Screening Colonoscopies For the Uninsured Janet Samples, APN, MSN, FNP, CGRN

1. Screening Colonoscopies For the Uninsured Janet Samples, APN, MSN, FNP, CGRN

2. Objectives • Participants will be able to: • Identify the characteristics of their local uninsured population over 50 years of age • Arrange primary care screening for those over 50 in most need of a screening colonoscopy • Develop a program to approach vendors and ancillary services for their support and services • Understand the need to promote the program for volunteer staff, ancillary services and sponsors in order to follow through on any findings

3. Facts versus Fiction • Fact: Colorectal Cancer is the number 2 cancer killer in the United States • One in every four adults, age 50-64, lack adequate health insurance or does without health insurance. • Misconception: uninsured = unemployed • In 2005, 14% of 50-64 age group were retired and uninsured, 23% were unemployed • Majority of uninsured were self-employed or worked for small employers • 26% were self-employed • 30% worked for employers with less than 25 employees AARP Public Policy Institute, May 2007

4. Income of Uninsured • One in five lived in families with income below federal poverty level (12,830/yr for family of two) in 2005 • >Two in five had income <16,038 for family of two which is 200% of poverty level • An even higher proportion of retirees were below the poverty level, 27% at poverty level, 51% <16,038 for family of two • One-third of those 50-64 were above poverty level, but with income less that 20,000 AARP Public Policy Institute, May 2007

5. Out-of-Pocket Health Expenses • Uninsured, ages 50-64, spend an average of $915 per year • This is 2.5 to 4 times higher than for the younger uninsured • Income usually increases with age, but can flatten in the decade before age 65 due to disability or early retirement AARP Public Policy Institute, May 2007

6. Other Facts • Of the uninsured age 50-64 • 40% are in very good or excellent health • 21% report fair to poor health • Versus their insured peers • 53% report excellent or very good health • 18% report fair or poor health • Health spending burden of underinsured • Roughly 28% with or without coverage are underinsured which falls highest among the poor or low incomes AARP Public Policy Institute, May 2007

7. Recession Facts • Number of uninsured jumped nearly 3 million in 2009 • CDC reports in 2009, 46.3 million U.S. adults lacked health insurance. • This equals to one in five working age adults. Texas is the worst with 24.6% of population uninsured • “In the U.S., health insurance means access to health care” CDC • Uninsured are less likely to get preventative care and often delay care until condition is serious. • Since 2007 insurance with high deductibles discourage preventative care. Steven Reinberg, HealthDay News for Healthier Living, June 2010

8. CDC Colorectal Cancer Control Program • Estimated 142,570 new cases in 2010 with 51,370 deaths from CRC • Successful screening results: Now more than 1 million survivors of colorectal cancer in the United States • 80 million baby boomers are set to retire and 91% of new CRC cases occur in this age group • Program’s goal is to increase screening rates of individuals over 50 through education and screening • These are tailored for low-income, uninsured and underinsured individuals aged 50-64 • AGA supports this program and is requesting that Congress continue to support the CDC’s programming American Cancer Society, Cancer Facts and Figures 2009

9. Communication Barrier • Survey focused on the uninsured to examine disparities in colorectal cancer screening • Results show that the uninsured were 64% less likely to be screened than the insured • Provider recommendation was the only significant communication measure. • Uninsured lacking a recommendation were 98.5% less likely to be screened than those with a recommendation

10. Getting Started • Set up your team – you will assign sections of program to each team member • Initial team decisions will include: • Determine how many colonoscopies you want to perform • How many volunteers will be needed • Give yourself 2-3 months to set this up • Set your dates – one for preps, one for colonoscopy

11. Team Assignments • Volunteers: This person will present plan to physicians and employees. • Ancillary Services: Anesthesia, pathology, surgeons and hospital. • Supplies: Determine needs and sources • Patients: Identify and approach the source Primary Care Providers for the uninsured • Program: Set up flow of program, promotional items, post-program advertising

12. Volunteers

13. Volunteers • Set up meeting to present plan and need for volunteers • Announce both dates • Post sign up sheets for specific tasks to be done • Registration and discharge on both dates • History, set up charts on prep date • Colon prep instructions • Dispense prep kit and t-shirts (our plan) • Pre-op, post-op staff, follow up call • Physician, assistant and anesthesia

14. Ancillary Services • Explain the plan to each one personally • Anesthesia: Line up volunteers for each suite being clear about how many patients they will see • Pathology: Ask your primary lab to process biopsies at no charge. Work to prevent charges to patient • Surgeons: Have a back-up for complications • Hospital: Get your hospitals on board to provide services if needed • Inform these providers of any advertising or promotional credit they may receive

15. Supplies

16. Supplies • Take note of all necessary supplies and costs, using daily usage as source • Ask pharmaceutical vendors for donated prep kits • Ask equipment vendors for donated forceps, snares, etc. or replacement for those used • Decide on main sedation and any back up – approach supplier or plan to donate from your supplies

17. Primary Care Providers

18. Patient Source • Contact and meet with the PCP’s who provide care to uninsured patients • Divide available screenings among them • Ask for patients 50 years and older with no symptoms, no previous colonoscopy, keeping this a screening colonoscopy • Arrange for advance receipt demographic sheets • Provide your required forms to be filled out and brought to first visit • Prepare for language and literacy barriers

19. Program Promotion • Meet with volunteers to answer questions and set up plan for smooth flow of patients • Get sizes and order T-shirts with vendor/donor logos on back and theme on front, as gift to volunteers and patients. Have everyone wear on day of colon. This will increase the bond of all involved • Keep communications going among teams • Refreshments for patients

21. Give Credit • Marketing to contact media for coverage on day of colonoscopy, no advertisement prior to this • Publish a big thank you to all participants • Follow up with a media impact report • Challenge others to step up – In April 2010 the Tri-Cities Gastroenterology Group partnered with free clinics for a similar program

22. Our Results • Our goal was to perform 50 screening colonoscopies • Each patient received premium care from our staff • 48 of the 50 selected patients followed through with the screening • Nine physicians performed 48 colonoscopies one Saturday morning into early afternoon • 25 of the 48 patients had polyps removed eliminating them as a risk for colorectal cancer

24. The End??NO WAY! We did it again10/09/10