Latest News 


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  • June 21, 2017 1:29 PM | Sally Winkelman (Administrator)

    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.

  • June 15, 2017 10:44 AM | Sally Winkelman (Administrator)

    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.

  • June 12, 2017 10:27 AM | Sally Winkelman (Administrator)

    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.

  • June 07, 2017 8:38 AM | Sally Winkelman (Administrator)

    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.

  • June 01, 2017 12:54 PM | Sally Winkelman (Administrator)

    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. 

    Register now.

  • May 30, 2017 12:49 PM | Sally Winkelman (Administrator)

    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.

  • May 10, 2017 11:32 AM | Sally Winkelman (Administrator)

    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.

  • May 10, 2017 11:27 AM | Sally Winkelman (Administrator)

    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. 
  • May 08, 2017 10:34 AM | Sally Winkelman (Administrator)

    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.

  • May 08, 2017 8:47 AM | Sally Winkelman (Administrator)

    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

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