ICD-10 What To Do Now

chauvinBy David B. Chauvin, DO, FACEP

With passage of the Medicare Access and CHIP Reauthorization Act of 2015 it is official that ICD-10 CM will become a reality October 1st 2015. This is a huge deal for your billing company, hospital, payer contracts and you.

ICD-10 CM is an updated and expanded diagnosis coding system that will replace ICD-9.
At the very least, every clinician working in the ED will need to know how to document in an ICD-10 CM friendly manner. ICD-10 CM requires more specificity and details than ICD-9. Trauma and injuries make up a significant percentage of the new ICD-10 CM codes with laterality (left right upper and lower) now essential elements of the chart.
ICD-10 CM is ultimately tied to hospital and professional reimbursement; hence you also may be at risk for increased denials, charts deemed incomplete and an unhappy hospital CEO.

Here is a list of things you need to do now:

Identify your current systems and work processes that use ICD-9.
Diagnosis ICD coding is not just used for the final diagnoses, but is also used to justify ED testing such as CT scans, EKGs and lab tests. How does your current documentation system assign codes to diagnostics that you ordered? Although ED docs rarely order outpatient testing, be sure that your order form includes ICD-10 codes.

ED Professional Billing
Who is doing your professional billing? How are they going to implement ICD-10 CM? How are they conducting their internal and external validation testing?

Get to know your coder
Coder feedback will be critical. Try to develop a professional rapport with your coding staff such that they feel uninhibited to ask clarifying questions.  Now might be a good time to buy the coding staff a large box of cookies.

ED Nurse documentation
Can you make your nurse triage note and nursing documentation more ICD-10 friendly? Consider prompts for external cause of injury, geographic location of injury and mechanism of injury. Documentation of laterality, left right and upper and lower now needs to be clearly documented.

Physician Productivity
Yes, once again physician productivity may go down. Perhaps your group is on the tipping point for the employment of scribes or extenders. ICD-10 may make such a decision more clear cut.

Internal Audit
Randomly select 10-20 charts and ask your coders to code the charts via ICD-10 CM. This should provide a baseline to allow for individual provider education.

Resource Help
To help Emergency Physicians prepare for this change to ICD10, ACEP will be providing ICD-10 documentation tips and insights for the busy ED physician. You can find these resources in several locations, including:

ACEP’s monthly magazine, The Official Voice of Emergency Medicine, is planning articles in the months leading up to October 2015. Written by physicians, for physicians, news about ICD-10 will be specific to EM practice.

ACEP Website
ACEP’s home page will include the latest updates, and an ongoing list of resources will be added to the Reimbursement section of the site. Currently, you can find clinical examples, an information paper and an ICD-10-CM manual.

EM Today Newsletter
ACEP partners with Bulletin Health Care to bring the latest health care news each morning from Monday through Friday. Included within EM Today is news and events specific to ACEP. Updates and links to the latest articles on ICD-10 will be included in this newsletter.

Weekend Review
Each Saturday, a roundup of the week is delivered with ACEP partner, Multi-View. Also sprinkled throughout the newsletter are briefs specific to ACEP and emergency medicine. ICD-10 news will be included here.

Social Media
ACEP has an active following on social media. Here are the outlets for information about ICD-10 to be disseminated through ACEP’s membership.

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ACEP 2015 First Quarter Update

Gerardi UpdatedBy Michael J. Gerardi, MD, FAAP, FACEP

First of all, I’d like to thank ACEP members for allowing me to serve as your President since October. It has been a joy to do my part in advancing the specialty and continuing our efforts to improve your lives and the care of our patients. Each quarter, we’re going to offer a report about what we’ve been working on lately and some of the events that shaped emergency medicine. As you will read below, we have done a lot already in 2015, but a lot of important work is still to come over the next few months, particularly with legislation that directly impacts us and with our Clinical Emergency Data Registry. I look forward to visiting with many of you in Washington, D.C. in May.

SGR Repeal, EMTALA Legislation Top Advocacy List in Early 2015
Two major pieces of legislation kicked off the first quarter of 2015, beginning with the EMTALA Services Medical Liability Reform Bill in early February and continuing with an attempt to repeal the Sustainable Growth Rate in late March.

On Feb. 10, ACEP leaders joined Representative Charlie Dent (R-PA) at a news conference in Washington, D.C., to announce the introduction of the Health Care Safety Net Enhancement Act of 2015 — to improve emergency care for patients. H.R. 836 will encourage physicians and on-call specialists to continue their lifesaving work and ensure emergency medical care will be available for your constituents when and where it is needed. Specifically, the legislation addresses the growing crisis in access to emergency care by providing emergency and on-call physicians who provide EMTALA-related services with temporary protections under the Federal Tort Claims Act.

The Bill was referred to the House Energy and Commerce Committee. As of today, it has 32 co-sponsors, but we can use your help growing that number. Please click here to learn more, and please contact your Member of Congress and ask for support.

On March 26, the House approved a bill that proposed significant changes to the Medicare system’s reimbursement model. It signals what could repeal the Sustainable Growth Rate Formula. The New York Times called it the “most significant bipartisan policy legislation to pass through that chamber since the Republicans regained a majority in 2011.” If successfully passed, the bill would put an end to the recurring threat of payment cuts to physicians. The measure would also increase premiums for some higher income Medicare beneficiaries and extend the Children’s Health Insurance Program for two years.

Unfortunately, the Senate failed to consider the legislation on March 27 before adjourning for two weeks. Senate Democrats wanted a chance to consider several amendments to the House-approved bill, but Majority Leader Mitch McConnell (R-KY) did not agree to that request, instead stating he would work with Minority Leader Harry Reid (D-NV) during the recess to settle on a pathway forward as soon as the Senate returns on April 13, 2015. The Centers for Medicare & Medicaid Services has indicated that it will hold claims through April 14 to give Congress time to act.

We are disappointed the Senate failed to act before leaving town. We remain optimistic that, after fighting this battle for more than 12 years, we will finally rid ourselves of the flawed SGR permanently. We are calling for the Senate to act expeditiously as soon as they return and seize this opportunity to enact real, meaningful change in the Medicare program. Visit the ACEP Grassroots Advocacy Center to send a message to your Senators today.

Supreme Court Rules on Medicaid Rate Challenges
On March 31, 2015 the Supreme Court of the United States issued a ruling on the case of Armstrong vs. Exceptional Child Center. At issue was whether medical providers could sue over low Medicaid rates as a way to enforce federal payment requirements to assure that payments are consistent with efficiency, economy and quality of care sufficient enough to enlist providers so as to maintain adequate provider networks.

The opposing view was that such a ruling would result in endless litigation for higher pay and that Congress had not authorized such suits. The court was divided 5 to 4, ruling that providers do not have a federal cause of action to challenge low Medicaid rates. Instead providers with complaints must appeal to the federal government for enforcement.

ACEP has successfully used legal action in various states such as Louisiana, New York and Washington when the Medicaid plan offered unreasonably low payment, limited the number of ED visits for Medicaid patients, or restricted the approved diagnosis list so as to be unreasonable. Going forward, we will have to look to Congress or HHS regulatory staff to enforce Medicaid provisions, making strong relationships with your elected leaders important.

The ACEP Reimbursement Committee is considering whether a “white paper” should be developed to guide ACEP members and stakeholders regarding whether the Armstrong case could be distinguishable for emergency medicine. The issue is whether the “prudent layperson” provisions of the Balanced Budget Act of 1997 that apply to Medicaid HMOs and the ACA provisions barring prior authorization provide legal rights and/or remedies to emergency medicine that are unique and different from the legal basis presented by the plaintiffs in the Armstrong case.

American Hospital Association (AHA)
Publication Promotes Value of Emergency Care

In late March, the AHA issued a publication that highlighted emergency care’s value and role in the health care system. The report “explores the standby role and its critical importance to our nation’s health care system. It outlines the pressures hospitals face and frames critical economic and policy questions that must be addressed to ensure future hospital standby capacity can meet the growing health and public safety challenges.”

ACEP and the AHA worked together to issue a joint letter about the report, which was entitled “Always There, Ready to Care.” It was made available to all members. We encouraged ACEP members to share this report with key leaders and policy makers in your community and state and promote through social media. If you haven’t received a copy, click here.

ACEP Responds to Measles Crisis
On the heels of the Ebola crisis last fall, ACEP leaders and staff responded quickly to another epidemic when the United States experienced a record number of measles cases in early 2015.

This virus represents a challenge to Emergency Medicine because it is highly infectious and has been rarely seen in emergency departments in the recent past. ACEP developed a Fact Sheet about this disease for a review of its presentation, clinical course and implications for the ED. Emergency physicians and other health care professionals can visit acep.org/measles for more information and for new resources, which will be added as needed.


  • Comment Period on tPA Clinical Policy Closed March 13: Early in 2015, ACEP opened a 60-day comment period on the draft clinical guideline: “Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department.” The next step is for the Clinical Policy Committee to review comments and draft a revision as appropriate to submit for ACEP Board approval.
  • Mental Health, Substance Abuse Patient Care Resources Added to ACEP’s Website: In early January, ACEP combined numerous mental health and substance abuse resources at www.acep.org, anchored by the Emergency Medicine Practice Committee’s information paper on “Care of the Psychiatric Patient in the ED: A Review of the Literature.” Included on this new resource page was also information about sobering centers, ACEP Policy Statements, Patient Resources and more. See these resources here.
  • ACEP Releases New Publication, Cardiovascular Emergencies: More than 6 million people present to EDs each year with chest pain and forms of cardiac disease—arrhythmias, infections and cardiovascular complications from other conditions. ACEP’s newest publication, Cardiovascular Emergencies, provides information to help you deliver efficient and cutting-edge care to patients who present with acute cardiovascular conditions. Learn more.
  • EMRA Launches Updated PressorDex App: Newly revised and updated for 2015, PressorDex is a comprehensive therapeutic guide to the myriad of pressors, vasoactive drugs, continuous infusions, and other medications needed to treat the critically ill patient. Written by emergency medicine physicians for emergency medicine physicians, this app gives you concise tools for choosing the right medication and dosing regimen every time, even during the busiest of shifts. Find it and other useful EMRA apps here.

Ongoing Projects

  • Qualified Clinical Data Registry Work Continues: ACEP announced last year that it would begin work on a Qualified Clinical Data Registry (QCDR). This is a very complex project, but it will position emergency medicine to develop quality measures that will resonate with members and, we believe, improve quality. We can develop measures that apply to patients beyond the Medicare population. As Executive Director Dean Wilkerson, JD, MBA, CAE, wrote in the December issue of ACEP Now, “If we have our own QCDR, we can control the playing field and develop measures we believe are appropriate without having to submit them to the National Quality Forum for other groups to approve. Rather than having measures imposed on us, we will drive the measures ourselves.” Quality measure reporting and quality improvements are of increasing importance for physician reimbursement. ACEP’s QCDR will allow our members to avoid cuts to their reimbursement and obtain incentive payments. The initial testing and QCDR approval phase began in February 2015 with the participation of five emergency departments. The pilot phase is expected to begin in May of 2015. Through the aggregation and organization of data on clinical effectiveness, patient safety, care coordination, patient experience, efficiency and system effectiveness, ACEP’s Clinical Emergency Data Registry will provide clinicians with a definitive resource for informing and advancing the highest quality of emergency care. ACEP expects final approval of its Quality Measures and our QCDR later this month. Learn more about CEDR.
  • End of Life/Advance Care Planning: A task force led by Vidor Friedman, MD, FACEP, Mark Rosenberg, DO, MBA, FACEP, FACOEP-D, and Sandy Schneider, MD, FACEP, has been assembled to prepare a white paper within the next few months to make recommendations to the Board on our next steps to promote a national discussion on EOL/AC issues.
  • Psychiatric Emergency Care Initiative: We have already had our first summit of stakeholder organizations and have created COPE  – “Coalition on Psychiatric Emergencies.” ACEP is a leader on the Steering Committee, and subcommittees have been created to: address education of the public and caregivers, study the latest advances in diagnosis and treatment, develop a research agenda, and configure an advocacy approach for true parity of care for psychiatric emergencies. In addition, we are working on a public relations release in the next few weeks announcing our mission and the stakeholders. Sandy Schneider, MD, FACEP, along with Barbara Tomar and Cynthia Singh of our staff are leading this effort.
  • Sepsis Task Force: We have a task force led by Board Member John Rogers, MD, FACEP, Task Force Chair Don Yearly, MD, and Sandy Schneider, MD, FACEP, to review all of the current literature and summarize it for our members to use. We will also have an educational campaign for our members and other organizations highlighting our role in diagnosing and initiating treatment of sepsis to a point that we, Emergency Medicine, will “own sepsis.” We want to simplify sepsis management and also develop quality measures to be used by EP’s.

Coming Up

Join us in Washington, D.C. this May
The Legislative Advocacy Conference and Leadership Summit is coming up May 3-6 in Washington, D.C., and has been revamped for 2015. Don’t worry. The same excellent education will be available, but the schedule has been changed slightly to emphasize the unique opportunities available at this event. Sunday’s Leadership Essentials, presented by EMRA and the Young Physicians Section, is particularly appealing to those just getting started in advocacy and developing leadership skills. Monday is packed with the latest information about policy, payment models, innovation and much more.

Tuesday is Capitol Hill Day, when more than 500 emergency physicians head to the House and Senate office buildings to advocate for pending legislation and the need for reforms to strengthen emergency medicine and improve access to better patient care. Wednesday is a full day of leadership training and includes valuable CME courses. Please don’t miss this conference. I love our annual meeting in the fall, but this conference offers a chance to spend some time with people in a much more intimate setting while doing some excellent and crucial work for our specialty.
I’ll see you in Washington. Click here for more information.

Dr. Steven Stack to Take Over as AMA President
By the time our next quarterly update comes around, Steven Stack, MD, FACEP, will be the AMA’s 170th President. Dr. Stack takes over in June at the AMA annual meeting. He is the first emergency physician to ever hold that position, and when he assumes office, he will be the youngest president in the past century.

Dr. Stack currently practices in Lexington and surrounding central Kentucky. He has served as medical director of multiple emergency departments, including St. Joseph East (Lexington), St. Joseph Mt. Sterling (rural eastern Kentucky) and Baptist Memorial Hospital (Memphis, Tenn.). Born and raised in Cleveland, Dr. Stack graduated magna cum laude from the College of the Holy Cross in Worcester, Mass., where he was a Henry Bean Scholar for classical studies. He then returned to Ohio, where he completed his medical school and emergency medicine residency training at the Ohio State University before moving to Memphis to begin his clinical practice.

An expert in health information technology, Dr. Stack speaks on behalf of ACEP and emergency medicine at numerous events and conferences throughout the year and delivered the Rorrie Lecture last year at our annual conference.

We appreciate his efforts and congratulate Dr. Stack for his important new position.

New Headquarters Groundbreaking Set for April 16
I’m excited to announce that we will break ground on a new headquarters on April 16 on a six-acre tract of land near the Dallas-Fort Worth International Airport.

The new building will be three stories with approximately 57,000 square feet. This building will have all the things we do not have in our current building, including many member amenities, work areas, top-notch A/V capabilities and video conferencing, a small media room for filming and interviews, history recognition throughout the building and celebration of our specialty.

We have outgrown our space and comparison studies of other professional societies underscored what we expected – our outstanding staff is working under less than desirable conditions, especially as we grow in membership and management responsibilities (SEMPA, EMRA, CORD, EMF).  A new building is also symbolic or our coming of age as a recognized and MAJOR specialty. We need advances in our headquarters for our staff and volunteers to serve our members and our patients.

This new building’s location is also nestled between two major hotels, allowing us to offer better service to our chapters and groups that use the national office for meetings and training, such as the Emergency Medicine Basic Research Skills (EMBRS) courses and the Emergency Medicine Foundation grant projects. The Texas chapter also uses our building for meetings, and this will assist in their efforts. There are other educational meetings ACEP may hold in this new building.

We have been in our current building for more than 30 years, and it has served us well. Our specialty is much different now, and this new headquarters is necessary for future growth.

Thanks for allowing me to update you on recent projects and offer a little about what’s coming around the corner. If you need anything, please don’t hesitate to contact me.


Dr. Michael Gerardi
ACEP President




From the President: ACEP Asks You to Share AHA Report on Value of EM

ACEP is pleased to provide our members with a recent publication from the American Hospital Association (AHA) “Always There, Ready to Care,” promoting the extraordinary value of emergency medicine. The AHA is promoting this report by sharing it with policymakers, media and the public.

This publication describes the invaluable role of emergency physicians who must be prepared to respond to a wide range of medical conditions and are now experiencing capacity constraints in the face of rising demands.

It also describes the challenges of psychiatric patients in emergency departments, the complex issues of rural America and the nation’s increasingly heavy reliance on 24-hour access to care. In addition, it demonstrates the crucial role of emergency medicine in responding to disasters, featuring last year’s Ebola emergency and the outstanding response of emergency physicians following the explosions during the Boston Marathon.

The report concludes with a description of the funding challenges to maintaining the emergency department’s 24/7 role in an environment of declining financial support, asking the following policy questions:

  • How will financing mechanisms need to be designed in order to support the 24/7 role in the future?
  • How can the standby role be financed in an increasingly competitive health care marketplace where payers want to pay the lowest price?
  • What is the appropriate role of government in supporting hospital-based disaster preparedness and relief?
  • Should all health care facilities be required to support the community’s standby capacity and care needs?
  • What steps can be taken to promote greater access to and utilization of primary care among low-income vulnerable populations to improve their health status and reduce the need for ED care?

Please share this report with key leaders and policymakers in your community and state and promote through social media.


Michael J. Gerardi, MD, FAAP, FACEP
ACEP President
Rich Umbdenstock
AHA President and Chief Executive Officer
AHA Horzontal


Critical Care and Social Media Come Together in Chicago this June at “smacc”

Web Banner 425x255ACEP has asked the organizers of the Social Media and Critical Care Conference to contribute a piece to The Central Line, explaining the event and how it can help emergency medicine.

By Nell Harrison
Scott Weingart labeled smacc the “Best conference ever” but is it really worthy of all the hype?

In the past two decades we have seen the Information, Technology and Communication revolution. In 2015 we can access the internet almost anywhere on our smart phones and tablets to connect with each other.  The way we communicate and share information is changing. Social media platforms like “YouTube” and “Twitter” enhance the dissemination of learning material but more importantly they provide the opportunity for a two conversation between the teacher and student. We should ask ourselves then how can this new era of communication facilitate learning, particularly at critical care and emergency medicine conferences?

Smacc (Social media and Critical Care) so named because it is powered by a collaboration of FOAM (Free Open Access Meducation) websites from around the world, is truly different. It is a high power critical care conference but more importantly it is inspirational, informative and innovative. The collective experience gained growing these websites has guided the program formation.

There is energy at smacc that not only augments the learning atmosphere but it recharges our commitment to critical care. In the words of one delegate from #smaccGOLD 2014: “This was the first conference where I not only learnt plenty, but I came away proud to be a professional in critical care. I feel excited about taking all this back to work!”

Here are 10 reasons you should consider smacc Chicago in June 23-26 2015.
1: Speakers – The speakers are hand picked from both the FOAM world and the conventional conference circuit because they are inspirational leaders in their fields. http://www.smacc.net.au/speakers/
2: Topics – The sessions are delicately pieced together to cover issues from hard core medical science and research to education and end of life care, but more critically they embrace controversy. http://www.smacc.net.au/program/
3: Format – The style has an informal open feel that encourages a two-way conversation, which is further enhanced by the integration of social media into the sessions.
4: Community – smacc brings together all the critical care community together from Pre-Hospital/Emergency/Critical Care and Anaesthesia.
5: Excitement – The energy at smacc powers a vibrant atmosphere
6: Networking – All breaks and lunches are catered free to provide a relaxed atmosphere for delegates to come together
7: Social – All social functions are included in the registration to bring all delegates together as part of one critical care community
8: Workshops – Over 30 pre-conference workshops cater for every need from communication and debriefing to Airway and Ultrasound http://www.smacc.net.au/program/workshops/
9: Post-conference – All sessions at smacc are podcast and released FREE in a serial fashion over 6 months post conference as part of FOAM http://www.smacc.net.au/the-talks/
10: Not for Profit – smacc is administered by a charitable trust and no individual benefits financially

The theme for smacc Chicago is smaccFEST, because it is more than a conference, it is a festival. Smacc is a celebration of medical science, knowledge, education, ideas, community and innovation united by a love of practicing critical care. There are already over 1,300 delegates and many pre-conference workshops have sold out. Get more information here.


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March Annals Audio

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

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

And much more…

Email any time, let us know what you think!


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Annals podcast for January posted!

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

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

And much much more,

Reach out any time at annalsaudio@acep.org,


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

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

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

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

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

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Holiday podcast is posted!

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

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

And much much more!

Happy holidays to all and email any time,


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

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

and much much more!

Email any time, annalsaudio@acep.org,


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Dr. Rosenau End of Presidential Term Update

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Goal 2 – Enhance Membership Value and Member Engagement

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

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

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

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

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

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

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

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

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

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



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