 | |  | |  | |  | |  | |  | |  | |  | |  |
The Pediatric Council is a forum to enable meaningful dialogue between pediatricians and
medical directors of health plans and strives towards enhancing the health care of NM's
children. It is chaired by president-elect Joanne Ray, DO and it's members are Albert Bourbon,
PA, Michelle Stam-MacLaren, Karen Carson, and Irene Moody.
medical directors of health plans and strives towards enhancing the health care of NM's
children. It is chaired by president-elect Joanne Ray, DO and it's members are Albert Bourbon,
PA, Michelle Stam-MacLaren, Karen Carson, and Irene Moody.
Our Inaugural Pediatric Council Meeting: A Summary
We thank Lovelace Medical Director Jeannette Velarde, MD, for her attendance and for her thoughtful
suggestions. I was disappointed with the attendance, but pleased with the preparations that were painstakingly
put together by Executive Director Erin Damour, by American Academy of Pediatrics senior health policy analyst
Lou Terranova; and me. Lynne Christiansen, director of Children’s Medical Services sent her representative,
Susan Chacon. Lowell Gordon of the State Medical Services Division attended. Claire Dudley, Lt. Gov. Diane
Denish’s Children’s Cabinet assistant, was called away at the last minute by political campaign commitments. Our
own Jane McGrath, MD represented the School Health office. Lou Terranova, Senior Health Policy Analyst at the
AAP national office, and front-man for chapter Pediatric Councils, met with our four Pediatric Society
representatives Thursday afternoon and Friday morning before the afternoon meeting. Our representatives are
Albert Bourbon, PA-C, Las Vegas; Irene Moody, MD, Albuquerque; Michelle Stam-MacLaren, MD, Gallup, and
Karen Carson, MD, Roswell. MacLaren, MD, Gallup, and Karen Carson, MD, Roswell.
The Friday Nov.3 Council meeting featured a slide talk which established the foundation for the Council and its
work. It was closely patterned after the presentation used by the Hawaii Chapter, which chose obesity as its
clinical focus. Our chapter chose asthma. My slide talk aimed at showing our guests that the Pediatric Society is
an organization worthy of attention. After introducing the AAP and the NMPS (and its successes), I introduced the
concept of Pediatric Councils. Lou spoke of council work across the country.
The following phrase laid out the purpose of a Pediatric Council: “A forum to enable meaningful dialogue between
pediatricians and medical directors of health plans.” Ultimately the goal is to “Enhance the health care of New
Mexico’s children.” The dialogue among us has begun, in any case. It remains to be seen how meaningful it is or
will be.
Once the foundation was laid, we moved to our clinical focus. Loretta Cordova de Ortega, MD, interim chair of the
UNM Department of Pediatrics, gave a talk on the prevalence of asthma in New Mexico, and our president, Rob
Miller, MD talked about the stepwise approach to asthma treatment. Our intent was to tie in these facts with our
difficulty dealing with prior authorizations for asthma medications that are indicated for use in the stepwise
approach. This problem had been identified by our members as their number one complaint. Our members had
their own examples ready to relay from their own practices, carefully crafted Thursday afternoon and Friday
morning during practice
sessions with Lou. In addition, our members had identified problems obtaining nebulizers for their patient with
asthma. Did you know that no Medicaid Salud program contracts with nebulizer suppliers in Gallup? Michelle told
us of two-hour waits to get nebulizers delivered—at best—with the equipment sometimes being driven down from
Colorado. Sometimes she and her peers have had to admit a patient to the hospital because they can’t get them
the equipment they need in a timely fashion. This surely would have gotten the attention of an MCO medical
director.
Loretta was able to tell of the UNM Department of Pediatrics’ need to hire two people just to handle prior
authorizations and intra-departmental referrals. After Rob’s presentation, the discussion stopped, and so did the
presentation. We were unable to go forward with practice-specific concerns.
In the end, Jeannette Velarde agreed to meet with the pharmacy directors of the MCOs to start work on a
standardized PA form for meds; Karen Carson volunteered her office
manager to develop a PA form that links the stepwise approach to a check-box PA form. We haven’t decided how
to approach the nebulizer issue. We plan to hold our
next meeting on February 23, 2007.
Lou told us afterward that only one of 13 insurance payers attended Rhode Island’s first Pediatric Council
meeting; not a great start! Eventually, when BCBS learned that E.R. utilization was high, and pediatric practices
couldn’t keep their doors open to accommodate late patients because of poor payment for after-hours care, the
payer approached the Council. They met. Two weeks later, BCBS fixed the after-hour payment problem. As a
short-term goal, we will work for a standardized PA form and will meet to consider our long-term strategy with the
MCOs. We know that even though our first step seemed small and tentative, we won’t stop marching.
We thank Lovelace Medical Director Jeannette Velarde, MD, for her attendance and for her thoughtful
suggestions. I was disappointed with the attendance, but pleased with the preparations that were painstakingly
put together by Executive Director Erin Damour, by American Academy of Pediatrics senior health policy analyst
Lou Terranova; and me. Lynne Christiansen, director of Children’s Medical Services sent her representative,
Susan Chacon. Lowell Gordon of the State Medical Services Division attended. Claire Dudley, Lt. Gov. Diane
Denish’s Children’s Cabinet assistant, was called away at the last minute by political campaign commitments. Our
own Jane McGrath, MD represented the School Health office. Lou Terranova, Senior Health Policy Analyst at the
AAP national office, and front-man for chapter Pediatric Councils, met with our four Pediatric Society
representatives Thursday afternoon and Friday morning before the afternoon meeting. Our representatives are
Albert Bourbon, PA-C, Las Vegas; Irene Moody, MD, Albuquerque; Michelle Stam-MacLaren, MD, Gallup, and
Karen Carson, MD, Roswell. MacLaren, MD, Gallup, and Karen Carson, MD, Roswell.
The Friday Nov.3 Council meeting featured a slide talk which established the foundation for the Council and its
work. It was closely patterned after the presentation used by the Hawaii Chapter, which chose obesity as its
clinical focus. Our chapter chose asthma. My slide talk aimed at showing our guests that the Pediatric Society is
an organization worthy of attention. After introducing the AAP and the NMPS (and its successes), I introduced the
concept of Pediatric Councils. Lou spoke of council work across the country.
The following phrase laid out the purpose of a Pediatric Council: “A forum to enable meaningful dialogue between
pediatricians and medical directors of health plans.” Ultimately the goal is to “Enhance the health care of New
Mexico’s children.” The dialogue among us has begun, in any case. It remains to be seen how meaningful it is or
will be.
Once the foundation was laid, we moved to our clinical focus. Loretta Cordova de Ortega, MD, interim chair of the
UNM Department of Pediatrics, gave a talk on the prevalence of asthma in New Mexico, and our president, Rob
Miller, MD talked about the stepwise approach to asthma treatment. Our intent was to tie in these facts with our
difficulty dealing with prior authorizations for asthma medications that are indicated for use in the stepwise
approach. This problem had been identified by our members as their number one complaint. Our members had
their own examples ready to relay from their own practices, carefully crafted Thursday afternoon and Friday
morning during practice
sessions with Lou. In addition, our members had identified problems obtaining nebulizers for their patient with
asthma. Did you know that no Medicaid Salud program contracts with nebulizer suppliers in Gallup? Michelle told
us of two-hour waits to get nebulizers delivered—at best—with the equipment sometimes being driven down from
Colorado. Sometimes she and her peers have had to admit a patient to the hospital because they can’t get them
the equipment they need in a timely fashion. This surely would have gotten the attention of an MCO medical
director.
Loretta was able to tell of the UNM Department of Pediatrics’ need to hire two people just to handle prior
authorizations and intra-departmental referrals. After Rob’s presentation, the discussion stopped, and so did the
presentation. We were unable to go forward with practice-specific concerns.
In the end, Jeannette Velarde agreed to meet with the pharmacy directors of the MCOs to start work on a
standardized PA form for meds; Karen Carson volunteered her office
manager to develop a PA form that links the stepwise approach to a check-box PA form. We haven’t decided how
to approach the nebulizer issue. We plan to hold our
next meeting on February 23, 2007.
Lou told us afterward that only one of 13 insurance payers attended Rhode Island’s first Pediatric Council
meeting; not a great start! Eventually, when BCBS learned that E.R. utilization was high, and pediatric practices
couldn’t keep their doors open to accommodate late patients because of poor payment for after-hours care, the
payer approached the Council. They met. Two weeks later, BCBS fixed the after-hour payment problem. As a
short-term goal, we will work for a standardized PA form and will meet to consider our long-term strategy with the
MCOs. We know that even though our first step seemed small and tentative, we won’t stop marching.
|
| pediatric council |