April 2011

Register Now for the Summit to Sound - Northwest Emergency Medicine Assembly

May 18-20, 2011
Bell Harbor International Conference Center
Seattle, Washington

Featuring 3 days of Effective Strategies and Scientific Updates

  • Approved for 23.5 AMA PRA Category I Credits
  • Topic specific panel discussions with a host of local and national experts
  • Exhibitors to help you find solutions to your toughest challenges
  • Networking opportunities with colleagues from around the state
  • LIVE & WEBINAR: Therapeutic Hypothermia Journal Club

Register Online
Meeting Brochure

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WA-ACEP Action Alert: Urge No on Limiting ED Visits

Washington State legislators and government officials are focused on reducing cost from health care. One of the ways they are proposing to do this is by reducing payment for emergency room visits. HB 1087/SB 5094 included measures to limit emergency room visits to three per year. This proposal is estimated to save the state up to $76 Million dollars in the next two years. The WA-ACEP is actively opposing any efforts to limit Emergency Department visits. We need to ensure that our most vulnerable population has access to medical treatment. We need you to act now and contact your elected officials.

Please use the talking points below to urge your legislators to oppose this measure.

  • In the Balanced Budget Act of 1997, CMS states that Medicaid managed care plans must follow the prudent layperson standard and cannot set limitations on the number of ED visits that Medicaid managed care plans would pay.
  • In the Patient Protection and Affordable Care Act passed last year, private insurers are prohibited from setting a limitation on ED visits.
  • There is a critical shortage of primary care physicians in Washington, and most physicians will not see Medicaid patients. This means that the only access to care is through the Emergency Department.
  • Medicaid patients with serious, multiple or chronic health care conditions who often have the greatest need for emergency care will be placed at greatest risk.
  • Patients will decide against seeking needed emergency care out of concern about taking one of their three allowable visits. The end result of this is, of course, the need for prolonged and more intensive care, which will not only put people’s health at risk, but increase the overall costs of caring for these patients.
  • Providers of emergency care are required by federal law to screen and, as necessary, work to stabilize every patient that seeks emergency care. Limiting the number of emergency department visits that Medicaid will pay for does not eliminate the requirement that Medicaid patients must still be seen, no matter how many ED visits they’ve made.
  • Problems associated with uncompensated and undercompensated care are exacerbating significant financial burdens on emergency care providers and contributing to emergency department closings across the country.
  • Emergency physicians bear the brunt of uncompensated care. According to the American Medical Association, individual emergency physicians lose on average $138,300 annually by providing EMTALA-mandated care. ("Physician Marketplace Report: The Impact of EMTALA on Physician Practices" June 2003)

This is bad policy and could result in severely jeopardizing the health of individuals who need emergency care and need to be opposed.

Click Here to Contact Your Legislator

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Emergency Cardiac and Stroke System Update

Kim Kelley , Cardiac/Stroke Systems Coordinator

Cardiac and Stroke Triage Tools Revised

The Emergency Cardiac and Stroke Technical Advisory Committee recommended revisions to the cardiac and stroke triage tools based on feedback provided by EMS and hospitals earlier this year. We’ll post the revised tools on the website once the department finishes the final review next week. These will be the official triage tools EMS will use to triage and transport cardiac and stroke patients when a community is ready to implement the system locally. The first year we use these tools will be a time to evaluate them and identify areas for improvement. We will provide a way for you to submit suggestions for improvement and concerns about the tools to be considered when the tool is reviewed in 2012.

List of Participating Hospitals and April Open Application Period

The second open application period begins April 1, 2011. Applications are due May 31, 2011. If you want to apply, or you already applied and want to change your categorization level, request applications from Kim Kelley, Please indicate which categorization level you want.

Next Steps for Implementation

In a previous update, we told you the system will be phased in as communities are ready rather than an absolute “go live” date on July 1, 2011. A community is ready when:

  • Participating hospitals are identified. The first list will be released in early April 2011, and the second list in August 2011.
  • Cardiac and stroke regional patient care procedures (PCP’s) are developed and approved. These documents were reviewed, and recommendations made, for all 8 regions at the March EMS and Trauma Steering Committee meeting.
  • Cardiac and stroke county operating procedures (COP’s) are updated based on the PCP’s and participating hospitals . COP’s define how the EMS system operates at the county level, including which hospitals to transport patients to. COP’s are developed, collaboratively, by county EMS Councils and EMS medical program directors. Once the list of participating hospitals is released in April, councils and MPDs will begin to develop COPs or finalize them if they’ve already started working on them. Cardiac and stroke hospital staff will play a key role in the development of these COPS and you are encouraged to participate in the process. You can contact your local EMS office or the MPD in your county to find out how to become involved in this process.
  • MPD patient care protocols are in place. These protocols define the clinical care EMS provides to patients. Each county MPD develops protocols based on state guidelines for EMS providers in their county.
  • EMS providers are trained on the destination triage tools, PCP’s, COP’s and protocols.
    A customizable training template has been developed for MPDs and EMS trainers. We’re updating it right now due to the triage tool revisions. We’ll let you know when the updated version is available.

For more information, please contact Kim Kelley

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Medicaid Healthy Options/BHP Plan Preservation Act

Washington State Medical Association, Monday Memo

In the interest of transparency, the most recent legislation we have been calling the “ban on balance billing” bill should be termed “the Medicaid Healthy Options (HO)/BHP Plan Preservation Act.” This latest vexatious piece of unnecessary legislation is still alive via two companion bills – HB 2057/SB 5927.

  • For Medicaid HO/BHP patients, the bills would lock physician/provider fees in statute, incentivizing Medicaid and BHP managed care organizations to offer inadequate networks and reimbursement.
  • The bills give Medicaid HO/BHP carriers no incentive to contract with hospital based specialty groups (radiology and anesthesia). If it passes, these carriers will be obligated to pay non-contracted providers at Medicaid fee-for-service rates, leaving them no incentive to contract.
  • The legislation is overly broad and goes well beyond simply addressing the fiscal concerns allegedly raised by a recently successful lawsuit to allow non-contracted physicians to bill their customary rates.
  • Did we mention the need for it is questionable as its objectives should be obtainable via the state’s contracting processes, absent legislation?

The best case scenario: HB 2057/SB 5927 are killed during the special session. Next best case: adoption of our amendments to:

  • Require HO and BHP plans to negotiate in good faith with providers and facilities;
  • Establish a provider payment rate that is competitive with similar managed care organizations in the same geographic area for the same service; and
  • Sunset the bill when health care reform becomes effective.

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CMS Improperly Paid $38M for ED Outpatient Imaging, OIG Says

John Commins, for HealthLeaders Media, April 20, 2011

The Centers for Medicare & Medicaid Services' "inconsistent payment guidance" erroneously allowed about $38 million for improperly documented imaging claims in hospital outpatient emergency departments in 2008, a Department of Health and Human Services Office of Inspector General audit has determined.

Of the allowed Medicare claims for CTs and MRIs in hospital outpatient EDs in 2008, the OIG audit found that:

  • 12% ($18 million) did not have physicians' orders as part of the medical record
  • 12% ($19 million) did not have documentation to support that interpretation had been performed
  • 5% ($7.3 million) had overlapping errors

Full Article

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Health Alert: Hepatitis A in East King County

King County Public Health, April 21, 2011

Action Requested:

  • Be aware of three additional confirmed cases of hepatitis A among illicit drug users and their contacts in East King County, for a total of six cases
  • Take advantage of opportunities to vaccinate illicit drug users against hepatitis A, as is routinely recommended
  • Continue to administer routine hepatitis A vaccine to other adults at increased risk for hepatitis A infection, as well as children and teens
  • Be alert for potential cases of hepatitis A among patients who present with compatible clinical symptoms, including:
    • Fever
    • Fatigue
    • Nausea and loss of appetite
    • Diarrhea
    • Clay-colored stools
    • Abdominal pain
    • Joint pain
    • Jaundice or dark urine
  • For suspected cases of hepatitis A with acute illness, obtain a serum hepatitis A IgM, transaminases, and serology for hepatitis B and C
  • Report cases of hepatitis A to Public Health immediately upon suspicion by calling (206) 296-4774, 24 hours a day 7 days a week.


After the last health alert on hepatitis A in East King County on 3/25/11, Public Health was notified of three additional cases of hepatitis A infection. Currently there are a total of six confirmed cases of hepatitis A being investigated in East King County (North Bend, Snoqualmie, Preston) with symptom onset dates between 1/31/11 and 4/15/11. The ages range from early 20s to 40s, and all were reported or suspected of illicit drug use (particularly heroin or methamphetamine) or had close contact with persons who use illicit drugs.

Public Health recommends that health care providers take advantage of every opportunity to vaccinate illicit drug users against hepatitis A, as is routinely recommended. Routine vaccination against hepatitis A is also recommended for all children and teenagers, as well as adults at increased risk for hepatitis A, or anyone who wants to prevent infection. Groups at increased risk include international travelers, men who have sex with men, users of injection and noninjection drugs, persons with clotting factor disorders, and persons with chronic liver disease.


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Health Care Reform�the Washington Way

The governor’s project to find a way to reduce the rate of increase in health care costs to 4% annually by 2014 is moving ahead. Her invited group held its first meeting last week.

Steven Hill, former HCA administrator and current head of the state retirement systems administration and governor’s point man on this program, chaired the four-hour meeting. The governor spoke at the start and returned to hear reports from smaller work groups later in the morning.

The larger group was asked to vote on issue areas that should be pursued. The agreed upon areas of focus (and with much overlap):

  1. Care Coordination – medical home concept, attention on transitions of care, disease management
  2. Payment Reform – paying for outcomes and quality
  3. Prevention and Wellness
  4. Transparency – clinical and service quality and resource use monitoring and reporting

A leadership council of the CEOs of the WSMA, the WSHA, the Puget Sound Health Alliance, the Washington Healthcare Forum, the Association of Washington Health Plans, and the Washington Research Council was proposed to coordinate the efforts of work groups assembled around these issues, set goals, timelines and metrics.

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King County Diversion Project Update

The King County No-Diversion Pilot has reported a successful first month of this pilot project.  Preliminary reports indicate that the diversion free hospitals are excelling during this project and are improving their surge capacity plans, redesigning their current throughput models and implementing long term sustainable change.

The April 2011 edition of EMS World Magazine features a cover story about Seattle/King County.

Article Available Here.

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Might We ACE the Current Tort System?

Washington State Medical Association, Monday Memo

The WSMA is one of several organizations that have pushed for an alternate to the current medical tort system. Through the auspices of the Washington HealthCare Forum a work group put together a creative concept that would offer payment (from a schedule) for patients who experience preventable medical errors, offering certain, quick and fair compensation should they opt for that route vs. the Russian Roulette civil court system.

The framework includes ACE (Avoidable Classes of Events) the grouping of such errors deemed preventable. A list of 101 proposed ACEs that met two of the three criteria – either iatrogenic, or errors of omission and preventable – has been defined.

Last year the project received a grant from the Agency for Health Care Research and Quality (AHRQ) to develop a comprehensive plan for implementing such a program. The grant is funded from September 1, 2010 through August 31, 2011. The grant funds were awarded to MultiCare which has the lead on this project (AHRQ required a hospital system to receive the funds).

Other participants in the collaborative planning grant project are the Forum, the WSMA, WSHA, Regence Blue Shield, Premera Blue Cross, Physicians Insurance, Virginia Mason Medical Center, Swedish, the UW, and First Choice Health. Former WSMA President and WA-ACEP Board Member, Dr. Cindy Markus serves on the project’s steering committee.

The project’s principle investigator Dianne Garcia has a presentation available on the WSMA website at We could see an application for an implementation grant and some legislation grow out of this important work.

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Epidemic: Responding to America’s Prescription Drug Abuse Crisis

The Executive Office of the President of the United States has issued a report outlining action items that will be taken to improve educational efforts and to increase research and development on prescription drug abuse. The below items are included in the Healthcare Provider Education Section:

  • Work with Congress to amend Federal law to require practitioners (such as physicians, dentists, and others authorized to prescribe) who request DEA registration to prescribe controlled substances to be trained on responsible opioid prescribing practices as a precondition of registration. This training would include assessing and addressing signs of abuse and/or dependence. (ONDCP/FDA/DEA/SAMHSA)
  • Require drug manufacturers, through the Opioid Risk Evaluation and Mitigation Strategy (REMS), to develop effective educational materials and initiatives to train practitioners on the appropriate use of opioid pain relievers. (FDA/ONDCP/SAMHSA)
  • Federal agencies that support their own healthcare systems will increase continuing education for their practitioners and other healthcare providers on proper prescribing and disposal of prescription drugs. (VA/HHS/IHS/DOD/BOP)
  • Work with appropriate medical and healthcare boards to encourage them to require education curricula in health professional schools (medical, nursing, pharmacy, and dental) and continuing education programs to include instruction on the safe and appropriate use of opioids to treat pain while minimizing the risk of addiction and substance abuse. Additionally, work with relevant medical, nursing, dental, and pharmacy student groups to help disseminate educational materials, and establish student programs that can give community educational presentations on prescription drug abuse and substance abuse. (HHS/SAMHSA/ONDCP/FDA/HRSA/NIDA/ DOD/VA)
  • In consultation with medical specialty organizations, develop methods of assessing the adequacy and effectiveness of pain treatment in patients and in patient populations, to better inform the appropriate use of opioid pain medications. (HHS/CDC/SAMHSA/FDA)
  • Work with the American College of Emergency Physicians to develop evidence-based clinical guidelines that establish best practices for opioid prescribing in the Emergency Department. (CDC/FDA/ONDCP/NIDA/SAMHSA/CMS)
  • Work with all stakeholders to develop tools to facilitate appropriate opioid prescribing, including development of Patient-Provider Agreements and guidelines. (HHS/FDA/SAMHSA/NIDA)

Link to full text

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Bleeder to Feeder: How an ED Turned Its Business Around

Philip Betbeze, for HealthLeaders Media, March 11, 2011

Methodist Charlton Medical Center in south Dallas is staffed for 225 beds but its emergency department volume is equal to hospitals two and three times larger, says its president, Jonathan Davis. That's why when the ED is having problems, the rest of the hospital's problems are even bigger. The process challenges at Charlton's ED were numerous, but they all boiled down to a left-without-being-seen rate of 8-10% when Davis arrived 16 months ago.

Here's how hospital leaders re-engineered the department and its processes and stopped seeing business walk out the door.

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ACEP/Daniel Stern & Associates Clinical Emergency Medicine Compensation & Benefit Survey

Participants are now needed for the 2011 ACEP/Daniel Stern & Associates Clinical Emergency Medicine Compensation & Benefit Survey. The online survey should take approximately 15 to 20 minutes to complete and all participants will receive a free copy of the national survey results.

In an exciting new partnership, Daniel Stern & Associates is presenting this year's survey in conjunction with the American College of Emergency Physicians (ACEP). ACEP is urging all members to participate in the current survey to ensure a large number of participants and strong data.

The 2011 survey is based on compensation received by physicians who worked full-time in calendar year 2010. Because a most important calculation concerns the relationship between the total hours worked and the compensation earned, participants are asked to be prepared with a true estimate of the total hours worked at your primary position in 2010.

We are very excited about this new ACEP/DSA joint venture and hope you will participate in this critically important survey. All participants who complete the 2011 survey will be notified by e-mail when the survey results are released later this Spring.

Emergency physicians working in academic environments may prefer to participate in the Academic Emergency Medicine Compensation & Benefit Survey, which will be coming out in the next several weeks.

Please click on the link below to take the survey.

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HealthGrades Emergency Medicine in American Hospitals Study 2011

HealthGrades has compiled its 2011 listing of 268 “emergency medicine excellence hospitals” by state, based on criteria of risk-adjusted mortality outcomes for Medicare patients admitted through the emergency department.

Congratulations to the Washington State Hospitals who made the list!

Holy Family Hospital, Spokane WA
Providence Regional Medical Center Everett, Everett WA
Virginia Mason Medical Center, Seattle WA

Full Report

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WA-ACEP Job Watch

Urgent Care Physician - Vancouver
EM Physician - Shelton
EMS Supervising Physician - Southwest Snohomish County
Urgent Care Physician - Mount Vernon
EM Physician - Walla Walla
Medical Director - Whidbey Island
EM Physician - Bellingham
Medical Director Position - Seattle

2033 Sixth Avenue
Suite 1100
Seattle, WA 98121

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