Thursday, September 25, 2014

Flu Shot Clinic at ASHA October 8

If 92% of our staff are vaccinated, we could basically stop the spread of the flu within our workplace. Please consider getting a flu shot to protect yourself and those around you. 

Our clinic will be held on October 8 from 10:00 - 1:00. Shots for staff members are free and come complete with a Tootsie Pop. Family members can receive a shot for $26. This flyer from LifeWork Strategies explains what you should expect.

If you have coverage through our health plan, you have additional options for obtaining a flu vaccination for free. Please see the second flyer below.

Sunday, September 21, 2014

How to Be the CEO of Your Health

Rources for Empowered Patients

Last week, we had the good fortune of having Dr. Michelle Gourdine come talk to the ASHA staff. She delivered a presentation titled You're the Boss: How to be the CEO of Your Health. Dr. Gourdine is a physician and CEO of Michelle Gourdine and Associates. She is a Clinical Assistant Professor in the Departments of Epidemiology and Preventive Medicine and Pediatrics at the University of Maryland School of Medicine, and a Senior Associate in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. She served as Deputy Secretary for Public Health Services for the Maryland Department of Health and Mental Hygiene (DHMH) from 2005 - 2008. So, she knows both the medical and policy sides of health care. She is a nationally-sought-after speaker and author of the book, Reclaiming Our Health:  A Guide to African American Wellness. We have a few copies in HR if you're interested in checking it out.

She began by showing us slides that demonstrate how we spend too much on healthcare in the US and get results that pale in comparison to other countries. (The one to the left was my favorite.) She pointed out that chronic disease is driving a lot of our spending and that there is an inverse relationship to what we spend to improve our health and what really makes us healthier. She stressed that 90% of Type 2 diabetes, 80% of heart disease and 60% of all cancers can be prevented by basic healthy lifestyle choices. People manage their health through day-to-day decisions. She suggested we start by asking ourselves these questions.

She shared some practical approaches for accomplishing each and added a 5.1 How well am I managing my stress? She also mentioned the importance getting 7 to 9 hours of sleep each night. You can see her recommendations by flipping through the slide show below. I also recommend reading Eat, Move, Sleep by Tom Rath. It's full of compelling reasons to do all of the above and practical tips that will improve your health.

Dr. Gourdine moved on with tips to help us get the most out of relationship with our doctors. She recommended that we ask these five questions any time a doctor recommends that we take a medication or have a test or procedure.

She explained when seeking a second opinion is valuable and outlined which screenings she recommends. It seems these recommendations are changing all the time and I was grateful that she outlined everything clearly. She cautioned against chasing test results rather than treating a patient and cited The $50,000 Physical that was in JAMA last June as a cautionary tale. 

Here are her screening recommendations:
  • Blood pressure check every 2 years…more frequent if high 
  • Cholesterol test every 5 years 
  • Diabetes test every 3 years 
  • Colonoscopy every 10 years starting at age 50 
  • Dental exam and cleaning yearly 
  • Eye exam every 1 to 3 years 
  • Height, weight, BMI every year or 2 
  • Flu shot yearly 
  • Tetanus booster every 10 years 
  • Prostate cancer screening and PSA -- Discuss with provider starting at age 50…age 45 if African American 
  • Annual lung cancer screening (low dose CT scan) for smokers 55 – 80 with: 30 pack year smoking history AND currently smoke or have quit within past 15 years
  • Mammogram every 2 years starting at age 50
  • Pap smear (and HPV) -- Every 3 years starting at age 21 and every 5 years starting at age 40
She also shared 5 resources for empowered patients:
Again, I recommend flipping through the presentation and don't forget to mark your calendar for October 16 at 1:00 when Dr. Gourdine will be back. She'll be talking to us about where to seek care. 

Thursday, September 4, 2014

How Much Does a Screening Colonoscopy Really Cost?

Screening colonoscopies are included in the preventive care benefits mandated by the ACA and they're supposed to be covered without any patient cost-sharing, but are they really free?

You turn 50 and before the candles on your cake have stopped smoking your loved ones start talking to you about getting a colonoscopy. My husband, Patrick, finally gave in and scheduled his last month. I read that one of the reasons people don't get a screening colonoscopy when they turn 50 is the hassle of dealing with the insurance coverage, so I figured I'd write about his experience. I didn't expect it to cost us anything because screening colonoscopies are included in the preventive care benefits mandated by the ACA and they're supposed to be covered without any patient cost-sharing. I was surprised when that wasn't quite how it played out. Here's a breakdown of the bills. (We have ASHA's high-deductible plan, Choice Plus with HSA.)

When the ACA first required health plans to cover preventive services, consumers encountered problems when a polyp was discovered during the procedure. The doctor would, of course, remove the polyp, but even if it was benign, they would no longer bill the procedure as preventive. The government came out with a clarification that included treatment being done at the same time or "integral to the procedure" and specifically cited removal of a polyp, so this shouldn't be an issue for you. Just confirm that the provider will be billing the procedure with a preventive care code. 

Unfortunately, that's as far as the government's clarification went and I've run into a surprising interpretation from UHC. They are saying the initial consultation with the gastroenterologist and the prep kit are NOT integral to the procedure. Therefore, the services are subject to the deductible or the copays dictated by your plan. (Baffling, I know. I'll continue to look into it.)

Another common problem is winding up with a anesthesiologist that is out-of-network. This happened to Patrick, but the claims were reprocessed with one phone call to UHC. After that was done, I called the anesthesiologists office and, without my even making the request, they told me they'd written off the balance. In some instances, you may have to write a letter of appeal. ASHA staff can contact Health Advocate and they will write the appeal for you.

All in all, the screening cost us $209 and the money ASHA contributed to our HSA ($2,000) more than covered it. I compared notes with a colleague that has our Choice Plus PPO. She paid a $15 copay for the office visit and $25 for the prep kit for a grand total of $40. 

I'm a bit of a skeptic when it comes to some screenings, but it is widely believed that preventive colonoscopies detect and prevent colorectal cancer. Colorectal cancer is the second leading cause of cancer death in the U.S. and the third most common cancer in men and women. Gastroenterologists actually remove precancerous polyps and small cancers during a screening colonoscopy. The number of deaths from colon cancer could be reduced if more people were screened. Listen to your loved ones and set aside the money whether it's $40 or $200 to take care of yourself.

Related reading: