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CO ACEP President's Corner
Anna Engeln, MD, FACEP
If you don’t have a seat at the table, there is a chance you might be on the menu. -Senator Warren
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I just returned from the ACEP Leadership and Advocacy Conference in Washington DC, and I am thankful that we have a seat at the table. The legislative sessions at both the state and national level have been a whirlwind with all hands-on deck. As emergency medicine physicians, we are in a unique position to experience the impact that legislation has on our communities. Thus, I am grateful for the opportunity to share such insights with our legislators making the decisions that impact us and our patients. Our seat at the table allows us to share your stories from around the state, and your COACEP board members have been working diligently to advocate for our specialty and our patients.
Emergency medicine physicians are often the earliest and most frequently impacted by changes in healthcare whether it is at the hospital, system, state, or national level. This frontline vantage point gives us the opportunity to be the advocate, the fixer, and the brainstormer. We help find the solutions that work at the state and national level.
During this most recent session, we were able to advocate at the national level for the creation of a task force to look at all the variables that impact boarding. As we know this has significantly impacted our abilities to care for our patients. We also encouraged our representatives and senators to support the “Improving Access to Mental Health from the Emergency Department Act” (S. 1346) that would bring more resources for psychiatric care, including expanding availability of inpatient psychiatric beds, and hopefully impacting hospital boarding by having more appropriate resources available for our patients experiencing acute mental health crises.
We also stressed the importance of supporting the “Workplace Violence Prevention for Health Care and Social Service Workers Act” (H.R. 2663/S. 1176) and the “Safety from Violence for Healthcare Employees (SAVE) Act” (H.R. 2584) to help protect healthcare providers from violence in the workplace. We feel this legislation is imperative given that over two-thirds of emergency physicians reported being assaulted within the last year alone. Making sure our experiences are understood at the local and national levels is key to making our emergency departments safer for us and for our patients.
We additionally discussed physician reimbursement, as Medicare does not have an inflationary update for the Physician Fee Schedule (PFS) as it does for other Medicare providers such as hospitals or SNFs. We asked for support of the “Strengthening Medicare for Patients and Providers Act” (H.R. 2474) which would provide an inflationary update for the PFS. Also discussed was the impact of the No Surprises Act, as the effects and interpretation of its implementation is being negotiated out at the national and state levels. Finally, we advocated for additional support to navigate the opiate crisis so Colorado can continue to be a leader in this important arena.
At the state level, CO ACEP fought hard to protect physician-led care for the patients of Colorado. Although SB23-083 addressing Physician Assistant Collaboration Requirements passed, in conjunction with CMS, we were able to help ensure some important changes. Among these important amendments are:
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PA shall be liable for the care they provide.
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PA must complete 5000 hours of supervised practice (3000 hours if changing specialties) before a collaborative agreement can be considered and potentially longer in the Emergency Department setting.
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Level I and II trauma centers will maintain a supervisory relationship with PAs indefinitely.
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The “employer” for a collaborative relationship must be a physician actively practicing in Colorado.
We will continue to work hard to promote physician-led care for our patients, as the breadth of knowledge and life-saving skill set provided by Emergency Physicians is essential for patients.
Finally, we were involved in the Extreme Risk Protection Order Petition (SB23-170) that expands those that are allowed to place an Emergency Protection Order when there is a concern for harm to self or other to include licensed medical care providers, licensed mental health-care providers, licensed educators, and district attorneys. During these discussions, we advocated to maintain patient privacy rights and well as protect physician liability throughout the process.
I am continually humbled to work with such incredible and creative physicians as we navigate the challenges of emergency medicine. We are the front door for our communities and our door is always open. Your lived experiences concerning how boarding, workplace violence, compensation disparities, and shifting scope of practice have affected you and your patients help us paint the picture to our legislators to find the solutions to the problems we experience every day. Your continued support of COACEP enables us to have a seat at the table to share your experiences for positive change. This advocacy is essential to keep our specialty strong so we can continue to positively impact the lives of our patients.
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From the Capitol
Dan Jablan
CoACEP Lobbyist
It is important to begin by thanking the dedicated members of the CO ACEP legislative committee and those members who came to the Capitol to testify.
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When a Colorado EM physician comes to the Capitol, legislators pay attention. That said, midnight on Monday, May 8th could not have come soon enough. The Colorado Constitution grants the Colorado General Assembly 120 days each year to complete the State’s work. May 8th marked the 120th day.
Considering the political polarization of this General Assembly, CO ACEP was able to carefully navigate the 680+ bills introduced into this legislative session. Once again, health care policy was a primary theme, along with TABOR, taxes, housing, guns, abortion, and state versus local control of land use to name a few. Your CO ACEP identified 73 bills impactful to the practice and profession of emergency medicine and it’s patients.
This session we:
- Drove amendments ensuring appropriate collaboration between physicians and physician assistants (SB23-083)
- Responded to the opioid crisis with appropriate treatment for patients with chronic pain (SB23-144)
- Protected physicians from unnecessary processing fees when being reimbursed for billed claims (HB23-1116)
- Beat back efforts from trial lawyers that would have increased rates, number of settlements and exposed physicians to personal liability (HB23-1192)
- Ensured EM physicians were not in put a position to violate EMTALA by being forced to discuss costs of care prior to the provision of emergency care (SB23-093)
- Successfully advocated to allow EM physicians to petition for an extreme risk protection order (SB23-170)
Our focus has already shifted to preparation for the 2024 legislative session. As we look forward it is important to remember that the same 100 legislators and first floor participants (aka the Governor and his staff) will be coming back next year, therefore we can expect much of the same. The CO ACEP Board of Directors is actively involved in a coalition to preserve Colorado’s non-economic damages caps which are currently under threat as well as pursuing legislation to remove roadblocks impeding Colorado EM physicians from providing the highest quality care to their patients.
The strength of CO ACEP’s advocacy lies within our members. If you are interested in shaping the future advocacy of CO ACEP, we encourage you to become involved. Additionally, I encourage you to contribute $50 to the CO ACEP small donor committee. With the contribution of your time and $50, CO ACEP can continue to preserve and promote emergency medicine in Colorado.
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Leadership & Advocacy Conference '23
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Rebecca Kornas, MD, FACEP
President Elect CO ACEP
“There are three types of people:
Those who watch things happen.
Those who wait for things to happen.
And those who make things happen.”
-Chris Kang - 2023 National ACEP President
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Pictured: From L to R - Dr. Jasmeet Dhaliwal, Dr. Rebecca Kornas, Dr. Ramnik Dhaliwal, Dr. Anna Engeln
With this galvanizing opening to the conference, the physicians attending the ACEP Leadership and Advocacy Conference (LAC) began on a day of preparing for our day of advocating on the hill. Doctors Jamie Dhaliwal, Ricky Dhaliwal, Anna Engeln, Vidor Friedman, Rebecca Kornas, and Don Stader were the members of our Colorado ACEP contingent at this year’s LAC.
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Pictured: From L to R - Dr. Don Stader, Dr. Anna Engeln, Dr. Jasmeet Dhaliwal, Dr. Vidor Friedman, Dr. Ramnik Dhaliwal, Dr. Rebecca Kornas
This year our asks focused on:
- Boarding: Encouraging our representatives and senators to sign onto a bipartisan Dear Colleague letter to form a Task Force to delve into the complex forces that combine to create inpatient boarding.
- Mental Health: For legislators to cosponsor a bill, “Improving Mental Health Access from the Emergency Department Act” currently introduced by Reps Dr. Raul Ruiz and Brian Fitzpatrick and Sens Shelly Moore Capito and Maggie Hassan to increase Mental Health access by appropriating $25 million to mental health care.
- Workplace Violence: To cosponsor the “Workplace Violence Prevention for Health Care and Social Service Workers Act” and the “Safety from Violence for Healthcare Employees (SAVE) Act” Key in advocating for this was sharing personal stories of life working in the ED. Of the six Colorado emergency physicians who advocated at our nation’s capital, all of us had been the victims of physical violence while on the job in the ER. It is shocking, yet not that surprising that health care workers (HCW) are the victims of >50% of all workplace violence. The SAVE bill asks for federal penalties for violence against HCWs which criminalize intentional assault or intimidation that are similar to those of our other civil servants (police, firefighters, TSA), while also providing guardrails to protect individuals who may be mentally incapacitated due to illness or substance abuse.
- Medicare Inflationary Adjustment: The last increase to the Medicare Physician Fee Schedule (PFS) occurred in 1996. An analysis conducted by ACEP found that Medicare payments have decreased by 53% when compared to inflation between 1992 and 2016, and reimbursements have only gotten worse since then. A bill “Strengthening Medicare for patients and Providers Act” currently sponsored by a cadre of physician legislators, Dr. Raul Ruiz (EM), Dr. Ami Bera (IM), Dr. Larry Buschon (Cardiovascular Surgery), and Dr. Miller-Meeks (Optho) is aiming to establish an inflationary update in the Medicare Physician Fee Schedule based on the Medicare Economic Index (MEI). Effectively, offering increases yearly that are commensurate with inflation.
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We met with staffers for Reps. Jason Crow and Dianne DeGette and Sens. John Hickenlooper and Michael Bennet. All our legislators we chatted with had supported the previous workplace violence bill and were interested in helping with next steps to protect our health care team.
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Pictured: From L to R Dr. Don Stader, Dr. Jasmeet Dhaliwal, Dr. Rebecca Kornas, Sen. Michael Bennet, Dr. Ramnik Dhaliwal, Dr. Anna Engeln
Our day on the hill culminated at a local pub where we were able to rub elbows (literally) and discuss these issues with Senator Bennet, himself. We are lucky in Colorado to have such a smart, thoughtful, and well-informed Senator.
During our time at LAC, our team all had conversations with the leaders of ACEP, past presidents, board members and current presidents. This is like adult summer camp for advocacy. It is the place where relationships that last a lifetime are made and solidified.
You leave this conference with the fire in your blood to make a difference.
“We are the ones we’ve been waiting for, and we are the ones who will make the change.” - Chris Kang
Next year, LAC will be back in DC April 14-16, 2024. I invite you to join us. Oh and of course, if you are not yet an ACEP Member, join ACEP. Here is a handy link: https://www.acep.org/membership/membership/join-acep/payment-options/.
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Forensic Center of Excellence Grand Opening
Allison Trop, MD, FACEP
Immediate Past President CO ACEP
On April 19 the Grand Opening of the Forensic Center of Excellence at UCHealth Memorial Hospital Central in Colorado Springs was celebrated.
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This is a specialized unit within this Level 1 Trauma Center emergency department that is dedicated to the treatment of victims of physical and sexual violence. The unit features 5 exam rooms with specialized equipment for forensic exams, dedicated space for law enforcement, conference rooms, a telehealth hub and more. It was designed with trauma informed care in mind, a calming color palette and clean lines. This is the first unit of its kind in the nation.
The development of this space was made possible by a $3 million grant awarded to the forensic program at Memorial Hospital Central by the state of Colorado last year. The program will be able to provide telehealth services to 15 rural sites in the state, continue to be the hub for training of forensic nurses throughout the state with the Colorado SANE/SAFE Project, see victims of violence in the Colorado Springs area, and much more. Last year alone this program had nearly 3,000 patient encounters and has made a huge impact on the community.
The celebration was attended by several VIPs. The founder of the specialty of forensic nursing, Virginia Lynch, was present and was thrilled to see her vision for the profession being fulfilled 40 years after she pioneered this work. Jennifer Pierce-Weeks (CEO of the International Association of Forensic Nurses), Kelly Kissell (Colorado Office of Victims Programs), and Kristina Rose (director of the National Office for Victims of Crime in Washington, DC) were also in attendance.
For more information on the services offered or training please visit the project website.
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CPHP Remains Your Peer Assistance Provider
Sarah Early, PsyD,
Executive Director
Considering the tremendous challenges faced over the past couple of years, Colorado Chapter of ACEP wants to support every member physician to be healthy and at their best. The Colorado Physician Health Program (CPHP) remains the confidential, free of charge Peer Assistance Provider for all medical licensees. View this brief video that overviews CPHP’s services, as well as how confidentiality is paramount to the program. CPHP is your resource when dealing with burnout, stress or other health related problems and has helped nearly 700 clients during the last fiscal year (more details in the CPHP 2021-2022 Annual Report). ACEP-Colorado is proud to partner with CPHP to promote and advocate for health and wellbeing initiatives that assist physicians be their best. Hear what a Colorado physician, Dr. Smith*, had to say about his experience with CPHP.
My compassionate nature and interest in helping others drove my desire to become a physician. I knew that being able to connect with patients and their families during their most vulnerable time, along with a curiosity for the field of medicine would help me persevere through medical school. Exhaustion was inevitable during this time, but I was unaware that later in my career I would struggle with additional symptoms causing physician burnout.
As a seasoned Family Practice physician during the COVID pandemic, I was starting to feel the effects of the long hours and the demands required by our profession. I was also lacking enjoyment and satisfaction with the job I once treasured. Going to work simply felt like a chore. I had lost my love for medicine. Simultaneously my wife and I were struggling with marital difficulties, adding further stress that led to isolation.
Having practiced medicine for over twenty years and through my malpractice insurance carrier, I was familiar with CPHP. As a licensed physician, I knew I could self-refer but I was under the impression that CPHP only helped practitioners with Substance Use Disorders. I called CPHP to inquire about their services and learned they help physicians with any health condition affecting their ability to practice medicine safely. I also learned that CPHP could help me.
The team of professionals at CPHP were professional, understanding, and efficient. They helped me realize that meeting with a therapist skilled in working specifically with physicians would be beneficial to my career and my marriage.
With their support and perspective, my love for medicine returned. I recognized that in order to provide the best possible care to my patients and their families, I also needed to care for myself. I introduced new hobbies, started an exercise regimen and was able to develop better coping mechanisms for handling occupational and marital stress. I felt grounded and optimistic about my future and am happily practicing medicine today.
*Client’s name is changed to protect his anonymity.
Physicians may reach out to CPHP at 303-860-0122 to discuss if a referral is the right course of action for you. In addition, CPHP may provide physician wellness presentations to address burnout and other occupational challenges that medical providers face in remaining well. CPHP because Healthy Doctors Give Better Care.
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Upcoming Events Calendar
CO ACEP 2023 Board of Directors’ Meeting Schedule
- May 24, 2023, 12pm – 2pm – Board of Directors
- July 26, 2023, 12pm – 2pm – Board of Directors
- September 27, 2023, 12pm – 2pm – Board of Directors
- November 2, 2023, 11am – 1pm – Board of Directors, Park Hyatt Resort and Spa in Beaver Creek. CO
Additional Important Meeting Dates
- April 30 – May 2, 2023, ACEP’s Leadership and Advocacy Conference – Washington DC
- October 6 -9, 2023 ACEP’s 2023 Council Meeting, Philadelphia PA
- October 9 -12, 2023 ACEP’s Scientific Assembly – Philadelphia PA
- November 2, 2023, 1:00pm – 5:00pm, Park Hyatt Resort and Spa in Beaver Creek. CO
- November 3, 2023, 8am - 5pm CME Program “High Risk - Do Not Miss” in Beaver Creek, CO
For more information about participating in any of the meeting listed above, please contact CO ACEP Executive Director Suzanne Hamilton at suzanne.acep@comcast.net.
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Graduating in June? Renew Today. Get Discounted Dues, and Stay Involved
Congratulations on your upcoming graduation! ACEP and CO ACEP have been with you throughout your training, and we’re excited to stay by your side as you continue your EM journey. ACEP is the only EM organization that invested $1M+ of our member dues dollars to push back on scope creep. ACEP is currently involved in – not one, but nine -lawsuits to protect your autonomy and reimbursement. We also know money is tight. That's why ACEP discounts dues 75 percent in your first year after residency or fellowship. Help us stay in the fight, Renew Today.
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FROM NATIONAL ACEP
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Take Action
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Urge your Representative to help the ED boarding crisis. Our hospital emergency departments (EDs) have reached or are past the breaking point. Ask your House member to sign a bipartisan congressional “Dear Colleague” letter urging the Administration to swiftly convene an ED Boarding Task Force with broad stakeholder representation. The more legislators that sign onto the request to the Administration, the more likely it is that they will make it a priority! The letter closes on May 24 so we need your immediate action. Click here to take action.
Urge your legislators to cosponsor two bipartisan bills to address violence in the ED:
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ACEP Resources & Latest News
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New Indiana Bill Requires Hospital EDs to Have a Physician On Site. Indiana recently passed legislation that will require every emergency department in the state to have a physician onsite and responsible for the ED. Thanks to the tireless advocacy of Indiana ACEP, patients who need emergency care across the state of Indiana now have reassurance that a physician will be in the emergency department at all hours to provide high quality patient care. Read more.
As the situation with Envision develops, ACEP is focused on you - the emergency physician. We continue to monitor the transition closely and will ensure our members are empowered in their next steps. If you need help, view these resources.
How does advocacy affect reimbursement? Jordan G. R. Celeste, MD, FACEP, ACEP's RUC Advisor, gives a helpful overview in this regulatory blog post.
CONGRATULATIONS to the winners of ACEP's 2023 Leadership & Excellence and Council Awards!
This week, ACEP’s Well-Being Committee and Wellness Section invite you to participate in quick, daily challenges to mark EM Wellness Week. Today's focus is all about celebrating the small stuff. Intentionally seeking things to celebrate, however small, can increase your sense of wellbeing and life satisfaction.
It's EMS Week, and you are invited to this educational opportunity focused on EMS and pediatric patients:
Have you checked out the new asthma point-of-care tool? Asthma Exacerbation in the ED, available on acep.org and the ACEP Mobile app, walks through clinical features, pharmacologic treatments, life-threatening presentations, pediatric and pregnant considerations, discharge planning and more.
Join the Climate & Energy MIG to study and implement ways to decrease the carbon impact of our specialty. This new group has an interest in combating climate change, decreasing the use of single-use plastics in medicine and those who see the connection between climate change and global health.
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Upcoming ACEP Events and Deadlines
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May 21-27: EMS Week
May 21-27: EM Wellness Week
May 25: Last day to submit comments on Severe Agitation policy draft
July 25: Last day to apply for the Annals of Emergency Medicine Resident Fellow
Oct 9-12: ACEP23 Scientific Assembly, Philadelphia, PA
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Colorado Chapter ACEP
1520 W Dry Creek Rd.
Littleton, CO 80120
© 2023 Colorado Chapter ACEP. All rights reserved.
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