Dedicated to the health of children and adolescents.
February 2019
In this issue

Upcoming Events
PresidentPresident's Perspective

By Lisa Gilmer, MD, FAAP

With a snow covered neighborhood in the background, time to reflect on another week in life of a Kansas pediatrician.

Monday 2/11. The AAP National Nominating Committee announced the selections of Dr. Lee Savio Beers, District of Columbia Chapter and Dr. Pam Shaw, Kansas Chapter as 2019 National Candidates for AAP president-elect. These nominations recognize careers spent caring and advocating for children as well as teaching and inspiring pediatricians. 

Tuesday 2/12. More than forty pediatricians from across the state including residents, gathered in Topeka for the 2nd Annual KAAP Advocacy Day. Throughout the day attendees exercised newly learned advocacy skills in face to face meetings with their representatives and senators. Governor Laura Kelly addressed the group reiterating her commitment to pro-child policies that would fund public schools, expand Medicaid and fix the state's foster care system. Her priorities aligned with the day's focus, advocating for Kansas to take advantage of the Family First Prevention Services Act. In addition to improving the well-being of children already in foster care, this bill allows federal reimbursement for evidence based mental health services, substance use treatment, and intensive parenting skill training aimed to safely keep children in their own homes. Through first-hand stories, we shared how vulnerable children and families in our practices could benefit from Family First

Wednesday 2/13. Back to work where a mother-baby unit full of babies, 100+ emails and a long to do list awaited.

Thursday 2/14. Memorial services marked the one year anniversary of the loss of 17 students and staff in Parkland, Florida. Recent statistics estimate that 17,500 youths are injured or killed yearly due to gun violence in the US1. Why? Although polls show Americans broadly support specific measures that restrict access to guns, they also show pessimism that lawmakers will take action through legislation. For pediatricians this isn't a political issue. With 1 in 3 children living in homes with guns, it's a safety issue. As experts in child development, we will continue to ask about guns and recommend that they be stored unloaded and locked up.

Friday 2/15. A state of national emergency is declared and while I acknowledge illicit drugs and gangs come into our country illegally, I cannot call the migration of families looking for a better life for their children an invasion. We will continue to care for all children, no matter where they or their parents were born.

Every week brings emotional highs and lows, opportunities to learn, and the responsibility to help children grow up safe and strong. What's different about this past week is that none of it would have been possible without some remarkable people. To the KAAP Staff, Shanna, Amy, and especially Mel, thank you for going the extra mile to make Advocacy Day a success. To Dr. Dena Hubbard, thank you for passionately leading our Public Policy Committee. To our partners and staff, thank you for holding down the practices while we advocated for children. And last but not least, to our families and loved ones, thank you for supporting us through it all.

issues
Issues and Commentary


Physician Burnout

By 
Dena K. Hubbard, MD, FAAP

Recent literature recognizes that over 50% of physicians are suffering from burnout. Burnout is characterized as a syndrome of emotional exhaustion, loss of empathy, depersonalization, cynical or negative feelings towards work, and decreased feelings of personal achievement in response to long term stress. Burnout not only takes a steep toll on the health of physicians but has negative effects on quality of care with increased medical errors, litigation, health care costs, and decreased patient satisfaction, adherence to physician recommendations, and provider productivity. The system and delivery of healthcare has changed, and many providers are struggling to retain their sense of purpose. Key drivers of burnout include work flow inefficiencies, time pressures, loss of control, and lack of alignment of core values between providers and their organization. Burnout has become a public health issue. 

Lack of wellness and burnout impacts the personal lives of healthcare professionals and their families. Beyond individual provider dissatisfaction, burnout can lead to divorce, drug and alcohol abuse, depression, anxiety, and suicide. Replacement costs due to burnout are significant. Physicians who are not burned out are less likely to leave their organization and more likely to engage in quality improvement projects, go the extra mile for patients and administration, and provide higher quality care.  
ExecDirectorExecutive Director Update


All of this crazy weather hasn't stopped us from meeting with new leadership in Topeka and making sure that we are the voice for children and pediatricians in our state. I hope you take some time each week to review the Legislative Update that is sent out to all KAAP members, and don't hesitate to let me or our lobbyist, Stuart Little know if you have questions or comments on bills.

In January we began working on a new project with Gretchen Homan, MD, FAAP to help pediatric practices encourage caregivers to get all recommended adult vaccinations. We are looking for a few practices to pilot this project beginning this summer. Pilot sites will receive an on-site training with CME, local adult immunization resources, and a stipend. Let me know if you are interested in participating!

Chapter staff has been busy working on our in Salina on April 5th. I am excited for this new location and the line up of speakers and topics. Our meetings provide a great educational experience with the opportunity to spend the day with colleagues from across the state. I hope you will consider attending! Visit our meeting homepage to learn all about the speakers, the agenda, hotel and register online.

As always, let me know if you have questions or concerns that KAAP can help with! You can reach me at (913) 530-6265 or mel.hudelson@kansasaap.org .
PedPaymentPediatric Payment Corner

By Rebecca H. Reddy, MD, FAAP

Many of you who care for children with Kancare may be wanting an explanation of what has happened over the past 4 months with your Kancare MCO payments for KBH services. Sometime in the month of October, 2018, KDHE quietly published on its website the "KMAP General Bulletin 18154 EPSDT Update". This update caused a sharp decrease in payments for "KBH" well child checkups. Several private pediatric practices were stunned to see their payments from Kancare MCO's coming in by mid-November with $19 and $25 as total payment for a KBH, and alerted the KAAP.

KAAP investigated the issue and were told by KDHE that the change the bulletin made was not intended to affect payments to physicians, but rather only to eliminate the "-EP" bundled payment modifier. The intended effect was to precipitate Kansas physicians to submit KBH billing in detail including each separate component so the state could track the exact services provided to children on Medicaid. As an example, instead of billing an E and M code for a 9 month old KBH as 99391 - EP, practices would have to bill for each specific services that were provided at a 9 month visit. This might include 99391 (E and M), 96110 (dvlpmt screen), 85018 (Hb) and 80061 (lead).
LegUpdate
KAAP Legislative Update

By Dena K. Hubbard MD, FAAP
Legislative Coordinator

KAAP Spring 2019 Legislative Update
Advocacy is in the DNA of Pediatricians! Thank you for your ongoing advocacy!

KAAP 2019 Advocacy Day was a success! Kansas kids sent 45 pediatricians to the Kansas State House on February 12. The Family First Prevention Services Act (FFPSA) was the focus of our Advocacy Day. KAAP partnered with national AAP represented by Zach Laris, and Casey Family Programs represented by Anne Heiligenstein and Michael Martinez to provide two briefings on FFPSA to state legislators. Dr. Pam Shaw joined them to provide a personal briefing to Governor Kelly and her staff. This was followed by a visit from Governor Kelly to speak to our Advocacy Day attendees. We had a diverse group of topics presented by our Advocacy Day speakers including legislators Dr. Barbara Bollier, Dr. John Eplee, Rep. Monica Murnan. Our pediatricians met with their representatives and senators throughout the day to speak up for children. Melissa Rooker from Kansas Children's Cabinet and April Holman from Alliance for Healthy Kansas also updated our group. The day concluded with a reception at KMS with our partners at Immunize Kansas Coalition (IKC) which included a presentation by KAAP board member Dr. Gretchen Homan.
 
In February 2018, the U.S. Congress enacted FFPSA, a landmark bipartisan child welfare reform law that will support interventions to keep families in crisis safely together. Starting in October 2019, the law will allow states to use federal funds previously limited to foster care placements for evidence-based services for children and their caregivers that can prevent the need for foster care, including mental health, substance use disorder treatment, and parenting skills training while keeping them together safely. It may come as a surprise that the majority of kids in foster care are not there because of abuse. The far majority, ~76% in Kansas, are due to neglect, substance abuse, and other reasons, not physical and sexual abuse. About half are safely reunited with their parent or extended family. A shift in focus from foster care services to prevention and permanency services could not only decrease costs, and healthcare disruptions, but also trauma for many children and families.
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 $50,000 goal! Your contributions are helping to grow the Kansas Kids Fund and the Literacy Endowment so that we can continue to work to improve child health in Kansas.
 
With the addition of the 120,000 books handed out in 2018, Turn a Page. Touch a Mind.®  (TAP-TAM) providers have now handed out over 1,000,000 books! This is an amazing accomplishment and we are excited to share this milestone with all of the TAP-TAM providers that have participated in the program since it began in 2004.
 
Another exciting event for KPF will be our offering of the first Kansas Kids Fund - Pediatricians in Action Grant. The application process is currently open to KAAP members and will close on March 29. Click the orange button for application information
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Vaccines
Updated Vaccine Storage and Handling Toolkit 

from KDHE's Kansas Immunization Program (February 6, 2019) 

CDC's Vaccine Storage and Handling Toolkit has just been updated for 2019. This indispensable 48- page guide reflects the best practices for vaccine storage and handling compiled from the Advisory Committee on Immunization Practices' (ACIP) recommendations, product information from vaccine manufacturers, and scientific studies. The redesigned toolkit helps healthcare providers find the information they need quickly and easily. Revisions include: 
  • A reorganized layout with color-coded sections to help better navigate the toolkit 
  • Updated job aids and resource documents
  • Updated visuals for the vaccine storage and handling recommendations and best practices 

Access CDC's Vaccine Storage and Handling Toolkit web section. 

Access CDC's updated Vaccine Storage and Handling Toolkit (PDF format; 48 pages). 

flu
In-Home Isolation After a Diagnosis of Influenza

By Lisa Gilmer, MD, FAAP

The KDHE Requirements for Isolation and Quarantine of Infectious or Contagious Diseases- Influenza Control which went into effect in May 2019, non-hospitalized children with influenza should remain in home isolation for 7 days following onset of illness or for the duration of illness if the case is immune-compromised, except when seeking medical care. 1 The KDHE regulations are in line with CDC and AAP resources regarding the infectiousness and disease course of influenza.  

Important points:
  • KDHE policy applies to immunocompetent children who test positive for influenza. 
  • 7 days of in home isolation is required from the onset of the first symptoms, not from the day of diagnosis. 
  • In cases of other febrile respiratory illnesses, children should stay home for at least 24 hours following the last fever not treated with fever-reducing medication.2 
  • Individual school districts may have more restrictive policies which you should be familiar with. 

Once the flu season is over, KDHE will reevaluate the effectiveness of the influenza isolation regulation and the KAAP will look to be part of that process.  

If you have additional questions, the KDHE Epidemiology Hotline is a good resource at 877-427-7317. 
  1. http://www.kdheks.gov/epi/download/
    KDHE_Requirements_for_Isolation_and_Quarantine.pdf
  2. https://www.cdc.gov/flu/takingcare.htm
  3. https://www.cdc.gov/flu/professionals/diagnosis/consider-influenza-testing.htm
events
Register now for the KAAP CME meeting, Progress in Pediatrics (PIP) - Spring 2019 on April 5th in Salina, KS. 
Kansas SAFE-CARE Medical Provider Training

May 15-16, 2019;  9 a.m. - 4:30 p.m.
1600 N Lorraine St;  Hutchinson, Kansas
Free 2-day training, CMEs have been approved.  For more information contact Juliane Walker at  executive@kscac.org.
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Lisa Gilmer, MD, FAAP
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Mel Hudelson
Executive Director 

Kristie Clark, MD, FAAP
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Jon Janz, MD, FAAP
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Martha Atkinson
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Jennifer Mellick, MD, FAAP
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