New immunization codes can increase reimbursement

Newsmagazine of the Ohio Chapter, American Academy of Pediatrics
Winter 2011
New immunization codes
can increase reimbursement
In December, Ohio AAP’s Pediatric Care Council took a proactive
approach and sent letters to Ohio’s major medical plans urging
appropriate payment for immunization administration.
Ohio AAP Past President William
Cotton, MD, Columbus, received the
Chapter’s highest award at its Annual
Meeting for distinguished achievement
and outstanding contributions to pediatric care in Ohio.
Dr. Cotton receives
Pediatrician of Year
Columbus pediatrician William
Cotton, MD, received the Elizabeth
Spencer Ruppert Outstanding Pediatrician of the Year Award at the 2010
Ohio AAP Annual Meeting on Nov.
6. Dr. Cotton was recognized for his
distinguished achievements and outstanding contributions to the advancement of pediatric care and education for patients and physicians in
Ohio.
Dr. Cotton’s easy-going, welcoming personality has helped him to become a great leader. Under his leadership, the Chapter secured an
$800,000 grant to initiate the Chapter’s Autism Diagnosis Education
Pilot Program. During his presidency,
the Chapter received the Outstanding
Chapter of the Year Award for Very
See Award...on page 17
Starting January 1, the way your
office reports your vaccine counseling changed. For several years, many
pediatricians have asked to charge for
counseling by the vaccine component
that they have to explain and not by
the injection. In 2011, CPT reporting
for vaccines for minors does just that.
This allows you to get payment for
counseling for newer combination
vaccines that deliver necessary components in fewer injections.
It is important to note that the previous codes for physician counseling
for vaccine doses, which applied only
to patients younger than 8 years, will
be abolished. The new codes apply to
counseling, per component, for patients younger than 19 years.
The Ohio AAP’s Pediatric Council
sent letters prior to Jan. 1 to all the
major Ohio medical plans explaining
that the new codes better reflect the
work associated with administering
vaccines, including increased counseling inherent with administering
vaccines, particularly those with multiple components and asked for their
help in making the process a seamless transition.
The new codes are:
• 90460 Immunization administration
through 18 years of age via any route
of administration, with counseling by
physician or other qualified health-
care professional; first vaccine/toxoid
component
• 90461 Immunization administration through 18 years of age via any
route of administration, with counseling by physician or other qualified
health-care professional; each additional vaccine/toxoid component.
(List separately in addition to code
for primary procedure.)
Certain other administration codes
(CPT 90471 through 90474) will remain, but now will only be used to
report immunization administration
for children performed without physician counseling and for all immunizations for those 19 years of age
and older.
The 2011 Relative Value Units
have been assigned for all of these
codes. (See chart on page 15.)
Here’s an example of how some
common vaccines would be coded:
See CPT...on page 15
In this issue:
• Case Study: ACL tears
• New Council formed
• Coding Corner - IA codes
• Ounce of Prevention
• Annual Meeting Photos
Ohio Pediatrics
Update from the statehouse
Now is the time for pediatricians
to form relationships with new leaders
After months of hard-hitting politics, the 2010 election wrapped up
with some dramatic changes in the
political landscape. Voters sent a
clear message to elected officials
that it is time for a change in state
and federal policies. Although Republicans had a clear sweep in key
political offices, the upsets seemed
to be based on the need for change
and not a simple endorsement of a
political party.
What lies ahead for Ohio’s
pediatricians?
For this new session, Ohio AAP
leadership and legislative consultants will be meeting and getting to
know new legislators and preparing
for an important budget debate. With
a strong Republican state government, policymakers will likely be
ready to take on issues such as additional tort reforms, but less likely to
take on issues that reform or mandate insurance. Additionally, this Republican majority is less likely to
look at increasing taxes to balance
the state budget. Additional cuts in
Medicaid and throughout state government are expected.
Pediatricians On Call
This would be an excellent time to
become involved in the Ohio AAP’s
Pediatricians On Call program – a
network of pediatricians who interact with their state representative or
senator on behalf of pediatrics. Read
more about this program in “The
President’s Message” on page 3. For
more information on how you can
2
Ohio Pediatrics • Winter 2011
get involved, contact the Ohio AAP
at chapter@ohioaap.org or call the
office at (614) 846-6258.
The new players include:
Ohio Governor – John Kasich
In the contentious battle for the
Governor’s office that ran close during the many months of campaigning, former Republican Congressman John Kasich beat incumbent
Democrat Gov. Ted Strickland 49 to
47 percent.
U.S. Senate – Rob Portman
Former Republican Congressman
Rob Portman held a solid lead over
Democratic Lieutenant Governor
Lee Fisher throughout most of the
election season. The final tally:
Portman 57 percent; Fisher 39 percent. Despite turnover in this and a
few other key races, Democrats continue to hold a majority in the U.S.
Senate.
Ohio House
The Ohio House also faces a swing
in power as Republicans win a majority of the 99 races across the state.
The current House tally for the new
General Assembly in January is 59
Republicans, 40 Democrats. Of interest, Dr. Terry Johnson, a Republican
physician and colonel in the Ohio
National Guard from Portsmouth,
won a seat in the Ohio House, 89th
District. It will be refreshing to have
a “doctor in the House” this session.
See Legislation...on page 23
A Publication of the Ohio Chapter,
American Academy of Pediatrics
Officers
U.S. House of Representatives
Of the 18 Ohio members of the
U.S. House, currently 10 are Democrats and eight are Republicans.
With five key Republican victories
in Ohio, the majority in our state’s
congressional team shifts to 13-5 in
the Republicans favor. With similar
surges across the country, the U.S.
House has shifted to a Republican
majority. Also important to Ohio,
Congressman John Boehner (R-West
Chester) has the support of his colleagues to serve as Speaker of the
House in the new session.
President....Gerald Tiberio, MD, FAAP
President-Elect.....Judith Romano, MD, FAAP
Treasurer....Andrew Garner, MD, PhD, FAAP
Delegates-at-large:
Jill Fitch, MD, FAAP
Allison Brindle, MD, FAAP
Robert Murray, MD, FAAP
Executive Director:
Melissa Wervey Arnold
450 W. Wilson Bridge Road, Suite 215
Worthington, OH 43085
(614) 846-6258, (614) 846-4025 (fax)
Lobbyist:
Dan Jones
Capitol Consulting Group
37 West Broad Street, Suite 820
Columbus, OH 43215
(614) 224-3855, (614) 224-3872 (fax)
Editor:
Karen Kirk
(614) 846-6258 or (614) 486-3750
www.ohioaap.org
Ohio Pediatrics
President’s Message
Benefits to your Ohio AAP membership
When I started
practice, membership in the AAP
was an integral
part of being a
pediatrician. There
was never a question as to whether
to join and pay
dues upon comGerald Tiberio, MD
pletion of training.
For a number of years I was not
active in the Ohio Chapter. In the
early 1990s, I received a Healthy
Tomorrow’s grant improving access
for indigent children. Chapter President Libby Ruppert asked me to
present the work at the Ohio Chapter’s Annual Meeting. Shortly after,
Ed Rushton (then director of Community Pediatrics) at National, asked for an encore.
What I began to experience was
an opportunity for networking. Important work was accomplished, innovative ideas were shared, and
friendships were made. Another
world existed outside the exam
room and the hospital committee
structure. This phenomenon occurs
whether you are a generalist, a subspecialist, or a surgeon.
Another benefit of Chapter membership is education. Staying informed via this publication, the
Chapter website, E-newsletter, the
Annual Meeting – the list continues.
Many of you attended the November Annual Meeting where immunization coding, parental refusal of
vaccines, and immunizations and
infectious disease were discussed.
The three QI/MOC programs the
Chapter currently maintains provide
www.ohioaap.org
opportunities for learning, improving quality, and maintaining certification. Think about it, asthma, development/autism, and obesity are
all nuts and bolts in day-to-day
pediatrics.
A third benefit is an opportunity
for legislative and advocacy activities. The Chapter website has a video (under the Advocacy link) of Dr.
Terry Barber (immediate past president) and Melissa Wervey Arnold,
Ohio AAP’s Executive Director,
describing “Pediatricians On Call.”
It is a network of pediatricians who
interact with their state representative or senator on behalf of children.
Pediatricians enjoy a favorable reputation with legislators, and as constituents can influence policy. The plan
is to connect pediatricians with key
legislators around the state. You will
receive communications through the
E-newsletter, personal e-mail and a
newsletter summarizing important
bills. The sign-up process is on our
website.
During the past year, the chapter
gave testimony for required meningococcal vaccine, worked with the
Governor’s office for enhanced
Medicaid reimbursement, supported
obesity legislation, supported school
bus seatbelts, and the inclusion of
pediatrics in the Medical Home legislation. We also dealt with various
vaccine issues.
A fourth benefit is leadership and
leadership development. Serving as
a chairperson or member of a chapter-level committee in an area of interest or expertise is quite rewarding. Spearheading a specific chapter
project and/or initiative is always a
worthwhile endeavor. I have been
involved with the My Story Foster
Care initiative. We have improved
the lives of countless foster care
children and their families. The program has helped me grow professionally and has been the source of
great personal satisfaction.
Some pediatricians ask the question, what has the AAP done for me
lately? I never asked the question
because my mentors taught me the
answer. The AAP was the advocate
for children. It represents the interests of pediatricians in a world that
often does not value its children.
Remember the “pizza boxes” in the
AAP Strategic Plan. Topics like immunizations, obesity, CYSHCN,
foster care, are, or will be, integrated into the very fabric of our Academy.
The Committee on Infectious Diseases compiles and publishes the
most important reference on pediatric immunizations and infectious
disease, the Red Book, used on a
daily basis by all doctors who care
for children. There are countless
other examples.
Before I was invited to present my
Healthy Tomorrow’s grant, I was a
dues-paying supporter of “the”
voice for children and pediatricians.
What would our profession be without the AAP? Please remember
these four – Networking, Education,
Advocacy and Leadership. They are
the cornerstones of your career in a
profession unlike any other. Remember the adage, “One pediatrician CAN make a difference.”
– Gerald Tiberio, MD
Ohio AAP President
Ohio Pediatrics • Winter 2011 3
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Ohio Pediatrics • Winter 2011
www.ohioaap.org
Ohio Pediatrics
Case Study:
ACL tear in a female athlete
Editor’s note: The author of this
case study, Anastasia Fischer, MD,
is a pediatrician in the Department
of Sports Medicine at Nationwide
Children’s Hospital in Columbus.
Case presentation:
A 17-year-old female basketball
player presents with a knee injury.
She injured her knee last night, during a game, when coming down
from a rebound and landing unbalanced on her right leg. She felt a
pop internally in her knee and fell to
the ground. She was unable to continue play and needed to be assisted
off of the court. She noted immediate swelling in the knee. She diligently iced the knee last night, as
well as this morning, and had applied an ACE wrap for support. She
was seen by her PCP this morning,
who was concerned about internal
derangement of the knee. She has
never sustained an injury to this
knee before.
Physical Examination:
A bright, healthy, happy young lady
who walks with a severely limited
gait secondary to pain. Examination
of the right knee shows a mild intraarticular effusion without ecchymosis. There is minimal tenderness to
palpation over the lateral and posterolateral side of the knee at the
fibular head, as well as lateral joint
line and lateral collateral ligament
structures. Range of motion of the
knee is limited, with the patient
lacking approximately 15 degrees of
extension and only able to flex the
knee to approximately 90 degrees.
www.ohioaap.org
Strength is limited secondary to
pain. On special tests, the patient
has a loose Lachman’s test, as well
as pain with an anterior drawer test.
There is no obvious posterior sag
sign. Valgus and varus testing of the
knee reveals intact ligamentous
structures, but with reproduction of
pain. Meniscal testing is difficult
due to patient discomfort, but a
modified Apley’s test is negative –
flexion pinch, McMurray’s and the
bounce home test are unable to be
performed. No pain with manipulation of the patella. Neurovascular
examination of the lower extremity
is intact.
Differential diagnoses:
ACL tear, collateral ligament sprain,
occult meniscal tear, injury to the
posterolateral corner of the knee.
MRI done the next day reveals a
torn ACL without further derangement of the knee.
Radiographs:
X-rays, including AP, lateral, and
notch views, reveal a Segond fracture on the lateral tibial plateau.
Diagnosis:
Acute tear of the anterior cruciate
ligament.
Treatment:
The patient is referred to a pediatric
orthopedic knee specialist for reconstruction of the ACL.
Discussion:
ACL injuries are becoming more
common, especially in the female
athlete. Research shows that girls
are at a two to four times higher risk
of tearing their ACL than their male
counterparts in certain sports. Rates
of acute ACL tears are thought to
exceed 2,000 cases per year at the
college level, and perhaps as high as
See Case Study...on page 6
Ohio Pediatrics • Winter 2011
5
Ohio Pediatrics
Case Study...from page 5
9,000 cases per year at the high
school level nationally. Girls are
thought to have this increased risk
for several reasons:
• Anatomical differences in the knee
compared to boys – girl’s genu valgus (knock-kneed) stature and narrower femoral notch may result in
higher static tension to the ACL,
making it easier to tear.
• Biomechanical factors and landing
mechanics – girls have less muscle
mass, are slower at the rate of muscle force development (ms), have a
stronger, quicker reacting quadriceps
relative to hamstrings, tend to be
more upright when landing, and tend
to be “quad dominant” – all factors
that will increase anterior translation
of the tibia relative to the femur,
putting the athlete at risk for an ACL
tear.
• Hormonal differences from boys –
some previous studies have shown
that ACL tears are more common
during the ovulatory phase of the
menstrual cycle than the follicular
phase, but recent evidence is conflicting.
• Neuromuscular differences – girls
tend to be more “ligament dominant,” meaning that they rely on
their ligaments to absorb the force of
landing, rather than muscular control, and more “quad dominant,”
again, increasing the risk of anterior
tibial translation with respect to the
femur.
In women, four out of five ACL
tears are non-contact injuries, happening very often during deceleration activities, (i.e. landing from a
jump or planting and cutting) and
are due to being in the “position of
no return” – a position in which the
pelvis is tilted forward, the hips
6
Ohio Pediatrics • Winter 2011
extended and internally rotated, the
knee in valgus and extension, and
landing in a position of poor balance.
By teaching female athletes how
to avoid this position, ACL tear prevention programs have been seen to
reduce the incidence of non-contact
ACL tears by about 70-80% in girls
ages 14-18. Programs concentrate on
avoiding the “position of no return”
by increasing flexibility and
strength, improving balance through
agility training, and including sports
specific training in the program to
give more “real time” experience.
Programs typically meet three times
per week for six to eight weeks and
are best done before the next upcoming season, although the techniques learned in the course should be
performed two to three times per
week for the season to keep skills
fresh.
When ACL tears do occur, most
athletes will find that surgical reconstruction is the best option for them
to continue with their sporting career, even if only recreationally.
Knees without an intact ACL are
prone to recurrent instability with
cutting and pivoting motions, putting their menisci at risk for future
or further damage. Instability also
often causes bony bruises with associated pain, effusion, and limitation
in the short term. Surgical reconstruction is best done when the knee
has regained range of motion and
effusion is minimal, and recovery is
dependent upon the extent of damage in the joint, as meniscal or other
ligamentous or capsular injuries are
often repaired concurrently. Estimated time back to full sports is about
six months from the time of surgery
to allow for development of full
strength in the ACL graft, and to incorporate a rehabilitation program
that not only concentrates on regaining strength and motion of the knee,
but also a healthy helping of injury
prevention.
– Anastasia Fischer, MD
Department of Sports Medicine
Nationwide Children’s Hospital
References
Gilchrist J, etal. A Randomized Controlled Trial to
Prevent Noncontact Anterior Cruciate Ligament
Injury in Female Collegiate Soccer Players. Am J
Sports Med. 2008;36(8):1476-1483.
Meyer GD, Ford KR, Hewett TE. Rationale and
Clinical techniques for Anterior Cruciate Ligament
Injury Prevention Among Female Athletes. Journal
of Athletic Training. 2004;39:352-363.
Mandelbaum BR, Silvers HJ, et al. Effectiveness of
a Neuromuscular and Proprioceptive Training
Program in Preventing Anterior Cruciate Ligament
Injuries on Female Athletes. Am J Sports Med.
2005;33:1003-1010.
Olsen OE, Myklebust, et al. Exercises to Prevent
Lower Limb Injuries in Youth Sports: Cluster
Randomized Controlled Trial. British Medical
Journal. 2005;330:449-452
Save The Date!
Ohio AAP 2011
Annual Meeting
Aug. 25-27 at
Cherry Valley Lodge
in Newark
Highlights:
• Quality Improvement
Roundtable
• American Board of Pediatrics
representative discusses MOC
• Medical Home Reimbursement
Visit the Ohio AAP website
www.ohioaap.org
for more information
www.ohioaap.org
Ohio Pediatrics
Ounce of Prevention materials
now available in Spanish
Last year, the Ounce of Prevention
is Worth a Pound toolkit was updated
and expanded to include obesity prevention information for children from
birth through 18 years of age. Information on healthy serving sizes,
healthy snacking, sports nutrition,
and calcium were also developed and
added to the toolkit. Most recently,
the complete set of 25 handouts have
been translated into Spanish for further reach and usage.
“The best part of these new materials is not that they are just translated
into Spanish, but that they have been
modified to address the cultural and
family traditions of Latino families,”
says Amy Sternstein, MD, coordinator of the Ounce of Prevention program at Nationwide Children’s Hospital Center for Healthy Weight and
Nutrition.
The Ounce of Prevention toolkit
was developed in 2007 to address the
growing epidemic of childhood obesity. The goal is to provide primary
care providers with simple tools to
As part of the Statewide Obesity Prevention and Wellness grant the Ohio
AAP received, Robert Murray, MD,
(pictured above) along with Amy
Sternstein, MD, have presented An
Ounce of Prevention information to
nearly 250 health-care professionals
throughout Ohio.
www.ohioaap.org
educate parents in obesity
prevention strategies by
making good nutritional
and physical activity
decisions for their children.
The handouts are designed to highlight four
areas during each wellchild visit from the newborn visit through 18
years. Those areas are:
• Food for Thought
• Feeding Advice
• Be Active
• Notes
Carole Lannon, MD, PhD, introduces attendees of the
full-day learning session for Healthy Kids Ohio –
Ounce of Prevention to the basics of quality improvement work, including reviewing the key driver diagram which will be used by practices participating in
the obesity prevention learning collaborative. Practices from across Ohio came together in Columbus in
November to kick off their participation in a quality
improvement learning collaborative.
The Ounce of Prevention is Worth a Pound
program was developed
in collaboration with the
Ohio Chapter, American
Academy of Pediatrics;
the Ohio Department of
Health, Office of Healthy
Ohio; the American Dairy
Association Midwest; the
Ohio Dietetic Association; and Nationwide
Children’s Hospital.
Last January, the Ohio
Department of Health
awarded a Statewide
Wellness and Obesity
“The best part of these new materials is not that they
Prevention Program
Grant to the Ohio AAP to are just translated into Spanish, but that they have
been modified to address the cultural and family traspread the Ounce of Pre- ditions of Latino families,” says Amy Sternstein, MD,
vention materials. Eight shown here during a regional training at the Cuyawebinars and five region- hoga County Board of Health in October.
al trainings were held as
For more information on the Ounce
part of the grant. Further funding
of Prevention toolkit, or to download
may be available in the near future to
the handouts in English and in Spanprovide additional office-based trainish, visit the website at: www.
ings throughout the state.
theounceofprevention.org.
Ohio Pediatrics • Winter 2011 7
Ohio Pediatrics
Spring forum addresses specific
needs of young physicians, residents
Residents across Ohio connected
for the third year in a row at the
Annual Meeting in November. The
Young Physicians and Residents
Committee held a roundtable discussion on various topics pertinent to
residents including potential for a
statewide resident advocacy campaign, and transition from residency.
Ohio AAP President Gerald Tiberio,
MD, thanked the residents for their
commitment and pledged the Chapter’s support for their initiatives.
Many who attended the Annual
Meeting had previously attended the
spring Advocacy Training held in
May 2010. At the spring conference
speakers introduced residents to legislative advocacy and the Ohio legislative process.
Residents and young physicians
with continued interest in these topics
may consider attending the AAP
Legislative Conference in Washington, D.C. March 13-15, or consider
applying for AAP department of federal affairs internship program. The
Academy individualizes the internship, which is primarily designed for
those interested in child health policy, the legislative process, federal
advocacy, and public affairs. Information on these opportunities, as
well as advocacy grant opportunities
LA
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SERVING
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STUDENTS WITH
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LEARNING
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LE A R N I NG D
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EFICIT DISORDERS
D I SO R D E R S
8
Ohio Pediatrics • Winter 2011
Members of the Young Physicians and
Residents Committee met at the Ohio
AAP Annual Meeting in November to
discuss issues pertinent to residents.
available to young physicians and
residents, can be found at http://
www. aap.org/sections/ypn/.
Many attendees at the November
meeting expressed interest in developing a forum for residents in spring
2011. Potential topics of interest include pediatric obesity, access to care
and adolescent health, job searching
post-residency, and transitioning to
fellowship. Please stay tuned for
more details on this upcoming free
program. Additionally, we want your
input related to topics of interest and
potential speakers.
If you are a resident, or young physician, interested in helping to plan
this event, please contact leaders of
the YP&R Committee for more information.
Allison Brindle, MD – Co-Chair
(brindla@ccf.org)
Emily Decker, MD – Co-Chair
(emilydeckerosu@aol.com)
Norah Ledyard, DO – Co-Chair
(nledyard@rockinghorsecenter.org)
– Norah Ledyard, DO
Co-Chair, YP&R Committee
www.ohioaap.org
Ohio Pediatrics
Reach Out and Read and APA
announce Young Investigator Award
Research to focus on strategies for promoting early literacy and school readiness
Reach Out and Read and the
Academic Pediatric Association
(APA) have announced the creation
of a new Young Investigator Award
Program for Primary Care Strategies
for the Promotion of Early Literacy
and School Readiness. The award
will provide financial support for
young investigators whose research
projects focus on interventions in
primary care intended to support the
early stages of literacy development
and school readiness among children at risk for reading problems or
school failure.
The Young Investigator Award
Program may grant up to $15,000 to
one selected project annually, beginning in 2011.
"Pediatricians and other primary
care providers can play a critical
role in helping parents help their
young children grow up with books
and reading, and truly ready for
school," said Perri Klass, MD, National Medical Director of Reach
Out and Read.
"We believe that this new award
will stimulate new explorations of
the potential power of that primary
care encounter, and encourage new
investigators to launch exciting new
explorations in literacy research,"
she continued.
Through this award, the primary
goal is to foster development of
young investigators who will advance a research agenda related to:
1. Improving early literacy and
school readiness among children,
especially those at risk for language
www.ohioaap.org
delay and school problems, through
primary care-based interventions
including Reach Out and Read and
related programs.
2. Understanding home environmental and other influences (both
social and biological) related to
early literacy and school readiness,
in order to inform development and
refinement of primary care interventions.
The Academic Pediatric Association is a leading child health professional organization that promotes
education, research, and advocacy.
Preference will be given to new investigators, including those in training. New investigators are defined
as: 1) faculty members who are no
more than five years out from completion of all training (fellowship or
post-doc); 2) fellows; 3) post-doctoral trainees; 4) residents; 5) graduate students.
Questions about this program can
be directed to Connie Mackay at the
APA central office by calling 703556-9222, or e-mailing Connie@
academicpeds.org.
Reach Out and Read promotes
early literacy and school readiness
by working through pediatric primary care providers who give new
books to children and advice to parents about the importance of reading
aloud at regular medical checkups.
The model includes providing a
carefully-selected, new, age-appropriate book for each child to take
home from every checkup from 6
months through 5 years.
Currently, there are 14 peer-reviewed, published research studies
demonstrating the efficacy of the
Reach Out and Read model. This
simple intervention results in children entering kindergarten with larger vocabularies and stronger language skills.
For more information on becoming a Reach Out and Read site,
please contact Heather Hall at (614)
846-6258 or hhall@ohioaap.org.
Young
Physicians
and Residents
Advocacy Day
May 17, 2011
Riffe Center
Columbus
Watch Ohio AAP website
and publications for more
information.
Ohio Pediatrics • Winter 2011
9
Ohio Pediatrics
New Council supports strong Chapter
programming, promotes accountability
The first biannual meeting of the
Planning, Implementation, and Performance (PIP) Council was held at
the 2010 Annual
Meeting. The
Board of Directors
felt this new
Council was needed to continue the
Chapter's strong
programming and
to promote communication and
Andrew Garner, MD
accountability
between the
Board, the medical directors of the
various Chapter programs, and the
Chairs of the numerous Ohio AAP
Councils and Committees.
The rationale for forming this new
Council was multifaceted. First, increasingly complex financial audits
are requiring additional documentation of specific and objective deliverables and deadlines to "justify" the
salaries the Chapter pays its Medical
Directors. The PIP Council hopes to
make this process more "transparent"
to outsiders by requiring the Medical
Directors to submit a yearly report.
This report will be similar to the
"balanced scorecard" used by the
Chapter in its reports to the National
AAP, and its completion will allow
the Chapter's finances to be "beyond
reproach."
The PIP Council will also serve as
a means of tapping the expertise of
the Chapter's current Medical Directors to inform the development of
new programming. With the Chapter's recent commitment to provide
its members with interesting and
meaningful ways to obtain Part IV
10
Ohio Pediatrics • Winter 2011
MOC credit, future programs will benefit from the trailblazing leadership
of the current Medical Directors.
The PIP Council will also attempt to
draw upon the experience of past
leaders within the Chapter (e.g.,
alumni of the Board) when planning
and designing new programs for
MOC credit or otherwise.
Another reason for forming this
new Council is to improve communication between the Board of Directors and the Councils/Committee
Chairs. While Councils and Committees remain autonomous and are
encouraged to pursue their self-identified goals and objectives, increased
communication with the Board of
Directors should allow for more collaboration to ensure that the pressing
needs of the Chapter are addressed as
well. Council/Committee Chairs will
also be asked to submit an annual
report prior to the Annual Executive
Committee retreat that outlines their
goals, objectives and budget for the
coming year. Completion of this report will be necessary for the Chapter's continued financial support of
each Council/Committee.
No one familiar with the activities
of the Ohio Chapter would ever question the dedication and hard work of
its Medical Directors or its Council/
Committee Chairs. Hopefully, the
PIP Council will serve as a coordinating and oversight body to ensure
effective collaboration and to promote communication and accountability as the Chapter continues to
expand its service to its members.
Questions and suggestions can be
e-mailed to Andrew Garner, MD,
PIP Chair, at pip@ohioaap.org.
PIP Vision Statement:
All projects and programs within
the Ohio AAP are well planned,
properly implemented, and perform
as expected.
PIP Mission Statement:
To assist in the planning, implementation and oversight of Ohio AAP
programs and projects to ensure
their initial and continued success.
PIP Membership:
Meetings are open to all Chapter
members and invited guests, but
will include:
• The current Chapter Treasurer
(Committee Chair)
• The current Delegates-at-Large
• Medical Directors or leaders of
current or planned Ohio AAP projects or programs
• Council and Committee Chairs
• All Chapter members as interested
PIP Meetings:
At least biannually, at Annual Meeting and the Executive Committee
Retreat
The Annual Meeting discussion will
focus on the Chapter’s Programs
and Projects. (This is an excellent
time to propose that new project
that you’ve been planning)
At the Executive Committee Retreat
the focus will be on the Councils’
and Committees’ plans for the upcoming year. (This is an excellent
way to ensure that your concerns
are heard by the appropriate Council
or Committee.)
www.ohioaap.org
Advertisement
www.ohioaap.org
Ohio Pediatrics • Winter 2011
11
Ohio Pediatrics
Ohio AAP Foundation will continue
to flourish under new leadership
After serving four years as the
President of the Ohio AAP Foundation, John Duby, MD, has formally stepped down to explore other opportunities.
“I have thoroughly enjoyed my
time as President of the Ohio AAP
Foundation,” states Dr. Duby. “We
have increased services to children
through starting the My Story Foster
Care program, hosting Healthy,
Strong and Ready for Teens – a fullday symposium for parents and medical providers of pre-teen girls – and
expanding the Reach Out and Read
program. For that, I am especially
proud.”
In addition to supporting new programs, under Dr. Duby’s leadership,
the Foundation has expanded bylaws; increased Board membership to
involve new physicians, as well as
non-physician community members;
and hired a development officer to
coordinate Foundation activities and
fundraisers.
The first Ohio AAP Foundation
Golf Outing and Breakfast for Books
(a fundraiser for Reach Out and Read
Ohio) events were both held in 2007,
in direct response to the increased
development of the Foundation.
The number of children served by
Reach Out and Read programs
throughout Ohio has nearly doubled
in the past four years, now serving
approximately 155,000 children
annually. “When I started as Foundation president, I always hoped we
could have at least 150 programs in
Ohio by 2012. With 144 sites now, I
think we are definitely on pace to
reach that goal,” he said.
“I feel the Foundation is poised to
12
Ohio Pediatrics • Winter 2011
“I have thoroughly enjoyed my time as President of the Ohio
AAP Foundation. We have increased services to children
through starting the My Story Foster Care program, hosting
Healthy, Strong and Ready for Teens and expanding the
Reach Out and Read program. For that, I am especially
proud.” – John Duby, MD
flourish in the next few years,” he
continued, “especially under the
skillful leadership of Dr. Duffee,”
who replaced Dr. Duby as president
in January.
Jim Duffee, MD, is the founder
and Chief Medical Officer of the
Rocking Horse Center, a Federally
Qualified Health Center, in Springfield. Dr. Duffee has previously
served on the Ohio AAP Foundation
Board of Trustees, has been active
with the Ohio AAP Chapter, and received the Chapter’s Outstanding
Pediatrician of the Year Award in
2008.
“John has done a tremendous job in
growing the Ohio AAP Foundation
the past few years, and I look forward to building on the groundwork
he has already created,” said Dr.
Duffee. “It won’t be easy following
in his footsteps, but his vision and
forward thinking has prepared the
Foundation to be successful for years
to come.”
“Thank You” to Ohio AAP Foundation
supporters can be found on page 22.
Welcome new Foundation board members
At the most recent Ohio AAP Foundation Board meeting in November,
the Foundation also voted to accept the nominations of four new Board
members. Marisha Agana, MD; Michael McCabe, MD; Phil Heit; and
Judy Romano, MD, were all unanimously voted to the Ohio AAP
Foundation Board for a four-year term ending in 2014.
• Dr. Agana is a community pediatrician in Cortland, practicing at the
Pediatric Corporation of Warren.
• Dr. McCabe is a pediatrician at Aultman Health Foundation in Canton.
• Dr. Romano is serving on the Foundation board as president-elect of the
Ohio AAP, and is a pediatrician at Wheeling Hospital in Martins Ferry.
• Phil Heit is professor emeritus of Physical Activity and Educational
Services at The Ohio State University.
For more information on serving on the Ohio AAP Foundation Board
of Trustees, please contact Heather Hall, Assistant Executive Director,
Ohio AAP Foundation at hhall@ohioaap.org, or (614) 846-6258.
www.ohioaap.org
Sports Shorts
Guidelines for Pediatricians
This information is available on the Ohio Chapter, American Academy of Pediatrics’ website at www.ohioaap.org
ACL Injuries in Female Athletes
WHAT IS THE ACL (ANTERIOR CRUCIATE LIGAMENT)?
The ACL is an intra-articular ligament in the center of the knee joint,
providing the majority of stability in the knee. It is the primary restraint to anterior translation of the tibia relative to the femur and is a
secondary restraint to rotation and angulation; particularly during
weight bearing. Stability in the knee joint with cutting and pivoting
motions is important to help avoid meniscal and other ligamentous
tears, articular cartilage damage, and other internal derangement of
the knee.
WHEN SHOULD ONE SUSPECT AN ACL TEAR?
A knee injury that occurs while cutting, pivoting, or landing from a
jump, is described as a “pop” and swells within the first two to six
hours (indicating a hemearthrosis) has a high likelihood of including
an ACL tear. Most athletes are unable to continue to play, but some
may be able to finish the game or practice. The ACL can also be
injured when an athlete sustains a hit or direct contact to the knee.
Physical examination can be difficult due to patient discomfort and
guarding. A mobile joint effusion is common, although, rarely, the
ACL can be torn without producing an effusion. The Lachman test, a
test to evaluate integrity of the ACL, may be loose or noted to lack a
firm endpoint. Examination of the contralateral knee is helpful to
compare ACL integrity to an injured knee, if that knee has not been
previously injured. A false negative Lachman test can be produced
when hamstring spasm (due to pain and guarding) masks anterior
translation of the tibia on the femur.
WHAT IMAGING IS NECESSARY?
A four-view radiograph series, including an AP, lateral, tunnel or
notch view, and a sunrise/Merchant view should be done to assess for
possible fracture, physeal (growth plate) damage, osteochondral lesions and loose bodies. A Segond fracture (small fleck fracture from
the lateral tibia seen just proximal to fibular head on the AP radiograph), can indicate an ACL tear on plain film. An avulsion fracture
of the tibial spine can indicate instability of the ACL in the very
young athlete. MRI is indicated in cases of suspected ligamentous
instability, possible meniscal or cartilage injury or persistent symptoms of swelling, pain and/or instability for more than three weeks.
WHAT IS THE TREATMENT?
An athlete with a suspected ACL injury should not be allowed to return to sports participation without an evaluation by a primary care
sports medicine specialist or an orthopedic surgeon. For young, active individuals, ACL reconstruction provides the best opportunity for
a successful return to agility sports. Young athletes with open physes
or growth plates should still be referred early for surgical consultation – depending on the stage of growth, reconstruction may be delayed to allow for closure of the physes and a traditional repair, versus a physeal-sparing procedure done by orthopedic specialists.
www.ohioaap.org
WHAT CAN THE PHYSICIAN DO TO START TREATMENT?
Initial treatment includes rest, ice, and the use of crutches until the
athlete can walk without a limp. Knee immobilizers are not necessary and use should be limited to one to two weeks. Early range-ofmotion exercises are important. Full extension and flexion should be
regained as soon as pain and swelling permit and can easily be monitored in the athletic training room of high schools or colleges that
have a full time ATC on staff. Physical therapy after surgery is imperative to regain knee strength and function for sport, teach the athlete to use the knee correctly in sports-specific movements, and train
the athlete in safe landing techniques to help prevent future injury or
re-injury. ACL braces are poor at controlling translational or rotational forces but are useful for initial treatment and post-operatively.
The use of a brace will not substitute or avoid the need for surgery
for those desiring to return to agility sports. Nonoperative treatments
have limited success and often result in recurrent instability and irreversible damage to intra-articular cartilage or meniscal structures.
WHY ARE FEMALES MORE PRONE TO ACL INJURIES?
Hormonal (estrogen levels during various stages of the menstrual
cycle), anatomic, and neuromuscular differences between girls and
boys, although controversial, are thought to play a role in the increased ACL injury risk to female athletes, but biomechanical factors appear to be the most important. Females are more likely to perform cutting maneuvers and land from jumps in a more erect position than males with extended knees and hips and drop their knees
into a more valgus position. This generates abnormally high tension
on the ACL, making it more prone to non-contact tears. ACL tear
prevention programs have been seen to reduce the incidence of noncontact ACL tears by about 70-80% in girls ages 14-18. Programs
concentrate on avoiding the “position of no return” by increasing
flexibility and strength, improving balance and landing techniques
through agility training, and including sports-specific training in the
program to give more “real time” experience.
SUMMARY
Mechanism of injury
Non-contact collapse into valgus (knock-kneed)
position +/-“pop”
Physical examination
Effusion, decreased ROM, instability with Lachman test
Imaging
X-rays often normal; MRI 85-90% accurate for
ACL tears
Initial treatment
Ice, rest, ROM exercises, possible bracing, limitation
of activity
Definitive treatment
Surgical reconstruction of the ACL and repair to
any associated structures
Associated injuries
Meniscal tears, other cartilage or collateral ligament
injuries, consider growth plate injuries if skeletally
immature
Author: Anastasia Fischer, MD.
Sports Shorts is provided by the Home and School Health Committee of the Ohio Chapter,
American Academy of Pediatrics.
Ohio Pediatrics • Winter 2011
13
Sports Shorts
Guidelines for Parents, Coaches, Athletes
This information is available on the Ohio Chapter, American Academy of Pediatrics’ website at www.ohioaap.org
ACL Injuries in Female Athlete
WHAT IS ACL?
The ACL is an acronym for the Anterior Cruciate Ligament, a stabilizing ligament of the knee that connects the femur (thigh bone) to
the tibia (shin bone). This ligament prevents the tibia from sliding
forward on the femur, and helps to protect the knee during pivoting
and shifting while running or jumping/landing. It is named cruciate
for “cross” because it crosses the posterior cruciate ligament (PCL)
inside the knee. Stability within the knee is important to protect
other structures in the knee, such as the meniscus (cartilage).
position than males with extended knees and hips and drop their
knees into a more valgus position. This generates abnormally high
tension on the ACL, making it more prone to non-contact tears. ACL
tear prevention programs have been seen to reduce the incidence of
non-contact ACL tears by about 70-80% in girls ages 14-18. Programs concentrate on avoiding the “position of no return” by increasing flexibility and strength, improving balance and landing techniques through agility training, and including sports-specific training in
the program to give more “real time” experience.
WHEN SHOULD ONE SUSPECT AN ACL TEAR?
A knee injury that occurs while cutting, pivoting, or landing from a
jump, is described as a “pop” and swells immediately has a high
likelihood of including an ACL tear and should be evaluated in the
very near future. Most athletes are unable to continue to play, but
some may be able to finish the game or practice. The ACL can also
be injured when an athlete sustains a hit or direct contact to the
knee.
WILL TESTS NEED TO BE DONE?
Almost all suspected ACL injuries are severe enough that X-rays are
necessary. An additional test called an MRI (magnetic resonance
imaging) is often also done to confirm the ACL tear and look for
damage to associated cartilage (meniscus), ligaments, or the joint
capsule.
WHEN SHOULD AN INJURED ATHLETE SEEK
MEDICAL CARE?
1. Any time there is moderate or severe pain, swelling and/or the
inability to bend or straighten the leg completely.
2. When an athlete cannot continue to play that day or has difficulty
with walking, running or jumping for the next few days after the
injury.
3. When an athlete complains of “looseness” or giving way in the
knee from either a new or an old injury. Any athlete with a suspected ACL injury should NOT be allowed to return to sport participation without an evaluation by a primary care sports medicine specialist or an orthopedic surgeon. Continuing to play sports with a
torn ACL can lead to further injury and/or permanent damage.
WHICH ATHLETES GET ACL TEARS?
Any athlete can tear their ACL. Common ages are 15-25 years old,
but ACL tears are now being seen in children as young as 10 years
old. Female athletes are injured four to five times more frequently
than males. ACL tears occur in all sports, but jumping, cutting, and
pivoting sports such as basketball, soccer and other court or field
sports are at higher risk.
WHY IS THE ACL MORE COMMONLY INJURED IN
FEMALES?
Hormonal (estrogen levels during various stages of the menstrual
cycle), anatomic, and neuromuscular differences between girls
and boys, although controversial, are thought to play a role in the
increased ACL injury risk to female athletes, but biomechanical
factors appear to be the most important. Females are more likely to
perform cutting maneuvers and land from jumps in a more erect
14
Ohio Pediatrics • Winter 2011
WHAT IS THE TREATMENT?
The most successful treatment for an ACL tear is arthroscopic
surgery. A new ligament is made to “reconstruct” the old injured
ACL, usually from a piece of the athlete’s own tendon. The surgery
is not performed emergently, and treatment is often initiated with
rest, ice, and crutches, if necessary. A brace may be used before
and/or after surgery to help support the knee. Physical therapy will
be very important after the surgery (and sometimes before) to help
the knee regain its motion and strength, train the athlete to return to
sports, and to do injury-prevention exercises to help protect the new
ACL graft.
IS SURGERY NECESSARY?
Nearly all ACL tears in a young athlete should be repaired to ensure
a safe return to activity. Return to sports generally takes about six
months to ensure that the new ACL graft has full strength and healing, and to ensure that the athlete is strong and healthy enough to use
the knee. In general, athletes are able to return to their previous level
of activity without pain or limitation once fully recovered. Athletes
who choose to avoid having recommended surgery can have problems with pain, weakness, giving out/instability and can develop
knee arthritis at a young age.
ARE ACL TEARS PREVENTABLE?
Many non-contact ACL tears are preventable by programs called
“ACL prevention programs.” These programs have been designed to
help athletes avoid positions that make the knee more prone to ACL
tears by strengthening the knee and teaching agility and positioning
during activity and sport.
Author: Anastasia Fischer, MD.
Sports Shorts is provided by the Home and School Health Committee of the Ohio Chapter,
American Academy of Pediatrics.
Ohio Pediatrics
CPT...from page 1
A 6-month-old child receives the following vaccines:
The new codes were explained at the Chapter’s Annual
Meeting by District Vice-Chair and coding expert Rick
Tuck, MD. National AAP President O. Marion Burton
wrote to medical directors of insurance plans, asking
them to be ready on Jan. 1 to pay for the new codes.
Ohio AAP President Jerry Tiberio likewise wrote to
Ohio’s medical directors who participate in our Pediatric
Council representing Anthem-Wellpoint, Summa-Care,
UHC, Medical Mutual, ProMedica, Medicaid, Centene,
Molina, Caresource, CIGNA, and AmeriGroup. The letter
asserted there should be a seamless updating of insurance
companies’ payment system, stating that “America’s vaccine program depends on a reliable private sector delivery system. Pediatric offices in turn depend on an unbroken cycle of ‘supply-service-payment-resupply’ for expensive vaccines and significant administration costs.”
The letter reminded insurance companies that the Health
Insurance Portability and Accountability Act of 1996
(HIPAA) requires that covered entities must recognize
new/revised CPT codes starting on January 1, 2011.
Pentacel® (DTaP-Hib-IPV) vaccine (five vaccine components)
Hepatitis B (one vaccine component)
PREVNAR 13™ (one vaccine component)
Rotateq® (one vaccine component)
Whereas previously you would have reported that four
vaccines were administered, under the new codes, you
would report that eight vaccine components were administered.
In the example above, the codes would be reported as
follows:
Vaccine Product/Code
Pentacel® /90698
Hepatitis B/90744
Prevnar 13™/90670
Rotateq® /90680
Immunization Administration Code
90460, 90461, 90461, 90461, 90461
90460
90460
90460
Change to such an important part of a general pediatrician’s practice requires careful communication to both
providers and payers, so there have been major national
and Ohio Chapter efforts in the last few months.
– Jon Price, MD
Chair, Pediatric Care Council
See Dr. Tuck’s coding column on page 16.
2011 MEDICARE RELATIVE VALUE UNITS FOR IMMUNIzATION ADMINISTRATION
CPT code and description
Physician Work Practice Expense RVUs
RVUs
(non-facility)
Professional
Insurance
Liability RVUs
Total RVUs
Total RVUs 2011
Medicare Conversion
factor ($25.5217) =
Medicare Amount
90460 Immunization administration through 18 years
of age via any route of administration, with
counseling by physician or other qualified
health-care professional; first vaccine/toxoid
component
0.17
0.50
0.01
0.68
$17.35
90461 Immunization administration through 18 years
of age via any route of administration, with counsel
ing by physician or other qualified health-care professional; each additional vaccine/toxoid component.
(List separately in addition to code for primary
procedure.)
0.15
0.18
0.01
0.34
$8.68
90471 Immunization administration, one injection
0.17
0.50
0.01
0.68
$17.35
90472 Immunization administration, each additional
injection
0.15
0.18
0.01
0.34
$8.68
90473 Immunization administration by intranasal/oral
route, first administration
0.17
0.50
0.01
0.68
$17.35
90474 Immunization administration by
intranasal/oral route, each additional vaccine
0.15
0.18
0.01
0.34
$8.68
www.ohioaap.org
Ohio Pediatrics • Winter 2011 15
Ohio Pediatrics
Coding Corner
Understanding and using new IA codes
will increase your practice’s bottom line
The major 2011
CPT change for
pediatricians is the
addition of new
pediatric immunization administration codes. Implementing these
codes will be subject to predictable Richard Tuck, MD
turmoil. However,
understanding the application and
limitations of the codes will provide
an opportunity for increased reimbursement for the immunization services that are central to providing
quality pediatric care.
The new immunization codes
were developed at the request of
practicing pediatricians who were
experiencing significant decreased
income related to the loss of immunization administration fees using
the newer combination vaccines.
The new codes, if used, recognized,
and paid properly, should make
pediatricians financially whole for
the combination vaccines they provide.
As of Jan. 1, the old 90465-90468
pediatric immunization codes have
been deleted and replaced by the
new 90460-90461 code set. The new
codes are for patients who are
through 18 years of age, receiving
immunizations delivered by any
route of administration, and involving counseling by a physician or
other qualified health-care personnel. The codes are determined by
the number of disease components
in the vaccine. A component is de-
16
Ohio Pediatrics • Winter 2011
fined as the antigen in a vaccine that
prevents disease caused by one organism. Examples of the number of
components in a vaccine:
IPV
1 component
MMR
3 components
DTaP-HIB-IPV 5 components
The code specifics:
90460 – Immunization administration through 18 years of age via any
route of administration, with counseling by physician or other qualified health-care professional; first
vaccine/toxoid component.
90461 – Immunization administration through 18 years of age via any
route of administration, with counseling by physician or other qualified health-care professional; each
additional vaccine/toxoid component. (List separately in addition to
code for primary procedure.)
CPT has simplified vaccine administration by providing the 90460
universal base code for each vaccine
provided.
The two new requirements for
these codes, in addition to age, deserve some attention. “Counseling”
requires discussion with the parents,
addressing concerns and questions
regarding each vaccine product administered, as well as, how to treat
associated vaccine reactions. This
would be supported by discussing
the use and dosage of acetaminophen or ibuprofen, if needed. Specific documentation of this counseling should be made. The definition
of “other qualified health-care professional” is determined by individ-
ual state scope of practice. As of
this printing, Ohio AAP was unable
to get a definitive answer from our
sources on who qualifies. We will
continue to research this and keep
you informed on the Chapter’s website and in our e-newsletters.
Understanding the coding billing
issues for the new codes is important. The administration codes
should be “paired” with the product
provided. They should be listed as
line items below the product on the
same CMS 1500 page. The initial
90460 for each vaccine will be followed by 90461, listed multiple
times, or documented in units, as
determined by each payer. You will
always report the +90461 in addition to 90460. The AAP is working
with claims management companies
to clarify and encourage this multiple unit claim procedure.
The 90471-90474 immunization
administration code series remain
unchanged in CPT to use for young
adults ≥19 years if age, or when
counseling is not provided by the
physician or other qualified healthcare professional.
The AAP has also made the ICD-9
diagnosis coding recommendation to
use V06.8 for the six combination
vaccine products. For all other products, continue using the V03-V05
specific codes. Remember that for
vaccinations provided at a preventive medicine visit, linking them to
V20.2 (well infant/child visit) remains the payer accepted and easiest
method of diagnosis billing.
See Coding...on page 20
www.ohioaap.org
Ohio Pediatrics
Award...from page 1
Large Chapters from the AAP;
membership in general increased;
and attendance at meetings and
events also increased. He was instrumental in Reach Out and Read
Ohio receiving $200,000 from the
state budget, and in increasing the
Medicare reimbursement for Ohio
physicians.
Dr. Cotton serves on the Ohio
AAP Foundation Board, as well as
the Advisory Board of Reach Out
and Read Ohio. Dr. Cotton has
made the commitment to get involved in a wide range of related
organizations as well, including the
Ohio State Medical Association, the
Columbus Medical Society, Emergency Medical Society and national
AAP. He has also been a leader at
the hospital level serving as president of Nationwide Children’s Hospital Medical Staff demonstrating
his leadership skills.
As advocacy chair of Ohio AAP,
Dr. Cotton has testified on numerous
legislative issues for the well-being
of Ohio’s children including booster
seats, immunization funding and the
Medicaid budget. As chair of the advocacy committee, Dr. Cotton’s tireless efforts increased the primary
care reimbursement rate for Medicaid and vaccine immunization
funding by 100%.
Dr. Cotton’s great sense of humor
and quick wit makes him adored by
patients and staff. The Outstanding
Pediatrician Award focuses on longterm achievement. Dr. Cotton’s
commitment to the Ohio AAP; his
notable contributions to pediatrics;
his educating of patients and physicians in Ohio; and patient care made
him an ideal recipient of this award.
Immediate Past President Terry
Barber, MD, was recognized for his
leadership, achievements, and outwww.ohioaap.org
standing contributions to the advancement of the Ohio AAP during
his term as Chapter president from
2008-2010.
During his tenure as president, Dr.
Barber’s infectious positive attitude
led to major accomplishments. Dr.
Barber tackled the growing childhood obesity epidemic initiating the
Ounce of Prevention Program; took
major strides in treating children
with asthma in the asthma quality
improvement program; provided literature focusing on parental refusal
of vaccines through a Healthy
People 2010 grant; and re-energized
the Young Physicians and Residents
Committee. He also took the Chapter’s communications to the next
level by encouraging growth in social media and electronic publications.
Others receiving awards were:
Rep. John Carney, a member of
the Ohio House of Representatives,
received the Antoinette Parisi Eaton
Advocacy Award, for advocating for
children and furthering the mission
of the Ohio AAP in 2010. He will
formally receive his award at the
Breakfast for Books event this summer.
Cooper White, MD, and Kim
Spoonhower, MD, received the
Leonard P. Rome Award. This award
is presented to a Chapter member,
or members, whose leadership furthers the mission of the Ohio AAP
through a specific program or project. Drs. White and Spoonhower
were honored for their work with
the Chapter’s Quality Network
Asthma Pilot Project. During this
project, the physicians have guided
13 Ohio practices in improving asthma care for children.
The Outstanding Committee Chair
Award was presented to Emily
Decker, MD, Nationwide Children’s
Hospital; Norah Ledyard, DO, The
Rocking Horse Center; and Allison
Brindle, MD, Cleveland Clinic.
These three women dedicated their
time to increasing involvement of
young pediatricians and residents at
Ohio AAP meetings and in state legislative initiatives. They also assembled an outstanding, sold out, Advocacy Day in May 2010. This working mom team accomplished all of
this in addition to their professional
and home commitments, including
tending to newborns.
Natalie Riedman, MD, Nationwide Children’s Hospital, received a
Special Achievement Award, for her
unending work on the Advocacy
Day program and for her efforts
with the Young Physicians Committee.
David Roer, MD, member of the
Executive Committee at Dayton
Children’s Hospital, received the
Arnold Friedman Community Pediatrician Award. Dr. Roer focuses his
volunteering primarily on child-related issues. As a result of an interview with the Wall Street Journal in
2003, Dr. Roer was able to get junk
food out of school vending machines. Even before Ohio’s smoking
ban was established, he was able to
rid the Centerville City schools of
smoking by teachers in all of the
school buildings. He also led a
health initiative to improve the
nutritional value of school lunches.
Dr. Roer is chair and one of the
founding members of the South
Suburban Coalition – a coalition
that fights teenage drug and alcohol
use. In 2008, Dr. Roer and his wife
raised $100,000 for a March of
Dimes event that they co-chaired.
Congratulations to all the recipients.
Ohio Pediatrics • Winter 2011 17
Ohio Pediatrics
Ohio AAP Annual Meeting 2010
In her presentation on
Parental Refusal of
Vaccines, Ari Brown,
MD, National AAP
spokesperson, said
parents who delay
their child’s vaccinations are playing
Russian Roulette.
William Cotton, MD, left, receives the
Pediatrician of the Year Award from
Ohio AAP President Gerald Tiberio,
MD, at the Ohio AAP’s Annual Award
Luncheon in November.
At the Opening Reception of the 2010
Annual Meeting attendees of all ages
were entertained with visitors from the
Columbus zoo and Aquarium.
18
Ohio Pediatrics • Winter 2011
Immediate Past President Terry
Barber, MD, (left) was honored
for his many accomplishments
during his term as president,
and for challenging everyone to
step out of their comfort zone
and make changes to better the
Chapter.
The Outstanding Committee Chair Award
went to the team of (from left) Norah
Ledyard, DO, Emily Decker, MD, and
Allison Brindle, MD, for their work on the
Young Physicians/Residents Committee.
They also assembled a sold out Advocacy
Day last year. Natalie Riedman, MD,
(right, next to Dr. Tiberio) received a
Special Achievement Award for her contributions to the Advocacy Day program.
David Roer, MD, left, received
the Arnold Friedman Community Pediatrician Award for his
numerous hours of volunteer
services focusing primarily on
child-related issues. In 2008, Dr.
Roer and his wife, raised
$100,000 for a March of Dimes
event that they co-chaired.
www.ohioaap.org
Ohio Pediatrics
P. Cooper White, MD, right, received
the Leonard P. Rome Award for his
work on the Chapter’s Quality Network Asthma Pilot Project. Kim
Spoonhower, MD, was also honored
but unable to attend the luncheon.
During this project, the physicians
have guided 13 practices from around
the state in improving asthma care for
children.
Meg Fisher, MD, right, of Monmouth
Medical Center, one of the national
speakers at the Annual Meeting, talks
with attendees following her presentation on “Vaccines, Not Just for
Babies.”
Ohio AAP President Gerald Tiberio,
MD, left, congratulates John Duby,
MD, for his years of service as president of the Ohio AAP Foundation.
After four years, Dr. Duby has stepped
down to explore other opportunities.
www.ohioaap.org
Bob Murray, MD, brought members up-to-date on the activities of
the Statewide Obesity Prevention
and Wellness grant. Dr. Murray
along with Amy Sternstein, MD,
have presented Ounce of Prevention information to nearly 250
health-care professionals in the
state.
Robert Frenck, MD, left, and
Immediate Past President Terry
Barber, MD, discuss the days activities at Friday’s Opening Reception
of the Ohio AAP Annual Meeting.
Allison Brindle, MD, tries her
hand with the Wine Ring Toss
held during the Opening Reception of the 2010 Annual Meeting.
All the proceeds from the ring
toss, as well as the wine raffle,
went to the Ohio AAP Foundation.
President-Elect Judy Romano, MD,
is pleased with the bottle of wine
she won in the fundraiser for the
Ohio AAP Foundation.
Attendees at the Annual Meeting Members-Only Breakfast
received an update from Ohio AAP President Gerald Tiberio, MD,
on Chapter activities, as well as legislative updates from the
Chapter’s lobbyists. Also, P. Cooper White, MD, gave a brief presentation on the Asthma Quality Improvement Pilot Project.
Ohio Pediatrics • Winter 2011
19
Ohio Pediatrics
Critical decision support available 24/7
To address a shortage of child and
adolescent psychiatrists in Ohio, the
Ohio Department of Mental Health
and provider organizations across
the state have launched Pediatric
Psychiatry Network, an easy-access
consultation and support service for
primary care physicians.
The purpose of the network is to
help primary care doctors deliver
and coordinate care for Ohio’s youth
by direct answers to physician questions regarding mental health diagnosis and treatment.
“Ohio youth with psychiatric disorders and their primary care physicians have had critical problems
gaining access to needed care,” said
Marion E. Sherman, MD, medical
director at the Ohio Department of
Mental Health. “This network provides rapid access to professional resources for consultations. It enables
family doctors to better meet the
needs of Ohio’s children through
early detection of psychiatric symptoms and proactive positive intervention.”
The network provides primary
care physicians the ability to access
child and adolescent psychiatry decision support, education and triage
services 24 hours a day, seven days
a week. Future services are planned
to include consultations using video,
e-visits and telemedicine.
The network of providers is linked
through technology and can be accesed through a call-center number
and website. The technology infra-
Medical Opportunities in Ohio (MOO)
www.ohmoo.org – serves hospital employers
and private practices with an online recruitment
program, designed to connect Physicians,
Physician Assistants, and Nurse Practitioners
with jobs in Ohio. Job seekers register for
FREE! Our database of Physicians spans
more than 85 specialties!
Employers, contact us today to learn
more about how the MOO program can
work for you!
100’s of Physicians
seeking jobs in Ohio
800.479.1666
www.ohmoo.org
20
Ohio Pediatrics • Winter 2011
structure and clinical protocols were
developed using Ohio’s Transformation State Incentive Grant funds from
the Substance Abuse and Mental
Health Services Administration.
Network providers taking calls include Akron Children’s Hospital,
Northeastern Ohio Universities College of Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Nationwide
Children’s Hospital, The Ohio State
University, Toledo Children’s Hospital and University of Toledo. Additional network development support
was received through Wright State
University, Cleveland Clinic and
University Hospitals/Rainbow Babies
& Children’s Hospital.
To request a consultation, Ohio primary care physicians may call 1-877PSY-OHIO, or complete a request
form at www.pedpsychiatry.org.
Coding...from page 16
The Ohio AAP Pediatric Council is
aggressively addressing the HIPAA
required recognition and use of the
new codes and has sent out letters to
our major state payers (see story on
page 1). National AAP is providing a
summary of ongoing communication
with the major national payers regarding their policies related to the
new IA codes, as well as, a list of
FAQs from members seeking guidance with implementation of the
codes. You can find these at www.
aap.org, members-only site, PMO
(practice management online).
If we work together to pursue
recognition of the new IA codes, the
result will be an increase in our practice’s bottom line!
– Richard Tuck, MD, Zanesville
Ohio AAP Coding Expert
www.ohioaap.org
Ohio Pediatrics
Survey of vaccination coverage makes
change to benchmark PCV percentages
The 2008 National Immunization
Survey, a survey of vaccination coverage among U.S. children by age
36 months, was released in August
2010. The most identifiable change
in this years survey is the survey’s
benchmark for up-to-date percentages by age 36 months has changed
from the prior 4:3:1:3:3:1 series (4
DTaP, 3 Polio, 1 MMR, 3 Hib, 3
Hepatitis B and 1 Varicella vaccines) to a 4:3:1:3:3:1:4 series
which now includes 4 Pneumococcal vaccines.
The National Average for the
4:3:1:3:3:1:4 series for 2008 was
63.3%. Ohio’s average for 2008 was
68.8%. Once again Ohio is above
the national average and 5th highest
in the country. We should continue
to be proud of Ohio’s coverage
compared to the national average,
this is however a lower up-to-date
percentage than we have seen in the
past few years with the prior series.
The Ohio percentage for the
4:3:1:3:3:1 in 2008 was 68.8% and
in 2007 was 80.1%. For the past few
years the AFIX measurements from
the Ohio Department of Health have
reported individual practice up-todate percentages using both of the
series measurements. While the new
series may show a lower up-to-date
percentage compared to prior data,
this will be the benchmark moving
forward.
For practices that have had an
AFIX measurement in the past few
years, it may be beneficial to review
the prior data on up-to-date percentages and move forward as practices
review their patients vaccine records
to pay attention to their Pneumococcal (PCV) percentages.
– Ryan Vogelgesang, MD
MOBI Medical Director
We proudly announce that American Physicians
and The Doctors Company have united.
Together, we set a higher standard. We aggressively defend your name. We
protect good medicine. We reward doctors for their loyalty. We ensure members
benefit from our combined strength. We are not just any insurer. We are a
company founded and led by doctors for doctors. We are the largest national
insurer of physician and surgeon medical liability.
On October 22, 2010, The Doctors Company and American Physicians officially joined forces. With the addition
of American Physicians, we have grown in numbers, talent, and perspective__strengthening our ability to
relentlessly defend, protect, and reward our nearly 55,000 members nationwide. To learn more about how we
can protect your livelihood and reputation with our medical professional liability program, call (800) 666-6442,
or visit us at www.thedoctors.com.
We relentlessly defend, protect, and
reward the practice of good medicine.
www.ohioaap.org
American Physicians
www.thedoctors.com
Ohio Pediatrics • Winter 2011
21
The Ohio AAP Foundation would like to thank the following
individuals, hospitals and companies for their support in 2010.
Your support enables the Ohio AAP Foundation to sustain its three main programs:
Reach Out and Read Ohio, the My Story Foster Care Program, and the Parent Connection Series
Marisha Agana, MD
Akron Children’s Hospital+
Alice Appel
Razan Alkhoury, MD
Wendy Anderson, MD
Kevin Arnold, PhD &
Melissa Wervey Arnold
Justin Baker
Terry Barber, Sr, MD & Jackie
Barber
John Barnard, MD
Sally Baronda
Claudia Barrett
Ken Barton
Greg Bates, MD
Kerry Bierman
Borders
Allison Brindle, MD
Luke Brown
Max Brown*
Vivian Brown
Jeff Brubaker
James Bryant, MD
Buckeye Community Health
Plan*
Shelley Callahan
Karen Carbaugh
Shareena Casey
Center for Cognitive and
Behavioral Therapy of
Greater Columbus+
Children’s Practicing
Pediatricians*
Jeff Combs
Frank Combs
Commerce National Bank*
William Cotton, MD and
Patricia Davidson, MD
Kim Davis
Emily Decker, MD
Isaac DeLeon
Mark Denny, MD & Sarah
Denny, MD
Emanuel Doyne, MD &
Ellen Doyne
Dan & Rebecca Dragin
John Duby, MD & Sara
Guerrero-Duby, MD*+
Jim Duffee, MD
Brian Engle
Matt Esker
Antoinette Eaton, MD
Kevin Farrell
Jill Fitch, MD
Diana Foreman
Carla Fountaine
Robert Frenck, MD
Mike & Bonnie Gahn
Gardiner Early Learning Center
Andrew Garner, MD
Jessica Gliha
Tamu Gibbs
Joan Griffith, MD
Dan Gusty
Donald Hairston
Edwin & Carol Hall+
Eric & Katherine Hall
Heather Hall
Ginny Haller, MD
Melissa Hook
John Howenstine*
Vera Humes
Industrial Technology
Solutions*
Tracy Intihar
Richard & Sally Jameson+
+ Breakfast for Books Sponsor, Table Sponsor or Donor
John Duby, MD, Ohio AAP
Foundation President 2006-2010
22
Ohio AAP Foundation Golf Outing
at Rattlesnake Ridge Golf Club
Ohio Pediatrics • Winter 2011
Leonard Janchar, MD
Todd Jenkins, MD
Johnny Buccelli’s*
John R. Green Company+
Rhonda Johnson
Tracey Johnson
Mike & Cecelia Jokerst
Glenn Karr
Lisa Kelch, MD
Elizabeth Kelleher
Kelly Kelleher, MD
Karen Kirk
Katalin Koranyi, MD
Nick Lashutka
Lori LeGendre+
George Leugers
Andrew Maciejewski
Thad & Barbara Matta*+
McDonalds, USA, LLC+
Jonna McRury, MD
Bruce Meyer, MD
Grant Morrow, MD
Cheryl Morrow-White, MD
Robert Murray, MD
Victor Nanagas, MD & Maria
Nanagas, MD
Nationwide Children’s
Hospital*+
Garey Noritz, MD
Ray & Kathleen Oakes
Ohio Children’s Hospital
Association*
Anahi Ortiz, MD
Jennifer Ortman
Panera*
Mary Ann Partlow
Bindi Patel, MPH
PNC Bank & Grow Up Great
Jennifer Powers
Jonathan Price, MD
Primrose Schools
Dru Qualman
Suzette Rathke
Rattlesnake Ridge Golf Club*
Red Lobster*
David Rich, MD
JoAnn Rohyans, MD
Judy Romano, MD
Elizabeth Ruppert, MD
Rusty Bucket*
Kevin Sheedy
Charles Spencer, MD
Joe Stack
Tom & Debbie Stahl
John Steketee
Amy Sternstein, MD
Nancy Strater
Tim Sullivan
Ben Teske
The Step 2 Company, LLC+
Olivia Thomas, MD
Gerald Tiberio, MD & Clare
Tiberio
University of Toledo Medical
Center, Department of
Pediatrics+
Ryan Vogelgesang, MD
Clare Ward
Lynn Warner
Sharon Werner
Kathy Westfall
Wanda Whipkey
John Wiley
P. Cooper White, MD
Tom York
Julie Zuzolo
* Ohio AAP Foundation Golf Outing Sponsor or Donor
Guest Reader, Clark Kellogg, at
Breakfast for Books 2010
Ohio AAP Foundation Wine Raffle
at Ohio AAP Annual Meeting
www.ohioaap.org
Ohio Pediatrics
Legislation...from page 2
Ohio Senate
Republicans grew their majority in
the Ohio Senate by two seats after a
victory in Lorain County and the
Dayton area. North Ridgeville City
Councilman Gayle Manning beat incumbent Sue Morano and Sen. Fred
Strahorn lost to Bill Beagle of Tipp
City. Republicans now hold a 23-10
majority in this chamber.
Ohio’s Statewide Offices
Ohio Attorney General – DeWine
Former Republican U.S. Senator
and former lieutenant governor Mike
DeWine challenged current Democrat Attorney General Richard Cordray to serve as Ohio’s lead attorney.
DeWine won with 48 percent of the
vote.
Ohio Auditor – Yost
Republican Delaware County Prosecutor Dave Yost and Democrat David
Pepper battled for this seat in the fall
election. Many insiders predicted this
race would fall to Pepper. However,
Yost bested Pepper with a solid 51-44
percent victory.
Ohio Secretary of State – Husted
State Sen. Jon Husted (R-Kettering) beat Democrat Maryellen
O'Shaughnessy for Ohio’s secretary
of state seat – 54-41 percent of the
vote.
Ohio Treasurer – Mandel
Incumbent Democrat Kevin Boyce
faced a strong challenge by State
Rep. Josh Mandel (R-Lyndhurst).
Rep. Mandel won the seat 55-40.
Ohio Supreme Court – Lanzinger,
O’Connor and Pfeifer
Justice Maureen O’Connor (R)
won the Supreme Court’s Chief Justice position, easily beating Justice
Eric Brown. O’Connor will become
www.ohioaap.org
Ohio’s first female Chief Justice. Republican Justice Judith Lanzinger
beat back a challenge from Democrat
Mary Jane Trapp. Justice Paul Pfeifer
was also elected to the court as he
ran unopposed for his third term.
Key leadership posts announced
for 129th General Assembly:
Ohio House Republicans
Rep. William Batchelder (RMedina), speaker
Rep. Lou Blessing (R-Cincinnati),
speaker pro tem
Rep. Matt Huffman (R-Lima),
majority floor leader
Rep. Barbara Sears (R-Sylvania),
assistant majority floor leader
Rep. John Adams (R-Sydney),
majority whip
Rep. Cheryl Grossman (R-Grove
City), assistant majority whip.
House Democrats
Rep. Armond Budish (D-Beachwood), minority leader
Rep. Matthew Szollosi (D-Toledo),
assistant minority leader
Rep. Tracy Heard (D-Columbus),
minority whip.
Rep. Debbie Phillips (D-Athens),
assistant minority whip
Senate Republicans
Sen. Tom Niehaus (R-New Richmond), president
Sen. Keith Faber (R-Celina), president pro tem
Sen. Jimmy Stewart (R-Albany),
majority floor leader
Sen. Shannon Jones (R-Springboro),
majority whip.
Senate Democrats
Sen. Capri Cafaro (D-Hubbard) to
remain as Senate minority leader
Sen. Shirley Smith (D-Cleveland) is
the assistant minority leader
Sen. Edna Brown (D-Toledo), minority whip
Sen. Jason Wilson (D-Columbiana),
assistant minority whip
128th General Assembly Wrap-up
The two-year 128th General Assembly came to a close with many
reflecting on the inactivity of this
session more than anything. With a
Republican Senate and Democrat
House and Governor, stalemates
were the standard in this session.
Only 58 bills were signed into law
for this session, compared to an average of 247 bills during the previous
20 years.
Ohio AAP did see two bills of interest become law. First, House Bill
198, sponsored by Rep. Peggy Lehner (R-Dayton) to establish patientcentered medical home education
pilot programs for medical students.
Additionally, Ohio AAP was also involved in SB 210, a bill that was enacted in June 2010 to establish nutritional standards for foods and beverages sold in vending machines in
schools, as well as creating a pilot
program for daily physical activity.
Ohio AAP also actively advocated
for a number of agency-level funding
and policy decisions to ensure adequate reimbursement for pediatric
primary care and emergency care in
light of fiscal constraints as well as
timely and adequate immunization
reimbursement.
Although many challenges lie
ahead, Ohio AAP and our consultants
at Capitol Consulting Group will be
working to make sure the voices of
Ohio’s pediatricians and the children
are heard loudly and clearly.
– Capitol Consulting Group
Ohio AAP Lobbying Team
Ohio Pediatrics • Winter 2011
23
Ohio Chapter
American Academy of Pediatrics
450 W. Wilson Bridge Rd.
Suite 215
Worthington, OH 43085
Calendar of Events
The Ohio AAP announces the following meetings and events.
May 13, 2011 – Open Forum Meeting
University of Toledo
Topics: Electronic Health Record Incentive
Program; and ADEPP - Autism Diagnostic
Learning Session
May 17
– Young Physicians & Residents
“Advocacy Day”
Riffe Center, Columbus
Aug. 2
– Breakfast for Books
Huntington Park
Fundraiser for the Ohio AAP Foundation
Bring your whole family and stay for the ballgame
with the Columbus Clippers following the event.
Aug. 25-27
– Ohio AAP Annual Meeting
Cherry Valley Lodge & CoCo Key Water Resort
Topics: Quality Improvement Roundtable; American
Board of Pediatrics representative discussing MOC;
Medical Home Reimbursement
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DUBLIN, OH
Dues disclosure
statement
Dues remitted to the Ohio
Chapter are not deductible as
a charitable contribution, but
may be deducted as an ordinary and necessary business
expense. However, $40 of
the dues is not deductible as
a business expense because
of the chapter’s lobbying
activity. Please consult your
tax adviser for specific information.
This statement is in reference to fellows, associate
fellows and subspecialty fellows.
No portion of the candidate
fellows nor post residency
fellows dues is used for lobbying activity.