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Issues & Commentary – February 2015

By Dennis Cooley, MD, FAAP

Rather than concentrate on one topic I thought I would give some updates on current issues in our state that have an effect on pediatrics.

One of the most important changes facing pediatricians in the state is the reduction in payments for Medicaid primary care services. Starting in 2013 the ACA increased these Medicaid payments to Medicare levels for 2 years. This increase was not reauthorized by Congress so payments dropped back to 2012 levels starting January 1, 2015. This will have a major impact on the financial well being of pediatric practices in the state and have an adverse affect on access to care for our growing Medicaid population. President Obama recently released his budget for the 2016 fiscal year and included $6.3 billion dollars to restore the increase payments through 2016. Some states have restored the payments out of their own general funds but in view of the state’s current budget crisis this will not happen in Kansas. So unless Congress agrees with the President on this item in his budget, pediatricians in our state will be back to seeing Medicaid patients at a significant financial disadvantage. I refer you to Dr. Jon Jantz’s article in this newsletter for what you can do to help remedy this situation. One final note on this: I can assure you the AAP’s Department of Federal Government Affairs is working tirelessly to get those payments restored. I am scheduled to return to Washington in April and June of this year with COFGA .

The Infant mortality rate in the state has again increased slightly for the second straight year after annual reductions since 2007. The total number of deaths actually decreased to 248 in 2013 but the state also experienced a significant drop in births. The rate in 2013 was 6.4/1000. This continues to be above the national averages. Kansas continues to have high racial/ethnic disparities in infant mortality. In 2007 we had the highest back infant mortality rate in the country. Our rates of deaths for black infants has decreased but not at a rate to impact the disparity. We continue to have 2.5 times the rate of African American babies dying as white babies. According to data from KDHE in 2013, Kansas again had the highest rate of black infant mortality in the country. The Blue Ribbon Panel on Infant Mortality has been meeting since 2009 and has been monitoring infant death rates and coordinating efforts to lower them. While the 2013 numbers are certainly discouraging the five year rolling averages, which are a better indicator, indicate that Kansas is making improvement. There are many efforts in the state to reduce infant mortality.  However, many of these programs have not been in place long enough to see a significant change. Programs such as the March of Dimes’ Becoming A Mom are just now spreading throughout the state. The number of state FIMR programs has only within the last year expanded to 5. Starting in summer of 2014 Kansas became involved in the HHS sponsored Infant Mortality CoIIN ( Collaborative Improvement and Innovation Network) Program which is working regionally to develop state specific solutions to reduce infant mortality. From this group, a state wide plan has been developed. As Chairman of the Blue Ribbon Panel since its inception, I have been involved in this issue for many years. The state is moving in the right direction. There will be annual fluctuations but we need to put in place long term answers and I see this being done.Since 2011 when then HHS Secretary Kathleen Sebelius recommended Critical Congenital Heart Disease screening be done in the neonatal period, various individuals and groups in the state have worked to get this part of the Kansas Newborn Screening Panel.  KDHE was working to get this established as a standard of care issue and educate hospitals and birthing centers on the screening. It was hoped that when most birthing facilities in the state were performing the screening, adding it to the Newborn Screening Panel would be easier and could be done by the Secretary without the legislature being involved. As of November 2014 85% of birthing facilities and 95% of births in the state were being screened for CCHD. Within the last week, a bill ( HB 2239) making CCHD screening mandatory was introduced. When I contacted KDHE about the bill they indicated they were not sponsors of the bill. So far a hearing for it has not been set. I will let you know how this plays out.Prescription drug abuse is a serious problem throughout the country and Kansas is no different. The Department of Aging and Disability Services for Kansas has set up a multidisciplinary workgroup to deal with this issue. The KAAP was invited to be part of the group and I have represented the Chapter at the organizational meeting. I will keep you informed as this group sets up action plans.Another group that is meeting to deal with an issue dear to pediatricians is the Immunize Kansas Coalition. This group was established to increase immunization rates for all Kansans. It is an extension of the Immunize Kansas Kids  group, in which the KAAP was very active, that concluded its functions in 2014. The Immunize Kansas Coalition has also just had its organizational meeting and as more information and action items comes from this group I will pass it on.  Chris Steege, Pam Shaw and I are representing the Chapter.

I will close with an update on the situation at KDHE. As many of you know Dr. Robert Moser resigned as Secretary and Medical Director of KDHE in November of 2014. Dr. Susan Mosier who had headed the Medicaid Program was named Acting Secretary. She has now been officially chosen as Secretary of the Department.

If anyone has questions please feel free to contact me at: denniscooley664@gmail.com

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