This morning, Governor Evers announced important proposals he will include in his Executive Budget, scheduled to be introduced next week. Included are several proposals specifically aimed at reforming crisis intervention and emergency detention—all of which are a direct result of ongoing work of the WPA/WACEP Emergency Psych Task Force as part of a collaborative workgroup with the Badger State Sheriffs, Wisconsin Sheriffs and Deputy Sheriffs Association, and the Wisconsin Counties Association.   

While these proposals are only the first steps in the biennial budget process and must go through both the Joint Finance Committee and the full Legislature, WACEP is thankful both for the Governor’s leadership and recognition of these shared challenges, and the work of the Emergency Psych Task Force for bringing these proposals and important issues to the forefront.  

Read Gov. Evers' Budget Proposal Press Release. 

Bradley Burmeister, MD FACEP
WACEP President

February is always my favorite month. This February seems extra special: we have vaccines for COVID, COVID numbers are down, and the days are getting longer and longer.

I think, though, we have another glimmer of hope in our ongoing push for fair reimbursement from the Medicaid program. The state is projected to have a more than $600 million Medicaid surplus (partly due to increased federal funding related to COVID). WACEP has been making the case to the Governor and Legislature for increased Medicaid reimbursement rates. Having essentially the lowest reimbursement rates in the country for Emergency services and having not seen an increase in decades, WACEP continues to advocate for fair increase. This is hopefully the prime opportunity for us to move forward. We may need your help, so stay tuned—we’ll let you know if there becomes a time where we need your grassroots help!

In the meantime, save the date for these two important advocacy opportunities:

May 5: Wisconsin Doctor Day (virtual)  Visit https://www.widoctorday.org to sign up. Meet with your state legislator and/or their staff at the state level. Building relationship is incredibly important. Although the exact legislative priorities we will advocate are still to be determined it would be nice to have a good representation of Emergency physicians. 

July 25-27: ACEP Leadership and Advocacy Conference (LAC) Visit https://www.acep.org/lac/ to learn more. Meet with your federal legislators and/or their staff. This might be virtual, it might be in person, it might be a hybrid! For now, save the date!

Also, don’t forget about our own WACEP 2021 Spring Symposium on April 8. It’ll be virtual this year and is always a great opportunity to learn and network with your peers. Register today!

And finally, how can Wisconsin ACEP help you? If you have any questions, concerns or needs, please do not hesitate to reach out! My email is BradleyBurmeister@gmail.com.

The Wisconsin Hospital Association (WHA) sponsors an annual educational conference on leadership.  Because of the pandemic, this year's conference will be split into a half-day of online talks on March 12, and then two half-days of in-person talks and discussion on September 14 and 15, 2021.  

WHA welcomes physicians in leadership positions, and especially those physicians with a developing interest in leadership, to participate in the conference. 

Learn more and register. Be sure to click on the featured presenter tab near the top pf the web page to see the outstanding group of speakers for this conference.

Businesses, frontline workers, and communities from across the state have come together this past year to help slow the spread of COVID-19. As many await vaccines, and our health care providers battle new strains, we can’t let our guard down now.

The most recent public education message from the Stop the COVID Spread! coalition urges Wisconsinites to remain vigilant in the continuing fight against COVID-19, stressing the importance of continuing to practice key, simple measures like wearing face masks, social distancing, and washing hands regularly. 

WACEP is proud to be part of the “Stop the Covid Spread!” coalition, a group of Wisconsin’s leading health care, business, education, and advocacy organizations who have all joined together in the effort to urge the public to step up and take preventative measures seriously. The coalition has grown dramatically since its launch and now includes over 135 Wisconsin organizations. 

We’ve come a long way together but the fight’s not over yet! You can learn more about the coalition and how we all need to stay vigilant to help stop the spread: https://www.healthywialliance.com/Stop-The-COVID-Spread.  Please join us in sharing this crucial message with your friends and family!

While Doctor Day 2021 has shifted to a virtual format, the May 5^th event promises to offer equally important hot topics and content.

This year’s policy and politics panel will include members of the powerful budget-writing Joint Committee on Finance.  Committee co-chairs Representative Mark Born (R-Beaver Dam) and Senator Howard Marklein (R-Spring Green) will be joined by their Democrat colleagues Representative Evan Goyke (D-Milwaukee) and Senator Jon Erpenbach (D-West Point).  

You will hear a first-hand account of important budget topics, and during the middle of budget negotiations. This includes policy related to the Department of Health Services and funding for the Medicaid Program. This is a great opportunity to hear differing views on policy and spending priorities for the 2021-23 Biennial Budget and current legislative session.

Other components of the day will again include policy breakouts, priority issue briefings, a keynote presentation and of course, legislative visits.

Whether you’ve attended many advocacy days in prior years or none at all, be sure to sign up for Doctor Day 2021 and make your voices heard! The unique multi-specialty nature of Wisconsin's Doctor Day offers all physicians across the state from all specialties to come together and advocate for issues affecting their patients, their practices and their specialty.  Learn more and sign up at www.WIDoctorDay.org.

EMRA is looking for faculty for its Virtual Medical Student Forum taking place on Saturday, March 27, 2021 from 9:30 am to 12:45 pm CDT. Interested faculty should apply by February 1.

The EMRA Medical Student Forum is free to all EMRA medical student members. It brings together program directors and faculty to answer questions specific to your phase in training. General sessions answer big-picture topics, and breakout sessions per year to target exactly where you are in your training.

The annual Midwest Medical Student Forum, hosted by the Michigan College of Emergency Physicians, is taking place virtually on Thursday and Friday, January 28-29.  Register today by calling 517-327-5700. This year's Forum will include:

• Small-group advising
• Residency panel
• Residency fair
• Virtual SIMS course (space is limited)

Brad Burmeister, MD, FACEP
WACEP President

Welcome to 2021!

We are off to a great start! This is my first message as the new President, so "hello" to those of you I do not know. Just a bit about me... I work for an independent group in Green Bay which staffs Bellin Hospital.

Before we get to some updates, I want to thank our now Immediate Past President Ryan Thompson, MD, FACEP for all the important work he has done. I’m particularly thankful for his leadership along with our legislative committee and the lobbying team (HWZ) for their hard work on the WI CARES act, efforts on Surprise/Balance Billing at the state level, and ongoing work on Medicaid Reimbursement. I think we are in a great spot moving forward and have some excellent ground work accomplished.

On that note, the legislative team at ACEP has been very busy ensuring the voice of the Emergency Physicians are heard across the country. As a result, we have many favorable outcomes with the “2020 Year End Package” which Congress passed. In particular we have reasonable legislation on Surprise/Balanced Billing as well as better outcomes with Medicare cuts that what had been pending.

WACEP has been working on our own Surprise/Balanced Billing battles at the state level, ongoing efforts for Medicaid reimbursement increases, extending liability protections due to COVID-19, among many other things!

If you haven’t already checked out our virtual Spring Symposium please do so. It will be held Thursday, April 8th, so coming up quickly! We have some great speakers including Dr. David Talan with some insights into infectious disease and Emergency medicine, education on Buprenorphine (Suboxone) and Dexmedetomidine (Precedex), an ATLS update, and an update from Dr. Ryan Westergaard (“The Dr. Fauci of Wisconsin”).  Learn more and register!

If you have any questions or issues you want us to look at, please do not hesitate to contact me.

Please follow us on Facebook! @WiACEP

Stay safe!
Brad Burmeister, MD, FACEP

The DC-ACEP Chapter is hosting an EM MAT Waiver Training Course on Monday, February 1, 2021 and has extended an invitation to all ACEP members to participate for free. Anyone looking to get their waiver early this year is encouraged to register. 

The course is hosted by the DC ACEP Chapter and provided by national ACEP, in partnership with Providers Clinical Support System and the American Academy of Addiction Psychiatry. The 8-hour training is open to Physicians (MD/DO), Residents, Medical Students, NPs (including those in training) and PAs (including those in training). Medical Students and those currently in training can apply for the waiver once they complete their training.

• No expiration for Waiver Training Completion Certificate.
• No pre-work/course requirements.
• CME provided and in order to fulfill requirement for CME you will have to complete the post-course evaluation from national ACEP and from PCSS for evaluation of the Waiver Training Completion Certificate.
• This training course is not graded but completion or all evaluation questions is required.
• The only requirement to be eligible for completion is that you stay connected and logged in to the zoom platform through your email account for 8-hour duration of this course.
• The webinar will not be recorded but the slide deck will be shared with everyone after the webinar has been completed.

Learn more and register here (ACEP login is required). 

AJ Wilson and Greg Hubbard
Hubbard Wilson Zelenkova LLC

Election Recap

Election Day has come and gone but likely won’t be one we forget anytime soon.  When it was all said and done, now President-elect, Joe Biden defeated Donald Trump in Wisconsin by just over 20,000 votes.   The close result was anything but new for the Badger State at the top of the ballot.  Two years ago, Tony Evers defeated Scott Walker by 29,000 votes; in 2004, John Kerry defeated George W. Bush by only 11,000 votes; and in 2000, Al Gore defeated George W. Bush by only 5,700 votes.   As I type, a potential recount is still pending but unlikely to change results significantly.  

Notwithstanding the close presidential contest, legislative races were less competitive in Wisconsin. Despite very favorable pre-election polling, Democrats defeated only two incumbent Republicans in the State Assembly where Deb Andraca (D-MKE) and Sara Rodriguez (D-Brookfield) defeated Republicans Jim Ott and Rob Hutton respectively.   

The State Senate went the opposite way altogether as Republicans picked up two seats held by Democrats. In the 12th SD that encompasses much of Northwestern WI, Rob Stafsholt (R) defeated Patty Schachtner (D) handily in the seat that Schachtner won in a special election just under two years ago.  In the Green Bay area, Eric Wimberger (R) beat Jonathan Hansen (D) to snatch the open seat from Democrats that had long been held by retiring Dave Hansen.   

Therefore, Republicans will continue to hold strong majorities in both houses of the State Legislature.   The composition of the assembly will be 61-38 when they return in January.   The State Senate will be 20-12 with one seat vacant as Scott Fitzgerald’s seat will be open as he won the WI’s 5th Congressional District.  That heavily republican seat will most likely give Republicans a 21-12 majority early in session once the seat is filled.

Governor’s Proposal for additional COVID-19 response Legislation

The Governor proposed legislation in mid-November to address a number of pandemic related issues.   The Legislature has not said whether it will come in before the end of the year to consider any of the proposals.  The Governor’s draft, among several other provisions, includes the following:

• Require that insurers cover all telehealth services that would be covered were the services provided in- person.
• Prohibit insurers from requiring prior authorization or imposing quantity limitations below a 90 days supply through the end of 2021.
• Allow pharmacists to extend most Rx refills by 30 days through the end of 2021, where it is safe to do so.
• Ensure that health plans provide coverage for testing, diagnosis, treatment, prescriptions, and vaccines related to COVID-19.
• Prohibit cost-sharing and prior authorization for testing, diagnosis, treatment, prescriptions, and vaccines related to COVID-19.
• Establish that insurers will reimburse providers for out-of-network care (including telehealth) resulting from COVID-19 related disruptions at 250% of Medicare rates.
• Allow critical workers, including healthcare workers, to claim worker’s compensation benefits related to COVID-19, presuming that they received the illness from their occupation.

We are engaging with the Legislature to improve the Surprise Billing provision should this or any other bill move forward to include a definition of “usual and customary rate” as well as favorable dispute resolution.

We are also asking the Legislature to include a liability immunity provision for health care providers similar to what we were able to get included in the COVID response bill this Spring.

Board of Nursing Rulemaking Activity

The BON has taken action on three issues related to APNP scope of practice in the last two months.  The first is a rule proposal that would allow the BON to waive APNP Collaboration Requirements contained in WI Nursing Code 8.10(2) and (7) during a state declared emergency.  This rule change is in progress - Clearinghouse Rule 20-069.  The comment period closed on Dec. 10 with a hearing where a joint letter was submitted from WACEP, the WI Society of Anesthesiologists, and WI Psychiatric Association in opposition.

The second is a proposed scope statement that would give the BON the ability to draft a new rule that would permanently amend current law collaboration requirements for APNP contained in WI Nursing Code - N8.  The third is a proposed scope statement that would give BON the go ahead to draft permanent rule changes related to APNP prescribing limitations also contained in N8.   Undoubtedly, this would be to expand those privileges, but details are not yet available.  We have expressed front-end concerns and will continue to monitor and engage if these proposals move forward.

Surprise Billing Work Group

WACEP is working with the Wisconsin Radiological Society, the Wisconsin Society of Anesthesiologists, and the Wisconsin Society of Pathologists on comprehensive surprise billing legislation as well as the aforementioned proposal for pandemic response.  At this moment, negotiations are taking place again on a federal bill.   The direction Congress goes on this issue will dictate our response or pro-action on the state level. 

Emergency Psych Task Force Work with State Sheriffs and Wisconsin Counties Association 

HWZ, WCA, and Sheriffs’ lobbyists met recently with the Governor’s policy director to discuss options for including proposals of mutual agreement in the Governor’s executive budget.   Among those proposals was a more substantive suggestion for regional crisis stabilization centers as well as proposed codification of the SMART medical clearance form.

Looking Forward

Over the month, the legislature will fill out committee assignments and will then come back to start the new session in January.  It is unlikely that another pandemic response bill will be taken up before inauguration day, however we continue to do outreach on the aforementioned priorities just in case they do come into session.