PACEP NEWS FALL 2018
Executive Privilege THANKS TO YOU!
Ankur A. Doshi, MD, FACEP PACEP President
What a busy second half of 2018! Your PACEP leadership team and fellow PACEP members have been working hard on a myriad of EM-related issues in 2018, with many successes. We couldn’t do it without your support! I thought I should use my space this month in letting you know about the recent victories we’ve had, and then discuss the road ahead. Legislatively, your PACEP Governmental Affairs Committee has helped pass legislation important to us in the ED, and even more importantly, continue to fight against poor legislation. First, we opposed further restrictions on opioid prescribing, such as the ban on the use of fentanyl in hospitals. By explaining to legislators that deaths from fentanyl are not caused by diverted medications in the U.S., we helped them realize that taking away this medication from physicians only needlessly ties our hands and won’t change overdose deaths. Additionally, the PACEP Governmental Affairs Committee successfully amended legislation that revises the PA organ donation regulations to make them more in line with national guidelines. Finally, we collaborated with the Pennsylvania Emergency Nurses Association (PA-ENA) to pass legislation that allows our EMS colleagues to collect payment from insurance companies, even when they do not transport a patient to the hospital. This is a huge win for EMS agencies and will go a long way to helping solidify prehospital care in many parts of the Commonwealth. From a regulatory front, PAMED President (and PACEP member!) Ted Christopher, MD, FACEP and I met with the Secretary of Health, Rachel Levine, MD, about a number of EM regulations, as these are presently up for revision. Sec. Levine was supportive when we asked to include language that Board Certified Emergency Physicians do not require “merit badges”. Additionally, she agreed to look at regulations regarding treatment of sexual assault patients (and understanding that in some cases, transfer to a tertiary center for a Forensic Examination may be in the patient’s best interest) as well as those regarding patient boarding in the ED. This summer we held our PACEP Membership Drive which has helped us raise the number of members to almost 1,800! Congrats to our Connie, our Exec (see below), and the Communications and Membership Committee! The committee also began the roll out of engagED, our new association management software that we share with national ACEP (website). This program will help us share information more efficiently. Thirdly, we have just completed our first ever PEP-PAC Annual Challenge. This drive netted over $3,000 dollars that we can use to pass legislation important to emergency physicians. continued on page 2
Executive Privilege continued from page 1 If that’s not enough, our Education Committee helped design and sponsor two successful Resident Days (with over 200 EM residents attending). Additionally, our SA Committee, under the leadership of Anna Kalantari, DO, our SA Committee Chair, have put together an amazing program for PACEP19 Scientific Assembly which will be held April 10-12 at the Crowne Plaza in King of Prussia, PA. We hope to see everyone there! Lastly, our Council Delegation at ACEP 18 had a strong presence with 25 PACEP members involved in crafting and debating greater than 30 resolutions to help set the agenda for national ACEP in 2019. Our members wrote and sponsored five resolutions, all of which were passed by the Council. See the article in this issue for details. All of this is due to the hard work and contributions from you, our members! However, there is still much to do. First, we must push for legislation that helps our members. For example, our fight with the insurance companies on fair payment for out-of-network services will continue through the next legislative session (2019-2020). We still have to advocate for improving the medical liability climate in the Commonwealth. We also need to fight for our patients. To do this, we have to be the champions for implementing Warm Handoffs programs in all our EDs and work with the Department of Health to revise the ED regulations rationally. There are probably others issues that you feel are important and that you want PACEP to advocate for. If so, let us know! No idea is too big or too small. I am available to you at any time to listen.
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L i v e , Wo r k & P l a y W i t h U s !
mark your CALENDARS PACEP Board of Directors Meeting
Thursday, January 10, 2019 Harrisburg
PACEP Board of Directors Meeting
Friday, March 8, 2019 Harrisburg
PACEP19 Scientific Assembly
Wednesday, April 10 – Friday, April 12, 2019 Crowne Plaza, Valley Forge
PACEP Board of Directors Meeting
Wednesday, April 10, 2019 Crowne Plaza, Valley Forge
PACEP Committee Meetings
Wednesday, April 10, 2019 Crowne Plaza, Valley Forge
PACEP Ultrasound Workshop
Wednesday, April 10, 2019 Crowne Plaza, Valley Forge
PACEP YP Reception
Thursday, April 11, 2019 TBD, Valley Forge
PACEP Annual Membership Meeting
Friday, April 12, 2019 Crowne Plaza, Valley Forge
ACEP LAC
Sunday, May 5 – Wednesday, May 8, 2019 Washington, DC PACEP Board of Director Meetings are open to anyone in membership to attend.
SAVE THE DATE!
PACEP19 SCIENTIFIC ASSEMBLY
APRIL 10-12, 2019 CROWNE PLAZA, KING OF PRUSSIA PACEP News | FALL 2018 33
COMMITTEES Wellness – What You Eat Matters Mark F. Olaf, DO, FACEP Nutrition obviously effects our physical appearance, and even affects our emotional well-being.1,2 We would all love to find an evidence based and simple answer to how to eat better, but alas, we don’t yet have that one-size fits all magic recipe. But we do have morsels of advice that can help us eat smarter, and make informed choices. The “work smarter, not harder” mantra is familiar to an efficient ED physician and may be an approach that can help us overcome the dietary and weight management issues that plague us as Americans who are availed of innumerable sources of calories; we can learn to “eat smarter” and stress less.
Recent information suggests a rise in population obesity despite stable levels of exercise3 which confirms the adage from a 2015 BMJ article suggesting “you can’t outrun a bad diet.”4 Many health gurus support this claim, acknowledging that caloric expenditure through exercise is not enough to offset the excess of calories from diet and normal metabolism.5 We simply can’t “exercise away” poor food choices. But must we obsess over every macro, sift through the grocery store to find foods that our paleolithic ancestors ate, or eat only what is delivered in a pre-packaged box each week? Not necessarily.
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It turns out correlation still isn’t causation, and most dietary research does not consist of controlled studies; therefore, we don’t know exactly which diet is best, and how it affects us. But we do know about some dietary principles that can be helpful. Principled nutrition is critical to maintaining body weight and fitness and is related to our mood and cognition.6,7 Here are a few evidence-based concepts that can help us build a healthy diet or help us “hack” our current dietary preferences: Not all calories are created equal. Fat and sugar calories are more easily stored as fat in our bodies. Protein less so. It may be painful, but open up a bio-chem book and you’ll be reminded. The sources of these calories (plant versus animal) may also be impactful. What you eat matters. Everything about our food matters: the quantity that we eat, the proportion of calories from various macronutrient sources, and the quality from which those sources come.8 Eating highly processed “diet” foods is a nutritional advertising trick that is best avoided. Finding the right proportion of nutrients is a personal matter and dependent upon who body composition and nutrition goals. Taking a little time to investigate this, developing a plan and sticking to it is probably worth the initial upfront cost, especially when compared to fad diet plans. When you eat matters. Remember the fasting and fed states? These biochemical principles underlie the ketogenic diet – and for some people it works (at least for initial weight loss)! Our bodies use macronutrients differently depending on when we last slept, exercised or ate. Moderation may be the answer. A “calorie-shifted” diet (one high in carbs or low in carbs) seems to increase mortality9 but may promote weight loss.10 Again, these are correlational, but may help provide insight depending on your goals. So how does one align these principles and create a balance yet satiating diet? Reading nutritional books often falls short of the scientific approach that we value. Staying up to date on journal articles in a field other than EM is beyond challenging (it took over 10 hours to write this short editorial, which only contains bare bones information). The best source of information and individual advice is either a physician or dietician who
is versed in the nuances and literature related to dietary habits. If you’re inclined to do your own research, then choose a topic above and read up on it. Move on to the next topic when you feel informed enough to make a dietary decision or change. Most importantly, recall that most research supports the fact that fad diets tend to fade away over time, just as their results do. A dietary change is only effective if it can be maintained over time. When considering principled and informed nutrition in your life, do some research, focus on the principles above, involved a dietary expert and commit to success.
PACEP’s Wellness Committee promotes the health and wellness of emergency physicians through education and initiatives that encourage habits of wellness, increase awareness of factors and resources contributing to well-being, inspire and empower individuals to take responsibility for their own health and support a sense of community. If you are interested in becoming a Wellness Committee member, please email info@pacep.net.
REFERENCES 1. 2.
http://psycnet.apa.org/doiLanding?doi=10.1037%2Femo0000422 https://www.npr.org/sections/healthshots/2018/06/11/618395072/how-hunger-pangscan-make-nice-people-hangry?utm_source=facebook. com&utm_medium=social&utm_campaign=npr&utm_ term=nprnews&utm_content=20180611 3. AP: Survey: Exercise and obesity are both rising in US. June 28, 2018. Mike Stobbe 4. Malhotra A, Noakes T, Phinney S. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. Br J Sports Med. Published Online First: 22 April 2015. doi: 10.1136/bjsports-2015-094911. http://bjsm.bmj.com/content/ early/2015/05/07/bjsports-2015-094911.full 5. https://news.heart.org/you-cant-outrun-a-bad-diet-authors-say/ aha15-017428-01-baddiet_infographic_m/ 6. Toni M. Burkhalter, Charles H. Hillman; A Narrative Review of Physical Activity, Nutrition, and Obesity to Cognition and Scholastic Performance across the Human Lifespan, Advances in Nutrition, Volume 2, Issue 2, 1 March 2011, Pages 201S–206S, https://doi.org/10.3945/an.111.000331 7. Soh, N. L., Walter, G. , Baur, L. and Collins, C. (2009), Nutrition, mood and behaviour: a review. Acta Neuropsychiatrica, 21: 214227. doi:10.1111/j.1601-5215.2009.00413.x 8. https://www.hsph.harvard.edu/nutritionsource/healthy-weight/ best-diet-quality-counts/ 9. Sara B Seidelmann, Brian Claggett, Susan Cheng, Mir Henglin, Amil Shah, Lyn M Steffen, Aaron R Folsom, Eric B Rimm, Walter C Willett, Scott D Solomon Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis Lancet Public Health 2018; 3: e419–28 10. Davoodi SH, Ajami M, Ayatollahi SA, Dowlatshahi K, Javedan G, Pazoki-Toroudi HR. Calorie Shifting Diet Versus Calorie Restriction Diet: A Comparative Clinical Trial Study. International Journal of Preventive Medicine. 2014;5(4):447-456.
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PACEP News | FALL 2018 35
MEMBERS in the news CONGRATULATIONS! PACEP Residents Elected to Prestigious Positions Congratulations to PACEP resident members Drs. Karina Sanchez (Conemaugh) and Erik Blutinger (University of Pennsylvania) for being elected to the Board of Directors of the Emergency Medicine Residents’ Association (EMRA) during EMRA’s Representative Council Meeting in San Diego. Dr. Sanchez was elected EMRA Vice-Speaker and will serve a one-year term as Vice-Speaker followed by a one-year term as Speaker, the official officer of the EMRA Representative Council. Dr. Blutinger was elected to a two-year term as EMRA representative to the ACEP Board of Directors, during which he will be an ex-officio member of the ACEP Board of Directors and promote EMRA’s stance on issues of importance to Emergency Medicine. Join PACEP in congratulating Drs. Sanchez and Blutinger on this incredible accomplishment.
New EMRA Board Elected Meet the leaders: (front left to right) Past President Zach Jarou, MD; President Omar Maniya, MD, MBA; PresidentElect Hannah Hughes, MD, MBA (back, from left) Secretary/EM Resident Editor Tommy Eales, DO; Director of Membership Greg Tanquary, DO, MBA; Director of Education Sara Paradise, MD; Director of Technology Nick Salerno, MD; Vice-Speaker Karina Sanchez, MD; Director of Health Policy Angela Cai, MD, MBA; ACGME RC-EM Representative Eric McDonald, MD; Medical Student Council Chair Sarah Ring; Resident Representative to the ACEP Board Erik Blutinger, MD, MSc; and Speaker Nathan Vafaie, MD, MBA. (Photo used with permission of EMRA)
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Live. Win for PACEP and the PA Coalition for Out-of-Network Balance Billing at the PAMED House of Delegates Serving as a delegate at the House of Delegates (HOD) helps the Pennsylvania Medical Society (PAMED) develop meaningful policy that benefits Pennsylvania physicians and patients.
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PACEP President-Elect Arvind Venkat, MD, FACEP speaking on the Out-ofNetwork Balance Billing resolution.
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October 28-29, PACEP President-Elect Arvind Venkat, MD, FACEP spoke on behalf PACEP and the PA Coalition for Out-of-Network Balance Billing on a resolution that requests PAMED support state legislation to “get patients out of the middle” of billing disputes between insurers and providers that result from surprise insurance gaps, out-ofnetwork emergency services, or other situations where patients do not have the ability to select their provider. The resolution, supported by multiple medical specialties, was adopted as written. Medical specialties supporting the resolution and belong to the PA Coalition for Out-of-Network Balance Billing includes: Anesthesiology, Emergency Medicine, Oncology/Hematology, Oral and Maxillofacial Surgeons, Pathology, PA Orthopaedic Society, Plastic Surgery, Psychiatry, and Radiology.
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PACEP News | FALL 2018
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LEGISLATIVE UPDATE Milliron & Goodman Government Relations OVERVIEW
Pennsylvania lawmakers headed back to work after a summer break from the Capitol. Both the state House and Senate returned to Harrisburg on September 24. With the election stakes high, there were limited voting session days this fall. In fact, the last voting session day on substantive legislation was scheduled for October 17. The big agenda item left unresolved was addressing the recommendations of a grand jury report on clergy sex abuse in the state. What’s next for the remainder of session? Lawmakers are scheduled to come back to Harrisburg for Leadership Elections to be held November 13 in the House and 14 in the Senate. Although the two-year Legislative Session constitutionally ends on November 30, lawmakers have refrained from coming back to session to vote on bills after the November Election. Bills unresolved by the end of session will need to be reintroduced in the new Session, which begins on January 1, 2019.
LEGISLATION
Milliron Goodman continues to work with PACEP’s leadership on legislation affecting your profession, your colleagues, and your patients. Here is an update on some of the noteworthy bills we worked on this session that were signed into law. E-Prescribing (HB 353 – Rep. Tedd Nesbit, R-Mercer): This bill amends the Controlled Substance, Drug, Device and Cosmetic Act to require electronic prescriptions of a Schedule II, III, IV and V controlled substance. Working with various stakeholders, PACEP was successful in clarifying exceptions in the bill. As amended, the electronic prescription requirement shall not apply if the prescription is issued: by a veterinarian; under circumstances when an electronic prescription is not available to be issued or received due to a temporary technological or electrical failure, and in the instance of a temporary technological failure, a practitioner shall, within seventy-two hours, seek to correct any cause for
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the failure that is reasonably within his or her control; by a practitioner and dispensed by a pharmacy located outside this Commonwealth; by a practitioner who or health care facility that does not have either of the following: (i) internet access; or(ii) an electronic health record system; by a practitioner treating a patient in an emergency department or a health care facility under circumstances when the practitioner reasonably determines that electronically prescribing a controlled substance would be impractical for the patient to obtain the controlled substance prescribed by electronic prescription or would cause an untimely delay resulting in an adverse impact on the patient’s medical condition; for a patient enrolled in a hospice program or for a patient residing in a nursing home or residential health care facility; for controlled substance compounded prescriptions and prescriptions containing certain elements required by the Food and Drug Administration or any other governmental agency that are not able to be accomplished with electronic prescribing; for a prescription issued pursuant to an established and valid collaborative practice agreement between a practitioner and a pharmacist, a standing order or a drug research protocol; for a prescription issued in an emergency situation pursuant to Federal or State law and regulations of the board; under circumstances where the pharmacy that receives the prescription is not set up to process electronic prescriptions; or for controlled substances that are not required to be reported to the Prescription Drug Monitoring Program system administered by the department. PACEP voiced its support for the legislation. Status: HB 353 was signed into law as Act 96 of 2018. EMS Reimbursement for Non-Transport Services (HB 1013 – Rep. Steve Barrar, R-Delaware/ SB 1003 – Don White, R-Indiana): The intent of both bills is the same – to reimburse emergency medical services agencies for services provided even when transport to a hospital does not take place. Patients routinely experience emergent scenarios,
such as diabetic emergencies, asthma exacerbations, and opioid overdoses that require immediate, life-saving care. Some patients don’t require or refuse transport. If the patient is not transported, the cost of providing the service is directly assumed by the ambulance company - a burden which could be so significant that the company would need to close, and the public would inadvertently be put at risk. On the Senate side, PACEP worked to successfully amend SB 1003 to include prudent layperson basing reimbursement on “presenting symptoms”. As introduced, the bill would have allowed a managed care plan to make a determination as to whether the emergency services are medically necessary for payment. Both bills moved this Session with one making it to the governor’s desk. PACEP voiced its support for the legislation. Status: HB 1013 was signed into law as Act 103 of 2018. Donate Life PA Act (SB 180 – Sen. Stewart Greenleaf, R-Montgomery): This legislation marks the first update to Pennsylvania’s organ donor laws in nearly 20 years. The bill works to provide more access to organ donation, including tissue donation, as well as public education about the donation process and the importance of organ donation. The bill adds Pennsylvania to the group of 47 other states to adopt the Uniform Anatomical Gift Act (UAGA). The bill works to provide more access to organ donation, including tissue donation, as well as public education about the donation process and the importance of organ donation. It also increases opportunities to voluntarily contribute to The Governor Robert P. Casey Memorial Organ and Tissue Donation Awareness Trust Fund. PACEP supports efforts to increase organ donation. There was a small, but significant, word in the bill that went beyond the Uniform Anatomical Gift Act (UAGA) as adopted by 46 states. Working with stakeholders and lawmakers, PACEP successfully amended the bill to ensure that emergency physicians can meet our medical and ethical obligations in treating patients. Status: SB 180 was signed into law as Act 90 of 2018.
Assisted Outpatient Treatment (HB 1233 – Rep. Tom Murt, R-Montgomery): This legislation amends the Mental Health Procedures Act to establish a new standard for court ordered Assisted Outpatient Treatment (AOT) for seriously mentally ill individuals, while leaving in place current “clear and present danger” standard necessary for involuntary hospitalization. The bill creates a strictly civil, nonpunitive process and a continuum of services for seriously mentally ill individuals who are unwilling or unable to voluntarily seek treatment. Working with stakeholders and lawmakers, PACEP successfully amended the bill to ensure the petition is signed by a psychiatrist or clinical licensed psychologist as opposed to “any examining physician”. Emergency Physicians can involuntarily commit patients to inpatient psychiatric treatment when they represent “a clear and present danger to themselves or others.” Emergency Physicians are well versed in current 302 statute, and are very capable of determining “clear and present danger” for the purposes of the need for acute inpatient treatment. Nevertheless, it is not appropriate for emergency physicians to make determinations regarding mandatory outpatient treatment. Psychiatric assessments for outpatient treatment should take place outside of the Emergency Department by a qualified professional. PACEP also successfully amended the bill to clarify that 302 only applies to the clear and present danger standard and does not apply to the new standard for Assisted Outpatient Treatment. The amendment also requires the Department of Human Services to consult with the Pennsylvania College of Emergency Physicians on the appropriate guidance and instructions to the petitioner on use of emergency departments in conjunction with the petition process for involuntary inpatient commitment or assisted outpatient treatment. Status: HB 1233 was signed into law as Act 106 of 2018. This Session, Milliron & Goodman and PACEP were also actively engaged on the following legislation:
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Balance Billing (SB 678 – Senators Judy Schwank, D-Berks, Don White, R-Indiana, and Jay Costa, D-Allegheny)/HB 1553 – Reps. Matt Baker, R-Tioga (RESIGNED) and Tina Pickett, R-Bradford): This legislation seeks to address surprise balance bills, also known as surprise out-of-network medical bills. Among the concerns, the legislation would rely on health insurance companies to set and pay “the out-of-network amount due under the health insurance policy” without an impartial, transparent standard and require providers to ask for cost-sharing amounts rather than the information being automatically provided to the provider by the insurance company any time a bill is sent to the insurer. In addition, the bill provides for the use of arbitration as a dispute-resolution mechanism with a “loser pays” payment model that would mandate best-offer binary decision making, require deposit of arbitration costs prior to resolution, and lacks a floor above which arbitration would kick in. Insurance companies have more personnel and resources to contest reasonable charges by physicians who have already provided emergent care to patients at times of crisis without knowledge or concern for insurance network status. PACEP has added its voice to discussions with lawmakers and key decision makers and is working with other hospital-based specialties. Pennsylvanians should be able 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-ofnetwork. PACEP supports the intent of the legislation and agrees that patients should not receive surprise bills when care is provided unknowingly by an out-ofnetwork provider. Emergency physicians want to be part of the solution and work with the Legislature to avoid unintended consequences. The state House discussed using a Medicare rate as a standard for determining payment for out-of-network care. Medicare is not an appropriate benchmark for determining payment to outof-network emergency physicians. Medicare payments are politically derived and based on federal budgetary constraints. They are not based on the actual cost of providing care, especially in rural and emergency settings. This benchmark is especially concerning for emergency physicians, which provide the majority of charity care and Medicaid acute care. In many of our most vulnerable EDs, there are little to no operating margins. There will also be no incentive for insurers to negotiate with emergency providers if they can pay them an artificially low Medicare rate. PACEP and other medical specialty groups are advocating to set a transparent, impartial, market-based standard for reimbursement that takes the patient out of the equation in reimbursement for out-of-network 10 PACEP News | FALL 2018
care. This issue is a priority for PACEP. We will continue discussions with lawmakers and stakeholders. Please stay alert for updates. Status: SB 678 is in the Senate Banking and Insurance Committee and HB 1553 is on the House Tabled Calendar. Involuntary Commitment for Individuals with Substance Use Disorders (HB 713 – Rep. Matt Baker, R-Tioga (RESIGNED)/SB 391 – Sen. Jay Costa, D-Allegheny): This legislation amends the Mental Health Procedures Act to include individuals with substance use disorder which has caused an overdose within 30 days as an individual subject to involuntary commitment. This will subject individuals with substance use disorder to emergency examination and treatment to be undertaken at a treatment facility. The bill would expand that definition of “clear and present danger” to include the ingestion of drugs to the point of unconsciousness, or in need of medical treatment to “prevent imminent death or serious bodily harm.” Similar legislation has been introduced in the state Senate (SB 391). From an emergency medicine standpoint, the legislation would likely have far-reaching implications that would hinder rather than augment shared goals of enhancing substance use disorder treatment and decreasing overdose deaths in the Commonwealth of Pennsylvania. PACEP met with key lawmakers and staff in both chambers to share our concerns regarding this legislation and has offered alternative solutions. Status: HB 713 is in the House Appropriations Committee. SB 391 is currently in the Senate Judiciary Committee. Bed Registry Act (HB 825 – Rep. Doyle Heffley, R-Carbon): While there are no simple solutions to combatting the heroin and opioid epidemic, PACEP has proposed several recommendations, including a comprehensive, real-time statewide tracking system of available drug and alcohol treatment facility beds to allow for enhanced and timely placement of appropriate patients from the emergency department. This bill provides for a detoxification bed registry. PACEP is working with the Sponsor to enhance the legislation. The bill unanimously passed the state House by a vote of 187-0. Status: HB 825 is in the Senate Health and Human Services Committee. Mental Health Treatment – Database for Availability of Services (SB 179 – Sen. Camera Bartolotta, R-Washington): This bill would require the Health Department to establish the online database that would help doctors more quickly find inpatient beds for psychiatric patients in crisis. Participation of hospitals would be voluntary. Those electing to participate would input information, at least once every eight hours, about the number and
types of inpatient psychiatric beds they have available. Participation by hospitals with inpatient psychiatric units be mandatory, not voluntary, and a real-time database would be preferable to one updated every eight hours. However, the legislation advanced is a step forward. PACEP has long advocated for a way to find and utilize available psychiatric beds for patients requiring additional care, and commends the sponsors of the legislation, which seeks to mitigate a genuine and frustrating barrier to quality emergency care. The bill was unanimously voted out of the Senate Health and Human Services Committee. Status: SB 179 is in the Senate Appropriations Committee. Fentanyl Limited Use Legislation (HB 1987 – Rep. Bryan Barbin, D-Cambria): This bill amends the Controlled Substance, Drug, Device and Cosmetic Act adding a new section limiting the dispensing of fentanyl and fentanyl derivatives. PACEP was successful working with the Sponsor and key staff to amend the bill to exclude treatment associated with a medical emergency. Under the bill fentanyl and fentanyl derivatives shall only be dispensed: to a patient who is being treated on an in-patient basis or remains in observation status, or during a surgery that takes place in a health care facility; for use in palliative or hospice care; for use in the management of pain associated with cancer; to a patient whose treatment is associated with a medical emergency as documented in the individual’s medical record; and in instances where, in the professional medical judgment of the prescriber, fentanyl is required to stabilize an individual’s acute medical condition, the prescriber may prescribe no more than a 7-day supply. The bill also allows fentanyl and fentanyl derivatives to be dispensed to use in the management of chronic pain not associated with cancer. The prescriber must document the chronic medical condition in the individual’s medical record maintained by the prescriber and state the reason why another medication is not appropriate to address the chronic medical condition. The new section would expire in two years. The bill was unanimously passed by the state House. Status: HB 1987 is in the Senate Health and Human Services Committee. Opioid Prescribing Guidelines (SB 655 – Sen. Gene Yaw, R-Lycoming): This legislation would establish the Pennsylvania Safe and Effective Opioid Prescribing Advisory Council within the Department of Health. The advisory council shall examine and make recommendations regarding opioid prescribing and dispensing practices. It would require the Secretary of Health to promulgate regulations relating to the prescription of opioids consistent with guidelines issued by the advisory council. The intent of the bill is to give the prescribing guidelines “teeth”. The regulations would give the guidelines the force of law. Among the regulations to be issued are emergency department pain treatment guidelines. In the event the bill becomes law, 8
PACEP worked to successfully amend the bill to add a representative from PACEP to the advisory council that is developing the guidelines. The bill unanimously passed the state Senate. Status: SB 655 is in the House Health Committee. Prescribing Opioids to Patients (SB 472 – Sen. Gene Yaw, R-Lycoming): This bill limits prescriptions for a controlled substance containing an opioid to seven days unless there is a medical emergency that puts the patient’s health or safety at risk. The bill, among other things, also requires prescribers to discuss the risks of addiction and dangers of overdoses associated with the opioid medication with the patient or family. Currently, state law (changed last session by Act 125 of 2016) limits prescriptions designated for minors to a seven-day duration, unless there is a medical emergency that puts the child’s health or safety at risk. SB 472 would expand that limit to all individuals. Exceptions include cases involving acute pain, chronic pain, cancer treatment, or for palliative care or hospice care. In cases of acute pain, the medical professional would be required to document the acute medical condition in the minor’s record with the prescriber and indicate the reason why a non-opioid alternative is not appropriate to address the acute medical condition. Further amendments are being discussed to the bill, including an amendment for MAT and PACEP’s amendment to ensure nothing is the bill shall be construed to amend, modify or otherwise supersede the legislation PACEP negotiated last year for emergency physicians, known as the Safe Emergency Prescribing Act. The bill unanimously passed the state Senate 49-0. Status: SB 655 is in the House Health Committee. Given the end of the Legislative Session, these bills will have to be reintroduced in the new Session and start the legislative process all over again. Milliron & Goodman and PACEP will continue to be engaged.
GRASSROOTS ADVOCACY
At Milliron Goodman, we spend a lot of time emphasizing the importance of getting to know your legislators and more importantly, making sure they know you. Your involvement in the legislative process is crucial to the future success of your profession and your patients.
CONTACT If you have any questions regarding this legislative update or would like to get involved, please do not hesitate to contact us at 717.232.5322. We have an open door policy.
PACEP News | FALL 2018
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PA Delegation to ACEP Council Resolutions Success for PACEP Delegation to ACEP Council! 25 PACEP members traveled to San Diego in September to represent PACEP membership and work to advance key policy issues at the 2018 ACEP Council Meeting. After months of planning, resolution writing, and deliberation, this dedicated group of Pennsylvania emergency physicians presented five (5) PACEP-sponsored resolutions and considered more than 51 ACEP resolutions in onsite Reference Committee meetings, and full-Council deliberations during an intensive two-day event, held Sept 29-30 at the Manchester Grand Hyatt. The PACEP delegation submitted five (5) resolutions for consideration all of which were adopted:
PACEP Resolutions 1. Reduction of Scholarly Activity Requirements by the ACGME 2. Educational Materials on Care of Individuals with Autism Spectrum Disorder in the Emergency Department 3. No More Emergency Physician Suicides 4. Naloxone Layperson Training 5. Revision of ACEP Policy: Law Enforcement Information Gathering in the Emergency Department Do you have an idea for a 2019 Council resolution or interested in being a part of 2019 Council? Email info@pacep.net for more information. We hope to finalize the 2019 delegation before PACEP19 Scientific Assembly in April 2019. Please join us in thanking and congratulating the 2018 PACEP Delegation to ACEP Council for their hard work, successful resolutions, and ongoing dedication to thoughtful participation in ACEP’s annual policy-setting conference!
2018 PA Council Delegation on stage at ACEP Council.
2018 PACEP Delegation William Bell, MD Smeet Bhimani, DO Erik Blutinger, MD, MSc Merle A. Carter, MD, FACEP Ankur A. Doshi, MD, FACEP Todd Fijewski, MD, FACEP Maria Guyette, MD, MPPM, FACEP Ronald Hall, MD Richard Hamilton, MD, FACEP
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Marilyn J. Heine, MD, FACEP Priyanka Kailash, DO Scott J. Korvek, MD, FACEP Chadd K. Kraus, DO, DrPH, MPH, FACEP Jennifer Marin, MD, MSc Dhimitri Nikolla, DO Ericka Powell, MD, FACEP Shawn M. Quinn, DO, FACEP Meaghan Reid, DO
Ralph Riviello, MD, FACEP Alexander Rosenau, DO, FACEP Anna R. Schwartz, MD, FACEP Camilla Sulak, MD Michael Turturro, MD, FACEP Arvind Venkat, MD, FACEP Austin Williams, MD
Happy 50th Birthday, ACEP! Chadd K. Kraus, DO, DrPH, MPH, FACEP That was the theme for ACEP18 in San Diego. The 50th Anniversary Task Force, led by Past President Nick Jouriles, MD, FACEP, put together a great program of events, including several “Titan Talks” by past and current leaders and long-time ACEP members. Among those “Titans of EM” were PACEP members Drs. Jesse Weigel and Sam Slimmer. Dr. Weigel is a past PACEP President and Dr. Slimmer is among the longest continuous ACEP members. A living museum of the history of ACEP and the specialty of Emergency Medicine highlighted the considerable contributions of PACEP to the development
Longtime ACEP and PACEP member Dr. Samuel Slimmer (left) and past PACEP President Dr. Jesse Weigel (right)
and ongoing of our specialty and several key moments in the Chapter’s history. As part of the 50th celebration, copies of the books “Bring ‘Em All” and the second edition of Dr. Brian Zink’s renowned history of EM, “Anyone, Anything, Anytime”, were debuted and are available for purchase on the ACEP Bookstore. Happy Birthday ACEP, and cheers the continued care of our patients and our communities! (Photos courtesy of Dr. Chadd Kraus)
Dr. Nick Jouriles opens the 50th Anniversary festivities. PACEP News | FALL 2018 13
WELCOME
PACEP NEW MEMBERS Hussain Shakir, MD Paul J. Bartleson, DO Chika Agi, MD Andrea Albert, MD Ryan M. Arthur, MD Irtaza Asar, DO Katrina J. Augustin, MD Ryan Bartosh, MD Robert R. Brigman, MD Paul Copperman, MD Dheeraj Duggineni, MD Rachel Graves, MD John Z. Hillenkamp, MD Nancy Huynh, MD Sharon Jia, MD Ryan Andrew Keenan, MD Erin Kelly, MD Kevin Kucharski, DO Kelvin Z. Kwofie, MD Jennifer O. Larsen, MD Matthew Magda, MD Amy M. Maier, MD David Martin, DO Adam D. Musgrove, DO Megan E. Newnam, DO Chiemeke I Nwabueze, MD Chanel O’Brien, DO Matthew Olson, DO Alexandra Pizzaro, DO
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Megan B. Sanborn, MD Tristan Simmons, DO Clayton G. Soltesz, DO Robert C. Sooby, Jr, DO Kristopher Tkatch, DO Christopher VanEtten, DO Matthew Varley, MD TaReva Warrick-Stone, DO Broc Wenrich, MD Neil D. Khare, DO Alexandra Vinograd, MD Megan Wuebber, DO Elizabeth Avakoff Nathaniel James Baker Anne Basil David Basile, Lt Caroline Joy Blatcher Adrienne Caiado Jossie Antoinette Carreras Tartak Michael Edward Chase Valeria Chew Sulman Choudhary Jessica Dick Christopher Dilger Dan Dunaske Elizabeth A. Eich Michael P. Frein Brian P. Frodey Danny Ben Gersowsky
William Edward Grill John Alexander Hafycz, Jr. Matthew Heard Joseph Heron Piotr Jurgielewicz Hayat Khan Lohith Kini Richard J. LaVeau Gideon Napomaikaiapau Logan Sarayna McGuire Danielle Nicole Melisiotis Kevin A. Molyneux Michael Morris Max Walter Needham Emily Ann O’Brien Tito Osadebe Niketu Patel Michelle Saffermam Mak Sarich Kelsey Lynn Schrage Elizabeth Grace Shanahan Carol A. Stojinski Fermin Suarez Loren Touma Michael Jose da Cunha Valentim Thomas Joseph Woltemate Samuel Beach Wood
PACEP AWARDS PACEP offers awards that recognize a member’s significant professional contribution to emergency medicine. Each year members can show their appreciation and recognize their colleagues for their leadership and excellence. Award recipients are announced at the annual Scientific Assembly Awards Dinner which will be held April 11, in King of Prussia. The recipients are also recognized in the PACEP News newsletter and social media. Go to https://www.pacep.net/awards.html, read the award categories and nominate a worthy colleague today! Emergency Physician of the Year Meritorious Service Award Outstanding Contribution to Emergency Medicine (The Blunk Award) Legislator Award Resident Award - New Award!
PACEP Spivey & CPC Competitions Each year, PACEP holds their Spivey and CPC competitions for emergency physicians, residents, fellows, and medical students. These competitions are excellent cv builders and are held in conjuction with PACEP’s annual Scientific Assembly Conference. The 2019 Spivey and CPC Competitions are now open! The deadline for both competitions is January 20, 2019. Go to https:// www.pacep.net/spiveycpc.html to read details and to submit.
PACEP News | FALL 2018 15
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