Catherine Cooper Nellist

Pediatric News welcomes Herschel Lessin, MD, to the editorial advisory board.

Dr. Lessin has been a practicing pediatric clinician for the past 39 years at The Children’s Medical Group. In 1997, he was a founding partner of one of the first private practice “supergroups” by merging two competing pediatric practices into one and expanding it to 25 clinicians, with eight offices in three counties in New York state’s Mid-Hudson Valley. The group provides pediatric care to more than 30,000 children and has a nearly 90-year history, across its various incarnations, providing such care.

Dr. Lessin received his medical degree from Stanford (Calif.) University and trained in pediatrics at Yale-New Haven (Conn.) Medical Center. He has been active in national policy and leadership in the American Academy of Pediatrics, having served on the executive committee of the Section of Administration and Practice Management, the national Committee on Practice and Ambulatory Medicine, and his current appointment to the national Private Payer Advocacy Advisory Committee. In those roles he has authored several national policy statements and clinical guidelines, including “Increasing Immunization Coverage,” “Immunizing Parents and Other Close Family Contacts in the Pediatric Office Setting,” “Instrument-Based Pediatric Vision Screening Policy Statement,” and most recently, “Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” He is also the coeditor of the AAP’s ADHD toolkit for clinicians published in 2019. Dr. Lessin served as the director of clinical research for his group for 5 years and the medical director for the practice for 10 years.

He has served as a faculty member at numerous local and regional pediatric meetings. He has been a faculty member at the AAP’s annual national conference and exposition for the past decade, speaking on a variety of topics. Dr. Lessin also has been an invited speaker internationally at pediatric conferences in India and Egypt. He has participated in more than a dozen medical missions to developing countries in Latin America, the Caribbean, Africa, and Vietnam. His expertise includes practice management, the business of medicine, immunizations, ADHD, and liability topics. He has been a testifying expert witness for both defense and plaintiff in medical malpractice litigation for more than 30 years. He founded and served as president of a medical independent practice association that began with 12 physicians and grew to over 3,000 doctors. He is also a certified managed care executive. His most recent interest has been becoming a professional voice-over actor!

While performing all of the above, Dr. Lessin is a dedicated community pediatrician whose first love and primary goal has remained providing the highest quality medical care to children while helping his colleagues manage their businesses in order to be able to survive and continue to provide such care.

Pediatric News welcomes Herschel Lessin, MD, to the editorial advisory board.

Dr. Lessin has been a practicing pediatric clinician for the past 39 years at The Children’s Medical Group. In 1997, he was a founding partner of one of the first private practice “supergroups” by merging two competing pediatric practices into one and expanding it to 25 clinicians, with eight offices in three counties in New York state’s Mid-Hudson Valley. The group provides pediatric care to more than 30,000 children and has a nearly 90-year history, across its various incarnations, providing such care.

Dr. Lessin received his medical degree from Stanford (Calif.) University and trained in pediatrics at Yale-New Haven (Conn.) Medical Center. He has been active in national policy and leadership in the American Academy of Pediatrics, having served on the executive committee of the Section of Administration and Practice Management, the national Committee on Practice and Ambulatory Medicine, and his current appointment to the national Private Payer Advocacy Advisory Committee. In those roles he has authored several national policy statements and clinical guidelines, including “Increasing Immunization Coverage,” “Immunizing Parents and Other Close Family Contacts in the Pediatric Office Setting,” “Instrument-Based Pediatric Vision Screening Policy Statement,” and most recently, “Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” He is also the coeditor of the AAP’s ADHD toolkit for clinicians published in 2019. Dr. Lessin served as the director of clinical research for his group for 5 years and the medical director for the practice for 10 years.

He has served as a faculty member at numerous local and regional pediatric meetings. He has been a faculty member at the AAP’s annual national conference and exposition for the past decade, speaking on a variety of topics. Dr. Lessin also has been an invited speaker internationally at pediatric conferences in India and Egypt. He has participated in more than a dozen medical missions to developing countries in Latin America, the Caribbean, Africa, and Vietnam. His expertise includes practice management, the business of medicine, immunizations, ADHD, and liability topics. He has been a testifying expert witness for both defense and plaintiff in medical malpractice litigation for more than 30 years. He founded and served as president of a medical independent practice association that began with 12 physicians and grew to over 3,000 doctors. He is also a certified managed care executive. His most recent interest has been becoming a professional voice-over actor!

While performing all of the above, Dr. Lessin is a dedicated community pediatrician whose first love and primary goal has remained providing the highest quality medical care to children while helping his colleagues manage their businesses in order to be able to survive and continue to provide such care.

Pediatric News welcomes Herschel Lessin, MD, to the editorial advisory board.

Dr. Lessin has been a practicing pediatric clinician for the past 39 years at The Children’s Medical Group. In 1997, he was a founding partner of one of the first private practice “supergroups” by merging two competing pediatric practices into one and expanding it to 25 clinicians, with eight offices in three counties in New York state’s Mid-Hudson Valley. The group provides pediatric care to more than 30,000 children and has a nearly 90-year history, across its various incarnations, providing such care.

Dr. Lessin received his medical degree from Stanford (Calif.) University and trained in pediatrics at Yale-New Haven (Conn.) Medical Center. He has been active in national policy and leadership in the American Academy of Pediatrics, having served on the executive committee of the Section of Administration and Practice Management, the national Committee on Practice and Ambulatory Medicine, and his current appointment to the national Private Payer Advocacy Advisory Committee. In those roles he has authored several national policy statements and clinical guidelines, including “Increasing Immunization Coverage,” “Immunizing Parents and Other Close Family Contacts in the Pediatric Office Setting,” “Instrument-Based Pediatric Vision Screening Policy Statement,” and most recently, “Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” He is also the coeditor of the AAP’s ADHD toolkit for clinicians published in 2019. Dr. Lessin served as the director of clinical research for his group for 5 years and the medical director for the practice for 10 years.

He has served as a faculty member at numerous local and regional pediatric meetings. He has been a faculty member at the AAP’s annual national conference and exposition for the past decade, speaking on a variety of topics. Dr. Lessin also has been an invited speaker internationally at pediatric conferences in India and Egypt. He has participated in more than a dozen medical missions to developing countries in Latin America, the Caribbean, Africa, and Vietnam. His expertise includes practice management, the business of medicine, immunizations, ADHD, and liability topics. He has been a testifying expert witness for both defense and plaintiff in medical malpractice litigation for more than 30 years. He founded and served as president of a medical independent practice association that began with 12 physicians and grew to over 3,000 doctors. He is also a certified managed care executive. His most recent interest has been becoming a professional voice-over actor!

While performing all of the above, Dr. Lessin is a dedicated community pediatrician whose first love and primary goal has remained providing the highest quality medical care to children while helping his colleagues manage their businesses in order to be able to survive and continue to provide such care.

Dr. Karen Breach Washington returns to the Pediatric News editorial advisory board after a 10-year hiatus. She currently is employed as a medical director at WellCare of North Carolina/Centene. Her career spans 32 years in Charlotte, N.C., where she has practiced pediatrics and held medical director positions in a large health care system and a managed care organization, as well as worked in private practice and in a public health clinic.

A native of North Babylon, N.Y., she received her undergraduate degree at Hofstra University, Hempstead, N.Y., and her medical degree at George Washington University, Washington. Dr. Breach Washington has been an advocate for children, access to health care, and diversity and inclusion.

An active member of the American Academy of Pediatrics, Dr. Breach Washington served as an elected representative to the AAP National Nominating Committee, following her term as president of the North Carolina chapter of the AAP.

She is a past pediatric section chair of the National Medical Association and past president of the Charlotte Medical, Dental, and Pharmaceutical Society. She has served on the boards of the Simmons Branch YMCA, the Mecklenburg County Medical Society, and the Teen Health Connection (a facility of Carolinas Medical Center), plus many associated committees.

Dr. Breach Washington serves the community as an active life member of Alpha Kappa Alpha Sorority, Jack and Jill of America, and a member of The Links. She is the recipient of several awards for her commitment to diversity and inclusion, philanthropy, and community service.

Dr. Breach Washington is married and has an adult daughter. She is an avid fan of all sports, a dancer, and enjoys theater, fine dining, and travel.

Dr. Karen Breach Washington returns to the Pediatric News editorial advisory board after a 10-year hiatus. She currently is employed as a medical director at WellCare of North Carolina/Centene. Her career spans 32 years in Charlotte, N.C., where she has practiced pediatrics and held medical director positions in a large health care system and a managed care organization, as well as worked in private practice and in a public health clinic.

A native of North Babylon, N.Y., she received her undergraduate degree at Hofstra University, Hempstead, N.Y., and her medical degree at George Washington University, Washington. Dr. Breach Washington has been an advocate for children, access to health care, and diversity and inclusion.

An active member of the American Academy of Pediatrics, Dr. Breach Washington served as an elected representative to the AAP National Nominating Committee, following her term as president of the North Carolina chapter of the AAP.

She is a past pediatric section chair of the National Medical Association and past president of the Charlotte Medical, Dental, and Pharmaceutical Society. She has served on the boards of the Simmons Branch YMCA, the Mecklenburg County Medical Society, and the Teen Health Connection (a facility of Carolinas Medical Center), plus many associated committees.

Dr. Breach Washington serves the community as an active life member of Alpha Kappa Alpha Sorority, Jack and Jill of America, and a member of The Links. She is the recipient of several awards for her commitment to diversity and inclusion, philanthropy, and community service.

Dr. Breach Washington is married and has an adult daughter. She is an avid fan of all sports, a dancer, and enjoys theater, fine dining, and travel.

Dr. Karen Breach Washington returns to the Pediatric News editorial advisory board after a 10-year hiatus. She currently is employed as a medical director at WellCare of North Carolina/Centene. Her career spans 32 years in Charlotte, N.C., where she has practiced pediatrics and held medical director positions in a large health care system and a managed care organization, as well as worked in private practice and in a public health clinic.

A native of North Babylon, N.Y., she received her undergraduate degree at Hofstra University, Hempstead, N.Y., and her medical degree at George Washington University, Washington. Dr. Breach Washington has been an advocate for children, access to health care, and diversity and inclusion.

An active member of the American Academy of Pediatrics, Dr. Breach Washington served as an elected representative to the AAP National Nominating Committee, following her term as president of the North Carolina chapter of the AAP.

She is a past pediatric section chair of the National Medical Association and past president of the Charlotte Medical, Dental, and Pharmaceutical Society. She has served on the boards of the Simmons Branch YMCA, the Mecklenburg County Medical Society, and the Teen Health Connection (a facility of Carolinas Medical Center), plus many associated committees.

Dr. Breach Washington serves the community as an active life member of Alpha Kappa Alpha Sorority, Jack and Jill of America, and a member of The Links. She is the recipient of several awards for her commitment to diversity and inclusion, philanthropy, and community service.

Dr. Breach Washington is married and has an adult daughter. She is an avid fan of all sports, a dancer, and enjoys theater, fine dining, and travel.

Pediatric News welcomes Margaret Thew, DNP, FNP-BC, to the editorial advisory board.

Ms. Thew is the medical director of the department of adolescent medicine at Children’s Wisconsin in Milwaukee, in addition to working casually among Children’s Wisconsin pediatric urgent cares within the city of Milwaukee and surrounding suburbs. She has published articles on Nexplanon complications and management of the malnourished state of the eating disorder patient. She currently is involved in a longitudinal study on the health and nutrition of high school endurance runners. Ms. Thew has presented her research both nationally and internationally. Her most recent podium presentation was given at the International Conference for Eating Disorders May 2020 on her research working with high school endurance athletes.

Ms. Thew serves on several committees within Children’s Wisconsin including chair of the domestic violence committee and adjunct on the electronic health record provider committee. She is leading a quality improvement project on adolescent confidential care and the judicious use of the adolescent sensitive note. In addition, she is active within her state nursing organizations; she sits on the Wisconsin Nursing Association board as the advanced practice registered nurse director at large.

Ms. Thew was selected and graduated from the exclusive Duke Johnson & Johnson Nurse Leadership Fellowship in 2016 and was selected as the keynote speaker at graduation by her peers. She was asked to speak to this year’s cohort on her accomplishments as a leader at their virtual graduation April 2020.

Ms. Thew received her Doctor of Nursing Practice, Executive Nurse Leadership May 2020 from Concordia University Wisconsin, and her master’s degree in nursing specializing in family practice from the University of Wisconsin–Milwaukee in December 1997. She is presently enrolled in the nurse educator certificate program at Concordia University Wisconsin. She has worked in the department of adolescent medicine specializing in eating disorders and adolescent gynecology for 6 years and was named the medical director in October 2019. In addition to her work in adolescent medicine, she has an extensive history working as a nurse practitioner in pediatric hematology, oncology, and primary care.

Pediatric News welcomes Margaret Thew, DNP, FNP-BC, to the editorial advisory board.

Ms. Thew is the medical director of the department of adolescent medicine at Children’s Wisconsin in Milwaukee, in addition to working casually among Children’s Wisconsin pediatric urgent cares within the city of Milwaukee and surrounding suburbs. She has published articles on Nexplanon complications and management of the malnourished state of the eating disorder patient. She currently is involved in a longitudinal study on the health and nutrition of high school endurance runners. Ms. Thew has presented her research both nationally and internationally. Her most recent podium presentation was given at the International Conference for Eating Disorders May 2020 on her research working with high school endurance athletes.

Ms. Thew serves on several committees within Children’s Wisconsin including chair of the domestic violence committee and adjunct on the electronic health record provider committee. She is leading a quality improvement project on adolescent confidential care and the judicious use of the adolescent sensitive note. In addition, she is active within her state nursing organizations; she sits on the Wisconsin Nursing Association board as the advanced practice registered nurse director at large.

Ms. Thew was selected and graduated from the exclusive Duke Johnson & Johnson Nurse Leadership Fellowship in 2016 and was selected as the keynote speaker at graduation by her peers. She was asked to speak to this year’s cohort on her accomplishments as a leader at their virtual graduation April 2020.

Ms. Thew received her Doctor of Nursing Practice, Executive Nurse Leadership May 2020 from Concordia University Wisconsin, and her master’s degree in nursing specializing in family practice from the University of Wisconsin–Milwaukee in December 1997. She is presently enrolled in the nurse educator certificate program at Concordia University Wisconsin. She has worked in the department of adolescent medicine specializing in eating disorders and adolescent gynecology for 6 years and was named the medical director in October 2019. In addition to her work in adolescent medicine, she has an extensive history working as a nurse practitioner in pediatric hematology, oncology, and primary care.

Pediatric News welcomes Margaret Thew, DNP, FNP-BC, to the editorial advisory board.

Ms. Thew is the medical director of the department of adolescent medicine at Children’s Wisconsin in Milwaukee, in addition to working casually among Children’s Wisconsin pediatric urgent cares within the city of Milwaukee and surrounding suburbs. She has published articles on Nexplanon complications and management of the malnourished state of the eating disorder patient. She currently is involved in a longitudinal study on the health and nutrition of high school endurance runners. Ms. Thew has presented her research both nationally and internationally. Her most recent podium presentation was given at the International Conference for Eating Disorders May 2020 on her research working with high school endurance athletes.

Ms. Thew serves on several committees within Children’s Wisconsin including chair of the domestic violence committee and adjunct on the electronic health record provider committee. She is leading a quality improvement project on adolescent confidential care and the judicious use of the adolescent sensitive note. In addition, she is active within her state nursing organizations; she sits on the Wisconsin Nursing Association board as the advanced practice registered nurse director at large.

Ms. Thew was selected and graduated from the exclusive Duke Johnson & Johnson Nurse Leadership Fellowship in 2016 and was selected as the keynote speaker at graduation by her peers. She was asked to speak to this year’s cohort on her accomplishments as a leader at their virtual graduation April 2020.

Ms. Thew received her Doctor of Nursing Practice, Executive Nurse Leadership May 2020 from Concordia University Wisconsin, and her master’s degree in nursing specializing in family practice from the University of Wisconsin–Milwaukee in December 1997. She is presently enrolled in the nurse educator certificate program at Concordia University Wisconsin. She has worked in the department of adolescent medicine specializing in eating disorders and adolescent gynecology for 6 years and was named the medical director in October 2019. In addition to her work in adolescent medicine, she has an extensive history working as a nurse practitioner in pediatric hematology, oncology, and primary care.

The Food and Drug Administration has approved expanded use of Dysport to treat upper- and lower-limb spasticity – including that caused by cerebral palsy – for patients as young as 2 years and older, according to manufacturer Ipsen Biopharmaceuticals.

When Dysport (abobotulinumtoxinA) initially was approved for treating pediatric lower limb spasticity by the FDA in 2016, Ipsen was granted Orphan Drug exclusivity for children whose lower-limb spasticity was caused by cerebral palsy. In 2019, Dysport was approved by the FDA for treating of upper-limb spasticity in children 2 years older. But if that spasticity was caused by cerebral palsy, Dysport could be used to treat it only through Orphan Drug exclusivity granted to another manufacturer, according to an Ipsen press release.

“The proactive step to resolve the uncertainty created by the previous CP [cerebral palsy] carve out enables us as physicians to prescribe consistent therapy for pediatric patients experiencing both upper- and lower-limb spasticity,” Sarah Helen Evans, MD, division chief of rehabilitation medicine in the department of pediatrics at the Children’s Hospital of Philadelphia, said in the press release.

The most common adverse effects among children with lower-limb spasticity treated with Dysport were nasopharyngitis, cough, and pyrexia. Among children with upper-limb spasticity, the most common effects associated with Dysport treatment were upper respiratory tract infection and pharyngitis.

The press release also included a warning of the distant spread of the botulinum toxin from the area of injection hours to weeks afterward, causing symptoms including blurred vision, generalized muscle weakness, and swallowing and breathing difficulties that can be life threatening; there have been reports of death.

Suspected adverse effects can be reported to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

The Food and Drug Administration has approved expanded use of Dysport to treat upper- and lower-limb spasticity – including that caused by cerebral palsy – for patients as young as 2 years and older, according to manufacturer Ipsen Biopharmaceuticals.

When Dysport (abobotulinumtoxinA) initially was approved for treating pediatric lower limb spasticity by the FDA in 2016, Ipsen was granted Orphan Drug exclusivity for children whose lower-limb spasticity was caused by cerebral palsy. In 2019, Dysport was approved by the FDA for treating of upper-limb spasticity in children 2 years older. But if that spasticity was caused by cerebral palsy, Dysport could be used to treat it only through Orphan Drug exclusivity granted to another manufacturer, according to an Ipsen press release.

“The proactive step to resolve the uncertainty created by the previous CP [cerebral palsy] carve out enables us as physicians to prescribe consistent therapy for pediatric patients experiencing both upper- and lower-limb spasticity,” Sarah Helen Evans, MD, division chief of rehabilitation medicine in the department of pediatrics at the Children’s Hospital of Philadelphia, said in the press release.

The most common adverse effects among children with lower-limb spasticity treated with Dysport were nasopharyngitis, cough, and pyrexia. Among children with upper-limb spasticity, the most common effects associated with Dysport treatment were upper respiratory tract infection and pharyngitis.

The press release also included a warning of the distant spread of the botulinum toxin from the area of injection hours to weeks afterward, causing symptoms including blurred vision, generalized muscle weakness, and swallowing and breathing difficulties that can be life threatening; there have been reports of death.

Suspected adverse effects can be reported to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

The Food and Drug Administration has approved expanded use of Dysport to treat upper- and lower-limb spasticity – including that caused by cerebral palsy – for patients as young as 2 years and older, according to manufacturer Ipsen Biopharmaceuticals.

When Dysport (abobotulinumtoxinA) initially was approved for treating pediatric lower limb spasticity by the FDA in 2016, Ipsen was granted Orphan Drug exclusivity for children whose lower-limb spasticity was caused by cerebral palsy. In 2019, Dysport was approved by the FDA for treating of upper-limb spasticity in children 2 years older. But if that spasticity was caused by cerebral palsy, Dysport could be used to treat it only through Orphan Drug exclusivity granted to another manufacturer, according to an Ipsen press release.

“The proactive step to resolve the uncertainty created by the previous CP [cerebral palsy] carve out enables us as physicians to prescribe consistent therapy for pediatric patients experiencing both upper- and lower-limb spasticity,” Sarah Helen Evans, MD, division chief of rehabilitation medicine in the department of pediatrics at the Children’s Hospital of Philadelphia, said in the press release.

The most common adverse effects among children with lower-limb spasticity treated with Dysport were nasopharyngitis, cough, and pyrexia. Among children with upper-limb spasticity, the most common effects associated with Dysport treatment were upper respiratory tract infection and pharyngitis.

The press release also included a warning of the distant spread of the botulinum toxin from the area of injection hours to weeks afterward, causing symptoms including blurred vision, generalized muscle weakness, and swallowing and breathing difficulties that can be life threatening; there have been reports of death.

Suspected adverse effects can be reported to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

As the COVID-19 pandemic continues to spread across the United States, several members of the Pediatric News Editorial Advisory Board shared how practices have been adapting to the pandemic, especially in terms of immunization.

Karalyn Kinsella, MD, a member of a four-pediatrician private practice in Cheshire, Conn., said in an interview that “we have been seeing only children under age 2 years for their well visits to keep them up to date on their vaccinations” as recommended by infectious disease departments at nearby hospitals such as Connecticut Children’s Medical Center. “We also are seeing the 4- and 5-year-old children for vaccinations.”

Dr. Kinsella explained that, in case parents don’t want to bring their children into the office, her staff is offering to give the vaccinations in the parking lot. But most families are coming into the office.

“We are only seeing well babies and take the parent and child back to a room as soon as they come in the office to avoid having patients sit in the waiting room. At this point, both parents and office staff are wearing masks; we are cleaning the rooms between patients,” Dr. Kinsella said.

“Most of our patients are coming in for their vaccines, so I don’t anticipate a lot of kids being behind. However, we will have a surge of all the physicals that need to be done prior to school in the fall. We have thought about opening up for the weekends for physicals to accommodate this. We also may need to start the day earlier and end later. I have heard some schools may be postponing the date the physicals are due.”

Because of a lack of full personal protective equipment, the practice has not been seeing sick visits in the office, but they have been doing a lot of telehealth visits. “We have been using doxy.me for that, which is free, incredibly easy to use, and Health Insurance Portability and Accountability Act (HIPAA)–compliant,” she said. “I am finding some visits, such as ADHD follow-ups and mental health follow-ups, very amenable to telehealth.”

“The hardest part – as I am sure is for most pediatricians – is the financial strain to a small business,” Dr. Kinsella noted. “We are down about 70% in revenue from this time last year. We have had to lay-off half our staff, and those who are working have much-reduced hours. We did not get the first round of funding for the paycheck protection program loan from the government and are waiting on the second round. We are trying to recoup some business by doing telehealth, but [the insurance companies] are only paying about 75%-80%. We also are charging for phone calls over 5 minutes. It will take a long time once we are up and running to recoup the losses.

“When this is all over, I’m hoping that we will be able to continue to incorporate telehealth into our schedules as I think it is convenient for families. I also am hoping that pediatricians continue to bill for phone calls as we have been giving out a lot of free care prior to this. I hope the American Academy of Pediatrics and all pediatricians work together to advocate for payment of these modalities,” she said.

J. Howard Smart, MD, who is chairman of the department of pediatrics at Sharp Rees-Stealy Medical Group in San Diego, said in an interview, “We have been bringing all of the infants and toddlers in for checkups and vaccines up to age 18 months.” These visits are scheduled in the morning, and sick patients are scheduled in the afternoon. “Well-child visits for older ages are being done by video, and the kindergarten and adolescent vaccines can be done by quick nurse visits. We will have some catching up to do once restrictions are lifted.”

“A fair amount of discussion went into these decisions. Is a video checkup better than no checkup? There is no clear-cut answer. Important things can be addressed by video: lifestyle, diet, exercise, family coping with stay-at-home orders, maintaining healthy childhood relationships, Internet use, ongoing education, among others. We know that we may miss things that can only be picked up by physical examination: hypertension, heart murmurs, abnormal growth, sexual development, abdominal masses, subtle strabismus. This is why we need to bring these children back for the physical exam later,” Dr. Smart emphasized.

“One possible negative result of doing the ‘well-child check’ by video would be if the parent assumed that the ‘checkup’ was done, never brought the child back for the exam, and something was missed that needed intervention. It will be important to get the message across that the return visit is needed. The American Academy of Pediatrics made this a part of their recommendations. It is going to be important for payers to realize that we need to do both visits – and to pay accordingly,” he concluded.

Francis E. Rushton Jr., MD, of Birmingham, Ala., described in an interview how the pediatricians in his former practice are looking for new ways to encourage shot administration in a timely manner during the COVID-19 pandemic, as well as exploring ways to partner with home visitors in encouraging timely infant and toddler vaccinations.

At South Carolina’s Beaufort Pediatrics, Joseph Floyd, MD, described a multipronged initiative. The practice’s well-child visit reminder system is being reprogrammed to check for lapses in vaccinations rather than just well-child visit attendance. For the most part, Dr. Floyd stated parents appreciate the reminders and accept the need for vaccination: “In the absence of immunizations for coronavirus, families seem to be more cognizant of the value of the vaccines we do have.” Beaufort Pediatrics is also partnering with their local hospital on a publicity campaign stressing the importance of staying up to date with currently available and recommended vaccines.

Other child-service organizations are concerned as well. Dr. Francis E. Rushton Jr., as faculty with the Education Development Center’s Health Resources and Services Administration–funded home-visiting quality improvement collaborative (HV CoIIN 2.0), described efforts with home visitors in Alabama and other states. “Home visitors understand the importance of immunizations to the health and welfare of the infants they care for. They’re looking for opportunities to improve compliance with vaccination regimens.” Some of these home-visiting agencies are employing quality improvement technique to improve compliance. One idea they are working on is documenting annual training on updated vaccines for the home visitors. They are working on protocols for linking their clients with primary health care providers, referral relations, and relationship development with local pediatric offices. Motivational interviewing techniques for home visitors focused on immunizations are being considered. For families who are hesitant, home visitors are considering accompanying the family when they come to the doctor’s office while paying attention to COVID-19 social distancing policies at medical facilities.

As the COVID-19 pandemic continues to spread across the United States, several members of the Pediatric News Editorial Advisory Board shared how practices have been adapting to the pandemic, especially in terms of immunization.

Karalyn Kinsella, MD, a member of a four-pediatrician private practice in Cheshire, Conn., said in an interview that “we have been seeing only children under age 2 years for their well visits to keep them up to date on their vaccinations” as recommended by infectious disease departments at nearby hospitals such as Connecticut Children’s Medical Center. “We also are seeing the 4- and 5-year-old children for vaccinations.”

Dr. Kinsella explained that, in case parents don’t want to bring their children into the office, her staff is offering to give the vaccinations in the parking lot. But most families are coming into the office.

“We are only seeing well babies and take the parent and child back to a room as soon as they come in the office to avoid having patients sit in the waiting room. At this point, both parents and office staff are wearing masks; we are cleaning the rooms between patients,” Dr. Kinsella said.

“Most of our patients are coming in for their vaccines, so I don’t anticipate a lot of kids being behind. However, we will have a surge of all the physicals that need to be done prior to school in the fall. We have thought about opening up for the weekends for physicals to accommodate this. We also may need to start the day earlier and end later. I have heard some schools may be postponing the date the physicals are due.”

Because of a lack of full personal protective equipment, the practice has not been seeing sick visits in the office, but they have been doing a lot of telehealth visits. “We have been using doxy.me for that, which is free, incredibly easy to use, and Health Insurance Portability and Accountability Act (HIPAA)–compliant,” she said. “I am finding some visits, such as ADHD follow-ups and mental health follow-ups, very amenable to telehealth.”

“The hardest part – as I am sure is for most pediatricians – is the financial strain to a small business,” Dr. Kinsella noted. “We are down about 70% in revenue from this time last year. We have had to lay-off half our staff, and those who are working have much-reduced hours. We did not get the first round of funding for the paycheck protection program loan from the government and are waiting on the second round. We are trying to recoup some business by doing telehealth, but [the insurance companies] are only paying about 75%-80%. We also are charging for phone calls over 5 minutes. It will take a long time once we are up and running to recoup the losses.

“When this is all over, I’m hoping that we will be able to continue to incorporate telehealth into our schedules as I think it is convenient for families. I also am hoping that pediatricians continue to bill for phone calls as we have been giving out a lot of free care prior to this. I hope the American Academy of Pediatrics and all pediatricians work together to advocate for payment of these modalities,” she said.

J. Howard Smart, MD, who is chairman of the department of pediatrics at Sharp Rees-Stealy Medical Group in San Diego, said in an interview, “We have been bringing all of the infants and toddlers in for checkups and vaccines up to age 18 months.” These visits are scheduled in the morning, and sick patients are scheduled in the afternoon. “Well-child visits for older ages are being done by video, and the kindergarten and adolescent vaccines can be done by quick nurse visits. We will have some catching up to do once restrictions are lifted.”

“A fair amount of discussion went into these decisions. Is a video checkup better than no checkup? There is no clear-cut answer. Important things can be addressed by video: lifestyle, diet, exercise, family coping with stay-at-home orders, maintaining healthy childhood relationships, Internet use, ongoing education, among others. We know that we may miss things that can only be picked up by physical examination: hypertension, heart murmurs, abnormal growth, sexual development, abdominal masses, subtle strabismus. This is why we need to bring these children back for the physical exam later,” Dr. Smart emphasized.

“One possible negative result of doing the ‘well-child check’ by video would be if the parent assumed that the ‘checkup’ was done, never brought the child back for the exam, and something was missed that needed intervention. It will be important to get the message across that the return visit is needed. The American Academy of Pediatrics made this a part of their recommendations. It is going to be important for payers to realize that we need to do both visits – and to pay accordingly,” he concluded.

Francis E. Rushton Jr., MD, of Birmingham, Ala., described in an interview how the pediatricians in his former practice are looking for new ways to encourage shot administration in a timely manner during the COVID-19 pandemic, as well as exploring ways to partner with home visitors in encouraging timely infant and toddler vaccinations.

At South Carolina’s Beaufort Pediatrics, Joseph Floyd, MD, described a multipronged initiative. The practice’s well-child visit reminder system is being reprogrammed to check for lapses in vaccinations rather than just well-child visit attendance. For the most part, Dr. Floyd stated parents appreciate the reminders and accept the need for vaccination: “In the absence of immunizations for coronavirus, families seem to be more cognizant of the value of the vaccines we do have.” Beaufort Pediatrics is also partnering with their local hospital on a publicity campaign stressing the importance of staying up to date with currently available and recommended vaccines.

Other child-service organizations are concerned as well. Dr. Francis E. Rushton Jr., as faculty with the Education Development Center’s Health Resources and Services Administration–funded home-visiting quality improvement collaborative (HV CoIIN 2.0), described efforts with home visitors in Alabama and other states. “Home visitors understand the importance of immunizations to the health and welfare of the infants they care for. They’re looking for opportunities to improve compliance with vaccination regimens.” Some of these home-visiting agencies are employing quality improvement technique to improve compliance. One idea they are working on is documenting annual training on updated vaccines for the home visitors. They are working on protocols for linking their clients with primary health care providers, referral relations, and relationship development with local pediatric offices. Motivational interviewing techniques for home visitors focused on immunizations are being considered. For families who are hesitant, home visitors are considering accompanying the family when they come to the doctor’s office while paying attention to COVID-19 social distancing policies at medical facilities.

As the COVID-19 pandemic continues to spread across the United States, several members of the Pediatric News Editorial Advisory Board shared how practices have been adapting to the pandemic, especially in terms of immunization.

Karalyn Kinsella, MD, a member of a four-pediatrician private practice in Cheshire, Conn., said in an interview that “we have been seeing only children under age 2 years for their well visits to keep them up to date on their vaccinations” as recommended by infectious disease departments at nearby hospitals such as Connecticut Children’s Medical Center. “We also are seeing the 4- and 5-year-old children for vaccinations.”

Dr. Kinsella explained that, in case parents don’t want to bring their children into the office, her staff is offering to give the vaccinations in the parking lot. But most families are coming into the office.

“We are only seeing well babies and take the parent and child back to a room as soon as they come in the office to avoid having patients sit in the waiting room. At this point, both parents and office staff are wearing masks; we are cleaning the rooms between patients,” Dr. Kinsella said.

“Most of our patients are coming in for their vaccines, so I don’t anticipate a lot of kids being behind. However, we will have a surge of all the physicals that need to be done prior to school in the fall. We have thought about opening up for the weekends for physicals to accommodate this. We also may need to start the day earlier and end later. I have heard some schools may be postponing the date the physicals are due.”

Because of a lack of full personal protective equipment, the practice has not been seeing sick visits in the office, but they have been doing a lot of telehealth visits. “We have been using doxy.me for that, which is free, incredibly easy to use, and Health Insurance Portability and Accountability Act (HIPAA)–compliant,” she said. “I am finding some visits, such as ADHD follow-ups and mental health follow-ups, very amenable to telehealth.”

“The hardest part – as I am sure is for most pediatricians – is the financial strain to a small business,” Dr. Kinsella noted. “We are down about 70% in revenue from this time last year. We have had to lay-off half our staff, and those who are working have much-reduced hours. We did not get the first round of funding for the paycheck protection program loan from the government and are waiting on the second round. We are trying to recoup some business by doing telehealth, but [the insurance companies] are only paying about 75%-80%. We also are charging for phone calls over 5 minutes. It will take a long time once we are up and running to recoup the losses.

“When this is all over, I’m hoping that we will be able to continue to incorporate telehealth into our schedules as I think it is convenient for families. I also am hoping that pediatricians continue to bill for phone calls as we have been giving out a lot of free care prior to this. I hope the American Academy of Pediatrics and all pediatricians work together to advocate for payment of these modalities,” she said.

J. Howard Smart, MD, who is chairman of the department of pediatrics at Sharp Rees-Stealy Medical Group in San Diego, said in an interview, “We have been bringing all of the infants and toddlers in for checkups and vaccines up to age 18 months.” These visits are scheduled in the morning, and sick patients are scheduled in the afternoon. “Well-child visits for older ages are being done by video, and the kindergarten and adolescent vaccines can be done by quick nurse visits. We will have some catching up to do once restrictions are lifted.”

“A fair amount of discussion went into these decisions. Is a video checkup better than no checkup? There is no clear-cut answer. Important things can be addressed by video: lifestyle, diet, exercise, family coping with stay-at-home orders, maintaining healthy childhood relationships, Internet use, ongoing education, among others. We know that we may miss things that can only be picked up by physical examination: hypertension, heart murmurs, abnormal growth, sexual development, abdominal masses, subtle strabismus. This is why we need to bring these children back for the physical exam later,” Dr. Smart emphasized.

“One possible negative result of doing the ‘well-child check’ by video would be if the parent assumed that the ‘checkup’ was done, never brought the child back for the exam, and something was missed that needed intervention. It will be important to get the message across that the return visit is needed. The American Academy of Pediatrics made this a part of their recommendations. It is going to be important for payers to realize that we need to do both visits – and to pay accordingly,” he concluded.

Francis E. Rushton Jr., MD, of Birmingham, Ala., described in an interview how the pediatricians in his former practice are looking for new ways to encourage shot administration in a timely manner during the COVID-19 pandemic, as well as exploring ways to partner with home visitors in encouraging timely infant and toddler vaccinations.

At South Carolina’s Beaufort Pediatrics, Joseph Floyd, MD, described a multipronged initiative. The practice’s well-child visit reminder system is being reprogrammed to check for lapses in vaccinations rather than just well-child visit attendance. For the most part, Dr. Floyd stated parents appreciate the reminders and accept the need for vaccination: “In the absence of immunizations for coronavirus, families seem to be more cognizant of the value of the vaccines we do have.” Beaufort Pediatrics is also partnering with their local hospital on a publicity campaign stressing the importance of staying up to date with currently available and recommended vaccines.

Other child-service organizations are concerned as well. Dr. Francis E. Rushton Jr., as faculty with the Education Development Center’s Health Resources and Services Administration–funded home-visiting quality improvement collaborative (HV CoIIN 2.0), described efforts with home visitors in Alabama and other states. “Home visitors understand the importance of immunizations to the health and welfare of the infants they care for. They’re looking for opportunities to improve compliance with vaccination regimens.” Some of these home-visiting agencies are employing quality improvement technique to improve compliance. One idea they are working on is documenting annual training on updated vaccines for the home visitors. They are working on protocols for linking their clients with primary health care providers, referral relations, and relationship development with local pediatric offices. Motivational interviewing techniques for home visitors focused on immunizations are being considered. For families who are hesitant, home visitors are considering accompanying the family when they come to the doctor’s office while paying attention to COVID-19 social distancing policies at medical facilities.

As the COVID-19 pandemic continues to spread across the United States, several members of the Ob.Gyn. News Editorial Advisory Board shared their experiences.

• One person will cover labor and delivery.
• One person will cover triage and help on labor and delivery.
• One person will be assigned to the resident office.
• One person will be assigned to cover the team of the post call attending (Sunday through Thursday call).
• One person will be assigned to gynecology coverage, consults, and postpartum rounds.

To further minimize the patient interactions, when possible, each patient should be seen by the attending physician with the resident. This is a change from usual practice, where the patient is first seen by the resident, who reports back to the attending, and then both physicians see the patient together.

The network’s offices now open from 9 a.m. (many offices had been offering early-morning hours starting at 7 a.m.), and the physicians and advanced practice providers will work through the last scheduled patient appointment, Dr. Jaspan explained. “The office-based team will preferentially see in-person visits.”

Several offices have been closed so that ob.gyns. and staff can be reassigned to telehealth. The remaining five offices generally have one attending physician and one advanced practice provider.

The remaining team of ob.gyns. provides telehealth with the help of staff members. This involves an initial call to the patient by staff letting them know the doctor will be calling, checking them in, verifying insurance, and collecting payment, followed by the actual telehealth visit. If follow-up is needed, the staff member schedules the follow-up.

Dr. Jaspan called the new approach to prenatal care because of COVID-19 a “cataclysmic change in how we care for our patients. We have decided to further limit our obstetrical in-person visits. It is our feeling that these changes will enable patients to remain outside of the office and in the safety of their homes, provide appropriate social distancing, and diminish potential exposures to the office staff providers and patients.”

In-person visits will occur at: the initial visit, between 24 and 28 weeks, at 32 weeks, and at 36 or 37 weeks; if the patient at 36/37 has a blood pressure cuff, they will not have additional scheduled in-patient visits. We have partnered with the insurance companies to provide more than 88% of obstetrical patients with home blood pressure cuffs.

Obstetrical visits via telehealth will continue at our standard intervals: monthly until 26 weeks; twice monthly during 26-36 weeks; and weekly from 37 weeks to delivery. These visits should use a video component such as Zoom, Doxy.me, or FaceTime.

“If the patient has concerns or problems, we will see them at any time. However, the new standard will be telehealth visits and the exception will be the in-person visit,” Dr. Jaspan said.

In addition, we have worked our division of maternal-fetal medicine to adjust the antenatal testing schedules, and we have curtailed the frequency of ultrasound, he noted.

He emphasized the importance of documenting telehealth interactions with obstetrical patients, in addition to “providing adequate teaching and education for patients regarding kick counts to ensure fetal well-being.” It also is key to “properly document conversations with patients regarding bleeding, rupture of membranes, fetal movement, headache, visual changes, fevers, cough, nausea and vomiting, diarrhea, fatigue, muscle aches, etc.”

The residents’ schedule also has been modified to diminish their exposure. Within our new paradigm, we have scheduled video conferences to enable our program to maintain our commitment to academics.

It is imperative that we keep our patients safe, and it is critical to protect our staff members. Those who provide women’s health cannot be replaced by other nurses or physicians.

• Suspend initiation of new treatment cycles, including ovulation induction, intrauterine inseminations, in vitro fertilization including retrievals and frozen embryo transfers, and nonurgent gamete cryopreservation.
• Strongly consider cancellation of all embryo transfers, whether fresh or frozen.
• Continue to care for patients who are currently “in cycle” or who require urgent stimulation and cryopreservation.
• Suspend elective surgeries and nonurgent diagnostic procedures.
• Minimize in-person interactions and increase utilization of telehealth.

As a member of ASRM for more than 2 decades and a participant of several of their committees, my practice immediately ceased treatment cycles to comply with this guidance.

Then on March 20, 2020, the Florida governor’s executive order 20-72 was released, stating, “All hospitals, ambulatory surgical centers, office surgery centers, dental, orthodontic and endodontic offices, and other health care practitioners’ offices in the State of Florida are prohibited from providing any medically unnecessary, nonurgent or nonemergency procedure or surgery which, if delayed, does not place a patient’s immediate health, safety, or well-­being at risk, or will, if delayed, not contribute to the worsening of a serious or life-threatening medical condition.”

As a result, my practice has been limited to telemedicine consultations. While the ASRM guidance and the gubernatorial executive order pose a significant financial hardship on my center and all applicable medical clinics in my state, resulting in expected layoffs, salary reductions, and requests for government stimulus loans, the greater good takes priority and we pray for all the victims of this devastating pandemic.

The governor’s current executive order is set to expire on May 9, 2020, unless it is extended.

ASRM released an update of their guidance on March 30, 2020, offering no change from their prior recommendations. The organization plans to reevaluate the guidance at 2-week intervals.

Sangeeta Sinha, MD, an ob.gyn. in private practice at Stone Springs Hospital Center, Dulles, Va. said in an interview, “COVID 19 has put fear in all aspects of our daily activities which we are attempting to cope with.”

She related several changes made to her office and hospital environments. “In our office, we are now wearing a mask at all times, gloves to examine every patient. We have staggered physicians in the office to take televisits and in-office patients. We are screening all new patients on the phone to determine if they are sick, have traveled to high-risk, hot spot areas of the country, or have had contact with someone who tested positive for COVID-19. We are only seeing our pregnant women and have also pushed out their return appointments to 4 weeks if possible. There are several staff who are not working due to fear or are in self quarantine so we have shortage of staff in the office. At the hospital as well we are wearing a mask at all times, using personal protective equipment for deliveries and C-sections.

“We have had several scares, including a new transfer of an 18-year-old pregnant patient at 30 weeks with cough and sore throat, who later reported that her roommate is very sick and he works with someone who has tested positive for COVID-19. Thankfully she is healthy and well. We learned several lessons from this one.”

As the COVID-19 pandemic continues to spread across the United States, several members of the Ob.Gyn. News Editorial Advisory Board shared their experiences.

• One person will cover labor and delivery.
• One person will cover triage and help on labor and delivery.
• One person will be assigned to the resident office.
• One person will be assigned to cover the team of the post call attending (Sunday through Thursday call).
• One person will be assigned to gynecology coverage, consults, and postpartum rounds.

To further minimize the patient interactions, when possible, each patient should be seen by the attending physician with the resident. This is a change from usual practice, where the patient is first seen by the resident, who reports back to the attending, and then both physicians see the patient together.

The network’s offices now open from 9 a.m. (many offices had been offering early-morning hours starting at 7 a.m.), and the physicians and advanced practice providers will work through the last scheduled patient appointment, Dr. Jaspan explained. “The office-based team will preferentially see in-person visits.”

Several offices have been closed so that ob.gyns. and staff can be reassigned to telehealth. The remaining five offices generally have one attending physician and one advanced practice provider.

The remaining team of ob.gyns. provides telehealth with the help of staff members. This involves an initial call to the patient by staff letting them know the doctor will be calling, checking them in, verifying insurance, and collecting payment, followed by the actual telehealth visit. If follow-up is needed, the staff member schedules the follow-up.

Dr. Jaspan called the new approach to prenatal care because of COVID-19 a “cataclysmic change in how we care for our patients. We have decided to further limit our obstetrical in-person visits. It is our feeling that these changes will enable patients to remain outside of the office and in the safety of their homes, provide appropriate social distancing, and diminish potential exposures to the office staff providers and patients.”

In-person visits will occur at: the initial visit, between 24 and 28 weeks, at 32 weeks, and at 36 or 37 weeks; if the patient at 36/37 has a blood pressure cuff, they will not have additional scheduled in-patient visits. We have partnered with the insurance companies to provide more than 88% of obstetrical patients with home blood pressure cuffs.

Obstetrical visits via telehealth will continue at our standard intervals: monthly until 26 weeks; twice monthly during 26-36 weeks; and weekly from 37 weeks to delivery. These visits should use a video component such as Zoom, Doxy.me, or FaceTime.

“If the patient has concerns or problems, we will see them at any time. However, the new standard will be telehealth visits and the exception will be the in-person visit,” Dr. Jaspan said.

In addition, we have worked our division of maternal-fetal medicine to adjust the antenatal testing schedules, and we have curtailed the frequency of ultrasound, he noted.

He emphasized the importance of documenting telehealth interactions with obstetrical patients, in addition to “providing adequate teaching and education for patients regarding kick counts to ensure fetal well-being.” It also is key to “properly document conversations with patients regarding bleeding, rupture of membranes, fetal movement, headache, visual changes, fevers, cough, nausea and vomiting, diarrhea, fatigue, muscle aches, etc.”

The residents’ schedule also has been modified to diminish their exposure. Within our new paradigm, we have scheduled video conferences to enable our program to maintain our commitment to academics.

It is imperative that we keep our patients safe, and it is critical to protect our staff members. Those who provide women’s health cannot be replaced by other nurses or physicians.

• Suspend initiation of new treatment cycles, including ovulation induction, intrauterine inseminations, in vitro fertilization including retrievals and frozen embryo transfers, and nonurgent gamete cryopreservation.
• Strongly consider cancellation of all embryo transfers, whether fresh or frozen.
• Continue to care for patients who are currently “in cycle” or who require urgent stimulation and cryopreservation.
• Suspend elective surgeries and nonurgent diagnostic procedures.
• Minimize in-person interactions and increase utilization of telehealth.

As a member of ASRM for more than 2 decades and a participant of several of their committees, my practice immediately ceased treatment cycles to comply with this guidance.

Then on March 20, 2020, the Florida governor’s executive order 20-72 was released, stating, “All hospitals, ambulatory surgical centers, office surgery centers, dental, orthodontic and endodontic offices, and other health care practitioners’ offices in the State of Florida are prohibited from providing any medically unnecessary, nonurgent or nonemergency procedure or surgery which, if delayed, does not place a patient’s immediate health, safety, or well-­being at risk, or will, if delayed, not contribute to the worsening of a serious or life-threatening medical condition.”

As a result, my practice has been limited to telemedicine consultations. While the ASRM guidance and the gubernatorial executive order pose a significant financial hardship on my center and all applicable medical clinics in my state, resulting in expected layoffs, salary reductions, and requests for government stimulus loans, the greater good takes priority and we pray for all the victims of this devastating pandemic.

The governor’s current executive order is set to expire on May 9, 2020, unless it is extended.

ASRM released an update of their guidance on March 30, 2020, offering no change from their prior recommendations. The organization plans to reevaluate the guidance at 2-week intervals.

Sangeeta Sinha, MD, an ob.gyn. in private practice at Stone Springs Hospital Center, Dulles, Va. said in an interview, “COVID 19 has put fear in all aspects of our daily activities which we are attempting to cope with.”

She related several changes made to her office and hospital environments. “In our office, we are now wearing a mask at all times, gloves to examine every patient. We have staggered physicians in the office to take televisits and in-office patients. We are screening all new patients on the phone to determine if they are sick, have traveled to high-risk, hot spot areas of the country, or have had contact with someone who tested positive for COVID-19. We are only seeing our pregnant women and have also pushed out their return appointments to 4 weeks if possible. There are several staff who are not working due to fear or are in self quarantine so we have shortage of staff in the office. At the hospital as well we are wearing a mask at all times, using personal protective equipment for deliveries and C-sections.

“We have had several scares, including a new transfer of an 18-year-old pregnant patient at 30 weeks with cough and sore throat, who later reported that her roommate is very sick and he works with someone who has tested positive for COVID-19. Thankfully she is healthy and well. We learned several lessons from this one.”

As the COVID-19 pandemic continues to spread across the United States, several members of the Ob.Gyn. News Editorial Advisory Board shared their experiences.

• One person will cover labor and delivery.
• One person will cover triage and help on labor and delivery.
• One person will be assigned to the resident office.
• One person will be assigned to cover the team of the post call attending (Sunday through Thursday call).
• One person will be assigned to gynecology coverage, consults, and postpartum rounds.

To further minimize the patient interactions, when possible, each patient should be seen by the attending physician with the resident. This is a change from usual practice, where the patient is first seen by the resident, who reports back to the attending, and then both physicians see the patient together.

The network’s offices now open from 9 a.m. (many offices had been offering early-morning hours starting at 7 a.m.), and the physicians and advanced practice providers will work through the last scheduled patient appointment, Dr. Jaspan explained. “The office-based team will preferentially see in-person visits.”

Several offices have been closed so that ob.gyns. and staff can be reassigned to telehealth. The remaining five offices generally have one attending physician and one advanced practice provider.

The remaining team of ob.gyns. provides telehealth with the help of staff members. This involves an initial call to the patient by staff letting them know the doctor will be calling, checking them in, verifying insurance, and collecting payment, followed by the actual telehealth visit. If follow-up is needed, the staff member schedules the follow-up.

Dr. Jaspan called the new approach to prenatal care because of COVID-19 a “cataclysmic change in how we care for our patients. We have decided to further limit our obstetrical in-person visits. It is our feeling that these changes will enable patients to remain outside of the office and in the safety of their homes, provide appropriate social distancing, and diminish potential exposures to the office staff providers and patients.”

In-person visits will occur at: the initial visit, between 24 and 28 weeks, at 32 weeks, and at 36 or 37 weeks; if the patient at 36/37 has a blood pressure cuff, they will not have additional scheduled in-patient visits. We have partnered with the insurance companies to provide more than 88% of obstetrical patients with home blood pressure cuffs.

Obstetrical visits via telehealth will continue at our standard intervals: monthly until 26 weeks; twice monthly during 26-36 weeks; and weekly from 37 weeks to delivery. These visits should use a video component such as Zoom, Doxy.me, or FaceTime.

“If the patient has concerns or problems, we will see them at any time. However, the new standard will be telehealth visits and the exception will be the in-person visit,” Dr. Jaspan said.

In addition, we have worked our division of maternal-fetal medicine to adjust the antenatal testing schedules, and we have curtailed the frequency of ultrasound, he noted.

He emphasized the importance of documenting telehealth interactions with obstetrical patients, in addition to “providing adequate teaching and education for patients regarding kick counts to ensure fetal well-being.” It also is key to “properly document conversations with patients regarding bleeding, rupture of membranes, fetal movement, headache, visual changes, fevers, cough, nausea and vomiting, diarrhea, fatigue, muscle aches, etc.”

The residents’ schedule also has been modified to diminish their exposure. Within our new paradigm, we have scheduled video conferences to enable our program to maintain our commitment to academics.

It is imperative that we keep our patients safe, and it is critical to protect our staff members. Those who provide women’s health cannot be replaced by other nurses or physicians.

• Suspend initiation of new treatment cycles, including ovulation induction, intrauterine inseminations, in vitro fertilization including retrievals and frozen embryo transfers, and nonurgent gamete cryopreservation.
• Strongly consider cancellation of all embryo transfers, whether fresh or frozen.
• Continue to care for patients who are currently “in cycle” or who require urgent stimulation and cryopreservation.
• Suspend elective surgeries and nonurgent diagnostic procedures.
• Minimize in-person interactions and increase utilization of telehealth.

As a member of ASRM for more than 2 decades and a participant of several of their committees, my practice immediately ceased treatment cycles to comply with this guidance.

Then on March 20, 2020, the Florida governor’s executive order 20-72 was released, stating, “All hospitals, ambulatory surgical centers, office surgery centers, dental, orthodontic and endodontic offices, and other health care practitioners’ offices in the State of Florida are prohibited from providing any medically unnecessary, nonurgent or nonemergency procedure or surgery which, if delayed, does not place a patient’s immediate health, safety, or well-­being at risk, or will, if delayed, not contribute to the worsening of a serious or life-threatening medical condition.”

As a result, my practice has been limited to telemedicine consultations. While the ASRM guidance and the gubernatorial executive order pose a significant financial hardship on my center and all applicable medical clinics in my state, resulting in expected layoffs, salary reductions, and requests for government stimulus loans, the greater good takes priority and we pray for all the victims of this devastating pandemic.

The governor’s current executive order is set to expire on May 9, 2020, unless it is extended.

ASRM released an update of their guidance on March 30, 2020, offering no change from their prior recommendations. The organization plans to reevaluate the guidance at 2-week intervals.

Sangeeta Sinha, MD, an ob.gyn. in private practice at Stone Springs Hospital Center, Dulles, Va. said in an interview, “COVID 19 has put fear in all aspects of our daily activities which we are attempting to cope with.”

She related several changes made to her office and hospital environments. “In our office, we are now wearing a mask at all times, gloves to examine every patient. We have staggered physicians in the office to take televisits and in-office patients. We are screening all new patients on the phone to determine if they are sick, have traveled to high-risk, hot spot areas of the country, or have had contact with someone who tested positive for COVID-19. We are only seeing our pregnant women and have also pushed out their return appointments to 4 weeks if possible. There are several staff who are not working due to fear or are in self quarantine so we have shortage of staff in the office. At the hospital as well we are wearing a mask at all times, using personal protective equipment for deliveries and C-sections.

“We have had several scares, including a new transfer of an 18-year-old pregnant patient at 30 weeks with cough and sore throat, who later reported that her roommate is very sick and he works with someone who has tested positive for COVID-19. Thankfully she is healthy and well. We learned several lessons from this one.”

Ob.Gyn. News welcomes Angela Martin, MD, to the editorial advisory board.

Dr. Martin is an assistant professor of gynecology and obstetrics in the division of maternal-fetal medicine at the University of Kansas Medical Center in Kansas City, where she is the director of ultrasound training for the residency program. She also serves on the Pharmacy and Therapeutics Committee at the university.

Dr. Martin has been a primary author or coauthor of many articles published and accepted in refereed medical publications on topics including influenza infection during pregnancy, maternal and fetal risk associated with assisted reproductive technology, hepatitis B in pregnancy, umbilical cord blood banking, pregnancy and obesity, and cell-free fetal DNA. She currently is involved in research on resident operative delivery training, chorionic villus sampling, and preterm birth.

Graduating summa cum laude from Drake University in Des Moines, Iowa, with a bachelor of science degree in biology and a minor in psychology, Dr. Martin received her doctorate of medicine at the University of Missouri, Columbia. She completed her postgraduate training at Emory University in Atlanta with an internship and residency in the department of gynecology and obstetrics, followed by a fellowship in the maternal-fetal medicine division.

Dr. Martin has won numerous honors and awards, including Outstanding Research Proposal by a fellow at Emory University, Excellence in Teaching awards for a fellow for several consecutive years at the university, and a National Faculty Award from the American College of Obstetricians and Gynecologists.*

*This article was updated 2/7/2020.

Ob.Gyn. News welcomes Angela Martin, MD, to the editorial advisory board.

Dr. Martin is an assistant professor of gynecology and obstetrics in the division of maternal-fetal medicine at the University of Kansas Medical Center in Kansas City, where she is the director of ultrasound training for the residency program. She also serves on the Pharmacy and Therapeutics Committee at the university.

Dr. Martin has been a primary author or coauthor of many articles published and accepted in refereed medical publications on topics including influenza infection during pregnancy, maternal and fetal risk associated with assisted reproductive technology, hepatitis B in pregnancy, umbilical cord blood banking, pregnancy and obesity, and cell-free fetal DNA. She currently is involved in research on resident operative delivery training, chorionic villus sampling, and preterm birth.

Graduating summa cum laude from Drake University in Des Moines, Iowa, with a bachelor of science degree in biology and a minor in psychology, Dr. Martin received her doctorate of medicine at the University of Missouri, Columbia. She completed her postgraduate training at Emory University in Atlanta with an internship and residency in the department of gynecology and obstetrics, followed by a fellowship in the maternal-fetal medicine division.

Dr. Martin has won numerous honors and awards, including Outstanding Research Proposal by a fellow at Emory University, Excellence in Teaching awards for a fellow for several consecutive years at the university, and a National Faculty Award from the American College of Obstetricians and Gynecologists.*

*This article was updated 2/7/2020.

Ob.Gyn. News welcomes Angela Martin, MD, to the editorial advisory board.

Dr. Martin is an assistant professor of gynecology and obstetrics in the division of maternal-fetal medicine at the University of Kansas Medical Center in Kansas City, where she is the director of ultrasound training for the residency program. She also serves on the Pharmacy and Therapeutics Committee at the university.

Dr. Martin has been a primary author or coauthor of many articles published and accepted in refereed medical publications on topics including influenza infection during pregnancy, maternal and fetal risk associated with assisted reproductive technology, hepatitis B in pregnancy, umbilical cord blood banking, pregnancy and obesity, and cell-free fetal DNA. She currently is involved in research on resident operative delivery training, chorionic villus sampling, and preterm birth.

Graduating summa cum laude from Drake University in Des Moines, Iowa, with a bachelor of science degree in biology and a minor in psychology, Dr. Martin received her doctorate of medicine at the University of Missouri, Columbia. She completed her postgraduate training at Emory University in Atlanta with an internship and residency in the department of gynecology and obstetrics, followed by a fellowship in the maternal-fetal medicine division.

Dr. Martin has won numerous honors and awards, including Outstanding Research Proposal by a fellow at Emory University, Excellence in Teaching awards for a fellow for several consecutive years at the university, and a National Faculty Award from the American College of Obstetricians and Gynecologists.*

*This article was updated 2/7/2020.

Barbara J. Howard, MD, will receive the 2019 C. Anderson Aldrich Award at the American Academy of Pediatrics annual meeting on Oct. 26 in New Orleans.

The award is given by the AAP Section on Developmental and Behavioral Pediatrics to “recognize physicians who have made outstanding contributions to the field of child development,” according to the AAP. Previous recipients of the award include pediatricians such as Benjamin M. Spock, MD, and T. Berry Brazelton, MD, as well as psychoanalyst Anna Freud and child psychologist Erik H. Erickson.

Dr. Howard is a developmental-behavioral pediatrician who is an assistant professor of pediatrics at Johns Hopkins University, Baltimore, where she codirected a fellowship program to train developmental and behavioral pediatricians. She is a creator of CHADIS, an innovative online system that provides previsit questionnaires that allows physicians “to collect patient-generated data that can be used to support clinical and shared decisions, track data, and create quality improvement reports,” according to the CHADIS website. She has given free monthly case conferences through a federal grant for 30 years, initially in person and more recently through a national webcast. Over the last 2 decades, Dr. Howard has written about practical approaches to developmental and behavioral problems children experience for this newspaper in her Behavioral Consult column.

Michael S. Jellinek, MD, professor emeritus of psychiatry and pediatrics at the Harvard Medical School, Boston, said in an interview, “Barbara’s dedication to the emotional health of children has made an enormous difference. In addition to her clinical care and writing, her development of CHADIS has helped pediatricians recognize and treat thousands upon thousands of children. She is most deserving of this high honor.”
 

cnellist@mdedge.com

Barbara J. Howard, MD, will receive the 2019 C. Anderson Aldrich Award at the American Academy of Pediatrics annual meeting on Oct. 26 in New Orleans.

The award is given by the AAP Section on Developmental and Behavioral Pediatrics to “recognize physicians who have made outstanding contributions to the field of child development,” according to the AAP. Previous recipients of the award include pediatricians such as Benjamin M. Spock, MD, and T. Berry Brazelton, MD, as well as psychoanalyst Anna Freud and child psychologist Erik H. Erickson.

Dr. Howard is a developmental-behavioral pediatrician who is an assistant professor of pediatrics at Johns Hopkins University, Baltimore, where she codirected a fellowship program to train developmental and behavioral pediatricians. She is a creator of CHADIS, an innovative online system that provides previsit questionnaires that allows physicians “to collect patient-generated data that can be used to support clinical and shared decisions, track data, and create quality improvement reports,” according to the CHADIS website. She has given free monthly case conferences through a federal grant for 30 years, initially in person and more recently through a national webcast. Over the last 2 decades, Dr. Howard has written about practical approaches to developmental and behavioral problems children experience for this newspaper in her Behavioral Consult column.

Michael S. Jellinek, MD, professor emeritus of psychiatry and pediatrics at the Harvard Medical School, Boston, said in an interview, “Barbara’s dedication to the emotional health of children has made an enormous difference. In addition to her clinical care and writing, her development of CHADIS has helped pediatricians recognize and treat thousands upon thousands of children. She is most deserving of this high honor.”
 

cnellist@mdedge.com

Barbara J. Howard, MD, will receive the 2019 C. Anderson Aldrich Award at the American Academy of Pediatrics annual meeting on Oct. 26 in New Orleans.

The award is given by the AAP Section on Developmental and Behavioral Pediatrics to “recognize physicians who have made outstanding contributions to the field of child development,” according to the AAP. Previous recipients of the award include pediatricians such as Benjamin M. Spock, MD, and T. Berry Brazelton, MD, as well as psychoanalyst Anna Freud and child psychologist Erik H. Erickson.

Dr. Howard is a developmental-behavioral pediatrician who is an assistant professor of pediatrics at Johns Hopkins University, Baltimore, where she codirected a fellowship program to train developmental and behavioral pediatricians. She is a creator of CHADIS, an innovative online system that provides previsit questionnaires that allows physicians “to collect patient-generated data that can be used to support clinical and shared decisions, track data, and create quality improvement reports,” according to the CHADIS website. She has given free monthly case conferences through a federal grant for 30 years, initially in person and more recently through a national webcast. Over the last 2 decades, Dr. Howard has written about practical approaches to developmental and behavioral problems children experience for this newspaper in her Behavioral Consult column.

Michael S. Jellinek, MD, professor emeritus of psychiatry and pediatrics at the Harvard Medical School, Boston, said in an interview, “Barbara’s dedication to the emotional health of children has made an enormous difference. In addition to her clinical care and writing, her development of CHADIS has helped pediatricians recognize and treat thousands upon thousands of children. She is most deserving of this high honor.”
 

cnellist@mdedge.com

Ob.Gyn. News welcomes Iris Krishna, MD, MPH, to the editorial advisory board.

Dr. Krishna is an assistant professor of gynecology and obstetrics in the division of maternal-fetal medicine at Emory University in Atlanta.

She has published articles on topics such as low fetal fraction in noninvasive prenatal screening, breast cancer in pregnancy, intrahepatic cholestasis of pregnancy, obesity, diabetes, and chronic hypertension. She is currently involved in research on chronic hypertension during pregnancy.

Dr. Krishna serves on numerous committees at Emory for the department of gynecology and obstetrics, including the resident clinical competency committee and program evaluation committee, as well as similar committees for the maternal-fetal medicine fellowship program. She also is a member of the Emory University Hospital Midtown’s quality enhancement committee, ethics committee, and critical care committee.

Dr. Krishna received a Master of Public Health in epidemiology from Tulane University School of Public Health and Tropical Medicine in New Orleans, and a medical degree from Louisiana State University Health Sciences Center in Shreveport. She completed her residency training in obstetrics and gynecology and fellowship training in maternal-fetal medicine at Emory, where she received awards for her clinical skills in obstetrics and completed a thesis research project on prenatal genetic screening. She also was recognized by her staff and colleagues as Outstanding Emory Faculty for her contributions to teaching and clinical service. Dr. Krishna is board certified in obstetrics and gynecology and in maternal-fetal medicine. She is a member of the Society for Maternal-Fetal Medicine and a fellow of the American College of Obstetricians and Gynecologists.

cnellist@mdedge.com

Ob.Gyn. News welcomes Iris Krishna, MD, MPH, to the editorial advisory board.

Dr. Krishna is an assistant professor of gynecology and obstetrics in the division of maternal-fetal medicine at Emory University in Atlanta.

She has published articles on topics such as low fetal fraction in noninvasive prenatal screening, breast cancer in pregnancy, intrahepatic cholestasis of pregnancy, obesity, diabetes, and chronic hypertension. She is currently involved in research on chronic hypertension during pregnancy.

Dr. Krishna serves on numerous committees at Emory for the department of gynecology and obstetrics, including the resident clinical competency committee and program evaluation committee, as well as similar committees for the maternal-fetal medicine fellowship program. She also is a member of the Emory University Hospital Midtown’s quality enhancement committee, ethics committee, and critical care committee.

Dr. Krishna received a Master of Public Health in epidemiology from Tulane University School of Public Health and Tropical Medicine in New Orleans, and a medical degree from Louisiana State University Health Sciences Center in Shreveport. She completed her residency training in obstetrics and gynecology and fellowship training in maternal-fetal medicine at Emory, where she received awards for her clinical skills in obstetrics and completed a thesis research project on prenatal genetic screening. She also was recognized by her staff and colleagues as Outstanding Emory Faculty for her contributions to teaching and clinical service. Dr. Krishna is board certified in obstetrics and gynecology and in maternal-fetal medicine. She is a member of the Society for Maternal-Fetal Medicine and a fellow of the American College of Obstetricians and Gynecologists.

cnellist@mdedge.com

Ob.Gyn. News welcomes Iris Krishna, MD, MPH, to the editorial advisory board.

Dr. Krishna is an assistant professor of gynecology and obstetrics in the division of maternal-fetal medicine at Emory University in Atlanta.

She has published articles on topics such as low fetal fraction in noninvasive prenatal screening, breast cancer in pregnancy, intrahepatic cholestasis of pregnancy, obesity, diabetes, and chronic hypertension. She is currently involved in research on chronic hypertension during pregnancy.

Dr. Krishna serves on numerous committees at Emory for the department of gynecology and obstetrics, including the resident clinical competency committee and program evaluation committee, as well as similar committees for the maternal-fetal medicine fellowship program. She also is a member of the Emory University Hospital Midtown’s quality enhancement committee, ethics committee, and critical care committee.

Dr. Krishna received a Master of Public Health in epidemiology from Tulane University School of Public Health and Tropical Medicine in New Orleans, and a medical degree from Louisiana State University Health Sciences Center in Shreveport. She completed her residency training in obstetrics and gynecology and fellowship training in maternal-fetal medicine at Emory, where she received awards for her clinical skills in obstetrics and completed a thesis research project on prenatal genetic screening. She also was recognized by her staff and colleagues as Outstanding Emory Faculty for her contributions to teaching and clinical service. Dr. Krishna is board certified in obstetrics and gynecology and in maternal-fetal medicine. She is a member of the Society for Maternal-Fetal Medicine and a fellow of the American College of Obstetricians and Gynecologists.

cnellist@mdedge.com

NASHVILLE, TENN. – Is routine induction of labor in a healthy pregnancy at 39 weeks’ gestation a sensible thing to do? Aaron B. Caughey, MD, PhD, discussed this in a video at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

In a healthy pregnancy, with no medical indications for induction of labor, 39-40 weeks’ gestation is a time when there is a relatively low risk of stillbirth, although the risk is not zero, Dr. Caughey explained. The same is true for neonatal death. This gestational age is a time when there is a low risk for respiratory complications and a low risk for meconium.

“This might be a nice time to have a baby,” said Dr. Caughey, professor and chair of the department of obstetrics and gynecology at Oregon Health & Science University, Portland. “The trade-off is intervention. Don’t you increase the risk of C-sections?”

Actually, numerous retrospective studies have shown that there is either no difference or a decreased rate of C-sections with induction of labor at 39-40 weeks’ gestation, compared with expectant management.

These findings led to a prospective, randomized study by William A. Grobman, MD, and associates for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network called the ARRIVE trial (N Engl J Med. 2018;379:513-23). In that trial, the investigators randomized 3,062 women to induction of labor and 3,044 to expectant management. A significantly lower percentage of women in the induction of labor group underwent C-section than did women randomized to expectant management: 19% vs. 22% (relative risk, 0.84; P less than .001) – that is, 16% fewer C-sections. Also, 36% fewer women in the induction of labor group experienced preeclampsia. No significant differences were found between the two groups in terms of neonatal outcomes.

However, this is just one study, Dr. Caughey noted. What does is mean for a local community hospital? What does it mean for a busy private obstetrics practice?

Watch this video for his answer.



 

NASHVILLE, TENN. – Is routine induction of labor in a healthy pregnancy at 39 weeks’ gestation a sensible thing to do? Aaron B. Caughey, MD, PhD, discussed this in a video at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

In a healthy pregnancy, with no medical indications for induction of labor, 39-40 weeks’ gestation is a time when there is a relatively low risk of stillbirth, although the risk is not zero, Dr. Caughey explained. The same is true for neonatal death. This gestational age is a time when there is a low risk for respiratory complications and a low risk for meconium.

“This might be a nice time to have a baby,” said Dr. Caughey, professor and chair of the department of obstetrics and gynecology at Oregon Health & Science University, Portland. “The trade-off is intervention. Don’t you increase the risk of C-sections?”

Actually, numerous retrospective studies have shown that there is either no difference or a decreased rate of C-sections with induction of labor at 39-40 weeks’ gestation, compared with expectant management.

These findings led to a prospective, randomized study by William A. Grobman, MD, and associates for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network called the ARRIVE trial (N Engl J Med. 2018;379:513-23). In that trial, the investigators randomized 3,062 women to induction of labor and 3,044 to expectant management. A significantly lower percentage of women in the induction of labor group underwent C-section than did women randomized to expectant management: 19% vs. 22% (relative risk, 0.84; P less than .001) – that is, 16% fewer C-sections. Also, 36% fewer women in the induction of labor group experienced preeclampsia. No significant differences were found between the two groups in terms of neonatal outcomes.

However, this is just one study, Dr. Caughey noted. What does is mean for a local community hospital? What does it mean for a busy private obstetrics practice?

Watch this video for his answer.



 

NASHVILLE, TENN. – Is routine induction of labor in a healthy pregnancy at 39 weeks’ gestation a sensible thing to do? Aaron B. Caughey, MD, PhD, discussed this in a video at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.

In a healthy pregnancy, with no medical indications for induction of labor, 39-40 weeks’ gestation is a time when there is a relatively low risk of stillbirth, although the risk is not zero, Dr. Caughey explained. The same is true for neonatal death. This gestational age is a time when there is a low risk for respiratory complications and a low risk for meconium.

“This might be a nice time to have a baby,” said Dr. Caughey, professor and chair of the department of obstetrics and gynecology at Oregon Health & Science University, Portland. “The trade-off is intervention. Don’t you increase the risk of C-sections?”

Actually, numerous retrospective studies have shown that there is either no difference or a decreased rate of C-sections with induction of labor at 39-40 weeks’ gestation, compared with expectant management.

These findings led to a prospective, randomized study by William A. Grobman, MD, and associates for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network called the ARRIVE trial (N Engl J Med. 2018;379:513-23). In that trial, the investigators randomized 3,062 women to induction of labor and 3,044 to expectant management. A significantly lower percentage of women in the induction of labor group underwent C-section than did women randomized to expectant management: 19% vs. 22% (relative risk, 0.84; P less than .001) – that is, 16% fewer C-sections. Also, 36% fewer women in the induction of labor group experienced preeclampsia. No significant differences were found between the two groups in terms of neonatal outcomes.

However, this is just one study, Dr. Caughey noted. What does is mean for a local community hospital? What does it mean for a busy private obstetrics practice?

Watch this video for his answer.