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ACEP 911 Network Action Alert
SGR repeal legislation gaining momentum: Contact your legislators to make it happen!

Congress is closer than ever before in enacting bi-partisan, bi-cameral legislation to replace the Medicare Sustainable Growth Rate (SGR) formula with a payment system that rewards quality, efficiency and innovation (H.R.2/S.810).

Amplifying emergency physicians’ voice on this issue now is critical.

The House may take up the legislation as early as Thursday. Senate consideration is expected following the House vote.

Please take action by sending an email to your federal legislators through the ACEP Grassroots Advocacy Site or You can also call your legislators by telephone via the AMA’s Physicians Grassroots Network hotline at (800) 833-6354.

Click here to read more.

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21 percent reduction in physician Medicare reimbursement unless Congress acts by April 1
On March 19, leaders in the Senate and House introduced bi-partisan legislation to replace the Medicare Sustainable Growth Rate (SGR) formula with a payment system that rewards quality, efficiency and innovation. The deal was negotiated by House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) in recent weeks behind closed doors. But key committee members have signed on as sponsors of the legislation including Rep. Paul Ryan (R-WI), chair of the House Ways and Means Committee and Ranking Member Sandy Levin (D-MI), and Sen. Orrin Hatch (R-UT), chair of the Senate Finance Committee, among others.

The $213 billion deal would replace the SGR, as well as provide a two-year extension of the Children's Health Insurance Program. Funding for the package would come in part through $70 billion in spending reductions split between cuts to Medicare benefits and reductions in provider payments.

This SGR replacement measure is largely the same as legislation introduced last year to replace the SGR. While there was bipartisan, bicameral agreement on the legislation last year, both chambers of Congress failed to pass the legislation after lawmakers reached an impasse over how to pay for it. Congress in March 2014 then approved a short-term delay to scheduled reductions to Medicare physician reimbursement rates called for by the SGR, but physicians will face about a 21 percent reduction in Medicare reimbursement rates unless Congress acts by April 1, 2015.

Although financing the bill is subject to change, currently about $70 billion of the projected costs are offset. Roughly half of the possible deal's offsets would come from cuts to hospitals, insurers and acute-care providers. The other half of offsets would come from cuts to Medicare beneficiaries, such as additional means testing for high-income beneficiaries. Overall, the deal would be expected to add about $140 billion to the federal deficit over 10 years.
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DC Hill Visits Mix Experience with Passion
Michael T. Rapp, M.D., JD, FACEP former ACEP President and Director of the Quality Measurement and Health Assessment Group of the Centers for Medicare and Medicaid Services talks with Jesse Spangler, M.D. and VACEP Board of Director after meeting with Virginia Senators Warner and Kaine during the 2014 Legislative Advocacy Conference. A full-day Leadership Summit has been added on May 6, 2015. Registration:
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Rufus Phillips joins the Healthcare Leaders Institute
Healthcare Solutions Connection has announced Rufus Phillips, MBA, has joined the HSC network. Rufus served as the chief executive for the Medical Society of Virginia from 2007 to 2014. He specializes in leadership development and strategic planning for independent physician practices, and his recent work includes innovating within the retainer-based medicine industry

Innovative Strategies for Managing High Utilizers of the ED
Panelists Sharon Sanders, RN, BSN, MBA (left) and Dr. Reed Smith, FACEP (right) continue their discussion while Zac Corrigan, MBA, (center) EMA’s Director of Strategic Development listens during EMA and MHEI’s Value Based Emergency Medicine Summit in Baltimore, Maryland.

Tidewater EMS offers Advanced Trauma Life Support
At the Eastern Virginia Medical School, Two-day student courses
May 21-22 and Nov. 5-6, 2015
Half-day ATLS refresher courses on May 22, Nov. 6 for info and to register.
You can also call 757.446.5926
The American College of Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The American College of Surgeons designates this live activity for a maximum of 17 AMA PRA Category 1 Credits™ (for the two-day ATLS Student Course) and 5 AMA PRA Category 1 CreditsTM (for the half-day ATLS Refresher Course). Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Visit EM Career Central this to find your next job in emergency medicine.

  Join the VEP Virginia Team!

VEP Healthcare has emergency medicine physician and PA/NP opportunities at our Virginia partner hospitals. VEP offers flexibility, a collaborative & dynamic group of physician colleagues, leadership opportunities, competitive salary and the opportunity become a shareholder in our provider-owned company. To apply, visit our website or email:

Emergency Medicine Voice Influence Mental Health Taskforce

Bob Ramsey, VACEP Executive Director, Bruce Lo, M.D., FACEP and William Hazel, M.D., Secretary of Health and Human Resources.

Emergency physicians Bruce Lo, Scott Syverud and William Barker were personally thanked by Governor McAuliffe at the final meeting March 23, 2015 of the Governor’s Taskforce on Improving Mental Health Services and Crisis Response. The Taskforce approved 25 recommendations. “While the Taskforce has made good progress, there remains a fragmented level of service provide by the various CSBs across Virginia. We need more standardization among the groups that provide patient evaluations,” noted Dr. Lo.

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MSV' Protects Physician Interests in 2015 Virginia General Assembly
The Medical Society of Virginia (MSV) has achieved a major victory for all physicians and patients in Virginia requiring health plans’ adherence to the following prescription prior authorization reforms:
  • Provide a 24-hour turnaround on prior authorization requests for urgent medical needs and follow a deadline of two business days to act on a prior authorization request and
  • Honor an approved prior authorization from a patient’s previous health plan for at least 30 days when a patient switches health plans
  • Provide a reason when denying a prior authorization request and provide a tracking number when requested, so physicians can monitor the status of their request
  • Accept electronic prior authorizations that can be transmitted by electronic medical record, e-prescribing, or health information exchange
In addition to MSV’s win with prescription prior authorization reforms, we also achieved legislative successes in:
  • opposing a Medicare fee-based schedule in workers’ compensation;
  • opposing extending chiropractors’ scope of practice to include the performance of CDL physicals;
  • supporting child proof packaging for liquid nicotine; and
  • enhancing safe access to virtual care (telemedicine).

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The MacGyver of medicine; greatest diagnosticians in the world; prime comforters in times of crisis — Which of these are You?
Each year brings new challenges for our specialty to face and a new President to the lead the charge. Michael J. Gerardi, MD, FAAP, FACEP, who took over as ACEP President in October, shares his views on a few of those challenges with ACEP Now Medical Editor-in-Chief Kevin Klauer, DO, EJD, FACEP. Read more in March's ACEP Now.
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EM Academy – Phase 1 April 7-11, 2015 Baltimore, Maryland
Council of EM Residency Directors Academic Assembly April 13-16, 2015 Phoenix, Arizona
Mid-Atlantic Medical Student Symposium & Residency Fair April 25, 2015 Las Vegas, Nevada
Emergency Department Directors Academy – Phase II April 26-30, 2015 Dallas, Texas
Legislative Advocacy Conference May 3-6, 2015 Washington, DC
SEMPA 360 May 3-7, 2015 Lake Buena Vista, Florida
VACEP Board of Directors May 15, 2015 Charlottesville, Virginia
ACEP Simulation-based Immersive Medical Training Course May 18-20, 2015 Phoenix, Arizona
8th Annual Joint MedStar — GW LLSA Conference May 26, 2015 Washington, DC
Virginia Academy of Physician Assistants 33rd Annual CME Conference July 26-31, 2015 Virginia Beach, Virginia
VACEP Board of Directors Sept. 11, 2015 Richmond, Virginia
ACEP15 Oct. 26-29, 2015 Boston, Massachusetts
Virginia EMS Symposium Nov. 11-15, 2015 Norfolk, Virginia
VACEP Board of Directors Dec. 11, 2015 TBA

Whether you are job hunting, need to be credentialed, or just trying to stay organized...
Meet your new best friend — the ACEP Portfolio Tracker.

The use of bed-side ultrasound is growing — but are ERs ready?
By Dr. Afsaneh Motamed-Khorasani
Ultrasonographic investigation — in its traditional approach — involves many steps and multiple professionals, including radiologists and certified sonographers. This approach might not be necessarily helpful for critically-ill patients and immediate patient management. However, recent technological advances in ultrasonography, inherent safety, relative ease of use and portable machines capable of producing high-quality imaging have made it an invaluable point-of-care tool.
Doctors continue to hate their jobs — Is the ACA to blame?
By Scott E. Rupp
In news that we likely all knew (or had an inkling of), physicians are less happy than they have been or could be, a new survey suggests. There are a number of reasons for the lack of job satisfaction, including bureaucracy and a greater focus on technology and data entry, but the data reflected here — in a recent survey from the healthcare solutions group Geneia — is nothing new. Headlines have been gathering for some time that suggest similar results.
Battling opioid dependence in the emergency department
UMass Med Now
Emergency departments can play valuable roles in addressing the opioid abuse crisis, according to health psychologist Edwin Boudreaux, Ph.D. “The ED prescribes lots of opiates in order to help people manage their pain,” said Dr. Boudreaux, professor of emergency medicine, psychiatry and quantitative health sciences, vice chair of research for the Department of Emergency Medicine at UMMS, and director of Behavioral Health Services at the UMass Memorial Medical Center-University Campus emergency room.


Rural hospitals, one of the cornerstones of small town life, face increasing pressure
Kaiser Health News via U.S. News & World Report
Despite residents’ concerns and a continuing need for services, the 25-bed hospital that served this small East Texas town for more than 25 years closed its doors at the end of 2014, joining the ranks of dozens of other small rural hospitals that have been unable to weather the punishment of a changing national health care environment. For the high percentages of elderly and uninsured patients who live in rural areas, closures mean longer trips for treatment and uncertainty during times of crisis. “I came to the emergency room when I had panic attacks,” said George Taylor, 60, a retired federal government employee. “It was very soothing and the staff was great. I can’t imagine Mount Vernon without a hospital.”
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Affordable Care Act faces more hurdles in coming months
By Rosemary Sparacio
The Affordable Care Act has survived one repeal attempt in the Supreme Court, as well as more than 50 repeal attempts by the House of Representatives and the Senate. However, President Barack Obama's signature legislation faces yet another significant challenge to its existence. In the current case before the Supreme Court (King v. Burwell), a ruling in favor of the plaintiffs this June would essentially cut off the healthcare law's tax credits/subsidies in roughly two-thirds of the states.
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New protocol can help emergency departments evaluate patients with acute chest pain
A recently developed risk-evaluation protocol can help hospital emergency department personnel more efficiently determine which patients with acute chest pain can be sent home safely, according to a randomized trial conducted at Wake Forest Baptist Medical Center. The study, published in the current online issue of the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes, found that chest-pain patients who were evaluated with the new protocol, called the HEART Pathway, had 12 percent fewer cardiac tests, 21 percent more early discharges, and shorter hospital stays than those who received standard care.
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Patients don't always pick ER closest to home
HealthDay News via MPR
Less than half of all emergency department visits occur at the emergency department closest to a patient's home, according to a March data brief published by the U.S. Center for Disease Control and Prevention's National Center for Health Statistics (NCHS). Amy M. Brown, MPH, from the NCHS in Hyattsville, M.D., and colleagues examined which emergency department patients visit, how often patients visit the emergency department closest to their home, and the factors associated with emergency department selection patterns.
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Malpractice fears spurring most ER docs to order unnecessary tests
HealthDay News via U.S. News & World Report
Nearly all emergency room doctors surveyed order pricey MRIs or CT scans their patients may not need, mainly because they fear malpractice lawsuits, according to a new report. Of 435 ER physicians who completed the survey, 97 percent admitted to ordering some advanced imaging scans that weren't medically necessary, the findings showed. Such scans contribute to the estimated $210 billion wasted annually on unnecessary tests, procedures and treatments, the researchers contended.
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Telehealth's true success starts behind the scenes
By Karen R. Thomas
For the last few years, telehealth has been one of the biggest buzzwords in the healthcare industry. With recent predictions indicating that the number of patients using telehealth will hit 7 million by the year 2018, businesses are scrambling to create devices that can keep up with the high demand. Telemonitoring technologies make it possible for healthcare providers to monitor symptoms and measure vital signs remotely, and they also make it easier for patients, employees and others to manage their own healthcare better and more affordably.
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Emergency medicine resident: What it's like to lose a patient
The Blaze (opinion contribution)
Author Amy Ho writes: The sad thing is, I hardly remember the patient. Everything about her is just an overhead Pediatric Trauma alert followed by the flurry of cutting clothes off, throwing IV lines, and calling out our primary and secondary survey — “blown right pupil;” “unequal breath sounds;” “gross deformity to left ankle;” and then “no pulse” — followed by the age-old barbaric resuscitation efforts that are now muscle memory to us, as we compressed her sternum still with bits of her Forever21 bra on it and shoved an MAC blade past her pink braces.
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