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Louisiana Chapter leadership offers encouragement to their members and all healthcare providers on the front lines. #WeAreHereForYou

Keeping Up With Coronavirus

As new information is released it will be posted on our website. Bookmark https://www.laaap.org/coronavirus-resources/  to easily access this landing page. As information is available we will share it there. If you are experiencing a challenge in your practice, please email the chapter so we can work to find solutions together.

Guidance from LA AAP on Continuation of Well Child Visits

In a March 21, 2020 memo from the Louisiana State Board of Medical Examiners, providers were directed to transition all in person healthcare to telehealth and postpone all in-person healthcare visits for 30 days. Specific language from the memo is below. 

SECTION II. Healthcare Services, Other than Medical and Surgical Procedures

A The Department hereby directs that all healthcare providers transition all in­ person healthcare services to a telehealth mode of delivery, when medically appropriate and when the same standard of care can be met as an in-person visit. Providers shall make a determination about the appropriateness of telehealth on a case-by-case basis. Providers may encounter legitimate and valid barriers to telehealth delivery and may not be able to shift all services to telehealth. Providers acting in good faith shall not be found to be in violation of this directive 
B. The Department hereby directs that all healthcare providers postpone all in­ person healthcare services that can safely be postponed for 30 days. Providers shall use their best medical judgment within the scope of their license to make this determination. Providers shall consider the entire clinical picture when determining if a service can be safely postponed, including the consequences to the patient of postponement and the consequences to the healthcare system. Providers acting in good faith shall not be found to be in violation of this directive.


We have heard from many of our members seeking advice on how this applies to well-child visits. The Louisiana Chapter strongly believes that well visits, especially during the first 24 months of life are essential and necessary. We share our members concerns that postponing these critical visits and immunization administration could lead to negative health consequences. Guidance from the CDC at the time of the publication of this guidance states “If a practice can provide only limited well child visits, healthcare providers are encouraged to prioritize newborn care and vaccination of infants and young children (through 24 months of age) when possible.” (Source: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/index.html.) The Louisiana Chapter supports the CDC’s guidance as well as encourages providers to see patients needing/ requesting catch-up immunizations.

We recognize every provider’s situation is unique and resources vary among practices and regions. We encourage all providers to consider their own situation to determine what is best for their practice and the families you serve.

Suggestions for adjustments practices may consider making to their usual clinical operations:

  • Conduct well visits for newborns, infants and younger children up to 24 months who require immunizations and to reschedule well visits for those in middle childhood and adolescence to a later date.
  • Dedicate specific morning hours for well visits and specific afternoon hours for sick visits. Be sure to allow for adequate time for cleaning and disinfecting all patient areas.
  • Dedicate specific rooms for well visits and sick visits. For those operating in multiple sites, consider using one office for well child visits only.
  • Utilize a “drive through” for sick visits where the provider can assess the patient in their vehicle.
  • Increase use of telehealth/ telemedicine for any visit that can reasonably conducted using this modality.

If you have other suggestions that have been successful in your practice, please share them with the Louisiana Chapter at (225) 505-7611 or send to ashley.politz@laaap.org

CLICK HERE TO DOWNLOAD GUIDANCE


 

NEW Resource Section- Practice Management 

Webinar Part 1: The Business Impact Of COVID-19 On Pediatric Practices: Last week PMI's Paulie Vanchiere and PCC's Chip Hart discussed financial and operational issues Pediatric practices are facing as COVID-19 continues to evolve.  This webinar provided tangible action items every Pediatric practice needs to consider over the coming days, weeks, and months
Recording: https://www.pediatricsupport.com/covid19

Webinar Part 2: The Business Impact Of COVID-19 On Pediatric Practices
Thursday, March 26, 2020 @ 7:00 PM ET

Join PMI's Paulie Vanchiere and PCC's Chip Hart as they follow up from the March 19th webinar where over 985 people attended to learn about financial and operational issues Pediatric practices are facing as COVID-19 continues to evolve.  This upcoming webinar will focus on Human Resource issues as related to staff & providers as well as follow up on key items discussed in the last webinar. Special guests will be on hand along with a big announcement related to how everyone can stay connected and have access to the most up to date information that Pediatric practices need. 
Register: https://zoom.us/webinar/register/9015848598970/WN_lBuA6xpURxajRAxd36e1Uw 
 

PHARMACY FACTS - Program Updates from Louisiana Medicaid 

March 25, 2020 | COVID-19 Update 

As a precaution with the current COVID-19 pandemic, the Louisiana Department of Health (LDH) intends to take measures to minimize public exposure. A few pharmacy edits will be revised to encourage recipients to get all necessary maintenance medications during one pharmacy visit. 

On March 17, 2020, members were able to start receiving early refills and up to a 90-day supply, as appropriate, of maintenance medications that are not controlled substances. These include cardiovascular drugs (hypertension, coronary artery disease, thrombosis), diabetes drugs, respiratory drugs (inhaled and oral), contraceptives, antiretrovirals, direct-acting antivirals for hepatitis C, immunosuppressives, antipsychotics, and antidepressants, among others. 

On March 24, 2020, existing approved prior authorizations on prescribed drugs and physician-administered drugs (drugs included as a medical benefit) will be extended through June 30, 2020, with no action needed by the prescriber. This will not affect the number of refills originally authorized by the prescriber. Member copays for prescribed drugs are waived, effective March 24, 2020. 

To reduce exposure, providers should consider encouraging members to use pharmacies that offer free home delivery services or drive-through pickup services. To reduce contact, member signatures are no longer required. 

Healthy Louisiana Publishes Two New Informational Bulletins 


Informational Bulletin 20-5: COVID-19 Provider Update 
Informational Bulletin 20-6: COVID-19 - LMHP Telemedicine/Telehealth.

New Resource: State Comparison of Laws


Forbes has published a helpful state-by-state comparison of laws passed re: COVID-19 (i.e. testing cost share, Medicaid telehealth parity, etc.). Check it out here: https://www.forbes.com/sites/advisor/2020/03/24/states-request-health-insurance-changes-for-covid-19/#4821bdbd1e16

ICYMI:

The Louisiana Department of Health, Bureau of Family Health has created a go-to mental health resources geared toward individuals and families who are pregnant and/or parenting infants and young children. Click here to download. For additional resources from BFH, go to: https://partnersforfamilyhealth.org/mental-health-resources-families-coronavirus-outbreak/.

CDC Symptom Checker pagehttps://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/index.html


Quick links

Dept. of Health Provider Bulletins: 
Read 3/17/2020 Bulletin  |  Read the 3/14/2020 Bulletin  |   All Medicaid Provider Bulletins

Statewide information from the Louisiana Office of Community Preparedness and Health Protection: http://ldh.la.gov/index.cfm/page/3865 

LA Department of Health Coronavirus pagehttp://ldh.la.gov/Coronavirus/

Northwest Louisiana Pediatric Society Guidance to Families Regarding COVID-19: https://www.laaap.org/wp-content/uploads/2020/03/NWLPS_COVID19-guidance-for-familiesFinal_16MAR2020.pdf

Governor’s Office Newsroom: https://gov.louisiana.gov/index.cfm/newsroom/category/9 

for the LA Department of Education's interactive map of schools serving meals by parish: Click here  
LA Department of Education COVID-19 page: https://www.louisianabelieves.com/resources/covid-19

Have an issue or concern you need addressed? Have a resource to share? Click to submit to LA AAP for help.

From the Academy

Call to Action from AAP

March 24, 2020
From AAP President Sally Goza:

We continue to be alarmed by the increasingly dire need for increased supply of personal protective equipment (PPE) for pediatricians in the hospital and ambulatory settings. 
 
Last week, I joined the leaders of more than a dozen medical societies who asked the President and Vice President of the United States to take action. But we need all of our voices rising together to compel our federal leaders to act.
 
Never has there been a more urgent moment to make our voices heard on an issue that is so consequential not just to the health of our patients, but to the health and safety of all of you, and all of our colleagues who are doing all they can to save as many lives as possible.
 
Here's what you can do today: Call or email your elected officials with the below messages. Phone numbers for your representative and senators can be found below, and our website has all you need to send a quick email (under Key Issues).
 
Congressman Garret Graves
Phone: 202-225-3901

Senator Bill Cassidy
Phone: 202-224-5824

Senator John Kennedy
Phone: 202-224-4623
 
Here are the main messages:
 
You must act immediately to increase PPE.
  • Introduce yourself by your title and city/state.
  • I am urging you to do everything you can to make sure we have the personal protective equipment we need to safely care for coronavirus patients.
  • In my practice/hospital, I am already seeing shortages and we are just at the beginning of the impact here. {Fill in details from what you are experiencing}.
  • Physicians in other countries are dying because they don't have basic protective gear. I fear this will happen here too if we do not act immediately.
  • Medical professionals are counting on you - I am counting on you - to make sure we have the masks, gloves, gowns and equipment we need to save our patients and protect ourselves.
You must protect the healthcare workforce.
  • Medical professionals caring for patients during this pandemic do so at great personal risk to their health and safety, especially without proper protective equipment.
  • Please act immediately to protect frontline physicians responding to the COVID-19 pandemic by doing everything in your power to increase the supply of personal protective equipment.

We have also seen what can happen when pediatricians harness the power and reach of social media to put pressure on people in positions of power. Please consider adding your voice online using #GetMePPE, with your own message or one below:
  • I'm a pediatrician in {state}. I am here to protect patients from #COVID19. {insert your senators' & representative's Twitter handles} #GetMePPE so I can protect myself.
  • I am a pediatrician in {state} helping to fight #COVID19. We are running out of masks, gowns, gloves and more. I am pleading with our federal leaders for innovative, urgent solutions to this shortage. #GetMePPE
Thank you for all you do, every day, on behalf of children.

Update and Resources from AAP President Dr. Sally Goza (3/25/2020)

The Academy is advocating for immediate changes to Medicaid, CHIP, and private insurers so that pediatricians can provide and be paid for telehealth care services. To support these policy changes, the AAP has developed a new resource, AAP Guidance: Telehealth Payer Policy in Response to COVID-19, which outlines policy changes aiming to alleviate barriers to telehealth care. 

We've been reading your emails and hearing your comments about the biggest barriers to providing telehealth care and have tried to address them in this guidance. If you encounter other barriers or if you need additional support from the Academy, please contact COVID-19@aap.org. AAP staff monitor the inbox daily and can help. 

This guidance also includes additional AAP resources, Coding for COVID-19 and Non-Direct Care, and a regularly updated list of COVID-19 related state telehealth policy changes .

Chapter leaders will be receiving additional materials later today on how to advocate in your state for maximum payment for telehealth care. I also want to share with you the letter I sent to congressional leaders urging payment for telehealth and action on many other issues facing pediatricians and children. 

Many of you have been inquiring about how to launch telehealth in your own practice.  We just launched a webinar that offers tips and guidance as you begin seeing patients in a virtual setting. Also, be sure to view the online telehealth compendium for tools and resources to support your efforts.

I am so proud to work alongside all of you as you continue to serve your patients during such an unpredictable and unprecedented crisis. I hope these resources are helpful to you as you navigate this crisis. 

Thank you for all you do, every day, for children.



** Critical Updates on COVID-19- https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/ 

Recognizing the challenges the coronavirus pandemic poses to pediatricians and their practices, the AAP established an email box to field members’ questions -- COVID-19@aap.org --and help provide guidance. We encourage you to send us your questions, and we will respond in a timely manner

As the COVID-19 pandemic evolves, the AAP has been staying abreast of all confirmed developments related to its global spread and will continue to be vigilant in efforts to develop and share information and guidance with members.

Below you can find:

Resources for Clinicians

We recognize we are all practicing pediatrics in circumstances we have never encountered before in our careers. To give you some practical guidance, AAP experts have recorded the following webinars on COVID-19. Watch them whenever is convenient for you: In addition, the AAP established an email box to field members’ questions -- COVID-19@aap.org --and help provide guidance. We encourage you to send us your questions, and we will respond in a timely manner.
Wondering about well child visits? Read this Q/A on recommendations for primary care pediatric offices in terms of addressing well child and sick visits and provision of immunizations.
In addition, you can prepare to handle suspected cases in your patient population in the same way you prepare for other respiratory infection outbreaks, such as influenza or RSV. The same principles apply:
  • Keep children out of the health care system if it's not necessary.
  • Use telemedicine and other non-direct care, when appropriate.
  • Review infection-control measures, including asking patients with symptoms to call ahead so they can be evaluated in isolation from other patients.
  • Visual alerts to inform staff of symptoms upon registration and reminders about respiratory hygiene and cough etiquette Collaborate with hospitals and health systems on local response and to prepare for surges.
  • Check with local and state health departments for information on specific local and state responses.
If a patient is suspected of having COVID-19, follow the CDC Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 in Healthcare Settings. This document provides guidance on the use of personal protective equipment (PPE).
See additional details on infection prevention and control in the pediatric ambulatory setting in this AAP policy statement.
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