Lead

Hello everyone. I’m Rosalie Rivera. I’m a Clinical Quality Improvement Liaison for the Healthcare Management and Transformation Team. Today I’ll be talking about Lead and the importance of lead testing.

What I’ll be going over today is: An Overview, The Testing requirements, The Risk Assessment Questionnaire, Lead Reporting, Coding and reimbursement and MedTox.

What is Lead? Lead is a metal that is poisonous to humans when it gets into our bodies. It’s odorless and tasteless but is present in a lot of everyday things that we encounter and I will discuss the ways of exposure later in the presentation. We all have the potential to be exposed to lead, but because children grow so quickly, lead gets into their bodies a lot faster and can cause severe damage to children’s health. If lead poisoning is not treated early, it can cause developmental delays, behavior issues, learning problems and hearing impairments. So in this presentation, we will also discuss some important and practical ways we can avoid lead exposure and ways to monitor lead levels in children. Sources of Lead and ways of exposure: Lead can be found in Air, soil, water, and pesticides. NJ, which is known as the Garden State has a lot of agricultural lands that may use some of these pesticides. It may also be present in ceramics, welding, gasoline, batteries and cosmetics. More than 65 % of the housing in NJ was built before 1960’s, which means that some of the pipes, plumbing materials, and paint may contain lead. Before people knew how dangerous lead really was, it was used in things such as cookware, crayons and toys. Lead can still be found in products that come from other countries, such as pottery, candy wrappers and cosmetics. Lead can also be brought home from hobbies and remodeling projects.

Lead can found throughout a child’s environment. Homes built before 1978 when lead-based paints were banned probably contain lead-based paint. When the paint peels and cracks, it makes lead dust. Children can be poisoned when they swallow or breathe in lead dust. Certain water pipes may contain Lead. Some products such as toys and jewelry. Imported candy from other countries. Traditional home remedies. Certain jobs and hobbies working with lead-based products that the parents can bring home. Children who live near airports may be exposed to lead in air and soil from aviation gas.

You may have heard some myths regarding Lead poisoning so I’ll go over some of those myths and the reality of each. Myth: Children must eat paint chips to get lead poisoning. Reality: Children are more often poisoned by swallowing dust from lead paint, then by eating paint chips. Myth: Only high levels of lead have lasting effects on children. Reality: Even a low level of exposure to lead can cause long-term effects on a child’s learning and behavior. Myth: Just having lead paint in your home means an infant is at risk of lead poisoning. Reality: Undamaged lead paint generally poses no immediate danger to infants and toddlers. But when lead paint chips or deteriorates, children swallow lead dust on their hands and other things they put in their mouths, such as toys. Myth: Lead poisoning is a health problem that only a doctor can solve. Reality: lead poisoning is a housing problem and a health problem. Medical treatment cannot protect a child from breathing in more lead. Myth: Bad parenting is to blame for lead poisoning in their children. Reality: Lead, not parental negligence, is the cause of poisoning. Poisoning frequently occurs when children put hands, toys and other objects in their mouths. All children place items in their mouths. Myth: Lead poisoned children always have severe symptoms. Reality: A child with low and moderate levels may show no symptoms. When symptoms do appear, lead may have already done permanent damage. Symptoms are often confused with other causes. A blood lead screening is the only way to be sure your child has a low lead level.

Exposure to lead can seriously harm a child’s health and cause well-documented adverse effects such as: damage to the brain and nervous system, slowed growth & development, learning & behavioral problems, hearing & speech problems. This can cause: lower IQ, decreased ability to pay attention, underperformance in school. There is also evidence that childhood exposure to lead can cause long-term harm. The good news is, is that childhood lead poisoning is 100% preventable.

Ways to prevent Lead exposure. So far, we’ve talked about the prevalence of lead in everyday things and we have talked about the detrimental health effects of lead can have, especially in young children. But not to be alarmed, they’re several ways we can prevent lead exposure and these are simple, straightforward practices that you can encourage all parents to do. The goal is to prevent childhood lead exposure before any harm occurs. Encourage parents to have their child get a simple blood lead test. Make parents aware that they can go to their local health department about testing paint and dust in their home for lead if their home was built before 1978. The removal of lead hazards from the environment before a child is exposed is the most effective way to ensure that children do not experience harmful long-term effects of lead exposure for example, reminding parents to renovate safely and removing recalled toys and toy jewelry from their children and discard as appropriate.

These foods are recommended to limit absorption of Lead. Calcium in: milk, yogurt, green leafy vegetables like spinach. Iron in: lean red meats, beans, peanut butter and cereals. Vitamin C in: oranges, green and red peppers, and juices.

When Should a Child be tested? Blood lead screening and testing should be completed: 9 to 18 months of age, 12 months preferably. 18 to 26 months of age, 24 months preferably. 2 years 3 months to 6 years of age if child was not tested before. A Verbal Risk Assessment tool should be performed for lead toxicity at every periodic visit between the ages of 6 months to 6 years of age. Beginning at six months of age, children determined to be high risk for high doses of lead exposure must have a blood-screening test performed at the time of the high-risk determination. The New Reference Value on Assessment tool is more than 5 micrograms/dl. It used to be more than 10 micrograms/dl.

This form on the right is a lead risk assessment questionnaire that can be found on our horizon website www.horizonnjhealth.com or your practice may have a similar form. This verbal risk assessment should be performed for lead toxicity at every periodic visit between the ages of 6 months and 6 years of age.

The Lead Risk Assessment Questionnaire is used to screen and capture early lead exposure before it can do irreversible harm. Some example questions are: Does your child live in or regularly visit a house with peeling or chipping paint built before 1978? Does your child have a brother or sister, a playmate or other household member with a confirmed elevated blood level? Does your child frequently come in contact with an adult whose job or hobby involves exposure to lead? Do you give your child home or folk remedies that may contain lead? If the answer to all the questions are No, a child is considered at low-risk for high doses of lead exposure. If the answers to any of the 10 questions are Yes or Don’t Know, a child is considered at high-risk for high doses of lead exposure and a blood level should be attained. A child’s risk category can change with each administration of the verbal risk assessment. Again the new reference value for what is considered high-risk is more than 5ug/dl.

How do we report lead testing and ways of intervention? For those engaged in the Results and Recognition Program, we provide you a monthly quality performance report to identify those members with lead care gaps, these follow the HEDIS guidelines which look at children up to 2 years of age. The expectation from the state is that providers maintain a compliance rate of 80% or greater. Corrective action plans are administered to those practices that have fallen below 80% compliance for two consecutive 6-month periods. We support our providers and members with webinars, educational materials, and pediatric provider guidelines with best practices in our Provider Manual.

Horizon Healthy Journey is our outreach and intervention team. They send members semi-annual postcards on lead screening, IVR call reminders about lead and case management follows up with children with reported high lead levels. And this below is an example of a post card sent to members.

Lead screenings are monitored by the state of New Jersey and Horizon NJ Health. Providers are expected to surpass 80% compliance rate every 6 months or will placed on a corrective action plan. Methods of screening are venous blood draw and capillary stick. An alternative to a venous blood draw is MedTox it is an in-office collection of lead sample by finger stick, point-of-care reimbursable by Horizon NJ Health. MedTox kits can be obtained free from LabCorp.

These below are lead testing codes and Horizon NJ Health will reimburse $10 for an in-office collection of blood for lead screening.

Here is an update on MedTox. If you already have an account set up with LabCorp, you can now also order MedTox kits online as an alternative to venous blood draw. The benefits of using MedTox is: it is simple, cost-effective and accurate. Simple because screenings can be performed with 2 drops of blood during a routine office visit, May be less invasive and traumatic for a child than a venous collection, There’s no spinning, refrigeration, or phlebotomist required, Reports are available via fax, secure website or EMR. Cost-effective because collection supplies and specimen shipment are included, LabCorp files claims with Medicaid and most major insurance companies, No equipment to purchase or maintain. And accurate using state-of-the-art technology assures timely and accurate results, Samples are stable for up to 6 months, and LabCorp meets state reporting requirements for lead screening results.

If you have any questions regarding MedTox, please contact Joe Huffer at this number 1-877-725-7241.

Eliminating childhood lead poisoning is an achievable goal through: continued use of evidence-based practices at individual and population levels; intensive efforts to identify and provide services to children who have elevated blood lead levels. Evidence-based practices developed for children affected by lead involve ensuring that they receive these targeted interventions: timely and appropriate medical care, nutritional education, and environmental interventions. In conclusion, primary prevention strategies that control or eliminate sources of lead before children are exposed remain the preeminent public health approach to address lead poisoning and the only effective way to prevent the neurodevelopmental and behavioral abnormalities associated with lead exposure.

The Center for Disease Control and Prevention’s, CDC, Childhood Lead Poisoning Prevention Program is committed to the Healthy People 2020 goals of eliminating blood lead levels more than 10 micrograms/dL and differences in average risk based on race and social class as public health concerns. The program is part of the National Center for Environmental Health’s Division of Environmental Health Science and Practice. For additional information on lead you can go to CDC.gov.

(Question slide - nothing said) I want to thank you for continuing to collaborate with us to ensure the highest level of care and quality for our members. If you have any questions please contact Horizon Healthy Journey at 1-844-754-2451. Thank-you and have a good day.