Working toward Advances in Access to Care Everywhere

As ob-gyns, we all agree that women should have access to comprehensive health care throughout the continuum of life. We have been especially focused recently on ensuring prenatal, labor and delivery, and postpartum care, no matter their zip code. But access to maternal health care in rural areas is rapidly disappearing across the United States. Over the past nine years, more than 100 rural hospitals have closed in the United States, making delivering high-quality, safe health care to patients more difficult than ever before. Even more alarming is that more than 600 additional facilities, which represent more than one-third of rural hospitals in the United States, are currently at risk of closing.

Disparities in access to care in rural areas don’t affect everyone equally, either. Women of color are disproportionately affected by disparities in rural health care: U.S. Senator Tina Smith (D-MN) points out that rural counties with more black residents are at greater risk of losing their labor and delivery services.

It’s plain to see why increasing access to ob-gyn services in rural areas is an important issue to ob-gyns and our patients. I’m proud to share that ACOG’s advocacy has contributed greatly to the advancement of a number of new bills that will help improve access to ob-gyn care in rural areas—especially the Rural Maternal and Obstetric Modernization of Services (Rural MOMS) Act, which was introduced in the House and Senate. Our advocacy was crucial in drafting this piece of legislation and ensuring that it received bipartisan support.

The Rural MOMS Act is part of ACOG’s Momnibus, a collection of bills that would help eliminate preventable maternal mortality, support best practices, and enable ob-gyns to better serve their patients. The bill supports training for health care professionals in rural communities, expands telehealth programs, and establishes regional innovation networks. ACOG and our members worked tirelessly to make ob-gyns’ voices heard on the issue of rural maternal health care, and we succeeded.

Importantly, the Rural MOMS Act will help lessen disparities in rural health care in several ways. Rural obstetric network grants, administered by the Health Resources and Services Administration, will help connect women with needed care before, during, and after birth, measure and address inequities in birth outcomes among rural residents, and provide training for health facilities without obstetric health units, among other measures. The Rural MOMS Act will also expand telehealth networks and resource centers and improve federal collection of maternal health data based on geographic location.

Together with our Momnibus, the Rural MOMS Act will make meaningful progress toward reducing disparities in care in rural areas. Thanks to ACOG and our members’ advocacy, pregnant women in rural areas are one important step closer to being able to get the high quality care they need, when and where they need it.

Guest Blog: Giving Power to Patients and Physicians through Advocacy

Right: Heather Smith, MD, MPH
Right: Heather Smith, MD, MPH

One-on-one interaction and patient care is critical to me as an ob-gyn. It’s why I went to medical school after getting my master’s in public health and working in community education. It’s why I got involved in the Massachusetts Medical Society and the AMA during medical school. And it’s a big part of why I advocate.

Federal health policy and its effects on individual and community health first caught my attention while I was earning my master’s in public health at the Boston University School of Public Health, where I worked on a national project that evaluated the effects of welfare reform on children’s health. As I worked on this project I began to see that the intent of federal policy doesn’t always match up with the effects those policies have on an individual level, that public policy plays a significant role in determining community resources and individuals’ health, and that I could play a role in aligning federal policy with individual and community needs.

In today’s often unpredictable political and health care landscape, ob-gyns can often feel powerless to do anything for their patients outside of the exam room or for their specialty outside of their organization. But during my years spent as a practicing ob-gyn and an advocate for change in health policy, I learned that advocacy helps me give my patients and community power over their health that extends beyond my office and my one-on-one patient interactions. The time I spent working on advocacy issues with the AMA as an ACOG delegate and with ACOG’s Government Relations Committee showed me that my voice can also help move the needle on addressing maternal morbidity through establishing state-based maternal mortality review committees, extending Medicaid coverage to 12 months postpartum, surprise billing, prior authorization, and other key ACOG issues that would enable us as physicians to take care of our patients and advance our specialty as much as possible.

ACOG’s McCain Fellowship offered me an invaluable opportunity to build on my prior advocacy experience. The fellowship drove home the nuances of advocating ACOG issues to legislators and policy makers; especially the fact that getting your voice heard at all and making connections with legislators—an area in which Ob-GynPAC is critical—is just as important as the policy you’re advocating for. My time in Washington, D.C., has bolstered my advocacy in other ways, too: while learning more about how to interact with legislators and advocate on behalf of ACOG issues, I also had the opportunity to see how ACOG works behind the scenes and to understand how strong of a team ACOG truly is. Engaging with staff at ACOG national has helped me understand the difference that ACOG is making for us, our patients, and our specialty—and the difference that we can continue to make in the future.

I encourage anyone who wants to make lasting changes for their patients and their community to get started advocating today. ACOG makes it easy: for example, the Congressional Leadership Conference is a great way to learn the ropes of advocacy and get face time with the legislators who influence health care policy. Your Annual District Meeting will keep you up to date on the latest developments in women’s health care and bring issues that you may otherwise not have noticed to your attention, and your state Lobby Days will help you make a difference on issues such as reproductive health, family planning, and hospital safety on your home turf. If you’re already a seasoned advocate, you can multiply your impact by serving as a point person for your District or Section, which will allow you to share resources, get more people into advocacy, and show your fellow ACOG members what successful advocacy looks like. As an ob-gyn, I make a commitment to take care of my patients. Advocacy is one additional tool that helps me keep that promise.

Heather Smith, MD, MPH
Women & Infants Hospital
Providence, Rhode Island

Let’s Make Speaking Out on Surprise Billing a Priority

Balance billing, more commonly known as “surprise billing,” has garnered national attention and Congress is preparing to take action. The issue of surprise medical billing may arise when a patient goes to an in-network facility to receive care, such as emergency care, surgery, or childbirth, and receives care from out-of-network physicians. Finding a solution to surprise billing is critical, and ACOG is hard at work to ensure that the solution protects our practices and our patients. Our members of Congress need to hear from us – the physicians who would be impacted.

Billing disputes can impact the patient-physician relationship, as many patients look to you to answer their billing questions. Any solution must shield patients from out-of-network payment disputes between physicians and insurers. Patients are not always able to choose an in-network provider and shouldn’t be financially punished for circumstances beyond their control. It is also critical that legislation to address surprise billing ensure that physicians are appropriately compensated for the quality care they provide. Some congressional proposals would jeopardize physician reimbursement and access to care.  I was fortunate to be on Capitol Hill earlier this year with the “Group of 6*” to advocate for legislation to address this issue.  ACOG supports an independent dispute resolution process—like the one used in New York state—that protects patients and preserves the financial stability of physician practices.

This August Recess, ACOG is partnering with the physician community to make protecting our patients and our members from surprise medical bills a priority. In a joint letter to the US Congress signed by 57 medical specialty societies and nearly every state medical association, we let legislators know where we stand on this issue. But we need your help!

As a physician, your voice is powerful in impacting new legislation. Send a message to your members of Congress and tell them to support surprise billing legislation that relies on the proven dispute resolution process. Then, connect with them in person. Most members of Congress share their town hall and constituent engagement schedules on their websites. Find out when they’ll be in your neighborhood, consider getting a few of your colleagues together, and let them know that addressing surprise medical bills is a priority for ob-gyns.

Never advocated before? It’s easier than you may think. Here’s a simple message you can send to your representatives:

I’m an ob-gyn. Please work in Congress to protect my patients from surprise medical bills and ensure a solution that is fair for everyone and that enables me to continue to provide high-quality health care to the women of (YOUR STATE), similar to the proven model in New York state. When you get back to Washington, D.C., reach out to my specialty society, ACOG, to keep this conversation going.

Whether the issue is surprise medical billing, maternal mortality, or Violence Against Women Act reauthorization, ACOG will continue to advocate on behalf of you, our specialty, and our patients year-round. You can always join our efforts by visiting our ACOG Action web page, and stay up to date with breaking advocacy news by following @ACOGAction on Twitter.

Let’s do this!

* The Group of 6, representing America’s frontline physicians, is comprised of ACOG, The American Academy of Family Physicians, The American Academy of Pediatrics, The American College of Physicians, The American Osteopathic Association, and the American Psychiatric Association.


Zika Provider Action Week

The White House has declared this week Zika Provider Action Week. This call to action could not come at a better time. The Zika virus has occupied our profession and our patients nearly non-stop since news of it broke last fall. There is no doubt that Zika presents a very real concern to patients and challenge to health care providers. With the discovery of virus transmission by mosquitoes here in the United States, many of us are faced with the even more real possibility of treating patients with potential or confirmed exposure.

As ob-gyns, we are on the front lines of patients’ concerns about Zika. As each new finding is played out in the news, our patients call or come in looking for answers to help their understanding of the risk, and more often than not, assuage their fears. Unfortunately, in the instance of Zika, we too are often scrambling for knowledge, seeking elusive answers from research institutions and government agencies. The Centers for Disease Control and Prevention (CDC) has done an admirable job working quickly and efficiently to assess, address, and educate the American public about the Zika outbreak.

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