OKAAP November 2008

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					Volume 10, Issue 2                                                                  November 2008

                                   Caring for Oklahoma’s Kids


                              Pediatrician
             Newsletter for the Oklahoma Chapter, American Academy of Pediatrics
OKAAP CHAPTER OFFICERS
                                   PRESIDENT’S REPORT
Chapter President
J.W. Hendricks, MD
2000 S. Wheeling Ave. Ste 300      2008 was expected to be a year of repair and re-evaluation for
Tulsa, OK 74104                    the Chapter. The OKAAP Executive Board and management
918/747-7544                       have been working very hard these last few months. It is
Fax 918/747-3952                   appropriate to summarize a score card of this year’s efforts. I
e-mail: DocJWH@aol.com             am very grateful for all the efforts of the members and
                                   especially the Executive Board.
Chapter Vice President
Edward A. Legako, MD
3201 W. Gore Blvd. Ste 100         Completed
Lawton, OK 73505                    Administrative support has been stabilized and a new
e-mail:                               Executive Director is in place.
LegakoE@memorialhealthsource.com    Leadership divided and called Chapter members personally
                                      to update demographic information and invite to CME
Secretary-Treasurer                   Program.
Eve Switzer, MD                     Updated membership database with new demographic
3201 N. VanBuren Street Ste 300       information provided from calls.
Enid, OK 73703
                                    Completed a very successful 2008 Annual Meeting and CME
580/234-7070
                                      Program, August 22-23. 70 pediatricians attended the
e-mail:
                                      meeting.
Kidoctr@yahoo.com
                                          SPECIAL NOTE: The Board voted unanimously to
Immediate Past President                  name the Fall CME Conference in memory and
Michael F. Stratton, DO                   honor of Reta, the Chapter’s former Executive
3101 Chandler Road, Ste 101               Director.
Muskogee, OK 74403-4903             We achieved financial stability.
918/687-4411                              We want to thank every OKAAP member who
Fax 918/687-4448                          remitted the $150 lawsuit assessment to help the
e-mail:                                   Chapter.
kidsdoc3rvrs@hotmail.com            Created a new website with planned timely updates.
                                    Prepared/filed incorporation documents with the Oklahoma
Chapter Executive Director
                                      Secretary of State.
Don Orchard
                                    We have developed a support system to facilitate
6840 S. Trenton Ave.
Tulsa, OK 74136
                                      identification and prophylaxis administration for infants at
918/747-5585                          risk for RSV disease. This was presented at the annual
Fax: 918/858-0298                     meeting and placed on the website.
e-mail: dorchard@upal.com           Attended CME Re-accreditation Conference held by state
                                      medical association.
                                    Using a grant from national, Dr. Legako gave a presentation
                                      to residents in OKC and I plan a presentation to Tulsa
www.okaap.org                         residents November 5th about the importance and
                                      professional benefits of OKAAP and AAP membership.


                                                    1
   Prepared drafts of new Bylaws. Board adopted at October meeting.
   The Chapter (and you) have representation on the OHCA Child Health Advisory
     Committee.
   We have improved collaboration with the state family practitioners on legislative issues
     and submitted input on immunization, medical home, and anti-tobacco efforts.

In   Progress
   Developing interactive member survey tool.
   Developing business plan.
   Developing vaccine purchasing solution through survey of membership. – Please note,
     this survey is available as part of this newsletter and on the OKAAP
     website. Please complete and return it, so the Chapter can develop a cost-
     savings program.
   Planning two CME conferences – Spring (Tulsa) & Fall (OKC); creating marketing
     materials.
   Pursuing Maintenance of Certification sponsorship.
   We are improving collaboration with the state’s training institutions.
   The Chapter is contacting state agencies dealing with emergency preparedness and
     collaborating with the national organization.
   The Chapter is collaborating with the Community Action Project and OUHSC, Tulsa as
     the Community Medical Program develops.
   The Chapter’s current committees are being reviewed and membership restructured.

I know all of you are busy. We have endeavored to make newsletters, e-mail
communication, and the website important sources of information for the membership. If
you have suggestions for improvement, don’t hesitate to contact me or our Executive
Director, Don Orchard.




Your Chapter President,




J.W. Hendricks, M.D.




                                              2
            About the New Chapter Management Team

Chapter President Hendricks asked that I write a newsletter article about me, my role as
OKAAP Executive Director and the great team at UPAL which supports me in accomplishing
the goals and direction set by the OKAAP Board.

By professional training, I am an attorney. I have worked for and only represented
physicians and their interests for more than 20 years. So, I guess one could say, “I’m one
of the good guys.”

I’m a native Oklahoman – born and reared in Tulsa. I moved to Texas for school at Baylor.
Later, I moved to D.C. for grad school at American University. From there, I spent several
years working for the American Red Cross, until returning to Tulsa to attend law school and
work for a large multinational corporation.

For the last 20 years, I have been the CEO of Utica Physicians’ Association, Ltd. (UPAL).
UPAL is a physician cooperative and management organization providing managed care,
financial and group purchasing services to its 728 physician members.

By contract, UPAL provides certain management, accounting and administrative services to
OKAAP, Tulsa County Medical Society, Oklahoma Medical Group Management Association
and Eastern Oklahoma Medical Group Management Association.

I am the designated Executive Director of OKAAP and am supported in that role by a staff
of eight other UPAL employees. Several UPAL staff members are intimately involved daily
in the delivery of services to OKAAP. Debbie Aaron (many of you met her at the August
OKC CME Conference) serves as meeting planner and coordinator for both of the state-
wide meetings. Debbie also assists in putting together meeting promotional materials.
Kelly Hollabaugh keeps the Chapter financial records, pays its bills and tracks its
membership. Diane Russell works on the Chapter newsletter, designed and maintains the
new OKAAP website and helps maintain the membership database.

We are firmly committed to supporting the Chapter and its physician leadership in
implementing programs and services beneficial to Oklahoma pediatricians and the children
you serve.

On a personal note, I’ve met and worked with hundreds of physicians at this point in my
career in health care. What I have observed is that success in medicine is not measured
by the biggest salary, the fanciest sports car or the biggest house on the block. The most
successful physicians I’ve witnessed see success in terms of helping people in trouble.
They see certain values, like compassion, caring, empathy, honesty, dedication, access and
quality as fundamental to their profession. They have done the most to help those least
able to help themselves. They are pediatricians.

I am honored to be your ED. Please let me know if there’s ever anything I can do to assist
you personally or professionally. I would be pleased to try to help.


Don Orchard
OKAAP Executive Director


                                            3
             Important Message from the AAP President

Dear Member:

I need to share the following news item with you, because it concerns me greatly: a 7-year
old boy from San Diego became infected with measles while traveling in Switzerland
with his family this January. He had never been vaccinated.

He transmitted the disease to his two siblings, five classmates and four more children who
happened to be at the pediatrician's office during his visit. All eleven children had never
been vaccinated.

The trend to refuse inoculations for a number of preventable diseases is growing because of
misinformation. In some parts of the country, the rate of vaccine exemptions is approaching
30% - that means in those areas almost one in three children is not adequately
protected against preventable and very serious illnesses.

Your help is needed now to give a stronger voice to our message about childhood
immunization safety and the importance of disease prevention.

Your support of the Friends of Children Fund - Immunization Education Fund will be
used to provide education, support and advocacy to help ensure that:

 no child suffers from a preventable disease,
 parents and the public understand the need for and safety of vaccines, and
 members have the necessary resources to answer parents' questions.

Please join us in our efforts and make a contribution to the Academy's Friends of Children
Fund - Immunization Education Fund today. To make a contribution online, please
visit: http://eweb.aap.org/donations.

Sincerely,




Renée R. Jenkins, MD, FAAP
AAP President, 2007-08




                                             4
The OKAAP Group Purchasing Committee Chairman
on Adequate Payment for Vaccines
Dear Fellow OKAAP Member~

Adequate payment for vaccines has been a problem that our members continually
struggle with. There are 2 parts to this: the cost of the vaccines and what the
insurance companies will pay for us to give them.

The survey on page 8 of this newsletter is to help us assess whether through a
group purchasing agreement the OKAAP can significantly lower our costs of
purchasing the vaccines. The more members who fill this out, the better we will
be able to assess your needs. This survey was sent to our members via e-mail and
is also available on our website at: http://www.okaap.org.

Although the OKAAP cannot negotiate specific insurance payments, I want to draw
your attention to some information from the AAP that may help you in your
negotiations.   The first is their "Business Case For Pricing Vaccines and
Immunization Administration" , found on pages 6 and 7 of this newsletter. It
provides information you can present to insurers when negotiating vaccine
payments. It is also available in the Private Payer Advocacy section of the AAP
website at: http://www.aap.org/moc/displaytemp/BusinessCase.pdf.

Insurance companies use a variety of sources to get information on the cost of
vaccines. Some are inaccurate resulting in payments that are at times below our
costs to purchase the vaccines. The AAP has found that the most consistently
accurate source of information on what we in the private sector have to pay to
purchase vaccines is at the CDC website: http://www.cdc.gov/vaccines/programs/
vfc/cdc-vac-price-list.htm.   This is updated frequently by the vaccine
manufacturers. I encourage to look at this and refer insurance companies to it as
well.

Kenneth R. Setter, M.D.
Chairman, Group Purchasing Committee
Executive Board Member




                                        5
6
7
                        OKAAP VACCINE SURVEY

By percentage, tell us the volume of vaccines your practice administers to
private- versus VFC-covered children annually.

                % Private (every child but VFC regardless of method of pay-
                  ment)

                % VFC

                % TOTAL

Within the last year, have you purchased vaccines for private (non-VFC)
patients through any of the following group purchasing programs?
(please check all that apply)

        □   Atlantic Health Partners   □   Integrated Physicians Solutions
        □   Kelson                     □   Pediatric Federation
        □   PedsPal – Cook Childrens   □   National Physicians Care
        □   Physicians Alliance        □   Other(s):

By manufacturer, how many dollars do you spend annually
(approximately) and what is the total percentage discount you receive:

        $             Sanofi Pasteur   Discount %

        $             Merck            Discount %

        $             GlaxoSmithKline Discount %

        $             Wyeth/Lederle    Discount %

        $             MedImmune        Discount %

For future contact purposes, please print the name, phone number and
email address of the person completing this survey.

        Name                           Phone No. (          )
Email

If the above responses are for a group practice, indicate the no. of
physicians

                                  THANK YOU!

               PLEASE FAX COMPLETED SURVEY TO 918-747-5596.
                                           8
   NEW IMMUNIZATION ALLIANCE ISSUES NATIONAL CALL TO ACTION



For Immediate Release

CHICAGO (Sept. 18, 2008) — Concerns about keeping immunization rates at adequate
levels have prompted the nation’s leading medical and advocacy groups to join together to
raise the public’s confidence in vaccines. The Immunization Alliance calls on policymakers,
public health agencies, physicians, and the public to work together to preserve the health
of the nation’s children through immunization. The Alliance, which is made up of medical,
public health and parent organizations, met recently to discuss the increase in questions
from parents about the value of, and need for, today’s childhood vaccines.
“We do not want to become a nation of people who are vulnerable to diseases that are
deadly or that can have serious complications, especially if those diseases can be
prevented,” said Renee Jenkins, MD, FAAP, president of the American Academy of
Pediatrics. “The groups in this Alliance have made a commitment to pool our resources and
expertise, and to ask the government to help avert what could become a national
emergency. We want to impress upon the public the possible consequences—safety,
medical, personal, and economic issues—of having a population that is not adequately
protected against measles, whooping cough, meningitis, and many other diseases.”

Dr. Jenkins stressed that our current vaccines, and those that may be developed in the
future, provide an important safety net to protect against these consequences.

The Alliance has stated its commitment to ensure adequate levels of immunization in the
United States, and has jointly endorsed a Call to Action (see below) to enlist health
professionals, the public, the media and the government in supporting immunizations and
their importance to the public’s health. Included are requests for a public information
campaign by the government; a commitment to ongoing research to ensure the continued
safety, efficacy and development of vaccines; balanced reporting by the media; continued
efforts from doctors in working with parents; and confidence from parents themselves.

Although the Centers for Disease Control and Prevention (CDC) announced that 2007
immunization rates were adequate, recent data show that approximately one-fourth of
toddlers are not properly immunized. Recent outbreaks of measles in several cities, the
worst in a decade, are just one example of how the decision not to vaccinate can affect
individual children and the public’s health. Most cases have been among the unvaccinated.

The Alliance says many young parents have never seen these diseases, so they question
the need for the vaccines. Pediatricians are hearing from parents who fear that their
children are receiving too many vaccines, and recent inaccurate media reports have helped
to fuel their concerns. The group emphasizes that if children are not immunized, there
could be epidemics of many diseases that cause loss of life, or in many cases, severe loss
of quality of life due to mental retardation, blindness, amputation and other serious
consequences.




                                            9
“If immunization levels decline, epidemics are not out of the question,” said Georges C.
Benjamin, MD, FACP, FACEP (E), executive director of the American Public Health
Association. According to the Alliance, if a single disease reaches epidemic levels,
communities and families will suffer in terms of demands on our health care system, lost
productivity and wages, missed school time, and serious health effects.

“Children are particularly vulnerable,” said Dr. Jenkins, which is why experts have
recommended that specific vaccines be given during infancy and early childhood.
“Childhood vaccines are vital to growing up healthy,” she said.

Trish Parnell, Executive Director of Parents of Kids with Infectious Diseases (PKIDs),
added, “When you have seen your child fighting for his life because there is no magical
treatment for his disease, you wish with all of your heart that he had been vaccinated. My
daughter was not vaccinated against hepatitis B and she consequently became infected
with this horrible disease. Our story is just one of thousands told to PKIDs over the years
– we wish we never had to hear another.”

The Alliance also emphasizes that adolescents and adults should receive immunizations
and vaccine boosters according to recommendations from the CDC, the American Academy
of Family Physicians, the American Academy of Pediatrics, the American College of
Physicians, the American Medical Association, and the American College of Obstetricians
and Gynecologists in order to protect themselves and to do their part to keep infectious
diseases at bay in their communities.

Ardis Hoven, MD, infectious disease specialist and Board member of the American Medical
Association, said, “Vaccines are one of the best public health accomplishments of all time
and have proven time and time again their ability to keep horrific diseases at bay. Because
of vaccines, many diseases have been eliminated in the United States, but are still active
in other countries and could rebound here. The ongoing measles outbreaks in several
states are testimony that those who forgo vaccinations are vulnerable to infection from
imported disease, and can pose a significant health risk for their communities.”

More information about the importance of vaccines is available from the individual
organizations listed on the Call to Action, or from the CDC at www.cdc.gov


IMMUNIZATION ALLIANCE CALL TO ACTION

The Immunization Alliance, which comprises the groups listed below, sets forth the
following Call to Action for public health organizations, government, health care
professionals, the media and the public.




                                            10
What the Alliance commits to:

 We commit to continued partnerships with policy makers to ensure that:

       children receive recommended immunizations on time (according to the
          schedule of the Centers for Disease Control and Prevention/Advisory Committee
          on Immunization Practices, the American Academy of Family Physicians and the
          American Academy of Pediatrics) to protect them against vaccine-preventable
          diseases and to protect the public’s health;

       vaccines are as safe as possible and vaccine safety research is adequately
          funded;

       the vaccine supply is sufficient and equitably distributed;

       parents and caregivers have the knowledge and information they need to make
          fully-informed decisions in the best interests of their child.

What the Alliance asks:

 We ask the U.S. Department of Health and Human Services to undertake a public
   information campaign reinforcing the value and importance of immunization to
   empower parents to make informed decisions about vaccinating their children.

 We ask physicians and other health care professionals to work closely with parents and
   patients to foster an understanding of the need for, and timing of, recommended
   vaccines, and to assess what is needed to earn or regain the trust of some
   parents. The goal is to work as a team to fully protect infants and children against
   diseases that can result in death or life-long disability.

 We ask medical professional organizations and public health agencies to provide
   support and guidance to physicians in counseling parents about the importance and
   safety of vaccines. The goal is to facilitate informed decision-making by parents and
   caregivers.

 We encourage parents to ask questions at the doctor’s office, and to expect answers
   based on the best scientific information available. We ask them to rely on credible
   sources for their information about vaccine safety and effectiveness, and to take the
   time to understand the evidence on which immunization recommendations are based in
   order to make fully informed decisions about their children’s health.

 We ask the federal government to dedicate funding for continued research into vaccine
   safety and effectiveness.




                                              11
 We ask the media to take the time to understand vaccine science and the evidence on
   which immunization recommendations are based. We also ask the media to keep the
   public interest foremost in their treatment of this subject, and to consider the potential
   consequences of lending credence to various publicity efforts and spokespersons
   without a complete and critical review of the scientific merit of these sources.

 We ask that, given the importance of communicating scientifically based and
   trustworthy information, all editors of Internet content, publications and blogs should
   ensure that appropriate efforts are made to comply with the high standards associated
   with responsible journalism.


List of Participating Organizations

American Academy of Family Physicians
American Academy of Pediatrics
American Academy of Physician Assistants
American College of Preventive Medicine
American College of Obstetricians and Gynecologists
American College of Osteopathic Pediatricians
American Medical Association
American Public Health Association
America’s Health Insurance Plans
Association of State and Territorial Health Officials
California Immunization Coalition
Every Child By Two
Immunization Action Coalition
Infectious Diseases Society of America
March of Dimes
National Foundation for Infectious Diseases
Parents of Kids with Infectious Diseases
Pediatric Infectious Diseases Society
Sabin Vaccine Institute
UnitedHealth Group
Vaccine Education Center at The Children's Hospital of Philadelphia
Voices for Vaccines




                                             12
                    Please Mark Your Calendars!

The dates and location for the spring 2009 CME Conference in Tulsa have been tentatively
set.

The dates are April 24th (all day) and April 25th (one-half day). The host hotel will be the
DoubleTree at Warren Place, 61st Street and Yale Avenue. The discounted nightly room
rate will be $95 for a non-smoking, king room.

There will be a Past Presidents’ and Board dinner on Thursday evening, April 23rd.

The Board meeting will be conducted on Friday morning, April 24th, 9 – 11 a.m.

For the Annual Meeting and dinner on the evening of April 24th, the Warren Duck Club has
been reserved. It will be closed to the public that evening.

In order to grant CME credit under the new re-accreditation procedures, the Chapter will
have to conduct certain due diligence of the membership in order to establish a program
meeting performance improvement and “gap” educational standards. As part of this
process, the Chapter will begin surveying the membership soon. The results of these
surveys will be provided to the Chapter leadership for purposes of establishing the CME
course content and Conference agenda. When they hit your email or mailbox, please
respond to the surveys as this will help us formulate meaningful CME programs.

Please feel free to email or call us with any questions, comments or input.




                                             13
 Final Weeks of the Physician Practice Information Study:
        Act Now and Help Your Entire Profession!

The AAP, the American Medical Association and more than 70 other organizations are
conducting a comprehensive multi-specialty survey of America’s physician practices. The
section of the survey pertaining to your practice expenses is particularly important, and we
request that you complete it accurately and in its entirety. The Centers for Medicare and
Medicaid Services indicated it will use the results of the study to determine physician
payment. All responses will remain confidential.

Pediatrics has only 113 completed surveys! Please help ensure that our specialty will
benefit from this survey effort.

Let your office staff know that you would like to participate in this survey and convey the
importance of accepting incoming calls, faxes or e-mails from dmrkynetec. If you have
been selected to participate in this important effort and have questions, please call toll-free
at 877-816-8940 and ask to speak with one of dmrkynetec’s executive interviewers about
the 2008 Physician Practice Information Survey.




        AAP 2009-2010 National Committee Chairperson
                       Nominations

This is a reminder that the scheduled deadline for nominations is November 14, 2008.
Nominees must submit a letter of nomination, a fact sheet and completed biosketch to
their Chapter President and to the Central Office in Elk Grove Village, by e-mail, to
nominations@aap.org. Nomination materials may also be submitted via postal mail at 141
Northwest Point Blvd, Elk Grove Village, IL 60007, or by fax at 847/434-8000, attention
Melinda Bretz. All nominations must be date stamped or postmarked by November 14,
2008. It is the Chapter president's responsibility to verify each nominee's membership in
the Chapter and his or her willingness to serve if appointed. The Chapter presidents should
send copies of letters of support, fact sheets, and biosketch to their respective district
chairpersons.




                           National Election Results
Judith Palfrey, M.D., has been elected President-Elect. All five Bylaw Amendments were
approved. Of the 47,878 ballots distributed, 13,860 were returned (8,092 via the web and
5,768 via paper) for a nation voter participation rate of 28.9%.




                                              14
                 Pediatric Research in Office Settings Update

Many of the attendees at the OKAAP chapter meeting expressed interest in PROS.             The
PROS Chapter Coordinator group recently concluded 1½ days of meetings in Boston.

The topics of PROS projects in the field are:
Emergence of puberty in boys
       Data collection is nearing completion. There is a significant lack of data on pubertal
       development in black and Hispanic boys. Consequently, there is special interest in
       recruiting practitioners who see a high number of minorities in their practice.
Adolescent smoking cessation
       I am currently doing this study. It has opened up significant communication
       opportunities for discussing this issue with adolescents. It also has minimal impact
       on patient flow.
Parental smoking cessation
       One of the easiest PROS studies in recent years. PROS will even provide for a
       research assistant for your practice. With the latest data showing the smoking rate
       In Oklahoma is still over 25%, this study will not only give you demographic data
       but teach you the skills to impact second hand smoke exposure in your patients.
Brief motivational interviewing for childhood obesity
       Want to learn the skill set for using brief motivational interviewing at no cost, obtain
       CME, and participate in a landmark study dealing with childhood obesity? It just
       doesn’t get much better than this.

The topics of PROS projects in various stages of development are:
Enhancing parental involvement in teen driving
     One of the major public health problems in teens. This piloted study is just waiting
     for funding.
Common factors approach to child behavior problems
     There are many common factors used by pediatricians and mental health
     professionals in normal day to day interaction and intervention with patients and
     families. This study looks at these common factors and looks to build on these to
     facilitate intervention in a standard pediatrician’s clinic setup.
Improving therapy for persistent asthma
     Practitioners know that many of the guidelines are difficult to apply to everyday
     practice. This study will look at the effectiveness of distance learning to impact our
     care for children with chronic asthma (and other chronic disease).
Counseling to improve oral health
     Early childhood carries isn’t a minor problem, but, no one knows the best way to
     impact this issue in a time effective manner.

This is the time to join the PROS network. Each study is designed to have minimal impact
on practice flow. PROS practitioners have the option to participate in a study or not.
Participation in a study offers many benefits. Participation can be included in your CV.
Your name is listed in published articles, Involvement stimulates thought, gives you
important demographic information on your practice, and pays a stipend to cover costs.
On a personal note, I have learned something in every study in which I have participated.
It is easy to join. Just go to the web site at www.aap.org/pros or contact me at
DocJWH@aol.com

J. W. Hendricks, MD
Your Chapter President

                                              15
                      Oklahoma Health Care Authority
                  Physician Task Force Advisory Committee
                                   Update

Beginning January 1, 2009, the SoonerCare Choice program will be converted over to a
Medical Home model. Under this system there will be three different “tiers” from which the
physician can choose from. The higher the tier level, the more comprehensive the level of
care required.

Primary care providers participating in the program will receive a monthly care
coordination fee for each panel member enrolled. All other services (including office visits)
are reimbursed on a fee-for-service basis. SoonerCare members may receive primary care
from any contracted SoonerCare provider. If a patient sees a participating SoonerCare
primary care provider that is not their assigned PCP, that provider will be paid fee-for-
service for that visit. Referrals between PCP members will not be required, but will still be
required for subspecialty services.

The three levels are as follows:
      Tier 1: Entry Level Medical Home
      Tier 2: Advanced Medical Home
      Tier 3: Optimal Medical Home

Please go to www.okhca.org/medical-home for specific details of the requirements and fee
summary for the different levels.

There will be short-term transition payments available from OHCA for physicians who have
a drop in reimbursement initially transitioning to the new system. You can contact a
Provider Representative at 1-877-823-4529, option 2 to get more information on this.

You should receive specific information in the mail (including contract) to review and fill
out. OHCA encourages you to call or e-mail if you have questions or concerns.

Once the bugs are worked out of this new contract, it should be better overall than the
previous capitated system. The intent is to provide reimbursement commensurate with
the level of care provided by the physician with incentive payments available for those
individuals who wish to extra services (e.g., inpatient care).

Also of note, newborns statewide in the next few months should be able to receive PCP
assignment by time of discharge from the nursery – hopefully this will be fully in place
sometime in 2009. Also, once the patient is assigned to a PCP, that patient should remain
with this PCP from that point forward, with reassignment occurring only by the request of
the doctor or patient, or if the patient moves out of the PCP’s coverage area ( no random
reassignment of patients). If you do not see this happening over the next few months,
please let me know with specific examples.


Dwight T. Sublett, M.D.




                                             16
                    Newborn Screening in Oklahoma

Phenylketonuria was found to be the cause of severe mental retardation by the Norwegian
physician, Dr. A. Folling in 1934. Improvement in these affected individuals was found to
be possible in 1950 by Dr. Horstbicku who devised an amino acid mixture that did not
include the essential amino acid phenylalanine. These mentally retarded individuals
showed improvement primarily in the behavioral realm. It was found that earlier the
treatment was started, Horst Bickle mental retardation could be presented.

This led to an effort at early diagnosis. A delayed development could be noted as early as
4 months of age. This led to testing of the urine on each baby on well baby visits. This
was not affected. This was not affected with the newborn or affected babies would not
begin to spill phenyl ketones earlier than 15 days of age. These ketones would react with
iron and therefore one may put drops of a 10% aqueous solution of ferric chloride onto a
wet cloth diaper (all diapers were of cloth at that time). This testing became common in
the 1950s and I incorporated it into my practice when I was in the Army in 1958 (no
positive results).

The blood phenylalanine rises rapidly after the child is separated from his mother’s
metabolism. The determination of blood phenylalanine enabled the diagnosis to be made
in the first few hours of life. This could then be followed by beginning the diet, which was
low in phenylalanine with this usually being accomplished about 15 days of age.

A system was needed to quickly and accurately test for phenylalanine blood levels on small
amount of blood on all babies. Dr. Robert Guthrie devised a workable system beginning
with a few drops of blood obtained by lancet and absorbed onto a filter paper. The
phenylalanine would promote the growth of Bacillus subtilis on a potato agar plate. His
growth could be visualized and measured giving the amount phenylalanine in blood.

This proved to be a method that could be applied to all newborns the majority of whom
were still “captive” in the nursery. Confirmatory testing was needed, but one could have
the child on diet early on and began to normalize the blood phenylalanine levels.

This fulfilled the basic that principal newborn screening, which is to screen only for
treatable diseases. The screens followed were for hypothyroidism, galactosemia and
hemoglobinopathies. The addition of other screens was delayed by the need to develop
workable technologies and by finding the necessary funds.
Progress was made in developing “gold standard” of the newborn screening by Dr. Ed
Naylor. This was marketed as the NeoGen screen and now is called StepOne. This vast
expansion was made possible by advances in technology especially by the development of
tandem mass spectrometry. This screening battery became the primary tool for screening
newborns in many states. It appeared in the meantime, all states were developing their
own screen. StepOne is available online with the charge being $95.35. They market
directly to the health provider or to the consumer. They include a second tier screen
without additional charge with this consisting of doing the common DNA mutations for
biotinidase deficiency, cystic fibrosis, galactosemia, G6PD deficiency, glutaric aciduria type
1 (Amish population only), MCAD deficiency, LCHAD deficiency, sickle cell anemia and
other hemoglobinopathies. The services of a genetic counselor are provided.




                                             17
The     Oklahoma     newborn     screen    (NBS-OK)     now    consists   of   galactosemia,
hemoglobinopathies, PKU and other amino acids, congenital hypothyroidism, cystic
fibrosis, congenital adrenal hyperplasia and fatty acid disorders and organic disorders. It is
projected to add biotinidase deficiency. At that time NBS-OK will be similar to the
StepOne. It will not automatically offer the common mutations. It does offer coordinated
follow-up system, which is absolutely necessary because screening develops false positive
results, so as not to miss any false negatives.

The charge for NBS-OK is now $115.32. This cost is sent to the hospital and it is charged
to Medicaid or to the private insurance. If the patient is “self-pay,” discharge may be
placed upon their billing. It appears as though there are some differences among the
hospitals in handling charges. Positive results are shared with the pulmonology specialist,
the endocrinologist and the metabolic specialist in addition to the designated physician of
the patient. These specialists then coordinate with the child’s physician in determining
whether this positive result from the newborn screen actually indexes the disorder or
whether it is a false positive screen. In order to do this, sophisticated laboratory studies
are needed such as those at St. Francis Genetics Laboratory. The NBS-OK works on a
public health model, so that all babies will be screened.

Sincerely,



James G. Coldwell, M.D.




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                19
                Oklahoma Chapter
                American Academy of Pediatrics
                6840 S. Trenton Ave.
                Tulsa, OK 74136




INSIDE THIS ISSUE:
        President’s Report                                                                                         Pages 1-2
        About the New Chapter Management Team                                                                      Page 3
        Important Message from AAP President                                                                       Page 4
        OKAAP Group Purchasing Committee Chairman
          On Adequate Payment for Vaccines                                                                         Page 5
        The Business Case for Pricing Vaccines & Immunization Administration                                       Pages 6-7
        OKAAP Vaccine Survey                                                                                       Page 8
        New Immunization Alliance Issues National Call to Action                                                   Pages 9-12
        Please Mark Your Calendars                                                                                 Page 13
        Final Weeks of the Physician Practice Information Study:
           Act Now and Help Your Entire Profession!                                                                Page 14
        AAP 2009-2010 National Committee Chairperson Nominations                                                   Page 14
        National Election Results                                                                                  Page 14
        Pediatric Research in Office Settings Update                                                               Page 15
        Oklahoma Health Care Authority Physician Task Force
           Advisory Committee Update                                                                               Page 16
        Newborn Screening in Oklahoma                                                                              Pages 17-18


 The OK Pediatrician is published by the Oklahoma Chapter of the American Academy of Pediatrics. The Chapter does not en-
 dorse opinions or statements contained in this publication as they are not necessarily reflective of the Chapter, its officers or its
               staff. Manuscripts, articles, guest editorials and letters to the editor are encouraged for publication.

                                                                  20

				
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