March Annals Audio

This month’s Annals is loaded with useful clinical info:

-Pediatric c-spines in blunt trauma
-Intranasal ketamine v fentanyl: grudge match
-Can depilatories dissolve more than hair?
-Ultrasound for pediatric forearm fracture reduction
-Presyncope in the ED: first high quality data set
-Tourniquet use and mortality in military settings: surprise?
-Beta-blockers in MI: again??

And much more…

Email any time, let us know what you think!

D&A

Annals podcast for January posted!

Apologies for lateness, but this one is juicy. Check it out here.

Highlights include:
– After an ED visit for A fib, who should be anticoagulated——and who gets the adverse event?
– Clinical Policy: aortic dissection in the ED
– GAME CHANGER — Ketamine and ICP, a systematic review
– NEW SERIES — Expert Management: Managing propofol-induced hypoventilation
– Plain x-rays for pelvis fractures: they sometimes miss
– Geriatrics: Malnutrition in older ED patients

And much much more,

Reach out any time at annalsaudio@acep.org,

D&A

Use of Intravenous tPA Draft Clinical Guideline Open for Comment Until March 13, 2015

The Clinical Policies Committee of ACEP has completed a draft clinical guideline: “Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department.” Since the 2012 clinical policy on IV tPA, there have been changes to the clinical policies development process, the grading forms used to rate published research have continued to evolve, and some newer research articles have been published.

The draft is now open for comments until March 13, 2015.

To view the draft policy and comment form, Click Below:
Clinical Policy Comment Form – Intravenous-tPA

For questions, please contact Rhonda Whitson at rwhitson@acep.org.

Holiday podcast is posted!

The December (ie holiday) issue of the podcast is up and running, so check it out. Highlights include:

-Diagnosing diagnosis: a video based study of how EPs make diagnoses
-Flexible bed usage in the ED, finding the sweet spot
-Patient satisfaction and operational characteristics in an ED: IMPORTANT associations
-RCT of antidote for latrodectism (widow spider bite poisoning)

And much much more!

Happy holidays to all and email any time,

D&A

The Central Line 2014-11-24 15:20:45

Annals November podcast is posted for all to hear! Keep the feedback coming, and THANK YOU.

This month look out for:
-LEAN process for reducing ED LOS
-Case law on EMTALA and psych emergencies
-Press Gainey scores and ED analgesics: not what they thought
-Randomized trial of anti-emetics: no better than placebo???

and much much more!

Email any time, annalsaudio@acep.org,

D&A

Dr. Rosenau End of Presidential Term Update

Rosenau 2By Alexander M. Rosenau, DO, CPE, FACEP
At last month’s ACEP14, we came to the end of my Presidency. I’m writing to say, “Thank you,” for allowing me to serve and to offer an update about what the College accomplished over the past year. For me, the past year has been intense as I’ve connected with individual members, groups, organizations and legislators in concert with our strong Board of Directors, expert staff and amazing volunteer physician members. I’ve cherished every minute. Emergency physicians enjoy a tremendous relationship with each other, and we’ve done some things in the past year to make our bond even stronger and to move the College forward. Although my term is over, please know that I will continue to work hard for the specialty.

Ebola Grabs Attention, Headlines
The work ACEP members and staff did to make sure our colleagues were well-equipped with the best information available for diagnosis and treatment of Ebola was outstanding. We immediately convened a panel of eight emergency care infectious disease experts to review materials pertinent to emergency care for dissemination to members and respond to questions posted by members via an easily accessible form on the www.acep.org/ebola resource page. We developed a curated repository of best practices for managing the patient with suspected and confirmed Ebola and worked with CDC, WHO, and other federal, state and local agencies to develop protocols for hospitals with limited resources.  We added numerous resources to the ACEP website and identified short and long-term legislative initiatives designed to assist our members and other health care providers to enhance their disaster preparedness. We also linked reporters with ACEP experts in infectious disease and disaster preparedness. ACEP managed 10-20 calls a day from reporters on this issue.

A round-up of ACEP Spokespersons in the News can be found at http://www.acep.org/Content.aspx?id=80956. We also added courses to the ACEP14 session lineup and made the audio from those courses available for free to all emergency physicians, worldwide, at the end of the conference. We developed an Ebola response survey for dissemination through our Emergency Medicine Practice Research Network (EMPRN) to gather data on preparedness for Ebola, EV-D68 and other infectious diseases, and we surveyed the Disaster Medicine Section, EMS Committee and Section and ACEP infectious disease experts about response needs and preparedness.

To make sure we were getting the most accurate and up-to-date information, we also met with high-level officials at the CDC and convened meetings with American Hospital Association, Emergency Nurses Association, National Association of EMS Physicians, Emergency Medicine Residents’ Association, and other key stakeholders for information/resource sharing. ACEP acted quickly and collaboratively to help prepare our colleagues.

Leadership and Advocacy Conference A Major Success
More than 550 ACEP members attended LAC this year to review and discuss the major issues of health care reform affecting the practice of emergency medicine. In addition to getting up to speed on the issues, practicing physicians, residents, and medical students also learned how to be more effective advocates for our patients and our specialty. As always, the highlight of the meeting was ACEP’s Lobby Day. This year’s key issues were psychiatric patient boarding in the ED the lack of resources for mental health care, expansion of residency slots and funding for graduate medication education, and the need for liability protection for EMTALA care provided in the ED. Here is a rundown of the bills ACEP members spoke with Members of Congress and their staffs about during LAC:

The Helping Families in Mental Health Crisis Act of 2013 (H.R. 3717): Improve research and data collection of existing mental health programs, promote evidence-based medicine systems of care for patients with mental health issues.

The Health Care Safety Net Enhancement Act of 2013 (H.R. 36/S. 961): Provide liability protection for EMTALA-related services in the emergency department to emergency physicians and on-call specialists as federal employees under the Public Health Safety Act.

The Resident Physician Shortage Reduction Act of 2013 (H.R. 1180/S. 577): Expand the current cap, in place since 1997, on the number of Medicare-supported graduate medical education slots in the United States. It would create 15,000 new training slots over five years.

The SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015): Completely repeal the SGR and replace it with a workable formula.

The Saving Lives, Saving Costs Act (H.R. 4106): Provide increased liability protection in the form of legal safe harbors to physicians who demonstrate they followed clinical guidelines developed by a multidisciplinary panel of experts.

ACEP Announces New Building Plans
In 1983, when the current ACEP headquarters was built, emergency medicine was fairly new as a recognized specialty. Now, with more than 33,000 ACEP members, the needs of this dynamic, growing medical organization and its members have greatly evolved. Just as many aspects of emergency medicine were different 30 years ago, our building was designed for a very different organization with different staffing and space needs, as well as technological requirements.

In the 21st century, ACEP needs a headquarters that better represents the specialty and meets the needs of its members and its mission. In advance of the June meeting of the ACEP Board of Directors, the Finance Committee provided due diligence to make sure we could continue to advance and meet our financial benchmarks. The Board analyzed the options and decided that the best course of action is to buy land in Irving, Texas, near the DFW Airport and build a new ACEP headquarters building. The land, a 6.06-acre tract close to DFW Airport, was officially purchased on Oct. 20. ACEP commissioned a top-level space needs analysis and found that at ACEP’s current staff size, we need a building of approximately 42,527 square feet; currently we have 30,474 square feet. If staff grows by 25 percent in the next five years, we would need approximately 50,000 square feet. If we were to grow by 40 percent in 10 years, we could use a building of around 57,000 square feet.

For the convenience of our Board, committees, and members who visit, the purchased land is adjacent to a full-service hotel and can situate a 55,000 – 60,000 square-foot office building with adequate parking. The Board approved a plan to meet the total project cost of $14.5 million with $7 million down and financing of $7.5 million. ACEP has healthy financial reserves, with a substantial portion in very low-yielding CDs and fixed income investments. Additionally, when the current building is sold, ACEP can expect to net about $3.5 million. Groundbreaking will most likely be in the Spring of 2015 and take about18 months or more before move in. We believe value to our members and future members will be the result of this investment, and we anticipate more effective and efficient service for our Board, committees and chapters. A newer, modern headquarters presents further opportunities for ACEP to reflect, develop and disseminate our values and goals.

Steven Stack, MD, FACEP, Named AMA President-Elect
In June, emergency physician Steven J. Stack, MD, FACEP, was named President-Elect of the AMA, the first emergency physician to ever hold that position. Dr. Stack will be the youngest President in the past century when he takes over in June 2015. He currently practices in Lexington and surrounding central Kentucky and is a very active member of ACEP, speaking numerous times throughout the year on behalf of the specialty and advocating for emergency physicians everywhere. He delivered the Rorrie Lecture at ACEP14 and demonstrated his expertise in the Affordable Care Act and Health Information Technology. I congratulate Dr. Stack on his new office and know that he will continue to do great work for emergency medicine and indeed, for the entire house of medicine. If you have any membership dollars available in your professional budget, I hope you consider making this year one in which you might become an AMA member to bolster our ACEP delegation at the AMA.  There are certain things that are more do-able when we have a strong delegation within the AMA, whether advancing our cause within the house of medicine or in our negotiations at the RUC.

My Condolences to the Families of Emergency
Medicine Leaders Who Have Passed Too Soon
Emergency medicine lost some of its founders and leaders during my term, so I’d like to recognize them and offer my condolences. Dr. Gail Anderson, the first professor and chairman of an academic department of emergency medicine in the United States, died in September. Another early pioneer of our specialty and ACEP Past President, Dr. George Podgorny, passed away in November. I was honored to deliver a eulogy at Dr. George Podgorny’s memorial service. Just before ACEP14 in Chicago, we learned the sad news about the passing of Dr. Richard V. Aghababian, who founded the Department of Emergency Medicine at the University of Massachusetts and served as ACEP’s President from 1994-95. Dr. Aghababian died in October at his home in Southborough, Massachusetts. Dr. Francis Fesmire, a national leader in emergency medicine, former Chair of ACEP’s Clinical Practice Committee and recipient of ACEP’s “Hero of Emergency Medicine” award in 2009, died in January. In my home chapter, PACEP, we lost Dr. Noelle Rotundo, all too soon. Noelle was a widely respected Pennsylvania EM educator and leader whom will always be remembered. The contributions that these men and women made to the specialty are immeasurable. My thoughts are with their families and the families of other ACEP members who have passed away this year.

ACEP Launches 2014 PQRS Registry Reporting System
ACEP announced in late August that it developed a PQRS registry reporting option and provided it o ACEP, EMRA and SEMPA members at a discount. The registry comes in response to the Centers for Medicare and Medicaid Services announcement that failure to satisfy the 2014 PQRS requirements equals up to 4 percent of Medicare payments, approximately $2,500 per provider. For more information on these requirements, please visit www.acep.org/quality.

Report Card Garners Major Media Attention
In January, we released the 2014 State-by-State Report Card on Emergency Medicine. The nation’s grade of D-Plus was abysmal, but we hope that this grade will stimulate a positive effort for improvement. In fact, the report card not only sounds an alarm, it offers a road map for a better future, supporting the delivery of emergency medical care. Our Report Card has already fostered many a conversation with state legislators. Media outlets have pointed out what we already knew – that several states don’t have the resources and policies in place to support high-quality emergency care. Stories about the Report Card appeared in major newspapers, including The Washington Post, Chicago Tribune, New York Daily News, Forbes, The Huffington Post, Los Angeles Times, San Francisco Chronicle, The Philadelphia Inquirer, Houston Chronicle and The Seattle Times, to name a few. Along with print stories, nearly 800 broadcast stories aired on news organizations including ABC’s World News Tonight with Diane Sawyer, MSNBC, CNN, Fox News’ Your World with Neil Cavuto, Fox Business News, CNBC’s Kudlow and Kramer, WNBC New York, and Telemundo as well as dozens of local television stations across the country.  The estimated audience reach was 72.2 million. Our dedicated spokespersons will continue to make sure the results of this study resonate nationwide. Keep up with the progress at www.emreportcard.org.

ACEP Now Launched
When the calendar flipped to 2014, ACEP turned its monthly publication up a notch. We wanted to blend the needs of our membership with an edgy editorial vision related more closely to the world we work in. Beginning with a round-table discussion cover story and a compelling piece on breaking down racial barriers in the ED, the new-look ACEP Now hit mailboxes in mid-January and began receiving rave reviews from ACEP members.  I hope you like the direction of our new medical editor-in-chief Kevin Klauer, DO, EJD, FACEP, and our new publishing partner, Wiley Press. The new ACEP Now is not only bigger, it features more incisive opinions, real articles regarding our decision making and advice from some of emergency medicine’s most  renowned physicians. The news from ACEP and events related to the College will always be a part of the magazine, so none of that has changed. What has changed is the attention to detail and open dialogue when opinions differ on controversial issues. If you haven’t seen ACEP Now lately, grab a copy soon. Your feedback is welcome at www.acepnow.com

Strategic Plan Taking Shape
In leading the annual Board retreat late last year, top-level goals and objectives for the college from now until 2017 were debated, prioritized and built for impact. Goal 1 focused on care transitions and improvement as the reform of the health care delivery system continues in full gallop. Goal 2 received particular attention with the formation of the Membership Engagement Task Force, the Membership Bylaws Task Force and the Residency Visit Task Force. Your fellow member leaders of these groups, their Board of Director Liaisons, and assigned top-level staff are poised for success in member engagement and satisfaction.  Here’s an overview of the Strategic Plan:

Goal 1 – Reform and Improve the Delivery System for Emergency Care

Objective A – Identify, support, and promote delivery models that provide effective and efficient emergency medical and acute care in different environments.
Objective B – Promote quality and patient safety, including development and validation of quality measures.
Objective C – Pursue strategies for ensuring fair payment and practice sustainability.
Objective D – Pursue solutions for workforce issues that ensure access to high quality emergency care.
Objective E – Advocate for meaningful liability reform at the state and federal levels.
Objective F – Communicate the value of emergency medicine as an important component of the health care system.

Goal 2 – Enhance Membership Value and Member Engagement

Objective A – Increase total membership and transitioning resident retention.
Objective B – Provide robust educational offerings, including novel delivery methods.
Objective C – Support member well-being.
Objective D – Ensure adequate infrastructure to support growth.

Each December, your Board reviews and modifies its strategic plan for the year. We will continue strong efforts to protect fair reimbursement, continue to press for liability reform, and demand an end to boarding and especially psychiatric patient boarding.

Building Bridges and Strengthening Relationships
One of my goals as President was to align ACEP with others who share our passion for quality health care. If we build bridges and enhance our synergy with other health care organizations, we benefit and so do our patients. Our relationship with CORD continues to grow, as does our joint work with CORD and SAEM in GME matters. EMRA has a new executive director and our relationship with EMRA could not be stronger. We’re proud to announce the ACEP/SEMPA EM Academy last spring drew rave reviews and more than 300 physician assistants and nurse attendees. I participated as our two organizations penned a new five-year management service contract in New Orleans in May. I directed a new task force be formed to reach out to identify opportunities for collaboration with the Society of Hospitalist Medicine. When it comes to building bridges, there are many organizations whose activities, benchmarks and plans have relevance to us and we need to continue building those relationships. Indeed, EMRA, CORD and SEMPA have renewed their management services contract with ACEP. During this past year, it was a privilege to be the first ACEP President to keynote the ACOEP annual meeting, and to be one of the first two physicians to receive the SEMPA Diplomat Award along with ACEP Past President Dr. Linda Lawrence. I would also like to recognize the strong contributions of our chapter executives to the progress of our profession.

Two Clinical Policies Reviewed
ACEP conducted two major Clinical Policy reviews during my term. In response to the Council- and ACEP Board–adopted Amended Resolution 32(13), the “Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department” was reviewed. Also reviewed was: ““Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients with Suspected Acute Non-Traumatic Thoracic Aortic Dissection.” ACEP instituted a 60-day comment period for clinical policy development and the process meets national clearinghouse standards for guideline development.

EMF Continues Endowment Push
Over the past year, EMF has launched a new logo and continues the momentum of the ACEP $1 million match to bring the endowment to maturity with a corpus of $2.5 million.  EMF has a new board, new Director and new Strategic Plan. Its Goals and Objectives are to:

Goal 1 – Position EMF as the principal sponsor of scientifically rigorous research and education to to improve the care of the acutely ill and injured and policy research that aligns with emergency care priorities
Goal 2:  Increase EMF’s capacity to engage more people in emergency medicine research and award more grants
Goal 3 – Position EMF as the premier 501(c)(3) emergency medicine foundation
Goal 4 – Increase EMF revenue to fund more research grants and education projects

Please go to www.emfoundation.org, and make EMF your charity of choice.

Annals Added to eCME Options
In collaboration with ACEP’s online education program, articles from the Annals of Emergency Medicine are being offered as a CME component. As of October 2014, there were 20 Annals-based articles available to members. ACEP looks forward to seeing this educational offering become a robust element of ACEP’s overall online education program. Learn more at www.acep.org/ecme. Concurrent with the inauguration of the eCME program, Annals announced that it would continue its relationship with long-time publisher, Elsevier. The five-year contract runs through December 2018, and provides a solid and stable financial basis for journal revenues. The contract provides a generous editorial office stipend along with a guaranteed minimum royalty, enabling Annals to contribute substantially toward the overall financial success of the College.

ACEP Continues to Add Value, Enhance Image
The continued strength of our specialty requires us to do some heavy lifting in areas such as keeping prudent layperson as a recognized part of the ACA, working toward an SGR fix and changing perception about the cost of emergency care. Working together, we will make progress. As a result, our place in the House of Medicine will be enhanced. And we’re building strong connections with others while providing service to our chapters as they protect the interests of our members. Chapter efforts in Washington State and in Virginia underscore the need for our teamwork.

Thanks for the Past Year
I started my EM practice in the 1980s, and there are many reasons I value membership and the friends I’ve made over the years. I can pick up a phone and dial a colleague anywhere for advice. Like all families and all democratic groups filled with the riches of a knowledge-based constituency, we will have disagreements and some conflict. It’s all for a better result and a strong organization, as long as we stick together. The knowledge I’ve gained in reimbursement and coding and practice management has paid me back every dollar I ever contributed to ACEP, EMF and NEMPAC. The education I’ve received at conferences has made my practice better and improved the care of my patients. I was proud to join ACEP then, and I’m proud to have served as its President. ACEP is growing. ACEP is dynamic. ACEP gives you a good return on your dues investment dollars. Your partners, your colleagues, are the members of the committees, task forces, sections, Board, Council, and technical expert panels that create our future. Thank you for your contributions, and for your friendship.

Sincerely,

Alex

Alexander M. Rosenau, DO, CPE, FACEP
ACEP Immediate Past President