In addition, we were able to have successful chapter meetings with great input in the new directions for our chapter. Our Young Physicians section seemed to have the most lively lunch meeting and is ready to take on new challenges in our state in the immunization arena.

As I finish my first year as president, I am excited to move forward and work to improve health care for children in our state. Thank you to all who are participating in our many ventures. Please read through the rest of this newsletter to see what else is happening!

Sheila Idzerda

Chapter Champions:
Chapter Champions are members of our chapter who are interested in working on a particular part of pediatrics. They act as a point person for information in their area from National AAP and as a contact person for members within our chapter. We are fortunate that we have a large slate of chapter champions. If I have inadvertently left someone off the list, please contact me at sidzerda@aol.com and I will correct the list.

Asthma: Gerry Eichner, Caitlyn Hall, and Lori Byron
Breastfeeding: Maryann Carlson
Child Abuse: Anna Antonopolous and Caitlyn Hall
Medical Home: Marian Kummer, Michael Blake, Sam Yang and Deb Agnew
Mental Health/Behavioral Health: Alison Young and Laura Nicholson
Obesity: Pepper Henyon
Perinatal: Bonnie Stevens
Hearing: Maryann Carlson
Pediatric Council: Cathy White, Michelle Pierson
Cardiology: Dennis Ruggerie
Dental Health: Cathy White
Children with Special Healthcare Needs: Laura Nicholson, Nancy Maynard, and Marian Kummer
Immunizations: Tanya Jagodzinski and Angie Ostrowski

Immunizations:
Due to our low immunization rates, currently 45 or 46 in the U.S., our major priority as a chapter has been to improve these rates. We have started a multi-pronged approach which includes reaching out to other providers in the state, working with the state Board of Health and eventually to work with the state legislature. Saturday morning’s fellowship meeting was an update on immunization focus in the state.

Our next step in our plan has been taken up by the Young Physicians. They are planning to reach out to other providers in their communities–family doctors, urgent cares, mid-levels and Emergency Departments to see what we can offer to help with their struggles with immunizations.

In addition, the chapter has received a large grant to help with education about the Vaccine Hesitant parent. Our next meeting to plan for this state wide event will be October 30, 2011. We will be meeting in cyberspace. If you are interested in joining us, it will be by Go To Meeting. Please contact Pepper Henyon whose email is pepperhenyon@gmail.com to be invited to this meeting.

Finally, we need as much investment as possible about ImMTrax. This is the state wide vaccine registry which is being rolled out this fall. It promises to be easier to access and update. We are looking for opportunities to help with implementation.

Medical Home:
Medical Home is becoming a reality in Montana. As pediatricians, we have been a model for medical home. Most recently, there is a state-based initiative to provide reimbursement for medical home providers. The Montana AAP has not been actively involved in this endeavor, but Marian Kummer, Michael Blake, and Sam Yang, have stepped forward to help with this process. The state is using NCQA certification. If you are interested in the process, start at the medicalhome.org from AAP. This will provide you with a toolkit to start certification. In addition, go to the NCQA website for more information. Finally, if you are interested in helping with making sure that pediatricians are recognized and compensated for Medical Home funds, contact me at sidzerda@aol.com and I will include you in further planning for our state’s implementation.

Opportunities:
Angie Ostrowski has been our young physician’s representative. She is now moving to CATCH coordinator. We are looking for two young physicians to step into her role–one from Billings and one from the Western part of the state. Contact me at sidzerda@aol.com if you are interested.

Montana Health Care Programs Notice

Physician, Mid-Level Practitioner, and Pharmacy

Effective Immediately Prior Authorization for Children’s Vitamins

 Medicaid will now cover certain vitamins for children with special medical needs under the Early Periodic Screening Diagnosis, and Treatment (EPSDT) program when billed through a Montana Medicaid participating pharmacy.

Criteria

Patient must have a medically necessary diagnosis, and the vitamin must be used specifically for the treatment of a deficiency related to a disease state.

Limitations

Patient must be between the ages of 0–20 years old. The vitamin must be prior authorized. The vitamin must have a billable National Drug Code (NDC).

The prescriber (e.g., physician) or pharmacy may submit requests by mail, telephone, or fax to:

Drug Prior Authorization Unit

Mountain-Pacific Quality Health

3404 Cooney Drive

Helena, MT 59602

(406) 443-6002 or (800) 395-7961 (Phone) (406) 513-1928 or (800) 294-1350 (Fax)

To request prior authorization, providers must submit the information requested on the Request for Drug Prior Authorization form to the Drug Prior Authorization Unit.

This form can be downloaded from the Forms page of the Provider Information website: http://medicaidprovider.hhs.mt.gov/pdf/requestfordrugpriorauthorization.pdf

Contact Information

If you have questions regarding this notice, please contact Dave Campana at (406) 444-5951 or the Medicaid Drug Prior Authorization Unit at (406) 443-6002.

For claims questions or additional information, contact Provider Relations:

Provider Relations toll-free in- and out-of-state: 1-800-624-3958 Helena: (406) 442-1837 E-mail: MTPRHelpdesk@ACS-inc.com

Visit the Provider Information website:

http://medicaidprovider.hhs.mt.gov

PROS (Pediatric Research in Office Settings) is a practice-based research network that was established by the American Academy of Pediatrics (AAP) in 1986. PROS consists of about 1800 pediatric practitioners from 700 practices in all 50 states, Puerto Rico and Canada, teamed with a research staff at AAP headquarters in Elk Grove Village, IL and research consultants from around the country.

The mission of PROS is to improve the health of children and enhance primary care practice by conducting national collaborative practice-based research. PROS practitioners and researchers work together to generate research questions, design study materials and protocols, obtain research funding, collect study data, analyze collected data, and publish results. Since its inception, PROS has studied child health topics as diverse as the prevalence of preschool vision screening (Pediatrics, 1992; 89: 834-838), the onset of secondary sexual characteristics in young girls (Pediatrics, 1997; 99:505-512 and 2001: 108:347-353), the immunization status of children seen in private practice (Arch Pediatr Adolesc Med 1996; 150:1027-1031), the treatment of pediatric patients with psychosocial problems by primary care providers (Pediatrics electronic pages 2000: 106(4): e44), the coordination of referrals to specialists (Arch Pediatr Adolesc Med 2000; 154: 499-506), the management of very young febrile infants (JAMA 2004; 291: 1203-1212), decision-making for postpartum discharge of mothers and their healthy infants (Pediatrics, 2008, accepted for publication), and how practitioners diagnose child abuse in primay care settings (Pediatrics, 2008, accepted for publication). The new knowledge generated in PROS studies has led to changes in the clinical guidelines of the AAP and other organizations.

As a practitioner, you possess expertise on how a primary care practice runs and know which research questions are important for pediatric practice. By linking you with experts in study design and research methodology, PROS capitalizes on your expertise and lets you participate in generating new knowledge about pediatric practice and child health. You might even be able to see your own question develop into a project that can be researched throughout the network.
PROS practitioners tell us that they enjoy being part of an overall research effort that routinely solicits their input on study questions and study designs (protocols and materials) and that examines questions relevant to the day-to-day practice of pediatrics. They also tell us that parents view research involvement on the part of the pediatric practice in a very positive light, and are eager to fill out questionnaires when they are a part of a study. In addition, all participating practices are acknowledged at the end of published articles.

2000 surveys were sent out and approximately half were returned. Surprisingly 86% of parents stated that their child’s health care was well coordinated. Many respondents had more than one care coordinator. The most commonly listed coordinator was a family member and just under half listed a medical provider.

The top three needs sited were clinics to address the child’s special needs (62%), health insurance (54%), and access to dental care (52%). The barriers to obtaining these services were availability and cost. 48% of respondents had trouble accessing health care and cited cost as the major barrier.

83% of families were satisfied with the care their child received from their primary care physician. There was an opportunity for families to detail how their doctor could be more helpful to them (752 comments). Basically families wanted their doctors to be available 24/7 and to be knowledgeable about their child’s condition. Doctors needed to listen more to the parents concerns and take time to address the concerns.

Dr. Kummer presented the results of the grant at the state public health conference in the spring of 2006 and at the state pediatric conference in the fall of 2006. She also wrote an article for the (Parents Let’s Unite for Kids) PLUK newsletter- a statewide parents organization for CSHCN.

Dr. Kummer mentioned that the grant allowed her to work with several great people and to hear many parent’s concerns. She feels strongly that the state of Montana still needs a system that details all services available for this population.

1. Improve the nutritional environment by improving the affordability of healthy foods. NAPA will be working with interested grocery store and restaurants (including children’s menus) to improve the availability, pricing, and promotion of fruits, vegetables and other healthy foods.
2. Increase breastfeeding rates by working with local hospitals to implement the UNICEF/WHO “Ten Steps to Successful Breastfeeding.”
3. Improving the built environment by working with city planners, developers, elected officials, and school personnel to make communities more conducive to walking and biking.
4. Improve availability of healthy foods and physical exercise on the worksite.

As a part of the this grant all Montana AAP members will be receiving free handouts/posters in the mail to promote Turn Off TV Week which is April 20-26, 2009. Please post them in your office in April. Check out www.montananapa.org to get details on this amazing opportunity for our state.

Those of you who were not able to attend these talks in March and April of 2008 can get DVD copies of the talks from Molly Taylor our ED, and you may get CME’s for that at the AAP website under the oral health area. If you prefer to refer those HIGH RISK patients but are unable to find a dentist in your area, Jane Gillette DDS, PC 1-406-586-5880 has agreed to help you. She has been working as liaison between the AAP and MT Dental Association. She spoke at our annual meeting this year. If after watching the video you would like a demonstration in your office, with your nurses, I would be happy to do that.

This really, as you will see in the video with Dr Rencher DDS from Helena, is quite an easy process. I hope everyone gets talking about this and implementing it in their offices asap, as it is the right thing to do for our patients to decrease tooth decay. In other states, like North Carolina, who have taken this approach and “talked the talk”, they have greatly decreased childhood caries.

One fluoride varnish that Drs Czerepak and Deinard used when here was Cavity Shield from Omni Pharmaceuticals and it has a brown color so that you can see where it was applied. They had another varnish named Vanish also from Omni that comes in cherry and mint flavors and you didn’t see it on the teeth. These both came in unit doses with applicators. There are multiple other companies and varnishes out there but I am not familiar with their properties. I have a more complete list if anyone is interested. I also have a Fluoride Varnish Information Sheet with Risk Assessment and Consent Form on the back that you are welcome to copy and use in your office if you desire.

If you have questions please don’t hesitate to contact me at CMWMD@yahoo.com or 1-406-454-0145.

To many beautiful smiles across our great state,

Cathy White MD

The Boys’ Puberty Study (Secondary Sexual Characteristics in Boys) has finished data collection and analysis is almost complete, and the manuscript is being written for publication which should follow soon.

PROS is starting an exciting dissemination study in selected states (NY, FL, CA, PA, IN, HI, and NC) to address Teen Driving.  The study is funded by the CDC to help pediatricians help parents to discuss driving with their teens, and to promote safety rules and driving contracts to decrease accidents, injuries, and deaths.  The first six months of driving without adult supervision is the highest risk period for all teen drivers and setting limits above and beyond the graduated driving license laws have been shown to decrease morbidity and mortality. 

PROS has begun work on an effort to build and test an EHR-based version of the network, and to conduct a comparative effectiveness research project through this subnetwork.

PROS will also be starting a Teen Smoking Cessation Study (Smokebusters) very soon, and if you have a high adolescent population in your practice, this would be a great study for you!  Most smokers get hooked in their early teens and helping them to quit early would make a huge impact on the life of that teen and the teen’s future family.

The National Institute of Child Health and Development (NICHD) also presented a potential study to look at the use of atypical antipsychotics in children and the medical consequences of their use.  This is a topic of great interest to many pediatricians throughout the nation, whether there is or is not any viable access to mental health professionals.  And the NICHD also proposed future studies looking at the more common but unstudied “off-label” use of medications in the pediatric population.

Ongoing studies under development include studies to look at dental health of children,  ways to more accurately identify child victims of abuse, and the use of “Common Factors” to help address mental health topics during pediatric visits.

Current ongoing studies in the middle of data collection include CEASE (Clinical Effort to Address Second-hand Smoke Exposure to promote parental smoking cessation), a pilot study to look at the acceptability/tenability of a test for the tobacco marker cotinine in practice, and BMI2 (Brief Motivational Interviewing to reduce BMI to study obesity prevention).

This is a very exciting time for PROS and we welcome interested practitioners as several important studies are about to start.  

To join the PROS network, or to learn more, go to http://www.aap.org/pros/howjoin.htm  or contact Dr. Sue Daniels who is the PROS coordinator for the state of Montana at 406-522-5437 or sdaniels@acornpediatrics.com.