The ACEP DC office hosted an ACEP members only Surprise Billing Advocacy townhall on August 5th. Laura Wooster, Associate Executive Director, ACEP Public Affairs, provided an update on Congressional activity and spoke about the importance of utilizing the August congressional recess while legislators are back home to advocate for emergency physicians and patients. ACEP offered tips to effectively engage your legislators and a toolkit with resources to facilitate effective outreach. A link to the archived townhall is available here.

Login here to access the ACEP members-only surprise billing advocacy toolkit. Related resources are available to view and share here. 

For updates on ACEP’s federal advocacy activities, join the ACEP 911 Grassroots Network here. 

Wisconsin ACEP congratulates Amy Biondich, MD, FACEP of Rubicon, who has recently been awarded the distinct designation of Fellow of the American College of Emergency Physicians (FACEP).  Wisconsin now has 209 members with FACEP status.

Doctor Biondich will be recognized for this accomplishment at an October 26 reception in Denver, just prior to the kickoff of ACEP19. 

WACEP President's Message
Jeff Pothof, MD, FACEP

I must admit, I'm one of those people who often thinks bigger is better.  if a 60-watt light bulb is good, then the 100-watt bulb must be better.  I'd be completely content with the three-piece fish fry, but the all you can eat is only $2 more and the batter is so thin and crispy.  I won’t even get into what happened the last time I bought a truck, but I think you have a pretty good idea.

This type of thinking often follows us into the emergency department.  More is better.  It must be true.  It makes me feel better, re-assured.  It seems to make my patients feel better too.  What could be the harm in a more is better approach to patient care?

When reports came out from the Institute of Medicine in 2000¹ and 2001² characterizing healthcare as unsafe and describing the strategy for improving the performance of our healthcare systems an era of measurement was born.  We started measuring, with the assistance of the electronic health record, we measured everything. 

We had data on nearly anything we did with accompanying graphs in full color, benchmarks, control charts, goals, and incentive plans to match.  Therein was the problem, we measured what we did.  We inadvertently and with the assistance of fear from our tort system and lack of consequence from our reimbursement models fueled physicians into practicing with a more is better philosophy. 

Unfortunately for our patients more is not always better.  More recently we have begun to look at the things we do in medicine that perhaps we should not have done.  In 2012 the Choosing Wisely³ campaign was launched and challenged medical specialties to identify those things commonly done but were shown to have no meaningful benefit to patients.  Instead of thinking about quality of care delivered defined by what providers did, they instead looked at quality of care defined by what providers didn’t do.  Choosing Wisely is now in it’s seventh year.  Many of you have no doubt heard about it and ACEP with help from emergency physicians like you and I have developed our own list of 10 things we shouldn’t be doing that we commonly still do. Please take a moment to look at the list.⁴ 

Were there any surprises?  I think many of us at one time or another have done some of the things in that list.  Even conceding that individual patient factors sometimes makes doing these things necessary there are still times where I know I’ve done some of the things on that list.  Often time the act of doing is easier than the act of taking the time to adequately explain why we are not doing something.  Sometimes just the idea of the conflict that awaits us as we attempt to do the right thing is enough to make us hit the sign button on an order.

Although not what I look forward to most on a shift, I think part of being a physician is having those difficult conversations where we hold ourselves accountable to doing the right thing, often with the patient and family understanding the decision making and appreciating the time it took to paint the picture for them, but sometimes having to place safe and quality care over patient preference and expectations.  More so today than in the past I also worry about not only how my decisions to order something might affect the quality of care delivered, but what type of financial burden I may be putting on my patients and their families.  It used to be more out of mind for me.  Most of my patients had insurance and my perception was that cost wasn’t a big part of the equation.  I don’t know about you but more and more of my patients either don’t have insurance or have insurance that really isn’t insurance with deductibles that are 10 times the amount of money they currently have in their savings account.  This makes me even more vigilant about those things that I might do that likely have no meaningful benefit to my patients as the harm may not be in the small radiation exposure, but instead in having them miss their rent payment or fail to fill a prescription.

I encourage all of you to be intentional not only about those things that are important for you to do to ensure you are delivering safe and high-quality care to your patients, but also the things you do not do to ensure you are delivering safe and high-quality care. Both are equally important.  Choose Wisely Wisconsin emergency physicians.

References:

1. Institute of Medicine. 2000. To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies Press
2. Committee on Quality Health Care in America, Institute of Medicine.Crossing The Quality Chasm: a New Health System for the 21st Century. Washington, D.C.: National Academy Press, 2001
3. Choosing Wisely: http://www.choosingwisely.org/
4. http://www.choosingwisely.org/wp-content/uploads/2015/02/ACEP-Choosing-Wisely-List.pdf

August is right around the corner and timing is right for ACEP members to advocate on behalf their profession and their patients in the ongoing surprise billing debate on Capitol Hill.

Register for our upcoming ACEP Advocacy Townhall to learn how you can effectively engage with your Senators and Representative while they are back home for the month and get answers in real time about the latest congressional activity from ACEP's Associate Executive Director of Public Affairs, Laura Wooster. 

ACEP Townhall: Advocating on Surprise Billing in the August Recess
Monday, August 5, 2019; 12:00 pm CDT  
Register Here

After registering, you will receive a confirmation email containing information about joining the webinar. 

Jeffrey Pothof, MD, FACEP

It’s the middle of summer and I’m sure many of you are busy both in the ED and outside of the ED.  I wanted to take a moment to provide a concise update on a few of the things WACEP is working on as we move the agenda of emergency physicians forward in Wisconsin.

We have been watching the news out of Washington D.C. closely as it pertains to recent legislation moving through the Senate and House on out of network balanced billing.  The Senate bill which was passed out of the HELP Committee is seen as less favorable than the current House version.  Secondary to action from stakeholders like ACEP the House version contains provisions for independent dispute resolution (IDR) which is important.  We still have work to do as the IDR provision will not apply to most emergency care, and we are working to advocate for better legislation like HR 3502, first introduced by emergency medicine physician Paul Ruiz.  Please consider taking a moment to contact your Senators and Representatives as they need to hear from us to make an informed decision.  It doesn’t take long: 

Click here to send editable messages to your U.S. Senators and Representatives

Like many of you we were disappointed by Governor Evers' veto of the $24 million for medical assistance funding that had been in the original budget.  To add insult to injury, recent rankings continue to show Wisconsin’s emergency physicians as dead last in Medicaid reimbursement.  With that said we are encouraged that opportunities may exist within DHS to secure funding via an alternative route.  The WACEP board will continue to work hard to ensure you receive fair compensation for the services you provide.

There has been recent discussion with WACEP and the Sheriff’s Association on whether there is a better process that might be considered around Chapter 51 commitments.  I don’t need to remind any of you how challenging and consuming of time and resources these cases can be, and we will continue to work with stakeholders to optimize the mental health process for our members and patients.

One of the things that I’m really looking forward to is our rural outreach event being planned for September 6th in Richland Center.  We have an exciting day planned with a hands-on ultrasound workshop, a visit from UW Med Flight and CHETA, and an update from Dr.Wheeler a stroke neurologist on recent updates to acute stroke care focusing on neuro-endovascular interventions and when you should be thinking about these treatment options.  After these events, the WACEP board is planning to spend some time relaxing while enjoying some good food and company.  We are really interested to hear from emergency medicine providers practicing all over the state no matter your background or journey into the specialty. All the details and registration can be found online.  There is no cost to register so please consider attending and getting to know us. I’d really enjoy meeting some of you.

Enjoy summer!

ACEP’s on demand course Alternative Methods to Pain Management (2018-2021) has been approved by the Wisconsin Medical Examining Board as meeting the requirements for two (2.0) hours of continuing education on responsible opioid prescribing per Med 13.03(3) of the Wisconsin Administrative Code.

Please consider emailing and/or calling your legislators! ACEP has been working tirelessly to advocate for EM and patients in the surprise billing debate, and now we have a bill we can get behind in the House! Help us educate Congress that H.R. 3502 is the best solution to protect patients and ensure the long-term viability of your profession. 

This is the only proposal that provides a level playing field for physicians and insurers, taking patients out of the middle of billing disputes while ensuring access to care. It is critical we immediately build momentum.  Contact your representative to ask for support for H.R. 3502.

The Wisconsin Poison Center (WPC) is gathering accreditation criteria for 2020 and seeking input from emergency physicians.  Please respond to this seven-question survey designed to gauge satisfaction from those who utilize WPC services.  

WACEP President's Message, June 2019
Jeffrey Pothof, MD, FACEP

“If you see something, say something” has become common vernacular in post 9/11 America.  I suspect most of us think of air travel when we hear that phrase, but the phrase is equally applicable to healthcare and the environments we work in.

One of the most important aspects of safety culture in healthcare is the ability of anyone on our teams to say something when they know or suspect that something is amiss.  This includes everyone on our teams.  From providers to nurses to techs to volunteers and other supporting staff.  The more people who are being sensitive to how things are supposed to work the more likely we are to identify a problem before it ruins our day, or even worse, harms our patient.

Although this idea may seem intuitive and all of us would nod in agree that we as providers expect the rest of the team to speak up if they think a patient may be harmed, I’ve seen repeatedly in my work within patient safety that someone saw or knew something but didn’t say anything.  Many will be quick to blame the person who said nothing however the problem is rarely the person.  We hear things like “no one acknowledged my concerns before, why would I make the effort to say something this time”, or “the provider put me in my place the last time I raised a concern that turned out to be nothing, so now I just stay quiet because they know what they are doing”.

One of my mentors once told me that as physicians we don’t get a choice as to whether we want to be leaders or not.  The only choice we get is whether we are going to be good leaders or not.  Many on our teams in the ED look to us for guidance and tone setting whether we want that responsibility or not.  When it comes to saying something when you see something, I don’t think as providers it’s enough to raise our hand or speak up when we see something that isn’t right.  I think our role is also to communicate directly and with intention to our teams that we expect everyone on our teams to say something when they see something, and then have to foresight to identify when that is occurring and show respect to them while reaffirming that speaking up was the right thing to do--irrespective of whether they were right or wrong.  This is how we can change culture, and this is how we can keep patients safer.

Surprise billing is the most important issue facing emergency physicians today. Building on momentum from ACEP President Dr. Vidor Friedman’s testimony to Congress this week, ACEP is amplifying our efforts as we battle the insurance lobby and advocate for policy solutions that protect patients and support emergency physicians.

ACEP leadership is hosting an interactive townhall discussion on surprise billing — this is your chance to speak directly with ACEP leadership; stay current on the latest activity on Capitol Hill, get the latest news, hear about the recent flurry of Congressional activity and ACEP-supported policy, ask questions, and learn more about how you can act now and get involved.

Please join us Monday, June 17th at 4pm EST for an ACEP member-only Advocacy Townhall on Surprise Billing.

ACEP Advocacy Townhall: Surprise Billing
Monday June 17th at 4pm EST
Featuring: Vidor Friedman, MD, FACEP, President of ACEP, and;
Laura Wooster, MPH, Associate Executive Director, Public Affairs

Register here:
https://acep.zoom.us/webinar/register/WN_LXsbBBa2QjiIlXqThZWamA

Please register for townhall access whether you plan to watch live or view the townhall on-demand at your convenience.