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The Florida
Society of Neonatologists
Meeting Minutes
Annual Business Meeting -
September 30, 1999
2:30 pm – 4:00 pm
Sheraton Bal Harbour Resort
Hyperlinks: Approval of Minutes | Membership Report | Treasurer’s Report | NICU data forms | Universal hearing screening | Herpes practice parameters | Regional board members | AHCA physician advisory opportunities | Management of the Society | Management of society website. | Legislative Report | AHCA Report | CMS Report | Adjournment
MINUTES
Dr. Shahnaz Duara, President, called the meeting to order at 2:35 pm. Attendees are listed on the attachment.
Approval of Minutes (February 27, 1999)
Dr. Duara presented the minutes of the previous business meeting. These minutes were approved as recorded.
Dr. Kairalla reported that 82 neonatologists to date had paid dues during calendar year 1999. This represented a slight increase from 71 neonatologists who had paid dues during 1998. Efforts made in the past year to increase membership, including a letter of invitation from the Membership Chair, a recruitment brochure ("Why Should You Be A Member?"), and initiation of a website were felt to have been moderately successful in enhancing membership.
Dr. Hudak reported the YTD financial report of the Society. Income totaled $9,100 ($5,000 educational grant from Abbott Laboratories and 82 annual dues). Expenses totaled $5,275 with an additional $4,000 projected accrued expense for the current meeting. The account balance was projected to stand at approximately $14,161.81 at the end of the meeting. Dr. Hudak noted that although the Society was certainly solvent to conduct its mission over the next year, expansion of the Society’s educational objectives would require efforts to retain and expand its membership as well as some corporate sponsorship assistance.
Old Business
NICU data forms. Dr. Duara reviewed the recent history of efforts by Society members to develop a concise NICU outcomes data form that could be completed and reported on a voluntary basis by level II and level III NICUs in the state. She reported that she and Dr. Hudak had attended a CMS-sponsored meeting in Orlando of the Regional Perinatal Intensive Care Centers. Medical directors of RPICC NICUs are also engaged in developing a simple but meaningful data tool with unambiguous definitions to evaluate differences in morbidity and mortality across sites. Their final form will reflect input from the Society.
Members had many comments about the preliminary data form under development by the Society. Dr. Joseph Schulman reported that he was soon to move to Albany NY where one of his responsibilities would be to work with the State of New York in a similar effort. Dr. Duara promised to move the process forward and to report further developments to the Society.
Universal hearing screening. Dr. Duara noted that the FSN together with the Florida Pediatric Society had sponsored Resolution 99-57 through the FMA to support "the development of a statewide universal, comprehensive and co-ordinated interdisciplinary program of earl hearing screening, identification and follow-up care of newborns."
Herpes practice parameters. Dr. McCarthy was going to talk
Regional board members. Dr. Duara announced that appointment of the Board of Directors had been completed. At this time, the Board consists of: President (Dr. Shahnaz Duara), President-Elect (Dr. Andy Kairalla), Secretary-Treasurer (Dr. Mark Hudak), Immediate Past President (Dr. Tony Napolitano), 1 NW representative (Dr. Jon Nagle), 2 NE representatives (Dr. Mike McHahon and Dr. Rick Bucciarelli), 2 Central representatives (Dr. Richard Sheridan and Dr. Jeanne McCarthy), 1 SW representative (Dr. Deogracias Caangay) and 3 SE representatives (Dr. Mitchell Stern, Dr. Fred Miller, and Dr. Bob Stern). Dr. Duara also announced that in accordance with Society Bylaws, she had appointed Dr. Jeanne McCarthy as chairman of the Legislative Committee; Dr. Andy Kairalla as chairman of the Membership Committee; Dr. Mitchell Stern as chairman of the Educational Committee; and Dr. Mark Hudak as chairman of the Bylaws Committee.
New Business
AHCA physician advisory opportunities. Dr. Duara noted that AHCA was soliciting specialty physicians to partner with AHCA to share expertise with the Agency on an as-needed basis. A letter from AHCA’s Chief Medical Officer, Dr. Shea, was included in the meeting handout materials.
Management of the Society after January 1, 2000. Dr. Duara announced that ProNational (formerly Physicians Protective Trust Fund) had notified her on September 8 that effective December 31, 1999 it would cease to provide administrative services for all medical societies through its Society Service Program. Dr. Duara thanked Wanda Callahan and Crystie Morris, the Program and Administrative Directors of SSP, for their excellent services over the past nearly two years, and presented each with a small gift as a token of the Society’s appreciation. The Society will be evaluating the feasibility of outsourcing selected services currently provided by SSP in the future.
Management of society website. As a consequence of the ProNational decision, the FSN website will need to relocate. Dr. Kairalla has volunteered to manage the website.
Dr. Jeanne McCarthy presented her legislative review. She noted that AHCA had instituted requirements for physician and hospital reporting of congenital anomalies into a state registry. There is a parallel requirement for reporting of neural tube defects. She summarized the prospects for universal infant hearing screening legislation. She also reported that neonatal transport standards (64E) remain intact, and that AHCA is coming closer to finalizing pediatric facility standards. Finally, Dr. McCarthy related that AHCA will begin tracking RSV infections throughout the state through weekly communications with 16 sentinel geographically diverse hospitals who will voluntarily report the number of respiratory specimens submitted to their laboratories for RSV assay and the percent positive. This "registry" will allow providers to check on the status of RSV season in their area and make informed decisions about parental counseling and RSV prophylaxis.
Jeffrey N. Gregg, Chief of the Office of Health Policy at AHCA, reported on recent activities at AHCA. He passed out a detailed handout that provided an overview of AHCA activities, including a printout of the introductory web pages of "Online Sunshine", the official guide to the State of Florida Legislature at www.leg.state.fl.us as well as a web listing of relevant senate and house bills under consideration.
He noted that the Florida Legislature created AHCA in 1992 by combining parts of the Department of Health and Rehabilitative Services and the Health Care Cost Containment Board with the goal of consolidating health care financing and regulatory functions under one umbrella. AHCA acquired Medicaid in 1993 from HRS, and health-related professional boards in 1994 from the Department of Professional Regulation. Creation of the Department of Health in 1997 led to transfer of the professional boards to that agency, but AHCA retained the investigating and prosecuting functions. The two largest programs in AHCA are the Medicaid and the Managed Care/Health Quality programs. Medicaid is a $7 billion program that funds over 1.5 million recipients and 74,000 providers and accounts for 98% of AHCA’s budget. The remainder of AHCA’s budget funds functions such as health facility regulation, practitioner investigations, the State Center for Health Statistics, the Certificate of Need (CON) program and administrative support functions. AHCA’s toll-free information line is 1-888-419-3456 and internet web site is www.fdhc.state.fl.us.
Mr. Gregg reported that the Governor’s budget was likely to have some limited funding for universal hearing screening of newborns. He noted that the current political climate was exerting pressures for reform of the CON process to be more consistent with open-market standards. There is a task force on CON at work whose recommendations may produce some legislative reform. In general, a general downsizing of CONs may evolve. Elimination of the CON for level II NICUs may have specific implications for members of the FSN. Mr. Gregg supplemented Dr. McCarthy’s report on pediatric facility standards. The open meetings have generally been attended by up to 250 representatives and the final meeting is anticipated to occur on November 3. The final product is still uncertain. Once pediatric standards are finalized, AHCA/CMS may tackle issues related to standards for level I/II/III nurseries. Promulgation of such standards may allow retirement of the CON for these facilities.
On a related topic, the current hospital data base at AHCA may move to an internet system of reporting. Mr. Gregg volunteered in response to Dr. Duara’s question about modifying the RPICC stature for reporting that voluntary reporting of outcomes from non-RPICC sites would be more properly referred to/coordinated by the Department of Health.
Finally, Mr. Gregg announced that AHCA would begin tracking of RSV infections statewide on October 15, 1999.
Dr. Eric Handler, Deputy Secretary at the Department of Health, next shared his observations on developments at DOH that are of interest to Society members.
He reported that the legislature had cut the CMS budget by $1.4 million dollars last year in anticipating of potential savings with the Title XXI program. Dr. Handler noted that he had to make cuts in purchase client services and master contracts to balance his budget. He is facing an additional $2 million in budget cuts this year.
Dr. Handler noted that only 2% of infants underwent newborn hearing screens in 1997-98. Over the past year (1998-99), that number has increased to 58% due to increased awareness and one year funding of hospitals by CMS.
He pointed out the growth of the Telemedicine Program at CMS. There are now 9 operational sites used by child protection teams throughout the state under the direction of Dr. Jay Whitworth in Jacksonville. He noted that a unit can be purchased for $300 which on placement in a patient’s home and connection with a television and phone, can allow remote video analysis of an infant in the home setting. Forty such units have been placed in state EIP clinics increasing efficiency of care and reducing traveling costs. This technology is also being used at a feeding clinic in Tampa and has allowed 2-3 times per day video conferencing of parents in Marathon with their 2 year old child s/p kidney transplant in Miami.
Dr. Handler responded to the issue of voluntary reporting of NICU outcomes by non-RPICC centers that CMS and AHCA should work together on implementing the process.
Finally, Dr. Handler thanked the Society for its advisory role to CMS with respect to RSV prophylaxis.
The meeting was concluded at 5:15 pm for dinner and an presentation by Dr. Henrietta Bada on "Clinical Indicators and Outcomes of Perinatal Asphyxia".