See “Envisioning the Future: The CHEST Environmental Scan,” CHEST Physician, June 2019, p. 44, for an introduction to the series.

Philanthropy is a driving force supporting and promoting pioneering research and programs in many fields of medicine. Charitable giving, foundation support, and grants touch the lives of millions of patients and also have an impact across all fields of practice of medical practice. But philanthropy is being transformed by changing technology, interests of the giving public, and demands for accountability and transparency. Understanding where these trends are going will give physicians insights into what they can expect from philanthropy and what it might mean for their own institutions and interests.

Impact investing, transparency, and trust

The demand for increased accountability in philanthropy is growing. Today’s donors want to know their contributions will have a real impact in causes they believe in. As donors become more focused on results, organizations will need to demonstrate their ability to achieve short-term goals that bring them closer to accomplishing their mission and vision. This sentiment may be strongest among Millennials. Nonprofit organizations should expect an increased level of due diligence and a higher level of personal involvement by donors. At least 41% of donors have changed their giving because of increased knowledge about nonprofit effectiveness. Foundations and corporations donate to medical centers and research institutions, but recipients are have an expectation of close involvement of donors, the need for detailed accounts of how funds are spent, and a responsibility to show progress or measurable outcomes.²

Health care–related issues

Two of the top three issues identified by donors as a challenge to be addressed are related to health care, according to Fidelity Charitable. Thirty-nine percent identified “developing treatment or cures for a disease” and 33% cited “access to basic health services” as priority issues. A study by Giving USA estimated that charitable giving to health care organizations rose a strong 7.3% (5.5% adjusted for inflation) in 2017, but giving that year was fueled by a booming stock market and a favorable tax environment. Charitable donations to hospitals tend to reflect the economic health of the community in which the institution is located. Donations to rural hospitals in depressed communities are likely to be far less than to urban institutions in economically strong areas.³

Tax reform

The Tax Cuts and Jobs Act of 2017 will likely affect donations to charitable organizations in 2019. Specifically, the 2017 Tax Act doubled the standard tax deduction, thereby reducing the number of households having to itemize their deductions and eliminating many tax benefits for charitable donations. Middle-class families are expected to opt for the standard deduction while wealthier taxpayers will likely continue itemizing their deductions. As a result, some predict that donors may switch from giving annually to giving every third year so they can itemize in their giving years to get the deduction. Estimates that charitable donations from individuals may decrease as much as $4 billion to $11 billion because of the increase in standard deductions and $0.9 billion to $2.1 billion because of the decrease in the marginal tax rate.⁴

Technology and peer-to-peer giving

Technological advances that make researching and giving easier and more convenient are likely to have a significant impact on many charitable organizations in 2019. Online donations are likely to increase as organizations make it simple to donate from mobile devices, social media platforms and their websites. Although charitable organizations will continue to directly ask individuals for a donation, many are expanding their efforts to include online social campaigns that leverage peer-to-peer giving. Other technological advancements likely to affect donations in the future include the ability for organizations to incorporate contactless payment programs and blockchain technology. Online giving grew by 12.1% over 2018-2019 with monthly automatic giving increasing by 40% over 2016 to 2017.⁵

Generational differences in giving

Although the trends identified above are likely to affect the decision to give in 2019, there are some meaningful differences in how different generations embrace these changes. Technological advances, the rise of alternative forms of giving, and increased opportunities to connect with peers about giving influence Millennials significantly more than Baby Boomers. Millennials are more likely to say that they give to make a meaningful difference while Boomers are likely to say that giving is part of their values. Millennials also are more likely to say their giving is more spontaneous while Boomers say their giving is more planned. As many as 49% of Millennials cite technological advances influencing their giving, compared with only 23% of Baby Boomers. This trend continues for the rise of alternative forms of giving (32% of Millennials, compared with 14% of Boomers) and increased opportunities to connect with peers about giving (30%, compared with 11%).

Twenty-nine percent of Millennials are very optimistic about philanthropy’s ability to solve the issues most important to them, compared with only 15% of Baby Boomers.²

One thing they have in common is their priorities. Both generations prioritize challenges related to health, hunger, and the environment.⁶

Today, foundations need to focus on impact, not just education programs or scholarships. New tech-driven trends in giving, such as the emergence of digital peer-to-peer giving and crowdfunding campaigns, make it possible to tap into high-volume, small-amount donations. To recruit new donors, organizations will need to target their messages based on the audience segment.
 

References:

1. Giving USA 2019: Annual report for philanthropy for 2018. Accessed Nov. 14, 2019.

2. Fidelity Charitable (2019) Future of philanthropy. Accessed Nov. 10, 2019.3. Betbeze, Philip (2018) Charitable giving to health giving to health organizations rose 7.3% last year. Health Leaders. July 11.

4. Martis & Landy/Indiana University Lilly Family School of Philanthropy (2018) The Philanthropy Outlook 2018 & 2019.

5. M&R Benchmarks 2019.

6. Nonprofit Source (2019) The ultimate list of charitable giving statistics for 2018. Accessed Nov. 10, 2019.

Note: Background research performed by Avenue M Group.

CHEST Inspiration is a collection of programmatic initiatives developed by the American College of Chest Physicians leadership and aimed at stimulating and encouraging innovation within the association. One of the components of CHEST Inspiration is the Environmental Scan, a series of articles focusing on the internal and external environmental factors that bear on success currently and in the future. See “Envisioning the Future: The CHEST Environmental Scan,” CHEST Physician, June 2019, p. 44, for an introduction to the series.

Philanthropy is a driving force supporting and promoting pioneering research and programs in many fields of medicine. Charitable giving, foundation support, and grants touch the lives of millions of patients and also have an impact across all fields of practice of medical practice. But philanthropy is being transformed by changing technology, interests of the giving public, and demands for accountability and transparency. Understanding where these trends are going will give physicians insights into what they can expect from philanthropy and what it might mean for their own institutions and interests.

Impact investing, transparency, and trust

The demand for increased accountability in philanthropy is growing. Today’s donors want to know their contributions will have a real impact in causes they believe in. As donors become more focused on results, organizations will need to demonstrate their ability to achieve short-term goals that bring them closer to accomplishing their mission and vision. This sentiment may be strongest among Millennials. Nonprofit organizations should expect an increased level of due diligence and a higher level of personal involvement by donors. At least 41% of donors have changed their giving because of increased knowledge about nonprofit effectiveness. Foundations and corporations donate to medical centers and research institutions, but recipients are have an expectation of close involvement of donors, the need for detailed accounts of how funds are spent, and a responsibility to show progress or measurable outcomes.²

Health care–related issues

Two of the top three issues identified by donors as a challenge to be addressed are related to health care, according to Fidelity Charitable. Thirty-nine percent identified “developing treatment or cures for a disease” and 33% cited “access to basic health services” as priority issues. A study by Giving USA estimated that charitable giving to health care organizations rose a strong 7.3% (5.5% adjusted for inflation) in 2017, but giving that year was fueled by a booming stock market and a favorable tax environment. Charitable donations to hospitals tend to reflect the economic health of the community in which the institution is located. Donations to rural hospitals in depressed communities are likely to be far less than to urban institutions in economically strong areas.³

Tax reform

The Tax Cuts and Jobs Act of 2017 will likely affect donations to charitable organizations in 2019. Specifically, the 2017 Tax Act doubled the standard tax deduction, thereby reducing the number of households having to itemize their deductions and eliminating many tax benefits for charitable donations. Middle-class families are expected to opt for the standard deduction while wealthier taxpayers will likely continue itemizing their deductions. As a result, some predict that donors may switch from giving annually to giving every third year so they can itemize in their giving years to get the deduction. Estimates that charitable donations from individuals may decrease as much as $4 billion to $11 billion because of the increase in standard deductions and $0.9 billion to $2.1 billion because of the decrease in the marginal tax rate.⁴

Technology and peer-to-peer giving

Technological advances that make researching and giving easier and more convenient are likely to have a significant impact on many charitable organizations in 2019. Online donations are likely to increase as organizations make it simple to donate from mobile devices, social media platforms and their websites. Although charitable organizations will continue to directly ask individuals for a donation, many are expanding their efforts to include online social campaigns that leverage peer-to-peer giving. Other technological advancements likely to affect donations in the future include the ability for organizations to incorporate contactless payment programs and blockchain technology. Online giving grew by 12.1% over 2018-2019 with monthly automatic giving increasing by 40% over 2016 to 2017.⁵

Generational differences in giving

Although the trends identified above are likely to affect the decision to give in 2019, there are some meaningful differences in how different generations embrace these changes. Technological advances, the rise of alternative forms of giving, and increased opportunities to connect with peers about giving influence Millennials significantly more than Baby Boomers. Millennials are more likely to say that they give to make a meaningful difference while Boomers are likely to say that giving is part of their values. Millennials also are more likely to say their giving is more spontaneous while Boomers say their giving is more planned. As many as 49% of Millennials cite technological advances influencing their giving, compared with only 23% of Baby Boomers. This trend continues for the rise of alternative forms of giving (32% of Millennials, compared with 14% of Boomers) and increased opportunities to connect with peers about giving (30%, compared with 11%).

Twenty-nine percent of Millennials are very optimistic about philanthropy’s ability to solve the issues most important to them, compared with only 15% of Baby Boomers.²

One thing they have in common is their priorities. Both generations prioritize challenges related to health, hunger, and the environment.⁶

Today, foundations need to focus on impact, not just education programs or scholarships. New tech-driven trends in giving, such as the emergence of digital peer-to-peer giving and crowdfunding campaigns, make it possible to tap into high-volume, small-amount donations. To recruit new donors, organizations will need to target their messages based on the audience segment.
 

References:

1. Giving USA 2019: Annual report for philanthropy for 2018. Accessed Nov. 14, 2019.

2. Fidelity Charitable (2019) Future of philanthropy. Accessed Nov. 10, 2019.3. Betbeze, Philip (2018) Charitable giving to health giving to health organizations rose 7.3% last year. Health Leaders. July 11.

4. Martis & Landy/Indiana University Lilly Family School of Philanthropy (2018) The Philanthropy Outlook 2018 & 2019.

5. M&R Benchmarks 2019.

6. Nonprofit Source (2019) The ultimate list of charitable giving statistics for 2018. Accessed Nov. 10, 2019.

Note: Background research performed by Avenue M Group.

CHEST Inspiration is a collection of programmatic initiatives developed by the American College of Chest Physicians leadership and aimed at stimulating and encouraging innovation within the association. One of the components of CHEST Inspiration is the Environmental Scan, a series of articles focusing on the internal and external environmental factors that bear on success currently and in the future. See “Envisioning the Future: The CHEST Environmental Scan,” CHEST Physician, June 2019, p. 44, for an introduction to the series.

Each year, CHEST honors physicians and others who are making significant or meritorious contributions to chest medicine. All honorees are recognized for advancing work in specific areas of chest medicine, mentorship, and training, furthering the work of CHEST, and more.

If you believe you have a colleague who should be recognized for their distinguished work, please submit a nomination. Those selected for an annual award and honor lecture will be featured at CHEST 2020 in Chicago.

Deadline: Monday, January 6, 2020

Questions? Please contact Emily Petraglia, Manager, Volunteer Engagement ([email protected]).


The following awards are now open for nominations:

 Annual Awards

College Medalist Award

Distinguished Service AwardMaster FCCP

Honor and Memorial Lectures

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Endowed Honor Lecture.

Roger C. Bone Memorial Lecture in Critical CareMurray Kornfeld Memorial Founders Award

Distinguished Scientist Honor Lecture in Cardiopulmonary PhysiologyPasquale Ciaglia Memorial Lecture in Interventional MedicineMargaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical VentilationThomas L. Petty, MD, Master FCCP Endowed Memorial Lecture

Educator Awards

Early Career Clinician Educator

Master Clinician Educator
 

Each year, CHEST honors physicians and others who are making significant or meritorious contributions to chest medicine. All honorees are recognized for advancing work in specific areas of chest medicine, mentorship, and training, furthering the work of CHEST, and more.

If you believe you have a colleague who should be recognized for their distinguished work, please submit a nomination. Those selected for an annual award and honor lecture will be featured at CHEST 2020 in Chicago.

Deadline: Monday, January 6, 2020

Questions? Please contact Emily Petraglia, Manager, Volunteer Engagement ([email protected]).


The following awards are now open for nominations:

 Annual Awards

College Medalist Award

Distinguished Service AwardMaster FCCP

Honor and Memorial Lectures

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Endowed Honor Lecture.

Roger C. Bone Memorial Lecture in Critical CareMurray Kornfeld Memorial Founders Award

Distinguished Scientist Honor Lecture in Cardiopulmonary PhysiologyPasquale Ciaglia Memorial Lecture in Interventional MedicineMargaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical VentilationThomas L. Petty, MD, Master FCCP Endowed Memorial Lecture

Educator Awards

Early Career Clinician Educator

Master Clinician Educator
 

Each year, CHEST honors physicians and others who are making significant or meritorious contributions to chest medicine. All honorees are recognized for advancing work in specific areas of chest medicine, mentorship, and training, furthering the work of CHEST, and more.

If you believe you have a colleague who should be recognized for their distinguished work, please submit a nomination. Those selected for an annual award and honor lecture will be featured at CHEST 2020 in Chicago.

Deadline: Monday, January 6, 2020

Questions? Please contact Emily Petraglia, Manager, Volunteer Engagement ([email protected]).


The following awards are now open for nominations:

 Annual Awards

College Medalist Award

Distinguished Service AwardMaster FCCP

Honor and Memorial Lectures

Edward C. Rosenow III, MD, Master FCCP/Master Teacher Endowed Honor Lecture.

Roger C. Bone Memorial Lecture in Critical CareMurray Kornfeld Memorial Founders Award

Distinguished Scientist Honor Lecture in Cardiopulmonary PhysiologyPasquale Ciaglia Memorial Lecture in Interventional MedicineMargaret Pfrommer Endowed Memorial Lecture in Home-Based Mechanical VentilationThomas L. Petty, MD, Master FCCP Endowed Memorial Lecture

Educator Awards

Early Career Clinician Educator

Master Clinician Educator
 

We are living through an era of rapidly accelerated social, political, and environmental change. Spiraling costs of medical care, consumer activism around health care delivery, an aging population, and growing evidence of climate change are just some of the big currents of change. These trends are national and global in scope, and as such, far beyond any one profession or sector to shape or control. It remains for the medical profession to understand the currents of the time and adapt in order to thrive in the future.

Regulatory environment in flux

Hospitals and clinicians continue to struggle with a regulatory framework designed to improve higher quality of care yet may be creating additional barriers to access and efficiency. The passionate debate about health care costs and coverage is ongoing at the national level and appears to be a central issue on the minds of voters. Although the outcome of the debate cannot be foreseen, it will be left to the medical profession to maintain standards of care. Although the Affordable Care Act may not be repealed, the federal government’s role may diminish as policy is likely to be made by state politicians and bureaucrats.¹ As a result, organizations operating in multiple states may find it difficult to develop organization-wide business strategies. And with the shift to value-based reimbursement and issues related to data breaches regarding private patient health care information, many health care professionals will need better support and documentation tools to remain compliant. This puts a large burden on medical organizations to invest even more in information technology, data management systems, and a wide range of training up and down the organizational chart. Keeping up with the needs of physicians for secure data management will be costly but critical.

Patients will feel climate change

Environmental factors affecting the air we breathe are of primary concern for patients with a broad range of cardiorespiratory conditions.² Healthy but vulnerable infants, children, pregnant women, and the elderly may also feel the effects.³ Air pollution, increased levels of pollen and ground-level ozone, and wildfire smoke are all tied to climate change and all can have a direct impact on the patients seen by chest physicians.4 Individuals exposed to these environmental conditions may experience diminished lung function, resulting in increased hospital admissions.

Keeping up with the latest research on probable health impacts of these environmental trends will be on the agenda of most chest physicians.⁵ Professional societies will need to prepare to serve the educational needs of members in this regard. Continuing education content on these topics will be needed. The field will respond with new diagnostic tools and new treatments.⁶ Climate change may be a global-level phenomenon, but for many chest physicians, it means treating increasing numbers of patients affected by pulmonary disease.
 

Mind the generation gap

The population in the United States is primarily under the age of 65 years (84%), but the number of older citizens is on the rise. In 2016, there were 49.2 million people age 65 or older, and this number is projected to almost double to 98 million in 2060. The 85-and-over population is projected to more than double from 6.4 million in 2016 to 14.6 million in 2040 (a 129% increase).⁷

The medical needs of the aging population are already part of most medical institution’s planning but the current uncertainty in the health insurance market and the potential changes in Medicare coverage, not to mention the well-documented upcoming physician shortage, are complicating the planning process.⁸ Almost all acknowledge the “graying” of the population, but current approaches may not be sufficient given the projected the scale of the problems such as major increases in patients with chronic illnesses and the need for upscaling long-term geriatric care.

Planning for treating a growing elderly population shouldn’t mean ignoring some trends appearing among the younger population. E-cigarette use among middle- and high-school students may be creating millions of future patients with lung damage and nicotine addictions.⁹ Government intervention in this smoking epidemic is lagging behind the rapid spread of this unhealthy habit among young people.¹⁰ In 2019, health coverage of adults has begun to decline again after a decade of gains, and the possibility of this becoming a long-term trend has to be considered in planning for their treatment.^11,12

References

1. Statistica. “Affordable Care Act - Statistics & Facts,” Matej Mikulic. 2019 Aug 14.

2. American Public Health Association and Centers for Disease Control and Prevention (2018). Climate Change Decreases the Quality of the Air We Breathe. Accessed 2019 Oct 7.

3. JAMA. 2019 Aug 13;322(6):546-56. doi: 10.1001/jama.2019.10255.

4. Lelieveld J et al. Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions. Eur Heart J. 2019;40(20); 1590-6. doi: 10.1093/eurheartj/ehz135

5. European Respiratory Society. CME Online: Air pollution and respiratory health. 2018 Jun 21.

6. Environmental Protection Agency. “Particle Pollution and Your Patients’ Health,” Continuing Education for Particle Pollution Course. 2019 May 13.

7. U.S. Department of Health & Human Services. Administration on Aging. 2017 Profile of Older Americans. Accessed 2019 Oct 7.

8. Association of American Medical Colleges. Complexities of Physician Supply and Demand: Projection from 2017 to 2032. 2019 Apr.

9. Miech R et al. Trends in Adolescent Vaping, 2017-2019. N Eng J Med. 2019 Sep 18. doi: 10.1056/NEJMc1910739

10. Ned Sharpless, MD, Food and Drug Administration Acting Commissioner. “How the FDA is Regulating E-Cigarettes,” 2019 Sep 10.

11. Congressional Budget Office. Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029. Washington D;C.: GPO, 2029

12. Galewitz P. “Breaking a 10-year streak, the number of uninsured Americans rises.” Internal Medicine News, 2019 Sep 11.

Note: Background research performed by Avenue M Group.

CHEST Inspiration is a collection of programmatic initiatives developed by the American College of Chest Physicians leadership and aimed at stimulating and encouraging innovation within the association. One of the components of CHEST Inspiration is the Environmental Scan, a series of articles focusing on the internal and external environmental factors that bear on success currently and in the future. See “Envisioning the Future: The CHEST Environmental Scan,” CHEST Physician, June 2019, p. 44, for an introduction to the series.

We are living through an era of rapidly accelerated social, political, and environmental change. Spiraling costs of medical care, consumer activism around health care delivery, an aging population, and growing evidence of climate change are just some of the big currents of change. These trends are national and global in scope, and as such, far beyond any one profession or sector to shape or control. It remains for the medical profession to understand the currents of the time and adapt in order to thrive in the future.

Regulatory environment in flux

Hospitals and clinicians continue to struggle with a regulatory framework designed to improve higher quality of care yet may be creating additional barriers to access and efficiency. The passionate debate about health care costs and coverage is ongoing at the national level and appears to be a central issue on the minds of voters. Although the outcome of the debate cannot be foreseen, it will be left to the medical profession to maintain standards of care. Although the Affordable Care Act may not be repealed, the federal government’s role may diminish as policy is likely to be made by state politicians and bureaucrats.¹ As a result, organizations operating in multiple states may find it difficult to develop organization-wide business strategies. And with the shift to value-based reimbursement and issues related to data breaches regarding private patient health care information, many health care professionals will need better support and documentation tools to remain compliant. This puts a large burden on medical organizations to invest even more in information technology, data management systems, and a wide range of training up and down the organizational chart. Keeping up with the needs of physicians for secure data management will be costly but critical.

Patients will feel climate change

Environmental factors affecting the air we breathe are of primary concern for patients with a broad range of cardiorespiratory conditions.² Healthy but vulnerable infants, children, pregnant women, and the elderly may also feel the effects.³ Air pollution, increased levels of pollen and ground-level ozone, and wildfire smoke are all tied to climate change and all can have a direct impact on the patients seen by chest physicians.4 Individuals exposed to these environmental conditions may experience diminished lung function, resulting in increased hospital admissions.

Keeping up with the latest research on probable health impacts of these environmental trends will be on the agenda of most chest physicians.⁵ Professional societies will need to prepare to serve the educational needs of members in this regard. Continuing education content on these topics will be needed. The field will respond with new diagnostic tools and new treatments.⁶ Climate change may be a global-level phenomenon, but for many chest physicians, it means treating increasing numbers of patients affected by pulmonary disease.
 

Mind the generation gap

The population in the United States is primarily under the age of 65 years (84%), but the number of older citizens is on the rise. In 2016, there were 49.2 million people age 65 or older, and this number is projected to almost double to 98 million in 2060. The 85-and-over population is projected to more than double from 6.4 million in 2016 to 14.6 million in 2040 (a 129% increase).⁷

The medical needs of the aging population are already part of most medical institution’s planning but the current uncertainty in the health insurance market and the potential changes in Medicare coverage, not to mention the well-documented upcoming physician shortage, are complicating the planning process.⁸ Almost all acknowledge the “graying” of the population, but current approaches may not be sufficient given the projected the scale of the problems such as major increases in patients with chronic illnesses and the need for upscaling long-term geriatric care.

Planning for treating a growing elderly population shouldn’t mean ignoring some trends appearing among the younger population. E-cigarette use among middle- and high-school students may be creating millions of future patients with lung damage and nicotine addictions.⁹ Government intervention in this smoking epidemic is lagging behind the rapid spread of this unhealthy habit among young people.¹⁰ In 2019, health coverage of adults has begun to decline again after a decade of gains, and the possibility of this becoming a long-term trend has to be considered in planning for their treatment.^11,12

References

1. Statistica. “Affordable Care Act - Statistics & Facts,” Matej Mikulic. 2019 Aug 14.

2. American Public Health Association and Centers for Disease Control and Prevention (2018). Climate Change Decreases the Quality of the Air We Breathe. Accessed 2019 Oct 7.

3. JAMA. 2019 Aug 13;322(6):546-56. doi: 10.1001/jama.2019.10255.

4. Lelieveld J et al. Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions. Eur Heart J. 2019;40(20); 1590-6. doi: 10.1093/eurheartj/ehz135

5. European Respiratory Society. CME Online: Air pollution and respiratory health. 2018 Jun 21.

6. Environmental Protection Agency. “Particle Pollution and Your Patients’ Health,” Continuing Education for Particle Pollution Course. 2019 May 13.

7. U.S. Department of Health & Human Services. Administration on Aging. 2017 Profile of Older Americans. Accessed 2019 Oct 7.

8. Association of American Medical Colleges. Complexities of Physician Supply and Demand: Projection from 2017 to 2032. 2019 Apr.

9. Miech R et al. Trends in Adolescent Vaping, 2017-2019. N Eng J Med. 2019 Sep 18. doi: 10.1056/NEJMc1910739

10. Ned Sharpless, MD, Food and Drug Administration Acting Commissioner. “How the FDA is Regulating E-Cigarettes,” 2019 Sep 10.

11. Congressional Budget Office. Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029. Washington D;C.: GPO, 2029

12. Galewitz P. “Breaking a 10-year streak, the number of uninsured Americans rises.” Internal Medicine News, 2019 Sep 11.

Note: Background research performed by Avenue M Group.

CHEST Inspiration is a collection of programmatic initiatives developed by the American College of Chest Physicians leadership and aimed at stimulating and encouraging innovation within the association. One of the components of CHEST Inspiration is the Environmental Scan, a series of articles focusing on the internal and external environmental factors that bear on success currently and in the future. See “Envisioning the Future: The CHEST Environmental Scan,” CHEST Physician, June 2019, p. 44, for an introduction to the series.

We are living through an era of rapidly accelerated social, political, and environmental change. Spiraling costs of medical care, consumer activism around health care delivery, an aging population, and growing evidence of climate change are just some of the big currents of change. These trends are national and global in scope, and as such, far beyond any one profession or sector to shape or control. It remains for the medical profession to understand the currents of the time and adapt in order to thrive in the future.

Regulatory environment in flux

Hospitals and clinicians continue to struggle with a regulatory framework designed to improve higher quality of care yet may be creating additional barriers to access and efficiency. The passionate debate about health care costs and coverage is ongoing at the national level and appears to be a central issue on the minds of voters. Although the outcome of the debate cannot be foreseen, it will be left to the medical profession to maintain standards of care. Although the Affordable Care Act may not be repealed, the federal government’s role may diminish as policy is likely to be made by state politicians and bureaucrats.¹ As a result, organizations operating in multiple states may find it difficult to develop organization-wide business strategies. And with the shift to value-based reimbursement and issues related to data breaches regarding private patient health care information, many health care professionals will need better support and documentation tools to remain compliant. This puts a large burden on medical organizations to invest even more in information technology, data management systems, and a wide range of training up and down the organizational chart. Keeping up with the needs of physicians for secure data management will be costly but critical.

Patients will feel climate change

Environmental factors affecting the air we breathe are of primary concern for patients with a broad range of cardiorespiratory conditions.² Healthy but vulnerable infants, children, pregnant women, and the elderly may also feel the effects.³ Air pollution, increased levels of pollen and ground-level ozone, and wildfire smoke are all tied to climate change and all can have a direct impact on the patients seen by chest physicians.4 Individuals exposed to these environmental conditions may experience diminished lung function, resulting in increased hospital admissions.

Keeping up with the latest research on probable health impacts of these environmental trends will be on the agenda of most chest physicians.⁵ Professional societies will need to prepare to serve the educational needs of members in this regard. Continuing education content on these topics will be needed. The field will respond with new diagnostic tools and new treatments.⁶ Climate change may be a global-level phenomenon, but for many chest physicians, it means treating increasing numbers of patients affected by pulmonary disease.
 

Mind the generation gap

The population in the United States is primarily under the age of 65 years (84%), but the number of older citizens is on the rise. In 2016, there were 49.2 million people age 65 or older, and this number is projected to almost double to 98 million in 2060. The 85-and-over population is projected to more than double from 6.4 million in 2016 to 14.6 million in 2040 (a 129% increase).⁷

The medical needs of the aging population are already part of most medical institution’s planning but the current uncertainty in the health insurance market and the potential changes in Medicare coverage, not to mention the well-documented upcoming physician shortage, are complicating the planning process.⁸ Almost all acknowledge the “graying” of the population, but current approaches may not be sufficient given the projected the scale of the problems such as major increases in patients with chronic illnesses and the need for upscaling long-term geriatric care.

Planning for treating a growing elderly population shouldn’t mean ignoring some trends appearing among the younger population. E-cigarette use among middle- and high-school students may be creating millions of future patients with lung damage and nicotine addictions.⁹ Government intervention in this smoking epidemic is lagging behind the rapid spread of this unhealthy habit among young people.¹⁰ In 2019, health coverage of adults has begun to decline again after a decade of gains, and the possibility of this becoming a long-term trend has to be considered in planning for their treatment.^11,12

References

1. Statistica. “Affordable Care Act - Statistics & Facts,” Matej Mikulic. 2019 Aug 14.

2. American Public Health Association and Centers for Disease Control and Prevention (2018). Climate Change Decreases the Quality of the Air We Breathe. Accessed 2019 Oct 7.

3. JAMA. 2019 Aug 13;322(6):546-56. doi: 10.1001/jama.2019.10255.

4. Lelieveld J et al. Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions. Eur Heart J. 2019;40(20); 1590-6. doi: 10.1093/eurheartj/ehz135

5. European Respiratory Society. CME Online: Air pollution and respiratory health. 2018 Jun 21.

6. Environmental Protection Agency. “Particle Pollution and Your Patients’ Health,” Continuing Education for Particle Pollution Course. 2019 May 13.

7. U.S. Department of Health & Human Services. Administration on Aging. 2017 Profile of Older Americans. Accessed 2019 Oct 7.

8. Association of American Medical Colleges. Complexities of Physician Supply and Demand: Projection from 2017 to 2032. 2019 Apr.

9. Miech R et al. Trends in Adolescent Vaping, 2017-2019. N Eng J Med. 2019 Sep 18. doi: 10.1056/NEJMc1910739

10. Ned Sharpless, MD, Food and Drug Administration Acting Commissioner. “How the FDA is Regulating E-Cigarettes,” 2019 Sep 10.

11. Congressional Budget Office. Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029. Washington D;C.: GPO, 2029

12. Galewitz P. “Breaking a 10-year streak, the number of uninsured Americans rises.” Internal Medicine News, 2019 Sep 11.

Note: Background research performed by Avenue M Group.

CHEST Inspiration is a collection of programmatic initiatives developed by the American College of Chest Physicians leadership and aimed at stimulating and encouraging innovation within the association. One of the components of CHEST Inspiration is the Environmental Scan, a series of articles focusing on the internal and external environmental factors that bear on success currently and in the future. See “Envisioning the Future: The CHEST Environmental Scan,” CHEST Physician, June 2019, p. 44, for an introduction to the series.

Editor’s Note - As CHEST has just awarded the designation of Distinguished CHEST Educator (DCE) to 173 honorees at CHEST 2019 in New Orleans, this blog reminds fellows to start early to pursue a clinician educator role throughout their career.

While fellowship training is a time to continue building the foundation of expert clinical knowledge, it also offers an opportunity to start assembling a portfolio as a clinician educator. It takes time to compile educational scholarship and to establish a reputation within the communities of both teachers and learners, so it pays to get a head start. Moreover, it also takes time to master techniques for effective teaching to become that outstanding educator that you once looked up to as a medical student or resident. Below are some things that I found helpful in jump-starting that path during fellowship training.

Find a Capable Mentor

As with any sort of career planning, mentorship is key. Mentorship can open doors to expand your network and introduce opportunities for scholarship activities. Find a mentor who shares similar views and values with something that you feel passionate about. If you are planning on starting a scholarly project, make sure that your mentor has the background suited to help you maximize the experience and offer you the tools needed to achieve that end.

Determine What You Are Passionate About

Medical education is a vast field. Try to find something in medical education that is meaningful to you, whether it be in undergraduate medical education or graduate medical education or something else altogether. You want to be able to set yourself up for success, so the work has to be worthwhile.

Seek Out Opportunities to Teach

There are always opportunities to teach whether it entails precepting medical students on patient interviews or going over pulmonary/critical care topics at resident noon conferences. What I have found is that active participation in teaching opportunities tends to open a cascade of doors to more teaching opportunities.

Look for Opportunities to Be Involved in Educational Committees

Medical education, much like medicine, is a highly changing field. Leadership in medical education is always looking for resident/fellow representatives to bring new life and perspective to educational initiatives. Most of these opportunities do not require too much of a time commitment, and most committees often meet on a once-monthly basis. However, it connects you with faculty who are part of the leadership who can guide and help set you up for future success in medical education. During residency, I was able to take part in the intern curriculum committee to advise the direction of intern report. Now as a fellow, I’ve been able to meet many faculty and fellows with similar interests as mine in the CHEST Trainee Work Group.

Engage in Scholarly Activities

It is one thing to have a portfolio detailing teaching experiences, but it is another thing to have demonstrated published works in the space of medical education. It shows long-term promise as a clinician educator, and it shows leadership potential in advancing the field. It doesn’t take much to produce publications in medical education—there are always journals who look for trainees to contribute to the field whether it be an editorial or systematic review or innovative ideas.

About the Author

Justin K. Lui, MD, is a graduate of Boston University School of Medicine. He completed an internal medicine residency and chief residency at the University of Massachusetts Medical School. He is currently a second-year pulmonary and critical care medicine fellow at Boston University School of Medicine.

Reprinted from CHEST’s Thought Leader’s Blog, July 2019. This post is part of Our Life as a Fellow blog post series and includes “fellow life lessons” from current trainees in leadership with CHEST.

Editor’s Note - As CHEST has just awarded the designation of Distinguished CHEST Educator (DCE) to 173 honorees at CHEST 2019 in New Orleans, this blog reminds fellows to start early to pursue a clinician educator role throughout their career.

While fellowship training is a time to continue building the foundation of expert clinical knowledge, it also offers an opportunity to start assembling a portfolio as a clinician educator. It takes time to compile educational scholarship and to establish a reputation within the communities of both teachers and learners, so it pays to get a head start. Moreover, it also takes time to master techniques for effective teaching to become that outstanding educator that you once looked up to as a medical student or resident. Below are some things that I found helpful in jump-starting that path during fellowship training.

Find a Capable Mentor

As with any sort of career planning, mentorship is key. Mentorship can open doors to expand your network and introduce opportunities for scholarship activities. Find a mentor who shares similar views and values with something that you feel passionate about. If you are planning on starting a scholarly project, make sure that your mentor has the background suited to help you maximize the experience and offer you the tools needed to achieve that end.

Determine What You Are Passionate About

Medical education is a vast field. Try to find something in medical education that is meaningful to you, whether it be in undergraduate medical education or graduate medical education or something else altogether. You want to be able to set yourself up for success, so the work has to be worthwhile.

Seek Out Opportunities to Teach

There are always opportunities to teach whether it entails precepting medical students on patient interviews or going over pulmonary/critical care topics at resident noon conferences. What I have found is that active participation in teaching opportunities tends to open a cascade of doors to more teaching opportunities.

Look for Opportunities to Be Involved in Educational Committees

Medical education, much like medicine, is a highly changing field. Leadership in medical education is always looking for resident/fellow representatives to bring new life and perspective to educational initiatives. Most of these opportunities do not require too much of a time commitment, and most committees often meet on a once-monthly basis. However, it connects you with faculty who are part of the leadership who can guide and help set you up for future success in medical education. During residency, I was able to take part in the intern curriculum committee to advise the direction of intern report. Now as a fellow, I’ve been able to meet many faculty and fellows with similar interests as mine in the CHEST Trainee Work Group.

Engage in Scholarly Activities

It is one thing to have a portfolio detailing teaching experiences, but it is another thing to have demonstrated published works in the space of medical education. It shows long-term promise as a clinician educator, and it shows leadership potential in advancing the field. It doesn’t take much to produce publications in medical education—there are always journals who look for trainees to contribute to the field whether it be an editorial or systematic review or innovative ideas.

About the Author

Justin K. Lui, MD, is a graduate of Boston University School of Medicine. He completed an internal medicine residency and chief residency at the University of Massachusetts Medical School. He is currently a second-year pulmonary and critical care medicine fellow at Boston University School of Medicine.

Reprinted from CHEST’s Thought Leader’s Blog, July 2019. This post is part of Our Life as a Fellow blog post series and includes “fellow life lessons” from current trainees in leadership with CHEST.

Editor’s Note - As CHEST has just awarded the designation of Distinguished CHEST Educator (DCE) to 173 honorees at CHEST 2019 in New Orleans, this blog reminds fellows to start early to pursue a clinician educator role throughout their career.

While fellowship training is a time to continue building the foundation of expert clinical knowledge, it also offers an opportunity to start assembling a portfolio as a clinician educator. It takes time to compile educational scholarship and to establish a reputation within the communities of both teachers and learners, so it pays to get a head start. Moreover, it also takes time to master techniques for effective teaching to become that outstanding educator that you once looked up to as a medical student or resident. Below are some things that I found helpful in jump-starting that path during fellowship training.

Find a Capable Mentor

As with any sort of career planning, mentorship is key. Mentorship can open doors to expand your network and introduce opportunities for scholarship activities. Find a mentor who shares similar views and values with something that you feel passionate about. If you are planning on starting a scholarly project, make sure that your mentor has the background suited to help you maximize the experience and offer you the tools needed to achieve that end.

Determine What You Are Passionate About

Medical education is a vast field. Try to find something in medical education that is meaningful to you, whether it be in undergraduate medical education or graduate medical education or something else altogether. You want to be able to set yourself up for success, so the work has to be worthwhile.

Seek Out Opportunities to Teach

There are always opportunities to teach whether it entails precepting medical students on patient interviews or going over pulmonary/critical care topics at resident noon conferences. What I have found is that active participation in teaching opportunities tends to open a cascade of doors to more teaching opportunities.

Look for Opportunities to Be Involved in Educational Committees

Medical education, much like medicine, is a highly changing field. Leadership in medical education is always looking for resident/fellow representatives to bring new life and perspective to educational initiatives. Most of these opportunities do not require too much of a time commitment, and most committees often meet on a once-monthly basis. However, it connects you with faculty who are part of the leadership who can guide and help set you up for future success in medical education. During residency, I was able to take part in the intern curriculum committee to advise the direction of intern report. Now as a fellow, I’ve been able to meet many faculty and fellows with similar interests as mine in the CHEST Trainee Work Group.

Engage in Scholarly Activities

It is one thing to have a portfolio detailing teaching experiences, but it is another thing to have demonstrated published works in the space of medical education. It shows long-term promise as a clinician educator, and it shows leadership potential in advancing the field. It doesn’t take much to produce publications in medical education—there are always journals who look for trainees to contribute to the field whether it be an editorial or systematic review or innovative ideas.

About the Author

Justin K. Lui, MD, is a graduate of Boston University School of Medicine. He completed an internal medicine residency and chief residency at the University of Massachusetts Medical School. He is currently a second-year pulmonary and critical care medicine fellow at Boston University School of Medicine.

Reprinted from CHEST’s Thought Leader’s Blog, July 2019. This post is part of Our Life as a Fellow blog post series and includes “fellow life lessons” from current trainees in leadership with CHEST.

Christopher L. Carroll, MD, MS, FCCP

Darcy D. Marciniuk, MD, FCCP

Christopher L. Carroll, MD, MS, FCCP

Darcy D. Marciniuk, MD, FCCP

Christopher L. Carroll, MD, MS, FCCP

Darcy D. Marciniuk, MD, FCCP

About a year ago, I had the opportunity to don the honorary regalia of the American College of Chest Physicians as its 81st President. On that memorable day on the dais in San Antonio, I used the example of James Surowiecki’s book, “The Wisdom of Crowds: Why the Many Are Smarter than the Few and How Collective Wisdom Shapes Business, Economics, Societies, and Nations” to explain how we would use the collective wisdom of our members, our committee and NetWork members, and our talented association staff to build and shape CHEST over the coming year. For those of you not familiar with this concept, Surowiecki, a business columnist for New Yorker, outlines the concept that large groups of people are actually smarter than an elite few at solving the problems of an organization, fostering innovation, collectively coming to wise decisions, or even predicting the future. In channeling the lessons from the book, it has become obvious that listening to our members and partners, rather than trying to make all decisions from the top down, has been an effective method for coming to wise decisions about the strategy and operation of CHEST. Now that it’s already time to hand the responsibility of the organization as President over to my friend and colleague Dr. Stephanie Levine, I’ve reflected on actually how effectively we have listened and how smart the collective crowd has been in moving the success of CHEST forward.

We heard from members that it was difficult to know how to get involved and what happens at the highest leadership levels of the organization. This prompted the development of podcasts dubbed “The Inside Scoop,” recorded live approximately every 2 months and featured various leaders of the organization with an informal way for members to better understand how to become involved in CHEST activities and to feel the pulse of activity of the association between the time the annual meeting ends and the next one begins.

The crowd informed us that communication at the Board of Regents level could be better. To address this, regular communications were sent out to the Board of Regents to update them on activities and discussion of issues between scheduled board meetings, as well as providing board members the opportunity to have access to the minutes of phone calls of the “5Ps,” calls that included the Immediate Past, President-Elect, President-Designate, and current President of the association, as well as the CHEST Foundation President.

We were told by members through focus groups and surveys, then again told by experts we invited to the June board meetings from education, business, design, and venture capital sectors (and who were naïve to CHEST as an association) that we needed to double down on virtual educational offerings to learners across the health-care delivery team and to revamp its information technology infrastructure. To that end, a digital strategy work group was convened with expertise in information technology, social media, and marketing to inventory all digital assets of the College and make recommendations for not just improvement, but for a complete transformation of digital technology created and promulgated by CHEST. The board then approved a budget of nearly $1 million to upgrade and rebuild the user experience within CHEST’s digital environment, including its learning management system. We also opened a multimedia studio at CHEST headquarters, increased the numbers of serious educational gaming opportunities at the annual meeting, and are developing a line of serious game platforms that will allow for “edutainment” opportunities for our members and other learners around the world using various digital platforms.

Colleagues from around the world reminded us that 20% of CHEST membership was international and that our strategic plan included an international strategy. Thanks to the support of our colleagues around the world, we were able to enjoy a tremendously successful CHEST Congress in Bangkok, Thailand, in April, and a smaller regional meeting in June in Athens, Greece. Efforts of the Governance Committee have reshaped the structure of international representation, making it more relevant and allowing its members to have a stronger voice to the Board of Regents. Plans are underway for the next CHEST Congress in June 2020 in Bologna, Italy, to be held in collaboration with the Italian Chapter of CHEST in that country.

In an era when the majority of association annual meetings across multiple specialties are driving toward parity with similar looks, marketing, formats, and expectations, we listened to the needs and desires of attendees of last year’s meeting and have improved CHEST 2019 in New Orleans even more. With the most simulation courses ever delivered at an annual meeting, more serious game opportunities, CHEST Challenge finals, a new innovation competition called “FISH Bowl,” and even a medical escape room, CHEST volunteer leaders and organization staff have worked hard to provide a world class meeting that has a different look and feel from all the others. Plus, the crowd also told us that having CME and MOC credit available for the entire meeting was another variable that was desired, and has now been achieved.

The wisdom of the proverbial crowd of membership has spoken in terms of the need for philanthropic efforts in our specialty. The CHEST Foundation has responded by awarding tens of thousands of dollars to our members to recognize cutting-edge research, community service efforts, and, in addition, has allowed dozens of providers early on in training or in their career to attend the annual meeting with the help of travel grants.

CHEST guidelines continue to be updated and new ones created based on input from expert panel teams. The CHEST journal submission process, review turnaround times, and quality of manuscripts have improved each year thanks to useful feedback from authors and readers. Publications such as CHEST Physician are modified each year based upon feedback from our readers. Critiques from the board review courses have been the driving force keeping live learning formats and the electronic SEEK board preparation questions current and accurate when the science is constantly changing.

Truly, the collective wisdom of our members, talented clinicians and researchers, and colleagues in industry has provided incredibly valuable input to the CHEST leadership team. You have spoken, and we have been listening. Thanks to each of you who have reached out to me during this year as President. Traveling to four continents this past year to better understand the needs of members who are clinicians, educators, researchers, and caregivers positioned in each geographic region has been enlightening, educational, and transformative for me and my family. Your meaningful feedback, keen insights, and passion for outstanding patient care, impactful educational experiences, and life-changing research have helped push CHEST to a higher level of excellence and to offer unparalleled experiences for our members to ultimately provide the very best care to patients.

About a year ago, I had the opportunity to don the honorary regalia of the American College of Chest Physicians as its 81st President. On that memorable day on the dais in San Antonio, I used the example of James Surowiecki’s book, “The Wisdom of Crowds: Why the Many Are Smarter than the Few and How Collective Wisdom Shapes Business, Economics, Societies, and Nations” to explain how we would use the collective wisdom of our members, our committee and NetWork members, and our talented association staff to build and shape CHEST over the coming year. For those of you not familiar with this concept, Surowiecki, a business columnist for New Yorker, outlines the concept that large groups of people are actually smarter than an elite few at solving the problems of an organization, fostering innovation, collectively coming to wise decisions, or even predicting the future. In channeling the lessons from the book, it has become obvious that listening to our members and partners, rather than trying to make all decisions from the top down, has been an effective method for coming to wise decisions about the strategy and operation of CHEST. Now that it’s already time to hand the responsibility of the organization as President over to my friend and colleague Dr. Stephanie Levine, I’ve reflected on actually how effectively we have listened and how smart the collective crowd has been in moving the success of CHEST forward.

We heard from members that it was difficult to know how to get involved and what happens at the highest leadership levels of the organization. This prompted the development of podcasts dubbed “The Inside Scoop,” recorded live approximately every 2 months and featured various leaders of the organization with an informal way for members to better understand how to become involved in CHEST activities and to feel the pulse of activity of the association between the time the annual meeting ends and the next one begins.

The crowd informed us that communication at the Board of Regents level could be better. To address this, regular communications were sent out to the Board of Regents to update them on activities and discussion of issues between scheduled board meetings, as well as providing board members the opportunity to have access to the minutes of phone calls of the “5Ps,” calls that included the Immediate Past, President-Elect, President-Designate, and current President of the association, as well as the CHEST Foundation President.

We were told by members through focus groups and surveys, then again told by experts we invited to the June board meetings from education, business, design, and venture capital sectors (and who were naïve to CHEST as an association) that we needed to double down on virtual educational offerings to learners across the health-care delivery team and to revamp its information technology infrastructure. To that end, a digital strategy work group was convened with expertise in information technology, social media, and marketing to inventory all digital assets of the College and make recommendations for not just improvement, but for a complete transformation of digital technology created and promulgated by CHEST. The board then approved a budget of nearly $1 million to upgrade and rebuild the user experience within CHEST’s digital environment, including its learning management system. We also opened a multimedia studio at CHEST headquarters, increased the numbers of serious educational gaming opportunities at the annual meeting, and are developing a line of serious game platforms that will allow for “edutainment” opportunities for our members and other learners around the world using various digital platforms.

Colleagues from around the world reminded us that 20% of CHEST membership was international and that our strategic plan included an international strategy. Thanks to the support of our colleagues around the world, we were able to enjoy a tremendously successful CHEST Congress in Bangkok, Thailand, in April, and a smaller regional meeting in June in Athens, Greece. Efforts of the Governance Committee have reshaped the structure of international representation, making it more relevant and allowing its members to have a stronger voice to the Board of Regents. Plans are underway for the next CHEST Congress in June 2020 in Bologna, Italy, to be held in collaboration with the Italian Chapter of CHEST in that country.

In an era when the majority of association annual meetings across multiple specialties are driving toward parity with similar looks, marketing, formats, and expectations, we listened to the needs and desires of attendees of last year’s meeting and have improved CHEST 2019 in New Orleans even more. With the most simulation courses ever delivered at an annual meeting, more serious game opportunities, CHEST Challenge finals, a new innovation competition called “FISH Bowl,” and even a medical escape room, CHEST volunteer leaders and organization staff have worked hard to provide a world class meeting that has a different look and feel from all the others. Plus, the crowd also told us that having CME and MOC credit available for the entire meeting was another variable that was desired, and has now been achieved.

The wisdom of the proverbial crowd of membership has spoken in terms of the need for philanthropic efforts in our specialty. The CHEST Foundation has responded by awarding tens of thousands of dollars to our members to recognize cutting-edge research, community service efforts, and, in addition, has allowed dozens of providers early on in training or in their career to attend the annual meeting with the help of travel grants.

CHEST guidelines continue to be updated and new ones created based on input from expert panel teams. The CHEST journal submission process, review turnaround times, and quality of manuscripts have improved each year thanks to useful feedback from authors and readers. Publications such as CHEST Physician are modified each year based upon feedback from our readers. Critiques from the board review courses have been the driving force keeping live learning formats and the electronic SEEK board preparation questions current and accurate when the science is constantly changing.

Truly, the collective wisdom of our members, talented clinicians and researchers, and colleagues in industry has provided incredibly valuable input to the CHEST leadership team. You have spoken, and we have been listening. Thanks to each of you who have reached out to me during this year as President. Traveling to four continents this past year to better understand the needs of members who are clinicians, educators, researchers, and caregivers positioned in each geographic region has been enlightening, educational, and transformative for me and my family. Your meaningful feedback, keen insights, and passion for outstanding patient care, impactful educational experiences, and life-changing research have helped push CHEST to a higher level of excellence and to offer unparalleled experiences for our members to ultimately provide the very best care to patients.

About a year ago, I had the opportunity to don the honorary regalia of the American College of Chest Physicians as its 81st President. On that memorable day on the dais in San Antonio, I used the example of James Surowiecki’s book, “The Wisdom of Crowds: Why the Many Are Smarter than the Few and How Collective Wisdom Shapes Business, Economics, Societies, and Nations” to explain how we would use the collective wisdom of our members, our committee and NetWork members, and our talented association staff to build and shape CHEST over the coming year. For those of you not familiar with this concept, Surowiecki, a business columnist for New Yorker, outlines the concept that large groups of people are actually smarter than an elite few at solving the problems of an organization, fostering innovation, collectively coming to wise decisions, or even predicting the future. In channeling the lessons from the book, it has become obvious that listening to our members and partners, rather than trying to make all decisions from the top down, has been an effective method for coming to wise decisions about the strategy and operation of CHEST. Now that it’s already time to hand the responsibility of the organization as President over to my friend and colleague Dr. Stephanie Levine, I’ve reflected on actually how effectively we have listened and how smart the collective crowd has been in moving the success of CHEST forward.

We heard from members that it was difficult to know how to get involved and what happens at the highest leadership levels of the organization. This prompted the development of podcasts dubbed “The Inside Scoop,” recorded live approximately every 2 months and featured various leaders of the organization with an informal way for members to better understand how to become involved in CHEST activities and to feel the pulse of activity of the association between the time the annual meeting ends and the next one begins.

The crowd informed us that communication at the Board of Regents level could be better. To address this, regular communications were sent out to the Board of Regents to update them on activities and discussion of issues between scheduled board meetings, as well as providing board members the opportunity to have access to the minutes of phone calls of the “5Ps,” calls that included the Immediate Past, President-Elect, President-Designate, and current President of the association, as well as the CHEST Foundation President.

We were told by members through focus groups and surveys, then again told by experts we invited to the June board meetings from education, business, design, and venture capital sectors (and who were naïve to CHEST as an association) that we needed to double down on virtual educational offerings to learners across the health-care delivery team and to revamp its information technology infrastructure. To that end, a digital strategy work group was convened with expertise in information technology, social media, and marketing to inventory all digital assets of the College and make recommendations for not just improvement, but for a complete transformation of digital technology created and promulgated by CHEST. The board then approved a budget of nearly $1 million to upgrade and rebuild the user experience within CHEST’s digital environment, including its learning management system. We also opened a multimedia studio at CHEST headquarters, increased the numbers of serious educational gaming opportunities at the annual meeting, and are developing a line of serious game platforms that will allow for “edutainment” opportunities for our members and other learners around the world using various digital platforms.

Colleagues from around the world reminded us that 20% of CHEST membership was international and that our strategic plan included an international strategy. Thanks to the support of our colleagues around the world, we were able to enjoy a tremendously successful CHEST Congress in Bangkok, Thailand, in April, and a smaller regional meeting in June in Athens, Greece. Efforts of the Governance Committee have reshaped the structure of international representation, making it more relevant and allowing its members to have a stronger voice to the Board of Regents. Plans are underway for the next CHEST Congress in June 2020 in Bologna, Italy, to be held in collaboration with the Italian Chapter of CHEST in that country.

In an era when the majority of association annual meetings across multiple specialties are driving toward parity with similar looks, marketing, formats, and expectations, we listened to the needs and desires of attendees of last year’s meeting and have improved CHEST 2019 in New Orleans even more. With the most simulation courses ever delivered at an annual meeting, more serious game opportunities, CHEST Challenge finals, a new innovation competition called “FISH Bowl,” and even a medical escape room, CHEST volunteer leaders and organization staff have worked hard to provide a world class meeting that has a different look and feel from all the others. Plus, the crowd also told us that having CME and MOC credit available for the entire meeting was another variable that was desired, and has now been achieved.

The wisdom of the proverbial crowd of membership has spoken in terms of the need for philanthropic efforts in our specialty. The CHEST Foundation has responded by awarding tens of thousands of dollars to our members to recognize cutting-edge research, community service efforts, and, in addition, has allowed dozens of providers early on in training or in their career to attend the annual meeting with the help of travel grants.

CHEST guidelines continue to be updated and new ones created based on input from expert panel teams. The CHEST journal submission process, review turnaround times, and quality of manuscripts have improved each year thanks to useful feedback from authors and readers. Publications such as CHEST Physician are modified each year based upon feedback from our readers. Critiques from the board review courses have been the driving force keeping live learning formats and the electronic SEEK board preparation questions current and accurate when the science is constantly changing.

Truly, the collective wisdom of our members, talented clinicians and researchers, and colleagues in industry has provided incredibly valuable input to the CHEST leadership team. You have spoken, and we have been listening. Thanks to each of you who have reached out to me during this year as President. Traveling to four continents this past year to better understand the needs of members who are clinicians, educators, researchers, and caregivers positioned in each geographic region has been enlightening, educational, and transformative for me and my family. Your meaningful feedback, keen insights, and passion for outstanding patient care, impactful educational experiences, and life-changing research have helped push CHEST to a higher level of excellence and to offer unparalleled experiences for our members to ultimately provide the very best care to patients.