PACEP NEWS SUMMER 2018
Executive Privilege “The Insurers are coming; the Insurers are coming!” What are they coming for? They are coming to pay you less, in order to maximize their bottom line. I know that this is not really news to us. It’s nothing new to have to fight for fair reimbursement for the federally-mandated EMTALA services we provide. However, insurance companies are feeling their bottom lines being pinched; and they are trying harder to avoid paying emergency providers. This is happening both locally and nationally. In states such as Georgia, Missouri, Ohio, Indiana, New Hampshire, and Kentucky, Anthem Blue Cross has implemented a well-publicized (and criticized) ED policy to deny payment for ED visits that could “safely [be] treated in less acute facilities”. This policy forces patients to triage their own medical complaints to avoid getting bills from the ED if, in Ankur A. Doshi, retrospect, their insurance company feels that an ED visit was not warranted. Our colleagues in these MD, FACEP states have begun receiving multiple denials of ED claims. This is despite nationally published data PACEP President that shows that only 3.3% of ED visits are avoidable. ACEP and state chapters in those states have been on the front line fighting for fair payment for our time and resources. Closer to home, PA Medicaid payors, such as Gateway Health Plan in Western PA, have attempted to limit patients’ use of the ED by paying providers only a ‘screening fee’ totaling $25 for visits they feel are non-emergent. PACEP was successful in having Gateway rescind this policy in 2016 when we provided data to the state Department of Insurance showing the inappropriate application of this policy. However, now, the state legislature is looking at legislation to restrict Medicaid beneficiaries from using their benefits for ‘non-emergent’ care, thereby raising the cost of care to some of our most vulnerable patients, contrary to the prudent layperson standard. PACEP has been engaged on this issue both politically and in the media. How can you help? On the Eastern side of the Commonwealth, Independence Blue Cross, and their NJ 1. Contact your legislators counterpart AmeriHealth, have implemented a policy to reduce payment by 50% to and ask them to back a fair providers who use modifier 25 in their claims. Modifier 25 is used in addition to an E&M payment standard for out-ofcode when a separate procedure is documented during the same encounter (suture network services in the ED. repair, incision and drainage, central access, etc). Although we have not heard of specific The fairest standard comes downcodes in PA so far, PACEP, along with PAMED and a coalition of PA and NJ providers, from an independent database have been engaged with the insurance companies to ask for an explanation and rescinding of charges (there is one!). of this policy. Insurers should pay us based on There’s more…As part of the pending PA House legislation on Balance Billing (see PACEP reasonable charges (75-80%) of NEWS July 2017 and October 2017), IBC has publicly proposed mandating all providers at the charges in a given region. an in-network facility to be in-network with the insurance plans. This, like the insurance 2. Host a legislator in your ED so companies’ other strategies, aims to limit providers’ ability to negotiate for a fair payment that person can see the work rate. Once ED physicians must be in-network with payors, those companies can limit their we do, and understand why fair payments as much as they want, without repercussion. In the same vein, the insurance payment is necessary companies would like to set a non-market-based standard for payment of out-of-network 3. Join our PACEP 911 Network care – presently 150% of Medicare. If an insurance company can set a maximum out-of(find it at: www.pacep.net) network rate of 150% of Medicare, they have little reason to negotiate for a more fair in4. Donate to PEP-PAC at www. network rate of payment. Our Chapter has been represented every hearing and stakeholder pacep.net so we can support meeting and our leadership is actively working to tell legislators that this is not good policy. those legislators who ‘get’ I don’t want to be a ‘Chicken Little’, sounding alarms unnecessarily, however now is the time Emergency Medicine and are to rally as a specialty to push back against “Insurers Behaving Badly”. willing to fight the insurance companies with us.
COMMITTEES We’ve included the document in this issue as a tear-out for your convenience. (See opposite page.) This Spring, the PACEP EMS & Terrorism and Disaster Preparedness (EMS) Committee, in partnership with the Pennsylvania Emergency Health Services Council (PEHSC), developed an Interfacility Resource Document as a reference tool to assist referring and receiving physicians and other hospital staff with determining which type of transport is best suited to an individual patient’s need. PACEP knows that interfacility patient transfers often involve a complicated set of medical decisions. Referring facilities must ensure that patients receive appropriate care during transfer and upon discharge. Emergency medical service
NEW PACEP EMS RESOURCE! providers deliver a wide range of transport medical services, and the specific types of skills and medicines that can be administered during transport depend upon established statewide protocols, clinical guidelines, and staffing. The PACEP/PEHSC Interfacility Resource Document incorporates the latest updates from the PA Department of Health with respect to the current EMS Scope of Practice and will be periodically updated as necessary. It will also be available on PACEP’s website. Please join us in thanking and congratulating the PACEP EMS Committee and PEHSC for their hard work and collaboration on the development of this important resource!
Helping Pennsylvania Emergency Physicians to be Treated and Reimbursed Fairly Co-written by Heather Walker, MD, FACEP and F. Richard Heath, MD, FACEP You have sacrificed and worked hard to get to where you are. PACEP supports and advocates for emergency physicians in many ways, some of Glenn Geeting, which affect your personal MD FACEP finances. Over the last few PACEP Medical Economics decades, medicine has Committee Chair seen greater governmental involvement and corporate complexity. The need for emergency physicians to understand and engage in the economics and politics of our business has never been greater. The mission of the PACEP Medical Economics Committee is to help Pennsylvania emergency physicians be appropriately reimbursed by monitoring and influencing payor, legislative and regulatory policies that affect coding and payment, providing feedback to the PACEP Board, and educating in medical economics. Here are a few examples of actions PACEP, with input from the Medical Economics Committee, is taking on our behalf: • Interacting with the PA legislature regarding out of network billing, the “surprise bill” legislation 2
PACEP News | SUMMER 2018
• Advocating for transparent and objective reimbursement criteria (e.g. Fair Health) • Engaging in the governmental response and legislation related to the opioid epidemic • Pushing back when insurers like Independence Blue Cross, Anthem, and Aetna automatically downcode visits, or decrease payments when a procedure is done or for diagnoses that they consider minor • Monitoring for other examples of “insurers behaving badly” • Educating on How You Get Paid • Contributing to the AMA Relative Value Scale Update Committee (RUC) that updates costs for physician services Your engagement in PACEP and the Medical Economics Committee are welcome. The PACEP Medical Economics Committee monitors, analyzes, reports, and suggests strategies on policy, programs, and events related to the clinical and administrative aspects of emergency medicine, as well as monitors private payer and federal policies that may affect emergency physician practice and reimbursement. If you are interested, please send an email to info@pacep.net.
EMS Committee: Interfacility Resource Document Interfacility patient transfers often involve a complicated set of medical decisions. Referring facilities must ensure that patients receive appropriate care during interfacility transfer and upon discharge. Emergency medical service providers deliver a wide range of transport medical services. The specific types of skills and medicines that can be administered during transport depend upon established statewide protocols, clinical guidelines, and staffing. This document is intended to assist referring and receiving physicians and other hospital staff with determining which type of transport is best suited to an individual patient’s need. The Pennsylvania Department of Health currently licenses ambulances at the basic life support (BLS), advanced life support (ALS), critical care transport (CCT), and air medical transport levels. Each tier of transport medical care is authorized to administer specific medications and perform particular skills. Basic Life Support (BLS) A BLS ambulance is staffed by at least one emergency medical technician and an EMS Vehicle Operator (EMSVO). EMTs, in general, provide non-invasive monitoring of vital signs. EMTs are trained to administer oxygen, control bleeding and stabilize fractures. EMTs do not provide intravenous or intraosseous therapy. BLS transports are indicated for stable patients who do not require medications or cardiac monitoring. Intermediate Advanced Life Support (IALS) Advanced Emergency Medical Technicians (AEMTs) provide basic EMS and a limited set of ALS. AEMTs perform all the BLS skills listed above as well as use of Alternative Rescue Airways, suctioning, placement of a saline lock IV, IO placement, obtaining but not interpreting a 12 Lead ECG, blood glucose monitoring. IALS transports are indicated for stable patients who do not require medications or monitoring. Advanced Life Support (ALS) ALS ambulances are staffed with at least one paramedic, prehospital nurse, or prehospital advance practice provider (e.g. physician’s assistant). ALS personnel are trained to perform and interpret 12-lead ECGs, administer intravenous fluids, administer specific infusions, and provide cardiac monitoring. Critical Care Transport (Paramedic) State approved CCT programs staff ambulances with two ALS providers in addition to an EMSVO, of which one must be trained in an expanded scope of critical care transport. The State of Pennsylvania requires the presence of a PHRN for certain medications, but a CCT licensed paramedic ambulance provides additional services beyond the regular ALS scope of practice under a set of expanded statewide protocols. CCT crews transport patients requiring some forms of mechanical ventilation and certain infusions not routinely carried on an ALS ambulance. Critical Care Transport (PHRN/Paramedic) Critical Care Transport provided by licensed agencies provide air or ground transport with an expanded scope of practice determined by agency-specific protocols (air ambulance agencies) approved through the Department of Health. These teams are staffed with at least two advanced personnel (most commonly prehospital nurses or paramedics) trained as critical care providers. Capabilities of these critical care teams include the administration of paralytics and additional infusions based on an expanded scope of practice. An air ambulance CCT team may transport patients with advanced modes of mechanical ventilation or who are receiving blood products. The CCT staffed with an on board PHRN is best suited to interfacility transfers involving critically ill patients requiring vasoactive medications.
DISCLAIMER: This document is not intended to supplant clinical judgement or guide policy decisions. It is intended to serve as a resource to emergency medicine and other acute care clinicians who are tasked with arranging or managing interfacility patient transports. The document incorporates the latest updates from the Pennsylvania Department of Health with respect to the current EMS Scope of Practice. The recommendations in this document may change based on changes in EMS regulations and practice guidelines. Revision Date 5/24/2018
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EMS Committee: Interfacility Resource Document Capabilities of Various Transport Levels of Care BLS (Emergency Medical Technician)
IALS (Intermediate Advanced Life Support)
ALS (Advanced Life Support)
Critical Care Transport (Expanded Scope Paramedic)
Critical Care Transport with agency specific protocols (PHRN, PHP, PHPE)
Specialty Care Transport (Neonatal5, Pediatric5, ECMO)
Monitoring (Vitals and Sp02)
Yes
Yes
Yes
Yes
Yes
Yes
Cardiac monitoring
No
No
Yes
Yes
Yes
Yes
Cardiac pacing, transvenous
No
No
No
No
Yes
Yes
Bilevel Positive Airway Pressure
No
No
No (CPAP permitted)
Yes
Yes
Yes
Vasopressors
No
No
Yes (Limited and not titrated)
Yes
Yes
Yes
Antibiotics
No
No
Yes
Yes
Yes
Yes
Blood and blood products
No
No
No
No
Yes
Yes
Mechanical Ventilation
No
No
Yes (Limited to volume control modes and no anticipated need for adjustment)
Yes (Limited to volume control modes and no anticipated need for adjustment)
Yes (All modes approved by agency medical director, titration of settings)
Yes
Sedation and Paralysis
No
No
No (Limited to sedation)
Yes* (Limited sedation; may include paralysis when risks>benefits or CCT appropriately trained)
Yes (Sedation and paralysis)
Yes (Sedation and paralysis)
Chest tube to suction or water seal
No
No
No
Yes
Yes
Yes
Air medical Transport Considerations: Consultation with a transport medicine / EMS physician is recommended when considering the interfacility transport of a patient in need of critical care. Consider aeromedical transport when: 1. 2. 3. 4. 5.
Air medical transport confers a significant, time saving benefit to the patient Air medical crews can perform a skill or deliver a therapy beyond the capabilities of the local EMS agency/ground crews Specialty care resources needed but otherwise unavailable (Neonatal transport, ECMO, balloon pump) Local EMS resources are not sufficient to meet patient needs. (No available ambulances, planned interfacility transport would leave a community without EMS coverage, etc) Neonatal and Pediatric transports require specialty team care when the patients are exceed the resources available by the local EMS provider. A pediatric transport system should be capable of rapidly delivering advanced pediatric skilled critical care to the patient's bedside at the referring hospital and of maintaining that level of care during transport to the receiving hospital.
Additional Resources The following documents contain additional information about the scope of practice of emergency medical services providers: 1. Pennsylvania Department of Health Bulletin: Scope of Practice for Emergency Medical Services Providers 2. Pennsylvania Department of Health Bulletin: Scope of Practice for Critical Care Transport Emergency Medical Services Providers DISCLAIMER: This document is not intended to supplant clinical judgement or guide policy decisions. It is intended to serve as a resource to emergency medicine and other acute care clinicians who are tasked with arranging or managing interfacility patient transports. The document incorporates the latest updates from the Pennsylvania Department of Health with respect to the current EMS Scope of Practice. The recommendations in this document may change based on changes in EMS regulations and practice guidelines. Revision Date 5/24/2018
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Create a Sense of Connection for Wellness Katherine Lund, DO PACEP Wellness Committee Co-Chair Let’s face it, none of us got to where we are by taking “the easy road.” As physicians, we push ourselves to extremes. But we have to remember that we are human. We should learn to recognize our limitations and acknowledge when we need help or a break. This article touches on some of my keys to handling stress and achieving balance in life. While there are many ways to manage stress, there are three ways I approach it: by taking any project or goal one step at a time; drawing inspiration from my daily life; and getting involved with local or national groups that have meaning to me. We have all heard the analogy that medical school is like drinking water from a fire hydrant, but I didn’t realize that life in general can feel the same way. If you are like me, you have a “to do list” a mile long. It can be daunting and overwhelming. Approach your goals and projects as you would your “to do list,” one step at a time. By doing so, life and the huge stressors that lay before us become achievable. Being a mother and a physician comes with many stressors and limitations. I often don’t know how to handle these but find inspiration in the people that surround me. I look to my colleagues who seem to be taking on the challenge and ask them questions. You may find answers and comfort knowing that others have similar stressors. If you are going through strife or depression, look for inspiration in those that have shown courage
or strength. You may find this will give you courage and strength, as well. Camaraderie can help issues not feel so overwhelming. This method also has helped me feel connected to those with whom I live and work. The sense of being connected has been a huge benefit to my stress and wellness. My daughter was born pre-mature, and since her birth I have been involved in a local charity for children. Find a committee, local organization, or club of interest to you and get involved. It doesn’t mean you have to give money or do everything for the organization, but by being involved, it will help you feel more connected. I know it helps me feel more balanced and fulfilled. PACEP’s Wellness Committee promotes the health and wellness of emergency physicians through education and initiatives that encourage habits of wellness, increase awareness of factors and resources contributing to well-being, inspire and empower individuals to take responsibility for their own health and support a sense of community. If you are interested in becoming a Wellness Committee member, please email info@pacep.net.
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PACEP News | SPRING 2018
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MEMBERS in the news Congratulations to PACEP’s Emergency Physician of the Year Michael J. Lynch, M.D., who was appointed by the U.S. Department of Health and Human Services to the Pain Management Best Practices Inter-Agency Task Force. The Task Force was established to propose updates to best practices and issue recommendations that address gaps or inconsistencies for managing chronic and acute pain. HHS is overseeing this effort with the U.S. Department of Veterans Affairs and U.S. Department of Defense. The Task Force will: • Determine whether there are gaps or inconsistencies in pain management best practices among federal agencies; • Propose updates to best practices and recommendations on addressing gaps or inconsistencies; • Provide the public with an opportunity to comment on any proposed updates and recommendations; and • Develop a strategy for disseminating information about best practices.
Leadership & Advocacy Conference May 20-23, 2018 PACEP leadership visited Washington D.C. for ACEP’s Leadership & Advocacy Conference. The 2018 Leadership & Advocacy Conference offered thought-provoking, inspiring and challenging sessions by nationally recognized speakers and key decision makers who provided inside information and skills you need to maximize your effect as an emergency medicine leader and advocate. Pictured: PACEP Executive Director Cicely Elliott and Board Member Chadd Kraus, DO, DrPH, MPH, FACEP met with Congressman Perry and Congressman Marino during #LAC18.
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PACEP News | SUMMER 2018
Live. Work. PAMED Announces 2018 Top Physicians Under 40! Congratulations to PACEP Immediate Past President Maria K. Guyette, MD, MPPM, FACEP, and PACEP ‘s 2017 Emergency Physician of the Year Award Winner Erik I. Kochert, MD FACEP for being named by the Pennsylvania Medical Society as Top Physicians Under 40. Dr. Guyette is the Chief of Emergency Medicine Services for UPMC Shadyside and Assistant Professor of Emergency Medicine for the University of Pittsburgh. She has been involved with patientfocused initiatives on issues like appropriate opioid prescribing for ED patients and bystander CPR training for middle- and high-school students. Dr. Kochert is an emergency physician with UPMC Pinnacle. He has served as a physician champion for the venous thromboembolism clinical effectiveness team and the hospital chest pain center efforts which help ensure that the clinical care offered by his organization is evidence-based, safe, and efficient. As the York County Medical Society Immediate Past President, Dr. Kochert serves as a role model to colleagues and advocates for addressing public health issues in his community.
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Contact Rachel Jones, MBA FASPR Office: 717-231-8796 rajones@pinnaclehealth.org Teaching and academic director roles available.
PACEP President-Elect Arvind Venkat, MD, FACEP met with Speaker Turzai and his staff in June on how to protect patients from out-of-network balance billing while ensuring the ability to continue to care for all patients in the emergency department.
UPMCPinnacle.com/Providers EOE. UPMC Pinnacle is an Equal Opportunity Employer.
PACEP News | SUMMER 2018
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LEGISLATIVE UPDATE Milliron & Goodman Government Relations OVERVIEW
After three years of protracted budget fights, Pennsylvania’s election year budget plan was wrapped-up more than a week ahead of its June 30th deadline. And, for the first time in Democratic Governor Tom Wolf’s tenure, he has signed a budget. His signature came hours after the Republicancontrolled Legislature sent a $32.7 billion spending plan to his desk, barely three days after the first details of the no-new-taxes package were unveiled. The budget invests in education with an emphasis on workforce development and school safety initiatives. Funding to prevent the spread of Lyme disease was a key part of the 2018-2019 state spending plan. The $2.5 million line item will support awareness, prevention and surveillance associated with the tickborne illness. Pennsylvania leads the nation with more recorded cases of Lyme disease than any other state. The budget also maintains the prior funding increase requested by Governor Wolf for assistance to drug and alcohol programs, which provides grants to single county authorities across the state to implement programs to prevent and address substance abuse. Outside of the department, the budget includes $4.5 million in new funding to provide home visiting services to approximately 800 families affected by substance use disorder. With the state budget complete, Lawmakers are back in their home districts gearing up for the looming general election. All 203 state House members and half of the state Senate (25 seats – even numbered district seats) are on the November ballot along with Democratic Governor Tom Wolf. The House will return to Harrisburg the week of September 12 and Senate, the week of September 24. With the election stakes high, there will be limited voting session days this fall – 9 days in the Senate and 10 days in the House. The House plans to focus on limiting regulations, including a proposal to give the legislature power to revoke individual rules. On the Senate side, school safety measures is one of their top priorities.
ELECTIONS 2018
Nearly 30 state lawmakers are not seeking reelection. Four incumbent lawmakers – Sen. Randy Vulakovich (R-Allegheny), Rep. Paul Costa (D-Allegheny), Rep. 8
PACEP News | SUMMER 2018
Emilio Vazquez (D-Philadelphia), and Rep. Dom Costa (D-Allegheny) – and Lt. Governor Mike Stack lost their Primary Elections and will not be on the November ballot. State Senator Scott Wagner secured the GOP nomination for governor, setting up an Election Day matchup between him and a fellow millionaire and York Countian Democratic Governor Tom Wolf. The Wolf campaign entered June with a big cash advantage over challenger Scott Wagner. With five months until the Nov. 6 election, Wolf reported $15.2 million in his campaign account as of June 4, while Wagner reported $1.6 million. Lawmakers who are not running for reelection in 2018 are: Rep. Hal English (R-Allegheny); Rep. Michael Corr (R-Montgomery); Rep. Stephen Bloom (R-Cumberland); Sen. John Eichelberger (R-Blair); Rep. Jim Christiana (R-Beaver); Rep. Rick Saccone (R-Allegheny); Rep. Nick Miccarelli (R-Delaware); Rep. Dave Reed (R-Indiana); Rep. John McGinnis (R-Blair); Rep. Curtis Thomas (D-Philadelphia); Rep. William Keller (D-Philadelphia); Rep. Mike Hanna (D-Clinton); Rep. John Maher (R-Allegheny); Rep. Joe Markosek (D-Allegheny); Rep. Mark Mustio (R-Allegheny); Rep. Flo Fabrizio (D-Erie); Rep. Kevin Haggerty (D-Lackawanna); Rep. C. Adam Harris (R-Juniata); Sen. Stewart Greenleaf (R-Montgomery); Sen. Charles McIlhinney (R-Bucks); Rep. Ron Marsico (R-Dauphin); Rep. Bob Godshall (R-Montgomery); Rep. Katharine Watson (R-Bucks); Rep. Will Tallman (R-Adams); Rep. Harry Lewis (R-Chester); Rep. John Taylor (R-Philadelphia); and Rep. Eli Evankovich (R-Westmoreland). Lawmakers who are running for a different seat in 2018 are: Sen. Guy Reschenthaler (R-Allegheny) - running for US House (not up for reelection to State Senate); Rep. Marguerite Quinn (R-Bucks) - running for State Senate; Sen. Scott Wagner (R-York) - running for Governor; Rep. Kristin Phillips-Hill (R-York) - running for State Senate; and Rep. Judith Ward (R-Blair) - running for State Senate. Lawmakers who are running for reelection in their current seat and running for a different seat are: Rep. Tina Davis (D-Bucks) - also running for State Senate; Rep. Madeleine Dean (D-Montgomery) - also running for US House.
2018 FALL LEGISLATIVE SESSION SCHEDULES SENATE FALL SESSION SCHEDULE September October November
24, 25, 26 1, 2, 3, 15, 16, 17 14
HOUSE FALL SESSION SCHEDULE September October November
12, 13, 24, 25, 26 1 (Non-Voting), 2 (Non-Voting), 9, 10, 15, 16, & 17 13
LEGISLATION
Milliron Goodman continues to work with PACEP’s leadership on legislation affecting your profession, your colleagues, and your patients. Here is a look at some of the noteworthy bills this session. E-Prescribing (HB 353 – Rep. Tedd Nesbit, R-Mercer): This bill amends the Controlled Substance, Drug, Device and Cosmetic Act to require electronic prescriptions of a Schedule II, III, IV and V controlled substance. Working with various stakeholders, PACEP clarified exceptions in the bill. As amended, the electronic prescription requirement shall not apply if the prescription is issued: by a veterinarian; under circumstances when an electronic prescription is not available to be issued or received due to a temporary technological or electrical failure, and in the instance of a temporary technological failure, a practitioner shall, within seventy-two hours, seek to correct any cause for the failure that is reasonably within his or her control; by a practitioner and dispensed by a pharmacy located outside this Commonwealth; by a practitioner who or health care facility that does not have either of the following: (i) internet access; or(ii) an electronic health record system; by a practitioner treating a patient in an emergency department or a health care facility under circumstances when the practitioner reasonably determines that electronically prescribing a controlled substance would be impractical for the patient to obtain the controlled substance prescribed by electronic prescription or would cause an untimely delay resulting in an adverse impact on the patient’s medical condition; for a patient enrolled in a hospice program or for a patient residing in a nursing home or residential health care facility; for controlled substance compounded prescriptions and prescriptions containing certain elements required by the Food and Drug Administration or any other governmental agency that are not able to be accomplished with electronic prescribing; for a prescription issued pursuant to an established and valid collaborative practice agreement between a practitioner and a pharmacist, a standing order or a drug research protocol; for a prescription issued in an emergency situation pursuant to Federal or 8
State law and regulations of the board; under circumstances where the pharmacy that receives the prescription is not set up to process electronic prescriptions; or for controlled substances that are not required to be reported to the Prescription Drug Monitoring Program system administered by the department. The bill passed the state House by a vote of 194-0. The bill was unanimously voted out of the Senate Health and Human Services Committee and is now before the full Senate. It is currently in the Senate Appropriations Committee. PACEP is supporting this legislation as amended. Involuntary Commitment for Individuals with Substance Use Disorders (HB 713 – Rep. Matt Baker, R-Tioga (RESIGNED)/SB 391 – Sen. Jay Costa, D-Allegheny): This legislation amends the Mental Health Procedures Act to include individuals with substance use disorder which has caused an overdose within 30 days as an individual subject to involuntary commitment. This will subject individuals with substance use disorder to emergency examination and treatment to be undertaken at a treatment facility. The bill would expand that definition of “clear and present danger” to include the ingestion of drugs to the point of unconsciousness, or in need of medical treatment to “prevent imminent death or serious bodily harm.” Similar legislation has been introduced in the state Senate (SB 391). From an emergency medicine standpoint, the legislation would likely have far-reaching implications that would hinder rather than augment shared goals of enhancing substance use disorder treatment and decreasing overdose deaths in the Commonwealth of Pennsylvania. HB 713 is currently in the House Appropriations Committee. SB 391 is currently in the Senate Judiciary Committee. PACEP Leadership has had several meetings with key lawmakers and staff in both chambers to share our concerns regarding this legislation and has offered the following proposed solutions: • Increase support for community based engagement and harm reduction resources. Rather than force individuals into an inpatient treatment system that is already overwhelmed with little chance of success, meet that individual where he/she is physically and psychologically so that a therapeutic relationship based upon trust and collaboration can be established. • Develop and expand support and educational resources for family members and loved ones of individuals with SUDs. Programs aimed at assisting family members can improve their own health, provide tools to help in their relationship with loved ones with SUDs, and actually play a role in facilitating voluntary and effective treatment engagement and retention. • Current confidentiality rules in PA related to sharing information regarding substance use disorders (Pa. Cons. Stat. Ann. tit. 71 § 1690.108) limit the ability PACEP News | SUMMER 2018
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for treatment providers to coordinate care. Federal guidelines are less restrictive and application of those standards may improve the ability of providers to care for individuals with substance use disorders while maintaining appropriate confidentiality. • Continue to expand access to inpatient as well as outpatient substance use disorder treatment, including medication assisted therapy (MAT). Optimize existing and developing warm handoff programs. • Waive current regulations that prevent rehabilitation facilities from accepting individuals who are already on methadone, buprenorphine or other legal substances. Bed Registry Act (HB 825 – Rep. Doyle Heffley, R-Carbon): While there are no simple solutions to combatting the heroin and opioid epidemic, PACEP has proposed several recommendations, including a comprehensive, real-time statewide tracking system of available drug and alcohol treatment facility beds to allow for enhanced and timely placement of appropriate patients from the emergency department. This bill provides for a detoxification bed registry. PACEP is has been working with the sponsor to enhance the legislation. The bill unanimously passed the state House by a vote of 187-0. The bill is now in the Senate Health and Human Services Committee. Mental Health Treatment – Database for Availability of Services (SB 179 – Sen. Camera Bartolotta, R-Washington): This bill would require the Health Department to establish the online database that would help doctors more quickly find inpatient beds for psychiatric patients in crisis. Participation of hospitals would be voluntary. Those electing to participate would input information, at least once every eight hours, about the number and types of inpatient psychiatric beds they have available. Participation by hospitals with inpatient psychiatric units be mandatory, not voluntary, and a real-time database would be preferable to one updated every eight hours. However, the legislation advanced is a step forward. PACEP has long advocated for a way to find and utilize available psychiatric beds for patients requiring additional care, and commends the sponsors of the legislation, which seeks to mitigate a genuine and frustrating barrier to quality emergency care. The bill was unanimously voted out of the Senate Health and Human Services Committee and is now before the full Senate. It is currently in the Senate Appropriations Committee. EMS Reimbursement for Non-Transport Services (HB 1013 – Rep. Steve Barrar, R-Delaware/ SB 1003 – Don White, R-Indiana): The intent of both bills is the same – to reimburse emergency medical services agencies for services provided even when transport to a hospital does not take place. Patients routinely experience emergent scenarios, such as diabetic emergencies, asthma exacerbations, and opioid overdoses that require immediate, life-saving care. Some 10 PACEP News | SUMMER 2018
patients don’t require or refuse transport. If the patient is not transported, the cost of providing the service is directly assumed by the ambulance company - a burden which could be so significant that the company would need to close, and the public would inadvertently be put at risk. PACEP voiced its support for HB 1013. The bill unanimously passed the House by a vote of 190-0 and is currently in the Senate Banking and Insurance Committee. On the Senate side, PACEP worked to successfully amend SB 1003 to include prudent layperson basing reimbursement on “presenting symptoms”. As introduced, the bill would have allowed a managed care plan to make a determination as to whether the emergency services are medically necessary for payment. The bill unanimously passed the Senate by a vote of 49-0 and is currently in the House Insurance Committee. Balance Billing (SB 678 – Senators Judy Schwank, D-Berks, Don White, R-Indiana, and Jay Costa, D-Allegheny)/HB 1553 – Reps. Matt Baker, R-Tioga (RESIGNED) and Tina Pickett, R-Bradford): This legislation seeks to address surprise balance bills, also known as surprise out-of-network medical bills. Among the concerns, the legislation would rely on health insurance companies to set and pay “the out-of-network amount due under the health insurance policy” without an impartial, transparent standard and require providers to ask for cost-sharing amounts rather than the information being automatically provided to the provider by the insurance company any time a bill is sent to the insurer. In addition, the bill provides for the use of arbitration as a dispute-resolution mechanism with a “loser pays” payment model that would mandate best-offer binary decision making, require deposit of arbitration costs prior to resolution, and lacks a floor above which arbitration would kick in. Insurance companies have more personnel and resources to contest reasonable charges by physicians who have already provided emergent care to patients at times of crisis without knowledge or concern for insurance network status. PACEP has added its voice to discussions with lawmakers and key decision makers and is working with other hospital-based specialties. Pennsylvanians should be able to use the closest and most appropriate emergency department when they have an acute need. No patient at a time of medical crisis should have to worry about insurance network coverage. At the same time, insurance companies should be required to pay fair and reasonable reimbursement rates to emergency care providers, regardless of whether they are considered in- or out-of-network. PACEP supports the intent of the legislation and agrees that patients should not receive surprise bills when care is provided unknowingly by an out-of-network provider. Emergency physicians want to be part of the solution and work with the Legislature to avoid unintended consequences. The state House is considering using a Medicare rate as a standard for determining payment
for out-of-network care. Medicare is not an appropriate benchmark for determining payment to out-of-network emergency physicians. Medicare payments are politically derived and based on federal budgetary constraints. They are not based on the actual cost of providing care, especially in rural and emergency settings. This benchmark is especially concerning for emergency physicians, which provide the majority of charity care and Medicaid acute care. In many of our most vulnerable EDs, there are little to no operating margins. There will also be no incentive for insurers to negotiate with emergency providers if they can pay them an artificially low Medicare rate. PACEP and other medical specialty groups are advocating to set a transparent, impartial, market-based standard for reimbursement that takes the patient out of the equation in reimbursement for out-of-network care. SB 678 is currently in the Senate Banking and Insurance Committee and HB 1553 is on the House Tabled Calendar. Please stay alert for updates as Milliron Goodman and PACEP’s leadership continue discussions with lawmakers and stakeholders. We need you to join the effort to urge legislators to vote NO on the current language in the balance billing legislation. Considers military education for EMT/paramedic (HB 302 – Rep. Jesse Topper, R-Bedford): This bill establishes that any person who is professionally licensed/certified by the Department of Health (DOH) and who is called to active duty will be exempt from continuing educational requirements or in service training requirements, and will not forfeit his/her current license/ registration. Currently, a military medic or paramedic who applies for a Department of Health license does not receive credit for military training. Many military veterans are forced to go through training they have already received. This “retraining” of veterans is costly and not needed. The bill unanimously passed the House (188-0) and is currently in the Senate Veterans Affairs & Emergency Preparedness Committee. PACEP sent a support letter to the state Senate. Fentanyl Limited Use Legislation (HB 1987 – Rep. Bryan Barbin, D-Cambria): This bill amends the Controlled Substance, Drug, Device and Cosmetic Act adding a new section limiting the dispensing of fentanyl and fentanyl derivatives. PACEP worked with the Sponsor and key staff on exceptions to the bill to exclude treatment associated with a medical emergency. Under the bill fentanyl and fentanyl derivatives shall only be dispensed: to a patient who is being treated on an in-patient basis or remains in observation status, or during a surgery that takes place in a health care facility; for use in palliative or hospice care; for use in the management of pain associated with cancer; to a patient whose treatment is associated with a medical emergency as documented in the individual’s medical record; and in instances where, in the professional medical judgment of the prescriber, fentanyl is required
to stabilize an individual’s acute medical condition, the prescriber may prescribe no more than a 7-day supply. The bill also allows fentanyl and fentanyl derivatives to be dispensed to use in the management of chronic pain not associated with cancer. The prescriber must document the chronic medical condition in the individual’s medical record maintained by the prescriber and state the reason why another medication is not appropriate to address the chronic medical condition. The new section would expire in two years. HB 1987 was unanimously passed by the state House and is currently in the Senate Health and Human Services Committee. We expect additional amendments in the Senate. It was brought to our attention that there are many offices who are doing cases outside of DOH ASF regulations under the Dental Board rules. There is an exception for surgery in HB 1987 that applies to those taking place in a health care facility as defined in the “Health Care Facilities Act”, which includes ASFs. However, we understand that the definition does not include individual or group practice offices of private physicians or dentists. Opioid Prescribing Guidelines (SB 655 – Sen. Gene Yaw, R-Lycoming): This legislation would establish the Pennsylvania Safe and Effective Opioid Prescribing Advisory Council within the Department of Health. The advisory council shall examine and make recommendations regarding opioid prescribing and dispensing practices. It would require the Secretary of Health to promulgate regulations relating to the prescription of opioids consistent with guidelines issued by the advisory council. The intent of the bill is to give the prescribing guidelines “teeth”. The regulations would give the guidelines the force of law. Among the regulations to be issued are emergency department pain treatment guidelines. In the event the bill becomes law, PACEP worked to successfully amend the bill to add a representative from PACEP to the advisory council that is developing the guidelines. SB 655 unanimously passed the state Senate and is currently in the House Health Committee.
GRASSROOTS ADVOCACY
At Milliron Goodman, we spend a lot of time emphasizing the importance of getting to know your legislators and more importantly, making sure they know you. Your involvement in the legislative process is crucial to the future success of your profession and your patients. We encourage you to get engaged.
CONTACT If you have any questions regarding this legislative update or would like to get involved, please do not hesitate to contact us at 717.232.5322. We have an open door policy.
PACEP News | SUMMER 2018 11
WELCOME PACEP NEW MEMBERS Chika Agi, MD Andrea Albert, MD Taylor J. Anspach Ryan M. Arthur, MD Irtaza Asar, DO Elizabeth Avakoff Bharath Balu Hannah Barnes, DO Paul J. Bartleson, DO Ryan Bartosh, MD Tim Batchelor, MD Patrick Bauer Amy Bestick, MD Robert R. Brigman, MD Adrienne Caiado Michael Edward Chase Jigar Chauhan Sulman Choudhary Peter J. Christiano, MD Elizabeth A. Ciccocioppo Ryan Cocca Ian Coote Paul Copperman, MD Thomas Crum Dheeraj Duggineni, MD Bryce Ebersole Kyle C. Fierro Julia Finkel Liza Gergenti Rachel Graves, MD
Kevin M. Hanneken, MD John Z. Hillenkamp, MD Nancy Huynh, MD Abhi Jain Joseph Jee Jean, MD Sharon Jia, MD Chase L. Jones, DO Piotr Jurgielewicz Ryan Andrew Keenan, MD Kelvin Z. Kwofie, MD Belinda Lao, MD Jennifer O. Larsen, MD Richard J. LaVeau Matthew Magda, MD Mohit S. Mahalan Amy M. Maier, MD Nardos H. Makonnen Tyler C. McCardell Matthew M. McCarthy Conor J. McLaughlin Andrew Miller, DO Ashita Mittal Damian E. Mosher Gurjot S. Multani Adam D. Musgrove, DO Matthew Nelson, DO Megan E. Newnam, DO Steven T. Nguyen, DO Chiemeke I. Nwabueze, MD Joe Odierno
Tito Osadebe Nicole P. Pantle Danielle M. Pilarte Alexandra Pizzaro, DO Nishad A. Rahman Tara G. Romanyshyn Megan B. Sanborn, MD John L. Schmeitzel, MD Tom Sewatsky Hussain Shakir, MD Samantha Shepard Robert C. Sooby, Jr, DO William Spinosi, DO Fermin Suarez Meghan K. Tape, DO Colleen D. Taylor Spencer Emmett Thompson, MD Kenneth Thomson Kristopher Tkatch, DO Daniel Torens, DO Christopher VanEtten, DO Matthew Varley, MD Alexandra Vinograd, MD Kaitlyn R. Votta Leslie Weaver Arianne Wenk Broc Wenrich, DO Yuchen Yang
PA Delegation to ACEP Council Resolutions
Each year, the PACEP Board of Directors appoints PACEP members who will represent the chapter at the ACEP Council. A councillor/alternate councillor is a key participant in the leadership and development of ACEP policy and has the responsibility to voice the concerns of their (Pennsylvania) constituents on the floor of the Council meeting and in reference committees. Councillors can 12 PACEP News | SUMMER 2018
also express the will of their constituents by voting for or against resolutions and electing board members and Council officers. This year, PA Delegation to ACEP Council submitted six resolutions for consideration at the annual national ACEP policy-setting event to be held October 1-4, in San Diego, CA. Resolutions submitted include: • Reduction of Scholarly Activity Requirements by the ACGME • Educational Materials on Care of Individuals with Autism Spectrum Disorder in the Emergency Department • Care for the Boarded Behavioral Health Patient • No More Emergency Physician Suicides • Naloxone Layperson Training • Revision of ACEP Policy: Law Enforcement Information Gathering in the Emergency Department We will provide updates on these resolutions in our Fall newsletter.
mark your CALENDARS Eastern PA Resident Career Night
Tuesday, September 11, 2018 Time Bar, Philadelphia
Eastern PA Residents Day
Wednesday, September 12, 2018 Jefferson University, Philadelphia
PACEP Board of Directors Meeting
Wednesday, September 12, 2018 Jefferson University, Philadelphia
Western PA Residents Day
Thursday, September 20, 2018 Ambassador Conference Center, Erie
ACEP Council
Saturday, September 29 – Sunday, September 30, 2018, San Diego, CA
PA Delegation Dinner @ ACEP Council
Saturday, September 29, 2018 San Diego, CA
PA Delegation Breakfast Meeting @ ACEP Council
Sunday, September 30, 2018 San Diego, CA
PACEP Board of Directors Meeting
Thursday, November 15, 2018 Harrisburg
SAVE THE DATE!
PACEP19 SCIENTIFIC ASSEMBLY
APRIL 10-12, 2019 CROWNE PLAZA, KING OF PRUSSIA
CORRECTION: In PACEP’s Spring issue we announced PACEP18 Scientific Assembly Spivey Winners. Our 1st Place Spivey Winner Iryna Matkovska, DO was incorrectly listed as attending Einstein University. Dr. Makovska is from the Albert Einstein Health Network. Also in our Spring issue, in our Resident Spotlight, the author’s name was incorrectly listed as Josh Mervin. The author’s name is Josh Mirkin.
PACEP News | SUMMER 2018 13
Understanding the Sexual Assault Victims Emergency Services Act: An Emergency Department Perspective Ralph J. Riviello, MD, MS, FACEP Professor and Chair, Department of Emergency Medicine Crozer-Keystone Health System Past PACEP President In 2008, the Commonwealth passed the Sexual Assault Victims Emergency Services (SAVES) Act to provide minimal requirements for the physical and psychological treatment of sexual assault (SA) victims by hospitals in the state. The act states hospitals must promptly provide SA patients1: • Medical examinations and laboratory or diagnostic tests, including forensic evidence; • Utilize a rape kit approved under the Sexual Assault Testing and Evidence Collection Act; • Oral and written information about STD and pregnancy possibility; • Oral and written information about accepted medical procedures, medications and their contraindications available for the prevention or treatment of infection/disease; • Medication for HIV and STD prophylaxis; • Tests and examinations to determine presence or absence of STD; • Oral and written instructions advising of the need for additional testing at time periods after the assault; • Information on the availability or a rape crisis counselor and the ability of a patient to consult with them in the hospital; • Provide emergency contraception; and • Maintain a record of all examinations and services. Hospitals can obtain exemptions to providing these services based on religious and moral grounds, and other criteria; however, the intent is that all services should be available to all victims in the Commonwealth at any hospital. The Department of Health is responsible for enforcement of the regulation. Several counties in the state have designated regional hospitals/centers for the care of SA patients; this is especially true for pediatric patients. Recently, it has come to our attention that DOH Inspectors have been asking about the care that is provided to SA at their hospitals and citing them as noncompliant with the SAVES Act and/or EMTALA when patients are transferred. Both the American College of Emergency Physicians (ACEP) and the US Department of Justice (US-DOJ) support a more nuanced approach to these patients. ACEP clinical policy states, “the selective 14 PACEP News | SUMMER 2018
triage for victims of sexual assault to designated exam facilities.” 2,3 The US-DOJ, in the National Sexual Assault Exam protocol, states, “Health care facilities have an obligation to provide services to sexual assault patients4. Designated exam facilities or sites served by specially educated and clinically prepared examiners increase the likelihood of a state-of-the-art exam, enhance coordination, encourage quality control, and increase quality of care for patients. Recommendations for jurisdictions to build capacity of health care facilities to respond to sexual assault cases: • Recognize the obligation of health care facilities to serve sexual assault patients in a culturally and linguistically appropriate manner. • Ensure that exams are conducted at sites served by examiners with advanced education and clinical experience, if possible. • Explore possibilities for optimal site locations. • Communities may wish to consider developing basic requirements for designated exam sites. • If a transfer from one health care facility to a designated exam site is necessary, use a protocol that minimizes time delays and loss of evidence and addresses patients’ needs.” Even more so, pediatric patients may present acutely or in a delayed fashion following disclosure of sexual assault/abuse. There may or may not be a need for an acute examination with forensic evidence collection. For pediatric patients, the examination should be performed by specialized and trained pediatric examiners3,5. Emergency Departments without pediatric examiners must work closely with CAC/MDITs to develop a triage protocol to differentiate between acute/nonacute exams and have a clear plan for immediate action and referrals. This will require basic education on pediatric genital anatomy and physiology. It is also necessary to have staff education on minimal facts history taking to avoid trauma and the negative effects of how obtaining this improperly may affect evidentiary value. The USDOJ, in the Pediatric exam protocol, advocates a multidisciplinary response team and states, “Although it may not be feasible for every health care facility in a community to offer specialized care for this population, every community should make available5:
• Pediatric examiners who provide this specialized care as part of a multidisciplinary team response; and • Health care facilities in which pediatric examiners conduct acute and non-acute examinations and where optimal access is offered to the full range of medical services that child victims may require (for acute care)”
Virginia | Maryland | Washington, DC | West Virginia
Several organizations including the Pennsylvania College of Emergency Physicians (PACEP), the Hospital Association of Pennsylvania, the Pennsylvania Coalition Against Rape, and PA Chapter of the International Association of Forensic Nurses are willing to collaboratively work with the Department of Health to describe best practices for SA patients in the state and to realize that a one size fits all approach may not work in certain locations and may not be in the best interests of the patient.
EMA, an established twenty-four hospital regional, physician-
In the meantime, we want to make sure that if you do triage patients to a different location for SA services, that the transfer be timely and EMTALA compliant. Having someone at the front the desk tell the patient, “We don’t do that here, go to hospital X” is unacceptable. Transport, at no cost to the victim, should be provided to the patient and they should be afforded the opportunity to decline said transfer and receive services at the hospital they chose. This action, however, could be interpreted by the DOH as non-compliant, presently. Also, if you have any questions or difficulties, please contact HAP or PACEP.
• Full benefits package for physicians and family
partnership, physician-managed group seeks full and part-time BC or BP Emergency physicians to practice in Virginia, Maryland, Washington, D.C. and West Virginia. Since 1971, EMA has offered our physicians an unmatched quality-of-life with the secruity of our 100% contract stability. • Partnership opportunities • Quality-of-life centered practice • Administrative & clinical opportunities
Send CV: Se V: Emergency Medicine Associates, P.A., P.C. Phone: 1-800-942-3363 Email: Recruitment@EMAonline.com www.EMAonline.com
L i v e , Wo r k & P l a y W i t h Us !
We will keep you posted on any changes and our progress. REFERENCES 1. The Pennsylvania Code. § 117.52. Minimum requirements for sexual assault emergency services. 2008. Available at: https://www.pacode.com/secure/data/028/ chapter117/s117.52.html 2. American College of Emergency Physicians. Selective triage for victims of sexual assault to designated exam facilities. February 2018. Available at: https://www.acep. org/patient-care/policy-statements/selective-triage-forvictims-of-sexual-assault-to-designated-exam-facilities/#s m.000i4y8a517nveyay5l2d5qfsr3l 3. American College of Emergency Physicians. Policy statement: Management of the patient with the complaint of sexual assault. April 2014. Available at: https://www.acep.org/patient-care/policy-statements/ management-of-the-patient-with-the-complaint-ofsexual-assault/#sm.000i4y8a517nveyay5l2d5qfsr3lm 4. US Department of Justice. A national protocol for sexual assault medical forensic examinations: adult/ adolescent (2nd ed). April 2013. Available at: https:// www.ncjrs.gov/pdffiles1/ovw/241903.pdf 5. US Department of Justice: A national protocol for sexual assault medical forensic examinations: pediatrics. April 2016. Available at: https://www.justice.gov/ovw/ file/846856/download PACEP News | SUMMER 2018 15
Emergency Medicine Opportunity – Rural Pennsylvania $25,000 Starting Bonus and Loan Repayment St. Luke’s Hospital - Miners Campus is recruiting for full-time Emergency Medicine physicians to be an integral part of our successful physician team. The hospital is a fully accredited, not-for-profit, 45-bed acute care hospital located in Coaldale, Pennsylvania in Schuylkill County. It boasts a state of the art 14-bed Emergency Department and is on pace to treat more than 18,000 patients per year and is the first certified Level IV Trauma Center in Pennsylvania. We possess our own full-time 24/7 EMS transport team who work alongside our very experienced and patient focused nursing team. Candidate must be ABEM board certified. The ED physicians are partial single coverage with 12 and 10 hour shifts (Physician & PA) and are supported by state of the art radiology. This employed position offer: •
$25,000 starting bonus and up to $100,000 in loan repayment
•
Location and retention bonuses
•
Competitive salary with incentive plan
•
Rich benefits package, including relocation, malpractice, health & dental insurance, CME allowance
St. Luke’s Miners Memorial Hospital is a member of the nationally recognized St. Luke’s University Health Network, a nonprofit network comprised of physicians and hospitals, providing care in eastern Pennsylvania and western NJ. The Network includes more than 200 locations and seven hospitals and employs more than 450 physicians and 200 advanced practitioners. The Miners Campus is just 12 miles west of The Pocono Mountains of Jim Thorpe, PA. The location is ideal for skiers, mountain biking, hunting and fishing yet is just 35 minutes north of the Lehigh Valley, 90 minutes of Philadelphia and 2 hours to Downtown Manhattan.
{ Job Opportunities }
Assistant Medical Director Pediatric Emergency Medicine Leadership Assistant Program Director Vice Chair, Research
What We’re Offering: • We’ll foster your passion for patient care and cultivate a collaborative environment rich with diversity • Salaries commensurate with qualifications • Sign-On Bonus • Relocation Assistance • Retirement options • Penn State University Tuition Discount • On-campus Fitness Center, day care, credit union and so much more! What We’re Seeking: • Experienced leaders with a passion to inspire a team • Ability to work collaboratively within diverse academic and clinical environments • Demonstrate a spark for innovation and research opportunities for Department • Completion of an accredited Emergency Medicine Residency Program • BE/BC by ABEM or ABOEM • Observation experience is a plus
What the Area Offers: We welcome you to a community that emulates the values Milton Hershey instilled in a town that holds his name. Located in a safe family-friendly setting, Hershey, PA, our local neighborhoods boast a reasonable cost of living whether you prefer a more suburban setting or thriving city rich in theater, arts, and culture. Known as the home of the Hershey chocolate bar, Hershey’s community is rich in history and offers an abundant range of outdoor activities, arts, and diverse experiences. We’re conveniently located within a short distance to major cities such as Philadelphia, Pittsburgh, NYC, Baltimore, and Washington DC.
FOR ADDITIONAL INFORMATION PLEASE CONTACT: Susan B. Promes, Professor and Chair, Department of Emergency Medicine c/o Heather Peffley, Physician Recruiter, Penn State Health Milton S. Hershey Medical Center 500 University Drive, MC A595, P O Box 855, Hershey PA 17033 Email: : hpeffley@pennstatehealth.psu.edu or apply online at: http://hmc.pennstatehealth.org/careers/physicians The Penn State Health Milton S. Hershey Medical Center is committed to affirmative action, equal opportunity and the diversity of its workforce. Equal Opportunity Employer – Minorities/Women/Protected Veterans/Disabled.
Opportunities in Pennsylvania's Busiest ED! Advancing Health. Transforming Lives.
Tower Health is seeking Emergency Medicine physicians across its six acute-care hospitals to help serve a population of more than 2.5 million with comprehensive services and technology! Spotlight: Reading Hospital in West Reading, PA • • • • • •
#1 Busiest Emergency Department in Pennsylvania #8 Busiest Emergency Department in the US in 2017 Over 50 physicians treating 135,000+ patients annually Adult Fast Track Opening Fall 2018: 16-bed self-contained Pediatric Emergency Unit 120 Beds; 100+ specialty and multi-purpose treatment rooms
CURRENTLY HIRING:
Emergency Medicine Physicians Pediatric Emergency Medicine Physicians
The Reading Hospital Emergency Medicine Residency With 120 ED beds, Reading Hospital’s EM residents practice in an outstanding clinical environment with a large variation of patient conditions and populations. The curriculum has been designed to expose residents to a multitude of experiences throughout their training to ensure they're equipped to practice Emergency Medicine in any setting. Energetic and forward-thinking residents are sought to join our team!
For more information, contact: Carrie Moore, MBA 484-628-8153 Carrie.Moore@towerhealth.org Visit our websites: towerhealth.org careers.towerhealth.org Equal Opportunity Employer
A WellSpan
Emergency Medicine Career:
What’s your goal? WellSpan's Gettysburg Hospital is seeking an additional physician to join their collegial emergency medicine team. Secure employment with WellSpan Medical Group, a mature, well-established and physician-led group of more than 1,200 providers. • Join a staff of 11 experienced physicians and 3 APCs • Physicians work 36 hours per week • Non-trauma hospital with 30,000+ ED visits/year • Beautiful state-of-the-art emergency department • Up to $80K in student loan repayment and $20K signing bonus • Competitive salary & generous hourly rate for voluntary shifts • Six weeks of paid and scheduled time off If you are a BC/BE Emergency Medicine physician who's passionate about providing care in a community hospital setting and transforming patients’ health, explore our opportunities at WellSpan Gettysburg Hospital. Historic Gettysburg, PA is a family oriented community that is centrally located near the Baltimore/DC metro area. You'll feel right at home in our region!
Join us, and achieve your Emergency Medicine career goals. To learn more, visit JoinWellSpan.org. Or contact Ann Reid, Physician Recruiter, at 717-812-4377 or at areid2@wellspan.org.
PRSRT STANDARD U.S. POSTAGE PAID
PACEP NEWS
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Own your future now. Visit usacs.com or call Darrin Grella at 844-863-6797 careers@usacs.com