December 2010

House Beats December 1 Deadline, Grants One Month SGR Reprieve

Earlier this week, the U.S. House approved a one-month delay in Medicare SGR driven payment cuts, giving a short-term reprieve to a looming crisis over treatment of the nation's elderly. The Senate acted on this reprieve just before the Thanksgiving break.

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Opening Salvo on Preventing 2011 SGR Cut Launched by AARP

The Washington State chapter of AARP announced a campaign to urge Congress to prevent the pending imposition of the 25% Medicare SGR cut, now set for January 1, 2011. Our state’s Congressional Delegation has repeatedly affirmed its commitment to stopping a cut. AARP’s campaign—initially aimed at our two US Senators—urges them to lean on their colleagues to take action before the end of the year to defer any cuts through December 31, 2011. The effort is to engage an estimated 15,000 seniors.

Here are key points made in AARP’s announcement:

  • “An overwhelming number of AARP members across Washington say they are concerned they could lose their doctor if Congress fails to stop a 25 percent pay cut facing Medicare doctors, according to a recent survey. The survey also found that AARP members fear it could be very difficult for them to find a new doctor that would accept Medicare patients if Congress fails to act.
  • “’We constantly hear from seniors that, after their children and grandchildren, the person they trust most is their doctor,’ said AARP Advocacy Director Ingrid McDonald. ‘This survey is a message to lawmakers that seniors will be watching to see whether they vote to prevent people in Medicare from losing their doctors.’
  • “The majority of survey respondents (84%) said they’d be either ‘very concerned’ or ‘somewhat concerned’ that doctors may stop treating Medicare patients because of this cut. In addition, eighty-percent (80%) said they’d have trouble finding a new doctor that would take Medicare should the looming cut take effect.
  • “Physician payment has been an ongoing issue facing seniors and the doctors who care for them. More than 10 years ago, Congress created a flawed system to pay doctors who treat Medicare patients. Because lawmakers have been unable to fix this system, Medicare can no longer pay doctors what it costs to care for seniors. Now, unless Congress acts by January 1 the scheduled (…2011...) 25 percent cut will take place, which could result in many seniors losing their doctors or have trouble finding a new one.
  • “’Washington’s seniors count on the security and peace of mind they get from seeing the doctor they trust,’ McDonald added. ‘We urge Senators Cantwell and Murray to stop this cut and work to provide doctors with a stable payment system so they’ll continue to treat Medicare patients.’
  • “The survey also found that seventy-nine percent (79%) of AARP members would be more favorable to their Senators if they fought to preserve access to physicians by protecting Medicare payments to doctors.
  • “Finally, in response to some lawmakers who proposed to stop the cut for three months, sixty-seven percent of AARP members said they would prefer a long-term solution. AARP is urging Congress to stop cuts now for one year while the new Congress works towards a permanent solution that will give seniors the peace of mind that they can keep seeing their doctors.”

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Hospital Applications for the Emergency Cardiac and Stroke System are Now Available

The Department of Health is now accepting applications to participate in the Emergency Cardiac and Stroke (ECS) System

Applying to participate in the ECS System is easy. There are three categorization levels for stroke centers and two for cardiac centers. Most hospitals already meet the criteria to participate at one of the levels. Steps to apply:

  1. Determine which level of cardiac and stroke center categorization best fits your hospital’s resources and capabilities. See the participation criteria here [NOTE: we have provided clarification and made minor modifications to the criteria on the application. Please request an application even if you think your hospital doesn’t meet the participation criteria exactly as stated on the website.]
  2. Request an application for the categorization level you wish to apply for by sending an email to Kim Kelley, Cardiac/Stroke Systems Coordinator, We will begin sending applications out Friday, December 3, 2011.
  3. 3) Complete and submit the application according to the instructions on the application.

You’ll hear back from the DOH within 60 days of your application. The sooner we can let EMS know which hospitals are participating, the faster we can get the system in place and start saving more lives and reducing disability for the people in our communities.

If you have questions, contact Kim Kelley, 360-236-3613,

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Know Your Options Re: Medicare

From mid-November through December 31, physicians will have their annual opportunity to review and perhaps change their Medicare participation status. Given the severe Medicare payment disruptions and uncertainty going forward the WSMA encourages you to review your options carefully.

To help you choose the direction that is right for your practice, the AMA has developed the “Know your options: Medicare participation guide.” This kit contains a detailed explanation of the three available options:

  1. participation (PAR),
  2. non-participation (non-PAR), and
  3. private contracting.

It also includes a helpful revenue calculator and various sample materials to help physicians share information with current, new, and prospective patients. The Medicare options kit is accessible at

Also, please continue to urge your patients to get involved by directing them to our online petition See item below.

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Interpreter Services Payment Cut Delayed

The Washington Medicaid program has delayed until March 1, 2011 its proposed elimination of coverage for interpreter services. As part of the state’s budget crisis, the cut was scheduled to take effect on January 1.

The WSMA, in cooperation with Physicians Insurance A Mutual Company, has prepared updated guidance on interpreters’ services, available on (Practice Resource Center, Practice Management Operations).

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Hole Deeper, Hill Steeper: The State Budget

The state budget problems worsen.  As the governor wrote to state agency heads, “Like you, I can’t stomach more bad fiscal news.  Today’s forecast took an already difficult situation and made it worse. The projection takes $385 million from this year’s budget and $809 million from the 2011–13 budget.  While the projection has immediate consequences, it also creates a $5.7 billion deficit for the next biennium.”

 The steep decline in revenues announced by the state economist were not anticipated, and just to get through June 30, 2011 would add another 4.6 percent to the 6.3 percent across the board reductions ordered last month. Rather than do that, the governor asked legislative leaders of both parties to provide their options on how to address the shortfall.  

The drama that is unfolding, now that revenues continue to drop and voters have tied the hands of the legislature to increase revenues, brings to mind the axiom that “one (in this case, the voters) should be careful what they wish for; he or she might get what they want.”  When the cuts come, we’ll see how far into the middle class they go – and whether state employees and state retirement plans are affected – and to what degree voters reconsider their positions. In the meantime, our Olympia staff is in steady contact with legislators and the governor’s office regarding health care programs and issues.

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Study: 40% of ED patients have low health literacy

U.S. researchers reported about 40% of emergency department patients have limited health literacy, which may influence their reasons for seeking ED care and their outcomes. The study found that the low health literacy group had skills assessed at or below the eighth-grade level, while ED patient materials usually are written at or above the ninth-grade level.


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CDC sees drop in cold medication-related ED visits for toddlers

CDC researchers said the number of children below age 2 who were taken to the emergency department for adverse reactions from cough and cold medications decreased by more than 50% between the 14 months before and the 14 months after the products were pulled from the market. However, researchers noted that two-thirds of the ED visits before and after withdrawal involved unsupervised ingestion of the medications. 


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Joint Commission Alert: Suicides a risk in the ER, hospital

A new Joint Commission Sentinel Event Alert urges greater attention to the risk of suicide for non-psychiatric patients in emergency departments and medical/surgical inpatient units and recommends education for caregivers about warning signs that may indicate when these patients are contemplating harming themselves. The Alert cautions that many patients who kill themselves in general hospital units do not have a psychiatric history or a history of suicidal attempts.

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Washington Needs a Statewide Drug Take-Back Program Access to Safe Disposal Can Prevent Accidental Poisonings and Abuse

Each year about one-third of the medicines sold to Washington households, about 33 million containers of drugs, go unused. That’s a big problem.  

Last year, the Washington Poison Center received more than 17,000 calls regarding young children that were poisoned by prescription or over-the-counter medicines. In addition to poisonings, kids are now being tempted by these same drugs because they perceive them as “safe”. A staggering 12 percent of Washington high school seniors abuse medicines. And more than half of teens abusing medicines get them from a family member or friend, often without their knowledge.

The best solution to curbing this epidemic is a permanent drug take-back program where Washington residents can bring their unwanted medicine to be properly destroyed. The Washington Chapter American College of Emergency Physicians is part of Take Back Your Meds, a group of organizations that are advocating for legislation that requires drug companies to pay for a take-back programs to collect and destroy these medicines. For about a penny per container of medicine sold in Washington state drug manufacturers could provide a convenient, safe program and relieve the financial burden on local governments, retailers and taxpayers.

To find out more about Take Back Your Meds and help support efforts to create a statewide drug take-back program go to

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Medicaid expands “Generics First” initiative to include mental health drugs (anti-psychotics)

The Washington State Medicaid program will expand its successful Generics First initiative to mental health drugs on November 1, encouraging prescribers to use lower-cost generic drugs. A similar program for children has been up and running for a year without issues.

The initiative will not apply to Medicaid clients who are already on a drug regimen involving a brand-name drug or a combination of drugs that includes a brand. Although brands are considerably more expensive than generics, the program will continue to pay for those drugs.

Dr. Jeffery Thompson, Medicaid’s chief medical officer, said the Generics First initiative has been successful in other categories of drugs – saving the state approximately $2 million a year in every 1 percent increase in the generics fill rate. 

For More Information: Jim Stevenson, Communications, 360-725-1915 (Pager: 360-971-4067).

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Online Death Filing Starts Early 2011

The Washington State Department of Health is releasing a new online Electronic Death Registration System (EDRS) to Pierce, Thurston, Mason, Benton, Franklin and Spokane counties in early 2011, with a statewide release to follow. Those who file death records in Washington State are encouraged to enroll in the new system. EDRS will streamline the death registration process, improve the quality of the death data collected, improve communication among those who file, and use the internet to make filing faster. To enroll or request information, contact Field Services at 800-525-0127 or

Everyone Benefits with EDRS

  • Physicians will quickly complete a death record from any computer with internet access and file it with a single click. This paperless system does not require extensive computer knowledge. It will streamline communication between funeral directors and physicians and eliminate the need to fax or sign paper records. It will offer a fast, easy, more accurate way to file.
  • Families will get death certificates faster and will be able to do so from any local health jurisdiction across the state. EDRS will deliver better service to families because delays with paper processing will be reduced.
  • Funeral homes will save time and money by collecting physicians’ signatures electronically. They will view cases online and get death certificates faster.
  • The people of Washington will benefit by having immediate and accurate death data used to combat public health threats

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E-Update Contributions and Suggestions

The WA-ACEP NewsWatch is your newsletter! All member contributions are welcome! We encourage you to submit articles, letters, practices tips to share in the newsletter, or send us a question you would like answered or your ideas for future articles. Email your contribution and suggestions to the WA-ACEP office at

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Calendar of Events

California Chapter ACEP
34th Annual Emergency Medicine in Yosemite
January 12-15, 2011
4th Annual Forensic Investigations
March 30 – April 1, 2011
Kansas City, MI
Summit to Sound – NW Emergency Medicine Assembly
May 19-20, 2011
Seattle, Washington

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