June 2011

WA-ACEP Elects a New Board of Directors

At our recent Annual Meeting, Summit to Sound - Northwest Emergency Medicine Assembly, the membership elected the following Board Members for a three year term. Hunter Hodge, MD (Seattle); William Hurley, MD (Olympia); John Matheson, MD (Kennewick); Nathan Schlicher, MD (Tacoma); Patrick Solari, MD (Seattle); and Liam Yore, MD (Everett).

Dr. Stephen Anderson was installed as President of WA-ACEP. Dr. John Milne, now moves to the Past President.

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Washington Emergency Department Opioid Prescribing Guidelines

Recent data shows that health care providers are prescribing more opioid pain medicine. An unintended consequence of this prescribing has been an increase in overdose deaths, hospitalizations, and substance abuse treatment admissions. In addition, teens are using prescription opioid medication to get high. The cause of this public health problem and its solutions are complex.

As part of the solution, the Washington State Department of Health convened an emergency department provider workgroup, consisting of WA-ACEP leadership, and created emergency department guidelines for opioid prescribing. These guidelines are available here . Posters to educate your patients about these guidelines are available here. Our goal is to have a consistent, statewide message for patients hung in each hospital by July 31, 2011. Patient Educational Posters will be mailed to your ED nurse manager next week. The large poster (20 x 30) is for the waiting room, and smaller posters (11 x 17) are for exam or triage rooms.

If you need additional copies, or Spanish or Russian translations of the smaller poster, they can be printed from the following website:

If you have any questions, please contact Jennifer Sabel via email or Shannon McDonald via email

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2011 Legislative Session Summary

The WA-ACEP legislative agenda includes a number of policy issues important to Emergency Medicine, in addition to budget issues relative to access to care.

The 2011-2013 Biennial Budget

Reduced projected state spending by $4.6 billion (more than a projected 12 percent of the overall budget). The total operating budget is $32.2 billion. A reserve of $723 million has been left. No new taxes were raised, but a number of fees were increased or added in various sectors. There were, however, no fee or tax increases for the medical community, in spite of a number of proposals to do so. Priority health care budget issues were affected:

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Elimination of Non-Contracted Physicians’ Ability to Balance Bill

The issue of banning balance billing for services provided by non-contracted physicians to a health plan’s subscriber in the hospital for purposes of satisfying EMTALA requirements was hotly debated early in the session.

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Limiting Non-Emergent ED Visits

The Washington State legislature passed the 2011-2013 operating budget, including the provision to limit ED visits by Medicaid patients to three “non-emergent” visits per year. WA-ACEP has been at the forefront of this battle.

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2011 ACEP Leadership and Advocacy Conference Highlights

On May 24, in conjunction with the LAC meeting, nearly 500 emergency physicians from around the country met with lawmakers on Capitol Hill to discuss everything from liability reform to the costs of emergency care and reforming the Medicare physician payment system. Some of our members were given a video camera to document their experiences on Capitol Hill. Footage from the videos is now on our YouTube site and available on the ACEP Website where you can also find talking points and position papers on the issues discussed during the Hill meetings.

Washington State had strong representation this year. Our constituency consisted of John Milne, MD, Immediate Past President; Christopher Kang, MD, Secretary-Treasurer, Nathan Schlicher, MD, Legislative Chairman; Alison Haddock, MD; Joshua Simmons, MD and Shannon McDonald, WA-ACEP Executive Director. Successful meetings were held with the offices of Senator Patty Murray, Senator Maria Cantwell as well as Congressman Norman Dicks, Congressman Adam Smith, Congressman Dave Reichert.

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ACTION ALERT: Contact your U.S. Representative today to urge his/her co-sponsorship of ACEP-supported legislation, H.R. 157, the “Health Care Safety Net Enhancement Act of 2011.”

This legislation would extend the same legal protection that physicians employed under the Public Health Service Act have to physicians who care for patients in the ED. This safeguard does not prevent someone from taking legal action. Rather, the bill requires that any tort or medical liability case must be brought against the federal government, which, in turn, would defend qualifying (through a statutory credentialing and privileging system) physicians against any alleged wrongful action.

Please go to the ACEP Advocacy Site to send a letter to your U.S. Representative today urging co-sponsorship and support of H.R. 157. Please note that if your Representative is already a co-sponsor of the bill, you will be directed to a thank you letter after entering your home zip code.

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Blue Shield of Calif. plans net income cap, refund

Blue Shield of California, San Francisco, has pledged to cap net income at 2% of revenue and refund $180 million, the sum the company's earnings exceeded that level in 2010.

According to a news release, $167 million of the refund will be distributed as a 30% credit to individual and fully insured group members toward one month of premium, and a 10% premium credit for customers that share risk. Another $10 million will be invested in hospitals and physician groups seeking to form accountable care organizations, and $3 million will go to the Blue Shield of California Foundation, which supports organizations that provide healthcare to low-income Californians.

Blue Shield of California has recently come under fire by state regulators for rate hikes. In March, the company abandoned plans to raise rates on individual policyholders for the rest of the year, under pressure from the California Department of Insurance. In April, the California Department of Managed Health Care questioned rate hikes that averaged 37.5%.

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Health Alert: Shigellosis among MSM in King County

  • Be alert for patients with symptoms of possible Shigella infection: diarrhea (may be watery or bloody), fever, abdominal cramps, nausea, or vomiting
  • Obtain stool cultures for patients with compatible symptoms
  • Obtain antibiotic sensitivity testing on all Shigella isolates
  • Exclude persons with symptoms of acute infectious diarrhea from settings with a high risk of transmission to others (e.g., child care attendees and workers, health care workers, food workers)
  • Educate patients that shigellosis can be transmitted sexually through exposure to fecal matter, especially during oral-anal and oral-genital contact
  • Report cases of shigellosis to Public Health within 24 hours at (206) 296-4774


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CMS PQRS 2009 Experience Report Shows Emergency Physicians Reported Most Frequently

CMS recently released its report on the 2009 Physician Quality Reporting System (PQRS). The report notes that among participating professionals, emergency physicians, followed by anesthesiologists, had the largest representation among all professional specialties, and also had a high rate of participation at 63%. (CMS 2009 Reporting Experience Including Trends (2007 � 2010) PQRS and eRx Incentive Program, p.12). CMS explained that hospital-based practices most likely have current processes in place to capture clinical data accurately therefore allowing quicker uptake of reporting quality measure data. Additionally, there are several emergency medicine measures in the PQRS, allowing emergency physicians to easily identify applicable measures for a majority of their Medicare population.

The CMS report may be accessed at this link:

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LNI PROVIDER FEE SCHEDULE: The 2011 Medical Aid Rules and Fee Schedules (MARFS) is now available

The department has published the 2011 edition of the Medical Aid Rules and Fee Schedules.

2011 Fee Schedule

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Reducing Preventable Emergency Room Visits

As you may already know, the WSHA, along with the Medicaid Quality Incentive Program has launched a campaign to reduce preventable ER visits. The Medicaid program will pay an additional one percent increase for inpatient payments at non-critical assess hospitals who meet certain quality matrices. Your facility must develop a written plan to reduce preventable ER visits of Medicaid managed care clients. This plan must be approved by the Medicaid Purchasing Administration. Final plans are due by September 1, 2011. A template can be found here . The plan, when completed, should be emailed to

If you have additional questions, contact Ken Rudberg at (206) 577-1851 or or Carol Wagner,

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Fear of Lawsuits Drives Costs in ED, Says ACEP

John Commins, for HealthLeaders Media, May 31, 2011

More than half of emergency physicians in a recent poll say they practice defensive medicine to protect themselves from lawsuits.

The survey from the American College of Emergency Physicians found that 44% of nearly 1,800 emergency physicians say the fear of lawsuits is the biggest challenge to cutting costs in the emergency department. And 53% say that fear of litigation drives many of the tests they order.

“Medical liability reform is essential to meaningful healthcare reform,” ACEP President Sandra Schneider, MD, said in a media release. “Without it, healthcare costs will continue to rise. Estimates on the costs of defensive medicine range from $60 billion to $151 billion per year. That dwarfs total expenditures on emergency care, which at $47.3 billion in 2008 represented just 2% of all healthcare spending.”

The poll also found that 68% of respondents said there has been no improvement in the number of medical specialists willing to take ED call since healthcare reform legislation passed last year. Many specialists cite the fear of being sued as one of the top reasons.

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Visits to ER rise despite MA health law

The Boston Globe, June 8, 2011

Emergency room visits have been on the rise in Massachusetts since the passage of the 2006 healthcare law, much to the chagrin of supporters who projected that the opposite would happen as more people had insurance and were connected with primary care providers. A new study published online shows that the issue may be a bit more nuanced. While overall emergency room visits increased about 4.1% between 2006 and 2008, visits for "low severity" problems fell slightly, by 1.8%, among patients who are poor or uninsured, according to the study posted last month by the Annals of Emergency Medicine. The decline is a small step in the right direction, but it also provides a reality check, said the lead author, Peter Smulowitz, MD, an emergency physician at Beth Israel Deaconess Medical Center.

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WA-ACEP Job Watch

 Jobs in Emergency Medicine

To post your job, please send an email to

2033 Sixth Avenue
Suite 1100
Seattle, WA 98121

(206) 441-9762 ext. 3038
1 (760) 552-0612 ext. 3038