Inside this issue:

State Law Changes

Confidential Path to Recovery

Ohio Department of Health Update

The Spread of Syphilis in Stark County

and more…

Click here:  SCMS News Spring 2017

● 32-pages inside the July Health & Wellness issue of About, reaching 35,000 households
in Stark County, w/overrun of book-only for your membership distribution.
●  Piece prints June 2.

● ~35,000 copies included as a special section inside the July issue of About magazine,
reaching a combination of subscribers to About and The Canton Repository.
● 1,000 copies to be distributed by SCMS.

For complete details click here: Stark Medical Society 2017-18 Rate Card

Rotary Club of Canton Semi-Annual
Health Screen & Wellness Fair!
Saturday,
Apr. 29, 2017
7 a.m. – 11 a.m.
Mercy Hall Auditorium, 1320 Mercy Drive NW, Canton, Ohio 44708

For more information, click here:  RotaryWellnessScreenFlyer 4-29-17

I had just finishing my evaluation of a potentially problematic patient. Ben (not his real name), a 52yo 2 pack per day cigarette smoker, had presented with a mass in his throat which was, unless proven otherwise, most likely cancer. He was scheduled to undergo a biopsy procedure to obtain a definitive diagnosis and I was formulating an anesthesia management plan. Coincidentally, I had just read a blog on KevinMD entitled “Who coordinates patient care? Maybe no one.”¹ Then I was presented with the answer to that question for cancer patients treated at our institution.

A diminutive woman was standing in the doorway in polite deference while I completed my preoperative assessment. Once I told her that I had finished she took control of the situation with a no-nonsense demeanor that instantly spoke of competence and engendered confidence. She directly stated that the mass in Ben’s throat appeared to be cancer and that the biopsy would determine whether or not that was the case. She informed him that this was the beginning of a process and that she would be helping to guide him and his family through that process. She assured him that he was “not alone” and that she would be with him “at every step of the way!”

I was so impressed with Candace (another alias) that I reached out afterwards to learn more about her. In the years since her graduation with a Bachelor of Science degree in Nursing she has worked solely with cancer patients. She has cared for patients in both inpatient and outpatient settings. In addition she has participated in clinical trials that research innovative cancer treatment regimens. So she brings a tremendous wealth of knowledge to her approach to cancer patients.

She believes that the paramount strategy begins with an attempt to “take the fear out” of the experience. Most if not all of her patients are “scared to death”. Her goal is to let them know what to expect because she believes that knowledge is the key to their surviving the experience successfully. Once the biopsy confirms the diagnosis as cancer the treatment process begins. It is a complicated journey that includes enduring numerous consultations with many different doctors, and submission to a multitude of lab tests and imaging procedures. It may also include undergoing one or more surgical procedures as well as chemotherapy and radiation therapy. Through this maze Candace is the one constant link. She communicates among the various providers so that all involved in a particular patient’s case are up to speed as to what has been their respective input into the patient’s care as well as that patient’s progress. In addition, she addresses the multiple concerns of the patients and their families. Not only does she act as an interpreter, explaining the often complex nature of cancer therapy, but she also helps deal with what she terms as “barriers to treatment”. These are such practical issues as “transportation to the numerous appointments, securing a babysitter, or paying bills”.

Providing such comprehensive care is wrought with frustrations. Among the most vexing issues are the various “hoops” that she has to “jump through”. These include the fact that Medicare and other payers do not provide transportation to and from appointments. But perhaps the most frustrating “hoop” is the specter of prior authorization. This is the process by which approval is sought from an insurer to perform a certain diagnostic or therapeutic procedure or provide medication. Without prior authorization, payments for these services are withheld. This approval is too often illusive and the decisions are seemingly arbitrary and the approval, when obtained, can be revoked retroactively.

This emotionally and professionally taxing job can lead to exhaustion and “burnout” among its providers. Candace was quick to provide the answer to the question, “Why am I doing this?” The answer is “staring her right in the face”. It is the gratitude that she sees in the faces of her patients and their families. It is appreciation that is well deserved!

1. kevinmd.com/blog/2017/01/coordinates-patient-care-maybe-no-one.html

2017 OHIO DIVERSITY AND INCLUSION CONFERENCE

Access & Equity:  Intersections in Education and Health

April 21, 2017

8:00 a.m. – 4:15 p.m.

Venue: Stark State College

The Gateway Center

6200 Frank Avenue

For more details click here: Conference flier 2017 FINAL

I was struck by the incongruity in GOP policy with regard to the “repeal and replace” of the Affordable Care Act (ACA), the defunding of Planned Parenthood and the opportunity for economic advancement for those who have felt left behind. A major obstacle for young people to overcome is early pregnancy. The major portion of services (80%) provided by Planned Parenthood are for prevention of unwanted pregnancies¹. Of the 2.5 million visits to their clinics 84% of the men and women served are 20 years old or older and 1 in 5 women have been served in those same clinics at least once in their lifetimes¹. So the defunding of Planned Parenthood is a move that jeopardizes those services and insofar as part of the legislation against the ACA involves a rollback of the expansion of Medicaid GOP policy is about to deliver a “double whammy” to the systems that provides birth control services to the most vulnerable women in the country.

To thrive in this economy one needs marketable skills. The skills that are most marketable require highly technical training. Having the responsibility of child rearing presents an almost insurmountable burden for many poor women and men, especially the mothers. At the website babycenter.com the “cost of raising a child calculator” computes that raising a child to 18 years costs $164,160². So the likelihood of achieving self- sufficiency is greatly increased by avoiding early unwanted pregnancy.  It seems that GOP policy against the ACA is inconsistent with their purported policy to address economic inequality.

Single mothers are usually young and are members of communities where having a baby is viewed as normal. The relationships from which their pregnancies result are not stable and the parents soon drift apart. In doing so they find new partners and new offspring result. Research has shown that a majority of children (60%)³ have a half-sibling at birth and an even larger majority by age 5 (70%)³. Thus is the manner by which single-parent families are made and the mothers are by far the predominant heads-of-households in these families. And single-parent families and income inequality are intimately linked.

Mothers as heads-of-households are at a disadvantage in the job market. As a consequence their families are disadvantaged with respect to economic status, health care, and housing conditions¹. Furthermore the reduced resources that plague single-parent families lead to lower educational attainment in many of their children. In fact, teens from single-parent families tend to leave school earlier than their counterparts from two-parent families. This is a situation that tends to perpetuate a cycle of poverty which has led to the development of a permanent underclass.

So it seems to me that part of the strategies that should be put in place to address income inequality should include policies intended to reduce unplanned and unwanted pregnancies. Policies that support and promote reproductive education, life skills counseling, better contraception, as well as delayed sexual activity are some of the approaches that can be utilized to reduce the problems encountered by single-parent families. As the GOP proceeds with the “repeal and replace” of the ACA and the defunding of Planned Parenthood they would do well to consider the effects that these actions will have on at-risk populations.

Click here to review SMCS News:  november-december-2016

Dr. Tom Price, the 6 term Representative from the suburban Atlanta 6^th Congressional District is a veteran health-care policy maven. He is well versed in all aspects of health care and has been a vocal critic of the Affordable Care Act (ACA). He has produced a comprehensive GOP alternative in the form of the 242 page “Empowering Patients First” Act. Among his proposals are tax credits to purchase health insurance based on age rather than income as well as tax credit incentives to opt out of Medicare and Medicaid in favor of private insurance. He has also proposed expansion of Health Savings Accounts (HSA) as well as allowing interstate health insurance sales.¹

Dr. Price voted in favor of the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) which enjoyed support from the AMA. However he has been critical of both the Center for Medicare and Medicaid Services and the Center for Medicare and Medicaid Innovation. His major objection was the requirement that doctors and hospital participate in bundled payment models. He has been very vocal in his concern that the revamped payment models amount to a hostile take-over of clinical decision-making as well as possible detrimental effects on the doctor-patient relationship.²

As the GOP uses its control of both the legislative and executive branches of government to supplant the ACA, it is Dr. Price will be the head of the agency that will write the regulations that will enable the changes that will take place. It will be very interesting to see how things develop.

1. marketplace.com/story/what-to-expect-from-tomprice-president-elect-trumps-pick-for-hhs-secretary-2016-11-29
2. forbes.com/sites/brucejapsen/2016/11/29/as-trumps-tom-price-could-slow-shift-to-value-care/2/#1ea0e7cf7116