February 2, 2016 Progress Notes
In this Edition:
- Flu Season Begins: Severe Influenza Illness Reported
- 2016 Physician Guide for the Louisiana WIC Program
- 2016 immunization schedules include several updates
- Department of Health and Hospitals outlines $131 million in cuts to meet anticipated budget shortfall
- PAR Releases Plan to Control State Spending
Progress Reports 2016
- DHH and MCOs to Co-host Noon Provider Calls
- Bayou Health Informational Bulletins
- Health Plan Advisories
- Happy February Birthdays
- Welcome New Members
- SUDIA Recipe: Couscous with Tomatoes, Spinach and Two Cheeses
- Red River Potpourri | 8/19-21/16 | Shreveport, LA
This is a message from the Louisiana Department of Health and Hospitals Emergency Operations Center (DHH EOC). To remain current on newly released information about the 2015/2016 Influenza Season, visit the Centers for Disease Control and Prevention (CDC) website at http://www.cdc.gov/flu/
Influenza activity is increasing across the country and CDC has received reports of severe influenza illness. Clinicians are reminded to treat suspected influenza in high-risk outpatients, those with progressive disease, and all hospitalized patients with antiviral medications as soon as possible, regardless of negative rapid influenza diagnostic test (RIDT) results and without waiting for RT-PCR testing results. Early antiviral treatment works best, but treatment may offer benefit when started up to 4-5 days after symptom onset in hospitalized patients. Early antiviral treatment can reduce influenza morbidity and mortality.
Since October 2015, CDC has detected co-circulation of influenza A(H3N2), A(H1N1)pdm09, and influenza B viruses. However, H1N1pdm09 viruses have predominated in recent weeks. CDC has received recent reports of severe respiratory illness among young- to middle-aged adults with H1N1pdm09 virus infection, some of whom required intensive care unit (ICU) admission; fatalities have been reported. Some of these patients reportedly tested negative for influenza by RIDT; their influenza diagnosis was made later with molecular assays. Most of these patients were reportedly unvaccinated. H1N1pdm09 virus infection in the past has caused severe illness in some children and young- and middle-aged adults. Clinicians should continue efforts to vaccinate patients this season for as long as influenza viruses are circulating, and promptly start antiviral treatment of severely ill and high-risk patients if influenza is suspected or confirmed.
1. Clinicians should encourage all patients who have not yet received an influenza vaccine this season to be vaccinated against influenza. This recommendation is for patients 6 months of age and older. There are several influenza vaccine options for the 2015-2016 influenza season (seehttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm), and all available vaccine formulations this season contain A(H3N2), A(H1N1)pdm09, and B virus strains. CDC does not recommend one influenza vaccine formulation over another.
2. Clinicians should encourage all persons with influenza-like illness who are at high risk for influenza complications (see list below) to seek care promptly to determine if treatment with influenza antiviral medications is warranted.
3. Decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza. Clinicians using RIDTs to inform treatment decisions should use caution in interpreting negative RIDT results. These tests, defined here as rapid antigen detection tests using immunoassays or immunofluorescence assays, have a high potential for false negative results. Antiviral treatment should not be withheld from patients with suspected influenza, even if they test negative by RIDT; initiation of empiric antiviral therapy, if warranted, should not be delayed.
4. CDC guidelines for influenza antiviral use during 2015-16 season are the same as during prior seasons (seehttp://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm).
5. When indicated, antiviral treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. Clinical benefit is greatest when antiviral treatment is administered early. However, antiviral treatment might still be beneficial in patients with severe, complicated, or progressive illness, and in hospitalized patients and in some outpatients when started after 48 hours of illness onset, as indicated by clinical and observational studies.
6. Treatment with an appropriate neuraminidase inhibitor antiviral drugs (oral oseltamivir, inhaled zanamivir, or intravenous peramivir) is recommended as early as possible for any patient with confirmed or suspected influenza who
a. is hospitalized;
b. has severe, complicated, or progressive illness; or
c. is at higher risk for influenza complications. This list includes:
o children aged younger than 2 years;
o adults aged 65 years and older;
o persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
o persons with immunosuppression, including that caused by medications or by HIV infection;
o women who are pregnant or postpartum (within 2 weeks after delivery);
o persons aged younger than 19 years who are receiving long-term aspirin therapy;
o American Indians/Alaska Natives;
o persons who are morbidly obese (i.e., body-mass index is equal to or greater than 40); and
o residents of nursing homes and other chronic-care facilities.
7. Antiviral treatment can also be considered for suspected or confirmed influenza in previously healthy, symptomatic outpatients not at high risk on the basis of clinical judgment, especially if treatment can be initiated within 48 hours of illness onset.
8. Clinical judgment, on the basis of the patient’s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for outpatients.
9. While influenza vaccination is the best way to prevent influenza, a history of influenza vaccination does not rule out influenza virus infection in an ill patient with clinical signs and symptoms compatible with influenza. Vaccination status should not impede the initiation of prompt antiviral treatment.
Seasonal influenza contributes to substantial morbidity and mortality each year in the United States. In the most recent influenza season—the 2014-2015 season—CDC estimates that there were approximately 19 million influenza-associated medical visits and 970,000 influenza-associated hospitalizations . The spectrum of illness observed thus far during the 2015-2016 season has ranged from mild to severe and is consistent with that of other influenza seasons. Although influenza activity nationally is low compared to this time last season, it is increasing; and some localized areas of the United States are already experiencing high activity. Further increases are expected in the coming weeks. Typically, influenza seasons begin with increases in influenza-like-illness and the percent of respiratory specimens testing positive for influenza in clinical laboratories. Those indicators are rising at this time. Increases in severity indicators tend to lag behind. At this time, national surveillance systems that track severity are not elevated, but CDC will continue to watch for indications of increased severity from influenza virus infection this season.
Laboratory data so far show that most circulating flu viruses are still like the viruses recommended for the 2015-2016 influenza vaccines. CDC will continue to monitor circulating influenza viruses for changes that might impact vaccine effectiveness and publish these data weekly in FluView (http:/www.cdc.gov/flu/weekly/summary.htm). CDC also is conducting epidemiologic field studies to determine vaccine effectiveness this season.
It is not too late to obtain influenza vaccination for this flu season. Vaccine is still available at community pharmacies, doctors offices, and local public health units. Visit www.fighttheflula.com for more information.
2016 Physician Guide for the Louisiana WIC Program
2016 immunization schedules include several updates
by H. Cody Meissner, M.D., FAAP
The 2016 immunization schedules for children and adolescents from birth through 18 years of age include several changes from last year, including updated recommendations for the human papillomavirus (HPV) and meningococcal B vaccines.
The schedules are approved annually by the Academy, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists to reflect current recommendations for use of vaccines licensed by the Food and Drug Administration.
The 2016 format is similar to last year and includes a single schedule for people from birth through 18 years of age. A catch-up schedule provides recommendations for children and adolescents who start late or are more than one month behind.
Footnotes contain recommendations for routine and catch-up vaccination as well as for vaccination of children and adolescents with high-risk conditions or in special circumstances. Providers are encouraged to use figures, tables and footnotes together.
The schedules are available at www.cdc.gov/vaccines/schedules/index.html and will be published in the March issue of AAP News. The AAP policy statement Recommended Childhood and Adolescent Immunization Schedule — United States, 2016 is available at www.pediatrics.org/cgi/doi/10.1542/peds.2015-4531 and will be published in the March issue of Pediatrics.
Providers should be aware that changes in recommendations for a specific vaccine may occur between annual updates to the immunization schedule and will be posted on Red Book Online,http://redbook.solutions.aap.org/SS/Immunization_Schedules.aspx, and the CDC website,www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html.
In addition, the CDC website includes tables (job-aids) to clarify recommended use of Haemophilus influenzaetype b, pneumococcal and pertussis-containing vaccines as a function of age, the number of doses previously administered and the time interval since the last dose.
Here is a closer look at the changes to the 2016 immunization schedule:
- The order of vaccines has been changed to group vaccines by recommended age of administration. The order of footnotes also has been changed.
- A purple bar was added for Haemophilus influenzae type b vaccine for children ages 5 through 18 years to denote the recommendation to vaccinate certain unimmunized high-risk children in this age group.
- A purple bar has been added for HPV vaccine for children starting at 9 years of age with a history of sexual abuse.
- A new row has been added for meningococcal B vaccine. A purple bar indicates the recommendation to vaccinate certain high-risk people ages 10 years and older. A blue bar indicates the recommendation for permissive administration to non-high risk groups subject to individual decision-making for those 16 through 18 years.
- In the catch-up schedule, Tdap/Td was added to the list of possible previous vaccines in the Tdap line for children ages 7 years and older, dose 2 to dose 3 column.
Changes to the 2016 footnotes include:
- The hepatitis B vaccine footnote was revised to present the timing for post vaccination serologic testing for infants born to hepatitis B surface antigen positive mothers.
- The DTaP footnote was clarified to present recommendations following an inadvertent early fourth dose of DTaP vaccine.
- The inactivated polio vaccine footnote was updated to provide guidance for vaccination of people who received only oral polio vaccine and received all doses before 4 years of age.
- The footnotes for the meningococcal vaccines were updated to include recommendations for administration of the meningococcal B vaccine.
- The HPV footnote has been updated to reflect the 9-valent nomenclature (9vHPV). Guidance has been added for vaccination beginning at 9 years of age for children with a history of sexual abuse, recognizing their increased risk of HPV infection.
Reporting adverse events
Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS). Guidance on how to obtain and complete a VAERS form is available atwww.vaers.hhs.gov or by calling 800-822-7967. Additional information can be found in the 2015 Red Book and at Red Book Online, http://bit.ly/1KA2YjK.
Dr. Meissner is professor of pediatrics at Floating Hospital for Children, Tufts Medical Center. He also is an ex officio member of the AAP Committee on Infectious Diseases and associate editor of the AAP Visual Red Book.
Department of Health and Hospitals outlines $131 million in cuts to meet anticipated budget shortfall
Wednesday, January 27, 2016 | Contact: Media & Communications: Phone: 225.342.1532, E-mail:email@example.com
Today, the Department of Health and Hospitals (DHH) submitted a plan to the Division of Administration that outlines how $131 million in cuts would be spread across the Medicaid program to address the current budget shortfall. DHH Secretary Rebekah E. Gee, MD, MPH said cuts of this magnitude are a worst-case scenario and would only be implemented if the Legislature failed to find additional revenues to address this year’s anticipated shortfall.
“We have outlined two options that will reduce Medicaid spending,” Gee said. “The reality is both plans will have a catastrophic impact to those served by Medicaid; insurance companies who administer the Bayou Health Plan, hospitals and other providers, and to the patients and people with disabilities who rely on Medicaid for their health care.”
DHH developed two reduction plans, one that targets seven specific programs and a second option that eliminates all optional Medicaid programs. Both plans cut $131 million in state funds. In addition, because these state funds attract federal matching dollars, the total impact of both plans are $346.5 million.
Under Option One, the proposed reductions are as follows:
- Public-Private Partnerships – Reduce spending on the Public-Private Partnerships by $119.1 million in state funding. This equals a $315 million total reduction when federal matching funds are lost. The reductions will be as follows:
– Eliminate $45 million in state funding ($119.1 million total) in supplemental payments to the partner hospitals that were included in the 2016 Appropriations Act.
– Eliminate an additional reduction of $9.5 million ($25 million total) to the New Orleans partner hospital in its supplemental payments that were included in the 2016 Appropriations Act.
– Further reduce the payments to partner hospitals by 12.7 percent. This reduction is $64.6 million in state dollars, $170.9 million total.
- Reduce Payments to Bayou Health Insurers – This represents a reduction in the per member per month payments to Bayou Health. The reduction is $10.4 million in state funds, $27.4 million total.
- Eliminate the Pediatric Day Health Care Program – This program serves 612 medically fragile children between the ages of birth to their 21st birthday. It is anticipated that these services could be continued by other Medicaid providers or by school districts. The reduction is $1.6 million in state funds, $4.2 million total.
Under Option Two, the following programs would be eliminated:
- Reduce Payments to Bayou Health Insurers – This is the same reduction outlined in Option One; $10.4 million in state funds, $27.4 million total.
- Pediatric Day Health Care Program – This is the same reduction discussed under Option One; is $1.6 million in state funds, $4.2 million total.
- Hospice Program – Impacts 6,282 hospice recipients. State savings of $200,000, total reduction of $600,000.
- Children’s Choice Waiver – Impacts 1,227 children with developmental disabilities who receive community-based services. State savings of $1.2 million, total reduction of $3.2 million.
- Adult Day Health Care Waiver – Impacts 900 people who currently receive community-based services as an alternative to nursing home care, and another 4,000 people who are on the waiting list for these services. State savings of $700,000, total reduction of $1.8 million.
- Residential Options Waiver – This is a program that serves 26 people who are former long-time residents of adult foster care but who now receive home-based care. State savings of $100,000, total reduction of $300,000.
- PACE Program – PACE is the Program for All-Inclusive Care for the Elderly. PACE offers health care and social services to nursing home-eligible seniors in an adult day care environment. The program currently serves 235 seniors and has a maximum capacity of 600 participants. State savings of $1.2 million, total reduction of $3.1 million.
- Supports Waiver – This program provides specific, activity-focused services to individuals with disabilities in their homes. The program will impact 1,739 people currently receiving services as of January 2016. State savings of $1.2 million, total reduction of $3.2 million.
- Long Term Personal Care Services – This service provides hands-on assistance with basic self-care tasks such as eating, bathing, dressing, grooming, and toileting to low-income elders and people with adult-onset disabilities. Elimination of this program will impact more than 17,300 recipients. State savings of $16.6 million, total reduction of $44 million.
- Community Choices Waiver – This is the primary home and community-based waiver program serving as an alternative to nursing facility care for seniors and people with adult onset disabilities. As of November 2015, there were 5,581 people in the program and another 33,000 individuals on the waiting list. State savings of $10.8 million, total reduction of $28.7 million.
- Intermediate Care Facilities – These are institutions that serve people with developmental disabilities in a 24-hour managed care environment. Elimination of this program will impact 4,914 recipients currently receiving services. State savings of $24.9 million, total reduction of $66 million.
- NOW Waiver – The New Opportunities Waiver (NOW) allows people with developmental disabilities to be served in community and home based settings instead of an institution. Elimination of this program will impact 8,686 people currently receiving services. State savings of $42.7 million, total reduction of $113 million.
- Ambulatory Surgical Center Program – Provides day surgery procedures to an estimated 16,172 recipients. State savings of $200,000, total reduction of $500,000.
- Hemodialysis Program – Provides free-standing End Stage Renal Disease services to 5,904 recipients. State savings of $3.3 million, total reduction of $8.82 million.
- Prescription Limits in Adult Pharmacy Program – Medicaid pays for prescription drugs for Medicaid beneficiaries with a limit of four prescriptions per patient (recipient) per calendar month. But, there is an option to get more prescriptions under the “medically necessary override” provision. Eliminating this provision is expected to save $15.9 million in state funds, and $42.1 million total.
In addition to these two options, the Department might also consider a combination of some reductions and program eliminations to achieve the necessary savings.
“Both of these options are worst-case scenarios that we hope will not have to be implemented. The Department has always worked to address the yearly budget shortfalls without cutting provider fees and by minimizing program impacts by using various internal solutions. However, this year’s budget reality is monumental, and the potential cuts and their results are staggering,” said Gee. “If this reduction plan becomes a reality, its impact will be felt by almost all residents. Vital health care services across Louisiana will be completely eliminated or diminished if additional revenue is not identified in the upcoming special session.”
Read online at: http://www.dhh.state.la.us/index.cfm/newsroom/detail/3695
PAR Releases Plan to Control State Spending
The Public Affairs Research Council of Louisiana released a report and proposals to help control the state budget. PAR recommends the governor and legislators submit strong and specific assurances for budget cuts, controls and cost containments prior to approving tax increases.
Click here for full report.
House Chairmanships Announced
Foil, Vice Chair
HEALTH & WELFARE
Willmott, Vice Chair
Thibaut, Vice Chair
For all other committee assignments, please visit:http://house.louisiana.gov/H_Reps/H_Reps_StandCmtees.aspx
Medicaid/ Bayou Health
DHH and MCOs to Co-host Noon Provider Calls
Beginning Feb. 1, 2016, the noon provider calls will follow a new format. To continue to offer support to providers during the integration of mental health and substance use services into Bayou Health, the Department of Health and Hospitals (DHH) will co-host the calls with the Managed Care Organizations (MCO). The calls will take place Monday through Friday with a different MCO each day during the month of February. The calls will allow DHH to continue to keep providers up to date with announcements and will allow providers to make comments or ask the MCOs questions. If you email your questions or comments firstname.lastname@example.org before the calls, Medicaid will forward your email to the appropriate MCO. This will allow the MCOs time to prepare a response. All provider types are welcome to participate on the calls. The call schedule will be as follows:
• Monday – Aetna
• Tuesday – Amerigroup
• Wednesday – AmeriHealth Caritas
• Thursday – Louisiana Healthcare Connections
• Friday – United Healthcare
All calls will take place from noon until 1 p.m. The call-in information is as follows:
Call-in #: 1-888-636-3807
Access Code: 1133472
– – – – –
Bayou Health Informational Bulletins for Providers
Informational Bulletins cover a variety of topics related to Bayou Health, and all are available here.
– – – – –
Health Plan Advisories
Health Plan Advisories are available at http://new.dhh.louisiana.gov/index.cfm/page/1734
|2/1 Jessica Simone Butler
2/1 John J Chiosi, MD
2/2 Jane Everist, MD, FAAP
2/2 Kenneth Wayne Falterman, MD, FAAP
2/2 Carmen S Payne, MD, FAAP
2/2 Keren Elizabeth Ray, MD, FAAP
2/4 Sherry Gu, MD
2/4 Robert Stewart, MD, FAAP
2/5 Juan M Bossano, MD, FAAP
2/5 Mallory J Hitt
2/5 Elizabeth Phillips DrMedSc
2/6 Kimberly Michelle Stewart, MD, FAAP
2/7 Joanna Cross-Call, MD
2/7 Jonathan Wallace Gurr, MD
2/7 Spandana R Induru
2/7 Davis Ogitani, MD
2/8 Heather Baskind, MD
2/8 Jennette S Bergstedt, MD, FAAP
2/8 Donald Faust
2/8 Mackey Sugar Quinlan, MD, FAAP
2/9 Flora Finch-Cherry, MD, FAAP
2/9 Abigail Leathe
2/9 George James Schwartzenburg, MD, FAAP
2/10 Emily Simon, MD, FAAP
2/11 Madhuri D Dixit, MD, FAAP
2/12 Claire Cali Neumann, MD, FAAP
2/12 Janice Neill Nugent, MD, FAAP
2/13 Richard Warren Pratt, MD, FAAP
2/14 Liza Maria Melendez, MD, FAAP
2/14 William Lamar Morgan, MD, FAAP
2/14 Charla Nicole Poole
|2/15 Farrah Ricks Huval, MD, FAAP
2/15 Kimberly Mukerjee, MD
2/16 Stephen Epps, MD
2/16 Casey McAtee, MD, FAAP
2/17 Wanda Henderson Thomas, MD, FAAP
2/18 Kimberly Ann Cooper, DO
2/18 Charles W. Daniel, MD
2/19 Shannon Palombo, MD
2/20 Susan Melinda Bankston, MD, FAAP
2/20 Richard Kelt III, MD
2/21 Carolyn Forgey Green, MD, FAAP
2/21 Thomas Kazecki, MD
2/21 Ethan Rosenblatt
2/21 Rajini Yatavelli, MD
2/22 Laura Marie Boudreaux, MD, FAAP
2/22 Amanda Marie Glinky
2/22 Emily Klepper, MD, FAAP
2/22 Alice Madani, MD
2/22 Do_Quyen Pham
2/23 Quynh Tran Dang, MD, FAAP
2/23 Natalie Ball Evans, MD, FAAP
2/23 Monica LaRose Haynes , MD, FAAP
2/25 Sarah Marie Wilks, MD
2/27 Kieran Leong, DO
2/27 Jonna Marret, DO
2/27 Alicia Ortiz
2/27 Emily Brown Vigour, MD, FAAP
2/27 Scott Rory Zander, MD, FAAP
Please join us in welcoming our newest member to the LA Chapter of the American Academy of Pediatrics. There is strength in numbers
and we are so glad you have chosen to add your voice to the more than 700 Louisiana Chapter members who are speaking out on behalf of the
Children of Louisiana and the profession of Pediatrics.
Ulana Pogribna, MD, FAAP
SUDIA Recipe: Couscous with Tomatoes, Spinach and Two Cheeses
Top flavored couscous with spinach and tomatoes and sprinkle with cheese for an easy meatless entrée. Use any flavor of couscous you prefer.
Yield: 6 servings
Preparation time: 10 minutes
Cook Time: 20 minutes
Source: Cabot Creamery
3 1/2 cups packaged couscous
1 (8-ounce) can Italian-style diced tomatoes
1/2 small red onion, sliced into rings
1 tablespoon minced garlic
1/2 teaspoon olive oil
10 cups fresh spinach (about 10 ounces)
1 tablespoon water
1 1/2 cups grated Cabot 50% Light Cheddar cheese
3 tablespoons grated Parmesan cheese
Fresh basil (optional)
Prepare couscous according to package directions. Heat tomatoes in small saucepan or in microwave oven.
In large skillet, combine onion, garlic and oil; cook over medium heat until onions are heated and fragrant, stirring often.
Add spinach and water; cook 2 minutes until spinach is wilted and tender, but still bright green.
On large platter, layer couscous, spinach and tomatoes. Sprinkle with Cheddar and Parmesan cheese and garnish with basil, if desired.
For more information and recipes visit www.southeastdairy.org
Red River Potpourri
August 19-21, 2016
Shreveport Convention Center
Registration details will be forthcoming
Call us for more information 337.988.1816
Red River Potpourri is presented by The Louisiana Chapter of the American Academy of Pediatrics
For all the latest updates, go to: www.laaap.org/2016potpourri