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  • July 01, 2019 3:54 PM | Sally Winkelman (Administrator)

    The Wisconsin Poison Center (WPC) is gathering accreditation criteria for 2020 and seeking input from emergency physicians.  Please respond to this seven-question survey designed to gauge satisfaction from those who utilize WPC services.  

  • June 19, 2019 10:41 AM | Sally Winkelman (Administrator)

    WACEP President's Message, June 2019
    Jeffrey Pothof, MD, FACEP

    “If you see something, say something” has become common vernacular in post 9/11 America.  I suspect most of us think of air travel when we hear that phrase, but the phrase is equally applicable to healthcare and the environments we work in.

    One of the most important aspects of safety culture in healthcare is the ability of anyone on our teams to say something when they know or suspect that something is amiss.  This includes everyone on our teams.  From providers to nurses to techs to volunteers and other supporting staff.  The more people who are being sensitive to how things are supposed to work the more likely we are to identify a problem before it ruins our day, or even worse, harms our patient.

    Although this idea may seem intuitive and all of us would nod in agree that we as providers expect the rest of the team to speak up if they think a patient may be harmed, I’ve seen repeatedly in my work within patient safety that someone saw or knew something but didn’t say anything.  Many will be quick to blame the person who said nothing however the problem is rarely the person.  We hear things like “no one acknowledged my concerns before, why would I make the effort to say something this time”, or “the provider put me in my place the last time I raised a concern that turned out to be nothing, so now I just stay quiet because they know what they are doing”.

    One of my mentors once told me that as physicians we don’t get a choice as to whether we want to be leaders or not.  The only choice we get is whether we are going to be good leaders or not.  Many on our teams in the ED look to us for guidance and tone setting whether we want that responsibility or not.  When it comes to saying something when you see something, I don’t think as providers it’s enough to raise our hand or speak up when we see something that isn’t right.  I think our role is also to communicate directly and with intention to our teams that we expect everyone on our teams to say something when they see something, and then have to foresight to identify when that is occurring and show respect to them while reaffirming that speaking up was the right thing to do--irrespective of whether they were right or wrong.  This is how we can change culture, and this is how we can keep patients safer.

  • June 13, 2019 4:25 PM | Sally Winkelman (Administrator)

    Surprise billing is the most important issue facing emergency physicians today. Building on momentum from ACEP President Dr. Vidor Friedman’s testimony to Congress this week, ACEP is amplifying our efforts as we battle the insurance lobby and advocate for policy solutions that protect patients and support emergency physicians.

    ACEP leadership is hosting an interactive townhall discussion on surprise billing — this is your chance to speak directly with ACEP leadership; stay current on the latest activity on Capitol Hill, get the latest news, hear about the recent flurry of Congressional activity and ACEP-supported policy, ask questions, and learn more about how you can act now and get involved.

    Please join us Monday, June 17th at 4pm EST for an ACEP member-only Advocacy Townhall on Surprise Billing.

    ACEP Advocacy Townhall: Surprise Billing
    Monday June 17th at 4pm EST
    Featuring: Vidor Friedman, MD, FACEP, President of ACEP, and;
    Laura Wooster, MPH, Associate Executive Director, Public Affairs

    Register here:
    https://acep.zoom.us/webinar/register/WN_LXsbBBa2QjiIlXqThZWamA

    Please register for townhall access whether you plan to watch live or view the townhall on-demand at your convenience.

  • June 06, 2019 11:32 AM | Sally Winkelman (Administrator)

    June 5, Wisconsin Health News

    The Joint Finance Committee approved a Republican plan Tuesday night that would provide around $200 million more in state money for Medicaid beyond its cost-to-continue over the next biennium.

    Overall, the Republican proposal boosts state spending for health services by $588 million, which includes $356 million for the cost-to-continue for the Medicaid. 

    The proposal, which passed 11-4 along party lines, would provide $60 million more in state money for disproportionate share hospital payments, which head to providers that serve a high volume of Medicaid patients. It would also provide $4 million more in state money for payments that go to rural hospitals.

    Other changes include $92 million more in state money for long-term care. That breaks down to $30 million for nursing homes, $36.9 million for personal care workers and $27 million for direct caregivers in Family Care. The motion also includes $24.7 million in additional state and federal money to expand reimbursement for physicians and behavioral health services. 

    Democrats criticized the plan because it didn’t take federal dollars to expand Medicaid. The money used for the motion comes at the cost of other parts of the state budget, said Rep. Evan Goyke, D-Milwaukee. 

    “This motion advances, by and large, the status quo with additional investment here, and additional investment there, pick a winner here, pick a loser there,” he said. “But it isn’t a plan to bring forward the entire state’s healthcare system.”

    JFC Co-Chair Rep. John Nygren, R-Marinette, pushed back against claims that expansion would cover an additional 82,000 people as those covered through expansion can find subsidized health plans through the Affordable Care Act’s exchange.

    He noted that around half of those who would be covered by expansion already have insurance.

    “That’s the lie of the year that has been presented before us – the lie of the year,” he said. “This motion addresses the needs of the most vulnerable in our state.”

    The GOP-backed motion makes greater investments than Evers’ budget in some areas, keeps in place other parts of his plan, pared back some of his proposals and axes other provisions.

    It also includes several new items, including a $2.5 million Medicaid rate increase for physical health services providers and $1 million in grants for free and charitable clinics over the biennium.

    New to the proposal are $500,000 in state money for a child psychiatry consultation program and $1 million over the biennium for programs that provide clinical supervised practice to those training to become social workers, counselors, psychologists or family and marriage therapists.

    Lawmakers also opted to add $100,000 for a suicide prevention grant, $100,000 for an outreach campaign on vaccinations and $250,000 for respite care.

    At a press conference before the committee took up the measure, Nygren said Republican lawmakers were tripling the investment Evers put toward nursing homes, as well as making greater investments in personal care and Family Care.

    Other provisions stayed in place from Evers’ budget, including providing funding for a hub-and-spoke model of care that would provide a medical home health benefit for people with substance abuse disorders. Lawmakers modified the provision so the Department of Health Services would have to ask the committee to release state funding for the proposal.

    Also adopted from the governor’s budget were plans to expand funding for intake, application and screening costs for the children’s long-term care services program, $6.9 million in state and federal funding for telehealth in Medicaid and a $250,000 a year increase for grants under the minority health program. 

    GOP lawmakers backed additional money for the Wisconsin Well Woman Program, which provides preventive health screenings. They set aside funds for money that would help public safety answering points comply with training requirements that dispatchers provide assistance on administering CPR. And they backed Evers’ call for DHS to reallocate five full-time positions to staff an infant mortality prevention program.

    They also adopted Evers’ recommendation to eliminate the sunset date on Medicaid reimbursement for clinical consultations. And they backed $66,700 in state money to develop a plan for a mental health consultation program.

    The motion opts to have the state cover a greater share of county crisis intervention share through a $13.4 million increase in state and federal money as Evers proposed. But the committee deleted a provision in his budget that would have provided $2.5 million in state money for regional crisis stability facilities. 

    GOP lawmakers also scaled back Evers’ proposed investments in dental care. They opted to provide $2.5 million in state and federal funding for dental services provided to patients with special needs, half of what was included in the governor’s budget. 

    They backed additional funding for dental health initiatives, including Seal-A-Smile, which provides preventative services in schools, but axed a plan to provide more money to support oral health program positions at DHS.

    Gone from the proposal is Evers’ plan for $38.8 million for new dental access payments. The lawmakers left in place a program that increased Medicaid rates for pediatric and adult emergency dental services rates in Brown, Marathon, Polk and Racine Counties that Evers’ budget would have ended.

    Also pared back were Evers’ plans to hire more dementia care specialists and his lead poisoning prevention initiative.

    Provisions cut from Evers’ plan include his proposed funding for doula services, an extension of how long post-partum women can remain on Medicaid after giving birth and a proposed community health benefit to offer non-medical services to Medicaid members.

    And lawmakers didn't include proposals for additional funding for tobacco control efforts and $500,000 over the biennium for healthy aging grants.

    The adopted motion ends a proposed expansion of Birth to 3, a program offering early intervention services to children who are at risk of developmental delays. It instead directs the department to transfer, on a one-time basis, $2.3 million for the 2019-2020 fiscal year and keeps the budget level flat the following year. 

    Nygren ruled a Democratic motion that would have accepted federal funding to expand Medicaid “out of order” as the committee already voted to remove the provision from the budget. 

  • May 16, 2019 4:43 PM | Sally Winkelman (Administrator)

    Lisa Maurer, MD
    Immediate Past President

    WACEP board members, Drs. Lisa Maurer, Bill Falco and Brad Burmeister [pictured here with U.S. Representative Bryan Steil (R-WI-01)] traveled to Washington DC for the annual Leadership and Advocacy Conference and the ACEP-coordinated visits with Wisconsin’s legislators. 

    The conference began with outstanding speakers and breakout sessions on leadership and how leadership might intersect with violence prevention, diversity in medicine, civic duties of physicians as community leaders, and practical tips on how to be an effective advocate for your patients and colleagues.  Wisconsin emergency medicine will certainly benefit from lessons learned. 

    As the focus narrowed a bit at the conference to legislative advocacy, Drs Falco, Burmeister and Maurer met personally with staff and legislators from five different offices, including both Senate offices, and informed staff for many other offices from around Wisconsin.  Although there are many issues related to emergency medicine that are important to our legislators, our conversations turned to current and pressing issues for them right now: surprise medical bills and improving care for our patients in psychiatric crises. 

    Related to increasing access to care for our patients with psychiatric disease, we spoke in support for recent bills both on the House and Senate that would supply states with grant funds to use as they see most helpful at the local level to bolster psychiatric care.  Discussions around surprise bills were more complicated and detailed, making sure that lawmakers understand that it is important to emergency physicians that our patients are not faced with narrow networks and insurmountable bills as they access crucial emergency care.  We were able to explain that for most cases of “surprise bills,” this is actually a description of high out of pocket costs from unrealistically high deductibles. 

    To that end, our legislators were very interested to hear about our suggested mechanisms for ensuring fair payments for emergency care without escalating costs of care, all the while leaving the patient out of the process.  They now understand that while it’s paramount for protecting our patients’ access to care, it’s also very important for protecting emergency physicians as we continue to face challenges in negotiating contracts with insurance companies. 

    Overall, our team was comforted to see how well informed our legislators and staff are regarding issues that are important to us.  The lawmakers actively asked for our follow up with them to make sure they keep our issues in the forefront of their minds.  To this end, our board will be asking for help from our members who live and work in the various districts around our state, to make sure these legislators know about how these issues affect you and your patients specifically. 

  • May 15, 2019 3:35 PM | Sally Winkelman (Administrator)

    WACEP President's Message, May 2019
    Jeffrey Pothof, MD, FACEP

    We as emergency physicians have chosen a demanding career.  Not only do we work days, nights, weekends and holidays, we also play witness to some of the best, and often the worst experiences people and families go through.  Being the ever-present patient advocate can also be an exhausting activity, almost daily having to think outside the box to get patients what they need in a system and society that at times just seems broken.  At the same time the ratio of value-added to non-value-added work seems to be going in the wrong direction.  It’s no surprise that in a recent Medscape survey 48 percent of us reported burnout.

    Lately there has been more attention to this issue.  Many have been exploring the “why” and others have been offering suggestions on “what” to do about it.  I’m no expert in wellness and I can’t really tell you how much you should exercise or how you’ll find the time to sleep a little more.  Everyone is a bit different when it comes to connecting with other people and many of us have different ideas of how what we do is part of something bigger than any one of us.  I sometimes struggle to use my electronic health record, so I don’t think I’d be the right one to show you how to use yours.

    As I reflect on all the headlines, reports, and studies on wellness among physicians and especially emergency physicians, my first reaction is one of appreciation.  Despite all the reasons you see, hear, and experience you still don your scrubs, throw on the white coat, and head in to the department.  I just want to say THANK YOU to all of you for being such dedicated professionals and standup individuals.  Hats off to you emergency physicians.  Although it sometimes doesn’t feel like it amidst all the distractions, all of you are making a difference in the lives of others however big or small.

    For those of you who may not be finding the meaning you need in a demanding career such as emergency medicine, I encourage you to take action.  You are far to valuable to your patients but also to your family and friends.  We need you.  All of us at WACEP are here to support you and there are many resources available to find what works best for you.  ACEP has a dedicated site and section that I encourage you to check out at https://www.acep.org/life-as-a-physician/wellness/

  • May 08, 2019 2:37 PM | Sally Winkelman (Administrator)

    WACEP members are invited to collaborate on an AACT grant-funded project initiated by Colorado ACEP to examine providers attitudes toward treating opioid use disorder and initiating buprenorphine/naloxone treatment in the ED. Survey respondents will be entered in a drawing for a chance to win a $100 Amazon gift card. 

    On many shifts we see patients whose lives have been negatively impacted by the opioid crisis. Some have overdosed, some have abscesses, and others are requesting opioid pain medications in the ED yet again. We do a great job of treating their acute issue, knowing their addiction will make a repeat visit inevitable. These are the names we recognize as soon as we pick up the chart; the PDMP’s we’ve checked multiple times before. We’re hoping you can help us develop some options.

    We are surveying ED providers to determine their experience with and attitudes toward initiating suboxone in the ED. Please head to https://is.gd/EDbupe to participate in our quick survey. 

    It’s completely voluntary and any ED provider can take this anonymous survey to see how they feel about ED buprenorphine (commonly called Suboxone) and what tools they need to improve care for patients with opioid use disorder. 

    COMIRB# 19-0088 PI: Matthew Zuckerman
    Study Title: Attitudes to Emergency Department Medication Assisted Therapy
    matthew.zuckerman@ucdenver.edu 

  • May 06, 2019 5:41 PM | Sally Winkelman (Administrator)

    Bradley Burmeister, MD

    On May 1st, over 20 Emergency physicians were among the more than 300 physicians from across Wisconsin to participate in Doctor Day in Madison.

    The two main policy issues for this year focused on Medicaid reimbursement and the personal conviction waiver for immunizations.  

    As you know, Wisconsin continues to be at or near the bottom for Medicaid reimbursement. In fact, for most Emergency Department levels of service, Wisconsin is dead last for reimbursement often at rates far below overhead costs. Adequate and fair Medicaid reimbursement is important in order for patient to have access to both primary and specialty physicians.

    In general, legislators provided feedback that they understand the Medicaid issue is regarding access. Many had a very strong understanding, and realize the issue is not just about the bottom line for physicians.

    This year’s particular “ask” regarding Medicaid was focused on institutional versus non-institutional payments. The Governor’s budget includes Medicaid expansion and with expansion, over $300 million dollars would become available. The budget, however, allocates all of these funds as institutional payments to hospitals and health systems, and not toward physicians or other non-physician providers.

    The second issue was around support of proposed legislation to end the personal conviction waiver for school-mandated vaccines. Wisconsin is one of only 18 states that continue to permit a personal conviction to waive the requirement to have vaccines for school-aged children. In many states, parents can seek a medical waiver or a religious waiver. But only a few states, including Wisconsin, allow parents to essentially check a box exempting their children from the vaccine requirement. Since 1997, Wisconsin has seen a significant increase in parents obtaining a vaccination waiver. While medical and religious waivers, which represent less than 1% of all waivers, have not increased over time, the personal conviction has seen a steady and dramatic increase and represents the vast majority of total waivers. 

    Legislation has been introduced that seeks to end the personal conviction exemption but continues to permit medical and religious waivers. As you know, the science is clear on immunizations, and we must maximize our “herd immunity” for the betterment of the whole community.

    To summarize, Doctor Day 2019 was a tremendous success. To continue our advocacy efforts, several of us from WACEP leadership are now in Washington DC to participate in ACEP’s Leadership and Advocacy Conference. There, we will meet with legislators and staff from Wisconsin, and will engage in advocacy at the national level. Stay tuned for additional updates, and in the meantime, save the date for Doctor Day 2020, scheduled for January 29, 2020 in Madison. We hope to see you there!

  • May 02, 2019 4:27 PM | Sally Winkelman (Administrator)

    Prescribed pain medication after surgery and traumatic injury is among the most common first exposures to opioids. SPOTS offers an opportunity for collaborative learning with experts about best practices in opioid prescribing, and with other providers around the state about the current challenges and opportunities in treating our injured patients’ pain.

    Between March and September, the program offers a monthly session hosted from the teleconference facilities at the University of Wisconsin. Each are hour-long session will start with a 15-20 minute didactic presentation from an expert in the field, followed by an open conversation between our expert presenters and the participants. 

    The May 23, 2019 session will begin at 4:00 pm and will feature Drs. Mike Repplinger and Benjamin Schnapp, who will present "Opioid prescribing for surgery and trauma in the Emergency Department." Register here.

    Participants will receive Opioid CME credit, and may either attend live or view recorded sessions online. Note that if you prescribe controlled substances, Wisconsin’s Medical Examining Board requires that you earn two CME credits on responsible opioid prescribing between 1/1/2018-1/1/2020. Each session in the SPOTS series counts toward one hour.

    SPOTS is a collaborative learning series presented by the South Central Wisconsin Healthcare Emergency Readiness Coalition (SCWIHERC), South Central Regional Trauma Advisory Council (SCRTAC), and the Surgical Collaborative of Wisconsin (SCW), through a generous grant from the Wisconsin Department of Health Services.

  • May 02, 2019 12:43 PM | Sally Winkelman (Administrator)

    Meet your Wisconsin Colleagues for a Reception during SAEM!

    WACEP Members are invited to join the University of Wisconsin Department of Emergency Medicine for a sponsored event at SAEM's 2019 Annual Meeting in Las Vegas. 

    Wednesday, May 15 at 6:00 pm
    The Loft at Cabo Wabo
    3663 Las Vegas Blvd. South
    Las Vegas, NV 89109

    Please RSVP by Friday, May 10th .

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