Legislative, September 2015

The Committee has been active at the Federal, and State and County level advocating for pediatric healthcare issues.

At the federal level, district meetings were held on September 10, 2015 to follow-up on six major legislative issues/bills supported by the national American Academy of Pediatrics for which the chapter authored letters of support. House Resolution 1462, the “Protecting Our Infants Act,” aimed to increase funding and direct federal institutions to create a national standard for the treatment of neonatal abstinence syndrome. The bill passed the House of Representatives on September 9th and the chapter helped obtain co-sponsorship by Reps. Grace Meng and Steve Israel. A letter of support for the Child Liquid Nicotine Poisoning Act (HR 3342), which would mandate child-proof packaging on liquid nicotine products is now co-sponsored by Rep. Kathy Rice after her staff received our letter earlier this month. House Resolution 1552, the “Preserving Antibiotic Treatment in Medicine Act (PAMTA) would help reduce the emergence of antibiotic resistance partially by increasing funding for antibiotic stewardship programs. After receiving our letter this summer and speaking with Anthony Lemma, her district staff chair, Rep. Meng is a now a co-sponsor of this bill. A bill titled, “Bringing Post-Partum Depression Out of the Shadows,” (HR 3235), would nationally grant pediatricians the ability to expand the scope of practice to include screening for post-partum depression – thus allowing our colleagues across the country the same privileges we have in New York for combating this condition. To date, we have no local co-sponsors for this legislation. Finally, HR 1859, the “Ensuring Children’s Access to Subspecialty Care,” would allow pediatric subspecialists to enroll in the Federal National Health Service Corps debt-relief program and is co-sponsored by Rep. King. At all meetings we discussed the need for funding the Agency for Healthcare Research and Quality, whose budget is threatened this legislative season.

Washington D.C. based meetings at these offices are in the process of being scheduled for Tuesday, October 27th in conjunction with the National Conference and Exhibition, “White Coat Rally” for children on the steps of the Capitol. Any chapter members who are attending are encouraged to contact the office and we will facilitate a legislative meeting. I will also be meeting with Denzel Singletary of Sen. Gillibrand’s office to discuss support for the neonatal abstinence bill given House passage.  As the chapter re-designs and expands web content, copies of all letters to legislators are being readied for posting on the website so they can be easily accessed as templates by other chapter members.  Finally, Dr. Shah was awarded a Leonard Rome CATCH Visiting Professorship in Advocacy to the University of Arkansas to take place later this year.

At the state level, the committee’s resolution on mandating insurance coverage for donor breast milk in the NICU (endorsed by the District and the Section on Breastfeeding Medicine) passed the Annual Leadership Forum last March but did not advance in the state legislature. Meetings with local state legislators to outline the state AAP Agenda, including this bill will be scheduled for October/November after the agenda is outlined by the State Advocacy Committee on its conference call later this month.

At the county level, an Opinion-Editorial on the need to raise the age for tobacco sales to 21 years was published by CNN.COM in the late spring. In hopes of advancing the legislation in Nassau County (the only county which does not have it), we are hoping to arrange a ½ day of advocacy in Mineola. I attended the summer meeting of the Nassau Pediatric Society and they are in support. However, scheduling a date has been difficult. The initial date, October 7th was abandoned because the county calendar scheduled budget talks that day. We have requested other possible dates from Legislator Jacobs and have yet to hear. After consultation with the Nassau County counsel, it was determined that the county has no authority to limit the age of retail-based clinics in the county as this is a state issue.

The Committee is actively seeking new members interested in advocacy, child health policy or advancing child health. Please contact me if interested.

Respectfully submitted,

Shetal I. Shah, MD, FAAP
Chair, Legislative Committee

Pediatric Council, September 2015

Quarterly Report, September 2015
ICD-10 is just around the corner, and those of you requiring further guidance should check the Chapter and District’s previous emails about resources for understanding and making the transition. The CMS and AAP websites are another great source for guidance.

The mission of the Pediatric Council is to act as a liaison between the Chapter’s members and insurers to create a forum to resolve coverage issues, advocate for access to services and quality pediatric care, foster discussion when managed care decisions adversely affect the provision of care, and enhance communication between pediatricians and payers. The development of a network of contacts at the local, state and national levels with government and insurers helps speed the resolution of issues that arise.

Recently, Amerigroup, the Medicaid Managed Care Plan of Empire Blue Cross sent out recoupment notices for those physicians that received payment for immunization administration code 90461. 90461 is the add-on code for vaccine administration involving counseling and education by a qualified provider when a vaccine has more than one component. The VFC program does not recognize this as a required code for payment, and work at the national level is in progress to rectify this situation. Amerigroup paid many physicians for this code between 2013 and 2015, although it was not required to do so. Some practices with multiple practitioners received requests for a large recoupment. There is an ongoing dialogue with Dr. Sajidah Husain, the Medical Director of Amerigroup, to resolve this issue. Our last request was to postpone recoupment until the issue is resolved, and I am waiting for a response. Some of you may remember when Americhoice, the United HealthCare Managed Medicaid Care Plan asked for return of fees going back two years, and we were able to resolve that issue. I am optimistic that this issue can be resolved.

Amerigroup is changing its name as of October 1st, 2015 and will be known as Empire BlueCross BlueShield HealthPlus.

I believe that the Pediatric Council’s work creates value for our members by its actions and advocacy with insurers. Chapter AAP backing helps ensure that insurers consider the concerns of our members. Resolution of even a small matter by our intervention can pay for AAP membership many times over. Please continue to inform me of your concerns and payer issues—and let others know about our work on behalf of children and pediatricians.
Respectfully submitted,
Steven J. Goldstein, M.D., F.A.A.P.
Chair, Pediatric Council, Chapter 2, District II
SJG34@Cornell.edu

Fetus & Newborn, September 2015

Quarterly Report September 2015
The Committee so far has been successful in inspiring neonatologists from Brooklyn, Queens, Nassau & Suffolk counties in networking, discussing policies and other neonatal issues through our annual meetings.
Goals:

  • Keep enthusiasm and increase membership
  • Encourage networking
  • Discuss policies
  • Invite renowned speakers to discuss state-of-the-art topics
  • Bring new research ideas through meetings
  • Encourage pediatricians to attend meetings to better understand neonatal issues in providing follow-up care to infants

Last meeting date – November 6, 2014
Topic: “Preventing Blindness from Neonatal Retinal Disease: Digital Imaging, Treatment and Beyond”
Understand anatomy and physiology of premature eye development, its morbidities and possible complications beyond the neonatal period.
Respectfully submitted,
Renu Aggarwal, MD, FAAP
Chair, Fetus and Newborn Committee

Breastfeeding

Lauren Macaluso, MD, FAAP, FABM

Lauren Macaluso, MD, FAAP, FABM

Challenges for Breastfeeding Mothers and How to Overcome Them

 

Breastfeeding is the normal way to feed our babies. A mother’s breast milk is considered the BEST nutritional option for babies according to the American Academy of Pediatrics. Medical contraindications to breastfeeding are rare. Women’s bodies are MADE for breastfeeding, initiating breast development in utero with continued growth through puberty, pregnancy and after delivery. Minutes-old newborn infants have feeding reflexes, the ability to root, suck, and swallow at the breast to attain optimal nutrition, growth and protection.

Though it is a natural process, it is common for women to run into barriers breastfeeding our infants. Mothers and infants may have medical issues that can interfere with breastfeeding. Even if both mother and infant are healthy, exclusive breastfeeding may not be successful and require extra help. As a pediatrician, mother, member of both the local and national American Academy of Pediatrics and a specialist in breastfeeding medicine, here are common challenges encountered by exclusively breastfeeding women and how to overcome them.

EXPECTATIONS

Mothers often have unrealistic expectations of the breastfeeding experience. Unforeseen medical issues such as delivery by Caesarian section, premature labor or difficulty with infant weight gain sometimes occur. Keeping expectations simple and making short term goals can be helpful. Taking one day at a time and having patience and perseverance are paramount. A positive outlook and a strong support team may improve breastfeeding. In certain cases, a breastfeeding specialist, working with your infant’s pediatrician may be helpful in setting reasonable goals for breastfeeding your infant and prevent discouragement.

SUPPORT TEAM

A support team is extraordinarily important. Surrounding yourself with a team that shares your support for breastfeeding is a powerful tool in reaching your breastfeeding goal. Discuss your feeding plan with your partner, close family members, and friends during pregnancy. Consider an obstetrician, midwife and a pediatrician who are supportive of breastfeeding. Some families may benefit from a doula and/or lactation consultant at home or in coordination with the hospital staff. A breastfeeding medicine specialist who does office visits for breastfeeding moms and babies upon discharge may also suit your needs. A breastfeeding support group in your community can provide help and a social network.

EDUCATION

Empower and educate yourself so you understand what is biologically normal. Read about basics: how often to breastfeed, normal urine and stool patterns in breastfed babies, normal weight loss and gain. Observe family members or friends breastfeed if possible. Take a breastfeeding class; query friends who have breastfeed previously. Have a prenatal office visit with a pediatrician or breastfeeding medicine physician to address any issues that can impact breastfeeding.

COMMUNICATE

Address potential breastfeeding challenges as early as possible and with positive communication. Let your workplace know you plan to breastfeed and will require space and time to pump breast milk upon your return. In certain cases, companies may be required to provide you with time and a private space for breastfeeding and/or expressing breast milk. Talk about breastfeeding with your other children and let them know this is how mothers normally feed babies. Read a book together about breastfeeding and encourage them if they imitate you with their dolls so they are empowered for the future.

BE HEALTHY

Have a healthy lifestyle. Eat healthy, low fat, whole grain, nutrient dense foods and emphasize fruits and vegetables. Work exercise into (or back into) your life once medically cleared and make sure exercise is fun. Get rest as often as possible. As a mother, YOUR JOB IN THOSE FIRST FEW WEEKS AFTER DELIVERY IS BREASTFEEDING. Have support team members cook, clean and do laundry. Relax, breathe deeply, meditate or write about your feelings and experiences in a journal.

Breastfeeding is a life changing experience that has its barriers and obstacles. A strong support team, managing expectations, communicating positively, having a healthy lifestyle, and educating yourself will help you achieve your goals.

Dr. Lauren Macaluso, MD FAAP FABM is a pediatrician, breastfeeding specialist and co-chairman of the Breastfeeding Committee of the New York State (District II), Chapter 2 (Long Island) of the American Academy of Pediatrics.

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President’s Newsletter, March 2015

Dear Chapter 2 Member,

Marc Lashley Photo

Greetings AAP NY Chapter 2!

Please read on for a short list of our top priorities and other important information:

 


ICD-10

Colin Powell once said: “There are no secrets to success.  It is the result of preparation, hard work and learning from failure.”  As ICD-10 transition approaches (205 days as of this writing), we must all prepare and do some hard work.  100 pediatricians attended the ICD-10 lecture given by Chapter 2 on March 2, 2015.  If you were not able to attend, please review the attached slides from the presenters to get a glimpse of some of the things we must start doing NOW to get ready.  This transition is sure to be painful, and is sure to disrupt cash flow in the average practice.  In addition, if you email our secretary (contact info below), he will send you additional files and links to help in your research.  Let us be prepared.

Click the link below for PowerPoint slides:


Anti-Vaccine Movement

Recently a parent in Rochester filed numerous complaints against area pediatricians who refused to accept her non-vaccinated child-alleging religious discrimination. The opinion of our lawyer at the firm of Kern Augustine Conroy and Schoppmann is that if the physicians can give a rational explanation – based upon clinical considerations, why they withdraw from treatment of a child whose parent refuses vaccination – the doctor can argue that the determination is based upon clinical considerations rather than upon religious discrimination.  I would like to remind our members that it is the official policy of the AAP not to refuse these patients, but to work with them to use any opportunity to educate them about the benefit of vaccines.  Also, here is a humorous clip from a recent episode of Jimmy Kimmel (Warning – some inappropriate language).


Know a physician who wants to become a member of chapter 2?  E-mail his or her name to our secretary below.

Sincerely,

 

Marc Lashley M.D.,FAAP

President AAP NY Chapter 2