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  • January 17, 2018 11:24 AM | Sally Winkelman (Administrator)

    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.

  • January 11, 2018 5:21 PM | Sally Winkelman (Administrator)

    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 10th.

  • January 04, 2018 12:19 PM | Sally Winkelman (Administrator)

    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 1st.

    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!

  • January 04, 2018 11:46 AM | Sally Winkelman (Administrator)

    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

  • January 02, 2018 4:33 PM | Sally Winkelman (Administrator)

    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

  • December 20, 2017 11:14 AM | Sally Winkelman (Administrator)

    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
  • December 20, 2017 11:12 AM | Sally Winkelman (Administrator)

    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? 

  • December 20, 2017 11:10 AM | Sally Winkelman (Administrator)

    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!
  • December 13, 2017 5:08 PM | Sally Winkelman (Administrator)

    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 1st 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 30th. 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 14th-15th 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/

  • December 12, 2017 5:21 PM | Sally Winkelman (Administrator)

    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.

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