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  • May 11, 2021 12:47 PM | Sally Winkelman (Administrator)

    Bradley Burmeister, MD, FACEP

    Happy May!

    Advocacy for Medicaid reimbursement for Emergency services continues to be our hot button issue. We held “Doctor Day” virtually last week, which brought together over 300 physicians across the state. We had three issues to discuss:

    • Telehealth
    • Medicaid coverage for women 12-months post-partum instead of just 60 days
    • Medicaid reimbursement with a specific ask for legislatures to support reimbursement increases for Emergency physicians.

     We've received favorable feedback from multiple meetings and continue to be optimistic that we will see this $15.66 million increase per biennium to support emergency practices.

    WACEP has been working on this issue for years and we are excited to see this progress. As you likely know, this provision has been included in the Governor’s budget. We are awaiting to see what the Joint Finance Committee from the legislature will do as they reconcile the Governor’s budget and create their own.

    We have individually met with multiple key leaders to discuss the issue and, if you haven’t already, we encourage you to reach out to your own legislators as now is the time to provide your input to your local legislators.  Here's how:

    • Visit https://legis.wisconsin.gov/ and under “Who Are My Legislators” enter your home address.
    • Your legislators will pop up complete with phone number and email address.
    • Call and/or email your legislators to convey this message.

    Also, check out this interview Wisconsin Health News conducted with our WACEP Legislative Chair Dr. Lisa Maurer. 

    Moving forward I have some important dates to remind you of:

    • June Board Meeting, Tuesday, June 8, 2021 in Green Bay. Board meetings are open to all members so if you want to join us let us know!
    • ACEP's Leadership & Advocacy Conference (LAC), July 25-27, 2021 in Washington DC.  Let us know if you want to attend or need more info.
    • WACEP Fall Rural Outreach Program, date and location TBD, watch for updates! 
    • ACEP 2021, October 25-28, 2021 in Boston, MA. Watch for info on the WACEP meet-up!

    As always, if you have any issues you would like us to take a look at please reach out!

    ~Brad

  • May 11, 2021 12:02 PM | Sally Winkelman (Administrator)

    Sally Winkelman, Outgoing Executive Director

    June will bring some changes to WACEP staff as the organization welcomes Maggie Gruennert, CMP as the Chapter’s new Executive Director. Maggie has worked in association management for over six years including work with medical specialty societies and has expertise in regional and community outreach and event management. Maggie graduated from UW-Stevens Point with BS in Communications and Public Relations, is certified in meeting and event planning, and holds her Certified Meeting Professional (CMP) designation.  In her free time, Maggie enjoys baking, sewing and spending time with her husband Kenny, daughter Peyton (3), son Ryder (18 months), and their yellow lab Henley. 

    As we transition, I’d like to offer my thanks for the opportunity and privilege to work alongside some of the most amazing volunteer leaders and members that I’ve come across in my 25 years in association management. Emergency physicians clearly have a unique energy and passion. You truly want to make a difference, and you ARE making a difference. One only needs to look at this past year to see the level of engagement, support for one another, and dedication to your profession that allows you to make a profound difference in the lives of so many. I look forward to following along in the years to come to see the continued progress of WACEP and emergency medicine. 

  • May 07, 2021 9:11 AM | Sally Winkelman (Administrator)

    May 6, Wisconsin Health News

    Emergency physicians would see their first boost in Medicaid rates in more than two decades under a proposal in Gov. Tony Evers’ next biennial budget. 

    Wisconsin pays less than any other state for emergency medicine evaluation and management, the Medicaid code that emergency physicians submit for more than 90 percent of the care they provide, said Dr. Lisa Maurer, legislative committee chair of the Wisconsin Chapter, American College of Emergency Physicians. 

    Emergency doctors last saw an increase in Medicaid rates in 1994, she said. More hospitals now contract out clinical services for providers working in the emergency department, with around half of emergency department physicians part of a separate practice group.

    On top of that, emergency physicians are federally mandated to see anyone who has an emergency, which differs from other doctors in other specialties like primary care who can manage their patient payment mixes to make their practice viable, Maurer said. 

    Current Medicaid reimbursement doesn't cover the cost of providing that care, paying 40 cents on the dollar for the care provided, she said.  

    “It really puts the practice groups and the hospitals that employ their physicians for that matter in a tough spot,” Maurer said. 

    The state has an “amazing network” of emergency physicians, but it’ll be hard to retain that unless there’s a significant increase in the Medicaid reimbursement rate, she said. 

    Evers' 2021-23 budget would boost the rate to around 70 cents on the dollar, Maurer said.

    “It’s a big increase,” she said. “The timing couldn’t be better.” 

    Mark Grapentine, chief policy and advocacy officer at the Wisconsin Medical Society, said that Wisconsin's emergency physician reimbursements for common Medicaid services lag behind all neighboring states.

    "Because many emergency physicians are organized as independent groups so that they can contract with hospitals from multiple systems, Medicaid reimbursement rates that don’t come close to paying the basic cost of providing care threaten the viability of these independent entities," he said.

    Per the Legislative Fiscal Bureau, the budget would provide $10.4 million in state and federal funds to temporarily increase reimbursement rates in calendar year 2022. 

    That would set the rate at 50 percent of the rate paid by Medicare, boosting payments for physician services for emergency room visits by about 36 percent in aggregate that year. 

    Department of Administration Secretary Joel Brennan told legislators last month in a letter requesting budget modifications that the provision was intended to provide a permanent and ongoing rate increase.

    To do that, he asked for an increase in the appropriation of $5.2 million, which breaks down to $2 million in state funds and $3.2 million in federal money, to cover through June 30, 2023, when the two-year state budget ends. 

    “We are over the moon that we are even being considered for an increase,” Maurer said. 

    Joint Finance Committee Co-Chair Rep. Mark Born, R-Beaver Dam, said during a legislative panel on Doctor Day on Wednesday that “no final decisions” have been made, given that Assembly Republicans have to determine their positions and negotiate with senators. 

    “I think it’s something that we should do something on," he said. "I also think EMS is an area that I would like to see some rate increases, but we haven’t had a caucus discussion on either one of those yet.”

  • April 13, 2021 5:58 AM | Sally Winkelman (Administrator)

    Bradley Burmeister, MD FACEP
    WACEP President

    Thanks to all who were able to participate in last week’s virtual Spring Symposium! I will use this opportunity to recap the report I shared during our Annual Membership Meeting.

    First, I hope everyone is finding themselves a bit more optimistic this year compared to last year at this time.  Even through our annual conference and membership meeting were virtual, I’m thankful that we had an opportunity to get together to continue our important work and to come together as a state. I certainly look forward to when we can all be together again in person.

    This year has been incredibly challenging for our entire community. As you all have no doubt experienced, unique challenges have presented themselves in practicing Emergency Medicine. WACEP leadership has been working hard to support you, our members, and all emergency physicians in the state. Specifically, we heard that emergency physician groups were struggling with decreased volumes and revenue and were forced to cut back hours and lay off staff. We worked with the Governor’s office to make CARES Act dollars available via CAPP patients. This resulted in millions of dollars to support emergency physician practice in Wisconsin.

    We have worked tirelessly both at the state and national levels to mitigate potential risk with surprise billing legislation. Here, insurance companies saw significant potential financial advantage by rate setting potentially allowing out-of-network reimbursement to be even worse than negotiated in-network fees. In fact, many of your peers in WI traveled to DC to discuss concerns with our policymakers, and we think we have pretty good policy going forward.

    Through the Emergency Psych Task Force, WACEP continues to work cooperatively with the Wisconsin Psychiatric Association on mental health issues. Together we’ve made great progress on improving mental health access and building on the relationship between emergency department and psychiatric centers across the state.

    Lastly, as hopefully you have heard, we are very excited that emergency medicine has finally been considered in the Governor’s proposed executive budget for a Medicaid reimbursement rate increase that is planned to be permanent, not linked to Medicaid expansion, and that would improve rates by more than 30% of current rates. Though this move would advance us from last in the nation to just 45th, the move would be a giant step forward and would effectively represent millions of dollars in additional funding to your practice per year if it survives the legislative budget process. Stay tuned for information on how you can help!

    I’ve outlined just a few of the many things that we have been working on as your professional association. None of this would be possible without you, our members. As a membership organization we depend largely on your membership and engagement to allow for our continued advocacy work.  Your membership will help us make needed advancements in Emergency Medicine in Wisconsin. We are YOUR voice; we are there to protect you, your practice and your patients.  Thanks for your membership!

    ~Brad

  • April 07, 2021 8:05 AM | Sally Winkelman (Administrator)

    April 6, Wisconsin Health News

    The premium holiday for Wisconsin’s medical malpractice fund will continue until mid-2022 to help offset impacts on providers from COVID-19. 

    Insurance Commissioner Mark Afable notified the Joint Finance Committee last week that he’s requesting that fiscal year 2022 rates for healthcare providers participating in the Injured Patients and Families Compensation Fund remain the same as the current fiscal year, which ends June 30. 

    The committee has until April 15 to approve the request. Currently, the fund is waiving fees for participating healthcare professionals and providers, per a request from the Wisconsin Medical Society. The premium holiday is set to last until June 30, 2022. 

    OCI spokeswoman Sarah Smith said that the rates will remain the same because the fund won’t be charging due to the COVID-19 pandemic. 

    Mark Grapentine, chief policy and advocacy officer at the Wisconsin Medical Society, said independent clinics are still fighting COVID-19 related costs and lost revenue and keeping the status quo for now makes sense. 

    “We’re doing all we can to advocate for those independent clinics who provide such important care to their communities while being on the front lines of the pandemic,” he said in an email. “We’re very fortunate to have a fund that’s run prudently and is in a stable financial condition so that it can provide a little fiscal relief for physicians.” 

    The Injured Patients and Families Compensation Fund covers claims beyond state-mandated insurance limits, which are set at $1 million by occurrence and $3 million by aggregate annually.

  • March 31, 2021 3:07 PM | Sally Winkelman (Administrator)

    Colleagues - 

    WACEP needs your help!  As you know, we have been working for decades to obtain an increase in Medicaid reimbursement to help support our work as the state's healthcare safety net.  We are honored to take care of anyone who comes to the ED 24/7/365, but currently, Medicaid reimbursement only pays for 40% of the cost of taking care of a Medicaid enrollee patient. 

    For years, WACEP has continued to communicate our concerns about being able to attract and retain emergency physicians to our state, given that our Medicaid reimbursement is lower than any other state in the nation. Now more than ever after the COVID roller coaster of ED volumes, and after federal support has come and gone, it remains questionable whether our ED safety net is sustainable. 

    Governor Evers heard us, and his budget bill contains funding to increase Medicaid reimbursement specifically for emergency physicians!  We need your help to push this across the finish line as our legislators now consider priorities for their version of a budget bill. 

    We need you to do three things:

    1. Register for the April 8th WACEP Spring Symposium (if you're not already).  Governor Evers is confirmed to provide remarks at our conference, and we need to show him that emergency physicians are engaged. It's just a few short months before he'll be signing a final budget bill. 
    2. Donate to the WI Emergency Medicine Political Action Committee and plan to attend the VIP Coffee Hour Reception during the Symposium that is exclusively offered as an opportunity for WEMPAC donors.  The reception will feature Rep. Mark Born, co-chair of the powerful Joint Finance Committee that is instrumental in the budget process. Please join us to inform Rep. Born why increased Medicaid reimbursement for emergency physicians is desperately needed. 
    3. Watch for a call to action via grassroots advocacy in the next couple of weeks where we will prompt you to send messages to your legislators regarding our specific budget ask for increased Medicaid reimbursement for emergency physicians.

    Thank you so much for keeping emergency medicine in Wisconsin strong!

    Lisa Maurer, MD, FACEP
    WACEP Legislative Committee Chair

    Brad Burmeister, MD, FACEP
    WACEP President

  • March 24, 2021 4:03 PM | Sally Winkelman (Administrator)

    Join your colleagues (virtually) for Doctor Day on May 5, 2021 to fight for your patients, profession and sound health care policy. Doctor Day 2021 will include morning breakout sessions on health equity, public health and the latest legal issues facing physicians so you can customize the day to your interests. Organizers are once again lining up presentations from premier experts and policymakers. The schedule features three breakout sessions:

    Health Equity
    What are we doing to achieve long-lasting and equitable health outcomes for ALL Wisconsinites? The State of Wisconsin has an overall health disparities grade of “D” according to a recent University of Wisconsin Population Health Institute Health of Wisconsin Report Card. The Report Card notes that while Wisconsin's grade for overall health has remained the same since 2007, the health disparities grade has worsened since 2010. What are we doing to change this?

    Public Health
    Join us for an outbreak session on local public health response to the COVID-19 pandemic. City of Milwaukee Health Commissioner Kirsten Johnson will provide an overview of the challenges and successes Wisconsin's local public health departments faced throughout the last 12 months. As fellow frontline workers, local public health officers have experienced this crisis through the lens of both health care and governmental response to public health crises. 

    Legal Update
    The always popular and pertinent legal update will explore the latest “hot topics” physicians need to know about. Axley attorneys Guy DuBeau and Aneet Kaur will walk us through the landscape of litigation trends, scope of practice developments and more.

    To learn more about this virtual day of advocacy, go to widoctorday.org to register (it’s free) and see the day’s agenda.

  • March 24, 2021 3:59 PM | Sally Winkelman (Administrator)

    March 18, Wisconsin Medical Society

    The State of Wisconsin’s Medical Examining Board (MEB) at its most recent monthly meeting advanced a proposed administrative rule that will extend for another biennium the requirement that most physicians obtain two credits of continuing education related to opioid prescribing. The requirement applies to physicians who hold a Drug Enforcement Administration registration number, with the two credits being part of the 30 credits required each biennium. Courses must be approved by the MEB in order to satisfy the subject matter requirement.

    The Wisconsin Medical Society (Society) spoke in favor of the rule at the MEB public hearing March 17, noting how the COVID-19 pandemic has exacerbated opioid abuse across the county. The Society also expressed appreciation that the rule widens the scope of qualifying coursework beyond opioid prescribing to include “other controlled substances.” This will allow physicians who hold a DEA number but may not prescribe opioids to access coursework more relevant to their practice.

    The MEB also began to discuss whether to add a provision to the “unprofessional conduct” section of the MEB’s administrative code (MED 10) that could require physicians to offer patients a chaperone for certain sensitive physical exams. The idea comes from a January 2020 ACOG Community Opinion paper recommending that a chaperone be present for all breast, genital and rectal examinations. While the MEB discussed the issue only generally during its meeting March 17, it will review potential language at its April meeting.

    Contact Society Chief Policy and Advocacy Officer Mark Grapentine, JD for more information.

  • March 13, 2021 9:01 AM | Sally Winkelman (Administrator)

    Bradley Burmeister, MD FACEP
    WACEP President

    Hello WACEP Members!

    I’m hoping this isn’t going to be an “in like a lamb, out like a lion" March! We’ve been pretty lucky, and I’ll be honest, I’m slightly bummed at the quickly deteriorating skiing conditions across the ski resorts in our state!

    WACEP continues to be very busy. We continue to follow multiple pieces of legislation moving through at the state level including: the proposed Medicaid reimbursement budget increase; proposed balanced billing legislation; the PA bill; many bills impacting EMS and more. I’m anticipating many updates over the next few months so will save you from information overload now, but obviously if you have questions, please reach out to us!

    Our most important update in the coming month is that our virtual annual meeting / Spring Symposium is April 8th! We have a great day planned full of education and networking, and I encourage everyone to join us if available! Sign up here.

    Another exciting transition is that the WACEP Board is planning an in-person meeting the morning of June 8th at Lambeau Field! If you are in the region or want to join us for the conversation or just the phenomenal view, Board meetings are open to all members. Just let us know if you plan to come and we’ll get you details!

    Thank you for your membership.

    ~Brad

  • March 12, 2021 9:35 AM | Sally Winkelman (Administrator)

    Barack Obama signed the CURES Act into law in 2016.  This 996 bill has many provisions that can be found online through ACEP, and also through HHS. This Act impacts Emergency Physicians in a number of ways and a brief review of the bill may be worth your time. 

    Throughout the past year, our institution has changed the default setting to share all emergency physician notes with certain exceptions.  This action has resulted in a handful of patient complaints or requests to change the medical record. 

    Here are some helpful hints that I have found through review of patient concerns. 

    Common Documentation or Pitfalls

    Considered Revision

    Patient is obese

    Patient’s BMI >30 or meets the medical criteria for obesity.

    Patient refused admission to the hospital

    After discussion of the risks and benefits of hospital admission the patient elected to continue treatment as an outpatient.  Patient is decision and understands they are at increased risk of myocardial infarction….  The patient is concerned if they are admitted there will be nobody to watch their children and they will get fired from their job.

    Patient appears SOB

    Patient is short of breath

    Patient refuses to take their medication

    Patient has difficulty affording medication, or has had difficulty tolerating pills…..

    Patient is paranoid and refuses to acknowledge

    Consider revising using direct quotes.  “The transmitters in my brain tells me the medication is the devil.” 

    Beware of just loading the macro

    Patients will likely notice when they come for an ankle sprain and you preload the heart, lung and full neuro exam.


    While this is not an exhaustive list, I think the take home message is that direct quotes and non-judgmental language will decrease concerns from patients and strengthen the quality of the medical record.  Knowing why the patient elected to be discharged, couldn’t take their medications, or providing direct quotes may even help other members of the care team give better care for the patient.  Medical records reflecting the compassionate and thoughtful care will build trust with the patient and result in more efficient care and better physician-patient relationships. 

    There may be a few instances in which the physician may not want a note visible to the patient.  Examples include forensic nurse evaluations or instances in which a mother’s spouse may not be the father of an infant.  Check with your institution on how to opt out of sharing notes. While guided by the CURES Act each institution has its own workflow. 

    Familiarizing ourselves with the CURES act in our daily practice our health system’s implementation will ensure the physician’s note reflects our commitment to safe and compassionate care.

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