Sunday, February 7, 2016

Clinton County Healthy Hometown Coalition publishes testimonials from local residents who turned their health around

Part of the reason for news coverage of health topics is to help readers, listeners and viewers live healthier lives. That usually requires a change in their behavior, which doesn't come easy. One of the better motivators can be personal testimonies from people in similar situations. That approach is being taken by the Clinton County Healthy Hometown Coalition, a project funded by the Healthy Hometowns program of the Foundation for a Healthy Kentucky.

The coalition has a column in the weekly Clinton County News, where coordinator April Speck often shares the stories of people who adopted healthier lifestyles: losing weight, increasing physical activity, eating more fruits and vegetables and so on. Right: most recent example; click on it for larger version.

"We started highlighting folks mainly because it's more personal to show success rather than talk about it," Speck told Kentucky Health News. She said the series is also "a personal tribute my brother, who helped inspire [us] saluting folks." He began "making healthy choices, eating right and exercising daily," decreased his body-mass index and lost 53 pounds, she said.

Speck said she has had no trouble finding examples after the first one. "Once I highlighted the first person then I was getting emails, calls and ideas of other folks, so basically the community helped me recruit folks," she said. So far, there have been eight columns with personal examples, and "We will continue to highlight folks who have made healthy lifestyle changes," she said.

Of course, a community doesn't need a a foundation-funded coalition to learn about local lifestyle changes that make a difference and set an example. All it needs is a newspaper or other media outlet that seeks out these uplifting stories.

Friday, February 5, 2016

Pineville Community Hospital restructures debt and creates a geriatric psychiatric unit; 326 jobs saved and 12 new ones created

A combination of local, state and federal efforts have saved more than 300 Pineville Community Hospital jobs and created 12 new ones, according to a Kentucky Highlands Investment Corp. news release.

KHIC worked with First State Financial and the hospital to restructure the hospital's existing debt into a $3.1 million Business and Industry Guaranteed Loan from the U.S. Department of Agriculture, which allowed the bank to provide private working capital through a $3 million line of credit from First State, according to the release.

“The $3.1 million USDA loan guarantee is important to the Pineville community in many ways: It provides residents access to quality health care, supports the employment of 326 employees and allowed for the creation of 12 additional jobs,” Tom Fern, Kentucky director for USDA Rural Development, said in the release. “In a time when the region has seen a significant loss of employment, these existing and new jobs being created by Pineville Community Hospital are critical.”

In addition to restructuring its existing debt, the hospital used some of the funds to convert an unused labor-and-deliver wing into a 12-bed geriatric psychiatric unit and used other funds for repairs.

“Research showed this type of service was not being offered within 30-mile radius, which affects more than 38,000 residents," hospital CEO Stace Holland said in the release.

U.S. Rep. Hal Rogers said in the release. “I commend the board of directors for not only diligently working to protect the jobs at this facility, but for having the vision to expand health care in an area under-served for mental-health concerns.”

Parent firm of Medical Center at Bowling Green takes over bankrupt Albany hospital, adding to its regional network

"Commonwealth Health Corp. has assumed management of Clinton County Hospital effective immediately," Alyssa Harvey reports for the Bowling Green Daily News. The parent firm of The Medical Center at Bowling Green plans to complete its acquisition of the Albany hospital, which has been in bankruptcy, in March. After that it will be called The Medical Center at Albany.

The company also has acquired and given similar names to the old Caverna Memorial Hospital in Horse Cave and similar facilities in Franklin and Scottsville. The Albany hospital is the greatest distance from Bowling Green, 88 miles. It is in a county of 10,000 on the Tennessee border south of Lake Cumberland.

CHC Vice President Doris Thomas said, "We know how important community hospitals are and how important it is to have good quality health care close to home, so we're happy to provide this to the residents of Clinton County. Acquiring the Clinton County Hospital will help us further our mission."

J.D. Mullins, former administrator of the 42-bed hospital, told Harvey that it has been housing 13 to 17 patients a day and treating about 16 per day in its emergency department. It recently converted one floor to a skilled nursing facility.

The hospital has blamed its problems on federal budget cuts and changes in Medicare and Medicaid, which provide more than 80 percent of the hospital's revenue -- particularly the managed-care companies that oversee Medicaid. It was also burdened by a nearly $18 million debt on a federal loan it used to expand and modernize in 2008. The Department of Agriculture forgave just over half the debt last summer.

The move continues a round of consolidations involving rural hospitals in Southern Kentucky. TJ Samson Community Hospital of Glasgow is buying the bankrupt Westlake Regional Hospital in Columbia. A study by the state auditor's office last year said as many as one-third of Kentucky's rural hospitals are in financial trouble.

Health cabinet offers no budget-cut details at committee meeting; legislators say they need this information to draft budget

Democrats on the state House Budget Subcommittee on Human Services pressed the Cabinet for Health and Family Services for more details on how it planned to implement Republican Gov. Matt Bevin's proposed budget cuts of 4.5 percent in the fiscal year that ends June 30 and 9 percent in the upcoming biennium, Kevin Wheatley reports for cn|2's "Pure Politics."

"The CHFS budget includes proposals to raise wages for social workers, assist community mental health centers and local health departments with rising retirement cost and increase funding for child advocacy centers, among others," Wheatley notes.

The budget will not cut Medicaid funding, Bevin said at his Jan. 26 budget speech, although his administration is negotiating with federal officials for changes to the program to make it less costly. In the same speech, he also promised to end the Medicaid expansion if this is not accomplished.

Former Gov. Steve Beshear, under federal health reform, expanded Medicaid to include those with incomes up to 138 percent of the federal poverty level to join the program. Since then, Medicaid has added about 425,000 Kentuckians to its rolls.

Secretary Vickie Yates Brown Glisson
CHFS Secretary Vickie Yates Brown Glisson told the committee Feb. 3 that her staff was "still considering what to cut within social services, public health, aging services, mental health and other key areas that fall within her cabinet," Deborah Yetter reports for The Courier-Journal.

Glisson said it would be early March before she would have more answers about the cuts, although she believed they would not impact the cabinet's essential services, Wheatley reported.

The lack of detail didn't set well with the lawmakers, Wheatley noted. Committee member Rep. Jim Wayne, D-Louisville, told Glisson that they needed this information sooner than that so the House, which originates the budget legislation, could have time to get it drafted and sent to the Senate for action.

“The process here is that we need to review this budget and we need to know its impact as soon as possible because we’ve started this process now, and essentially you’re saying, ‘I don’t have the information to give you to do the work that you as the committee members need to do,’” Wayne said. “So two weeks is really, in this process, I think is long.”

Rep. George Brown, D-Lexington, asked exactly how much it was going to cost the state to dismantle Kynect, the health-insurance exchange Beshear created, and move to the federal exchange. Beshear’s administration said moving to the federal exchange would cost the state $23 million, but Bevin has disputed that amount, apparently expecting the federal government to pay most of the bill.

Andrew McNeill, a senior adviser to Bevin, told the committee the administration had some "preliminary quotes" that weren't "anywhere close" to the previously cited $23 million, but couldn't share them because they weren't final. He also said the 1 percent assessment on insurers to pay for Kynect would be used to dismantle it.

Rep. David Watkins, a Henderson Democrat and retired physician, expressed his disappointment in losing Kynect, saying the exchange helped Kentuckians get coverage and often helped people discover they were eligible for Medicaid: "It is going to be much harder for them to sign up for the programs available to them."

Wheatley reports, "Glisson said the cabinet will have a new computer system available at its local offices for residents to enroll in health coverage through the federal exchange or in Medicaid. She also suggested that some 'Kynectors', or workers hired to help residents navigate the state exchange, could remain during the transition."

Rep. Addia Wuchner from Burlington was the only Republican lawmaker who spoke during Wednesday’s meeting, "praising Bevin’s budget proposal and saying that access to health care doesn’t necessarily improve health outcomes," Wheatley reports.

Thursday, February 4, 2016

Kentucky leads the nation in percentage reduction of citizens without health insurance, according to Gallup polling

Kentucky and Arkansas continue to lead the nation in reduction of the percentage of their people without health insurance, according to polling by Gallup Inc.

They were the only Southern states to expand Medicaid and have a state health-insurance marketplace under the Patient Protection and Affordable Care Act.

In both states the uninsured rate was cut by well over half. Kentucky's dropped to 7.5 percent from 20.4 percent; Arkansas' dropped to 9.6 percent from 22.5 percent.

Both states registered a decline of 12.9 percentage points, but in percentage terms, Kentucky's was larger, 63.2 percent, to Arkansas' 57.3 percent. Oregon's rate declined 62.3 percent, for second place.

With 7.5 percent still uninsured, Kentucky still trails several states in the percentage of population that does have health insurance, as illustrated by this map from Gallup:

"Americans' attitudes about the health law known as 'Obamacare' have shown little change since 2013," Dan Witters reports for Gallup. "More Americans continue to disapprove of the law than approve of it, even as uninsured rates for nearly all states have declined since that time. Political identity is closely related to approval or disapproval of the ACA, so entrenched attitudes toward the Obama presidency are likely driving the stability in Americans' views of the ACA."

Tuesday, February 2, 2016

Share of Kentuckians without health coverage dropped to 7% in third quarter, lower than all neighboring states except W. Va.

Illustrations are from the report; click on images for larger versions
An ongoing study of federal health reform's impact in Kentucky has found that Medicaid expansion continues to help lower the number of Kentuckians without health coverage, which dropped to 7 percent in the third quarter of 2015. The uninsured rate was 9.8 percent in 2014, the first year of the expansion and federally subsidized health insurance. In 2013, it was 20.4 percent.

This rate is lower than the U.S. uninsured rate of 10.6 percent and "significantly lower" than four of the seven adjoining states plus Arkansas, said the Foundation for a Healthy Kentucky. The foundation is paying the State Health Access Data Assistance Center at the University of Minnesota more than $280,000 to study how the Patient Protection and Affordable Care Act is affecting Kentuckians. Data from this third-quarter report covers the July-September period.

Under health reform, then-Gov. Steve Beshear, a Democrat, allowed those with incomes up to 138 percent of the federal poverty level to enroll in Medicaid. Republican Gov. Matt Bevin's administration is negotiating with federal officials for changes to the program that would make it less costly. The federal government is paying for the expansion through this year; next year states will start paying 5 percent, rising in annual steps to the law's limit of 10 percent in 2020.

Bevin has said that Kentucky can't afford to pay for the expansion. During his Jan. 26 budget speech said of the negotiations with federal officials, "If we cannot get it done we will not have the ability to have expanded Medicaid in the state of Kentucky."

One of the essential health benefits of the reform law is free preventive health care, a benefit that thousands of newly insured Kentuckians have used.

The study found that during from July to September, Medicaid funded 1,180 diabetes screenings; 9,806 breast cancer screenings; 6,227 colon cancer screenings, with 5,561 of those for Medicaid expansion participants; and 82,056 dental services. In addition, Medicaid paid for 7,797 deliveries.

Treatment for substance abuse increased to 7,993 people during this quarter, up from 6,660 in the last quarter. The total included 5,758 Medicaid expansion participants.

This year, Kentuckians shopping for health insurance had more plans than ever to choose from on the state's online health insurance marketplace, Kynect. The report noted that the exchange offered 60 plans in the enrollment period that ended Jan. 31, compared to 40 the year before.

And compared to Kentucky's neighboring states, the study found that Kynect had the lowest median premiums for the "silver" level plan at $585.01. This was based on premiums for a 30-year-old couple with two children.

Bevin says he will abolish Kynect and have Kentuckians use the federal exchange; it remains to be seen whether insurers will put as many, more or fewer Kentucky plans on that exchange.

The study found that Medicaid enrollment remains concentrated in Eastern Kentucky, with 31 percent of the total; followed by Western Kentucky with 26 percent.

Apollo 8 and 13 astronaut Jim Lovell to speak at UK Center on Aging Foundation's annual fund-raising dinner April 7

Capt. Jim Lovell
Apollo 8 and 13 astronaut Jim Lovell will be the keynote speaker at the University of Kentucky Center on Aging Foundation annual dinner at the Lexington Center's Bluegrass Ballroom April 7. Proceeds from the event will support Alzheimer's disease research, education and clinical programs at the center.

Lovell, 87, is best known for his calm, careful command of his final space flight to the moon on Apollo 13 in 1970 when he reiterated those famous words, "Houston, we've had a problem." This happened after an explosion two days into the flight caused the mission to be aborted and Lovell and his crew had to convert their lunar module "Aquarius" into a lifeboat to get home safely.

Lovell was the pilot on Gemini 7, which involved the first manned spacecraft rendezvous; commander of Gemini 12; and command module pilot of Apollo 8, the first manned mission to orbit the moon. Lovell and his two crewmates gave humans their first long-range view of our planet and read a passage from the creation story in Genesis on Christmas Eve.

Individual tickets to the event are $175 and table sponsorships start at $1,500. For more information contact the foundation office at 859-323-5374 or click here for more information.

KentuckyOne Health promoting whole-food, plant-based diet, named No. 1 for heart health by U.S. news panel of experts

One in every eight Kentuckians suffers from diabetes, and the state ranks 12th in adult obesity, with 31.6 percent of its adults obese and 39 percent suffering high blood pressure, according to the State of Obesity report. These diagnosis generally results in recommendations for exercise and changes in diet, but what kind of diet?

KentuckyOne Health is promoting the Ornish Diet, a whole-food, plant-based diet that is naturally low in both fat and refined carbohydrates. The hospital chain says it is the only health-care provider in the state to offer the diet, starting in Louisville in July 2015 and in Lexington in October.

The diet was named the No. 1 Best Heart-Healthy Diet for the sixth year in a row by U.S. News & World Report. The magazine ranked it fourth Best Diabetes Diet, 11th Best Diet for Healthy Eating and 11th best overall diet. Nutrition and health experts determined the U.S. News rankings after reviewing information on 38 diet plans.

The first group of KentuckyOne patients using the diet averaged a loss of 7.5 pounds; three patients lowered their blood-pressure medication; and one patient who had diabetes came off his insulin and another is discussing coming off cholesterol medication after 25 years, according to a KentuckyOne news release.

The diet is part of the Ornish Reversal Program, which also includes exercise, meditation and cardiac rehabilitation strategies that include group support, the release said.

“It’s been amazing to see the interest we’ve had in the program from people across the state,” said Alice Bridges, vice president of healthy communities for KentuckyOne. “So much so, that even we’ve been surprised by it. I think we’re at a tipping point culturally where there is more openness to this kind of lifestyle change.”

In Kentucky, the Ornish Reversal Program is reimbursed for qualified and eligible members of Medicare and Anthem and Aetna insurance plans, and there is a discount for self-paying patients, says the release.

Monday, February 1, 2016

Stephanie Mayfield Gibson, former state health commissioner, assumes new role at KentuckyOne Health

Stephanie Mayfield Gibson
Former state health commissioner Stephanie Mayfield Gibson has joined the leadership team of KentuckyOne Health to coordinate its population health initiatives, according to a KentuckyOne Health news release.

Mayfield Gibson will serve as vice president of population health for KentuckyOne and chief medical officer for KentuckyOne Health Partners, its Medicare-approved accountable care organization.

Mayfield Gibson is a board-certified anatomic and clinical pathologist with 10 years of management experience in public health. She served as the commissioner for the state Department of Public Health from 2012 until the end of the Beshear administration in December 2015.

“From expanding Kentucky’s newborn screening to introducing new tuberculosis and heart disease testing technology, Dr. Mayfield Gibson has proven herself to be a warrior for the health of the people of the Commonwealth,” Don Lovasz, president of KentuckyOne Health Partners, said in the release. “We are thrilled to have a population health veteran like her join our team so we can make even greater strides improving the quality and value of Kentucky health care.”

Preliminary research finds a web-based reward program helps teens and pregnant smokers in Appalachia quit smoking

A new web-based program that uses a reward system to help people quit smoking has shown some promise in Appalachian Kentucky, an area that has some of the highest smoking and smoking-related disease rates in the nation, according to a University of Kentucky news release.

Brady Reynolds (UKNow photo)
The research is led by Brady Reynolds, a native of Appalachian Virginia who works in the Department of Behavioral Science in UK's College of Medicine. It is testing the "contingency management approach" on adolescents and pregnant smokers from Appalachia who have difficulty traveling to health centers for counseling and could potentially benefit the most from the new strategy.

Contingency management requires participants to log on to a website each day to record videos of themselves measuring the carbon monoxide levels in their blood with a breath test. This information is used to monitor the participants.

As participants cut back on the number of cigarettes they smoke, they are rewarded with either money or vouchers for rewards. The more progress they make, the greater the reward. Such programs have been successful with other addictive drugs, such as opiates and cocaine, the release says.

Though each of the studies have been small, they have shown promising results with roughly one-third of pregnant mothers stopping completely, and adolescent cigarette use being cut in half. Even more encouraging, six weeks after the studies concluded, most participants did not relapse.

Reynolds plans to increase the number of participants in future studies to see if these results hold. If they do, his team will work on making the program economically feasible for a larger population, says the release.

“Smoking during pregnancy is the leading cause of low birth weight and pre-term birth, and these infants often spend substantial time in neonatal intensive care units,which can be very costly for hospitals and insurers,” Reynolds said. “If we find our smoking cessation programs reduce preterm birth, then we can start making the argument to stakeholders for implementing the programs on a larger scale.”

One of the challenges associated with the program is the lack of broadband Internet in the region. The release notes that more than 95 percent of Reynolds’ participants needed to borrow Internet equipment for the studies.

The research is conducted out of the Appalachian Health Research Center near Morehead and is supported in part by UK's Markey Cancer Center, the National Cancer Institute and the Foundation for a Healthy Kentucky Endowed Chair in Rural Health Policy at UK. Reynolds and Tyrone "Ty" Borders of the UK College of Public Health are the co-chairs.

Eastern Kentucky stroke survivors in community support program get the support they need to keep from returning to the hospital

Early results of a new program show that stroke patients who get support with education, resources and care coordination after they leave the hospital are less likely to be readmitted, according to the University of Kentucky.

Community Transition Program Stroke Support Group (UKNow image)
The Community Transition Program, which serves Perry and surrounding counties in Eastern Kentucky, has provided this type of support to 23 stroke survivors since July 2015 by connecting a "patient navigator" with stroke survivors before they leave the hospital. The navigator communicates with the survivor during the next year or longer, helping them to better understand their health-care and insurance needs, and connecting them with community resources, including a support group.

“A lot of people who have had a stroke get home and they feel like they’re lost. They don’t know what to do, they don’t know who to contact for questions, they don’t get all the education they need about stroke and co-morbidities,” Keisha Hudson, the patient navigator for the program, said in a UK news release. “They get lost in the system, and therefore some of them end up back in the hospital. Our goal is to keep them out.”

And while the most recent data are still being finalized, Patrick Kitzman, director of the program, said its readmission rates are well below comparison groups. As of late January, none of the stroke survivors who participated in the program have been readmitted for stroke-related issues.

“It’s showing that our population is very involved and requires a lot of help,” Kitzman said. “Standard of care is that you send them home and one week later you check on them, and then that’s it. But we’re showing that you need to be much more hands on. A lot of data now show that these folks require support for an extended period of time, and our data is bearing that out at as well.”

After a pilot period, the program has been funded since July 2015 by Appalachian Regional Healthcare and the UK Center for Excellence in Rural Health.

Lloyd Cornett, a stroke survivor from Slemp, said he "couldn't have survived" without the program as he had gotten so "downhearted" because people were telling him he would have another stroke within a year, and it would be worse than the first one. He said Hudson and the physicians helped him understand that that wasn't true.

"They sit you down and they’ll talk to you, tell you every little thing to look for, what to do, and how to do it. I’m a diabetic, and they have people come to the stroke meetings to talk about that, or blood pressure or health things we need to know. I just can’t say enough about how good they are," said Cornett, whose stroke made him unable to speak and numb on his right side.

The program has led to some life-saving interventions, including: discovering one patient in a diabetic coma, finding an infected surgical site, and directing medical care for a patient who was breathing heavily during a telephone call and was hospitalized with dangerous levels of fluid on her lungs.

Kitzman said such close-call stories show the need for coordinated care, especially in Kentucky, which ranks 47th for incidence of stroke. He noted that stroke rates are higher in Appalachian Kentucky.

In the region, Kitzman said, many stroke survivors have some of the greatest needs for care and some of the heaviest financial burden, and need dedicated support to navigate the health-care system.

Kitzman said there is a need to have programs like this for other conditions and in other geographic areas.

“The more that we do this program, the more I’m so absolutely convinced that the only way we can have proper support for people whose conditions are so complex is to have programs like this,” Kitzman said. “They have the fewest resources available to them, and they’re the furthest away from specialized care and from what they need. Many of them don’t know what resources exist. They need someone to walk them through this change in their life. And you absolutely need someone from their community who knows where all the little pockets of support exist.”

Saturday, January 30, 2016

Frankfort approves needle exchange; Northern Kentucky remains resistant though that's where the heroin problem is worst

By Melissa Patrick
Kentucky Health News

The Franklin County Health Department can now operate a needle exchange program in Frankfort, following a 3-2 vote by the Frankfort City Commission, Seth Littrell reports for The State Journal.

This brings the number of needle exchange programs in Kentucky to seven. Others are or will be in Louisville, Lexington, Pendleton County, Jessamine County and one that will serve both Carter and Elliott counties. They are designed to thwart the spread of HIV and hepatitis C, a disease that is commonly spread by intravenous drug use and is expensive to treat. Kentucky leads the nation in hepatitis C cases and suffers more than 1,000 drug overdose deaths a year.

Franklin County's program will operate one day a week from a mobile unit using various locations around the county, Health Director Judy Mattingly told the commission at its December meeting, Littrell reported. The program will supply enough clean needles for someone to get through a week and will offer counseling with each visit.

Under the state anti-heroin law passed in 2015, needle exchanges require local government approval. The Franklin County Fiscal Court gave its approval in October. The commission deadlocked 2-2 in December, with Commissioner Lynn Bowers abstaining for "more time to think" even though she seconded the motion to approve it.

This month, Bowers voted a "hesitant yes" but added a requirement that the commission receive updates on the program every six months, Littrell reports. She told health officials, "You all have recommended this, and you are the experts in the area and it’s for the public health."

The commissioners who voted no have voiced typical concerns, including a belief that its "immoral" to give needles to addicts, a belief that the issue belongs in the courts and a belief that needle exchanges enable drug users, despite evidence to the contrary. Commissioner John Sower, one of those who voted no, is running for mayor against incumbent Bill May, who voted yes.

Northern Kentucky struggles with the issue

The heroin problem is worst in Northern Kentucky, but Pendleton County is the only jurisdiction to approve a needle exchange.

The Florence City Council didn't say no to an exchange at its Jan. 19 meeting, but Mayor Diane E. Whalen said she wanted the approval of the Boone County Fiscal Court before allowing more discussion or taking a vote, Chris Mayhew reports for The Cincinnati Enquirer.

Mark Hansel reported in December for the Northern Kentucky Tribune that the fiscal court and the City of Florence "have no intention of approving needle exchange in their communities any time soon." The Northern Kentucky Health Department wants to operate exchanges at existing health centers in each county in Covington, Florence and Newport.

Mayhew also reported that the city of Williamstown in Grant County passed a resolution approving a needle exchange in August, but the department has not yet gotten approval from Grant County Fiscal Court, according to Emily Gresham Wherle, public information administrator for NKHD.

Mina "Mike" Kalfas, a family-medicine physician in Northern Kentucky, called for governments in the region to allow needle exchanges, reiterating in an Enquirer op-ed that the area has done nothing in the 10 months since the law passed.

"Since the law was passed, almost 800 people in Northern Kentucky have been diagnosed with hepatitis C and more than 100 have been diagnosed with hepatitis B," Kalfas wrote. "While a syringe access exchange program won’t eliminate these viruses, it can reduce their spread. When faced with outbreaks of communicable disease, public health officials look to interventions to stop the spread."