Spring 2011

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

I received a phone-call from a friend recently who was desperately seeking advice and reassurance on how to respond to the threat of a malpractice suit. He sounded torn by the scenario of a practitioner who offered care above the standard, but who could not avert a bad-outcome for the patient to whom he gave his best effort, highest skill, knowledge, and deepest emotion. Traversing a sea of uncertainty, he is a young colleague, still in training, and quite susceptible to the self-doubt that the most experienced of us might feel when faced with even the most unwarranted of litigation.

I’ll spare my friend the use of his name and won’t reference the facts of the case.  He is an excellent student of emergency medicine; he will have a great career helping emergency patients, though I don’t think he is alone in asking: “Is it worth it?”

The long hours, the non-compliant patients, the uncompensated care, the pressure to provide both quality and service excellence, for a job where the specialist we call upon to assist us are the one’s who get the patient’s ever-lasting thanks….need I go on or does this feel familiar enough?

Over two thirds of us will have been sued at least once by the time we reach mid-career. Further, the Ohio Department of Insurance has reported that for 2009, there were 126 malpractice suits filed against emergency physicians; of these, only 20 settled with indemnity (fault) of the emergency physician. This is a 16% “successful” law suit rate, or as better defined, an 84% over-litigation rate. Compared against the average for all of medicine, EM is a hotter target with a lower success rate than all doctors combined; the average indemnity rate is 24% for all of medicine.

Imagine, if you got in your car and it started successfully only a quarter of the time. You’d call it a “Tin Lizzie,” a Jalopy, a lemon, and you’d be right with your frustration. Of course, if you knew of this limitation, you’d buy some insurance to go along with it: perhaps a back-up car, a bike, or have a few extra batteries and a starter lying around. To use an Economics term, this is a highly inefficient system.

In healthcare, we call this inefficiency “Defensive Medicine,” and it costs the U.S. taxpayers over $50 Billion Dollars a year. For those 106 Ohio cases in 2009, our system paid $3.7 million in direct defense costs.

What would happen to our national productivity if this money were spent on transitioning our health system from one focused on episodic sick care to one enhancing the maintenance of health and healthy lifestyle choices?

While there are certainly many paths this message could take from here, I’d like to focus on the waste that our current tort system has for emergency medicine. While I don’t claim to know what the “right” indemnity rate should be for malpractice, I can say with certainty that EM falls well off the par, and this is causing many trained ER docs to question whether or not the practice is worth the emotional or financial risk.

One fix would be to recognize the special environment that is the ER and adjust the tort law accordingly. We must make decisions with limited information and in a time sensitive manner. 

Oh, and our patients don’t even know us very well either; According to Dr. Greg Henry, we have all of seven seconds to establish credibility in this doctor – patient relationship, something that office based practices have a luxury of time to finesse.

In Ohio, that fix would be Senate Bill 129, OH ACEP’s Access to Emergency and Disaster care, which would modify the standard for emergency medicine to Reckless Disregard for those who provide EMTALA mandated care. This would help incent our on call colleagues to take call by reducing the litigation risk we all fear. And yes, there is also an on-call problem in this country. Over 65% of our ER medical directors have said so and it has led to delays in care, inferior outcomes, and more inter-hospital transfers than should be under a better system.

Think of all the time sensitive diseases that have worse outcomes because an on call specialist is not available: Time is Muscle; Time is Brain; Time is Tissue.

Some argue the pain of those 20 cases that succeeded under the Negligence standard would suffer from lack of remedy. Anyone who tells you they couldn’t succeed under the refined statute is suffering from hyperbolic speculation, for some surely could. Senate Bill 129 is designed to reduce the number of unwarranted malpractice cases that see the light of day. It is this number, the one-hundred and six, that we are after.

Similar statute has passed in other states, and it has led to great increases in board certified residency trained ER and other specialty docs into those states. Surely we could expect the same results right here in Ohio.

SB 129 is in committee right now. The Ohio State Medical Association (OSMA) has actively joined OH ACEP in advocating for this legislation. I ask that you join the house of medicine and contact your Senator to express your opinion on this matter today.

To my dear friend, I offer my hope: that the practice of emergency medicine, the reward of helping others, is worth the emotional, financial, and legal risk. But, I also offer the advocate’s assertion to reducing the weight of that question: improved Emergency Department Access could help us better help our patients.

Yours in service,

Gary

Ohio ACEP Board of Directors and Leadership Academy Class and Guests attend Advocacy Day at the Ohio Statehouse

On April 13, 2011, chapter members, the leadership class and the Board of Directors came together for an EM Advocacy Day at the Ohio Statehouse. We had a packed agenda viewing and discussing the bills we are currently tracking. Our guests/visitors included Dr. Terry Johnson, the new Ohio state representative and first doctor in the House in nearly 50 years. Representative David Burke and Dr. Bill Johnson are joint sponsors of House Bill 93, the primary objective which is to provide tools for combating the prescription drug abuse epidemic in Ohio, and particularly Southeastern Ohio. This legislation specifically takes aim at certain pain management clinics, dubbed “pill mills” that inappropriately dispense large quantities of controlled substances. 

Senator Eric Kearney and Representatives Matt Huffman, Lynn Wachtmann, and John Patrick Carney also stopped to visit with Ohio’s emergency physicians. Representative Wachtmann is the chair of the house health committee and past supporter of legislative action to allow advanced practice nurses (APN) to prescribe schedule II controlled substances. He reported that the testimony about the pill mills has shaken his commitment to the APN bill for the very reasons we have communicated- why give expanded prescriptive authority to even more people in the face of the prescription drug epidemic. He has not reversed his support, but noted that testimony has given him pause.
 

The leadership class also visited the statehouse with the chapter lobbyist for a mini tour. The class had Ohio ACEP

first aid bags to leave at their Senator's offices; they visited the Senate chambers; and they attended the senate health committee hearing which was hearing testimony on the APN schedule II drug bill and the 'pill mill' bill. Finally, they reported to the North Hearing Room for the Senate Civil Justice Committee. The Ohio ACEP Legislative proposal for extending limited liability protection to physicians providing EMTALA care, Senate Bill 129, was

heard in committee.  I was pleased to work alongside Dr. Michael Frank to deliver proponent testimony on behalf of Ohio ACEP. The questions were challenging and we were appreciative that Dr. Frank was there to handle the legal issues with great finesse.

Ohio ACEP has an uphill battle ahead to get Senate Bill 129 out of this committee. If you are interested in additional information about our lobbying efforts, visit the website for the complete legislative and lobbying report.

The Ohio State Medical Association (OSMA) House of Delegates and EM in the House of Medicine
John Lyman, MD, FACEP
Ohio ACEP Board of Directors and Ohio ACEP Delegate to the OSMA HOD

As a member of Ohio ACEP with an interest in, and appreciation for, advocacy and political involvement, it was a great thrill to be asked to represent the emergency medicine community at the annual Ohio State Medical Association (OSMA) meeting. This yearly business meeting was held at the Easton Hilton the first weekend in April. Missing the wedding of the daughter of a friend was the price to pay…but life is certainly a series of choices.

The Ohio State Medical Association can well be viewed as the state affiliate of the American Medical Association.  Despite the affiliation, though, the OSMA is fiercely independent of the AMA. This independence was most recently demonstrated in OSMA’s voting antithetical to the position the AMA had taken regarding the PPAC legislation, controversially enacted over a year ago.

The basic structure of OSMA sees the state of Ohio being separated into 12 regions, each region being comprised of multiple county medical societies. These 12 regions elect delegates to attend the business meeting, the number of delegates allowed for each region being dependent on the number of active members in the county societies. In addition to these regional delegates, a number of specialty societies are asked to select a delegate to represent the society at the meeting. It was in this capacity, as the delegate for Ohio ACEP representing emergency medicine, that I attended this year’s meeting.

The emergency medicine community has been wonderfully represented over the past many years in this House of Medicine venue. One very important leadership role, that of Parliamentarian, has been held be our own Dr. Wheeler these past many years. Other emergency physicians with influential leadership roles in OSMA include Dr. Rick Nelson, and Dr. Gary Katz. Both have served many years on the OSMA delegation to the AMA.

Gary also had the honor of seconding the nomination of Dr. Deepak Kumar in his run for the Presidency of OSMA.  Facing an excellent candidate from the Cincinnati region, Deepak came away the winner (could it have been Gary ’s seconding speech????). Deepak happens to be from Montgomery County, my county society. He is a wonderful choice, and OSMA is fortunate to have him leading the way during these somewhat contentious times.

The business of the OSMA is conducted similarly to the ACEP Council, with Resolutions considered appropriate for consideration referred to one of two Resolution Committees. These resolution committees are “open”, and each resolution is reviewed and testimony given by anyone with a desire to speak to the resolution. The Resolution Committees then close and a decision is made as to what to recommend to the full council for action.

To view the resolutions, and the action taken on each, please refer to OSMA’s web site.  When you get to this site, you can see the general assembly’s decision on each proposed resolution.

There was a great deal of discussion regarding a reorganization of the structure and relationship of the county chapters to the state chapter, with potentially significant dues implications. This reorganization plan passed, and the changes will commence immediately with the allowance for people to join the OSMA without having to join their county medical society (and visa-versa). While this resolution will not have direct influence on Ohio ACEP, it is a reminder that the relationship between chapter and parent organizations need to be continually monitored and evaluated.

About 11% of Ohio's Emergency Physicians are also members in the OSMA. 

View Full Article online.

Ohio’s Opiate Epidemic: A Summit on Policy, Prevention & Treatment

Nearly one thousand attendees attended the April 5, 2011 daylong summit. The event began with a message from Gov. John Kasich on his administration’s commitment to combating prescription drug abuse and diversion in Ohio. State Reps. Terry Johnson, DO, (R-McDermott) and David Burke (R-Marysville) discussed legislation they co-sponsored to combat this public health epidemic. (See above) House Bill 93 passed the Ohio House unanimously and is working its way through the Ohio Senate.

Several breakout educational sessions and a policy summit were held in the afternoon. The Ohio Association of County Behavioral Health Authorities, the Ohio Department of Alcohol and Drug Addiction Services, the OSMA and medical specialty societies and many other organizations helped create the agenda for the policy summit. Ohio ACEP members Dawn Prall, MD and Richard Nelson, MD, participated on a panel sharing the perspective of the emergency physician.

Finally, Ohio’s prescription drug abuse and diversion epidemic has also drawn national attention. A&E television highlights the fight against prescription drug abuse in Scioto and Adams Counties in a special Intervention entitled, “Intervention In-Depth: Hillbilly Heroin.” The special aired April 11, 2011, at 8 p.m. on A&E television.

Don’t miss the Ohio ACEP EM Residents’ Assembly and All Member Annual Meeting June 7th!

This year the Ohio ACEP EM Residents’ Assembly and All Member Annual Meeting will be held on June 7, 2011 at the Doubletree Hotel, Columbus, Ohio. The Residents’ Assembly  “Life After Residency” program offers second and third year emergency medicine residents an opportunity to meet with experienced regional and national experts and develop a strategic approach to a career in emergency medicine. Residents’ Assembly workshops will include: contracts, financial concerns, resume tips, interview skills, professional liability and a practice options panel. If you are currently looking for a position or reviewing your options, come ready to engage!

All Ohio ACEP Members are invited to attend the All Member Annual Meeting from 12:00 pm – 4:30 pm on June 7, 2011 at the Doubletree Hotel, Columbus, Ohio.

The annual meeting provided members with an occasion to learn more about Ohio ACEP’s priority issues and actively participate in the organization. Participants will have an opportunity to network with Ohio and National colleagues; discuss pressing issues facing the practice of emergency medicine; and elect representatives to the Ohio ACEP Board of Directors. Join your colleagues for Board elections, Ohio ACEP EM Awards and special guest speakers including: David Seaberg, MD, President-Elect, American College of Emergency Physicians, Steven J. Stack, MD, Secretary, Board of Trustees, American Medical Association and Dr. Paul Austin, EM Physician and Author, Something for the Pain; Compassion and Burnout in the ER.

Ohio ACEP Candidates Board of Directors, 2011-2014 Terms

At the Annual Meeting on June 7, 2011, at the Doubletree Hotel in Worthington, Ohio ACEP Board members shall be elected by ballot by majority vote of the Chapter membership present. Board members shall serve for three years or until their successors are elected. Board members have no term limits and may run for consecutive terms. Their terms of office shall begin at the close of the Annual Meeting at which they are elected.

Five Board members will be elected by the membership for three year terms at the annual meeting and One Board member will fill a two year term vacated by a Board member’s relocation. Current declared candidates are listed below. Nominations may also be taken from the floor at the Annual Meeting.

2011 Ohio ACEP Board of Directors Candidates (view full candidate statements online) 

In addition, Ohio's emergency medicine residents will elect a resident representative to the Board of Directors for a one year term at the Residents’ Assembly on June 7th.

Chapter Councillors
There are also seven available Chapter Council seats. Six current Councillors are eligible for re-election to a two-year term. These seats are currently held by Eileen F. Baker, MD, FACEP (Bowling Green); Thomas E. Carter, DO (Portsmouth); Gary R. Katz, MD, FACEP (Dublin); Kevin M. Klauer, DO, FACEP (Canton); Catherine A. Marco, MD, FACEP (Toledo); and Daniel R. Martin, MD, FACEP (Westerville).

Ohio Chapter ACEP has been allotted thirteen (13) Councillors for the October 2011 Council meeting in San Francisco.

Join us in celebrating Ohio’s Emergency Medical Services Stars!

Ohio ACEP proudly announces the 13th Annual EMS Star of Life Awards Ceremony. The EMS Star of Life Awards are designed to:

HONOR exceptional EMS personnel from Ohio’s EMS Regions.
RECOGNIZE Ohio’s emergency medical services system and organizations.
REUNITE EMS providers with the person treated and present the actual patient scenario.
GENERATE positive media stories regarding prehospital care and the EMS Star of Life Award.
MAGNIFY the profile of National EMS Week in the State of Ohio.

The chapter has an opportunity to raise public awareness on how important EMS service is to the community and to honor the selfless dedication and courage that firefighters and EMTs show every day when they perform their duties to assist the needs of their community. We will host our 13th Annual EMS Star of Life Awards ceremony in conjunction with the Ohio State EMS Board’s 2nd Annual Ohio EMS Awards ceremony on:
Wednesday, May 18, 2011, 9:30 AM, at the Ohio Department of Public Safety/Ohio Department of Transportation Auditorium, 1980 West Broad Street, Columbus.

EMS Star of Life Awards will be presented to:

Miami Township Fire & EMS and University Air Care (Milford, OH and Cincinnati, OH)
Huber Heights Fire Division (Huber Heights, OH)
Bath Township Fire Department (Lima, OH)
Citizen’s Ambulance Service and Wakeman Fire District (Wakeman, OH)
The Columbus Division of Fire: Medic 18 2 Unit (Columbus, OH)
New Concord Fire Department (New Concord, OH)
Central Fire District (Smithville, OH)
Bath Fire Department (Akron, OH)
Brooklyn Fire Department (Brooklyn, OH)
Western Reserve Joint Fire District (Poland, OH)

Attend ACEP’s Leadership and Advocacy Conference May 22-25, 2011 - Washington, DC

At the Leadership & Advocacy Conference, you will have the opportunity to learn advocacy skills, be exposed to the latest issues facing emergency medicine and receive updates directly from members of Congress. At the end of the conference you will have the chance to walk across the mall and take an active part in forming healthcare policy. Bring your excitement to learn and your desire to advocate for the rights of patients, physicians and emergency medicine. ACEP's National Lobby Day is May 24, 2011.

Nominations for the Ohio ACEP Bill Hall Award for Service and the EM Physician of the Year Award are due May 20, 2011

Bill Hall Award for Service to Ohio Chapter ACEP
The Bill Hall Award is named in honor of Dr. Bill Hall who served as Ohio Chapter ACEP President from 1974 to 1975 and as Treasurer from 1979-1985. The Award has been presented 17 times to individuals who have made significant contribution to Ohio Chapter ACEP or the field of emergency medicine through the selfless giving of time, dedication and enthusiasm.
Bill Hall Award Past Recipients
Bill Hall Award nomination criteria and instructions

Emergency Physician of the Year Award for Ohio Chapter ACEP
The purpose of this award is to recognize clinicians of unusual merit, to espouse and encourage members to pursue the ideals of emergency medicine and to convey these same ideals to the public through the news media. Current and past members of the Ohio Chapter ACEP Board of Directors and officers are not considered eligible for the award except in special circumstances as determined by the awards committee. Click here for a list of all
Emergency Physician of the Year Past Recipients
Emergency Physician of the Year nomination criteria and instructions

The 2011 Bill Hall Award and the Emergency Physician of the Year Award will be presented at the Ohio Chapter ACEP Annual Meeting and Awards Luncheon on June 7, 2011.

Emergency Medicine Action Fund Announced
New Grassroots Effort Aims to Influence Health Care reform’s regulatory implementation

With changes in the health care system already underway, a new initiative is looking to positively impact the regulations that will be written and implemented under this sweeping reform.

The Emergency Medicine Action Fund, launched by ACEP in February, will pool contributions from individual emergency physicians and groups, chapters, and anyone else interested in advancing emergency care to provide financial support for advocacy activities in the regulatory arena.

“This is probably the most important, defining moment for emergency medicine in our lifetime,” said ACEP President Dr. Sandra Schneider. “The decisions that are made now will set the course for us for years to come and we must positively influence the regulatory agenda. This Action Fund will help us do that and create a practice environment we can thrive in.” The Emergency Medicine Action Fund will pursue a regulatory agenda that supports emergency physicians and quality emergency care. For example, evolving practice models and demonstration projects, such as accountable care organizations and bundled payments, are two areas of the Patient Protection and Affordable Care Act where the Action Fund might be able to wield some influence.

One of the unique features of the Emergency Medicine Action Fund is that chapters can band together to form coalitions that would be eligible to have a seat on the Board of Governors. Or chapters can organize individuals and groups in their states for collective representation. The first 10 groups of contributors at $100,000 will be granted seats on the Action Fund’s Board of Governors.

“We are encouraging chapters and small to mid-sized groups to combine their resources,” Dr. Schneider said. “This is intended to be an inclusive effort, and everyone’s contributions are needed.”

The Emergency Medicine Action Fund is modeled on a successful initiative sponsored by CAL/ACEP, CAL/AAEM, EDPMA, and rural emergency physicians in California that has raised several million dollars for state advocacy since 2004.

Wes Fields, chair of the California Emergency Medicine Advocacy Fund, said their program doubled the size of the CAL/ACEP advocacy staff, increased the number of lobbyists and consultants, and engaged in legal activities related to physician payment practices. He has been appointed by Dr. Schneider as the founding chair of the new national Action Fund.

Find out more about the Emergency Medicine Action Fund.

Clinical News

Hospitals Vary Widely in Applying Proven STEMI Treatments
Implementation of evidence-based treatments for patients with acute myocardial infarction saves lives, but hospitals show substantial variation in the extent to which they apply these treatments, according to a study of more than 60,000 patients treated at 72 Swedish hospitals during 1996-2007.

During the period studied, Swedish hospitals increasingly used proven treatments for patients presenting with ST-elevation MIs, including increased use of reperfusion therapies, aspirin, clopidogrel, statins, beta-blockers, and ACE inhibitors or angiotensin receptor blockers. Concurrently with increased use of these interventions, the standardized, 1-year mortality of patients dropped from 19% in 1996 to 11% in 2007, Dr. Tomas Jernberg, a cardiologist at Karolinska University Hospital in Stockholm, and his associates reported in an article published online on April 27 (JAMA 2011;305:1677-84).

But in addition to documenting the efficacy of evidence-based therapies for treating acute STEMI, the findings also revealed a wide variation in the application of these therapies by all 72 Swedish hospitals that provide care for patients with acute cardiac diseases.
Read the entire article online.

Antibiotics Alone May Suffice for Uncomplicated Acute Appendicitis
Uncomplicated acute appendicitis can be safely treated by antibiotics alone, a systematic meta-analysis suggests.

Use of antibiotics may prevent unnecessary appendectomy and reduce overall complication rates, lead author Dr. Katherine J. Liu said at the annual meeting of the Central Surgical Association.

“Appendectomy may be reserved for antibiotic treatment failure and recurrent appendicitis,” she said.

Dr. Liu pointed out that antibiotics have become progressively more powerful in the last 30 years and that spontaneous resolution of acute appendicitis occurs in 24-48 hours without any treatment in up to 20% of patients in large series. A recently published study found that the negative appendectomy rate in the era of computed tomography is 5% with CT and 10% without CT (Ann. Surg. 2008;248:557-63). Also, perforated and nonperforated appendicitis are probably two separate disease entities, based on several very large epidemiologic studies, she said.
Read the entire article online.

Focus On: Variceal Hemorrhage
“Focus On” is an ongoing series of articles that examine common complaints that present to the emergency department or highlight new literature or treatment options. The February 2011 article reviews current therapy for gastroesophageal varices and the importance for emergency physicians to deliver life-saving treatment.

Learning objectives for this article include to assume that patients with a history of cirrhosis who present with upper GI bleeding have esophageal varices until proven otherwise; recognize that patients with esophageal varices have an extremely high mortality rate; always perform a rectal exam and consider nasogastric lavage in the evaluation of esophageal varices; treat esophageal variceal bleeding with octreotide, proton pump inhibitors, antibiotics, intravenous fluids, and early blood product transfusion; and consult GI specialists and interventional radiology early in the evaluation of variceal bleeding.
After reading the article, take the CME quiz online.

Spring Brings New Member Benefits to ACEP

New ACEP member benefits are blooming this spring, with products and savings to make it easier for you to practice emergency medicine and provide the highest quality care for your patients.

• Free CME Credits for “Focus On”
  You asked, we’ve responded. ACEP Members can now earn free CME by taking the “Focus On” quizzes online. These quizzes are based on ACEP News articles that address new approaches to common presentations or a refresher on topics that might fall into a learning gap. Certificates can be printed instantly after completing the quiz. Sign in and explore this new member benefit. Non-members still pay $10 a quiz. Sorry, no refunds for quizzes already purchased.
   
• Discounts for National Salary Surveys
   ACEP has partnered with Daniel Stern and Associates to offer their annual national emergency medicine salary surveys to our members at a discounted price. You can now find clinical, academic, regional and even trends reports in the ACEP Bookstore. Whether you are getting your first job or want a snapshot of the current job market, there are a variety of salary survey products that can help you with your practice needs and goals.
   
• Easier Access to the Health Care Notification Network, More Features
  Get Physicians’ Desk Reference (PDR) drug alerts from the Health Care Notification Network sent right to your inbox with no log-in required. Just sign up for the service on our website. Once registered, you will begin receiving FDA-approved information and alerts on a real-time basis. ACEP members can also access other PDR Network features, including free CME courses and a free copy of mobilePDR, which brings the most widely used drug information resource to your smartphone.
   
• Enhancements to the Member Renewal Process
  A new Online Member Guide is now being sent to each member after they join or renew. Each guide is personalized and populated with data that is particular to the recipient. And online dues statements now contain the same statement the member received in the mail. These automated member renewal messages contain their statement, which can be downloaded and printed.

ACEP understands the practice challenges you face and we want to help you with the issues that matter most to you and your patients.

Thank you for your continued membership in ACEP, the leading emergency medicine advocate for our specialty and your career.

ACEP Joins Partnership of Professional Organizations to Improve Care for Patients with Hereditary Angioedema

ACEP is excited to announce its partnership with the American College of Allergy, Asthma and Immunology (ACAAI), the American Gastroenterological Association (AGA) Institute, and the World Allergy Organization (WAO) in the “HAE: Learn About It, Talk About It” program, an innovative, peer-driven campaign aimed at uniting disparate specialties that see patients with hereditary angioedema (HAE) to help advance the standard of care.

HAE is a rare and potentially fatal genetic disease characterized by sudden, severe, and painful swelling episodes that can affect any part of the body. Because HAE symptoms can mimic other emergencies, including appendicitis, acute abdomen, or an allergic reaction, the average patient can endure 13 years of repeated misdiagnoses before HAE is identified.

As the first line of contact with undiagnosed and diagnosed patients in many cases, emergency physicians and physicians’ assistants can play an important role in improving care for patients by quickly recognizing HAE symptoms, understanding new disease management paradigms, and referring patients to an HAE-treating physician for appropriate management.

With new, targeted therapy options available in the U.S., now is the time for specialists on the front lines of HAE to work together to improve patient care through increased awareness and education, faster diagnosis, and appropriate disease management.

Visit their website to learn more about HAE and its impact in emergency medicine, to be prepared by finding an HAE-treating allergist in your area, and to take advantage of free educational resources, including an HAE Webinar, podcast series, and iPhone app.

“HAE: Learn About It, Talk About It” is supported by ViroPharma Incorporated.

The 2011 Emergency Department Director of the Year Winner and Finalists Announced by the Emergency Medicine Foundation and Blue Jay Consulting

Blue Jay Consulting and the Emergency Medicine Foundation (EMF) announced that Royce D. Coleman, MD, FACEP, has been named the 2011 Emergency Department Director of the Year. Dr. Coleman, Medical Director at the University of Louisville Hospital and Associate Professor at the University of Louisville, Department of Emergency Medicine, will be honored at the Emergency Department Directors Academy on Monday, May 2nd in Dallas, TX. Three additional finalists will be honored later this year.

“The Blue Jay Consulting/Emergency Medicine Foundation Emergency Department Director of the Year Award recognizes current emergency department physician leaders who made significant impacts on improving the operations of their departments, resulting in improvements in the quality of patient care,” said Jim Hoelz, Chief Nurse Executive/Managing Partner at Blue Jay Consulting.

“This year’s winner, Dr. Royce D. Coleman was chosen for his active collaboration with nursing to achieve departmental improvements, his commitment to providing excellent patient care, his work to implement programs to improve the quality of the patient experience and community involvement, as well as professional involvement with the American College of Emergency Physicians,” Mr. Hoelz said.

An Emergency Department Director wears many hats,” said EMF Chair, Michael Gerardi, MD, FACEP. “Daily they are charged with providing leadership; planning; ensuring ethical practices; coordinating with nurses and administrators; improving utilization of the facility, service and staff; all while ensuring quality care for the patients.

 “We are pleased to honor Dr. Coleman, as he truly set himself apart; and demonstrated his dedication to improvement and sustaining excellence in both quality of care and employee and physician satisfaction,” Dr. Gerardi said.

The three finalists in alphabetical order are:
Dave A. Holson, MD, MPH is the Mount Sinai Services at Queens Hospital Center in Queens, New York.

Robert L. Muelleman, MD, FACEP, is the Emergency Medicine Chair, Department of Emergency Medicine at the University of Nebraska Medical Center in Omaha, NE and the Emergency Medicine Medical Director at The Nebraska Medical Center in Omaha, NE.

Mark Rosenberg, DO, MBA, FACOEP-D, FACEP is the Medical Director with St. Joseph’s Healthcare System in New Jersey.

A Letter from the Emergency Medicine Foundation Chair
The Emergency Medicine Foundation is having a busy year already in 2011! The 13  EMF grantees are concluding a great research year. With projects in stroke care, binge drinking prevention in college-age students, health care reform, mild TBI, and so much more, we are anxiously awaiting their results to be presented at ACEP’s Scientific Assembly Research Forum in San Francisco this October.

EMF’s ability to fund emergency medicine research, coach and encourage up-and-coming researchers, and recognize leadership in our specialty is because of members like you. ACEP members continue to increase their support of EMF each year, providing a majority of EMF’s funding. Corporations, foundations, physician groups, and ACEP chapters are also supporting EMF in record numbers. We thank all our donors for their commitment to improving emergency care in our nation.

EMF not only appreciates your financial support but your ideas, as well. Recently, Dr. John Rogers led the charge to encourage the Georgia and Tennessee chapters to donate $1 per member to EMF. We appreciate Dr. Rogers’ initiative and the chapters’ willingness to meet this challenge. I encourage other chapters to join Georgia and Tennessee in supporting EMF through this Chapter Challenge.

Our donors are the reason that EMF grows more successful each year. Your support is so valuable and vital to spearheading emergency medicine research. I encourage you to continue to support EMF and the future of emergency medicine. To learn more or to make a donation, go to our website or call (800) 798-1822 x3216.

Sincerely,

Michael J Gerardi, MD, FACEP
Chair, Emergency Medicine Foundation
Member, ACEP Board of Directors

AAEM, Small Groups Join EM Action Fund

Recognizing the potential threat to the independent practice of emergency medicine, the American Academy of Emergency Medicine (AAEM) and several small to mid-sized groups have joined the Emergency Medicine Action Fund, which is collectively working to impact health care reform's regulatory implementation.

These contributors are looking past the differences of the varied participants in the EM Action Fund and recognizing the need to improve the emergency medicine practice for everyone, said Dr. Wesley Fields, Chairman of the EM Action Fund.

“What I hope AAEM, the other EM organizations vested in the EM Action Fund, and EM groups large and small will do is to change the conversation about the acute care continuum among policy makers and thought leaders regarding the future of health care in the U.S.,” Dr. Fields said.

“There will never be a better time or a more compelling need for emergency physicians to find common cause,” he added. “The macro forces that threaten our specialty and our health care system are far greater than any intramural disputes between EM organizations.”

AAEM will join the American College of Emergency Physicians, the Emergency Medicine Residents’ Association (EMRA), the American College of Osteopathic Emergency Physicians (ACOEP), and the Society of Academic Emergency Medicine (SAEM) on the EM Action Fund Board of Governors. AAEM and SAEM each contributed $25,000 to the Action Fund, and EMRA contributed $100,000 over the next two years. ACOEP contributed $50,000 over the next two years.
 
Invitations to sit on the Board also have been extended to the Association of Academic Chairs of Emergency Medicine (AACEM), and the Emergency Department Practice Management Association (EDPMA) and were still being considered in mid-April.

The reminding 10 Board seats will be allocated to the largest contributors. Several small and mid-sized groups are working together to form coalitions in hopes of attaining a seat on the Board.

As of mid-April, 12 physician groups of various sizes have contributed to the EM Action Fund, along with two companies that work closely with emergency physicians. There have also been dozens of individual contributions.

As an adjunct to ACEP’s Washington, DC staff, the EM Action Fund’s consulting firms have been developing analysis pieces about the recently released draft regulations for Accountable Care Organizations (ACOs) from the Centers for Medicare & Medicaid Services (CMS).

There is a synopsis of the quality reporting requirements for ACOs, a summary of the ACO waivers of various federal laws, and many other useful resources useful for review as a formal response to CMS is being prepared.

The website also has a list of the issues and provisions in the Patient Protection and Affordable Care Act (PPACA) relating to emergency medicine, a timeline of implementation dates of various provisions, and a status update of current legal challenges to PPACA.

“Regardless of one's personal views of the Act, it is obvious to any serious observer that the federal government is likely to continue to have more and more influence over the practice of emergency medicine,” Dr. Fields said. “That is why the Emergency Medicine Action Fund will focus on federal regulatory affairs, which, under IRS guidelines, are not political in nature or in tax law.”

There is still time to contribute to the EM Action Fund, which is expecting to have its Board in place and being regular meetings later this summer.

“Regardless of your mode of practice, EMAF deserves your support and needs your intellectual capital as much as your financial pledge,” Dr. Field said.

Find out more and use the new online contribution form.

Make A Difference: Write That Council Resolution

ACEP is a living entity, which needs new ideas to keep it healthy and viable in the 21st century. Many College members introduce new ideas and current issues to ACEP through Council resolutions. This may sound daunting to our newer members, but the good news is that only takes two ACEP members to submit a resolution for Council consideration. In just a few months the ACEP Council will meet and consider numerous resolutions.

ACEP’s Council, the major governing body for the College, considers resolutions annually in conjunction with Scientific Assembly. During this annual meeting, the Council considers many resolutions, ranging from College regulations to major policy initiatives thus directing fund allocation. For 2011, the Council has 338 Councillors: ACEP members representing chapters, sections, EMRA, AACEM, and CORD.

This Council meeting is your opportunity to make a resounding impact by setting our agenda for the coming years. Topics such as the direct election of the president-elect, or working with the Emergency Nurses’ Association on staffing models, grew directly from member resolutions submitted to the Council. If you have a hot topic that you believe the College should address, now is the time to start writing that resolution.

I’m Ready to Write My Resolution
Resolutions consist of a descriptive Title, a Whereas section, and finally, the Resolved section. The Council only considers the Resolved when it votes, and the Resolved is what the Board of Directors reviews to direct College resources. The Whereas section is the background, and explains the logic of your Resolved. This should be short, focus on the facts, and include any available statistics. The Resolved section should be direct and include recommended action, such as a new policy or action by the College.

There are two types of resolutions: general resolutions and Bylaws resolutions. General resolutions require a simple majority vote to pass, while Bylaws resolutions require a two-thirds majority. When writing Bylaws resolutions, list the Article number, and Section from the Bylaws you wish to alter. Then, in the resolution, you should show the current language, and bold your suggested new language while striking through the suggested edits. See the ACEP Web site article, “Guidelines for Writing Resolutions,” which further details the process and offers tips on writing a resolution.

I Want to Submit My Resolution
It takes at least two members to submit a resolution, or a Chapter, Section, AACEM, CORD, or EMRA may submit a resolution. If the resolution comes from a Chapter or Section, then a letter of support from the President of the Chapter or Chair of the Section is required. The Board of Directors or an ACEP committee can also submit a resolution. The Board of Directors must review any resolution from an ACEP committee, and usually reviews all drafts at their June meeting. Bylaws resolutions pass through the Bylaws committee for review and suggested changes. These changes and suggestions are referred back to the author of the resolution for consideration. One may submit a resolution by mail, fax, or email. Resolutions are due at least 90 days before the Council meeting. This year the deadline is July 16, 2011.

Debating The Resolution
Councillors receive the resolutions prior to the annual meeting along with background information from ACEP staff. Discussion often occurs on the Council electronic list serve prior to the Council meeting. At the discretion of the Speaker, non-Councillor resolution authors may be added to the Council e-list serve upon request.

At the Council meeting, the Speaker and Vice-Speaker divide the resolutions into four reference committees. The reference committees meet and hear testimony on each resolution. You, as the author of your resolution, should attend the reference committee that discusses your resolution. Reference committees allow for open debate and unlimited testimony, and participants often have questions best answered by the author. Afterwards, the reference committee summarizes the debate and makes a recommendation to the Council.

The Council then meets to discuss all the resolutions. Each reference committee presents each resolution, providing a recommendation and summary of the debate to the Council in writing and on the podium, and then the Council debates each resolution. Any ACEP member may sit in the back and listen to the Council debate whether a Councillor or not. If you wish to speak directly to the Council, you may request to do so in writing to the Speaker before the debate. Include your name, organization affiliation, issue to address, and the rationale for speaking to the Council. Alternatively, you may ask your Chapter or Section for alternate Councillor status and permission for Council floor access during debate. Chapters and Sections often have alternate Councillor slots and encourage the extra participation.

The Council’s options are: Adopt the resolution as written; Adopt as Amended by the Council; Refer to the Board, the Council Steering Committee, or the Bylaws Interpretation Committee; Not Adopt (defeat or reject) the resolution; or Postpone.

Hints from Successful Resolution Authors

• Present your resolution prior to submission to your Chapter or Section for sponsorship on the Council floor. This way, they can give advice and assistance.
• Consider the practical applications of your resolution. A well-written resolution that speaks to an important issue in a practical way passes through the Council much more easily.
• Do a little homework before submitting your resolution. The ACEP web site is a great place to start. Does ACEP already have a policy on this topic? Has the Council considered this before? What happened?
• Find and contact the other stakeholders for your topic. They have valuable insight and expertise. Those stakeholders may co-sponsor your resolution.
• Attend debate concerning your resolution in both reference committee and before the Council. If you cannot attend, prepare another ACEP member to represent you.

I Need More Resources
Go to ACEP’s Web site, http://elist.acep.org/t/611299/5956095/20381/0/. Click on “About Us,” then “Leadership,” and finally click on “Council.” Scroll down and you will see a link to the “Guidelines for Writing Resolutions” article. All authors should review this article prior to writing their resolution. Additionally, there is information about the Council Standing Rules, Council committees, and Councillor/Alternate Councillor position descriptions. Of special note, there is a link to Actions on Council Resolutions. Under this link are PDF documents dating back to 1998 summarizing each resolution and what has occurred with each of them. You can review past actions, or keep track of what happens once your resolution passes.

Well, Get To It
Writing and submitting Council resolutions keeps our College healthy and vital. A Council resolution is a great way for College members to speak to the leaders of the College and the Board of Directors. Even if your resolution does not pass, the College will debate the topic and consider its ramifications. Additionally, other members may have resources or suggestions to address your issue. I encourage you to take advantage of this opportunity and exercise your rights as part of our Emergency Medicine community. Dare to make a difference by submitting a resolution to the ACEP Council.

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Ohio Chapter ACEP
3510 Snouffer Rd #100
Columbus , OH 43235-4299
http://elist.acep.org/t/611299/5956095/20534/0/
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