AAP News •
www.aapnews.org • September 2015 7
Lynda M. Young, M.D., FAAP
The current climate poses financial challenges for pediatricians that threaten the continued survival of our long-standing and successful model of practice. Simply put, the
question asks what role the Academy can play in helping
pediatricians reduce overhead and increase revenue.
On the overhead side of the equation, the Academy has
made a start by providing Web-based resources with guidance on structuring operations as well as hiring and management procedures. The Academy could do
more particularly with regard to providing benchmarks, such as standard hourly
wages, salary levels, federal and state labor regulations, and production targets to
assess appropriate staffing levels. Facilitating exchange of information, for example
supporting a blog for practices to share successful initiatives to control and even
reduce overhead, would also be helpful.
On the revenue side, the Academy has taken a major step by providing extensive resources to support practice transformation to address future payment models. Medical
homes, accountable care organizations, value-based payments, and innovative practice
models all hold the promise of enhanced revenue opportunities for pediatricians and
involve practice transformation to realize these opportunities.
The Academy can continue its evaluation and guidance with regard to new
technologies that can lead to increased revenue for practices. Telehealth ventures
offering virtual visits can expand engagement and retention of patients as well as
offer payment mechanisms for the care provided. Success in managing revenue
will call for further exploration of collaboration and partnering with telemedicine
companies, retail clinics and payers to assert the clinical expertise and knowledge
of the pediatric community and to ensure continued continuity and quality of
care for our patients.
Finally, perhaps introducing a somewhat sensitive topic, the stability of the primary care pediatric workforce depends on realistic levels of payment. The Affordable
Care Act has been emphasizing lower cost outpatient care, and payers are giving financial benefits to primary care physicians to improve outcomes and increase quality.
Federal programs, state programs and private insurers all need to hear a clear voice
that pediatric primary care practice is not sustainable with low payment levels. The
Academy can be that voice and guide us as we move to value-based payment models.
Fernando Stein, M.D., FAAP
The Academy promotes pediatricians as the ideal provider for children in health and disease. As such, it must
continue with renewed vigor the promotion of the profession of pediatrics and the defense of pediatricians and
pediatric surgeons as the leaders of the team of pediatric
providers. The AAP can help pediatricians decrease cost,
From the cost of doing business to the Maintenance of Certification, the Academy
can help in very specific ways:
1. Provide data support of like-size practices offering benchmarks for comparison
(overhead, rent, staff and average pay per visit).
2. Build a robust technology platform members can use to harness data from their
electronic medical records and the Academy database. Members can gather demographics, economic data, and distribution and health indicators to promote
their business model.
3. The Academy should facilitate purchasing co-ops to decrease the cost of doing
business for pediatricians (such as procurement of medical and office supplies,
4. Amend the necessary requirements for certification and Maintenance of Certification as well as the cost for both.
5. Promote by every means necessary the pediatrician as the best provider for
children and integrate with nontraditional points of care delivery.
The AAP needs to redefine its mission more clearly. We cannot be all things to
all people. We need to take time now to focus on the problems of the 21st century
for the profession. In order to manage the budget of the AAP in the direction of
the needs of the membership, we need to apply “sunset” policies to all aspects of
the various programs (as we do with policy statements).
To be true to our mission, the first scorecard the Academy should receive must
come from the membership through frequent and periodic surveys of the needs
and wants of its members. We must be polled in a comprehensive study of the
direction and expenditures of the Academy that is undertaken by a task force that
is accurately representative of the different constituencies that form the AAP. This
includes surgeons, pediatricians, affiliates and candidate members.
from the Food and Drug Administration
Office of Pediatric Therapeutics, Division of
Product Quality Research and Division of
Pediatric and Maternal Health
The lack of pediatric-friendly drug formulations is
a problem for children, parents and pediatricians. To
address this need, the Food and Drug Administration
(FDA) and National Institutes of Health (NIH) entered into an interagency agreement to develop formulation strategies that provide optimal pediatric delivery.
An evaluation of the 400 best-selling adult drugs
on the market in 2014 showed that 222 contained
pediatric use information, but only 138 had pediatric-friendly dosage forms.
Oral dosage forms suitable for children include liq-
uids, chewable tablets and orally disintegrating tablets.
The Biopharmaceutical Classification System (BCS),
which classifies drugs by solubility and permeability,
may assist in the development of oral dosage forms
(see table above). A list of 382 products and their BCS
classification based on the values obtained from liter-
ature is available at http://1.usa.gov/1h8udde. Highly
water soluble drugs (from BCS Class I or III) typically
are chosen to formulate liquid dosage forms, although
some may have taste/stability issues.
New technology can help solve many pediatric for-
mulation obstacles. Techniques like micro-coating,
complexation and co-crystallization can be used to
make tasteless products. Micro- and nano-sizing of
drugs or co-solvents can be used to formulate low sol-
ubility drugs (BCS II or IV) as oral solutions.
The FDA and NIH will continue to collaborate on
pediatric formulations to advance the science in pediatric drug development.
The AAP National Nominating Committee has named and Lynda M. Young, M.D., FAAP, and Fernando Stein, M.D., FAAP, as candidates for AAP president-elect. The candidates were asked: How can the Academy support pediatricians in light of increasing overhead costs and decreasing revenue?
Agencies work to increase availability of pediatric-friendly drug formulations
BCS classification Drug substance properties
Class I high solubility–high permeability
Class II low solubility–high permeability
Class III high solubility–low permeability
Class IV low solubility–low permeability RESOURCES
• Health care professionals and the public can search for
medication content and labeling as found in medication
package inserts at DailyMed, http://dailymed.nlm.nih.
gov/dailymed/ about.cfm. The National Library of Medicine website provides the most recent drug labeling
information submitted to the FDA.
• Search FDA-approved drug products by name, active
ingredient or application number at Drugs@FDA, www.
• For more information on efforts by the FDA and NIH to
provide pediatric drug formulations, visit http://1.usa.