Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
1.
limit of viability, neonatal resuscitation
2.
See #5
3.
encouraging a nuclear family....too many single mothers
4.
1. inadequate clinical training of fellows
5.
?
6.
access to health care, distribution of neonatologists in a regionalized system
7.
Failure to obttain affordable health insurance
8.
Cost containment, medical liability
9.
Physician shortages
10.
Administrative curtailment of services to some patients.
11.
Prospective studies of blood pressure treatment and monitoring.
12.
Guidelines for appropriate managements for diseases of preterm newborn
13.
limits of viability
14.
Billing
15.
spiraling accreditation requirements that hamper education. need evidence-based accreditation.
16.
Developmental friendly care, Family involvement, Evidenced-based care
17.
Achieving a balance between demand for neonatologists / unfilled positions at hospital centers and
training of future neonatologists, bridging gap between academic and private neonatologists
18.
International health inequities. Follow-up and services for high risk and disabled infants.
19.
Closer working relationship with obstetrical community. The section would better meet the needs of
the physicians and patients by aligning more with obstetrical/MFM community than pediatrics.
20.
regionalized NICU care
21.
Reasonable approaches to setting limits of viabiilty, guidance for physicians and families, dealing with
limited resources
22.
Appropriate credentialling
23.
appropriate training for fellow not only in the clinical arena, but in the research arena as well
24.
Re-establishment of regionalized perinatal care
25.
Increasing number of smaller units springing up
26.
paying for follow up of hgih-risk infants so good data on outcomes - need push payors to cover.
consistent on-line lectures for all fellows so equal in all programs.
27.
Evidenced Based Medicine
28.
research and evolving coding issues
29.
reduction of medical liability issues
30.
Prevention of infection Prevention of fungal infections in extremely low birth weight infants(evidence
and safety is there) Mandatory HIV testing nationally (and internationally) Management of preterm
labor Management of the extremely preterm infant regarding care and resuscitation does not seem
ethical for them as individuals (since some do better than other and should have that right to survive if
they can) and should have broader discussion. OB coordination to test mothers with no prenatal
care(rapidly for HIV and HepB) Hypothermia for HIE
31.
Family-centered care in the NICU setting. Development of community support systems for post-NICU
patients and their families.
1
Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
32.
aging of the work force more clinical training of fellows
33.
more cohesion on practices at the limits of viability
34.
Insurance allowance for back-transport to get babies closer to their families
35.
keep tabs on NNP and neonatology staffing needs/projections
36.
broader and more support for education and development
37.
The section must continue to advocate for access and funding issues. The section must also continue
to promote research into improvements in care and advocate for adoption of beneficial practices.
38.
all above
39.
Same as above.
40.
resource allocation
41.
Clinical guidelines, scoring outcomes measures for hospitals and networks in a meaningful way.
42.
Incorporation of above issues into training of fellows. Keep practice of Neonatology in the domain of
neonatologists, not managed care administrators.
43.
Public education and awareness that we CAN'T do everything.
44.
Quality management, consistency of practice
45.
maldistribution of intensive care units/perinatal
46.
ethical guidelines for allocation of resources
47.
proper controlled research that parallels adult advances; safety issues
48.
"induced" prematurity Reducing disparities in perinatal care improving perinatal regionalized systems
of care providing equity and quality of care
49.
Management of the anxiety associated to having your baby in the NICU during the hospitalization and
afterwards.
50.
interfacing & designing EMR and CPOE. Work flow and process changes.
51.
All of the above
52.
reimbursement from insurers
53.
PREVENTION OF PREMATURITY
54.
decreasing neonatal mortality in this country
55.
Research Data reporting Continue excellent education forums...expand if possible
56.
Preventing insurance companies from dictating or limiting care, e.g., the use of Synagis.
57.
training and continuing education
58.
Quality improvement, follow up care.
59.
Withdrawl of life support, addressing quality of life issues in survivors and when to stop coding a baby
especially in the Delivery/ Operating room
60.
Healtcare coverage for the uninsured.
61.
coordination of services
62.
Adequate reimbursement for professional services of neonatologists and all pediatric subspecialists
63.
Adequate funding of perinatal programs. Regionalization of perinatal care. Continuing education and
current awareness of issues affecting the care of neonates.
64.
> Improvement of neurodevelopmental outcomes in ELBW infants >Education and improved access
to adequate prenatal care
2
Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
65.
A seriour question relates to training. Neonatal hours for residents are limited, procredural
opportunities therefore expertise is limited so physicians practicing in non tertiary centers may not be
able to provide quality resuscitation and stabilization. Should the whole rotation of neonatology be
revamped to focus more on DR amnagement and follow up (level 2) care vs care for NICU patients
with high tech and acuity needs.
66.
1) Issues listed in #5, as well as increased compensation for P4P programs and CQI efforts-we are
jumping through more hoops for relatively fewer dollars; 2) more research $$$ for Neonatal-Perinatal
Medicine, which is very underfunded, in my opinion.
67.
see above.
68.
The added cost of fragmentation of services (e.g., transport of the VLBW & ELBW neonate instead of
maternal transport markedly increases morbidity/mortality of the neonate and markedly inflates the
medical costs to families and society
69.
improved followup and interventional straegies post NICU
70.
Provision of funding, cost-effective medical practices, medicolegal liability
71.
leadership and support of professional activities (e.g. quality improvement)
72.
Robust training in pediatrics that includes more critical care training. The pendulum has swung in the
wrong direction.neonatologists
73.
make available knowledge on newer therapies
74.
1. appropriate management of the infant born at 22-23 weeks gestation. 2. continued advocacy and
refinement of coding system
75.
Outcomes and ethics at the limit of viability - Who decides what the limit of viability is and then how do
we support those families - both those who choose to resuscitate and those who don't
76.
Costs and de-regionalization
77.
standards of care and helping drive appropriate benchmark standards
78.
The linit of viability and outcomes
79.
Reimbusement issues, REducing the risk of adverse neurodevelopmental outcome
80.
Education Clinical Guidelines and Statements NRP
81.
recruitment of pediatricians and nurses into the field litigation caps
82.
Simplified recertification process for NPM exam
83.
unsure
84.
advocate for research in neonatal care practices
85.
Extreme prematurity and resuscitation at peri-viability - legal and guideline clarification
86.
None
87.
1)adequate source of competent providers 2)continued emphasis on perinatal as well as neonatal
3)having adequate state and other resources to reimburse and otherwise support those who care for
these patients (including legislation that quite directly impacts perinatal health such as tobacco taxes,
tort reform, etc.) 3)
88.
Training of Echocardiographic skills for fellows. Formalizing a definition a what constitutes exactly a
car seat exam.
89.
Limits of Viability
90.
Standards of care
91.
More support for research
92.
advocacy for our patients against insurance companies
3
Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
93.
Providing effective healthcare at a reasonable cost.
94.
coding changes Joint Commision regulations impacting newborn care Leapfrog and other quality
evaluation agencies/group and the standards chosen for quality evaluations
95.
the requirement that all newborn orders get called to pediatricians( sometimes also neos) in the
middle of the night for normal new born orders. It is not practical, and can result in missing important
information
96.
Funding
97.
Patient Care Funding; Research initiatives;improve relations between private sector and academic
sector; recruit more private sector Neos on Section Executive Committee
98.
breastfeeding
99.
Advocacy
100. Ethics and financial considerations in heroic care
101. Chronic lung disease
102. workforce pipeline - AMG vs. IMG
103. Burnout. Increasing administrative duties. Insurance problems.
104. Lack of regionalization and proliferation of units throughout the country without planning or
organization
105. Maternal health and NOT inducing early because of parental pressure or physician plans
106. limits of viability and the ability for society to pay
107. Reimbursement issues-medicaid
108. healthcare costs and reimbursement
109. reimbursement for neonatal ICU care Dissemination of research findings that improve neonatal care
110. Easier coding of neonatal care
111. Stricter evaluation of training programs--too many weak ones still turning out neonatologists not ready
for practice in the outside world.
112. Improved patient safety for this fragile population.
113. Guidelines for care and discouraging "experimental" care in non teaching facilities
114. manpower professional collaboration
115. Ethical dilemnas in neonatology
116. access to health care for all irrespective of socio economics
117. Access to care of High risk pregnant mother and the VLBW.
118. Role of neonatalogists in non academic centers and assisting in the services provided
119. Financial issues. Fair compensation for a high risk job.
120. Who cares for ALL newborns in the hospital- preferably neos and their employees!
121. How to prevent the epidemic of prematurity and the associated shortterm and longterm complications
in view of limited resources and the lack of universal health care coverage
122. Collaboration between neonatologists and perinatologists
123. Translational research and quality improvement
124. medicolegal issues; supply/demand of neonatologists;
125. Improving reimbursment for Neonatal care; too many potential candidates discouraged by the poor
4
Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
commitment:reimbursement ratio
126. 1)Malpractice Testimony 2) Appropriate Guidelines for the care of terminal Genetic conditions, ie
Trisomy 18
127. evidence-based care through compelling research endeavors
128. Treatment and care of critically ill newborns.
129. slippary slopes of lower gestation ( 23-25 wks)
130. quality improvement and evidence based practice
131. See above, plus reimbursement to hospitals & healthcare workers for services so they can continue to
provide care.
132. Ensuring the quality of training programs
133. Cost effectiveness of neonata care and wide variations in practice
134. Accessibility to care, decrease the elective induction, advocate for pregnant women in the work force
as a guarantee of our future
135. -the dumming down of the field training glorified technicians rather than professionals -cut back the
excessive paperwork burdens in the ACGME process, great theory but lots of paper
136. 1) work with ACOG to attempt to get their members to follow their own guidelines RE elective
inductions and C-sections only at or after 39 weeks. The perinatal section ought to "take a stand" on
the late preterm baby's bad RDS, hosp readmissions, kernicterus risk issues,etc. We all talk about it,
but as a formal group have not addressed it RE obstetrical practice. 2) work with the section on
breastfeeding to advertise and disseminate the soon to be published "model hospital policy", to put
pressure on US hospitals to be more breastfeeding friendly (not crazy baby-friendly) by using
guidelines based in science to support BF on post-partum units,and to strongly suggest that hospitals
quit marketing formula (for the formula companies) by giving away formula and diaper bags to new
moms.
137. quality improvement
138. government reimbursement, training
139. 1. speak for babies and families 2. continue to provide care 3. assure good md reimbursement
140. response to change
141. Threats to payment from P4P efforts.
142. Immunizations, evidenced based medicine
143. No comment
144. See my response in the survey submitted yesterday before #4 was corrected.
145. resident preparation with the decreased time in NICU
146. 1. prematurity 2. loss of high quality neonatologists from academic institutions
147. public health
148. Evidence-based practice
149. aging population of neos
150. see above--assure quality care
151. evidence based practices
152. Cost of therapies such as meds (neoprofen) and iNO
153. Federal funding to support Mediacaid
154. Nutrition
5
Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
155. Workforce balance Performance standards and outcomes analysis
156. .
157. Access to care for mothers/babies
158. 1. Academic future of neonatology as a specialty 2. Closing the gap between academic and non
academic salaries
159. Racial disparities in perinatal outcomes. Malpractice crisis. Education of residents, not only in
Pediatrics, but in Family Medicine, Emergency Medicine, and Ob-Gyn.
160. Preventive medicine and education.
161. The above as well as adequate training for Neonatologists in the era of decreased work hour
requirements during training
162. Need for more NNPs, PAs, NICU hospitalists, and more flexibilty in definitions of "academic
neonatology" so we can bring a new generation of Pediatric trainees into neonatology, and support
the running of NICUs, both academic and non-academic.
163. preventing late prematurity
164. Reimbursement for increasingly complex care, transitional care units for long term care
165. "Manpower" needs, distribution, and insane documentation necessitated by silly billing system.
166. n
167. increasing the quality of fellowship education
168. Changing needs of Neonatal Trainees
169. I have always been troubled by the lack of direct communication between the National Committee on
the Fetus and Newborn and the various State Chapter meetings. National meeting minutes may be on
line, but not timely. No coordination of efforts between state chapters and the national group.
170. facilitate networking (VON, NICHD, quality collaboratives)
171. facilitate networking (VON, NICHD, quality collaboratives)
172. Ceding of normal newborn care to neonatologists and how to provide cost effective care of these
babies
173. making sure that every family has health care benefits.
174. Fellowship training -- work force issues. Many depts of peds no longer wish for us to train any neos
other than academic ones - is this practical? How do we fund training good clinicians if we feel this is
a priority?
175. how far do we go, how to stop. CME
176. tort reform
177. Health care coverage for mothers and babies Ethics of care at the border of viability
178. career paths for neonatologists in the era of in-house coverage as they age
179. The U.S.'s poor perinatal outcomes as relative to the world.
180. Use of ultrasound by neonatologists Use of probiotics in the NICU
181. 1. levels of care and appropriate patients at appropriate centers 2. training of future neonatologists 3.
fair and appropriate recertification process
182. research interest in outgoing fellows
183. Resources and hours of work
184. Your recent newsletter said the average age of Neonatologists in the US is 54. The section must be
doing something wrong!! Perhaps its time to access why a specialty which is interesting, dynamic and
6
Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
financially rewarding cannot attract American born Physicians. I suggest one of the reasons is that
training is too long and consideration should be given to going back to a 2 year fellowship. At the
current rate we may very well run out of neonatologists.
185. funding for clinical care and research payment for physician services requirements for maintenance of
certification
186. the role of neonatologist and relationship to pediatricians ; should there be any involvement of family
practice in the ICN?
187. Association with OBGYN for prenatal care emphasis
188. Education and quality improvement; bringing the 900+ NICUs in the US to some form of benchmarks
for evaluation of care
189. no opinion
190. Re-imbursement for provider services and procedures Influx of electronic systems: charting, nursing
charts and order entry. Increased time demands. Changing demographic of neonatologists in practice,
more part-time. Be proactive in addressing pay for performance and quality indicators, partner with
payors to consider meaningful indicators.
191. the poor outcomes of newborns in the U.S. compared to other developed nations
192. inadequate training/exposure of residents to neonatology (work hour limitations)
193. potential physician shortage
194. no answer
195. Availability of subspecialty consultation in the community. Will digital technology allow for good
readings of echo, ultrasound, EEG studies or should community neonatologist know how to interpret
these? Also, it would be nice to be grandfathered in to conscious sedation. As this is run by
anesthesiologists, a test written by them must be taken in each facility. There should be a universal
credential that is part of fellowship training and/or board certification., recognized by the major
anethesia groups. This would allow for quicker medical staff privileging. It shoul include Propofol and
ketamine (deep sedatives.
196. Evidence-based practices Addressing "social" issues - access to care etc
197. Access to care
198. community vs academic issues
199. 1 - Increasing access to longterm supportive therapies (PT, OT, Speech, sensory integration,
behavioral) 2 - Continue education efforts related to coding
200. the appropriate minimal role for neonatologists, nurse practitioners and other physician extenders in
the daily care of neonates at the various levels of care
201. new therapies
202. /
203. Life style/work. Promotion of academic neonatology - new grads seem to be directed to "shift"
mentality.
204. training requirements
205. dosing of surfactant and frequency in the EELBW infants who were not living when the original
surfactant trials were carried out
206. See 5 above...Adequate support of academic activities.
207. Universal health insurance.
208. Limits of viability issues.
209. advocacy, international, education
7
Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
210. Written in previous version of survey
211. Training of neonatal fellows should include a well defined follow up training component; collaboration
with other organizations with common interests in perinatal health.
212. academic work protection with increasing clinical demands
213. Improving access to prenatal care and preconceptual education
214. establishing clinical guidelines
215. limits of viability, the late preterm
216. survival at the edge of viability
217. Adequate oppotunities for the QA portion of Maintenance of certification Adequate reimbursement of
billing especially in Medicaid Rescources for older neonatologists and different career paths prior to
retirement - the aging of neonatology
218. evidenced-based perinatal medicine
219. We need to do a better job of more fully informing families regarding long-term outcomes for infants
born at less than 26 completed weeks gestation so that they might make better informed choices and then we need to support those choices.
220. Fair payment, medical/medical issues.
221. The need and right of every baby to have access to the care which they require
222. Research
223. Accesibility/availability to all. International outreach. Education/preparation of the next generation of
Neos Evidence-Based practice; and not spending money on what does not work.
224. Requirements for NICU's to have established capabilities and volumes of patients sufficient to
maintain competency.
225. Advocacy Research funding Uninsured
226. continuing education
227. medicaid and third party reimbursement
228. The risks/benefits of small community nurseries Level III nurseries where outcomes are poor but the
units make money for the hospital.
229. the above
230. Strengthening academic programs.
231. Enhance feedback to regulatory organisms such as ACGME, Board of Pediatrics and IOM
232. ridiculous JACHO policy of notifity pediatricians at all hours day & night for NORMAL newborn orders,
this will drive pediatricians out of normal nurseries and dilute urgency of important phone calls
233. Problem if licensing where no one physician takes care of patient - a team effort
234. how outcome data will be tied to reimbursement
235. Training standards; pursuit of "evidence-based" care.
236. Late preterm infant surge
237. Aging population of neonatologists Changing field of medicine - EMRs, funding issues
238. Advocate for the well being of babies. Block legislation allowing llay midwivery without any nursing or
medical training.
239. outcome data related to rescuscitation of borderline viable infants
240. research money allocation, encouraging relationships between obstetric and neonatal medicine
8
Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
241. Prevention of premature birth
242. Promtion of breastfeeding and/or breast milk, even banked, especially for at-risk newborns.
243. Pediatric residency and fellowship education
244. The section must push the RRC to increase the number of rotations that the pediatric residents may
attend in the NICU or well baby nursery.
245. Regionalization of high tech and micro premie care.
246. Long term neurodevleopmental outcomes
247. limits of viability and potential lawsuits that may arise from resucitating and not resucitating in the grey
zone of viability
248. collabaration with developmental pediatrics for longterm care of the neonates discharged home
249. Humanpower issues, coding and reimbursement.
250. Government payment for services.
251. Resident education and lack of proper training/experience in the delivery room before entering private
practice
252. Fragmentation of neonatal care
253. payment issues especially if a one payor system comes when is care futile? issues of ethics and care
adequate research in care continued and systems to insure adequate trials(especially drugs)
254. outcomes in developing countries
255. Attracting members into academic practice to encourage education and research.
256. Retaining and enhancing Integration of Neonatal intensive and newborn care into the education of
young peds and retention of Neo Divisions as necessary/important components of Departments of
Peds
257. Global Health; aging population of neoantologists
258. Quality metrics Coding and reimbursement
259. Getting insurance to pay for back-transfers
260. The inability of ethical discussion to keep up with advances in medical technology in neonatology.
261. Lack of general pediatric training in neonatology
262. Ethical guidelines and cost containment.
263. development of FACULTY -- recruitment and retention of talented people to maintain supply of the
best and the brightest into neonatology
264. reimbursement, access to care, competition, manpower
265. #1 priority: In house night call, different states with different regulations, what are expectations, what
is needed, etc...
266. medical malpractice
267. Role of neonatologists and neonatology care extenders, as general pediatricians continue to lose
ability and desire to handle complicated neonatal care. Role & training of pediatricians at institutions
underserved by neonatologists.
268. see above
269. Continue to work to maintain appropriate regionalization of perinatal centers.
270. See above
271. universal health insurance
9
Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
272. continued support for multicenter trials to provide answers to some of our big questions. continued
advocacy for childrens healthcare. Continued work on smart practice including coding and
reimbursement
273. no answer
274. long term care for NICU grads with disabilities
275. aging of workforce, adequate number of docs; adverse effect of training guidelines on neonatal care
by general pediatricians and how to address that situation
276. How to train physicians with the goal of having them stay in academic practice.
277. manpower and working conditions, quality of professional life issues, physician extenders in the NICU;
there are 40 neonatal positions being advertised in this JOP
278. do not support mandatory recertification (perinatal-neonatal boards) for those of us who became
board-certified in the 1980s and before
279. organization of health care
280. end of life care and parental involvement; delivery of care and extreme limit of viability
281. Consider education to the public on limits of viability and problems resulting from prematurity.
282. Patient safety and improved outcomes
283. Differences in newborn care in developing countries
284. Advocating regionalization in the face of a growing for-profit community sector.
285. preterm inductions
286. tort reform
287. ROP, telemedicine using the Retcam, availability of an opthalmologic provider.
288. Billing, coding.
289. resources, VLBW and viability, consensus on follow-up
290. Evidence based practice
291. Research and research training
292. establish guidelines
293. Emphasis on quality and the practice of evidence based medicine in our specialty. Research networks
need advocacy at the national level for this to be most effective and inclusive.
294. Encourage more research
295. Addressing better ways to resource clinical research in community based hospitals with large volumes
of patients
296. Appropriate utilization of the "graying" neonatologists.
297. See above comments. We must also promote clinical Neonatology as a profession with flexible work
hours for our increasingly female Pediatric trainees (I have heard that the average age of a
Neonatologist in this country is greater than 50 years old). Finally, we must revisit Neonatal outcomes
demographics. The major ones (survival, IVH, NEC, etc.) have not changed in the past 10 years
298. decrease litigenous tendencies
299. encouragement for people to enter the subspecialties healthcare reform
300. access to care Continuing education
301. developing and keeping qualified practitioners
302. Funding, education of the public, care for evry pregnant woman irrespective of her insurance status,
10
Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
but the burden should not be placed on neonatologists and hospitals
303. MARKET MONOPOLY BY PEDIATRIX
304. Guidelines for Pay for Performance and Outcomes Measures
305. No comment.
306. Training of echocardiography and CFM basics to fellows.
307. reimbursements for care
308. Help fellows achieve meaningful research during fellowship that fosters an academic career and
continued research. My fellowship research experience was very poor and therefore I chose only a
clinical position. Now I have practiced 3.5 years and feel like I would like to contribute more to
research and wish I could make a change. It feels too late?
309. See Answer #5
310. Mentoring young fellows and junior faculty.
311. Physician shortage
312. n
313. LEGAL , economic ,PR aspects of practicing neonatal medicine ( Very low BW)- addressing our
contribution to the world's disabled
314. Continuinng education for practitioners and common clinical evidence based
315. workforce
316. Support for top quality research training of fellows to make this an even more attractive career choice.
Right now the balance is in favor of lucrative practice jobs over academics. I see this getting work with
the now ACGME-mandated trainee 80 hr work week that seems likely to become 60 hr in the next 2-3
years.
317. causes of prematurity/viabilty issues to let community know about the real outcomes of extremely
premature infants
318. The funding for neonatal care and research
319. n/a
320. reimbursement access to care
321. Endless and wasteful "stuff" sent out by the American Academy of Pediatrics
322. Research is vital for the future of neonatal-perinatal medicine and there is an appalling lack of
research funding for topics in neonatology.
323. Funding for children's healthcare - universal would be ideal.
324. Reduction of the frequency of iatrogenic late preterm infants Collaboration with reproductive
endocrinologists to reduce higher order multiples Personalized and predictive medicine for infants to
predict risk of pediatric and adult diseases
325. Obstetric practices running counter to optimal newborn care such as C-section on demand. Rising
percentago of c-section and elective induction
326. Research & education. The neonatologist has evolved into a hospitalist because of financial forces.
327. Improving Neurodevelopmental outcomes
328. Counseling re Genetic & Developmental Disasters
329. Regionalized care, delivery level matching facility of care level
330. 1. staffing models - physician extenders vs neonatologists 2. payments 3. International medical
graduates 4. Note that question #4 does not allow for ranking 5 choices
11
Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
331. outcomes research
332. Quality standards
333. Collaborative efforts between Obstetrics and Neonatal medicine to improve the care for all.
334. education of physicians to embrace family centered care continue research development educational
advocacy continue clinical guideline development
335. Significant variance in care, even when clinical practice guidelines exist
336. reimbursement
337. Advocacy for true evidence based practice in Neonatology
338. Single-payer system
339. quality of care quality of outcomes quality of fellows more involvement of nonacademic input in COFN
340. translational research guidelines to imprtove outcome of preterm infants ans follow-up
341. Will society continue to pay for 23 & 24 week admissions.
342. Training and Education
343. payor issues controlling medical care, availability
344. it's viewed as too much of an "old boys' club" by young neonatologists - you must reach out to and
recruit younger members
345. Coverage for developmental surveillance for early detection and treatment of delays
346. All pertaining to Preventive Medicine
347. Clinical Outcomes Research
348. Regionalization!!! Regionalization!!! Regionalization!!! If we can increase regionalization, we will save
a lot of lives, and even more significant disabilities. This will be difficult for the organization, given that
a large share of the members are not currently practing in large tertiary centers. In the short term,
improved regionalization shouldn't have any real effect on the demand for neonatologists, as jobs will
just be shifted. Start now to reduce the number of neonatologists that are trained to reduce the future
glut of neonatologists. Again, this will be hard for the organization.
349. reimbursement for medical care compassion in care curtail experimental practice in non teaching
hospitals
350. access to health care appropriate reimbursement/coding make board REcertification take home again
or else make recertification required for ALL neonatologists require recertification
351. research, education, reimbursement
352. Health insurance, training issues. -There is more and more paperwork involved, more requirements,
and less time. This cannot continue indefinitely!
353. communication between families, medicine and appropriate portrayal by the media; stop the drama
and blitz about higher order multiples
354. Prevention of prematurity
355. Ethical issues - where to make limits in futile treatments.
356. Pre/probiotics
357. evidence based practices
358. Teen pregnancy Prematurity (although a smaller part makes a big impact on morbidity and mortality)
Tort reform
359. Pay for performance - must have expert leadership for appropriate goals for top performance
360. hours of work, quality of care, treatment pathways, transparency to the public and tort reform
12
Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the
Section proactively address?
361. Malpractice, Salary and Research Funding
362. Push for a single payer system that would provide optimum prenatal and postnatal care to all mothers
and infants regardless of income or status
363. Levels of care provided by pediatricians versus neonatologists, particularly as physicians shift to a
division between in-patient and out-patient care more and more. Also, residents do less and less in
patient care hours and are less comfortable with inpatient care.
364. How to maintain the population of active educators and investigators
365. Having private Neonatal group supply incentive money to fellow trainees without funding the neonatal
program that trains their future manpower.
366. limit of viability reproductive medicine
367. keep us acaemic
368. medical coverage
369. *
370. Aspects of late preterm infant.
371. ACGME Program guidelines needs to come from neonatologists/Program Directors
372. Reimbursement for services
373. continued funding for research, appropriate reimbursement for services
374. Guidelines and standards for newborn and child/adolescent health
375. Ability to attract high quality trainees to stay in academic settings - far too many are leaving
academics because of discrepancies in salaries offered by private practices
376. importance of continued (and expanded) payor support of NICU care in a climate of constraints on
health care spending
377. billing reimbursement tort reform govt health care plans/reforms
378. Insurance coverage, education of the members communication with other disciplines and other
nations
/J:_Newborn.PRI/VanMarterAssistant/AAP/MemberQuestionairre/Perisurvey#6
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