PACEP News - Spring 2019

SPRING 2019

Executive Privilege A tap on the shoulder. My first awareness of PACEP was when my friend, former colleague, and now predecessor Ankur Doshi, MD, FACEP, asked if I wanted to help plan the PACEP Scientific Assembly. I knew nothing about PACEP, but agreed to help and quickly discovered how extraordinary our organization is. Little did I realize that my first experience with PACEP would lead me to be elected to the PACEP Board of Directors and now serve as your President. As I begin my term, I find myself thinking of that first moment of involvement with PACEP and about how all of us can build a better future for our colleagues, our residents and fellows, and our patients.

Standing on the Shoulders of Giants Arvind Venkat, MD, FACEP PACEP President, 2019 - 2020

I believe we now stand at a crossroads in emergency medicine in Pennsylvania.

To begin, I want to recognize our remarkable history. Among our members are two of the original members of ACEP, former ACEP Presidents, Officers, Council Speakers, and Committee Chairs. In my time on the Board, I have had the privilege of serving with an extraordinary set of leaders who have advanced emergency care in Pennsylvania. But more importantly, it is the work of our members in the emergency department, in the pre-hospital setting, in the classroom, in the halls of government, and in positions of leadership at the departmental, hospital, medical school, and health system level that has taken our specialty from the fringes to the center of medical care. We recently celebrated ACEP’s 50th anniversary and will do the same for our chapter in 2021. While we should never rest on our laurels, our future is built on the efforts of these pioneers who broke barriers to ensure that emergency care was recognized as a vital part of how we care for patients.

The Best of Times, The Worst of Times From this history, I believe we now stand at a crossroads in emergency medicine in Pennsylvania. In some ways, it is the best of times. PACEP now has over 1,700 members.

We are expanding our educational offerings at Scientific Assembly with new and larger Residents Days and an Ultrasound Procedure Course. PACEP is established as an important player with state government on issues ranging from opioids to hospital regulations to organ donation to mental health care. We have a new recognition and focus within PACEP on Wellness. Our EMS colleagues have successfully advocated for improvements in reimbursement, education of pre-hospital providers, and streamlining inter-facility transports. More residents are part of our Board and Committees to ensure we are engaging the next generation of emergency physicians in the Commonwealth.

PACEP members are leaders in emergency medicine in clinical care, research, education, and administration, and medical students clamor to join our ranks. When tragedy strikes, it is emergency physicians who are the heroes that care for the sick and injured, regardless of condition, ability to pay, or time of day.

And yet, we face many threats. Poorly crafted balance billing legislation could further continued on page 3

{ Job Opportunities } Division Chief, Pediatric Emergency Medicine EMS Fellowship Director/EMS Medical Director Assistant Medical Director PEM/EM Core Faculty Vice Chair Research Emergency Medicine

What We’re Offering: • We’ll foster your passion for patient care and cultivate a collaborative environment rich with diversity • Salaries commensurate with qualifications • Sign-on bonus • Relocation assistance • Retirement options • Penn State University Tuition Discount • On-campus fitness center, daycare, credit union, and so much more!

What We’re Seeking: • Experienced leaders with a passion to inspire a team • Ability to work collaboratively within diverse academic and clinical environments • Demonstrate a spark for innovation and research opportunities for Department • Completion of an accredited Emergency Medicine Residency Program • BE/BC by ABEM or ABOEM • Observation experience is a plus

What the Area Offers: We welcome you to a community that emulates the values Milton Hershey instilled in a town that holds his name.

Located in a safe family-friendly setting, Hershey, PA, our local neighborhoods boast a reasonable cost of living whether you prefer a more suburban setting or thriving city rich in theater, arts, and culture. Known as the home of the Hershey chocolate bar, Hershey’s community is rich in history and offers an abundant range of outdoor activities, arts, and diverse experiences.

We’re conveniently located within a short distance to major cities such as Philadelphia, Pittsburgh, NYC, Baltimore, and Washington DC.

FOR ADDITIONAL INFORMATION PLEASE CONTACT: Susan B. Promes, Professor and Chair, Department of Emergency Medicine c/o Heather Peffley, Physician Recruiter, Penn State Health Milton S. Hershey Medical Center 500 University Drive, MC A595, P O Box 855, Hershey PA 17033 Email: hpeffley@pennstatehealth.psu.edu or apply online at: hmc.pennstatehealth.org/careers/physicians Penn State Health is committed to affirmative action, equal opportunity and the diversity of its workforce. Equal Opportunity Employer – Minorities/Women/Protected Veterans/Disabled.

Executive Privilege continued from page 1

curtail our ability to provide quality emergency care to all Pennsylvanians. Politicians regularly point wrongly to the emergency department as the source of expensive, unnecessary care when we are the true safety net within the health care system. Our EDs are overcrowded as we care for sicker patients and are asked to do more with less. Our medicallegal environment is tenuous, further threatened by maneuvers to allow malpractice venue shopping, as we lose emergency medicine residents and emergency physicians from Pennsylvania. There is a crisis of burnout among our colleagues as we confront a cynicism that suggests we cannot change things for the better and ensure that our care of patients is high quality, efficient, and compassionate.

Ask What We Can Do Together None of these challenges are easy. But I believe that the answer lies in how we as emergency physicians

come together and apply our passion and expertise to advance emergency care. Our successes have come from the diversity of our members and the unity of our actions. We need to make our voices heard in every venue of the importance of emergency care. I pledge that I will give my all to build on our extraordinary past to hand to the next generation of emergency physicians in Pennsylvania a chapter and an emergency care environment that is better for our colleagues and our patients. But ultimately, it comes down to the tap on the shoulder. I would ask all of you to engage our colleagues, our residents and fellows, and our patients and communities to raise our voice together on how we can ensure emergency care thrives in Pennsylvania. PACEP, its leaders, and I stand with you in trying to make the worst of our tomorrows better than the best of our yesterdays as we work together to advance emergency care in Pennsylvania.

WELCOME NEW PACEP MEMBERS Nicole Caltabiano, DO Katharine Campbell, MD Brandon Fong, MD Nancy Rixe, MD Charles Addo-Yobo Mona Ahmed Gina Baiamonte Justin Becker Mahesh Botejue Matthew DeLuca Kathryn DeMarre Ashley, Dunning Madeline Dwyer Peter Fedyshin Geoffrey Gao Carine Gregory Emily Harlos Julianne Heater

Angela Hirsh Memu-Iye Kamara Blase Kania Jasmeen Kaur Jessica Kerns Michael Khoury Bradley King Shaylor Klein Danielle Kovalsky Daniel LaReaux Jerry Lee Andrew Luo Evan Lynn Mary McGoldrick Jade McLain Anna Mereminskaya Danielle Miller Ryan Mischler Kristofer Montoya

Matthew Myers Spencer Nendza Tennessee Park Amish Patel Nima Pourrajabi, PA-C Bo Qin Mohibur Rahman Abagayle Renko Mike Rotstein Blaine Rourke Hayden Schenker Alexander Scott, EMT Madison Strony Harrison Supnick Stephanie Tauscher Matthew Tobias Alvin Varghese Anna Volski Jefrey Watkins

PACEP News | SPRING 2019

3

PACEP Committee Chairs/Co-Chairs

2019 - 2020 PACEP Board of Directors

Communications & Membership

Chair Vacant Board Liaison Richard J. Hamilton, MD, FACEP

Executive Committee

Education

Chair Co-Chair Board Liaison

Elizabeth Werley, MD, FACEP Annahieta Kalantari, DO, FACEP Robert J. Strony, DO, FACEP

EMS & Terrorism and Disaster Prep Chair Co-Chair Co-Chair FACEP Board Liaison Government Affairs

Chair Co-Chair PEP-PAC Chair Board Liaison

Scott Goldstein, DO, FACEP Gregory Hellier, DO, FACEP Benjamin J. Lawner, DO, EMT-P, Ferdinando L. Mirarchi, DO, FACEP

Michael Boyd, MD Marcus Eubanks, MD, FACEP Todd Fijewski, MD, FACEP Michael Lynch, MD, FACEP

President President-Elect Vice President Treasurer Secretary Immediate Past President

Arvind Venkat, MD, FACEP Shawn M. Quinn, DO, FACEP F. Richard Heath, MD, FACEP Ronald V. Hall, MD, FACEP Chadd Kraus, DO, DrPH, MPH, FACEP Ankur A. Doshi, MD, FACEP

Board Members Richard J. Hamilton, MD, FACEP Michael J. Lynch, MD, FACEP Jennifer Marin, MD, MSc, FACEP Ferdinando L. Mirarchi, DO, FACEP Jennifer L. Savino, DO, FACEP Robert J. Strony, DO, FACEP Resident Representatives

Smeet R. Bhimani, DO (Lehigh Valley) Gary Khammahavong, MD (Allegheny General Hospital) Priyanka Lauber, DO (Lehigh Valley) Daniel Tannenholtz, DO (Tower Health Reading Hospital)

Medical Economics Chair Co-Chair Board Liaison

Glenn Geeting, MD, FACEP Dan McIntyre, MD, FACEP Jennifer Marin, MD, MSc, FACEP

Wellness

Chair Co- Chair Board Liaison

Hannah Mishkin, MD Monisha Bindra, DO Jennifer L. Savino, DO, FACEP

Young Physicians

Chair Co-Chair Board Liaison Board Liaison

Vishnu Patel, MD Dhimitri Nikolla, DO Smeet Bhimani, DO Priyanka Lauber, DO

4

PACEP News | SPRING 2019

Please see page 16 for details on the 2019 - 2020 Board of Directors.

PACEP Looks at Insurance Downcoding of Emergency Visits

By F. Richard Heath, MD, FACEP It is widely known that insurers are looking for any means possible to reduce their costs. Emergency medicine is currently a major target. Highmark is a major Blues insurer in much of the Commonwealth.

Highmark has recently started auditing emergency medicine groups for level 5 (99285) services. They start by requesting a statistically valid sample of about 150 charts. They code these and routinely find that many of them are “overcoded.” They then determine the amount that they “overpaid” and extrapolate that over the entire universe of level 5 claims that they paid. They then demand that the emergency medicine group repay the “overpayment” within 30 days. To give an idea of the magnitude of the financial impact, here is an illustration: An EM group sees 100,000 visits per year. Of those, 25% are insured by Highmark. Of those, 40% are coded and billed as level 5. The audit finds that 60% of the level 5s were overcoded by one level, so those are reduced to level 4. Highmark’s fee schedule pays a level 5 visit $70 more than a level 4 visit. Extrapolating the audit result to the entire universe of level 5s billed to Highmark results in a demand for $420,000.

PACEP supports emergency physicians and emergency medicine groups across the Commonwealth

There is an appeal process, which goes to Highmark’s own Medical Review Committee of nominally “independent” physicians. Their decision is final and binding on both sides.

A recently completed audit of an emergency medicine group in western Pennsylvania highlighted two areas where Highmark took issue with the group’s coding.

1. Highmark interprets “additional workup planned” (one of the components of medical decision making) as requiring that the workup be done after the end of the ED encounter. Nothing done during the ED visit qualifies. Most emergency medicine coders count

any workup done during the ED visit as “additional workup planned”.

ACEP supports this position.

2. Highmark scores the risk to the patient (another component of medical decision making) lower when the patient is discharged.

Coding guidelines refer to the nature of the presenting problem as being most important in determining the level of service. Disposition does not enter into the equation. Highmark is using the final diagnosis, which typically reflects the disposition, to determine the level of risk to the patient.

Additionally, Highmark’s auditor noted that physicians did not explicitly state that they personally reviewed the actual EKG tracings or x-ray images, rather than just the reports. This is a valid issue from a coding standpoint, since the argument that there isn’t anyone else providing EKG interpretations to emergency physicians in real time is overruled.

PACEP supported this emergency medicine group in its appeal to Highmark’s Medical Review Committee.

However, the committee ruled in favor of Highmark.

Despite this, PACEP is supporting the remaining groups in their audits. Additionally, PACEP arranged a meeting with Highmark to better understand the logic behind Highmark’s positions, and tried to persuade them that they are misapplying coding guidelines.

PACEP supports emergency physicians and emergency medicine groups across the Commonwealth. We work with legislators, specialty societies, and medical interest groups to make caring for our patients easier and ensure appropriate payment for our efforts. We need your help to continue these efforts. If you or your colleagues are not already PACEP members, please join. Together we are stronger.

PACEP News | SPRING 2019

5

Government Affairs Committee

By Michael Boyd, MD PACEP Emergency Physician Chair, Government Affairs Committee The PACEP Government Affairs Committee has been advocating for a variety of important issues on behalf of our patients and members across the Commonwealth. Of all of the benefits that PACEP brings to its membership, perhaps none has a bigger impact than legislative advocacy.

Educating policymakers about life in the emergency department and issues affecting our profession truly has a profound impact on how we deliver care.

In order to advance our mission in 2019, the Government Affairs Committee is focused on three legislative and regulatory goals: Out of Network Balance Billing, the Opioid Epidemic, and the Pennsylvania Department of Health re-write of hospital and emergency department regulations.

Perhaps no [member benefit] has a bigger impact than legislative advocacy

Out of Network Balance Billing:

PACEP believes that no patient should worry about insurance networks in an emergency. We support a legislative solution to the issue of balance billing to ensure that during an emergency, everyone can go to the closest, most appropriate emergency department and expect that an insurance company will fulfill their obligation to pay the bill. Insurance companies take advantage of our EMTALA mandate and moral obligation to care for any patient at any time by narrowing physician networks and paying unreasonably low reimbursement rates.

PACEP members lead the Provider Coalition for Fair Access, a group representing a broad variety of medical specialties, in advocating for a fair solution that takes patients out of the middle of billing disputes, ensures fair and reasonable reimbursement for physician services, increases

PA House Majority Leader Rep. Bryan Cutler (R-Lancaster) and Arvind Venkat, MD, FACEP transparency and ultimately preserves access to care.

To advance this mission, this winter our PACEP leaders provided congressional testimony to the PA House Insurance Committee regarding Balance Billing, and our PACEP advocacy champions continue to visit and educate state senators and representatives across the state.

Opioid Legislation Emergency physicians are on the front-lines of the opioid epidemic, and the Government Affairs Committee continues to engage with lawmakers to improve our ability to care for patients with Opioid Use Disorder. PACEP members have discussed their innovative emergency department warm handoff programs at Department of Health Warm Handoff Summits across the state. On behalf of PACEP, Dr. Charles Barbera presented testimony to the House Human Services Committee regarding proposed Warm Handoff Legislation, and we successfully lobbied to have an emergency physician serve on the PA Pediatric Opioid Task Force. The opioid epidemic will remain a key focus of the PA Congress throughout 2019, and PACEP experts in this field will continue to educate lawmakers to ensure evidence-based legislation that helps patients and improves emergency departments’ capabilities to care for this vulnerable population.

Department of Health Hospital Regulations For the first time in many years, the Department of Health is in the process of re-writing hospital and emergency department regulations. PACEP members continued on page 7

6

PACEP News | SPRING 2019

Legislative Update

By Milliron Goodman LLC The spring legislative session is well underway. The legislature will be in session throughout May and June until the budget is complete; Pennsylvania has a budget deadline of June 30.

The following is an update on PACEP’s three priority legislative areas. As always, if you have any questions regarding this update, feel free to contact Milliron Goodman at 717-232-5322.

Hospital Regulations Due to some staffing changes in the Drs. Dan McIntyre and Erik Kochert of PACEP hosted legislators from Governor’s Office of General Counsel, the Lancaster area at the Lancaster General Hospital ED on March 28. the hospital regulations have been delayed. At the time of this writing, the From left, Rep. Zimmerman; Bret Levy, asst. chair, LGH ED; Don regulations have not yet been sent to Berkow, chair, LGH ED; Rep. Greiner; Dan McIntyre, President the Attorney General. Once they are, Lancaster Emergency Associates; Erik Kochert; Rep. Mentzer. the AG will review the regulations to ensure that they are compliant with existing law. If the regulations are not found to be in compliance, the regulations will be sent back to the agency for changes. If they are found to be in to complete. compliance, they will then be sent to the Independent Regulatory Review Commission (IRRC) to be published Opioids for public comment.

On Tuesday, March 12, Dr. Barbera testified before It’s important to remember that the publishing of the the House Human Services Committee regarding proposed regulations signals the official start of the House Bill 424 (Heffley) which is a bill that would regulatory process, which can take well over two years mandate warm handoff procedures across the Commonwealth. After the hearing, Representative Todd Polinchock asked if PACEP would be willing to send a representative to sit on a taskforce regarding continued from page 6 the feasibility of codifying warm handoff procedures in statute. have provided feedback to Department of Health officials about these regulations. A draft of the regulations open for public comment is expected this summer, and we stand ready to provide input.

Emergency physicians have a unique understanding of the wide variety of complex medical and socioeconomic issues affecting our patients. Through advocacy, PACEP shares this knowledge with legislators in an effort to ensure that policy helps us fulfill our mission of effectively caring for any patient at any time.

If you would like to join the PACEP Government Affairs Committee or learn more about how you can help advocate for our patients and our profession, please e-mail Michael Boyd at mboyd412@gmail.com.

The resolution that would create this task force is currently being drafted, but it does have a seat for an emergency physician. The Human Services Committee will hold a meeting on Tuesday, April 16th to vote on this resolution.

While there are several other bills that we are monitoring, two others that we are actively working on are SB 112 and HB 316. SB 112 would mandate a 7-day limit on opioid prescriptions. Last session, Milliron Goodman had secured language ensuring that the continued on page 8

PACEP News | SPRING 2019

7

Legislative Update continued from page 7

current law known as the “Safe Emergency Prescribing Act” would apply to emergency physicians. While we are working again to insert this language through the amendment process, know that SB 112 still has a very long way to go until final passage.

The other bill, HB 316, creates an Opioid Abuse Child Impact Task Force. Milliron Goodman is currently working through the amendment process on this bill to try and ensure that an emergency physician is a part of this task force.

Balance Billing Legislation addressing out-of-network emergency services and balance billing was discussed during the last two legislative sessions but did not make it across the finish line. House Leadership has signaled this is an important patient protection issue, and legislation is expected to be introduced. House Insurance Committee Chair Tina Pickett (R-Bradford) is drafting legislation to protect consumers from out-of-network balance bills from medical providers.

PACEP and its lobbying firm, Milliron Goodman, continue to be actively engaged in the discussions with lawmakers and are working with other hospitalbased specialties, as part of the Provider Coalition for Patient Access, on a solution to take patients out of the middle of billing disputes.

The state House Insurance Committee, chaired by Rep. Pickett, wrapped-up a series of three informational meetings on the topic to educate members and staff before moving forward with drafting legislation. The first informational meeting focused on FAIR Health – what it is and its experience in other states. The second meeting focused on provider and insurer feedback on proposed solutions. Dr. Maria Koenig Guyette (PACEP), along with Dr. Josh Atkins (PSA), testified on behalf of the Provider Coalition for Patient Access. The third informational meeting focused on network adequacy.

Bill Wiegmann, Director of the Bureau of Managed Care, Department of Health (DOH), provided testimony on how the department reviews and approves provider networks.

PACEP agrees that patients should not receive surprise bills when care is provided unknowingly by an outof-network provider. Pennsylvanians should be able

8

PACEP News | SPRING 2019

to use the closest and most appropriate emergency department when they have an acute need. No patient at a time of medical crisis should have to worry about insurance network coverage. At the same time, insurance companies should be required to pay fair and reasonable reimbursement rates to emergency care providers, regardless of whether they are considered in- or out-of-network. PACEP continues to advocate for transparent and objective reimbursement criteria (e.g. Fair Health).

Emergency physicians want to be part of the solution and work with the Legislature to avoid unintended consequences. Please stay alert for updates. In the interim, we encourage you to continue your discussions with your local legislators on this important issue.

WHAT IS

PEP-PAC?

E

p

A Political Action Committee is created by a private group with common interests formed to raise money to make contributions to the campaigns of political candidates whom they support.

• PEP-PAC is the Pennsylvania Emergency Physicians Political Action Committee, a separately chartered affiliate of PACEP.

o

W

o

1

•

•

•

•

Sen Se

• PEP-PAC represents emergency physicians and is the only political action organization in Pennsylvania devoted solely to emergency medicine causes.

• PEP-PAC funds are directed to legislators and candidates of both parties who support the issues and positions most important to emergency medicine.

Ho pit car gra as

SA19 RECAP 6 Sponsors

29 Exhibitors

Penn State Health (Diamond) Geisinger (Young Physicians Reception) OJM Group (Awards Dinner) UPMC Emergency Medicine (Residents Lunch) US Acute Care Solutions (Wellness and Breaks) Vapotherm (Product Showcase)

AcelRx Pharmaceuticals, Inc. Allergan ApolloMD BMS/Pfizer Brault CEPHEID GE Healthcare Gottlieb, LLC Lehigh Valley Health Network LogixHealth Mindray North America PACEP Wellness Committee PenBlade, Inc. Penn State Health Portola Progressive Emergency Physicians Seabrook TeamHealth The Guthrie Clinic Tower Health UPMC Emergency Medicine US Acute Care Solutions US Army Health Care Vapotherm Vistas WellSpan Health WPA Emergency Medicine Staffing, LLC WVU Medicine Zotec Partners

US Attendees

SA Attendees

32

236

CPC Submissions

Spivey Submissions

12

41

PEP-PAC Donations $5120

Meetings Committee: 7 Board: 1 Annual: 1

Product Showcase

Awards Presented

1

6

PACEP News | SPRING 2019

9

Wellness Activities at In the welcome bag, everyone received a coloring page created by Dr. Katie Hanson, a resident from Aria Health.

There was also a large coloring page at the wellness booth for a group coloring activity. In our last newsletter article, we discussed the benefits of adult coloring. If you missed it, check it out on the PACEP website at www.pacep.net > PACEP News > Current Newsletter Issue and Archives > Winter 2019 Issue.

Here were the Wellness Activities at SA in case you missed them!

Wellness Committee Chairs Drs. Hannah Mishkin, Monisha Bindra, Jenn Savino, and Katie Lund at the Wellness booth in the exhibit hall.

Inactive adults experience a 3%-8% loss of muscle mass per decade, accompanied by resting metabolic rate reduction and fat accumulation. Resistance bands increase tension in your muscles causing them to contract. Resistance training therefore helps to strengthen muscles and enhances cardiovascular health.

Here are some of the top benefits of resistance bands: 1. Portable. Take it to work and use it if you have a slow shift.

Pack it in your suitcase and take it on trips. Use it outside.

They are compact and light, and do not take up much room.

Perfect for fitting in work-outs on the go!

2. Affordable.

3. Scalable. The more you stretch the band, the more intense the resistance and the harder the exercise becomes.

You can modify existing workouts to incorporate resistance bands, so you do not have to learn all new movements. They can be used to work all muscle groups in your body. Our exercise cards provided a few movements to get you started.

They are also great for stretching, especially if you lack flexibility/mobility. The band will help to increase your range of motion. The resistance band do not apply pressure like weights do, so they are good for people of any age and fitness level. Hopefully, you got one from us at the wellness booth. If not, as mentioned above, they are very affordable so you can pick one up at your local sporting goods store.

Thanks to everyone who participated in our wellness activities!

We are looking for feedback. At the end of the CME survey there will be questions about the wellness activities. Please fill out this portion of the survey so we can better plan and serve you in the future!

10

PACEP News | SPRING 2019

Wellness Booth

Scientific Assembly 2019

Yoga both Thursday & Friday morning!

Residents & attendings from Conemaugh Memorial Medical Center coloring the wellness wheel, created by Dr. Katie Hanson from Aria Health.

The finished product

Wellness Swag = Resistance Bands & Exercise Cards Inspiration Board

PACEP News | SPRING 2019

11

PACEP 2019 Competition Award Winners The William H Spivey, MD, FACEP Research Abstract Competition E-Poster Runner up: Samuel Sun, MD

York Wellspan “Contrast-induced Nephropathy Post-CTA for Suspected Stroke after

Elimination of Creatinine Screening”

First place: Christopher Berry, MD Geisinger

“In Out-of-hospital Cardiac Arrest, Longer on-scene Times are Associated with

Higher Survival Rates: ‘Scoop and Run’ May be Deadly” Platform Runner up: Nishad Rahman Jefferson

“Hospital-level Variability in Emergency Department Prevention Quality Indicators” First place:

Victoria Goodheart, DO Lehigh Valley Health Network “Sex Specific Outcomes of an ED Stopping Elderly Accidents, Deaths, and Injuries (ED-STEADI) Program”

The Richard Wuerz, MD, FACEP CPC Competition Runner-Up Faculty Discussant: Jeffrey Rixe, MD, University of Pittsburgh (Parathyroid Storm) 1st Faculty Discussant: Ryan Anderson, DO, Lehigh Valley Health Network (Gastric Outlet Obstruction) Runner-Up Resident: Jamie Allen, DO, Lehigh Valley Health Network (Fat Embolism) 1st Place Resident: J. Zach Hillenkamp, MD, University of Pittsburgh (Sarcoidosis with Multi-system Involvement)

Save The Date!

12

PACEP News | SPRING 2019

PACEP 2019 Annual Award Winners

2019 PACEP Emergency Physician of the Year Award: Jennifer L. Savino, DO, FACEP 2019 PACEP Resident of the Year Award: Dhimitri Nikolla, DO 2019 David Blunk Outstanding Contribution to Emergency Medicine Award of the PA College of Emergency Physicians: Daniel R. Wehner, MD, MBA, FACEP

2019 PACEP Meritorious Service Award: Merle A. Carter, MD, FACEP

Special Recognition Award for Service to Emergency Medicine: Samuel C. Slimmer, Jr., MD, FACEP (left) Jesse A. Weigel, MD, FACEP

PACEP News | SPRING 2019

13

PACEP Education Committee Elizabeth Barrall Werley, MD, FACEP The Education Committee has several tasks and projects it works on at any given point in time. Two of the biggest endeavors each year include coordinating and planning the Scientific Assembly and the Residents Days. As most of our membership knows, the Scientific Assembly expanded in 2018 to include the Ultrasound Course.

I would like to take this time to acknowledge Dr. Annahieta Kalantari, the Scientific Assembly Program Chair, for all of her efforts in making this year’s recent Scientific Assembly one of the best yet. A “call for speakers” was implemented in the planning phase for the Scientific Assembly, and Dr. Kalantari was able to provide a schedule of reputable speakers “Providing Evidence-Based Medicine at Your Doorstep.” Dr. Steven Selbst provided an overview on subtle findings of child abuse for the Noelle M. Rotondo Memorial Lecture. I

would also like to express my gratitude to Dr. Robert Strony for demonstrating growth and success with the Ultrasound Course, especially impressive as it is only in its second year. Because of the attention to detail paid to ensuring a diverse line up of speakers, this year the Scientific Assembly was able to maximize the CME opportunities available, offering up to 19 AMA PRA Category 1 Credits (6 hours for the Ultrasound Course and 13 hours for Scientific Assembly) and 14 AOA Category 1-A Credits (4.5 hours for the Ultrasound Course and 9.5 hours for the Scientific Assembly).

The Education Committee looks forward to ensuring another successful Ultrasound Course and Scientific Assembly in 2020. The focus of Scientific Assembly 2020 will entail the scientific evidence behind “Medical Myths.” I strongly encourage those PACEP Residents Days: interested in participating to submit to the PACEP Scientific Assembly 2020 Call for Western: Thursday, September 12, 2019 Speakers. Scientific Assembly would not be successful without the participation of Allegheny General Hospital, Pittsburgh our members. If you have any questions,

please don’t hesitate to reach out to me Eastern: Wednesday, September 25, 2019 or the Scientific Assembly 2020 Planning Chair, Dr. Jestin Carlson.

Parx Casino, Bensalem

Upcoming Events

Central (Inaugural Event): Wednesday, September 18, 2019 Penn State Health, Hershey

Ultrasound Course and Scientific Assembly 2020

Wednesday-Friday, April 1-3, 2020 Omni William Penn Hotel, Pittsburgh

14

PACEP News | SPRING 2019

If anyone has suggestions regarding areas of focus or future activities for the Education Committee, please let me know.

“You Make the Call!” Case Studies

By Benjamin J. Lawner, DO, MS, EMT-P, FACEP Medical Director, Prehospital Care Services: LifeFlight and EMS Allegheny General Hospital Pittsburgh, PA During a busy night shift, an EMS crew calls in to request consultation with a medical control physician.

Two vehicles have collided on a rural road, and the first responding rescue crew reports multiple injuries. There is significant entrapment and at least one patient who is presumed dead on arrival. You are the medical control physician on duty at a critical access hospital, and you hastily begin jotting down notes as the paramedic relays further information.

and will evolve to incorporate suggestions from physicians across the state. The goal of the revised curriculum includes the development of a more uniform approach to EMS consultation.

“Doc, I can’t get one patient intubated due to trismus and a concurrent head injury! I’d like permission to perform a cricothyroidotomy….” You don’t know the paramedic personally and are wondering about the remaining injuries at the incident scene. The paramedic continues his report and mentions something about declaring a multiple casualty incident. It’s been months since you completed the required online medical control training, and you are single coverage in an already overwhelmed ED.

After taking a deep breath and refilling your perpetually empty coffee mug, you work with the on-scene paramedic to obtain accurate information.

The paramedic relays the total number of casualties and their initial triage priority. You concur that there are 2 red , 3 yellow, and 3 green patients in need of medical attention. 1 patient is categorized as, “black” and remains deceased at the scene. The paramedic hands you off to the recently arrived incident commander. The physician and incident commander review available resources, and two local helicopters are autolaunched to the incident scene. The local hospital is alerted about receiving a trauma patient and immediately initiates resuscitation and transfer procedures. The patient with airway failure is extricated and you advise the on-scene paramedic to begin ventilations with a bag valve mask and non-invasive airway adjuncts. One of the helicopters currently en route to the scene is diverted to your critical access hospital in anticipation of receiving one of the “red” patients.

There is no pre-written playbook that reviews contingencies for every incident, but resources are available.

Incidents such as the one highlighted above are low in frequency yet high in stress. There is no pre-written playbook that reviews contingencies for every incident, but resources are available. Members of the PACEP EMS Committee have been tasked to provide input on the next iteration of the Bureau of EMS’s online medical control course. The course reviews core EMS concepts and outlines a standardized approach to critical incidents and EMS medical decision making. Committee members have also authored several case studies to illustrate key components of the medical control physician’s knowledge base. The curriculum is intended to serve as a living document,

Providing online medical control is predicated upon a nuanced understanding of local EMS resources and capabilities. It is hoped that the revised curriculum will provide emergency physicians with information that can help fill gaps in EMS knowledge and encourage medical decision making that is in line with local practices and EMS protocols. The medical control physician curriculum also includes case studies to highlight some of the more intricate aspects of medical decision making, and the EMS Committee looks forward to incorporating suggestions and feedback from the membership.

PACEP News | SPRING 2019

15

New Pennsylvania College of Emergency Physicians Leadership At the conclusion of the Annual Meeting at Scientific Assembly 2019 on April 12, 2019, Arvind Venkat, MD, FACEP of Pittsburgh took the oath of office and became the 46th president of the Pennsylvania College of Emergency Physicians.

In addition to Dr. Venkat being installed as President, the members of the new Executive Committee elected by the Board of Directors were announced. Shawn Quinn, DO, FACEP of Allentown is President-Elect.

F. Richard Heath, MD, FACEP of Pittsburgh is VicePresident. Ronald V. Hall, MD, FACEP of Williamstown is continuing as Treasurer. Chadd Kraus, DO, DrPH, MPH, FACEP of Lewisburg is Secretary. Ankur A. Doshi, MD, FACEP of Pittsburgh, having completed his term as PACEP President, is now Immediate Past President.

All Executive Committee positions are one-year terms except for Treasurer. The Treasurer may serve two consecutive one-year terms.

of Johnstown join the Board of Directors. Board members serve for a maximum of two consecutive three-year terms. Resident Representatives, Gary Khammahavong, MD, Allegheny General Hospital and Daniel Tannenholtz, DO, Tower HealthReading Hospital, also join the board. The Resident Representatives serve a two-year term on the Board of Directors. PACEP is committed to involving Residents in the governance of the organization as well as developing leaders for the future of emergency medicine.

Additionally, the Leadership Fellowship Program participants were announced. Mark Olaf, DO, FACEP of Lewisburg and Theresa Walls, MD, MPH of Merion Station began the year-long program this month. The Leadership Fellowship Program combines mentoring, organizational education and guided experiences to provide leadership development to Fellows.

The results of the Board of Directors election were announced as well. Richard J. Hamilton, MD, FACEP of Philadelphia, F. Richard Heath, MD, FACEP (reelected) of Pittsburgh, Michael J. Lynch, MD, FACEP of Pittsburgh, and Jennifer L. Savino, DO, FACEP

Finally, PACEP welcomed new Executive Director E. Marie Queen, an association executive with more than 20 years of nonprofit association management experience. She can be reached at exec@pacep.net.

Executive Committee

Arvind Venkat, MD, FACEP president@pacep.net President

Shawn M. Quinn, DO, FACEP president-elect@pacep.net President-Elect

F. Richard Heath, MD, FACEP vicepresident@pacep.net Vice President

Chadd Kraus, DO, DrPH, MPH, FACEP secretary@pacep.net Secretary

Ankur A. Doshi, MD, FACEP pastpresident@pacep.net Immediate Past President

16

PACEP News | SPRING 2019

Ronald V. Hall, MD, FACEP treasurer@pacep.net Treasurer

Board Members

Richard J. Hamilton, MD, FACEP Board Member – Newly Elected

Michael J. Lynch, MD, FACEP Board Member – Newly Elected

Jennifer Marin, MD, MSc, FACEP Board Member

Robert J. Strony, DO, FACEP Board Member

Resident Representatives

Jennifer L. Savino, DO, FACEP Board Member – Newly Elected

Ferdinando L. Mirarchi, DO, FACEP Board Member

Smeet Bhimani, DO Resident Representative Board Member

Gary Khammahavong, MD Resident Representative Board Member

Priyanka Lauber, DO Resident Representative Board Member

Daniel Tannenholtz, DO Resident Representative Board Member

Leadership Fellowship

Mark Olaf, DO, FACEP

Theresa Walls, MD, MPH PACEP News | SPRING 2019

17

Questions?

Contact info@pacep.net Submissions due July 31, 2019

Call for Speakers - Scientific Assembly 2020 The Pennsylvania College of Emergency Physicians (PACEP) Education Committee is now accepting submissions for speakers for Scientific Assembly 2020 to be held at the Omni William Penn Hotel in Pittsburgh April 1-3, 2020.

Each year, more than 200 emergency medicine professionals gather to hear national and state faculty share their knowledge and expertise in presenting clinical updates as well as cutting-edge issues in emergency medicine care. Our goal is to continue to present outstanding content that provides PACEP members and conference attendees the opportunity expand his or her expertise.

This year’s theme is “Medical Myths: Presenting Both Sides” Expressing interest does not guarantee acceptance, but your submission will be collected for possible future calls.

Submissions will be reviewed by the Education Committee, and potential speakers will be notified by the PACEP Scientific Assembly 2020 Program Chair, Jestin Carlson, MD after the September Board of Directors Meeting.

NOTE: While we cannot provide payment for your session, we do cover travel costs and a portion of your hotel stay during the conference.

SUBMIT TO HTTPS://FORM.JOTFORM.COM/90704285638160

Live.

Clinical, Academic, and Leadership Opportunities Available

Work.

Your work is your passion. But it’s not your whole life. Join a system that supports your need to balance work and home life. You can find great dining, art, entertainment, and culture in our cities, as well as peace and quiet in our rural areas. With opportunity for advancement and great schools and colleges nearby, it’s a great place to grow your career and your family.

UPMC Pinnacle — a growing, multisite health system in south central Pennsylvania — can meet your needs at one of our seven acute care hospitals.

Join our Emergency Medicine Team ■ ■

Balance.

■

■

Employed position Traditional block and flexible schedules UPMC Emergency Residency Program coming soon!

Competitive salary — above MGMA median salary

■

■

■

Shift based pay with differentials for nights, weekends, and holidays Strong advanced practice provider support at all locations Great administrative and clinical leadership support

Schedule a call with our recruiter today!

Contact Rachel Jones, MBA, FASPR Physician Recruiter rajones@pinnaclehealth.org 717-231-8796 UPMC Pinnacle is an Equal Opportunity Employer.

18

PACEP News | SPRING 2019

UPMCPinnacle.com/Providers EOE

In the News Cambria County hosted a summit on the Warm Handoff Program recently to highlight the statewide program’s early successes.

Stakeholders in the effort to guide drug users into treatment from Cambria County and nine others in southwestern Pennsylvania gathered for the summit Wednesday, March 27, in Johnstown.

Newly elected PACEP Board Member Jennifer Savino, DO, FACEP, was interviewed for the Johnstown Tribune Democrat article covering the event: Envisioned at a time when Cambria County’s drugrelated hospitalization rate was Pennsylvania’s highest, Conemaugh’s program was developed to provide rehabilitation options for people in withdrawal at any hour of the day and any day of the

week, Dr. Jennifer Savino told attendees Wednesday.

Savino, the hospital’s emergency medicine chairwoman, said anyone committed to receiving rehabilitative treatment services can walk into any of Conemaugh’s hospitals and seek help. The move enables hospital administrators to directly administer Suboxone to patients for up to three days while efforts are made to get them into detox centers, ongoing drug-assisted treatment programs with counseling or other options.

For the complete article, go to: https://www.tribdem. com/news/cambria-county-hosts-summit-on-handoffprogram-successes-treatment-innovations/article_ fee9b512-50eb-11e9-aed5-eb571416f981.html

PACEP News | SPRING 2019

19

777 East Park Drive | P.O. Box 8820 Harrisburg PA 17105-8820

PRSRT STANDARD U.S. POSTAGE PAID HARRISBURG PA PERMIT NO. 922

As a physician-owned group, we protect each other.

At US Acute Care Solutions, we under-stand that the possibility of medical malpractice lawsuits can weigh heavily on your mind.

With every full-time physician becoming an owner in our group, we have the power to reduce risk and protect our own. In fact, our continuing education and risk management programs cut lawsuits to less than half the national average. If a case is ever brought against you, we’ll have your back with our legendary Litigation Stress Support Team and the best medical malpractice insurance. It’s one more reason to weigh the importance of physician ownership. It matters.

Discover the benefits of physician ownership and check out career opportunities at USACS.com.

Own your future now. Visit USACS.com

or call Darrin Grella at 800-828-0898. dgrella@usacs.com