NOMINATING COMMITTEE
Chair: Pamela A. Ross, MD, FACEP
Committee Members: James R. Dudley, MD, MBA; Mark D. Tripp, MD, FACEP
Goals and Accomplishments:
The committee developed a slate of candidates for open positions on the Board of Directors, as well as Councillors and Alternates, for vote by the members present at the Annual Meeting. In addition, the committee will make recommendations for Officer Positions, for vote by the Board at its next meeting.
/gmh
MEMBERSHIP COMMITTEE
Chair: Stuart E. Brown, III, MD, FACEP
Committee Members: Renate Austin, MD, FACEP; C. Christopher Turnbull, MD; James E. Barton, MD, FACEP; Peter J. Paganussi, MD, FACEP
Goals and Accomplishments:
Maintain/Increase VACEP Membership. As of end of 2003, there were 506 VACEP members. This number puts us over the magic 500 member mark putting us into the large chapter category which increases our total number of seats at the ACEP Council.
A VACEP specific flyer was sent out with current packet sent out by ACEP in its new membership campaign in an effort to recruit new members to VACEP and inspire others to reinstate their membership.
The Membership Committee has been working with Virginia EMPAC to elicit contributions from VACEP members and nonmember physicians practicing Emergency Medicine within the state. The goal is to enhance the voice of VACEP at the state capital.
/seb

GOVERNMENT AFFAIRS COMMITTEE
Chair: James R. Dudley, MD, MBA
Committee Members: Renate Austin, MD, FACEP; James E. Barton, MD, FACEP; Michael J. Bono, MD, FACEP; Shawn M. Borich, MD, MPH; Sabina A. Braithwaite, MD, FACEP; Stuart E. Brown, III, MD, FACEP; Francis L. Counselman, MD, FACEP; Cynthia E. Dorr, MD, FACEP; Luis F. Eljaiek, Jr., MD, FACEP; Timothy C. Evans, MD, FACEP; Kelly Anne Foley, MD, FACEP; Kenneth Frumkin, MD, FACEP; Michael S. Gonzales, MD, FACEP; Joanne E. Lapetina, MD, FAAP; Peter J. Paganussi, MD, FACEP; Michael W. Potter, MD, FACEP; Pamela A. Ross, MD, FACEP; David R. Steinbruner, MD; Mark D. Tripp, MD, FACEP; Christopher Turnbull, MD; Carl F. Wentzel, III, MD, FACEP
Goals and Accomplishments:
WIN SOME, LOSE SOME
The best way to summarize our legislative activity for the '03 year is 'we win some, we lose some.' Although VACEP did not author any specific legislation, we were active in supporting those issues important to Emergency Physicians and our patients. VACEP supported the Board of Medicine reforms to help restore confidence in the disciplinary procedures for physicians.
The Helmet Laws, proposals to repeal the laws requiring motorcyclists to ride wearing helmets, were narrowly defeated. That was a very close victory, and this perennial issue is once again being fought over as this report goes to press. Meanwhile, the proposed primary seatbelt laws, allowing motorists to be stopped for failing to have adequate restraints, failed by the slimmest of margins. VACEP is once again following this issue closely during the 2004 General Assembly session.
VACEP received a presentation from Katie Webb of the Virginia Hospital and Healthcare Association at our August Board meeting, regarding the Commonwealth Care Coalition, and we voted to join that coalition at the October meeting.
During the fall, a delegation from VACEP met with Governor Warner's Secretary of Health and Human Services, the Honorable Jane Woods, to discuss the dire situation as far as healthcare funding, and the impacts the budget crisis has on our practices.
As we move into a new year, it becomes ever clearer that we must work together, within the legislative process, to protect our interests and those of our patients.
/jrd
HEALTH FINANCE/REIMBURSEMENT COMMITTEE
Chair: Michael W. Potter, MD, FACEP
Committee Members: Neil Grahame Brown, MD; Luis F. Eljaiek, Jr, MD, FACEP; Jason T. Garrison, MD, FACEP; Paul Gibney, MD; Derik K. King, MD, FACEP; Gaylord W. Ray, MD, FACEP; Todd L. Vanden Hoek, MD, FACEP; Thomas W. Wagner, MD, FACEP
Committee Advisors: Gay Barnes; Kathleen M. Cardella, MBA; Martin Gottlieb; Susan Harris; Rusty Hundley; Kimberly Kelly; Brenda Little; David McKenzie; Garland Mosby; Sandy Oliver; Patricia A. Pitrolo; Fran Rogers; Kaye Wear
Goals & Accomplishments:
The Committee interacted with the Dept. of Medical Assistance Services (DMAS) concerning DMAS’ excessive down coding of Medicaid claims and non-compliance with the Prudent Layperson Standard. To briefly summarize the most recent highlights: After presenting to DMAS a report outlining our concerns we met with DMAS director Patrick Finnerty and his staff in April of this year. Mr. Finnerty was quite receptive and sympathized with the concerns raised by the HF&R committee. He indicated that DMAS would consider our suggestion of automatic payment of higher level E&M codes at prevailing emergency rates.
In a letter to VACEP dated Sept. 25th, 2003, Mr. Finnerty has agreed to just that. DMAS will automatically pay all claims coded 99284 & 99285. They will also pay the corresponding hospital claim at the full Medicaid rate. In addition they will continue to abide by changes they have already instituted as a result of our interactions, namely automatic payment of all claims for patients admitted to the hospital, assaults, and any patient sent to the ED by their PCP (so remember to document this when appropriate). Claims coded 99281 through 99283 will be processed as is currently done using the pay and pend lists.
As with any silver lining however, there comes a cloud. DMAS plans to delay implementation of automatic payment of codes 99284 & 99285 until April of 2004. We are told this is primarily due to the installation of a new computer system at DMAS which necessitates release of new system modifications in stages. We had suggested that they might consider manually paying these in the interim, but DMAS felt the difficulty in matching the physician and hospital claims as well as resolving such errors when they occurred made this unfeasible. As a safeguard against inappropriate up coding DMAS will conduct periodic reviews of submitted 99284 & 99285 claims once automatic payment commences.
I would like to offer my most sincere thanks to the members of the HF&R committee for their concerted and diligent efforts over the past several years. Our interactions with DMAS began way back in February of 2000. Due to our persistence we have reached a very significant milestone on behalf of all Virginia emergency physicians. Reimbursement will be much more equitable and the administrative burden of resubmitting denied claims significantly reduced. The next time you are paying your ACEP/VACEP dues be comforted that in the year 2004 (and each year beyond that) you will more than likely receive several times that amount in increased reimbursement/administrative savings because of this one policy change. Combine that with the other educational and legislative benefits offered by VACEP locally and ACEP nationally, and you are certainly getting your money’s worth – and then some!
/mwp


EMERGENCY MEDICAL SERVICES
Chair: Carl F. Wentzel, III, MD, FACEP
Committee Members: Shawn M. Borich, MD, MPH; Sabina A. Braithwaite, MD, FACEP; Michael S. Gonzalez, MD, FACEP; Cheryl Haas, MD, FACEP; Robert Mark Jones, MD; Joanne E. Lapetina, MD, FAAP; Stewart William Martin, MD, FACEP; Kimberly J. Mitchell, MD, FACEP; John M. Sheridan, III, DO, FACEP; Lewis H. Siegel, MD, FACEP; Daphne Thomas, MD, FACEP; Mark D. Tripp, MD, FACEP
Liaison Members:
Kenneth Frumkin, MD, FACEP
Goals and Accomplishments:
This year the committee’s efforts were again focused on strengthening the ties between VACEP, Virginia’s EMS Physicians and Virginia’s EMS providers. We again co-sponsored the Virginia EMS Medical Director’s class at the state-wide EMS Symposium in November. Through the committee’s efforts, the entire EMS Symposium also qualified for Category 1 CME for any physician who attended. This CME was provided free of charge for all physician attendees. Over 26 hours of CME was available during the four day event. More than 40 physicians registered and attended the class and symposium. This was an outstanding turnout and represents one of the highest number of attendees for any VACEP sponsored CME event. The Medical Director course will be presented again as part of the 2004 VACEP Scientific Assembly at the Homestead and we are expecting another well attended event.
Looking forward, we plan on continuing our level of involvement with the 2004 EMS Symposium. We will also continue our role as the leader in curriculum development for the Virginia Medical Director course.
/cfw
EMERGENCY MEDICAL SERVICES FOR CHILDREN COMMITTEE
Liaison: Kenneth Frumkin, MD, FACEP
Goals and Accomplishments:
This official subcommittee of the EMS Advisory Board continues to meet quarterly. I continue to monitor the short and long-term programs of this group and provide input on behalf of VACEP. The major focus of Virginia's EMS-C program remains pediatric education for health care professionals and EMS education for child-care professionals. Plans to investigate Pediatric categorization of Emergency Departments have been put on hold.
/kf
GOVERNOR’S EMS ADVISORY BOARD
Representative: Michael S. Gonzalez, MD, FACEP
Goals and Accomplishments:
Report not submitted.
BASIC TRAUMA LIFE SUPPORT PROGRAM, STEERING COMMITTEE
Chair: Carl F. Wentzel, MD, FACEP, State Medical Director for BTLS
Members: J. David Barrick, NREMT-P; Gwen E. Messler Harry, Executive Director
Goals and Accomplishments:
This year the BTLS program enacted its proposed program to increase efficiency while maintaining a quality program. We reduced our instructor programs down to 4 (a cost savings) but produced the same number of instructors as in previous years. We have met all of our goals for streamlining the program and saving money. I can report that BTLS is a self sufficient program within VACEP and its revenues help to support other chapter activities.
VACEP’s BTLS program remains the 4th largest program in the country. Annually we provide over 80 provider courses using 300 instructors, 30 state affiliate faculty and 40 medical directors. VACEP’s sponsorship of BTLS in Virginia continues the strong ties between Emergency Physicians and EMS providers.
/cfw
EDUCATION COMMITTEE
Chair: Timothy C. Evans, MD, FACEP
Committee Members: Tamera C. Barnes, MD, FACEP; Ioliene Boenau, MD, FACEP; Cynthia E. Dorr, MD, FACEP; Michael S. Gonzales, MD, FACEP; Carl F. Wentzel, III, MD, FACEP; Antonio E. Muniz, MD, FACEP; Michael W. Potter, MD, FACEP; Jeffrey M. Preuss, MD, FACEP
Goals and Accomplishments:
A summary of educational programs offered this past year is as follows:
2003 Scientific Assembly. In total, there were 71 attendees, including faculty and staff. Revenues ($39,520) exceeded direct expenses ($25,018) by $14,502 compared to budget target of $29,456 for net revenues.
Spring Reimbursement Seminar. Program Director Michael Potter, April 9 at the Wyndham Hotel, Richmond, offered 7 hours CME. There were 44 attendees, including faculty and staff. Revenues ($4,918) exceeded direct expenses ($4,418) by $500 compared to budget of $1,800.
ACLS/PALS. VACEP jointly sponsors ACLS and PALS certification and recertification courses with Network Medical Systems, Inc. throughout the year. Net revenues derived from this were $4,226 vs. net revenues $3,150 budgeted.
Other VACEP jointly sponsored programs included:
?   State EMS Medical Director training courses, offered during both the VACEP Scientific Assembly and Statewide EMS Symposium. Funding for these free courses is provided by OEMS.
?    Planning for Peace/Coping with Terror held November 13 – 14 in Emek Heffer, Israel, jointly sponsored by ACEP, VACEP and the Jewish Community Federation of Richmond, Inc. Approved for 8 Category I ACEP/AMA credits. This course provided up-to-date information on the topic of emergency preparedness and the response to terror incidents in Israel.
?    VACEP cosponsored the Mental Health and the Law Symposium “Emergency Mental Health: Understanding EMTALA” held June 4 in Richmond, along with other stakeholders involved with mental health issues. VACEP provided speaker suggestions, marketing advice to encourage emergency physician participation, including application for ACEP Category I credit, and circulated announcements to the VACEP elist; this required no funding and only a few staff hours.
?    Airway Management Course, developed by Gregory Christiansen, DO, and offered to a closed class of physicians at EVMS on February 14th.
Evaluations are conducted at all College CME and results indicate excellent satisfaction in the quality of the programs.
/tce
RESEARCH AWARDS COMMITTEE
Chair: Shawn Borich, MD, MPH
Committee Members: Eunice M. Singletary, MD, FACEP; Kelly Anne Foley, MD, FACEP; Manuel A. Armada, MD; Kathryn L. Kenders, MD, FACEP; Judith Mechanick, MD; Heather Hollowell, MD
Goals and Accomplishments:
This year was a year of re-organization of the McDade Award. The information coversheet and application form were both re-designed for simplification. The Award was also introduced on the internet, making information and the application downloadable via the VACEP website. We also implemented a rolling application acceptance policy, with applications being accepted throughout the year. The award will now be given at the annual meeting, with part of the monetary award going to pay for lodging and symposium registration.
The committee has continued to notice decreased participation and quality of research submitted. Therefore, we will begin an intense publicity campaign with articles appearing each issue of EPIC and letters to each resident being sent twice a year as opposed to once a year. We will continue to discuss ways to increase involvement in the allied health area where award publicity had been problematic.
/sb
BYLAWS COMMITTEE
Chair: Kenneth Frumkin, MD, FACEP
Committee Members: Michael J. Bono, MD, FACEP; James R. Dudley, MD, MBA; Mark D. Tripp, MD, FACEP; Peter J. Weimerskirch, MD, FACEP
Goals & Accomplishments:
This year the Bylaws Committee assisted the Board of Directors in formulating Bylaws changes governing voting. Voting by mail was deleted from the Bylaws.
At the 2003 Annual Meeting the members passed an amendment to permit multiple terms for the President upon agreement of the President Elect and Board of Directors vote.
/kf
TECHNOLOGY COMMITTEE
Chair: Renate Austin, MD, FACEP
Committee Members: Sabina A. Braithwaite, MD, FACEP; C. Christopher Turnbull, MD; Leonard R.Yang, MD, FACEP
Goals and Accomplishments:
Completed update and replacement of the current computer system at the VACEP office. We contracted with KIB consulting who is overhauling our entire website for better communication with our VACEP members.
/ra
LONG RANGE PLANNING COMMITTEE
Chair: Mark D. Tripp, MD, FACEP
Committee Members: Andrew B. Cole, MD, FACEP; Stanley E. Heatwole, MD, FACEP; Kimberly D. Keith, MD, FACEP; Peter J. Weimerskirch, MD, FACEP
Goals & Accomplishments:
There is nothing to report.
/mdt
FINANCE/BUDGET COMMITTEE
Chair: Sabina Braithwaite, MD, FACEP
Committee members: James R. Dudley, MD, MBA; Michael W. Potter, MD, FACEP;     
Mark D. Tripp, MD, FACEP; Stuart E. Brown, III, MD, FACEP; Timothy C. Evans, MD, FACEP; Pamela A. Ross, MD, FACEP; Carl F. Wentzel, III, MD, FACEP
Goals and Accomplishments:
Goal: to most effectively utilize the chapter’s financial resources to support the VACEP mission.
Accomplishments:
1.    renegotiation of our current mortgage in February 2003, decreasing the interest rate by 1.5% to 6.75%.
2.    favorable audit for FY ending September 30, 2003 by Frye and Wolcott, CPA as directed by the Board.
3.    increased unrestricted net assets end FY 2003 by 35% compared to FY 2002, also increased cash and cash equivalent balance by 10% compared to FY 02 (see statements)
4.    increased membership income by 6% due to increased member numbers
5.    additional staff training in QuickBooks to maximize effectiveness of the transition to the accrual accounting system and computerized tools.
Activities:
1.    budget created and approved for current fiscal year, including conservative estimates of rental income (currently no tenant, have been marketing since notification of vacancy by previous tenant).
2.    review of current financial policies and recommendations for upgrades and consolidation of policies into single financial policy which addresses the organizations overall financial plan. This includes a unified approach to investments, reserves, etc. Update of financial primer for Board. Pending final input from Executive Director.
3.    consideration of creating 501c3 organization for VACEP, felt to be inadvisable currently.
4.    reformulation of reports presented to Board for quarterly meetings to enhance understanding of financial trending and provide improved overview of revenue-generating activities.
/sab
PROFESSIONAL LIABILITY COMMITTEE
Chair: Luis F. Eljaiek, Jr., MD, FACEP
Committee Members: Stuart E. Brown, III, MD, FACEP; Mark E. Franke, MD, FACEP; Charles G. Penick, Jr, MD; W. Andrew Reese, MD
Goals & Accomplishments:
Report not submitted.
EMERGENCY MEDICINE POLITICAL ACTION COMMITTEE
Chair: Lucy B. Gibney, MD
Committee members: Michael J. Bono, MD, FACEP; Asher Brand, MD, FACEP; Neil Grahame Brown, MD; Francis L. Counselman, MD, FACEP, James R. Dudley, MD, MBA; Kenneth Frumkin, MD, FACEP; Peter J. Paganussi, MD, FACEP; Michael E. Watts, MD
Goals and Accomplishments:
FUNDS RAISED IN 2003
    $27,100.00     (2002 - $6,650.00)
Number of Physicians Contributing
    129     (2002 – 28)    EP in Virginia - estimate 1,000; VACEP Members 510
Funds Distributed in 2003
    $22,750.00
Number of Legislators/Candidates Receiving
    67    ($250 average)   
Region Most Represented
    Southeastern Virginia
Accomplishments
    Produced two inserts to EPIC
    Website enhancement
    Exceeded previous fundraising
CHALLENGES
    Full EMPAC Board participation
    Full VACEP Board participation
    Greater statewide participation
CURRENT AGENDA
    Address challenges listed above
Review criteria/mechanism for funds distribution
Raise remaining $12,900 of $40,000 goal
/lbg
ACEP COUNCIL COMMITTEE
Senior Councillor: Michael J. Bono, MD, FACEP
Goals and Accomplishments:
Virginia was well represented at the 2003 ACEP Council meeting in Boston. Senior Councillor Michael J. Bono, MD, FACEP, prepared a full report published in the Fall EPIC as did Resident, Corbett Smith, MD.
/mjb
LIAISON TO MEDICAL SOCIETY OF VIRGINIA 2003 HOUSE OF DELEGATES
Delegate: Michael J. Bono, MD, FACEP
Alternate: Joanne E. Lapetina, MD, FAAP
Goals and Accomplishments:
The Medical Society of Virginia House of Delegates meeting was held in Norfolk October 24th through 26th. The meeting was excellent. I got the sincere feeling that the Medical Society of Virginia really does represent all of us as emergency physicians, as well as all other specialties.
Virginia ACEP had some concern about resolutions 201 and 202, which dealt with “any willing provider”.
In 1999, the HMO’s put forth some legislation concerning “any willing provider”. In that legislation, which was defeated at the state General Assembly, there was language allowing HMO’s to pay emergency physicians little or nothing for evaluating HMO patients in the ED if the ED physician did not participate in their plan. Virginia College of Emergency Physicians made it quite clear that any legislation at the 2004 General Assembly would be carefully scoured for any such language and vigorously opposed by both the Virginia College of Emergency Physicians and the MSV.
Other than the “any willing provider” resolution, there were no resolutions specifically related to Emergency Medicine. The tone of the meeting was that tort reform is absolutely essential for viability of many practices in Virginia. There were multiple resolutions dealing with medical liability reform, including medical malpractice review panel decisions, physician/patient contracts requiring binding arbitration, possibility of implementing a no-fault medical liability system, and specialized courts for malpractice cases.
There was an interesting resolution on malpractice expert testimony. The resolve stated that “the Board of Directors of the Medical Society of Virginia charge a committee of its choosing with input from appropriate specialty societies in the Commonwealth who should develop a plan to review testimony by expert witnesses for both the plaintiffs and defendants, and be it further resolved that this plan includes mechanisms for discipline of physicians found providing false or misleading testimony and medical malpractice trials to include notification of the Board of Medicine, Virginia Bar, and the appropriate Virginia specialty society as well as possible expulsion, reprimand or other appropriate sections from the Medical Society of Virginia. And be it further resolved that this plan be presented no later than August 1, 2004 so it can be adopted by the Board of Directors at the September 2004 meeting.” This resolution was referred to the Board of Directors and it represents a very positive step to combat the problem of egregious medical testimony.
Overall, I feel that Virginia emergency physicians are very adequately represented at the state level. I thought the meeting was excellent.
/mjb
MEDICARE CARRIER ADVISORY COMMITTEE
Liaison: Jason T. Garrison, MD, FACEP
Goals and Accomplishments:
Meetings of the Virginia Medicare CAC were attended this year in Richmond to review the Local Medical Review Policy for Medicare and Medicaid reimbursement. In the process, many protocols have been presented for physician specialty review and comment prior to release for public comment and final action by CMS. In spite of the wealth of information presented at these meetings, little was germane to our specialty.
Discussed early in the year was the issue of ambulance transport, diversion and transfer and whether CMS needed to dip into this matter. A presentation by representatives from the Richmond Ambulance Authority seemed to answer those few questions presented by the CMS Directors and the issue has seemed to pass quietly off the radar for now.
At the latest meeting, the subject of reimbursement for bedside ultrasound was found tucked into the policy for echocardiography. It appears that, not unexpectedly, CMS will not likely reimburse for this as a separate procedure, opting to call it an extension of the physical exam instead of a diagnostic evaluation. This was released for public comment in December but will likely be incorporated as policy. If this becomes a more standard procedure in emergency practices and separate reimbursement is desired, this issue can be revisited by introducing a specific policy request to Medicare at a later date.
The mechanism of policy review is set to change this year as CMS would like to move from small regional protocols toward national medical policies. This may be difficult with the regional variations in standard practices but is a goal to simplify reimbursement. Also to be expanded is the review and publication of error rates in CMS reimbursement to practices in an attempt to reduce improper, excessive or inaccurate payments.
/jtg
HEATWOLE AWARD COMMITTEE
Chair: Pamela A. Ross, MD, FACEP
Committee Members: Sabina A. Braithwaite, MD, FACEP; James R. Dudley, MD, MBA; Mark D. Tripp, MD, FACEP; Stuart E. Brown, III, MD, FACEP
Goals and Accomplishments:
No award was presented in 2004.
STATE CHILD FATALITY REVIEW BOARD
Liaison: Pamela A. Ross, MD, FACEP
Goals & Accomplishments:
Report not submitted.
Medicaid Physician Advisory Committee (MPAC)
Representative: Todd L. Vanden Hoek, MD, MBA, FACEP
Goals and Accomplishments:
The MPAC was formed by Department of Medical Assistance Services (DMAS) Director Patrick Finnerty to “give a voice to physicians who work within the Medicaid system.” The first introductory meeting was held April 24, 2003 at the DMAS offices in Richmond. Subsequent meetings were held there on July 15, October 14, and Dec 16. Issues discussed included telemedicine, how provider rates are calculated, modification of the DMAS preferred drug list, definition of medical necessity criteria, DMAS Pharmacy Program changes, Medicaid fee-for-service versus managed care differences, and electronic claims filing. For more details, DMAS meeting minutes are posted on their website at http://165.176.249.159/ab-minutes_of_various_dmas_meetings.htm.
These meetings and the ongoing communication with DMAS staff have given them a better understanding of the concerns of Virginia emergency physicians, especially fair and proper DMAS payment under the Prudent Layperson standard. Patrick Finnerty cited his meetings with VACEP Health Finance / Reimbursement Committee members regarding Prudent Layperson concerns and the subsequent modification of DMAS policy to automatically pay all 99284 and 99285 claims as an example of DMAS’ willingness to address Virginia physician concerns. This committee has helped to forge professional relationships with key DMAS staff, including Patrick Finnerty, Director; Cindy Jones, Chief Deputy Director; Cheryl Roberts, Deputy Director of Operations; Moses Adiele, MD, Director, Medical Support Services; and Jim Cohen, Director, Program Support Division. Continued communication with and education of DMAS staff will continue to be critical to proactively promoting the interests of Virginia emergency physicians.
/tlv