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

PresidentPresident's Perspective

By Lisa Gilmer, MD, FAAP

After spending five days with thousands of fellow pediatricians being inspired by clinicians, researchers, advocates, patients and parents at the 2018 AAP National Convention and Exhibition in sunny Orlando, my excitement began to wane as my plane approached a cold, wet Kansas City on an uncertain election night. With my vote already cast, all I could do was wait for the returns and try to stay warm.
 
By the end of the night, the voices of nearly a million Kansans had spoken. Leading up to election day, many of the contests were predicted to be anyone's guess but at the end of the day, the closest margin turned out to be a narrow victory for the Kansas Jayhawks. Children stand to be some of the biggest winners of the midterm election. Changing course on school funding, immigration and healthcare are key priorities for many of our newly elected officials. I anxiously await the opportunity to meet Governor-Elect Kelly, potentially at our Advocacy Day on February 12th and Congresswoman-Elect Davids' office number will soon be programed into my cell phone. I am optimistic about the prospect of the KAAP partnering on issues that affect children in Kansas, but I am not particularly patient. Nothing happens quickly in Topeka or in D.C. so how do we make a difference right now even if only for one child? By picking up our sword and shield to protect those who need it the most.    
 
For me the most memorable talk at the NCE was the keynote address at the opening plenary presented by Adam Foss, JD, a former district attorney in the juvenile division of the Boston DA's office. An advocate of criminal justice reform, he shared his own story of being a young black man protected by a shield instead of being sent to jail. Through statistics and personal stories, he implored pediatricians to help black children overcome obstacles early in life. He challenged us to do something, to be part of a "a new civil rights movement" with a shift in focus from incarceration to transformation for black youth. His emotional conclusion-"Each of you has the opportunity to stick your arm into that pipeline and pull out one kid. Exercise your sword and shield, because when you do, amazing things will happen."
 
Amazing things are already happening as members of the Kansas Chapter exercise their swords and shields to change the lives of children facing obstacles. Dr. Liz Musil and the Foster Care Taskforce are working with state agencies to implement a standardized health information form for children in foster care. Their voice and determination to get this done right is a sword for children in foster care. With a newly awarded grant from the Kansas Health Foundation, Dr. Gretchen Homan will pilot a project in several high Medicaid practices using regular encounters as opportunities to educate families about the importance of adult vaccinations in order to increase adult immunization rates. Her willingness to apply for and lead this grant is a shield for infants not old enough to be fully vaccinated against diseases such as whooping cough and influenza.
 
The unique swords and shields we carry as pediatricians can make a difference in the lives of those we care for every day- a black child, a Muslim child, a migrant child, a child with special health care needs, or a pregnant mother fighting opioid addiction. When we use them to protect someone who has less than we do, to protect against discrimination based on race, color, religion, national origin, disability or age, we will indeed become leaders in Mr. Foss's new civil rights movement.
issues
Issues and Commentary


Family First will help kids, but Kansas must act 

By 
Pam Shaw, MD, FAAP

As a pediatrician, I see the ongoing crisis in our state's child welfare system firsthand.
 
Two siblings I cared for in my clinic lived with foster parents in Kansas City, 2 ½ hours away from their biological family. They entered foster care because their birth mother is struggling with a substance use disorder and can't safely care for them without treatment. Their foster parents are dedicated and loving people, but did not have proper support from our state's underfunded child welfare system. Unfortunately, this disconnect meant a lack of medical history and prescription information that I needed to help these children, which further fragmented their care.
 
A recent article in Governing underscored what I already know from working with vulnerable children and families; the programs that serve them are so underfunded that children are at risk. The stakes are incredibly high. In 2016, the most recent year for which we have data, 3,879 children in Kansas entered foster care. In 40 percent of those cases, parental substance use-a caregiver's struggles with drugs or alcohol-was part of why that child could no longer safely remain with their parents. The siblings I saw are emblematic of this tragedy. Like many families, they likely could have safely remained with their mother if she had access to treatment and other support services. Thankfully, a new federal law gives us reason for hope.
 
Buried in the budget deal that passed at the beginning of the year is a groundbreaking new law that creates a shift in the way our nation treats its most vulnerable children. The  Family First Prevention Services Act could have a profound impact for children and families in our state, and offers Kansas the opportunity to access the federal resources it needs to modernize our approach to child welfare.
ExecDirectorExecutive Director Update


It's an exciting time for the Kansas Chapter as we are in the midst of our Year End Appeal for our charitable arm, the Kansas Pediatric Foundation and getting started on a couple of exciting new projects that will launch in 2019.

In 2014 the Kansas Pediatric Foundation created the Kansas Kids Fund to have funding that the board can use to address child health issues important to members and Kansas children. I am excited to announce the first grant cycle for this funding will launch in early 2019! Kansas Chapter members can apply for funding to address a child health need in their practice or community. Details will be available in January, and I am really looking forward to being able to work with members on our first grant cycle.

Chapter staff worked with Gretchen Homan, MD to submit a grant to the Kansas Health Foundation for an initiative to promote adult vaccinations in pediatric practices. We were awarded the grant and are now looking for a few pilot sites to be a part of this project. Participating practices will receive a stipend and materials to share with caregivers about getting vaccinated. You can email me at mel.hudelson@kansasaap.org if you would like more information.

I hope you will consider giving a gift to the Kansas Pediatric Foundation before the end of the year that will be matched, making double the impact for Kansas kids! Have a safe and enjoyable holiday season, and don't hesitate to reach out if there is something you need from KAAP.
LegUpdate
KAAP Legislative Update

By Dena K. Hubbard MD, FAAP
Legislative Coordinator

The best time to advocate is always! The Department of Homeland Security recently proposed a new regulation on "public charge" that could harm immigrant families' willingness to access nutrition support, housing assistance and health care. Please submit personalized comments on the proposal by December 10th. Tell your stories and how this proposal would impact the health of your patients. There is a Public Charge Advocacy Toolkit with step-by-step instructions on how you can customize and submit your comments here . It is important that the pediatrician perspective is heard as many times as possible during this crucial period for public comment, and we hope you will add your voice to these efforts. Thank you for your ongoing advocacy!
Your KAAP Public Policy committee has been actively strategizing for the 2019 Kansas legislative session and we are ready to hit the road running in 2019. Stuart Little is the lobbyist assisting us in these efforts, and we have increased the budget for his services this year. This is a benefit to your membership, so utilize it and reach out with your issues and concerns.

The following policy priorities are the areas where the KAAP will focus legislative efforts in the 2019 legislative session. 1) Medicaid, including Medicaid expansion, opposing work requirements and lifetime caps, and supporting expansion services including mental health services; 2) Neonatal Abstinence Syndrome (NAS), providing education for legislators, reporting trends in Kansas, and promoting legislation that is family and patient centered; 3) Tobacco and marijuana, supporting the Tobacco 21 legislation and opposing medical marijuana bills; 4) Gun safety, including safe storage, ban on assault weapons, and universal background checks for gun purchases.

The KAAP Public Policy Committee will develop relationships with the incoming governor, cabinet secretaries, members of health committees, as well as legislators at the state and federal levels, with the goal that KAAP will be the go-to resource for any child health or pediatric provider related issues in Kansas. We will continue to work with the AAP State Government Affairs office and optimize the utilization of their expertise and resources. The policy committee will have weekly conference calls during session and will communicate with you through weekly emails.
Don't forget advocacy day February 12, 2019 in Topeka. This will be a full day meeting, concluding with a networking reception with the Kansas Immunization Coalition. Pediatric residents in Kansas will have advocacy training prior to advocacy day. If you are interested in learning more about advocacy, consider attending the AAP Legislative conference April 7-9, 2019. As always, please feel free to contact me at dkhubbard@cmh.edu if you have questions, concerns, comments, or want to help the KAAP chapter with any piece of legislation.
paymentPediatric Payment Corner

What are your payment concerns?

As pediatricians we advocate for the health and well being of Kansas kids. But in order to do that we need to advocate for ourselves to get appropriate payment so we can maintain adequate resources to provide preventive care according to Bright Futures. We need to be able to afford to treat chronic disease like asthma and ADHD. We need to address social determinants of health and address at risk kids.
 
Your KAAP Pediatric Council needs to hear from you. We will be meeting with managed care organizations both private and public to reduce barriers for good health for all Kansas kids.
  1. Are you being paid for developmental and autism screens?
  2. Are you being paid for Edinburgh/maternal depression screens?
  3. Are you being paid for lead screens?
  4. Are you being paid for vaccine product and vaccine administration?
  5. Are you being paid for sick and well on the same day? 
Please email your payment concerns to pediatriccouncil@kansasaap.org before December 15th. We look forward to addressing your concerns and working together with managed care to ensure the good health of all Kansas kids.
 

Did you know?

National AAP has a Pediatric Practice Manager's Alliance (PPMA). Your manager can join and get helpful business advice from managers all over the country and you can join the Section of Administration and Practice Management (SOAPM) and learn form other private practice pediatricians as well on the robust SOAPM listserv.

SOAPM Membership link ($30 annual membership dues fee)
(Fellows, Specialty Fellows, Candidate Members, National Affiliate Membership, Post Residency Training Members, Resident Members, Senior Member, Honorary Fellows and Corresponding Fellows.)

PPMA Membership link   (NOTE: New members will be required to create an individual account first, prior to selecting the "Administration & Practice Management" option). 
  • Complete the PPMA Recommendation Form and submit along with the application and required documentation (ie CV, current resume).
  • The $75 annual membership dues will be collected once membership has been approved. Payment can be made either online at the end of the online application process or by calling the AAP Customer Service at 866/843-2271.

Good News

Aetna will change its policy that limited coverage for one instance of CPT code 96127 (Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument) per year. As of 11/18/18 Aetna will no longer have per 365-day frequency limits on CPT code 96127 in which they would only pay for one 96127 in a 365 day period.
 
Aetna's policy change will provide benefits coverage and payment for pediatricians providing multiple assessments reported by 96127 within 365 days. 
KPF
KPF Update

The Kansas Pediatric Foundation has had another big year with the Turn a Page. Touch a Mind.® (TAP-TAM) program growing to over 120 sites and more than 600 participating pediatric primary care providers. TAP-TAM has put more than 940,000 books into the hands of Kansas kids since 2004!
 
The KPF Literacy Endowment is a consistent source of funding for TAP-TAM that will last far into the future. We are proud of the success of TAP-TAM and all of the important partnerships that have made this sustainable program possible.
 
Looking to build on the successes of the TAP-TAM program, the Kansas Kids Fund was created to expand our reach to even more children's health initiatives. Contributions to the Kansas Kids Fund will be used as directed by the KPF Board of Directors to fund projects in the areas of immunizations, early brain development, child safety, tobacco cessation, and more.
 
Please consider a tax-deductible gift to the Kansas Pediatric Foundation before the end of the year to help us grow!
IKC
Kansas DCF Announces New Child Welfare Providers

Kansas Department for Children and Families announced the new child welfare grantees. They also announced that the new Case Management grant will be divided into eight catchment areas across Kansas instead of the current four. For a list of the new providers and map of the revised areas, please click the button below. This transition will begin January 2019 with new providers beginning service July 1, 2019
webizKSWebIZ   Statutory Mandated Reporting Coming  

from KDHE

We want to remind all providers of the statute passed into law last year which requires that any vaccine administered in Kansas must be reported in KSWebIZ by the provider of the vaccine. This requirement is to be fully implemented no later than July 1, 2020.  

There are two different ways to meet this requirement. The first is to transmit vaccination information from the clinic's electronic medical record (EMR) to KSWebIZ electronically via an HL7 message. This process involves work with the EMR vendor and KSWebIZ to make the connection and depending upon the EMR vender agreement with the clinic, there may be a charge for this enhancement. This option allows for single entry by staff into the EMR and the rest of the reporting is done automatically.  
The second option for clinics is to enroll as a direct entry user of KSWebIZ. This means provider staff enter vaccine administration information directly into KSWebIZ through an internet connection but this may also mean double entry into the provider EMR and then into KSWebIZ. For clinic or providers who do only a small number of vaccinations, this may be a more cost effective answer to meeting the statute requirements.  

KSWebIZ staff are available to help you assess the option that is best for your practice and to assist you with either connection option. If you are not already connected, we encourage you to contact us soon to begin the process.  
talking_booksThe Kansas Talking Books Service 

The Kansas Talking Books Service provides free talking book and braille library service for people with temporary or permanent low vision, blindness, or a physical disability that prevents them from reading or holding the printed page. Kansas Talking Books also provides services and materials to institutions that serve such individuals (i.e. nursing homes, schools, hospitals, etc.)
 
This no-cost library service features:
  • Audio & braille books and magazines mailed directly to your house and returned postage free.
  • Special audio playback equipment and accessories lent to you at no charge.
  • Downloadable books from the Braille and Audio Reading Download (BARD) website or mobile app.
  • A collection that includes romance, mysteries, bestsellers, science fiction, westerns, biographies, fiction, children's books, young adult books and more.
  • Access to the world's largest collection of braille and large-print musical scores.
For more information call 1-800-962-3699, email KTB@ks.gov or visit us online https://kslib.info/talking . Kansas Talking Books is a division of the State Library of Kansas and a Network Library of the National Library Service for the Blind & Physically Handicapped.

dairy
The Importance of a Well-Balanced Diet for Adolescent Girls


By Elieke Demmer, PH.D., RD
"This article originally appeared on NationalDairyCouncil.org and is used with permission from National Dairy Council."


People want food that is not only nutritious and delicious, but also good for the environment. While some have suggested a plant-centered eating plan may be better for health and more environmentally sustainable than animal foods, more research is needed, and it is unclear what the nutritional impact will be -- especially among adolescent girls. National Dairy Council's Nutrition Research team conducted a  research study  to find out.

Adolescence is a unique time period. Youth start to exercise their own independent behaviors and develop habits that can carry forward throughout adulthood. Additionally, adolescence marks a phase of rapid physical growth increasing the needs of several nutrients, including vitamin D, iron, zinc, folate, energy (i.e., calories) and protein. Adolescent girls can be at greater risk for not meeting the recommended amounts of nutrient than their male counterparts, thus it is critical that the foods they eat are nutrient rich foods including milk, cheese and yogurt. Milk is a good or excellent source of calcium, protein, phosphorus and vitamins A, D, B12, riboflavin, pantothenic acid and niacin.

 

refluxReflux: What Parents Want to Know

article provided by Pathways.org

More than 50% of infants regurgitate daily, even multiple times per day.( 1) Infant gastroesophageal reflux (GER), the passage of gastric contents into the esophagus with or without regurgitation and vomiting, is a constant concern for many families and a frequent topic of discussion with their healthcare provider.  (2)
 
Parents typically have these recurring questions in their well-child visits:
  1. Is this a serious problem and should I be worried?
  2. Is my baby getting enough calories or losing weight?
  3. How common is reflux in infants?
  4. What causes reflux?
  5. Does it matter what my baby eats? 
Providing answers to the above questions or solutions to help manage reflux can be reassuring to families.
 
Tell your patients some of the behaviors that contribute to reflux, such as swallowing air while feeding. If baby is looking around and taking their mouth off the nipple, they may swallow air mid-feed, contributing to regurgitation. Drinking too much or too quickly is another common behavior that leads to reflux. Providers should also remind parents that laying baby down too soon after feeding is a contributing factor. When it comes to what baby eats, the American Academy of Pediatrics recommends a diet of only breastmilk for the first 6 months of life. Studies have found infants who drink only breastmilk exhibit less reflux and spit up behaviors than babies with a mixed diet including formula. Partially breastfed babies suffer from more frequent regurgitation.(2)  While reflux will typically involve a dribble of spit up after feeding, tell parents of the warning signs of GER becoming a bigger problem, such as if baby is not gaining weight, if baby is fussy and in pain during regurgitation, frequent projectile vomiting, refusing food, or respiratory problems such as difficulty breathing or a chronic cough. These symptoms can signal gastroesophageal reflux disease, or GERD.  (2), (3)
KBC
Upcoming Events

Giving Tuesday is November 27th! Please consider making the Kansas Pediatric Foundation part of your 
tax-deductible, year-end giving. Check your inbox next Tuesday or donate today.
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About Us

Officers
Staff
Lisa Gilmer, MD, FAAP
President
Mel Hudelson
Executive Director 

Kristie Clark, MD, FAAP
President-Elect

Shanna Peters
Associate Director

Jon Janz, MD, FAAP
Treasurer

Martha Atkinson
Staff Accountant

Jennifer Mellick, MD, FAAP
Past President
Amy Trollinger
Marketing Communications Manager

Board of Directors
Chris Steege
Special Project Manager

KAAP Committees

Coordinators



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