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MNAAP Newsletter

Coverage, Coding and Billing for Pediatric Obesity Services

By Jessica Larson, MD, Co-Chair of MNAAP’s Pediatric Obesity Work Group and Pediatrician at Fairview Clinic in Elk River; Russ Kuzel, MD, Senior VP and CMO at UCare; and Megan Ellingson, MHA, Consultant to the Minneapolis Health Department

In 2012 the Minnesota Partnership on Pediatric Obesity Care and Coverage (MPPOCC) set out to better understand clinics’ experiences obtaining reimbursement for pediatric obesity services, and to provide guidance on best practices and coverage.

Led by MNAAP and the Minnesota Council of Health Plans, this group is dedicated to improving pediatric obesity care and coverage by identifying effective referral pathways and advocating for reimbursement for necessary, evidence-based services.

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Consumers Can Now Rely on Gluten-Free Label

By Sarah Jane Schwarzenberg, MD, FAAP, Pediatric Gastroenterologist and Hepatologist at University of Minnesota Masonic
Children’s Hospital and member of AAP’s Committee on Nutrition

As of August 5, 2014, any food product manufactured in the United States that bears the “gluten-free” claim on its label must meet new and more restrictive rules. Gluten is a group of proteins that are found in wheat, rye, barley, and some other grains.

The Food and Drug Administration has now defined the “gluten-free” as having less than 20 ppm in foods that carry this label. This is the lowest level of gluten that can be detected using currently available tools. The same standard applies to foods labeled “without gluten,” “free of gluten” and “no gluten.”

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Pediatric Residency Programs Collaborate to Improve Physical Activity Policies in Early Childhood

By Leslie King-Schultz, MD, MPH, chief resident, Mayo Clinic Pediatric Residency program

More than three-quarters of Minnesota children age 0-5 are enrolled in childcare centers. As with the rest of the population, this demographic is also experiencing a rise in the rate of obesity. In fact, among low-income preschoolers, 30 percent are considered overweight or obese. As concerned pediatricians-in-training, the University of Minnesota and the Mayo Pediatric Residency programs teamed up to improve physical activity in daycare centers in Minneapolis and Rochester through the Move2Grow project, funded by a Healthy Active Living grant from the American Academy of Pediatrics. Most pediatric residents have limited knowledge of childcare environments and the challenges that childcare providers face in offering high quality care, including adequate physical activity opportunities. This project afforded residents the chance to become familiar with childcare centers in the context of promoting child health. Using pediatric obesity as a platform for community engagement, the project aimed to develop residents’ skills in advocacy, inspire interest in life-long activism, and impact child health on a community level.

Through the Move2Grow project, leadership teams of residents and faculty from each program in partnership with the Minnesota Chapter of the AAP identified childcare centers in each community interested in improving physical activity within the center. The University of Minnesota chose four distinct centers in different regions of the city. The Mayo residency partnered with the largest Head Start center in Rochester. Teams of residents visited the centers periodically throughout the academic year, serving as coaches for the teachers in the classroom to achieve the goals they set at the start of the year. At Mayo, residents also visited the centers to observe and participate in a typical day. At each site, the residents helped lead a parent night to share the messages about healthy lifestyles including adequate physical activity with parents. Additionally, the residents helped craft new physical activity policy statements for the centers to incorporate into their existing policies.

In total, 51 residents from both programs participated in the project. In comparing pre and post-survey responses, residents reported increased confidence in counseling families regarding physical activity guidelines. They also demonstrated increased self-efficacy with regards to community engagement and policy activities with more residents feeling prepared to work at the community level to impact child health. In addition, more residents reported interest in public health, health policy, and community advocacy after participating in the project. Overall the centers really enjoyed having residents in the classrooms. The residents were most helpful in sharing resources with the teachers to help parents improve activity levels at home. The teachers felt the parent nights were very helpful, with fun shared by all.

Pediatricians have a responsibility to promote child health not only at an individual level, but also at a community level. The Move2Grow project gave pediatric residents in Minnesota a better understanding of the childcare setting and its important role in supporting child well-being. The project began relationships between residents and childcare centers which will continue to grow with new projects in coming years. At the same time, residents gained important skills to become stronger and more confident child advocates through community engagement in their future careers.

Working Outside Clinic Walls: A Case Study in Vida Sana Minneapolis

By Julie Boman, MD, FAAP, pediatrician at Children’s Hospitals and Clinics of Minnesota

As pediatricians, we are well-versed in the rising rates of obesity among children over the past fifty years. Childhood obesity is theoretically a simple disease to treat: eat less, move more. But as most of us know, simple theories are often hard to put into practice when the underlying causes happen far from the exam room.

Statistics show that childhood obesity rates among certain minority groups are substantially higher than among white children. My practice at Children’s Hospitals and Clinics in Minneapolis has a high percentage of Latino children and we see obese children much too often. I saw an opportunity to do something slightly different than the usual office visit and follow up that I’d like to share with you.

In January of 2012 I asked the Minnesota Chapter of the American Academy of Pediatrics (MNAAP) to help me in applying for a small grant through the National Institute for Children’s Healthcare Quality (NICHQ) to reach out to local overweight/obese Latino children and their families. We were awarded a small start-up grant that gave us the seed money to get the ball rolling.

Our goal was to create a program that connected Latino families to people who could help them avoid — or reduce — obesity.  We wanted a program that got everyone involved — moms and dads and children — and we wanted to include community groups that had gained the trust of Latinos, such as CLUES (Comunidades Latinas Unidas en Servicio), the Waite House, the Minneapolis Park and Recreation Board, the University of Minnesota Extension Service and the YWCA.

The following summer we began spreading the word about this new program. We started our first classes with just a handful of people. Today these classes are overflowing with 80 people or more. Once a week families gather at a large meeting hall at the Waite House. They dance to Zumba; they create healthy meals and learn about real-world portion size; they measure and track their BMI; they discuss ways they can eat better and move more. If you were to visit one of these gatherings, you’d find it doesn’t look like a normal doctor’s office. It is a community based extension of the office visit.

So far, the early results are encouraging. More than 100 Latinos have gotten involved with Vida Sana on a regular basis.  Most of the adults and children have BMIs in the overweight or obese category, but many are seeing changes in their BMI in addition to changes in health habits.

Finally, and perhaps most importantly, we’re doing a better job of reaching a patient group that has been difficult to reach using traditional office visit  medicine.