August 2011

Health Care Authority’s three “non-emergent” visit limit

Over the last month WA/ACEP, along with the Washington State Medical Association (WSMA) and Washington State Hospital Association (WSHA) have met for long discussions with the Health Care Authority regarding a change to emergency room benefits for Medicaid clients.  The change will mean no payment for visits from any client who has accessed the emergency department more than three times for a “non-emergent” condition each year.  These negotiations are a direct result of the Washington 2011-2013 operating budget that directed the Health Care Authority to save $72 million through this initiative.  The authority plans on implementing this benefit limit on October 1, 2011.

Our priority has been to preserve the safety net of the emergency department and continue quality care.  The authority originally proposed a diagnostic list that was overly broad and included many diagnoses that are truly emergent conditions. WA/ACEP has been working with the authority to develop a limited list of diagnostic codes as well as exemption and review procedures that support patient safety. The authority will make the final decision on the list later this month.

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WA/ACEP UPDATE: Balance Billing

During the 2011 session, WA/ACEP and WSMA were successful in amending legislation to ban balance billing into a consumer transparency bill, the bill died in the House Rules Committee.

A Writ of Mandamus asking the court to compel the OIC to apply the 1997 Act as written was filed by the WSMA and WA-ACEP. The Court has denied the OIC petition to dismiss the case. The Court also remanded the case to the Thurston County Superior Court for a hearing. WA/ACEP is actively supporting this legal action.  

The OIC has had preliminary meetings with the WSMA to work on draft language to put Washington state law in compliance with Affordable Care Act, which specifically permits balance billing practices.  We anticipate that the legislators will pursue further legislation to ban on balance billing during the 2012 session. We hope that we can again limit the bill to a consumer transparency bill.

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Washington Emergency Department Opioid Prescribing Guidelines

The WA/ACEP sponsored guidelines were mailed to each ED in Washington during the first week of July.  Have you received them you?  Are the posters hanging in your ED waiting rooms and exam rooms?  Please send us your feedback.  To order more posters or for more information, visit

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Improvements in Door-to-Balloon Time in the United States, 2005-2010

Most heart attack patients needing angioplasty treated within recommended time

Nearly all heart attack patients who require emergency artery-opening procedures are treated within the recommended 90 minutes from hospital arrival, compared with less than half the patients five years prior, according to research reported in Circulation: Journal of the American Heart Association.

Study highlights:

  • More than 90 percent of heart attack patients who require an emergency artery-opening procedure known as angioplasty, are treated within the recommended 90 minutes, compared to less than half five years before.
  • From 2005-2010, the average time from hospital admission to angioplasty decreased from 96 to 64 minutes.

This significant improvement resulted from a concerted nationwide effort to improve care, including initiatives such as the American Heart Association's Mission: Lifeline.

Full Article

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State Health Care Policy on a Tight Budget

The State is in an admittedly tough spot - required to move forward to implement the federal health care law while at the same time being forced to limit state funded services as revenue projections continue to sour.  The September revenue forecast, due in 30 days, is expected to project a $0.5-$1 billion budget shortfall for the remainder of the 2011-2013 biennium (best case scenario) up to $1-$2.5 billion (worst case scenario).  The governor has instructed state agencies to prepare for 5 to 10 percent cuts.  A special session in October is a real possibility.

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Washington State Prescription Monitoring Program

State law, RCW 70.225, authorized the Washington State Department of Health to establish the Washington State Prescription Monitoring Program (WA PMP). Pharmacies and practitioners that dispense Schedules II, III, IV, and V controlled substances in Washington State, or to an address in the state, must electronically report to the WA PMP starting October 7, 2011.
The WA PMP, also known as Prescription Review, promotes public health and safety and helps improve patient care. Practitioners and pharmacists have access for reviewing patient prescription histories to help determine appropriate medical treatment and referral needs.

Click here for a fact sheet provides more information about the program.

If you have policy related questions please contact Chris Baumgartner, PMP Director at 360.236.4806, or at

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WA/ACEP Call for Nominations

The WA/ACEP is looking for one new board member to sit on the WA/ACEP Board of Directors.  WA/ACEP is led by an energetic, engaged Board of Directors. The organization has a structure that provides opportunities for members to participate in governance activities and help shape the future of the profession.  Do you want to get involved or know someone who does?  Please send me an email if you are interested

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Emergency Cardiac and Stroke System Update

The Emergency Cardiac and Stroke System is currently accepting applications for cardiac and stroke center categorization to participate in the Emergency Cardiac and Stroke System from August 1, 2011 - September 30, 2011. If you want to apply, or you are already categorized and want to change your level, request applications from Kim Kelley, . Please indicate whether you want an application for level I, II, or III for stroke and level I or II for cardiac. For more information on categorization levels, see the participation criteria.

To date, Seventy-five Washington hospitals have applied for one or both categorizations, and one Idaho hospital has applied. That means if 14 more hospitals apply, we’ll have all WA hospitals participating in the system (not counting naval hospitals and children’s hospitals)! It would be wonderful to have 100% participation by the end of 2011. So far:

Total WA hospital applications:  75; Idaho hospital applications: 1

Level I Cardiac:  29

Level II Cardiac:  39

Level I Stroke:  9

Level II Stroke:  29

Level III Stroke:  35

To see which hospitals are participating and at what categorization level, check the participating hospitals lists by region.

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Young Physician’s Column: Gold fever

Editor’s note: This column is meant to provide a forum to discuss issues of particular concern to younger physicians. If you have a question on work-life balance, personal finance or contract law, please email Viral Shah, MD at Dr. Shah is a hospitalist in Tacoma and also an investment advisor representative with Prudent Financial Planning, LLC in Federal Way. Answers here are general in nature and meant for education only and do not create an adviser-client relationship. Answers are not tax or legal advice.

By Viral Shah, MD FACP

How good an investment is gold?

A: Up until the 20th century the citizens of Yap, a Micronesian Island, used stone disks (called “fei”) as currency. The Yapese had to travel by canoe to distant islands to get large fei. The largest fei remained in plain view in the town square, but their ownership changed when their owner “spent” them. The larger the disk, the richer the owner. No one had ever seen the largest fei that lay on the ocean floor, but they all believed in its existence. This fei at the bottom of the ocean traded hands like all other fei physically present on the island.

Fei and gold share similar properties-relative rarity, lack of practical utility and strong durability. Fast forward to the 21st century: My paycheck is deposited directly in my account. I spend with a plastic card. I pay off my card with an online money transfer. Where is my money? It may as well be a giant stone at the bottom of the sea!

Fei, paper currency or gold all serve the same purpose - they allow us to define our purchasing power, to barter goods, to quantify and to display the worth of our possessions. Any material can be used as currency as long as people have trust in it. The inflation in Zimbabwe increased by 130,000% recently because its citizens lost faith in their own currency. Today, Zimbabweans use the South African rand, the U.S. dollar or the euro to trade.

Those who followed the price of gold through the 1980s will recall that it peaked at $850 on January 21, 1980 but plunged by $145 the next day. By 1985, gold was down to around $300.

When you hear that gold returned 500% over the last decade, you must remember that such an experience is not typical of just any investor. First, one must have purchased gold in 1999 or 2000 when it was less than $300 per ounce and held it until 2011 when it was $1,500 per ounce. The New York Times wrote on May 14, 1999, “Who needs gold when we have Greenspan?” This headline reflected a widely held view of the era. Your financial advisor was unlikely to recommend in 1999 that you purchase gold. To achieve maximum returns, investors must “buy low and sell high.” But anyone who purchases gold today may fall prey to the converse-“buy high and sell low.” People with financial acumen are no exception. The State of Alaska retirement system bought a ton of gold in 1980 at $651/ounce, and a second ton at the end of 1980 at $575/ounce. The state sold this gold in 1983 at $414/ounce!

Gold has no intrinsic value. Return on a gold “investment” is solely dependent on an increase in its price. Unlike a factory that produces goods, or a company that provides services, gold merely sits like a rock. When people trust their currency and the government backing it, the price of gold falls. Investing in an asset simply because its price has gone up (“performance chasing”) is not a prudent investment strategy. Just ask the investors who invested at or near peak during the recent tech or real estate bubbles. Buying gold is speculation, not an investment.

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Economist Links Higher ER Spending to Lower Mortality

John Commins, for HealthLeaders Media , July 27, 2011

Hospitals that spend more money on emergency department care for cardiac patients have lower mortality rates for those patients, a Massachusetts Institute of Technology study has found.

In a paper published in the July issue of the American Economic Journal: Applied Economics, Doyle examined tens of thousands of cases in which out-of-state visitors were admitted to emergency rooms in Florida hospitals from 1996-2003. He discovered that an increase of about $4,000 per patient in hospital expenditures led to a 1.4 percentage-point decrease in the mortality rate. Overall, a 50% increase in what Doyle calls a hospital's "spending intensity" allows it to reduce mortality rates due to heart problems to about 26% below the mean, the study found.

The findings are sure to prompt more debate about the linkage between cost and quality care.

Full Article

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Health Care Authority and Medicaid Merger

Friday, July 1, the Washington State Medicaid program and the Health Care Authority merge together in a single state agency called the Health Care Authority.

The Governor’s plan was outlined a little over one year ago - April 1, 2010 - when she issued Executive Order 10-1, saying the move to combine the two operations would help the state leverage more effective health purchasing strategies as well as prepare the state for national health care reform in 2014. All told, the consolidation is a major step toward policy changes that will make all state government health programs more effective and efficient.

“The mission of the new agency will be to promote evidence-based medicine, realign incentives to improve quality care and reduce costs,” Doug Porter, Director.

Here are some data to keep in mind:

today the combined agency is responsible for health care for:

  • 1,200,000 on public assistance
  • 350,000 public employees and retirees

Beginning in 2014 the state will be responsible for an additional:

  • 400,000 residents newly eligible for Medicaid
  • An estimated 200,000 BHP enrollees, and
  • 150,000 to 300,000 people through the Health Insurance Exchange

The grand total: State government will be purchasing health care for up to 2.45 million state residents out of a population of 6.7 million, or 37% of the market.

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Free Provider CME on New Statewide Rules for Pain Management

Four FREE continuing education credits are now available to help providers (MD, DO, PA, ARNP, DPM) comply with new statewide rules on pain management and the prescribing of opioids for chronic, non-cancer pain.

Go to the “CME Activities” tab on the Opioid Guideline page at the Agency Medical Directors’ Group (AMDG) website:

The 2010 legislature passed a bill in response to concerns about the consequences and risks of prescribing opioids for chronic, non-cancer pain. In response, five boards and commissions adopted regulations related to pain management.

To meet the 4 hour CME provision in these rules, the Medical Quality Assurance Commission (MQAC) in consultation with the Department of Health (DOH) and Agency Medical Directors’ Group (AMDG), offer a free Category 1 CME (continuing education) package available online and on-demand! Users may print certificates from their own computer at no charge - no need to wait for a certificate in the mail!

This CME package is applicable to the licensees of all five boards and commissions named in this legislation.

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Classified & Job Posting Information

Place your message where Emergency Department directors and leaders can’t miss it! Consider advertising in the WA/ACEP JobWatch, where your ad will be seen by the practicing Emergency Medicine professionals and residents that read our newsletter and view website regularly.

To have your job posting or classified advertising included in the WA/ACEP NewsWatch and JobWatch, submit your copy to Please include your contact information for billing purposes.

Your ad will appear in 2 issues of our electronically distributed NewsWatch. Ads for job postings will also be placed in the JobWatch section of the WA/ACEP website for 3 months, or until the position has been filled.

Job Posting/Classified Ad rates based on one time placement

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E-Update Contributions and Suggestions

The WA/ACEP JobWatch 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

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Job Watch

Medical Director - Seattle
EM Physicians - Seattle
EM Physician - Port Angeles
EM Physician - Seattle
Clinic Physician - Everett
EM Physician - Seattle
EM Physician - Redding & Red Bluff, CA
EM Physician - Paradise, CA
EM Physician - San Bernardino, CA
EM Physician - Humboldt County, CA
ED/UCC Physician Assistants - Eureka, CA
Emergency Physicians - Wenatchee

2033 Sixth Avenue
Suite 1100
Seattle, WA 98121

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