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Pediatric Councils
Chapter Based Advocates for Pediatricians
 A “Pediatric
Council” is a forum that facilitates communication between pediatricians and
health insurance plans in order to improve the quality of and access to health
care for children, obtain more appropriate coverage for pediatric services, and
simplify and expedite health plan claims adjudication.
NY Chapter 1 Pediatric Councils
Albany Pediatric Council
The Albany
Pediatric Council has just been formed. Meetings with CDPHP and MVP will occur
in the near future.
Buffalo Pediatric Council
The Buffalo Area Pediatric Society was formed approximately 2 years ago and is
chaired by Michael Terranova, MD. Its many accomplishments include the
following:
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Established a mechanism to alert insurers of vaccine company price
increases
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Initiated payment of administration fees and their current monetary value
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Addressed the issue of sub-standard pediatric care at urgent care centers,
which inhibits the medical home concept
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Consistently opposes retail Based Clinics
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Documented the inadequacies in payment for newborn hospital services;
insurers responded with either increased payments or an agreement to
reinvestigate this issue
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Insurers are collaborating with NYS and private grants to standardize
quality measures, and in the future this may lead to more coherent programs
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Insurers will pay for 30 month and yearly Well Child Care visits for
patients 3 years-21 years old
Rochester Pediatric Council
The Rochester
Area Pediatric Council, chaired by Edward Lewis, MD, has been meeting since
2006. Representatives from Rochester Individual Practice Association, Monroe
Plan for Medical Care, Preferred Care/MVP, Excellus BlueCross BlueShield and
pediatricians from the Rochester and Southern Tier areas regularly attend the
meetings. The agenda allows for IPA and health plan reports as well as updates
from pediatricians. Discussion items have included-timely response to vaccine
pricing increases, consideration of payment for telephone codes and other non
face-to-face codes, as well as quality concerns related to the care delivered at
urgent care centers. As a result of these discussions, a process is now in place
to monitor vaccine price increases and health plans are taking a closer look at
the credentialing process and patient outcomes at urgent care centers.
NY Chapter 2 and 3 Pediatric Council
The NY Chapter 2 and 3 Pediatric Council, chaired by Steven Goldstein, MD, and
Evelyn Ha, MD, has been busy these past few months, meeting with Empire three
times and with United Healthcare once. The council was successful in making
these companies aware of the struggles that pediatricians face every day.
Specifically, we referenced and made them aware of the fact that pediatricians
are called upon to do so much more these days in the area of mental health. The
Pediatric Council has made it clear that pediatricians have been caring for the
mental health needs of their patients and should be well compensated for the
excellent care they are giving:
The Pediatric Council has done a good job of opening up the communication
process between the pediatrician and the health insurer. In addition to mental
health, other issues that were discussed included:
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Immunization issues (adequate and timely payment)
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Bright Futures and what the insurer expects from the pediatrician
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Lack of fee schedules (United)
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Childhood Obesity and how to code for it
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Importance of documentation when getting paid
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Lack of Provider Reps (both companies are re-instating these reps)
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Why referrals cannot be done online (Empire)
We have taken some important steps in developing ongoing positive relationships
with both United and Empire. The Pediatric Council will continue to work hard to
improve the practice of pediatrics and the health of our patients.
By
Michael Terranova, MD, FAAP (NY Chapter
1),
Nancy Adams, Elie Ward, and George Dunkel
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