WA-ACEP April 2010 NewsWatch

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.

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.

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 synopsis- Following 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.

The paramedic 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 Circuit.

Amicus Curiae Arguments:

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 supervision;

We also argue that:

The 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

During the 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.

The study 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

Though 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.

"People 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 Emergency Physicians.

Because 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.

That 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 do."

AAPS Ramping Up Campaign for Recognition

The 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.

The 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 department.

AAPS 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.

In 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 fails
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 actions.

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.

CMS Releases Guidance To Contractors On New Timeliness Standards For Processing Provider Enrollment

The 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

A new 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 prescription form.

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.

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ProviderOne Goes Live May 9 - Are You Ready?

DSHS 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

Important:
1. If 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

2. If 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 Announcement
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 ID cards

During April, the Department of Social and Health Services will start mailing its one million medical assistance clients the same kind of plastic ID card used by private health insurance companies.

The new "Service Cards" are part of the changeover to the new ProviderOne payment system, which will go on line May 9. They represent a convenience for clients, doctors, dentists, hospitals and other kinds of providers. They replace monthly mailings of a paper coupon.

The new cards, which are free, will be mailed out first in the Spokane area and northeastern Washington, from April 9 to April 13.

The rest of the mailings will cross the state, finishing in the southwestern corner 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

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Washington Chapter American College of Emergency Physicans

2033 6th Ave Ste 1100

Seattle, WA 98121

206-956-3648

smc@wsma.org