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The Florida Society of
Neonatologists
Meeting Minutes
Annual Business Meeting - September 1, 2000
Orlando World Center Marriott Resort,
Hyperlinks: Approval of Minutes | Treasurer’s Report | Membership Report | Legislative Report | Data Collection Form | Education Committee | Discussion of Future Meetings | Florida Pediatric Society Report | FMA Report | American Academy of Pediatrics | Neonatal Transport | RSV Registry | Expert Testimony | Elections | Adjournment
MINUTES
Dr. Shahnaz Duara, President, called the meeting to order at 2:16 pm. Attendees are listed on the attachment.
Dr. Duara presented the minutes of the previous business meeting of September 30, 1999 and the phone conference of July 27, 2000. These minutes were approved as recorded.
Dr. Hudak reported the YTD financial report of the Society. At the conclusion of last year’s meeting, the account balance was $14,161.81. Income since that time has consisted of corporate sponsorship by Ross Laboratories ($1000) and Mead Johnson ($2125) as well as annual dues submitted by 22 members. The current balance stands at $17,466.39 with anticipated meeting expenses projected at approximately $5000. Dr. Hudak noted that although the Society remained fiscally solvent and could conduct its mission over the next year, expansion of the Society’s goals including its educational objectives would necessitate vigorous efforts to increase its dues-paying membership as well as to seek new corporate sponsors.
Dr. Kairalla reported that an optimistic count of membership of the Society totalled 102, which by best estimate represents about fifty percent of active neonatologists in the State of Florida. This compared to a tally of 82 dues-paying members at the same time last year. Dr. Kairalla noted that Mead Johnson had been very active in assisting the Society to identify neonatologists throughout the state, and had circulated Society newsletters to individual practices in an effort to promote the Society and to retain and recruit members.
In Dr. McCarthy’s absence, Dr. Napolitano presented the legislative report:
(1) The major goal of the Florida Pediatric Society for the next year is to lobby the state legislature to raise Medicaid reimbursements to all providers for pediatric patients to Medicare levels. The estimated cost of this initiative would be $80 million. The Society supports this goal.
(2) The Birth Defects Registry was started in January 1999. Current funding for this endeavor supports passive review and active surveillance limited to reporting of certain neural tube defects. Increase funding of $4 million to enhance active surveillance is being sought.
(3) The Healthy Start Coalitions are requesting funding for establishment of a statewide Fetal and Infant Mortality Review program and also for support of a Pediatric Mortality Review program.
(4) Pediatric standards as developed by AHCA are undergoing a final revision before becoming a rule. This is anticipated to occur in October or November.
(5) Neonatal-perinatal standards are under development in AHCA. Several meetings of neonatologists, obstetricians, and perinatologists have occurred with the next meeting scheduled for October 3. Dr. Duara and Dr. McCarthy are Society representative involved in these preliminary discussions.
(6) AHCA has had discussions with pediatric cardiologists and is considering the development of standards for pediatric cardiovascular surgery.
(7) AHCA will review and update the Neonatal Sepsis Guidelines.
As an item of old business, Dr. Duara reviewed the history of the attempts by the Society to facilitate implementation of a short report form to capture demographic information and pertinent outcomes on every infant cared for at a level II or level III NICU in the state of Florida. She recalled that the Society has been working on this for the past three years. She noted that several years ago there had been an attempt to modify the weight requirement (1000 grams) that triggered transfer of infants to level III NICUs under state rules. At the time, rational deliberation on the merits of this proposal had been hampered by a lack of data that addressed comparative outcomes at level I, II and III NICUs.
Drs. Duara and Hudak were guest attendees at a September 1999 RPICC program directors meeting in Orlando. At that meeting, the limitations of the current RPICC outcome reporting tool were discussed. It was agreed that the tool required revision and that the FSN would have input in the final product. Dr. Duara submitted a recommendation for a tool after a consensus was achieved in a phone conference with FSN representatives. All of the RPICC Directors gave input, and a final consensus document was submitted to Dr. Curran, the State RPICC Consultant. Dr. Curran agreed in principle to the form but has not implemented it for the RPICC Centers.
It was noted that the United Kingdom has a mechanism for uniform reporting of NICU outcomes. Data from this UK effort have been published in a number of reputable journals (including the New England Journal of Medicine). The implication is that given sufficient infrastructure funding, meaningful data can be assimilated on a large scale. However, Dr. Bucciarelli observed that costs associated with data collection (primarily on the hospital side) and data management (primarily on the recipient side) would be significant and noted the lack of commitment of state government and hospitals to front these expenses. As an example of how difficult it would be to acquire new state funding, he pointed out that Governor Bush has told all government agencies to submit proposals detailing how they would cut their budgets by 5% by September 15. Although Dr. Brooks, the Secretary of Health, is an advocate of benchmarking and quality, the issue is one for AHCA to decide. .
Dr. Curran then presented a brief review of the history of the RPICC data collection tools. He noted that even interpretation of comparative survival data among the RPICC centers was difficult, complicated by differences in reporting and by differences in population demographics. Overall, collection of these data has had little impact on changing care. He noted that Governor Bush is an advocate for less state regulation and more local determination of health care resource allocation. As an example of why the Bush administration shies away from new regulatory spending, Dr. Curran observed that funding for extensive risk screening of pregnant women through Healthy Start has not been able to be linked to improvements in neonatal outcomes.
Dr. Duara said that the Society has always supported the goal of some reporting, but Dr. Auerbach observed that the Society had failed to effectively articulate explicit purposes for more widespread data collection and analysis. Dr. Kairalla reminded the members that Dr. Schulman, a former FSN member, had accepted a position in New York State government that oversaw a statewide neonatology database. He volunteered to contact Dr. Schulman to learn from his experience over the past year.
Dr. Duara stated that she would draft a statement of principle for the Society on the issues of data collection and neonatal standards and finalize this in a conference call with officers in the fall.
Dr. Kairalla noted that despite major efforts by Society officers over the past two years, attendance at the FSN sponsored lecture following the annual meeting was disappointing. He has considered his priority as President-Elect to be to increase the educational mission of the Society and presented a number of ways to accomplish this. Dr. Kairalla distributed four issues of a new "FSN Journal Club" that he has edited that have summarized and commented on recent neonatology literature or meeting proceedings. He encouraged members to use the FSN web site (
www.fsneo.org) to add comments to on-line discussion of the articles, or to post new article commentary to the web site. He gave a demonstration of the capabilities of the website, and also presented Dr. Alfonso’s Neuroneonatology 2000 CD-ROM publication. He reminded members that at the present time, to access the web site, members should response "member" and "fsneo" to the name and password prompts, respectively.Dr. Bucciarelli complimented Dr. Kairalla on his undertaking the journal club program and suggested that the FSN budget funds to enhance electronic education initiatives such as the website and the CD-ROM publication. He also recommended establishing a link to the Florida Pediatric Society website from
www.fsneo.org.Dr. Duara introduced a discussion of the role of the annual meeting as an item of new business. She noted that the annual meeting has attracted fewer members than desired over the past several years and attributed this partly to the increasing clinical responsibilities that neonatologists in general have experienced, even in large practices, that makes it difficult for sometimes even one group member to attend an offsite weekday meeting. She noted that the periodic phone conference calls among Society officers have resulted led to clearer agenda setting and more effective communication among participating membership than in the past. A variety of options for next year’s meeting were discussed, including coupling with the FPS annual meeting. With elections for Secretary/Treasurer set for November and a transfer to new leadership due in February, the format and timing of the next yearly meeting should be the first order of business for the new officers and Board of Governors.
Florida Pediatric Society Report
Dr. Bucciarelli addressed three items.
(1) He reported that efforts to increase Medicaid reimbursements for pediatric patients to Medicare levels had failed at the 11th hour in this year’s legislative session. Family practitioners had successfully lobbied FMA to support across the board Medicaid increases (including for the 21+ age group), but this resulted in a 4% across the board increase by the legislature. Hopefully, next year the FMA will support the concept of an incremental approach, targeting increased reimbursement to all providers of patients aged 0-21.
(2) Apparently the Governor wants to investigate the merits of "privatizing" Children’s Medical Services in pursuit of his goal of a smaller government. He has appointed/will appoint a task force to address this issue.
(3) Dr. Bucciarelli noted that an FSN member, Dr. Todd Patterson in Tallahassee, was running for the House in his District, and that it appeared that Dr. Patterson might make it to a runoff.
Dr. Duara noted that the FMA claimed success in sponsoring newborn universal hearing screening. She pointed out that the FMA was assisted in this effort by the FSN and the FPS.
American Academy of Pediatrics
Dr. Kairalla reported in the absence of Dr. Chandler that (1) the elected chairperson for the newly created District 10 is Dr. Wally Carlo; (2) a new CPT code for infants weighing 1500 to 2000 grams – 992XX – is being discussed at the AMA CPT October 30 meeting; and (3) there will likely be a new ICD-9 code for periventricular leukomalacia within one year.
Dr. Napolitano observed that the state will be inspecting transport teams beginning in October. This will only pertain to hospitals that own and license their own vehicles. Also, new language in 64E invests physician directors of transport teams with more responsibility. He encouraged transport directors to become familiar with these new requirements.
Dr. Duara noted, as follow-up of old business, that the FSN had contributed to the implementation of a statewide RSV registry. Microbiology laboratories associated with 16 pediatric inpatient facilities across the state report the number of respiratory panels and the percent positive for RSV on a weekly basis. This information is compiled, analyzed by region, and reported back to the facilities to provide early warning about the timing of the onset of RSV season by geographical area. This should help guide neonatologists and pediatricians concerned about timing of RSV prophylaxis.
Dr. Sheridan related his concerns about a neonatologist in Florida providing expert testimony about a standard of care with which he disagreed, and suspected that no other neonatologist in Florida would endorse. He inquired whether there was anything the Society could do in this regard. A spirited discussion ensued. In the absence of legal advice, no conclusions were reached. Dr. Bucciarelli stressed the importance of members getting involved in legal review as a strategy to improve the medico-legal climate for physicians.
Dr. Duara noted that the two candidates for Secretary-Treasurer would be Dr. Fred Miller and Dr. Michael McMahan. Ballots would be sent out in the fall. She noted that her duties as President ended in the spring and that Dr. Kairalla would be invested with the responsibilities of President at that time. She planned to conclude her role as President with a final conference call among Society officers in a few months.
The meeting was adjourned at 4:45 for dinner and a presentation by Dr. Thomas Wiswell on Meconium Aspiration Syndrome.
Respectfully submitted,
Mark L. Hudak MD
Secretary-Treasurer