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.

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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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.