July 2016 Arizona Thoracic Society Notes

The July 2016 Arizona Thoracic Society meeting was held on Wednesday, July 27, 2016 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 14 in attendance representing the pulmonary, critical care, sleep, and radiology communities.

Prior to the case presentations, a discussion was held on 4 issues. First, Dr. Rick Robbins  gave a summary of ATS Hill Day. During Hill Day a presentation was given by a representative from the Campaign for Tobacco-Free Kids. Their web site lists tobacco company contributions to members of Congress on their web site. Dr. Gary Ewart from the ATS office in Washington gave a presentation on the Traditional Cigar Manufacturing and Small Business Jobs Preservation Act before Congress (aka the Cigar Bill) which the ATS opposes. He noted that cosponsors for the bill included several Congressmen from Southwestern states. Dr. Robbins combined the two sets of data to see if there was a correlation between the tobacco company contributions and cosponsorship of the Cigar Bill. There was a highly significant correlation and Dr. Robbins asked the group if they felt this data was worthy of publication in the SWJPCC. The consensus was that Dr. Robbins should write an article and send it out for review.

Second, the Arizona Hospital Executive Compensation Act 2016 was discussed. This is an Arizona state proposition to limit hospital executive pay to $450,000/year which was circulated by Service Employees International Union and submitted to the Arizona Secretary of State to include on the November ballot. Although the required number of signatures were present, the validity of those signatures is being challenged by Arizona Chamber of Commerce. The Arizona Hospital and Healthcare Association said a cap on executive pay would "harm healthcare and hurt patients.“ Dr. Robbins asked if a survey through the SWJPCC should be conducted to determine whether the act would harm patients. After discussion, the Arizona Thoracic Society asked Dr. Robbins to conduct the survey the report on the results.  

Third, a discussion was held on Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The ATS along with other groups has been asked for input for quality measures. However, Rep. Kevin Brady (R-Texas), chairman of the House Ways and Means Committee, was recently quoted by Medpage Today as saying “MACRA is a good law, but I'm frustrated with the implementation…The heart of this [was supposed to be] how do you measure quality? Should we measure it from Washington, or measure the best practice of what is occurring in that region or in those physician practices?” (1). After discussion and noting that many previous quality measures are not evidence based, the Arizona Thoracic Society thought that local input was important. Dr. Robbins is to ATS CCR representatives from the Southwest and to report to a committee consisting of Dr. Wesselius, Parides and Robbins to determine how best to voice the Arizona Thoracic Society's input into determining quality measures.

Lastly, Dr. Parides moved to name Dr. Lewis Wesselius as the Arizona Thoracic Society clinician of the year. This was unanimously approved.

Dr. Lewis Wesselius presented a 52-year-old woman with a past renal transplant for eclampsia and hypertension who presented with a low grade fever 38.2º C and a right upper lobe mass. Her coccidioidomycosis serology was negative. Bronchoscopy with bronchoalveolar lavage was performed but was initially non-diagnostic.

After bronchoscopy, the mass markedly enlarged but the patient refused further diagnostic studies since despite her worsening radiologic appearance, she felt somewhat better. Her Legionella serology subsequently returned positive as did her Legionella culture from her bronchoscopy. She was treated with levofloxacin and markedly improved.

Dr. Gerry Swartzberg presented two cases of positive Gold Quantiferons in an asymptomatic 76 year old woman whose father had tuberculosis and a 35 year drug addict. After discussion, the consensus was not to treat the elderly woman but treat the younger drug addict.

Dr. George Parides again asked for input on bringing more young people into the Arizona Thoracic Society. Several suggestions were given and several members said they would contact the local fellowship directors.

There being no further business, the meeting was adjourned about 8 PM. The next meeting will be in Phoenix on Wednesday, September 28, 2016 at 6:30 PM.

Richard A. Robbins, MD

Editor, SWJPCC

Cite as: Robbins RA. July 2016 Arizona thoracic society notes. Southwest J Pulm Crit Care. 2016;13(1):38-9. doi: http://dx.doi.org/10.13175/swjpcc071-16 PDF

March 2013 Council of Chapter Representatives Meeting and “Hill Day” Notes

March 18, 2013

As part of “Hill Day” the Council of Chapter Representatives meant on March 18, 2012 in Washington, D.C. beginning at 2:00 PM.

1. Welcome/Open meeting: Dona Upson 2:00 PM

Roll call determined there were representatives present from Arizona, Colorado, DC-Metro, Louisiana, Michigan, Mississippi, New York, and Washington. Linda Nicci, CCR Chair from Rhode Island, was delayed by weather and attended by conference call.

2. ATS Leadership Update 2:15pm

Presentations were given by Monica Kraft, ATS president, and Steven Crane, ATS executive director. Highlights of their presentations included –

• A discussion of hospitalists eligibility for critical care boards
• The ATS bottom line 
  • Bottom line was positive beginning in 2010 and growing in 2011 and 2012
  • Reserves have also increased (about 2/3 of a year)
• Ken Adler will serve 3 more years as editor of the “Red Journal”
• Annals of the ATS will be published shortly. It is hoped to be clinician friendly.
• A 3 year core curriculum aligned to ABIM’s exam has been posted on the ATS website.
• 2013 International Meeting
  • Over 5000 abstracts (1500 more than ERS and 3-4000 more than ACCP
  • 40% of revenue comes from ATS meeting
  • Registration down about 12% compared to San Francisco
• Some drop in membership in 2013 attributed to the meeting not in San Francisco and Hurricane Sandy delayed processing applications-expect numbers to rise
• ATS webinars have had over 1200 participants
• 8000 are following ATS on Facebook and Twitter
• ATS developing bridge funding for NIH grantees because of sequestration
• ALL money given to the ATS Foundation goes for research-no administrative costs

 3. Chapter Activity Update 2:40pm

• A handout was distributed with the 2012-13 Chapter Educational Meetings
• A brief discussion was held of the Chapter publications from Arizona and California
• Some inactive chapters showing renewed interest
• A brief discussion of ALA relationship and administration

4. Outstanding Clinician Award (OCA) 3:00pm

• The 2013 OCA finalists were from AZ, NM, WA
• The ATS OCA for 2013 is Allen Thomas, MD, Arizona

5. Committee Updates by CCR reps 3:15pm

• Verbal/written updates from CCR reps on committees they cover
  • Clinicians Advisory-Chris Fukui
  • Education-Linda Nici
  • Ethics and Conflict of Interest-Anthony Scardella
  • Health Policy-Dona Upson
  • Planning and Evaluation-Carol Welsh
  • Quality Improvement-Chris Fukui Wilhelm
  • Research Advocacy-Rajesh Bhagat
  • Training-Rajesh Bhagat

6. Advocacy Update - 3:45pm

Gary Ewart, ATS lobbyists, presented an advocacy update. Highlights included:

• Advocacy by CCR
• A review of the list of chapter ‘advocacy’ champions (CCR)
• An open discussion other (potential) advocacy initiatives

7. Future Activity/Additional Role of CCR 4:25pm

• Linda Nicci made a presentation.
• Highlights of the discussion included
  • Increased CCR presence at International Conference
  • Officers to commit to times in Clinicians Center and Fellows Center.
  • Review of CCR brochure
  • CCR/ATS Foundation Partnership
  • Report on CCR involvement with Better Breathing Alliance

8. Great Cases Symposium at International Conference – organized by CCR 4:50pm

A reminder and a brief discussion was held of the Great Cases Symposium Organized by CCR: Session A83: Great Cases: Clinical, Radiologic and Pathologic Correlations by Master Clinicians

9. CCR Meeting date in Philadelphia 4:55pm

A CCR meeting will be held in Philadelphia on Saturday, May 18 from 11:00 AM-1:00 PM.

10. There being no further business the meeting was adjourned 5:00pm

March 19, 2013

1. Presentations were made by James Kiley, Director of the Division of Lung Diseases, and several staff from Congressional including the Veterans Affairs and research related committees from 8 AM-10 AM.

2. Meetings with Congressional representatives were held throughout the day. The offices were presented with handouts advocating (Click on title to be directed to the handouts)

• Opposition to the “Cigar Bill” (H.R. 792)
• Repeal and replacement of the Medicare Sustainable Growth Rate Factor (SGR)
• Urging Congress to provide $32 billion for the National Institutes of Health for fiscal year 2014

Meetings with Arizona, New Mexico and Colorado representatives included:

 Arizona

• Michael Nelson from the Office of Senator Jeff Flake (R-AZ)
• Christopher Bowlin from the Office of Senator John McCain (R-AZ)
• Lliam Morrison from the Office of Representative Matt Salmon (R-AZ)
• Laurie Ellington from the Office of Representative Ed Pastor (D-AZ)

New Mexico 

• Sandra Wilkniss from the Office of Senator Martin Heinrich (D-NM)
• Representative Michelle Lujan Grisham (D-NM) and Kristin Palmer from her office
• Lauren Arias from the Office of Tom Udall (R-NM)

Colorado

• Representative Michael Coffman (R-CO and sponsor of the HR 792 tobacco bill) and legislative assistant Stephen Beck
• Jacquelyn White, health policy fellow from the office of representative Dianna DeGette (D-CO)
• Kristen Joyce legislative correspondent from the office of senator Mark Udall (D-CO)
• Rina Shah, legislative fellow from the office of senator Michael Bennet (D-CO)
• Morning coffee with Senator Michael Bennet (D-CO)

3. A dinner debriefing was held later that evening to discuss the advocacy efforts.

Richard A. Robbins, MD

Arizona CCR Representative

Reference as: Robbins RA. March 2013 council of chapter representatives meeting and "hill day" notes. Southwest J Pulm Crit Care. 2013;6(3):145-7. PDF