December 2016

COLORADO CHAPTER American College of EPIC Emergency Physicians® FROM THE PRESIDENT MIPS, the new PQRS by David Friedenson, M.D. FACEP Decreasing costs and radiation exposure to our patients is the 2017 rolls out a host of new pay for performance measures. goal. You’ll need to make sure patients have an Historically, Emergency Physicians have been limited in appropriate indication prior to ordering a CT scan of the their ability to participate in pay for performance and have head for minor blunt head trauma. The nice thing is, been left behind in the fee for service world, held hostage unlike the last time they tried to have us order fewer CTs, to our hospital systems’ dated and user unfriendly EHRs. this measure actually makes sense. When patients have an We are criticized for our costs, while actually being the indication, you should order the CT. However, when they most efficient piece of the health care delivery system. don’t, you shouldn’t let a patient talk you into getting one done. The list of indications matches some good decision While we as a specialty have been working on real quality rules such as PCARN for kids and are more liberal with changes, CMS has been a little slow on the uptake. Over inclusion criteria than the Canadian CT rule for adults. the last couple of years as So they’re not asking you to hold back on appropriate a specialty, we’ve utilization but just don’t order them ‘because’. We are criticized decreased inappropriate for our costs, while CT utilization; we’re The next new measure deals with antibiotic stewardship. decreasing excessive Basically, CMS is asking that we prescribe only topical anti- actually being the opiate prescriptions in biotics for otitis externa and that we prescribe no antibiotics most efficient piece the ED-opting for novel for presumably viral infections. Not bad rules and we now of the health care pain management have the government’s backing when having those shared decision making discussions with our patients. delivery system. techniques such as trigger point injections and The next one is the infamous blood pressure measure Lidocaine for kidney that most of us have figured out how to conquer—so stones, and changed the course of sepsis care, drastically keep on trucking on with that one. improving survival in the sickest patients who show up at our doors. This coming year, PQRS changes to MIPS and Finally, there are the pregnancy measures. We all know things are changing as 2017 marks the new world of CMS we see lots of pregnant Medicare patients so it’s pay for performance in the emergency department. important you’re perfect with this one in case you do see one of the few patients who qualify for the ultrasound in Out with the old and in with the new; since we do certain pregnancy with abdominal pain or bleeding and the things really well like performing EKGs on patients with Rhogam for women at risk measures. chest pain and saving lives through sepsis bundles, CMS is eliminating the EKG measure and came up with a few new CMS didn’t quite get the specifications completed in time measures for us to learn. This year’s big additional for the New Year so more details will be forthcoming but measures come in the form of utilization control. for now, those are the measures that have been fully vetted.

President’s Letter continued on page 2 Annual Meeting at Denver ChopHouse . . . pg 2 Residents’ Corner...... pg 6 Nominate A Colleague...... pg 3 2017 Legislative Reception ...... pg 7 INSIDE: 2016 ACEP Council Report...... pg 4 Legislative News...... pg 8 Upcoming COACEP Meetings . . . . . pg 5 Update on Free Standing EDs. . . . . pg 11 President’s Letter continued from page 1

In addition to quality reporting, Emergency Physicians will have to report new advancing care information and practice improvement EPIC measures this year. These two components replace HER meaningful use which we’ve gotten a pass on in the past. Some of those measures are actually good patient centered measures such as using the CORHIO and PDMP, letting PCPs know that you saw their patients and for what, or reporting to public health databases, all of which many of us are already doing.

“The mission of the Chapter, American It will be a little more work to report successfully this year but the College of Emergency Physicians is to serve as the measures are starting to be reasonable attempts to appropriately control primary organization in the State of Colorado costs and limit unnecessary testing and treating. CMS also gives you an representing the specialty of Emergency Medicine, out this year if you just want to avoid a penalty and not shoot for the promoting the interests and values of emergency stars, you can report “something” for 90 days instead of all for a year. More to come in January. physicians and patients by giving physicians the tools to support the highest quality of See you at the Annual Meeting. E emergency medical care.”

OFFICERS David Friedenson, MD, FACEP. President JOIN US Andrew French, MD, FACEP, President-Elect Kevin McGarvey, MD, FACEP, Secretary/Treasurer Eric Olsen, MD, FACEP, ANNUAL Immediate Past President

BOARD OF DIRECTORS MEETING Caleb Hernandez, DO, FACEP Nathaniel Hibbs, DO, FACEP Christopher Johnston, MD January 18, 2017 • 12:00 noon Garrett Mitchell, MD, FACEP Carla Murphy, DO, FACEP Denver ChopHouse Dave Ross, DO, FACEP Fred Severyn, MD, FACEP 1735 19th Street • Suite 100 Lee Shockley, MD, FACEP Donald Stader, MD Denver, CO 80202

EXECUTIVE DIRECTOR See You There! Barb Burgess

CHAPTER OFFICE Colorado ACEP 10465 Melody Drive #101 Northglenn, CO 80234 Phone: 303-255-2715 Fax: 303-255-2704 Email: [email protected] www.coacep.org

2 2017 Colorado ACEP Board of Directors Elections

Gain new perspectives on emergency medicine! Nominations are now being accepted for Colorado ACEP Board of Director Positions.

If you are interested in serving on the Colorado ACEP Four positions are available on the Colorado ACEP Board Board of Directors or would like to nominate someone of Directors beginning January 18, 2017. As per the please contact Barb Burgess at the Colorado Chapter office. Colorado ACEP Bylaws: Section 3. Terms: Elected directors Candidates must complete the Board Candidate Data Sheet shall serve a term of two (2) years and may serve no more (Download the Board Nomination Form HERE. Return than 2 consecutive terms. Resident representative term will Board Nomination Form and CV to Colorado ACEP by be for one (1) year. Terms shall begin at the end of the December 31. In your candidate statement you may comment annual meeting. Terms of office shall be staggered in such a on any ACEP issues, plans or ideas for the Chapter. fashion so that Board vacancies occur annually. E

Nominate Your Colleagues Award Nominations are now being accepted

This is your opportunity to recognize those individuals who have made significant contributions to the profession and ACEP. Awards will be given at the Annual Meeting. CLICK HERE 3 October 14 & 15, 2016 • Las Vegas 2016 ACEP Council Report By Doug Hill, DO, FACEP

Board Officer Elections. Paul Kivela, individual resolutions that were passed reimburse emergency physicians for MD, FACEP (California) was elected addressing these. Included were: these services and support efforts to President-elect of the American appeal denials; oppose exclusive imaging College of Emergency Physicians. John 1. Free Standing Emergency Centers contracts limiting EM ultrasound and Rogers, MD, FACEP (Georgia) was 2. Ultrasound support those who face opposition from elected Chairman of Board, Bill 3. Substance Abuse and Opioids those that hold such contracts. Jaques, MD, FACEP (Maryland) 4. Psychiatry and Behavioral Health elected Vice-President, and Vidor Issues Substance Abuse and Opioids: develop Friedman, MD, FACEP (Florida) was guidelines and provide educational elected Secretary-Treasurer. FSECs: explore minimum resources for harm reduction accreditation standards and serve as strategies and transitioning substance Board of Directors Elections. the accrediting (not licensing) entity; use disorder patients to long-term Incumbents James Augustine, MD, lobby MedPAC & CMC that all FSECs treatment; review evidence on ED FACEP (Ohio) and Debra Perina, MD, be subject to same regulations and initiated treatment of patients with FACEP (Virginia) were reelected to payment schedule for technical care substance use disorders and support their 2nd three-year terms, and Kevin and suggest AMA also join the lobbying novel induction programs; seek Klauer, DO, FACEP (Ohio) and Gillian effort; develop an information paper reimbursement for counseling on safe Schmitz, MD, FACEP (Government analyzing use of FSECs to maintain opioid use, reversal agent instructions, Services) were elected to their 1st terms. access to emergency care where and drug abuse counseling, and Critical Access and Rural Hospitals develop a toolkit and education for Resolutions. There were some have closed or in process of closing. implementation; support training and recurring themes present in this years’ equipping all first responders in the use resolutions and the following four Ultrasound: develop a statement of Nasal Spray Naloxone, pharmacists issues are summaries of the several declaring insurance companies must CO ACEP Councillors in Action

4 2016 ACEP Council Report cont.

to dispense naloxone without Rx; devel- examinations for MOC; national promoting the interests and values of op a comprehensive policy on prevent- decriminalization of small amounts emergency physicians and their ion and treatment of opioid use disorder of marijuana; emergency medical patients, and supporting quality epidemic including innovative treatment. treatment of marijuana intoxication; emergency medical care. The collaboration with non-medical entities award was presented to Barb at the Psychiatry and Behavioral Health: on quality and standards; and the President’s Award Banquet and she develop throughput quality data insurance collection of beneficiary made us extremely proud with her measures and dashboard reporting for deductibles. presence and acceptance remarks. behavioral patients in the ED, endorse Congratulations from all emergency integration of a dashboard for reporting Honorary Membership Award. physicians in Colorado! and tracking of those patients in the Colorado ACEP would like to ED, communicating the impact of acknowledge and congratulate Barb Councillors. Lastly, we would like to boarded behavioral health patients, Burgess, our Executive Director, in acknowledge this years’ councillors and collaborate with all appropriate health- receiving the esteemed American alternates who represented Colorado care and government stakeholders; College of Emergency Physicians’ ACEP. They were Nathaniel Hibb, DO, partner with the American Psychiatric Honorary Member- Association and others to develop ship Award! Her model practices such as bed capacity, service to Colorado alternatives to ED evaluations, reducing ACEP for the past LOS for mental health patients; 21 years has been develop best practices to reduce exemplary and has mental health visits, boarding, and included main- improve overall care of these patients. taining a consistent leadership role in Other resolutions that were passed by the chapter, as well the Council included such topics as: a resource as an assuring safe and effective care for institutional patients by senior/late career physi- memory; innovating cians; encouraging diversity in EM; such programs as studying and influencing the impact lobbyist support and of narrow networks; opposing CMS a small donor mandated treatment expectations; committee to help Barb Burgess, COACEP Executive Director, supporting 24/7/365 availability of guide our legislative initiatives; receiving Honorary Membership Award. hyperbaric medicine; studying the continuing education activities such moral and ethical responsibilities of as our Fall CME Program and the FACEP; Douglas Hill, DO, FACEP; the EP in the context of court-ordered Summer Rocky Mountain Trauma and Kevin McGarvey. MD, FACEP; Carla collection of forensic evidence; and EM Conference; and developing our Murphy, DO, FACEP; Eric Olsen, MD, supporting the transition of military chapter’s Member Awards Program. FACEP; Lee Shockley, MD, FACEP; and medics integrating into civilian EMS. Barb exemplifies the Values of James Thompson, MD, FACEP. Thank Emergency Care in Colorado by you for your service to the Chapter, the Resolutions referred to the Board were representing the specialty of College, and to the Specialty of those opposing required high stakes Emergency Medicine in the state, Emergency Medicine. E

JOIN US UPCOMING COLORADO ACEP MEETINGS

• January 18, 2017 – Annual Meeting at Denver ChopHouse All meeting will be held at • March 22, 2017 COPIC/Colorado Medical • May 17, 2017 Society Offices located at • July 19, 2017 7351 Lowry Blvd., Denver, CO • September 20, 2017 unless noted otherwise. Meetings start at 12:00 noon. • November 15, 2017 5 RESIDENTS’ CORNER

Denver Health Emergency Medicine Residency: Dr. Zach Jarou

As residents, we are continuously confronted with different Zach Jarou (ZJ): I was born in Flint, Michigan, went to views of emergency medicine and how it should be undergrad and medical school at Michigan State (Go practiced. The perspectives come from our attendings, Green!), and now I’m a third year resident at the best our hospital administration, our fellow residents and peers, emergency medicine training program in the world. and even our patients. Every now and then, there are a few individuals that are compelled to address and promote CB: Why EM? our experiences on a national level. Dr. Zach Jarou, a third year resident at Denver Health, is doing just that. He has ZJ: As a medical student rotating in the emergency been involved with the Emergency Medicine Residents’ department, I was amazed by the breadth of skills and Association (EMRA) since medical school and was recently knowledge that one must have to expertly navigate elected to be the next President of EMRA. We want to take “the most interesting 15 minutes of every other specialty.” the time to highlight him and his accomplishments as well I also liked the social mission of the specialty - “anyone, as delve into what plans he has in store for emergency anything, anytime.” medicine residents and emergency medicine in general over the next few years. CB: What inspired you to become involved with EMRA on a national level? Here is our conversation: ZJ: I’ve always been the sort to get involved with things Cara Bergamo (CB): Tell me a little about yourself. bigger than myself. I was chair of Michigan State’s EMIG

“The role of president is to have a vision and be the voice.” – Dr. Zach Jarou

6 Residents’ Corner cont.

when a student from the University of Arkansas e-mailed me to develop EMRA Match, creating new and unique in-person about joining some “residents association,” which seemed experiences at national conferences, encouraging resident like they might have my graduation date mixed up given wellness, increasing Diversity & Inclusion in emergency that I was still a couple years from earning the “MD” after medicine, and so much more. We’ll see what remains to be my name. But I checked out EMRA.org, learned about the finished and what new opportunities present themselves amazing opportunities available for students, residents, over the upcoming year. I am lucky to follow in the footsteps fellows, and alumni; and since joining, being an EMRA of some amazing leaders. member and leader has benefitted me enormously both personally and professionally. CB: What message, if any, do you have for the Colorado ACEP members about the state of EM residencies and CB: What are your goals as President-Elect of EMRA? residents nationwide?

ZJ: The EMRA Presidency is a three-year gig, one as ZJ: To all who came before us, thank you for paving the way president-elect, one as president, one as immediate past. for my generation to seamlessly step into a well-established, Since I’ve already been on the EMRA Board as Medical well-respected, purposeful medical specialty. As ACEP gears Student Council Chair and Membership Coordinator, I’m up to celebrate it’s 50th anniversary in 2018, I’m looking fortunate to be able to hit the ground running. My personal forward to what my young physician colleagues will development goals are to become a more deliberate accomplish over the next 50 years! communicator, a more comfortable delegator, and a more captivating speaker. The President-Elect also serves as Editor CB: What do you like to do in your free time? of EMRA’s monthly “What’s Up in Emergency Medicine” newsletter and oversees EMRA’s 17 committees & divisions. ZJ: In my very limited free time, I enjoy traveling, binge watching Hulu/Netflix, and searching for amazing sour/ CB: How will those change as President of EMRA? hoppy beers!

ZJ: The role of president is to have a vision and be the voice. CB: Don’t we all. Thank you so much! EMRA has a three-year strategic plan that was developed by the board elected by the EMRA Representative Council. We ZJ: My pleasure! E are currently working on re-vamping EMRA.org, continuing

2017 Legislative Reception Co-Sponsored by The Colorado Radiological Society, Colorado Regards from Society of Anesthesiologists, and the Colorado Chapter American College of Emergency Physicians, Society Presidents cordially invite you to attend a Legislative Reception Richard Sharpe, MD Colorado Radiological Society Wednesday, February 1, 2017 5:00pm - 6:30pm Daniel Janik, MD Colorado Society of The Art Hotel Anesthesiologists 1201 Broadway David Friedenson, MD, FACEP Denver, CO 80203 Colorado Chapter American Grand Colonnade Room College of Emergency Physicians

RSVP requested by January 18, 2017 Email - [email protected]

7 LEGISLATIVE NEWS 2017 Expected Legislation for Colorado ACEP By Suzanne Hamilton The list of 2017 legislative proposals is already lengthy. Below is a general categorization of what is expected to be debated in the 2017 Legislative Session which begins at 10:00 AM on Wednesday, January 11th.

Since the Colorado health care system is not an alignment of, but a mirror image of the Affordable Care Act, should the new Republican-controlled federal government repeal the ACA or any portion thereof, Colorado will need to make state statutory changes. Medicaid is expected to move to a block grant program. The 2017 session has not yet started and there are already rumors of a Special Legisla- tive Session next fall focused on restructuring the health care system in our state. The Colorado Cost Commission submitted its’ recommendations to the Governor and Since the Colorado health care legislature on November 16, 2016. To download this report, system is not an alignment of, but a CLICK HERE mirror image of the Affordable Care

The Colorado Hospital Association will attempt to exempt Act, should the new Republican- the Hospital Provider Fee from TABOR limits by controlled federal government transforming it into an Enterprise. This will be the third attempt at this proposal. The Governor’s balanced budget repeal the ACA or any portion proposal is based on capping the fee at $195 million. This thereof, Colorado will need to transformation has a difficult road ahead of it, but may gain support should the federal government indicate that make state statutory changes. the Medicaid expansion will be sustained. Colorado ACEP will be closely involved with numerous The Mental Health Task Force has continued to meet issues including physician reimbursement under Medicaid, and is struggling to put forth recommendations to an appropriate resolution to the out-of-network provider improve the M-1 Hold process. Legislators are hesitant issue, addressing the appropriate utilization and costs to remove jails as an option for persons on an M-1 Hold associated with FSEDs as well as other health insurance because there is no viable alternative. The Task Force reforms. David Freidenson, MD, FACEP, President of will meet twice in December and is expected to finalize Colorado ACEP, has been very involved in developing its recommendations. There are at least 9 proposals policy and working collaboratively with the Colorado on the table. To review the activity of the Task Force, Medical Society and other physician specialty organizations CLICK HERE to address these and other matters. We expect to have a full slate of bills for which Colorado ACEP members will need There are multiple groups looking into curbing substance to communicate with their local legislators. abuse, some focusing on opioid abuse in particular. The Department of Regulatory Agencies is doing an agency With the passage of proposition 106 (medical aid in dying) wide review of their opioid related policies. In addition, some statutory clarification will likely be necessary. The Senator Jahn is holding a stakeholder meeting in early Board of Medicine has already repealed their Rule December in an attempt to tackle this issue. addressing this issue so that physicians are not in violation when the proposition is deemed effective. They will 8 Legislative News cont.

standing emergency departments in Colorado and the costs of care associated there to. We can expect to see several of 2017 Legislative Session the proposals from past sessions addressing signage and patient disclosures. Adequate provider networks, certificate begins at 10:00 AM on of need requirements, an emphasis on dual-track systems (urgent care/emergent care,) the regulation of facility fees Wednesday, January 11th. and a moratorium on FSEDs pending a new state licensing scheme are some of the proposals on the table.

consider new rules at their February Board meeting. The Additionally, several scope of practice proposals are Hospice community is seeking clarification, specifically anticipated, including expanding the scope of naturopaths regarding the requirement that the death certificate of an to include limited prescriptive authority and removing the individual who uses the medication be signed by the primary articulated plan as a requirement for advanced practice physician or hospice medical director and must list the nurses to practice independently. There is an effort underway underlying terminal illness as the cause of death. COPIC is which would require criminal background checks performed quickly navigating the differences between the Oregon and by the Colorado Bureau of Investigations for physicians (and Colorado language and taking appropriate action on behalf other health care providers) upon an application for of physicians choosing to participate in this voluntary licensure or the renewal of a license. This will have a prescribing of lethal medication to terminally ill patients. significant fiscal impact on the budget. Early estimates range Additionally, the Colorado Hospital Association is seeking from $3 million to $5 million. The CBI estimates conducting clarification about a facility’s options to participate or not to an additional 40,000 background checks per year. participate. At the time of this writing we have yet to reach the deadline Drs. Nathaniel Hibbs and Paul Davidson have been for legislators to file their first of five bill titles. If the above representing Colorado ACEP at a series of stakeholder referenced list of anticipated legislative proposals is any meetings convened by Senator Kefalas to address various indication, Colorado ACEP members can expect a busy concerns being raised about the rapid growth of free legislative year. E 2016 ELECTION UPDATE for Colorado ACEP By Suzanne Hamilton, Lobbyist for Colorado ACEP

After a long and grueling election cycle, Colorado ACEP State Senate is well positioned with the new Colorado Legislature. Republicans continue their 18-17 control of the State Colorado ACEP was involved in 54 of the contested races, Senate. There will be only two brand-new faces in the losing only one. Senate, Democrat Stephen Fenberg from Boulder County and Republican of Douglas County. Seven Federal Elections House members are moving to the Senate chambers, The state will send its entire congressional delegation back including Democrats , , Daniel to Washington. The U.S. Senate race was won by the Kagan, and Angela Williams. incumbent – Senator – but he was held Republican is making the move, as is Bob under 49%. The closest House race, Congressional District Gardner, a former House member who’s been out of the 6 – the Aurora based seat held by Representative Mike Capitol for a couple of years. Coffman – didn’t turn out to be the close race that was anticipated. Representative Coffman beat State Senator There were three high profile State Senate races: Morgan Carroll by a margin of 52% to 43%. In Western • In Jefferson County, former Senator Colorado, Scott Tipton easily won reelection over former (D) beat incumbent Senator Laura Woods (R) by just State Senator Gail Schwartz by a margin of 55% to 41%. over 1,000 votes.

9 Legislative News cont.

• In Adams County, Representative Kevin Priola (R) beat former Senate Republicans Senate Democrats Representative Jenise May (D) by a 54% to 46% margin. President - Minority Leader • In Arapahoe County, Representative Daniel Kagan (D) President Pro Temp - Lucia Guzman beat Nancy Doty (R), 53% to 47%. - Assistant Minority Leader Majority Leader - - State House Assistant Majority Leader Caucus Chair - Lois Court The Democrats will hold the House and increase their - Ray Scott Minority Whip - Michael margin by picking up three seats for a 37-28 majority. Caucus Chair - Vicki Marble Merrifield Three Republican incumbents lost: Whip - John Cooke JBC - Dominick Moreno • In Southwest Colorado, Rep. J. Paul Brown (R) lost to JBC - Barbara McLachlan (D) in a slim margin of 49% to 50%. JBC - Kevin Lundberg • In Adams County, Rep. JoAnn Windholz (R) lost to Dafna Michelson Jenet (D), 48% to 52%. • In Colorado Springs, in a seat that “flips” in every recent Ballot Measures election, did this year with Rep. Kit Roupe (R) losing to A number of initiatives passed: former Rep. (D), 42% to 49%. • Amendment 70 – increase in the minimum wage • Amendment 71 – “raise the bar” for future constitutional There are 20 newly elected members to the 65-member changes House of Representatives. Two of them do have a head start: • Proposition 106 – medical aid in dying Democrat Tony Exum and Republican , both of • Proposition 107 – establishing an open presidential primary Colorado Springs, previously served in the chamber. • Proposition 108 – allowing unaffiliated voters to vote in

primaries New House members are:

Democrats - Chris Kennedy (District 23) Two initiatives failed: Barbara McLachlan (District 59) • Amendment 69 - single payer health care was (District 32) (District 62) resoundingly defeated by an 80-20 margin. Jeff Bridges (District 3) (District 36) • Amendment 72 - the effort to raise the state’s tobacco James Coleman (District 7) tax failed. (District 32) Republicans - Chris Hansen (District 6) (District 38) Referenda: (District 8) Phil Covarrubias (District 56) The two referenda on this year’s ballot both failed: (District 10 Kimmi Lewis (District 64) • Amendment T – to eliminate references to involuntary Dominique Jackson (District 42) Hugh McKean (District 51) servitude from the constitution. Dafna Jenet (District 30) Dave Williams (District 15) • Amendment U – to modify possessory interest – was handily defeated. E

Leadership Elections The legislative caucuses met the Thursday after the elections to elect leadership and the legislative Joint Budget Committee members (which again will have a split of three members of each party and began meeting on November 14th.)

House Democrats House Republicans Speaker - Crisanta Duran Minority Leader - Majority Leader - K. C. Becker Assistant Minority Leader Assistant Majority Leader - Cole Wist - JBC - Caucus Chair - Caucus Chair - Lori Saine Assistant Caucus Chair Minority Whip - Perry Buck - Jeni Arndt Whip - Deputy Whip - Jovan Melton JBC - Millie Hamner JBC - Dave Young

10 Update on Free Standing Emergency Departments (FSED) in Colorado

By Nathaniel Hibbs, DO, MS, FACEP

Over the past 2 years we have seen a tremendous growth in • Encourage creation of dual track (UC/ED) facilities the number of FSEDs in the state of Colorado. As of 9/1/16, through state grants or extra funding Colorado had 40 designated Community Clinics and • Limiting facility fees allowed by FSEDs Emergency Centers (CCECs) nearly all of which are FSEDs. Fifteen of these FSEDs are affiliated with specific hospitals • Institution of public education campaigns directed and there were 7 who’s licenses were pending. There are towards consumers trying to differentiate services and two separate models of FSEDs currently operating with costs between UC,s FSEDs, and hospital based EDs. expected inter-facility variation: the standard FSED and the dual track model of Urgent Care/ED. We will learn the direction of legislation in the next month.

With this growth has come increased scrutiny from many groups including consumer advocates, We have all heard or read about “surprise insurers, and legislators. The biggest area of concern revolves around cost and consumer bills” that patients have received from their protection. We have all heard or read about “surprise bills” that patients have received from their visit to the visit to the an FSED and this has become a an FSED and this has become a primary driver for primary driver for legislative change . legislative change.

Currently there are several groups working on developing legislation for the regulation of FSEDs. The If you have interest in this issue, I would encourage you to following are several possibilities that may be submitted in contact your local state legislator and volunteer to act as a various forms of legislation: resource to them when legislation is introduced. Colorado ACEP will keep you updated on this issue and continue to • Reinstitution of the Certificate of Need (CON) advocate on behalf of all Emergency Physicians in Colorado. requirement. This requires a governmental agency to approve the creation of new healthcare facility. These programs can have a scope that is broad or narrow. There Dr. Hibbs is Medical Director of the Centura Meridian Urgent and is discussion of CONs for both FSEDs and hospitals.1 Emergent Care Center and member of the CO ACEP Board of Directors • Instituting a moratorium on the creation of new FSEDs to References allow the state to determine the impact of FSEDs on the 1. Sealover, E. (2016, November 14). Hickenlooper considers change that would slow the growth community of suburban hospitals. Denver Business Journal. Retrieved from http://bizjournals.com 2. AHCCCS. (2016, August 21). AHCCCS Free Standing ED Final Rule. Retrieved from • Possible creation of new CPT codes for FSED visits which http://azhha.org would reduce current payments (this has already been E instituted in Arizona)2

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