• Congress Advances SCHIP Reauthorization
• Compensation Survey: ER Docs Salaries at Threshold
• AHA Survey: More Hospitals Pay for ED Coverage
• Legislation Introduced to Enhance EMS and Emergency Medicine Research
• Physicians May Edit and Save Changes to Medicare Enrollment Forms Electronically
• CMS Announces NPI Dissemination Date and Gives Additional Time to Edit Provider Information
• PQRI Alert Regarding NPIs
• PQRI Update
• Use Of "Tamper-Proof" Prescription Pads Mandated On Oct. 1
• Study: Physician Stress Following Medical Errors
• Medicare Hospital Outpatient Draft Regulation Bundles Observation
• NQF Issues Call for ED Transfer Measures
• Welcome New WA/ACEP Members
• Calendar of Events
• Employment Opportunities

Send comments regarding NewsWatch or email address changes to the WA/ACEP.

COMPENSATION SURVEY: ER DOCS SALARIES AT THRESHOLD
The Modern Physician's annual survey of physician compensation collected data from 14 healthcare-staffing groups and trade organizations to track compensation for 20 specialties.

The compensation range for some specialties is particularly dramatic, with more than a $200,000 difference between the top and bottom numbers for dermatologists, gastroenterologists, invasive cardiologists and oncologists. The biggest gap was in compensation for dermatologists, which ranges from $465,000 to $223,000. In contrast, the ranges for hospitalists and internists are less than $26,000.

For hospitalists, the top number provided is $201,357-only $22,457 higher than the lowest figure of $178,900. For some specialties, compensation can be linked to supply and demand, but for others-particularly emergency medicine-this year's figures have more-complex explanations. Although the Centers for Disease Control and Prevention released figures in June showing that there were 5 million more emergency-room visits in 2005 than 2004 and total visits reached an all-time high of 115 million, average ER physician compensation increased only 6.25%-less than half the increase registered for oncologists.

"There is an ER crunch," says Travis Singleton, vice president of marketing with Irving, Texas-based recruiter Merritt, Hawkins & Associates, one of the groups participating in the survey. "But just because numbers have risen less than expected doesn't mean there is less of a demand. With ER physicians, I think we've hit a plateau and groups are doing other things to be attractive."

According to the survey, compensation for emergency physicians ranges from $272,500 to $207,600. Singleton says salaries have just about reached the threshold that most emergency-medicine groups can afford to offer, so they are offering a shorter workday instead. Where 12-hour shifts were once the norm, he says that today's emergency doctor may only have to fill an eight- to 10-hour slot and work during the busiest trauma times only once or twice a month.

"The buzzwords for the new physician are 'quality of life,' " he says. "An ER physician coming out of training can get a job anywhere and be paid something that-by some people-would be considered too much."

Singleton also says some rural hospitals now fill emergency positions with family physicians, internists and general surgeons who choose to work in a rural ER because of the quality-of-life benefits provided by shift work.

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AHA SURVEY: MORE HOSPITALS PAY FOR ED COVERAGE
More than one-third of hospitals now pay for some physician specialty emergency department call coverage, according to results from AHA's survey of hospital leaders. The 2007 State of America's Hospitals - Taking the Pulse also found 55% of hospitals experienced gaps in physician specialty coverage with coverage issues most prevalent in orthopedics and neurosurgery. In addition, nearly half of EDs are "at" or "over" capacity, with a majority of urban hospitals experiencing time on diversion. Hospital leaders cited a lack of staffed critical care beds as the most common reason for diversion. The survey also found that hospital workforce shortages, including an estimated 116,000 registered nurse vacancies as of December 2006, are affecting patient care. Regarding disaster readiness, hospitals are taking a variety of actions to bolster preparedness, including participating in large scale drills, establishing back-up communication plans and developing resource plans with other hospitals. The survey, which had a 17% response rate, was sent to about 5,000 community hospital CEOs in late February 2007 via fax and email.

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LEGISLATION INTRODUCED TO ENHANCE EMS AND EMERGENCY MEDICINE RESEARCH
On July 25, 2007, Senator Barack Obama (D-IL) and Representative Henry Waxman (D-30-CA) introduced the “Improving Emergency Medical Care and Response Act of 2007” (S. 1873 and H.R. 3173). The bill will support four regional demonstration programs aimed at designing, implementing and evaluating a regionalized, accountable emergency care system. Data gathered from these programs will lead to improved coordination, efficiency and effectiveness of EMS programs across the United States. This legislation will also establish support for emergency medical research throughout the federal government, ultimately leading to enhanced patient outcomes through improved medical service delivery.

The ACEP fully supports this legislation as it complements, the “Access to Emergency Medical Services Act” (S. 1003 and H.R. 882), our key legislative initiative. Both bills address recommendations made by the Institute of Medicine in its landmark 2006 report on The Future of Emergency Care.

"This bill is directly responsive to two key observations from my committee's recent hearing on the crisis in emergency care--the urgent need to promote regionalized, coordinated and accountable emergency care systems and an equally urgent need to advance the science of emergency care," said Senator Waxman.

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PHYSICIANS MAY EDIT AND SAVE CHANGES TO MEDICARE ENROLLMENT FORMS ELECTRONICALLY
Doctors who download Medicare enrollment forms from the Centers for Medicare & Medicaid Services (CMS) Web site now have the ability to save changes electronically, a capacity the many medical associations have repeatedly urged CMS to develop for these forms.

The Medicare enrollment forms (CMS-855 series) previously contained no functionality to allow physicians to input their information in the form electronically; the forms could only be printed and information entered manually. Now, physicians who need to submit an enrollment form or changes to their enrollment information can input their enrollment information electronically by keying in their information, saving the changes to their computer and then printing them.

The Medicare enrollment process overall continues to see significant backlogs. CMS has placed added attention on carriers experiencing the most significant delays and is working on developing an electronic system for submitting enrollment applications online, which is expected to be announced early next year.

Visit http://www.cms.hhs.gov/MedicareProviderSupEnroll/03_EnrollmentApplications.asp#TopOfPage for more information about the Medicare enrollment forms.

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CMS ANNOUNCES NPI DISSEMINATION DATE AND GIVES ADDITIONAL TIME TO EDIT PROVIDER INFORMATION
One August 6, CMS announced that it will disseminate National Provider identifier (NPI) data from the National Plan and Provider Enumeration System (NPPES) beginning Sept. 4. Data will be available in two forms: a query-only NPI registry and a downloadable file (expected to be available on Sept. 11).

CMS also extended the time in which providers can view their FOIA-disclosable NPPES data. Providers can make edits until Aug. 20; those who submit edits on paper need to ensure that they mail them in time for receipt by the NPI Enumerator by Aug. 20. Physicians are being urged to remove optional data elements from the NPPES and remind you that all NPI contingencies that may have been implemented by clearinghouses and health plans must end by May 23, 2008.

Access a list of FOIA-disclosable data elements and read assistance in making edits
Read additional information on the NPI

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PQRI ALERT REGARDING NPIS
This week, CMS alerted fee-for-service providers that some Clearinghouses are stripping National Provider Identifiers (NPIs) from claims prior to submission to Medicare. As this practice will prevent claims from counting toward the 80% reporting requirement under PQRI, CMS is asking participants to identify whether NPIs are being stripped from their claims and if so, consider other billing options. CMS has released a Special Edition MLN Matters article on this topic at:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf.

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PQRI UPDATE
2007 PQRI program reporting began on July 1 with eleven (11) measures impacting emergency medicine. The list of measures and additional information may be accessed on the CMS and ACEP websites. Provisions for PQRI are also included in the recently released physician fee proposal. Under the proposal:
· The 2008 PQRI will be funded with the $1.35 billion Physician Assistance and Quality Initiative (PAQI) Fund provided for in the enabling law.
· The 2008 PQRI will be limited to measures endorsed or adopted by the National Quality Forum (NQF) or AQA Alliance.
· While quality measures developed through the use of a consensus-based process are preferred for measures used for PQRI, the proposal states this preference will not “preclude CMS from selecting measure for PQRI based upon a lesser degree of consensus when necessary to meet CMS’ program needs as determined by the Secretary.”
· A number of specific measures are proposed for eligibility in the 2008 PQRI program. The measures include those on the 2007 PQRI list, measures under development by the AMA-PCPI, the American Podiatric Medical Association and the Pennsylvania QIO (including non-physician, and Health IT adoption measures), as well as additional AQA starter-set and NQF-endorsed measures. The final 2008 PQRI quality measures must be determined and published in the Federal Register by November 15.
· Beginning in the first quarter of 2008, CMS plans to evaluate and test registry-based reporting, exploring at least five data options. Registries selected for testing must be HIPAA and CHI compliant and capable of interfacing with the CMS clinical warehouse electronic data exchange interface (EDI).
· The proposal includes a plan for CMS to also explore receiving data from EHRs in 2008, for a limited number of PQRI/DOQ-IT overlapping ambulatory care measures.

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USE OF "TAMPER-PROOF" PRESCRIPTION PADS MANDATED ON OCT. 1
Effective Oct. 1, 2007, Medicaid outpatient drugs will be reimbursable only if non-electronic written prescriptions are executed on a tamper-resistant pad.

CMS is expected to send a letter to state Medicaid directors regarding state implementation of this federal requirement. State insurance commissioners will most likely have the ultimate implementation authority through a state definition of tamper-proof prescription pad. Many states already have laws requiring varying levels of tamper-proof prescription pads. These states require prescription pads to be written in triplicate; require pads to contain chemicals that reveal efforts to alter the paper; or require pads to display serial numbers so pharmacists can match the physician' orders.

It is not yet known whether this new federal requirement will apply to all drugs or just narcotics, but the start date leaves little time for education and compliance. Medical and pharmacy organizations have raised concerns, but the agency has no regulatory authority to delay the start date mandated by Congress.

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STUDY: PHYSICIAN STRESS FOLLOWING MEDICAL ERRORS
A first of its kind study indicates many physicians experience significant emotional distress and job-related stress following near misses and medical errors. The study released last month by The Joint Commission Journal on Quality and Patient Safety, points out the need to improve organizational resources for all health care professionals to receive the support they need following an error.

Interviews and surveys with 3,100 physicians from St. Louis, Seattle and Canada, revealed that ninety-two percent had been involved with a near miss, or a minor or serious error. Approximately half of the physicians surveyed reported that their involvement in medical errors increased their job-related stress. One in three physicians involved with near misses reported that their lives were negatively affected. However, the greater the severity of the error, the more likely the physician would be affected.
Physicians reported increased anxiety about future errors (61 percent), loss of confidence (44 percent), sleeping difficulties (42 percent), reduced job satisfaction (42 percent), and harm to their reputation (13 percent) following errors.

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MEDICARE HOSPITAL OUTPATIENT DRAFT REGULATION BUNDLES OBSERVATION
The proposed Hospital Outpatient Prospective Payment System (OPPS) rule for 2008 includes a 3.3 % update for inflation. To stem the large (10.5%) growth in expenditures, CMS is proposing to increase the size of the OPPS payment bundles for seven categories including observation. ACEP has repeatedly urged CMS to expand the number of diagnoses/conditions eligible for separate facility payment. Most observation departments are managed by emergency physicians and reduce crowding by allowing patients to be monitored for several hours in an adjacent unit. This proposal could create a disincentive for hospitals to develop or expand observation units.

On the quality reporting front, CMS is required by statute to reduce the annual payment update factor in CY 2009 and subsequent years by two percentage points for hospitals that do not report quality measures. The ten hospital outpatient quality measures proposed include five emergency department acute myocardial infarction transfer measures; two surgical care improvement measures; and measures for the treatment of heart failure, community-acquired pneumonia, and diabetes.

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NQF ISSUES CALL FOR ED TRANSFER MEASURES
On June 29, the National Quality Forum (NQF) issued a call for fully developed and tested, public domain measures that address ED transfers to another acute care hospital or ED, specifically in the areas of AMI, heart failure, pneumonia respiratory compromise, and surgical/trauma conditions. Submissions are due by August 3. The call is “phase one” of the NQF Hospital-based Emergency Care project, funded by CMS. NQF has also issued a notice of intent to call for comprehensive measures regarding wait times, overcrowding, boarding and diversions in the fall. ACEP will work to secure representation on the NQF Steering Committee/Workgroup tasked with reviewing measures submitted in response to the calls.

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New Members:
James P. Gerard, MD – Seattle
David Kammer – Seattle

Moved into chapter:
Niels C. Beck, MD – Seattle
Francisco de la Fuente, MD – Seattle
Dominic T. Diciro, MD – Snohomish
Paula J. Godfrey, DO – Chehalis
Alison Haddock, MD – Seattle
Roy Hanaki, MD – Lynnwood
Benjamin J. Killey, MD – Seattle
J. Hunter Mafera, MD – Spokane
J. Michael Roseberry, MD – Everett
Jonathan Thierman, MD – Seattle
Tonia M. Willekes, MD - Normandy Park
Nathanael Wood, MD – Seattle
Thomas H. Wu, MD - Seattle

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Cruise Ship Physicians wanted for 14-day (or longer) assignments with Holland America Line. Take a break from the ED & enjoy a slower pace on a premium passenger vessel, surrounded by the clear blue waters and beautiful scenery of Alaska, the Caribbean and other itineraries worldwide. Known for setting the industry standard in cruise ship medicine, Holland America Line has been recognized by Conde Nast Traveler and Porthole magazines as having the “Best Medical Facilities At Sea.” Travel to and from ship provided; family travel benefits available. Competitive industry pay & malpractice coverage; limited clinic hours, well-equipped medical facilities, RN and crew physician support staff, officer privileges. Please contact Susan Suver at (206) 301-5279 or send CV to ssuver@hollandamerica.com

Mason General Hospital, Shelton, WA is recruiting for a full-time member of a completely democratic ED group. We are looking for an 8th EM residency trained, EM board certified or board prepared physician to join an existing group of 7 ED docs. Shelton sees approximately 20K visits/year of a good mix of medical, blunt trauma and pediatric patients. We offer paid medical liability insurance, very competitive hourly rate and immediate partner status. Please call Dean Gushee, MD 360-427-6791 or email deangushee@gmail.com.

Tacoma Emergency Care Physicians, a stable, democratic, two hospital group (60,000 pts./yr.) of 18 board certified emergency physicians, is looking to hire another excellent BC/BP emergency physician for a full-time position (12-14 eight hours shifts/month). We offer the chance to practice challenging, high-acuity emergency medicine in a supportive environment with highly competitive compensation and a quick transition to full shareholder status. New ED at Tacoma General coming on line in 2008!
Please contact Rob Ripley at 206 290 2123 or rip-tecp@comcast.net

Wenatchee Emergency Physicians is looking for board certified physicians for part-time employment. 8-10 shifts per month with competitive reimbursement. Friendly congenial group and excellent staff relations make this an enjoyable place to work. Plenty of regional outdoor recreational activities in all seasons! Send CV to Dr. Scott Stroming (stroming@nwi.net) or call 509 679-3635 or 509 665-6163.

Are you considering a change of employment? If so, don't make a move until you give us a call. At any one time we have physician openings across, Washington, Oregon, Idaho, Montana and Wyoming. Northwest Emergency Physicians-TEAMHealth is the largest employer of emergency medicine physicians in the Northwest. Contact: Emily Simpson (800) 336-8614 x 2115 or email: emily_simpson@teamhealth.com or Lynn Benson at (800)336-8614 ex 2123/fax (253)838-6418 or lynn_benson@teamhealth.com

CRAssociates, Inc. (CRA) is a national healthcare management company that is committed to the delivery of high-quality health care services. We have a need for full-time Emergency Medicine Physician to support the Naval Hospital Bremerton. Requirements include:
· Board Certified as an Emergency Medicine Physician
· Min one year exp in last 3 years
CRA is proud to offer you a team environment, excellent compensation and benefits, as well as company-paid professional liability insurance. Please send your resume to Human Resources at one of the following: Fax: 866-550-1476 (Toll Free) Email: ckm@crassoc.com CRA is proud to be an equal opportunity employer.

Washington, Kitsap Peninsula: We staff two brand-new ED's seeing a total of 60,000 pts/annually and seek a full-time BC EM Physician to expand coverage. Established, progressive, democratic group with excellent compensation and benefit package. Mountain and Ocean recreation opportunities abound. One-hour ferry ride to Seattle. See Website: www.harrisonmedical.org E-mail CV to: Gail Donavan at gdonavan@harrisonmedical.org

Longview- Cascade Emergency Associates is looking for BC/BP emergency physicians. Stable and growing practice in a Level III trauma center. Usually one of the busiest practices in the state, with a census in 2005 of 49,500. Brand new ED under construction. Wonderful family-oriented community located on the Columbia River close to a myriad of recreational opportunities. Democratic scheduling and compensation. Contact Dennis Ford, MD, FACEP, 136 Elk Ridge Dr., Longview, WA, 98632 or dmford2@adelphia.net.

Immediate Full-Time Position for BC/BE EM Physician with Kennewick Emergency Physicians, a Democratic Group staffing a single hospital, 30,000 annual visits with moderate acquity on the banks of the Columbia River. Generous Competitive Package, Guarantee plus Incentive Compensation, Liability Insurance included, Relocation Expenses included, Full Partnership Tract in 18 months, 8-11hour shifts, Double coverage during peak hours, average 12-14 shifts/month with 3 weeks off/quarter built into schedule. Enjoy a peaceful lifestyle in this friendly community of approximately 200,000. Take advantage of hundreds of miles of waterways- fishing, water sports and beautiful sunsets- all near the mountains, over 300 days of sunshine annually, over 40 local wineries. Contact Louis K. Koussa DO, FACEP; 509-521-3396 or 509-627-1798 and email your CV to loukoussa@yahoo.com

WANTED: Emergency physicians for bipolar company. Quark (www.quarkexpeditions.com) leases Russian Icebreakers for 10 to 25 day voyages to the polar regions. We are in need of ED physicians willing to serve as ship’s doctor. On any ship, there at most 110 passengers and 50 crew members. No dressing up and no night life except the scenery and animals. Contact Dr. Dan Zak at zak38@aol.com. Please let your colleagues know about this as well.

Looking for FT & PT physicians in Central WA. (180 miles from Seattle). Enjoy this desert garden with the finest fruits and vegetables as well as the home to award-winning wineries! Washington State designated Level-4 Trauma Center with a 17K estimated annual patient volume. Efficient support staff with a great pace & good mix of patients. Medium to low acuity. Qualifications: Board Certified or Board Eligible IM, FP or EM. We offer an A-rated malpractice insurance program with no-tail obligation upon departure. This is an Independent Contractor facility with a competitive hourly rate and generous sign-on bonus! For more information, please contact John Torres, (800) 230-5160 ext. 3025, john_torres@emcare.com Visit our website at www.emcare.com

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