Archive for category ACEP News
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 Dennis Beck, MD, FACEP
ACEP is working with a leading registry vendor who currently provides PQRS registry reporting for more than 40 medical societies. The penalty for failure to satisfy the 2014 PQRS requirements equals up to 4% of Medicare payments, approximately $2,500 per provider.
As a member benefit, ACEP is providing ACEP, EMRA & SEMPA members with $100 off the $299 per provider fee. We have negotiated a deeper discount of 10% off ($179) for groups of 10 or more and 15% ($169) for groups of 20 or more. For more information on reporting requirement, go to www.acep.org/qualityregistry. And be sure to return in early September to take advantage of this member benefit.
In 2014 a group of 10 or more eligible professionals may avoid the 2% PQRS penalty as well as the 2% VBM penalty (both applied to 2016 payments) if at least 50% or more of the individual eligible professionals in the group satisfy PQRS reporting requirements in 2014. Even just one Medicare Fee-For-Service claim for the calendar year qualifies a provider (physician or midlevel) as an eligible professional in a group for purposes of the “50% threshold.” However, please note that those eligible professionals in the group, who do not submit PQRS measures, will still be subject to the PQRS payment adjustment of 2%. To avoid the VBM penalty, at least 50% of individual EPs in a group must meet the minimum PQRS reporting requirements (for more information on these requirements visit www.acep.org/quality. So the choice of whether to report as individuals or to report as a group is a decision that is up to your group.
If your group decides to participate in the 2014 PQRS group practice reporting option (GPRO), the group is required to register through the Physician Value-Physician Quality Reporting System (PV-PQRS) Registration System by September 30, 2014. This registration process can take up to two weeks, so start now! Groups will need an Individuals Authorized Access to the CMS Computer Services (IACS) account to access the PV-PQRS Registration System. Registration lets CMS know which groups want to be analyzed at the group level (or TIN-level analysis).
Complete information about IACS and 2014 PQRS GPRO registration is available on the CMS website. Click here for that information.
During registration, the group practice will need to indicate the size of their group at the time they register. For GPRO Group size is based on the number of eligible professionals including PAs and NPs billing under the TIN. Be sure that your group’s Medicare Provider Enrollment, Chain, and Ownership System (PECOS) information is updated for before you begin registration.
Whatever your decision, to report as a group via GPRO registry or to report as individuals, the ACEP PQRS Wizard registry option will be available for you. Although you can upload quality data codes from your practice management, coding, or billing software to the portal through February of 2015, if you want to participate via GPRO your group must complete the PV-PQRS registration process by September 30, 2014. If you plan to report as individuals you can sign up through Dec. 31, 2014.
Dr. Beck is President and CEO of Beacon Medical Services in Aurora, Colorado. He is past chair and current member of the ACEP Reimbursement, Quality and Performance Committees. Dr. Beck is also a member of the ACEP Coding and Nomenclature Committee and chair of the Colorado ACEP Finance Network.
The ACEP Board Directors accepted a recommendation last week from its Clinical Policies Committee to begin working on a tPA policy exclusive to ACEP instead of a joint project with the American Academy of Neurology.
The 2013 Council had asked that ACEP reconsider its current “Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department,” which had been developed with the AAN and published in February 2013.
After an open 60-day comment period in early 2014 and a subcommittee review of the comments and literature findings, the Clinical Policies Committee recommended to pursue an independent policy, which will include updated evidence and grading criteria. The Board unanimously approved this recommendation.
Once the draft is developed, it will be available for members to review and comment for 60 days prior to the Committee’s presentation to the Board. An estimated timeline was not available.
Additionally, the Board confirmed its commitment to the clinical policy development process and agreed to add three methodologists to the committee, additional meetings, and another staff person to ensure a robust review process.
Editor’s Note: In lieu of flowers, please consider a memorial donation to the Emergency Medicine Foundation. The family will be notified of any gifts received in his memory.
By Brian J. Zink, MD
Author, “Anyone, Anything, Anytime: A History of Emergency Medicine”
November 5, 2013
Life has sweet and sad moments, sometimes too closely juxtaposed. At the October 2013 ACEP Scientific Assembly meeting in Seattle, emergency physicians, residents, medical students, and long-time colleagues were pleased and intrigued to watch Dr. George Podgorny in the premiere of the EMRA Legacy Initiative 24/7/365 documentary, and then to hear him interviewed later that evening and in a panel discussion the following day. Many learned about the key role that Dr. Podgorny played in establishing emergency medicine (EM) as a legitimate US medical specialty through the creation of the American Board of Emergency Medicine (ABEM). At the time of the approval of ABEM by the American Board of Medical Specialties in 1979, Dr. Podgorny was clearly in the mix – serving as both President of ACEP and President of ABEM that year. He was integrally involved in the negotiations that created the approved “modified conjoint” ABEM board after the original ABEM proposal had been roundly defeated in an American Board of Medical Specialties (ABMS) House of Delegates vote in 1977. After ABEM was approved, Podgorny was the Chief Examiner for the first ABEM exam. He also became the head of the newly created Residency Review Committee and served in that capacity for 6 years. He tirelessly surveyed and approved residencies, helping to ensure the quality of new emergency medicine residency programs.
Unfortunately, after gracing us with his encyclopedic memory, wit, and insights at ACEP, Dr. Podgorny fell ill after his trip to Seattle and died in Winston Salem, North Carolina on November 5th, 2013.
George Podgorny was born in Iran, but his heritage was Czech and Armenian. His father taught physical education to the children of the Shah of Iran, and his mother wrote children’s books. It was decided that George would come to the United States after high school because the family felt that a US university education would be superior. Podgorny left his family and came alone to Maryville College in Tennessee and decided to go in to medicine. He became enamored with Wake Forest University School of Medicine (then the Bowman Gray Medical School) and its Baptist Hospital, was accepted there for medical school and never left the region. Podgorny excelled as a medical student and was accepted in to the general surgery residency. As a surgery resident he spent a great deal of time in the emergency department, and was struck by the fact that the sickest patients were cared for by the least trained residents who were rarely supervised. He worked diligently to improve care in the ED even as a resident. Podgorny then completed vascular surgery training and was in a cardiothoracic surgery training fellowship when he began to learn more about physicians who were practicing full time in emergency departments (EDs). He attended the 1970 ACEP meeting and met many of the early leaders. After this, he joined with a couple friends to work in the ED of Forsyth Hospital in Winston-Salem. He loved this work, and the possibility of being involved in a new specialty of medicine, and did not return to surgery.
As someone who was academically-oriented and had 7 years of residency training, Podgorny linked with the early ACEP leaders and began to push for formation and approval of a specialty board in EM. His background and connections in the surgical world helped to lend some credibility to the early group, and allowed him to battle the opposition that came from surgical fields. He came across as a unique individual, always sporting a handlebar mustache, with an exotic sounding accent and an eloquent but raspy voice. People paid attention when he spoke.
One of his most important roles came at the “Workshop Conference on Education of the Physician in Emergency Medicine” in Chicago in 1973. Podgorny was an important, persuasive figure in a comprehensive gathering of medical leaders from government, the other medical specialties, and academia. The fate of EM going forward hinged on the early EM leaders convincing others that the field was credible and that residency training and specialists in EM were just as important as in other medical fields. The outcome of the meeting was favorable and Podgorny and other early leaders in EM then made a concerted push, against considerable odds, to get ABEM established over the next 6 years. Podgorny was a key negotiator in the process, particularly in the final compromise that allowed ABEM to be approved in 1979.
George Podgorny continued to practice emergency medicine for many years in Greensboro, North Carolina after his direct leadership in ACEP and ABEM ended. However, he was a constant presence at the annual Scientific Assembly and offered advice and counsel to the new leaders in EM. On a personal level, George loved his Persian heritage, and his home was lavishly decorated with Persian art and furniture. He was a widely read intellectual, and an astute scholar of the history of medicine. He also loved his adopted home state of North Carolina, and was a regular at the local barbeque restaurants.
Dr. Podgorny is one a handful of people who can be considered to have been truly essential to the formation of emergency medicine. Without his forceful, scholarly, and gracious diplomacy, some of the early deliberations of the future of EM could have gone the other way. His loss leaves us greatly saddened, but we can also warmly reflect on how his determination, skill in negotiation, and perseverance made EM become a reality in the US. This is his tremendous legacy. We are grateful to have had the pleasure of seeing and hearing this senior icon of emergency medicine one last time at the ACEP Scientific Assembly 2013.
The American College of Emergency Physicians is set to undertake a new editorial direction for our monthly news magazine, ACEP News, which coincides with a new publishing contract with Wiley Periodicals Inc. beginning in 2014.
Kevin Klauer, DO, EDJ, FACEP will take over as medical editor-in-chief in January 2014, helping to set the tone and editorial direction of the publication. In June, Dr. Klauer will resign as editor-in-chief of Emergency Physicians Monthly, a position he has held since 2008.
Robert Solomon, MD, FACEP, ACEP News’ current medical editor, has served in this role for almost eight years. Under his leadership, the magazine has grown from a small, insider newsletter to a robust and trusted source of up-to-date clinical information, valued articles on practice trends, and entertaining features on emergency physicians worldwide. Dr. Solomon will continue as ACEP News’ medical editor through December 2013.
ACEP would like to thank Dr. Solomon for his tireless dedication and the progress he has helped ACEP achieve with ACEP News.
Dr. Klauer will bring a new voice to ACEP News that will resonate with the 31,000 ACEP members and additional 8,000 emergency physicians who read the publication each month. He has a following in the emergency medicine community, where he is a respected, popular and dynamic faculty member at emergency medicine educational conferences. He will augment the current 21-member ACEP News Editorial Advisory Board with different perspectives and additional columnists.
Dr. Krome graduated from the Wayne State University surgery residency in 1969 and was assigned staff-oversight responsibility for the Detroit General Hospital emergency room – a position that became necessary after the 1967 Detroit riots.
By the early 1970s, Dr. Krome had begun to develop an emergency physician staff that practiced exclusively in emergency medicine and the emergency department had become a formal part of the hospital’s administrative structure.
In 1971, he joined ACEP and ultimately became a life member. In 1972, he was chosen editor in chief of JACEP, which became Annals of Emergency Medicine in January 1980, due to the strong credibility established by the publication under Dr. Krome’s guidance.
He served as ACEP President from 1976-77 and was presented the John G. Wiegenstein Leadership Award in 1979 for effectively promoting excellence in emergency medicine education.
Dr. Krome was on the team that successfully negotiated recognition for emergency medicine as a specialty in 1979, and chaired the Test Committee appointed to develop the first certification exam. As an active chapter member, he served as a councillor from Michigan for nine years.
A decade after he was president, Dr. Krome received the John D. Mills Outstanding Contribution to Emergency Medicine Award in 1987 for his exemplary long-term contribution to both ACEP and the specialty.
Long after completing his tenure as an elected College leader, Dr. Krome continued to be diligent in striving for increased legitimacy of the specialty through expanding the body of research. His contributions to the Blue Ribbon Commission on the Future of Emergency Medicine and his commitment to Annals of Emergency Medicine has had lasting effects on emergency medicine, as has his work as a teacher and mentor of emergency physicians.
In addition to being a past president of ACEP, he was also a past president of the American Board of Emergency Medicine (ABEM).
He was the first recipient in 1983 of the Michigan ACEP chapter’s Meritorious Service Award, which was then named in his honor. He also published a book, “The Floaters’ Log,” about his emergency department experiences.
He served as chief of the division of emergency medicine at Wayne State University, Detroit, MI, as well as chief of emergency medicine at William Beaumont Hospital, Royal Oak, MI. He attracted many to the field, and mentored many physicians who have since achieved professional prominence.
In 2008, he was named one of ACEP’s Heroes of Emergency Medicine, and reported that his favorite saying was that he receives the greatest joy from seeing his students achieve successes even greater than his.
Contributions in his memory may be sent to the Emergency Medicine Foundation, PO Box 619911, Dallas TX 75261-9911 or online at www.emfoundation.org/donate.
After an extensive look at ways to provide cost effective care to emergency department patients, the American College of Emergency Physicians believes there is room to improve the use of specific tests or procedures in emergency medicine to participate in the national “Choosing Wisely” campaign.
“Choosing Wisely” is part of a multi-year effort of the American Board of Internal Medicine (ABIM) Foundation to help physicians be better stewards of finite health care resources. The campaign encourages medical specialty organizations to identify five tests or procedures commonly used in their field, the necessity of which should be questioned and discussed by patients and physicians.
ACEP had previously declined participation in the “Choosing Wisely” campaign because of the challenges of this approach with the unique nature of emergency medicine, liability concerns, and a potential harm to physician reimbursement.
The College meanwhile remained steadfast in its commitment to cost-effective care and a high-value health care system, and last year, Immediate Past President Dr. David Seaberg appointed a Cost Effective Care Task Force, chaired by Dr. David Ross. The Task Force was charged with considering tests, processes and procedures with little or no value to emergency care that might represent meaningful cost savings if eliminated.
In a report to the ACEP Board of Directors this month, Task Force member Dr. Jay Schuur said that their Delphi panel and ongoing member surveys have suggested that a number of tests will meet the criteria of the “Choosing Wisely” campaign. They also determined that these tests would not increase the physician’s liability, and would not negatively impact payments for emergency physicians.
After being reviewed by experts, emergency medicine leaders, and the ACEP Board, the report’s data indicates that it would be appropriate for emergency medicine to participate in the campaign. A letter of ACEP’s intention to participate was sent to the ABIM Foundation today.
The list of recommendations should be established by June. ACEP’s Task Force is finalizing the evidence base for these recommendations, in part though the Emergency Medicine Practice Research Network (EMPRN). Attaching estimates of potential real-dollar savings to the recommendations is also being completed. Members of the Task Force and the ACEP Board believe this responsible approach will validate the substance of our recommendations, and provide assurance that there will be a real savings to the health care system while not impacting patient care.
But joining this national campaign is not the only approach ACEP is using its in journey to identify cost savings measures without compromising patient care.
In order for there to be a serious reduction in unnecessary tests and costs of defensive medicine over time, meaningful liability reform and safe harbors are vital. ACEP is encouraging ABIM and its campaign partners to lend their voices to the need for medical liability reform. This remains a top priority in ACEP’s advocacy agenda.
Additionally, the College is working on other significant and impactful efforts, including proposing an elimination of the 3-day-stay rule and better management of transitions of care.
A variety of recommendations that strive to improve patient care and provide meaningful cost savings continue to be initiated, developed, and adopted by ACEP. We are dedicated to ensuring that our specialty can be leaders in health care system efficiency while maintaining a high quality of emergency care and patient safety.
[This article will be published in the November issue of ACEP News. See the entire ACEP News libary online at www.acepnews.com]
After considerable debate, the ACEP Council voted this month to refrain from participation in the national “Choosing Wisely” campaign in large part due to the other efforts being taken by ACEP to achieve the same and even larger goals.
“Choosing Wisely” is part of a multi-year effort of the American Board of Internal Medicine (ABIM) Foundation to help physicians be better stewards of finite health care resources, according to its website. As part of the campaign, specialty organizations identify five tests or procedures commonly used in their field, the necessity of which should be questioned and discussed by patients and physicians.
ACEP had considered joining this campaign three distinct times since its launch in December 2011. Three different workgroups of various ACEP members, committees and Board members looked at the campaign and decided that while the concept is positive, the scope of listing tests, especially for emergency physicians, was too narrow.
Despite this extensive review by ACEP members, a resolution was submitted by the New York Chapter asking the ACEP Council to decide if ACEP should join the “Choosing Wisely” campaign.
As part of the Council process, resolutions are first debated in a reference committee where members of the Council provide background about the resolution, give testimony to its merit or explain reasons why it should not be adopted. It was standing room only for the debate about this resolution and discussion was spirited. The debate continued the next day with many of the same reasons echoed on the open floor of the Council with mroe than 300 voting members in attendance.
Those in support of ACEP joining the campaign said that 26 medical specialties (except for emergency medicine and anesthesia) have joined or committed to participate. They added that participating could give ACEP more national visibility and bargaining power, and that ACEP could use its participation to educate other specialties about emergency medicine’s particular challenges.
Those opposed to ACEP joining the campaign said that the Choosing Wisely campaign does not involve any negotiation with others in medicine, and that it could lead to unintended consequences, including a lack of liability protection, vulnerability to the False Claims Act and automatic payment denials from insurance companies based on tests that the campaign deems to be “unnecessary.”
One large concern was that the intent of the campaign had already eroded, with several specialties offering only minimal savings and stepping outside of their field and including tests on their lists that are outside the scope of their practice.
The issue generated strong feeling on both sides and the majority of the Council ultimately decided to refrain from participation.
ACEP already had opted to strive to identify cost savings measures without compromising patient care. Three task forces were established in 2012 to work toward this idea – the Cost Effective Care Task Force, the Delivery System Reform Task Force, and the Transitions of Care Task Force.
ACEP’s Cost Effective Care Task Force is developing recommendations on ways to reduce costs in emergency care. Through member surveys, a Delphi approach, and use of the Emergency Medicine Practice Research Network (EMPRN), this group will not only consider unnecessary tests and procedures but also processes with emergency care that might represent meaningful cost savings while improving patient care. This task force is expected to complete its work and offer its report to ACEP’s Board in February of 2013.
It is hoped that these reports of significant recommendations can fuel a public campaign and support health policy advocacy concerning how emergency physicians are not just making a list of tests to cut, but instead are looking at much larger initiatives, processes and transitions that could result in real health care savings while improving patient care.
The Delivery System Reform Task Force gave its report to the ACEP Board of Directors on Oct. 5. It can be found online at www.acep.org/advocacy/federalissues/.
“The emergency department remains at least one of the reasonable solutions for addressing many of the health care system’s most vexing problems from a delivery system perspective,” the report states. “Emergency physicians are well positioned to provide innovation and leadership across the acute care continuum. Even from the perspective of employers, the patients, and payers, the allegedly high cost of care is incompletely characterized, often misconstrued, and lacks sufficient perspective in the broader context of community economics and the health care delivery system itself. Addressing these dynamics will require significant and intensive efforts to bring data, information, and solutions to a delivery system in rapid evolution.”
In addition to efforts that should be continued, the report also lists several recommendations of efforts that should be started or enhanced, including information sharing to primary care providers (and specialists), care coordination for high-cost users, regionalization of patient care resources (mobile technology, telemedicine), cost effective alternatives to hospital admission and others.
The report also recommends efforts that should be stopped or reduced (because emergency physicians are not trained or resourced for it, or could be more efficiently delivered in an alternative setting), such as longitudinal care for chronic illnesses, primary preventative care, non-value driven convenience care, and treatment of medical conditions that have no incremental benefit to the patient or value to the system.
The Transitions of Care Task Force also developed an information paper that was submitted to the ACEP Board of Directors in draft form on Oct. 5. When it is finalized, it will be announced to ACEP members and posted on ACEP’s website.
The Task Force paper notes that “The emergency department has an important, in fact pivotal, role in transitions of care and can enhance its value to the system by implementing more successful transition programs. As the emphasis and oversight of quality and cost increase, successful coordination of patients’ journeys through the health care system will help advance the triple aim of better population health, better patient experiences, and reduced cost to the system. “
To achieve this goal, the Transitions of Care Task Force made several recommendations, including
- improve residency training and continuing professional development for emergency physicians on the importance of handoffs in effective transitions of care
- work with emergency department information system vendors to produce transition support tools
- identify strategies that make handoffs successful, and use them to establish goals for emergency departments
- develop a web-based toolkit that includes resources, assessment and support tools, and best practices
- develop education resources on palliative care in the emergency department to enhance knowledge and increase the number of emergency department-based palliative care programs
- and more.
ACEP has a strong focus on these issues of improving patient care and providing cost savings. To that end, multiple recommendations continue to be developed and adopted by the College. We are dedicated to ensuring that our specialty brings ideas that truly will improve care for the millions of patients we treat and provide real, substantial savings to the nation’s health care expenses.
ACEP News, January 2011 — More than a decade after issuing its first report on suicides in hospitals, the Joint Commission has followed up with a new one, reminding clinicians that suicides and suicide attempts can occur anywhere – not just in psychiatric units.
But emergency physicians say that suicides in nonpsychiatric units are part of a broader and more difficult problem to solve: a lack of appropriate care for psychiatric patients that forces other units – particularly emergency departments – to hold these patients in environments not designed for their safety.
Since 1995, the commission wrote, there have been 827 reports of patient suicides, 14% of which occurred in nonpsychiatric settings, more than half of these in emergency departments. The 827 cases represented only those voluntarily reported, the commission noted, and therefore is likely an undercount.
The suicides occurred in bathrooms, bedrooms, closets, showers, or just after patients left the hospital against medical advice. Patients hung, shot, lacerated, or asphyxiated themselves, jumped from high places, or ingested drugs. A number of suicides were carried out using materials immediately available in the hospital – bell cords, bandages, sheets, plastic bags, or elastic tubing.