Guest Blog: How I Learned to Speak Up for Women

Susan P. Raine, MD, JD, LLM

Susan P. Raine, MD, JD, LLM

ACA, SGR, CR, E&C—the list goes on. I thought once I became an ob-gyn, my days of being lost in the world of strange acronyms were over. Then I arrived on Capitol Hill. Thanks to the wisdom of the District XI leadership, I proudly accepted the honor of becoming the first McCain Fellow from our district. This opportunity allowed me to spend two weeks this past September with the Government Affairs staff of the American Congress of Obstetricians and Gynecologists (ACOG).

Every February, I attend the ACOG Congressional Leadership Conference (CLC) in Washington, DC. During an exciting three-day meeting, ob-gyns learn about the legislative issues most likely to impact us and our patients. We then visit congressional offices to present ACOG’s legislative “asks.” It is an invigorating process—particularly when you are doing it with 300 other ob-gyns. Personal politics aside, this was an amazing opportunity for me and for the women I was there to represent.

When I came back to DC this past September as the McCain Fellow, I was worried that I had forgotten all I had learned seven months earlier at the 2013 CLC. However, after a day of warm-up, I felt ready to speak intelligently to Congressional members and their staff about ACOG’s legislative priorities. That doesn’t mean I felt I could do it as well as the lobbyists or that I did it without anxiety. But I did it. And it’s not enough. That’s the great responsibility that comes with my “forever” status as a McCain Fellow. It’s not enough to advocate for my colleagues and our patients; I have to convince others that they need to do the same. We must be the voice of those who have none.

Many doctors tell me that they hate politics and that they can’t stand the partisan bickering. When I was younger, a little more naïve, and very idealistic, I wanted a career in politics but became disillusioned by what I saw happening in our government. With the benefit of a little age, wisdom, and perspective, I now realize that we live in the greatest country in the world. I can speak up and disagree with our leaders without going to jail. I am not tortured for my opinions nor is my family taken from me. As a woman with two doctorates and two master’s degrees, my opinions are valued. Not just because I am educated and not despite the fact that I am a woman, but because I am an American. Our system is far from perfect, but it’s ours. If we really want to make a difference for women, we will embrace it rather than rail against it.

So what can you do? If you have a few days to get away, plan on coming to next year’s CLC. If you have a little more time or a particular interest in advocacy and health policy, apply to serve on ACOG’s Government Affairs Committee. Don’t forget, local opportunities offer a chance to get involved with minimal time away from your practice. Most of all, be aware of every opportunity to advocate—for yourself, for the next generation of ob-gyns, for your patients, and for women everywhere. It is an honor and a privilege to do what we do. With your contribution to our advocacy efforts, maybe we can keep the legislators out of our exam rooms.

For information on getting involved in advocacy, go to http://bit.ly/1brBOLV.

Susan P. Raine, MD, JD, LLM, is vice chair of Global Health Initiatives, and associate professor in the department of obstetrics and gynecology, at Baylor College of Medicine in Houston.

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Guest Blog: Navigating ACA, SGR, and Changes in Ob-Gyn Practice

Mark DeFrancesco, MD, MBA

Mark DeFrancesco, MD, MBA

As the Affordable Care Act (ACA) is rolled out, expanded insurance coverage will encourage more women to obtain preventive care. Payment models will shift from “fee for service” to capitated or bundled payments. This applies to both Medicare and government plans, and private insurers who usually follow The Centers for Medicaid & Medicare Services’ (CMS) lead.

With more doctors accepting new Medicare patients and an expected increase in patients with insurance of all types, we must adapt our practices to accommodate them and provide more comprehensive care. This will be easier if you are in a large practice. It might be a large merged practice like mine, perhaps a hospital or health system, or even a “virtual network” of clinically integrated separate practices. We will need to perfect a team approach, no matter what form it takes. We can be much more efficient if we collaborate with other providers, such as certified nurse-midwives and advance practice nurses.

This shift to new practice models has been in the works for years. In 1997, as I saw some of these changes on the horizon, I helped create Women’s Health Connecticut, a statewide ob-gyn private practice. Now with almost 200 ob-gyns and 35 collaborative providers, we are one of the largest single-specialty women’s healthcare groups in the country, and have raised the quality of care given to patients in our state. This model is also developing rapidly in Florida, North Carolina, and many other states.

In addition to developing better practice models, we must solve the physician payment piece of the puzzle. The unfortunate reality is that under the CMS sustainable growth rate (SGR)—a formula originally intended to control physician-related Medicare costs—doctors are not fully reimbursed for the costs of treating patients. If actually applied, the SGR would reduce payments to physicians each year. At this point, if allowed to kick in, the SGR would require a cut exceeding 25% in physician reimbursements. Each year, Congress passes legislation that postpones the cuts. To more definitively deal with the SGR problem, while further containing health care cost increases, Congress is considering a more comprehensive re-design of the payment system.

Because of my experience in growing a profitable new model of practice that delivers improved patient care, ACOG President Dr. Jeanne Conry has asked me to chair ACOG’s SGR Task Force. The task force will help ACOG develop and review legislative proposals to eliminate the SGR and to significantly redesign the payment system in a way that rewards quality and appropriately covers the cost of providing care.

When we keep our practices healthy, we are able to provide better care to our current and future patients. I have no doubt that ACOG will continue to provide guidance and assistance in adapting to the changes in the health care environment, and I am proud to be able to help.

Mark S. DeFrancesco, MD, MBA is an ob-gyn and chief medical officer at Women’s Health Connecticut.

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Finally, Women’s Health Gets Its Due

It is an amazing time for women in the US. The recent passage of the Affordable Care Act (ACA) shows that women’s health has been embraced as a national priority. Implementation of this landmark legislation will improve and expand health care for millions of women. From yearly well-woman visits to cancer screenings and domestic violence screening and counseling, to breastfeeding support and contraceptive coverage, more women’s health services will be accessible and affordable than ever before.

It’s with this backdrop that I take the reins as president of The American Congress of Obstetricians and Gynecologists, and I couldn’t be more excited. As a nation, we’re finally recognizing that health care is about more than solving accute health crises. It’s about promoting wellness to prevent disease. For ob-gyns, providing top-notch health care includes having meaningful interactions with women and providing them tools not only to maintain their physical health, but to improve their physical, mental, and emotional health, too.

Ob-gyns will be greatly affected by the new law, but we’ll also have a chance to make a great impact. We will be gaining new patients and collaborating with colleagues to optimize their health. We should strive to make the most of these patient-doctor visits and encourage women to put their health first—take advantage of the services ACA offers; get preexisting health conditions under control; make time for eating right, exercise, and the stress-relieving activities that they enjoy. These are fundamental health reminders that we must convey to every woman, every time.

As an ob-gyn, I believe that no medical specialty knows women’s health better than we do. We have a duty to speak up in the best interest of women’s health. During my year as ACOG president, I plan to take every opportunity to advocate for women. I challenge ACOG Fellows to let your voices be heard as well. Talk to your legislators and your community about women’s health, but most of all, talk to your patients. Working with them one-on-one to build the foundation for a healthier future is where we can make the biggest difference.

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Guest Blog: Every Reproductive-Age Woman At Risk, Every Time

Frances Casey, MD

Frances Casey, MD

Full implementation of the Affordable Care Act (ACA) will remove many of the financial barriers women face to obtain effective methods of contraception. While making contraception affordable for every woman is a good first step toward improved prevention of unintended pregnancies, it remains the responsibility of health care providers to counsel women about all methods of contraception and help them find the one that may be the most effective.

The CHOICE project demonstrated that removing financial barriers related to the most effective methods of contraception decreases rates of unintended pregnancy and abortion. But the CHOICE project also did something many of us ob-gyns do not. Every reproductive-age woman eligible for the study was read a script about the effectiveness of long-acting reversible contraceptives (LARC), such as intrauterine devices (IUD) and hormonal implants.Instead of discussing LARC with their patients, many providers continue recommending less effective contraceptive methods based on misconceptions that adolescents, women who have never been pregnant, or women they estimate are at high risk for sexually transmitted infections (STIs) are not good candidates for LARCs. However, according to ACOG, LARC is the most effective form of contraception available and safe for use in all of these groups.

Because LARCs don’t require ongoing effort by the user, continuation and correct usage rates are higher. This could significantly reduce unintended pregnancy among teens and women if widely adopted. Additionally, women at high risk of both STIs and unintended pregnancy can be screened, obtain a LARC method the same day, and receive treatment without removing the device. Women with medical conditions and physical and mental disabilities can also benefit from both the pregnancy prevention and the non-contraceptive benefits of LARC.

Other women may also benefit from a longer-acting option. Without strict breastfeeding, postpartum moms are at risk for ovulation and repeat pregnancies even earlier than six weeks after delivery. LARC methods can be inserted immediately following delivery or at four weeks postpartum. Despite slightly higher expulsion rates, the benefits of immediate postpartum insertion of LARC methods may outweigh risks for women who are unlikely to receive postpartum care.

Minimizing financial barriers will make contraceptive methods more accessible for women at risk of unintended pregnancies, but it is up to us, as their partners in prevention, to counsel them on the most effective methods, including LARCs, at every opportunity.

Frances Casey, MD, is a Family Planning Fellow at Washington Hospital Center in DC.

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Guest Blog: With the ACA, Many Ounces of Prevention

Barbara S. Levy, MD

Barbara S. Levy, MD

Have you ever heard the phrase “an ounce of prevention = a pound of cure”? It’s an often-used mantra in the medical community and a message we continuously repeat to our patients. That’s because intervention through prevention makes good sense. In many cases, catastrophic illness can be avoided by nipping small problems in the bud or diagnosing and treating disease early. In addition to living a healthy lifestyle, regularly visiting your doctor for routine screenings and counseling is paramount to achieving this goal.

As women, we are often the primary (or sole) caregiver for our families—not to mention the cook, head nurse, and chief financial officer among many other roles. Without a second thought, we may put the needs of others before our own. This is especially true if money is tight and it’s a decision between getting an annual well-woman exam, paying $50 for a birth control prescription, or meeting the needs of a child, spouse, parent, or friend. But this philosophy doesn’t serve women well—if you’re sick, who will look after the people you care about?

The Affordable Care Act (ACA)—the new US law that expands health care coverage by making health care more affordable and accessible—focuses on expanded access to preventive services. Making preventive services available for little or no out-of-pocket cost makes it easier for women to do the right thing for their health and put themselves first. As I discussed in my last post, a growing number of women are now eligible to receive contraception and other preventive health services without a co-pay.

Preventive services that are now covered include:

  • Annual well-woman visit
  • Human papillomavirus (HPV) testing
  • Preventive vaccinations including HPV, flu, hepatitis A & B, shingles, and chicken pox
  • Sexually transmitted disease prevention counseling
  • Obesity screening and counseling
  • Smoking cessation
  • Depression screening

The ACA chips away at many of the barriers to access and care that women have faced for years. Here at ACOG, we’re closely monitoring the implementation of the law and will continue to advocate for comprehensive care for the women we serve. I believe this legislation is a major step in the right direction to improving women’s health and improving health outcomes for all Americans.

Check out these links to learn more about ACA and how it will affect you:

Prevention, Wellness, and Comparing Providers (HealthCare.gov)

Benefits for Women and Children of New Affordable Care Act Rules on Expanding Prevention Coverage (HealthCare.gov)

Effective Date: Women’s Preventive Health Coverage Requirements (ACOG)

Barbara S. Levy, MD, is vice president of health policy at ACOG.

Guest Blog: The Co-Pay Question—Contraceptive Access Under the ACA

Barbara S. Levy, MD

Barbara S. Levy, MD

If you’ve been to the pharmacy or doctor’s office lately, there’s a good chance that you noticed something different about your bill—there may not have been one. Depending on what type of insurance you have, you may now be eligible to receive all FDA-approved contraception and other preventive health services without a co-pay. This is due to the Affordable Care Act (ACA), a law with a lofty goal: overhauling our current health care system to provide the majority of Americans with affordable access to health care. While the intricacies of the ACA—and health insurance policies—are complex, it’s important for women to understand these most recent changes because they so specifically apply to us.

Whether or not you still have a co-pay for contraceptives depends on where you get your health insurance. More than half of people in the US get their insurance either through their job or by purchasing an individual insurance plan. Currently, the contraceptive coverage provision applies to most of these private plans. Insurance companies that adopted ACA policy changes early on may have already updated their plans to offer free contraception beginning in August 2012. As time passes, more plans will comply. However, there are some exceptions—some plans have grandfathered status that gives them more time to meet the terms of the new requirements, and some religiously affiliated organizations are currently exempt from providing this coverage.

State Medicaid programs already provide no-cost contraception to enrollees. The ACA expands Medicaid’s reach, potentially decreasing the number of uninsured women ages 19–64 from 20% to 8%. Many states are still hammering out exactly how Medicaid provisions will be implemented. ACOG is following this issue closely and supports the adoption of the ACA’s Medicaid expansion in all states.

So how can you find out whether your plan has changed and what new services are covered? You’ll need to ask a few questions and then update your records to be sure your health care team (you, your insurer, pharmacy, and your doctor) is on the same page:

  • Ask your employer or your health insurer whether the ACA has caused any significant changes to your plan. If so, what are they, and specifically, is contraception now covered without a co-pay?
  • If there are updates to your plan, be sure to notify your pharmacy and your doctor’s office and report any problems to your plan administrator or insurance company. It’s up to you to be sure you’re being charged correctly based on what your policy covers.

As an ob-gyn, I am thrilled by the increased availability of no-cost contraception that the ACA provides. Contraception is a basic health necessity for women. More access puts women in the driver’s seat, helping us avoid unintended pregnancy and take control of our reproductive health.

Learn more about contraceptive coverage and the ACA.

Barbara S. Levy, MD, is vice president of health policy at ACOG.

Guest Blog: Why Expanding Medicaid Matters for Women

Gerald F. Joseph Jr, MD

Many women in the United States do not have health insurance. As a result, they don’t get the health care they need and their health suffers. Compared to women with health insurance, uninsured women are:

* Less likely to receive preventive care or treatment for disease.

* More likely to be diagnosed with cervical and other cancers at a late stage and die from the disease or its complications due to a delay in diagnosis.

* Less likely to get prenatal care during pregnancy. The babies of uninsured women are also more likely to be born with a low birthweight and die within the first year of life.

* Less likely to use a prescription contraceptive, which can lead to unintended pregnancy.

The Affordable Care Act (ACA) can help. It expands Medicaid—the state-federal health insurance program for low-income individuals—which is one of the health care reform provisions that ACOG supports. The percentage of uninsured women ages 19–64 could decrease from 20% to 8%, but this will happen only if all 50 state governors decide to expand their Medicaid programs. ACOG encourages all states to accept this expansion offer, under which the federal government will pay all the costs until 2016. After that, the federal contribution gradually drops, but only to 90% in 2020 and beyond.

The ACA also makes it easier for states to provide Medicaid birth control coverage to low-income women by eliminating bureaucratic red tape.

With Election Day approaching rapidly, I encourage you to find out what the candidates in your state support. Use your vote to make it clear to your state lawmakers that expansion of Medicaid is good for women’s health.

For more information:

Protect Medicaid and Women’s Health

What the Medicaid Eligibility Expansion Means for Women

Medicaid Expansion Resources

Gerald F. Joseph Jr, MD, is ACOG vice president for practice activities.

Health Care Hope for Millions after Supreme Court Ruling

The lead up to the US Supreme Court’s decision on the Affordable Care Act (ACA) has been a bumpy road at best. But beneath all the rhetoric and partisanship surrounding the ACA lies a solemn and unfortunate truth: Too many Americans are uninsured, and lives are being lost because of it. An estimated 18,000 Americans between the ages of 25 and 64 die prematurely each year because they lack health insurance. The uninsured receive less preventive care, disease diagnoses at more advanced stages, and fewer medical interventions post-diagnoses than people with insurance.

The ACA is important and necessary legislation. It helps ensure insurance reforms that guarantee availability and renewability, prohibit preexisting condition exclusions, and prohibit gender rating—insurance reforms that will work best under an individual mandate. Beginning in 2014, the ACA prohibits new insurance plans from denying women coverage on the basis of pregnancy, previous cesarean delivery, history of domestic violence, or other preexisting medical conditions. These protections are landmark improvements in women’s health. The ACA also guarantees women direct access to obstetric and gynecologic care. My own state of Nevada and 42 other states already allow direct access—now, with this new national ob-gyn direct-access standard, all women in every state will no longer face costly and burdensome delays and denials.

Today’s Supreme Court ruling affirming the constitutionality of the ACA is a victory for women indeed. It gives the US Congress the opportunity to act now to improve the legislation to ensure that America’s practicing physicians are able to provide quality health care for all. ACOG supports the many elements of the ACA that have enormous potential to improve women’s health, and we urge all states to act swiftly to implement these important access and coverage guarantees.