Latest News 


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

    Policy statements on Alcohol Advertising and Trauma Care Systems were recently revised and approved by the ACEP Board of Directors. Furthermore, four information papers and once resource paper were recently created by ACEP committees: 

    • Disparities in Emergency Care – Public Health and Injury Prevention Committee
    • Empiric and Descriptive Analysis of ACEP Charges of Ethical Violations and Other Misconduct – Ethics Committee
    • Fostering Diversity in Emergency Medicine through Mentorship, Sponsorship, and Coaching – Academic Affairs Committee
    • The Single Accreditation System – Academic Affairs Committee 
    • Resource: Opioid Counseling in the Emergency Department – Emergency Medicine Practice Committee

    These resources will be available on the new ACEP website when it launches later this month. In the meantime, for a copy of any of the above, please contact Julie Wassom, ACEP's Policy and Practice Coordinator.

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

    Lisa Maurer, MD, FACEP, President of the Wisconsin Chapter, ACEP, is the 2018 recipient of the National ACEP Council Horizon Award. 

    This award is presented to an individual within the first five years of Council service who demonstrates outstanding contributions and participation in Council activities. Past award winners include Gary Katz, Nathaniel Schlicher, and Alison Haddock.

    Lisa's nomination stood out because her Council leadership, like her Chapter leadership, is exemplified by focus, hard work, and an ability to motivate others.

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

    Anthem Blue Cross Blue Shield has announced it will not pay for emergency visits in six states—Indiana, Georgia, Kentucky, Missouri, New Hampshire and Ohio—if the company decides after the fact that patients were not having medical emergencies, even if they thought they were!  But how do you know?  Do you know the difference between a migraine and a brain aneurysm? 

    Unless stopped, this policy will be implemented in more states where Anthem "provides coverage," and it is likely more health insurance companies will follow with similar unlawful policies of their own. 

    On May 1st, ACEP launched a video campaign to continue exposing Anthem for denying coverage to emergency patients. View and share the videos, linked below, and visit www.FairCoverage.org for important information on how to put an end to Anthem’s unlawful policy.

    Video: Aneurysm or stomach cramps?
    https://www.youtube.com/watch?v=GB28DDFnDFk

    Video: Chest pain or injured ribs?
    https://www.youtube.com/watch?v=zqyHWOSI340

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

    New data from the Centers for Disease Control and Prevention (CDC) show that 136.9 million people visited the emergency department in 2015 and only 5.5 percent of these visits were considered “nonurgent,” according to the latest CDC National Hospital Ambulatory Medical Care (NHAMC) survey. 

    “Emergency care is a unique success story,” said Paul Kivela, MD, MBA, FACEP, president of ACEP. “No other medical specialty is the safety net for millions of patients with such a broad range of symptoms and conditions. The nation’s emergency physicians care for any patient, any time, regardless of ability to pay — and we play an increasingly integral role in our health system.”

    Wait times continued to improve, according to the report. Typically, about 35 percent of patients waited less than 15 minutes to see a provider and 68 percent were seen in less than one hour. The median wait time to see a physician or advanced practice provider is 18 minutes, and the median time spent in the emergency department was around 180 minutes, which includes time with the physician and other members of the care team and other clinical services.

    Injuries, stomach pain and chest pain top the list of conditions bringing patients to the emergency department. Various injuries accounted for about 28 percent of visits. Illness accounted for about 65 percent of visits, and mental health related conditions or other reasons made up the remaining 7 percent or so.

    Leading Reasons for Emergency Department Visits

    Symptom

    Number of Visits

    % Total Visits

    Stomach and abdominal pain, cramps and spasms

    12 million

    8.8%

    Chest pain and related symptoms

    7.2 million

    5.3%

    Fever

    5.9 million

    4.4%

    Cough

    4.5 million

    3.4%

    Headache

    3.8 million

    2.8% 


    The leading causes of injury were falls (10.6 million visits, 25 percent of injuries) and motor vehicle crashes (4 million visits, 9.6 percent of injuries).

    Among the highest users of emergency care, 15.6 percent of patients are senior citizens (age 65 or older) and 19.8 percent are pediatric patients (under age 15). 

    “Patients are living longer, managing more complex and chronic conditions and for many reasons may not always receive regular primary care,” said Dr. Kivela. “This means the emergency department is now more than ever the ‘front door’ to the hospital – our care and reimbursement models must continue to evolve to reflect this reality.”

    Nearly two in five (38 percent) of the 2.2 million emergency visits by seniors residing in nursing homes resulted in hospital admissions with an average length of stay reaching 5.5 days. And, a full two-thirds (67 percent) of hospital inpatients were processed through the emergency department, according to the Emergency Department Benchmarking Alliance, another source of performance data.

    Among patients presenting with chronic disease, the most frequent conditions reported were hypertension (23.6 percent), diabetes (10.9 percent), asthma (9.8 percent), substance/alcohol abuse (9.4 percent), depression (9.3 percent), and coronary artery disease (6 percent). Patients with a primary diagnosis of a mental disorder visited the emergency department 5.7 million times. Slightly less than half of those patients were seen by mental health providers while in the emergency department. 

    For the second year, Medicaid and CHIP (Children’s Health Insurance Program) were the largest payment sources (34.8 percent).  Private insurance covered 34.3 percent of visits, followed by Medicare (17.7 percent) and the uninsured (9.8 percent).

    Some insurance companies continue to deny coverage for emergency visits that they do not deem to be emergencies, putting patients in the risky position of self-diagnosing, potentially delaying or avoiding necessary care.

    “Your insurance company is legally required to cover your emergency visit based on your symptoms, not the final diagnosis,” said Dr. Kivela. “Insurance that abandons you in an emergency is no insurance at all. With nearly 90 percent of urgent and nonurgent symptoms overlapping, insurers should not leave patients to figure out themselves if their symptoms are truly life-threatening.”

    The report also found that patients were transported to the emergency department by ambulance 23 million times in 2015. And, almost 60 percent of emergency care is delivered outside of traditional business hours (8am-5pm).

    The CDC National Hospital Ambulatory Medical Care (NHAMC) survey is based on 21,061 emergency patient reports from 267 emergency departments. The data does not include freestanding emergency centers.

    Summary tables are available here: https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf 

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

    Mental Health America of Wisconsin has released "The Essentials of Suicide Prevention in the Emergency Department." This document includes links to resources, including the five core suicide prevention interventions for the ED. 

  • May 01, 2018 7:24 AM | Sally Winkelman (Administrator)

    Brittaney Khong, a medical student at the University of Wisconsin, Madison, received Honorable Mention in the ACEP 2018 National Outstanding Medical Student Award Program. 

    Four medical student awardees and two honorable mentions were selected from numerous submissions from across the country. The program recognizes medicals students who demonstrate humanism, professionalism, and clinical judgment; scholarly achievement; leadership and service to medical organizations with a focus on service and advocacy; community service; research and publications. 

    Khong's nomination was submitted with the following testimonials:

    “ On shift, we consistently saw BK exemplify the behaviour and attitude of a provider who carries herself with true compassion and empathy."

    "...when it came time for faculty to consider a student to nominate for this award, Brittaney Khong was the standout choice. She truly embodies the definition of this award, as she has demonstrated clinical excellence, dedication to patient care as a service opportunity, devotion to community service, and leadership experience.”

    Khong will receive a certificate of achievement as well as an invitation to the ACEP Academic Affairs Committee meeting and mentions in ACEP Now and on the ACEP website.

  • April 19, 2018 8:10 PM | Sally Winkelman (Administrator)

    WMS Medigram, April 19

    The Wisconsin Supreme Court heard arguments this morning in Mayo v. Wisconsin Injured Patients and Families Compensation Fund, a case involving a constitutional challenge to Wisconsin’s $750,000 cap on noneconomic damages in medical liability cases (Cap). The case could have far-reaching effects on Wisconsin’s well-balanced, relatively stable medical liability environment.

    On July 5, 2017 the Wisconsin Court of Appeals struck down the Cap, concluding that it violates the equal protection rights of plaintiffs in medical liability cases. The Wisconsin Supreme Court subsequently agreed to review the lower appellate court’s decision. On Jan. 18, 2018 the Society, along with the AMA Litigation Center, filed an amicus brief in support of the Cap, explaining its value to patients and the health care community alike. For more background on the Mayo case, see this article from the Oct. 9, 2014 Medigram.

    Today’s arguments provided the Court’s seven members with the opportunity to ask questions, follow up on points raised in briefs, including the Society’s amicus brief, and give an indication of their thinking.

    “It’s clear from the questions raised today that the Court understands the lengths the legislature went to create a well-balanced, comprehensive medical liability system that provides unique protections for Wisconsin patients and why the cap is essential to that system,” said Society General Counsel John Rather, JD. “We are encouraged with what we heard today and are hopeful the Court will restore the cap.”

    The Court spent a considerable portion of the arguments exploring the relationship of the Cap to controlling health care liability and overall health care costs, attracting and retaining physicians and protecting the viability of the Fund.

    A decision by the Supreme Court is expected by mid-summer. For more information, contact John Rather, JD. For an in-depth examination of the Mayo case and its implications for Wisconsin health care, listen to Episode 3 of WisMed OnCall, “The Mayo Case and Its Potential Impact,” available here.

  • April 18, 2018 12:41 PM | Sally Winkelman (Administrator)

    Lisa Maurer, MD, FACEP

    Wisconsin is unique.  We use the word "bubbler."  We drink our Old Fashioneds with brandy.  And our process for Emergency Detention psychiatric holds is unlike most you’ll find in most of the rest of the country.  Yeah us!

    A big headline you need to know about is the recent passage of new WI law that changes the liability environment around ED holds for physicians.  We’ve enlisted help from an attorney to interpret this new law from the viewpoint of an emergency physician, so be sure to read his summary memo and FAQs.  This new law clarifies that if you have concern that a patient should be on an ED hold and notify the proper authorities, you are not responsible for involuntarily treating the patient or preventing them from leaving the hospital if the patient is not placed on hold.  What’s more, you are not liable for any harm done by the patient to him/herself or others thereafter. 

    One question that came up during our most recent WACEP board meeting was, "does this new statute mean that if we do not reach out to county officials for an ED hold that we are at increased liability risk for future harm done?"  Our legal counsel says "no."  As always, be sure to document your reasoning for why information available to you at the time of evaluation leads you to conclude there is not a substantial probability of harm.  

    Lastly, we asked for clarification of the language in this bill which protects physicians from liability in releasing personal health information (PHI) to third parties in good faith due to lessen a threat of future harm.  For example, a physician would be protected from liability if he/she shared information to a third party about a patient is homicidal toward a particular individual.  The question was whether this interpretation could be extended to cover liability for releasing PHI to friends or family members of a patient who accidentally overdoses on opioids, with the thinking that informing third parties may reduce risk of future self-harm by the patient. Legal counsel states there is a potential safe harbor in this law for doing so, but interpretation really hinges on whether you conclude that an accidental overdose translates to true risk of self-harm.  Since the risk of self-harm is your judgement to make as a physician, use this information to help protect you if you believe a patient is at clear risk for future self-harm; be sure to properly document that risk to be in compliance with federal, and now state HIPAA law. 

    Also, here at WACEP, improving the process for caring for our patients in psychiatric crisis is one of our top priority goals.  I’m so excited to let you know that we are actively working with the Wisconsin Psychiatric Association on removing barriers to shortening the length of stay for our patients in the ED on Chapter 51 holds.  We’re even discussing if there could be a statewide common-sense standard for “medical clearance” before psychiatric admissions, based on physician assessment of medical risk rather than predetermined cookbook protocols.  The sub-committee of physicians from both organizations working on this topic is looking to change your practice for the better, so please let us know if you have input.

  • April 18, 2018 12:24 PM | Sally Winkelman (Administrator)

    WACEP members are invited to participate and help out at the upcoming mock Oral Boards events at both MCW and UW! If you are interested, please reach out directly as indicated below.

    Medical College of Wisconsin - Mock Oral Boards Day at MCW is Thursday, May 31st from approximately 7:30 am to 12:00 pm. Volunteers are needed for a minimum two-hour time slot, or for the full session. Any help from WACEP members is appreciated. Sign up to volunteer by contacting Jamie Aranda, MD at jaranda@mcw.edu

    University of Wisconsin – Oral Boards Day for residents at UW is Thursday, June 7th from 8:00 to 11:00 am. Cases will be prepared ahead of time, and faculty will be responsible for administering the cases to residents and providing feedback on their performance. Four or five volunteers are being sought from outside UW’s EM department. If interested, please contact Aaron Kraut, MD at askraut@medicine.wisc.edu.

  • April 18, 2018 11:11 AM | Sally Winkelman (Administrator)

    Eric Jensen, WACEP Lobbyist  

    Mayo v. WIPFCF, et al.: The Mayo case will be argued before the Wisconsin Supreme Court on Thursday, April 19th.  Before the Court is an Appeals Court decision rendering Wisconsin’s cap on non-economic damages in medical liability cases unconstitutional.  At present, pending the Court’s decision (not expected until sometime this summer), there is effectively no cap on non-economic damages.  WACEP led a coalition of eight medical specialty organizations in writing and submitting an Amicus (“friend of the court”) brief in defense of the caps.

    AB 538 Signed into Law: Governor Walker signed Assembly Bill 538 (now 2017 Act 140) providing emergency physicians additional liability protections in cases involving involuntary commitments.  Quoting from a memo written by WACEP counsel, Guy DuBeau:

    "The Act accomplishes three major goals toward this end. Specifically, the Act clarifies that providers acting in good faith can seek, without fear of liability, emergency detention even though the process must be formally initiated by law enforcement or county crisis workers. The Act also provides greater control over transfers in that it requires emergency providers to agree that transfer is medically appropriate before the transfer can be made by law enforcement. Lastly, the Act explicitly aligns Wisconsin law with HIPAA by noting that providers may disclose information to third parties in good faith effort to prevent or lessen as serious and imminent threat to third parties."

    Medicaid Reimbursement for Emergency Physician Services: Known all too well to you, Wisconsin lags the nation in terms of Medicaid reimbursement for physician services, ranking a shocking 50th for its rate paid for Level 2, 3 and 4 trauma services; it’s a remarkable situation given Wisconsin’s consistently high overall healthcare rankings.  In early April, WACEP President, Lisa Maurer, MD and WACEP’s government affairs consultant met with new Medicaid Director, Heather Smith, in our continuing effort to educate policy-makers about the situation and its consequences for emergency care in Wisconsin, and ultimately to increase reimbursements to a level that is at least competitive with our border states. 

    Earlier this year, WACEP succeeded in convincing the Legislature’s Joint Finance Committee, and ultimately the full Legislature, to insert a provision into the State Budget bill directing the Department of Health Services (DHS) to convene a working group including WACEP members to discuss ideas for saving money in Medicaid emergency room services to be used to increase reimbursements without increasing overall taxpayer dollars committed.  At the request of the prior Medicaid Director, Governor Walker ultimately vetoed the provision citing overlapping existing efforts within DHS; but the issue is now on the radar screens of policy makers in the Legislature and Administration.

    Doctor Day 2018 and 2019: As many of you know, on January 30th nearly 500 physicians and medical students came to Madison for the 5th annual Doctor Day advocacy event – our biggest turnout yet!  While in Madison, attendees heard from Governor Walker, received a legal update on the Mayo case in which a state appeals court invalidated Wisconsin’s non-economic damages cap for medical liability cases, appeal of which is now pending before the Wisconsin Supreme Court, listened to a legal discussion relating to network adequacy and surprise billing.  The morning session wrapped with briefings on issues including worker’s compensation, advanced practice nurse collaboration and chiropractors conducting youth sports physicals.   Once again, following an afternoon of legislative visits attendees retired to a nearby restaurant for debriefing and camaraderie. Looking ahead, next year’s event will be scheduled later in the year to better coincide with the Legislature’s primary activity for the year – the State Budget.  Subject to change, Doctor Day 2019 is tentatively scheduled for May 1, 2019 – mark your calendars now!

    Chiropractor Sports Physicals: One of the items discussed at Doctor Day, Assembly Bill 260, in its original form would have authorized chiropractors to conduct youth pre-participation athletic physical exams and require the WIAA to accept those exams for athletic participation. WACEP joined a large number of health care organizations opposing AB 260, but last June the bill passed the State Assembly.  In the wake of Doctor Day, however, the Senate Health Committee amended AB 260 to remove the sports physical authority (with the amendment, physician organizations dropped their opposition).  The amended AB 260 then passed the Senate, was concurred in by the Assembly and ultimately signed by Governor Walker.  This is a testament to the impact of physicians can have lobbying their lawmakers at Doctor Day!

    Campaign Season is Upon Us: Finally, with an odd-year Spring finally upon us, the Legislature has formally adjourned the 2917-18 Session and heads off to campaign for November.  Republicans presently dominate Wisconsin politics holding the Governor’s office, the Attorney General’s office, a 63-35 majority in the Assembly and a 18-15 majority in the Senate.  November will see races for Governor, Attorney General, all 99 Assembly seats and 17 of the 33 Senate seats.  (As well as all 8 of Wisconsin’s Congressional seats and one U.S. Senate seat.)  Recent special elections and Supreme Court elections in Wisconsin, as well as other states, suggest a typical anti-President’s party mid-term election coming.  Republicans downplay prospects of a “blue wave” election favoring Democrats, touting Wisconsin’s economic status and low unemployment among their achievements.  Democrats, meanwhile, believe the  electorate is ready for change and are working hard to recruit candidates and raise money in as many Wisconsin districts as possible.  There is much time between now and November, and elections tend to tighten up as voting day approaches regardless of who appears to be leading early on, but without a doubt 2018 is shaping up to be another in a series of very interesting recent Election Days.