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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


Ohio Pediatrics • Winter 2011

get involved, contact the Ohio AAP at 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

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

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 â&#x20AC;¢ Winter 2011

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.

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


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


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 for more information

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.

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. 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






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. 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 ( Emily Decker, MD – Co-Chair ( Norah Ledyard, DO – Co-Chair ( – Norah Ledyard, DO Co-Chair, YP&R Committee

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

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@ 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

Young Physicians and Residents Advocacy Day May 17, 2011 Riffe Center Columbus Watch Ohio AAP website and publications for more information.

Ohio Pediatrics â&#x20AC;˘ Winter 2011


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


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 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.)


Ohio Pediatrics â&#x20AC;˘ Winter 2011


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


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, or (614) 846-6258.

Sports Shorts Guidelines for Pediatricians This information is available on the Ohio Chapter, American Academy of Pediatrics’ website at

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.

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


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


Sports Shorts Guidelines for Parents, Coaches, Athletes This information is available on the Ohio Chapter, American Academy of Pediatrics’ website at

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


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.


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






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.)






90471 Immunization administration, one injection






90472 Immunization administration, each additional injection






90473 Immunization administration by intranasal/oral route, first administration






90474 Immunization administration by intranasal/oral route, each additional vaccine






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-


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

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

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.


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.

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.

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


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) – 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



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

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., 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

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

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Ohio Pediatrics • Winter 2011


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


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

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

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


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


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.

Ohio Pediatrics - Winter 2011