Latest News

  • November 27, 2017 2:49 PM | Deleted user

    The legislature is considering legislation based on proposals from the Workers Compensation Advisory Council.  The proposals were developed Labor and Management representatives on the Council.  But not all of the proposals share the support of the Council’s health care representatives, including a recommended fee schedule.  Health care organizations will need to be even more active this session than last to again defeat the fee schedule proposal.

    It is important to note that works compensation premiums have dropped – without a government mandated fee schedule.  This year alone, employers received an 8.46 percent reduction in their worker’s compensation insurance premiums, saving employers an estimated $170 million.  At the same time, Wisconsin’s health care system continues to lead the nation in outcomes with injured employees returning to work a full three weeks earlier than the national average.  And health care costs per worker’s comp claim lower than the national average.

    Your calls are needed to both the State Assembly and State Senate to explain why the proposed health care fee schedule could harm Wisconsin’s model worker’s compensation system. Entering your address under "Who Are My Legislators" on the State Legislature’s website to locate their contact information.

    Let your State Representative and State Senator know you are a physician in their district, serving patients who are also constituents and that you are opposed to an artificial fee schedule for a worker’s compensation system that provides the nation’s best care at a below-average worker’s compensation cost.  Thank you for your time and action on this important issue.

  • November 20, 2017 1:47 PM | Deleted user

    Deputy Insurance Commissioner J.P. Wieske will outline what a Wisconsin version of the Affordable Care Act could look like at the Dec. 13 Wisconsin Health News Newsmaker Event.

    Wieske announced this fall the state is considering applying for a 1332 waiver from the law, which allows states to develop unique solutions for providing affordable healthcare coverage. Wieske will discuss the state’s next steps, as well as provide an update on open enrollment and the current insurance market.

    Wieske has served as the state's deputy insurance commissioner since 2016. Before that he was the department's legislative liaison and public information officer for five years. He previously served as the executive director of the Council of Affordable Health Insurance.

     Register here.

  • November 20, 2017 1:45 PM | Deleted user

    November 3, WMS Medigram

    The Wisconsin Medical Society Board of Directors has named Clyde “Bud” Chumbley, MD, MBA, chief executive officer of the Wisconsin Medical Society.

    “I’m excited to have the opportunity to serve as the next CEO of the Wisconsin Medical Society; I consider it a tremendous honor,” said Dr. Chumbley, who will begin on November 27. “Having been a Society member for 37 years, I’m a firm believer in its mission to advance the health of the people of Wisconsin by ensuring access to high-quality, cost-efficient care. And I look forward to drawing on my experience to further strengthen the Society so we can continue to make a difference for our patients and our profession.”

    In addition to caring for patients as a board-certified obstetrician/gynecologist throughout his 36-year medical career, Dr. Chumbley has held numerous leadership and management positions, including serving nearly 20 years as president and CEO of a large, independent multi-specialty medical group practice. He currently serves as chief medical adviser for Wisconsin Medical Society Holdings and as chief medical officer for the Wisconsin Medical Society Holdings Association Health Plan.

    Past leadership roles in Wisconsin include serving as chief medical officer/chief clinical integration officer for Aspirus Health and president of Aspirus Clinics, and as president and CEO of ProHealth Care Medical Associates. He also has served on the board of directors and as past chair and treasurer for the Wisconsin Collaborative for Healthcare Quality. In Texas, he served as chief medical officer for Scott & White Healthcare in the Austin region.  

    Doctor Chumbley is a graduate of the University of Missouri School of Medicine and the Kellogg School of Management at Northwestern University and holds medical licenses in Wisconsin and Texas.

    “We were fortunate to have a number of highly qualified candidates interested in this position,” said Jerry Halverson, MD, chair of the Society’s Board of Directors and co-chair of the search committee. “Doctor Chumbley is an excellent advocate for physicians and the patients we serve, and with his extensive administrative experience and medical expertise, we believe he is an outstanding choice to lead the Society. We look forward to all we can accomplish under his leadership.”

    Doctor Chumbley is the eighth Society CEO in its 176-year history. Susan L. Turney, MD, MS, FACMPE, FACP, was the first physician to hold the position from 2004 to 2011.

  • November 13, 2017 9:33 AM | Deleted user

    U.S. Antibiotic Awareness Week - November 13-19, 2017
    By Bobby Redwood, MD, MPH, FACEP

    Greeting Wisconsin Emergency Physicians! As we boldly stride forth into cold and flu season (or perhaps we’re getting dragged, kicking and screaming), I would like to take a moment to celebrate one of the lesser-known Fall holidays: U.S. Antibiotic Awareness Week is November 13-19, 2017!

    To celebrate the occasion, academic and community emergency physicians from across the state have compiled two top 10 lists to help guide emergency physicians’ clinical practice.  These evidence-based recommendations have been compiled by the Department of Health Services Antimicrobial Stewardship Emergency Medicine Sub-Committee and will be available in print form next month.

    Here’s an online preview; feel free to print out the PDFs (which include references) and post in your ED!

    Top Ten Ways for Emergency Physicians to Avoid Prescribing Unnecessary Antibiotics (download)

    1. Beware UTI myths. 40% of antibiotics given in hospital settings are avoidable. Odor, bacteriuria, nitrates, leukocyte esterase, and pyuria cannot diagnose UTI without clinical signs/symptoms.
    2. Use the modified Centor Score for pharyngitis. One point is assigned for each of the following criteria: fever, absence of cough, tonsillar exudates, and swollen/tender anterior cervical nodes. Current guidelines recommend no rapid testing and withholding antibiotics in patients with scores of zero and one, and treating only positive rapid test results for scores of two or greater.
    3. Treat sinusitis as viral unless strict criteria are met. Sinusitis symptoms must be present for ≥10 days without any evidence of clinical improvement OR patient has severe symptoms or signs of high fever (≥39°C [102°F]) and purulent nasal discharge or facial pain lasting for at least 3–4 consecutive days OR worsening symptoms or signs characterized by the new onset of fever, headache, or increase in nasal discharge following a typical viral upper respiratory infection. If criteria are met, first-line therapy should be a 10-day course of amoxicillin.
    4. Avoid screening for asymptomatic bacteriuria. Asymptomatic bacteriuria is common, It is present in up to 5% healthy premenopausal women, 22% community dwelling elder women, 50% and 35% of institutionalized women and men respectively. Urinalysis for infection should only be sent in patients with urinary symptoms.
    5. Think twice about “UTIs” in patients with altered mental status. Implement wait and see approach to non-specific symptoms of weakness, falls, fatigue, and/or delirium in elders, long term care residents, and patients with cognitive impairment before starting antibiotic for UTI
    6. Consider not prescribing antibiotics for uncomplicated abscesses. Several studies conducted in the ED provide data to support withholding antibiotics after incision and drainage of uncomplicated abscesses, even in cases of suspected methicillin-resistant Staphylococcus aureus. One large RCT supports TMP/SMX use in abscesses.
    7. Avoid double coverage for community-acquired cellulitis. TMP/SMX retains nearly 100% effectiveness vs. CA-MRSA. Wisconsin clindamycin resistance rates approaching 30%. No need to double cover uncomplicated cellulitis, single agent cephalexin is sufficient.
    8. Consider watch and wait prescriptions with acute otitis media. Most otitis media is viral. Delaying treatment is usually associated with resolution of clinical signs and symptoms. Only 40% of watch and wait prescriptions are filled.
    9. Use procalcitonin to help guide decision to antibiose in COPD. The FDA approved procalcitonin in 2017 to guide antibiotic initiation in LRTI.
    10. Avoid antibiotics for routine dentalgia. Reversible pulpitis, periodontitis, and mechanical endodontic conditions present as tooth pain, but do not require antibiotics. NSAIDs and nerve blocks are recommended therapy. Antibiotics are appropriate if there is an adjacent space infection, trismus or odynophagia.

    Top Ten Ways for Emergency Physicians to Improve Antibiotic Choices (download)

    1. Post-prescription culture review. Ensuring that antibiotic coverage is sufficient limits adverse outcomes related to treatment failure, while narrowing coverage based on culture results enhances stewardship and reduce adverse medication reactions. We recommend utilizing non-physician staff for all aspects except antibiotic selection decisions.
    2. Antibiotic order sets and clinical decision support systems. Institutions have successfully implemented strategies using written forms and, in some cases, computerized physician order entry to streamline the selection of empirical antibiotics in the ED. Ideally, such systems should be tailored to the patient based on data obtained during the evaluation (e.g., risk factors, comorbidities, etc)
    3. A multidisciplinary, antibiotic usage, quality improvement process. Pharmacists and infection disease specialists can provide invaluable feedback and guidance on the optimal use and appropriate dosing of antibiotics in the ED.
    4. An antibiotic stewardship champion. An ED Antibiotic Stewardship Champion can coordinate continuing education on antibiotic resistance/stewardship topics and may empower individual clinicians to utilize evidence-based guidelines rather than prescribe under pressure.
    5. An ED-specific antibiogram. If your ED has sufficient volume, ED-based antibiograms can provide ED physicians with a comprehensive resource for clinical decision-making, especially with the development of more rapid molecular based testing for drug resistance.
    6. Consider cultures when initiating antibiotic therapy. While the results of cultures obtained from blood, urine, and other potential infection sites are unlikely to return in the course of an ED stay, they play an important part in confirming infection and assuring that the causative microorganism is susceptible to the empiric antibiotic regimen initiated in the ED.
    7. Think twice before prescribing a macrolide for lower respiratory tract infection. Macrolide (azithromycin) resistance in Midwest is around 50%. Consider a single agent regimen like doxycycline 100 mg BID x 5 days .
    8. Think twice before prescribing ciprofloxacin. Fluoroquinolones are a major driver of Clostridium difficile outbreaks. They are less useful than ever with Midwest E. Coli resistance to ciprofloxacin averaging 82%. Detrimental side effects include tendonopathies, neuropathies and QT prolongation.
    9. Avoid combination therapy for ventilator-assisted pneumonia. The use of two antibiotics against gram-negative infections is not routinely required, especially if empiric therapy involves an antipseudomonal penicillin, cephalosporin, or carbapenems.
    10. Use penicillin for dental infections. Penicillin is the first choice for treating uncomplicated early ondontogenic infections. Coverage of anaerobes in these infections is only indicated with longer standing moderate to severe dental infections with adjacent space involvement.

    Happy U.S. Antibiotic Awareness Week! For more information and clinical resources, visit

    Bobby Redwood, MD, MPH, FACEP
    President, Wisconsin Chapter, American College of Emergency Physicians

  • November 08, 2017 11:56 AM | Deleted user

    November 8, Wisconsin Health News 

    The Assembly’s mental health reform committee has unanimously approved a bill that would prohibit law enforcement from transporting an individual to emergency detention from an emergency room unless a hospital or medical staff member gives the OK. 

    The bill, a result of about three years of negotiation with the Wisconsin Counties Association and the Wisconsin Hospital Association, also extends immunity under the emergency detention statute to healthcare providers. 

    Rep. Melissa Sargent, D-Madison, called the bill an “important piece of legislation” but asked for clarification from Legislative Council in response to a memo from Mental Health America of Wisconsin. 

    In the memo, Mental Health America of Wisconsin agreed on the need for medical clearance but asked for clearer language to ensure that it does not override the authority of counties to make final disposition determinations. 

    “Part of my concern is not creating a circular firing squad, so to speak, where it’s not like everyone is pointing their finger at somebody else and saying, ‘We’re giving this to you, it’s not ours,'” Sargent said. 

    Brian Larson, senior staff attorney for the committee, said his reading of the bill is that it doesn’t override the county’s authority. 

    Under law though, individuals can only be detained for 72 hours without a court order. So a county’s decision could be “kind of considered a conditional approval” if someone ends up needing an emergency room for 72 hours, Larson said. 

    “This statutory change makes it so that when the county is giving its approval, it’s basically saying, ‘We approve the emergency detention once the person is suitable to be detained,’” he said.

  • November 02, 2017 2:44 PM | Deleted user

    By Lisa Maurer, MD
    WACEP Board of Directors 

    For two days before the Scientific Assembly, councilors from each state meet to discuss proposed ACEP policy.  Some new topics of ACEP policy just approved include:

    1. Work to prevent abrupt changes in ED contract groups 
    2. Supporting paid parental leave and work on producing best practice guidelines for how to actually implement this fairly in various EM practice environments
    3. Increase resources (read: money) to promote EM physician wellness and workforce diversity 
    4. As oxy abuse transitions to heroin abuse, support development and study of supervised injection facilities that although controversial in some ways, have been successful in other countries.

    Then during Scientific Assembly, I was able to do lots of work on policy issues pertinent to our Wisconsin's efforts.  Ongoing projects include:

    1. Medicaid reforms, including reimbursement.  As states get more flexibility, ACEP is considering drafting model Medicaid reform legislation, and then selecting a state that could utilize national ACEP resources to push through legislation. I know what state I'll be volunteering for the pilot!
    2. Fighting unfair legislation on out-of-network balanced billing.  In many states, groups are getting squeezed out of contracts by unfair compensation, then state legislatures are banning balanced billing.  This is creeping into WI, and WACEP is working with PFC to be proactive. Check them out:
    3. Lots of insurance companies are starting to implement policies that try to limit "non emergent" visits, often by refusing to pay claims for visits they retrospectively consider non emergent based on the final dx.  This is a clear violation of the prudent layperson standard, which is law for most public and private insurance companies, and it IS starting to happen in WI.  (What is the PLP standard? Our patients will be put in a dangerous position, with increased delayed care due to fear of insurmountable out of pocket costs.  I'm working with ACEP to decide how to use their resources to fight this.  Keep me updated if you see/hear about this with patients.

    Lastly, CMS director Seema Verma has declared a "Patients Over Paperwork" initiative, which looks like it may actually be more than just a headline.  Director Verma met with ACEP last week, and discussed specifics, including the decreasing EHR burdens and getting rid of MIPS.  With ACEP's new president, Paul Kivela, being a doc from an independent one-hospital group, there is a new push to focus on improving practice for docs working in the trenches.

  • November 02, 2017 2:33 PM | Deleted user

    By Bradley Burmeister, MD
    WACEP Board of Directors

    On November 1st, seven Wisconsin physicians stood up for our profession at White Coat Day on Capitol Hill during the ACEP Scientific Assembly. Members met with both Wisconsin senators as well as several representatives from throughout the state. During their visit to Capitol Hill, Wisconsin ACEP members advocated for two key issues: 1) Liability tort coverage for federally mandated EMTALA-related services and 2) Information regarding the prudent layperson standard and potential violations of existing law.

    The first issue is regarding HR 548 and SB 527, the Health Care Safety Net Enhancement Act. This resolution provides federal legal protections for physicians and on-call consultants providing EMTALA-related care much like physicians in the VA, Indian Health Service, and FQHC’s have. Having protections such as these would likely decrease the cost of liability coverage, encourage emergency physicians to relocate to locations where the liability environment is less than ideal, and also incentivize more robust coverage by on-call specialists.

    The second issue relates to the prudent layperson standard, which is law in federal institutions as well as in 47 states (including Wisconsin). Recently, insurance companies have started to once again use antiquated scare tactics to inhibit patients form pursuing care in the emergency department. The decision to cover the cost of care is being based on the discharge diagnosis. For example, a patient in Georgia reportedly was in a motor vehicle crash and had an emergency department evaluation which fortunately was able to exclude a significant injury.  The patient was discharged with a diagnosis of “cervicalgia.” Astonishingly, this was not covered as the insurance company deemed the diagnosis non-emergent, even though a more emergent diagnosis could have been made had it not been ruled-out by the treating provider. Emergency care only encompasses about 2-3% of health care dollars and these tactics have not been proven to be effective. Already, roughly 40% of patients defer obtaining emergency care due to fear of expense. These tactics could lead to a delay in obtaining care when an emergent condition does present. This delay could cause harm.

    In terms of updates from our legislators, representatives let the Wisconsin ACEP team know that, within health policy, there are relatively few issues being actively debated, primarily due to the focus is on tax reform. It’s anticipated; however, that the energy will renew next year so keep checking the Wisconsin ACEP website for updates and action alerts. Also, be sure to attend Wisconsin's Doctor Day 2018 on Tuesday, January 30 in Madison for your own opportunity to advocate for emergency medicine!

  • October 25, 2017 10:14 AM | Deleted user

    October 25, Wisconsin Health News 

    Hospitals say a bill would clarify the role and liability of providers in emergency departments when people who are having a mental health crisis are detained by law enforcement. 

    The proposal got a public hearing in an Assembly committee Tuesday. 

    Currently, law enforcement officers can take someone they believe to be mentally ill, drug dependent or developmentally disabled into custody for emergency detention. The person has to pose a danger to themselves or others and can’t be detained for more than 72 hours. 

    A county department has to approve the need for detention and can't do so unless a mental health professional has performed a crisis assessment. 

    Under the bill, law enforcement couldn’t transport an individual for detention from an emergency room until a hospital employee or medical staff member who is treating the individual approves the transfer. 

    The Wisconsin Hospital Association spent almost three years negotiating with the Wisconsin Counties Association on the proposal, which they say remedies a regulatory conflict between state and federal law.

    “This legislation does not change the process to initiate an emergency detention, but necessarily and correctly leans on the medical judgment of healthcare professionals in hospital emergency departments to ensure a patient transfer is medically appropriate,” Matthew Stanford, WHA general counsel, wrote in testimony.

    Sarah Diedrick-Kasdorf, deputy director of government affairs for the Wisconsin Counties Association, wrote in testimony that "there was significant back and forth" between providers and counties as they developed the bill.

    The counties association is comfortable with the proposal's language, she said. She acknowledged that changes to the law are difficult given the number of players involved and "an already complicated section of the statutes."

    In its testimony, WHA said the bill would also address a recent attorney general opinion that found immunity for those who act in accordance with Wisconsin emergency detention statute doesn’t extend to healthcare providers. Some providers are concerned that they may be liable to a patient or third party if the county or law enforcement decides to let a patient go against medical advice, according to WHA.

    “This bill provides better clarity in statute so that a healthcare provider’s liability to an individual or third party more is more clearly limited to the healthcare provider’s authority to seek, but not impose, an emergency detention on the individual,” Stanford wrote. “The bill further clarifies that a healthcare provider may fulfill a duty to warn by contacting law enforcement or the county crisis agency.”

    Kit Kerschensteiner, Disability Rights Wisconsin managing attorney, has concerns about the bill since the processes around emergency detention can get complicated.

    “It gets messy,” she said. “There should be more people at the table to discuss how this would work and come up with a viable solution.”  

    Kerschensteiner also raised concerns about liability under the bill.

    Jonathan Safran, a Milwaukee personal injury attorney, said he had concerns about part of the bill that would insert those who determine that transfer of an individual is medically appropriate into current law that governs the liability of others involved in the emergency detention process. 

    “I’m not a fan at all with putting in legislation an indication of to how someone should be relieved of any potential liability,” he said. “I’m not a fan when there’s a presumption that someone acts in good faith and then I’m not a fan when it provides what one needs to prove that someone didn’t act in good faith.”

    The State Public Defender’s Office provides representation for commitments under the same chapter of law that includes emergency detentions. They’re currently reviewing the bill.

    “State and federal statutes and case law govern this process,” spokesman Randy Kraft said in a statement. “The SPD is cognizant of the challenge in balancing the liberty interests against the necessity to conduct needed medical procedures.”

    Both the Badger State Sheriffs' Association and the Wisconsin Sheriffs and Deputy Sheriffs Association are neutral on the proposal. 

  • October 24, 2017 4:26 PM | Deleted user

    By Julie Doniere, MD
    WACEP Board of Directors

    There is a dark, smelly staircase leading from the parking garage into my Emergency Department.   Five years ago when I climbed those stairs at the beginning of my shifts, I distinctly recall feeling like I was walking down to the gallows.  In retrospect, I was completely burnt out and I now recognize that one of the things sucking the life out of my soul was the constant head-butting with my patients over opiate prescriptions.  

    Admittedly, I still don't ascend those steps on the wings of doves; however, after becoming more involved and educated about the opiate epidemic my work-related stress has substantially subsided. 

    It is important for us to realize that emergency physicians did not cause the opiate crisis!  New research led by the Mayo Clinic shows opioid prescriptions from the ED are written for a shorter duration and smaller dosage than those written elsewhere.  Similarly, a study recently published in the Annals of Emergency Medicine, also demonstrates that patients who receive an opioid prescription in the ED are less likely to progress to long-term use. We may not be the cause of the problem, but we sure have to deal with its outcome every shift at work. We are fortunate to be practicing in Wisconsin at this time, as our state has been particularly proactive in this arena.

    Changes that Wisconsin has implemented over the past few years have been impressive.  State Representative John Nygren put together a forward thinking and very effective initiative on opioid prescriptions, the EPDMP has been a useful tool for all ED physicians, and the number of prescriptions for opiates has fallen across the State. WACEP has, of course, been an active presence throughout this journey. Milestones include publishing statewide best practices and information handouts for opiate prescribing in the ED, providing original EM-specific CME to comply with the mandatory opiate education requirements, and having emergency physician and WACEP member Tim Westlake honored by the Wisconsin Medical Society as a physician citizen of the year for his dedicated efforts in combatting the opioid epidemic.

    Most recently, I attended the October meeting of the Wisconsin Coalition for Opiate Prescription Reduction on WACEP’s behalf. At the meeting, key stakeholders highlighted steps that our state has taken in the opiate crisis and outlined a vision for the future.  As mentioned earlier, it has been shown that the ED has not been the prevalent source of narcotic prescriptions.  OB, Neurology, and Primary Care were well represented at this meeting.  They, too, have curtailed their prescriptions greatly.  That is encouraging news of course; however, as it has become more difficult and costly to attain prescription narcotics, there has been a dramatic rise in heroin abuse.  It is heartening that the Wisconsin state legislature is directing its focus towards the treatment of that abuse and that funding for treatment centers is increasing.  WACEP will continue to negotiate to ensure equal access to those in need across our state.

    So, continue to fight the good fight.  Please know that WACEP will continue to work with the legislature to increase funding and access to treatment of opiate abuse. 

  • October 18, 2017 10:55 AM | Deleted user

    Oct. 12, 2017 WMS Medigram

    In partnership with the Wisconsin Department of Justice (DOJ) and the Drug Enforcement Administration (DEA), local law enforcement agencies will be holding Prescription Drug Take Back Day on Saturday, Oct. 28. Police and sheriffs’ departments will host events throughout Wisconsin as part of the Take Back Day.

    In partnership with the Wisconsin Department of Justice (DOJ) and the Drug Enforcement Administration (DEA), local law enforcement agencies will be holding Prescription Drug Take Back Day on Saturday, Oct. 28. Police and sheriffs’ departments will host events throughout Wisconsin as part of the Take Back Day.

    The goal of Prescription Drug Take Back Day is to provide a safe, convenient and responsible means of disposal of unused or expired prescription drugs, while also educating the community about the potential abuse and consequences of improper storage and disposal of these medications.

    Drug take back days are held each spring and fall across the country, and according to Attorney General Brad Schimel, the April 2017 Drug Take Back events in Wisconsin reached a record-breaking collection of 66,830 pounds of unused medications. Wisconsin had more law enforcement agencies participate in the biannual event than any other state in the country with 267 police and sheriffs’ departments from 69 counties hosting 150 events.

    In addition to the semiannual Take Back Day event, there are 328 permanent drug disposal drop boxes throughout Wisconsin, providing citizens a convenient, environmentally friendly and anonymous way to dispose of unused medications all year. Wisconsin has more drug disposal boxes than 46 other states, behind only California, Texas and Pennsylvania.

    For more information, including a list of accepted medications, visit the DOJ’s website. Additional information also is available on the “Dose of Reality” website, which features an interactive map people can use to find a drug take-back location near them.

Wisconsin Chapter, American College of Emergency Physicians
563 Carter Court, Suite B
Kimberly, WI 54136
920-750-7725 |

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