February 1, WMS Medigram

Doctor Day 2018 brought more than 450 physicians and medical students from across the state to Madison to meet with legislators and their staffs on Tuesday. Key issues included a proposed Worker’s Compensation fee schedule, a bill allowing chiropractors to perform comprehensive sports physicals for high school and college athletes, and legislation removing the requirement for certain nurses to work in collaboration with a physician. 

Prior to meeting with legislators at the State Capitol, attendees heard from speakers including Gov. Scott Walker, who highlighted his Health Care Stability Plan to lower individual health care premium costs, provide seniors with greater health care stability, and protect those with preexisting conditions. He also discussed recent initiatives to combat the opioid crisis in Wisconsin. 

“Addiction knows no boundaries. It involves all of us,” he said. “Over the past four years I’ve had the honor of signing 28 pieces of legislation that have come out of the HOPE agenda, but there is still more work to be done. 

“We can’t afford to have anybody on the sidelines, and that includes those suffering from addiction today,” he continued. “We need to get them healthy, back up on their feet again, and right back into the workforce where they can lead strong and healthy and safe lives and be a part of making this state even better going forward.” 

In addition to hearing from Governor Walker and other speakers, attendees participated in an issue briefing before heading to the State Capitol to meet with lawmakers. 

Now in its fifth year, Doctor Day is a partnership among the Wisconsin Medical Society and other key physician groups and physician-led organizations. The day-long event provides a unique opportunity for physicians from across the state to collaborate and share with policymakers facts and data on timely health care issues. 

“As physicians, we have the privilege of caring for patients every day, and when we come together for Doctor Day, we are reminded how important it is to also have a voice outside the exam room,” said Society President Noel Deep, MD. “Doctor Day continues to grow each year, and it’s incredibly gratifying to see physicians from all specialties and practice types united to advocate on behalf of patients and the medical profession.” 

Today’s participants represented 24 different physician organizations and partners: the Wisconsin Medical Society, Medical College of Wisconsin, University of Wisconsin School of Medicine and Public Health, Axley Brynelson, Association of Wisconsin Surgery Centers, Brown County Medical Society, Waukesha County Medical Society, Wisconsin Academy of Family Physicians, Wisconsin Academy of Ophthalmology, Wisconsin Association of Hematology and Oncology, Wisconsin Chapter American College of Emergency Physicians, Wisconsin Chapter of the American College of Physicians, Wisconsin Council of Child and Adolescent Psychiatry, Wisconsin Dermatological Society, Wisconsin Neurological Society, Wisconsin Orthopaedic Society, Wisconsin Psychiatric Association, Wisconsin Radiological Society, Wisconsin Section-American College of Obstetricians and Gynecologists, Wisconsin Society of Addiction Medicine, Wisconsin Society of Anesthesiologists, Wisconsin Society of Pathologists, Wisconsin Society of Plastic Surgeons, and Wisconsin Surgical Society. 

January 30, Wisconsin Health News

The Office of the Commissioner of Insurance is drafting a proposal that would update state law and regulations on network adequacy for health insurers. 

Spokeswoman Elizabeth Hizmi said in an email that the agency anticipates working on the proposal through summer. 

Deputy Commissioner J.P. Wieske said the bill is based on work the agency did with the National Association of Insurance Commissioners to create model legislation that had the support of consumers, the medical community and the insurers. 

“We felt that modernizing our network adequacy procedures to reflect that model made some sense,” he said at a Wisconsin Health News event last month. He said current rules are “very complicated” and that the legislation would simplify the process. 

The legislation would ensure that insurers have adequate networks to provide care and that consumers have access to care they need in-network, he said.

Lisa Maurer, MD, FACEP

If you’re reading this newsletter thinking, “Sure I’m a WACEP member, but that doesn’t really impact my daily grind,” this President’s Message is for you!

Over the course of 2017, the WACEP board led by Bobby Redwood as President brought amazing structure and focus to our activities, ensuring that our resources are being used to help our patients, our profession and our physician workforce. Building on the excellent content now established, I intend to focus this year on the theme of our Spring Symposium: Building Connections. I hope to connect members to the value that already exists and may not be taken advantage of, and to connect with underrepresented members to ensure our work reflects what you value.

Our average member is a pit doc like me, and on last year’s membership survey, you told us you want WACEP’s priority to be advocacy above all else. We listened: our top advocacy issues are to 1) improve the care for our patients with psychiatric emergencies by decreasing their length of stay in the ED and 2) improve reimbursement for emergency care by our Medicaid department. What’s more, our organization is working to increase outpatient treatment for our patients struggling with opioid addiction, leading a multispecialty group of physicians advocating to restore medical malpractice caps, and ensuring Wisconsin regulators have a fair reimbursement system in place for our patients forced onto narrow-network insurance plans. 

But for the average pit doc, we may represent your practice with our advocacy issues, but does the diversity of the WACEP Board of Directors represent you?  We have a great opportunity to broaden the scope of the voices in our leadership, and this year we will be actively looking to do so. Case in point: all members are welcome at Board meetings, and in fact, I would LOVE for you to come. Please consider joining us on March 14 from 3-5:30 pm just before the Spring Symposium kicks off. Let us know if you will join us!

After last year’s amazing Spring Symposium, we are looking to this year’s event to further integrate the academic emergency physicians and residency programs into our organization. With huge thanks to Drs. Hamedani and Hargarten, we are excited to partner our annual conference with the decades-long tradition of the UW/MCW Emergency Medicine Research Forum as it alternates between Madison and Milwaukee each year. In addition to bringing back the popular LLSA course, simulation session and roundtable discussions on hot topics in EM practice, attendees will now have access to ground breaking research happening right here in our state. 

But what about the residents at those academic programs? Those who are deepest in the trenchiest of trenches? We want to improve how we support you! For those of you interested in policy, please come to Doctor Day on January 30th, where I’ll host a policy primer to get everyone up to speed on how policy is affecting your career and practice. We also have plans to visit both residency programs every year to discuss how we can help on issues that are meaningful to you. Lastly, we want to recognize our resident members. The WACEP Board of Directors includes three resident representatives from each program, who can be great resource for anyone looking to learn more. At the Spring Symposium, one resident from each program will be recognized with the WACEP Resident Advocacy Award celebrating how our WI EM residents advocate for important issues, for their patients, and for each other every day.

Another important theme reflected in our membership survey last year was the importance of education and information sharing among Wisconsin emergency physicians. Our Spring Symposium will alternates between Madison and Milwaukee, as do our board meetings.  It is not lost on me that access to this valuable resource can be difficult for many of our members in the other 90% of the state.  As WACEP certainly prioritizes Wisconsin residents’ access to amazing emergency care, we plan on taking advantage of the great opportunity to develop increased opportunities for cutting edge education for all our colleagues practicing emergency medicine in Wisconsin, WACEP members or not, Emergency Medicine trained or not. We are looking for feedback on how to make this a realistic, enduring, valuable resource. One great way to discuss this as well as other WACEP activities would be to attend a Listening Tour event near you. Look for information about upcoming stops on the Tour, when our board members will come to an ED break room or department meeting near you.  Please let us know if you’d like a visit in your neck of the woods!  We’ll supply the board member and the pizza.

If these above opportunities would bring value to your practice, take advantage! Follow along and stay updated via social media, check us out on Facebook or Twitter (@WisconsinACEP).  Join us for Doctor Day in Madison on January 30th.  Let us know if you’d like to come to our board meetings. Attend our Spring Symposium on March 14th-15th in Madison. And perhaps most importantly, if you have a different point of view, let’s CONNECT!  Drop me a line and let me know how we would be valuable to you.

ACEP wants to recognize innovative and successful approaches to managing two of the most vexing issues facing emergency departments across the country: end-of-life care and opioid use.  

ACEP’s Leadership and Advocacy Conference in May 2018 will feature a day-long Solutions Summit in which select success stories in these areas will be highlighted.  Any physician or emergency department that has developed a new approach to better address these problems is encouraged to submit their story. Some of the successes submitted will be recognized in the Summit program.  A few who submit notable success stories will also be given an opportunity to present live at the Summit.  

For end-of-life care, examples of innovative programs could include expanded use of POLST, enhanced coordination with hospice, palliative care initiatives, etc.   For opioids, we’re interested in recognizing programs designed to curtail the use and prescribing of opioids in the emergency department as well as programs to help treat patients of opioid abuse.

To submit your story, go to https://www.acep.org/solutionssummitideas to fill out the brief online submission form. And please feel free to share this e-mail with others you think might have a success story to share.

The deadline for submissions is February 10^th.

Jamie Schneider, MD and Brad Burmeister, MD
Delegation from WACEP to WMS

The Wisconsin Medical Society (WMS) meets annually to review resolutions and adopt them as new policy. This process is incredibly important as it sets the tone for the societies advocacy efforts as well as determines what testimony the society will provide for proposed legislation.

The annual meeting is coming up April 13-14, with a deadline for resolutions on February 1^st.

Any member can submit resolutions and WACEP is here to help! Assistance with authoring or developing resolutions as well as consideration for sponsorship by our society is available!

If you have any interest in serving as a delegate please let us know so we can help find a position for you! WMS can always use more voice from the frontlines which is Emergency Medicine!

Please e-mail Brad Burmeister, MD bradleyburmeister@gmail.com or Jamie Schneider jlschneider@mcw.edu with any thoughts, ideas you might have! If you are already bringing forward a resolution through a county society or another specialty society please let us know so we can consider in advance!

ACEP’s CEDR team is hosting a webinar “MIPS 2018 – What’s New? Why use CEDR to comply?” on Tuesday, January 9, 2018 at 12:00 pm CST. 

This webinar will provide an overview of MIPS 2018 and how CEDR can be beneficial in helping your group adhere to the guidelines. Learn what is happening and where ACEP is heading to provide exceptional value to ED providers and groups.

Please register at: https://attendee.gotowebinar.com/register/7845331410927108609

ACEP members serving on committees make a significant contribution toward the important work of the organization on behalf of emergency medicine.

Volunteer committee members provide important leadership to ACEP members, its Board and Council as strategic priorities are developed. ACEP’s many committees and task forces work on a variety of diverse issues. Committees are each appointed by the President to assist with activities for a specific period of time, and are accountable to the President for achievement of assigned objectives. Task forces operate much like committees, but once their work is complete they are deactivated. 

Wisconsin ACEP recognizes and thanks the following members for their current service on ACEP Committees:

Arthur R Derse, MD, JD, FACEP
 -Ethics Committee
 -Medical Legal Committee

Azita Hamedani, MD, MBA, MPH, FACEP
 -Clinical Data Registry Committee
 -Quality & Patient Safety Committee
-Emergency Medicine Practice Committee

Kacey Kronenfeld, MD
 -Disaster Preparedness & Response Committee

Lisa J Maurer, MD, FACEP
 -Reimbursement Committee
 -State Legislative/Regulatory Committee

Brooke Michelle Moungey, MD
 -Academic Affairs Committee
 -Education Committee

Michael Dean Repplinger, MD, PhD, FACEP
 -Research Committee

Jamie R Santistevan, MD
 -Public Health/Injury Prevention Committee

Manish Shah, MD, FACEP
 -Research Committee

Brian Sharp, MD, FACEP
 -Quality & Patient Safety Committee

The following policy statements and PREPs were approved by the ACEP Board of Directors at their October 2017 meeting. 

Policy Statements 
Medical Transport Advertising, Marketing, and Brokering – revised
Clinical Emergency Data Registry Quality Measures – new
Mechanical Ventilation – new
Hospital Disaster Physician Privileging – revised
Unsolicited Medical Personnel Volunteering at Disaster Scenes – revised
Sub-dissociative Dose Ketamine for Analgesia – new
Writing Admission and Transition Orders – revised
The Clinical Practice of Emergency Medical Services Medicine – new
The Role of the Physician Medical Director in EMS Leadership – new
State Medical Board Peer Review – new
Pediatric Medication Safety in the Emergency Department – new
Distracted and Impaired Driving – revised
 
PREPs 
Sub-dissociative Dose Ketamine - new
Writing Admission and Transition Orders – new

As we wind down 2017, we kick off a year-long celebration of ACEP’s 50th anniversary starting January 2018. Plan to participate in social media campaigns that highlight the highs, lows and life-changing moments in EM. Get hyped for a historical timeline following the history of our specialty as well as anniversary-themed podcasts. Watch for anniversary editions of ACEP Now and Medicine’s Frontline in addition to proclamations from members of Congress and sister medical societies. Don't forget to order copy of our commemorative coffee table book featuring the breath-taking photographs that capture a day in the life of emergency physicians collected by famed photographer Eugene Richards. Book tickets now to ACEP18 and our blow-out anniversary celebration in San Diego featuring an interactive history museum showcasing the journey of emergency medicine from battlefield to inner city to rural America to every spot in between.

As we enter 2018, we begin the celebration of 50 years of life saving and boundary pushing. Are you on call for 50 more? 

by Harry J. Monroe, Jr.
ACEP Director, Chapter and State Relations

Two years after the nearly miraculous successful retreat by the British army from Dunkirk, Prime Minister Winston Churchill remarked on the first actual British victory of the war by declaring, “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” 

We may be at a similar point in our legislative battles over balance billing and out of network reimbursement. In many states, policymakers that have been considering the issue for multiple sessions will look to address the issue once and for all. Thus, it will be important that we stand ready to engage an issue that continues to pose a threat to our specialty and most importantly, access to care for our patients. Certainly, we want to be paid fairly, but we also want to focus on making sure that insurer practices are not causing patients to delay receiving emergency care out of uncertainty as to what the insurer will pay.

ACEP has developed, and is continuing to refine, resources to help states engaging this issue. On our website you will find numerous documents that will be of help in working on this issue, including talking points, copies of written testimony produced in a number of states, information on why Medicare is not a sound benchmark for determining reimbursement, and many other materials. I would encourage you to take a look.

Additionally, we have worked hard over the last two years to build relationships with other specialty societies and the AMA, based on shared consensus principles and solutions documents that are included on the website, that have helped us collaborate on these issues. In most states that we have engaged, the national collaboration has helped with building alliances at the state level, with the result that the house of medicine has been largely united in our response to legislation. In addition to fighting off bad legislation, we have looked for opportunities to promote positive legislation on the issue, and model legislation has been developed to that end. In addition, to our collaboration with other specialties, another outside organization, Physicians for Fair Coverage, has been formed and has helped to provide and coordinate resources in this fight.

At the time of this writing, we are also working on developing regional teams of experts that can help provide assistance in terms of legislative interpretation, understanding financial impacts, and advocacy. These should be in place by the time 2018 sessions begin.

We believe that as many as 25 states will see significant efforts by legislatures to address balance billing and out of network legislation this year. If you are facing it in your state, reach out to me via email or at 972-550-0911, ext. 3204. 

In addition to balance billing and out of network issues, there will be many other important issues to address in the coming year. The prudent layperson standard remains under attack in many places by both Medicaid and commercial payers. The opioid epidemic continues to be a critical public policy concern. Of course, what the federal government does about health care, and how that filters down to the state level, promises to require our attention. This will be a busy year at the state house!