by Richard Lander, M.D., FAAP
of communication and nurturing productive relationships with private payers are more important than ever as health care
delivery and financing evolve to value-based payment.
AAP advocacy with private commercial health plans
is continuing, primarily through the Private Payer
Advocacy Advisory Committee (PPAAC) and chapter
pediatric councils. The councils have the potential to
facilitate better working relationships between pediatricians and health insurance plans at the local level and
to improve quality of care for children.
The following recent successes are attributable to the
Academy’s advocacy strategies to foster communication
• Based on input from PPAAC and the Section on
Ophthalmology Executive Committee, the Acad-
emy advocated that UnitedHealthcare (UHC) re-
vise its policy on instrument-based vision screen-
ing to cover children until their 4th birthday
instead of age 3. UHC agreed to the change.
• Input from the Section on Endocrinology led Anthem to change its coverage policy on testosterone
injections to reduce the age requirement from 18
to 16 years and expand the list of diagnoses considered medically necessary for testosterone therapy.
• For over a year, PPAAC has urged Aetna to work
with AAP chapter pediatric councils on issues of
concern to pediatricians. Key Aetna staff recently
agreed to encourage their regional medical directors to work with pediatric councils in the Aetna
• Recently, the New York Chapter 2 pediatric council had several conversations with CareConnect
regarding underpayment for vaccines. After sharing the AAP Business Case for Pricing Vaccines
and the Business Case for Pricing Immunization
Administration, CareConnect committed to follow the AAP payment guidelines and promised to
reconsider most of the vaccine visits it underpaid.
The new vaccine payment schedule went into effect Jan. 1.
To be successful, AAP private payer advocacy needs
to occur at the national, state and practice levels. While
the national AAP and chapters engage payers, pedia-
tricians also are urged to seek opportunities to work
with their private payers to enhance their practice’s via-
bility. Admittedly, tension exists in any payer/provider
relationship. However, by seeking common priorities
for the well-being of children and adolescents, pedia-
tricians can be successful in advocating
for appropriate benefits coverage and
payment from private payers.
Dr. Lander is chair of the AAP Private
Payer Advocacy Advisory Committee.
New process will make it easier for physicians to practice in multiple states
from the AAP Division of State Government Affairs
A streamlined process soon will be available for pediatricians, pediatric medical subspecialists and pediatric surgical specialists who want to practice medicine
across state lines.
The Interstate Medical Licensure Compact is in the
process of establishing an expedited pathway to license
qualified physicians to practice in multiple states in a
safe and accountable manner. Physicians now face the
burdensome process of applying individually to each
state in which they want to practice.
The Federation of State Medical Boards (FSMB),
which represents U.S. medical and osteopathic licensing boards, released model language in July 2014 to
help states create the compact. In addition to improving efficiency for applicants, the compact will increase
patients’ access to care.
The Academy, the American Academy of Family
Physicians, the American College of Physicians, the
American Medical Association and other medical societies have endorsed the compact.
As of January, 18 states (Alabama, Arizona, Colorado, Iowa, Idaho, Illinois, Kansas, Minnesota, Missouri, Montana, New Hampshire, Nevada, Pennsylvania,
South Dakota, Utah, Wisconsin, West Virginia and
Wyoming) have enacted laws and five states (Arkansas,
Michigan, Nebraska, North Dakota and Washington)
have introduced legislation that would allow them to
participate in the compact.
A commission that consists of two voting representatives from each member state governs the compact.
Commission members promulgate rules, enforce compliance with compact provisions and issue advisory
opinions on the meaning or interpretation of the compact. The commission reports annually to the legislatures and governors of member states as to its activities,
financial audits and any adopted recommendations.
To obtain licensure through the compact, physicians
will designate a member state as a “state of principal
licensure” and then select other states where they wish
to be licensed. A physician must have a full and unrestricted license in the state of principal licensure,
which is the physician’s primary residence, the state
where at least 25% of the practice of medicine occurs
or the location of the physician’s employer. If no state
qualifies, the state of principal licensure would be the
state designated as the physician’s residence for federal
income tax purposes.
The state of principal licensure will use the physician’s existing license and records to verify eligibility
and then provide the credentialing information to the
commission. Once eligibility is verified and state licensure fees are paid, each state would issue a full license.
Physicians will need to be licensed in the state where
the patient is located.
The compact ensures that state medical boards retain
authority over the practice of medicine and disciplinary
authority over physicians. There is no impact on Med-
ical Practice Acts.
“It is important that states preserve their current authority over
physicians who are licensed in their
state. Local oversight is vital to the
safety and well-being of patients,”
said J. Gary Wheeler, M.D., FAAP,
chair of the AAP Committee on
State Government Affairs.
The compact has the potential to
have a positive impact on the practice of pediatrics
as well as children and families. The most direct application would be to expand access to pediatricians
and pediatric subspecialists through telehealth care.
For example, many children lack access to pediatric
mental health services, and telehealth care could help
primary care practices expand access to child and adolescent psychiatrists.
William B. Moskowitz, M.D.,
FAAP, chair of the AAP Committee on Pediatric Workforce, said
easing the administrative burden of
obtaining a medical license in multiple states will increase the reach of
“The AAP wants to reduce barriers to the practice of telehealth care
in order to achieve the goal of pediatric physicians offering care to all children. The compact can help to
alleviate one of those barriers,” Dr. Moskowitz said.
Being licensed in multiple states also can help pediatricians collaborate with subspecialists or surgical
specialists in other states to care for children with special health care needs; assist with emergency or disaster
responses; and extend the reach of pediatric subspecialists to underserved or rural areas.
The Academy continues to monitor the compact’s
progress and commission’s work and will keep pediatricians informed as to when expedited licenses will
• The Interstate Medical Licensure Compact Advocacy
Action Guide for AAP Chapters is available at http://bit.
ly/2jZTSqe to assist in advocating for state legislation.
• For more information on the Interstate Medical Licensure Compact, visit http://licenseportability.org/
A plan endorsed by the Academy and others would
establish an expedited pathway to license physicians to practice in multiple states without applying
to each one.
Keeping lines of communication open with health insurers pays dividends
• Sample letters, talking points and other resources that
pediatricians can use in their discussions with payers
are available on the AAP Practice Transformation site,
• The AAP Business Case for Pricing Vaccines is available at http://bit.ly/2kbjCn6, and the Business Case
for Pricing Immunization Administration is available