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

PresidentPresident's Perspective

By Lisa Gilmer, MD, FAAP

Earlier this month, Melissa Hudelson and I represented the KAAP at the District VI and VIII meeting. The personalities of these pediatricians is as diverse as their home states which span from Arizona to the south, Hawaii to the west, Alaska to the north and Illinois to the east. While our chapter sizes, resources, local governments, patient populations, practice types and of course weather vary significantly, our shared commitment to the health and well being of all children is resolute.
 
The world we live in impacts all of us, professionally and personally. How do you console a child whose older brother committed suicide? Will your children practice fire, tornado and active shooter drills in the first weeks of school? Is the show rate for your Hispanic patients decreasing as ICE activity increases? Have you stopped posting science on Facebook due to the barrage of antivax comments? Are you wary of the Juul is bad speech? How is your wellness? Now imagine this world through the eyes of a child.
 
At a time when there are so many threats to children, I am proud to be a part of an organization that fights for them on our behalf every day. The AAP leads the way in child health frequently partnering with other physician and public health organizations to magnify its voice. Here are some examples from the last few weeks.

The AAP Policy on Impact of Racism on Child and Adolescent Health warns that racial bias is a serious health risk for children that we need to be educated about and screen for. Along with five other health organizations, the AAP issued a joint statement denouncing the current administration's public charge rule. And in this month's Annals of Internal Medicine, seven physician professional societies including the AAP called for policies to reduce firearm injuries and death. The AAP is sounding the alarm on these and so many issues that impact children and families and you have an important role to play as well but how do you add one more thing to your day?

Got 5 minutes? Call or email you elected officials about issues important to you and your patients, share messages on Twitter and Facebook, encourage families and colleagues to vote.

Got 1 hour? Check out resources on the KAAP and AAP websites such as toolkits and policies to improve patient care and practice management.

Got 1 day? Attend the KAAP Advocacy Day in Topeka or a KAAP Pediatric in Progress meeting.

Got a free evening every few months? Join a chapter committee or council, mentor an early career physician, participate in a chapter QI project, or submit content for the chapter website.

In doing what you can, when you can, you'll be practicing aloha spirit. Introduced by Dr. Kyle Yasuda, AAP President, the aloha spirit is a concept roughly defined as an emphasis on mutual respect, getting along and taking care of one another. A simple Hawaiian idea for our complex world.
issues
Issues and Commentary  

By Gretchen Homan, MD, FAAP

I am happy to tell you about my exciting year as chair of the Immunize Kansas Coalition (IKC). This is an amazing group of hard-working individuals representing different perspectives in public health. The group is super busy and forward thinking and we all benefit from their efforts. I feel so fortunate to have served as the IKC chair and I plan to stay involved going forward.

KAAP is an important partner organization for IKC and I want to encourage anyone who is interested to check out an IKC meeting and consider joining the group. If you don't have time to join, you can subscribe to email updates, engage on social media or visit the website. Physicians are crucial, valuable partners and subject matter experts who are trusted by parents and families as well as other professions and partners. Your voice matters! Be a strong vaccine advocate for your staff, patients and peers. Provider recommendation is key to maintaining and increasing vaccine rates.
If you have ideas about immunization please reach out to me or IKC. My email is  ghoman@kumc.edu

IKC contacts:
ExecDirectorExecutive Director Update


In early 2018 a KAAP member reached out to our office to ask if KAAP could look into the issue of continuity of care for children in the foster care system. These children are moved around the state and often show up to a physician's office for care without much medical history if any at all. Follow up care is challenging when you don't know where the patient has gone. How can you communicate with the next physician or medical provider who cares for the child to let them know what medication was prescribed and why?
 
In response to the inquiry from the member, KAAP created a Foster Care Task Force made of up pediatricians from across the state, foster care contractors and a family court judge. This group met regularly for over a year to identify solutions to this problem. While an electronic system that could be updated and accessed by physicians and other medical providers is the ideal solution, that is something that is still years away in Kansas.
 
To have something to help with this issue now, a medical form was created that can be used when you care for a child in the foster care system. It is a one-page document that can be filled out and sent with the foster family to keep with the child. The hope is that the next physician or medical provider to care for the child will have access to the form to at least have some information from the last time the child visited a physician or medical provider. I hope you will print off this form and have it available in your office to use the next time a child in the foster care system comes in for an appointment. The foster care contractors have let their staff know to expect to see these forms.
 
The KAAP Foster Care Task Force also created a tool kit with information on how to care for children in the foster care system that I hope you will check out. The Task Force will continue to work with DCF and the foster care contractors to improve medical care for children in the foster care system.
 
Do you have an idea for how KAAP can improve child health in Kansas? We would love to hear from you and get to work! I hope you will consider attending our Progress in Pediatrics - Fall 2019 on October 10-11 in Wichita.
events
The KAAP CME meeting, Progress in Pediatrics (PIP) - Fall 2019 is just seven weeks away on October 10 and 11. Register today!

You don't want to miss this fun and educational event. Topics will include Neonatal Abstinence Syndrome, lead poisoning, and the "no hit zone." When you register, be sure to reserve your spot for the Thursday evening dinner and social event at Fredo's!
PedPaymentPediatric Payment Corner

By Jennifer Mellick, MD, FAAP

The Kansas AAP Pediatric Council held its first joint meeting with representatives from MCOs on June 17th in Topeka, Kansas. Representatives from KAAP as well as KMS and several MCOs met to outline goals and objectives of this joint Pediatric Council. The meeting was quite productive and laid a good foundation for continued collaboration between payers and physicians who care for Kansas kids. Several topics were discussed but the crux of the meeting centered on building a relationship between KAAP and other interested groups in providing best care across the state. 
 
We are hoping to have quarterly meetings, both face to face as well as via conference calls. We first focused on discussing who else should be at the table in our joint meetings. We had good representation from Medicaid MCOs but not as much from commercial payers. Information has been shared after the meeting identifying and inviting additional representatives from commercial BCBS, UHC, Cigna, Aetna and Humana. We also plan to work collaboratively with family physician groups across the state and potentially hospitals that serve children throughout Kansas. 
 
Each meeting we plan to discuss challenges that affect pediatric care in Kansas. To open our group we discussed how to increase well child visit rates. Certain MCOs and other insurers mentioned offering incentives such as gift cards to their members for getting well child exams. Portals to track rates for providers are also provided for review by several insurers. Our plan going forward is to share rates from MCOs and other insurers to help define the problem and determine which age group is most at risk. We also discussed the important problem of billing well visits and sick visits as well. It is problematic that if a patient presents for a sick visit that is separate and identifiable that must be addressed that day, we are penalized by decreased payment for a sick CPT code (or denied payment) if we convert that visit to a well visit plus a sick visit. MCO representatives listened and promised to discuss within their organizations and help us work to improve this issue. 
 
Overall, I am encouraged by the response to our first meeting and look forward to updating our KAAP members as we continue our conversations. If anyone has ideas for next topics to tackle, please email us at the Kansas Chapter at  mel.hudelson@kansasaap.org.
LegUpdate
KAAP Legislative Update

By Dena K. Hubbard MD, FAAP
Legislative Coordinator

 
Gun Violence Prevention
 
Recent mass shootings in El Paso and Dayton add to the growing number of children and families affected by gun violence. Every day 83 children, teens, and young adults are killed or injured by guns. Pediatricians see the toll gun violence takes on children and families every day. This adds up to 56 standard school buses or 22 jet planes full of children each year.
 
In Kansas, Speaker of the House Ron Ryckman and Health Committee Chair Rep. Brenda Landwehr issued a press release and called for "continued investment in mental health access." Both lawmakers drew attention to the need for more behavioral health workers, especially in rural areas, as well as a greater focus on integrated care and community services. Both legislators also support expansion of the Mental Health Intervention Pilot in schools. Other lawmakers are focusing their response on gun violence prevention. One bill introduced last Session, House Bill 2129, would enact the gun safety red flag act. Essentially, the bill would allow family members to request a gun safety protective order if they are concerned for the health and safety of themselves or their family members and can request firearms be removed from the home.   Advocacy groups have renewed conversations about this bill.
 
Mental health services are desperately needed, but that is not enough. We know a person with mental illness is more likely to be a victim of violence than a perpetrator.


KPF
KPF Update

The 2018-2019 Kansas Pediatric Foundation annual report is now available to view at  kansaspediatricfoundation.org. Since 2004, our mission has been to connect with individuals and organizations who share our commitment for a healthy and meaningful life for our children and adolescents in Kansas. These important collaborations have allowed KPF to offer the first Kansas Kids Fund grants, put over 1,000,000 books into the hands of Kansas kids through Turn a Page. Touch a Mind. (TAP-TAM) ®, and has continued to support Kansas KidLink, our children's mental health initiative.
 
This year, the TAP-TAM program added 12 new sites and currently has 125 active sites, with over 650 participating providers. These providers will be handing out over 125,000 books to Kansas children at their well-child visits over the next year.
 
Over the next year, through the Kansas Kids Fund - Pediatricians in Action grants, we will be supporting a foster care volunteer fair in Wichita, a vaccination program working with local schools and the health department in Winfield, and an obesity program in Overland Park. Thank you to each individual and organization who contributed to the Kansas Pediatric Foundation this year to make these grant opportunities possible!
publiccharge
Public Charge: What you need to know

By Dena K. Hubbard MD, FAAP
Legislative Coordinator
 
The American Academy of Pediatrics strongly opposes the final rule issued August 12th to expand the definition of what it means to be a "public charge', making it harder for immigrants to enter the US and advance through the immigration process. Interim AAP CEO Mark Del Monte states "Make no mistake, this rule is a threat to the health of immigrant children and families." Public charge is a test used to decide if someone can become a permanent US resident. The proposal would expand this test to look at whether an immigrant is more likely to use certain government programs. The programs include Medicaid, SNAP, housing assistance, and target the health and welfare of children. With 1 in 4 children in the US living in an immigrant family, the potential impact is enormous. Investing in nutrition, health care, and other essential needs keeps children learning, parents working, families strong, and allows all of us to contribute fully to our communities.
 
Recent data show that nearly 1 million fewer children are enrolled in Medicaid and CHIP, and Public Charge is likely one factor driving unenrollment. Pediatricians across the country are already seeing the chilling effects of this proposed rule as children and families are avoiding critical health programs and services, they are eligible to receive. Like all children, children in immigrant families benefit when they have access to programs and services that promote their development. Public Charge will make it harder for these children to get the care they need and remain with their parents. Families should not have to choose between accessing vital health services and staying together.
 
Link to AAP comment.  Please contact your members of congress to urge them to reverse this public charge final rule.
KanCare
KanCare Ombudsman's Office

The KanCare Ombudsman office has two satellite offices, one in Wichita and one in Olathe. They are available by phone or email to assist current Medicaid members and applicants with questions about the application process and filling out applications. They can also assist with grievances, appeals and fair hearings.

Call: (855) 643-8 ,180 (Relay: 711)
BFM
New Tools for Breastfeeding Awareness Month  

In honor of Breastfeeding Awareness Month, the Kansas Breastfeeding Coalition is sharing new tools for physicians to talk with their patients about how breastfeeding lowers a women's risk of breast and ovarian cancer.  A new blog " Breastfeeding For Cancer Prevention" published by the CDC today explains one reason for this connection may be that when a woman is breastfeeding, she experiences hormonal changes that    reduces her lifetime exposure (video) to hormones such as estrogen, which are linked to an increased risk of breast and ovarian cancers.
 
The KBC created the following    Handout for Physicians/Health Care Providers with the following action items:
  • Tell patients that breastfeeding reduces the risk of breast cancer-even if the woman is not of childbearing age. She is probably a friend or family member to women who are having children. She will pass this information along.
  • Add lactation history to patient health history form-this will raise awareness about the woman's breastfeeding history and its impact on her lifelong health.
  • Provide patients with the accompanying "Patient" handout-this information maybe personally useful and/or may be shared with others in their lives.
medicationLactation
Free Webinar: Medication in Lactation 

August 27, 2019;  12-1 pm

The Kansas Breastfeeding Coalition is providing a free webinar for health care professionals to introduce "Medications in Lactation", an algorithm tool to help providers support breastfeeding families when considering medications during lactation.

No need to register. simply join August 27th at Noon here:  https://global.gotomeeting.com/join/445066437
or dial in at (571) 317-3122, Access Code: 445-066-437
Vote
Don't forget to vote!

Voting for AAP president-elect and national officers will take place from Sept. 7-21. All terms begin Jan. 1, 2020. Voting will be conducted online only. Watch for an email message that contains your personalized link to the election ballot (no additional ballot login information will be required).

Members will choose their next president-elect: Lee Savio Beers, M.D., FAAP, or Pamela K. Shaw, M.D., FAAP. The winner will serve as AAP president in 2021.
ActionAlertsWould You Like to Receive Legislative Action Alerts?

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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


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