If you have never attended the ACEP Scientific Assembly, you’re missing the world’s largest and most prestigious emergency medicine educational conference. Register today and find out why more than 6,000 emergency care professional will travel to Denver this year to be part of this unique ACEP experience!
Did you know that ACEP has an official CME publication? Critical Decisions in Emergency Medicine, is highly rated by subscribers for its leading-edge clinical information. Not only is it the best source for timely and practical emergency medicine information, it was developed for your practice needs.
With a 1-year subscription, you’ll have the opportunity to earn up to 60 AMA PRA Category 1 Credits™. In addition to the CME opportunities and relevant take-home points, you’ll get TWO clinical lessons with topics chosen from the “EM Model.” Lessons are written by your peers under the direction of leaders in emergency medicine education, and guide you through the “critical decisions” you must make – When are imaging studies warranted? Which laboratory studies will guide you toward the right diagnosis? Which patients should be admitted?
Every issue of Critical Decisions also includes four Bonus features to help you with all the other areas of your practice. “The LLSA Literature Review” brings you synopses of the articles from ABEM’s yearly LLSA reading lists. Each summary features bulleted highlights of the articles to help you focus your continuous learning efforts. “The Critical ECG”, provides an ECG illustrating a challenging condition, along with a discussion of the subtleties of its interpretation. “The Critical Image” provides an image (CT, radiograph, etc.) along with a discussion of the visual clues leading to the correct diagnosis. “The Drug Box” is a concise review of indications, dosage, and contraindication for commonly used medications.
Preview a sample issue to see why ACEP’s official CME publication should be YOUR CME publication.
Healthcare providers learning from their peers help ensure healthcare quality. Comprehensive and impartial reviews of medical cases by physicians — as opposed to non-medical professionals — works for safer patients and healthier Missourians. By joining the physicianreviewer team at Primaris, the Medicare Quality Improvement Organization for the state, emergency physicians can join this effort. All reviewing – and training for reviewing – can be done remotely, from the comfort of your home or office. Physician reviewers are paid and covered by Primaris’ liability insurance. To get started, contact Primaris Medical Director Sharon Hoffarth, MD, MPH, FACPM, at email@example.com or 800-735-6776 ext. 170.
Resolution #2 – Prescription Drug Monitoring Program
Resolution #8 – Prescription Drug Monitoring Program
Adopted – Resolved, the Missouri State Medical Association encourage legislation to develop a Prescription Drug Monitoring Program to gather data on Schedule II-IV controlled substances that will allow Missouri physicians to access information to identify patients seeking prescribed medications, and be it further
Resolved, the Missouri State Medical Association encourage such legislation to protect the legitimate practice of prescribing pain
Resolution #3 – Credentialing CME
Referred to MSMA Council – Resolved, that the Missouri State Medical Association:
1. Reduce constraints on pharmaceutical and instrument companies for providing CME to physicians; 2. Simplify CME procedures for documentation of scientific presentations, particularly joint sponsorship and cost reduction.
Resolution #6 – Committee Composition of the US Preventive Task Force
Adopted – Resolved, that the MSMA through its delegates to the AMA House of Delegates and its statewide membership through communication to Congressional Representatives and Senators promote and encourage the inclusion of clinical specialists on a proportional basis on the US Preventive Task Force
Resolution #9 – Prohibition of Local Ordinances Circumventing State Control of Controlled Substances or Other Pharmaceuticals
Resolution Not Adopted – Resolved, that the Missouri State Medical Association pursue legislation in Missouri that would prevent Missouri cities, municipalities and counties from enacting local ordinances overriding or circumventing state law with regard to the sale and distribution of controlled substances and other pharmaceuticals.
Resolution #10 – State Board of Healing Arts Disciplinary Website Addition
Referred to MSMA Council – Resolved, that the Missouri State Medical Association work with the State Board of Healing Arts to insure that any physician who has had their license to practice medicine revoked, or has resigned their license pending disciplinary action (including that which would follow criminal conviction), will be appropriately so designated on the website.
Resolution # 11 – Missouri State Volunteer System (Revisited)
Resolution Not Adopted – Resolved, that the Missouri State Medical Association staff continues to work with renewed effort with the state in making the volunteer process as expeditious, simple and as seamless as possible in the future, insuring that volunteer physician assistance will be available when needed.
Resolution #12 – Malpractice Tail Coverage
Referred to MSMA Council – Resolved, that the Missouri State Medical Association should work with the state Department of Insurance to encourage private insurers to provide free malpractice tail coverage making it more economically feasible for senior physicians to practice medicine.
Resolution #13 – Bill Requiring Out of State Expert Witnesses to have a Missouri License
Referred to MSMA Council – Resolved, that the Missouri State Medical Association pursue Missouri legislation patterned after the Florida legislation (Florida HB 479) regarding expert medical witness testimony.
Resolution #14 – Standardizing Faxed Prescription Requests
Adopted – Resolved, that the Missouri State Medical Association petition the State of Missouri to adopt a standardized legal form in order to transmit prescription requests by means of fax.
Resolution #15 – Adoption of Goals for Freedom in Medical Practice
Adopted – Resolved, that the Missouri State Medical Association state a public position in favor of stability in Medicare reimbursement, transparency in medical costs, and alternatives to current medical negligence lawsuit system, and be it further Resolved, that the MSMA seek and support legislative and court action to further these positions.
Resolution #16 – Missouri Patients Ability to Receive Direct Access to Their Laboratory Test Results
Referred to MSMA Council – Resolved, that the Missouri State Medical Society support and encourage the state legislature to enact
legislation to enable patients to receive or acquire their test results directly from the individual laboratory facilities.
Resolution #17 – Clerkship in Advocacy for Medical Students and Residents
Adopted – Resolved, that the Missouri State Medical Association (MSMA) work with representatives of all medical schools in Missouri and interested resident training programs to develop a model training program in Advocacy.
Resolution #18 – Medical Student Indebtedness, Primary Care and the Tobacco Tax
Referred to MSMA Council – Resolved, that the Missouri State Medical Association (MSMA) work with the State Legislature to increase the State tobacco tax to a level equivalent to that in our contiguous surrounding states, and be it further
Resolved, that revenue generated by increasing the tobacco tax be allocated to the PRIMO program to encourage physicians to practice primary care medicine in underserved or shortage areas, with remaining funds going towards underfunded state programs.
Resolution #19 – Defining the Current Physician Workforce in Missouri
Referred to MSMA Council – Resolved, that the Missouri State Medical Association (MSMA) work with the Missouri Department of Health and Senior Services, the Missouri Board of Healing Arts and other relevant state agencies
to collate information on physician practices and, if necessary, devise a survey instrument to collect comprehensive information describing the geographic and professional distribution of physicians, and be it further Resolved, that MSMA arrange to have said data analyzed in such a fashion as to define those practice types and geographic areas in the most acute shortage situations, and be it further Resolved, that such data be published on an annual basis to ensure the most current knowledge on the type of practice and geographic distributions in the State of Missouri.
Meet the New MSMA President, Steve Slocum, MD of St. Louis, Missouri
Stephen G. Slocum, MD, a board-certified Ophthalmologist from St. Louis, Missouri, will serve as President of the Missouri State Medical Association in 2012-2013. He was formally installed in St. Louis, March 31, 2012,
during the MSMA’s 154th Annual Convention.
His goals MSMA during his tenure as President are:
- Advocacy for fewer regulations and encumbrances which have negative effects on the doctor-patient relationship.
- Further establish the MSMA as the preferred resource of medical information for the Missouri Congressional delegation.
Dr. Slocum was born and raised in St. Louis. He received his medical degree from Saint Louis University School of Medicine in 1975. He completed his post-graduate internship in Internal Medicine at St. Mary’s Health Center in St. Louis, and his residency in Ophthalmology at the Tulane University School of Medicine in New Orleans, La.
Dr. Slocum worked in private, solo practice in St. Louis for many years before joining West County Ophthalmology in 1999. His hospital affiliation is currently St. Luke’s Hospital in Chesterfield. He serves on the faculty of St. Louis University as Assistant Clinical Professor of Ophthalmology.
In addition to his clinical practice, Dr. Slocum has been long active in organized medicine. He is a member of the American Medical Association, the Missouri State Medical Association, and the St. Louis Metropolitan Medical Society (SLMMS). For much of this time he has served in numerous positions, including representing District Three as a Councilor on the MSMA Council, and serving on the Consumer Driven Healthcare and Performance Review Committees. In St. Louis, he was President of SLMMS in 2007, and also served and chaired the Physicians and Patients Grievance Committee, and continues to serve on the Legislative Committee.
He is a Fellow of the American Academy of Ophthalmology, and a Fellow of the American College of Surgeons.
Dr. Slocum has served his medical specialty in several areas. He is a past-president of the Missouri Ophthalmological Society. He has served on the Council of the American Academy of Ophthalmology, as well as the Academy’s Secretariat for State Affairs. He is a reviewer for the Missouri Patient Care Review Foundation, and represents Ophthalmology on the Eastern Missouri Medicare Carrier Advisory Committee. He serves on a consultative committee with Anthem/Blue Cross Blue Shield.
It’s sunny and warm, which means people are taking vacations and spending more time outside, possibly camping, boating, and hiking. It also means that more people will unintentionally have encounters with snakes, and for us in the Emergency Department, we’ll be treating patients presenting with snakebites. It was not very long ago that the antivenom used to treat crotalid (rattlesnake, cottonmouth, and copperhead) envenomations had such a high rate of adverse events, that very few people received it. This was particularly true for copperhead envenomations as mortality from the bite was incredibly low and many patients did well with aggressive pain control and supportive care.
This all changed with the development of Crofab® and its approval in 2000. This newer antivenom was shown to have a much better safety profile than the older antivenom. As the rate of adverse events dramatically dropped, and physicians became more familiar with the new medication, the amount of patients receiving it skyrocketed. This was particularly true for patients who were bitten by copperheads since Crofab® helped control symptoms and had a much more favorable benefit-to-risk profile than the older antivenom. A retrospective review of envenomations reported to Poison Centers showed a 13.7% national increase in the administration of antivenom for snakebites from 2000-2007. While overall this may only seem like a small increase, the number of patients treated with antivenom after a copperhead envenomation more than tripled, from 9.8% to 35.8%. In Missouri, the number of patients reported to Poison Centers that were treated with antivenom after a snake envenomation increased by 339% from 2000-2007. While I don’t have the exact breakdown, my guess is most of this increase was related to the treatment of copperheads.
Recently, a patient presented to a hospital in California after being bitten by a rattlesnake. From the limited information available, he was treated with antivenom, admitted to an ICU overnight, and discharged the next day. He was charged $128,050 for antivenom alone…more than what I paid for my first house! I bring up this case not to criticize the physician’s decision making or to suggest that the care provided was substandard, because rattlesnake envenomations are associated with cardiovascular dysfunction and coagulopathy, but to make physicians aware of the potential cost of this treatment. To clarify, I’m not advocating withholding Crofab® in all snakebites, or stating that money should be the overriding factor when making patient care decisions, but I do think there are serious financial ramifications for the patient that we need to be aware of when we order this medication. Currently, there are trials underway evaluating Crofab® and its ability to reduce morbidity in copperhead envenomations, such as returning someone to work sooner compared to supportive treatment alone, which may help us in our decision making. However, the results will not be published soon,
and in the meantime, it may be prudent to think twice before ordering Crofab® for the next patient with a mild snakebite that walks through your door.
The Missouri College of Emergency Physicians Board of Directors would like to welcome our newest member, Kene Chukwuanu, MD. He is the resident member representing the program at St. Louis University. He attended The University of Missouri-Columbia (Go Tigers) for undergrad and medical school while playing football for the Tigers (Go Tigers). We would all like to welcome him to the board and congratulate him on this honor.
The ACEP 2012 Leadership and Advocacy Conference set a new attendance record of 532 attendees. A record number of Hill visits were conducted at this meeting with emergency physicians representing 49 states meeting with elected officials and staff in 227 House offices and 98 Senate offices.
Missouri had strong representation at the Leadership and Advocacy Conference.
Brian Robb, DO, FACEP
Larry Slaughter, MD, FACEP
Randy Jotte, MD, FACEP
Robert Poirier, MD, FACEP
Jonathan Heidt, MD
Sarah Hoper, MD
Irena Vitkovitsky, MD
Matthew Rudy, MD
Timothy Koboldt, MD
Kene Chukwuanu, MD
- Join the 911 Network, ACEP’s award winning grassroots advocacy program for ACEP members.
- Invite your federal legislator to tour your emergency department. Contact Jeanne Slade in the ACEP Washington, D.C. office.
Missouri Legislature – Past, Present and Future
The Missouri legislative session has concluded and the Governor has begun signing or in some instances, vetoing legislation. The governor has until July 14th to act, otherwise legislation passed will automatically go into effect. That is rare however and in fact I believe the Governor has only taken that path once during his term.
A quick recap will really serve as an outline of where we start for 2013 session. Here it is:
Prescription Drug Monitoring –
didn’t pass in 2012, leaves Missouri as the last state (Ihave heard that before) to implement a drug monitoring program. Several senators opposed to the bill have since either retreated or termed out, and the primary opposition is down to Senator Rob Schaaf (physician from Buchanan and Platte County). A coalition, to which we will belong, will begin a grassroots campaign, and some paid media, to promote this issue over the summer months. You will receive updates on activity of the group. This of course will culminate in a bill being introduced next session.
passed on time, something the feds have a difficult time accomplishing, and the Governor signed it without many restrictions or vetoes. I do not see the Medicaid budget, as it relates to you, changing from past practices. One note however is that new Medicaid Managed Care vendors are enrolling providers now and will go live in July. Since there are some new insurers administering the Medicaid program, be sure to share positive or negative experiences about them, since your issue is likely NOT an isolated one and will want to detect trends.
Two additional notes on the Budget: First, I believe that State’s budget will improve each year if the trends remain steady. This will allow us to request a Medicaid rate increase with a straight face. It is tough to ask for a rate increase when other programs are being whacked. Second, the new Medicaid enrollee eligibility due to the federal health care law will increase total enrollment in the program by 35%.
Medicaid Expansion –
A massive expansion of the Medicaid program under PPACA was struck down by the Supreme Court last week. Missouri would have increased their Medicaid enrollment by 35% had this provision stood. See the following assessment by the NY Times I found informative on this topic, “Very quietly, the Affordable Care Act introduced a revolutionary change: All poor people in America would get Medicaid.” The new law would have extended Medicaid to everyone with incomes up to 133 percent of the federal poverty line ($23,050 a year for a family of four). Aren’t the poor already covered? That depends on where they live. In New York, most adults up to 150 percent of the poverty line are covered; in Texas [and Missouri], Medicaid reaches only to 26 percent of the poverty line — a family of four is not eligible if they earn, say, $9,000 a year. The court ruled that Congress may not require states to expand Medicaid. States can stick to their old Medicaid programs. Stingy states may choose to stay stingy. That part of the decision flew under the media radar. But it is a significant blow to liberals who had a simple way to grow benefits by expanding programs.
Most Favored Nations –
will be introduced next session – this is to ensure an insurance carrier cannot tie your reimbursement to are imbursement schedule you have with another carrier. The Blues have actually taken this one step further and in some cases that
have been reported to me, they require your rate with them be at least 5% less than your lowest contracted amount you have with any other carrier.
This bill narrowly failed, after passing the Senate and House Committee. The bill would have required insurers to complete the credentialing procedure within 60 days. This primarily affects providers practicing in institutions. The “institution” (hospital, rural health clinic, FQHC) is a provider, but a carrier cannot reimburse a recently hired health care practitioner of such institution until the carrier’s credentialing process is completed. This leaves the institution and provider in a tough spot. Patients expect services, but the carrier will not reimburse for the services. This will be a high priority of provider groups again next year. As issues begin to develop, I will distribute a short summary of which legislators are involved and what issue they are promoting.