Volume 3, Number 3
July, 1996
The Newsletter of the Section on Critical Care of the American Academy of Pediatrics.
Questions or comments should be addressed to the editorial staff
IN THIS ISSUE:
The Pediatric Critical Care Section at Children's Hospital of Wisconsin will host the 9th Annual Pediatric Critical Care Colloquium at the Pfister Hotel in downtown Milwaukee from September 25-28, 1996.The afternoon before the PCCM begins, a workshop for educators, "Bedside Teaching in the PICU: Making it Easier" is being offered under separate registration.
During the PCCC, panel discussions will include managed care, critical pathways / CQI, and the information age: informatics and Internet. New this year will be two sessions with research and clinical issues of interest to Advanced Practice Nurses in pediatric critical care.
By the time you receive this newsletter, if you have not received a brochure with registration materials for the PCCC, please contact Susan Day at sday@its.mcw.edu or (414) 266-3360. The deadline for hotel reservations and PCCC registration is August 24.
Today's turbulent health care environment has led to changes to the way in which pediatricians are reimbursed by public and private payers. Driven primarily by the expansion of the Medicare Resource-Based Relative value Scale (RBRVS) physician fee schedule into the private and public sectors, the American Academy of Pediatrics continues to advocate through the AMA CPT Editorial Panel, American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC), and the Health care Financing Administration (HCFA), for the inclusion of pediatric services.The Medicare RBRVS physician fee schedule, based on research proposed and developed by William C. Hsaio, Ph.D. and his colleagues at the Harvard School of Public Health was implemented by the HCFA on January 1, 1992. The Medicare RBRVS physician fee schedule consists of three key components: physician work, practice expense, and professional liability insurance, that quantify, through a measure of relative value units (RVUs), the amount of resources utilized in the provision of physician services.
The original Hsaio studies included minimal pediatric-specific services and participation by pediatricians. This is a critical fact for pediatrics because, in their attempt to control their escalating health care costs, public and private payers, such as Blue Cross/Blue Shield and Medicaid agencies, have begun to adopt the Medicare Fee Schedule (MFS) to reimburse all physicians for the provision of care. In fact. many managed care organizations are introducing modified fee schedules based on the MFS and it is now estimated that roughly 40 percent of Medicaid programs have, or are in the process of adopting various elements of the MFS for physician reimbursement.
The Academy's pediatric RBRVS project began in October of 1992. In addition to assuming a formal seat on the RUC, it was at this time that the Academy began lobbying for the development of a "pediatric RBRVS" through the incorporation of language supporting the creation of a pediatric RBRVS into the Clinton administration's budget bill. This did not occur because this policy initiative did not directly relate to the reduction of the federal deficit. However, the Academy did not let this hinder its initiative to expand the Medicare RBRVS to incorporate pediatric services.
In October of 1994, the American Academy of Pediatrics established the Resource-Based Relative Value Project Advisory Committee (RBRVS PAC) to coordinate the pediatric RBRVS project. The activities of the RBRVS PAC include assisting Academy members in acquiring information on the Medicare RBRVS physician fee schedule through monitoring the development and actively participating in the ongoing enhancement of the Medicare RBRVS. The RBRVS PAC has also worked toward the development and dissemination of Academy policies relating to proposed changes to CPT, ICD and RBRVS that could affect pediatricians and the provision of pediatric services. In addition, a vital role that the RBRVS PAC has executed for the Academy is the organization, review and submission of pediatric-specific code proposals to the CPT Editorial Panel, as well as the coordination of the distribution and completion of the RUC surveys used for the development of physician work RVUs. In accordance with these responsibilities, the RBRVS PAC has also established an internal schedule and structure for the development of age-specific CPT code proposals that more effectively represent the services provided by pediatricians.
The RBRVS PAC can not do all of this alone, however, and needs the support and assistance of Academy members who are willing to work toward the development of age-specific procedural codes. In addition, the RBRVS PAC is requesting that any Academy member who is interested in completing the RUC surveys used to determine appropriate RVUs for CPT codes, to contact their State Chapter (Section Executive Committee RVU Work Group Chairperson) and indicate their willingness to do so. For additional information regarding the Academy's pediatric RBRVS initiative or to find out more about developing CPT code proposals and completing RUC surveys, please contact Matthew Katz, Health Policy Analyst for the Division of Physician Payment Systems, at the Academy's Elk Grove Village office (800/433-9016 extension 7931).
The following is an anonymous survey to determine Section members' opinions about pediatric critical care workforce issues. Results of this survey will appear in a future issue of this newsletter. We request that only pediatric critical care physicians currently in practice and who are board certified or eligible complete and return the survey. You may answer the survey in one of three ways: 1) mail to Dr. Timmons at the address at the end of this newsletter; 2) Fax to Dr. Timmons at 704-355-1221; or 3) copy this survey to an e-mail message, indicate your answers by placing an "X" in front of the desired answer or by filling in the blanks, and e-mail the survey to otimmons@med.unc.edu.Survey Questions--Please circle your response.
Demographic Questions
- 1. The number of pediatric intensivists currently practicing is
- a. Too few
- b. Just right
- c. Too many
- 2. In ten years, the number of practicing pediatric intensivists will be
- a. Too few
- b. Just right
- c. Too many
- 3. Compared to today, the pediatric intensivist workforce in ten years will cause
- a. Reduced quality of patient care
- b. No change in quality of patient care
- c. Increased quality of patient care
- 4. Compared to today, the pediatric intensivist workforce in ten years will cause
- a. Reduced cost of patient care
- b. No change in cost of patient care
- c. Increased cost of patient care
- 5. The presence of fellows in a PICU causes
- a. Reduced quality of patient care
- b. No change in quality of patient care
- c. Increased quality of patient care
- 6. The presence of fellows in a PICU causes
- a. Reduced cost of patient care
- b. No change in cost of patient care
- c. Increased cost of patient care
- 7. Compared to today, the pediatric intensivist workforce in ten years will cause
- a. Reduced intensivist compensation
- b. No change in intensivist compensation
- c. Increased intensivist compensation
- 8. Compared to today, the pediatric intensivist workforce in ten years will cause
- a. Reduced intensivist job security
- b. No change in intensivist job security
- c. Increased intensivist job security
Your age: _____
Year you completed fellowship: _____
PICU Director: Y __ N __
Division Chief: Y __ N __
Type of practice: Academic ___ Private ___ Combined ___
Academic rank (if applicable): Instructor ___ Asst. Prof ___ Assoc. Prof ___ Prof ___
First residency: Pediatrics __ Anesthesiology __ Other (please specify if other):___________
Specialty(ies) you practice in addition to Peds CC: ______________/_____________
Are you a member of the AAP Critical Care Section? Y ___ N ___
Comments:
The University of Utah is becoming a prominent center for epidemiologic research on childhood motor vehicle injury. Emergency care for children is the focus of Utah researchers who have received major grants to study diverse but related aspects of the issue.J. Michael Dean, Professor and interim chair of the Department of Pediatrics, is principal investigator for a two-year cooperative agreement with the Maternal and Child Health Bureau of the Health Resources and Services Administration. Dean's grant will fund the University of Utah's National Emergency Medical Services (EMS) for Children Data Analysis and Resource Center, a clearinghouse for data collection and analysis related to emergency medical care for children. Pat Nechodom, M.P.H., is Center director.
The Resource Center is one of three in the nation and is the only center devoted to data analysis and collection. "The Centers will help state and regional EMS agencies identify relevant data, including procedures and treatments rendered at the emergency site, hospital files, and trauma registries and will provide training in statistics and statistical methodology," Dean said. James C. Reading, Ph.D., Professor of Family and Preventive Medicine, is the project statistician and co-investigator on the grant.
Anthony J. Suruda, M.D., M.P.H., Associate Professor of Family and Preventive Medicine, has received a three-year grant from the Agency for Health Care Policy and Research . Donald D. Vernon, M.D., Associate Professor of Pediatrics, Reading, and Dean are co-investigators on this project, which will examine emergency care of injured and sick children in Utah in 1991-92, with an emphasis on EMT and paramedic care.
These studies follow an initial project directed by Dean since 1992, when he received a multi-year grant to look at the effect of seat belt use in preventing injuries and economic costs following motor vehicle crashes in Utah. Known as the Crash Outcomes Data Evaluation System (CODES), this study was funded by the National Highway Traffic Safety Administration (NHTSA), Department of Transportation. Utah was one of only seven states selected for CODES projects. The other states were Maine, Wisconsin, Missouri, Pennsylvania, Hawaii, and New York.
According to Nechodom, the CODES project, which she also directed, was the beginning of probabilistic data linkage--the collection and analysis of information from multiple sources to provide a more realistic picture of what happens in emergency situations. Funding is pending from NHTSA for CODES project staff to provide technical assistance about data linkage for other states. A grant is anticipated this spring for this "Peer to Peer" program, which will be directed by Dean and Nechodom.
CODES has filled more than 600 requests for data from legislators, public safety officials, educators, news media, health district planners, and the Utah Governor's office. "Since the CODES data linkage and dissemination rely heavily on the cooperation of the state's hospital and rehabilitation services, the Department of Transportation and the Bureau of Emergency Medical Services, their participation in all facets of grant activities has been crucial to the CODES success," Dean said.
From the Office of Public Affairs, University of Utah Health Sciences Center, April 11, 1996
Members of the Critical Care Section may submit articles and announcements to Critical Care News. Priority will go to concise articles of current interest to pediatric critical care practitioners. We hope to run announcements for openings for critical care staff positions in future issues. The deadline for the Fall '96 issue is August 15. Please mail submissions to Brahm Goldstein or Otwell Timmons. Please direct comments or suggestions regarding this issue to the editorial staff. Thank you.
CRITICAL CARE NEWS EDITORIAL STAFF
Kristan Outwater, M.D. (Section Chairperson)
Pediatric ICU
St. Lukes Health Care Association
700 Cooper Avenue
Saginaw, MI 48602
Telephone 517-793-6373
Fax 517-793-7649
kmoutwater@msn.comBrahm Goldstein, M.D. (Co-Editor)
Chief, Division Pediatric Critical Care
OHSU 3181 S.W. Sam Jackson Park Road
Portland, OR 97201
Telephone 503-494-8194
Fax 503-494-4953
goldsteb@ohsu.eduOtwell Timmons, M.D. (Co-Editor)
Carolinas Medical Center
P.O. Box 32861
Charlotte, NC 28232-2861
Telephone 704-355-7815
Fax 704-355-1221
otimmons@med.unc.eduThe success and utility of this newsletter is dependent upon input from Section members. Ideas for articles, job listings, and notices of upcoming events related to Pediatric Critical Care are welcome.
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