Latest News

  • May 18, 2022 1:28 PM | Anonymous

    ACEP’s Legislative and Advocacy Conference was in Washington DC May 1-3 of this year. WACEP had five attendees this year (including one virtual). They met with 6 (of 8) of the congressional offices as well as both senator offices regarding several topics important to Emergency physicians.

    Senator Baldwin made a special guest appearance this year speaking at a special lunch event on “Diversity in Action: Women in Politics.” Senator Baldwin is also the author of “The Workplace Violence Prevention for Health Care and Social Services Workers Act.” This bill, which has corresponding legislation which already passed the House asks OSHA to issue a standard which would require workplace violence prevention plans be considered by hospitals.

    The group also discussed with their representatives the instability of Medicare with a total of a 9% cut anticipated at the end of year unless Congress acts. This is the result of anti-inflationary and budget neutrality policies of CMS. Essentially, even though we are netting 10,000 beneficiaries per day being added to the Medicare role, Congress and CMS have decided that we won’t be spending additional funds to deliver this care. In the past, congress had elected to forego this requirement such that rates are not cut for the subsequent year. This goes without saying with inflation increasing the disparity between the consumer price index (CPI) and physician reimbursement by the Medicare system will continue to grow as it has for the last 20+ years. Our ask at this point is the congress act before the end of the year to avoid cuts to Medicare reimbursement rates as well as consider a permanent fix to this so we can avoid this issue year after year.

    LAC 2023 is scheduled from April 30-May 2, 2023. Please email us at WACEP@badgerbay.co should you have interest attending next year or add yourself to the interest list to get the latest updates from ACEP: https://www.acep.org/lac/interested/


  • April 27, 2022 9:10 AM | Anonymous

    Ukrainian Medical Association of North America (https://umana.org/)  are working with the Illinois chapter (https://www.facebook.com/UMANAIllinois) to build out a medical supply pipeline from Chicago O'hare to Ukraine via Lublin, Poland.  2 cargo flights of up to 100 tons have already gone over

    They are now running a parallel operation here in Wisconsin through a donated warehouse outside Milwaukee (https://www.facebook.com/UMANA.Wisconsin)

    There's a list of high need medications and supplies here, but basically anything you would need in a trauma suite and in trauma aftercare are the highest needs:

    http://umanawisconsin.org/

    The Milwaukee Rotary is helping to organize. People can sign up to volunteer for this drive and/or future ones here

    http://milwaukeerotary.com/bigdreamslocally/ukraine-support/

    You can also directly donate to UMANA (https://umana.org/UkraineDonation.php


  • April 23, 2022 10:50 AM | Anonymous

    Happy Spring WACEP,

    Thank you to everybody who was able to make it to the WACEP Spring Symposium this week. While “Getting the Band Back Together” was an appropriate and catchy slogan, it really was amazing to gather IN PERSON for the first time in three years and I look forward to this again being an annual event.  The ability to reconnect with so many across the state, to learn from some from expert lecturers and innovative research, and to celebrate some of the accomplishments of WACEP and some its individual members was simply wonderful.  I wanted to use this opportunity to also recap the report I shared during our business meeting:

    • This was another busy year in the state legislature with some significant wins for WACEP that really demonstrate the power and value of WACEP.  Just a few (very important) highlights include the governor’s veto of the APRN bill and the long overdue Medicaid reimbursement rate increases.
    • WACEP hosted a webinar in January that included updates on pediatric respiratory care as well as OB emergencies, targeted at providers who may practice in more resource limited sites.  We are looking at expanding this valuable resource to our members across the state.
    • WACEP membership numbers continue to remain steady with 538 total members.  Please encourage any partners you have or colleagues who are not a member of WACEP to consider joining
    • WACEP continues to be in a very good financial position ending 2021 with approximately 38 months in operating reserves.
    • Congratulations to the award winners who were announced.  This includes:
      • WACEP Resident Advocate Award:
        • From UW: Dr. Rudi Zurbuchen
        • From MCW: Dr. Paul Benz
      • WACEP Distinguished Service Award: Dr. Jeff Pothof
      • WACEP Past President’s Award: Dr. Brad Burmeister

    Thank you again to all who worked so hard to organize such an incredible event as well as all our sponsors and exhibitors who made this event possible.

    Please as always, let us know what WACEP can do to support you and the important work that you do and THANK YOU!!

    Best,
    Brian


  • April 23, 2022 10:48 AM | Anonymous

    WACEP Legislative Report
    Hubbard Wilson & Zelenkova
    April 20, 2022

    The two-year legislative session ended in March, which means that all legislation previously introduced that did not pass is dead. 

    SB 394/AB 396 – the APRN Bill - authored by Senator Patrick Testin, Rep. Rachel Cabral Guevara did of course pass both houses of the legislature.  We are very happy to report that the Governor vetoed this legislation last Friday.   While the bill was improved slightly in the assembly to at least include two years of clinical experience before an APRN could practice independently, it was not improved enough.   To that end we advocated for the veto including the grassroots action alert and countless meetings along the way with the Governor’s team. 

    In the end, the physician coalition’s position was, and continues to be, that the bill needed to include at least the following: 

    1.  4 years of clinical experience as a requirement for independent practice - 2 years as an RN and 2 years as an APRN or 4 years as an APRN.   (This requirement would at least be relatively on par with many medical residencies.)

    2.  For the practice of pain management, continue to require collaboration with a physician, specifically with a physician trained/experienced in pain medicine.  (This is a basic guardrail that still provided far more leeway than our pain specialists were comfortable with given the complexities of pain medicine and chronic pain management). 

    3. Explicit “Truth in advertising”/“Title Protection” for physician specialty titles and terms associated with physicians. This is the one true ask of physicians in defense of their profession and credential and is basic common sense to include in a bill that will no doubt reduce transparency and increase confusion among patients in a new universe of “independent practice”.  

    The Assembly moved forward without addressing all of our concerns - adopting an amendment that only included the following:

    1.  2 years (3840 hours) of clinical experience as an APRN before being allowed to practice completely independently.

    2.  Require physician collaboration for an APRN to practice pain management independently; except if the APRN is working in a hospital or in a hospital affiliated clinic - then no collaboration requirement.  (It does not include that the collaborating physician be a physician who is trained and experienced in pain medicine.)   So that’s worse than current law, slightly better than the original bill, but not enough.

    We expect this bill to come back next session regardless of election outcomes.  Interesting note: the senate author Testin is running for Lieutenant Governor and the assembly author, Cabral Guevara, is running to replace Roger Roth who is retiring from his Appleton senate seat to also run for Lt. Governor. 

    SB 532/AB 529, introduced by Senator Kathy Bernier of northwestern Wisconsin and Rep. Jesse Rodriguez of Oak Creek / Milwaukee County, created a regulatory framework for naturopaths.   Naturopaths were not regulated at all in WI.  WMS negotiated a compromise on this bill  and the result rewrites the legislation in a way that significantly skinnies down the overall scope that includes the creation of a regulatory board that will NOT have future scope rulemaking abilities; naturopaths are prohibited from prescribing controlled substances; the title “naturopathic medical doctor” is NOT allowed; and a specific provision in the definitions sections regarding what naturopaths are allowed to do makes it clear that it is distinct from the definition of “practice of medicine and surgery” that applies to physicians.  AB 529 was signed into law by the Governor with the compromise amendment. 

    Emergency Psych:   Proposed JFC 13.10 request re: crisis stabilization:  Governor Evers’ 2021-23 biennial budget recommended $17.6 million GPR and statutory changes to establish and support crisis urgent care and observation centers as a new provider category, as well as support short-term residential crisis stabilization and inpatient psychiatric beds. The Legislature did not adopt the Governor’s recommendation and instead placed $10 million GPR in the Committee’s appropriation for crisis services.

    DHS has drafted a request to the Joint Finance Committee for the transfer of funds from the Committee’s appropriation to support grants to strengthen the system under current law. The Department plans to award the funds in FY 23 through a competitive grant application process to organization(s) that aim to support and improve regional crisis intervention and stabilization services through a county-based collaborative approach.

    Certified county crisis programs will be invited to apply for the funding opportunity focused on partnership with local agencies such as law enforcement, providers of crisis supports, or hospital systems. The grants can be used to expand or enhance current operations in the county crisis system with the intention of reducing the number of emergency detentions in inpatient facilities and reducing the burden on law enforcement in responding to and transporting individuals in crisis.

    This proposal has been discussed with the EmPsych Taskforce.  No sense on whether this is going to move forward sat this point. 

    Surprise Billing/NSA:  While the federal No Surprises Act and the interim rule are in effect, in a recent development, the U.S. District Court for the Eastern District of Texas vacated some problematic provisions of the Interim Final Rule related to the independent dispute resolution process.  The lawsuit was brought by the Texas Medical Association.  The decision will likely be appealed but if it stands will hopefully balance out the unfair advantages health insurance companies have in the interim rule’s IDR process.  ACEP, the American College of Radiology, and the American Society of Anesthesiologists have an ongoing challenge to similar provisions of the rule in a District Court in Chicago.  WACEP has interacted with the WI OCI recently on this issue but it appears clear that OCI will be strongly deferring to the federal law and rule.  Input was shared on some ways to simplify processes in Wisconsin regarding identification of what type of plan a patient is insured by to know if NSA even applies.  We do not know yet whether this input was well-taken.   

    Redistricting:  State legislative boundaries are still in limbo.  Previously the WI Supreme Court chose maps drafted by Governor Evers.  Its ruling was appealed to the US Supreme Court which overturned the decision related to concerns on the number of “majority-minority” districts in the Milwaukee area.  The WI Supreme Court, as opposed to only adjusting the districts that SCOTUS took issue with, went in a very different direction and instead selected the proposal submitted previously by legislative republicans.  We expect this decision to also be appealed to the US Supreme Court.  Whether the high court will hear it, remains to be seen.  But it appears that new district lines – at least in state assembly and senate seats – remain in uncertain for a few more days or even weeks.  

    Legislative Not Running for Re-election in Current Office: 

    Congress

    • District 3 - Ron Kind (D) - Not Seeking Re-election

    State Senate:

    • District 15 – Janis Ringhand (D) – Not Seeking Re-election
    • District 25 – Janet Bewley (D) - Not Seeking Re-election
    • District 27 – Jon Erpenbach (D) - Not Seeking Re-election
    • District 23 – Kathy Bernier (R) - Not Seeking Re-election
    • District 19 – Roger Roth (R) - Running for Lt. Governor
    • District 29 – Jerry Petrowski (R) - Not Seeking Re-election
    • District 5 – *Dale Kooyenga (R) (If he stays drawn out of seat after Redistricting)

    State Assembly:

    • District 5 – Jim Steineke (R) - Not Seeking Re-election
    • District 6 – Gary Tauchen (R)  - Not Seeking Re-election
    • District 10 – David Bowen (D) – Running for Lt. Governor
    • District 13 – Sara Rodriguez (D) – Running for Lt. Governor
    • District 15 – Joe Sanfelippo (R)  - Not Seeking Re-election
    • District 27 – Tyler Vorpagel (R) - Not Seeking Re-election
    • District 31 – Amy Loudenbeck (R)  - Running for Sec. of State
    • District 33 – Cody Horlacher (R) - Not Seeking Re-election
    • District 45 – Mark Spreitzer (D) – Running for Senate
    • District 46 – Gary Hebl (D) – Not Seeking Re-election
    • District 52 – Jeremy Thiesfeldt (R)  - Not Seeking Re-election
    • District 54 – Gordon Hintz (D) - Not Seeking Re-election
    • District 55 – Rachel Cabral-Guevara (R)  – Running for Senate
    • District 59 – Tim Ramthun (R) - Running for Governor
    • District 61 – Samantha Kerkman (R) – Won Kenosha County Executive Race
    • District 68 - Jesse James (R)  – Running for Senate
    • District 73 – Nick Milroy (D) – Not Seeking Re-election
    • District 74 – Beth Meyers (D) - Not Seeking Re-election
    • District 79 – Dianne Hesselbein (D) - Running for Senate
    • District 80 – Sondy Pope (D) – Not Seeking Re-election
    • District 82 – Ken Skowronski (R) - Not Seeking Re-election
    • District 84 – Mike Kuglitsch (R) - Not Seeking Re-election

    Notes: 

    Sen. Brad Pfaff (D) (SD 32) – free shot at CD 3

    Sen. Patrick Testin (R) (SD 24) – free shot at Lt. Gov.


  • February 28, 2022 9:07 PM | Anonymous

    Fellow designation speaks to your contributions to ACEP and highlights your commitment to emergency medicine. Congratulations to our newest class of FACEP designees! Congratulations to WI ACEP's own Shera Teitge, MD, FACEP and Scott Kunkle, DO, FACEP your Fellow Designation!

    Learn more at acep.org/FACEP.


  • February 22, 2022 4:11 PM | Anonymous

    ATLS Instructor Course is a 1–1½-day course designed for MDs who satisfy the qualifications and characteristics of the model ATLS Instructor. The Instructor Course teaches MDs how to teach in the ATLS Program. Established educational principles form the foundation for the design and development of the Instructor Course. These principles are essential to the conduct of the course, and the basic course de¬sign may not be altered to fit individual or institutional desires. Learning is enhanced when the process occurs within a short period during which cognitive activity is closely linked in time and content with application of teaching skills. Therefore, the course is conducted over a 1–1½ day consecutive period with a mutual sequencing of learning and teaching skills.

    You may register for this course on MyLearning or through the Education Hotline at 651-254-7788


  • February 22, 2022 4:11 PM | Anonymous

    No Surprise Act Update and Resources
    Written by: Lisa Maurer, MD - Legislative Committee Chair

    As of January 1st, the No Surprises Act prohibits emergency physicians from billing patients for the balance of charges after an out-of-network payor pays for the services, a practice historically referred to as “balanced billing.” Relatedly, it provides a mechanism for negotiation and arbitration if the physician does not find the payment to be reasonable. WACEP has been closely tracking progress of this federal law, participating in federal advocacy on behalf of emergency physicians as the regulations have been released over the last year, and is now staying up to date on implementation in our state.

    National ACEP has published a fantastic website displaying an overview of the No Surprises Act with infographics and tables.

    In Wisconsin, almost all processes for out of network billing will revolve around federal law, regulation, and enforcement of those requirements. As opposed to some other states, Wisconsin does not have it’s own law governing balanced billing practices and determination of payment for out-of-network services. The Wisconsin Office of the Commissioner of Insurance (OCI) recently held a public hearing where it was outlined what portions of the new federal process they would be responsible for enforcing as opposed to federal CMS. OCI will be enforcing compliance for claims for services provided to patients insured by individual and group commercial insurance products. CMS will enforce compliance for federally regulated ERISA (employer funded) insurance products. CMS will oversee all remaining processes including determination of qualifying payment amounts and independent dispute resolution.

    There are multiple lawsuits currently in process against the federal government regarding the regulations that determine how arbiters would determine the reasonable payment amount for out of network services. ACEP is involved in one of those lawsuits, having filed suit against the federal government along with the federal specialty societies for anesthesiologists and radiologists, charging that the rules released last year are in conflict with the law that Congress passed in late 2020. Although we must move forward with processing bills according to the rules as they stand now, WACEP will keep you informed of any changes based on legal action going forward.

    If you would like to receive updates regarding the No Surprises Act from the Wisconsin OCI, please request that you be added to a recipient list by emailing ocinsacomplaints@wisconsin.gov with your name, email, phone number and address. For more information, please see OCI’s summary of the No Surprises Act or feel free to contact WACEP at WACEP@badgerbay.co


  • February 22, 2022 4:09 PM | Anonymous

    The WACEP is pleased to announce that the nominations for the 2022 Distinguished Service Award is now open!

    The Distinguished Service Award recognizes a WACEP member who has made extraordinary contributions to the advancement of the emergency medicine specialty, and who has demonstrated the ideals of the organization through their ongoing activities and accomplishments.

    Nomination Deadline: March 1

    Nominate Someone Today!

  • February 22, 2022 4:08 PM | Anonymous

    President's Message, February 2022
    Brian Sharp, MD

    For those of you who tuned in for the Super Bowl, how incredible was that halftime show?  While it has generated plenty of hilarious memes poking fun at people like myself who were able to relive their “glory days,” I sure enjoyed all the artists getting back together for this show.  Whether or not the show featuring the music of Dr. Dre, Snoop Doggy Dogg, and Mary J Blige among others was targeted to your generation or your music taste, it does provide me with a great excuse to remind everybody about the upcoming WACEP Spring Symposium—April 20th and 21st.  Appropriately themed, “Getting the Band Back Together,” this will be an opportunity for us to finally gather, to learn together, and to celebrate the amazing work being done across our state.  To highlight some of the various reasons to attend, what better way than to quote some of the Super Bowl performers.

    You can teach an old dog new trick if that old dog listens.

    -Snoop Dogg

    The WACEP Spring Symposium is packed with rich educational opportunities.  This includes keynote speakers, Dr. Tom Aufderheide and Dr. Gail D’Onofrio as well as talks on topics ranging from ED critical care to ED dental trauma.  You won’t want to miss the high yield “Hot Topics” roundtable discussions or the “Unique Procedures Workshop.”  Lastly, the popular LLSA Article Review Workshop returns—use this to knock that off your to-do-list.

    Never let me slip cuz if I slip then I’m slippin’

    -Dr. Dre

    The WACEP research forum is an incredible opportunity to see the cutting-edge research work being done in Emergency Medicine across our state.  There will be numerous oral and poster presentations to learn from and a chance to celebrate the great achievements of our statewide researchers.

    My mind on my money and my money on my mind

    -Snoop Dogg

    After 2 years of limited opportunities for in person conferences—including many conferences canceled, many of you have may extra CME money to use.  Take this opportunity to do that in a packed, fun conference—one where you don’t even have to fly.

    Sunny days wouldn’t be special…if it wasn’t for rain.

    Joy wouldn’t feel so good…if it wasn’t for pain.

    -50 cent

    Let’s be honest, the last two years have been rough at times.  April will be a great time to finally come together, to celebrate the value of emergency medicine and to grow relationships with our colleagues from around the state.  It has been three years since we were able to last hold our WACEP Spring Symposium in person and we have all been through a lot personally and professionally.  Let’s make this one count!!

    So don’t forget to make your plans now, to register for the conference, and hopefully I will see you all in April in Milwaukee. 

    Best,

    Brian

    Please do not hesitate to reach out to me if WACEP can help you or if you would like to connect.  My email address is bsharp@medicine.wisc.edu.


  • February 18, 2022 2:03 PM | Anonymous

    Congratulations to WACEP's Resident Representative and Symposium Planning Committee Member, Dr. Matthew Stampfl, University of Wisconsin School of Medicine, on being the winner of the Essentials of Emergency Medicine 2022 blog post contest! Here is the winning post! 

    Written by Matthew Stampfl

    The Controversy | Topical TXA for Epistaxis
    An 83-year-old male with history of dementia and atrial fibrillation on warfarin comes in with bleeding from the nose for the past 90 minutes. Direct pressure doesn’t seem to have helped, but his caregiver really wants to avoid packing if possible, since he became extremely agitated last time he received it. Your attending says to pull out the vial of TXA, but you ask: “Wait, wasn’t there a recent study that found TXA didn’t help?”

    The Case for TXA
    TXA is a fixture in algorithms for epistaxis, including a recent one promulgated by the New England Journal of Medicine. This is based on multiple smaller studies showing promising efficacy.

    For instance, a 2018 RCT included 124 patients with epistaxis on antiplatelet agents and compared topical TXA (500 mg) on a pledget to topical lidocaine-epinephrine on a pledget followed by nasal packing. Patients were only eligible for inclusion if 20 minutes of direct pressure failed to resolved their symptoms. The primary outcome was cessation of bleeding within 10 minutes, which occurred 73% of the time in the TXA group vs 29% in the lidocaine-epinephrine/nasal packing group.

    Another RCT in 2019 took 135 patients and split them between three arms: atomized TXA (500 mg) with compression, nasal packing with Merocel, and compression alone. Primary outcome was cessation of bleeding within 15 minutes. This occurred 91.1% of the time in the TXA arm vs 93.3% in the Merocel packing arm and 71.1% in the compression alone group. On analysis, both TXA and Merocel were significantly better than placebo, though they were not different from each other.

    The Argument Against
    However, the largest RCT (NoPAC, 2021) on TXA in epistaxis comes to a different conclusion. It was a double-blinded multicenter RCT which enrolled 496 patients with epistaxis that failed to resolve with 10 minutes of direct pressure followed by topical vasoconstrictor application and then another 10 minutes of direct pressure. Patient were randomized between TXA or saline delivered via cotton wool dental rolls (the UK’s equivalent to pledgets). The protocol called for 200 mg TXA soaked into the dental roll which was held in place in the nare via nasal clip for ten minutes. If this did not control the bleeding, the treatment would be repeated once. Primary outcome in this trial was need for anterior nasal packing, which was placed at the discretion of the treating clinician. There was no significant difference in rates of packing between the groups, with 43.7% of the TXA undergoing packing vs. 41.3% of the placebo group.

    My Take and Recommendations
    So where does this leave us? We want to be evidence-based, and the largest study on the topic calls into question whether TXA in epistaxis improves outcomes. On the other hand, we know our 83-year-old won’t tolerate packing well, and we would like to spare him (and us) that experience if possible.

    Digging into the NoPAC trial reveals a few differences that might contribute to its divergent findings. For one, TXA was given as a 200 mg dose x 2 rather than the single 500 mg used elsewhere. Moreover, all patients enrolled in NoPAC had to first fail a topical vasoconstrictor, which potentially selects a somewhat different patient population. Finally, NoPAC was conducted in the UK, which may limit generalizability to the US given practice variation (e.g. UK patients who undergo nasal packing are admitted for an average of three days). 

    A 2021 systematic review of topical TXA in epistaxis included 1,299 patients across 8 studies (including NoPAC). Unfortunately, NoPAC was excluded from the analysis of bleeding cessation because its outcome was avoiding packing, but the remaining trials showed that TXA had 3.5 times greater odds of bleeding control at first reassessment.

    Thus, the evidence isn’t clear. But as with all treatments we provide to our patients, we have to weigh the risks and benefits. On the benefit side of the ledger, it is unclear if TXA will help this patient to avoid packing. Conversely, topical TXA has minimal adverse effects, is quite inexpensive and won’t take long to trial. Given the negligible downsides of TXA and the known harms of packing this patient, let’s give TXA a try!

Wisconsin Chapter, American College of Emergency Physicians
563 Carter Court, Suite B
Kimberly, WI 54136
920-750-7725 | WACEP@badgerbay.co



© Wisconsin Chapter, ACEP. All rights reserved.