NewsWatch November 2007 |
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| From Your WA/ACEP President, David Dabell MD FACEP | |
WASHINGTON PHYSICIANS
LAUNCH STATEWIDE QUALITY IMPROVEMENT PROGRAM
A collaboration between the Washington State Medical Association (WSMA)
and Premera Blue Cross has resulted in the state's first physician-led
quality improvement program. The WSMA Education and Research Foundation's
(WSMERF) Quality Improvement Program will give physicians throughout the
state access to valuable data on their patients in convenient, yet confidential,
registries to help identify those in need of preventive and chronic care
services. It will also give physicians free reports on their performance
as compared to best practices.
"The WSMA is committed to evidence-based care and the need to reduce variation
in treatment to achieve optimal health outcomes for patients," said
Hugh Maloney, MD, WSMA president and vice chair of the WSMERF. "The
WSMERF quality improvement program will provide primary care physicians
around the state with data they can use to improve patient care."
Visit http://www.wsma.org/press-room_detail.cfm?nid=296 to learn more about
Washington state's new quality improvement program.
ACEP continues to play a leadership role in the nation’s disaster preparedness, bringing the best practices and training to the forefront.
The Department of Homeland Security awarded ACEP a $1.15 million grant
for medical response collaboration, planning and coordination training
for disaster preparedness. Under the grant, ACEP will provide Web-based
training to develop pre-incident plans to ensure the efficient distribution
of patients, sharing of information and resources, and coordination of
roles and responsibilities of state and local agencies involved in responding
to disaster victims. This grant build on another $1.1 million grant we
already received to work with 18 states on assessment of disaster preparedness.
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LABOR-HHS
FUNDING UPDATE
On November 13, President Bush vetoed the FY 2008 Labor-HHS-Education
appropriations bill (H.R. 3043), which contained funding for many federal
agencies and
programs that ACEP supports, on the basis that it contained more spending
than he had requested. These agencies included: Rural & Community Access
to AEDs, Trauma/EMS, EMSC, TBI, Rural Outreach Grants, Rural Hospital Flex
Grants, and Poison Control. On November 15, the House of Representatives
fell two votes short of overriding the president's veto.
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NEW RESOURCE TARGETS KEY HEALTH
PREDICTOR
The Puget Sound Health Alliance unveiled a one-stop shop where patients
and doctors can get tools and other resources to communicate with each
other more effectively. This new community resource is called "Health
in Plain Terms" and is available at http://www.pugetsoundhealthalli
ance.org/resources/PlainHealth.html.
Earlier this year, the Alliance and United States Centers for Medicare
and Medicaid Services (CMS), Region 10, brought together more than two-dozen
representatives of literacy groups, library systems, clinics, hospitals
and health plans to begin to address problems related to low health literacy.
According to the American Medical Association, health literacy-the ability
to find, understand and use health information- is "a stronger predictor
of an individual's health status than income, employment status, education
level, and racial or ethnic group."
Already the Alliance Board adopted Communication Principles targeted at
improving written materials for use by consumers. They are a series of
recommendations for presenting information in plain and clear ways.
Increasingly, patients and other consumers are being asked to take a more
active role in their own health and health care. At the same time, according
to the Joint Commission on Accreditation of Healthcare Organizations, more
than 90 million Americans-- nearly half the U.S. adult population--lack
the ability to find, understand or use the information they need to make
good decisions about their health.
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CMS
ANNOUNCES LIMITED DELAY IN APPLICATION OF STARK II, PHASE III FINAL
RULE
The Centers for Medicare & Medicaid Services (CMS) this week delayed
for one year the application of a provision in the final Stark II,
Phase III rule as it relates to academic medical centers and integrated
section 501(c)(3) health care systems.
As part of its final physician self-referral rule, CMS enacted a provision
it has dubbed the "stand in the shoes" requirement. This
Phase III provision treats physicians the same as their physician organizations
for purposes of analyzing compensation arrangements. After receiving
comments from industry stakeholders, CMS decided to delay applicability
of the "stand in the shoes" requirement 1) with respect to
academic medical centers (as described in the regulation at 42 C.F.R. § 411.355(e)(2)),
for compensation arrangements between a faculty practice plan and another
component of the same academic medical center, and 2) with respect
to integrated 501(c)(3) health care systems, for compensation arrangements
between an integrated affiliated DHS entity that provides designated
health services and an affiliated physician practice in the same integrated
section 501(c)(3) health care system. In particular, industry representatives
expressed concerns about "support payments" and similar monetary
transfers that are common in such arrangements and previously did not
trigger application of the Stark law.
CMS recognized the importance of academic medical centers and nonprofit
integrated health care systems with respect to community service and
teaching missions. Thus, it decided to further evaluate the potential
unintended impact the "stand in the shoes" requirement would
have on these entities. The new effective date of this provision will
be Dec. 4, 2008.
Read
the full document.
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Key members of the House and Senate continue their efforts to find a compromise on the State Children's Health Insurance Program (SCHIP) that a veto-proof majority in Congress can support. These negotiations have been ongoing since the House and Senate each approved the second version of the SCHIP reauthorization. That bill, H.R. 3963, has not been sent to the president because he has vowed to veto it and there is still hope that a compromise on a comprehensive reauthorization of SCHIP may still be reached. However, several major issues must still be rectified, such as rules for coverage, eligibility, citizenship verification, adult phase-out, etc., and with the Thanksgiving recess approaching, a successful negotiation of a complete package looks increasingly less likely. SCHIP is currently operating under a temporary extension through December 14.
If negotiators ultimately fail to deliver a comprehensive SCHIP bill that can pass both chambers and be enacted, further extensions of the program may be the only option. The Congressional Research Service calculates that 21 states need a combined additional $1.6 billion from the government in fiscal year 2008 or the resulting possible shortfalls could force them to drop coverage for some children.
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NEW
CO-SPONSORS FOR EM ACCESS BILL
H.R. 882, the “Access to Emergency Medical Services Act of 2007” reached
104 co-sponsors in the House this week. The newest co-sponsors are:
Reps. Brad Ellsworth (D-IN), Phil Hare (D-IL), and Tim Bishop (D-NY).
Senator Susan Collins (R-ME) was added this week as a co-sponsor of the
Senate version of the bill, S.1003.
For a complete list of co-sponsors, please go to the ACEP
Website.
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The cost of uncompensated hospital care in the United States totaled $31.2 billion in 2006, up from $28.8 billion in 2005 and $21.6 billion in 2000, according to data from the American Hospital Association.
In a separate report, the AHA noted that underpayment from Medicare and Medicaid reached nearly $30 billion in 2006, an increase from the $25.3 billion in 2005 and $4 billion in 2000. Medicare reimbursed 91 cents for every dollar hospitals spent caring for these patients, while Medicaid reimbursed 86 cents.
The data from the two reports show that hospitals continue to see an increasing number of patients despite uncertain future funding, emergency departments continue to be overcrowded, and fewer healthcare workers are available to provide patient care, according to AHA representatives.
The information from the reports was compiled from the AHA’s Annual Survey of Hospitals, a comprehensive source of hospital financial data. The AHA also notes that the two reports do not account for many other services and programs that hospitals provide at little or no cost to their communities. The full reports are available online at www.aha.org.
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HOSPITALS
STILL SEARCHING FOR ON-CALL PAY SOLUTIONS
Hospitals have made progress when it comes to compensating specialties
that are in the highest demand for ED call--for example, orthopedic surgeons,
neurosurgeons, and OB/GYNs. These were some of the first specialties to
be compensated for being on call, and pay rates are beginning to stabilize.
These specialists are also the highest paid for call coverage, typically
earning more than $1,000 per day. The following are the median daily stipends
each specialty earned for unrestricted call in SullivanCotter's 2006 and
2007 Physician On-Call Pay Survey reports:
·
Trauma surgery--$1,350, up from $1,200
·
Orthopedic surgery--$968, down from $1,000
·
Neurosurgery--$1,175, up from $1,000
Another sign of progress: In SullivanCotter's 2006 survey, nearly a quarter
of trauma centers and 13 percent of nontrauma centers had to shut down
at least one service due to a lack of physicians available for coverage.
This year, only 15 percent of all participants (combined trauma and nontrauma
centers) reported shutting down a service.
Despite the progress in some areas, hospitals are still struggling when
it comes to compensating other specialists who are increasingly asking,
and in some cases demanding, to be paid for call coverage.
One-fifth of respondents to the SullivanCotter survey plan on implementing
on-call pay in the next six months for physicians who currently aren't
receiving it.
With physician resistance growing, hospitals are exploring methods of
enticing physicians to take call. For physicians with admitting privileges,
the
most common method is to simply let the physician retain professional
fees--this was cited by 74 percent of respondents to the SullivanCotter
survey.
However, professional fees often aren't enough to satisfy doctors who
may treat patients who can't pay or physicians who want compensation
for when
they aren't called in. Twenty-one percent of respondents provide a subsidy
to physicians, and another 26 percent provide either a guaranteed level
of payment or an hourly rate. Other pay arrangements include fee-for-service
payments, compensation based on work relative value units (wRVU), and
subsidies for malpractice insurance.
The pay practices tend to be a little different for physicians with contractual
relationships with the hospital. Sixty-five percent of respondents provide
a guaranteed level of payment for contractual physicians or are considering
it. The next most popular methods for contractual physicians were fee-for-service
payments (47 percent) and hourly rates (37 percent).
Because of rising rates for contractual physicians and those with admitting
privileges, many hospitals are looking to employed physicians for ED
coverage. Eighty-three percent of survey respondents employ physicians,
and 66 percent
of those require employees to provide nontrauma call coverage.
The vast majority, 78 percent, doesn't offer additional compensation
to employed physicians called in to work. Instead, the call requirements
may
be outlined in the employment contract and considered when setting the
employee's annual compensation. Only 10 percent offer fee-for-service
payments when an employee is called in, 6 percent pay for call based
on wRVUs, and
6 percent offer an hourly rate. Hospitals are still paying employees
for coverage, but they are freed from the hassle of negotiating for call
and
the uncertainty of working under temporary contracts.
Some are going a step further and hiring specialists specifically for
covering the ED under a model similar to hospitalist programs. OB/GYN
and general
surgery--known as laborists and surgicalists when working under this
model--have been the first specialties to adapt the hospitalist concept,
but others
may follow suit as more hospitals find this to be an effective alternative
to paying for call.
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2008
MEDICARE PHYSICIAN FEE SCHEDULE CONTAINS A 10.1% CUT
The Senate Finance Committee continued its work this week to develop a
Medicare proposal that would avert the 10.1 percent physician payment cut
scheduled for 2008, and possibly the five percent cut for 2009, extend
several rural health measures, and include other provisions. Disagreement
among committee members remains as to the scope of the package and how
to off-set the cost of the bill. It also remains unclear whether any work
will be done over the Thanksgiving recess to finalize the Senate proposal
or to further negotiations with House lawmakers about what should be included
in the final bill.
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MEDICARE
CLAIMS BEING DENIED FOR PHYSICIAN NUMBER PROBLEMS
Effective October 22, 2007, Noridian Medicare Part B began editing
physicians and other providers’ old “legacy” identification numbers
and new NPI number for validity against the NPI “crosswalk file.” When
Noridian cannot find a match between a physician’s two numbers, claims
will be rejected or returned. Practices are cautioned to monitor the use
of these identification numbers carefully.
Effective
January 1, 2008, Medicare fee-for-service claims received must include
an NPI in the primary fields on the claim (i.e., the billing
and pay-to fields). You may continue to submit NPI & “legacy” number
pairs in these fields or submit only the NPI. Claims with only a legacy
provider identifier for the primary fields will be returned as unprocessable.
Note also that the UPIN Registry will be discontinued. See Memo 5584:
www.cms.hhs.gov/MLNMattersArticles/downloads/MM5584.pdf.
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MURRAY PUSHES FOR AID
TO TRAUMA HOSPITALS
A bipartisan group of senators is pushing a plan to funnel millions in
federal dollars to hospital trauma centers, including Harborview Medical
Center, that lose money providing care to poor and uninsured patients.
The proposal, sponsored by Sens. Patty Murray, D-Wash., and Kay Bailey Hutchison, R-Texas, would authorize $100 million in annual grants to trauma centers, with the bulk of the money reserved for those that lose the most on charity care.
Since 2000, at least 19 trauma centers nationwide have closed, according
to the National Foundation for Trauma Care. Several others have been
downgraded from Level One, the highest designation given to emergency
care facilities, according to the foundation.
Murray's bill, which also is backed by Sen. Johnny Isakson, R-Ga., and
Sen. Jeff Bingaman, D-N.M., would establish three new grant programs
designed to reimburse trauma centers for providing uncompensated care
to patients who are uninsured or do not have the money to pay for their
treatment.
The
three-year grants could mean as much as $2 million annually for individual
trauma
centers
that win funding. Some of the grants would
be reserved for centers that have the highest levels of charity care
nationwide; another grant program would send money to trauma facilities
at an "emergency" risk of closing.
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2008
PQRI MEASURES AND SPECIFICATIONS
The 2008 Medicare Physician Fee Schedule (MPFS) Final Rule, effective for
services on or after January 1, 2008, is available in the Federal Register
and will be published on November 27, 2007. The rule can be found on the
CMS Website. The Physician Quality Reporting Initiative (PQRI) provisions
begin on page 653. A summary of these provisions is available here.
The rule identifies 119 measures CMS has selected for eligible professionals
to use to report quality-of-care information under the 2008 Physician Quality
Reporting Initiative (PQRI). Specifications for the measures contained
in the Rule have been posted on the CMS
Website along with the Release
Notes. The new measures include 11 that emergency physicians can choose
to report, which have been modified for 2008 as indicated in the Release
Notes. PQRI Measure #29, “Beta-Blocker at Time of Arrival for Acute
Myocardial Infarction (AMI)” has been retired for 2008.
#28. Aspirin at Arrival for Acute Myocardial Infarction (AMI)
#31. Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis
(DVT) for Ischemic Stroke or Intracranial Hemorrhage
#34. Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator (t-PA)
Considered
# 47. Advance Care Plan
#54. Electrocardiogram Performed for Non-Traumatic Chest Pain.
#55. Electrocardiogram Performed for Syncope
#56. Vital Signs for Community-Acquired Bacterial Pneumonia\
#57. Assessment of Oxygen Saturation for Community-Acquired Bacterial Pneumonia
#58. Assessment of Mental Status for Community-Acquired Bacterial Pneumonia
#59. Empiric Antibiotic for Community-Acquired Bacterial Pneumonia
#75. Prevention of Ventilator-Associated Pneumonia – Head Elevation.
Additional Information on the 2007 and 2008 PQRI programs are posted on
the PQRI web page.
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WA/ACEP
NEWLY ELECTED FELLOWS:
Roy G. Belville, MD, FACEP
Antonio L. Brandt, MD, FACEP
Eric Scott Cooper, MD, FACEP
Salma F. Gharib, MD, FACEP
C. Hunter Hodge, MD, FACEP
A. Eve Kaiyala, MD, FACEP
Heather Anne Marshall, MD, FACEP
John M. Strayer, MD, FACEP
Thomas Tobin, MD, FACEP
Ralph E. Weiche, MD, FACEP
Daniel A. Zak, MD, FACEP
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New Members:
S. Heath
Ackley, MD – Seattle
Todd Davidson – Seattle
Lynn E. Gower, MD – Seattle
Robert Johnson, MD – Yakima
Douglas R. Migden, DO, JD, FACEP – Seattle
Louise B. Andrew, MD, JD, FACEP – Port Angeles
Katisha D. Baldwin, MD – Tacoma
James D. Collins, MD – Seattle
Jennifer Dorfman – Seattle
Oliver L. Edwards, MD – Seattle
Lisa T. Eych, MD – Tacoma
Joanne M. Torres, MD – Gig Harbor
Theresa A. Walls, MD – Mill Creek
Virginia
Mason Medical Center (VMMC) is a 425-physician regional referral center
located in Seattle, Washington, combining a centrally located tertiary
care facility and 8 suburban clinics. VMMC is a progressive organization,
on the cutting edge of quality improvement efforts with a new hospital,
including a new Emergency Department coming
in 2010. We offer great teaching opportunities as well as competitive
salary and benefits for excellent, team-oriented physicians. Join our
Health Care Team today! We currently have 3 opportunities available at
our downtown location for:
• ED
Director
We are seeking someone with: clinical excellence, change management,
quality improvement experience, leadership, and excellent interpersonal & communication
skills to lead our Emergency Department
• Full
Time ED provider
Our ED volume is approximately 30,000/yr, seeing predominately complex
and critical adult medical cases, and small volume of trauma, peds,
GYN.
• Temporary
ED provider
Coverage needed from December through April of 2008
Contact Christi Lenz
Professional Staff Services
(206) 341-0149
Email CV and cover letter to: christi.lenz@vmmc.org
Visit our website at: http://www.VirginiaMason.org
Wenatchee
Emergency Physicians seeking a BC/BE emergency physician for full
time employment and partnership. We see 30k patients per year at a
level
III trauma center. We offer superb recreational opportunities, excellent
physician and nursing staff, a growing community, and affordable
housing. Contact Tom Ettinger MD FACEP morsno@charter.com 509-679-9708,
Scott Stroming MD FACEP 509-679-3635, or one of our partners at Central
Washington Hospital 509-665-6163.
We are looking for a board certified/eligible emergency physician
to join our group of sixteen emergency physicians at Northwest Hospital
in Seattle. We are
a congenial group who enjoys a very good relationship with the rest of the
staff and hospital administration. We offer excellent fee for service
compensation
on a scenic hospital campus in north Seattle with a good patient mix (40,000
annual visits) and superb medical staff. If interested, please send CV to Dr.
Bill Johnston (billj@nwlink.com) or call
206-999-1772.
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
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@comcast.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
To have your job posting included free in future WA/ACEP NewsWatch transmissions, send your information to WA/ACEP
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