The Wisconsin Chapter ACEP joined a coalition of medical societies in Wisconsin that created an open letter to the people of Wisconsin on the importance of wearing masks and social distancing to help curb further spread of COVID-19.  Read letter.

The Wisconsin Department of Health Services (DHS) invites you to attend a Medicaid Telehealth Expansion interactive webinar.

Agenda

This webinar will seek your response to DHS’s proposed launch of Wisconsin Act 56: Telehealth Expansion, which will significantly expand Wisconsin Medicaid’s permanent telehealth policy. The presentation will include the following items:

• General overview of telehealth expansion
• General policy information
• Wave 1 priority acute and primary service areas:
• Proposed services included in telehealth
• Proposed services excluded from telehealth
• Input from attendees

Following the presentation, DHS will take questions from attendees via the DHS telehealth mailbox.

How to join

Thursday, July 30, 10:30 am – 12:00 pm

• Click this URL to join; Password: 07302020
• Join by phone: 646-558-8656; Webinar ID #933 1403 1869

Friday, July 31, 2:00-3:30 pm

• Click this URL to join; Password: 07312020.
• Join by phone: 646-558-8656; Webinar ID #999 9957 0817

Hubbard Wilson Zelenkova LLC, WACEP Lobbyists

Legislative News

The legislative floor session was cut short by the onset of the Covid-19 public health emergency.   While the Assembly completed its action on regular session legislation in February, the Senate intended to finish up on March 25th.   That of course did not happen.   The Senate has kept the door open to returning to finish action on bills it planned to concur on from the Assembly.  Under normal circumstances, any bills that had failed to pass by now would be dead for the session.  Under these unusual circumstances, however, the Senate may still come back to act.   Bills that could still receive action include: 

• AB 526:  CME requirement for suicide prevention.  Passed assembly with bipartisan opposition.  Likely would not be taken up by the Senate if they return.  
• AB 575:  Physician Assistants’ “Cares Act”.   Passed assembly on voice vote after significant amendments.
• Of note, AB 664, that created and funds a school based mental health consultation pilot program passed both houses and was signed into law as WI Act 117 in early March.  

Both houses of the legislature did return to pass legislation related to the public health emergency.   The covid-response legislation, most notably, included changes necessary for the state to accept increased FMAP funding under MA and gave DHS the ability to take actions during the Emergency Declaration that would otherwise require at least passive review under normal circumstances.   The legislation also included “balance billing” provisions that were a step in the right direction but fell short of what WACEP would support in permanent legislation.  Those concerns were outlined in a letter to the legislature.  It is encouraging, however, that the legislature is recognizing the issue and gives hope that a bill that WACEP can support will have traction next legislative session. 

Significantly, HWZ worked with WACEP, the Wisconsin Medical Society and other physician groups to include immunity to civil liability for claims that arise as a result of treatment decisions made in response to the emergency.   WACEP’s proaction on this issue was a huge boost to the effort.  We made it a priority for WMS, and obtained bipartisan support from key legislators prior to the session.  The application of this provision however recently ran out as its duration applied for only 60 days after the Governor’s emergency declaration expired on May 11.  

During the Governor’s 60 day Emergency Declaration, numerous emergency orders were issued.  Many EO provisions were related to healthcare, particularly availability and staffing for emergency response including delaying license renewals, easing temporary licensure guidelines, and the like.  Other provisions increased access and expanded services like telehealth applications and MA benefits.  Most provisions related to the Emergency Orders and covid-response legislation have now expired unless otherwise extended by administrative rule. 

Efforts are underway to continue some of the covid-related regulatory flexibilities related to telehealth, licensure and liability.

There has been much speculation as to whether or not the Legislature will convene a special or extraordinary legislative session prior to the beginning of the 2021-2022 legislative session in January.  As mentioned, in the Senate there was unfinished work to do on regular business legislation.   But more importantly, depending on where state revenues stand as a result of the pandemic, it is possible that a Budget Repair bill may be necessary.   State law requires that should state revenue estimates, on which the biennial budget was based, dip below .5% of funds necessary to maintain a balanced budget then corrective legislation is necessary.  However, even if budget action is triggered, it is our assessment that it is very unlikely the legislature would address a budget shortfall before the November election.   Instead, if necessary, it would be more likely that a budget shortfall would be addressed when the new legislature convenes in January 2021.

On behalf of WACEP, we continue to lobby the Governor and DHS for federal CARES Act Funding for Emergency Physician Practice Groups.   WACEP has written the Governor and DHS multiple letters and we have had numerous contacts with top staff requesting CARES funding to be specifically allocated to assist our private practice groups.  These efforts are ongoing.  In addition, we continue to advocate with DHS, the Governor’s office, and the Legislature in support of increased MA rates for emergency codes.   As agencies begin putting their biennial budget requests together, these efforts are continuous.  

2020 Elections

Despite limitations on collecting signatures, candidate nomination papers were due on June 1st and we are now in the full swing of election season.  While some incumbents will get a free ride, most legislative seats will have contested races.   Several legislative retirements have left vacancies in the legislature and a dash for open seats.   Here is a list of sitting legislators who are either retiring or running for other elected office:

Retiring Senators:   

• Sen. Luther Olsen (R- Ripon)
• Sen. Dave Craig, (R-Big Bend)
• Rep. Fred Risser (D-Madison)
• Sen. Mark Miller (D-Monona), 
• Sen. Dave Hansen (D-Green Bay) 
• Sen. Jen Shilling (D-La Crosse) (vacated senate seat on May 15)

Retiring Senators running (or successfully ran) for higher office: 

• Sen. Tom Tiffany (R- Hazelhurst) (Won 7th CD special election)
• Sen. Scott Fitzgerald (R-Juneau) (Running for 5th CD)

Retiring Representatives:   

• Rep. Chris Taylor (D-Madison) (Appointed Dane County Circuit Judge effective August 1)
• Rep. Deb Kolste (D-Janesville)
• Rep. Jason Fields (D-Milwaukee)
• Rep. Mike Rohrkaste (R-Neenah)
• Rep. Bob Kulp (R- Stratford)
• Rep. Romaine Quinn (R-Barron)

Retiring from Assembly and running (or successfully ran) for higher office:   

• Rep. Joan Ballweg (R- Markesan) (Running for 14th SD)
• Rep. Mary Felzkowski (R-Irma) (Running for 12th SD) 
• Rep. David Crowley (D-Milwaukee) (new Milwaukee County Executive)
• Rep. Amanda Stuck (D-Appleton) (Running for 8th CD)
• Rep. Rob Stafsholt (R-New Richmond) (Running for 10th SD)
• Rep. Jocasta Zamarripa (D-Milwaukee) (new Milwaukee city council member)
• Rep. Melissa Sargent (D-Madison) (Running for 16th SD)

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

Medicine has a history of at best ignoring, and at worst shaming, physicians who struggle with mental health. It is long past time for that to change. Today’s EM physicians face unprecedented challenges and ever-mounting pressures. In addition to managing the increasing risk of contracting COVID at work, the physical demands of wearing PPE all day, and dealing with increasingly complex and seriously ill patients, many EM physicians across the state are seeing cuts in pay or slashed hours, adding financial pressures to the mix. 

While there has always been an element of thrill-seeking and relishing in the stress of a busy ED, we must recognize the toll the job takes on each of us. It is time to end the stigma associated with seeking therapy or counseling, and recognize it for what it is—self-care. Just as a physician who is ill cannot take the best possible care of their patients, neither can one struggling under a mountain of stress. We owe it to our patients to be at the top of our game when caring for them, and that means seeking out mental health care when it’s needed.

 Many physicians fear being labeled as “problematic” or “less-than” if they seek care. If you are a medical director, make sure that your physicians are not being asked to report on seeking counseling, as this can be a huge deterrent for physicians to get the care they need. Both ACEP and WACEP are against physicians being forced to report their mental health care.

If you feel like you could benefit from counseling, ACEP offers free, confidential sessions via phone, text, or chat.  If you are in southeastern Wisconsin, the BRaVe (Building Resilience Virtually) Clinic also offers free and confidential remote counseling (braveclinic@mcw.edu).

WACEP offers its congratulations to Wisconsin’s 2020 Emergency Medicine residency graduates.

The University of Wisconsin Emergency Medicine Residency Program Grads:

• Dr. Josh Buehler will be joining Eugene Emergency Physicians in Eugene, OR
• Dr. Eric Collins will be joining Mayo Clinic Eau Claire Hospital in Eau Claire
• Dr. Emily Fleming will be completing an EMS Fellowship in Madison
• Dr. Alok Harwani will be completing an Administration Fellowship in Madison
• Dr. Rosalia Holzman is heading to The Ohio State University Nationwide Children's Hospital in Columbus, OH
• Dr. Corlin Jewell will be completing an Education Fellowship in Madison
• Dr. Ilan Kolkowitz will be completing a Global Health Fellowship in Madison
• Dr. Michelle Lum will be completing an Ultrasound Fellowship in Madison
• Dr. Erik Morrow will be joining Mayo Clinic Eau Claire Hospital in Eau Claire
• Dr. Eric Ohlrogge will be completing a Medflight Fellowship in Madison
• Dr. Dan Ritter will be going to Mercy Health in Iowa City/Cedar Rapids, IA
• Dr. Katie Ulrich will be going to Dignity Health in Chandler & Gilbert, Phoenix, AZ

The Medical College of Wisconsin Emergency Medicine Residency Program Grads:

• Dr. Sean Mackman will be joining Emergency Medicine Specialists.
• Dr. Adam Haggerty will be joining Gundersen Health System.
• Dr. Justine Wergin will be joining Emergency Medicine Specialists.
• Dr. Marielle Brenner will be completing a toxicology fellowship at IU Health in Indiana.
• Dr. Rachel Nordstrom will be practicing at the Medical College of Wisconsin.
• Dr. Cody Bonk will be completing an ultrasound fellowship at Nebraska Medical Center.
• Dr. Reece Cooper will be joining Appleton Emergency Services SC, Thedacare Regional Medical Center in Appleton
• Dr. Sarah Kessenich will be practicing at the Medical College of Wisconsin.
• Dr. Daniel Kopatich will be doing Locum Tenens.

The U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR), in collaboration with the National Ebola and Special Pathogens Training and Education Centers (NETEC), and Project ECHO, launched a series of COVID-19 Clinical Rounds on March 24th.

This initiative supports a series of three weekly teleECHO programs – 1) Critical Care: Lifesaving Treatment and Clinical Operations; 2) Emergency Department: Patient Care and Clinical Operations; and 3) EMS: Patient Care and Operations.

The aim is to create peer-to-peer learning networks where clinicians who have more experience treating patients with COVID-19 share their challenges and successes with clinicians across the U.S. and around the world with a wide variety of experience treating COVID-19. Each Clinical Rounds session includes brief presentations from experienced expert clinicians; the presentations have included representatives from Bellevue Hospital in New York City, Emory University, University of Minnesota, University of Washington, and Nebraska Medicine, among others. Representatives from more than 15 relevant national professional organizations round out the panel of expert discussants.

The majority of each session is spent in discussion related to Q&A generated by the participants. As of mid-April more than 7500 people from all 50 states and more than 30 countries have participated in the sessions.

To receive announcements on this program join our list serve here: http://eepurl.com/gXrm1z

BRaVe Clinic—Building Resilience Virtually—is a new program that offers free counseling to healthcare workers in Southeast Wisconsin. The program was developed by Stephen Hargarten, MD, MPH, professor of emergency medicine and associate dean for global health at the Medical College of Wisconsin,

The clinic is grant-funded and offers free services to healthcare workers by appointment. The program is intended to assist first responders, EMS and emergency department personnel with behavioral health challenges they face while responding to the demands of COVID and other health issues in their communities.

WACEP members are encouraged to disseminate this program flyer widely, and members who qualify are encouraged to utilize the program’s services.

ACEP is collaborating with the American Association of Emergency Psychiatry on some new resources related to physician wellness and mental health during COVID-19. 

 On June 11, ACEP hosted "Who's got your back? Psychological Awareness & Team Support," a free webinar about the value of peer support and how you can help your colleagues - and yourself. Panelists include Jack Rozel, MD, MSL, president of the American Association for Emergency Psychiatry, Victor Stiebel, MD, who is board certified in emergency medicine, psychiatry, forensic psychiatry, and psychosomatic medicine, and Anthony Ng, MD, DFAPA, chair-elect of the Coalition on Psychiatric Emergencies. 

The webinar is now available in the eCME library (worth 1 AMA PRA Category 1 Credits™). 

ACEP is committed to eliminating obstacles to EM physicians seeking mental health care. By anonymously sharing your story, you can help inform and further ACEP’s advocacy efforts to remove the existing barriers to seeking treatment, including fears surrounding licensure and credentialing, and better encourage professional support and non-clinical mental health initiatives, such as peer support. 

Share your experience.

June 18, Wisconsin Health News

The state’s medical malpractice fund is waiving premiums for the next fiscal year for participating healthcare professionals and providers. 

The Injured Patients and Families Compensation Fund’s Board of Governors approved the premium holiday on Wednesday. The holiday, originally requested by the Wisconsin Medical Society, will run from July 1 to June 30, 2021. 

Dr. Bud Chumbley, CEO of the Wisconsin Medical Society and a board member, said the action will “provide some financial relief to many of the Wisconsin medical professionals and providers who have been affected by the pandemic and who face ongoing challenges.”

The fund covers claims beyond state-mandated insurance limits, which are set at $1 million by occurrence and $3 million by aggregate per year.  In April, lawmakers signed off on a plan not to increase participation fees for the fund for the next fiscal year.