Dedicated to the health of children and adolescents.
February 2018
In this issue

KAAP Advocacy Day KPF Update! 
PresidentPresident's Perspective

By Jennifer Mellick, MD, FAAP

At our first annual Kansas AAP Legislative Day in Topeka early in February, I was inspired by what I learned. I heard talks from legislators, senators, and our Kansas AAP lobbyist, Stuart Little. I learned how little I really know about all the different ways that we can help improve pediatric care in Kansas. I learned that there are still people who care enough to uproot their own daily lives to work to improve the lives of our children. And, to be honest, I felt a little small in all of it. Medicaid expansion, payment parity for telehealth, school funding, immunization mandates and more were discussed. I won't go into the details (for that please follow our Legislative Updates from Stuart Little) but it was honestly a bit dizzying.
 
I began to wonder how one person can really make a difference. Of course, those of us who care for kids already know the answer to that . . . one encounter at a time. But for a moment, I was daunted. Then I realized, I wasn't alone. I saw my friends at the KAAP and recognized that we must be the voice for children because they don't have one of their own, at least not at the voting booth.
 
Introductions were made and the KAAP found some new partners and allies. We learned that one particular senator is interested in helping to improve child safety, particularly as it relates to gun safety. This is a topic we are working on in a new Task Force at KAAP. We learned that there are others besides pediatric care providers that know that to truly take the best care of children, we have to take good care of their parents. Most inspiring I heard that there were people out there who were still willing to fight battles that are highly unlikely to be won in Kansas because they should be fought, because it is the right thing to do.
 
I realized that I need to invite all of our members to join us. Continue to call your legislators. It really is important. You do make a difference. And if you have a great idea or just find an issue that needs a solution, let the KAAP know. We are here not just for the kids, but for the pediatricians as well.
issues
Issues and Commentary


CHIP, Advocacy Day, Medicaid Waivers

By 
Dennis Cooley MD,FAAP
KAAP Legislative Coordinator

A lot has happened since the last newsletter. The biggest news was the reauthorization of funding for the CHIP program. The political journey of this popular bipartisan program's reauthorization, which began over 6 months ago, is a perfect example of the current problems with Congress. Despite almost universal support of CHIP and assurances from congressional members that it would be easily reauthorized it went almost 5 months without funding. It was placed on the back-burner as other more "important" issues became priorities. It was used as a bargaining chip for controversial problems. It was quite frankly abused. Congress should hold its head in shame for the worry it inflicted on the families of 9 million children in this country. Congress should apologize to state governments for the added administrative time and expenses they incurred as a result of the delay in reauthorization. Congress should get its act together. And this all happened because Congress played politics. But in the long run a better result could not have  been anticipated.
 
After all of the politics funding for CHIP was finally extended as part of a Continuing Resolution, which passed at the end of January.  The reauthorization was given for 6 years, which was remarkable since most of the recent reauthorizations had only been for 2 years. If Congress had extended funding to 10 years though it would actually save the federal government money according to the most recent Congressional Budget Office Report. There had been some talk of increasing funding to 10 years at a latter date but it seemed unlikely in view of the previous difficulties. But you can never predict how things will go with this Congress. On the verge of another shutdown both chambers passed a budget deal and extending funding of CHIP for a total of 10 years was part of this. Unbelievable.    
 
The AAP played no small part in the passage of this important legislation. Pediatricians called their Congressional representatives, wrote OP-eds and letters to the editors, gave interviews on television and the radio, and took to social media. Many of you were part of these efforts and I want to thank you for all did. The AAP is over 60,000 strong and I think this showed what a force we can be when get involved.
 
Which brings me to the first annual Advocacy Day the KAAP held at the Capitol on February 6th. Due to weather attendance was small but it was a successful initial effort. We heard from a number of speakers including chairs and ranking members of the health committees in both chambers. We heard from experts on such issues as Medicaid expansion and KanCare. And attendees were encouraged to meet with their own legislators. This is an example of the benefits the Chapter provides members and I hope that it will lead to pediatricians in the state being more of a political force.
 
Finally I want to make members aware of the current state of KanCare. As many of you heard the newest version, KanCare 2.0, was been put on hold by previous Governor Brownback and current Governor Colyer. This was after legislators and advocates expressed concerns that the problems exposed in KanCare 1.0 have not been adequately resolved and demanded that these be fixed before any changes be made.  But the state did not withdraw the 1115 waiver sent to CMS. This means that the changes that were in KanCare 2.0 are still being evaluated by CMS. These include work requirements and 36 month caps to some enrollees. So is KanCare 2.0 really on hold or not? Despite the statements from the Governors I would assume it is still moving forward and I would advise any Chapter members that have concerns about how the current program is being run and/or the requested changes in KanCare 2.0 to notify Governor Colyer's  office and their state legislators. 

KAAP_Staff
Meet the KAAP Staff

2018 has brought big changes to the Kansas Chapter (KAAP) staff, including several changes in roles and the addition of a new staff member. I am excited to introduce myself as the new Executive Director for KAAP, and I am looking forward to continuing the incredible work of Chris Steege. For almost three decades, she has been dedicated to improving child health in Kansas and she has a passion for this organization that I felt when I first joined the staff almost 9 years ago. I am honored to be taking over the reigns of the Kansas Chapter, and I plan to build on the great work of my predecessor.

I am proud of the work that I have been a part of through both the Kansas Chapter and the Kansas Pediatric Foundation (KPF) and I know that every success to date is because of members who give their time and expertise to important initiatives. I have learned that pediatricians truly are a special group who work tirelessly to improve the lives of the patients that they care for. Please know that the KAAP staff is here to support you in any way that we can. This is your Chapter and I hope you will plan to get involved in a committee, task force, grant project, or educational opportunity.

I work out of my home in Lenexa where I spend most of my free time at track meets and ball games for my three boys. Feel free to contact me any time at  mel.hudelson@kansasaap.org or (913) 530-6265.

I would also like to introduce the rest of our staff:

Shanna Peters is the new Associate Director for both KAAP and KPF. Shanna has been on staff since 2011 as a Project Coordinator and has done great work with the Turn a Page. Touch a Mind.® (TAP-TAM) and CME projects. She will continue to oversee those projects and will add management of the Smoke Free for Kansas Kids initiative along with some other duties. Shanna works out of her home office in Prairie Village where she lives with her husband and twin sons. You can reach Shanna at   shanna.peters@kansasaap.org.

Heather Williams has been the staff accountant for KAAP and KPF since 2011. She handles book payments for TAP-TAM sites, budgets for grants, the annual audit, the membership database, CME registration and finances, and is the Chair of the Finance Committee. Heather works out of her home office in Meriden where she lives with her husband and two sons. You can reach Heather at heather.williams@kansasaap.org.

Amy Trollinger is the newest member of the team who joined us in January as the Marketing and Communications manager for KAAP and KPF. Amy is in charge of our websites, email communications, promotions for our meetings and programs, and social media. Amy works out of her home office in Shawnee where she lives with her husband and daughter. You can reach Amy at  amy.trollinger@kansasaap.org.

Chris Steege does not need an introduction, but I am happy to announce that she will be staying on with KAAP and KPF as a Special Project Manager. She will be working with the Kansas Maternal and Child Health Council (KMCHC) and other projects where the chapter can benefit from her experience. Chris works out of her home office in Lenexa, and can be reached at chris.steege@kansasaap.org
paymentPediatric Payment Corner

By Jonathan Jantz, MD, FAAP

In the process of focusing on various private insurances like BCBS or public like Medicaid or Tricare, it is easy to overlook the work the front office staff must do before the patient is even seen. Two key functions impact our bottom line. 
 
The first is the important step of checking eligibility for all the patients showing up each day in our offices. Many electronic health/medical records programs can do this  electronically as our EHR does automatically early in the morning. There is usually a signal generated to the system so that those checking in a patient can see the eligibility is good. Our system uses a stop light: Red means not eligible, yellow means something needs checking, and green means the patient is eligible.
 
For the most part, this works well for commercial insurances. However, occasionally the EHR will report back that a patient is eligible when they are not. The electronic checking sees the policy in the father's name, but the child's eligibility is not in place. This may be because the child's name is spelled wrong or the date of birth is wrong. If so, that is not the child that is presenting for services.
 
One could just make  a date of birth wrong or a name misspelled in the EHR so that the electronic claims go through. After all, the reasoning goes, we're just talking to computers, and why fight it? But that is no favor to a patient. If they show up at the ER, go to an Emergent care, have hospital admission or go to a referral specialist, that wrong item follows them and infects more systems. Alternatively, they incur a large bill they can't pay, or can't get the services they need.
LegUpdate
KAAP Legislative Update

The Legislature has wrapped up committee hearings for the first half of the session and both the House and Senate will spend this week on their chamber floors debating bills that must pass their chamber of origin before the mid-session break. If bills have been advancing and they are not from exempt committees, they will be worked and fail or die this week. By the end of this week we will have a good summary of the mid-point of the legislative session.  Click the button below to r ead the full KAAP Legislative Update provided by KAAP's lobbyist.
HPV
KAAP HPV MOC-4 Grant  

KAAP has received a grant to improve HPV vaccination rates in the state of Kansas by applying QI methods. Program participants will receive 25 MOC-4 credits at the completion of the program as well as CME credits.  This opportunity is open to any provider that has not yet participated in the HPV MOC-4 EQIPP program previously offered. There will be three one-hour webinars that participants must attend, then the rest of the program runs at your own pace, dependent on the number of qualifying patients you see. The first webinar will take place in March and the program runs through August.  
Advocacy
KAAP Advocacy Day

KAAP held its first Advocacy Day in Topeka on February 6th. Attendees met with Senator Vicki Schmidt, Chair of the senate Committee on Health and Public Welfare, Representative Monica Murnan, ranking minority member of the House Health Committee, and Senator Barbara Bollier to discuss important health issues. Amanda Gress with Kansas Action for Children and Sheldon Weisgrau from the Alliance for Healthy Kansas visited the group to share updates on Medicaid expansion and other legislative topics that affect KAAP members and their patients.
KAAP members met with their representatives and shared with them KAAPs legislative priorities including:
  • Restoring funding for early childhood and childhood programs
  • Expand mental health services to children
  • Expansion of Medicaid
  • Oppose work requirements and 36 month coverage caps for Kancare 2.0
  • Setting guidelines for the use of telehealth care in the state
Thank you to everyone who spent time in Topeka advocating for child health. 
breastfeedingKansas Breastfeeding Friendly Practice Designation

The Kansas Breastfeeding Friendly Practice Designation is in the third and final year, and we have space for a few more practices to participate! Created by KAAP in collaboration with the Kansas Breastfeeding Coalition, 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 mel.hudelson@kansasaap.org for more information.

Congratulations to the following practices who have earned the Kansas Breastfeeding Friendly Practice Designation:

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 Pediatrics - Kansas City
  • KU Wichita Pediatrics - Wichita
  • Drs. Morris and Hill Medical Clinic - Fredonia
  • Medical Heights Medical Center - Dodge City
  • O'Shea Memorial Clinic - Jetmore
  • Pediatric Partners, PA - Overland Park
  • KU Department of Family Medicine - Kansas City
  • Prairie Star Health Center - Hutchinson
Designation in Progress
  • GraceMed - Wichita
  • Hays Family Medicine - Hays
  • Sunflower OBGYN - Winfield
  • Hutchinson Clinic - Hutchinson
  • Prairie Band Potawatomie Health Center
  • Cottonwood Pediatrics - Newton
KPF
KPF Update

Thank you to the generous supporters who contributed to the Kansas Pediatric Foundation's Year End Appeal. We were able to meet our full matching gift and even exceed our $30,000 goal! Contributions helped to grow the Kansas Kids Fund and the Literacy Endowment so that we can continue to work to improve child health in Kansas.

Turn a Page. Touch a Mind. ®  (TAP-TAM) put over 120,000 books in to the hands of Kansas kids in 2017, and have given close to 900,000 books out since the program began in 2004! This year we will continue work grow TAP-TAM to include even more practices in this important program. 
MCOMCO Fast Facts

Amerigroup:  Case management services are available at Amerigroup Kansas, Inc. Just call 877-434-7579 extension  35717 to reach a case manager with a referral. More information here.

Sunflower Health Plan: A care management team is available to help all providers manage access to services for their patients who are Sunflower members. We look forward to hearing from you about any Sunflower members whom you think can benefit from the addition of a Sunflower care management team member.  To contact a care manager, call:  Sunflower Care Management Department 1-877-644-4623. Click here for more information.

United Healthcare: Check out the new UHCprovider.com, the new home for the latest news, policy information and access to Link self service tools. This website will house provider content in one place. For more provider news, click here.

Immunizations
Immunization Updates


PIP
CRIBS
Inaugural symposium of the  Kansas Center for Research for Infant  Birth and Survival (CRIBS)


APRIL 12, 2017
Wichita Art Museum
1400 Museum Blvd
Wichita, KS 67203



lactose
February is Lactose Intolerance Awareness Month 

from Midwest Dairy Association

Whether real or perceived,  lactose intolerance  can be a top barrier to people consuming dairy. Consumer research reports there's confusion surrounding lactose intolerance , with some people mistaking digestive issues with a milk allergy and others considering themselves to be lactose intolerant without a diagnosis from a physician. Roughly  one in 10 people  say they're lactose intolerant through self-reporting.

Because lactose intolerance is often misunderstood, people may be
missing out on the nutritional and taste benefits of dairy foods, and they may not have to. The most important thing to know is lactose intolerance is very individual and people often can tolerate varying amounts of lactose. In addition, there are solutions within the variety of cow's milk and milk products on the market to meet most needs.
  • Natural cheeses, such as Cheddar, Monterey Jack and Swiss have less than 0.2 grams of lactose per ounce. And if your patient is watching his/her sodium, he/she can choose cheeses such as Swiss or fresh Mozzarella that generally require less salt to make or reduced sodium versions of his/her favorite varieties.
  • A 6-ounce serving of yogurt typically contains about 13 grams of lactose and the live and active cultures help digest the lactose, which help make yogurt easier to tolerate. Six ounces of Greek-style yogurt contains 4 grams of lactose. This is less than regular yogurt as the straining process that gives Greek yogurt its thick texture removes some of the lactose. 
  • A cup of milk typically has about 12 grams of lactose. For many, smaller amounts of regular milk on cereal, in smoothies or with meals can be tolerated. Lactose-free milk is another option - it's real milk, just without the lactose.
  • Have your patients try drinking milk with a meal or snack. Solid foods help slow digestion and allow the body more time to digest lactose. 
  • If your patient is lactose intolerant, he/she can work small amounts of dairy into his/her meals or choose dairy foods with minimal lactose. Then, gradually increase the portion size to find his/her comfort level.
Quick_LinksQuick Links
About Us

Officers
Staff
Jennifer Mellick, MD, FAAP
President
Mel Hudelson
Executive Director 

Lisa Gilmer, MD, FAAP
President-Elect

Shanna Peters
Associate Director

Dennis Cooley, MD, FAAP
Treasurer

Heather Williams
Staff Accountant

Robert Wittler, MD, FAAP
Past President
Amy Trollinger
Marketing Communications Manager

Board of Directors
Chris Steege
Special Project Manager

KAAP Committees

Coordinators



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