Latest News

  • March 29, 2019 7:52 AM | Deleted user

    Eric Jensen, WACEP Lobbyist

    In November, Wisconsin elected Democrat Tony Evers as its 46th Governor, and simultaneously returned large Republican majorities to both the State Assembly and State Senate.  This ended nearly a decade of total Republican control of Wisconsin state politics, and gave Wisconsin split control of state politics for the first time in more than a decade.

    As with each Legislative session, the State Budget will dominate the first half of the 2019-20 Session.  On February 28th Governor Evers introduced his Biennial Budget proposal, including a variety of items of interest to physicians:

    1. Accept Federal Medicaid Expansion, anticipated to provide coverage of an additional 20,000 Wisconsin residents, and bring in $320 million in additional Federal funds over the biennium.
    2. “Provide” $365 million for payments to “institutions” (hospitals) providing care to MA patients (it is unclear how great an increase this represents overall).
    3. Separately provides additional funding for increasing payments for Critical Access rural hospitals and “stand alone pediatric teaching hospitals”
    4. “Increase” incentive payments for Dentists by $38.5 million.
    5. “Provide” $69 million for MA non-institutional (physicians, other providers and clinics) Mental Health Payments (again, it is unclear how great an increase this represents overall).
    6. Provides funding for expanding reimbursement of “telehealth” beyond current “real-time communications” – to include sharing of data/info among providers, to specifically allow telephone/internet communications between provider/patient and among providers.
    7. Creates an “Admissions Medical Education Unit” at Winnebago, adding supervisory staff for evening and overnight shifts.
    8. Proposes legalizing “Medical Marijuana,” and decriminalizing possession of small amounts of marijuana for non-medical purposes.

    The Legislative majorities have already signaled their displeasure with Governor Evers’ proposals, especially his Medicaid expansion.  While few of the Governor’s Budget provisions will survive the Legislature’s process as originally proposed, details on Republican plans are scarce. 

    The Joint Finance Committee (JFC) will begin its work reviewing, debating and voting on the Governor’s budget proposals in April.  Generally, JFC concludes its work and provides the Legislature with a revised Budget Bill in June, but with a Republican-controlled Legislature and Democrat Governor, it is widely anticipated the Budget process may last well into the Fall of 2019.

  • March 19, 2019 11:38 AM | Deleted user

    Attend the Midwest Student Symposium on April 13

    The annual Midwest Medical Student Symposium is just over three weeks out, taking place on Saturday, April 13, 2019 at the Hilton Garden Inn Toledo in Perrysburg, Ohio. 

    The event runs from 7:30 am to 3:15 pm with a Residency Fair taking place from 12:45 to 2:45 pm. Wisconsin's EM Residency Programs will be well represented along with many other programs from the Midwest. 

    A $25 registration fee includes continental breakfast, lunch, workshops, EM Residency Fair, and Airway & Ultrasound Skills Labs. 

    Gather a group of students together for a road trip to Ohio! Be sure to register first. Sign up today:

  • March 05, 2019 8:39 AM | Deleted user

    Summer is only a few months away, and the Wisconsin Medical Society has teamed up with the Medical College of Wisconsin (MCW) and the University of Wisconsin School of Medicine and Public Health (UWSMPH) to make sure your health care team is prepared.

    From Asthma to Zika: A Physician's Guide to Summer is being held April 5-6 in Madison. Focusing on emerging health trends in infectious disease, environmental health and trauma, the new two-day education conference features a full lineup of speakers from MCW and UWSMPH, plus the opportunity to fulfill opioid education required by the Medical Examining Board and plenty of time to network with colleagues from across the state.

    Click here for details including session descriptions, speaker bios and registration information. The conference has been approved for AMA PRA Category 1 Credit™. Application for CME credit with the American Academy of Family Physicians is pending.

  • March 01, 2019 4:47 PM | Deleted user

    In a vote of 240-190 earlier this week, the U.S. House of Representatives passed the ACEP-supported bill H.R.8 - The Bipartisan Background Checks Act of 2019.  Under the nation's current federal law, licensed gun dealers are required to run a background check to make sure buyers don't have a criminal record or a history of mental illness, but law currently excludes private sellers/unlicensed dealers. H.R.8 would close this loophole.

  • February 26, 2019 6:27 PM | Deleted user

    by Bobby Redwood, MD, MPH

    George Orwell’s 1984 really gave big brothers a bad rap. Sure, you can view the Healthcare Effectiveness Data and Information Set (HEDIS) as our government overlords squeezing the art (and fun) out of emergency medicine…but I tend to view their role as that of a real big brother. Big brothers can be overbearing, they smack us when we’re acting the fool, but they also keep us out of trouble and help us navigate tricky areas of our practice.

    Enter HEDIS measure “FUA”: Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence.

    We all know that the opioid epidemic in Wisconsin is getting out of hand and we all see these patients suffering from maladaptive behavior, overdose, and withdrawal. From the 20,000-foot view, in 2016, 20.1 million Americans over 12 years of age (about 7.5% of the population) were classified as having a substance use disorder and in 2017, 70,200 Americans died from an opioid overdose. When and how is this epidemic going to end? No one knows when it will end of course, but we have a pretty good idea how the ED can help:

    As luck would have it, our big brother HEDIS is here to help us stay on track in terms of getting patients access to MAT. The two rates reported in the 2017 FUA measure are:

    • ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
    • ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).

    The literature unequivocally shows that timely follow-up care for patients with OUD who were seen in the ED is associated with a reduction in substance use, future ED use, and hospital admissions. Unfortunately, the 2017 HEDIS data on FUA has just been released and only about 10% of adult OUD patients are getting follow-up care within a week of their ED visit and only 13% are getting that care within 30 days of their ED visit. We can do better and the solution is an ED to MAT care pathway.

    The arguments against starting an ED to MAT care pathway are abundant: its not the ED’s role, we can’t get started without PCP follow-up spots, the burden of getting a DEA X-waiver is unreasonable, my ED is going to turn into a buprenorphine clinic, etc, etc, etc.

    I’ll let you all in on a secret… an ED to MAT care pathway is fulfilling for providers and is not hard to operationalize:

    • Step 1: Find two primary care physicians in your area who can reserve two Monday appointments and two Tuesday appointments for patients requesting MAT.
    • Step 2: Ask patients to stop using their opioids 48 hours before their allotted appointment time and provide them with a starter prescription of clonidine 0.2mg BID (#10) and Zofran 4mg ODT prn (#10) to help stave off early withdrawal symptoms.

    If your ED group is willing to get X-waivered, you can get more sophisticated and actually prescribe a buprenorphine starter pack from the ED. To learn how this all works:

    • Check out WACEP/WHA’s webinar: Buprenorphine 101: Demystifying Medication Assisted Treatment in Wisconsin (link); and/or 
    • Register for the WACEP Spring Symposium, where we break down the details of an ED to MAT care pathway at our hot topics roundtable.
    • For an easy to follow protocol, check out this excellent resource that applies to both the ED and clinic setting. 

    2019 is going to be the year for ED to MAT care pathways in the Wisconsin. Your hospital administrators have likely already heard about the FUA HEDIS measure and (if it has not already) it will likely be showing up in your ED soon. We at WACEP urge you to stay ahead of the curve and start saving lives now: watch the webinar, print out the protocol, go to the conference, and get your X-waiver! Let’s make our big brother proud.

  • February 22, 2019 4:19 PM | Deleted user
    The new ACEP MOC Center is the "easy button" for MOC! It's a One-Stop-Shop to keep it all together and on track for all things MOC. See what you have to do to stay certified AND what resources ACEP has to help you do it. 

    ABEM has made (at least) three big changes in the way they present MOC information to diplomates – 1) they launched a new website, 2) they changed the names and order of the MOC components, and 3) they changed the language they use to describe them (no more "Part" anything). ABEM also announced an alternative to the ConCert Exam, which they'll pilot in 2020 and launch in 2021. 
  • February 22, 2019 4:16 PM | Deleted user

    The new ACEP policy statement, Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline, was approved by the Board in September 2018 and has been endorsed by several other organizations. Read the policy here

  • February 22, 2019 4:12 PM | Deleted user

    ACEP has a number of web-based tools for you to use at the bedside.  From sepsis, to acute pain to agitation in the elderly – we’ve got you covered!   

    • ADEPT - Confusion and Agitation in the Elderly ED Patient 
    • ICAR2E - A tool for managing suicidal patients in the ED 
    • DART - A tool to guide the early recognition and treatment of sepsis and septic shock
    • MAP - Managing Acute Pain in the ED
    • BEAM - Bariatric Examination, Assessment, and Management in the Emergency Department. For the patient with potential complications after bariatric surgery
  • February 18, 2019 8:37 AM | Deleted user

    Jeffrey Pothof, MD, FACEP

    Wisconsin emergency physicians, welcome to the February edition of the WACEP newsletter.  I hope all of you are as eager is I am to attend the WACEP Spring Symposium and 27th annual Emergency Medicine Research Forum.  We have secured a great venue in the Harley-Davidson museum and have some top-notch programming ready to go.  I hope to see all of you there April 3rd and 4th.  If you haven’t already registered, sign up today.

    A handful of years ago I had an opportunity to hear Maureen Bisognano, then president of the Institute for Healthcare Improvement (IHI), deliver a keynote address at the Institute’s national forum in Orlando.  It was simple enough.  Instead of asking your patient “what’s the matter?”, we were challenged to ask our patients “what matters to you?”  This seemingly small change in words, can lead to a much deeper understanding of the patient and will improve the care you deliver.  I’ve used this approach in the ED and anecdotally can say it’s been effective in illuminating why a patients come to my ED, and allows me to better meet their needs.  Each patient brings to the ED a different set of life circumstances, they have their own fears and they have their own logic for seeking us out. 

    By asking “what matters to you?” I discovered that the 35yo sitting in front of me worried sick about an episode of seemingly benign chest pain wasn’t the anxious hypochondriac I was suspecting, but instead was the child of a parent who passed away from sudden cardiac death at the same age.  What mattered to my patient was knowing that the same thing wasn’t happening to him.  The conversation we had around his fear was more impactful to him than the negative troponin or perfect ECG I was banking on.

    By asking “what matters to you?” I witnessed one of my patients tear up and disclose the long history of intimate partner abuse she was suffering from.  I wouldn’t have figure that out by asking what was the matter with her abdominal pain.  Instead of ordering a CT scan, we conversed on how no one deserves to be treated that way, and I was able to share resources to try and make an inflection point in her life.

    Many of you have similar stories where an encounter took an unexpected turn, and you experienced one of those moments where you connected more deeply with a patient.  A time when you made a difference not through anything you learned in medical school or residency, but because you took the time to listen and understand the human condition.

    I challenge all of you on your next shift, or perhaps on all your shifts, to ask your patients not only what brought them in today, but what matters to them today.  I’d love to hear how this impacts your practice so if you are willing, share your stories with me

  • February 15, 2019 9:46 AM | Deleted user

    Looking for a deeper dive in Buprenorphine training? Here are some complimentary educational offerings:

    • Between February and August, a series of ten complimentary buprenorphine X-Waiver courses are being made available to all eligible prescribers in Wisconsin. The training, presented by the Wisconsin Society of Addiction Medicine (WISAM) in partnership with Wisconsin DHS, is designed to increase treatment capacity for opioid use disorders in Wisconsin. Learn more and sign up for a course.
    • "Buprenorphine 101 Demystifying Medication Assisted Treatment in Wisconsin" is an ED-focused webinar available on demand. View webinar
    • "Developing an ED Initiated Buprenorphine Program" is an ED-focused webinar available on demand. View webinar