Ohio Pediatrics - Summer 2012 - Ohio AAP

Thanks to the efforts of the OhioAAP and its lobbyists, Ohio phy-sicians and children should bewell provided for when Ohio im-plements the Patient Protectionand Affordable Care Act(ACA).

Some of the main issues affect-ing Ohio physicians and chil-dren include:• Medicare/Medicaid Pay Par-ity. The Ohio AAP is actively in-volved with the Office of HealthTransformation and MedicaidDirector John McCarthy to ad-dress these concerns and en-sure fair and accurate reim-bursement for pediatricians. • Expansion of coverage.Medicaid expansion couldbring 200,000 Ohio children intothe Medicaid program. OhioAAP is continuing to monitorMedicaid expansion and essen-tial benefits, and will work withthe Kasich Administration toensure all Ohioans, especiallychildren, have access to healthcare. • Health insurance exchange.The Chapter is keeping a closeeye on the progress of healthinsurance exchange. Ohio AAPand several providers and insur-ers have expressed an interest

The Supreme Court has spoken – and with the exception of a Medi-caid expansion provision – the Affordable Care Act is the law of theland. So what does it mean for pediatricians and children in Ohio?States have many decisions to make, including those on exchanges,essential health benefits (EHB), and other reforms. States also mustsuccessfully implement the increase in Medicaid payment for pri-mary care services that begins in January 2013.

Ohio AAP’s Annual Meeting (Sept. 28-29 at the Embassy Suites Hotelin Dublin) will provide more about the law and where Ohio stands interms of progress during this presentation by staff from the AAP Di-vision of State Government Affairs. National AAP expert Dan Walterswill be on hand to deliver this update.

On the state level, William Cotton, MD, Charlie Solley, and our new-est lobbyist, Danny Hurley, will address issues that are critical to yourpractice. These issues include the upcoming elections, prior autho-rization, and the new Medicaid MCOs.

Please visit our website, www.ohioaap.org, for more details. See ACA...on page 15

So what now? Where doesOhio stand with ACA law

Ohio AAPis advocating for members

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The Ohio AAP Foundation’s sixth annual fundraiser, Safety,Sandwiches & Slapshots, held Aug. 7 at Nationwide Arena,Columbus, raised $10,000 for the Ohio AAP Foundation pro-grams. For the full story, and more photos, see page 12.

34144_Peds Summer 2012_Ped Spring 2007copy 4 co copy 2 8/23/12 2:50 PM Page 1

See Legislation...on page 6

www.ohioaap.org Ohio Pediatrics • Summer 2012

A Publication of the Ohio Chapter, AmericanAcademy of Pediatrics

OfficersPresident....Judith Romano, MD

President-Elect....Andrew Garner, MD, PhD

Treasurer....Robert Murray, MD

Delegates-at-large:Jill Fitch, MDAllison Brindle, MDMike Gittelman, MD

Executive Director:Melissa Wervey Arnold450 W. Wilson Bridge Road, Suite 215Worthington, OH 43085(614) 846-6258, (614) 846-4025 (fax)

Lobbyist:Dan Jones Capitol Consulting Group37 West Broad Street, Suite 820Columbus, OH 43215(614) 224-3855, (614) 224-3872 (fax)

Editor:Karen Kirk(614) 846-6258 or (614) 486-3750

Ohio AAP’s plan of action on ACAWith a high stakes election andnewly drawn legislative maps,members of the General Assem-bly are spending much of theirtime in their districts this summer.That didn’t stop Representativesand Senators from dealing with aflurry of bills before departing Co-lumbus in June. The staff of theOhio AAP was very engaged dur-ing this legislative work periodand saw movement on a num-ber of key bills. We continue tomonitor several issues includingOhio’s implementation of thePatient Protection and Afford-able Care Act (ACA) as theydevelop.

HB 143—Youth ConcussionLegislationPrior to departing Columbus, theOhio House of Representativespassed HB 143 by a vote of 84 to4. This legislation, sponsored byReps. Michael Stinziano (D-Co-lumbus) and Sean O’Brien (D-Trumbull County) would expandeducation about and protectionfrom head injuries to coachesand participants in sports teamsin an effort to curb the growingnumber of such injuries. While thisoverwhelming bipartisan vote isencouraging, House Bill 143 wasamended to allow chiropractors,optometrists, and physical thera-pists to clear a child to return toplay without an examination by aphysician. HB 143 will likely seemovement in the Senate duringthis year’s post election lameduck session. Ohio AAP will workhard to ensure this legislation pro-vides the appropriate level ofprofessional care in youth athlet-ics.

ACA ImplementationFollowing the U.S. SupremeCourt’s landmark ruling on theAffordable Care Act (ACA)attention is now turning to statesto implement various provisionsincluding: Medicaid expansion,the creation of an insurance ex-change, and Medicaid primarycare provider rate increases. Be-low is a summary of each provi-sion and Ohio AAP’s plan ofaction:

• Medicare/Medicaid Pay Parity:ACA provides for a two-year en-hanced Medicaid reimbursementrate for primary care physicians;at no cost to the state, pediatri-cians and pediatric subspecialistswill be reimbursed at Medicarerates for Medicaid services. Con-cerns have been raised that theState may not be able to imple-ment this enhanced rate by Jan.1, 2013 nor can they correctlyidentify pediatric specialists in thecurrent MITS system. Ohio AAP isactively engaged with the Officeof Health Transformation andMedicaid Director John Mc-Carthy, to address these con-cerns and ensure fair and accu-rate reimbursement for pediatri-cians.

• Medicaid Expansion: UnderACA, Medicaid eligibility is in-creased to 133% federal povertyguidelines (FPG) for all adults and300% FPG for the aged, blind,and disabled (ABD) population.The Supreme Court decision al-tered this provision so that statesnow have to opt into expandedMedicaid coverage. The federalgovernment will cover all costsassociated with expansion for the

first few years and at least 90%beginning in 2018. If Ohio expandsMedicaid eligibility, the cost to theState would reach nearly $1 billionby 2018. Even if the Kasich Ad-ministration keeps current enroll-ment standards, Ohio’s Medicaidrolls increase due to the ‘wood-work effect.’ Under the woodworkeffect, Medicaid enrollmentwould grow among persons whoare currently eligible for Medicaidbut not currently enrolled. Thesenew enrollees would be encour-aged to enroll due to the individ-ual mandate becoming effective,increased outreach and aware-ness of Medicaid, and streamlinedenrollment systems. Despite thesenew costs, Medicaid expansioncould bring more than 200,000Ohio children into the Medicaidprogram. Ohio AAP will continueto monitor Medicaid expansion

Update from the Statehouse

2


I am honored to become thePresident of the Ohio AAP andlook forward to serving in thatcapacity for the next two years.

The OAAP is a very successful,well-oiled machine that repre-sents almost 3,000 pediatriciansin the state of Ohio, caring forapproximately a million children.Because of your membership,along with a dedicated leader-ship team, and a dedicated staffled by Melissa Wervey Arnold,the OAAP has become a leaderamong other AAP Chapters hav-ing been awarded numerousnational awards. As I move intothe Presidency, I see my role assculpting and nurturing the mo-mentum and activities that haveresulted in our successes. To thatend, I offer an approach that willallow the process of our work todictate the structure of our orga-nization.

At a recent Executive Commit-tee retreat, your leaders em-

braced this approach identifyingfour broad areas that representthe scope of our work yet allowfor direction and development offuture projects. These four areasor “pillars” help ensure the orga-nization is moving in the right di-rection while providing membervalue to you.

The four pillars are Child Health,Pediatric Practice, Advocacy,and Operations. Your leadershiphas identified goals and measur-able outcomes that relate toeach of the pillars which I willintroduce to you today. I will gointo more detail about each onein upcoming articles.

Child HealthChild health represents all areasof care of children but with thepriority to have an overall shift inapproach from treatment-focusto a focus on child wellness.

Pediatric PracticePediatric practice represents allareas that relate to you, thepractitioner, such as coding, bill-ing, and ACOs. Also outreach tospecific populations of pedia-tricians such as hospitalists, sub-specialists and young physicians.

AdvocacyFunding for programs, legislativeconcerns and “being the expertsat the table” for children’s issuesare examples in this area.

OperationsOur MOC programs, our relation-ship to the OAAP Foundationand fiscal responsibility to the

organization are examples. Allcurrent committees, projects,and operations relate to one orseveral of these pillars.

The structure also allows for in-creased participation by you, ourmembers, by affording you theopportunity to follow an interest,a passion, or solve a practiceproblem. You can serve as an ex-pert or work with a group aroundyour interests without the com-mitment of a “committee.”

Our restructured Executive Com-mittee meetings/Open Forumswill be opportunities to cometogether to learn about currentprojects and to develop newones. The first will be in conjunc-tion with our Annual Meeting inDublin, Ohio on Sept. 28, 2012.

Speaking of the Annual Meet-ing... Don’t miss it, as there issomething for everyone fromMOC opportunities to talks onnew AAP policies by nationalexperts, to state and nationallegislative updates. Casino Nightis a fun way to support the OhioAAP Foundation and its projects.

Please get to know Ohio AAP.Whether you are a generalist, aspecialist, a hospitalist, in privatepractice, hospital-based prac-tice, or in an academic setting –you have expertise to share andthe Chapter can serve you, sothat you can serve children.

Judy Romano, MDOhio AAP President

www.ohioaap.org Ohio Pediatrics • Summer 2012

President’s Message

‘Four pillars’ approach ensuresChapter moving in right direction

3

President Judy Romano, MD


KIDS LOVE THE TASTE!Milk provides nutrients essential for good health and kids drink morewhen it’s flavored.

NINE ESSENTIAL NUTRIENTS!Flavored milk contains the same nine essential nutrients as white milk - calcium, potassium, phosphorus, protein, vitamins A, D and B12, riboflavin and niacin (niacin equivalents) –and is a healthful alternative to soft drinks.

HELPS KIDS ACHIEVE 3 SERVINGS!Drinking low-fat or fat-free white or flavored milk helps kids get the 3 daily servings* of milk and milk products recommendedby the Dietary Guidelines for Americans.

BETTER DIET QUALITY!Children who drink flavored milk meet more of their nutrient

needs; do not consume more added sugar or total fat; and are notheavier than non-milk drinkers.

TOP CHOICE IN SCHOOLS!Low-fat chocolate milk is the most popular milk choice in schools

and kids drink less milk (and get fewer nutrients) if it’s taken away.

REFERENCES:1. National Health and Nutrition Examination Survey (2003-2006), Ages 2-18 years.2. Johnson RK, Frary C, Wang MQ. The nutritional consequences of flavored milk consumption by school-aged children and

adolescents in the United States. J Am Diet Assoc. 2002; 102: 853-856.3. National Dairy Council and School Nutrition Association. The School Milk Pilot Test. Beverage Marketing Corporation for

National Dairy Council and School Nutrition Association. 2002. Available at:http://www.nationaldairycouncil.org/ChildNutrition/Pages/SchoolMilkPilotTest.apx.

4. National Institute of Child Health & Human Development. For Stronger Bones…for Lifelong Health…Milk Matters! Available at:http://www.nichd.nih.gov/publications/pubs/upload/strong_bones_lifelong_health_mm1.pdf Accessed on June 21, 2011.

5. U.S. Department of Health and Human Services. Best Bones Forever. Available at: http://www.bestbonesforever.gov/ Accessed June 21, 2011.

6. Frary CD, Johnson RK, Wang MQ. Children and adolescents’ choices of foods and beverages high in added sugars are associatedwith intakes of key nutrients and food groups. J Adolesc Health. 2004; 34: 56-63.

7. American Academy of Pediatrics, Committee on School Health. Soft drinks in schools. Pediatrics. 2005; 113: 152-154.8. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2010.

7th Edition, Washington DC: U.S. Government Printing Office, December 2010.9. Greer FR, Krebs NF and the Committee on Nutrition. Optimizing bone health and calcium intakes of infants, children and

adolescents. Pediatrics. 2006; 117: 578-585.10. Murphy MM, Douglas JS, Johnson RK, et al. Drinking flavored or plain milk is positively associated with nutrient intake and is

not associated with adverse effects on weight status in U.S. children and adolescents. J Am Diet Assoc. 2008; 108: 631-639.11. Johnson RK, Appel LJ, Brands M, et al. Dietary Sugars Intake and Cardiovascular Health. A Scientific Statement From the

American Heart Association. Circulation. 2009; 120: 1011-1020.12. 2010-2011 Annual School Channel Survey, Prime Consulting Group, May 2011.13. Patterson J, Saidel M. The Removal of Flavored Milk in Schools Results in a Reduction in Total Milk Purchases in All Grades,

K-12. J Am Diet Assoc. 2009; 109: A97.

Reasons Why Flavored Milk Matters

*DAILY RECOMMENDATIONS – The 2010 Dietary Guidelines for Americans recommends 3 daily servings of low-fat or fat-free milk and milk products for those 9 years and older, 2.5 for those 4-8 years, and 2 for those 2-3 years.

www.nationaldairycouncil.org/childnutrition ©National Dairy Council 2011®

Adding Chocolate to Milk Doesn’t Take Away Its Nine Essential NutrientsAll milk contains a unique combination of nutrients important for growth and development.Milk is the #1 food source of three of the four nutrients of concern identified by the 2010Dietary Guidelines for Americans: calcium, vitamin D and potassium. And flavored milk contributes only 3% of added sugars in the diets of children 2-18 years.

www.ohioaap.org Ohio Pediatrics • Summer 2012 4


5www.ohioaap.org Ohio Pediatrics • Summer 2012

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Legislation...from page 2

and will work with Administrationofficials to ensure all Ohioans, es-pecially children, have access tohealth care.

• Health Insurance Exchange: Thedeadline for states to notify theDepartment of Health and HumanServices (HHS) of their plans forcreating an insurance exchange isNov. 16, 2012; every indicationfrom Lt. Governor and Ohio De-partment of Insurance DirectorMary Taylor is that Ohio will join thefederal exchange in lieu of creat-ing a state-based exchange. De-spite this hard line from the Ad-ministration, several providers andinsurers, including Ohio AAP, haveexpressed interest in Ohio creatinga state-based exchange. Besidesa $1 million planning grant, Ohio

has missed out on millions more infederal funding to establish an ex-change; with speculation loomingthat HHS might push back thedeadline for implementation thereis hope that Lt. Governor Taylor willchange course. In fact, the OhioSenate might begin informationalhearings on creating an ex-change in the fall. Ohio AAP willmonitor these hearings and anyother developments on this front.

HB 543—Youth Suicide PreventionLegislation HB 543, referred to as the “JasonFlatt Act” passed the House priorto summer recess by a vote of 97-0. The bill was introduced by Rep.Marlene Anielski (R-Lakewood),whose son took his own life in 2010.The bill would require teachers to

be trained on how to recognizedepression and suicidal tenden-cies among students. By providingteachers with these tools they caninform parents when a child mightbe contemplating suicide and in-tervene. This legislation shouldmove quickly through the OhioSenate during lame duck.

Although many challenges lieahead, the Ohio AAP and its con-sultants at Capitol ConsultingGroup will be working to makesure the voices of Ohio’s pediatri-cians and Ohio’s children areheard loudly and clearly.

Ohio AAP LobbyistsCapitol Consulting Group

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See Pound...on page 17

Ohio Chapter CQN2 Asthma Projectrewarded for Planned Care Approach National AAP recognized each ofthe four participating chapters –Alabama, Maine, Oregon andOhio – for an area in which theyexcelled in the Chapter QualityNetwork Asthma Project (CQN2)during Learning Session 4, on July20. Ohio AAP was recognized forexemplary skills in using a plannedcare approach. Thank you to allof the following teams for makingus stand out in this area:

• Akron Children’s Hospital –Adolescent Medicine

• Akron Children’s HospitalPediatrics – Brecksville

• Cleveland Clinic Avon PointePediatrics

• Cleveland Clinic Lorain InstitutePediatrics

• Cleveland Clinic Pediatrics –Chesterland

• Cleveland Clinic Pediatrics –Independence• Cleveland Clinic Twinsburg

• Cleveland Clinic Strongsville

• Cleveland Clinic WestlakePediatrics

• Cleveland Clinic Willoughby HillsFamily Care Center

• Cleveland Clinic Wooster FamilyCare Center

• Galion Community HospitalHealth Services

• MetroHealth Medical Center

• Muskingum Valley HealthCenters

• Pediatric Associates of Fairfield

• PriMed Physicians in Dayton

• Public Health Department ofDayton and Montgomery County Community Child Health Centers

The final learning session of thiswave of CQN had an ambitiousagenda, with the overall goal ofachieving the following objectives:• Celebrate project success • Provide practice teams withstrategies to review/synthesizedata to �drive practice improve-ment • Teach spread concepts to en-gage physicians and senior lead-

ership in quality improvement�

Each Chapter was asked to high-light a high performing practiceon their webinar. The Ohio Chap-ter leadership chose to highlightPriMed Physicians Pediatric Group.Alonzo Patterson, MD, was inter-viewed by CQN2 Co-Lead, KimGiuliano, MD. PriMed has shownadvancement throughout CQN2,by having 17 physicians gothrough QI basics and enteringencounter forms each month.

For more information, please con-tact Elizabeth Dawson at [email protected] or call theChapter office (614) 846-6258.

“It is very useful to create a system of recording what you areactually doing to know if you are

doing as good a job as youthink.” – Ohio practice

Physicians across the country turn to ChildLab because we care about your patients as much as you do.

For a complete list of our pediatric laboratory tests and pathology services, visit www.childlab.com or call 800-934-6575.


efit from both CME and MOCcredit that is provided by the OhioAAP free of charge to its mem-bers for being part of this project.For more information, contactSean O’Hanlon at [email protected] or call the Chapteroffice at (614) 846-6258.

Another aspect of the project isthe incorporation of the PediatricPsychiatry Network (PPN). The Pediatric Psychiatry Network teamhas created a plan for providinga statewide network of expertconsultation by child and adoles-cent psychiatrists and other men-tal health professionals. The incor-poration of PPN into the BMW pro-ject has been extremely benefi-cial to the practices and their pa-tients. With that being said, weknow that there are still additionalimprovements that can be madein the way that the BMW prac-tices utilize the PPN.

If you are interested in more infor-mation about the PPN, and alsowant to provide your thoughts onhow it can be better utilized,please take part in our PPN FocusGroup that will take place at theOhio Annual Meeting in Septem-ber. The focus group is Friday,Sept. 28 at 11 a.m. In addition tohaving the opportunity to shareyour opinions, you will also benefitfrom a $50 discount on your An-nual Meeting registration fee, anda $20 gift card.

John Duby, MD Medical DirectorBuilding Mental Wellness

As Medical Director of theBuilding Mental WellnessLearning Collaborative(BMW), I have had the ex-citing experience of over-seeing a group of prac-tices who are revolutioniz-ing the way that we pro-vide care in the area ofmental health. The project, whichwas introduced in the last issue ofOhio Pediatrics, was created tohelp improve the delivery of chil-dren’s mental health services inthe state of Ohio, including antici-patory guidance, screening, earlydiagnosis, and management ofsocial-emotional problems in pri-mary care.

The first wave of the project start-ed with a learning session thattook place on June 6 and 7. Sincethe learning session, the eightpractices that were chosen totake part in the pilot phase havebeen working hard to incorporatethe BMW “toolkit” into their dailypractice. The toolkit is comprisedof a variety of screening forms, tipsheets, and therapeutic devicesthat aid in addressing mental

health in children and their fami-lies.

With the pilot phase of the projectunder way, we are excited to an-nounce that we are starting to re-cruit practices for the next waveof the project. The Learning Ses-sion that will kick off this nextphase of the project will takeplace on Nov. 14 and 15 at theMid-Ohio Foodbank in Grove City,OH. In preparation for this LearningSession, we will hold various infor-mational and pre-work calls toanswer any questions that prac-tices may have, and to begin tooutline what is involved in partici-pating in the project. In additionto having the opportunity to im-prove care within a practice, par-ticipating practices can also ben-


Pilot phase under way; BMWstarts to recruit for second wave

Physician Resources are available at:www.NationwideChildrens.org/physicianresources



Obesity management counselingstrategy provides useful resources“’This Guide to the Food Groups’handout is more helpful than adietician visit,” stated one parentfrom the Wheeling Hospital Centerfor Pediatrics at a Pound of Cureoffice visit.

Designed to help parents andchildren determine the recom-mended daily servings per foodgroup, this Guide to the FoodGroups is one of the many re-sources practitioners have beengiven as part of the Pound ofCure Learning Collaborative. Inaddition to being able to individu-alize the handout for each childby filling in the ounces, cups orteaspoons recommended, thishandout provides families withexamples that will help themmeet their daily needs, and illus-trates the amounts using a humanhand. The back of the handoutprovides additional tips per foodgroup to ensure families arechoosing the proper foodsthroughout the day.

Amy Jean, MD, pediatric endocri-nologist at the Wheeling HospitalCenter for Pediatrics, believes thishandout “… makes it easy for meto talk to patients and parentsabout servings, how to measureportion sizes, and ideas for meet-ing their daily requirements ineach of the food groups. It is pre-sented in a very practical way forfamilies to understand and use.”

Working in conjunction with theGuide to Food Groups is thePound of Cure branded MyPlateWheel. This easy-to-use wheelidentifies the ounces, cups or tea-spoons recommended per food

group, by the gender, age andactivity level of the child. This infor-mation is then transferred to theGuide to Food Groups for thepatient.

These are just two of the resourcesgiven to the practices that attend-ed the Pound of Cure LearningCollaborative – Wave 2 LearningSession on July 30, 2012 at the Mid-

Ohio Foodbank. Throughout theday, health-care professionalswere trained in the Pound of Curecounseling strategy, including howto take a comprehensive family,medical, nutrition and physicalactivity history; motivational inter-viewing; tips for billing and coding;and quality improvement methodsand tools to help practices with

See Obesity...on page 14

a pound of cure

www.poundofcure.org

A Guide to Your Food GroupsThis is a guide for the daily amounts your child should eat from each food group. Use the examples below to help your child meet their daily needs.

Grains Aim for ______ ounces each day

Fruits Aim for ______ cups each day

Vegetables Aim for ______ cups each day

Dairy Aim for ______ cups each day

Protein Aim for ______ ounces each day

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erreuurccuff coof AThis is a guide for the daily amounts your child should eat from each food group. Use the examples below to help your child meet their daily needs.

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Fruits

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What counts as an ounce of grains?

Aim for ______ ounces each day

Aim for ______ cups each day

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hand to measure an age appropriate amount



hand to measure an age appropriate amount

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What counts as a cup of fruit?

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What counts as a cup of vegetables?

What counts as a cup of fruit?

What counts as a cup of vegetables?



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Use this as a guide to include fruit

Portioning it out



Use this as a guide to include fruit

Dairy

What counts as a cup of dairy?

What counts as a cup of dairy?


Portioning it out

appropriate amount of cheese for a single


appropriate amount of cheese for a single

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Oils

What counts as an ounce of protein foods?

What counts as a teaspoon of oil?

What counts as an ounce of protein foods?

What counts as a teaspoon of oil?


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What counts as an ounce of protein foods? Portioning it out

appropriate amount of meat for a single meal

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Aim for ______ teaspoons each day

appropriate amount of meat for a single meal

.poundofcure.orgwww

appropriate amount of oil for a single meal

appropriate amount of oil for a single meal



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Six Ohio hospitals chosen to participatein nationwide initiative on breastfeedingSix Ohio maternity hospitals wereamong the 90 of 235 applicantsselected to participate in “BestFed Beginnings” – a nationwide ini-tiative from the National Initiativefor Children’s Healthcare Quality(NICHQ), in collaboration with theCenters for Disease Control andPrevention (CDC), that aims toincrease breastfeeding rates. Thebirthing hospitals selected include:• Atrium Medical Center, Middle-town • Doctors Hospital, Columbus • Riverside Methodist Hospital,Columbus • Summa Health System, Akron • UC Health/University Hospital,Cincinnati • University Hospitals MacDonald

Women’s Hospital, Cleveland

These maternity hospitals are lo-cated in regions with low breast-feeding rates and high rates of for-mula supplementation, but had toprovide in their application bothdetails and passion for the task athand! Best Fed Beginnings (http://www.nichq.org/who_we_are/in_the_news.html?id=80) aims to pro-vide technical assistance for birth-ing hospitals to achieve “BabyFriendly” status. Baby Friendly Hos-pital Initiative (BFHI) is an interna-tional program, initiated byUNICEF/WHO, that designates ma-ternity facilities as “Baby-Friendly”if no free milk substitutes are ac-cepted (all formula must be pur-

chased at fair market value) and10 specific maternity practicesthat support breastfeeding areadopted. Achieving Baby-Friendlydesignation is very challenging:just over 6% of U.S. birthing hospi-tals achieved this goal. Each ofthe 10 steps requires hospital em-ployees at all levels of service tobe fully “on board” – a logisticallyand financially difficult task. BestFed Beginnings offers a variety ofways for hospitals to succeed, in-cluding: webinars with directcoaching, step-by-step planningand strategies for a team-basedapproach, support from otherhospitals, and a series of writtengoals and objectives to keepeach hospital team moving for-ward.

The “10 steps” required are: 1. Have a written breastfeedingpolicy that is routinely communi-cated to all health-care staff. 2. Train all health-care staff in skillsnecessary to implement this poli-cy. 3. Inform all pregnant womenabout the benefits and manage-ment of breastfeeding. 4. Help mothers initiate breast-feeding within one half-hour ofbirth. 5. Show mothers how to breast-feed and maintain lactation,even if they should be separatedfrom their infants. 6. Give newborn infants no foodor drink other than breastmilk, un-less medically indicated. 7. Practice rooming in – that is,allow mothers and infants to re-main together 24 hours a day. 8. Encourage breastfeeding on

See Breastfeeding...on page 16



Help families prevent injuriesDo you feel comfortable address-ing burn safety with families?When do you address uninten-tional ingestions? What type of an-ticipatory guidance do you givefamilies on water safety?

The Ohio AAP has developed anew quality improvement learningcollaborative to help you feelmore comfortable addressingthese, and many more topics, atwell-child visits from birth throughthe 12 month visit. The goal of theInjury Prevention Learning Colla-borative is to offer pediatricianswith a tool that enables them toscreen families for the greatest in-jury risks at every well-child visitfrom newborn to 1 year, and thatalso allows them to address tar-geted, individually pertinent issueswith families. Health-care pro-viders will be trained in appropri-ate injury prevention strategies,and will be given talking points on

Ohio AAP welcomes new membersCeyda AcunJessica AdermanIlona Brener AlbrechtRoopali BapatRajit Kumar BasuMelissa BenbowKristen BenningerTarun BhaliaJason BihnDavid BillmireKimberly BlazerDeborah Ann BoydMary Carol BurkhardtMatthew ByersTeresa ByrneSophia ChenAbigail ChudzinskiStephanie ClarkEthel ClementeRachel ColbyJoel DavidsonChristine Davis

Rachel DickersonElizabeth DiekrogerChristina DillerErin DonleyAlison DownesClifford EllingsonCharles ElmaraghyLindsay EwanEne FairchildEmily FergusonBrad FillerAdam GarlockSamatha GeeJoshua GoldbergKatherine GriswoldNeepa GurbaneCraig GurneyMichael HokensonAdam HouserLisa HumphreyJohn HuttonTracy Ivy

Leonard JancharMelissa JonesJustin KahnJessica KanisOriaku Kas-OsokaSara KellyZahida KhanZaid KhatibMichael KoniarczykBenjamin KoppCarole LannonSara LappeTamra LemleyLisa LightTraci LynchJamie MacklinNegati MahajanErin MaleyAnne Chopin MayStephanie MerharLeah MiddlebergLeanne Mehata

Cameron MillerMohannad MoallemTeresa MoonWilla MooreMatthew O’RourkeCharles PaceAmber PattersonWilliam PayneErin NienaberAdam PowellKatherine PowellJohn RafordGreg RuppElizabeth RuppertTimothy SavageDavid SayersRebecca ScheinRandall SchlievertElizabeth SchlossKristen SchneiderDaniel SchumacherTeresa Seto

Meera ShahVanessa ShanksBrad SobolewskiLoretta SonnierCorinne BrooksKat erine SteingassChristopher StrykerDieter SumerauerDouglas TeskeAnthony TheileGina ThompsonRichard TurnerTiffany TurnerBrian VernauJanak WadwaKatherine WagnerDane WarnerStephen WarrickCaroline WeingartEmily WilandJulie WilsonSarah Youssef

Akron ChildrenʼsAd

4-colorEmailed to Prepress

items to address with families ontopics such as car safety, sleepsafety, fire/burn safety, family inter-actions, fall prevention, watersafety, choking, unintentional in-gestions, play safety, and homesafety.

Pediatricians participating in theInjury Prevention Learning Colla-borative will receive 25 Part IV

Maintenance of Certification cred-its for their involvement. The learn-ing collaborative will launch priorto the Ohio AAP Annual Meetingwith a full-day learning session onThursday, Sept. 27, 2012 at the Em-bassy Suites in Dublin, Ohio.

To learn more, please contact Pro-ject Manager, Sean O’Hanlon [email protected].

h


about the My Story Foster CareProgram. Dr. Thackeray expressedhow important it is that pediatri-cians recognize the unique needsof foster children and their familiesas they transition from a biologicalhome into a foster home. In 2011,the Ohio AAP Foundation distrib-uted foster care bags to 150 Ohiochildren in need.

Sara Guerrero-Duby, MD, spokeabout the Early Literacy Initiative,a program near and dear to her.The Foundation is in the process ofevolving this program. However,

the Chapter continues to supportthose members with Reach Outand Read sites and emphasizesearly literacy as a main priority. In2011, the Foundation raised morethan $100,000 for Early Literacy,purchasing new and gently usedbooks to distribute to Ohio chil-dren.

Amy Sternstein, MD, discussedOunce and Pound of Cure, theFoundation’s obesity preventionprograms. Pound of Cure, offerstraining and resources to aid clini-cians in evaluating, interviewing,educating, tracking and followingup with overweight and obesechildren and their families. Lastyear, 80 pediatricians received theOunce of Prevention and Poundof Cure training.

This year’s Safety, Sandwiches &Slapshots, was a huge success as itraised nearly $10,000 for the OhioAAP Foundation initiatives.


Foundation fundraiser raises $10,000The more than 70 attendees atthe sixth annual Ohio AAP Foun-dation fundraiser were treated toprizes, three guest readers, aColumbus Blue Jackets bouncehouse, and a tour of NationwideArena including the Blue Jacketslocker room.

Safety, Sandwiches & Slapshotsheld Aug. 7 at Nationwide Arenain downtown Columbus was a funevent for the whole family. Theevent focused on the Ohio AAPFoundation’s main goals of InjuryPrevention, Obesity Prevention,Early Literacy and Foster Care.

Bob McElligott, color analyst forthe Columbus Blue Jackets RadioNetwork served as emcee andguest reader, along with DanHinote, Columbus Blue JacketsAssistant Coach, and Bill Davidge,Fox Sports Ohio analyst.

Throughout the event – other thanstorytime – the children in atten-dance were entertained with thebounce house and practicingtheir hockey moves in the streethockey area.

Sarah Denny, MD, and MikeGittelman, MD, co-chairs of theInjury Prevention Committee,spoke about the Chapter’s safetyawareness campaign – Put A LidOn it! – promoting the message ofwearing a helmet while biking,skating, and sledding. More than2,600 bike helmets were distri-buted in 2012 during Ohio BikeHelmet Safety Awareness Week inMay.

Jonathan Thackeray, MD, whoworks with the Chapter initiativesrelated to foster care, spoke

Bill Davidge, Fox Sports Ohioanalyst, a guest reader,reads from “Is Your Mama aLlama?”

The Columbus Blue Jackets’bounce house was a big hit forthe children in attendance.

Emcee Bob McElligott,color analyst for theColumbus Blue Jackets,does a good job keep-ing the children en-grossed by reading“Good Night Moon.”



The Ohio AAP Foundation Would Like To Say

Thank You to Our Generous Sponsors:“Goodnight Moon” Sponsors:

“Green Eggs and Ham” Sponsors:

Special Thank You to:

o

o

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Sarah Denny, MD, and Mike Gittelman, MD, co-chairs of the Injury Prevention Committee, spokeon the Chapter’s safety awareness pro-gram.

Future goalieAlex Denny is

dressed for thepart, and readyto demonstrate

his hockeymoves.

More than 70 attendees turned out for the sixth annual OhioAAP Foundation fundraiser at Nationwide Arena on Aug. 7.Safety, Sandwiches & Slapshots was a fun event for thewhole family.

Amy Sternstein, MD, andher son, Travis, get abehind-the-scenes tour ofthe Blue Jackets lockerroom at NationwideArena.



Obesity...from page 9

a pound of cure

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implementing the Pound of Cure strategy within aprimary care practice.

The counseling strategy is intended to review thechild’s current energy balance, and set goals atconsecutive office visits calculated to level the bal-ance of energy in (calories) and energy out (activi-ty).

Wave 2 of the Pound of Cure Learning Collabora-tive launched in late July, and will proceed over thenext nine months.

For more information on how to get involved in theLearning Collaborative, please contact ProjectManager Samantha Anzeljc ([email protected]) or Elizabeth Dawson([email protected]) or call the Chapter officeat (614) 846-6258.

We created the Tribute Plan to provide doctors with more than just a little gratitude for a career spent practicing good medicine. Now, the Tribute Plan has reached its five-year anniversary, and over 22,700 member physicians have qualified for a monetary award when they retire from the practice of medicine. More than 1,300 Tribute awards have already been distributed. So if you want an insurer that’s just as committed to honoring your career as it is to relentlessly defending your reputation, request more information today. Call (800) 666-6442 or visit us at www.thedoctors.com/tribute.

We do what no other medical liability insurer does. We reward loyalty at a level that is entirely unmatched. We honor years spent practicing good medicine with the Tribute® Plan. We salute a great career with an unrivaled monetary award. We give a standing ovation. We are your biggest fans. We are The Doctors Company.

Tribute Plan projections are not a forecast of future events or a guarantee of future balance amounts. For additional details, see www.thedoctors.com/tribute.

www.thedoctors.com


in Ohio creating a state-based exchange. Lt. Governor and OhioDepartment of Insurance Director Mary Taylor is indicating thatOhio will join the federal exchange in lieu of creating a state-based exchange. The Ohio Senate is planning to begin informa-tional hearings on creating an exchange. Ohio AAP will monitorthese hearings, and any other developments on this front.

As always, the Ohio Chapter will continue to advocate for Ohiophysicians and Ohio’s children for the best interest of both.

For more information on the Affordable Care Act, please see thelegislative article on Page 2.

the meeting. Peds 21 on Friday willfocus on Health Disparities in Prac-tice and the Community and willsurely present important concepts.

As we approach the fall season, itis time to start to consider topics tobe presented as Chapter and Dis-trict Resolutions. A resolution is yourdirect voice to the AAP Board,and I strongly urge you to expressyour issues though this process.Contact either your Chapter lead-ership or me ([email protected]) forhelp.

Looking forward to the future offinance of care for children willmake the November election ex-tremely important. Meet AAP “FlatCharlie” and join your colleaguesin getting out the vote for children.It is critical that we become in-formed about the issues that willaffect our patients and our prac-tices for years to come. Down-load AAP “Flat Charlie” (http://www.aapgoTV.org) and join the

Sectionon Med-ical Stu-dents,Residentsand Fel-lowshipTrainees intheir cam-paign toget outthe vote.Take aphoto ofyour FlatCharlie and email it to [email protected] to help demonstrate thatyou care for kids, and you vote.

Thank you once again for all youdo for children, and please let meknow if there is any way in which Ican help.

Marilyn Bull, MD FAAPDistrict V Chairperson

The Ohio Chapter leadership islooking forward to many AAPevents in the weeks ahead aspart of Dis-trict andNationalAAP meet-ings.

The chap-ters of Dis-trict Vgatheredin Indiana-polis Aug.23-27 withmembersof District II of New York to discussand network about issues of im-portance to everyone. The contri-butions they made, and the valuethey glean, are significant. Someof the topics addressed were: Im-migrant Children and Health Lit-eracy, Accountable Care Asso-ciations and Population Health,Subspecialists and the MedicalHome, and Patient-CenteredMedical Home Certification.Membership issues and Hot Topicswere also prominent on the agen-da. I can assure you that manyaspects from the discussions will fil-ter into your Chapter affairs in theweeks and months ahead.

I also hope to see many of you atthe National Conference and Ex-hibition in October. New Orleanspromises to be a very inspiring ex-perience for CME, collaboration,and enjoying the pleasures of thecity. We will meet at the DistrictBreakfast on Sunday morning andseveral other events throughout

District V Report

Marilyn Bull, MD

November elections extremelyimportant for care of children


AAP Flat Charlie

ACA...from page 1



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demand. 9. Give no artificial teats or paci-fiers (also called dummies orsoothers) to breastfeeding infants. 10. Foster the establishment ofbreastfeeding support groups andrefer mothers to them on dis-charge from the hospital or clinic.

Although breastfeeding is acknow-ledged internationally and by theAAP as the optimal way to feedbabies, facts and figures show thatthe U.S. has not met its own goalsfor breastfeeding initiation, exclu-sivity, and duration. Certain sub-populations (e.g. WIC eligibility,young age, low educational level,African-American race) have low-er breastfeeding rates than theU.S. as a whole. The CDC began to “grade” ma-ternity hospitals using a 52 ques-

tion survey called the MaternityPractices in Infant Nutrition andCare (mPINC), which measuresfacility support for breastfeeding.Ohio’s 2012 score is 71 (out of 100),but only 4.2% of births occur atBaby-Friendly designated hospi-tals, and Ohio’s rates of everbreastfed (62.3% vs. 76.9% U.S.),and of exclusive breastfeeding at3 months (29.1% vs. 36% U.S.) and 6months (11% vs. 16.3% U.S.) do notyet make us proud.

Hopefully Best Fed Beginnings willhelp Ohio surge forward in helpingmothers meet their breastfeedinggoals.

Lydia Furman, MDAAP Chapter Breastfeeding Coordinator

Breastfeeding...from page 10

Big changes were announcedfor The Community Access ToChild Health (CATCH) Grants.Now, pediatricians can applyfor both Planning and Imple-mentation grants each cycle,not just alternating cycles.

The 2013 Cycle 2 CATCH Plan-ning, Implementation, andResident Call for Proposals willopen Nov. 1, 2012. The appli-cation deadline will be Jan.31, 2013 at 2 p.m. CST.

For more information, contactState CATCH facilitators, JonnaMcRury, MD, ([email protected]) or Heng Wang, MD, PhD([email protected]).

CATCH grants are nowavailable each cycle



Friday Night…

CASINO NIGHT!A fundraiser for the Ohio AAP Foundation

Spouses and other guests are also invited to attend this fun evening!

2 drink tickets per person (cash bar available) and gaming chips

**NOTE: No childcare provided.



Heat-related deaths spiked in AugustWith all the fun ofsummer, there isundoubtedly anincrease in pedi-atric traumas andfatalities. Sadly, inthe first week ofAugust therewere seven pedi-atric deaths fromchildren being leftin hot cars. Al-though no oneever thinks thatthey would forgettheir child in thecar or “it would never happen to me,” it hasaffected families from all walks of life, includingphysicians. It seems like a silly thing to mention dur-ing a well-child visit, but it could save a life.KidsandCars.org, an organization devoted to theprevention of child injury and fatalities in andaround motor vehicles, recommends the followingBE SAFE strategy to help prevent these tragicdeaths. Further information can be found atwww.kidsandcars.org.

• Back seat – Put something in the back seat soyou have to open the door when leaving the vehi-cle – cell phone, employee badge, handbag, etc.Every child should be correctly restrained in theback seat.

• Stuffed animal – Move it from the car seat to thefront seat to remind you when your baby is in theback seat.

• Ask your babysitter or child-care provider to callyou within 10 minutes if your child hasn't arrived ontime.

• Focus on driving – Avoid cell phone calls and tex-ting while driving.

• Every time you park your vehicle open the backdoor to make sure no one has been left behind.

Fatalities following Ingestions of Buckyballsand BuckycubesThe U.S. Consumer Product Safety Commission(CPSC) has filed a formal complaint against themanufacturer of Buckyballs and Buckycubes fol-lowing evidence provided by pediatricians andconsumers about serious injuries – and evendeaths – associated with accidental ingestions ofthese products. According to CSPC data, at leasthalf of all magnet ingestions involved Buckyballs orBuckycubesand there-fore theCommis-sion deter-mined thatthis productis defectiveand unsafeto be sold.An informalsurvey ofpediatricgastroen-terologists identified more than 60 magnet inges-tions in the last two years, which required 26 surg-eries. Injuries sustained from swallowing these prod-ucts include bowel perforations or fistulas,ischemia, sepsis, bowel obstructions resulting inbowel perforations and even death.

Ohio’s new texting lawOn Sept. 1, 2012 Ohio’s new texting law goes intoeffect. The new law makes texting while driving asecondary offense for adults, resulting in up to $150fine, but for minors, the law is a primary offenseand makes it illegal for teen drivers to use anyhandheld device, including ipods, phones, ipads,laptops, etc, while driving. Minors in violation of thelaw receive a 60-day license suspension and a$150 fine for their first offense, and a one-yearlicense suspension and a $300 fine for repeatoffenses.

Sarah Denny, MDCommittee on Injury and Violence Prevention



The Ohio AAP wants to bring our FREE Ounce of Prevention program

TRAINING…

free CME!

…that COMES TO YOU!

SIGN UP TODAY! http://www.theounceofprevention.org/parentsurvey/ounce-of-prevention-training-


The Ohio AAP announces the following meetings and events.

Sept. 27-29 – 2012 Ohio AAP Annual MeetingEmbassy Suites, Dublin

Sept. 27 – Injury Prevention Learning Collaborative Learning Session

Sept. 28 – First ever Poster PresentationSept. 28 – Opening Reception and Awards CeremonySept. 28 – Casino Night benefitting the Ohio AAP

Foundation Sept. 29 – Presentations from national experts on:

• AAP Guidelines on Safe Sleep• Translating Developmental Science into Healthy

Lives: Toxic Stress and the Role of the Pediatrician• Healthcare Reform from a State and National

Perspective

Nov. 14 & 15 – Building Mental Wellness Learning Session, Mid-Oho Foodbank, Grove City

Jan. 11, 2013 – Executive Committee, Columbus

April 16, 2013 – Executive Committee, Cleveland

Calendar of Events

Dues remitted to the OhioChapter are not deductibleas a charitable contribution,but may be deducted as anordinary and necessary busi-ness expense. However, $40of the dues is not deductibleas a business expense be-cause of the Chapter’s lob-bying activity. Please consultyour tax adviser for specificinformation.

This statement is in referenceto fellows, associate fellowsand subspecialty fellows.

No portion of the candidatefellows nor post residencyfellows dues is used for lob-bying activity.

Ohio ChapterAmerican Academy of Pediatrics450 W. Wilson Bridge Rd. Suite 215Worthington, OH 43085

PRESORTEDSTANDARD

Permit No. 156U.S. Postage

PAIDDUBLIN, OH

Dues disclosurestatement


Documents

Ohio Pediatrics - Summer 2012 - Ohio AAP