Latest News 


  • February 03, 2017 9:00 AM | Sally Winkelman (Administrator)

    ACEP has launched its #ILookLikeAnERDoc Campaign on the organization's Facebook and Twitter channels to promote the importance diversity and inclusion. Learn and share why diversity matters to emergency physicians.

  • January 24, 2017 12:34 PM | Sally Winkelman (Administrator)

    Advocacy is the Cure for the Political Frustrations of 2016
    By Bobby Redwood, MD, WACEP President

    You don't need me to tell you; 2016 was kind of a rough year. We lost Bowie, Prince, and Princess Leia. Zika cast its shadow over our vacations, while authoritarian regimes thrived, the E.U. frayed, and democracy stumbled. The political tension in America and in Wisconsin reached a fever pitch throughout one of history's most negative presidential campaigns ever and then, on November 9th, republican and democratic physicians alike were left exhausted and confused, wondering what will happen to our patients and our profession under the Trump administration.

    Well, we at WACEP implore you: don't despair! Here are some of the (solvable) challenges that we, as emergency physicians, can expect in the upcoming year.

    • The Affordable Care Act will likely go away. Will it just be a name change (it was basically RomneyCare after all)? Will the individual mandate be undone leaving a glut of 234,000 uninsured patients in its wake? Will Medicaid really be transformed into a block grant system as many have foreseen? 
    • The opiate epidemic will continue to challenge our state and our state's physician workforce. Will the new ePDMP provide the accountability and real-time information that we were promised it would? Will the new medical examining board CME help get all providers on the same page in terms of best practices for opiate prescriptions? Will WACEP's opiate prescribing guidelines have the reach and influence that we are hoping they will have?
    • Mental health services will evolve...for the better? Suicide is at a 30-year high and fewer than half of the 800,000 Wisconsinites who need mental health treatment actually get professional help. A consensus bill, the Mental Health Reform Act of 2016 (S. 2680), passed the Senate HELP committee in March 2016 and will likely come to vote in the Senate this year. If passed, will it deliver the community crisis response systems and increased access to acute psychiatric hospital care that were anticipated? Will the Wisconsin psychiatric bed database come to fruition? Will psychiatric transfers from Wisconsin EDs become easier to facilitate?

    Engagement is the way forward. Emergency physicians are problem solvers, and whether your motivated by compassion for your patients, consideration for your physician-group, or simple self-preservation; we at WACEP need you to step forward and engage with your colleagues, so that we can solidify our message, amplify our voice, and help solve the challenges ahead together. Need a roadmap for getting engaged in emergency medicine advocacy? Here are the next steps:

    1. Register for the March 28th WACEP Spring Symposium. Get the 4-1-1 on emergency medicine advocacy from national ACEP president Rebecca Parker. REGISTER HERE.
    2. Sign up for the March 29th Doctor Day event at the Capitol. Feel the comradery of your profession as hundreds of physicians swarm the state capitol. REGISTER HERE.
    3. Attend the March WACEP listening tour in Merrill, WI. Let us know how WACEP can better serve your needs. REGISTER HERE.
    4. Donate to the WACEP PAC. Since its inception, the WACEP PAC has given emergency physicians unprecedented access to state lawmakers. As our PAC grows, so does our collective voice. DONATE HERE.
    5. Reach out to your legislators. There is no better cure for political frustration than connecting directly with your lawmakers and making your voice heard.

    There is no doubt that the healthcare landscape will be changing in 2017 and we have the power to shape the future of our practices and our specialty. By showing up, by putting our money where our mouth is, by connecting with our peers and our political leaders; emergency physicians can use the same strength and tenacity that we exude in our clinical work to shape the future of emergency medicine in Wisconsin.  

    Thank you to each and every emergency physician in Wisconsin for your dedication to your patients, colleagues, and profession. Whether you are excited about the Trump shake-up or sense a bad moon rising, now, more than ever, we need physician engagement in local and national advocacy.

  • January 23, 2017 10:50 AM | Sally Winkelman (Administrator)

    The Wisconsin Department of Safety and Professional Services (DSPS) launched the new Wisconsin Enhanced Prescription Drug Monitoring Program (ePDMP) on January 17, replacing the former program.

    2015 Act 266 requires physicians and other prescribers to review patient information from the ePDMP before issuing a prescription for any controlled substance beginning April 1, 2017. (More information, including exceptions to the requirement to consult the PDMP, in this nonpartisan Legislative Council memo.)

    Be ready with the following information in order to register for the ePDMP, and note that prior login credentials no longer work.

    • Last name.
    • Last four digits of your social security number.
    • License number.
    • License type (profession).
    • Specialty or primary area of practice.
    • DEA number.

     The ePDMP supports current browsers and two previous versions, except it only supports the current and previous version of Internet Explorer. If you experience issues, DSPS suggests that you update your browser.

    Once the registration process is complete, users can begin looking up patients and managing delegates. The multistate search function will be available to both prescribers and their delegates as soon as their accounts are established. Training materials, including brief tutorial videos and information about creating and maintaining delegates are available at pdmp.wi.gov.

    If you have questions or experience problems with the registration process, contact pdmp@wisconsin.gov.

  • January 11, 2017 2:34 PM | Sally Winkelman (Administrator)

    The Assembly Committee on Health and the Senate Committee on Health and Human Services for the 2017-18 Session have been set. Committee membership is as follows:

    Assembly Committee on Health

    • Representative Joe Sanfelippo, R- New Berlin (Chair)
    • Representative Kathy Bernier, R – Chippewa Falls (Vice-Chair)
    • Representative James Edming, R – Glen Flora
    • Representative Ken Skowronski, R - Franklin
    • Representative Jesse Kremer, R - Kewaskum
    • Representative Chuck Wichgers, R - Muskego
    • Representative Dave Murphy, R - Greenville
    • Representative Andre Jacque, R – De Pere
    • Representative Deb Kolste, D Janesville
    • Representative JoCasta Zamarripa, D – Milwaukee
    • Representative Lisa Subeck, D - Madison
    • Representative Chris Taylor, D - Madison

    Senate Committee on Health and Human Services

    • Senator Leah Vukmir, R – Brookfield (Chair)
    • Senator Terry Moulton, R – Chippewa Falls (Vice-Chair)
    • Senator Devin LeMahieu, R - Oostburg
    • Senator Jon Erpenbach, D - Middleton
    • Senator LaTonya Johnson, D - Milwaukee
  • January 11, 2017 2:26 PM | Sally Winkelman (Administrator)

    January 6, Wisconsin Health  News

    Gov Scott Walker called for a special session of the Legislature Thursday to consider 11 bills that aim to combat the heroin and opioid epidemic. 

    The bills are based on recommendations from a task force that Walker convened last year, chaired by Lt. Gov. Rebecca Kleefisch and Rep. John Nygren, R-Marinette. 

    The task force released an interim report Thursday. Even though it hasn't finished its work, the opioid and heroin epidemic are "such a crisis to deal with, we need to start acting now," Walker said.

    "We need to tackle this issue head on," Walker told attendees of a Wisconsin Bankers Association event in Madison Thursday. "Not because it's a quality of life, not because it's a public health issue, but because it's a key part of our workforce."

    Among the proposals the Legislature will consider are bills that would in the 2017-'19 biennium provide $2 million to support new medically assisted treatment centers, $1 million for consultation services helping medical professionals connect with addiction medicine specialists and $126,000 to the rural hospital graduate training program.

    Another bill would provide money to the Department of Justice to fund criminal investigation agents focused on drug trafficking. And another would expand the Screening, Brief Intervention and Referral to Treatment training program offered by the Department of Public Instruction.

    "All of us know someone personally affected by a heroin overdose or drug death," Kleefisch said in a statement. "Together, we're going to continue this initiative as we look for new ideas and evaluate the impact of the policies we've adopted the past several years."

    An additional proposal would allow school personnel that can administer life-saving drugs like EpiPens to use the anti-overdose drug Naloxone. And two more would require schedule V substances that contain codeine like some cough syrups by dispensed with a prescription and extend limited immunity from prosecution to overdose victims.

    Other bills include permitting the University of Wisconsin System to open a recovery school for students who need in-patient care and allowing relatives to commit a drug-addicted family member in the same way as is currently allowed for alcoholism.

    Walker's order doesn't include all the recommendations made in the report, such as providing $2 million over the next biennium for Wisconsin hospitals to hire in-house recovery coaches. His spokesman said the bills are in the final stages of draft form and will be released when introduced.

    Another order signed by Walker Thursday directs state agencies to pursue a number of different initiatives to curb opioid abuse, including having the Office of the Commissioner of Insurance conduct a survey of opioid addiction treatment coverage for major insurers in Wisconsin. 

    "The recommendations included in this report are not the silver bullet," said Nygren, who's authored 17 laws fighting drug abuse though his Heroin, Opioid Prevention and Education Agenda. "I look forward to continuing the fight."  

    Wisconsin Hospital Association CEO Eric Borgerding noted that the interim report includes recommendations they suggested, like providing investments in fellowship training for addiction medicine and streamlining regulations for healthcare providers that are trying to expand access to substance abuse treatment.

    Wisconsin Medical Society Chief Medical Officer Dr. Donn Dexter called the package of bills "ambitious, which is exactly what dealing with this crisis demands." The Pharmacy Society of Wisconsin said the proposals aim to increase access to treatments and prevent new addictions.

    "We're especially excited about the investments to increase the number of providers available and in telemedicine," Bernie Sherry, senior vice president and Ministry market executive for Ascension Wisconsin, said in a statement. "This is a good day for Wisconsin." 

    Myranda Tanck, a spokeswoman for Senate Majority Leader Scott Fitzgerald, R-Juneau, said they'll likely maintain their current session calendar for when the full body meets. 

    Kit Beyer, a spokeswoman for Assembly Speaker Robin Vos, R-Rochester, said they hope to have the bills ready for committee hearings by the end of the month.

    Assembly Democratic Leader Peter Barca, D-Kenosha, said the urgency of the special session is warranted.  

    "The opioid epidemic in our state is a very serious issue that requires a very aggressive response," Barca said in a statement. "I hope the committees will collect input from those who know this issue firsthand -from law enforcement, to educators, to medical professionals - as this will help us address this crisis in the most comprehensive manner possible."

    Walker also signed an order directing the Department of Health Services to apply for funding available through the 21st Century Cures Act, which was approved by the federal government last year. The act makes $7.6 million per year available for two years to Wisconsin. His order directs the department to apply for the grants by Feb. 17.   

    Sen. Tammy Baldwin, D-Wis, said she helped lead the effort in Congress to include $1 billion in the act for the opioid epidemic. 

    "The opioid epidemic is not a partisan issue, and a strong partnership between the federal government and our state is essential to an effective response," she said in a statement. "This is a significant step forward for communities fighting the opioid epidemic across Wisconsin."

  • January 11, 2017 2:22 PM | Sally Winkelman (Administrator)

    The Wisconsin Department of Safety and Professional Services (DSPS) plans to launch the new Wisconsin Enhanced Prescription Drug Monitoring Program (ePDMP) on Tuesday, Jan. 17.

    2015 Act 266 requires physicians and other prescribers to check patient information from the ePDMP before issuing a prescription for any controlled substance beginning April 1, 2017. (More information, including exceptions to the requirement to consult the PDMP, in this nonpartisan Legislative Council memo).

    All prescribers will have to register to use the ePDMP—even if they are registered with and use the current system, which is being replaced and will not be available after Jan. 17.

    The new ePDMP is designed to promote streamlined workflow integrations and improved data quality using analytics and visualizations to draw user’s attention to the most relevant and possibly concerning data in each report.

    Questions about the ePDMP can be directed to pdmp@wisconsin.gov.

  • January 11, 2017 2:19 PM | Sally Winkelman (Administrator)

    More than 50 leaders from health care organizations and systems statewide participated in a Health Care Reform Summit hosted by the Wisconsin Medical Society on Dec. 16. The summit provided stakeholders the opportunity to learn about and discuss pending changes to the Affordable Care Act (ACA) and featured several speakers including Tommy Thompson, former Wisconsin governor and Health and Human Services secretary; Wisconsin Medicaid Director Michael Heifetz; Richard Deem, senior vice president of advocacy for the American Medical Association; and Wisconsin Deputy Commissioner of Insurance J.P. Wieske.

    The speakers addressed a number of topics including the likelihood of repeal and replacement of the ACA, the role Medicaid will play in health care reform and the possibility of a transition from an entitlement program to one financed by block and/or per capita grants, and an overview of the health insurance market in Wisconsin.

    The Summit also featured a review of various health care reform proposals, including the following:

    • A Better Way Health Plan—Speaker Paul Ryan
    • Empowering Patients First Act—Rep. Tom Price, MD, Health and Human Services Secretary nominee
    • Patient CARE Act—Sen. Orrin Hatch, Sen. Richard Burr and Rep. Fred Upton
    • Improving Health and Health Care Plan—American Enterprise Institute
    • Universal Tax Credit Plan—Avik Roy
    • Healthy Indiana Plan 2.0—Indiana Family Social Services Administration (Medicaid reform only)

    Following the presentations, Summit attendees identified several key areas to focus reform efforts that include ensuring those who are currently covered do not lose insurance, maintaining access to affordable and adequate coverage for low-to-moderate income populations, maintaining adequate Medicaid funding, and evaluating opportunities to reduce regulatory burdens.

    A subgroup of Summit participants will continue to meet as a steering committee to help direct future advocacy efforts.

    For more information, e-mail Chris Rasch, Society vice president of Advocacy and Membership.
  • January 11, 2017 2:07 PM | Sally Winkelman (Administrator)

    January 5, Wisconsin Health News 

    The number of Wisconsin residents in accredited rural-focused residency programs jumped 10 percent from the previous year, according to a December report from the Wisconsin Rural Physician Residency Assistance Program. 

    There were a total of 87 residents in the programs as of the end of November. That's up from 79 the previous year. 

    Between Dec. 1, 2015 and Nov. 30, 2016, WRPRAP awarded seven grants, totaling $528,866. 

    Some programs supported by WRPRAP are looking to bring in their first residents this year. The Aurora Lakeland Rural Training Track Family Medicine Program, which hopes to have 12 residents by July 2020, is recruiting its first four residents. 

    And the UW Obstetrics & Gynecology Residency Program, the nation's first rural track in the specialty, will match its first resident this year after about 100 applicants competed for the position.  

    "We are confident that WRPRAP's funding will continue to champion long-term, viable solutions that address the shortage of physicians in rural Wisconsin communities," the report noted.  

    Read more.

  • January 06, 2017 4:36 PM | Sally Winkelman (Administrator)

    When Ascension formally acquired Wheaton Franciscan Healthcare in 2016, it gave the nation's largest nonprofit health system a firm foothold in the state. Ascension Wisconsin, which also includes Ministry Health Care and Columbia St.  Mary's Health System, now boasts 24 hospitals and more than 100 clinics.  

    In August, Ascension tapped Columbia St. Mary's CEO Travis Andersen to head its south region and Wheaton executive Debra Standridge to oversee the northern part of the state. At a Wisconsin Health News Newsmaker event on Feb. 7 in Milwaukee, Andersen and Standridge will take part in a wide-ranging discussion on the system's future in the state. Panelists include: 

    • Travis Anderson, south region president, Ascension Wisconsin 
    • Debra Standridge, north region president, Ascension Wisconsin  

    This luncheon event will be held at the Wisconsin Club, 900 West Wisconsin Avenue, Milwaukee, 53233. Register now.

  • December 19, 2016 11:31 AM | Sally Winkelman (Administrator)

    By Bobby Redwood, MD, MPH, WACEP President, and Lisa Maurer, MD, WACEP Secretary/Treasurer

    Across the country, innovative health systems are embarking on a grand experiment and exploring "Alternative Payment Models" (APMs). There are a variety of flavors of APM, but the most commonly mentioned are the Coordinated Care Model and the Patient Centered Medical Home, both of with aim to improve the quality and perhaps efficiency of primary care delivery and thus cut costs on those pesky, wasteful, expensive ED visits*. My question is this: How will APMs affect ED workflows and will EDs be appropriately compensated for their support and contribution to a successful APM?

    To be fair, the theory behind the APMs is quite promising. Weinick et al. found that roughly 14–27% of all ED visits could be treated in clinics and urgent-care centers at a lower cost; a potential savings of $4.4 billion per year. By reorganizing primary care, the APMs will hopefully create a new style of health care delivery where continuity, expanded access, coordination, and a team-based approach are used to help patients avoid exacerbations of chronic conditions, treat chronic pain and psychiatric complaints proactively in the home-setting, and gain access to their primary care team for urgent health care needs. If successful, APMs will cut down on ED visits for complaints like chronic pain, depression, medication refills, work excuses, migraine headaches, asthma/COPD/CHF exacerbations, missed dialysis, etc. Who among us would not breathe a sigh of relief to come to work and spend more time treating life-threats and less time plugging holes in the social safety net? 

    The evidence supporting APMs continues to grow with over 500 peer reviewed articles on the topic and a generally strong review by the Agency for Healthcare Research and Quality. The main concern that many emergency physicians have with APMs is not the concept itself, but rather the notion that the ED is somehow separate from the Coordinated Care Model or the Patient Centered Medical Home. When I look at policy-makers' flow diagrams for a Coordinated Care Model or read about a Patient Centered Medical Home in the literature, the care coordination seems to magically occur with no emergency department involvement whatsoever. This may sometimes be the case; however, in speaking with my emergency physician colleagues, the consensus is that the ED actually plays an integral role in the success of the APMs. The reality of the situation is that APMs that truly coordinate care work with ED providers to maximize value of any ED visits that do happen, or even work with ED providers in an abbreviated fashion to streamline care and avoid a full ED visit.

    Let's walk through a few examples: 

    • An after-hours medication refill visit is avoided by a primary care physician calling the emergency physician and asking her to write an InstyMeds prescription that the patient can pick up in the ED lobby without having to actually check in. 10 minutes of emergency physician time spent.
    • A patient with CHF presents with a typical exacerbation. After initial evaluation and diuresis, the emergency physician is able to coordinate with the patient’s cardiologist regarding optimizing his medical regimen.  After reviewing the plan with the emergency physician, an emergency coordinator is able to make an urgent follow up appointment with the cardiologist, arrange transportation, and set up a home nurse visit for the next day.  The physician has an extended conversation with the patient regarding disposition options, and ultimately hospitalization is avoided.  20 minutes of emergency physician time spent coordinating care.  30 minutes of care coordinator time spent. 
    • An asthmatic patient is having a routine asthma exacerbation due to his nebulizer malfunctioning. As part of a community paramedicine program whose medical director is a hospital-based emergency physician, the patient is evaluated by paramedics. They troubleshoot and repair his nebulizer, and then call the emergency physician to confirm a no-transport. The emergency physician calls the primary care physician to keep him in the loop and coordinate prompt follow-up. 10 minutes of emergency physician time spent. 60 minutes of paramedic time spent.
    • The extended family of a dementia patient is home for the holidays and, noting grandpa's gradual physical and mental decline, decide that it is time for him to go to a nursing home. They incorrectly present to the ED, but the ED care coordinator is able to avoid a full evaluation by hosting a conference call with his primary care physician and a social worker to facilitate placement. 60 minutes of emergency coordinator and ED conference room time spent. 

    For a real life example, let's look to the literature. Murphy et al. found that a $554 investment per enrollee saved the health system $6091 per extreme ED user and $1285 per frequent ED user, a net savings of $710,474. These results are striking, but they required the ED to invest in a 0.25 full-time equivalent (FTE) medical director for the coordination program, a 1.0 FTE case coordinator, and a 1.0 FTE administrative assistant (hence the $554 per enrollee investment cost). Ultimately, the costs associated with frequent and improper ED use are incurred not only by the patients themselves, but also by other patients, hospitals, emergency physicians, third-party payers, and society in general. Reducing the costs of ED overuse is clearly going to take a team effort and compensation plans for these efforts should not overlook the time, expertise, and facility expenses incurred by the nation's EDs. 

    We at Wisconsin ACEP would like to know more about how this issue is impacting our emergency physicians and EDs. 

    • Is your health system participating in an APM, how is emergency care coordination being compensated?
    • Are you an ED director, what are some of the coordination costs that are not always obvious to CMS or third party payers?
    • Do you participate in any healthcare payment reform workgroups or advisory panels, are the ED costs of care coordination being acknowledged in policy making circles?

    Email WACEP@badgerbay.co with your questions and comments. If you'd like to learn more, check out this article on Cost-effective ED Care Coordination by our colleagues at Washington ACEP!

    *Emergency physicians will immediately recognize the irony here, emergency care represents less than 2 percent of the nation's $2.4 trillion in health care expenditures while covering 136 million people a year and the focus on preventing so-called “non-urgent” emergency department visits distracts policymakers from the real cost savings in reducing hospital admissions and investing in preventive measures.
    Sources:
    Report: Accounting for the cost of US health care: A new look at why Americans spend more, McKinsey Global Institute, December 2008
    Agency for Healthcare Research and Quality. Emergency Room Services-Mean and Median Expenses per Person With Expense and Distribution of Expenses by Source of Payment: United States, 2006. Medical Expenditure Panel Survey Household Component Data. (March 04, 2013)