In the News
General Pediatric Resources
National Medicaid/ EPSDT Resources
Community Health in the District of Columbia
Are we making
a difference? Are there outcome measures for primary care?
enrolled in Medicaid, a key outcome measure of primary
care is successful delivery of EPSDT services. CMS requires each
state Medicaid program, including the DC Department of Health Care Finance, to provide a comprehensive program of Early
and Periodic Screening, Diagnostic, and Treatment (EPSDT) services
to its Medicaid enrollees. These EPSDT services are based on “best
practice” recommendations and clinical guidelines from
the American Academy of Pediatrics and Bright Futures developmental
screening and counseling.
Community Health Improvement Story
all the recommended EPSDT services is a huge challenge – especially
for the underserved children covered in Medicaid. In a
landmark legal decision, Salazer vs District of Columbia,
U.S. District Judge Gladys Kessler ordered the District
of Columbia to improve delivery of comprehensive EPSDT services to its Medicaid enrollees.
than ten years, DC’s Department of Health (DOH), Medical Assistance Administration [now the DC Department of Health Care Finance, DCHF], health plans,
and provider community have struggled to improve documentation
of EPSDT care. Unfortunately, this often translated into
increasingly burdensome documentation requirements for
frontline providers – redirecting precious resources
away from actual care delivery.
2002, Children’s National Medical Center (CNMC)
pediatricians, Drs. Mark Weissman, Nathaniel Beers, and
Denice Cora-Bramble, petitioned to meet with Judge Kessler
to identify a more constructive approach. Following an
unprecedented meeting with DC’s pediatric provider
community in her chambers, Judge Kessler approved an
innovative collaborative quality improvement approach
to improving EPSDT delivery.
successful immunization registry, the provider community
proposed to partner with DC’s DHCF, and the
plans to develop and implement city-wide “standardized
medical record forms” (SMRFs) to guide and document
a comprehensive “HealthCheck” EPSDT visit.
Copies of SMRFs have been submitted to DC’s DHCF for
entry into one of the nation’s first comprehensive
child health data registries. Key child health data will
then be available to improve point-of-service care and
continuity as well as track outcomes and identified improvement
initiatives. Provider participation and registry use
will be encouraged through provider quality report cards
and pay-for-performance (P4P) – also among the
nation’s first for Medicaid.
Late in 2005,
the Goldberg Center received start-up funding from the Commonwealth
Fund, National Initiative for Children’s
Healthcare Quality, and Children’s National Medical Center
to formally establish the DC Partnership for Children’s
Healthcare Quality (DC PICHQ) – with the EPSDT improvement
as its initial quality improvement initiative. DC PICHQ has
engaged an unprecedented
collaboration of public health, managed care organizations,
academic health centers, community pediatric providers, and
PIHCQ Collaborative Partners
Academy of Pediatrics – DC Chapter
Futures at Georgetown University
Health Plan, Inc.
National Medical Center
of Columbia Department of Health
- DC Department of Health Care Finance
Washington University School of Medicine
Services for Children with Special Needs (HSCSN), Inc.
- MEDSTAR – Georgetown
University Medical Center
- Unison Health Plan, Inc.
PICHQ Executive Committee
Weissman, MD, Chief, General Pediatrics & Community
Health, Children’s National Medical Center
Beers, MD, Medical Director, Children’s Health
National Medical Center and President-Elect, DC Chapter, American Academy
Schuyler, Program Director, DC Partnership to Improve
Healthcare Quality, Goldberg Center for Community Pediatric Health
Bellamy, Chief Operating Officer, Health Services for
Children with Special Needs, Inc.
- Colleen Sonosky, JD, DC Department of Health Care Finance
Campbell, Chief Medical Officer, Health Services for
Children with Special
Christopher, JD, Family Advocate and LEND Fellow, Children’s
National Medical Center
Levy, MD, Medical Director, Community Pediatrics, MEDSTAR – Georgetown
Orr, MD, Chief Medical Officer, Chartered Health Plan,
Richards, MA, Program Director, Bright Futures at Georgetown
Smith, JD, President and Chief Executive Officer, Chartered
Health Plan, Inc.
Watkins, Chief Operating Officer, Chartered Health Plan,