• Chapter Hosted Gala Welcomes ACEP S.A. to Seattle
• Medicare Cuts to Physicians Will Harm Washington Seniors
• NPI Data Goes Public
• US Senate Questions Arizona Specialty Hospitals Use of 911/Community ED
• Medicaid Imposes Copays for Non-Emergency ED Visits
• Cell Phones in the Hospitals
• Rural Emergency Department Staffing
• Medicaid Tamper-Proof Prescription Requirement to Go Into Effect October 1
• National Voluntary Error Reporting System Still A Year Away
• CMS Issues Final Rule Prohibiting Physician Self-Referral
• Welcome New WA/ACEP Members
• Calendar of Events
• Employment Opportunities

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

This reception is made possible through the generous contributions the following ED physician groups, as well corporate support from Marina Medical, Physicians Insurance, and Ultrasonix
Associated Emergency Physicians
Edmonds Emergency Physicians
Emergency Physicians at Overlake
Highline Emergency Physicians
North Sound Emergency Medicine
Northwest Acute Care Specialists
Seattle Emergency Physicians
Tacoma Emergency Care Physicians
Wenatchee Emergency Physicians

MEDICARE CUTS TO PHYSICIANS WILL HARM WASHINGTON SENIORS
AMA Makes 'House Call' to Washington, Discusses New National Physician Survey

As part of the AMA National House Call campaign, leaders from the AMA and the Washington State Medical Association (WSMA) this week drew public attention to the need for Congress to stop impending reductions in Medicare physician payments. AMA Immediate Past President William G. Plested III, MD, and WSMA Executive Director/CEO Tom Curry led a media blitz to alert seniors about how the Medicare cuts threaten access to medical care.

"We are deeply concerned about patients' access to care in our state," WSMA President W. Hugh Maloney, MD, said. "Clearly, the Medicare access problem will become more severe as physicians find it increasingly difficult to subsidize this portion of their practice. Already in numerous counties across Washington state, patients on Medicare are having trouble finding a physician who will see them."

Under current law, Medicare will cut payments to physicians about 40 percent over the next nine years, even as physicians' practice costs increase 20 percent. Over that period, Washington state stands to lose almost $4 billion for medical care for Medicare patients. An AMA Member Connect® Survey showed that 60 percent of physicians say they will be forced to limit the number of new Medicare patients they can treat if the first payment reduction, a 10 percent cut to take effect Jan. 1, 2008, is imposed.

Congressional action is the only way to stop the Medicare cuts and preserve seniors' access to physician care. The AMA and the WSMA are urging patients to contact Senators Patty Murray and Maria Cantwell and ask them to stop the Medicare physician payment cuts and provide physicians with a payment update in line with increases in the costs of caring for patients.

View http://www.ama-assn.org/ama/pub/category/17979.html to read more about the House Call.

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NPI DATA GOES PUBLIC
The Centers for Medicare & Medicaid Services (CMS) will made available to the public on Sept. 4 National Provider Identifier (NPI) data that are disclosable from the National Plan and Provider Enumeration System (NPPES) under the Freedom of Information Act. CMS will make information available via the Internet in two forms: a query-only NPI Registry and a downloadable file (available Sept. 11).

CMS has posted several documents on its Web site to help users understand the downloadable file and other aspects of the NPPES.

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US SENATE QUESTIONS ARIZONA SPECIALTY HOSPITALS USE OF 911 / COMMUNITY ED
Senate Finance Committee leaders are questioning six Arizona surgical and orthopedic hospitals about the prevalence of 911 calls to handle emergency cases at their facilities. Chairman Max Baucus (D-Mont.) and ranking member Chuck Grassley (R-Iowa) sent identical letters Aug. 23 to the hospitals, following a local Phoenix news report that found the physician-owned specialty hospitals had called 911 emergency responders to transport a total of 150 patients to full-service community hospitals when they experienced complications following surgeries. The senators wrote that they were "deeply disturbed" to hear that specialty hospital staffs seemingly had relied on 911 to handle emergency cases in their facilities. The letters asked hospital executives to provide information about staff capabilities in emergency care and other areas, as well as specifics pertaining to the financial situation of the hospitals.

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MEDICAID IMPOSES COPAYS FOR NON-EMERGENCY ED VISITS
After a long hiatus, CMS released a Medicaid letter to state directors implementing the DRA Sec. 6043 allowing states to impose co-pays for ED visits that are non-emergencies. The letter says that hospitals can impose cost sharing for "services" furnished in an ED. While not explicit, we interpret this to include physician services (specifically - post EMTALA screening). However, hospitals are also to provide patients with names and locations of available alternative providers. CMS has $ 50 million in federal grant funds to assist states in expanding non-emergency service provider alternatives

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CELL PHONES IN THE HOSPITALS
Some health care facilities are creating wireless networks to let patients, family members, physicians and staff members use their phones.

The concern about cell phones is that their signals could create electromagnetic interference with sensitive medical devices, such as ventilators or external pacemakers. Opinion is divided, however.
Some doctors even say cellphones promote better communication, which reduces medical errors. And people rely more heavily now on their wireless devices to stay connected to work and family.

An increasing number of hospitals have installed antenna systems for better cellphone use. The system puts the antenna inside the medical facility instead of a mile or more away. This allows a cellphone to connect using a lower signal strength. As a result phone signals are reduced, and engineers can measure and better control the electromagnetic energy in-house. The system even penetrates areas called "black zones," such as the thick-walled radiology area.

A spokesman for the American Hospital Association says most hospitals still restrict cellphone use in critical-care areas and around their most sensitive electronic devices: "Until they have scientific proof that these phones can be used anywhere and everywhere, hospitals are going to restrict it in those areas most sensitive.

Many hospitals and clinics reevaluated their cellphone bans recently after a five-month study by the Mayo Clinic showed that the phones caused no noticeable interference with equipment. The study, which appeared in the March issue of Mayo Clinic Proceedings, said bans should be reconsidered because of the inconvenience they cause for patients and families who must leave care areas to use their cellphones.

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RURAL EMERGENCY DEPARTMENT STAFFING
The quality of emergency care is an important issue for rural hospitals. Increased policy interest at the national and state levels is evident in efforts to establish statewide trauma systems, promote the use of protocols for care provided in EDs, implement electronic medical records, and encourage reporting on quality measures, the study says.

The report, "Rural Emergency Department Staffing: Potential Implications for the Quality of Emergency Care Provided in Rural Areas," surveyed a random sample of rural hospitals with less than 100 beds in June to August 2006. A total of 408 hospitals responded to the survey. ED managers were asked about the volume of ED patients, type of staffing, training of ED physicians and other providers, specialty coverage arrangements, and the use of ED protocols and quality measures.

Key findings include:
· The majority of rural hospitals use more than one type of staffing to cover their emergency department, including combinations of physicians on their medical staff and contracts with emergency physician management groups, individual physicians, physician assistants and nurse practitioners.

· The type of ED staffing varies by hospital characteristics including ownership type, region and size. Smaller hospitals (with 25 or fewer beds) and those with lower ED volume are more likely to use regular medical staff only, while larger hospitals (with 26-99 beds) and those with higher ED volume are more likely to use contracted coverage either alone or with regular medical staff.

· One-third of hospitals that contract for ED coverage indicate that the primary reason is an insufficient number of physicians on the medical staff or problems recruiting physicians to cover the ED.

· The majority of hospitals report that most or all of their ED physicians, NPs and PAs have current Advanced Cardiac Life Support certification, but Pediatric Advanced Life Support and Advanced Trauma Life Support training and certification are less common.

· Eighty percent of hospitals use a paper medical record in the ED, while 9 percent use an electronic medical record, and 11 percent use a combination of paper and electronic records.

· About two-thirds of hospitals use standard protocols for ED patients with pneumonia and trauma patients, and 94 percent use standard protocols for ED patients with chest pain or suspected acute myocardial infarction.

· Ninety-eight percent assess ED performance on quality measures using medical record review.

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MEDICAID TAMPER-PROOF PRESCRIPTION REQUIREMENT TO GO INTO EFFECT OCTOBER 1
Thanks to a provision tucked into the Iraq Accountability Appropriations Act of 2007, handwritten prescriptions for Medicaid fee-for-service patients must be written on tamper-resistant pads as of October 1, 2007.

The Centers for Medicare and Medicaid Services has released guidance to State Medicaid Directors on the Oct. 1 requirement for handwritten prescriptions to be written on tamper-resistant prescription pads in order to be covered by Medicaid. Please note the following key elements of the guidance:

Exemptions:
· Prescriptions paid for by a managed care entity (i.e., Healthy Options) are exempt
· Electronic, faxed and telephoned prescriptions are exempt
· Prescriptions provided in nursing facilities and certain other settings are exempt
· Refills of written prescriptions presented at a pharmacy before Oct. 1 are exempt

Requirements:
By Oct. 1, 2007, prescription pads must meet one of the following standards, and by Oct. 1, 2008 they must meet all three:
· Features to prevent unauthorized copying of a blank or completed prescription
· Features to prevent erasure or modification of information written on the prescription
· Features to prevent use of counterfeit prescription forms

State laws and requirements for tamper-resistant prescriptions must meet or exceed the CMS standard.
The requirement does not restrict emergency refills if the prescriber provides the pharmacy with a verbal, faxed, electronic, or tamper-resistant written prescription within 72 hours of the date the prescription was filled.

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NATIONAL VOLUNTARY ERROR REPORTING SYSTEM STILL A YEAR AWAY
American Medical News reports that a national system for the voluntary reporting of medical errors is at least a year away from introduction. The system, which will be operated by the U.S. Agency for Healthcare Research and Quality (AHRQ), was mandated by the 2005 Patient Safety and Quality Improvement Act. An AHRQ representative explains that the system is taking a long time to implement due to the number of federal agencies that must sign off on rules governing patient safety organizations-third parties to which physicians and other professionals will be able to confidentially report errors. For more information: http://www.ama-assn.org/amednews/2007/08/20/gvsc0820.htm

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CMS ISSUES FINAL RULE PROHIBITING PHYSICIAN SELF-REFERRAL
CMS recently issued final regulations prohibiting physicians from referring Medicare patients for certain items, services and tests provided by businesses in which they or their immediate family members have a financial interest.

This regulation is the third phase of the final regulations implementing the physician self-referral prohibition commonly referred to as the Stark law. The biggest changes will affect indirect compensation arrangements, physician recruitment, and personal service arrangements. CMS is asking physicians to "stand in the shoes" of their group practice. Under this provision, arrangements currently considered indirect compensation arrangements will now be deemed direct compensation arrangements and may need to be restructured to comply with the Stark requirements. In terms of recruitment, a physician can restrict moonlighting and have non-compete agreements. Phase III responds to comments made about Phase II and addresses the entire regulatory scheme, and should be read together as a whole.

For view the entire press release, please click here: http://www.cms.hhs.gov/apps/media/press_releases.asp
To read the final rule,click here: http://www.cms.hhs.gov/PhysicianSelfReferral/

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New Members:
John R. Bennett, MD – Seattle
Elizabeth L. Brown – Seattle
Ritik Chandra, MD – Seattle
Jeremy Dewall, MD – Seattle
Dominic T. Diciro, MD – Snohomish
Sara Jo Gahm, MD – Arlington
Roy Hanaki, MD – Lynnwood
Bryce C. Inman – Seattle
Aaron Isaac – Seattle
Konrad Kessler – Seattle
John P. Lemos – Seattle
John P. Liboon, MD – Woodway
Peter S. Millikan, MD – Everett
Robert Montana, MD – Seattle
J. Michael Roseberry, MD - Everett

Moved into chapter:
Barrett F. Adams, MD – Shoreline
Francisco A de la Fuente, MD – Seattle
Troy E. Mattox, MD – Spokane
Bessie McCann, MD – Olympia
Christine M. Perry, DO – Gig Harbor
Ryan Pursley, MD – Spokane
Adam Ruscher, MD – Seattle
Amol J. Shah, MD, FACEP – Puyallup
Laura A. Sohren, MD – Yakima
Amy L. Szyszko, MD – Seattle

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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@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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