Welcome to day two of the 2020 Pediatric Section Meeting. Just some housekeeping, I was asked to remind you to visit the Remo Lounge to catch up with your colleagues and interact with speakers between sessions. I'd also request that you visit the exhibitors who have supported this program. On behalf of Andrew Jay and the American Academy of Pediatric Section on Neurological Surgery, I'd like to welcome you to the 2020 AAP SANS session. After a conversation with Mark earlier this week, I'm guessing that some, and maybe many of you, find it odd that an entity other than the Pediatric Section is afforded a platform during this meeting. You might ask, what is SANS? SANS is a group of pediatric neurosurgeons, trainees, and advanced practice providers with an interest in advocacy, health policy, media, networking opportunities with pediatricians and parents, and education and scholarly pursuits related to children. Regarding the question, why do you belong to SANS? Each member has his or her own reasons. As an example, Doug Brockmeyer provided the following reason. I joined the AAP SANS to amplify my pediatric neurosurgical voice. In matters that concern children's health, there is no better avenue to make sure that where pediatrics and pediatric neurosurgery intersect, our voice is heard and taken seriously. Our parent organization, the American Academy of Pediatrics, numbers 67,000 members, more than three times the membership of the AANS and CNS combined. 2020 has been a remarkable year. While politics and the COVID pandemic have dominated the news cycle, the year has also been marked by amplified calls for social justice and attacks on the validity of science at a time that science is desperately needed. 2020 reminds us of the duty of citizenship, of the need for citizens to engage locally, regionally, and nationally on issues of importance to them. Mark opened this meeting with a reminder that each of you is a leader and influencer. In selecting this year's speaker, the SANS Executive Committee endeavored to provide you with access to the pinnacle of AAP leadership. It is our hope that understanding the vision of the AAP might provide insight in what would assist each of you with projecting your voice for the betterment of the children you serve. With that in mind, I'd like to introduce Dr. Goza, the current president of the American Academy of Pediatrics and our speaker today. Dr. Goza has been a practicing hometown pediatrician in Fayetteville, Georgia for more than 30 years. Prior to her ascension to her role as president, Dr. Goza served in multiple regional and national roles with the AAP. One of her signature initiatives is the Child Health Improvement through Longitudinal Data or Child Registry, which has been designed to collect, store and analyze real world patient data in order to improve our understanding of relationships between conditions, comorbidities and payment in pediatric disease. Dr. Goza shared with me that she considered a career in neurosurgery when she was a medical student at the Medical College of Georgia and was excited for the opportunity to join us today. I, for one, am looking forward to her talk. Dr. Goza. Thank you so much for that introduction. And good afternoon or good morning according to where you are. I'm so pleased to be joining you virtually, though I'd much rather be in Salt Lake City with you guys. That would be much more fun. I do finally remember my neurosurgery rotation in medical school. What you do is so impactful in children's lives and I appreciate your dedication to the health and wellbeing of all children. I consider all of us who care for children a community, a community of physicians with children as our North Star because children need our collective voices at the state, the federal and the local arenas so that we can let politicians and lawmakers know what they need to do to make this world better for all children because together we can make a difference. This was not the year I expected when I became president of the American Academy of Pediatrics, but it has been a consequential year. From the COVID-19 pandemic to the racial crisis, to the economic crisis and the war on science, we have been put to the test repeatedly and unfortunately we are not done. The numbers of COVID-19 cases are still on the rise. We passed the million mark for children weeks ago and we're at I think 1.3 million now of children that have been diagnosed. The economy is still struggling and people are still trying to survive the loss of jobs. Families are losing their health insurance. About one in four children now do not have enough to eat. Social isolation is affecting the mental health of our children, but also of us. And many of our children are not getting the education or the healthcare they need. That's why I want to start by thanking each of you for your ingenuity, your resolve and your pragmatic optimism as we make the best of a difficult, disruptive time by inspiring the world and proving that courage and hope can be contagious. We've learned so much about SARS-CoV-2 these past 10 months, yet in many ways, this virus remains something of an unknown player. Even our infectious disease experts can only make educated guesses about what comes next and when. Yet with a vaccine being available soon, we do have a sense of hope. The coronavirus may not be as catastrophic to global health as the 1918 flu pandemic or the 14th century bubonic plague, but it has revealed the shaky foundations on which much of the developed world is built. From the interwoven nature of globalized supply chains and manufacturing infrastructure to the stark contrast between the health of populations and their access to healthcare. And it will continue to reshape society and the systems we rely on, reorienting our relationship to government, the outside world and to each other. To be able to understand the future of pediatrics, we need to know who are going to be our patients. So really, who are our nation's more than 73 million children for whom so much is at stake? They are highly diverse. Half are identified as a race or ethnicity other than white or non-Hispanic and a quarter are in immigrant families. Over the past two decades, the percent of children without insurance has dropped more than half to 5%, while the portion covered by public insurance has doubled to about 42%. Children are also more likely than adults to be living in poverty. 16% versus 11%. One in six children live below the poverty line. This next slide just shows when we talk about the future of pediatrics, this is kind of what I think in my head. It's all jumbled together and it's a lot of noise and what does it all mean? And so based on the trends we see emerging, I'm going to talk about eight predictions about the future of pediatric practice and what will be our new next normal. The first is there will be more flexible models of care delivery. The pandemic has proven that the in-person visit is not the only way to deliver high quality care. Patients and families have embraced the convenience and benefits of telehealth and home visits and pediatricians, pediatric medical subspecialists and pediatric surgical specialists will have more flexibility to deliver care using the mechanism they believe is most appropriate based on clinical needs and patient and family preference. According to an AAP Places study, our members use of telehealth has increased dramatically. Prior to COVID-19, 85% of primary care pediatricians said they never use telehealth. But just one month into the pandemic, 77% of primary care pediatricians said they use telehealth often. A report by the Department of Health and Human Services also shows a dramatic increases in telehealth use among specialists with countless patients receiving important care while avoiding unnecessary exposure to the virus. Now that providers of patients have had a taste, it's hard to imagine the telehealth genie going back into the bottle for patients or physicians. And I think we have a polling question now. I don't see the polling question, so I don't know what I'm doing wrong, but I'll just tell a quick story about telehealth while I'm waiting to see if it comes up. We had already been doing telehealth, but with the pandemic, as I realized what was going on, I told our practice that we were gonna have to start really triaging all of our patients to do telehealth visits for sick patients before they came in so that we wouldn't be exposing ourself to the COVID virus. And it was crazy. I mean, we were all trying to relearn how to exactly do it, what kind of questions to ask. But I had one family who called in and they were like, this is great, I'm never coming back in your office, ever again, I love this. And so patients really do love it. And I don't know, do we have, is it still going? I don't see it. I don't see it on my screen, sorry guys. Just a minute, I'm not so good at this stuff. Okay. Okay, so just to know that AAP has lots of good information for anybody that wants to learn more about using telehealth, there's lots of good information there on that. So I think it is something that will stay with us for a long time. Prediction number two is that healthcare will continue to become more consumer driven, meaning patients and families will have more options for where, when and how they access care in an environment where they may experience narrow provider networks or with the growth of high deductible plans, be responsible for a greater proportion of healthcare expenses. The pandemic has created a dichotomy between essential versus non-essential services. Anything considered non-urgent is being delayed or cut back from certain surgeries to vaccinations, from routine checkups to mental health support. And I'm sure you guys have seen some of that as we went through this crisis back earlier in the spring. Unfortunately, this focus on a single health threat has had negative, sometimes heartbreaking side effects. And while throughout the pandemic, the Academy has taken the stance that what is deemed essential versus non-essential is not a dichotomy, but a continuum that takes into account the bigger picture and cumulative risk. We believe patients will continue to use the essential versus non-essential framework to evaluate their need for care. As regulatory requirements loosen, there will be greater competition from non-medical home providers as well. And practices will need to adapt by building a better mousetrap and partnering with urgent care centers, school-based clinics, retail-based clinics and community-based programs to provide services patients will perceive as having higher value. The third trend we see is a move toward value-based payment models. We know for sure now that the current healthcare financing system falls apart immediately in a pandemic like this, and that we need new kinds of payment models for value and flexible models of care that include telemedicine and new technologies so that pediatricians, medical subspecialists and pediatric surgeons can use the most appropriate mechanism to deliver care based on clinical needs and what is best for the patient. Now that the pandemic has exposed the risk associated with fee-for-service or volume-based payment models, we believe payment will become more individualized and sophisticated so that we'll have a mix of fee-for-service bundled payments and capitation. If a practice is not part of a larger system that accepts full risk, payment distribution will be complex. Practices, particularly independent practices will either have to prove their need for advanced levels of fee-for-service bundled payment and capitation by sharing their cost structure makeup and how it impacts health or risk being left behind. Total cost of care and health will be the measures of success, particularly for children and youth with special health needs. To this end, practices will need a firm understanding of their practice expenses, with states struggling financially and higher unemployment rates leading to more Medicaid recipients. Medicaid may be a likely target for states needing to cut their budgets as well. Practices will need to know what it costs to provide care to patients with varying levels of risk, be it due to chronic conditions or social determinants of health so that they can better negotiate value-based payment models and put in place cost-saving measures as needed. Prediction number four is that care will become more data-driven. Data matters. As I said earlier this week about something else, if you don't have the data, you really can't track anything. And it's importance in understanding the needs of patients and families will continue to grow. Practices will need to be able to measure performance and health of their patient panel to maximize value-based payment and implement population health interventions. That is why the AAP Section on Neurological Surgery Database is so important to our members in terms of benchmarking, research, and education. And the Academy will do all we can to support it. That's why I'm so excited we'll be launching the AAP Children's Informational Longitudinal Database or CHILD Registry to collect, store, and analyze electronic health record data on U.S. children. This registry will be crucial in providing timely data upon which to base our clinical interventions and policy recommendations. I was talking earlier about how I was involved in asking for the startup money to even look to see if this was a possibility. And we had some naysayers, but we got the money. And we're now about four years into thinking of this, and we have a vendor and it's starting. So keep a lookout for it. There should be a webpage on the AAP website about this coming fairly soon. As I said, this concept began four years ago as an outgrowth of our strategic plan. And if we didn't know we needed this registry before the pandemic, we certainly know we need it now. With increasing incidents of poorly understood conditions and their long-term impact on children, lack of data on correlations between conditions and comorbidities, and the pressures pediatricians are facing regarding payment, the Child Registry is built to support higher reimbursement, define and improve quality of services, and aid in clinical and health services research and public health initiatives. And I think we have another polling question here. So I'm gonna let you guys go to that. And it is, which attributes of the AAP Child Health Information Logical Data Registry would you perceive as most valuable? So I have to tell the story. I had to go and ask for the seed money for this. And I was in this big room with our committee on development which had a lot of older pediatricians in there who had been through a time where the academy had invested some money in something IT-wise that had not panned out. And boy, did I take some questions for it about, are you sure this is gonna work? How do we, do we really wanna spend this money? And we stood firm, those of us that were there asking for it and said, yes, this is really needed. We need to have something where we can show what it is that we do for children and what really makes a difference for children. So it's still in the early stages, but I would encourage any of you guys who are interested in learning more about it to let us know. So do we have our data? Those that we have our results, 50% often, 40% occasionally, 10% never. Okay, all right, all right, so I'll go to the next slide. We also foresee our next trend would be a stronger emphasis on equity and a shift to a system that takes into account what is going on outside the clinic in terms of social determinants of health. International lockdowns and the suspension of civic and commercial activity across entire countries has thrust a mirror on how our economic, social, and political systems operate and force the beginnings of a global conversation on how they need to change. The pandemic has magnified existing health disparities and there's greater acknowledgement of the impact of racism and institutional racism and the importance of using an equity lens in pediatric health care delivery. We also see an increased focus on families as part of a medical home and prevention is central to population health. The sixth trend we see is emerging is increased use of computerized medicine and artificial intelligence as a support tool, not a replacement for care. These technological advances have the potential to lead to earlier diagnosis and intervention as well as improvements in vaccine development, testing capacity, and novel treatments. We also predict a renewed emphasis on infection prevention and control. How many of you guys have had to change how you do things in your office with the pandemic? Now more than ever, practices will need to follow, need to show that they can keep patients and families safe when they receive care. New protocols for the delivery of pediatric care will likely remain post-pandemic, including use of PPE, temperature checks, scheduling, and office design to separate sick and well spaces and decrease time spent in waiting rooms. Practices will likely find themselves marketing safety as much as health. So this is just about a screenshot of pretty much everything I've just been talking about and while state licensing requirements will continue to exist in some form, the ability for pediatricians and other health care clinicians to provide care to patients across the nation will increase. It may not may not be uncommon for a family to maintain a relationship with a pediatric office or a pediatric subspecialist despite moving out of state. It will also be possible for cost-effective practices to move their brick-and-mortar operations into less costly geographic areas while preserving clients and higher income areas. Those are my predictions for the future based on emerging trends and now I'd like to talk a little bit about what we'd like to see happen and opportunities we have to make this change possible. I'd like to see pediatricians, pediatric medical subspecialists, and pediatric surgical specialists redefine their roles so that they not only manage the medical care of individual patients but the health of patient populations using a quality improvement framework. We need patient-centered technology to support patient care and population health, meeting the needs and preferences of patients who increasingly want more convenience and accessibility. And we'd like to see an expanded understanding through our law and policymaking bodies of what really creates health and universal acknowledgement that social and economic factors account for a full 40% of a person's health potential. Of course, this means addressing the social determinant of racism which drives so many health inequities in our culture because it impacts a child's body and brain, undermines the safe supportive environments all children need to thrive, and has devastating effects on development and outcomes. The American Academy of Pediatric Ideal is that all children and all systems of care maintain health equity and we have an ambitious agenda to make this happen by equipping pediatricians to create equitable systems and continue to confront racism through child health policy and programs as well as community engagement and broader social change to achieve equity within the walls of our exam rooms, throughout the health care delivery and justice systems, as well as the halls of Congress. This is our year one work plan of our equity agenda which has just come out, it's available now, but we talk about what we want to do with this and so we want to implement organizational change necessary to eliminate racism and promote equity, diversity, inclusion, and we have a lot of different things to implement underneath that goal that we'll be rolling out over the next year. We want to equip members with knowledge and skills to address equity, diversity, inclusion. We're all in our own place in this journey and so what we can put out there for people to understand where they are in the journey and where they want to go will be very important. Strengthen and diversify the pipeline for pediatrics and for AAP leadership, you know, making sure we have people coming down the road that want to do these jobs. Equip members with the knowledge, skills, and capacity to advance health equity and confront racism through clinical practice so that when you see these kids in your practice and you see the inequities that go on that you can do something about it and advance the AAP equity agenda through advocacy and policy development. What we're really talking about is that this permeates everything we do at the Academy, that the equity, diversity, and inclusion will become just something that we don't even have to think about. It's just included in everything that we do as we move forward. And now I'd like to talk a little bit about our advocacy agenda. Before the election, we put out a blueprint, an updated blueprint, which we do every four years when there's a presidential election and from that after the election results, we've created the transition plan for the Biden- Harris administration. And it has over 140 plus recommendations, 27 issue areas. You can see them here. They're broken down into healthy children, strong communities, secure families, and leading nation. And so it really goes back to that we need to do what we need to do to take care of children. Vaccines, children with special health care needs, access to care, mental health and substance use disorders, strong communities, our environmental health, our gun violence prevention, child care and housing, disaster preparedness for secure families, the child welfare, nutrition, injury prevention, and military health. And for the leading nation, we've got to work on staunching this virus, the COVID-19 pandemic. We need to address immigration issues, global child health issues, and probably one of the most important ones is that we have to get back the respect for science. That has been lost and it's something we really have to work hard to make sure that we get people to believe science again, because it affects all of us and everything we do. And it will continue to affect our children if people are not believing in science. We have before us an unprecedented opportunity to fix broken systems and structures and to remake the world and our health system into one where every child can grow up to be healthy and have a bright future. But to do this, physicians must be in the driver's seat when it comes to reimagining the future of health care and health coverage. Throughout this pandemic, physicians have distinguished themselves at every level, expanding and redefining what it means to be a hero or a patriot, as they protect the lives and cultivate the health of our communities. Yet while this pandemic has reeled the strength of our health care professionals, it has exposed longstanding weaknesses in the health care system that can no longer be ignored. All this gives new license to pediatricians and pediatric subspecialists and pediatric surgical specialists to create something new, to architect a better future for what health care can be. We can build a new future on the other side of this crisis. And it must begin with clear leadership and the premise that physicians drive that future. Only then can we move to a post-virus world where optimal child health intersects with optimal pediatrician wellness, and every child has the opportunity to grow up healthy and have a bright future. As this little girl says here, the best way to predict the future is to invent it. And I look forward to working with all of you to help make that happen. I think I had two more polling questions, but I don't know that we can get them up. Charlie, anything you can do to help us with that? Yeah, there was one that was, what activity of the AAP do you believe will have the most impact on achieving health equity for all children? I'm sorry, I can't see the results. I can see those for you. That's no problem, Dr. Goza. My technology skills are getting better over the year, but they haven't gotten to where they're perfect yet. So at this point, in answer to that, 42% say advocacy. I just dropped out, 38% advocacy, 37% education, 25% policy, and I'm counting the votes before they're all done. I heard that's a losing philosophy. So we'll wait another minute for that. I've done a lot of this virtual stuff over the course of the year, even around the world, and it's different every time, you guys. I mean, sometimes things work great, and other times you have these little glitches, and I've had interviews where I would freeze every time I tried to answer a question. So I think the interviewer and the person recording it both got frustrated, and I was like, I don't know what's wrong. So certainly, it seems that advocacy appears to be the overwhelming winner there. Alright. Can we go on to the next poll question? Right. What activity of the AAP do you believe holds the most value for surgical specialists, and especially for neurosurgical, pediatric neurosurgeons? So that's one for me to take back to the academy, you guys, so y'all answer it honestly. I love it. Democracy in action here. Yes. So I will have to say, the Department of Practice at the academy is really looking closely at what the future of pediatrics is gonna look like, for based on... And really trying to work hard, not only for the primary care pediatricians, but for our subspecialists, and for the surgical specialists, because we know whatever changes are gonna happen are gonna affect all of us, and to varying degrees with different things with it, as you saw those trends, but really and truly, it really will affect all of us, because... And we really want pediatrics to be taking the lead in that, and what's gonna happen to us. We don't want other people to tell us how it's gonna be, and so I am truly invested in that we have to create the future we wanna see in medicine. I certainly think that you've got the right group if you wanna see a group of people who don't want anyone else to tell them what to do. Neurosurgery is it. Looks like we are very closely paired between advocacy and education, with policy being just a little further down the list. Dr. Goz, if it's okay, we're gonna open up to questions. I'd appreciate folks submitting questions online. I also have some questions from the SANS leadership, if we... Perfect. If we run a little light in terms of materials from the crowd. So Dr. Goz, I'm gonna start out with Dr. David Hirsch. What do you see as the biggest challenge to achieving policy change, and how can the average practitioner help? I think the biggest thing with policy change is that the people that make policies in our governments are not experts in what we're talking about. And so I think we all believe that we have no power when we talk and when we reach out to these people. And I think that it takes people talking to these policy makers and telling them what we know, telling them our stories, telling them what we know about children and what we know is right for children, because that's what they need to hear. And when they hear that, then the policies can come from... After that. But it really does mean having more people calling your congressman, calling your legislators. If it's local, calling your local officials and telling them what you need them to do, because they really will listen. I've always been amazed. Sometimes I feel like I go and I talk and they don't pay any attention. But what the DC staff tell us is, for every person that calls, they know that represents more than just you. And the other thing is that pediatricians and pediatric subspecialists and surgical specialists, we hold a place in their heart because they all have children or grandchildren or nieces or nephews. And so what we tell them about children makes a difference because they know our stories are true, they know we're talking for the kids, and so we have a lot of credibility. And so I think, understand that you have that credibility. Not everybody is gonna be able to go to DC and meet with their congressman, but the academy makes it really easy when there are things that we need to talk about with our legislators. They have an advocacy alert and you can actually go on it. They have you hooked up with who your congressmen are and your senators are. They have a letter typed up that you can personalize, and all you have to do after you personalize it and make sure it's okay is hit send and it goes directly to them. And so it's really, really an easy task to do that, and it takes probably no more than five minutes, maybe 10, if you really wanna make the letter seem like it's totally from you and not just what they wrote on there. But I think that's probably the smallest thing you can do. The larger thing is to get involved, to get involved at the academy, get involved at your state level, whatever you can. If there's something you're passionate about and you want to change policy, the more you work on it and the more time you put towards it, the sooner that policy is gonna change. And we don't always get wins. I'm gonna be honest and tell you, I mean, think about how long it took us to get gun violence prevention money. I mean, it was years, many, many years, but we finally did it. So sometimes it's a marathon and not the sprint. And so you have to remember to keep hanging in there and keep working on it, because if we hang in there long enough, it usually happens. We've had some wins with e cigarettes that way too, that were not easy wins, but we have had some. So that's actually a great segue, Dr. Goza, into sort of a combined question from Drs. Adelson and Pyatt, which relates to science skepticism. Why do you believe that there is such skepticism of science in today's environment, and how can it be restored? We were seeing the science skepticism even before COVID. I think it's gotten a lot worse with the messages that are being put out there, with the misinformation and the conflicting information that's out there that people are like, I don't know what to believe. I mean, my family members tell me that, and I'm like, well, you should believe me. That's what I tell them. But I think we had vaccine hesitancy even before COVID-19. We had the anti vaccine people who were very loud, they're very vocal. With the advent of the internet and the social media, people can read things and they see it all the time, and people can pass that on ad nauseum. And so all of a sudden, something that probably has no basis in any reality is all of a sudden something that's written in stone. And so I think we as physicians have to just start really going, okay, we have to just keep saying what is true. I mean, we have to keep talking about the science, we have to keep talking about what's the truth, and really using some of the social media even to do that. I know the younger doctors, the younger pediatricians are doing a lot of that where they get on the social media and try to counteract a lot of that misinformation that's out there. But we also need some national policy about how do we build trust again in science and in public health because it's really been torn apart during this pandemic. And so I think it's going to take a lot of work from organizations like the AMA and your group and the AAP to really try to organize a media campaign about here is the science, here's what's right, here's what's true, and just keep hammering away at it because it's not going to be easy. I see a future for you on TikTok, Dr. Goza. A lovely segue again from Dr. Tayagi on social media. Based on your own personal experience, Dr. Goza, do you think AAP social media efforts have been effective in influencing parents? I think they have to some degree for those parents who want to be influenced by it. I do think it has an effect. I think the younger parents really do look at social media more than they do anything else. And so I think anything we can put out there that's truth and it's repeated and retweeted. I don't even know some of the other. I'm old. Twitter is about all I've gotten to. They tell me that is way old. Nobody uses that anymore except for old people. And so the newer ones are out there. The younger pediatricians are really using them. I do think it makes a difference. I think anytime you put stuff out there, it puts the misinformation. The more we put it out there, the more the misinformation is diluted. And I think that's probably the key is that we have to dilute and drown out the misinformation that's put out there. Maybe we could do that on Dr. Krieger's Instagram page. I'm not sure, but we can move on to another question. As pediatric neurosurgeons, we are committed to providing optimal care, especially for as our patients transition to adulthood. There are two challenges we regularly encounter, finding adult neurosurgeons who are willing to take on care for our graduated patients. And if we wish to continue providing care ourselves, there are often barriers put up by pediatric hospitals. How can this organization most effectively advocate for improving transition of care on a large scale? I think this is a really critical question because it's not just neurosurgeons that have this issue. And so I think this is where the American Academy of Pediatrics could be your friend and your place to go for this because I think there are a lot of subspecialists who need the same question answered because a lot of the adult specialists don't want to take care of the children once they age out. And we also have those children who chronologically age out, but who are really not adults. And so we really need to have that advocacy with the children's hospital associations too, that we can say, you know, if these children really are not truly adults and we can't find good care for them to let them still be taken care of at a pediatric hospital, but also trying to work through the academy with some of the other societies and trying to figure out how can we make that transition work smoothly. The academy has a big transition plan. There was a big push for that. And I think that, you know, we need to work with you guys on where do we go with that? Who do we need to partner with at the academy for the neurosurgeons to have that, the bigger voice, as I said, that collective voice to say that, you know, not all children when they turn 18 or 21 need to age out of pediatric care. I see kids sometimes up to 23 and 24 and it can be a challenge, especially my children with special health care needs who go on Medicare because Medicare doesn't want to pay me. We have another question here from Dr. Stadler. You excellently described a number of rapidly evolving priorities. Do you think this risks deprioritizing longer standing goals? You mentioned gun violence and e-cigarettes. How can this be avoided as we face new challenges, the whack-a-mole phenomenon? I think it's solved. So, yeah, you know, the academy is a huge, I mean, it's a big organization. We have 67,000 members. We have over 450 employees. And so I'm amazed that even with COVID-19 taking up so much of our time that we have not really missed a beat on the gun violence injury prevention. We've not missed a beat on a lot of the other Medicaid. It's amazing to me how much was done in a year when I thought everything was going to be COVID-19 and that was all we were going to talk about. We put out our truth and reconciliation statement about racism. We put out our, we did the bylaws referendum so that we, so no discrimination on membership for the academy. We came up with the equity agenda. We're working on a mental health agenda. But yes, all of those other things, all of the injury prevention, gun violence, vaping, smoking, tobacco, all of those things still have people working on them constantly. So it's, yes, you do. The spotlight for the president sometimes gets shifted according to what's really the bigger issue at the time. But I think there are people working every day on all of those other issues and continue to work on them. And I still hear about them occasionally and still get to talk about them sometimes. So that's always good. We also had environmental health, which is another biggie. And we just had a big meeting about, with ECHO America about environmental health. So we're not letting any of that other stuff slide. Maybe it did early in March, March and April, but it really picked right back up after that. Yeah, the infrastructure you have at the AAP is really enviable. And as a really small group of people, you know, we have a lot of people that are as a really small group of subspecialists, you know, to hear the agenda that you're able to maintain based on your membership is, it fills us with envy. A couple of other questions that we have here. We're a group of specialists and even subspecialists. Over the past decade, there has been an increase in referrals from primary care for diagnoses that might have been managed entirely in the primary care setting in the past. Some examples are plagiocephaly, concussion, familial macrocephaly, et cetera. Do you see the trend of just to be sure referrals continuing to increase or reaching a plateau? I hope they will reach a plateau and that we will really work, look at value-based care and not, you know, spend your time dealing with things you don't need to deal with. I think that goes to why we need you all in the academy and we need you to be members of the section. We're looking for people to do educational seminars, not only at the national level, but we have chapters in every state and in Puerto Rico. And so I know the chapters are looking for people to give talks at their meetings to talk about those things so that pediatricians can be better informed about what really needs to be referred and what doesn't. I will tell you the back to sleep campaign has really messed up the head shape thing because every parent is so worried about it and they all think they need a helmet and it drives me crazy. But I do believe that referrals to you guys have gone up because of that. I mean, I think parents are so anxious about it that, you know, sometimes no matter how much we try to reassure them, you know, it's like, okay, you can go. But I do believe that that's where pediatricians and pediatric neurosurgeons really have a synergy. We need to be a team. We need to be working together for the care of our patients. You know, I know here in Georgia, I mean, I pick up the phone and call the neurosurgeons when I have a question sometimes. And they're so, you know, they're gracious. They answer me. They talk to me. They tell me what I need to do. And then if I need to refer them, I do. But, you know, I think that's where we, that's where the change in pediatric care is going to be, is that it's going to be value based. And so it's not going to be to anybody's benefit for us to be sending things to specialists that don't need to be there because you guys are going to need to be doing what you need to do and do it well and do it. And so I think it will hopefully drop as we learn more about that. And we're here. I will tell you that I see Joseph Pye had a question earlier on. He did the last Pediatric Clinics of North America on pediatric neurosurgery. That's being updated as we speak and we publish next year. We are starting to participate in your pediatric online webinars through SANS. And there's a lot of other content. I'll tell you that one of our colleagues, Dr. Sandy Lamb out of Lurie Children's is very interested in really developing a central repository for content that can be utilized by providers anywhere to interface with their state. There's a lot of things that SANS is doing through the infrastructure that you have to be able to disseminate that information. And from a primary care person, I really appreciate it because it's so nice to be able to look at that and not have to try to find it somewhere else. It really is. A really pragmatic and practical question. Does the AAP have easy access guidance to COVID-related health issues? Yes. So as of starting in March, we formed an internal group to be our COVID-19 task force. Ann Edwards and Deborah Waldron were the co-chairs of that. And we immediately realized that we needed to put out quick guidance for members because there were so many questions coming to us about how do we do this? What do we do? How do we do this? And so we started putting out guidance. It's not policies, you guys. If any of you guys have ever seen an AAP policy, it takes forever. These are quick guidance. They come out fairly quickly. We have our experts working on them. And they're updated every 30 days. So we have guidance on how to take care of children in your office, what you need to do to keep your office safe. We have guidance about just being re-updated on return to sports, which I think would probably be right up something y'all would be in about the cardiac issues with children that have had COVID. So that should be being released to hopefully next week. There's a guidance out there, but the new guidance has a little more information in it. We have guidance about daycares, about back to school. You know, we have guidance about how to care for children with special health care needs, the social emotional care of children with COVID. So it's all out there. And then we also have information for parents on HealthyChildren.org. If anybody has parents that are worried and they don't really know what's on that HealthyChildren.org website has a lot of good information. Though anyone, whether you're a member or not can access AAP.org, the COVID page. So any of the COVID information is available to anyone that wants to access it. You do not have to be a member to access that. I appreciate that because yes, we all have patients that we care for, but most of us have children and parents. And I think it's very useful information. So thank you. Another question here from Jason Blatt. I perceive that the AMA has lost support over the years because many physicians don't feel they are effective advocates for the medical community on issues like reimbursement, fighting insurance companies, et cetera. What do you think the appropriate balance is for the AAP between patient advocacy and physician advocacy? How do you maintain this balance in the organization? You know, we've heard that about the Academy too, that the Academy only cares about children. We don't ever advocate for pediatricians and subspecialists and surgical specialists. I think that has changed in the last few years. And I think this year has really borne that out. We fought long and hard for pediatricians and pediatric subspecialists, people that didn't take Medicare to be able to get some of the CARES money. I mean, that was the AAP fighting for that. We were on their case about that from the day that money started coming out. The PPP loans, we were really working closely with trying to make sure people could get that if they qualified and also working with Medicaid to cover telehealth visits at parity within office visits. And that's national and that's the state chapters that do a lot of that advocacy on payment. We've been talking to the health insurance plans about covering telehealth care during this crisis. You know, we've talked to them about vaccine administration rates, which probably doesn't have anything to do. You guys probably don't care about those so much, but for us, that's a big deal. And then physician wellness. I think, you know, payment is a big thing. But right now, I'm probably more, well, I'm worried about payment and practices staying open and people being able to stay employed. But I'm also concerned about just the emotional drain that COVID has had on all of us and the racial crisis and the economic crisis. I mean, it is a drain on all of us. And as I've told many talks, you know, it's okay not to be okay right now. And I think we have to remember that. But if we're not okay, we need to reach out to people in our community, you know, your son's group, the AP, you know, whoever, because we just need to make sure that we can be okay at the end of this. You know, we need to figure out how to get there. And so I think that's another way we're advocating for pediatricians, because being okay has lost, you know, it can be emotional, social and emotional, but it can also be financial. You know, if you're struggling and not making ends meet, you know, that's a big pressure. So we are trying to work with payers, Medicaid, and the federal government to make sure that pediatricians and pediatric subspecialists, surgical specialists stay solvent during this crisis. Dr. Duhame has just chimed in, what opportunities are there to get involved in AAP advocacy for mitigation for climate change, as this will affect children most of all? Oh, our environmental, section on environmental health would love to have you involved. But there there's a lot going on with that. We are we really have some good work going on with that. And I would encourage you to look probably on the section on environmental health. I think they have a list, sir. But you know, anybody, you can email any of the people at the academy or me even, and I can hook you up with the right people to get involved. But yes, we are constantly testifying to Congress, you know, with the transition, hopefully we'll have some more traction to get some things done to save our planet and really make sure people understand that all the things they do environmentally have a bigger impact on children than they even than they do on adults. All right. Well, Dr. Goza, we really appreciate you taking the time to join us here today. I know you're busy, just in the green room. Prior to this, Dr. Goza received, what, two or three additional interview requests for later today. None of them had to do with the Georgia election, though. No, we won't talk about that. So, but I would like to say, you know, I know we talked a little bit about this in the green room, too, is that, you know, it's hard because you guys have multiple organizations you have to belong to. I'm, of course, prejudiced that the AAP is a very important organization for the health and well-being of children, but also for positions as well. And there are some ways that you may be able to work on some. There's a thing called enterprise membership that I told Jonathan about, and he may try to get that out to you guys that may help make it easier for people to feel like they, you know, can join and it not be quite such a burden to do that. Because when you pay three different dues organizations, it does get old. And they're probably more than that, even if you start thinking about AMA and all the other ones, too. Thank you for that bit of information. I'll be sharing that with Dr. Jay prior to our business meeting, which is tomorrow evening. Yeah. All right. All right. Well, then, again, thank you so much for your time. And I just remind the attendees to please visit the Remo rooms to catch up with your colleagues and please visit the exhibitors who are supporting today's meeting. Thank you guys very much for your time and attention. Thanks. Thank you.

AAP

SANS

pediatric neurosurgeons

COVID-19 pandemic

CHILD Registry

data-driven care

equity

policy change

pediatric healthcare