Background:

Access to high quality health care for all children is the highest priority of the American Academy of Pediatrics (AAP). Inadequate reimbursement jeopardizes children’s access to health care services by failing to support he provision of health care this is patient-centered and evidenced-based. In addition to the child and family, the economic health of pediatricians is threatened by the confluence of inadequate reimbursement rates I the public and private markets and significant increases in overhead costs.

The Private Sector Advocacy Advisory Committee (PSAAC) is the next generation of the AAP strategic action on reimbursement. The initial AAP Task Force on Reimbursement (TOFR) surveyed the pediatric health care payment environment and developed recommendations. One of those recommendations was the development of a Pediatrician Reimbursement Advisory Team (P-TEAM) to advise the Academy in identifying opportunities to improve the reimbursement environment and strengthen reimbursement initiatives undertaken by AAP committees, sections and chapters. As the Academy’s private sector advocacy initiative has evolved, the need became apparent for a permanent entity within the Academy to carry o the work of the P-TEAM. As a result, the PSAAC works in tandem with the Committee on Child Health Financing (COCHF) in setting the course for the Academy’s continued efforts to improve the fiscal environment for it’s member pediatricians.

Private Sector Advocacy Advisory Committee Members:

· Steve Berman, MD, Chair

· Kathy Cain, MD, practicing pediatrician from Kansas, member the Section on Administration and Practice Management

· Anne Francis, MD, Chair, Section on Administration and Practice Management and practicing pediatrician from New York

· Thomas McInerny, MD, Chair, Committee on Child Health Financing

· Joe Ponzi, Md, practicing pediatrician from North Carolina, member of the Section on Administration and Practice Management

· Mark Rueben, MD, practicing pediatrician from Pennsylvania and member Section on Administration and Practice Management

Private Sector Advocacy Advisory Committee Charge:

• Examine the effect of reimbursement and health plan medical policy and operations in the private market on access to quality care and identify strategies to enhance access through improved health care coverage for children and pediatric services;
• Advise the AAP and its leadership on a reimbursement strategy, including specific goals and action steps, to improve pediatrician’s economic and organizational position in the private marketplace;
• Monitor and collaborate with other AAP committees the Academy’s private sector advocacy activities and advise staff;
• Refine and monitor criteria for prioritizing issues and strategies to engage private health plans;
• Recommend practical and innovative education programs and tools to assist pediatricians in strengthening their strategies and techniques in practice management including negotiating their contracts with health plans;
• Develop strategies to ensure consistent and effective communication and coordinated activities with AAP members, committees, sections, chapters and staff;
• Assist COCHF in its efforts to improve the financing of children’s health care by examining issues and developing policy relevant to private sector reimbursement;
• Periodically evaluate its work in the context of achieving its purpose and charges.

The PSAAC has developed on ongoing workplan for private sector advocacy activities. Current workplan objectives include:

Communications:

• Enhance communications of private sector advocacy (PSA) issues and activities within the AAP
• Establish ongoing relationships with private payers to foster recognition of the value of pediatric services

Priority Pediatric Issues:

• Develop an ongoing and dynamic process to identify private sector advocacy issues and possible strategies to address those issues
• Enhance the reimbursement for pediatric immunizations
• Preserve coverage and enhance quality and reimbursement for preventive care services
• Engage payers to integrate coverage for mental health services within pediatric primary care
• Engage payers to enhance coverage for pediatric obesity
• Encourage: 1) pediatricians to bill properly, document appropriately and monitor claims submissions 2) payers to adhere to CPT guidelines and adjudicate claims in a timely manner
• Enhance the reimbursement for non-face to face care
• Provide information to AAP members on managed care contract evaluation and negotiation

For additional information about private sector advocacy, contact Lou Terranova at lterranova@aap.org or at 800/433-9016 ext. 7633. For updates and resources, link to AAP Member Center, and link to private sector advocacy page

(http://www.aap.org/moc/reimburse/default.cfm)