Patient Advocacy: Healthcare on your side

Monday, March 17, 2014

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

by Martine G. Brousse,

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

Women's Health in France: Major

Differences vs. US Healthcare System

Born and raised in France and living in the States for over 3 decades (but still French at heart when it comes to cheese and pastries), I recently came across an article in a French magazine that peeked my interest.

The article cast a light on midwives, a profession well established in France, but whose scope I was not aware of. Further research highlighted the vast disparity of coverage, cost and social rights between "socialized" medicine and the US healthcare system.

Though French citizens have the choice to opt out of the state-sponsored insurance system, and use private physicians or clinics in much the same way a patient here can go "out of network", their medical coverage, unlike that in the US, will not be reduced or penalized them in such exorbitant ways.

Let us go over some major differences:

1. French women use midwives

It is estimated that 70% of all births in France are performed by midwives, whether in private clinics, public hospitals (those under the state-sponsored system) or at home.

This number speaks not only of the competence of and respect for midwives, but also of a system which places great emphasis on expanding access to care while effectively managing risks with fewer resources and at a lower cost.

Doctors are not routinely part of the childbirth process, unless complications arise, or in high-risk cases. This explains why the rate of C/sections is much lower in France than in the U.S. It also highlights a type of medicine which does not consider childbirth an illness, thus not extending the vast amount of resources and money the US system does.

A profession too little used in the US, midwives are the main destination for French women when it comes to their reproductive and sexual health. Well-respected as a profession, students' education starts with the first year of medicine classes that future MDs also attend, then continue thorough 4 years of specialization and training.

Further studies in acupuncture, haptonomy (bounding with Baby), tobacco cessation or homeopathy for example add to their long list of competence.

2. A widespread reach

Usually associated with childbirth, French midwives have been entrusted with a vast variety of responsibilities:

Preventive screenings such as Pap smears, and other general gynecological consultations
Education and supervision of puberty-related issues
Contraception education and evaluation
Prescription of contraceptive methods, insertion of IUD or implant
Sexuality-related issues or questions at all ages
STD prevention, detection, and treatment
Yearly well-woman visits including screening labs
Pregnancy supervision and preparation to childbirth
Echography
Pre-natal tests and screenings
Childbirth and delivery
Breast feeding support and supervision
Postnatal care for Mom
Initial baby evaluation and care
Parental education on how to care for Baby at home and about new family dynamics
Perineal reeducation after birth and throughout life
Education on child-proofing the home, and on developmental stages
Home visits after birth to check on health and progress (up to 12 days after birth)

A referral to a physician is usually only made under specific circumstances: complications, serious health issues, disability lasting over 2 weeks, or the need for more advanced or specialized care such as pre-determined need for a C-section.

Midwives also offer the listening skills, easier access, emotional support and knowledge of social services that physicians are too often not able to provide.

3. Talk about lower costs!

As of 9/1/3013, the set price for a consultation with a midwife is 23 Euros, or about $ 30.00 (the same as a visit with a French G.P.). Pre-natal or perineal reeducation classes are less. A home visit will cost a few euros more but services are usually covered at 100%. An echography costs about $ 4.00.

A regular delivery is priced at about $ 407.00, twins a little higher at about $ 500.00. There is a $ 52.00 surcharge for night deliveries. These charged are usually covered at 100% by the French government-issued insurance.

Prices for the facility and for the anesthesiologist are separate. Hospital costs are covered at 100%, unless services are rendered in a private or non-participating clinic. New mothers will enjoy a 3-day stay after birth, and 5 days minimum after a C/section.
When I had my twins in the US 25 years ago, I was scheduled to be sent home 12 hours after the birth; an additional day was only authorized by my insurance because of complications. At that time, my sister stayed hospitalized one full week for a regular birth!

4. Women Health in the US

With the implementation of the ACA guidelines in 2014, women are now able to receive some of the same benefits as their French counterparts.

Multiple preventive services are now covered at no cost to patients. Those include:

for pregnant women: screenings for anemia, folic acid, gestational diabetes, Hepatitis B, Rh incompatibility, syphilis, urinary tract and other infections as well as breastfeeding support and counseling.

for all women: mammography screenings, cervical cancer screenings, STD prevention and detection, domestic and interpersonal violence evaluation, contraception education and methods, sterilization, tobacco use intervention and well-woman visits.

For those at risk: Breast cancer genetic test counseling, breast cancer chemo prevention counseling, HIV testing, HPV DNA testing, osteoporosis evaluation.

For Women and Men: Screenings for alcohol misuse, blood pressure, cholesterol, colorectal cancer, depression, diabetes, obesity, tobacco use. Also included are immunizations and diet counseling.

While childbirth is still treated as a disease, along with menopause, we are seeing a small shift toward using a less radical (and less costly) approach.
Nurse practitioners are taking over some of the physicians' duties, especially where routine or screening visits are concerned. A shortage of physicians may contribute, especially is some areas, to turn more to Nurse practitioners and Physician Assistants to handle those duties, thus widening the range of services women can get access to.

As more ACA mandates are implemented, and as the planned shift in administration, methods and results in medicine develops, we can hope that American women can get as attentive, professional and efficient a care as their French counterparts, for much less than its current cost.

© [2016] Advimedpro.

© [2016] Martine G. Brousse.

My objective is to offer you, the patient, concrete and beneficial information, useful tips, proven and efficient tools as well as trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements.

AdvimedPro (424) 999 4705 or (877) 658 9446 fax (424) 226 1330

www.advimedpro.com contact@advimedpro.com

Monday, March 10, 2014

Patient Advocacy: Healthcare on your side

Patient Advocacy: Healthcare on your side

by Martine G. Brousse,

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

Four New Trends in Medicine

Patients will Benefit from (part II)

Following part I of this report on the new trends in medicine, I will highlight longer-term changes and implementations this week.

Aimed primarily at generating the optimum cost/quality/result balance and at making the best use of resources while providing the most effective results, these innovations will bring patients the benefits and success they may not always enjoy at this time.

The switch from a quantity, fee-for-service, wasteful, high cost and inefficiency system to one encouraging provider cooperation, patient participation, prevention and better management is likely to encounter hurdles and resistance, but will ultimately go a long way to resolving the healthcare system existentialist problems seen today.

1. Predictive Medicine

Prepare for the rise in interest in your health by your insurance company, employer or governmental agencies (especially if they insure you). And for an early interest, before symptoms, before your first medical consultation and before you get that first prescription or treatment. It's all about risk, and how to minimize it in a system with scarcer resources, fewer denial options for insurance companies, reduced payments and greater access to data.

The legal precedent set by the Supreme Court now allows genetic tests to become "generic". Once reserved to the already ill (i.e. breast cancer patients being tested in order to pinpoint the better treatment) or the at-risk population (those with a family or personal history), these genetic tests will multiply in scope and reach. According to Robert M. Wenzel, owner of London Global Laboratories, gene analysis will accurately predict of an individual's risks, based on algorithms derived from the analysis supported by Electronic Health Records and the universal access to and sharing of medical data.

Predictions about a risk of disease, about the success of a specific treatment, or the effectiveness of a particular drug will become part of the medical arsenal. By making an early diagnosis (and with a prompt intervention), physicians will take a more efficient, pro-active stance, while patients benefit from cheaper, less invasive and more curative outcomes.

2. Preventative Medicine

Once risks have been established, and for the population as a whole, expect an early intervention from those interested in your health, whether for clinical or financial reasons. The US system is definitely turning into a prevention-centric system, similar to the other health systems in developed countries, almost all of whom are government-run.

Monitoring of vital signs, especially with the use of technology such as phone apps or sensors, aim at reducing the number of conditions made chronic by lack of medical care or responsible behavior. More data crunching will lead to the better use of diagnostic tools such as labs or imaging, and to more specific guidelines about proven processes. Early and consistent screenings, especially for those identified as "at risk", are expected to lower late and costly diagnoses, especially those requiring extensive treatments and heavy price tags.

Changes in lifestyle choices, advice on nutrition, emphasis on exercise or other healthy activities, intervention at early ages, and supportive measures are part of a trend that will require more and more personal involvement and commitment.

A system of rewards or penalties is already growing, especially among employers seeking a reduction in premiums with a improvement of their employees' conditions or vital signs. Encouragement and resources are already becoming more available, and will become more widespread and commonplace as the emphasis on health becomes more prevalent, and important in people's minds.

3. Personalized Medicine

"Trying out" this or that medication, undergoing multiple treatments, searching for the best way to a successful outcome might soon be viewed as a thing of the past.

Biomarkers, nanosensors and virtual models are some of the tools medicine can use to establish an individual's profile and identify the most effective, most affordable course of action. Clinical trials could achieve better results by being more selective and focused.

Technology can now bring real time diagnoses, ensuring the proper triage and intervention without using the ER as the default. Medical errors due to a lack of information, or unavailable medical history and medication list, will be reduced significantly.

Based on quantitative data, selective criteria and established guidelines, any course of action will be better able to guarantee success than ever before.

4. Smarter Medicine

Learning to practice medicine from a more technical and technological approach is new to medical providers. This trend will not be reversed; and physicians not "on board" may soon lose patients and funding and see a dip in their ratings or reputation.

The new models point to a sharp learning curve, which the medical profession, and many patients, have been resisting out of fear, ignorance or financial concern. Stepping into a smarter, less invasive, more focused and better adapted system is not only good medicine, but the only way all players can survive and thrive.

We will be seeing an accelerated number of new innovations, technologies, models and guidelines. Based on real time data, easily quantified and verified, these changes will not only bring the healthcare system into the current technological age, but will soon catch up with most other developed countries. The benefits and health levels enjoyed by those members can become a real possibility for all US consumers too. Financial rewards, in the form of lowered costs and elimination of waste, would also benefit all of us.

Conclusion:

Personalized healthcare and these new trends mostly mean "transparent healthcare".

Access to medical records, widespread information, public data banks and analyses, as well as the monitoring of one's own bio readings can encourage communication and coordination of efforts. Rather than accepting a prescription or treatment at face value, patients will become more aware of risks, options and costs. Better informed about their diagnosis and a partner in their physician's decision, they will be able to participate more fully in their care.

The days of turning one's life over to a physician with little participation and an obscure understanding might well be counted, as self-responsibility becomes a more essential and necessary part of the process. It can be easily argued that early detection, screenings, and prompt intervention will save lives and certainly dollars.
But it will be even cheaper and better for all if the population, especially as it ages, remains healthy and independent as long as possible without entering a hospital or being diagnosed with an incurable chronic condition. Hopefully, the entry of medicine into the age of responsible, applied, personalized and proven technology can help achieve this goal.

© [2016] Advimedpro.

© [2016] Martine G. Brousse.

AdvimedPro (424) 999 4705 or (877) 658 9446 fax (424) 226 1330

www.advimedpro.com contact@advimedpro.com

Monday, March 3, 2014

Patient Advocacy: Healthcare on your Side

Patient Advocacy: Healthcare on your side

by Martine G. Brousse,

Healthcare Specialist, Patient Advocate, Certified Mediator

ADVIMEDPRO

IT'S PRIVATE PROFESSIONAL

PATIENT ADVOCATE WEEK!

As Trisha Torrey, the spokeswoman for patient advocacy and founder of the Alliance of Professional Health Advocates has noted, advocates have not been receiving the recognition for the successful work they have done on behalf of patients. For this reason, and to bring attention to this new but growing profession, she has declared the first week in March as "private Professional patient Advocates Week".

As a Patient Advocate (one of a few hundreds in the U.S.), I spend, it seems, as much time getting the word out and explaining what I do than actually working on cases! Though the need is great, patients and their caregivers are unaware of the services advocates may offer, and that help, in many forms, is available.

Whether locating that perfect nursing home for Grandpa, reviewing and negotiating down excessive medical bills, accompanying far away Mom to appointments, or helping a torn family find a united course of action in face of a serious diagnosis, advocates can provide the necessary knowledge, support, compassion and skills.

Some advocates may specialize in researching treatment options and educate you on a new condition, while others provide in-home nursing care or hospital beside monitoring.
While I deal mostly with financial matters (finding assistance for cancer patients, handling medical accounts, appealing insurance payments or auditing and settling bills), some of my peers can advise you with end-of-life decision making, can guide you when applying for disability or other benefits or can research home birth alternatives.

It is a sad but true fact that patients are not receiving the supportive care, detailed explanations, extensive reviews of conditions, treatments and options, or financial solutions from their medical providers that they often require. Navigating alone the intricacies of this vast and complex U.S. healthcare system in its various forms, can take a large emotional and financial toll. Medical providers are so stressed by time constraints and financial concerns that they and their staff are unable or unwilling to address more than the basic inquiries from patients. They in turn are left to face and try resolving multiple complex intricacies and details, often at the expense of the most important: their health.

Who has time to learn a coding system to be able to read statements, or can understand an insurance policy at first glance? What are all your treatment options if the physician does take into account your preference or needs, or how this will affect you? How does a patient express to his loved ones and medical team that his choice should be respected despite their objections?

A patient advocate is trained, and usually has extensive experience, in finding solutions, bringing clarity and understanding to a situation, removing obstacles and overcoming mistrust through collaboration.

Private patient advocates work on behalf of clients, as they are hired and paid by them, but also seek to find ways to involve all parties in the solution-seeking process. In fact, advocates often act as mediators, working toward an equally acceptable and beneficial agreement, with mutually respectful interaction and improved communication.

And while hospitals and insurance companies count advocates on their payroll, patients are unlikely to be their primary focus, especially in a dispute, as this person will tend to the other side's interests above all. If you went to court, would you trust the opposing attorney to safeguard your rights?

Personal advocates are often not welcomed by medical providers or billers out of fear and ignorance. But their growing number and influence will hopefully reverse this adversarial stand once more positive resolutions reflect their value.

Patient Advocacy is still too new a profession to have a specific certification, training or licensing process. Most are using their background in nursing, medical billing or mediation as the first step of a new career. Using their experience and skills on the side of patients is their way to stop being part of the problem.

When hiring an advocate, consider matching your specific needs with the area of expertise offered by different individuals. Due to the lack of a nationally recognized set of credentials, many abide by a set of conduct and professional standards which promote integrity. Details at: http://HealthAdvocateCode.org/

APHA, the association founded by Trisha Torrey, keeps a list of vetted member advocates and their credentials. Consult it to locate the most appropriate or skilled professional, or to learn more about the different ways we can assist you.

http://advoconnection.com/register/

Consider hiring a private professional patient advocate next time you need to argue with your insurance company, require support finding info or financial assistance for a newly diagnosed condition, wish to have a local trustworthy person supervise a loved one's care or negotiate bills. A small financial investment can usually turn trouble into solutions and worry into peace of mind. It might also just save you a lot of dough too!

AdvimedPro (424) 999 4705 or (877) 658 9446 fax (424) 226 1330

www.advimedpro.com contact@advimedpro.com