Summer 2010 Issue

From the President
Gary R. Katz, MD, MBA, FACEP

This past year we focused extensively on enhancing the “value” of your membership. From the iPhone app, and acquiring the Dr. Carol Rivers’ educational product line for continued publication to lobbying the Ohio Senate to launch The Access To Emergency and Disaster Care legislation (SB 86), I had the chance to share some of the great efforts Ohio ACEP has delivered to you. At each instance, your chapter evaluated how such an effort could make your practice or professional life better. It is my true hope that we have succeeded for you in every endeavor. 

Despite these successes, I know that many of our members continue the daily struggle with advocating the advancement of emergency care (quality, access, reimbursement, etc.) for each of our patients and colleagues. Further, the advancements the medical community have fought so hard for in the past few years are successes that are tenuous at best. In particular, I am concerned about the state of medical liability reform.

By the time you read this message the race to November’s elections will be well underway. Hopefully you have already had the chance to evaluate and voir dire the candidates and are well on your way to making the choice that best fits your belief system. That being said, I would like to take this chance to point out two key statewide races and ask for your assistance in Ohio ACEP’s efforts to move SB 86 forward in the statehouse.

Over the past decade the general medical malpractice environment in Ohio has gone from tragic to survivable. This is a direct result of key tort-reform measures passed by the legislature; most notably is the cap on non-economic damages. Caps similar to this had been tried before, but had always failed challenges in the court system. Fortunately, the makeup of the current Ohio Supreme Court is such that its majority philosophy is to show appropriate deference to the will of the legislature. In other words, since the people of the state desire such reform, as evidenced by legislative action, then the Supreme Court is not likely to hear a case to challenge this law.

This success, however, is only present because of the make-up of the Supreme Court. Other states have recently seen similar tort reform measures overturned as their respective state Supreme Courts have changed to a more activist mix of jurists. Similarly, Ohio is not immune to such change and the court’s philosophy in our state will be a key question being asked in this fall’s election of Supreme Court jurists.

The two races to which I would encourage your utmost attention are the races for Chief Justice (M. O’Connor) and Supreme Court Justice (J. Lanzinger).

Supreme Court Justice Maureen O’Connor has long served on the Ohio Supreme Court and has often discussed her philosophy of judicial restraint in the manner discussed above. She is pitted against an incumbent Chief Justice, who was recently appointed to this position after the death of Chief Justice T. Moyer. It is important to remember that this incumbent is only in this position after a gubernatorial appointment following this untimely vacancy. Moreover, his position on issues of greatest import to physicians is much less favorable.

Similarly to Justice O’Connor is Justice Lanzinger. Touted as the real “Judge Judy,” Judith Lanzinger is a veteran Justice to the Ohio Supreme Court. She holds the philosophy that the judicial system should interpret and apply law, not create social change external to the legislature. Judge Lanzinger is running against an appellate court justice who has previously stated that a major impetus to running is her philosophical disagreement with the current Supreme Court; something that I believe will be a detrimental change and a step towards halting the progress that has enhanced life for Ohio physicians and their patients.

Please check out the campaign websites and attend an event to meet the Justices. Nothing gets our message across as firmly as your personal stories. www.jjudy.com and www.oconnorforchiefjustice.com

Finally, I’d like to ask your support and donation to the Ohio ACEP PAC. Over the past several years, your PAC leadership has worked fervently to advance the legislative mission of Emergency Medicine right here in Ohio. By hosting educational sessions and opportunities to meet the legislators, OH ACEP PAC has been able to share your stories and the stories of your patients that highlight the barriers we face in providing access and the highest quality of care for each of our patients. This year, these stories have gained great traction and have facilitated the passage of Senate Bill 86 through the Senate. Though this is a key step, there remains a terrific uphill battle in that we need to now educate the State House of Representatives with some of the same messages about access to care, EMTALA, and other such barriers.

Recent information shared with me showed that the average attorney donates in excess of $2,000 a year to his/her professional PAC’s. Counter to this is the average physician’s annual donation of a meager $25. It is clear that the advancement of Emergency Medicine’s agenda is an effort that will take support from each and every one of you (our members). As the NEMPAC saying goes: let’s all give a SHIFT and donate one work-day towards advocacy. Thus, I ask for your additional commitment to the OH ACEP PAC today with time and/or money. To donate, please visit www.ohacep.org and find the Ohio ACEP PAC page under the Advocacy tab.

Over this past year we have worked to deliver value to you through programming enhancement and legislative advancement. We hope we can be even more successful in making your professional practice prosperous in this next year.

Let me know what value means to you.
Sincerely,
Gary Katz

Update on Senate Bill 86

On May 19, 2010, the Ohio Senate passed S.B. 86 by a bipartisan floor vote of 22-10. Ohio ACEP's legislative initiative which extends limited liability protections for physicians providing emergency care under EMTALA to a standard of reckless disregard, instead of simple medical malpractice.

Ohio ACEP would like to thank all members who contacted their State Senator and asked for his or her support to pass this bill. We would also like to thank chapter leaders, Dr. Catherine Marco, Ohio ACEP Government Affairs Committee Chair, Dr. Gary Katz, Ohio ACEP President, the Ohio ACEP Board of Directors and Towner Policy Group lobbyists for their tireless efforts and hard work in the pursuit of this outcome. Special thanks to Senator Steve Buehrer for sponsoring this bill for Ohio ACEP.

Senate Bill 86 has now been referred to the House Civil and Commercial Law Committee. Ohio ACEP looks forward implementing grassroots advocacy throughout the summer months.

Senate Bill 86 will:

Laura Tiberi, Executive Director, Ohio ACEP; Senator Steve Buehrer, sponsor SB 86 and  Amanda Sines, Towner Policy Group, in the Senate Chambers, May 19, 2010

• Provide additional limited liability for emergency medical providers under EMTALA requirements.
• Encourage participation, particularly of on-call specialists, in emergency medical care. State liability laws should act to encourage these specialists to provide vital on-call services to emergency patients, not inhibit them. 
• Improve access to and quality of emergency care for patients in the State of Ohio and the practice environment for emergency physicians.
   

Ohio ACEP Gets a New Web site!

Over the past few months the Ohio ACEP staff has been busy building a new web site.
Please take a look at www.ohacep.org.

Ohio ACEP Residents’ Assembly & Annual Meeting

The Ohio ACEP Residents' Assembly and Annual Member Meeting were held June 9, 2010 at the Hilton at Easton in Columbus, Ohio. The full-day event was filled with many networking and education opportunities and attended by nearly 100 Ohio chapter members, residents and attendings. Seventeen exhibitors and sponsors assisted the chapter in making the day possible and offering EM job opportunities.

Thanks to the following for exhibiting: 4M Emergency Systems, Inc.; APS Medical Billing; BestPractices, Inc.; Canton Aultman Emergency Physicians; Cleveland Clinic; EmCare, Inc.; Emergency Consultants, Inc. – breakfast sponsor; Emergency Medicine Physicians; Emergency Physicians Medical Group - morning break sponsor; Healthcare Underwriters Group Mutual of Ohio; Hospital Physician Partners; Martin Gottlieb & Associates; MEDS – treat sponsor; MESA; Premier Health Care Services, Inc. – notebook sponsor; TeamHealth – Residents’ Assembly Partner and The Exigence Group.

Ohio ACEP Announces the establishment of the Carol S. Rivers, MD, Emergency Medicine Foundation

The late Carol S. Rivers, MD, FACEP was honored at the Ohio ACEP Annual Meeting as Emergency Physician of the Year in recognition of her commitment to the ideals of emergency medicine and dedication to the education of emergency physicians. Ohio ACEP was also proud to announce the establishment of the Carol S. Rivers, MD, Emergency Medicine Foundation for the advancement of EM Resident education. Memorial contributions may be made to the Carol S. Rivers, MD Emergency Medicine Foundation, 3510 Snouffer Rd., Ste. 100, Columbus, Ohio 43235. For more information call 614-792-6506.

Member Kudos

Catherine Marco, MD, FACEP was presented with the Bill Hall Award for service for making a significant contribution to Emergency Medicine and the Ohio Chapter ACEP and for leading the government affairs advocacy activity in support of Senate Bill 86 - Access to Emergency Care.

Congratulations to the re-elected Ohio Chapter ACEP Board members, Dr. Tom Tallman and Dr. Jim Horn and welcome to the new Board member, Dr. Mike Nauss and the emergency medicine resident representative, Dr. William Saunders!

The Board of Directors elected the following executive officers: Thomas W. Lukens, MD, FACEP, President-Elect; Michael D. Smith, MD, FACEP, Secretary; Robert I. Broida, MD, FACEP, Chapter Treasurer; Gary R. Katz, MD, FACEP, Chapter President and Eileen F. Baker, MD, FACEP, Immediate Past-President.

The complete list of Directors is as follows: Jason Cheatham, DO, FACEP; Paul Culler, MD, FACEP; Christian Chisholm (C.C.) Halloran, MD, FACEP; James M. Horn, MD, FACEP; Nicholas J. Jouriles, MD, FACEP; John L. Lyman, MD, FACEP; Catherine A. Marco, MD,FACEP; Michael Nauss, MD; John A. Russ, III, MD, FACEP; Thomas Tallman, DO, FACEP; Resident Representative William P. Saunders, III, M.H.A., MD.

Congratulations to Michael C. Plewa, MD for being published in the April 2010 issue of Annals of Emergency Medicine. 

Ohio Prescription Drug Abuse Task Force
 

The task force continues to work with strategic partners in efforts intended to stop prescriptiondrug abuse in Ohio. An interested party meeting was held on June 15, 2010 to discuss HB 547, sponsored by State Representatives, Nancy Garland (D-New Albany) and Raymond A. Pryor (D-Chillicothe). The bill establishes licensing requirements for pain clinics and requires the State Medical Board to develop rules related to physician use of the Ohio Automated Rx Reporting System (OARRS). Ohio ACEP is carefully monitoring any suggestion by the bill sponsors or the state medical board that would require emergency physicians to utilize OARRS.
 

Ohio Medicaid to use MITS

In December 2010, Ohio Medicaid will begin using the newly developed Medicaid Information Technology System (MITS) for claims processing, provider enrollment, prior authorizations and financial processes.

The Ohio Department of Job and Family Services (ODJFS) and Hewlett-Packard are partnering to distribute to Ohio Medicaid providers, MITS related information and notification of upcoming MITS events.

Due to the vast scope of the upcoming implementation ODJFS is asking provider organizations to assist in the distribution effort by cascading the information to their membership to help make this a smooth transition for all parties. Additionally, if you would be interested in having someone speak at one of your association meetings, please send a request via email indicating the date, time and location and ODJFS will see if there is a representative available.

If you would like more information on the Ohio MITS implementation, please review the documents on the website. 

In Addition to the Bedside: Turning an Idea into an Opportunity

Many clinicians, at one time or another, consider “leaving the bedside” and pursuing a non-medical career. And many have done so with spectacular success (think Michael Crichton or Thomas Fogarty – inventor of the Fogarty balloon catheter and founder of Thomas Fogarty vineyard and winery) and many more with quiet success. Some leave clinical practice altogether and others combine non-clinical interests with continued medical practice.

And that brings us to BIOSTART LifeScience Catalyst and Community. BIOSTART is a non-profit biotech and health sciences and services incubator located in Cincinnati’s uptown area. They provide facilities, funding, support, advice, connections and more to entrepreneurs starting a business or pursuing research that will lead to a business.

BIOSTART has capacity now and is searching for inventors, or an idea that could become an invention, or a healthcare service model. Over the past 11 years, BIOSTART has provided assistance to 125 companies helping them raise over $180 million. Some of those stories:

• CardioQuickSys founded by Michael Price, a paramedic, is an example of company that was incubated at BIOSTART and now is a thriving business.
• M&T Vascular is a company currently at BIOSTART, started by a vascular surgeon and a resident, both of who remain in practice and involved with their company.
• Inotek Corporation started at BIOSTART in 1997 and eventually licensed their product for $325 million.

The first step is to contact BIOSTART for a discussion about your concept and its implementation. Then, if there is a fit, BIOSTART will provide an initial market opportunity identification, topline technology assessment, assessment of patentability/intellectual property protection, and execution strategies depending on level of desired involvement. BIOSTART will also provide a proposal on how you and they could work together.

You are invited to contact BIOSTART’s inventor’s portal and take the first step to perhaps turning your idea into an opportunity.

Linda Law, MD, FACEP
Life Science Consultant to BIOSTART

Clinical News

CME Article on Reversal of Anticoagulation Now Available
Originally printed in ACEP News, the “Focus On” series of articles brings the latest literature and best practices to help the busy emergency physician provide the best care possible.

This issue’s topic, Reversal of Anticoagulation, will help the physician understand the indications for reversal of warfarin, identify the side effects of protamine in heparin reversal, and recognize the advantages and disadvantages of fresh frozen plasma (FFP) vs. prothrombin complex concentrates (PCC) in the treatment of warfarin reversal.
Read the article online and then take the CME quiz.

Perspective EHR Report: What's Missing From the Meaningful Use Criteria
Since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in February of 2009, there has been a tremendous amount of discussion about the idea of “meaningful use.” And now that the full set of rules for meaningful use is available, it might surprise some to know what has actually been excluded from the criteria.

The first and most fascinating exclusion is any requirement for encounter note generation. The criteria specifically state that it will not be necessary for providers to document their encounter notes using the EHR. In other words, while most EHR products emphasize electronic note generation, the authors feel this does not provide a significant benefit over handwritten charting in meeting the goals of HITECH.
Read the full article

Diffuse Nature of MRSA Abscesses Contribute to High Treatment Failures
Methicillin-resistant Staphylococcus aureus abscesses, when compared by ultrasound with those caused by other pathogens, are smaller and more likely to lack a defined edge. They are also more likely to have edema in surrounding tissue planes as well as pus divided into multiple pockets within the abscess, according to an abscess ultrasound study presented at the Society for Academic Emergency Medicine’s annual meeting. The characteristics could make it more likely that an abscess is caused by methicillin-resistant Staphylococcus aureus (MRSA), helping guide antibiotic selection pending culture and sensitivity reports, according to the study’s author.
Read the full article

Emergency Medicine Foundation Announces Emphasis Area
in 2011-12 Grant Funding

The Emergency Medicine Foundation (EMF) is pleased to announce an area of special emphasis for its fully funded grant categories in the 2011-2012 grant cycle. To better improve emergency patient care, illustrate value in emergency medicine research, and assist the practice of emergency physicians in a changing health care environment, the EMF Board of Trustees is emphasizing innovative health services and health policy research.

EMF has been committed to supporting emergency medicine research by helping young investigators. Grants currently fully funded by EMF are the EMF Health Policy Grant ($50,000), the EMF Fellowship ($150,000 over two years), and the EMF Career Development Grant ($50,000). For this grant cycle, EMF encourages applications with a focus on health services research, including but not limited to, health policy, practice, medical liability, regionalization, patient safety, and hospital utilization. However, it is important to note that EMF welcomes all applications, including research that is not health services-based.

“The Emergency Medicine Foundation has committed to supporting actionable research that directly impacts the care of our patients,” said EMF Board Chair Alexander Rosenau, DO, FACEP . “EMF will continue to underwrite a wide variety of research. The EMF Board of Trustees believes that this new era in health care reform is not only momentous, but pivotal. It demands serious investigation by the best that emergency medicine researchers have to offer in health services and health policy research.”

The Emergency Medicine Foundation also offers several co-sponsored grants, including:

EMF/SAEM Medical Student ($2,400 each, two available).
EMF/EMRA Resident Research ($5,000 each, three available).
EMF/ENAF Team Grant ($50,000, one available).

The EMF is pleased to announce two new co-sponsored partnerships:
EMF/Medical Toxicology Foundation Resident Research ($5,000, one available).
EMF/Emergency Medicine Patient Safety Foundation ($10,000, one available).

Also new this year will be one directed research grant underwritten by Baxter in
sub-cutaneous infusion ($50,000, one available).

Grant applications will be available online in August 2010. Grant deadline is January 5, 2011.

About The Emergency Medicine Foundation

For more than 35 years, the Emergency Medicine Foundation has funded innovative clinical and laboratory research and continues to lead the way in emergency medicine education and research. To date, EMF has funded nearly $10 million in grants for these purposes. Created to demonstrate and advance the distinctive specialty of emergency medicine through research and education, the Emergency Medicine Foundation was founded in 1972 as a 501(c) 3 charitable foundation. For more information, visit www.emfoundation.org.

ACEP Artistic Expressions
2010 Application Instructions

ACEP Artistic Expressions provides a unique opportunity for ACEP members to share their creative side with their colleagues. The purpose of the gallery is to encourage creative expression among members and to provide an area for reflection. The ACEP Artistic Expressions gallery will be located in the exhibit hall, in the ACEP Resource Center, during the conference and will remain on display from September 28-30, 2010.

Please submit no more than two (2) pieces of art or literature for display in the gallery. A separate application must be submitted for each piece. Articles must not have been accepted for past galleries. If accepted, you must ship your artwork to ACEP headquarters no later than August 23, 2010, to be included in the shipment to the meeting. If artwork is not received by this date, you will be responsible for all mailing/shipping costs, including insurance, and delivery to the exhibit. Work must be delivered to the Convention Center on Monday, September 27, 2010.

Security will be provided for the gallery area but ACEP cannot guarantee safety of all art and creative displays. You MUST commit to the availability of your work during the entire Scientific Assembly. You are responsible for pick up of your artwork, unless you agree to donate it to EMF (see application). If you do not arrange for pick up of your artwork by the end of the exhibit, it will be discarded or donated to EMF for auction.

If you wish to display your works, please complete the application and submit this application and all required supporting materials no later than August 2, 2010 to:

American College of Emergency Physicians
Attn: Tracy Napper
P.O. Box 619911
Dallas, TX 75261-9911

Or via e-mail to tnapper@acep.org

Supporting materials for rejected submissions will not be returned so please submit copies or digital images rather than original pieces.

Welcome New Members

Terrance E. Banaszak, MD
David K. Bishop, DO
Nicholas A. Boraggina, MD
Rachel Coe, DO
Sean C. Crowley, MD
Seth DeAtley, DO
James F. Fair
Omar Ferrari, DO
Steven T. Foy
Scott M. Glick, DO
Ryan G. Hartman
Miles P. Hawley, MD
Nathan Holbrook
Willis Kann
Leah R. Kream, DO
Scott E. McMaster, DO
Michael Petit, DO
David N. Ricks
Julie Rogers, MD
Shaun Sanucci, DO
Eric A. Savory
Julie C. Swartz, MD
Patty Truman
Ryan Udink, DO
Brodon Urrutia, DO.

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