Archive for category ACEP News

ACEP ‘Chooses’ Differently, Opts for Alternative Approach to Find Cost Savings

[This article will be published in the November issue of ACEP News. See the entire ACEP News libary online at www.acepnews.com]

After considerable debate, the ACEP Council voted this month to refrain from participation in the national “Choosing Wisely” campaign in large part due to the other efforts being taken by ACEP to achieve the same and even larger goals.

“Choosing Wisely” is part of a multi-year effort of the American Board of Internal Medicine (ABIM) Foundation to help physicians be better stewards of finite health care resources, according to its website. As part of the campaign, specialty organizations identify five tests or procedures commonly used in their field, the necessity of which should be questioned and discussed by patients and physicians.

ACEP had considered joining this campaign three distinct times since its launch in December 2011. Three different workgroups of various ACEP members, committees and Board members looked at the campaign and decided that while the concept is positive, the scope of listing tests, especially for emergency physicians, was too narrow.

Despite this extensive review by ACEP members, a resolution was submitted by the New York Chapter asking the ACEP Council to decide if ACEP should join the “Choosing Wisely” campaign.

As part of the Council process, resolutions are first debated in a reference committee where members of the Council provide background about the resolution, give testimony to its merit or explain reasons why it should not be adopted.  It was standing room only for the debate about this resolution and discussion was spirited. The debate continued the next day with many of the same reasons echoed on the open floor of the Council with mroe than 300 voting members in attendance.

Those in support of ACEP joining the campaign said that 26 medical specialties (except for emergency medicine and anesthesia) have joined or committed to participate. They added that participating could give ACEP more national visibility and bargaining power, and that ACEP could use its participation to educate other specialties about emergency medicine’s particular challenges.

Those opposed to ACEP joining the campaign said that the Choosing Wisely campaign does not involve any negotiation with others in medicine, and that it could lead to unintended consequences, including a lack of liability protection, vulnerability to the False Claims Act and automatic payment denials from insurance companies based on tests that the campaign deems to be “unnecessary.” 

One large concern was that the intent of the campaign had already eroded, with several specialties offering only minimal savings and stepping outside of their field and including tests on their lists that are outside the scope of their practice.

The issue generated strong feeling on both sides and the majority of the Council ultimately decided to refrain from participation.

ACEP already had opted to strive to identify cost savings measures without compromising patient care. Three task forces were established in 2012 to work toward this idea – the Cost Effective Care Task Force, the Delivery System Reform Task Force, and the Transitions of Care Task Force.

ACEP’s Cost Effective Care Task Force is developing recommendations on ways to reduce costs in emergency care. Through member surveys, a Delphi approach, and use of the Emergency Medicine Practice Research Network (EMPRN), this group will not only consider unnecessary tests and procedures but also processes with emergency care that might represent meaningful cost savings while improving patient care. This task force is expected to complete its work and offer its report to ACEP’s Board in February of 2013.

It is hoped that these reports of significant recommendations can fuel a public campaign and support health policy advocacy concerning how emergency physicians are not just making a list of tests to cut, but instead are looking at much larger initiatives, processes and transitions that could result in real health care savings while improving patient care.

The Delivery System Reform Task Force gave its report to the ACEP Board of Directors on Oct. 5. It can be found online at www.acep.org/advocacy/federalissues/.

“The emergency department remains at least one of the reasonable solutions for addressing many of the health care system’s most vexing problems from a delivery system perspective,” the report states. “Emergency physicians are well positioned to provide innovation and leadership across the acute care continuum. Even from the perspective of employers, the patients, and payers, the allegedly high cost of care is incompletely characterized, often misconstrued, and lacks sufficient perspective in the broader context of community economics and the health care delivery system itself. Addressing these dynamics will require significant and intensive efforts to bring data, information, and solutions to a delivery system in rapid evolution.”

In addition to efforts that should be continued, the report also lists several recommendations of efforts that should be started or enhanced, including information sharing to primary care providers (and specialists), care coordination for high-cost users, regionalization of patient care resources (mobile technology, telemedicine), cost effective alternatives to hospital admission and others.

The report also recommends efforts that should be stopped or reduced (because emergency physicians are not trained or resourced for it, or could be more efficiently delivered in an alternative setting), such as longitudinal care for chronic illnesses, primary preventative care, non-value driven convenience care, and treatment of medical conditions that have no incremental benefit to the patient or value to the system.

The Transitions of Care Task Force also developed an information paper that was submitted to the ACEP Board of Directors in draft form on Oct. 5. When it is finalized, it will be announced to ACEP members and posted on ACEP’s website.

The Task Force paper notes that “The emergency department has an important, in fact pivotal, role in transitions of care and can enhance its value to the system by implementing more successful transition programs. As the emphasis and oversight of quality and cost increase, successful coordination of patients’ journeys through the health care system will help advance the triple aim of better population health, better patient experiences, and reduced cost to the system. “

To achieve this goal, the Transitions of Care Task Force made several recommendations, including

  • improve residency training and continuing professional development for emergency physicians on the importance of handoffs in effective transitions of care
  • work with emergency department information system vendors to produce transition support tools
  • identify strategies that make handoffs successful, and use them to establish goals for emergency departments
  • develop a web-based toolkit that includes resources, assessment and support tools, and best practices
  • develop education resources on palliative care in the emergency department to enhance knowledge and increase the number of emergency department-based palliative care programs
  • and more.

ACEP has a strong focus on these issues of improving patient care and providing cost savings. To that end, multiple recommendations continue to be developed and adopted by the College. We are dedicated to ensuring that our specialty brings ideas that truly will improve care for the millions of patients we treat and provide real, substantial savings to the nation’s health care expenses.

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ED Suicides: More Vigilance, Less Boarding

ACEP News, January 2011 — More than a decade after issuing its first report on suicides in hospitals, the Joint Commission has followed up with a new one, reminding clinicians that suicides and suicide attempts can occur anywhere – not just in psychiatric units.

But emergency physicians say that suicides in nonpsychiatric units are part of a broader and more difficult problem to solve: a lack of appropriate care for psychiatric patients that forces other units – particularly emergency departments – to hold these patients in environments not designed for their safety.

Since 1995, the commission wrote, there have been 827 reports of patient suicides, 14% of which occurred in nonpsychiatric settings, more than half of these in emergency departments. The 827 cases represented only those voluntarily reported, the commission noted, and therefore is likely an undercount.

The suicides occurred in bathrooms, bedrooms, closets, showers, or just after patients left the hospital against medical advice. Patients hung, shot, lacerated, or asphyxiated themselves, jumped from high places, or ingested drugs. A number of suicides were carried out using materials immediately available in the hospital – bell cords, bandages, sheets, plastic bags, or elastic tubing.

Read the entire ACEP News article online.

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Would you like to know your Ranking?

As an emergency medicine resident, I remember taking tests and wondering where I stood compared to my peers. I would review different materials and focus on areas that I did not feel strong in. As a resident, I took the Ohio Acep review course and took their 700 question CD and reviewed all the explanations. I later was able to review the quiz questions and make suggestions.

Interesting enough, I was able to create the iPhone, Ipod Touch, * iPad edition of the quiz question for Ohio Acep. The app was just released and should show up on the app store in the next 48hrs. The app allows users to take the test and review each answer. It allows the user to focus on the questions or course materials they need to work on by creating custom test. The app also allows users to “know their ranking”, the app will ask users for an alias and will upload their test scores on each section of the test and will give an overall rank based on the users that have already taken the test. The ranking will update every time someone takes the test and clicks on ranking. To see the current ranking of beta testers and updated ranking please click here. To download the app or to see screen shots of the app click here.

* on iPad you will be able to double the size of the screen but the images might be slightly distorted.

Below I have included more information about the app.

Description

Emergency Medicine Quiz Questions
On Sale for limited time, Price is 20% off.

Includes a new, 50-question pictorial review! Contains 700 review questions and referenced answers in an easy-to-use multiple choice format.

** “New Rankings feature, only users to see where they are ranked compared to their peers around the world. The app will rank each person based on subject and overall ranking depending on percent correct! Visit our website for more information.” **

The Emergency Medicine Review Course held annually by Ohio ACEP offers a comprehensive review for the physician preparing for the Qualifying examination, ConCert examination or continuous certification, or who simply desires an intensive review of emergency medicine. Attended by hundreds of physicians each year from across the country, this premier review course promotes high pass rates and receives high compliments.

Email us your feedback so we can make this app even better.

They have created this CD based on years of experience with preparing Emergency Medicine Physicians. The CD edition of this program retails for 100$ US Dollars.

The iPhone app is easy to use.

Topics include:
Administrative
C-Spine
Cardiology
Dermatology
EMS
Endocrine, Metabolic & Nutritional Disorders
ENT/Dental
Environmental
Gastrointestinal
Hand
Hematology
Infectious Disease
LifeLong Learning Self Assessment (LLSA)
Medicolegal
Neurology
OB/GYN
Oncology
Opthalmology
Orthopedics
Pharmacology
Pictorial Review
Psychiatry
Pulmonary
Renal
Rheumatology/Soft Tissues
Toxicology
Ultrasound
Urology

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EM Leaders Discuss ABEM’s Maintenance of Certification Program

In late December, the American Board of Emergency Medicine (ABEM) sent out letters to its diplomates outlining the process for Part 4 of its Maintenance of Certification program.

ACEP does not set the requirements or mandate the process of continuous certification. However, because many ACEP members expressed confusion about the ABEM letter, ACEP leaders wanted to try to help clarify the process for its members.

ACEP President-Elect Sandy Schneider, MD, had a conversation with ABEM President Debra Perina, MD, for ACEP News to pose some FAQs, get ideas on how to meet the patient communication portion, and clarify what qualifies as a quality assurance project.

Here are a few snippets:

SS: Can you break this down so we can understand exactly what is going to happen? I see there are two parts. Start with the patient communication survey.

DP: The Communications Professional Activity must be conducted one time in your 10-year cycle, which starts at the point when you are certified or re-certified. At one time during that 10-year cycle, each physician must complete an activity related to communication and professionalism. There are multiple ways you can meet that requirement …

SS: Let’s talk about Quality Assurance.

DP: The Patient Care Practice Improvement Activity is a four-step process that you have to complete twice during your 10-year cycle. You collect data that reflects what you are doing with your patients now. Then you compare that data to evidence-based guidelines … A perfect example is the ubiquitous aspirin in suspected STEMI. You want to give aspirin to those patients 100% of the time. We know many hospitals are looking at this initiative and giving feedback on patients that should have received aspirin … This is one very clear example of a qualifying activity that physicians are already doing …

SS: I believe one of the biggest reasons for the reaction to the new requirement is simply that it is new …

DP: We believe most individuals are already engaged in most of the activities that are being required. We are just trying to create a system that makes it as painless as possible to report what folks are already doing.

Read the entire ACEP News article online.

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