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District II Member, |
we cycle out of summer and into the changes of autumn, we will all be
challenged by the many changes in health care that this new season
read on for details.
Laraque, MD, FAAP
NYS AAP, District II
of us are already experiencing changes in payment, or new
systems of care. Many offices are affiliating with larger
practices, joining new networks, or exploring invitations by
hospitals and emerging community health systems to join
population based health care consortiums. The federal government
is expanding options for ACO's, more hospitals are merging or
changing their scope of services, insurers are also merging and
changing the kinds of coverages they are offering. Employers
large and small are looking at new coverage options that the New
York State Health Insurance Exchange, called New York State of
Health, can offer, and some are already deciding to purchase
coverage through the Exchange or provide for their employees to
purchase through the Exchange.
York State's Medicaid Reform Initiatives started with the MRT
(Medicaid Reform Task Force) and are moving forward on several
levels. Health Homes for medically complex adults are being
created, supported and evaluated. Models for Health Homes for
Children are being explored by various state work groups.
Behavioral Health services are being integrated into primary
care, either as contract ancillary services or co-located
attached to primary care. Population health approaches are also
being explored by larger health systems. Many of these new
initiatives have the potential to impact on your practice and
the practice of pediatrics in New York.
communities are already experiencing significant changes in how
and where they will access all levels of health care. School
based health care services for children in all settings from
Buffalo to the tip of Long Island, are on schedule to be
integrated in Medicaid Managed Care as part of the MRT process.
This initiative opens up many questions about coordination of
care, communication, responsibility of the PCP, and even more
basically who is the PCP for a particular child. But it also
offers opportunities to explore the notion of an expanded
Medical Home to care for children and families. There are many
questions and many concerns, but change is the constant that all
health care systems and those delivering health care to children
will be facing. The implemented and proposed changes are or will
affect everyone, from the solo practitioner to the largest
hospital based pediatric network practices.
concert with all these changes, October 1st will bring the
official opening of New York State's Health Insurance Exchange,
New York State of Health. It is imperative that all
pediatricians have information about the Exchange available to
share with families in their practices. Research has shown that
families who have health insurance for parents and children
access more regular health care for their children. Therefore,
family coverage can and does improve children's health. We have
provided access to New York State specific information about the
Exchange for you on our website (under "Current News"
on the homepage: www.aapdistrictii.org).
In addition, here is a link to the New York State of Health web
portal that you can share with families who bring their children
to you: www.nystateofhealth.ny.gov.
We are bringing this to your attention because it is possible
that many families who currently have some level of health
insurance through their employers, especially small employers,
will be asked to now purchase insurance through the Exchange. If
parents have questions, or families are confused about their
health insurance options, it is important that you help them
choose an insurer that will allow them to continue to bring
their children to you for pediatric care.
also brings an increased focus on childhood immunization. This
is the time that parents become more acutely aware of the
immunization status of their children, and school, child care
and recreational activity requirements. It is also the time that
many families bring their children in for school and sports
physicals. All visits are opportunities for immunization.
Although our track record for compliance with mandated
immunizations on the ACIP/AAP schedule is reasonable, we as
pediatricians are not doing as well on non-mandated vaccines.
Our City and statewide influenza coverage remains subpar. Only
65% of the youngest and most vulnerable children in NYC received
influenza vaccine last year. The statewide figure is similar.
The numbers are even worse for those over five and into their
teen years. The older cohort of those over the age of nine had
only 35% influenza vaccination rate. We can and must do better.
If we want to continue to be perceived by the health care system
as the most effective immunizers of children, we need to make
sure all of our kids are immunized against influenza. And we
need to work harder to get young patients immunized against HPV.
stakes for pediatricians are high. Not only are we fighting off
Retail Based Clinics, we are also holding off allowing children
to be immunized in pharmacies and other community based sites.
But we cannot simply say we don't want other points of services
for childhood immunizations, we have to decide that this is part
of what we do and we must find ways to do it better. There are
experts in your local AAP NY Chapters and in the NYS AAP. If you
are having difficulties, or if you are exhausted trying to work
with parents who continually refuse or delay immunization for
their children, you are not alone. There are human and material
resources to help. Please reach out and get whatever help you
may need to assure that we can and will immunize more children
against influenza this year. And please, let's all work to be a
positive force to help young people and parents understand the
importance and protections that HPV vaccine offers. We are the
immunizers. Let's make sure that we immunize children in a
timely fashion. One additional point, please help assure that
you and your colleagues have taken the time to be vaccinated
this influenza season. This simple step will help protect your
patients, their families, you and your own family!
NYS AAP remains committed to working with the State Health
Department and the Department of Financial Services to pass
legislation or create regulation that sets a fair statewide
immunization administration fee and requires all commercial
insurers to pay pediatricians 27% above the CDC retail cost of
vaccines for all vaccines. Yes, we have to work harder to get
our child patients fully immunized, but we also have to be able
to keep our pediatric practices afloat.
* * * *
with Community Based Child Serving Systems
NYS AAP is also exploring ways we can partner with other
community based child serving systems in a focused way to help
children and families achieve and maintain higher levels of
health and well-being. Finding effective and efficient ways to
work with child care, teachers and schools, recreation and
sports programs, and children's mental health services will help
all of us better serve and support our patients. The new
concepts of population based health and Medical Homes as
community engaged teams pushes us to expand the walls of our
offices and accept that we need to work with people who spend
many hours a day every day with our patients.
are also clear in our support of services that contribute and
help sustain the development of healthy children and stable
healthy families. The NYS AAP supports expanded high quality
affordable infant and child care, the expansion of the evidenced
based Nurse Family Partnership for all families caring for a new
baby in challenging circumstances and Universal Pre-K.
Recognizing the importance of brain development in the early
years, we are committed to building services and supports that
can and will create and maintain resilient children and
supportive nurturing families and communities.
commitment to children also reflects our commitment to
pediatricians and to pediatrics. We want to be the physician
that parents see as a partner in the healthy development of
their children. We also want to be the expert on children who
knows what a child needs and knows how to get them what they
need. We are physicians, but we are also care managers and
referral services. We know that we have to take care of the
whole child in their environment if they are to be and stay
* * * *
Compensation for Pediatricians
our complex role and needing to be fairly compensated for what
we do and should be doing, we need to be able to negotiate with
health insurance companies on a level playing field. One way to
level that playing field is to allow physicians to create groups
to collectively bargain with insurers. The NYS AAP remains
committed to the concept of allowing physicians to collectively
bargain with insurers for fair compensation. We will once again
advocate for collective bargaining legislation this year.
* * * *
urge you to become active in the work that we are all doing.
There are many ways you can advocate for the services that
children and families need, and there are many ways you can
advocate for pediatricians and for pediatrics in New York State.
There are simple short actions like a phone call or e-mail on a
specific subject or issue, or there are longer, deeper
involvements such as working on legislation or meeting with
legislators. We urge you to do whatever you can. What New York
State decides about how to deliver health care to children and
how to pay for it, directly impacts what you do in your office
and how you can treat and advise your patients. Join us, and add
your voice to those that care deeply about children and the
physicians who care for them.