AAP leaders unveiled a new initiative to address payment issues during the annual Leadership Conference and discussed the need to support pediatrician well-being and members in states where recently enacted laws undermine health care.
Chapter, committee, council and section leaders attended the event Aug. 3-6 in Itasca, Ill. The conference culminated with leaders voting on more than 70 resolutions submitted by AAP groups and members for consideration, with 63 being adopted. Resolutions are advisory to the Board of Directors and provide input on the direction of policies and activities of the Academy. The top 10 resolutions will be referred to areas of the Academy with related expertise for review and potential action.
Reforming payment, coverage
AAP President Sandy L. Chung, M.D., FAAP, announced the new AAP Agenda for Payment Transformation, which will:
- be informed by policy and committees, sections and councils;
- address Medicaid, the Children’s Health Insurance Program (CHIP) and commercial insurance;
- cover issues related to eligibility, enrollment, benefits and access;
- address solutions to payment challenges unique to pediatrics (built on the unique value proposition of pediatric care);
- explore alternative and value-based models for both commercial and Medicaid plans (MCOs);
- include issues related to pediatric primary care and pediatric medical subspecialty and pediatric surgical care; and payment for social determinants of health;
- address payment challenges in pediatrics that contribute to burnout and workforce equity; and
- involve input from across the AAP.
The new payment transformation agenda was brought up during a health care finance session. Panelists emphasized the need to ensure equitable access to care for both publicly and commercially insured children while improving payment for pediatrician practices.
“Supporting pediatric payment advocacy” was voted the No. 2 resolution.
Working to address these concerns, the AAP Committee on Child Heath Financing (COCHF) has updated a range of policies (https://bit.ly/3VCJPZq), said COCHF Chair and AAP Past President James M. Perrin, M.D., M.P.H., FAAP (2014).
A forthcoming policy will tackle Medicaid and CHIP, which cover more than half of U.S. children. Among the issues is the wide variation in policies and quality standards, Dr. Perrin noted.
“We need to end state variation, decades of underpayment and achieve at least Medicare parity,” Dr. Perrin said. Other goals are universal enrollment, continuous enrollment to age 26, a strengthened and enforced national standard of care and quality through the Early and Periodic Screening, Diagnostic and Treatment protocols, and Medicaid and CHIP combined into a single program.
“No child should leave the nursery without insurance,” he added.
Panelist Greg Barabell, M.D., CPC, FAAP, brought up concerns over payment denials, private equity and hospital systems buying up practices, prior authorization problems and workforce shortages. He is chair of the AAP Payer Advocacy Advisory Committee and a COCHF member.
Eli Sprecher, M.D., FAAP, the AAP inaugural Russell Libby, M.D., FAAP, Fellow in Pediatric Practice and Payment Transformation, provided updates on value-based care and alternative payment models. He is working on ways to improve pediatric practice infrastructure to identify practice management and administrative structures that add value and highlight innovative payment methods.
Dr. Chung said medical students may not view pediatrics and pediatric subspecialties as viable options since pediatricians are among the lowest-paid doctors.
“If we don't have pediatricians, we don't have pediatric medical subspecialists and pediatric surgical specialists, and then we don't have access to care,” she said. “So ultimately, we're doing this for the children.”
Support for members facing adversity
The AAP has responded to a host of challenges this year while continuing its core work of policy, advocacy and education, said AAP CEO/Executive Vice President Mark Del Monte, J.D.
He thanked the grassroots leaders for “representing your fellow pediatricians in your states and your specialties so we can address the burden of their hardships, the threats to their patients and practices, and redefine what is possible.”
A resolution to relocate the 2024 National Conference from Orlando, Fla., because of state policies that hurt children and adolescents was defeated after some leaders called for supportive action instead.
“I can only speak for the pediatricians in Alabama and then pediatricians in District X,” said Alabama Chapter President Nola Jean Ernest, M.D., Ph.D., FAAP. “But we are worn out … because we are literally at the frontlines of what seems like every culture war these days, and we don’t need you to leave us. We need you to come and stand next to us. Turning your backs on us causes us further trauma.”
Del Monte said programming at the National Conference will center on Florida pediatricians’ experiences.
He also discussed six new alliances that will realign the 92 AAP internal entities, the ongoing work for health equity and the importance of addressing social determinants of health and vaccine disinformation. Del Monte emphasized efforts to push for evidence-based policies that put an end to gun violence and the need to ensure millions more children have access to mental and behavioral health services.
He referenced the board’s decision to reaffirm the 2018 policy supporting gender-affirming care, while authorizing development of expanded guidance based on a systematic review of the evidence. Del Monte said the AAP has submitted amicus briefs in states seeking to ban gender-affirming care and will continue to stand up for patients and pediatricians.
“While the litigation continues, we will persist to protect your decision-making and have your back,” he said. “We will leave no member and no child behind.”
The No. 1 resolution selected by voting members calls for the AAP to advocate for federal protections of gender-affirming care.
Standing up for colleagues
The conference also featured a panel discussion titled “Advancing EDI & Health Equity: Where We Are, Where We’re Going and How Do We Get There?” Panelists said a more equitable workplace requires support and resources from colleagues and institution leaders to ensure a healthy environment for all.
“A lot of times people don’t intervene because they don’t know what to do,” said panelist V. Faye Jones, M.D., Ph.D., M.S.P.H., FAAP. “Enhance your toolbox so you can be the one.”
When an audience member mentioned conversations about differing beliefs with a family member, panelists said difficult conversations often need to take place with close contacts.
“Things seem to be accelerating and people are being increasingly comfortable with racism, their biases, their discrimination,” Mikah Owen, M.D., FAAP, said. “If we cannot hold those close to us accountable, it’s (not) possible to expect change.”
Pediatrician safety remains a priority
The safety and well-being of pediatricians was top of mind for many amid increasing threats.
Panelist Jason Yaun, M.D., FAAP, spoke of personal and professional challenges during the discussion “Health Equity, EDI, and Physician Well-Being and Safety.” Dr. Yaun, president of the Tennessee Chapter, spoke of attacks health care professionals have been subject to, including around COVID-19, immunizations and gender-affirming care.
He also spoke of the loss of colleague Benjamin Mauck, M.D., who was killed by a patient at a clinic in a Memphis suburb in July.
“We’ve seen a relentless onslaught of attacks against our profession and against our members and against our children. It’s been a lot,” Dr. Yaun said. “It’s great to know you all are with us, and we definitely feel that support.”
Kerri Lockhart, M.D., FAAP, spoke of the personal challenges she has faced in medicine, which included being diagnosed with breast cancer and attention-deficit/hyperactivity disorder. She stressed the need for more institutional supports for professionals like her.
“When you’re in an unsafe environment, you can’t do any work,” Dr. Lockhart said. “You can’t be innovative. You can’t be all the things you need to be efficient when your cognitive load is just trying to survive. If we truly want to become the organization we want to be, we have to look at what does our inclusion and safety look like.”
Alyson Sulaski Wyckoff, associate editor, contributed to this article.
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