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151103HealthcareReform1Health care reform has pushed primary care offices like Eugene Pediatrics to rapidly adapt to a multitude of new requirements aimed at improving patients’ health.

Under the new law, a portion of Medicare and Medicaid payments are withheld across the state of Oregon each year. That money is then awarded to individual Coordinated Care Organizations and clinics within those regions, based on “quality metrics” performance, which is determined by the Oregon Health Authority. The same process is happening in every other state in the U.S.  

Eugene Pediatrics has remained a top performing pediatric clinic in our region. What’s our secret? We spent a great deal of time, money and effort to hire new staff, update our computer systems and develop work flows to support the new requirements.  

But the process of improving health care, according to these quality measures, is hitting an interesting roadblock. Under the new law, doctors and hospitals are now judged on their ability to get patients to comply with the medical advice they are given. If they don’t, the payments clinics receive for their services are docked.

Let me give you an example: We know from well-designed research studies that if a parent is hesitant about vaccinating their child, a physician’s advice often fails to change that. So, it is no surprise that nearly one third of the families who come to Eugene Pediatrics do not follow our advice on immunizing their kids. Because of that, our “quality” profile and associated payments will suffer.

If doctors cannot meet the requirements, they are deemed a lower quality clinic and receive fewer reimbursements from insurance. Ultimately, that means they struggle financially to keep their doors open. Or, in an attempt to minimize their losses, some physicians could ask non-compliant patients to leave the practice. In both scenarios, patients may soon find fewer places that will offer them care. If clinics close or patients are “fired,” nobody wins—and a system meant to improve health care will have failed.  

I will be the first to say that I do not have all the answers, but I will ask the tough questions: How can we grapple with the ethical dilemmas created by health care reform? What happens when the rights of an individual to choose how to manage his or her health runs contrary to the health of the larger community? How can we support all patients without being penalized for trying to help those who might not always want to do (or have the capacity to do) what’s best for their health?  

This is an interesting time to be a doctor, certainly unlike any era of health care I have seen in my decades as a pediatrician. But there’s one thing I can guarantee—your physicians at Eugene Pediatrics are working hard, within the framework of health care reform, to demonstrate our quality to the State Health Authority, to private insurers, and most of all to you, our patients and families.

We are dedicated to helping every child be well. We want to partner with families and provide individualized care in a way that puts kids on a path to good health. Without you, we have no purpose.

Posted by on in News
140924EPA domesticviolence-smPrevention of domestic violence starts with how we raise our kids. As parents, we must step up and take this strong stand with our kids: Hitting another human being is wrong. Every time. And if someone hits you, the right thing to do is run the other way and get help to protect yourself from that person. Don’t return and be hit again.

I am a huge football fan, but the recent Adrian Peterson and Ray Rice headlines have made my stomach turn. But they have proven to be a superb teaching moment at our home. If you have teenage children, sit down with them and watch the YouTube video of Ray Rice in the elevator. Let your teens share their reactions while you listen.

Then tell them your own reactions and beliefs. Here is how that exercise went at our house:

Jack, age 16: “There’s nothing manly about that, Mom. It’s disgusting.”
Liesl, age 13: “How did he know he didn’t kill her, and how could he do that if he loved her?”

My responses:
“Jack, the biological fact is that men are generally bigger and stronger than women, which means they have an extra obligation to keep women safe. If you are ever so mad that you cannot find words, your dad and I expect you to walk away. We believe it’s wrong for any human being to hit another. Ever. If I ever hear that you hit a woman, I will tell her to walk away from you and never come back.”

“Liesl, it’s always wrong for women to be hit. They never deserve it. If any guy ever lays a finger on you when he’s angry, walk away and don’t ever go back, no matter what he says after he’s done being angry. And tell your dad, or me, or the cops, or a friend that you trust.”

Thanks, Ray Rice, for giving every parent in America the perfect chance to teach our kids that hitting is always wrong.

140415EPA TeacherMeetingPart2 finalThe school experience. It is obviously an important one for your child and affects all aspects of a child’s life, including health. We hear a lot about the school experience at Eugene Pediatrics.

Part 1 of this two-part blog series reviewed steps to take before meeting with teachers or school officials when you have concerns.

Here you’ll find tips on preparing for the meeting and handling it to encourage the best outcomes possible.

  1. Start with the teacher, not the principal. If your input about your child’s education is needed, start the conversation with your child’s teacher. Don’t go straight to the school or district administration unless it’s an extraordinary situation. If you feel for some reason that the principal needs to be involved at the outset, when sharing your concern with the teacher, let the teacher and principal know ahead of time that you’d like to meet with the both of them.
  2. Write your concerns down. Prepare your list of concerns ahead of time by writing them out. This will help you stay focused and avoid getting emotional.
  3. Bring supporting documents. Bring tests, homework samples or whatever other documents you have to help kick-start the conversation.
  4. Ask and listen. Before you dive deeply into your concerns, ask teachers for their input and listen closely. It happens quite often that the entire issue is one of a simple miscommunication between teacher and student and can be fixed easily.
  5. Try to leave the meeting with an action plan — and a handshake or hug. Try to agree on steps both the teacher and child can take to improve the problems. Leave the meeting with good feelings so that everyone wins.
  6. Request additional help. If questions arise regarding your child’s ability to do the schoolwork, ask for a meeting with the school psychologist to talk about formal testing. This is a key step in developing an appropriate Individualized Education Plan for your child.
  7. Close the loop with your child. After meeting with the teacher, tell your child what happened in an age-appropriate way. Focus on the good outcome you and the teacher reached. Tell your child what steps you and the teacher feel they can take to help things improve.
  8. Conduct weekly check-ins. Check in weekly with your child and the teacher until you are convinced the issue is resolved.

Everyone — you, your child, the teachers and your pediatricians — wants the same thing, for your child to be happy and successful at school. Constructive steps focused on a collaborative approach enable you to support your child as best as possible throughout the school experience.

Please talk to you providers at Eugene Pediatrics if you need help regarding school issues and your child.

140303EPA vaccinationblogA front page article Friday in The Register-Guard highlighted a new law that went into effect March 1 requiring all children who attend school either be vaccinated or have a parent produce evidence that they have been educated about vaccines and still chose not to vaccinate.

Proof of exemption can include a form signed by your child’s physician and a certificate obtained by watching an online education module produced by the State of Oregon about vaccines.

Here is some information I want to share on the new vaccine exemption process:

  • Your pediatricians at Eugene Pediatric Associates believe strongly that vaccinating kids saves lives. We have all seen firsthand the impact of vaccine-preventable diseases on kids. Dr. B vaccinated her own precious children based on many years of experience and confidence in the safety and efficacy of childhood shots.
  • We welcome your questions about shots during your visits at Eugene Pediatrics. You can also read information on vaccines on our website under both the Vaccines and the Resources sections.

131112epa-parentteacherconferenceAutumn leaves falling each year herald an annual ritual: the first parent-teacher conferences at school. Starting in preschool and through high school, these opportunities to sit face to face with the educators who spend a lot of time working with our kids can be invaluable. Here are some suggestions to help you get the most out of the conferences:

  • Be sure to attend, and both parents, if possible. It’s easy to get busy and skip conferences, but it’s important your child and the teacher see you care enough to take the time.
    Be open to both the good and the constructive feedback. Don’t be upset if you hear that your child isn’t perfect. Nobody is! 
  • Be ready with a few questions. If you don’t know where to begin, try these:

“What are her best attributes as a student?”
“What do you think she needs to work on?”
“How can I support his education at home?”