Question #9. What can the Section do to better serve and advocate for
neonatologists?
1.
Reimbursment
2.
More regular consensus statements regarding new or unproven therapies. More trainee involvement
(including free or deeply discounted registration at NCE etc) in order to encourage a non 'shift-work'
attitude to neonatololgy
3.
Majority of patients are insured by medicaid. Improve medicaid reimbursement nationwide.
4.
We need a description and evalaution of all the various ways in which neonatologists practice now.
Also-create an up to date electronic addressboook for neonatologists
5.
?
6.
more coding info and billing benchmarking to assist in contract negotiations
7.
Develop a computerized algorithm to help with the maze of billing codes.
8.
Same
9.
Advocate to improve allowable physician charges
10.
Help maintain reasonable reimbursement legislation.
11.
Continue to update evidence-based recommendations.
12.
We should have discussion groups online to discuss a topics
13.
?
14.
Improve reimbursement
15.
n
16.
Bring it to Neonatologists
17.
Better correspondence & announcements on how we may become more involved in the section,
perhaps via email
18.
We may need to revisit models for care in busy settings to meet needs of resident education, roles of
ancilliary staff, care of emotional needs of parents, parent education focused on special needs of their
child - what the future holds.
19.
Aggressively pursue improved reimbursement. Pediatricians are notoriously poor at fighting for our
fair share of the health care dollar. We have made remarkable progress with Dr. Molteni and Martin
leading the way, but there is much work to do.
20.
more coding education and advocacy for reimbursement for prenatal counseling
21.
Consideration of ways to improve our ability to provide service and to maintain our own quality of life
22.
coding practices and advocacy with all payers.
23.
work on tort reform
24.
Push for regionalized perinatal care; improved coding issues;
25.
Produce a yearly list of salaries (averages with range) and rank, and type of practice to help keep
everyone practicing at the same level equivalently reimbursed.
26.
Better payment from Medicaid. Malpractice issues
27.
?
28.
better communication specially with NICU's that are not university based since they care for a large
number of the patient population as well.
29.
cme
30.
More policy statements with attention to implementation locally. Benchmarking for neonatologists and
ancillary care (social workers, lactation consultants)
1
Question #9. What can the Section do to better serve and advocate for
neonatologists?
31.
Encourage, facilitate, provide opportunities for networking among Section members especially those
outside of research centers.
32.
more involvement in board issues
33.
continued educational opportunities
34.
X
35.
Love the Spring meeting. Newsletter is very useful - would be okay to make this online to save mailing
costs.
36.
6,7
37.
The section can continue to be active in funding and reimbursement issues. The section's research in
manpower needs and projections for the future is also very important.
38.
nothing new
39.
On line review materials.
40.
promote data sharing
41.
Find ways to foster better relationa between community neonatologists and academic centers
42.
Back them up in the struggle to prevent managed care from getting control of the practice of
neonatalogy.
43.
Income support by preserving the concept of regionalization of neonatal care.
44.
Promote evidence-based residency and fellowship training in neonatal-perinatal medicine
45.
reimbursements, connections between private and academic practices
46.
improved reimbursements for ridiculously underpaid care
47.
educational activites on line
48.
push for maintaining clinical time in pediatric residency
49.
Perform surveys to determine what are the most common issues or barriers to provide quality care.
50.
If the role is education, then I am not sure.
51.
Same as above, plus lobby for enhanced reimbursement
52.
See # 6 & 7
53.
ADDRESS INSURANCE COMPANIES UNREASONABLE DEMANDS
54.
assist with insurance issues
55.
Coordinate collaborative clinical research groups and projects Support regionalization
56.
Advocate the ACGME or the RRC to allow Pediatric residents to have more than 4 months of
Neonatology or more than 6 months or total intensive care out of 36 months of residency.
57.
Continue with coding guidelines/support (though not ranked above!)
58.
Promote outcomes based research, coordinate quality improvement initiatives with other national
organizations (Vermont Oxford, state Quality Collaboratives, NICHD, etc. )
59.
Increase the awareness of Neonatology speciality among the lay population
60.
I imagine for most people including myself is how to deal with physician reimbursement.
61.
spend more time listening than telling people what to do
62.
Focus more on the needs of neonatologists who work in non-academic settings, those in smaller
communities. Encourage more participation by Kaiser neonatologists.
63.
Ensure timely and fair remuneration from third party payors.
2
Question #9. What can the Section do to better serve and advocate for
neonatologists?
64.
No suggestions at this time.
65.
Lobby states and federal government. Improve ability to proovode services for families. It is difficult to
say that neonatologists need more remuneration. Perhaps more support for legal issues- esp
regarding resusciation, and continuation of care in seemingly futile circumstances.
66.
Clarify its mission for members, create the perception that the Section truly values its membership
through effective advocacy, and constantly reinforce these values. I don't know how many people can
describe the difference, for example, between the Perinatal Section and the Committee on the Fetus
and Newborn. This is a sad commentary, but reflects the fact that many people do not take the of the
Section as being synonymous with their own goals, so they don't really care much about it.
67.
maintain communication
68.
1. Continue to work with the Organization of Training Directors 2. Get neonatologists appointed to
other national AAP committees aside from COFN & NRP Steering Committee by working actively in
state chapters and 3. Attempt to have neonatologists elected to national office via the District
Leadership route.
69.
I am very concerned about the takeover of neonatology by a large for-profit publically traded
company; who is looking out for the best interests of the specialty and the population it serves
70.
Practical medicolegal education, tort reform!, adequate funding, ongoing educational programs
71.
Continue the effort to promote universal insurance and access to care
72.
not sure
73.
Send periodic updates to help preactice evidence based medicine
74.
continue present advocacy
75.
Advocate for malpractice reform
76.
Continue education
77.
help better drive measurements to be used for comparison
78.
Be more visible
79.
none
80.
Ensure appropriate reimbursement for our work
81.
streamline board recertification
82.
Coding
83.
n/a
84.
continue to provide neonatologists a way to keep up with new information
85.
Extreme prematurity and resuscitation at peri-viability - legal and guideline clarification
86.
None
87.
1)advocate for a reasonable program of re-certification (not for me - I am "grandfathered") 2)monitor
and try to influence legislation and other plans that will negatively impact our ability to provide care
and be appropriately reimbursed for our services 3) Recognize and support the non-academic
practitioners (I have spent 24 years in the academic setting and 4 in the non-academic setting) I
believe that those in academics do more to impede the non-academics than to help them develop
better ways to improve patient care.
88.
Support research for non-academic/university based neo's.
89.
proactive statements on medico-legal "experts" who lie about standard of care
90.
active involvement with coding issues
91.
More access/assistance to what ABP is requiring for recertification.
3
Question #9. What can the Section do to better serve and advocate for
neonatologists?
92.
work with the FDA for meds we give babies
93.
See #7 above.
94.
Provide web based or email access for questions or comments on a regular basis Provide a resource
for common forms/protocols in pdf files to be used in NICU's as a guideline for new units or programs
(ie billing sheets, admission orders, protocols, etc.) - the coding section of the perinatal section is
excellent and might be expanded. The addition of the lectures from the Perinatal Workshop to the
website is a great idea - access for those unable to attend the meeting.
95.
Lobby for a ciriculum for the test
96.
Create interactive means for communication so that the leaders hear more frequently from the fellows
97.
Represent all neonatologists, regardless of academic affiliation.
98.
no recommendations
99.
??
100. Don't know
101. update neonatal evidence-based medicine
102. help with meeting requirements of re-certification process
103. Lobby for improved reimbursement for infant care.
104. Advocate for equal reimbursement for neonatal and pediatric care than for adults
105. access to latest research
106. educational materials for parents
107. address reimbursement issues. billing is so complicated-it needs to be further simplified!
108. same thing - more of being an ear to problems
109. support standardized billing codes and reimbursement for our services. Be very cautious about
guidelines/policies to insure that they don't reflect personal views of the COFN.
110. Have a panel of neonatologists serve as an advisory panel to media/government contacts
111. See #5
112. Improve coding accuracy and ease. Assist with fellowship program monitoring.
113. reimbursement of services
114. n/a
115. No suggestions
116. see *7
117. Malpractice insurance insurance and liability cap, ensure payment for patient care in line with inflation,
rather cut.
118. Educate members about areas of concern and ways to be involved.
119. poll neos more often before making major policy decisions
120. Combine Section with F-N Committee- makes NO sense to be funding both, when 1 could do the job.
The AAP is top heavy with beaurocrats!@
121. Better reimbursements, development of more clinical practice guidelines and courses on quality
management
122. Continue to advocate for better coding and reimbursement
123. No ideas at this time
4
Question #9. What can the Section do to better serve and advocate for
neonatologists?
124. doing a fair job
125. Squeeze the heck out of adversarial insurance companies
126. Require all members be willing to review cases, evaluate care and issue an opinion from the section
in cases of disputed care, ie Malpractice cases
127. Again, Medicaid reimbursement is being lost rapidly and the amount of reimbursement does not cover
hospital or physician costs of providing care; private insurances then tend to follow Medicaid
reimbursement
128. Support less direct patient care for Neonatologists.
129. more political clout
130. reach out with a listserve/ online forums work with payors
131. See above.
132. See #6
133. Improve RBVS and RVU for neonatal services. We are grossly underpaid compared to adult critical
care specialists with similar years of training and expectations of 24/7 availability
134. Continue to look for better practices, look at standardized approach to reimbursement.
135. -advocate to reduce the excessive paper work in fellowship progams via ACGME -Focus on better
distribution of billing information
136. plenty already, with the coding document
137. opportunities for self improvement and better quality of life so we can become better physicians and
better people.
138. make continuing education as available and affordable as possible
139. 1. Reimbursement 2. recruit neo reps from the ranks of clinical neonatologist for committees
140. Make some of the conferences, i.e. perinatal strategies/Scottsdale, more accessible by decreasing
the cost.
141. don't know
142. unsure
143. No comment
144. See my response in the survey submitted yesterday before #4 was corrected.
145. not sure
146. See #7
147. already doing a good job; better salary surveys/benchmarks
148. ?
149. more education
150. ?????
151. billing and coding education
152. ?
153. Make payment of our global NICU codes uniform nationwide
154. Enhance the regional activity
155. Enhance the dialogue between colleagues of different generations Foster ongoing participation and
cooperation with AAP leadership's priorities
5
Question #9. What can the Section do to better serve and advocate for
neonatologists?
156. .
157. CME over the internet
158. See 6
159. Rejuvenate the committees that develop guidelines and recommendations. Too often, it seems that
statements are made that are out of touch with the day-to-day practice of the specialty.
160. No comment
161. As above-better advocacy for careers in academic neonatology
162. see 6
163. improve physician payment
164. Try to strengthen greater involvement and communication at the District level with chapters
165. Mobilize the parents of our kids, and our grown ex-patients, to let people know the value of what we
do. Most lay people seem to think I waste a fortune getting rich while creating "vegetables".
166. n
167. continue the advocacy with the groups in Washington that determine reimbursement rates, as Rich
Molteni has done so effectively.
168. none
169. Help us figure out where we belong within the AAP
170. regional meetings, continuing education
171. regional meetings, continuing education
172. More information on ethical dilemmas in the NICU would be helpful, more info on how to deal with
"difficult families" or "difficult families in difficult situations" would be great. Maybe some videos or
scripts of prenatal consultations or family meetings that new faculty/fellows can use to model behavior
from.
173. Provision for educational activities and better communications.
174. Continue with CME, networking adn coding advocacy.
175. coding nightmares
176. provide a better support structure
177. Continue the excellent advocacy for appropriate reimbursement.
178. More guidance on coding, enlist input from neonatologists o that subject
179. More advocay issues in the newsletter
180. Provide comparative salary structure for NewEngland vs. other parts of the US.
181. 1. push for a more appropriate recertification process 2. push for tort reform
182. address "pay for performance" changes
183. Education Fellowship requirements
184. Advocate for better reimbursement. Many of the steps over the last few years, in sub-catogorizing our
patients have reduced reimbursement
185. Continue to press the AAP to address the issues germane to the practicing neonatologist and
education in and the practice of neonatal medicine
186. continue to advocate for improving care
187. ?
6
Question #9. What can the Section do to better serve and advocate for
neonatologists?
188. Continue to advocate for reimbursement through Medicaid and other 3rd party payors
189. no opinion
190. Appeal to trainees through publications and sessions at national meetings. They are interested in how
to integrate profession with lifestyle, family.
191. engage neos in principles of clinical decision-making: ebm, standardization, safety emphasis
192. enhance reimbursement; continue development of ONTPD fellowship curricula
193. liability
194. no answer
195. Keep active with AMA (billing, etc). Set minimum standards for call rooms (temp control, noise,
cleaning, showers etc.).
196. When new administration starts health care will be addressed and we need your support there.
197. Not sure
198. speak withone voice politically
199. Not sure
200. use a more structured review process for guideline development so that the levels of evidence and
recommendations appear in a style similar to Cochrane reviews.
201. coding, billing
202. /
203. Study lifestyle issues for the practicing neonatologist- perhaps this could be the basis of an
educational seminar; important since the average age of neonatologists is in the 50s.
204. distribute work and compensation from across the continuum of practices
205. continue to provide concrete aids for billing; that has been a tremendous help. Giving examples of the
various clinical scenarios and how to bill appropriately.
206. see questions above
207. Advocate tort reform. Malpractice suits are a poor way of attaining quality improvement.
208. Continue to work on coding issues.
209. Web Site, enhanced educational offerings
210. Written in previous version of survey
211. Same as question 8.
212. See #6
213. SDtimulate more involvement.
214. continue to advocate fair coding/reimbursement for the neonatologist
215. provides a great voice and vehicle now
216. Instant access to information
217. Be better represented within the AAP
218. not sure
219. No change required.
220. Provide CME activities.
221. Promote an understanding of the role of a neonatologists and adequate compensation
7
Question #9. What can the Section do to better serve and advocate for
neonatologists?
222. See number 8
223. Continue to pay attention to coding and reimbursement. Assist with training our staff and co-workers-Continue the great work on NRP; support PCEP and keep it up to date.
224. Support for maintenance of funding levels.
225. Address and welcome the resident/fellow changes in work hours, challenges for women and minority
physicians
226. Work with the government and insurers for adequate and appropriate, simplified coding and
reimbursement.
227. better representation of neonatologists in clinical (nonacademic) practice
228. Better Medicaid reimbursement.
229. n/a
230. Adequate payment for services.
231. Enhance feedback to regulatory organisms such as ACGME, Board of Pediatrics and IOM
232. see above
233. ?
234. no comment
235. Facilitate geographic sectional meetings
236. Reimbursement from governmental sources
237. Expand the activites designed to influence policy and payors
238. See # 8.
239. n/a
240. legal support - work towards capping awards for families suing neonatologists and OB's
241. Continue to work for appropriate coding/reimbursement, value for work comparable to adult medicine.
242. Perhaps a discussion of what constitutes reasonable work hours (over the months/year, not day to
day) and appropriate compensation for academic neonatologists would help give those of us being
abused some platform from which to negotiate.
243. .
244. Continue to assist with billing issues, educate about contracting with 3rd party payors and assist with
Medicaid reimbursement issues at the national level.
245. Lobby for better research funding for fellowships.
246. Provide parent education
247. not sure
248. be proactive for reimbursement issues
249. Promote collaboration
250. Same as #8.
251. Continue with the good work on coding and reimbursement issues
252. Advocate for increased NICHD funding
253. I believe district meetings could help bring people together make sure we are heard well by AAP as a
whole
254. Dissemination of evidence based guidelines through journals, meetings, etc. Come-up with national
8
Question #9. What can the Section do to better serve and advocate for
neonatologists?
guidelines for work hours and uniform salary. Pediatric residents are unlikely to join academic
neonatology unless they are paid well and uniformly (slight adjustments for cost of living in local area
allowed).
255. Expand its activities on education and research.
256. same as 8
257. Train/guide younger neonatologists from the Section to be able to perform more duties in the Section;
increase membership in the Section
258. More support for lobbyists and policymakers
259. Set standards for unit size/births to reduce number of small (esp. level II) units.
260. ?
261. Continue coding work Guidelines for work hours/patients for neonatologists
262. I don't know
263. coding education about how to deal with hospitals tools for teambuilding with perinatal specialists
264. same
265. N/A
266. compensation for care of indigent patients needs to more closely approach that of insured patients
267. Continue to promote educational tools. Continue to support appropriate coding & reimbursement.
268. see above
269. Continue to maintain remuneration of neonatal services at present levels.
270. Enhance membership by practicing neonatologists in smaller communities. This would be an
outstanding forum for this type of interchange.
271. develop guidelines
272. more work on quality of life, time management. Studying staffing patterns - what works, what doesn't,
for whom and why. Make coding training and knowlege more easily accessable without having to pay
for general peds coding info.
273. no answer
274. provide networking around job descriptions and salaries
275. Good question. The efforts related to coding have been greatly appreciated and should continue to be
a primary section goal.
276. Encourage more regional activity.
277. manpower and quality of professional life are going to be huge issues as hospitals try and make us
their interns
278. have more input on guidelines that affect neonates (although it reviews new guidelines, I have seen
little to no response by the outside committees to the section's suggestions)
279. Provide more educational materials at reduced prices.
280. assure quality of neonatal fellowship programs
281. Promote careers in neonatology and recruit new fellows.
282. Appropriate and uniform re-imbursement for coding
283. xx
284. Continue its current agenda of educational programs
9
Question #9. What can the Section do to better serve and advocate for
neonatologists?
285. research
286. lobby ofr tort reform
287. support coding, develop standard in care (evidence based)
288. keep up the good work
289. Hours of work
290. Advocate for universal payment for the NICU bundled codes nationwide
291. Presence on the American Board of Pediatrics - there is lack of training at the resident level combined
with shortened work hours placing a large burden on neonatologists. This work burden has not been
addressed with "attending" work hours.
292. create a panel of experts in different fields who can address clinical questions
293. Current work is in line with the needs for neonatologists. Educational program focusing on evidence
based practice and peer pressure for networking on quality are key roles for the section.
294. Establish research mission
295. work with legislation for malpractice reforms
296. Continue to aid Neos with payers regarding QI and other resonable methods of showing compentcies.
297. Improve academic/non-academic relations. Create a "buzz" at the Residency program level to interest
more trainees. Promote either market-based or universal health care options to assure that all
children/infants have health care insurance.
298. Help more actively with downcoding and unilateral dispensation by insurers
299. lobby for healthcare reform
300. Regional CME's or meetings of short duration so that more members can attend
301. lobby for improved reimbursement and malpractice ceiling
302. Be available to individual practicing physicians and not tolerate hospitals which abandons their
responsibility to ALL mothers and their infants. Teach them caring is not just high tech gimic but a lot
more to it.
303. FIGTH AGAINST SOCIALIZED MEDICINE
304. Advocate for better billing and coding practices
305. Advocate for a reasonable board recert process. PR articles in lay literature re: history of/advances in
neonatology
306. Continue to negotiate good payment for bundled billing codes.
307. Enhance professional resources for neonatologists across the spectrum of of the profession.
308. Continued coding and billing advocacy
309. See #8
310. Don't issue blanket statements like all NICU'S should have in house neonatologists etc
311. liability reform
312. n
313. All the above
314. I am not sure....
315. Coding/payment issues with insurers
316. Keep codes for billing with fair rates that can be used by all types of neonatology practice, including
10
Question #9. What can the Section do to better serve and advocate for
neonatologists?
academic practice. Further educate section membership on importance of their support of academic
training that includes scholarship and research, ie, not just clinical training.
317. advocate with obstetricians to stop the delivery of late preterm infants
318. The significant changes in outcomes in the last 30-20-10 yrs. and the dedication 24/7 of these docs.
319. n/a
320. lobby for better reimbursement, especially for medicaid patients
321. Step on the American Board of Pediatrics
322. The more training the better. Neonatal-perinatal medicine continued medical education has to fit their
neonatologist practice needs.
323. Provide funding for recruitment
324. Advocate against the insurance companies in collaboration with the rest of pediatric providers
325. Work to protect funding. Advocate for maintaining regionalized perinatal care.
326. Neonatology should be reviewed by other neonatologists, Care plans & protocols are fine for factory
created items but not human beings 7 the typical nurse or health related professional is not aware of
all the interceding complications that alter a neonates course.
327. Consinuting to work toward tort reform
328. Sift the Current Literature; be gutsy enough to attach a Value Judgment to those FEW articles that
you choose to cite.
329. legal support
330. address lifestyle issues
331. don't know
332. advocate strong recertification programs
333. .
334. Neonatalogists should be vocal to let AAP know the current issues and I don't see the Academy's
primary role as advocating for already powerful providers.
335. More data available, case mix/severity adjusted on performance/outcomes
336. workshops for cading
337. No comment
338. More coding updates
339. Institute numbers 5-8 above
340. advocacy for research support for neonatologists
341. Keep up the good work keeping coding fair and easy.
342. I think you do a great job with that through coding, Neoprep. ONTPD etc
343. be more inclusive
344. develop more of a public face
345. Better reimbursement for time - now so much is in house
346. Establish maximum hours or workload per week per neonatologist
347. Provide outcomes data and clinical guidelines to achieve good outcomes
348. no opinion
11
Question #9. What can the Section do to better serve and advocate for
neonatologists?
349. reimbursement of services provided, unlocking the insurance coding game and denials
350. see above re: board recertification
351. make access to clinical/research journals available through AAP website. Not just the AAP journals
352. Not sure.
353. reimbursement rates
354. Arrange for perinatal education programs for obstetricians and neonatologists together
355. Not sure.
356. Link Neonatologists taking on similar advocacy issues to help make us more powerful and more
efficient. Enlist the resources of medical students, pediatric residents, and neonatal fellows by
organizing AAP endorsed quality improvement projects that would fulfill the ABP's likely requirements.
357. billing and coding information
358. Keep up the updates and online CME's. Many of us working neonatologists with families can not
attend the national meetings but enjoy leaning via internet.
359. n/a
360. by doing the above
361. Advocate for increased salary and coverage requirements. Increase stringency of fellowship
programs.
362. Take on the Pediatric Residency Training Directors and ensure that, if training in Neonatology
remains a requirement of pediatric residency training, then it is done with some consultation with the
neonatologists.
363. no suggestions
364. Continue its role with the AMA and payment guidelines
365. More CME choices
366. clincal guideline statements
367. more research dollars
368. Doing well
369. *
370. answers 5-8.
371. Access to healthcare for children from uninsured or underinsured families; increasing the
reimbursement for physicians caring for these fargile infants,
372. Maintain an active organization in which we speak with one voice
373. .
374. I believe the section is doing a fine job presently
375. Continue to work on coding and billing issues
376. na
377. 378. Education
/J:_Newborn.PRI/VanMarterAssistant/AAP/MemberQuestionairre/Perisurvey#9
12