Wednesday, May 23, 2012

Late-stage diagnosis galvanizes patient's advocacy for early detection

Colon Cancer: A Patient's Story

Trish Simon, who received her colon cancer diagnosis after giving birth at age 32, did not fit the textbook profile of a colorectal cancer patient because of her age and lack of family history of the illness.  

In her case, cramps gave way to severe pain and then to a full hysterectomy after scans revealed masses on her ovaries.  Further scans and tests eventually revealed that an aggressive tumor in her GI tract had metastasized from her colon to her ovaries. 

Early detection through a colonoscopy could have spared Simon the stage four colon cancer diagnosis that has been a part of her life for the past six years.  Today, she is an advocate for early colon cancer screenings, who has convinced fellow nurses and doctors within the Alexian Brothers Health System to donate time and equipment to screen high-risk patients.  

Simon's story almost mirrors that of former Today Show host Katie Couric who launched a campaign to encourage early screenings after her husband’s passing from colon cancer in 1998. Couric underwent a nationally televised colonoscopy in March 2000.  Since then, there has been a 20% increase in the number of colonoscopies performed, and we now know these facts about the procedure and colon cancer:

  • Patients are sedated throughout the process, putting to rest some fears that the procedure is painful.
  • Men and women are equally affected by colon cancer.
  • Risk of colon cancer increases with age.
  • Screenings should begin at age 50, unless there is a family history of colon cancer.
  • A balanced, high-fiber diet, consistent exercise and overall healthy lifestyle reduce risks.
In spite of greater awareness, the Centers for Disease Control reported that colorectal cancer cases are often detected at late stage when treatment is less effective.

Read more on Trish's story here.

Friday, May 18, 2012

Vermont on Course to Single-Payer System by 2017

Vermont's road to its first in the nation, single-payer system named Green Mountain Care began within four months of Gov. Peter Shumlin's transition to power in 2011.  That year, the governor and legislators commissioned Harvard economist William Hsiao to conduct a cost-benefit analysis on the best healthcare options for the state.  After analyzing many models that included fully-private systems, Hsiao recommended the single payer because of its potential 25% savings to consumers, businesses and government.

This week, Gov. Shumlin signed into law a bill that builds another major section in Vermont's road to single payer by creating federally mandated by Obamacare healthcare exchanges, which will introduce a marketplace for individuals and small businesses to purchase policies from private insurers as well as multi-state and state-sponsored plans.  Uninsured  residents meeting specific income requirements will receive federal subsidies to purchase policies.

When Gov. Shumlin laid the first bricks in Vermont's road to a state funded and operated system, he also established a five-member board charged with setting reimbursement rates and delivering a financing plan by 2013.  Now that the details of the exchanges are being worked out for a 2014 launch, next step for the state is another federal waiver request to operate a fully functioning single-payer system by 2017.   

Saturday, May 5, 2012

Preventive Care's Central Role as Massachusetts Considers Cost-Cutting Reforms

If imitation still is the sincerest form of flattery, Massachusetts received the ultimate compliment in 2010 when the federal government adopted a model of its healthcare reforms for the nation. In mid-April, the Commonwealth quietly marked the sixth anniversary of its law with health insurance coverage rates growing from 86.6% in 2006 to 94.2% in 2010.

Among the statistics the Washington Post includes in a recent slideshow on the law, the data on the accessibility of internal and family practitioners to patients raised questions on whether there needs to be greater buy-in by primary care physicians into the system.  The number of general internists willing to accept new patients dropped from 66% in 2005 to 49% in 2011. For family doctors, the figure was 70% in 2007 and 47% in 2011.

Perhaps the limited access to these physicians explains why the state saw minimal changes in residents' visits to the emergency room.  The Post collected statistics about ER visits from two sources:  One study in Health Affairs reported ER visits decreased by 3.5% between 2009 and 2010.  Another by the University of Illinois comparing Massachusetts ER visits to that of other states found an 8% decrease.

In many cases, primary care physicians are the healthcare system's gatekeepers.  They funnel patients to specialists for closer attention or prescribe the medications that heal a developing condition before it becomes serious.  Their focus is on preventive care, and they work with patients to ensure they receive appropriate screenings as they age.  Most importantly, they charge less than specialists and the ER.      

That primary care reduces costs is important for Massachusetts.  The state is entering the next phase of its reforms by focusing on healthcare spending.  It does so as healthcare costs comprise 41% of its fiscal year 2013 budget.  To contain costs, the legislature is taking up various bills that shifts the state toward global (flat fees) rather than current fee-for-service payments.

So what's the connection between primary care, fiscal reforms to the Massachusetts budget and chronic disease?  The answer is everything. While healthier people need access to preventive care, too, the chronically ill use the system more frequently no matter its shortcomings now. New fiscal reforms that boost access to primary care would implement an immediately useful policy that removes a significant barrier to better disease management.