Issue 143 | May 2020
Pressing Forward Amid
Phased Reopening
May has brought us a phased reopening for the Commonwealth and new guidelines on how we move forward. Already, physicians are seeing slight increases in volume, which will continue as reopening progresses.

VACEP leaders have been hard at work fighting against the Governor's budget amendment regarding Medicaid reimbursement (details below). Through all of this, we've been unflagging in our attention to this evolving pandemic and how we can best support our member physicians, the healthcare community, and the patients under our care.

In this issue:
  • VSAE and RTD profile Sarah Marshall
  • Our letter to CMS asking to review new Virginia reimbursement policy
  • Children & COVID-19
  • Physician mental health
  • Reopening impacts and mask mandates

And much more.

Thank you for your work on Virginia's healthcare front lines. You continue to make us proud every day.
Virginia Medicaid reimbursement policy challenged by VACEP, docs, hospitals
A reimbursement policy contained in Virginia's new biennial budget is designed to reduce Medicaid reimbursements for emergency care if the visit is deemed, after the fact, to be "preventable."

We sent a letter to the Centers for Medicare and Medicaid Services this month asking them to review this program for compliance with CMS guidance, which we believe it violates.

Details:

  • Under the budget language, Medicaid reimbursements would be automatically reduced to a level 1 claims — $14.97 — if an ER visit code is on the “preventable” diagnosis list, which includes 789 level 2, 3 and 4 codes. 
  • We believe that 1.) the Prudent Layperson Standard obligates Medicaid programs and MCOs to reimburse doctors and hospitals for the delivery of emergency medical care based on presenting symptom; and, 2.) that payments cannot be solely determined using a diagnosis list.
  • Such reimbursement reductions are not sustainable, violate current standards for emergency care and threaten the emergency medicine safety net, particularly in areas that are often already facing health equity issues because of a high Medicaid population.
  • Review the Low Acuity Non-Emergent ER Diagnosis Code List, which would result in automatic down-coding.
Get to Know Sarah Marshall, our Executive Director

The Virginia Society of Association Executives did a Q&A with Sarah Marshall, VACEP Executive Director, for its May newsletter. She shared insights on what it's like to lead a group on the frontlines of the COVID-19 pandemic.

Sarah was also profiled this month in the Richmond Times-Dispatch's " Getting to Know" feature.
Parker on ACEP Podcast Frontline
VACEP Executive Committee member — and self-proclaimed "data nerd" — Todd Parker, MD, FACEP joined ACEP Frontline podcast host and emergency physician Ryan Stanton to talk "clickbait and false narratives" and uncovering the facts in the time of COVID-19.

Also, check out Dr. Parker's " The Emergency Doc" blog on Facebook, where he provides his own professional, evidence-based insights on the pandemic.
Support for Long-term Care Facilities
In response to the COVID-19 pandemic, the  Virginia Hospital & Healthcare Association   and the   Virginia Department of Health embarked on an effort to allocate support and resources to long-term care facilities across the Commonwealth.

This initiative provides backing in a number of areas including infection prevention and control, access to personal protective equipment (PPE) and other medical supplies, COVID-19 testing and support, clinical practice and staffing support, and the sharing of best practices.
Reporting and Treating MIS-C in COVID-19 cases
There are reports in New York and the U.K. — and now a handful in Virginia — of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. This month, the Virginia Department of Health asked state healthcare providers to immediately and rapidly report any patient who meets certain case criteria to the local health department (indeed, the first case of MIS-C was reported in Virginia days later). Public health officials developed a standardized case definition for suspected cases.

Case definition:
  • An individual aged <21 years presenting with fever*, laboratory evidence of inflammation**, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND 
  • No alternative plausible diagnoses; AND 
  • Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms

*Fever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours
**Including, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin 
Masks for All in Public, Indoor Spaces
This week, Gov. Ralph Northam signed Executive Order 63, requiring Virginians over age 10 to wear face coverings in public indoor settings. The order goes into effect Friday, May 29.

  • The Virginia Department of Health will endorse the order, and violation can result in a Class 1 misdemeanor, punishable by up to a year in jail and a $2,500 fine.
  • Children over the age of two are strongly encouraged to wear a face covering to the extent possible.
  • Exemptions include while eating and drinking at a food and beverage establishment; individuals who are exercising; children under age two; a person seeking to communicate with a hearing-impaired person, for which the mouth needs to be visible; and anyone with a health condition that keeps them from wearing a face covering.
The University of Virginia Health System campus.
Heart Attacks, Heart Failure, Stroke: COVID-19’s Cardiovascular Complications

COVID-19 can cause serious cardiovascular complications including heart failure, heart attacks and blood clots that can lead to strokes, emergency physicians report in a new scientific paper out of the University of Virginia. They also caution that COVID-19 treatments can interact with medicines used to manage patients’ existing cardiovascular conditions.

The new paper from UVA Health’s William Brady, MD, and colleagues aims to serve as a guide for emergency physicians treating patients who may have or are known to have COVID-19. Read the summary over at the UVA newsroom , or...
Hotels, coffee, transit, and mental health: Discounts for ACEP members

A number of companies are offering discounts for healthcare workers. They can help with places to stay, aid around the home, and keep you healthy (NoVA-area pizza deals aside). ACEP (which has partnered with a few companies on these discounts) has some of them compiled here.
ACEP's COVID-19 resources

ACEP continuously updates its COVID-19 Alert page to ensure members have the latest information. Find clinical content, federal guidance, daily news updates, wellness resources and more.

Webinar: Preventing Physician Suicide

We all have a role to play. Peer recognition of the signs of burnout and depression, plus knowing how to create a supportive environment, are important in team-based settings. Join ACEP and others for a webinar June 23 at 2 p.m. EST to provide you with best practices for peer-recognition of the signs and symptoms of suicidal ideation.

ACEP's Ethics Committee is also conducting a study on workplace stress, designed to identify symptoms of work-related stress and PTSD. Your input helps ACEP support member needs. Take the survey (5 min).
ACEP offering free 3-month membership to increase access to COVID-19 resources
 ACEP is offering free 3-month membership to all emergency physicians eligible for membership.

If you have a colleague who is not a member, let them know about this offer so they can have access to ACEP's COVID-19 resources and discussion thread.

If interested, email  membership@acep.org , or call (844) 381-0911.
Advocating for Emergency Medicine

VACEP supports candidates who support us and issues that matter to our specialty. The goal of the Virginia Emergency Medicine Political Action Committee (EMPAC/VA) is to assure the election or re-election of those members of the General Assembly who are supportive of organized medicine in general — and emergency medicine in particular.
Virginia College of Emergency Physicians | (804) 297-3170 |  E-mail  |  Website