Thursday, March 23, 2017

Health officials and advocates list Kentucky's top 5 health issues, including one newly identified: adverse childhood events

About 125 people worked on the state health assessment at the
Kentucky History Center in Frankfort on Wednesday, March 22.
By Melissa Patrick
Kentucky Health News

A group of about 125 people spent March 22 with health officials from the Kentucky Department of Public Health to prioritize the top health issues in the state, and after a long, deliberate process decided they were substance abuse, obesity, tobacco, health-care access and adverse childhood events.

"Adverse childhood events" such as abuse and household dysfunctions, like having a household member in jail or coming from a divorced family, can have lasting effects on health and well-being.

ACEs affect 59 percent of Kentuckians, according to the 2015 Kentucky Behavioral Risk Factor Survey, the first one to include questions about 11 such events. The results showed that Kentucky has a higher-than-average percentage of people with six or more ACEs.

"There are things that happen to us early that make a huge difference as we get older," Dr. Connie White, senior deputy commissioner of the state health department, told the gathering of about 125 people, about half of them from outside the agency.

As for the other big issues, "Eating less, good exercise and not smoking would solve so many of our problems," said Deputy Secretary Tim Feeley of the Cabinet for Health and Family Services. He said the solution to Kentucky's health problems rested in early health education and personal responsibility.

"There isn't a pill that will fix everything," he said. "We need to make people more responsible, more in tune with their own health and we need to do that through education; we need to do that through access to good health care that encourages them to do it that way."

Various health officials reviewed data on the state's health, reminding the room full of health-minded participants that Kentucky has the nation's highest smoking rate (26 percent of adults) and the highest rate of new hepatitis C infections; has seen its opioid overdose deaths triple between 2006 and 2015; is largely sedentary; and has some of the nation's highest rates of cancer, diabetes, heart disease and obesity.

One of the few bright spots in the overview was the drop in the share of Kentuckians without health insurance, from 18 percent to 7 percent since the implementation of the Patient Protection and Affordable Care Act. This was largely because Kentucky expanded Medicaid under federal health reform to those who earn up to 138 percent of the federal poverty level.

Throughout the meeting, participants expressed concerns about Republican plan to repeal and replace the Patient Protection and Affordable Care Act, which among other things would phase out the Medicaid expansion, drop the requirement to cover 10 essential health benefits and turn Medicaid into a block grant program and give the states control of it.

Allison Adams, director of the Buffalo Trace District Health Department and president of the Kentucky Health Department Association, gave an overview of Public Health 3.0. This national initiative calls for local health-department leaders to become the "chief health strategists" in their communities, focusing on prevention and social determinants of health. This new approach to public health relies on health departments working with community partners to address the health needs of their community.

Participants wrapped up the day-long meeting by forming work groups centered around each of the five identified priorities. The groups were charged to find out what is already being done in the state around these issues, and to then decide the best holistic plan to "move the needle forward."

Wednesday, March 22, 2017

The divide between dentistry and medicine can have deadly consequences; policymakers are getting more interested

(Photo from ancienthistorybulletin.ca)
As anyone who has ever mistakenly thought that medical insurance would cover their visit to the dentist knows, the worlds of medicine and dentistry don't overlap much.

They almost never overlap when it comes to education, insurance coverage or practice. Physicians go to medical school, and dentists go to dental school. Your doctor likely isn't concerned with whether you floss regularly, and your dentist is probably uninterested in your exercise habits.

But they probably should be, since the body doesn't know it's supposed to keep oral health problems separate from other medical issues, and the two commonly overlap. In fact, oral health problems can lead to dire medical complications if left untreated, according to the National Institute of Dental and Craniofacial Research.

Mary Otto explores this strange divide in her new book, Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America. One story that shapes Otto's book is the tragic case of 12-year-old Deamonte Driver, who died in 2007 after bacteria from an abscessed tooth infected his brain.

Otto discussed the history of dentistry, its practices and the cultural divide of good oral care in an interview with Julie Beck of The Atlantic magazine. She described the first push for reform in the 1920s by William Gies, a biological chemist.

"He visited every dental school in the country and in Canada for the Carnegie Foundation, for this big report, and he called for dentistry to be considered an essential part of the health-care system. He said: 'Dentistry can no longer be accepted as mere tooth technology.' He wanted oral health and overall health to be integrated into the same system, but organized dentistry fought to keep dental schools separate," Otto told Beck.

Former Surgeon General David Satcher called for reform again in his 2000 report "Oral Health in America." "He said we must recognize that oral health and general health are inseparable," Otto said. "And that too, was a kind of challenge. And it seems like things are changing, but very slowly."

An an example of the effect of separating dentistry from medicine, Otto said more than a million Americans visit emergency rooms with dental problems each year.

"It costs the system more than a billion dollars a year for these visits," she told Beck. "And the patients very seldom get the kind of dental care they need for their underlying dental problems because dentists don’t work in emergency rooms very often. The patient gets maybe a prescription for an antibiotic and a pain medicine and is told to go visit his or her dentist. But a lot of these patients don’t have dentists. So there’s this dramatic reminder here that your oral health is part of your overall health, that drives you to the emergency room but you get to this gap where there’s no care."

Otto said that all the health-care programs we’ve had in our nation's history, including private insurance, have on some level neglected oral health or treated it as a fringe benefit. She said oral care highlights the economic inequality in America, because many dentists are focused on expensive, cosmetic procedures.

"Of course there is a lot more money to be made with some of these really high-end procedures. But on the other hand there’s this vast need for just basic, basic care," Otto told Beck. "A third of the country faces barriers in getting just the most routine preventive and restorative procedures that can keep people healthy."

Rural and poorer areas face shortages of dentists. Otto said a group of dental hygienists in South Carolina, where 250,000 children living in rural areas aren't getting dental care, fought to change state law so they could serve the needy kids without them first having to see a dentist. The dentists' lobby fought back, but the Federal Trade Commission stepped in and won the case for the hygienists "in the interest of getting economical preventive care to all these children who lacked it," Otto said.

Dentists say they're not to blame for such problems. "Organized dentistry continues to say the current supply of dentists can meet the need, that if the system paid more for the care, more providers would locate in these poorer areas, that we Americans need to value our care more and go out and find care more aggressively," Otto said. "They see the fault as being with society at large."

What does Otto see as the solution? She said something that needs to be discussed more in dentistry is the "Triple Aim," a concept discussed in planning for the Patient Protection and Affordable Care Act. It involves bending the cost curve toward prevention, expanding care more broadly and more cheaply, and creating a better quality of care.

"It seems like it’s capturing an increasing amount of attention from state lawmakers, governors, and public-health officials who are interested in bringing costs down for all kinds of health care and seeing that these things show promise," she said. "They're saying we’re spending too much on emergency rooms, we're spending too much on hospitalization for these preventable problems, so there are cost incentives to get more preventive and timely routine restorative care to people."

Tuesday, March 21, 2017

High-school students' research finds smokers are more likely to want to quit smoking after seeing their carbon monoxide levels

Taryn Kerley and Becca Calvert, Barren County High School seniors
Cigarette smokers who saw their carbon monoxide levels rise after they smoked were more likely to want to quit smoking, according to a study led by two students at Barren County High School, Will Perkins reports for the Glasgow Daily Times.

CO is a poisonous, colorless and odorless gas that is produced as a result of the incomplete burning of combustible products. When a person smokes, carbon monoxide enters the blood through the lungs and blocks its ability to carry oxygen to body cells.

The study, "Effects of Education and Exhaled Carbon Monoxide Testing on Smoking Cessation in a Rural Kentucky Community," was led by Taryn Kerley and Becca Calvert, both seniors who are part of the high school's nationally certified Project Lead the Way Biomedical Science program, Perkins reports.

The study included 30 participants, who ranged in age from 16 to the 50s, at a band competition.

“We would ask people who came to our table if they smoked,” Calvert said. “If they did, then we would talk to them about carbon monoxide and how it affects the body, and if they already knew that beforehand. We would ask them to rate themselves on a scale of one to 10, if they wanted to quit smoking and how much. Then we would use a smokerlyzer to get their carbon monoxide reading.”

Clavert told Perkins that participants were asked to hold their breath "for a really long time" and then blow smoke into a smokerlyzer, a device that tells how many parts per million of CO a person has in their lungs.

After the participants used the smokerlyzer, they were shown their results and asked again how they rated their desire to quit smoking, and if it had changed.

Kerley told Perkins that data showed that “there was a significant difference in the desire to quit smoking from before they saw their level to after they saw their carbon monoxide level.”

However, Kerley and Calvert said long-term smokers were less likely to change their desire to quit smoking after getting their results.

"If people had been smoking for a longer amount of time, like say, 20 to 30 years, and they smoked at least a pack a day, then they were less likely to change their desire to quit because they had gotten to a point of no return in their smoking habits," Calvert said,

Calvert also noted that the younger smokers made a game out of the smokerlyzer, trying to see who could get the highest readings, but the older participants didn't want to know how bad their results were.

Kerley and Calvert worked with Eric Fisher, assistant professor at the University of Louisville/ Glasgow Family Medicine Residency, and Brent Wright, associate dean of rural health innovation at UofL/ Glasgow FMR on their research. They presented their findings in Frankfort, along with other student researchers.

Baptist Health lays off 288, loses its CEO amid losses

Steve Hanson
Kentucky's biggest hospital operator, Baptist Health, is going through a shakeup.

The not-for-profit firm said last week that it would lay off 288 employees, most of them at its Louisville headquarters, and it announced Tuesday that its CEO for the last four years, Steve Hanson, is leaving “immediately.”

Baptist Health has been losing money for more than a year.
Baptist wouldn’t comment further, "but the organization has reported operating losses for the last five quarters, including a $28.3 million loss for the three-month period ended November 30," notes Chris Otts of WDRB.com. "It lost $41 million in its most recent fiscal year ended Aug. 31, 2016."

“We appreciate Steve Hanson’s contributions to Baptist Health over the past four years,” Allen Rudd, the chairman of the nonprofit’s board of directors, said in a press release. He declined to be interviewed.

The release said Baptist will be led for the time being by Vice President and Chief Legal and Regulatory Affairs Officer Janet Norton and Chief Financial Officer Steve Oglesby, who have been with the firm for more than 20 years.

Baptist has eight hospitals in Kentucky (in Louisville, Lexington, Corbin, LaGrange, Madisonville, Paducah, Richmond and Elizabethtown) and recently bought Floyd Memorial Hospital in New Albany, Ind., next to Louisville. It said last week that the layoffs were not related to that $301 million purchase.

"More than three million people live in Baptist’s service area, and more than 300,000 people visited Baptist Health emergency rooms in fiscal 2015," Boris Ladwig reports for Insider Louisville. "In Kentucky, the organization ranks first in the number of admissions, cancer patients, outpatient visits and births, and second in ER visits and open heart surgeries. One out of every four babies in Kentucky is delivered at a Baptist Health facility."

Better-off Kentuckians exercise more; foundation CEO says policymakers can help increase access to exercise venues

By Melissa Patrick
Kentucky Health News

Health status and income matter when it comes to being physically active. Kentucky adults who reporting good health and higher incomes also saying they are more physically active than those reporting fair or poor health or lower incomes, according to the latest Kentucky Health Issues Poll.

"One of the things policy makers and communities can do is make it easier for residents to get exercise in their own neighborhoods," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, a poll sponsor, said in the news release. "The U.S. Office of Disease Prevention and Health Promotion says all adults should avoid inactivity, and those who participate in any amount of physical activity will gain at least some health benefits."

The poll, conducted Sept. 11 through Oct. 19, found that eight in 10 Kentucky adults said they were physically active, with 30 percent of this group reporting they were "very physically active" and 49 percent of them reporting they were "somewhat physically active."

However, these responses varied by health status and income.

Almost nine out of 10 Kentucky adults who reported excellent, very good or good health said they were very or somewhat physically active, compared to only 54 percent of those reporting fair or poor health. And those with higher incomes reported more activity than those with lower incomes, 84 percent and 76 percent respectively.

The survey also asked respondents if their neighborhood is a good place to walk, jog or bike. It found that 76 percent said their neighborhoods were excellent, very good or good for these activities, while 24 percent said their neighborhoods were only fair or poor.

But when asked if they had sidewalks and road shoulders to walk on, the results weren't as positive. Half said their neighborhoods rated excellent, very good or good for this measure and 44 percent said their neighborhoods rated fair or poor.

The survey also asked about safety for exercise; 46 percent said their neighborhoods were safe, 35 percent said they were somewhat safe and 19 percent said their neighborhood was somewhat unsafe or not safe at all for exercise.

Neighborhood exercise conditions also varied by region. Excellent, very good or good neighborhoods for physical activity were reported by 84 percent from Louisville; 81 percent from Lexington; 78 percent from Western Kentucky; 77 percent from Northern Kentucky; and 61 percent from Eastern Kentucky.

Two-thirds of Kentucky adults said increasing their level of exercise would improve their overall health. One-fourth said it would make no difference and 7 percent said it could make their health worse. This attitude varied with education. Those with more education were more likely to say that increased activity would improve their health, compared to those with less education who were more likely to say it would make no difference.

"The foundation is funding demonstration projects to improve neighborhood conditions, such as the health park in Paducah that includes a walking trail, playground and community garden. Kids who learn good physical activity habits will grow up to be healthier adults," Chandler said.

The poll was funded by the foundation and Cincinnati-based Interact for Health. It surveyed a random sample of 1,580 Kentucky adults via landlines and cell phones, and has an error margin of plus or minus 2.5 percentage points.

Sunday, March 19, 2017

Kentucky lawmakers have passed several health-related bills to deal with the opioid epidemic, and could pass several more

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The 2017 General Assembly has passed several bills meant to put more "tools in the toolbox" as the state works to combat its growing opioid epidemic.

And several more are in the pipeline to pass when lawmakers come back March 29 and 30. Those two days are provided to reconsider any bills Gov. Matt Bevin vetoes, but legislation in the pipeline can also get initial passage. It would be subject to a veto without the opportunity for an override.

Opioid-related bills that have passed:

House Bill 314, sponsored by Rep. Danny Bentley, R-Russell, would require hospitals to report positive drug tests to the Cabinet for Health and Family Services,, including results from newborn babies if the provider thinks they have been exposed to drugs. This data would be entered into the KASPER (Kentucky All Schedule Prescription Electronic Reporting) database and would give federal prosecutors, medical professionals and pharmacists access to the system.

The bill would also require hospitals and emergency departments to report all drugs with a high potential for abuse that are dispensed to patients during their stay, exempting Schedule III and IV drugs if they are dispensed for a maximum of 48 hours and not dispensed by a hospital's emergency department. The bill also requires the reporting of all positive drug tests conducted in an ER. This bill has passed both houses and been delivered to the governor.

HB 158, sponsored by Rep. Kim Moser, R-Taylor Mill, brings state controlled-substance listings into compliance with federal policy. This bill has been delivered to the governor.

Senate Bill 32, sponsored by Sen. Danny Carroll, R-Paducah, would require the Administrative Office of the Courts to forward drug-conviction data to the health cabinet for inclusion in KASPER. This bill has been delivered to the governor.

Likely to pass: 

HB 333, sponsored by Moser, would limit painkiller prescriptions such as oxycodone and morphine to a three-day supply if prescribed for acute pain, with exceptions for the terminally ill and some other circumstances.

The bill would also increase jail time for those who deal in the synthetic opioid pain killer fentanyl or any derivative of it, as well as carfentanil, which is used as an elephant tranquilizer. It would make it a felony to bring any amount of fentanyl, fentanyl derivative, or carfentanil into the state for sale or distribution. And it would create a felony offense for those who misrepresent a controlled substance including fentanyl, fentanyl derivatives or carfentanil as a legitimate prescription drug.

Also, HB 333 would ease penalties for those found guilty of selling less than two grams of heroin and excludes cannabidoiol, or CBD, products from the definition of marijuana under state law if the products are approved as a prescription medication by the U.S. Food and Drug Administration. This bill passed the House and a Senate committee and is in the Senate Judiciary Committee with two readings.

HB 305, sponsored by Moser, is meant to improve treatment options and costs associated with involuntary treatment for alcohol and drug addiction under Casey's Law.

The bill would allow a judge to order a person to undergo treatment for up to a year with the option of an additional year, and limit the costs that could be incurred by a family member or friend who asks the court to order involuntary treatment for a loved one, among other provisions. This bill unanimously passed the House, passed a Senate committee and is now on the Senate floor.

HB 308, sponsored by Rep. Addia Wuchner, R-Florence, would require Kentucky health insurers to have at least two abuse-deterrent opioid painkillers in their formulary and prohibit the substitution or dispensing of an equivalent drug product without documentation from the prescribing provider.

Abuse-deterrent opioid analgesic drugs cannot be crushed, snorted, or injected by drug abusers as readily as other opioids can. This bill passed the House and a Senate committee and has had one reading in the Senate. Bills need three readings on separate days before they can get a floor vote.

HB 145, sponsored by Rep. James Tipton, R-Taylorsville, would require age-appropriate physical and health education instruction about prescription-opioid abuse prevention and the connection between abuse and addiction to other drugs. This bill unanimously passed the House, passed a Senate committee and is on the Senate floor with two readings.

HB 454, Rep. Johnathan Shell, R-Lancaster, would require the Kentucky Department of Education and others to develop an age-appropriate drug awareness and prevention program and would require local school boards to ensure that students receive annual instruction in drug awareness and prevention, starting next academic year. The bill passed the House and a Senate committee, and resides in the Senate Education Committee with two readings.

After meeting with Trump, Rep. Andy Barr tells town meeting that he will vote 'enthusiastically' for Republican health-reform bill


Lexington Herald-Leader video

A day after meeting with President Trump, Republican U.S. Rep. Andy Barr of Lexington told constituents Saturday that he would vote for the health-reform bill proposed by leaders of his party because it is the only alternative to Democrats' 2010 reform law.

Asked if he would vote against the bill, “I’m not going to vote no on something that’s better than the status quo. I’m going to vote yes enthusiastically.”

Barr met with about 150 people at Eastern Kentucky University in Richmond, reports Kevin Wheatley of Spectrum News: "Many in the audience repeatedly jeered and interrupted as Barr defended aspects of both proposals and touched on other topics like climate change and banking reform."

The meeting came the day after Barr and several other Republicans met in the Oval Office with Trump, who said they all had been planning to vote against the bill, or "maybe" vote no. But as a result of discussions that will lead to changes in the bill, including work requirements for able-bodied Medicaid members without dependents, "Every single person in this room is now a yes," Trump said.

"Barr said the bill will lower health insurance costs for many, provide people with more choices and will eliminate a government mandate to buy insurance," Daniel Desrochers reports for the Lexington Herald-Leader.

"He said the bill keeps some popular elements of Obamacare, which he called a disaster, such as ensuring coverage for people with pre-existing conditions and allowing children to stay on their parent’s insurance plans until they turn 26. Plus, Barr said, the bill would reduce the federal deficit and would cut taxes by $600 billion."

"The audience wasn’t buying it," Desrochers reports. "They cited a report issued by the Congressional Budget Office that said about 24 million people would lose health coverage, either in the private marketplace or through Medicaid, under the Republican proposal. They also cited studies that showed the bill would significantly raise health care costs for older and low-income Americans."

Barr said the non-partisan CBO wrongly predicted enrollment under the 2010 Patient Protection and Affordable Care Act, and noted that Republicans have two more instruments to change the law: administrative regulations and a second bill that, unlike the current one, will be subject to a filibuster in the Senate.

The current bill would end the expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level. Barr's 6th District has 75,100 people on expansion Medicaid, including the son of a woman who asked Barr about her son. “If your son is currently enrolled in Medicaid, he won’t be taken off,” Barr replied.

Desrochers writes, "That is true, but many Medicaid recipients have incomes that vary from year to year and could potentially lose coverage if they take a job that doesn’t last long."

Barr told Wheatley after the meeting, "There is some concern, as was voiced in our town hall today, that older Americans who are not yet Medicare-eligible but aren’t getting health care through work, they may need a stepped-up tax credit in order to afford the higher level of costs associated with their health plan,” he said. “That is another change that could be made.”

Here is Wheatley's report:

New Medicaid boss, mentor Pence and Trump seek changes in program like some Bevin has asked her agency to approve for Ky.

Seema Verma (Getty Images)
By Al Cross
Kentucky Health News

The newly confirmed director of the nation's Medicaid program quickly served notice that she wants states to make changes like those she has helped make in Indiana and helped design in Kentucky, including work requirements. Then President Trump and key members of the U.S. House backed her up, in an effort to pass their initial bill to repeal and replace the Patient Protection and Affordable Care Act.

The Senate voted 55-43 Monday night to confirm Seema Verma, an Indiana health care consultant and protégé of Vice President Pence, to run the Center for Medicare and Medicaid Services. The next day, she and Health and Human Services Secretary Tom Price sent a letter to governors, "urging states to alter the insurance program for poor and disabled people by charging them insurance premiums, requiring them to pay part of emergency-room bills and prodding them to get jobs," Amy Goldstein reports for The Washington Post. The letter "also derides the Medicaid expansion that 31 states and the District of Columbia adopted under the Affordable Care Act."

Under Pence as governor and Verma as his consultant, Indiana expanded Medicaid, but under a federal waiver of certain Medicaid rules. Then Verma helped design a waiver request for Kentucky that would establish small, income-based premiums, impose work-related requirements and make other changes. That request is now pending before her agency, and Gov. Matt Bevin has suggested that it will not only be approved, but expanded to include other changes that the Obama administration frowned upon.

Critics of the Indiana plan say it "has been confusing for beneficiaries and some have incurred penalties through no fault of their own," reports Ricardo Alonso-Zaldivar of The Associated Press. "At her Senate confirmation hearing, Verma defended her approach by saying that low-income people are fully capable of making health care decisions based on rational incentives."

The letter from Verma and Price called for "a new era" in Medicaid "where states have more freedom to design programs." They said, "The best way to improve the long-term health of low-income Americans is to empower them with skills and employment."

However, "Such requirements would be nearly impossible to enforce, conservative and independent experts on the Medicaid program said Friday," Max Ehrenfreund reports for The Washington Post. "About 78 percent of adults enrolled in Medicaid who are not elderly live in households with at least one person working, according to an analysis by the nonpartisan Kaiser Family Foundation. Those who are not working might have good reasons for doing so, said Diane Rowland, an executive vice president at the foundation." The foundation says "about 18 percent of adult Medicaid beneficiaries who are not working are in school. Another 28 percent report that they are taking care of members of their family, and 35 percent say that they are sick or disabled." But work requirements are "a long-held goal of conservative reformers," Ehrenfreund reports.

To attract more votes from strongly conservative House members in a floor vote set for Thursday, March 24, Trump embraced amendments that the House Budget Committee said should be added to the bill. Those include allowing states to impose work requirements on healthy Medicaid enrollees who don't have dependents, Alan Fram and Erica Werner of The Associated Press report. Also, "The agreement would let states accept lump-sum federal payments for Medicaid, instead of money that would grow with the number of beneficiaries." However, "It seemed clear that GOP leaders remained short of the 216 votes they'll need, and additional changes were in the works."

Pence told a meeting of the financially conservative Club for Growth in Palm Beach, Fla., Saturday night, "We’re going to have an amendment to allow states to include a work requirement for able-bodied adults on Medicaid so we can ensure the program is there for people who actually need it." Earlier in the day, with Verma at his side, he told a crowd in Jacksonville, "We’re going to have an orderly transition to a better healthcare system in America that makes affordable, high-quality health insurance accessible for every American."

Beginning in 2020, the House Republican health-care bill backed by President Trump "would limit overall federal financing for Medicaid in the future. Taken together, those changes could leave 24 million more people uninsured by 2026, the Congressional Budget Office said Monday in an assessment," Goldstein notes. The impact would be greater in rural areas, The Wall Street Journal reports.

To see a Democratic-compiled rundown of how CBO thinks the bill would affect each of the 435 congressional districts, click here. Among Republican districts, Kentucky's 5th District has the third highest Medicaid expansion enrollment in the nation, about 105,000 out of the 440,000 expansion enrollees in Kentucky. The district also had the third largest decline in percentage of its population without health insurance, from 17.4 percent to 5.7 percent.

The 1st District, almost as rural, ranked 20th in decline of the uninsured, falling from 15.1 percent to 6.8 percent, with 76,000 in Medicaid expansion. The 2nd District was 25th, with an uninsured rate that dropped from 13.2 percent to 5.3 percent. It has 68,200 expansion enrollees. The 6th District has 75,100, the 3rd District 62,200 and the 4th District 53,000.

This story was first published on March 15 and was updated March 18, 19 and 20.

Saturday, March 18, 2017

Legislature passes bill requiring ads against nursing homes to include their correction plan and when problem was corrected

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The 2017 General Assembly has passed two bills long supported by the nursing-home industry and other health-care providers -- one to impose another obstacle on medical-malpractice lawsuits, and one that would require law firms to publish "complete information" in advertisements about long-term care facilities. Both bills are on their way to Gov. Matt Bevin.

Sen. Ralph Alvarado
Senate Bill 4 would require a panel of three medical-care providers and a non-voting attorney to review a malpractice claim before submitting it to a court. The panel would have nine months to render an opinion, but could be bypassed if all sides agreed. Trial judges would decide on the opinion's admissibility.

Similar legislation from Republican Sen. Ralph Alvarado, a Winchester physician, had passed the Senate in earlier sessions, but wasn't heard in the House, which was led by Democrats. Both chambers now have GOP majorities, but some House Republicans doubted the measure's constitutionality, so it was amended in that chamber and passed by only 51-45, with 11 Republicans joining 34 Democrats in voting against it. The Senate concurred with the changes March 3.

Proponents of medical review panels say they will cut down on frivolous lawsuits and lower malpractice insurance costs. Opponents say such laws have proven ineffective in other states and that they delay a person's right to a trial by jury.

Sen. Danny Carroll
The "truth in advertising" legislation, SB 150, would require that any advertising about a long-term care facility that includes information about surveys, inspections or investigations, also include the date of any report, the facility's plan of correction and the date the deficiency was corrected. The ad must also state that it is not authorized or endorsed by any government agency. And all of this information must be in the same color, type font and size as the other language on the publication and be equally prominent.

The bill, which raises constitutional questions about freedom of speech, is aimed at ads from lawyers seeking plaintiffs to file lawsuits against nursing homes. It awaits Bevin's signature or veto.

The sponsor, Sen. Danny Carroll, R-Paducah, said during the bill's Senate hearing that most of these "unscrupulous and unethical" advertisements come from out-of-state law firms and that this measure "creates a level playing ground." In his legislative update, Carroll said this bill "will in no way restrict civil discourse or lessen accountability for long-term care facilities."

Bills can still be passed when legislators reconvene March 29 and 30 to reconsider any bills the governor has vetoed.

Alvarado is the sponsor of SB 18, which would ban doctors' peer reviews at hospitals from being used as evidence in malpractice cases.

Rep. Chad McCoy (Image from KET)
This bill has passed the Senate and a House committee and is before the House, with an amendment filed by freshman Rep. Chad McCoy, R-Bardstown, that would exempt statements of fact from the ban.

In effort to get around McCoy's amendment, language from SB 18 has been included in amendments to several other bipartisan bills that involve children. One of those includes House Bill 524, sponsored by Rep. Addia Wuchner, R-Florence, aimed at protecting children from sex trafficking. The bill awaits a vote on the Senate floor.


Friday, March 17, 2017

Legislature passes bills to name caregivers, help smokers quit; could still pass dense-breast notice and student-concussion bills

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Kentucky lawmakers have passed bills this year to make sure someone knows how to care for you when you leave a hospital, expand the role of pharmacists, increase access to smoking cessation, and offer some hope to terminally ill patients, among other health-related measures.

The bills now await Gov. Matt Bevin's signature or veto. Legislators will reconvene March 29 and 30 to reconsider any bills he vetoes; they could also pass additional legislation, but it would be subject to a veto without the opportunity for a override. Now that both houses of the General Assembly are controlled by the governor's party, such eleventh-hour legislation may be more likely.

Health bills that have passed

The "Kentucky Family Caregivers Act," Senate Bill 129, would require hospitals to record the name of a lay caregiver when a patient is admitted, notify that person when the patient is moved or discharged, and instruct the caregiver on the medical tasks he or she will need to perform when the patient goes home. The patient can decline this request. The bill, sponsored by Sen. Paul Hornback, R-Shelbyville. passed unanimously through both chambers and awaits the Governor's signature.

AARP, which supports this legislation, estimates that there are 650,000 family caregivers in Kentucky who save the state around $7 billion a year in health-care costs. AARP said in a statement that the bill will save even more money by improving post-discharge outcomes, reducing hospital readmissions and better allowing Kentuckians to recover at home, where they want to be.

The "Right to Try" bill, SB 21, also awaits the governor's signature. Sponsored by Sen. C.B. Embry Jr., R-Morgantown, it would make it easier for terminally ill patients to use experimental treatments. Terminal patients would be able to try drugs that have successfully completed the first phase of clinical trials but have not yet been approved by the U.S. Food and Drug Administration, with appropriate documentation from their health-care provider and approval of the drug company. The bill passed unanimously through the Senate and cleared the House 87-7.

"Right to Try" legislation has passed in 33 states and has been introduced in Congress, and has the support of Vice President Pence, Bloomberg News reports.

Kentucky lawmakers passed two bills that would expand the role of pharmacists.

SB 101, sponsored by Sen. Julie Raque Adams, R-Louisville, would allow pharmacists to administer all age-appropriate immunizations to minors aged 9 to 17. Current law allows pharmacists to administer flu vaccines starting at age 9, but for all other vaccines, pharmacists can only administer to minors starting at age 14. This bill unanimously passed both chambers and awaits the governor's signature.

SB 205, sponsored by Sen. Stephen Meredith, R-Leitchfield, would allow pharmacists to dispense a 90-day-supply of a non-controlled maintenance drug, such as those for blood pressure or high cholesterol, unless the prescription provides to the contrary. The bill passed unanimously in both Chambers and awaits the governor's signature.

Only one bill aimed at decreasing the state's high smoking rate has passed this session. SB 89, sponsored by Adams, would require all Kentucky health plans, including Medicaid, to provide barrier-free access to any smoking-cessation treatments approved by the U.S. Preventive Service Task Force. Some insurance companies have barriers to treatment, such as co-payments and prior authorizations. Bevin signed the bill March 21.

Health bills unlikely to pass

SB 78, which would have made Kentucky's schools 100 percent tobacco free, passed the Senate but couldn't get enough support among Republicans who control the House to be brought up in committee.

Two other bills aimed at protecting the health of children made no headway: House Bill 252, which would require an automated external defibrillator in every school; and HB 122, which would require children up to the age of 12 to wear a bicycle helmet.

Three bills that would increase the state's access to health-care providers also did not pass this session. SB 158 would repeal the requirement for nurse practitioners to work under a collaborative agreement with a physician to prescribe narcotics and some other controlled substances, and for the first four years of prescribing other drugs. HB 19 and SB 55 would have permitted physician assistants to prescribe and dispense controlled substance. The bills may have been hamstrung by the state's epidemic of opioid abuse.

Another bill that is dead this session is Senate Bill 108, dubbed the "Palliative Care" bill. This bill passed the Senate unanimously, but Rep. Addia Wuchner, chair of the House Health and Family Services Committee, says it needs more work. The bill's aim is to use training and education to increase access to palliative care, which is aimed at providing the best quality of life possible for patients with chronic or terminal diseases.

Health bills that could pass

One health bill likely to pass in the final two days is HB 78, which would require providers of standard mammograms to inform patients if they have "dense breast tissue" when appropriate, because such tissue can hide cancers. The notice would allow patients who have dense tissue the opportunity to determine with their provider if they need further screening.

Almost 40 percent of women have dense breast tissue, and some men do. They are twice as likely to develop breast cancer, Rep. Jim Duplessis, R-Elizabethtown, the bill's sponsor, said at the bill's hearings. The Dense Breast-info website says 27 states require some level of breast density notification after a mammogram. The bill passed unanimously through the House, passed a Senate committee and is before the full Senate.

Another bill that could pass would prohibit a coach from playing a student-athlete who has been diagnosed with or is suspected of having a concussion without written clearance from a physician. House Bill 241, sponsored by Rep. John Sims, D-Flemingsburg, passed unanimously in the House, passed a Senate committee and is before the full Senate.

This story was updated March 22.

Thursday, March 16, 2017

Though more have insurance and can see a doctor, Ky. shows little gain on health outcomes; Chandler says that takes time

By Melissa Patrick
Kentucky Health News

The percentage of Kentuckians without health insurance has dropped by more than half since the implementation of the Patient Protection and Affordable Care Act three years ago, and few of the insured are having trouble finding a doctor when they need one, according to a report for the Foundation for a Healthy Kentucky.

However, the report also said little progress has been made to improve Kentuckians' health-care quality and health outcomes since the law was fully implemented in 2014.

"The ACA has led to clear progress for many Kentuckians in three of the five areas we tracked: insurance coverage, access to regular doctor visits and health-care costs for families," said Ben Chandler, president and CEO of the foundation. As for health-care quality and outcomes, he said, "Often, it takes longer to see these results; you don't turn around low birth weights or lengthen average lifespans in a couple of years."

The report found that since the implementation of the ACA, Kentucky's uninsured rate dropped to 6.1 percent from 13.6 percent. The highest coverage increase came in Medicaid and the Children's Health Insurance Program; 13.4 percent of Kentuckians had such coverage in 2012, and 19.8 percent had it in 2015.

Kentucky and other states that fully expanded Medicaid under the ACA saw the greatest increases in coverage. Neighboring states that expanded Medicaid had uninsured rates of 7 percent or lower; those that didn't, such as Tennessee, had rates of 9.1 percent or higher. It also noted that two neighboring states that expanded Medicaid through an "alternative" approach, like Kentucky has proposed to do, have uninsured rates similar to the non-exemption states.

The report also found that more Kentuckians said they had seen a health-care provider in the year prior to being surveyed (73.8 percent in 2012, rising to 78.7 percent in 2015) and fewer Kentuckians said they were delaying or skipping health care because they couldn't afford it (dropping from 11.7 percent to 6.5 percent). However, this wasn't true for the poorest and sickest Kentuckians who said health care cost still kept them from getting the care they needed.

Contrary to assertions by Republican Gov. Matt Bevin, the report says there is no evidence that the newly insured in Kentucky are having trouble finding a doctor when they need one, nor have they had an increase in average out-of-pocket spending on health care since 2012.

"Nearly 95 percent of Kentuckians could still find a doctor when they needed one," said Chandler, who voted against the ACA when he was a Democrat representing the 6th District in 2009.

Other improvements included fewer elderly Kentuckians delaying prescription refills or skipping or reducing medication doses because of high drug costs; a more than 500 percent increase in the number of covered substance-abuse treatments through Medicaid; a drop in the number of Kentuckians having trouble paying their medical bills; and lower monthly premiums in Kentucky's marketplace compared to most surrounding states and the U.S.

The report also looked at "quality-of-care" indicators and found they had neither improved nor declined since the ACA was implemented.

It noted that three of the quality measures that they looked at had "shown some progress," including the number of infants who were breastfed at discharge from the hospital, preventable hospitalizations due to high blood pressure, and asthma and colorectal screenings. It also noted that the state's smoking rate had dropped from 28.3 percent in 2012 to 26 percent in 2015, though the high-school student smoking rate had a smaller decline, from 17.9 percent in 2013 to 16.9 percent in 2015.

The report cites negative trends related to health behavior. Preventable hospitalizations due to short-term complications from diabetes increased, and the state's obesity rate rose from 31.3 percent in 2012 to 34.6 percent in 2015.

Chandler noted that some health measures, especially related to chronic health issues, may have worsened at first but then improved because many Kentuckians were seeing providers for the first time and were newly diagnosed. He noted that this increased access to care will ultimately improve the health of Kentuckians and decrease health care cost in the future.

"Myriad factors contribute to health and it takes time to change the tide in health outcomes," Chandler said. "In the long run, though, increased coverage, improved access and lower costs lead to better quality and outcomes. That's why I'm grateful Kentucky continues to support Medicaid expansion. We all want to sustain the gains we've achieved under the ACA and see the long-term benefits of increased coverage and access."

The foundation's study on the impact of the ACA over its first three years in Kentucky was conducted by the State Health Access Data Assistance Center at the University of Minnesota. Click here to see the full report.

Bill passes to decrease smoking; one doesn't; lawmakers set to pass resolution for feds to ditch plan to limit tobacco carcinogen

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Smoke-free advocates would say that this legislative session's record is 1-2.

That's because Kentucky lawmakers have passed one bill that will increase access to smoking-cessation treatments, but can't find enough support to pass one that would make Kentucky schools 100 percent tobacco-free -- and are poised to pass a resolution that asks federal officials to withdraw a proposal that would reduce the carcinogen levels in smokeless-tobacco products.

Sen. Julie Raque Adams' bill to decrease insurance barriers to smoking-cessation treatments is one of two tobacco-related bills that passed this legislative session and is on its way to the Governor for his signature.

The Patient Protection and Affordable Care Act requires all insurance policies to cover smoking-cessation treatments, but insurance barriers, like co-payments, prior authorization requirements and limits on length of treatment, make them not readily available.

Senate Bill 89 would require barrier-free access to all U.S. Preventive Services Task Force-recommended smoking cessation treatments in all Kentucky health plans, including Medicaid.

The other tobacco bill, sponsored by Sen. Ralph Alvarado, R-Winchester, which would have banned tobacco use on all school properties and at school events, is all but dead in the state House, despite its quick passage in the Senate.

Just over half of Kentucky's public-school students are in school districts with tobacco-free policies: 62 of the state's 173 districts, covering 654 schools.

Kentucky's high school students have a higher smoking rate than the national average, 17 percent compared to 15 percent; and 24 percent of them use electronic cigarettes, according to the 2015 Youth Risk Behavior Survey. The survey also found that 22.5 percent of the state's middle-school students have tried smoking.

Alvarado called Senate Bill 78 "low-hanging fruit" because it involves the health and safety of Kentucky's children and polling shows that 85 percent of Kentuckians support such an effort, but House Speaker Jeff Hoover said, "There was just not enough support in the caucus right now to do it."

Another piece of tobacco-related legislation introduced this session is a resolution that urges the the U.S. Food and Drug Administration to withdraw its proposal to reduce the levels of N-nitrosonornicotine, or NNN, a carcinogen, in all smokeless tobacco products sold in the U.S.

The FDA's proposal states,"NNN is a potent carcinogenic agent found in smokeless tobacco products and is a major contributor to the elevated cancer risks associated with smokeless tobacco. The FDA estimates that, in the 20 years following implementation of its proposed product standard, approximately 12,700 new cases of oral cancer and approximately 2,200 oral cancer deaths would be prevented in the U.S. because of this rule."

The resolution notes that the majority of farmers who raise the dark tobacco that makes up the main ingredient of smokeless tobacco products live in Kentucky and "raise approximately 24,000 acres of the crop with an estimated cash value of approximately $173 million per year."  It also says that the proposed standards in the FDA proposal are "technically unachievable" and that the impact of this rule would be "far-reaching and onerous because of the negative impact on agriculture and on manufacturing jobs in Kentucky."

House Concurrent Resolution 48, sponsored by Walker Thomas, R-Hopkinsville, passed the House 69-3 and is expected to pass the Senate in the final two days of the session, after the veto recess. The FDA is accepting public comment on this proposal until April 10, 2017. Click here for directions.