Dear Fellow Emergency Clinicians,

During this unprecedented time, the Well-Being Committee and Wellness Section, both want to express our appreciation to all who accepted the call to serve in the field of Emergency Medicine. You are not alone in this. Your passion and dedication to provide care for those in need is noticed and recognized, even more today during this critical time.

We are proud to be your colleagues and stand firm in knowing that you are doing the very best to provide care during these difficult times. Though we are overworked, tired, and stretched thin, we continually answer the call to care for our individual communities during the time they need us most. Selflessly, we put ourselves on the front lines; running towards the problems and work tirelessly to find the solutions that allow us to provide the needed care.

As we work through this pandemic, we want to echo that we hope everyone is able to be safe. In trying times such as these, we as Emergency Clinicians, tend to take care of ourselves last. However, the leadership teams are standing with you to ensure that your wellness is not sacrificed.

In this setting, we recognize the need to provide you with resources to assist you during this time of need. In response, work behind the scenes continues to support the provision of care to patients and their communities, while protecting your work environment, health, and well-being.

ACEP is working closely with Federal Government regulators as an advocate for our profession. In doing so, interstate licensing barriers have been changed, protection of liability measures are being developed, and Dr. Bill Jaquis, ACEP President, has met with the White House Administration advocating for PPE and more testing. A new website has been developed to host all clinical resources for our colleagues. In addition, ACEP has many resources to assist you through difficulties.

ACEP Wellness & Assistance Program

The ACEP Wellness & Assistance Program offers ACEP members exclusive access to THREE (3) FREE CONFIDENTIAL COUNSELING OR WELLNESS SESSIONS in partnership with Mines & Associates. The one-on-one sessions are available 24/7 by phone, text or online messaging. 

Counseling sessions can cover everyday issues including stress, anxiety, depression, family issues, drug and alcohol abuse, relationships, death and grief, and more. Wellness coaching sessions are 30-minute phone calls to help you reach your personal wellness goals. NBME board-certified wellness coaches can help you set specific wellness goals and plan for progress checks along the way to help you reach your objectives. This new program is strictly confidential and is free with your ACEP membership.  

• ACEP members, please log in to learn more about the program
• To learn more about membership, read about ACEP's membership eligibility
• Access ACEP's additional physician wellness resources

ACEP ‘Let’s Talk’ Community on EngagED

This online community was specifically designed to create a safe space where peers can discuss ongoing challenges within their roles, ED’s, and life in general. Here, everyone has a voice and a platform where they can reach out to fellow colleagues for advice and encouragement pertaining to the internal and external factors that affect the balance of our wellness.

If you are interested in having a conversation, all you need to do is click here to sign up. 

Our parting thought to you is simple: Even though we are in a crisis, we can still provide compassion and respect for every person who crosses our path.

ACEP Well-Being Committee

• Arlene Chung, MD, FACEP, Chair
• Rita A. Manfredi MD, FACEP
• Alison Haddock, MD, FACEP

ACEP Wellness Section

• Randall Levin, MD, FACEP, Chair
• Randy Sorge, MD, FACEP
• Pamela Ross, MD, FACEP
• Susan Haney, MD, FACEP
• Angelica McPartlin, MD, FACEP
• Kristen Nordenholz, MD
• Matthew Wong, MD, FACEP
• Michelle Caskey, MD

In response to the COVID-19 outbreak, ForwardHealth is temporarily changing certain policy requirements for services delivered through telehealth.

Beginning March 12, 2020, these altered policy requirements will be in effect during, and only during, the public health emergency declared by the State of Wisconsin in Executive Order 72.

Download the ForwardHealth UPDATE for full details.

March 25, Wisconsin Health News

More health systems and other labs in Wisconsin are coming on line with in-house COVID-19 testing.

Advocate Aurora Health said that as of Monday, ACL Laboratories, part of the health system, will be able to process COVID-19 tests for emergency department patients authorized for inpatient admission, those being treated in hospitals and team members.

They expect to be able to process at least 400 tests a day and provide results back in fewer than 24 hours for the affected populations.

Gundersen Health System said it’s developed a test to detect COVID-19, allowing the health system to process the results in house. That will reduce the amount of wait time for results, according to a statement from the health system. 

The University of Wisconsin-La Crosse provided the health system with enough supplies for thousands of tests. 

The Wisconsin State Lab of Hygiene, Milwaukee Health Department and national labs - including LabCorp and Quest - are also running tests in the state. 

In addition, Children’s Wisconsin and Froedtert Health have confirmed in-house testing for their patients. Mayo Clinic Health System has been sending its specimens to Mayo Clinic in Rochester, Minn.

“We are seeing more of our healthcare partners and critical labs like UW, Froedtert, Children’s Hospital in Milwaukee, others coming on line with testing capacity,” Department of Health Services Secretary-designee Andrea Palm said Monday. 

A UW Health spokesperson did not confirm by the newsletter's deadline when or if it would start processing tests. Dr. Nasia Safdar, medical director of infection control and prevention at UW Health, said last week that setting up in-house processing was a "high priority" but couldn't say when when it would happen.

Dr. Patricia Golden, primary care medical director of Ascension Medical Group Wisconsin, said that they're sending specimens from their mobile testing sites to Quest and LabCorp.

"We hope to have in-house labs able to process our own tests soon," she said in a statement. "This additional testing capacity will allow COVID-19 testing for a wider group of patients." 

Dr. Susan Turney, Marshfield Clinic Health System CEO, said last week that they hope to have the ability to process COVID-19 tests soon.

Gov. Tony Evers told reporters on Monday that Exact Sciences is looking to help boost testing capacity.

Scott Larrivee, Exact Sciences spokesman, said the cancer diagnostics company is collaborating with Evers, DHS and the Wisconsin National Guard to determine how their Madison-based labs could help process COVID-19 tests and support the state’s response. 

“We look forward to being a part of shared solutions," Larrivee said in a statement.

Having trouble obtaining CME credits for licensure due to the COVID-19 pandemic?

The Wisconsin Department of Safety and Professional Services has confirmed that persuant to Wis. Stat. § 440.08 (2), the required renewal date for the Physician credential is October 31 in the odd numbered years. 

Therefore, no extension or suspension of licensing and registration renewal requirements, including CME requirements, is necessary at this time.  

Governor Evers has issued Emergency Order #12 to institute a Safer At Home policy. The order is effective at 8:00 am on Wednesday, March 25, 2020 and remain in effect until 8:00 am Friday, April 24, 2020, or until a superseding order is issued.

Wisconsin residents must comply with this order. As outlined in the order, individuals can leave their home to perform tasks essential to maintain health and safety, get services and supplies necessary for staying home, and care for others.

After reviewing the order, if a business believes their business is doing essential work and they are not exempted in this order please go to this link https://wedc.org/essentialbusiness/.

These are important steps to ensure we working to slow the spread of COVID-19. 

Essential services, such as healthcare and public health operations, will continue to be provided to the communities across Wisconsin.

March 23, 2020

Governor Evers announced today that he be issuing a “Safer at Home” order effective Tuesday, March 24.  Organizations and individuals providing essential care and services will be allowed to continue travelling to and from work.  This includes healthcare professionals, grocers and family caregivers.  The full details of the order to be announced by the Governor’s office.  Everyone else is asked to not take any unnecessary trips, and to limit travel to essential needs such as getting medications and groceries.

This order is based on the advice and counsel of public health experts, healthcare providers and first responders on the front line of our state’s response to the pandemic.  These unprecedented measures are necessary to reduce rate of spread in COVID-19 cases.  We must do everything we can to keep our healthcare systems from becoming overwhelmed and protect both the public and essential healthcare workers who are taking care of the critically ill.

At the direction of Gov. Tony Evers, Wisconsin Emergency Management (WEM) is asking the Federal Emergency Management Agency (FEMA) to assist the state in obtaining protective medical supplies that can be used by law enforcement officers and firefighters who are at risk of direct exposure to COVID-19 while performing their jobs.

“We are asking FEMA to help us purchase valuable medical supplies that will be used to protect our first responders as they do the important work of keeping Wisconsin safe,” said Gov. Evers. “It is our hope that the federal government can identify a source for these supplies as quickly as possible.”

FEMA is being asked to help Wisconsin obtain 50,000 non-surgical masks, 10,000 face shields, 11,000 coveralls, 3,000 N95 face masks, and 35,000 pairs of protective gloves through its procurement process.

“We recognize that this equipment is in high demand, and we thank our first responders for their patience as we work to identify additional sources of personal protective equipment,” said Dr. Darrell L. Williams, WEM administrator. “This initial request is intended to help meet the immediate needs of agencies across the state that continue to perform their daily duties, knowing they are at risk of being exposed to the virus.”

The request comes in addition to the state’s ongoing efforts to obtain personal protective equipment (PPE) from the Strategic National Stockpile (SNS). So far, the state has received about 52,000 N95 face masks, 130,000 surgical masks, 25,000 face shields, 20,000 surgical gowns, 100 coveralls, and 36,000 pairs of gloves from the SNS. Those materials are being distributed to direct healthcare providers in areas with known community spread. The governor is calling on federal officials to help identify additional resources.

The Department of Health Services is working with local and tribal health officers, health care providers, and other partners to adjust the response to COVID-19 as needed. As always, the public should follow simple steps to avoid getting sick, including:

• Frequent and thorough handwashing.
• Covering coughs and sneezes.
• Avoiding touching your face.
• Staying home as much as possible, but especially when sick.
• Avoiding gatherings of 10 or more people.
• Practicing social distancing.

It is the position of the Wisconsin Department Safety and Professional Services that under the Emergency Management powers of Wisconsin’s governor under Wis. Stat. Ch. 323.81, and as a member of the Interstate Medical Licensure Compact, if there is a shortage of physicians in Wisconsin during a declared emergency, the Governor may request support from other states and license requirements for physicians in good standing from such states would be waived during the emergency.   

Wis. Stat. Ch. 323.81  (5) Article V — Licenses, Certificates, and Permits.  Whenever a person holds a license, certificate, or other permit issued by any participating jurisdiction evidencing the meeting of qualifications for professional, mechanical, or other skills, and when such assistance is requested by the receiving participating jurisdiction, such person is deemed to be licensed, certified, or permitted by the jurisdiction requesting assistance to render aid involving such skill to meet an emergency or disaster, subject to such limitations and conditions as the requesting jurisdiction prescribes by executive order or otherwise.

Interstate Medical Licensure Compact map and statutory authority by state:
https://imlcc.org

AJ Wilson, Greg Hubbard, Ramie Zelenkova
Hubbard Wilson Zelenkova, Lobbyinig & Legislative Services Firm for WACEP

WPA in partnership with its lobbying firm, Hubbard Wilson Zelenkova, has been tracking Wisconsin DHS efforts to expand Telehealth services in response to COVID 19.   In line with efforts at the federal level, Wisconsin DHS is currently reviewing what can be done under existing policies and authority and what flexibilities could be put in place moving forward, particularly as more federal guidance is provided.  As of this post:

• For currently covered telehealth services, DHS will expand 'originating site’ to allow services to be provided regardless of the member location. 
• DHS will not make changes to originating site fee policy at this time. 
• DHS will allow coverage of e-visits, certain phone visits, and certain Medicare-allowable telehealth services. While there is variation in electronic prescribing (e-prescribing) capabilities and use, the majority of Wisconsin Medicaid hospitals, providers, and pharmacies have the technology to support e-prescribing.  

DHS will provide policy details and guidance in a forthcoming ForwardHealth provider updates.  For your reference, view existing Telehealth guidelines in Wisconsin. 

CMS Administrator Seema Verma and agency leaders will discuss 1135 waivers, the agency’s latest telehealth guidance, & other updates. There will be audience Q&A and the call will be recorded if you are unable to join on Wednesday, March 18 from 7:00–8:00 PM EST.
Dial-In: 888-603-8935
Access Code:321077