The ACA and OTC Medications – What Physicians Need to Know About Changes in Coverage

January 1 has come and gone, but many of us are unaware of some of the changes with the Affordable Care Act, particularly related to coverage of medications and supplements that became effective in 2014. For our patients who are enrolled in ACA-compliant plans, certain over-the-counter (OTC) medications are now covered at no cost when written as a prescription. Translation: Write prescriptions for these medications when medically necessary.

As an example, aspirin is now a covered medication under the ACA for women ages 55–79 when the benefit of reducing heart attacks outweighs the risk of gastrointestinal bleeding. The cost of OTC emergency contraception is also covered if a prescription is written for it. Vitamin D supplements are covered for women ages 65 and older to prevent fractures. And folic acid supplements are covered for women capable of becoming pregnant.

This change in insurance coverage comes at a time when research is looking closely at the benefits of supplements. Certainly all of us are confused at times when related research appears in the media and the benefits of vitamins and supplements are questioned. That’s why we as physicians need to make recommendations to our patients based on their individual needs. This ensures that reproductive-age women don’t forgo important and proven supplements—for instance, folic acid to reduce birth defects like spina bifida—based on a single study.

As physicians, we are in a position to not only recommend, but to reinforce the use of these medications and vitamin supplements for preventive health. It’s up to us health care providers to recommend and prescribe them.

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Guest Post: My Journey to Women’s Health Advocate

E. Christine Brousseau, MD

E. Christine Brousseau, MD

For many years I had no interest in politics. I focused my energy on caring for my patients and my family. My interest in public policy wasn’t cultivated in college, medical school, or at work. Instead, it was born of necessity, groomed by mentors, and became a passion.

In 2010, I was elected the Rhode Island Section vice chair/legislative chair. I was expected to testify at the State House, meet with legislators, and write op-eds. I was invited to ACOG’s Congressional Leadership Conference, which emphasized and trained proper advocacy. Two days into the conference, I met with Rhode Island’s federal lawmakers—alone. I returned home inspired to advocate on behalf of women and women’s health practitioners. Advocacy did not come naturally, but my passion for the issues did.

I was thrilled to be selected as a 2013 McCain Fellow. On my second day, I met with a coalition of lobbyists supporting maternal and childhood health formed to educate Congress on sequestration’s negative effects on families. I was surprised to learn how many bills affect maternal-fetal health. Briefings on the Pregnant Workers Fairness Act and a reproductive rights bill seemed obvious, but the Toxic Substances Control Act hearings were unexpectedly relevant.

I attended numerous meetings with congressional leaders. At one, I sat beside Rep. Tammy Duckworth (D-IL), an Iraq War veteran and one of the first females to fly combat missions in Iraq. During one mission, her helicopter was shot down; she lost both legs and partial use of her arm. When I asked how she handles today’s partisan politics, she replied, “Listen, I’ve been blown up! I think my worst day at the office is behind me.” Rep. Duckworth traces her family’s legacy of military service back to the Revolutionary War. A career in service seemed to be her calling, but she could not have predicted that her greatest service would be in politics, not combat.

Many of my academic and career choices have also been guided by family legacy. My father, Patrick Sweeney, also was a McCain Fellow, something I learned only recently. His dedication to women’s health policy and advocacy led me to practice medicine and has had a tremendous positive influence on countless women. While I never envisioned being involved in politics, advocacy presented me with an opportunity to improve women’s health in Rhode Island and beyond. Like Rep. Duckworth, I will embrace the opportunity with persistence and, hopefully, a sense of humor.

E. Christine Brousseau, MD, is an ob-gyn in Providence, RI and serves as Vice Chair for ACOG’s Rhode Island Section.

Have We Really “Come a Long Way, Baby?”

Fifty years ago, Surgeon General Luther Terry submitted a landmark report linking smoking to illness and death and said the government should do something to curb tobacco use. At the time, a third of American women were regular smokers. Today, the rate is down to 16%.

There was a time when smoking was portrayed as glamorous. Now we know that smoking negatively impacts every body organ and is the leading cause of premature death for adults. Women smokers have greater risks of reproductive health problems, many forms of gynecological and other cancers, heart disease, chronic obstructive lung disease, and osteoporosis. Quitting smoking is one of the most important things a pregnant woman can do for her and her baby’s health.

There are a number of effective methods to help our patients stop smoking, and we should be as familiar with them as we are with methods of birth control. These include using the 5 As (Ask, Assess, Advise, Assist, and Arrange follow-up), referring patients to the smokers’ quit line (1-800-Quit Now), and prescribing therapy to ease nicotine withdrawal. Nicotine replacement and medication improve the chances for sustained smoking cessation in non-pregnant women by 20–36%.

Of course, ACOG has several great tools and resources to help ob-gyns and their practices address tobacco use.

So, yes, we have come a long way toward reducing women’s smoking, but we can’t stop now. We need to continue making it a priority to counsel our patients about the health hazards of smoking and offer them help in quitting. And we can have an impact in our communities by promoting hefty taxation on tobacco products and supporting clean air legislation.

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A Call to Action for Increased Funding for Endometriosis

An estimated 176 million women and girls throughout the world are affected by endometriosis, according to the World Endometriosis Society. I’m pleased to announce that ACOG, ASRM, and other organizations are co-sponsoring the worldwide Million Woman March for Endometriosis to raise awareness and advocate for increased funding for this common and often painful gynecologic condition. We believe that an internationally-coordinated campaign is absolutely necessary to effect change. So on March 13, we’ll be marching on the National Mall in Washington, DC, while similar events take place throughout the world.

Endometriosis affects 6–10% of all reproductive-age women. It’s a leading cause of chronic pelvic pain and a common cause of infertility. Unfortunately, we still don’t know what causes it. And the treatments that we have, while helpful, are not curative. According to the Endometriosis Foundation of America and the World Endometriosis Research Foundation, the health care costs of endometriosis are estimated to be $70–95 billion each year in the US alone. Although this is comparable to other chronic diseases, two-thirds of these costs are due to loss of productivity at work.

Our campaign goals include:

  • Empowering women and teens by encouraging them to unite with their supporters to take a stand against endometriosis.
  • Raising awareness about endometriosis and its effects on women and girls.
  • Educating and training the medical community to promote early detection and improved treatment.
  • Finding a cure for endometriosis and developing non-invasive diagnostic tests.
  • Working with Congress to allocate funding for endometriosis.

We won’t be marching alone in March. Awareness campaigns also will be occurring in dozens of capitals around the world—Amsterdam, Belfast, Berlin, Brasilia, Buenos Aires, Copenhagen, Dublin, Helsinki, Kingston, Lisbon, London, Madrid, Oslo, Reykjavik, Rome, and Stockholm, to name just a few.

Throughout my presidential term, I have advocated for well-woman health care and prevention. Wouldn’t it be wonderful to one day have endometriosis on the list of “preventable” conditions? That will only happen when our research discovers the cause.

Please plan to join us in Washington, DC, on March 13. For more information about supporting the Million Woman March for Endometriosis, go to www.millionwomanmarch2014.org.

Resource: Endometriosis Fact Sheet (PDF)

Vaccine Safety Facts: Overcoming the Hype

It’s National Influenza Vaccination Week, a time for ob-gyns and health professionals to encourage the annual flu vaccine for everyone 6 months and older, including pregnant women. We’ve all seen the numbers on the many millions of lives that have been saved by the flu vaccine and other vaccinations. Vaccines have been a major public health triumph. In fact, they have been so successful that the average American has fortunately never personally seen a single case of polio or even measles, diseases that were commonplace and often deadly not so long ago. So getting everyone vaccinated should be easy, right?

Yet, we sometimes encounter resistance from our patients who may have heard myths and inaccuracies about vaccines. That’s especially true when vaccine safety has been in the news, as it’s been over the past few weeks, this time related to the HPV vaccine. While this type of sensational media coverage can be frustrating, we must focus on our role as health care providers to be the experts, to dispel the myths, and to provide the facts.

How can we overcome the vaccine hype? By sharing these and other key vaccine facts with our patients, consistently and regularly:

Vaccine Facts

Fact: More than 100 million diseases have been prevented because of vaccinations in the US alone.

Fact: Vaccines are safe. Extensive research has found no link between vaccines and autism or other serious health conditions.

HPV Vaccine Facts

Fact: The HPV vaccine is safe.

Fact: The HPV vaccine is nearly 100% effective in preventing cervical cancer caused by certain HPV strains.

Flu Vaccine Facts

Fact: Getting the flu vaccine does not cause the flu.

Fact: It’s safe for pregnant women to get the flu vaccine.

As ob-gyns, we are in a unique position to educate women about the facts on vaccines. Together with our patients, we can be more effective than the hype of an uninformed or misguided spokespeople who knowingly or unknowingly undermines the value of vaccines. The overwhelming evidence is clear—vaccines are safe and effective, and we need to take every opportunity to communicate these facts to our patients.

For more information on immunizations, go to www.immunizationforwomen.org.

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HIV Screening Should Be Routine

This past Sunday marked World AIDS Day. The truth is every day is a good day for us to encourage our patients to know their HIV status and to educate women on ways to reduce their risk of infection.

Some facts: According to the Centers for Disease Control and Prevention, women account for 20% of all new HIV infections each year. Most women with HIV (84%) are infected through heterosexual sex. The remaining women acquire HIV through intravenous drug use. Of the more than 1.1 million Americans living with HIV today, almost 24% of them are women. Unfortunately, women of color, particularly African-American women, continue to be disproportionately impacted by HIV and AIDS. Even though black women make up only 13% of the total US population, they account for 64% of all new infections each year.

A few years ago, many physicians probably screened patients for HIV only if they were high risk, were pregnant, or requested the test. Today, I believe that is changing. ACOG’s guidelines issued in 2008 recommend that ob-gyns routinely screen all our patients between the ages of 19 and 64 for HIV, regardless of their individual risk factors. Sexually active women younger than age 19 and women older than 64 who have had multiple partners in recent years should also be tested.

A lot of progress has been made in the fight against HIV/AIDS, but we haven’t won the war yet. Approximately one-quarter of Americans who have HIV don’t know it. The best defense our patients have is knowing their HIV status. Women who know that they are HIV-positive can take steps to reduce HIV-related illnesses, avoid unintended pregnancy, and protect their sexual partners from infection. Another benefit is that pregnant women who know their status can greatly reduce the risk of mother-to-child transmission of HIV (to less than 2%) by taking antiretroviral therapy.

My hope is that as more women gain health insurance coverage under the Affordable Care Act, more of them will get tested for HIV and receive appropriate health care. Getting more people tested and receiving treatment for HIV will go a long way in preventing new infections. As ob-gyns, we must increase our efforts to routinely screen all our patients for HIV, particularly in areas where HIV infection rates are highest.

A Week of Thanks, A Year of Thanks, A Life of Thanks…

We have some special holidays in the United States, and Thanksgiving is one of my favorites. I know I should give thanks for a wonderful life every day, but sometimes I don’t take the time. So let me take a moment now to share some of the many things for which I’m grateful.

As ACOG President, I am thankful for the Fellowship of physicians who devote their lives to women’s health by providing exceptional care and by sacrificing their personal lives for their patients’ care. We are a profession of givers. We are there to hold the hand of a patient with a life-threatening illness and to hand a newborn into the arms of a loving family. We teach and mentor, we laugh and cry—with friends, colleagues, and our patients.

I am thankful for the past six months in my role as ACOG President. I have been given the enormous opportunity to represent our Fellows before Congress, across the country at our regional meetings, and with our colleagues from around the world. This week ACOG hosted the leaders from the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the United Kingdom’s Royal College of Obstetricians and Gynaecologists (RCOG). We discussed our shared goals and promised to do much more together.

As one can only imagine, we all face many of the same dilemmas. Even in health care systems as diverse as the US fee-for-service environment to the United Kingdom’s National Health Service, we appreciate the common threads. Each of our organizations is developing systems to provide ob-gyns with the best guidance for delivering health care. Each of us is deliberating changes in our workforce, and we are devoted to improving patient care within our own country and abroad. We can do so much more as we collaborate.

So this week I give thanks to the wonderful organizations of ACOG, SOGC, and RCOG, and their great leaders. And I’m thankful for each of you, our Fellows, my blog readers. What are you thankful for?

Wishing each of you a Happy Thanksgiving.

Guest Blog: Connecting with Social Media—The Doctor Will Tweet You Now

Meadow M. Good, DO

Meadow M. Good, DO

As an ob-gyn and active user of social media, I enjoy being able to connect online with friends, family, and colleagues. Turns out, I’m in good company: Nearly all physicians in the US are now on social media, and more and more of us are using social for professional purposes.

Social media opens up an exciting new world for physicians and health professionals: Sharing important health messages with the community, promoting your practice and services, or communicating with colleagues via professional social networks, to name a few.  And the medium is great for relaying information quickly and easily: With the touch of your finger, you can relay a message or post an image about anything to a few people or the entire world, and we can truly make a difference with social media.

With the great possibilities and benefits of social media also comes caution for those of us in the medical community. Instantaneous access to information is great, except when it’s information that may be misinterpreted, misunderstood, or may contain inappropriate or unprofessional expressions or images. It can result in health professionals being seen as insensitive and unprofessional, and even more seriously, violate privacy law and HIPAA.

OK, but you’re thinking—I would never post anything inappropriate, and this doesn’t happen very often anyway, does it? Unfortunately, there are more and more online incidents like the above examples involving health professionals. A recent survey of state medical boards revealed some surprises about professional violations: About 92% reported at least one online violation that led to major actions such as license revocation, and the problems occurred across every age and demographic group.

The offending examples of what caused the problems may also surprise you. One ob-gyn was scrutinized for venting her frustrations online about patients’ tardiness.  A patient is suing an anesthesiologist who put stickers on her face, and the nurse shared it on social media. Posts such as these have caused strained relationships, public complaints, and led to disciplinary action from employers, medical boards, and judges.

As health professionals, we need to harness the power of social media while avoiding the issues and risks. To help make this possible, ACOG has developed a Social Media Guide, including some do’s and don’ts of posting. There’s also a short video that I produced with my colleagues from the ACOG Junior Fellow Congress Advisory Council, which shows the type of behavior to avoid—including how humor online may be misconstrued and taken out of context.

Here are five of my essential tips to ensure social media professionalism for health professionals:

  1. Pause before you post.
  2. When in doubt, leave it out.
  3. Avoid posting pictures from your personal life that could be misunderstood when viewed in a professional context. This might include pictures involving alcohol (including alcoholic glasses, cups, or bottles); tobacco/smoking, being intoxicated or using other substances; or pictures of you or others in suggestive or provocative attire such as bathing suits.
  4. Avoid posting about specific situations related to your work or a patient, even if you’re not identifying anyone in particular.
  5. Remember that it’s easy for your personal life and professional life to blend together online, so avoid personal expressions of anger, grief or venting online.

What are your favorite tips on social media for health professionals? I believe that it’s our responsibility to help each other learn how to use social media to interact with our colleagues and patients. As the medical and technology fields continue to change rapidly, it’s important for health professionals to share critical medical knowledge that the public depends on to make sound medical decisions. We have an opportunity to provide medical facts and advice, and the public wants to hear from us.

Meadow M. Good, DO, is chair of ACOG’s Junior Fellow Congress Advisory Council. You can follow her on Twitter @MeadowGood.

Men’s Health Matters to Ob-Gyns

“Movember.” That’s the subject line of a recent email that landed in my inbox.

Movember?

My first reaction was that this was a misspelling. Then I thought, what the heck is that? It turns out that my male ob-gyn colleagues have decided to draw attention to men’s health by shaving their mustaches and beards at the start of the month. They’re having a contest to judge who grows the best mustache and beard by month’s end, all in the spirit of men’s health. Why? They want to ‘change the face’ of men’s health through awareness and education.

Launched in 2003 in Australia, Movember is now a global effort in which men grow a “Mo” (moustache) for 30 days during the month of November in an effort to raise awareness about men’s health.

What better way to raise awareness of men’s health than through ob-gyns? After all, we know that women tend to make health care decisions for the family, and often a woman is the one to bring (or drag!) her partner or parent in to the doctor for care. Perhaps if we share some men’s health statistics with our patients, the messages will reach more men. Movember has certainly created a buzz around my entire department, and often that “buzzzzzz” is the key to messaging.

Here are some key messages about men’s health to consider (from the us.movember.com website):

  • 24% of men are less likely to go to the doctor compared with women.
  • 1 in 6 men will be diagnosed with prostate cancer in his lifetime. In 2013, more than 238,000 new cases of the disease will be diagnosed and almost 30,000 men will die from it.
  • Testicular cancer is the most common cancer in males between the ages of 15 and 35. In 2013, 7,920 men will be diagnosed with testicular cancer and 370 will die from it.
  • 1 in 13 men will be diagnosed with lung cancer in his lifetime.
  • While not common, men can get breast cancer. About 2,240 new cases of breast cancer will be diagnosed among men and about 410 will die from it in 2013.
  • An estimated 13 million men, or 11.8% of all men over the age of 20, have diabetes.
  • More than 6 million men are diagnosed with depression each year. Almost four times as many males as females die by suicide each year.

As arguments continue around the Affordable Care Act, my message remains consistent: Prevention matters. We need to do everything we can to make healthy lifestyle choices for ourselves and our families. Regardless of whether it’s a male or a female, whether it’s prenatal care for a woman or aneurysm screening for a man—preventive health care is an investment in this AND future generations. Preventive health care is something we should all support.

Lessons From Our Ob-Gyn Colleagues in Mexico

Last week, I had the wonderful opportunity to take part in The Federacion Mexicano de Colegios de Obstetricia y Ginegologia (FEMECOG) meeting in Mexico City. The outstanding program provided the most up-to-date discussions on all aspects of women’s health to about 4,000 of Mexico’s 14,000 ob-gyns. Imagine if ACOG was able to share cutting-edge information with 30 percent of our Fellows at one meeting.

Our own Dr. James Martin, former ACOG President, was a bit of a ‘rock star’ as he delivered seven different lectures on preeclampsia. He was surrounded by physicians afterward asking for photographs with him! The variety of lectures at this meeting was impressive—and certainly challenged my understanding of Spanish. Our hosts—from outgoing FEMECOG President, Dr. Jose Montoya, to the newly elected FEMECOG President Ernesto Castelazo, and his spouse, Gabriela—made every moment enjoyable. ACOG Mexico Section Chair, Dr. Francisco Ruiloba, and his spouse, Gabriela, attended to every detail during our stay in Mexico City.

One of the best discussions we had was about medical student and residency training in image (2)Mexico. Students there have four years of medical school, followed by a one-year internship that is required before medical school completion. Every student from each of the almost 80 medical schools must complete one year of public service to underserved populations in Mexico City or in the deepest jungles of Mexico.

Our hosts, Felipe Gonzalez and Maru Morales, discussed their concern when their eldest daughter, Sofia, accepted her public service assignment in Santa Cruz, Huamuxtitlan, in Guerrero, one of Mexico’s most remote locations. No one was willing to serve there the year before. I can only imagine leaving my daughter in a remote valley for a year of service.

Sofia says her time in Santa Cruz was one of the best and most important years of her life. In fact, Sofia thrived as she provided primary care to the 1,000 local inhabitants of the surrounding countryside. She said she learned self-reliance and independence. She saw 40 patients a day because she was one of only a handful of physicians in the surrounding towns. About 45 minutes away from her was a support clinic to handle deliveries and advanced emergency care.

image_7Sofia treated patients with diabetes and hypertension, but she also gave hope to so many in other ways. She started exercise classes in the town square (Zumba in the plaza!) to emphasize healthy lifestyle choices for everyone. She talked friends, colleagues, and a university into donating computers because there were none in town. The computer center near the town kiosk is now named the ‘Dr. Sophia Gonzalez Center.’ At her graduation, Sophia was the first recipient of her university’s newly established “Best Social Service Award.”

I also had an opportunity to discuss the desire of ob-gyn residents in Mexico to work with ACOG through our Junior Fellow programs. ACOG’s programs are inspiring the many ob-gyn residents throughout Mexico to want to exchange skills and interests with ob-gyn residents here in the US. What better opportunity than to develop exchange programs so that we can foster mutual respect, understanding, and knowledge from our diverse programs.

As we look closely at our health care system, it’s clear that we have much to learn from other countries. Most of us enter medicine with an interest in serving others, but we have never had a system dedicated to achieving such lofty goals. Although many academic programs have a global presence, often we can achieve more by collaborating closely with our ob-gyn colleagues in other countries.

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