Every Woman, Every Time…Cada Mujer, Cada Vez

What a difference a year makes. It was only a year ago that I said 2013 was “The Year of the Woman” and asked ob-gyns around the nation to lead efforts on behalf of women’s health. We saw a rocky start to the Affordable Care Act, yet as ob-gyns we have appreciated that so much of what we value for our patients is now considered a health benefit:  cervical and breast cancer screening, preconception health, maternity care.

The challenge in front of us is to provide care, lead change efforts in our hospitals and communities, and sustain our practices. At times it is daunting. This last year, we heard your concerns and worked on your behalf to improve our care delivery, to empower safety efforts, and to challenge those who fight reproductive health access, payment reforms and medical liability reform. We have worked hard to keep legislators out of our exam rooms!

A year ago I introduced a mantra that reinforces all that we hold dear: Every Woman, Every Time. For every woman, at every encounter in our health care delivery system, we need to help her achieve optimal health and wellness in the context of reproductive choices. This year has seen uncertainty and changes in health care delivery. I challenged all of us as ACOG Fellows to take the lead, because the changes in medicine will come at a cost that requires each and every one of us to foster change and collaboration.

No longer can we sit back and let change happen. Rather, we need to direct the changes, to lead the transformation that places women first. Only if we place the focus on quality, on service and on attaining health care access for all women will our practices—and our skills—flourish. By making women our focus, we will succeed. This past year, ACOG led a well-woman task force, to achieve consistency in well-woman care across all medical providers. We have opportunities to share with colleagues in internal medicine, pediatrics and family practice, and with our partners who are nurse midwives and nurse practitioners, in all aspects of well-woman care.

It has been an honor to represent the most wonderful specialty, both here and abroad. ACOG has a strong voice—in the halls of Congress, amongst our colleagues across the US, and amongst our sister organizations around the world. We are leaders.

ACOG relies on the work of all our Fellows. I thank each and every one of you for the gift of this year, to represent women, to represent Fellows, to represent ACOG

For Every Woman, Every Time.

Behind Many Olympic Champions Stands a Mom

I confess: I am an Olympics junkie. In 2012, I had the good fortune to spend two weeks in London for the Summer Olympics. Now, I’m getting ready to watch the Winter Games. I say I’m a junkie because I watch anything and everything leading up to the Olympics, and then I watch any event I can. Luge—wow! Snowboarding—so cool. And there’s curling, of course. And ice skating, downhill skiing, hockey, and speed skating. I love them all!

Now why would I mention this personal passion in my blog? Because of the moms. I enjoy the commercials that highlight the sacrifices of athletes—the arduous practice, the long journey, and living away from home are just a few of them. Then, the athletes acknowledge that it was their mothers who helped them succeed. Well, of course.

As we celebrate the Olympic Games, let’s remember that caring for all moms is our investment in the next generation. Optimum health does not happen by accident. Just as their child’s Olympic success depends on maintaining healthy lifestyle choices, including proper nutrition, avoiding tobacco and alcohol, and getting enough sleep, so, too, do moms need to make their own health a priority.

The Affordable Care Act ensures that moms—indeed all women—are covered for annual well-woman preventive health care with no co-pays or deductibles. Annual well-woman visits are important to help keep mothers healthy and strong so that they can raise healthy children. It’s all full circle!

So, let’s take a minute to applaud these mothers and remind all women that their children’s health begins with them. Here’s to the Olympics, to athletes, and to moms everywhere.

 

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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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.

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.

New Contraception Counseling Aid Available for Ob-Gyns

As I said in my presidential address at the Annual Clinical Meeting in May, we need to address reproductive health and well-woman care at every single point of contact that women have in our health care system. If we are going to be successful in reducing the high rates of unplanned pregnancies in this country and all of the related maternal and infant health problems that go along with them, then we really only have one option: We must counsel and encourage all of our patients to use effective contraception.

The good news is that more women will have health insurance as the Affordable Care Act continues its roll-out. And under the ACA, more good news: Women now have access to all FDA-approved contraceptives without a co-pay. Coinciding with this, a new ACOG Committee Opinion in the November Obstetrics & Gynecology endorses the CDC’s US Selected Practice Recommendations for Contraceptive Use, 2013 (US SPR). The US SPR helps ob-gyns and other providers counsel our patients about how to use these contraceptives most effectively. This is a companion piece to the US Medical Eligibility Criteria for Contraceptive Use, 2010 (US MEC) that ACOG endorsed in a 2011 Committee Opinion. The US MEC provides guidance for determining which contraceptives are safe for women who have certain medical conditions.

The US SPR is arranged by contraceptive method and is easy to follow. It addresses a host of common as well as complicated issues related to contraceptive use that both doctors and patients may encounter. For instance, it provides guidance on which specific exams and tests we need to provide before prescribing a particular contraceptive method. It helps us advise our patients about exactly what do when they forget to take their daily birth control pill or are late in returning for their next injectable contraceptive. It also explains how to deal with side effects, such as breakthrough bleeding, and when and for how long to use backup contraception.

I think one of the many important points contained in the US SPR is that any contraceptive method can be started at any time during the menstrual cycle, as long as there is reasonable certainty that a woman is not pregnant.

I encourage you to read through and utilize both the US SPR and the US MEC. An eBook for the US SPR will be available soon. As I said at the ACM: Whether it’s a pill, patch, ring, injection, implant, insertable, or a ligation, we can address reproductive health for what it represents—an investment in our future.

Every Woman, Every Time. It’s up to us.

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ACOG and ACA: Investing in Women’s Health

As many of you know, I started my ACOG presidency announcing 2013 as “The Year of the Woman” because for the first time we, as a nation, are investing in women’s health care with the Affordable Care Act. It is an investment in our future when we provide all women with preconception care, prenatal care, and contraception.

I spent last week in Washington, DC, discussing the impact of environmental chemicals on our reproductive health with our elected officials. And what a week it was! I saw firsthand the dedication of the furloughed employees who were trying to help everyone. I heard the frustration of many DC residents as they faced reduced work hours and uncertainty about what the next day or week will bring.

Amidst all of this chaos, the ACA’s health insurance exchanges opened for business. Yes, there are going to be some difficulties along the road with implementing health care reform, but there will be fewer of them when we work together to make health care changes a success.

I was in the hair salon recently and found out that the women working there had no health coverage. I opened my iPad and showed them how to enroll in Covered California. In no time, they logged in, found affordable benefits, and were singing its praises. These are working women who had gone without coverage because they could not afford it and their small businesses did not provide health benefits. All of these women—some young, some single moms—all shared one uncertainty: What would they do if they became sick? They had not even considered getting preventive health care.

We need our government to open for business, we need to work on our health care delivery system, and we need to remind everyone that women are finally getting what we said is essential all along: Screening for cervical and breast cancer, screening for intimate partner violence and depression, contraception coverage, and prenatal care. Worrying about not being able to afford or even get health insurance because of a pre-existing condition can now be a thing of the past. Losing your health insurance coverage during the course of a difficult disease when you need it the most can also be a worry of the past. What a wonderful year!

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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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