New officers were recently elected by the Wisconsin Medical Examining Board (MEB). Tim Westlake, MD, an emergency physician, with ProHealth Care, was elected as Chair, Sheldon Wasserman, MD, FACOG, was elected Vice Chair and Alaa Abd-Elsayed, MD, was elected Secretary. 

Among discussion at the recent MEB meeting were the ramifications of the May 11 expiration of the Governor's Executive Order #72 and the impact on temporary licenses for physicians working across state lines to help with the COVID-19 pandemic response. 

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

Across the state, ED patient volumes remain significantly decreased, with some EDs seeing half or even a third of their usual volumes. While the initial decrease in volume was seen as something of a relief for some – who doesn’t love an easier overnight? – the persistent downturn has led to mounting concerns.

The first concern is, of course, for our patients. In the early days of the COVID outbreak, I was routinely having patients apologize to me for being in the ED for non-COVID related problems, even when they clearly needed to be seen for emergency care. They were worried that they were pulling me away from other people who might need my care, or that they would be “wasting” healthcare resources. While this concern for their neighbors is admirable, it is clearly ill-advised in the case of severe symptoms requiring ED evaluation, such as chest pain or abdominal pain.

Another cohort of patients avoiding the ED were people who were simply afraid that they would be exposed to COVID while in the hospital. I saw more than a few patients walk into the ED, look around at the isolation procedures in the waiting room and staff in their masks and face shields, and turn right around and walk back out. While this might seem like a reasonable fear, the fact is that we deal with highly infectious diseases in the ED all the time and are experts at preventing cross-contamination of patients.

This decrease in patients seeking ED care is doubly concerning when you consider the lack of outpatient care available right now. These patients aren’t seeking alternative care – they aren’t seeking care at all. This has led to a rash of delayed presentations and worse outcomes. Anecdotally, I’ve seen more ruptured appendices and perforated ulcers in the last 2 months than I normally would in a year.

Another major concern caused by low volumes is a significant drop-off in revenue for some groups. Small groups and rural hospitals run on thin margins as it is, and a sustained drop in volume could lead to corporate takeovers and hospital closings. While some government aid is available, it’s nowhere near enough to cover the losses. Compounding the problem is the significant amount of planning and sweat equity that went into preparing our EDs for COVID, often completely unfunded. Even for hospital employees and those employed by large groups, EPs across the state are seeing pay cuts and hours cut – an unneeded additional stressor in these already stressful times.

In order to try to reassure patients that Wisconsin’s EDs and hospitals are safe and have more than enough bandwidth to care for both COVID and non-COVID patients alike, WACEP has partnered with the Wisconsin Hospital Association. A new PSA will be hitting the airwaves soon across Wisconsin, reminding people that Wisconsin EDs are safe, well-equipped, and ready to care for them when they need us.

ACEP and EMRA have announced winners and honorable mentions of the 2020 National Outstanding Medical Student Award program. This year’s honorees include Jennifer Mirrielees from the University of Wisconsin School of Medicine and Public Health, who received an honorable mention.

As shared in her nomination, Jennifer’s strong commitment to service toward not only underserved patient communities, but to her peers, and her strong leadership in clinical and administrative capacities, embodies the heart of this award. In support of her candidacy, faculty commented on her strong work ethic, clinical efficiency, and her ability to form strong therapeutic bonds with her patients. “Overall, Jennifer is a superbly accomplished student. This is easy to measure when looking at her care for those in great need, her desire to lead and care for her peers, and her translation of this passion into the clinical environment in the ED.”

The Award annually recognizes up to five fourth year EM-bound medical students who excel in humanism, professionalism, leadership/service, research, and academic excellence. Award winners will be recognized at the EMRA Medical Student Forum in October and honorable mentions will be mailed a commemorative plaque.

Paul Benz, MD
Medical College of Wisconsin Emergency Medicine Residency
Class of 2022

On April 28, 2020 I had the opportunity to join fellow WACEP Board Members Drs. Lisa Maurer, Brad Burmeister, Aurora Lybeck, Bill Falco and Stephanie Wagner and other Emergency providers from across the state for ACEP’s first Virtual Hill Day. Due to the COVID-19 pandemic, these meetings were held virtually. We participated in conference calls with the staff of Wisconsin Senators Tammy Baldwin and Ron Johnson as well as those from all eight Wisconsin Representatives, many including the Congress members themselves.

Though the meetings were held virtually, it was a great learning experience, and I was happy to help advocate for our specialty. Now more than ever Emergency Medicine providers as well as all personnel working in Emergency Departments across the country must have our perspectives understood as we truly are the frontline providers of the COVID-19 pandemic. I believe that we were able to successfully highlight the importance of that message to our Congress members on Virtual Hill Day.

During each meeting we discussed four topics agreed upon as the most pertinent by ACEP leaders nationwide given the current climate in Emergency Medicine. These included personal protective equipment (PPE), liability, hazard pay, and patient coverage. We stressed the importance of our rights for appropriate and adequate PPE including N-95 masks. Across the board, the Congress members and their staff acknowledged the magnitude of this issue and offered to continue supporting us on this effort. We discussed how the COVID-19 pandemic has altered the practice of Emergency Medicine in terms of provider liability, and that many providers are forced to make economic sacrifices that should be compensated with hazard pay. We also asked the Congress members to advocate for extending healthcare coverage beyond COVID-19 tests and testing related services to encompass additional care that COVID-19 positive or suspected positive patients receive.

Overall, we were encouraged by the discussions that took place and are optimistic for the future. While there is still more work to be done and we are all adapting to living and working during the COVID-19 pandemic, Virtual Hill Day was successful in its goal to advocate for the well-being of Wisconsin Emergency Medicine providers.

The Wisconsin Chapter of the American College of Emergency Physicians and the Wisconsin Hospital Association have partnered to spread the message that hospital emergency rooms and urgent care clinics remain safe, clean and ready to help give patients the care they need. We believe it is important to remind the public that hospitals are hard-wired to provide a safe environment and prevent infection spread.  Along with a press release, two versions of an audio Public Service Announcement have been distributed:

• 30 second PSA: https://youtu.be/vdMQgW9VEzw 
• 15 second PSA: https://youtu.be/pJA-4-TEhIU

The Joint Commission released a statement that supports "the removal of any barriers that inhibit clinicians and health care staff from accessing mental health care services, including eliminating policies that reinforce stigma and fear about the professional consequences of seeking mental health treatment."  View statement.

In the podcast, Taking Care of Yourself: Mental Health in the Time of COVID-19,  Dr. Ryan Stanton talks with Dr. Jack Rozel, Medical Director at Resolve Crisis Services and President of the American Association of Emergency Psychiatry.

May 4, Wisconsin Health News

Gov. Tony Evers announced a plan Monday to make Wisconsin one of the top states for COVID-19 testing per capita. 

Evers said the state is prepared to provide 85,000 tests per week.  

“We want every Wisconsin resident who needs a test to get a test,” Department of Health Services Secretary-designee Andrea Palm told reporters. 

As of Monday, the state has already provided more than 60,000 tests to hospitals, clinics, local public health departments, long-term care facilities and others.

Fifty-seven of the state’s counties have requested and are getting supplies. 

Other key components of the plan, according to a statement from the governor’s office, are: 

• Providing free testing and diagnostics to Wisconsin’s 373 nursing homes to test all nursing home residents and staff. The goal is to test more than 10,000 residents and staff per week during the month of May. 
• Working with the Wisconsin National Guard and local health groups to test all workers and families linked to outbreaks. 
• Increasing the number of free drive-thru community testing sites throughout the state.
• Mobilizing 15 more National Guard units to help local health departments set up testing sites and respond to outbreaks. That would bring the total number of National Guard units working on testing to 25. 
• Providing free tests for state-sponsored test sites for those experiencing COVID-19 symptoms. No doctors’ visits will be required at sites sponsored by the National Guard.  
• Providing test supplies to all Wisconsin healthcare systems. As of Monday, the state has provided 41,255 tests to healthcare systems. 

April 30, Medigram, Wisconsin Medical Society

Settlers Bank is a Wisconsin business focused on serving the needs of physicians and clinics throughout the state. In order to best serve those needs during this time, they will assist physicians and clinics with questions regarding the SBA/PPP loan application process – even if they are not a current client.

To use Settlers Bank for the SBA/PPP loan application process, a physician or clinic is simply required to open an operating account and have a conversation about their overall banking needs. Settlers Bank also works closely with the clinic’s CPA to help determine the qualified loan amount as well as financial modeling.

Settlers Bank offers a one-call approach to the medical community, because they understand that now more than ever time is of the essence. 

Anne Fink, CFP® is a private banker specializing in working with physicians. Contact Anne at afink@settlerswi.com or 608.842.5025. To learn more about Settlers Bank click here.

Settlers Bank is MEMBER FDIC

April 23, Wisconsin Health News

Wisconsin emergency rooms are seeing a decline in visits since the start of the COVID-19 pandemic, which providers attribute to a drop in injuries and respiratory illnesses due to social distancing, a boost in telehealth and fear of potential exposure to the new coronavirus. 

“It’s a little amazing - what used to be an emergency or an urgent care visit isn’t there anymore,” Froedtert Health CEO Cathy Jacobson said during a Wisconsin Health News webinar last week. “It’s just not coming in.” 

Health systems throughout the state say they’ve seen emergency department visits drop by around half during the pandemic. And the patients that emergency rooms are seeing tend to be sicker and more likely to need hospital care.

Providers stress that they've taken measures to protect patients from possible COVID-19 infection. 

Dr. Joshua Ross, executive vice chair of the BerbeeWalsh Department of Emergency Medicine at the University of Wisconsin School of Medicine and Public Health, said nationally emergency room visits are down around 50 percent. UW Health isn’t different. 

Ross said they’ve spent a lot of time in preparation to make sure that emergency rooms can separate those with COVID-19 symptoms from those who don’t, as well as cleaning rooms and having appropriate personal protective equipment. He said the fact that visits are lower is good for preparation purposes.

“But it’s also somewhat concerning because we know that there’s probably people out there with small heart attacks and strokes that aren’t seeking care," he said.

Ross noted that volumes may be down because there aren’t influenza and other seasonal infections due to social distancing measures. They’re also not seeing traffic accidents or sports-related injuries. 

He said they’re concerned about people not seeking care, adding that there are risks at home, including concerns around mental health and domestic violence.

“We still have to be vigilant in terms of making sure our healthcare infrastructure and support systems are in place,” he said.  

Ashley Lyman, Bellin Hospital's emergency department team leader, said visits are about half of their pre-pandemic normal, and hospital admission rates are up 5 to 10 percent. Part of that has to do with staying home, which is lowering the spread of contagious diseases. 

Other factors could be expanded telehealth services that help triage patients to the appropriate level of care, patients being afraid to come to the department during the epidemic and suspension of elective care, which means fewer people coming in due to complications. 

No school and limited daycare options could also be playing a role, as children with fevers aren’t able to go back to school or daycare the next day, she noted. 

Dr. Michael Dolan, executive vice president at Gundersen Health System, said their emergency room volumes are down about 45 percent.

He said they opened a respiratory clinic for people under investigation for COVID-19 where they’re sending patients who might otherwise head to an emergency room. 

Dolan noted that their trauma cases are similar to what they normally see, while other hospitals have seen a decline due to fewer road accidents.

“I think we’re making up for that in non-motor vehicle accident trauma,” he said. “We’re a rural area. Farmers are really trying to get out in the fields and get started with their crops. We see some farming-related trauma, some ATV-related trauma, things people can get into trouble with at home.” 

Dolan said they also haven’t seen a decline in heart attacks as well as stroke numbers. But they’re seeing fewer patients with mild heart failure or mild infectious disease. 

During the last six months, the emergency department at Children’s Wisconsin has seen a 60 percent decrease in the number of kids they’d expect this time of year. Spokesman Andy Brodzeller said part of that is expected, due to closed playgrounds and families driving less. 

He added that families may be choosing other options, like online urgent care or reaching out to a primary care doctor.

Dr. Brian Hoerneman, Marshfield Medical Center-Marshfield vice president of medical affairs, said part of their 40 percent drop in emergency department use could be a decline in illness due to social distancing.

But he said that some of it appears to be people not seeking care when they need it. 

“In conditions such as heart attacks and strokes, the window for treatment is narrow,” he said in an email. “Time is of the essence and outcomes worsen for every hour that treatment is delayed."

Hoerneman stressed that the emergency department is safe for patients, and that telehealth is available to help people assess their medical situation. 

Aspirus Wausau Hospital Emergency Department Director Robin Rudie echoed concerns that the decrease they're seeing in visits and the increase in severity could be due to fear of exposure of the virus.

“We wouldn’t typically expect the pandemic to reduce our overall volumes,” she said in remarks to the media.

Health systems stressed that emergency rooms are safe. LeeAnn Betz, a spokeswoman for Advocate Aurora Health, said that they’re taking all precautions to protect their health and safety, including separating COVID-19 patients from those with other symptoms or injuries. 

“Staying home, ignoring the symptoms and suffering out of fear of COVID-19 is a risk people shouldn’t take with their health” Dr. Gregory Brusko, Ascension Wisconsin Chief Clinical Officer, said in a statement.