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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal align=center style='text-align:center'><span style='font-size:9.5pt'><img width=540 height=163 style='width:5.625in;height:1.6979in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_1" src="cid:image001.jpg@01D5C896.9A19F660" alt="cid:image003.jpg@01D413DA.65584930"><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><div style='margin-left:15.0pt;margin-top:7.5pt;margin-right:15.0pt;margin-bottom:7.5pt' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782content"><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#7F7F7F'>Jan. 11, 2020</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:red'>Submit Your Feedback to CMS - Medicare Executive Order on Scope of Practice</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:15.0pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#0070C0'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width="100%" style='width:100.0%;border-collapse:collapse'><tr><td width=630 valign=top style='width:472.5pt;background:#4F5959;padding:7.5pt 7.5pt 7.5pt 7.5pt'><p class=MsoNormal align=center style='text-align:center'><b><span style='font-size:13.5pt;font-family:"Arial",sans-serif;color:white'>Provider Scope of Practice Feedback to CMS by Jan. 17<o:p></o:p></span></b></p></td></tr><tr><td width=630 valign=top style='width:472.5pt;padding:7.5pt 7.5pt 7.5pt 7.5pt'><p class=MsoNormal><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>As you all have likely heard, the most recent </span><span style='font-size:10.5pt;font-family:"Arial",sans-serif'><a href="http://send.aaem.org/link.cfm?r=JNKVjha_Lg3HjCCRLQiEmw~~&pe=v3t8ITNvepYov6ZmSq9GbMVt_WT7VY4B1FIaRwXofUeBQ8WifGF6SWneVc3BsiFwOlco-2nlzKo2bKpSAZ7KNg~~&t=wi5CBv1upgwncK37jqkcJw~~"><span style='color:#EC1C2D'>Executive Order</span></a><span style='color:#333333'> includes recommendations for CMS to relax certain restrictions on the scope of practice of non-physician practitioners (NPPs) so as to eliminate restrictions that keep NPPs from practicing "at the top of their profession."</span></span><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'> <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>The AAEM EM Workforce Committee has been following these developments closely and believes this language is concerning. This Executive Order promotes the independent practice of medicine by non-physician practitioners and therefore is strongly opposed by AAEM.</span><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'> <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>We need our members to contact </span><span style='font-size:10.5pt;font-family:"Arial",sans-serif'><a href="mailto:patientsoverpaperwork@cms.hhs.gov"><span style='color:#EC1C2D'>patientsoverpaperwork@cms.hhs.gov</span></a><span style='color:#333333'> to express our concerns for this expansion of NPPs. Emails should be addressed to </span><a href="mailto:patientsoverpaperwork@cms.hhs.gov"><span style='color:#EC1C2D'>patientsoverpaperwork@cms.hhs.gov</span></a><span style='color:#333333'> to the attention of Secretary Alex Azar and Ms. Seema Verma, Administrator CMS. Please include "Scope of Practice" as your subject line.</span></span><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'> <o:p></o:p></span></p><div class=MsoNormal align=center style='text-align:center'><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><hr size=2 width="100%" align=center></span></div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'> <o:p></o:p></span></p><p class=MsoNormal><strong><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>One example of language that can be used includes:</span></strong><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><br></span><em><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>I am a physician in _______. I am asking you to OPPOSE the changes that would remove supervision requirements for non-physician practitioners caring for Medicare patients. The minimum non-physician practitioner (NPP) training and education is very different and a fraction of the minimum training that physicians require to become board certified in their area of expertise, and differs in many aspects. The risk of harm increases when patients are not cared for by physician-led teams.</span></em><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><br></span><em><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>Increasing the scope of practice by NPPs and implementing unsupervised practice will not fix the physician shortage and will not improve access to quality medical care. Furthermore, the proposed regulation changes that would allow </span></em><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>parity of Medicare reimbursement<em><span style='font-family:"Arial",sans-serif'> between physicians and NPPs is devaluing of physicians, and </span></em><strong><span style='font-family:"Arial",sans-serif'>financially irresponsible of CMS</span></strong><em><span style='font-family:"Arial",sans-serif'>.</span></em></span><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><br></span><em><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>I ask you to keep the most highly trained professional as the leader of the healthcare team and safeguard the quality of care for Medicare patients.</span></em><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><br></span><em><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>Sincerely,</span></em><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><p class=MsoNormal><em><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>Your Name</span></em><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'> <o:p></o:p></span></p><div class=MsoNormal align=center style='text-align:center'><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><hr size=2 width="100%" align=center></span></div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'> <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>If you prefer, we have provided a template to send your information to CMS. You may provide your scope of practice feedback at the link below.</span><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'> <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>Sincerely,</span><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:10.5pt;font-family:"Arial",sans-serif;color:#333333'>AAEM EM Workforce Committee</span><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p></td></tr><tr><td width=650 valign=top style='width:487.5pt;padding:7.5pt 0in 7.5pt 0in'><div align=center><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width=200 style='width:150.0pt;background:#EC1C2D'><tr><td style='padding:7.5pt 7.5pt 7.5pt 7.5pt'><p class=MsoNormal align=center style='text-align:center'><b><span style='font-size:12.0pt;font-family:"Arial",sans-serif;color:white'><a href="http://send.aaem.org/link.cfm?r=JNKVjha_Lg3HjCCRLQiEmw~~&pe=s6_Gg1T1nGCVAFlY5Epi6k5x7coOJbs9PhkEixT6ndj0IWzO7qcWXYvt_AC-Orv0d189c0cU0ituyRNjZhqcFw~~&t=wi5CBv1upgwncK37jqkcJw~~"><span style='color:white;text-decoration:none'>Comment Form</span></a><o:p></o:p></span></b></p></td></tr></table></div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p></td></tr></table></div><p class=MsoNormal><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><strong><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Brian Potts</span></strong><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> MD, MBA</span></b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><br>Managing Editor, CAL/AAEM News Service</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt'> <o:p></o:p></span></p></div><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'>Contact us at: </span><span style='color:black'><a href="mailto:calaaem.news.service1@gmail.com" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>calaaem.news.service1@gmail.com</span></a></span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'><br><br>For more articles, visit our </span><span style='color:black'><a href="https://www.aaem.org/get-involved/chapter-divisions/calaaem/news-service" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>archives</span></a></span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'>. <br><br></span><span style='color:black'><a href="mailto:somcaaem@uci.edu" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black;text-decoration:none'>To</span></a><a href="https://maillists.uci.edu/mailman/listinfo/calaaem" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#0070C0;text-decoration:none'> </span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>unsubscribe</span></a></span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'> from this list, visit our mail server.<br><br>Copyright (C) 2018. The California Chapter of the American Academy of Emergency Medicine (CAL/AAEM).</span><span style='font-size:9.0pt;color:black'> </span><span style='color:black'><a href="http://www.calaaem.org/" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>http://www.calaaem.org</span></a></span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'>. All rights reserved.<br><br>CAL/AAEM, a nonprofit professional organization for emergency physicians, operates the CAL/AAEM News Service solely as an educational resource for physicians. Dissemination of an article by CAL/AAEM News Service does not imply endorsement, agreement, or recommendation by CAL/AAEM News Service, CAL/AAEM, or AAEM.</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><b><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black'>Follow CAL/AAEM on Facebook and Twitter and check out WestJEM:</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:black'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><span style='color:black'><a href="http://www.facebook.com/CALAAEM" target="_blank"><span style='font-size:9.5pt;color:black;text-decoration:none'><img border=0 width=40 height=40 style='width:.4166in;height:.4166in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_2" src="cid:image002.jpg@01D5C896.9A19F660" alt="cid:image002.jpg@01D0A9FD.796449A0"></span></a></span><span style='font-size:9.5pt;color:black'>     </span><span style='color:black'><a href="https://twitter.com/CALAAEM" target="_blank"><span style='font-size:9.5pt;color:black;text-decoration:none'><img border=0 width=43 height=43 style='width:.4479in;height:.4479in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_3" src="cid:image003.jpg@01D5C896.9A19F660" alt="cid:image003.jpg@01D0A9FD.796449A0"></span></a></span><span style='font-size:9.5pt;color:black'>    </span><span style='color:black'><a href="https://westjem.com/" target="_blank"><span style='font-size:9.5pt;color:black;text-decoration:none'><img border=0 width=160 height=43 style='width:1.6666in;height:.4479in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_4" src="cid:image004.jpg@01D5C896.9A19F660" alt="cid:image004.jpg@01D0A9FD.796449A0"></span></a></span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:9.5pt;color:black'> </span><span style='fon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