WACEP congratulates five well-deserving members for being among the newest group to meet the eligibility requirements and achieve Fellow Status of the American College of Emergency Physicians. The following individuals will be recognized next month during ACEP16 in Las Vegas:

• Gemma C L Bornick, MD of Green Bay
• Suhas Channappa, MD of Marshfield
• Alex A Pasquariello, MD of Fitchburg
• Brian W Patterson, MD of Madison
• Louis J Scrattish, MD of Madison

ACEP Fellowship was first established in 1982 to honor members who made special contributions to the College and the specialty of emergency medicine. Requirements for Fellow Status include Active membership status for three continuous years; board certification by ABEM, AOBEM, or ABP certification for pediatric emergency physicians; and additional service to the specialty. In Wisconsin, 176 WACEP members are currently Fellows of the American College.

August 17, Wisconsin Health News

Wisconsin hospitals saw more visitors to their facilities and emergency rooms last year, but patients were there for shorter periods of time, according to a report recently released by the Wisconsin Hospital Association.

Emergency room visits shot up 4.7 percent in 2015 to 1.79 million, compared to 1.71 million in 2014, while hospitalizations at general medical-surgical hospitals inched up 0.2 percent to 580,881. The average length of stay decreased 0.5 percent from 4.2 days to 4.1.

Meanwhile, the average charge per hospitalization grew 5.2 percent to $32,197.

Brian Potter, senior vice president at the Wisconsin Hospital Association, said charges are going up because of rate increases, as well as the trend of lower cost discharges moving to the outpatient setting, increasing the acuity of inpatient stays. 

The downward trend of length of stays, which were 4.7 days in 2000, is significant because many of the short stay cases are now done on an outpatient basis, according to Potter. He attributed the increase in ER visits to the federal health reform law's coverage expansion.

"People with coverage tend to use more services and if they are new to the system, they often begin with an ER visit," he said.

The most common reason for going to the hospital was childbirth, representing 16 percent of all hospitalizations. In the emergency room, abdominal pain was the most frequent diagnosis, accounting for 6 percent of visits.

View WHA data here.

Bobby Redwood, M.D., M.P.H.
President, Wisconsin Chapter, American College of Emergency Physicians

August is national immunization awareness month and a great opportunity to discuss the role that Wisconsin emergency physicians play in immunization care. We all know that every emergency is a failure of prevention, so some careful planning now can help us stave off the flood of infectious diseases that is bound to hit our ED's during the winter months.

While the southern US is scrambling to deal with Zika, we northerners already know who our enemy will be this winter: influenza. Wisconsin department of health services releases weekly influenza reports and rates this week remain low in all regions of Wisconsin. Typically our influenza numbers start to skyrocket in the second week of November and don't level off again until the second week of May. That's seven months of headaches, body aches, and pediatric fevers that we would rather not have end up on our doorstep. In the 2015-2016 flu season, Wisconsin saw 5,136 cases of influenza...and that's just the cases that were confirmed.

So let's talk prevention! For those vaccine geeks out there, the trivalent vaccines for use in the 2016-2017 influenza season will contain the following virus-like strains: A/California/7/2009 (H1N1); A/Hong Kong/4801/2014, and B/Brisbane/60/2008. No one knows (yet) what strains the 2017-2018 vaccine will contain...let's hope its not called A/Wisconsin/2016. We'll find out soon enough, CDC expects the 2016-2017 vaccine to available later this month for at-risk populations and available for all populations by the first week of September. 

On your next shift, take some time to educate your patients about the importance of getting their flu shot early. How about celebrating August by taking the WACEP national immunization awareness month challenge: try to educate one patient in each of the following age groups about the importance of vaccination in general:

• Parents: Emphasize the important role vaccines play in protecting their child's health;
  
• College students: Remind them to talk to their healthcare professional about any vaccines they may need for school entry;
• Adults, especially older adults and adults with chronic conditions: When appropriate, encourage vaccines for shingles, pertussis, pneumococcus, and flu;
• Pregnant women: Talk about getting vaccinated to protect newborns from diseases like pertussis and flu;
• Everyone: Let Wisconsinites know that the next flu season is only a few months away.

August 4, Wisconsin Health News

Gov. Scott Walker on Thursday appointed Linda Seemeyer to serve as secretary of the Department of Health Services. Seemeyer served as director of the Walworth County Department of Health and Human Services from 2007 to 2015. She was also director of the Milwaukee County Department of Administrative Services and deputy secretary of the Department of Administration under Gov. Tommy Thompson.

Seemeyer starts Aug. 22. She succeeds Kitty Rhoades who passed away in June. Interim Secretary Tom Engels will resume his duties as deputy secretary.

August 3, Wisconsin Health Information Organization

The Wisconsin Health Information Organization (WHIO) has named Dana Richardson its new CEO. Richardson succeeds Josephine Musser who is retiring.

Richardson has been serving since April as Acting Executive Director of the non-profit PCPI® Foundation in Chicago. Previously, she served six years at the American Medical Association (AMA) as Director of Operations and Strategic Initiatives for the PCPI, which was originally convened by the AMA. From 2002-2010, Richardson was Vice President for Quality Initiatives at the Wisconsin Hospital Association (WHA).

With a BS in Nursing and an MA Business, Health Service Administration from the University of Wisconsin-Madison, and prior experience at St. Mary’s Hospital in Madison and the Dean Health System, Richardson has deep ties to Wisconsin’s health care system, as both a provider and administrator, beginning in 1983.

“Dana Richardson is a proven leader who thinks strategically and acts decisively, setting goals, solving problems and seeing tangible results,” said WHIO Board Chair Linda Syth. “Her background in quality and efficiency at the local and state level in Wisconsin, along with her work at the national level with physician societies and performance measurement, make her uniquely qualified to engage caregivers where their heart is – great patient care. We’re delighted to welcome Dana to WHIO,” Syth said.

WHIO provides health care information to consumers, clinicians, providers, employers and payers to support decision-making. “I am excited to be joining an organization focused on the quality, safety and affordability of health care. Knowing that Wisconsin is a high value state for health care services, my goal is to further leverage the WHIO information to set a higher bar,” said Richardson.

Richardson will assume her new post on August 30th and collaborate with outgoing CEO Jo Musser until the end of the year to ensure a smooth transition.

The Wisconsin Health Information Organization (WHIO) is a non-profit 501(c)(3) organization dedicated to improving the quality, affordability, safety and efficiency of health care in Wisconsin.

The Wisconsin Medical Examining Board (MEB) approved best practice guidelines for opioid prescribing at its monthly meeting in Madison in July. This action is a result of Wisconsin State Assembly Rep. John Nygren’s HOPE legislative package; 2015 Act 269 granted the MEB authority to post the guidelines, which are inspired by those already in place from the Centers for Disease Control and Prevention and the state’s Worker’s Compensation program.

While the guidelines are not mandatory practice parameters, they are expected to assist physicians with making more informed decisions about their prescribing practices. Click here to view the guidelines.

The MEB also moved closer to finalizing new continuing medical education (CME) rules that will eventually require physicians to include coursework on the new guidelines as part of their 30 hours per biennium requirement. The likely outcome of this CME-related rule will be:

All physicians who have a Drug Enforcement Administration (DEA) number will be required to take two credits of CME in prescribing-related areas as part of their biennial 30-credit total.

This requirement will take effect for the next two complete CME reporting cycles (essentially for 2017-2019 and then again for 2019-2021).

The first time a physician satisfies that two-credit requirement, the CME will need to include information on the new opioid prescribing guidelines. (It is likely the Wisconsin Medical Society’s opioid prescribing webinar series, which is now available on-demand, will be grandfathered in as satisfying the guidelines-related subject matter requirement.)

The second time the physician satisfies the two-credit requirement, it can be in the arena of “responsible controlled substances prescribing.”

This requirement COULD end after two CME cycles—it will depend on the status of the opioid crisis and whether or not the MEB continues the requirement for future cycles.

The MEB is expected to finalize these requirements at its meeting later this month.

Bobby Redwood, M.D., M.P.H.
President, Wisconsin Chapter, American College of Emergency Physicians

Wisconsin ACEP is in the midst of a productive and exciting year. Here’s a recap of some of what the Chapter has been up to: 

• Vision—a Three-Prong Approach. WACEP will take stock of our resources and establish three concrete goals addressing this question: What can we do for our specialty, for our physicians, and for our patients? Member feedback is important as we craft strategic goals for 2017. Contact us!
• Fair Payment: EM Medicaid reimbursement rates in Wisconsin are worst in the nation. We have developed a task force to explore legislative solutions to achieve fair payment.
• WACEP Website: Keep an eye out for a newly designed Chapter website, which should go live by early fall.
• WMS House of Delegates: WACEP now has three emergency physicians serving in the Wisconsin Medical Society’s House of Delegates. We hope to increase the influence of emergency medicine in the broader house of medicine in Wisconsin.
• Wisconsin EM CME Conference: WACEP is currently exploring the logistics of hosting an annual Wisconsin Emergency Medicine CME conference.

Thank you for your service to emergent patients in Wisconsin and your involvement with Wisconsin ACEP. Remember to check the Wisconsin ACEP website for updates on legislative victories, educational opportunities, resident scholarships, and more! 

July 21, Wisconsin Health News

A subcommittee of the Medical Examining Board tasked with developing rules on telemedicine anticipates sending a final version to the board for approval later this fall.

The board first drafted the proposed rules last year but formed a subcommittee to rewrite them after hospitals and others raised concerns at a January public hearing. The new set of rules, modeled on those approved by the state of Florida, is less prescriptive than the original set.

Members of the subcommittee said Wednesday they plan to revise the proposal to reference physician assistants. The Wisconsin Academy of Physician Assistants called for the change.

According to the academy, physician assistants "are already experiencing difficulty being authorized to provide telemedicine by certain health systems."

Elli Health, a Wisconsin-based telehealth company, wrote that they had some concerns about Florida's rules. But after seeing the Wisconsin proposal, they said their concerns had been addressed.

Mark Grapentine, senior vice president of government relations at the Wisconsin Medical Society, praised the board's process.

"I really appreciate how you guys have done this and how you responded from the initial go-around, which was interesting to say the least," Grapentine told board members. "I think you've pivoted to an area that will be helpful for you and understandable for the folks out in the field."

Dr. Kenneth Simons, the board's chair, said they hope to have an additional public hearing on the rule later this fall before deciding to approve it.

July 6, Wisconsin Health News

Sen. Ron Johnson, R-Wis., lauded a proposal Wednesday from the Department of Health and Human Services to sever the connection between Medicare funding and pain management questions on a survey of consumers. 

HHS plans to remove the link between Medicare funding and pain management questions on the Hospital Consumer Assessment of Healthcare Providers and Systems survey.

Hospitals would continue to use the same questions in the survey, but those questions wouldn't affect the level of payment they received, HHS announced Tuesday.

Johnson introduced legislation earlier this year that would have made the federal government unable to tie reimbursement to pain outcome measures.

"Removing questions from payment calculations that could lead to inappropriate pressure on doctors is a bipartisan, commonsense solution to tackling the enormous challenges we face in the ongoing opioid epidemic," Johnson said in a statement. He called the proposal "the responsible thing to do."

Dr. Timothy Westlake, vice-chair of the state's Medical Examining Board called Johnson's bill "the single most important piece of federal legislative reform" at an April congressional field hearing in Pewaukee. 

U.S. Senate Committee on Health, Education, Labor and Pensions Chair Lamar Alexander, R- Tenn., called the HHS announcement a "big win for Senator Johnson, for the people of Wisconsin and for the country."

"These survey questions had the unintended consequence of actually encouraging the overprescribing of painkilling opioids," Alexander said in a statement. "I'm glad to see the administration correct this mistake by removing them from Medicare payment calculations."

HHS Secretary Sylvia Burwell said that they've heard from physicians that some have felt pressure to overprescribe opioids because of the questions. 

"While we haven't found evidence to support this concern, out of an abundance of caution, we have proposed a rule to change that," Burwell said on a conference call with reporters. 

HHS also released a request for information to seek provider, consumer and other public comments on current prescriber education and training programs on Tuesday.

Other federal agencies announced steps to combat the opioid and heroin epidemic as well. Indian Health Service will require its prescribers and pharmacists to check their state PDMP databases before prescribing any opioid for more than seven days. 

The Department of Veterans Affairs will also require prescribers in most cases to check state PDMPs before prescribing a new controlled substance.

November 19, Wisconsin Medical Society

As part of its extraordinary session day on Monday, the Wisconsin State Assembly approved an amendment made by the State Senate to Assembly Bill 253, legislation allowing Wisconsin to join the Interstate Medical Licensure Compact. By concurring with the Senate’s change, the bill now goes to Gov. Scott Walker for his final action. The Society anticipates the Governor will sign the bill into law in the next few weeks.

The Compact cuts administrative red tape for physicians who wish to apply for a medical license in multiple states by eliminating the need for each state to separately re-verify the same basic information about a physician applicant (education, liability history, etc.). This new option will be voluntary, with physicians maintaining the option to apply state-by-state if desired.

Contact Mark Grapentine, JD, in the Society’s Government and Legal Affairs Department with any questions. Visit the Society’s Lobbying Tracker for information on this and other bills the Society is following.