Fall 2011

Ohio Chapter ACEP

Gary R. Katz, MD, MBA, FACEP

Thomas W. Lukens, MD, FACEP, President

Laura Tiberi, CAE
Executive Director

Phone: 614-792-6506
Fax: 614-792-6508

From the President
Tom Lukens, MD, FACEP

Dr. Lukens & Dr. Broida - 2011 Scientific Assembly

I recently returned from ACEPs Scientific Assembly and Council meeting in San Francisco. I had a great time meeting new physicians, renewing friendships with former residents and colleagues and enjoying some terrific educational programs. At the Council meeting, Dr. David Seaberg became the new ACEP president and Dr. Andy Sama was elected as the president-elect. Ohio’s own Dr. Kevin Klauer was elected as Council vice-speaker and will serve a two year term. Kevin was a former president of Ohio ACEP and has been an active participant on the board in Ohio for many years. He will be an excellent addition to the Council leadership. Also, congratulations for Dr. Gary Katz, the immediate past president of Ohio ACEP, who received the Council Horizon Award for service during the meeting; and to Dr. Robert Strauss, who received the Over the Top Faculty Award for his dedication to excellence in education.

Dr. Seaberg discussed in his inaugural address the three pillars of health care reform—access,

Dr. Katz receiving the Council Horizon Award

quality and cost. All will be major initiatives in the coming year. The Affordable Care Act (ACA) has as one of its major goals the coverage of the currently uninsured, numbering greater than 50 million of our citizens. Dr. Seaberg pointed out clearly that coverage doesn’t equal access. ED visits in Massachusetts, for example, have increased in spite of insurance coverage of nearly all their residents. As the safety net for our health care system, our emergency departments will continue to see increases in the number of patients. ED costs consume 2% of the national health care budget and we represent 4% of the total US physicians yet we provide 28% of the total ambulatory care visits in this country and 2/3 of all after hour visits. These figures illustrate the great value emergency medicine supplies to our nation. We need to be active players in the coming health care reform, with or without the contested personal mandate provisions, because we play such a pivotal role. I am confident ACEP and our leaders are positioning our specialty well in the upcoming dialogue.

Ohio's Dr. Kevin Klauer, DO, FACEP, Elected Council Vice Speaker

I also learned upon returning from ACEP that CMS has made major changes in the rules governing Accountable Care Organizations (ACO). These ACOs are really a major part of the ACA and are set up as groups of physicians and hospitals to coordinate care of Medicare patients to improve efficiency and lower costs. CMS responded to many of the concerns voiced from organized medicine about their draft set of rules released this past spring. Meeting quality metrics are an important part of ACOs, but initially, the number proposed was far too great and the required amount has been decreased. CMS also reduced the financial risks groups need to take on as they form to provide care to their covered patients. While all the perceived problems with ACOs haven’t been addressed, the AMA has acknowledged the recent changes are welcomed and will facilitate participation in forming and maintaining ACOs.

Members of the Ohio Delegation at the 2011 Scientific Assembly

Major change, without doubt, is coming in healthcare delivery and we need to accept the challenges and the opportunities these changes provide.

Stay in touch!
Tom
Thomas W. Lukens, MD, FACEP

Leadership Development Academy Represents the Ohio Chapter at 2011 Scientific Assembly
By Sara Laskey, MD
Leadership Committee Co-Chair

The Leadership Development Academy Class attended Council in San Francisco this year in the role of Alternate Councillors for the Ohio Chapter. Members of the class, Drs. Purva Grover, Michael McCrea, Michael Nauss, Sarah Orlousky and Matt Sanders arrived Wednesday evening in time to join me and Chapter Executive, Laura Tiberi, for a quick meal and networking prior to heading to new Councillor orientation and a reception. (Dr. Venk Kambhampati arrived later and joined us for Council the following day)

Councillor orientation offered information on what to expect when attending the Council meetings, but it also offered the class our first introduction to some of the candidates for ACEP President-Elect and Board of Directors. We registered our first impressions and many questions. We had a great time tasting all of the desserts before getting some much needed sleep prior to our first day as Councillors and alternates. The next day was an interesting mix of the larger Council session and the smaller reference committee meetings to hear discussion about the resolutions. Along with Alternate Councillor, Dr. Sarah Orlousky, Chapter Councillors John Lyman, MD, Tom Tallman, DO and I attended Reference Committee ‘C’, which was very engaging and entertaining, as there was much debate surrounding our issues. In all the reference committees, we also had more exposure to the candidates in the morning and afternoon. Drs. Michael McCrea and Michael Nauss were able to get in a couple of targeted questions that helped us watch how the candidates performed under pressure. We also got to cheer on Ohio’s own Kevin Klauer, DO, candidate for Vice-Speaker.

Leadership Development members, Dr. Orlousky &
Dr. Grover

After the first day of Council, the Ohio delegation gathered as a group to discuss the results of the reference committee meetings. We all learned some lessons in diplomacy and leadership as we watched our current and former Presidents (Drs. Lukens, Katz, Keaton and Jouriles) handle the complex issue of working with an Ohio ACEP member on a somewhat controversial resolution she had submitted. We also learned by comparing our experience with the candidates, often from only campaign material and one campaign stop in reference committees, with the thoughtful assessment of candidates shared with us by College leaders. Like any campaign, it takes a great deal of thought and balance to determine who will make a good leader for the coming year. We had a great discussion and as a group learned a great deal from the Ohio Chapter leaders and those who had served the College in National offices. We truly appreciated their presence both at that meeting as well as the Council meetings that day and the next. These Ohio leaders serve as good mentors for physicians wishing to become leaders and advocates for their profession and peers.

As co-chair of the Ohio ACEP Leadership Development Committee, it was rewarding for me to watch the various members of the class find different elements of the Council meeting that resonated with them. I have some personal predictions which I will write down and stick in an envelope or time capsule and pull out in a few years. I won't be surprised to see a few members of this class on the National Board by 2016... And I have no doubt that we have a future Speaker and President amongst us as well.

Capitol Hill Visits and More… A Pediatric Perspective
By Purva Grover, MD
Children’s Hospital of Akron, Ohio

Nervousness, anticipation and excitement - I guess these would sum up my emotions as I geared up for the Leadership and Advocacy Conference in DC this year. My first time at this event (part of the Ohio Leadership Development Academy training) provided a forum for me to listen and learn about recent developments in legislation and policy and how they will affect our patients and our careers. It was an opportunity to connect with friends and to make a difference. Armed with a story to tell and a passion to make a difference, hundreds of emergency medicine advocates flooded the halls of Congress and met with nearly 400 senators and representatives. The sense of empowerment was not only felt walking the halls of Congress. It was present on each day of the conference – whether during the opening session where advocates from across the country announced their presence in Washington or in the “Prep for the Hill” session.

As a pediatric emergency medicine (PEM) physician, it is important to understand issues that affect our patient population, to identify resources available to the pediatric community, to become involved with mentors and organizations for ongoing education and, ultimately, to understand our responsibility as physicians to advocate change. Our patients need us to voice their concerns.

Strangely, despite the enormous number of emergency medicine physicians advocating about multiple issues, sometimes I felt alone. “Why?” you might ask. I have pondered deeply and thought much about this. It really came to the lack of connections with other PEM physicians. Perhaps it was just the greater number of EM physicians, or maybe it was the fact that they were more vocal. In any case, it made me wonder…Where are the pediatric advocates?

Inspired by my experience in Washington, I am looking to connect and build a wider network of PEM advocates while also strengthening relationships among those that are currently active. If you are one of them, I hope to hear from you soon!

If not me, who? If not now, when?

Get Involved!

We would like to help interested members get involved in emergency medicine-related issues that are important to them.

Would you like to join Dr. Purva Grover for a Pediatric Emergency Medicine peer group? Email Dr. Grover.

Are you interested in in joining an Ohio ACEP Committee? Check out our Committee page for more information.

The Ohio Department of Health and Ohio ACEP are looking for an emergency medicine physician representative for the Sexual Assault Advisory Board of Ohio (SAABO). The Board’s mission is to ensure that all victims of sexual assault and sexual abuse have consistent access to quality medical care. For more information, contact Justin Spicer.

The Ohio Department of Public Safety, Division of EMS, is looking for an emergency physician to be seated on the State Trauma Committee. If you would like to be considered as the Ohio ACEP nominee, or for more information, contact Laura Tiberi.

Do you have another special interest related to the field of emergency medicine? Let us know by contacting Justin Spicer.

Ohio ACEP Holds Successful EMR Courses in Columbus

Over 500 attended our EMR courses in Columbus

From September 19-26, Ohio ACEP hosted its popular Emergency Medicine Review Long Track and Emergency Medicine Review Fast Facts & Fundamental Courses. This educational event was held at Renaissance Hotel in Downtown Columbus and was attended by over 500 physicians.

Many attendees praised the Review Courses as a convenient, painless way to receive their continuing medical education credits while attending lectures and presentations from world-class instructors.

For certification, recertification and the best in emergency medicine review, be sure to mark your calendars for our 2012 course offerings:

2012 EMR Long Track Course:
August 20-24
October 22-26

2012 EMR Fast Facts & Fundamentals:
August 25-27

Project IMPROVE: Implement Medicaid Programs for the Reduction of Avoidable Visits to the Emergency Department
A Report from the Statewide Summit October 19, 2011
Laura Tiberi, MA, CAE, Executive Director

In late 2010, Ohio Medicaid initiated a statewide effort to reduce “avoidable” emergency department (ED) visits. Their concern was that despite current efforts to reduce ED visits, more than half of the ED services utilized by Ohio Medicaid members were labeled as “non-emergent” and could have been treated safely and effectively in a primary care setting.

Ohio Medicaid hired consultants who proposed to address avoidable ED visits through an intensive, multifaceted approach that maximized existing healthcare resources, encouraged information-sharing and promoted community-specific solutions as essential elements in re-directing patients seeking avoidable care in the ED. In collaboration with key stakeholders including hospitals, community providers, managed care plans and Medicaid consumers, they developed five IMPROVE collaboratives (Toledo, Cincinnati, Columbus, Akron and Cleveland) charged with creating high impact and high volume primary care diversion solutions.

One group worked on reducing dental visits: They identified community resources (dental clinics accepting Medicaid) that would accept “fast-tracked” dental referrals from the ED. This was well-accepted and reduced ER visits.

Another group targeted upper respiratory infections (URI) with separate interventions for children and adults. The collaborative’s four-pronged URI intervention for children statewide included a colds toolkit that was mailed to households. It included such items as a thermometer, tissues, hand wipes and a phone number to call the nurse help-line.

Other groups developed interventions for frequent ED utilizers with severe mental illness, chronic back pain or non-mental health conditions.

The demonstration projects concluded in September 2011 with a statewide summit to report the findings. They found that the interdisciplinary team approach reduced ED visits, satisfied patients, changed patient behavior and increased the number of follow-up appointments kept by the Medicaid patients. Notably, the summit organizers did not report on the cost of the program or the amount of money saved.

Discussion:
Who in emergency medicine doesn’t shudder when projects are designed by payors to impact avoidable ED visits? In this particular project, the “avoidable” definition came from the diagnosis codes, not presenting symptoms.

It only takes one glance at your colleagues in Washington State to understand how problematic and worrisome this is. The Washington State plan limits payment for Medicaid patients to three “non-emergency” visits to emergency departments each year. This plan classifies more than 700 diagnoses as “non-emergent” including chest pain, abdominal pain, miscarriage and breathing problems. This affects all Medicaid patients, including children. Your colleagues at Washington ACEP have filed suit.

In the case of the IMPROVE project in Ohio, emergency physicians were asked to be part of the project, and indeed, we had representatives at the table and in the collaboratives. The IMPROVE integrated care teams did achieve post-intervention outcomes that included a modest reduction of ED utilization and hospitalization for the targeted patients. However, the total number of patients in these pilot programs was quite small, numbering between 10 and 44. In fact, there were frequently more people attending the IMPROVE development meetings than patients affected by the interventions!

In order to achieve a modest reduction of ED utilization, the program used intensive direct interventions with patients by managed care caseworkers for guidance and facilitated access to appropriate care (e.g. a dentist, a mental health provider, or pain clinic). The project was resource, labor and time intensive.

It was no surprise that, when shepherded carefully and individually through the system, patients were more likely to access primary care. As Mary Applegate, MD, Medicaid Chief Medical Officer (Ohio Department of Job and Family Services) noted: “ED utilization is not the problem in and of itself; the problem is somewhere upstream.” And upstream, as many emergency physicians know, is a problem with access to timely, convenient, quality primary care. The ED is not the problem, it is the solution.

Today’s health care reform challenges require innovative health models. Emergency physicians must continue to be stakeholders at the table. Our continued support of the prudent layperson standard for an emergency is vitally important. ED care and/or payment for emergency services are endangered when payors use final diagnoses to determine that non-emergent care was provided. The 18-month Project IMPROVE trial program helped managed care organizations improve access to care for some patients, but should not be held as a standard in the reduction of ED visits.

Life After Residency – It’s closer than you think!
By Mary Werick, MD
Ohio ACEP Chapter Resident Representative

Mary Werick, MD

As the end approaches, we can’t help but have a few questions about our future. There is no hard and fast clinical decision rule or algorithm for choosing a job, which leaves many of us lost in a haze of recruitment flyers and endless options. Fellowship or not? Academic or community? Independent contractor or employee status?

After much debate and questioning countless staff, I’ve found that while there is no algorithm, there are a few pearls to share that may be particularly useful to those residents approaching their final year. I’ve compiled these helpful tips into an article on the Ohio ACEP website. To view the article, click here.

Member Kudos

Ohio ACEP is pleased to congratulate members that achieved their FACEP designation this fall: Rami A. Ahmed, DO, FACEP; Amber Bradford-Saffles, DO, FACEP; Adam P. Dine, DO, FACEP; Aaron Dora-Laskey, MD, FACEP; Sarah M. Greenberger, MD, FACEP; Andrew Jacques, MD, FACEP; Kevin Joseph, MD, FACEP; Rahi Kapur, MD, FACEP; Nicholas Edward Kman, MD, FACEP; Sara Laskey, MD, FACEP; Kerry M. McCabe, DO, FACEP; Michael McCrea, MD, FACEP; Michael D. Nauss, MD, FACEP; Alex M. Reodica, MD, FACEP; Sean M. Roth, DO, FACEP; Matthew J. Sanders, DO, FACEP; Stephen Sayles, MD, FACEP; Alison Southern, MD, FACEP; Anita Toussi, MD, MBA, FACEP; and Matthew White, MD, FACEP.

Colin G. Kaide, MD, FACEP, for being recognized by his high school as a Distinguished Alumnus.

Robert W. Strauss, Jr., MD, FACEP, for being awarded ACEP’s 2010-11 “Over the Top” Faculty Award for his dedication to teaching excellence.

Gary R. Katz, MD, MBA, FACEP, for being awarded ACEP’s “Horizon” Council Award for his outstanding contributions and participation in Council activities.

Mark L. DeBard, MD, FACEP, for being awarded the 2011 Distinguished Educator in Undergraduate Education Award for the Ohio State College of Medicine.

Howard A. Werman, MD, FACEP, for being published in Development of Statewide Geriatric Patients Trauma Triage Criteria, as part of his work as a member of the Trauma Committee of the State of Ohio EMS Board.

Rita K. Cydulka, MD, MS, for being published in the August 2011 edition of Annals of Emergency Medicine.

David F. Baehren, MD, FACEP; and Catherine A. Marco, MD, FACEP, for contributing articles to the September and October, 2011 editions of ACEP News.

Michael Frank, MD, JD, FACEP; Kevin M. Klauer, DO, FACEP; Catherine A. Marco, MD, FACEP; Robert W. Strauss, Jr., MD, FACEP; and Thomas E. Syzek, MD, FACEP, for serving as faculty at the 2011 Scientific Assembly.

W. Frank Peacock, MD, FACEP; Kevin M. Klauer, DO, FACEP; James Luz, Medical Student; Catherine Marco, MD, FACEP; David Baehren, MD, FACEP; Sharon E. Mace, MD, FACEP; Jason T. McMullan, MD; Rahi Kapur, MD, FACEP; Erin K Broderick, MD; William A. Knight, MD; Opeolu Adeoye, MD; Kris R. Brickman, MD, FACEP; Peter D Akpunonu, Medical Student; John S. Zimmerman, MD, FACEP; Nicole R. Dominiak, Medical Student; Gregory J. Fermann, MD, FACEP; Michael J. Ward, MD; Baruch Fertel, MD; Michael S. Lyons, MD; Donald L. Norris, MD, FACEP; Michael McCrea, MD; and Stacy Poznanski, DO, for participating in the 2011 Research Forum.

Clinical News

COPD Exacerbations Twice as Common in Winter
Exacerbations and deaths among patients with chronic obstructive pulmonary disease follow a pronounced pattern of seasonal variation, according to an analysis of data from a randomized, controlled trial.
Read the entire article online.

Bacteria Ride Along on Many Hospital Uniforms
Some people wear their hearts on their sleeves. Doctors and nurses wear a lot more there, it seems. Sixty percent of doctors' hospital uniforms and 65% of nurses' uniforms tested contained potentially pathogenic bacteria in at least one place, according to research published in the American Journal of Infection Control.
Read the entire article online.

Focus On: The Cyanotic Neonate
“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.

Learning Objectives for this article include the ability to recognize and treat uncommon presentations of common pathology and common presentations of rare pathology, discuss the presentation, evaluation, differential diagnosis and treatment of the cyanotic neonate.The physician will be able to discuss the pathophysiology of the transition from fetal to newborn circulation,explain the significance of the hyperoxia test and discuss the management of a neonate with methemoglobinemia.
After reading the article, take the CME quiz online.

Welcome New Members

Eric R. Abrams	Jeremy Greg Gilbert, DO	Emily Roberts, MD
Brett Anderson, MD	Dina Gozman, MD	Darilynn Tommy Russell, MD
Shaza M. Aouthmany, MD	Kathryn M. Guffrey, MD	Pedro Salcido, Jr, MD
Scott Gibb Blanchard, DO	Danielle Rae Hans, MD	Alicia Shelby, MD
Paul Francis Bucchi, MD	Jessica Elizabeth Hilst, DO	Mehrdad Soleimani, MD
Anthony Burgess, MD	David Oman Jones, MD	Hans W. Steck, Jr., MD
Holli Charbonneau, MD	Viktoria Koskenoja	Benjamin Tishman, DO
Thomas C. Damhoff	Harveen Lamba	Elaine Lynn Todd, MD
Domenic DiBartolomeo	Kie Yung Lee, MD	Joshua Trester
Julia M. Dixon	Adam Levin	Daniel B. Van Bibber
Nicole R. Dominiak	Nicholas S. Libertin, III	Kyle Walsh, MD
Catherine Fernando, DO	Jason Paul Manross, MD	Tammy Weiner
Jamie A. Foley	Laura Beth Miller, DO	Derrick Williams, DO
Kristopher Ford, MD	Cortney Owoc, DO	Clifford Williamson, MD
Jonathan Frommelt	Thomas Peachman	Aaron A. Wolfe, DO
Loren Gavaghan, MD	Victor Alexis Ramos, MD	Samuel B. Wright, DO
Harpreet K. Ghuman, MD	Jessica Rando	Cyrus Yamin, MD

Unsubscribe