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  • July 19, 2017 12:12 PM | Sally Winkelman (Administrator)

    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.

  • July 19, 2017 12:11 PM | Sally Winkelman (Administrator)

    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.

  • July 14, 2017 10:23 AM | Sally Winkelman (Administrator)

    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.

  • July 12, 2017 10:42 AM | Sally Winkelman (Administrator)

    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.

  • July 10, 2017 10:55 AM | Sally Winkelman (Administrator)

    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.

  • June 29, 2017 12:02 PM | Sally Winkelman (Administrator)

    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.

  • 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.

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