[Ohioaap-practicemanagers] School based health clinic in our back yard

[Jon Price]

I’m not aware of a pre-made letter on this.
My personal opinion is that 
1)a joint communication from as many of your area’s pediatricians as possible should communicate with the medical director of the school district in order  to clearly work out a way to keep the school based clinic for the underserved and not to sever the patients whom you’re serving from their medical home. I would encourage you all to be imperative in your tone.

2) A fellow COCHF member summarizes basic problems between school clinics and medical homes as communication and as about responsibility for managing chronic problems in the summer and during school breaks. 
    The following longer list of problems is from the Academy’s May 2017 policy statement “Nonemergency Acute Care: When It’s Not the Medical Home” published in Pediatrics. Though this list was devised for retail clinics and urgent cares without pediatric expertise, most of the problems apply to your situation. Feel free to use it. 
  "It is important to develop and implement recommendations to avoid potential risks and unsafe situations, such as the following:
treatment that is not consistent with pediatric best practice;

fragmentation of care that is disconnected from the medical home;

lack of access to the child’s complete medical and social history;

lack of maintenance of a complete, accessible, central health record that contains all pertinent patient information;

treatment recommendations that do not take into account the child’s previous response to treatment, chronic conditions, special health care needs, and family circumstances such as social determinants of health (eg, inability to afford prescription medications, prescribing opioids in family with parental dependence);

missed opportunities for identifying unmet needs or delivering preventive services;

use of tests for the purpose of diagnosis without proper follow-up;

treatment of physical symptoms without recognition of a behavioral health illness or occult medical condition driving the symptoms;

failure to maintain an appropriate and predetermined scope of practice for the acute care of children in an acute care setting;

suboptimal care of children in an adult-focused delivery system, including under- and overutilization of diagnostic testing and medications; and

failure to appropriately transfer patients who would best be served in the medical home or in an emergency department."


3) From a practice management point of view , all measures of practice transformation so as to remain competitive in this environment are worth considering. Hints from the recent Pediatric Practice Management Institute conference in Charleston last month included providing early morning before-school appointments for middle school and high school well care (since parents often will not have their children miss after school sports, even for the doctor), being aware of the times of any long lunch periods in area schools for scheduling well visits, and to these I would add a question: any way you can get pediatric expertise involving yourselves and local colleagues into a contract for providing school based clinic care?
  Jon Price
  Ohio Pediatric Council Co-chair


> On Jan 29, 2018, at 9:20 AM, Michael Chamberlin via Ohioaap-practicemanagers <ohioaap-practicemanagers at lists.deltaforce.net> wrote:
> 
> We have recently discovered that our local school district is opening a school based health clinic.  While I understand the need for school based health clinics in underserved areas, that is not the case in our area.  There will be an FNP on site at the middle school and they will offer transportation from the elementary and high schools.  In addition to acute illness visits, this FNP will be doing well care, sports physicals, chronic illness diagnosis and management, vaccines, etc.
> 
> Obviously, this is undermining the medical home and will deliver substandard care for these children and families.  Have any of you dealt with situations like this before?  What has worked and what hasn't?
> 
> Right now, our plan is to send a letter to all families in this school district to remind them of the importance of a medical home and how this fractured care can affect their children.  We also plan on sending a letter to the superintendent of the school board to voice our concerns and ask for a meeting to more fully discuss this issue.  I have alerted the other large pediatric group in this school district to this issue so that we can work together to find a solution.
> 
> Does anyone have a letter that they have sent out to families in similar situations that they would be willing to share?
> 
> Thanks in advance for your help with this,
> 
> Mike
> 
> -- 
> Michael Chamberlin, M.D., FAAP
> Pediatric Assoc. of Mt Carmel
> 4371 Ferguson Dr
> Cincinnati, OH  45230
> 513-752-3650
> 513-752-3387 (fax)
> 
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