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Dear FCEP and FEMF supporters,

We are looking forward to hosting you at our official groundbreaking ceremony on April 30 at 10 a.m. to witness the soon-to-be constructed EMLRC — home to FCEP and FEMF. This has been a real journey, and your support continues to be greatly appreciated.

FCEP and FEMF have always placed the patient first in our activities and programs, which is why education of our first responders is a priority. Through the new educational facility, we will be able to provide hands-on simulation education, didactic instruction, innovation through public policy initiatives and a wide range of distance-learning programs. Our home may be Orange County, but we reach many other Florida counties, states and countries. We are closely tied with the National Center for Simulation to advance opportunities and partner with others in creating the best patient care scenarios to prepare our health care professions for any type of emergency.

We hope you join us to celebrate a new leg in our journey to provide "lifesaving education to lifesavers."

Budget forecasters confirm cost of pharmacy bill, which would be paid by state
Legislative budget forecasters determined a bill that would define the ways pharmacy benefit managers do business would impact the State Employees' Group Insurance Trust fund by $34 million over five years, according to a report released last Monday afternoon.

The employees of state agencies and universities enrolled in health plans would not be affected, and the cost would be left up to the state, according to Ben Wolf, spokesman for the state Department of Management Services.

State economist Amy Baker said the cost would likely affect how lawmakers vote.

"As of right now, the cost could be whether the Legislature wants to vote for it or not," Baker said. "Those are the numbers we're still calculating."

Baker and other staffers from the state Office of Economic and Demographic Research met with experts on Monday morning from DMS and the pharmaceutical industry on Monday to determine how SB 1014 would impact the State Employees' Health Insurance Trust Fund. A series of staff analysis estimated a price structure written in the bill would cost the fund from $3 million to $29 million annually.

The EDR report estimated the bill would impact the trust fund by 1.29 percent in the coming fiscal year, which comes to about $6.3 million. The following fiscal year would see a slight decrease of $6 million and then costs would slowly rise.

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Senate bill to expand step therapy medication plan clears final committee
Opponents say a proposal that would allow doctors to override a drug prescription formula in plans under the State Managed Medical Assistance contracts would cost too much. Senator Denise Grimsley, R-Sebring, countered that the more important consideration is relieving people's pain.

"I think when you start talking about dollars versus someone's pain, is $90 a year too much for me to pay or take care of someone else's pain?" said Grimsley before she closed on SB 1354. "I don't think so."

Grimsley's bill sailed through the Banking and Insurance Committee last Tuesday, which was its second and possibly last stop before reaching the chamber floor. Groups mostly affiliated with businesses and insurance companies said changing the formula known as Step or Fail First therapy would only degrade a system proven to reduce cost and effectively treat patients.

A weakened telemedicine bill passes second committee

A Senate panel voted Wednesday in favor of an amended bill setting up a framework for telemedicine. It accepted an amendment by Sen. Rene Garcia, R-Hialeah, requiring out-of-state telemedicine providers to hold a Florida license to practice medicine and carry the same liability coverage as Florida professionals.

The crux of discussion during Wednesday's Appropriations Subcommittee on Health and Human Services revolved around allowing out-of-state physicians to work with Florida patients. A previous version of SB 1646, by Senator Aaron Bean, R-Jacksonville, would have allowed non-Florida doctors to use telemedicine if they were affiliated with a Sunshine State-based health provider or insurer. A strike-all amendment Bean presented before the committee would have required out-of-state doctors to only work as a consultant to a patient whose care was overseen by a Florida-licensed physician.

However, that amendment failed and instead, the committee approved Garcia's amendment

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House introduces less restrictive telemedicine plan in omnibus health care bill
The House version of a plan that would provide framework for Florida's budding telemedicine services is not as strict as the Senate version, but still requires out-of-state physicians to sign up in a registry.

The plan was tacked on to HB 7113, which was initially created to ensure the continued operation of three HCA-run centers opposed by non-profit hospitals which argue they are putting a strain on resources and have not been proven to be necessary. The HCA trauma centers are facing a court challenge.

Now, HB 7113 includes telemedicine regulations, changes to the state prescription drug monitoring program and a provision that would allow high-level nurses to play a more independent role in treating patients. The bill passed with a vote of 15-2, with Representatives Ronald "Doc" Renuart, R-Coral Gables and Gayle Harrell, R-Stuart, voting in opposition.

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Trauma center plans both pass
A House proposal initially focused on ensuring the continued operation of three HCA-run centers was passed by Health & Human Services Committee on April 10, 2014. The committee added language to HB 7113 for the independent practice of nurse practitioners and out-of-state doctors to use telemedicine — aimed at addressing a physician shortage.

The Senate plan to protect trauma centers, SB 1276, was passed by its final panel, the Appropriations Committee on April 10. It does not include the additional House language.

Referring to an ongoing fight between non-profits and HCA-run centers, the bill sponsor, Senator Denise Grimsley, R-Sebring, said, "Both side have made this about them and forgot about the's disgusting," in her closing argument.

Both plans now head to their respective chamber floors.

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House approves abortion restriction
A plan that would ban an abortion if the fetus can survive outside the womb passed the House on Friday afternoon after about a half hour of debate.

With a vote of 70-45, HB 1047 was sent to the upper chamber, where a similar bill already was under consideration. House Democrats continued presenting arguments that the language of the bill was too broad and could put the mother at risk. Republicans said the bill only fell in line with federal and state high court law that eliminated the third trimester of a pregnancy and proclaims the state's interest in a fetus when it can survive outside the womb with medical support.

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Mandatory minimum plan has passed both chambers
A bill increasing the amount of certain painkillers it takes to receive a mandatory prison sentence and a fine for trafficking has now been passed by both chambers of the Florida Legislature. The House passed SB 360 on April 11, 2014, by a vote of 113-2.

The legislation increases the threshold to 7 grams for oxycodone and 14 grams of hydrocodone from 4 grams of either. The starting mandatory penalty remains at 3 years and a $50,000.

It will head to Governor Rick Scott for his final approval.

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Negron: Budget conference meetings to begin on April 21
Senator Joe Negron, the Senate's chief budget writer, told the Senate Friday he expects budget conference committees to begin meeting on April 21 after a holiday break next week.

The House version of the 2014-15 state budget is $75.3 billion, slightly larger than the $74.9 billion Senate spending plan.

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Low income pool
Florida Medicaid received word Friday evening that federal officials have authorized a $2 billion hospital fund for indigent care starting July 1 and an extra $200 million for the state's medical schools.

Justin Senior, Florida's Medicaid director, said the Centers for Medicaid and Medicare Services okayed $2.2 billion for the "Low Income Pool (LIP)," which is used to support "safety-net" hospitals and clinics that treat a lot of Medicaid patients. The LIP is a combination of local and state funds that draw down federal match.

The letter to the state Agency for Health Care Administration, parent agency for Florida Medicaid, was from Cindy Mann, director of the federal Medicaid program. It sounded as though this would be the last year for which CMS will authorize LIP spending. In the eyes of the federal government, Florida would not need to prop up the hospitals if the state accepted Medicaid expansion money offered to the state through the Affordable Care Act.

For state officials, this is good news in several ways:
  • It's more than double the $1-billion extension Florida Medicaid officials had hoped for after their original request of $4.5 billion ran into trouble.
  • The authorization arrived in time for state budget writers to process and include it as they try to wrap the the spending plan for the fiscal year July 1, 2014 through June 30, 2015. Budget negotiators have to come up with an agreement by April 29.
  • The funds include $200 million for the state's medical schools to support teaching of students and residents. This will plug a gap that would have been left by changes in federal spending under the Affordable Care Act.
Senior said the money is needed because Florida is "undertaking a very significant shift in the way we deliver our Medicaid services."

The Low-Income Pool creates a "glidepath and more evolutionary process for hospitals to adjust" to the Statewide Medicaid Managed Care Program, which will no longer pay hospitals directly.

Instead, the state will pay for-profit HMOs and non-profit networks on a monthly basis to cover all costs for their Medicaid enrollees — a system that discourages inpatient care.

It also may make it harder for medical schools to support faculty physician groups because so much of their doctors' time is spent in training in addition to patient care.

The state started the shift to total managed care last fall with patients who needed long-term care, because they are the costliest and most in need of programs that provide alternatives to nursing-home and hospital care.

Next month, the rest of the Medicaid enrollees — mostly children and mothers — will be asked to choose plans, region by region. Those who don't choose on their own will be assigned to a plan.

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Follow @FCEP and @FCEPprez on Twitter

FCEP has been working to grow our social media reach using popular channels; one of those is Twitter,

We intend to use Twitter as a means of communication; most tweets will be done in conjunction with the latest news regarding FCEP's legislative hot topics and to let you know of any changes happening around here.

Connect with FCEP:         

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Upcoming webinar
Please join the ACEP Trauma and Injury Prevention Section and the White House Office of National Drug Control Policy (ONDCP) for a co-sponsored webinar entitled ‘Naloxone Distribution from the ED for patients at-risk for Opioid Overdose’ on Friday, April 25th at 2 p.m. EDT.

Poisoning or drug overdose recently surpassed motor vehicle crash as the number one cause of injury-related death in the United States. There has been a rapid increase in fatal overdose since the mid-1990's which is largely attributable to the increase in prescribed opioids as well as prescription opioid misuse and abuse. Additionally, heroin-related overdose deaths are also increasing and many new-initiates of heroin report first misusing prescription opioids. Along with this rise in fatal overdose, there has also been an increase in opioid related ED visits secondary to non-fatal overdose or misuse.

The distribution of naloxone, an opioid agonist, has been associated with a with a decline in fatal overdoses in population based studies, has been long used by community-based/public health programs and is increasingly used in medical settings including primary care and emergency departments. This webinar will discuss recent research and programs on provision of take-home naloxone to ED patients at risk for opioid overdose, as part of a strategy to reduce opioid related harms and substance abuse. Lastly, we will highlight a successful take-home Naloxone program to discuss the real-world application and implementation of a take-home Naloxone program. At the end of the webinar, there will be time for a question and answer period and we hope to generate conversation and enthusiasm around this important topic.

Please register here
Registration URL:

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May 7, 2014 FCEP Committee Meetings at FEP Offices*
May 8, 2014 FCEP Board Meeting at FEP Offices*
May 18-21, 2014 ACEP Leadership and Advocacy Conference
June 10, 2014 FCEP Board Conference Call
June 16, 2014 FCEP Board Conference Call
July 17-20, 2014 ClinCon
Aug. 7-10, 2014 Symposium by the Sea
Aug. 7, 2014 FCEP Board of Directors Meeting
Aug. 7-8, 2014 FCEP Committee Meetings

*FEP OFFICES: 500 Winderley Pl #115, Maitland, FL 32751

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August 7-10, 2014

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July 17-20, 2014

Register Online Now!
Book Your Hotel Room Now!

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Saint Luke's Health System is sponsoring their 7th Annual Forensic Investigations Conference, May 14-16, in Kansas City, MO! ACEP is trying to improve the availability of specific medical-forensic content for ACEP members (sexual assault, domestic violence, elderly and child abuse), as well as our forensic colleagues in nursing, criminal justice and advocacy. Last year we had over 480 participants who came to KC for forensic education, fun and great BBQ!

ACEP will offer a specific Pre-Conference, an "Advanced Sexual Assault Medical-Forensic Course for Physicians," on May 12 & 13. This ACEP Category I CME approved course has been well received by physicians, residents and program directors across the country and it concentrates not only on up-to date necessary clinical forensic skills, but important sexual assault program medical director, court room and legal issues. This intense 2-day presentation is taught by physician colleagues with over 50 years of experience in these medical-forensic areas.

Please click on the below link to access the full conference brochure details and registration.

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How a Iowa emergency room saved millions, and what it means for state
Iowa Public Radio
Emergency rooms are often the catch-all of the medical world, where patients can receive care at any hour, regardless of their ability to pay. But physicians and hospital administrators say it's an expensive and disjointed way for people to receive care, particularly when patients visit the ER multiple times a year.
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Exchange enrollment exceeds expectations, however it's too early to determine impact
By Pamela Lewis Dolan
The Obama administration's last-ditch efforts to get people to sign up for insurance through the insurance exchanges paid off as the total enrollment numbers exceeded 7 million by the March 31 open enrollment deadline. The enrollment data surprised nearly everyone. Just weeks before the deadline, the Congressional Budget Office revised its estimate of new enrollees down to 6 million. But while proponents of the Affordable Care Act had reason to celebrate, there are still many unknowns that will determine the long-term success of the law.
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HHS Secretary Kathleen Sebelius to resign from position
EHR Intelligence
Kathleen Sebelius' time as Secretary of the Department of Health and Human Services is apparently coming to an end. According to multiple reports, Sebelius tendered her resignation after five years as serving as the head of the federal agency. The resignation was accepted by President Barack Obama, who is expected to nominate the Director of the Office of Management and Budget Sylvia Mathews Burwell, Michael Shear of The New York Times is reporting.
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California committee backs measure to regulate billing in emergency room
California Healthline
The California Senate Committee on Health passed a bill designed to ease the out-of-pocket expense of high emergency department costs. Emergency physicians said the bill could severely impact emergency care. The bill — which was written by Sen. Ed Hernandez — seemed innocuous at first presentation, but it created a bit of a stir before the Senate health panel. "This bill makes modest changes to provisions of a law that requires hospitals and emergency physicians to establish policies for charity care and discounted payment programs for eligible individuals," Hernandez said.
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5 myths about the ER, debunked
The hospital emergency room is the front door of the health care system. Most people will only have to visit a handful of times in their lives, but visiting an ER can be both a lifesaving and frightening experience. However, several myths prevail about what happens in the ER and what you can expect. Here are five that need to be declared DOA.
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Time to rein in the 'Wild West' of medical apps
Mobile applications for cellphones and other devices hold great promise for helping patients care for themselves, but like any patient intervention, they must first be subjected to study before we can claim they are useful. Some are studied but many are not. "It is somewhat the 'Wild West' right now," says Dr. Homero Rivas, an assistant professor of surgery at Stanford School of Medicine in California. There is a definite absence of regulation or peer-review of apps in health care, and that can be "somewhat distressing for medical practitioners," adds Rivas.
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Looking for similar articles? Search here, keyword(s): Staying healthy on hectic work schedule.

ICD-10: Fact or fiction
By Charlotte Bohnett
As with any major change, the rumor mill churns at a mighty pace. With all the hearsay, telephone games and disbursement of misinformation, it's easy for the myths to swallow the truth. No worries, though. We're here to sort the fact from the fiction when it comes to the latest information on ICD-10. The first bit of fiction is that coders will spend an overwhelming amount of time dealing with external cause codes.
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Researchers seek to enhance medicine with Google Glass
The Brown Daily Herald
Physicians and researchers at Rhode Island Hospital are conducting a study to test the feasibility of using Google Glass as an interface for physician consultation in an emergency department setting. In this pilot study, emergency department physicians treating patients with dermatological issues wear Google Glass, which records video and audio that is relayed to an on-call dermatologist. This feedback allows the dermatologist to see and hear the patient in real time and provide treatment advice without being present.
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Young doctors still pulled to specialties
Epoch Times
Despite nationwide efforts to encourage medical students to pursue primary-care specialties like pediatrics and internal medicine, most University of Maryland School of Medicine graduates are choosing other specialties. This year, 57 percent of Maryland graduates will begin residencies in non-primary-care fields, the same percentage as last year's graduating class and slightly more than the class of 2012, of which 51 percent chose non-primary-care fields.
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