Latest News 


  • May 08, 2019 2:37 PM | Sally Winkelman (Administrator)

    WACEP members are invited to collaborate on an AACT grant-funded project initiated by Colorado ACEP to examine providers attitudes toward treating opioid use disorder and initiating buprenorphine/naloxone treatment in the ED. Survey respondents will be entered in a drawing for a chance to win a $100 Amazon gift card. 

    On many shifts we see patients whose lives have been negatively impacted by the opioid crisis. Some have overdosed, some have abscesses, and others are requesting opioid pain medications in the ED yet again. We do a great job of treating their acute issue, knowing their addiction will make a repeat visit inevitable. These are the names we recognize as soon as we pick up the chart; the PDMP’s we’ve checked multiple times before. We’re hoping you can help us develop some options.

    We are surveying ED providers to determine their experience with and attitudes toward initiating suboxone in the ED. Please head to https://is.gd/EDbupe to participate in our quick survey. 

    It’s completely voluntary and any ED provider can take this anonymous survey to see how they feel about ED buprenorphine (commonly called Suboxone) and what tools they need to improve care for patients with opioid use disorder. 

    COMIRB# 19-0088 PI: Matthew Zuckerman
    Study Title: Attitudes to Emergency Department Medication Assisted Therapy
    matthew.zuckerman@ucdenver.edu 

  • May 06, 2019 5:41 PM | Sally Winkelman (Administrator)

    Bradley Burmeister, MD

    On May 1st, over 20 Emergency physicians were among the more than 300 physicians from across Wisconsin to participate in Doctor Day in Madison.

    The two main policy issues for this year focused on Medicaid reimbursement and the personal conviction waiver for immunizations.  

    As you know, Wisconsin continues to be at or near the bottom for Medicaid reimbursement. In fact, for most Emergency Department levels of service, Wisconsin is dead last for reimbursement often at rates far below overhead costs. Adequate and fair Medicaid reimbursement is important in order for patient to have access to both primary and specialty physicians.

    In general, legislators provided feedback that they understand the Medicaid issue is regarding access. Many had a very strong understanding, and realize the issue is not just about the bottom line for physicians.

    This year’s particular “ask” regarding Medicaid was focused on institutional versus non-institutional payments. The Governor’s budget includes Medicaid expansion and with expansion, over $300 million dollars would become available. The budget, however, allocates all of these funds as institutional payments to hospitals and health systems, and not toward physicians or other non-physician providers.

    The second issue was around support of proposed legislation to end the personal conviction waiver for school-mandated vaccines. Wisconsin is one of only 18 states that continue to permit a personal conviction to waive the requirement to have vaccines for school-aged children. In many states, parents can seek a medical waiver or a religious waiver. But only a few states, including Wisconsin, allow parents to essentially check a box exempting their children from the vaccine requirement. Since 1997, Wisconsin has seen a significant increase in parents obtaining a vaccination waiver. While medical and religious waivers, which represent less than 1% of all waivers, have not increased over time, the personal conviction has seen a steady and dramatic increase and represents the vast majority of total waivers. 

    Legislation has been introduced that seeks to end the personal conviction exemption but continues to permit medical and religious waivers. As you know, the science is clear on immunizations, and we must maximize our “herd immunity” for the betterment of the whole community.

    To summarize, Doctor Day 2019 was a tremendous success. To continue our advocacy efforts, several of us from WACEP leadership are now in Washington DC to participate in ACEP’s Leadership and Advocacy Conference. There, we will meet with legislators and staff from Wisconsin, and will engage in advocacy at the national level. Stay tuned for additional updates, and in the meantime, save the date for Doctor Day 2020, scheduled for January 29, 2020 in Madison. We hope to see you there!

  • May 02, 2019 4:27 PM | Sally Winkelman (Administrator)

    Prescribed pain medication after surgery and traumatic injury is among the most common first exposures to opioids. SPOTS offers an opportunity for collaborative learning with experts about best practices in opioid prescribing, and with other providers around the state about the current challenges and opportunities in treating our injured patients’ pain.

    Between March and September, the program offers a monthly session hosted from the teleconference facilities at the University of Wisconsin. Each are hour-long session will start with a 15-20 minute didactic presentation from an expert in the field, followed by an open conversation between our expert presenters and the participants. 

    The May 23, 2019 session will begin at 4:00 pm and will feature Drs. Mike Repplinger and Benjamin Schnapp, who will present "Opioid prescribing for surgery and trauma in the Emergency Department." Register here.

    Participants will receive Opioid CME credit, and may either attend live or view recorded sessions online. Note that if you prescribe controlled substances, Wisconsin’s Medical Examining Board requires that you earn two CME credits on responsible opioid prescribing between 1/1/2018-1/1/2020. Each session in the SPOTS series counts toward one hour.

    SPOTS is a collaborative learning series presented by the South Central Wisconsin Healthcare Emergency Readiness Coalition (SCWIHERC), South Central Regional Trauma Advisory Council (SCRTAC), and the Surgical Collaborative of Wisconsin (SCW), through a generous grant from the Wisconsin Department of Health Services.

  • May 02, 2019 12:43 PM | Sally Winkelman (Administrator)

    Meet your Wisconsin Colleagues for a Reception during SAEM!

    WACEP Members are invited to join the University of Wisconsin Department of Emergency Medicine for a sponsored event at SAEM's 2019 Annual Meeting in Las Vegas. 

    Wednesday, May 15 at 6:00 pm
    The Loft at Cabo Wabo
    3663 Las Vegas Blvd. South
    Las Vegas, NV 89109

    Please RSVP by Friday, May 10th .

  • April 17, 2019 1:39 PM | Sally Winkelman (Administrator)

    Jeff Pothof, MD, FACEP
    WACEP President

    You know we all practice in a special place when you can run in shorts and a t-shirt and two days later be shoveling a few inches of snow.  With the warmer weather comes an important annual event in the state. 

    Known as “Doctor Day” we all have an opportunity to don a white coat and engage in face to face conversation with those individuals whose decisions affect not only our practice, but the lives and wellness of our patients.  This year is particularly impactful for us as emergency physicians as we have many issues important to our specialty that need legislative support.

    For those of you who have participated in the past, thank you.  If you’ve never attended a Doctor Day and can find some time to get away on May 1st I’m certain it would be worth your effort.  WACEP will be hosting a private policy primer update beforehand to prepare all of you on the key issues. The Doctor Day agenda itself promises to be high yield.  We have Wisconsin’s governor Tony Evers slated to speak and the topics that will be front and center for the day include Medicaid access and the historically low reimbursement rates in Wisconsin, as well as the extremely hot topic of childhood vaccination and personal conviction exemptions.  I’m nearly certain all of you have an opinion on that topic.  The day wraps up with time for you and other providers to talk with legislatures, and finishes with a reception close by at Madison’s on King.

    For more details and the link to register please visit https://www.widoctorday.org.

  • April 17, 2019 1:29 PM | Sally Winkelman (Administrator)

    Lisa Maurer, MD
    Immediate Past President, WACEP

    As a part of replacing the Sustainable Growth Rate (SGR), CMS has deemed that we must start reviewing "appropriate use criteria" (AUC) before ordering any CT, MRI, PET, or nuclear medicine studies (does not apply to Xray, U/S).  The American College of Radiology (ACR) has been approved as an eligible group to participate in defining what is and isn’t “appropriate.” 

    Starting in 2021, if an ordering physician does not demonstrate through an EHR Clinical Decision Support tool (CDS) that they have consulted the AUC for the study your ordering, CMS will not reimburse the professional or technical charges for the study. 

    To clarify, you have to review the AUC, but not necessarily adhere to them.  Emergency physicians will find it to be important because CMS also gives radiologists the green light to refuse to do the studies for which appropriateness criteria were not reviewed.  This system is already in place in the ambulatory care setting.  It will be implemented in the emergency department in less than a year, on Jan 1 2020, but the first year is for "education and operations" and no claims will be denied.  As patterns amongst insurers normally happen,  we can certainly expect commercial insurers to follow suit soon thereafter.  This follows a trend happening for having higher standards for "indications" for studies we order, as already evidenced by our dropdown boxes, etc when you order any image. How this will work in practice for testing from the ED is unclear.

    1. These criteria do not apply for patients that have an Emergent Medical Condition as defined by EMTALA.  However, this is a rather high bar that arguably some of our patients do not meet, and we all know the reputations of payors for determining if care was "emergent" based on final diagnosis rather than presenting symptoms.  
    2. The regulations released from CMS specifically name EDs as being a place of service where these AUC apply. 

    Given the above somewhat conflicting information, our hospitals will likely roll this out for all CTs, V/Qs, and MRIs that are ordered from the ED, not excluding patient care that we determine in the moment to be for someone having a true Emergent Medical Condition. 

    What will this actually look like in real practice?  It would be reasonable to expect a more extensive clicking process as you enter the order rather than just choosing the indication in a drop down.  In order to minimize impact on workflow, ideally it would just be a modified drop down to choose the most applicable (predetermined to be appropriate) criteria, with an additional option to demonstrate that you have reviewed the criteria and feel it appropriate to deviate from them.  Hospitals will have to invest in CDS as an adjunct to the EHR, or the existing EHR will have to be updated to meet this need.

    Reviewing a couple specific examples of “appropriateness” scores helps to clarify what a future rollout in our workflow may look like.  Take a look at the table from ACR grading various studies looking for aortic dissection.  Graded on evidence for utility and radiation exposure.  Doing a PET scan, for example, would be considered "usually not appropriate" but MRA/CT/echo would all be considered "usually appropriate." 

    For a more common example, consider head CT imaging for head injury.  ACR describes that a noncontrast head CT is “usually not appropriate” for patients with GCS of at least 13 that do not meet criteria for imaging based on New Orleans Criteria, Canadian CT Head Rules, or NEXUS II guidelines.  However, if GCS is less than 13 or if imaging is indicated based on the above listed guidelines, then the head CT is “usually appropriate.” 

    What should you do now?  Contact your hospital administrators to see how they are planning to meet this requirement:

    1. Prevent this from creeping to other imaging study orders such as X-rays, ultrasounds, etc. 
    2. Make sure that whatever EHR adaptations are done are sensical and workable.  ACEP recommends the CDS created by the ACR, called "ACR Select."  We should not be expected to access an external web portal for our CDS, which also exist.  
    3. If the workflow is clunky, we need to have a process in place to bypass choosing criteria for studies that must be done immediately for critically ill patients. 

    References:
    ACEP summary article from March 2017 (link)
    ACR site for CDS (link
    Complete list of ACR appropriateness criteria organized by clinical topic (link)

  • April 12, 2019 9:28 AM | Sally Winkelman (Administrator)

    Bradley Burmeister, MD, Emergency Medicine Delegate to WMS 

    The Wisconsin Medical Society House of Delegates met on Sunday, April 7, 2019.  Several Emergency physicians participated in the annual policy-making function of the society. Three resolutions introduced and sponsored by WACEP were discussed and accepted as policy. 

    The first resolution, Assessing Medical Stability of Patients with Acute Mental Health Needs in the Emergency Department, seeks to form consensus principles on the utility of the Emergency department to provide medical clearance and hopefully expedite the process to make it more patient-centered. 

    The second resolution, Addressing Mental Health Treatment Barriers Created by the Medicaid IMD Exclusion, asks the Society to provide information on the exclusion to interested membership and support a Medicaid waiver demonstration application that seeks to receive federal financial participation for Institutions for Mental Diseases services provided to Medicaid beneficiaries. The IMD exclusion is a decades-old law that was intended to pass the cost of mental health treatment to the states. It prevents federal Medicaid dollars from be utilized for certain inpatient psychiatric care. This exclusion has contributed to the challenges of financing, and therefore placement of inpatient psychiatric care for the Medicaid population. 

    The final resolution seeks to revise the Wisconsin Psychiatric Bed Locator. This portal is meant to provide up-to-date information on psychiatric bed availability; however the information available is not always up-to-date or accurate, and the system has not been utilized by most emergency departments. This resolution brings together psychiatrist and emergency physicians to help improve effectiveness of the application. 

    Lastly, the WMS Board presented an informational report outlining a proposed revision of the organization’s Constitution and Bylaws, whereby the policy-making body of the Society would transfer from the House of Delegates model to the Board of Directors. It was reported that several other states have successfully transitioned to this governance model. The new process would seek input from members throughout the year, rather than once per year as is done under the current model, and would provide a significant cost-savings to the organization. The proposal will be discussed and potentially voted on at the 2020 House of Delegate meeting next April.

    If you have any interest in collaborating on behalf of emergency physicians at the Wisconsin Medical Society or beyond, or if you’d like further information on the items of business discussed at this year’s House of Delegates, please feel free to contact me.

  • March 31, 2019 12:25 PM | Sally Winkelman (Administrator)

    On March 21, WACEP Delegation Chair, Dr. Bill Falco, met with Congressman Bryan Steil, who represents the 1st District of Wisconsin in the U.S. House of Representatives. 

    The meeting was coordinated as part of an aggressive push by ACEP for members of ACEP's 911 Network to meet with many of the nearly 100 new members who were sworn in to the 116th Congress on January 3rd.

    During the meting, Dr. Falco had an opportunity to introduce Rep. Steil to ACEP and to share pertinent information on the specialty of emergency medicine and its role in the health care delivery system. Dr. Falco successfully established himself as a local contact in the health care space, as evident by the invitation he received to serve on Rep. Steil's healthcare advisory panel. 

  • March 29, 2019 10:33 AM | Sally Winkelman (Administrator)

    With federal lawmakers actively working on legislation to address the surprise billing/out-of-network payment issue that is expected to move in the Senate by June, ACEP member advocacy at the 2019 Leadership and Advocacy Conference could be hugely consequential for the future of emergency medicine. Visits to the Hill to advocate on critical issues like this do make a difference.

    Click here to see how advocacy from ACEP members at LAC last year directly led to big wins for ACEP and emergency medicine.

    In addition to making these critical Hill visits, LAC attendees will hear from policymakers and experts about the latest developments on public policy issues that directly impact their practice. The conference will also include an afternoon dedicated to effective chapter leadership and a solutions forum highlighting innovative approaches to reduce boarding of psychiatric patients and successful uses of telemedicine. Two post conference events are also available: MAT Waiver Training and an Acute Pain Management Bootcamp.

    To learn more and register to attend LAC, go to www.acep.org/lac.

  • March 29, 2019 7:52 AM | Sally Winkelman (Administrator)

    Eric Jensen, WACEP Lobbyist

    In November, Wisconsin elected Democrat Tony Evers as its 46th Governor, and simultaneously returned large Republican majorities to both the State Assembly and State Senate.  This ended nearly a decade of total Republican control of Wisconsin state politics, and gave Wisconsin split control of state politics for the first time in more than a decade.

    As with each Legislative session, the State Budget will dominate the first half of the 2019-20 Session.  On February 28th Governor Evers introduced his Biennial Budget proposal, including a variety of items of interest to physicians:

    1. Accept Federal Medicaid Expansion, anticipated to provide coverage of an additional 20,000 Wisconsin residents, and bring in $320 million in additional Federal funds over the biennium.
    2. “Provide” $365 million for payments to “institutions” (hospitals) providing care to MA patients (it is unclear how great an increase this represents overall).
    3. Separately provides additional funding for increasing payments for Critical Access rural hospitals and “stand alone pediatric teaching hospitals”
    4. “Increase” incentive payments for Dentists by $38.5 million.
    5. “Provide” $69 million for MA non-institutional (physicians, other providers and clinics) Mental Health Payments (again, it is unclear how great an increase this represents overall).
    6. Provides funding for expanding reimbursement of “telehealth” beyond current “real-time communications” – to include sharing of data/info among providers, to specifically allow telephone/internet communications between provider/patient and among providers.
    7. Creates an “Admissions Medical Education Unit” at Winnebago, adding supervisory staff for evening and overnight shifts.
    8. Proposes legalizing “Medical Marijuana,” and decriminalizing possession of small amounts of marijuana for non-medical purposes.

    The Legislative majorities have already signaled their displeasure with Governor Evers’ proposals, especially his Medicaid expansion.  While few of the Governor’s Budget provisions will survive the Legislature’s process as originally proposed, details on Republican plans are scarce. 

    The Joint Finance Committee (JFC) will begin its work reviewing, debating and voting on the Governor’s budget proposals in April.  Generally, JFC concludes its work and provides the Legislature with a revised Budget Bill in June, but with a Republican-controlled Legislature and Democrat Governor, it is widely anticipated the Budget process may last well into the Fall of 2019.