Sara “Sally” Goza, MD, FAAP
August 28, 2020
Late summer is usually a busy time in my pediatric practice – and likely yours as well. We have back-to-school visits and sports physicals, and we are ramping up for flu shots and all the acute illnesses that bring children into the office in the fall and winter. This year is like none I’ve experienced. We are just now starting to see patient volumes tick up. And while we don’t know what this flu season will look like – we do know children will get sick, not only from COVID-19, but from all the other viruses and bacteria that typically circulate.
This week, the AAP published new interim guidance to help pediatricians triage and manage acute illnesses, including fever and respiratory illness, in their practices. The best place to assess and diagnose children for fever and other illnesses is in their medical home. The recommendations from AAP include guidance on PPE, hygiene and safety; scheduling and triage; telemedicine protocols; and working with community partners that communicate with the medical home. For more, see the AAP News article, which also discusses new interim guidance on transport medicine.
AAP Criticizes CDC Guidance on Asymptomatic Testing
Today, AAP spoke out against a dangerous revision by the Centers for Disease Control and Prevention of its testing guidance for COVID-19. Testing individuals who have been exposed to the virus, even those who do not display symptoms, is critical to contact tracing and reducing transmission of COVID-19. We must be led by the science, in a transparent process that engages the public’s trust and confidence. The AAP strongly urges CDC to reverse this decision.
Advocacy Continues on School Funding, Vaccines, Provider Relief
The AAP also continues to advocate at the federal level on behalf of pediatricians and the children you care for, whether it comes to calling for increased funding to allow schools to open safely, or reiterating the importance of the medical home as the best place for children and adolescents to receive vaccines. Today, AAP and 44 of our chapters wrote to Health and Human Services Secretary Alex M. Azar II, J.D., to express alarm at the decision to allow pharmacies to deliver all vaccines to children ages 3 years and older, regardless of state laws. Instead we should support the existing pediatric immunization delivery system: our nation’s pediatric practices.
We also have an important update on provider relief funding. The deadline for pediatricians to apply for financial relief from the federal government is extended to September 13, and the process is now easier than ever. Please visit this HHS website to learn more and apply for these funds.
AAP will continue to share messages urging parents to call their pediatricians for urgent and well-child visits, including across social media platforms and in a new national TV and radio PSA campaign. In the midst of all the uncertainty and chaos, one thing remains clear: Families need and depend on the trusted advice from their pediatrician.
Thank you for all that you do, every day, on behalf of children and families.
Sally Goza, MD, FAAP
President, American Academy of Pediatrics
Like all of you, I am watching the tragic events unfolding in Minneapolis and other cities with both sadness and alarm. Sadness that we as a nation must still combat racism, discrimination and violence toward black and brown people. And alarm in what we as pediatricians know are racism’s profound impacts on children and adolescents.
As AAP stated last year in our policy statement "Racism and Its Impact on Child and Adolescent Health,” racism’s societal impact, particularly on communities of color and populations that are historically disenfranchised, is wide-reaching, systemic, and complex. A growing body of scientific research has found that racism harms children’s mental and physical health in myriad ways. We are watching this play out now, in real time, and we cannot avoid a deep examination of how to improve the role of policing. Systemic violence requires systemic responses.
These events are occurring in the context of a global pandemic, which has also crystalized the uneven access to health care experienced by so many people of color in this country. COVID-19 is having a more severe impact on both illness and death among racial and ethnic minority groups. The same economic and social conditions that contribute to health disparities overall become exacerbated during a public health emergency. These and other structural factors prevent people from accessing the resources they need to protect themselves during an outbreak.
In addition to the work we are all doing to create medical homes that are welcoming and culturally effective, we must also advocate at the local, state and federal level for equitable policies that reduce disparities and advance social justice. We must also level our expertise to collaborate with first responders, including law enforcement, around the fundamental tenets of child and adolescent development particularly as relates to background, culture and difference. We must counsel and support our patients, especially our adolescents and young adults, and their families, to help ameliorate the impact of racism on all our lives. This is essential work if we are to make our nation one where the health of all children is valued and supported.
Unraveling racism requires a great investment from all of us. As president of the AAP, I am committed to doing this work alongside each of you.
Sally Goza, MD, FAAP
President, American Academy of Pediatrics
Recent data from the Centers for Disease Control and Prevention (CDC) have confirmed what we as pediatricians, pediatric medical subspecialists and pediatric surgeons have known for months: children and adolescents are missing important health visits and immunizations. Vaccination rates have dropped to dangerously low levels during this pandemic, and overall office visits are down. In fact, another CDC study published Monday found that in Michigan, immunization rates for some diseases have dropped to below 50%.
At your American Academy of Pediatrics, we are doing everything we can to urge families to continue seeking care in their medical home, talk to the doctor and catch up on needed vaccines. As children return for care and practice volumes increase, we can provide needed care and begin to ease the terrible financial strain on practices. The AAP's advocacy agenda remains front and center. Here is a link to the latest Advocacy Report, which describes all that we are working on with your help.
Today, I am proud to announce that we are launching a #CallYourPediatrician campaign to help get patients back into your offices and to help make sure children are vaccinated on time. This is a pivotal moment for our profession and for the children we care for.
So, we are launching a new digital media campaign that directly appeals to parents using humor and empathy. Our new toolkit on AAP.org will take you to downloadable images and videos along with pre-written sample social media posts, like the one below.
Please consider sharing these messages on social media and spread the word to parents in your practices. We hope they bring a smile to your face and cause your phones to ring more often.
We will have more to share in the next week or two as we expand this content even further, and look forward to your feedback.
Sara "Sally" Goza, MD, FAAP
As we learn more about new cases of Pediatric Multi-System Inflammatory Syndrome and what it might mean for the impact of COVID-19 on children, one thing could not be more clear: A child’s pediatrician is the best source of trusted, credible advice for parents to turn to during such a uncertain time. We have a new resource on HealthyChildren.org explaining what we know about Pediatric Multi-System Inflammatory Syndrome and directing parents to contact their pediatrician with any questions.
Alarmingly, new data released last week from the Centers for Disease Control and Prevention (CDC) confirms what so many of us are experiencing at our individual practices: The number of children accessing needed health care has sharply declined, and as a result, far too many are missing important immunizations. This drop in vaccine rates also means that children are missing everything else that occurs at well-child visits.
We want all families to feel reassured that going to the pediatrician is not only safe, but vital to their children’s health. To that end, here’s a summary of some of the new resources and activities AAP is undertaking to support pediatricians and urge parents to have their children seen during the pandemic:
- Newly updated guidance on telehealth and well-child care, summarized in this AAP News article
- Our news release on CDC’s vaccination data
- An advocacy opportunity to urge federal financial relief for pediatricians
- A link to sign up for tomorrow’s weekly Facebook live chat for parents
- A new HealthyChildren article on Pediatric Multi-System Inflammatory Syndrome
- A social marketing campaign debuting in the coming days urging parents to take their children to the pediatrician
- National media appearances taking place this week where pediatricians will continue to discuss the imperative of parents taking their children to the pediatrician
We will continue to do all we can to make sure you can keep your doors open and care for your patients, and appreciate all you are doing to keep your patients and communities safe.
Sara “Sally” Goza
Today, the Centers for Disease Control and Prevention (CDC) released new data that reveals what so many of you have been experiencing across the country: Children aren't going to the pediatrician, and as a result, far too many are missing important immunizations to protect them against diseases like measles, meningitis and whooping cough. This AAP News article summarizes the latest information.
This drop in vaccine rates also means that children are not receiving all the other important health care that usually occurs at well-child visits, including physical exams, developmental screenings, and other important care. These visits are important for children's health, and today the Academy is publishing updated guidance for pediatricians to manage these visits during the pandemic.
What's new from AAP
We want all families to feel reassured that going to the pediatrician is not only safe, but vital to their children's health, especially as parts of the country begin to open up and people begin to interact more often.
That's why next week, we will be launching a national digital marketing campaign urging parents to take their children to the pediatrician. And we're continuing to reach parents where they are, including on our websites and in social media through events like weekly Facebook live chats.
And why we have updated our guidance on telehealth and well-child care, which include recommendations such as:
- All well-child care should occur in person whenever possible.
- Pediatricians should contact families whose children have missed well-child visits and/or recommended vaccines to schedule in person appointments.
- Care by pediatricians, pediatric medical subspecialists and pediatric surgical specialists should not be unnecessarily delayed and referrals should continue to be made.
- Well visits for children may be initiated through telehealth, recognizing that some elements of the well exam must be completed in-person.
- All payers should pay for telehealth visits at parity with in-person visits.
What's new from CDC
New data from CDC shows troubling declines in childhood immunization administration during the pandemic. As the Academy issued in our news release, this is just one dangerous example of what happens when children are not being seen by the pediatrician.
As physical distancing restrictions begin to lift around the country, children and teens who are not vaccinated will be at higher risk for contracting a disease that could be prevented by a vaccine. The last thing we want to see happen during a global pandemic is an outbreak of vaccine-preventable illness.
The road ahead
Though so much is uncertain right now, one thing we do know for sure is that in order for children to be as protected as soon as possible, they must be seen by their pediatrician. And we will continue to do all we can to make sure you can keep your doors open and care for your patients.
Sara "Sally" Goza, MD, FAAP
Stories continue to pour in about how you, your patients and your work have been impacted by the coronavirus pandemic.
Please know that we hear you and we have not stopped speaking up for you. We are in regular conversation with top officials at the White House and the Department of Health and Human Services (HHS). We have pressed them on the urgency of getting direct financial relief to pediatricians and shared the consequence of children missing routine pediatrician appointments, especially for life-saving vaccinations. We are outlining the very difficult decisions that pediatric practices are being forced to make in order to keep their doors open.
We are doing all we can in every way we can, and that includes using the media as a microphone to get our message out.
Individual stories from pediatricians in all parts of the country put a face to this crisis, like these in the New York Times and the Los Angeles Times. I also joined David Hill, MD, FAAP, yesterday for a Facebook Live discussion with parents, urging them to take their children to the pediatrician.
At the national level, Congress has provided more than $175 billion in Provider Relief Funding and despite promises from HHS that a portion of this funding would go to pediatricians, this has not yet happened. That is why we need you to speak up and urge action.
Here are two ways you can add your voice to these efforts:
- Contact your members of Congress. Urge them to ensure that pediatricians, pediatric medical specialists and pediatric surgeons receive immediate financial relief. Take action by visiting federaladvocacy.aap.org and find "Provide Needed Financial Support for Pediatricians Impacted by COVID-19 Crisis" under Key Issues.
- Help show how #PedsPutKids1st in the media and on social media. If you've had to make changes in your practice, furlough or lay off staff, or are concerned about your ability to stay open for business over the next month or two without federal funding, please share your perspective with us. We are highlighting them on social media and urging journalists to write about what pediatricians are experiencing.
Together, we will keep showing and telling our country's leaders what children and pediatricians need throughout this crisis. We know what it means when children cannot access health care and it is our job to make sure they do too. Thank you for your continued advocacy – we will be in touch at every step of the way.
Sara "Sally" Goza, MD, FAAP
As so often happens when confronted with unpredictable challenges in our profession, pediatricians have shown remarkable resilience, flexibility and creativity during COVID-19. Seeing the stories pour in from the frontlines of your work to keep children safe and healthy has been inspiring, and also illuminating.
The truth is that pediatricians are facing unprecedented challenges. You’re trying to do all you can without the right protective equipment, or a road map for how to do telemedicine on this scale, or assurances that your practice will be able to remain open next month or even next week.
Today I want to talk to you about all your AAP is doing to get the word out. Take a look at my video message.
We also need your help. Here are two ways you can add your voice to our efforts:
- Urge your members of Congress to ensure that pediatricians, pediatric medical specialists and pediatric surgeons receive immediate financial relief. Take action by visiting federaladvocacy.aap.org and find "Provide Needed Financial Support for Pediatricians Impacted by COVID-19 Crisis" under Key Issues.
- We talk regularly with Congress and senior officials within the Administration, and have shared our concern and alarm that despite earlier assurances, pediatricians were ultimately left out of the first rounds of federal funding for providers.
- I wrote yesterday in USA Today with the president of the American Medical Association on the vital role of pediatricians, especially now. And yesterday we sent a letter with our colleagues in family medicine and gynecology/obstetrics urging immediate support for our members. Please amplify our efforts by sharing your personal perspective with your legislators today.
- Help show how #PedsPutKids1st in the media and on social media.
- Last week, I did more than 20 television interviews on the perils pediatric practices, including my own, are facing right now. I also urged parents to continue taking their children to the pediatrician during the pandemic, and that disrupting immunization schedules, even for brief periods, can lead to outbreaks of infections like measles or whooping cough.
- If you’ve had to make changes in your practice, furlough or lay off staff, or are concerned about your ability to stay open for business over the next month or two without federal funding, please share your perspective with us. We are highlighting them on social media and urging journalists to write about what pediatricians are experiencing.
Lifting up your stories to lawmakers, media, and the public can make a real difference in helping them understand what happens when pediatricians are not able to stay open: children will not get the care they need, and their health will suffer. The impacts of this compromised access to care will be long-lasting.
We will keep up this fight together, and I will keep you posted on our progress. Thank you for all you do for children.
Sara “Sally” Goza, MD, FAAP
Dear AAP members:
Yesterday, Congress passed needed supplemental funding to the Paycheck Protection Program (PPP). This program has helped many pediatrician practices and we encourage those still eligible to apply.
Earlier this week, the Department of Health and Human Services (HHS) released its second wave of funding through the CARES Provider Relief Fund. The AAP has been working hard to assure that pediatricians, pediatric medical subspecialists and pediatric surgeons receive needed help. We have been in regular communication with HHS senior officials and the White House and had been assured that pediatricians would be included in this round of funding. Unfortunately, we were not.
The round of funding announced by HHS targets hospitals, Medicare providers, and rural hospitals and clinics. While pediatricians who have provided COVID-19 testing or treatment to uninsured patients can apply for reimbursement, we are deeply concerned that pediatricians are left out of the funding going out in this round. We have reason to believe that pediatricians may be eligible for an additional allocation of funding, the details and timing of which have yet to be announced. We will make every effort possible to advocate for this.
Pediatric practices across the country are hurting. This New York Times article published yesterday crystallizes one especially dangerous outcome of the crisis on pediatricians’ ability to continue to keep the doors open: missed appointments for childhood vaccines. A vaccine-preventable disease outbreak during a global pandemic would be a public health crisis adding needless morbidity and mortality to a health system already stretched thin.
AAP President Sally Goza, MD, FAAP, did 20 television interviews yesterday on a virtual media tour, all focused on the urgent need for parents to continue seeing their pediatrician and on the tremendous challenges pediatric practices, including hers, are facing right now.
If you’ve had to make changes to your practice, whether furloughing or laying off staff, or if you have genuine concerns about your ability to stay open for business over the next month or two absent federal funding, please share your perspective with us at www.aap.org/COVIDstory. In addition to using these stories as advocacy tools, we will be sharing them on social media using #PedsPutKids1st to highlight all our members are doing to keep children and communities safe during COVID-19.
We are not done fighting for this needed financial relief. Far from it. As we continue to make the case to the Administration and Congress to provide this essential, urgent funding for pediatricians, we need your help to amplify our message. The more stories and data we can point to on the ground of the toll this lack of federal support is having on pediatric practices, the more effective our advocacy will be. Thank you for all you are doing every day.
Mark Del Monte, JD
Chief Executive Officer/Executive Vice President
As we enter the next phase of the COVID-19 pandemic, I know that so many of you are, like me, doing your best to continue doing your job, take care of patients, protect yourself and your colleagues and keep your doors open. Whether you’re a primary care pediatrician, a surgeon or a subspecialist, this pandemic has hit our profession hard.
This is why I am so proud to share that yesterday, the AAP reached out to the Department of Health and Human Services (HHS) with a bold, urgent and needed request: immediately distribute relief grants to pediatricians to help us stay open.
Our letter to HHS outlines the details, but we are asking for immediate financial relief through no-strings federal grants to general pediatricians, pediatric medical subspecialists or pediatric surgical specialists. This money would be a flat amount sent directly to individuals, whether you care for children on Medicaid or not and no matter your practice setting.
We recognize that this is just one small part of what you need to keep your doors open, but it’s an important part that we hope can make a meaningful impact. While we don’t know exactly when an announcement will be made, AAP leaders spoke with HHS yesterday to discuss this proposal and we are confident our views are being taken seriously.
And that’s not all we’re fighting for right now. We are also urging Congress and the Administration to offer stronger support for Medicaid, including more federal funding to states, payment rates at parity with Medicare, expanded eligibility, retention payments to physicians, and other policies to protect and improve Medicaid during this crisis. Take a look at our comprehensive summary of COVID-19 related federal and state advocacy activities.
Many of you are facing difficult, even unimaginable, financial challenges right now. I know many of you, like me, have had to furlough staff, reassure worried parents or make difficult diagnoses through telemedicine. We are all worried about the toll of missed pediatric appointments on short- and long-term child health. Some of us have colleagues or family members in critical condition with COVID-19. Some of us fear exposing our loved ones to the virus when we come home each day.
These are trying times, and while I cannot say for certain how or when they will end, I can tell you that we will get through it the way we always do, with our eyes on the children and our arms (virtually) around one another.
Sara “Sally” Goza, MD, FAAP
This week saw the release of preliminary data on COVID-19 cases in the U.S. and while I’m to some extent heartened that initial evidence indicates children are less likely than older Americans to experience severe illness or require hospitalization, I am deeply troubled by statistics that show disproportionate impact on marginalized and minority communities – particularly among African Americans. Sadly, this trend is emerging across the country.
In Chicago, Black residents are dying from the coronavirus at a rate nearly six times greater than White residents. In Louisiana, 70 percent of the victims have been African American, even though the state is less than a third Black. And in Milwaukee County, Wisconsin, where the population is just 26 percent Black, African Americans comprised almost half of the county’s cases and 81 percent of deaths.
This is a crisis within a crisis.
In addition to its disproportionate health impacts on minority communities, COVID-19 is likely to exacerbate social and economic inequities as well. So, while the direct health impact of the disease on children may be minimal, children in households of color and other marginalized groups will be disproportionately hurt by factors such as housing instability, food insecurity, and educational disparities. As our response to the pandemic continues, the needs of the communities who are being disproportionately impacted by COVID-19 should be prioritized; this also includes those living in foster care, youth in juvenile detention, children in immigrant families and those with limited English proficiency. We will continue to look for ways that we can elevate these needs through our advocacy and education.
A brief by the Kaiser Family Foundation (KFF) provides insight into how and why the health and financial impacts of COVID-19 vary across racial/ethnic groups. While a New York Times op-ed by Aletha Maybank, MD, MPH, chief health equity officer at the American Medical Association, explains why it’s so important that our nation’s laboratories, health institutions, state and local health departments, and the Department of Health and Human Services standardize, collect and publish race and ethnicity data.
If we are to effectively manage this pandemic, we must understand and acknowledge the unique vulnerabilities some communities face as we propose solutions, treatments, and financial supports. Any plan to flatten the curve must take into account the spread and impact among communities of color and other marginalized groups. For example, Black and Latino youths fear wearing a homemade mask could exacerbate racial profiling and place them in danger. As one Black male put it, “I want to stay alive, but I also want to stay alive.” And our Committee on Native American Child Health (CONACH) warns us that due to lack of internet access, messaging is not reaching our Native American communities and telehealth and distance learning is not possible.
Failing to take into account a deep-rooted system of haves and have-nots, increases the burden of disease not only for those in tenuous situations, but for everyone.
The Academy’s Section on Minority Health, Equity and Inclusion (SOMHEI) will be offering a webinar on how to pursue equity and help prevent COVID-19 from further widening existing health gaps. And we invite you to join the COVID-19 discussion board to share your thoughts and experiences on how to lift up those who need help and keep the disease from compounding burdens children and youth of color already face.
Because crises like COVID-19 create and deepen existing inequities in society, it’s more important than ever that we prioritize equity and make sure we reach the children and families who need us most.
Sometimes terrible events cause positive change. My fervent hope is that when we get to the other side, our nation emerges with a shared dedication to pursuing the greater good rather than the convenience of the individual and a universal commitment to ensuring optimal health for all people.
Thank you for the many sacrifices you are making to protect and care for children and families. You are the best of the best, and I am with you and for you.
Sally Goza, MD, FAAP
Dear AAP Member,
In response to the national emergency, Congress passed the Families First Coronavirus Response Act (FFRCA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Together, these laws provide more than $2 trillion to support the U.S. pandemic response and provide economic relief for businesses and workers, including pediatric practices. Below are some resources and programs that may be helpful to your practice. The AAP has published detailed guidance for all of these programs at AAP.org.
I encourage you to please consult your accountant, banker, financial advisor, or human resources consultant for additional guidance about the right business decisions for your practice.
Paycheck Protection Program
This new loan program provides federally guaranteed, forgivable loans of up to $10 million available to qualifying small businesses. These loans are available April 3 through June 30, 2020. Information on eligibility, amounts, forgiveness, terms of the loan and how to apply can be found at the Small Business Administration's (SBA's) website.
Economic Injury Disaster Loans and Loan Advance
The SBA's Economic Injury Disaster Loan program provides economic relief to businesses that are currently experiencing a temporary loss of revenue. Small businesses with fewer than 500 employees affected by COVID-19 are eligible. More information and application are available at the SBA's Disaster Loan Assistance web page.
Equipment and Infrastructure Grants for Health Care Providers
Health care entities, such as physician practices, that provide health care, diagnoses, or testing will be eligible for grants to pay for PPE, testing supplies, increased workforce training, emergency operation centers, and more. Additional guidance on the application process is expected soon.
Contact your state department of labor to learn more about economic supports that may be available to you or your practice. Search here to find and contact your state's small business administration office.
Employee Retention Credit for Employees Subject to Closure Due to COVID-19
Employers who are providing required paid sick or family leave wages to employees who are unable to work or telework due to certain circumstances related to COVID-19 may be entitled to a refundable tax credit. Learn more at the IRS FAQ: Employee Retention Credit under the CARES Act.
Paid Family and Sick Leave
Learn more at the Department of Labor COVID-19 website.
The U.S. Department of Labor supports an Unemployment Benefits Finder website that will connect you to resources in your state.
Member Affinity Programs
Detailed information on member affinity programs can be accessed at aap.org/memberadvantage.
- New Financing Program for AAP Members: The AAP has partnered with Bankers Healthcare Group, a direct lender, offering a variety of loan features, including a subsidiary who can assist members with the Paycheck Protection Program and other SBA 7(a) loans.
- Telehealth Medicine: The AAP has partnered with SnapMD to provide Virtual Care Management private-label telehealth software that allows a practice to brand their private telehealth solution and maintain the integrity of the medical home.
- Student Loan Financing: The AAP Insurance Program, in partnership with SoFi, offers members a way to reduce the cost of and consolidate student loans by refinancing, both federal and private. SoFi also is offering loan modification options for those directly or indirectly impacted by COVID-19 for their customers that may be available as a result of the CARES Act. Call 833-277-7634 or email firstname.lastname@example.org.
Vaccine Payment Advocacy
The Academy is closely monitoring the impact the COVID-19 pandemic is having on the national vaccine delivery system. This week we contacted all major manufacturers of child and adolescent vaccines asking each to consider implementing payment flexibilities for customers. Most have already put some payment term modifications into place; however, we are urging manufacturers to do more. Specifically, we are proposing that GSK, Merck, Pfizer, and Sanofi pause collections on vaccine invoices during the federal emergency and extend payment terms for customers by an additional 90-120 days following the lift of the federal emergency status.
The AAP will continue to work on identifying resources and advocating for our members to help you navigate the challenges of operating a practice during these challenging times. We are committed to sharing with you in the coming days additional information related to payment for vaccine purchasing, malpractice premiums and Public Health and Social Services Emergency Grants. In the meantime, I urge you to monitor AAP.org, which is continuously updated. Specific questions and comments can be emailed to COVIDemail@example.com.
Thank you for all you do for children.
Mark Del Monte, JD
CEO/Executive Vice President
Today, the Academy is launching a new virtual community for all of us to connect directly with one another about everything related to the novel coronavirus, from the impact on your practice to PPE to telehealth.
We have heard from many of you these past two weeks with questions and ideas about how to respond to the COVID-19 pandemic. As physicians, we are challenged by having to sort through too much information from many sources but not the right information we may need at the right time. We are trying to respond appropriately and adapt while there is unprecedented strain on our pediatric workforce.
Our new discussion board will facilitate direct peer-to-peer engagement, and I look forward to participating myself. Share your questions, helpful tips, practice pearls, clinical conundrums or just offer support and encouragement for all of us. In the discussion board you will find:
- Different topics, including: clinical care, diagnosis, PPE, practice management/payment, and telehealth
- A resource library to upload helpful resources you've come across that could help your colleagues
Please take a moment to log in and add your voice to this community. And let us know how it's working and what might be missing. Our goal is always to provide you with what you need most in this time of crisis, and we welcome your feedback.
Tomorrow is National Doctors' Day. In the midst of a global health pandemic, there could not be a more meaningful moment to recognize the doctors and medical professionals who are risking their lives to keep their patients and communities healthy. Happy #NationalDoctorsDay, and thank you for all you do!
We're all in this together.
Sally Goza, MD, FAAP
Like all of you, I am working to adapt my pediatric practice to the COVID-19 pandemic. We know resources are limited, particularly in personal protective equipment and testing, and financial challenges are mounting. We at AAP will continue to advocate at every level of government to support our members so you can do this critical work, on behalf of children and communities.
Despite the challenges, I am inspired and impressed by the ingenuity, passion and commitment of our members who are delivering care to children in these circumstances. Many of our colleagues have nimbly escalated the ability of their practices to offer telehealth care at unprecedented levels. We have provided support to families who are stressed and struggling with the new challenges of parenting during the pandemic. And, we have been on the front lines, serving our communities, often at great personal risk, because we are committed to making sure every child we care for is safe and healthy, no matter what.
Below are a few additional resources I'd like to share with you today:
- Here again is the new resource, AAP Guidance: Telehealth Payer Policy in Response to COVID-19, which outlines policy changes aiming to alleviate barriers to telehealth care. We also offer a webinar on telehealth and guidance on structuring your practice during the pandemic.
- The CDC has updated the priorities for testing patients with suspected COVID-19 infection. This guidance prioritizes health care professionals and first responders to receive testing. It also recommends more aggressive testing (even for milder cases) in communities where there are more COVID-19 hospitalizations.
- The CDC offers recommendations on maintaining children's immunizations and well-child visits during the pandemic.
- HealthyChildren.org has new articles with advice on formula shortages and information for families of children with special health care needs.
We are all doing the most important work of our lives. From the bottom of my heart, thank you.
Sally Goza, MD, FAAP
As we all adapt pediatric practice in response COVID-19, I have been amazed at how rapidly pediatricians in primary and subspecialty care have mobilized, continuing to provide care to children while maximizing social distancing to protect families. As part of this effort, many of you are now expanding your use of telehealth care or providing it for the first time.
We are here to help.
Specifically, 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 COVIDfirstname.lastname@example.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.
Sally Goza, MD, FAAP
Last Wednesday, 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 to increase the supply of personal protective equipment (PPE) for pediatricians in the hospital and ambulatory settings. We've heard from many of you on the front lines who are pleading for action as the pandemic spreads and shortages become acute. We share your alarm and join you in demanding urgent action from our leaders. We must make sure that you and all medical professionals caring for patients during this time are protected and prioritized. Tomorrow we will issue a call for action on PPE and we hope that all of you will take a moment to help us with this advocacy. Know that we will not relent until we see rapid, sweeping action to address this aspect of the crisis.
We will also be releasing new telehealth resources this week including a state-by-state guide to covered telehealth services. These resources are designed to help members access appropriate payment from public and private sources and will include practical tips across practice settings.
As many families enter week 2 (or more) of being isolated at home, we are increasingly mindful of the financial, emotional and other stresses that families may be facing. Research shows that when families are stressed, children are at an increased risk of being abused.
Today, AAP is offering advice for families about the importance of self-care for everyone in the household, including eating healthy, exercising, getting enough sleep, and maintaining social connections by phone, video, email or other ways. Because bored or frustrated children may be more likely to act out, we're offering positive parenting tips on HealthyChildren.org on effective discipline, including time-outs, redirection, positive attention and rewards. We also offer specific advice on coping with a new baby during COVID-19, when new parents may not have access to an extended network of friends and family for in-person support.
We know families are stressed, and we want to do whatever we can to protect children who may be more vulnerable. Please remain vigilant for injuries that could indicate a child needs protection. More information is available in an updated policy statement AAP is publishing today on Abusive Head Trauma in Infants and Children. You can read more in this news release and this AAP News article.
Thank you for all you do, every day, on behalf of children.
Sally Goza, MD, FAAP
As we continue to press on amidst the coronavirus pandemic, I wanted to focus today's message on an opportunity for us to spread some virtual joy and celebrate the next class of pediatricians who are matching across the country today.
Due to coronavirus, medical school graduations and match day ceremonies are canceled, so today's Match Day marks an especially opportune moment to let all newly matched pediatricians in training know that we are thrilled to welcome them to the pediatrics family. Indeed, this outbreak has reminded us all too well how vital our pediatric workforce is and how much they are needed.
Add Your Voice to Match Day Celebrations
Stay tuned for the official data later today from AAP News on how pediatrics fared in the annual match. In the meantime, on social media, I encourage you to share your sentiments using #FutureFAAP, especially on Twitter. I shared this video earlier today.
Feel free to share your own match day story, follow #FutureFAAP and engage with other pediatricians who are newly matched, or just offer support and virtual connection. It's also a chance to recognize and thank those on the front lines of the coronavirus pandemic.
New Communications to Support Social-Distancing
To reduce the impact of this virus and to help flatten the curve, we must urge our families and communities to practice social distancing. This new blog post by NIH Director Dr. Francis Collins explains why simply avoiding symptomatic people is not enough; in China, people with undetected symptoms were found to be responsible for 86% of confirmed cases. Comprehensive social distancing is our best chance now to slow the spread of the virus.
AAP offers a new article on HealthyChildren.org, "Working and Learning From Home During the Covid-19 Outbreak," that offers advice for parents on setting a daily schedule for children and connecting with friends and family while maintaining social distancing. I encourage you to share this broadly with your networks, so we can help parents manage this difficult time while keeping their families safe.
New Webinar on Disaster Preparedness Response
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 webinars on COVID-19 for you to watch at your convenience, including the one below just added to our resource page:
- Disaster Management for the Pediatrician in the COVID-19 Response: Utilizing preparedness principles to mobilize pediatricians to adapt protocols, learn new models, and serve as champions for children in a pandemic.
Sally Goza, MD, FAAP
I hope everyone is staying healthy and safe. I cannot tell you how proud I am of the pediatricians, pediatric medical subspecialists and pediatric surgeons on the front lines of the coronavirus pandemic working around the clock to protect your communities.
I want to assure you that during this uncertain time, we are in constant contact with state and federal leaders, we are updating clinical guidance to our members and we are keeping parents informed on how to navigate this new normal. Below are a few key updates and resources I wanted to share personally with you today.
Making our voice heard at the White House
Today, I joined by phone with leaders from other leading medical organizations to advocate for the Academy's coronavirus response priorities directly to President Trump. The administration was engaged and very grateful for all we are doing to care for children and families during this crisis.
Here's what I urged:
- Enable telehealth services for all patients by ensuring that Medicaid, CHIP and commercial payors cover care via video, phone, and email, to reach patients where they are – including in their homes. This includes paying for telehealth services at the same levels they would pay for face-to-face care.
- Support pediatricians' ability to care for children whether they are sick or well. That includes vaccines for preventable infectious diseases, so we don't have outbreaks of other illnesses.
- Take swift action to make more personal protective equipment available, including for ambulatory care providers.
- Ensure that any coronavirus vaccine or therapeutic is adequately tested and approved for use in children.
I left the meeting encouraged, but realizing it is our duty to keep children in the conversation with our leaders.
Having a seat at the virtual table matters, and we will not stop pushing for our priorities until we see them addressed.
Earlier today, we also sent a letter to Congress with the Children's Hospital Association and released joint recommendations with the Group of 6 frontline physicians, reiterating these asks and calling for Medicaid payment parity with Medicare. We'll keep sharing advocacy opportunities as Congress considers coronavirus response legislation.
Updating clinical guidance on well-child and sick visits
One question we've received from many of you is, how do we provide routine preventive and sick care during this pandemic? I am still seeing patients in my practice in Georgia, and this question is top of mind for me too. That's why I'm especially proud to share that today, we published recommendations to give you some best practices for how to care for your patients under these conditions. Some key takeaways are:
- Continue to offer well-child check-ups. Consider conducting well visits for newborns, and for infants and younger children who require immunizations, and rescheduling well visits for those in middle childhood and older to a later date.
- Be flexible. Consider modifying your clinical schedule and physical space to minimize risk. Increase capacity to deliver telehealth when possible.
What You Can Do
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 two new webinars on COVID-19. Watch them whenever is convenient for you:
- COVID-19 Pandemic – Clinical Guidance for Pediatric Practices: Strategies for pediatricians to increase infection control practices in their office to protect patients and health care workers.
- Talking to and Supporting Children During a Pandemic: Helping clinicians understand how to talk to and support children during the COVID-19 pandemic, including how to help parents talk to their children.
Look for an update soon on emergency actions related to telehealth services, including how to engage with your state Medicaid agency and other payors.
Consult our new parent resources: HealthyChildren.org has a constantly updated page on coronavirus and a new resource on social distancing. We also offer new tips for helping parents find ways to occupy children during these challenging times.
Thank you for all you do especially in this unprecedented moment. I will continue to be in touch as developments unfold. Until then, stay safe and continue to support one another.
Sally Goza, MD, FAAP
As COVID-19 continues to spread in communities, pediatricians can prepare to handle suspected cases in their patient population in the same way they prepare for other infectious disease outbreaks, such as influenza or RSV. The same principles apply:
- Keep children out of the health care system if it's not necessary
- Advise individuals to stay home if they are sick.
- Review infection-control measures. This can include asking patients with symptoms to call ahead, so they can be evaluated in isolation from other patients.
- 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.
We have also heard from members that children and adolescents in their practice have expressed fear and anxiety about the outbreak. Pediatricians can be a calm, reassuring voice that can help alleviate these fears.
As a general pediatrician myself who has been in practice through especially severe RSV and flu outbreaks, I understand how important it is to remain reassuring to worried parents, clear in my guidance and practical and transparent in my approach to talking to patients who are old enough to understand what's going on.
David Schonfeld, MD, FAAP, a member of the AAP Council on Disaster Preparedness and Recovery, recommends keeping the conversation straightforward and direct, while avoiding graphic details. More information is available in the HealthyChildren.org article on talking to children about disasters and other events in the news. He also offers advice specific to COVID-19 in this interview for CNN.
AAP also offers general information for parents on COVID-19 in the HealthyChildren.org article authored by H. Cody Meissner, M.D., FAAP. This article will be updated to reflect the most recent information as the outbreak evolves.
AAP continues to be in close communication with leaders at the Centers for Disease Control & Prevention. We are committed to providing you with updates and information about practice recommendations and infection-control measures as it is developed.
Updated information will also be posted on the Red Book Online Outbreaks page and in AAP News.
Sally Goza, MD, FAAP
American Academy of Pediatrics