Archive for category ACEP Updates
This week, ACEP signed a letter from the Council of Medical Specialty Societies (CMSS) expressing “concern that the recent executive order suspending some foreign entry into the United States will have a negative impact on patient care, medical research, the education of health professionals, and international scientific collaboration.”
ACEP joins more than 30 other medical associations in signing the CMSS letter, which aligns with ACEP’s mission and values of access to care for all, diversity and inclusion, medical education support and research.
The following statement was issued by the ACEP Board of Directors on January 27, 2017
The ACEP Board of Directors and its leadership have had multiple communications with the parties involved and others affected by the recent abrupt emergency department contract transition at a health system in Ohio. The ACEP Board met recently and discussed the matter extensively.
Rapid transition of emergency department contracts may lead to serious disruption. Assuring that any such process is as smooth as possible is critically important to our specialty, and to ACEP.
ACEP is committed to promoting the highest quality of emergency care. To effectively achieve our mission, we are committed to supporting and protecting the interests of our specialty, patients, all members, residents in training programs, and academic and research elements of emergency medicine.
ACEP will be developing a white paper regarding best practices for how contract transitions should occur. When completed, it will not only be disseminated to the emergency medicine community, but also to hospitals and their administrators. We will also be publicizing to our members the availability of existing resources regarding ED contract provisions, negotiations, and other related materials.
We welcome the input of our members and others as we develop supportive resources.
In response to a January 1 emergency department staffing contract change at Summa Health System in Akron, Ohio, the president of the American College of Emergency Physicians Becky Parker, MD, FACEP, released the following statement:
“We are deeply concerned about the continuity and stability of training for the emergency medicine residents working in the Summa Health System following the abrupt shift in contracted emergency physician services from Summa Emergency Associates to U.S. Acute Care Solutions. Hospitals and health systems change staffing contracts routinely, but what is not routine at Summa Health is the abruptness of the change. Typically, it takes 90 to 120 days for a transition to be completed, to allow for adjustments to personnel, schedules and infrastructure. We are concerned about what plans Summa Health has to ensure smooth transition for the residency program and the residents directly involved.
“One of Summa Health’s top priorities must be to preserve the integrity of the training and support of its emergency medicine residents. Residency is a critical part of any physician’s education, and a clear plan, executed quickly, by Summa Health, is crucial to its residents’ education, training and well-being. The three years of residency are intensely focused on putting into practice, under stable supervision, the skills that are essential to a lifelong career in emergency medicine. Disruptions to that training can have damaging reverberations.
“We look forward to hearing about a more detailed plan from Summa Health on a seamless transition while continuing to provide a first-rate education to their emergency medicine residents of today and for the years to come.”
September 25, 2016
The following statement is from ACEP President Jay A. Kaplan, MD, FACEP:
As an organization that represents more 37,000 emergency physicians around the country and the world, the American College of Emergency Physicians applauds our members who stand on the front lines of the violence that occurs in our country every day. Some of that violence makes the nightly news. Sadly, the majority does not.
Our members treat victims and perpetrators, abusers and the abused, law enforcement officers, paramedics, firefighters, prisoners, and death row inmates. We treat the destitute and the wealthy, men and women, citizens and foreigners, and Presidents and pariahs.
ACEP members do it without regard to race, religion, sexual orientation, creed, nationality, socioeconomic class or the ability to pay. We daily see in our emergency departments victims of violence and abuse who no one ever hears about and who we continue to worry about; sometimes that violence is directed against us, just as it is against the law enforcement officers with whom we work.
We are saddened by recent events that that seem to dominate the news every day, as well as by the stories we experience recurrently which do not make the news. We join the call for an honest dialogue about how to turn the tide on the lack of humanity and compassion that leads to the violence we witness outside and inside our departments every hour of every day. Until the day it ends, our members will be on duty around the country to heal the wounds that afflict the victims and our country.
Report from the Section Council on Emergency Medicine: Highlights of the AMA Interim Meeting, Nov 2015, Atlanta, GA
515 of 540 Delegates sat for debate on the Monday opening of the House of Delegates (HOD). We were fresh off a Capitol Club luncheon starring a PBS anchor and Fox News reporter about the current state of Presidential Campaigning. Fascinating but impossible to predict seems the result as all known rules don’t seem to apply.
We typically have a 30-minute opening session of the HOD on Sunday morning. Instead, 90 minutes later the House recessed to reference committees after a lengthy exercise in parliamentary procedure referable to a new rule on “A motion to table” which is not debatable. The AMA recently changed its parliamentary resource from Sturgis to the American Institute of Parliamentarians Standard Code of Parliamentary Procedure. With the addition of this rule, it was used to prevent debate on a subject that the HOD did not seem to want to spend time discussing, namely issues related to Planned Parenthood. Arguments ensued about denial of opportunity for a minority to be heard. The House voted about 350 to 109 to table. Part of this plurality was due to the issue and part probably due to angst against the physician who brought the issue, having brought similar issues to the HOD repetitively in the past.
A special reference committee on the Modernized Code of Medical Ethics heard testimony on the latest Council on Ethical and Judicial Affairs (CEJA) effort to modernize the code. The code was again referred back for further work based on numerous objections. An example is the Code does not allow a physician to participate in assisted suicide. However many states have laws that allow physicians to do so. California law apparently stipulates that the state law will trump the AMA Code of Ethics. But many states do not have this protection.
Unanimous testimony was offered in support of the medical student resolution to remove disincentives and study the use of incentives to increase the national organ donor pool. Misery and disability due to lack of organs is evidenced every day in our practices. The HOD voted first to support a study on use of incentives, including valuable consideration, second to eliminate disincentives and third to remove legal barriers to research investigating the use of incentives.
The HOD voted to support seeking over the counter approval from the FDA for Naloxone and to study ways to expand the access and use of naloxone to prevent opioid-related overdose deaths.
There were resolutions that touched on balance billing and network adequacy as it relates to emergency services. One was reaffirmed as previous AMA policy endorsing fair payment for emergency care. Another was adopted directing the AMA to advocate that health plans be required to document to regulators that they meet requisite standards of network adequacy, including for hospital-based physician specialties at in-network facilities and supporting that insurers pay out-of-network physicians fairly and equitably for emergency and out-of-network bills in a hospital.
There were again multiple resolutions regarding MOC which were referred to the Board for ongoing action reflecting the productive dialogue between ABMS and the AMA/Council on Medical Education. GME was again highlighted as an urgent need for action to expand GME positions to better match the expansion of medical school graduates.
Medical students proposed multiple resolutions regarding the need to address wellness throughout the medical education/practice environment.
As usual, several educational sessions were also held at the AMA. The AMA website summarizes several of those sessions, including:
- “5 things every modern medical practice needs”
- “Physicians reaffirm commitment to stop insurance mergers”
- “Attend to EHRs so we can attend to patients, physicians say”
- “CDC panel shares solutions to combat antibiotic resistance”
- “New program helps develop the skill set every physician needs”
- “Get published using these 5 writing and research tips”
Highlights of the opening session were two. First was a presentation by President Steve Stack to Cal Chaney, an executive recognition award for his outstanding contributions to the AMA and ACEP during his many years as staff of the Section Council on Emergency Medicine. Second was of course an outstanding address by our AMA President, Steve Stack, a speech interrupted numerous times by thunderous applause. The Board of Trustees members are uniformly complimentary and appreciative of Steve’s service on the Board and his performance as President. We are justly proud of him and having an emergency physician as President of the AMA. You can see a synopsis of his speech and hear it at the following link:
ACEP and EMRA were also proud to host a reception for medical students attending the Interim Meeting to mingle and discuss careers in emergency medicine with the medical students. In addition to ACEP’s five delegates and five alternate delegates, the EM footprint in the HOD continues to grow and flourish. 21 emergency physicians serve as HOD delegates or alternate delegates for their state societies. Several others serve in key positions on various councils and sections. Among those emergency physicians, other interested physicians, medical students and ACEP staff attending one or both of the Section Council on Emergency Medicine meetings were:
Nancy J. Auer, MD, FACEP
Mark Bair, MD
Michael D. Bishop, MD, FACEP
Brooks F. Bock, MD, FACEP
Michael L. Carius, MD, FACEP
Ted Christopher, MD
John Corker, MD
Shamie Das, MD, MPH, MBA
Erick Eiting, MD
Stephen K. Epstein, MD, MPP, FACEP
Hilary Fairbrother, MD, MPH
Catherine Ferguson, MD
Gary Figge, MD
Diana Fite, MD, FACEP
Wayne Hardwick, MD
Marilyn Heine, MD, FACEP
David Hexter, MD, FACEP
Rebecca Hierholzer MD
Amy Ho, MD
Tiffany Jackson, MD
Jay Kaplan, MD, FACEP
Gary Katz, MD
Seth M. Kelly
Marc Mendelsohn, MD
John C. Moorhead, MD, MS, FACEP
Joshua B. Moskovitz, MD, MPH, FACEP
Richard Nelson, MD
Reid Orth, MD, PhD, MPH
Rebecca B Parker, MD, FACEP
Craig Price, CAE
Alexander M. Rosenau, DO, CPE, FACEP
Matthew Rudy, MD
Sarah Selby, DO
Michael J. Sexton, MD, FACEP
Steven Stack, MD, FACEP
Richard L. Stennes, MD, MBA, FACEP
Ellana Stinson, MD
Arlo Weltge, MD
Jennifer Wiler, MD, MBA, FACEP
Dean Wilkerson, JD, MBA, CAE
Joseph P. Wood, MD, JD, FACEP, FAAEM
Carlos Zapata, MD
ACEP is pleased to provide our members with a recent publication from the American Hospital Association (AHA) “Always There, Ready to Care,” promoting the extraordinary value of emergency medicine. The AHA is promoting this report by sharing it with policymakers, media and the public.
This publication describes the invaluable role of emergency physicians who must be prepared to respond to a wide range of medical conditions and are now experiencing capacity constraints in the face of rising demands.
It also describes the challenges of psychiatric patients in emergency departments, the complex issues of rural America and the nation’s increasingly heavy reliance on 24-hour access to care. In addition, it demonstrates the crucial role of emergency medicine in responding to disasters, featuring last year’s Ebola emergency and the outstanding response of emergency physicians following the explosions during the Boston Marathon.
The report concludes with a description of the funding challenges to maintaining the emergency department’s 24/7 role in an environment of declining financial support, asking the following policy questions:
- How will financing mechanisms need to be designed in order to support the 24/7 role in the future?
- How can the standby role be financed in an increasingly competitive health care marketplace where payers want to pay the lowest price?
- What is the appropriate role of government in supporting hospital-based disaster preparedness and relief?
- Should all health care facilities be required to support the community’s standby capacity and care needs?
- What steps can be taken to promote greater access to and utilization of primary care among low-income vulnerable populations to improve their health status and reduce the need for ED care?
Please share this report with key leaders and policymakers in your community and state and promote through social media.
|Michael J. Gerardi, MD, FAAP, FACEP
AHA President and Chief Executive Officer
By Alexander M. Rosenau, DO, CPE, FACEP
At last month’s ACEP14, we came to the end of my Presidency. I’m writing to say, “Thank you,” for allowing me to serve and to offer an update about what the College accomplished over the past year. For me, the past year has been intense as I’ve connected with individual members, groups, organizations and legislators in concert with our strong Board of Directors, expert staff and amazing volunteer physician members. I’ve cherished every minute. Emergency physicians enjoy a tremendous relationship with each other, and we’ve done some things in the past year to make our bond even stronger and to move the College forward. Although my term is over, please know that I will continue to work hard for the specialty.
Ebola Grabs Attention, Headlines
The work ACEP members and staff did to make sure our colleagues were well-equipped with the best information available for diagnosis and treatment of Ebola was outstanding. We immediately convened a panel of eight emergency care infectious disease experts to review materials pertinent to emergency care for dissemination to members and respond to questions posted by members via an easily accessible form on the www.acep.org/ebola resource page. We developed a curated repository of best practices for managing the patient with suspected and confirmed Ebola and worked with CDC, WHO, and other federal, state and local agencies to develop protocols for hospitals with limited resources. We added numerous resources to the ACEP website and identified short and long-term legislative initiatives designed to assist our members and other health care providers to enhance their disaster preparedness. We also linked reporters with ACEP experts in infectious disease and disaster preparedness. ACEP managed 10-20 calls a day from reporters on this issue.
A round-up of ACEP Spokespersons in the News can be found at http://www.acep.org/Content.aspx?id=80956. We also added courses to the ACEP14 session lineup and made the audio from those courses available for free to all emergency physicians, worldwide, at the end of the conference. We developed an Ebola response survey for dissemination through our Emergency Medicine Practice Research Network (EMPRN) to gather data on preparedness for Ebola, EV-D68 and other infectious diseases, and we surveyed the Disaster Medicine Section, EMS Committee and Section and ACEP infectious disease experts about response needs and preparedness.
To make sure we were getting the most accurate and up-to-date information, we also met with high-level officials at the CDC and convened meetings with American Hospital Association, Emergency Nurses Association, National Association of EMS Physicians, Emergency Medicine Residents’ Association, and other key stakeholders for information/resource sharing. ACEP acted quickly and collaboratively to help prepare our colleagues.
Leadership and Advocacy Conference A Major Success
More than 550 ACEP members attended LAC this year to review and discuss the major issues of health care reform affecting the practice of emergency medicine. In addition to getting up to speed on the issues, practicing physicians, residents, and medical students also learned how to be more effective advocates for our patients and our specialty. As always, the highlight of the meeting was ACEP’s Lobby Day. This year’s key issues were psychiatric patient boarding in the ED the lack of resources for mental health care, expansion of residency slots and funding for graduate medication education, and the need for liability protection for EMTALA care provided in the ED. Here is a rundown of the bills ACEP members spoke with Members of Congress and their staffs about during LAC:
The Helping Families in Mental Health Crisis Act of 2013 (H.R. 3717): Improve research and data collection of existing mental health programs, promote evidence-based medicine systems of care for patients with mental health issues.
The Health Care Safety Net Enhancement Act of 2013 (H.R. 36/S. 961): Provide liability protection for EMTALA-related services in the emergency department to emergency physicians and on-call specialists as federal employees under the Public Health Safety Act.
The Resident Physician Shortage Reduction Act of 2013 (H.R. 1180/S. 577): Expand the current cap, in place since 1997, on the number of Medicare-supported graduate medical education slots in the United States. It would create 15,000 new training slots over five years.
The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015): Completely repeal the SGR and replace it with a workable formula.
The Saving Lives, Saving Costs Act (H.R. 4106): Provide increased liability protection in the form of legal safe harbors to physicians who demonstrate they followed clinical guidelines developed by a multidisciplinary panel of experts.
ACEP Announces New Building Plans
In 1983, when the current ACEP headquarters was built, emergency medicine was fairly new as a recognized specialty. Now, with more than 33,000 ACEP members, the needs of this dynamic, growing medical organization and its members have greatly evolved. Just as many aspects of emergency medicine were different 30 years ago, our building was designed for a very different organization with different staffing and space needs, as well as technological requirements.
In the 21st century, ACEP needs a headquarters that better represents the specialty and meets the needs of its members and its mission. In advance of the June meeting of the ACEP Board of Directors, the Finance Committee provided due diligence to make sure we could continue to advance and meet our financial benchmarks. The Board analyzed the options and decided that the best course of action is to buy land in Irving, Texas, near the DFW Airport and build a new ACEP headquarters building. The land, a 6.06-acre tract close to DFW Airport, was officially purchased on Oct. 20. ACEP commissioned a top-level space needs analysis and found that at ACEP’s current staff size, we need a building of approximately 42,527 square feet; currently we have 30,474 square feet. If staff grows by 25 percent in the next five years, we would need approximately 50,000 square feet. If we were to grow by 40 percent in 10 years, we could use a building of around 57,000 square feet.
For the convenience of our Board, committees, and members who visit, the purchased land is adjacent to a full-service hotel and can situate a 55,000 – 60,000 square-foot office building with adequate parking. The Board approved a plan to meet the total project cost of $14.5 million with $7 million down and financing of $7.5 million. ACEP has healthy financial reserves, with a substantial portion in very low-yielding CDs and fixed income investments. Additionally, when the current building is sold, ACEP can expect to net about $3.5 million. Groundbreaking will most likely be in the Spring of 2015 and take about18 months or more before move in. We believe value to our members and future members will be the result of this investment, and we anticipate more effective and efficient service for our Board, committees and chapters. A newer, modern headquarters presents further opportunities for ACEP to reflect, develop and disseminate our values and goals.
Steven Stack, MD, FACEP, Named AMA President-Elect
In June, emergency physician Steven J. Stack, MD, FACEP, was named President-Elect of the AMA, the first emergency physician to ever hold that position. Dr. Stack will be the youngest President in the past century when he takes over in June 2015. He currently practices in Lexington and surrounding central Kentucky and is a very active member of ACEP, speaking numerous times throughout the year on behalf of the specialty and advocating for emergency physicians everywhere. He delivered the Rorrie Lecture at ACEP14 and demonstrated his expertise in the Affordable Care Act and Health Information Technology. I congratulate Dr. Stack on his new office and know that he will continue to do great work for emergency medicine and indeed, for the entire house of medicine. If you have any membership dollars available in your professional budget, I hope you consider making this year one in which you might become an AMA member to bolster our ACEP delegation at the AMA. There are certain things that are more do-able when we have a strong delegation within the AMA, whether advancing our cause within the house of medicine or in our negotiations at the RUC.
My Condolences to the Families of Emergency
Medicine Leaders Who Have Passed Too Soon
Emergency medicine lost some of its founders and leaders during my term, so I’d like to recognize them and offer my condolences. Dr. Gail Anderson, the first professor and chairman of an academic department of emergency medicine in the United States, died in September. Another early pioneer of our specialty and ACEP Past President, Dr. George Podgorny, passed away in November. I was honored to deliver a eulogy at Dr. George Podgorny’s memorial service. Just before ACEP14 in Chicago, we learned the sad news about the passing of Dr. Richard V. Aghababian, who founded the Department of Emergency Medicine at the University of Massachusetts and served as ACEP’s President from 1994-95. Dr. Aghababian died in October at his home in Southborough, Massachusetts. Dr. Francis Fesmire, a national leader in emergency medicine, former Chair of ACEP’s Clinical Practice Committee and recipient of ACEP’s “Hero of Emergency Medicine” award in 2009, died in January. In my home chapter, PACEP, we lost Dr. Noelle Rotundo, all too soon. Noelle was a widely respected Pennsylvania EM educator and leader whom will always be remembered. The contributions that these men and women made to the specialty are immeasurable. My thoughts are with their families and the families of other ACEP members who have passed away this year.
ACEP Launches 2014 PQRS Registry Reporting System
ACEP announced in late August that it developed a PQRS registry reporting option and provided it o ACEP, EMRA and SEMPA members at a discount. The registry comes in response to the Centers for Medicare and Medicaid Services announcement that failure to satisfy the 2014 PQRS requirements equals up to 4 percent of Medicare payments, approximately $2,500 per provider. For more information on these requirements, please visit www.acep.org/quality.
Report Card Garners Major Media Attention
In January, we released the 2014 State-by-State Report Card on Emergency Medicine. The nation’s grade of D-Plus was abysmal, but we hope that this grade will stimulate a positive effort for improvement. In fact, the report card not only sounds an alarm, it offers a road map for a better future, supporting the delivery of emergency medical care. Our Report Card has already fostered many a conversation with state legislators. Media outlets have pointed out what we already knew – that several states don’t have the resources and policies in place to support high-quality emergency care. Stories about the Report Card appeared in major newspapers, including The Washington Post, Chicago Tribune, New York Daily News, Forbes, The Huffington Post, Los Angeles Times, San Francisco Chronicle, The Philadelphia Inquirer, Houston Chronicle and The Seattle Times, to name a few. Along with print stories, nearly 800 broadcast stories aired on news organizations including ABC’s World News Tonight with Diane Sawyer, MSNBC, CNN, Fox News’ Your World with Neil Cavuto, Fox Business News, CNBC’s Kudlow and Kramer, WNBC New York, and Telemundo as well as dozens of local television stations across the country. The estimated audience reach was 72.2 million. Our dedicated spokespersons will continue to make sure the results of this study resonate nationwide. Keep up with the progress at www.emreportcard.org.
ACEP Now Launched
When the calendar flipped to 2014, ACEP turned its monthly publication up a notch. We wanted to blend the needs of our membership with an edgy editorial vision related more closely to the world we work in. Beginning with a round-table discussion cover story and a compelling piece on breaking down racial barriers in the ED, the new-look ACEP Now hit mailboxes in mid-January and began receiving rave reviews from ACEP members. I hope you like the direction of our new medical editor-in-chief Kevin Klauer, DO, EJD, FACEP, and our new publishing partner, Wiley Press. The new ACEP Now is not only bigger, it features more incisive opinions, real articles regarding our decision making and advice from some of emergency medicine’s most renowned physicians. The news from ACEP and events related to the College will always be a part of the magazine, so none of that has changed. What has changed is the attention to detail and open dialogue when opinions differ on controversial issues. If you haven’t seen ACEP Now lately, grab a copy soon. Your feedback is welcome at www.acepnow.com
Strategic Plan Taking Shape
In leading the annual Board retreat late last year, top-level goals and objectives for the college from now until 2017 were debated, prioritized and built for impact. Goal 1 focused on care transitions and improvement as the reform of the health care delivery system continues in full gallop. Goal 2 received particular attention with the formation of the Membership Engagement Task Force, the Membership Bylaws Task Force and the Residency Visit Task Force. Your fellow member leaders of these groups, their Board of Director Liaisons, and assigned top-level staff are poised for success in member engagement and satisfaction. Here’s an overview of the Strategic Plan:
Goal 1 – Reform and Improve the Delivery System for Emergency Care
Objective A – Identify, support, and promote delivery models that provide effective and efficient emergency medical and acute care in different environments.
Objective B – Promote quality and patient safety, including development and validation of quality measures.
Objective C – Pursue strategies for ensuring fair payment and practice sustainability.
Objective D – Pursue solutions for workforce issues that ensure access to high quality emergency care.
Objective E – Advocate for meaningful liability reform at the state and federal levels.
Objective F – Communicate the value of emergency medicine as an important component of the health care system.
Goal 2 – Enhance Membership Value and Member Engagement
Objective A – Increase total membership and transitioning resident retention.
Objective B – Provide robust educational offerings, including novel delivery methods.
Objective C – Support member well-being.
Objective D – Ensure adequate infrastructure to support growth.
Each December, your Board reviews and modifies its strategic plan for the year. We will continue strong efforts to protect fair reimbursement, continue to press for liability reform, and demand an end to boarding and especially psychiatric patient boarding.
Building Bridges and Strengthening Relationships
One of my goals as President was to align ACEP with others who share our passion for quality health care. If we build bridges and enhance our synergy with other health care organizations, we benefit and so do our patients. Our relationship with CORD continues to grow, as does our joint work with CORD and SAEM in GME matters. EMRA has a new executive director and our relationship with EMRA could not be stronger. We’re proud to announce the ACEP/SEMPA EM Academy last spring drew rave reviews and more than 300 physician assistants and nurse attendees. I participated as our two organizations penned a new five-year management service contract in New Orleans in May. I directed a new task force be formed to reach out to identify opportunities for collaboration with the Society of Hospitalist Medicine. When it comes to building bridges, there are many organizations whose activities, benchmarks and plans have relevance to us and we need to continue building those relationships. Indeed, EMRA, CORD and SEMPA have renewed their management services contract with ACEP. During this past year, it was a privilege to be the first ACEP President to keynote the ACOEP annual meeting, and to be one of the first two physicians to receive the SEMPA Diplomat Award along with ACEP Past President Dr. Linda Lawrence. I would also like to recognize the strong contributions of our chapter executives to the progress of our profession.
Two Clinical Policies Reviewed
ACEP conducted two major Clinical Policy reviews during my term. In response to the Council- and ACEP Board–adopted Amended Resolution 32(13), the “Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department” was reviewed. Also reviewed was: ““Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients with Suspected Acute Non-Traumatic Thoracic Aortic Dissection.” ACEP instituted a 60-day comment period for clinical policy development and the process meets national clearinghouse standards for guideline development.
EMF Continues Endowment Push
Over the past year, EMF has launched a new logo and continues the momentum of the ACEP $1 million match to bring the endowment to maturity with a corpus of $2.5 million. EMF has a new board, new Director and new Strategic Plan. Its Goals and Objectives are to:
Goal 1 – Position EMF as the principal sponsor of scientifically rigorous research and education to to improve the care of the acutely ill and injured and policy research that aligns with emergency care priorities
Goal 2: Increase EMF’s capacity to engage more people in emergency medicine research and award more grants
Goal 3 – Position EMF as the premier 501(c)(3) emergency medicine foundation
Goal 4 – Increase EMF revenue to fund more research grants and education projects
Please go to www.emfoundation.org, and make EMF your charity of choice.
Annals Added to eCME Options
In collaboration with ACEP’s online education program, articles from the Annals of Emergency Medicine are being offered as a CME component. As of October 2014, there were 20 Annals-based articles available to members. ACEP looks forward to seeing this educational offering become a robust element of ACEP’s overall online education program. Learn more at www.acep.org/ecme. Concurrent with the inauguration of the eCME program, Annals announced that it would continue its relationship with long-time publisher, Elsevier. The five-year contract runs through December 2018, and provides a solid and stable financial basis for journal revenues. The contract provides a generous editorial office stipend along with a guaranteed minimum royalty, enabling Annals to contribute substantially toward the overall financial success of the College.
ACEP Continues to Add Value, Enhance Image
The continued strength of our specialty requires us to do some heavy lifting in areas such as keeping prudent layperson as a recognized part of the ACA, working toward an SGR fix and changing perception about the cost of emergency care. Working together, we will make progress. As a result, our place in the House of Medicine will be enhanced. And we’re building strong connections with others while providing service to our chapters as they protect the interests of our members. Chapter efforts in Washington State and in Virginia underscore the need for our teamwork.
Thanks for the Past Year
I started my EM practice in the 1980s, and there are many reasons I value membership and the friends I’ve made over the years. I can pick up a phone and dial a colleague anywhere for advice. Like all families and all democratic groups filled with the riches of a knowledge-based constituency, we will have disagreements and some conflict. It’s all for a better result and a strong organization, as long as we stick together. The knowledge I’ve gained in reimbursement and coding and practice management has paid me back every dollar I ever contributed to ACEP, EMF and NEMPAC. The education I’ve received at conferences has made my practice better and improved the care of my patients. I was proud to join ACEP then, and I’m proud to have served as its President. ACEP is growing. ACEP is dynamic. ACEP gives you a good return on your dues investment dollars. Your partners, your colleagues, are the members of the committees, task forces, sections, Board, Council, and technical expert panels that create our future. Thank you for your contributions, and for your friendship.
Alexander M. Rosenau, DO, CPE, FACEP
ACEP Immediate Past President
As emergency physicians, we are skilled in responding to disasters and treating every kind of medical condition as part of our daily routines. We also are critical to America health care response to infectious diseases. This is because patients often show up first in emergency departments, as we saw during the anthrax attacks after 9/11 and in Dallas, Texas, yesterday when the first case of Ebola was confirmed in the United States. Clearly this disease deserves our attention and emphasis from health care providers across the country.
Ebola is a serious communicable disease. Heightened vigilance for case presentations and strict adherence by health care personnel to CDC advice, public education and a pre-planned medical response is necessary. Hospital physicians and entire health care teams have planned for these types of medical threats. Like SARS, MERS, and Hantavirus, newly identified serious population health threats continue to occur.
Even if this Ebola case is isolated, it is incumbent upon emergency physicians and other health care providers to properly screen and manage potential Ebola presentations. The CDC, the Emergency Care Coordination Center and the Assistant Secretary for Preparedness and Response, have provided materials that are excellent resources for emergency physicians and other staff in the ED to have readily available for dissemination.
These resources are available on ACEP’s website at www.acep.org/ebola.
The CDC recommends two initial steps in screening for Ebola Virus Disease:
- The symptoms are likely to be fever, headache, joint and muscle aches, weakness, fatigue, diarrhea, vomiting, stomach pain and lack of appetite, and in some cases bleeding.
- Travel to West Africa or other countries where EVD transmission has been reported by the World Health Organization within 21 days of symptom onset.
If both of these criteria are met, the patient should be moved to a private room, and standard-contact and droplet isolation precautions followed during further assessment.
We see dozens of patients each week, and particularly at this time of year, many will have a common cold or influenza. All health care professionals in the emergency department should know the protocols and what to ask so we can do everything possible to ensure that this Ebola case in Dallas remains isolated.
By Andrew E. Sama, MD, FACEP
With nearly two-thirds of all admitted septic patients presenting to the ED, and with the clear time sensitivity that exists between recognition, treatment, and outcomes, our members are on the front lines to save lives from this frequently fatal disease. In the CY 2015 IPPS rule, in which CMS cited the fact that “that patients admitted through the ED had a 17% lower likelihood of dying from sepsis than when directly admitted,” CMS finalized NQF #0500: Early Management Bundle for Severe Sepsis and Septic Shock, which mandated the invasive monitoring of CVP and ScVO2 via the placement of a central line in the ED. However, late on Friday, CMS notified hospitals, that it will suspend data collection for the Severe Sepsis and Septic Shock: Management Bundle measure (NQF #0500) until further notice.
Emanuel Rivers, MD, MPH, and his team improved mortality and raised the awareness of the EM community about sepsis through their Early Gold Directed Therapy (EGDT) study in the early 2000s. A few years later, the measure was initially endorsed by the NQF in 2008 without the requirement for a central line for the emergency department. While it is certain that early intervention does reduce mortality, not all elements of the sepsis composite bundle were equally evidence-based. Many studies over the years have demonstrated dramatic improvements in sepsis-related mortality after the implementation of early interventions for septic patients, which included early antibiotic administration, source control, and aggressive fluid resuscitation without invasive monitoring of CVP and ScVO2. One study addressing this, authored by Dr. Alan Jones and colleagues, was conducted at three EDs in the US, and compared two protocols that both included central venous pressure measurement; however, one used lactate clearance and the other used central venous oxygenation monitoring as a way to guide resuscitation. Dr. Jones’ 2010 study found no differences in mortality, suggesting that using central venous oxygenation to guide resuscitation may not be necessary.
In 2012 the measure underwent routine NQF maintenance review for re-endorsement in 2012-2013. During those proceedings, under the leadership of David Seaberg, MD, FACEP and myself ACEP commented that central venous pressure (CVP) was not the only reliable measure of intravascular volume. Several members of ACEP’s Quality and Performance Committee (QPC) including chair Jeremiah D. Schuur, MD, MHS, FACEP, Michael Phelan, MD, RDMS, FACEP, Todd Slessinger, MD, FACEP, FCCM, FCCP, Christopher Fee, MD, FACEP, and others testified on conference calls and at in-person meetings, that there were equally effective and less invasive methods for monitoring septic patients. Nonetheless, the NQF endorsed the requirement for the central line, noting that they would re-consider if additional evidence warranted it.
Within a few months the Protocolized Care for Early Septic Shock (ProCESS) trial was published on March 18, 2014 and under Dr. Alexander Rosenau’s leadership ACEP immediately requested that NQF #0500 undergo an ad hoc review given the impact that this new data would have on this quality measure. After reviewing the data from the ProCESS trial, NQF questioned whether NQF #0500’s item ‘F’, which measures central venous pressure and central venous oxygen saturation, should be retained or removed from the measure. During the review, one of the PIs, Donald Yealy, MD, FACEP engaged in a scientific debate noting that the ProCESS trial enrolled 1,341 patients, with a power to detect a 6-7 percent absolute difference, yet demonstrated no difference in mortality 60-day mortality 90-day mortality, one year mortality, or the need for organ support. The ProCESS also noted no benefit in any outcome when using CVC- guided care and the simpler approaches that stressed early and ongoing care produced the same good outcomes.
CMS, NQF, and others are now also convinced that honing the sepsis bundle is a move forward for our septic patients, with or without invasive monitoring depending on the progression of their disease, their unique circumstances, and the resources available at the ED where they are being treated. As it is ACEP’s mission, we will continue to advocate on behalf of our patients presenting with a diagnosis of sepsis to ensure that they receive the highest quality of emergency care. We look forward to continuing to work with the measure developer to ensure that all septic patients receive the timely, effective care they need, and to continue to save lives from this deadly disease.
Dr. Sama is ACEP’s Immediate Past President and Chair of the Board of Directors
By James M. Cusick, MD, FACEP
Chair, Candidate Forum Subcommittee of the ACEP Council
ACEP is a member-driven organization with a representative body of our peers – the ACEP Council – chosen through component bodies, including our chapters (1 representative per 100 members), our Sections of Membership, and other aligned organizations.
Each year, this body democratically votes to establish ACEP policy and elect leadership positions. Candidates present themselves to the Council through written statements, scheduled speeches, and unrehearsed Question and Answer sessions during the Candidate Forum, which is open to all members. Elections must be fair, follow guidelines applicable to all, and be free of undue influence or pressure on candidates.
The ACEP Council’s Candidate Forum Subcommittee recently performed its annual review of the campaign rules to ensure a fair campaign and elections process for all Board of Directors and President-elect candidates. The changes were approved by the Council Steering Committee.
This year, restrictions on the use of social media were substantially relaxed to allow forms of communication most of us use on a daily basis.
In addition, protections were incorporated into the rules to keep candidate interviews in ACEP publications. Our goal is to avoid candidates being put in the position of commenting on College policy without adequate preparation and to ensure that the campaign process is fair and equal for all candidates.
Certain candidates may unfairly benefit from coverage in non-ACEP publications, while some may be disadvantaged. In order to ensure a fair election, campaign questions and the vetting of candidates is the responsibility of ACEP, its Council and its Council Committees.
If there are specific questions you would like asked of the candidates prior to the election, please send them to firstname.lastname@example.org. The Candidate Forum Subcommittee will consider them, the selected questions will be posed to candidates and their responses will be made public.
Elections will occur during the Council meeting on Oct. 26 in Chicago. The Nominating Committee has selected the final slate of candidates for 2014:
Jay Kaplan, MD, FACEP
Robert O’Connor, MD, FACEP
Rebecca Parker, MD, FACEP
Board of Directors Candidates (4 positions to be filled)
Stephen Anderson, MD, FACEP (WA)
Jon Mark Hirshon, MD, FACEP (MD)
Hans House, MD, FACEP (incumbent – IA)
Mark Mackey, MD, FACEP (incumbent – IL)
John Rogers, MD, FACEP (incumbent – GA)
Mark Rosenberg, DO, FACEP (NJ)