Job WatchTo view the numerous job postings available for
Emergency Physicians in our state, click here.
Emergency Medicine Basic Research Skills (EMBRS) Workshop
Session II: April 6-8, 2010TeamSTEPPS National Implementation Courses
April 28-30, 2010
June 2-4, 2010
August 11-13, 2010
FMI: http://teamstepps.ahrq.gov/ACEP Leadership & Advocacy Conference
May 16-19, 2010
Omni Shoreham Hotel - Washington, DCWA-ACEP 2010 Summit to Sound - Northwest Emergency Medicine Assembly
May 19-21, 2010
Bell Harbor International Conference Center
Seattle, WARegister OnlineMeeting Bruchure2010 ED Leadership Summit
November 3, 2010
Hilton Conference Center
|Register Now for WA-ACEP's Summit
to Sound Northwest Emergency Medicine Assembly!
May 19-21, 2010
Bell Harbor International Conference Center
Featuring 3 days of educational programming and pre-conference workshops:
- Infectious Disease Symposium
- Critical Care Symposium
- Trauma Symposium
- Cardiology Symposium
- Ultrasound IV Placement Workshop
- Regional Anesthesia Workshop
- Difficult EKG Workshop
WA-ACEP's looking for
volunteers: Get Involved!
you want to get involved in your state specialty organization? The WA-ACEP Board of Directors has voted to
implement standing committees to keep you and your practice up to date with the
most current education, legislation and practice management resources. We are looking for volunteers to serve on the
following committees: Education,
Legislative, Membership, and Rural Medicine.
Are you interested? Please email the WA-ACEP office at firstname.lastname@example.org.
Protection and Affordable Care Act Update
system reform legislation signed into law by President Obama on March
23-contains a number of key provisions for you and your patients. Some
provisions may have an immediate impact on your practice and patients, while
others will not take effect for some time.
Given the new
direction for the nation's health system, the AMA has developed Health System Reform Insight
to help you understand the new law and how it will affect you, when certain
provisions are scheduled to take effect, how you can be ready when the
regulations go into effect and what your patients need to know. Throughout the
series, we have explained how health system reform will affect physician practicesand your patients(PDF), and provided a summary of last week's first online
question-and-answer session, hosted by the Department of Health and Human
Services, on the new health reform law. If you missed it, view the archived webinar, or view some of the questions and answersfrom the session.
Medicare SGR Disaster & Petition
Senate returns next week and is expected to promptly reconsider H.R. 4851, a
30-day measure that would extend the freeze on Medicare's physician payment
rates through April 30. By law, the 21.3 percent cut to Medicare physician
payments took effect April 1. However, the Centers for Medicare & Medicaid
Services instructed its contractors to hold claims containing services paid
under the Medicare physician fee schedule for the first 10 business days of
The WSMA has joined several medical societies across
the US in launching an online petition drive. The petition urges Congress to fix the flawed payment formula that
threatens care for Washington's 897,000 Medicare recipients, including senior
citizens and people with disabilities, and 337,000 military family members
covered by TriCare. Congress must
replace it with a stable, fair funding mechanism that reflects the true cost of
Please sign the petition today at: http://www.ipetitions.com/petition/meltdown/
Governor Creates Health Care Cabinet, Shuffles Some Positions, Applies
for BHP Funding
At a Seattle
press conference April 1st the governor announced:
- Creation of a new Health Care Cabinet to coordinate the
state's implementation of the national health care reform bill.
- The following appointments:
Insurance Commissioner Mike Kreidler will be invited to
participate on issues within his jurisdiction. The OIC expects to have
about 2,000 insurance policies to review and approve as properly reflecting the
insurance reforms in the federal legislation and this needs to be done quickly.Application to keep BHP Afloat has
been submitted. The state might get $60 million for the rest of
this biennium to prop up the BHP, and more in the next biennium. The
governor indicated that the money would be sufficient to cover increased BHP
health care costs and another 5,000 BHP enrollees.
- The new Health Care Authority Administrator - Medicaid
Director Doug Porter. Former HCA administrator Steve Hill moves over to
become Chair of the Puget Sound Health Alliance, and keeps his job as director
of retirement systems).
- The secretaries of DoH, and DSHS; and, the directors of the
Executive Policy Office and OFM.
- The Secretary of Corrections. The directors of
Retirement Systems, of Veterans Affairs, and Labor and Industries will be
involved on an as-needed basis.
- Jonathan Seib from her policy staff is now the "go-to-guy"
for reform and apparently will staff this group.
Who's In Charge on Trauma Supervision?
The WSMA has joined the University of Washington, the City of
Seattle, and the state hospital association in an amicus curiae brief in
a case related to the rights associated with a physician supervising the work
of a paramedic. A brief
an incident on an emergency call, a paramedic physician supervisor determined
that a paramedic had an anger management problem, failed to identify medically
significant symptoms in the patient, and had abandoned the patient. The
physician told the paramedic that he was no longer authorized to act as a
paramedic under the physician's medical license. The paramedic was reassigned
to work as a fire fighter, without reduction in pay. No action was taken
to restrict or revoke his certificate.
claimed that the physician's decision violated his property interest in his
employment as a paramedic, he had a liberty interest in continued employment as
a paramedic which was violated, and he suffered reputational harm. He
also claimed that his right to due process had been violated, and the
physician had tortuously interfered with his employment relationship.
The District Court
granted the defendant's motion for summary judgment and denied the plaintiff's
motion for partial summary judgment. The paramedic has appealed the
District Court decision to the United States Court of Appeals for the Ninth
There are several
important policy considerations beyond the arguments already made. Reversal of the District Court decision:
- Could have wide-ranging adverse effects on the health care system in general, since it could lead to a physician being unable to discharge any "at will" health
care professional dependant on the physician for employment (potentially
including physician assistants, nurses, or any other licensed or certified
health care professional) absent a "pre-deprivation" due process hearing;
- Cause patient care to suffer, since physicians
and hospitals may justifiably become unwilling to hire or utilize licensed or
certified health care professionals;
- Would undercut the public's interest in a strong EMS
system if a Medical Director is unable to make a determination regarding the
qualifications, competence, and suitability of paramedics under his or her
entire emergency medical system is designed by law to be under the control
of physicians, including who is chosen to work as the eyes, ears, and hands
of the supervising physician;
The professional judgment of the physician supervisor is
sufficient due process in a decision made regarding the delivery of emergency
medical care, since ultimately it is the physician's license on the line when
that care is delivered; and
There is no deprivation of liberty interests when information
about the competence of a paramedic is communicated to professional oversight
officials or entities - indeed, it is a priority of the Washington State
Legislature that information flows from employers and supervisors to oversight
officials and bodies in order to assure that medical personnel practice with
reasonable skill and safety.
Study finds H1N1 affected emergency department workers more than any
other hospital employee
H1N1 pandemic, almost half of the reported H1N1 cases in hospital health care
workers occurred in emergency medicine, pediatrics, ambulatory care and
anesthesiology, with emergency medicine workers having the highest infection
rate. This is according to new findings published today in the AMA's Disaster
Medicine and Public Health Preparedness journal.
found that 49 percent of the H1N1 cases occurred in hospital departments that
together comprised 19 percent of total health care workers. The health care
workers in this group are emergency medicine, pediatrics, ambulatory care,
intensive care units and anesthesiology. Visit http://www.ama-assn.org/ama/pub/news/news/h1n1-study-dmphp.shtml to learn more about this study.
Emergency Rooms and Docs Brace Themselves For Newly Insured
new health reform laws won't take effect for at least three months and most
provisions won't come into play until six months to four years, hospital
emergency rooms and physicians are bracing for an onslaught almost immediately.
will start coming because they think they have health coverage" when they
don't or reform provisions that apply to them don't kick in for quite some
time, says Angela F. Gardner MD, president of the American College of
other states start out with higher numbers of people who have been uninsured
than Massachusetts had, hospitals nationally can expect to see a 10% surge in
their emergency room load, Gardner estimates.
could have a serious impact on two aspects of emergency room care: the number
of patients who are boarded-that is retained in the emergency room while they
await admission to an inpatient bed- and the number of emergency room visitors
who leave without being seen, says Gardner, a full-time emergency physician.
Another load of
patients will come from physician office practices, she predicts. "More
and more physicians in the community will send patients to the ED instead of
the office when they know the patient will probably need admission. That's
because of a growing trust of what emergency department physicians can
AAPS Ramping Up
Campaign for Recognition
American Association of Physician Specialists
(AAPS) is pushing for wider acceptance of its board
certification in emergency medicine through its affiliate, the American Board of Physician Specialties (ABPS). The
quest has put leaders of emergency medicine's professional organizations on
edge, and brings into question the value of an emergency medicine residency.
plan puts ABPS on a collision course with the American
Board of Medical Specialties as well as the Bureau of Osteopathic
Specialists and Boards of Certification of the American Osteopathic Association, the most widely
accepted agencies for medical specialty certification.
While ABEM bases board
certification on completing an emergency medicine
residency and testing, ABPS's certifying body, the Board of Certification in Emergency Medicine (BCEM), allows
applicants to have completed a primary care or anesthesiology residency along
with 7,000 hours of experience in an emergency
efforts to achieve recognition for its board certification are close to
fruition in Texas, where the board's director and legal counsel ruled that
existing regulations appear to allow physicians to advertise that they are
board certified by ABPS. In Oklahoma, new rules
specifically recognize board certification by the
group. In 2006, ABPS lost its bid for recognition by the board in North Carolina, and it is now renewing that proposal as
North Carolina reconsiders a variety of licensing rules. In September, a
federal district court granted the state of New York summary judgment in a suit
by AAPS that claimed the state agency had violated the Constitution's 14th amendment
on equal protection by not recognizing the group's medical specialty
certification. That ruling is now being appealed in higher courts.
a statement by Dr. Gardner, ACEP President, she said, "As outlined in ACEP's
policy statement 'ACEP Recognized Certifying Bodies in Emergency Medicine,'
ACEP recognizes ABEM and AOBEM as the only certifying bodies for emergency
medicine. This has been ACEP's position for many years, and it has not changed.
In recent years, ACEP and its chapters have actively defended this position in
opposing similar ABPS initiatives in other states including Florida, Kentucky,
New York, and North Carolina."
"ACEP's opposition is
based on concerns that BCEM allows and encourages new physicians to enter
unsupervised practice without residency training in the specialty," said Dr.
Gardner in her official statement. "ACEP has maintained a consistent position
on the critical importance of residency training for physicians entering
emergency medicine. The specialty has grown such that residency training is
widely available, and should be the pathway for new physicians entering the
practice of emergency medicine."
DEA Publishes Regulation Permitting
E-Prescribing Of Controlled Substances
The Drug Enforcement
Administration (DEA) released an interim final rule (IFR) outlining the process
for practitioners to have the option of electronically writing prescriptions
for controlled substances. The IFR provides physician practices, hospitals, and
pharmacies with the ability to use modern technology to issue these
prescriptions while maintaining a closed system of controls over the dispensing
of controlled substances. Key provisions of the IFR include:
- The requirement that practitioners obtain authentication credentials from
federally approved credentialing service providers or certification
authorities. (Only DEA registrants may be granted the authority to sign
e-prescriptions for controlled substances.)
- A "two factor authentication" is required for the practitioner to prove his
or her identify (i.e., a password and either a hard token, such as a security
card, or use of a "biometric," such as retina or fingerprint)
- No paper duplicates of the prescription are allowed, unless the transmission
- The security system used by the e-prescription software must, to the greatest
extent possible, prevent creation or alteration of a prescription for a
controlled substance by unauthorized employees of the practice
- Practice audit logs need to be modified to permit the development of a list
of auditable events (i.e., events that indicate a potential security problem)
- The e-prescription records must be reliable enough to be used in legal
Physicians practices' current e-prescribing software and workflows will most
likely need significant modification to comply the DEA's IFR requirements- especially in the area of
security. The IFR includes a 60-day comment period.
Guidance To Contractors On New Timeliness Standards For Processing Provider
Centers for Medicare & Medicaid Services (CMS) recently released instructions to contractors revising the timeliness standards for processing
Medicare paper 855 applications. Effective June 21, 2010, contractors must
process initial paper-based Medicare applications in a more expeditious manner;
Internet-based applications are not affected. If the application is complete
and no follow-up is necessary, contractors must process 80 percent of 855I and
855B applications within 60 calendar days of receipt and 95 percent within 90
calendar days of receipt. Timeframes differ for applications requiring
follow-up. Providers should reply as soon as possible to any contractor
requests for additional or missing enrollment information, and applicants must
furnish the information within 30 days. CMS has emphasized the need for
Medicare providers to have accurate, up-to-date enrollment records in the PECOS
database. MGMA recently updated its Medicare Provider Enrollment Toolkit, which provides
guidance to members on the Medicare enrollment process.
Tamper Resistant Prescription Pads/Paper
law signed by the governor in 2009 requires that prescriptions written in
Washington be on tamper resistant paper or pads (TRPP) approved by the
Washington State Board of Pharmacy. Beginning July 1 this year all medication
prescriptions hand delivered to a pharmacy must have a new look. While the
layout will be much the same as previous forms - with two signature lines for
prescriber and patient information - the forms will include a "seal of
approval." Prescribers, pharmacists, and patients can identify approved forms
by the "seal of approval" printed in the lower right-hand corner of the
tamper resistant prescription paper and pads now in use won't comply with the
new law. Only board-approved forms are to be used for hard copy given to a
patient or patient designee, including prescriptions printed from an electronic
medical record system.
ProviderOne Goes Live May 9 - Are You Ready?
has announced that the changeover to its ProviderOne system will take place May
9. All providers with Medicaid patients should have completed the three key
phases of this transitional process: Security, Registration and Claim Testing
your practice has not completed ProviderOne transition tasks (Security,
Registration and Testing), please contact the DSHS live help desk for
assistance at 1-800-562-3022. Option 2 (for provider) and Option 4 (for
ProviderOne). Or visit: http://hrsa.dshs.wa.gov/providerone/providers.htm
your practice has attempted to complete ProviderOne transition tasks (Security,
Registration and Testing) and has unresolved problems that require additional
assistance beyond what the help desk has provided, please post the specifics of
the issue (including your Provider ID# and/or Help Desk ticket #), so we can
share those comments with DSHS lead staff.
View Key Dates for Cutover and Transition
If you have
additional questions of ProviderOne contact Gena Cruciani by email to CRUCIGM@dshs.wa.gov
Medicaid to Start Mailing Out Plastic
April, the Department of Social and Health Services will start mailing
million medical assistance clients the same kind of plastic ID card used
private health insurance companies.
new "Service Cards" are part of the changeover to the new ProviderOne
system, which will go on line May 9. They represent a convenience for
doctors, dentists, hospitals and other kinds of providers. They replace
mailings of a paper coupon.
new cards, which are free, will be mailed out first in the Spokane area
northeastern Washington, from April 9 to April 13.
rest of the mailings will cross the state, finishing in the southwestern
of the state:
April 14-19: Other Eastern Washington points
· April 20-23: Northwestern Washington
· April 24-28: King County
· April 29-May 3: Pierce County
· May 4-7: Olympic Peninsula and Southwestern Washington
Washington Chapter American College of Emergency Physicans
2033 6th Ave Ste 1100
Seattle, WA 98121