In This Issue:
Michael Walters, MD JD FAAEM
President, GLAAEM Board of Directors
It is hard to believe that spring is in the air around the Great Lakes. The changing weather definitely brings excitement and hope about the possibilities of spring and summer ahead. Like the change in the season, I am excited and enthused about the direction of GLAAEM and AAEM after attending the 21st Scientific Assembly. At the assembly we had the opportunity to attend some top-notch lectures, meet with fellow chapter division members, decide on new benefits for GLAAEM members, and consider future endeavors for GLAAEM.
The 2015 Scientific Assembly was a wonderful experience. The educational content was excellent as usual. Additionally, as a chapter we were able to conduct our second annual chapter division meeting. More importantly, we had a fun time at our first ever chapter division social. I was honored to meet so many friendly members from the Great Lakes. There is definitely something to the "Midwestern hospitality" thing. For those of you that did not attend, I would encourage you to do so next year. Vegas baby! While this may sound all in good fun, many of you may be asking so what? While being a great educational offering, the assembly offers a chance to meet fellow AAEM and GLAAEM members and discuss issues important to our collective everyday practice. In addition, the meeting provides GLAAEM members a chance to make some decisions for our chapter division in person. (Difficult given our geographic breadth). As for our annual GLAAEM meeting at the Scientific Assembly, probably our biggest decision related to our resident members. As many of you have hopefully noticed, you started receiving the Western Journal of Emergency Medicine (WestJEM) as a GLAAEM membership benefit. Now, we are taking another step forward with regards to this excellent publication and resident research. For any resident member of at least six months that has a publication accepted by the Western Journal of Emergency Medicine, we will pay the submission/publication fee of $300. The reason for this benefit is to promote resident research and help facilitate publication of their work. We wanted to remove the financial barrier, if any existed. To be eligible for this benefit the resident must be a member of GLAAEM and their work already accepted for publication by the journal. The resident can then submit a request to the board.
The 21st Scientific Assembly also allowed the board members of GLAAEM to interact with our colleagues from other chapter divisions. Most notable from this interaction was ideas brought forward by other chapter division board members regarding common issues. We will continue to explore these with other chapter division board members, focusing on how we can collaborate to bring value and substance to our members. For example, the Florida chapter division has been working to obtain its membership discounts to Advance Medical Certifications and the American Seminar Institute. I think this is an excellent value to our membership and the board will explore ways to collaborate with FLAAEM to extend discounts to GLAAEM members. Lastly, as relates to the Scientific Assembly and our chapter division meeting, we are still looking for a representative from Minnesota. So if you were one of the wonderful individuals I met at our social or a member from the land of ten thousand lakes, please consider joining the GLAAEM board to represent your fine state. Additionally, I encourage all AAEM members within the GLAAEM region to join the chapter division. We are working for you.
Getting done with the business side, I wanted to take a few lines to raise the issue of one topic that gave me pause at the Scientific Assembly, emergency physician burnout. I can honestly say that I always felt that residency trained emergency physicians were less susceptible to burnout than non-residency trained physicians that work in emergency departments. Why did I have this belief? We were trained from day one to deal with the stressors and idiosyncrasies of our job. However, I have come to learn that this belief is erroneous. A lecture at the Scientific Assembly stated that emergency physicians had the second highest level of burnout in medicine, just behind critical care physicians. Also, a recent discussion thread on my residency's alumni listserv focused on this issue and I was shocked to hear from so many dealing with this issue. So what can GLAAEM do to help? That is exactly the question. Please let us know how we can help. We want to be a partner and resource in improving your job satisfaction and reducing burnout. I think as your professional organization this is our duty.
Have a great spring! Hopefully all the snow will stay gone and we can get onto enjoying a fantastic Midwestern summer.
Christopher Wood, MD FAAEM
Indiana State Representative, GLAAEM Board of Directors
First off, I apologize for “diving right in” back in October without an introduction. I was born and raised in the Hoosier State, and am a 1999 graduate of Indiana University School of Medicine and a 2004 graduate of the Emergency Medicine-Pediatrics combined residency program at IU. After spending the first part of my post-residency career within the IU health system, I’ve spent the last six years as a partner with Lafayette Emergency Physicians, an independent democratic group that currently staffs three emergency departments in central Indiana. I currently serve as director for our group’s Advanced Practice Providers and as a preceptor for the Butler University Physician Assistant program (Go Dawgs!).
I am honored to be able to serve in this position with the GLAAEM chapter division. I strongly believe there is a place for AAEM to represent the interests of board-certified emergency physicians in this rapidly changing health care environment. Please don’t hesitate to contact me (firstname.lastname@example.org) if you have any questions, concerns, or issues that arise; this is your chapter division, and we are here to serve you!
Now on to live action…
HIP 2.0 Update
On January 27, 2015, the CMS approved Indiana’s application for Healthy Indiana Plan (HIP) 2.0.1, 2 This alternative to traditional Medicaid allows the state to provide coverage to adults 19-64 with household incomes up to 138% of Federal poverty level (FPL). Coverage began February 1, and those already covered under traditional Medicaid and the previous HIP plan were transitioned to HIP 2.0.
HIP 2.0 will offer access to coverage for as many as 350,000 uninsured Hoosiers with a “consumer-driven” health care plan for low-income populations. HIP coverage includes three main coverage options3,4,5:
- HIP Plus is touted as the preferred plan for all HIP members. Participation requires a monthly contribution to a Personal Wellness and Responsibility (POWER) account that does not exceed 2% of household income. Each POWER account is funded by the state at $2,500 per year and pays for most services. There are no co-pays for office visits, ED visits (except “non-emergency” visits; see below), inpatient admission, or prescriptions. HIP Plus also includes vision and dental coverage and an expanded drug benefit. Total out of pocket expenses are capped at 5% of household income.
- HIP Basic provides coverage for individuals at <100% of FPL who choose to not contribute to a POWER account and participate in HIP Plus. Those with household incomes 100-138% of FPL are not eligible. HIP Basic requires co-payment for office, ED, and inpatient services. It also does not provide vision or dental benefits, and the drug benefit is more limited and requires co-payment for prescriptions.
- HIP Link is a program to assist adults 21 and over who have access to employer-sponsored insurance. The state will provide a $4,000 annual contribution into a POWER account. Instead of contributing to this account, the individual contributes to their premium through a payroll deduction capped at 2% of household income. The POWER account is then used to pay the state portion of their premiums. Remaining funds in the account can be used to pay co-pays, deductibles, and out-of-pocket costs. Total out-of-pocket expenses are capped at 5% of household income.
Those with incomes between 100-138% FPL who do not contribute to their POWER accounts within a 60 day grace period are kicked out of HIP Plus and are ineligible to re-enroll for six months. Those with incomes <100% FPL who do not contribute to their POWER accounts will be transitioned to HIP Basic. Pregnant women are eligible for HIP Basic or Plus, and are not required to pay co-pays. Special exceptions are present for “medically frail” individuals, Native Americans, low-income parents. and caretakers.
Regardless of plan, HIP members will be required to pay a co-pay for “inappropriate” emergency department visits. Payment is $8 for the first visit, and $25 for each visit thereafter. Co-pays will be waived if the individual contacts his/her managed care plan hotline before going to the ED (or if the provider contacts the plan before sending the patient). In order to test the impact of this “cost-sharing,” 5,000 enrollees will be charged a $8 co-pay for all “nonemergency” visits.4 Whether this will impact ED visits remains to be seen; a recent article in JAMA Internal Medicine suggests that co-pays in other states had little impact on ED utilization.6
Another item of interest for emergency physicians is that HIP 2.0 implementation will generally improve reimbursement. Rates for most physician services will be adjusted, in aggregate, to 75% of the 2014 Medicare Physician Fee Schedule.7 Prenatal care and some maternity services will be reimbursed as much as 100% of Medicare rates, and behavioral health services will be reimbursed at 80% of Medicare rates. Not only might this improve reimbursement for ED visits, there is also hope that improved reimbursement will improve provider access for HIP members.
For more information, go to http://www.in.gov/fssa/hip/.
- Siddiqui M, Roberts ET, Pollack CE. The Effect of Emergency Department Copayments for Medicaid Beneficiaries Following the Deficit Reduction Act of 2005. JAMA Intern Med. Published online January 26, 2015.
Opinions expressed are those of the authors and do not necessarily represent the official views of AAEM, its chapter divisions or affiliates. These articles are intended for the individual use of AAEM members.