Ohio Pediatrics - Summer 2007 - Ohio AAP

Newsmagazine of the Ohio Chapter, American Academy of Pediatrics Summer 2007

Breakfast for Books’fundraiser is huge successSay!I like green eggs and ham!I do! I like them Sam-I-am!

Approximately 100 people weresaying those words and enjoyingtheir “green eggs” and hambreakfast on Wednesday, May 30at Breakfast for Books, a fund-raiser for Reach Out and Read(ROR) Ohio, a program of theOhio AAP and Ohio AAP Foun-dation. Archie Griffin, Presidentand CEO of The Ohio State Uni-versity Alumni Association, alongwith Faith Christian InstituteAcademy’s first grade student,Veroman Woods, read Dr. Seuss’Green Eggs and Ham to the atten-dees of the first ever fund-raisingevent for ROR Ohio held at TheFawcett Center on the OSU cam-pus.

The event was a success in rais-ing awareness about the program,and the need for early literacypromotion, as well as bringing inmore than $7,500 for ROR Ohio.Prior to Griffin reading Dr. Seuss’classic, Robert Needlman, MD,co-founder of Reach Out andRead and associate professor ofpediatrics at Case School of Med-icine, spoke to the audience abouthow ROR was started, how themodel works, and who the pro-gram helps by using oversizedphotographs of children interact-

Archie Griffin, President and CEOof The Ohio State UniversityAlumni Association, and first-grad-er Veroman Woods read Dr. Seuss’Green Eggs and Ham to attendeesat the “Breakfast for Books” fund-raiser for Reach Out and ReadOhio.

See Breakfast...on page 4

Ohio AAPAnnual Meeting Sept. 14-15

Pack your swimsuit, golfclubs, and family and headto Cherry Valley Lodge andCoCo Key Water Resort inNewark (outside of Colum-bus) Sept. 14-15 (Friday andSaturday) for the OhioAAP’s Annual Meeting.

Prior to the start of theAnnual Meeting the OhioAAP Foundation is hostinga golf outing/fundraiserFriday, Sept. 14 at 8 a.m. atthe Granville Golf Course.Prizes will be awarded tothe top three teams. (Seepage 5 for more details onthe golf outing.)

Also on Friday, the OhioAAP will host a CodingWorkshop for practice man-agers and interested phy-sicians. “Pediatric PowerCoding 2007: The Basicsand Beyond” will be pre-sented by Richard Tuck,MD, a nationally knownexpert in primary care CPT,ICD and RBRVS coding. Hisdynamic interactive stylemakes learning this impor-tant information a reward-ing experience.

A reception will be heldfrom 7:30 to 9 p.m. on

ing with books to illustrate hiskey messages.

John Duby, MD, president ofthe Ohio AAP Foundation, em-ceed the event, and relayed hisown experiences with ROR to theaudience. He also promoted thesale of raffle tickets for a numberof items including tickets to aColumbus Crew game, a familyfour pass to a Columbus Sym-phony Orchestra Popcorn Popsconcert, and autographed memo-rabilia from Griffin, OSU football

See Meeting...on page 5

33711 Ohio Pediatrics 7/2/07 2:47 PM Page 1

Ohio Pediatrics • Summer 20072

Ohio Pediatrics

A Publication of the Ohio Chapter,American Academy of Pediatrics

OfficersPresident....William H. Cotton, MD

President-Elect..... Terry P. Barber, MD

Treasurer....Gerald Tiberio, MD

Delegates at large:Robert Frenck, MDJames Duffee, MDJudith Romano, MD

Executive Director:Melissa Wervey Arnold450 W. Wilson Bridge Road, Suite 215Worthington, OH 43085(614) 846-6258, (614) 846-4025 (fax)

Lobbyist:Dan Jones Capitol Consulting Group37 West Broad Street, Suite 820Columbus, OH 43215(614) 224-3855, (614) 224-3872 (fax)

Editor:Karen Kirk, (614) 846-6258 or (614) 486-3750

www.ohioaap.org

this funding stream had beenidentified, Ohio had been one of ahandful of states unable to affordthe vaccine for this population. Ifsecuritization of the entire MasterSettlement Agreement occurs asoutlined in the budget, it will eli-minate this funding stream. Re-placement funds for the vaccineare not included in the budget.Ohio AAP will continue to workwith state policymakers to ad-dress the $4.7 million shortfallthat occurs the second year of thebiennium and in future years forpurchase of pneumococcal con-jugate vaccine.

The Ohio House and Senate

Legislative Update

Update from the StatehouseFor the first time in more than

50 years, the Ohio House andSenate voted unanimously forthe state’s biennial budget. WhileStatehouse insiders speculatedthis year’s budget – with a Dem-ocrat administration and Repub-lican legislature – would result infireworks, the reality was a verycivil, open and deliberative pro-cess to balance the state’s two-year spending plan.

The bill included a number ofproposals important to pedia-tricians:

• HB 119 increases the incomeeligibility for the State Children'sHealth Insurance Program(SCHIP) from 200 to 300 percentof the federal poverty limit.

• The House removed a pro-posal included in the Governor’sbudget that would allow familiesbetween 300 and 500 percent ofpoverty to “buy-in” to the Medi-caid system for health care fortheir children. The Senate addeda language requiring a study ofsuch a program for children offamilies with income greater than 300 percent of poverty withcatastrophic mental or physicalillness or disability.

• The bill authorizes $200,000of Temporary Assistance forNeedy Families (federal fundingadministered by the state) forReach Out and Read Ohio.

• Pediatricians and other pri-mary care physicians advocatedfor an additional increase inMedicaid provider rates, how-ever, the House and Senate main-tained the Governor’s proposed3 percent increase for commu-

nity providers, including pedia-tric subspecialists.

As part of the budget proposal,Gov. Strickland also recommend-ed an increase in funding for theAccess to Better Care initiativewithin the Department of MentalHealth, a program designed toimprove mental health care tochildren through prevention,early intervention and treat-ment. This provision was main-tained by the House and Senate.

• The bill also includes a 22percent increase in the first yearof the biennium to the Bureau forChildren with Medical Handi-caps, an important program thatprovides health care to childrenwith multiple and serious handi-caps and disabilities. The OhioHouse and Senate also supportedthis important funding increase.

• The budget bill also includesthe creation of the Autism Diag-nosis Education Pilot. Supportedby the Autism Society, this pro-vision will provide support, in-formation and education to Ohiopediatricians on identifying andresponding to developmentaldisabilities. The bill included anappropriation of $500,000 forFY08 and $300,000 for FY09.

While the budget included anumber of important provisionssupported by Ohio AAP, one im-portant issue remains outstand-ing. Last year, legislation waspassed using a portion of the to-bacco settlement funds ($4.7 mil-lion per year) to purchase thepneumococcal conjugate vaccinefor underinsured children visit-ing public health centers. Until

See Legislation...on page 14


are low and posted, so the con-sumer knows exactly how muchtheir visit will cost. This is parti-cularly important for someoneusing a health savings account.The RBCs have a 93% “excel-lent” response from users with a99% “will definitely return” re-sponse.

How do the RBCs keep theirprices low? The answer is lowoverhead. The number of em-ployees is minimal (often just anurse practitioner) and they op-erate on a cash-only basis, withno billing of insurance, etc. Theyalso follow strict protocols (manyuse AAP protocols for the ped-iatric patients) to evaluate andtreat patients. This assures thatthe visits are complete and thatnon-protocol, time expensive,complicated patients are elimi-nated. The RBCs are also goodfor the “hosting” grocery ordrugstore. One company an-nounced that they dispense anaverage of 1.2 prescriptions perpatient and have increased theirsales of OTC products by 1.5products per patient.

What has organized medicinedone to respond to the RBCs?The National AAP has put to-gether a policy statement thatfocuses on the downside of theRBCs. The Ohio AAP has pro-vided a handout to share withyour patient. Some states arechallenging the legality of theseclinics, but in most states theRBCs are operating well withinthe medical legal guidelines setup by their state. At a trademeeting of RBCs, minute clinic

representatives were quoted assaying that they feel that they are“beyond legislative disruption”at this time.

What can we do as pediatri-cians to compete with the RBCs?We can work to show our pa-tients the importance and valueof the medical home. We canmake our offices more availabletime wise and assure that theyare convenient. You can workwith your local RBCs and makesure that you are on their referrallist so patients looking for a phy-sician can find you. You can alsoencourage the RBCs to send youcopies of your patient interac-tions so you know who is beingtreated for what problem. Youcould consider going head tohead with the RBC by formingyour own RBC-type operation onyour own or as a consortiumwith other practices in your area.This topic is covered in an articlein the June issue of PediatricNews.

Nonetheless, the RBCs are heretoday and are seeing pediatricpatients. They may have an effecton your practice and you need todecide how you are going torespond.

– William Cotton, MDOhio AAP President

I would like to discuss theMinute Clinic, retail based clinic(RBC). I have spent some timereviewing thehistory, evo-lution, and theimpact that theseclinics are makingon the traditionalpractice of med-icine.

The RBC isn’t anew idea, but itis a businessthat is rapidly taking off. The sizeof the RBC market seems to begrowing exponentially. CVS nowowns 175 and is planning to open30 RBCs in the Chicago areaalone. Hospitals are getting intothe action with several hospitalsystems buying into the concept.Premier, the largest hospital sys-tem in Dayton, is opening RBCsin seven Dayton area grocerystores. Most threatening is Wal-Mart’s plan for opening 400 ofthese RBCs across the nation.Wal-Mart doesn’t enter into busi-nesses without knowing that theyare likely to do well, so I thinkyou know what this means.Health insurance companies arebeginning to include RBCs ontheir panels.

What makes these RBCs soattractive for the patients? Theyare quick, guaranteeing 15-minutewaits. They have a very limitedmenu of services which can bedelivered quickly. They are avail-able. The clinics are located inareas that are conveniently lo-cated with times that are conve-nient for the parents. Their prices

Ohio Pediatrics • Summer 2007 3

Ohio Pediatrics

www.ohioaap.org

President’s Message

What can you do to compete with RBCs?

William Cotton, MD



Ohio Pediatrics

www.ohioaap.org

Breakfast...from page 1

coach Jim Tressel and others. More than $2,000 was raised

onsite with the sale of raffle tick-ets and the table centerpieces,which were stacks of ROR ap-proved books – including GreenEggs and Ham autographed byGriffin – and a plush Clifford theBig Red Dog animal.

Dr. Duby presented a plaque toTerrie Hare of the Ohio Depart-ment of Job & Family Services forthe ODJFS gift of $100,000 fornew books for the ROR sites inOhio.

Reach Out and Read is a na-tional early literacy program thatprovides books to low-incomechildren at their well-child visitsfrom six months to 5 years of age.The goal of ROR is for children togrow up with books and a love ofreading.

ROR Ohio was formed 13 yearsago as a collaborative programamong National Reach Out andRead, the Ohio AAP, and theOhio AAP Foundation. Themoney raised at the fundraiserwill aid in the expansion of RORin Ohio with the continued addi-tion of new sites, funding supportto existing sites, and program-matic assistance to all sites.

Currently, there are 103 RORsites in Ohio, serving 131,000children, most of who are livingat or below the federal povertyline. It is anticipated that RORsites will distribute more than230,000 new, high quality booksin Ohio this year.

For more information, or tobecome a ROR site, please contactCoalition Leader, Heather Hall [email protected] or (614) 846-6258.

(See page 7 for a list of sponsors.)

John Duby, MD, president of theOhio AAP Foundation, thanksTerrie Hare and the Ohio Depart-ment of Job & Family Services fora gift of $100,000 for new booksfor ROR sites in Ohio.

Participating in the fundraiser were: Jim Duffee, MD, JoAnn Rohyans, MD,Mark Pilkington, John Duby, MD, Veroman Woods, Ohio AAP ExecutiveDirector Melissa Arnold, Terry Barber, MD, and Archie Griffin.

First-grader Veroman Woods helpsOhio AAP President Bill Cotton,MD, draw names for raffle prizes atthe “Breakfast for Books” fund-raiser May 30. The event raisedmore than $7,500.

Guests at the“Breakfast forBooks” fund-raiser had an

opportunity tolearn more

about theReach Outand Read

Ohio programwhile enjoyinga breakfast of“green” eggs

and ham.



Ohio Pediatrics

www.ohioaap.org

Friday. This is an opportunity tonetwork with your colleaguesand the exhibitors over cocktailsand appetizers.

The Annual Meeting will kick-off with a breakfast meeting at7:30 a.m. Saturday, Sept. 14. Thebusiness meeting gives attendeesan opportunity to find out whatthe Chapter has been working onover the past year. Following themeeting there will be a break tovisit the exhibits.

The first workshop, A Red BookUpdate, held from 9 a.m. to 10:30a.m., will be presented byMichael Brady, MD, and RobertFrenck, MD, Ohio’s own repre-sentatives on the Red Book Com-mittee. Participants will be givena review and update of the new-est information on infections andimmunizations found in the AAPRed Book.

The second workshop, HowHealth Policy Effects You and HowYou Can Influence Health Policy,will be presented by three dy-namic speakers – Mary Apple-gate, MD, Medical Director forMedicaid, Alvin Jackson, MD,new Ohio Department of HealthDirector, and Lisa Simpson, MD,Director of Child Policy ResearchCenter at Cincinnati Children’sHospital Medical Center. Atten-dees will learn about recent pub-lic policy decisions, and their af-fects on pediatrics. Participantswill discusss with the presentershow they can be more proactivein areas of public health.

Participants will receive 3.0Category 1 CME hours for atten-ding both of these workshops.

An awards banquet and lun-

cheon will follow the workshops.It is at this luncheon that theChapter award winners includ-ing the “Pediatrician of the Year”are honored. Also at this lun-cheon, Ed Cox, MD, District VVice Chair, will present the chap-ter with its 2007 OutstandingVery Large Chapter of the YearAward which the chapter won atthe American Academy of Pedia-trics Annual Leadership Forumin March.

An Executive Committee meet-ing will be held following theluncheon. This is a meeting ofthe officers, committee chairs,resident directors and Chapterliaisons. The meeting is open toall members of the Ohio AAP.Please plan to join us if you areinterested.

To attend the entire AnnualMeeting which includes the Cod-ing Workshop on Friday,Opening Recep-tion, AnnualMeeting Breakfast, AnnualMeeting Workshops, and AwardsLuncheon the cost is $185 forOhio AAP members; $275 fornon-members. If you register byAugust 1, you will re-ceive a $10discount on your registration fee.You must register for the AnnualMeeting no later than Sept. 4,2007.

If you are interested in attend-ing only specific workshops andevents, please review the AnnualMeeting program that was mail-ed to you, or visit the Ohio AAPWeb site at www.ohioaap. org, orcall the Chapter office at (614)846-6258.

Meeting...from page 1

Golf outing to benefitOhio AAPFoundation

Join the Ohio AAP Foun-dation on Friday, Sept. 14for a golf outing at Gran-ville Golf Course prior tothe Annual Meeting atCherry Valley Lodge andCoCo Key Water Resort.

The scramble will beginat 8 a.m., and prizes will beawarded to the top threeteams.

Lunch will be providedafter golf, and awards willbe presented at the recep-tion on Friday evening.

The cost is $150 for an in-dividual which includesgreen fees, golf cart, lunch,prizes and golf shirt.

Proceeds benefit the OhioAAP Foundation and theFoundation’s three majorinitiatives – Reach Out andRead Ohio, UnfundedCATCH Grants and Chap-ter Initiatives which aredetermined by the Foun-dation and the Ohio AAPChapter.

For more information, orto register, please contactHeather Hall, DevelopmentOfficer for the Ohio AAPFoundation, at (614) 846-6258, or [email protected].


The political election in Novem-ber presentedAmerica’s pedia-tricians with apromising newopportunity toadvance a Na-tional Agenda forChildren. This isthe new StrategicPriority for theAAP for 2008 –2009.

An Agenda for Children is nota new AAP focus. In 1982, theAAP developed a Health Agendafor Children called “Speak Up for

Ohio Pediatrics

6 www.ohioaap.org

District V Report

Ellen Buerk, MD


Children.” We have accomplishedmuch of the 1982 Agenda. But tohave effective policies for childhealth, the AAP must broaden itsfocus and have meaningful re-lationships with new health part-ners.

America’s Promises, chaired byColin Powell and his wife Alma,began in 1997. The promises arebased on evidence from the colla-borative research of Peter Benson,PHD (he developed the Asset-based approach for what youthneed to succeed as adults) andJames Heckman, PHD, an awardwinning Nobel economist.

The promises are:1. Adults who care about you2. Healthy start in life3. An effective Education4. Safe Communities5. Opportunities for service to

othersThe research is clear. If a child

gets 4 or 5 promises, then thatchild will grow up to be a pro-ductive citizen. If a child gets 1 or2 of these promises then that childwill have some difficulty succeed-ing as a productive adult.

But there are 10.5 million chil-dren in our country who get 0 to1 promise! As citizens of our com-munities and as trusted commu-nity leaders, we must work with-in our communities to help chil-dren attain more promises.

America’s Promises has selected100 communities to pilot thechange packets that will increasepromises for youth. Michigan hasfive communities that are Amer-ica’s Promise Communities. Theyare Kalamazoo, Greater MidlandCommunity, Saginaw County,and Lawrence County.

The AAP Board is working withAmerica’s Promises. Jay Berkel-hamer, AAP President is co-chair-ing the “Agenda for Health” andI am part of the work group of“Schools as a Hub.”

Each of us can do little things inour community to make sure thatwe get more assets for children sothat more of America’s chidrencan grow up to be productivecitizens. We Promise!

– Ellen Buerk, MDDistrict V Chairperson

AAP helping children attain more promises

Pediatrician ConsultantOpening

Location: Rehabilitation Services CommissionBureau of Disability Determination400 E. Campus View Blvd.Columbus, OH 43235

The Bureau of Disability Determination seeks pediatric consultants with either an MD or DO licensure in the stateof Ohio to assist in evaluating disability claims for children

applying for Social Security SSI disability benefits.Computer skills are necessary.

For more information, please contact:

The medical administration department at: 614-438-1541.One of our Professional Relations Officers will assist you

with any questions you may have.


How do you motivate yourmembers to get involved? Howdo you find thetime? What is in-volvement? Wantto see a pedia-trician squirm?Ask them to getinvolved!

I have fre-quently dis-cussed thesecomments withvarious pedia-tric leaders. Responses recognizethat pediatricians are workingharder than ever with increasingtime constraints. The demands ofpatient care, business manage-ment, civic or community activi-ties, and family priority univer-sally exhaust our time, energyand motivation for outside pur-suits. Many hear, “I simply don’thave the time, and anyway, I’mnot an expert in anything.”

The leadership at Ohio AAP hasdiscussed various resolutions tothe dilemma faced by pediatri-cians everywhere. How do youfind the time? Where are the op-portunities?

At the Ohio Chapter, we’veconcluded that involvement isdefined by opportunity. The op-portunity to be involved has beenexpanded through the restruct-uring of our committees to betterserve our members. We are re-solved to keep them dynamic bychallenging each to evolve withthe issues and share the loadthrough interaction.

The opportunity to meet hasbeen expanded through a moreaccommodating Chapter office

Five Minutes. That’s all I askwhere small or large groups cangather. The availability to tele-conference is now a standard op-tion for those who cannot travel,providing the convenience ofhome or office participation.Also, our Web site is being re-designed to become more user-friendly and interactive.

Involvement is also defined byregional issues or even a singleoccurrence. Your experience oropinion expressed to a local of-ficial or coalition partner in-volves you. A phone call, letter,or e-mail that shares what youknow defines involvement. Itmay be one isolated meeting,conversation, or correspondencethat makes a lasting difference.The fact that you are a pedia-trician has qualified you as anexpert. We have witnessed sub-stantial impact result from in-dividual pediatricians who hap-pened to express an opinion.

Passive observation is enter-taining, but sometimes reactiveand frustrating. Proactive in-volvement adds purpose and

generates pride in our profes-sion, organization, and in ourselves. Your “small role” makes ahuge difference.

Consider what issues concernyou about our profession. Whatarea of pediatrics do you like?What could you do given yourtime limitations? What informa-tion do you need or what re-sources would help you?

Take five minutes. Ask how canthe Ohio Chapter make it easierfor you to be involved?

Contact us (614) 846-6258 or e-mail [email protected] andtell us, that’s all I ask. Becauseyour opinions become our ini-tiatives.

– Terry P Barber, Sr, MD, FAAPPresident-Elect

(For updates on Ohio AAPCommittees see pages 8, 9 and10)

7

Ohio Pediatrics

www.ohioaap.org

Terry Barber, MD


Reach Out and Read Ohio wouldlike to thank the following compa-nies and organizations for theirsupport of the “Breakfast forBooks” fundraiser:

Sponsors – Center for Cognitive and Be-

havioral Therapy of Greater Co-lumbus

Columbus Children’s HospitalKeyBank

Olentangy Pediatrics, Inc. Ross Products Division, Abbott

Exhibitors –American Dairy Association

MideastMedImmune Inc.Merck & Co.TAP Pharmaceutical Products,

Inc. Wyeth Vaccines

ROR thanks sponsors



Ohio Pediatrics

www.ohioaap.org

Reports from Ohio AAP CommitteesNew committee to supportSocial-Emotional Health

The Ohio Chapter of the AAPhas convened a new committeeon the Social-Emotional Aspectsof Child and Family Health(SEACFH). A direct product of astrategic planning conferenceheld in February of 2005,SEACFH hopes to become aforum for primary care pediatri-cians, developmental and behav-ioral pediatricians, counselors,psychologists, psychiatrists,child advocates and representa-tives of numerous statewideagencies to discuss methods toimprove the social-emotionalhealth of Ohio’s children. Spe-cifically, the committee hopes toidentify, develop, and dissem-inate ways to engage, educateand support primary care pedia-tric providers to better addressthe social, emotional and behav-ioral needs of their patients andfamilies. As the national AAPTask Force on Mental Healthbegins to release its recommen-dations over the next fewmonths, SEACFH will be poisedto support their implementationin Ohio.

If you are interested in joiningthe committee and working onthese important issues, pleasecontact either Ohio AAP ExecutiveMelissa Arnold at [email protected], or call (614) 846-6258, or Andrew Garner, MD,the committee chair, at [email protected].

The committee has also writtena potential vision statement forSEACFH which states: “All of

Ohio’s children, regardless ofinsurance type, are screenedroutinely for social, emotional,and behavioral concerns in adevelopmentally appropriateand standardized way, and theirpediatric primary care providersare given the skills, referral re-sources, and reimbursementneeded both to administer thescreen and to address any identi-fied concerns in an expedient,family-centered, culturally-sen-sitive, and evidence-based man-ner.”

– Andrew Garner, MD Chair

Adolescent Committee

The Adolescent Committee hasbeen advocating for teens inmany areas, particularly thoseliving in nontraditional sites (i.e.detention homes and runawayshelters). Education has been oursecond activity. Many of youmay recall the excellent vehicleSport Shorts which was a pro-duct of this committee. In 2007-2008, the committee will focuson three educational areas; rec-ognition and treatment of type IIdiabetes in teens, teen-age de-pression (office recognition andtreatment) and teen substanceabuse. In a manner similar toSport Shorts and Mind Menderswe will develop Teen Tools forthese topic areas. Our third focusrelated to advocacy is access tocare. This is often difficult forteens with mental health needs,eating disorders and substanceabuse problems.

If you have specific needs or

questions we are not addressing,contact Ohio AAP ExecutiveDirector Melissa Arnold [email protected], or call(614) 846-6258. If you would liketo join the committee let usknow. The committee meets twoto three times per year by phoneconference and meets once peryear face-to-face.

Adolescents are always chal-lenging but I always find themstimulating. I learn as muchfrom them as they do from me.

– James Fitzgibbon, MD Chair

Committee on Children withDisabilities

Ohio has a unique and specialcollaboration between the OhioChapter, American Academy ofPediatrics (Ohio AAP) and itsfederal Title 5 Children withSpecial Health Care Needs(CSHCN) Program. This closecollaboration occurs in the JointChildren with Disabilities Com-mittee. The committee has abroad base of membership andaddresses a wide range of issuesimpacting CSHCN. The commit-tee is co-chaired by JamesBryant MD, Chief of the Bureaufor Children with Medical Han-dicaps BCMH at the Ohio De-partment of Health (ODH), andRoberta Bauer MD, Develop-mental Pediatrician at the Cleve-land Clinic Pediatric Rehabili-tation Hospital. In the past yearthe committee has taken the leadon issues such as:

See Committees...on page 9


For the past several years, theOhio AAP’s Committee on theFetus and Newborn (COFN) hasbeen relatively quiet. Once the“family feuds” (Level II v LevelIII and academic v private prac-tice neonatology groups) resol-ved following the revision of thematernity licensure rules, thecommittee has not been veryactive. As chair, I’ve testified forthe Chapter on issues importantto mothers and infants, e.g. op-posing privatization of the new-born screening program, sup-porting universal newborn hear-ing screening, etc. But, now wemay have to gear up for a new

challenge, P4P or pay for per-formance.

In their May Pediatrics article,Profit et al. state “the NICU is aprime target for payers (for P4Pinitiatives) because of the highcost, available databases, relativestrength of research evidence,and…low incidence of co-morbi-dities.” With that prediction inmind, I think the COFN and theOhio neonatal community, ingeneral, need to think abouttheir quality. How good is it?Well, let’s say that there is roomfor improvement. Our infantmortality is above the nationalaverage (7.8 v 6.8 per 1000 live

births in 2004). During the 27years that I have practice neona-tology, the prematurity rate inOhio has increased 31%. Nearlyone-third (28.6%) of Ohiomother’s smoke during preg-nancy; the national average is21.7%. Nearly 1 of every 5 preg-nant Ohioans does not have ade-quate prenatal care.

Here is the good news! We aredoing something about it.Through the leadership of neo-natologists, neonatal nurses andothers, the Ohio Perinatal Qual-ity Committee (OPQC) was

9

Ohio Pediatrics

www.ohioaap.org Ohio Pediatrics • Summer 2007

1) Medical Homes for CSHCN– how do we support them andhelp them grow?

2) Transition of Young Adultswith SHCN from the PediatricSystem of Care to the AdultSystem of Care.

3) Medicaid Managed Careand its effect on the care ofCSHCN.

4) Support of Service Coordi-nation activities for CSHCN.

5) Coordination of BCMH andHelp Me Grow (HMG) services.

6) Mental Health and Behav-ioral issues for CSHCN.

7) Disaster planning forCSHCN and their families.

8) Linking CSHCN and their

families with services.

9) Autism identification andservice provision.

10) Standardized Develop-mental Screening of all children.

The committee has developedan Ohio Medical Home Plan andwill be working with the Officeof Ohio Health Plans on increas-ing the number of physicians inOhio performing systematic,standardized DevelopmentalScreening in their offices. Theseare exciting and at the same timedifficult times both for the prac-tice of pediatric medicine and foraddressing the medical needs ofCSHCN and the Committee forChildren with Disabilities will beaddressing these challenges.

The committee always wel-comes new active membership.Please let Dr. Bryant know if youwould like to serve. If you havetopics you would like the com-mittee to address, please sendthat information to Dr. Bryant [email protected] committee meets three tofour times each year and the nextcommittee meeting will be Tues-day, Sept. 11. All are welcome.

– James Bryant, MD Co-Chair

Committees...from page 8

See COFN...on page 19

Ohio AAP Committee on Fetus andNewborn to move in new direction


10 Ohio Pediatrics • Summer 2007 www.ohioaap.org

Ohio Pediatrics

In 2005 and 2006, the Ohio AAPCommittee on Healthy Lifestyles& School Health, as a member ofthe coalition Action for HealthyKids, participated in a series ofeducational breakfasts for leg-islators. As a result of these ef-fects, two pieces of legislationwere crafted. All Ohio pediatri-cians should become familiarwith these two bills and lend sup-port as they are publicly discus-sed this fall.

In recent years, policymakershave recognized the importanceschools can play to help curtailthe rapid rise in childhood over-weight. Fifty-four million childrenattend school daily and consume35-40% of their calories there. In2004, the federal Child NutritionAct required that all schools par-ticipating in the National SchoolLunch program establish a localschool wellness policy by the be-ginning of the 2006-2007 schoolyear. Since that time, legislationhas been introduced in severalstates to support a more health-promoting environment at school.

Two bills recently introduced inOhio address nutrition, physicaleducation and physical activity.Senate Bill 118, sponsored by Sen.Randy Gardner, addresses physi-cal education standards andHouse Bill 254, sponsored byReps. Jon Peterson and FredStrahorn addresses school well-ness and nutrition standards inOhio schools. These bills willensure that Ohio’s children have

access to quality nutrition, physi-cal education, and physical activ-ity opportunities to promote life-long healthy habits.

Here is a synopsis of each bill,with recommendations to sup-port them and be a catalyst forpositive change for Ohio’s chil-dren.

House Bill 254School wellness legislation is

comprised of three key areas: nu-trition environment, localschool wellness policies, andstate level infrastructure.

Nurtrition EnvironmentPurpose: To ensure Ohio’s

children have access to a qualitynutrition program that promotesfoods and beverages that contri-bute to their overall nutritionalwell-being.

1. Legislation will define nutri-tion standards for healthier snackand beverages sold on a la carteline, in vending machines and inschool stores.

a. Nutrition standards for bev-erages are adapted from the Clin-ton Foundation, Alliance for aHealthier Generation.

b. Nutrition standards forsnack foods consider the overallnutritional quality of each snackrather than restricting certain nu-trients. This will enable Ohio’schildren to choose snack foodsthat offer a better nutritionalprofile.

2. Allow more children accessto the school breakfast program

by providing breakfast at no costto students who qualify for thefree and reduce price breakfast.

3. Professional developmentwill be required for individualsworking in school food servicewho are responsible for over-seeing the food service depart-ment.

Local School Wellness PoliciesPurpose: To ensure Local Edu-

cational Agencies (LEAs) are im-plementing effective districtschool wellness policies so thatOhio’s children will receive qual-ity nutrition and physcial educa-tion and activity in school.

1. All schools in Ohio, not justthose on the National SchoolLunch Program (NSLP), will im-plement a school wellness policy.

2. Ohio schools will have anactive wellness council, use anassessment tool to evaluate theschool wellness program andmonitor the progress made inimplementing the wellness pol-icy each school year.

State Level InfrasctructurePurpose: To provide state level

guidance and oversight to ensurethat nutrition standards, physicaleducation, and activity are im-plemented in all Ohio schools.

1. The Ohio Child WellnessAdvocacy Council – a 31-mem-ber council housed in the Gover-nor’s office will promote a statelevel awareness to the impor-tance of child health and well-

See Healthy...on page 19

Two pieces of legislation address nutrition,physical education and physical activity

Committee on Healthy Lifestyles & School Health


www.ohioaap.org

Ohio Pediatrics



Ohio Pediatrics

Ohio Pediatrics • Summer 200712 www.ohioaap.org

Coding for ImmunizationAdministration – Get it right!

Coding Corner

Providing immunizations in themedical home is a top priority forpediatricians. This is becomingmore difficult each year with theincreasing number of new andmore costly vaccines. The issuesrelated to timely recognition andpayment for these immunizationsby the payers creates additionalbarriers. Providing immuniza-tions should be a profit, not a losscenter for pediatricians.

Coding for immunizations should include billingand documentation for all the following:

E/M visit – Office or Preventive MedicineImmunization Administration

90471 – 9047490465 – 90468 (2005 Pediatric Specific)

Vaccine/Toxoid Product90476 – 90749

Link to ICD diagnosis codesV 20.2 Well ChildVaccine Specific “V” Codes

The component which has created significantconfusion is the pediatric specific immunizationadministration codes (90456 – 90468). This codingseries was new in 2005 and was created to providethe CMS (Center for Medicare and Medicaid Ser-vices) an opportunity to publish work values forimmunization administration. When taken times adollar conversion factor, these work values translateinto a payment for vaccine administration. Thepediatric specific administration codes parallel thelong established administration codes (90471 –90474) with two important additions. They requirethat the patient be less than 8 years of age and thatthe physician (or Advanced Practice Nurse/ PA)counsel the family.

Rick H. Tuck, MD

2005 “NEW” CPT CODESVaccine Administration

• 90465 Immunization administration under 8 years of age (includes percutaneous, intrader-mal, subcutaneous, or intramuscular injections) when the physician counsels the patient/fami-ly; first injection (single or combination vaccine/toxoid), per day

• 90466 each additional injection (single or combination vaccine/toxoid), per day

• 90467 Immunization administration under age 8 years (includes intranasal or oral routes ofadministration) when the physician counsels the patient/family; first administration (single orcombination vaccine/toxoid), per day

• 90468 each additional administration (single or combination vaccine/toxoid), per day (Listseparately in addition to code for primary procedure)


Ohio Pediatrics

www.ohioaap.org Ohio Pediatrics • Summer 2007 13

Vaccine AdministrationRVUs for 2007

• Values - Existing codesRVU 2007 Medicare

– 90471 – 0.49/ $19.33– 90473 – 0.37/ $12.89

• Values - New codes– 90465 – 0.49/ $19.33– 90467 – 0.35/ $12.51

RVU 2007 Medicare

– 90472 – 0.29/ $10.23– 90474 – 0.26/ $ 8.72

– 90466 – 0.00/ $10.23– 90468 – 0.27/ $ 9.47

Counseling does not need to be extensive butshould include any concerns specific to the vaccineproduct, possible side effects and their manage-ment, as well as answering any additional ques-tions. The physician must provide and documentcounseling for the immunizations at each visitwhere an immunization is given.

There can only be one “initial” administration ateach visit, including injection, oral or intranasalcodes. This has been a particular area of confusion.

Example: A 2-month-old infant receives age-speci-fic recommended immunizations:

Code 90465 – initial injection90466 X 3 – subsequent injections90468 – subsequent oral Rotateq immunization administration

(NOT 90467 – initial oral vaccine)The initial code should always be the injection

code. It has a higher relative value than the initialoral code, therefore a higher expected payment.Remember, inject first, then provide the oral vaccinewhen the mouth is open screaming next!

If you have not yet started using the pediatricspecific immunization administration codes, givethem a try. Many providers have found that the newcodes are paid at a higher rate than the long estab-

lished 90471 – 90474 series. This was not expected,based on identical relative values for the new andold codes. This could well be based on insurers in-putting the published relative values for the newcodes, while maintaining inadequate payment forthe old immunization administration codes. Try thenew pediatric specific immunization administrationcodes. This could be a win for you!

Remember the AAP for your coding needs andresources (aap.org , Members Only, PMOL (PracticeManagement Online); and the AAP coding hotlinefor prompt answers to all your questions:[email protected]

– Richard Tuck, MDOhio AAP Coding ExpertZanesville, OH

Dr. Tuck will be conducting a coding workshop forpractice managers and interested physicians at the OhioAAP Annual Meeting on Friday, Sept. 14. The title ofthe workshop is “Pediatric Power Coding 2007: TheBasics and Beyond.” For more information see theAnnual Meeting story on page 1.

The current Medicare equivalent payments for these codes are:


Ohio Pediatrics

14 www.ohioaap.org

will continue to make changes toHouse Bill 119, the State’s biennialbudget bill, during the last twoweeks of June. The governor mustconsider all of the budget provi-sions and veto those sections hedoes not support by the statutorybudget deadline, June 30. Theseand all budget provisions are sub-ject to change until this final step.

Other Bills of InterestOhio AAP continues to monitor

the following bills: • House Bill 52 and Senate Bill

95 (Rep. Arlene Setzer, R-Vandaliaand Sen. Gary Cates, R-WestChester) to allow for the produc-tion and sale of raw milk. Hear-ings continue in both the Houseand Senate. Ohio AAP has sent aletter of opposition.

Legislation...from page 2

• House Bill 81 (Rep. EdnaBrown, R-Toledo) would requiregirls enteting the sixth grade to bevaccinated against HPV. This billhas had one hearing. Additionalhearings are not expected in thenear future.

• House Bill 99 (Rep. MichelleSchneider, R-Cincinnati) and Sen-ate Bill 114 (Sen. Kevin Coughlin,R-Cuyahoga Falls) to allow thesubstitution of drugs intended totreat epilepsy only with physicianand patient approval. This billhas had a number of hearings.Pharmacists are actively oppos-ing the bill.

• House Bill 125 (Rep. MattHuffman, R-Lima) and Senate Bill127 (Rep. Kevin Coughlin, R-Cuyahoga Falls) to establish cer-tain uniform contract provisionsbetween health care providersand third-party payers, to estab-lish standardized credentialing,and to require third-party payersto provide to health-care provid-ers specified information concern-ing enrollees. These bills have hadinitial hearings in both chambers.A vote on House Bill 125 is ex-pected in late June.

• Senate Bill 27 (Sen. Eric Kear-ney, D-Cincinnati) to requirebooster seats for children betweenthe ages of 4 and 8. This bill hashad one hearing; AAP continuesto advocate for this bill.

• Senate Bill 29 (Sen. Eric Kear-ney, D-Cincinnati) to establish agrant program to pay lead hazardremoval costs incurred by quali-fied homeowners.

• Senate Bill 58 (Sen. KevinCoughlin, R-Cuyahoga Falls) andHouse Bill 73 (Rep. John Adams,R-Sidney) to expand the immuni-

zations that can be administeredby pharmacists. This bill wasclose to enactment last GeneralAssembly and requires flu vac-cines offered by pharmacists tochildren 14-18 be reported to thechild’s medical home. The Gover-nor recently signed this bill.

• Senate Bill 61 (Sen. Ray Miller,D-Columbus) to establish pilotprograms in seven counties forthe purpose of providing door-to-door health checks by nurses orother health professionals in areaslacking access to health-care pro-viders or services.

• Senate Bill 104 (Sen. LarryMumper, R-Marion) to require in-surers and other third-party pay-ers to accept and honor assign-ment-of-benefit agreements en-tered into between plan benefi-ciaries and treating health-careproviders.

• Senate Bill 110 (Sen. JohnBoccieri, D-New Middletown) torequire schools to test students fordyslexia and related disordersand to provide intervention.

• Senate Bill 115 (Sen. SteveStivers, R-Columbus) to requirehealth insurers to provide cov-erage for dependent children un-til the age of 30 if the child meetsspecified conditions.

• Senate Bill 118 (Sen. RandyGardner, R-Bowling Green) to re-quire daily physical education in-struction in grades K-6, to requirecompletion of one unit of physicaleducation in grades 7-12, to re-quire physical education teachersto be licensed in their subject area.This bill has had sponsor testi-mony.

– Dan Jones, MD Ohio AAP Lobbyist

The University of Toledo, College of Medicine

presents the 34th AnnualPediatrics for the Practicing

Physician CME symposium to be held

September 14-16, 2007, atthe beautiful Maumee Bay

Conference Center, Oregon, Ohio

Topics include: • Adolescent Medicine, • Allergy, • Complementary Medicine, • Emergency Medicine, • Infectious Disease, • Orthopaedics, and

• Psychopharmacology.

Please visit our Web site atwww.hsc.utoledo, edu/cmefor additional information.


Advertisement

15www.ohioaap.org Ohio Pediatrics • Summer 2007


Ohio Pediatrics

for ROR Ohio, from August 1-31.The Borders stores will have adisplay promoting ROR andcustomers will be encouraged topurchase books to donate toROR. In addition, Borders willdonate 5% of the books salesback to ROR Ohio.

Welcome New SitesROR Ohio would like to wel-

come the new sites joining thecoalition:

Scott Anzalone, MD – Logan Caughman Health Clinic –

Findlay

Martha Kleinberg – Pediatricsand Adolescents – Toledo

Logan View Pediatrics –Bellefontaine

NorthEast Ohio Neighbor-hood Health Services, Inc. –Cleveland

Parma Pediatrics – Parma Western Lucas County Clinic –

Holland

ROR Ohio is excited about itsgrowth, and encourages every-one to participate by purchasinga book at Borders or by becom-ing a ROR site. For more infor-mation, visit our Web site atwww.ohioaap.org/reachoutandread or contact Heather Hall,ROR Ohio Coalition Leader at(614) 846-6258, or [email protected]

P&G fund grant provides 30,000 booksA typical middle class child

enters first grade with approxi-mately 1,000 hours of being readto, while a corresponding childfrom a low income family entersfirst grade with only 25 hours ofbeing read to.

That is why Reach Out andRead (ROR) is dedicated to mak-ing literacy promotion a standardpart of pediatric care – so all chil-dren will grow up with books anda love of reading.

By capitalizing on the relation-ship between physicians andparents, the ROR model success-fully promotes learning, in-creases the likelihood of schoolreadiness and educates parents onthe importance of early literacytools.

P&G Fund GrantNew, developmentally and age-

appropriate books are critical tothe success of ROR. In May, ROROhio and Reading for Life wereawarded a joint grant from theP&G Fund which will provide30,000 copies of the book WhenMy Mama Reads to Me for dis-tribution in English and Spanishthrough ROR sites. This book waswritten by Julie Elkus, co-founderof Reading for Life, a Cincinnati-based non-profit organizationdedicated to making reading apart of every child’s life.

Borders Book DriveAlso ensuring new, high quality

books will be available for distri-bution, 11 Borders book stores inAkron/Canton, Cincinnati,Toledo and Youngstown haveagreed to conduct a book drive

Reach Out and Read

Ohio AAP Foundation donorsThe Ohio AAP would like to

thank the following Ohio AAPFoundation donors from Aprilthrough June 1, 2007:

Kevin and Melissa Arnold Sandra AuredTerry Barber, MDTheorphlis BordonJeff BorlandColumbus Blue JacketsColumbus Children’s HospitalWilliam Cotton, MD & PattyDavidson, MDScott DiMauroKim DennisJohn Duby, MD & SaraGuerrero-Duby, MDJames Duffee, MD

Julie ElkusJune GerkenTracy IntiharMichael & Cecelia JokerstGlenn KarrMark LevyRay & Kathleen OakesDaniel & Kimberly O’DonnellKim PaulRex & Sherri RaderstorfJoAnn Rohyans, MDRichard & Libby Ruppert, MDDaniel Scherzer, MDAmy SwansonClare WardDana Wilkie

www.ohioaap.org16 Ohio Pediatrics • Summer 2007


Ohio Pediatrics


About 45 people – pediatri-cians, social workers and othercommunity agency representa-tives – were in attendance for theOhio AAP Open Forum in Mayheld at Akron Children’s Hospi-tal.

The two topics discussed were:Navigating the Turbulent Sea ofFoster Care and Adoption and OralHealth and Medicaid Fluoride Var-nish Progam.

For the first topic, we werefortunate to have a panel of ex-perts in the field of social workand adoption – Ellen Kempf,MD, director of the Oak Adop-tion Center at Akron Children’s;

Alanna Updegraff, PhD, anAkron child clinical psycholo-gist; Abbey Parris, a singlemother with two adopted chil-dren from China; LindseyHoulihan, a Cleveland socialworker; and Judy Romano, MD,Ohio AAP Chair of the EarlyChildhood, Dependent Care andAdoption Committee.

The panelists shared personalexperiences as well as ways thatOhio pediatricians can help faci-litate the care of these children.

Dr. Updegraff discussed thespecial emotional needs of adop-tive and foster children. Thispanel also identified the process

for developing and using aMedical Passport System forchildren in foster care and/oradoption in Ohio.

Dr. Romano provided an up-date from national AAP – whosenumber one priority this year isfoster care.

Speakers and attendees were inagreement that pediatricianshave an important role in work-ing with foster and adoptivefamilies to not only help with aneasier transition process for thewell-being of the child, but inaddition, to care for their medi-

Recap from Ohio AAP Open Forum in Akron

See Open Forum...on page 18


Ohio Pediatrics

www.ohioaap.org18 Ohio Pediatrics • Summer 2007

Ohio contigent in Washington

Ohio pediatricians, from left,Mike Gittelman, MD, LainieHolman, MD, Andy Garner,MD, Ellen Buerk, MD, andChris Rizzo, MD, met with

Ohio legislators and senatorsas part of their attendance at

the AAP LegislativeConference in Washington,

D.C. in June.

cal and emotional needs. The second topic dealt with

oral health. Mark Siegal, DDS,with the Ohio Department ofHealth, and David Krol, MD,MPH, FAAP, chair of the Depart-ment of Pediatrics at the Uni-versity of Toledo College of Med-icine, provided an overview oforal health care in pediatrics.

Dr. Siegal explained the Smilesfor Ohio Medicaid Fluoride Var-nish Program developed byODH. He said that tooth decay isthe most common chronic child-hood disease. He pointed outthat cavities in baby teeth can notonly be painful but affect achild’s ability to eat, speak, sleepand learn properly.

In 2003, only 3 percent of OhioMedicaid-eligible children under3 years of age received anydental services through Medi-caid. However, 78 percent re-ceived medical services. Sinceprimary care providers are morelikely to see these children, theyhave a unique opportunity to

provide fluoride varnish beforeearly caries occur, said Dr. Siegel.

A one-hour training session canbe provided, free of charge, forprimary care providers and staff.The training is conducted by adental hygienist/nurse practi-tioner team.

Any child can receive fluoridevarnish, but the Smiles for Ohioprogram is directed at childrencovered by Medicaid from thetime of tooth eruption until thethird birthday.

Physicians can receive reim-bursement for providing thefluoride varnish application forMedicaid patients under age 3.

As a result of this discussion,the Ohio AAP Committee onPractice Management will pursuegetting oral health care coveredby insurance companies.

If you’d like more informationabout the Smiles for Ohio Pro-gram go to the Ohio AAP Website (www. ohioaap.org) under“Open Forum.” Dr. Siegal’spresentation is available there.

Open Forum...from page 172008 Open Forums

If you have not attendedone of the four previousOhio AAP Open Forums,plan to come in 2008. Themeetings are free and heldin varioius cities around thestate. The Ohio AAP pro-vides refreshments, as wellas CME for attending themeetings.

While definite dates havenot been secured, two OpenForums are planned for nextyear one in February inAthens, and the other inMay in Toledo. Details onthe topics, dates and loca-tions will be sent to you bythe end of summer so thatyou can get them on yourcalendar.

If you would like theChapter to address a topicat an Open Forum meetingthat has not been covered,contact Executive DirectorMelissa Arnold at [email protected]


Ohio Pediatrics


formed. This group is a partner-ship of state agencies, neonatal/obstetrical providers, and profes-sional organizations. With sup-port from a center with expertisein quality improvement, we willimprove pregnancy outcomes forall Ohioans by promoting systemchanges to increase the use ofevidence based practices in theobstetrical and NICU patients. Isee an active role for the COFN inthis process. Stay tuned. You ain’tseen nothin, yet.

– Richard E McClead, MD, MHAChair, Ohio AAP Committee onthe Fetus and Newborn

COFN...from page 9Healthy...from page 10

being. The Ohio AAP will have aplace on this council.

2. The council will make policyrecommendations to promote,coordinate, implement, and mon-itor statewide efforts to improveOhio’s children nutrition, physi-cal education, and physical activ-ity through school-based activi-ties and programs.

3. Requires a full-time physicaleducation coordinator employedat the Department of Educationto oversee and advise educatorsand district personnel in the areaof physical education.

Senate Bill 118 Purpose: To provide quality

physical education in Ohioschools K-12.

1. The State Board of Educationwill adopt national physical edu-cation standards for K-12.

2. A full-time physical educa-tion coordinator will be employ-ed at the Department of Educa-tion to oversee and advise educa-tors and district personnel in thearea of physical education.

3. Schools will provide high-quality physical education in-struction (both content and activ-ity) in K-6.

4. Remove the ability for highschools to exempt physical edu-cation coursework for marchingband, cheerleading and inter-scholastic athletics.

5. Increase the physical educa-tion requirement from a half toone full Carnegie unit to grad-uate from high school and allowscredits to be earned in grade 7-12.

6. Teachers employed to teachphysical education will hold avalid teaching license for Physi-

cal Education (PE) K-12.This legislation will address

one important aspect of the prob-lem of overweight among Ohiochildren. Your support will en-able Ohio schools to build schoolpolicies that promote childhealth. The bills will result in aconsistent message in an en-vironment in which childrenmake nutrition and physical ac-tivity choices every day. A sup-portive environment will shapelifelong healthy habits for Ohio’schildren by providing access toquality nutrition, physical educa-tion, and physical activity oppor-tunities at school.

You can support these effortsand be a part of positive changefor Ohio’s children through thefollowing:

• Contact your local legislatorsthrough the Ohio AAP ([email protected]) and ask for theirsupport for Senate Bill 118 andHouse Bill 254.

• Become an active member ofyour local school wellness com-mittee. For more information callShelly Roth, Ohio Action forHealthy Kids (614) 341-7700, ore-mail her at [email protected]

• Educate your parents andyour community of the impor-tance of these bills in helping tocurtail the problem of over-weight among our children.

To access a copy of Senate Bill118 and House Bill 254 go towww.legislature.state.oh.us

– Robert Murray, MD Chair

– Jan Ritter, RD

If you are interested injoining a committee, you caneither contact the committeechair directly – you will finda list of committees, chairsand contact information onthe Ohio AAP Web sitewww.ohioaap.org go to“Leader List” – or you cancontact the Ohio AAP Exe-cutive Director MelissaArnold at [email protected], or call (614)846-6258.

Get involved.Join a committee


The Ohio AAP announces the following 2007 meetings.

July 20 – Executive Committee MeetingOhio AAP Chapter Office, Worthington

– Board Meeting

Sept. 14-15 – 2007 Ohio AAP Annual MeetingCherry Valley Lodge, Newark

– Executive Committee MeetingCherry Valley Lodge, Newark

Sept. 14 – Golf outing/fundraiserGranville Golf Course

Oct. 3 – First Signs Autism Education ProgramColumbus, OH

Oct. 26-30 – AAP NCE MeetingSan Francisco, CA

Calendar of Events Dues disclosurestatement

Dues remitted to the OhioChapter are not deductible asa charitable contribution, butmay be deducted as an ordi-nary and necessary businessexpense. However, $40 of thedues is not deductible as abusiness expense because ofthe chapter’s lobbying activi-ty. Please consult your taxadviser for specific informa-tion.

This statement is in refer-ence to fellows, associate fel-lows and subspecialty fel-lows.

No portion of the candi-date fellows nor post residen-cy fellows dues is used forlobbying activity.

Ohio ChapterAmerican Academy of Pediatrics450 W. Wilson Bridge Rd. Suite 215Worthington, OH 43085

PRESORTEDSTANDARD

Permit No. 156U.S. Postage

PAIDDUBLIN, OH


Documents

Ohio Pediatrics - Summer 2007 - Ohio AAP