The legislation passed by the House will give the FDA authority to stop Big Tobacco from marketing deadly tobacco products to the children of America. The American Thoracic Society is proud to have been a strong partner in the efforts to move this legislation forward.

The ATS Washington Office organized membership phone and email campaigns and has several times flown in ATS members from the around the country to meet with members of Congress to express our strong support for this legislation. Members of the ATS Council of Chapter Representatives (CCR), Clinicians Advisory Committee (CAC) and Public Advisory Roundtable (PAR) joined the effort.

Attention now turns to the Senate. The ATS and the rest of the tobacco control community will focus efforts on getting the Senate to take up the FDA tobacco bill as soon as possible. While supporters of the bill are confident they have a majority of the votes in the Senate, it is unclear if they have the 60 votes needed to prevent a filibuster.

Last week, the ATS leadership held a series of meetings with the National Heart, Lung and Blood Institute (NHLBI), the National Cancer Institute (NCI) and the Agency for Healthcare Quality and Research (AHQR) to advance ATS priorities with these agencies. ATS President Jo Rae Wright, Ph.D., President-Elect Randall Curtis, MD, Past President David Ingbar, MD, and Secretary-Treasurer Dean Schraufnagel, MD, met with NHLBI Director Betsy Nabel, MD, to discuss the progress of the institute's COPD awareness campaign, institute support for young investigators and global climate change. The ATS thanked Dr. Nabel for the COPD awareness campaign and encouraged her to expand the initiative. ATS leaders also requested enhanced integration and streamlining for young investigators transitioning between fellowships and research grants.

The leadership held a first-ever meeting with the Director of the AHRQ, Carolyn Clancy, MD, to discuss issues of collaboration on quality improvement and patient safety. During this meeting, the ATS stressed the need for research on hospital acquired conditions and invited the AHRQ to present a session at an upcoming ATS International Conference. Dr. Clancy responded that this and other collaborations with the ATS would be a priority.

ATS leaders also met with staff at the National Cancer institute to discuss our society's interest in research on lung cancer. During the meeting the ATS leaders stressed the need for improved prevention and detection of lung cancer as well as improved treatment tools. The leaders discussed the need for increased research on improved detection strategies using genetic markers and bio markers, chemo prevention and intervention strategies using bronchoscopic technology and better smoking cessation therapies.

These three conditions will join the following list of HACs that started implementation in 2008:

1. pressure ulcer stages III and IV;
2. falls and trauma;
3. surgical site infection after bariatric surgery for obesity, certain orthopedic procedures, and bypass surgery (mediastinitis);
4. vascular-catheter associated infection;
5. catheter-associated urinary tract infection;
6. administration of incompatible blood;
7. air embolism; and
8. foreign object unintentionally retained after surgery.

CMS had initially proposed a much wider list of HACs for 2009, including a number of conditions that had direct impact on pulmonary and critical care patients. The proposed list of HACs included:

1. Legionnaires' Disease.
2. Extreme Glycemic Aberrancies.
3. Iatrogenic Pneumothorax
4. Delirium
5. Ventilator-Associated Pneumonia (VAP)
6. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)
7. Staphylococcus aureus Septicemia
8. Clostridium Difficile-Associated Diseases (CDAD)
9. Surgical Site Infections Following Specific Elective Surgeries

The ATS and sister organizations met with CMS to express our concerns with the proposed list of HACs and strongly suggested CMS significantly narrow the scope of the HACs. We are pleased that CMS listened to our concerns and significantly narrowed the HACs that impact pulmonary and critical care patients.

It is expected that CMS will continue to expand the list of HACs in future years and its is likely that many of the conditions proposed, but not adopted, for 2009 will again be considered in future years. The ATS will continue to monitor the CMS HAC policy and provide comment on how best to apply the policy to pulmonary and critical care patients.