Wednesday, November 30, 2011

U of L spinal cord center brings in $13.7 million in 2011, $64.1 million since 2000

The University of Louisville's spinal cord scientists attracted more than $13.7 million in outside funding in 2011 alone, and have brought in a total of $64.1 million since 2000.

"This is tangible evidence of our effort to become a nationally recognized premier metropolitan research university," said U of L President James Ramsey. "We have taken the investment that the state has made in our program, brought in the best researchers to work on spinal cord injury, and begun to help people."

One major success story was that of Rob Summers, who played college baseball in Oregon and was paralyzed below the chest after a car accident in 2006. "In May, a team from U of L and two California universities announced that they had used electrical stimulation and rehabilitation to help (him) stand and take steps with assistance — a breakthrough with implications for millions of paralyzed people around the world," reports Laura Ungar of The Courier-Journal. (Read more)

Tuesday, November 29, 2011

Beshear says hand over child abuse records; cabinet immediately files for more time

Gov. Steve Beshear ordered the release of "state records of children who have been killed or nearly killed as a result of abuse and neglect," reports Beth Musgrave of the Lexington Herald-Leader. (Photo by H-L's Pablo Alcala)

"Transparency will be the new rule," he said at a news conference Tuesday.

But, immediately after he spoke, the Cabinet for Health and Family Services filed a motion in Franklin Circuit Court asking for more time. "It also asked Judge Phillip Shepherd to sharply limit the information the cabinet must release and allow it to remove a significant amount of detail — restrictions that seem to contradict the governor's pledge of openness," reports Deborah Yetter of The Courier-Journal.

The two newspapers have been suing the cabinet to see the records, and Shepherd has twice ruled that the newspapers should be able to view them. "State law says that the child protection records are private with one clear exemption — in the deaths or near-deaths of children who have died as a result of abuse or neglect," Musgrave reports.

The cabinet argued releasing the documents would run counter to federal privacy laws and could lead to a loss in federal funding.

Attorney Jon Fleischaker, who represents the C-J, was not impressed by the governor's move. "It's a sham, in my judgment," he said.

In 2009, both newspapers sued the cabinet after being denied access to documents pertaining to Kayden Branham, a toddler who died after drinking drain cleaner that was reportedly to be used in the manufacture of methamphetamine.

The Todd County Standard likewise sued the cabinet when it refused to turn over documents pertaining to Amy Dye, a 9-year-old who was beaten to death by her adoptive brother. "This crime has drawn a lot of attention, has left this community dazed, confused and angry and searching for answers as to why this could have happened and why this happened," said Todd Circuit Court Judge Tyler Gill.

The motion filed by the cabinet Tuesday would exclude details of Amy's case, such as the circumstances of her adoption, the names of her siblings, information about foster care, and the termination of parents' rights and juvenile court records, "all of which were elements of Amy's case," Yetter reports.

Records that Shepherd ordered be released Nov. 7 showed evidence that state social service workers either ignored or dismissed repeated complaints by school officials that Amy was the victim of abuse. "The cabinet had initially denied it had any records, then refused to disclose them, citing confidentiality," Yetter reports.

At the news conference Tuesday, Beshear said he planned to propose legislation in 2012 to make it more clear as to what information the cabinet is subject to releasing.

To read more in The Courier-Journal, click here.
To read more in the Herald-Leader, click here.

Baptist-Trover hospital merger another example of trend

Though the proposed merger of Saint Joseph Health System, University Hospital and Jewish Hospital & St. Mary's HealthCare has grabbed recent headlines, another merger is under way, with Baptist Healthcare System hoping to expand its reach to Western Kentucky with the acquisition of Trover Health System in Madisonville.

"There's a lot of territory . . . and certainly Trover fits a geographic hole that Baptist has in the western part of the state," said Andy Sears, vice president of planning and development for the Louisville-based Baptist system.

Trover is made up of a 390-bed regional medical center and several clinics, resulting in the company having seven locations in six counties, reports Patrick Howington for The Courier-Journal.

"With reimbursements from government health plans set to tighten under health-care reforms, experts say stand-alone hospitals will have more difficulty keeping up than larger systems, which can spread costs and have more purchasing power," Howington reports.

During the first nine months of 2011, there were 71 deals involving 132 hospitals and totaling $6.9 billion, according to Sanford Steever, editor of Health Care M&A Report. (Read more)

To read more about hospitals merging nationwide, click here.

Move to managed care involves a steep learning curve, patients and providers tell Noelle Hunter of The Morehead News

Patients and providers are "ascending a steep learning curve as they implement Medicaid managed care," reports Noelle Hunter in a two-part series in The Morehead News. Even for a proactive patient, the changeover has its challenges, and vulnerable populations are at risk of falling through the cracks, providers say. For health administrators, it means getting accustomed to three new systems, all of which require pre-authorization before treatment can begin.

The move to managed care, which took place Nov. 1, was intended to fill a $166 million shortfall in the Medicaid budget. Gov. Steve Beshear pushed hard for the switch and estimates it will save the state $1.3 billion in the next three years. Managed care will be handled by four organizations — Kentucky Spirit, CoventryCares, WellCare and Passport — across the state. Passport was already handling the Louisville region.

When the switch took place, Medicaid recipient Mary Jo Long discovered "45 percent of Medicaid recipients were automatically enrolled in Kentucky Spirit," Hunter reports. "None of the doctors (in Rowan County) take Kentucky Spirit," Long said. Discovering this, she waited on hold 30 minutes before being switched to CoventryCares and doesn't "anticipate any problems from here," she said.

While Long was able to navigate the challenge, many patients, particularly those with mental or behavioral health issues, might find it difficult, said Kimberly McClanahan, CEO of Pathways, Inc., a drug or alcohol rehabilitation center. "A lot of our patients are seriously mentally ill and they don't or cannot always pay attention to the information they are getting in the mail about the change," she said. "When they got their first letter about the changes, it was seven pages long. A lot of our consumers just threw it in the trash."

Health administrators are likewise dealing with lengthy forms from managed care organizations. "We've essentially gone from a one-page document to a sometimes 25-30 page document that has to be faxed to the MCOs before any care can be given," said G.R. "Sonny" Jones, chief financial officer at St. Claire Regional Medical Center.

The paper overload stems from the fact that Medicaid patients must be pre-authorized before they can receive any treatment, the likely key to savings in such a system. "I was talking to a case manager who said she spent an hour and 45 minutes on the telephone trying to obtain a pre-authorization," said Charlotte Walker, administrative director for clinical operations at St. Claire.

Moreover, the existing network of providers is not extensive enough, in part because the move to managed care happened in just 120 days, as per the state's directive, "when it usually takes a year or two to develop a satisfactory network," Jones said.

Behavioral health organizations and pharmacies are also experiencing challenges, with some patients not able to access their prescriptions "because each MCO has different prescription formularies," Hunter reports.

Whether the move will indeed save money remains to be seen, administrators say. "In the long run, the financial incentives are there to pay hospitals and providers less," Jones said. "It will make it more difficult for us."

An op-ed piece in the Lexington Herald-Leader indicated likewise. "There will now be four bureaucracies, with each sopping up Medicaid money to pay for the bureaucrats needed to keep track of everything," writes Edward L. Smith, a charter member of Northern Kentucky's Mental Health/Substance Abuse Regional Planning Council. "Where will the money for the bureaucrats come from? From services, of course." (Read more)

To read Part 1 of Noelle Hunter's series Mandatory Medicine, click here. For Part 2, click here.

Monday, November 28, 2011

Dec. 1 is World AIDS Day; 1.2 million Americans are thought to be infected, but only 1 in 5 know it

Friday is World AIDS Day, an opportunity to learn the facts about the virus and show support for people living with it.

In the United States, there are 1.2 million people living with the HIV infection, which leads to AIDS. Of those who are infected with the virus in the U.S., only one in five know they have it, the Centers for Disease Control and Prevention report. Each year, about 50,000 Americans become infected. About 1,700 Kentuckians were diagnosed with HIV between Jan. 1, 2005 and Dec. 31, 2009; Kentucky ranks 19th in the country for the number of people who have the HIV infection.

Since the epidemic began, nearly 594,500 people have died with AIDS in the U.S. Between 1981 and 2007, more than 25 million people have died from the virus around the world.

Secretary of State Hillary Rodham Clinton spoke of the epidemic in a Nov. 8 address at the National Institutes of Health. "The fight against AIDS began three decades ago in June 1981. American scientists reported the first evidence of a mysterious new disease," she said. "Thirty years later, we ... know a great deal about the virus itself. We understand how it is spread, how it constantly mutates in the body, how it hides from the immune system. And we have turned this knowledge to our advantage."

Most at risk are gay, bisexual or other men who have sex with men. The CDC estimates that though this population accounts for just 2 percent of the U.S. population, it accounted for 61 percent of all new HIV infections in 2009. But heterosexuals and people who inject drugs can also contract the disease. Heterosexuals account for 27 percent of new cases. Another 9 percent of people who contracted the virus did so by using injected drugs.

Blacks accounted for 44 percent of new HIV infections in 2009, though they only represent 14 percent of the U.S. population. In 2009, the rate of new infection was 6.5 times greater for black men than it was for white men.

People can now be tested for the infection using a saliva sample and have the results in just 15 to 20 minutes. To find an HIV/AIDS prevention and service provider by county, click here.

Wednesday, November 23, 2011

Corbin City Commission enacts smoking ban

The Corbin City Commission passed an ordinance this week to ban smoking in all enclosed public areas and enclosed public buildings. The ordinance will also require smokers to remain at least 25 feet from building entrances. Areas subject to the ban include bingo parlors, restaurants except for outdoor seating, and motels and hotels, "which may not offer more than 20 percent of rooms as smoking," Dean Manning of The News Journal reported. "Once the ordinance is advertised, it will become law," Becky Kilian of The Times-Tribune reports.

Tuesday, November 22, 2011

Poll finds Kentucky has the highest smoking rate in the country; a statewide ban would reduce it, advocates say

Kentucky has the highest smoking rate in the country, with 29 percent of people surveyed by the Gallup-Healthways Well-Being Index answering "yes" to the question, "Do you smoke?" (United Press International photo by Alexis G. Glenn)

Kentucky's number is 8 percentage points higher than the national average, which remains unchanged from 2008. Utah had the lowest rate, 11 percent. The survey included answers collected from 1,000 Americans from January to June.

Smoking rates remain highest in the South and Midwest. "The findings suggested government smoking bans were effective," United Press International reports. "There were no bans on smoking in bars in all but one of the states where rates are 25 percent or higher and no bans on smoking in restaurants in all but two." (Read more)

In an op-ed piece in Monday's Lexington Herald-Leader, public health advocate Joan Buchar of the Foundation for a Healthy Kentucky asks the upcoming General Assembly to pass a statewide ban, and lists the benefits: Teens and preteens are less likely to begin smoking because they see fewer adults smoking. There are fewer visits to the emergency room for heart attacks in communities with comprehensive bans. And businesses are attracted to areas where bans are in effect, Buchar writes.

"Kentucky is known for its hospitality and beautiful places," she writes. "We can be known, too, as a beautiful and healthful place to live. Twenty years from now, our children will thank us for taking this bold step today." (Read more)

Monday, November 21, 2011

Abuse must be reported to officials in Ky., unlike scandalized Pa.

State law should prevent the child abuse scandal that has rocked Penn State from happening in Kentucky. (Associated Press photo: Penn State head coach Joe Paterno, assistant coach Mike McQueary and quarterback Mike McGloin.)

Unlike in Pennsylvania, where people are only required to report sexual abuse to a supervisor, in Kentucky suspected abuse must be reported to police, prosecutors or Child Protective Services. If a person fails to report it, that constitutes a crime, reports Andrew Wolfson of The Courier-Journal. "Telling your boss in Kentucky doesn't take you off the hook," said Terry Brooks, executive director of Kentucky Youth Advocates. "We don't let folks in Kentucky wash their hands of abuse."

Interest in the law has surfaced since a graduate assistant Paterno "saw former defensive coordinator Jerry Sandusky raping a boy in a shower in 2002 and told Paterno about it rather than alerting authorities," Wolfson reports. Paterno told his athletic director, but not police or other authorities. He was fired Nov. 9.

Advocates believe the Kentucky law "shows that we are all responsible," said Dan Fox, president of Family and Children's Place, a nonprofit counseling agency. Kentucky is one of 18 states with such a law. Those who fail to report abuse can be charged with a misdemeanor punishable up to 90 days in jail and a $250 fine, though prosecution is relatively rare. There were just 57 cases filed with the Administrative Office of the Courts since 2006. One case involved a Bed Bath & Beyond store, which was charged in 2008 after it didn't help a couple who had found a toddler locked in a hot van in the parking lot. The manager said getting involved was against store policy.

Kentucky had twice as many reported child-abuse cases as Pennsylvania 2009, though it has just one-third the number of children. That difference is believed to stem from the reporting laws of the two states, not because abuse or neglect is less common in Kentucky, Wolfson reports.

Pat Boone commercial about Medicare has many inaccuracies

A television commerical misleads seniors into believing the federal health-care reform law will ration and deny care and contains other inaccuracies, according to, a non-partisan, non-profit service based at the University of Pennsylvania.

The ad features singer Pat Boone and is being aired repeatedly in Ohio (and presumably in Northern Kentucky) by the conservative 60 Plus Association. It claims the Patient Protection and Affordable Care Act will create the Independent Payment Advisory Board, made up of elected bureaucrats who "can ration care and deny certain Medicare treatments so Washington can fund more wasteful spending."Boone says,"Unaccountable bureaucrats should never have the power to deny you the care you deserve."

The board is neither made up of bureaucrats, nor can it ration care. "The IPAB is tasked with finding ways to reduce the growth in Medicare spending," FactCheck reports. "Its 15 voting members won't be bureaucrats, according to the health care law (see page 502); they will be doctors and medical professionals, economists and health care management experts."

The law also says proposals from the IPAB "shall not include any recommendation to ration health care, raise reveneues or Medicare beneficiary premiums ... increase Medicare beneficiary cost-sharing (including deductibles, coinsurance and copayments), or otherwise restrict benefits or modify eligibility criteria."

The ad says the law will cut $500 billion from Medicare, but fails to mention that cut is in the future growth of Medicare over 10 years and will come from the supplemental Medicare plans seniors can buy.  Moreover, though Boone suggests seniors should object to the $500 billion in cuts, they are meant to extend the funding of Medicare Part A by 12 years.

The ad also states Medicare will be bankrupt in nine years. "The truth is that Medicare Part A — the hospital insurance trust fund, one of four parts of Medicare — is expected to be insolvent by 2020, according to the projections from the Congressional Budget Office, or perhaps 2024, according to the Social Security and Medicare Boards of Trustees," FactCheck reports. "Shortfalls have been projected for Part A 'almost from inception,' says a Congressional Research Service report," but Congress has always found a way to extend the program. (Read more)

Kentucky second highest in antibiotic consumption in U.S.

The next time you ask your doctor for an antibiotic, or if he or she offers to give you one, think again. It might do your health no good, but could be bad for public health.

"Every time an antibiotic is used ... future effectiveness of that drug is diminished," but Kentuckians take antibiotics at the second highest rate in the country, with 1,205 prescriptions per 1,000 people, says a study by the Centers for Disease Dynamics, Economics and Policy. Only West Virginia had a higher rate, 1,214 per 1,000. 

Studies show 1 million antibiotics are prescribed unnecessarily every year. "Though antibiotics offer no benefits for colds and other viral infections, many people, including doctors, continue to view these drugs as a quick fix," said a press release by the Robert Wood Johnson Foundation, which helped fund the study.

The problem with the overuse of antibiotics is that bacterial infections become resistant to them. To illustrate the issue, CDDEP says, "High-level penicillin resistance in Streptococcus pneumonia in the United States has experienced a thousand-fold increase in the last 20 years," rising from 0.02 percent in 1987 to more than 20 percent in 2004. The prevalence of methicillin-resistant Staphylococcus aureus — known more commonly as staph — increased from about 2 percent in 1974 to 50 percent in many U.S. hospitals in 2004.

"The problem of resistance is an evolutionary game played between humans and microbes: we try to stay ahead by creating new antibiotics, and microbes develop resistance to our drugs," CDDEP reports. "Unfortunately for us, microbes evolve resistance to antibiotics faster than we can create new drugs, meaning that, in recent years, bacteria have been winning this 'arms race.'"

Though there is no cure to resistance, managing the levels at which people become resistant is possible through judicious prescribing, vaccination, hospital infection control, treatment strategies and new antibiotics. (Read more)

Sunday, November 20, 2011

Retailers like Walmart, CVS getting into primary care, eyeing the prize that awaits if health reform takes effect in 2014

Last week, a document leaked showing Walmart's intention to become the country's largest provider of primary health services, but the company's interest is not unique. Drug retailers like CVS Caremark and Walgreens are eyeing the same prize: "the millions of Americans with costly illnesses such as diabetes and heart disease," reports Julie Appleby of Kaiser Health News. CVS already has 550 retail clinics, the most in the country. Walgreens has also set up programs aimed at diabetic customers, which includes counseling with pharmacists.

The retail industry is looking at ways it can use its clout to save money and offer a primary care infrastructure that experts say will be short by 21,000 doctors by 2015, largely because of the 30 million more people becoming insured by 2014 under the federal health-care reform law. "It's sad that the existing health care establishment has not figured out a way to make primary care affordable and accessible," said Jerry Avorn, a professor of medicine at Harvard University. "We should not be surprised if someone outside of our world comes in and does it for us."

Costs at retail clinics are "roughly 30 percent to 40 percent less than similar care at a doctor's office and 80 percent cheaper than at an emergency room," Appleby reports, referring to a study in the American Journal of Managed Care. Those savings appeal to insurers. Retail clinic use by people with health insurance increased tenfold from 2007 to 2009, with clinics accounting for 7 percent of all medical visits for 11 common acute conditions, the study found. "If these trends continue, health plans will see a dramatic increase in retail clinic utilization ... particularly among young, healthy and higher income patients living close to retail clinics," the study concluded.

Patients like the clinics for the predictability, with costs made clear ahead of time. And employers — who under the new health law could get incentives to provide wellness programs for their employees — may partner with the clinics to provide blood testing, nutrition counseling and diabetes management. However, there are still many unknowns. While the clinics have proved useful for acute care, it remains to be seen how they will deal with complicated issues like diabetes management.

Some states prevent clinics from employing physicians, nurse practitioners or physician assistants. "Other states cap the number of nurses each doctor can oversee," Appleby reports. The vast majority of clinics are staffed not by doctors, but physician assistants and nurse practitioners. A report by the Convenient Care Association shows 95 percent of the clinicians are nurse practitioners. With these practitioners able to provide basic care, part of the fear among doctors is they will be left to treat only the sickest patients and won't be reimbursed accordingly.

Most of the clinics are in the South and Midwest. In January, Merchant Medicine listed 40 retail clinics in Kentucky, with more to open in 2011. The clinics "are more likely to be in areas with lower overall poverty and only 12.5 percent were in medically underserved areas," Appleby reports, though 21 percent of the U.S. population lives in those areas.

The clinics have typically offered vaccinations and simple physical exams and treatment for strep throat and ear infections, but plan to expand their services and enlarge retail's foothold in the medical world. "Think about Toyota; they didn't start off by competing with Cadillac and BMW. They started with cheap little cars but got better and better over time," said Mark Smith, president and CEO of the California Healthcare Foundation. (Read more)

Friday, November 18, 2011

Even the experts seem to have more questions than answers when it comes to the federal health-care reform law

By Tara Kaprowy
Kentucky Health News

LEXINGTON, Ky. -- Confusion, primary care doctors overwhelmed by an influx of new patients, and employers opting to pay fines rather than health insurance are among the fears experts have about the federal health-care reform law. The experts discussed the issues this week in Lexington at the fall meeting of the Friedell Committee for Health System Transformation, a non-partisan, non-profit group formed several years ago to improve health in Kentucky.

Under the Patient Protection and Affordable Care Act, 30 million more people will become eligible for health insurance by 2014. People who have an income 133 percent above the federal poverty level — now $14,404 for individuals or $29,326 for a family of four — will qualify for Medicaid starting in 2014. Additionally, the federal government will give subsidies to help Americans whose income is up to 400 percent above the poverty level. With them, they must buy private coverage through state insurance exchanges.

The experts see problems arising from both options. "If you look at the overall population, it's very clear that the majority of these patients are going to be in the Medicaid program," said Elizabeth Cobb, vice president of health policy at the Kentucky Hospital Association. "Since Medicaid only pays hospitals at 85 percent of cost, that's a real concern" for providers. Cobb estimated that Kentucky hospitals will lose nearly $1 billion in revenue in the next 10 years because of the Medicaid expansion, along with cuts to other federal programs.

While hospitals will feel the stretch, so will doctors, with Kentucky lacking the primary-care infrastructure it needs to support the influx of new patients, said Dr. Steve Davis, acting commissioner for the state Department of Public Health. Davis said the average age of a practicing dentist in Kentucky is 58 years, and "in a few years," the state will have 3,000 fewer primary-care doctors.

"We don't have enough clinicians to meet those needs and that's a real problem," added Kevin Shuer, assistant professor at the University of Kentucky's College of Health Sciences.

Kentucky has taken no firm steps toward creating a state insurance exchange, a marketplace in which people will have to choose from a variety of plans. That will likely have to be done in the 2012 legislative session if the state opts to run its own exchange.

One reason for the delay is a lack of information, said Cris Miller, a partner in the Louisville accounting firm of Mountjoy Chilton Medley. "We know there will be four plans," each paying 60, 70, 80 or 90 percent of the covered benefit, she said. "We know the bronze plan is going to pay 60 percent of the covered benefit, but what is the covered benefit?"

Despite the unanswered questions, Julia Costich, chair of the Department of Health Services Management at UK's College of Public Health, believes Kentucky will set up a state-specific health insurance exchange, rather than let the federal government handle it, and will do so alone rather than partner with other states, since "the logistics to make that happen would be very complicated."

Costich's research shows about 400,000 Kentuckians will be eligible for federal subsidies as part of the exchange. Medicaid will eventually be included in the exchange and, after coverage expansion, the program's numbers could grow from its current 830,000 participants to 1.1 million in Kentucky. The federal government would cover the initial cost, but the state would gradually pick up a share, just as it does for current Medicaid patients.

The area of the state with the highest uninsured population is between Somerset and Bowling Green, according to Costich's research. There, one in four people under the age of 65 don't have any form of insurance. County-specific estimates show Franklin, Fayette and Jefferson counties have the lowest percentage of people without any form of insurance (4 to 8 percent) and Edmonson, Todd and Elliott have the highest (38 to 45 percent).

In 2014, employers with more than 50 employees who don't provide health coverage will be required to pay a penalty. The experts said paying the fines may be cheaper than offering insurance. According to global consulting firm Towers Watson, 3 in 10 American corporations are considering ending employee health coverage when the exchanges begin.

Though about 58 percent of Kentuckians have insurance through their employer, that's down from about 70 percent a decade ago, said Mark Lamberth, president-elect of the Kentucky Association of Health Underwriters. Lamberth said the drop is not surprising. "We've built a system that is really strapped on the back, for premium purposes, on employers," he said.

Another unknown is how accountable care organizations will work in Kentucky. Starting in 2012, providers that are part of an ACO — in which providers and hospitals team up to take care of a specific population in a coordinated way — will start receiving increased reimbursements from Medicare and Medicaid.

So far, there are no ACOs in Kentucky, which Miller said is not surprising. "If you know anything at all about ACOs, you know they're driven by volume," she said. "We're going to have a few in Louisville, probably as many as three in Lexington. Maybe have one in Bowling Green, one in Paducah. But I can promise you we will not have one in Pikeville, we will not have one in Somerset. There's not enough population."

With pieces of the law still undergoing legal scrutiny — the Supreme Court seems likely to decide by July whether Americans can be required to buy health insurance — and with many wondering what will remain of the law after the 2012 presidential and congressional elections, it's unclear what answers, if any, consumers might get before the end of the year. For now, "mass confusion" is what the experts are witnessing, Lamberth said. Miller agreed. "The biggest things we are hearing from our customers is fear."

Thursday, November 17, 2011

Independent pharmacists say managed care costs them money

Because two of the three new Medicaid managed-care companies have slashed the dispensing fee they will pay them, independent pharmacists are in danger of going out of business all over the state, pharmacists told the interim joint Health and Welfare Committee yesterday.

But one managed-care firm said that's the cost of saving money for the taxpayers, the reason the state implemented managed care statewide. "We recognize ... there's a big change here for everyone," said Barb Witte, CEO of CoventryCares. "All health care providers are going to have to tighten their belts."

Under the traditional Medicaid system, "pharmacists were paid a 'dispensing fee' per prescription of $4.50 to $5 plus reimbursement for their actual cost of the drug based on an industry formula called the 'maximum allowable cost,'" reports Deborah Yetter of The Courier-Journal.

But the dispensing fee of CoventryCares is only $1 to $1.50. WellCare increased its fee to $3 from $1.50, but cut reimbursement for cost, making the increase only worth about 80 cents. Kentucky Spirit is still paying $4.50 to $5.

Because the maximum allowable cost fluctuates on a monthly basis, pharmacists don't know their return until they file a claim. Often, "pharmacists find they are being paid less than it cost them to buy the drug from a wholesaler," Yetter reports.

"How long will I be able to stay in business losing money?" asked Mayfield pharmacist Sam Willett. "Not very long."

Rep. Tom Burch, D-Louisville, told the MCOs and pharmacists to come to an agreement. "There must be a way to work this out," he said. (Read more)

Tuesday, November 15, 2011

FDA finds more than 1,000 retailers selling tobacco products to minors, several in Kentucky

More than 1,200 retailers, including CVS, Walgreens and Rite Aid, were issued warning letters by the Food and Drug Administration this year for illegally selling cigarettes to minors. FDA inspectors conducted 27,500 undercover checks by sending children under 18 into stores to buy cigarettes. These checks resulted in hundreds of letters being sent to retailers. Many of the warnings were sent to stores in rural areas where a recent U.S. Department of Health and Human Services report found youth are more likely to use tobacco products.

Alina Selyukh reports for Reuters that under the Tobacco Control Act of 2009, the FDA was given broad authority over tobacco manufacture and sales. One of the provisions of the act "allows the agency to contract with states to inspect spots where youths could buy cigarettes or chewable tobacco." Under the law, store workers are required to check identification of anyone looking younger than 27. Selyukh writes: "FDA officials said they are on a mission to begin battling the stubbornly high U.S. smoking rates by keeping tobacco out of underage hands in the first place."

The agency posted the warning letters on its website last week along with a searchable database of all checks it conducted. The letters allow retailers to correct their infractions without fines, but repeat offenders could face fines or loss of ability to sell tobacco products of any kind. To see if retailers in your state, community or city were issued a warning letter, search the FDA database of compliance checks.

Monday, November 14, 2011

'Pill mills' proliferating in Ky.; legislators plan countermeasures

Suspected "pill mills" that feed Kentucky's "epidemic of prescription-drug abuse" have proliferated in the last two years, and "not just in Eastern Kentucky, where the problem was once most prominent," the Lexington Herald-Leader reported yesterday. "Faced with a growing problem, calls are mounting for increased regulation of pain clinics" with proposed laws for the 2012 General Assembly, said the story by Josh Kegley, Valarie Honeycutt Spears and Bill Estep.

Pain-pill cases have become the most prevalent type of drug case for state police in Central Kentucky, outpacing cocaine and marijuana, Lt. Todd Dalton, assistant commander of the state police drug-enforcement unit for the eastern half of the state, told the newspaper. Dalton "said that when Florida authorities started discussing legislation aimed at curbing pill mills, clinic owners started looking to move into Kentucky." (Read more)

Saturday, November 12, 2011

Center for Excellence in Rural Health marks 20th anniversary by adding new program in medical lab science

The University of Kentucky’s Center for Excellence in Rural Health celebrated its 20th anniversary this week and announced the addition of a new baccalaureate degree in medical laboratory science, which will start next fall at the facility in Hazard.

At a ceremony honoring current and former faculty, staff and students of the center, speakers include UK President Eli Capilouto, 5th District U.S. Rep. Harold "Hal" Rogers and Dr. Wayne Myers, the center’s first director and a former director of the federal Office of Rural Health Policy.

Capilouto, a dentist by trade, said “With approximately 80 percent of the center’s graduates working in Appalachia or other rural communities, it’s a testimony to the fact that this idea worked.” More than 550 people are graduates of the center's academic programs. The center also includes Kentucky Homeplace, a nationally recognized community health worker initiative; the Kentucky Office of Rural Health; and the East Kentucky Family Medicine Residency Program, a UK news release said.

Friday, November 11, 2011

Race for city commission seat puts an end to debate over city's smoking ban, advocate and opponent agree

The Bowling Green City Commission candidate who said he wanted to rewrite the city's smoking ban ran last in the five-way race for an unexpired term on the commission Tuesday, and he and a commissioner in the 3-2 majority that enacted the ban said the result is an indicator of public opinion on the issue.

Candidate Bill Goodwin got only 682 votes, or 8.6 percent of the total. "Commissioner Brian 'Slim' Nash said he believes voters sent a message in Tuesday’s election: Citizens are satisfied with the city’s smoking ban," Andrew Robinson of the Daily News reports. "Goodwin said he spoke to a few citizens who told him the result is a clear sign there’s little support for revisiting the ordinance."

“The people spoke or the people didn’t show up,” Goodwin told the  newspaper. “It’s got to be an issue that’s dead right now. That’s all there is to it.” (Read more)

Thursday, November 10, 2011

Nursing-home violations went up in third quarter, but a record 8 facilities had no deficiencies

In the third quarter of 2011, inspectors found 403 deficiencies in 56 Kentucky nursing homes, an average of 7.2, up from 5.9 in the second quarter. But no deficiencies were found in eight facilities, the first time that has happened in so many.

"I guess you could call that progress," Bernie Vonderheide of Kentuckians for Nursing Home Reform told The Courier-Journal's Deborah Yetter. The non-profit organization advocates for nursing home residents and obtains this data regularly through open-records requests to the Kentucky Cabinet for Health and Family Services and distributes it statewide. The information is posted as part of Medicare's nursing-home comparison data.

Inspections assess a facility on the care of residents and how that care is administered; on how staff and residents interact; and on its environment. Certified nursing homes must meet more than 180 regulatory standards. The state Office of Inspector General website has more data, such as the results of inspections and the ownership of each facility.

Nursing homes with 10 or more deficiencies in the third quarter were: Christopher East Health Care Center, Louisville, 20; Glasgow Health & Rehabilitation Center, Glasgow (18); Springhurst Health and Rehab, Louisville (17); Woodland Terrace Health Care, Elizabethtown (16); Parkview Nursing and Rehabilitation Center, Pikeville (16); Windsor Care Center, Mount Sterling (14); Bluegrass Care & Rehabilitation Center, Lexington (14); The Good Samaritan Society, Jeffersontown (12); Green Valley Health & Rehabilitation Center, Carrolton (12); Carmel Manor, Fort Thomas (12); Breckinridge Memorial Nursing Facility, Hardinsburg (11); Glenview Health Care Facility, Glasgow (11), Professional Care Health & Rehabilitation Center, Hartford (11); Salyersville Health Care Center (10); Stanton Nursing Center, Stanton (10); Colonial Health and Rehabilitation Center, Bardstown (10); Owsley County Health Care Center, Booneville (10); and Edgemont Healthcare, Cynthiana (10).

Nursing homes with no deficiencies were: Lourdes Transitional Care (Paducah); Westport Place Health Campus (Louisville); Carter Nursing & Rehabilitation Center (Grayson); Regional Medical Center of Hopkins County (Madisonville); Belle Meade Home (Greenville); Robertson County Health Care Facility (Mount Olivet); Windsor Gardens (Bardstown); and the Loretto Motherhouse Infirmary (Nerinx).

For the first time, inspection results were also released for assisted-living facilities. Inspectors found 19 deficiencies at Charleston Assisted Living in Danville, by far the highest number among the 10 facilities inspected. Other inspection results at assisted living facilities were: The Harrod Assisted Living, Harrodsburg (12); Highland Ridge Assisted Living, Glasgow (7); Atria Highland Crossing, Fort Wright (6); Bluegrass Assisted Living, Elizabethtown (4); Bowling Green Retirement Village, Bowling Green (4); Trinity Station Retirement Community, Flatwoods (4); The Neighborhood of Somerset, Somerset (2); Twin Oaks Assisted Living, New Castle (2); and The Village of Lebanon, Lebanon (2). There are 100 assisted-living facilities in Kentucky. (Read more)

Kentucky Youth Advocates gets $100,000 to push for income-tax policies aimed at helping the poor improve their health

Kentucky Youth Advocates is one of 12 coalitions nationwide to receive a "Roadmaps to Health" grant from the Robert Wood Johnson Foundation. The non-profit children's advocacy organization will receive $100,000 for two years to build statewide support for tax policies that would help low-income families keep more of their income to pay for doctor visits, healthier diets and weight-loss or smoking-cessation services.

The 12 grantees were selected from more than 300 initial applicants. "Kentucky Youth Advocates has long been a proponent of improving economic policies for families, and promoting child health throughout the state," said Tara Grieshop-Goodwin, deputy director of the coalition. "We know income can impact health, and we are excited to ahve the opportunity to combine our economic well-being efforts with our health work and look forward to fostering partnerships between advocates from both disciplines throughout the state." (Read more)

Merger would give Jewish and St. Mary's $83 million for their assets, which would have to be used for charitable causes

If the much-debated merger between Saint Joseph Health System, University Hospital and Jewish Hospital & St. Mary's HealthCare overcomes legal obstacles, it could result in a $83 million payment for Jewish and St. Mary's assets that would have to be used for charitable purposes, according to law.

The money could be used for medical causes, research and to pay for historical support for the Jewish community in Louisville. The sum would make it one of the largest philanthropic funds in the city. "That would enable parent Jewish Hospital HealthCare Services to keep supporting those causes even after effectively losing control of Jewish & St. Mary's and its roughly $1 billion a year in revenue once the merger becomes final," reports Patrick Howington of The Courier-Journal.

Stu Silberman, president and CEO of Jewish Community of Louisville, said the fund "certainly means we'll be able to continue developing new and vibrant programming to support Jewish families, Jewish seniors in need, provide Jewish education." The Jewish population in Louisville is about 8,300.

News of the money came from a financial report by Catholic Health Initiatives, which owns Saint Joseph Health System. The report also suggested the hospital merger could become final as early as Dec. 31, seven months earlier than expected. (Read more)

Wednesday, November 9, 2011

Primary care and management of chronic diseases could soon be coming to your local Walmart store

Just weeks after announcing part-time employees would no longer receive health insurance benefits, Walmart said Monday it is planning to offer extended medical services in its stores, report NPR's Julie Appleby and Sarah Varney. Since many of its stores are in rural areas, this move could extend medical coverage to people who often can't afford transportation to a doctor. The retailer "sent out a request for partners to help it 'dramatically lower the cost of health care by becoming the largest provider of primary health care services in the nation.'"

In a 14-page request, Walmart asks health-care providers to define their expertise in a variety of medical areas, including managing patients with chronic health problems like asthma, HIV, arthritis, depression and sleep apnea. The retailer is also trying to find health partners who can monitor patients with diabetes and high blood pressure. Appleby and Varney say "The move would capitalize on growing demand for primary care in 2014, when the federal health law fully kicks in and millions more Americans are expected to have government or private health insurance." This effort could also capitalize on "collaborations between doctors and hospitals to streamline care and lower costs," they report.

Though expansion of medical services in Walmarts "could help lower costs for some patients and increase access to primary care services," it has its fair share of nay-sayers. Glen Stream, president of the American Academy of Family Physicians, tells Abbleby and Varney that Walmart's "proposal takes health care in the wrong direction by further fragmenting care. Ann O'Malley, physician and senior researcher at the Washington think tank Center for Studying Health System Change, said she's not sure Walmart's approach will work. She said she "would be surprised if this were a model that could truly attack cost problems." Colin McGranahan, retail analyst for Sanford C. Bernstein & Co., said this could simply be a move to boost foot traffic and sales in Walmarts: "If you get someone in the door, you can also sell them milk and a shotgun." (Read more)

Federal judge rules proposed warning labels on cigarettes are too biased, blocks them from appearing on packs

The graphic warning labels that were going to start appearing on cigarette packages in the fall of 2012 have gotten hung up in court, with a federal judge ruling Monday they "impinge on the tobacco companies' right to free speech," reports James R. Carroll of The Courier-Journal.

District Judge Richard Leon's ruling will prevent the labels from being used until tobacco companies resolve a lawsuit against the federal government regarding the issue, something that could end up in the Supreme Court and take years. Leon said the five tobacco companies involved in the lawsuit "have demonstrated a substantial likelihood that they will prevail on the merits of their position."

Leon said the labels do not objectively warn about the risks of smoking and that tobacco companies "will suffer irreparable harm" if a ruling is not made on the label's constitutionality.

The labels, which were released by the Food and Drug Administration this summer, show graphic images of rotting teeth, a man with a zipper-like scar down the length of his chest and a man with smoke coming out of a tracheotomy tube. It is the first time in 25 years warning labels on cigarette packages have been altered, a move that was made possible when the FDA was given the authority to regulate tobacco products as part of a 2009 law.

FDA's aim is to "reduce the number of smokers by 213,000 by 2013 and save between $221 million and $630 million every year over the next 20 years," Rob Stein of the Washington Post reported in June.

Leon wrote that the images cause an emotional response that provokes "the viewer to quit, or never to start smoking: an objective wholly apart from disseminating purely factual and uncontroversial information. Thus, while the line between the constitutionally permissible dissemination of factual information and the impermissible expropriation of a company's advertising space for government advocacy can be frustratingly blurry here — where these emotion-provoking images are coupled with text extolling consumers to call the phone number '1-800-QUIT' — the line seems quite clear."

Matthew Myers, president of the Campaign for Tobacco-Free Kids, called Leon's ruling wrong. "If allowed to stand, this ruling would make it impossible to implement any effective warning labels," he said. An FDA spokesman said the agency is reviewing the ruling and had no immediate comment. More than 40 countries have pictorial health warnings on their cigarettes packages, including Canada. (Read more)

Light up at school? Face a $150 fine in Jessamine County

If students at the two Jessamine County high schools are found with cigarettes or any kind of tobacco product while on campus, they can face a fine up to $150.

East Jessamine High started issuing tickets a few years ago, and West Jessamine joined the effort last month, reports Jim Warren of the Lexington Herald-Leader. Since it was implemented, the number of students caught with the contraband items has gone down at East, with 120 incidents in 2009-09 and 149 in 2009-10. "Last year, we only had 39," Principal Janet Granada said. "Once the word spreads that there's a fine involved, it seems to lessen smoking greatly."

The idea came from Billy King, a school resource officer at East Jessamine High. "We recognized we had a problem with minors using tobacco," he said. "I felt that it would prevent them from bringing tobacco to school if they knew they could get a fine. But I also knew that they probably didn't think it would happen. Police generally don't cite juveniles for tobacco possession, even though the law has been on the books forever."

King posted signs around the school warning students of the possibility of a fine. A few weeks later, he started handing out tickets. "The word got around pretty quickly," he said. School resource officers write up the citations, which are referred to juvenile court. Fines are paid to the court, so the schools have no financial incentive to issue the citations.

Though many school districts in Kentucky have adopted tobacco-free policies on their campuses, Lisa Gross, spokeswoman for the Kentucky Department of Education said this is the first she's heard of students being given a fine. (Read more)

Thursday, Nov. 17, will be first National Rural Health Day

Nov. 17, 2011 will be the first annual National Rural Health Day sponsored by the National Organization of State Offices of Rural Health. The goals of the event are to highlight rural communities as wonderful places to live and work, increase awareness of rural health-related issues and promote the roles of state rural-health offices in addressing those issues.

On Nov. 17, the organization will host a series of free webinars in conjunction with the observance. To learn more about the webinars, click here. The group also has a series of free tools newspapers can use to promote the event. (Read more) The Center for Rural Health is hosting a photo contest to promote the event. To find your state's rural health office, click here.

Tuesday, November 8, 2011

McCracken County to consider banning new kind of synthetic pot

In response to several teenagers overdosing on it, officials in McCracken County are considering banning chemicals that are being sold as synthetic marijuana.

"Death is a realistic side effect when using this stuff," said Jamey Locke, emergency director for Mercy Regional Hospital.

Between July 10 and Aug. 21, 17 people — 13 of them teenagers — were taken to hospitals by ambulance after having smoked synthetic marijuana. "In almost every case they ended up in ICU," McCracken County Sheriff Jon Hayden said.

An ordinance will be introduced Nov. 14 at a Fiscal Court meeting. It would outlaw the sale or possession of the new synthetic marijuana. Although Kentucky has previously banned certain types of synthetic marijuana, "It appears manufacturers have changed the chemical composition to meet that requirement," The Associated Press reports. (Read more)

Nursing home ombudsman program at risk because of 'callous and apparenly clueless' move by feds, advocate writes

The Kentucky long-term care ombudsman program is at risk in Kentucky due to a change in federal policy. The Centers of Medicare and Medicaid Services is "quietly telling some state aging leaders that by Jan. 1 they will no longer be allowed to use civil monetary penalty funds to help pay for the nursing home ombudsman program in their states," Bernie Vonderheide, president and founder of Kentuckians for Nursing Home Reform, writes an op-ed piece in The Courier-Journal.

The civil penalties are assessed for violations in nursing homes. In Kentucky, the fund contains about $15 million. But if the move by CMS goes through, Kentucky "stands to lose more than a half million dollars a year from the CMP fund that has gone into supporting full-time ombudsmen in all of the 15 area development districts in the state," Vonderheide writes. "We are concerned about the callous and apparently clueless action by the federal Centers for Medicare and Medicaid Services. It is obvious that the Washington bureaucrats who make decisions like this have never been in a nursing home and are oblivious to the needs of the people."

Nursing-home ombudsmen investigate alleged abuse and neglect in facilities, and visit residents. "In the average nursing home, surveys show that more than half the residents never have a visitor — family member or friend — except for one, and that's the ombudman," Vonderheide writes. "We can't lose our nursing home residents' best friends — those angels of mercy, the ombudsmen." (Read more)

Smokers should pay more for health insurance, but obese should not, national poll finds

Nearly 60 percent of people in October's Thomson Reuters-NPR Health Poll said smokers should pay more for their health insurance than those who don't smoke, but 69 percent said "no" when asked if people who are overweight or obese should pay more.

Support for punishing smokers was greatest among groups less likely to smoke. Almost three-fourths of people in households with an annual income of $100,000 or more felt smokers should pay more than nonsmokers, Sarah Kliff of The Washington Post reports. There was nearly as much support — 70 percent — among people asked with at least a college degree.

But when it came to the weight-related question, the majority of people, regardless of education or household income, did not support having people who are overweight or obese pay more. Just 31 percent supported the idea.

Overwhelmingly, nearly 85 percent of respondents felt people who eat right and do not smoke should receive a discount on their health insurance premiums.

Each month, the poll surveys 3,000 Americans to gauge opinions on a variety of health-care topics. The poll, which is independently funded, has a margin of error of 1.8 percent. (Read more)

The poll results were released at a time when many mid- and large-scale companies are asking their smoking, obese employees to pay higher premiums than their more healthy colleagues. In 2012, almost 40 percent of these companies, including Walmart, will start using penalties to control unhealthy behavior. That's up from 19 percent this year and just 8 percent in 2009. (Read more)

Monday, November 7, 2011

University Hospital files suit saying it is not public; could affect merger, open records

 Attorney General Jack Conway may have ruled it a public entity and thus subject to open-records laws, but University Hospital officials are insisting that's not the case and have filed a lawsuit saying it should not have to turn over documents to, among others, The Courier-Journal.

The implications go beyond the records issue and could affect the merger between University Hospital, Saint Joseph Health System and Jewish Hospital & St. Mary's HealthCare. A public governmental entity cannot favor one religion over another, under the state constitution. But if the merger goes through, all three health systems would be subject to certain Catholic health directives, such as those pertaining to sterilization, because Saint Joseph is owned by Catholic Health Initiatives.

"A ruling in the public-records case that University Hospital is a public entity will bolster the arguments of those opposed to the merger, while a ruling that it isn't a public entity will favor merger supporters," reports Dan Klepal of The Courier-Journal.

The lawsuit argues that University Hospital is a private, nonprofit corporation "because it is controlled by a board of directors, not the University of Louisville," Klepal reports. U of L board members also cannot constitute a majority at any board or committee meetings; the hospital selects its own CEO; and manages its own finances and daily operations.

The suit further points to the fact that former Attorney General Greg Stumbo ruled it was not a public entity in 2006. "But that ruling was made when two private companies, Norton Healthcare and Jewish & St. Mary's, were still partners with U of L in governing the facility. The following year, Norton and Jewish withdrew, leaving U of L as the hospital's only overseer," Klepal reports. (Read more)

Louisville hospital merger would be just one of dozens across the country, driven by economic and regulatory concerns

Hospitals are banding together to create organizations better able to withstand the changing tides of the economy and health-care policy. The proposed merger of Louisville's Jewish Hospital & St. Mary's HealthCare, Lexington-based Saint Joseph Health System and University Hospital at the University of Louisville is just one of many examples.

"The small, community hospital is soon to go the way of the dinosaurs," said Angela Mattie, associate professor of health-care management of Connecticut's Quinnipiac University, told Laura Ungar of The Courier-Journal.

Through September, 2011 had seen 71 mergers nationwide involving 132 hospitals worth $6.9 billion, plus another four deals in October. In all of last year, there were 74 mergers involving 126 hospitals and $5.8 billion, Ungar reports.

The poor economy is part of the reason for hospital systems merging because "people don't use hospitals as often; even those with insurance sometimes forego care to avoid co-pays," Ungar reports. In a tight economy, credit is more difficult to obtain, but bigger, richer systems have less trouble. Finances are a major impetus behind the big Louisville merger, with officials at University Hospital and Jewish arguing "if they don't merge they'll lack the money to make improvements going forward, partly because of economic pressures such as rising levels of indigent care," Ungar reports.

Catholic Health Initiatives, which owns the Saint Joseph Health System, plans to invest $320 million "to launch the merged network and strengthen its balance sheet," said CHI spokeswoman Mary Elise Biegert. Of another $300 million that would be generated by operations, two-thirds would be invested in Louisville's academic health center and $100 million would help pay for a switch to electronic health records.

Experts also say big systems have more bargaining power with health insurers, nd the federal health-care reform law means "It makes sense to enlarge a hospital system to capture as many as possible of the 30 million Americans expected to eventually be newly insured under the new law," Ungar writes.

Mergers also allow hospitals to consolidate and save costs, "by having one human resource or finance department instead of three," Ungar reports. (Read more) For another story on what has been termed "merger mania," click here.

Beshear appoints panel to identify docs with suspicious prescribing practices

Gov. Steve Beshear has appointed a panel that will help identify the state's health providers who are prescribing a suspicious amount of pain pills. The move is to help combat the prescription-pill abuse in Kentucky.

"The panel is made up of four practicing physicians, including a psychiatrist, a pain-management specialist and an oncologist; three pharmacists; an advance-practice registered nurse; a dentist; a substance-abuse and mental-health professional from the University of Kentucky faculty; and a representative of community mental-health centers, which provide drug treatment," reports Bill Estep of the Lexington Herald-Leader.

The inclusion of an APRN is in keeping with a request from the Kentucky Coalition of Nurse Practitioners and Nurse Midwives. "We believe that the addition of APRNs who are prescribing controlled substances for different populations will be very helpful ... in creating guidelines for generally accepted practices," said Julianne Ewen, president of the 2,049-member coalition.

The council will use the state's prescription-monitoring system — known as KASPER — that is already in place and will work with the state's health-care licensing boards and law enforcement to establish acceptable prescribing practices. "For instance, it may be routine for a cancer doctor to write 50 prescriptions for pain pills in a month, but that would be very high for a dentist," Estep reports.

The work of the panel could be used by the Cabinet for Health and Family Services to track unusual activity through KASPER. The cabinet would then notify the applicable licensing boards of the activity. (Read more)

Prescription pill abuse has been a growing concern in Kentucky and nationwide, with the Centers for Disease Control and Prevention recently calling the problem "an epidemic." On Friday, police arrested three people that were allegedly part of a larger drug ring that trucked more than 50,000 pain pills into Pike County alone last year. The pills came from Michigan. "Many people in Eastern Kentucky have relatives in Michigan because people moved from Appalachia decades ago to look for work in Midwest factories," Estep reports. "People work through those family connections to bring drugs to Kentucky after obtaining pills in Michigan through large-scale 'doctor shopping.'" (Read more)

Friday, November 4, 2011

Ky. premature births declining, but still above national average

Giving birth to a baby before it has been brought to full term has become less common in the U.S. and Kentucky, but the nation still only received a C, and the state a D, in the 2011 Premature Birth Report Cards compiled by the March of Dimes. Each year, nearly half a million babies are born prematurely.

In Kentucky, 13.6 percent of women gave birth to babies prematurely in 2009, down by 0.4 percentage points over 2008. Only Vermont was given an A, with a pre-term birth rate of 9.3 percent, reports Bonnie Rochman of Time Healthland. Three states and Puerto Rico got Fs; 19 got Cs and 11, as well as the District of Columbia, got a D.

Data from 2006 to 2009 were analyzed. In 2009, the preliminary preterm birth rate was 12.2 percent, compared to 12.8 percent in 2006. The March of Dimes wants that number to drop to 9.6 percent by 2020. Pre-term birth is the leading cause of newborn death in the U.S.

The study analyzed three factors that can contribute to pre-term birth, including the percentage of uninsured women in each state and the percentage of women who smoke. Late pre-term birth, which occurs when a baby is born between 34 to 36 weeks gestation, was also considered, as it "has been linked to rising rates of early induction of labor and C-sections," the study says.

In Kentucky, the percentage of uninsured women has remained the same at 22.8 percent from 2006 to 2009. The smoking rate has dropped from 30.5 percent to 27.3 percent, as has the late pre-term birth rate, down to 9.7 percent from 10.2 percent. (For other states, click on the map above, then click on the state in the larger image.)

The pre-term birth rate was calculated by looking at the percentage of all live births in which the babies had reached 37 weeks gestation or less.

March of Dimes President Dr. Jennifer Howse called the study results positive, "given that for the past 30 years, the rate of preterm birth has been increasing."

"It's not a lot, and the rate is still too high, but the good news is some things are starting to work," she said. (Read more)

Wednesday, November 2, 2011

Prescription drug abuse is an epidemic nationwide and in Ky.

Prescription pain medicine overdoses now kill more people in the U.S. than heroin and cocaine combined, with 40 Americans dying every day from painkiller abuse.

"This stems from a few irresponsible doctors," said Thomas Frieden, director of the Centers for Disease Control and Prevention. "The problem is more from them than from drug pushers on street corners." One California study found 3 percent of doctors wrote 62 percent of painkiller prescriptions, reports Daniel J. DeNoon of WebMD Health News.

Prescription-drug abuse has tripled since 1999, with 1 in 20 U.S. adults admitting to taking the drugs for pleasure rather than need. According to the CDC, the drugs most abused are Vicodin (hydrocodone), OxyContin (oxycodone), Opana (oxymorphone) and methadone. In 2010, pharmacies sold enough of those drugs, and ones similar to them, "to give everyone in the U.S. a typical 5-milligram dose of hydrocodone every four hours for one month," DeNoon reports.

Abuse is more common in men than women; in rural than urban areas; in non-Hispanic whites than in other races or ethnicities; and in middle-age adults than younger or older adults.

The problem has grown to epidemic proportions in Kentucky, with more people dying from prescription drug overdoses than car accidents, The Courier-Journal reported in February. Much of the problem stems from Florida, which until September did not have a drug-monitoring system in place. Dealers from Kentucky would drive down to the Sunshine State and obtain prescriptions from several doctors at a time. They would then return to Kentucky to sell their haul. While a tracking system is now in place, there continues to be loopholes in Florida's law and the fear is pill mill operators will move to other states.

Frieden said states need to monitor who is prescribing the drugs; prevent doctor shopping; make prescriptions available for just three days of use at a time; and have doctors resort to narcotics only as a the last measure to control pain. "We are in an epidemic of prescription drug abuse," Frieden said. "This epidemic can be stopped."

In Kentucky, an effort has been launched to target "drug dealers in white coats" and involves a plan designed to root out doctors with suspicious prescription practices and pass legislation to better track prescriptions.

U.S. "drug czar" Gil Kerlikowske, director of the Office of National Drug Control Policy, said the White House has a goal of cutting down on prescription drug abuse by 15 percent by 2015. Kerlikowske visited Kentucky and adjoining states in February to assess the problem. (Read more)

Study finds doctors often overestimate how well they communicate in English as a second langauge

A study appearing in Health Services Research shows physicians who speak English as a second language, an increasing phenomenon in the U.S. and parts of Kentucky, often overrate how well they are communicating with patients.

The finding is the result of a language scale adopted by the Palo Alto Medical Foundation, which rates language proficiency in five levels: poor, fair, good, very good and excellent.

After the new scale was introduced in 2009, out of four of physicians who participated changed their rating. Of the 258 participants, 31 who had considered themselves "fluent" downgraded to "good" or "fair." Just 11 percent deemed their proficiency "excellent." "Seventeen percent used 'very good' and 38 percent said they were 'fair,'" reports Glenda Fauntleroy of research-reporting service Newswise. "Being 'fair' was defined as 'can get the gist of most everyday conversations but has difficulty communicating about health care concepts.'"

"This is a very tricky area as this demonstrates how many providers overestimate their proficiency in another language," said Joseph Betancourt, director of the Disparities Solutions Center at Massachusetts General Hospital in Boston. "This can lead to miscommunication and even medical errors." (Read more)

UK surgeons first to do life-saving lung procedures in tandem

Surgeons at the University of Kentucky are the first in medical history to perform two procedures in tandem to bridge a lung transplantation. The procedures were performed first on Wanda Craig, 68, who is now the oldest person to be "bridged to transplant using an artificial lung device, also known as an extracorporeal membrane oxygenation," reports research-reporting service Newswise. (Photo of Wanda Craig and Dr. Enrique Diaz by Julia Meador)

Craig, of Lexington, had chronic obstructive pulmonary disease and emphysema for which she has been treated for the past 10 years. In November 2010, she took a turn for the worse. "I was so out of breath from walking to the kitchen ... I didn't have enough energy to even scoop ice cream out of the carton," she said. Pulmonary hypertension, from which she also suffered, had caused the right half of her heart to fail, which prevented blood from going through the lungs to fill the left side of the heart, explained Dr. Charles Hoopes, director of UK's heart and lung transplant program.

To fix the problem, Hoopes and Dr. Enrique Diaz, the program's medical director, performed a procedure called an atrial septostomy, in which a small hole is created between the upper two chambers of the heart. This procedure, along with the extracorporeal membrane oxygenation procedure, saved Craig's life, the news release says. "These procedures are novel in terms of a bridge to transplantation, and the use of an artificial lung together with an atrial septostomy for cases of respiratory and right ventricular failure have not been performed together until now," Diaz said.

Three days later, Craig underwent a double lung transplant, and has been healing since. "More than anything I am looking forward to doing those normal everyday things like going to the grocery store and watching my grandson's T-ball games," she said. "And scooping my own ice cream." (Read more)

Smokeless tobacco can help you quit cigarettes, Owensboro-area residents are told (partly with tobacco money)

"Switch and quit" is the theme of an advertising campaign being promoted by a prominent cancer center in Kentucky, in which smokers are advised to lay off the cigarettes in favor of smokeless tobacco such as chew or snuff. "Supporters say smokers who switch are more likely to give up cigarettes than those who use other methods such as nicotine patches, and that smokeless tobacco carries less risk of disease than cigarettes do," The Associated Press reports.

AP reports the program is partly funded with grants from the tobacco industry, though program director Brad Rodu, a University of Louisville professor of medicine, said the industry has "absolutely no influence whatsoever." Smokeless tobacco has been linked to oral cancer.

"We need something that works better than what we have," said Dr. Donald Miller, an oncologist and director of the James Graham Brown Cancer Center, which is co-sponsoring the campaign with the university. "This is as reasonable a scientific hypothesis as anybody has come up with and it needs to be tried."

The campaign is being pushed in Owensboro using print, radio, billboard and other advertising. Residents of Owensboro and the surrounding area reportedly consume about 3 million cigarettes a week. "That amounts to well over a pack for every man, woman and child in the community of about 115,000 people," AP reports.

"The worst that you can say about smokeless tobacco is that it's the lesser of two evils," said Dr. Randall Thomas, an oncologist at the Owensboro Medical Health System. "I don't think we have any problem in telling a person that drinks a six-pack a day that if they could cut it back to two beers a day or two drinks a day that their health risks are greatly reduced ... Finding a way to let people have their nicotine that carries less risk, it's the realistic solution."

But there are opponents to the program, including Matthew Myers, president of the Campaign for Tobacco-Free Kids, who called it "a giant experiment with the people of Owensboro without rules or guidance designed to protect individuals from experimental medicine." The theme of the program does seem to run counter to warnings by the Centers for Disease Control and the National Cancer Institute at the National Institutes of Health, whose websites say the use of all varieties of tobacco products "should be strongly discouraged" and that there is "no scientific evidence that using smokeless tobacco can help a person quit."

Owensboro is an old tobacco town, and in the face of falling cigarette sales, tobacco companies are marketing more smokeless tobacco and other cigarette alternatives. (Read more)

Health Care Transparency and Patient Advocacy Conference to be held Nov. 11 in Lexington

Focusing on issues like hospital- and health care-acquired infections, the impact of medical errors and infections on patients, and the importance of transparency, the Health Care Transparency and Patient Advocacy Conference will be held Nov. 11 in Lexington.

Speakers include John Santa, director of the Health Ratings Center for Consumer Reports, who will discuss the principles of transparency; author Maryn McKenna, who will present the history of MRSA; Dr. Keith Sinclair, medical director of Bluegrass Oakwood in Somerset, who will speak of how transparency has nearly eliminated pressure sores at his institution; and Frances Griffin, a faculty member at the Institute for Healthcare Improvement, who will present on the IHI global trigger tool.

The gathering is from 8:30 a.m. to 5 p.m. at Embassy Suites in Lexington. Registration is $50 and includes a box lunch. Physicians, physician assistants, nurse practitioners, nurses, physical therapists and human resource managers attending the conference will receive 6.5 hours of continuing education credits. To register, click here.

Tuesday, November 1, 2011

Rural children face more health risks; most parents say their kids are healthy

Children in rural areas face more health challenges than those in urban parts of the country, and are more likely to be poor, more vulnerable to death from injuries, and more likely to use tobacco. Rural families also have more difficulty in gaining access to health care. But the majority of parents, regardless of whether they live in urban or rural communities, say their kids are healthy.

These findings are from a report entitled "The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2007," compiled by the U.S. Department of Health and Human Services' Health Resources and Services Administration. The report's results are based on the National Survey of Children's Health, conducted in 2007.

The survey classified children as living in an urban area, a large or well-populated rural area or a small or isolated rural area. Large rural areas include large towns with populations of 10,000 to 49,999. Small rural areas include small towns with populations of 2,500 to 9,999. Survey results were not broken down by state.

The report found children's overall health status does not vary substantially according to location. Four-fifths of parents said their children are in excellent or very good health, regardless of where they live.

But the analysis found rural children, as a whole, face more health risks than their urban counterparts. Only 67.6 percent of children in large rural areas and 69.8 percent in small rural areas are breast-fed, compared to 77 percent of urban children. (About 59 percent of new mothers breast-feed in Kentucky, compared to 75 percent nationwide.)

Rural children are also more likely to be overweight or obese — 34.6 percent of children in large rural areas and 35.2 percent in small rural areas compared to 30.9 percent of urban children. Rural children are also more likely to live with someone who smokes — one in three children in large rural areas and 35 percent in small rural areas do. Only one in five urban children do.

Though about 90 percent of children surveyed had health insurance, those in rural areas were more likely to have public coverage like Medicaid or CHIP. Urban children were more likely to have private insurance. Access to health care also remains a factor. Of the 2,052 non-metropolitan counties identified in 2010, 704 were designated as health professional shortage areas. Of those, 467 had shortages for dental care and 521 lacked adequate mental health services. To find if a Kentucky county is in a health professional shortage area, click here.

There are some advantages for rural children, however. They tend to be better protected and more connected to their families and communities. More than half of children in small rural areas shared a meal with their families every day in the past week. Children in small rural areas are also more likely to get physical activity every day (34.7 percent), though they are less likely to have access to community centers, parks or playgrounds. However, rural children are more likely to spend more than an hour each weekday watching television or videos — 60.9 percent of children in large rural areas did so, compared to 53 percent in small rural areas and 53.9 percent of urban children.

The data for the National Survey of Children's Health was generated using a random telephone survey, in which 2.8 million telephone numbers were randomly generated. After non-working and non-residential numbers were eliminated, the remaining numbers were called and surveyors spoke to respondents to see if children less than 18 years of age lived in the household. From each of those households, one child was randomly selected to be the focus of the interview and parents responded to the survey questions. Surveys were conducted in English, Spanish, Mandarin, Cantonese, Vietnamese and Korean.

Hike in health insurance premiums due to rising health costs, not reform law, concludes

Health insurance premiums for employer-sponsored family plans shot up by 9 percent from 2010 to 2011, but the bulk of the hike is due to the increase in health care costs, not the federal health-care reform law, non-partisan has found.

The law is responsible for about 1 to 3 percent of the increase, however, in large part because the law requires an increase in benefits, including: covering preventive care without co-pays or deductibles; allowing adult children to stay on parents' policies until age 26; increasing annual coverage limits; and covering children regardless of preexisting conditions.

"On the other hand, the fact that the law caused any increase at all casts more doubt on Obama's promise that the law 'could save families $2,500 in the comings years.' We've been calling that claim into question for several years now," stares. "The plan fact is that — so far — the law has caused an increase in premiums, though not so large an increase as some Republicans claim." (Read more)

Haven't quit smoking, lost weight? Pay more for health insurance, more companies say

In an effort to keep health-care costs down, companies across the country, including Walmart, are opting to charge workers who smoke or are obese higher premiums than their more healthy colleagues. (Reuters photo by Lucas Jackson)

The move is the follow-up to a strategy many companies have already tried: to encourage workers to take better care of their health by offering benefits like weight-loss programs or smoking-cessation classes. But with few signs of the health-care landscape changing, "They're replacing the carrot with a stick and raising costs for workers who can't seem to lower their cholesterol or tackle obesity," reports Jillian Mincer of Reuters.

One example is Walmart, which in 2012 will start charging its smoking workers higher premiums. It will also offer cessation classes. A company spokesman said people who use tobacco use about 25 percent more health-care services than people who don't: "These decisions aren't easy, but we need to balance costs and provide quality coverage."

Critics say the move will limiting people's freedoms, create employee resentment and hut the lowest-paid workers hardest. "It's not inherently wrong to hold people responsible," said Lewis Maltby, president of the National Workrights Institute. "But it's a dangerous precedent."

Though well-intentioned, these policies can create bitterness. Mark A. Rothstein, a lawyer and professor at the University of Louisville School of Medicine, said having a colleague call to ask about a person's weight loss can be seen as intrusive. That's part of the reason why the janitors at the school participate, but "the professors on campus consider it a privacy tax, so we don't get some stranger calling us about how much we weigh."

Nevertheless, many companies are moving forward with the option. In 2012, almost 40 percent of large and mid-size companies will start using penalties to control unhealthy behavior. That's up from 19 percent this year and just 8 percent in 2009, an October survey by consulting firm Towers Watson and the National Business Group on Health shows. "Nothing else has worked to control health trends," said NBGH Vice President LuAnn Heinen. "A financial incentive reduces that procrastination."

Cleveland Clinic, with a staff of 40,000, has implemented a comprehensive program and seen its health-care costs grown just 2 percent this year. "The effort began several years ago when it banned smoking at the medical center and then refused to hire smokers," Mincer writes. "It later recognized that having a gym and weight -oss classes wasn't enough to get people to participate. It made these facilities and programs free and provided lower premiums to workers who maintained their health or improved it." Paul Terpeluk, medical director of occupational health at the clinic, said employers have to develop a program and change the culture: "You don't do this overnight." (Read more)