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

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

“I have no idea what's awaiting me, or what will happen when this all ends. For the moment I know this: there are sick people and they need curing.”

When I read Albert Camus’s novel The Plague in high school, I imagined that plagues and epidemics were a thing of the past. Surely I would never see one in our modern world! Twenty years later, there is no doubt that we are living with a pandemic, and it is now here in Wisconsin. I see this not as a reason to panic, but an opportunity to use our training and expertise to help as many people as we can get through this with as little damage done as possible, much as Dr. Rieux did in Camus’s story. 

Each of us has taken an oath to treat the sick, and it’s important that we arm ourselves as best as possible to prepare for the flood that may be coming our way. For up-to-date information and recommendations, including practical clinical guidance, I recommend the national ACEP COVID website. For more local information, the best resource is the WI Department of Health Services, which has up-to-date State guidelines and a county-by-county case tracker.

As you work with your hospital to prepare your department, Jeff Pothof, former WACEP president and Chief Quality Officer for UWHealth, offers these questions as guidance for discussion with administrators:

1. What are our criteria to test someone for COVID19? (These are changing almost daily)
2. What PPE should I be wearing if I’m going to take care of a COVID19 patient? Do PPE requirements differ for aerosolizing procedures such as NIPPV or intubation?
3. Where will a COVID19 patient be admitted in my hospital because other hospitals may not have capacity?
4. How are we securing our PPE so it doesn’t get stolen?
5. Can I travel right now, either professionally or personally?
6. If I care for a patient with COVID19 will you furlough me?  If so, in what situations, for how long, and what will employee health be doing? If I am quarantined, will I be paid?
7. Are we looking at off-site testing centers so worried patients don’t flood our EDs and Urgent Cares?
8. Is our incident command open and meeting daily to ensure we can meet the needs of our community when we get cases?
9. Is our hospital communicating our PPE and equipment needs to the State so we can ensure a steady supply?

It is imperative that we are given the resources we need to protect our patients and ourselves. Contact your federal representatives and encourage them to pass legislation to boost the availability of PPE and support the front-line healthcare workers facing this growing crisis here. 

Finally, remember to take care of yourselves and your loved ones. Keep up the good work in caring for our patients – what you do matters!

View ACEP's redesigned COVID-19 Clinical Alert page: www.acep.org/COVID-19. The robust site makes it easy for ACEP members to quickly find resources and updates.