Volume 33 • Number 7 • July 2012
What the Medicaid payment increase
means for pediatric practice
by Jamie Poslosky • Washington Correspondent
Ensuring access to appropriate health care for all children — and payment to the pediatricians providing
such care — has been at the helm of the Academy’s
advocacy efforts since its founding in 1930. This concept
also was cemented as one of the Academy’s “ABCs” of
child health priorities during the health reform debate:
Access to care through appropriate payment rates and
pediatric workforce support, age-appropriate Benefits
in a medical home and Coverage for all children in the
The Academy endorsed the Affordable Care Act
because of its strong steps to address the ABCs, including
its unprecedented Medicaid payment rate increase to
at least 100% of Medicare rates in 2013 and 2014 for
certain primary care services and immunizations.
As part of the implementation of this provision, the
Centers for Medicare & Medicaid Services (CMS)
released a proposed rule in May requesting public comment to help determine how the payment increase will
take effect. The Academy submitted comments June
See Washington Report, page 5
Focus On Subspecialties
Don’t let plants, bugs, sun mar
your patients’ summer fun
by Michael L. Smith, M.D., FAAP, FAAD
As families head outdoors this summer, it is imperative that they protect their children from potential
dermatologic dangers, including plants, bugs and sun.
The most common plants responsible for contact
dermatitis are poison ivy, poison oak and poison sumac.
Exposure times as brief as 15-20 minutes may produce
reactions in highly allergic individuals. The linear streaks
or clusters of pruritic papules and vesicles may develop
a few hours after exposure.
Plant contact allergy reaction times depend on the
amount of oleoresin applied to the skin. Areas with the
most sap react quickly, while areas with less sap may
take two to three days. Even lighter contact may delay
the rash by five to six days. A single exposure may pro-
duce new crops of itchy bumps for more than a week.
Contrary to popular belief, the blister fluid does not
“spread” the rash.
What’s the Dx?
Toddler with fever, lesions
on body and in mouth
by H. Cody Meissner, M.D., FAAP
Cutaneous lesions of the distal extremities are
a characteristic of a disease found in children
under age 5.
A toddler presents with a history of high fever and
several painful oral lesions that make it difficult to
swallow. The toddler also has vesicular lesions on his
thighs that progressed to his arms and hands similar
to those shown in the photograph. He is crying and
irritable. His mother was told that several children
at the child care center he attends were absent because
of fever and rash.
A likely cause of the toddler’s lesions is:
a. herpes simplex virus
b. varicella zoster virus
c. poison ivy
d. hand, foot and mouth disease
Answer d: hand, foot and mouth disease (HFMD).
See ID Snaphot, page 4
In this issue
Know your AAP candidates
An up-close look into the professional lives of the two candidates
for AAP president-elect and what inspired them to pursue careers
in pediatrics. Pages 8, 9