Volume 34 • Number 1 • January 2013
HHS to partner with pediatricians
as Medicaid payments increase
infections in pediatric
by Kathleen Sebelius, Secretary, U.S.
Department of Health and Human Services
From the earliest public debates about the
Affordable Care Act to our current efforts
implementing the law, pediatricians have
played a critical role in shaping the health
Thanks in part to the guidance and leadership of pediatricians across the country, the 2010
health care law has made an unprecedented investment in children’s health. For example, today health
insurance companies no longer can impose lifetime
dollar limits on children’s benefits or refuse to cover
children with pre-existing conditions. Bright Futures,
or recommended preventive services, for children
are covered with no co-pays or deductibles for families with private insurance. And families can designate a pediatrician as their primary care provider
in covered plans. These protections have been in
effect for more than two years, and they are making
an enormous difference in the lives of millions of
children and families.
This month another provision of the law takes effect
that will improve access to care for children covered
by Medicaid. On Jan. 1, the federal government will begin to fund a two-year increase
in Medicaid payment rates for certain primary care and immunization services. That’s
good news for the children who make up
more than half of our country’s Medicaid
recipients — and also for the pediatricians
who serve more Medicaid patients than any
other group of primary care providers.
The policy works by setting a floor on Medicaid
payments for covered primary care services that is
equal to the Medicare payment level that would
apply. Our goal is to support pediatricians like you
to continue providing checkups, preventive screenings, vaccines and other primary care services to children, especially the most vulnerable.
The increased payment rates will translate into
significant increases in income. For many pediatricians serving Medicaid patients, earnings will
increase by tens of thousands of dollars, and for substantial numbers of pediatricians, the increase will
be even larger.
Last November, we released final rules on the Medicaid payment increase after gathering input from
See Commentary, page 8
by Gordon E. Schutze, M.D., FAAP,
and Rodney E. Willoughby Jr., M.D., FAAP
The incidence of Clostridium
difficile infections (CDIs) among
hospitalized children has been
increasing in the United States
since 1997. While clinical practice guidelines on
managing CDIs recently were published, they focus
To address this gap in knowledge surrounding
CDIs in pediatric patients, the Academy has published a new policy statement that provides updated
information and recommendations for pediatricians. The statement, Clostridium difficile Infection
in Infants and Children from the AAP Committee
on Infectious Diseases (Pediatrics. 2013;131:196-
10.1542/peds.2012-2992), discusses diagnostic
testing, treatment and control.
Incidence of disease, carriage
C. difficile is the most common cause of antimi-crobial-associated diarrhea and is a common health
care-associated pathogen. The spore-forming, obligate anaerobic, gram-positive bacillus is acquired
from the environment or by the fecal-oral route.
Toxins A and B are responsible for intestinal disease.
Although testing of infants is not recommended,
recent data have shown that 26% of children hospitalized with CDIs were younger than 1 year,
and 5% were neonates. What cannot be determined from these data is whether hospitalization
rates for CDIs represent true disease or asymptomatic carriage.
C. difficile carriage rates average 37% for infants
0 to 1 month of age and 30% between 1 and 6
See C. difficile, page 8
Students of all ages benefit from a break in the school day, whether they play
sports or games, or simply talk with their friends, according to a new AAP policy
statement. The report outlines why schools should set aside time for unstructured
recess. See story on Page 7.
In this issue
Premature mortality studied
The CDC looks at the years of potential life lost due to unintentional
injuries among those 0 through 19 years of age. Page 10
Preventing excessive radiation
The FDA is developing guidance that will result in safety improvements to pediatric imaging devices. Page 14