-
In This Issue Case Study: Lower extremity
overuse injuries
Bike Helmet initiative
Phase 2 of asthma project
Coding Corner: Work smarter, not harder
Annual Meeting 2011
Are you attending this years
Ohio AAP Annual Meeting?
Make sure you register for
Casino Night on Friday, Aug.
26! Casino Night is a fundraiser
for the Ohio AAP Foundation,
and parents attending Casino
Night can take their children to
a Pajama Party at the same
time!
Casino Night and the Pajama
Party both run from 7-10 p.m.
For a $50 donation to the Ohio
AAP Foundation, adults can
play Blackjack, Texas Holdem,
What is your first approach to common ill-
nesses in your practice? What should it
be? Join the Ohio AAP at its 2011 Annual
Meeting August 25-27 at Cherry Valley
Lodge to find out the most common prob-
lems that patients present to your office
with and how they can be treated based
on real cases from real patients. You will
also learn about vaccine myths and up-to-date information about
com-
mon and uncommon infectious diseases from Robert Frenck, MD,
Cincinnati Childrens Hospital, in his presentation Case-based
Studies of
Common Pediatric Problems.
Other topics on the agenda for the 2011 Ohio AAP Annual
Meeting
include quality improvement, the medical home, and Maintenance
of
Certification.
FREE bike helmets to be distributed
Bike safety is a common area of
concern for pediatric health-care
professionals as well as parents
and safety advocates. Each year,
about 300,000 children under the
age of 15 are treated in U.S. hos-
pital emergency rooms for bicy-
cle-related injuries.
As part of the Pre-Annual Meeting
programs, Mike Gittelman, MD,
Cincinnati Childrens Hospital
Medical Center, and Sarah
Denny, MD, Nationwide Childrens
Hospital, chairs of the Ohio AAP Related story on page 8
See Annual...on page 6
See Casino...on page 6
All bets are goodat Casino Night
Maintenance of Certification, Quality Improvement,Payment for
Medical Home and more
Newsmagazine of the Ohio Chapter, American Academy of
Pediatrics
S
Newsmagazine of the Ohio Chapter
Newsmagazine of the Ohio Chapter
, American Academy of Pediatrics hio Chapter r, American Academy
of Pediatrics
, American Academy of Pediatrics
H
, American Academy of Pediatrics
H
Committee on Injury, Violence &
Poison Prevention, will provide
anticipatory guidance around
safety and bike helmets on Thurs-
day, Aug. 25 from 2:45-4 p.m. FREE
helmets will be distributed for use
in your practice.
S T A N D I N G B E H I N D O H I O S C H I L D R E N S U M M E
R 2 0 1 1
-
See Legislation...on page 8
www.ohioaap.org Ohio Pediatrics Summer 2011
A Publication of the
Ohio Chapter, American
Academy of Pediatrics
Officers
President....Gerald Tiberio, MD, FAAP
President-Elect....Judith Romano, MD, FAAP
Treasurer....Andrew Garner, MD, PhD, FAAP
Delegates-at-large:
Jill Fitch, MD, FAAP
Allison Brindle, MD, FAAP
Robert Murray, MD, FAAP
Executive Director:Melissa Wervey Arnold450 W. Wilson Bridge
Road, Suite 215
Worthington, OH 43085
(614) 846-6258, (614) 846-4025 (fax)
Lobbyist:Dan Jones Capitol Consulting Group
37 West Broad Street, Suite 820
Columbus, OH 43215
(614) 224-3855, (614) 224-3872 (fax)
Editor:Karen Kirk(614) 846-6258 or (614) 486-3750
Pediatrics fares well in state budgetRecent legislative activity
at the
Ohio Statehouse is driven by con-
sideration of the states two-year
$56 billion operating budget.
When the Governors budget
proposal was announced on
March 15, it was clear that the
budget would be balanced with
cuts rather than revenue en-
hancements. The expenditure
cuts were focused on three con-
stituencies: primary education,
local governments, and nursing
homes.
In the case of primary education
and Medicaid expenditures asso-
ciated with nursing home care,
consistent funding was only possi-
ble in the last general assembly
because of federal stimulus dol-
lars. The Governors budget did
not propose reductions in Medi-
caid expenditures associated
with pediatric care, rather a
number of proposals required as
a result of the Affordable Care
Act should benefit pediatrics.
These proposals include the in-
crease in Medicaid payment for
preventative services up to Medi-
care payment levels and cover-
age for obesity screening ser-
vices. The budget process did
present some challenges for Ohio
AAP; an early review of the bud-
get did reveal the elimination of
immunization funding critical to
pediatrics.
Upon the introduction of the bud-
get bill, HB 153, Ohio AAP and
the Capitol Consulting Group
identified that $2.5 million in fund-
ing for Pnemoccocal Conjugate
Vaccine (Prevnar) had been
eliminated. These funds are vital
to ensuring that underinsured
children have access to this vac-
cine. Funding for Pneumococcal
Conjugate Vaccine had been
cobbled together from unique
sources over the past two bud-
gets, and it was not a complete
surprise that in a budget with $8
billion in cuts this would be left
out of the budget at introduc-
tion.
Ohio AAP advocacy to restore
the Prevnar funding included tes-
timony by Dr. William Cotton, be-
fore the House Finance Commit-
tee and dozens of meetings with
legislators conducted by Capitol
Consulting Group. State Senator
Shannon Jones (R- Springboro)
was exceptionally supportive of
the restoration of these important
funds, authoring the amendment
that fully funded the Prevnar vac-
cine program.
Another budget concern for
Ohio AAP did not arise until the
HB 153 was amended in the
House of Representatives. While
in the House, the budget was
amended to exempt children
enrolled in an Ohio eSchool from
state immunization requirements.
If enacted this amendment
would have exempted more
than 30,000 children from Ohios
basic immunization requirement.
Ohio AAP advocated vigorously
for the removal of this language.
The Ohio Senate later stripped the
House amendment from the bill,
maintaining the integrity of Ohios
immunization program.
The final budget concern of Ohio
AAP arose in the last step of the
state budget process, the Con-
ference Committee. In the final
week of June, the budget moved
to Conference Committee, a step
in the process intended to recon-
cile the hundreds of differences
between the House and Senate
passed versions of the bill. In Con-
ference Committee an amend-
ment was added to the bill, delet-
ing the BMI screening provisions
enacted through the Healthy
Choices for Healthy Children
Update from the Statehouse
2
The Governors budget did
not propose reductions in
Medicaid expenditures asso-
ciated with pediatric care,
rather a number of propos-
als required as result of the
Affordable Care Act should
benefit pediatrics.
-
www.ohioaap.org Ohio Pediatrics Summer 2011
Presidents Message
Members needs priority of retreat
3
The general reader may not be
aware the Ohio AAP Board and
Committee Chairs have an
annual retreat. Strategic plan-
ning sessions have been around
for a long time, initially birthed in
the business world.
Every retreat requires compre-
hensive planning well in ad-
vance. Key components include:
a pre-retreat questionnaire, an
appropriate setting, a skilled
facilitator with adequate know-
ledge of the organization, key
players at the table, and ground
rules for time and efficacy.
I believe the pre-retreat question-
naire is useful to our membership:
1. Please rank the following ob-
jectives in order of importance
To understand the challenges
facing our organization in
todays environment
To discuss directions our or-
ganization should take in the
future
To discuss the relationship
between the board and staff
and how that relationship
could be improved
To discuss the relationship
between the board and the
committee chairs and how
that relationship could be
improved
To discuss our educational
programs, such as the open
forum and Annual Meeting,
and how to improve these
opportunities to better
serve our members.
2. Is there anything not included
in the above that you would like
to accomplish?
3. What are the top three major
issues facing our organization in
the next 3-5 years?
4. What are two suggestions for
ways that we can better serve
our members?
One main focus will be an in-
depth look at the open forums. A
SWOT (Strengths, Weaknesses,
Opportunities and Threats) analy-
sis was utilized as we split up in
work groups.
An abbreviated list of pertinent
points listed:
Strengths:
CME
Networking
Linkages with members/
hospitals
Weaknesses:
Too didactic
Too much top down/more
grassroots
Need more outcome data
Opportunities:
Professional/personal relation-
ships
Poll local community for
areas of interest
Marketing MOC potential
Multiple practice models
Being viewed as inclement
(other sources for CME Internet)
Economics
Three overriding goals surfaced
from in-depth discussions (Board
members and Committee
Chairs):
1. Membership: Activate; recruit,
engage, retain
2. Provide a value-added experi-
ence for pediatricians at the
local level
3. Build alliances and collabora-
tions
The Open Forums have been in-
stituted to support our member-
ship. The Board and Committee
Chairs used time and talent to
redefine and fine-tune those to
meet member needs.
The retreat questions have been
laundry-listed above. Please note
them and consider providing in-
formation to help us meet your
specific needs/concerns.
The staff is always readily avail-
able. I will be most happy to
communicate with you by any
means you prefer. Collective
thinking/action is quite powerful.
Please help the Ohio AAP to
serve you and advance the
health and well-being of Ohios
children.
Gerald Tiberio, MD
Ohio AAP President
President Gerald Tiberio, MD
-
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3
-
Case Study: Lower extremity overuse injuryEditors note: The
author of this
case study, Jeffrey R. Peiffer, DO,
is a Sports Medicine Fellow at
Akron Childrens Hospital in Ak-
ron, Ohio. He also serves as a
team physician for the University
of Akron and Walsh University.
History:
Michael is a 16-year-old cross
country and track runner who
participates in year-round training
and competition. His training
schedule consists of 8-12 hours of
running per week. He complains
of eight weeks of worsening left
ankle and foot pain with running.
Mechanism of injury:
There was no specific trauma to
ankle or lower extremity. He had
gradual onset of symptoms with
running activities.
Past Medical History:
Unremarkable with no previous
ankle or foot injuries.
Examination:
Gait analysis showed mild prona-
tion but no major anomalies.
There was no swelling, ecchymo-
sis, or deformity. Arch height was
normal. The ankle joint had nor-
mal plantarflexion, dorsiflexion,
inversion, and eversion. There was
no particular pain produced with
resisted active motion by foot dor-
siflexors or plantar flexors. No
focal tenderness was found on
the malleoli or the base of the fifth
metatarsal. There was mild focal
tenderness over the dorsal aspect
of the medial midfoot. This pain
was described as different than
the pain he has with running. The
anterior drawer test was negative.
5www.ohioaap.org Ohio Pediatrics Summer 2011
There was no loss of sensation.
Pedal pulses were symmetric and
appropriate.
Since pain was not able to be
reproduced, the patient was
placed on the treadmill for five
minutes until the pain started in
typical fashion. He states that
there is dorsal midfoot pain with
radiation down the medial arch.
Radiographs:
An X-ray is ordered because of
pain around the tarsal navicular.
Left foot AP, lateral, and oblique
views were ordered and revealed
no obvious fracture.
Subsequently a bone scan was
obtained due to strong concern
for stress fracture with his type of
pain and level of activity. The scan
showed highlighted area over
tarsal navicular consistent with
stress fracture.
Treatment:
Patient was placed in a walking
boot and was non-weight bearing
for four weeks. Gradual weight
bearing and then weaning of the
boot was done over the next four
weeks. He had no pain at the fol-
low-up office visits. Follow-up radi-
ographs showed no evidence of
displacement, delayed healing, or
nonunion, therefore no CT scan or
orthopedics consultation was
ordered.
Rehabilitation program:
After the walking boot was totally
weaned off, he received a biome-
chanical evaluation and orthotic
fabrication.
Return to play:
He gradually built up to his previ-
ous running schedule over four
weeks. A total of 12 weeks passed
from diagnosis to full return to play.
He was also advised to take at
least one season off per year to
avoid future overuse injuries.
Jeffrey R. Peiffer, DO
Akron Childrens Hospital
In 2010, the number of people injured by NOT wearing a bike
hel-
met was 51,000 - enough people to fill Nationwide Arena in
Columbus two and a half times.
Join Gov. John Kasich and the Ohio AAP in a statewide effort
ded-
icated to raising awareness of the importance of wearing a
bike
helmet.
Wear Your BikeHelmet to Work or School DaySept. 21, 2011
-
Casino..from page 1
Annual Meeting...from page 1
6
Beat the Dealer and Wheel of Fortune, as well as enjoy music,
partici-
pate in a Wii Just Dance contest, enter to win raffle prizes or
the 50/50
drawing, and more. The entry fee includes gaming chips to
participate
in the games, as well as two drink tickets per adult.
Next door, the children will enjoy a Pajama Party, free of
charge!
Children will watch movies, participate in activities, and will
be provid-
ed popcorn, water and lemonade. At the end of the night, they
will be
read a bedtime story (or two).
For more information on the Ohio AAP Foundation Casino Night and
Pajama Party, log onto
http://www.ohioaap.org/foundation/casino-night-fundraiser
Pre-Annual meeting sessions, which start on Thursday, Aug. 25,
will focus on
Chapter programs developmental screening; childhood obesity;
Maximizing
Office-Based Immunization (MOBI); and the bike helmet
initiative. This day is
FREE of charge for Ohio AAP members and their staff. If you
attend the entire
day youll earn 6.5 hours of CME and receive free materials
valued at more
than $650!
On Friday, Ramesh Sachdeva, MD, American Academy of Pediatrics,
will pro-
vide practitioners with the tools to bridge the gap from theory
to practice for
quality improvement (QI) through a deeper understanding of the
growing
need for QI in practices, and creating strategies to overcome
barriers for
implementing successful QI.
A Quality Improvement roundtable discussion will explore Ohio
AAP opportu-
nities for QI in the following programs:
Ounce of Prevention is Worth a Pound of Cure
Concerned About Development Learning Collaborative
Chapter Quality Network Asthma Project, Phase Two
The Chapter has also brought together a panel of experts to
discuss the med-
ical home. Hear an update on Ohio House Bill 198, which seeks to
establish
the medical home model. Learn about new sources of reimbursement
and
resources, the benefits of medical homes for patients and future
opportunities
for physicians in Ohio. The experts include: Ted Wymyslo, MD,
Medical Direc-
tor, Ohio Department of Health; John McCarthy, Ohio Medicaid
Director,
James Bryant, MD, Ohio AAP member; and Mary S. Applegate, MD,
Medical
Director, Ohio Medicaid.
Following the afternoon programs, an opening reception will be
held from
4:30-6 p.m. This is a good time to network with other attendees,
guests and
exhibitors. The evening also includes our Foundation fundraiser,
Casino Night,
and a new 50/50 raffle.
For more information, and to register, visit our website
www.ohioaap.org.
7 a.m. - Members Break-fast. Learn about theChapters
programs,goals, and advocacy ini-tiatives.
9 a.m. - James Brown,
MD, American Board of
Pediatrics, will speak on
projects that have im-
proved care and are
approved for MOC
credit.
10:45 a.m. - Robert
Frenck, Jr, MD, Cincin-
nati Childrens, will speak
on case-based studies of
common pediatric prob-
lems.
12:30-2 p.m. - Annual
Awards Luncheon
Celebrate our members
and advocates who
have been champions
for children in 2011.
2-4 p.m. - Executive
Committee Meeting
All are welcome.
Saturdaysactivities
www.ohioaap.org Ohio Pediatrics Summer 2011
-
www.ohioaap.org Ohio Pediatrics Summer 2011 7
Accepting the House of Representatives Resolution are, from
left,
Terry Barber, MD, Immediate Past President; William Cotton,
MD,
Ohio AAP Advocacy Chair; Melissa Wervey Arnold, Ohio AAP
Executive Director; and Gerald Tiberio, MD, Ohio AAP
President.
Ohio Househonors OAAPfor Very LargeChapter AwardOn May 18, the
Ohio House of
Representatives honored the Ohio
Chapter as the 2010 Outstanding
Very Large Chapter.
The resolution stated, This presti-
gious accolade is a fitting tribute
to the Ohio AAP for its excellence
in programs that promote the
health and welfare of children.
The Chapter has attained a re-
markable record of service to the
state, and its achievements are a
justifiable source of pride and a
fine reflection not only on the
organization itself but also on its
dedicated members for these in-
dividuals have certainly distin-
guished themselves as conscien-
tious and hard-working Ohioans.
Over the years, the Ohio AAP
has enhanced the quality of life
within our state, and through its
generous contributions, it has
earned the respect and gratitude
of the many citizens it has so
capably served. We are certain
that as this worthy organization
maintains its commitment to ser-
vice, it will continue in the tradi-
tion of excellence that has long
been the hallmark of the AAP.
The Ohio AAP is truly deserving of
high praise. We are proud to note
that it is through the unceasing
efforts of organizations such as this
that Ohio has gained a reputation
as a state that is responsive to the
needs of its citizens and has re-
mained a pleasant place in which
to live and work.
We the members of the House of
Representatives of the 129th Gen-
eral Assembly of Ohio, in adopting
this Resolution, commend the Ohio
AAP on its national accolade and
extend best wishes for ongoing
success.
The Resolution was initiated by
Representatives Mike Duffey and
Anne Gonzales and signed by
Speaker of the House of Repre-
sentatives William G. Batchelder
and Clerk of the House of Repre-
sentatives Laura P. Clemens.
CATCH Implementation Fund grants will be open Nov. 1, 2011
and
are due Jan. 31, 2012. These grants, of up to $12,000, support
pe-
diatricians in the initial and/or pilot stage of developing and
imple-
menting community-based child health initiatives that
provide:
Medical home access
Access to health services not otherwise available
Connecting uninsured/underinsured populations with available
programs
Secondhand smoke exposure reduction
Visit www.aap.org/catch/implementgrants.htm for more
informa-
tion.
Contact our state CATCH co-facilitators, Jonna McRury, MD,
([email protected]) or Mark Redding, MD, ([email protected])
for support.
CATCH grants available November 1
-
8www.ohioaap.org Ohio Pediatrics Summer 2011
Bicycle helmet initiative rolls out at Annual Meeting sessionDid
you know that helmet use can reduce the risk of
head injury by 85% and severe brain injury by 88%?
Did you also know studies show that patients and
their families listen to their pediatrician and that
what YOU say can actually change behavior?
The Ohio AAP Committee on Injury, Violence and
Poison Prevention has been working on a bike hel-
met initiative to try to increase the rate of bicycle
helmet use among Ohios children and make antici-
patory guidance around bicycle safety easier for
you.
Governor Kasich has declared Sept. 21, 2011, Wear
Your Helmet to School/Work Day. On this day we
are kicking off a big media campaign encouraging
people to wear their bicycle helmets. We have de-
veloped press kits including talking points, fact
sheets and story ideas and will be working with state
legislators to hold local media events.
We have reviewed the Behavioral Risk Factor Sur-
veillance Survey data from 2008 and 2010, conduct-
ed by the Ohio Department of Health, to get an
idea of how many children are wearing bicycle hel-
mets. We will be doing observation studies this sum-
mer and plan to continue those twice a year to
track change as our initiative progresses.
Pediatricians are an integral partner for success in
this campaign. Many of you have already expressed
interest in participating in our bicycle helmet study
and we are excited to get this under way this fall.
Participating practices will receive a survey to be
distributed to children between the ages of 5 and
14 when they present for well child visits. The survey
will ask about various safety issues, including bicycle
helmet use. Those patients who answer that they do
not use or own a helmet will be randomized to re-
ceive either anticipatory guidance on bicycle hel-
met use, or anticipatory guidance and a bicycle
helmet. These families will receive a follow up call in
a month to see if there has been any change in
behavior in either group. Participating practices will
receive bicycle helmets from the Ohio AAP for distri-
bution.
Please join us on Thursday, Aug. 25 at Cherry Valley
Lodge for the bicycle helmet session. This day of the
Annual Meeting is free for Ohio AAP members and
their staff.
If you are interested in participating, have any ques-
tions, or would like any marketing materials, please
contact Lee Ann Henkin, [email protected].
Sarah Denny, MD
initiative last year. As originally
passed the BMI screening pro-
gram allows for school districts
to opt out of the program, this
amendment would have elimi-
nated the program all together.
Thanks in large part to the advo-
cacy of the Ohio Business
Legislation...from page 2 Roundtable, a coalition partner
on the Healthy Choices for
Healthy Children initiative, and
some timely budget bill analysis
by the Capitol Consulting Group,
the Governor vetoed the trou-
blesome amendment.
On June 30, the budget was
signed by Gov. Kasich, marking
the end of another intense bud-
get process. The General Assem-
bly is now off for summer recess;
a recess that likely will last until
September.
Ohio AAP members should be
very proud of these important
accomplishments in a very diffi-
cult budget year.
-
www.ohioaap.org Ohio Pediatrics Summer 2011 9
GUIDELINES FOR PEDIATRICIANS
Overuse injuries in athletesOveruse injuries are a result of
progressive repetitive cyclic overloading of tissues. Repetitive
microtrauma overwhelms thetissues ability to repair itself and will
lead to an overuse injury. Injury damage can progress from
microdamage (pain) tomacrodamage (swelling, redness, warmth). High
velocity cyclic overloading can produce an overuse injury in
seconds.An example would be a 100 meter sprinter who sprints for 10
seconds and then suffers a hamstring muscle pull. Low veloci-ty
cyclic overloading, combined with increasing training volumes, can
lead to an overuse injury after weeks or months ofcontinuous
stress. An example would be a marathon runner with a one-year
history of progressively worsening Achilles ten-dinitis. The body
is unable to adequately adapt to the physiological stress placed on
it.
Types of overuse injuries1. Tendonopathies (tendinitis,
tenosynovitis, tendinosis)
such as achilles tendinitis, epicondylitis2. Medial tibial
stress syndrome (shin splints, periostitis)3. Apophyseal injuries
such as Severs, Osgood-Schlatters
and Little league elbow4. Stress fractures5. Muscle soreness and
strains6. Bursitis
Factors contributing to overuse injuries
1. Repetitive cyclic overloading of tissue
2. Increased training volume (too much, too soon, too
frequent, too hard)
3. Poor or improper mechanics or technique
4. Improper training techniques
5. Lack of rest to allow the body to adapt to training
6. Improper equipment such as wrong shoes, wrong
racquet size
General Treatment Principles Most overuse injuries are treated
successfully by adhering tothe following principles:
1. The principle of P.R.I.C.E.
P = Protection protect the injured extremityR = Rest relative
rest: cross train or deep-water runningI = Ice apply ice for 20-30
minutes every 2-3 hrs for first
3 daysC = Compression apply an elastic wrap to reduce
swellingE = Elevation raise extremity above the level of the
heart
2. Rehabilitation
1. Muscle strengthening2. Improve balance and range of motion3.
Flexibility4. Functional sports specific activities5. Cross
training sports activities
3. R.E.S.T. = Resume Exercise Below Soreness Threshold
1. Reduce Volume: 25 30%
2. Reduce Intensity: 10 20%
3. Reduce Frequency: 25 50%
4. Correct Biomechanical and Training Errors 1. Obtain a formal
biomechanical analysis2. Have your biomechanics and technique
evaluated
and corrected3. Use orthotics or a brace if recommended4. Use
correct shoes 5. Use proper equipment correct fit and well
maintained6. Strengthen muscle imbalances7. Adhere to a regular
stretching program8. Review training program with an expert
Preventing overuse injuries
1. Localized pain 6. Loss of motion
2. Swelling 7. Loss of function
3. Redness 8. Localized tenderness
4. Warmth 9. Worsened with activity
5. Weakness
1. Educate. Have athletes
carefully monitor their
training progression.
2. Recognize the early signs
of injury
3. Address all injuries, even
minor ones
4. Have athletes include a
daily stretching and
strengthening program
5. Evaluate and correct bio-
mechanical problems
6. Educate on proper
equipment and fit
7. Avoid early specialization
and year-round single
sports competition
8. Instruct on appropriate
warm-up and cool-down
periods with each training
session
Author: Troy Smurawa, MD
Sports Shorts is provided by the Home and School Committee
of the Ohio Chapter, American Academy of Pediatrics
This information is available on the Ohio Chapter, American
Academy of Pediatrics website www.ohioaap.org
-
10www.ohioaap.org Ohio Pediatrics Summer 2011
GUIDELINES FOR PARENTS, COACHES, ATHLETES
Physical activity is good for children. Organized sports help
chil-
dren build a sense of character, self-esteem, self-discipline
and
positive skills that will last into adulthood. But for all the
advan-
tages sports can bring, parents need to take caution because
kids are at greater risk for injury than ever before.
While organized sports are much more competitive and kids
are under a lot of pressure, parents should seek a balance.
Some parents are told that for children to be competitive,
they
need to focus on a single sport starting at a young age. And
they need to play and work at that sport year round. As a
result, there is no rest and recovery for the parts of the
body
they are using. Kids are doing the same drills and repeating
the
same movements over and over again, making them suscepti-
ble to an abnormal amount of stress and load. Even worse,
athletes are expected to play through the pain.
Overuse injuries on the riseOveruse injuries have risen steadily
over the past 10 years for
young athletes ages 6 to 15. These injuries occur when
tissue
(muscle, tendon, growth plates, bone) exceeds capacity to
absorb or accept stress and breaks down, causing pain.
Previously, it would have taken years to reach this capacity,
as
in the case of an aging major league baseball pitcher with
arthritis. But in pre-adolescent children, growth plates are
espe-
cially vulnerable. They are spongy, cartilage like spots in
the
body where bone is still growing and developing. Children
ages 6 to 18 have more than 200 in the body. At first pain
starts
only with the activity or just after, but later it begins to
hurt with
normal daily activities.
The most common overuse injuries occur in gymnastics, dance
(in particular ballet, especially if they dance en pointe),
baseball, softball, soccer and weight training. Training too
much, too hard, too soon, too frequent is the most common
cause of overuse injuries in athletes. Gymnasts who practice
15 to 20 hours a week are overloading the growth plates in
their wrists. Little League pitchers who throw more than 100
pitches a week overstress their shoulders and elbows.
Basketball players who are on several teams and work out
four
or five nights a week may be overloading their knees. Physi-
cally, these kids appear over the hill by age 14 or 15.
These types of injuries sometimes require surgical repair,
but
because rest is required before rehabilitation can begin it
can
take months to return to activity. Unfortunately, too often,
ath-
letes dont rest or go through rehabilitation so they can get
back in the game and re-injury occurs. If overuse injuries
are
severe enough, they can end a childs participation in a
sport.
The typical signs and symptoms of overuse injuries include
pain
with movement, swelling, warmth, redness, weakness,
difficulty
performing a sport, and pain at rest.
How did this happen? How did this happen? Many parents and
coaches see success-
ful athletes making huge salaries or getting college
scholarships
and they want the same for their kids. Some are living their
sports dreams through their children. Most parents simply
want
to expose their children to the benefits of organized sports
as
well as regular fitness and exercise.
The problem is that each child is different and when you
push
one to keep up with another, thats when injuries occur.
1. Rest complete rest or limited activities2. Apply ice to area
20 30 minutes3. Compression with an ace wrap4. Elevation of the
affected limb5. Nonsteroidal Anti-inflammatory medication 6.
Protective bracing may be helpful in certain
conditions7. A gradual progression back into sports
participation
Guidelines for overuse injuries
1. Avoid over-training carefully monitor your training
progression; remember the10% per week
2. Listen to your body and REST when needed; DO NOT try to
make-up missed training session
3. Recognize the early signs of an injury4. Address all
injuries, even minor ones5. Allow your body time to recover and
heal6. Include daily stretching into your program7. Include a
strengthening program in your training8. Correct biomechanical
problems9. Warm-up and cool-down adequately with each
training session10. Avoid early sports specialization and year
round
single sports competition
Tips for preventing overuse injuries
Sports Shorts is provided by the Home and School Committee
of the Ohio Chapter, American Academy of Pediatrics
This information is available on the Ohio Chapter, American
Academy of Pediatrics website www.ohioaap.org
Author: Troy Smurawa, MD
Overuse injuries in athletes
-
11www.ohioaap.org Ohio Pediatrics Summer 2011
-
Using developmentalscreening in your office
12
100s of Physiciansseeking jobs in Ohio
Medical Opportunities in Ohio (MOO) www.ohmoo.org serves
hospital employers
and private practices with an online recruitment
program, designed to connect Physicians,
Physician Assistants, and Nurse Practitioners
with jobs in Ohio. Job seekers register for
FREE! Our database of Physicians spans
more than 85 specialties!
Employers, contact us today to learn
more about how the MOO program can
work for you!
800.479.1666www.ohmoo.org
www.ohioaap.org Ohio Pediatrics Summer 2011
The last Open Forum of the year
was held in May at the University
of Toledo. The 100+ attendees
learned in a presentation about
the Concerned About Develop-
ment Learning Collaborative
(CADLC), a quality improvement
program of the Ohio AAP, how to
How to differentiate the maincauses of delays in languageand
social-emotional develop-ment are explained to atten-dees by
Jessica Foster, MD.
Cathy Costello from the OhioHealth Information
Partnership,explains the use of electronichealth information
exchange. See Forum...on page 13
Ohio AAP hard at work for youThe Ohio AAP has been work-
ing with the Ohio Medical
Board and their Pill Mill rules.
Initially, the medical board was
going to require mandatory
OARRS (Ohio Automated RX
Reporting System) checks by
doctors who prescribe ADHD
medication at the initial pre-
scription visit and every 12
weeks. After testimony of many
experts (including Ohio AAP)
the medical board has current-
ly decreased the reporting re-
quirement to the initial pre-
scription visit and then yearly.
More frequent checks would
be expected with concerning
patients or parent behavior.
Ohio AAP is also working with
Ohio Medicaid to minimize the
hassle factor associated with
Medicaid prescriptions requir-
ing prior authorization. The for-
mularies were given back to
the Medicaid HMOs and there
will no longer be an Ohio Uni-
versal Medicaid formulary.
Ohio AAP is trying to make
Medicaid HMOs match formu-
laries as much as possible.
differentiate the main causes of
delays in language and social-
emotional development, includ-
ing autism. Attendees also
learned how to complete and
interpret a comprehensive assess-
ment for these delays.
Through CADLC, physicians are
provided with evidence-based
tools that can help identify poten-
tial problems even parents might
miss. Physicians are taught how to
use and interpret the screening
tools without disrupting the busy
office flow.
Presenter Jessica Foster, MD, also
-
www.ohioaap.org Ohio Pediatrics Summer 2011 13
Chapter Quality Network AsthmaProject begins work in August
Physicians across the country turn to ChildLab because we care
about your patients as much as you do.
For a complete list of our pediatric laboratory tests and
pathology services, visit www.childlab.com or call
800-934-6575.
=SYFYMPH]SYVTEXMIRXVIPEXMSRWLMTWSREJSYRHEXMSRSJXVYWX7SHS[I
'LMPH0EF8VYWXMRXLIVIWYPXW
In an effort to continue the work completed by the
Ohio AAP and the 13 practices who participated in
the Chapter Quality Network (CQN) Asthma Pilot
Project, the Ohio AAP with funding from the
CareSource Foundation is launching into phase two
in late August.
The national office of the American Academy of
Pediatrics is providing the Alabama and Ohio chap-
ters, along with Ohios Partners for Kids, with tools,
resources and technical support to lead a quality
improvement (QI) effort amongst 10 to 15 member
practices. Chapters will support practices in imple-
menting the National Heart, Lung, and Blood Institute
(NHLBI), National Asthma Education and Prevention
Program (NAEPP), Expert Panel Report 3 (EPR3) asth-
ma guidelines.
In phase two the CQN will focus on
moving toward full population data,
building payor engagement, and
improving parent involvement.
Results of CQN Pilot Asthma ProjectFour AAP chapters were
selected to participate in
the CQN Asthma Pilot Project, which began in
September, 2009. The Alabama, Maine, Ohio and
Oregon chapters recruited 49 practices which in-
cluded 282 clinicians to participate in a 12-month
learning collaborative. Rapid improvement in care
processes related to using a validated instrument to
assess asthma control, using the NHLBI stepwise tables
to adjust treatment, assuring that all patients had an
See Asthma...on page 14
told attendees how to organize a
process for linking families with
local diagnostic and evidence-
based intervention services relat-
ed to language and social-emo-
tional development in their area.
(See related story on Page 18.)
Electronic Medical RecordsIn the second part of the pro-
gram, attendees learned how to
implement the use of electronic
health information exchange (HIE)
in order to improve the safety,
quality, accessibility, availability
and efficency of health care for
patients.
The next Ohio AAP Open Forum
meeting will be held in January/
February 2012 in Cincinnati.
Watch the Chapter website and
publications for topics.
Forum..from page 12
-
asthma action plan, and providing or recommending
a flu shot, were recorded monthly. In September 2009
initial data showed that these four processes, bun-
dled into one measure of optimal care, were adminis-
tered for only 35% of asthma patient visits. At the one
year mark, optimal care was provided at 85% of
patient visits, just shy of the pre-set goal of 90%.
Providing patients with self-management support was
recorded for 60% of patient visits at the start of the
collaborative and rose to 87% by the one year mark.
Other changes in care practices included:
Performance of spirometry per NHLBI guidelines for
diagnosis or monitoring improved from 49% to 62% of
encounters.
An increase in the percent of patient visits at which
the patient is provided an updated asthma action
plan from 49% to 91%.
Of the 216 physicians in the collaborative, 92% com-
pleted the requirements of the project to be award-
ed credit for the ABPs Maintenance of Certification
Part 4.
CQN2 MissionThe CQN Asthma Project, Phase Two (CQN2) works
at
the practice, state and national levels to build a net-
work of AAP chapters and enhance their ability to
lead a quality improvement collaborative to achieve
measurable improvements in the health outcomes of
children.
The CQN2 provides chapters and partners with tools,
resources and technical support to lead this quality
improvement (QI) effort. The Ohio AAP will gain QI
knowledge and work to increase their capacity to
support member practices in QI efforts. The Academy
has received ABP MOC QI project approval so that
participants can receive part 4 Performance in Prac-
tice credits for completion of the project.
In phase two, the CQN will focus on moving toward
full population data, building payor engagement,
and improving parent involvement.
For more information on CQN2, please contact,
Chapter Project Manager, Heather Hall at (614) 846-
6258 or [email protected].
14www.ohioaap.org Ohio Pediatrics Summer 2011
SERVING STUDENTS WITH LANGUAGE-BASED LEARNING DIFFERENCES AND
ATTENTION DEFICIT DISORDERS
TEACH | IGNITE | INSPIRE
LAWRENCE SCHOOL
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Asthma...from page 13
At the one year mark op-
timal care was provided at
85% of patient visits up from
35%
Providing patients with
self-management support
was recorded for 60% of
patient visits at the start of
collaboration and rose to
87%
Performance of spirome-
try per NHLBI guidelines for
diagnosis or monitoring im-
proved from 49% to 62%
An increase in the per-
cent of patient visits at
which the patient is provid-
ed an updated asthma
action plan went from 49%
to 91%
Asthma PilotProject at a glance
-
District V Report
One of my personal heroes, and
very possibly one of yours, is
Marion Wright Edelman, founder
and presi-
dent of
the Chil-
drens
Defense
Fund. She
says, In-
vesting in
[children]
is not a
national
luxury or a
national
choice. It's a national necessity.
In this era, as we continue to strive
to improve the health and well-
being of all children, this concept
remains important to direct our
cause.
The American Academy of Pedi-
atrics has as its purpose: Ded-
cated to the Health of All Chil-
dren and never has that been
more important. As a nation we
recognize that there are many
challenges and choices that will
be made in the months and years
ahead and those that speak for
children will need to keep their
voices steady and strong.
We recognize that to be effec-
tive, we as pediatricians need to
be strong ourselves, and address-
ing the needs of our members is
essential.
Some of the ways nationally and
in our district that we are meeting
the needs of members are by sup-
porting young physicians and pe-
diatric subspecialists. We also are
meeting members needs by en-
hancing resources for Maintena-
nce of Certification.
Each of these areas has been ad-
dressed specifically in the district
and your chapter leaders have
provided support as well. Nation-
ally, the Office of Federal Affairs
has added a full-time staff mem-
ber to focus on specialty pedia-
trics. Additional examples of pro-
motion of young and specialty
physicians include the Section on
Perinatal Pediatrics that has en-
gaged their trainees in an initiative
called TECaN (Trainees and Early
Career Neonatologists) to foster
career development and en-
hancement of leadership in Neo-
natal-Perinatal Medicine.
The Section on Surgery is working
with the Section on Residents and
the Association of Pediatric Pro-
gram Directors to develop a cur-
riculum for pediatric surgery for
pediatric residents and practicing
pediatricians.
The Ohio Chapter continues to ad-
vance the opportunities for Main-
tenance of Certification, and na-
tionally more programs are being
developed. Your chapter leaders
are ensuring that your needs are
met. We seek your input and sug-
gestions for specific areas where
we can support your interests and
encourage direct communication
to focus on your needs.
Marilyn J. Bull, MD
District V Chair
Marilyn Bull, MD
We need to be strong tobe effective for children
www.ohioaap.org Ohio Pediatrics Summer 2011 15
MOBI scoreshigh marks inCDC report
The Ohio Department of
Health (ODH) is asked by the
Centers for Disease Control
(CDC) to evaluate one of
their grant programs every
two years. This year, ODH
chose to examine the Max-
imizing Office Based Immu-
nization (MOBI) program,
which is funded through a
grant from CDC and ODH
and implemented by the
Ohio AAP.
The overall goal of the MOBI
program is to increase immu-
nization rates to 90% among
children 2 years of age living
in Ohio.
The object of the evaluation
was to get a clearer picture
of the strengths and weak-
nesses of the program. The
recommendations from the
evaluation will aid in ensur-
ing appropriate goals are
set, as well as identifying
areas in which the MOBI pro-
gram can be developed so
that it can more effectively
meet these goals.
The evaluation showed that
the MOBI program has been
successful in aiding the
adoption of immunization
best practices by pediatric
and family practice primary
care offices throughout
Ohio.
Measurements taken during
the MOBI presentation and
See MOBI...on page 19
-
Work smarter, not harderCoding Corner
16
The bread and butter codes
for most pediatricians, both
generalists and specialists, is
the established patient
99212-99215 series. These
codes are to be used for
problem-oriented estab-
lished patient office visits,
and are selected based on
criteria defined in the CPT
book. Traditionally it has
been assumed by payers
and providers alike, that the
use distribution of these codes is in a bell-shaped
curve or bar graph as represented (figure 1), with
the 50% peak number of visits provided at 99213.
Multiple studies have now shown that for general
pediatricians, seeing a typical patient population,
this graph should be shifted to the right (figure 2),
with a significant
number of 99214
visits provided.
To make the
opportunity
even greater, it
has also been
determined that
most pediatri-
cians code with
a coding curve shifted to the left, with few 99214,
and rare 99215 visits (figure 3). Specialists will often
have a graphic coding representation shifted to the
right with a significant number of 99215 visits. This
results in a huge
opportunity to
increase a pedi-
atricians bot-
tom line, with-
out additional
work or prac-
tice overhead,
by appropriate-
ly coding 99213
and 99214
established patient office visits.
The 99213 or 99214 level is selected based on meet-
ing two of the
three key criteria
of history, exami-
nation, and
medical deci-
sion. The code
can also be
selected based
on time, when
more than 50%
of the face-to-face encounter time is spent coun-
seling and/or coordinating care in the outpatient
setting.
It is helpful to consider reasons for visits when you
ask yourself if a particular office visit should be a
99214 instead of the typical 99213 established office
visit. A partial list of problems with examples, which
should raise the question of coding 99214 vs. 99213
include:
A Child with Special Health Care Needs
Ex : Cerebral palsy, ADHD, premature infant
An Established Patient with a New Diagnosis
Ex : newly diagnosed bronchiolitis, urticaria
Multiple active diagnoses
Ex: patient with pneumonia and otitis media
A repeat visit for a patient problem patient worseEx: Patient
returning with persisting sore throat andfever, strep negative at
earlier visit
Co-morbities - not inherent in the problem being
seen
Ex: Pharyngitis with fever and lethargy
A patient requiring Lab or X-ray to diagnose and
manage the problem
Ex: CXR to diagnose pneumonia, CBC to r/o leuko-
cytosis
A patient problem requiring consultation with anoth-
er physician or facility (telephone or face-to-face
consultation)
Ex: Patient with infectious disease prompting call to
local ID specialist
Richard Tuck, MD
EM ESTABLISHED OFFICE- Expected
0055
110011552200225533003355440044555500
EEMM EESSTT OOFFFFIICCEE
99992211119999221122999922113399992211449999221155
EM ESTABLISHED OFFICE- Real Pediatrics
00
55
1100
1155
2200
2255
3300
3355
4400
EEMM EESSTT OOFFFFIICCEE
99992211119999221122999922113399992211449999221155
EM ESTABLISHED OFFICE- Actual
00
1100
2200
3300
4400
5500
6600
EEMM EESSTT OOFFFFIICCEE
99992211119999221122999922113399992211449999221155
Figure 1
Figure 3
Figure 2
www.ohioaap.org Ohio Pediatrics Summer 2011
See Coding...on page 17
-
www.ohioaap.org Ohio Pediatrics Summer 2011 17
We proudly announce that American Physiciansand e Doctors
Company have united.
Together, we set a higher standard. We aggressively defend your
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On October 22, 2010, e Doctors Company and American Physicians o
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medicine. American Physicians
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A prescription written for the problem(s)
Ex: Antibiotics prescribed for recurrent otitis media
(straightforward otitis media would typically be a
99213 visit)
The problem requires office procedures (aerosol,
pulse ox)
Ex: Patient with exacerbation of asthma requiring
office aerosols, pulse ox
A patient with chronic problem requiring change in
treatment
Ex: Patient with asthma and frequent exacerbations,
requiring treatment adjustment in controller/rescue
meds
A patient with a time-based office visit or consulta-
tion not truly meeting the requirements of a consul-
tation visit
Ex: Patient with behavior or toilet training problems
requiring extensive time-based counseling
A follow-up visit requiring extensive discussion
Ex: F/U visit for ADHD with significant home and
school behavior problems
Although, the problems in this list generally support a
99214 visit level, they are not in and of themselves the
defining element in code selection. They should, how-
ever, prompt you asking yourself if this visit could be a
99214, instead of the too frequently used 99213.
In addition to appropriate documentation to support
these visit levels, ICD diagnosis coding should also
support the CPT level selected, consistent with the
considerations outlined above. This includes coding
multiple diagnoses, co-morbidities, and all problems
addressed at the visit.
Remember: Code and work smarter; not many of us
can work harder!
Richard Tuck, MD, Zanesville
Ohio AAP Coding Expert
Coding...from page 16
-
Ohio AAP welcomes new members
18www.ohioaap.org Ohio Pediatrics Summer 2011
Ilona Brener Albrecht, Dayton
Alicia Marie Alcamo, Cincinnati
Amber Ellis Anastasi, Cincinnati
Katherine Scott Auger, Ann Arbor,
Raymond C. Baker, Cincinnati
Lauren Cantor Bar-lev, Columbus
Elizabeth Barnes, Dayton
Paul S. Bellet, Glendale
Melissa K. Benvow, Dayton
Thomas F. Boat, Cincinnati
Aparna Bole, Cleveland
Ada Booth, Corpus Christi, TX
Eric Scott Bowman, Grove City
Miles J. Burke, Cincinnati
Mary Carol Burkhardt, Cincinnati
Lindsay C. Burrage, Houston
Rolly Chaudhary Chawla, Avon
Sophia W. Chen, Broadview Hts.
Mary Lorentz Clough, Gates Mills
Victoriano T. Co, Fairfield
Leandro Cordero Jr., Columbus
Corin Cozzi, Columbus
Dannika Cross, Gwynn Oak, MD
Joel Davidson, Akron
Sarah Anne Denny, Worthington
Katie Ellgass, APO
Rachel M. Engen, Brookline, MA
Benedicta G. Enrile, Worthington
Emily Tancous Ferguson, Colum-
bus
Adam Garlock, Columbus
Kristin Leigh Garton, Columbus
Rakhi Gupta, Cleveland
Scott E. Hickey, Hilliard
Susan E. Ingraham, Columbus
Irwin B. Jacobs, Chagrin Falls
Stephen A. Koff, Columbus
Venkatesan Krishnan, Sylvania
Eileen Murtagh Kurowski, Cincin-
nati
Lisa M. Light, Twinsburg
Jamie R. Macklin, Grove City
John C. Markovich, Cincinnati
Mindy Deason Marlowe, Sanford
John David Martino, Columbus
Margaret McBride, Akron
Bruce P. Meyer, Columbus
Cameron Miller, New Albany
Jillian Miller, Stow
Laurie Mitan, Cincinnati
Teresa Moon, Barberton
Andrew Newburn, New
Philadelphia
Andrew Garrett Norris, Columbus
Gregory J. Omior, Akron
Tiffany Jan Owens, Dayton
Douglas P. Powell, Cleveland
Regina E. Ramirez, Strongville
Charles R. Redman, II, Columbus
JoAnn Clare Rohyans, Columbus
Sarah Ronis, Rochester, NY
Allison L. Rund, Shaker Hts.
Melissa Lynn Skaug, Columbus
Mary Kathleen Skoch, Lakewood
Michael Slogic, Witchita, KS
Denise Anne Somsak, Cincinnati
Libbie Stansifer, Cleveland Hts.
Hurikadale P. Sundaresh, Solon
Sherri Ann Thomas, Bowling Green
Jonathan Lee Tolentino,
Cincinnati
James Tschudy, Mountain Home
Carrie Tuten, Columbus
Kleuhoa Tran Vo, Columbus
Kirstin Weerdenburg, Toronto, ON
Valerie T. Whitcomb, Royal Oak,
MI
Pamela Hood Williams-Arya, Cin-
cinnati
Matthew J. Wyneski, Medina
Rachael Zanotti-Morocco, New
Albany
Campaign raises awareness ondelays in developmentThanks to a
grant provided by the Ohio Department
of Health, Bureau of Early Intervention Services, the
Ohio AAPs Autism Diagnosis Education Pilot Program
(ADEPP), and the coordinating Concerned About
Development Learning Collaborative (CADLC), was
able to hire a communications firm to raise public
awareness about developmental delays.
The campaign focuses on three common develop-
mental milestones smiling, crawling and talking
which show parents holding their child asking if he/
she should be smiling/crawling/talking yet? Mobile
billboards, print ads, and radio spots are already
popping up around the state.
A campaign to raise public awareness aboutdevelopmental delays
are using mobile bill-boards to get the message out to parents.
-
Ounce makes office callsThe Ohio AAP wants to help you. After
much success with the Ounce of Prevention regional trainingsand
webinars, the Ohio AAP has decided to bring the Ounce of Prevention
program to your ofce!
With a grant from the Ohio Department of Health, Robert Murray,
MD, or Amy Sternstein, MD, willtravel to your ofce and provide a
one-hour FREE CME training on a date and time that works bestfor
YOU!
Along with training for pediatricians and ofce staff, you will
receive an Ounce of Prevention toolkit thatincludes: Parent
handouts on nutrition, physical activity, calcium, snacks and
serving sizes Anticipatory guidance tip sheets for the patient's
chart, ofce posters, BMI growth charts, and BMI wheels
CD with all educational materials in English and Spanish
To register, please visit:
http://www.theounceofprevention.org/parentsurvey/ounce-of-
prevention-training-information/ofce-based-training
www.ohioaap.org Ohio Pediatrics Summer 2011 19
one month following showed that
the MOBI program was successful
in helping offices change in seven
of the eight recommended immu-
nization practices.
Prior to their MOBI presentation,
more than two-thirds of the offices
had scheduled or had AFIX mea-
surements. An additional 26 offices
scheduled or had AFIX measure-
ments done at the time of the
one-month follow up. The practice
of checking patients immunization
status at every visit was improved
upon most with 66.0% of offices
engaging in the practice before
the MOBI and 85.9% of offices
practicing it after. Sixty-eight per-
cent of the offices gave immuniza-
tions even if a mild illness was pre-
sent before the MOBI. This im-
proved to 75.9% one month after.
Three hundred and ten offices
(69.2%) gave all vaccines that pa-
tients are due previous to the
MOBI and 350 or 78.1% did at fol-
low up. The percent of offices that
updated their policies to reduce
barriers to immmunization im-
proved from 53.1% to 65.0%. The
use of reminder recall system im-
proved from 50.9% to 65.0% of of-
fices. Finally, 68.3% of offices were
using the IMPACT SIIS immunization
registry, which increased from
59.4% at the baseline.
The only practice that did not
show significant improvement was
VFC enrollment. Three hundred
forty-five offices were enrolled in
the VFC program prior to the MOBI
and four offices became providers
or started the process between
the times of the MOBI to the one-
month follow up.
Key recommendations from the
report include adding behavioral
change objectives to the logic
model in order to build more ef-
fective strategies to address and
target barriers practices may have
to adopting the recommended
MOBI practices.
As a result of the report, the MOBI
program will refine its current sur-
vey tool for improved validity and
reliability which are key steps to
enhance measurement accuracy.
MOBI...from page 15
-
The Ohio AAP announces the following meetings and events.
Aug. 25-27 Ohio AAP Annual Meeting
Thursday, Aug. 25 - FREE day for members and their staff.
9 a.m. Developmental Screening
11:15 a.m. Ounce of Prevention is Worth a Pound of Cure
1:30 p.m. Maximizing Office-Based Immunization (MOBI)
2:45 p.m. Bike Helmets: Anticipatory Guidance and Free
Helmets
Friday, Aug. 26
12:30 p.m. Quality Improvement
1:45 p.m. Quality Improvement Roundtable Discussion
2:45 p.m. Medical Home Panel: Reimbursement, Resources &
Benefits
4:30 p.m. Opening Reception
7 p.m. Casino Night for Adults; Pajama Party for Kids
Saturday, Aug. 27
7 a.m. Ohio AAP Annual Breakfast
9 a.m. Maintenance of Certification
10:45 a.m. Case-based Studies of Common Pediatric Problems
12:30 p.m. Annual Awards Luncheon
2 p.m. Ohio AAP Executive Committee Meeting
Sept. 21 Wear Your Helmet to School/Work Day
Calendar of Events
Dues remitted to the Ohio
Chapter are not deductible
as a charitable contribution,
but may be deducted as an
ordinary and necessary busi-
ness expense. However, $40
of the dues is not deductible
as a business expense be-
cause of the Chapters lob-
bying activity. Please consult
your tax adviser for specific
information.
This statement is in reference
to fellows, associate fellows
and subspecialty fellows.
No portion of the candidatefellows nor post residency
fellows dues is used for lob-
bying activity.
Ohio ChapterAmerican Academy of Pediatrics450 W. Wilson Bridge
Rd. Suite 215Worthington, OH 43085
PRESORTEDSTANDARD
Permit No. 156
U.S. Postage
PAID
DUBLIN, OH
Dues disclosure
statement