Society News

As the NetWorks Challenge draws to a close, CHEST Foundation staff want to thank every member who donated to support this year’s drive for our COVID-19 Community Grants. When the fund was established in April, we started with a pool of $60,000 to award to patient support groups and small community organizations providing resources and interventions for those most vulnerable to develop severe complications from COVID-19 – American’s living with chronic lung disease. Within 2 months, we’d awarded all available funds to 25 organizations and had several others still seeking funding. The lion’s share of these groups were providing direct service to medically fragile and isolated patients – purchasing PPE, cleaning supplies, pulse oximeters, and even groceries to patients who otherwise wouldn’t have access to these critical supplies.

Because of YOUR support of the NetWorks Challenge, we are proud to share that we are providing an additional $43,850 in support of COVID-19 Community Grants. Because of you – we can continue to provide vital funding to support group members who lives’ you’ve changed forever.

“Receiving the CHEST Foundation grant for COVID-19 support was a real boost to all of our spirits. Our staff have been working tirelessly to care for our residents 24/7, and there have been some trying and exhausting moments. When we received the community-based grant, it reminded us that there are still people in our community cheering us on, and it’s an acknowledgment that our clients matter just as much to the community as they do to us, personally.” –– Katherine A. Brown, St. Coletta’s of Illinois

As the NetWorks Challenge draws to a close, CHEST Foundation staff want to thank every member who donated to support this year’s drive for our COVID-19 Community Grants. When the fund was established in April, we started with a pool of $60,000 to award to patient support groups and small community organizations providing resources and interventions for those most vulnerable to develop severe complications from COVID-19 – American’s living with chronic lung disease. Within 2 months, we’d awarded all available funds to 25 organizations and had several others still seeking funding. The lion’s share of these groups were providing direct service to medically fragile and isolated patients – purchasing PPE, cleaning supplies, pulse oximeters, and even groceries to patients who otherwise wouldn’t have access to these critical supplies.

Because of YOUR support of the NetWorks Challenge, we are proud to share that we are providing an additional $43,850 in support of COVID-19 Community Grants. Because of you – we can continue to provide vital funding to support group members who lives’ you’ve changed forever.

“Receiving the CHEST Foundation grant for COVID-19 support was a real boost to all of our spirits. Our staff have been working tirelessly to care for our residents 24/7, and there have been some trying and exhausting moments. When we received the community-based grant, it reminded us that there are still people in our community cheering us on, and it’s an acknowledgment that our clients matter just as much to the community as they do to us, personally.” –– Katherine A. Brown, St. Coletta’s of Illinois

As the NetWorks Challenge draws to a close, CHEST Foundation staff want to thank every member who donated to support this year’s drive for our COVID-19 Community Grants. When the fund was established in April, we started with a pool of $60,000 to award to patient support groups and small community organizations providing resources and interventions for those most vulnerable to develop severe complications from COVID-19 – American’s living with chronic lung disease. Within 2 months, we’d awarded all available funds to 25 organizations and had several others still seeking funding. The lion’s share of these groups were providing direct service to medically fragile and isolated patients – purchasing PPE, cleaning supplies, pulse oximeters, and even groceries to patients who otherwise wouldn’t have access to these critical supplies.

Because of YOUR support of the NetWorks Challenge, we are proud to share that we are providing an additional $43,850 in support of COVID-19 Community Grants. Because of you – we can continue to provide vital funding to support group members who lives’ you’ve changed forever.

“Receiving the CHEST Foundation grant for COVID-19 support was a real boost to all of our spirits. Our staff have been working tirelessly to care for our residents 24/7, and there have been some trying and exhausting moments. When we received the community-based grant, it reminded us that there are still people in our community cheering us on, and it’s an acknowledgment that our clients matter just as much to the community as they do to us, personally.” –– Katherine A. Brown, St. Coletta’s of Illinois

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field.

In case you missed it, here are some clinical discussions and Roundtables in the newsfeed this month:

• AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review (https://community.gastro.org/posts/22199)
• Establishing an acute colitis pathway (https://community.gastro.org/posts/22171)
• Preprocedure COVID testing (https://community.gastro.org/posts/22164)
• Patient case: Gastroesophageal varices (https://community.gastro.org/posts/22098)
• Patient case: IBD with intra-abdominal sepsis (https://community.gastro.org/posts/22055)
• Patient case: Hypervascular pancreatic parenchyma (https://community.gastro.org/posts/22039)

Roundtables (https://community.gastro.org/discussions/)

• Windows on Clinical GI
• Clinical Challenges in IBD: Ulcerative colitis and a fistula
• GI COVID-19 Connection: Implementing an effective long-term telehealth program in a post-COVID world

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field.

In case you missed it, here are some clinical discussions and Roundtables in the newsfeed this month:

• AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review (https://community.gastro.org/posts/22199)
• Establishing an acute colitis pathway (https://community.gastro.org/posts/22171)
• Preprocedure COVID testing (https://community.gastro.org/posts/22164)
• Patient case: Gastroesophageal varices (https://community.gastro.org/posts/22098)
• Patient case: IBD with intra-abdominal sepsis (https://community.gastro.org/posts/22055)
• Patient case: Hypervascular pancreatic parenchyma (https://community.gastro.org/posts/22039)

Roundtables (https://community.gastro.org/discussions/)

• Windows on Clinical GI
• Clinical Challenges in IBD: Ulcerative colitis and a fistula
• GI COVID-19 Connection: Implementing an effective long-term telehealth program in a post-COVID world

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The upgraded networking platform now features a newsfeed for difficult patient scenarios and regularly scheduled Roundtable discussions with experts in the field.

In case you missed it, here are some clinical discussions and Roundtables in the newsfeed this month:

• AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review (https://community.gastro.org/posts/22199)
• Establishing an acute colitis pathway (https://community.gastro.org/posts/22171)
• Preprocedure COVID testing (https://community.gastro.org/posts/22164)
• Patient case: Gastroesophageal varices (https://community.gastro.org/posts/22098)
• Patient case: IBD with intra-abdominal sepsis (https://community.gastro.org/posts/22055)
• Patient case: Hypervascular pancreatic parenchyma (https://community.gastro.org/posts/22039)

Roundtables (https://community.gastro.org/discussions/)

• Windows on Clinical GI
• Clinical Challenges in IBD: Ulcerative colitis and a fistula
• GI COVID-19 Connection: Implementing an effective long-term telehealth program in a post-COVID world

View all upcoming Roundtables in the community at https://community.gastro.org/discussions.

AGA has released a new Clinical Practice Update providing best practice advice for clinicians screening and diagnosing pancreatic cancer in high-risk individuals. Screening to detect pancreas cancers and their precursor lesions in high-risk patients can improve survival if it facilitates surgical resection for early-stage disease.

In the AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review, published in Gastroenterology’s July issue, the authors provide 13 best practice advice statements to address key issues in clinical management of these patients.

For more information, visit www.gastro.org/PancreasCPU.

[email protected]

AGA has released a new Clinical Practice Update providing best practice advice for clinicians screening and diagnosing pancreatic cancer in high-risk individuals. Screening to detect pancreas cancers and their precursor lesions in high-risk patients can improve survival if it facilitates surgical resection for early-stage disease.

In the AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review, published in Gastroenterology’s July issue, the authors provide 13 best practice advice statements to address key issues in clinical management of these patients.

For more information, visit www.gastro.org/PancreasCPU.

[email protected]

AGA has released a new Clinical Practice Update providing best practice advice for clinicians screening and diagnosing pancreatic cancer in high-risk individuals. Screening to detect pancreas cancers and their precursor lesions in high-risk patients can improve survival if it facilitates surgical resection for early-stage disease.

In the AGA Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals: Expert Review, published in Gastroenterology’s July issue, the authors provide 13 best practice advice statements to address key issues in clinical management of these patients.

For more information, visit www.gastro.org/PancreasCPU.

[email protected]

A new evidence-based review published in Gastroenterology helps you answer the question: Should my endoscopy center test asymptomatic patients for SARS-CoV-2 prior to endoscopy?

Key guidance for GIs

1. Endoscopy centers in areas with an intermediate prevalence of SARS-CoV-2 infection should consider testing patients for the virus before endoscopy. Several important factors contribute to this decision including testing feasibility, personal protective equipment (PPE) availability, and risk aversion threshold of endoscopists and staff.

2. Endoscopy centers in both low- and high-prevalence areas may not benefit from a pre-testing strategy.

• Rationale for low-prevalence areas: Diagnostic tests have a high proportion of false positives with significant downstream consequences, such as patient burden (quarantining and out of work for 14 days), unnecessarily delayed cases, and over-utilization of testing which may already be limited in availability. Therefore, PPE availability may drive decision-making for case triage instead. If PPE is not limited, then the majority of endoscopists and staff may reasonably select to use N95/N99 respirators or PAPRs.
• Rationale for high-prevalence areas: Highest available PPE (such as N95/N99 respirators or PAPRs) would be used universally, as available. Additionally, testing is often limited because of a high demand for a potential surge of cases.

AGA created an online tool to help endoscopy centers make decisions about their pre-endoscopy testing strategy. This tool combines local prevalence with diagnostic test performance data to calculate the proportion of true versus false positives and negatives to help endoscopy centers understand the downstream consequences of implementing a pre-procedure testing strategy.

To access the Rapid Review and online tool, visit www.gastro.org/COVID.

[email protected]

A new evidence-based review published in Gastroenterology helps you answer the question: Should my endoscopy center test asymptomatic patients for SARS-CoV-2 prior to endoscopy?

Key guidance for GIs

1. Endoscopy centers in areas with an intermediate prevalence of SARS-CoV-2 infection should consider testing patients for the virus before endoscopy. Several important factors contribute to this decision including testing feasibility, personal protective equipment (PPE) availability, and risk aversion threshold of endoscopists and staff.

2. Endoscopy centers in both low- and high-prevalence areas may not benefit from a pre-testing strategy.

• Rationale for low-prevalence areas: Diagnostic tests have a high proportion of false positives with significant downstream consequences, such as patient burden (quarantining and out of work for 14 days), unnecessarily delayed cases, and over-utilization of testing which may already be limited in availability. Therefore, PPE availability may drive decision-making for case triage instead. If PPE is not limited, then the majority of endoscopists and staff may reasonably select to use N95/N99 respirators or PAPRs.
• Rationale for high-prevalence areas: Highest available PPE (such as N95/N99 respirators or PAPRs) would be used universally, as available. Additionally, testing is often limited because of a high demand for a potential surge of cases.

AGA created an online tool to help endoscopy centers make decisions about their pre-endoscopy testing strategy. This tool combines local prevalence with diagnostic test performance data to calculate the proportion of true versus false positives and negatives to help endoscopy centers understand the downstream consequences of implementing a pre-procedure testing strategy.

To access the Rapid Review and online tool, visit www.gastro.org/COVID.

[email protected]

A new evidence-based review published in Gastroenterology helps you answer the question: Should my endoscopy center test asymptomatic patients for SARS-CoV-2 prior to endoscopy?

Key guidance for GIs

1. Endoscopy centers in areas with an intermediate prevalence of SARS-CoV-2 infection should consider testing patients for the virus before endoscopy. Several important factors contribute to this decision including testing feasibility, personal protective equipment (PPE) availability, and risk aversion threshold of endoscopists and staff.

2. Endoscopy centers in both low- and high-prevalence areas may not benefit from a pre-testing strategy.

• Rationale for low-prevalence areas: Diagnostic tests have a high proportion of false positives with significant downstream consequences, such as patient burden (quarantining and out of work for 14 days), unnecessarily delayed cases, and over-utilization of testing which may already be limited in availability. Therefore, PPE availability may drive decision-making for case triage instead. If PPE is not limited, then the majority of endoscopists and staff may reasonably select to use N95/N99 respirators or PAPRs.
• Rationale for high-prevalence areas: Highest available PPE (such as N95/N99 respirators or PAPRs) would be used universally, as available. Additionally, testing is often limited because of a high demand for a potential surge of cases.

AGA created an online tool to help endoscopy centers make decisions about their pre-endoscopy testing strategy. This tool combines local prevalence with diagnostic test performance data to calculate the proportion of true versus false positives and negatives to help endoscopy centers understand the downstream consequences of implementing a pre-procedure testing strategy.

To access the Rapid Review and online tool, visit www.gastro.org/COVID.

[email protected]

The AGA Equity Project advisory board has released a new commentary in Gastroenterology: “From Intention to Action: Operationalizing AGA Diversity Policy to Combat Racism and Health Disparities in Gastroenterology.”

The commentary provides a transparent self-examination of AGA’s recent racial and ethnic demographic data of its members, volunteer leaders, and staff compared with U.S. population data. It also assesses AGA’s previous initiatives focused on diversity, equity, and inclusion. It then looks ahead by detailing AGA’s plans to further operationalize the goals enumerated in the AGA Diversity Policy.

For more information, read the full commentary at www.gastro.org/diversitycommentary.

[email protected]

The AGA Equity Project advisory board has released a new commentary in Gastroenterology: “From Intention to Action: Operationalizing AGA Diversity Policy to Combat Racism and Health Disparities in Gastroenterology.”

The commentary provides a transparent self-examination of AGA’s recent racial and ethnic demographic data of its members, volunteer leaders, and staff compared with U.S. population data. It also assesses AGA’s previous initiatives focused on diversity, equity, and inclusion. It then looks ahead by detailing AGA’s plans to further operationalize the goals enumerated in the AGA Diversity Policy.

For more information, read the full commentary at www.gastro.org/diversitycommentary.

[email protected]

The AGA Equity Project advisory board has released a new commentary in Gastroenterology: “From Intention to Action: Operationalizing AGA Diversity Policy to Combat Racism and Health Disparities in Gastroenterology.”

The commentary provides a transparent self-examination of AGA’s recent racial and ethnic demographic data of its members, volunteer leaders, and staff compared with U.S. population data. It also assesses AGA’s previous initiatives focused on diversity, equity, and inclusion. It then looks ahead by detailing AGA’s plans to further operationalize the goals enumerated in the AGA Diversity Policy.

For more information, read the full commentary at www.gastro.org/diversitycommentary.

[email protected]

Join us for our new GI Forging Forward virtual symposia series, a practical educational training program covering timely topics for GIs through the lens of COVID-19. Experts in the field will present the latest COVID-19 findings, share proven strategies to communicate and manage disaster and crisis situations, and educate participants on evidence-based recommendations to meet today’s evolving needs. Upcoming topics will cover keeping you, your staff, and patients safe, new approaches and training in research, leading in times of crisis, and rapid-response guideline development.

Registration for this month’s virtual webinars are now open:

Demystifying publishing in AGA journals: Perspectives from our authors and editors: Sept. 3, 2020, 5:30 p.m. EDT

Flexing your communications skills during a time of crisis: Sept. 17, 2020, 5:30 p.m. EDT

For more information, visit www.gastro.org/GIForgingForward.

[email protected]

Join us for our new GI Forging Forward virtual symposia series, a practical educational training program covering timely topics for GIs through the lens of COVID-19. Experts in the field will present the latest COVID-19 findings, share proven strategies to communicate and manage disaster and crisis situations, and educate participants on evidence-based recommendations to meet today’s evolving needs. Upcoming topics will cover keeping you, your staff, and patients safe, new approaches and training in research, leading in times of crisis, and rapid-response guideline development.

Registration for this month’s virtual webinars are now open:

Demystifying publishing in AGA journals: Perspectives from our authors and editors: Sept. 3, 2020, 5:30 p.m. EDT

Flexing your communications skills during a time of crisis: Sept. 17, 2020, 5:30 p.m. EDT

For more information, visit www.gastro.org/GIForgingForward.

[email protected]

Join us for our new GI Forging Forward virtual symposia series, a practical educational training program covering timely topics for GIs through the lens of COVID-19. Experts in the field will present the latest COVID-19 findings, share proven strategies to communicate and manage disaster and crisis situations, and educate participants on evidence-based recommendations to meet today’s evolving needs. Upcoming topics will cover keeping you, your staff, and patients safe, new approaches and training in research, leading in times of crisis, and rapid-response guideline development.

Registration for this month’s virtual webinars are now open:

Demystifying publishing in AGA journals: Perspectives from our authors and editors: Sept. 3, 2020, 5:30 p.m. EDT

Flexing your communications skills during a time of crisis: Sept. 17, 2020, 5:30 p.m. EDT

For more information, visit www.gastro.org/GIForgingForward.

[email protected]

CHEST President-Elect Steven Q. Simpson, MD, FCCP, is Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at the University of Kansas. He is also senior advisor to the Solving Sepsis initiative of the Biomedical Advanced Research and Development Authority (BARDA) of the US Department of Health and Human Services.

As we greet our new incoming CHEST President, we asked him for a few thoughts about his upcoming presidential year. He kindly offered these responses:
 

What would you like to accomplish as President of CHEST?

This is an interesting question, because a global pandemic and other developments in our world dictate that our organizational goals must adapt to a landscape that has shifted in recent months. My goals as President are somewhat different from what I stated when I ran for the office.

1. First, I will build on the efforts of my predecessors to ensure that CHEST is an inclusive and anti-racist organization. All CHEST members must have equal opportunities within our organization to advance their lives and their careers, regardless of race, ethnicity, sex, or gender. My goal is to examine our structures for participation and advancement to positions of leadership in the organization and to evaluate our educational and research offerings, all with the purpose of discovering and remedying places where we have been blind to our own systematic bias. Further, CHEST must advocate for and lead others to advocate for equality, for equal access to medical care, and for policies that promote them. We must be leaders in this arena, through both our voice and our actions.

2. We will build on CHEST’s new initiative to support the wellness of our members and to help us all perform at our best, day in and day out. I hope for our newly established Wellness Center to become a frequent stop for all CHEST members, myself included, to help us to sustain ourselves through the pandemic and beyond.

3. We must maintain both the quality and the feel of our educational and research offerings during this time when we cannot come together in person. My goal for us is that we use this time to embrace remote and nontemporally synchronous education, ie, web-based education, to make CHEST’s offerings the best anywhere. In the remainder of the 21st century, digital transformation of teaching and learning will advance tremendously, and our creative use of technology will become a norm. I hope that we never abandon in-person meetings, but using technology to improve information transfer and augmenting our members’ continuing education are clearly here to stay. My goal for us is that we maintain an atmosphere to both our in-person meetings and our remotely delivered meetings that makes generating new knowledge and learning what we generate enjoyable, even fun. I believe our digital transformation will make some interesting things possible over time.

4. My overall goal for CHEST in the coming year is not that we “make it through” the current pandemic, but that we emerge stronger, smarter, and better for the experience, and prepared for the next challenge(s).

Before COVID-19, I had goals for my presidency, and these issues have not disappeared. CHEST needs to be user- friendly for our members, from our website, to the ways in which we deliver education, to the type of research we develop and promote. On the research side, our members have long been interested in clinical research that informs and improves our patient care. My goal is to double down on promoting, supporting, and presenting research that serves exactly this purpose. We are growing our team-based education, and I have a special goal for CHEST to become the home for pulmonary, critical care, and sleep advanced practice providers. I care tremendously about our international members, and I will promote both international growth and catering of CHEST’s offerings to benefit our international members.
 

What do you consider to be the greatest strength of CHEST, and how will you build upon this during your Presidency?

There is zero doubt that CHEST’s greatest strength is the people who gravitate to our organization. From pure clinicians to academicians; from clinical researchers to clinical educators to outcomes mavens—all levels of the health-care team. At every level of this organization are members who all want to be better at what we do, who want to figure out the ways for doing that, who want to explore the boundaries of what that means, and who want to help others to do the same. That goes, as well, for the professional staff who support the members, and who have adopted the motto, “CRUSH lung disease,” because they share our mission and are here to help us do it better.

The absolutely most enjoyable thing about leadership is having the opportunity to survey the landscape and see who’s looking for opportunity, who’s a rising star, who’s looking for people to mentor, then matching those people with opportunities and with jobs to do. Good people who are motivated by the right principles rise to the occasion. My job as President is to help ensure that the organization via the CHEST Board of Regents is addressing the correct problems with the right vision, to identify the right talented and dedicated members for the jobs, and then to support and stay out of their way as they make the vision a reality.
 

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

The major immediate challenges facing CHEST are pandemic-related, in terms of helping to ensure the well-being of our members, and in helping them to address the inequities and disparities in care for our patients of color, who have been hardest hit by the emergence of SARS-CoV-2. I addressed these with my goals, above. To be more specific, though, our board will be using various techniques, including dialogue with our members of color, to understand and address our own implicit biases, so that we can achieve the correct vision and tone of inclusion for all of our members. Also addressed in my goals is the isolation from one another that we are all experiencing because of the pandemic. This situation makes it difficult for us to maintain the style and tone of live learning experiences that our CHEST members are accustomed to. The challenge is to develop materials that can be interactive at a distance, and this likely includes gamification of educational content and employing virtual reality. CHEST Innovations is already working in this arena, and it will be our job as member volunteers to support those efforts. The isolation affects our international members, as well, and our ability to travel to maintain relationships. The nice thing is that web conferencing works just as well for international meetings as for meetings in the US, although somebody often has to go to bed very late or get up very early in the morning to make them work! The efforts are worth our time. Again, we will be working in various arenas to maintain and grow our international relationships.
 

And finally, what is your charge to the members and new Fellows (FCCPs) of CHEST?

We do not yet see clearly whether to expect a massive winter surge of COVID-19 infections. However, it is a reasonably likely possibility. My charge to our members and our new Fellows is first to stay safe, yourself, and to take care of your mental and physical well-being, so that you can be present and functioning at peak levels for your patients. Make sure your family is, likewise, being safe. Secondly, keep doing what you do, which is excellent patient care, excellent teaching, excellent research to push the boundaries of our knowledge. And finally, you’ve seen my ideas of the challenges facing CHEST. I want you to survey, yourself, and tell me what you think our challenges, goals, and responsibilities should be. And if anything I’ve said resonates with you, volunteer to help us address our challenges and keep CHEST the professional home that you deserve and that you will never want to leave. CHEST wants you and needs you. We are so happy you are with us!

CHEST President-Elect Steven Q. Simpson, MD, FCCP, is Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at the University of Kansas. He is also senior advisor to the Solving Sepsis initiative of the Biomedical Advanced Research and Development Authority (BARDA) of the US Department of Health and Human Services.

As we greet our new incoming CHEST President, we asked him for a few thoughts about his upcoming presidential year. He kindly offered these responses:
 

What would you like to accomplish as President of CHEST?

This is an interesting question, because a global pandemic and other developments in our world dictate that our organizational goals must adapt to a landscape that has shifted in recent months. My goals as President are somewhat different from what I stated when I ran for the office.

1. First, I will build on the efforts of my predecessors to ensure that CHEST is an inclusive and anti-racist organization. All CHEST members must have equal opportunities within our organization to advance their lives and their careers, regardless of race, ethnicity, sex, or gender. My goal is to examine our structures for participation and advancement to positions of leadership in the organization and to evaluate our educational and research offerings, all with the purpose of discovering and remedying places where we have been blind to our own systematic bias. Further, CHEST must advocate for and lead others to advocate for equality, for equal access to medical care, and for policies that promote them. We must be leaders in this arena, through both our voice and our actions.

2. We will build on CHEST’s new initiative to support the wellness of our members and to help us all perform at our best, day in and day out. I hope for our newly established Wellness Center to become a frequent stop for all CHEST members, myself included, to help us to sustain ourselves through the pandemic and beyond.

3. We must maintain both the quality and the feel of our educational and research offerings during this time when we cannot come together in person. My goal for us is that we use this time to embrace remote and nontemporally synchronous education, ie, web-based education, to make CHEST’s offerings the best anywhere. In the remainder of the 21st century, digital transformation of teaching and learning will advance tremendously, and our creative use of technology will become a norm. I hope that we never abandon in-person meetings, but using technology to improve information transfer and augmenting our members’ continuing education are clearly here to stay. My goal for us is that we maintain an atmosphere to both our in-person meetings and our remotely delivered meetings that makes generating new knowledge and learning what we generate enjoyable, even fun. I believe our digital transformation will make some interesting things possible over time.

4. My overall goal for CHEST in the coming year is not that we “make it through” the current pandemic, but that we emerge stronger, smarter, and better for the experience, and prepared for the next challenge(s).

Before COVID-19, I had goals for my presidency, and these issues have not disappeared. CHEST needs to be user- friendly for our members, from our website, to the ways in which we deliver education, to the type of research we develop and promote. On the research side, our members have long been interested in clinical research that informs and improves our patient care. My goal is to double down on promoting, supporting, and presenting research that serves exactly this purpose. We are growing our team-based education, and I have a special goal for CHEST to become the home for pulmonary, critical care, and sleep advanced practice providers. I care tremendously about our international members, and I will promote both international growth and catering of CHEST’s offerings to benefit our international members.
 

What do you consider to be the greatest strength of CHEST, and how will you build upon this during your Presidency?

There is zero doubt that CHEST’s greatest strength is the people who gravitate to our organization. From pure clinicians to academicians; from clinical researchers to clinical educators to outcomes mavens—all levels of the health-care team. At every level of this organization are members who all want to be better at what we do, who want to figure out the ways for doing that, who want to explore the boundaries of what that means, and who want to help others to do the same. That goes, as well, for the professional staff who support the members, and who have adopted the motto, “CRUSH lung disease,” because they share our mission and are here to help us do it better.

The absolutely most enjoyable thing about leadership is having the opportunity to survey the landscape and see who’s looking for opportunity, who’s a rising star, who’s looking for people to mentor, then matching those people with opportunities and with jobs to do. Good people who are motivated by the right principles rise to the occasion. My job as President is to help ensure that the organization via the CHEST Board of Regents is addressing the correct problems with the right vision, to identify the right talented and dedicated members for the jobs, and then to support and stay out of their way as they make the vision a reality.
 

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

The major immediate challenges facing CHEST are pandemic-related, in terms of helping to ensure the well-being of our members, and in helping them to address the inequities and disparities in care for our patients of color, who have been hardest hit by the emergence of SARS-CoV-2. I addressed these with my goals, above. To be more specific, though, our board will be using various techniques, including dialogue with our members of color, to understand and address our own implicit biases, so that we can achieve the correct vision and tone of inclusion for all of our members. Also addressed in my goals is the isolation from one another that we are all experiencing because of the pandemic. This situation makes it difficult for us to maintain the style and tone of live learning experiences that our CHEST members are accustomed to. The challenge is to develop materials that can be interactive at a distance, and this likely includes gamification of educational content and employing virtual reality. CHEST Innovations is already working in this arena, and it will be our job as member volunteers to support those efforts. The isolation affects our international members, as well, and our ability to travel to maintain relationships. The nice thing is that web conferencing works just as well for international meetings as for meetings in the US, although somebody often has to go to bed very late or get up very early in the morning to make them work! The efforts are worth our time. Again, we will be working in various arenas to maintain and grow our international relationships.
 

And finally, what is your charge to the members and new Fellows (FCCPs) of CHEST?

We do not yet see clearly whether to expect a massive winter surge of COVID-19 infections. However, it is a reasonably likely possibility. My charge to our members and our new Fellows is first to stay safe, yourself, and to take care of your mental and physical well-being, so that you can be present and functioning at peak levels for your patients. Make sure your family is, likewise, being safe. Secondly, keep doing what you do, which is excellent patient care, excellent teaching, excellent research to push the boundaries of our knowledge. And finally, you’ve seen my ideas of the challenges facing CHEST. I want you to survey, yourself, and tell me what you think our challenges, goals, and responsibilities should be. And if anything I’ve said resonates with you, volunteer to help us address our challenges and keep CHEST the professional home that you deserve and that you will never want to leave. CHEST wants you and needs you. We are so happy you are with us!

CHEST President-Elect Steven Q. Simpson, MD, FCCP, is Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at the University of Kansas. He is also senior advisor to the Solving Sepsis initiative of the Biomedical Advanced Research and Development Authority (BARDA) of the US Department of Health and Human Services.

As we greet our new incoming CHEST President, we asked him for a few thoughts about his upcoming presidential year. He kindly offered these responses:
 

What would you like to accomplish as President of CHEST?

This is an interesting question, because a global pandemic and other developments in our world dictate that our organizational goals must adapt to a landscape that has shifted in recent months. My goals as President are somewhat different from what I stated when I ran for the office.

1. First, I will build on the efforts of my predecessors to ensure that CHEST is an inclusive and anti-racist organization. All CHEST members must have equal opportunities within our organization to advance their lives and their careers, regardless of race, ethnicity, sex, or gender. My goal is to examine our structures for participation and advancement to positions of leadership in the organization and to evaluate our educational and research offerings, all with the purpose of discovering and remedying places where we have been blind to our own systematic bias. Further, CHEST must advocate for and lead others to advocate for equality, for equal access to medical care, and for policies that promote them. We must be leaders in this arena, through both our voice and our actions.

2. We will build on CHEST’s new initiative to support the wellness of our members and to help us all perform at our best, day in and day out. I hope for our newly established Wellness Center to become a frequent stop for all CHEST members, myself included, to help us to sustain ourselves through the pandemic and beyond.

3. We must maintain both the quality and the feel of our educational and research offerings during this time when we cannot come together in person. My goal for us is that we use this time to embrace remote and nontemporally synchronous education, ie, web-based education, to make CHEST’s offerings the best anywhere. In the remainder of the 21st century, digital transformation of teaching and learning will advance tremendously, and our creative use of technology will become a norm. I hope that we never abandon in-person meetings, but using technology to improve information transfer and augmenting our members’ continuing education are clearly here to stay. My goal for us is that we maintain an atmosphere to both our in-person meetings and our remotely delivered meetings that makes generating new knowledge and learning what we generate enjoyable, even fun. I believe our digital transformation will make some interesting things possible over time.

4. My overall goal for CHEST in the coming year is not that we “make it through” the current pandemic, but that we emerge stronger, smarter, and better for the experience, and prepared for the next challenge(s).

Before COVID-19, I had goals for my presidency, and these issues have not disappeared. CHEST needs to be user- friendly for our members, from our website, to the ways in which we deliver education, to the type of research we develop and promote. On the research side, our members have long been interested in clinical research that informs and improves our patient care. My goal is to double down on promoting, supporting, and presenting research that serves exactly this purpose. We are growing our team-based education, and I have a special goal for CHEST to become the home for pulmonary, critical care, and sleep advanced practice providers. I care tremendously about our international members, and I will promote both international growth and catering of CHEST’s offerings to benefit our international members.
 

What do you consider to be the greatest strength of CHEST, and how will you build upon this during your Presidency?

There is zero doubt that CHEST’s greatest strength is the people who gravitate to our organization. From pure clinicians to academicians; from clinical researchers to clinical educators to outcomes mavens—all levels of the health-care team. At every level of this organization are members who all want to be better at what we do, who want to figure out the ways for doing that, who want to explore the boundaries of what that means, and who want to help others to do the same. That goes, as well, for the professional staff who support the members, and who have adopted the motto, “CRUSH lung disease,” because they share our mission and are here to help us do it better.

The absolutely most enjoyable thing about leadership is having the opportunity to survey the landscape and see who’s looking for opportunity, who’s a rising star, who’s looking for people to mentor, then matching those people with opportunities and with jobs to do. Good people who are motivated by the right principles rise to the occasion. My job as President is to help ensure that the organization via the CHEST Board of Regents is addressing the correct problems with the right vision, to identify the right talented and dedicated members for the jobs, and then to support and stay out of their way as they make the vision a reality.
 

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

The major immediate challenges facing CHEST are pandemic-related, in terms of helping to ensure the well-being of our members, and in helping them to address the inequities and disparities in care for our patients of color, who have been hardest hit by the emergence of SARS-CoV-2. I addressed these with my goals, above. To be more specific, though, our board will be using various techniques, including dialogue with our members of color, to understand and address our own implicit biases, so that we can achieve the correct vision and tone of inclusion for all of our members. Also addressed in my goals is the isolation from one another that we are all experiencing because of the pandemic. This situation makes it difficult for us to maintain the style and tone of live learning experiences that our CHEST members are accustomed to. The challenge is to develop materials that can be interactive at a distance, and this likely includes gamification of educational content and employing virtual reality. CHEST Innovations is already working in this arena, and it will be our job as member volunteers to support those efforts. The isolation affects our international members, as well, and our ability to travel to maintain relationships. The nice thing is that web conferencing works just as well for international meetings as for meetings in the US, although somebody often has to go to bed very late or get up very early in the morning to make them work! The efforts are worth our time. Again, we will be working in various arenas to maintain and grow our international relationships.
 

And finally, what is your charge to the members and new Fellows (FCCPs) of CHEST?

We do not yet see clearly whether to expect a massive winter surge of COVID-19 infections. However, it is a reasonably likely possibility. My charge to our members and our new Fellows is first to stay safe, yourself, and to take care of your mental and physical well-being, so that you can be present and functioning at peak levels for your patients. Make sure your family is, likewise, being safe. Secondly, keep doing what you do, which is excellent patient care, excellent teaching, excellent research to push the boundaries of our knowledge. And finally, you’ve seen my ideas of the challenges facing CHEST. I want you to survey, yourself, and tell me what you think our challenges, goals, and responsibilities should be. And if anything I’ve said resonates with you, volunteer to help us address our challenges and keep CHEST the professional home that you deserve and that you will never want to leave. CHEST wants you and needs you. We are so happy you are with us!

Preparation is key for disaster management. It includes identifying heath-care worker capability, surge capacity, disposable medical resources, and expert consultation availability.   

Staff 

In disaster, the hospital transitions to a mass casualty strategy,  repurposing noncritical care staff to a tiered critical care model focusing on disaster triage and mass critical care. The goal is to provide care to minimize mortality.   

Stuff 

Critical care supplies improve survival and are implemented quickly and easily. Essential supplies include personal protective equipment, basic modes of mechanical ventilation, hemodynamic support, antimicrobial therapy or other disease-specific countermeasures, oxygen, and prophylactic treatments. 

Structure 

Disaster critical care can be delivered in noncritical care areas. Hospital policies should establish surge capacity strategies.  

System 

Providing quality lifesaving care to appropriately triaged patients by utilizing minimal qualifications for survival, predetermined ICU admission criteria, and dynamic protocols using the highest level of evidence available scalable to local resources.  
Inappropriate triage results in suboptimal care and can lead to increased mortality. 
Virtual critical care can augment critical care capacity and capability. 
The implementation of mass critical care requires hospitals to rapidly increase its patient volume above its normal capacity. The essential four components are staff, stuff, space, and structure. Effective mass critical care requires a different mindset than critical care in day-to-day operations. 

Patrick Moon, MD; and Alexis MacDonald, MD 
(Drs. Reed and Tripp's Fellows) 
Mary Jane Reed, MD, FCCP, and Michael Tripp, MD, FCCP 
Steering Committee Members 

Practice Operations 

Coding for telemedicine in the COVID-19 era 

Over the years since telemedicine (TM) was developed in the 1960s, it has transformed into more mobile, compact, and interconnected forms. However, its widespread adoption has been limited by the regulatory, compensatory, and licensing status quo. The emergence of the COVID-19 pandemic and its necessity for physical distancing has brought TM into the limelight. With restrictions on TM use lifted by CMS, the scope of TM could extend from outpatient to inpatient care to emergency triaging and management of chronic medical conditions.  

In February 2020, the comprehensive 2020 COVID-19 ICD 10 coding guidelines were released. To date, CMS has approved approximately 80 codes, which can be used with telehealth and non face-face-to-face (NFTF) encounters. They include telephone calls, online digital E/M services, interprofessional telephone/internet/electric health record consultations, digitally stored data services/remote physiologic monitoring, remote reporting of self-measure blood pressure, and remote physiologic monitoring treatment management services. Some of the key "rules of the game" are highlighted below. 

• For telephone visits in the outpatient setting use the codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (21-30 minutes). 
• For interactive real-time audio and video telecommunication (RAVT) in the outpatient setting, use the codes normally used for outpatient E/M: 99201-99215. 
• For using RAVT to perform an initial visit for an inpatient, use the codes that are normally used for inpatient E/M: 99221-99223. 
• For using RAVT to perform a subsequent visit for an inpatient, use the codes that are normally used for subsequent hospital care service E/M: 99231-99233. 
• Seeing a critically ill patient without being in the patient's room is allowed, as a physical exam is not required for either 99291 or 99292. Be sure to use 99292 for each 30 minutes beyond the initial 74 minutes and document the time spent on the patient. 

The details of the coding/billing guidelines are intricate and full of nuances and for a better understanding on how to utilize TM both in an inpatient and outpatient setting, consider the following resources:  
1. CHEST Experience presentation entitled "TELE MEDICINE/TELE HEALTH IN THE ERA OF PANDEMIC" at the CHEST Annual Meeting 2020. 
1. Coding and Billing Guidelines by ATS:  
https://www.thoracic.org/about/newsroom/newsletters/coding-and-billing/resources/2020/mostrecentcbqapril.pdf 
2. Coding specific for management of COVID patients by the AMA: 
https://www.ama-assn.org/system/files/2020-05/covid-19-coding-advice.pdf 
 

Humayun Anjum, MD, FCCP 
Vice-Chair, Practice Operations

Haala Rokadia, MD, FCCP 

Practice Operations NetWork Steering Committee Member

Transplant  

The COVID 19 pandemic led the health-care community to rapidly adopt telecommunication tools allowing provision of care equivalent to in-person visits. Implementation of telemedicine visits demonstrated that providers can simultaneously distance and connect with patients to provide expert care.   
The University of Pennsylvania lung transplant team adapted video communications to provide individualized physical therapy (PT) recommendations for lung transplantation candidates. The evaluation includes a systems review, musculoskeletal screen, submaximal aerobic capacity testing, and performance of the short physical performance battery test (SPPBT), a frequently used frailty evaluation tool focused on lower extremity function and balance. In the era of social distancing, telemedicine capabilities have made this crucial aspect of pretransplant evaluation possible.  
In advance, patients are emailed a document outlining the telemedicine PT assessment, including the SPPBT. Patients receive videos of the SPPBT to ensure they understand the test and can prepare their home to safely perform the tasks. We are able to highlight the patient's functional capabilities and detail accurate assessments of their deficits. Our teleconsultations utilize BlueJeans for connectivity and typically last about 30 minutes. At this time, we are billing for these pretransplant visits but not for posttransplant PT follow-up.  

Patient experiences with the PT teleconsultations have been overwhelmingly positive. Patients and their families appreciate the uninterrupted evaluation time and the individualized recommendations for improving their deficits. The providers can devote their full attention to the patient directly in front of them. Importantly, patients and providers report they have never felt a stronger connection than through these telemedicine encounters. Longitudinal telemedicine PT assessments will enable us to better monitor our patients throughout the lung transplantation process.  
 

Joshua Diamond, MD 
Steering Committee Member 
Derek Zaleski, PT, DPT 
 

Women's Lung Health  

The SARS-COV-2 pandemic has brought on many fears and uncertainties with new information emerging daily, including the effect during pregnancy. At the time of this article,however, data pertaining to COVID-19 and pregnancy remain limited. Pregnant women do not seem to have a higher infection rate than the general population. In a correspondence where pregnant women admitted for delivery underwent universal screening in NY, 1.9% of women were symptomatic and tested positive, and 13.7% of the asymptomatic patients were found to be SARS-COV-2 positive.1  Furthermore, unlike H1NI, data suggest that pregnant women infected with SARS-COV-2 currently do not seem to have worse outcomes than the average person.2,3  As of now, there have not been any reports of maternal fetal vertical transmission from COVID-19 or any other coronavirus variants.4  Postpartum testing of infants has yielded a very small number of babies who have tested positive for virus, but this more likely represents transmission after birth. There are currently no specific FDA-approved medications for the treatment of moderate-severe infections with COVID-19 in pregnant women, although there are several clinical trials underway. Patients with moderate to severe symptoms should seek medical attention, while those with mild symptoms should continue with conservative therapies, as well as maintaining proper hygiene.5  Delivery methods and timing remain unchanged with cesarean delivery as currently indicated per established guidelines.5   
 

Mariam Louis, MD 
Steering Committee Member 
Jorge Trabanco, MD  
 
1. N Engl J Med. 2020 Apr 13;382:2163-4. April 13, 2020, DOI: 10.1056/NEJMc2009316 
2. N Engl J Med. 2020 Jun 18; 382:e100. April 17, 2020 DOI: 10.1056/NEJMc2009226 
3. Acta Obstet Gynecol Scand. 2020 Jul;99(7):823-829. 2020 Apr 7. doi: 10.1111/aogs.13867. [Epub ahead of print] 
4. Arch Pathol Lab Med. 2020 Apr 27. doi: 10.5858/arpa.2020-0211-SA. [Epub ahead of print] 
5. ACOG practice advisory, Novel Coronavirus 2019 (COVID-19) April 23, 2020. 
 

Preparation is key for disaster management. It includes identifying heath-care worker capability, surge capacity, disposable medical resources, and expert consultation availability.   

Staff 

In disaster, the hospital transitions to a mass casualty strategy,  repurposing noncritical care staff to a tiered critical care model focusing on disaster triage and mass critical care. The goal is to provide care to minimize mortality.   

Stuff 

Critical care supplies improve survival and are implemented quickly and easily. Essential supplies include personal protective equipment, basic modes of mechanical ventilation, hemodynamic support, antimicrobial therapy or other disease-specific countermeasures, oxygen, and prophylactic treatments. 

Structure 

Disaster critical care can be delivered in noncritical care areas. Hospital policies should establish surge capacity strategies.  

System 

Providing quality lifesaving care to appropriately triaged patients by utilizing minimal qualifications for survival, predetermined ICU admission criteria, and dynamic protocols using the highest level of evidence available scalable to local resources.  
Inappropriate triage results in suboptimal care and can lead to increased mortality. 
Virtual critical care can augment critical care capacity and capability. 
The implementation of mass critical care requires hospitals to rapidly increase its patient volume above its normal capacity. The essential four components are staff, stuff, space, and structure. Effective mass critical care requires a different mindset than critical care in day-to-day operations. 

Patrick Moon, MD; and Alexis MacDonald, MD 
(Drs. Reed and Tripp's Fellows) 
Mary Jane Reed, MD, FCCP, and Michael Tripp, MD, FCCP 
Steering Committee Members 

Practice Operations 

Coding for telemedicine in the COVID-19 era 

Over the years since telemedicine (TM) was developed in the 1960s, it has transformed into more mobile, compact, and interconnected forms. However, its widespread adoption has been limited by the regulatory, compensatory, and licensing status quo. The emergence of the COVID-19 pandemic and its necessity for physical distancing has brought TM into the limelight. With restrictions on TM use lifted by CMS, the scope of TM could extend from outpatient to inpatient care to emergency triaging and management of chronic medical conditions.  

In February 2020, the comprehensive 2020 COVID-19 ICD 10 coding guidelines were released. To date, CMS has approved approximately 80 codes, which can be used with telehealth and non face-face-to-face (NFTF) encounters. They include telephone calls, online digital E/M services, interprofessional telephone/internet/electric health record consultations, digitally stored data services/remote physiologic monitoring, remote reporting of self-measure blood pressure, and remote physiologic monitoring treatment management services. Some of the key "rules of the game" are highlighted below. 

• For telephone visits in the outpatient setting use the codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (21-30 minutes). 
• For interactive real-time audio and video telecommunication (RAVT) in the outpatient setting, use the codes normally used for outpatient E/M: 99201-99215. 
• For using RAVT to perform an initial visit for an inpatient, use the codes that are normally used for inpatient E/M: 99221-99223. 
• For using RAVT to perform a subsequent visit for an inpatient, use the codes that are normally used for subsequent hospital care service E/M: 99231-99233. 
• Seeing a critically ill patient without being in the patient's room is allowed, as a physical exam is not required for either 99291 or 99292. Be sure to use 99292 for each 30 minutes beyond the initial 74 minutes and document the time spent on the patient. 

The details of the coding/billing guidelines are intricate and full of nuances and for a better understanding on how to utilize TM both in an inpatient and outpatient setting, consider the following resources:  
1. CHEST Experience presentation entitled "TELE MEDICINE/TELE HEALTH IN THE ERA OF PANDEMIC" at the CHEST Annual Meeting 2020. 
1. Coding and Billing Guidelines by ATS:  
https://www.thoracic.org/about/newsroom/newsletters/coding-and-billing/resources/2020/mostrecentcbqapril.pdf 
2. Coding specific for management of COVID patients by the AMA: 
https://www.ama-assn.org/system/files/2020-05/covid-19-coding-advice.pdf 
 

Humayun Anjum, MD, FCCP 
Vice-Chair, Practice Operations

Haala Rokadia, MD, FCCP 

Practice Operations NetWork Steering Committee Member

Transplant  

The COVID 19 pandemic led the health-care community to rapidly adopt telecommunication tools allowing provision of care equivalent to in-person visits. Implementation of telemedicine visits demonstrated that providers can simultaneously distance and connect with patients to provide expert care.   
The University of Pennsylvania lung transplant team adapted video communications to provide individualized physical therapy (PT) recommendations for lung transplantation candidates. The evaluation includes a systems review, musculoskeletal screen, submaximal aerobic capacity testing, and performance of the short physical performance battery test (SPPBT), a frequently used frailty evaluation tool focused on lower extremity function and balance. In the era of social distancing, telemedicine capabilities have made this crucial aspect of pretransplant evaluation possible.  
In advance, patients are emailed a document outlining the telemedicine PT assessment, including the SPPBT. Patients receive videos of the SPPBT to ensure they understand the test and can prepare their home to safely perform the tasks. We are able to highlight the patient's functional capabilities and detail accurate assessments of their deficits. Our teleconsultations utilize BlueJeans for connectivity and typically last about 30 minutes. At this time, we are billing for these pretransplant visits but not for posttransplant PT follow-up.  

Patient experiences with the PT teleconsultations have been overwhelmingly positive. Patients and their families appreciate the uninterrupted evaluation time and the individualized recommendations for improving their deficits. The providers can devote their full attention to the patient directly in front of them. Importantly, patients and providers report they have never felt a stronger connection than through these telemedicine encounters. Longitudinal telemedicine PT assessments will enable us to better monitor our patients throughout the lung transplantation process.  
 

Joshua Diamond, MD 
Steering Committee Member 
Derek Zaleski, PT, DPT 
 

Women's Lung Health  

The SARS-COV-2 pandemic has brought on many fears and uncertainties with new information emerging daily, including the effect during pregnancy. At the time of this article,however, data pertaining to COVID-19 and pregnancy remain limited. Pregnant women do not seem to have a higher infection rate than the general population. In a correspondence where pregnant women admitted for delivery underwent universal screening in NY, 1.9% of women were symptomatic and tested positive, and 13.7% of the asymptomatic patients were found to be SARS-COV-2 positive.1  Furthermore, unlike H1NI, data suggest that pregnant women infected with SARS-COV-2 currently do not seem to have worse outcomes than the average person.2,3  As of now, there have not been any reports of maternal fetal vertical transmission from COVID-19 or any other coronavirus variants.4  Postpartum testing of infants has yielded a very small number of babies who have tested positive for virus, but this more likely represents transmission after birth. There are currently no specific FDA-approved medications for the treatment of moderate-severe infections with COVID-19 in pregnant women, although there are several clinical trials underway. Patients with moderate to severe symptoms should seek medical attention, while those with mild symptoms should continue with conservative therapies, as well as maintaining proper hygiene.5  Delivery methods and timing remain unchanged with cesarean delivery as currently indicated per established guidelines.5   
 

Mariam Louis, MD 
Steering Committee Member 
Jorge Trabanco, MD  
 
1. N Engl J Med. 2020 Apr 13;382:2163-4. April 13, 2020, DOI: 10.1056/NEJMc2009316 
2. N Engl J Med. 2020 Jun 18; 382:e100. April 17, 2020 DOI: 10.1056/NEJMc2009226 
3. Acta Obstet Gynecol Scand. 2020 Jul;99(7):823-829. 2020 Apr 7. doi: 10.1111/aogs.13867. [Epub ahead of print] 
4. Arch Pathol Lab Med. 2020 Apr 27. doi: 10.5858/arpa.2020-0211-SA. [Epub ahead of print] 
5. ACOG practice advisory, Novel Coronavirus 2019 (COVID-19) April 23, 2020. 
 

Preparation is key for disaster management. It includes identifying heath-care worker capability, surge capacity, disposable medical resources, and expert consultation availability.   

Staff 

In disaster, the hospital transitions to a mass casualty strategy,  repurposing noncritical care staff to a tiered critical care model focusing on disaster triage and mass critical care. The goal is to provide care to minimize mortality.   

Stuff 

Critical care supplies improve survival and are implemented quickly and easily. Essential supplies include personal protective equipment, basic modes of mechanical ventilation, hemodynamic support, antimicrobial therapy or other disease-specific countermeasures, oxygen, and prophylactic treatments. 

Structure 

Disaster critical care can be delivered in noncritical care areas. Hospital policies should establish surge capacity strategies.  

System 

Providing quality lifesaving care to appropriately triaged patients by utilizing minimal qualifications for survival, predetermined ICU admission criteria, and dynamic protocols using the highest level of evidence available scalable to local resources.  
Inappropriate triage results in suboptimal care and can lead to increased mortality. 
Virtual critical care can augment critical care capacity and capability. 
The implementation of mass critical care requires hospitals to rapidly increase its patient volume above its normal capacity. The essential four components are staff, stuff, space, and structure. Effective mass critical care requires a different mindset than critical care in day-to-day operations. 

Patrick Moon, MD; and Alexis MacDonald, MD 
(Drs. Reed and Tripp's Fellows) 
Mary Jane Reed, MD, FCCP, and Michael Tripp, MD, FCCP 
Steering Committee Members 

Practice Operations 

Coding for telemedicine in the COVID-19 era 

Over the years since telemedicine (TM) was developed in the 1960s, it has transformed into more mobile, compact, and interconnected forms. However, its widespread adoption has been limited by the regulatory, compensatory, and licensing status quo. The emergence of the COVID-19 pandemic and its necessity for physical distancing has brought TM into the limelight. With restrictions on TM use lifted by CMS, the scope of TM could extend from outpatient to inpatient care to emergency triaging and management of chronic medical conditions.  

In February 2020, the comprehensive 2020 COVID-19 ICD 10 coding guidelines were released. To date, CMS has approved approximately 80 codes, which can be used with telehealth and non face-face-to-face (NFTF) encounters. They include telephone calls, online digital E/M services, interprofessional telephone/internet/electric health record consultations, digitally stored data services/remote physiologic monitoring, remote reporting of self-measure blood pressure, and remote physiologic monitoring treatment management services. Some of the key "rules of the game" are highlighted below. 

• For telephone visits in the outpatient setting use the codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (21-30 minutes). 
• For interactive real-time audio and video telecommunication (RAVT) in the outpatient setting, use the codes normally used for outpatient E/M: 99201-99215. 
• For using RAVT to perform an initial visit for an inpatient, use the codes that are normally used for inpatient E/M: 99221-99223. 
• For using RAVT to perform a subsequent visit for an inpatient, use the codes that are normally used for subsequent hospital care service E/M: 99231-99233. 
• Seeing a critically ill patient without being in the patient's room is allowed, as a physical exam is not required for either 99291 or 99292. Be sure to use 99292 for each 30 minutes beyond the initial 74 minutes and document the time spent on the patient. 

The details of the coding/billing guidelines are intricate and full of nuances and for a better understanding on how to utilize TM both in an inpatient and outpatient setting, consider the following resources:  
1. CHEST Experience presentation entitled "TELE MEDICINE/TELE HEALTH IN THE ERA OF PANDEMIC" at the CHEST Annual Meeting 2020. 
1. Coding and Billing Guidelines by ATS:  
https://www.thoracic.org/about/newsroom/newsletters/coding-and-billing/resources/2020/mostrecentcbqapril.pdf 
2. Coding specific for management of COVID patients by the AMA: 
https://www.ama-assn.org/system/files/2020-05/covid-19-coding-advice.pdf 
 

Humayun Anjum, MD, FCCP 
Vice-Chair, Practice Operations

Haala Rokadia, MD, FCCP 

Practice Operations NetWork Steering Committee Member

Transplant  

The COVID 19 pandemic led the health-care community to rapidly adopt telecommunication tools allowing provision of care equivalent to in-person visits. Implementation of telemedicine visits demonstrated that providers can simultaneously distance and connect with patients to provide expert care.   
The University of Pennsylvania lung transplant team adapted video communications to provide individualized physical therapy (PT) recommendations for lung transplantation candidates. The evaluation includes a systems review, musculoskeletal screen, submaximal aerobic capacity testing, and performance of the short physical performance battery test (SPPBT), a frequently used frailty evaluation tool focused on lower extremity function and balance. In the era of social distancing, telemedicine capabilities have made this crucial aspect of pretransplant evaluation possible.  
In advance, patients are emailed a document outlining the telemedicine PT assessment, including the SPPBT. Patients receive videos of the SPPBT to ensure they understand the test and can prepare their home to safely perform the tasks. We are able to highlight the patient's functional capabilities and detail accurate assessments of their deficits. Our teleconsultations utilize BlueJeans for connectivity and typically last about 30 minutes. At this time, we are billing for these pretransplant visits but not for posttransplant PT follow-up.  

Patient experiences with the PT teleconsultations have been overwhelmingly positive. Patients and their families appreciate the uninterrupted evaluation time and the individualized recommendations for improving their deficits. The providers can devote their full attention to the patient directly in front of them. Importantly, patients and providers report they have never felt a stronger connection than through these telemedicine encounters. Longitudinal telemedicine PT assessments will enable us to better monitor our patients throughout the lung transplantation process.  
 

Joshua Diamond, MD 
Steering Committee Member 
Derek Zaleski, PT, DPT 
 

Women's Lung Health  

The SARS-COV-2 pandemic has brought on many fears and uncertainties with new information emerging daily, including the effect during pregnancy. At the time of this article,however, data pertaining to COVID-19 and pregnancy remain limited. Pregnant women do not seem to have a higher infection rate than the general population. In a correspondence where pregnant women admitted for delivery underwent universal screening in NY, 1.9% of women were symptomatic and tested positive, and 13.7% of the asymptomatic patients were found to be SARS-COV-2 positive.1  Furthermore, unlike H1NI, data suggest that pregnant women infected with SARS-COV-2 currently do not seem to have worse outcomes than the average person.2,3  As of now, there have not been any reports of maternal fetal vertical transmission from COVID-19 or any other coronavirus variants.4  Postpartum testing of infants has yielded a very small number of babies who have tested positive for virus, but this more likely represents transmission after birth. There are currently no specific FDA-approved medications for the treatment of moderate-severe infections with COVID-19 in pregnant women, although there are several clinical trials underway. Patients with moderate to severe symptoms should seek medical attention, while those with mild symptoms should continue with conservative therapies, as well as maintaining proper hygiene.5  Delivery methods and timing remain unchanged with cesarean delivery as currently indicated per established guidelines.5   
 

Mariam Louis, MD 
Steering Committee Member 
Jorge Trabanco, MD  
 
1. N Engl J Med. 2020 Apr 13;382:2163-4. April 13, 2020, DOI: 10.1056/NEJMc2009316 
2. N Engl J Med. 2020 Jun 18; 382:e100. April 17, 2020 DOI: 10.1056/NEJMc2009226 
3. Acta Obstet Gynecol Scand. 2020 Jul;99(7):823-829. 2020 Apr 7. doi: 10.1111/aogs.13867. [Epub ahead of print] 
4. Arch Pathol Lab Med. 2020 Apr 27. doi: 10.5858/arpa.2020-0211-SA. [Epub ahead of print] 
5. ACOG practice advisory, Novel Coronavirus 2019 (COVID-19) April 23, 2020. 
 

The CHEST Foundation is excited to announce that the NetWorks Challenge will be reinvented for 2020! Instead of raising funds to support travel grants to CHEST’s Annual Meeting as in previous years, the NetWorks Challenge will focus on raising funds to support COVID-19 community service grants. With so many people suffering due to the pandemic, we believe this change will make a tangible impact on the lives of people who need it most.

To date, the CHEST Foundation has dispersed over $60,000 in payments for patient support groups that provide services to those living with chronic lung disease, and we hope this year’s efforts will enable us to continue this work. For every $2,500 raised by a NetWork, the CHEST Foundation will provide a grant to a community support group in need.

While providing vulnerable populations with funds to purchase essential items (PPE, cleaning supplies, emergency food purchases, etc), each grant will be named in honor of the NetWork raising the funds, and all stories of impact will be shared with NetWorks’ members, once they are available.

The NetWorks Challenge spans from Monday, July 20, to the end of Board Review on August 22, and members can easily designate their donation to their NetWork on the CHEST Foundation’s donor page.

In addition to receiving named recognition of your NetWork, the NetWork that raises the most funds, along with the NetWork with the highest percentage of participation, will receive additional prizes, including two complimentary registrations to CHEST 2020. These registrations are specifically for early-career clinicians and fellows-in-training, which will be selected by each NetWorks’s steering committee.

For every $5,000 raised by a NetWork, that NetWork will receive one complimentary registration to CHEST 2020, which will be awarded to their early-career and fellows-in-training as selected by that NetWorks’s steering committee.

In addition to directly impacting patients across the United States, NetWorks members will have a chance to test their knowledge against their peers by participating in a NetWork Challenge Game Series, where they will be asked a series of hand-selected board review questions each week through the end of Board Review.

For additional Information about the NetWorks Challenge, visit the CHEST Foundation’s website.

The CHEST Foundation is excited to announce that the NetWorks Challenge will be reinvented for 2020! Instead of raising funds to support travel grants to CHEST’s Annual Meeting as in previous years, the NetWorks Challenge will focus on raising funds to support COVID-19 community service grants. With so many people suffering due to the pandemic, we believe this change will make a tangible impact on the lives of people who need it most.

To date, the CHEST Foundation has dispersed over $60,000 in payments for patient support groups that provide services to those living with chronic lung disease, and we hope this year’s efforts will enable us to continue this work. For every $2,500 raised by a NetWork, the CHEST Foundation will provide a grant to a community support group in need.

While providing vulnerable populations with funds to purchase essential items (PPE, cleaning supplies, emergency food purchases, etc), each grant will be named in honor of the NetWork raising the funds, and all stories of impact will be shared with NetWorks’ members, once they are available.

The NetWorks Challenge spans from Monday, July 20, to the end of Board Review on August 22, and members can easily designate their donation to their NetWork on the CHEST Foundation’s donor page.

In addition to receiving named recognition of your NetWork, the NetWork that raises the most funds, along with the NetWork with the highest percentage of participation, will receive additional prizes, including two complimentary registrations to CHEST 2020. These registrations are specifically for early-career clinicians and fellows-in-training, which will be selected by each NetWorks’s steering committee.

For every $5,000 raised by a NetWork, that NetWork will receive one complimentary registration to CHEST 2020, which will be awarded to their early-career and fellows-in-training as selected by that NetWorks’s steering committee.

In addition to directly impacting patients across the United States, NetWorks members will have a chance to test their knowledge against their peers by participating in a NetWork Challenge Game Series, where they will be asked a series of hand-selected board review questions each week through the end of Board Review.

For additional Information about the NetWorks Challenge, visit the CHEST Foundation’s website.

The CHEST Foundation is excited to announce that the NetWorks Challenge will be reinvented for 2020! Instead of raising funds to support travel grants to CHEST’s Annual Meeting as in previous years, the NetWorks Challenge will focus on raising funds to support COVID-19 community service grants. With so many people suffering due to the pandemic, we believe this change will make a tangible impact on the lives of people who need it most.

To date, the CHEST Foundation has dispersed over $60,000 in payments for patient support groups that provide services to those living with chronic lung disease, and we hope this year’s efforts will enable us to continue this work. For every $2,500 raised by a NetWork, the CHEST Foundation will provide a grant to a community support group in need.

While providing vulnerable populations with funds to purchase essential items (PPE, cleaning supplies, emergency food purchases, etc), each grant will be named in honor of the NetWork raising the funds, and all stories of impact will be shared with NetWorks’ members, once they are available.

The NetWorks Challenge spans from Monday, July 20, to the end of Board Review on August 22, and members can easily designate their donation to their NetWork on the CHEST Foundation’s donor page.

In addition to receiving named recognition of your NetWork, the NetWork that raises the most funds, along with the NetWork with the highest percentage of participation, will receive additional prizes, including two complimentary registrations to CHEST 2020. These registrations are specifically for early-career clinicians and fellows-in-training, which will be selected by each NetWorks’s steering committee.

For every $5,000 raised by a NetWork, that NetWork will receive one complimentary registration to CHEST 2020, which will be awarded to their early-career and fellows-in-training as selected by that NetWorks’s steering committee.

In addition to directly impacting patients across the United States, NetWorks members will have a chance to test their knowledge against their peers by participating in a NetWork Challenge Game Series, where they will be asked a series of hand-selected board review questions each week through the end of Board Review.

For additional Information about the NetWorks Challenge, visit the CHEST Foundation’s website.

The Board of Regents met remotely in June because of ongoing travel restrictions and safety concerns for staff and board members.

• The meeting was opened with Stephanie Levine, President; Steve Simpson, President-Elect; and Robert Musacchio, CEO/EVP discussing the impacts of the COVID-19 pandemic and Business Continuity Planning. The COVID-19 Task Force, chaired by Steve Simpson, continues to meet weekly to identify emerging content needs toward supporting membership and their patients through the pandemic, connecting with the Education Committee and Foundation to ensure robust coverage, drawing on the expertise of the NetWorks for content development, and leveraging the Social Media Workgroup for dissemination. Key activities include: a regular Thursday webinar series at 3:00 pm CDT titled: “Advice From the Front Lines”; clinical resources in the form of infographics and guides are posted in the resource center and circulated through social media; Alex Niven, MD FCCP, led a team to develop a wellness curriculum and series; the CHEST Foundation developed patient education videos and guides, a public service announcement in partnership with the American Thoracic Society, and a pilot partnership with AMITA Health enabling access to telehealth.

• The Finance Committee, chaired by John Howington, reported that CHEST is on track to meet its budget and exceed its debt covenants and operating reserve policy for the current fiscal year. The record attendance at the October 2019 annual meeting, along with strong performance from our digital offerings offset the financial impacts of the global pandemic. Bob Musacchio, CEO/EVP, reminded the Board why CHEST is switching from a fiscal year to calendar year budget. A calendar year budget process creates better alignment with budgets of pharma, other clients, and vendors; facilitates various accruals that are based on the calendar year, such as benefits, vacation, sick, and PTO days; provides for greater continuity for doing business throughout the year, and permits more planning time for staff in setting individual goals related to the annual meeting.

• CHEST’S Digital Transformation strategy that kicked off in 2019 was timely considering the pandemic. With education as one of our main foci, CHEST has hired and onboarded a Chief Learning Officer, Jim Young, to actively examine how we develop and deploy our educational products and services. Our first movement toward remote meetings occurred on June 26 with the Virtual Congress originally slated for Bologna, Italy. Here, we piloted a new platform and brought to life the tenets established in the new learning strategy—providing choice, demonstrating responsiveness, and fostering connection.

• CHEST’s Governance Committee reviewed the College bylaws for revisions, as per the group’s practice every 2-3 years, and the Board approved the revisions to the bylaws as proposed by the committee.

• CHEST’s newly formed Health Policy and Advocacy Committee (HPAC), chaired by Neil Freedman, MD, FCCP, is holding monthly meetings with a goal of making a recommendation to the Board of Regents on CHEST’s regulatory and policy priorities during the August meeting. The HPAC assists CHEST leadership and the BOR in developing and implementing health policy positions, setting chest advocacy agendas in the legislative and regulatory arenas, engaging with policymakers as directed by the BOR, and educating CHEST members of government affairs relevant to CHEST’s mission. The HPAC is currently setting its priorities to bring to the BOR for approval later this summer. Areas of focus include home mechanical ventilation and competitive bidding access to in education four home auction therapy, only rehabilitation and tobacco vaping education,

• Peter Mazzone, MD, FCCP; Editor in Chief, CHEST journal, reviewed his editorial team, which now consists of three Deputy Editors, nine Associate Editors, an Assistant Editor, a Statistical Editor, and three Case Series Editors and the publishing staff and partners.

The Board’s next meetings will be a scheduled teleconference in August, followed by their meeting that will occur concomitantly with the CHEST meeting in October.

The Board of Regents met remotely in June because of ongoing travel restrictions and safety concerns for staff and board members.

• The meeting was opened with Stephanie Levine, President; Steve Simpson, President-Elect; and Robert Musacchio, CEO/EVP discussing the impacts of the COVID-19 pandemic and Business Continuity Planning. The COVID-19 Task Force, chaired by Steve Simpson, continues to meet weekly to identify emerging content needs toward supporting membership and their patients through the pandemic, connecting with the Education Committee and Foundation to ensure robust coverage, drawing on the expertise of the NetWorks for content development, and leveraging the Social Media Workgroup for dissemination. Key activities include: a regular Thursday webinar series at 3:00 pm CDT titled: “Advice From the Front Lines”; clinical resources in the form of infographics and guides are posted in the resource center and circulated through social media; Alex Niven, MD FCCP, led a team to develop a wellness curriculum and series; the CHEST Foundation developed patient education videos and guides, a public service announcement in partnership with the American Thoracic Society, and a pilot partnership with AMITA Health enabling access to telehealth.

• The Finance Committee, chaired by John Howington, reported that CHEST is on track to meet its budget and exceed its debt covenants and operating reserve policy for the current fiscal year. The record attendance at the October 2019 annual meeting, along with strong performance from our digital offerings offset the financial impacts of the global pandemic. Bob Musacchio, CEO/EVP, reminded the Board why CHEST is switching from a fiscal year to calendar year budget. A calendar year budget process creates better alignment with budgets of pharma, other clients, and vendors; facilitates various accruals that are based on the calendar year, such as benefits, vacation, sick, and PTO days; provides for greater continuity for doing business throughout the year, and permits more planning time for staff in setting individual goals related to the annual meeting.

• CHEST’S Digital Transformation strategy that kicked off in 2019 was timely considering the pandemic. With education as one of our main foci, CHEST has hired and onboarded a Chief Learning Officer, Jim Young, to actively examine how we develop and deploy our educational products and services. Our first movement toward remote meetings occurred on June 26 with the Virtual Congress originally slated for Bologna, Italy. Here, we piloted a new platform and brought to life the tenets established in the new learning strategy—providing choice, demonstrating responsiveness, and fostering connection.

• CHEST’s Governance Committee reviewed the College bylaws for revisions, as per the group’s practice every 2-3 years, and the Board approved the revisions to the bylaws as proposed by the committee.

• CHEST’s newly formed Health Policy and Advocacy Committee (HPAC), chaired by Neil Freedman, MD, FCCP, is holding monthly meetings with a goal of making a recommendation to the Board of Regents on CHEST’s regulatory and policy priorities during the August meeting. The HPAC assists CHEST leadership and the BOR in developing and implementing health policy positions, setting chest advocacy agendas in the legislative and regulatory arenas, engaging with policymakers as directed by the BOR, and educating CHEST members of government affairs relevant to CHEST’s mission. The HPAC is currently setting its priorities to bring to the BOR for approval later this summer. Areas of focus include home mechanical ventilation and competitive bidding access to in education four home auction therapy, only rehabilitation and tobacco vaping education,

• Peter Mazzone, MD, FCCP; Editor in Chief, CHEST journal, reviewed his editorial team, which now consists of three Deputy Editors, nine Associate Editors, an Assistant Editor, a Statistical Editor, and three Case Series Editors and the publishing staff and partners.

The Board’s next meetings will be a scheduled teleconference in August, followed by their meeting that will occur concomitantly with the CHEST meeting in October.

The Board of Regents met remotely in June because of ongoing travel restrictions and safety concerns for staff and board members.

• The meeting was opened with Stephanie Levine, President; Steve Simpson, President-Elect; and Robert Musacchio, CEO/EVP discussing the impacts of the COVID-19 pandemic and Business Continuity Planning. The COVID-19 Task Force, chaired by Steve Simpson, continues to meet weekly to identify emerging content needs toward supporting membership and their patients through the pandemic, connecting with the Education Committee and Foundation to ensure robust coverage, drawing on the expertise of the NetWorks for content development, and leveraging the Social Media Workgroup for dissemination. Key activities include: a regular Thursday webinar series at 3:00 pm CDT titled: “Advice From the Front Lines”; clinical resources in the form of infographics and guides are posted in the resource center and circulated through social media; Alex Niven, MD FCCP, led a team to develop a wellness curriculum and series; the CHEST Foundation developed patient education videos and guides, a public service announcement in partnership with the American Thoracic Society, and a pilot partnership with AMITA Health enabling access to telehealth.

• The Finance Committee, chaired by John Howington, reported that CHEST is on track to meet its budget and exceed its debt covenants and operating reserve policy for the current fiscal year. The record attendance at the October 2019 annual meeting, along with strong performance from our digital offerings offset the financial impacts of the global pandemic. Bob Musacchio, CEO/EVP, reminded the Board why CHEST is switching from a fiscal year to calendar year budget. A calendar year budget process creates better alignment with budgets of pharma, other clients, and vendors; facilitates various accruals that are based on the calendar year, such as benefits, vacation, sick, and PTO days; provides for greater continuity for doing business throughout the year, and permits more planning time for staff in setting individual goals related to the annual meeting.

• CHEST’S Digital Transformation strategy that kicked off in 2019 was timely considering the pandemic. With education as one of our main foci, CHEST has hired and onboarded a Chief Learning Officer, Jim Young, to actively examine how we develop and deploy our educational products and services. Our first movement toward remote meetings occurred on June 26 with the Virtual Congress originally slated for Bologna, Italy. Here, we piloted a new platform and brought to life the tenets established in the new learning strategy—providing choice, demonstrating responsiveness, and fostering connection.

• CHEST’s Governance Committee reviewed the College bylaws for revisions, as per the group’s practice every 2-3 years, and the Board approved the revisions to the bylaws as proposed by the committee.

• CHEST’s newly formed Health Policy and Advocacy Committee (HPAC), chaired by Neil Freedman, MD, FCCP, is holding monthly meetings with a goal of making a recommendation to the Board of Regents on CHEST’s regulatory and policy priorities during the August meeting. The HPAC assists CHEST leadership and the BOR in developing and implementing health policy positions, setting chest advocacy agendas in the legislative and regulatory arenas, engaging with policymakers as directed by the BOR, and educating CHEST members of government affairs relevant to CHEST’s mission. The HPAC is currently setting its priorities to bring to the BOR for approval later this summer. Areas of focus include home mechanical ventilation and competitive bidding access to in education four home auction therapy, only rehabilitation and tobacco vaping education,

• Peter Mazzone, MD, FCCP; Editor in Chief, CHEST journal, reviewed his editorial team, which now consists of three Deputy Editors, nine Associate Editors, an Assistant Editor, a Statistical Editor, and three Case Series Editors and the publishing staff and partners.

The Board’s next meetings will be a scheduled teleconference in August, followed by their meeting that will occur concomitantly with the CHEST meeting in October.