2002 Annual Meeting on Successful Statewide
Early Hearing Detection and Intervention Programs
- Roundtable Summaries -

Roundtable Topic: Effective strategies for linking EHDI to the Medical Home provider
Session: 2:45 PM
Moderator: Betty Vohr, MD (RI)

Summary

Facilitator: Betty Vohr, MD (RI)
Recorder: Ellen Kurtzer-White, MS CCC-A (RI)

Participants: Leslie Frederick (IL),Sunnah Kim(IL), Kathy Michal (WI), Tom Truman (FL), Dolores Orfanafis (OR),Tom Young (NC), Julie Kikuchi (NM),Kim Sykes (KS), Carrie Dayham (IL),Merl W. Simmons (OK), Louis Levy (MD), Mark Gaylord (TN)

The following is a summary of points made during the roundtable discussion.

Notes:

  1. The meeting began with introductions of all participants.
  2. The group agreed that the discussion would focus on professional and physician needs relative to an educational/informational component of community resources and linkages at the state level of EHDI. It was noted that 40 states attending this meeting had pediatrician "champions" and that there was now an opportunity to educate and inform pediatricians throughout the country about providing coordinated care and follow up for children who have an early diagnosis of hearing loss within a medical home.
  3. Concerns raised by the group in delivering care within a medical home
    1. Definition of the medical home.The group discussed the need to clearly define "medical home" and who has responsibility for family counseling and diagnosis.
    2. Tracking patients. Some of the difficulties lie with the fact that "the medical home is a mobile home." There are challenges to tracking families because of the frequency of multi site care provision as well as family name changes, etc.
    3. Time and financial constraints in pcp practices. Time and reimbursement in providing care within a medical home must be considered. How will pediatricians be able to afford to participate, given the amount of time and coordination needed by children with special health care needs (including hearing loss? Those pediatricians who self-identify as a medical home may find themselves with an increased caseload and poor reimbursement for care. There needs to be better reimbursement for care coordination.
    4. Identifying pediatricians who practice as a medical home. In Illinois, pcps who so wish to be known as medical home providers of children with special health care needs take an on-line course for CMEs offered through the AAP. Those PCPs who agree, are reimbursed for their time.
    5. Identifying qualified pediatric audiologists. How can expert pediatric audiologic services be more easily identified and accessed?
    6. Identifying community based resources. What are the appropriate services and resources that support families and children with hearing loss at the community level?
    7. "On time information." Because hearing loss is a relatively low prevalence condition, PCPs may not have experience with coordinating care for this population. They need on time information about appropriate referrals, what to do next for the child. The "average pediatrician wants to be able to facilitate access to referrals and resources." Who? (see f. above).
  4. How to educate primary care physicians/pediatricians about "what do children with hearing loss need?" What is good/recommended practice?
    1. WEB. The AAP website could be a potential resource in providing guidelines, however group participants felt that "the academy is woefully behind in its website." The site needs to be user friendly,
    2. Pediatrician in practice and in training programs need information about hearing loss, beyond care for otitis media.
    3. Grand rounds, department meetings, chapter newsletters and state medical meetings are forums for information/education. In IL, pediatricians have paired with audiologists to present grand rounds.
    4. Lunch time presentations to private practice groups
    5. Link pcps to mentors who provide care in a medical home
  5. How are states facilitating development of linkages to medical homes and early hearing detection and intervention?
    1. Illinois: There is a project to help physicians who are already caring for families who are financially eligible for services through the state's division of specialized care for children to serve as the medical home to those patients. Those physicians who wish to participate take an online course for CME/s that is available on the AAP website. These medical homes are provided technical assistance by regional case coordinators (nurses, audiologists, speech language pathologists) who are highly knowledgeable of resources in the area and available to inform and educate office staff in the medical home. Physicians acting as medical home are reimbursed for services involved in the development of a care coordination plan, such as telephone consultations with specialists or time spent with the family identifying appropriate referrals. Illinois is consulting with New Hampshire to evaluate "medical homeness" of the medical practices as a quality improvement effort.
    2. Georgia: Local resource groups of audiologists, ENTs and hospitals are forming for the purposes of tracking and surveillance of infants identified through newborn hearing screening and to identify local, community resources.
    3. North Carolina: Reimbursement is available for medical home care through the state's immunization process.
    4. Rhode Island: A medical home for children with hearing loss task force has been created through the HRSA grant, First Connections. The task force is comprised of parents, audiologists, pediatricians, otolaryngologists, specialty early intervention providers and Early Intervention (Part C, IDEA). The task force is developing a series of algorithms for care providers and families that will chart out the logical sequence of "next steps." The algorithms are an attempt to assure timely, coordinated, integrated follow up care and to make the EHDI system more easy to navigate. One of the barriers to creating a system of coordinated care has been communication amongst the service providers and with the families. IT is hoped that the algorithms can help that.
  6. What would help develop medical homes and support PCPs?
    1. The group supported the development of algorithms as useful tools.
    2. Suggestions in designing algorithms:
      1. Keep the information succinct, bulleted
      2. Include names and phone numbers of appropriate referrals/resources at each "branch" of the algorithm
      3. Include information about billing
    3. Coordination at the state level
    4. Not another resource guide that gets lost on the counter!
    5. Send the algorithm with the diagnostic report. On time information!
    6. All children deserve a medical home
  7. Next steps
    1. share resources with AAP champions
    2. improve AAP website
    3. gather list of relevant websites
    4. address reimbursement issues