ACEP Receives Transforming Clinical Practice Initiative Award From CMS

Press Release:

The American College of Emergency Physicians (ACEP) is one of 39 health care organizations selected to participate in the Transforming Clinical Practice Initiative (TCPI), announced today by Health and Human Services Secretary Sylvia M. Burwell.

ACEP will receive up to $3 million over 4 years to provide technical assistance to help equip clinicians nationwide with tools, information and network support to improve quality of care, increase patients’ access to information and spend health care dollars wisely.

“Supporting doctors and other health care professionals change the way they work is critical to improving quality and spending our health care dollars more wisely,” said Secretary Burwell. “These awards will give patients more of the information they need to make informed decisions about their care and give clinicians access to information and support to improve care coordination and quality outcomes.”
“ACEP is a perfect partner to participate in this critical effort to improve quality and reduce costs for emergency patients,” said Dr. Mike Gerardi, president of ACEP. “Emergency physicians are dedicated to providing the best care for their patients, and this grant is designed to improve early identification and treatment of patients with sepsis, reduce hospitalizations and improve emergency care for patients with chest pain, and support clinicians implementing ACEP’s Choosing Wisely recommendations.”

As a Transforming Clinical Practice Initiative (TCPI) Support and Alignment Network (see definition below), ACEP will support up to 34,000 clinicians to expand their quality improvement capacity, learn from one another, and achieve common goals of improved care, better health and reduced cost. The network will lead quality improvement learning projects to help clinicians reduce costs and improve patient care.

These awards are part of a comprehensive strategy advanced by the Affordable Care Act that enables new levels of coordination, continuity, and integration of care, while transitioning volume-driven systems to value-based, patient-centered, health care services. This award builds on work that ACEP is doing to improve value through projects, such as its Clinical Emergency Data Registry (CEDR), Choosing Wisely initiative and Geriatric Emergency Department Guidelines.

“Emergency medicine plays a critical role in the nation’s health care system, and we are excited to lead this important effort,” said Dr. Gerardi. “We are the only medical providers available 24/7, and more than 130 million patients depend on us each year. ACEP is eager to lead this important effort to help improve their care and the coordination of their care.

The project will be co-led by Arjun K. Venkatesh, MD MBA, MHS, of Yale University School of Medicine and Jeremiah D. Schuur, MD, MHS, FACEP, of Brigham and Women’s Hospital.

“We are excited and honored to work with ACEP to provide emergency departments and emergency providers with innovative solutions, including toolkits, online continuing medical education, benchmarking data and social media communities to accelerate practice transformation that distinguishes the role of the emergency department in our health care system,” said Dr. Schuur. “ACEP has brought together leaders from across emergency medicine into the SAN and will be supported by our new clinical emergency department registry [CEDR].”

For more information on the Transforming Clinical Practice Initiative, please visit: http://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/

CMS defines TCPI Support and Alignment Networks as providing “a system for workforce development using national and regional professional associations and public-private partnerships that are currently working in practice transformation efforts. Utilizing existing and emerging tools (e.g., continuing medical education, maintenance of certification, core competency development) these networks will help ensure sustainability of these efforts. These will especially support the recruitment of clinician practices serving small, rural and medically underserved communities and play an active role in the alignment of new learning.”

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

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New Emergency Room Social Workers Address Critical Needs of High Risk Patients

From UCSD:

“Our emergency services medical team is dedicated to providing the highest quality of health care, but there are also significant psychosocial issues that need to be addressed with these patients – that’s where the social worker’s role is critical,” said Anarde.

Anarde and her counterparts work with high risk patients to determine the best fit with community resources, such as detox centers, emergency shelters, crisis houses and in-home support services. The Emergency Department social workers also partner with numerous community providers serving the same population, including the Psychiatric Emergency Response Team, the Homeless Outreach Team and the Resource Access Program.

“A patient who is repeatedly visiting the Emergency Department has several complex needs that are not being met,” said Anarde. “From my experience, the solution lies in partnering with the individual in a self-directed and goal-oriented way to better link him or her with appropriate community resources corresponding to health, mental health, social and emotional needs.”

UC San Diego Health Emergency Department social workers see more than 300 patients a month, Anarde said, directly placing several each day into community programs.

Reducing emergency room use by targeting ‘super utilizers’

From the Sun:

Sinai officials believe they have a promising model to keep people like Hardy healthy and out of the hospital. More than a year into a three-year, state-funded $800,000 pilot program, they’ve eliminated more than 1,000 emergency visits and earned back the investment.

They flagged about 318 people through electronic medical records who had emergency trips at least four times in four months and linked them to primary care doctors and insurance, as well as mental health and substance abuse programs, and often social services.

Cancer survivor clinics linked to fewer emergency room visits

From Reuters:

Specialized clinics for childhood cancer survivors may help reduce the odds these patients will need emergency medical care as adults, a Canadian study suggests.

Researchers followed almost 4,000 adult survivors of childhood cancers in Ontario for two decades. Compared with survivors who never used the specialized clinics, patients who went at least once were 19 percent less likely to visit the emergency department, the study found.

Each additional visit to the specialized survivor clinics was linked to a 5 percent lower rate of subsequent emergency department visits.

Family Physicians Play Major Role in Urban ERs

From the AAFP:

It’s probably not all that surprising that in rural areas where the nearest physician might be a long drive away, ER patients are likely to receive treatment from a family physician. Now, though, researchers have learned that even in urban ERs, patients are likely to be cared for by a family physician.

The findings, published this month in American Family Physician as a one-pager from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, were totally unexpected.

“We know that family physicians in outlying rural settings are contributing to ERs, but nobody ever looked at their contribution in urban and suburban settings,” said paper co-author Gerald Banks, M.D., M.S., a researcher at the Graham Center.

Zotec Partners’ Ed Gaines, JD, CCP Appointed as Chair to New ACEP and EDPMA Joint Task Force

Press Release:

Zotec Partners, a national firm providing billing and practice management services to emergency medicine practices and hospital-based physicians, announces that its Chief Compliance Officer in Emergency Medicine, Ed Gaines, JD, CCP has been appointed by ACEP President Dr. Michael Gerardi to Chair a newly created Task Force of the American College of Emergency Physicians (ACEP) and the Emergency Department Practice Management Association (EDPMA) to deal with Out of Network, Balance Billing and Medicaid Payment issues.

“We hope to determine the feasibility of preserving balance billing for out-of-network services in states that still allow it. It is also the goal of the task force to develop recommendations and model legislation on cost-effective strategies to protect patient access to Medicaid and improve Medicaid reimbursement, among other initiatives.”

The ACEP EDPMA joint task force is tasked with developing recommendations on two important areas: (i) a strategy to work at the state level on out-of-network reimbursement and balance billing; and (ii) a comprehensive strategy and potential broad coalition to protect and enhance Medicaid reimbursement and patient access, especially in light of the recent Supreme Court Armstrong vs. Exceptional Child decision, which held that providers (and, by implication, beneficiaries as well) may not turn to the courts for help in requiring that states live up to the minimum legal terms of the Medicaid statute.

According to the Ed Gaines, JD, CCP, “These are high priority issues facing both organizations and I am honored to be among a group of highly respected peers in the specialty and appointed to the task force to develop strategies that will best serve the emergency medicine community.” He adds, “We hope to determine the feasibility of preserving balance billing for out-of-network services in states that still allow it. It is also the goal of the task force to develop recommendations and model legislation on cost-effective strategies to protect patient access to Medicaid and improve Medicaid reimbursement, among other initiatives.”

T. Scott Law, founder and CEO of Zotec Partners states, “We are thrilled that Ed will chair a task force that addresses these critical issues in emergency medicine. He possesses the experience and knowledge to contribute to these initiatives, and Zotec Partners will support his efforts to effectively serve on this task force, as we continue to keep a finger on the pulse of health care policy matters that shape the specialty for years to come.”

Ed Gaines, JD, CCP has more than 21 years’ experience specializing in emergency medicine. He and his colleagues established the first voluntary corporate compliance program in the ED coding and billing industry in 1994. Mr. Gaines is responsible for compliance and coding quality assurance and training for Zotec’s emergency medicine clients. He is actively involved with Zotec’s clients in the areas of Medicare fee schedule, CPT coding, balance billing issues at the state and federal levels. He obtained a Bachelor of Arts Degree with Honors from Alma College and graduated from Wake Forest University School of Law with a Juris Doctor.

Ed is a member of the ACEP Reimbursement Committee and is a co-founder, past chairman, current Board of Directors and Executive Committee member of the EDPMA. His honors and awards include: ACEP Honorary Membership Award 2012; EDPMA’s Founder’s Award 2008; ACEP’s Outstanding Speaker of the Year Award 2008; NC ACEP’s Emergency Medicine Outstanding Advocate Award 2006 and he was named a Fellow in the Health Ethics Trust in 2000. He is a member of the North Carolina State Bar, North Carolina Bar Association’s Health Law Section and the Bar of the United States Supreme Court. Mr. Gaines currently works out of Zotec’s Greensboro, North Carolina offices.

About Zotec Partners

Founded in 1998 by CEO T. Scott Law, Zotec Partners is the Indianapolis-based industry leader in specialized medical billing and practice management services for the hospital-based specialty market. Zotec Partners is committed to the continual pursuit of excellence in the physician revenue cycle and practice management industry by delivering effective solutions through its innovative software, personalized service and measurable client results. Currently, the company serves more than 8,000 physicians in all 50 states. For more information about Zotec Partners, visit http://www.zotecpartners.com.

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Acute Community Care to Avoid Unnecessary Emergency Department Visits

From PCORI:

According to the Institute of Medicine, today’s emergency medical system (EMS) in the United States is overburdened and “at a crossroads,” with emergency departments (EDs) pushed “to the breaking point.” Focus groups indicate that patients with physical and mental health disabilities fear the following: going to EDs, care being delayed because of stigma or incorrect assumptions about their disability, inappropriate or dangerous care because ED staff knows little about their conditions, physical discomfort, and emotional distress. Nonetheless, a responsive EMS is critical to the health and well-being of all Americans, regardless of socioeconomic status, health condition, and geographic location.

Confronting similar EMS breakdowns, other countries have experimented with new ways of delivering urgent care. One promising approach is acute community care (ACC), in which highly trained paramedics evaluate and treat urgent care patients within their homes or institutional residences, such as nursing homes, when medically appropriate. ACC paramedics arrive in an SUV equipped with special diagnostic testing equipment, numerous medications to treat nonemergency problems, and extensive medical supplies, such as intravenous lines and various catheters. Furthermore, ACC paramedics have access to patients’ centralized electronic health records and communicate continuously with on-call clinical staff. ACC aims to avoid unnecessary ED transports that are required by protocol when standard ambulances respond to urgent care calls.

ACC has successfully reduced ED visits in England, Canada, Australia, and New Zealand, but it is not widely used in the United States. The proposed project aims to evaluate a new ACC Program (ACCP) in Massachusetts, a collaboration between the EasCare ambulance service provider and Commonwealth Care Alliance, which serves adults who have both Medicare and Medicaid coverage. This socioeconomically disadvantaged patient population has a heavy burden of chronic disease and physical and mental health disabilities, and, thus frequent urgent care needs.

The project will use a variety of approaches to evaluate ACCP, comparing outcomes between ACCP and standard urgent care. We will look at how often ACCP patients go to the ED despite paramedic care. Lead by Disability Policy Consortium, which represents persons with significant disability and chronic disease, we will conduct interviews and surveys, comparing experiences and perceptions of patients receiving ACCP versus standard urgent care. We will also interview and survey a family member, friend, neighbor, or paid caregiver (for example, personal care assistant) designated by the patient as involved in his or her urgent care episode. We will work with paramedic stakeholders to compare job satisfaction of ACCP paramedics with standard urgent care paramedics. Finally, we will examine resources required and practical issues raised in providing ACCP compared with standard urgent care.