Wisconsin ACEP Latest News

ACEP Fighting New Anthem Policy

Tue, 16 Dec 2025 17:31:46 GMT

ACEP is actively pushing back against Anthem’s new facility policy in 11 states, including Wisconsin, that would impose a 10% payment cut on its in-network hospitals when out-of-network physicians are involved in care. While emergency services are currently exempted, this policy is a clear subversion of the federal No Surprises Act, and is of strong concern to ACEP. ACEP therefore joined with the American Society of Anesthesiologists (ASA) and the American College of Radiology (ACR) to send a joint letter to Elevance (Anthem’s parent company) outlining how the policy is unworkable and threatens access to care, and requested a meeting with company leadership.

ACEP leaders will be joining ASA and ACR leaders in a meeting on Monday to further press these concerns. In addition, ACEP has joined a broad AMA-led federation sign-on letter urging the insurer to rescind the policy and instead pursue collaborative solutions that support physician practices and protect patient access to care.

WisMed Board Approves WACEP Policy Proposal on Fair Medicaid Reimbursement

Tue, 18 Nov 2025 18:19:31 GMT

The Wisconsin Medical Society (WisMed) Board of Directors acted on a policy proposal by WACEP. The proposal, Enacting a Strategy for Fail Medicaid Reimbursement in Wisconsin, creates a new policy providing prioritizing Medicaid payment advocacy and suggests that the Board create a special Task Force dedicated to improving Medicaid payments for physician services. The Board Approved these items on Nov. 8.

Advocating for Patient Safety at the Capitol

Tue, 18 Nov 2025 18:08:20 GMT

WACEP Member, Dr. Michael Repplinger represented WACEP at the Senate Health Committee, providing testimony opposing SB 435, which would grant physician assistants independent practice and change professional titles.

Dr. Repplinger emphasized that while PAs are valued members of the care team, they do not have the extensive training of physicians—especially in emergency medicine, where patients depend on highly specialized expertise. He shared WACEP’s concerns that removing physicians from emergency care teams could put patient safety at risk and move Wisconsin further away from ensuring the highest quality care for all communities.

WACEP remains committed to advocating for physician-led, team-based care to best protect the health and safety of Wisconsinites.

Co-Sponsorship Memo on adopting the title of physician associate for physician assistants, independent practice of certain physician associates.

Wed, 03 Sep 2025 20:57:07 GMT

Sen. Rachael Cabral-Guevara (R-Appleton) and Rep. Nancy VanderMeer (R-Tomah) began circulating to their colleagues in the legislature a bill draft relating to physician assistants. Please see below a memo to the legislature from the Wisconsin Medical Society asking legislators NOT to sign on as cosponsors. Included in this email is the memo and bill draft from Cabral-Guevara and VanderMeer.

Be assured that our coalition of the Wisconsin Medical Society and physician specialty organizations continue to work on these scope issues.

Please contact your state legislators asking them not to sign on to this legislation. Find your Legislator Here: WSL - Find Your Legislator

Members of the Wisconsin State Legislature:

On behalf of the Wisconsin Medical Society – the state’s largest physician membership organization representing more than 10,000 physicians statewide – we respectfully urge you not to cosponsor LRB 0509/1 and instead oppose. This proposal would create a path for physician assistants (PAs) to practice independently, which we believe is not in the best interest of Wisconsin patients.

Patients receive the highest-quality care when they have access to physician-led health care teams, which include physician assistants and other professionals. Unfortunately, this bill would further fragment those teams, weakening the collaborative model that best serves patient safety and outcomes.

Physicians undergo the most rigorous education and training of any health care provider. By contrast, PAs complete shorter educational programs (typically 2-2.5 years compared to physicians’ 4 years of medical school) and are not required to complete residency training. Physicians, on the other hand, complete 3-7 additional years of residency after medical school before practicing independently. Clinical experience requirements also differ significantly: approximately 2,000 hours for PAs versus 12,000 - 16,000 hours for physicians. These differences are appropriate because PAs are valued members of physician-led teams – not independent practitioners.

This proposal is an outlier nationally: 45 states currently require physician supervision or collaboration for PAs. Eliminating that requirement in Wisconsin would move us away from the proven team-based model that benefits patients.

Finally, the bill proposes changing the title “physician assistant” to “physician associate.” If the goal is independence from physician-led care, why maintain the term “physician” in the title? This risks confusing patients who reasonably assume that the word “physician” indicates someone who has completed medical school and residency.

There are additional concerning elements within the bill that we would be happy to discuss in detail with you or your staff. Please feel free to contact us with any questions.

Mark Grapentine, JD

Chief Policy & Advocacy Officer

Wisconsin Medical Society

mark.grapentine@wismed.org

CO-SPONSORSHIP MEMORANDUM

TO: All Legislators

FROM: Sen. Rachael Cabral-Guevara

Rep. Nancy VanderMeer

DATE: September 2nd, 2025

RE: Co-Sponsorship of LRB-0509/1 relating to: adopting the title of physician associate for physician assistants, independent practice of certain physician associates, extending the time limit for emergency rule procedures, and providing an exemption from emergency rule procedures.

DEADLINE: Wednesday, September 10th, 2025 at 3:00 P.M.

The Physician Assistant/Associate (PA) profession was established over 50 years ago in response to a critical shortage of physicians, particularly affecting underserved rural and urban communities — a challenge that remains relevant today. This proposal offers a valuable opportunity to ensure that these vulnerable populations throughout Wisconsin continue to have access to high-quality, cost-effective healthcare.

Currently, PAs in Wisconsin are licensed and regulated by the Physician Assistant Affiliated Credentialing Board. There are over 4,600 licensed PAs practicing across the state in diverse medical specialties. All PAs receive comprehensive education and training, earning a Master’s degree through rigorous didactic coursework and more than 2,000 hours of supervised clinical rotations. Wisconsin is home to four accredited PA educational programs. Upon graduation, PAs must pass the Physician Assistant National Certifying Exam (PANCE) administered by the NCCPA before obtaining licensure. To maintain certification, PAs must complete at least 100 hours of continuing medical education every two years and pass a recertification exam every ten years to demonstrate continued medical knowledge in all areas of medicine, regardless of the specialty in which they may practice.

A PA’s scope of practice includes conducting physical examinations, diagnosing and managing illnesses, assisting in surgery, and prescribing medications. Presently, Wisconsin law requires PAs to practice pursuant to a collaborative agreement or under the overall direction and management of a physician.

This bill aims to modernize the PA practice in Wisconsin by allowing PAs who have completed four years of clinical practice with a physician to apply for autonomous practice outside of a formal collaborative agreement — largely mirroring recent changes signed into law for advanced practice registered nurses (APRNs). Importantly, PAs will continue to be restricted to practicing within the bounds of their experience, education, and training to ensure patient safety and would continue to be legally required to consult with or refer to another healthcare provider when a patient's care needs exceed the physician assistant's experience, education, or training. Furthermore, similar to APRN regulations, PAs would be required to collaborate with a physician when using invasive techniques to treat pain syndromes, except when working in hospital or hospital-affiliated clinic settings.

Additionally, the bill updates the professional title from “Physician Assistant” to “Physician Associate.” From the profession’s inception, PAs were never intended to be mere assistants but largely autonomous healthcare providers. The current title has often caused confusion about their role. Adopting the “Physician Associate” title aligns Wisconsin with the national standard used by the AAPA and reflects the terminology embraced by a growing number of countries worldwide, providing clarity and consistency about the important role PAs play in modern healthcare.

We encourage you to join us in co-sponsoring this legislation to support Wisconsin’s healthcare workforce and improve access to care for all communities.

If you would like to cosponsor this legislation, please contact Sen. Cabral-Guevara’s office at 6-0718 or Rep. VanderMeer’s office at 7-9170, or by email.

Analysis by the Legislative Reference Bureau

This bill adopts the term “physician associate” for “physician assistant” in the statutes, changes the title of the credentialing board that licenses physician associates to “Physician Associate Affiliated Credentialing Board,” allows physician associates to assume the title “physician associate” in addition to other titles allowed under current law, and allows a physician associate to practice independently from physicians if the physician associate satisfies certain criteria.

Under current law, a physician assistant who provides care to patients may provide the services of a physician assistant only if there is a physician who is primarily responsible for the overall direction and management of the physician assistant’s professional activities and for assuring that the services provided by the physician assistant are medically appropriate or if the physician assistant has entered into a written collaborative agreement with a physician that describes the physician assistant’s individual scope of practice and includes a protocol for identifying an alternative collaborating physician for situations in which the collaborating physician or the physician’s designee is not available for consultation.

To qualify to practice independently under the bill, a physician associate must satisfy certain criteria, including that the physician associate has completed 7,680 hours of clinical practice as a physician associate while practicing with a physician who is primarily responsible for the overall direction and management of the physician associate’s professional activities and for assuring that the services provided by the physician associate are medically appropriate or while practicing under a written collaborative agreement that satisfies the requirements under current law. In order to qualify to practice independently, the physician associate must maintain certain evidence that, during the 7,680 hours of clinical practice, the physician associate maintained a mutual, professional relationship with at least one physician; maintained documentation indicating the relationships the physician associate had with one or more physicians to deal with issues outside of the physician associate’s knowledge, training, or experience; and maintained evidence that he or she was subject to a quality assurance program, peer review process, or other similar program or process that was implemented for and designed to ensure the provision of competent and quality patient care and that also included participation by a physician. The 7,680 hours of clinical practice may include the lawful practice of the physician associate outside this state or the lawful practice of the physician associate in this state prior to the effective date of this bill, the lawful practice of the physician associate as an employee of the federal government as a civilian or as a member of a uniformed service while performing duties incident to that employment or service, including hours of independent practice outside of a supervisory or collaborative relationship with a physician, and any clinical hours completed pursuant to an educational program that qualifies an individual for licensure as a physician assistant under current law.

The bill provides that, regardless of whether a physician associate has qualified to practice independently, a physician associate may provide treatment of pain syndromes through the use of invasive techniques only while practicing with a physician who, through training, education, and experience, specializes in pain management and who either is primarily responsible for the overall direction and management of the physician associate’s professional activities and for assuring that the services provided by the physician associate are medically appropriate or is under a written collaborative agreement with the physician associate. However, the bill provides that a physician associate may provide treatment of pain syndromes through the use of invasive techniques if the physician associate has qualified to practice independently under the bill and provides treatment of pain syndromes through the use of invasive techniques in a hospital or a clinic associated with a hospital. Further, the bill provides that a physician associate may provide treatment of pain syndromes through the use of invasive techniques if the physician associate has qualified to practice independently under the bill and has privileges in a hospital to provide treatment of pain syndromes through the use of invasive techniques without a collaborative relationship with a physician.

Finally, the bill adds physician associates who have qualified to practice independently as mandatory participants in the Injured Patients and Families Compensation Fund. The Injured Patients and Families Compensation Fund provides excess medical malpractice coverage for health care providers who participate in the fund and meet all other participation requirements, which includes maintaining malpractice liability insurance in coverage amounts specified under current law. Under current law, no physician assistant may practice as a physician assistant unless they maintain such medical liability insurance.

For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

WACEP Hosts Successful Rural Outreach Procedure Day in Wisconsin Rapids

Tue, 24 Jun 2025 21:35:14 GMT

WACEP’s Rural Outreach Procedure Day, held at the Mid-State Simulation Center in Wisconsin Rapids, brought attendees together for a focused day of hands-on training tailored to rural practice needs.

Participants sharpened essential skills through five high-impact stations:

Ultrasound-Guided Nerve Blocks – For advanced pain control in low-resource settings.
OB Procedures – Boosting confidence in obstetric emergencies.
Chest Tube Insertion – Managing pneumothorax and pleural effusion.
Cricothyrotomy – Emergency airway access when intubation fails.
Fiberoptic Intubation – Handling difficult airways with advanced tools.

Attendees enjoyed event’s practical value and expert instruction. WACEP is proud to support rural physicians and looks forward to hosting more training opportunities in the future.

Advocating for Emergency Medicine!

Wed, 04 Jun 2025 16:44:29 GMT

WACEP members Dr. Lisa Maurer and Dr. Brad Burmeister met with Representative Barbara Dittrich during Wisconsin Doctor Day to discuss critical legislation impacting Emergency Department staffing requirements. Physician advocacy in action — thank you for representing the voice of emergency medicine at the Capitol!

Aspirus Wausau Hospital expands emergency department

Wed, 04 Jun 2025 15:57:59 GMT

Wisconsin Health News
June 4, 2025

Aspirus Wausau Hospital has finished its emergency department expansion, which will support its work as a regional referral and tertiary care center.

Eight new patient rooms came online Tuesday, boosting the department’s capacity to 30 treatment spaces. When work on the expansion began in 2022, the department had 18 beds.

The additions include enhanced trauma and critical care rooms.

Aspirus is seeing a growing demand for emergency and trauma care.

“This final phase is about more than just physical space,” said Mason Lucca, director of the hospital’s emergency department. “It represents our ongoing commitment to providing timely, high-quality emergency care to people throughout our service area.”

WACEP Testifies and Raises Concerns over ED Care in APRN Compromise

Tue, 20 May 2025 15:00:58 GMT

Wisconsin Health News May 15, 2025

Nursing independence bill receives support, but concerns raised over ER care

A compromise bill that would allow some nurses to practice independently of physicians received support at a public hearing Wednesday. But a doctors’ group raised concerns about emergency rooms operating without emergency physicians.

Advanced practice nurses have pushed for more than a decade for independence. They’ve faced opposition from doctors and Gov. Tony Evers, who vetoed their last two proposals.

The latest plan would allow advanced practice nurses to work independently of doctors after four years, with restrictions around practicing pain management and title protections for physicians.

“We're confident the bipartisan bill before you — a compromise reached between our offices, so many stakeholders and the governor's office — will make it across the finish line,” bill author Rep. Tony Kurtz, R-Wonewoc, told the Assembly Committee on Health, Aging and Long-Term Care.

“This legislation is long overdue,” said Terri Vandenhouten, a nurse practitioner in New Franken in northeast Wisconsin. “I look forward to my colleagues providing the best care possible to those in need of care.”

Dr. Aurora Lybeck, an executive board member for the Wisconsin Chapter of the American College of Emergency Physicians, testified for information only. She said the bill has a “major deficiency” by not having physician staffing requirements for emergency rooms.

Lybeck said emergency physicians are trained to handle complex medical cases and provide life-saving treatment based on minimal medical information. They’re seeing trends like for-profit microhospitals with minimal staffing as well as emergency departments without emergency physicians, particularly in rural areas.

“I'd argue that an emergency department without an emergency physician is really just an urgent care,” she said.

Lybeck acknowledged the Legislature may be concluding the discussion on advanced practice nursing independence, but said that conversation — and potentially legislation — on emergency department staffing may follow.

Five Crisis Stabilization Facilities Now Open Across Wisconsin

Wed, 05 Jun 2024 16:18:55 GMT

Regional centers will serve those with mental health and substance use needs

Wisconsin has taken another step forward to help people with mental health and substance use emergencies with the opening of five crisis stabilization centers for adults. Crisis stabilization facilities support people who can't stay in their community safely, but don't need to be hospitalized. Funded by the Department of Health Services (DHS), the centers provide a dedicated location for this level of care for most counties.

"Whether it's been declaring 2023 the Year of Mental Health, securing new investments for school-based mental health and other initiatives, or supporting the launch of the state's 988 Suicide & Crisis Lifeline contact center, we've been working to find solutions to the burgeoning mental health crisis facing our state since 2019," said Gov. Tony Evers. "This includes bolstering our state's crisis care infrastructure so that folks can access the care and support they need when and where they need it—especially in an emergency. While the opening of these new facilities is a tremendous step forward, we know there's far more to do, and we're committed to building on these efforts to ensure every Wisconsinite has access to mental and behavioral health care regardless of their ZIP code."

"The need for services for people experiencing mental health and substance use emergencies has been rising steadily over the past several years," said DHS Secretary-designee Kirsten Johnson. "Our investment in these five crisis stabilization facilities for adults is a commitment to ensuring the right care is available at the right time in the right place for all state residents who need help."

DHS set aside $10 million in 2021 to support the development of five crisis stabilization facilities for adults, with each location serving multiple counties. The funding is part of Wisconsin's share of American Rescue Plan Act (ARPA) funds reserved for mental health and substance use services. Today's announcement represents the work of four providers who each received a share of the funding in 2022 to establish these home-like centers. The services areas are based on partnerships the providers have set up with county agencies providing mental health and substance use services.

ACTION ALERT - Nursing Independence Bill Heading to Governor - Urgent Action Required to Urge Veto

Wed, 28 Feb 2024 21:32:38 GMT

Wisconsin Senate Bill 145 – the “APRN bill” - has again passed both houses of the legislature. Far beyond licensure, this bill expands scope of practice and eliminates current law physician collaboration requirements for nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists.

Last legislative session, Governor Tony Evers vetoed this legislation. Despite his previous veto, the bill was not improved significantly and still lacks provisions and guardrails that WACEP and other physician groups consider vital. So again, our last hope to protect patient safety in Wisconsin is another veto by Governor Evers.

Far beyond creating an APRN license, this bill takes physicians out of patient care and jeopardizes patient safety. From independent practice without any physician involvement to prescribing privileges that are regulated solely by the state’s Board of Nursing, this bill disrupts the cooperative and collaborative team-based model of health care that makes Wisconsin a leader in patient care. WACEP believes that emergency care is best led by an emergency physician and that the best solutions to increase access to care in rural areas does not include complete advanced practice nurse independence. Passage of this bill will translate into nurse practitioners working independently in your local urgent care or an emergency department with no physician involvement or backup.

Urge Governor Evers to veto this ill-advised legislation.

Your advocacy is needed now!

Contact the Governor Now

Seeking your updated contact information for NIA funded interhospital transfer study

Wed, 20 Sep 2023 20:25:26 GMT

Dear Member,

I am writing to request your preferred contact information for a study led by Dr. Angie Ingraham at the University of Wisconsin-Madison. Dr. Ingraham is conducting the Support Interhospital Transfer Decisions (SITe) study. Through this study, Dr. Ingraham seeks to understand providers’ experiences communicating during calls about interhospital transfers for older adults with emergency general surgery (EGS) diagnoses.

Emergency medicine physicians play a critical role in the transfer of EGS patients. Dr. Ingraham seeks to gather contact information for emergency medicine physicians now, so that you can be reached quickly if you participate in a transfer call that meets study criteria. If you call the UW Health-Meriter Access Center regarding an older EGS patient, you may be contacted about this study. Your contact information will be kept confidential and only used to invite you to complete a 3-minute survey each time you make an eligible call. Participation in the study will not affect transfer requests.

Please take one minute to share your contact information here: https://go.wisc.edu/egs

This study has been funded by the National Institute on Aging and approved by the University of Wisconsin Institutional Review Board.

Thank you for taking the time to support this important effort.

Please email egstransferstudy@surgery.wisc.edu with any questions.

Best regards,
Dr. Kerry Ahrens

Survey on Workplace Violence in Wisconsin EDs

Wed, 20 Sep 2023 20:21:36 GMT

Dear Wisconsin ACEP Member,

You are invited to take part in this research project entitled “Effects of Legislation on Workplace Violence in Emergency Departments Across Wisconsin.”

You will be asked to complete a survey to evaluate your experiences surrounding workplace violence. The survey will take about 10-15 minutes to complete.

More information is provided at the link to the survey below.

Link: bit.ly/45xFQT0

You may forward the survey to any colleagues (MD/DO, NP, PA, or RN) who practice in an emergency department in Wisconsin who did not receive the survey.

Sincerely,

Corey Sell, MD and Matthew Chinn, MD

Principal Investigators

Department of Emergency Medicine

Medical College of Wisconsin

Department Phone: 414-955-6450

E-mail: csell@mcw.edu; mchinn@mcw.edu

Call for Presentations! 2024 WACEP Spring Symposium

Thu, 10 Aug 2023 15:37:33 GMT

The WACEP Spring Symposium Planning Committee is opening a call for presentations for the 2024 Spring Symposium! We are looking for topics you are interested in presenting and you think others will enjoy learning more about! This could include clinical topics, hot topics, interesting cases and more.

Submit your Presentation Here

Time slots will range from 15-min to 1-hour sessions. The Spring Symposium will take place March 6-7, 2024 at the Brookfield Conference Center in Brookfield, WI. You must be available to present in-person.

Presenters will be selected based on topic of interest and brief description of the presentation. Please submit your presentation proposal no later than September 30, 2023 for consideration. If you have questions contact the WACEP office at WACEP@badgerbay.co.

WACEP 2024 Board Nominations - Now Open!

Thu, 10 Aug 2023 15:19:41 GMT

Interested in serving as leader of your professional membership organization?

The Wisconsin Chapter, ACEP Nominating Committee is now accepting nominations of any member in good standing interested in serving in WACEP leadership through the WACEP Board of Directors, Councillors to ACEP or on the WEMPAC Board.

Nominate yourself or someone here!

Nominations are being accepted for the positions listed below (terms begin January 1, 2024):

WACEP Board of Directors Positions

(3) Directors-at-Large on the Board of Directors (4-year term)
President-Elect (1-year term followed by 2-year President term and 1-year Past-President term)
Secretary/Treasurer (2-year term)
(1) Alternate Councillor Position

WEM-PAC Board Positions

Director

WACEP's Board of Directors meets quarterly and provides ongoing strategic oversight as the organization works to advance the effectiveness, sustainability and mission of the Chapter. Board members are expected to participate in all Board meetings, the annual Spring Symposium, and to volunteer for other activities that will help advance the organization's strategic priorities.

A councillor/alternate councillor is a key participant in the leadership and development of ACEP policy. The councillors represent WACEP and have the responsibility to voice the concerns of their constituents on the floor of the council meeting and in reference committees. Councillors can also express the will of their constituents by the execution of their votes for or against resolutions and electing the president-elect, Board members and Council officers at the annual meeting.

WEM-PAC Board of Directors meets 2-3 times per year and makes decisions on PAC contributions. The board is also responsible for promoting the PAC and encouraging donations throughout the year.

If you or any of your colleagues are committed to serving in a leadership capacity and being a resource for information, education, networking and advocacy, we encourage you to get involved!

Nominate yourself or a colleague today! Nominations are due by September 15, 2023.

WACEP DISTINGUISHED SERVICE AWARD - Now Accepting Nominations!

Thu, 10 Aug 2023 14:52:45 GMT

NOW ACCEPTING NOMINATIONS FOR THE
2023 DISTINGUISHED SERVICE AWARD

SUBMIT NOMINATIONS HERE

About the Award:

The WACEP Distinguished Service Award program began in 2018 to annually recognize a WACEP member who has made extraordinary contributions to the advancement of the emergency medicine specialty, and who has demonstrated the ideals of the organization through their ongoing activities and accomplishments. The recipient is recognized annual during the during the annual WACEP Spring Symposium.

Criteria:

Nominee must be a WACEP member in good standing.
Nominations should detail the unique or extraordinary impact the nominee has made within emergency medicine.
Nominee's contributions may be at the local, state, or national level.

Past Distinguished Service Award recipients include:

2023 - Julianna Doniere, MD, MPH
2022 - Jeffrey Pothof, MD, FACEP
2021 - Michael Pulia, MD, MS, FACEP
2020 - Michael Repplinger, MD, PhD, FACEP
2019 - Howard J. Croft, MD, FACEP
2018 - Azita Hamedani, MD, MBA, MPH, FACEP

Senate committee unanimously backs yearlong postpartum Medicaid coverage

Wed, 28 Jun 2023 15:12:51 GMT

WHN; June 28, 2023

A Senate committee voted unanimously Tuesday to advance a plan that would extend Medicaid postpartum coverage to a year.

Currently, the program offers 60-day postpartum coverage to those making a little more than three times the federal poverty level. Federal officials are considering a request by the state to bump that to 90 days.

All five members of the Committee on Insurance and Small Business voted by paper ballot to recommend passage of the yearlong extension. The bill has the support of 72 legislators and a number of healthcare organizations. It received a public hearing in March.

“Postpartum care, including recovery from childbirth, follow-up on pregnancy complications, management of chronic health conditions and addressing mental health concerns, is essential to increasing positive health outcomes for mothers and babies, and often requires follow-up beyond the current 60-day period,” bill author Sen. Joan Ballweg, R-Markesan, wrote in testimony submitted at the public hearing. “This is especially true for pregnant women of color, who experience large disparities in maternal mortality before and after childbirth.”

Assembly Speaker Robin Vos, R-Rochester, said at a Wisconsin Health News event in mid-June that he opposes the extension, in part because he wants to encourage people to leave Medicaid as soon as possible and enter the private insurance market.

The Legislature’s budget-writing committee voted along party lines around two weeks ago to block an attempt by Democratic members to add the proposal to the 2023-25 budget

Joint Committee on Finance voted to increase funding for MA reimbursement rates for ED physician services

Mon, 19 Jun 2023 19:08:29 GMT

Last week the Joint Committee on Finance voted to increase funding for MA reimbursement rates for ED physician services to 40% of Medicare rates. This is another needed increase to get Wisconsin in line with the rest of the United States! The budget will be approved in the next couple of weeks by the legislature and then go to the Governor. We expect the legislature to sign off and the Governor to ultimately approve (as he proposed an increase in his executive budget). So unless there is a full veto of the entire budget, we expect this increase to be implemented as of January 1, 2024 (still need to confirm after budget process) and the new rate will continue going forward.

This is another huge win for Emergency Medicine! Thank you to the WACEP Legislative Committee, Chaired by Dr. Lisa Maurer and WACEP’s Lobbying team Greg Hubbard, AJ Wilson and Dan Romportl at HWZ for their continued advocacy on this important issue.

Legislative Update - June 2023

Wed, 14 Jun 2023 13:34:34 GMT

Hubbard Wilson & Zelenkova

The State Budget process is moving forward. To date, the Joint Finance Committee (JFC) has taken on mostly low hanging fruit as a local funding (shared revenue) and local taxation stand-alone bill is being negotiated separately. The local funding increase will have impacts on the rest of the state budget, so until that is resolved, bigger ticket items like MA and DHS will likely wait. Either way, we expect MA and DHS to be voted on in the next two weeks or so. Typically, JFC budget deliberation wraps up in early to mid-June and the legislature takes up the budget in the subsequent two weeks. We still expect that to be roughly the case and hopefully the Governor will be signing a new 2023-25 budget into law in early July.

Specific Issues

Emergency Physician Medicaid Reimbursement Increase: As you recall, Gov. Evers proposed an executive budget that included a significant increase MA reimbursement for emergency physician codes. The intent of the Governor’s provision is to increase overall emergency physician services reimbursement rates to 50% of Medicare. This is part of the biennial budget bill and deliberations. We are actively lobbying all members of the Joint Finance Committee and will continue to do so to include the Governor’s proposed increase in the final version of the budget.

APRN /Nurse Independent Practice and Physician Title Protection: The Senate Health Committee had a hearing on both SB 143 and SB 145 last week (APRN license/independent practice and Physician Title Protection). This hearing was arguably premature as negotiations continue between stakeholder, key legislators, and the governor’s office. As a coalition we continue to fight for four years of clinical experience before an APRN can practice independently, physician title protection, guardrails on APRN pain practice, and ED requirements. As you recall, our advocacy resulted in the Governor including the following language in his executive budget proposal which he deems part of an overall deal on APRN: 50.36 (3s) of the statutes is created to read: 50.36 (3s) The department shall require a hospital that provides emergency services to have sufficient qualified personnel at all times to manage the number and severity of emergency department cases anticipated by the location. At all times, a hospital that provides emergency services shall have on-site at least one physician who, through education, training, and experience, specializes in emergency medicine.

We know that the WI Hospital Association is opposed to this language, as is the APRN senate bill author, so it is an uphill battle. But we continue to work to keep this important provision on the table.

Post-partum 12 Month Medicaid Extension: WACEP is part of a coalition working to extend post-partum benefits to twelve months. This provision was contained in the Governor’s budget and is also being circulated as stand-alone legislation by republican legislators as LRB 1377/1 and LRB 0324/1 authored by Senators Joan Ballweg and Mary Felzkowski and Representatives Donna Rozar and Tony Kurtz.

SB 205/AB 173: Suicide Prevention Grants: WACEP also registered its support for this bill, authored by Sen. Jesse James and Rep. Shae Sortwell, that requires the Department of Health Services to award grants to organizations or coalitions of organizations, including cities, villages, towns, counties, and federally recognized American Indian tribes or bands, for 1) training staff at a firearm retailer or firearm range on how to recognize a person that may be considering suicide; 2) providing suicide prevention materials for distribution at a firearm retailer or firearm range; or 3) providing voluntary, temporary firearm storage for the lawful owner of a firearm. A grant recipient must contribute matching funds or in-kind services having a value equal to at least 20 percent of the grant amount.

Individual Invitation to Sign on to Proposed EPA Rules

Mon, 12 Jun 2023 15:21:07 GMT

Healthy Climate Wisconsin invites you to sign onto three letters that support "Solutions for Pollution".

Read additional information here: https://www.wiclimatehealth.org/epa

If you wish to sign on, please click here: https://www.wiclimatehealth.org/support-clean-air

The deadline is Friday, June 16th

WACEP joins over 400 organizations urging Congress to support funding for gun violence prevention research

Wed, 19 Apr 2023 16:31:56 GMT

WACEP and more than 400 other national, state, and local medical, public health, and research organizations sing on urging Congress to support funding for gun violence prevention research. The letter urges support providing $35 million for the Centers for Disease Control (CDC), $25 million for the National Institute of Health (NIH), and $1 million for the National Institute of Justice (NIJ) for firearm morbidity and mortality prevention research as part of FY 2024 appropriations. This research is critical for developing a comprehensive, evidence-based approach to reducing firearm-related violence, including suicides, violent crime, and accidental shootings.

Read the full Letter

WACEP urges Legislators not to cosponsors LRB 0589 Legislation as Drafted

Mon, 13 Mar 2023 15:23:09 GMT

WACEP, along with other organizations representing thousands of WI physicians urge legislators not to cosponsor LBR 0589 - APRN Legislation as drafted.

Read full memo here.

WACEP commends Gov. Evers for an executive budget proposal that prioritizes patient safety, care, and numerous health care needs for WI

Thu, 16 Feb 2023 14:40:52 GMT

FEBRUARY 16, 2023

WISCONSIN EMERGENCY PHYSICIANS (WACEP)STATEMENT ON EXECUTIVE BUDGET PROPOSALS

The Wisconsin Chapter of the American College of Emergency Physicians commends Governor Evers for an executive budget proposal that prioritizes patient safety, care, and numerous health care needs for Wisconsin residents and providers.

The Governor’s proposed budget provides a significant and desperately needed increase to Medicaid rates that will help patients, facilities, and emergency physicians continue to provide the vital emergency services our communities expect.

Additionally, emergency departments across Wisconsin are regularly on the frontline of mental health crisis care. WACEP strongly supports the significant investment in mental health initiatives that will benefit our youth, our veterans, and all of our state residents. Funding for Crisis Urgent Care, Youth Crisis Stabilization Facilities, and 988 Suicide and Crisis Lifeline, among numerous other proposals, are vital investments in the well-being of Wisconsinites.

WACEP physicians are available 24 hours a day, 365 days a year to provide care regardless of the severity of a patient’s condition or a patient’s ability to pay. We thank the Governor for his recognition of our work and the needs of Wisconsin residents. We look forward to working closely with the Legislature to advance these important issues.

View the Press Release Here.

WACEP Signs to extend 12-months Medicaid postpartum coverage

Tue, 14 Feb 2023 20:50:03 GMT

WACEP along with a number of other organizations signs on to extend 12-months Medicaid postpartum coverage. Read the full letter. 12-Month Extension Coalition 2023_FINAL.pdf

Medical Examining Board signs off on chaperone rule

Thu, 22 Dec 2022 17:21:06 GMT

Wisconsin Health News
December 22, 2022

The Medical Examining Board on Wednesday signed off on a draft of a rule on use of chaperones and other observers during sensitive patient exams. The proposal will now head to the governor's office and then the Legislature for their consideration.

Jameson Whitney, an attorney for the Department of Safety and Professional Services, said the final version factors in comments from Legislative Council, public feedback and a meeting with the Wisconsin Hospital Association.

Under the plan, the Medical Examining Board, when determining whether alleged misconduct occurred, could take into consideration the failure of a doctor to follow the rules established by their employer regarding chaperones or other observers in patient exams.

Self-employed doctors or those practicing in practice settings that do not involve hospitals or employers will have to establish and comply with their own written procedures. They’d have to make those available and accessible to all patients likely to receive a non-emergency examination of the breasts, genitals or rectal area.

The board couldn't find doctors in violation of the rule because a third-party didn't create a chaperone policy or allow its posting or notification.

Another change to the rule clarifies that it’s not intended to impose a requirement on any person or entity the board doesn’t oversee. There are also modifications to the definition of chaperone, whom is chosen by the doctor, and observer, whom is chosen by a patient.

Matthew Stanford, WHA general counsel, said those working on the rule reached “a good place ... that both will protect patients and provide a good framework for physicians” to know what’s required and what’s not.

Previous attempts at drafting the rule ran into hurdles from doctor and hospital groups

Doctors' groups argue courts shouldn't compel providers to administer ivermectin as COVID-19 treatment

Mon, 12 Dec 2022 16:53:41 GMT

Wisconsin Health News
December 12, 2022

Two doctors’ groups filed a brief with the Wisconsin Supreme Court last week arguing that courts shouldn’t compel physicians to provide the antiparasitic drug ivermectin as a COVID-19 intervention.

The American Medical Association and Wisconsin Medical Society asked that the court uphold an appeals court ruling earlier this year that found no legal authority to compel private healthcare providers to administer treatments that they have determined are below the standard of care.

The ruling came in a case brought by Allen Gahl, whose uncle was placed on a ventilator in October 2021 while hospitalized at Aurora Medical Center-Summit with COVID-19.

Gahl obtained a prescription for ivermectin for his uncle, but the hospital staff declined to provide it after deeming the medication below the standard of care. Gahl sued, which led a Waukesha County Court to initially order that the hospital provide his uncle with the drug.

The hospital appealed, and the Waukesha County judge later revised his order to require that the healthcare facility let Gahl find a doctor outside the hospital to administer ivermectin to his uncle. However, an appeals court put a hold on that order.

In their brief, the American Medical Association and Wisconsin Medical Society wrote that most studies investigating ivermectin haven’t found it to be an effective COVID-19 treatment. The consensus view is, apart from clinical trials, it shouldn’t be used to treat the illness, they noted.

They wrote that the hospital met its legal and ethical duties by treating the patient with an “evidence-based protocol” that did not include the drug and that the Wisconsin Supreme Court should affirm the court of appeals' ruling.

"Holding otherwise would allow courts to compel treatments that the medical consensus finds to be substandard,” they wrote. “That outcome forces Wisconsin's physicians to choose between the law and their ethical duties, potentially exposing patients to harm and physicians to liability.”

The Wisconsin Supreme Court agreed to hear the case in September, with the plaintiff in the case arguing that the appeals court acted in error and that its decision “left a wake of confusion with citizens regarding the right to request to receive ivermectin.”

What do the Election Results Mean for WACEP?

Tue, 29 Nov 2022 17:43:02 GMT

Hubbard, Wilson, Zelenkova
November 2022

Despite an Election Night that was in many ways shocking; generally speaking, the status quo was maintained in Wisconsin. While a few legislators who worked well with WACEP did not run again, the political dynamics and the players who were key allies in supporting our policy positions and successful efforts to increase MA reimbursement in the last budget will be returning.

Governor Evers’ victory, by over three percentage points, marked the first time in thirty-two years that a Wisconsin governor won reelection during a midterm in which the President of the United States was of the same political party. Attorney General Josh Kaul, won reelection in an even tighter race. Democrats – comprising the majority parties in Congress - generally faced strong headwinds: lagging presidential approval ratings, historic trends of voters turning against the party in power at the midterm elections, and of course kitchen table issues like inflation and rising costs. Despite these factors, voter turnout, especially among young voters, was immense and helped level the tide.

In other statewide races, incumbent US Senator Ron Johnson narrowly defeated Lt. Gov. Mandela Barnes. Democrat Doug LaFollette was reelected as Secretary of State by only seven thousand votes. And republican Jon Lieber was elected as State Treasurer by 1.5% points. These very close results again proved that Wisconsin, for statewide races, is a very purple state. That’s not the case however in the state legislature.

Election results in the State Assembly and State Sente were very much what we expected to see. The major question going into the election cycle was whether Tony Evers, if re-elected, would still have enough democrats in at least one house to uphold his vetoes. While republicans expanded their legislative majorities, democrats did manage to protect the democratic governor’s veto power.

In the State Assembly, Republicans expanded their majority to 64-35, two less than what they needed to become “veto proof”. Assembly Democrats lost a net three seats, two open seats in the northern part of the state held by retiring democrats and one incumbent, Rep. Don Vruwink of Milton, who was forced to run in a mostly new area due to redistricting.

In the State Senate, Republicans gained one seat where former state representative Romaine Quinn defeated Kelly Westlund. This victory expanded republican numbers to a 22-11 super majority. Democrats were unable to answer in the open 5^th Senate district (Brookfield area) or the open 19^th Senate district (Appleton area). Both of those seats were held by republicans and will stay that way.

Overall, there are 24 new members of the state assembly and 4 new members of the state senate (three of whom were previously representatives in the state assembly).

In addition to the US Senate race on the federal level, all congressional republicans were re-elected as were democrats who were running again. Republicans picked up the one open congressional seat where Derick Van Orden defeated Brad Pfaff to replace retiring democrat Ron Kind. The WI congressional delegation is now comprised of six republicans and two democrats in the House of Representatives.

Inauguration and the start of the 2023-2024 Wisconsin legislative session will be in early January. If you are not sure who your state legislators are, please follow this link https://legis.wisconsin.gov and enter your address at “Who are my Legislators?”

Make Sure Your Voice is Heard: What You Need to Know for Election Day

Fri, 28 Oct 2022 13:22:25 GMT

Voting is a cornerstone of American democracy and gives citizens a voice in choosing the elected officials whose decisions impact us, not only personally, but often professionally for those who work in highly regulated industries. With that in mind, take a few minutes to educate yourself on what you need to know to cast your vote on Election Day – Tuesday, November 8^th.

Wisconsin allows both traditional absentee voting, as well as early in-person voting, which starts today, Tuesday, October 25th.
Anyone can request an absentee ballot in Wisconsin. Click here to make the request electronically.
Click here to find out additional information on how to cast an absentee ballot in-person between now and the Sunday before election day.
Your election day polling place can be found here.
If you still need to register to vote, it’s not too late, you can register to vote in-person on election day. Click here to find out what is required to register.
Enter your home address here to find out which candidates will be on your ballot

WACEP President's Message, October 2022

Fri, 28 Oct 2022 13:20:35 GMT

Dear WACEP Members,

I hope that October is bringing you more treats than tricks thus far, although this early respiratory season sure feels like a nasty trick. I wanted to start this month’s message with an update of the ACAEP Scientific Assembly that occurred the last week of September in San Francisco. Thank you all who made it out for the WACEP reception—what a great night. There was also some very important business conducted at a successful two-day ACEP Council Meeting. The selection of college leadership and the discussion and voting on 65 resolutions by the representatives of each chapter and section helps to direct the future of the college in order to best represent each ACEP member. This year, that included:

45 Resolutions adopted with 4 others referred to the Board of Directors. This includes several resolutions addressing the reproductive rights. If you are interested in reviewing these resolutions, they can be found here.
The selection of Aisha Terry, MD as the ACEP President Elect. For those of you who remember, Dr. Terry was a speaker at our WACEP Spring Symposium in 2021.
The inauguration of Christopher Kang, MD as the WACEP President.
The election of four ACEP Board of Directors members: Jeffrey M. Goodloe, MD, FACEP (incumbent), Gabe Kelen, MD, FRCP(C), FACEP (incumbent), Kristin McCabe-Kline, MD, FACEP, and Ryan Stanton, MD, FACEP, (incumbent).

The last thing that I want to emphasize is that voting for the midterm elections is rapidly upon us with in-person voting taking place on November 8th. WACEP has a very active PAC (political action committee) that works hard to create relationships with government representatives in order to represent our chapter’s interests and this has paid huge dividends in recent years with some big wins for WACEP. Please consider donating to the PAC, but also please make sure that if you get out to vote on November 8th to represent your individual interests (if you have not already done so by absentee ballot). There are several high-profile races and this is one of the best ways to make sure your voice is heard while our state addresses some critical issues in the years to come.

Thanks as always for everything you all do and of course Trick or Treat!!

Best,

Brian

New Resources Added for Encouraging Physician Lead Care

Tue, 13 Sep 2022 20:23:59 GMT

View new Resources below

Article: Analysis of Nurse Practitioners’ Educational Preparation, Credentialing, and Scope of Practice in U.S. Emergency Departments
ACEP "My Experience Matters" blog posts

WisMed offering abortion law webinar September 20

Fri, 09 Sep 2022 18:39:46 GMT

With many questions surrounding the status of Wisconsin’s abortion-related law following the U.S. Supreme Court’s Dobbs decision in June 2022, the Wisconsin Medical Society (WisMed) is offering members a special webinar with legal experts to describe the current legal landscape. Attorneys from the Madison law firm Pines Bach will present “Providing Patient Care Post-Dobbs: A Look at Wisconsin Abortion Law” live at noon on Tuesday, September 20, including time for Q&A. The presentation will also be recorded and available on-demand for a limited time.

Register for this members-only event here. There is no cost for this WisMed member benefit. If you have questions about the current status of Wisconsin law you think should be covered in the program, please contact WisMed Chief Policy and Advocacy Officer Mark Grapentine, JD.

About the legal experts, Pines Bach attorneys Diane M. Welsh and Leslie A. Freehill:

Attorneys Diane Welsh and Leslie Freehill of Pines Bach LLP

Attorney Diane Welsh is a partner at Pines Bach LLP, where she advises clients on a variety of matters, including government and health law, and represents clients in all levels of litigation. Prior to joining Pines Bach, Diane served as Chief Legal Counsel for the Wisconsin Department of Health Services and as assistant attorney general at the Wisconsin Department of Justice. Attorney Leslie Freehill is an associate at Pines Bach, where she practices in the areas of civil litigation, administrative law and appeals. Prior to joining Pines Bach, she served as a staff attorney for the Dane County Circuit Court

Meet Up with Wisconsin Emergency Physicians in San Francisco!

Mon, 29 Aug 2022 20:29:42 GMT

Wisconsin Meetup @ ACEP22
Sunday, October 2, 2022
7:00-10:00 pm
Black Hammer Brewing
544 Bryant Street | San Francisco, CA

Join your Wisconsin colleagues for drinks and light snacks at this annual WACEP reception during ACEP's Annual Meeting.

This year's event will take place at Black Hammer Brewing, about a half mile from the Moscone Convention Center. The event is complimentary, but please RSVP if you plan to attend.

RSVP Here

State MEB moves forward with revamped chaperone rule

Thu, 25 Aug 2022 17:20:53 GMT

Wisconsin Medical Society
August 18, 2022

The state of Wisconsin Medical Examining Board (MEB) put the final touches on its revamped chaperone rule for sensitive physical exams at its monthly meeting August 17, significantly scaling down the proposal’s scope following individual physician and Wisconsin Medical Society (WisMed) advocacy ever since the potential rule was first discussed in April 2021. The current version of the rule would require physicians to post their clinic/office’s chaperone policy “in at least one location reasonably likely to be seen by all affected patients.” If a self-employed physician does not have a chaperone policy, the rule requires the physician to create one and follow the posting requirements. The rule does not specify any parameters for what a chaperone policy must include – those decisions are left to the physician or their employer.

The MEB grappled with a thorny issue inherent in a state where so many physicians are employed by large health care systems: what if the physician has little or no control over their employer’s practice of posting a chaperone policy?

“My specific question on this new language is that it does put some of the onus on the physician to make and post the copy of these rules – which is effective in a small practice or a clinic where a physician has more control over those things,” said MEB member Emily Yu, MD. “But many people practice in an environment where that's more of a hospital responsibility of posting procedures – and so how would an individual physician be affected if their hospital corporation didn't comply with some of this language?”

Wisconsin Department of Safety and Professional Services legal staff acknowledged that the MEB’s authority does not extend to hospitals or non-physician employers – prompting MEB public member Rachel Sattler to ask, “Wouldn't this compel the hospitals to actually do that as well?”

”One would hope,” replied the MEB’s Sumeet Goel, DO.

“Sometimes it's difficult for an individual physician in a big corporation to make sure those things happen,” Dr. Yu said, “and I don't think it's fair to ask a physician to be responsible for that – not that it shouldn't stay in this language, but I think it's a consideration as far as who is actually responsible for that part of the process if a complaint is filed against a physician in that situation,” Dr. Yu said.

“If there is a complaint directed at a specific doctor for not having this posted in the hospital, we have the discretion to handle that,” Sattler said. “And if their position is ‘I don't control what the hospital does,’ that seems legitimate.”

Following discussion, the MEB unanimously approved moving forward with the new rule language, triggering another public comment process. The first step will be an Economic Impact Assessment period where physicians and other entities can comment on the projected fiscal effects of complying with the new rule. Following that feedback, the MEB can decide whether to continue moving forward with the proposal. If it decides to do so, the MEB would schedule a public hearing as part of a future MEB monthly meeting. Stay tuned to future editions of Medigram for news of when these comment periods are officially scheduled.

ACEP Advocacy At Home Resource

Thu, 04 Aug 2022 18:56:27 GMT

Elected officials are heading back to their districts for the month check out ACEP's Advocacy At Home: August Recess Toolkit can help you set and prepare for local meetings with federal legislators or staff. This is a great time to share your stories that personalize our calls for policy changes.

Wisconsin Emergency Medicine PAC Update

Thu, 28 Jul 2022 16:42:22 GMT

Your PAC has had a busy summer prior to the mid-term elections. We are just short of our goal of $20,000 for this election cycle having raised about 75% of our goal. Your PAC board has been busy visiting multiple campaign events the last few months to discuss issues important to emergency physicians.

Photo captions:
Wisconsin Emergency PAC board member attends a fundraiser for Tammy Baldwin which was sponsored by NEMPAC

Wisconsin Emergency PAC members attend a fundraiser for Tony Evers.

Wisconsin Emergency PAC board member attends a fundraiser for Andrew Thomsen a republican candidate for state senate in the Fox Valley area.

Contribute to the PAC Today!

Suicide and crisis lifeline now available

Fri, 22 Jul 2022 13:59:41 GMT

Wisconsin Medical Society
July 21, 2022

The 988 Suicide & Crisis Lifeline (Lifeline), a free, confidential behavioral health and support line is now available. Anyone can utilize the Lifeline at any time by calling 988 (multiple languages available), texting a message to 988 (English only), or using the chat feature at 988lifeline.org (English only). People can connect with a trained crisis counselor to get help for themselves or a loved one experiencing a crisis, such as is thoughts of suicide, a mental health concern, substance use issue or any kind of emotional distress.

Additional details about the Lifeline:

Wisconsin Lifeline counselors are trained to reduce stress, provide emotional support and connect people with local resources.
The 988 Suicide & Crisis Lifeline is available to use at no cost to Wisconsin residents. Additional care or intervention may come with a cost.
Wisconsin Lifeline is not able to send an in-person response directly. An in-person response requires a transfer to another service and could involve law enforcement.
Calls, texts and chats with Wisconsin Lifeline are confidential between the person and counselor, unless there is imminent danger for the person or others.

Jerry Halverson, MD, DFAPA, WisMed Board Chair and Rogers Behavioral Health Chief Medical Officer, told Fox6, "The purpose of 988 is to help you get over that crisis point, and get you someone that can help you more definitively. This is going to open up access to a lot of people who wouldn’t have taken advantage in the past. It can be a game-changer."

The 988 Suicide & Crisis Lifeline is a network of more than 200 support centers around the country. Contacts not answered by in-state partners roll over to a national backup system. The Wisconsin Lifeline has helped ensure that as many contacts as possible are answered by Wisconsin-based counselors who have the best understanding of local communities, cultures and resources.

Learn more about Lifeline here.

Med Board revamping chaperone rule proposal

Fri, 22 Jul 2022 13:39:01 GMT

Wisconsin Medical Society
July 21, 2022

The state of Wisconsin’s Medical Examining Board (MEB) will likely move in a new direction on a proposed administrative rule designed to promote the use of chaperones for physicians conducting sensitive physical exams. The change in direction follows more than a year’s input from physicians around the state and two separate Economic Impact Assessment (EIA) periods on two different versions of the proposal.

Results of the second EIA period showed that physician offices, clinics and hospitals would face an estimated $75 million in training and compliance costs in just the first year under that version of the rule. Under state law, any proposed administrative rule that would cost more than $10 million in additional costs over two years requires the rule’s progress to be halted and instead submitted to the state legislature as potential legislation – a path the MEB does not appear to desire.

The Wisconsin Medical Society (WisMed) has been the lead force raising concerns about another part of the proposed rule: if a physician did not use a chaperone during an exam and an inappropriate touching/conduct complaint is subsequently filed, then the physician would have been presumed guilty and forced to prove their innocence. This change in “presumption” is the opposite of the current discipline procedure, fundamentally interfering with physicians’ rights. The new proposed language removes that presumption of guilt and instead aims at ensuring patients are aware of any office/clinic/hospital policy on chaperones. The new language includes:

Med 10.03 (2)(f)(4): A physician who practices in a hospital or works for any other employer shall comply with the rules established by their hospital or employer regarding chaperones or other observers in patient examinations. Physicians who are self-employed or in other practice settings that do not involve hospitals or employers shall establish written procedures for the use of chaperones or other observers in patient examinations and shall comply with these procedures once established. A physician shall make a copy of the rules and procedures regarding the physician’s use of chaperones or other observers available to patients and shall post their procedures or policy regarding chaperones or other observers in at least one location that is visible to all patients.

The MEB’s attorney explained that this language would not require a facility to have any specific chaperone policy – or even offer chaperones at all. For example, a facility could fulfil the rule’s requirements by posting “this facility does not offer chaperones as part of a patient visit” if that is the case. The attorney termed this version of the rule: "Have a policy. Follow the policy. Make the policy available."

The MEB plans to use this language as a starting point for discussion at its next scheduled meeting on August 17, 2022. During the June 20 meeting, Board Chair Sheldon Wasserman, MD, asked WisMed for initial thoughts on the new language. WisMed Chief Policy and Advocacy Officer Mark Grapentine replied that at first glance it was positive to see the guilt presumption provision removed, and he thanked the MEB for listening to physician feedback on that issue. Grapentine also emphasized WisMed members’ agreement with the MEB that inappropriate sexual conduct complaints should be thoroughly investigated, with wrongdoers severely disciplined following a finding of guilt.

Contact WisMed Chief Policy and Advocacy Officer Mark Grapentine, JD via email or message him in WisMed Mobile for more information.

Legislative Update - June 2022

Thu, 23 Jun 2022 17:52:46 GMT

WACEP Board Report

Hubbard Wilson & Zelenkova

June 2, 2022

Policy Issues

APRN Bill/Nurse Independent Practice: Although the legislature is out until next January, work continues on policy issues and initiatives. Nurse groups have gone on the attack concerning the veto of their APRN bill (SB 394) and turned an early resignation by the BON chair into a cause for media attention. This effort has been bolstered by conservative Americans For Prosperity. Since an initial burst of media, however, there has no new attention to the issue.

Medicaid Reimbursement: WACEP intends to again prioritize an increase of Medicaid reimbursement rates associated with emergency codes. While the increase obtained in the last budget has taken effect and improved reimbursement for emergency codes for the first time in three decades, there is still more work to be done to get on par with other states. Outreach to the Administration will begin this summer in hopes of including another boost in agency budget request, the Governor’s executive budget, and ultimately through the legislative Joint Finance Committee.

Political Landscape

The US Supreme Court overruled the Wisconsin Supreme Court’s approval of the Evers drawn state legislative maps in March based on Voting Rights Act violations. This action required the Wisconsin Supreme Court to approve a new set of maps, under a very tight timeline, because districts needed to be established by April 15—the date nomination papers begin to be circulated. After a couple weeks of silence from the Court, they ended up approving the maps passed by the legislature and drawn by Republicans. As we reported before, while the Evers map could have been considered a “win” for democrats compared to the alternative of the Court selecting the legislative republican-drawn maps, both maps still reflected clear majorities for republicans in the state based on historical electoral results.

On June 1, all candidates for state and federal office were required to have their nomination papers turned in. We will now know definitively who is on the ballot for the November election and which races we expect to be competitive.

Below is a list of what may be competitive races in the legislature. At bottom is a list of all retirements.

ASSEMBLY

AD 1 (Kitchens)--Held by GOP. Door County and Kewaunee County. Always a seat that is identified as competitive. Kitchens has won by double digits in the past 4 elections.

AD 4 (Steffen)—Held by GOP. Green Bay, Ashwaubenon, Allouez. GOP numbers have reduced in 2018 and 2020 making it a seat to watch

AB 21 (Rodriguez)—Held by GOP. South Milwaukee and Oak Creek. Highly competitive (51%) GOP district. Rodriguez tends to outperform the top of the ticket.

AD 29 (Moses)—Held by GOP. NW WI—Menomonie, Colfax, Baldwin. This is a Lean GOP District (53%), but it changed significantly in redistricting reducing the benefit of incumbency.

AD 33 (Vruwink)—Held by DEM. SC WI—Fort Atkinson, Jefferson, Palymyra. Redistricting moved Vruwink out of his old seat (AD 43) into AD 33, which is much more competitive. Top of the ticket it is a 51% GOP, but Vruwink has been on the ballot in over half the new district.

AD 49 (Tranel)—Held by GOP. SW WI—Grant County. Highly competitive as the top of the ticket slightly lean Dem (51%). However, Tranel greatly outperforms the top of the GOP ticket since 2014

AD 51 (Novak)—Held by GOP. SC WI—Monroe, Lafayette Co, Iowa Co. This is the seat the Dems target every election. 54% Dem top of the ticket, but Novak wins.

AD 85 (Snyder)—Held by GOP. Wausau, Schofield. Highly competitive GOP seat (51%). Snyder usually outperforms by 2-3 points.

AD 94 (Doyle)—Held by DEM. Onalaska, West Salem, Holmen. Highly competitive Dem seat (51%). Doyle has held the seat since 2012 and performs much better in gubernatorial years.

AD 96 (Oldenburg)—Held by GOP. Monroe Co, Vernon Co and Crawford Co. Highly competitive Dem (51%). Assembly Republicans have continually outperformed the top of the ticket for decades.

SENATE

SD 5 (OPEN)—Held by GOP. Brookfield, Wauwatosa, New Berlin. Senator Kooyega held the seat but decided not to run. It was highly competitive in the last election but picked up 4 GOP points after redistricting. It will still be competitive as an open seat.

SD 17 (Marklein) –-Held by GOP. SW Wisconsin. Highly competitive Dem seat (51%). Marklein won 54% in 2018 and 55% in 2014.

SD 19 (Open)—Held by GOP. Appleton, Neenah, Menasha. Highly competitive GOP seat (52%). Formerly held by Sen Roth, who decided to run for Lt. Governor. It will be competitive as an open seat.

SD 25 (OPEN)—Held by Dem. NW WI. Held by Sen Bewley, who decided not to run. This once strong Dem area has changed over the last decade to a true 50-50 seat. As an open seat, it will be highly competitive.

LEGISLATORS NOT SEEKING RE-ELECTION

Congress

District 3 - Ron Kind (D) - Not Seeking Re-election

State Senate:

District 15 – Janis Ringhand (D) – Not Seeking Re-election
District 25 – Janet Bewley (D) - Not Seeking Re-election
District 27 – Jon Erpenbach (D) - Not Seeking Re-election
District 23 – Kathy Bernier (R) - Not Seeking Re-election
District 19 – Roger Roth (R) - Running for Lt. Governor
District 29 – Jerry Petrowski (R) - Not Seeking Re-election
District 5 – Dale Kooyenga (R)

State Assembly:

District 5 – Jim Steineke (R) - Not Seeking Re-election
District 6 – Gary Tauchen (R) - Not Seeking Re-election
District 10 – David Bowen (D) – Not seeking Re-election
District 13 – Sara Rodriguez (D) – Running for Lt. Governor
District 15 – Joe Sanfelippo (R) - Not Seeking Re-election
District 19 – Jonathan Brostoff (D) – Not Seeking Re-election
District 27 – Tyler Vorpagel (R) - Not Seeking Re-election
District 31 – Amy Loudenbeck (R) - Running for Sec. of State
District 33 – Cody Horlacher (R) - Not Seeking Re-election
District 45 – Mark Spreitzer (D) – Running for Senate
District 46 – Gary Hebl (D) – Not Seeking Re-election
District 52 – Jeremy Thiesfeldt (R) - Not Seeking Re-election
District 54 – Gordon Hintz (D) - Not Seeking Re-election
District 55 – Rachel Cabral-Guevara (R) – Running for Senate
District 59 – Tim Ramthun (R) - Running for Governor
District 61 – Samantha Kerkman (R) – Won Kenosha County Executive Race
District 68 - Jesse James (R) – Running for Senate
District 73 – Nick Milroy (D) – Not Seeking Re-election
District 74 – Beth Meyers (D) - Not Seeking Re-election
District 79 – Dianne Hesselbein (D) - Running for Senate
District 80 – Sondy Pope (D) – Not Seeking Re-election
District 82 – Ken Skowronski (R) - Not Seeking Re-election
District 84 – Mike Kuglitsch (R) - Not Seeking Re-election

Notes:

Sen. Brad Pfaff (D)– free shot at CD 3

Sen. Patrick Testin (R) – free shot at Lt. Gov.

Donate to the PAC!

Wed, 18 May 2022 18:31:10 GMT

Wisconsin ACEP PAC Short of Fundraising Goal

The Wisconsin Emergency Medicine PAC Board has set a goal of $20,000 to be raised this election cycle. This is a very important cycle as many offices are up for re-election at the state level and because we recently had a significant number of legislative wins. The PAC is another avenue to continue building relationships with our legislators. We currently have $15,000 raised which is a fantastic amount but we are hoping to do a bit more to extend our influence.

The PAC supports bipartisan candidates as well as party committees. Funds typically support candidates who have demonstrated positions on issues important to emergency physicians or serve on relevant legislative committees.

PAC contributions can be made via PayPal or by mail with this PAC contribution form.

Donate Online

Consider joining many of your peers with a monthly recurring donation! This stability ensures the ongoing ability of our PAC to respond to needs even after the conventional fund-raising season is over.

Recommended Annual Donation Levels:

$500 (~$42/month) – Match the commitment made by the WACEP Board members
$365 (~31/month) – Participate at the “Dollar a Day” Level
$200 ($17/month) – Can’t swing the dollar a day? $200 makes a huge impact for us still!
$60 ($5/month) – Residents are encouraged to consider a $5/month contribution
Other – Any amount helps!

WACEP visits Washington DC to Advocate for Emergency Medicine at LAC 2022!

Wed, 18 May 2022 18:28:57 GMT

ACEP’s Legislative and Advocacy Conference was in Washington DC May 1-3 of this year. WACEP had five attendees this year (including one virtual). They met with 6 (of 8) of the congressional offices as well as both senator offices regarding several topics important to Emergency physicians.

Senator Baldwin made a special guest appearance this year speaking at a special lunch event on “Diversity in Action: Women in Politics.” Senator Baldwin is also the author of “The Workplace Violence Prevention for Health Care and Social Services Workers Act.” This bill, which has corresponding legislation which already passed the House asks OSHA to issue a standard which would require workplace violence prevention plans be considered by hospitals.

The group also discussed with their representatives the instability of Medicare with a total of a 9% cut anticipated at the end of year unless Congress acts. This is the result of anti-inflationary and budget neutrality policies of CMS. Essentially, even though we are netting 10,000 beneficiaries per day being added to the Medicare role, Congress and CMS have decided that we won’t be spending additional funds to deliver this care. In the past, congress had elected to forego this requirement such that rates are not cut for the subsequent year. This goes without saying with inflation increasing the disparity between the consumer price index (CPI) and physician reimbursement by the Medicare system will continue to grow as it has for the last 20+ years. Our ask at this point is the congress act before the end of the year to avoid cuts to Medicare reimbursement rates as well as consider a permanent fix to this so we can avoid this issue year after year.

LAC 2023 is scheduled from April 30-May 2, 2023. Please email us at WACEP@badgerbay.co should you have interest attending next year or add yourself to the interest list to get the latest updates from ACEP: https://www.acep.org/lac/interested/

Resources to Help in Ukraine

Wed, 27 Apr 2022 14:10:11 GMT

Ukrainian Medical Association of North America (https://umana.org/) are working with the Illinois chapter (https://www.facebook.com/UMANAIllinois) to build out a medical supply pipeline from Chicago O'hare to Ukraine via Lublin, Poland. 2 cargo flights of up to 100 tons have already gone over

They are now running a parallel operation here in Wisconsin through a donated warehouse outside Milwaukee (https://www.facebook.com/UMANA.Wisconsin)

There's a list of high need medications and supplies here, but basically anything you would need in a trauma suite and in trauma aftercare are the highest needs:

http://umanawisconsin.org/

The Milwaukee Rotary is helping to organize. People can sign up to volunteer for this drive and/or future ones here

http://milwaukeerotary.com/bigdreamslocally/ukraine-support/

You can also directly donate to UMANA (https://umana.org/UkraineDonation.php

President's Message - April 2022

Sat, 23 Apr 2022 15:50:52 GMT

Happy Spring WACEP,

Thank you to everybody who was able to make it to the WACEP Spring Symposium this week. While “Getting the Band Back Together” was an appropriate and catchy slogan, it really was amazing to gather IN PERSON for the first time in three years and I look forward to this again being an annual event. The ability to reconnect with so many across the state, to learn from some from expert lecturers and innovative research, and to celebrate some of the accomplishments of WACEP and some its individual members was simply wonderful. I wanted to use this opportunity to also recap the report I shared during our business meeting:

This was another busy year in the state legislature with some significant wins for WACEP that really demonstrate the power and value of WACEP. Just a few (very important) highlights include the governor’s veto of the APRN bill and the long overdue Medicaid reimbursement rate increases.
WACEP hosted a webinar in January that included updates on pediatric respiratory care as well as OB emergencies, targeted at providers who may practice in more resource limited sites. We are looking at expanding this valuable resource to our members across the state.
WACEP membership numbers continue to remain steady with 538 total members. Please encourage any partners you have or colleagues who are not a member of WACEP to consider joining
WACEP continues to be in a very good financial position ending 2021 with approximately 38 months in operating reserves.
Congratulations to the award winners who were announced. This includes:
- WACEP Resident Advocate Award:
- - From UW: Dr. Rudi Zurbuchen
  - From MCW: Dr. Paul Benz
- WACEP Distinguished Service Award: Dr. Jeff Pothof
- WACEP Past President’s Award: Dr. Brad Burmeister

Thank you again to all who worked so hard to organize such an incredible event as well as all our sponsors and exhibitors who made this event possible.

Please as always, let us know what WACEP can do to support you and the important work that you do and THANK YOU!!

Best,
Brian

Legislative Update - April 2022

Sat, 23 Apr 2022 15:48:46 GMT

WACEP Legislative Report
Hubbard Wilson & Zelenkova
April 20, 2022

The two-year legislative session ended in March, which means that all legislation previously introduced that did not pass is dead.

SB 394/AB 396 – the APRN Bill - authored by Senator Patrick Testin, Rep. Rachel Cabral Guevara did of course pass both houses of the legislature. We are very happy to report that the Governor vetoed this legislation last Friday. While the bill was improved slightly in the assembly to at least include two years of clinical experience before an APRN could practice independently, it was not improved enough. To that end we advocated for the veto including the grassroots action alert and countless meetings along the way with the Governor’s team.

In the end, the physician coalition’s position was, and continues to be, that the bill needed to include at least the following:

1. 4 years of clinical experience as a requirement for independent practice - 2 years as an RN and 2 years as an APRN or 4 years as an APRN. (This requirement would at least be relatively on par with many medical residencies.)

2. For the practice of pain management, continue to require collaboration with a physician, specifically with a physician trained/experienced in pain medicine. (This is a basic guardrail that still provided far more leeway than our pain specialists were comfortable with given the complexities of pain medicine and chronic pain management).

3. Explicit “Truth in advertising”/“Title Protection” for physician specialty titles and terms associated with physicians. This is the one true ask of physicians in defense of their profession and credential and is basic common sense to include in a bill that will no doubt reduce transparency and increase confusion among patients in a new universe of “independent practice”.

The Assembly moved forward without addressing all of our concerns - adopting an amendment that only included the following:

1. 2 years (3840 hours) of clinical experience as an APRN before being allowed to practice completely independently.

2. Require physician collaboration for an APRN to practice pain management independently; except if the APRN is working in a hospital or in a hospital affiliated clinic - then no collaboration requirement. (It does not include that the collaborating physician be a physician who is trained and experienced in pain medicine.) So that’s worse than current law, slightly better than the original bill, but not enough.

We expect this bill to come back next session regardless of election outcomes. Interesting note: the senate author Testin is running for Lieutenant Governor and the assembly author, Cabral Guevara, is running to replace Roger Roth who is retiring from his Appleton senate seat to also run for Lt. Governor.

SB 532/AB 529, introduced by Senator Kathy Bernier of northwestern Wisconsin and Rep. Jesse Rodriguez of Oak Creek / Milwaukee County, created a regulatory framework for naturopaths. Naturopaths were not regulated at all in WI. WMS negotiated a compromise on this bill and the result rewrites the legislation in a way that significantly skinnies down the overall scope that includes the creation of a regulatory board that will NOT have future scope rulemaking abilities; naturopaths are prohibited from prescribing controlled substances; the title “naturopathic medical doctor” is NOT allowed; and a specific provision in the definitions sections regarding what naturopaths are allowed to do makes it clear that it is distinct from the definition of “practice of medicine and surgery” that applies to physicians. AB 529 was signed into law by the Governor with the compromise amendment.

Emergency Psych: Proposed JFC 13.10 request re: crisis stabilization: Governor Evers’ 2021-23 biennial budget recommended $17.6 million GPR and statutory changes to establish and support crisis urgent care and observation centers as a new provider category, as well as support short-term residential crisis stabilization and inpatient psychiatric beds. The Legislature did not adopt the Governor’s recommendation and instead placed $10 million GPR in the Committee’s appropriation for crisis services.

DHS has drafted a request to the Joint Finance Committee for the transfer of funds from the Committee’s appropriation to support grants to strengthen the system under current law. The Department plans to award the funds in FY 23 through a competitive grant application process to organization(s) that aim to support and improve regional crisis intervention and stabilization services through a county-based collaborative approach.

Certified county crisis programs will be invited to apply for the funding opportunity focused on partnership with local agencies such as law enforcement, providers of crisis supports, or hospital systems. The grants can be used to expand or enhance current operations in the county crisis system with the intention of reducing the number of emergency detentions in inpatient facilities and reducing the burden on law enforcement in responding to and transporting individuals in crisis.

This proposal has been discussed with the EmPsych Taskforce. No sense on whether this is going to move forward sat this point.

Surprise Billing/NSA: While the federal No Surprises Act and the interim rule are in effect, in a recent development, the U.S. District Court for the Eastern District of Texas vacated some problematic provisions of the Interim Final Rule related to the independent dispute resolution process. The lawsuit was brought by the Texas Medical Association. The decision will likely be appealed but if it stands will hopefully balance out the unfair advantages health insurance companies have in the interim rule’s IDR process. ACEP, the American College of Radiology, and the American Society of Anesthesiologists have an ongoing challenge to similar provisions of the rule in a District Court in Chicago. WACEP has interacted with the WI OCI recently on this issue but it appears clear that OCI will be strongly deferring to the federal law and rule. Input was shared on some ways to simplify processes in Wisconsin regarding identification of what type of plan a patient is insured by to know if NSA even applies. We do not know yet whether this input was well-taken.

Redistricting: State legislative boundaries are still in limbo. Previously the WI Supreme Court chose maps drafted by Governor Evers. Its ruling was appealed to the US Supreme Court which overturned the decision related to concerns on the number of “majority-minority” districts in the Milwaukee area. The WI Supreme Court, as opposed to only adjusting the districts that SCOTUS took issue with, went in a very different direction and instead selected the proposal submitted previously by legislative republicans. We expect this decision to also be appealed to the US Supreme Court. Whether the high court will hear it, remains to be seen. But it appears that new district lines – at least in state assembly and senate seats – remain in uncertain for a few more days or even weeks.

Legislative Not Running for Re-election in Current Office:

Congress

District 3 - Ron Kind (D) - Not Seeking Re-election

State Senate:

District 15 – Janis Ringhand (D) – Not Seeking Re-election
District 25 – Janet Bewley (D) - Not Seeking Re-election
District 27 – Jon Erpenbach (D) - Not Seeking Re-election
District 23 – Kathy Bernier (R) - Not Seeking Re-election
District 19 – Roger Roth (R) - Running for Lt. Governor
District 29 – Jerry Petrowski (R) - Not Seeking Re-election
District 5 – *Dale Kooyenga (R) (If he stays drawn out of seat after Redistricting)

State Assembly:

District 5 – Jim Steineke (R) - Not Seeking Re-election
District 6 – Gary Tauchen (R) - Not Seeking Re-election
District 10 – David Bowen (D) – Running for Lt. Governor
District 13 – Sara Rodriguez (D) – Running for Lt. Governor
District 15 – Joe Sanfelippo (R) - Not Seeking Re-election
District 27 – Tyler Vorpagel (R) - Not Seeking Re-election
District 31 – Amy Loudenbeck (R) - Running for Sec. of State
District 33 – Cody Horlacher (R) - Not Seeking Re-election
District 45 – Mark Spreitzer (D) – Running for Senate
District 46 – Gary Hebl (D) – Not Seeking Re-election
District 52 – Jeremy Thiesfeldt (R) - Not Seeking Re-election
District 54 – Gordon Hintz (D) - Not Seeking Re-election
District 55 – Rachel Cabral-Guevara (R) – Running for Senate
District 59 – Tim Ramthun (R) - Running for Governor
District 61 – Samantha Kerkman (R) – Won Kenosha County Executive Race
District 68 - Jesse James (R) – Running for Senate
District 73 – Nick Milroy (D) – Not Seeking Re-election
District 74 – Beth Meyers (D) - Not Seeking Re-election
District 79 – Dianne Hesselbein (D) - Running for Senate
District 80 – Sondy Pope (D) – Not Seeking Re-election
District 82 – Ken Skowronski (R) - Not Seeking Re-election
District 84 – Mike Kuglitsch (R) - Not Seeking Re-election

Notes:

Sen. Brad Pfaff (D) (SD 32) – free shot at CD 3

Sen. Patrick Testin (R) (SD 24) – free shot at Lt. Gov.

Congratulations to WI ACEP's own Shera Teitge, MD, FACEP and Scott Kunkle, DO, FACEP your Fellow Designation!

Tue, 01 Mar 2022 03:07:04 GMT

Fellow designation speaks to your contributions to ACEP and highlights your commitment to emergency medicine. Congratulations to our newest class of FACEP designees! Congratulations to WI ACEP's own Shera Teitge, MD, FACEP and Scott Kunkle, DO, FACEP your Fellow Designation!

Learn more at acep.org/FACEP.

ATLS Instructor Course | March 24-25, 2022 Regions EMS in Oakdale, MN

Tue, 22 Feb 2022 22:11:29 GMT

ATLS Instructor Course is a 1–1½-day course designed for MDs who satisfy the qualifications and characteristics of the model ATLS Instructor. The Instructor Course teaches MDs how to teach in the ATLS Program. Established educational principles form the foundation for the design and development of the Instructor Course. These principles are essential to the conduct of the course, and the basic course de¬sign may not be altered to fit individual or institutional desires. Learning is enhanced when the process occurs within a short period during which cognitive activity is closely linked in time and content with application of teaching skills. Therefore, the course is conducted over a 1–1½ day consecutive period with a mutual sequencing of learning and teaching skills.

You may register for this course on MyLearning or through the Education Hotline at 651-254-7788

No Surprise Act Update and Resources

Tue, 22 Feb 2022 22:11:00 GMT

No Surprise Act Update and Resources
Written by: Lisa Maurer, MD - Legislative Committee Chair

As of January 1st, the No Surprises Act prohibits emergency physicians from billing patients for the balance of charges after an out-of-network payor pays for the services, a practice historically referred to as “balanced billing.” Relatedly, it provides a mechanism for negotiation and arbitration if the physician does not find the payment to be reasonable. WACEP has been closely tracking progress of this federal law, participating in federal advocacy on behalf of emergency physicians as the regulations have been released over the last year, and is now staying up to date on implementation in our state.

National ACEP has published a fantastic website displaying an overview of the No Surprises Act with infographics and tables.

In Wisconsin, almost all processes for out of network billing will revolve around federal law, regulation, and enforcement of those requirements. As opposed to some other states, Wisconsin does not have it’s own law governing balanced billing practices and determination of payment for out-of-network services. The Wisconsin Office of the Commissioner of Insurance (OCI) recently held a public hearing where it was outlined what portions of the new federal process they would be responsible for enforcing as opposed to federal CMS. OCI will be enforcing compliance for claims for services provided to patients insured by individual and group commercial insurance products. CMS will enforce compliance for federally regulated ERISA (employer funded) insurance products. CMS will oversee all remaining processes including determination of qualifying payment amounts and independent dispute resolution.

There are multiple lawsuits currently in process against the federal government regarding the regulations that determine how arbiters would determine the reasonable payment amount for out of network services. ACEP is involved in one of those lawsuits, having filed suit against the federal government along with the federal specialty societies for anesthesiologists and radiologists, charging that the rules released last year are in conflict with the law that Congress passed in late 2020. Although we must move forward with processing bills according to the rules as they stand now, WACEP will keep you informed of any changes based on legal action going forward.

If you would like to receive updates regarding the No Surprises Act from the Wisconsin OCI, please request that you be added to a recipient list by emailing ocinsacomplaints@wisconsin.gov with your name, email, phone number and address. For more information, please see OCI’s summary of the No Surprises Act or feel free to contact WACEP at WACEP@badgerbay.co

Nominate Someone Today for the WACEP Distinguished Service Award

Tue, 22 Feb 2022 22:09:59 GMT

The WACEP is pleased to announce that the nominations for the 2022 Distinguished Service Award is now open!

The Distinguished Service Award recognizes a WACEP member who has made extraordinary contributions to the advancement of the emergency medicine specialty, and who has demonstrated the ideals of the organization through their ongoing activities and accomplishments.

Nomination Deadline: March 1

Nominate Someone Today!

WACEP President's Message, February 2022

Tue, 22 Feb 2022 22:08:30 GMT

President's Message, February 2022
Brian Sharp, MD

For those of you who tuned in for the Super Bowl, how incredible was that halftime show? While it has generated plenty of hilarious memes poking fun at people like myself who were able to relive their “glory days,” I sure enjoyed all the artists getting back together for this show. Whether or not the show featuring the music of Dr. Dre, Snoop Doggy Dogg, and Mary J Blige among others was targeted to your generation or your music taste, it does provide me with a great excuse to remind everybody about the upcoming WACEP Spring Symposium—April 20^th and 21^st. Appropriately themed, “Getting the Band Back Together,” this will be an opportunity for us to finally gather, to learn together, and to celebrate the amazing work being done across our state. To highlight some of the various reasons to attend, what better way than to quote some of the Super Bowl performers.

You can teach an old dog new trick if that old dog listens.

-Snoop Dogg

The WACEP Spring Symposium is packed with rich educational opportunities. This includes keynote speakers, Dr. Tom Aufderheide and Dr. Gail D’Onofrio as well as talks on topics ranging from ED critical care to ED dental trauma. You won’t want to miss the high yield “Hot Topics” roundtable discussions or the “Unique Procedures Workshop.” Lastly, the popular LLSA Article Review Workshop returns—use this to knock that off your to-do-list.

Never let me slip cuz if I slip then I’m slippin’

-Dr. Dre

The WACEP research forum is an incredible opportunity to see the cutting-edge research work being done in Emergency Medicine across our state. There will be numerous oral and poster presentations to learn from and a chance to celebrate the great achievements of our statewide researchers.

My mind on my money and my money on my mind

-Snoop Dogg

After 2 years of limited opportunities for in person conferences—including many conferences canceled, many of you have may extra CME money to use. Take this opportunity to do that in a packed, fun conference—one where you don’t even have to fly.

Sunny days wouldn’t be special…if it wasn’t for rain.

Joy wouldn’t feel so good…if it wasn’t for pain.

-50 cent

Let’s be honest, the last two years have been rough at times. April will be a great time to finally come together, to celebrate the value of emergency medicine and to grow relationships with our colleagues from around the state. It has been three years since we were able to last hold our WACEP Spring Symposium in person and we have all been through a lot personally and professionally. Let’s make this one count!!

So don’t forget to make your plans now, to register for the conference, and hopefully I will see you all in April in Milwaukee.

Best,

Brian

Please do not hesitate to reach out to me if WACEP can help you or if you would like to connect. My email address is bsharp@medicine.wisc.edu.

Dr. Matthew Stampfl wins the EEM 2022 Blog Post Contest!

Fri, 18 Feb 2022 20:03:14 GMT

Congratulations to WACEP's Resident Representative and Symposium Planning Committee Member, Dr. Matthew Stampfl, University of Wisconsin School of Medicine, on being the winner of the Essentials of Emergency Medicine 2022 blog post contest! Here is the winning post!

Written by Matthew Stampfl

The Controversy | Topical TXA for Epistaxis
An 83-year-old male with history of dementia and atrial fibrillation on warfarin comes in with bleeding from the nose for the past 90 minutes. Direct pressure doesn’t seem to have helped, but his caregiver really wants to avoid packing if possible, since he became extremely agitated last time he received it. Your attending says to pull out the vial of TXA, but you ask: “Wait, wasn’t there a recent study that found TXA didn’t help?”

The Case for TXA
TXA is a fixture in algorithms for epistaxis, including a recent one promulgated by the New England Journal of Medicine. This is based on multiple smaller studies showing promising efficacy.

For instance, a 2018 RCT included 124 patients with epistaxis on antiplatelet agents and compared topical TXA (500 mg) on a pledget to topical lidocaine-epinephrine on a pledget followed by nasal packing. Patients were only eligible for inclusion if 20 minutes of direct pressure failed to resolved their symptoms. The primary outcome was cessation of bleeding within 10 minutes, which occurred 73% of the time in the TXA group vs 29% in the lidocaine-epinephrine/nasal packing group.

Another RCT in 2019 took 135 patients and split them between three arms: atomized TXA (500 mg) with compression, nasal packing with Merocel, and compression alone. Primary outcome was cessation of bleeding within 15 minutes. This occurred 91.1% of the time in the TXA arm vs 93.3% in the Merocel packing arm and 71.1% in the compression alone group. On analysis, both TXA and Merocel were significantly better than placebo, though they were not different from each other.

The Argument Against
However, the largest RCT (NoPAC, 2021) on TXA in epistaxis comes to a different conclusion. It was a double-blinded multicenter RCT which enrolled 496 patients with epistaxis that failed to resolve with 10 minutes of direct pressure followed by topical vasoconstrictor application and then another 10 minutes of direct pressure. Patient were randomized between TXA or saline delivered via cotton wool dental rolls (the UK’s equivalent to pledgets). The protocol called for 200 mg TXA soaked into the dental roll which was held in place in the nare via nasal clip for ten minutes. If this did not control the bleeding, the treatment would be repeated once. Primary outcome in this trial was need for anterior nasal packing, which was placed at the discretion of the treating clinician. There was no significant difference in rates of packing between the groups, with 43.7% of the TXA undergoing packing vs. 41.3% of the placebo group.

My Take and Recommendations
So where does this leave us? We want to be evidence-based, and the largest study on the topic calls into question whether TXA in epistaxis improves outcomes. On the other hand, we know our 83-year-old won’t tolerate packing well, and we would like to spare him (and us) that experience if possible.

Digging into the NoPAC trial reveals a few differences that might contribute to its divergent findings. For one, TXA was given as a 200 mg dose x 2 rather than the single 500 mg used elsewhere. Moreover, all patients enrolled in NoPAC had to first fail a topical vasoconstrictor, which potentially selects a somewhat different patient population. Finally, NoPAC was conducted in the UK, which may limit generalizability to the US given practice variation (e.g. UK patients who undergo nasal packing are admitted for an average of three days).

A 2021 systematic review of topical TXA in epistaxis included 1,299 patients across 8 studies (including NoPAC). Unfortunately, NoPAC was excluded from the analysis of bleeding cessation because its outcome was avoiding packing, but the remaining trials showed that TXA had 3.5 times greater odds of bleeding control at first reassessment.

Thus, the evidence isn’t clear. But as with all treatments we provide to our patients, we have to weigh the risks and benefits. On the benefit side of the ledger, it is unclear if TXA will help this patient to avoid packing. Conversely, topical TXA has minimal adverse effects, is quite inexpensive and won’t take long to trial. Given the negligible downsides of TXA and the known harms of packing this patient, let’s give TXA a try!

Assembly signs off on nursing bill, Medicaid changes

Fri, 18 Feb 2022 19:56:19 GMT

The Assembly amended and approved a bill Thursday that would allow advanced practice nurses to practice independently, while also taking up two bills passed on party lines that would bar automatic Medicaid renewals and stop some from turning down work to stay in the program.

Under an amendment to the nursing bill, advanced practice nurses who have completed 3,840 clinical hours of practice while working with a physician or a dentist would be allowed to work independently.

They could only provide pain management services while working in a collaborative relationship with a doctor, except if providing the services in a hospital or clinic associated with a hospital.

“Ultimately, this bill, when passed, will lower healthcare costs as well as increase access,” bill co-author Rep. Rachael Cabral-Guevara, R-Appleton, said on the floor before passage of the plan.

Cabral-Guevara said “not only the nurses, but the physicians” worked “to come to a bill that is passable.”

But Mark Grapentine, Wisconsin Medical Society chief policy and advocacy officer, said that the coalition of physician groups that were working on the bill did not reach a deal with lawmakers. They’ll ask Gov. Tony Evers to veto the plan.

“While the amendment that passed today took some smaller steps in the direction physicians felt were necessary to protect our state’s patients, it left other concerns unaddressed,” he said. “So what the Assembly passed fails to include what we felt were bare minimum guardrails.”

Grapentine said it was disappointing to hear comments on the Assembly floor that made it seem like doctors signed off on the bill as amended.

Doctor groups pushed for an amendment requiring 4,000 hours of experience of professional nursing practice and an additional 4,000 hours of physician-supervised experience after obtaining an advanced practice registered nursing certification before the nurses could practice independently.

They also asked that physician-specific terms like medical doctor and anesthesiologist only be used by those with physician-specific degrees.

And they wanted to see nurses outside a hospital setting practice pain management under the supervision of, or in collaboration, with a doctor trained in pain medicine.

The amendment doesn’t include specific training for the doctor the nurse would work with, “which doesn’t provide the level of safety we think is necessary for this area of medicine,” Grapentine said.

Wisconsin Nurses Association CEO Gina Dennik-Champion said the bill would allow advanced practice nurses to practice at the full scope of their license. They’ll be asking Evers to support the bill, which she says provides “access to quality, safe, affordable” care.

“Our state desperately needs these providers to be practicing in these places where there are no physicians,” she said.

Dennik-Champion said the “guardrails are there” with what the bill requires nurses to do to be licensed as advanced practice nurses.

The amendment includes a “transition to practice” provision similar to other states that requires nurses to practice for two years with a doctor before working independently, she noted.

Dennik-Champion said that title protections for physicians can be “addressed at another time” and including it “didn’t make sense at this time” since the bill focuses on advanced practice nurses. If physicians want the protections, they could look at including it in their own practice act, she said.

Certified registered nurse anesthetists delivering pain management services in clinics have to complete a fellowship before they can provide the service, she added, in response to doctors' concerns about that provision in the amendment.

“We think we have a bill that is clean and should be supported and enacted,” Dennik-Champion said.

Besides acting on the bill, the chamber also took up a series of workforce plans that, among other things, would make changes to the state’s Medicaid program.

One of the measures approved by lawmakers would bar the Department of Health Services from automatically renewing a Medicaid recipient’s eligibility. DHS would have to determine eligibility every six months, rather than annually. Any enrollee failing to report changes that affect their eligibility would be ineligible for benefits for six months from the date DHS discovers the change.

Wisconsin’s Medicaid program is under a continuous enrollment policy to qualify for more federal dollars during the COVID-19 national public health emergency. Under the bill, DHS would have to “promptly” remove people deemed ineligible for Medicaid once the funding ends. Until then, it would have to report the number of ineligible enrollees still receiving benefits.

A separate measure, from Rep. Calvin Callahan, R-Tomahawk, would bar some BadgerCare adults from turning down work or accepting a raise in order to maintain eligibility for the program.

“We are not kicking people off healthcare,” he said. “This bill would only affect those who are able-bodied and actually refuse work in an attempt to maintain their eligibility status.”

Advocates for those with disabilities and lower-income people oppose the measures. William Parke-Sutherland, health policy analyst for Kids Forward, said Callahan’s measure doesn’t take into account whether jobs provide affordable health insurance, offer hours recipients can’t meet or offer work that is unsuitable for their circumstances.

The Medicaid enrollment bill would pose hurdles for people to renew their coverage, requiring them to submit twice as much paperwork to keep it. The plan would also bar the state from using one of its best tools to ensure people have continuous health insurance coverage, Parke-Sutherland said.

“These changes would weaken the workforce by making our state sicker and would worsen stark racial inequities in who has access to care and coverage,” he said in a statement.

The Assembly passed the Republican-backed measures on party lines, advancing them to the Senate for further consideration.

The chamber also passed a measure along party lines that would bar the governor from declaring certain businesses essential or nonessential during a public health emergency. Any actions applied during such an emergency to businesses would have to be applied to all uniformly.

They also signed off on legislation requiring additional reporting on public benefits and the work of the Wisconsin Department of Health Services’ Office of the Inspector General.

Lawmakers signed off on a bill that would regulate and license genetic counselors, amending the plan so that it bars those in the profession from encouraging an expectant parent to obtain an elective abortion.

The Assembly also advanced the biennial agreed-upon bill recommended by the Worker’s Compensation Advisory Council.

Evers invests in EMS, mental health

Wed, 16 Feb 2022 16:39:21 GMT

Wisconsin Health News
February 16, 2022

Gov. Tony Evers said Tuesday he’s investing around $27 million to support emergency medical services providers and $25 million in mental health initiatives for schools, the University of Wisconsin System and the Wisconsin National Guard.

There are nearly 800 emergency medical service providers in the state, with more than half either operated by volunteers or a combination of volunteers and paid staff, Evers said in his State of the State address. Finding new volunteers has been difficult, he said, noting that state aid to local governments fell over the past decade as costs increased.

“Some have even gone without ambulance services, left with no other option but to hope and rely upon neighboring providers,” Evers said. “No one should be calling for an ambulance and have to wonder whether help will come.”

Around $20 million in American Rescue Plan Act money will head to rural Wisconsin to increase staffing support, get first responders more training and help purchase ambulances, medical equipment and supplies.

Evers' administration will also fund a 16 percent Medicaid rate increase for private and municipal ambulance services for emergency medical transportation, around $7.4 million in state and federal funds.

“This announcement and investment will be a tremendous help for EMS in Wisconsin, especially our rural and smaller services,” Alan DeYoung, Wisconsin

EMS Association executive director, said in a statement.

Evers also said he’ll invest $15 million to support additional mental health services in schools. Schools will be able to use the money to provide mental healthcare, hire and support mental health navigators, provide training and offer family assistance programs.

He’ll give $5 million to the University of Wisconsin System to provide mental health services through telehealth and additional mental health staff. And he’ll put $5 million toward expanding access to mental health supports for Wisconsin National Guard members.

Evers will also establish a Blue Ribbon Commission on Veteran Opportunity to make recommendations for his next budget. That could include mental health and substance use treatment investments, he said.

And he’ll sign an executive order on Wednesday calling for a special session to take up his plan to spend part of the state’s anticipated $3.8 billion surplus by the end of the 2021-23 biennium, including providing $100 million in tax relief to family caregivers.

In response, Senate Majority Leader Devin LeMahieu, R-Oostburg, criticized Evers for his stay-at-home order at the beginning of the pandemic, saying the governor deemed “hundreds of Main Street employers ‘non-essential’” and “devastated our small business community.”

“Now, Tony Evers’ COVID response centers on handing out giant, cardboard checks using the federal tax dollars, which are borrowed against our kids and grandkids’ futures,” LeMahieu said. “He promised to ‘get the money out the door’ as quickly as possible. But, now nine months later, he still has nearly $1 billion left in his Madison bank account.”

LeMahieu called on the governor to sign into law a series of initiatives aimed at getting more people into the state’s workforce.

They include a measure that would prohibit automatic renewal for Medicaid and require eligibility to be determined every six months, rather than every year. A separate bill would bar some BadgerCare recipients from declining work for the sole reason of continuing eligibility for the program.

Kind, Grothman urge revision of surprise medical billing rule

Wed, 17 Nov 2021 16:28:35 GMT

Wisconsin Health News
November 17, 2021

U.S. Reps. Ron Kind, D-La Crosse, and Glenn Grothman, R- Glenbeulah, recently joined 150 other lawmakers in urging the federal government to revise the interpretation of its surprise billing rule.

In a letter sent to Department of Health and Human Services Secretary Xavier Becerra, U.S. Department of Labor Secretary Martin Walsh and Department of the Treasury Secretary Janet Yellen, the lawmakers said the administration’s interpretation does not “reflect congressional intent” when the No Surprises Act passed Congress in December 2020.

Specifically at issue is the administration’s use of the median in-network rate as the primary determining factor in payment disputes between providers and payers during the independent dispute resolution process established in the law.

"This approach is contrary to statute and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and jeopardize patient access to care – the exact opposite of the goal of the law,” they said in the letter. “It could also have a broad impact on reimbursement for in-network services, which could exacerbate existing health disparities and patient access issues in rural and urban underserved communities.”

The law, effective Jan. 1, states that patients are held harmless and will not be responsible for medical bills higher than what they would pay an in-network provider. If providers or insurers believe an out-of-network medical bill or payment is unreasonable, either party may initiate the independent dispute resolution process

Dr. Brad Burmeister inducted into ACEP's Young Physicians Leadership Society!

Mon, 15 Nov 2021 16:13:12 GMT

Congratulations to WACEP President, Dr. Brad Burmeister, for being inducted into ACEP's Young Physicians Leadership Society. This Annual Award program recognizes attending emergency physicians who have demonstrated exceptional leadership within the specialty. Dr. Burmeister was recognized during the Young Physicians Leadership Section Leadership Summit at ACEP21 in Boston. He will also be recognized in the YPS "What's Up" newsletter, on the YPS website and in ACEP Now magazine.

“Since joining the WACEP Board two years ago, Dr. Burmeister has been incredibly active, taking the reins of the Membership Committee and going above and beyond in recruiting new members to ACEP around the state, and improving our retention numbers with personal outreach… As the current president of our chapter, he continues to grow and diversify our board beyond the Madison/Milwaukee area and has been a great proponent of rural outreach, helping our rural colleagues get education focused on the care of the patients that they see in resource-limited settings.”

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

President's Message - November 2021

Mon, 15 Nov 2021 16:11:27 GMT

Members,

What is your mission?

Our mission at WACEP is to “support quality emergency medical care and to promote the interests of emergency physicians.”

We do this in many ways. At WACEP, I think that the foundation of our work is advocacy at the state level. We are the only physician-based organization representing emergency medicine in Madison and we have a strong and growing voice there. Outside of advocacy, we also strive to provide educational opportunities for our members and to connect each other as a social function.

What is your mission? What is your purpose in this career? Emergency medicine is challenging, but people come to you because they need some sort of help. I like to think that it is my job to try and make people’s lives just a little bit better. For some this means perhaps trying to change the trajectory of their life. Whether it is to perform a life-saving intervention or to give them some medical advice to alleviate their concern that’s my purpose. When things are tough in the department, I try to remind myself that I have a mission and make sure that everything I do aligns with this.

As far as current things WACEP, in Madison things have been a little less busy than they were earlier this year during the budget process. In terms of working with ACEP, we just returned from the Scientific Assembly in Boston where we had several representatives on the ACEP Council where the priorities of ACEP are developed for the coming years. Lastly, the American Medical Association is currently meeting (or has just concluded) and as Emergency physicians via ACEP we have a growing presence there. Though things seem quiet right now a lot of work is happening to set our foundation for the future. I’m really happy as I follow along with this work and things look great.

Anyway, have a great early winter!

Best,
Brad

Sally Winkelman receives 2021 ACEP Honorary Membership Award

Tue, 19 Oct 2021 14:11:12 GMT

Sally Winkelman, former Executive Director of the Wisconsin Chapter, ACEP, was nominated by the WACEP Board and selected as the 2021 recipient of the ACEP Honorary Membership Award. The award is annually presented to an individual who has rendered outstanding service to the College or to the specialty of emergency medicine. Sally's name will be inscribed on a master plaque at ACEP Headquarters. The recipient is considered a lifelong member of the College, is not required to pay any dues, and cannot vote or hold office but receives all other benefits and privileges of membership.

Sally, who received her Bachelor of Business Administration degree in management and marketing from the University of Wisconsin-Madison, spent most of her career working with non-profit professional membership organizations. Prior to retirement, she served for eight years as an account executive with Badger Bay, a Wisconsin-based association management company, where she was the executive director for the Wisconsin Chapter of the American College of Emergency Physicians and several other statewide medical specialty associations. She is grateful to have been part of a professional community of ACEP chapter executives who support each other and serve their state chapters with unwavering dedication and professionalism.

Congratulations Sally!

WACEP President's Message, October 2021

Tue, 19 Oct 2021 14:09:46 GMT

It’s starting to feel like fall!

In just over a week your representatives from Wisconsin will be meeting at representing your voice at the ACEP Council. A diverse group of Emergency physicians from around the country which essentially considers new proposed policies (called resolutions). This is where the agenda for our national organization comes from. It helps to determine what things are we going to care about over the coming years and where should we put our collective resources. This year there are over 70 resolutions that will be considered during this process. They can be found here: https://www.acep.org/what-we-believe/actions-on-council-resolutions/council/action-on-2021-resolutions/. Should you have interest in policy, or being a member of our board, our meetings are always open and we can always use your help. At the same time, your membership is important no matter how active you care to be as your voice makes us stronger!

Thanks!
Brad

WACEP's own Dr. Lisa Maurer honored as one of EMRA's 25 und 45!

Thu, 07 Oct 2021 15:10:02 GMT

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!

WACEP Legislative Update - September 2021

Wed, 29 Sep 2021 16:29:19 GMT

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 Joint Letter in Opposition to 2021 Senate Bill 394

Thu, 29 Jul 2021 16:59:02 GMT

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

WI Emergency Physicians Attend ACEP LAC21 in Washington, DC

Thu, 29 Jul 2021 16:51:21 GMT

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:

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.
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.
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!

ACEP Research Forum - Special Edition: COVID

Wed, 21 Jul 2021 13:22:43 GMT

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!

RSVP for the WACEP Meet-up at ACEP21 | October 26, 2021

Thu, 15 Jul 2021 13:41:40 GMT

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

Thu, 15 Jul 2021 13:40:54 GMT

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

ACEP Webinar: Pandemics and Behavioral Health: What we learned and what we need to know for next time

Mon, 12 Jul 2021 19:53:33 GMT

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.

ACEP Webinar: White Coat Investor, Financial Planning

Mon, 12 Jul 2021 19:50:27 GMT

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.

WACEP Legislative Update

Fri, 18 Jun 2021 14:55:50 GMT

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.

Annual Membership Survey

Fri, 18 Jun 2021 14:54:47 GMT

Thank you for being a valued member of the WACEP. It is important to the WACEP Leadership to collect feedback from our members to evaluate and improve WACEP membership and continue to offer benefits to our members.

Please take 2-3 minutes to provide feedback in the Annual Membership Survey.

Your feedback is important!

BEGIN SURVEY

WACEP President's Message, June 2021

Fri, 18 Jun 2021 14:53:41 GMT

Happy Summer Everyone! Up here in NE Wisconsin at least we could use a rain dance!

We are having an exciting summer at WACEP. We had our first in person board meeting in over a year and met at Lambeau Field — home of America’s Favorite football team. We had a great day and have a lot of ongoing advocacy work on behalf of you.

Our most exciting news is that the Joint Finance Committee met on Tuesday and decided to include in their budget a raise for emergency services. This is our first MA rate increase in nearly 30 years (the last increase was a 1% increase). Though the final numbers are not yet complete this should be a significant, double digit increase accounting for at least $4m dollars per year from Medicaid to Emergency department professional fees. We anticipate the provision will be approved when the full legislature takes up the bill. Considering the Governor proposed the rate increase in his executive budget proposal, we expect a favorable result when it arrives at his desk. In the event that the Governor vetoes the entire legislative budget for other reasons, we will continue our advocacy armed with bipartisan support.

As always our team continues to work on many other issues: psychiatric care, violation of the prudent layperson standard by denying claims for emergency care, balanced billing issues, and many more items.

Thanks for being a member! Please know our next meeting is Tuesday, September 14th. Board meetings are open to anyone who may like to join. Also please save the date for the 2022 Spring Symposium, April 21-22, 2022 in Milwaukee, WI.

As always, if you have any issues you would like us to take a look at please reach out!

-Brad

WACEP President's Message, May 2021

Tue, 11 May 2021 17:47:55 GMT

Bradley Burmeister, MD, FACEP

Happy May!

Advocacy for Medicaid reimbursement for Emergency services continues to be our hot button issue. We held “Doctor Day” virtually last week, which brought together over 300 physicians across the state. We had three issues to discuss:

Telehealth
Medicaid coverage for women 12-months post-partum instead of just 60 days
Medicaid reimbursement with a specific ask for legislatures to support reimbursement increases for Emergency physicians.

We've received favorable feedback from multiple meetings and continue to be optimistic that we will see this $15.66 million increase per biennium to support emergency practices.

WACEP has been working on this issue for years and we are excited to see this progress. As you likely know, this provision has been included in the Governor’s budget. We are awaiting to see what the Joint Finance Committee from the legislature will do as they reconcile the Governor’s budget and create their own.

We have individually met with multiple key leaders to discuss the issue and, if you haven’t already, we encourage you to reach out to your own legislators as now is the time to provide your input to your local legislators. Here's how:

Visit https://legis.wisconsin.gov/ and under “Who Are My Legislators” enter your home address.
Your legislators will pop up complete with phone number and email address.
Call and/or email your legislators to convey this message.

Also, check out this interview Wisconsin Health News conducted with our WACEP Legislative Chair Dr. Lisa Maurer.

Moving forward I have some important dates to remind you of:

June Board Meeting, Tuesday, June 8, 2021 in Green Bay. Board meetings are open to all members so if you want to join us let us know!
ACEP's Leadership & Advocacy Conference (LAC), July 25-27, 2021 in Washington DC. Let us know if you want to attend or need more info.
WACEP Fall Rural Outreach Program, date and location TBD, watch for updates!
ACEP 2021, October 25-28, 2021 in Boston, MA. Watch for info on the WACEP meet-up!

As always, if you have any issues you would like us to take a look at please reach out!

~Brad

WACEP Staff Update and Reflections

Tue, 11 May 2021 17:02:25 GMT

Sally Winkelman, Outgoing Executive Director

June will bring some changes to WACEP staff as the organization welcomes Maggie Gruennert, CMP as the Chapter’s new Executive Director. Maggie has worked in association management for over six years including work with medical specialty societies and has expertise in regional and community outreach and event management. Maggie graduated from UW-Stevens Point with BS in Communications and Public Relations, is certified in meeting and event planning, and holds her Certified Meeting Professional (CMP) designation. In her free time, Maggie enjoys baking, sewing and spending time with her husband Kenny, daughter Peyton (3), son Ryder (18 months), and their yellow lab Henley.

As we transition, I’d like to offer my thanks for the opportunity and privilege to work alongside some of the most amazing volunteer leaders and members that I’ve come across in my 25 years in association management. Emergency physicians clearly have a unique energy and passion. You truly want to make a difference, and you ARE making a difference. One only needs to look at this past year to see the level of engagement, support for one another, and dedication to your profession that allows you to make a profound difference in the lives of so many. I look forward to following along in the years to come to see the continued progress of WACEP and emergency medicine.

Emergency doctors would see boost under Evers’ budget

Fri, 07 May 2021 14:11:33 GMT

May 6, Wisconsin Health News

Emergency physicians would see their first boost in Medicaid rates in more than two decades under a proposal in Gov. Tony Evers’ next biennial budget.

Wisconsin pays less than any other state for emergency medicine evaluation and management, the Medicaid code that emergency physicians submit for more than 90 percent of the care they provide, said Dr. Lisa Maurer, legislative committee chair of the Wisconsin Chapter, American College of Emergency Physicians.

Emergency doctors last saw an increase in Medicaid rates in 1994, she said. More hospitals now contract out clinical services for providers working in the emergency department, with around half of emergency department physicians part of a separate practice group.

On top of that, emergency physicians are federally mandated to see anyone who has an emergency, which differs from other doctors in other specialties like primary care who can manage their patient payment mixes to make their practice viable, Maurer said.

Current Medicaid reimbursement doesn't cover the cost of providing that care, paying 40 cents on the dollar for the care provided, she said.

“It really puts the practice groups and the hospitals that employ their physicians for that matter in a tough spot,” Maurer said.

The state has an “amazing network” of emergency physicians, but it’ll be hard to retain that unless there’s a significant increase in the Medicaid reimbursement rate, she said.

Evers' 2021-23 budget would boost the rate to around 70 cents on the dollar, Maurer said.

“It’s a big increase,” she said. “The timing couldn’t be better.”

Mark Grapentine, chief policy and advocacy officer at the Wisconsin Medical Society, said that Wisconsin's emergency physician reimbursements for common Medicaid services lag behind all neighboring states.

"Because many emergency physicians are organized as independent groups so that they can contract with hospitals from multiple systems, Medicaid reimbursement rates that don’t come close to paying the basic cost of providing care threaten the viability of these independent entities," he said.

Per the Legislative Fiscal Bureau, the budget would provide $10.4 million in state and federal funds to temporarily increase reimbursement rates in calendar year 2022.

That would set the rate at 50 percent of the rate paid by Medicare, boosting payments for physician services for emergency room visits by about 36 percent in aggregate that year.

Department of Administration Secretary Joel Brennan told legislators last month in a letter requesting budget modifications that the provision was intended to provide a permanent and ongoing rate increase.

To do that, he asked for an increase in the appropriation of $5.2 million, which breaks down to $2 million in state funds and $3.2 million in federal money, to cover through June 30, 2023, when the two-year state budget ends.

“We are over the moon that we are even being considered for an increase,” Maurer said.

Joint Finance Committee Co-Chair Rep. Mark Born, R-Beaver Dam, said during a legislative panel on Doctor Day on Wednesday that “no final decisions” have been made, given that Assembly Republicans have to determine their positions and negotiate with senators.

“I think it’s something that we should do something on," he said. "I also think EMS is an area that I would like to see some rate increases, but we haven’t had a caucus discussion on either one of those yet.”

WACEP President's Message, April 2021

Tue, 13 Apr 2021 10:58:19 GMT

Bradley Burmeister, MD FACEP
WACEP President

Thanks to all who were able to participate in last week’s virtual Spring Symposium! I will use this opportunity to recap the report I shared during our Annual Membership Meeting.

First, I hope everyone is finding themselves a bit more optimistic this year compared to last year at this time. Even through our annual conference and membership meeting were virtual, I’m thankful that we had an opportunity to get together to continue our important work and to come together as a state. I certainly look forward to when we can all be together again in person.

This year has been incredibly challenging for our entire community. As you all have no doubt experienced, unique challenges have presented themselves in practicing Emergency Medicine. WACEP leadership has been working hard to support you, our members, and all emergency physicians in the state. Specifically, we heard that emergency physician groups were struggling with decreased volumes and revenue and were forced to cut back hours and lay off staff. We worked with the Governor’s office to make CARES Act dollars available via CAPP patients. This resulted in millions of dollars to support emergency physician practice in Wisconsin.

We have worked tirelessly both at the state and national levels to mitigate potential risk with surprise billing legislation. Here, insurance companies saw significant potential financial advantage by rate setting potentially allowing out-of-network reimbursement to be even worse than negotiated in-network fees. In fact, many of your peers in WI traveled to DC to discuss concerns with our policymakers, and we think we have pretty good policy going forward.

Through the Emergency Psych Task Force, WACEP continues to work cooperatively with the Wisconsin Psychiatric Association on mental health issues. Together we’ve made great progress on improving mental health access and building on the relationship between emergency department and psychiatric centers across the state.

Lastly, as hopefully you have heard, we are very excited that emergency medicine has finally been considered in the Governor’s proposed executive budget for a Medicaid reimbursement rate increase that is planned to be permanent, not linked to Medicaid expansion, and that would improve rates by more than 30% of current rates. Though this move would advance us from last in the nation to just 45th, the move would be a giant step forward and would effectively represent millions of dollars in additional funding to your practice per year if it survives the legislative budget process. Stay tuned for information on how you can help!

I’ve outlined just a few of the many things that we have been working on as your professional association. None of this would be possible without you, our members. As a membership organization we depend largely on your membership and engagement to allow for our continued advocacy work. Your membership will help us make needed advancements in Emergency Medicine in Wisconsin. We are YOUR voice; we are there to protect you, your practice and your patients. Thanks for your membership!

~Brad

Premium holiday for state’s medical malpractice fund to last until June 2022

Wed, 07 Apr 2021 13:05:17 GMT

April 6, Wisconsin Health News

The premium holiday for Wisconsin’s medical malpractice fund will continue until mid-2022 to help offset impacts on providers from COVID-19.

Insurance Commissioner Mark Afable notified the Joint Finance Committee last week that he’s requesting that fiscal year 2022 rates for healthcare providers participating in the Injured Patients and Families Compensation Fund remain the same as the current fiscal year, which ends June 30.

The committee has until April 15 to approve the request. Currently, the fund is waiving fees for participating healthcare professionals and providers, per a request from the Wisconsin Medical Society. The premium holiday is set to last until June 30, 2022.

OCI spokeswoman Sarah Smith said that the rates will remain the same because the fund won’t be charging due to the COVID-19 pandemic.

Mark Grapentine, chief policy and advocacy officer at the Wisconsin Medical Society, said independent clinics are still fighting COVID-19 related costs and lost revenue and keeping the status quo for now makes sense.

“We’re doing all we can to advocate for those independent clinics who provide such important care to their communities while being on the front lines of the pandemic,” he said in an email. “We’re very fortunate to have a fund that’s run prudently and is in a stable financial condition so that it can provide a little fiscal relief for physicians.”

The Injured Patients and Families Compensation Fund covers claims beyond state-mandated insurance limits, which are set at $1 million by occurrence and $3 million by aggregate annually.

Action Alert to Support EM in Wisconsin

Wed, 31 Mar 2021 20:07:25 GMT

Colleagues -

WACEP needs your help! As you know, we have been working for decades to obtain an increase in Medicaid reimbursement to help support our work as the state's healthcare safety net. We are honored to take care of anyone who comes to the ED 24/7/365, but currently, Medicaid reimbursement only pays for 40% of the cost of taking care of a Medicaid enrollee patient.

For years, WACEP has continued to communicate our concerns about being able to attract and retain emergency physicians to our state, given that our Medicaid reimbursement is lower than any other state in the nation. Now more than ever after the COVID roller coaster of ED volumes, and after federal support has come and gone, it remains questionable whether our ED safety net is sustainable.

Governor Evers heard us, and his budget bill contains funding to increase Medicaid reimbursement specifically for emergency physicians! We need your help to push this across the finish line as our legislators now consider priorities for their version of a budget bill.

We need you to do three things:

Register for the April 8th WACEP Spring Symposium (if you're not already). Governor Evers is confirmed to provide remarks at our conference, and we need to show him that emergency physicians are engaged. It's just a few short months before he'll be signing a final budget bill.
Donate to the WI Emergency Medicine Political Action Committee and plan to attend the VIP Coffee Hour Reception during the Symposium that is exclusively offered as an opportunity for WEMPAC donors. The reception will feature Rep. Mark Born, co-chair of the powerful Joint Finance Committee that is instrumental in the budget process. Please join us to inform Rep. Born why increased Medicaid reimbursement for emergency physicians is desperately needed.
Watch for a call to action via grassroots advocacy in the next couple of weeks where we will prompt you to send messages to your legislators regarding our specific budget ask for increased Medicaid reimbursement for emergency physicians.

Thank you so much for keeping emergency medicine in Wisconsin strong!

Lisa Maurer, MD, FACEP
WACEP Legislative Committee Chair

Brad Burmeister, MD, FACEP
WACEP President

Doctor Day 2021 to include timely breakout sessions

Wed, 24 Mar 2021 21:03:29 GMT

Join your colleagues (virtually) for Doctor Day on May 5, 2021 to fight for your patients, profession and sound health care policy. Doctor Day 2021 will include morning breakout sessions on health equity, public health and the latest legal issues facing physicians so you can customize the day to your interests. Organizers are once again lining up presentations from premier experts and policymakers. The schedule features three breakout sessions:

Health Equity
What are we doing to achieve long-lasting and equitable health outcomes for ALL Wisconsinites? The State of Wisconsin has an overall health disparities grade of “D” according to a recent University of Wisconsin Population Health Institute Health of Wisconsin Report Card. The Report Card notes that while Wisconsin's grade for overall health has remained the same since 2007, the health disparities grade has worsened since 2010. What are we doing to change this?

Public Health
Join us for an outbreak session on local public health response to the COVID-19 pandemic. City of Milwaukee Health Commissioner Kirsten Johnson will provide an overview of the challenges and successes Wisconsin's local public health departments faced throughout the last 12 months. As fellow frontline workers, local public health officers have experienced this crisis through the lens of both health care and governmental response to public health crises.

Legal Update
The always popular and pertinent legal update will explore the latest “hot topics” physicians need to know about. Axley attorneys Guy DuBeau and Aneet Kaur will walk us through the landscape of litigation trends, scope of practice developments and more.

To learn more about this virtual day of advocacy, go to widoctorday.org to register (it’s free) and see the day’s agenda.

MEB approves prescribing CME requirement extension; begins work on potential chaperone rule

Wed, 24 Mar 2021 20:59:58 GMT

March 18, Wisconsin Medical Society

The State of Wisconsin’s Medical Examining Board (MEB) at its most recent monthly meeting advanced a proposed administrative rule that will extend for another biennium the requirement that most physicians obtain two credits of continuing education related to opioid prescribing. The requirement applies to physicians who hold a Drug Enforcement Administration registration number, with the two credits being part of the 30 credits required each biennium. Courses must be approved by the MEB in order to satisfy the subject matter requirement.

The Wisconsin Medical Society (Society) spoke in favor of the rule at the MEB public hearing March 17, noting how the COVID-19 pandemic has exacerbated opioid abuse across the county. The Society also expressed appreciation that the rule widens the scope of qualifying coursework beyond opioid prescribing to include “other controlled substances.” This will allow physicians who hold a DEA number but may not prescribe opioids to access coursework more relevant to their practice.

The MEB also began to discuss whether to add a provision to the “unprofessional conduct” section of the MEB’s administrative code (MED 10) that could require physicians to offer patients a chaperone for certain sensitive physical exams. The idea comes from a January 2020 ACOG Community Opinion paper recommending that a chaperone be present for all breast, genital and rectal examinations. While the MEB discussed the issue only generally during its meeting March 17, it will review potential language at its April meeting.

Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

WACEP President's Message, March 2021

Sat, 13 Mar 2021 15:01:51 GMT

Bradley Burmeister, MD FACEP
WACEP President

Hello WACEP Members!

I’m hoping this isn’t going to be an “in like a lamb, out like a lion" March! We’ve been pretty lucky, and I’ll be honest, I’m slightly bummed at the quickly deteriorating skiing conditions across the ski resorts in our state!

WACEP continues to be very busy. We continue to follow multiple pieces of legislation moving through at the state level including: the proposed Medicaid reimbursement budget increase; proposed balanced billing legislation; the PA bill; many bills impacting EMS and more. I’m anticipating many updates over the next few months so will save you from information overload now, but obviously if you have questions, please reach out to us!

Our most important update in the coming month is that our virtual annual meeting / Spring Symposium is April 8th! We have a great day planned full of education and networking, and I encourage everyone to join us if available! Sign up here.

Another exciting transition is that the WACEP Board is planning an in-person meeting the morning of June 8th at Lambeau Field! If you are in the region or want to join us for the conversation or just the phenomenal view, Board meetings are open to all members. Just let us know if you plan to come and we’ll get you details!

Thank you for your membership.

~Brad

CURES Act Update and Helpful Hints

Fri, 12 Mar 2021 15:35:45 GMT

Barack Obama signed the CURES Act into law in 2016. This 996 bill has many provisions that can be found online through ACEP, and also through HHS. This Act impacts Emergency Physicians in a number of ways and a brief review of the bill may be worth your time.

Throughout the past year, our institution has changed the default setting to share all emergency physician notes with certain exceptions. This action has resulted in a handful of patient complaints or requests to change the medical record.

Here are some helpful hints that I have found through review of patient concerns.

Common Documentation or Pitfalls	Considered Revision
Patient is obese	Patient’s BMI >30 or meets the medical criteria for obesity.
Patient refused admission to the hospital	After discussion of the risks and benefits of hospital admission the patient elected to continue treatment as an outpatient. Patient is decision and understands they are at increased risk of myocardial infarction…. The patient is concerned if they are admitted there will be nobody to watch their children and they will get fired from their job.
Patient appears SOB	Patient is short of breath
Patient refuses to take their medication	Patient has difficulty affording medication, or has had difficulty tolerating pills…..
Patient is paranoid and refuses to acknowledge	Consider revising using direct quotes. “The transmitters in my brain tells me the medication is the devil.”
Beware of just loading the macro	Patients will likely notice when they come for an ankle sprain and you preload the heart, lung and full neuro exam.

While this is not an exhaustive list, I think the take home message is that direct quotes and non-judgmental language will decrease concerns from patients and strengthen the quality of the medical record. Knowing why the patient elected to be discharged, couldn’t take their medications, or providing direct quotes may even help other members of the care team give better care for the patient. Medical records reflecting the compassionate and thoughtful care will build trust with the patient and result in more efficient care and better physician-patient relationships.

There may be a few instances in which the physician may not want a note visible to the patient. Examples include forensic nurse evaluations or instances in which a mother’s spouse may not be the father of an infant. Check with your institution on how to opt out of sharing notes. While guided by the CURES Act each institution has its own workflow.

Familiarizing ourselves with the CURES act in our daily practice our health system’s implementation will ensure the physician’s note reflects our commitment to safe and compassionate care.

Emergency Medicine Needs You! ACEP Committee Application Process Now Open

Tue, 02 Mar 2021 23:27:33 GMT

The ACEP committee application process is now open to any member interested in joining a committee. The deadline to apply is May 1st.

ACEP has more than 35 committees and task forces working on issues such as ethics, emergency medicine practice, pediatric emergency care, disaster medicine and more. Please consider volunteering—ACEP and emergency medicine need your experience and expertise. Committees provide important leadership to ACEP members, its Board and Council.

EMRA members who are interested in serving as that organization's representative on an ACEP committee should also apply. The process is the same for resident and active members and you can expedite the process by using the online application. Residents and candidate applicants may provide a letter from their program directors and/or mentors as well.

The majority of committee work is accomplished through e-mail and conference calls. Committee members are expected to attend the organizational meetings at the annual meeting in Boston, October 23-24, 2021.

Those not currently serving on a national ACEP committee will be required to submit a current CV to volunteer for a committee. Please attach your CV to the online form or mail it to ACEP headquarters. You may also want to submit a letter of support from the Wisconsin Chapter, ACEP.

Review the online application for details and to begin the process. After completion of the form, you should receive an acknowledgement that your committee interest form has been submitted. Committee appointments will be finalized in late June. If appointed to an ACEP national committee, your appointment will not be considered final unless a completed Conflict of Interest form is submitted by the deadline.

Each Committee is appointed by the President to assist with activities for the year. Committee members serve 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.

Questions may be directed to Mary Ellen Fletcher, CPC, CEDC, at 800-798-1822, ext. 3145, or mfletcher@acep.org.

Gov. Evers Includes Emergency Medicine Medicaid Reimbursement Rate Increase in State Budget Plan

Tue, 23 Feb 2021 20:58:23 GMT

WACEP Members,

We have great news to report! Governor Evers included a proposed budget increase of over $5.2 million annually in his executive budget to improve Medicaid emergency services reimbursement rates in Wisconsin. WACEP has been advocating for this increase for over 20 years since our last consideration of an increase.

As you probably know, the Wisconsin Medicaid program reimburses the worst in the country for our most commonly used E/M codes, and we have a lot of work to do to make this increase a reality. The budget proposal must go through the Joint Finance Committee and be approved by the full legislature over the next four months.

At this point, the budget provides an increase, however exactly how that increase would be operationalized (should it make it through the Legislature) would be determined by the Department of Health Services (DHS). We continue to work with the Administration to understand exactly what $5.2 million might look like to specific reimbursement coding. Obviously WACEP will continue to work with the state should this budget item make it through the earmark.

It’s important to know that while the Governor included this funding in his budget, it has a long way to go before it becomes reality. With certainty, we will need YOUR help over the coming months to contact your legislators to help ensure that this item remains in the budget.

As we learn more and work out details of the specific ask to your individual legislators, there are two things you can consider doing now. First would be to send a “thank you” to the Governor:

E-mail: EversInfo@wisconsin.gov
Phone: 608-266-1212
Mail: The Honorable Tony Evers, Governor of Wisconsin
115 East, State Capitol
Madison WI 53702

Second, please consider attending Doctor Day on May 5th, which will be virtual. While Doctor Day addresses issues pertinent to all physicians, this could be a great opportunity for you to meet with your legislators during what is anticipated to be a key time in the budget process. Notably, attending Doctor Day should not supplant other grassroot efforts (calls, meetings, letter writing) during the budget process, but the additional exposure and participation could be very helpful.

Finally, thank you for your membership in Wisconsin ACEP. You give a voice to Emergency Medicine in Wisconsin. Should you find yourself interested in helping our organization continue to build relationships please consider giving to our PAC or recruiting a colleague to ACEP/WACEP membership.

Please know that our physician legislative committee members and advocacy team are monitoring developments daily. Stay tuned for additional updates.

Thanks!

Brad Burmeister, MD, FACEP, WACEP President
Lisa Maurer, MD, FACEP, WACEP Legislative Committee Chair

Gov. Evers' Budget to Include $25 Million on Crisis Intervention and Emergency Detention

Wed, 10 Feb 2021 19:34:16 GMT

This morning, Governor Evers announced important proposals he will include in his Executive Budget, scheduled to be introduced next week. Included are several proposals specifically aimed at reforming crisis intervention and emergency detention—all of which are a direct result of ongoing work of the WPA/WACEP Emergency Psych Task Force as part of a collaborative workgroup with the Badger State Sheriffs, Wisconsin Sheriffs and Deputy Sheriffs Association, and the Wisconsin Counties Association.

While these proposals are only the first steps in the biennial budget process and must go through both the Joint Finance Committee and the full Legislature, WACEP is thankful both for the Governor’s leadership and recognition of these shared challenges, and the work of the Emergency Psych Task Force for bringing these proposals and important issues to the forefront.

Read Gov. Evers' Budget Proposal Press Release.

WACEP President's Message, February 2021

Tue, 09 Feb 2021 20:31:33 GMT

Bradley Burmeister, MD FACEP
WACEP President

February is always my favorite month. This February seems extra special: we have vaccines for COVID, COVID numbers are down, and the days are getting longer and longer.

I think, though, we have another glimmer of hope in our ongoing push for fair reimbursement from the Medicaid program. The state is projected to have a more than $600 million Medicaid surplus (partly due to increased federal funding related to COVID). WACEP has been making the case to the Governor and Legislature for increased Medicaid reimbursement rates. Having essentially the lowest reimbursement rates in the country for Emergency services and having not seen an increase in decades, WACEP continues to advocate for fair increase. This is hopefully the prime opportunity for us to move forward. We may need your help, so stay tuned—we’ll let you know if there becomes a time where we need your grassroots help!

In the meantime, save the date for these two important advocacy opportunities:

May 5: Wisconsin Doctor Day (virtual) Visit https://www.widoctorday.org to sign up. Meet with your state legislator and/or their staff at the state level. Building relationship is incredibly important. Although the exact legislative priorities we will advocate are still to be determined it would be nice to have a good representation of Emergency physicians.

July 25-27: ACEP Leadership and Advocacy Conference (LAC) Visit https://www.acep.org/lac/ to learn more. Meet with your federal legislators and/or their staff. This might be virtual, it might be in person, it might be a hybrid! For now, save the date!

Also, don’t forget about our own WACEP 2021 Spring Symposium on April 8. It’ll be virtual this year and is always a great opportunity to learn and network with your peers. Register today!

And finally, how can Wisconsin ACEP help you? If you have any questions, concerns or needs, please do not hesitate to reach out! My email is BradleyBurmeister@gmail.com.

Physician Leaders Invited to Hybrid Leadership Development Conference

Tue, 09 Feb 2021 19:05:08 GMT

The Wisconsin Hospital Association (WHA) sponsors an annual educational conference on leadership. Because of the pandemic, this year's conference will be split into a half-day of online talks on March 12, and then two half-days of in-person talks and discussion on September 14 and 15, 2021.

WHA welcomes physicians in leadership positions, and especially those physicians with a developing interest in leadership, to participate in the conference.

Learn more and register. Be sure to click on the featured presenter tab near the top pf the web page to see the outstanding group of speakers for this conference.

Stop the COVID Spread! Coalition: “The Fight’s Not Over Yet”

Tue, 09 Feb 2021 18:02:02 GMT

Businesses, frontline workers, and communities from across the state have come together this past year to help slow the spread of COVID-19. As many await vaccines, and our health care providers battle new strains, we can’t let our guard down now.

The most recent public education message from the Stop the COVID Spread! coalition urges Wisconsinites to remain vigilant in the continuing fight against COVID-19, stressing the importance of continuing to practice key, simple measures like wearing face masks, social distancing, and washing hands regularly.

WACEP is proud to be part of the “Stop the Covid Spread!” coalition, a group of Wisconsin’s leading health care, business, education, and advocacy organizations who have all joined together in the effort to urge the public to step up and take preventative measures seriously. The coalition has grown dramatically since its launch and now includes over 135 Wisconsin organizations.

We’ve come a long way together but the fight’s not over yet! You can learn more about the coalition and how we all need to stay vigilant to help stop the spread: https://www.healthywialliance.com/Stop-The-COVID-Spread. Please join us in sharing this crucial message with your friends and family!

Doctor Day to Feature JFC Panel on State Budget

Wed, 03 Feb 2021 14:20:48 GMT

While Doctor Day 2021 has shifted to a virtual format, the May 5^th event promises to offer equally important hot topics and content.

This year’s policy and politics panel will include members of the powerful budget-writing Joint Committee on Finance. Committee co-chairs Representative Mark Born (R-Beaver Dam) and Senator Howard Marklein (R-Spring Green) will be joined by their Democrat colleagues Representative Evan Goyke (D-Milwaukee) and Senator Jon Erpenbach (D-West Point).

You will hear a first-hand account of important budget topics, and during the middle of budget negotiations. This includes policy related to the Department of Health Services and funding for the Medicaid Program. This is a great opportunity to hear differing views on policy and spending priorities for the 2021-23 Biennial Budget and current legislative session.

Other components of the day will again include policy breakouts, priority issue briefings, a keynote presentation and of course, legislative visits.

Whether you’ve attended many advocacy days in prior years or none at all, be sure to sign up for Doctor Day 2021 and make your voices heard! The unique multi-specialty nature of Wisconsin's Doctor Day offers all physicians across the state from all specialties to come together and advocate for issues affecting their patients, their practices and their specialty. Learn more and sign up at www.WIDoctorDay.org.

Calling All Faculty for EMRA Virtual Medical Student Forum

Thu, 28 Jan 2021 19:36:36 GMT

EMRA is looking for faculty for its Virtual Medical Student Forum taking place on Saturday, March 27, 2021 from 9:30 am to 12:45 pm CDT. Interested faculty should apply by February 1.

The EMRA Medical Student Forum is free to all EMRA medical student members. It brings together program directors and faculty to answer questions specific to your phase in training. General sessions answer big-picture topics, and breakout sessions per year to target exactly where you are in your training.

This Week! Midwest Medical Student Forum

Tue, 26 Jan 2021 17:39:40 GMT

The annual Midwest Medical Student Forum, hosted by the Michigan College of Emergency Physicians, is taking place virtually on Thursday and Friday, January 28-29. Register today by calling 517-327-5700. This year's Forum will include:

Small-group advising
Residency panel
Residency fair
Virtual SIMS course (space is limited)

WACEP President's Message, January 2021

Mon, 18 Jan 2021 16:37:01 GMT

Brad Burmeister, MD, FACEP
WACEP President

Welcome to 2021!

We are off to a great start! This is my first message as the new President, so "hello" to those of you I do not know. Just a bit about me... I work for an independent group in Green Bay which staffs Bellin Hospital.

Before we get to some updates, I want to thank our now Immediate Past President Ryan Thompson, MD, FACEP for all the important work he has done. I’m particularly thankful for his leadership along with our legislative committee and the lobbying team (HWZ) for their hard work on the WI CARES act, efforts on Surprise/Balance Billing at the state level, and ongoing work on Medicaid Reimbursement. I think we are in a great spot moving forward and have some excellent ground work accomplished.

On that note, the legislative team at ACEP has been very busy ensuring the voice of the Emergency Physicians are heard across the country. As a result, we have many favorable outcomes with the “2020 Year End Package” which Congress passed. In particular we have reasonable legislation on Surprise/Balanced Billing as well as better outcomes with Medicare cuts that what had been pending.

WACEP has been working on our own Surprise/Balanced Billing battles at the state level, ongoing efforts for Medicaid reimbursement increases, extending liability protections due to COVID-19, among many other things!

If you haven’t already checked out our virtual Spring Symposium please do so. It will be held Thursday, April 8th, so coming up quickly! We have some great speakers including Dr. David Talan with some insights into infectious disease and Emergency medicine, education on Buprenorphine (Suboxone) and Dexmedetomidine (Precedex), an ATLS update, and an update from Dr. Ryan Westergaard (“The Dr. Fauci of Wisconsin”). Learn more and register!

If you have any questions or issues you want us to look at, please do not hesitate to contact me.

Please follow us on Facebook! @WiACEP

Stay safe!
Brad Burmeister, MD, FACEP

Feb. 1 - Free EM MAT Waiver Course Training

Tue, 12 Jan 2021 15:49:36 GMT

The DC-ACEP Chapter is hosting an EM MAT Waiver Training Course on Monday, February 1, 2021 and has extended an invitation to all ACEP members to participate for free. Anyone looking to get their waiver early this year is encouraged to register.

The course is hosted by the DC ACEP Chapter and provided by national ACEP, in partnership with Providers Clinical Support System and the American Academy of Addiction Psychiatry. The 8-hour training is open to Physicians (MD/DO), Residents, Medical Students, NPs (including those in training) and PAs (including those in training). Medical Students and those currently in training can apply for the waiver once they complete their training.

No expiration for Waiver Training Completion Certificate.
No pre-work/course requirements.
CME provided and in order to fulfill requirement for CME you will have to complete the post-course evaluation from national ACEP and from PCSS for evaluation of the Waiver Training Completion Certificate.
This training course is not graded but completion or all evaluation questions is required.
The only requirement to be eligible for completion is that you stay connected and logged in to the zoom platform through your email account for 8-hour duration of this course.
The webinar will not be recorded but the slide deck will be shared with everyone after the webinar has been completed.

Learn more and register here (ACEP login is required).

Legislative & Advocacy Update, December 2020

Thu, 17 Dec 2020 18:19:43 GMT

AJ Wilson and Greg Hubbard
Hubbard Wilson Zelenkova LLC

Election Recap

Election Day has come and gone but likely won’t be one we forget anytime soon. When it was all said and done, now President-elect, Joe Biden defeated Donald Trump in Wisconsin by just over 20,000 votes. The close result was anything but new for the Badger State at the top of the ballot. Two years ago, Tony Evers defeated Scott Walker by 29,000 votes; in 2004, John Kerry defeated George W. Bush by only 11,000 votes; and in 2000, Al Gore defeated George W. Bush by only 5,700 votes. As I type, a potential recount is still pending but unlikely to change results significantly.

Notwithstanding the close presidential contest, legislative races were less competitive in Wisconsin. Despite very favorable pre-election polling, Democrats defeated only two incumbent Republicans in the State Assembly where Deb Andraca (D-MKE) and Sara Rodriguez (D-Brookfield) defeated Republicans Jim Ott and Rob Hutton respectively.

The State Senate went the opposite way altogether as Republicans picked up two seats held by Democrats. In the 12th SD that encompasses much of Northwestern WI, Rob Stafsholt (R) defeated Patty Schachtner (D) handily in the seat that Schachtner won in a special election just under two years ago. In the Green Bay area, Eric Wimberger (R) beat Jonathan Hansen (D) to snatch the open seat from Democrats that had long been held by retiring Dave Hansen.

Therefore, Republicans will continue to hold strong majorities in both houses of the State Legislature. The composition of the assembly will be 61-38 when they return in January. The State Senate will be 20-12 with one seat vacant as Scott Fitzgerald’s seat will be open as he won the WI’s 5th Congressional District. That heavily republican seat will most likely give Republicans a 21-12 majority early in session once the seat is filled.

Governor’s Proposal for additional COVID-19 response Legislation

The Governor proposed legislation in mid-November to address a number of pandemic related issues. The Legislature has not said whether it will come in before the end of the year to consider any of the proposals. The Governor’s draft, among several other provisions, includes the following:

Require that insurers cover all telehealth services that would be covered were the services provided in- person.
Prohibit insurers from requiring prior authorization or imposing quantity limitations below a 90 days supply through the end of 2021.
Allow pharmacists to extend most Rx refills by 30 days through the end of 2021, where it is safe to do so.
Ensure that health plans provide coverage for testing, diagnosis, treatment, prescriptions, and vaccines related to COVID-19.
Prohibit cost-sharing and prior authorization for testing, diagnosis, treatment, prescriptions, and vaccines related to COVID-19.
Establish that insurers will reimburse providers for out-of-network care (including telehealth) resulting from COVID-19 related disruptions at 250% of Medicare rates.
Allow critical workers, including healthcare workers, to claim worker’s compensation benefits related to COVID-19, presuming that they received the illness from their occupation.

We are engaging with the Legislature to improve the Surprise Billing provision should this or any other bill move forward to include a definition of “usual and customary rate” as well as favorable dispute resolution.

We are also asking the Legislature to include a liability immunity provision for health care providers similar to what we were able to get included in the COVID response bill this Spring.

Board of Nursing Rulemaking Activity

The BON has taken action on three issues related to APNP scope of practice in the last two months. The first is a rule proposal that would allow the BON to waive APNP Collaboration Requirements contained in WI Nursing Code 8.10(2) and (7) during a state declared emergency. This rule change is in progress - Clearinghouse Rule 20-069. The comment period closed on Dec. 10 with a hearing where a joint letter was submitted from WACEP, the WI Society of Anesthesiologists, and WI Psychiatric Association in opposition.

The second is a proposed scope statement that would give the BON the ability to draft a new rule that would permanently amend current law collaboration requirements for APNP contained in WI Nursing Code - N8. The third is a proposed scope statement that would give BON the go ahead to draft permanent rule changes related to APNP prescribing limitations also contained in N8. Undoubtedly, this would be to expand those privileges, but details are not yet available. We have expressed front-end concerns and will continue to monitor and engage if these proposals move forward.

Surprise Billing Work Group

WACEP is working with the Wisconsin Radiological Society, the Wisconsin Society of Anesthesiologists, and the Wisconsin Society of Pathologists on comprehensive surprise billing legislation as well as the aforementioned proposal for pandemic response. At this moment, negotiations are taking place again on a federal bill. The direction Congress goes on this issue will dictate our response or pro-action on the state level.

Emergency Psych Task Force Work with State Sheriffs and Wisconsin Counties Association

HWZ, WCA, and Sheriffs’ lobbyists met recently with the Governor’s policy director to discuss options for including proposals of mutual agreement in the Governor’s executive budget. Among those proposals was a more substantive suggestion for regional crisis stabilization centers as well as proposed codification of the SMART medical clearance form.

Looking Forward

Over the month, the legislature will fill out committee assignments and will then come back to start the new session in January. It is unlikely that another pandemic response bill will be taken up before inauguration day, however we continue to do outreach on the aforementioned priorities just in case they do come into session.

So Long, 2020

Thu, 17 Dec 2020 16:36:43 GMT

WACEP President's Message, December 2020
Ryan Thompson, MD, FACEP

As I write this message, I just scheduled my appointment to get my first COVID-19 vaccine. It feels fitting for this to be the way 2020 finally goes out – a year that has been absolutely dominated by the coronavirus pandemic. State guidelines have designated frontline healthcare workers as 1A priority for vaccination, front of the line for protection. This is far from the end of COVID-19, as viral precautions, limited opening of businesses, and mask orders are likely to continue until a large portion of the general population can be vaccinated (hopefully mid 2021). However, it does perhaps feel like the end of the beginning, as Churchill might say.

This year has been a stressful one for emergency physicians all over the state. We were thrust into a pandemic with extremely limited PPE supplies, and little to go on for treatment options other than what could be glommed together from earlier hot spots like China, Italy, and New York. We saw our volumes plummet as patients feared contamination in the hospital, only to be inevitably replaced by scores of patients suffering from the virus months later, and nowhere to admit them. Some of us caught the disease ourselves. Many of us have been called liars by patients when we tell them they contracted COVID-19, even while being placed on BiPAP machines, due to rampant misinformation. Some of us had the misfortune of seeing beloved family members, friends, and colleagues succumb to the plague.

As my tenure as WACEP President draws to a close, I want to heartily thank each and every one of you for your resilience, your dedication, and your commitment to you patients and your communities. Without you, thousands more Wisconsinites would not be with their loved ones this holiday season. What you all do matters, and that fact has never been more clear than it is now. May the light at the end of the tunnel provide you some warmth, and hope, as we enter this next phase of the pandemic.

God speed, and keep up the good work. It has been an honor to serve you.

Trouble Admitting that Psych Patient? Try the Doc-to-Doc

Thu, 17 Dec 2020 16:02:32 GMT

One of the most common complaints that I hear from Emergency Physicians around Wisconsin is the difficulty in medically clearing patients for admission to outside psychiatric facilities. Sometimes EM docs are being asked to get serial labs for minute electrolyte abnormalities, or prolonged observation for non-toxic overdoses. This leads to delays in transfer, prolonged ED stays, agitated patients, and exasperated ED staff.

WACEP has been a part of a joint task force with Wisconsin Psychiatric Association (WPA) to help address issues germane to both our specialties. While emergency physicians struggle on one end of the transfer, every inpatient psychiatrist can share stories of a patient who decompensates shortly after arrival at their facility, so they are appropriately wary.

At the end of the day, we all want to do what is best for patients. It is imperative that we provide a thorough evaluation and appropriately diagnose and treat any comorbid medical issues in the ED prior to transfer, but what to do when you feel your due diligence has been done and you are getting pushback you feel is inappropriate?

Often the first screener for admission is a nurse or APP, and many of these requests for additional workup come from a lack of medical understanding and an abundance of caution. The psychiatrists have encouraged us to ask to speak directly to the psychiatrist on-call for a given facility if you feel that further workup is not warranted. In particular, Dr. Pope, Medical Director at Winnebago, endorses this approach.

WACEP and WPA hope that this will help to alleviate unnecessary delays, and still ensure safe hand-off of patients between EDs and psychiatric facilities.

WACEP Joins The Medical Society Consortium on Climate & Health

Thu, 17 Dec 2020 15:46:28 GMT

Caitlin Rublee, MD, MPH

WACEP has followed in ACEP's lead and joined the Medical Society Consortium on Climate & Health, which represents more than 60% of physicians in the U.S.

The Wisconsin chapter (Wisconsin Health Professionals for Climate Action or WHPCA), has several working groups and activities planned for the coming year. WACEP members can get involved here.

Check out our recent report that highlights the health and economic opportunities of transitioning to clean energy, which would result in $21 billion per year in avoided health damages and would prevent 1,910 early deaths, 650 emergency department visits for respiratory concerns, 34,400 asthma exacerbations, and 650 heart attacks.

Climate change certainly has several implications for emergency medicine. Heat-related illnesses, acute on chronic disease exacerbations, changing infectious disease burdens (water and vector-borne), and traumatic injuries, even an increase in cold-water drownings from thinner ice. While the current pandemic cannot be ignored, higher mortality rates from COVID-19 were found in U.S. counties with worse air pollution.

All people are at risk, but specific populations are at increased risk of poor health from climate-related events. Older adults, infants and children, those with other medical problems, outdoor workers, and those with unstable housing or lower incomes are just a few examples. In severe circumstances, shortages in supplies (sterile saline) related to hurricanes and other tropical storms affect health care service delivery even far away from the area of impact. The health sector is also responsible for almost 10% of U.S. greenhouse gas emissions, which continues to fuel further warming.

December has been a busy month for climate change and health. December 12 marked the 5th Anniversary since the Paris Agreement was signed by 196 parties. The U.S. is expected to re-join in 2021. The 2020 Lancet Countdown on Health and Climate Change U.S. Brief and Appendix were released with recommendations for a just and equitable path forward. The Wisconsin Governor’s Task Force on Climate Change released their report with next steps for action across nine sectors and three policy pathways.

As we celebrate the New Year, let’s look for opportunities within our healthcare systems and across our great state to support the health of our residents and each other.

EMRA Leadership Opportunities - December Deadlines

Mon, 23 Nov 2020 21:47:10 GMT

Do you know an EM-bound medical student ready to lead? Encourage them to apply to the EMRA Medical Student Council to advocate for and offer programming to our medical student members. Deadline is December 1. These are funded positions to attend the ACEP Scientific Assembly in 2021.

EMRA Committee Leadership - From Admin/Ops to Social EM to Wilderness Medicine, EMRA's Committees have a place for student, resident and fellow members. Applications for Chair Elect and Vice Chair positions are due December 1. These are funded positions to attend the ACEP Scientific Assembly in 2021.

The EMRA/ACEP Leadership Academy is the perfect place for current and emerging leaders. This program teaches the soft-skills of leadership through MBA-like courses. Applications are due December 31.

Call to the Masters of Patient Flow: Consider transfer to the COVID Alternate Care Facility from the ED

Thu, 19 Nov 2020 14:53:35 GMT

Lisa Maurer, MD, FACEP
WACEP Past-President & Current Legislative Chair

“I love it here,” my patient at the Alternate Care Facility (ACF) said, and if I hadn’t been wearing a respirator, my jaw may have dropped. Since my EM group staffs the ACF, I knew the quality of care would be excellent. However, I didn’t expect the patients to feel so relaxed and comfortable in the middle of a state fair exposition center.

During my recent first shift working at the ACF, I saw patients who were happy to come from overwhelmed hospitals to receive expert care, provided by warmly attentive staff, in a surprisingly relaxing environment. If open inpatient beds are disappearing and ED holds are growing at your shop, I hope the details of my experience working at the ACF help you to convey the benefits of transfer to the ACF to your next patient with COVID.

After being propped up by the U.S. Army Corps of Engineers in the Spring, the ACF was activated on October 16th to serve as an overflow facility for Wisconsin. Check out this 15-second time lapse video showing the process of turning an Expo Center into a facility with the capacity to care for hundreds of patients. “Cubicle” type rooms are surprisingly quiet and have hospital beds. It’s not uncommon to see a patient’s room featuring a blanket or keepsake from home. Catered food is available three times daily, and on game day, the patients might be found in the common area by the big screen. There are pods of bathrooms and showers for those who feel up to it. Patients told me that they were getting more rest there than they were ever able to get in the hospital or even at home.

From a medical standpoint, almost 300 of the cubicles have in-line oxygen with capabilities for nasal cannula, high flow, or opti-flow up to 50L at 50% FiO2. They can receive IV fluids and medications, including remdesivir. As of the time of this article’s publication, there were 18 patients at the ACF with 6:1 nursing ratio and two providers. The onsite pharmacist is top notch, and many of the nurses and RTs are “travelers” who are more than comfortable caring for patients with COVID given their vast experience. In the case where a patient needs respiratory support or other medical care than surpasses what’s readily available, the onsite EMS unit transfers them to a nearby hospital at the discretion of the onsite emergency physician.

In response to feedback from around the state, the intake form has once again been revised and simplified. If you have a patient in your ED that meets the eligibility criteria as per the Reference Guide, fill out pages 4-5 of the guide and email to the address listed. The information will be reviewed by the CMO or designee, who is another fellow emergency physician. They review patients for transfer daily from 9a-5p, and patients may now arrive until 6:30p, updated from a previous 5p arrival deadline.

Everyone involved wishes we didn’t need an ACF. However, if you’re like me, I’m so grateful to have it as an option, especially now that I know it has proven to be a good experience for patients. I would expect nothing less than the EM physicians of Wisconsin to lead the effort in managing patient flow around our state as we continue to fight this pandemic.

Editor’s Note: this article was written for informational purposes only and does not constitute any endorsement of care. The author, the author’s independent group practice/employer, and Wisconsin ACEP do not benefit in any manner from the transfer of patients or their care at the Alternate Care Facility in Milwaukee, WI.

Thanks for Giving on Thanksgiving

Tue, 17 Nov 2020 15:31:27 GMT

WACEP President Message, November 2020
Ryan Thompson, MD, FACEP

Remember back in March when it seemed you couldn’t go through a shift without your department receiving pizza, cupcakes, or some other treat from well-wishers? Emergency physicians, nurses, and other staff were being hailed as heroes despite our mostly empty departments.

These days, that sort of praise and support feels a distant memory. As we enter this new phase of the pandemic where Emergency Departments are being asked to treat more and more COVID patients in addition to the myriad of health conditions brought on by delayed treatments, limited access to specialists, and prolonged social isolation, it seems we have fallen out of the public eye.

To be honest, I was never comfortable with all the hero talk. Emergency Physicians were working in the trenches before this pandemic began and we’ll keep on trucking right through it and beyond. We don’t do it for the plaudits. We do it because we have the skill, we have the drive, and most of all, because we care about our patients, and we care about our communities.

So, while we may not be front and center in the minds of our communities anymore, we will keep giving back. To that end, I wanted to share a few of my favorite charities in case you were looking for even more ways to give back to your community.

Child’s Play: This charity gives games and toys to hospitalized children to make their stay in the hospital less daunting. You can either given monetarily or order directly off of the Amazon Wish lists curated by Child Life Specialists at your Children’s Hospital of Choice. http://childsplaycharity.org/

Wisconsin Youth Symphony Orchestra: Supporting musically-inclined children and teens from across the state, this group provides opportunities to perform and high-quality lessons (even remotely during COVID) to diverse and low-resource aspiring young musicians. https://wysomusic.org/

Alzheimer’s & Dementia Alliance of Wisconsin: Every emergency physicians recognizes the stress and difficulty that dementia can put on a family. This group offers support, education, and advocacy for patients and their families. https://www.alzwisc.org/

By no means are these the only worthwhile charities in our communities – I encourage you to find something near and dear to your heart. This year has been hard on all of us, and I can’t think of a better way to continue to support the communities we serve. So thank you all for the dedicated work you have put in over the course of this year, and thank you for continuing to give to support those who need it most during these difficult times.

Emergency Physicians Urge Thanksgiving Precautions to Avoid Becoming a COVID Super Spreader Event

Thu, 12 Nov 2020 21:38:17 GMT

This Thanksgiving, the American College of Emergency Physicians (ACEP) recommends that holiday hosts and guests prioritize efforts to prevent the spread of COVID-19 and take steps to protect the health and safety of friends and family.

“If you are planning to get together on Thanksgiving, it is a good idea to reduce the risks that invite COVID-19 into your home,” said Mark Rosenberg, DO, MBA, FACEP, president of the American College of Emergency Physicians (ACEP). “Even a small gathering of family or close friends can still contribute to the spread of the virus.”

Emergency physicians recommend everyone heed the Centers for Disease Control and Prevention (CDC)’s holiday safety recommendations this year.

Remember anyone can get or spread COVID-19. Close friends and family with whom you don’t live with can still contract and spread the virus to you the same way a stranger could.

Trim the guest list. Rather than a specified “safe” number of guests, public health experts suggest that hosts determine the size of a gathering by how many guests from different households can remain at least six feet apart. Note that a “household” is made of people who live in the same house every day. Family members who are close but don’t live at home, such as college students visiting for the holiday, are considered a separate household in public health terms.

Cover your face and maintain your distance. It may be difficult but try to avoid hugs and handshakes. People should also cover their face when they are not eating or drinking.

Stay outside and stay safer. If it is possible, hosting a small event outside instead of inside is preferable.

Encourage good hygiene. Hosts should make sure that bathrooms have plenty of soap so guests can frequently wash their hands and single-use towels.

While there are precautions you can take this holiday season, the safest option for some will be to stay home. Do not attend an in-person gathering if you or anyone in your household has been diagnosed with COVID-19 and has not met the CDC’s criteria for when it is safe to be around others. Stay home if you show symptoms, if you are waiting for COVID-19 test results, or if you have been exposed to somebody with COVID-19 in the last 14 days.

“Unfortunately, the safest option for older individuals or people with weakened immune systems is to skip in-person gatherings this year,” said Dr. Rosenberg. “It may be disappointing to adjust traditions or modify plans in the short-term, but these decisions can save lives.”

Remember, emergency physicians work 24/7, even on holidays. Do not ignore your symptoms if you think you are having a medical emergency—if something is wrong call 911 or visit your closest emergency department. Emergency departments across the country are taking extensive precautions to adapt and protect patients. If holiday plans go awry, emergency departments are safe and ready for anything or anyone that comes their way.

Read more about COVID-19 and Thanksgiving safety at www.emergencyphysicians.org.

Pediatric Trauma & Burn Update - Dec. 11 Webinar

Tue, 10 Nov 2020 15:07:47 GMT

Join WACEP at 12:00 noon on Friday, December 11 for a lunch & learn webinar on the management of pediatric trauma and burns, during which we will focus on these challenging presentations in rural and low-resource departments.

Hear from experts Dr. Jennifer Roberts, Trauma Surgeon at Marshfield Clinic Health System, and Mark Johnston, RN, BSN, Manager of the Burn Program at Regions Hospital in St. Paul, on the best approach to these children and the best ways to prepare these patients for transport to pediatric care centers.

After the presentations, there will be time for questions and discussion on these important topics. We hope to see you there! Register Here.

UW Grad Savannah Vogel Receives ACEP Medical Student Award

Wed, 28 Oct 2020 20:58:17 GMT

Savannah Vogel, a 2020 graduate of the University of Wisconsin School of Medicine and Public Health, was recognized by the American College of Emergency Physicians (ACEP) for her excellence in compassionate care of patients, professional behavior and service to the community and/or specialty.

Vogel was a recipient of the National Medical Student Professionalism and Service Award, and was officially announced as part of the 2020 Awards Ceremony during ACEP20.

Wisconsin ACEP Congratulates Five New FACEPs

Wed, 28 Oct 2020 19:33:57 GMT

Established almost 40 years ago, the designation of Fellow of the American College of Emergency Physician (FACEP) is earned by those committed to the preservation and growth of emergency medicine.

The Wisconsin Chapter, ACEP congratulates five members who have achieved FACEP status and were recognized during ACEP20:

Bradley Burmeister, MD, FACEP
Abigail Dahlberg, MD, FACEP
Andrew Fischer Dean, MD, FACEP
Theodore F Elsaesser, MD, FACEP
Joshua C. Timpe, MD, FACEP

WACEP is proud to honor these five members who now join 190 other emergency physicians in Wisconsin who hold this distinction, point of pride and badge of honor. Congratulations.

UW Awarded Research Funding to Identify Ways to Improve ED Visits for People with Dementia

Wed, 21 Oct 2020 20:52:10 GMT

The University of Wisconsin School of Medicine and Public Health (SMPH) is one of four sites awarded a total of $7.5 million from the National Institutes of Health (NIH) to conduct research that could lead to improved care in emergency departments for people with dementia.

The effort aims to leverage expertise in emergency medicine, geriatrics and Alzheimer’s disease and related dementias to identify gaps in emergency care for people with dementia and address those gaps, according to Manish Shah, MD, MPH, professor of emergency medicine and co-principal investigator.

For example, many commonly used medications are problematic for people with dementia. Better understanding which medications are safest for this vulnerable population would help clinicians better care for them, he said.

“The emergency department is not an ideal care setting for people with dementia,” Shah said. “What we want to do is find better ways to care for one of our most vulnerable populations, namely older adults with cognitive impairment.”

The funds will support Geriatric Emergency Care Applied Research Network 2.0 – Advancing Dementia Care (GEAR 2.0 ADC), which is a collaboration between SMPH, Yale School of Medicine, Feinberg School of Medicine at Northwestern University and Washington University School of Medicine in St. Louis. All four institutions are home to an NIH-National Institute on Aging-designated Alzheimer’s Disease Research Center.

GOTV, WI EMPs!

Mon, 19 Oct 2020 22:20:00 GMT

WACEP President's Message
October 2020
Ryan Thompson, MD, FACEP

Another election cycle is upon us, in case that wasn’t already abundantly apparent by the barrage of political ads that have taken over our televisions and airwaves! Ahh, the joys of living in a swing state.

Despite the commercial fatigue, the outcome of this election will no doubt shape the future of our specialty for years to come. Both state and federal elections have significant impacts on health and fiscal policy, as well as the potential to upend legislative priorities. Of course, WACEP does not endorse any specific candidate or party, and we are committed to working with whoever is willing to help us to better the care of WI patients and make the state a more appealing place for emergency physicians to practice. That being said, we do necessarily shift our strategies and priorities to what we can most effectively get done with any given group of legislators in power.

This promises to be a unique election, with the COVID pandemic raging all around our state. Many people have likely already voted absentee, but if you haven’t, there are still a lot of options open to you. If you are already registered, you can request an absentee ballot online at myvote.wi.gov by October 29th, although be aware they have to be returned by November 3rd at 8pm in order to be counted. If you aren’t interested in voting by mail, early voting starts on October 20th and runs until November 1st in most areas. Early voter registration can occur in-person until October 30th. And of course, you can always both register and vote on election day at your local polling place, although be aware that long lines may be expected at some polling places.

Depending on where you live in the state, there may still be a need for poll workers to assist on election day. Who better than emergency physicians to don PPE, stay on their feet all day, and manage large volumes of people? If you are interested in signing up to be a poll worker, you can learn more here.

Vote your conscious, vote for the candidate who will help your patients, vote your party, vote on a single issue, vote on many issues, vote of the candidate with the best hair, it doesn’t matter. Just VOTE!

Search for EM Jobs Online through WACEP

Mon, 19 Oct 2020 21:44:56 GMT

Looking for a new EM Career Opportunity? Be sure to visit WACEP's online Career Center where you can sign up for new job alerts, upload your CV, filter your search criteria by desired function, browse existing jobs and apply with fewer clicks. Create your job search strategy today.

WACEP Joins Vote Safe Wisconsin Coalition

Mon, 12 Oct 2020 16:07:42 GMT

Wisconsin ACEP has joined the Vote Safe Wisconsin 2020 coalition. We are committed to sharing information and resources with our community partners on how to safely vote. We encourage everyone to vote absentee, vote early, or vote at the polls with a mask and socially distancing. Learn more.

WACEP Supports Governor's Restriction on Indoor Gatherings

Wed, 07 Oct 2020 02:44:51 GMT

The Wisconsin Chapter of the American College of Emergency Physicians (WACEP) released a statement in support of the Governor's temporary restriction on indoor gatherings announced on Tuesday.

Gov. Tony Evers directed Department of Health Services (DHS) Secretary-designee Andrea Palm to issue Emergency Order #3 limiting public gatherings to no more than 25 percent of a room or building’s total occupancy. See full the order and list of exemptions here.

This directive is effective at 8 a.m. on Oct. 8, 2020, and will remain in effect until Nov. 6, 2020. It applies to any gatherings at locations that are open to the public such as stores, restaurants, and other businesses that allow public entry, as well as spaces with ticketed events. A frequently asked questions document is available for review here.

“We’re in a crisis right now and need to immediately change our behavior to save lives,” said Gov. Evers. “We are continuing to experience a surge in cases and many of our hospitals are overwhelmed, and I believe limiting indoor public gatherings will help slow the spread of this virus. Folks, we need your help and we need all Wisconsinites to work together during this difficult time. The sooner we get control of this virus, the sooner our economy, communities, and state can bounce back.”

October Updates from the Wisconsin Medical Society

Tue, 06 Oct 2020 14:39:04 GMT

WACEP is pleased to share these updates from our partners at the WI Medical Society

As Governor extends statewide mask order, the Society urges proactive public behaviors

As Governor Tony Evers declared a new public health emergency and issued a new face covering mandate on September 22 due to increases in the state’s COVID-19 case rate, the Wisconsin Medical Society (Society) took the opportunity to remind the public how they can take proactive measures to help reduce the spread of the virus, regardless of any government action related to the pandemic.

In a media statement sent statewide the afternoon of the Governor’s announcement, Society CEO Bud Chumbley, MD, MBA, emphasized how mask wearing, physical distancing and regular hand washing are proven effective strategies to reduce the spread of COVID-19. “If we all agree to take simple steps, we can reduce the spread of the pandemic and protect our state’s physical and economic health,” Dr. Chumbley said in the statement. “We strongly urge everyone to wear masks, maintain social distancing and continue to wash hands often and thoroughly,” Dr. Chumbley said. The statement also emphasized that with seasonal influenza season looming, getting a flu vaccination is another action individuals can take that helps protect themselves and the public.

The statement is the latest in a series of actions the Society has taken to help remind the public of their important role in helping stem community spread, including three public service announcements that have been aired on statewide television and on the Society’s various social media channels.

Contact Mark Grapentine, JD for more information.

Medical Examining Board concerned over possible proposal to change nursing collaboration requirement

Many physician members of the state’s Medical Examining Board (MEB) raised concerns at its monthly meeting on September 16 over a potential Board of Nursing (BON) proposal that would repeal a requirement that Advanced Practice Nurse Prescribers (APNP) work in collaboration with at least one physician or dentist. While the MEB does not have jurisdiction over how nurses are regulated, numerous MEB members were concerned that such a proposal would have negative impacts on Wisconsin’s high-quality health care system.

The MEB’s concerns rose from a BON meeting on Sept. 10, which included initialization of the process used to change the administrative code: preparing a proposed “Scope Statement” laying out the desired change. The specific scope statement proposal, which requires approval from the Governor before it can be developed further, was included in yesterday’s MEB agenda for discussion.

State MEB administrative staff indicated that the BON may be withdrawing or further modify the scope statement and said a BON subcommittee will be discussing the issue Sept. 18. The Society will attend that subcommittee meeting and has already been in contact with other physician-centric advocacy organizations to ensure all are aware of the possible attempt to alter the collaboration requirement.

In other action, the MEB unanimously approved its own scope statement for a regulatory update that would extend the current requirement for physicians holding a U.S. Drug Enforcement Administration number to complete controlled substance education as part of the 30 hour biennial license requirement.

That statement will now be sent to the Governor for review; the Board will further develop the rule following the Governor’s likely approval.

Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

Society's COVID-19 Task Force asks physicians to review DHS alert on antigen testing

The Wisconsin Medical Society’s (Society) COVID-19 Task Force recommends that Wisconsin physicians review a COVID-19 Health Alert on antigen testing issued today, September 24, by the state’s Department of Health Services’ (DHS) Bureau of Communicable Diseases.

Calling this testing an “important and evolving topic,” DHS Chief Medical Officer and State Epidemiologist for Communicable Diseases Ryan Westergaard, MD, PhD, MPH, provides important information regarding various aspects of this type of testing, including considerations for using antigen tests in symptomatic vs. asymptomatic patients, the characteristics of the antigen tests for SARS-CoV-2 currently available and a list of antigen tests currently authorized for use in the U.S.

The Society’s COVID-19 Task Force continues to meet biweekly as Wisconsin battles the pandemic, and regularly updates relevant information on the Society’s COVID-19 Resources webpage.

Contact Society CEO Bud Chumbley, MD, MBA with any questions for the COVID-19 Task Force.

Virtual trivia – October 8

Join your fellow Wisconsin Medical Society members for a virtual WisMed Meet Up! Trivia nights provide an opportunity to connect with your peers across the state from the comfort of your home.

The Society will create trivia teams, or you are welcome to invite colleagues to create a team of your own by emailing Jess. (Maximum of 4 people per team).

Date: Thursday, October 8, 2020
Time: 6:00-7:00 p.m.
Register here!

Gift cards will be awarded to the winning team! Please contact our Membership Specialist at jessica.schreiter@wismed.org with any questions.

Thanks to Exact Sciences for sponsoring this member exclusive event!

WACEP Legislative Update, October 2020

Mon, 05 Oct 2020 13:02:30 GMT

Lisa Maurer, MD, FACEP
WACEP Legislative Chair

Wisconsin ACEP continues to advocate for the practicing emergency physician and your patients with the state’s legislators and regulators. In the last year, we supported EM physicians as COVID-19 hit, and we’ve also continued important work in our ongoing priorities of Medicaid reimbursement and psychiatric care.

Even though March seems lightyears away, I’ll never forget that overwhelming feeling of the unknown as we started to see patients with COVID. There was little to no research to support best practices, and even our patients without COVID feared hospitalization for concern of having an exposure. In times of such uncertainty, WACEP fought to bring medical liability protection to the physicians on the front line. Wisconsin now provides civil liability immunity for care provided during the Public Health Emergency pending “actions or omissions do not involve reckless or wanton conduct or intentional misconduct.”

We also heard from our members that independent EM physician practice groups should be eligible for state distributions of CARES Act financial support, just as hospitals were, for lost revenue and increased expenses due to COVID. In September, DHS announced that emergency physician practice groups could apply for those funds, and they will be distributed before the month is over.

WACEP will continue its focus on improving Medicaid reimbursement rates, especially as we expect post-pandemic Medicaid enrollment to rise and our state budget to be squeezed. We absolutely must improve our worst-in-the-nation Medicaid fee schedule for emergency services. Our state values the expertise of emergency physicians standing by to save lives, and this is not accurately reflected currently as Medicaid reimbursement does not even pay for half of the cost of providing emergency care to its enrollees. We are honored to have Wisconsin Medical Society also name this as a priority issue as we craft the next state budget. Of note, our state passed a bill last November that would ensure all services covered under Medicaid would be equally valued if provided via telehealth, including consultations and home monitoring.

WACEP also recognizes that we continue to have room to improve our care for patients with psychiatric emergencies, and oftentimes that necessitates progress in legislation. We continue to actively participate in the Wisconsin Emergency Psychiatric Task Force, partnering with our colleague psychiatrists as well as other stakeholders such as law enforcement, the Attorney General, WI Counties Association, and others. We have agreed and published a SMART protocol for risk-based medical evaluation of patients with emergent psychiatric conditions, and look forward to upcoming projects and bipartisan legislation regarding increased transparency in bed availability, regional approaches to stabilization, and pilot projects for novel admissions procedures. We supported legislation that was already passed in March 2020 whereby law enforcement agencies may contract a DHS-approved third-party vendor to transport an individual for emergency detention.

Thank you to all WACEP members for your support and engagement in grassroots advocacy over the last year. Without you, none of this would happen. Please continue to stand together as we anticipate a busy legislative session in the upcoming year, including bills on physician assistant scope of practice, balanced billing for out-of-network care, and much more.

Calling Emergency Physicians to Become Poll Workers: How You Can Help Wisconsin Elections

Mon, 05 Oct 2020 12:51:38 GMT

The Wisconsin Elections Commission encourages every eligible citizen to vote and to become involved in the election process. One way to get involved is to become an Election Day poll worker, also known as an election inspector).

Citizen involvement is essential to conduct open, accurate and fair elections in Wisconsin. And, Emergency Physicians as well as other healthcare providers are uniquely positioned given the comfort level with PPE.

There are several different jobs at polling places in Wisconsin, all of which are appointed by municipal clerks. Learn more at elections.wi.gov.

Governor Evers Announces New Emergency Order

Fri, 02 Oct 2020 13:12:16 GMT

In response to the increasing COVID-19 cases, Governor Evers announced a new Emergency Order—EO-2. Included in this new order are new provisions applicable to health care providers including interstate reciprocity, credentialing, and Telemedicine.

In addition, the provisions from previously released EO-16 related to physician assistants and nurses are included by reference. The new order is effective immediately and unless suspended by the legislature or the courts, will remain in effect for the duration of the federal declared public health emergency.

View the Governor's press release.

ACEP20 Countdown is On!

Wed, 23 Sep 2020 13:20:15 GMT

The ACEP20 countdown is on. This year's conference is October 26-29 and has much to offer! Watch this short video that will surely get you pumped up to attend and take part in the innovative features and creative programming of this year's virtual experience. Everyone has their reasons: The education, the community, the career advancement opportunities. Maybe it's the chance to break from the daily grind and treat yourself to some “me time.” Whatever your reason, register today!

Annual WACEP President's Report

Thu, 17 Sep 2020 14:49:15 GMT

2020 WACEP President’s Report
Ryan Thompson, MD, FACEP
(Excerpted from the 2020 WACEP Business Meeting, September 15, 2020)

This has been an unprecedented year, with a myriad of challenges. COVID-19 has upended our state and our world in ways we couldn’t have dreamed of a year ago. So first I would like to thank each and every one of you for what you have done this year. Emergency physicians in our state stepped up in every conceivable way to face this challenge. Your ability to continue to provide incredible care to Wisconsinites despite the challenges of PPE shortages, despite the risks to your own health, and that of your families, even while facing budget shortfalls, constantly shifting guidelines, and a mountain of uncertainty, has been absolutely incredible. So thank you all!

This year of my presidency has certainly not been what I expected. My background is as an educator, and I was excited to bring that energy to this year’s Spring Symposium and continue to expand our Rural Outreach educational program. However, events conspired to cancel both of those events, and our focus by necessity shifted to advocating for our members and patients during a pandemic. I will be forever in the debt of my fellow physicians on the WACEP Executive Board and Board of Directors. Without their expertise and hard work, none of what we have accomplished this year would be possible. If you know any of these folks, please reach out to them with a hearty thank you!

I am happy to report that we have been able to have a big impact during COVID. We advocated for liability protections during the Emergency order, and were also able to convince the state to include emergency groups in eligibility for CARES funds. WACEP joined other medical societies in supporting common-sense masking and social distancing, and collaborated with the Wisconsin Hospital Association to produce a PSA reassuring Wisconsinites about the safety of our Emergency Departments despite the pandemic.

Beyond COVID, we’ve had great success in other areas as well, including state level advocacy, membership retention, and collaborative efforts to improve mental health care in Wisconsin. Despite the challenges of the year, I feel good about what WACEP has achieved, and I look forward to what we will continue to accomplish in the year to come.

Advocating for EM physicians and our patients requires us to have the means to get our ideas and advocates in front of Wisconsin politicians. Each of our board members has committed to donating to our PAC, and I would encourage all of our members to make a contribution as well—our PAC is what allows us to advocate for substantive change in the state. There are great things on the horizon in our state, but also significant challenges. A strong PAC will allow us to face those challenges head-on. If you feel that WACEP has improved your practice environment, please consider making a contribution today!

Call for Board Nominations

Thu, 17 Sep 2020 14:00:49 GMT

The Wisconsin Chapter, ACEP Nominating Committee is now accepting nominations of any member in good standing interested in serving in WACEP leadership.

WACEP's Board of Directors meets quarterly and provides ongoing strategic oversight as the organization works to advance the effectiveness, sustainability and mission of the Chapter. Board members are expected to participate in all Board meetings, the annual Spring Symposium, and to volunteer for other activities that will help advance the organization's strategic priorities.

Nominations are being accepted for the positions listed below (terms begin January 1, 2021):

(3) Directors-at-Large on the Board of Directors (4-year term)
President-Elect (this is a 3-year commitment, one year each as President-Elect, President and Immediate Past President)
Secretary/Treasurer (1-year term)

If you or any of your colleagues are committed to serving in a leadership capacity and being a resource for information, education, networking and advocacy, we encourage you to get involved!

Nominate yourself or a colleague today! Nominations are due by November 20, 2020. Submit nominations here.

Michael Repplinger Honored with Distinguished Service Award

Thu, 17 Sep 2020 13:51:06 GMT

WACEP congratulates Michael Repplinger, MD, PhD, FACEP as the recipient of this year's WACEP Distinguished Service Award. The award was presented during the virtual Annual Membership Meeting on September 15, 2020 by WACEP President Ryan Thompson, MD, FACEP.

Over the last 10 years, Dr. Michael Repplinger has demonstrated a commitment to improving patient care and promoting the profession of emergency medicine. He was UW’s first resident delegate to the WACEP Board and has continued to serve in various roles in WACEP including President in 2013 and Councilor for the past 3 years. During his tenure on the Board, Dr. Repplinger has substantially contributed to numerous WACEP initiatives, resulting in important changes to Wisconsin’s statutes. Examples include changing the statutory definition of informed consent for medical care, reinstating medical malpractice caps for noneconomic damages, and providing statutory liability protection when conducting body cavity searches.

Outside of political lobbying, Dr. Repplinger has advocated for emergency physicians at the Wisconsin Medical Society and in teaching medical students and residents. He has personally penned and successfully promoted the adoption of resolutions favorable to emergency medicine including a policy supporting the increase of Medicaid reimbursement for EMTALA-related services. Current initiatives led or substantially bolstered by Dr. Repplinger include streamlining and standardizing the medical assessment of patients being admitted with mental health crises, improving the current version of a web-based statewide psychiatric bed locator, and reversing the current Medicaid policy that bars reimbursement for inpatient psychiatric care at freestanding psychiatric hospitals.

Beyond his patient and profession-centered advocacy efforts, Dr. Repplinger is a stellar emergency care researcher, focused on the use of radiation-free imaging in the ED. He has been awarded several federal, foundation, and institutional grants, published nearly 40 peer-reviewed articles, and received numerous research awards. His unique line of research is innovative and practice changing.

For all these reasons and more, WACEP is delighted to announce that Dr. Repplinger is this year’s recipient of the Distinguished Service Award.

It's National Suicide Prevention Week

Tue, 08 Sep 2020 14:10:12 GMT

It's National Suicide Prevention Week. ACEP will be sharing relevant patient care tools and resources for members on social media while also conducting an awareness campaign for the public.

Next week, ACEP will share advocacy updates and wellness tools to mark Physician Suicide Awareness Day on Sept. 17. Join the conversation as we work together to raise awareness about this important issue during an especially challenging season for EM physicians and society as a whole.

WACEP Past President Dr. Jeff Pothof Discusses COVID-19 Vaccine

Tue, 08 Sep 2020 13:22:38 GMT

WACEP Immediate Past President and UW Health's Chief Quality Officer, Dr. Jeff Pothof was interviewed on PBS Wisconsin’s Here and Now. Dr. Pothof was the first among an expected 1,600 volunteers to take an experimental COVID-19 vaccine at a study run jointly by UW Health and the UW School of Medicine. He joins the program from Madison. View interview.

CARES Funds Now Available to Independent EM Practice Groups

Thu, 03 Sep 2020 20:12:34 GMT

WACEP is excited to announce that as a result of our legislative committee’s grassroots efforts, and especially our lobbyists’ outreach to Governor Evers and the Department of Health Services, federal CARES Act funds distributed by the State of Wisconsin are being made available to Independent Emergency Physician Practice Groups to help offset expenses and lost revenue as a result of the COVID-19 pandemic.

The application is expected to be open within the next few days. We encourage interested members to sign up on the DHS listserve to stay up to date with application announcements. Alternatively, go to the DHS COVID-19 page and sign up using the box on the right side of the page labeled, "Stay up to date on the CARES Act Provider Payments Program."

During the application process, questions can be directed to:
DHSDMSDCPP@dhs.wisconsin.gov.

View the official DHS press release. Please contact WACEP if we can be of assistance.

New suicide prevention call center opens

Tue, 01 Sep 2020 16:41:17 GMT

September 17, Wisconsin Health News

A new National Suicide Prevention Lifeline call center recently opened in Wisconsin.

Family Services of Northeast Wisconsin will manage the new center, known as the Wisconsin Lifeline, under a $2 million grant from the Department of Health Services. It’s part of Wisconsin’s share of the federal Community Mental Health Services Block Grant.

The center will accept calls originating from communities not covered by one of the four existing Wisconsin-based centers that are part of the national lifeline’s network.

“Adding capacity to handle Wisconsin calls to the National Suicide Prevention Lifeline is part of our ongoing effort to ensure the right supports are available at the right time for people in emotional distress,” DHS Secretary-designee Andrea Palm said in a Wednesday statement. “It’s about offering hope and promoting healing.”

The new center began answering calls in August. During its first week, the percent of Wisconsin calls to the lifeline answered in-state increased to 85 percent, above the national benchmark of 70 percent. Before its launch, the in-state answer rate was at 30 percent due to the large volume of calls coming from areas outside of the four locally funded call centers’ responsibility.

The new center will also position Wisconsin well to handle a predicted surge in calls when the 10-digit nationwide helpline number switches to 988 in July 2022, DHS noted.

National Physician Suicide Awareness Day is Sept. 17

Mon, 31 Aug 2020 22:29:51 GMT

Thursday, September 17, 2020, marks the 3rd annual National Physician Suicide Awareness Day. This year’s theme, One of Us, is meant to remind us that suicide can affect anyone... our families, our friends, our colleagues.

The Wisconsin Chapter, American College of Emergency Physicians, is proudly among numerous organizations across the country who support the event, which was created to honor the memory of physicians who have died by suicide and to continue to raise awareness and discussion on how to prevent it.

Join us and Support National Physician Suicide Awareness Day at your work setting:

Create a safe space by dedicating time to talk about mental health and suicide. Setaside time at your morning report, morning huddle or faculty meeting to discuss physician mental health, depression and suicide. This allows your group to speak freely about it without a spotlight on them personally.
Say the names of your colleagues who have died by suicide. Remember them, honor their memory, share stories and lessons learned.
Be vulnerable and a role-model for your colleagues and trainees. Physicians are notoriously constricted in sharing their own emotions and experiences which may contribute to the higher rates of burnout, depression and suicide rate. Start the conversation and break the ice. By role-modeling vulnerability, you are helping to change the culture in medicine.
Identify and promote access to mental health. Review and share how mental health care and resources are addressed and accessed locally.

Preparing for the Next Pandemic - ACEP Summit Aug 31-Sept. 10

Mon, 24 Aug 2020 19:26:40 GMT

Registration is now open for ACEP's upcoming summit, "Preparing for the Next Pandemic" with sessions taking place between August 31 and September 10, 2020.

ACEP's president, Dr. Bill Jaquis, will serve as moderator for eight, one-hour sessions focused on lessons learned during the COVID-19 crisis and strategies to better respond to the next pandemic. Session topics include: Communications, Data and Analysis, Deployment and Distribution of Physicians and Other Health Care Workers, Disparities and Vulnerable Populations, Information Flow, Research, Supply Chain, and Workforce Support and Sustainability.

View event information & register

Alternatively, you may register for each session directly using the session links below:

Communications Session; Mon, Aug 31 01:00 PM CT - Link
Disparities and Vulnerable Populations Session; Mon, Aug 31 02:30 PM CT - Link
Supply Chain Session; Wed, Sep 2 01:00 PM CT – Link
Research Session; Thu, Sep 3 03:00 PM CT - Link
Information Flow Session; Fri, Sep 4 01:00 PM CT - Link
Deployment and Distribution of Physicians and Other Health Care Workers Session; Wed, Sep 9 01:00 PM CT - Link
Data and Analysis Session; Wed, Sep 9 03:00 PM CT - Link
Workforce Support and Sustainability Session; Thu, Sep 10, 01:00 PM CT - Link

The Foundation of Emergency Medicine is Being Undermined

Tue, 18 Aug 2020 16:41:04 GMT

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

I recently started work on an addition for my house, and after digging a giant hole, my contractor discovered that the sandy dirt under my foundation had largely eroded away in the 90 years since the house had been built. This was an unwelcome (and expensive!) discovery, but even more concerning is that I suddenly had to worry about my house collapsing – a possibility I had never even considered in my 5 years of living there. How could something as seemingly small as sand have such a major impact on the stability of my home?!

Just like the sand under my home, Medicare reimbursement is probably something most emergency physicians rarely think about. However, since we see such a large number of Medicare patients, those payments do serve as the foundation for the financial solvency of many of our practices. And also like that sand, those payments are at threat of bringing down the whole house if they erode away.

ACEP had actually made great headway on increasing CMS payments for emergency E/M codes in this year’s CMS reimbursement fee schedule update. They were able to secure an increase of about 12.7% for level 3 charts, and an increase of about 5.25% for level 4 and 5 charts. This is good news! However, as always, the devil is in the details. In order to promote primary care, CMS increased payments for all outpatient office codes. However, CMS has a mandate to remain budget neutral, so they have proposed a rule slashing all other physician reimbursements by 9%. Factoring in the increase in ED codes, emergency physicians are facing a 6% decrease in reimbursement in 2021, taking a veritable firehose to the sand that supports many small practice groups.

However, we don’t have to stand idly by and watch this happen. If Congress waives the budget neutrality requirement, we will actually see an increase of about 3%. And in the midst of facing down a pandemic, now is not the time to start shortchanging the nation’s physicians. Reach out to your legislators and let them know that emergency physicians need relief right now, not belt tightening. A cut of this scale could force smaller groups out of business all around the nation, and Wisconsin has a high percentage of small independent groups.

If Congress fails to stop this erosion of the foundations of Emergency Medicine, the long-term damage will be far more expensive and difficult to fix than is apparent at first glance. Just ask my contractor!

Anthony S. Fauci, MD, NIAID Director to Keynote ACEP20

Mon, 17 Aug 2020 17:54:49 GMT

Hear from the man who has been at the epicenter of this pandemic and get a first-hand account of the nation’s response to COVID-19. Dr. Anthony Fauci will offer his unique perspective on the virus and the care given to Americans in 2020.

He will kick off ACEP20 at 9 am CDT, Oct. 26, followed by a panel of international emergency physicians on “Lessons Learned: Global Response to COVID-19.”

Dr. Fauci was appointed Director of National Institute of Allergy and Infectious Diseases (NIAID) in 1984. He oversees an extensive research portfolio of basic and applied research to prevent, diagnose, and treat established infectious diseases such as HIV/AIDS, respiratory infections, diarrheal diseases, tuberculosis and malaria, as well as emerging diseases such as Ebola and Zika. NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies.

Dr. Fauci has advised six Presidents on HIV/AIDS and many other domestic and global health issues. He was one of the principal architects of the President’s Emergency Plan for AIDS Relief (PEPFAR), a program that has saved millions of lives throughout the developing world.

Feedback Sought on Epistaxis Management

Wed, 12 Aug 2020 17:18:22 GMT

Andrew Culp, a community ED physician based in Madison, is gathering physician feedback on epistaxis management for an upcoming Phase I NIH SBIR (Small Business Innovation Research) grant. Please consider taking this 3-minute survey to share your perspective.

Urge Congress to Halt Impending Medicare Cuts for Emergency Physicians

Tue, 11 Aug 2020 15:47:35 GMT

ACTION ALERT! Contact your member of Congress today and urge them to waive the budget neutrality requirement for calendar years 2021 and 2022 by signing on to a bipartisan “Dear Colleague” letter led by Rep. Bobby Rush. It is essential that they hear directly from emergency physicians in their district just how devastating these cuts could be for access to emergency care for patients across the country. Learn more and take action today.

DHS Telehealth Webinar Recordings Now Available

Tue, 11 Aug 2020 15:31:12 GMT

The Wisconsin Department of Health Services (DHS) hosted all-inclusive webinars last week to engage providers, provider associations, members, and member advocates in telehealth expansion. These webinars provided an overview of the telehealth expansion project and gathered input on permanent telehealth policy. View Provider webinar here, and visit the DHS webpage for additional resources on telehealth expansion.

Emergency physicians cite 11 ways to ease their pandemic-related stress

Sun, 26 Jul 2020 17:26:20 GMT

Becker's Hospital Review

A vast majority of emergency medicine physicians said increasing the availability of personal protective equipment would relieve their stress related to the COVID-19 pandemic, a new survey shows. The survey was emailed to all emergency medicine physicians at seven U.S. academic emergency departments. A total of 426 physicians responded. Survey results were published in the journal Academic Emergency Medicine. READ MORE

HHS Secretary Alex Azar Extends Public Health Emergency Declaration

Fri, 24 Jul 2020 17:29:22 GMT

On Thursday, the Secretary of the Department of Health and Human Services (HHS), Alex Azar, extended the COVID-19 public health emergency for another 90 days. This is the second time Secretary Azar has extended the public health emergency. It is now set to expire at the end of October.

The extension of the public health emergency means that the waivers and flexibilities that the Centers for Medicare & Medicaid Services (CMS) and other federal agencies have put into place to help health care practitioners and facilities respond to the pandemic (including those related to telehealth and EMTALA) will remain in place.

For more information about CMS’ emergency waivers click here, and for ACEP's summary of federal guidance related to COVID-19, click here.

Open Letter Encourages Mask-Wearing

Thu, 23 Jul 2020 21:45:33 GMT

The Wisconsin Chapter ACEP joined a coalition of medical societies in Wisconsin that created an open letter to the people of Wisconsin on the importance of wearing masks and social distancing to help curb further spread of COVID-19. Read letter.

Wisconsin Medicaid Telehealth Expansion Webinar: Stakeholder Input Session for Providers

Tue, 21 Jul 2020 15:34:19 GMT

The Wisconsin Department of Health Services (DHS) invites you to attend a Medicaid Telehealth Expansion interactive webinar.

Agenda

This webinar will seek your response to DHS’s proposed launch of Wisconsin Act 56: Telehealth Expansion, which will significantly expand Wisconsin Medicaid’s permanent telehealth policy. The presentation will include the following items:

General overview of telehealth expansion
General policy information
Wave 1 priority acute and primary service areas:
Proposed services included in telehealth
Proposed services excluded from telehealth
Input from attendees

Following the presentation, DHS will take questions from attendees via the DHS telehealth mailbox.

How to join

Thursday, July 30, 10:30 am – 12:00 pm

Click this URL to join; Password: 07302020
Join by phone: 646-558-8656; Webinar ID #933 1403 1869

Friday, July 31, 2:00-3:30 pm

Click this URL to join; Password: 07312020.
Join by phone: 646-558-8656; Webinar ID #999 9957 0817

Legislative and Political Update, July 2020

Mon, 20 Jul 2020 21:56:10 GMT

Hubbard Wilson Zelenkova LLC, WACEP Lobbyists

Legislative News

The legislative floor session was cut short by the onset of the Covid-19 public health emergency. While the Assembly completed its action on regular session legislation in February, the Senate intended to finish up on March 25th. That of course did not happen. The Senate has kept the door open to returning to finish action on bills it planned to concur on from the Assembly. Under normal circumstances, any bills that had failed to pass by now would be dead for the session. Under these unusual circumstances, however, the Senate may still come back to act. Bills that could still receive action include:

AB 526: CME requirement for suicide prevention. Passed assembly with bipartisan opposition. Likely would not be taken up by the Senate if they return.
AB 575: Physician Assistants’ “Cares Act”. Passed assembly on voice vote after significant amendments.
Of note, AB 664, that created and funds a school based mental health consultation pilot program passed both houses and was signed into law as WI Act 117 in early March.

Both houses of the legislature did return to pass legislation related to the public health emergency. The covid-response legislation, most notably, included changes necessary for the state to accept increased FMAP funding under MA and gave DHS the ability to take actions during the Emergency Declaration that would otherwise require at least passive review under normal circumstances. The legislation also included “balance billing” provisions that were a step in the right direction but fell short of what WACEP would support in permanent legislation. Those concerns were outlined in a letter to the legislature. It is encouraging, however, that the legislature is recognizing the issue and gives hope that a bill that WACEP can support will have traction next legislative session.

Significantly, HWZ worked with WACEP, the Wisconsin Medical Society and other physician groups to include immunity to civil liability for claims that arise as a result of treatment decisions made in response to the emergency. WACEP’s proaction on this issue was a huge boost to the effort. We made it a priority for WMS, and obtained bipartisan support from key legislators prior to the session. The application of this provision however recently ran out as its duration applied for only 60 days after the Governor’s emergency declaration expired on May 11.

During the Governor’s 60 day Emergency Declaration, numerous emergency orders were issued. Many EO provisions were related to healthcare, particularly availability and staffing for emergency response including delaying license renewals, easing temporary licensure guidelines, and the like. Other provisions increased access and expanded services like telehealth applications and MA benefits. Most provisions related to the Emergency Orders and covid-response legislation have now expired unless otherwise extended by administrative rule.

Efforts are underway to continue some of the covid-related regulatory flexibilities related to telehealth, licensure and liability.

There has been much speculation as to whether or not the Legislature will convene a special or extraordinary legislative session prior to the beginning of the 2021-2022 legislative session in January. As mentioned, in the Senate there was unfinished work to do on regular business legislation. But more importantly, depending on where state revenues stand as a result of the pandemic, it is possible that a Budget Repair bill may be necessary. State law requires that should state revenue estimates, on which the biennial budget was based, dip below .5% of funds necessary to maintain a balanced budget then corrective legislation is necessary. However, even if budget action is triggered, it is our assessment that it is very unlikely the legislature would address a budget shortfall before the November election. Instead, if necessary, it would be more likely that a budget shortfall would be addressed when the new legislature convenes in January 2021.

On behalf of WACEP, we continue to lobby the Governor and DHS for federal CARES Act Funding for Emergency Physician Practice Groups. WACEP has written the Governor and DHS multiple letters and we have had numerous contacts with top staff requesting CARES funding to be specifically allocated to assist our private practice groups. These efforts are ongoing. In addition, we continue to advocate with DHS, the Governor’s office, and the Legislature in support of increased MA rates for emergency codes. As agencies begin putting their biennial budget requests together, these efforts are continuous.

2020 Elections

Despite limitations on collecting signatures, candidate nomination papers were due on June 1st and we are now in the full swing of election season. While some incumbents will get a free ride, most legislative seats will have contested races. Several legislative retirements have left vacancies in the legislature and a dash for open seats. Here is a list of sitting legislators who are either retiring or running for other elected office:

Retiring Senators:

Sen. Luther Olsen (R- Ripon)
Sen. Dave Craig, (R-Big Bend)
Rep. Fred Risser (D-Madison)
Sen. Mark Miller (D-Monona),
Sen. Dave Hansen (D-Green Bay)
Sen. Jen Shilling (D-La Crosse) (vacated senate seat on May 15)

Retiring Senators running (or successfully ran) for higher office:

Sen. Tom Tiffany (R- Hazelhurst) (Won 7th CD special election)
Sen. Scott Fitzgerald (R-Juneau) (Running for 5th CD)

Retiring Representatives:

Rep. Chris Taylor (D-Madison) (Appointed Dane County Circuit Judge effective August 1)
Rep. Deb Kolste (D-Janesville)
Rep. Jason Fields (D-Milwaukee)
Rep. Mike Rohrkaste (R-Neenah)
Rep. Bob Kulp (R- Stratford)
Rep. Romaine Quinn (R-Barron)

Retiring from Assembly and running (or successfully ran) for higher office:

Rep. Joan Ballweg (R- Markesan) (Running for 14th SD)
Rep. Mary Felzkowski (R-Irma) (Running for 12th SD)
Rep. David Crowley (D-Milwaukee) (new Milwaukee County Executive)
Rep. Amanda Stuck (D-Appleton) (Running for 8th CD)
Rep. Rob Stafsholt (R-New Richmond) (Running for 10th SD)
Rep. Jocasta Zamarripa (D-Milwaukee) (new Milwaukee city council member)
Rep. Melissa Sargent (D-Madison) (Running for 16th SD)

EM Physician, You Don’t Have to Heal Thyself

Tue, 14 Jul 2020 17:47:19 GMT

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

Medicine has a history of at best ignoring, and at worst shaming, physicians who struggle with mental health. It is long past time for that to change. Today’s EM physicians face unprecedented challenges and ever-mounting pressures. In addition to managing the increasing risk of contracting COVID at work, the physical demands of wearing PPE all day, and dealing with increasingly complex and seriously ill patients, many EM physicians across the state are seeing cuts in pay or slashed hours, adding financial pressures to the mix.

While there has always been an element of thrill-seeking and relishing in the stress of a busy ED, we must recognize the toll the job takes on each of us. It is time to end the stigma associated with seeking therapy or counseling, and recognize it for what it is—self-care. Just as a physician who is ill cannot take the best possible care of their patients, neither can one struggling under a mountain of stress. We owe it to our patients to be at the top of our game when caring for them, and that means seeking out mental health care when it’s needed.

Many physicians fear being labeled as “problematic” or “less-than” if they seek care. If you are a medical director, make sure that your physicians are not being asked to report on seeking counseling, as this can be a huge deterrent for physicians to get the care they need. Both ACEP and WACEP are against physicians being forced to report their mental health care.

If you feel like you could benefit from counseling, ACEP offers free, confidential sessions via phone, text, or chat. If you are in southeastern Wisconsin, the BRaVe (Building Resilience Virtually) Clinic also offers free and confidential remote counseling (braveclinic@mcw.edu).

WACEP Congratulates Class of 2020 EM Residents

Tue, 14 Jul 2020 16:52:34 GMT

WACEP offers its congratulations to Wisconsin’s 2020 Emergency Medicine residency graduates.

The University of Wisconsin Emergency Medicine Residency Program Grads:

Dr. Josh Buehler will be joining Eugene Emergency Physicians in Eugene, OR
Dr. Eric Collins will be joining Mayo Clinic Eau Claire Hospital in Eau Claire
Dr. Emily Fleming will be completing an EMS Fellowship in Madison
Dr. Alok Harwani will be completing an Administration Fellowship in Madison
Dr. Rosalia Holzman is heading to The Ohio State University Nationwide Children's Hospital in Columbus, OH
Dr. Corlin Jewell will be completing an Education Fellowship in Madison
Dr. Ilan Kolkowitz will be completing a Global Health Fellowship in Madison
Dr. Michelle Lum will be completing an Ultrasound Fellowship in Madison
Dr. Erik Morrow will be joining Mayo Clinic Eau Claire Hospital in Eau Claire
Dr. Eric Ohlrogge will be completing a Medflight Fellowship in Madison
Dr. Dan Ritter will be going to Mercy Health in Iowa City/Cedar Rapids, IA
Dr. Katie Ulrich will be going to Dignity Health in Chandler & Gilbert, Phoenix, AZ

The Medical College of Wisconsin Emergency Medicine Residency Program Grads:

Dr. Sean Mackman will be joining Emergency Medicine Specialists.
Dr. Adam Haggerty will be joining Gundersen Health System.
Dr. Justine Wergin will be joining Emergency Medicine Specialists.
Dr. Marielle Brenner will be completing a toxicology fellowship at IU Health in Indiana.
Dr. Rachel Nordstrom will be practicing at the Medical College of Wisconsin.
Dr. Cody Bonk will be completing an ultrasound fellowship at Nebraska Medical Center.
Dr. Reece Cooper will be joining Appleton Emergency Services SC, Thedacare Regional Medical Center in Appleton
Dr. Sarah Kessenich will be practicing at the Medical College of Wisconsin.
Dr. Daniel Kopatich will be doing Locum Tenens.

HHS/ASPR COVID-19 Clinical Rounds

Tue, 14 Jul 2020 13:21:25 GMT

The U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (ASPR), in collaboration with the National Ebola and Special Pathogens Training and Education Centers (NETEC), and Project ECHO, launched a series of COVID-19 Clinical Rounds on March 24th.

This initiative supports a series of three weekly teleECHO programs – 1) Critical Care: Lifesaving Treatment and Clinical Operations; 2) Emergency Department: Patient Care and Clinical Operations; and 3) EMS: Patient Care and Operations.

The aim is to create peer-to-peer learning networks where clinicians who have more experience treating patients with COVID-19 share their challenges and successes with clinicians across the U.S. and around the world with a wide variety of experience treating COVID-19. Each Clinical Rounds session includes brief presentations from experienced expert clinicians; the presentations have included representatives from Bellevue Hospital in New York City, Emory University, University of Minnesota, University of Washington, and Nebraska Medicine, among others. Representatives from more than 15 relevant national professional organizations round out the panel of expert discussants.

The majority of each session is spent in discussion related to Q&A generated by the participants. As of mid-April more than 7500 people from all 50 states and more than 30 countries have participated in the sessions.

To receive announcements on this program join our list serve here: http://eepurl.com/gXrm1z

BRaVe Clinic offers Free Counseling to Healthcare Workers

Wed, 08 Jul 2020 14:24:51 GMT

BRaVe Clinic—Building Resilience Virtually—is a new program that offers free counseling to healthcare workers in Southeast Wisconsin. The program was developed by Stephen Hargarten, MD, MPH, professor of emergency medicine and associate dean for global health at the Medical College of Wisconsin,

The clinic is grant-funded and offers free services to healthcare workers by appointment. The program is intended to assist first responders, EMS and emergency department personnel with behavioral health challenges they face while responding to the demands of COVID and other health issues in their communities.

WACEP members are encouraged to disseminate this program flyer widely, and members who qualify are encouraged to utilize the program’s services.

The Value of Peer Support - Webinar Recording

Mon, 29 Jun 2020 16:28:51 GMT

ACEP is collaborating with the American Association of Emergency Psychiatry on some new resources related to physician wellness and mental health during COVID-19.

On June 11, ACEP hosted "Who's got your back? Psychological Awareness & Team Support," a free webinar about the value of peer support and how you can help your colleagues - and yourself. Panelists include Jack Rozel, MD, MSL, president of the American Association for Emergency Psychiatry, Victor Stiebel, MD, who is board certified in emergency medicine, psychiatry, forensic psychiatry, and psychosomatic medicine, and Anthony Ng, MD, DFAPA, chair-elect of the Coalition on Psychiatric Emergencies.

The webinar is now available in the eCME library (worth 1 AMA PRA Category 1 Credits™).

Help Eliminate Barriers to Physician Mental Health Care

Mon, 22 Jun 2020 13:17:36 GMT

ACEP is committed to eliminating obstacles to EM physicians seeking mental health care. By anonymously sharing your story, you can help inform and further ACEP’s advocacy efforts to remove the existing barriers to seeking treatment, including fears surrounding licensure and credentialing, and better encourage professional support and non-clinical mental health initiatives, such as peer support.

Share your experience.

Medical malpractice fund waives premiums for providers

Thu, 18 Jun 2020 16:02:54 GMT

June 18, Wisconsin Health News

The state’s medical malpractice fund is waiving premiums for the next fiscal year for participating healthcare professionals and providers.

The Injured Patients and Families Compensation Fund’s Board of Governors approved the premium holiday on Wednesday. The holiday, originally requested by the Wisconsin Medical Society, will run from July 1 to June 30, 2021.

Dr. Bud Chumbley, CEO of the Wisconsin Medical Society and a board member, said the action will “provide some financial relief to many of the Wisconsin medical professionals and providers who have been affected by the pandemic and who face ongoing challenges.”

The fund covers claims beyond state-mandated insurance limits, which are set at $1 million by occurrence and $3 million by aggregate per year. In April, lawmakers signed off on a plan not to increase participation fees for the fund for the next fiscal year.

Racial Inequality is a Public Health Crisis in Wisconsin

Tue, 16 Jun 2020 19:29:31 GMT

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

Emergency Medicine is uniquely situated in the House of Medicine to bear witness to the failures of our society. We are there for people in their darkest hours and as a result we see the more overt societal problems – violence, child abuse, drug and alcohol addiction, sexual assault, and suicide. However, it is sometimes easy for us to overlook some of society’s more insidious ills.

Wisconsin has a long history of racial inequality. Our communities of color were confined to certain neighborhoods in our cities for large swaths of our state’s history – a practice known as redlining. The resultant deficiencies in housing, healthcare, education, and job opportunities remain even today. The education gap between black and white children in Wisconsin is the worst in the nation. Wisconsin has the highest rate of incarceration of black men in the nation. White people in Wisconsin make 37% more money than black people doing similar jobs. There is a 48% gap between black and white home ownership.

This housing, education, and income inequality has led to disparities in health, as well. Black infants in our state have a rate of mortality that is nearly 3 times that of other races. Rates of obesity, asthma, hypertension, lower extremity amputation from diabetes, arthritis, and hyperlipidemia are all significantly higher among African Americans. Shockingly, the rate of end-stage renal disease from diabetes is nearly 5 times that of white people.

As physicians, we are obligated to work toward better health for all of our patients. It can sometimes be difficult to see what we can do to be helpful- after all, we try to do our best for each and every patient in the ED. But there are things we can do, both big and small, to make a difference: Listen to your patients. Advocate for additional social work resources in your department. Help your patients get registered to vote. Support organizations that buoy underserved communities. Make sure your department is attempting to hire people of color at all levels. Double check that your patient can afford their prescriptions. Mentor students of color. Recognize your own biases so that you can start to work against them.

We are at a unique moment both in Wisconsin and our nation as a whole. Emergency Physicians should take this opportunity to improve the lives of our patients and the health of our communities. The time for action is now.

VotER - A Collaboration on Healthcare and Voter Registration

Tue, 16 Jun 2020 18:56:27 GMT

Alister Martin, MD, MPP and Marin Darsie, MD

As the coronavirus pandemic has exacerbated longstanding healthcare inequalities that disproportionately affect communities of color and low socioeconomic status, many of us in the medical community are left wondering what we can do. Disparities in Wisconsin are especially sobering. Though Black Wisconsinites make up just 6% of the population, they account for 25% of COVID-19 deaths. The events of the past few months have shined a spotlight on health inequity, creating a pivotal moment for improving our healthcare system.

We want to provide those of you who are interested in a concrete action step: help your patients vote in a safe and healthy manner this November.

Dr. Alister Martin, an EM physician at Mass General Hospital and a faculty member at the Harvard Medical School, leads an organization called VotER that partners with healthcare providers to help patients register to vote. He started the project as a response to what we all see each and every day we care for patients – the healthcare inequities that stem from a democratic process where 51 million citizens aren’t registered to vote. VotER wants to ensure that patients, particularly those most left behind by the healthcare system, are empowered to fix it by inviting their voices into the democratic process.

VotER recently created Healthy Democracy Kits: badge-backers and lanyards with a QR code that patients can scan to register to vote or request an absentee ballot on their phones. It takes them 90 seconds or less while you go on to see the next patient. Voting from home is the safest way to participate in the November elections — this platform makes it easy for you to help your patients get ready to do so.

In the past few weeks, over 5,000 health care providers, including doctors, nurses, and social workers, have ordered their free kits. This effort will be featured in August during national Civic Health Month, a nonpartisan collaboration between healthcare organizations, voter registration organizations, and providers aimed at making the connection between civic engagement and healthcare. Join a rapidly growing number of health care providers across the country who are helping their patients vote safely by ordering your free kit today!

Potential actions:

VotER’s Healthy Democracy Kit is free. Order yours here: http://vot-er.org/kit.
Share this message with colleagues in your network or hospital/department who would be interested. Group orders are welcomed!
Get involved in VotER’s work in other ways, like digitally engaging with patients about safe voting. Feel free to reach out to VotER directly at alister@vot-er.org.

Thank you.

Dr. Darsie is a WACEP member practicing emergency medicine and neurocritical care at the University of Wisconsin Hospitals and Clinics.

Advocating for Patients during a Period of Unrest

Tue, 16 Jun 2020 18:39:43 GMT

Christopher J Ford, MD
Infinity/Envision Healthcare-Ascension Columbia St. Marys Milwaukee
Advisory Board Member-Wisconsin Emergency Services for Children

Dear Fellow EM Providers of Wisconsin,

Last week I sent an email to my group, Infinity/Envision Healthcare, regarding the unrest and much-needed self-reflection our county is experiencing now given the Floyd tragedy. My goal was to advocate for our patients and provide an environment that was even more welcoming, given the circumstances. The email was well received and subsequently sent to my partners nationwide. I got many emails in response from throughout the country, often offering personal experiences of racial and social injustices experienced by the sender or their family members. I was genuinely appreciative of each story shared and respectful of the acceptance of the message I was trying to relay.

Similarly, I wanted to share my personal experiences in this forum, and offer the perspective of some of our patients as context. Despite growing up in an extremely politically active family, I will try to keep this as a-political as possible. In my experience, this has been the best approach to work interactions.

Growing up on the Southside of Chicago, I’ve had many interfaces with police as an African-American male. Some very positive, and some I will never forget, which tailor my interactions with law enforcement to this day. I share with some of my partners in a joking fashion, as is classically my coping mechanism, of how conscious I am of how I appear when driving through my (mostly white) neighborhood after a night shift as a black man. Or, more-so, how careful I am with my interactions with police even at work. Although jovially presented, there is much context, and more so, PTSD attributed. Unfortunately, these experiences are not held by myself alone but by many African-Americans and Latinos, many of whom are our patients.

I write this not to garner sympathy, but rather to invoke even more empathy into our interactions with our minority patient population over the coming days. Even if a member of this population has not had adverse run-ins with the police, the stressors of our current times remain triggers. The Floyd funeral services, the protests, or witnessing of the eight minutes and forty-six seconds of unconscionable disregard for human life will likely re-open scars of the tragic loss of family or friends some have had subconsciously. Us of whom have grown up in inner-city environments probably will have a similar story of loss that rises again to surface with a tragedy such as the Floyd incident.

I ask that we all be incredibly mindful of our patient interactions, starting with our next shift. The entire nation is on edge at this time, and any form of confrontation will now be magnified. Although I am confident you all bring to your practice always an air of empathy and gentle touch, I will admit, I have had moments of frustration fueled by adverse patient interactions. Upon later reflection, I wish I could have de-escalated some of these situations sooner. We are all human, and to deny our potential for mirroring anger is ignoring a huge blind spot in our practice. For all of our safety and the safety of our patients, we must take care to maintain an environment that is as least provocative as possible, even more so than usual.

I thank you all for taking the time to read this email, and I also thank you all for the work that you do. Years later, future providers will reflect on all we have been through as a discipline in the middle of a pandemic and social unrest; these are unprecedented times indeed. You all are truly heroes, never forget that!

~Christopher J. Ford, MD

ACEP20 Goes All Digital, High-Tech Education Experience

Mon, 15 Jun 2020 13:12:55 GMT

These unprecedented times call for an unconventional ACEP20. After thoughtfully considering many different options and ideas, ACEP has made the decision to move ACEP20 to an online-only experience. More details will be released soon as the ACEP annual meeting evolves in exciting new ways. And while the delivery may be different, you can expect the same expert education and CME credit from the world-class faculty you respect. Read more from the ACEP President

COVID-19 Wellness Hub

Thu, 11 Jun 2020 18:10:29 GMT

ACEP launched the COVID-19 Wellness Hub to support EM physicians through the COVID-19 grind.

You'll find options for peer support and crisis counseling, plus the latest advocacy efforts related to removing barriers to care. You can address stress at its source, whether it's related to patient care, workplace, litigation, finances or personal stuff.

For those who want to do a deeper dive into specific issues, the Hub has topical libraries for burnout, PTSD, physician suicide and more.

Latest ACEP Updates

Tue, 09 Jun 2020 15:00:49 GMT

New COVID-19 Website, Plus Updates to COVID-19 Field Guide

Featuring more than 400 resources, the ACEP revamped COVID-19 website will help you find what you need, when you need it. Our most popular resource, the ACEP Field Guide for Managing COVID-19 in the ED (link), has grown to more than 230 pages and been translated to 5 additional languages. The following sections are newly updated: decontamination/cleaning, HCW checklist, HFNO, treatment and management.

Capital Minute

Tune into our newly formatted Capital Minute webinar as we continue to bring you updates on our latest efforts to support and protect emergency physicians in the fight against COVID-19. Click here to view the Capital Minute. Click here to register for the next live ACEP Capital Minute on Thursday, June 11.

Medicare Telehealth Flexibilities…Are They Here to Stay?

We are seeing an expansion of telehealth that we have never seen before, and it is hard to imagine ever going back to where we were before. However, for us to keep up the momentum and not return to the pre-pandemic telehealth world, a few things need to happen---read this Regs & Eggs blog.

COVID-19 Financial Survival Guide: What You Need to Know

ACEP is standing up for our members who, despite serving on the frontlines of the COVID-19 pandemic, are having their livelihoods threatened. Cutting benefits, reducing shifts or canceling contracts in today’s environment is akin to signing a ‘Do Not Resuscitate’ order for many emergency departments and the physicians who care for patients, especially those in rural or underserved areas. Access the guide.

Member Benefits: COVID-19 No Cost, Discount & Other Offers

You are risking your lives to care for patients from this unprecedented pandemic, and we all appreciate the additional stress on you and your families. We want to help. And, so do a lot of companies out there. So, thanks to you and thanks to the companies willing to support our healthcare heroes. View the benefits.

Joining Forces to Support Clinician Mental Health

Thu, 04 Jun 2020 13:14:50 GMT

ACEP and other leading medical associations released a joint statement outlining steps to support the mental health of EM physicians and other clinicians during this pandemic.

Developed by ACEP and the Coalition on Psychiatric Emergencies, the joint statement was signed by more than 40 groups. It emphasizes that a clinician's history of mental illness or SUD treatment shouldn't be used as an indicator of their current/future ability to competently practice medicine.

"A physician's choice to address his or her mental health should be encouraged, not penalized," said ACEP President Bill Jaquis, MD, FACEP.

ACEP Survey of Workplace Stress During the COVID-19 Pandemic

Fri, 29 May 2020 14:12:58 GMT

The ACEP Ethics Committee is conducting a survey of Workplace Stress during the COVID-19 Pandemic. The study is IRB approved and anonymous, and should take less than five minutes. ACEP members who have not yet participated are encouraged to take the survey here:
https://www.surveymonkey.com/r/LMRBFDT

Emergency Physician Tim Westlake Elected MEB Chair

Thu, 28 May 2020 23:04:48 GMT

New officers were recently elected by the Wisconsin Medical Examining Board (MEB). Tim Westlake, MD, an emergency physician, with ProHealth Care, was elected as Chair, Sheldon Wasserman, MD, FACOG, was elected Vice Chair and Alaa Abd-Elsayed, MD, was elected Secretary.

Among discussion at the recent MEB meeting were the ramifications of the May 11 expiration of the Governor's Executive Order #72 and the impact on temporary licenses for physicians working across state lines to help with the COVID-19 pandemic response.

Low Volumes in EDs Sound the Alarm

Wed, 20 May 2020 14:21:45 GMT

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

Across the state, ED patient volumes remain significantly decreased, with some EDs seeing half or even a third of their usual volumes. While the initial decrease in volume was seen as something of a relief for some – who doesn’t love an easier overnight? – the persistent downturn has led to mounting concerns.

The first concern is, of course, for our patients. In the early days of the COVID outbreak, I was routinely having patients apologize to me for being in the ED for non-COVID related problems, even when they clearly needed to be seen for emergency care. They were worried that they were pulling me away from other people who might need my care, or that they would be “wasting” healthcare resources. While this concern for their neighbors is admirable, it is clearly ill-advised in the case of severe symptoms requiring ED evaluation, such as chest pain or abdominal pain.

Another cohort of patients avoiding the ED were people who were simply afraid that they would be exposed to COVID while in the hospital. I saw more than a few patients walk into the ED, look around at the isolation procedures in the waiting room and staff in their masks and face shields, and turn right around and walk back out. While this might seem like a reasonable fear, the fact is that we deal with highly infectious diseases in the ED all the time and are experts at preventing cross-contamination of patients.

This decrease in patients seeking ED care is doubly concerning when you consider the lack of outpatient care available right now. These patients aren’t seeking alternative care – they aren’t seeking care at all. This has led to a rash of delayed presentations and worse outcomes. Anecdotally, I’ve seen more ruptured appendices and perforated ulcers in the last 2 months than I normally would in a year.

Another major concern caused by low volumes is a significant drop-off in revenue for some groups. Small groups and rural hospitals run on thin margins as it is, and a sustained drop in volume could lead to corporate takeovers and hospital closings. While some government aid is available, it’s nowhere near enough to cover the losses. Compounding the problem is the significant amount of planning and sweat equity that went into preparing our EDs for COVID, often completely unfunded. Even for hospital employees and those employed by large groups, EPs across the state are seeing pay cuts and hours cut – an unneeded additional stressor in these already stressful times.

In order to try to reassure patients that Wisconsin’s EDs and hospitals are safe and have more than enough bandwidth to care for both COVID and non-COVID patients alike, WACEP has partnered with the Wisconsin Hospital Association. A new PSA will be hitting the airwaves soon across Wisconsin, reminding people that Wisconsin EDs are safe, well-equipped, and ready to care for them when they need us.

UW’s Jennifer Mirrielees receives honorable mention by ACEP/EMRA

Wed, 20 May 2020 14:20:57 GMT

ACEP and EMRA have announced winners and honorable mentions of the 2020 National Outstanding Medical Student Award program. This year’s honorees include Jennifer Mirrielees from the University of Wisconsin School of Medicine and Public Health, who received an honorable mention.

As shared in her nomination, Jennifer’s strong commitment to service toward not only underserved patient communities, but to her peers, and her strong leadership in clinical and administrative capacities, embodies the heart of this award. In support of her candidacy, faculty commented on her strong work ethic, clinical efficiency, and her ability to form strong therapeutic bonds with her patients. “Overall, Jennifer is a superbly accomplished student. This is easy to measure when looking at her care for those in great need, her desire to lead and care for her peers, and her translation of this passion into the clinical environment in the ED.”

The Award annually recognizes up to five fourth year EM-bound medical students who excel in humanism, professionalism, leadership/service, research, and academic excellence. Award winners will be recognized at the EMRA Medical Student Forum in October and honorable mentions will be mailed a commemorative plaque.

Reflection on Virtual Hill Day 2020

Wed, 20 May 2020 14:18:31 GMT

Paul Benz, MD
Medical College of Wisconsin Emergency Medicine Residency
Class of 2022

On April 28, 2020 I had the opportunity to join fellow WACEP Board Members Drs. Lisa Maurer, Brad Burmeister, Aurora Lybeck, Bill Falco and Stephanie Wagner and other Emergency providers from across the state for ACEP’s first Virtual Hill Day. Due to the COVID-19 pandemic, these meetings were held virtually. We participated in conference calls with the staff of Wisconsin Senators Tammy Baldwin and Ron Johnson as well as those from all eight Wisconsin Representatives, many including the Congress members themselves.

Though the meetings were held virtually, it was a great learning experience, and I was happy to help advocate for our specialty. Now more than ever Emergency Medicine providers as well as all personnel working in Emergency Departments across the country must have our perspectives understood as we truly are the frontline providers of the COVID-19 pandemic. I believe that we were able to successfully highlight the importance of that message to our Congress members on Virtual Hill Day.

During each meeting we discussed four topics agreed upon as the most pertinent by ACEP leaders nationwide given the current climate in Emergency Medicine. These included personal protective equipment (PPE), liability, hazard pay, and patient coverage. We stressed the importance of our rights for appropriate and adequate PPE including N-95 masks. Across the board, the Congress members and their staff acknowledged the magnitude of this issue and offered to continue supporting us on this effort. We discussed how the COVID-19 pandemic has altered the practice of Emergency Medicine in terms of provider liability, and that many providers are forced to make economic sacrifices that should be compensated with hazard pay. We also asked the Congress members to advocate for extending healthcare coverage beyond COVID-19 tests and testing related services to encompass additional care that COVID-19 positive or suspected positive patients receive.

Overall, we were encouraged by the discussions that took place and are optimistic for the future. While there is still more work to be done and we are all adapting to living and working during the COVID-19 pandemic, Virtual Hill Day was successful in its goal to advocate for the well-being of Wisconsin Emergency Medicine providers.

WACEP and WHA Promote Safe Care in Hospitals and ERs

Sat, 16 May 2020 15:03:32 GMT

The Wisconsin Chapter of the American College of Emergency Physicians and the Wisconsin Hospital Association have partnered to spread the message that hospital emergency rooms and urgent care clinics remain safe, clean and ready to help give patients the care they need. We believe it is important to remind the public that hospitals are hard-wired to provide a safe environment and prevent infection spread. Along with a press release, two versions of an audio Public Service Announcement have been distributed:

30 second PSA: https://youtu.be/vdMQgW9VEzw
15 second PSA: https://youtu.be/pJA-4-TEhIU

Joint Commission Statement on Removing Barriers to Mental Health Care for Clinicians and Health Care Staff

Tue, 12 May 2020 23:11:24 GMT

The Joint Commission released a statement that supports "the removal of any barriers that inhibit clinicians and health care staff from accessing mental health care services, including eliminating policies that reinforce stigma and fear about the professional consequences of seeking mental health treatment." View statement.

Podcast: Taking Care of Yourself

Mon, 11 May 2020 12:51:50 GMT

In the podcast, Taking Care of Yourself: Mental Health in the Time of COVID-19, Dr. Ryan Stanton talks with Dr. Jack Rozel, Medical Director at Resolve Crisis Services and President of the American Association of Emergency Psychiatry.

Evers seeks to make Wisconsin a top state for COVID-19 testing

Mon, 04 May 2020 19:21:40 GMT

May 4, Wisconsin Health News

Gov. Tony Evers announced a plan Monday to make Wisconsin one of the top states for COVID-19 testing per capita.

Evers said the state is prepared to provide 85,000 tests per week.

“We want every Wisconsin resident who needs a test to get a test,” Department of Health Services Secretary-designee Andrea Palm told reporters.

As of Monday, the state has already provided more than 60,000 tests to hospitals, clinics, local public health departments, long-term care facilities and others.

Fifty-seven of the state’s counties have requested and are getting supplies.

Other key components of the plan, according to a statement from the governor’s office, are:

Providing free testing and diagnostics to Wisconsin’s 373 nursing homes to test all nursing home residents and staff. The goal is to test more than 10,000 residents and staff per week during the month of May.
Working with the Wisconsin National Guard and local health groups to test all workers and families linked to outbreaks.
Increasing the number of free drive-thru community testing sites throughout the state.
Mobilizing 15 more National Guard units to help local health departments set up testing sites and respond to outbreaks. That would bring the total number of National Guard units working on testing to 25.
Providing free tests for state-sponsored test sites for those experiencing COVID-19 symptoms. No doctors’ visits will be required at sites sponsored by the National Guard.
Providing test supplies to all Wisconsin healthcare systems. As of Monday, the state has provided 41,255 tests to healthcare systems.

Settlers Bank to assist physicians and clinics with SBA/PPP applications

Mon, 04 May 2020 16:00:49 GMT

April 30, Medigram, Wisconsin Medical Society

Settlers Bank is a Wisconsin business focused on serving the needs of physicians and clinics throughout the state. In order to best serve those needs during this time, they will assist physicians and clinics with questions regarding the SBA/PPP loan application process – even if they are not a current client.

To use Settlers Bank for the SBA/PPP loan application process, a physician or clinic is simply required to open an operating account and have a conversation about their overall banking needs. Settlers Bank also works closely with the clinic’s CPA to help determine the qualified loan amount as well as financial modeling.

Settlers Bank offers a one-call approach to the medical community, because they understand that now more than ever time is of the essence.

Anne Fink, CFP® is a private banker specializing in working with physicians. Contact Anne at afink@settlerswi.com or 608.842.5025. To learn more about Settlers Bank click here.

Settlers Bank is MEMBER FDIC

Wisconsin ERs see Decline in Visits

Thu, 23 Apr 2020 15:16:42 GMT

April 23, Wisconsin Health News

Wisconsin emergency rooms are seeing a decline in visits since the start of the COVID-19 pandemic, which providers attribute to a drop in injuries and respiratory illnesses due to social distancing, a boost in telehealth and fear of potential exposure to the new coronavirus.

“It’s a little amazing - what used to be an emergency or an urgent care visit isn’t there anymore,” Froedtert Health CEO Cathy Jacobson said during a Wisconsin Health News webinar last week. “It’s just not coming in.”

Health systems throughout the state say they’ve seen emergency department visits drop by around half during the pandemic. And the patients that emergency rooms are seeing tend to be sicker and more likely to need hospital care.

Providers stress that they've taken measures to protect patients from possible COVID-19 infection.

Dr. Joshua Ross, executive vice chair of the BerbeeWalsh Department of Emergency Medicine at the University of Wisconsin School of Medicine and Public Health, said nationally emergency room visits are down around 50 percent. UW Health isn’t different.

Ross said they’ve spent a lot of time in preparation to make sure that emergency rooms can separate those with COVID-19 symptoms from those who don’t, as well as cleaning rooms and having appropriate personal protective equipment. He said the fact that visits are lower is good for preparation purposes.

“But it’s also somewhat concerning because we know that there’s probably people out there with small heart attacks and strokes that aren’t seeking care," he said.

Ross noted that volumes may be down because there aren’t influenza and other seasonal infections due to social distancing measures. They’re also not seeing traffic accidents or sports-related injuries.

He said they’re concerned about people not seeking care, adding that there are risks at home, including concerns around mental health and domestic violence.

“We still have to be vigilant in terms of making sure our healthcare infrastructure and support systems are in place,” he said.

Ashley Lyman, Bellin Hospital's emergency department team leader, said visits are about half of their pre-pandemic normal, and hospital admission rates are up 5 to 10 percent. Part of that has to do with staying home, which is lowering the spread of contagious diseases.

Other factors could be expanded telehealth services that help triage patients to the appropriate level of care, patients being afraid to come to the department during the epidemic and suspension of elective care, which means fewer people coming in due to complications.

No school and limited daycare options could also be playing a role, as children with fevers aren’t able to go back to school or daycare the next day, she noted.

Dr. Michael Dolan, executive vice president at Gundersen Health System, said their emergency room volumes are down about 45 percent.

He said they opened a respiratory clinic for people under investigation for COVID-19 where they’re sending patients who might otherwise head to an emergency room.

Dolan noted that their trauma cases are similar to what they normally see, while other hospitals have seen a decline due to fewer road accidents.

“I think we’re making up for that in non-motor vehicle accident trauma,” he said. “We’re a rural area. Farmers are really trying to get out in the fields and get started with their crops. We see some farming-related trauma, some ATV-related trauma, things people can get into trouble with at home.”

Dolan said they also haven’t seen a decline in heart attacks as well as stroke numbers. But they’re seeing fewer patients with mild heart failure or mild infectious disease.

During the last six months, the emergency department at Children’s Wisconsin has seen a 60 percent decrease in the number of kids they’d expect this time of year. Spokesman Andy Brodzeller said part of that is expected, due to closed playgrounds and families driving less.

He added that families may be choosing other options, like online urgent care or reaching out to a primary care doctor.

Dr. Brian Hoerneman, Marshfield Medical Center-Marshfield vice president of medical affairs, said part of their 40 percent drop in emergency department use could be a decline in illness due to social distancing.

But he said that some of it appears to be people not seeking care when they need it.

“In conditions such as heart attacks and strokes, the window for treatment is narrow,” he said in an email. “Time is of the essence and outcomes worsen for every hour that treatment is delayed."

Hoerneman stressed that the emergency department is safe for patients, and that telehealth is available to help people assess their medical situation.

Aspirus Wausau Hospital Emergency Department Director Robin Rudie echoed concerns that the decrease they're seeing in visits and the increase in severity could be due to fear of exposure of the virus.

“We wouldn’t typically expect the pandemic to reduce our overall volumes,” she said in remarks to the media.

Health systems stressed that emergency rooms are safe. LeeAnn Betz, a spokeswoman for Advocate Aurora Health, said that they’re taking all precautions to protect their health and safety, including separating COVID-19 patients from those with other symptoms or injuries.

“Staying home, ignoring the symptoms and suffering out of fear of COVID-19 is a risk people shouldn’t take with their health” Dr. Gregory Brusko, Ascension Wisconsin Chief Clinical Officer, said in a statement.

Governor Announces Badger Bounce Back Plan

Mon, 20 Apr 2020 22:01:08 GMT

Governor Evers today announced Wisconsin's "Badger Bounce Back" plan which outlines important criteria for Wisconsin to be able to reopen its economy in phases and includes steps to make sure workers and businesses are prepared to reopen as soon as it is safe to do so. In coordination with this announcement, at the direction of the governor, Wisconsin Department of Health Services Secretary-designee Andrea Palm issued Emergency Order #31 establishing the process and outlining the phases of the plan. The emergency order is available here.

The Badger Bounce Back plan is informed in part by the President's Guidelines for Opening Up America Again that was issued by the White House on April 16, 2020. Currently, Wisconsin does not meet the criteria the White House established to start reopening our state. The Badger Bounce Back plan takes important steps to get the state of Wisconsin there.

The goal of the Badger Bounce Back plan is to decrease cases and deaths to a low level, and increase capacity in our healthcare system so the phased reopening of businesses is possible. As part of that plan the state will be working to increase access to more testing and expand lab capacity. Under the Badger Bounce Back plan, everyone who needs a test should get a test. The state is setting a goal of 85,000 tests per week, averaging about 12,000 tests per day. More information on the state's testing efforts was released earlier today, and is available for review here.

Next, the state will be expanding contact tracing and more aggressively tracking the spread with the goal of every Wisconsinite who tests positive being interviewed within 24 hours of receiving their test results and their contacts being interviewed within 48 hours of test results.

Additionally, the state will continue to pursue every avenue to grow Wisconsin’s supply of personal protective equipment (PPE) for healthcare and public safety entities to conduct COVID-19 testing, patient care, and public safety work. Finally, the plan works to bolster healthcare system capacity where patients can be treated without crisis care and there are more robust testing programs in place for at-risk healthcare workers.

The state will be looking for a downward trajectory of influenza-like illnesses and COVID-19 symptoms reported within a 14-day period, and a downward trajectory of positive tests as a percent of total tests within a 14-day period. When the state has seen these efforts be successful, Wisconsin can begin to turn the dial, re-open the state, and get businesses and workers back on their feet.

The Badger Bounce Back plan is available here. The Wisconsin Economic Development Corporation’s portion of the Badger Bounce Back plan aimed at helping to ensure workers and businesses are prepared and ready to bounce back is available here. The Badger Bounce Back plan in brief is also available here.

Gov. Evers Directs DHS to Extend Wisconsin's Safer at Home Order

Thu, 16 Apr 2020 18:56:22 GMT

Gov. Tony Evers today directed Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm to extend the Safer at Home order from April 24, 2020 to 8 a.m. Tuesday, May 26, 2020, or until a superseding order is issued. The order implements some new measures to ensure safety and support the progress we've made in containing COVID-19, but also allows certain activities to start up again. The order is available here.

“A few weeks ago, we had a pretty grim outlook for what COVID-19 could mean for our state, but because of the efforts of all of you, Safer at Home is working. That said, we aren't out of the woods just yet,” said Gov. Evers. “As I've said all along, we are going to rely on the science and public health experts to guide us through this challenge. So, as we extend Safer at Home, I need all of you to continue doing the good work you've been doing so we can keep our families, our neighbors, and our communities safe, and get through this storm together.”

“Before we lift Safer at Home, the steps of testing and more robust public health measures must be in place,” explained Secretary-designee Palm. “These steps will help us reduce the risk of a second wave of the virus. If we open up too soon, we risk overwhelming our hospitals and requiring more drastic physical distancing measures again.”

The extension of the Safer at Home order includes a few changes. Some changes allow more businesses and activities to open back up, while other changes help make businesses safer for employees and customers. The changes in this order include:

Businesses and activities ramping up service and operations:

Public libraries: Public libraries may now provide curb-side pick-up of books and other library materials.
Golf Courses: Golf courses may open again, with restrictions including scheduling and paying for tee times online or by phone only. Clubhouses and pro shops must remain closed.
Non-essential Businesses: Non-essential businesses will now be able to do more things as Minimum Basic Operations, including deliveries, mailings, and curb-side pick-up. Non-essential businesses must notify workers of whether they are necessary for the Minimum Basic Operations.
Arts and Crafts Stores: Arts and craft stores may offer expanded curb-side pick-up of materials necessary to make face masks or other personal protective equipment (PPE).
Aesthetic or Optional Exterior Work: Aesthetic or optional exterior law care or construction is now allowed under the extended order, so long as it can be done by one person.

Safe Business Practices:

Safe Business Practices for Essential Businesses and Operations: Essential Businesses and Operations must increase cleaning and disinfection practices, ensure that only necessary workers are present, and adopt policies to prevent workers exposed to COVID-19 or symptomatic workers from coming to work.
Safe Business Practices for Retailers that Essential Businesses and Operations: Retail stores that remain open to the public as Essential Businesses and Operations must limit the number of people in the store at one time, must provide proper spacing for people waiting to enter, and large stores must offer at least two hours per week of dedicated shopping time for vulnerable populations.
Supply Chain: Essential Businesses and Operations that are essential because they supply, manufacture, or distribute goods and services to other Essential Businesses and Operations can only continue operations that are necessary to those businesses they supply. All other operations must continue as Minimum Basic Operations.

Other changes include:

Schools: Public and private K-12 schools will remain closed for the remainder of the 2019-2020 school year.
Local parks and open space: Local health officials may close public parks and open spaces if it becomes too difficult to ensure social distancing or the areas are being mistreated.
Travel: People are strongly encourage to stay close to home, not travel to second homes or cabins, and not to travel out-of-state if it is not necessary.
Tribal Nations: Tribal Nations are sovereign over their territory and can impose their own restrictions. Non-tribal members should be respectful of and avoid non-essential travel to Tribal territory. Local government must coordinate, collaborate, and share information with Tribal Nations.
Duration: The changes in this order go into effect on April 24, 2020. The order will remain in effect until 8 a.m. on May 26, 2020.

If you have questions, a Frequently Asked Questions (FAQ) document is available here for your review.

The public should continue to follow simple steps to avoid exposure to the virus and prevent illness including:

Avoiding social gatherings with people of all ages (including playdates and sleepovers, parties, large family dinners, visitors in your home, non-essential workers in your house);
Frequent and thorough hand washing with soap and water;
Covering coughs and sneezes;
Avoiding touching one's face; and
Staying home.

This is a rapidly evolving situation, and we encourage you and the public to frequently monitor the DHS website. We encourage you to follow @DHSWI on Facebook, Twitter, or dhs.wi on Instagram. Additional information can be found on the CDC website.

Wisconsin Legislature Passes COVID-19 Response Legislation

Wed, 15 Apr 2020 18:41:11 GMT

The State Legislature passed, and the Governor has signed, the state's COVID-19 response package, which includes liability immunity provisions. A late amendment broadens the measure and ensures there is no ambiguity about protections applying to COVID and non-COVID patients alike.

The legislation also includes provisions that will help the state draw down additional federal dollars for Medicaid as well as a provision related to out of network billing.

Below is the liability immunity language as adopted.

SECTION 98. 895.4801 of the statutes is created to read:

895.4801 Immunity for health care providers during COVID-19 emergency.

(1) DEFINITIONS. In this section:

(a) “Health care professional” means an individual licensed, registered, or certified by the medical examining board under subch. II of ch. 448 or the board of nursing under ch. 441.

(b) “Health care provider” has the meaning given in s. 146.38 (1) (b) and includes an adult family home, as defined in s. 50.01 (1).

(2) IMMUNITY. Subject to sub. (3), any health care professional, health care provider, or employee, agent, or contractor of a health care professional or health care provider is immune from civil liability for the death of or injury to any individual or any damages caused by actions or omissions that satisfy all of the following:

(a) The action or omission is committed while the professional, provider, employee, agent, or contractor is providing services during the state of emergency declared under s. 323.10 on March 12, 2020, by executive order 72, or the 60 days following the date that the state of emergency terminates.

(b) The actions or omissions relate to health services provided or not provided in good faith or are substantially consistent with any of the following:

Any direction, guidance, recommendation, or other statement made by a federal, state, or local official to address or in response to the emergency or disaster declared as described under par. (a).
Any guidance published by the department of health services, the federal department of health and human services, or any divisions or agencies of the federal department of health and human services relied upon in good faith.

(3) APPLICABILITY. This section does not apply if s. 257.03, 257.04, 323.41, or 323.44 applies.

Burmeister Continues COVID-19 Discussion with Fox11-Green Bay

Tue, 14 Apr 2020 14:26:09 GMT

Brad Burmeister, MD, an emergency physician and President-Elect of Wisconsin ACEP, continues his COVID-19 discussion with Fox 11-Green Bay "Good Day Wisconsin" morning show. View interview here.

COVID-19 Research Grants

Mon, 13 Apr 2020 13:06:38 GMT

The Emergency Medicine Foundation is awarding funding of up to $100,000 in new research grants on emergency medicine areas related to COVID-19.

Topics may include, but are not limited to, the following:

Personal Protective Equipment (PPE), including Design, Cleaning, Re-use
Ventilator Scarcity
Telemedicine
Laboratory Testing
Rapid Screening, Triage and Testing
Clinical Diagnosis
Epidemiology of Disease
Therapeutics
Diagnostic Radiology, including Point of Care Ultrasound
Emergency Medicine Workforce, including Safety
Emergency Physician Wellness
Special Populations, such as High Risk, Homeless, Non-English Speaking, Transplantation Patients

Proposals are due June 5, 2020. Learn more and read the RFP.

COVID-19 Volunteer Program Announced

Sat, 11 Apr 2020 01:54:24 GMT

Governor Evers announced that the state is seeking volunteers to support Wisconsin's healthcare system during the COVID-19 pandemic. Active and retired healthcare professionals and those who wish to help in non-clinical support positions are encouraged to sign up to volunteer through the Wisconsin Emergency Assistance Volunteer Registry (WEAVR).

The number of patients in Wisconsin who need to be treated for COVID-19 is expected to surge in the coming weeks. Building a network of available volunteers now will greatly reduce the hardships on hospitals and clinics that would not normally have the capacity to care for the increase in patients.

Both active and retired healthcare professionals can volunteer for critical clinical roles by entering their information into the WEAVR, a secure, password-protected, web-based volunteer registration system for healthcare and behavioral health professionals. Individuals who are not licensed professionals are also encouraged to sign up to volunteer for non-clinical support positions.

Volunteers will be assigned to locations across Wisconsin to support ongoing efforts related to the COVID-19 national emergency. Those who are willing to travel should note that when they sign up. All volunteers should also be aware that they will be required to complete a background check.

The full copy of the Governor’s press release is available online (link).

ACEP Launches Field Guide to COVID-19 Care in the ED

Wed, 08 Apr 2020 23:33:47 GMT

The American College of Emergency Physicians has launched the Field Guide to COVID-19 Care in the ED to assist emergency physicians on the front lines in the current crisis. The guide is a compilation of current knowledge on the evaluation and treatment of COVID-19.

It is a living document; ACEP will continue to update it as new information, guidance, and best practices evolve. Some sections are listed as "Coming" - that is because ACEP is working with NIH to develop the national guidelines for COVID-19.

WACEP President-Elect Brad Burmeister, MD Featured on Fox11 News-Green Bay

Tue, 07 Apr 2020 22:53:22 GMT

Brad Burmeister, MD, an emergency physician and President-Elect of Wisconsin ACEP, discussed COVID-19 during three segments on the April 7th Fox 11-Green Bay "Good Day Wisconsin" morning show. View interview here.

Webinar - How the Stimulus Can Help Physicians

Tue, 07 Apr 2020 20:18:35 GMT

As the COVID-19 crisis continues, there are wide-ranging resources available for physicians and health care professionals. However, identifying which resources would benefit your health care practice is difficult.

The Wisconsin Medical Society (WisMed), gener8tor and WisMed Assure hosted a free webinar about the government resources available to independent physicians and health care practices, as it relates to the stimulus package. Topics covered include:

Which federal grant/loan programs is my business eligible for?
SBA Disaster Loan (e.g. Economic Injury Disaster Loan or EIDL)
CARES Act and the Paycheck Protection Program (PPP)

View webinar, and visit the COVID-19 resource pages for other important updates and information on the Wisconsin Medical Society's website.

WACEP Urges Adherence to Public Health Orders in Wisconsin

Mon, 06 Apr 2020 16:24:07 GMT

The Wisconsin Chapter of the American College of Emergency Physicians (WACEP), whose member physicians are on the frontlines in the battle against the COVID-19 pandemic, strongly urge all Wisconsinites to stay home and avoid gatherings of any type.

WACEP favors postponement of the April 7th Spring Election in Wisconsin. In lieu of such action, voters who have already received an absentee ballot are strongly encouraged to vote absentee and have their ballot postmarked by the deadline of April 7th, election day, and received by April 13th at 4:00 pm.

To stop the spread of COVID-19 and flatten the curve, Wisconsin must adhere to current emergency orders, recommended social distancing and make all efforts to stay at home when possible. In our state, the worst days of this crisis are still ahead of us but will be more manageable if we all act responsibly.

Wisconsin Granted Federal Disaster Declaration Due to COVID-19 Pandemic

Sat, 04 Apr 2020 20:13:43 GMT

Governor Evers announced that Wisconsin has been granted a major disaster declaration for the entire state of Wisconsin, as a result of the COVID-19 pandemic. The declaration provides access to Public Assistance programs for all 72 Wisconsin counties and the state’s federally recognized tribes.

Gov. Evers earlier this week requested that the federal government provide the following programs to support the state’s response: Public Assistance, Direct Assistance, Hazard Mitigation (statewide), and certain Individual Assistance programs; Crisis Counseling, Community Disaster Loans and the Disaster Supplemental Nutrition Program.

The Federal Emergency Management Agency (FEMA) notified the state today that it is granting the request for Public Assistance to help provide reimbursement for emergency protective measures taken by state and local governments in their response to the COVID-19 outbreak. The declaration also authorizes direct Federal Assistance which means when the State and local governments lack the capability to perform or to contract for eligible emergency work and/or debris removal, the State may request that the work be accomplished by a federal agency. The governor’s additional requests for assistance remain under review.

The major disaster declaration covers assistance to public entities, and will cover eligible projects submitted by counties, cities, townships, tribes, and certain private, not-for-profit organizations. Local governments in the declared counties are now eligible for federal assistance and should contact county emergency management directors for further information. Under the program, FEMA provides 75 percent of eligible costs, while the remaining 25 percent is the responsibility of state and local agencies.

The Governor’s full press release is available online (link).

Wisconsin DHS Announces Resilient Wisconsin Initiative

Fri, 03 Apr 2020 20:25:31 GMT

The Department of Health Services announced the creation of the Resilient Wisconsin Initiative (website) on Friday, which provides Wisconsinites with resources to cope with stress and mental health challenges from COVID-19.

DHS recommends that Wisconsinites do the following:

Get the three goods. That’s good-for-you foods, a good night’s sleep, and a good amount of exercise every day.
Stay connected to your support system. Reach out to family and friends, colleagues, and community groups in whatever way you can—calls, texts, video chats, and more.
Spend time away from focusing on COVID-19. Don’t let the pandemic take over what you read, watch, or talk about. And don’t be afraid to ask friends and family to talk about something else.
Reduce anxiety by reducing your risk. Stay safer at home. Wash your hands for at least 20 seconds. Cover your nose and mouth when you cough or sneeze. Stay at least 6 feet apart while running essential errands at the store, pharmacy, or gas station. Knowing you’re doing everything you can to stay healthy can help you worry less.
Check in with yourself. Everyone’s reaction to stress is different. Difficulty concentrating or sleeping, irritability, fatigue, and even stomachaches can be normal. But if you find you are overwhelmed or having thoughts of self-harm or suicide, reach out for help right away. Text HOPELINE to 741741 or call the National Suicide Prevention Lifeline at 1-800-273-8255.

Wisconsin Emergency Order 16 Telehealth Guidance

Thu, 02 Apr 2020 17:19:18 GMT

The Wisconsin Department of Safety and Professional Services has received numerous inquiries regarding Emergency Order 16 and the status of telemedicine/telehealth practice as a result of the COVID-19 public health emergency.

The emergency order covers a wide range of issues across many health care professions. The order took action that will make it easier to quickly expand the health care workforce by readmitted those with expired licenses and by welcoming providers from other states. It will also enhance flexibility so providers can more effectively respond to areas of greatest need. DSPS created a Frequently Asked Questions document to provide additional clarifications. Both Emergency Order 16 and the FAQ document address individuals who have expired licenses and wish to return to practice.

The practice of telehealth is generally allowed under existing Wisconsin law unless there is some profession-specific requirement or restriction. Credential holders must use their professional judgment to determine if telehealth is appropriate for the patient or client being treated, to abide by all other applicable rules of practice and professional conduct, and to be properly credentialed or authorized to practice in the state of Wisconsin. If someone can practice in Wisconsin via an Emergency Order, a compact, or a temporary or permanent license, that individual can practice telehealth in Wisconsin and provide services to Wisconsin residents to the same extent as similarly licensed Wisconsin practitioners.

The Wisconsin Medical Examining Board has the only telemedicine rule currently in effect in Wisconsin. This rule may be found at Wis. Admin. Code Med chapter 24 (link). While this rule applies only to the Medical Examining Board, many of the concepts in this rule may be informative to credential holders in other professions. Note that portions of this rule were suspended when Governor Evers issued Emergency Order 16. Please review both Med chapter 24 as well as the statutory and rule provisions governing your profession when evaluating telemedicine/telehealth practice options during the COVID-10 public health emergency.

If practice-related questions arise, DSPS encourages credential holders to consult with a supervisor, with their own private or institutional legal counsel, with their colleagues within the profession, or other sources familiar with their profession’s standards of practice. Profession-related statutes and rules can be found by clicking on a profession under the Rule/Statutes column here.

Also, there have been recent changes to Medicaid reimbursement of telehealth services. The Wisconsin Department of Health Services issued guidance on telehealth reimbursement changes and status during the COVID-19 public health emergency. The Office of the Commissioner of Insurance has also sent this letter regarding related insurance (malpractice) issues to insurers.

This information will be posted to the DSPS website. Please visit often, as we are updating it daily as decisions are made and new information is available.

WACEP Policy & Advocacy Update

Thu, 02 Apr 2020 16:44:47 GMT

Lisa Maurer, MD, FACEP
WACEP Legislative Chair

As we all continue to care for patients on the front line of this public health emergency, legislators and regulators have been working to support us. Please see the summary below and visit our WACEP COVID-19 Resources page (link) for news and links to many external resources.

Telehealth

Wisconsin Medicaid now allows for parity for telehealth visits as compared to face to face encounters
CMS has added typical ED codes 99281-99285 and 99291-99292 to the list of codes that are approved for telehealth. These should be submitted using a 95 modifier and the typical Place of Service
A telehealth encounter performed by a typical Qualified Medical Provider is sufficient for MSE requirements for EMTALA
CMS loosened HIPAA requirements as it pertains to telehealth as to allow for a wider variety of allowed platforms

Liability

The CARES Act passed limitation on liability for volunteer care by health care providers during response to the COVID-19 public health emergency
WACEP is working with state officials and other medical organizations including WHA and WMS to push for other liability protections here in Wisconsin. Modeled after AMA-ACEP recommended language, we are specifically asking that those providing COVID-related care be immune to civil liability absent gross negligence

EMTALA

CMS is currently waiving a small part of EMTALA requirements, allowing redirection to another location (offsite alternate screening location) to receive a medical screening exam under a state emergency preparedness or pandemic plan, thus allowing hospitals to screen patients at a location offsite from the hospital's campus to prevent the spread of COVID

The offsite location must be in compliance with the State's Pandemic\Emergency Preparedness Plan
The waiver may obviate sanctions (citation/fines), but not necessarily an investigation
The waiver may not necessarily limit your civil or regulatory liability
Typical processes for MSE should remain in place if possible

CMS goes on to clarify what is and is not allowed during the Public Health Emergency regarding EMTALA, even without using the above described waiver. (see EMTALA Guidance)

Patients presenting to the ED can be referred to "on-campus" screening sites such as tents, drive-thrus, etc.
Hospitals can post signage informing patients of these on-campus screening sites. They can even post signage about off-campus testing sites, but these are for patients presenting for testing only, not for MSE
It still must be a physician or APP (qualified medical provider) who performs the MSE (QMPs have not been expanded to nurses)

Reimbursement

Medicare sequestration is temporarily lifted, resulting in a 2% increase in payments across the board through the rest of 2020 (CARES Act)
The “geographic practice cost index” (GPCI) 1.0 floor has been extended through December 1, 2020, thus retaining a higher RVU for codes especially in rural areas where the GPCI would usually float below 1.0 (CARES Act)
Gov Evers has proposed a bill for legislative consideration (LRB-5920), which would temporarily prohibit any increased out-of-pocket costs for patients who receive OON care as compared to care from in-network providers. In this case, provider reimbursement would be set at least 250% of Medicare rates directly from the payor
There are several other opportunities for financial support from the federal government for hospitals and small physician groups

Wisconsin LFB Published Report on State Funding in CARES Act

Thu, 02 Apr 2020 01:35:48 GMT

Wisconsin nonpartisan Legislative Fiscal Bureau (LFB) published an analysis of the approximately $2.2 billion Wisconsin is expected to receive from the Coronavirus Relief Fund created by the Act. About $1.8 billion would go to the state government while the remaining funds would go to the City of Milwaukee, Milwaukee County and Dane County. The LFB has also provided Wisconsin-specific estimates for some of the programmatic increases provided by the stimulus package. The report is available online (link).

The report includes a summary on all programs funded in the Act, including:

Public Health Emergency Preparedness funding from CDC;
Administration for Community Living
Public Health and Social Services Emergency Fund
Direct Payments to State and Local Governments
Transportation, Housing and Unemployment Programs

Details on the full $2 trillion COVID-19 stimulus package are also available in the full bill available online (link). The following is a summary of some of the healthcare related provisions in the bill.

Health and Long-term Care

Grants to Hospitals and Health Care Providers: Provides $100 billion to reimburse, through grants or other mechanisms, eligible health care providers for health care related expenses or lost revenues that are attributable to coronavirus. Medicaid and Medicare providers are included in the definition of health care provider. To apply, providers must submit an application to the Secretary of Health and Human Services that includes a statement justifying their need.

Delay of Disproportionate Share Hospital Reductions. Delays scheduled reductions in Medicaid disproportionate share hospital payments through November 30, 2020.

Increasing Provider Funding through Immediate Medicare Sequester Relief. Temporarily lifts the Medicare sequester from May 1 through December 31, 2020, boosting payments for hospital, physician, nursing home, home health, and other care by 2%. The Medicare sequester would be extended by one-year beyond current law to provide immediate relief without worsening Medicare’s long-term financial outlook.

Medicare Add-on for Inpatient Hospital COVID-19 Patients. Increases the payment that would otherwise be made to a hospital for treating a patient admitted with COVID-19 by 20%. It would build on the Centers for Disease Control and Prevention (CDC) decision to expedite use of a COVID-19 diagnosis to enable better surveillance as well as trigger appropriate payment for these complex patients. This add-on payment would be available through the duration of the COVID-19 emergency period.

Grants to the V.A.: Provides $14.4 billion to the Veteran’s Administration for medical services.

CDC: Provides $4.3 billion to the CDC. Of these funds, $1.5 billion is set aside for grants to states, territories and tribes to help carry out surveillance, epidemiology, laboratory capacity, infection control, mitigation, communications, and other preparedness and response activities.

Strategic National Stockpile: Provides $16 billion in funding for the Strategic National Stockpile to procure personal protective equipment, ventilators and other supplies.

Hospital Preparedness: Provides $250 million for grants to improve the capacity of healthcare facilities to respond to medical events.

Rural Health: Provides $180 million to expand services and capacity for rural hospitals, telehealth, poison control centers.

Health Savings Accounts for Telehealth Services. Allows a high-deductible health plan (HDHP) with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible.

Providing Hospitals Medicare Advance Payments. Expands, for the duration of the COVID-19 emergency period, an existing Medicare accelerated payment program. Specifically, qualified facilities would be able to request up to a six month advanced lump sum or periodic payment. This advanced payment would be based on net reimbursement represented by unbilled discharges or unpaid bills. Most hospital types could elect to receive up to 100% of the prior period payments, with Critical Access Hospitals able to receive up to 125%. Finally, a qualifying hospital would not be required to start paying down the loan for four months, and would also have at least 12 months to complete repayment without a requirement to pay interest.

Extension of Physician Work Geographic Index Floor. Extends payments for the work component of physician fees in areas where labor cost is determined to be lower than the national average through December 1, 2020.

National Academies Report on America’s Medical Product Supply Chain Security: Requires the Department of Health and Human Services to enter into an agreement with the National Academies to examine and report on the security of the United States medical product supply chain. Part of the report requires the examination of the United States’ dependence on critical drugs and devices that are sourced or manufactured outside of the U.S.

Requiring the Strategic National Stockpile to Include Certain Supplies: Requires the strategic national stockpile to include personal protective equipment, ancillary medical supplies, and other applicable supplies required for the administration of drugs, vaccines and other biological products, medical devices, and diagnostic tests.

Preventing Medical Device Shortages: Requires manufacturers of medical devices that are critical during public health emergencies to notify the federal government of any discontinuance or interruption to manufacturing of the device that could disrupt the supply of the device in the U.S. The information will be used to compile a list of devices that are determined to be in short supply.

Rapid Coverage of Preventive Services and Vaccines for Coronavirus: Requires insurers to cover without cost-sharing any qualifying coronavirus preventive service. Qualifying preventive services include any evidence-based item, service, or immunization that is intended to prevent or mitigate coronavirus disease.

Increased Funding for Health Centers: Provides $1.3 billion in additional funding to community health centers in fiscal year 2020.

Telehealth Network and Resource Center Grants: Provides $29 million per year through 2025 and reauthorizes Health Resources and Services Administration (HRSA) grant programs that promote the use of telehealth technologies for health care delivery, education, and health information services.

Rural health care services outreach, rural health network development, and small health care provider quality improvement grant programs. Provides $79.5 million per year through 2025 and reauthorizes HRSA grant programs to strengthen rural community health by focusing on quality improvement, increasing health care access, coordination of care, and integration of services.

Limitation on liability for volunteer health care professionals during COVID-19 emergency response. Makes clear that doctors who provide volunteer medical services during the public health emergency related to COVID-19 have liability protections. In order to have the liability protections provided by the bill, a volunteer provider must be acting within the scope of their license, registration or certification as defined by the state.

Health Care Workforce

Reauthorization of health professions workforce programs.

Provides $51.4 million per year between 2021 and 2025 for scholarships to health care students. The funding is given to eligible entities, which includes schools of medicine, nursing, dentistry, optometry, public health, etc.
Provides $48.9 million per year for the primary care training and enhancement program. Adds language prioritizing grant awards to programs that train physicians in rural areas.#@#_WA_-_CURSOR_-_POINT_#@#
Provides $41.2 million for eligible entities to establish health care workforce educational programs.
Provides $1.1 million per year for a loan repayment program for medical, dental and nursing students who agree to serve as faculty following graduation.
Provides $15 million per year to provide educational assistance to individuals from disadvantaged backgrounds to pursue health care education.

Extension of Demonstration Projects to Address Health Professions

Workforce Needs: Extends the Health Professions Opportunity Grants (HPOG) program through November 30, 2020 at current funding levels. This program provides funding to help low-income individuals obtain education and training in high-demand, well-paid, health care jobs.

Education and training relating to geriatrics. Provides $40.7 million per year and reauthorizes and updates Title VII of the Public Health Service Act (PHSA), which pertains to programs to support clinician training and faculty development, including the training of practitioners in family medicine, general internal medicine, geriatrics, pediatrics, and other medical specialties. It emphasizes integration of geriatric care into existing service delivery locations and care across settings, including home- and community-based services. The Secretary may provide awardees with additional support for activities in areas of demonstrated need, which may include education and training for home health workers, family caregivers, and direct care workers on care for older adults. Eligible entities could receive awards of at least $75,000.

Economic Relief

Recovery Rebates for Americans: Provides a one-time payment of $1,200 to individuals with incomes below $75,000 or a one-time payment of $2,400 for joint filers with incomes below $150,000. Payments are increased by $500 per child. The bill requires the one-time payments to be made as soon as possible.

Relief Payments to States, Tribal Governments and Local Units of Government: Provides $150 billion in direct payments to states, tribal governments and local units of government with. To qualify, local governments must have populations of more than 500,000 people. Payments are required to be used to cover expenditures related to COVID-19 that occur between March 1, 2020 and December 30, 2020. Expenditures must not have been accounted for in the state or local government’s most recent budget. The bill requires the Treasury Secretary to make these payments within 30 days of enactment.

Loans for Small Businesses, Non-profits, Contractors and Self-Employed Individuals. Allows nonprofits and other businesses with less than 500 employees to get loans from the Small Business Administration if they were adversely impacted by COVID-19. Loans can be used to cover payroll costs, health care benefits, mortgage or rent payments, utilities or interest on debt. Borrowers will be eligible for loan forgiveness if they maintain employees and their salaries. The eligibility period runs from February 15, 2020 to June 30, 2020. Maximum loan amounts will be determined using the organization's average monthly payroll amounts over a one year period. The bill appropriates $349 billion for this loan program.

Employee retention credit for employers subject to closure due to COVID-19. Provides a refundable payroll tax credit for 50% of wages paid by employers to employees during the COVID-19 crisis. The credit is available to employers whose (1) operations were fully or partially suspended, due to a COVID-19-related shutdown order, or (2) gross receipts declined by more than 50 percent when compared to the same quarter in the prior year.

Small Business Administration Disaster Loans: Provides $562 million to the Disaster Loan Program.

Broadband and Telehealth

Rural Utilities Service--Distance Learning, Telemedicine and Broadband Program: Provides $25 million for telemedicine and distance learning services in rural areas.

Reconnect Pilot: Provides $100 million for grants for the costs of construction, improvement, or acquisition of facilities and equipment needed to provide broadband service in eligible rural areas.

Federal Communications Commission Telehealth: Provides $200 million to the FCC to respond to COVID-19. This includes supporting health care providers by providing telecommunications services, information services, and devices necessary to enable the provision of telehealth services.

Higher Education and Student Loans

Temporary Relief for Federal Student Loan Borrowers: Requires the Secretary to defer student loan payments, principal, and interest for 6 months, through September 30, 2020, without penalty to the borrower for all federally owned loans.

Adjustments of Subsidized Loan Limits. For students who dropped out of school as a result of COVID -19 excludes the term from counting toward lifetime subsidized loan eligibility.

Exclusion from Federal Pell Grant Duration Limit. For students who dropped out of school as a result of COVID -19 excludes the term from counting toward lifetime Pell eligibility.

Institutional Refund and Federal Student Loan Flexibility. For students who dropped out of school as a result of COVID -19, the student is not required to return Pell grants or federal student loans to the Secretary. Waives the requirement that institutions calculate the amount of grant or loan assistance that the institution must return to the Secretary in the case of students who dropped out of school as a result of COVID-19.

Exclusion for certain employer payments of student loans: Allows employers to provide a student loan repayment benefit to employees on a tax-free basis. Under the provision, an employer may contribute up to $5,250 annually toward an employee’s student loans, and such payment would be excluded from the employee’s income. The $5,250 cap applies to both the new student loan repayment benefit as well as other educational assistance (e.g., tuition, fees, books) provided by the employer under current law. The provision applies to any student loan payments made by an employer on behalf of an employee after date of enactment and before January 1, 2021.

Governor Evers Announces Second Package of Comprehensive Legislative Proposals Providing COVID-19 Relief and Support

Wed, 01 Apr 2020 19:25:26 GMT

Governor Evers today announced a second package of comprehensive legislative proposals that would provide critical investments in health services, support for essential workers, and assistance for Wisconsin families and businesses in response to the COVID-19 pandemic.

The governor’s announcement today comes just days after Gov. Evers announced a first piece of legislation, which included additional funding and flexibility for public health professionals and healthcare professionals, a repeal of the one-week waiting period for unemployment insurance, expanding and improving access to telehealth services, among many other proposals.

As additional needs and issues arise from agencies and stakeholders, the governor is committed to working with legislators to find bipartisan solutions. The governor’s office welcomes the opportunity to hear and consider any proposals that legislators have to address the impacts of COVID-19 on the health and well-being of Wisconsin residents, businesses and communities.

This package, among many other proposals, includes:

Increasing funding for Medicaid providers via supplemental payments and rate increases to support the healthcare system’s response to the public health emergency;
Establishing a fund to reduce providers’ uncompensated care costs targeting reimbursement for treatment-related costs for uninsured individuals;
Establishing a COVID-19 reinsurance program to reduce health insurance premiums;
Providing grant funding to provide food assistance and meal delivery;
Prohibiting utility cooperatives from disconnecting customers and prohibiting land-lord directed disconnections from rental units during a public health emergency;
Ensuring workers receive back payment for any lost unemployment insurance benefits as a result of the delay in suspending the one-week waiting period;
Providing supplemental payments to child care providers, if that provider needed to shut down during the public health emergency;
Allowing households to apply for heating assistance under the low-income energy assistance program anytime during the 2020 calendar year;
Increasing the Earned Income Tax Credit for low-income families;
Providing municipalities the flexibility to implement multiple installments of three or more payments for 2020 property taxes;
Waiving interest and penalties on delinquent property taxes included in the 2019 payable 2020 tax roll, on and after April 1, 2020;
Creating a fund through the Wisconsin Housing and Economic Development Association to provide 6 months of support for prevention of single-family foreclosures and providing refinancing opportunities to current borrowers; and
Providing grant funding for small businesses and workers through the Wisconsin Economic Development Corporation.

The Governor’s first COVID-19-related legislation was introduced last week as LRB-5920 and is available here for review. A brief explanation of LRB-5920 is available here. A brief explanation of the governor’s second round of proposed legislation announced today is available online (link).

ForwardHealth Expands List of Drugs Available Through Expedited Emergency Supply

Wed, 01 Apr 2020 19:20:48 GMT

Effective for dates of service on and after April 1, 2020, ForwardHealth, which has an expedited emergency supply policy dispensing option available for certain drugs, has expanded the list of drugs available through expedited emergency supply and will allow most drugs to be dispensed in up to a 100-day expedited emergency supply.

A table with the expanded list of drugs available by expedited supply is included below and is also available on the Pharmacy Resources page of the ForwardHealth Portal. Pharmacy providers should continue to follow the current processes for requesting an expedited emergency supply of drugs detailed in the Emergency Medication Dispensing topic (#1399) of the ForwardHealth Online Handbook.

This Action Alert 10 and others are available on the ForwardHealth website (link).

New Marquette Law School Poll Finds Strong Support for Coronavirus Closings

Wed, 01 Apr 2020 19:18:10 GMT

A new Marquette Law School poll of Wisconsin registered voters finds strong support for government actions to control the coronavirus pandemic, even as the poll also shows these actions to be having a substantial financial impact on voters.

The survey found:

Eighty-six percent say that it was appropriate to close schools and businesses, and restrict public gatherings, while 10 percent say that this was an overreaction to the pandemic;
A large majority of voters approve of Gov. Tony Evers’ handling of the coronavirus issue, with 76 percent saying they approve and 17 percent saying they disapprove;
A majority, 51 percent, approve of President Donald Trump’s handling of the pandemic, while 46 percent disapprove;
Opinion is divided on holding the April 7 spring election as scheduled, with 51 percent saying the date should be moved and 44 percent saying it should be held as scheduled.

A full copy of the survey is available online (link).

Wisconsin Receives Additional PPE from Strategic National Stockpile

Wed, 01 Apr 2020 01:09:25 GMT

Wisconsin has received its second phase of Personal Protective Equipment (PPE) from the Strategic National Stockpile (SNS) and is in the process of distribution. The second phase of supplies from the SNS are being delivered to healthcare workers, emergency medical services, and medical facilities including hospitals, nursing homes, assisted living facilities and clinics across Wisconsin.

“We are doing everything we can to get more protective equipment as fast as we can to our healthcare workers and those on the frontlines to protect them from COVID-19,” said Gov. Evers. “We want to make sure our healthcare workers can continue doing their good work and taking care of our neighbors in communities across our state, and we are working to get these supplies to the folks who need them the most as quickly as possible.”

The State Emergency Operations Center and Department of Health Services continue working to supply medical facilities with supplies requested from the Strategic National Stockpile. The second phase includes approximately 51,880 N95 respirators, 130,840 face/surgical masks, 23,400 face shields, 20,226 surgical gowns, 96 coveralls, and 79,000 pairs of gloves. Today’s shipment comes as Governor Evers announced Wisconsin’s first delivery of SNS supplies which included approximately 52,800N95 respirators, 130,000 face/surgical masks, 24,768 face shields, 20,286 surgical gowns, 96 coveralls, and 61,750 pairs of gloves. In total Wisconsin has received approximately 104,680 N95 respirators, 260,840 face/surgical masks, 48,186 face shields, 40,512 surgical gowns, 192 coveralls, and 140,750 pairs of gloves from the SNS.

The SNS supply shipments do not include supplies the governor has requested from FEMA for non-medical personnel or supplies being aggressively pursued through procurement, donations, or the governor’s buyback program.

Governor Evers Asks for Presidential Disaster Declaration

Tue, 31 Mar 2020 22:04:11 GMT

Governor Evers today sent a letter to the Federal Emergency Management Agency (FEMA) requesting that the president issue a major disaster declaration for the entire state of Wisconsin, as a result the COVID-19 pandemic. The request covers all 72 counties and the state’s federally recognized tribes.

Having determined that Wisconsin met all of the criteria required to receive a major disaster declaration, Gov. Evers in his letter requested that the federal government provide the following programs to support the state’s response: Public Assistance, Direct Assistance, Hazard Mitigation (statewide), and certain Individual Assistance programs; Crisis Counseling, Community Disaster Loans and the Disaster Supplemental Nutrition Program.

Gov. Evers declared a public health emergency on March 12 in response to the outbreak, which directed the Department of Health Services to take all necessary and appropriate actions to help combat the spread of the virus. On March 14, the governor directed Wisconsin Emergency Management to activate the State Emergency Operations Center (SEOC) to provide additional coordination in support of the state’s response.

A copy of the governor’s letter (link) and the full press release are available online (link).

Governor Evers Sets Up State COVID-19 Voluntary Isolation Facilities

Tue, 31 Mar 2020 22:01:19 GMT

Governor Evers today announced the State of Wisconsin Emergency Operations Center (SEOC) is opening two state-run voluntary isolation facilities in Madison and Milwaukee and is providing guidance to local communities throughout Wisconsin. The two sites are set to open April 1, 2020 are at Lowell Center in Madison and a Super 8 hotel in Milwaukee.

These facilities are for symptomatic individuals suspected to be infected with COVID-19 or who have a confirmed case of COVID-19. Individuals will not be permitted to register at the facility unless referred by a medical provider or public health official. Individuals register and stay at the isolation facility on a voluntary basis. The expected length of stay will be about 14 days, or 72 hours after symptoms dissipate. At any time, either the individual or the facility may terminate the individual’s presence at the site. Those staying at the facility will have wellness checks by phone every four hours during the day and if needed at night.

Additionally, the SEOC also issued guidance for communities seeking to open their own voluntary self-isolation centers. This guidance will aid local communities with the following:

How do we select, set up, and staff an isolation site?

How does a person get referred to and checked into the isolation site?

What happens while occupants are at the isolation site? Including details about medical monitoring/wellness check calls and other on-site services.

When do occupants leave the site? Including details about discharge and involuntary check out from the isolation site.

The full press release is available online (link).

Wisconsin Partnership Program Releases RFP for $1.5 Million in COVID-19 Grant Funding

Tue, 31 Mar 2020 22:00:29 GMT

The Wisconsin Partnership Program released an RFP Tuesday for a new $1.5 million grant program to support projects that “aim to improve the health of the people of Wisconsin by lessening the impact of the COVID-19 pandemic.”

About $750,000 will be available for programs led by Wisconsin-based nonprofits, tax exempt, 501(c)(3) organizations or tribal/government entities. Special emphasis will be given to projects that target vulnerable populations.

Grant applications are due April 15, 2020.

CMS Policies and Waivers that Provide Regulatory Flexibility to Physicians

Tue, 31 Mar 2020 16:11:42 GMT

Jeffrey Davis, ACEP Director of Regulator Affairs, shared the following details regarding the announcement of CMS policies including big wins for emergency medicine:

EMTALA: CMS issued the long-awaited revised guidance on EMTALA that will allow medical screening exams to be delivered via telehealth. This has been a major ACEP priority, and we repeatedly asked CMS to issue this revised EMTALA guidance. There are other temporary changes to EMTALA, and Dr. Todd Taylor will send a separate email explaining these.
Telehealth: CMS added the ED E/M codes (CPT codes 99281 to 99285) and the critical care codes (CPT codes 99291 and 99292) to the list of approved Medicare telehealth services for the duration of the COVID-19 national emergency. CMS had previously expanded the ability to perform telehealth services but had not allowed emergency physicians to use the ED E/M codes-which most accurately reflect the intensity and value of emergency services. ACEP had identified this issue as a top regulatory priority, and through ACEP's advocacy, CMS has now recognized that ED E/M codes are indeed the most appropriate codes to use when delivering emergency telehealth services.
Expanding the Healthcare Workforce: CMS is allowing hospitals to increase their workforce capacity by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community as well as those licensed from other states without violating Medicare rules. ACEP had urged CMS to relax state licensure requirements.
CMS Hospital Without Walls: CMS is allowing hospitals to provide services in locations beyond their existing walls to expand care capacity and to develop sites dedicated to COVID-19 treatment. Under CMS's temporary new rules, hospitals will be able to transfer patients to outside facilities, such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories, while still receiving hospital payments under Medicare. Ambulances will also be able to transport patients to a wider range of locations when other transportation is not medically appropriate. These destinations include community mental health centers, federally qualified health centers (FQHCs), physician's offices, urgent care facilities, or ambulatory surgery centers.
Waiver of Physician Self-Referral Law: CMS issued blanket waivers of sanctions under the physician self-referral law.

These are only some of the many policies announced. ACEP is scheduling a webinar with CMS for Friday, April 3rd to discuss EMTALA. More details to follow.

Wisconsin Assembly to consider emergency Medicaid waiver

Tue, 31 Mar 2020 15:58:42 GMT

March 31, Wisconsin Health News

Assembly Speaker Robin Vos, R-Rochester, said Monday that the Legislature will act on a request by the Department of Health Services to waive Medicaid rules in response to COVID-19.

DHS plans to pursue an emergency 1135 waiver from the federal Centers for Medicare and Medicaid Services. It needs legislative approval to do so under a law enacted after Gov. Tony Evers was elected, but before he took office.

Vos said the Assembly hopes to hold a floor session soon and they’re exploring ways to convene it without “adversely impacting” at-risk populations within their membership and support staff.

He’s also expecting a final analysis from the Legislative Fiscal Bureau on the federal stimulus law approved last week.

“We know legislative action will need to be taken, including a request for an emergency waiver from CMS to allow for flexibilities to healthcare providers,” Vos said in a statement.

He added that they’re having daily discussions with the governor’s office and legislative Democratic leaders.

DHS officials submitted a request for an emergency waiver to the Legislature’s Joint Finance Committee last week. Spokesman for the committee's leaders said they don't have authority to act on the request.

Evers on Monday called on the Legislature to allow for “greater flexibilities within the Department of Health Services so they can act rapidly and ensure folks are getting the care they need without any unnecessary barriers such as pre-authorization requirements.”

“Lives are on the line here, and we can’t afford being hamstrung by bureaucratic hurdles,” he told reporters.

Governor Announces New Public-Private Partnership to Increase COVID-19 Laboratory Testing Capacity

Tue, 31 Mar 2020 15:28:40 GMT

Governor Evers announced a new public-private partnership among Wisconsin industry leaders to increase Wisconsin's laboratory testing capacity for COVID-19. Prior to today's announcement, the Wisconsin State Lab of Hygiene and the Milwaukee Public Health Lab were leading the Wisconsin Clinical Lab Network labs to bring additional COVID-19 testing online.

The new partnership now includes laboratory support from Exact Sciences, Marshfield Clinic Health System, Promega, and UW Health. These organizations, along with the Wisconsin Clinical Lab Network, will now share knowledge, resources, and technology to bolster Wisconsin’s testing capacity.

The Wisconsin Clinical Lab Network labs have been averaging completion of 1,500-2,000 COVID-19 tests per day. The expanded capacity from the state’s new public-private partnership is expected to double that capacity initially and continue to expand as additional platforms and supplies become available.

Residents who are seeking a COVID-19 test are still required to receive an order from a doctor. These labs are not testing sites.

The full press release is available online (link).

UW Med Flight Establishes ECMO Transport Program

Mon, 30 Mar 2020 19:20:34 GMT

Andrew Cathers, MD
Associate Medical Director, UW Med Flight
Univ. of WI BerbeeWalsh Dept of Emergency Medicine

UW Med Flight has established an ECMO Transport Program. Through close partnerships with UW Health’s Critical Care and Cardiothoracic Surgery teams, Med Flight has been able to devise and implement a program wherein these critically ill patients can be safely transported. In addition, in select situations, the team can travel to the patient, cannulate them at a referring facility, place them on ECMO, and then transport them back to UW Health.

Extracorporeal Membrane Oxygenation (abbreviated as ECMO), is a treatment that is becoming steadily more widespread and prevalent. It is typically used for patients with severe cardiorespiratory illness. There are two primary variants – veno-venous (VV) and veno-arterial (VA). VV ECMO is typically used in patients with intact cardiac function but severely compromised respiratory function, such as ARDS. VA ECMO is used for patients in cardiac arrest or severe circulatory shock, with the ECMO device supporting both the heart and the lungs. Typically, large-bore cannulas are placed in the central vessels, and then an ECMO pump and circuit is utilized, which will circulate and oxygenate the blood. As technology advances and ECMO transport has become more common, the ECMO devices themselves have become smaller and some are even specifically designed for ease of transport in mind.

ECMO has traditionally only been initiated and maintained in large, tertiary centers. However, recent advances, including more widespread use of percutaneous cannulation techniques, have seen ECMO use spread to the smaller hospitals. Many of these hospitals lack the capability to longitudinally care for ECMO patients. In other cases, patients are placed on ECMO in order to “bridge” them to further treatment, such as Ventricular Assist Device placement or lung transplant. Because of this, these critically ill patients often need to be transferred from the smaller facility to the destination center. Finally, there are critically ill patients at outlying facilities who may not survive conventional interfacility transport – in these cases, it is actually safer for the patient if they are cannulated and supported by ECMO prior to moving between facilities.

Our teams have completed ECMO transports via both helicopter and ground ambulance. Mode of transport is flexible and dictated by distance, weather conditions, and most importantly – the needs of the patient.

Team

Board-Certified Emergency Medicine Physician with additional transport and ECMO training
Critical Care Registered Nurse with additional transport and ECMO training
Board-Certified Cardiothoracic Surgeon with ECMO expertise
Perfusionist

Vehicle

EC-145 Helicopter
Critical Care Transport Ambulances

Patient Population

Adult Patients already on VA or VV ECMO – either centrally or peripherally cannulated
Adult Patients who are not yet on ECMO but may benefit from this intervention who are at an outside facility

CMS Approves the Use of ED E/M Codes for Telehealth

Mon, 30 Mar 2020 16:59:57 GMT

CMS has released a regulation that added the emergency department (ED) evaluation and management (E/M) codes (CPT codes 99281 to 99285) to the list of approved Medicare telehealth services for the duration of the COVID-19 national emergency.

CMS had previously expanded the ability to perform telehealth services, but had not allowed emergency physicians to use the ED E/M codes—which most accurately reflect the intensity and value of emergency services .

CMS has now recognized that ED E/M codes are indeed the most appropriate codes to use when delivering emergency telehealth services.

Governor Issues Order to Expedite Expansion, Enhance Efficiency of Healthcare Workforce

Sun, 29 Mar 2020 01:24:24 GMT

Governor Evers and Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm today exercised their authority under Article V, Section 4 of the Wisconsin Constitution and Sections 323.12(4) and 252.02(6) of the Wisconsin Statutes to simplify healthcare license renewals during the COVID-19 public health emergency and to encourage recently retired professionals with expired licenses to re-enter practice. This full order is available online (link).

The order includes the following policy changes:

Interstate Reciprocity: allows any out-of-state health can provider licensed and in good standing to practice in Wisconsin without a Wisconsin credential. The order requires the out-of-state physician to apply for a temporary or permanent Wisconsin license within 10 days of first working at a Wisconsin health care facility; and the health care facility must notify DSPS within 5 days. The order temporarily suspends the visiting physician practice limitations in Med 3.04.
Temporary License: Any temporary licensed to an out-of-state provider during the emergency will be valid until 30 days after the conclusion of the emergency.
Telemedicine: Allows physicians licensed and in good standing in Wisconsin, another U.S. state or Canada to provide telemedicine services to Wisconsin residents.
Physician Assistants: Suspends several current rules regulating the practice of PAs in Wisconsin. This includes: the requirement of PAs to notify the MEB of changes to their supervising physician within 20 days (order changes it to 40 days); the requirement that PAs limit their scope of practice to that of their supervising physician (the order allows them to practice to the extent of their experience, education, training and abilities. It also allows them to delegate tasks to another health provider); the physician to PA ratio of 4:1 (the order allows a physician to oversee up to 8 on-duty PAs at a time, but there is no limit on how many PAs a physician may provide supervision to over time. It also allows a PA to be supervised by multiple physicians while on duty).
Nurse Training and Practice: The order suspends many rules related to nursing. This includes suspending a rule that prohibits simulations from being utilized for more than 50% of the time designated for meeting clinical learning requirements. It also suspends the requirement for nurses to submit an official transcript in order to get a temporary license and allows a temporary license to remain valid for up to 6 months. In addition, it suspends the rule requiring license renewal within 5 years.
Advanced Practice Nurse Prescribers: Temporarily suspends the requirement that Nurse Prescribers must facilitate collaboration with other health care professionals, at least 1 of whom shall be a physician or dentist.
Recently Expired Credentials: Requires the state to reach out to individuals with recently lapsed credentials about renewal options. The order also suspends many of the late renewal fees and continuing education requirements for most health professions. The order temporarily suspends MED 14.06(2)(a) to allow a physician whose license lapsed less than 5 years ago to renew without fulfilling the continuing education requirements. It also suspends RAD 5.01 (1) and (2) to allow radiographers or LXMO permit holders who have let their license lapse renew without completing continuing education.
Fees: The order also gives DHS the ability to suspend fees or assessments related to health care provider credentialing.

The order is effective immediately and will remain in effect through the duration of the public health emergency.

The full version of the Governor’s press release is available online (link).

Governor Releases COVID-19 Legislation

Sat, 28 Mar 2020 16:29:59 GMT

Governor Evers released a 65-page draft piece of legislation and a draft joint resolution on Saturday night aimed at addressing COVID-19. The Governor also released a chart outlining the proposal. The Legislative Fiscal Bureau also provided a Summary of provisions Governor Evers’ proposed legislation and Joint Resolution indefinitely extending public health emergency to state legislators.

The bill includes several healthcare provisions, including language related to out-of-network bills that occur during the public health emergency. The language caps physician payment rates at 250% of the Medicare rate.

Insurance

Prohibits health plans from charging patients more for out-of-network services related to the diagnosis and treatment of the condition for which a public health emergency has been declared than they do for in-network services (if an in-network physician is not available).
The bill requires the plan to reimburse the out-of-network provider at 250% of the Medicare rate. Providers and facilities are prohibited from charging patients more than what they are reimburse by the plan.
Creates a process for out-of-state physicians to have liability coverage in Wisconsin during a public health emergency. They would need to provide OCI with a certificate of insurance for a policy of health care liability insurance issued by an insurer that is authorized in a jurisdiction accredited by the National Association of Insurance Commissioners.
Requires health plans to cover without cost-sharing any testing, treatment or vaccines related to COVID-19.
Requires health plans to cover any services provided via telehealth if they cover that service when it is provided in-person.
Prohibits health plans from canceling policies due to non-payment during the COVID-19 emergency
Prohibits health plans and pharmacy benefit managers from requiring prior authorization for any early refills of prescriptions or restricting the period of time in which a drug may be refilled.
Creates a process for pharmacists to extend prescription orders by up to 30 days during public health emergencies.

Emergency Preparedness

Provides $300 million to the Department of Military Affairs to respond to the public health emergency.
Provides $200 million to the Department of Administration to respond to the public health emergency.

Health

Creates a public health emergency fund for the Department of Health Services.
Provides $100 million for a new health care provider grant program specific to planning, preparing for and responding to COVID-19.
Provides $17.4 million to local health departments.
Creates 64 positions within the Department of Health Services’ Division of Public Health.
Allows DHS to suspend any premium or cost-sharing requirements for childless adults on BadgerCare in order to qualify for enhanced federal Medicaid matching funds related to COVID-19.
Exempts the Department of Health Services, during a public health emergency, from the current law legislative review requirements for submitting waiver requests to the federal government, amending the state Medicaid plan or raising Medicaid reimbursement rates.
Expands the definition of public health emergency to include toxins or other threats to health.

Health Care Workforce

Allows former health care providers to receive a temporary license to provide services during a public health emergency. This would apply to physicians, nurses, PAs, dentists, pharmacists, phycologists, social workers and other health providers who have practiced within the last 5 years but do not currently have a license. The temporary license would be valid until 90 days following the conclusion of the health emergency.
Allows out-of-state health care providers to receive a temporary license to practice in Wisconsin. The temporary license would be valid until 90 days following the conclusion of the health emergency.
Allows the state to waive licensure fees for physicians, physician assistants, nurses, dentists, pharmacists, psychologists, and certain behavioral health providers.
Exempts certain health care provider credentials issued by credentialing boards in DSPS from having to be renewed during the public health emergency.

Unemployment Insurance

Eliminates the one-week waiting period for Unemployment Insurance

Voting

The bill contains several provisions related to voting during public health emergencies. Specifically, for elections held during a declared public health emergency, it would:

Require elections held during public health emergencies to be held by mail.
Waive the state’s Photo ID requirement.
Waive the requirement that mail-in absentee ballots need a witness signature.
Allow mail-in ballots to be counted as long as they are postmarked by Election Day.
Allow voters to register electronically until 5 days before the election.

COVID-19 UPDATE: Reports of Hospitals Restricting PPE Usage

Fri, 27 Mar 2020 16:16:41 GMT

March 26, ACEP COVID-19 Communications Hub

After hearing a growing number of reports over the past week of emergency physicians being restricted by their hospital from wearing PPE or even being punished for doing so (whether the PPE was supplied by the hospital or personally obtained), ACEP has been in discussions with the Joint Commissions and OSHA advocating for official guidance or clarification from them to hospitals so that your rights to wear PPE are protected. We've been asked to provide them with specific examples of such occurrences, and are therefore reaching out to you here for your help.

If you've experienced such PPE restrictions or been sanctioned or punished in any way by your hospital for wearing it, please email me with a short description of what happened at lwooster@acep.org.

Please rest assured that no identifying information will be passed along to the Joint Commission or OSHA; all individual physician names and hospitals will be redacted before I send any collected anecdotes on to them. Please note that while first-hand accounts are greatly preferred, if you do know of such actions against a colleague at your own hospital only, these could be helpful to us as well, as long as they contain sufficient detail that you are confident is accurate.

Thank you, and please stay safe.

Laura Wooster, MPH
Associate Executive Director, Public Affairs
American College of Emergency Physicians
O: (202) 370-9298

ACEP's Well-Being Committee and Wellness Section Letter of Support

Fri, 27 Mar 2020 16:06:36 GMT

Dear Fellow Emergency Clinicians,

During this unprecedented time, the Well-Being Committee and Wellness Section, both want to express our appreciation to all who accepted the call to serve in the field of Emergency Medicine. You are not alone in this. Your passion and dedication to provide care for those in need is noticed and recognized, even more today during this critical time.

We are proud to be your colleagues and stand firm in knowing that you are doing the very best to provide care during these difficult times. Though we are overworked, tired, and stretched thin, we continually answer the call to care for our individual communities during the time they need us most. Selflessly, we put ourselves on the front lines; running towards the problems and work tirelessly to find the solutions that allow us to provide the needed care.

As we work through this pandemic, we want to echo that we hope everyone is able to be safe. In trying times such as these, we as Emergency Clinicians, tend to take care of ourselves last. However, the leadership teams are standing with you to ensure that your wellness is not sacrificed.

In this setting, we recognize the need to provide you with resources to assist you during this time of need. In response, work behind the scenes continues to support the provision of care to patients and their communities, while protecting your work environment, health, and well-being.

ACEP is working closely with Federal Government regulators as an advocate for our profession. In doing so, interstate licensing barriers have been changed, protection of liability measures are being developed, and Dr. Bill Jaquis, ACEP President, has met with the White House Administration advocating for PPE and more testing. A new website has been developed to host all clinical resources for our colleagues. In addition, ACEP has many resources to assist you through difficulties.

ACEP Wellness & Assistance Program

The ACEP Wellness & Assistance Program offers ACEP members exclusive access to THREE (3) FREE CONFIDENTIAL COUNSELING OR WELLNESS SESSIONS in partnership with Mines & Associates. The one-on-one sessions are available 24/7 by phone, text or online messaging.

Counseling sessions can cover everyday issues including stress, anxiety, depression, family issues, drug and alcohol abuse, relationships, death and grief, and more. Wellness coaching sessions are 30-minute phone calls to help you reach your personal wellness goals. NBME board-certified wellness coaches can help you set specific wellness goals and plan for progress checks along the way to help you reach your objectives. This new program is strictly confidential and is free with your ACEP membership.

ACEP members, please log in to learn more about the program
To learn more about membership, read about ACEP's membership eligibility
Access ACEP's additional physician wellness resources

ACEP ‘Let’s Talk’ Community on EngagED

This online community was specifically designed to create a safe space where peers can discuss ongoing challenges within their roles, ED’s, and life in general. Here, everyone has a voice and a platform where they can reach out to fellow colleagues for advice and encouragement pertaining to the internal and external factors that affect the balance of our wellness.

If you are interested in having a conversation, all you need to do is click here to sign up.

Our parting thought to you is simple: Even though we are in a crisis, we can still provide compassion and respect for every person who crosses our path.

ACEP Well-Being Committee

Arlene Chung, MD, FACEP, Chair
Rita A. Manfredi MD, FACEP
Alison Haddock, MD, FACEP

ACEP Wellness Section

Randall Levin, MD, FACEP, Chair
Randy Sorge, MD, FACEP
Pamela Ross, MD, FACEP
Susan Haney, MD, FACEP
Angelica McPartlin, MD, FACEP
Kristen Nordenholz, MD
Matthew Wong, MD, FACEP
Michelle Caskey, MD

Wisconsin Releases Updated Telehealth Guidelines

Wed, 25 Mar 2020 22:24:49 GMT

In response to the COVID-19 outbreak, ForwardHealth is temporarily changing certain policy requirements for services delivered through telehealth.

Beginning March 12, 2020, these altered policy requirements will be in effect during, and only during, the public health emergency declared by the State of Wisconsin in Executive Order 72.

Download the ForwardHealth UPDATE for full details.

COVID-19 testing capacity grows

Wed, 25 Mar 2020 16:34:21 GMT

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.

Physician CME and Licensing Requirements

Wed, 25 Mar 2020 16:25:20 GMT

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.

Wisconsin "Safer at Home" Order

Wed, 25 Mar 2020 13:16:23 GMT

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.

COVID-19 Update: WI Governor Announces Stay at Home Order

Mon, 23 Mar 2020 20:05:51 GMT

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.

Wisconsin Requests FEMA Assistance in Obtaining Protective Medical Supplies

Mon, 23 Mar 2020 18:15:23 GMT

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.

Temporary License for Emergency Physicians in WI

Wed, 18 Mar 2020 22:28:58 GMT

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

Wisconsin Telehealth Services in Response to COVID-19

Wed, 18 Mar 2020 16:15:22 GMT

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.

March 18 - CMS Hosts COVID-19 Call with Physicians

Wed, 18 Mar 2020 13:17:04 GMT

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

Emergency Physicians Provide the First Line of Defense Against COVID-19 in Wisconsin

Tue, 17 Mar 2020 15:57:19 GMT

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:

What are our criteria to test someone for COVID19? (These are changing almost daily)
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?
Where will a COVID19 patient be admitted in my hospital because other hospitals may not have capacity?
How are we securing our PPE so it doesn’t get stolen?
Can I travel right now, either professionally or personally?
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?
Are we looking at off-site testing centers so worried patients don’t flood our EDs and Urgent Cares?
Is our incident command open and meeting daily to ensure we can meet the needs of our community when we get cases?
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!

COVID-19 Clinical Alert Page

Tue, 17 Mar 2020 15:51:19 GMT

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.

WACEP 2020 Spring Symposium Cancelled

Mon, 16 Mar 2020 15:38:27 GMT

The WACEP 2020 Spring Symposium, scheduled for April 15-16 in Madison, has been CANCELLED due to the COVID-19 pandemic.

Guests who made hotel reservations at the Madison Marriott West are requested to cancel their reservations individually via the hotel's central call line at 888-745-2032. Your patience is appreciated as wait times may be longer than usual.

WACEP is exploring the option of offering sessions from the Symposium as online, on-demand courses. Details and registration information will be shared as available.

ACEP Committee Application Process is Now Open

Fri, 06 Mar 2020 21:26:05 GMT

The ACEP committee application process is now open to any member interested in joining a committee. The deadline to apply is May 1, 2020.

Review the online application for details and to begin the process. After completion of the form, you should receive an acknowledgement that your committee interest form has been submitted. Mark S. Rosenberg, DO, MBA, FACEP, ACEP's President-Elect, will finalize committee appointments in late June. If appointed to an ACEP national committee, your appointment will not be considered final unless a completed Conflict of Interest form is submitted by the deadline.

Questions may be directed to Mary Ellen Fletcher, CPC, CEDC, at 800-798-1822, ext. 3145, or mfletcher@acep.org.

Evers signs HOPE bills into law

Wed, 04 Mar 2020 21:03:01 GMT

March 4, Wisconsin Health News

Gov. Tony Evers signed into law four bills on Tuesday that target substance use disorder and opioid use in Wisconsin.

Evers said more needs to be done to expand access to healthcare across the state and bolster treatment and recovery services.

“Folks have seen firsthand how substance use disorder—especially opioid use—has torn apart families and communities across our state, and we need to get serious about tackling this issue in Wisconsin," Evers said in a statement. "I am proud to sign these bipartisan bills into law today that are a step in the right direction, but we know that there is more work we have yet to do."

The bills are part of Marinette Republican Rep. John Nygren's Heroin, Opioid Prevention and Education Agenda. The four bills bring the total number of HOPE Agenda laws to 34.

“While there is always more work to be done, more lives to save, and more avenues to recovery that need opening, today’s actions are another arrow in the state’s quiver to combat substance abuse," Nygren said in a statement.

Nygren also called on the Senate to act on two more bills that passed the state Assembly.

One bill would repeal a sunset for a law that provides some legal immunity for aiders who help a person experiencing an overdose as well as overdose victims.

The other would create a Medicaid benefit for acupuncture and increase rates for chiropractors and physical therapists.

The bills signed by Evers will:

Allow county jails to enter into agreements to obtain naloxone and training and require the Department of Health Services to study the availability of medication-assisted treatment for opioid use disorder in county jails and prisons.
Prevent state employees from being disciplined for using or possessing a controlled substance if they're using it as part of their treatment, require DHS to maintain a registry of recovery residencies and mandate that the residencies allow residents to participate in medication-assisted treatment.
Extend a sunset date on a mandate that prescribers check the prescription drug monitoring program before issuing a prescription order through April 1, 2025.
Create a Medicaid benefit for peer recovery coach services and mandate that DHS establish a program to coordinate and continue care following an overdose.

Evers also signed into law additional healthcare-related bills that will:

Allow medication or treatment records administered at a recreational camp to be maintained electronically.
Allow for changes in the supervision of physical therapy and physical therapy assistant students.
Increase the amount of funding for an award grant program for retired volunteer firefighters, first responders and emergency medical technicians.
Allow physician assistants, registered nurses and nurse anesthetists to perform official duties of the armed services or federal health services in Wisconsin without being licensed by the state.
Clarify that reimbursement of patient-incurred expenses in cancer clinical trials aren't considered undue inducement to participate.
Require the DHS to implement a diabetes care and prevention plan.
Update state law for respiratory therapists.
Create a Lyme disease awareness campaign.
Allow municipalities to increase levy limits to pay for charges assessed by a joint emergency medical services district.

Covid19 - ACEP Public Policy Priorities

Wed, 04 Mar 2020 16:59:15 GMT

Novel Coronavirus (COVID-19) Policy Priorities

As anticipation grows for more widespread community transmission of COVID-19 in the United States, emergency physicians will be on the frontlines of caring for those affected. In order to help ensure our health care system is prepared, a number of policy changes will need to be implemented to address the unique needs of this growing public health emergency.

Ensuring access to care for those infected or suspected infected

Consider implementing alternative testing sites for faster, more cost-effective testing while freeing up hospital capacity for those who need it most and allowing those infected to self-quarantine, should they test positive.
Alternative sites of care for respiratory patients to reduce contamination of other patients, and to reduce the need for PPE
Public education on when and where to seek testing (including alternative testing sites mentioned above), when and where to seek care, self-quarantine procedures, home care if infected (including supplies to have on hand, etc), etc.
Ensure production of medications relevant to treatment of Covid-19 is prioritized and their distribution directly to relevant sites of care is emphasized.

Securing an adequate workforce

Prioritize availability of personal protective equipment (PPE) for emergency workers and other frontline personnel responding to the epidemic (including EMS, clerical staff, nurses, emergency physicians, etc.).
Temporarily loosen restrictions on hospital privileging and removing barriers that impede workforce movement across state lines, such as licensure and liability protection.
Ensure health care workers who become infected receive treatment quickly and readily.

Ensuring adequate resource allocation

Ensure full coverage of testing and diagnosis by payers without patient cost-sharing.
Temporarily remove the originating site limitation under CMS telemedicine rules, and add emergency telehealth services to the list of approved Medicare telehealth services.
Ensure federal and state emergency funding is targeted and distributed beyond hospitals, such as for EMS and emergency and other relevant hospital-based specialty physicians who are not hospital employed.

Wisconsin, Milwaukee conducting coronavirus tests

Tue, 03 Mar 2020 16:17:15 GMT

March 3, Wisconsin Health News

The Wisconsin State Laboratory State Lab and City of Milwaukee Health Department are now able to test for the new coronavirus, health officials said Monday.

Positive test results will be presumed positive and forwarded to the Centers for Disease Control and Prevention for confirmation, according to a statement from the Department of Health Services.

Jeanne Ayers, state health officer and administrator of the DHS Division of Public Health, said the ability to test in the state will allow for faster results to let people with symptoms of the disease know if they have it.

“Faster test results will also help our epidemiologists and local health departments monitor people suspected of having the virus and other people who may have been exposed to it,” she said in a statement.

She added that the risk remains low.

So far, there’s only been one confirmed case in the state. They were released from isolation last Friday after testing negative for the virus twice.

The agency has investigated 21 state residents for the virus. Eighteen tested negative, and two test results were pending as of Monday afternoon.

Tom Haupt, respiratory disease epidemiologist and influenza surveillance coordinator, told reporters that the flu season is also peaking in Wisconsin, with more than 500 hospitalizations in the last week. He called that “amazing for this time of year.”

“We want people to be aware not only of the COVID-19, but also the influenza virus that’s currently circulating,” he said on a conference call.

Until Help Arrives

Mon, 24 Feb 2020 22:53:06 GMT

The first few minutes after a major medical emergency are critical for survival, and emergency personnel aren’t always the first ones on the scene. To educate the general public on basic life-saving skills, the American College of Emergency Physicians (ACEP) created Until Help Arrives, a one-hour training course taught by emergency physicians in their local communities. More than 470 certified instructors are now participating across the country.

Visit ACEP's Until Help Arrives website at untilhelparrives.org, which is being developed as a helpful tool for instructors as they prepare to plan for and host trainings. Instructor resources are currently being distributed by Simulab through an instructor portal.

Articles of Interest in Annals of Emergency Medicine - Winter 2020

Mon, 24 Feb 2020 22:49:26 GMT

Sam Shahid, MBBS, MPH
Practice Management Manager, ACEP

ACEP would like to provide you with very brief synopses of the latest articles and articles coming soon to Annals of Emergency Medicine. Some of these have not appeared in print. These synopses are not meant to be thorough analyses of the articles, simply brief introductions. Before incorporating into your practice, you should read the entire articles and interpret them for your specific patient population. View synopses here.

Updates on Doctor Day 2020, CARES Act, and Federal OONB Legislation

Mon, 17 Feb 2020 21:22:45 GMT

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

Multiple WACEP members represented our specialty at this year’s Doctor Day, meeting with their legislators to discuss issues relevant to the house of medicine. We were also able to collaborate with physicians of all stripes from around the state. It’s such a pleasure to meet with other docs and discover that we are facing many of the same issues across the full spectrum of medicine and come together to advocate for the health of our state. This year, over 315 Wisconsin physicians met with their local legislators, covering 31 of 50 State Senators, and 57 out of 99 Assembly members.

One of the most popular breakout sessions at Doctor Day was a legislative update, and one of the most-talked-about topics was the CARES act. For those who are not aware, the CARES act was put forth by the Wisconsin Academy of Physician Assistants (WAPA) with the goal to improve parity with nurse practitioners in the state, who currently enjoy significantly more autonomy than PAs. The Wisconsin Hospital Association strongly supports the bill, as it makes it easier for hospitals to employee PAs. The bill removes the currently mandated ratios of physicians to PAs, changes the PA-physician relationship to one of “collaboration” rather than “supervision”, and allows PAs to work remotely from their collaborating physician. At the time of Doctor Day, several provisions in the bill were causing concern amongst physicians, including a titling change which would allow PAs to call themselves “Associate Physicians”, and the creation of an independent PA licensing board separate from the medical licensing board (NPs are licensed through the Nursing Board). Also controversial was the language surrounding the collaboration agreement between a PA and a physician.

The Wisconsin Medical Society (WMS) has been negotiating with WAPA and the bill sponsors to alter some of the more problematic portions of the bill. An updated version of the bill stripped out the title changes, and supports the creation of an associate PA board, underneath the state Medical Board – similar to how Podiatry currently has an associate board in the state. The associate board would not be permitted to expand the scope of practice of PAs without the approval of the Medical Board. The language around the collaboration agreement also was changed to ensure that a physician can provide collaborative care for a patient cared for by a PA within a medically reasonable amount of time. With these changes in place, WMS supported the bill, and it quickly passed both the Assembly and Senate, and awaits signature by Governor Evers.

In other legislative news, the US House of Representatives seems highly motivated to pass an Out-of-Network Bill this year. For some background, if this legislation ends up being unfavorable for EM physicians, it could cause the biggest disruption in Emergency Medicine since EMTALA went into place in the 80s! National ACEP has been working hard to push for fair compromise and promote negotiation between physician groups and insurers and avoid price-fixing. The insurance industry has been swinging their considerable political weight and lobbying coffers into this, so it is vital that EM physicians take a strong stand in response. If insurers get their way, we can expect EM compensation to drop considerably nation-wide, and the patient safety-net of Emergency Departments to disintegrate.

Several House committees have developed bills with various levels of favorability. First, the bad: The Education and Labor Committee has put forth a bill that sets the lower limit to allow arbitration between physicians and insurance companies at $750, far above most ED bills, essentially locking out emergency care from this solution. ACEP is understandably opposed to this bill. There is, however, a more promising bill coming from the Ways and Means Committee, known as “Consumer Protections Against Surprise Medical Bills Act of 2020”. This bill has no threshold, and is the most fair bill to EM physicians because it encourages robust insurance networks to help protect patients. ACEP supports this bill, and it moved out of committee on February 12th. Now the full House must reconcile these bills and amend them before going forward with a full House vote.

It is vital that our Wisconsin legislators hear from Emergency Physicians on these bills! Please write, call, meet with, or email your house legislator today, and let them know that you support the protections offered to patients in the Ways and Means Bill. In particular, ACEP is still pushing for some amendments to that bill, so it essential that Wisconsin representatives Ron Kind (WI 3 – Western WI) and Gwen Moore (WI 4 -Milwaukee) hear from their EM physician constituents. The only Wisconsin representative on the Education and Labor Committee is Glenn Grothman (WI 6 -Eastern WI) so if you are in his district, be sure to let him know the reasons you oppose the bill coming from his committee.

It has been a surprisingly busy winter in terms of legislation both at the state and federal level, but you can count on WACEP to keep you up-to-date on the issues that matter to you and your patients!

Rural Outreach Program - June 19 in Rice Lake WI

Mon, 17 Feb 2020 21:09:02 GMT

Wisconsin ACEP is planning a second Rural Outreach Program on Friday, June 19, 2020 as part of an initiative to engage emergency physicians in more rural and remote practice settings for education, networking and fun.

Save the date and plan to join us on Friday, June 19th at Marshfield Medical Center, Rice Lake.

The program will have a pediatric focus with updates on Peds ICU, Peds Trauma, Best Practices in Burn Care, and much more! Whether you practice in that part of the state or elsewhere, join us and learn the unique challenges and opportunities in more rural settings. You'll likely discover that despite differences in transfer times and resources, many more similarities actually do exist across practices, regardless of location.

Save the date of Friday, June 19 and plan to make a weekend of all that is offered in beautiful Northwest Wisconsin! Program registration will be open soon, and will include optional social and/or family excursions.

Call for Nominations - ACEP Council and Leadership Awards

Mon, 17 Feb 2020 20:55:28 GMT

March 1st is the deadline to submit nominations for ACEP Leadership and Excellence Awards. Learn more and submit a nomination.

Nominations are also being accepted through March 1st by ACEP's Council Awards Committee for the following Awards:

Council Teamwork Award
Council Horizon Award
Council Curmudgeon Award
Council Champion Award in Diversity & Inclusion

Descriptions of the Council awards can be found online. and nominations may be submitted here.

Local Tragedy Underscores Need for State EM Organization

Fri, 24 Jan 2020 16:26:06 GMT

WACEP President's Message, January 2020
Ryan Thompson, MD, FACEP

A recent tragic case which occurred in Milwaukee is garnering national media attention. You can read the full story here, but the broad strokes are that a young woman 9 months status post a stillbirth presented to an ED with chest pain, left after waiting 2 hours, and subsequently collapsed and died a short time later -presumably related to postpartum cardiomyopathy. (If you want to brush up on peripartum care, our friends at Wisconsin-ACOG have provided this great reference). Ultimately, this woman’s death was heartbreaking and very likely preventable.

The immediate and predictable media reaction was to blame the ED for the wait times she experienced. I do not know the physicians who were working at the time, but I’m confident that if the patient had stayed in the ED that she would have received the life-saving care that she needed. To lay the blame solely at the feet of these physicians and other ED staff is unfair and misses the whole host of failures that contributed to this woman’s death. Fortunately, ACEP’s Dr. Howie Mell was able to provide a small amount of context for the story, pushing back against the failed ED narrative.

As emergency physicians, we would like nothing better than to have EDs with enough staff, space, and resources to see every patient with little or no wait times at all. Unfortunately, this is far beyond our control. Innumerable forces contribute to ED crowding: a woefully overwhelmed mental health system that leaves patients boarding for days in the ED, inadequate Medicaid funding which leads to a lack of primary care availability and budget shortfalls in EDs, hospital system failures to decompress ED boarding through creative surgical scheduling and inpatient hallway beds, and many more.

I originally joined the WACEP board to head up the planning of the annual Spring Symposium (this year occurring April 15-16th in Madison, sign up here), but I have come to increasingly recognize the value WACEP offers in addressing the systemic issues we struggle with every day. National ACEP simply doesn’t have the resources or awareness of state-level problems to intervene effectively, but by working on the local level we can do so much. Dedicated members of our board monitor for state legislation relevant to EM so we can provide our perspective to legislators, sit on a multi-specialty task force dedicated to fixing ED psych boarding, have designed opiate-alternative guidelines to attenuate the opiate crisis, meet with state regulators to push for increased Medicaid reimbursement for EM so we can recruit more docs, and help craft position statements that EM physicians can use to advocate for change within their own institutions. I am constantly humbled by the passion and dedication displayed by our membership.

In the hustle and bustle of our lives it can become all too easy to lose sight of the challenges that face our specialty and our patients on a daily basis. WACEP has been working for years to give EM docs a voice so we can advocate for ourselves and our patients. As your new president, I will strive to continue that mission, but we need your help as well. Please reach out to us if you have an issue you are passionate about, tell an EM friend about the work we are doing on their behalf, and contribute to our PAC so we have the clout to push for legislative change in the state. WACEP is nothing without its members, so please help us help you!

Deputy Insurance Commissioner Nathan Houdek to Headline Feb. 10 WHN Newsmaker Lunch

Wed, 22 Jan 2020 23:22:47 GMT

Nathan Houdek was appointed deputy commissioner of insurance in January of 2019. He's chairing the Governor's Task Force on Reducing Prescription Drug Prices and is vice chair of the Group Insurance Board.

Mr. Houdek will detail the work of both groups at a Wisconsin Health News Newsmaker Event on Monday, February 10 at the Madison Club in Madison. He'll also discuss the future of the ACA market, protections for people with pre-existing conditions, surprise medical bills and more.

Learn more and sign up here.

Lawmakers consider emergency detention reforms

Wed, 22 Jan 2020 23:15:13 GMT

January 21, Wisconsin Health News

A new proposal would create a pilot program in western Wisconsin so law enforcement wouldn’t have to transport those in mental health crisis across the state.

The bill would require that the Department of Health Services reimburse hospitals located in Barron, Burnett, Dunn, Pierce, Polk, St. Croix and Washburn counties for housing patients for emergency detention.

Bill author Rep. Rob Stafsholt, R-New Richmond, said at an Assembly Committee on Mental Health hearing last week that those in crisis in his district are often transported to Winnebago Mental Health Institute in Oshkosh.

“It’s a roughly five-hour trip, often in handcuffs, across the state while you’re in a mental health crisis,” Stafsholt said. “And the reason we do that is there’s not access to those types of facilities in northwestern Wisconsin.”

Participating providers would be able to opt into the program. DHS would cover up to 80 percent of the difference between the hospitals' average cost per bed per day and the average rate received per bed per day. Counties would have to pay the remainder.

St. Croix County Sheriff Scott Knudson said that emergency detentions can impact law enforcement staffing, calling it one of their more “draining duties." Any additional resources would help, he said.

Sarah Diedrick-Kasdorf, Wisconsin Counties Association deputy government affairs director, said the plan isn’t specific on how much of the difference DHS would cover, making it difficult for counties to budget.

She questioned how the bill would relate to federal law and county contracts for emergency detention services.

“These are all things we can sit down and talk about and come to some sort of resolution on,” she said.

Call for Nominations - WACEP Distinguished Service Award

Mon, 30 Dec 2019 22:31:53 GMT

Nominations are now being accepted for the WACEP 2020 Distinguished Service Award.

This award annually recognizes a WACEP member in good standing who has demonstrated exceptional commitment and service to the organization, and/or made a significant contribution toward the advancement of emergency medicine in Wisconsin or beyond.

If you know of an emergency physician who is deserving of this award, submit your nomination today.

The deadline to accept nominations is March 1^st and the selected award recipient will be recognized during the WACEP Annual Spring Symposium.

Leadership & Advocacy Conference Travel Funds Available

Mon, 30 Dec 2019 20:50:56 GMT

Interested in taking a deeper dive into federal and state legislative issues important to emergency medicine? Plan to attend ACEP’s Leadership and Advocacy Conference (LAC), April 26-28, 2020 at the Grand Hyatt in Washington DC.

At LAC, you will learn tips and tools to advocate on issues at both the federal and state levels, hear updates on proposed legislation that could impact you and your patients, and have an opportunity to meet with your federal legislators in person.

The Wisconsin Chapter, ACEP has earmarked funds to support travel and conference registration expenses for up to four residents and four members in practice. Simply submit your brief statement of interest no later than January 31^st explaining your why you’d like to attend and what you hope to do with information you obtain at the conference. Notice of funding will be made by mid-February.

President's Message, December 2019

Wed, 18 Dec 2019 22:54:10 GMT

Jeffrey Pothof, MD, FACEP
WACEP President

Dear WACEP members,

As we close out yet another year it seems a brief reflection of the previous year is the natural starting point as we start to focus on what we aim to accomplish in the upcoming year. 2019 was a busy year for Wisconsin emergency physicians.

Top of my mind is that we lost a friend and colleague in Eric Jensen who passed away after a courageous battle with cancer. His enthusiasm and passion to leverage his skill and talent to improve the lives of others was self-evident in the work and guidance he provided our organization and will not be forgotten.

Legislatively there were a multitude of issues we worked on to ensure patients had access to the great care all of you deliver while advocating for fair remuneration for our work while ensuring patients continue to receive high quality and safe care. Most recently the call went out to contact your representatives about an out of network balance billing (insurance network inadequacy) legislation that would have been attached to the year end funding package. This legislation was incomplete and unfavorable. As of this writing it appears your engagement and advocacy was able to help us and others concerned about the impact of this language on patients put a hold on this so that all stakeholder have a chance to be heard and all implications understood. Thank you to all of you who took the time to contact your legislators in Washington as your efforts were not in vain.

We continue to be engaged in proposed legislation that looks to address the mental health crisis that burdens our emergency departments and inhibits out ability to provide the care we think Wisconsin citizens deserve in our emergency departments. We also continue to closely follow the CARES Act and have not slowed our focus on drawing attention and action to Medicaid reimbursement rates for emergency physicians as Wisconsin continues to maintain the record of worst in the United States.

We look forward to another exciting Doctor Day where your voice can be heard at the State Capitol in Madison. WACEP will be having a policy primer the evening prior, Tuesday, January 28, which I promise will be informative and a great way to meet other emergency physicians passionate about our specialty. The main event will take place on Wednesday, January 29 before. For more information and to register, visit www.WIDoctorDay.org/schedule.

This spring will bring another WACEP Spring Symposium to be held in Madison. The committee has secured top talent in emergency medicine to come speak, and I encourage you to drop by the research forum to see how impressive our EM residents in the state are as they look to advance emergency care. You can learn more or register by visiting www.WisconsinACEP.org/WACEP2020.

As my time as WACEP president is drawing to a close I look forward confidently knowing that committed emergency physicians will continue to step forward to meet the challenges we face as a specialty and promote the interests of the patients whose lives we have the privilege of being part of. Dr. Ryan Thompson, the incoming WACEP president, is a strong leader and certain to advance our organization.

In closing I can’t express how thankful I am for a WACEP board of intrinsically motivated and engaged colleagues and friends. Kudos to Badger Bay and Sally Winkelman for their commitment and leadership to our organization, and to all of you, the emergency medicine providers in our state who every hour of every day are there for anyone who needs our help without caveat or exclusion. Thank you for everything you do.

~Jeff

Committee plans vote on emergency detention transportation bill

Mon, 16 Dec 2019 15:03:49 GMT

December 12, Wisconsin Health News

An Assembly committee plans to vote next week on a bill that would make it clear that law enforcement agencies can contract with others to transport those in mental health crisis for emergency detention.

The plan also directs the Department of Health Services to pursue federal approval to reimburse transport for Medicaid recipients.

Rep. Mark Born, R-Beaver Dam, said some agencies already contract for emergency detention transports. But the majority don’t because their attorneys feel that state law may not allow it.

“We want to make it clear that this is an option for local governments to work with third-party vendors, ambulance services or other law enforcement agencies to help in this process,” Born told members of the Assembly Committee on Mental Health Tuesday.

Law enforcement testified in support of the plan. Dodge County Sheriff Dale Schmidt said transferring those in crisis is time-consuming.

“We have an epidemic in the state of Wisconsin with emergency detentions,” Schmidt said. “My opinion, and I think the opinion of many law enforcement executives is that emergency detentions by far take up the most time of any incident that we deal with on a daily basis.”

Schmidt said he’s waiting for the passage of the bill before contracting for emergency detention transports.

Disability Rights Wisconsin Milwaukee Officer Director Barbara Beckert wrote in testimony submitted to the committee that they respect the intent of the bill.

But the plan doesn’t provide criteria for providers like requirements that they are trained on safety, mental illness, trauma and other topics.

“Currently the law enforcement personal who provide transport are public employees and as such have greater accountability,” Beckert wrote. “It is unclear how accountability would be addressed for third-party contractors. Use of a third party potentially leaves the door open to abuse.”

Born said it’s the responsibility of law enforcement agencies to vet their contract providers and to have solid contracts.

The committee is scheduled to vote on the measure next Tuesday.

Legislative package aims to boost rural EMS

Wed, 11 Dec 2019 13:56:11 GMT

December 10, Wisconsin Health News

A new legislative package aims to support rural emergency medical service providers.

Sen. Howard Marklein, R-Spring Green, began circulating the measures last week for co-sponsorship with Sen. Steve Nass, R-Whitewater, and five GOP Assembly lawmakers.

Marklein said in a statement that the bills are based on four summits he held with local EMS volunteers this fall.

“This package of rural EMS legislation is a small step toward supporting our local, rural volunteer EMS providers,” Marklein said in a statement. “It removes some obstacles, improves state-level regulation and makes the funding whole.”

One plan would provide an additional $239,800 in state money annually to the Funding Assistance Program, which gives ambulance service providers the only state money they receive. The increase will allow EMS services to buy equipment and compensate members for training.

Another bill makes a series of changes, like clarifying a recent state law allowing an ambulance service provider to upgrade its service level to the highest level of an EMS practitioner staffing the ambulance. The plan would clarify that a practitioner can perform up to their certification, but the ambulance doesn’t have to be stocked to that highest level.

The bill also allows ambulances to be staffed with one emergency medical technician and a driver with CPR certification for low-risk transports, like transporting patients between nursing homes and hospitals for dialysis.

Another part of the bill streamlines the process of applying for the Funding Assistance Program. And it also bars EMS departments from prohibiting their employees or volunteers from working with another department.

Marklein said he was "shocked" to hear that some large EMS departments bar their employees from volunteering for volunteer departments.

“They say that they worry about the person getting hurt," he said in a statement. "I would wager that a person is more likely to get hurt playing church league softball than dedicating their considerable skill, talent and knowledge to saving the life of their neighbors.”

A final bill would make passing the National Registry of Emergency Medical Technicians exam optional for emergency medical responders, the lowest EMS licensure level in the state. Individual departments would be able to decide whether the test is required.

Responders would have to complete a DHS-approved training course and pass all tests and hands-on learning experiences to receive a license.

ACEP Council - Setting Direction for Emergency Medicine

Tue, 03 Dec 2019 00:29:17 GMT

Jeff Pothof, MD, FACEP
President's Message, November 2019

Dear Wisconsin Emergency Physicians,

I wanted to use this month’s column to update you on our participation in the 2019 Annual ACEP Council Meeting that occurred late last month.

For those that may not be aware ACEP’s annual council meeting is the process by which the college determines both it’s leaders for the next year as well as the direction of the college by listening to and adopting resolutions that direct the board of directors as to what they should be committing resources to and working on. The council is made up of councilors from every state. Each state has councilors allocated based on total state chapter members. The council also includes representation from the college’s sections as well as EMRA.

This year our Wisconsin Chapter co-authored two resolutions. The first resolution was aimed at increasing awareness of implicit bias among physicians and requiring ACEP to create and make available online implicit bias training free to all ACEP members. The second resolution we co-authored was aimed at requiring ACEP to develop a policy statement in favor of physician salary and benefit package equity and transparency. Both resolutions were adopted by the council. The WACEP board became involved with these two resolutions based on recent data that continues to show disparities in medicine especially as it pertains to compensation of women and minorities. We feel this issue is important to providers practicing in Wisconsin and were please that the council agreed to devote more attention and training of providers on this issue.

There were many other important discussions this year on an array of topics from private equity companies acquiring medical practices and the impact on the practice of emergency medicine to ACEP supporting emergency physician’s compensation during contract transitions. We also adopted a resolution that would require ACEP to issue a statement that strongly supports vaccination by any person detained by ICE or ICE contracted facilities and a resolution that opposed legislation requiring reporting of naloxone prescriptions to state PDMPs.

This year the council elected the president elect Dr. Mark Rosenberg as well as the college’s new board members and council vice speaker.

If you are interested in learning more about ACEP council I encourage you to visit this site: https://www.acep.org/how-we-serve/council/.

If any of you are interested or have questions about how your Wisconsin chapter interfaces with national ACEP, or desire to become more involved in setting the direction of our specialty and improving our professional lives please reach out to myself or any of our board members “HERE” (insert email link). Likewise, please share with colleagues of your group who are not yet ACEP members the work the college does to preserve and promote our specialty. We’d be happy to discuss ACEP council or any of our other initiatives we are working on to improve our specialty with any of you.

HWZ Legislative and Political Update, December 2019

Tue, 03 Dec 2019 00:23:48 GMT

AJ Wilson and Greg Hubbard
Hubbard Wilson & Zelenkova Government Relations

Legislative News

The state legislature had its most active period thus far in the 2019-2020 legislative session during the fall months. Several bills of interest were introduced or saw action. Other bills continued to lay dormant.

AB 267/SB 249 creates an additional system of licensure for advanced practice registered nurses (APRNs), has received no legislative action. WACEP is registered opposed to this bill and there is no expectation it will be moving forward this session.

AB 575/SB 515 changes the relationship between physician and physician assistant to that of collaboration rather than supervision. This bill transfers licensure and regulation of PAs to a newly created Physician Assistant Examining Board and makes changes to licensure requirements. WI Medical Society is working against this bill. The Wisconsin Hospital Association is working for it. WACEP has not taken a position to date.

AB 329/SB 313 addresses the issue of “surprise billing” for patients brought to an out of network ER. This bill does not appear to be moving this session. Insurance interests have registered “undisclosed” but it is widely known that they oppose. WACEP should be sure it agrees with how the bill addresses the issue. Federal action is still a slight possibility.

AB 526/SB 520 requires all continuing medical education to include two hours of instruction on suicide prevention. The bill was amended to require it only once for a physician. The bill passed the Assembly but no action thus far in the Senate. WMS is opposed.

AB 573/SB 540 – “Red Flag Law” – this bill covers two subjects – Extreme Risk Protection Orders and Universal Background Checks for gun purchases. The Governor called a special session to take up such legislation but the Legislature did not move forward. This bill, that was introduced prior to the special session call, is authored by Rep. Sargent and Sen. Taylor. No legislative action is expected.

The Emergency Psych taskforce met with the Attorney General’s office in September and led a break out session at the Attorney General’s Summit on Emergency Detention on Medical Clearance Process Improvements on October 31^st. The group (Dr. Repplinger and psychiatrist Dr. Thrasher) also met with WI Sheriffs Association to discuss shared issues and concerns. The Sheriffs Association shared a bill on private transport that has since been circulated for cosponsors (LRB 1247). This bill is authored by Rep. Mark Born (R) has yet to be introduced.

AB 443/SB 405 creates a $15 million grant to an Eau Claire County hospital to fund an expansion of psychiatric bed capacity. This bill provision was included in the budget that passed the legislature but was vetoed by the Governor. Further, legislative republicans attempted to override the governor’s budget veto but failed. If this bill is passed, it will likely be vetoed again.

AB 433/SB 392 requires DHS to award grants totaling $5 million to regional crisis stabilization facilities for adults based on criteria established by DHS established in five regions of the state. While this bill has bipartisan support, it is unlikely to move this session.

We continue to work towards the goal of increased Medicaid reimbursement rates. At present we are scheduling a WACEP meeting with the Division of Medicaid Services that will hopefully take place in December.

Political News

A special election will be held for the 7^th Congressional District seat vacated by Sean Duffy (R). The seat leans republican and because it will have to be defended again in November 2020, democrats have not made it a priority despite success in recent special elections. The primary will take place on December 30 and the general is scheduled for January 27^th. On the Republican side, current State Senator Tom Tiffany, Jason Church, a retired Army captain and current staffer for US Senator Ron Johnson, and Michael Opela, a hobby farmer, will face off. On the Democratic side, Lawrence Dale, a businessman who actually lives in Michigan and Tricia Zunker, the Wausau School Board president and associate justice in the Ho Chunk nation will compete.

In the 5^th Congressional District to replace the retiring Jim Sensenbrenner, current Senate Majority Leader Scott Fitzgerald appears to have cleared the field in this heavy GOP district. (This is also significant because it pretty much guarantees there will be a new Senate Majority Leader next session.) Fitzgerald at present is expected to face Tom Palzewicz, a Waukesha County democrat.

The most significant political news on the local level at present is that Chris Abele announced he will not run for reelection as Milwaukee County Executive this spring. Several candidates have announced their interest or intention to run including: David Crowley (current state representative), Chris Larson (current state senator), and Theo Lipscomb (Milwaukee Co. Supervisor and Board Chair).

Independent Groups Encouraged to Sign Specialty Coalition Surprise Billing Letter

Tue, 03 Dec 2019 00:10:53 GMT

A letter to Congressional leadership is circulating with an aim to obtain signatures from several hundred smaller and independent groups from various impacted specialties, providing maximal visual impact and local connections related to surprise billing. The turn-around is very quick with a planned deadline to sign on by mid-day on Thursday, December 5.

Please share notice of this effort with as many smaller and independent groups as possible. The more sign on, the more compelling in its impact. Each specialty is defining "smaller group" for themselves, since there's such variation on relative group sizes across specialties. For EM, ACEP is requesting groups that serve 10 hospitals or less to sign-on, which is consistent with the EM smaller group letter that went to the Hill in early September.

Download, review and sign your group to the letter at bit.ly/SmallIndGrpLetter.

Bipartisan Letter Circulating on Surprise Billing

Mon, 02 Dec 2019 23:50:03 GMT

ACEP is requesting additional action on Out of Network Billing/Surprise Billing. Several Congressional champions (Reps Morelle, Shala, Roe, and Taylor) are circulating a bipartisan letter in the House to leadership to collect Congressional signatures. Anything members can do to encourage more Congressional offices to sign on would be a big help. The turn-around time is pretty tight--signatures are due Dec 5. Please see the letter below, and if you have good relationships with any House offices, please encourage them to sign on.

To sign on, please contact:

Maria Oparil, Legislative Assistant
Office of Congressman Joseph D. Morelle (NY-25)
1317 Longworth House Office Building
202-225-3615 | maria.oparil@mail.house.gov

The Honorable Nancy Pelosi
Speaker of the House
H-232, U.S. Capitol
Washington, DC 20515

The Honorable Kevin McCarthy
House Minority Leader
H-204, U.S. Capitol
Washington, DC 20515

Dear Speaker Pelosi and Leader McCarthy,

Thank you for your leadership on addressing the unfortunate practice of "surprise billing," which leaves patients with unexpected charges after they receive emergency or out-of-network medical care. Many of our own constituents have been left helpless in disputes between health care providers and insurance plans, saddled with untenable out-of-pocket costs after receiving potentially life-saving care.

As you know, ongoing bipartisan, bicameral negotiations continue with the goal of addressing this critical issue in a larger legislative package before the end of this year. We are supportive of these efforts, and unequivocally believe Congress should complete legislation that will hold patients harmless in unplanned out of network care. However, we also believe it is critical that this legislation includes a balanced independent dispute resolution system between providers and insurers. We are committed to ensuring that our local doctors, hospitals, and communities are not disproportionately impacted by an approach that fails to include true measures of accountability.

Patients, doctors, and hospitals are relying on us to address this issue without harming the quality of our health care system or hurting our local economies. A benchmarked, one-size-fits-all, approach would hinder network adequacy and access to care, particularly in rural and underserved areas. In contrast, instituting a neutral, independent review process after direct negotiations between the parties can lower health care costs without massive disruptions to the health care market.

An accessible and meaningful appeals process would also ensure that the playing field is not tilted toward health insurance companies at the expense of our local hospitals or doctors, especially those who are already in-network, while still ensuring that the patient is out of the middle and not financially responsible for a surprise medical bill.

We look forward to working with you to end the practice of surprise billing through balanced legislation. This is a tremendous opportunity to ensure that no American family is faced with an unaffordable bill for unexpected out-of-network care ever again, without threatening the quality of care they receive from physicians and hospitals across the nation or increasing the cost of care for anyone.

Thank you again for your work to address this pressing issue-we are confident we can achieve a fair result to protect patients, providers, and insurers.

Sincerely,

Joseph D. Morelle
Donna Shalala
Phil Roe
Van Taylor

Medicaid Copayment, Coming to Your ED February 2020

Wed, 20 Nov 2019 21:30:54 GMT

Lisa Maurer, MD
WACEP Legislative Chair

Wisconsin is one of many states that has received federal approval to change our Medicaid program, called a waiver project, in some substantial ways that will affect our patients in the emergency department.

There are several characteristics of the changes that will affect our patients. Namely, there will be a new work requirement for some Medicaid enrollees in order to maintain their eligibility for coverage, new Medicaid coverage for inpatient substance use disorder treatment, and some mandatory screening for substance abuse disorders. Most impactful for our patients and workflow, the waiver also contains a new potential for copayment for Medicaid patients for ED visits. As these new laws are implemented in Spring of 2020, it is our responsibility as advocates for our patients to ensure that we maintain protections under the Prudent Layperson Standard.

This waiver project starts a new $8 copay for ED patients who receive care in the ED for non-emergencies as of February 2020. This is not a new concept, whereby fourteen other states already charge copays to Medicaid enrollees who receive non-emergent care in the ED. A minority of states have even gotten federal approval to charge more than the historic maximum of $8 copayment. The real risk to emergency patients lies in the variance among the states in how they define a “non-emergency,” and what direction Wisconsin moves in this regard. Scarily, some states’ Medicaid departments chose to define non-emergency based on final diagnosis. Choosing to define non-emergency in this way is a clear violation of the Prudent Layperson (PLP) Standard as defined by federal law, which protects patients who present with symptoms concerning for emergency, even though ultimately, they might not be diagnosed with a life- or limb-threatening condition.

Thankfully, the Wisconsin Department of Medicaid has chosen to define emergency (and therefore non-emergency) based on the PLP. What’s more, this definition of non-emergency is as determined by the physician caring for the patient. Hence, our judgement is paramount, as it should be, as we are the ones who have the best sense of the patient’s concerns at the time of presentation. Of note, in Wisconsin, this copayment will be applied to the facility charges, not the professional fee charged by the physician. Therefore, each hospital system will need to determine what the workflow will be to assess for non-emergency and then somehow alert the registration staff so they can apply the copay to the patient’s cost-sharing responsibilities. In other states that have implemented a copay for non-emergent services in the ED, actual utilization of the copay by the hospitals has been low.

In the coming months, DHS will be rolling out pre-implementation outreach and communication activities about the program. Thank you in advance for making sure the implementation of this copay makes sense for emergency physicians and our patients at your hospital.

Take Action to Prevent Reimbursement Cuts

Wed, 20 Nov 2019 18:36:50 GMT

Your Medicare reimbursements will be cut unless Congress acts before the end of the year. Help us urge Congress to take action to improve MACRA and to stop the upcoming cuts to ensure Medicare patients continue to have access to high quality emergency care. Click here to learn more and send a message to Congress today.

CMS Releases Final 2020 Medicare Physician Fee Schedule

Wed, 20 Nov 2019 18:18:01 GMT

Recently, CMS released its final 2020 Medicare Physician Fee Schedule (PFS) rule that includes changes that will affect Medicare physician payments and MIPS starting Jan. 1. ACEP's Regs & Eggs blog breaks down the final rule, emphasizing policies that apply to EM.

Evers signs vaccine, EMS and 911 call center bills

Wed, 20 Nov 2019 17:41:57 GMT

November 20, Wisconsin Health News

Gov. Tony Evers signed into law three health-related bills Tuesday. The measures will:

Allow pharmacists with appropriate training to administer vaccines to young children.
Make technical changes so that EMS providers can apply for a Medicare pilot program.
Create a grant program to update 911 service infrastructure. Grants could go to staff training, equipment updates and consolidation of public safety answering points.

Evers said in a statement that the measures will help "promote safer and healthier communities in Wisconsin."

ACEP Offers New Resources to Help Small Groups

Tue, 12 Nov 2019 14:29:49 GMT

ACEP has developed new resources specifically to benefit small groups. A new Small Group Advisory Group is a team of seasoned small group members who have volunteered to support the small group practice model by sharing their expertise with other small group members who are looking for guidance or wanting to tap into the experience of others as they face various challenges unique to small groups. If your small group is dealing with an issue that you’d like to ask the advisory group about, just send us an email at smallgroups@acep.org.

ACEP has also developed an online community for small group members to share ideas and discuss issues. To joint that group and see the other small group resources available, go to www.acep.org/smallgroups.

ACEP Introduces Citizen First Responder Program

Tue, 12 Nov 2019 14:27:19 GMT

ACEP’s new first responder training program, Until Help Arrives, was officially unveiled during ACEP19 in Denver with a series of events to highlight how emergency physicians can positively impact their communities by conducting training sessions to teach the public basic life-saving skills. Learn more.

ACEP Offers Complimentary Counseling & Wellness Coaching

Mon, 04 Nov 2019 23:11:13 GMT

New ACEP member benefit now available

ACEP members care for their patients 24-7-365… but are you are taking care of yourself? At ACEP19 in Denver, ACEP launched the ACEP Wellness & Assistance Program., a service available to all members that provides access to three confidential counseling or wellness coaching sessions, free of charge.

Call 1-800-873-7138 to register and receive support whenever, however iyou need it.

Counseling is available 24 hours a day, 7 days a week
Sessions can cover stress, anxiety, depression, family issues, drug and alcohol abuse, relationships, death, grief, and more
The service is strictly confidential and can be scheduled face-to-face, over the phone, via text, or through online messaging
Wellness coaching sessions are 30-minute phone calls to help reach your personal wellness goals which can include weight loss, nutrition, healthy habits, stress, caffeine reduction, injury recovery, relationships, sleep, smoking cessation, and more

Members may choose three free sessions in any combination of counseling and wellness coaching, up to the session limit.

An additional resource is available at a nominal fee of $15/year that will help members manage legal and financial issues through ACEP’s partner, Mines & Associates. Participants will have unlimited access to an extensive online resource library and unlimited 30-minute in-person consultations for each individual legal or financial matter and a 25% discount on legal and financial services within the Mines network.

Westlake testifies against AB526

Thu, 31 Oct 2019 22:22:43 GMT

During Tuesday’s Public Hearing for the Assembly Committee on Health, emergency physician and vice-chair of the Medical Examining Board Tim Westlake, MD, testified against Assembly Bill 526 on behalf of the Wisconsin Medical Society.

This bill is one of nine bills produced by the Speaker’s Task Force on Suicide Prevention. The first draft of the bill would require two credits of CME every two years on the topic of suicide prevention for all physicians, psychologists, social workers and several other professions. The Wisconsin Medical Society raised concerns to the Speaker’s office, the chair of the Speaker’s Task Force and the bill author, and an amendment was offered by Rep. Tony Kurtz (R – Wonewoc) that would only require the two hours once upon the next renewal.

The Wisconsin Medical Society opposes the legislation (even with the amendment) for the following reasons:

Suicide prevention and mental health treatment are already part of best practices for physicians.
Physicians are the best judges of what education they need to serve their patients, and the CME requirement is another example of government interference and regulation in medicine.
The recent Opioid CME requirement was successfully created through the action of the Medical Examining Board, not through legislation.
Physicians already take significantly more education than is required under state law to maintain Board certification.

Doctor Westlake stressed that all physicians care deeply about preventing suicide, mentioning that he treated four suicidal patients in the ER the night before. He then pointed out that a requirement of CME is unlikely to impact patient care. “A responsible physician will make sure they are up to date on all aspects of their practice,” Westlake said, “but requiring CME won’t change behavior. You can’t legislate responsibility.”

Call for Board Nominations

Thu, 24 Oct 2019 20:10:36 GMT

The Wisconsin Chapter, ACEP Nominating Committee is now accepting nominations of any member in good standing interested in serving in WACEP leadership.

WACEP's Board of Directors meets quarterly and provides ongoing strategic oversight as the organization works to advance the effectiveness, sustainability and mission of the Chapter. Board members are expected to participate in all Board meetings, the annual Spring Symposium, and various other activities related to the organization's strategic priorities.

Nominations are being accepted for the positions listed below (terms begin January 1, 2020):

(2) Directors-at-Large on the Board of Directors (4-year term)
(4) Councillors to ACEP (3-year term)
President-Elect (this is a 3-year commitment, one year each as President-Elect, President and Immediate Past President)
Secretary/Treasurer (1-year term)

If you or any of your colleagues are committed to serving in a leadership capacity and being a resource for information, education, networking and advocacy, we encourage you to get involved Nominations close November 25, 2019. Submit nominations here.

Awesome and Amazing

Mon, 21 Oct 2019 21:02:40 GMT

President's Message, October 2019
Jeff Pothof, MD, FACEP
WACEP President

It was well over a year ago when one of my colleagues and fellow flight physician, David Hindle, launched a new conference at our staff meeting. Entitled “Awesome and Amazing,” it was a case conference that highlighted some of the best medical care teams in the flight program delivered to critical patients. It seemed like such an obvious thing to share and an effective tool to promote learning and collaboration on our teams, but also 180 degrees opposite from what we as clinicians typically experience.

I think it’s just human nature to focus on those things that aren’t quite perfect or still need a little fine tuning. I postulate the rigors of medical education and the hoops we all jump through predispose us to being hypercritical of ourselves. I’ve been to many a lecture hall to discuss cases at the monthly M&M case review conference. Most cases would not be well described by the “awesome” adjective. I’ve looked at the blinded data during performance reviews and must secretly admit that there is a twinge of self-disappointment when I’m not a top performer on any single metric. I’m not arguing that we shouldn’t learn from our mistakes, and I’m not saying that we shouldn’t continue to hold ourselves to a very high standard. I do think we’d all be well served by just as frequently looking back to those awesome and amazing moments that seemingly come out of nowhere during our careers.

I encourage you to take a moment to reflect back to a time when you were part of something that was “awesome and amazing.” Think about a time when you added immense value and where your presence on a shift or in a room made an inflection point in someone else’s life trajectory. Anyone who’s committed themselves to a career in emergency medicine has these moments. I find that looking back to those times helps make that overnight shift that just won’t end a little shorter, or that case where you wish you could have a do-over sting just a little bit less.

So, without overly inflating our egos, I embolden all of you to spend a little more time thinking about the awesome and amazing things you’ve done in addition to the things you strive to be better at. It’s an important balance that paints a more accurate portrait of who we are as emergency physicians.

Know Your Obligation to Report

Fri, 18 Oct 2019 21:17:48 GMT

Editor’s Note: This article appeared in the August 2018 issue of Medigram, a monthly publication of the Wisconsin Medical Society

Physicians are required by law to report information to entities or individuals such as county health officials or law enforcement in certain situations. Most recently, that includes threats of school violence, which was enacted as part of a school safety law earlier this year.

Both HIPAA and Wisconsin confidentiality laws allow disclosure of protected health information where such disclosure is required by law. Failure to report as required can result fines, civil or criminal liability and/or professional discipline. Physicians should check with their legal counsel or risk manager if they have questions about when they are required to report information to others and how to do so.

The following is a summary of some of the more common mandatory reporting obligations applicable to Wisconsin physicians.

Threats of School Violence—Physicians and other health care professionals who believe in good faith, based on a threat made by an individual seen in the course of professional duties regarding violence in or targeted at a school, that there is a serious and imminent threat to the health or safety of a student or school employee or the public must “immediately inform, by telephone or personally, a law enforcement agency of the facts and circumstances contributing to” that belief. (Wis. Stat. § 175.32)

Child Abuse and Neglect—Physicians and other health care professionals who have reasonable cause to suspect that a child seen by them in the course of professional duties has been abused or neglected or has been threatened with abuse or neglect must “immediately inform, by telephone or personally,” the county department or local law enforcement of the facts and circumstances giving rise to that suspicion. (Wis. Stat. § 48.981)

Conduct of Colleagues—Physicians must make a written report to the Wisconsin Medical Examining Board if they have reason to believe a Wisconsin licensed physician:

Has engaged in acts constituting a pattern of unprofessional conduct under Wis. Admin Code § MED 10.
Has engaged in acts that create an immediate or continuing danger to one or more parties or to the public.
Is medically incompetent.
Is or may be mentally or physically unable to safely to engage in the practice of medicine or surgery. (Wis. Stat. § 448.115)

Elder Abuse—Physicians and other health care professionals must file a report with the county department, elder-adult-at-risk agency, local law enforcement, the Department of Health Services or the state board of aging and long-term care if they have reasonable cause to believe that an individual over the age of 60 seen in the course of professional duties, or another elder-at-risk, is at imminent risk of serious bodily harm, death, sexual assault or significant property loss, or if requested to make such a report by the patient. (Wis. Stat. § 46.90)

Sexual Contact by a Therapist—A therapist who has reasonable cause to suspect a patient or client he or she has seen in the course of professional duties is a victim of sexual contact by another therapist must ask the patient if he or she wants them to report the information and must, if authorized by the patient, report the suspicion to the Department of Safety and Professional Services or the local district attorney within 30 days. (Wis. Stat. § 940.22)

Danger to Others—Physicians, like all individuals, have a duty of reasonable care in light of foreseeable harm. This may, under certain circumstances, require physicians to warn or take reasonable actions, such as notifying law enforcement or potential targets, if they believe a patient, individuals or the public is at risk of serious and imminent harm as a result of information obtained in the course of providing professional services. Where such a duty may exist, Wisconsin law specifies that it is satisfied by doing one or more of the following: contacting law enforcement, contacting the applicable county department or taking other action a reasonable health care professional would consider as fulfilling a duty to warn a third party of substantial probability of harm under the circumstances (Wis. Stat. § 51.17). Physicians are encouraged to discuss such matters with their legal counsel or risk manager.

Other—Physicians are required by law to report certain other events or acts to state or local officials, including the following:

Certain injuries such as gunshot wounds and severe burns. (Wis. Stat. § 255.40)
Certain deaths, such as homicides or deaths that are unexplained or suspicious. (Wis. Stat. § 979.01)
Birth if delivery occurs outside a hospital. (Wis. Stat. § 69.14)
Positive results of infant screening for controlled substances, controlled substance analogs or fetal alcohol spectrum disorder. (Wis. Stat. §§ 146.0255 and .0257)
Certain birth defects. (Wis. Stat. § 253.12)
Lead poisoning. (Wis. Stat. § 254.13)
Certain communicable diseases. (Wis. Stat. § 252.05; Wis. Admin Code § DHS 145)
Cancer and certain precancerous conditions. (Wis. Stat. § 255.04)
Positive HIV tests. (Wis. Stat. § 252.15)

HWZ to Provide Lobbying Services for WACEP

Mon, 14 Oct 2019 16:00:17 GMT

Wisconsin ACEP is pleased to be partnering with Hubbard, Wilson & Zelenkova LLC (HWZ) for lobbying and legislative services. The firm is led by seasoned lobbyists with vast experience and exceptional relationships with policymakers across the political spectrum and on both sides of the aisle. HWZ represents groups and organizations including trade associations, healthcare interests, Fortune 500 companies, trade unions, and state and national non-profits.

Greg Hubbard has over 15 years experience representing a wide range of interests and has successfully lobbied on landmark issues in energy, telecommunications, taxation, natural resources and land use. Formerly, Greg worked for several republican legislators including as Chief of Staff to former Senate Majority Leader Mary Panzer. During contentious legislative redistricting efforts in 2001, he provided analysis and advice to Assembly and Senate Republican leadership. Greg is a graduate of the University of Wisconsin-La Crosse.

AJ Wilson is a principal at Hubbard Wilson & Zelenkova with nearly two decades of experience in and around the Wisconsin State Capitol. AJ represents clients ranging from trade associations and national non-profits to trade unions and Fortune 500 companies on legislative, regulatory, and procurement issues. Prior to lobbying, AJ was Chief of Staff to Assembly Democratic Leader Jim Kreuser and spent over seven years in the Wisconsin Legislature developing strategy, crafting legislation, and maintaining critical relations between legislative leadership, members, state agencies, and the Governor's office. AJ is a graduate of the University of Wisconsin-Madison and earned his JD from the University of Miami School of Law.

Ramie Zelenkova has over a decade of experience in lobbying and grassroots advocacy and has worked to maintain strong relationships with legislative members on both sides of the aisle. Ramie represents a variety of clients including nonprofits, professional associations, trade associations and Fortune 500 companies in areas such as healthcare, long-term care, education and child welfare. Ramie’s experience includes an extensive background representing client interests before the Wisconsin Department of Health Services with particular experience representing client interests related to the delivery of Medicaid programs. Ramie is a graduate of the University of Wisconsin- Madison.

Katie White is Associate at HWZ with ten years of combined government affairs and legislative experience. Katie has crafted and advanced policies and political strategies for diverse clients and interests ranging from education, healthcare, and long-term care to agriculture and energy. She provides extensive knowledge of the legislative process and excellent relationships with policymakers. Prior to lobbying, Katie worked for Wisconsin Senator Rob Cowles. She received her Bachelor’s degree in Political Science from the University of Wisconsin-Madison.

ED RN Manager Input Sought in Retention Study

Thu, 03 Oct 2019 19:09:00 GMT

Annual turnover rate for nurses is 17.5%, and while limited department-level data exists, annual RN turnover rate in the Emergency Department is estimated at 21.5%, the second highest of any medical specialty.

To better understand department-level data on turnover rates and the factors associated with them, the Studer Group, together with representatives from ACEP and ENA, have created the 2019 Emergency Department Nurse Retention Study.

Please ask your ED RN Managers to complete a brief, 90-second survey to help with the study. Responses will be confidential and aggregate data will help gain better insight into the problem and gather solutions. Begin survey.

Emergency Departments Play Key Role in Preventing Hepatitis A Infections

Fri, 27 Sep 2019 19:59:40 GMT

Outbreaks of hepatitis A virus (HAV) have been reported across the U.S., with Minnesota being the most recent state affected. During these outbreaks, 24,952 individuals have become ill, and 60% of them needed to be hospitalized.

As of this writing, the Department of Health Services (DHS) has not detected HAV outbreaks in Wisconsin. However, most Wisconsin adults are not immune to HAV, making the state vulnerable to an outbreak unless HAV vaccination is scaled up. Because the current outbreaks of HAV are predominantly impacting communities with identifiable risk factors, including unstable housing, recent incarceration, and injection drug use, targeted efforts to vaccinate high-risk individuals could substantially reduce the risk of HAV outbreaks in the state. A single dose of HAV vaccine has been shown to control outbreaks of hepatitis A and provides up to 95% seroprotection in healthy individuals for up to 11 years.

Emergency departments are a critically important partner for providing HAV vaccine to patients in need because this setting provides care for many high-risk individuals who may not seek routine preventive care elsewhere.

We are asking you and your staff to work with your patients and clients to reduce the spread of hepatitis A infection. Please share the following information widely.

What can you do to help prevent hepatitis A infections?

Check the immunization history of at-risk groups: Many individuals who are at risk of HAV have no consistent medical home. Checking their immunization history in the Wisconsin Immunization Registry (WIR) or in your organization’s Electornic Health Record (EHR) is a good way to make sure they are up-to-date on their vaccines, including HAV vaccine and influenza.
Provide HAV vaccine to patients who are unvaccinated and at-risk in the emergency department and urgent care clinics. Providers who do not have available vaccine may direct patients to local health departments or tribal health care clinics. Homeless individuals and injection and non-injection drug users are also at higher risk for other vaccine preventable diseases and should be brought up-to-date per the relevant CDC immunization schedule.
Consider HAV infection in individuals, especially the homeless and those who use illicit drugs, with discrete onset of symptoms and jaundice or elevated liver function tests. Symptoms include nausea, vomiting, diarrhea, anorexia, fever, malaise, dark urine, light-colored stool, or abdominal pain.
Promptly report all confirmed and suspect HAV cases. Please contact your local health department by telephone IMMEDIATELY upon identification of a confirmed or suspected case and report through the Wisconsin Electronic Disease Surveillance System (WEDSS) within 24 hours upon recognition of a case.
Provide post-exposure prophylaxis (PEP) for close contacts of confirmed HAV cases. Susceptible people exposed to hepatitis A virus (HAV) should receive a dose of single-antigen HAV vaccine or intramuscular (IM) immune globulin (IG) (0.02 mL/kg), or both, as soon as possible within 2 weeks of last exposure. The efficacy of combined HAV/Hepatitis B virus (HBV) vaccine for PEP has not been evaluated, so it is not recommended for PEP.
Ensure that all health care workers use standard precautions in patient care to protect themselves against HAV. HAV, like norovirus, is a non-enveloped virus, and it may be similarly difficult to inactivate in the environment. Alcohol-based hand rubs and typically-used surface disinfectants may not be effective.
Work with community partners for a second vaccine dose as needed. Many local health departments and pharmacies have the second dose in the Hepatitis A series. Find out where the second dose can be given so you can recommend your patient seeks out their services after they leave your care.

Who is at high risk for getting hepatitis A?

People who use drugs, whether injected or not (for example, cigarettes, joints, vaping products, pills)
People who have experienced unstable housing or homelessness
People who have sexual contact with someone who has hepatitis A (for example, engaging in oral-anal sex, also known as “rimming”)
Men who have sex with men
People who have close person-to-person contact with someone who has hepatitis A (for example, those who share bathroom facilities or a cell)
People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C
Individuals in correctional and jail settings, due to the close living conditions which allow the virus to spread easily

What is hepatitis A and how is it spread?

Hepatitis A is a highly contagious disease that is spread from person to person and is found in the feces (poop) of people with hepatitis A virus. Hepatitis A can be easily spread if someone does not wash their hands properly after using the bathroom.

How is hepatitis A different from other types of hepatitis?

Hepatitis A is different from hepatitis B and hepatitis C. While all three can damage the liver, they are caused by different viruses and are spread in different ways. Most often, hepatitis A is spread by eating or drinking food or water with the virus in it. In recent outbreaks, hepatitis A has been spread by sharing drugs or drug products, or having sexual contact with someone with hepatitis A.

What are the signs and symptoms?

Symptoms usually start four weeks after the individual has come in contact with the hepatitis A virus. However, they can start as early as two and as late as seven weeks after the virus enters the body. Symptoms can start quickly and can include:

Fever
Fatigue
Loss of appetite
Nausea
Vomiting
Abdominal pain
Dark urine (pee)
Diarrhea (loose stools)
Clay-colored stools
Joint pain
Jaundice (yellowing of the skin and eyes)

What should you know about the hepatitis A vaccine?

The hepatitis A vaccine is safe and an effective tool for preventing the spread of disease. It is important to use the single-antigen hepatitis A vaccine when vaccinating staff.

One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A. It provides up to 95% protection against hepatitis A in healthy individuals for up to 11 years.

What resources are available to order from DHS?

Task Force Meets with AG's Office To Discuss Emergency Detentions

Fri, 27 Sep 2019 16:16:55 GMT

On Wednesday, September 25, members of the Emergency Psychiatry Task Force, a collaboration between WACEP and the Wisconsin Psychiatric Association, met with staff from Attorney General (AG) Josh Kaul’s office to discuss the issue of emergency detention and how it impacts physicians and patients.

Attorney General Kaul is convening key stakeholders from across the state to discuss the issue of emergency and civil commitments, which will be the focus of the AG’s Annual Summit on October 31 at Union South in Madison. The summit will include representatives from the law enforcement, county administration and health care communities.

Emergency physician Michael Repplinger, MD, PhD and psychiatrists Tony Thrasher, DO, Molli Rolli, MD, John Schneider, MD, and Angela Janis, MD, provided the AG's office with best practices regarding how to best care for patients who arrive at the emergency department and need to be taken into custody for their safety and the safety of others.

The group shared a series of resources including the white paper scheduled to be published in WMJ, a SMART form for working with patients in crisis and one-pager detailing the focus areas of the Task Force. Conversation also covered processes for admitting patients, transporting patients to facilities, parity, access, workforce, medical stability and models from other states. All agreed that both pre- and post-admission processes need to be revamped.

Rural Outreach Program Recap

Mon, 23 Sep 2019 20:29:19 GMT

Lisa Maurer, MD, FACEP
Immediate Past President & Rural Outreach Coordinator

Earlier this month, the WACEP Board of Directors held our quarterly meeting in beautiful Richland Center and paired it with educational sessions and a dinner reception for board members and regional docs. What a great experience! Shout out to all you EPs working in the truly gorgeous corners of the state. Our Chapter arranged this event to get a better understanding of what rural practice is like and attempted to connect EPs working in rural Wisconsin with colleagues at their typical receiving facilities.

In Richland Center, we were welcomed by the most gracious host and medical director of Richland Hospital, Dr Andy Harris. I’m sure I wasn’t the only one who was impressed and a little bit jealous of the practice environment, hospital support, and the skill of the emergency physicians who practice there.

To paint a picture, Richland Hospital is a pristine, independent critical access hospital with 25 inpatient beds in the southwestern corner of the state, tucked among the bluffs and rivers. When transfers are needed, they partner with receiving facilities in both La Crosse and Madison. They have bedside ultrasound in the ED, 24-hour access to OB support, and are successfully continuing to build on their team of physicians dedicated to the community. Their success is in large part due to the fantastic leadership of Dr Harris, who moved from Illinois to join their staff just two years ago, and who brings a real passion for the area and for rural practice in general.

We had fantastic educational opportunities for everyone involved, ranging from hands-on workshop for bedside ultrasound skills to the ins-and-outs of cutting-edge stroke care for patients who arrive at non-stroke centers. See below for my personal takeaways and lessons learned.

On behalf of the WACEP Board of Directors, I’d like to offer our sincere thanks to 1) the UW Emergency Medicine Ultrasound faculty; 2) Dr. Natalie Wheeler, neurologist who provided updates on transfers from the UW-Madison stroke team; and 3) UW Med Flight team whose participation hugely complimented the conversation on stroke care in rural areas.

Personally, I can attest that the lessons I learned in rural Wisconsin directly apply to my suburban and urban community practice. I found that despite differences in transfer times, more similarities abound between my practice and those of our colleagues in rural Wisconsin. WACEP looks forward to offering another Rural Outreach Program with similar experiences in another rural part of the state next summer. Please let us know if your ED is interested in hosting, and what topics you’d like to see discussed with emergency physicians and specialists you interact with at your primary receiving facilities.

MY QUICK TAKEAWAYS

Ultrasound

When doing an ultrasound-guided peripheral IV, don’t try to advance the catheter off the needle as soon as you see a flash. Advance the needle just a little (3-5 mm) while visualizing it inside the vessel on ultrasound before advancing catheter off the needle. The IV should be long enough to have distal 1/3 of the catheter inside the vein when the procedure is complete.
When trying to decide if someone's heart has a happy squeeze or a sad squeeze in parasternal long axis view, look to see if the mitral valve leaflets are happily touching the septal intraventricular wall when the myocardium squeezes and the valve flaps open. I picture someone happy saying "yay!" with their arms up and out.

Stroke at a Non-Stroke Center

Consider moving toward a CT/CTA imaging protocol right off the bat for all acute stroke. Dr. Wheeler is happy to share a protocol if you're interested.
If your facility's protocol is to just do noncontrast CT, consider asking your radiologist to give you a HECTS score - this may help communicate risk of ischemic stroke to your potential receiving neuro team.
The list of absolute exclusions for tPA is becoming shorter and more lenient - talk with a potential receiving neurologist. Even consider calling when you patient has a low NIHSS, seeing as mild stroke syndromes oftentimes progress to moderate to severe stroke syndromes in the first 24 hours.
There is a new trial exploring bolus tPA vs bolus/gtt tPA, which might make delay for transport less of an obstacle for physicians who work with EMS partners who cannot take a patient with a tPA drip going.

Med Flight

Med flight physicians want to stress that they are happy to take over for complicated patients at any stage of the game—even if the patient needs procedures and is not "wrapped up in a bow." They understand that our rural docs are often pulled in ten directions at once.
Capabilities of local EMS teams vary greatly. You do not necessarily have to reserve the use of Med Flight for critical patients. Rather, think of them for any patient that supersedes the capabilities of your local resources.

President's Message, September 2019

Mon, 23 Sep 2019 20:04:28 GMT

Jeffrey Pothof, MD, FACEP

There are a few things happening in emergency medicine that I’d like to draw your attention to as we kickoff the fall season

First, I want to thank those that attended our rural outreach event earlier this month in Richland Center. We had very accommodating hosts and the educational sessions and networking were superlative. We’ll be sure to plan another event like this next year so stay tuned for more details.

ACEP’s Scientific Assembly is drawing closer and I hope to see some of you October 27-30 in Denver. If you find yourself in town, please make your way to Wynkoop Brewing Company at 6:00 pm local time on Monday, October 28 for our annual Wisconsin Meet-Up. Also, know that along with Scientific Assembly comes the annual ACEP Council meeting where the future direction of the college is debated and takes form. The WACEP delegation to the Council meeting will be reviewing many resolutions in the upcoming weeks. If there is something that you are particularly excited about or have a strong opinion on, please reach out to us with your thoughts.

Many of our EM groups in the state schedule shifts far out. Given that, I want to bring to your attention our largest and most important advocacy event, Wisconsin Doctor Day, planned for January 29, 2020. If you haven’t submitted schedule requests yet, please consider blocking that day off and hanging out with your peers in Madison for a fun day at the State Capitol. And don't forget to sign up if you plan to attend.

Finally, I want to make mention of the passing of Eric Jensen, our long-term lobbyist. Eric’s work in advocating for better ways to deliver healthcare to residents in our state demonstrated his desire to make a difference in the lives of others. His skill in understanding health policy and strategy is only surpassed by his unmistakable smile, deep laughter, and friendship to those that had the opportunity to know him. Our deepest condolences to Eric’s family.

Sept. 19 Sepsis Awareness Month Twitter Chat

Wed, 18 Sep 2019 17:32:18 GMT

Join WACEP leader Bobby Redwood, MD, MPH for an online Twitter chat!
Thursday, September 19, 2019 | 11:00 am - 12:00 pm CDT

How to Participate
- You will need to have a Twitter account set up to participate
- Join the chat be searching for the hashtag #KeystoneSepsis. Click on the hashtag to join the conversation. You should see a few tweets using that hashtag.
- Feel free to join the conversation as soon as you’re ready and share your message with the hashtag #KeystoneSepsis included. Let everyone know you’ve joined the chat and that you’re ready to participate.
Ex: “Hello everyone! I’m here and ready to talk about sepsis prevention and identification. #KeystoneSepsis”

Tips, Tricks and Important Information
- Please use #KeystoneSepsis in all Tweets when participating.
- If you ask a question or respond to someone in the chat, use the hashtag #KeystoneSepsis so everyone can be in on the conversation.
- Share tweets from the conversation with your network by re-tweeting or by commenting on posts in the chat.
- Use other relevant hashtags in your posts, including:
#Sepsis #SAM2019 #SepsisAwarenessMonth
- Let people know you’ll be participating in the Twitter chat in advance. This is a nice way to let your network know you may be a bit noisy during the chat time.

Medical Spanish Seminar Oct. 4-6

Fri, 13 Sep 2019 16:56:39 GMT

Rios and Associates is offering a three day seminar on Medical Spanish, October 4-6, 2019 in Stevens Point. You’ll learn how to take a history, perform a physical exam and discuss treatments and building a foundation that could be invaluable to you and your Spanish speaking patients. CME/CEU credits are available for all levels of providers. Learn More.

National Physician Suicide Awareness Day is September 17

Wed, 28 Aug 2019 14:17:21 GMT

At its core, National Physician Suicide Awareness Day remains a day for remembrance of colleagues and friends who have died by suicide and the pursuit of continued awareness and discussion on how to prevent it.

This year, September 17, 2019 marks the 2nd annual National Physician Suicide Awareness Day. The Council of Residency Directors in Emergency Medicine (CORD) is planning to highlight and share stories of hope and recovery.

Tips for making this day locally impactful:

Encourage your physicians to share a few words of reflection on physician suicide at team huddles
Host discussions (on-shift or in conference) with colleagues & trainees about burnout-depression-suicide
Provide information on access to mental health care

Use your voice to raise the issues related to physician suicide and well being through social media or webpage posts, participate in online social media discussions, and highlight how your organization is acting to prevent suicide. Consider purchasing pins or pens for yourself and or your team to not only support this initiative, but also the CORD Cares Foundation.

Learn more by visiting the National Physician Suicide Awareness (NPSA) webpage.

FACEP Deadline Extended to Sept. 1

Thu, 22 Aug 2019 16:05:30 GMT

More than 4,000 ACEP members meet minimum membership requirements – three years of continuous membership post-training – to become a Fellow of the College. Is that you? Apply today, and be recognized at a ceremony on Oct. 26, the day before ACEP19 in Denver. If you can’t make it to ACEP19, no worries. You will be included in the program and can start using your new FACEP credential immediately. Learn more here!

Congress Needs to Hear about Surprise Billing

Thu, 22 Aug 2019 16:02:34 GMT

The ACEP DC office hosted an ACEP members only Surprise Billing Advocacy townhall on August 5th. Laura Wooster, Associate Executive Director, ACEP Public Affairs, provided an update on Congressional activity and spoke about the importance of utilizing the August congressional recess while legislators are back home to advocate for emergency physicians and patients. ACEP offered tips to effectively engage your legislators and a toolkit with resources to facilitate effective outreach. A link to the archived townhall is available here.

Login here to access the ACEP members-only surprise billing advocacy toolkit. Related resources are available to view and share here.

For updates on ACEP’s federal advocacy activities, join the ACEP 911 Grassroots Network here.

Wisconsin's New FACEP

Tue, 20 Aug 2019 17:05:17 GMT

Wisconsin ACEP congratulates Amy Biondich, MD, FACEP of Rubicon, who has recently been awarded the distinct designation of Fellow of the American College of Emergency Physicians (FACEP). Wisconsin now has 209 members with FACEP status.

Doctor Biondich will be recognized for this accomplishment at an October 26 reception in Denver, just prior to the kickoff of ACEP19.

Emergency Physicians – Please Choose Wisely

Mon, 19 Aug 2019 21:21:08 GMT

WACEP President's Message
Jeff Pothof, MD, FACEP

I must admit, I'm one of those people who often thinks bigger is better. if a 60-watt light bulb is good, then the 100-watt bulb must be better. I'd be completely content with the three-piece fish fry, but the all you can eat is only $2 more and the batter is so thin and crispy. I won’t even get into what happened the last time I bought a truck, but I think you have a pretty good idea.

This type of thinking often follows us into the emergency department. More is better. It must be true. It makes me feel better, re-assured. It seems to make my patients feel better too. What could be the harm in a more is better approach to patient care?

When reports came out from the Institute of Medicine in 2000¹ and 2001² characterizing healthcare as unsafe and describing the strategy for improving the performance of our healthcare systems an era of measurement was born. We started measuring, with the assistance of the electronic health record, we measured everything.

We had data on nearly anything we did with accompanying graphs in full color, benchmarks, control charts, goals, and incentive plans to match. Therein was the problem, we measured what we did. We inadvertently and with the assistance of fear from our tort system and lack of consequence from our reimbursement models fueled physicians into practicing with a more is better philosophy.

Unfortunately for our patients more is not always better. More recently we have begun to look at the things we do in medicine that perhaps we should not have done. In 2012 the Choosing Wisely³ campaign was launched and challenged medical specialties to identify those things commonly done but were shown to have no meaningful benefit to patients. Instead of thinking about quality of care delivered defined by what providers did, they instead looked at quality of care defined by what providers didn’t do. Choosing Wisely is now in it’s seventh year. Many of you have no doubt heard about it and ACEP with help from emergency physicians like you and I have developed our own list of 10 things we shouldn’t be doing that we commonly still do. Please take a moment to look at the list.⁴

Were there any surprises? I think many of us at one time or another have done some of the things in that list. Even conceding that individual patient factors sometimes makes doing these things necessary there are still times where I know I’ve done some of the things on that list. Often time the act of doing is easier than the act of taking the time to adequately explain why we are not doing something. Sometimes just the idea of the conflict that awaits us as we attempt to do the right thing is enough to make us hit the sign button on an order.

Although not what I look forward to most on a shift, I think part of being a physician is having those difficult conversations where we hold ourselves accountable to doing the right thing, often with the patient and family understanding the decision making and appreciating the time it took to paint the picture for them, but sometimes having to place safe and quality care over patient preference and expectations. More so today than in the past I also worry about not only how my decisions to order something might affect the quality of care delivered, but what type of financial burden I may be putting on my patients and their families. It used to be more out of mind for me. Most of my patients had insurance and my perception was that cost wasn’t a big part of the equation. I don’t know about you but more and more of my patients either don’t have insurance or have insurance that really isn’t insurance with deductibles that are 10 times the amount of money they currently have in their savings account. This makes me even more vigilant about those things that I might do that likely have no meaningful benefit to my patients as the harm may not be in the small radiation exposure, but instead in having them miss their rent payment or fail to fill a prescription.

I encourage all of you to be intentional not only about those things that are important for you to do to ensure you are delivering safe and high-quality care to your patients, but also the things you do not do to ensure you are delivering safe and high-quality care. Both are equally important. Choose Wisely Wisconsin emergency physicians.

References:

Institute of Medicine. 2000. To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies Press
Committee on Quality Health Care in America, Institute of Medicine.Crossing The Quality Chasm: a New Health System for the 21st Century. Washington, D.C.: National Academy Press, 2001
Choosing Wisely: http://www.choosingwisely.org/
http://www.choosingwisely.org/wp-content/uploads/2015/02/ACEP-Choosing-Wisely-List.pdf

August 5 ACEP Townhall: Advocating on Surprise Billing in the August Recess

Tue, 30 Jul 2019 15:31:14 GMT

August is right around the corner and timing is right for ACEP members to advocate on behalf their profession and their patients in the ongoing surprise billing debate on Capitol Hill.

Register for our upcoming ACEP Advocacy Townhall to learn how you can effectively engage with your Senators and Representative while they are back home for the month and get answers in real time about the latest congressional activity from ACEP's Associate Executive Director of Public Affairs, Laura Wooster.

ACEP Townhall: Advocating on Surprise Billing in the August Recess
Monday, August 5, 2019; 12:00 pm CDT
Register Here

After registering, you will receive a confirmation email containing information about joining the webinar.

President's Message July 2019

Tue, 23 Jul 2019 17:53:08 GMT

Jeffrey Pothof, MD, FACEP

It’s the middle of summer and I’m sure many of you are busy both in the ED and outside of the ED. I wanted to take a moment to provide a concise update on a few of the things WACEP is working on as we move the agenda of emergency physicians forward in Wisconsin.

We have been watching the news out of Washington D.C. closely as it pertains to recent legislation moving through the Senate and House on out of network balanced billing. The Senate bill which was passed out of the HELP Committee is seen as less favorable than the current House version. Secondary to action from stakeholders like ACEP the House version contains provisions for independent dispute resolution (IDR) which is important. We still have work to do as the IDR provision will not apply to most emergency care, and we are working to advocate for better legislation like HR 3502, first introduced by emergency medicine physician Paul Ruiz. Please consider taking a moment to contact your Senators and Representatives as they need to hear from us to make an informed decision. It doesn’t take long:

Click here to send editable messages to your U.S. Senators and Representatives

Like many of you we were disappointed by Governor Evers' veto of the $24 million for medical assistance funding that had been in the original budget. To add insult to injury, recent rankings continue to show Wisconsin’s emergency physicians as dead last in Medicaid reimbursement. With that said we are encouraged that opportunities may exist within DHS to secure funding via an alternative route. The WACEP board will continue to work hard to ensure you receive fair compensation for the services you provide.

There has been recent discussion with WACEP and the Sheriff’s Association on whether there is a better process that might be considered around Chapter 51 commitments. I don’t need to remind any of you how challenging and consuming of time and resources these cases can be, and we will continue to work with stakeholders to optimize the mental health process for our members and patients.

One of the things that I’m really looking forward to is our rural outreach event being planned for September 6th in Richland Center. We have an exciting day planned with a hands-on ultrasound workshop, a visit from UW Med Flight and CHETA, and an update from Dr.Wheeler a stroke neurologist on recent updates to acute stroke care focusing on neuro-endovascular interventions and when you should be thinking about these treatment options. After these events, the WACEP board is planning to spend some time relaxing while enjoying some good food and company. We are really interested to hear from emergency medicine providers practicing all over the state no matter your background or journey into the specialty. All the details and registration can be found online. There is no cost to register so please consider attending and getting to know us. I’d really enjoy meeting some of you.

Enjoy summer!

ACEP eCME Course Receives MEB Approval for Opioid Prescribing Education

Wed, 17 Jul 2019 20:26:52 GMT

ACEP’s on demand course Alternative Methods to Pain Management (2018-2021) has been approved by the Wisconsin Medical Examining Board as meeting the requirements for two (2.0) hours of continuing education on responsible opioid prescribing per Med 13.03(3) of the Wisconsin Administrative Code.

Support H.R. 3502: Protecting People from Surprise Medical Bills

Mon, 15 Jul 2019 21:57:13 GMT

Please consider emailing and/or calling your legislators! ACEP has been working tirelessly to advocate for EM and patients in the surprise billing debate, and now we have a bill we can get behind in the House! Help us educate Congress that H.R. 3502 is the best solution to protect patients and ensure the long-term viability of your profession.

This is the only proposal that provides a level playing field for physicians and insurers, taking patients out of the middle of billing disputes while ensuring access to care. It is critical we immediately build momentum. Contact your representative to ask for support for H.R. 3502.

Wisconsin Poison Center Seeks Emergency Physicians' Input

Mon, 01 Jul 2019 20:54:23 GMT

The Wisconsin Poison Center (WPC) is gathering accreditation criteria for 2020 and seeking input from emergency physicians. Please respond to this seven-question survey designed to gauge satisfaction from those who utilize WPC services.

“If you see something, say something”

Wed, 19 Jun 2019 15:41:59 GMT

WACEP President's Message, June 2019
Jeffrey Pothof, MD, FACEP

“If you see something, say something” has become common vernacular in post 9/11 America. I suspect most of us think of air travel when we hear that phrase, but the phrase is equally applicable to healthcare and the environments we work in.

One of the most important aspects of safety culture in healthcare is the ability of anyone on our teams to say something when they know or suspect that something is amiss. This includes everyone on our teams. From providers to nurses to techs to volunteers and other supporting staff. The more people who are being sensitive to how things are supposed to work the more likely we are to identify a problem before it ruins our day, or even worse, harms our patient.

Although this idea may seem intuitive and all of us would nod in agree that we as providers expect the rest of the team to speak up if they think a patient may be harmed, I’ve seen repeatedly in my work within patient safety that someone saw or knew something but didn’t say anything. Many will be quick to blame the person who said nothing however the problem is rarely the person. We hear things like “no one acknowledged my concerns before, why would I make the effort to say something this time”, or “the provider put me in my place the last time I raised a concern that turned out to be nothing, so now I just stay quiet because they know what they are doing”.

One of my mentors once told me that as physicians we don’t get a choice as to whether we want to be leaders or not. The only choice we get is whether we are going to be good leaders or not. Many on our teams in the ED look to us for guidance and tone setting whether we want that responsibility or not. When it comes to saying something when you see something, I don’t think as providers it’s enough to raise our hand or speak up when we see something that isn’t right. I think our role is also to communicate directly and with intention to our teams that we expect everyone on our teams to say something when they see something, and then have to foresight to identify when that is occurring and show respect to them while reaffirming that speaking up was the right thing to do--irrespective of whether they were right or wrong. This is how we can change culture, and this is how we can keep patients safer.

June 17 ACEP Advocacy Townhall on Surprise Billing; Registration Required

Thu, 13 Jun 2019 21:25:37 GMT

Surprise billing is the most important issue facing emergency physicians today. Building on momentum from ACEP President Dr. Vidor Friedman’s testimony to Congress this week, ACEP is amplifying our efforts as we battle the insurance lobby and advocate for policy solutions that protect patients and support emergency physicians.

ACEP leadership is hosting an interactive townhall discussion on surprise billing — this is your chance to speak directly with ACEP leadership; stay current on the latest activity on Capitol Hill, get the latest news, hear about the recent flurry of Congressional activity and ACEP-supported policy, ask questions, and learn more about how you can act now and get involved.

Please join us Monday, June 17th at 4pm EST for an ACEP member-only Advocacy Townhall on Surprise Billing.

ACEP Advocacy Townhall: Surprise Billing
Monday June 17th at 4pm EST
Featuring: Vidor Friedman, MD, FACEP, President of ACEP, and;
Laura Wooster, MPH, Associate Executive Director, Public Affairs

Register here:
https://acep.zoom.us/webinar/register/WN_LXsbBBa2QjiIlXqThZWamA

Please register for townhall access whether you plan to watch live or view the townhall on-demand at your convenience.

Joint Finance Committee backs GOP Medicaid plan

Thu, 06 Jun 2019 16:32:02 GMT

June 5, Wisconsin Health News

The Joint Finance Committee approved a Republican plan Tuesday night that would provide around $200 million more in state money for Medicaid beyond its cost-to-continue over the next biennium.

Overall, the Republican proposal boosts state spending for health services by $588 million, which includes $356 million for the cost-to-continue for the Medicaid.

The proposal, which passed 11-4 along party lines, would provide $60 million more in state money for disproportionate share hospital payments, which head to providers that serve a high volume of Medicaid patients. It would also provide $4 million more in state money for payments that go to rural hospitals.

Other changes include $92 million more in state money for long-term care. That breaks down to $30 million for nursing homes, $36.9 million for personal care workers and $27 million for direct caregivers in Family Care. The motion also includes $24.7 million in additional state and federal money to expand reimbursement for physicians and behavioral health services.

Democrats criticized the plan because it didn’t take federal dollars to expand Medicaid. The money used for the motion comes at the cost of other parts of the state budget, said Rep. Evan Goyke, D-Milwaukee.

“This motion advances, by and large, the status quo with additional investment here, and additional investment there, pick a winner here, pick a loser there,” he said. “But it isn’t a plan to bring forward the entire state’s healthcare system.”

JFC Co-Chair Rep. John Nygren, R-Marinette, pushed back against claims that expansion would cover an additional 82,000 people as those covered through expansion can find subsidized health plans through the Affordable Care Act’s exchange.

He noted that around half of those who would be covered by expansion already have insurance.

“That’s the lie of the year that has been presented before us – the lie of the year,” he said. “This motion addresses the needs of the most vulnerable in our state.”

The GOP-backed motion makes greater investments than Evers’ budget in some areas, keeps in place other parts of his plan, pared back some of his proposals and axes other provisions.

It also includes several new items, including a $2.5 million Medicaid rate increase for physical health services providers and $1 million in grants for free and charitable clinics over the biennium.

New to the proposal are $500,000 in state money for a child psychiatry consultation program and $1 million over the biennium for programs that provide clinical supervised practice to those training to become social workers, counselors, psychologists or family and marriage therapists.

Lawmakers also opted to add $100,000 for a suicide prevention grant, $100,000 for an outreach campaign on vaccinations and $250,000 for respite care.

At a press conference before the committee took up the measure, Nygren said Republican lawmakers were tripling the investment Evers put toward nursing homes, as well as making greater investments in personal care and Family Care.

Other provisions stayed in place from Evers’ budget, including providing funding for a hub-and-spoke model of care that would provide a medical home health benefit for people with substance abuse disorders. Lawmakers modified the provision so the Department of Health Services would have to ask the committee to release state funding for the proposal.

Also adopted from the governor’s budget were plans to expand funding for intake, application and screening costs for the children’s long-term care services program, $6.9 million in state and federal funding for telehealth in Medicaid and a $250,000 a year increase for grants under the minority health program.

GOP lawmakers backed additional money for the Wisconsin Well Woman Program, which provides preventive health screenings. They set aside funds for money that would help public safety answering points comply with training requirements that dispatchers provide assistance on administering CPR. And they backed Evers’ call for DHS to reallocate five full-time positions to staff an infant mortality prevention program.

They also adopted Evers’ recommendation to eliminate the sunset date on Medicaid reimbursement for clinical consultations. And they backed $66,700 in state money to develop a plan for a mental health consultation program.

The motion opts to have the state cover a greater share of county crisis intervention share through a $13.4 million increase in state and federal money as Evers proposed. But the committee deleted a provision in his budget that would have provided $2.5 million in state money for regional crisis stability facilities.

GOP lawmakers also scaled back Evers’ proposed investments in dental care. They opted to provide $2.5 million in state and federal funding for dental services provided to patients with special needs, half of what was included in the governor’s budget.

They backed additional funding for dental health initiatives, including Seal-A-Smile, which provides preventative services in schools, but axed a plan to provide more money to support oral health program positions at DHS.

Gone from the proposal is Evers’ plan for $38.8 million for new dental access payments. The lawmakers left in place a program that increased Medicaid rates for pediatric and adult emergency dental services rates in Brown, Marathon, Polk and Racine Counties that Evers’ budget would have ended.

Also pared back were Evers’ plans to hire more dementia care specialists and his lead poisoning prevention initiative.

Provisions cut from Evers’ plan include his proposed funding for doula services, an extension of how long post-partum women can remain on Medicaid after giving birth and a proposed community health benefit to offer non-medical services to Medicaid members.

And lawmakers didn't include proposals for additional funding for tobacco control efforts and $500,000 over the biennium for healthy aging grants.

The adopted motion ends a proposed expansion of Birth to 3, a program offering early intervention services to children who are at risk of developmental delays. It instead directs the department to transfer, on a one-time basis, $2.3 million for the 2019-2020 fiscal year and keeps the budget level flat the following year.

Nygren ruled a Democratic motion that would have accepted federal funding to expand Medicaid “out of order” as the committee already voted to remove the provision from the budget.

WACEP Leaders Travel to DC to Advocate for Emergency Medicine

Thu, 16 May 2019 21:43:50 GMT

Lisa Maurer, MD
Immediate Past President

WACEP board members, Drs. Lisa Maurer, Bill Falco and Brad Burmeister [pictured here with U.S. Representative Bryan Steil (R-WI-01)] traveled to Washington DC for the annual Leadership and Advocacy Conference and the ACEP-coordinated visits with Wisconsin’s legislators.

The conference began with outstanding speakers and breakout sessions on leadership and how leadership might intersect with violence prevention, diversity in medicine, civic duties of physicians as community leaders, and practical tips on how to be an effective advocate for your patients and colleagues. Wisconsin emergency medicine will certainly benefit from lessons learned.

As the focus narrowed a bit at the conference to legislative advocacy, Drs Falco, Burmeister and Maurer met personally with staff and legislators from five different offices, including both Senate offices, and informed staff for many other offices from around Wisconsin. Although there are many issues related to emergency medicine that are important to our legislators, our conversations turned to current and pressing issues for them right now: surprise medical bills and improving care for our patients in psychiatric crises.

Related to increasing access to care for our patients with psychiatric disease, we spoke in support for recent bills both on the House and Senate that would supply states with grant funds to use as they see most helpful at the local level to bolster psychiatric care. Discussions around surprise bills were more complicated and detailed, making sure that lawmakers understand that it is important to emergency physicians that our patients are not faced with narrow networks and insurmountable bills as they access crucial emergency care. We were able to explain that for most cases of “surprise bills,” this is actually a description of high out of pocket costs from unrealistically high deductibles.

To that end, our legislators were very interested to hear about our suggested mechanisms for ensuring fair payments for emergency care without escalating costs of care, all the while leaving the patient out of the process. They now understand that while it’s paramount for protecting our patients’ access to care, it’s also very important for protecting emergency physicians as we continue to face challenges in negotiating contracts with insurance companies.

Overall, our team was comforted to see how well informed our legislators and staff are regarding issues that are important to us. The lawmakers actively asked for our follow up with them to make sure they keep our issues in the forefront of their minds. To this end, our board will be asking for help from our members who live and work in the various districts around our state, to make sure these legislators know about how these issues affect you and your patients specifically.

Hats Off to You, Emergency Physicians!

Wed, 15 May 2019 20:35:25 GMT

WACEP President's Message, May 2019
Jeffrey Pothof, MD, FACEP

We as emergency physicians have chosen a demanding career. Not only do we work days, nights, weekends and holidays, we also play witness to some of the best, and often the worst experiences people and families go through. Being the ever-present patient advocate can also be an exhausting activity, almost daily having to think outside the box to get patients what they need in a system and society that at times just seems broken. At the same time the ratio of value-added to non-value-added work seems to be going in the wrong direction. It’s no surprise that in a recent Medscape survey 48 percent of us reported burnout.

Lately there has been more attention to this issue. Many have been exploring the “why” and others have been offering suggestions on “what” to do about it. I’m no expert in wellness and I can’t really tell you how much you should exercise or how you’ll find the time to sleep a little more. Everyone is a bit different when it comes to connecting with other people and many of us have different ideas of how what we do is part of something bigger than any one of us. I sometimes struggle to use my electronic health record, so I don’t think I’d be the right one to show you how to use yours.

As I reflect on all the headlines, reports, and studies on wellness among physicians and especially emergency physicians, my first reaction is one of appreciation. Despite all the reasons you see, hear, and experience you still don your scrubs, throw on the white coat, and head in to the department. I just want to say THANK YOU to all of you for being such dedicated professionals and standup individuals. Hats off to you emergency physicians. Although it sometimes doesn’t feel like it amidst all the distractions, all of you are making a difference in the lives of others however big or small.

For those of you who may not be finding the meaning you need in a demanding career such as emergency medicine, I encourage you to take action. You are far to valuable to your patients but also to your family and friends. We need you. All of us at WACEP are here to support you and there are many resources available to find what works best for you. ACEP has a dedicated site and section that I encourage you to check out at https://www.acep.org/life-as-a-physician/wellness/.

Share your Attitude toward Initiating Suboxone in the ED

Wed, 08 May 2019 19:37:25 GMT

WACEP members are invited to collaborate on an AACT grant-funded project initiated by Colorado ACEP to examine providers attitudes toward treating opioid use disorder and initiating buprenorphine/naloxone treatment in the ED. Survey respondents will be entered in a drawing for a chance to win a $100 Amazon gift card.

On many shifts we see patients whose lives have been negatively impacted by the opioid crisis. Some have overdosed, some have abscesses, and others are requesting opioid pain medications in the ED yet again. We do a great job of treating their acute issue, knowing their addiction will make a repeat visit inevitable. These are the names we recognize as soon as we pick up the chart; the PDMP’s we’ve checked multiple times before. We’re hoping you can help us develop some options.

We are surveying ED providers to determine their experience with and attitudes toward initiating suboxone in the ED. Please head to https://is.gd/EDbupe to participate in our quick survey.

It’s completely voluntary and any ED provider can take this anonymous survey to see how they feel about ED buprenorphine (commonly called Suboxone) and what tools they need to improve care for patients with opioid use disorder.

COMIRB# 19-0088 PI: Matthew Zuckerman
Study Title: Attitudes to Emergency Department Medication Assisted Therapy
matthew.zuckerman@ucdenver.edu

Emergency Physicians Make Strong Showing at Doctor Day

Mon, 06 May 2019 22:41:24 GMT

Bradley Burmeister, MD

On May 1^st, over 20 Emergency physicians were among the more than 300 physicians from across Wisconsin to participate in Doctor Day in Madison.

The two main policy issues for this year focused on Medicaid reimbursement and the personal conviction waiver for immunizations.

As you know, Wisconsin continues to be at or near the bottom for Medicaid reimbursement. In fact, for most Emergency Department levels of service, Wisconsin is dead last for reimbursement often at rates far below overhead costs. Adequate and fair Medicaid reimbursement is important in order for patient to have access to both primary and specialty physicians.

In general, legislators provided feedback that they understand the Medicaid issue is regarding access. Many had a very strong understanding, and realize the issue is not just about the bottom line for physicians.

This year’s particular “ask” regarding Medicaid was focused on institutional versus non-institutional payments. The Governor’s budget includes Medicaid expansion and with expansion, over $300 million dollars would become available. The budget, however, allocates all of these funds as institutional payments to hospitals and health systems, and not toward physicians or other non-physician providers.

The second issue was around support of proposed legislation to end the personal conviction waiver for school-mandated vaccines. Wisconsin is one of only 18 states that continue to permit a personal conviction to waive the requirement to have vaccines for school-aged children. In many states, parents can seek a medical waiver or a religious waiver. But only a few states, including Wisconsin, allow parents to essentially check a box exempting their children from the vaccine requirement. Since 1997, Wisconsin has seen a significant increase in parents obtaining a vaccination waiver. While medical and religious waivers, which represent less than 1% of all waivers, have not increased over time, the personal conviction has seen a steady and dramatic increase and represents the vast majority of total waivers.

Legislation has been introduced that seeks to end the personal conviction exemption but continues to permit medical and religious waivers. As you know, the science is clear on immunizations, and we must maximize our “herd immunity” for the betterment of the whole community.

To summarize, Doctor Day 2019 was a tremendous success. To continue our advocacy efforts, several of us from WACEP leadership are now in Washington DC to participate in ACEP’s Leadership and Advocacy Conference. There, we will meet with legislators and staff from Wisconsin, and will engage in advocacy at the national level. Stay tuned for additional updates, and in the meantime, save the date for Doctor Day 2020, scheduled for January 29, 2020 in Madison. We hope to see you there!

May 23 SPOTS webinar on Opioid Prescribing in the ED

Thu, 02 May 2019 21:27:53 GMT

Prescribed pain medication after surgery and traumatic injury is among the most common first exposures to opioids. SPOTS offers an opportunity for collaborative learning with experts about best practices in opioid prescribing, and with other providers around the state about the current challenges and opportunities in treating our injured patients’ pain.

Between March and September, the program offers a monthly session hosted from the teleconference facilities at the University of Wisconsin. Each are hour-long session will start with a 15-20 minute didactic presentation from an expert in the field, followed by an open conversation between our expert presenters and the participants.

The May 23, 2019 session will begin at 4:00 pm and will feature Drs. Mike Repplinger and Benjamin Schnapp, who will present "Opioid prescribing for surgery and trauma in the Emergency Department." Register here.

Participants will receive Opioid CME credit, and may either attend live or view recorded sessions online. Note that if you prescribe controlled substances, Wisconsin’s Medical Examining Board requires that you earn two CME credits on responsible opioid prescribing between 1/1/2018-1/1/2020. Each session in the SPOTS series counts toward one hour.

SPOTS is a collaborative learning series presented by the South Central Wisconsin Healthcare Emergency Readiness Coalition (SCWIHERC), South Central Regional Trauma Advisory Council (SCRTAC), and the Surgical Collaborative of Wisconsin (SCW), through a generous grant from the Wisconsin Department of Health Services.

Wisconsin Reception at SAEM on May 15

Thu, 02 May 2019 17:43:24 GMT

Meet your Wisconsin Colleagues for a Reception during SAEM!

WACEP Members are invited to join the University of Wisconsin Department of Emergency Medicine for a sponsored event at SAEM's 2019 Annual Meeting in Las Vegas.

Wednesday, May 15 at 6:00 pm
The Loft at Cabo Wabo
3663 Las Vegas Blvd. South
Las Vegas, NV 89109

Please RSVP by Friday, May 10th .

President's Message, April 2019

Wed, 17 Apr 2019 18:39:09 GMT

Jeff Pothof, MD, FACEP
WACEP President

You know we all practice in a special place when you can run in shorts and a t-shirt and two days later be shoveling a few inches of snow. With the warmer weather comes an important annual event in the state.

Known as “Doctor Day” we all have an opportunity to don a white coat and engage in face to face conversation with those individuals whose decisions affect not only our practice, but the lives and wellness of our patients. This year is particularly impactful for us as emergency physicians as we have many issues important to our specialty that need legislative support.

For those of you who have participated in the past, thank you. If you’ve never attended a Doctor Day and can find some time to get away on May 1^st I’m certain it would be worth your effort. WACEP will be hosting a private policy primer update beforehand to prepare all of you on the key issues. The Doctor Day agenda itself promises to be high yield. We have Wisconsin’s governor Tony Evers slated to speak and the topics that will be front and center for the day include Medicaid access and the historically low reimbursement rates in Wisconsin, as well as the extremely hot topic of childhood vaccination and personal conviction exemptions. I’m nearly certain all of you have an opinion on that topic. The day wraps up with time for you and other providers to talk with legislatures, and finishes with a reception close by at Madison’s on King.

For more details and the link to register please visit https://www.widoctorday.org.

Appropriate Use Criteria

Wed, 17 Apr 2019 18:29:59 GMT

Lisa Maurer, MD
Immediate Past President, WACEP

As a part of replacing the Sustainable Growth Rate (SGR), CMS has deemed that we must start reviewing "appropriate use criteria" (AUC) before ordering any CT, MRI, PET, or nuclear medicine studies (does not apply to Xray, U/S). The American College of Radiology (ACR) has been approved as an eligible group to participate in defining what is and isn’t “appropriate.”

Starting in 2021, if an ordering physician does not demonstrate through an EHR Clinical Decision Support tool (CDS) that they have consulted the AUC for the study your ordering, CMS will not reimburse the professional or technical charges for the study.

To clarify, you have to review the AUC, but not necessarily adhere to them. Emergency physicians will find it to be important because CMS also gives radiologists the green light to refuse to do the studies for which appropriateness criteria were not reviewed. This system is already in place in the ambulatory care setting. It will be implemented in the emergency department in less than a year, on Jan 1 2020, but the first year is for "education and operations" and no claims will be denied. As patterns amongst insurers normally happen, we can certainly expect commercial insurers to follow suit soon thereafter. This follows a trend happening for having higher standards for "indications" for studies we order, as already evidenced by our dropdown boxes, etc when you order any image. How this will work in practice for testing from the ED is unclear.

These criteria do not apply for patients that have an Emergent Medical Condition as defined by EMTALA. However, this is a rather high bar that arguably some of our patients do not meet, and we all know the reputations of payors for determining if care was "emergent" based on final diagnosis rather than presenting symptoms.
The regulations released from CMS specifically name EDs as being a place of service where these AUC apply.

Given the above somewhat conflicting information, our hospitals will likely roll this out for all CTs, V/Qs, and MRIs that are ordered from the ED, not excluding patient care that we determine in the moment to be for someone having a true Emergent Medical Condition.

What will this actually look like in real practice? It would be reasonable to expect a more extensive clicking process as you enter the order rather than just choosing the indication in a drop down. In order to minimize impact on workflow, ideally it would just be a modified drop down to choose the most applicable (predetermined to be appropriate) criteria, with an additional option to demonstrate that you have reviewed the criteria and feel it appropriate to deviate from them. Hospitals will have to invest in CDS as an adjunct to the EHR, or the existing EHR will have to be updated to meet this need.

Reviewing a couple specific examples of “appropriateness” scores helps to clarify what a future rollout in our workflow may look like. Take a look at the table from ACR grading various studies looking for aortic dissection. Graded on evidence for utility and radiation exposure. Doing a PET scan, for example, would be considered "usually not appropriate" but MRA/CT/echo would all be considered "usually appropriate."

For a more common example, consider head CT imaging for head injury. ACR describes that a noncontrast head CT is “usually not appropriate” for patients with GCS of at least 13 that do not meet criteria for imaging based on New Orleans Criteria, Canadian CT Head Rules, or NEXUS II guidelines. However, if GCS is less than 13 or if imaging is indicated based on the above listed guidelines, then the head CT is “usually appropriate.”

What should you do now? Contact your hospital administrators to see how they are planning to meet this requirement:

Prevent this from creeping to other imaging study orders such as X-rays, ultrasounds, etc.
Make sure that whatever EHR adaptations are done are sensical and workable. ACEP recommends the CDS created by the ACR, called "ACR Select." We should not be expected to access an external web portal for our CDS, which also exist.
If the workflow is clunky, we need to have a process in place to bypass choosing criteria for studies that must be done immediately for critically ill patients.

References:
ACEP summary article from March 2017 (link)
ACR site for CDS (link)
Complete list of ACR appropriateness criteria organized by clinical topic (link)

2019 WMS House of Delegates Recap

Fri, 12 Apr 2019 14:28:50 GMT

Bradley Burmeister, MD, Emergency Medicine Delegate to WMS

The Wisconsin Medical Society House of Delegates met on Sunday, April 7, 2019. Several Emergency physicians participated in the annual policy-making function of the society. Three resolutions introduced and sponsored by WACEP were discussed and accepted as policy.

The first resolution, Assessing Medical Stability of Patients with Acute Mental Health Needs in the Emergency Department, seeks to form consensus principles on the utility of the Emergency department to provide medical clearance and hopefully expedite the process to make it more patient-centered.

The second resolution, Addressing Mental Health Treatment Barriers Created by the Medicaid IMD Exclusion, asks the Society to provide information on the exclusion to interested membership and support a Medicaid waiver demonstration application that seeks to receive federal financial participation for Institutions for Mental Diseases services provided to Medicaid beneficiaries. The IMD exclusion is a decades-old law that was intended to pass the cost of mental health treatment to the states. It prevents federal Medicaid dollars from be utilized for certain inpatient psychiatric care. This exclusion has contributed to the challenges of financing, and therefore placement of inpatient psychiatric care for the Medicaid population.

The final resolution seeks to revise the Wisconsin Psychiatric Bed Locator. This portal is meant to provide up-to-date information on psychiatric bed availability; however the information available is not always up-to-date or accurate, and the system has not been utilized by most emergency departments. This resolution brings together psychiatrist and emergency physicians to help improve effectiveness of the application.

Lastly, the WMS Board presented an informational report outlining a proposed revision of the organization’s Constitution and Bylaws, whereby the policy-making body of the Society would transfer from the House of Delegates model to the Board of Directors. It was reported that several other states have successfully transitioned to this governance model. The new process would seek input from members throughout the year, rather than once per year as is done under the current model, and would provide a significant cost-savings to the organization. The proposal will be discussed and potentially voted on at the 2020 House of Delegate meeting next April.

If you have any interest in collaborating on behalf of emergency physicians at the Wisconsin Medical Society or beyond, or if you’d like further information on the items of business discussed at this year’s House of Delegates, please feel free to contact me.

WACEP Delegation Chair Meets with Rep. Steil

Sun, 31 Mar 2019 17:25:45 GMT

On March 21, WACEP Delegation Chair, Dr. Bill Falco, met with Congressman Bryan Steil, who represents the 1st District of Wisconsin in the U.S. House of Representatives.

The meeting was coordinated as part of an aggressive push by ACEP for members of ACEP's 911 Network to meet with many of the nearly 100 new members who were sworn in to the 116th Congress on January 3rd.

During the meting, Dr. Falco had an opportunity to introduce Rep. Steil to ACEP and to share pertinent information on the specialty of emergency medicine and its role in the health care delivery system. Dr. Falco successfully established himself as a local contact in the health care space, as evident by the invitation he received to serve on Rep. Steil's healthcare advisory panel.

Visit the Hill! Attend LAC, May 5-8

Fri, 29 Mar 2019 15:33:54 GMT

With federal lawmakers actively working on legislation to address the surprise billing/out-of-network payment issue that is expected to move in the Senate by June, ACEP member advocacy at the 2019 Leadership and Advocacy Conference could be hugely consequential for the future of emergency medicine. Visits to the Hill to advocate on critical issues like this do make a difference.

Click here to see how advocacy from ACEP members at LAC last year directly led to big wins for ACEP and emergency medicine.

In addition to making these critical Hill visits, LAC attendees will hear from policymakers and experts about the latest developments on public policy issues that directly impact their practice. The conference will also include an afternoon dedicated to effective chapter leadership and a solutions forum highlighting innovative approaches to reduce boarding of psychiatric patients and successful uses of telemedicine. Two post conference events are also available: MAT Waiver Training and an Acute Pain Management Bootcamp.

To learn more and register to attend LAC, go to www.acep.org/lac.

Legislative Update, Spring 2019

Fri, 29 Mar 2019 12:52:07 GMT

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:

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.
“Provide” $365 million for payments to “institutions” (hospitals) providing care to MA patients (it is unclear how great an increase this represents overall).
Separately provides additional funding for increasing payments for Critical Access rural hospitals and “stand alone pediatric teaching hospitals”
“Increase” incentive payments for Dentists by $38.5 million.
“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).
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.
Creates an “Admissions Medical Education Unit” at Winnebago, adding supervisory staff for evening and overnight shifts.
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.

Medical Student Road Trip to Ohio!?!

Tue, 19 Mar 2019 16:38:24 GMT

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: www.ohacep.org/medicalstudents.

Wisconsin Medical Society, medical schools partner to host conference April 5-6

Tue, 05 Mar 2019 14:39:41 GMT

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.

US House Passes Bipartisan Background Checks Act of 2019

Fri, 01 Mar 2019 22:47:45 GMT

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.

Big Brother is Watching our ED Rate of Follow-up Care for Opioid Use Disorder

Wed, 27 Feb 2019 00:27:20 GMT

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:

We can order fewer opioids in the ED (i.e. ALTO programs)
We can prescribe fewer opioids (i.e. WACEP’s opioid prescribing guidelines)
We can embrace harm reduction techniques (i.e. over-the-counter nalaoxone, needle exchanges, etc.)
We can get patients access to Medication-assisted treatment or MAT (i.e. buprenorphine, methadone, or vivitrol)

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.

MOC Made Easy

Fri, 22 Feb 2019 22:19:12 GMT

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.

Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline

Fri, 22 Feb 2019 22:16:46 GMT

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.

Bedside Tools

Fri, 22 Feb 2019 22:12:00 GMT

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

What Matters to You? vs. What's the Matter?

Mon, 18 Feb 2019 14:37:58 GMT

Jeffrey Pothof, MD, FACEP
President

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.

Buprenorphine Training Opportunities

Fri, 15 Feb 2019 15:46:34 GMT

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.

DHS Announces State EMS Meeting Schedule for 2019

Fri, 08 Feb 2019 15:35:34 GMT

Beginning in 2019, the Wisconsin EMS Board has adopted a quarterly meeting schedule. State EMS meetings are open meetings and WACEP members are welcome to attend as members of the general public and/or at the Physician Advisory Committee.

Dr. Aurora Lybeck, WACEP Board member, regularly attends the meetings and encourages additional WACEP participation. Dr. Riccardo Colella, current Wisconsin State Medical Director, and Dr. Steven Zils, chair of the EMS Physician Advisory Committee, are both WACEP members.

The EMS Board and Committees will meet in 2019 as follows:

March 5/6
June 4/5
September 3/4
December 3/4

The committees of the Board will meet on the first day (Tuesday) and the full Board will meet on the second day (Wednesday). Links to the Agendas and meeting minutes will be posted when available.

Buprenorphine in the ED: Busting the Myths

Fri, 08 Feb 2019 15:18:26 GMT

Julie Doniere, MD
WACEP Board of Directors

I know… another article about opiates. Bear with me, I am writing this because I am anxious to start some conversations about treatment of opiate abuse. Specifically, I am eager to hear about what is happening in the ED’s across Wisconsin.

In my practice, I feel like the biggest challenge is finding treatment for those patients that are seeking help with their opiate abuse. Current practice is often symptomatic treatment, a referral list, and a “good luck!” We see people at their most vulnerable. We are either taking care of them after overdose, identifying their abuse disorder by looking at old charts, or being there when they realize they have a problem and present themselves to the ED.

There are some caveats to opiate treatment. Opioid addiction does not respond to the same treatments as alcoholism. Abstinence therapies do not typically work. These patients have a desperate need to avoid withdrawal.

This is where buprenorphine can be helpful. While incorporating bup into my treatment in the ED, I have encountered multiple misconceptions about the drug:

Myth #1: You can’t administer Buprenorphine in the ED without an X-Waiver.
BUSTED: Any ED physician or midlevel provider can use buprenorphine in the ED to treat opiate withdrawal. The patient can return to the ED for 3 days In a row to get buprenorphine.

Myth #2: Buprenorphine is a scary drug and will throw my patient into withdrawal.
BUSTED: Well, kind of busted. Buprenorphine will cause withdrawal symptoms. It should be given only to that subset of patients who are already in withdrawal; the COWS scale can measure this, I use MDcalc. When a patient has a COWS scale of 8 or greater, buprenorphine can be given.

Myth #3: Every opiate addicted patient in the county will be inundating my ED for buprenorphine.
BUSTED: ED’s that have initiated buprenorphine have seen a decline on drug seeking behavior.

Myth #4: We are trading one addiction for another.
BUSTED: The goal of medical assisted treatment is to trade addiction for dependency. Abstinence from opiates is the goal. While buprenorphine is an opiate agonist, it works primarily to control withdrawal symptoms so that individuals have more control over their cravings and avoid the risky use of opiates.

By no means is this article meant as a fully informative review of buprenorphine in the ED. I am not smart enough for that! If you are interested in a deeper dive into the role of buprenorphine in the ED, please view one of these two webinars:

Developing an ED Initiated Buprenorphine Program (View)
Buprenorphine 101 - Demystifying Medication Assisted Treatment in Wisconsin (View)

The following information about ED dosing concepts is thanks to Dr. Donald Stader, an ED doc in Colorado:

Inside Marshfield Medical Center Eau Claire's Emergency Department

Mon, 21 Jan 2019 16:42:08 GMT

In a news feature aired last summer on WEAU Channel 13 in Eau Claire, new WACEP Board member Nate Blankenheim, MD was interviewed in an exclusive look inside the new Marshfield Medical Center Eau Claire Emergency Department. Doctor Blankenheim talked with the reporter about the new facility and tried to teach him how to put on a cast. Watch video.

Medical Examining Board Modifies Opioid Prescribing Guidelines

Fri, 18 Jan 2019 14:09:31 GMT

January 17, WMS Medigram

The State of Wisconsin Medical Examining Board modified the Opioid Prescribing Guideline at its monthly meeting in Madison on Wednesday. Expressing a desire to be less proscriptive in the “Discontinuing Opioid Therapy” section of the guideline, the Board has removed specific clinical suggestions for situations when opioid therapy leads to evidence of addiction risk or is proving ineffective.

The section’s first two subsections have been shortened, while the third section remains the same:

Discontinuing Opioid Therapy
a. If lack of efficacy of opioid therapy is determined, safe discontinuation of opioid therapy should be performed.
b. If evidence of increased risk develops, safe discontinuation of opioid therapy should be considered.
c. If evidence emerges that indicates that the opioids put a patient at the risk of imminent danger (overdose, addiction, etc.), or that they are being diverted, opioids should be immediately discontinued and the patient should be treated for withdrawal, if needed. Exceptions to abrupt opioid discontinuation include patients with unstable angina and pregnant patients. These patients should be weaned from the opioid medications in a gradual manner with close follow-up.

The Board also added a new general provision near the top of the overall guideline:

2. It is best practice for a practitioner to consider guidelines within their specialty when prescribing opioids.

The remaining guideline provisions were renumbered to reflect this addition. The new guideline became effective upon Wednesday’s vote approving the changes.

In other action, the MEB elected its leaders for 2019. They are the same as in 2018, with Ken Simons, MD, reelected chair, Tim Westlake, MD, as vice chair and Mary Jo Capodice, DO, as secretary.

President's Message, January 2019

Wed, 16 Jan 2019 18:47:58 GMT

Jeffrey Pothof, MD, FACEP
WACEP President

Dear WACEP members,

Thank you for everything you do day in and day out to ensure our communities, our families, and our patients in Wisconsin and beyond have access to great emergency care. I’m humbled to be your president and commit to working hard to ensure you are supported in your professional practice and that we, collectively, advocate for high quality emergency medical care.

I wanted to take a moment to introduce myself to all of you. My hope is that during the next year I’ll be able to meet many of you in person through our mutual involvement in the things that matter most to us as emergency physicians. I grew up in Randolph, a small town in rural Wisconsin. I attended Edgewood College and subsequently the UW School of Medicine and Public Health for my doctorate degree. I completed residency at the University of Michigan. While in Ann Arbor I finished a medical education scholars program in healthcare administration and served as chief resident during my fourth year of residency.

I came back to Madison after residency as faculty at the University of Wisconsin. I had developed a strong passion in health system operations as well as patient safety and quality while in residency that spilled over into my early professional career. I held various leadership roles over the last decade including Service Chief of Emergency Medicine for the William S. Middleton VA Hospital, Clinical Service Chief for the UW Division of Emergency Medicine, Vice Chair of Quality and Operation for the UW Department of Emergency Medicine, and most recently a health system role now serving as Chief Quality Officer for UW Health. I continue to work shifts both at our University Hospital emergency department and at the smaller emergency department at our American Center campus. I’ve been a flight physician with UW Med Flight for the last 8 years and still enjoy it as much today as I did back then.

My interest in organized medicine began early in my career. I joined ACEP’s Quality Improvement and Patient Safety Section in 2012. I served the section in many roles culminating as chair of the section in 2015. I was also a member of the Quality and Performance Committee from 2013-2017. More recently my interests have shifted from the national level to the local level. In 2016 I began serving as a board member for WACEP and have enjoyed working on issues that impact the physicians and patients in my own back yard and being able to represent our interests at the annual ACEP council meeting.

I want to encourage all of you no matter what your background to attend our Spring Symposium. Registration is currently open and can be found here. There has been tremendous effort expended by our team to provide a very valuable experience for those in attendance. I really think all of us no matter our practice environment will take something away from this year’s conference.

I’ll have more updates as we move through the year, but WACEP has its hands in many pots. We are committed to being good partners in the fight against the opioid crisis. We are devoted to improving both the patient and provider experience when it comes to navigating our mental health system. We are eager to develop initiatives to assist providers in finding meaning in their work, and we continue to advocate for fair Medicaid reimbursement for the care you deliver. My hope for this year is that we become closer as physicians who provide emergency care without any additional qualifiers. Whether in democratic groups, national group practices, small rural practices, or large academic practices there is more that holds us together than pulls us apart.

I’m excited to embark on this journey with you and look forward to WACEP’s accomplishments in 2019.

Sincerely,

Jeff

A Shift in Focus: Perspectives of an Early Career Emergency Physician

Wed, 16 Jan 2019 18:33:27 GMT

Jamie Schneider, MD
EM3, MCW Emergency Medicine Residency
WACEP Alternate Delegate to WMS and ACEP

As the end of residency nears I have noticed a subtle shift in my education. Until recently, I had been focused on how to treat patients; medical school taught me disease and diagnosis and the broad strokes, and the first years of residency honed my treatment of crashing patients and worried well.

It’s only in the last year that I’ve really started learning what it means to be a physician in the real world. This includes billing workshops, applying for jobs, reviewing contracts, and engaging in philosophical discussions on management of our profession.

To this end, I had the awesome opportunity to join the WACEP delegation at the ACEP 2018 Annual Meeting last fall as an alternate delegate. Where the ACEP Scientific Assembly adds to our education and tools for treating patients, the Annual Meeting gives us a venue to shape the practice and profession of Emergency Medicine.

ACEP, as with seemingly every other organization in America, spent much of its time at the Annual Meeting on opioids. Just as interesting, however, was the vast amount of discussion about what Emergency Medicine is, and how we as a profession should manage and advance it. We heard keynotes on how to tackle the lack of trained EPs in rural areas, bylaws amendments on who should be a part of ACEP, and resolutions on topics from protecting physicians’ mental and physical health to ensuring fair and appropriate remuneration to appropriately training future EPs.

As a physician early in my career, these debates were valuable in shaping my understanding and views, and for our more experienced members gave a forum for sharing their wisdom. It can be argued that Emergency Medicine attracts one of the most diverse groups of practitioners, caring for the most diverse group of patients in the most diverse environments in all of medicine. There is clearly no “one best way” forward for our profession, but forums like the ACEP Annual Meeting are invaluable for allowing us to find common ground.

With that in mind, I am looking forward to the Wisconsin Medical Society’s Annual Meeting coming up on April 7. Representatives from each Wisconsin specialty society (including WACEP) and from all geographic districts of the state will gather in Madison to discuss topics relevant to the entire house of medicine of Wisconsin. Resolutions this year will include at least two that are sponsored by WACEP. If you don’t happen to be sleeping off a Saturday overnight shift, consider joining us for what is sure to be interesting and enlightening discussion.

Midwest Medical Student Symposium & Residency Fair

Wed, 16 Jan 2019 16:49:30 GMT

ATTENTION MEDICAL STUDENTS! If you're considering Emergency Medicine for residency the April 13th Midwest Medical Student Emergency Medicine Symposium is for you!

We know the residency match process can be overwhelming. That's why Wisconsin-ACEP is teaming up with the MCW and UW Emergency Medicine Residency Programs to co-sponsor the event alongside Ohio and Michigan Chapters of ACEP, EMRA, and some of the top residency programs from around the country.

This event will show medical students the ropes on choosing the right residency, rocking your interview, and standing out from the competition! Don't miss out on this one-of-a-kind event with a dynamic agenda designed to maximize your participation.

Midwest Med Student Symposium & Residency Fair

April 13, 2019
Hilton Garden Inn Toledo/Perrysburg, Ohio

Learn more and register online. Registering by phone? Call Monday-Friday, 1-888-642-2374 between 7am and 4pm CST.

MAT in the ED

Tue, 15 Jan 2019 19:36:56 GMT

A recent article in the USA Today quoted WACEP leader Bobby Redwood, MD, MPH, FACEP, and highlighted over a year of work being done by Wisconsin ACEP, the Wisconsin Hospital Association, and other organizations in regards to initiating Medication Assisted Treatment (Buprenorphine), in the Emergency Department.

Redwood points out a few of the efforts to date: 1) WACEP surveyed the EM workforce in Wisconsin on MAT; 2) WACEP developed an infographic on MAT & the ED; 3) WACEP and other organizations scheduled and promoted X-waiver training opportunities in Wisconsin; and 4) WHA developed a webinar to encourage MAT cooperation between primary care and emergency physicians.

WACEP's next steps are to work with key stakeholders to secure funding and develop regional streamlined care processes to make sure patients get the coordinated care they need.

"While WACEP will continue its efforts in 2019," says Redwood, "I am really hopeful that we will start to stem the tide of morbidity and mortality from opioid overdoses in Wisconsin. Thanks to all who contributed to this important work."

2019 Webinar Series on Physician Resilience

Fri, 11 Jan 2019 19:36:36 GMT

A monthly webinar series, Health Care Workforce Resilience, jointly sponsored by the Wisconsin Medical Society and the Wisconsin Hospital Association, is offered the second Tuesday of each month throughout 2019.

Each month will focus on a unique topic. Participants will receive one hour of continuing education credit, as well as practical and easy-to-implement tools for dealing with burnout in health care.

Resources and the recording of the January webinar, Prevalence & Severity of Burnout: Workforce Resilience as Care Quality, are available online.

The next monthly webinar, Enhancing Resilience: The Science and Practice of Gratitude, will occur on February 12 and will demonstrate a simple, enjoyable and effective tool for improving well-being by cultivating gratitude. Learn more and register.

Legislative Update, January 2019

Fri, 11 Jan 2019 19:03:40 GMT

Eric Jensen, Jensen Government Relations, LLC

After what feels like a never-ending election cycle, the 2019-20 Session of the Wisconsin Legislature is finally under way. Dominating early news following the election:

Governor Tony Evers’ victory in November changes the partisan political dynamic in Madison for the first time in nearly a decade. While Republicans maintained wide majorities in both the Assembly and Senate, they do not have sufficiently large majorities to override gubernatorial vetoes on their own, meaning as a general rule legislation will need bipartisan support to ensure passage.

The “Lame Duck” (post-election) Legislative Session in December set a contentious early tone to the 2019-20 Session. However, as Inauguration Day approached, and in speeches given on Inauguration Day, Senate Majority Leader Scott Fitzgerald, Assembly Speaker Robin Vos and Governor Evers all spoke to a desire for cooperation, bipartisanship and civility.

The coming Budget Debate. Prior to his inauguration, Governor Evers announced a variety of items he intends to include in his 2019-21 Budget Proposal (generally announced in Mid-February). Of particular interest, the Governor made clear he intends to include a Medicaid Expansion proposal based on the original Affordable Care Act’s MA Expansion program. While Republicans have historically and openly opposed MA Expansion, Senator Fitzgerald has signaled that the Senate will remain open-minded heading into the Budget process.

Typically, the Governor introduces the Budget in mid-February in a speech to a Joint Legislative Session. Once introduced, the Budget Bill moves on to the Joint Finance Committee (currently made up of 8 Assembly Representatives – 6 GOP and 2 DEM, and 8 Senators – 6 GOP and 2 DEM). JFC’s work on the Budget includes informational hearings, a period of research and analysis by the non-partisan Legislative Fiscal Bureau, a period of hearings during which the Budget is debated and voted on piece-by-piece, and finally passage of a recommended Budget Bill that moves on to the full Legislature. While the Wisconsin Constitution requires the Budget to be signed by July 1, if that does not happen the State government does not shut down, rather all agencies continue operating at the prior Budget’s funding and programming levels.

This year, it is widely anticipated that rather than working from Governor Evers’ Budget proposal, the GOP-led Legislature will write their own version starting from scratch. But because the Wisconsin Governor has the power of the line-item veto when it comes to the Biennial Budget, the final product will be one of negotiation – but we may be waiting well into the Fall of 2019 before a final Budget deal is reached.

National ACEP Now Accepting Nominations for Board of Directors

Fri, 11 Jan 2019 14:30:17 GMT

The ACEP Nominating Committee is accepting individual and component body recommendations for Board of Directors, Council speaker, and Council vice speaker candidates.

A true measure of a leader is knowing when it is time to accept the challenge of leadership. One must carefully consider their education, life experiences, and potential to determine when they are ready to lead. If you know you are ready to lead, don't wait for a phone call to determine your interest in seeking nomination! Take the initiative to contact your component body president or section chair to express your interest in nomination, and ask that a letter of support be submitted on your behalf.

To qualify for a Board position or Council office, a candidate must:
be highly motivated to serve ACEP and be committed for three years for a Board position;

be an ACEP member in good standing with no delinquent dues;
be an ACEP member for at least five years;
show evidence of ACEP involvement in both national and chapter activities (such as current or past chapter officer, current or past national committee leadership, current or past service as a councillor or alternate councillor, or current or past section leadership);
show chapter and/or section support for candidacy.

Criteria for nomination to Council office include:

nominees must be active members of the Council (presently or recently);
nominees must be active nationally (presently or recently); and
there will be no exclusions because of past service.

Nominations must be received by March 1, 2019 and may be emailed to John G. McManus, Jr.. MD, MBA, FACEP and copied to Sonja Montgomery.

Elections for the Board of Directors will occur on Saturday, October 26, 2019, during the Council meeting in Denver, CO. Please contact Sonja Montgomery at 800-798-1822, ext. 3202 with questions about the nomination process.

Top Five Chief Complaints and what WACEP is Doing About Them

Mon, 17 Dec 2018 22:39:21 GMT

Lisa Maurer, MD
WACEP President's Message, December 2018

In keeping with essentially every organization providing a year-end countdown list, I would love to finish my last president’s message with a "Top-5 Chief Complaints" list and describe what WACEP is doing as an organization to improve each one of them for our physician members. Think of me as Casey Kasem reading off the chief complaints as they populate into your tracking board.

#5. “Spider monkeys have moved into my living room.” Yes, you guessed it, there are no spider monkeys. Not to make light of the frequent psychiatric crises that we stabilize. Frustrating part,? It takes us so long to connect these patients in crisis to the definitive and specialized care they need and deserve. WACEP has worked all year long with the Wisconsin Psychiatric Association to work towards a streamlined process of medical stabilization. A white paper reflecting best practices for our state will be released soon, and this task force between our two organizations will keep chipping away at the small problems that build up an amount to major delays. In the meantime, check out the SMART protocol, which included in this group’s conclusions for best practices.

#4. “I took my blood pressure at Walgreens and it was high.” Ahhhhhh, asymptomatic hypertension. Are you taking your medications? No. Why don't you have medications? I don't have a doctor. Why don't you have a doctor? I have Medicaid can't find anyone to take my insurance. Yes in the state of Wisconsin, our Medicaid program covers a notably large population without even doing the official “expansion” of the ACA. However, the financial burden then rests on the physicians backs with record low reimbursement rates, drowning any practice that sees a significant amount of Medicaid enrollees. When primary care doctors can limit these patients in their panel, they come for emergency departments further exacerbating the unfunded mandate of EMTALA. WACEP has worked with legislative and regulatory state leaders to make sure they understand the logistics of our situation, and keep this as a high priority in mind as we move toward the next state budget. We have come farther than ever before in making our case heard, and are confident that we will be moving forward with progress. Please help us to continue to support friends of emergency medicine in Wisconsin through supporting our political action committee.

#3. Wait - stop seeing patients. This chief complaint is from your hospital president, who wants you to field a patient complaint. Good thing WACEP has continued to develop our annual Spring Symposium, scheduled for April 3-4 at the Harley-Davidson Museum in Milwaukee. This year we are featuring a new leadership development content, targeting all of you emergency department leaders who manage staff, colleagues, patients, (hospital administrators, police officers….) everyday. Come check this out as well as information on ED-initiated Medication-Assisted Treatment for substance abuse disorders, alternatives to opioids hands-on work sessions, presentations by the immediate-past president of ACEP, ultrasound workshop for emergency physicians, and definitely check out the reception the evening of April 3rd. Invite your physician and non-physician colleagues to join us!

#2. “N/V/D.” Stomach flu going around? Guess again. This “flu” also comes with goosebumps, severe diffuse pain, and a patient who really just wants you to help them transition into medication-assisted treatment for opioid abuse rather than prescribe 12 more Oxycodone to get them by till their next ER visit two days from now. Patients who are started on buprenorphine from the emergency department for their active withdrawal from opioids have a much better chance of staying clean in the long run. But how can emergency physicians play this important role when we do not have clear outpatient ongoing treatment resources for our patients, and need to partake in additional training to have the necessary DEA waiver. The good news is WACEP will be working to gather and disseminate information around the state for what the medication assisted treatment resources are in your community. What's more, look for our partnership and promotion of the Wisconsin Society of Addiction Medicine's series of X-waiver training courses traveling around the state in the next year.

#1. Woohoo! Rough shift. This chief complaint is from you. Come to think of it, they've all been rough recently. And it's hard to schlep to each of my six shifts in a row when I'm not sleeping in between my 12s, I haven't seen fresh produce for weeks, and let's just say exercise is not how I get my release on my days off. It's hard to prioritize our own mental health when we see patients in crisis every day, and the crutches to deal with this stress can lead to the slippery slope of substance abuse among our colleagues. WACEP has declared it a priority to decrease the stigma of substance abuse disorders and mental illness and work together to find ways to increase access to treatment for both. More to come on this important project in 2019.

A huge THANK YOU to the WACEP Board members and staff for all of your work to make progress on these and many other important programs that our chapter works on. Happy Holidays!

Alternatives to Opioids Have Arrived in Wisconsin

Fri, 14 Dec 2018 20:49:08 GMT

Bobby Redwood, MD, MPH, FACEP

The WACEP opioid task force has been very active in 2018, working with key stakeholders across Wisconsin to explore and develop opportunities to stem the tide of opioid-related morbidity and mortality in our state. One key initiative has been the development of the WACEP Alternatives to Opioids (ALTO) Pathways. The WACEP ALTO Pathways provide a roadmap for emergency physicians to treat a variety of acute pain syndromes using a multi-modal, receptor-based approach to analgesia. Using the ALTO approach, opioids are reserved as a rescue therapy with a goal of exposing fewer ED patients to this dangerous and addictive class of medications.

A State in Crisis

The opioid epidemic in Wisconsin is unprecedented in scale and scope. 20,590 Wisconsinites suffered from opioid use disorder in 2016 (triple the rate observed in 2005). 1,074 Wisconsinites died from an opioid overdose in 2016 (double the rate observed in 2005). Wisconsin led the nation in in ED opioid overdose visits between 2016-2017 with an increase of 109%. Nationwide, 42,249 Americans died of an opioid overdose in 2016 and the death rate from all opioids (including heroin) now exceeds the death rate from motor vehicle accidents. One of every 550 patients started on opioid therapy died of opioid-related causes a median of 2.6 years after the first opioid administration.

Your Last Blue Patient?

Do you work nights or weekends? If so, you have probably treated a patient presenting with an opioid overdose in the last month…or week…or day. I am writing this newsletter after my third night shift at a community emergency department and I have treated a patient with a life-threatening opioid overdose each of the past three shifts. All three survived, but one young woman suffered an anoxic brain injury and will spend the rest of her life in a long-term care facility. We cannot save all of our patients, but we can certainly take steps to prevent the next opioid overdose or at least ensure that Wisconsin emergency physicians are not exacerbating the epidemic.

A Plan to Save Lives and Curb an Epidemic

The ED is actually a minor source of opioid prescriptions (4% of all opioid prescriptions originate from the ED); however, initial exposure to opioids is common in the ED setting since patients routinely present in acute pain. In an effort to do our part, proactive emergency physicians have developed a four-fold strategy to address the opioid epidemic from the ED: (1) Reduce the amount of opioids used in the ED, (2) Reduce the amount of opioids prescribed from the ED, (3) Offer patients harm reduction interventions from the ED if appropriate (i.e. naloxone prescriptions), (4) Treat addicted/withdrawing patients and refer them to treatment.

A Duty to the Individual Patient

The WACEP ALTO pathways address the need to reduce opioid use and prescriptions in the ED, while respecting the need to provide analgesia to patients in acute pain. ALTO interventions are not one-size-fits-all and should always be administered with the individual patient’s risk profile in mind (age, allergies, weight, etc.)

Balancing Evidence-based Practice with the Urgency of this Historical Moment

ALTO interventions are based on the evidence that is available, but have not been as rigorously investigated to the extent that we, as emergency physicians, are accustomed to in our usual practice. At WACEP, we recognize the importance of this moment in history and have made a conscious decision to prioritize opioid harm reduction over the potential harm of using alternative therapies that (in some cases) have only a low level of evidence to support their efficacy. That being said, most of the ALTO interventions will be recognizable to seasoned physicians as common off-label practice (migraine cocktail, etc). WACEP members can expect multiple iterations of these pathways, updated as the evidence evolves.

Becoming an ALTO Physician Champion

Want to get involved? WACEP is here to help! As an individual physician, you can download the protocols, post them prominently in your physician-workspace, and start using the pathways (as long as there is not conflict with your established hospital protocols). Or better yet, why not change the culture of your entire ED and join the Midwest ALTO Project? The Midwest ALTO project will provide your hospital with a comprehensive ALTO toolkit that includes sample protocols, order sets, public realtions materials, and data abstraction tools to ensure that your ED’s ALTO care transformation has a successful launch. It is led by emergency physicians, nurses, and pharmacists, and coordinated through the Wisconsin Hospital Association. To join, have your quality department contact Shruthi Murali.

Statewide EMS Protocols, An Update from NAEMSP-WI

Fri, 14 Dec 2018 20:18:35 GMT

Suzanne Martens, MD, FACEP, FAEMS, EMT
President, NAEMSP-WI Chapter
Immediate Past WI State EMS/Trauma Medical Director

There have been many questions generated over the discussion that Wisconsin EMS is headed towards universal statewide protocols. This is a 180 degree turn in the historical decentralized, or “home rule” philosophy for Wisconsin. However, I ask you to join me in anticipating a positive change.

The resource document for the developing protocols, or perhaps more correctly termed patient care guidelines, is an excellent evidence-based project supported by the National Association of State EMS Officials (NASEMSO). If you have never visited their website, please do… the site is home for other EMS projects including the Compass Project, the Fatigue in EMS project, and Naloxone Evidence-Based Guidelines.

Excerpts from the NASEMSO/Projects page:

The National Model EMS Clinical Guidelines Project was first initiated by NASEMSO in 2012 and has produced two versions of model clinical guidelines for EMS – the first in 2014 and the most recent version in late 2017.

The model guidelines project has been led by the NASEMSO Medical Directors Council in collaboration with eight national EMS physician organizations, including: American College of Emergency Physicians (ACEP), National Association of EMS Physicians (NAEMSP), American College of Osteopathic Emergency Physicians (ACOEP), American Academy of Emergency Medicine (AAEM), American Academy of Pediatrics, Committee on Pediatric Emergency Medicine (AAP-COPEM), American College of Surgeons, Committee on Trauma (ACS-COT) and Air Medical Physician Association (AMPA). Co-Principal Investigators, Dr. Carol Cunningham and Dr. Richard Kamin, directed the 2017 project as well as the original 2014 endeavor. Countless hours of review and edits were contributed by subject matter experts and EMS stakeholders who responded with comments and recommendations during two public comment periods. Drs. Cunningham and Kamin presented this project at the NAEMSP Annual Conference in January 2018.

Excerpts from the Guidelines -Introduction/Purpose & Notes:

NASEMSO recognizes the need for national EMS clinical guidelines to help state EMS systems ensure a more standardized approach to the current practice of patient care and, as experience dictates, adoption of future practices. Model EMS clinical guidelines promote uniformity in prehospital care which, in turn, promotes more consistent practice as EMS providers move across healthcare systems. They also provide a standard to EMS medical directors upon which to base practice.

The focus of these guidelines is solely patient-centric. As such, they are designed to provide a resource to clinical practice and to maximize patient care, safety, and outcomes regardless of the existing resources and capabilities within an EMS system. They are a set of clinical guidelines that can be used as is or adapted for use on a state, regional or local level to enhance patient care and benchmark performance of EMS practice.

The long-term goal is to develop a full range of evidence-based pre-hospital care clinical guidelines. However, until there is a sufficient body of evidence to fully support this goal, there is a need for this interim expert, consensus-based step.

The National Model EMS Clinical Guidelines can fill a significant gap in uniform clinical guidance for EMS patient care, while also providing input to the evidence-based guideline (EBG) development process.

Successful development into State EMS guidelines and protocols include these examples:

Ohio (link)
Connecticut (link)
New Hampshire (link)
Maine (link)
Rhode Island (link)

It is anticipated that the Wisconsin version of these patient care guidelines will become available in part during 2019, with development, roll out, implementation and editing to phase in over subsequent years. There will be consideration for Wisconsin scope of practice and medication formulary choices. It is recognized that not all sections will apply to all agencies. The EMS Physicians Advisory Committee and Dr. Colella, as the State EMS Medical Director, will have primary input.

These meetings, as well as the State EMS Board sessions, are open to the public and have remote access links for anyone who wishes to keep up with the debate, decisions and developments. Meeting information and member contact information are listed online.

Please join me in supporting this project!

Registration is Open for WACEP 2019 Spring Symposium

Fri, 14 Dec 2018 19:24:34 GMT

"Emergency Medicine: Where the Rubber Meets the Road" is the theme for Wisconsin ACEP's 2019 Spring Symposium & Annual Emergency Medicine Research Forum, scheduled to take place April 3-4, 2019 at the Harley-Davidson Museum in Milwaukee. Online registration is open!

Approved for AMA PRA Category 1 Credits™, the WACEP 2019 conference will kick off at noon on Wednesday, April 3 with an open Q&A forum over lunch, immediately followed by a plenary session that will walk attendees through the process of initiating medications for opioid addiction treatment in the ED. Attendees will then have the option between an MAT/ALTO workshop, or a leadership forum specifically for ED directors and emerging EM leaders. Wednesday's dinner presentation will feature ACEP President, Paul Kivela, MD,

Thursday's program features a number of sessions back by popular demand, including: 2018 LLSA articles workshop that will help attendees prepare for the ABEM-required exam; Hot Topics in Emergency Medicine round-table discussions featuring a variety of timely topics; hands-on Ultrasound workshop; and optimizing antibiotic stewardship.

WACEP is proud to continue its partnership with the UW and MCW Emergency Medicine Programs by offering the annual Emergency Medicine Research Forum on Thursday morning during the conference. The Forum will feature both poster and oral presentations and showcase the great research being done across our state. In the lunchtime general session on Wednesday, Daniel Spaite, MD from the University of Arizona will present on new findings in traumatic brain injury management.

Afternoon sessions on Thursday will include a session led by Edwin Leap, MD on doing more with less; updates in managing and treating agitation; sex trafficking and what to look for; optimizing antibiotic stewardship; and more.

Learn more and sign up today!

Legislative Update: Extraordinary Session Report

Wed, 05 Dec 2018 19:01:56 GMT

After weeks of speculation and media coverage, the Republican-controlled Legislature passed a number of bills in a “lame duck” Extraordinary Session. All bills were passed on party-line votes, and while Governor Walker has signaled his willingness to sign the legislation, he has provided no details.

Evident by the media reporting on the Extraordinary Session, these proposals were by and large forgone conclusions; they were destined to pass regardless of outside support or opposition. While the Senate Republican caucus, in particular, was divided on key items in the various bills, ultimately they were able to make amendments sufficient to secure votes for final passage of the legislation. (Though unrelated to healthcare, the controversial proposal to change Wisconsin’s presidential primary election date was not taken up.)

Of particular interest to WACEP and other health organizations is Senate Bill 886, which makes a variety of changes to how the Department of Health Services (DHS) can make or recommend changes to the Medicaid program. In advance of yesterday’s votes, and to no avail, a group of 20+ healthcare organizations and systems (led by the Wisconsin Medical Society and Wisconsin Hospital Association) wrote a joint letter to the Legislature expressing concerns about the breadth of SB 886, the lack of time for a full analysis of the legislation and the potential for unintended consequences.

Among other things, the original SB 886 solidified in statute items contained in the most recent Medicaid Waiver approved by the Federal Government related to Wisconsin’s Medicaid/BadgerCare coverage for childless adults, including new work and premium requirements for eligibility. Among those items, the Waiver contained a new $8 copay for non-emergency visits to Emergency Rooms – quoting SB 886’s official Analysis:

DHS must charge recipients an $8 copayment for nonemergency use of the emergency department and must comply with other requirements imposed by the federal DHHS in its waiver approval effective October 31, 2018. The requirements in the bill must end no sooner than December 31, 2023, and the bill prohibits withdrawal of the requirements and DHS from requesting withdrawal, suspension, or termination of the childless adults demonstration project requirements before that date unless the legislation has been enacted specifically allowing for withdrawal, suspension, or termination.

In addition, the original SB 886 limits DHS’s ability to make other changes to Medicaid programs including changes to provider reimbursement – again, quoting SB 886’s official Analysis:

This bill prohibits DHS from submitting an amendment to the state's Medical Assistance plan or implementing a change to the reimbursement rate for or making a supplemental payment to a provider under the Medical Assistance program without first submitting the proposed state plan amendment, rate change, or payment to JCF. If the state plan amendment, rate change, or payment has an expected fiscal effect of less than $1,000,000 from all revenue sources over a 12-month period following the implementation date of the amendment…

Ultimately, to secure agreement on SB 886, the Senate adopted (and the Assembly concurred) an amendment raising the original $1,000,000 fiscal effect to $7,500,000. In other words, DHS may still make changes that cost less than $7,500,000 for the immediately following 12-month period without Legislative approval.

Winner of FitWell Announced

Wed, 21 Nov 2018 14:06:37 GMT

Nicole Forbord, PA-C is the winner of the FitWell contest, WACEP's most recent wellness initiative. Nicole, a PA with Emergency Medicine Specialists, SC who contracts for Ascension, posted her activity and fitness images on WACEP's social media accounts during the summer. She was selected as the winner in a random drawing from among contestants, and has been awarded a WACEP branded fleece and $200 towards a gym/club membership of her choice. Congratulations Nicole!

Election Update 2018

Wed, 07 Nov 2018 18:13:01 GMT

Eric Jensen, Jensen Government Relations, LLC

Searching for a word to summarize last night’s Wisconsin state elections this morning (including early this morning as I obsessively watched the final results trickling in!), all I could come up with was: Wow.

Neck and neck all night, at about 1:00 am came an announcement that nearly 50,000 absentee ballots from Milwaukee County were still being counted and would be reported shortly. With the Governor and Attorney General races very close at that point, the announcement of those ballots yet to come from the traditional Democratic stronghold signaled that both races were likely over, and indeed they were. Those ballots gave Tony Evers a nearly 30,000-vote lead over Governor Walker, and gave Josh Kaul a nearly 15,000-vote lead over Attorney General Schimel. Despite possible recounts, barring any unanticipated irregularities most insiders agree those totals will be sufficient to sustain victories for both Evers and Kaul. (Of note, Democrats also won all three other statewide races – US Senate, Secretary of State and State Treasurer.)

While the statewide races were swept by Democrats, with results that were quite close to the closely watched Marquette Law School poll results leading into Election Day, the real “wow” factor came through in the races for State Senate and State Assembly.

Democrats entered Election Day optimistic that high turnout for the statewide races would help their causes in both the State Assembly and Senate. In the end, it did not. In fact, Assembly Republicans did not lose a single seat – including several seats they hold in what have long been viewed as traditionally strong Democratic areas – and will maintain a 64-35 majority. Meanwhile, Senate Republicans, viewed by many as quite vulnerable after losing two GOP-held seats during Spring Special Elections, actually expanded their majority by holding all of their seats and winning back the 1st Senate District up in Door/Kewaunee Counties they had lost during the June Special Election.

Drawing conclusions from all of this will be an interesting political and social science discussion for some time to come, but what the numbers showed is fairly simple: the very high concentration of Democratic voters in Dane and Milwaukee Counties voting in large numbers is sufficient to win statewide races (borne out during this Spring’s Supreme Court race as well). Meanwhile, there remain more areas of the state where Republican voters appear to outnumber Democratic voters by smaller percentages (compared to the Democratic advantages in Dane and Milwaukee Cos.) allowing Republicans to out-perform their statewide candidates by just enough to win the smaller Assembly and Senate districts and control the Legislature.

The Governor, Attorney General, State Senators and State Representatives will be sworn in the first week of January, and action will commence soon after. What the dynamic will be between the new Governor and the existing Legislative majorities will be interesting to see. Also interesting, will be watching the dynamic between the two Republican majorities that did not see eye-to-eye on several major policy areas last session.

Free Medication-Assisted Treatment Training

Tue, 30 Oct 2018 17:37:01 GMT

Eight hours of training on medication-assisted treatment (MAT) is required to obtain a waiver from the Drug Enforcement Agency to prescribe buprenorphine, one of three medications approved by the FDA for the treatment of opioid use disorder. Providers Clinical Support System (PCSS) offers free waiver training for physicians to prescribe medication for the treatment of opioid use disorder. PCSS uses three formats in training on MAT:

Live eight-hour training
“Half and Half” format, which involves 3.75 hours of online training and 4.25 hours of face-to-face training.
Live training (provided in a webinar format) and an online portion that must be completed after participating in the full live training webinar

Trainings are open to all practicing physicians. Residents may take the course and apply for their waiver when they receive their DEA license. For upcoming trainings consult the MAT Waiver Training Calendar. For more information on PCSS, click here. Please email Sam Shahid at ACEP for more information on MAT training.

Mental Health Patients with Nowhere Else to Go are Overwhelming Emergency Departments

Wed, 24 Oct 2018 17:08:49 GMT

October 18, STAT

When I walk through my hospital’s emergency department, I’m sometimes overwhelmed by the number of people languishing there as they wait for help with a mental health issue, like the woman clutching her chest as if she’s having a heart attack but is really suffering from a panic attack. It’s her third time here in a week.

She is just one of the hundreds of patients who will be admitted this year to my emergency department in the Mat-Su Regional Medical Center in Palmer, Alaska, experiencing psychiatric emergencies.

Many stay in the emergency department for hours; some even stay there for a few days. The practice, called psychiatric boarding, occurs when an individual with a mental health condition is kept in an emergency department because no appropriate mental health care is available. It’s rampant around the country.

Millions of Americans with mental health issues are not getting the care they need. It’s a crisis so profound that it is overwhelming emergency departments and the entire health care system. The causes? Too few outpatient resources and inpatient treatment options for mental health issues; separate systems for treating mental health and physical health; and a shortage of specialists able to respond to patients in the midst of mental health crises, to name just a few.

I believe hospitals can curb this trend by doing a few key things, beginning with improved collaboration.

The statistics are staggering: Nearly 1 in 5 U.S. adults — about 44 million — experiences mental illness in a given year, a number that is certain to increase. And it comes at a time when the demand for mental health professionals is outstripping the supply. For psychiatrists alone, a 2017 report published by the National Council for Behavioral Health estimates the shortage will be between 6,100 and 15,600 practitioners by 2025. That same report points out that lack of access to psychiatric services in hospital emergency departments is especially problematic.

Read full article.

Legislative Update, Fall 2018

Wed, 17 Oct 2018 20:33:51 GMT

Eric Jensen, WACEP Lobbyist

In less than three weeks, on Tuesday, November 6^th, Wisconsinites will go to the polls to vote in races for the U.S. Senator, Governor, 17 of Wisconsin’s 33 State Senate districts, all 99 of Wisconsin’s State Assembly districts and a variety of local elections and referenda. Between now and then, we’ll be inundated with radio and TV ads, campaign flyers (and maybe candidates) at our front doors, political “robocalls” and media reports about candidates, races, polls and predictions. ‘Tis definitely the season!

Political insiders watch political polls like hawks, hoping to glean from them predictions of election outcomes. But in 2016 we learned a powerful lesson about political polling in modern times – not one national pollster predicted victory by President Trump, either in Wisconsin or nationally. More and more, people of different demographics are moving from landlines to mobile phones increasing the difficulty of getting a representative population sample in a poll. That simple fact, along with how questions are asked, who asks the questions and a variety of other factors increase the difficulty of getting statistically accurate poll results.

For WACEP, our attention is primarily on the races for Governor, State Senate and State Assembly as the outcomes of those races can have a profound effect on health care policy making for the next two years and beyond.

The Governor’s race is the one most discussed in the state’s media. Governor Walker has served two four year terms, yet won election as Governor three times. Tony Evers, his Democratic challenger, has served as Wisconsin’s State School Superintendent, himself winning multiple statewide elections. As divided as Wisconsin’s voting population has become, and both candidates holding strong name recognition throughout the state, this race figures to be close to the end.

In the State Senate, after Democrats won two previously Republican-held seats during Spring Special elections, Republicans hold a 18-15 majority heading into November. Democrats are focusing on two key Republican seats (one in the Appleton area, one in the large rural district west of Madison) in an effort to win the majority. But Republicans see opportunities of their own to win back one of the Special Election seats in the 1^st Senate District in Door/Kewaunee County, as well as a far northern seat that includes Superior, Ashland and Rice Lake.

In the State Assembly, Republicans hold a far larger 64-35 majority. To win the majority, Democrats must hold all their current seats and win 15 more. It’s a daunting challenge, and while anticipated high voter turnout in places like Democratic stronghold Dane County may have a big impact on the Governor’s race, it won’t affect Assembly races in central and northern Wisconsin.

The outcomes of these 2018 elections will come down to voter turnout for both parties – throughout the state, not simply in party stronghold areas. As you see polls being reported in the media, remember 2016. Elections aren’t won by polls or pundits, they’re won by votes – so get out and cast yours on November 6^th!

Cannabis: Getting into the Weeds

Mon, 15 Oct 2018 14:53:03 GMT

WACEP President's Message, October 2018
Lisa Mauer, MD

Emergency physicians do not typically think of cannabis as pertinent to our typical clinical practice. This is demonstrated by the fact that ACEP has not adopted any of 14 resolutions (both in favor of and in opposition to recreational marijuana) that have been proposed in the last 10 years. On the other hand, our practice is, in some ways, is defined by the failures of the healthcare system, from chronic intractable conditions in need of a novel treatment to the unanticipated side effects of increasing exposure to a recreational substance. We may get pulled into this debate on the national level.

But what about at the state level? Marquette Law School poll done in August showed that 61 percent of Wisconsinites say marijuana should be fully legalized and regulated like alcohol while 36 percent oppose legalization. Advisory referendum questions on marijuana will be included on ballots in 16 different counties and 2 cities next month. With all of this local action, I was recently faced with the question of “What would you say to a reporter who asked what emergency physicians of Wisconsin think about marijuana?” While our state chapter of ACEP does not form individual policy apart from our national organization, it is important that our chapter reflects our local environment. I believe there are likely low-hanging fruit that would reflect commonalities among WI emergency physicians’ opinions on how we could best represent our patients in this public debate. Read below for background information on what pertinent policy exists, and then email me with how you think emergency physicians in Wisconsin should publicly regard marijuana for recreational use, medical use, research, or other!

Recreational use: Nine states and the District of Columbia have legalized recreational use of marijuana for adults over the age of 21. Twenty-two states and the District of Columbia have decriminalized small amounts of marijuana. AMA has policy on recreational use or legalization of marijuana:

Initially established in 1997 and modified several times until it was reaffirmed last year, the AMA urges legislatures to delay initiating the legalization of cannabis for recreational use until further research is completed on its consequences.
Advocates for point of sale warnings and product labeling regarding potential dangers of cannabis-based product use during pregnancy and breastfeeding.
For states that have already legalized cannabis, they should take steps to regulate it. If taxed, a substantial portion of the revenue should be used for public health purposes.
Public health based strategies, rather than incarceration, should be used to handle individuals possessing cannabis for personal use.
Supports continued educational programs on substance abuse to include marijuana

It is notable that ACEP does not have policy on legalization of recreational marijuana. This also includes a proposal last month in San Diego at ACEP18 Council to approve policy language mirroring the first AMA policy listed above. Discussion on the ACEP council floor in opposition to policies regarding recreational marijuana often centers around the idea that recreational marijuana is not within the scope of emergency medicine, although emergency physicians may have opinions on recreational marijuana as individuals.

Medical use: Thirty-one states have legalized marijuana for medicinal use. In addition, 15 other states, including Wisconsin, only allow use of low THC, high cannabidiol products for limited medical conditions such as seizure disorders.

Much of existing AMA policy about medical use of marijuana focuses on the basis of physician-patient relationship being free from interference by the government:

Cannabis products for medicinal use should be considered for approval by the FDA, not legalized through legislative, ballot, or referenda initiatives. Any FDA-approved cannabidiol medications should be regulated as other prescription products are, rather than state laws that may apply to unapproved cannabis products.
Cannabis products not approved by the FDA will have warning labels indicating such
Supports protection against federal prosecution for physicians who discuss cannabis with patients or recommend cannabis in accordance with state laws

The Wisconsin Medical Society (WMS) policy affirms the third point above, and also goes on to state that smoked marijuana should only be used for therapeutic reasons for which we have scientific data regarding safety and efficacy.

Again of note, ACEP has a noticeable lack of policy in this realm, and in fact did not adopt 3 proposed policies over the last few years, including proposal to protect the right of emergency physicians to prescribe medical marijuana and a proposal to officially take no position on the medical use of cannabis products.

Research: AMA again takes the lead in ample policy regarding research of cannabis use. They encourage public health agencies to improve data collection of effects of cannabis. The AMA and WMS have the same following policy:

Urge that marijuana’s status as a schedule I controlled substance be reviewed with the goal of facilitating the conduct of research and potential development of medicines
Call for adequate studies of cannabinoids
Urge federal agencies to fund and facilitate the conduct of research

Interestingly, although the ACEP Council voted to not approve a resolution in 2014 to specifically promote research of medical marijuana, they did just last month approve the very first ACEP resolution regarding cannabis, mirroring language of the first above AMA/WMS policy point.

Psychiatric Bed Locator Survey

Sun, 14 Oct 2018 14:57:19 GMT

Wisconsin statute includes a provision that a psychiatric bed locator be maintained as a single point of reference of psychiatric bed availability. The bed locator website was developed, and is maintained, by the Wisconsin Hospital Association. The site is meant to assist emergency departments when seeking to transfer and admit patients for psychiatric reasons.

In an effort to work with WHA to identify possible areas of improvement for the bed locator, WACEP has developed a short survey for its members regarding the site’s usage. Please take a moment to answer the survey.

Is Psychiatric Boarding Out of Control in Your ED?

Sat, 22 Sep 2018 16:54:49 GMT

Is psychiatric boarding out of control in your ED too? WACEP hears you!

Drs. Redwood and Repplinger visited Kaye Zwiacher, MD, director of Winnebago Mental Health Institute, to discuss the SMART protocol. The SMART protocol decreases ED length of stay and costs by eliminating unnecessary diagnostic labs in 65% of psychiatric medical clearances.

Transferring Your Patient in Psych Crisis: Ambulance? Private Vehicle? Piggyback Ride?

Fri, 14 Sep 2018 17:21:58 GMT

WACEP President's Message, September 2018
Lisa Maurer, MD

You’re working a busy 12 hour shift, and a patient with chief complaint of “SI” pops up on the board. Gulp. The evaluation is uniquely straightforward: this 54 year old female has a history of depression and is having passive thoughts of suicide in a stressful time, very clearly presents with her husband for voluntary admission. No ED hold needed. You find no other medical concerns and even get her accepted at the nearest psych hospital promptly, which happens to be 50 miles away. Bingo bango, you’re on a roll!

Then comes the question of what “mode of transportation” are you going to fill out on the EMTALA form? The patient just assumes that her husband can drive her there, but your hospital has a policy that all psych transfers must go by ambulance, sticking this family with a hefty bill. Your gut is that she is extremely low risk for harm or non-adherence to the care plan during private transport. Is there merit to insisting on ambulance transfer?

We had this exact question presented to our chapter by our members. Certainly, there is a time and place when your spidey sense tells you to opt for ambulance transfer even for voluntary admissions. However, for the seemingly low risk patients, we wanted to supply our members with data who wish to have discussions with their hospital administrators if you want to pursue more flexible standards for transportation in voluntary psych transfers. See here for a seven-page legal summary concluding that the mode of transportation should be left to the judgement of the physician, done by our contracted attorney, Guy DeBeau from Axley Brynelson, LLP. It includes an interesting summary of pertinent case law, and tips for how to safely document characteristics you may have considered when assessing your patient’s level of risk for harm during transfer. It is worth pointing out that the memo does not include any examples of civil suits for harm that occurred during a similar transfers in Wisconsin, because there aren’t any such lawsuits.

For other points of discussion, WACEP has received some helpful tips from our partners in the WI Psychiatric Association. They refer to the CMS booklet on Non-Emergent Medical Transport for the “standard of care” for transportation of psychiatric patients, which comments on the difference between clinical scenarios that necessitate emergent transport and those that are non-emergent. For potential discussions of other transportation options, keep in mind non-ambulance secure transport choices as well, such as JBM, Able- Access, or Lock n Load.

Does your hospital have a policy to mandate that all patients being transferred for voluntary inpatient psychiatric care go by ambulance? Do you feel that this is appropriate, or are you looking for a change? We are interested in how we can further help with this issue in Wisconsin EDs.

Congratulations New Wisconsin FACEPs

Wed, 12 Sep 2018 15:13:09 GMT

Six Wisconsin ACEP members have recently been awarded the distinct designation of Fellow of the American College of Emergency Physicians (FACEP), bringing WACEP's total number of members with this status to 208. Congratulations to Wisconsin's most recent Fellows:

Joseph Humphrey, MD, FACEP
Timothy J. Lenz, MD, FACEP
Michael Mancera, MD, FACEP
Jessica N. Schmidt, MD, MPH, FACEP
Michael Thomas Steuerwald, MD, FACEP
Joseph D. Verzwyvelt, MD, FACEP

The Fellow designation speaks to a member's contributions to ACEP and highlights their commitment to emergency medicine. More than 12,000 ACEP members proudly use the prestigious FACEP designation.

Call for Nominations

Tue, 04 Sep 2018 19:02:13 GMT

The Wisconsin Chapter, ACEP Nominating Committee is now accepting nominations of any member in good standing interested in serving in WACEP leadership.

WACEP's Board of Directors meets quarterly and provides ongoing strategic oversight as the organization works to advance the effectiveness, sustainability and mission of the Chapter. Board members are expected to participate in all Board meetings, the annual conference, and various activities related to the organization's strategic priorities.

For terms of office beginning January 1, 2019, nominations are being accepted for the following positions:

Director at Large on the Board of Directors (4-year term)
Councillor to ACEP (3-year term)
President-Elect (this is a 3-year commitment, one year each as President-Elect, President and Immediate Past President)
Secretary/Treasurer (1-year term)

Submit Nomination Here

Healthcare and the 2018 Elections: What's at Stake?

Mon, 20 Aug 2018 22:34:52 GMT

Healthcare is poised to play a central role in the 2018 state and federal elections, and the results could reverberate across Wisconsin.

Democrats are hoping a blue wave will put the brakes on President Trump’s attack on the Affordable Care Act, but if Republicans retain control of Congress, it may seal the law’s fate. Meanwhile, the races for Governor and the Legislature are certain to shape the future of healthcare for years to come.

A panel of the state’s top healthcare lobbyists will analyze what’s at stake for the Badger State and preview their priorities for the coming year. Panelists:

Eric Borgerding, CEO, Wisconsin Hospital Association
Dr. Bud Chumbley, CEO, Wisconsin Medical Society
Stephanie Harrison, CEO, Wisconsin Primary Health Care Association
John Sauer, CEO, LeadingAge Wisconsin
Nancy Wenzel, CEO, Wisconsin Association of Health Plans

The event is Tuesday, September 11 at the Madison Club (11:30am – 1pm). Register here.

My So-Called Life

Wed, 15 Aug 2018 14:00:10 GMT

WACEP President's Message, August 2018
Lisa Maurer, MD

I’m a partner in a medium-sized democratic group, big enough to generally be sheltered from huge swings in clinical load due to any individual's personal leave or hiring of a new partner. I have EM doc friends who have mentioned that they’d have to miss out on previous commitments because of staffing changes such as those. That always felt like a far-away problem, until recently, when our group was fortunate to pick up another contract, significantly increasing the clinical load faster than any group could hire. Bottom line: I got steam rolled, drowning in work and losing contact with my “real” life. It was all voluntary by the way; in our group’s typical uber-democratic fashion, I was able to choose how many shifts I could bear for a handful of months until more docs were hired on. Just now I’m coming out on the other side as a great new group of docs recently joined our ranks, and I’m able to look back and reflect on lessons learned during my own ebb and flow of clinical work that is common for emergency physicians.

Professional Lessons

The Good - I typically work a lesser load of clinical shifts than most partners in my group due to also taking on administrative work, but had more of a typical load as of late. I felt all warmed up every time I was heading into the hospital! The usual stale cobwebs and inertia after a few days off of clinical work was never there, making the first patient encounter of a shift just as smooth as the last. Clinically I felt like a well-oiled machine and it makes me appreciate that there truly is a critical mass of patients that I personally must see on a regular basis to keep sharp. This will likely prove useful to remember as I near retirement or consider other non-clinical opportunities. Perhaps even now, clustering my shifts might be the way to go as I try to balance clinical and non-clinical duties.
The Bad - I am typically an everlasting gobstopper of empathy. I would never question the logic of a patient’s choice of ED visit versus a PCP office, or why 3 a.m. seemed like the right time to stop on in. People have their reasons. But just jack up my clinical load a bit (ok, a lot) and my shoulders started to tense with each bell of the ambo door. I knew it was taking a toll on me when I would read the triage nurse’s note and immediately internally start to question the motives of the patient I was about to see. An alarm bell went off in my head. Although I realized one could argue that this type of questioning is totally appropriate, I knew it wasn’t my typical outlook, and it was an outlook that certainly made it harder for me to love my profession everyday. Keeping my previous empathy might even be more important that having a warmed-up clinical mind, in my opinion. It has quickly returned with my now decreased clinical load.
The Ugly - see below.

Personal Lessons:

Prioritize priorities - I had it all set. My google calendar was loaded up, defending my personal life from my shifts. Workouts? Check. Sleeping? Check check. My kids were even getting scheduled so I would be sure to set aside time for them. But man, something was lost in translation. My husband and I were interacting more as the changing of the guards than anything else. Google calendar doesn’t do well providing downtime and spontaneity. Everything but the bare essentials went to the wayside. I hadn’t hung out with my sister for months. I stopped turning down invitations to meet up with friends because the invitations stopped coming after being turned down so regularly. A friend even asked me what it was like to live and breathe work. Eek! That’s not what I signed up for. We made it to the other side just fine and I’m having a great time catching up with everybody, but when there not enough slots to fit in all the priorities, something’s got to give. I don’t think I’m alone among emergency physicians who aim to work to live, rather than live to work. It’s easier than I thought to let it slip the other way.
Guilt was gone - On the lighter side, the trouble I normally have with trying to balance work with everything else was suddenly easier when work ticked up, mostly because I got very skilled at saying no to protect my time. Meeting mid-morning after a night shift? No way, Jose. PTA meeting on my night off? Sorry, not sorry. Cook dinner? I’ve prepared some exquisite Subway for the family. Outsourcing was in full force: yardwork, grocery shopping, scrubbing toilets? Buh-bye, buh-bye, buh-bye. Even now that things have slowed down again, as long as I can swing it, I’ll attempt to keep the guilt away and the outsourcing full speed. It’s amazing how the world continues to spin even though I haven’t personally balanced the school budget nor picked up a toilet brush. Nothing like a little stress on my time management to help me flex those boundaries I should always set for myself.

For those of you in smaller shops with even smaller staffs, I imagine this swing in lifestyle is your reality. Hats off to you. You likely have many more lessons to share with the rest of us. Share them! Hopefully, my lessons could better prepare or at least normalize this sort of transition for a Wisconsin EM doc who will experience something similar soon. Most importantly, it was worth it. The docs in my group are my family, and even though I might have a few more tricks up my sleeve next time, I know I’m ultimately in the right place because I’d do it all again in a heartbeat for my group and profession that I am so lucky to have.

Editor's note: Send your own lessons-learned, stories from the front, and comments to Dr. Maurer by emailing WACEP@badgerbay.co.

A Smarter Way to Medically Clear ED Patients in Acute Psychiatric Crisis?

Tue, 14 Aug 2018 16:55:59 GMT

Bobby Redwood, MD, Immediate Past President

Each year the Wisconsin ACEP board of directors, in conjunction with our membership, chooses three strategic priorities: one for our profession, one for our physicians, and one for our patients. These priorities are assigned to a task force, which is in turn given the institutional resources needed to effect real change.

In 2018, WACEP is focused on reducing the ED length of stay for patients in acute psychiatric crisis (aka psychiatric boarding). To achieve this admittedly lofty goal, the WACEP psychiatric task force joined forces with the Wisconsin Medical Society and the Wisconsin Psychiatric Association with the shared goal of reducing ED length of stay for one of our most vulnerable patient populations. Our group meets once every six weeks, strategically laying the groundwork to revolutionize the way we operationalize the medical clearance and transfer of psychiatric patients in Wisconsin EDs. Thus far, the work group has recognized some of the most common bottlenecks in the medical clearance process, including unnecessary testing, requiring lab results prior to initiating the transfer discussion, lack of bed availability, lack of bed coordination, and various suboptimal transportation procedures. As of our last meeting, we are happy to report that we have reached a phase where feedback from our emergency physician workforce is needed.

Our task force has honed in on the medical clearance process and the (unofficial) requirement that all patients have labs drawn as one of the most egregious bottlenecks in our broken system. Of psychiatric clearance and transfer. In collaboration with our psychiatry colleagues, the work group has identified the SMART medical clearance protocol as a potential solution to this bottleneck.

The protocol, developed and tested in the Sacramento area, consists of a series of questions under the acronym SMART. A score of ‘0’ on the form indicates no further workup is necessary, and would allow for prompt transfer of patients from the ED to a more appropriate inpatient setting. In Sacramento, the SMART protocol has been successful in speeding up the transfer process for ED psychiatric patients, reducing costly and unnecessary diagnostic tests, and ensuring that patients receive timely treatment.

Moving forward, our work group aims to draft a consensus white paper on best practices in the medical clearance of psychiatric patients in acute crisis, publish a recommended medical clearance protocol, and then begin the real leg work of implementing reforms in our state’s medical clearance process. We’d like to hear from you: What do you think of the SMART protocol? What are its strengths? What portions of the protocol will have to be modified for Wisconsin? What aspects of the protocol might not operationalize well in your ED and why?

Email your responses to WACEP@badgerbay.co and help us decrease ED length of stay for Wisconsinites suffering from acute psychiatric crisis.

Robert Redwood MD, MPH, FACEP
Immediate Past WACEP President

Sources:

"The SMART Medical Clearance Protocol As A Standardized Clearance Protocol For Psychiatric Patients In the Emergency Department." Chi J. Nwaobiora. International Journal of Current Research, Vol. 9, Issue, 09, pp.57140-57147, September, 2017.

"Stop the Madness: A Smarter Way of Medical Clearance". Aimee Moulin, M.D., Sierra Sacramento Valley Medical Society Medicine, November/December 2017.

National Physician Suicide Awareness Day #NPSADay

Mon, 13 Aug 2018 17:18:51 GMT

In order to address the issue of physician suicide, the Council of Emergency Medicine Residency Directors (CORD), in collaboration with AAEM, ACEP, ACOEP, EMRA, RSA, RSO and SAEM have come together to annually dedicate the 3rd Monday in September as National Physician Suicide Awareness (NPSA) Day, #NPSADay.

Physician suicide is a tremendous issue in healthcare today. While estimates of the actual number of physician suicides vary, literature has shown that the relative risk for suicide being 2.27 times greater among women and 1.41 times higher among men versus the general population. Each physician suicide is a devastating loss affecting everyone - family, friends, colleagues and up to 1 million patients per year. It is both a very personal loss and a public health crisis. Vision Zero calls on individuals, residency programs, health care organizations and national groups to make a commitment to break down stigma, increase, open the conversation, decrease the fear of consequences, reach out to colleagues, recognize warning signs and learn to approach our colleagues who may be at risk. Let us challenge each other as individual, community, institutional and organizational to make changes to reach zero physician suicides.

Suicide can be prevented. Be the one to be there. Shed light on this issue and change the culture of medicine to save lives. Learn more and receive updates and information as it is released.

UW to host Suicide Bereavement Clinician Training, Sept. 19

Mon, 13 Aug 2018 13:54:45 GMT

UW Madison will host a day-long workshop on Suicide Bereavement Clinician Training, presented by national experts Drs. Jack Jordan and Nina Gutin, on Wednesday, September 19, 2018 at the Pyle Center in Madison.

This unique opportunity in the arena of suicide post-vention and prevention coincides closely with the conclusion of National Suicide Prevention Week. Few clinicians have been properly trained to understand and respond to the complicated features of grief associated with suicide loss. The workshop is designed to prepare clinicians for working with individuals who are grieving the loss of someone to suicide.

Addressing the Increased Threat of Vectorborne Illnesses

Wed, 18 Jul 2018 17:29:17 GMT

Ben Ho, MD
WACEP Board Member

For many of us summer in Wisconsin means time spent outside, whether on a trail, by the lake, in our yards, or if we are lucky, somewhere on a tropical vacation. As we enjoy the activities that we love, however, we knowingly expose ourselves to a number of seasonal environmental factors: heat, UV light, and of course, ticks and mosquitoes. We may know these arthropods best as nuisances that crash our barbecues and hitchhike on our trail walks. As vectors for important communicable diseases, however, their significance goes much beyond this.

Earlier this spring, the Department of Health and Human Services and the Center for Disease Control published a review of vectorborne pathogen transmission in Morbidity and Mortality Weekly Report. Using data from the National Notifiable Disease Surveillance System, the authors reported on trends in both tick- and mosquito-borne illnesses from 2004, the first year that arboviral illnesses became notifiable, to 2016, within the United States and its Territories. The report not only indicates a global increase in the incidence of vectorborne illnesses throughout the United States, but also identifies unique patterns of transmission at the local level. Two general patterns are evident. Tickborne illness reports rose steadily, doubling over the 13-year study period, and their greatest impact was on the eastern half of the country. While Lyme disease accounted for more than 82% of tickborne illness reports, other diseases such as anaplasmosis, ehrlichiosis, Rocky Mountain Spotted Fever, and babesiosis also increased in identification. The occurrence of mosquito-borne illnesses, on the other hand, was punctuated by epidemics, and was much more geographically dispersed. While endemic outbreaks of Zika, Dengue, and chikungunya were limited to the Territories, local transmission in the Southeast was likely due to infected travelers returning home from these areas.

A number of messages can be taken from this report. Although Lyme disease might be the illness that we consider most commonly in Wisconsin, the world of vectorborne diseases includes many more pathogens. In fact, if the next twelve years is anything like the last, we should expect increasing incidences of all kinds of different tick- and mosquito-borne illnesses. The epidemiology of these diseases is unique, largely because transmission depends heavily on environmental factors such as the geographical range of their hosts, the feeding cycles of their vectors, temperature, and rainfall patterns. Regions that were once too cold for ticks may eventually see Lyme disease; mosquito-borne illnesses once limited to tropical climates may creep further into the continental U.S., encouraged by heat waves, deforestation, flooding patterns, and human travel. It already appears that the physical range of A. aegypti is increasing, setting the scene for outbreaks of dengue, Zika, and chikungunya in years to come. To make matters worse, there are not many vaccines available to protect us (Rosenberg et al., 2018). As the world around us changes, so will the diseases that we see and treat.

Despite these challenges, there are several things that we can do as physicians and health advocates to address the growing threat of vectorborne illnesses. As with everything in medicine, awareness of these diseases and having appropriate clinical suspicion based on history and physical exam will not only aid in diagnosis and treatment of our patients, but also improve reporting of disease transmission. We can also reinforce common-sense strategies to limit transmission of these diseases to our patients: wearing long-sleeves and pants in tick and mosquito habitat, avoiding exposure during mosquito feeding times, keeping outdoor spaces clear of leaf litter and standing water, performing frequent tick checks on fellow humans and pets, and protecting ourselves with Deet and permethrin. The world may indeed be changing, but our process of limiting risks and exposures to vectors have not.

As a final point – have you ever wondered how effective the combination of Deet and permethrin is in deterring mosquito bites? A study done in the 1980’s by the U.S. Air Force compared mosquito bite rates on control subjects wearing no protection verses subjects treated with 35% Deet and/or permethrin at a remote test site in Alaska. Subjects using both 35% Deet and permethrin-treated clothing experienced only one mosquito bite per hour; subjects using no protection experienced on average 1,188 mosquito bites per hour, with a maximum rate reported at 3,360 bites per hour (Lillie et al., 1988). There are two clear take-aways from this study: 35% Deet combined with permethrin offer excellent protection against mosquitoes, and never volunteer as a research subject for the Air Force.

References:

Rosenberg R, Lindsey NP, Fischer M, Gregory CJ, Hinckley AF, Mead PS, Paz-Bailey G, Waterman SH, Drexler NA, Kersh GJ, Hooks H, Partridge SK, Visser SN, Beard CB, Petersen LR. 2018. Vital signs: trends in reported vectorborne disease cases – United States and Territories, 2004-2016. MMWR-Morbid Mortal W. 67(17): 496-501.

Lillie TH, Schreck CE, Rahe AJ. 1988. Effectiveness of personal protection against mosquitoes in Alaska. J Med Entomol. 25(6): 475-478.

July 25 Webinar: CMS Moving from Volume to Value

Tue, 17 Jul 2018 17:17:48 GMT

ACEP’s Quality Division is hosting a webinar “Hear from the Authorities: CMS moving from Volume to Value. The near and long term future of MACRA policy and MIPS scoring.” on Jul 25, 2018 at 1:00 PM CDT.

Register: https://attendee.gotowebinar.com/register/2256949217905190401

After registering, you will receive a confirmation email containing information about joining the webinar.

Workers’ Comp. Premiums Decline for Third Year

Mon, 16 Jul 2018 15:32:54 GMT

July 12, Wisconsin Health News

Workers’ compensation premiums for businesses are set to decline by 6.03 percent this October, according to a statement from the Department of Workforce Development.

That could result in an estimated $134 million in annual savings for businesses, the Tuesday statement noted. It’s the third year that workers’ compensation rates have declined, following an 8.46 percent decrease last year and a 3.19 percent decline in 2016.

“A safe workplace results in a more productive and profitable one for employers,” Ted Nickel, insurance commissioner, said in a statement. "Employers are recognizing the relation between their employees' safety and the savings that ensue as premiums continue to decline."

Mark Grapentine, senior vice president of government relations for the Wisconsin Medical Society, said the report shows that “good news keeps coming” for the state’s workers’ compensation program.

“We’re already a national model, with faster return to work, fantastic patient satisfaction and ready access to the highest-quality healthcare in the nation – all at a cost per claim that is below the national average,” he wrote in an email. “Another significant insurance rate reduction is just more evidence that Wisconsin’s system is win-win for both businesses and their employees.”

Grapentine added that there’s room for improvement, pointing to a need for the state’s on-the-job injury rate drop below the national average. He added that healthcare providers are “always striving to find better ways to improve care.”

Chris Reader, director of health and human resources policy, also lauded the announcement. He said the reduction follows a national trend as employers and workers have invested in and focused on safety. But he noted that costs for medical treatment for workplace injuries are on the rise.

“Had Wisconsin enacted a medical fee schedule like almost every other state, medical costs also would have been kept in check and the insurance reduction today would have been even greater," he wrote in an email.

Reader also argued that the rate reduction doesn’t mean much to fully-insured employers who don’t pay insurance costs and are left footing “incredibly high medical bills.”

Proposals to establish a fee schedule haven't gained traction with lawmakers.

WHN Hospital CEO Roundtable

Mon, 16 Jul 2018 15:31:27 GMT

The annual Wisconsin Health News CEO Roundtable is August 14 in Madison. A panel of the state’s leading health system and hospital leaders will discuss the most pressing issues facing their industry. Panelists include:

Dr. Sue Turney, CEO, Marshfield Clinic Health System
Robert Van Meeteren, CEO, Reedsburg Area Medical Center
Dr. Alan Kaplan, CEO, UW Health

Supreme Court Upholds Cap on Noneconomic Damages

Wed, 27 Jun 2018 17:09:09 GMT

The Wisconsin Supreme Court issued its ruling today in the Ascaris Mayo v. Wisconsin Injured Patients and Families Compensation Fund case to uphold the $750,000 cap on noneconomic damages, thus restoring medical malpractice caps in Wisconsin.

In January, a coalition of medical specialty organizations jointly filed an amicus brief with the Supreme Court in support of the cap. The collaborative efforts of Wisconsin’s medical community resulted in a major victory for physicians and helped preserve access to healthcare across Wisconsin.

An amicus brief was filed on behalf of the Wisconsin Chapter of the American College of Emergency Physicians, the Wisconsin Academy of Family Physicians, the Wisconsin Academy of Ophthalmology, the Wisconsin Orthopaedic Society, the Wisconsin Psychiatric Association, the Wisconsin Radiological Society, the Wisconsin Society of Anesthesiologists, and the Wisconsin Society of Plastic Surgeons by Guy DuBeau and Axley Brynelson, LLP.

The case centers around Ascaris Mayo, who lost her limbs after a Milwaukee emergency room failed to identify an untreated infection. A court awarded her economic damages as well as $15 million intended to compensate for pain and suffering.

The state’s Injured Patients and Families Compensation Fund, which covers large medical malpractice claims in the state, moved to reduce the $15 million to $750,000. An appeals court backed the award and ruled the law unconstitutional.

Chief Justice Patience Roggensack wrote the majority opinion upholding the law, in part because she said the Legislature acted rationally when creating the law.

“We conclude that the Legislature's comprehensive plan that guarantees payment while controlling liability for medical malpractice through the use of insurance, contributions to the fund and a cap on noneconomic damages has a rational basis,” she wrote. “Therefore, it is not facially unconstitutional.”

Clinical Training for Treating Substance Use Disorders

Wed, 20 Jun 2018 18:27:43 GMT

Join the Wisconsin Society of Addiction Medicine on Saturday, September 29, 2018 in Madison for a high-impact workshop day designed to provide education on high quality, evidence-based practices.

The case-based learning format is designed for front line clinicians and trainees who have faced and will face the challenge of helping patients with substance use disorders. Clinicians who will benefit include nurse practitioners, physician assistants, primary care providers, emergency room providers, and other sub-specialists. Two morning and one afternoon options are available, including:

The ASAM Treatment of Opioid Disorder Course: Focus on Buprenorphine
Naltrexone in Treatment for Alcohol and Opioid Use Disorders: Case Studies and Practical Applications
Buprenorphine 2.0: I Have My X-DEA, So Now What? Case Studies and Practical Applications

Learn more and register.

WACEP FitWell Contest Begins July 1

Tue, 19 Jun 2018 16:25:31 GMT

FitWell is a wellness initiative of the Wisconsin Chapter, ACEP, that encourages members to exercise and share their successes. The contest is open to Wisconsin EM physicians, EM residents, medical student members of an EMIG, and APPs. One contest participant will be randomly selected to win a WACEP braded fleece, and $200 to be applied toward a gym/club membership of their choice. Contest Guidelines include:

On Twitter or Instagram using hashtag #fitwellWACEP, post pics of yourself being active, during a workout, or tips on how to squeeze physical activity into your busy day. Make sure your posts are public!
Tag your EM friends on your posts and your entries will count double!
One entry per post with unlimited entries.
All entries must be posted by August 31, 2018. Winner will be chosen by random drawing on September 1^st.

Questions? Contact us at WACEP@badgerbay.co.

Initiative Aims to Provide Statewide Dispatcher-Assisted CPR Instructions

Tue, 19 Jun 2018 15:27:26 GMT

Suzanne Martens, MD
State of Wisconsin EMS Medical Director

The Advancing a Healthier Wisconsin Endowment has awarded funding to the Wisconsin EMS Association, which will help expand a Milwaukee County pilot project for dispatcher-assisted CPR instructions statewide.

The Milwaukee County Dispatcher Assisted Bystander CPR program was created to increase the overall cardiac arrest survival rate within the Milwaukee County. Through the program, dispatcher assisted bystander CPR pre-arrival instructions are made available to all callers in the County.

Out-of-hospital cardiac arrest is a significant health problem. In Milwaukee County, only 10% of out-of-hospital cardiac arrest patients survive to hospital discharge. When CPR is started by bystanders, the odds of survival double, however, bystander CPR is attempted on only 19% of cardiac arrest victims in the County. This rate could be improved if every 911 caller received CPR coaching. With the implementation of dispatcher assisted CPR instructions in Seattle, Washington, the rate of bystander CPR doubled and survival rates for the entire County increased.

2017 Wisconsin ACT 296, Dispatcher Assisted CPR, mandates that by May 21, 2021, every Public Safety Answering Point (PSAP) will provide dispatcher assisted CPR in one of two methods, either by dispatcher training or call transfer to a trained PSAP. This program will also include monitoring and continuous quality improvement. Act 296:

affords protection from civil liability in performance of dispatcher assisted CPR;
provides $250,000 for fiscal year 2017-18 in funding for emergency dispatcher CPR;
specifies that DHS must include a proposal for funding an emergency dispatcher CPR training in its 2019-21 biennial budget request;
creates a 0.5 full-time equivalent position in DHS to administer the emergency dispatcher CPR training grant program.

The bill was strongly supported by members of the WI EMS Advisory Board, as well as representatives from the American Heart Association, and its enactment was recognized on the HeartRescue Project website.

The Milwaukee County EMS dispatch pre-arrival instructions for CPR are freely available. PSAPs that pursue training will require assistance and medical oversight. EM and EMS physicians will be asked to support these programs and their community. Start asking questions and becoming involved now. Three years is not a lot of time to enact this vital public safety program, and sooner is better.

President's Message, June 2018

Mon, 18 Jun 2018 19:32:25 GMT

Lisa Maurer, MD, FACEP

At the risk of addressing a sensitive topic perhaps not ideally discussed via email newsletter, WACEP needs feedback from our members on how, or if, we should be involved in possible future Wisconsin firearm regulations.

Inspired by Dr. Stephen Hargarten’s presentation at WACEP Spring Symposium 2017, I believe there is room for growth in how physicians discuss firearm safety from a health perspective while steering clear of political biases. Who better to give input than my colleagues working in Wisconsin’s EDs every day?

This will be a timely legislative topic for Wisconsin in the near future, judging by the fact that the Wisconsin Legislative Council released an Information Memorandum on Firearm Regulation this last session. If we should be involved in possible future regulations, it is useful to learn about the regulation currently in place in Wisconsin. The memorandum summarizes that Wisconsin’s constitution gives people have the right to keep and bear arms for security, defense, hunting, recreation, or any other lawful purpose. Current regulations (including pertinent federal laws):

Prohibit possession of a firearm by individuals who are: convicted of a felony or domestic violence crime, involuntarily committed under chapter 51 statute, adjudicated incompetent, addicted to any controlled substance, or under the age of 18;
Permit background checks in specific scenarios such as purchasing a firearm from a federal firearm licensed dealer or to apply for a license to carry a concealed weapon;
Impose penalties for transferring firearms to an ineligible person or providing false information;
Provide geographic restrictions on carrying a firearm. For example, a person may not carry a firearm onto a public or private property if the owner has notified the person not to enter while carrying a firearm, into a school zone, or in a vehicle for the case of loaded long guns; and
Regulate certain devices such as fully automatic firearms, armor-piercing ammunition, and special processes for obtaining silencers.

Our country has seen growing momentum for a particular type of firearm regulation known as “red flag laws,” where courts and police may temporarily seize an individual's firearms if they are thought to be a threat to self or others. This type of regulation now exists in six states and is being considered in 20 more, including Wisconsin. The specifics of the “red flag” laws vary from state to state. Generally, police may only seize firearms owned by the individual in question, even if there may be other firearms in the home owned by others. The individual typically has an annual opportunity to petition the court for return of their firearm, although that time interval may be shorter in some states. Also, the definition of “thought to be a threat” can be described as “substantially likely to harm” or the more difficult to prove, “imminent danger.” Likewise, the type of individuals permitted to make this judgement of threat varies among states. Some states specify that immediate family members may be the ones to notify police, whereas other states include household members or other close contacts.

To my knowledge, no state includes physicians in the list of specific contacts that may alert law enforcement for the purpose of firearm possession regarding an individual thought to pose a threat to themselves or others. Should Wisconsin include physicians as they consider “red flag” laws? This is ironically reminiscent of our statutes regarding involuntary holds for psychiatric disease that may render an individual an imminent threat to themselves or others. Seeing as our state’s process of placing and removing Emergency Detention holds is so unique, should we be the pioneers of implementing a similar system for physicians alerting officers when it may be indicated to remove someone’s firearm? On the other hand, many emergency physicians in Wisconsin suggest that the Emergency Detention process in our state should be completely revised. Perhaps we should avoid reinforcing that system by mirroring it in another statute.

In summary, WACEP is looking for your opinion: if Wisconsin decides to proceed with a “red flag” firearm regulation, should physicians be among the individuals who are allowed to make the determination of threat to self or others? Please do send us your thoughts!

My LAC Experience

Thu, 07 Jun 2018 22:17:09 GMT

Rosalia Holzman, MD
Univ. of WI Emergency Medicine Residency, Class of 2020

As I have progressed through my training, I have realized more and more that I cannot expect things to change just because I believe something is wrong or unfair. It takes initiative from those who identify different issues to work towards a solution. It finally occurred to me that this includes myself. I need to speak up for what needs to change. My residency program passed along information about the ACEP Leadership & Advocacy Conference (LAC) and I knew immediately I wanted to go.

It was an amazing experience (especially for my first national conference as an emergency intern) and I cannot wait to go back again. I met so many motivated and passionate emergency physicians that are going to change our practice and our country for the better. I sat through different sessions on the opioid epidemic, medicare reimbursement, drug shortages, and more. There was an amazing panel discussing women in leadership in emergency medicine and how women like myself need to step up to the table and make ourselves heard. We also had the opportunity to listen to the Surgeon General as our keynote speaker!

On top of conference sessions and discussions, we spent an entire day on Capitol Hill advocating for 3 particular issues: the opioid crisis, drug shortages, and disaster preparedness. It was an eventful day working alongside fellow Wisconsin EM physicians. This conference really opened my eyes as to everything that is being done and all of the opportunities there are for me to really advocate for my patients and my profession. I would like to thank WACEP for helping me attend the conference, and I cannot wait to get more involved!

President's Message, May 2018

Tue, 15 May 2018 15:05:37 GMT

Lisa Maurer, MD, FACEP

One of WACEP’s three priority issues this year is to improve Wisconsin's Medicaid reimbursement for emergency care. For many of you who are seasoned members of this organization, you know that this is not a new goal. Before your eyes glaze over and you scroll on, know that this is now a truly re-energized movement for the last few years, and we are closer than ever. We are currently having active meetings with the decision makers within DHS, who now recognize that as our emergency physicians are being reimbursed worse than any other state in the nation, our healthcare safety net is not sustainable. Record-low reimbursement for federally-mandated care is making it hard for our physician groups and hospitals to compete with Illinois and Minnesota for quality emergency physicians.

Perhaps we are getting such a captive audience within DHS because we come with solutions on how to trim unnecessary costs from the Medicaid budget, which funds could then be used for proper reimbursement. It makes sense, right? We are emergency physicians, we are the solutions people. Our board has been working for years on gathering data on several ideas of how the state might not only maintain or improve quality of care delivered in the emergency department, but how they can save money doing it.

What would you do?

Looking at Medicaid waiver demonstrations in many states, the current trend to save money i state budgets is to implement work requirements as a condition of eligibility for Medicaid, increase cost-sharing for Medicaid enrollees, and - right in our backyard - add ED copays. In fact, Wisconsin DHS has applied for a waiver demonstration in our state that would implement work requirements, impose drug screening, and also add copays for ED care. To clarify, whereas traditionally allowed ED copays for Medicaid enrollees are applied to visits determined to be “non-emergent,” the proposed ED copays in Wisconsin would be for any ED visit. This does sound appealing at first glance, but history has proven that states that implement ED copays do not actually reduce non-emergent visits to the emergency department nor save money on their Medicaid budgets.

So again, if our state is currently using the above-mentioned methods for saving money and attempts at decreasing non-emergency visits to the emergency department, but perhaps will not be very successful, what should we tell them to do instead? Is there a certain health system flaw in Wisconsin that leads patients to your ED unnecessarily? Have you found a practice pattern that helps Medicaid beneficiaries to get plugged into the appropriate outpatient resources in your community? Do you think that if EM physicians participate more actively in determining which visits were non-emergent, then the ED co-pays would be more effective? I sincerely believe that emergency physicians are unavoidably systems-minded physicians and have many solutions to offer that might be more insightful than what the agency professionals can see from the outside. Let's help them, let's be part of the solution. Let's get this system change done this year to bolster our state’s emergency medicine network. Send me your ideas!

EATWELL Wellness Initiative Photos

Tue, 15 May 2018 12:59:15 GMT

Wisconsin ACEP is proud to announce the conclusion of our EATWELL contest, the first of many wellness topics we will tackle in the upcoming months. Thank you to all who posted pictures of your health conscious meals and amazing eating tips to inspire your colleagues to take care of themselves. We will announce the winner via Facebook, Twitter and Instagram soon, so stayed tuned!

Make Change Happen in ACEP

Thu, 03 May 2018 16:04:33 GMT

The ACEP Council meeting is YOUR opportunity to influence the ACEP agenda. If you have a hot topic that you believe ACEP should address, let your Wisconsin ACEP Councillors know! Resolutions must be written ans submitted by July 1. Your WACEP Councillors for 2018 include:

Howie Croft, MD
William Falco, MD
William Haselow, MD
Jeff Pothof, MD
Bobby Redwood, MD, MPH
Mike Repplinger, MD, PhD
Alternate Councillors: Lisa Maurer, MD and Jamie Schneider, MD

It takes just two members to submit a resolution. Contact any of the Chapter Councillors us through the WACEP office. Learn more about the process of submitting resolutions here.

Free Training on Medication-Assisted Treatment

Thu, 03 May 2018 16:00:59 GMT

Eight hours of training on medication-assisted treatment (MAT) is required to obtain a waiver from the Drug Enforcement Agency to prescribe buprenorphine, one of three medications approved by the FDA for the treatment of opioid use disorder. Providers Clinical Support System (PCSS)offers free waiver training for physicians to prescribe medication for the treatment of opioid use disorder.

PCSS uses three formats in training on MAT:

Live eight-hour training
“Half and Half” format, which involves 3.75 hours of online training and 4.25 hours of face-to-face training.
Live training (provided in a webinar format) and an online portion that must be completed after participating in the full live training webinar (Provided twice a month by PCSS partner organization American Osteopathic Academy of Addiction Medicine)

LAC is May 20-23 - Register Today!

Thu, 03 May 2018 15:57:23 GMT

Don’t Miss the Premiere Event for Emergency Medicine Advocates and Leaders!

Attendees at ACEP's annual Leadership & Advocacy Conference will advocate for improvements in the practice environment for our specialty and access for our patients. First-timers will receive special training on how to meet and educate your Members of Congress while seasoned participants will build upon valuable Congressional connections. A new “Solutions Summit” has been added on May 23 where attendees will discover innovative solutions on key topics such as opioids and end-of-life issues that demonstrate emergency medicine's value and leadership. CME credit will be given for the Summit.

Confirmed Speakers Include:

U.S. Surgeon General Vice Admiral (VADM) Jerome M. Adams, M.D., M.P.H.
HHS Assistant Secretary for Preparedness and Response Bill Kadlec, MD will be presenting during the Public Policy Town Hall on Emergency Preparedness.
Amy Walter, National Editor for The Cook Political Report, will offer her predictions for the mid-term elections.
Senator Bill Cassidy, MD (R-LA)
Representative Kyrsten Sinema (D-AZ)

New ACEP Resources Available

Thu, 03 May 2018 15:54:55 GMT

Policy statements on Alcohol Advertising and Trauma Care Systems were recently revised and approved by the ACEP Board of Directors. Furthermore, four information papers and once resource paper were recently created by ACEP committees:

Disparities in Emergency Care – Public Health and Injury Prevention Committee
Empiric and Descriptive Analysis of ACEP Charges of Ethical Violations and Other Misconduct – Ethics Committee
Fostering Diversity in Emergency Medicine through Mentorship, Sponsorship, and Coaching – Academic Affairs Committee
The Single Accreditation System – Academic Affairs Committee
Resource: Opioid Counseling in the Emergency Department – Emergency Medicine Practice Committee

These resources will be available on the new ACEP website when it launches later this month. In the meantime, for a copy of any of the above, please contact Julie Wassom, ACEP's Policy and Practice Coordinator.

Maurer Recognized with Council Horizon Award

Wed, 02 May 2018 19:40:13 GMT

Lisa Maurer, MD, FACEP, President of the Wisconsin Chapter, ACEP, is the 2018 recipient of the National ACEP Council Horizon Award.

This award is presented to an individual within the first five years of Council service who demonstrates outstanding contributions and participation in Council activities. Past award winners include Gary Katz, Nathaniel Schlicher, and Alison Haddock.

Lisa's nomination stood out because her Council leadership, like her Chapter leadership, is exemplified by focus, hard work, and an ability to motivate others.

Help Stop Anthem's Denial of Emergency Care Coverage

Wed, 02 May 2018 18:28:32 GMT

Anthem Blue Cross Blue Shield has announced it will not pay for emergency visits in six states—Indiana, Georgia, Kentucky, Missouri, New Hampshire and Ohio—if the company decides after the fact that patients were not having medical emergencies, even if they thought they were! But how do you know? Do you know the difference between a migraine and a brain aneurysm?

Unless stopped, this policy will be implemented in more states where Anthem "provides coverage," and it is likely more health insurance companies will follow with similar unlawful policies of their own.

On May 1^st, ACEP launched a video campaign to continue exposing Anthem for denying coverage to emergency patients. View and share the videos, linked below, and visit www.FairCoverage.org for important information on how to put an end to Anthem’s unlawful policy.

Video: Aneurysm or stomach cramps?
https://www.youtube.com/watch?v=GB28DDFnDFk

Video: Chest pain or injured ribs?
https://www.youtube.com/watch?v=zqyHWOSI340

Only 5.5 Percent of Emergency Visits Are Nonurgent and Wait Times Continue to Improve, CDC Says

Tue, 01 May 2018 14:07:46 GMT

New data from the Centers for Disease Control and Prevention (CDC) show that 136.9 million people visited the emergency department in 2015 and only 5.5 percent of these visits were considered “nonurgent,” according to the latest CDC National Hospital Ambulatory Medical Care (NHAMC) survey.

“Emergency care is a unique success story,” said Paul Kivela, MD, MBA, FACEP, president of ACEP. “No other medical specialty is the safety net for millions of patients with such a broad range of symptoms and conditions. The nation’s emergency physicians care for any patient, any time, regardless of ability to pay — and we play an increasingly integral role in our health system.”

Wait times continued to improve, according to the report. Typically, about 35 percent of patients waited less than 15 minutes to see a provider and 68 percent were seen in less than one hour. The median wait time to see a physician or advanced practice provider is 18 minutes, and the median time spent in the emergency department was around 180 minutes, which includes time with the physician and other members of the care team and other clinical services.

Injuries, stomach pain and chest pain top the list of conditions bringing patients to the emergency department. Various injuries accounted for about 28 percent of visits. Illness accounted for about 65 percent of visits, and mental health related conditions or other reasons made up the remaining 7 percent or so.

Leading Reasons for Emergency Department Visits

Symptom	Number of Visits	% Total Visits
Stomach and abdominal pain, cramps and spasms	12 million	8.8%
Chest pain and related symptoms	7.2 million	5.3%
Fever	5.9 million	4.4%
Cough	4.5 million	3.4%
Headache	3.8 million	2.8%

The leading causes of injury were falls (10.6 million visits, 25 percent of injuries) and motor vehicle crashes (4 million visits, 9.6 percent of injuries).

Among the highest users of emergency care, 15.6 percent of patients are senior citizens (age 65 or older) and 19.8 percent are pediatric patients (under age 15).

“Patients are living longer, managing more complex and chronic conditions and for many reasons may not always receive regular primary care,” said Dr. Kivela. “This means the emergency department is now more than ever the ‘front door’ to the hospital – our care and reimbursement models must continue to evolve to reflect this reality.”

Nearly two in five (38 percent) of the 2.2 million emergency visits by seniors residing in nursing homes resulted in hospital admissions with an average length of stay reaching 5.5 days. And, a full two-thirds (67 percent) of hospital inpatients were processed through the emergency department, according to the Emergency Department Benchmarking Alliance, another source of performance data.

Among patients presenting with chronic disease, the most frequent conditions reported were hypertension (23.6 percent), diabetes (10.9 percent), asthma (9.8 percent), substance/alcohol abuse (9.4 percent), depression (9.3 percent), and coronary artery disease (6 percent). Patients with a primary diagnosis of a mental disorder visited the emergency department 5.7 million times. Slightly less than half of those patients were seen by mental health providers while in the emergency department.

For the second year, Medicaid and CHIP (Children’s Health Insurance Program) were the largest payment sources (34.8 percent). Private insurance covered 34.3 percent of visits, followed by Medicare (17.7 percent) and the uninsured (9.8 percent).

Some insurance companies continue to deny coverage for emergency visits that they do not deem to be emergencies, putting patients in the risky position of self-diagnosing, potentially delaying or avoiding necessary care.

“Your insurance company is legally required to cover your emergency visit based on your symptoms, not the final diagnosis,” said Dr. Kivela. “Insurance that abandons you in an emergency is no insurance at all. With nearly 90 percent of urgent and nonurgent symptoms overlapping, insurers should not leave patients to figure out themselves if their symptoms are truly life-threatening.”

The report also found that patients were transported to the emergency department by ambulance 23 million times in 2015. And, almost 60 percent of emergency care is delivered outside of traditional business hours (8am-5pm).

The CDC National Hospital Ambulatory Medical Care (NHAMC) survey is based on 21,061 emergency patient reports from 267 emergency departments. The data does not include freestanding emergency centers.

Summary tables are available here: https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf

Essentials of Suicide Prevention in the ED

Tue, 01 May 2018 13:49:32 GMT

Mental Health America of Wisconsin has released "The Essentials of Suicide Prevention in the Emergency Department." This document includes links to resources, including the five core suicide prevention interventions for the ED.

Khong Receives National Honorable Mention

Tue, 01 May 2018 12:24:51 GMT

Brittaney Khong, a medical student at the University of Wisconsin, Madison, received Honorable Mention in the ACEP 2018 National Outstanding Medical Student Award Program.

Four medical student awardees and two honorable mentions were selected from numerous submissions from across the country. The program recognizes medicals students who demonstrate humanism, professionalism, and clinical judgment; scholarly achievement; leadership and service to medical organizations with a focus on service and advocacy; community service; research and publications.

Khong's nomination was submitted with the following testimonials:

“ On shift, we consistently saw BK exemplify the behaviour and attitude of a provider who carries herself with true compassion and empathy."

"...when it came time for faculty to consider a student to nominate for this award, Brittaney Khong was the standout choice. She truly embodies the definition of this award, as she has demonstrated clinical excellence, dedication to patient care as a service opportunity, devotion to community service, and leadership experience.”

Khong will receive a certificate of achievement as well as an invitation to the ACEP Academic Affairs Committee meeting and mentions in ACEP Now and on the ACEP website.

Supreme Court hears arguments on cap on damages

Fri, 20 Apr 2018 01:10:22 GMT

WMS Medigram, April 19

The Wisconsin Supreme Court heard arguments this morning in Mayo v. Wisconsin Injured Patients and Families Compensation Fund, a case involving a constitutional challenge to Wisconsin’s $750,000 cap on noneconomic damages in medical liability cases (Cap). The case could have far-reaching effects on Wisconsin’s well-balanced, relatively stable medical liability environment.

On July 5, 2017 the Wisconsin Court of Appeals struck down the Cap, concluding that it violates the equal protection rights of plaintiffs in medical liability cases. The Wisconsin Supreme Court subsequently agreed to review the lower appellate court’s decision. On Jan. 18, 2018 the Society, along with the AMA Litigation Center, filed an amicus brief in support of the Cap, explaining its value to patients and the health care community alike. For more background on the Mayo case, see this article from the Oct. 9, 2014 Medigram.

Today’s arguments provided the Court’s seven members with the opportunity to ask questions, follow up on points raised in briefs, including the Society’s amicus brief, and give an indication of their thinking.

“It’s clear from the questions raised today that the Court understands the lengths the legislature went to create a well-balanced, comprehensive medical liability system that provides unique protections for Wisconsin patients and why the cap is essential to that system,” said Society General Counsel John Rather, JD. “We are encouraged with what we heard today and are hopeful the Court will restore the cap.”

The Court spent a considerable portion of the arguments exploring the relationship of the Cap to controlling health care liability and overall health care costs, attracting and retaining physicians and protecting the viability of the Fund.

A decision by the Supreme Court is expected by mid-summer. For more information, contact John Rather, JD. For an in-depth examination of the Mayo case and its implications for Wisconsin health care, listen to Episode 3 of WisMed OnCall, “The Mayo Case and Its Potential Impact,” available here.

President's Message, April 2018

Wed, 18 Apr 2018 17:41:28 GMT

Lisa Maurer, MD, FACEP

Wisconsin is unique. We use the word "bubbler." We drink our Old Fashioneds with brandy. And our process for Emergency Detention psychiatric holds is unlike most you’ll find in most of the rest of the country. Yeah us!

A big headline you need to know about is the recent passage of new WI law that changes the liability environment around ED holds for physicians. We’ve enlisted help from an attorney to interpret this new law from the viewpoint of an emergency physician, so be sure to read his summary memo and FAQs. This new law clarifies that if you have concern that a patient should be on an ED hold and notify the proper authorities, you are not responsible for involuntarily treating the patient or preventing them from leaving the hospital if the patient is not placed on hold. What’s more, you are not liable for any harm done by the patient to him/herself or others thereafter.

One question that came up during our most recent WACEP board meeting was, "does this new statute mean that if we do not reach out to county officials for an ED hold that we are at increased liability risk for future harm done?" Our legal counsel says "no." As always, be sure to document your reasoning for why information available to you at the time of evaluation leads you to conclude there is not a substantial probability of harm.

Lastly, we asked for clarification of the language in this bill which protects physicians from liability in releasing personal health information (PHI) to third parties in good faith due to lessen a threat of future harm. For example, a physician would be protected from liability if he/she shared information to a third party about a patient is homicidal toward a particular individual. The question was whether this interpretation could be extended to cover liability for releasing PHI to friends or family members of a patient who accidentally overdoses on opioids, with the thinking that informing third parties may reduce risk of future self-harm by the patient. Legal counsel states there is a potential safe harbor in this law for doing so, but interpretation really hinges on whether you conclude that an accidental overdose translates to true risk of self-harm. Since the risk of self-harm is your judgement to make as a physician, use this information to help protect you if you believe a patient is at clear risk for future self-harm; be sure to properly document that risk to be in compliance with federal, and now state HIPAA law.

Also, here at WACEP, improving the process for caring for our patients in psychiatric crisis is one of our top priority goals. I’m so excited to let you know that we are actively working with the Wisconsin Psychiatric Association on removing barriers to shortening the length of stay for our patients in the ED on Chapter 51 holds. We’re even discussing if there could be a statewide common-sense standard for “medical clearance” before psychiatric admissions, based on physician assessment of medical risk rather than predetermined cookbook protocols. The sub-committee of physicians from both organizations working on this topic is looking to change your practice for the better, so please let us know if you have input.

Call for Volunteers! Mock Oral Boards Days

Wed, 18 Apr 2018 17:24:06 GMT

WACEP members are invited to participate and help out at the upcoming mock Oral Boards events at both MCW and UW! If you are interested, please reach out directly as indicated below.

Medical College of Wisconsin - Mock Oral Boards Day at MCW is Thursday, May 31st from approximately 7:30 am to 12:00 pm. Volunteers are needed for a minimum two-hour time slot, or for the full session. Any help from WACEP members is appreciated. Sign up to volunteer by contacting Jamie Aranda, MD at jaranda@mcw.edu.

University of Wisconsin – Oral Boards Day for residents at UW is Thursday, June 7th from 8:00 to 11:00 am. Cases will be prepared ahead of time, and faculty will be responsible for administering the cases to residents and providing feedback on their performance. Four or five volunteers are being sought from outside UW’s EM department. If interested, please contact Aaron Kraut, MD at askraut@medicine.wisc.edu.

Legislative Update, Spring 2018

Wed, 18 Apr 2018 16:11:12 GMT

Eric Jensen, WACEP Lobbyist

Mayo v. WIPFCF, et al.: The Mayo case will be argued before the Wisconsin Supreme Court on Thursday, April 19^th. Before the Court is an Appeals Court decision rendering Wisconsin’s cap on non-economic damages in medical liability cases unconstitutional. At present, pending the Court’s decision (not expected until sometime this summer), there is effectively no cap on non-economic damages. WACEP led a coalition of eight medical specialty organizations in writing and submitting an Amicus (“friend of the court”) brief in defense of the caps.

AB 538 Signed into Law: Governor Walker signed Assembly Bill 538 (now 2017 Act 140) providing emergency physicians additional liability protections in cases involving involuntary commitments. Quoting from a memo written by WACEP counsel, Guy DuBeau:

"The Act accomplishes three major goals toward this end. Specifically, the Act clarifies that providers acting in good faith can seek, without fear of liability, emergency detention even though the process must be formally initiated by law enforcement or county crisis workers. The Act also provides greater control over transfers in that it requires emergency providers to agree that transfer is medically appropriate before the transfer can be made by law enforcement. Lastly, the Act explicitly aligns Wisconsin law with HIPAA by noting that providers may disclose information to third parties in good faith effort to prevent or lessen as serious and imminent threat to third parties."

Medicaid Reimbursement for Emergency Physician Services: Known all too well to you, Wisconsin lags the nation in terms of Medicaid reimbursement for physician services, ranking a shocking 50^th for its rate paid for Level 2, 3 and 4 trauma services; it’s a remarkable situation given Wisconsin’s consistently high overall healthcare rankings. In early April, WACEP President, Lisa Maurer, MD and WACEP’s government affairs consultant met with new Medicaid Director, Heather Smith, in our continuing effort to educate policy-makers about the situation and its consequences for emergency care in Wisconsin, and ultimately to increase reimbursements to a level that is at least competitive with our border states.

Earlier this year, WACEP succeeded in convincing the Legislature’s Joint Finance Committee, and ultimately the full Legislature, to insert a provision into the State Budget bill directing the Department of Health Services (DHS) to convene a working group including WACEP members to discuss ideas for saving money in Medicaid emergency room services to be used to increase reimbursements without increasing overall taxpayer dollars committed. At the request of the prior Medicaid Director, Governor Walker ultimately vetoed the provision citing overlapping existing efforts within DHS; but the issue is now on the radar screens of policy makers in the Legislature and Administration.

Doctor Day 2018 and 2019: As many of you know, on January 30^th nearly 500 physicians and medical students came to Madison for the 5^th annual Doctor Day advocacy event – our biggest turnout yet! While in Madison, attendees heard from Governor Walker, received a legal update on the Mayo case in which a state appeals court invalidated Wisconsin’s non-economic damages cap for medical liability cases, appeal of which is now pending before the Wisconsin Supreme Court, listened to a legal discussion relating to network adequacy and surprise billing. The morning session wrapped with briefings on issues including worker’s compensation, advanced practice nurse collaboration and chiropractors conducting youth sports physicals. Once again, following an afternoon of legislative visits attendees retired to a nearby restaurant for debriefing and camaraderie. Looking ahead, next year’s event will be scheduled later in the year to better coincide with the Legislature’s primary activity for the year – the State Budget. Subject to change, Doctor Day 2019 is tentatively scheduled for May 1, 2019 – mark your calendars now!

Chiropractor Sports Physicals: One of the items discussed at Doctor Day, Assembly Bill 260, in its original form would have authorized chiropractors to conduct youth pre-participation athletic physical exams and require the WIAA to accept those exams for athletic participation. WACEP joined a large number of health care organizations opposing AB 260, but last June the bill passed the State Assembly. In the wake of Doctor Day, however, the Senate Health Committee amended AB 260 to remove the sports physical authority (with the amendment, physician organizations dropped their opposition). The amended AB 260 then passed the Senate, was concurred in by the Assembly and ultimately signed by Governor Walker. This is a testament to the impact of physicians can have lobbying their lawmakers at Doctor Day!

Campaign Season is Upon Us: Finally, with an odd-year Spring finally upon us, the Legislature has formally adjourned the 2917-18 Session and heads off to campaign for November. Republicans presently dominate Wisconsin politics holding the Governor’s office, the Attorney General’s office, a 63-35 majority in the Assembly and a 18-15 majority in the Senate. November will see races for Governor, Attorney General, all 99 Assembly seats and 17 of the 33 Senate seats. (As well as all 8 of Wisconsin’s Congressional seats and one U.S. Senate seat.) Recent special elections and Supreme Court elections in Wisconsin, as well as other states, suggest a typical anti-President’s party mid-term election coming. Republicans downplay prospects of a “blue wave” election favoring Democrats, touting Wisconsin’s economic status and low unemployment among their achievements. Democrats, meanwhile, believe the electorate is ready for change and are working hard to recruit candidates and raise money in as many Wisconsin districts as possible. There is much time between now and November, and elections tend to tighten up as voting day approaches regardless of who appears to be leading early on, but without a doubt 2018 is shaping up to be another in a series of very interesting recent Election Days.

Dates Set for WACEP 2019 Spring Symposium

Tue, 17 Apr 2018 14:36:42 GMT

Save-the-Date! Mark your calendars and plan to attend the WACEP 2019 Spring Symposium & 27th Annual Emergency Medicine Research Forum. The event will take place April 3-4, 2019 at the Harley-Davidson Museum, Milwaukee WI. Stay tuned for more details.

Ahrens Recognized with Young Physician Award

Mon, 16 Apr 2018 18:43:53 GMT

The annual WMS Foundation Fundraising Dinner took place on Friday, April 13 on the eve of the Wisconsin Medical Society's 2018 Annual Meeting, and WACEP was proud to sponsor the event, during which BayCare Emergency Physician Dr. Kerry Ahrens MD, MS was awarded the Kenneth M. Viste, Jr. MD Young Physician Award. This award is presented each year to a young physician who demonstrates commitment to patients, the medical profession and the community.

Doctor Ahrens serves as chair of the Wisconsin Stroke Coalition and medical director for the Oshkosh Fire Department, provides director level services for outlying smaller emergency medical services agencies, sits on the board of the Region 6 Regional Trauma and Advisory Counsel and is an associate professor for the University of Wisconsin School of Medicine and Public Health working with residents as a physician on UW MedFlight. She was nominated by her colleagues for her tireless advocacy work and for serving as a trusted source for medical and wellness information for the Green Bay media and her advocacy related to rural health issues, alternatives to opiates, vaccinations, driver safety, and bicycle and motorcycle helmet use.

The Foundation dinner was emceed by Rep. John Nygren (R-Marinette), pictured here in the center with WACEP Past President Bobby Redwood, MD, MPH, FACEP, (left), and WACEP President-Elect Jeff Pothof, MD, FACEP (right).

EM Represented at WMS House of Delegates

Mon, 16 Apr 2018 17:31:39 GMT

Brad Burmeister, MD, EM Delegate to WMS

The WACEP delegation braved Blizzard Evelyn to attend the 2018 Wisconsin Medical Society House of Delegates (HOD) April 14-15.

This year, WACEP, together with the Wisconsin Society of Anesthesiologists, proposed a resolution regarding consensus principles on Insurance Coverage for Out-of-Network Care. This resolution seeks to outlay principles to address the issues of balanced billing and surprise out-of-network bills our patients receive.

Other issues germane to Emergency medicine that were addressed at the HOD include:

Elimination of Prior Authorization for Buprenorphine
Opposition to Medicaid Work Requirements, Drug Screening Requirements, and Eligibility Limits
Support for National (and State) Registry for Advanced Directives
Public Health Case for Firearm Regulation

If you have any interest in advocacy or policy and would like to attend a future meeting of the Wisconsin Medical Society please contact us! The society values input from Emergency Physicians and there is room for more representatives from our specialty.

Your membership with WACEP and WMS is valuable as we continue to work on the important issues such as those listed above. If your WMS membership has lapsed but you are willing to reconsider membership, please contact Diane Stampfli, diane.stampfli@wismed.org. Maximizing Emergency physician membership with the Society is an important aspect of our Emergency Medicine Section’s advocacy efforts.

WACEP EatWell Contest Runs April 15 to May 15

Sun, 15 Apr 2018 13:43:27 GMT

EATWELL is a wellness initiative of the Wisconsin Chapter, ACEP, encouraging members to eat well and share their successes! The contest is open to Wisconsin EM physicians, EM residents, medical student members of their EMIG, and APPs.

One winner will be randomly selected for a WACEP fleece, and $200 to be applied toward food/catering for you and your colleagues during a shift in the ED or a department meeting.

Contest Rules:

Post your pictures of healthy snacks, meals or healthy eating tips on Facebook or Twitter using the hashtag #eatwellWACEP. (Make sure your posts are public!).
Follow WACEP on Twitter @WisconsinACEP and Facebook @WiACEP
One entry per post. Unlimited entries.
One winner will be randomly selected by drawing on May 15, 2018.

Statewide Prescription Drug Take Back Day is April 28

Fri, 13 Apr 2018 14:31:06 GMT

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

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

Drug take back days are held each spring across the country. The October 2017 Drug Take Back events in Wisconsin collected 63,941 pounds of unused medications, the largest fall drug take back collection to date. Wisconsin also had more law enforcement agencies participate than any other state in the country with 266 police and sheriffs’ departments hosting 130 events. Since October 2015, the Drug Take Back Day program has successfully collected and disposed of nearly 360,000 pounds of unused medications in Wisconsin alone.

In addition to the semiannual Take Back Day, there are 349 permanent drug disposal drop boxes throughout Wisconsin, providing citizens a convenient, environmentally friendly and anonymous way to dispose of unused medications all year.

For more information, including a list of accepted medications, visit the “Dose of Reality” website, which also features an interactive map to find a drug take-back location.

Governor Walker Proclaims April 23-29 National Addiction Treatment Week

Tue, 03 Apr 2018 16:42:25 GMT

Scott Walker, Governor of Wisconsin, signs proclamation declaring April 23-29, 2018 "Addiction Treatment Awareness Week" throughout the State of Wisconsin. National Addiction Treatment Week, an initiative by the American Society of Addiction Medicine (ASAM), raises awareness that addiction is a disease, evidence-based treatments are available, and recovery is possible.

Nearly 20.5 million Americans suffer from a substance use disorder (SUD), yet only 1 in 10 people with SUD receive treatment.[1] An estimated 1.8 million Americans have opioid use disorder (OUD) related to prescription opioids [2]; 626,000 have heroin-related OUD [3] with an estimated cost of over $504 billion [4]. Every year in the State of Wisconsin, an average of at least 1,706 people die from an alcohol-related issue. In 2016, an estimated 1,074 people died from a drug overdose in Wisconsin [5], according to the Center for Disease Control and Prevention (CDC).

“Generating awareness that addiction is a disease and more clinicians need to be trained in addiction medicine is critical to saving patients’ lives.” said Matthew Felgus, MD, FASAM, President, Wisconsin Society of Addiction Medicine. “We are thrilled that Governor Walker has taken this important step to help increase awareness in Wisconsin.”

National Addiction Treatment Week promotes that addiction is a disease, recovery is possible, and more clinicians need to enter the field of addiction medicine.

Learn more on how to get involved and spread the word about the need for a larger addiction medicine workforce.

1 U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016. CH 4-2
2 Council of Economic Advisers. (2017, November). The underestimated cost of the opioid crisis. Washington, DC: Executive Office of the President of the United States.
3 ibid
4 Center for Behavioral Health Statistics and Quality. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration
5 https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm

IPFCF Board Approves Fund Fee Decrease

Mon, 26 Mar 2018 13:49:50 GMT

March 23, Wisconsin Medical Society Insurance and Financial Services

The Injured Patients and Families Compensation Fund (Fund) Board this week approved a 10 percent decrease in Fund fees for the 2018-2019 fiscal year. This is the sixth decrease approved by the Fund Board in as many years.

Wisconsin’s excellent medical liability environment is good for your organization’s business: money not spent to obtain coverage and settle claims can be allocated to improve quality and the overall patient experience.

Your Wisconsin Medical Society (Society) continues to work vigilantly to preserve Wisconsin’s relatively stable medical liability environment, most recently by filing amicus briefs at both the appellate and Supreme Court level in Mayo v. the Injured Patients and Families Compensation Fund—a case that has challenged the constitutionality of the state’s cap on noneconomic damages in medical liability cases. We are also maintaining our active involvement in the primary insurance market, working with our exclusive partner, ProAssurance. Additionally, the WMS Holdings Risk Purchasing Group and Captive are designed to help health systems decrease liability costs and improve quality and efficiency.

The Society was influential in obtaining this rate reduction through its participation on the Fund Board. This is a great example of how the Society’s advocacy efforts—which the profits generated by Wisconsin Medical Society Insurance & Financial Services help support—benefit the medical community in Wisconsin.

President's Message, March 2018

Sat, 24 Mar 2018 13:29:03 GMT

Lisa Maurer, MD, FACEP

A huge thanks to all who came to our 2018 Spring Symposium in Madison last week! I'm still riding high from all the amazing connections and inspiration. Nothing like getting a bunch of problem-solving EM docs together in one place! Our WACEP board is happy to have all the homework of following up on the fresh ideas and connections started there. I was especially excited to see the electric partnership between WACEP, MCW EM, and UW EM. An unstoppable trio that you can expect more from for years to come. No offense to my urban community docs (my people!), but the residents and the docs from rural Wisconsin definitely were the VIPs of the event. Your unique perspectives on our common issues are invaluable to us as an organization. Keep 'em coming.

Next up, WACEP looks ahead to having a big presence at Wisconsin Medical Society's House of Delegates meeting on April 14th in Madison and then at ACEP's Leadership and Advocacy Conference in Washington DC May 20-23. Have a flare for Wisconsin public health, the business of medicine, or medical ethics? Check out the HOD next month with our WACEP posse lead by Brad Burmeister and Jamie Schneider.

Want to dive into federal issues important to EM and meet with our federal legislators in person to discuss? I promise ACEP makes it easy. Let us know if you'd like to take advantage of WACEP funding available to support your travel expenses to the LAC.

This month, I would especially like to extend an invitation to those of you who are feeling rundown by the holes in the healthcare system that present themselves repeatedly in our departments. I can guarantee that participation in our organization in an active way will help you feel a new sense of control in your practice, and many have found it to be extremely life-giving for their careers. Give us a heads up if we can welcome you as a guest at our next board meeting on June 12th in Delafield.

Senate wraps up work, passes opioid bills

Wed, 21 Mar 2018 17:03:16 GMT

March 21, Wisconsin Health News

The Senate approved more than a dozen bills during its final planned floor period of the session Tuesday, sending them to Gov. Scott Walker’s desk for approval.

The bills range from creating an intensive care coordination program in Medicaid, supporting efforts to fight the opioid epidemic and providing grants to increase awareness of Alzheimer’s and dementia.

But the chamber didn’t take up some proposals approved by the Assembly in recent weeks. That includes bills that would define direct primary care in state law and allow small businesses to band together and self-insure their health plans.

The bills approved by the Senate and heading to the governor would:

Create an intensive care coordination pilot in the Medicaid program.
Provide funding to fight drug trafficking, support prevention, establish treatment courts and offer medication-assisted treatment to those leaving jails.
Boost treatment and prevention efforts to combat the opioid epidemic.
Allow first responders, emergency medical technicians and ambulance services providers to renew their certifications or licenses every three years instead of two years.
Allow podiatrists to supervise physician assistants and advanced practice nurse prescribers.
Axe a state law requiring the Milwaukee County Mental Health Board to appoint a board of trustees to manage its mental health facilities and modify how members are appointed to the board.
Guarantee pharmacists can delegate duties to pharmacy technicians, following confusion about current state regulation.
Allow the Department of Health Services to expand a dental reimbursement pilot program to additional counties.
Provide $500,000 to award grants to increase awareness of Alzheimer’s disease and dementia in rural and underserved areas.
Require 911 dispatchers to provide assistance on administering CPR over the phone.
Recognize supported decision-making agreements, which allow older adults and those with disabilities to designate another person to help them make a decision.
Prohibit the sale of dextromethorphan, an ingredient in over-the counter cough medicine, to children without a prescription.
Require the Department of Veterans Affairs to administer a program providing outreach and mental health services to at-risk veterans.
Make it easier for physicians licensed in other states to treat patients at certain sporting events.
Change how high an applicant has to score on an examination to be granted a chiropractor license.
Allow unaccompanied youth access to outpatient mental health treatment without parental consent.
Require health plans to cover refills of prescription eye drops

Ultrasound guidance of central lines: Archive images for reimbursement

Tue, 20 Mar 2018 13:10:15 GMT

by Dana Resop, MD

After reviewing some ultrasound images, I recently noted that we have few archived images of procedures, although we use ultrasound in procedures often. Likely we get distracted by the procedure and forget to record screen images, but the images required vary by the procedure and this may be part of the issue.

If you have an ultrasound machine in your department, most likely this is at least partly due to the Agency for Healthcare Research and Quality (AHRQ) recommendation to use dynamic ultrasound guidance for central lines. You have devoted time and money to learn to use the ultrasound and stay proficient at it. It also costs money to keep that machine working, supply sterile probe covers and gel, as well as to support the infrastructure to get the images into the patient medical record. To reimburse you for this additional knowledge, materials and practice, there is an additional reimbursement for use of ultrasound for procedural guidance in central lines (and codes for peripheral lines, procedures, etc.)

The current CPT description for Code (76937) applies to central venous access with ultrasound guidance. The description follows.

"Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent real-time ultrasound visualization of vascular needle entry, with permanent recording and reporting."

Dynamic guidance recommended for vascular procedures is different from static ultrasound guidance required for paracentesis, thoracentesis or other stable, larger targets. To document static ultrasound guidance, such as for a paracentesis, ultrasound to identify the location appropriate for procedure, archive an image for the record, mark the site, then put the probe down, prep the patient and do the procedure.

In contrast, due to the dynamic nature of venous access, ultrasound is used throughout the needle placement. In a perfect world (CPT), we capture an image of the needle entering the vessel. However, attempting this may result in one of the following: broken sterile field, dropped probe, guidewire knocked off the bed, or losing the vein. Even the ACEP Ultrasound Section experts admit obtaining this image is unlikely in most ED patient settings.1

To safely document dynamic guidance during the central line procedure, use ultrasound to identify the vein, confirm patency (squish it) and then guide needle insertion. Now feed the wire into the vessel and remove the needle from the vein. Now there is nothing sharp in the patient or in the provider’s hands. Record two images of the inserted wire in the vessel: one in short-axis and one in long-axis (See figures). This is intra-procedure documentation of dynamic guidance. It also proves that the blood vessel that will shortly be dilated with a 7-French introducer (in the hypotensive patient on blood thinners) is NOT the carotid. Two wins! Remember to save the images to the patient’s chart per your department’s practice.

For further information about use of ultrasound, including guidelines about documenting and billing, please refer to Ultrasound the ACEP website. Experts in the ACEP Ultrasound interest group have put together multiple guidelines Multiple specialties refer to these guidelines in their own literature. I’m not a billing expert, please discuss your institution’s practice with your specialists!

1: Ref: Ultrasound FAQs (2017, Feb. 13). ACEP.org. https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Financial-Issues-/-Reimbursement/Ultrasound-FAQs

Dr. Dana Resop is an EM Clinical Assistant Professor at the Univ. of WI Madison and a Board Member of WACEP. She obtained her MD at University of Wisconsin School of Medicine and Public Health, and her EM Residency and Ultrasound Fellowship training at the University of Massachusetts. She now focuses on residency education and point of care bedside ultrasound.

Redwood to Present Antimicrobial Stewardship Webinar Series

Mon, 12 Mar 2018 20:12:34 GMT

As part of the Wisconsin Hospital Association's Antimicrobial Stewardship Journal Club Series, Bobby Redwood, MD, MPH, FACEP, Immediate Past President of WACEP, will be presenting a four-part webinar series focusing on hot topic issues affecting health care antimicrobial stewardship.

The Antimicrobial Stewardship Journal Club is a four-part series of education and conversation focused on clinical decision making and population health considerations in Antimicrobial Stewardship. Each Club includes a review of current literature, discussing case scenarios, and a time for questions. The series is intended for physicians, mid-level providers, quality improvement leaders, and others with a special interest in the Club topic being discussed.

All sessions are 12:00 pm - 1:00 pm via webinar:

Journal Club #1: When to Test and When to Treat—A Deep Dive on Asymptomatic Bacteriuria Thursday, April 12, 2018
Journal Club #2: Evidence-based Strategies to Avoid Prescribing Unnecessary Antibiotics Monday, June 11, 2018
Journal Club #3: Evidence-based Strategies to Prescribe Antibiotics More Effectively Monday, August 13, 2018
Journal Club #4: Pre-op Urinalysis Before Orthopedic Surgery—What is the Current Evidence? Monday, October 15, 2018

Learn more.

March 13 Webinar: Coordinating Responses to Opioid Overdoses Treated in ED

Sun, 11 Mar 2018 16:01:52 GMT

Coordinating Clinical and Public Health Responses to Opioid Overdoses Treated in Emergency Departments

Join the 20th US Surgeon General, Acting CDC Director, a CDC subject matter expert, and other clinical and public health professionals for a webinar discussing new data and coordinated efforts by clinicians, public health government, and communities to respond to increasing opioid overdose emergency department visits. This combined webinar joins these two audiences together to provide a discussion on how clinicians and public health communities can work together in coordinating a more robust response to the opioid overdose epidemic.

The nonmedical use of prescription opioids and illicit opioids causes significant morbidity in the United States. The latest data indicate that rates of overdoses treated in emergency departments are rising across all regions and require a coordinated response between public health, clinicians, public safety, and community organizations.

During this call, clinicians and public health practitioners will learn about the increases in opioid-related morbidity and steps they can take together to reverse these trends.

Date: Tuesday, March 13, 2018
Time: 2:00 - 3:30 PM (Eastern Time)

Join the webinar here: https://zoom.us/j/662731210

Or iPhone one-tap: US: +16699006833, 662731210#

Or Telephone: 1 669 900 6833 or +1 408 638 0968

Webinar ID: 662 731 210

The webcast (slides with audio) for this call will be posted on the webpage a few days after the COCA Call. The transcript will be posted a few weeks after the call.

Follow these steps to earn free continuing education

Funds Available to Support Recovery Coaching/Peer Support in the ED

Thu, 08 Mar 2018 14:23:34 GMT

Wisconsin Voices for Recovery at the UW-Madison Division of Continuing Studies will provide re-grant awards for organizations to employee Recovery Coaches and Certified Peer Support Specialists. Peer support providers will begin providing recovery support in the hospital-based setting (Emergency Department) with individuals who have survived an opioid overdose. This statewide peer support network will function as a portion of the State Targeted Response to the Opioid Crisis. The ultimate goal of the program is to create sustainable peer support models across the state that will:

Increase treatment and recovery support service utilization of the target population
Reduce Emergency Department recidivism
Decrease the number of overdose fatalities in Wisconsin

Read the article, Wisconsin Voices for Recovery receives $1.4 million grant to combat opioid abuse.

Please consider applying for this amazing opportunity to help address the opioid crisis in Wisconsin! If you would like more information or have questions about this Request for Proposal, please contact wivoiceshn@dcs.wisc.edu.

Report: Wisconsin emergency departments see 109 percent increase in opioid overdoses

Wed, 07 Mar 2018 16:14:01 GMT

March 7, Wisconsin Health News

Wisconsin emergency departments saw suspected opioid overdoses more than double between July 2016 and last September, according to a report released by the Centers for Disease Control and Prevention Tuesday.

The data show that the opioid epidemic hit the Midwest hardest among the country’s regions during that period. The Midwest experienced a 70 percent increase in opioid overdose emergency department visits, according to an analysis that covered 60 percent of emergency department visits in the United States. The average was 30 percent nationwide.

The CDC also separately analyzed data for 16 states, including Wisconsin, which saw a 109 percent increase in suspected opioid overdose emergency department visits during that period. It was the highest increase among the analyzed states.

“This fast-moving epidemic does not distinguish age, sex or state or county lines, and it’s still increasing in every region of the United States,” CDC Acting Director Dr. Anne Schuchat told reporters on a press call.

Other Midwest states saw increases too, with Illinois reporting a 66 percent increase, Indiana a 35 percent increase, Ohio a 28 percent increase and Missouri a 21 percent increase.

The findings show a need for better coordination between public health and public safety agencies to address overdose outbreaks. It also shows a need for more prevention and treatment efforts, according to the CDC.

“Research shows that people who have had at least one overdose are more likely to have another,” Schuchat said. “However, if the person is seen in an emergency department, we are presented with an opportunity to take steps to prevent a repeated overdose.”

Emergency Or Not? Ky. Medicaid Changes Will Penalize For Unnecessary ER Visits

Mon, 26 Feb 2018 20:32:56 GMT

NOTE: Wisconsin ACEP President Lisa Maurer, MD was interviewed by NPR and featured in the following article. The article inadvertently shows Dr. Maurer's affiliation with Ohio rather than Wisconsin.

89.3 WFPL/HEALTH - February 21, 2018
By Lisa Gillespie

Starting July 1, some Medicaid enrollees could be fined for going to a hospital emergency room if they end up not actually having an emergency. The new policy is part of bigger changes to the Medicaid program led by Governor Matt Bevin.

The penalties apply to adults who gained coverage after Kentucky expanded Medicaid, such as adults without dependents, or some parents who are in families that make between 54 and 138 percent of the poverty line.

“The intent of the policy is to reduce inappropriate emergency department use and educate individuals about the most appropriate setting for their health care needs,” Doug Hogan, a spokesman for the Kentucky Cabinet for Health and Family Services, wrote in an email.

Medicaid, the state-federal health care program for low-income and disabled Americans, is paying for a bigger chunk of ER visits since the health insurance program expanded in 2014. In 2015, for instance, almost 47 percent of the ER visits in Kentucky were paid for by Medicaid, up from about 30 percent in 2012, according to a report by the Foundation for a Healthy Kentucky.

Here’s how it’ll work: Enrollees will be given a “My Rewards” account. If the state deems an ER visit as unnecessary, My Rewards dollars will be deducted from that account, ranging between $20 to $75. That account will also be used to earn “dollars” for dental and vision services, since these Medicaid enrollees are losing automatic coverage of those benefits.

Enrollees could also make a co-payment if they don’t have a My Rewards account.

If an enrollee calls their insurance company nurse hotline before going to the ER, that penalty will be waived, even if the ER visit isn’t for an emergency.

Here’s who could be affected:

Parents earning between 54 percent and 138 percent of the poverty line;
Adults without dependents.
Pregnant women, former foster care youth and enrollees who obtain a “medically frail” exemption will have access to a My Rewards account, but won’t face these penalties.

Determining A ‘Non-Emergency’

There’s debate about what percentage of emergency room visits are unnecessary. The answer depends on where the information comes from.

Health care researcher Truven Health Analytics analyzed millions of ER claims from 2010 and found 71 percent of visits were avoidable or unnecessary. The American College of Emergency Physicians, meanwhile, says only about 3.3 percent of ER visits are “avoidable.”

There’s also a difference in how the state, an ER doctor and a patient define “non-emergency.”

“There are very few patients who come to the ER who truly know that they didn’t have an emergency right up front,” said Dr. Lisa Maurer, an emergency room doctor in Wisconsin.

Maurer understands that Kentucky’s new policy is supposed to discourage unnecessary ER visits but she worries it will deter patients who truly need to come.

“We want to make sure that our patients feel that if they’re having an emergency, they can come to the emergency department,” Maurer said, who is also on the state legislative-regulatory committee at the American College of Emergency Physicians.

Dr. Ryan Stanton works as a doctor in an emergency room in Lexington. He agrees with Maurer that people can’t always tell when something is an emergency. To regular people, conditions that a health insurer or an ER doctor might not see as an emergency, is to a patient, an emergency. Stanton used the example of patients with high blood pressure who fear they are on the verge of having a stroke.

“We’re hearing on the radio these ads about blood pressure causing stroke, and you need to go to the ER right away,” said Stanton. “But blood pressure is rarely an emergency. But to the lay public, blood pressure is a stroke waiting to happen.”

A visit because of high blood pressure and fear of a stroke could be classified as a non-emergency if Stanton finds the patient wasn’t actually unstable or about to have a stroke.

An Emergency In ‘Access to Care’

“How many people do we have that call the family doctor, and the receptionist says, ‘If you can’t wait three days to get an appointment with us, then just go to the ER?’” asked David Wesley Brewer, former president of the Kentucky chapter of the American College of Emergency Physicians.

Brewer said another reason people come to the ER, even if they know know it’s not an emergency, is because Medicaid enrollees have a hard time finding a primary care practice with immediate availability. The Truven Health analysis found that of the 71 percent of what it deemed “unnecessary” ER visits, more than 40 percent of those people could have been safely treated in a primary care setting.

And locally, at the University of Louisville Hospital, two thirds of ER visits occur after hours, when cheaper alternatives like primary care offices or free clinics are closed. And the vast majority of visitors, the hospital said, have either been directed by their primary care office/insurance nurse line to go to the ER, or have a time sensitive medical need.

Maintaining Sustainability and Longevity in our Practice

Sun, 18 Feb 2018 17:43:32 GMT

Lei Lei, MD
WACEP Secretary/Treasurer

I have been out of residency for five years, and it is remarkable that even in my relatively young career, I find myself and my colleagues all over the country burdened with burnout. After having kids and starting my life anew after almost a decade of the “it’ll get better” mentality, I sometimes wonder if I was overly optimistic about the practice of medicine. Though it seems like it is the current “hot topic,” it is becoming increasingly apparent that physician burnout is a persistent and growing issue in our profession which leads to significant downstream effects. Burnout contributes to poor physician retention, which results in worsening physician shortages, which in turn will self-propagate as the remainder physicians struggle to fill the holes leading to medical errors, bad patient care, and of course more burnout. Physician burnout contributes to depression and one of the highest suicide rates of any profession.

Our profession is woven into our identities. Work is not just work; it comes home with us; and goes to sleep with us. Physicians have been trained to project an indomitable image. In reality the typical emergency physician statically does not sleep well, eat well, and doesn’t seek treatment for mental and physical ailments. Our irregular schedules working holidays and weekends make it difficult to manage family life; our unwieldy student loans hold us financially captive to the medical field as we are often not in a position to replace our income by alternative means. Third shifters are at particular risk for metabolic syndrome and chronic sleep disturbance correlating with an increase incidence of hypertension, diabetes, and decreased lifespan.1 At the hospital we are charged with caring for our patients, striving to please exacting administrators, and being the stoic leader in the chaos of the ED. Self-care is always a peripheral after-thought. Even at home, we are often primary providers and our family members often view us as an endless resource for medical expertise. We care for others, but our own wellness is not a priority.

Physicians are leaving medicine or looking for alternative revenue streams for this reason. The Association of American Medical Colleges is projecting a shortage between 40,800-104,900 physicians by 2030. One third of practicing physicians will be of retirement age within the next 10 years. The younger physician cohort are suffering from burnout and cynicism not previously experienced by other generations of physicians. A Facebook group “Physician Side Gigs” boasts twelve thousand members of practicing docs who looking to decrease clinical work and supplement their income. Our profession is facing some serious issues, but physicians can only affect part of a solution. Hospital administrations, medical educators, and federal and state regulators will have to prioritize physician wellness by addressing physician burnout. Many residency programs are enacting curriculum changes that build new physician resiliency and minimize burnout, but we should also ask ourselves: what can practicing docs do to improve their own resilience and what can hospitals and governments do to promote physician wellness.

My goal is to convince our collective profession that prioritizing our health and wellness needs to come off of the back burner. It is time to stop viewing self-sacrifice as a necessity in the culture of medicine. Hospital administrators will not do this for us. Hospital staff will not do this for us. Only we can advocate for ourselves. This can mean telling your colleagues to take a break during a shift that allows for eating, pumping, or just a simple escape from the chaos of the department. This can mean offering positive reinforcement for our colleagues who are making healthy choices. This can mean standing up for our colleagues who are being singled out. We need normalize these behaviors as the standard and not the exception. Let us be more honest with ourselves and in our daily interactions. The grumbling we hear during shift change and on our day-to-day exchanges with worn-out colleagues is a symptom of a larger problem. We need to start and sustain these conversations. The more we passively absorb the stresses of this dysfunctional healthcare system, the more devalued we will be as doctors.

We must also focus on enacting changes across the system that favors sustaining physician wellness and changing the long standing cultural practices within medical communities that reinforce self-sacrifice as a necessity in medical practice. Healthy practices should be reinforced by our community and government. The biggest hurdle is simply making this a conscious priority in our minds as well as those of hospital administrators. This could mean framing the issue in terms of loss in productivity, physician retention, poor patient care, and mistakes in health care. As a member of professional organizations like WACEP and the Wisconsin Medical Society, you are supporting initiatives that benefit physicians and helping these issues to gain visibility and attention in legislation and policy.

With that I would like to announce that in the following months, WACEP will be starting a social media initiative to promote physician wellness. Please follow us on Twitter @WisconsinACEP or Facebook @WIACEP for updates.

1. Wang, F., Zhang, L., Zhang, Y., Zhang, B., He, Y., Xie, S., Li, M., Miao, X., Chan, E. Y. Y., Tang, J. L., Wong, M. C. S., Li, Z., Yu, I. T. S. and Tse, L. A. (2014), Meta-analysis on night shift work and risk of metabolic syndrome. Obes Rev, 15: 709–720. doi:10.1111/obr.12194

Spring Symposium Hotel Deadline is Feb. 19

Thu, 15 Feb 2018 17:54:07 GMT

WACEP 2018 SPRING SYMPOSIUM - HOTEL RESERVATION DEADLINE IS FEBRUARY 19th!

Planning to attend the Wisconsin ACEP 2018 Spring Symposium next month? Make your hotel reservations NOW! The deadline to receive overnight accommodations at the WACEP group rate of $149 is on MONDAY.

Book your stay by calling The Edgewater directly at 1-800-922-5512 and request the Wisconsin Chapter, American College of Emergency Physicians room block. You may also book online using this direct link for WACEP's room block: http://theedgewater.link/WACEP2018. The cut-off date to book at the group rate is February 19, 2018.

JFC approves opioid bills

Mon, 12 Feb 2018 20:25:59 GMT

February 12, Wisconsin Health News

The Joint Finance Committee signed off on two bills last week targeting the state’s opioid epidemic, teeing up the proposals for votes in the Assembly and Senate.

One of the bills would provide funding to combat drug trafficking, support substance abuse prevention efforts, establish treatment courts and provide medication-assisted treatment to inmates leaving jail. The other would make a series of changes to boost treatment and prevention efforts.

The committee approved an amendment to the second bill, which aimed to address some concerns raised about the bill streamlining the process for people to become substance abuse counselors.

“Wisconsin already has a pretty high threshold for requirements, both from an educational standpoint and from a clinical standpoint,” said bill author and JFC Co-Chair Rep. John Nygren, R-Marinette. "Even with these changes, we are still on the high end of all our neighboring states.”

The amendment also changed a part of the bill mandating that the Department of Health Services remove prior authorization requirements for prescribing buprenorphine combination products, a treatment for opioid addiction. Instead, DHS would have to report back to the Legislature every six months until the requirements change.

The amendment didn't include a request by the medical community to remove parts of the bill requiring some healthcare providers take continuing medical education credits on prescribing opioids.

The Wisconsin Medical Society, which supported the bills, said in testimony that the proposal is unnecessary for the Medical Examining Board, which has issued rules requiring such education through 2019. Nygren praised the Medical Examining Board’s work.

“This is not a move to be punitive,” he said. “The Medical Examining Board has actually taken steps. Others haven’t.”

Doctor Day 2018 draws record crowd

Tue, 06 Feb 2018 16:08:16 GMT

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.

OCI plans to work on network adequacy proposal through summer

Wed, 31 Jan 2018 18:19:45 GMT

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.

President's Message, January 2018

Wed, 17 Jan 2018 17:24:48 GMT

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.

Wanted: Success Stories on Opioid Use and End-of-Life Care

Thu, 11 Jan 2018 23:21:45 GMT

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.

Wisconsin Medical Society Resolutions - Deadline Approaching

Thu, 04 Jan 2018 18:19:07 GMT

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!

Jan. 9 Webinar on MIPS Compliance

Thu, 04 Jan 2018 17:46:17 GMT

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

Wisconsin ACEP Members Volunteer on National Committees

Tue, 02 Jan 2018 22:33:25 GMT

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

ACEP Policy Statements & PREPS

Wed, 20 Dec 2017 17:14:33 GMT

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

ACEP - You Make 50 Look Good!

Wed, 20 Dec 2017 17:12:50 GMT

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?

State Legislative Issues for 2018

Wed, 20 Dec 2017 17:10:18 GMT

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!

President's Message, December 2017

Wed, 13 Dec 2017 23:08:12 GMT

Bobby Redwood, MD, MPH, FACEP
President, Wisconsin Chapter, ACEP

A Roller Coaster of a Year for Wisconsin Emergency Medicine

December is a natural time for reflection and there is certainly plenty to contemplate in the Wisconsin Emergency Medicine landscape of 2017. Let’s take a moment to revisit the major events of 2017 that affected our specialty at the state and national level and also look towards the future at what 2018 holds in store for WACEP and Wisconsin Emergency Medicine. Fair warning, this newsletter is a little longer than our usual format—its worth it though—2017 has been a wild ride.

A Political Neophyte in the White House and an Assault on Health Care Access

As I write this, Donald Trump’s national approval rating sits at 32%*, the lowest fourth-quarter approval rating of any president since polling began. The president blew his trust with many of us early by lying about historic attendance at his inauguration and stacking his cabinet with less than credible individuals (Flynn, Bannon, Scaramucci, etc, etc, etc) and then went on to shock and isolate large numbers of emergency physicians with his self-proclaimed Muslim travel ban** and apparent inability to condemn white supremacy after a violent KKK rally in Charlottesville. ACEP responded to the intolerance by redoubling its commitment to diversity in our specialty and initiating the viral twitter hashtag #ilooklikeanerdoc.

By July, the mismanagement had shifted towards health care as congress tried to force through the Better Care Reconciliation Act, a half-baked attempt at repealing the Affordable Care Act that would have eliminated insurance coverage for more than 20 million people over the next decade, including 394,100 Wisconsinites. WACEP launched a successful action alert against the BCRA as well as the subsequent “Skinny Repeal,” and the Affordable Care Act (ACA) remains the law of the land. Unfortunately, the president and congress remain determined to limit access to care and have taken some reckless actions that include withholding the ACA cost-sharing subsidies, failing to fund the Children's Health Insurance Program, approving the sale of “junk” insurance plans, and shortening the annual ACA enrollment period to an abysmally short six weeks. We at WACEP considered asking Trump’s health and human services secretary, Tom Price, to help ensure that access to care is preserved in Wisconsin, but he resigned in September after racking up $400,000 in travel bills for chartered flights on a taxpayer-funded Gulfstream 4.

Great Strides for Wisconsin ACEP

If you find the national political scene a bit depressing, rest assured that WACEP has been working overtime to provide a rewarding practice experience for emergency physicians in our state.

This year we hosted our first ever Wisconsin Emergency Medicine Spring Symposium that included over 75 attendees, 14 exhibitors, 13 faculty presenters, 2 hands-on workshops, and one physician-led jazz band! We felt especially flattered that national ACEP immediate past president Becky Parker and president-elect John Rogers made the trip to Wisconsin to attend our Spring Symposium. The event started with education and moved forward into advocacy as our specialty recorded its highest ever attendance (really) for the subsequent Wisconsin Doctor Day at the capitol. At that event, the house of medicine honored our specialty by highlighting Emergency Medicine medicaid reimbursement as one of the four priority issues to be presented to our legislators in 2017.

If you missed the Spring Symposium and Doctor Day, we hope you had a chance to attend another one of WACEP’s events in 2017. The list is long and includes gems like our posh Wisconsin EM reception at Del Campo in Washington DC; our listening tour stops in Janesville, Eau Claire, Merrill, and Appleton; or one of our four open board meetings, held quarterly in either Madison or Milwaukee. Still looking for a chance to connect with the WACEP board? The pizza party is on us…starting in 2018, just drop us an email and we’ll schedule a listening tour at your convenience, in your ED or hospital!

Three-Pronged Mission 2017/2018

While the events above highlight progress for WACEP as an organization, our central focus continues to be our three-pronged mission to serve our profession, our physician workforce, and our patients. In April of 2017, we renewed this three-pronged commitment by voting on our organization’s priorities for the 2017/2018 year. We voted to support our profession by advocating for increased Medicaid reimbursement in Wisconsin, to support our physician workforce by expanding the size and scope of the Spring Symposium, and to support our patients by working with the Wisconsin Medical Society to decrease the length of stay for psychiatric patients in the emergency department.

As a demonstration of their commitment to WACEP’s three-pronged mission, I am extremely proud to report that 100% of the WACEP board of directors donated to the WI Emergency Medicine PAC. Likewise, general WACEP members came out in force, raising over $8000 for the PAC in 2017, thus surpassing all previous years’ contributions and facilitating first-rate access to our state legislators and their staff.

David and Goliath

One major development for Wisconsin Emergency Medicine in 2017 is the arrival of a national contract management group to our physician staffing landscape. In June of this year, Envision bought Infinity HealthCare, a democratically run (via a board of directors) multi-specialty physician group practice based out of Milwaukee that includes more than 340 providers in Wisconsin and Illinois and staffs 25 emergency departments.

Envision is a publicly traded physician staffing corporation (NYSE: EVHC) and the parent company of EmCare. Nationwide, Envision manages physician staffing/contracts for more than 1,600 clinical departments in 45 states and the District of Columbia. A large proportion of their physician employees are emergency physicians. Envision has a larger market share than Team Health and the physician services "unit" of Envision makes about $6 billion of Envision's total annual revenue.

Wherever you stand on the issue, a titan of physician staffing has arrived in Wisconsin. What will the job landscape look like for our 2020 Wisconsin EM graduates? Madison Emergency Physicians brought to you by Team Health. Emergency Medicine Specialists brought to you by USACS? Perhaps Wisconsin will buck the nationwide trend and physician operated practices will persevere in the Badger State? Or better yet, perhaps we’ll find that perfect mix?

Ghosts of Christmas Past

If that last section got you riled up, settle down and pour yourself a mug of mulled wine, because this one’s a doozy. The advocacy nerds and policy wonks among us know that certain issues, like Scrooge’s three ghosts, tend to come back and haunt emergency physicians and in 2017, the chains are really rattling.

First, the prudent layperson standard of 1997, which requires that insurance coverage is based on a patient's symptoms, not their final diagnosis, has come under attack in multiple states. We have to make sure Wisconsin does not become the next Missouri, where Anthem BCBS has created a list of over 2,000 diagnoses that it considers to be “non-urgent”.

Second, the specter of out-of-network billing has finally arrived in Wisconsin. What does out-of-network billing look like in practice? To put it simply, a patient’s emergency physician does the work and the insurance company does not pay. The insurer is able to do this by offering in-network rates that are far below fair market value, thus forcing physicians “out-of-network” and sticking the patient with the bill for physician services. We have to ensure that Wisconsin emergency medicine protects its climate of fair coverage and resists the scourge of out-of-network billing.

Third, medical malpractice caps in Wisconsin could soon be non-existent. Wisconsin lawmakers have put a $750,000 per-occurrence cap on non-economic damages in medical malpractice cases, but that limit was deemed “unconstitutional on its face” by a Wisconsin appeals court in July 2017. The matter is on its way to the state supreme court as of November 1^st and WACEP has organized a multi-specialty coalition to help protect the cap. Malpractice caps are proven to prevent lawsuits, if they are lifted, let the malpractice free-for-all begin.

On top of all that, the ghost of Christmas present is currently at work in the U.S. Congress, as our legislators are trying to eliminate the individual mandate as part of their year-end tax bill. The move would increase the number of uninsured patients in Wisconsin and increase the proportion of uncompensated emergency care. Enough with the chain rattling Jacob Marley…give us a break!

Hope for the Future and a Milestone for Emergency Medicine

Looking forward to 2018, the WACEP team is working hard to make sure that your new year is as bright and shiny as a healthy glottis beneath the warm light of a Mac-3. For starters, Wisconsin Doctor Day is just around the corner on January 30^th. We are committed to getting out-of-network-billing on the agenda, thus cementing the leadership of emergency medicine on this key issue. Just two months later, emergency physicians from around the state will descend upon the gorgeous Edgewater Hotel in Madison for the second annual WACEP Spring Symposium! In response to all the divisiveness at the national level, our theme this year is “Building Connections.” The two-day event will be held on March 14^th-15^th and will—for the first time ever—be combined with the UW/MCW Emergency Medicine Research Forum. The festival of emergency medicine will continue in the summer with a joint Illinois-Wisconsin career fair at Northwestern University and culminate in San Diego as WACEP celebrates 50 years of Emergency Medicine at our annual Wisconsin event at the ACEP Scientific Assembly.

On a personal note, I will be greeting the New Year with a wistful tear in my eye, as I pass the baton to the incoming WACEP president. It has been a privilege and an honor to serve each and every one of you. You are the tireless emergency physicians who work 24/7/365 to help keep the great state of Wisconsin safe. You are the professionals entrusted with the stewardship of our loved ones’ health when they are most vulnerable. 2017 may have been a bit of a rollercoaster, but with emergency physicians like you sustaining our professional society, I knew this ride would never fly off the rails.

*Pew Research Center
**http://time.com/4703614/travel-ban-judges-donald-trump-words/

Sign-up Now for Doctor Day 2018

Tue, 12 Dec 2017 23:21:09 GMT

Doctor Day 2018 is fast approaching and it’s important that physicians like YOU participate in our annual advocacy event in Madison on Tuesday, Jan. 30.

It’s a full day of speakers, issue briefings and a visit to the Capitol to advocate on behalf of your profession. The day will conclude with a reception at DLUX. The tentative schedule and online registration can be found at widoctorday.org. The event is free to all physicians and medical students thanks to very generous support from sponsorship organizations.

Each year, Doctor Day attendees hear from some of the leading voices in Wisconsin politics and health care policy. We’re awaiting final confirmation from speakers, but physicians attending Doctor Day 2018 will enjoy the same high-level experience. Also, our speakers will update physicians on health care issues still under debate in the State Capitol. The January 30 meeting date coincides nicely with the final days of the state legislature’s activity, and therefore puts physicians in policymakers’ offices at the best time to maximize impact on the issues physicians care about.

Physicians also will hear the latest regarding Wisconsin's cap on noneconomic damages in medical liability cases—currently being heard by the Wisconsin Supreme Court. One of the state’s top medical liability attorneys, Guy J. DuBeau, will explain how a lone case—tried in Milwaukee County—left Wisconsin with no limit on noneconomic damages and what physician organizations are doing to fix that problem.

Staff and committee members will take care of every detail—from breakfast, briefings, speakers, lunch and scheduling your visits with legislators to the reception at the end of the day!

Please consider joining us for a great day of advocacy on behalf of your profession and your patients! Register now on the Doctor Day website.

Heifetz Resigns as Medicaid Director

Mon, 11 Dec 2017 23:15:47 GMT

December 6, Wisconsin Health News

The Department of Health Services has accepted the resignation of Medicaid Director Michael Heifetz, who is leaving for the private sector, according to a statement.

Heifetz, who also serves as administrator of the Division of Medicaid Services, will leave the department Dec. 13. Deputy Administrator Casey Himebauch will serve as the division's interim leader.

“Michael has been invaluable in his role as Medicaid director, representing Wisconsin’s vision for the future in the national spotlight,” DHS Secretary Linda Seemeyer said in a statement. “We will greatly miss his leadership and insight, as well as his candor and energy.”

A DHS spokeswoman said that Heifetz is "pursuing career opportunities" in the private sector. She did not respond to a question asking for more specifics.

Heifetz joined the department as Medicaid director in September of last year. He previously served as state budget director. Before that, he was vice president of governmental affairs at Dean Clinic and SSM Health of Wisconsin.

Heifetz has also left his position on the Group Insurance Board and was replaced by State Budget Director Waylon Hurlburt in October.

WI Emergency Medicine on TV!

Fri, 08 Dec 2017 17:00:37 GMT

WACEP President to be featured on Wisconsin’s 57 Television

As the 2017/2018 Flu Season Ramps Up, Wisconsin Emergency Providers Take Charge on Vaccine and Antibiotic Education. Wisconsin ACEP President Bobby Redwood, MD, MPH, FACEP and Brian Kayon, PA-C will be featured on Wisconsin Doctors, episode #183, to promote the flu shot and clarify basic antibiotic stewardship principles. You are encouraged to watch this 30-minute program and to spread the word to others to become informed.

Where to watch:

Charter: 6
Charter HDTV: 613
AT&T Uverse: 57
AT&T HDTV: 1057
Direct TV: 57
Dish: 58

When to watch:

12/11: 11:30a, 9:00p
12/12: 6:30a
12/13: 5:00p
12/14: 5:30a
12/17: 9:30p
12/18: 11:30a, 9:00p
12/19: 6:30a
12/20: 5:00p
12/21: 5:30a
12/24: 9:30p

The show will be posted to the Wisconsin Doctors YouTube page as it becomes available.

Call to Action - Workers Comp

Mon, 27 Nov 2017 20:49:05 GMT

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.

Deputy Insurance Commissioner to Headline Dec. 13 WHN Event

Mon, 20 Nov 2017 19:47:40 GMT

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.

Society Selects New CEO

Mon, 20 Nov 2017 19:45:39 GMT

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.

President's Message, Nov. 2017

Mon, 13 Nov 2017 15:33:42 GMT

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)

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.
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.
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.
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.
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
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.
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.
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.
Use procalcitonin to help guide decision to antibiose in COPD. The FDA approved procalcitonin in 2017 to guide antibiotic initiation in LRTI.
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)

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.
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)
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.
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.
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.
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.
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 .
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.
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.
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 https://www.cdc.gov/antibiotic-use/week/index.html

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

Mental health committee green lights emergency detention bill

Wed, 08 Nov 2017 17:56:26 GMT

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.

Updates from ACEP17

Thu, 02 Nov 2017 19:44:40 GMT

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:

Work to prevent abrupt changes in ED contract groups
Supporting paid parental leave and work on producing best practice guidelines for how to actually implement this fairly in various EM practice environments
Increase resources (read: money) to promote EM physician wellness and workforce diversity
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:

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!
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: http://thepfc.org/the-issue/
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? http://newsroom.acep.org/2017-05-16-Emergency-Physicians-Anthem-Blue-Cross-Blue-Shield-Policy-Violates-Federal-Law). 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.

Wisconsin ACEP Members Advocate for Emergency Medicine at White Coat Day on Capitol Hill

Thu, 02 Nov 2017 19:33:13 GMT

By Bradley Burmeister, MD
WACEP Board of Directors

On November 1^st, 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!

Providers seek changes to complex emergency detention process

Wed, 25 Oct 2017 15:14:56 GMT

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.

An Emergency Physician's Perspective on the Opioid Epidemic in Wisconsin

Tue, 24 Oct 2017 21:26:51 GMT

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 28 is Prescription Drug Take Back Day

Wed, 18 Oct 2017 15:55:14 GMT

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.

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.

Is the Workers Comp System Working? Learn More at Nov. 7 WHN Panel Luncheon

Wed, 18 Oct 2017 15:36:34 GMT

Whether lawmakers should reform the state’s workers’ compensation program is shaping up to be a top legislative issue this fall. Business and labor groups contend that treatments are too expensive and see a fee schedule as a solution. Provider groups tell a different story. They say costs per claim are below the national average, while patient satisfaction rates remain high and workers return to the job faster than other states.

Learn more about the latest legislative proposal, including new efforts to combat opioid abuse, at a Wisconsin Health News panel, Tuesday Nov. 7 in Madison. Panelists:

Joanne Alig, Senior Vice President of Policy and Research, Wisconsin Hospital Association
Mark Grapentine, Senior Vice President of Government Relations, Wisconsin Medical Society
Chris Reader, Director of Health and Human Resources Policy, Wisconsin Manufacturers & Commerce

Learn more and register

Opioid CME Required for Medical License Renewal

Wed, 18 Oct 2017 14:37:21 GMT

The deadline for Wisconsin medical license renewal is approaching—Oct. 31, 2017, for MDs and Feb. 28, 2018, for DOs—and new this cycle is the Medical Examining Board (MEB) requirement for most physicians to complete two CME credits on its Opioid Prescribing Guideline.

Upon renewal, physicians must attest that they have completed the required opioid prescribing CME or will by Dec. 31, 2017. Only MEB-approved courses satisfy the mandate. All physicians should maintain a record of their participation; however, documentation is required only in the event of an audit.

Schimel, other attorneys general, call for insurers to review opioid-prescribing policies

Thu, 05 Oct 2017 14:32:08 GMT

September 19, Wisconsin Health News

Attorney General Brad Schimel has joined the chief legal officers for 36 other states and territories to ask that insurers revise policies to reduce opioid prescribing.

Schimel and the other attorneys general wrote Marilyn Tavenner, the CEO of America's Health Insurance Plans, requesting that her members review payment and coverage policies to prioritize non-opioid pain management.

"We have witnessed firsthand the devastation that the opioid epidemic has wrought on our states in terms of lives lost and the costs it has imposed on our healthcare system and the broader economy," Schimel and others wrote.

They added that they'll soon be working with state insurance commissioners and others "to initiate a dialogue" with insurers to identify practices that can reduce opioid prescription and those that don't.

"The status quo, in which there may be financial incentives to prescribe opioids for pain which they are ill-suited to treat, is unacceptable," the attorneys general wrote. "We ask that you quickly initiate additional efforts so that you can play an important role in stopping further deaths."

Cathryn Donaldson, spokeswoman for America's Health Insurance Plans, said they share the attorneys general's commitment to addressing the opioid epidemic. Health plans cover approaches to pain management that include more cautious opioid prescribing, careful patient monitoring and other treatments, she said.

Many health plans have already instituted programs that are helping to "dramatically reduce how much - and how often - opioids are prescribed," she said.

"By working together, doctors, hospitals, health plans and policy leaders can provide people with better pathways to healing - without putting their lives in danger because of opioids," she said.

Medical Liability Award Caps

Fri, 22 Sep 2017 15:47:33 GMT

In July a State Court of Appeals decision in the Mayo v. WIPFCF case ruled unconstitutional Wisconsin’s $750,000 cap on non-economic damages for medical malpractice cases (passed by the Legislature in the late 1990’s). The case has been appealed to the Wisconsin Supreme Court and awaits the Court’s decision (which is anticipated to occur in the next couple of weeks) on whether they will take the case; most court watchers believe they will do so.

The case has great significance for Wisconsin’s medical liability climate. Facing many other medico-economic challenges, and building from Doctor Day partnerships, WACEP has taken the lead organizing a coalition of eight specialty medical societies to petition the Court to be named Amici (“friends of the court”) -- non-parties to the original case who may be affected by, or who can offer unique insight into the impact of the Court’s ultimate decision.

If granted Amici status, the coalition will work together to submit a brief explaining to the Court the potential impact on specialty physicians and their patients. No doubt many similar briefs will be offered in a case of this significance, and it is anticipated the Court will set a briefing schedule later this fall.

State Budget Update

Fri, 22 Sep 2017 15:45:53 GMT

You may recall that for several years, WACEP has attempted to work cooperatively with the WI Department of Health Services (DHS) to educate staff about Wisconsin’s worst-in-the-nation rates for reimbursement of Emergency Physician Services in Wisconsin’s Medicaid programs, and seek "fair" reimbursement at least on par with surrounding states. Having once again experienced empathy without action from DHS, WACEP undertook a more aggressive legislative solution this year.

As a part of the State Legislature's Joint Finance Committee’s (JFC) review of the 2017-19 State Budget, Representative John Nygren led an effort to require DHS to create a study group made up of Medicaid program staff and outside Emergency Physicians to examine care provided to Medicaid patients, search for ways to save money, and make recommendations back to JFC. The goal was to find savings in the system that could then turned back into increasing reimbursements for Emergency Physician Services – ultimately costing the Medicaid program nothing more.

This study group, if successful, would have served as a model for other private-public efforts. The JFC ultimately incorporated a requirement for an Emergency Physician Study Group, and it was approved by the full Legislature in September.

Unfortunately, Governor Walker vetoed the provision (along with 99 other items, many of them similar studies or reports from agencies) this week, stating in his veto message that the study duplicated existing “managed care and care coordination efforts in the DHS.”

With healthcare reform, the ACA, discussions about future Medicaid program funding and block grants all still in flux in Washington, these discussions are far from completed, and we will plan to regroup and continue these efforts in the coming months.

Many thanks to Lisa Maurer, MD, WACEP Board member who spearheaded the effort, as well as to all of you who responded to WACEP’s recent Legislative Alerts asking you to contact the Governor’s office.

Pediatric Readiness Project

Fri, 08 Sep 2017 17:00:08 GMT

Enhancing the pediatric readiness of the nation’s emergency departments (EDs) to care for children is of utmost importance to improve the quality of care and outcomes for ill or injured children. Wisconsin Emergency Physicians are encouraged to participate in pediatric ED readiness initiatives.

The US Department of Health and Human Services Health Resources and Services Administration (HRSA) EMS for Children (EMSC) Program and the EMSC Innovation and Improvement Center (EIIC) have partnered with the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association to support a pediatric quality improvement collaborative. The collaborative began in April 2016 and efforts are ongoing with a goal of working with existing emergency care systems to improve and encourage pediatric readiness based on compliance with the 2009 joint policy statement, “Guidelines for Care of Children in the Emergency Department (ED).”

In 2013 the National Pediatric Readiness Project provided a baseline assessment of the nation’s capacity to care for children in an emergency. This assessment identified that the majority of children are cared for in community and rural emergency departments rather than specialized hospitals such as children’s hospitals. It was also noted that the readiness of these institutions to care for the emergency needs of children varied greatly (www.pedsready.org).

Pediatric readiness programs assist state and territory-specific teams in working closely with stakeholders to identify criteria and characteristics, and to supply resources such as policies, procedures, and equipment, to best meet the needs of children within their own state or territory.

Additional Resources:

Guidelines for Care of Children in the Emergency Department policy statement (link)
EMSC Innovation and Improvement Center (link)

Contacts:

Ms. Loren Rives, Senior Manager, Academic Affairs, ACEP
Dr. Madeline Joseph or Dr. Kathleen Brown, ACEP Liaisons on the EIIC

President's Message: Surprise Bill for Emergency Physician Services? Blame Your Physician, Right?

Mon, 21 Aug 2017 21:09:58 GMT

Bobby Redwood, MD, MPH
President, Wisconsin ACEP

Out of network billing (OONB) is a concept that is understandably difficult for our patients to grasp. The usual story goes like this: an insured patient presents to an emergency department during a period of vulnerability and need, they receive high quality emergency care, but then receive a bill six weeks later stating that their hospital fees are covered by insurance, but their physician services are not. From a patient perspective, that looks like the hospital is charging a couple hundred dollars, while the emergency physician is charging a couple thousand…what gives?!

As physicians, the problem seems pretty simple…the insurer is refusing to pay. In other words, the patient’s emergency physician did the work and the insurance company, in an effort to increase revenues for their shareholders, has created an unreasonably narrow network of providers in order to cut costs (and stick the patient with the bill for physician services). The patient has done nothing wrong here. They bought insurance and had an emergency. It is quite reasonable to be angry that the insurance they spent their hard-earned money on is not paying for the services it was supposed to cover.

Of course, as physicians, we have an intimate knowledge of the health care bureaucracy and the unscrupulous maneuvers that insurers turn to in order to avoid payment are nothing new to us. The problem is that physicians and physician staffing companies have been receiving the lion’s share of the blame for a phenomenon that we have very little (if any) control over. The New York Times has reported extensively on OONB. They routinely call it “surprise billing” and have quoted health policy experts calling the practice everything from, “a bait-and-switch” to “financial roulette” to “the health equivalent of a carjacking.” The Times is one of my most trusted news sources, but on this issue, they really miss the mark.

In an article titled, Surprise! Insurance Paid the E.R. but Not the Doctor, the Times authors state that; “These doctors negotiate separate deals with insurance companies for payment. If the doctor and the insurance company never strike a deal, the visit is billed at much higher out-of-network rates”. There is a partial truth here, some independently owned physician groups are placed in the difficult position of having to contract with as many insurance companies as possible to mitigate the effect of the insurance companies’ cruel insistence on not covering all aspects of emergency care. Still, it is disingenuous to paint problem in such a way that places physicians as equal partners in this inhumane withholding of emergency care coverage. For those physician groups that do need to negotiate their rates in order to be considered “in-network”, the rates that payers offer are often far below fair market value. Personally, as a contracted employee of an independently owned hospital, I am not out there negotiating which unfairly narrow networks will cover my labor—I clock in, I see patients, I clock out.

Another Times article titled, The Company Behind Many Surprise Emergency Room Bills tries to pin the blame on the national physician staffing company EmCare. Citing a single study that has been widely criticized for flawed methodology, the authors portray EmCare as an evil corporation that swooped in to a rural emergency department, increasing the cost of an average level 5 visit from $467 to $1,649. This sounds concerning of course, but the readers are not told that patients are now being seen by emergency specialists. Has the quality of care improved? Is the hospital able to handle more complex pathophysiology in-house with specialists in the emergency department? Were they even able to staff the facility appropriately prior to the EmCare contract? We do not know, because the article does not say, but I suspect there is a lot more to the story than EmCare running up the tab.

There is a practical solution to the OONB problem of course. Four states have adopted the Minimum Benefit Standard, which essentially mandates that insurers cannot pay providers less than 80% of usual professional service charges. These charges are based on a geographically comparable database of usual and customary clinician charges and the database is maintained by an independent non-profit organization. In other words, these states let a third party decide what fair compensation is and then compensate their providers fairly without putting the patient in the crosshairs of our unnecessarily complicated insurance landscape. An in-network discount is reasonable, but patients should not be financially punished for having a medical emergency.

At present, we at WACEP have thankfully not heard many OONB horror stories in our state, but we are keeping our ears to the ground and have put together a task force to explore the issue. Has your group been a victim of unfair OONB practices? Are your patients complaining about billing practices that are out of your control? We’d like to hear from our membership on this important issue.

For more information, check out ACEP’s website on fair coverage and the cited NY Times articles below:

WHN Panel Series presents: How are technology innovations changing healthcare delivery?

Wed, 16 Aug 2017 18:45:28 GMT

Join Wisconsin Health News for a discussion on Innovation... one of the biggest buzzwords in healthcare.

Tuesday, Sept. 5, 2017; 11:30 am - 1:00 pm
The Wisconsin Club, 900 West Wisconsin Avenue, Milwaukee, WI 53233

How are providers and insurers embracing, and advancing, new technologies? What hurdles stand in their way?
Which advancements will have the most impact on patient health?

Panelists include:

Mike Anderes - chief innovation and digital officer for Froedtert Health and the president of Inception Health, a company formed by Froedtert & the Medical College of Wisconsin to accelerate the adoption of digital health, identify and partner with innovative companies and increase the innovation capacity of the network.
Ilya Avdeev - professor of mechanical engineering at the University of Wisconsin-Milwaukee. He's the principal investigator and co-director of the National Science Foundation I-Corps Site of Southeastern Wisconsin - a partnership of UWM, Marquette, Medical College of Wisconsin, Concordia and Milwaukee School of Engineering.
Craig Hankins - vice president of digital products at UnitedHealthcare. He oversees the strategy and delivery of mobile solutions. His responsibilities include developing new and innovative mobile technologies that serve an array of healthcare stakeholders, including consumers, care providers and employers.
Mike Lappin - chief administrative officer of Aurora Health Care. He is responsible for overseeing compliance, government relations, human resources, information services, internal audit, legal services, real estate and facilities management, as well as affiliations, acquisitions, joint ventures and other transactions.

WHA Presents Emergency Preparedness Conference, September 20 in Madison

Wed, 26 Jul 2017 17:22:07 GMT

On September 20, the Wisconsin Hospital Association is sponsoring the “WHA Emergency Preparedness Conference: Ready to Respond” at the Sheraton Hotel in Madison. Conference details and registration are available online.

This important, one-day conference will feature national experts who will share communication and preparedness lessons learned from real world events and focus on current threats facing health care organizations, including workplace and community violence and highly infectious diseases. Attendees will have the opportunity to collect strategies to enhance their current emergency management programs, practice them through interactive exercises, and integrate those preparedness and communication strategies into daily operations.

Vincent Covello, PhD, will keynote the conference and offer a deep-dive session in the afternoon specifically for public information officers and health care public relations professionals.

Covello is a nationally and internationally recognized trainer, researcher, consultant and expert in crisis, conflict, change and risk communications. Over the past 25 years, he has held numerous positions in academia and government. Covello was a senior scientist at the White House Council on Environmental Quality in Washington, D.C., a study director at the National Research Council/National Academy of Sciences and the director of the risk assessment program at the National Science Foundation. Covello has authored or edited more than 25 books and published over 75 articles on risk assessment, management and communication.

Covello will share principles, strategies and practical tools for communicating effectively in a high stress situation.

Chris Sonne and William Castellano, both of HSS EM Solutions, will share best practices and lessons learned from live active shooter scenarios, as well as direct tabletop exercises and a practical, scenario-based training exercise, during a special afternoon session focused on planning and preparing for an active shooter.

Additional sessions include a look at infectious disease outbreaks and what hospitals can do to better prepare; as well as the role of governmental agencies, including the Department of Health Services and the Department of Public Health during an emergency.

This conference has been designed for hospital emergency preparedness directors, emergency department directors and physicians, infection prevention staff, department directors, public relations professionals and public information officers.

Registration is Open for Sept. 14-16 WISAM Conference

Wed, 26 Jul 2017 16:55:17 GMT

September 14-16, 2017: WISAM Conference
Advancing the Art and Science of Addiction Prevention and Treatment in Wisconsin
Pyle Center, Madison, WI

This two day conference on addiction prevention and treatment is open to all providers across disciplines.

A post-conference workshop on Saturday, September 16 will provide training for clinicians in the use of buprenorphine and naltrexone for the office-based management of substance use disorders. Attendees will also have the opportunity on Saturday to participate in an Opioid Prescribing Guidelines session that meets the Wisconsin Medical Examining Board’s mandatory education requirement.

View conference agenda . Learn more and register.

President's Message: The BCRA is Bad for Wisconsin’s Emergency Care and Emergency Physicians

Wed, 19 Jul 2017 17:12:14 GMT

Bobby Redwood, MD, MPH

Wisconsin emergency physicians should be leery of the U.S. Senate’s latest version of The Better Care Reconciliation Act (BCRA). Stripping away the loaded messaging from the special interest groups and the political baggage that haunts the Affordable Care Act (ACA), what the Senate has proposed is a bill that will deliver a triple blow to emergency medicine in Wisconsin. Stated simply, passing the BCRA will have a negative impact on our patients, our profession, and our physician workforce.

Painful Cuts for Patients: With the BCRA, our patients are definitely being forced to take their medicine (and there is no spoonful of sugar to help it all go down). Tax credits for out-of-pocket expenses will be phased out by 2019, insurers can charge older patients up to five times as much as younger patients, and annual/lifetime limits on individual coverage are coming back. Furthermore, patients will again have the option to buy what Kaiser Health News calls “junk insurance” (low cost, minimal coverage plans that were eliminated under the ACA). Oh, and guess what, the BCRA eliminates the individual mandate, so all those invincible young patients coming in with mental health crises, overdoses, and traumatic injuries will no longer be obligated to have insurance, but EMTALA will still require emergency physicians to provide their uncompensated care. The congressional budget office sums up this can of worms quite nicely, estimating that the BCRA will eliminate insurance coverage for more than 20 million people over the next decade and Wisconsin’s hit would be 394,100 newly uninsured patients.

Painful Cuts for Emergency Department Revenue: Since Wisconsin has a thriving, diverse payer mix; the best course for our state would be to reform the ACA, rather than repeal it, so that even more Wisconsinites can have access to private insurance plans. Wisconsin is already worst in the nation in terms of Medicaid reimbursement*, compensating emergency physicians just $37.77 for a level 5 visit (compared to Medicare’s $169.14 for a level 5 visit). The changes proposed by the BCRA will distribute federal Medicaid funds to the states based on a capped, per-capita or block grant basis. Our state government has already shown us how much they value our work…what will happen to emergency department and emergency physician compensation under the (presumed) cuts of a block grant system?

Painful New Realities for Practicing Emergency Physicians: For the 99% of us who are not policy wonks, how will the BCRA affect our daily workflow in the emergency department? For starters, an greater underinsured population will equate to more challenges securing inpatient psychiatric beds, so expect those mental health boarding times to increase. Blocking federal payments to Planned Parenthood will decrease young women’s access to contraception, HPV vaccines, cervical cancer screening, and prenatal care; so expect more pelvic exams, more abnormal findings on pelvic exams, and more pregnancy complications. Some of those patients who were briefly insured under the ACA, but have since lost coverage, will be turning to the ED to manage their recently discovered chronic health conditions and lets not forget the return of lifetime limits on individual coverage. “I’m sorry Mrs. Smith, you reached your coverage limit with your last cardiac stent, how about this DNR paperwork instead?” If the BCRA passes, I sincerely hope you compensation is not tied to patient satisfaction, because we are going to be seeing a lot of unhappy individuals under this substandard attempt at health insurance reform.

National ACEP has already weighed in, warning that “the BCRA would allow insurance companies to offer skimpy plans that offer no essential benefits coverage to consumers” and that “the consequences for emergency patients could be devastating.” I agree and would add that the consequences for Wisconsin will be particularly jarring for our state’s patients, profession, and physician workforce. Tammy Baldwin is a vocal opponent of the BCRA, but Ron Johnson is still on the fence.

Tell Ron Johnson to vote "NO" on the BCRA:
https://www.ronjohnson.senate.gov/public/index.cfm/email-the-senator

*WACEP is working hard to improve this dismal statistic.

Advocacy Update: Wisconsin Caps Overturned

Wed, 19 Jul 2017 17:11:28 GMT

By: Lisa Maurer, MD, WACEP Treasurer/Secretary

Earlier this month, the Wisconsin Court of Appeals decision in Mayo v Wisconsin Injured Patients and Families Compensation Fund (IPFCF) made changes to the liability system in our state that will affect every practicing physician by removing the cap on noneconomic damages altogether. The trial court for this case initially found that although the cap on noneconomic damages was constitutional, the plaintiff in this case was an exception and was awarded $16.5 million in non-economic damages. This ruling by the Court of Appeals goes one step further, arguing that any cap on noneconomic damages is unconstitutional, and removing it completely.

Wisconsin has adjusted this noneconomic cap several times over the last decade or so. Prior to 2005, Wisconsin had a $350,000 cap on economic damages. In 2005, a decision in Ferdon v. IPFCF struck down the $350,000, stating that it violates the equal protection rights of severely injured patients. The cap of $750,000 that was in place until just this month was adopted in 2006 on the basis that a cap would protect the IPFCF and patient’s access to care, with the limit of $750,000 based on other states’ experiences. In contrast, Wisconsin has not had a limit on economic damages. For clarification, whereas noneconomic damages corresponds to any pain and suffering the plaintiff may have undergone, economic damages corresponds to actual expenses or lost wages.

The IPFCF is expected to file an appeal with the Wisconsin Supreme Court, but has not done so at this point, and advocates on either side of the issue are watching closely. Patient advocates worry that a cap such that was in place limits the injured patients’ ability to be made whole. Most recently, the Court of Appeals argued that in a situation that we had where a cap was in place, but individuals were made to be exceptions to that cap, creates two classes of plaintiffs: one that is fully compensated and one that is not. Proponents for a cap on noneconomic damages, such as the Wisconsin Medical Society, argue that reasonable caps are what maintains a strong IPFCF, ensuring that Wisconsin patients have the ability to recover unlimited economic damages. They also have concerns that a lack of cap incentivizes attorneys to file groundless claims.

Unlike the Wisconsin Medical Society, WACEP does not have a policy compendium to dictate an official position on topics such as this. Let us know what you think the Wisconsin Supreme Court should decide if this case is brought to them. Send us an email, post to our Facebook page or tweet us.

UnitedHealthcare Warns that Walker's Medicaid Waiver Could Lead to More ER Use

Fri, 14 Jul 2017 15:23:12 GMT

July 14, Wisconsin Health News

UnitedHealthcare raised concerns about Gov. Scott Walker's administration's proposal to terminate Medicaid benefits for six months for childless adults that don't complete certain requirements under its proposed waiver.

The Department of Health Services is seeking federal approval on a waiver to drug screen childless adults. Under the proposal, DHS would also be allowed to impose premiums on that population and cap eligibility for the program for those not working or in work training programs at four years.

If a member hits that cap or doesn't pay premiums, they'd be ineligible for Medicaid for six months. The state provides ways for members to regain their benefits sooner if they complete certain requirements. A federal public comment period on the waiver ends Saturday.

UnitedHealthcare Community Plan of Wisconsin, which serves 166,000 Medicaid members in Wisconsin, warned that limiting benefits for a six-month period could "negatively impact continuity of care" for childless adults, "driving up overall healthcare costs for the population."

Interruptions in Medicaid coverage can lead to greater emergency department use, they warned, as well as increases in hospitalizations for conditions that can be managed through other means.

"While Wisconsin's coverage suspension is limited to six months, research has shown that even short-term losses of coverage can have significant impact," said Ellen Sexton, UnitedHealthcare Community Plan of Wisconsin CEO.

The insurer recommended that Wisconsin use a tiered benefit system, like Indiana pursued. Medicaid recipients in Indiana that meet specific requirements have access to a full benefits package while those that don't lose access and receive a "skinnier" package of benefits. The state could also consider a hardship exemption for members that can't meet all the requirements to maintain coverage.

A spokesman for UnitedHealthcare declined to comment on the testimony or whether the organization still has the same concerns about the proposal. The insurer has other recommendations in the letter, relating to its role under the provision and the proposed healthy behavior incentives.

In its revised waiver application submitted to the federal government, DHS noted that exemptions to their proposal mean a small percentage of members would be affected. DHS notes that it'll consider including community service and actively seeking work as qualified activities.

"As the federal comment period closes on the 15th and the negotiations with CMS progress, we look forward to working with our partners to implement this substantial entitlement reform and continue our success in eliminating the coverage gap in Wisconsin while helping our childless adult members transition from government dependence to independence," DHS spokeswoman Jennifer Miller wrote in an email.

Infinity Healthcare Acquired by Envision

Wed, 12 Jul 2017 15:42:09 GMT

July 10, Wisconsin Health News

Milwaukee-based Infinity Healthcare has been acquired by Envision Physician Services, part of Colorado-based Envision Healthcare Corporation.

Infinity Healthcare currently staffs 25 emergency medicine sites, 10 urgent care centers and other programs for health systems in Wisconsin and Illinois, including Ascension and Hospital Sisters Health System.

It has more than 340 physicians and other providers who deliver emergency and hospitalist medicine as well as anesthesia and radiology services.

"The opportunity to align with Envision Physician Services is an exciting next chapter for us," Dr. Glenn Aldinger, co-founder and CEO of Infinity, said in a statement last week.

Envision provides services at more than 1,600 clinical departments in 45 states and Washington D.C. It also owns and operates 264 surgery centers and one surgical hospital.

Appeals Court Strikes Down Cap on Malpractice Awards

Mon, 10 Jul 2017 15:55:44 GMT

July 6, Wisconsin Health News

An appeals court struck down a state law Wednesday capping the amount of money that injured patients can receive for some malpractice claims.

The 1st District Court of Appeals ruled that a state law capping awards for noneconomic damages at $750,000 was unconstitutional. Noneconomic damages are intended to compensate for pain and suffering.

Judge Joan Kessler, who penned the majority opinion, wrote that the law imposes "an unfair and illogical burden only on catastrophically injured patients, thus denying them the equal protection of the laws."

The case involves Ascaris Mayo, who lost her limbs after she wasn't notified she had an infection after visiting a Milwaukee-area emergency room in May 2011. Mayo and her husband sued, and a jury awarded them $16.5 million for noneconomic damages.

The state's Injured Patients and Families Compensation Fund, which is funded by hospitals and doctors and covers large medical malpractice claims, moved to reduce that amount to the $750,000 limit. The Mayos challenged that.

Hospitals and doctors in the state were concerned about the Wednesday's ruling. Wisconsin Hospital Association CEO Eric Borgerding expects the state's Supreme Court to review the decision.

"We believe the court will uphold the well-supported and bipartisan public policy balance set by the Legislature to help ensure accessible healthcare in Wisconsin," he said in a statement.

A spokeswoman for the Office of Commissioner of Insurance, which provides administrative staff to the 13-member board, didn't respond to a request for comment on whether the state would appeal the decision.

Dr. Noel Deep, Wisconsin Medical Society president, said the decision"endangers the long-term solvency of the Injured Patients and Families Compensation Fund and its ability to adequately compensate patients." He warned that it could incentivize "attorneys to file questionable cases in hopes of astronomical jury awards seen in other states without caps."

Dan Rottier, an attorney for the Mayos, called the society's claim regarding fund's solvency "ridiculous." The fund reported a net position of $879 million as of June 2016, according to an annual report.

Rottier said that pursuing such cases are difficult because "they're extremely expensive...these cases are not taken lightly.

Rottier said the court's decision has "implications for a few cases every year where there's horrendous injuries...it's those cases where the inequity is the most severe." He noted that applying a cap in this case would have reduced the jury award by more than 95 percent.

"I would call it 5 percent justice instead of 100 percent justice," he said.

Senate Approves Final Special Session Bills Targeting Opioids

Thu, 29 Jun 2017 17:02:28 GMT

June 15, Wisconsin Health News

The Senate approved the final two proposals that are part of a special legislative session on opioids that Gov. Scott Walker called in January.

All 11 proposals that are part of that session have now passed the Legislature and await Walker's signature to become law.

The bills were based on recommendations from an interim report released in January by the Governor's Task Force on Opioid Abuse, which was chaired by Lt. Gov. Rebecca Kleefisch and Rep. John Nygren, R-Marinette.

"We have a lot of work left to do on a massive epidemic that's sweeping our state," said Ashland Democratic Sen. Janet Bewley, who served on the task force as well. "We are learning that it's even bigger and more profound than we ever thought."

The Senate approved a proposal Tuesday that would provide limited legal immunity to overdose victims. Sen. Steve Nass, R-Whitewater, was the sole no vote.

The chamber also approved a bill allowing for families and others to involuntarily commit a person with drug dependence.

The Senate also voted down along party lines a Democratic amendment to the latter proposal requesting the attorney general to consider filing a lawsuit against opioid manufacturers. A few states, like Ohio, have filed lawsuits against drugmakers.

Senate Majority Leader Scott Fitzgerald, R-Juneau, predicted that a class action lawsuit against drugmakers "is coming. It's just a matter of time...and I'm sure we'll be part of that at some point." He moved to reject the proposal as he didn't want it tied with the bill.

See a list of the special session bills.

Date Announced for Doctor Day 2018

Wed, 21 Jun 2017 18:29:09 GMT

Mark your calendars and plan to join your emergency medicine colleagues in Madison on Tuesday, January 30, 2018 for Doctor Day 2018!

Stay tuned for registration information, sponsorship opportunities, and other event details.

Walker Officially Asks for Medicaid Changes

Thu, 15 Jun 2017 15:44:16 GMT

June 8, Wisconsin Health News

Gov. Scott Walker's Department of Health Services officially asked the federal government Wednesday to allow Wisconsin to become the first state to drug screen adult Medicaid enrollees without children. The waiver amendment also caps eligibility, imposes work requirements and charges premiums to members living below the poverty line.

DHS pared back some of the changes after receiving more than 1,000 pages of comments on the proposal.

That includes shrinking the income tiers for premiums from four tiers to two and not making anyone under 50 percent of the poverty level pay premiums. Childless adults with household incomes between 51 percent and 100 percent of the poverty level would pay $8 a month. Walker originally proposed a range of $1 a month to $10 a month for members making between 21 percent of the poverty level and 100 percent. DHS is also considering a grace period of 12 months for members that miss a payment.

In addition, the application decreases a copay for subsequent visits to the emergency room. And members who skip a drug screening can sign back up for coverage as soon as they consent to treatment, instead of waiting six months.

Walker called the application "a step in the right direction." "We're continuing to build on Wisconsin's legacy as a leader in welfare reform," he said in a statement Wednesday.

Jon Peacock, research director for the Wisconsin Council on Children and Families, said the latest changes to the proposal were "modest improvements." But they don't "change the basic problem that the waiver would add new barriers to BadgerCare participation that increase administrative costs and keep people from getting the care they need."

Last month, the state's budget committee voted to require that the panel approve the waiver amendment before it's implemented. At a Wisconsin Health News event Monday, Joint Finance Co-Chair Rep. John Nyrgen, R-Marinette, said he overall supported Walker's plan, but "there's still a lot of unanswered questions in the proposal." "For us to feel comfortable that we're moving in the right direction, we believe the proposal should come back to Joint Finance and we have the opportunity to vote it up or down," he said.

HSHS appoints Johnson as new System VP and Chief Physician Executive

Mon, 12 Jun 2017 15:27:35 GMT

Springfield-based Hospital Sisters Health System (HSHS) announced the appointment of Kenneth M. Johnson, MD, as HSHS vice president and chief physician executive. Johnson currently serves as chief physician executive for HSHS Eastern Wisconsin Division (EWD), which includes HSHS St. Vincent Hospital and HSHS St. Mary’s Hospital Medical Center in Green Bay; HSHS St. Nicholas Hospital in Sheboygan; and HSHS St. Clare Memorial Hospital in Oconto Falls.

"In his new role, Dr. Johnson will lead System initiatives around quality, patient safety, and clinical integration," said HSHS President/CEO Mary Starmann-Harrison. "We look forward to having Dr. Johnson bring the leadership he has shown in our Eastern Wisconsin Division to our entire system."

Johnson received his Bachelor of Science from Louisiana State University A&M; his Doctor of Medicine from Louisiana State University Medical School; and his Masters of Public Health from the University of Illinois – Chicago, where he also completed his residency. Prior to joining HSHS, Johnson served as an emergency room physician at Columbia Hospital in Milwaukee, WI; and at St. Francis Hospital in Evanston, IL.

He will begin serving in his new role July 10.

Class of 2017: It’s Time to Fly!

Wed, 07 Jun 2017 13:38:54 GMT

By Brad Burmeister, MD
Resident Representative to the WACEP Board

There is a pair of geese and maybe six or seven of their babies that just love to sit out on my porch. It’s awesome to watch them come up and snack on the droppings from the birdfeeder. Over the last couple of weeks, I’ve seen these little fuzz balls grow up in to nearly mature birds. They are at a point now where their feathers are starting to peek out and they are looking more and more like Mom and Dad. Soon they’ll be completely grown adults and soaring all by themselves.

These geese remind me of the residency process. Initially, new residents are clumsy, requiring a lot of guidance from their attending. Soon though, they start to gain a few feathers. They can’t yet fly, but they start to develop their own attitude and way to do things. Sometimes they even make bad choices, but the attending is nearby to correct it. Soon they have a full set of feathers and are ready to fly all by themselves.

The transition from emergency medicine residents to attending physicians is about to begin for 21 or so graduates in Wisconsin. It’s a period filled with excitement and a little anxiety. Soon these residents will start their new jobs. They’ll develop new relationships with the staff and their peers and fill the sometimes desperate void of a qualified Emergency physician in their communities. They’ll also soon have the opportunity to finally start making some progress on those student loans!!

Class of 2017, soon it will be time to trust your wings. The last several years have readied them for this new journey. Every one of your feathers was earned and is strong! In just a few days, it’s going to be time for you to fly! There will certainly be times over the next year that test your skills, but always go back to your fundamentals and never forget why you went in to this career in the first place, and you’ll soar.

JFC Co-Chair Nygren to headline June 5 Newsmaker Event

Thu, 01 Jun 2017 17:54:57 GMT

Rep. John Nygren, R-Marinette, and Sen. Alberta Darling, R-River Hills, the influential co-chairs of the Joint Finance Committee, will provide an update on the state budget, discuss a proposal to self-insure the state employee health plan, preview what's next for the Heroin, Opioid Prevention and Education agenda and highlight other healthcare legislation at a Wisconsin Health News Newsmaker Event.

The event is Monday, June 5 at the Madison Club (5 E Wilson Street, Madison). Lunch begins at 11:45; conversation starts at 12:15pm and adjourns by 1pm.

Management Brings Back Fee Schedule Proposal for Workers' Compensation

Tue, 30 May 2017 17:49:03 GMT

May 18, Wisconsin Health News

The management side of a council charged with developing changes to the state's workers' compensation system has proposed creating a fee schedule for healthcare services.

The Worker's Compensation Advisory Council, which consists of representatives from management and labor, crafts a bill that updates state law around workers' compensation every two years. Management and labor introduced their proposals at a meeting last week.

Management is calling for setting initial rates at 150 percent of Medicare rates starting in 2017. The schedule would adjust each year with the medical consumer price index.

The proposal differs from a measure that was pursued by the council four years ago but failed to make it into law, which was based on rates for surgeries and procedures negotiated by group health plans.

"The goal is the same, which is to bring cost containment to the state," said Chris Reader, an advisory council member and director of health and human resources policy at Wisconsin Manufacturers and Commerce.

He said it's easier to construct the fee schedule using Medicare as it's difficult for the state to obtain average group health plan rates. More than 40 other states have fee schedules, he said.

Mark Grapentine, Wisconsin Medical Society senior vice president of government relations and liaison to the council, questioned why Wisconsin would want to mimic other states when it already has a successful system.

"The value of the current workers' comp system as it exists is by just about every measure fantastic," he said. "For whatever reason, the management side tends to have this fascination with sticker prices of individual procedures and not the overall cost of care."

Reader pointed to other proposals from management they believe could help with costs. That includes allowing employers to direct workers to healthcare providers and requiring providers to follow treatment guidelines.

If a provider decides to deviate from the guidelines, they would have to get prior approval. That ensures providers get employees back to work as soon as possible, he said.

"Let me be clear - most do an excellent job of getting workers back to work," he said. "But having strong treatment guidelines will ensure that everybody has to do that unless there's a good reason not to."

Grapentine said they're concerned about both proposals. Treatment guidelines could make it inefficient and frustrating for physicians to provide care to injured workers, he said.

The proposal relating to guidelines, he said, is coupled with the fee schedule approach. States with fee schedules aren't as efficient in providing care, and treatment guidelines can cut utilization. He compared it to pushing on both sides of a balloon at the same time.

"If you push on both sides of the balloon really hard, you know what happens," he said. "Why on earth would you do that to a system that people across the board think is a national model?"

Management and labor are set to negotiate over the coming months to craft an agreed-upon bill for introduction to the Legislature.

Stephanie Bloomingdale, secretary-treasurer of the AFL-CIO and an advisory council member, declined to comment through a spokeswoman.

Grant Extends WISHIN's Reach to Milwaukee-Area Safety-Net Clinics

Wed, 10 May 2017 16:32:12 GMT

April 2017, WISHIN Connections

Eight safety-net clinics in the Milwaukee area are upgrading clinical data-sharing capabilities thanks to a grant from the Greater Milwaukee Business Foundation on Health (GMBFH) to the Wisconsin Statewide Health Information Network (WISHIN).

The grant, facilitated by the Milwaukee Health Care Partnership (MHCP), a public/private consortium, will provide two-year subscriptions to all services offered by WISHIN, and fund one-time implementation fees for those clinics that are new WISHIN participants.The GMBFH grant will enable the clinics to fully participate in the statewide health information exchange, improve care coordination and better serve their patients.

"Enhancing the coordination of care, within and across the complex health care delivery system, is a priority strategy for the MHCP," said Joy Tapper, MHCP Executive Director. "We work to ensure access, improve health outcomes and reduce avoidable emergency-department utilization and associated costs for low-income populations. The GMBHF shares those same goals."

MHCP health system members use WISHIN as an essential tool to help improve clinical decision-making and enhance care coordination for uninsured and under-insured patients in Milwaukee. Patients served at safety-net clinics often have complex health and social needs and frequently access care across multiple health care organizations. The WISHIN community health record helps clinics better manage and support their patients in a primary-care setting.

The Milwaukee clinics benefiting from the grant are: the AIDS Resource Center of Wisconsin, Bread of Healing Clinic, Gerald Ignace Indian Health Center, Milwaukee Health Services Inc., Muslim Community Health Center, Outreach Community Health Centers, Progressive Community Health Centers, and Sixteenth Street Community Health Centers.

WISHIN for Care Coordination

The WISHIN Pulse Community Health Record is an aggregated, longitudinal, patient-centric view of a patient's clinical history (including Medicaid-paid prescriptions) that is supplemented by integrated access to state data sources like the Wisconsin Immunization Registry and the Prescription Drug Monitoring Program.

Participating health care organizations feed information from their EHR systems to WISHIN in real time, and WISHIN makes it available for query by other members of the network. By using WISHIN, health care organizations don't have to make special arrangements to receive or send clinical information, or build point-to-point connections with all of their trading partners. One connection to WISHIN can connect them with every other organization in the network.

"Users of the WISHIN Pulse system don't need to know where a patient may have received care elsewhere," said Joe Kachelski, CEO of WISHIN. "They just need the patient's name."

Another feature of WISHIN Pulse that will be implemented for the safety-net clinics is the Patient Activity Report for clinics (PAR-C). The PAR-C is a daily notification triggered when clinic patients have an emergency department (ED) or inpatient admission or discharge anywhere in the WISHIN network. The report includes the most recent demographic and contact information about the patient and high-level clinical information about the hospital encounter. It is delivered in an electronic format that can be ingested into care-management systems or other patient databases, so that care managers can quickly provide outreach and follow-up care for their patients.

"WISHIN has a substantial presence in Milwaukee," said Kachelski. "All of the Milwaukee-based health systems, the Milwaukee County Behavioral Health Division, and several independent clinics are participating in WISHIN. We are grateful to the Foundation for their contribution allowing us to extend our network to include Milwaukee's federally qualified health centers and other essential safety-net providers. As participation in WISHIN grows, all of our clients benefit."

MHCP's Emergency Department Care Coordination Initiative

Nearly half of ED visits in Milwaukee County are for non-emergencies, with a large percentage of those visits made by uninsured or underinsured individuals lacking a primary-care provider.

Since 2007, MHCP's Emergency Department Care Coordination (EDCC) initiative has worked to decrease avoidable ED visits and related hospitalizations, reduce duplicative tests and procedures and use ED encounters to connect high-risk individuals with primary-care health homes and other health resources. With a target population that includes low-income patients with chronic conditions (asthma, COPD, diabetes, hypertension and HIV/AIDS), frequent ED users and pregnant women, the initiative facilitates the referral of about 500 ED visitors a month to primary care, dental and behavioral health clinics.

Along with practicing standardized transition care management processes, the initiative uses health technology services, including WISHIN Pulse, to connect hospital EDs and community clinics in Milwaukee County.

"We've seen the power of WISHIN as used in emergency departments to reduce avoidable utilization and connect or reconnect patients to medical homes and other health resources," said Tapper. "This WISHIN expansion will ensure that the largest safety-net providers in Milwaukee are able to improve care for Medicaid and uninsured patients and assist them in securing the right care, at the right place, at the right time."

For more information, contact: Milwaukee Health Care Partnership - www.mkehcp.org; Greater Milwaukee Business Foundation on Health - www.gmbfh.org.

State Medical Lawmakers Approve Bills Targeting Opioid Addiction

Wed, 10 May 2017 16:27:10 GMT

May 3, Wisconsin Health News

The Senate and Assembly passed a number of bills that are part of Gov. Scott Walker's special session targeting opioid addiction Tuesday.

The proposals originated from a preliminary report issued in January by a task force co-chaired by Rep. John Nygren, R-Marinette, and Lt. Gov. Rebecca Kleefisch.

"With the nine special session bills advanced today, the Senate has taken several great strides towards helping to combat our state's ongoing opioid crisis," Senate Majority Leader Scott Fitzgerald, R-Juneau, said in a statement.

But Democrats questioned whether the bills go far enough. "After years of struggles, we're taking baby steps when we should be making major strides to improve outcomes and strengthen community safety," Senate Democratic Leader Jennifer Shilling, D-La Crosse, said in a statement.

The Senate approved proposals that would:

prohibit the dispensing of schedule V controlled substances containing codeine, dihydrocodeine, ethylmorphine and other substances listed under the section of law the bill targets.
allow school district personnel and college and university residence hall directors to administer naloxone.
provide $2 million a year for alternatives to prosecution and incarceration for those with substance use disorders, $150,000 a year to expand those alternatives to more counties and $261,000 a year for an additional pilot program.
provide $50,000 to help establish a recovery charter school.
provide $63,000 a year to expand graduate medical training on addiction.
provide $1 million a year to create more opioid treatment programs in the state.
provide $500,000 a year to establish an addiction medicine consultation program.
provide $420,000 a year to hire four additional drug trafficking investigators at the Department of Justice.
provide $200,000 a year to expand substance abuse screening by the Department of Public Instruction.

The Assembly approved the bills last month, so they now head to Walker's desk for his approval.

The chamber also approved two additional bills Tuesday that are part of the package but haven't been taken up by the Senate. Those measures would:

provide limited legal immunity to overdose victims.
allow those with substance abuse disorders to be involuntarily committed.

President's Message, May 2017

Mon, 08 May 2017 15:34:04 GMT

Parallel Parking and Aryepiglottic Folds
by Bobby Redwood, MD, MPH

I am really good at parallel parking; I pride myself on it. I went to medical school in Chicago and used to wedge my Volkswagen Jetta into parking spaces with less than a three inch gap on either bumper (we won't talk about the "love taps"). I recently bought a new car and, for the first time ever, I am now parallel parking with the assistance of a back-up camera. The precision is amazing. If needed, I can shrink that three inch gap down to one or two with no bumper to bumper contact whatsoever. The speed with which I parallel park has increased as well. A one-minute maneuver can reliably be done in 45 seconds with the assistance of the handy back-up camera. Still, some things seem a bit off. I've hit the curb a few times, which never happened before and I notice myself paying less attention to the traffic around me compared to my pre-back-up camera days. Basically, my level of situational awareness has decreased since I've been supplied with the luxury of direct rear bumper visualization. In inclement weather, when my back-up camera is fogged up or otherwise obscured, it feels clunky and awkward to go back to the old rubbernecking method. My once-lauded parallel parking skills are slipping.

As an emergency physician, its hard to look at the little rectangular screen of the back-up camera and not be reminded of another innovation in my life: video laryngoscopy. Video laryngoscopy (VL) is certainly on the rise in U.S. emergency departments. Recent surveys report that about 30% of emergent intubations are performed with VL compared to only 1% a decade ago. In residency, I almost exclusively intubated using direct laryngoscopy (DL), using VL as a rescue method for difficult intubations. In my current practice, I find that I'm clinging to DL in order to keep my skills up, but increasingly reaching for VL first in a variety of scenarios including C-collars, severe kyphosis, trismus, and angioedema. In all honesty, I am inching my way towards a VL-dominated practice, but I want to be sure I don't lose my situational awareness during "inclement weather" (read: blood and vomit). As VL becomes more ubiquitous, I imagine many EPs across the state are experiencing a similar tug-of-war in their practice style, which of course begs the question: which is better?

Like any reasonable emergency physician seeking an answer to a clinical question, I went to the literature...unfortunately, there's just not that much out there. An April 2016 non-blinded, non-randomized controlled trial at Hennepin County Medical Center ED found similar first past success rates between DL (86%) and VL (92%), even with difficult airways [difference was not statistically significant]. Similarly, a March 2017 meta-analysis on the same topic from the critical care literature included four randomized controlled trials and concluded that VL did not improve the rate of successful intubation on first attempt compared to DL. The EMRAP podcast made a statement that VL should be considered standard of care and the comment section exploded with DL supporters expressing a spectrum of emotions ranging from calm composed dissent to shock and righteous indignation. By any measure, the EM jury is still out on DL vs. VL.

In a 2010 report, the Department of Transportation's National Highway Traffic Safety Administration reported that each year 210 people die and 15,000 are injured in light-vehicle backup incidents, with about 31% of the deaths among kids under age 5 and 26% adults over 70. They estimated that 58 to 69 lives will be saved each year (not including injuries prevented) if the entire on-road vehicle fleet had "rear-view visibility systems." Acting on this observational, retrospective evidence, the NHTSA, will soon require that all automobiles sold in the United States (beginning in May 2018) be equipped with back-up cameras.

Government officials are not typically trained in the scientific method. Unlike the house of medicine, the NHTSA doesn't need a randomized controlled trial to make a judgement call. They feel pretty confident that back-up cameras make driving safer and also save lives. While the jury may still out on DL vs. VL for emergent intubations, that doesn't mean we at WACEP can't opine a bit. What has your experience been with VL? Has it become standard of care in your ED? Does a generation gap exist between DL and VL as it does with other forms of technology? Are there pros or cons that we have not discussed here?

Let's get some (admittedly non-scientific) Wisconsin specific data on the subject. Please fill out the following survey and use the last free text field to answer any of the questions posed above. If we get greater than 25 responses, we'll report the data on the WACEP website and hopefully inspire an ongoing conversation about how Wisconsin EPs feel about DL and VL (...not to mention back-up cameras).

BEGIN SURVEY

Happy intubating!

Bobby Redwood MD, MPH
WACEP President

Sources:
Driver, BE et al. Direct versus video laryngoscopy using the C-MAC for tracheal intubation in the emergency department, a randomized controlled trial. Acad Emerg Med. 2016 Apr;23(4):433-9.
Zhao, Bing-Cheng, Tong-Yi Huang, and Ke-Xuan Liu. "Video laryngoscopy for ICU intubation: a meta-analysis of randomised trials." Intensive Care Medicine (2017): 1-2.

WACEP Opioid Prescribing Webinar Now Available

Mon, 08 May 2017 13:47:56 GMT

Emergency physicians who weren't able to participate in the WACEP 2017 Spring Symposium now have an opportunity to view the recorded presentation on responsible opioid prescribing.

Registration is open for physicians to view the session on demand. Participation in the webinar has been approved to meet the requirement for two hours of continuing education as mandated by the Wisconsin Medical Examining Board per Med 13.03(3) of the Wisconsin Administrative Code.

Learn more and register online.

Doctors, Acupuncturists Blast Chiropractic Bill

Tue, 02 May 2017 21:16:50 GMT

April 27, Wisconsin Health News

Doctors and acupuncturists oppose a bill that would allow chiropractors to perform physical examinations for student athletes and practice "chiropractic acupuncture" and "chiropractic dry needling" if they receive additional training.

The bill received a public hearing Wednesday before the Assembly Committee on Health.

Under the proposal, schools that require a pupil to have a physical examination to participate in sports and other activities will have to accept a physical examination completed by a chiropractor the same way it accepts those completed by doctors. The chiropractor would have to hold a certificate in health or physical examinations.

The same requirement would apply to the state's technical colleges or a two-year campus within the University of Wisconsin System that require physical examinations for students to participate in sports.

"With some additional training, doctors of chiropractic could provide a high quality exam," Mark Cassellius, a chiropractor practicing in Onalaska, told lawmakers.

Dr. Tosha Wetterneck, past president of the Wisconsin Medical Society, opposes the bill.

The physical examination isn't just focused on the athletics, but on at-risk behaviors, immunizations and other factors that might impact sports participation, she said. That requires extensive training.

"This is rocket science," she said. "This is difficult."

The bill would also allow chiropractors to practice "chiropractic acupuncture" if they complete at least 200 hours of instruction and the acupuncture examination administered by the National Board of Chiropractic Examiners.

The bill would also allow chiropractors to practice "chiropractic dry needling," which involves puncturing the skin with needles to treat "neuromusculoskeletal pain and performance," if they complete 50 hours of postgraduate study.

Shawano-based chiropractor Brian Grieves said the bill could help address the opioid epidemic by increasing access to alternatives pain treatments.

"We have very limited, proven, effective non-drug options to offer people for pain," he said. "Being able to augment that by offering chiropractic acupuncture would greatly expand that access."

Elissa Gonda, chair of the legislative committee for The Wisconsin Society of Certified Acupuncturists, opposes the bill.

"Acupuncture is a serious and rigorous profession," she said. "It's not a method or technique that can be employed on an occasional basis by another healthcare practitioner."

Steve Conway, executive director of the Chiropractic Society of Wisconsin, said they're generally supportive of the bill but they're still vetting it.

Wisconsin Receives 7.6 Million to Fight Opioid Addiction

Tue, 02 May 2017 21:07:23 GMT

April 27, Wisconsin Health News

Wisconsin will receive $7.6 million from the federal government to combat opioid addiction, the Department of Health and Human Services announced Thursday night.

HHS is providing $485 million to all 50 states, the District of Columbia and six U.S. territories. The funding, made available under the 21st Century Cures Act, will go toward prevention, treatment and recovery services.

States were awarded funding based on rates of overdose deaths and unmet need for treatment. Florida received the most money at $27.2 million, while five territories received $250,000 each.

Gov. Scott Walker directed the Department of Health Services to seek the funding in an early January executive order. DHS can re-apply for additional funding next year.

Senate Education Committee Backs Bills Targeting Drug Addiction

Tue, 02 May 2017 19:23:37 GMT

April 25, Wisconsin Health News

The Senate Committee on Education approved two bills Monday that are part of a special session ordered by Gov. Scott Walker to tackle the opioid epidemic.

A bill that would provide $50,000 to help establish a recovery charter school, which would serve 15 high school students in recovery from substance use disorder, passed out of committee 6-1. Sen. Steve Nass, R-Whitewater, voted against it.

An additional proposal providing $200,000 a year to expand the use of a substance abuse screening by the Department of Public Instruction passed 7-0. The Assembly has already approved both measures.

Medical Examining Board Approves Final Telemedicine, Opioid CME Rules

Tue, 02 May 2017 18:03:45 GMT

April 24, Wisconsin Health News

The Medical Examining Board approved permanent rules last week that govern the practice of telemedicine and mandate continuing medical education requirements for doctors on opioid prescribing.

The rules are expected to go into effect June 1, Department of Safety and Professional Services staff told board members.

The final telemedicine rule clarifies that a physician-patient relationship can be established through telemedicine and provides guidelines on the use of telemedicine.

The other rule requires doctors renewing their licenses to complete two hours of training on guidelines written by the board that relate to opioid prescribing. Doctors have to complete 30 hours of continuing medical education every two years.

Walker Approves CBD Oil Bill

Mon, 01 May 2017 21:05:13 GMT

April 18, Wisconsin Health News

Gov. Scott Walker has signed into law a bill ending state penalties for those who possess cannabidiol without psychoactive effect if they have written certification from a doctor.

The bill also directs the state's Controlled Substances Board to reschedule CBD oil, which is derived from marijuana and sometimes used to treat seizures in children, within 30 days following a change at the federal level. The bill passed the Senate 31-1, and the Assembly 98-0.

The bill builds on a 2014 law that aimed to make the drug available with a prescription in the state. But supporters said that providers weren't able to prescribe the drug, which is still illegal to obtain under federal regulations.

Registration is Open - 2017 Wisconsin Health News Conference

Thu, 20 Apr 2017 19:51:21 GMT

While Republicans may have walked away from the American Health Care Act, the healthcare debate is certain to continue. Will the Trump Administration fight to keep the Affordable Care Act afloat? Or will it use its power to hasten the law’s demise? Will lawmakers move left or right to forge a new deal?

In the meantime, Gov. Scott Walker is pushing ahead with Medicaid reforms that likely would not have been approved a year ago. What does it mean for the program?

National and regional healthcare experts will tackle these questions and more at the 2017 Wisconsin Health News Conference, July 19 at the Monona Terrace in Madison. Registration is now open (link).

WHA Education Available for Expedited Physician Licensure Process

Tue, 18 Apr 2017 19:45:17 GMT

April 14, WHA Valued Voice

With the Interstate Medical Licensure Compact’s voluntary expedited licensure process becoming operational this month, WHA will be offering a 45-minute webinar on how the new Compact process can help physicians more quickly receive a Wisconsin medical license or a license in another state if the physician already holds a medical license in a Compact state. WHA General Counsel Matthew Stanford will present information on eligibility, which states are participating in the Compact, completing the application process, fees, how to maintain a Compact expedited license and considerations for utilizing the Compact expedited process versus the traditional licensure process.

The webinar, scheduled Tuesday, May 23 from 12:00-12:45 pm, is being offered through a partnership between WHA and the Wisconsin Medical Group Management Association (WMGMA). There is no fee to participate in this webinar, but pre-registration is required. Registration is now open at: www.cvent.com/d/z5qq0r.

Wisconsin joined the Interstate Medical Licensure Compact through the enactment of legislation in December 2015, which was a key legislative priority for WHA. To apply for a medical license through the Interstate Medical Licensure Compact expedited process, individuals should visit https://imlcc.org.

New Society Resources Address ePDMP FAQs

Tue, 18 Apr 2017 19:43:26 GMT

Effective April 1, 2017, Wisconsin Act 266 requires all Wisconsin-licensed physicians and other prescribers to review a patient’s records from Wisconsin’s Enhanced Prescription Drug Monitoring Program (ePDMP) before issuing a prescription order for a monitored prescription drug.

To help members and their health care teams assess options for compliance with this new requirement, the Wisconsin Medical Society has prepared Wisconsin ePDMP: Frequently Asked Questions. Click here to download the PDF.

Part of the Wisconsin legislature’s Heroin, Opioid Prevention and Education (HOPE) Agenda, the requirement pertains to each prescription order for a controlled substance unless one of the following exceptions applies:

1. The patient is receiving hospice care.

2. The prescription is for a three-day or less supply with no refills.

3. The drug is lawfully administered to the patient.

4. Due to an emergency, it is not possible to review the ePDMP before issuing the prescription.

5. The practitioner is unable to review the ePDMP data because either the ePDMP or the means to access it are not operational.

Monitored prescription drugs include most Schedule II, III, IV or V controlled substances (as well as any other substance identified by the Controlled Substances Board as having a substantial potential for abuse).

Prescribers subject to this requirement must register with the ePDMP to access the system. Click here to register if you have not done so already.

Interstate Medical Licensure Compact Launches

Mon, 17 Apr 2017 19:49:32 GMT

April 12, Wisconsin Health News

A compact that aims to expedite the process for doctors obtaining medical licenses in multiple states launched in Wisconsin last week.

So far 18 states have passed legislation to join the Interstate Medical Licensure Compact, which aims to make it easier and faster for doctors to get a license in other participating states.

Illinois, Iowa and Minnesota have entered the agreement. Other states, including Michigan have bills pending in their legislatures that would allow them to join.

The compact began accepting and processing applications from qualified physicians on April 6, according to a statement from the commission overseeing it.

Mark Grapentine, senior vice president of government relations at the Wisconsin Medical Society, said there are still details to work out before the compact process is functional among all participating states. But Iowa and Wisconsin are ready to go, he said.

"It will greatly help physicians and patients who may cross the Mississippi River to either give or receive care," he wrote in an email.

Dr. Donn Dexter, vice chief medical officer at Mayo Clinic Health System northwest Wisconsin, said the compact will help attract doctors to the state, particularly in underserved areas.

It will also support educational efforts by making it easier to get a license in Wisconsin, allowing doctors in neighboring states to "come over and work and train in our community and hopefully stay," he said.

Brian Vamstad, government relations manager for Gundersen Health System, called the launch a "great step." The compact will help with telemedicine efforts, he said.

"It really will help us and others to meet the needs of communities," he said.

So far, doctors with licenses who are either living, employed or have 25 percent of their business in Wisconsin can apply through the compact to practice in any of the other participating states, according to the Interstate Medical Licensure Compact Commission.

Eleven states, including Minnesota, aren't comfortable serving as states of principal licensure, meaning doctors solely licensed by those states and either residing or practicing there can't use the compact until policymakers approve technical fixes.

Diane Shepard, secretary for the commission, said Minnesota is close to approving its technical fix.

Mental Health and High Use of Emergency Departments

Thu, 06 Apr 2017 15:55:11 GMT

April 4, Treatment Advocacy Center, Research Weekly

Mental health conditions increase the likelihood that adults who visit hospital emergency departments (ED) will become frequent utilizers, according to a new analysis of ED use by high-need, high-cost patients who repeatedly use healthcare services.

In 2014, ED super utilizers made up no more than 6% of ED patients by age or payer category but generated up to 26% of all ED visits in 13 states, according to a statistical brief published by the Agency for Healthcare Research and Quality (AHRQ).

Mental health symptoms increased the likelihood a patient would be a super utilizer.*

The Role of Mental Health in ED Super Utilization

The authors of "Characteristics of emergency department visits for super-utilizers by payer, 2014" maintain that identifying the characteristics of ED super utilizers is essential to addressing their high use of the ED services.

"Over the last several years, health care stakeholders have paid increasing attention to issues specific to high-need, high-cost patients who constitute a very small percentage of the population but account for a disproportionally high amount of health care utilization," H. Joanna Jiang and colleagues say. "These patients, dubbed super-utilizers, represent a broad spectrum of demographic and clinical characteristics and socioeconomic conditions.

"Programs designed to improve care for super-utilizers need to be tailored to the specific needs of the different subgroups of these patients. As part of this effort, it is important to examine differences in utilization patterns among different types of super-utilizers, in comparison to national benchmarks."

For the statistical brief, AHRQ examined 2014 ED data from 13 geographically dispersed states that are home to about 28% of the US population. They compared ED use patterns by payer: Medicare for recipients 65 years and older, Medicare for recipients 1 to 64 years old, Medicaid, private insurance.

Findings

Among the findings:

Mental health ED visits were more common for super-utilizers than for other patients regardless of payer. Among super utilizers insured by Medicaid, for example, 7% of ED visits were for mental health complaints, double the rate for individuals who were not making high use of the ED. Super utilizers insured by Medicare, regardless of age, and by private insurers also were more likely than other patients to visit the ED with mental illness symptoms.
Super utilizers as defined by AHRQ made an average of four to five more ED visits per year than other patients. The 6.1% of Medicare patients 1-64 years old who were super utilizers, for example, made 26.2% of all ED visits. Similar patterns were seen for older Medicare, privately insured and Medicaid patients.
Super utilizers accounted for an outsized proportion of ED costs. For example, while only about 4% of ED users insured by Medicaid were super utilizers, these patients accounted for nearly 20% of total ED charges to Medicaid.
Among the payer groups, Medicare and Medicaid patients 1-64 years old were the most likely to be super utilizers. Approximately one in 10 patients in this age group were super utilizers. In contrast, approximately one in 20 patients who were privately insured or 65 years old and insured by Medicare were classified as super utilizers.

The most common reasons for super utilizers visiting the ED were medical (e.g., chest pain, superficial injury, abdominal pain and other physical conditions). Patients with three or more chronic conditions were more prevalent among the super-utilizer population than among other ED visitors.

The role of mental illness on super utilization in America's EDs is one of several issues the Treatment Advocacy Center examines in its upcoming study, A Crisis in Search of Data: The Revolving Door of Serious Mental Illness in Super Utilization, scheduled for release April 18.

*AHRQ defines ED super utilizers as private patients age 1-64 years who make four or more ED visits in a year or Medicaid/Medicare patients who make six or more visits.

May 2 WHN Panel Event: Wisconsin's aging population and the future of long-term care

Thu, 06 Apr 2017 15:49:00 GMT

Wisconsin's population is aging and healthcare care costs for the elderly and those needing long-term care are growing along with it. Gov. Walker's budget increases Medicaid reimbursement for nursing homes and provides more money for direct care workers. Is it enough to address workforce shortages? And what's next for Family Care? After puling back its plans to overhaul the program, the administration is pushing forward with a statewide expansion. Will they incorporate other proposed program changes?

Learn more at a Wisconsin Health News Panel Event May 2 in Madison. Panelists:

Lynn Breedlove, Co-Chair, Wisconsin Long Term Care Coalition
Curtis Cunningham, Assistant Administrator of Long-Term Care Benefits and Programs, Department of Health Services
Tim Garrity, Chief Innovation Officer, Community Link
John Vander Meer, Executive Director, Wisconsin Health Care Association

Register Online

President's Message, March 2017

Fri, 31 Mar 2017 20:03:26 GMT

March at Wisconsin ACEP: In Like a Lion, Out Like a Tiger
By Bobby Redwood, MD

We are over the moon here at Wisconsin ACEP (WACEP). The last month has really showcased the positive impact that Wisconsin emergency physicians can create when we work together and show up in force. To put it succinctly, March was a time of Influence, Education, and Accolades for Wisconsin emergency medicine.

Influence. Our month started off with an important milestone: the WACEP PAC reached an historic high and 100% of the WACEP board (as well as many general members) donated to the cause. The strength of our PAC gives emergency physicians unprecedented access to representatives in the state and national legislature at a time when the future of our healthcare safety net is more uncertain than ever. With the collapse of the American Health Care Act, our elected officials are scrambling to come up with strategies to provide broad access to care and also maintain a high level of quality care. WACEP will continue to advocate for increased Medicaid reimbursement for emergency physicians (we are 50th in the nation after all, in terms of Medicaid reimbursement for level 3, 4, and 5 emergency visits). Our thriving PAC is how we are able to build relationships, gain access to key meetings, and ensure that emergency medicine always has a seat at the table. Are you feeling me on this? Be a catalyst for change and contribute to the WACEP PAC at http://www.wisconsinacep.org/PAC

Education. On March 28th, emergency physicians from across the state felt the love of their colleagues and the pride of their specialty at the WACEP 2017 Spring Symposium. We pounded out our 2016 LLSA articles, we learned cutting edge emergency ultrasound techniques, and we celebrated the role of women in emergency medicine while also strategizing against the harmful gender stereotypes that unfortunately continue to plague our physician workforce. Dr. Steve Hargarten gave a provocative and inspiring keynote address on the epidemic of firearm violence in Wisconsin; local EM celebrities Tim Westlake, Brian Sharp, and Julie Doniere educated our membership on the new mandatory opioid prescribing guidelines issued by the state medical examining board; and then educational speed dating ensued with breakout sessions on hot topics in emergency medicine that ranged from contract negotiations to fluid resuscitation in the septic CHF patient. It was a fabulous example of scholarly fellowship in Wisconsin emergency medicine and we cannot wait to reveal what we have planned for the 2018 Spring Symposium.

Accolades. WACEP was honored to have our signature issue highlighted as a one of three priority issues at the 2017 Doctor Day at the Capitol on March 29th. More than 470 physicians from all specialties flooded the halls of the capitol and, in the spirit of unity and collective impact, advocated face-to-face with our legislators for increased Medicaid reimbursements for EMTALA related care. With passion and conviction, physicians across the board presented legislators with the graphic pasted below, a striking reminder that Wisconsin Medicaid reimbursement rates pale in comparison to our neighbors in the Midwest.

But the accolades don't end there. While presenting at the WACEP Spring Symposium, Dr. Rebecca Parker (president of national ACEP) revealed that she has just been named by Modern Healthcare as one of the top 50 Most Influential Physician Executives and Leaders of 2017. We at WACEP are incredibly proud of Dr. Parker (who has visited Wisconsin twice in the past year!) and are asking all WACEP members to vote for Dr. Parker to be THE most influential physician executive and leader by casting your vote at https://www.surveymonkey.com/r/XFVWR78

I remember learning in grade school that March comes in like a lion and goes out like a lamb. Let's be real, this is Wisconsin; March comes in like a lion and goes out like a tiger. The wind is howling, the rain is nipping fiercely at our noses, and we at Wisconsin ACEP are loving every minute of it!

Emergency Physicians at the Capitol

Fri, 31 Mar 2017 19:58:03 GMT

Doctor Day 2017 Recap
By Lisa Maurer, MD

WACEP has been a long-time proud sponsor of Doctor Day, where physicians of all specialties come to Madison to discuss issues important to our practice and our patients.

At this week's event, which drew nearly 500 physicians from across the state, Medicaid physician reimbursement--and specifically emergency physician reimbursement--was, without a doubt, the issue that garnered the most energy at the Capitol.

What I did expect, was that our specialty would be well represented. We had 24 emergency physicians at the event, telling our story of how we are stuck in our practices between a federal mandate and state fee schedule, losing money on each encounter with Medicaid enrollees.

What I didn't expect was the overwhelming support from our colleagues in other specialties. We didn't even have to be the ones to speak up!

Primary care physicians were the ones to ask legislators, "If the ED's lose their ability to attract quality EM docs, who will be the front lines for the opioid epidemic?"
Psychiatrists challenged the legislators, "How can we expect EM groups to stay afloat when they lose money every time we have to send them our patients with psychiatric emergencies?"
Our physician partners working as CMOs of Wisconsin insurance companies were there at our sides saying, "Payors in Wisconsin have a responsibility to support the safety net of our health care system."

The legislators of Wisconsin heard loud and clear that patients AND physicians of many specialties depend on us! WACEP looks forward to using this momentum to find a solution for our state. Be sure to thank your colleagues around your community this week for the huge impact they had on our behalf.

WI ePDMP Requirement Starts April 1

Fri, 31 Mar 2017 19:44:55 GMT

Wisconsin physicians are now required to follow an additional procedure before prescribing Schedule II, III, IV, and V controlled substances, or any other drug identified by the board by rule as having a substantial potential for abuse.

Beginning on April 1, 2017, under Wisconsin Statute 961.385, Wisconsin practitioners must review a patient's records in the Wisconsin Prescription Drug Monitoring Program before the practitioner issues a prescription order for the patient.

This requirement does not apply under the following circumstances:\

The patient is receiving hospice care.
The prescription is for a dosage that is intended to last 3 days or less and is not refillable.
The monitored prescription drug is lawfully administered to the patient.
Because of an emergency, it is not possible for the practitioner to review patient records before issuance of the prescription.
The practitioner cannot review records because the program is not operational or due to some other technological failure (if the practitioner reports the failure to the board).

More information regarding Wisconsin's Prescription Drug Monitoring program can be found online at https://pdmp.wi.gov/

Vote Becky Parker for Modern Healthcare's Top Physician Leaders

Thu, 30 Mar 2017 18:19:02 GMT

ACEP President On the Ballot for Most Influential Physician Executives and Leaders

Voting Open Through April 28: Cast Your Ballot

ACEP President Becky Parker has been nominated to be on the ballot for the 50 Most Influential Physician Executives and Leaders as recognized by Modern Healthcaremagazine.

Becky has already made the cut for the top 150 people most nominated to be put on this ballot, which in itself is a tremendous accomplishment considering how many influential physician executives and leaders there are and that were no doubt nominated.

The voting is open now for who will be the Top 50 recognized by this widely read publication. Cast your vote for Becky today!

Only one vote per device is allowed, but you may vote from your computer, your phone, your tablet, etc. Your vote will help Becky be recognized for her outstanding leadership, and this honor would be a great credit to Becky, ACEP, and our specialty.

Professional groups oppose proposed healthcare board consolidations

Wed, 29 Mar 2017 17:13:10 GMT

March 20, Wisconsin Health News

Professional groups oppose a move by Gov. Scott Walker to eliminate state boards that regulate optometrists, radiographers and podiatrists as well as consolidate advisory councils and boards that oversee healthcare professions.

Walker's 2017-19 budget would end the Radiography Examining Board, the Podiatry Affiliated Credentialing Board and the Optometry Examining Board and transfer their functions, rules and pending matters to the Medical Examining Board.

The budget would also create a Medical Assistants Council, consolidating advisory councils on physician assistants and others. And it establishes a Medical Therapy Examining Board, ending boards overseeing physical therapists and others.

"Currently, taxpayer dollars are going to provide administrative services to each of the boards that are proposed to be consolidated," Alicia Bork, Department of Safety and Professional Services spokeswoman, wrote in an email. "Merging these functions...will allow efficiencies that cannot be found when separate silos exist."

The combined actions, along with other changes at DSPS, would cut state spending by $50,800 in program revenue over the next two fiscal years, according to the Legislature Fiscal Bureau. There were 1,172 optometrists, 424 podiatrists and 6,994 radiographers with active licenses in Wisconsin as of July 2016.

Peter Theo, executive vice president of the Wisconsin Optometric Association, said his members have "serious concerns" about the proposal as turning regulatory control over to another profession may hurt their ability to diagnose and treat eye diseases.

"Optometrists are primary eye care providers whose regulatory independence is critical to maintaining the high standard of care needed to ensure the safe and competent practice of optometry," he said.

The Wisconsin Podiatric Medical Association raised concerns about not having representation on the Medical Examining Board.

"The Medical Examining Board cannot be expected to keep up with the advances in all of the professions that they are looking to be charged with," Dr. Bob Sage, the association's president, said in a statement. "It is unrealistic."

Sandy Helinski, legislative committee chairperson for the Wisconsin Society of Radiologic Technologists, said the elimination of the Radiography Examining Board, established in 2010, would be an "indisputable step backward in the health of Wisconsin's patients."

"Anything that could possibly dilute the effectiveness of what we've been able to accomplish in these last seven years is of great concern to us," she said.

Connie Kittleson, president of the Wisconsin Physical Therapy Association, opposes eliminating of the Physical Therapy Examining Board and the creation of a Medical Therapy Examining Board.

She noted other states have tried consolidation in the past and have returned to independent boards.

"The data out there shows it doesn't make things more efficient, it doesn't save money," she said. "But more importantly, it wouldn't be worth the risk to public safety to have people who do not have expertise or training in a particular field regulating professionals of another field."

Reid Bowers, Wisconsin Academy of Physician Assistants' advocacy committee chair, raised concerns about the proposed Medical Assistants Council, saying it "would severely limit the ability of PAs to shape how they are regulated by the Medical Examining Board."

At a Medical Examining Board meeting last week, Chair Dr. Kenneth Simons said the budget would put them "in charge of things we have no expertise" in. Others raised similar concerns.

Tom Ryan, the board's executive director, said that the boards put under the authority of the Medical Examining Board meet three to four times a year. Doctors on the board could do "curbside consults," he said.

"I don't think it's as formidable a challenge as you would think," he said.

Mark Grapentine, senior vice president of government relations for the Wisconsin Medical Society, said the Medical Examining Board has to investigate complaints against physicians and regulate the profession.

"If adding these non-medical professions to their duties takes away from that responsibility or makes fulfilling that duty less efficient, it's difficult to divine the upsides to the proposal," he said in a statement.

April 4, 2017 WHN Event - Coordinating care coordination

Fri, 17 Mar 2017 22:23:50 GMT

Buoyed by the promise of better care and lower costs, health organizations are increasingly flocking to care coordination models. But they are not always easy to organize in today’s disjointed healthcare system and current payment structures often don’t reward the effort. Also, coordination among different programs is lacking.

A panel of experts will share their experiences from the field. Find out what’s working, what’s not and what they see as the future of care coordination. Panelists:

· Joy Tapper, Executive Director, Milwaukee Health Care Partnership
· Tom Lutzow, CEO, Independent Care Health Plan
· Jane Pirsig-Anderson, Director, Aurora Health Care Family Service

The event is Tuesday, April 4 from 11:30am – 1pm at the Wisconsin Club in Milwaukee (900 West Wisconsin Avenue). Register now.

Wisconsin Medical Society Initiative to Focus on Mental and Behavioral Health

Fri, 17 Mar 2017 22:18:14 GMT

Leaders of the Wisconsin Chapter of the American College of Emergency Physicians were invited to join the Wisconsin Medical Society and a small group of key health care stakeholders last week in Madison to begin to address myriad issues related to mental and behavioral health.

Representatives from the Psychiatric Association and the Wisconsin Academy of Family Physicians were also part of the discussion. The group’s goal is to find ways for physicians to influence and improve three key areas: stigma, access and workforce.

“Through this steering committee, we hope to reduce the stigma around mental/behavioral health both within the medical community and in the public at-large; expanding the workforce available to treat and deal with mental health issues; and increasing access for mental/behavioral health treatment particularly in rural, urban, and other health shortage areas,” said Molli Rolli, MD, chair of the Wisconsin Medical Society’s Board of Directors.

The group plans to engage other stakeholders in the coming months and plans to develop a comprehensive strategy to achieve these goals.

Committees Green Light Opioid Bills

Fri, 17 Mar 2017 14:22:28 GMT

March 10, Wisconsin Health News

Two Assembly committees approved five bills that target the state's opioid addiction Thursday. The bills are part of the special session ordered by Gov. Scott Walker to fight the epidemic.

Most of the bills made it out of committee on bipartisan, unanimous votes. But a proposal providing $420,000 over the next two fiscal years to hire four investigators at the Department of Justice targeting drug trafficking passed 9-3.

Reps. Jesse Kremer, R-Kewaskum; Fred Kessler, D-Milwaukee; and Rep. David Crowley, D-Milwaukee, voted against passage.

"This means of course we're going to send up more people into prison," Kessler told members of the Assembly Committee on Criminal Justice and Public Safety. "Because now we're going to investigate more, find more and prosecute more. You have to take that into consideration."

Other special session bills that made it out of committee, including the Assembly Committee on Education:

A bill allowing school district personnel to administer naloxone, an anti-overdose drug. Lawmakers also backed an amendment from Rep. Jill Billings, D-La Crosse, extending the bill to residence hall directors at colleges and universities.
A bill that would continue providing $2 million annually s to fund more treatment and diversion programs in the state and provide $150,000 annually to expand the program and $261,000 annually for a pilot program for expanded efforts. Lawmakers voted down an amendment 8-4 on party-lines from Rep. Evan Goyke, D-Milwaukee, that would have added more funding to the bill.
A bill that would allow the University of Wisconsin System to establish a charter recovery high school for up to 15 students with substance abuse disorders. Lawmakers backed two amendments.
A bill that would provide funding to expand a substance abuse disorder screening tool used in public schools. Lawmakers amended the bill to provide $400,000 over the next two years, bringing the amount in line with the governor's budget.

Committee Approves Rural Broadband Bill

Thu, 16 Mar 2017 21:11:11 GMT

March 10, Wisconsin Health News

The Senate Committee on Revenue, Financial Institutions and Rural Issues approved a bill Thursday that would increase funding for rural broadband and add healthcare criteria the Public Service Commission should consider when awarding money.

DOJ Reaches Agreement for Discounted Narcan

Tue, 28 Feb 2017 22:57:37 GMT

February 24, Wisconsin Health News

The Wisconsin Department of Justice has reached an agreement with Adapt Pharma to offer an anti-overdose nasal spray at a discounted rate when bought in bulk by police, first responders and state or local government agencies.

Narcan Nasal Spray can reverse some of the effects of an opioid or heroin overdose. Under the agreement, approved entities that purchase the nasal spray in quantities of greater than 48 units can receive a 40 percent discount.

That reduces the price from $125 to $75 for two 4mg doses. The rate is set until Feb. 15, 2018.

Schimel earlier in February renewed an agreement with Amphastar Pharmaceuticals that established a rebate program for each of its naloxone syringe purchased by public entities in Wisconsin through Feb. 1, 2018.

March 21 Newsmaker Event with Linda Seemeyer

Tue, 28 Feb 2017 21:00:41 GMT

Join Wisconsin Health News for a Newsmaker Event with Department of Health Services Secretary Linda Seemeyer, who will outline Gov. Scott Walker's 2017-19 budget and discuss department priorities.

The event is being held March 21st from 11:30 am to 1:00 pm at the Madison Club, 5 E. Wilson St, Madison WI 53703. Register now.

More than 12,000 Sign Up for ePDMP

Fri, 24 Feb 2017 20:59:23 GMT

February 20, Wisconsin Health News

More than 12,000 doctors and other prescribers have registered for the state's Enhanced Prescription Drug Monitoring Program, Department of Safety and Professional Services staff told the Medical Examining Board last week.

That's about a third of the total number of expected eventual participants, said Andrea Magermans, PDMP analyst. More than 5,000 delegate users, which act on behalf of prescribers, have signed up too, she told board members last Wednesday.

The registration process is different than under the older program, which has posed a challenge, she said.

"There have been some customer service type of issues," she said. "We've been addressing them as they've come up."

Magermans noted that getting used to the new format has posed a challenge for users as well. But once they're used to it, "it seems to be going well," she said. They've received positive feedback about the changes.

Effective April 1, those prescribing controlled substances will have to review a patient's records before writing a prescription. Prescribers will also have to update the PDMP by end of the next business day after dispensing a controlled substance in most cases.

Magermans said they hope to create a new category in the PDMP for medical directors by April 1, which will allow those overseeing prescribers to review their prescribing methods. By the start of April, DSPS also plans to add a component to the program so prescribers can review their own prescribing history.

DSPS is also in talks with health systems, including Aurora Health Care, Gundersen Health System, Marshfield Clinic Health System, ProHealthcare and UW Health, about pilot projects allowing health systems to integrate their electronic health records with the ePDMP, she said.

At least one pilot organization will be working on it prior to April 1, but Magermans didn't know how far they would be in the process.

Gov. Scott Walker's 2017-'19 state budget, released earlier this month, recommends $1 million to fund five positions "for the continued improvement" of the PDMP. Dr. Tim Westlake, vice chair of the Medical Examining Board, said the new positions should help with the rollout.

But he said that a concern they should have is whether the board has the resources to prosecute the cases, in case there's a spike.

"We want to make sure we have enough investigative resources to be able to prosecute the cases," he said. "If we get an extra 20, 30 or 50 opioid prescribing cases that can bog the whole system down."

GIB Letter Reveals More Details about Self-Insurance Process

Mon, 20 Feb 2017 14:11:47 GMT

February 15, Wisconsin Health News

Group Insurance Board members sent a letter last week to lawmakers, revealing more information on the process they used when deciding to self-fund and regionalize the health plan for state employees.

Their plan, approved last week, would shift the state away from a fully insured model, which involves 18 companies, to a model with six vendors. They estimate the move could save more than $60 million in the 2017-'19 state budget from reduced administrative and insurer risk fees as well as improved discounts. Department of Employee Trust Funds spokesman Mark Lamkins did not provide a further breakdown of the savings.

Any self-insurance contract is subject to approval by the Legislature's Joint Finance Committee.

The board selected Compcare Health Services Insurance Corp. to offer a statewide option as well as a regional option. The other companies serving regions would be Dean Health Plan, HealthPartners Administrators, Network Health Administrative Services, Security Administrative Services and Quartz, which is affiliated with Unity Health Insurance and Gundersen Health Plan.

In a letter sent Friday to JFC co-chairs, GIB Chair Mike Farrell and board member Stacey Rolston, who is a deputy administrator in the Division of Personnel Management at the Department of Administration, wrote that those participating in the state employee health plan will have greater access to providers than are currently available to most members under a proposed move to self-insurance because CompCare has a broader network.

They also wrote that providers that are part of Group Health Cooperative of South Central Wisconsin, which did not respond to an RFP on administering the program, will be included via other third party administrators. In addition, Physicians Plus, which responded to the RFP but wasn't selected as a vendor, is exploring a partnership with Unity and Gundersen, according to the letter.

According to GIB, nine companies responded to the RFP. That also included Mayo Clinic Health Solutions, the self-insurance business unit of Health Traditions Health Plan, which wasn't chosen. WEA Trust also participated in the process and did not receive an offer.

GIB noted that many of the plans with minimal participant enrollment in the program chose not to respond, including Arise, Group Health Cooperative - Eau Claire, MercyCare Health Plans and Medical Associates.

But Patrick Cranley, MercyCare chief operating officer, said GIB's characterization was "a little bit disingenuous."

"We could not respond to the RFP because the RFP required that respondents be able to serve an entire region defined by the RFP," Cranley said. He called it "a conscious decision to limit the number" of plans participating in the state program.

Cranley called the board's decision an "unfortunate choice" for the wider market as it eliminates a number of high quality community health plans from participation in the health plan.

"I think it does long-term damage to the competitive insurance market in the state of Wisconsin," he said. "You're essentially perhaps even crippling some of the plans that are smaller plans that provide important competition in the markets in which they participate."

Cranley said MercyCare serves 1,400 members in Jefferson, Rock and Walworth Counties through the state plan. That's out of 48,000 total members for his plan.

"I would prefer to continue to serve these folks and let them have access to our health plan," he added.

ETF often pursues an "aggressive education campaign" to ensure participants understand their choices under the program, according to the letter. The communication strategy for 2018 "will be unprecedented," Farrell and Rolston wrote.

The board plans to finish contract negotiations by the end of March.

Read the letter.

March 7 Panel: The Rise of Prescription Drug Costs

Fri, 17 Feb 2017 23:17:05 GMT

Increasing prescription drug costs have caught the attention of the President and the public. What's behind the rapid rise and how far are lawmakers willing to go?

Would allowing Medicare to negotiate with drugmakers make an impact? What about cutting taxes and regulations? And would lower prices mean less innovation?

Learn more at a Wisconsin Health News Panel Event March 7 at the Madison Club. Panelists include: Holly Campbell, Senior Director of Public Affairs, PhRMA; Dr. Mark Huth, CEO, Group Health Cooperative of South Central Wisconsin; Andy Pulvermacher, Specialty Services Supervisor, UW Health; and Paul Rosowski, Senior Director, Industry Relations and Contracting, Navitus Health Solutions.

Learn more and register (link).

WHA Physician Quality Academy

Fri, 17 Feb 2017 23:06:14 GMT

February 8, Wisconsin Hospital Association

As you know, physicians are often assigned a role with a hospital or health system’s quality department or committee or asked to lead a quality improvement project.

The Wisconsin Hospital Association (WHA) has developed an important resource for physicians and advance practice providers who have an assigned role related to quality measurement and improvement within a WHA member hospital or health system. The WHA Physician Quality Academy will provide physicians the opportunity to increase their knowledge of quality improvement tools and principles; therefore, increasing the likelihood that a physician will be more successful in and comfortable with this leadership role.

The Academy offers two non-consecutive days of in-person training and access to supporting resources both between and after the live sessions: May 10 and July 21, 2017 at the Glacier Canyon Lodge at The Wilderness Resort, Wisconsin Dells; OR September 29 and November 3, 2017 at the Glacier Canyon Lodge at The Wilderness Resort, Wisconsin Dells.

As part of the Academy, participants will learn to:

design and conduct quality improvement projects utilizing proven improvement models;
interpret data correctly;
facilitate physician colleague engagement in quality improvement and measurement ;and,
discuss quality requirements, medical staff functions and their link to quality improvement.

The Academy is offered twice in 2017 (dates below), allowing physicians associated with a WHA member hospital/health system to choose the cohort that works best for his/her schedule. Attendance will be limited to the first 100 registrants per cohort, so if interested, register today at http://www.cvent.com/d/wvq5nm. Download brochure (link).

GIB Votes to Self-Fund and Regionalize Health Plan

Fri, 17 Feb 2017 23:03:29 GMT

February 8, Wisconsin Health News

The Group Insurance Board voted 10 to 1 to self-fund and regionalize the health plan for state and local employees at a meeting Wednesday. They estimate the move would save more than $60 million over the 2017-2019 biennium.

An additional $30 million in fees under the federal health reform law could be avoided by moving to a self-funded regionalized model. GIB gave the Department of Employee Trust Funds the power to enter into contract negotiations to move to a self-funded health plan effective Jan. 1, 2018.

Compcare Health Services Insurance Corp., run by Anthem Blue Cross and Blue Shield in Wisconsin, will serve as the third party administrator for a statewide option.

Security Administrative Services will serve the northern region of the state. Compcare and Network Health Administrative Services will serve the eastern part of the state.

Dean Health Plan and Quartz will cover the southern part of the state. HealthPartners Administrators Inc. will cover the western region.

The contracts will be for three years. They are subject to Joint Finance Committee approval.

I Look Like an ER Doc Campaign

Fri, 03 Feb 2017 15:00:49 GMT

ACEP has launched its #ILookLikeAnERDoc Campaign on the organization's Facebook and Twitter channels to promote the importance diversity and inclusion. Learn and share why diversity matters to emergency physicians.

President's Message, January 2017

Tue, 24 Jan 2017 18:34:58 GMT

Advocacy is the Cure for the Political Frustrations of 2016
By Bobby Redwood, MD, WACEP President

You don't need me to tell you; 2016 was kind of a rough year. We lost Bowie, Prince, and Princess Leia. Zika cast its shadow over our vacations, while authoritarian regimes thrived, the E.U. frayed, and democracy stumbled. The political tension in America and in Wisconsin reached a fever pitch throughout one of history's most negative presidential campaigns ever and then, on November 9th, republican and democratic physicians alike were left exhausted and confused, wondering what will happen to our patients and our profession under the Trump administration.

Well, we at WACEP implore you: don't despair! Here are some of the (solvable) challenges that we, as emergency physicians, can expect in the upcoming year.

The Affordable Care Act will likely go away. Will it just be a name change (it was basically RomneyCare after all)? Will the individual mandate be undone leaving a glut of 234,000 uninsured patients in its wake? Will Medicaid really be transformed into a block grant system as many have foreseen?
The opiate epidemic will continue to challenge our state and our state's physician workforce. Will the new ePDMP provide the accountability and real-time information that we were promised it would? Will the new medical examining board CME help get all providers on the same page in terms of best practices for opiate prescriptions? Will WACEP's opiate prescribing guidelines have the reach and influence that we are hoping they will have?
Mental health services will evolve...for the better? Suicide is at a 30-year high and fewer than half of the 800,000 Wisconsinites who need mental health treatment actually get professional help. A consensus bill, the Mental Health Reform Act of 2016 (S. 2680), passed the Senate HELP committee in March 2016 and will likely come to vote in the Senate this year. If passed, will it deliver the community crisis response systems and increased access to acute psychiatric hospital care that were anticipated? Will the Wisconsin psychiatric bed database come to fruition? Will psychiatric transfers from Wisconsin EDs become easier to facilitate?

Engagement is the way forward. Emergency physicians are problem solvers, and whether your motivated by compassion for your patients, consideration for your physician-group, or simple self-preservation; we at WACEP need you to step forward and engage with your colleagues, so that we can solidify our message, amplify our voice, and help solve the challenges ahead together. Need a roadmap for getting engaged in emergency medicine advocacy? Here are the next steps:

Register for the March 28th WACEP Spring Symposium. Get the 4-1-1 on emergency medicine advocacy from national ACEP president Rebecca Parker. REGISTER HERE.
Sign up for the March 29th Doctor Day event at the Capitol. Feel the comradery of your profession as hundreds of physicians swarm the state capitol. REGISTER HERE.
Attend the March WACEP listening tour in Merrill, WI. Let us know how WACEP can better serve your needs. REGISTER HERE.
Donate to the WACEP PAC. Since its inception, the WACEP PAC has given emergency physicians unprecedented access to state lawmakers. As our PAC grows, so does our collective voice. DONATE HERE.
Reach out to your legislators. There is no better cure for political frustration than connecting directly with your lawmakers and making your voice heard.

There is no doubt that the healthcare landscape will be changing in 2017 and we have the power to shape the future of our practices and our specialty. By showing up, by putting our money where our mouth is, by connecting with our peers and our political leaders; emergency physicians can use the same strength and tenacity that we exude in our clinical work to shape the future of emergency medicine in Wisconsin.

Thank you to each and every emergency physician in Wisconsin for your dedication to your patients, colleagues, and profession. Whether you are excited about the Trump shake-up or sense a bad moon rising, now, more than ever, we need physician engagement in local and national advocacy.

ePDMP Now Live; Registration Required

Mon, 23 Jan 2017 16:50:31 GMT

The Wisconsin Department of Safety and Professional Services (DSPS) launched the new Wisconsin Enhanced Prescription Drug Monitoring Program (ePDMP) on January 17, replacing the former program.

2015 Act 266 requires physicians and other prescribers to review patient information from the ePDMP before issuing a prescription for any controlled substance beginning April 1, 2017. (More information, including exceptions to the requirement to consult the PDMP, in this nonpartisan Legislative Council memo.)

Be ready with the following information in order to register for the ePDMP, and note that prior login credentials no longer work.

Last name.
Last four digits of your social security number.
License number.
License type (profession).
Specialty or primary area of practice.
DEA number.

The ePDMP supports current browsers and two previous versions, except it only supports the current and previous version of Internet Explorer. If you experience issues, DSPS suggests that you update your browser.

Once the registration process is complete, users can begin looking up patients and managing delegates. The multistate search function will be available to both prescribers and their delegates as soon as their accounts are established. Training materials, including brief tutorial videos and information about creating and maintaining delegates are available at pdmp.wi.gov.

If you have questions or experience problems with the registration process, contact pdmp@wisconsin.gov.

Legislature Appoints Health Committee Members

Wed, 11 Jan 2017 20:34:21 GMT

The Assembly Committee on Health and the Senate Committee on Health and Human Services for the 2017-18 Session have been set. Committee membership is as follows:

Assembly Committee on Health

Representative Joe Sanfelippo, R- New Berlin (Chair)
Representative Kathy Bernier, R – Chippewa Falls (Vice-Chair)
Representative James Edming, R – Glen Flora
Representative Ken Skowronski, R - Franklin
Representative Jesse Kremer, R - Kewaskum
Representative Chuck Wichgers, R - Muskego
Representative Dave Murphy, R - Greenville
Representative Andre Jacque, R – De Pere
Representative Deb Kolste, D Janesville
Representative JoCasta Zamarripa, D – Milwaukee
Representative Lisa Subeck, D - Madison
Representative Chris Taylor, D - Madison

Senate Committee on Health and Human Services

Senator Leah Vukmir, R – Brookfield (Chair)
Senator Terry Moulton, R – Chippewa Falls (Vice-Chair)
Senator Devin LeMahieu, R - Oostburg
Senator Jon Erpenbach, D - Middleton
Senator LaTonya Johnson, D - Milwaukee

Walker Calls for Special Session to Consider Opioid Bills

Wed, 11 Jan 2017 20:26:46 GMT

January 6, Wisconsin Health News

Gov Scott Walker called for a special session of the Legislature Thursday to consider 11 bills that aim to combat the heroin and opioid epidemic.

The bills are based on recommendations from a task force that Walker convened last year, chaired by Lt. Gov. Rebecca Kleefisch and Rep. John Nygren, R-Marinette.

The task force released an interim report Thursday. Even though it hasn't finished its work, the opioid and heroin epidemic are "such a crisis to deal with, we need to start acting now," Walker said.

"We need to tackle this issue head on," Walker told attendees of a Wisconsin Bankers Association event in Madison Thursday. "Not because it's a quality of life, not because it's a public health issue, but because it's a key part of our workforce."

Among the proposals the Legislature will consider are bills that would in the 2017-'19 biennium provide $2 million to support new medically assisted treatment centers, $1 million for consultation services helping medical professionals connect with addiction medicine specialists and $126,000 to the rural hospital graduate training program.

Another bill would provide money to the Department of Justice to fund criminal investigation agents focused on drug trafficking. And another would expand the Screening, Brief Intervention and Referral to Treatment training program offered by the Department of Public Instruction.

"All of us know someone personally affected by a heroin overdose or drug death," Kleefisch said in a statement. "Together, we're going to continue this initiative as we look for new ideas and evaluate the impact of the policies we've adopted the past several years."

An additional proposal would allow school personnel that can administer life-saving drugs like EpiPens to use the anti-overdose drug Naloxone. And two more would require schedule V substances that contain codeine like some cough syrups by dispensed with a prescription and extend limited immunity from prosecution to overdose victims.

Other bills include permitting the University of Wisconsin System to open a recovery school for students who need in-patient care and allowing relatives to commit a drug-addicted family member in the same way as is currently allowed for alcoholism.

Walker's order doesn't include all the recommendations made in the report, such as providing $2 million over the next biennium for Wisconsin hospitals to hire in-house recovery coaches. His spokesman said the bills are in the final stages of draft form and will be released when introduced.

Another order signed by Walker Thursday directs state agencies to pursue a number of different initiatives to curb opioid abuse, including having the Office of the Commissioner of Insurance conduct a survey of opioid addiction treatment coverage for major insurers in Wisconsin.

"The recommendations included in this report are not the silver bullet," said Nygren, who's authored 17 laws fighting drug abuse though his Heroin, Opioid Prevention and Education Agenda. "I look forward to continuing the fight."

Wisconsin Hospital Association CEO Eric Borgerding noted that the interim report includes recommendations they suggested, like providing investments in fellowship training for addiction medicine and streamlining regulations for healthcare providers that are trying to expand access to substance abuse treatment.

Wisconsin Medical Society Chief Medical Officer Dr. Donn Dexter called the package of bills "ambitious, which is exactly what dealing with this crisis demands." The Pharmacy Society of Wisconsin said the proposals aim to increase access to treatments and prevent new addictions.

"We're especially excited about the investments to increase the number of providers available and in telemedicine," Bernie Sherry, senior vice president and Ministry market executive for Ascension Wisconsin, said in a statement. "This is a good day for Wisconsin."

Myranda Tanck, a spokeswoman for Senate Majority Leader Scott Fitzgerald, R-Juneau, said they'll likely maintain their current session calendar for when the full body meets.

Kit Beyer, a spokeswoman for Assembly Speaker Robin Vos, R-Rochester, said they hope to have the bills ready for committee hearings by the end of the month.

Assembly Democratic Leader Peter Barca, D-Kenosha, said the urgency of the special session is warranted.

"The opioid epidemic in our state is a very serious issue that requires a very aggressive response," Barca said in a statement. "I hope the committees will collect input from those who know this issue firsthand -from law enforcement, to educators, to medical professionals - as this will help us address this crisis in the most comprehensive manner possible."

Walker also signed an order directing the Department of Health Services to apply for funding available through the 21st Century Cures Act, which was approved by the federal government last year. The act makes $7.6 million per year available for two years to Wisconsin. His order directs the department to apply for the grants by Feb. 17.

Sen. Tammy Baldwin, D-Wis, said she helped lead the effort in Congress to include $1 billion in the act for the opioid epidemic.

"The opioid epidemic is not a partisan issue, and a strong partnership between the federal government and our state is essential to an effective response," she said in a statement. "This is a significant step forward for communities fighting the opioid epidemic across Wisconsin."

ePDMP Scheduled to Launch Jan. 17; Registration Required

Wed, 11 Jan 2017 20:22:35 GMT

The Wisconsin Department of Safety and Professional Services (DSPS) plans to launch the new Wisconsin Enhanced Prescription Drug Monitoring Program (ePDMP) on Tuesday, Jan. 17.

2015 Act 266 requires physicians and other prescribers to check patient information from the ePDMP before issuing a prescription for any controlled substance beginning April 1, 2017. (More information, including exceptions to the requirement to consult the PDMP, in this nonpartisan Legislative Council memo).

All prescribers will have to register to use the ePDMP—even if they are registered with and use the current system, which is being replaced and will not be available after Jan. 17.

The new ePDMP is designed to promote streamlined workflow integrations and improved data quality using analytics and visualizations to draw user’s attention to the most relevant and possibly concerning data in each report.

Questions about the ePDMP can be directed to pdmp@wisconsin.gov.

Society Hosts Summit to Identify Healthcare Reform Priorities

Wed, 11 Jan 2017 20:19:10 GMT

More than 50 leaders from health care organizations and systems statewide participated in a Health Care Reform Summit hosted by the Wisconsin Medical Society on Dec. 16. The summit provided stakeholders the opportunity to learn about and discuss pending changes to the Affordable Care Act (ACA) and featured several speakers including Tommy Thompson, former Wisconsin governor and Health and Human Services secretary; Wisconsin Medicaid Director Michael Heifetz; Richard Deem, senior vice president of advocacy for the American Medical Association; and Wisconsin Deputy Commissioner of Insurance J.P. Wieske.

The speakers addressed a number of topics including the likelihood of repeal and replacement of the ACA, the role Medicaid will play in health care reform and the possibility of a transition from an entitlement program to one financed by block and/or per capita grants, and an overview of the health insurance market in Wisconsin.

The Summit also featured a review of various health care reform proposals, including the following:

A Better Way Health Plan—Speaker Paul Ryan
Empowering Patients First Act—Rep. Tom Price, MD, Health and Human Services Secretary nominee
Patient CARE Act—Sen. Orrin Hatch, Sen. Richard Burr and Rep. Fred Upton
Improving Health and Health Care Plan—American Enterprise Institute
Universal Tax Credit Plan—Avik Roy
Healthy Indiana Plan 2.0—Indiana Family Social Services Administration (Medicaid reform only)

Following the presentations, Summit attendees identified several key areas to focus reform efforts that include ensuring those who are currently covered do not lose insurance, maintaining access to affordable and adequate coverage for low-to-moderate income populations, maintaining adequate Medicaid funding, and evaluating opportunities to reduce regulatory burdens.

A subgroup of Summit participants will continue to meet as a steering committee to help direct future advocacy efforts.

For more information, e-mail Chris Rasch, Society vice president of Advocacy and Membership.

Report: Number of Wisconsin Residents in Rural Residencies up 10 Percent

Wed, 11 Jan 2017 20:07:40 GMT

January 5, Wisconsin Health News

The number of Wisconsin residents in accredited rural-focused residency programs jumped 10 percent from the previous year, according to a December report from the Wisconsin Rural Physician Residency Assistance Program.

There were a total of 87 residents in the programs as of the end of November. That's up from 79 the previous year.

Between Dec. 1, 2015 and Nov. 30, 2016, WRPRAP awarded seven grants, totaling $528,866.

Some programs supported by WRPRAP are looking to bring in their first residents this year. The Aurora Lakeland Rural Training Track Family Medicine Program, which hopes to have 12 residents by July 2020, is recruiting its first four residents.

And the UW Obstetrics & Gynecology Residency Program, the nation's first rural track in the specialty, will match its first resident this year after about 100 applicants competed for the position.

"We are confident that WRPRAP's funding will continue to champion long-term, viable solutions that address the shortage of physicians in rural Wisconsin communities," the report noted.

February 7, 2017 Newsmaker Event with Ascension's Regional Presidents

Fri, 06 Jan 2017 22:36:27 GMT

When Ascension formally acquired Wheaton Franciscan Healthcare in 2016, it gave the nation's largest nonprofit health system a firm foothold in the state. Ascension Wisconsin, which also includes Ministry Health Care and Columbia St. Mary's Health System, now boasts 24 hospitals and more than 100 clinics.

In August, Ascension tapped Columbia St. Mary's CEO Travis Andersen to head its south region and Wheaton executive Debra Standridge to oversee the northern part of the state. At a Wisconsin Health News Newsmaker event on Feb. 7 in Milwaukee, Andersen and Standridge will take part in a wide-ranging discussion on the system's future in the state. Panelists include:

Travis Anderson, south region president, Ascension Wisconsin
Debra Standridge, north region president, Ascension Wisconsin

This luncheon event will be held at the Wisconsin Club, 900 West Wisconsin Avenue, Milwaukee, 53233. Register now.

Will Emergency Departments Be Recognized and Compensated in Alternative Payment Models?

Mon, 19 Dec 2016 17:31:39 GMT

By Bobby Redwood, MD, MPH, WACEP President, and Lisa Maurer, MD, WACEP Secretary/Treasurer

Across the country, innovative health systems are embarking on a grand experiment and exploring "Alternative Payment Models" (APMs). There are a variety of flavors of APM, but the most commonly mentioned are the Coordinated Care Model and the Patient Centered Medical Home, both of with aim to improve the quality and perhaps efficiency of primary care delivery and thus cut costs on those pesky, wasteful, expensive ED visits*. My question is this: How will APMs affect ED workflows and will EDs be appropriately compensated for their support and contribution to a successful APM?

To be fair, the theory behind the APMs is quite promising. Weinick et al. found that roughly 14–27% of all ED visits could be treated in clinics and urgent-care centers at a lower cost; a potential savings of $4.4 billion per year. By reorganizing primary care, the APMs will hopefully create a new style of health care delivery where continuity, expanded access, coordination, and a team-based approach are used to help patients avoid exacerbations of chronic conditions, treat chronic pain and psychiatric complaints proactively in the home-setting, and gain access to their primary care team for urgent health care needs. If successful, APMs will cut down on ED visits for complaints like chronic pain, depression, medication refills, work excuses, migraine headaches, asthma/COPD/CHF exacerbations, missed dialysis, etc. Who among us would not breathe a sigh of relief to come to work and spend more time treating life-threats and less time plugging holes in the social safety net?

The evidence supporting APMs continues to grow with over 500 peer reviewed articles on the topic and a generally strong review by the Agency for Healthcare Research and Quality. The main concern that many emergency physicians have with APMs is not the concept itself, but rather the notion that the ED is somehow separate from the Coordinated Care Model or the Patient Centered Medical Home. When I look at policy-makers' flow diagrams for a Coordinated Care Model or read about a Patient Centered Medical Home in the literature, the care coordination seems to magically occur with no emergency department involvement whatsoever. This may sometimes be the case; however, in speaking with my emergency physician colleagues, the consensus is that the ED actually plays an integral role in the success of the APMs. The reality of the situation is that APMs that truly coordinate care work with ED providers to maximize value of any ED visits that do happen, or even work with ED providers in an abbreviated fashion to streamline care and avoid a full ED visit.

Let's walk through a few examples:

An after-hours medication refill visit is avoided by a primary care physician calling the emergency physician and asking her to write an InstyMeds prescription that the patient can pick up in the ED lobby without having to actually check in. 10 minutes of emergency physician time spent.
A patient with CHF presents with a typical exacerbation. After initial evaluation and diuresis, the emergency physician is able to coordinate with the patient’s cardiologist regarding optimizing his medical regimen. After reviewing the plan with the emergency physician, an emergency coordinator is able to make an urgent follow up appointment with the cardiologist, arrange transportation, and set up a home nurse visit for the next day. The physician has an extended conversation with the patient regarding disposition options, and ultimately hospitalization is avoided. 20 minutes of emergency physician time spent coordinating care. 30 minutes of care coordinator time spent.
An asthmatic patient is having a routine asthma exacerbation due to his nebulizer malfunctioning. As part of a community paramedicine program whose medical director is a hospital-based emergency physician, the patient is evaluated by paramedics. They troubleshoot and repair his nebulizer, and then call the emergency physician to confirm a no-transport. The emergency physician calls the primary care physician to keep him in the loop and coordinate prompt follow-up. 10 minutes of emergency physician time spent. 60 minutes of paramedic time spent.
The extended family of a dementia patient is home for the holidays and, noting grandpa's gradual physical and mental decline, decide that it is time for him to go to a nursing home. They incorrectly present to the ED, but the ED care coordinator is able to avoid a full evaluation by hosting a conference call with his primary care physician and a social worker to facilitate placement. 60 minutes of emergency coordinator and ED conference room time spent.

For a real life example, let's look to the literature. Murphy et al. found that a $554 investment per enrollee saved the health system $6091 per extreme ED user and $1285 per frequent ED user, a net savings of $710,474. These results are striking, but they required the ED to invest in a 0.25 full-time equivalent (FTE) medical director for the coordination program, a 1.0 FTE case coordinator, and a 1.0 FTE administrative assistant (hence the $554 per enrollee investment cost). Ultimately, the costs associated with frequent and improper ED use are incurred not only by the patients themselves, but also by other patients, hospitals, emergency physicians, third-party payers, and society in general. Reducing the costs of ED overuse is clearly going to take a team effort and compensation plans for these efforts should not overlook the time, expertise, and facility expenses incurred by the nation's EDs.

We at Wisconsin ACEP would like to know more about how this issue is impacting our emergency physicians and EDs.

Is your health system participating in an APM, how is emergency care coordination being compensated?
Are you an ED director, what are some of the coordination costs that are not always obvious to CMS or third party payers?
Do you participate in any healthcare payment reform workgroups or advisory panels, are the ED costs of care coordination being acknowledged in policy making circles?

Email WACEP@badgerbay.co with your questions and comments. If you'd like to learn more, check out this article on Cost-effective ED Care Coordination by our colleagues at Washington ACEP!

*Emergency physicians will immediately recognize the irony here, emergency care represents less than 2 percent of the nation's $2.4 trillion in health care expenditures while covering 136 million people a year and the focus on preventing so-called “non-urgent” emergency department visits distracts policymakers from the real cost savings in reducing hospital admissions and investing in preventive measures.
Sources:
Report: Accounting for the cost of US health care: A new look at why Americans spend more, McKinsey Global Institute, December 2008
Agency for Healthcare Research and Quality. Emergency Room Services-Mean and Median Expenses per Person With Expense and Distribution of Expenses by Source of Payment: United States, 2006. Medical Expenditure Panel Survey Household Component Data. (March 04, 2013)

Fund Board Votes to Decrease Fees by 30%

Thu, 15 Dec 2016 16:04:46 GMT

December 15, WMS Medigram

The Injured Patients and Families Compensation Fund (Fund) Board approved a 30 percent decrease in Fund fees for the 2017-2018 fiscal year on Wednesday. This is the fifth time in as many years that the Board has approved a decrease in Fund fees, and the second consecutive year fees decreased by 30 percent.

The Board’s decision to decrease fees was based on the recommendation of its actuarial committee, which noted—among other considerations—a better-than-expected return on investments and the release of previously held claims. Fund fees decreased by 30 percent in 2016-2017, 34 percent in 2015-2016, 10 percent for 2014-2015 and 5 percent for 2013-2014. Fee notices reflecting the new decrease will be mailed to physicians and other Fund participants in mid-2017.

The Fund, which was created by statute in 1975, is a trust that is set up to pay medical negligence claims that exceed physicians’ primary layer of medical liability insurance. In 2011, the state returned $200 million, plus lost earnings and interest to the Fund, following the Wisconsin Medical Society’s successful lawsuit challenging the state’s raid on the Fund in 2007.

In other business by the Board, the fees for physicians and surgeons insured through the Wisconsin Health Care Liability Insurance Plan (WHCLIP) will not change in 2017-2018, and there was no change in fees for hospital professional liability and hospital liability coverage.

WHCLIP was created by statute in 1975 as an insurer of last resort to provide the primary level of medical liability insurance to Wisconsin health care providers. WHCLIP is managed by an outside manager with oversight by the Office of the Commissioner of Insurance.

Wisconsin 20th Healthiest State

Thu, 15 Dec 2016 14:32:43 GMT

December 15, Wisconsin Health News

Wisconsin ranks as the 20th healthiest state in the nation, up from last year when it was 24th, according to United Health Foundation's 2016 America's Health Ranking Annual Report.

Wisconsin was one of three states to increase their ranking by four places or more. It ranked behind Minnesota and Iowa, which came in 4th and 17th respectively. But the state received a higher score than Illinois and Michigan, ranked 26th and 34th respectively.

Wisconsin had a high percentage of residents who have graduated from high school, which leads to better health outcomes, according to the report. It also had a lower uninsured rate and prevalence of diabetes compared to other states.

But Wisconsin had the second highest amount of binge drinking in the nation and a high incidence rate of whooping cough. And the state has some of the lowest per capita public health funding in the nation.

"Ranking the states in relativity to one another gives us an opportunity to look at where we can improve," said Dr. Rhonda Randall, chief medical officer of UnitedHealthcare Medicare and Retirement.

In the past five years, drug deaths in Wisconsin have increased 23 percent from 11.4 to 14.0 deaths per 100,000. And in the last year, the number of children living in poverty has increased 13 percent from 16.2 percent to 18.3 percent.

Disparities in health status by education have decreased. Randall noted in the past, Wisconsin has had a greater disparity between the percentage of adults with a high school education reporting good or excllent health compared to those without a degree.

That disparity decreased 20 percent in the past year, from 32.2 percent to 25.8 percent.

"What we're seeing are some very favorable trends and some trends that are concerning us," Randall said. "That kind of puts us at a crossroads with our health in the United States."

She noted that nationwide the number of smokers has decreased and that the rate of uninsured Americans has hit the lowest level in history.

On the other hand, the obesity rate has increased by 157 percent since the first report in the 1990. And the 2016 report shows death rates from heart disease increasing for the first time in the report's 27-year history.

"One year is not enough to make a trend, but it's a very concerning change," she said.

See Wisconsin's profile.

Registration is Open for Doctor Day 2017

Wed, 14 Dec 2016 18:37:11 GMT

Building off record attendance at Doctor Day 2016, specialty societies and the Wisconsin Medical Society are expecting to draw another record attendance at the 2017 Doctor Day. The event is scheduled in Madison on March 29. Click here for a list of participating organizations.

This annual advocacy event is timed well for physicians to be able to meet with their legislators and/or staff members, and to have input on the budget and other important health care issues. Participants will hear from Medicaid Director Michael Heifetz of the Wisconsin Department of Health Services and others, then will take part in an issue briefing before heading to the Capitol. Lunch will be provided, and the day will conclude with a reception in downtown Madison.

Visit the Doctor Day website for more information and to register.

Group Insurance Board Delays Action on Self-Insurance

Wed, 14 Dec 2016 16:09:29 GMT

December 14, Wisconsin Health News

The Group Insurance Board delayed a decision Tuesday on changes to the health plan for state employees, including whether to shift to a regional or self-insurance model.

Chair Michael Farrell said the board has directed Department of Employee Trust Funds staff and Segal Consulting to gather more information and data about the proposals. The board will reconvene in January.

"There is much complexity and volumes of information that relate to our consideration," he said. "We're not taking these decisions lightly."

During closed session Tuesday, members weighed seven scenarios offered by ETF staff, according to a memo.

One proposal could continue the current fully insured model with minimal changes. That model would have up to 16 different vendors participating.

Other scenarios under consideration would have between six and 11 participating vendors. Those proposals could be fully insured, self-insured or a hybrid. Some of them would divide the state into regions.

A seventh proposal, which is not recommended by ETF or Segal, would have one or two vendors under a self-insured model.

The board has been considering self-insurance off and on for five years according to the memo. It's also considering other changes like three-year contracts with health plans.

Phil Dougherty, spokesman for the Wisconsin Association of Health Plans, said his members "recognize that more can be done in the current competitive model to achieve the state's financial and quality goals."

"Moving to Segal's regionalization strategy would create the risk of reducing competition and choice, eliminating high quality healthcare networks and separating plan participants from their doctors and medical homes," Dougherty said in a statement. "The right answer for the state is to use the current competitive structure and Wisconsin health plans to build on what works."

Read a summary memo on the proposals and discussion.

WMS Webinar Meets New CME Requirement

Wed, 14 Dec 2016 14:54:41 GMT

The Wisconsin Medical Society is offering “Wisconsin Medical Examining Board Opioid Prescribing Guidelines,” a two-hour webinar available on-demand. The course satisfies the new MEB mandate requiring physicians with a DEA number to complete two continuing medical education (CME) credits on its Opioid Prescribing Guidelines during the current CME cycle, as well as another two credits during the next cycle.

Presented by Society member Michael McNett, MD, the webinar provides a comprehensive review of the guidelines. I completed it myself last week and thought it was not only outstanding, but a good reminder of the excellent work the Society does every day to meet its members’ needs. Click here to register or for more information.

Jan. 12 Panel Event - "TrumpCare: What's in Store?"

Mon, 12 Dec 2016 18:54:00 GMT

Major changes are likely in store for the country's healthcare system. Obamacare, Medicaid and Medicare could all be in for overhauls.

How far will lawmakers go? Will people with pre-existing conditions get to keep their coverage? What about the 22 million Americans, and 200,000 Wisconsinites, who have gained health insurance? How would the industry react to a transition period? Are they ready to start over? Learn more at a Wisconsin Health News Panel Event Jan. 12 at the Madison Club. Panelists include:

Eric Borgerding, CEO, Wisconsin Hospital Association
Coreen Dicus-Johnson, CEO, Network Health Plan
Donna Friedsam, Health Policy Programs Director, University of Wisconsin Population Health Institute
Mike Wallace, CEO, Fort HealthCare

Register now.

Sanfelippo to Chair Assembly Health Committee

Thu, 08 Dec 2016 18:34:59 GMT

Wisconsin Health News

Rep. Joe Sanfelippo, R-New Berlin, will continue to chair the Assembly Committee on Health next session, according to a Wednesday statement. Rep. Samantha Kerkman, R-Salem, will serve as vice chair of the committee.

Assembly Speaker Robin Vos, R-Burlington, also reappointed Rep. Paul Tittl, R-Manitowoc, to serve as chair of the Assembly Committee on Mental Health. Rep. John Jagler, R-Watertown, will vice chair the committee. Rep. Tom Weatherston, R - Caledonia, will chair the Assembly Committee on Aging and Long-Term Care. Rep. Warren Petryk, R-Eleva, will vice chair that committee. Rep. Kevin Petersen, R-Waupaca, was tapped to chair the Assembly Committee on Insurance and Rep. Cindi Duchow, R-Delafield, was picked for vice chair.

Vos also announced new committees for next session, including one focused on science and technology and one on regulatory licensing reform.

See more committee leadership appointments.

GIB Members Question Savings Under Current Model

Thu, 01 Dec 2016 22:50:00 GMT

Wisconsin Health News

Group Insurance Board members questioned the amount of savings the state receives under its current health insurance model and called for increased access to data as they discussed a possible move Wednesday to self-insurance.

Michael Heifetz, state Medicaid director, said the board needs better access to data to make sure they're providing the best care at the best price to employees who "have more skin in the game - a phrase I hate but gets used all the time - than they ever had before.”

"We need data to know if we are getting the best deal and to know if we are getting the best quality," he said. "For us not to have that control and to rely on the vendors puts us at a disadvantage."

The board selected Truven Health Analytics to serve as its data warehouse vendor at the meeting. But Heifetz noted that if the board doesn't have "any actual good data to shove into that data warehouse, it's not going to help us very much."

"Folks can analyze the self-insured vs. fully insured model, but if we don't have data, whatever decision we make is not well-founded," he said. "Politics at the national level have changed. Great. Maybe the Affordable Care Act goes away, maybe it doesn't. This board's mission hasn't changed and we still have to ensure high quality at a reasonable price for our members. And again, it takes data to do that."

He questioned the $283 million in cost reductions over the last nine years under the current model, described in a memo prepared by the Department of Employee Trust Funds. The reductions were determined by the difference between the preliminary and final bids by health plans.

"Without the right data, I don't know if those initial bids are great numbers or not, or if it's 'Let's see what the state will give us or not,'" said Heifetz, a former lobbyist for SSM Health Care of Wisconsin. "I've been on the other side of this to some degree and that number keeps being thrown at us as if it's sacrosanct and absolute. And I simply don't accept that premise."

He said it's "pretty self-serving" for someone to provide a number, then lower it and "tell us how much they saved," he said. "We don't know if we really saved that much."

Heifetz added that "a piece of me would love" to have the discussion on self-insurance held in open session, rather than the closed session the board held Wednesday afternoon.

"There are folks who will criticize us for being in closed session even though it's all proprietary things that they probably wouldn't want aired in the public arena," Heifetz said. "I have mixed emotions about going into closed session to discuss these things. I am a member of the public, I'm a taxpayer and I'm a member who gets benefits for my family through this process."

Phil Dougherty, senior executive officer for the Wisconsin Association of Health Plans, noted that health plans' rates for the State Group Health Program match the healthcare risk they cover.

"Driven by the market competition structure of the program, annual premium increases for the program over the past nine years averaged 3.7 percent, significantly below the national trend," he wrote in an email.

The state's decision to contract with Truven will provide data to ensure it gets competitive rates from health plans serving the program, he added.

J.P. Wieske, deputy insurance commissioner, noted that the average costs of the plans sold on the state's individual exchange are cheaper than those sold though the employers' exchange.

"Some of these carriers in Milwaukee and Dane County are carriers in the exchange as well," he said. "And the fact that their rates have been lower in the exchange than the employee plan is really surprising given the risks. I don't believe the population inside the exchange, especially with the problems that they have, especially with how (the Department of Health and Human Services) has administered it, the health of that individual market is probably worse than the state employee population, which is stable, large and consistent."

Herschel Day, a professor at the University of Wisconsin-Eau Claire, said that part of the problem could be that members are insulated from the carriers. He noted that they pay the same amount for plans in the highest tier regardless of how plans charge and called for more transparency.

"Folks can see what the actual premiums charged are, but given that there's no impact within Tier 1 for the member, I think in some sense we're insulating them from that difference," he said. "That could feed into the higher rates."

Hot off the presses: UW ED and WACEP president's take on Antimicrobial Stewardship in the Management of Sepsis

Tue, 29 Nov 2016 21:34:59 GMT

Michael S. Pulia, MD, MS^a; Robert Redwood, MD, MPH^b; Brian Sharp, MD^c

^a Emergency Medicine Antimicrobial Stewardship Program, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 310, Madison, WI 53705, USA
^b Antibiotic Stewardship Committee, Divine Savior Healthcare, 2817 New Pinery Road, Portage, WI 53901, USA
^c The American Center, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 310, Madison, WI 53705, USA

Keywords

Antimicrobial stewardship; Antibiotics; Sepsis; Clinical decision support; Biomarkers; Rapid pathogen identification assays; Quality measures; Emergency medicine

Key points

Antimicrobial stewardship refers to efforts aimed at enhancing judicious prescribing of these unique therapeutic agents in health care settings.
Inappropriate use of antimicrobials represents a global threat to public health and a direct threat to individual patient safety.
Sepsis is a life-threatening, complex clinical syndrome without a gold standard diagnostic test and thus represents a unique clinical dilemma with regard to antimicrobial stewardship.
Recent literature questioning the clinical impact of time to antimicrobials in sepsis before the onset of shock and improving the definition of sepsis may have a positive impact on antimicrobial stewardship.
Electronic health record clinical decision support, biomarkers, and rapid pathogen identification assays have tremendous potential to enhance antimicrobial stewardship in sepsis care and should be a focus of future research efforts.

Introduction

The term antimicrobial stewardship is often mistakenly considered to only include efforts to reduce or restrict use of these agents. A more comprehensive view includes a focus on the “4 Ds” of optimal antimicrobial therapy coined by Joseph and Rodvold¹ in 2008: drug, dose, de-escalation, and duration. The focus here is on getting the right antimicrobial in the right dose to the right patient for the right amount of time. The opposite of optimal antimicrobial therapy is often referred to as inappropriate or overuse. These terms can refer to a range of practices, such as prescribing when no antimicrobial was indicated, prescribing an overly broad-spectrum agent, or prescribing an excessive length of therapy. In some instances, such as bronchitis, the right antimicrobial is no antimicrobial. In cases of septic shock, the right antimicrobial is broad-spectrum coverage of all likely pathogens. Both of these scenarios represent widely accepted approaches to antimicrobial stewardship. Unfortunately, when it comes to suspected sepsis in the emergency department (ED) setting, the ideal approach to the antimicrobial management is less clear.

The timely administration of antimicrobial agents with activity against the causative pathogen has been a cornerstone of sepsis management long before it was included in the original Surviving Sepsis consensus guidelines.² Based on the literature linking time and appropriateness of antimicrobials to mortality in sepsis,^{3, 4, 5, 6 and 7} the ED implementation of this concept has been to rapidly cover all potential pathogens with broad-spectrum agents. De-escalation of therapy is left to occur days later after the patient has stabilized or when pathogen information is available.

The problem with this approach stems from a lack of a true gold standard for diagnosing the complex syndrome that is sepsis and the corresponding inaccuracy of widely used diagnostic criteria. The Sepsis 2.0 definition of 2 systemic inflammatory response syndrome (SIRS) criteria plus suspected infection suffers from poor discriminant validity due to a lack of specificity for both infection and the occurrence of adverse outcomes.^{8, 9 and 10} The combination of flawed diagnostic criteria with incredible time pressure to provide broad-spectrum antimicrobial therapy is troubling from the stewardship perspective, as it is not uncommon for patients with otherwise uncomplicated cases of common infections (eg, influenza, pneumonia, or pyelonephritis) to meet this widely used definition of sepsis.

Emerging literature that questions the optimal timing and clinical impact of antimicrobial agents in sepsis before the onset of shock may relax some of the pressure on emergency providers and allow more judicious and targeted administration in response to clinical judgment and patient trajectory rather than rigid definitions.^{11, 12, 13 and 14} Also, recently updated definitions of sepsis and septic shock appear to offer an improved ability to identify septic patients at risk for adverse outcomes and thus most likely in need of early broad-spectrum antimicrobials.^9 and 15 As these definitions were developed with hospital mortality as the primary outcome variable,¹⁵ their value as broad screening tools for sepsis in the ED and impact on antimicrobial stewardship will require further study. Unfortunately, these promising developments for antimicrobial stewardship in sepsis exist in sharp contrast to the recently implemented Centers for Medicare and Medicaid Services (CMS) ED Sepsis Quality Measure, which codifies poor performing and outdated definitions of sepsis and links them to mandated use of a specific list of broad-spectrum agents.

The discussion around more judicious use of antimicrobials in sepsis also must include data that suggest that up to 30% of patients diagnosed with sepsis in US EDs do not receive antibiotics before admission.¹⁶ There is clearly much work to be done in both defining what constitutes optimal antimicrobial use in sepsis and the development of implementation strategies that facilitate their appropriate administration. The aim of this article was to provide an overview of antimicrobial resistance, evidence-based antimicrobial stewardship interventions for the ED, and potential future directions with regard to antimicrobial use in sepsis care. Due to a paucity of interventional research aimed at improving antimicrobial use in sepsis, aside from enhancing time to administration, much of this information is gleaned from interventional ED stewardship research involving other types of infection.

Public health implications of antimicrobial overuse

Antimicrobial resistance is a naturally occurring phenomenon in which antimicrobials exert selective pressure on pathogens that, in turn, develop defense mechanisms against that antimicrobial agent’s mode of attack.¹⁷ Overuse and misuse of antimicrobials has accelerated this natural process, resulting in multidrug-resistant organisms or “super bugs,” as well as a general trend toward antimicrobial resistance outpacing humankind’s ability to develop novel, effective antimicrobials.¹⁸

Read Full Article.

PROP Act Effectively Ends Pain Scale

Wed, 23 Nov 2016 16:44:16 GMT

CMS Untethers Pain Quality Metrics from Reimbursement

Until now, pain management questions on patient satisfaction surveys have been seen by some physicians as a barrier to moving toward optimal use of opioids in emergency care. Many thanks to our member, Dr. Timothy Westlake, for working with Senator Ron Johnson (R-Wis) on legislation known as the Promoting Responsible Opioid Prescribing (PROP) Act, which prohibits those pain management questions on satisfaction surveys from being used to calculate Medicare reimbursement.

Due to the support seen for the PROP Act as well as feedback from the medical community during the comment period, the Department of Health and Human Services finalized a rule implementing provisions of the PROP Act to help curb the opioid epidemic.

“I applaud the administration for implementing my bipartisan, commonsense solution to fight the opioid epidemic,” said Sen. Ron Johnson (R-Wis.), chairman of the Senate Homeland Security and Governmental Affairs Committee. During the Committee’s field hearing in Pewaukee, Wisconsin, in April, Dr. Westlake, the Vice Chairman of the State of Wisconsin Medical Examining Board, testified that the PROP Act is “the single-most important piece of legislation reform that [policymakers] could do.”

“Physicians must be free to exercise their best judgment when prescribing the proper level of pain medication – that’s what patients and taxpayers expect,” said Johnson.

Wisconsin, ACEP has developed Opioid Prescribing Guidelines specific to emergency medicine. Members are encouraged to download and post these guidelines, and also to attend the WACEP 2017 Spring Symposium on March 28 in Madison when up-to-date education and information on opioid prescribing will be presented.

President's Message, November 2016

Tue, 22 Nov 2016 18:34:47 GMT

Asymptomatic Bacteriuria: Are Emergency Physicians Part of the Problem or Part of the Solution?
Bobby Redwood, MD, MPH

A 72 year-old female presents from your local nursing home with altered mental status. She's comfortable and conversive with normal vital signs and no pain on exam, but thinks its 1956 and calls you and all your staff, "Ralphie". You're handed seven pages of medication administration records without any past medical history or history of present illness. You call for additional information, but they just had a shift change and no one at the facility is able to tell you what happened. After a head CT, chest Xray, EKG and rainbow labs, the only abnormal finding is a urinalysis with bacteria, pyuria, nitrites, and leukocyte esterase. Your nurse reports the urine was dark and foul smelling.

Alright Ralphie, this is where the rubber hits the road...what do you do?

If you are like me, you are probably tempted to do a quick fist pump because you found something to treat, order a gram of ceftriaxone, admit the patient to the medicine floor and get on with your shift. Depending on where you work, this method of management may earn you a talking to from the nursing home director or your infectious disease department. You may find yourself being shamed for practicing sloppy medicine and contributing to antibiotic resistance. Deep down, you have doubts that the bacteriuria caused the altered level of consciousness, but you were practicing in the real world, with little clinical background on the patient, and needed to make a game day decision...what's an emergency physician to do?

Asymptomatic bacteriuria (also known as an asymptomatic urinary infection) is defined as an isolation of bacteria in an appropriately collected urine sample without signs or symptoms to a urinary infection (sorry folks, altered mental status is not a sign of a UTI). The prevalence of asymptomatic bacteriuria is between 5-7% in healthy adult women, but skyrockets to 10-50% in the nursing home population and nearly 100% in patients with chronic indwelling catheters.

There was a time when all asymptomatic bacteriuria was treated as though it were a clinical UTI. The practice started because pregnant women with asymptomatic bacteriuria frequently went on to develop pyelonephritis. When the asymptomatic bacteriuria was treated, no pyelonephritis ensued. Clinicians of that era hypothesized that asymptomatic bacteriuria was consistently harmful in all populations and thus warranted antimicrobial treatment. This turns out not to be true; outside of pregnancy and patients undergoing urologic procedures, treating asymptomatic bacteriuria gives your patient all the risks of antimicrobial therapy with none of the benefit. Adding insult to injury, the practice of treating asymptomatic bacteriuria contributes significantly to the public health threat of antimicrobial resistance (especially in nursing home populations). Ready for a shock? A 2014 report from the CDC estimates that 39% of antibiotics prescribed for "UTI" were not necessary. The data is there, but so is the dogma...so I ask you again...what's an emergency physician to do?

By arming ourselves with information, we can develop an approach to asymptomatic bacteriuria that is reasonable, defensible, and protects the public health without jeopardizing the health of the individual patient. Here are some common myths about UTIs and asymptomatic bacteriuria:

Smelly pee = UTI. Foul smelling urine or change in urine appearance does not correlate with infection. It is usually related to hydration status.
WBCs = UTI. Pyuria is inflammation within the genitourinary tract and is measured as WBCs in the urine. It is a common accompaniment of asymptomatic bacteriuria and should not influence decisions about antimicrobial therapy.
Leukocyte esterase and/or nitrites = UTI. Not so fast, leukocyte esterase suggests pyuria and nitrites suggest bacteria--either of these could be present in asymptomatic bacteriuria, so clinical context (i.e. symptoms) really matters.
Positive culture always means UTI. A good specimen has fewer than five epithelial cells per low-power field on urinalysis. A "positive" culture is meaningless if the sample was contaminated.
UTI is a common cause of altered mental status in the elderly. Actually it is an uncommon cause and this type of anchoring bias can work against us in terms of uncovering the true cause of our patient's altered mental status. Before you think UTI, think of more common (and also more subtle) etiologies like medication reactions, sundowning, dehydration or sensory impairment.

Let's get back to our patient; she's altered, her urinalysis sure looks "positive", and she lives in a nursing home that is likely covered from floor to ceiling in a thin film of gram positive rods, so I ask you yet again...what's an emergency physician to do?

First, check prior records to see if her urinalysis always appears "positive", you may discover a trend of asymptomatic bacteriuria.
Second, recall that UTI is an actually an uncommon cause of delirium and the chances that your patient has occult bacteremia from a urinary source are low.
Third, do not administer antibiotics and let your admitting physician know that you are consciously resisting the urge to treat the "UTI" in favor of uncovering the more likely alternate cause of her altered mental status.
Lastly, check your inbox to read emails of praise from your infectious disease and long term care colleagues--you, my friend, are a cautious physician and a noble steward of antibiotics!

In summary, inappropriate treatment of asymptomatic bacteriuria is a big problem. Some of us are part of the problem, others are part of the solution. If 39% of the antibiotics prescribed for UTIs are unneccesary, we have some work to do in terms of educating our workforce and our patients about asymptomatic bacteriuria. If this is a topic that is relevant in your ED, think about sitting down with your inpatient team and hammering out a protocol to ensure a uniform approach towards asymptomatic bacteriuria.

Want to learn more? Check out this 2016 article on the topic by Wisconsin emergency physician Jeff Pothof!

Bottom line: "Elderly patients with acute mental status changes accompanied by bacteriuria and pyuria, without clinical instability or other signs or symptoms of UTI, can reasonably be observed for resolution of confusion for 24–48 h without antibiotics, while searching for other causes of confusion" [J Emerg Med. 2016;51(1):25-30].

MEB Approves Telemedicine Rule

Thu, 17 Nov 2016 20:09:00 GMT

Wisconsin Health News

The Medical Examining Board approved a revised version of a rule defining telemedicine Wednesday. It now heads to Gov. Scott Walker's office and then the state Legislature for approval.

The board has spent the last year drafting the rule, scrapping its original proposal after healthcare providers raised concerns. The final rule clarifies that a physician-patient relationship can be established through telemedicine and provides guidelines on equipment and technology as well as internet diagnosis and treatment.

"The two different versions of the telemedicine rule are pretty stark," said Mark Grapentine, senior vice president of government relations at the Wisconsin Medical Society. "One was super-detailed and lengthy, the other one is much more flexible and probably usable by the board itself."

The Alliance of Health Insurers also backed the rule. "Telehealth is a means to improve upon the high-quality healthcare system we already enjoy, particularly by improving patient access, regardless of distance and mobility," Executive Director R.J. Pirlot wrote in testimony.

Claudia Tucker, vice president of government affairs for Texas-based TelaDoc, said they're pleased that the board accepted their recommendations to address HIPAA concerns and said they also support the latest version of the rules.

But some testimony questioned whether the rule could be construed to prohibit other healthcare professionals from providing care through telehealth. Linda Roethle, vice president of regional business development at Bellin Health, said that more than just physicians and physician assistants should be covered under the rule, including nurse practitioners, clinical psychologists and clinical social workers. "Please do not create any additional barriers for patients," she wrote in her testimony.

Tine Hansen-Turton, executive director of the Convenient Care Association, recommended language stipulating that nurse practioners can practice telehealth. The association represents clinics located inside retail locations like grocery stores and pharmacies. "Wisconsin's retail clinics are primarily staffed by nurse practitioners," Hansen-Turton wrote. There are 35 retail clinics in the state, according to her testimony.

Dr. Kenneth Simons, board chair, said the board can't create rules for professions it doesn't oversee.

Concerned about Mandatory Education on Opioid Prescribing?

Wed, 16 Nov 2016 17:32:33 GMT

WACEP to offer opioid-specific education at 2017 Spring Symposium

Now in effect, a Wisconsin Medical Examining Board emergency rule requires continuing medical education (CME) on opioid prescribing guideline. The CME requirement is one component of a comprehensive statewide strategy to address prescription drug abuse in the best interest of public health and safety.

To address the requirement, WACEP is incorporating an opioid educational component into the Spring Symposium schedule. Mark your calendars and plan to attend the symposium, scheduled to take place on Tuesday, March 28, 2017 at The Madison Concourse Hotel, Madison, WI. Plan also to stay in Madison the following day for Doctor Day 2017.

The conference planning committee has been working with members of the MEB. While details are still being finalized, preliminary indication is that the Spring Symposium curriculum will be approved to meet the state's educational requirement.

Also on the opioid front, WACEP has been invited by Tim Westlake, MD, Vice Chairman of the Medical Examining Board and Chairman of the Licensing and Controlled Substances Committees, to participate on the Wisconsin Coalition for Prescription Drug Abuse Reduction. WACEP will be represented on the Coalition by Board Member Julie Doniere, MD, and will have an opportunity to showcase WACEPs' efforts in combating the opioid epidemic.

WACEP Spring Symposium event registration will soon be available. Visit the WACEP Conference web page for schedule information, and check back to register. In the meantime, See below and book your lodging through the WACEP room block today!

WACEP Among Health Groups to Band Together on Self-Insurance

Tue, 15 Nov 2016 18:16:44 GMT

Wisconsin Health News

Heathcare organizations called on Gov. Scott Walker's administration and lawmakers to consider the impact that self-funding the health plan for state and local employees could have on Wisconsin's healthcare market.

Fourteen groups, including the Wisconsin Chapter, ACEP, Wisconsin Counties Association, Wisconsin Hospital Association and the Wisconsin Medical Society, sent a memo to lawmakers Monday cautioning that the "potential repercussions" of self-insuring "could be far-reaching" and "significant" for the state's taxpayers and economy.

The Department of Employee Trust Funds has issued a request for proposals to self-insure the health plan for state and local employees. In such an arrangement, the state would take on the risk for the roughly 250,000 state and local employees, as well as their families, currently covered under the program.

The proposal could reduce the number of HMOs serving the program. It could also save the state up to $42 million, according to one report. A different report said the move could save $20 million or cost the state up to $100 million. Walker has said any savings would go to education.

The 14 organizations called on the state's Group Insurance Board, members of the Joint Finance Committee and Walker to "fairly compare" the results of the RFP to the current system, evaluate "possible significant risks to state taxpayers" and assess whether self-funding protects the competitive strength of the state's health insurance market.

"The State Group Health Program has been remarkably successful in using choice and competition to control costs, improve quality and maintain financial stability and value for taxpayers," they wrote. "Any alternative the state considers should be held to this high standard."

Walker spokesman Tom Evenson wrote in an email that the governor appreciated the input and will take it in consideration.

"In the end, we will move forward with a plan that is best for Wisconsin," he said.

Panel to Address Scope of Practice, Team-Based Care

Tue, 15 Nov 2016 17:06:24 GMT

Join Wisconsin Health News on December 6th in Madison for a panel presentation on scope of practice, team-based care and the future healthcare workforce.

The federal health reform law has ushered in a new wave of patients. Meanwhile, the state could face a shortfall of more than 4,000 doctors by 2035, and a 35 percent gap between the demand for nurses and the actual supply by 2040.

So, who is going to take care of all these new patients? How will primary care be delivered in the future? In what areas does it make sense to expand the scope of practice? Where does it not?

A panel of experts will tackle these questions and more during a Wisconsin Health News Panel Dec. 6 at the Madison Club. Panel participants will include:

Dr. Dave Clemens, President-Elect, Wisconsin Dental Association
Gina Dennik-Champion, Executive Director, Wisconsin Nurses Association
Eric Elliot, President-Elect, Wisconsin Academy of Physician Assistants
Linda Jorgenson, Former President, Wisconsin Dental Hygienists Association
George Quinn, Executive Director, Wisconsin Council on Medical Education and Workforce
Steve Rush, Vice President, Workforce and Clinical Practice, Wisconsin Hospital Association
Dr. Ken Schellhase, President-Elect, Wisconsin Academy of Family Physicians

DSPS Approves Rule on Opioid Prescribing CME

Mon, 14 Nov 2016 18:21:26 GMT

Doctors who prescribe controlled substances will have to complete training relating to the Medical Examining Board's opioid guidelines under a rule that went into effect earlier this month.

The Department of Safety and Professional Services signed off on the emergency rule last week. It requires doctors renewing their licenses to complete two hours of training on the guidelines out of their 30 hours of bienniel mandatory continuing medical education.

Read the rule.

Grant Expands Telemedicine Program at Ministry Health Care

Mon, 07 Nov 2016 20:05:56 GMT

November 3, Wisconsin Health News - A federal grant will help Ministry Health Care expand its telemedicine program to clinics across seven northcentral Wisconsin counties.

The United States Department of Agriculture announced the $432,258 grant last week. It'll expand a project allowing advanced practice nurse practitioners to consult with physicians and provide care in facilities serving Clark, Forest, Lincoln, Marathon, Portage, Vilas and Waupaca counties.

"These investments will help provide better healthcare and educational opportunities for rural residents," USDA Secretary Tom Vilsack said in a statement.

Ministry, which is part of Ascension, plans to add therapeutic services to the program, including dietary and diabetic counseling, tele-psychiatry and post-hospitalization, post-surgical follow-up, according to the USDA.

The project will connect 13 rural clinics and two hospitals to Ministry Saint Claire's Hospital in Weston, according to Ministry spokesman Tom Weaver.

It will allow Ministry to care for more complex patients within their home communities and has the potential to provide more than 100,000 telemedicine visits during the next three years, Weaver said.

Ministry's project was one of only seven healthcare projects and the only Wisconsin project funded in the grant cycle. Eighteen projects in 16 states received $4.7 million.

State Collects 58,729 Pounds of Drugs During Take Back Day

Mon, 07 Nov 2016 20:02:40 GMT

November 2, Wisconsin Health News - The state collected 58,729 pounds of unwanted medications and prescription painkillers during a national prescription drug take back day on Oct. 22, the Department of Justice said Tuesday.

The state's also increased the number of registered permanent medication return boxes in the state to 295. That's nearly double the 152 in September 2015.

"The fight against this epidemic isn't over, but with continued effort from citizens, we will save lives," Attorney General Brad Schimel wrote in a blog post.

In late April, the state collected 62,618 pounds of prescription drug. The amount of collected drugs at that point was third in the nation, behind California and Texas.

October Issue of “WISHIN Connections” Available

Mon, 07 Nov 2016 19:52:13 GMT

November 1, WISHIN - WISHIN Connections is the monthly e-Newsletter from the Wisconsin Statewide Health Information Network (WISHIN). We will keep you up to date with WISHIN activities, news on health information exchange (HIE) and new product developments.

In the October 2015 edition of WISHIN Connections, we outlined the benefits of regional and statewide health information exchanges (HIEs) like WISHIN in enabling collaboration among groups striving for healthcare interoperability. A year has passed and the content of that article is still relevant. But as HIE evolves, questions remain about how all of the options compare and contrast with each other.

Call for Session Abstracts! Participate in WACEP's Spring Symposium

Thu, 03 Nov 2016 12:12:26 GMT

Interested in sharing your emergency medicine expertise? Wisconsin ACEP is now accepting abstracts from members and others interested in hosting a roundtable session at the WACEP 2017 Spring Symposium, Tuesday, March 28, 2017, at the Madison Concourse Hotel in Madison.

The symposium will offer, "Hot Topics in Emergency Medicine" an afternoon session that will include a variety of roundtable discussions. Table hosts will facilitate five 15-minute discussions on their topic of expertise, as attendees rotate tables during the 75-minute session.

Abstract Submissions:

Brief abstracts must be submitted via email to WACEP@badgerbay.co.
Content described in the abstract must be appropriate for facilitating 15-minute discussions on the topic.
Abstracts must include at least one learning objectives for your roundtable topic.
The Symposium planning committee will review all abstracts to make a final determination of roundtable topics by December 1st.

Pokémon Go: Emergency Medicine Friend or Foe?

Wed, 26 Oct 2016 18:31:47 GMT

President's Message, October 2016
Bobby Redwood, M.D., M.P.H.

From October 26 to November 1, Pokémon Go is having a special Halloween event where players are heavily incentivized to get outside and catch Pokémon. Translation: there will be a lot of absent-minded kids (AND adults—40% of players are over age 25) wandering around the side of the road and maybe even your hospital for the next few days.

We're having a little fun at WACEP this Halloween, so here's our take on Niantic's smash-hit smart phone game Pokémon Go and how it affects emergency medicine in Wisconsin.

Pokémon Go was released on July 6, 2016, and on the eve of its five-month birthday, the app has already achieved legend status with 600 million downloads, 25 million active daily users, and more than $500 million in net revenue thus far.
The app is essentially an augmented reality game that is played on a smart phone and encourages users to go out and hunt mythical "pocket monsters" (Pokémon) in the real world.
Augmented reality means that players see the Pokémon on their smart phone screen as though the monsters were floating in the real world (see photo of a "Ghastly" Pokémon floating around my emergency department).
Players are rewarded for physical activity and also for visiting Poké-Gyms where they can have their Pokémon battle in order to advance in the game. Poke-Gyms tend to be located in parks, shopping centers and other community gathering places...including hospitals. There is a Poké-Gym outside of my ED and I frequently spot Pokémon players clustered around the site.

So why does this matter? From an injury prevention stand-point, Pokémon Go is certainly problematic. The game seems to throw players into a trance-like state where their level of situational awareness is similar to that of intoxicated person. This would be fine if the players were sitting at home, but they are typically wandering the streets, biking, or (gulp) driving while trying to catch a rare Charmander or Dratini.

News reports have highlighted multiple cases where pedestrians have walked into traffic and—in one case—off of a cliff. Even scarier, there was a report in New York of a mugger using Pokémon lures (an item in the game that is publicly view-able to all players and lures Pokémon to a certain spot) to bring victims into his vicinity. Luckily, that appears to have been an isolated incident.

Having acknowledged the downside of the game, here's the case for why emergency physicians should be happy that Pokémon Go is out there.

First of all, this game really does encourage physical activity and Americans across the country are getting off the couch and reducing their risk for chronic health conditions through good clean fun. In fact, Business Insider magazine reported in September that Pokémon Go players have walked a cumulative total of 4.6 Billion kilometers since the game's release. What is the Pokémon Go number needed to treat to prevent one myocardial infarction?
Second, the game encourages real-life socialization (as opposed to online chatting) in that Pokémon Go players often meet in person to play and even host events to bond over the game. Within households, countless family-focused organizations and parenting blogs have celebrated how the game gives parents and their children an opportunity to spend quality time together. This is good for our communities in terms of building social support networks, strengthening family ties, and getting isolated individuals to engage in a productive way with their peers. Pokémon Go schizophrenia support groups?
Third, the Pokémon platform has been repeatedly praised on college and high school campuses as a weekend social activity that doesn't center around alcohol consumption. One-less drunk teenager trying to keep the party going in your ED at three in the morning?

So what do you think? Emergency providers are generally a fun-loving, active bunch...is Pokémon Go the monkey bars of 2016, or is it a welcome alternative to drinking on the couch? Share your comments and have fun this Halloween--with or without Pokémon Go.

Bobby Redwood, M.D., M.P.H.
President: Wisconsin Chapter of the American College of Emergency Physicians
WACEP@badgerbay.co

Board Approves Opioid Prescribing Emergency Rules

Mon, 24 Oct 2016 15:16:01 GMT

October 24, Wisconsin Health News - The Medical Examining Board has approved emergency rules that require doctors who prescribe narcotics to complete biennial training relating to the board's opioid guidelines.

Under the rule approved last week, doctors who renew their licenses in 2017 or 2018 will have to complete an educational course or program relating to the guidelines for at least two of their 30 hours of required continuing medical education. Those who renew in 2019 or 2020 will also have to complete at least two hours.

The rule doesn't apply to physicians who lack a U.S. Drug Enforcement Administration number to prescribe controlled substances. The rules could go into effect as early as next month, according to the board's newsletter. The board plans to hold a public hearing next month regarding telemedicine rules.

Malcore to Serve as DHS Assistant Deputy Secretary

Fri, 21 Oct 2016 02:00:00 GMT

October 20, Wisconsin Health News - Jennifer Malcore will serve as the next assistant deputy secretary at the Department of Health Services, according to a Wednesday statement.

Bill Hanna, who's held the position since August 2015, has accepted a job outside of state government, according to DHS.

Malcore is currently chief of staff for Rep. John Nygren, R-Marinette, and has worked on his Heroin, Opioid Prevention and Education Agenda.

Hanna will leave DHS Oct. 26. Malcore starts Nov. 14.

Ultrasound Workshop for Emergency Physicians

Wed, 19 Oct 2016 12:32:13 GMT

Plan to participate in the Ultrasound Workshop for Emergency Physicians on November 5, 2016 at the University of Wisconsin-Madison. Learn the life-saving ultrasound skills of finding free fluid in abdomen and chest, pneumothorax, pericardial effusion and cardiac tamponade; and assess left ventricular function and IVC size to guide therapy on critically ill patients.

Why is this better than other ultrasound workshops you’ve been to?

Focus is on the ultrasounds that matter when seconds count
Live patient models for scanning practice and state of the art ultrasound simulators for pathology
No more than 3 participants per instructor to allow for focused, tailored teaching and feedback
4 hours of CME for $300

Learn more and register.

Nominations Open for 2017 Physician Citizen of the Year Award

Tue, 11 Oct 2016 16:18:58 GMT

September 29, WMS Medigram

The Wisconsin Medical Society is now accepting nominations for its 2017 Physician Citizen of the Year Award. First established by the Society in 1982, the award recognizes and encourages Wisconsin physicians who volunteer their time and talents through civic and cultural activities—helping to improve the health and well-being of their communities.

Consider nominating a friend, colleague or personal physician for this award. Details and a nomination form are available on the Society’s website. The nomination deadline is Dec. 15, 2016.

Michael Ostrov, MD, MS, received 2016 Physician Citizen of the Year for his extraordinary efforts to further the conversation regarding advance care planning and end-of-life care in Wisconsin. A family medicine physician, Dr. Ostrov is chief medical officer for WPS Health Insurance and Arise Health Plan. He was recognized during the Society’s Annual meeting last April, and also was featured in the June issue of WMJ.

Medicaid Prescription Data Now in WISHIN Pulse

Tue, 11 Oct 2016 16:01:47 GMT

September 2016, WISHIN Connections

Medicaid prescription-fill data for Wisconsin Medicaid members is now included in WISHIN Pulse, the statewide community health record. Medicaid prescription-fill history dating back to May 1, 2015, has been loaded into WISHIN Pulse and the data is being refreshed twice daily from the Medicaid pharmacy claims system, thus providing near-real-time prescription information to support better informed patient care and safety for Medicaid patients.

"We are constantly adding new participants and data sources to WISHIN Pulse to provide value to our participants and the patients they serve," says Joe Kachelski, CEO of WISHIN. The addition of Medicaid prescription-fill data substantially enhances the clinical data available through WISHIN Pulse.

"With hundreds of thousands of Wisconsinites covered by Medicaid, the addition of up-to-date prescription information is going to add substantially to the value of WISHIN Pulse."

Providers using the WISHIN Pulse system will be able to view Medicaid prescriptions in a tab under the "medications" section. WISHIN Pulse also includes information such as diagnoses, immunizations, lab results, care plans, and visit summaries. In addition, WISHIN Pulse has integrated with the state's Prescription Drug Monitoring Program (PDMP) to allow clinicians to see a patient's history of controlled-substance prescriptions without having to log on to the state's system and separately search for a patient.

WISHIN Pulse users should be aware that the data displayed represents the vast majority of drugs paid for by Medicaid. However, it possible that in the transmission process a small number of records may fail to immediately load. It is also possible that prescription-drug claims may be reversed after appearing in WISHIN Pulse.

Register Now for Oct. 18 Insurance CEO Roundtable

Tue, 11 Oct 2016 15:59:41 GMT

Join WHN on October 18 when insurance leaders will discuss exchanges, narrow networks and more during a roundtable discussion moderated by Wisconsin Health News Editor Tim Stumm. Panelists include:

Julie Brussow, CEO, Security Health Plan
Dustin Hinton, CEO, UnitedHealthcare Wisconsin
Sherry Husa, CEO, MHS Health Wisconsin
Paul Nobile, President, Anthem Blue Cross and Blue Shield in Wisconsin

Tuesday, Oct. 18, 2016
11:30 am to 1 pm - discussion begins at noon
Madison Club; 5 E Wilson St.; Madison, WI 53703
Register now

WCMEW and AHEC November 10-11 Conference

Tue, 11 Oct 2016 15:57:46 GMT

The Wisconsin Council on Medical Education & Workforce (WCMEW) and the Wisconsin Area Health Education Center (AHEC) System invite you to register for Interprofessional Collaborations: Advancing Wisconsin’s Healthcare and Education, an interprofessional conference.

This Thursday-Friday conference is designed to bring together educational institutions and health care facilities from across Wisconsin. The event is being presented through a partnership of AHEC and WCMEW. The conference will take place on Thursday, Nov. 10 and Friday, Nov. 11, 2016, at the Marriott West in Madison.

Register here for the conference and access more information including the agenda, event details and learning objectives. The conference room rate of $139 has been negotiated for a block of hotel rooms at the Marriott. The room block will be held until October 12.

Improving Care Management with the WISHIN Patient Activity Report

Mon, 10 Oct 2016 21:02:53 GMT

September 2016, WISHIN Connections

In many cases, Medicaid health plans and other payers are not aware of their members' Emergency Department (ED) or other hospital admits or discharges unless they make arrangements individually with each hospital to get notifications or until the claim resulting from the visit is received, which may take up to 30 days.

The Patient Activity Report for Payers (PAR-P) provides daily notifications of patient hospital or ED visits to payers. The report, which includes admission, discharge and transfer (ADT) information, was created to help payers follow up proactively and timely with members who have visited a hospital or ED. The PAR-P can help to assure compliance with care plans, avoid preventable re-admissions, prevent duplicative testing and procedures and connect targeted Medicaid ED visitors with medical homes or appropriate follow-up care.

Working in Partnership for Improved Care Coordination

The PAR-P project was developed by the WISHIN team with input from payers and completed in partnership with and supported by funding from the Wisconsin Department of Health Services (DHS). The first sites, Medicaid health plans serving certain members in Milwaukee, went live in April 2015. Many of the health plans chose to include members beyond those in the pilot population.

In September 2015 a survey was distributed to the pilot sites to gather feedback on the organizations' experiences with PAR-P and what they would like to see in Phase 2.

More than 80% of respondents indicated that they found the PAR report useful and timely. When asked how the patient care coordination process changed with information from the report one respondent commented that the follow-up process has been made easier by having the most recent demographic information on a patient. The respondent continued,

"It also allows us better access to patients that have been floundering in the system without access to a [primary care physician (PCP)] due to their own lack of knowledge. The hospital inpatient notification has allowed us to share this information with their PCP and obtain referrals to our care coordination team for temporary or permanent placement into a care coordination or disease management program. These patients in the past were typically lost until they presented to an office and at that point their disease may have progressed needlessly."

Phase 2 Improvements

By the request of the pilot sites, the PAR is now delivered to an sFTP folder rather than via secure email. The sFTP folder process can simplify health plans' workflows so that their systems can automatically retrieve the file from the folder rather than taking multiple steps to open secure emails and download the files.

Additional Phase 2 improvements were made to provide more details to payers receiving the report to clearly indicate what event triggered the PAR. For example, event identifiers were added to encounters including whether the notification is being sent because of an admission, discharge or change in demographics, or change in diagnoses. Furthermore, five new data elements have been added to PAR-P: event type, discharge date & time, discharge disposition, internal visit/account numbers and the primary-care physician. With the addition of these details, case managers can quickly move through their workflow rather than spending time identifying why the report was generated or tracking down contact and other information critical to a swift follow-up.

WISHIN is pleased about the potential of the PAR-P report to connect health plans and their members to accelerate and improve care. The addition of the PAR-P to WISHIN's services builds on its mission to promote and improve the health of all communities and patients in Wisconsin.

If you have questions about the PAR-P's capabilities and uses or would like to find out if your organization could use the report, contact WISHIN at wishin@wishin.org or (608)274-1820.

‘Town Hall Meetings' will Highlight Details on New Association Health Plan

Fri, 07 Oct 2016 16:24:19 GMT

September 29, WMS Medigram

Six “Town Hall Meetings” are scheduled during the next two weeks to provide Wisconsin Medical Society members and their health care teams more information about the Society’s new Association Health Plan (Plan).

The Plan was created to continue to serve Society members in the changing health insurance market. It provides a range of options, allowing groups to offer as many as six of eight plan designs to their employees. Wisconsin Medical Society Insurance and Financial Services, Inc. is the Plan’s sole broker and WPS is the insurance carrier.

During each meeting, Insurance Advisor Chris Noffke will present the Plan’s benefit options and underwriting requirements. The presentation is designed to help human resources staff, office managers and administrative personnel guide their employees through the online application process. The meetings are:

Monday, Oct. 3 at NeuroSpine Center of Wisconsin, 5320 W. Michaels Drive, Appleton, WI 54913. Presentations will be at 10 am and 3 pm
Wednesday, Oct. 5 at OakLeaf Surgical Hospital—River Prairie Conference Room, 1000 OakLeaf Way, Altoona, WI, 54720. Enter through door #2 and follow the signs to the conference room. Presentations will be at 10 am and 12 pm
Wednesday, Oct. 12 at Wisconsin Medical Society—Milwaukee Office, 6737 W. Washington Street, Suite 1120, West Allis, WI 53214. Presentations will be at 10 am and 3 pm

There is no cost to participate but seating is limited. To register or for more information, please e-mail Chris Noffke.

Governor Names Society to Task Force on Opioid Abuse

Fri, 07 Oct 2016 16:15:28 GMT

September 29, WMS Medigram

The Wisconsin Medical Society has been named to a new Task Force on Opioid Abuse announced by Governor Scott Walker last Friday. The announcement came after Gov. Walker issued Executive Order #214, which also appoints several agency secretaries, or their designees, to the task force.

“We’ve recently seen opioid use and abuse escalate throughout Wisconsin,” said Gov. Walker. “The bottom line is this has become an epidemic and every year we see more people dying from opioid overdose. We’ve taken serious steps in the past to combat opioid abuse in Wisconsin, including signing Heroin Opiate Prevention and Education, or H.O.P.E., legislation into law last spring, and issuing a standing order allowing naloxone to be dispensed without individual prescriptions. These efforts are saving lives and helping people get the support they need to recover. Our announcement today about the creation of the Governor’s Task Force on Opioid Abuse demonstrates our unified efforts and brings us closer to our goal of ending opioid abuse and overdose in Wisconsin.”

The task force will meet in the coming weeks and months to advance work already being done to combat opioid abuse, and to make additional recommendations to end the opioid crisis in Wisconsin. Lieutenant Governor Rebecca Kleefisch and Rep. John Nygren will serve as co-chairs. Other participants include Attorney General Brad Schimmel, representatives from law enforcement and public health, the Wisconsin Hospital Association, the Pharmacy Society of Wisconsin and the Wisconsin Coalition for Prescription Drug Abuse Reduction, and legislators and members of the public.

“One of the strengths of Wisconsin’s strategy in fighting the opioid abuse epidemic is the collaboration among elected officials, law enforcement, physicians and other health care groups. We all bring different perspectives and experiences about this crisis and we all learn from one another,” said Society Chief Medical Officer Donn Dexter, MD. “Governor Walker’s action this morning will enhance these efforts even further. Coordinating government agencies’ statewide reach with health professionals’ knowledge will maximize our ability to make progress by saving lives.”

More information about the task force is included in this press release.

Interstate Compact Licensure Expected to Go Live in January

Fri, 07 Oct 2016 16:08:21 GMT

September 26, Wisconsin Health News

The chair of the state's Medical Examining Board said last week that he expects doctors should be able to obtain a license under the interstate licensure compact in January.

"We want to be issuing the first licenses by Jan. 1," said Dr. Kenneth Simons, who called it a conservative timeline. Simons serves as one of the state's commissioners for the group developing the compact.

Clinical Care Practice Update: Carfentanil

Thu, 06 Oct 2016 15:12:45 GMT

Warning to all first responders, including Law Enforcement and canine officers - Dermal and mucosal exposure is significant. Carfentanil has not been found in WI yet. When large vet anesthesiologists handle this, always in small quantities, they have emergency providers standing by with a box of Narcan. Any accidental exposure requires presumptive treatment, even without any symptoms, of 2mg IM every 3 minutes until an IV can be established and they get to the ED. Read more on the recent DEA warning.

News from National ACEP, Oct. 2016

Sat, 01 Oct 2016 16:42:38 GMT

New Epinephrine Labeling:
There has been a change to the labeling of epinephrine. Epi 1:1000 used for anaphylaxis and asthma is now labeled 1.0mg/ml. Epi 1:10,000 used for cardiac arrests is now labeled 0.1 mg/ml. There has been concern that the current labeling caused confusion and inappropriate dosing.

New Crowding Solutions Resource:
A new information paper on the causes, impacts and solutions to the crowding and boarding problem has been approved by the Board of Directors. Members are encouraged to distribute this reader-friendly paper to their hospital administrators or local policymakers who may benefit from a better understanding of why they must, and how they can, address this vexing and dangerous problem. A link to the new paper entitled “Emergency Department Crowding: High Impact Solutions” is available at: https://www.acep.org/Clinical---Practice-Management/Emergency-Medicine-Crowding-and-Boarding/

Blood Clot Information for Patients Developed:

ACEP (through an educational grant from Bristol Myers Squibb) is providing UNBRANDED resources to patients with newly diagnosed VTE/PE. The program provides text messages to connect patients to video based education which discusses the importance of taking medication and getting follow up. No product name is mentioned or implied. The program is called Know Blood Clots, and is explained on the website www.knowbloodclots.com. Patients can also text CLOTWEB to 412-652-3744 to sign up for the Know Blood Clots program. If you have questions, feel free to email sschneider@acep.org and I will try to supply further details.

New Sections at ACEP:
A sufficient number of members have come together to officially form three new Sections in the College. The Pain Management Section was formed earlier this year and is now being followed by the creation of the Medical Directors Section and the Event Medicine Section. The new Sections will meet at ACEP16 for the first time. Members interested in any of these topics are invited to attend the Section meetings and/or join the new Sections.

WACEP President's Message, September 2016

Wed, 21 Sep 2016 16:54:31 GMT

Bobby Redwood, M.D., M.P.H.
President
Wisconsin Chapter, American College of Emergency Physicians

For the past two years, national ACEP has released five practice changing recommendations each October under their Choosing Wisely Campaign. These recommendations (see below) represent ways that the emergency physician can contribute to the triple aim of efficient, equitable, and patient-centered care. Inspired by ACEP's campaign, my group began to practice these ten recommendations routinely in our rural emergency department with a consensus that we feel more career fulfillment after agreeing to follow these evidence-based, patient-centered practices.

The current Choosing Wisely recommendations are written for a national audience. Given that regional practice patterns vary widely, my question for our membership this October is this: What would Wisconsin-specific choosing wisely recommendations look-like? Are there evidence-based, best EM practices being implemented in your ED that exemplify the triple aim? Are you willing to share? Send your recommendations to WACEP@badgerbay.co. With you help, we at Wisconsin ACEP can publish our own local edition of the Choosing Wisely Campaign for the Badger State!

For your reference, ACEP's Choosing Wisely to date:

Avoid computed tomography (CT) scans of the head in emergency department patients with minor head injury who are at low risk based on validated decision rules.
Avoid placing indwelling urinary catheters in the emergency department for either urine output monitoring in stable patients who can void, or for patient or staff convenience.
Don't delay engaging available palliative and hospice care services in the emergency department for patients likely to benefit.
Avoid antibiotics and wound cultures in emergency department patients with uncomplicated skin and soft tissue abscesses after successful incision and drainage and with adequate medical follow-up.*
Avoid instituting intravenous (IV) fluids before doing a trial of oral rehydration therapy in uncomplicated emergency department cases of mild to moderate dehydration in children.
Avoid CT of the head in asymptomatic adult patients in the emergency department with syncope, insignificant trauma and a normal neurological evaluation.
Avoid CT pulmonary angiography in emergency department patients with a low-pretest probability of pulmonary embolism and either a negative Pulmonary Embolism Rule-Out Criteria (PERC) or a negative D-dimer.
Avoid lumbar spine imaging in the emergency department for adults with non-traumatic back pain unless the patient has severe or progressive neurologic deficits or is suspected of having a serious underlying condition (such as vertebral infection, cauda equina syndrome, or cancer with bony metastasis).
Avoid prescribing antibiotics in the emergency department for uncomplicated sinusitis.
Avoid ordering CT of the abdomen and pelvis in young otherwise healthy emergency department (ED) patients (age <50) with known histories of kidney stones, or ureterolithiasis, presenting with symptoms consistent with uncomplicated renal colic.

*a recent NEJM study by Talan et al has revived this as a topic of discussion

Wisconsin ACEP Meet-Up in Vegas

Wed, 21 Sep 2016 16:05:28 GMT

Planning to attend ACEP's 2016 Scientific Assembly in Las Vegas? WACEP is coordinating a Wisconsin Chapter Dessert & Drink Reception! We hope you can join us for this complimentary mix and mingle!

Monday, October 17, 2016; 8:30 to 10:30 pm
Vice Versa Patio & Lounge at Vdara Hotel & Spa
2600 W. Harmon Avenue, Las Vegas, NV 89158

Find us on the Patio! We look forward to seeing many of you in Vegas!

WACEP Legislative Activity Updates

Wed, 21 Sep 2016 15:21:00 GMT

Lisa Maurer, MD, WACEP Treasurer

I recently had an opportunity to participate with other WACEP board members and our Chapter lobbyist at two important events affecting emergency physicians in Wisconsin.

On September 1, we met with a group of emergency physicians from the Milwaukee-based group ERMED to discuss both our top legislative priority, improving Medicaid reimbursement for EMTALA-related services, and how our membership can work with ERMED to help with the effort. Thanks to the physicians of that group for their time and enthusiasm! Many expressed an interest in helping with our Chapter efforts to improve reimbursement, and were willing to contribute to our Political Action Committee. Please consider making a PAC donation today!

Also on September 1, I was among several WACEP board members who attended a round-table discussion hosted by Senator Ron Johnson (R-Wis) regarding the opioid epidemic. A primary focus of the discussion was the important Promoting Responsible Opioid Prescribing (PROP) Act, which aims to exclude certain pain-related measures for purposes of calculating incentive payments under the value-based purchasing program. Senator Johnson highlighted the need to reeducate ourselves as physicians on alternatives to opioids, as well as the crucial need to educate our patients about safer and more effective modes of pain control.

A big thanks goes out to WACEP member Tim Westlake, MD, who serves as Vice Chair of the Medical Examining Board, for his participation on the panel. His presence shed light on the EM physician perspective relating to this important issue.

Congratulations to Newest WACEP Members to Achieve Fellow Status

Wed, 21 Sep 2016 15:08:45 GMT

WACEP congratulates five well-deserving members for being among the newest group to meet the eligibility requirements and achieve Fellow Status of the American College of Emergency Physicians. The following individuals will be recognized next month during ACEP16 in Las Vegas:

Gemma C L Bornick, MD of Green Bay
Suhas Channappa, MD of Marshfield
Alex A Pasquariello, MD of Fitchburg
Brian W Patterson, MD of Madison
Louis J Scrattish, MD of Madison

ACEP Fellowship was first established in 1982 to honor members who made special contributions to the College and the specialty of emergency medicine. Requirements for Fellow Status include Active membership status for three continuous years; board certification by ABEM, AOBEM, or ABP certification for pediatric emergency physicians; and additional service to the specialty. In Wisconsin, 176 WACEP members are currently Fellows of the American College.

Hospitalizations, ER Visits up at Wisconsin Hospitals in 2015

Fri, 26 Aug 2016 16:46:51 GMT

August 17, Wisconsin Health News

Wisconsin hospitals saw more visitors to their facilities and emergency rooms last year, but patients were there for shorter periods of time, according to a report recently released by the Wisconsin Hospital Association.

Emergency room visits shot up 4.7 percent in 2015 to 1.79 million, compared to 1.71 million in 2014, while hospitalizations at general medical-surgical hospitals inched up 0.2 percent to 580,881. The average length of stay decreased 0.5 percent from 4.2 days to 4.1.

Meanwhile, the average charge per hospitalization grew 5.2 percent to $32,197.

Brian Potter, senior vice president at the Wisconsin Hospital Association, said charges are going up because of rate increases, as well as the trend of lower cost discharges moving to the outpatient setting, increasing the acuity of inpatient stays.

The downward trend of length of stays, which were 4.7 days in 2000, is significant because many of the short stay cases are now done on an outpatient basis, according to Potter. He attributed the increase in ER visits to the federal health reform law's coverage expansion.

"People with coverage tend to use more services and if they are new to the system, they often begin with an ER visit," he said.

The most common reason for going to the hospital was childbirth, representing 16 percent of all hospitalizations. In the emergency room, abdominal pain was the most frequent diagnosis, accounting for 6 percent of visits.

View WHA data here.

WACEP President's Message, August 2016

Tue, 16 Aug 2016 16:59:46 GMT

Bobby Redwood, M.D., M.P.H.
President, Wisconsin Chapter, American College of Emergency Physicians

August is national immunization awareness month and a great opportunity to discuss the role that Wisconsin emergency physicians play in immunization care. We all know that every emergency is a failure of prevention, so some careful planning now can help us stave off the flood of infectious diseases that is bound to hit our ED's during the winter months.

While the southern US is scrambling to deal with Zika, we northerners already know who our enemy will be this winter: influenza. Wisconsin department of health services releases weekly influenza reports and rates this week remain low in all regions of Wisconsin. Typically our influenza numbers start to skyrocket in the second week of November and don't level off again until the second week of May. That's seven months of headaches, body aches, and pediatric fevers that we would rather not have end up on our doorstep. In the 2015-2016 flu season, Wisconsin saw 5,136 cases of influenza...and that's just the cases that were confirmed.

So let's talk prevention! For those vaccine geeks out there, the trivalent vaccines for use in the 2016-2017 influenza season will contain the following virus-like strains: A/California/7/2009 (H1N1); A/Hong Kong/4801/2014, and B/Brisbane/60/2008. No one knows (yet) what strains the 2017-2018 vaccine will contain...let's hope its not called A/Wisconsin/2016. We'll find out soon enough, CDC expects the 2016-2017 vaccine to available later this month for at-risk populations and available for all populations by the first week of September.

On your next shift, take some time to educate your patients about the importance of getting their flu shot early. How about celebrating August by taking the WACEP national immunization awareness month challenge: try to educate one patient in each of the following age groups about the importance of vaccination in general:

Parents: Emphasize the important role vaccines play in protecting their child's health;
College students: Remind them to talk to their healthcare professional about any vaccines they may need for school entry;
Adults, especially older adults and adults with chronic conditions: When appropriate, encourage vaccines for shingles, pertussis, pneumococcus, and flu;
Pregnant women: Talk about getting vaccinated to protect newborns from diseases like pertussis and flu;
Everyone: Let Wisconsinites know that the next flu season is only a few months away.

Walker Appoints Seemeyer to Lead DHS

Wed, 10 Aug 2016 16:00:00 GMT

August 4, Wisconsin Health News

Gov. Scott Walker on Thursday appointed Linda Seemeyer to serve as secretary of the Department of Health Services. Seemeyer served as director of the Walworth County Department of Health and Human Services from 2007 to 2015. She was also director of the Milwaukee County Department of Administrative Services and deputy secretary of the Department of Administration under Gov. Tommy Thompson.

Seemeyer starts Aug. 22. She succeeds Kitty Rhoades who passed away in June. Interim Secretary Tom Engels will resume his duties as deputy secretary.

WHIO Names Dana Richardson CEO

Tue, 09 Aug 2016 19:00:00 GMT

August 3, Wisconsin Health Information Organization

The Wisconsin Health Information Organization (WHIO) has named Dana Richardson its new CEO. Richardson succeeds Josephine Musser who is retiring.

Richardson has been serving since April as Acting Executive Director of the non-profit PCPI® Foundation in Chicago. Previously, she served six years at the American Medical Association (AMA) as Director of Operations and Strategic Initiatives for the PCPI, which was originally convened by the AMA. From 2002-2010, Richardson was Vice President for Quality Initiatives at the Wisconsin Hospital Association (WHA).

With a BS in Nursing and an MA Business, Health Service Administration from the University of Wisconsin-Madison, and prior experience at St. Mary’s Hospital in Madison and the Dean Health System, Richardson has deep ties to Wisconsin’s health care system, as both a provider and administrator, beginning in 1983.

“Dana Richardson is a proven leader who thinks strategically and acts decisively, setting goals, solving problems and seeing tangible results,” said WHIO Board Chair Linda Syth. “Her background in quality and efficiency at the local and state level in Wisconsin, along with her work at the national level with physician societies and performance measurement, make her uniquely qualified to engage caregivers where their heart is – great patient care. We’re delighted to welcome Dana to WHIO,” Syth said.

WHIO provides health care information to consumers, clinicians, providers, employers and payers to support decision-making. “I am excited to be joining an organization focused on the quality, safety and affordability of health care. Knowing that Wisconsin is a high value state for health care services, my goal is to further leverage the WHIO information to set a higher bar,” said Richardson.

Richardson will assume her new post on August 30th and collaborate with outgoing CEO Jo Musser until the end of the year to ensure a smooth transition.

The Wisconsin Health Information Organization (WHIO) is a non-profit 501(c)(3) organization dedicated to improving the quality, affordability, safety and efficiency of health care in Wisconsin.

MEB Approves Opioid Prescribing Guidelines

Tue, 02 Aug 2016 16:34:03 GMT

The Wisconsin Medical Examining Board (MEB) approved best practice guidelines for opioid prescribing at its monthly meeting in Madison in July. This action is a result of Wisconsin State Assembly Rep. John Nygren’s HOPE legislative package; 2015 Act 269 granted the MEB authority to post the guidelines, which are inspired by those already in place from the Centers for Disease Control and Prevention and the state’s Worker’s Compensation program.

While the guidelines are not mandatory practice parameters, they are expected to assist physicians with making more informed decisions about their prescribing practices. Click here to view the guidelines.

The MEB also moved closer to finalizing new continuing medical education (CME) rules that will eventually require physicians to include coursework on the new guidelines as part of their 30 hours per biennium requirement. The likely outcome of this CME-related rule will be:

All physicians who have a Drug Enforcement Administration (DEA) number will be required to take two credits of CME in prescribing-related areas as part of their biennial 30-credit total.

This requirement will take effect for the next two complete CME reporting cycles (essentially for 2017-2019 and then again for 2019-2021).

The first time a physician satisfies that two-credit requirement, the CME will need to include information on the new opioid prescribing guidelines. (It is likely the Wisconsin Medical Society’s opioid prescribing webinar series, which is now available on-demand, will be grandfathered in as satisfying the guidelines-related subject matter requirement.)

The second time the physician satisfies the two-credit requirement, it can be in the arena of “responsible controlled substances prescribing.”

This requirement COULD end after two CME cycles—it will depend on the status of the opioid crisis and whether or not the MEB continues the requirement for future cycles.

The MEB is expected to finalize these requirements at its meeting later this month.

WACEP President's Message, July 2016

(Past member) — Sat, 30 Jul 2016 14:30:00 GMT

Bobby Redwood, M.D., M.P.H.
President, Wisconsin Chapter, American College of Emergency Physicians

Wisconsin ACEP is in the midst of a productive and exciting year. Here’s a recap of some of what the Chapter has been up to:

Vision—a Three-Prong Approach. WACEP will take stock of our resources and establish three concrete goals addressing this question: What can we do for our specialty, for our physicians, and for our patients? Member feedback is important as we craft strategic goals for 2017. Contact us!
Fair Payment: EM Medicaid reimbursement rates in Wisconsin are worst in the nation. We have developed a task force to explore legislative solutions to achieve fair payment.
WACEP Website: Keep an eye out for a newly designed Chapter website, which should go live by early fall.
WMS House of Delegates: WACEP now has three emergency physicians serving in the Wisconsin Medical Society’s House of Delegates. We hope to increase the influence of emergency medicine in the broader house of medicine in Wisconsin.
Wisconsin EM CME Conference: WACEP is currently exploring the logistics of hosting an annual Wisconsin Emergency Medicine CME conference.

Thank you for your service to emergent patients in Wisconsin and your involvement with Wisconsin ACEP. Remember to check the Wisconsin ACEP website for updates on legislative victories, educational opportunities, resident scholarships, and more!

Telemedicine Rules Set to Move from Subcommittee to Full Medical Examining Board

Tue, 26 Jul 2016 16:00:00 GMT

July 21, Wisconsin Health News

A subcommittee of the Medical Examining Board tasked with developing rules on telemedicine anticipates sending a final version to the board for approval later this fall.

The board first drafted the proposed rules last year but formed a subcommittee to rewrite them after hospitals and others raised concerns at a January public hearing. The new set of rules, modeled on those approved by the state of Florida, is less prescriptive than the original set.

Members of the subcommittee said Wednesday they plan to revise the proposal to reference physician assistants. The Wisconsin Academy of Physician Assistants called for the change.

According to the academy, physician assistants "are already experiencing difficulty being authorized to provide telemedicine by certain health systems."

Elli Health, a Wisconsin-based telehealth company, wrote that they had some concerns about Florida's rules. But after seeing the Wisconsin proposal, they said their concerns had been addressed.

Mark Grapentine, senior vice president of government relations at the Wisconsin Medical Society, praised the board's process.

"I really appreciate how you guys have done this and how you responded from the initial go-around, which was interesting to say the least," Grapentine told board members. "I think you've pivoted to an area that will be helpful for you and understandable for the folks out in the field."

Dr. Kenneth Simons, the board's chair, said they hope to have an additional public hearing on the rule later this fall before deciding to approve it.

Johnson Praises Removing Link between Medicare Payments and Pain Management Questions

Mon, 11 Jul 2016 17:07:49 GMT

July 6, Wisconsin Health News

Sen. Ron Johnson, R-Wis., lauded a proposal Wednesday from the Department of Health and Human Services to sever the connection between Medicare funding and pain management questions on a survey of consumers.

HHS plans to remove the link between Medicare funding and pain management questions on the Hospital Consumer Assessment of Healthcare Providers and Systems survey.

Hospitals would continue to use the same questions in the survey, but those questions wouldn't affect the level of payment they received, HHS announced Tuesday.

Johnson introduced legislation earlier this year that would have made the federal government unable to tie reimbursement to pain outcome measures.

"Removing questions from payment calculations that could lead to inappropriate pressure on doctors is a bipartisan, commonsense solution to tackling the enormous challenges we face in the ongoing opioid epidemic," Johnson said in a statement. He called the proposal "the responsible thing to do."

Dr. Timothy Westlake, vice-chair of the state's Medical Examining Board called Johnson's bill "the single most important piece of federal legislative reform" at an April congressional field hearing in Pewaukee.

U.S. Senate Committee on Health, Education, Labor and Pensions Chair Lamar Alexander, R- Tenn., called the HHS announcement a "big win for Senator Johnson, for the people of Wisconsin and for the country."

"These survey questions had the unintended consequence of actually encouraging the overprescribing of painkilling opioids," Alexander said in a statement. "I'm glad to see the administration correct this mistake by removing them from Medicare payment calculations."

HHS Secretary Sylvia Burwell said that they've heard from physicians that some have felt pressure to overprescribe opioids because of the questions.

"While we haven't found evidence to support this concern, out of an abundance of caution, we have proposed a rule to change that," Burwell said on a conference call with reporters.

HHS also released a request for information to seek provider, consumer and other public comments on current prescriber education and training programs on Tuesday.

Other federal agencies announced steps to combat the opioid and heroin epidemic as well. Indian Health Service will require its prescribers and pharmacists to check their state PDMP databases before prescribing any opioid for more than seven days.

The Department of Veterans Affairs will also require prescribers in most cases to check state PDMPs before prescribing a new controlled substance.

State Legislature Approves "Interstate Compact" Bill

(Past member) — Thu, 19 Nov 2015 23:00:00 GMT

November 19, Wisconsin Medical Society

As part of its extraordinary session day on Monday, the Wisconsin State Assembly approved an amendment made by the State Senate to Assembly Bill 253, legislation allowing Wisconsin to join the Interstate Medical Licensure Compact. By concurring with the Senate’s change, the bill now goes to Gov. Scott Walker for his final action. The Society anticipates the Governor will sign the bill into law in the next few weeks.

The Compact cuts administrative red tape for physicians who wish to apply for a medical license in multiple states by eliminating the need for each state to separately re-verify the same basic information about a physician applicant (education, liability history, etc.). This new option will be voluntary, with physicians maintaining the option to apply state-by-state if desired.

Contact Mark Grapentine, JD, in the Society’s Government and Legal Affairs Department with any questions. Visit the Society’s Lobbying Tracker for information on this and other bills the Society is following.