Monday, February 25, 2013 at 12:00PM From the HealthyChildren.org website:
Medicines can be helpful for a child’s health. But if they’re given in the wrong dose or at the wrong time, they can actually be harmful. Here’s how to give medicine to your child with confidence!
Wednesday, February 13, 2013 at 12:00PM 
I found this list today. At first I thought, do parents really need to be reminded to show their love towards their children. I mean, I love them every single moment of every single day. But then I thought, how often do I show them? And is it enough?
Some of these may be silly, others not practical to your situation. Others are obvious. But that is OK. The important thing here is to remember to show love to our children every single moment we can whether these tips are useful or not to you.
Respond promptly and lovingly to your child's physical and emotional needs and banish put-downs from your parenting vocabulary.
When your child is angry, argumentative or in a bad mood, give him a hug, cuddle, pat, secret sign or other gesture of affection he favors and then talk with him about it when he’s feeling better.
Make plans to spend time alone with your young child or teen doing something she enjoys. Mark family game nights on your calendar so the entire family can be together. Put a different family member's name under each date, and have that person choose which game will be played that evening.
Owning a pet can make children, especially those with chronic illnesses and disabilities, feel better by stimulating physical activity, enhancing their overall attitude, and offering constant companionship. One of the best ways to familiarize your child with good food choices is to encourage him to cook with you. Let him get involved in the entire process, from planning the menus to shopping for ingredients to the actual food preparation and its serving. It is wonderful when families eat together as much as possible. Good food, good conversations. As your child grows up, she'll spend most of her time developing and refining a variety of skills and abilities in all areas of her life. You should help her as much as possible by encouraging her and providing the equipment and instruction she needs.
Wednesday, November 7, 2012 at 12:00PM
Today, we have Dr Kristen Stuppy as our guest blogger. Dr. Stuppy is a practicing pediatrician in Kansas. She feels privileged to be able to help families keep their children healthy and she loves watching entire families grow! Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.
In this post, she answers a common question among parents - My child has a cold, should I take her to the ER, urgent care or the pediatrician.
As cold and flu season approaches, I have been thinking about how our kids are managed when they become sick. Not only what we do to treat symptoms, but how, when, and where patients get medical advice and care.
We are a busy society. We want things done now. Quickly. Cheaply. Correctly. Resolution so we can get back to life.
Illness doesn’t work that way. Most childhood illnesses are viruses and they take a few weeks to resolve. There’s no magic medicine that will make it better.
Please don’t ask for an antibiotic to prevent the runny nose from developing into a cough or ear infection.
Don’t ask for an antibiotic because your child has had a fever for 3 days and you need to go back to work.
Don’t ask for an antibiotic because your teen has a big test or tournament coming up and has an awful cough.
Antibiotics simply don’t work for viruses. They also carry risks, which are not worth taking when the antibiotic isn’t needed in the first place.
Many parents in this community have grown accustomed to using after hour urgent cares because they are convenient.
Convenient isn’t always the best choice. Many times kids go to an urgent care after hours for issues that could wait and be managed during normal business hours. I know some of this is due to parents trying to avoid missing work or kids missing school, but is this needed? Can it hurt?
Some kids will get unnecessary tests, xrays, and treatments at urgent cares that don’t have a reliable means of follow up. They attempt to decrease risk often by erring with over treating. Our office does have the ability to follow up with you in the near future, so we don’t have to over treat.
They might choose an inappropriate antibiotic due to allergy or recent use (making that antibiotic more likely less effective). They might not recognize if your child doesn’t have certain immunizations or if they do have a chronic condition, therefore leaving your child open to illnesses not expected at their age.
We know that parents can and should tell all providers these things, but our own new patient information sheets are often erroneous when compared to the transferred records from the previous physician… parents don’t think about the wheezing history or the surgery 5 years ago every visit. It is so important to have old records!
There is some evidence that treating things too soon does not allow our bodies to make immunity against the germ. A great example of this is Strep throat. Years ago we would go to a doctor when our sore throat didn’t get better after a few days.
They would swab our throat and send the swab for culture, which took 2 days. We would treat only after that culture was positive. That delay in treatment allowed our bodies to recognize the Strep and begin making antibodies against it.
Now kids are brought in the day they have symptoms, and if the rapid test is positive, they immediately start antibiotics. The benefit? They are less likely to spread Strep to others and they can return to school 24 hrs after starting the antibiotic.
The negative? They might be more susceptible to recurrent illness with Strep, so in the end are potentially sick more often and end up missing more school.
Receiving care at multiple locations makes it difficult for the medical home to keep track of how often your child is sick. Is it time for further evaluation of immune issues? Is it time to consider ear tubes or a tonsillectomy? If we don’t have proper documentation, these issues might have a delay of recognition.
I’m not talking about cute pictures or smaller exam tables. I’m talking about the experience of the provider. If they are trained mostly to treat adults, they might be less comfortable with kids. They often order more tests, xrays, and inappropriate treatments due to their inexperience.
This increases cost as well as risk to your child. We have been fortunate to have many urgent cares available after hours that are designed specifically for kids, which does help. But this is sometimes for convenience, not for the best medical care.
As previously mentioned, cost is a factor. I hate to bring money into the equation when it comes to the health of your child, but it is important. Healthcare spending is spiraling out of control. Urgent cares and ERs charge more. This cost is increasingly being passed on to consumers.
Your co pay is probably higher outside the medical home. The percentage of the visit you must pay is often higher. If you pay out of pocket until your deductible is met, this can be a substantial difference in cost. (Not to mention they tend to order more tests and treatments, each with additional costs.)
(note: I can’t list every medical problem, parental decisions must be made for individual situations)
If your child gets a vaccine at any other location, please send us documentation (including the date, brand, lot number, and place administered) so we can keep the records complete.
Remember your pediatrician’s website might offer trusted answers to questions and many treatments to try at home for various illnesses and conditions! Be careful of surfing for answers though… the internet is full of bad advice! Go only to trusted sources (such as your doctor’s website or HealthyChildren.org).
Wednesday, October 10, 2012 at 12:00PM
Recently I had a frank conversation with a mom who told me “I have been dying to ask a doctor this question for years and I think you might be able to give me a reasonable answer, so here it goes: Why do I have to wait so long to see the doctor? Is there any good reason? A patient’s time is valuable too!
During my 30 years of practice, Our office has been trying our best to remedy this chronic problem with some degree of success, but some degree of failure as well.
As I thought about the question, I realized that it has a multitude of answers and explanations, as anyone who has ever worked in a medical office realizes. When I run behind schedule, it makes me absolutely crazy. The patients are angry, the staff is harried and I hate feeling rushed.. Here are just a few of the factors, which add up to a most difficult problem:
1. Unpredictability - When I walk into a room to see a child, I have no idea whether that child will have a minor illness or a major problem. Most kids are healthy, but when they are sick, they are often VERY sick.
All it takes is one of these complex patients to completely disrupt a patient schedule. It is not like you can tell a family that you don’t have enough time to admit their child to the hospital today.
2. Seasonality - If you come in the middle of winter, there are going to be lots and lots of sick kids. We rarely, if ever, refuse to see a sick child on a same day basis. While we leave open many slots for same day calls, and are open until 9 pm every night, if it is winter, it will be busier and you may have to wait longer.
If you come in the summer months, it seems every child in the universe needs a physical for camp or school. Certain laws and misguided insurance company policies make this problem even worse. If you can do your check up any other time, please do so.
In summer it will be busy, and you do not want to be told that you cannot have your form filled out because we are completely booked up. We try to hire more doctors when we seem busier, but when the crunch time comes, we just have to get the job done. You don’t want your child to be ineligible for sports or miss the first day of school.
3. Human nature – This issue applies both to patients and doctors. Some doctors seem to think that it’s OK if they are late, but not if the patients are late. Your doctor should show up on time and start on time.
But patients are subject to human nature as well. No one wants to take their child out of school or miss too much work, so I am often sitting around doing nothing from 1-3 pm while it is totally swamped from 3-5 pm. It is kind of like rush hour.
If you don’t want rush hour traffic, try to drive some other time. It is always busier on Mondays and after school than any other times of the week. If you have an infant, don’t schedule your check up in the late afternoon for the reasons above. Our office does time and motion studies to try to figure out where the problem lies.
We have discovered that a good part of the problem (assuming the doctor is arrives and starts on time) is patients coming 10 minutes early or 10 minutes late. That doesn’t seem like much, but it has enormous impact on the ability to see patients in a timely fashion.
This will blow the schedule out of the water and disruption builds as the day goes on. Believe it or not, if everyone actually showed up on time both doctors and patients, things would be a great deal better for everyone.
So, I ask all of you to try to understand. Running an office on time is better for patients and their doctors. Scheduling enough time to discuss the problem is critical. You cannot expect to have your child’s chronic stomachaches for the past 6 months be properly addressed in a same day sick visit.
There is not enough time scheduled. A good doctor will make you come back and schedule enough time to evaluate your child properly. Most doctors hate running late as much as their patients do. If we all could try to understand the above issues and work together a bit better, we would all be much happier.
Dr. Lessin has been practicing Pediatrician in the Hudson Valley since 1982. He is a founding partner and serves as both Medical Director and Director of Clinical Research at the Children's Medical Group
Wednesday, September 12, 2012 at 12:00PM This post was originally featured on the Survivor Pediatrics Blog
One of the things that I do a lot here at our practice is talk to parents about their health insurance coverage. The conversation is usually about why they have a balance on their child’s account.
Health insurance is very complicated. At our practice, we deal with health insurance all the time and even for us, it gets to be very complicated sometimes.
Today, I had a conversation with a patient’s parent regarding medical billing issues. After explaining some in-and-outs about why we do certain things, the parent mentioned she had no idea things were the way they were and now understands why doctors’ offices have to do what they have to do.
She also mentioned that we should do something to spread the word. She said, “I think it is important for other parents to know this. Otherwise, how are things going to get better?”
I thought her idea to spread the word was very good. Therefore, I decided to summarize our conversation in an effort to help other parents understand, at the very least, a portion of medical health insurance.
At a restaurant, generally you’ll get an itemized check that shows all the things you’ve ordered. Doctors do the same thing, but they do it in the medical chart.
Virtually every doctor who accepts health insurance uses codes (called CPTcodes) that are assigned to every task they and their staff performs. Everything from a simple blood draw, to immunizations, to the ear check, to specimen handling — all these things are “coded” separately.
These codes are used by the patient’s health insurance company to determine the payment amount that the doctor will receive for his or her services. In other words, the health insurance company (the one actually paying for the services) wants to see what was done during a patient’s appointment. Hence, everything the doctor and the staff does has a code.
For example, if you are coming in for a child’s well visit, the pediatrician will submit a “claim” to the insurance company using the following codes:
If the child gets immunizations, those have codes too.
Vaccine administration also uses a distinct set of codes. To further complicate things, some vaccines have a single administration code used with them, and others have multiple administration codes for a single vaccine.
Let’s say while you are in the examining room, you ask the doctor, “Ya know doc, little Lisa here has been pulling on her ear lately… she may have an ear infection. Can you check that for me really quick?”
This question requires the doc to perform an entirely different assessment than the well visit the child was getting.
The doctor, in order to show the insurance company that she did a completely different assessment, codes the ear pain diagnosis and adds a 99213 – which is an evaluation and management code that documents in the chart and on the claim to the insurance company that the doctor also checked the patient’s ear.
Parents often think when they are looking at the bill that the doctor is nickel-and-diming parents, when in reality, it is the insurance company that requires the doc to show their work in this matter.
The health insurance company doesn’t accept the doctor telling them, “I did a well visit — pay me our agreed-upon fee.” They want to know all the things the doctor did during a patient’s visit so they can decide how much they ought to pay the doctor for his/her services.
Since most patients (or in the pediatrician’s case, parents) don’t pay the doctors directly, but rather the health insurance company, they want to know what took place during the visit so they know how much they ought to pay the doctor.
It is the same as going to the restaurant and getting billed for all the side and extra orders. Although the main meal is accompanied by other things, like french fries or a salad, refills, side orders, substitutions and additions to the order are billed as extra.
Health care services are a la carte as well.
The insurance policy that a patient has chosen may not pay for all the services the doctor performed. So when the doc’s billing staff submits a claim for a visit, the health insurance company often comes back and says, “We are not responsible for these codes/services; these are the member’s responsibility per the member’s health insurance policy. ”
For example, the health insurance company may say, the policy your patient chose pays for a vision screen, but not for a hearing screen. Or they may say, we cover the well visit code, but not the ear ache code at the same time as the wellness visit.
The doctor, already having performed services, now has to go to the patient and say, “Hey, remember that school physical I performed and you asked me about little Lisa’s earache? Well, your insurance says that the policy you have doesn’t cover the earache part, so I’d like to be paid for the work I perform in assessing your child’s earache.”
Of course, doctors don’t actually say that, but when a parent gets a bill for the earache, that is in essence what the doc is trying to say to the parent. And if one looks carefully at the explanation of benefits (that document that the insurance company sends after they process a patient’s claim) one will notice they give an explanation as to why they are not going to pay the doctor for the service.
Here is an interesting, but crazy fact. In many cases, had the doctor deferred the earache question and told the mom to make another appointment to address that issue during another appointment, the health insurance company would have most likely paid for the office visit.
However, had the doctor done that, the patient would have most likely gotten upset at the doctor.
By treating the earache question during the wellness visit, the doctor runs the risk of not being paid despite doing the work. On the other hand, not addressing the ear ache, the doc runs the risk of upsetting the parent, who will probably think the doc is trying to squeeze another $30 copayment, which is clearly not the case.
One of the major problems with this is that patients don’t understand what they are financially responsible for. Or, it’s often the case where patients don’t understand what type of health insurance they’ve purchased.
Just like with anything else, you get what you pay for. But patients overlook this issue when purchasing health insurance. They usually look at the monthly premiums and choose the lowest one. But by doing that, they are often reducing the amount of coverage, which means patients will get stuck with larger portions of their medical bills.
The health insurance company, in an effort to keep their premiums low, have shifted the cost to customers and their doctors. While in the past health insurance companies may have covered 100%, now they are reducing the monthly premiums but only covering 70% of one’s medical expense. Hence allthe high deductible plans out there.
In our practice – which is a small three-provider practice – we see on average 60 to 75 patients daily.
Add to that there are virtually thousands and thousands of different health plans. In fact, we have patients whose parents work for the same company, but because they are at different pay grades, have different insurance plans.
The answer is, we don’t have enough manpower or time to sit on the phone verifying every single patient’s healthcare coverage. I know of practices that do, and God bless them. But as a practice we believe it is the patient’s responsibility to find out what is covered and what is not covered. The more time we spend on the phone with a patient’s insurance company, the less time we are able to spend providing health care for our patients.
As a practice, we consider that treating patients based on what the insurance covers and what it doesn’t, instead of treating by what the patient actually needs, is an unethical way to practice medicine.
Although most doctors that I know will take into consideration health insurance stipulations, they will not compromise a child’s health as a result of health insurance restriction and cheap health insurance coverage plans.
I hope this post will give all that read it some insight and perspective on medical billing. If you have a question, or don’t understand why doctors’ office do medical billing, feel free to leave a comment and we will try to address it.
Oh, and thanks for reading…
Brandon Betancourt is a practice administrator for Salud Pediatrics. You can follow him on Twitter @pediatricinc
