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Question #6. Which aspects of the future of Neonatal-Perinatal Medicine must the Section proactively address?

1. limit of viability, neonatal resuscitation

2. See #5

3. encouraging a nuclear family....too many single mothers

4. 1. inadequate clinical training of fellows

5. ?

6. access to health care, distribution of neonatologists in a regionalized system

7. Failure to obttain affordable health insurance

8. Cost containment, medical liability

9. Physician shortages

10. Administrative curtailment of services to some patients.

11. Prospective studies of blood pressure treatment and monitoring.

12. Guidelines for appropriate managements for diseases of preterm newborn

13. limits of viability

14. Billing

15. spiraling accreditation requirements that hamper education. need evidence-based accreditation.

16. Developmental friendly care, Family involvement, Evidenced-based care

17. Achieving a balance between demand for neonatologists / unfilled positions at hospital centers and training of future neonatologists, bridging gap between academic and private neonatologists

18. International health inequities. Follow-up and services for high risk and disabled infants.

19. Closer working relationship with obstetrical community. The section would better meet the needs of the physicians and patients by aligning more with obstetrical/MFM community than pediatrics.

20. regionalized NICU care

21. Reasonable approaches to setting limits of viabiilty, guidance for physicians and families, dealing with limited resources

22. Appropriate credentialling

23. appropriate training for fellow not only in the clinical arena, but in the research arena as well

24. Re-establishment of regionalized perinatal care

25. Increasing number of smaller units springing up

26. paying for follow up of hgih-risk infants so good data on outcomes - need push payors to cover. consistent on-line lectures for all fellows so equal in all programs.

27. Evidenced Based Medicine

28. research and evolving coding issues

29. reduction of medical liability issues

30. Prevention of infection Prevention of fungal infections in extremely low birth weight infants(evidence and safety is there) Mandatory HIV testing nationally (and internationally) Management of preterm labor Management of the extremely preterm infant regarding care and resuscitation does not seem ethical for them as individuals (since some do better than other and should have that right to survive if they can) and should have broader discussion. OB coordination to test mothers with no prenatal care(rapidly for HIV and HepB) Hypothermia for HIE

31. Family-centered care in the NICU setting. Development of community support systems for post-NICU patients and their families.

32. aging of the work force more clinical training of fellows

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33. more cohesion on practices at the limits of viability

34. Insurance allowance for back-transport to get babies closer to their families

35. keep tabs on NNP and neonatology staffing needs/projections

36. broader and more support for education and development

37. The section must continue to advocate for access and funding issues. The section must also continue to promote research into improvements in care and advocate for adoption of beneficial practices.

38. all above

39. Same as above.

40. resource allocation

41. Clinical guidelines, scoring outcomes measures for hospitals and networks in a meaningful way.

42. Incorporation of above issues into training of fellows. Keep practice of Neonatology in the domain of neonatologists, not managed care administrators.

43. Public education and awareness that we CAN'T do everything.

44. Quality management, consistency of practice

45. maldistribution of intensive care units/perinatal

46. ethical guidelines for allocation of resources

47. proper controlled research that parallels adult advances; safety issues

48. "induced" prematurity Reducing disparities in perinatal care improving perinatal regionalized systems of care providing equity and quality of care

49. Management of the anxiety associated to having your baby in the NICU during the hospitalization and afterwards.

50. interfacing & designing EMR and CPOE. Work flow and process changes.

51. All of the above

52. reimbursement from insurers

53. PREVENTION OF PREMATURITY

54. decreasing neonatal mortality in this country

55. Research Data reporting Continue excellent education forums...expand if possible

56. Preventing insurance companies from dictating or limiting care, e.g., the use of Synagis.

57. training and continuing education

58. Quality improvement, follow up care.

59. Withdrawl of life support, addressing quality of life issues in survivors and when to stop coding a baby especially in the Delivery/ Operating room

60. Healtcare coverage for the uninsured.

61. coordination of services

62. Adequate reimbursement for professional services of neonatologists and all pediatric subspecialists

63. Adequate funding of perinatal programs. Regionalization of perinatal care. Continuing education and current awareness of issues affecting the care of neonates.

64. > Improvement of neurodevelopmental outcomes in ELBW infants >Education and improved access to adequate prenatal care

65. A seriour question relates to training. Neonatal hours for residents are limited, procredural

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opportunities therefore expertise is limited so physicians practicing in non tertiary centers may not be able to provide quality resuscitation and stabilization. Should the whole rotation of neonatology be revamped to focus more on DR amnagement and follow up (level 2) care vs care for NICU patients with high tech and acuity needs.

66. 1) Issues listed in #5, as well as increased compensation for P4P programs and CQI efforts-we are jumping through more hoops for relatively fewer dollars; 2) more research $$$ for Neonatal-Perinatal Medicine, which is very underfunded, in my opinion.

67. see above.

68. The added cost of fragmentation of services (e.g., transport of the VLBW & ELBW neonate instead of maternal transport markedly increases morbidity/mortality of the neonate and markedly inflates the medical costs to families and society

69. improved followup and interventional straegies post NICU

70. Provision of funding, cost-effective medical practices, medicolegal liability

71. leadership and support of professional activities (e.g. quality improvement)

72. Robust training in pediatrics that includes more critical care training. The pendulum has swung in the wrong direction.neonatologists

73. make available knowledge on newer therapies

74. 1. appropriate management of the infant born at 22-23 weeks gestation. 2. continued advocacy and refinement of coding system

75. Outcomes and ethics at the limit of viability - Who decides what the limit of viability is and then how do we support those families - both those who choose to resuscitate and those who don't

76. Costs and de-regionalization

77. standards of care and helping drive appropriate benchmark standards

78. The linit of viability and outcomes

79. Reimbusement issues, REducing the risk of adverse neurodevelopmental outcome

80. Education Clinical Guidelines and Statements NRP

81. recruitment of pediatricians and nurses into the field litigation caps

82. Simplified recertification process for NPM exam

83. unsure

84. advocate for research in neonatal care practices

85. Extreme prematurity and resuscitation at peri-viability - legal and guideline clarification

86. None

87. 1)adequate source of competent providers 2)continued emphasis on perinatal as well as neonatal 3)having adequate state and other resources to reimburse and otherwise support those who care for these patients (including legislation that quite directly impacts perinatal health such as tobacco taxes, tort reform, etc.) 3)

88. Training of Echocardiographic skills for fellows. Formalizing a definition a what constitutes exactly a car seat exam.

89. Limits of Viability

90. Standards of care

91. More support for research

92. advocacy for our patients against insurance companies

93. Providing effective healthcare at a reasonable cost.

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94. coding changes Joint Commision regulations impacting newborn care Leapfrog and other quality evaluation agencies/group and the standards chosen for quality evaluations

95. the requirement that all newborn orders get called to pediatricians( sometimes also neos) in the middle of the night for normal new born orders. It is not practical, and can result in missing important information

96. Funding

97. Patient Care Funding; Research initiatives;improve relations between private sector and academic sector; recruit more private sector Neos on Section Executive Committee

98. breastfeeding

99. Advocacy

100. Ethics and financial considerations in heroic care

101. Chronic lung disease

102. workforce pipeline - AMG vs. IMG

103. Burnout. Increasing administrative duties. Insurance problems.

104. Lack of regionalization and proliferation of units throughout the country without planning or organization

105. Maternal health and NOT inducing early because of parental pressure or physician plans

106. limits of viability and the ability for society to pay

107. Reimbursement issues-medicaid

108. healthcare costs and reimbursement

109. reimbursement for neonatal ICU care Dissemination of research findings that improve neonatal care

110. Easier coding of neonatal care

111. Stricter evaluation of training programs--too many weak ones still turning out neonatologists not ready for practice in the outside world.

112. Improved patient safety for this fragile population.

113. Guidelines for care and discouraging "experimental" care in non teaching facilities

114. manpower professional collaboration

115. Ethical dilemnas in neonatology

116. access to health care for all irrespective of socio economics

117. Access to care of High risk pregnant mother and the VLBW.

118. Role of neonatalogists in non academic centers and assisting in the services provided

119. Financial issues. Fair compensation for a high risk job.

120. Who cares for ALL newborns in the hospital- preferably neos and their employees!

121. How to prevent the epidemic of prematurity and the associated shortterm and longterm complications in view of limited resources and the lack of universal health care coverage

122. Collaboration between neonatologists and perinatologists

123. Translational research and quality improvement

124. medicolegal issues; supply/demand of neonatologists;

125. Improving reimbursment for Neonatal care; too many potential candidates discouraged by the poor commitment:reimbursement ratio

126. 1)Malpractice Testimony 2) Appropriate Guidelines for the care of terminal Genetic conditions, ie

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Trisomy 18

127. evidence-based care through compelling research endeavors

128. Treatment and care of critically ill newborns.

129. slippary slopes of lower gestation ( 23-25 wks)

130. quality improvement and evidence based practice

131. See above, plus reimbursement to hospitals & healthcare workers for services so they can continue to provide care.

132. Ensuring the quality of training programs

133. Cost effectiveness of neonata care and wide variations in practice

134. Accessibility to care, decrease the elective induction, advocate for pregnant women in the work force as a guarantee of our future

135. -the dumming down of the field training glorified technicians rather than professionals -cut back the excessive paperwork burdens in the ACGME process, great theory but lots of paper

136. 1) work with ACOG to attempt to get their members to follow their own guidelines RE elective inductions and C-sections only at or after 39 weeks. The perinatal section ought to "take a stand" on the late preterm baby's bad RDS, hosp readmissions, kernicterus risk issues,etc. We all talk about it, but as a formal group have not addressed it RE obstetrical practice. 2) work with the section on breastfeeding to advertise and disseminate the soon to be published "model hospital policy", to put pressure on US hospitals to be more breastfeeding friendly (not crazy baby-friendly) by using guidelines based in science to support BF on post-partum units,and to strongly suggest that hospitals quit marketing formula (for the formula companies) by giving away formula and diaper bags to new moms.

137. quality improvement

138. government reimbursement, training

139. 1. speak for babies and families 2. continue to provide care 3. assure good md reimbursement

140. response to change

141. Threats to payment from P4P efforts.

142. Immunizations, evidenced based medicine

143. No comment

144. See my response in the survey submitted yesterday before #4 was corrected.

145. resident preparation with the decreased time in NICU

146. 1. prematurity 2. loss of high quality neonatologists from academic institutions

147. public health

148. Evidence-based practice

149. aging population of neos

150. see above--assure quality care

151. evidence based practices

152. Cost of therapies such as meds (neoprofen) and iNO

153. Federal funding to support Mediacaid

154. Nutrition

155. Workforce balance Performance standards and outcomes analysis

156. .

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157. Access to care for mothers/babies

158. 1. Academic future of neonatology as a specialty 2. Closing the gap between academic and non academic salaries

159. Racial disparities in perinatal outcomes. Malpractice crisis. Education of residents, not only in Pediatrics, but in Family Medicine, Emergency Medicine, and Ob-Gyn.

160. Preventive medicine and education.

161. The above as well as adequate training for Neonatologists in the era of decreased work hour requirements during training

162. Need for more NNPs, PAs, NICU hospitalists, and more flexibilty in definitions of "academic neonatology" so we can bring a new generation of Pediatric trainees into neonatology, and support the running of NICUs, both academic and non-academic.

163. preventing late prematurity

164. Reimbursement for increasingly complex care, transitional care units for long term care

165. "Manpower" needs, distribution, and insane documentation necessitated by silly billing system.

166. n

167. increasing the quality of fellowship education

168. Changing needs of Neonatal Trainees

169. I have always been troubled by the lack of direct communication between the National Committee on the Fetus and Newborn and the various State Chapter meetings. National meeting minutes may be on line, but not timely. No coordination of efforts between state chapters and the national group.

170. facilitate networking (VON, NICHD, quality collaboratives)

171. facilitate networking (VON, NICHD, quality collaboratives)

172. Ceding of normal newborn care to neonatologists and how to provide cost effective care of these babies

173. making sure that every family has health care benefits.

174. Fellowship training -- work force issues. Many depts of peds no longer wish for us to train any neos other than academic ones - is this practical? How do we fund training good clinicians if we feel this is a priority?

175. how far do we go, how to stop. CME

176. tort reform

177. Health care coverage for mothers and babies Ethics of care at the border of viability

178. career paths for neonatologists in the era of in-house coverage as they age

179. The U.S.'s poor perinatal outcomes as relative to the world.

180. Use of ultrasound by neonatologists Use of probiotics in the NICU

181. 1. levels of care and appropriate patients at appropriate centers 2. training of future neonatologists 3. fair and appropriate recertification process

182. research interest in outgoing fellows

183. Resources and hours of work

184. Your recent newsletter said the average age of Neonatologists in the US is 54. The section must be doing something wrong!! Perhaps its time to access why a specialty which is interesting, dynamic and financially rewarding cannot attract American born Physicians. I suggest one of the reasons is that training is too long and consideration should be given to going back to a 2 year fellowship. At the current rate we may very well run out of neonatologists.

185. funding for clinical care and research payment for physician services requirements for maintenance

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of certification

186. the role of neonatologist and relationship to pediatricians ; should there be any involvement of family practice in the ICN?

187. Association with OBGYN for prenatal care emphasis

188. Education and quality improvement; bringing the 900+ NICUs in the US to some form of benchmarks for evaluation of care

189. no opinion

190. Re-imbursement for provider services and procedures Influx of electronic systems: charting, nursing charts and order entry. Increased time demands. Changing demographic of neonatologists in practice, more part-time. Be proactive in addressing pay for performance and quality indicators, partner with payors to consider meaningful indicators.

191. the poor outcomes of newborns in the U.S. compared to other developed nations

192. inadequate training/exposure of residents to neonatology (work hour limitations)

193. potential physician shortage

194. no answer

195. Availability of subspecialty consultation in the community. Will digital technology allow for good readings of echo, ultrasound, EEG studies or should community neonatologist know how to interpret these? Also, it would be nice to be grandfathered in to conscious sedation. As this is run by anesthesiologists, a test written by them must be taken in each facility. There should be a universal credential that is part of fellowship training and/or board certification., recognized by the major anethesia groups. This would allow for quicker medical staff privileging. It shoul include Propofol and ketamine (deep sedatives.

196. Evidence-based practices Addressing "social" issues - access to care etc

197. Access to care

198. community vs academic issues

199. 1 - Increasing access to longterm supportive therapies (PT, OT, Speech, sensory integration, behavioral) 2 - Continue education efforts related to coding

200. the appropriate minimal role for neonatologists, nurse practitioners and other physician extenders in the daily care of neonates at the various levels of care

201. new therapies

202. /

203. Life style/work. Promotion of academic neonatology - new grads seem to be directed to "shift" mentality.

204. training requirements

205. dosing of surfactant and frequency in the EELBW infants who were not living when the original surfactant trials were carried out

206. See 5 above...Adequate support of academic activities.

207. Universal health insurance.

208. Limits of viability issues.

209. advocacy, international, education

210. Written in previous version of survey

211. Training of neonatal fellows should include a well defined follow up training component; collaboration with other organizations with common interests in perinatal health.

212. academic work protection with increasing clinical demands

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213. Improving access to prenatal care and preconceptual education

214. establishing clinical guidelines

215. limits of viability, the late preterm

216. survival at the edge of viability

217. Adequate oppotunities for the QA portion of Maintenance of certification Adequate reimbursement of billing especially in Medicaid Rescources for older neonatologists and different career paths prior to retirement - the aging of neonatology

218. evidenced-based perinatal medicine

219. We need to do a better job of more fully informing families regarding long-term outcomes for infants born at less than 26 completed weeks gestation so that they might make better informed choices - and then we need to support those choices.

220. Fair payment, medical/medical issues.

221. The need and right of every baby to have access to the care which they require

222. Research

223. Accesibility/availability to all. International outreach. Education/preparation of the next generation of Neos Evidence-Based practice; and not spending money on what does not work.

224. Requirements for NICU's to have established capabilities and volumes of patients sufficient to maintain competency.

225. Advocacy Research funding Uninsured

226. continuing education

227. medicaid and third party reimbursement

228. The risks/benefits of small community nurseries Level III nurseries where outcomes are poor but the units make money for the hospital.

229. the above

230. Strengthening academic programs.

231. Enhance feedback to regulatory organisms such as ACGME, Board of Pediatrics and IOM

232. ridiculous JACHO policy of notifity pediatricians at all hours day & night for NORMAL newborn orders, this will drive pediatricians out of normal nurseries and dilute urgency of important phone calls

233. Problem if licensing where no one physician takes care of patient - a team effort

234. how outcome data will be tied to reimbursement

235. Training standards; pursuit of "evidence-based" care.

236. Late preterm infant surge

237. Aging population of neonatologists Changing field of medicine - EMRs, funding issues

238. Advocate for the well being of babies. Block legislation allowing llay midwivery without any nursing or medical training.

239. outcome data related to rescuscitation of borderline viable infants

240. research money allocation, encouraging relationships between obstetric and neonatal medicine

241. Prevention of premature birth

242. Promtion of breastfeeding and/or breast milk, even banked, especially for at-risk newborns.

243. Pediatric residency and fellowship education

244. The section must push the RRC to increase the number of rotations that the pediatric residents may

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attend in the NICU or well baby nursery.

245. Regionalization of high tech and micro premie care.

246. Long term neurodevleopmental outcomes

247. limits of viability and potential lawsuits that may arise from resucitating and not resucitating in the grey zone of viability

248. collabaration with developmental pediatrics for longterm care of the neonates discharged home

249. Humanpower issues, coding and reimbursement.

250. Government payment for services.

251. Resident education and lack of proper training/experience in the delivery room before entering private practice

252. Fragmentation of neonatal care

253. payment issues especially if a one payor system comes when is care futile? issues of ethics and care adequate research in care continued and systems to insure adequate trials(especially drugs)

254. outcomes in developing countries

255. Attracting members into academic practice to encourage education and research.

256. Retaining and enhancing Integration of Neonatal intensive and newborn care into the education of young peds and retention of Neo Divisions as necessary/important components of Departments of Peds

257. Global Health; aging population of neoantologists

258. Quality metrics Coding and reimbursement

259. Getting insurance to pay for back-transfers

260. The inability of ethical discussion to keep up with advances in medical technology in neonatology.

261. Lack of general pediatric training in neonatology

262. Ethical guidelines and cost containment.

263. development of FACULTY -- recruitment and retention of talented people to maintain supply of the best and the brightest into neonatology

264. reimbursement, access to care, competition, manpower

265. #1 priority: In house night call, different states with different regulations, what are expectations, what is needed, etc...

266. medical malpractice

267. Role of neonatologists and neonatology care extenders, as general pediatricians continue to lose ability and desire to handle complicated neonatal care. Role & training of pediatricians at institutions underserved by neonatologists.

268. see above

269. Continue to work to maintain appropriate regionalization of perinatal centers.

270. See above

271. universal health insurance

272. continued support for multicenter trials to provide answers to some of our big questions. continued advocacy for childrens healthcare. Continued work on smart practice including coding and reimbursement

273. no answer

274. long term care for NICU grads with disabilities

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275. aging of workforce, adequate number of docs; adverse effect of training guidelines on neonatal care by general pediatricians and how to address that situation

276. How to train physicians with the goal of having them stay in academic practice.

277. manpower and working conditions, quality of professional life issues, physician extenders in the NICU; there are 40 neonatal positions being advertised in this JOP

278. do not support mandatory recertification (perinatal-neonatal boards) for those of us who became board-certified in the 1980s and before

279. organization of health care

280. end of life care and parental involvement; delivery of care and extreme limit of viability

281. Consider education to the public on limits of viability and problems resulting from prematurity.

282. Patient safety and improved outcomes

283. Differences in newborn care in developing countries

284. Advocating regionalization in the face of a growing for-profit community sector.

285. preterm inductions

286. tort reform

287. ROP, telemedicine using the Retcam, availability of an opthalmologic provider.

288. Billing, coding.

289. resources, VLBW and viability, consensus on follow-up

290. Evidence based practice

291. Research and research training

292. establish guidelines

293. Emphasis on quality and the practice of evidence based medicine in our specialty. Research networks need advocacy at the national level for this to be most effective and inclusive.

294. Encourage more research

295. Addressing better ways to resource clinical research in community based hospitals with large volumes of patients

296. Appropriate utilization of the "graying" neonatologists.

297. See above comments. We must also promote clinical Neonatology as a profession with flexible work hours for our increasingly female Pediatric trainees (I have heard that the average age of a Neonatologist in this country is greater than 50 years old). Finally, we must revisit Neonatal outcomes demographics. The major ones (survival, IVH, NEC, etc.) have not changed in the past 10 years

298. decrease litigenous tendencies

299. encouragement for people to enter the subspecialties healthcare reform

300. access to care Continuing education

301. developing and keeping qualified practitioners

302. Funding, education of the public, care for evry pregnant woman irrespective of her insurance status, but the burden should not be placed on neonatologists and hospitals

303. MARKET MONOPOLY BY PEDIATRIX

304. Guidelines for Pay for Performance and Outcomes Measures

305. No comment.

306. Training of echocardiography and CFM basics to fellows.

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307. reimbursements for care

308. Help fellows achieve meaningful research during fellowship that fosters an academic career and continued research. My fellowship research experience was very poor and therefore I chose only a clinical position. Now I have practiced 3.5 years and feel like I would like to contribute more to research and wish I could make a change. It feels too late?

309. See Answer #5

310. Mentoring young fellows and junior faculty.

311. Physician shortage

312. n

313. LEGAL , economic ,PR aspects of practicing neonatal medicine ( Very low BW)- addressing our contribution to the world's disabled

314. Continuinng education for practitioners and common clinical evidence based

315. workforce

316. Support for top quality research training of fellows to make this an even more attractive career choice. Right now the balance is in favor of lucrative practice jobs over academics. I see this getting work with the now ACGME-mandated trainee 80 hr work week that seems likely to become 60 hr in the next 2-3 years.

317. causes of prematurity/viabilty issues to let community know about the real outcomes of extremely premature infants

318. The funding for neonatal care and research

319. n/a

320. reimbursement access to care

321. Endless and wasteful "stuff" sent out by the American Academy of Pediatrics

322. Research is vital for the future of neonatal-perinatal medicine and there is an appalling lack of research funding for topics in neonatology.

323. Funding for children's healthcare - universal would be ideal.

324. Reduction of the frequency of iatrogenic late preterm infants Collaboration with reproductive endocrinologists to reduce higher order multiples Personalized and predictive medicine for infants to predict risk of pediatric and adult diseases

325. Obstetric practices running counter to optimal newborn care such as C-section on demand. Rising percentago of c-section and elective induction

326. Research & education. The neonatologist has evolved into a hospitalist because of financial forces.

327. Improving Neurodevelopmental outcomes

328. Counseling re Genetic & Developmental Disasters

329. Regionalized care, delivery level matching facility of care level

330. 1. staffing models - physician extenders vs neonatologists 2. payments 3. International medical graduates 4. Note that question #4 does not allow for ranking 5 choices

331. outcomes research

332. Quality standards

333. Collaborative efforts between Obstetrics and Neonatal medicine to improve the care for all.

334. education of physicians to embrace family centered care continue research development educational advocacy continue clinical guideline development

335. Significant variance in care, even when clinical practice guidelines exist

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336. reimbursement

337. Advocacy for true evidence based practice in Neonatology

338. Single-payer system

339. quality of care quality of outcomes quality of fellows more involvement of nonacademic input in COFN

340. translational research guidelines to imprtove outcome of preterm infants ans follow-up

341. Will society continue to pay for 23 & 24 week admissions.

342. Training and Education

343. payor issues controlling medical care, availability

344. it's viewed as too much of an "old boys' club" by young neonatologists - you must reach out to and recruit younger members

345. Coverage for developmental surveillance for early detection and treatment of delays

346. All pertaining to Preventive Medicine

347. Clinical Outcomes Research

348. Regionalization!!! Regionalization!!! Regionalization!!! If we can increase regionalization, we will save a lot of lives, and even more significant disabilities. This will be difficult for the organization, given that a large share of the members are not currently practing in large tertiary centers. In the short term, improved regionalization shouldn't have any real effect on the demand for neonatologists, as jobs will just be shifted. Start now to reduce the number of neonatologists that are trained to reduce the future glut of neonatologists. Again, this will be hard for the organization.

349. reimbursement for medical care compassion in care curtail experimental practice in non teaching hospitals

350. access to health care appropriate reimbursement/coding make board REcertification take home again or else make recertification required for ALL neonatologists require recertification

351. research, education, reimbursement

352. Health insurance, training issues. -There is more and more paperwork involved, more requirements, and less time. This cannot continue indefinitely!

353. communication between families, medicine and appropriate portrayal by the media; stop the drama and blitz about higher order multiples

354. Prevention of prematurity

355. Ethical issues - where to make limits in futile treatments.

356. Pre/probiotics

357. evidence based practices

358. Teen pregnancy Prematurity (although a smaller part makes a big impact on morbidity and mortality) Tort reform

359. Pay for performance - must have expert leadership for appropriate goals for top performance

360. hours of work, quality of care, treatment pathways, transparency to the public and tort reform

361. Malpractice, Salary and Research Funding

362. Push for a single payer system that would provide optimum prenatal and postnatal care to all mothers and infants regardless of income or status

363. Levels of care provided by pediatricians versus neonatologists, particularly as physicians shift to a division between in-patient and out-patient care more and more. Also, residents do less and less in patient care hours and are less comfortable with inpatient care.

364. How to maintain the population of active educators and investigators

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365. Having private Neonatal group supply incentive money to fellow trainees without funding the neonatal program that trains their future manpower.

366. limit of viability reproductive medicine

367. keep us acaemic

368. medical coverage

369. *

370. Aspects of late preterm infant.

371. ACGME Program guidelines needs to come from neonatologists/Program Directors

372. Reimbursement for services

373. continued funding for research, appropriate reimbursement for services

374. Guidelines and standards for newborn and child/adolescent health

375. Ability to attract high quality trainees to stay in academic settings - far too many are leaving academics because of discrepancies in salaries offered by private practices

376. importance of continued (and expanded) payor support of NICU care in a climate of constraints on health care spending

377. billing reimbursement tort reform govt health care plans/reforms

378. Insurance coverage, education of the members communication with other disciplines and other nations

/J:_Newborn.PRI/VanMarterAssistant/AAP/MemberQuestionairre/Perisurvey#6

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