Virginia Chapter, AAP Board Meeting
Hilton Garden Inn - January 30, 2014 ~ 1:00 PM
I.
Call to Order and Introductions
Dr. William Rees called the meeting to order at 1:10 PM and made introductions of
the members in attendance and on the conference phone.
Members in attendance: Drs. Ted Abernathy, Sam Bartle, Valerie Bowman, Sandy
Chung, Barbara Kahler, John Moore, Bill Moskowitz, Diane Pappas, Kristina
Powell, Helen Ragazzi, William Rees, Dave Reynolds, Bruce Rubin, Robert Shayne,
John Unkel
Staff in attendance: Jane Davis, Aimee Seibert
II.
Review of Minutes
Motion seconded and approved that the minutes of the September 20 Board
Meeting were approved as submitted.
Drs. Moore, Chung and Powell agreed to review minutes for the current meeting.
III.
Advance Child Health
Pediatric Council Report – Ted Abernathy, MD
For the past several months the Pediatric Council has been working with both United
Healthcare and Anthem Healthkeepers Plus Administration to better improve our
communication and efforts to quickly resolve issues that arise for Virginia Pediatricians.
As you may remember, most of our contacts have been elevated or moved to other jobs
and we have had to reconnect and build relationships for the most part with all new staff.
We have been able to however with anthem move ourselves to a working with high-level
administration and this is helped tremendously in getting decisions made quickly and
appropriately.
We have suggested before that we need to reorganize the Council to more effectively
serve the chapter member’s needs. The plan is to assign members of the Council to each
carrier and not use our rapid response team as we’ve done in the past. This will produce a
faster and more effective response to questions or issues we have about each carrier. We
are looking for volunteers who would like to serve on this newly organized and revive
pediatric Council.
We have been working with administration on their recent decision to follow the national
correct coding initiative and require the use of modifier 25 on all immunizations that
were billed with administration counseling codes and with Anthem Health Keepers Plus
we have been working to resolve many if not all of the issues you may or may not be
having with this program.
ANTHEM:
1) In all cases, Anthem is reimbursing Virginia Pediatricians at least at 98% of
DMAS rates.
2) In some cases, Anthem is reimbursing Pediatricians at 160% of DMAS rates
(when ACA Rate Reimbursement is applied correctly).
3) It may be true that you may be getting paid at about 60% of ACA rates.
ACA Rate Increase: Anthem recognizes that some of us may not be getting paid at the
appropriate ACA rate increase level. Anthem is aware that this may span a multitude of
providers and they identified the issue several weeks ago. Anthem Teams are working as
quickly as possible to complete the corrections to their current configuration. Once the
configurations are changed, I have been assured that Anthem will work as quickly as
possible to re-process all claims underpaid due to issues related to the ACA
Reimbursement Rate. Anthem thinks this will take at least 2 weeks but I think realize the
magnitude of the issue it will be at least 3 weeks minimum before the issue is completely
resolved and claims can be reprocessed.
The Council and Anthem team is working very hard to get these issues resolved.
UNITED HEALTHCARE - below is a release from their January Newsletter. To be
100% sure we understood exactly the new policy, and to be sure that the use of –modifier
25 would not precipitate an audit by the repeated use of the modifier, we ask United to
clarify and explain exactly this new rebundling policy. Here is the policy statement, and
United’s response to our questions.
"Previously announced as a revision to the Re-bundling Policy and effective in the first
quarter of 2014, UnitedHealthcare will deny Preventive Medicine Evaluation and
Management (E/M) services (CPT codes 99381-99397) when reported on the same
date of service as an immunization administration service (CPT codes 90460-90461
and 90471-90474) through the CCI Editing Policy. This change aligns with the CMS
National Correct Coding Initiative (NCCI) and the American Medical Association
Current Procedural Terminology (CPT®)
If modifier 25 is reported with the Preventive Medicine E/M service and the
documentation supports that a significant and separately identifiable E/M service was
provided on the same date as the administration service, both would be reimbursed. It
would not be appropriate to additionally report the Preventive Medicine E/M code for the
counseling provided when a vaccine is administered.
UNITED’S RESPONSE - This policy is not limited to well visits, the edits are true for
any E&M code, sick or well. All E&M codes also include an element of counseling. So
both include face time with the patient. For both the vaccine administration and an E&M
service to be payable on the same day the provider has to identify that the E&M service is
distinct from the vaccine administration, by use of the 25 modifier, but the diagnosis
codes should support the use of the 25 modifier. Additionally E&M code 99211 cannot
be modified for consideration, even with a 25 this code will deny. It is a very low level
E&M code, 5 minutes with patient, and so really cannot be distinct based on the limited
amount of time spent with the patient.
The edit is applicable for most E&M codes, not just well child. Sick or medical E&M
services are also subject to this edit. E&M codes 99201-99380 and 99401-99499.
Vaccine administration codes include an element of counseling, face time with the
patient. So for two sets of counseling to be reimbursable on the same day, one would
have to be modified for consideration if appropriate.
As to concerns regarding the precipitation of an audit by using excessive modifier 25, this
would only happen if the modifier is misused. If Pediatricians are billing vaccine
administration codes on the same day as an E&M service then to follow the NCCI edits
the 25 must be used. The only time that would or should be flagged for overuse of the
modifier is if the modifier is not needed. But in order to bypass the edit the modifier must
be used. As long as a modifier is being correctly used there should not be a problem.
They should not be flagged.
Vice President’s Report
Dr. Kahler provided the board with information several issues:
1. Emergency Medical Services for Children – 119 preventable deaths
2. Oral Health Coalition – reimbursement for dental services
3. PROS – Clinical Effort Against Secondhand Smoke Exposure (CEASE) Study and
Implementation of a Parental Tobacco Control Intervention in Pediatric Practice
Increase Advocacy for Children
Drs. Bowman and Ragazzi and Aimee Seibert, Chapter Lobbyist gave the chapter’s 2014
legislative report.
It was a great week for pediatricians at the Virginia legislature. We had our annual
“White Coats on Call Day” today and had an impressive turnout. Many of our members
were able to meet with their Delegates and Senators and discuss our legislative priorities.
We started off the day with Lieutenant Governor Northam and at lunch, we were treated
to an update on children’s mental health issues from Margaret Nimmo Crowe, the
Executive Director of VOICES for Virginia’s Children
Both of our bills to require all hospitals to administer a pulse oximetry screening for
newborns have passed their respective floors. HB 387 (Comstock) passed unanimously
on the House floor. Our Senate version of the bill, SB 183 (McWaters), already passed
the Senate floor unanimously.
We supported HB 34 (Kory), which would have required local school boards to set the
daily school calendar so that the school day could start no earlier than 8:00AM.
Unfortunately, the legislation was tabled in subcommittee. The subcommittee felt it was
not necessary because school divisions already have the ability to set the start time later
in the morning.
We are one of many groups supporting legislation to ban e-cigarettes for minors. HB 218
(Albo) and SB 96 (Reeves) would prohibit minors from purchasing vapor products by
adding them to the definition of tobacco products. HB 218 was reported unanimously
from subcommittee and will soon be heard in full committee. SB 96 was reported
unanimously from Senate Courts of Justice and referred to the Finance committee
because of its fiscal impact.
We also support SB 479 (Barker), which will prohibit indoor tanning for children 14 and
under and require parental notification for children 15, 16 and 17 years old. This
legislation has already passed the Senate and will be heard in the House after Crossover.
The House has already defeated two similar bills.
With the swearing in of two new Senators, the Virginia Senate’s power dynamics shifted
dramatically. With 20 Republicans, 20 Democrats and a Democratic Lieutenant
Governor, the Democrats are now in control of the Senate. The Democrats assigned new
Committee Chairs and reorganized the membership of the committees. There are many
unknowns right now regarding how the Senate Democrats will address legislation that
has already been heard in the Senate before the power shift.
IV.
Member Value
Education Report
2015 VA-AAP Annual Meeting
The Executive Board wanted to revive the VA-AAP Annual meeting so the 2015
Planning Committee met on December 5. Dr. Abernathy used his influence and
secured the Westin in Richmond for the May 15 & 16 dates for the 2015 VA-AAP (or
VAABC) conference. Dr. Natasha Sriraman has secured CHKD to be our CME
provider. Dr. Sriraman will be working on a draft agenda which would offer 8 hours
of CME.
Breastfeeding Committee Report
Drs. Kellams and Sriraman advised the board of the plan to have a statewide
Maternity Care Quality Improvement Collaborative. The date for the event will be
Friday, May 16th. Their plan is to send the initial event invitation(s) to the
administrator of each hospital facility. The administrator will be tasked with selecting
the three key stakeholders that will attend the event.
Text for Baby
Dr. Valerie Bowman advised that Text4baby is a public-private collaboration, led by
the National Healthy Mothers, Healthy Babies Coalition to bring together
government, business, non-profits and academic institutions to launch and evaluate
innovative new models for using mobile phones and the mobile phone infrastructure
to address critical health care challenges. The focus of text4baby is to launch and
evaluate a mobile information service that will provide timely information to pregnant
women and new mothers that will improve their health and the health of their babies.
Partners Include:
White House Office of Science and Technology Policy
US Centers for Disease Control and Prevention
The Wireless Foundation
Voxiva
WPP/Grey Healthcare Group
The George Washington University
Johnson & Johnson
Outreach Partners:
Other Government (state), academic and corporate partners
Text4baby the Virginia Experience
 First launched February 2010
 Initial Team: representatives from VDH, DMAS, professional groups such as
AAP and ACOG
 Service is free to users. VDH supports the customized monthly maintenance
fee of $4000.
Text4baby has been selected by VDH to be apart of the implementation team for the
IMSP (Infant Mortality Strategic Plan)
There are 5 strategic goals for Text4baby
Strategic Goal: To improve interconception care and family planning across the
Commonwealth
Objective 1: Reduce the rate of unintended pregnancies among women of
reproductive age.
Objective 2: Increase the percentage of women who have an interval from birth to
subsequent birth of at least 24 months from 23.3% to 25.5% (10%) by 2018.
Strategy 2: Promote the utilization of Text4baby and 2-1-1VIRGINIA by
childbearing age families
Success Indicator: Number of Virginia enrollees in text4baby
Media Project
Dr. Helen Ragazzi advised that she has began working with Liz Pearce, Director of
Parenting Engagement at the Children's Museum of Richmond, and Common Sense
Media, a not-for-profit organization that provides reviews and information for parents
about media.
They have identify 3 goals for the project.


First, they are creating an exhibit at the Museum that demonstrates -- hands on -- the
impact of media on the health and well-being of children. This exhibit will be directed
directly at parents and children, last several months and will likely circulate to the other
CMOR's sites across central Virginia.
They are creating a brief, engaging, parent tip sheet that could serve as a link between the
exhibit, the community and pediatrician's offices and schools. This would be a parenting
education tool and would provide an evidence based framework for parents to approach
their children's media intake. The vision is the creation and distribution of a RDA/"My
Plate"/5210 approach to media. This will comply with AAP recommendations regarding
media intake for children.
Dr. Ragazzi wanted to see if the board would approve of our chapter giving it
support.
2014 AAP Legislative Conference
Dr. Kristina Powell will represent the chapter by attending the 2014 AAP Legislative
Conference in Washington, DC June 16 – 17, 2014.
Member Services
Obesity task Force Update
Dr. Shayne he is still looking for funding ideas. He have some fresh ideas to take to
the pediatric retreat to share with Sandra Hassink, one of the true leaders in the
pediatric obesity movement, head of the Obesity Program at Dupont in Delaware and
incoming AAP president.
V.
Financials
Quarterly Report on Chapter Finances
Dr. Bartle gave the quarterly report on Chapter Finances. The Chapter is financially
sound, with a balance of $231,289.88 ($28,889.09 checking plus $202,400.79 in
Reserve) as of December, 2013. He advised that overall year-to-date expenses are
within budget.
VA-AAP Mileage Allowance
The VA-AAP Board has been advised by their auditors that they can supply a
certification form for board members advising that they attended board
meetings/events and the board member will be able to use as a deduction on their
taxes. The set reimbursement amount is applicable to the federal rate which is
currently .555 a mile. The board member would need to retain the VA-AAP
certification form that verifies that you attended the meeting/function and need to file
with your tax return.
Governance Policies
The VA-AAP has three governance policies that require reaffirmation annually and/or
as new board members come on. The VA-AAP’s governance policies were reviewed
(IRS Form 990 Policy, Document Retention and Destruction Policy and
Whistleblower Policy and accepted. Each member is required to complete a “Conflict
of Interest Disclosure Statements” and provide to Jane for record keeping.
2014 Board Retreat
Dr. Rees proposed that the Board Retreat would be March 21 & 22, 2014at the
Wintergreen Resort. Dr. Rees has invited Sandy Hassink, MD AAP President Elect.
Motion seconded and passed to hold the Board Retreat Saturday, March 22 at
the Wintergreen Resort from 9-2.
New Business
Dr. Bill Moskowitz will be working on the 2014-2016 Slate of Officers to be
presented at the board retreat.
The board would like to purchase an AAP brick for Tom Sullivan, MD who died in
an recent car accident. The board approved the expense to memorialize Dr. Sullivan.
The meeting was adjourned at 4:30 p.m.