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  • February 17, 2020 3:22 PM | Sally Winkelman (Administrator)

    WACEP President’s Message, Feb 2020
    Ryan Thompson, MD, FACEP

    Multiple WACEP members represented our specialty at this year’s Doctor Day, meeting with their legislators to discuss issues relevant to the house of medicine. We were also able to collaborate with physicians of all stripes from around the state. It’s such a pleasure to meet with other docs and discover that we are facing many of the same issues across the full spectrum of medicine and come together to advocate for the health of our state.  This year, over 315 Wisconsin physicians met with their local legislators, covering 31 of 50 State Senators, and 57 out of 99 Assembly members.

    One of the most popular breakout sessions at Doctor Day was a legislative update, and one of the most-talked-about topics was the CARES act. For those who are not aware, the CARES act was put forth by the Wisconsin Academy of Physician Assistants (WAPA) with the goal to improve parity with nurse practitioners in the state, who currently enjoy significantly more autonomy than PAs. The Wisconsin Hospital Association strongly supports the bill, as it makes it easier for hospitals to employee PAs. The bill removes the currently mandated ratios of physicians to PAs, changes the PA-physician relationship to one of “collaboration” rather than “supervision”, and allows PAs to work remotely from their collaborating physician. At the time of Doctor Day, several provisions in the bill were causing concern amongst physicians, including a titling change which would allow PAs to call themselves “Associate Physicians”, and the creation of an independent PA licensing board separate from the medical licensing board (NPs are licensed through the Nursing Board). Also controversial was the language surrounding the collaboration agreement between a PA and a physician. 

    The Wisconsin Medical Society (WMS) has been negotiating with WAPA and the bill sponsors to alter some of the more problematic portions of the bill. An updated version of the bill stripped out the title changes, and supports the creation of an associate PA board, underneath the state Medical Board – similar to how Podiatry currently has an associate board in the state. The associate board would not be permitted to expand the scope of practice of PAs without the approval of the Medical Board. The language around the collaboration agreement also was changed to ensure that a physician can provide collaborative care for a patient cared for by a PA within a medically reasonable amount of time. With these changes in place, WMS supported the bill, and it quickly passed both the Assembly and Senate, and awaits signature by Governor Evers.

    In other legislative news, the US House of Representatives seems highly motivated to pass an Out-of-Network Bill this year. For some background, if this legislation ends up being unfavorable for EM physicians, it could cause the biggest disruption in Emergency Medicine since EMTALA went into place in the 80s! National ACEP has been working hard to push for fair compromise and promote negotiation between physician groups and insurers and avoid price-fixing. The insurance industry has been swinging their considerable political weight and lobbying coffers into this, so it is vital that EM physicians take a strong stand in response. If insurers get their way, we can expect EM compensation to drop considerably nation-wide, and the patient safety-net of Emergency Departments to disintegrate.

    Several House committees have developed bills with various levels of favorability. First, the bad: The Education and Labor Committee has put forth a bill that sets the lower limit to allow arbitration between physicians and insurance companies at $750, far above most ED bills, essentially locking out emergency care from this solution. ACEP is understandably opposed to this bill. There is, however, a more promising bill coming from the Ways and Means Committee, known as “Consumer Protections Against Surprise Medical Bills Act of 2020”. This bill has no threshold, and is the most fair bill to EM physicians because it encourages robust insurance networks to help protect patients. ACEP supports this bill, and it moved out of committee on February 12th. Now the full House must reconcile these bills and amend them before going forward with a full House vote.

    It is vital that our Wisconsin legislators hear from Emergency Physicians on these bills! Please write, call, meet with, or email your house legislator today, and let them know that you support the protections offered to patients in the Ways and Means Bill. In particular, ACEP is still pushing for some amendments to that bill, so it essential that Wisconsin representatives Ron Kind (WI 3 – Western WI) and Gwen Moore (WI 4 -Milwaukee) hear from their EM physician constituents. The only Wisconsin representative on the Education and Labor Committee is Glenn Grothman (WI 6 -Eastern WI) so if you are in his district, be sure to let him know the reasons you oppose the bill coming from his committee.

    It has been a surprisingly busy winter in terms of legislation both at the state and federal level, but you can count on WACEP to keep you up-to-date on the issues that matter to you and your patients!

  • February 17, 2020 3:09 PM | Sally Winkelman (Administrator)

    Wisconsin ACEP is planning a second Rural Outreach Program on Friday, June 19, 2020 as part of an initiative to engage emergency physicians in more rural and remote practice settings for education, networking and fun.

    Save the date and plan to join us on Friday, June 19th at Marshfield Medical Center, Rice Lake.

    The program will have a pediatric focus with updates on Peds ICU, Peds Trauma, Best Practices in Burn Care, and much more! Whether you practice in that part of the state or elsewhere, join us and learn the unique challenges and opportunities in more rural settings. You'll likely discover that despite differences in transfer times and resources, many more similarities actually do exist across practices, regardless of location.

    Save the date of Friday, June 19 and plan to make a weekend of all that is offered in beautiful Northwest Wisconsin! Program registration will be open soon, and will include optional social and/or family excursions. 

  • February 17, 2020 2:55 PM | Sally Winkelman (Administrator)

    March 1st is the deadline to submit nominations for ACEP Leadership and Excellence Awards. Learn more and submit a nomination.

    Nominations are also being accepted through March 1st by ACEP's Council Awards Committee for the following Awards:

    • Council Teamwork Award 
    • Council Horizon Award
    • Council Curmudgeon Award
    • Council Champion Award in Diversity & Inclusion 

    Descriptions of the Council awards can be found online. and nominations may be submitted here.

  • January 24, 2020 10:26 AM | Sally Winkelman (Administrator)

    WACEP President's Message, January 2020
    Ryan Thompson, MD, FACEP

    A recent tragic case which occurred in Milwaukee is garnering national media attention. You can read the full story here, but the broad strokes are that a young woman 9 months status post a stillbirth presented to an ED with chest pain, left after waiting 2 hours, and subsequently collapsed and died a short time later -presumably related to postpartum cardiomyopathy. (If you want to brush up on peripartum care, our friends at Wisconsin-ACOG have provided this great reference). Ultimately, this woman’s death was heartbreaking and very likely preventable. 

    The immediate and predictable media reaction was to blame the ED for the wait times she experienced. I do not know the physicians who were working at the time, but I’m confident that if the patient had stayed in the ED that she would have received the life-saving care that she needed. To lay the blame solely at the feet of these physicians and other ED staff is unfair and misses the whole host of failures that contributed to this woman’s death. Fortunately, ACEP’s Dr. Howie Mell was able to provide a small amount of context for the story, pushing back against the failed ED narrative.

    As emergency physicians, we would like nothing better than to have EDs with enough staff, space, and resources to see every patient with little or no wait times at all. Unfortunately, this is far beyond our control. Innumerable forces contribute to ED crowding: a woefully overwhelmed mental health system that leaves patients boarding for days in the ED, inadequate Medicaid funding which leads to a lack of primary care availability and budget shortfalls in EDs, hospital system failures to decompress ED boarding through creative surgical scheduling and inpatient hallway beds, and many more.  

    I originally joined the WACEP board to head up the planning of the annual Spring Symposium (this year occurring April 15-16th in Madison, sign up here), but I have come to increasingly recognize the value WACEP offers in addressing the systemic issues we struggle with every day. National ACEP simply doesn’t have the resources or awareness of state-level problems to intervene effectively, but by working on the local level we can do so much. Dedicated members of our board monitor for state legislation relevant to EM so we can provide our perspective to legislators, sit on a multi-specialty task force dedicated to fixing ED psych boarding, have designed opiate-alternative guidelines to attenuate the opiate crisis, meet with state regulators to push for increased Medicaid reimbursement for EM so we can recruit more docs, and help craft position statements that EM physicians can use to advocate for change within their own institutions. I am constantly humbled by the passion and dedication displayed by our membership.

    In the hustle and bustle of our lives it can become all too easy to lose sight of the challenges that face our specialty and our patients on a daily basis. WACEP has been working for years to give EM docs a voice so we can advocate for ourselves and our patients. As your new president, I will strive to continue that mission, but we need your help as well. Please reach out to us if you have an issue you are passionate about, tell an EM friend about the work we are doing on their behalf, and contribute to our PAC so we have the clout to push for legislative change in the state. WACEP is nothing without its members, so please help us help you!

  • January 22, 2020 5:22 PM | Sally Winkelman (Administrator)

    Nathan Houdek was appointed deputy commissioner of insurance in January of 2019. He's chairing the Governor's Task Force on Reducing Prescription Drug Prices and is vice chair of the Group Insurance Board.

    Mr. Houdek will detail the work of both groups at a Wisconsin Health News Newsmaker Event on Monday, February 10 at the Madison Club in Madison. He'll also discuss the future of the ACA market, protections for people with pre-existing conditions, surprise medical bills and more.

    Learn more and sign up here.

  • January 22, 2020 5:15 PM | Sally Winkelman (Administrator)

    January 21, Wisconsin Health News

    A new proposal would create a pilot program in western Wisconsin so law enforcement wouldn’t have to transport those in mental health crisis across the state.

    The bill would require that the Department of Health Services reimburse hospitals located in Barron, Burnett, Dunn, Pierce, Polk, St. Croix and Washburn counties for housing patients for emergency detention.

    Bill author Rep. Rob Stafsholt, R-New Richmond, said at an Assembly Committee on Mental Health hearing last week that those in crisis in his district are often transported to Winnebago Mental Health Institute in Oshkosh.

    “It’s a roughly five-hour trip, often in handcuffs, across the state while you’re in a mental health crisis,” Stafsholt said. “And the reason we do that is there’s not access to those types of facilities in northwestern Wisconsin.”

    Participating providers would be able to opt into the program. DHS would cover up to 80 percent of the difference between the hospitals' average cost per bed per day and the average rate received per bed per day. Counties would have to pay the remainder.

    St. Croix County Sheriff Scott Knudson said that emergency detentions can impact law enforcement staffing, calling it one of their more “draining duties." Any additional resources would help, he said.

    Sarah Diedrick-Kasdorf, Wisconsin Counties Association deputy government affairs director, said the plan isn’t specific on how much of the difference DHS would cover, making it difficult for counties to budget.

    She questioned how the bill would relate to federal law and county contracts for emergency detention services.

    “These are all things we can sit down and talk about and come to some sort of resolution on,” she said. 

  • December 30, 2019 4:31 PM | Sally Winkelman (Administrator)

    Nominations are now being accepted for the WACEP 2020 Distinguished Service Award.

    This award annually recognizes a WACEP member in good standing who has demonstrated exceptional commitment and service to the organization, and/or made a significant contribution toward the advancement of emergency medicine in Wisconsin or beyond.

    If you know of an emergency physician who is deserving of this award, submit your nomination today.

    The deadline to accept nominations is March 1st and the selected award recipient will be recognized during the WACEP Annual Spring Symposium.

  • December 30, 2019 2:50 PM | Sally Winkelman (Administrator)

    Interested in taking a deeper dive into federal and state legislative issues important to emergency medicine? Plan to attend ACEP’s Leadership and Advocacy Conference (LAC), April 26-28, 2020 at the Grand Hyatt in Washington DC.

    At LAC, you will learn tips and tools to advocate on issues at both the federal and state levels, hear updates on proposed legislation that could impact you and your patients, and have an opportunity to meet with your federal legislators in person. 

    The Wisconsin Chapter, ACEP has earmarked funds to support travel and conference registration expenses for up to four residents and four members in practice. Simply submit your brief statement of interest no later than January 31st explaining your why you’d like to attend and what you hope to do with information you obtain at the conference.  Notice of funding will be made by mid-February. 

  • December 18, 2019 4:54 PM | Sally Winkelman (Administrator)

    Jeffrey Pothof, MD, FACEP
    WACEP President

    Dear WACEP members,

    As we close out yet another year it seems a brief reflection of the previous year is the natural starting point as we start to focus on what we aim to accomplish in the upcoming year.  2019 was a busy year for Wisconsin emergency physicians. 

    Top of my mind is that we lost a friend and colleague in Eric Jensen who passed away after a courageous battle with cancer.  His enthusiasm and passion to leverage his skill and talent to improve the lives of others was self-evident in the work and guidance he provided our organization and will not be forgotten.

    Legislatively there were a multitude of issues we worked on to ensure patients had access to the great care all of you deliver while advocating for fair remuneration for our work while ensuring patients continue to receive high quality and safe care.  Most recently the call went out to contact your representatives about an out of network balance billing (insurance network inadequacy) legislation that would have been attached to the year end funding package.  This legislation was incomplete and unfavorable.  As of this writing it appears your engagement and advocacy was able to help us and others concerned about the impact of this language on patients put a hold on this so that all stakeholder have a chance to be heard and all implications understood.  Thank you to all of you who took the time to contact your legislators in Washington as your efforts were not in vain.

    We continue to be engaged in proposed legislation that looks to address the mental health crisis that burdens our emergency departments and inhibits out ability to provide the care we think Wisconsin citizens deserve in our emergency departments.  We also continue to closely follow the CARES Act and have not slowed our focus on drawing attention and action to Medicaid reimbursement rates for emergency physicians as Wisconsin continues to maintain the record of worst in the United States.

    We look forward to another exciting Doctor Day where your voice can be heard at the State Capitol in Madison. WACEP will be having a policy primer the evening prior, Tuesday,  January 28, which I promise will be informative and a great way to meet other emergency physicians passionate about our specialty. The main event will take place on Wednesday, January 29 before. For more information and to register, visit www.WIDoctorDay.org/schedule.

    This spring will bring another WACEP Spring Symposium to be held in Madison.  The committee has secured top talent in emergency medicine to come speak, and I encourage you to drop by the research forum to see how impressive our EM residents in the state are as they look to advance emergency care.  You can learn more or register by visiting www.WisconsinACEP.org/WACEP2020.

    As my time as WACEP president is drawing to a close I look forward confidently knowing that committed emergency physicians will continue to step forward to meet the challenges we face as a specialty and promote the interests of the patients whose lives we have the privilege of being part of.  Dr. Ryan Thompson, the incoming WACEP president, is a strong leader and certain to advance our organization.

    In closing I can’t express how thankful I am for a WACEP board of intrinsically motivated and engaged colleagues and friends. Kudos to Badger Bay and Sally Winkelman for their commitment and leadership to our organization, and to all of you, the emergency medicine providers in our state who every hour of every day are there for anyone who needs our help without caveat or exclusion.  Thank you for everything you do.

    ~Jeff 

  • December 16, 2019 9:03 AM | Sally Winkelman (Administrator)

    December 12, Wisconsin Health News

    An Assembly committee plans to vote next week on a bill that would make it clear that law enforcement agencies can contract with others to transport those in mental health crisis for emergency detention.

    The plan also directs the Department of Health Services to pursue federal approval to reimburse transport for Medicaid recipients.

    Rep. Mark Born, R-Beaver Dam, said some agencies already contract for emergency detention transports. But the majority don’t because their attorneys feel that state law may not allow it.

    “We want to make it clear that this is an option for local governments to work with third-party vendors, ambulance services or other law enforcement agencies to help in this process,” Born told members of the Assembly Committee on Mental Health Tuesday.

    Law enforcement testified in support of the plan. Dodge County Sheriff Dale Schmidt said transferring those in crisis is time-consuming.

    “We have an epidemic in the state of Wisconsin with emergency detentions,” Schmidt said. “My opinion, and I think the opinion of many law enforcement executives is that emergency detentions by far take up the most time of any incident that we deal with on a daily basis.”

    Schmidt said he’s waiting for the passage of the bill before contracting for emergency detention transports.

    Disability Rights Wisconsin Milwaukee Officer Director Barbara Beckert wrote in testimony submitted to the committee that they respect the intent of the bill.

    But the plan doesn’t provide criteria for providers like requirements that they are trained on safety, mental illness, trauma and other topics.

    “Currently the law enforcement personal who provide transport are public employees and as such have greater accountability,” Beckert wrote. “It is unclear how accountability would be addressed for third-party contractors. Use of a third party potentially leaves the door open to abuse.”

    Born said it’s the responsibility of law enforcement agencies to vet their contract providers and to have solid contracts.

    The committee is scheduled to vote on the measure next Tuesday. 

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