American Pediatric Society & Society for Pediatric Research

Public Policy Council

 2008–2009 Activities Report 

Return to APS/SPR Homepage

The Public Policy Council, completing a quarter century of service to academic pediatrics, was joined by the Academic Pediatric Association in 2008-2009 and now comprises two representatives from each of four constituent societies, the Academic Pediatric Association (APA), the American Pediatric Society (APS), the Association of Medical School Pediatric Department Chairs (AMSPDC) and the Society for Pediatric Research (SPR).  Except for APA, members serve simultaneously as representatives to the AAMC Council of Academic Societies and as liaison and alternative liaison representatives to the AAP Committee on Federal Government Affairs (COFGA).

The Public Policy Forum is a loosely knit assembly of designated representatives at each major academic institution represented in AMSPDC; it serves as a communications network with the membership of the constituent societies and with academic pediatrics in general.  Materials are distributed regularly to the Forum, including periodic legislative updates as well as relevant items on a time-sensitive basis. These are supplemented by the Public Policy Council's home page on the APS/SPR web site http://www.aps-spr.org/Public_Policy/index.htm which also provides E-mail access to our Washington coordinators and to myself. The Forum also serves as a vehicle for the annual legislative breakfast forum at the PAS meeting. The legislative breakfast for this year's PAS meeting in Baltimore, the twenty-third annual, was conducted on Monday, May 4, and devoted to “Expanding Health Care Coverage for All Children in the 111^th Congress”.  The Forum featured Jay Berkelhamer, former president of the American Academy of Pediatrics and APA and currently chair of COFGA’s Subcommittee on Health Insurance and Access to Care or “The Access Subcommittee”, with commentary by Peter Szilagy, immediate past president of APA. 

The sixteenth annual Public Policy Plenary Symposium, a collaborative effort of the Public Policy Council and the APA Public Policy and Advocacy Committee, which I moderated, was held on Saturday, May 2 on “Personalized Medicine: Social and Ethical Issues in Screening for Genetic Disease and Susceptibility”.  The Symposium examined the medical, ethical, and public policy aspects of widespread population-based genetic screening, including expanded state-conducted newborn screening programs, and implications of genetic variations associated with increased susceptibility to common disorders with multi-factorial origins.  Speakers included Edward McCabe, chair, Department of Pediatrics, UCLA School of Medicine and past president, American Pediatric Society; Alan Guttmacher, acting director, National Human Genome Research Institute, NIH, and Jeffrey Bottkin, professor of pediatrics and associate vice president for Research Integrity at the University of Utah. 

For the fifth successive year there was a special plenary session “An Update on the National Children’s Study” on Monday, May 4 led by outgoing SPR President and Public Policy Council member Elena Fuentes-Afflick, who has just been named to the NCS Federal Advisory Committee.  Participants included Ruth Brenner, who provided an update on the NCS Scientific Plan, recently reviewed by the National Academy of Sciences, and leaders from two of the seven vanguard centers, which began recruitment early this year: Leo Trasande, from Mt. Sinai School of Medicine, who described his center’s urban focus and Emanuel Walter, Jr., from Duke University Medical Center, who outlined the rural focus of his site. 

With adoption of new operating guidelines, developed by an ad hoc committee representing each of the Council’s four constituent societies, the Public Policy Council begins its twenty-sixth year under a new operating structure with each sponsoring society appointing two representatives for up to two three-year terms commencing in May following the annual PAS meetings.  The chair, though a member of at least one of the sponsoring societies, will not be regarded as one of the society representatives and will serve a five-year term, renewable for another five years.  Thus, during the 2008-09 year, the American Pediatric Society, which had only one change in its representatives over twenty-five years, conducted an open solicitation from which Steve Berman, professor of pediatrics at the University of Colorado and a past president of the AAP, and Rick Bucciarelli, chair of pediatrics at the University of Florida, were selected, their three-year terms commencing at the conclusion of the 2009 PAS meetings.  Jimmy Simon thus retired from the Public Policy Council after twenty-three years of service, and I will serve as Chair until a successor is determined.   As with the SPR solicitation a few years earlier, the solicitation to the APS membership generated considerable interest with a final slate of twelve candidates from whom the two representatives were selected in February. 

Elena Fuentes-Afflick, outgoing president of the Society for Pediatric Research, and Tom Green, continued to represent the Society for Pediatric Research, and David Clark and Russ Chesney, the Association of Medical School Department Chairs.  Representing the Academic Pediatric Association were Mark Schuster and Lisa Simpson, chair and past chair respectively of the APA’s Public Policy and Advocacy Committee, though Nancy Nelson continues to represent APA on the AAMC Council of Academic Societies where she serves as a member of the CAS Leadership.  Tina Cheng, President of APA, has represented APA at COFGA meetings, as well as Mark Schuster. 

Karen Hendricks continued her exemplary service as the Public Policy Council’s Washington Coordinator, ably assisted by Becky Fowler, through the Academy of Pediatrics’ Department of Federal and Government Affairs in Washington.  Just prior to the 2009 PAS meeting, Ms. Hendricks announced that she would be departing the Academy of Pediatrics’ Washington office to accept a position as Director of Policy Development for the Trust for America’s Health, a broad-based advocacy group which promotes public health and disease prevention and is headed by former Sen. Lowell Weicker.  Over nearly eighteen years, Ms. Hendricks provided exemplary service and guidance to the Public Policy Council and more broadly to academic pediatrics.  The accolades she received at the 2009 PAS meeting and presentation of the SPR Distinguished Service Award at the preceding 2008 meeting constitute a well-deserved testament to her contributions to the Public Policy Council’s success and to her service more generally to academic pediatrics. 

At the same time Elizabeth “Jackie” Noyes, Associate Executive Director of the American Academy of Pediatrics and head of the Academy’s Washington office for more than 30 years, announced that she would be retiring at the end of the 2009 year.  Her departure, together with that of Ms. Hendricks, leaves a significant void in the professional support upon which the Public Policy Council has depended over 25 years.  We have been assured by leadership of the Academy that the breadth and quality of services provided to the academic Societies will be sustained and that the Societies will have an active voice in selection of successors for both Ms. Hendricks and Ms. Noyes.  I will report progress in completing these searches over the forthcoming months.   

During the year the council's activities continued to be conducted primarily through a monthly conference call, supplemented by frequent mailings and e-mail correspondence from the Academy's Washington office as well as from the AAMC’s Council of Academic Societies, in particular the bi-weekly “Tony Mail”.  Conference calls generally included Ted Sectish, executive chair of the Federation of Pediatric Organizations (FOPO) and the chair of the AAP’s Committee on Federal Government Affairs (COFGA) for the conference call prior to scheduled COFGA meetings.  On specific issues, we have also been joined by the lead Academy staff.  Materials, including minutes of conference calls, are regularly shared with the leadership of the four societies and thus provide opportunity for input on specific issues and agenda items. The periodic legislative reports prepared for the Societies’ leadership and testimony by Public Policy Council members are routinely placed on the Public Policy Council web site. Programs of the Public Policy Council continue to be conducted from both the Academy's Department of Federal Affairs and my office at Yale’s Child Health Research Center. A comprehensive legislative report, prepared in March, was posted on the web site and appeared in the program book for the annual meeting. 

A substantial portion of the Public Policy Council activities during the 2008-2009 year related to the historic 2008 election and in preparing materials which reflected the perspectives and priorities of academic pediatrics as well as, more generally, health care for children.  A summary of the highly-successfully Public Policy Plenary Symposium at the 2008 PAS meetings “A National Agenda for America’s Children and Adolescents in 2008: Recommendations from the Fifteenth Annual Public Policy Plenary Symposium, Annual Meeting of the Pediatric Academic Societies, May 3, 2008” was published in the October issue of Pediatrics and was widely circulated.  Following the election, Ms. Hendricks was in touch with the NIH transition team for the incoming Obama/Biden administration and subsequent to their request, a document was prepared outlining research issues that were important to the pediatric community in general and specifically to academic pediatrics.  With a very tight time frame, the document was prepared together with Scott Denne, chair of the AAP’s Committee on Pediatric Research, and provided to the transition team in early December.  A meeting with the transition team could not be scheduled as planned, but the submission “An Overview/Outline of Pediatric Research Issues Important to the Pediatric Community in the Obama/Biden Administration” was posted on the transition team’s web site.  The submission also included the October Pediatrics paper from the 2008 Public Policy Plenary Symposium and a paper by David Gitterman and Bill Hay “That Sinking Feeling, Again…The State of Pediatric Research Funding at NIH, FY 1993-2010” from the November issue of Pediatric Research. 

As usual, much of the Public Policy Council advocacy was devoted to securing adequate funding for medical research and public health, in particular related to the National Institutes of Health, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC).  With the FY ’09 appropriations budget on a continuing resolution through March, attention focused on securing funding in the Obama Administration’s Economic Stimulus Package – the American Recovery and Reinvestment Act – with efforts coordinated with the Ad Hoc Group on Medical Research Funding, on which Ms. Hendricks serves on the Executive Committee.  Primarily through the efforts on Sen. Arlen Specter (PA), the final package included a $10.4 billion two-year addition to the NIH budget, of which $7.4 billion is being transferred to the individual institutes.  An additional $400 million will be transferred to AHRQ as part of a $1.1 billion comparative effectiveness initiative.  To determine how the latter will be utilized, a special committee, including Public Policy Council member Lisa Simpson, has been established by the Institute of Medicine and charged with making recommendations by June 30. 

We continued to closely monitor progress of the National Children’s Study and advocate for its successful funding, in concert with the Academy of Pediatrics, the March of Dimes, and other organizations.  During the year, the NCS Study Plan was extensively reviewed by the National Academy of Sciences/National Research Council which made a number of recommendations, including a lengthened pilot phase before full implementation of the study plan.  Awards to 25 new study centers serving thirty study locations were announced in October and two vanguard sites began enrollment in January 2009 as part of what will be an extended pilot phase involving the seven vanguard centers.  In recognition of this the final FY ’09 appropriations bill provides up to $192 million for the National Children’s Study.  After four years of service, my term on the NCS Federal Advisory Committee concluded this spring.  I am delighted that Elena Fuentes-Afflick has been appointed so that the Public Policy Council will continue to have a significant role in the study’s progress. 

The Pediatric Research Consortia Establishment Act was reintroduced in the 111^th Congress with bipartisan support.  The Senate bill was introduced by Senators Sherrod Brown and Kit Bond and has four co-sponsors.  The House bill was introduced by Representatives Diane DeGette and Peter King and has thirty-one co-sponsors.  A coalition of children’s hospitals have formed the Coalition for Pediatric Medical Research and, together with the pediatric societies which constitute the Public Policy Council, plus the American Academy of Pediatrics, the Association of Pediatric Program Directors and American Board of Pediatrics, which constitute the Federation of Pediatric Organizations (FOPO), have been working actively to secure passage of this enabling legislation.  Public Policy Council member Tom Green has been actively involved in the development and legislative advocacy for the bill’s passage.  Briefly, the Consortia Establishment Act would authorize up to twenty consortia in a “spoke and wheel” architecture devoted to both basic and translational research and funded for five years at up to $2.5 million annually, renewable upon favorable peer review.  The Coalition assembled a Washington meeting with Capitol Hill visits on February 3 with close to 50 participants.  Karen Hendricks provided an overview of prospects for research funding in the 111^th Congress and other issues of importance such as CHIP re-authorization and funding for children’s hospital residency programs.  FOPO, through its Child Health Research Working Group, sponsored a special symposium on pediatric research issues, highlighting the Consortia Act, on Saturday, May 2 at the PAS meetings.  

Throughout the year, the Public Policy Council, through its Washington Coordinators, continued to participate in various issue-specific Washington coalitions supporting Title VII Re-authorization and full funding (Health Professions and Nursing Education Coalitions), full funding and re-authorization of the Agency for Health Care Research and Quality (Friends of AHRQ) and, with the National Association of  Children’s Hospitals (NACH), full funding of the Children’s Hospital Graduate Medical Education funding to the authorized level of $330 million. 

AAP Committee on Federal Government Affairs (COFGA):
COFGA includes six members appointed by the Academy plus liaison representatives from the four societies which form the Public Policy Council, the Society for Adolescent Medicine, the Academy’s Committee on State Government Affairs (COSGA), the chair of the COFGA Subcommittee on Health Insurance Coverage and Access to Care (Jay Berkelhamer), FOPO (Ted Sectish), NACHRI, and representatives from the AAP’s Sections on Seniors and Residents.  COFGA’s chair is Olson Huff, from Ashville, NC.  Dr. Huff replaced the previous chair, Mary Ann McCaffree, upon her successful election to the AMA Board of Directors.  All members of the Public Policy Council serve simultaneously as liaison representatives to COFGA with the exception of the APA, whose president, Tina Cheng, serves together with Mark Schuster. 

COFGA met on three occasions in the past year, on May 31-June 1, 2008, September 28-29, 2008 and March 8-9, 2009, as always in the Washington, DC area.  Full meetings are preceded by a meeting of the Access Subcommittee which has provided leadership in directing the Academy’s advocacy for re-authorization and expansion of the Children’s Health Insurance Program (CHIP) and for subsequent passage of comprehensive coverage and access for all children, based on the AAP’s “Principles on Access” developed and refined by the Access Subcommittee, and ratified at the September 28-29 meeting of COFGA.  Considerable effort has been devoted to positioning the Academy at the forefront of discussions on health care access and reform, culminating in the rapid re-authorization of the CHIP program early in the new Obama/Biden administration.  Funding for the expanded CHIP program will be financed by a 61¢ increase in the Federal tobacco excise tax.  The CHIP Reauthorization Act establishes a new Medicaid and CHIP Payment Access Commission or MACPAC, long advocated by the Academy.  Significantly, the re-authorization adds dental services and includes provisions requiring development and assessment of measures to evaluate the quality of care provided through Medicaid and CHIP programs as well as funding for demonstration projects.  These efforts reflect successful advocacy on the part of the pediatric community, in particular through the APA’s Public Policy and Advocacy Committee. 

Much of the recent March meeting was devoted to developing strategies to ensure that, with successful passage of CHIP authorization, children’s health issues were imbedded in forthcoming discussions regarding comprehensive health care reform as promoted by the new Administration.  The Academy will continue to support the MediKids proposal, which has been re-introduced by Rep. Pete Stark, chair of the House Ways and Means Committee, but at the same time seek to ensure that the Academy’s principles on access are incorporated within emerging comprehensive legislative proposals.  Summaries of the Academy’s policy with respect to areas of access, quality and finance were drafted and favorably reviewed at the COFGA meeting.  The Academy’s advocacy will stress efforts to provide high quality care in all pediatric health care settings with a quality improvement agenda utilizing a Quality Cabinet in the Academy working with a Steering Committee on Quality Improvement and Management.  The Academy is working with a number of national organizations to fulfill its strategic plan for quality including the Patient-Centered Primary Care Collaborative, the National Committee for Quality Assurance (NCQA), the American Board of Pediatrics and with various AAP chapters through the Chapter Alliance for Quality Initiatives  Much of this is centered on the primary care medical home model that has been championed by the Academy for a number of years.  An extensive 36-page report was provided by the Academy’s Washington staff summarizing a host of legislative issues at the commencement of the 111^th Congress and the Obama/Biden administration.  Copies can be made available upon request.   

AAMC Council of Academic Societies (CAS):
The Council of Academic Societies is one of three governing councils of the Association of American Medical Colleges (AAMC) together with the Council of Deans and the Council of Teaching Hospitals and Health Systems.  CAS is presently comprised of 89 academic societies devoted to biomedical and behavioral research, medical education and patient care.  Four of these societies - the parents of the Public Policy Council - represent pediatrics.  Members of the Public Policy Council serve simultaneously as their societies’ representatives to the CAS, with the exception of the Academic Pediatric Association, whose representative for a number of years has been Kathy Nelson, senior associate dean for faculty development at the University of Alabama School of Medicine.  Dr. Nelson has been a member of the CAS Administrative Board (Executive Council) for the past few years.  The CAS current chair is Randall Holmes, chair of the Department of Microbiology at the University of Colorado School of Medicine.  Tony Meyer, chair of the Department of Surgery at the University of North Carolina, Chapel Hill School of Medicine, is chair-elect.   

Darrell Kirch, has now been president of the AAMC for almost three years, succeeding Jordan Cohen in 2006 and has overseen a restructuring of the AAMC’s governance and full-time leadership, which is now complete with the departure of a number of long-time AAMC leaders and colleagues including Dick Knapp, in governmental relations, David Korn, in biomedical and health sciences research, and Bob Dickler, in health care affairs (hospitals and health care)  Tony Mazzaschi remains as the second in command in the Division of Biomedical and Health Sciences Research and is the primary staff contact for the CAS.  His bi-weekly listserve, commonly referred to “Tony Mail”, remains one of the most comprehensive and useful sources of what is happening in academic medicine.  The new AAMC leadership includes Carol Aschenbrener, former chancellor of the University of Nebraska Medical Center, as executive vice president and chief operating officer, Atul Grover, chief advocacy officer, John Prescott, chief academic officer and most recently Ann Bonham, executive associate dean for academic affairs at the University of California, Davis, as chief scientific officer effective July 1. 

Upon Darrell Kirch assuming the presidency, an extensive review was undertaken of the AAMC’s governance structure with multiple meetings and input from various stakeholders, resulting in a significant overhaul with dissolution of the AAMC’s Assembly and Executive Committee and replacement with a 17-member Board of Directors, including designated slots for the CAS chair and chair-elect.  The governance review also led to creation of an AAMC Leadership Forum comprising more than 80 constituents representing 60 AAMC member institutions including all of the AAMC councils, organizations, groups, and advisory panels, which met for the first time in December 2008.  Five members of the CAS serve on the Leadership Forum in addition to those who participate by virtue of their other activities in the Association.  Simultaneously a parallel review of the CAS structure, composition, governance and operations took place with a general reaffirmation of the CAS primary role to represent medical school faculty in the AAMC and a restructuring of CAS committees including a membership committee with more explicit criteria for membership in the CAS.

The CAS met on two occasions during the academic year – October 31-November 5, 2008 in San Antonio, TX, as part of the annual general meeting of the AAMC and March 5-7 in Charleston, SC.  In addition to Kathy Nelson, Public Policy Council member David Clark attended the November meeting, representing AMSPDC.  CAS-sponsored sessions at the AAMC annual meeting included programs on financing continuing medical education, complying with the new NIH Public Access Policy and the “Time Bomb” awaiting retirement of the baby boomers. 

The CAS spring meeting in Charleston was built around the theme of “Assessing the Forces of Change: Finding Allies in Turbulent Times”.  Unfortunately, none of the Public Policy Council members were able to attend because of conflicts with the preceding COFGA meeting and the overlapping annual meeting of AMSPDC.  Key discussions at this meeting concerned health care reform proposals with the potential to affect the academic medicine enterprise, changes in the medical education curriculum demanded by external stakeholders, managing curriculum changes and measuring the effect of such reform and the role of faculty in both human subjects and animal care program accreditation.  There was a special session on proposed changes in the USMLE examination schedule and content.  Presentations from this meeting are posted on the CAS member web page.   

The spring meeting, which I have attended for most of the past 25 years, is an excellent opportunity for ongoing interaction with the leadership of other disciplines and provides direct input into AAMC policy.  The fall annual meeting truly represents an ingathering of leadership in academic medicine from all disciplines and remains a major opportunity for the voice of academic pediatrics to be heard.  The 2009 AAMC Annual Meeting will be held November 6-11 in Boston and the annual CAS Spring Meeting, March 4-6, 2010 at the Driskill Hotel in Austin, TX.  The 2010 AAMC Annual Meeting will return to Washington, DC November 5-10, 2010.   

Submitted by Myron Genel, M.D.

Chair

Public Policy Council