Pediatric care plan finally comes to PASS

By Erin Prather Stafford


The Department of Pediatrics has created a novel telephone consultation and referral network to improve access to subspecialty pediatric care for children served by Texas Medicaid.

The administration team running the new Texas PASS initiative is (from left) Nicole Santiago, Dr. Carol Podolsky, Dr. George Lister and Jeanne Nightingale.

Known as Texas Pediatric Access to Subspecialists (Texas PASS), the network was developed by Dr. George Lister, chairman of pediatrics, in conjunction with Dr. Carol Podolsky, assistant professor of pediatrics and medical director of the network, and program coordinators Jeanne Nightingale and Nicole Santiago. Texas PASS is sponsored and supported by the Texas Health and Human Services Commission in collaboration with the Department of Pediatrics.

The network offers primary care providers (PCPs) access to telephone consultations with pediatric subspecialists in child psychiatry, cardiology and gastroenterology. As the program expands, other subspecialties will be added. PCPs in Northeast and North Central Texas may obtain a telephone consultation at any time by calling a toll-free number.

“Texas has the largest number of uninsured or underinsured children of any state in the nation and also faces a huge shortage of pediatric subspecialty providers,” Dr. Lister said. “Moreover, many families live far from pediatric subspecialists and a large number of those subspecialists do not accept Medicaid. Texas PASS will give pediatric primary care providers telephone access to a subspecialist within 30 minutes of their request for consultation.”

The program is designed to provide prompt consultation while the patient is in the office, clinic or urgent-care facility; to improve communication and care coordination between the PCP and subspecialist; and to reinforce the resources of the patient’s medical home. It is anticipated that the program will minimize patient travel and missed time from work and school.

After receiving a request, Texas PASS program coordinators will arrange a telephone consultation within 30 minutes between PCPs and pediatric subspecialists. All of the network’s subspecialists are UT Southwestern faculty and members of the medical staff at Children’s Medical Center Dallas. There is no charge to PCPs or their patients for telephone consultations. The program covers reimbursement for the telephone consultations provided by the subspecialists for Medicaid-enrolled children.

During the telephone discussion, the child’s need for direct evaluation will be determined. If the patient needs to be seen by a subspecialist, the program coordinators will provide a list of referral resources. After the telephone consultation, the program coordinators will follow up with the PCPs to provide documentation of the encounter and to assess the quality of the service.

“Encouraging coordination between PCPs and pediatric subspecialists can break down barriers that interfere with direct communication and ultimately will improve patient care,” Dr. Podolsky said.

Drs. Lister and Podolsky said they anticipate that Texas PASS will not only improve patient access to subspecialty services and reduce unnecessary visits to subspecialists or emergency rooms, but also will serve as a model to be used by other states intent on improving subspecialty care for underserved children.

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Dr. Lister holds the Robert L. Moore Chair in Pediatrics.