Spring 2013 Issue

Kentucky Chapter ACEP

Spring 2013

Kentucky Chapter ACEP

Ryan Stanton, MD, FACEP
President

Ashlee Melendez, RN, MSPH
Executive Director

Contact us: 
ky.chapter@acep.org

Phone: 502-852-7874
Fax: 502-852-0066

From the President
Ryan Stanton, MD, FACEP

It's Official...

Well, it's official. The "Pill Mill Bill" which was HB1 and became HB217 which was translated via the KBML "Emergency Regulations" into the "Regular Regulations" is now in place. Thus, it is key that you familiarize yourself with the regulations and law which can be found on the KBML website (www.kbml.ky.gov). We will provide "cheat sheets" of the regs on the KACEP website and I am happy to help with any questions you have as well. Here are the highlights..

  1. Every licensed provider with a DEA must open and maintain an active KASER account.
  2. We are exempt for orders and controlled substances administered directly to patients in the ER.
  3. For any prescription at discharge, you must perform a KASPER and meet all documentation requirements.
  4. Must provide written consent and appropriate education on controlled substance prescriptions.
  5. "Shall Not" administer IV controlled substances for exacerbations of chronic pain.*
  6. "Shall Not" provide replacement doses of methadone, suboxone, or subutex.
  7. "Shall Not" provide replacement prescriptions for lost, stolen, or destroyed prescriptions.
  8. "Shall Not" prescribe long acting or controlled release controlled substances.
  9. "Shall Not" administer meperidine.
  10. "Shall Not" prescribe more than medically necessary or more than a 7-day supply.*
  11. "Shall Not" provide refills on controlled substances.
  12. Must complete 4.5 hrs of KBML approved CME on topics every 3 year cycle.

*- Unless absolutely necessary or the only viable option and any variation in the standards must be clearly documented in the chart as to the "what and why" of your choice.
#- This is not comprehensive, so please review the complete regulations.

It is key to know the law and the regs, but let me tell you that countless people have worked tirelessly to clean up this legislation and make it as "ok" as possible. We will continue to do this ongoing.

US Representative Andy Barr and Ryan Stanton, MD, FACEP
 
Penne Allison; Ted Qualls, MD; US Rep. Andy Barr; Ryan Stanton, MD, FACEP

I did have the opportunity to attend the first "2013 Symposium for Medical Professionals: Kentucky Medical Communities UNITEd" held at Morehead State University. It is a live event which features KBML, KASPER, and substance abuse professionals that not only fulfills the 4.5hr CME credit but also provides some great information on the law, regs, and the problem. There are at least 3 more scheduled around the state with online version planned. The event is free and you can find details on the KMBL and CECentral websites.

In other news, we hosted US Representative Andy Barr at the University if Kentucky ER's a few weeks ago. He was very interested in what we do and very impressed with the work of the ER community and the University of Kentucky. In fact, he wants to come back in and shadow a shift. This is important because Mr. Barr has co-sponsored some legislation addressing EMTALA care and promises to be an ally for emergency medicine. I would encourage you to invite your local, state, and federal representatives to your ER so they can better understand the incredible work you do every day. Party affiliation is not important, it is the support of our profession, our work, and most importantly our patients. We welcome all, regardless of "side of the isle", of they support the efforts of emergency medicine and healthcare.

I always welcome your thoughts, assistance and questions. Please help us support KACEP and emergency medicine in Kentucky. These years are pivotal for healthcare and our profession and it's integral that we stand at the forefront to facilitate the changes and progress necessary to ensure the longevity of our profession and the services we provide to our patients.

Thanks,

Ryan Stanton MD, FACEP
President KACEP

Governor Beshear vetoes HB 5
Melissa Platt, MD, Past President

No one would argue that you should be paid promptly for the service you provide as an emergency physician. However I’m sure that if you ask your billing manager/company, you will find that “prompt payment” is not a phase commonly used among some of the Kentucky MCOs. Even Gov. Beshear vowed to “crack the whip” to make sure the billing problem stops. 

Yet, a funny thing happened on the way to the Capital. A bill (HB 5) passed by both legislative bodies that would have set up an administrative review process to sort out disputes between Kentucky’s Medicaid managed care companies and doctors who say they’re not getting paid like they should was vetoed by Gov. Beshear. Yes that’s right, he vetoed it citing possible contractual interference and expanding costs.

Government Affairs
Wes Brewer, MD, Committee Chair

EMTALA AND PAIN MANAGEMENT.

During the past several months as we have struggled to adapt to increasing oversight of our prescribing practices by the state government it seemed logical to inform patients about the new paradigm. Should we not inform the patient that ibuprofen has replaced percocet as the recommended analgesic of choice? As a result the chapter developed a brochure explaining the new rules about prescribing of pain medicines and many ACEP chapters around the country developed similar literature. I am aware of several ED’s around the state that have developed posters for the registration or waiting area that describe policy for prescribing pain medicines. If your facility has such a poster go now to your administration and ask that it be removed immediately. If you use a brochure be sure that it is given as an explanation after the fact, perhaps with discharge instructions but never let it be seen by patients before they are evaluated and have had an appropriate medical screening exam.

The practice came to light when the South Carolina Hospital Association developed a uniform sign for posting in emergency departments across the state describing their pain policy and had the foresight to ask the regional CMS office to comment on its legality. The CMS opinion was that this constituted a clear and unequivocal EMTALA violation. Although this was the interpretation of a regional CMS office and another CMS region could conceivably see things differently, the expert consensus is clearly that this is a dangerous practice. The bottom line for EMTALA compliance is that you may not do anything that might conceivably discourage a patient from seeking medical care. This means that if you see a patient for the third time in 48 hours needing a refill, you will go ahead and do your thorough evaluation sufficient to determine that no emergency medical condition and then EMTALA ends. Then go ahead and bring out the brochures and posters.

I would highly recommend that each of us dig out the April issue of ACEP news and review Dr. Robert Bitterman's “ LEGALESE” column which is an excellent review of EMTALA and severe pain as a presenting complaint.

FYI there is still time to register and attend the ACEP Leadership and Advocacy meeting in Washington, DC May 19 -22.

Emergency and Disaster Preparedness
Tadd Roberts, MD, Committee Chair

Tornado season is upon us yet again. It’s the time of year when we all lay in bed listening to wailing weather sirens and wonder if we are being foolish for wanting a full night of sleep. We can all recite the safety recommendations we hear repeated on the nightly news. “Take cover away from windows.” “Seek a centrally located room.” “Cover yourself with a blanket.” Usually this is the extent of our preparedness.

Tornado season is a yearly spring time ritual we are all accustomed to. With each passing year we are barraged with sirens and news warnings. For most of us, the season will come and go with little local damage. Television news stations will display images of regional municipalities who have been affected directly but without the storm hitting home it is easy to minimize the perceived risk. With each passing year of near misses, complacency develops.

As Emergency Department directors, public safety officials, and front line physicians we have a separate list of responsibilities. The actuality of a severe weather event will bring increased volume, acuity, and challenges to our Emergency Departments. Not only must we be ready for the influx of the acutely injured but also those with chronic conditions whose daily support system has failed amid chaos. Depending on the scale of the event, the medical response may last hours to days.

Now is the time to review hospital emergency procedures, review stock supplies, and ensure rarely used emergency equipment is present and in working order. Take action now. Waiting until the sirens sound will be too late.

Make A Difference: Write That Council Resolution!

Many College members introduce new ideas and current issues to ACEP through Council resolutions. This may sound daunting to our newer members, but the good news is that only takes two ACEP members to submit a resolution for Council consideration. In just a few months the ACEP Council will meet and consider numerous resolutions. 

ACEP’s Council, the major governing body for the College, considers resolutions annually in conjunction with Scientific Assembly. During this annual meeting, the Council considers many resolutions, ranging from College regulations to major policy initiatives thus directing fund allocation. This year there are 357 councillors representing chapters, sections, AACEM, CORD, EMRA, and SAEM.

The Council meeting is your opportunity to make an impact and influence the agenda for the coming years. If you have a hot topic that you believe the College should address, now is the time to start writing that resolution.

I’m ready to write my resolution
Resolutions consist of a descriptive Title, a Whereas section, and finally, the Resolved section. The Council only considers the Resolved when it votes, and the Resolved is what the Board of Directors reviews to direct College resources. The Whereas section is the background, and explains the logic of your Resolved. Whereas statements should be short, focus on the facts, and include any available statistics. The Resolved statement should be direct and include recommended action, such as a new policy or action by the College.

There are two types of resolutions: general resolutions and Bylaws resolutions. General resolutions require a majority vote for adoption and Bylaws resolutions require a two-thirds vote. When writing Bylaws resolutions, list the Article number and Section from the Bylaws you wish to amend. The resolution should show the current language Bylaws language with additions identified in bold, green, underline text and red strikethrough for any deleted text. Please refer to the ACEP Web site article, “Guidelines for Writing Resolutions,” for additional details about the process and tips on writing a resolution.

I want to submit my resolution
Resolutions must be submitted by at least two members or by any component body represented in the Council. The national ACEP Board of Directors or an ACEP committee can also submit a resolution. The Board of Directors must review any resolution from an ACEP committee, and usually reviews all drafts at their June meeting. Bylaws resolutions are reviewed by the Bylaws Committee to ensure there are no conflicts with the current Bylaws. Any suggestions for modifications are referred back to the authors of the resolution for consideration. Resolutions may be submitted by mail, fax, or email (preferred). Resolutions are due at least 90 days before the Council meeting. This year the deadline is July 15, 2013.

Debating the resolution
Councillors receive the resolutions prior to the annual meeting along with background information and cost information developed by ACEP staff. Resolutions are assigned to reference committees for discussion at the Council meeting. You, as the author of your resolution, should attend the reference committee that discusses your resolution. Reference committees allow for open debate and participants often have questions that are best answered by the author. At the conclusion of the hearings, the reference committee summarizes the debate and makes a recommendation to the Council. 

The Council considers the recommendations from the reference committees on the second day of the Council meeting. The reference committee presents each resolution providing a recommendation and summary of the debate to the Council. The Council debates each resolution and offers amendments as appropriate. Any ACEP member may attend the Council meeting, but only certified councillors are allowed to participate in the floor debate and vote. Non-councillors may address the Council at the discretion of the Speaker. Such requests must be submitted in writing to the Speaker before the debate. Include your name, organization affiliation, issue to address, and the rationale for speaking to the Council. Alternatively, you may ask your component body to designate you as an alternate councillor status and permission for Council floor access during debate.

The Council’s options are: Adopt the resolution as written; Adopt as Amended by the Council; Refer to the Board, the Council Steering Committee, or the Bylaws Interpretation Committee; Not Adopt (defeat or reject) the resolution. 

Hints from Successful Resolution Authors

  • Present your resolution to your component body for sponsorship consideration prior to the submission deadline.
  • Consider the practical applications of your resolution. A well-written resolution that speaks to an important issue in a practical way passes through the Council much more easily.
  • Do a little homework before submitting your resolution. The ACEP website is a great place to start. Does ACEP already have a policy on this topic? Has the Council considered this before? 

    What happened?
  • Find and contact the other stakeholders for your topic. They have valuable insight and expertise. Those stakeholders may co-sponsor your resolution.
  • Attend debate concerning your resolution in both reference committee and before the Council. If you cannot attend, prepare another ACEP member to represent you.

I need more resources
Visit ACEP’s website. Review the “Guidelines for Writing Resolutions” prior to submitting your resolution. There is also information about the Council Standing Rules, Council committees, and Councillor/Alternate Councillor position descriptions. Of special note, there is a link to Actions on Council Resolutions. This link contains information about resolutions adopted by the Council and Board of Directors in prior years. 

Well, get to it
Writing and submitting Council resolutions keeps our College healthy and vital. A Council resolution is a great way for members to provide information to their colleagues and ACEP leadership. Please take advantage of this opportunity and exercise your rights as part of our Emergency Medicine community. Dare to make a difference by submitting a resolution to the ACEP Council!

Clinical News

Kids and clots: Expecting the unexpected
In the general pediatric population, annual incidence is around 1 per 100,000. In hospitalized children, the number is much higher - up to 57 per 100,000. Rates of pulmonary embolism and deep vein thrombosis have increased markedly over the past decade, said Dr. Callahan of the Children’s Hospital of Philadelphia.
Read the entire article

How to tell TIA/stroke from mimics
The key to differentiating transient ischemic attacks and strokes from their main mimics - including partial seizures and complicated migraine - lies in the clinical history, Dr. Susan L. Hickenbottom said at the International Stroke Conference sponsored by the American Heart Association.
Read the entire article


New concussion guidelines stress individualized approach
Any athlete with a possible concussion should be immediately removed from play pending an evaluation by a licensed health care provider trained in assessing concessions and traumatic brain injury, according to a new guideline from the American Academy of Neurology.

The guideline for evaluating and managing athletes with concussion was published online in the journal Neurology on March 18 (doi:10.1212/WNL.0b013e31828d57dd) in conjunction with the annual meeting of the AAN. The guideline replaces the Academy’s 1997 recommendations, which stressed using a grading system to try to predict concussion outcomes. 
Read the entire article

Doctors, We Want to Hear Your Stories!

“Untold Stories of the ER” is back for its 8th season on Discovery Fit & Health and TLC. If you have a story to share, we want to hear from you!

“Untold Stories of the ER” features unusual, touching, humorous, critical and lifechanging stories from the ER, told through the eyes of the participating doctors, EMT’s and nurses. Through dramatic reenactments, we bring the events to life, paying close attention to the medical accuracy of each story - making this a television series that everyone involved can be proud of.

The best stories recount surprising medical or personal challenges, deal with ethical or moral issues, involve new or unusual procedures, inspire us, or simply entertain us with insight and humor. We are open to a wide range of ER events, from the life threatening to the light-hearted, from the mysterious to the bizarre.

If your story is chosen, you’ll be asked to appear in an on-camera interview and to spend a day in Vancouver, Canada, recreating the events in our studio.

Please email a short description of each story you’d like to share.

We will contact you, so please include a phone number and return email address. If you have questions, please call Ann Hassett toll free: 1-888-588-3608 x 157.

We Want to Hear Your Story!

The EMF Chapter Initiative - Invest in the Future
John J. Rogers, MD, CPHQ, FACS, FACEP
Chair-Elect EMF

Without research we would still be trephining to let out the evil demons, bleeding to balance the humors and applying grandma’s poultices to wounds. Through scientific investigation we learn, we improve and often turn today’s dogma into tomorrow’s folly. It is our professional duty to ensure we advance our craft and EMF exists to help us on that journey. EMF funds emergency medicine research that develops career investigators, advances clinical care, and provides the basis for health policy. 

EMF historically receives contributions from individual members, corporations, and from Councillors through Dr. David Wilcox’s very successful Annual Council Challenge. However the EMF Board of Trustees believes that Chapters also have a duty to support research and it is on this basis that EMF will promote its new Chapter Initiative.

If each Chapter would contribute a $1 for each member of their Chapter ($1 x total # members) we would collect over $30,000. Although this may seem to be a small amount, it would fund the EMF Resident and Medical Student Grants. These residents and students are our future leaders, our future academicians and our future researchers. A small donation now to help form our future is truly an investment worthy of support.

Great things have small beginnings. Now is the time to plant the seeds of our future. On behalf of the EMF Board of Trustees, we ask the Officers and Directors of each Chapter, to consider making a Chapter contribution to EMF and to do so on an annual basis.

To donate or to learn more about EMF, go to our website or call Cathey Wise, Director of EMF, at 469-499-0296

Welcome New Members

Matthew Allinder, MD Matthew C Lally, MD
Annie-Laurie Auden Daniel Joseph Lumbrezer, MD
William O Baldwin Jessica H Mullins
Joseph E Bales, MD Katherine Marie Nichols, MD
Erin Marie Brumley, MD Robert M O'Bryan, MD
Keevin Bybee Philip W Oliver
Taylor Collins Ravi J Patel
Jennifer A Cotton Justen W Pettigrew
Benjamin Thomas Cunningham, MD Andrew Ramsey
Benjamin James Favier, MD Jeffrey S Rhea
Kean O Feyzeau David J Roach
Sonia D Ford Justin Boone Rose, MD
Joe Grossman Sara Sonali Singhal, MD
James Willis Hickerson, Jr, MD Kory Smith
Adam Matthew Isacoff, MD Wayne Nelson Stark, MD
Richard Karrel, MD Forest P Walker, MD
Patrick T Kehl Amanda M Zhang, MD

 

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Kentucky Chapter ACEP
P.O. Box 2831
Louisville, KY 40201

Copyright © 2009 Kentucky Chapter ACEP. All rights reserved.