September 2011 A Newsletter for the Members of ACEP

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From the President

Nick Zenarosa, MD, FACEP

I wanted to give the membership an update on recent events at TCEP.

People:

I am pleased to announce that we have renewed the employment contract with Jim Coles, our executive director for TCEP. Mr. Coles has been an invaluable part of our College for the past 19 years. I look forward to many more years of his stewardship and guidance.

We have announced new leadership with regard to the committees. We are excited about the additional perspectives and skill-sets they will bring to our organization. We still have plenty of room for other members to get involved.

Thanks in large part to members such as Dr. Angela Fisher, our membership is at an all time high of 1546 members.

TCEP Residency Visits- We are in the middle of a very successful year regarding the TCEP residency visit program. Thanks are due to Drs. de Moor, Fisher, and Knowles on an outstanding program. We are embrac-ing our future members to educate them on the importance of our Professional Organization to the Practice of Emergency Medicine.

Leadership and Advocacy Program- Again under the guidance of Dr. Angela Fisher, we are gearing up for a productive year of leadership development of our future TCEP/ACEP leaders. This program has been a solid format to introduce fellows to the political process and leadership challenges that we face now and in the fu-ture regarding the practice of Emergency Medicine.

Don’t forget the Council Meeting at ACEP in San Francisco this year. There is still plenty of time to register and attend. There are some significant issues that will be discussed and represented during this venue.

Quality:

Drs. Daphne Fullerton and Arze have performed a technology assessment of the organization. We will follow- up on some of their recommendations to embrace available technology to make the College better organized and robust. Some of the functionality includes better use of email and project management software. We truly appreciate their efforts.

PRESIDENT

Nick Zenarosa, MD, FACEP

PRESIDENT ELECT

Dan Peckenpaugh, MD, FACEP

TREASURER

Rick Robinson, MD, FACEP

SECRETARY

Bruce Moskow, MD, FACEP

IMMEDIATE PAST PRESIDENT

James Williams, DO, MS, FACEP

BOARD OF DIRECTORS

Shannon Bagwell, MD

Carrie de Moor, MD

Angela Siler Fisher, MD, FACEP

Juan Fitz, MD, FACEP

Shkelzen Hoxhaj, MD, FACEP

Heather Owen, MD

Harbir Singh, MD

CHAPTER OFFICE

Jim Coles, CAE

Executive Director

Nancy Davis

Executive Assistant

2525 Wallingwood Bldg 13-A

Austin, Texas 78746

OFFICE: 512/306-0605

FAX: 512/329-8943

tcep@aol.com

NATIONAL ACEP

PO BOX 619911

Dallas, TX 75261-9911

OFFICE: 800/798-1822

FAX: 972/580-2816

2011-2012 Board of Directors

Service:

The EMS Medical Director’s Seminar is scheduled for September 16-17 in Arlington Texas. It seems to be a great lineup with topics that will have a positive impact on our practices.

We have begun the process of planning for next year’s annual meeting. If you would like to be involved, please contact TCEP.

Finance:

We had a banner year at our last annual meeting. Both attendance and sponsorship was increased over last year. We look forward to the opportunities this year brings.

Warmest Regards,

Nick Zenarosa, MD, FACEP

TCEP President

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Texas College of Emergency Physicians Meeting Dates 2011-2012

MEETING DATES 2011

September, 2011

8 Residency Visit – Texas A&M Scott & White, Temple, TX 15 TCEP Board of Director’s Meeting Sheraton Hotel, Arlington, TX 16-17 EMS Medical Director’s Seminar Sheraton Hotel, Arlington, TX October, 2011

13-18 ACEP Scientific Assembly San Francisco, CA 18 ACEP Board of Director’s Meeting San Francisco, CA 21-22 TMA Fall Conference Hyatt Regency, Austin, TX

November, 2011

12-15 AMA House of Delegates Interim Meeting New Orleans, LA

MEETING DATES 2012

January, 2012

27-28 TMA Winter Conference AT&T Center, Austin, TX April, 2012

18-22 TCEP Annual Meeting Westin Riverwalk, San Antonio, TX

May, 2012

18-19 TexMed 2012 Sheraton Hotel, Dallas, TX 20-23 ACEP Leadership & Advocacy Meeting Omni Shoreham, Washington DC June, 2012

16-20 AMA House of Delegates Annual Meeting Hyatt Regency, Chicago, IL

October, 2012

5-6 TMA Fall Conference AT&T Center, Austin, TX 8-11 ACEP Scientific Assembly Denver, CO

November 2012

10-13 AMA House of Delegates Interim Meeting Honolulu, HI

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Elizabeth Arrington, MD

Alison Barrow, MD

Beau Baum

Mike Berry

Benjamin Blake, DO

Aaron Blue, MD

Jonathan Canion

Dustin Corgan, MD

Kathryn Danesi, MD

Romeo Fairley

David Fernandez, DO

Donald Foran, MD

Robert Frolichstein, MD

Ismael Garcia, MD

Zachary Gibson

Ye He, MD

Russell Hill, MD

Bashar Ismail, MD

Julio Jayes, MD

Maimoona Khan, MD

Andrew Kretschmer, MD

Nashat Latib, DO

Nicholette Lawson, MD

Patrick Liu

Pablo Lizardi-Vila, MD

Tracy Mak, MD

Kyle Marshall

Afton McNierney-Moore, DO

Laura Medford-Davis, MD

Michael Menowsky, MD

Garrett Merriman, MD

Samara Moore, MD

Jessica Nelson, MD

Michael Pandya

Terrence Pattinson, MD

Erica Peethumnongsin

Ferran Ros, DO

John Russell, DO

James Scribner, MD

Telemate Sokari, MD

Ammundeep Tagore

Joseph Taiwo, MD

Tricia Teoh, MD

Christine Tracy, DO

YenTe Tu, MD

Veer Vithalani, MD

Charles Williams, MD

Samar Yusuf, DO

Welcome new TCEP Members!

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The Texas College of Emergency Physicians would like to congratulate Dr. Denise Parker for receiving the

Texas College of Emergency Physicians Award. Dr. Denise Parker, a former medical student at UT South-

western, is now an intern at UT Southwestern - Parkland Memorial Hospital. Given to fourth year medical

students, the award acknowledges excellence in Emergency Medicine with special recognition for dedication

to Texans who need emergency care. TCEP wishes her the best in her pursuit of Emergency Medicine and

look forward to Dr. Parker’s future success.

TCEP additionally congratulates Dr. Alex Black, another former student at UT Southwestern and now intern at

UT Southwestern - Parkland Memorial Hospital for receiving the 2011 Society of Academic Emergency Medi-

cine (SAEM) award for demonstrating an immense commitment to Emergency Medicine. A former paramedic

who previously worked for Dallas Fire Rescue, Dr. Black has demonstrated devotion to the spectrum of Emer-

gency Medicine. TCEP looks forward to this rising star of Emergency Medicine and wishes him the best

through residency.

TCEP Recognizes New Physicians

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Government Relations Committee Report

Diana Fite, MD, FACEP

This report from the Government Relations Committee will focus on what happened in the legislative session, and particularly in the special called session held in June, regarding Medicaid and physician reimbursement,

and provisions affecting emergency care related to Medicaid.

At the beginning of the legislative session, we were well aware that the focus of the leg-islators would be on the budget, with up to a $27 billion dollar deficit for the current budg-et plus the next two-year budget combined; and on redistricting. We were well aware that any bills introduced that would require funding might as well be considered null and void on the spot. It was almost a foregone conclusion that payments to physicians under Medicaid would be cut by ten percent.

TCEP advocated not cutting payments, of course. Not only are payments to care for Medicaid patients in the ED far below Medicare reimbursement rates in the first place,

but if payments were cut and even less primary care physicians were seeing Medicaid patients, then those additional patients would be coming to the crowded emergency departments. The Texas Medical Association (TMA) took the lead role, with the support of multiple specialty associations including ours, to work to prevent or at least lessen the amount of the cuts. Thanks to the hard work of many, and special thanks to Repre-sentative Zerwas (anesthesiologist from Houston), SB 7, authored by Senator Nelson and sponsored by Rep-resentative Zerwas, was passed in the June special session and signed by Governor Perry. This bill did not cut any Medicaid payments to physicians after all.

Representative Zerwas did have to come up with some wording that involves emergency medicine and po-tential savings to the Medicaid program in order to get this to pass. I have read this bill word for word in its entirety (192 pages), and have discussed his provisions personally with Dr. Zerwas, and there has been a bit of exaggeration written or perceived by some about the provisions. However, since the general perception among legislators is that emergency department care of Medicaid patients is abused by the patients and is expensive, including provisions in the bill to try to correct these issues was necessary in order to get it to pass.

Please forgive me for this long paragraph for those of you who can barely get through these legislative re-ports. You all can just skip the rest of this paragraph. But some of us like to see the exact wording, and here it is, verbatim: “Sec. 531.086. STUDY REGARDING PHYSICIAN INCENTIVE PROGRAMS TO REDUCE HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS. (a) The commission shall conduct a study to evaluate physician incentive programs that attempt to reduce hospital emergency room use for non-emergent conditions by recipients under the medical assistance program. Each physician incen-tive program evaluated in the study must:

(1) be administered by a health maintenance organization participating in the STAR or STAR + PLUS Medi-caid managed care program; and

(2) provide incentives to primary care providers who attempt to reduce emergency room use for non-emergent conditions by recipients.

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(b) The study conducted under Subsection (a) must evaluate:

(1) the cost-effectiveness of each component included in a physician incentive program; and

(2) any change in statute required to implement each component within the Medicaid fee-for-service payment model.

(c) Not later than August 31, 2013, the executive commissioner shall submit to the governor and the Legisla-tive Budget Board a report summarizing the findings of the study required by this section.

(d) This section expires September 1, 2014.

Sec. 531.0861. PHYSICIAN INCENTIVE PROGRAM TO REDUCE HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS. (a) If cost-effective, the executive commissioner by rule shall estab-lish a physician incentive program designed to reduce the use of hospital emergency room services for non-emergent conditions by recipients under the medical assistance program.

(b) In establishing the physician incentive program under Subsec-tion (a), the executive commissioner may include only the program components identified as cost-effective in the study conducted un-der Section 531.086.

(c) If the physician incentive program includes the payment of an enhanced reimbursement rate for routine after-hours appointments, the executive commissioner shall implement controls to ensure that the after-hours services billed are actually being provided outside of normal business hours.

(b) Section 32.0641, Human Resources Code, is amended to read as follows:

Sec. 32.0641. RECIPIENT ACCOUNTABILITY PROVISIONS; COST-SHARING REQUIREMENT TO IMPROVE APPROPRIATE UTILIZATION OF [COST SHARING FOR CERTAIN HIGH-COST MEDICAL] SERVICES. (a) To [If the department determines that it is feasible and cost-effective, and to] the extent permitted under and in a manner that is consistent with Title XIX, Social Security Act (42 U.S.C. Section 1396 et seq.) and any other applicable law or regula-tion or under a federal waiver or other authorization, the executive commissioner of the Health and Human Services Commission shall adopt, after consulting with the Medicaid and CHIP Quality-Based Payment Advisory Committee established under Section 536.002, Government Code, cost-sharing provisions that encourage personal accountability and appropriate utilization of health care services, including a cost-sharing provision applicable to [require] a recipient who chooses to receive a nonemergency [a high-cost] medical service [provided] through a hospital emergency room [to pay a copayment, premium payment, or other cost-sharing payment for the high-cost medical service if:

[(1) the hospital from which the recipient seeks service:

[(A) performs an appropriate medical screening and determines that the recipient does not have a condition requiring emergency medical services;

[(B) informs the recipient:[(2) after receiving the information and assistance described by Subdivision (1) from the hospital, the recipient chooses to obtain emergency medical services despite having access to medi-cally acceptable, lower-cost medical services].

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[(i) that the recipient does not have a condition requiring emergency medical services;

[(ii) that, if the hospital provides the nonemergency service, the hospital may require payment of a copay-ment, premium payment, or other cost-sharing payment by the recipient in advance; and

[(iii) of the name and address of a nonemergency Medicaid provider who can provide the appropriate medi-cal service without imposing a cost-sharing payment; and

[(C) offers to provide the recipient with a referral to the nonemergency provider to facilitate scheduling of the service; and

(b) The department may not seek a federal waiver or other authorization under this section [Subsection (a)] that would:

(1) prevent a Medicaid recipient who has a condition requiring emergency medical services from receiving care through a hospital emergency room; or

(2) waive any provision under Section 1867, Social Security Act (42 U.S.C. Section 1395dd).

[(c) If the executive commissioner of the Health and Human Services Commission adopts a copayment or other cost-sharing payment under Subsection (a), the commission may not reduce hospital payments to re-flect the potential receipt of a copayment or other payment from a recipient receiving medical services provid-ed through a hospital emergency room.]”

Yes, that is confusing, but it is about studying these options, not putting into effect for the entire state or Medi-caid program at this point. And there seem to be safety net provisions acknowledged that we can work with if necessary.

Another provision in the bill is this: “(11) a requirement that the managed care organization's usages of out-of-network providers or groups of out-of-network providers may not exceed limits for those usages relating to total inpatient admissions, total outpatient services, and emergency room admissions determined by the com-mission; (12) if the commission finds that a managed care organization has violated Subdivision (11), a re-quirement that the managed care organization reimburse an out-of-network provider for health care services at a rate that is equal to the allowable rate for those services, as determined under Sections 32.028 and 32.0281, Human Resources Code.” Granted, I find this wording to be confusing (and remember this bill is about Medicaid, so this does not refer to managed care plans that are not Medicaid). Some emergency physi-cians have contacted me that their hospital administrators are telling them that the hospital will no longer be paid for Medicaid admissions from the ED. But I do not think that the statement says that. I think it says that the payment might be lower than what would have been paid to out-of-network providers, and the potential is there that the payment may be so low that it does not cover the actual hospital costs.

As we always remind our TCEP members, we would appreciate you working one shift per year to give to EM-PACT. And larger donations are appreciated, of course. We need to fund EMPACT so that we can give do-nations to legislators, particularly those in positions of importance to our issues or who have helped us out with our bills or with support of our agenda. This whole report has been a perfect example of the importance of having a strong voice when it comes to legislation that affects us so directly. We have to help legislators get elected who understand our issues and help us advocate for our patients. EMPACT needs money to ac-complish this. Please send your check to TCEP or call 1-800-TEX-ACEP with your credit card information. You can donate with credit card deductions monthly or quarterly if that is helpful. And please call me (713-301-3564) or e-mail me (dianafite@mail.com) or call our executive director, Jim Coles (1-800-TEX-ACEP) or e-mail him (tcep@aol.com), if you wish to discuss any of the information in this report.

Diana Fite, MD, FACEP Chair, Government Relations Committee

EARLY REGISTRATION HAS BEEN EXTENDED

DON’T MISS THIS OPPORTUNITY

APPROVED FOR 11.75 CME HOURS

Early registra�on for the 2011 EMS Medical Director’s Seminar, September 16-17, 2011 at The Sheraton Arlington Hotel, 1500 Con-

ven�on Center Drive, Arlington, TX has been extended. Make your hotel reserva�ons by calling 800.442.7275 and men�on you are

with TCEP. You won’t want to miss this year’s mee�ng with something for all the EMS Medical Directors and the non-physician

EMS professional. Be sure to bring your Fire Chief’s, and Administers as well.

Register now online at www.texacep.org and join your colleagues and friends at this very important mee�ng! For more infor-

ma�on check our website or contact TCEP at 800-839-2237 or tcep@aol.com

The EMS Medical Director’s Seminar is an annual forum for EMS Physicians, Administrators, and Providers to meet and exchange

new ideas and informa�on on the Texas EMS Systems

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