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  • December 30, 2019 4:31 PM | Sally Winkelman (Administrator)

    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 1st and the selected award recipient will be recognized during the WACEP Annual Spring Symposium.

  • December 30, 2019 2:50 PM | Sally Winkelman (Administrator)

    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 31st 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. 

  • December 18, 2019 4:54 PM | Sally Winkelman (Administrator)

    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 

  • December 16, 2019 9:03 AM | Sally Winkelman (Administrator)

    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. 

  • December 11, 2019 7:56 AM | Sally Winkelman (Administrator)

    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.   

  • December 02, 2019 6:29 PM | Sally Winkelman (Administrator)

    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.

  • December 02, 2019 6:23 PM | Sally Winkelman (Administrator)

    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 31st.   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 7th 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 27th.   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 5th 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). 

  • December 02, 2019 6:10 PM | Sally Winkelman (Administrator)

    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.

  • December 02, 2019 5:50 PM | Sally Winkelman (Administrator)

    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

  • November 20, 2019 3:30 PM | Sally Winkelman (Administrator)

    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.

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