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KAAP can provide CME at your next activity!
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KAAP has been approved by KMS to jointly provide AMA PRA Category 1 Credit(s) for your live conference or webinar!
Contact
for more information!
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| About Us Officers Jennifer Mellick, MD, FAAP President Lisa Gilmer, MD, FAAP President-Elect Dennis Cooley, MD, FAAP Treasurer Robert Wittler, MD, FAAP Past President Staff Chris Steege Executive Director [email protected] Mel Hudelson Associate Director [email protected] Heather Williams Staff Accountant [email protected] Shanna Peters Project Coordinator [email protected] Board of Directors KAAP Committees Coordinators |
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President's Perspective
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By Jennifer Mellick, MD, FAAP
The Urban Dictionary defines "long game" as a long-term strategy or endeavor. This applies to many facets of life but anyone who works with kids understands playing the long game. Investing in our children's future is one way to play a long game. Patience is needed, persistence is a must, and strategy and redirection are key ingredients to winning this type of "game". Much of what is done by pediatricians is exactly this. We are experts on long game health care. So often, the benefits of our care and advice aren't realized until long into a person's adult life. While we understand that this is paramount to the success of a healthy nation of people, not everyone gets it. Many only look to short term outcomes and how it impacts their every day. This can be incredibly frustrating as it minimizes the importance of good pediatric care on the overall health of our nation. It also devalues us as providers to the health care industry.
I have been thinking a lot about long term planning lately. It is only natural this time of year as I plan my children's new school year. I also professionally will have time to breathe a bit as patients head back to school with their sports and school physicals in hand and the cold and flu season hasn't yet hit. I intend to use this time to develop our strategic plan for my office. This is important for all of us who care for kids to consider. We have to start playing not just for children to win but for pediatricians to survive. A new horizon in reimbursement is coming and we have to think about what exactly is valued in what we are providing to our patients. The KAAP touched on this a bit at our past Progress in Pediatrics CME Meeting and will continue to monitor these issues in the future.
Some of these payment planning things are frustrating to us. Coding for nutrition counseling and BMI calculation is almost insulting. Of course we counsel on this. This at the crux of what we do yet if we "don't code it, we didn't do it". It is almost as if we must jump through hoops instead of actually spend time helping our patients. This is where the long term strategy will come in. Sometimes we have to play the game to truly stick around to save the children. Pay for performance is going to have to be mastered if we want to continue to be able to survive to care for kids.
The AAP is working on how to help pediatricians accomplish this task. The amount of resources available to an AAP member is amazing. Coding books, newsletters, experts ready to help are just a few. And the leadership is listening, too. I was able to listen to and meet both of the AAP Presidential Candidates this past June and each focused on how to help pediatricians stay viable in the coming of Pay for Performance. I know that none of us chose pediatrics for the money but we have to stop thinking of profit as a dirty word. We have to realize that to play a long game, we must survive in the short one.
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| Issues & Commentary |
Stay in the Boat for Kansas Kids
By Dennis Cooley, MD, FAAP, KAAP Legislative Coordinator
After 7 months of the Trump administration, the Affordable Care Act (Obamacare) is still the law of the land. Medicaid is still an entitlement program. This despite efforts by the White House and a Republican controlled Congress to get rid of one and radically change the other. It was like going on a roller coaster ride and the brakes didn't work. Each day brought a new proposal. 'Repeal and Replace', 'Repeal and Not Replace', 'Let it Die'. And each new proposal brought dire warnings from the non-partisan Congressional Budget Office about how many millions of people would lose coverage. But we are back to where we started. And we are still just as uncertain about where healthcare is headed as we were in January. Insurance companies are worried, safety net clinics are worried, providers are worried and worst of all the citizens of this country are worried. And that is just the issue of health care. What about racial tensions, immigration, nuclear war, trade policies, safety nets. The list goes on and on. I didn't know there was a national version of toxic stress but I believe we are living in one now. Just like a child living with a dysfunctional parent, we are ourselves living with a dysfunctional administration.
So what do we do? We need to follow the advice of Mark Delmonte, Chief Deputy and Senior Vice President of Advocacy for the AAP. When Mark talks about the assault on Medicaid he likens it to white water rafting. According to Mark, the first rule of white water rafting is to stay in the boat. That is what he tells us we have to do. Stay in the boat. Efforts by many in this country including the AAP and pediatricians like you have stalled the attacks on Medicaid and the attempts to take away access to health care for millions of people, but we need to stay in the boat. We have to be vigilant and keep up the pressure. I have learned that bills, be they state or federal, are like zombies. They never die! This is true with the recent health care legislation.
Attempts to change Medicaid and repeal the ACA will be back when Congress returns from the summer recess. I know you have grown weary from the Chapter's constant reminders to contact your legislators, write letters, and attend town hall meetings. I am sorry and wish we didn't have to send these out.
But remember:
Stay in the boat!
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| KAAP Executive Director Retiring at the End of 2017 |
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Chr
is Steege plans to retire as KAAP Executive Director after 28 years. She started with the Kansas Chapter in 1989 as a part-time Chapter Administrator and moved to full-time in 2004 as the Executive Director. The current KAAP Associate Director, Melissa Hudelson, will take over as the new KAAP Executive Director.
Chris hopes members will make plans to come celebrate KAAP's 40th Anniversary and
help celebrate her upcoming retirement at the 2017 KAAP Annual Fall CME PIP meeting on Oct. 5-6 at the Hotel at Old Town in Wichita.
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| Help Us Celebrate 40 Years at PIP - Fall 2017 |
Join us on October 5th as we celebrate 40 years of leading the way in child health in Kansas on at Hotel at Old Town in Wichita. There will be a reception at 6:30pm followed by dinner and a short program to commemorate this important milestone. Chris Steege, Executive Director of KAAP will be retiring at the end of 2017 after 28 years of service, so be sure to congratulate her on her retirement at the event.
Progress in Pediatrics (PIP) - Fall 2017 will have workshops on Thursday afternoon, October 5th and plenary on October 6th at Hotel at Old Town in Wichita. Don't miss the expert speakers and important topics like new peanut allergy guidelines, neonatal abstinence syndrome, overuse of antibiotics and much more!
Click here for the full agenda and to register for PIP-Fall 2017 and the 40th Anniversary Dinner.
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Pediatric Payment Corner
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By Jonathan Jantz, MD, FAAP
Beware: United Health Care is getting in the way of pediatric office billing.
Our office is in process of tracking an issue with United Health Care (UHC). We are currently working to find someone in charge of the MCOs to straighten out this issue.
In essence, sometimes a patient comes in and registers at our front desk as Medicaid, in this case specifically as United Health Care. Later we discover that they had private insurance. Blue Cross Blue Shield (BCBS) is a typical example. When we discover the discrepancy, we submit a claim to BCBS.
Our claim is then denied by BCBS as a duplicate because UHC/MDD is billing the primary themselves, instead of recouping the payment and telling us to bill the primary insurance. We always ask the patients for other coverage, but for some reason they don't disclose it to us (ignorance? MDD fraud?).
When they find a primary, somehow, Medicaid Management Information System (MMIS) sends a claim to the commercial (primary) payer using HMS (a recovery audit contractor) and informs us of the primary. When we try to bill the primary, we are denied as a duplicate.
When we call commercial primary (here, BCBS), they tell us to give them a claim number, which we don't have because we didn't send a claim, UHC did.
We call UHC and ask them to withdraw their claim and recoup and they give us an explanation about "Post Pay Billing."
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| Telemedicine in Private Practice |
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By Kathy Farrell, MD, FAAP
Telemedicine is a complex, dynamic, and growing venue to help care for patients. Healthcare professionals have different questions and concerns about how Telemedicine may fit in private practice.
Telemedicine is a billable, cost effective interactive service.
There are several platforms that offer patients the opportunity for a video non facilitated DTC (Direct to Consumer) encounter.
Some DTC companies advertise with the swipe of a credit card for $40, 24/7 non facilitated video coverage via a Smartphone to see a board certified physician. Most consumers do not recognize the difference in training between family practice physicians and pediatricians.
Consumers are driving the convenience of this service as it can be performed anywhere and often used in home, school, and kiosks in grocery stores. Some health systems are utilizing this application to direct minor illnesses away from the ER and when needed back to the medical home. It is essential DTC providers preserve continuity by integrating with the medical home.
The convenience of Telemedicine can be a threat to primary care office visits, and is important to understand the difference between a facilitated and non-facilitated visit.
Just as Urgent Care Walk-In Clinics have eroded continuity, we must ensure quality care is not jeopardized for convenience, such as prescribing medication without a full exam.
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| KPF Update |
KPF Annual Report Highlights Partnerships
The 2016-2017 Kansas Pediatric Foundation annual report is now available to review at
www.kansaspediatricfoundation.org and the big story this year is the impact of our partnerships. Since 2004, our mission has been to connect with individuals and organizations who share our commitment for a healthy and meaningful life for our children and adolescents in Kansas. These important collaborations have allowed KPF to put over 750,000 books into the hands of Kansas kids through Turn a Page. Touch a Mind.® and create Kansas KidLink, children's mental health initiative.
This year, Overland Park Regional Medical Center matched each gift during our Year End Appeal helping to make it our largest fundraiser to date. We have collaborated with the Dane G. Hansen Foundation to put more books into the hands of children in Northwest Kansas by bringing on more TAP-TAM sites in the region. In just a few months, we have added 25 new sites to bring our total number of TAP-TAM participating practices to over 100!
This year we will continue to seek out partners throughout the state to continue our work to improve child health. Thank you to each individual and organization who contributed to the Kansas Pediatric Foundation this year!
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| Kansas Breastfeeding Friendly Practice Designation |
The Kansas Breastfeeding Friendly Practice Designation is in the third and final year, and we have space for several more practices to participate! Created by KAAP, the Kansas Breastfeeding Friendly Practice Designation provides education and tools to support breastfeeding to practices. Participating practices receive a free one-hour training that includes CME and lunch, a tool kit, and recognition for earning the designation. Contact Mel at
[email protected] for more information.
Congratulations to the following practices who have earned the Kansas Breastfeeding Friendly Practice Designation already:
Five Star Practices
- Children's Mercy West - Kansas City
- Children's Mercy Pediatric Care Specialists
- HMG Pediatric Clinic - Hays
Four Star Practices
- Ashley Clinic - Chanute
- Heartland Primary Care - Lenexa
- KU Wichita Pediatrics - Wichita
- Drs. Morris and Hill Medical Clinic - Fredonia
- Pediatric Partners, PA - Overland Park
- KU Department of Family Medicine
To learn how to participate in the Kansas Breastfeeding Friendly Practice Designation contact Mel Hudelson at
[email protected] or (913) 530-6265.
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| Safe Sleep Messaging Research |
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In June, the Ohio AAP and the Ohio Children's Trust Fund (OCTF) announced results of research conducted to better understand how to communicate with parents about safe sleep as part of their efforts to educate parents and caregivers about the importance of safe sleep practices.
The research results indicated that families are most responsive to hearing safe sleep messages from healthcare providers. They prefer to receive education in a one-on-one situation from a healthcare professional in the hospital where they gave birth, and/or from their pediatrician.
The Ohio AAP's prescription for safe sleep provides four simple guidelines:
- Routine is the key. Consistently putting your baby to sleep in the same place, using the same routine will lead to good sleep habits.
- Create a calming environment with low lights, reading and singing.
- Always put babies on their back to sleep, in their own crib that is free from blankets, pillows, bumpers and stuffed animals. If the baby falls asleep elsewhere, they should be moved to their safe environment.
- Babies sleep safest in the room where you sleep, but not in your bed. AAP recommends infants share their parents' room for at least the first six months and, optimally, the first year of life.
The research also provided information about how parents are motivated and what types of messages resonate best. Messages should convey an understanding that parents are:
- Contributing to and providing for their family
- Experiencing high stress levels and are extremely busy
- Enjoy being supported by family and friends
- Using culture and family advice for childrearing
- Doing their best to make the right decisions when parenting
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| Beware of Unsolicited "Home Visits" to Patients Directed by UHC & Sunflower |
 
By Jonathan Jantz, MD, FAAP and Rebecca Reddy, MD, FAAP
Recently an area practice discovered that Kancare Managed Care Organizations (MCOs), United and Sunflower have hired third party entities to send out mid-level providers to Medicaid patients' homes to conduct some sort of assessment. These visits are unsolicited by the patient/family and have never been disclosed to this practice as the primary care provider/medical home. (This has happened at other offices in the state as well. At Cottonwood Pediatrics we thought we had opted out a few months earlier and then it started happening again.)
This practice found out about it when patients complained to providers at visits - many felt coerced and confused. Parents said they were threatened with immediate withdrawal of their children's Kancare Coverage if they did not allow the mid-level to come to the home to evaluate their child. They were also told or it was inferred to the family that these mid-levels were representatives of this practice, or were visited by a mid-level provider who did not speak the family's home language so could not communicate at all with the family. (This has been confirmed at other practices in the state.)
With difficulty, United Healthcare Community Plan (UHC) allowed this practice and our practice to "opt out" of this "program." The practice is still trying to get Sunflower to stop these "home visits" with their patient panel.
This practice contacted the new Kansas Medical Society (KMS) director, Jon Rosell, to see if they could explain. Neither the KMS or the KDHE Kansas Director of Medicaid's office had any knowledge this was occurring. At this point, after a meeting August 10, KDHE and KMS agreed that communication was poor. It will continue to be poor if they don't include KAAP in the discussion.
We are investigating now how/why this is happening. There must be something that is motivating UHC and Sunflower (Centene) to conduct these "home visits."
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