May 4 is Melanoma Monday.
While it’s not exactly fun to think about a potentially life-threatening disease, it’s critically important to encourage regular self-exams and medical screenings to detect suspicious spots, according to the American Academy of Dermatology. One in five Americans will be diagnosed with skin cancer in their lifetimes.
Dr. Kathleen Brown, of Oregon Coast Dermatology in Coos Bay, knows all too well how important it is for her small-town patients to have timely and thorough access to dermatological care.
“A lot of Medicare patients, tons of them, can’t get the coverage to do preventative exams with a skin-cancer screening,” said Brown. “We have a large retirement community and only two dermatologists.”
Coos Bay, with a population of about 16,000, has a high percentage of retirement-aged residents. Twenty-two percent are 62 or older, with a higher likelihood of cancer-causing sun exposure (though young people who use tanning booths are rapidly becoming a larger risk group). Many Coos Bay seniors have medical coverage from Medicare.
Patients pay
Brown, a dermatologist for 25 years, abandoned the managed-care route about 10 years ago and her patients pay with either cash or credit. By not tangling with pre-authorizations and billing, she’s kept her costs down and passed those savings to her patients.
Patients know her prices up front and can comparison-shop. That’s the idea behind “transparency,” the latest buzzword in healthcare. Though price transparency of is a popular concept with consumers, providers and insurers have fought it.
In late April, Senate President Peter Courtney killed Senate Bill 831, which would have made public the cost of hospital services. The high-profile bill met the same fate of little-known House Bill 3018, which Brown presented to the House Health Care Committee on March 18. She had the support of Rep. Caddy McKeown (D-Coos Bay), Sen. Arnie Roblan (D-Coos Bay) and former Oregon Insurance Commissioner Gary Weeks.
HB 3018 would have:
- Prohibited insurers from imposing cost sharing or similar requirements for services by out-of-network providers,
- Prohibited state agency and insurers from preventing people from paying for their own medical care, and required physicians to contract with insurers or a state medical assistance program.
Brown’s bill was dismissed by the healthcare committee, chaired by Rep. Mitch Greenlick (D-Portland) after legislators spent five minutes asking questions and making comments.
“It’s a shame that with that with 2,500 signatures, support from senators and a former insurance commissioner, that it wouldn’t make it out of committee and to a hearing,” says Brown. “I’m disappointed that they didn’t really consider it, they weren’t curious. They came to the conclusion it wasn’t going to be fixed by them.
Brown insists there’s another way.
“I made a whole new practice” to adjust to the changing healthcare landscape. “I have high standards for how I practice medicine. I always have to work for the patient, not the third-party payer. Our next move will be to expand into internal medicine, build some space,” said Brown of her growing practice, which is booked four months out.
“Politically, I might do something in the future,” she added. “But I’m not sure I believe in political solutions anymore.”
* To learn more Melanoma Monday, visit https://www.aad.org/spot-skin-cancer/community-programs-events/melanoma-monday
Kendra Hogue is a Portland-based freelance writer. She can be reached at [email protected].
Comments
Skin exam statistics
I am very familiar with all of that, of course, Don. It is confusing to lay people. The comments in the article are a little out of context, and NOT the main point of my legislation. However, this is why access to a doctor who can interpret statistics for INDIVIDUALS is important. Statistics are useful, but I don't treat populations; I treat individuals.
Kathleen Brown
Third-party-free practice
Correction: I have been in a third-party-free practice since July of 2011. Insurance companies and Medicare and Medicaid are increasingly "control freaks". I do not "buy" their argument that these controls lower costs and improve care. The controls may contain THEIR costs, but not the patient's costs or the actual costs of providing medical services, but they ARE harming medical care. People should see the bizarre consequences of the constant manipulation of doctor behavior under these contracts.
Kathleen Brown
Fear of skin cancer, especially melanoma, drives the idea of regular whole-body skin screening either by primary care or dermatology providers. Readers should consider the rational views based on available evidence in the U.S. Preventive Services Task Force recommendations regarding skin cancer screening. These are directed at those with average, not unusually high (like previous skin cancer, mostly) risk for skin cancer. The guideline is currently under study for an update. Adolescents from age 15 up will be added to the existing 2009 recommendations, in the upcoming 2015 update. This is a link to the update page on the USPSTF website:
http://www.uspreventiveservicestaskforce.org/Page/Document/final-research-plan104/skin-cancer-screening2
The existing 2009 recommendation is at this link:
http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/skin-cancer-screening?ds=1&s=skin%20cancer%20screening
The conclusion in the 2009 recommendation, for the adult general population, is: "The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using a whole-body skin examination by a primary care clinician or patient skin self-examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer in the adult general population."
Don Thieman