Articles
Regular Physicals/Check-ups for Children: Why Should They Occur in the Medical Home?
By Dr. Dave Tayloe, Jr., MD, FAAP
Founder, Goldsboro Pediatrics, PA
Pediatricians1 and Family Physicians1 promote the importance of all children receiving health supervision according to the guidelines of the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). These evidence-based guidelines prescribe a series of face-to-face visits for physicals/check-ups with a primary care provider.
In 1965, the federal government established Medicaid and published specific rules for providers who care for children covered by Medicaid. These rules include criteria for being paid by Medicaid to perform regular physicals and these physicals were referred to as EPSDT (Early Periodic Screening, Diagnosis, and Treatment) encounters. Most private insurance plans have adopted EPSDT and pay for approximately twenty of these visits between prenatal care and age 21 years, according to a periodicity schedule agreed upon by the AAP and AAFP.
Guidelines for these EPSDT encounters were established by a partnership that included the Maternal and Child Health Bureau of the federal government and representatives of the AAP. These recommendations are codified in Bright Futures such that all primary care providers try to include the elements of Bright Futures in all health supervision visits. Bright Futures guidelines are updated every 3-5 years, with the most recent volume dated April 2022.2
It is important for every child to have a “medical home” where she/he can receive 24-7 primary care from a competent primary care provider. The regular physicals should be performed within the medical home so that there is a health baseline known to the provider if and when health problems arise. The AAP does not recommend that these physicals be performed outside the context of the medical home in settings like schools, gymnasiums, civic centers, or churches. It has been shown that children who receive all their health services in the medical home are more likely to be completely immunized and to be carefully screened for disorders of growth and development, iron deficiency anemia, lead poisoning, abnormal vision, and hearing loss.It has become customary practice for children to have physical exams performed outside the medical home so that the children meet deadlines of schools for registration/attendance and sports. This practice undercuts the principles of the AAP and the AAFP and fragments the health care of the children.
Goldsboro Pediatrics will do whatever it can to assure that all its patients receive comprehensive primary care, including recommended physicals according to Bright Futures guidelines. If you are trying to meet a deadline by which your child must have a physical, call our office (919-734-4736) and make this deadline information clear to our staff and we will figure out a time and place within our practice for your child to receive the necessary health supervision services. We do not want our patients to receive fragmented care outside the medical home and our 7-days-a-week, 24-7 approach is our way of helping parents meet deadlines for regular physicals.
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The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be downloaded or photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, email reprints@jamanetwork.com.
1 pediatricians and family physicians in this context include nurse practitioners and physician assistants who work collaboratively with physicians in medical home settings.
2
Bright Futures Guidelines and Pocket Guide, 6th Edition
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