We invite you to take advantage of this unique opportunity to have a conversation with Dr. Rosenberg and Sue Sedory. What keeps you up at night? What do you see as a pressing issue that ACEP can work on to advance our specialty or protect it, or to improve the care we deliver to patients?”

Because most of our time together will be spent hearing from you, you can catch up on the latest from ACEP in the "From ACEP" section of this newsletter. In addition, if you haven’t seen Dr. Rosenberg or Sue's address to the Council in October where they discuss ACEP’s recent accomplishments and strategic initiatives for the year ahead, you can view them here:

Dr. Mark Rosenberg's 2020 address to the ACEP Council

Sue Sedory's 2020 address to the ACEP Council

If you have a specific question you would like asked or issue you would like addressed, please email it to paige@utahmed.org as soon as possible so we can provide it to ACEP in advance.

We look forward to hearing from you on February 16th!

UCEP Summit 2021

The annual UCEP Summit is slated for April 28th, 2021 and will be held in a virtual format this year. We are thrilled about the speaker series we have lined up, as well as the LLSA review. The Summit also provides FREE CME for all UCEP members. Please email Paige de Mille at paige@utahmed.org to register and mark the date on your schedule to virtually attend.

Speakers include the following:

Dr. Amal Mattu – University of Maryland School of Medicine
Dr. Megan Ranney – Brown University and Rhode Island Hospital
Dr. Jacob Avila – University of Kentucky
Dr. Robert Stephen – University of Utah

Leadership and Advocacy Conference 2021

New Dates: July 25-27

Have a Voice on Capitol Hill! Come together for ACEP's Leadership & Advocacy Conference (LAC) to celebrate emergency medicine’s accomplishments and continue to work for a better political environment for your specialty and your patients. First-timers to the conference will be trained to educate your Members of Congress while seasoned participants will build upon your already-valuable Congressional connections. We’ll tackle problems facing our specialty, develop tools to advocate at all levels, and build relationships with your Members of Congress. All while having a good time!

Approved for AMA PRA Category 1 Credit™

Go to LAC (acep.org) for more information and to register.

Several of your UCEP board members attend this conference every year and highly recommend it! In the past few years, we have had the opportunity to speak in a small, intimate setting with Senator Mike Lee, Representative Chris Stewart, and many legislative aides to advocate for our specialty and our patients in Utah.

Statewide Emergency Medicine Journal Club

Intermountain Healthcare and UCEP have been collaborating on development of a statewide Emergency Medicine quarterly journal club that is now open to all UCEP members with FREE CME. Selected articles focus on current or “hot topic” peer-reviewed studies with potentially practice-changing ideas. Three articles are presented by various EM physicians from Utah each month with subsequent discussion guided by participants and moderators. The next event will take place on March 2nd from 9-10:30 am, so save the date and please keep an eye out for an invitation in your inbox.

X-Waiver Changes Potentially Coming Down the Pipeline

The U.S. Department of Health and Human Services (HHS) released practice guidelines on January 14, 2021 that created a broad exemption to the current “X-waiver” requirement for physicians prescribing buprenorphine for the treatment of patients with opioid use disorder (OUD). Removing the X-waiver has been a top priority for ACEP, and while fully eliminating this requirement requires legislation from Congress, we believe the practice guidelines represent a critical intermediary step as we wait for Congressional action. Therefore, ACEP immediately issued a press statement praising the move. 16 organizations signed a letter to the Department of Health and Human Services (HHS) praising the move they were expected to make in dropping the X-waiver requirement.

However, this may have been premature, as HHS and the Office of National Drug Control Policy (ONDCP) announced in late January that the guidelines were released prematurely and “cannot be issued at this time.” HHS and ONDCP also state that they are “committed to working with interagency partners to examine ways to increase access to buprenorphine, reduce overdose rates and save lives.” While this is definitely disappointing news, ACEP will keep up the fight to X the X-waiver! On the bright side, we do have the upcoming changes to the “Three-day Rule” to look forward to, which (once finalized in June) will allow health care practitioners to dispense a three-day supply of buprenorphine to one person at one time.

You can read the full article here: ACEP // X-ing the X-Waiver: The Fight Continues!

ED Jail Clearance Standardization and Improvement Project

Led by UCEP President Dr. Alison Smith, the UCEP BoD has created a task force that is working with state law enforcement officials and correctional facilities to improve the process of medical screening exams for patients brought to the ED to be “cleared” medically before they are taken to jail or prison. Physicians statewide have encountered various challenges when caring for the arrested patient and understanding of what has often been referred to as “medical clearance for jail” is limited. Communication with other state chapters has confirmed that these challenges are not unique to Utah and are common around the country.

UCEP hopes to be a leader in the movement to standardize this process in order to ensure patients are receiving the correct type of care and maintaining their legal rights, that EM physicians are more protected from liability in this situation, and that hand off communication of prisoners with correctional facilities is improved. We also hope to eliminate some of the ambiguity, discordance, and uncertainty in the processes that currently exist for “jail clearance” encounters in the ED.

If you have an experience you want to share related to this issue OR are interested in serving on the ED Jail Clearance Task Force, please reach out to UCEP President Alison Smith so we can hear your input and/or get you involved.

Physicians in the Utah Legislature

UCEP expresses a heartfelt congratulations to Dr. Mike Kennedy (Family Medicine, Utah County) and Dr. Rosemary Lesser (retired OB/GYN, Weber County), both of whom were elected to the Utah Legislature this session. Dr. Kennedy will be a Utah State Senator and Dr. Lesser a Utah State Representative. We look forward to working with Dr. Kennedy and Dr. Lesser in the coming session and hope we will have their support to work on initiatives that protect our patients from unfair billing practices on behalf of insurance companies, ensure gender equality in physician pay, address Medicaid and Medicare reform, protect physicians from delayed or compromised care due to COVID-19, and other issues affecting our patients, physicians, and other healthcare workers in Utah.

Ultrasound Hot Topic with University of Utah Ultrasound Fellow, Dr. Neil Krulewitz

Neil provides a breakdown of a recent paper published regarding the role of ultrasound (US) in the diagnosis of diverticulitis. A Prospective Evaluation of Point-of-Care Ultrasonographic Diagnosis of Diverticulitis in the Emergency Department, Cohen et al, Ann Emerg Med online 9 July 2019

Overview: The study enrolled over 400 patients, and all patients got CT scans. They required the presence of ALL of the following US criteria to make the diagnosis:

Bowel wall edema > 5mm surrounding a diverticula (outer wall to inner wall of bowel)
Enhancement of the surrounding peri-colonic fat (fat stranding)
Sonographic tenderness to palpation.

Results: The authors found that compared with CT (considered gold standard in this study), US had a sensitivity of 92%, specificity of 97%, PPV of 94%, and NPV of 96%. There were some false positives and false negatives, which were mostly related to necessitating presence of all of the diagnostic criteria.

Limitations: This study was somewhat limited by scans being performed by only US-trained fellows and faculty, and nearly all the scans being performed by five "highly-trained" US faculty.

Neil’s takeaways:

Is this practice changing? Maybe. I think that POCUS might play a role in the right patient. Patients who are well appearing, with no large leukocytosis or other concerning factors (high fever, HD instability), particularly those with a history of diverticulitis, probably don't need any imaging at all. We've been seeing these patients and discharging with presumed diverticulitis for a long time. POCUS might help clinch the diagnosis, but it's probably not necessary.
In patients for whom the diagnosis is uncertain (no history of diverticulitis, for example), and who are well appearing without concerning features, POCUS might help make the diagnosis and prevent CT.
In patients with any concerning features (large leukocytosis, high fever, exquisite pain, etc.), I'd probably be inclined to CT those patients, particularly > 50 years old, to evaluate for complicated diverticulitis, phlegmon, abscess, perf, etc.

Seeking UCEP Physician Leader and Member to Serve to Work with ACEP to Develop Alternative Payment Models for Reimbursement

Dr. Peter Serina from the ACEP State Legislative and Regulatory Committee is seeking a Utah physician leader with a strong interest in reimbursement issues to be his point of contact for the state. ACEP is looking to coordinate with state chapters on bringing information to Medicaid Directors regarding our ACEP-developed alternative payment model, the Acute Unscheduled Care Model (AUCM). He states, “Ultimately, we'd be looking to get data and talking points to your chapter [UCEP], so together with this reimbursement leader or others you might identify, they could have a meeting with the UT Medicaid Director to discuss applying the model to the Medicaid population.”

If interested in working with Dr. Serina and representing Utah, please contact UCEP President Alison Smith.

Welcome New UCEP Members!

Craig B Cowan, II, DO

Todd J Davis, MD

Timothy R Fuller, MD

Robert W Graham, DO

Rok Richard Holmes

Joeann K R Leong, MD

Nathan Miller, MD

Andrew Oldroyd, MD

Austin Alan Poulson

Saeed Shihab

L Scott Van Wagoner, DO

Sydney Woods

Michael Scott Young, MD

FROM NATIONAL ACEP

ACEP Quick List: Upcoming Events and Deadlines

Feb. 17: #RealTimeVaccineChat happening on Twitter (2 p.m. CT)

Feb. 17: Free webinar focused on vaccine hesitancy (3 p.m. CT)

Feb. 18: Free webinar: The EMTALA Complaint Process (2 p.m. CT)

Feb. 24: Virtual Grand Rounds – "Simulation: OB Emergencies with EMRA"

March 1: Nominations due for ACEP Leadership Awards and Wellness Center of Excellence Award

March 14: Applications due for EM Innovators of the Year competition

March 22: Nominations due for ACEP Board of Directors, Council Office

April 19-21: Virtual Advanced Pediatric Emergency Medical Assembly

July 25-27: Leadership & Advocacy Conference (Washington, DC)

Stay current with the COVID-19 Center. It's your one-stop-shop for clinical and legislative updates.

New Resource: COVID-19 Data Visualizations

ACEP's newest resource provides visualizations of U.S. emergency department data across three categories: total visits, COVID-like illness visits, and influenza-like illness visits. The data are available at both national and Health and Human Services (HHS) regional resolutions and across several timescales (e.g., 7-day, 30-day, 90-day). It's sortable by time and region. Data is updated weekly. View the visualizations.

Vaccine Hesitancy Webinar: Register for “This is Our Shot: How EM Docs Empower Patients to End the Pandemic,” a free webinar hosted by ACEP's Diversity, Inclusion and Health Equity Section at 3 p.m. CT on Feb 17. Speakers: Pilar Ortega, MD; Ugo Ezenkwele, MD, MPH, FACEP and Robert Rodriguez, MD. Moderated by: Tracy MacIntosh, MD, MPH, FACEP.

The February 10 edition of the Capital (30) Minutes webinar provided updates on COVID relief, physician mental health and more.

Quick Links: COVID-19 Field Guide | COVID-19 Vaccination Toolkit | COVID-19 Microlearning Education

The COVID-19 Crisis is Uniquely Exhausting - ACEP Can Help

It’s vital to prioritize your own mental health and this is an especially vulnerable time of year in an extremely stressful environment. Take advantage of these resources whenever you need them:

Did you know your ACEP membership comes with three free counseling or coaching sessions available through phone, text or online chat? And for a small extra fee, you can add on financial and/or legal assistance.
The Physician Wellness Hub can help you find the right support, whether you’d like to talk with a peer or a professional counselor.

It’s a great time to gently check in with your friends, family and colleagues. Worried about saying the wrong thing? Read these peer support basics.

Want to remind your team about on-site support options? Create a mental health care access map. Already have one? Resend the map so your coworkers know how to find support during the challenging weeks ahead.

ACEP hosted two Theater of War performances in 2020 and recently partnered with the Infectious Disease Society of America on a podcast discussing how these performances can help EM physicians process the unprecedented hardships of working in the ED during a pandemic. Learn more.

Last but not least: If you’re passionate about peer support in emergency medicine, we invite you to join ACEP’s Peer Support Project.

Regulatory News

Answering Your Questions About the New Medicare Add-on for MAT in the ED

EM physicians can start getting reimbursed by Medicare for MAT services you deliver in the emergency department (ED)! This is a policy that ACEP strongly advocated for and helped secure in the 2021 Medicare physician fee schedule regulation (the major annual reg that impacts Medicare payments for physicians and other health care practitioners). In that reg, the Centers for Medicare & Medicaid Services (CMS) finalized a proposal to create a new add-on code for MAT (G2213) that can be billed in addition to an ED evaluation and management (E/M) code during an ED visit. READ MORE

Catch up on the latest federal regulatory news with ACEP's Regs and Eggs blog:

Breaking Down President Biden’s Executive Order on Strengthening Medicaid and the Affordable Care Act - February 4
X-ing the X-Waiver: The Fight Continues! - January 28, 2021
At the Buzzer! CMS’ Last Minute Regulatory Actions - January 21, 2021
Major Crisis Averted (for Now): Rather than Medicare Payment Reductions, a Raise May be Coming Your Way In 2021 - January 7, 2021

ACEP Member Resources

Prepare for your continuous EM board certification with Critical Decision's 2020 LLSA Literature Review issue (free member benefit). Get the highlights from each ABEM article to make your studying faster and more productive.

Podcast fans: ACEP's podcast family includes Frontline, ACEP Now, Annals of EM, Critical Decisions and JACEP Open + EMergence, a new EM innovation podcast.

Latest Pain Management and Opioid-Related Resources:

Latest Frontline podcasts: ACEP Pain and Addiction Care in the ED (PACED) Program with Dr. Alexis La Pietra and Cathlyn Robinson & California Bridge Program with Dr. Alicia (Kurtz) Gonzalez
ACEP's Managing Acute Pain (MAP) point-of-care tool was recently updated. It's available on the ACEP website and within the emPOC app (Mac App Store or Google Play).

PEER Can Help You Cram for the ConCert Exam

Getting ready for the spring ConCert Exams? ACEP has tools that can help! PEER is the leading resource for review and self-assessment. You can check your readiness with a free PEER pretest. Learn more.

Save the Dates: Virtual PEM21 and LAC21

ACEP's Annual Leadership & Advocacy Conference is now scheduled for July 25-27 in Washington, D.C. This is your chance to advocate for your specialty, engage with new members of Congress and connect with your peers. Join the Interest List for updates.

While you're marking your calendars, make plans to join us for this year's Virtual Advanced Pediatric Emergency Medical Assembly April 19-21, 2021. Learn what's new and gain the skills you need to take on your next pediatric emergency.

CORD 2021 Academic Assembly

CORD is excited to launch its ‘Virtually Unstoppable’ Academic Assembly on April 12-15, 2021. Registration information coming soon! Visit www.cordem.org for updates.

From the Emergency Medicine Foundation:

Show your love for EM research this Valentine's Day! For every EM practitioner who watches this video, Vapotherm will donate $10 ($20 per EM resident) to the Emergency Medicine Foundation.
EMF and AFFIRM have announced a new $40,000 grant in honor of Dr. Tamara O'Neal. Apply by March 31.

News From ABEM

ABEM Issues Statement on its Commitment to Maintaining Certification Standards

Feb 08, 2021

The American Board of Emergency Medicine (ABEM) understands that this past year was particularly challenging for emergency physicians, especially early career physicians. Every physician member of the ABEM Board of Directors is clinically active and understands the disruptions caused by the COVID-19 pandemic. The disruptions affecting our specialty have also affected ABEM certification. Read the full statement here.

Utah Chapter ACEP

310 E 4500 South #500

Salt Lake City, UT 84107

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