Congratulations to WACEP's own Dr. Lisa Maurer for being honored as one of EMRA's 25 under 45 Influencers in Emergency Medicine!  Dr. Maurer is a leader in WACEP serving on the Board of Directors in multiple capacities over the years including President (2018), Secretary/ Treasurer, and currently serves as the Legislative Committee Chair.   

"Advocacy is a language Dr. Maurer speaks fluently. She championed improved Medicaid reimbursement and fought for budget increases for reimbursement in Wisconsin. She was instrumental in the fight to allow independent emergency physicians to apply for state CARES act dollars. Her ability to network, motivate her peers and work across interest groups to accomplish goals is powerful voice for emergency physicians."

The EMRA 25 Under 45 campaign to recognizes young emergency medicine physicians who are changing the world.

Congratulations Dr. Maurer! We are proud to call you our own! 

Greg Hubbard and AJ Wilson of Hubbard Wilson & Zelenkova
September 12, 2021

The state budget was signed into law in early July.  The legislature has not been in session since but there has been an unusual amount of legislative activity for the summer months, including bills of significant concern to WACEP. 

BUDGET WRAP UP

The biennial state budget process wrapped up at the beginning of July and included the first increase in MA reimbursement for emergency services in over two decades.  While the Governor did propose a greater increase, the legislature settled on a 15% in rates going forward.  We are working with DHS at present to provide input on how the additional funding will be allocated among emergency department codes.  

The final budget also included provisions that were supported by the Emergency Pscyh Taskforce that will support an increase in crisis stabilization services. 

Funding for regional crisis services grants was included by the Legislature and signed by the Governor, but the funding was a bit less than originally proposed.  

The legislature also enumerated $5million in bonding to North Central Health Care to renovate the existing mental health facility in Marathon County that will provide 16 inpatient psychiatric beds, five beds for emergency stabilization and five beds for detoxification and substance abuse treatment.  It will serve Forest, Langlade, Lincoln, Marathon, Oneida and Vilas Counties.  

In addition, the legislature’s budget included $15 million in bonding for the Eau Claire County psychiatric bed expansion but the Governor vetoed the language and kept the appropriation so that those funds could be used across the state.   We are presently working with DHS and other stakeholders on how best to utilize those funds and seek legislative authorization to do so. 

LEGISLATION

 HWZ is presently engaged on two proposals of significant concern and presently monitoring a third.  

• SB 394/AB 396 authored by Senator Testin, Rep. Cabral Guerra, and Rep. Magnafici is an Advanced Practice Registered Nurse designation/licensure bill that also includes significant scope expansion.  This legislation is similar to bills introduced in previous sessions, but goes much further.  The bill proposes to designate and license nurse practitioners, certified nurse-midwives, certified registered nurse anesthetists, and clinical nurse specialists as APRN. It proposes to eliminate requirements for these APRNs to collaborate with physicians; codifies in state statute, the ability for an APRN to assess, diagnose and treat patients, including prescribing most drugs independently from a physician; mandates that the state "opt out" of federal certified registered nurse anesthetist supervision requirements; and eliminates current law requiring certified nurse midwives to have a collaborative arrangement with a physician who has experience with obstetrics. WACEP is registered against this bill, HWZ has been engaged against this bill on WACEP’s behalf.  Additionally, we will be circulating a memo from WACEP to committee members in the near future.
• SB 532/AB 529, introduced by Senator Kathy Bernier of northwestern Wisconsin and Rep. Jesse Rodriguez of Oak Creek / Milwaukee County area would create a regulatory framework for naturopaths.   Naturopaths are not regulated at all in WI.  While regulatory framework for naturopaths may make sense, this bill has troubling provisions in it in addition to creating the framework for regulation.  The bill allows prescribing - not all prescriptions and not narcotics - but it does allow prescribing;  It creates a “naturopathic medicine examining board” and gives it the power to determine the scope of  practice for “naturopathic medical doctors” going forward. Finally, it also authorizes the title “NMD”- naturopathic medical doctor - which is troubling. WACEP has registered against this bill as has WMS and several other physician groups.
• SB 407/AB430 authored by Senator Darling and Rep. Zimmerman removes the exemption under current law that allows physicians to prescribe opioids without checking the ePDMP.  As a result, providers will need to consult the ePDMP even when prescribing opioids in quantities of three days or less.  The WMS Council on Legislation voted to oppose the bill.  This bill has had no action taken. 

ADMINISTRATIVE RULES:  State Implementation of the federal “No Surprises Act”

WACEP was engaged in discussions regarding out of network / surprise billing legislation during the budget process.  Thankfully, the legislature inevitably deferred to the federal law that will come on line in January 2022.   Since that time, WACEP, working with the anesthesiologists’ and radiologists’ associations, have met with the Office of the Commissioner of Insurance regarding state rules on implementation.   Most recently an interim rule was released on the federal level.  WACEP along with other stakeholders will continue to work with OCI to ensure that its point of view is recognized for state rulemaking and implementation purposes.  

WACEP signs a joint letter with the Wisconsin Medical Society, the Medical College of Wisconsin and associations in the state that represent family physicians, ophthalmologists, pediatricians, dermatologists, psychiatrists, radiologists and anesthesiologists in opposition to the 2021 Senate Bill 394.

Read the full letter here

Six Wisconsin Emergency Medicine physicians traveled to Washington, DC this July to meeting with the offices of your legislators. This team met with the staff for Senators Baldwin’s and Johnson’s office and then representatives Pocan and Gallagher and the staff from Representative Fitzgerald’s and Moore’s office. While initially the plan was to once again have in person meetings for the first time since the pandemic began, the delta variant interfered with these plans and legislative meetings ended up happening from hotel rooms---though we had many additional talks and networking opportunities making it an all-around great experience!

This year we had three items to discuss:

1. Avoid the Impending Medicare Payment Cliff – You may recall last year we had a outreach campaign as there was an impending Medicare rate cut. While we avoided this, it was really just kicked down the line for another year. For those who remember SGR we are sort of finding ourselves in the same situation again. This year due to the sequestration cut (2% annually) a “PAYGO” cut which is an additional 4% and then a budget neutrality cut for Emergency physicians we are looking at a potential 10% cut should Congress not do something. Thankfully most everyone is supportive avoiding any cut, the exact mechanics of how this will be avoided are what is under discussion… it’s still infrastructure week but with an impending cliff we anticipate by the end of the year there will likely need to be additional grassroot efforts on this matter. Of note, physicians for decades have been advocating to avoid rate cuts due to Congress’s anti-inflationary policies. We have not kept up with consumer prices and that of many other health care sectors rates.
2. Improving access to Addiction Treatment (HR 1384/S 445) – Essentially here we are seeking congressional action to remove the X-waiver to prescribe medication assisted treatment for opioid use disorder. There are over 84 co-sponsors for this legislation with Representative Glenn Grothman form WI signing on as co-sponsor prior to our meeting. While many of those that we met with were favorable to legislation like this, we will be seeking and asking for additional co-sponsors as we follow up with staff.
3. Caring for Our Frontline Health Care Professionals (the Dr. Lorna Breen Health Care Provider Protection Act, HR 1667/S610). This act is named after an Emergency physician who died by suicide early in the COVID pandemic after caring for patients in New York after their peak census in the city. We all probably know someone who has been impacted by mental health in the workplace or are aware of the stigma that mental health has on physician and other health care professional’s wiliness to seek help when needed. This act seeks to provide grants and training to promote evidence-informed strategies to reduce and prevent burnout, suicide, and substance use, improve support programs for health care professionals suffering from mental and behavioral health challenges, and commission a federal study into reasons health care workers do not seek appropriate care and other factors leading to burnout and how to address them. Senator Baldwin was an original sponsor of this act. Mark Pocan is a co-sponsor of the house bill where it has over 100 bipartisan co-sponsors at this point.

So, in short, we did some great work in DC this year and it was great to be back. We value building these relationships and having conversations with our representatives and their staff. We would love to have you join ACEP's LAC next year in DC. Save the date for May 1-4, 2022 and feel free to email the WACEP Office or Dr. Brad Burmeister so we can keep you updated moving forward!

Research Forum - Special Edition: COVID
August 2 - August 6, 2021
Virtual

Join ACEP for its FREE inaugural Special Edition Research Forum highlighting COVID research. You'll hear from experts in the field, get the latest on research related to clinical-care, hear from a physician with Long COVID and so much more, including abstract presentations you know and love. Also featured will be an on-demand Virtual Poster Hall.

A special Theater of War event will also be held in conjunction with the Special Edition Research Forum.

Learn more and Register!

WACEP Meet-up at ACEP21 | October 26, 2021
Meet-up with WI Emergency Physicians in Boston!

Harpoon Brewery
306 Northern Ave | Boston, MA
7:00pm-10:00pm

RSVP

Join your Wisconsin colleagues for beer and pretzels at this annual WACEP reception during ACEP's Annual Meeting.

This year's event will take place at Harpoon Brewery, less than a mile from the Boston Convention Center. The event is complimentary, but please RSVP if you plan to attend.

WACEP President's Message, July 2021 Bradley Burmeister, MD, FACEP Dear Members! The big news this month is that the Wisconsin legislature has completed its work on the state budget and the Governor signed it. What this means is a roughly a $4.4 million permanent increase annually for emergency physicians and other providers. At WACEP we are ecstatic about this increase as it is the first increase in well over 10 years and the first sizeable increase in decades.

Having ranked 50th in the country for reimbursement for Emergency care by the Medicaid program this is a giant step forward. From here, Wisconsin DHS will work to implement the budget with increase probably starting January 2022.

This success would not have happened without YOU, the members of WACEP. There is no other organization in Wisconsin advocating for Emergency physicians. Without grassroot efforts from members across the state, the work of our board and legislative committee, and our advocacy consultants at HWZ this would not have happened. Hopefully this helps you rationalize your membership as this effort alone should cover a significant portion of your dues for years to come.

Again thanks for your membership! We need you, our members, to continue to have success with these initiatives.

Best,
Brad

Pandemics and Behavioral Health: What we learned and what we need to know for next time
Hosted by American College of Emergency Physicians
7/15/2021 at 2pm CDT
CME 1 Hours Approved for AMA PRA Category 1 Credit™
Register here

The impact of the COVID-19 pandemic on the mental health of populations and mental health systems has been profound and will likely endure after the pandemic. In order to address the increased need for mental health services during and after the pandemic, it's important to carry lessons learned into the future. Join Dr. Tony Thrasher, current President of the American Association for Emergency Psychiatry and Dr. Mike Wilson, Chair-elect of the Coalition on Psychiatric Emergencies on July 15th for a discussion synthesizing what you've seen in all the headlines. This webinar will provide specific insight into how COVID has impacted behavioral health. The webinar will present the mental health situation during the pandemic, as well as its implications for the future, and offer recommendations for improving mental health responses to pandemics.

Concerned about your finances? Has COVID upended your plans? Dr. James Dahle, The White Coat Investor, has tips for emergency physicians in ALL stages of your career during this July 13 webinar.  Free for members, $49 for non-members.

Sign up today & ask YOUR specific questions!

Greg Hubbard and AJ Wilson of Hubbard, Wilson & Zelenkova
June 17, 2021

It has been a busy few months in the State Capitol. The legislature has continued to meet regularly and the Joint Finance Committee wrapped up deliberations on the biennial state budget on June 18. The document now will head to the full legislature for approval and then to the Governor’s desk where he will use his powerful partial veto authority to make numerous changes but, more likely than not, sign the document into law.

Below is a status summary on budget efforts as well as recently circulated legislation of concern to WACEP.

I. BIENNIAL BUDGET
We are pleased to report that per the Governor’s recommendation, the Joint Finance Committee adopted an increase to Emergency Physician MA reimbursement rates. The increase, beginning on January 1, 2022 will increase reimbursement by $4.4 million annually, which is the first of its kind in nearly 30 years. Thanks to all of you who contacted your legislators to assist in advocacy efforts. MA increase was the top priority for WACEP this budget cycle.

Also on WACEP’s behalf, a great deal of work went into goals of the Emergency Psych Taskforce. The Joint Finance Committee approved funding for regional crisis service grants, a concept supported by the Taskforce. There is much more to be done on this front but willingness to address the shortfalls in the current system is improving.

Finally, the Governor’s proposed budget originally included an out-of-network “surprise billing” prohibition. This proposal was substantially similar to the compromise “No Surprises Act” passed by Congress late last year but would have left more room for state customization. The proposal however was removed from the budget as non-fiscal policy and the State will instead focus on implementing the “No Surprises Act” this summer until its effective date of January 1, 2022.

II. LEGISLATION
HWZ is presently monitoring two proposals of concerns.

• SB 394/AB 396 authored by Senator Testin, Rep. Cabral Guerra, and Rep. Magnafici is an Advanced Practice Registered Nurse designation/licensure and scope expansion bill that was recently introduced. SB 394/AB396 is similar to a bill introduced last session but goes further in terms of scope. The bill proposes to designate and license nurse practitioners, certified nurse-midwives, certified registered nurse anesthetists, and clinical nurse specialists as APRN. It proposes to eliminate requirements for these APRNs to collaborate with physicians; codifies in state statute, the ability for an APRN to assess, diagnose and treat patients, including prescribing most drugs independently from a physician; mandates that the state "opt out" of federal certified registered nurse anesthetist supervision requirements; and eliminates current law requiring certified nurse midwives to have a collaborative arrangement with a physician who has experience with obstetrics.
• AB 407 authored by Senator Darling and Rep. Zimmerman removes the exemption under current law that allows physicians to prescribe opioids without checking the ePDMP. As a result, providers will need to consult the ePDMP even when prescribing opioids in quantities of three days or less. The WMS Council on Legislation voted to oppose the bill.