December 2016

President’s Letter: Help Us Look for Opportunities

“When written Chinese, the word ‘crisis’ is composed of two characters – one represents danger, and the other represents opportunity.”  John F. Kennedy

Dear Colleagues –

As we enter the winter season with the New Year approaching, we sit at the edge of great change.  With a new administration in Washington, DC and tightening of control at the state level, medicine faces the potential for significant change.  Many see this as an impending crisis and they may not be wrong.  But out of every crisis is the opportunity for change if we engage and guide it.

Affordable Care Act Changes.  Few specialties benefited as much from the ACA as emergency medicine, replacing our uninsured with minimally insured Medicaid patients improved the book of business and allowed our patients to access care (sometimes).  With the repeal of Obamacare as the “first priority” of the new Congress, significant changes are expected.  Yet opportunity remains as many Republican leaders promise that the newly insured will continue with their coverage and the highlights of the program (children until age 26, guaranteed issue, and no lifetime caps) will remain. 

So what will change? The name for one.  Additionally, many believe that we will see a conversion of the Medicaid program into block grants.  The exchanges will likely change in character and funding with the loss of subsidies from the federal government.  The individual mandate will be challenged, but there is a question if this can be done while keeping the guarantee issue.  We in Washington attempted that in the 1990s and closed the individual insurance marketplace.  So many of the details will have to be worked out and it will be important to advocate for the patients that have gained coverage and the improvements that matter to emergency medicine.

Balanced Billing.  Of even more concern to us in the ED is the threat of a ban on balanced billing in the form of a Medicare linked rate setting at 125 percent of current rates.  Many of us have reviewed this and it poses an existential threat to our ability to recruit and retain providers, especially in urban departments that may face a potential bump in uninsured with the ACA’s repeal.  The data also shows that the problem is quite small in Washington State.  We are advocating strongly that solutions not destroy the status quo.  As the old proverb goes, we do not need to kill a mosquito with a cannon.  If your group is not employed by a hospital, your voice and advocacy will be critical in ensuring a fair solution.

Opiates.  We can all agree that there is a national epidemic of opiate abuse, a decent amount of which stems from prescribing habits.  Yet we also face a threat of increased bureaucracy and oversight that will further impede care.  Current proposals include pre-authorization for acute pain prescriptions, pill limits regardless of holiday weekends, and other arbitrary and capricious recommendations.  We in emergency medicine have made huge strides in our work on narcotics and can help lead a better way through shared guidelines, provider feedback, and ongoing engagement.  If we are to get there though we will have to educate and redirect bad policies like what have been proposed.

Engagement is key.  At the end of the day, your participation is critical.  We have wars on multiple fronts that pose potential existential threats to our ability to practice and provide care for our patients.  Out of these crises though is great opportunity to improve the care that is delivered if we can harness the desire for change and redirect it to good once more as we did with the ER is for Emergencies program.  We are scrappy tenacious and hard working emergency medicine doctors.  When there is a problem we can and will help fix it.  If you’ve got an itch to dive in and fight for our patients or just a simple sense of self-preservation of your practice, now is the time.  Next steps for all of us can include:

  1. Join the Washington ACEP 911 Network.  See information below.
  2. Join us Jan. 25 in Olympia for lobby day at the WSMA Legislative Summit.  Balanced billing and opiates are likely to be center stage and no one will do it better than you!
  3. Reach out to your legislators.  Talk to them now so that they know you when you are there on one of these major issues at the end of a tough session.

While it may seem challenging today, it is only in the darkness that we can appreciate the light.  Medicine will change as it always has done before.  There will be good and bad embedded in that change.  The degree of which will depend upon us.  Let’s make the most good and minimize the bad this year together. 

Thank you for all you do in caring for your patients in the ED and in the broader house of medicine.  If I can be of any help, do not hesitate to reach out.


Hon. Nathan Schlicher, MD, JD, FACEP
WA-ACEP President

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Be Part of the State-Level 911 Network


With the November elections past us, our work as Washington ACEP has only just begun. At the state level, we will be addressing several practice altering issues this year including:

  1. Balanced Billing and Surprise Coverage.  There is an effort to ban all balanced billing by providers and lock in a top payment rate of 125% of Medicare which would be devastating to our income.
  2. Opiate Treatment, Prescribing, and Provider options.  Prior authorization of prescriptions, mandatory use of the PDMP, and potential limits on our prescribing are all being discussed that would potentially hamper our prescribing.
  3. Medicaid payment, budget concerns.  With the McCleary decision still hanging over the legislature, every dime of the budget is being squeezed into education.  Thus Medicaid payment rates and other health programs are likely on the chopping block.

Given these major issues, Washington State ACEP is establishing a state level 911 Network to create a contact list for WA-ACEP members in every state legislative district.  This will be a rapid action response team that when an issue arises will be called on to send emails, letters, or provide testimony.  It can also serve as an opportunity to host ED visits or have individual meetings with state legislative representatives to educate them on issues of particular concern to EM physicians and our patients.

Your help is critical as we need 49 members to cover the 49 districts!  Please complete the survey to be a 911 Network member today. If you are unsure of the legislative district, please visit

The commitment is easy – you only need to read an email occasionally and participate when available.  If you have questions, please contact Pauline Proulx, Chapter Executive, at Thank you in advance for your dedication and support of the practice of emergency medicine in Washington.

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Thank You PAC Donors

The WA-ACEP PAC would like to thank all 2016 contributors for their generous support. Before the 2016 election, the WA-ACEP PAC distributed $15,500 in donations to Washington State candidates on both sides of the aisle, as well as the Democrat and Republican House and Senate campaign committees. Our success rate was 100 percent – all the candidates the PAC supported won their races!

Our work isn’t over yet! Donate in 2017 and be part of the WA-ACEP PAC Coffee Club.

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WA-ACEP Strategic Plan

The WA-ACEP Board of Directors gathered Nov.1 to identify the chapter’s direction for the next three years. The resulting Strategic Plan summarizes the chapter’s priorities into four subsets, or focuses: member, chapter, advocacy and systems. Each of the focuses has broad goals and a detailed list of tasks to meet those goals.

Member Focus Goals: Improved membership engagement; leadership development; and promoting wellness
Advocacy Focus Goals: Coordinated advocacy plus alliances; and fair coverage/compensation
Chapter Focus Goals: Providing educational excellence; and ensuring chapter financial health
Systems Focus Goals: Optimizing systems of care; and optimizing behavior health.

View the 2016-2019 Strategic Plan’s broad outline of goals on the WA-ACEP website. Email Pauline at to see an Excel spreadsheet with the specific tasks, person(s) in charge of those tasks, and due dates. Members interested in helping meet the chapter’s goals should contact Pauline.

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Save the Date: WA-ACEP 2017 Summit to Sound is April 26-28

Bell Harbor Conference Center
Seattle, WA
We have put together an outstanding lineup of speakers and topics. Check the WA-ACEP website later this month for details.

Lodging Accommodations
A conference room block has been arranged at The Edgewater for the 2017 Summit to Sound.
The Edgewater
2411 Alaskan Way, Pier 67 | Seattle, WA 98121
Special conference rate: $229.00 – Waterside Room. Reservations must be made by March 27, 2017 to qualify.

Ask for the Washington Chapter ACEP room block. Reservations can be made by calling the hotel directly at (206) 728-7000 or 1-800-624-0670 or by using the WA-ACEP Dedicated Hotel Website.

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Your Chapter Needs You!

Volunteer your time and talents as a member of the Washington ACEP Board of Directors. Provide your input to we determine the state’s emergency medicine priorities. Want to learn more? Contact John Matheson, MD, WA-ACEP Nominating Committee Chair, Those interested should submit a short bio to by Friday, Jan. 13, 2017.

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ACEP's Leadership & Advocacy Conference (LAC) is March 12-15 in DC

WA-ACEP would like to invite all members to be the voice of emergency medicine at the Leadership and Advocacy Conference at the Grand Hyatt in Washington, DC, March 12-15. LAC is your chance to advocate for your specialty, engage and connect with EM leaders. The conference kicks off with an in depth look at EM legislative and regulatory priorities, followed by visits to your legislators on Capitol Hill. The meeting ends with special leadership-focused talks.  Register today. Legislators need to hear from you!

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EM Wellness Week is Jan 22-28, 2017

Created by ACEP, the Emergency Medicine Wellness Week will remind all emergency physicians and their colleagues to take the time to self-renew while, at the same time, work the long and at times very difficult hours we do.

Make it about action rather than just ideas. Become more healthy, less burned out, and more resilient this year.

  • Sign up for daily email messages to keep you motivated and inspired during EM Wellness Week
  • Send a 30-second video about your EM Wellness Week participation
  • Engage with others at the AkosMed blog, where you can find even more articles
  • Come back at the end of the week & tell us about your success to prompt others to participate

Ultimately, we want you to feel better – about yourself, about your family/friends, about your patients and your work. We’d like you to remember, once again, why you chose medicine, and emergency medicine, for your life’s work. And to be proud and happy with that decision. Learn more.

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New Adolescent Treatment Facility in SW WA

Daybreak Youth Services brings nearly 60 beds online in rural Clark County, just north of Vancouver, WA, in February 2017, to be used as inpatient adolescent drug, alcohol and mental health treatment beds. The new 30,000 square foot facility will replace a 16-bed facility for boys in Vancouver and supplement an existing 40-bed facility for girls in Spokane.

Learn more about Daybreak Youth Services at

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New Association for Expert Witnesses in the PNW

Expert Witnesses from the Pacific Northwest (Oregon, Washington, Idaho, Montana, Alaska and British Columbia) have joined to create a new association named the Pacific Northwest Network of Forensic Expert Witnesses (PN2FEW). What started out as an informal networking group has grown into an active association to advance the cause and raise the profiles of expert witnesses in this region. 

The association’s main mission is to support experts through marketing assistance, professional development and information sharing in all disciplines.  The most important aspect of this association is to take the fear and mystique out of litigation.  Even doctors who do not wish to become expert witnesses might consider joining for the educational benefits. 

Criteria for membership is the willingness to take cases from both sides of the bar.  Members of the association are eligible to participate in the monthly continuing education meetings, have access to a private listserv to ask questions or receive referrals, and members can elect to be on the searchable expert witness database. 

Membership is free at this time while the association is building.  To learn more about the Pacific Northwest Network of Forensic Expert Witnesses and to see a list of upcoming trainings, visit  To request more information and to join, please email Kristin at

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Calendar of Events

WSMA Legislative Summit
January 25, 2017
Olympia, WA
Learn more

Emergency Medicine Payment Reform Summit
February 9-10, 2017
Emergency Medicine Learning and Resource Center (EMLRC)
Orlando, FL
Learn more

35th Annual Emergencies in Medicine Conference
Feb. 26-March 2, 2017
Hyatt Centric Park City Hotel
Park City, UT
Register and learn more

ACEP Leadership and Advocacy Conference
March 12-15, 2017
Washington, DC
Learn more

2017 WA-ACEP Summit to Sound
April 26-28, 2017
Bell Harbor Conference Center
Seattle, WA
Learn more

EM Leadership Summit
Nov. 10, 2017
The Conference Center at the Seattle Tacoma International Airport

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Like WA-ACEP on Facebook and follow us on Twitter @WashingtonACEP

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Washington ACEP Board

Nathan Schlicher, MD, JD FACEP
John Matheson, MD, FACEP
Past President
Patrick Solari, MD, FACEP
President Elect
Liam Yore, MD, FACEP

Cameron Buck, MD, FACEP
Russ Carlisle, MD, FACEP
Jaime Delcampo, MD, FACEP
Raul Garcia, DO, FACOEP
Jamie Jenkins, MD, FACEP
Catharine Ryan Keay, MD, FACEP
Brian Livingston, MD, FACEP
Gregg Miller, MD, FACEP
Susan Stern, MD
Jennifer L’Hommedieu Stankus, MD, JD, FACEP
Julianna Yu, MD

Stephen Anderson MD FACEP
Past President (Non voting)
Enrique Enguidanos, MD, FACEP
Past President (Non voting)
Christopher Kang MD FACEP
Past President (Non Voting)
Justin Bacon, DO
Resident Liaison
Sabiha Barot, DO
Resident Liaison

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Suite 2700
Seattle, WA 98121

(206) 441-9762 ext. 3038



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