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President's Perspective
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By Jennifer Mellick, MD, FAAP
We live in a very interesting and dichotomous world today. We are more connected than we have ever been, but at the same time often unable to communicate. Like most of the world, I spend some of my free time on Facebook and I had a very interesting exchange lately with a friend of a friend. My friend - we will call him Joe - was complaining about a group of people and saying they were corrupt. He was stating that this needed to change. I responded that of course corruption needed to change and that working to change it is needed, but complaining on Facebook does nothing. I asked for any suggestions for fixing this problem and none were offered by Joe. His friend - we will call her Susan - accused me of agreeing with the corrupt members of the group because I asked for solutions not just complaints. After several back and forth comments to each other, Susan and I found we did actually agree but were not communicating well. There are a couple of lessons to learn from this. First, listening is an active thing and we should do so much more of it than we do talking. Secondly, Facebook is not the place to solve complex problems. These types of issues need true communication. And serious issues need involvement not just a post, a share, or a like on Facebook. Eldridge Cleaver said it well, "You either have to be part of the solution, or you're going to be part of the problem. "
That is not to say that we don't gain much from our very electronically connected world. This is often a way to start serious conversations that need to be had. It can help identify problems that need to be solved. A recent on-line series "13 Reasons Why" has definitely started a dialogue of a problem that is a very timely issue, teenage depression and suicide. It highlights how words matter and bullying can have serious consequences. In my opinion, it was well done and watching it has made me more aware of how important it is to ask difficult questions of our patients. Most of them want to talk to adults; they just don't know how to start the conversation. It also reinforced to me that we have to get involved when we see a problem - IRL (In Real Life)!
This extends to other teenage issues as well including substance use disorders. At the recent KAAP Progress in Pediatrics (PIP) Spring meeting we were lucky to have an excellent speaker on this topic, Dr. Pamela Gonzalez. She opened my eyes to new ways to look at substance use disorders and how to screen for them. I am grateful for what I learn from others and am impressed each KAAP PIP meeting at the caliber of speakers we have. I would like to thank the planning committee (Drs. Lisa Gilmer, Anitha Parthiban, and Whitney Pressler) as well as our incredible KAAP staff for their work on putting together a great meeting. They informed many through their program on becoming part of the solution for kids.
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| Issues & Commentary |
AHCA, Medicaid and Kids
By Dennis Cooley, MD, FAAP, KAAP Legislative Coordinator
During the first week in May, the United States House of Representative passed the American Health Care Act as a first step in repealing the Affordable Care Act, better known as Obamacare. This bill was a modification of an earlier bill which failed to pass earlier this year. The new bill hardly had overwhelming support, as it squeaked by with one vote to spare. All of the Kansas House members voted on passage. So what does this mean and what would be the effect if the Senate passes a similar bill?
First, if you remember your Civics class (or School House Rock's "I'm Just a Bill") you know that passage by the House means it moves to the Senate for action on it. From reports in the mainstream news media, Senators are not especially happy with the House version and prominent Senators have said that they will basically start from scratch and develop their own version of health care legislation. This is hardly surprising when you consider the House bill was hastily put together, had no debate and was not evaluated by the Congressional Budget Office. Amazingly, some Representatives even admitted they voted on passage despite not having read the bill.
What does the House bill actually propose? I will hit some high points and then cover in more depth the effects on the Medicaid program and children. The House version will first and foremost eliminate taxes on the very wealthy. Some commentators have stated that this bill is really more of a tax bill than health care bill. The AHCA removes the individual mandate but allows for a 30% surcharge on the premiums if an individual becomes uninsured for more than 63 days. Older Americans are hit pretty hard. Insurance companies can charge premiums of up to three times that of younger policy holders. Older individuals may get some relief from tax credits which are based on age but these will not cover the increase in premium costs. The item that got the most press coverage was the loosening of protections on pre-existing conditions. States will be allowed to set up 'High Risk Pools' to help cover people with these pre-existing conditions. However, the money that was earmarked for these pools is generally considered woefully inadequate by health care policy experts. By the way, many of you may remember that Kansas had such a pool before the ACA and it did not prove to be very successful. Finally, if the new bill becomes law, states could relax requirements on essential health benefits including maternity coverage.
In my opinion, the biggest impact of this bill is the effect it would have on the Medicaid program. The Medicaid changes were reported by news outlets but coverage always seemed to center on Medicaid expansion with the adult population. There was hardly a mention of the effect on children. Here are the facts that are rarely mentioned. Children make up the biggest enrollment group in Medicaid. In states such as Kansas, this is between 60-70%. They also cost the least per enrollee. But more importantly, roughly 40% of children in this country are on Medicaid/ CHIP. Think about this. Anything that threatens the health of 40% of the children in this country will be devastating to our future. If there was an epidemic that attacked 40% of the children in this country, I can guarantee that the country would be in an uproar to find a "cure".
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| Newborn Screening for Severe Combined Immune Deficiencies: A TREC Analysis |
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 By Selina Gierer, DO, KUMC Immunologist
Primary immune deficiencies (PIDs) are diseases that are due to inherited defects in the immune system categorized according to the type of immune defect, clinical presentation, and genetic basis
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Severe Combined Immune Deficiency (SCID), occurring in 1:40,000 to 1:50,000 live births (more common in consanguineous families), is the most severe primary immune deficiency encompassing a genetically heterogeneous group of patients with impairment in T, B, and NK cells. These cells are vital for the function of the immune system, and without them, infection is inevitable. Although infants with SCID may be healthy at birth, life threatening bacterial, viral, and fungal infections will ensue and infants often die within the first year of life unless immune reconstitution with hematopoietic stem cell transplantation is performed. Dr. Rebecca Buckley, et al. demonstrated that if hematopoietic stem cell transplantation is accomplished before 3.5 months of age, newborns with SCID have a 95% chance survival of 20 years or greater. Unfortunately, if performed after 3.5 months of age, the survival rate drops to less than 70%.
Infants affected often succumb to fatal infections prior to diagnosis, therefore newborn screening is essential. Fortunately, the T-cell receptor excision circle (TREC) assay has enabled early detection. The TREC assay is sensitive, specific, and cost effective. The TREC assay was added to the recommended uniform newborn screening panel in the United States in 2010. It has been adopted by nearly all states and will start in the state of Kansas in late 2017. Once the TREC assay is available in the state of Kansas, if there is a positive result, please contact an immunologist immediately for assistance in managing this pediatric immunologic emergency.
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Pediatric Payment Corner
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By Jonathan Jantz, MD, FAAP
An unfortunate conundrum exists around newborn hospital charges.
For everyone who still sees newborns in the hospital, newborn rounds can be quite satisfying as we see the newborns for their first exams and early counseling and sometimes just enjoying an established family during a typically joyful event. Unfortunately, insurances around this time period can create confusion and frustration in the billing department.
Various insurances have different, but overlapping rules for coverage of newborns.
For example:
Commercial insurances frequently cover the infant on the mother's policy for the first 5 days if the insurance has maternal benefits. However, not all policies have maternal benefits if they were "grandfathered
in" as an insurance from before the Accountable Care Act (ACA).
If the mother is on Medicaid the child will automatically be placed on Medicaid on the same Managed Care Organization (such as Amerigroup, Sunflower or United Healthcare Community Plan) as the mother, assuming the child qualifies.
This creates the question of what coverage will be effective during the first 5 days (i.e. Is the child included in a ACA plan and covered by the mother's insurance for 5 days or is the child on a grandfathered-in plan and potentially not covered by that insurance during the first 5 days?
This can easily go under the radar until several months later when the insurance company that your billing department thought was covering the initial days after labor and delivery contacts you asking for their money back claiming that the child had a second policy that was primary and theirs was secondary or possibly not in effect.
Logically this seems ridiculous and absurd. So, how does it happen? It starts with your pediatric clinic billing department being responsible and filing insurance on the newborn promptly to avoid missing the tim
ely filing window (90 days). Then the hospital, up to 3 months later, files their portion of the claim for hospital charges to a different insurance that they now have information indicating was primary. This becomes complicated by the fact that the insurance company that the pediatrician thought was primary is now asking for their money back.
That means you now are obligated by contract to return the payment to the original insurance company and since your timely filing period, usually 90 days, has run out, can no longer obligate the true primary insurance company to pay for the services provided.
Click here to read remainder of article
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| 2017 KAAP Spring PIP CME Meeting |
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KAAP's Early Career Physicians enjoyed an afternoon reception with Dr. Pamela Gonzalez, MD, FAAP.
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Stuart Shanker, MD, FAAP presents
to attendees on ICD-10.
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The Kansas Chapter, American Academy of Pediatrics (KAAP) held its 2017 KAAP Spring Progress in Pediatrics (PIP) CME meeting on April 20-21 at the Marriott Hotel in Overland Park, KS.
Thursday was hig
hlighted by a Reception supported by Children's Mercy Hospital and a dinner with Keynote Speaker, Pamela Gonzalez, MD, MS, FAAP, from Minneapolis, MN. Dr. Gonzalez spoke on Adolescent Opioid Use Disorder and gave a presentation on Friday on Cannabis and "Medical Marijuana" for Youth.
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George Phillips, MD, MBA, FAAP presents to attendees on Pediatric Sports Medicine.
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On Friday, twenty-one Exhibitors gave attendees the opportunity to speak with industry supporters. The Friday Plenary session provided an array of topics and speakers that provide attendees with up to date best practices education on current children's issues.
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| KPF Update |
In 2016, the 81
Turn a Page. Touch a Mind.® (TAP-TAM) sites gave 122,110 books to Kansas children 6 months to 5 years at well-check appointments. The 475 participating TAP-TAM medical providers use the books in the exam room to assess a child's development, encourage parent-child interactions, and to talk about age appropriate behavior (like eating the book at 6 months old). Families walk away from these appointments with a new book and understand how to use the book in a developmentally appropriate way that will have many benefits for the child.
The Kansas Pediatric Foundation is working to grow the Literacy Endowment that supports the TAP-TAM program throughout the state so that we can be sure to have a secure source of funding far into the future. You can create a designated endowed fund that will benefit TAP-TAM programs in your community to be sure that children in your part of the state will always grow up with books. Contact Mel Hudelson at
mel.hudelson@kansasaap.org or (913) 530-6265 for more information about supporting TAP-TAM.
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| Kansas Breastfeeding Friendly Practice Designation |
The American Academy of Pediatrics (AAP) released a clinical report in April 2017 titled "
The Breastfeeding-Friendly Pediatric Office Practice" which called on pediatric offices to be conducive to breastfeeding support and avoid creating barriers to breastfeeding. The number of births in baby friendly hospitals has increased significantly, pediatricians are in a position to continue breastfeeding support and encouragement during the frequent office visits during the first year of life.
The KAAP has created the Kansas Breastfeeding Friendly Practice Designation in collaboration with the Kansas Breastfeeding Coalition to provide 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.
Congratulations to the following practices who have earned the Kansas Breastfeeding Friendly Practice Designation already:
Five Star Practices
- Children's Mercy West - Kansas City
- KU Department of Family Medicine - Kansas City
- 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
To learn how to participate in the Kansas Breastfeeding Friendly Practice Designation contact Mel Hudelson at
mel.hudelson@kansasaap.org or (913) 530-6265.
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| Free Event: Addressing Tobacco Dependence - Treatment Strategies for Tobacco-Free Recovery |
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National expert Jill Williams, MD will provide the latest research and treatment strategies to address tobacco dependence for people living with mental illness or addiction. The training is geared towards psychiatrists, nurses, counselors, educators, peer mentors, other behavioral health staff and pharmacists. Dr. Williams is Professor of Psychiatry and Chief of the Division of Addiction Psychiatry at Rutgers University. Click here for event flyer.
Treatment Strategies for Tobacco Free Recovery
June 8, 2017 10:00 am-3:00pm
Additional Training with Dr. Williams: Prescribing Cessation Medications
June 8, 2017 3:30pm-4:30pm
There is no registration cost and lunch will be provided for those attending the morning program.
A limited number of travel scholarships are available for either current smokers who want to quit or ex-smokers who have a history of mental illness or addiction disorder. Click here to apply.
For additional resources related to Tobacco Dependence, click here.
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