2012 Chapter Annual Report - txpeds.org€¦ · american academy of pediatrics chapter annual report january 1, 2012 – december 31, 2012 1 demographics name: gary floyd, md, faap

AMERICAN ACADEMY OF PEDIATRICS CHAPTER ANNUAL REPORT

January 1, 2012 – December 31, 2012

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DEMOGRAPHICS

NAME: Gary Floyd, MD, FAAP DISTRICT: 7 CHAPTER: Texas CHAPTER SIZE: Very Large

STRATEGIC PRIORITIES

Among the list of topics below, check a maximum of 3 topics that most closely align with your chapter’s top strategic priorities.

Access to care Adolescent health

X Advocacy/legislation Autism Breastfeeding Chapter visibility Child abuse/foster care Child care health & safety Child health finance Children with special health

care needs Community outreach/

public education Disaster preparedness Domestic violence Early brain & child

development

Early hearing detection & intervention

Early literacy Education/CME Environmental health Family engagement Genetics/epigenetics Health care reform Health information

technology Immunizations Injury and violence

prevention International/global child

health Leadership development Lead poisoning prevention Medical Home

Membership Mental health Obesity Oral health Pediatric councils Practice management

X Profession of pediatrics X Public health

Quality improvement Reach out & read Residents/young physicians School health Sports/fitness Substance abuse Tobacco prevention &

control Other(s). Please specify

Briefly describe in greater detail the 3 strategic priorities that you checked above. Include a description of the strategic priority, measurable objectives (up to 3), activities and outcomes/results as noted below. See Chapter Annual Report Guidance for further details. STRATEGIC PRIORITY 1: Strengthen the chapter’s position as the leading advocate for children and pediatricians in Texas Measurable Objectives (up to 3)

A) Ensure pediatric representation on all pertinent state agency advisory committees and councils

B) Collaborate with state agencies and partner organizations to strengthen programs for children and improve public health in Texas



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C) Use committee structure to identify priority issues and engage in actions that support priorities

Activities A) Senate Bill 1107, passed in 2011, required all students new to institutions of higher education to be vaccinated against bacterial meningitis. In addition to the language veering from Advisory Committee on Immunization Practices recommendations, the legislation raised the ire of many of Texas’ universities because it complicated registration processes. To appease their members, the Texas Higher Education Coordinating Board (HECB), used their rule process to create a second, hassle‐free conscientious exemption process. Previously only one conscientious exemption process existed, housed at the Texas Department of State Health Services (DSHS). Created in 2003, the Texas Chapter fought hard to ensure that DSHS had measures in place to ensure people couldn’t exempt from vaccination on a whim. Soon after implementation of SB 1107 in the winter of 2012, Texas physicians began to hear stories about registrar’s offices housing stacks of blank conscientious objection forms to help students quickly meet the requirement. Complicating matters further, students in medical‐based programming at Texas universities who are required by law to receive certain vaccinations, were still subject to the DSHS exemption process but their classmates were subject to the HECB process. Additionally, the HECB has no way to track the number of exemptions filed and it is unlikely that formal tracking processes were established at each of the universities that might be used in the event of a disease outbreak. The Texas Chapter engaged in the process early, monitoring the implementation of the legislation, participating in monthly stakeholder conversations that included the higher education community and did our best to provide input opposing the second exemption process when it was announced just days before the process was approved by the HECB. The Chapter also met with stakeholders to begin examining options for revising the statute and ensuring a consensus on next steps. All through the process the Texas Chapter worked with the physician members of the Chapter’s Infectious Disease and Immunization Committee to provide accurate information about meningococcal meningitis to the public and shared resources with members about the importance of educating prospective college students and parents about the requirement.

B) The Texas Chapter has become the recognized go‐to source for physician‐expertise on a litany of issues from pediatric practice to child safety. As such, our members serve in many advisory capacities to state agencies on these critical issues. In 2011, in an effort to find additional dollars and penalize what they saw to be abortion friendly programs, Texas legislators eliminated almost all funding to women’s preventative health programs in the state. In reshaping the program, rules were established that undermined the physician patient relationship essentially dictating what topics were allowed to be discussed between the doctor and patient. Although purely women’s health focused, the precedent set for all physicians was offensive. The Texas Chapter joined with other physician groups in the state to send a unified message to the legislative and executive leadership in charge of the policy. Many mediums were used to share dissatisfaction with the proposed rules including communication through trusted relationships with legislative leaders, print media and grassroots advocacy.



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The Medicaid payment increase set for January 2013 as part of the Affordable Care Act (ACA) has been difficult for Texas to implement, as it has been in for other states, because the Centers for Medicaid and Medicare Services was slow to provide guidance to states. Antiquated software and gaps in Medicaid provider information are also challenges. Several doctors within the Chapter leadership have been routinely meeting with agency officials to provide guidance on the various options available for implementation. These conversations occurred both before CMS released guidance and after. Other important discussions where the Texas Chapter has provided guidance to state regulatory leaders this year includes bringing state policy on head lice in schools in line with AAP recommendations and addressing the state’s attempts to expand the scope of practice for certified “lay” midwives. C) As are many states in the union, Texas is suffering from an obesity epidemic. Obesity and its related disorders cost the Texas economy a projected $9 billion in 2009. If unchecked, this cost is anticipated to grow to more than $32 billion by 2030. The fiscal impact is only slight compared to the impact the epidemic is having on Texas’ children where 32 percent are either overweight or obese. Raising awareness among children, parents and the community continues to be a top issue and as such the Chapter has focused much time on advocacy as a unique tool in prevention activities.

Outcomes/Results A) Representatives of the Texas Chapter began meeting with the Senate Chair of the Health and Human Services Commission on legislative fixes to the concerns raised during the implementation of SB 1107. As a result, Senate Bill 62 has been pre‐filed for the 2013 Texas legislative session (which begins January 8). It will lower from 30 to 22 the age of students new to college who must be vaccinated against meningococcal meningitis. This will capture those students most at risk for contracting the disease and reduce the burden on registrars to process a large number of vaccine and/or exemption forms. Additionally, the bill prohibits the HECB from hosting a separate vaccination exemption process, giving the authority for vaccine exemptions back solely to DSHS.

B) The messages from the Texas Chapter and our colleagues in medicine opposing any measures that would limit the physician‐patient relationship were heard loud and clear. Newspapers across the state reacted boldly, opposing the measure through their editorial pages. The Governor acknowledged the obvious overstep in the rules and the newly appointed Health and Human Services Commission (HHSC), Kyle Janek, (an anesthesiologist and former state senator) used the testimony provided by us to defend his action in pulling down the rules. As a result of our ongoing collaboration, HHSC has finally begun communicating with physicians about the expected timeframe for implementing the Medicaid payment increase. Messages are being filtered through the Texas Chapter and other physician groups before being disseminated to physicians statewide to ensure any potential questions are addressed or clarifications are provided at the start. Rates will not start January 1 but there is a plan in place to implement the increase and the Texas Chapter is well positioned to serve as a conduit to our members during this time of transition.



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We were equally successful in getting the state to reverse course on their update of rules governing school policies for children identified to have head lice. Although the state’s proposed version of the updated rules did not mirror AAP recommendations, Chapter members close to DSHS were able to point out the discrepancy and fill‐in the outdated information accordingly. Sadly, the Chapter leadership was not as successful when it came to the implementation of the rules governing certified “lay” midwives. The Midwifery Board, largely governed by midwives or those supportive of certified “lay” midwives as unsupervised practitioners, voted to approve rules expanding the scope of practice of certified “lay” midwives including a component that allows them to become Medicaid providers (as established by the ACA). Although frustrated by defeat, the Chapter has just recently re‐nominated our physician representative to the Midwifery Board in hopes that consistency in representation will eventually enhance the relationship between our groups.

C) In March, Chapter Incoming President, Kimberly Avila‐Edwards, and the Chapter’s Director of Advocacy and Health Policy, Carrie Kroll, were invited to speak to the National Association of Pediatric Nurse Associates and Practitioners during a pre‐meeting on obesity prevention hosted in connection with the annual meeting. Dr. Edwards presented information on how individual practitioners can identify issues within their community related to obesity prevention and build an advocacy program around those issues. Ms. Kroll spoke to the legislative history of obesity prevention policy in Texas, what issues are trending currently and what is anticipated in the future. In February of 2012, Public Broadcasting Stations (PBS) throughout Texas collaborated on the production of a documentary on the intersection between hunger and obesity. “Feeding Minds: Texas Takes on Hunger and Obesity” included footage from seven Texas PBS stations. The footage also included an interview with Carrie Kroll, who representing the Chapter, spoke to many issues including those physicians encounter in counseling families on obesity, the role schools play in prevention and how food desserts contribute to the childhood obesity problem. In November, Dr. Stephen Pont, a member of the Chapter’s Obesity and Executive Legislative Committees, testified in front of the Texas Sunset Advisory Commission, the entity charged with assessing the need for each state agency to exist, in opposition to a recommendation made by Sunset staff related to the Texas Education Agency (TEA). On the chopping block was a report that required officials within TEA to correlate in a non‐identified manner, data related to academic achievement and physical fitness. The Chapter created the requirement in 2011 to give schools, communities and parents the data necessary to inform change. Final recommendations from the Sunset Commission on TEA are expected in late December.

STRATEGIC PRIORITY 2: Ensure all children in Texas attain their full potential for physical, emotional, and social health. Measurable Objectives (up to 3)

A) Collaborate with state agencies and partner organizations to strengthen programs for children and improve public health in Texas



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B) Use committee structure to identify priorities issues and engage in actions that support priorities

C) Provide better linkages to patient information and resources

Activities A) Recent data from the National Immunization Survey, released in September 2011, shows that Texas has fallen to 33rd in the nation in immunization coverage. The primary series (4:3:1:0:3:1:4) dropped from 71.3% in 2009 to 70.9% in 2010. The Chapter’s Committee on Infectious Diseases and Immunizations has discussed the reasoning for this decrease in coverage, and though there may be multiple factors involved, vaccine hesitancy among parents certainly plays a role in our declining immunization rates. Discussions with families about the safety and value of immunization are important and appropriate, but take‐up much time during a visit and can be unsuccessful. Struggling against misinformation on vaccine safety which is rampant in the popular media, Texas has faced a unique barrier in this fight. Dr. Andrew Wakefield, the author of a now discredited study linking the measles, mumps and rubella (MMR) vaccine with autism and bowel disease, owns an autism clinic, established in Austin, TX, which has perpetuated the idea that vaccines cause autism ‐ having a particularly negative impact on immunizations in young children in our community and state. Because of the abundance of misinformation on vaccine safety reaching the general public and the increase in folks utilizing Texas’ vaccine exemption process, it is now more critical than ever to widely disseminate safety information to parents and provide physicians with the resources and tools to easily accomplish the mission of providing immunizations. In order to help physicians fully address parental concerns in a reasonable amount of time, the Chapter recognized the need to provide pediatricians the resources and know how to effectively communicate that vaccines are safe. Receiving grant dollars from GSK, the Chapter solicited member and resident vaccine safety expert, Dr. Ari Brown, to moderate a video on vaccine hesitancy. The goal of the tool, developed to be used by physicians in office waiting areas or patient exam rooms, is to share information about vaccine safety with parents before they encounter the physician to help define questions or defray concerns allowing physicians to make the most of their patient face time.

B) In April of 2012, the Chapter’s Committees on Child Abuse and Neglect and Infectious Disease and Immunizations began discussing the vaccine status of children who have been victims of sexual abuse and assault. Current Advisory Committee on Immunization Practices (ACIP) recommendations related to HPV vaccination covers 3 doses (second dose 1‐2 months and third dose 6 months after first dose) in males and females age 9 and older, and females and males 13‐18 years old not previously vaccinated. However, a random sample performed by a member of our Child Abuse and Neglect Committee who surveyed children seen in a children’s hospital (at a child abuse and neglect clinic) showed that of the 42 patients 10 years and older who presented for a sexual assault exams, 3 had completed HPV vaccine series (7%); 12(28.5%), including these 3, had at least one dose. Four were males and none of the males had any HPV immunizations.



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This data, combined with what committee members shared anecdotally compelled a larger discussion about best practice for the vaccination of children who have been sexually assaulted or abused. Of greatest concern is that sexual assault and abuse victims are themselves, a high risk pool as they are 2 to 3 times more likely to engage in unsafe/unprotected sexual intercourse at an earlier age than non‐abused children or adolescents. In response to this discussion both Committees proposed that HPV vaccination should be given to children/adolescents who present for sexual abuse/assault evaluations if they have not already been vaccinated. C) Texas is a vast state with distinct geographic regions, and has long recognized that not only does our RSV differ than much of the country, but there is also significant variation in the start and end dates for RSV in within our state. In order to better predict RSV season and ensure prophylaxis is being provided to protect at‐risk infants during the most optimal period, our Chapter has created an RSV Taskforce – which convenes experts from various regions of the state during critical months to discuss local epidemiology and review statewide and regional data.

Outcomes/Results A) In April 2012, at our Annual Leadership Planning Session, we released the video, “Talking to Parents About the Importance of Vaccinations: Two Texas Families Share Their Stories,” as a tool for health care providers and families. Dr. Ari Brown, featured in the video, spoke to the approximately 100 physicians in attendance about effective strategies to breaking through the vaccine misinformation engrained in society. She was joined by mom blogger and Social Media Manager for Every Child By Two, Christine Vara, who shared information about how physicians can utilize social media to discredit anti‐vaccine sentiment in their communities. Copies of the video were made available to attendees and can be accessed via the Chapter website. The video was also viewed by legislators and staff during a Public Health Coalition briefing on the importance of vaccination and a copy was given to each participant at September’s Texas Immunization Summit which hosted about 300 attendees representing among other groups, health care providers, public health workers and parents.

B) Responding to the committee discussion the Chapter’s Executive Board very quickly approved communication to ACIP outlining the recommendation. The letter was entered into the public record at the October ACIP meeting and there was a discussion about the need for professional associations to educate their membership about this vulnerable population as well as a discussion about adding related content to the Red Book. The Chapter followed‐up by submitting a resolution to the AAP for consideration at the Annual Leadership Forum in 2013. Additionally, Chapter representatives briefed their colleagues, participating in the relevant committees during the fall meeting of the Texas Medical Association, the Texas Chapter of the American Medical Association. A resolution in this regard will be submitted for consideration to their House of Delegates in 2013.

C) In addition to monitoring this season’s epidemiology, our RSV Taskforce has undertaken several important duties this year. With a statewide rollout of managed care in 2012, the RSV Taskforce felt it would be helpful to managed care organizations, when setting policy on prophylaxis, to have guidance on the predicted start date in each region to ensure authorization for palivizumab was available. The Taskforce analyzed data starting in 2001 to create an average



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start and end date for RSV in each health service region. This analysis has been written up by the chair of the RSV Taskforce and will be submitted to pediatric infectious disease and pulmonology journals. Additionally, when reporting information on RSV back to the states from the National Respiratory and Enteric Virus Surveillance System (NREVSS), the CDC does not include PCR data with the antigen test results. Because many of the large hospitals and reporting sites in Texas have shifted to performing primarily PCR testing, there was some concern among Taskforce members that NREVSS data may not be reflective of the complete picture of RSV. We have worked with several of the large hospitals using PCR testing, as well as the Texas Department of State Health Services, to get access to PCR data to compare with the antigen data reported by NREVSS. Thus far, antigen and PCR data seem to be fairly consistent, and following this season the Taskforce plans to analyze the data sets from both types of testing further to assess the best options for measuring and reporting on RSV.

STRATEGIC PRIORITY 3: Ensure the practice of pediatrics in Texas is both fulfilling and economically viable. Measurable Objectives (up to 3)

A) Tailor CME offerings to meet the evolving needs of our membership

B) Facilitate activities that support the practice of pediatrics

C) Collaborate with partner organizations to strengthen programs for children and improve public health in Texas

Activities A) In September 2011, Texas enacted a new concussion law (HB 2038), affecting all schools within the Texas University Interscholastic League (UIL) system. Some of the requirements of this law include the creation of a concussion oversight team for every school district, which must include at least one physician and the athletic trainer (if one is employed by the school district or charter school ), and may include other members as outlined in the law. The law requires the concussion oversight team to establish a return to play protocol, based on peer reviewed scientific evidence. The law also requires that every student athlete suspected of having a concussion be evaluated and obtain signed consent from a treating physician prior to return to athletic activity, including practice. Treating physicians are liable for the medical services and decisions provided to student athletes in their care. In the process of developing this legislation, TPS committed to providing education to primary care physicians who care for these athletes. Our Committee on Adolescence and Sports Medicine created a Concussion Sub‐committee that was responsible for developing materials and resources on this topic, as well as crafting a plan to disseminate information to pediatricians.



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B) Chapter leaders work with private and public payers to ensure pediatricians receive adequate payment for the services they provide. Recently we have advocated on behalf of members with regard to problems with the posted BCBSTX fee schedule resulting in refund requests.

C) As a result of legislation passed in Florida in 2011, there was significant concern among our membership that similar laws restricting physician discussion with patients on gun safety would be proposed in Texas during our next legislative session. In order to protect physicians’ ability to provide preventive counseling to patients on important safety issues and ensure organized medicine in our state had a unified position should this topic arise, the Texas Chapter submitted a resolution to the Texas Medical Association in the spring of 2012 which would address any efforts to limit physician and patient conversations.

Outcomes/Results A) In addition to promoting information on the new concussion management legislation through our website and e‐newsletter, one of our plenary sessions at the 2012 Texas Chapter Annual Meeting focused on this topic and provided pediatricians from around the state with details on the new regulations, and how their liability in this process may impact their practice of managing concussions in the office setting. We also worked with the Texas Medical Association to develop an online CME module for physicians, which underscores their responsibility in the return to play protocol and provides the latest information on best practices in concussion identification and management.

B) Through our efforts, BCBS recognized their error and money that was recuperated from approximately 1200 claims – totaling $73,000 – is being returned to physicians. Additionally, BCBS has stopped any other recuperation efforts related to vaccine payments for the period of 6/1/2011 – 7/31/2012.

C) The resolution submitted to TMA passed with overwhelming support, giving us the reassurance that organized medicine would stand unified to oppose any legislation seeking to limit the scope of conversations a physician can have with their patients or patient’s parents – including discussions on firearm safety. Following the decision from US District Judge Marcia G. Cooke, granting a permanent injunction blocking the enforcement of a Florida law which would prohibit physicians from asking about firearms in the home, pediatrician Dr. Seth Kaplan published an article for the TMA “Me and My Doctor” blog. The article discussed the landmark decision in this case, and underscored the important role preventive counseling plays in the practice of medicine.

Future Strategic Priorities: Discuss any strategic priorities planned for the upcoming year. DO NOT EXCEED 150 WORDS. Chapter leadership spent 2012 preparing a legislative agenda highlighting policy priorities in the categories of covering kids, building a high quality pediatric health care system and keeping kids healthy. January of 2013 marks the start of the 83rd Legislature and as such much focus will be put into achieving the priorities identified. For the first time, the Texas Chapter will bring together residents from each of the state’s residency programs to participate in a hands‐on advocacy day in the state capital of Austin.



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Residents will spend the morning being briefed on advocacy basics and specific legislation. They will also hear directly from a legislative leader before heading to the state capitol building to meet with legislators in small groups. Additionally, the chapter will be engaging in several different activities to increase membership. Along with a targeted campaign at the District level to increase membership by 5%, we will be offering discounted chapter fees to graduating residents and large physician groups who can engage a certain percentage of their employees.



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ACTIVITIES

Check all of the following other chapter activities (not the strategic priorities you have already indicated at the beginning of the report) in which your chapter is involved. X Access to care X Adolescent health X Advocacy/legislation

Autism X Breastfeeding X Chapter visibility X Child abuse/foster care X Child care health & safety X Child health finance X Children with special health care needs X Community outreach/ public education X Disaster preparedness X Domestic violence X Early brain & child development

X Early hearing detection & intervention

Early literacy X Education/CME X Environmental health X Family engagement X Genetics/epigenetics X Health care reform X Health information technology X Immunizations X Injury and violence prevention

International/global child health X Leadership development

Lead poisoning prevention X Medical Home

X Membership X Mental health X Obesity X Oral health X Pediatric councils X Practice management X Profession of pediatrics X Public health X Quality improvement X Reach out & read X Residents/young physicians X School health X Sports/fitness X Substance abuse X Tobacco prevention & control

Other(s). Please specify

Describe a maximum of 5 other chapter activities (of the ones you have checked above) in which your chapter is involved. DO NOT EXCEED 150 WORDS PER TOPIC AREA. 1) Other chapter activity: Reaching Out to the Community through the Texas PTA The Chapter collaborates with the Texas Parent Teacher Association, holding a seat on their Advisory Council. This opportunity has allowed the Chapter to participate in a recognition program for Texas teachers. The Texas’ Best Educators’ award program was developed in response to the toll taken on teachers after school districts implemented significant budget cuts, eliminating teacher positions and changing their levels of pay and sick leave. Because we know that teachers can have a profound influence on children, and cuts can be defeating, we joined with Texas PTA to promote this program, the goal of which is to recognize 100,000 educators by the end of the spring. Additionally we provided articles, penned by Chapter leadership, for the Texas PTA magazine and newsletter. Topics covered in 2012 included how to speak to children about traumatic events (in response to the shooting tragedy in Colorado) and important facts about vaccination. 2) Other chapter activity: Working with ECI to Improve Access to Care and Information Exchange Due to budget cuts resulting from the 2011 Legislative Session, many programs serving children were forced to limit eligibility or reduce the services they provide. Our Committee on Children with Disabilities has worked closely with our state’s Early Childhood Intervention (ECI) Program over the past year to ensure that, in spite of cuts, all eligible children would have ready access to necessary care. Through collaboration and open communication, our committee was able to communicate with ECI to streamline



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processes and remove barriers to initiating appropriate services. By creating an ECI subcommittee that consists of members from both our Committee on Children with Disabilities and our Early Childhood Committee, we worked together to develop a standardized referral form, making the process of referral easier for providers and ensuring children were able to access treatment in a timely fashion. By designing the form together, we were also able to ensure ECI programs had the necessary consents in place to communicate information back to the primary care provider. This collaboration has served to enhance the ability to coordinate care, and promote the medical home model. 3) Other chapter activity: Participation in the Development of Texas Infant and Toddler Early Learning Guidelines The Texas Early Learning Council (TELC) is a group established by our Governor to improve school readiness in Texas through targeted strategies stemming from the Councils four priority areas (Parental Outreach and Communications, Early Childhood Workforce and Professional Development, Collaborations and Standards, Data Systems and Quality Rating and Improvement Systems).In the spring of 2012, our Committee on Early Childhood met with the Director of the TELC to provide input on the development of statewide Infant and Toddler Early Learning Guidelines – which will be used by caregivers inside and outside of the home to improve the quality of care provided and promote appropriate practices. Our committee was pivotal in providing the physician perspective to ensure guidelines were consistent with latest scientific information on Early Brain and Child Development, and included accurate information on developmental milestones and medical intervention. 4) Other chapter activity: Convening Stakeholders Around Public Health Policy The Texas Chapter is a founding member of the Texas Public Health Coalition, which brings together advocates on the issues of immunization, obesity prevention, tobacco prevention and cessation and cancer. This year we hosted four policy forums to educate legislators and legislative staff, many new to public health, on the intricacies of these issues. Billed the “University of Health” and held over lunch each forum featured one or more issue area experts and included an electronic audience response survey to gather information about attitudes on the issues before and after the briefings. The Chapter was very involved in helping the Coalition develop legislative priorities, leading the immunization‐focused subcommittee and participating on the other three policy‐specific subcommittees as well as a fourth devoted to legislative activities. This group will guide the Coalition’s activities when the Legislature convenes in January 2013. 5) Other chapter activity: Expanding Advocacy for Breastfeeding The Chapter’s Committee on Early Childhood and Parenting led an effort to promote Breastfeeding‐Friendly status for teaching hospitals in Texas. The Committee identified teaching hospitals as an initial target because they are training the physicians of tomorrow and felt that it is duplicitous to teach them about the value and importance of breastfeeding while at the same time offering formula. Communication was established between the Chapter and the professional association for teaching hospitals in Texas, THOT. Additionally, a resolution to this effect was drafted by the Committee, supported by the Executive Board and submitted to the AAP for consideration at the 2013 ALF. The resolution supports Breastfeeding‐Friendly designation for all teaching hospitals, not just those in Texas.



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QUALITY IMPROVEMENT

Is your chapter involved in any quality improvement projects? If no, skip to the CATCH section of the report. X Yes

No Among the topics listed below, select “Yes” if your chapter has a QI project in the topic area or “No” if your chapter does not have a QI project in the topic area. Also indicate in the second column if the project(s) is/are approved by the American Board of Pediatrics for Part 4 Maintenance of Certification (MOC).

Topic Do you have a project in this topic area?

Do you offer MOC for the project in this topic area?

Adolescent health Yes No Yes No Asthma Yes No Yes No Bright Futures Yes No Yes No Children with special health care needs X Yes No Yes X No CHIPRA Yes No Yes No Developmental screening Yes No Yes No Early brain and child development Yes No Yes No Immunizations Yes No Yes No Medical home Yes No Yes No Mental health X Yes No Yes X No Obesity Yes No Yes No Oral health Yes No Yes No Other Yes No Yes No

Please specify “other” Provide a brief description of your quality improvement project(s). Feel free to copy and paste from other sections if applicable. DO NOT EXCEED 150 WORDS. Please note: If you have already detailed a quality improvement project in the strategic priorities section of the report, feel free to skip unless there is additional information you would like to report. The Texas Chapter has partnered with Texas Children’s Hospital on a HRSA funded grant program that creates a statewide regional learning collaborative to advance medical home initiatives and improve the quality of care provided to children across the state. We have assisted in recruiting regional partners for STARMHAC, The Statewide Association for Regional Medical Home Advancement, and are scheduled to begin convening these participants on December 20th. In addition to creating a stakeholder group and working with health plans on implementation of initiatives, STARMHAC will provide training for



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community partners and offer technical assistance to coalitions interested in developing improvement projects. Our initial meeting will provide an overview of the program, as well as provide examples of medical home initiatives already taking place in the state.

COMMUNITY ACCESS TO CHILD HEALTH (CATCH)

Are there any pediatricians in your chapter that have been awarded any CATCH grants? X Yes

No If yes, list the name(s) of the program(s). In 2012, 2 Texas residents received CATCH grants: ‐‐Camp CHAMPS Longitudinal Curriculum (Teresa Tseng, MD/Abby Kissel, MD; Dallas) ‐‐Improving Immunization for Children in Woman's Shelter (Shuya Wu, MD/Santiago Encalada, MD; Corpus Christi)

FINANCES

Provide the following details about your chapter’s finances. Operating Budget ($) $800,000

Reserves ($) $950,000

Total Full Time Staff 5

Total Part Time Staff 0

Does your chapter have a foundation? X Yes

No Describe the process you use to develop your budget, including the process of allocation of funds to goals, present and future. If your chapter has a foundation, include the name of the foundation, financial information, governance and role in chapter/member activities. The annual budget is developed based on actual expenditures and income from the previous 12‐month period with consideration of new programs and grant opportunities. The Executive Director, along with input from key staff members, develops the preliminary budget and the



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Executive Board amends the budget where needed and approves the final version. The Board reviews and revises the budget at each of their meetings throughout the year to monitor finances and address new issues as they arise. The chapter makes a conscious effort to allocate resources in areas that support our strategic plan and offer the largest benefit to our membership. Each year we review the income/expenses from the previous year, evaluate the success of meeting goals set forth in our strategic plan, and budget based on needs and expectations for the coming year. Our Chapter‘s foundation, the Texas Pediatric Society Foundation, is governed by a board of 15 people – including 8 pediatricians and 7 community representatives. This year the TPS Foundation raised over $56,000 through donations and their annual gala. The Foundation distributed $33,540 in grant funds to programs around the state that benefit children. The TPS Foundation’s annual gala is held in conjunction with the TPS Annual Meeting, and many of the projects funded by the TPS Foundation are submitted by TPS members or committees. Which of the following tactics does your chapter employ to generate non-dues revenue? Check all that apply. X Federal grants

X State grants

X National and/or state agency contracts to carry out projects and initiatives

X Chapter continuing medical education opportunities

Advertising space sold in the chapter newsletter and/or on chapter Web site

X Exhibit fees at chapter meetings

X Pharmaceutical/corporate contributions

Personal/individual donations

Private foundation donations

Other(s). Please specify.

MEMBERSHIP RETENTION AND RECRUITMENT

Check which retention and recruitment strategies your chapter employs. Check all that apply.

X Mailings/letters to members and non-members

X CME opportunities

X General communications (eg, e-mails, Web site, general correspondence)



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X Personal contact by chapter officers and/or staff

X Chapter newsletter

X New member information packets

X Resident outreach

X Membership recruitment campaigns

X Participation in advocacy efforts

Chapter membership committee

X Recruitment of affiliate members

X Member surveys

X Webinars

X Social media

Focus groups


Briefly describe your chapter’s success in retaining or recruiting members. In 2012, we added 141 new members, and retained 268 physicians whose membership was in jeopardy of lapsing, 54 of which were residents that chose to become Active members (which is roughly 10% of our resident membership base). The Chapter employs a variety of methods to retain and recruit members including; +Offering discounted registration fee for our Annual Meeting, which provides enough CME hours to meet physicians’ annual requirement and includes tailored educational sessions for office managers, residents and medical students +Working with residency programs to engage residents in a meaningful way, and foster a lasting relationship to the chapter +Engaging young physicians by providing an outlet for them to network and communicate with peers as part of a Young Physician Section. We also have had success recruiting members through targeted campaigns, and enlisting our leadership to personally reach out to potential members or chapter members who are in arrears. Committee members also invite non‐member colleagues to participate in their committee meetings, which generates interest in the committee and results in new memberships. We have successfully kept up‐to‐date with our email reminders for both lapsed and close to expiring members.

Briefly describe your chapter’s challenges in retaining or recruiting members.

Though we make every effort to obtain current contact information, sometimes having accurate mailing and email addresses is a barrier to communicating with members. A continued challenge for recruitment is tracking the residents that have completed residency and stayed in Texas – we work with both the AAP and resident programs to do our best to keep in touch post‐residency to encourage membership.



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We have also experienced that the economic troubles in our state are impacting membership and participation. Budget cuts in institutions and practices have limited funds for association memberships and travel, making it difficult for some to retain their membership or stay active within the chapter. We make every effort to promote the great work we are doing and the benefits of membership. In a state as large as Texas, it can be hard to do personal outreach to physicians in rural or outlying areas, though we make an effort to leverage our regional representatives to make these contacts. Specify how your chapter demonstrates value to your members The chapter demonstrates value to our members in a variety of ways. We provide full time representation on behalf of pediatricians and children at the state Capitol, and both our leadership and staff devote a great deal of time to advocacy efforts. Our advocacy also extends into working with state agencies and programs, as well as with public and private payers in the state. We support 14 active committees and 2 subcommittees that represent a wide array of topic areas and engage members in activities specific to their particular interests. We craft educational opportunities based on feedback gathered on a yearly needs assessment to ensure we are providing information that is relevant to our members. We also publicize education, information, chapter activities and advocacy efforts in our monthly newsletter, on our website and through our Facebook page. If applicable, describe how your chapter addresses diversity. We have a large Spanish speaking population in our state, and strive to make sure that many of the resources we create are available in both English and Spanish. Check all of the following member types for which your chapter has recruitment activities. X Medical students X Residents X Young physicians

Medical subspecialists/surgical specialists Academicians

X Seniors Underrepresented and minority physicians

X Other(s). Please specify. Office Administrators Briefly describe your chapter’s recruitment activities, if any, related to the following member types. If your chapter does not have activities related to a member type, leave blank. DO NOT EXCEED 50 WORDS PER CATEGORY. Medical students Students involved in our 2012 preceptor program, a 4‐week hands on learning experience in a pediatric practice, had their chapter dues waived as part of the program. We encourage medical student participation by inviting them to attend our Annual Meeting free of charge as a component of their membership, and design specific education for them. We also encourage medical student participation on all of our committees.



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Residents This year the Chapter Resident Executive Planning Committee grew from 3 to 10, and almost all residency programs are now represented. An additional position was also created on our Board. Together, staff and the Resident Committee developed programming geared to residents for their resident section meeting, held during our Annual Meeting. We hosted our 3rd annual Resident Jeopardy‐inspired trivia bowl. The Chapter sponsors an Annual Resident and Fellow Electronic Poster Contest. Chapter President Kim Avila Edwards, MD and staff met with a non‐participative resident program to establish a relationship. Finally, staff actively seeks out residents and fellows that have completed their residencies to join post‐residency.

Young physicians The Chapter's Young Physician Section hosted specific programming for the young physicians during our Annual Meeting, and the Chapter's Executive Board has a specific position for a young physician representative. Our YP section coordinators recruited members in their cities to attend the Annual Meeting, provided social networking taglines and offered family fun suggestions for those bringing their families. The coordinators have a conference call every 2 months to discuss ways to recruit and engage young physicians, as well as to plan special programs their group might initiate. Medical subspecialists / surgical specialists We enlist the participation of subspecialists on our committees as subject matter experts. The chapter also develops educational sessions for our annual meeting that have a subspecialty focus, and recruits subspecialists to speak at the conference. Additionally, subspecialists who are non‐members are given a discounted Annual Meeting registration if join the chapter. Academicians Academicians make up a large segment of our membership, and seem to have particular interest in committee participation and providing input to shape policy priorities – which are opportunities we provide our members. We strive to ensure there is an adequate balance on our board of physicians in academics and those in practice. Seniors The chapter does specific outreach to physicians who have 20 years of chapter membership and are nearing their 70th birthday to let them know that they will be eligible to achieve Life or Emeritus status. Membership in the chapter is free for both life and emeritus physicians. Emeritus Members, which is Board appointed, have badge ribbons at the annual meeting to signify their achieved status. Underrepresented and minority physicians Other(s). Please specify. Prior to our Annual Meeting, we recruit out‐of‐state pediatricians from the surrounding states to join as Associate Members for a discounted meeting fee. The Texas chapter also has an Office Managers Section, which is a benefit we provide to our physician members –membership for office staff is included in the physicians’ dues. Because of the important practice information they can access as members, as well as the meeting discount, some physicians join on behalf of their office managers. Describe your future plans or innovative ideas for retaining and recruiting members.



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+Provide the regional representatives of our Board with a list of new members in their area each month, and ask them to reach out to new members with information on TPS benefits +Send personalized letters from our leadership to those whose membership has lapsed +Create Section and Membership One Page Flyers, highlighting our benefits per membership type. +Use our web‐based database dashboard as a means of communication regarding the dues renewal, contact information and specialty interests. +Meet with county medical societies and local pediatric societies to spread the word about membership benefits. +During our District Membership Drive, offer a 50% discount to new members +Offer physicians a discount to renew their membership or establish a new membership while registering for the Annual Meeting. +Offer discounted dues to graduating residents moving to active member status +Offer member discounts or advertising packages for institutions with a certain percentage total members. New information coming from the AAP on Board certified pediatricians in the state, as well as personal email addresses for graduating residents will be very helpful in our recruitment/retention efforts. Improvements to the AAP database and content management system will also help streamline our processes.

GOVERNANCE

Do you have a strategic plan? X Yes

No If yes, when was it last reviewed? 2012 Do you use the balanced scorecard?

Yes X No Date your bylaws were last reviewed: 2012 During the past year, have there been any changes to your chapter’s infrastructure? X Yes

No If yes, please explain. Due to budget cuts in the state, we lost funding for one of our major programs – the Preceptorship Program. We continued to operate the program in 2012 on a shoestring budget with the hope that



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funding will be restored in our upcoming legislative session. However, we served fewer medical students this year as a result, and will not be able to continue the program without funding. Check all of the activities your chapter engages in to approach leadership development, mentorship and succession planning for its leadership and staff.

Implementation of Pediatric Leadership Alliance (PLA) principles and tools X Mentorship program X Succession planning

Professional education seminars/teleconferences X Sponsor attendance at the AAP national leadership conferences X Support membership in professional organizations

Other(s). Please specify. Briefly describe the activities your chapter engages in to support leadership development, mentorship and succession planning of chapter leadership and staff. If your chapter is not involved in an activity listed, leave blank. DO NOT EXCEED 50 WORDS PER ACTIVITY. Implementation of Pediatric Leadership Alliance (PLA) principles and tools Mentor program +This year we instituted training for our Board members and committee chairs +The chapter administers a preceptorship program, which gives medical students interested in pediatrics the opportunity to participate in a 4‐week, hands‐on learning experience in a pediatric clinical setting. The goal of the program is to promote interest in the profession of pediatrics through this practical mentoring. +Each of our committees has an appointed co‐chair to foster leadership opportunities for younger physicians.

Succession plan Our chapter has a unique structure, which fosters leadership opportunities and advancement at a variety of levels. Because of the size of our chapter and the great amount of work being done in our state, we have both AAP chapter representatives as well as state leadership positions – which allows us to focus efforts at both the state and national level while cultivating strong leaders. We have an internal President, President‐Elect and Immediate Past President which change yearly. Our AAP Vice‐Chair and Chairperson representatives rotate every 3 years, which allows for an individual to move through the full cycle of internal leadership positions before moving on to become an AAP representative. We feel this helps to distribute workload and facilitate a great learning process for our leadership. To ensure committee chair and board positions are filled by qualified members, and to allow our chapter leaders to move on to national positions, we have created a succession chart for mapping progression through the organization.



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Professional education seminars/teleconferences Sponsor attendance at AAP national leadership conferences Provide support for our state society president to attend the AAP Annual Leadership Forum, AAP Advocacy Summit, and District VII meetings

Support membership in professional organizations +We recommend candidates for membership of the committees and councils of the Texas Medical Association +Delegate and alternate representatives to the Texas Medical Association House of Delegates as members of the Chapter’s Executive Board +Support chapter members in pursuit of appointment to AAP committees and councils


OUTSTANDING CHAPTER AWARDS & SPECIAL ACHIEVEMENT AWARDS

One chapter in each size category, small, medium, large and very large, will be selected as the Outstanding Chapter based on their chapter annual reports. Special Achievement Awards for chapters will be considered by the DVC committee, based on a chapter’s activities in areas such as membership, education, advocacy and quality improvement. Provide a link to a video, up to 5 minutes in length, highlighting your chapter’s value to the children and pediatricians in your state and communities, including your accomplishments in the last year and plans for the future. (OPTIONAL) Alternatively, you may send the video/link to [email protected]. Please note: This is meant to be the Chapter President’s report to the District Vice Chairperson, not necessarily a recruitment piece. See the following chapter videos for examples of chapters that have successfully utilized videos in their activities:

Alabama Chapter California Chapter 3 Florida Chapter New York Chapter 3 Virginia Chapter

SPECIAL ACHIEVEMENT AWARDS Individuals: Briefly highlight a maximum of 3 - 5 individuals total to be considered for a Special Achievement Award due to their work on a new and innovative project in the past year or for their lifetime achievement. Include the reason that they should be considered for a Special Achievement Award. Individuals nominated must be a member of the Academy (including residents and candidate members). Please include the correct spelling and



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designation (ie, MD, FAAP) for each individual nominated as well as the exact wording that you would like to see on the certificate. Dr. Monique Mills – Chair of the Chapter’s Foundation Board, she devotes not only many hours to her work helping to administer the Board but is also one of the Foundation’s most prolific fundraisers. She very meticulously collects items for the Foundation’s annual silent auction year round and is very hands‐on during the event helping staff and physicians alike. Dr. Jason Terk – Longtime Chair of the Chapter’s Legislative Committee, Dr. Terk has served as example to his colleagues of how one can juggle private practice while also being a hands‐on advocate at the state capitol. Entering his third legislative session or 6 year as chair Dr. Terk will hand over leadership of the Committee in the spring of 2013 but he deserves to be acknowledged for his dedication and willingness to engage on behalf of pediatrics and Texas children. Dr. Nancy Kellogg – Respected pioneer in the field of child abuse pediatrics, Dr. Kellogg continues to push her colleagues to be at the forefront of their field. She identified a troubling trend among the children presenting to her clinic who were victims of sexual abuse or assault specifically that they are developing sexually transmitted diseases (STD) at a high rate, HPV being the STD of highest prevalence. She took the need for action to heart and is working with colleagues to push for HPV vaccination of this high risk population when receiving medical care immediately after sexual abuse or assault if the patient hasn’t been vaccinated previously. Dr. Shane Miller – A respected sports medicine physician, Dr. Miller has made educating his colleagues about concussions in student athletes a high priority. In 2011 the Texas Legislature required all school districts to develop concussion management teams to assist with new return to play protocols. Dr. Miller has been extremely busy since then treating children suspected to have concussions while also touring the state educating physicians on the change in law. He also partnered with the Texas Chapter to develop an online continuing education program that will help more physicians access this critical information.

10/18/12

Thank you for completing your Chapter Annual Report!

2012 Chapter Annual Report - txpeds.org€¦ · american academy of pediatrics chapter annual report january 1, 2012 – december 31, 2012 1 demographics name: gary floyd, md, faap

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