What does it look like when health care is not accessible?

Health care, and the lack of access to it, has been a prominent topic in the media recently. On Sunday, June 23, The Washington Post profiled a couple in rural Tennessee who, struggling with myriad health conditions, sought assistance at a weekend pop-up clinic staffed by a volunteer medical team. (See “Urgent needs from head to toe: This clinic had two days to fix a lifetime of needs“.)  Another article a few days earlier, “As price of insulin soars, Americans caravan to Canada for lifesaving medicine”, also in The Washington Post, focused on families traveling to Canada to purchase insulin, because it is much less expensive than in the US and available without a prescription.

These articles spoke to all of us at Mercy Health Clinic, as there are many truths in these stories that relate to experience of patients at Mercy. All of our patients are low-income and like the couple featured in the article, most have not had regular access to medical care because they lack insurance and cannot afford care.

Thanks to generous donors, Mercy will serve more than 2,000 patients this year, providing primary care and specialty care for patients who otherwise would have to use the services of the hospital emergency room, which is very expensive and cannot offer the ongoing support to manage chronic conditions, like diabetes or high blood pressure, that Mercy is able to provide.  

Approximately one third of Mercy’s patients are managing a chronic condition, such as diabetes or high blood pressure. If not properly managed, these individuals are at significant risk of hospitalization, re-hospitalization, heart attack, stroke and serious infection that could require amputation of limbs.

At Mercy, medications, including insulin, are provided free of charge to patients to patients so they do not have to choose between buying medicine or groceries, or reduce doses/skip days to stretch their medications until they can afford to refill them.

We are serving the poorest of the poor, including the “working poor” who have jobs but still cannot afford care. More than 70% of our patients live at or below the Federal poverty level, individuals who are caregivers or work in fields that are low-wage and often do not offer health insurance, such as childcare, housekeeping, construction labor and other service positions. Even though they are employed, and work full-time, they still do not have access to health insurance and cannot afford health care. The Affordable Care Act expanded access to care in many states, including Maryland, but there are still some 60,000 adults in Montgomery County who do not qualify for any insurance program. Often, those who do qualify for subsidized “affordable” plans find that they cannot keep up with premiums throughout the year and then return to the ranks of the uninsured. In addition, we are now facing uncertainty regarding local and national healthcare policy and the impact it may have on people struggling with poverty.

Mercy is committed to providing care for our low-income neighbors, and we are continually evaluating how best to meet their evolving needs.

America the Pink

October is National Breast Cancer Awareness Month. I know — it’s hard to believe that anyone wouldn’t be aware of breast cancer. You’d have to be living under a rock to not know it exists, what with all the walks, marches, bike rides, and pink merchandise to buy to show your support and help raise funds for research. Even the NFL offers special breast cancer awareness “gear”, since nothing puts the kibosh on breast cancer better than a Steelers zip-front hoodie.

Maybe we should call it Breast Cancer Attention Month instead. It seems to me that simple awareness isn’t sufficient. We need full-on attention, and if the pinking of America gets us to pay attention, more power to it. After all, breast cancer is the second most common cancer in American women (skin cancer is first) and the second most deadly cancer in women (lung cancer is first). Scary stuff.

The American Cancer Society estimates that in 2016:

  • Approximately 246,660 new cases of invasive breast cancer will be diagnosed in women.
  • Approximately 61,000 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer).
  • Approximately 40,450 women will die from breast cancer.[1]

Even one death is one too many. The good news is that death rates from breast cancer have been dropping since about 1989, with larger decreases in women younger than 50. These decreases are believed to be the result of finding breast cancer earlier through screening and increased awareness, as well as better treatments.[2] Regular screening improves the likelihood that cancer will be caught in its early stages, when it is easier and less costly to treat, and with a higher chance of a cure.

My attention to breast cancer is made simpler by being built into my health care – my health insurance plan allows me to have a mammogram every year, so I do. It’s not the most comfortable procedure due to extreme flattening, but it’s quick and non-invasive. Although I might take comfort in the fact that my family history with breast cancer is, to my knowledge, limited to a couple of very aged aunts, 85% of breast cancers are found in women with no family history of the disease.[3] Let’s face it: at the end of the day, no one is immune to breast cancer (not even men). I’m thankful to have access to screening and always relieved to get that “benign – no cancer found” report.

Everyone deserves this peace of mind, including people without health insurance. Mercy Health Clinic works to enable female patients 50 – 75 years old get a mammogram at least every two years, in accordance with standards set by the Primary Care Coalition and HEDIS (Healthcare Effectiveness and Data Information Set). During the most recent quarter for which statistics have been compiled, Mercy is proud that 66% of eligible women patients received this screening, placing the clinic near the top of Montgomery County’s safety net clinics.[4]

As you’re paying attention to breast cancer this month, don’t forget that when October ends and we move on to some other health observance, breast cancer will still be around. If you’d like to help support Mercy’s work to help low-income women stay a step ahead of breast cancer, click here. And then maybe check out that hoodie.

—- Pam Saussy, Board Member


[1] American Cancer Society http://bit.ly/2esLHDJ

[2] American Cancer Society http://bit.ly/2esLHDJ

[3] Breastcancer.org http://bit.ly/2epD62v

[4] Q2/2016 performance statistics. www.primarycarecoalition.org


The True Skinny

As a board member for the Mercy Health Clinic, part of my job is to ask people to contribute money or time to support the clinic’s mission of providing top-quality health care to uninsured people in Montgomery County. But hold on. Who says it’s “top-quality”? You could just take my word for it if you know me and trust my judgment. Come to think of it, it would be awesome if you would just do that, and write that check or hit that Donate Now button. Thanks so much.

But if you don’t want to take my word for it, you might want to know how we measure “quality”. We could point you to our Facebook page – we’ve got 4.5 stars! That’s nice, but not that useful when you’re a potential donor or volunteer and want to get the true skinny on whether Mercy delivers the goods.

No, for this job you need data – statistics, in fact, comparing Mercy’s performance against a set of quality metrics agreed upon in advance for the 12 Montgomery Cares safety-net clinics operating in Montgomery County[1]. For the low-income, primarily immigrant population served by the safety-net clinics, several health issues show up more often than others: diabetes, hypertension, and various kinds of cancer. So we measure specific aspects of these conditions, comparing them to nationally endorsed specifications and (and this is important) evidence that improvement in the measure correlates with improved patient outcomes.

So how is Mercy doing? Here are just a few examples from the most recent statistics gathered for Montgomery Cares clinics by the Primary Care Coalition[2].

For diabetes, some key metrics compared across the clinics include:

  • screenings for HGBA1c, which measures blood glucose levels – 92% of Mercy patients with diabetes had a screening within the last year
  • annual retina exams to screen for diabetic retinopathy, a complication that can lead to blindness – 67% of Mercy patients with diabetes had an annual retina exam within the last year (#1 among the clinics!)
  • foot exams to detect loss of protective sensation or ulceration that can lead to amputation and disability – 60% of Mercy patients with diabetes had a foot exam within the last year (#2 among the clinics!)
  • blood pressure control, to stave off complications such as stroke and heart failure – 83% of Mercy patients with diabetes had BP less than 140/90 (#1 among the clinics!)

For hypertension, metrics include:

  • measurement of blood pressure – 100% of Mercy patients with hypertension had their BP measured within the last year
  • hypertension patients with their BP under control – 74% of Mercy patients with hypertension had their BP under control (#1 among the clinics!)

For cancer, metrics include:

  • women aged 50 – 74 had a mammogram to detect breast cancer within the past two years – 69% of Mercy female patients in this age range (2nd among the clinics)
  • women aged 24 – 64 had a PAP smear for cervical cancer within the last 3 years – 58% of Mercy female patients in this age range
  • patients aged 51 – 74 had a colon cancer screening performed within the last year – 54% of Mercy patients in this age range (1st among the clinics!)

Low-income and uninsured people often forego healthcare until their conditions are much farther along and thus more expensive and difficult to treat. Monitoring of chronic conditions such as diabetes and hypertension helps patients keep their disease under control and reduce the likelihood of secondary complications such as vision problems or lower-extremity amputations. Screenings for cancers help identify potentially deadly disease in its early stages when treatments can be more effective.

Another benefit? Cost. Safety-net clinics like Mercy help uninsured patients avoid using costly ER facilities for their primary care, thus helping keep costs down for all of us. Mercy Health Clinic’s model of care relies heavily on volunteers, and provides a diverse multidisciplinary team at our Gaithersburg site. This improves the options for treatment, as patients have access to a primary care physician, nutritionist, and a specialist if they need one. 

These measures are by no means an exhaustive assessment of clinic performance or patient outcomes, and they are a snapshot of performance, which can vary over time. But they do give some idea of what we’re measuring on a regular basis to determine if we’re making a difference in our patients’ lives, and what we mean when we say that Mercy provides top-quality healthcare. I hope you’ll click here to support the Mercy Health Clinic’s mission to make Montgomery County a healthier place for everyone, including those without health insurance. That would be awesome. 

— Pam Saussy, Board Member

[1] Montgomery Cares measures are benchmarked against NCQA’s HEDIS Medicaid performance. NCQA measures healthcare system performance including primary and specialty care. For details about Mercy Health Clinic’s patient outcomes, contact Mark Foraker, Executive Director, at mark.foraker@mercyhealthclinic.org.

[2] www.primarycarecoalition.org