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  • May 15, 2018 10:05 AM | Sally Winkelman (Administrator)

    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!

  • May 15, 2018 7:59 AM | Sally Winkelman (Administrator)

    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!

  • May 03, 2018 11:04 AM | Sally Winkelman (Administrator)

    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.

  • May 03, 2018 11:00 AM | Sally Winkelman (Administrator)

    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) 
    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 More information on PCSS, click here
  • May 03, 2018 10:57 AM | Sally Winkelman (Administrator)

    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) 
    REGISTER TODAY!
  • May 03, 2018 10:54 AM | Sally Winkelman (Administrator)

    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.

  • May 02, 2018 2:40 PM | Sally Winkelman (Administrator)

    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.

  • May 02, 2018 1:28 PM | Sally Winkelman (Administrator)

    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 1st, 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

  • May 01, 2018 9:07 AM | Sally Winkelman (Administrator)

    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 

  • May 01, 2018 8:49 AM | Sally Winkelman (Administrator)

    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. 

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