Monday, December 31, 2012

UK has its pediatric heart program under review; chief is on leave, and patients are being referred to other hospitals

Kentucky Children's Hospital at the University of Kentucky is reviewing its cardio-thoracic surgery program and referring surgical patients to other hospitals, "but the reasons why are unclear," Brenna Angel reported Dec. 21 for WUKY-FM, the university-owned station.

Angel did identify "the surgeon at the center of the review," Dr. Mark Plunkett, left, who is on a leave of absence but "remains on staff at UK with a $700,000 annual salary," as chief of cardio-thoracic surgery. "UK denied an open-records request for the date of his most recent surgery and his patient mortality rate," citing privacy rules in the federal Health Insurance Portability and Accountability Act. It was unclear how release of such statistics, without any personally identifying information, would compromise privacy. Plunkett and officials of the medical center refused to be interviewed.

"It's been pretty hush-hush," Tabitha Rainey of Lexington, the mother of a Plunkett patient, told Angel, who reported: "Plunkett and his assistant Dr. Deborah Kozik operated on Waylon seven days after he was born. Tabitha was later told that Dr. Plunkett was taking a leave of absence." Rainey told Angel, "Months went past and they lost another patient, who was a dear friend of mine, and it was pretty heavy in the unit at the time. Then soon after I guess they decided to stop doing the surgeries and review the entire program."

Angle was able to get some records from UK and reported they showed that "The number of children Dr. Plunkett operated on this year is down around 43 percent from two years ago." UK Trustee Dr. Charles Sachatello, a surgeon who sits on the Board of Trustees' health-care committee, told Angel, "I was not aware of that, and that was never announced at the Board of Trustees meeting." Sachatello told Angel that UK should merge its pediatric heart program with the one at the University of Louisville because of the high operational costs of such programs. (Read more)

Friday, December 21, 2012

Generic OxyContin and Opana, headed for market soon, could make fight against pain-pill abuse tougher, McConnell says

With generic versions of the two most commonly-abused painkillers, Opana and OxyContin, coming on the market next year, police, hospitals and health clinics in Kentucky have voiced concern that "these generic crushable drugs lack the tamper-resistant gel coating of the brand-name drugs," says a news release from U.S. Sen. Mitch McConnell.

"Without this technology, addicts crush the pills in order to achieve an immediate heroin-like high from sniffing or injecting the painkillers," the release says. "If these generics come to market without the tamper-resistant coating, much of the work that law enforcement and health care providers have done to stem the tide of pain pill abuse in Kentucky will be lost."

McConnell's news release said he has asked the Food and Drug Administration to keep the crushable drugs off the market "until a workable solution can be found." McConnell, the Senate Republican leader, met Wednesday with the Department for Health and Human Services’ acting general counsel, Bill Schultz, to discuss the issue. (Read more)

Group of 550 doctors in Central Ky. leaving Medicaid's Coventry

A Lexington-area network of doctors says it will no longer contract with Coventry Cares, a Medicaid managed-care company, after Coventry said "it would begin to pay less than the established Medicaid rate in reimbursements — as much as 10 percent less for care from specialists," Cheryl Truman reports for the Lexington Herald-Leader.

The Physicians' Network is a group of 550 independent physicians, headed by Dr. Ralph Alvarado of Winchester. He said the cuts will mean that some doctors will be paying to treat Medicaid patients.

d more here: http://www.kentucky.com/2012/12/20/2450679/central-kentucky-doctors-cut-ties.html#storylink=cpy

Coventry issued a statement saying, "This decision would not take effect until March 7, and we do not expect any network access issues for our members. That said, Coventry would like our members to continue enjoying access to this group of providers. We remain committed to continuing negotiations . . . " (Read more)

Deaths from drug overdoses in Kentucky hit new high in 2010; more than half involved prescription drugs

Deaths from drug overdoses in Kentucky jumped to a new high in 2010, and "rose a staggering 296 percent from 2000 to 2010," Bill Estep of the Lexington Herald-Leader reports. "A tidal wave of prescription-drug abuse drove the steep increase," with just over half of the deaths involving prescription drugs, according to a study by researchers at the University of Kentucky.

As usual, the problem is worst in Appalachian Kentucky, as illustrated by this Herald-Leader map:


"The increase in deaths might have been even greater because information was not available for Kentucky residents treated in neighboring states, and because some death certificates might not have listed an overdose as the cause of a person's death when in fact it was," Estep reports. "The report did not measure the impact of changes Kentucky lawmakers made this year aimed at confronting the prescription-drug problem, though it will provide a way to help measure the impact of the law."

Read more here: http://www.kentucky.com/2012/12/20/2451315/drug-overdose-deaths-up-296-percent.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/12/20/2451315/drug-overdose-deaths-up-296-percent.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/12/20/2451315/drug-overdose-deaths-up-296-percent.html#storylink=cpy

Thursday, December 20, 2012

State Auditor Edelen faults Bluegrass mental-health agency for executive compensation, lax management and board oversight

The Bluegrass Regional Mental Health-Mental Retardation Board, a nonprofit agency that gets two-thirds of its money from taxpayers, "paid more than $2.8 million in executive-benefit contributions since 1997 to the president/CEO and various other employees solely at the discretion of the President/CEO with no scrutiny by board members," state Auditor Adam Edelen said in a press release this morning. "The contributions, which are designed to retain talent within an organization, were largely awarded to a core group of central office administrative staff while health-care employees received either no contributions or less significant amounts."

Edelen's release said the audit, made in response to "news media reports and anonymous concerns," also "found problems with . . . spending without supporting documentation and lax management practices." For example, Bluegrass spent $172,025 on lobbying from January 2011 to September 2012 without adequate documentation, and President/CEO Shannon Ware, right, and a consultant "spent nearly $38,000 on credit cards during an 18-month period without detailed receipts to document the business purposes," the release said. The full report is available here. It confirmed several findings by the Lexington Herald-Leader; for the H-L story on the audit, by John Cheves, go here.

U.S. teens' cigarette use drops to a new low, but use of alcohol goes up a bit and more 12th graders are smoking marijuana

Teenagers' cigarette smoking dropped to a record low this year but alcohol use rose slightly after seven years of decline, according to a survey of 45,000 eighth-, 10th- and 12th- graders for the National Institute of Drug Abuse.

The survey also found that the use of illicit drugs dropped slightly among eighth-graders but rose slightly among 12th-graders. Among them, 36.4 percent reported using marijuana in the past year, up from 34.8 percent in 2010, and the share who saw great risk in smoking marijuana occasionally dropped significantly, to 20.6 percent, from 24.5 percent in 2010.

Among all three age groups, only 10.6 percent said they had smoked cigarettes in the past 30 days, down from 11.7 percent in 2010. The University of Michigan researchers who did the survey said the decline was significant, and may have been driven by a big increase in the federal tobacco tax in 2009.

"A 1-percentage-point decline may not sound like a lot, but it represents about a 9 percent reduction in a single year in the number of teens currently smoking," principal researcher Lloyd Johnston said in a news release. Among eighth-graders, the decline was about 20 percent. For other results of the survey, click here; for a PDF version, here. For the full survey report, go here.

"Teen attitudes toward smoking also continued to become more negative. For example, 80 percent of teens said they preferred to date nonsmokers in 2012," Steve Gorman reports for Reuters. "But anti-tobacco advocates said their battle to stamp out teen smoking was far from over, noting that 17 percent of high school seniors still graduate as smokers." And the figure is higher in many rural areas.

Kentucky ranks at or near the top in youth smoking. In 2010, the last year for which state figures are available, 16 percent of Kentucky children aged 12 to 17 (a slightly younger group than the one above) reported smoking a cigarette in the past month. The national rate for that age group was 10 percent, according to the Centers for Disease Control and Prevention.

Wednesday, December 19, 2012

Feds tell states it's all or nothing on Medicaid expansion; Washington Post map shows Ky. is only state 'leaning' toward it

By Al Cross
Kentucky Health News

When the Supreme Court upheld federal health reform but said states could opt out of the expansion of Medicaid to people with incomes above the poverty line, to be funded with generous federal subsidies, one of the first questions was whether a state had to go all the way: to 133 percent of poverty (138 percent with an official fudge factor). Now the Obama administration has answered "no." And that could make the decision tougher for Kentucky, which is the only state The Washington Post listed this month as leaning toward expansion.


The Post's Sarah Kliff wrote, "The administration’s reasoning goes like this: The federal government was giving states a really, really good deal on the Medicaid expansion. It was footing the entire bill for the newly eligible enrollees for three years," 2014 through 2016, rather than the 72 percent it pays Kentucky for current enrollees. The subsidy for the new eligibles would drop to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019; and 90 percent in 2020.

White House aides told Kliff that in passing the bill, Congress (which is to say the Democrats in Congress) "gave states that really high funding in the service of a very specific goal: Ensuring all Americans have access to insurance options." But "If a state decided to cover, say, everyone up to the federal poverty line, they would be working with a smaller, more manageable population," Kliff explains. "Those living above the poverty line, meanwhile, wouldn’t be left in the lurch. The Affordable Care Act allows them to receive very generous subsidies in the private insurance market."

However, Medicaid Administrator Cindy Mann told Kliff that if states could fall short of the 133 percent level, they wouldn’t be within the spirit of the law. Kliff paraphrases Mann: "They wouldn’t offer all their residents a way to purchase affordable coverage, and if they’re not going to do that, the White House says they don’t deserve the extra funding."

Gov. Steve Beshear said again today that Kentucky should expand Medicaid "if we can afford it" because so many people in the state have no health insurance and are in poor health, and improving their health would be good for the state's economy.

Kentucky now makes Medicaid available to people with household incomes below 70 percent of the poverty line, which varies by household size. The Urban Institute has estimated that expanding the program to 133 percent of poverty would cost the state about 5 percent more than it would otherwise spend through 2022. That would be $1.3 billion extra in 2017-22, and some Republicans in the legislature have said the state can't afford it. The state expects to spend $1.5 billion on Medicaid in the 2013-14 fiscal year.

While the Post lists Kentucky as the only state "leaning yes" to expansion, it seems likely to be joined by several others. "States have stayed mum on whether they will participate in the expansion, seeing first if they could get a better deal — the partial expansion," Kliff writes. "The federal government took a while to show its cards; it wanted to see if states would sign up for the full expansion, without giving them a scaled-back option." Only 17 states have said yes, and as many are undecided, the Post reports.

In setting a firm rule, the White House may think states "will decide the 100 percent match is too good to pass up and that the federal money will pull everyone in," Kliff writes. "Or, it could indicate the Obama administration is okay with not all states participating with the Medicaid expansion on day one. Again, this wouldn’t be unprecedented: Only six states initially signed up for Medicaid when it launched in 1965."

States should realize that expanding Medicaid is a long-term investment in the health of their people that will pay off in the long run, Dr. Wayne Myers, who once ran Kentucky's rural-health office and was the first director of the federal Office of Rural Health Policy, writes in the Daily Yonder. He says that if a state doesn't expand Medicaid, many of its people will remain or become uninsured.

"Medicaid is a rural issue because a higher percentage of low-income people live in rural communities, and rural families are less likely to have private health insurance," Myers writes, adding that the program is also "a major economic driver." According to the National Center for Rural Health Works at Oklahoma State University, Medicaid was responsible for 113,000 jobs and a total of $10.5 billion in economic activity in Oklahoma in 2010.

Myers cites studies showing that patients with insurance who are hospitalized after accidents are 40 percent less likely to die than those without insurance, because uninsured patients got less attention from medical staff. Opting out of the expansion "may get a governor a self-inflicted gunshot wound to the foot, some dead hospitals and a bunch of dead citizens who needn't have died," Myers writes.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Managed-care doctor creates process to steer pregnant Medicaid recipients who are using dangerous drugs into treatment

When Dr. Jeremy Corbett of Lexington found that "nearly one in five pregnant women enrolled in the Medicaid managed-care program where he works were using narcotics or other harmful drugs," he tackled the problem. As medical director of the Kentucky Spirit Health Plan, "He designed a new program combining high-tech health information with case management to tackle the problem of addicted babies, which is exploding statewide," reports Laura Ungar of The Courier-Journal. (C-J photo by Tim Webb)

Ungar describes how Corbett's program works: "Employees examine patient records for pregnant Kentucky Spirit members. The pharmacy department uses an analytics report, coupled with the Kentucky All Schedule Prescription Electronic Reporting System, or KASPER, to cross-check for drugs that could be dangerous during pregnancy, including narcotics. Department employees also look at the pattern of prescriptions, which could point toward doctor-shopping for pills. . . . Kentucky Spirit sends letters to the prescribing doctor and the obstetrician the woman is seeing, letting them know she is pregnant and has received a prescription for dangerous drugs. Corbett said sometimes the prescribing doctor doesn’t know the woman is pregnant, and the obstetrician doesn’t know she’s taking narcotics. Corbett said they also send letters outlining the dangers of taking certain drugs during pregnancy, and case managers reach out to women at risk of giving birth to addicted babies."

The program started three weeks ago. Corbett said two women have asked to get substance-abuse treatment, for which Kentucky Spirit pays — "even residential treatment, which is not required by Kentucky law — because it saves money in the long run," Ungar reports. "Kentucky has seen its hospitalizations for addicted newborns climb from 29 in 2000 to 730 last year — a 2,400 percent increase that far outpaces the national increase." Corbett told her, “When these babies wind up in the neonatal intensive care unit, it’s a huge loss, emotionally, and it’s also a huge loss of state dollars.” (Read more)

Tuesday, December 18, 2012

Many Ky. parents don't realize children are overweight, or won't acknowledge it, but many report kids' poor health behavior

By Al Cross
Kentucky Health News

Many Kentucky parents don't realize that their children are obese or overweight, or at least aren't willing to acknowledge it. That is the obvious conclusion to draw from the latest results of the Kentucky Parent Survey, released Tuesday by the Foundation for a Healthy Kentucky.

The poll found that only 14 percent of Kentucky parents say their child weighs too much, but the National Survey of Children's Health found that 37 percent of Kentucky children are overweight or obese. Conversely, 76 percent of parents in the poll think their child's weight is about right, but the national survey found that only 58 percent of Kentucky kids have healthy weight.

The Kentucky Parent survey, taken by land-line and cell telephone from July 19 to Aug. 22 by the Center for Survey Research at the University of Virginia, interviewed 1,006 Kentucky parents, step-parents, grandparents, foster parents or other legal guardians of children in Kentucky selected at random. The statistical margin of error for that sample size is plus or minus 3 percentage points.

The poll also found that 56 percent of Kentucky children are watching more than the maximum daily recommended amount of “screen time” – watching television, playing video games or using the Internet – and that 59 percent drink sugar-sweetened beverages every day. Both are major factors in childhood obesity, research has found, and experts recommend no more than two hours of screen time a day and no sugar-sweetened drinks at all.

“Parents can help reduce this risk by encouraging healthy behaviors for their children,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky.“Our children’s habits and behaviors impact their health today and shape their quality of life as they grow. When kids eat poorly and don’t get enough physical activity, it increases their risk for obesity, diabetes, heart disease and other chronic diseases. This poll data helps us understand what parents think about the behaviors that are so critical to health.”

The Kentucky Parent Survey also found that only 56 percent of Kentucky parents said their child got "enough" fruits and vegetables every day during the preceding week, and 66 percent of parents reported their child got "enough" physical activity every day during the preceding week. It also found that elementary and high-school students often get less than the recommended amount of sleep per day (chart).

The survey did not define "enough." The foundation noted that one strategy to reduce childhood obesity in Kentucky is "5-2-1-0," reflecting experts' recommendations that each day, children should eat at least five servings of fruits and vegetables, have no more than two hours of screen time, engage in one hour of physical activity, and drink zero sugar-sweetened beverages. For the foundation's press release, click here.

Oregon may show the way for Kentucky in drug treatment

In facing up to its need for more drug-treatment facilities, Kentucky could learn some lessons from Oregon, Courier-Journal reporter Laura Ungar writes in the third and last part of her package of stories about drug treatment, or lack of it, in our state: "Oregon, like Kentucky, is a largely rural state with about 4 million people — and a substantial prescription-drug abuse problem. But Oregon has acted more quickly and aggressively to tackle treatment." She cites examples:

• Oregon is spending about $51 million annually on substance abuse treatment, $11 million more than six years ago. "Kentucky’s Department of Behavioral Health, Developmental and Intellectual Disabilities spends $29 million a year , and hasn’t increased that amount in more than a decade."

• Medicaid, the federally subsidized health-insurance program for the poor and disabled, covers substance abuse treatment in Oregon, "while Kentucky, with a few exceptions, does not."
• Oregon admits more than twice as many addicts for treatment, and "Oregonians are much more likely to receive intensive treatment: "10 percent of treatment admissions were to long-term, residential facilities, compared with 1.1 percent in Kentucky."
• Kentucky had a much higher rate of deaths from drug overdoses in 2008, the most recent year available — 17.9 per 100,000 compared with 11.7. "Health experts say effective treatment leads to fewer overdoses." (Read more)

Sunday, December 16, 2012

In starting its sixth package in series on prescription drug abuse, The Courier-Journal shows treatment programs fall short of need

Brittany Crouch suffers through withdrawal in Frenchburg
before leaving for treatment in Lexington, as daughter
Kaylee Adams, 3, cries. (C-J photo by Alton Strupp)
"In a state plagued by one of the worst prescription-drug abuse problems in the nation . . . treatment options are woefully limited, especially for hard-core addicts in need of the most intense care, Laura Ungar reports for The Courier-Journal in the opening story of its sixth package in the series called "Prescription for Tragedy."

"Only 40 of Kentucky’s 301 treatment and recovery sites offer 24-hour residential care, which experts say may be the only hope for the most severely addicted. And those 40 centers are concentrated in just 19 of the state’s 120 counties, mostly in urban areas, meaning addicts in rural counties often must travel hours for help, Ungar writes, noting that almost 80 percent of the sites "are for outpatients only, typically offering one hour of care a week."

That is the type of care received by two-thirds of Kentuckians admitted for treatment, but by 46 percent nationwide in 2009, the last year for which comparative figures are available. Fewer than 5 percent "entered residential care, compared with 17 percent nationally," Ungar writes. "Treatment shortages are most severe in Appalachian counties with the state’s highest overdose rates. Six Kentucky counties that rank among the 10 highest for overdose deaths have just one outpatient center or no center at all." (Read more)

Today's package includes a map of treatment centers in the state; in the print version, it is overlaid on a county map showing rates of death from prescription drugs, with the highest in Appalachian Kentucky. The dots in green, yellow and red on the Google-based map below indicate centers that provide care more intensive than outpatient.

Friday, December 14, 2012

Kentucky's week-long brand of flu now called 'widespread'

What started out early is now full-blown. The Kentucky Department for Public Health informed federal health authorities this week that data it has received from local health departments, hospitals, clinics and private doctors indicates that flu is now "widespread" in the state.

Darla Carter of The Courier-Journal reports that Louisville officials have confirmed nine cases and 127 positive rapid tests since the first week of November. For the status to be "widespread," the state explained it had received numerous reports from throughout the commonwealth. What is being reported is not a 24-hour bug, but a 7-10 day virus.  Health officials are vigorously encouraging flu vaccinations. (Read more)

Health care decisions by and for Medicare patients differ widely by place; Lexington big in back surgery, low in mastectomy

All medicine involves decisions and, according to a new series of nine reports published by the Dartmouth Atlas Project, those decisions differ drastically by location for Medicare patients. In the East South Central region -- Kentucky, Tennessee, Alabama and Mississippi), the variation between how things are diagnosed and treated can change when one crosses county lines.

An example, with numbers but without explanation: The total knee replacement rate in Harlan is 3.3 per 1,000 Medicare beneficaries; in Bardstown, it's 13.8. As the report goes on to note: "If you have heart disease and live in Huntsville, Ala., you are half as likely to undergo balloon angioplasty than if you live in Hattiesburg, Miss., and twice as likely to undergo back surgery if you live in Lexington, Ky." The greatest variation in the region was seen in mastectomy, ranging from a low of 0.3 percent per 1,000 female Medicare beneficiaries in Lexington to 2.1 per 1,000 in Tupelo, Miss.

The point, researchers say, is that providers and patients need to work together to determine care. The report looked at rates for early-stage breast cancer, stable angina, low back pain, arthritis of the knee or hip, carotid artery disease, gallstones, enlarged prostate, and early-stage prostate cancer. Read the report here.

Military culling overweight and obese troops; Ky. recruitment drops

Between 1998 and 2010, CNN reports, the number of active-duty military personnel deemed overweight or obese more than tripled. In 2010, 5.3 percent of the force -- or 86,186 troops -- received at least a clinical diagnosis of overweight or obese, according to the Armed Forces Health Surveillance Center. The trend has prompted the Pentagon to re-examine its training programs, and it is now actively weeding out soldiers deemed unfit to fight. It is also a tidy way to trim the budget at the same time as federal cuts loom. (CNN photo)

During the first 10 months of this year, 1,625 soldiers were dismissed for being out of shape. That's  about 15 times the number discharged for that reason in 2007 at the peak of wartime deployment, CNN reports. Overweight are considered "substandard" fighting units and a threat to national security and the nation' ability to maintain an adequate defense. Obesity is now the leading cause of ineligibility for those wishing to join, say military officials.

Kentucky ranks 34th in state recruitment rates. The numbers -- as a percentage of the recruits per 100,000 youth aged 18-24 -- dropped steadily from 2007, when it was 2.53 percent, to 2010, when it was 1.94 percent. Perhaps the state's high obesity rate was a reason. (Read more)

Wednesday, December 12, 2012

Republican legislators keep hammering state officials and managed-care companies about Medicaid payment delays

Republican lawmakers reitarated this week that the companies managing Medcaid in Kentucky are still not paying health providers promptly. According to Sen. Joe Bowen, R-Owensboro, in the year since the state moved more than a half a million people to managed care, the amount owed to hospitals has doubled, Beth Musgrave of the Lexington Herald-Leader reports. The state switched to managed care to reduce costs in the federal-state program that pays health care costs for the poor and disabled.

According to state Medicaid Commissioner Lawrence Kissner, WellCare and Kentucky Spirit have been cited by the state Department of Insurance for failing to meet their obligation to the state and the hospitals. A third managed care company, Coventry, has not been cited. The two companies, notes Musgrave, have submitted plans of correction to the insurance department.

None of the companies testified at Tuesday's meeting of the Interim Joint Committee on Health and Welfare where Bowen and other Republicans voiced their complaints. Despite the payment problems, Kisser said the move to managed care has helped stem rising costs. As of October, he said, Medicaid was $40 million under budget. (Read more)

Children with TVs in their bedrooms are twice as likely to have extra fat, three times greater risk of heart disease and diabetes

Kids who have TVs in their bedrooms are twice as likely to be fat and nearly three times as likely to be at risk for heart disease and diabetes as those who don’t, according to a new study that elevates concerns about health and screen time. The research, published in the American Journal of Preventive Medicine, studied 369 children, 5 to 18, who have TVs in their rooms and watched more than five hours of television a day. They showed dramatic evidence of extra belly fat, bigger waists, greater risk of heart disease and diabetes and elevated triglycerides, or fat in their bloodstream, said Amanda Staiano, a scientist with the Pennington Biomedical Research Center in Baton Rouge, La. (Getty Images photo)

A 2010 study cited by Staiano indicated that 70 percent of American children have a TV in their bedroom. In the Pennington study, 66 percent of the kids had a TV in the room and the precise relationship between TV and health, as measured by height, weight, waist measurements, blood pressures, fat deposits and other exams, revealed the stark disparity between the groups with and without their own TV. (Read more)

Annual health ratings of states still puts Kentucky 44th

Kentucky ranks 44th among the 50 states in overall health in United Health Foundation's America's Health Rankings. Darla Carter of The Courier-Journal reports that while this is the same rating Kentucky achieved last year, the state is not without some high points. Among them, Kentucky is 9th best nationwide for its low incidence of binge drinking. We are to be congratulated as well for our low violent crime, high immunization coverage and improved high-school graduation rate.

Smoking continues to be where Kentucky fails miserably. Still worst, with 29 percent of the population as smokers, the state also faces an uphill battle with more than 1 million obese adults and a high rate of cancer deaths. The state also needs to continue to improve its ability to control the nation's highest rate of preventable hospitalizations.

The rankings are published by the United Health Group's foundation, along with the American Public Health Association and the Partnership for Prevention. Kentucky’s challenges include having the nation’s highest smoking rate, more than 1 million obese adults and a high rate of cancer deaths. See more on Kentucky's ratings here. (Read more)

Dollar General to sell tobacco in most of its stores by mid-2013, reflecting 'customer demand' and 'competition pressure'

By the middle of 2013, most of Dollar General's 10,000 U.S. stores will carry cigarettes and other tobacco products.. The company has made the decision in response to “competitive pressures” which came about when Family Dollar Stores, a key competitor, began adding cigarettes to its stores last year. In a press release issued by Dollar General, customer demand also drove the company's decision, citing their perception that their core customers -- mostly based in rural America -- are more likely to smoke than the national average.

A 2012 study by the American Lung Association indicated that while rural Americans do smoke more than urban Americans, geography is less a factor in determining who smokes than socioeconomic status. The study also found that pregnant rural women are far more likely to smoke than their urban counterparts. (See actual numbers from the Centers for Disease Control and the American Lung Association study here.)

G. Chambers Williams III of The Tennessean in Nashville reports that business analysts think the idea is a good one for the company, which tested the product placement last year in Nevada. Analyst Mark Montagna with Avondale Partners in Nashville explained that the company found that the average purchase per customer was $14 where tobacco was sold, versus an average of $11 otherwise. But, he added, the one challenge the company will face with tobacco products, additional shoplifting.
Anti-smoking advocates expressed regret at the business choice. (Read more)

Monday, December 10, 2012

Haynes: Medicaid case managers threatened, and more bumps ahead, but state beginning to see advantages of new system

By Al Cross
Kentucky Health News

Some Medicaid case managers' lives have been threatened because they have tried to get Medicaid patients to go to primary-care doctors instead of emergency rooms, Health and Family Services Secretary Audrey Haynes said today.

Haynes, right, and two key legislators talked about managed care, the possible expansion of Medicaid under federal health-care reform, and the insurance exchange being set up under the law, at the Kentucky Chamber of Commerce's annual policy conference in Lexington.

The case managers work for insurance companies that oversee Medicaid under contracts with the state. Haynes said the cases of threats have been reported to police.

One key to making managed care work is more prevention, Haynes said, but "People want to go to the emergency room." She mentioned one case of a Medicaid recipient who had gone to emergency rooms 57 times in 30 days.  Under federal law, hospital emergency rooms generally cannot refuse to treat patients who present themselves.

"They will abuse the emergency room because that is the system they know," said Republican Sen. Tom Buford of Nicholasville, chairman of the Senate Banking and Insurance Committee.

Haynes said, "Our people are getting sicker, especially folks on Medicaid, and we can't allow people to use high-intensity . . . high-cost services."

Haynes, an appointee of Democratic Gov. Steve Beshear, and her cabinet have come under fire for not putting more pressure on managed-care companies to make timely payments to hospitals, doctors and other providers. She was not asked about that, but alluded to it: "There have been lots of bumps in the road, and some of them may continue."

But she said the state is only beginning to see what can be gained from the new system, which is supposed to save hundreds of millions of dollars. "We were one of the last states to look at managed care," she noted.

Buford said "I don't disagree with anything she has said," but said the Beshear administration rushed into managed care. "I don't think there's much we can do. We are in this lady's hands on this issue and we'd better support her."

Buford predicted that Beshear would try to expand the Medicaid program to households earning up to 138 percent of the poverty level, a key part of the federal reforms but one the Supreme Court said must be optional for states, not mandatory.

"It will be difficult for him to say no to the expansion of the Medicaid rolls," which the federal government would entirely cover in the first two years, Buford said. That would be reduced to 90 percent by 2020, but Buford predicted that the federal government will ask the states ot accept less because it won't have the money.

Haynes said Beshear would like to expand Medicaid, and a "deep-dive economic analysis" is being done now, with the help of the federal Department for Health and Human Services, to establish the financial parameters. "We probably won't know for several months because we're still getting a lot of guidance from HHS," she said.

Haynes said expanding Medcaid would bring $10 billion to $12 billion to the state, having a significant economic impact, and the managed-care companies came to the state expecting the expansion.

She said HHS is calling the state's effort to set up the insurance exchange, a marketplace for health coverage, a model for other states.

However, Buford said the Senate, which has 24 Republicans and 14 Democrats, in a state that voted against President Obama by a similar margin, will probably allow Beshear to re-issue the excutive order creating the exchange rather than adopting it into law. "That would be impossible to make it through the state Senate in the next two years," he said.

Buford said he favors a federal exchange as "the best bang for your buck on premium costs," but said the state is too far into its own exchange to do that now. However, when the grant funds being used to create it run out, "I don't know what this exchange will be," he said, indicating that the legislature would not authorize the fees on insurance companies that the exchange plans to levy to finance its operations.

Buford made many criticisms of the reform law, but Rep. Susan Westrom, chair of the House Health and Welfare Committee, asked, "If this is such a horrible thing," how would it be passed by Congress and "upheld by the Supreme Court?"

Colorful fruits and vegetables linked to lower breast cancer risk

Come to find out, pink isn't the most important color when it comes to breast cancer. According to researchers in the Journal of the National Cancer Institute, women loading up on carotenoids, the  micro-nutrients found in red, yellow and deeply colored fruits and vegetables such as carrots, sweet potatoes spinach and kale, showed lower rates of breast cancer than those who didn’t eat as many of them.

Alexandra Sifferlin at Healthland Time magazine explains that Dr. Heather Eliassen, an assistant professor of medicine at Harvard Medical School, led an analysis of data collected in various studies about the carotenoids and their effect on blood and breast cancer rates. The studies included 3,000 participants and nearly 4,000 controls. Women with carotenoid levels in the the top 20 percent of measured ranges had a 15-20 percent reduced risk of breast cancer compared to those with carotenoid levels in the lowest category. “It looks like it is a linear relationship,” says Eliassen. ”The higher you go, the [lower] your risk is."

Why carotenoids work against breast cancer isn't clear. They may metabolize into retinol, which regulates cell growth. Or they may improve cell communication and enhance immune system function. Eliassen urged caution. Other research carotenoids, in the form of beta-carotene supplements, are linked to an increased risk for lung cancer. (Read more

The Kentucky Fruit and Vegetable Conference will be held Jan. 7-8 at the Embassy Suites in Lexington. Deadline for preregistration is Dec. 19. The block of rooms for the conference will be held until Jan. 4. Program and registration information are available here or through John Strang at (859) 257-5685 or jstrang@uky.edu, or Tim Coolong at (859) 257-3374 or timcoolong@uky.edu.

UK team gets $1.5 million NIH grant to continue success with cell-level study of Alzheimer's disease factor

University of Kentucky researchers have provided the first direct evidence that activated astrocytes could play a harmful role in Alzheimer's disease.

A UK news release explains, "The astrocyte is a very abundant non-neuronal cell type that performs absolutely critical functions for maintaining healthy nervous tissue. However, in neurodegenerative diseases, like Alzheimer’s disease, many astrocytes exhibit clear physical changes often referred to as 'astrocyte activation.' The appearance of activated astrocytes at very early stages of Alzheimer's has led to the idea that astrocytes contribute to the emergence and/or maintenance of other pathological markers of the disease."

UK researchers gave mice gene therapy at a very young age and assessed them 10 months later. The astrocyte activation improved brain function and preserved cognitive function. The research, published recently in the Journal of Neuroscience, has led to a five-year, $1.5 million National Institutes of Health funding grant to the researchers and the UK Sanders-Brown Center on Aging to further this line of study. Chris Norris, an associate professor in the UK College of Medicine Department of Molecular and Biomedical Pharmacology, is the senior author of the study. (Read more)
 

Hey, fans! Lower your voice and protect your ears; your hearing might be at stake

Ray Hull (Wichita State Univ. photo)
December is the cruelest month, basketball fans -- in more ways than one. Witness this news out of Kansas.  Yes, Kansas: Loud basketball games can often generate deafening noise that result in real hearing loss. So says Wichita State University audiologist Ray Hull, who found that gymnasiums and arenas are built like reverberating echo chambers that can wreak havoc on ears by amplifying noise to dangerous levels.

Hull says the intensity level at some basketball games -- even at middle and high school games -- can reach 115 decibels. "We can stand that noise without permanent damage to our hearing for approximately seven and half minutes," he explained. "Those who are most susceptible to damage to their hearing are those who are sitting, for example, near the pep band or, of course for those in the pep band, because intensity levels can reach 125 to 130 decibels. At that intensity level, you are susceptible to permanent damage to your hearing after about a minute and a half of exposure."

Noise-reducing plugs, available in most grocery or sporting goods stores, would provide the protection necessary to prevent this kind of injury. (Read more)

Rural Obesity Prevention Tool Kit created to tackle epidemic: 40 percent of rural adults in U.S. are obese

When the Journal of Rural Health recently reported that 40 percent of adults living in rural areas are obese, compared with 33 percent of adults living in urban areas, the size of the disparity was larger than expected and previously estimated. In response to the severity and urgency of the obesity epidemic, the Rural Assistance Center of the U.S. Department of Health and Human Services has created a Rural Obesity Prevention tool kit which contains resources to help communities develop obesity prevention programs. (Read more)

Friday, December 7, 2012

Court of Appeals panel rules 2-1 that county boards of health can pass smoking bans; appeal in Bullitt County case seems likely

By Al Cross
Kentucky Health News

In Kentucky's first appellate-court ruling on the issue, the state Court of Appeals today upheld the Bullitt County Board of Health's smoking ban, which is virtually the same as others enacted by several other county health boards. However, the panel's 2-1 vote and the strength of the dissent suggests that the ruling will be appealed to the state Supreme Court.

UPDATE, Dec. 19: The county Fiscal Court voted Dec. 18 to appeal, Tom O'Neill of The Courier-Journal reports.

Health boards in Clark, Hopkins, Madison and Woodford counties have enacted smoking bans. The Hopkins County ban was upheld by the local circuit judge, whose ruling was not appealed. (Courier-Journal video story on smoking in Bullitt County bars)


In Bullitt County, the fiscal court and eight towns sued to stop the ban four days before it was to take effect last year. Bullitt Circuit Judge Rodney Burress ruled that the board lacked authority to ban smoking in public places, but the appeals court said the General Assembly had clearly given county health boards the power to impose regulations protecting public health, that secondhand smoke is a public-health issue, and that the board's regulation is reasonable, because it is virtually the same as an ordinance upheld in Lexington.

The majority cited regulations that the Jefferson County Board of Health had enacted in the 1970s to prevent lead poisoning, and cited other court decisions saying that courts should construe public-health laws liberally. The local governments argued that the Bullitt health board has usurped legislative  power held only by them, but the 2-1 majority said the state legislature had granted the board that authority in public-health matters.

Judge Jeff Taylor of Owensboro dissented, writing that the law cited by the majority and the board was passed 58 years ago. "I harbor grave doubt that the General Assembly intended to empower health departments at that time with the authority to regulate smoking as a threat to public health," he wrote. "In 1954, second-hand smoke was not a known public health issue." He said the legislature had specifically authorized the Jefferson County lead program, and the Lexington ban was passed by the local council, not the Fayette County Board of Health.

Taylor noted that the Bullitt board had relied on "national and international studies on the effects of secondhand smoke," with no local studies showing "smoking presents a threat to the health of the citizens of Bullitt County." And even if the board had such studies, he wrote, other state laws "reserve to cities and counties the authority to regulate smoking and secondhand smoke in their respective jurisdictions." The laws he cited do not appear to do that, but he argued that allowing health boards to enact smoking bans, he said, would give them "limitless" power to regulate guns, alcohol, sales of large-size soft drinks or "the number of cheeseburgers sold by fast-food restaurants."

Taylor wrote, "To the extent the cities and county, and their elected officials have failed to address a perceived serious public health issue, the citizens of Bullitt County have an easy method to remedy the problem – the ballot box," Taylor wrote. "Or, in the alternative, the Kentucky General Assembly can expressly authorize health boards to regulate smoking in each county." To read the seven-page majority opinion and the eight-page dissent, click here.

Kentucky's pill-mill problem and law to fight it get national airing, with issues of patient privacy versus public health debated

Kentucky's "pill problem" went more public Thursday when David Hopkins, head of the state's prescription drug monitoring program, told the National Conference of State Legislatures the true extent of our prescription pain pill addiction. Maggie Clark of Stateline reports that lawmakers "shook their heads in disbelief" when Hopkins said the state's doctors issued 60 million prescriptions for the 4.4 million Kentuckians in August of this year alone. The stark admission was a way to start talking about where patient privacy ends and public health concerns begin, Clark writes.

Kentucky is among 42 states with operational prescription-monitoring laws but few others require physicians to use the database to chronicle each patient and their drug use before prescribing as Kentucky does. And while the commonwealth allows its law-enforcement officers access to the database, the database is not controlled by the attorney general's office but, as a nod to patient privacy, by the Cabinet for Health and Family Services. In Vermont, legislators fought that battle earlier this year, with police there needing a warrant to access it. When Kentucky's law enforcement officers were surveyed about the law in 2010, 73 percent said they found the tool "excellent" for obtaining evidence.

At the conference, a report citing a Centers for Disease Control review explained that data collected through 2005 in a limited number of studies shows that having a prescription drug monitoring program in place had no clear impact on overdose mortality, Clark reports.

CDC: Kentucky grossly underuses tobacco settlement money when it comes to tobacco prevention and cessation programs

Kentucky is not even remotely up to snuff on state tobacco-prevention programming. According to a new report from the Robert Wood Johnson Foundation and the Centers for Disease Control, the state spends only $2.2 million on such programs. That amount is only 4.5 percent of what the CDC recommends that state, which has the highest incidence of tobacco use in the nation, spend. If the state spent what the nation's most prestigious health institution recommended, state spending to improve Kentucky's collective lungs should be in the $57 million range.

Kentucky ranks 36th in state tobacco control spending nationwide. According to the RWJ Foundation report, states will collect a record $25.7 billion in revenue from the tobacco settlement and from tobacco taxes this year, but will spend just 1.8 percent of that money on programs to prevent kids from smoking and help smokers quit. That's less than two cents of every tobacco dollar sent back to the states. Only Alaska and North Dakota are funding the levels that the CDC has recommended.

Read the report here. To view an interactive national map, with each state's spending outlined at here.

Cheaper heroin showing up in Eastern Kentucky as crackdown on pain pills makes that trade less attractive

About 60 grams of heroin, worth about
$8,000. (AP photo)
It was only few months ago that Northern Kentucky law enforcement officers and substance abuse clinics began expressing grave concern that heroin was fast becoming the go-to drug in their region. Today, there are signs that the drug is already moving swiftly east, into the already drug-ravaged mountains of Eastern Kentucky. The reason for the uptick in heroin use? Because pain pills aren't as available anymore.

Federal and state law enforcement have been cracking down on the prescription pain-pill drug trade for years in these parts. They've created electronic prescription-tracking systems, staked out pain management clinics and shut down a drug pipeline that starts in Florida. Some argue that last year's passage of House Bill 1 has discouraged even legitimate doctors from prescribing pain drugs. All these things make heroin usage an unintended consequence of their success, officials fear.

 "There's always some type of drug to step up when another gets taken out," Dan Smoot, law enforcement director of Operation UNITE, which handles drug investigations in 29 Eastern Kentucky counties, told Brett Barrouquere of The Associated Press. "We didn't know it was going to be heroin. We knew something was going to replace pills."

Officials say the heroin is trafficked from Mexico into the U.S., where it first goes to Illinois, Michigan and Ohio. Northern Kentucky counties have been the epicenter of heroin abuse in the state, but law enforcement officials in Louisville, Lexington and Appalachian counties are reporting "a dramatic rise in the number of arrests and seizures related" to heroin. Kentucky State Police seized 11 doses of heroin and other opiates in 2008 in the eastern half of the state; they have seized 395 doses there so far this year.

Users are attracted to heroin's low cost compared to pain pills, Barrouquere reports. A single oxycodone pill can cost from $80 to $100, but heroin can cost as little as $15 to $20 for an amount that will produce the same level of intoxication as one pain pill for 24 hours, Kentucky Office of Drug Control Policy Director Van Ingram said. (Read more)

One S.C. county serves as incubator for state's efforts to battle weight problems, with some good results

PE teacher Sharon Williams, right,
leads morning exercises before
classes start at Bells Elementary.
(The State photo by Tim Dominick)
With nearly two-thirds of South Carolina deemed overweight or worse, lucky Colleton County got picked to be a test case for doing better. That is, for improving its chances to beat the state's already overwhelming rates of diabetes, heart disease and stroke and for helping to lower the state's $1.2 billion dollar medical bill. Lucky, because in 2010, the county was awarded almost a half million Eat Smart Move More grant by the BlueCross BlueShield of South Carolina Foundation to see if it could promote health eating and more physical exercise countywide. Joey Hollerman of The State newspaper in Columbia, S.C., reports that "the results have been striking," though he notes that changing obesity numbers is "like turning an aircraft carrier, it's a slow process." Mostly, he's talking about attitude and perseverance.

How does the county-wide program work on a daily basis? First, of course, you have to have buy-in, which this county did. Hollerman explains that now when children arrive at Bells Elementary School in the county seat of Walterboro, "they go straight to the gym and walk laps before heading to classrooms. Worshipers at Power of Faith Delivery Ministry harvest collards as well as souls, and fried chicken is discouraged at church dinners. The local farmers market has a sparkling new home and a system set up to accept cards from the Supplemental Nutrition Assistance Program." The Let’s Go, Eat Smart program and exercise programs are posted in schools, workplaces, grocery stores and churches.

So how, if the numbers aren't clear yet, how to measure if it's working? Well, only one fried chicken basket showed up at a recent church supper and the member who brought it ended up apologizing for her breach. On the day the reporter visited only the elementary school only one child in the entire first grade tried to slip through without selecting a fruit or vegetable. He was sent back and grabbed a plastic container of grapes from the Go (instead of the Slow or Whoa) food options, Hollerman reports. There are also anecdotes galore, including those of children, once on insulin, who are now fine without it.

South Carolin's BlueCross BlueShield recently awarded another grant to Eat Smart Move More, in part to continue the work in Colleton County but also to for expand it to other communities. (Read more)

British researchers say a simple calculation can predict likelihood of a baby's chance of becoming obese during childhood

If only we knew from the start which babies were predisposed to becoming diabetic and hypertensive and overweight . . . News out this week suggests we can. NBC News reports that British researchers have published findings in the journal PLOS ONE saying that a simple assessment can predict at birth a baby's likelihood of becoming obese during childhood. The formula, available as an online calculator here, estimates the child's obesity risk based on its birth weight, the body mass index of the parents, the number of people in the household, the mother's professional status and whether she smoked during pregnancy.

The hope is to help families will take steps to control the weight of babies and small children before medical problems arise. Philippe Froguel of Imperial College London, who led the study, explained that teaching parents about the dangers of over-feeding and bad nutritional habits at a young age is much more effective than having to teach children how to lose weight. Froguel's team developed their formula following 4,000 Finnish children since 1986. Childhood obesity is a leading cause of early type 2 diabetes, as well as various types of cardiovascular disease. (Read more)

Study: Teenagers may buy fewer cigarettes if the product is not prominently displayed

For Kentucky which has the dubious distinction of having the nation's highest rate of teen smokers, an study published this week in Pediatrics reports that teenagers may be less likely to buy cigarettes at convenience stores if they aren't sold in plain sight. Genevra Pittman of Reuters Health explains that requiring stores to hide tobacco product displays is one option some states are considering to curb teen smoking after the Family Smoking Prevention and Tobacco Control Act of 2009 was passed, according to Annice Kim, the study's lead author. No state has yet banned the displays. (Associated Press photo)

The study was conducted using a virtual reality game where teens, ages 13 to 17, "visited" simulated stores to purchase items. In some cases, the cigarettes were displayed behind the counter; in others, they were covered up. The researchers from RTI International found that 16 to 24 percent of teens tried to buy tobacco when the display was open, compared to 9 to 11 percent when it was closed. Thirty-two percent said they were aware cigarettes were available when the display case was closed , compared to 85 percent of those who had the open version.

Dr. Michael Siegel, of the Boston University School of Public Health, told Pittman that the study was interesting but he was skeptical of extrapolating it into real life. Real life kids, he said, will go to a store when they want to buy cigarettes. "I don't know how many situations there are when a kid is hanging out in a convenience store with nothing to do and says, 'Oh, I'll just try a cigarette as long as they're here.' "(Read more)

CDC director: Flu season is three weeks early, could be a bad one

Prepare for a bad flu season. According to the Centers for Disease Control, this flu season seems to be ahead of schedule if you use the last decade as any judge of when the season should begin, which is usually around Christmas. Suspected cases have already showed up in Alabama, Louisiana, Florida, Mississippi, Tennessee and Texas, with two infant deaths already having been reported. (Getty Images)

Dr. Thomas Frieden, CDC director, sees good news in that fact that the nation seems well prepared this year. He told the Associated Press that more than a third of Americans have been vaccinated and that the vaccine is well matched to the strains of flu seen so far. (Read more)

Tuesday, December 4, 2012

Merry Christmas: Mistletoe extract being used for colorectal cancer treatment in Europe, could be a great boon for Kentucky

Kentucky has one of the highest rates of colorectal cancers in the nation, with about 50 of every 100,000 Kentuckians being diagnosed with the disease each year. The state also ranks among the worst in colorectal cancer deaths, with 18-20 deaths per 100,000 annually. So perhaps Kentuckians should care more about some research that was announced as seasonal fare: using mistletoe extract in chemotherapy. (Wikipedia image)

At the University of Adelaide, scientists found that an extract from mistletoe grown on ash trees was found to be highly effective against colon-cancer cells in cell cultures and was gentler on healthy intestinal cells compared with chemotherapy. In fact, the extract was found to be more potent against cancer cells than the chemotherapy drug. It has been authorized for use by sufferers of colon cancer in Europe, but has not been allowed yet in some countries such as Australia and the United States due to a lack of scientific testing. (Read more)

We should note that the leaves and berries of some mistletoe species are mildly toxic. The plant is parasitic, growing on trees and forming green clumps that are highly visible this time of year and popular as Christmas decorations, especially at the top of doorways, where tradition calls for anyone standing under the mistletoe to be kissed.

American Lung Association calls state's tobacco-cessation benefit inadequate now that Medicaid is under managed care

Kentucky added a robust tobacco cessation benefit to its Medicaid program, only to lose much of it in 2011 by putting the program under managed care by insurance companies, the American Lung Association notes in its annual report. Not only do their plans offer fewer treatments, explained the report, but information was confusing to patients and healthcare providers alike. The report also notes that the state -- which is not alone in this -- offers its smokers who desire to quit inadequate access to medications and counseling.

Robert Preidt of HealthDay reports that the U.S. Department of Health and Human Services late last month published a proposed rule that requires tobacco cessation as an essential health benefit under the Patient Protection and Affordable Care Act. The lung association report how states could put that rule to maximum use. "Giving all smokers access to a comprehensive cessation benefits is not only the right thing to do, it's the smart thing to do," Billings said. "The bottom line is that quitting smoking saves lives and saves money." One recent study, reports Preidt, showed that providing smokers with help to quit has a three-to-one return on investment, meaning $3 is saved for every for $1 spent. (Read more)

To see more about how Kentucky's tobacco cessation coverage rates, according to the American Lung Association, go here.

Health coalition asks Nickelodeon to stop marketing sugary and fatty snacks to children

A coalition of health groups thinks maybe it's time to enlist SpongeBob in the childhood obesity fight. Earlier this week, the groups asked the Nickelodeon Channel to stop airing commercials that promote unhealthy foods with the help of the doofy adorable sponge, among other lovable characters the children's channel employs. The letter the groups signed asked that Nickelodeon's parent company, Viacom, put in place strong nutrition standards for the foods marketed by it and by its characters. Their sentiment was strongly backed by the American Academy of Pediatrics.

Elise Viebeck of The Hill's Healthwatch blog quotes the letter: "Research shows that food marketing is an important factor contributing to children's poor diets and obesity. The majority of foods marketed to children remain of poor nutritional quality. The [federal Institute of Medicine] concluded that marketing puts children's health at risk." The letter went on to shake its finger at Nickelodeon for being behind Disney and other prominent child marketers on this front. (Read more)

This comes on the same day that the University of Missouri-Kansas City and the University of Kansas Medical Center release study results that found obese children may be more susceptible to food advertising than healthy-weight children, suggesting at least one reason the nation's childhood obesity rate could continue to climb as feared. (Read more)

Monday, December 3, 2012

Northern Kentucky included in Medicaid's pilot program to increase data about quality of health care

The Health Improvement Collaborative of Greater Cincinnati, which includes much of Northern Kentucky, is included as one of three regions to participate in a program designed to bolster availability of information about doctors, hospitals and health care providers, the federal Centers for Medicare & Medicaid Services has announced. According to the Robert Wood Johnson Foundation, the new program will match private data with Medicare claims data to create comprehensive reports on provider performance.  The other two organizations selected are Kansas City Quality Improvement Consortium and the Oregon Health Care Quality Corporation.

The program will place quality markers on those receiving Medicare claims data. For example, they must show that they can manage and process consumer-focused data, can prevent breaches of protected health information and that they are working with private insurers in order to produce comprehensive reports on provider performance. The program is also intended to protect patient privacy, enforcing strong penalties if Medicare data is misued.
(Read more)

Report: 110,000 Ky. youth 16 to 24 aren't in school or employed; state's rate of 'disconnected youth' exceeds U.S. average

Almost 110,000 teens and young adults in Kentucky are not enrolled in school and are not employed, even part-time, according to a new Kids Count report from the Annie E. Casey Foundation.  Nationwide, the number reaches nearly 6.5 million. In Kentucky between 2000 and 2011 the number of 16-19 year-olds not in school and not employed rose by 3 percent, but the number of idle young adults ages 20-24 climbed by a whopping 88 percent. Both rates exceed the national rate. (Getty Images)

The Kids Count report, "Youth and Work: Restoring Teen and Young Adult Connections to Opportunity," termed these 16- to 24-year-olds "disconnected." It found that they face many obstacles on their path to securing a stable financial future. For starters, many haven't finished high school and are competing with older Americans for the few entry-level jobs. In addition, they lack skills for higher-paying jobs. Many are poor and have attended under-performing schools. The report explains that, as such, this group can present a significant cost to taxpayers. (Read more) View the report here.

UK creates nation's first cancer-reporting system that uses electronic health records

Kentucky has the highest incidence of cancer in the United States, but it is about to be a national leader in delivering information about cancer cases to researchers.

With the help of an almost $1 million Centers for Disease Control grant, the University of Kentucky has created the nation's first working model for electronic reporting of cases to the state cancer registry. Kentucky's cancer doctors will be able to feed clinical data to the state's epidemiologists immediately so that they can see and analyze cancer statistics more quickly that ever before.

“This project is laying the groundwork for electronic reporting not only in Kentucky but across the United States,” said Eric Durbin, director of Cancer Informatics at the Kentucky Cancer Registry and one of the investigators who created the model. (Read more)

Sunday, December 2, 2012

Study: Raising cigarette taxes does curb even heavy smoking

The more you raise cigarette taxes, the less people smoke. That presumption was confirmed this week in a study by the Washington University School of Medicine in St. Louis. This has some resonance in Kentucky, where just last week the state’s Blue Ribbon Commission on Tax Reform told Gov. Beshear the state should raise taxes on tobacco, to $1 per pack from 60 cents. Other forms of tobacco would get a corresponding tax hike, reports Beth Musgrave of the Lexington Herald-Leader. The changes would raise an estimated $120 million in revenue and, if the research is right, cut down on long-term health care costs.

The researchers are the most adamant about the last point. “Most clinicians and researchers thought these very heavy smokers would be the most resistant to price increases,” says study author Patricia A. Cavazos-Rehg, PhD. “But our study points out that, in fact, change can occur. And that’s very good news.” In fact, in states where taxes on tobacco products rose by at least 35 percent, heavy smokers -- who averaged 40 cigarettes a day or more -- lowered their daily smoking by 14 cigarettes, on average.  In real numbers, the price for a pack of cigarettes increased from an average of $3.96 in 2001 to $4.41 in 2004. (Read more)

In Kentucky last year, almost 30 percent of residents said they were smokers, the highest in the nation. The state also has the highest rates of diabetes and lung cancer, reports Jim Malewitz of Stateline News. Kentucky’s cigarette tax is also among the country's lowest.

Medical licensure board changing rules to focus more on painkillers; fewer urine tests for patients, fewer reports for doctors

Patients in long-term treatment with controlled substances won't have to have their urine tested for drugs unless they are on painkillers, and doctors will have wide discretion over how often to do the tests, under new rules being drafted by the Kentucky Board of Medical Licensure.

That is just one example of the changes that the board is making in regulations authorized by the "pill mill bill" the General Assembly passed this year, reports Mike Wynn of The Courier-Journal. Other changes will put more focus on medicines with the painkiller hydrocodone and exempt some medicines that have only small amounts of painkillers.

"While the bill focused largely on pain pills, the board’s regulations covered a wider range of medications, including the sleep aid Ambien and the anti-anxiety drug Xanax," Wynn notes. "The regulations also called on doctors to perform a much broader array of administrative tasks to determine the appropriateness of prescriptions and a patient’s risk for abuse or diversion." Now they will have to do less, making follow-up reports to the state drug-tracking system only when prescribing painkillers.

The board's director, Michael Rodman, told Wynn it is responding to complaints by physicians and lobbying interests who say the the rules are too complex and go too far. The board filed the new rules last month for approval by legislative committees, but says it is already using them to make enforcement decisions. House Speaker Greg Stumbo, who sponsored the bill, has endorsed the changes.

The doctors' lobby, the Kentucky Medical Association, has voiced its pleasure with the changes but says others are needed, such as parts of the law that require specific medical practices such as standards for prescribing. (Read more)

Saturday, December 1, 2012

Kentucky hospitals score mostly Bs and Cs on hospital safety scorecard; most in U.S. earned an A or B

In an analysis of the nation's hospitals and their safety records, many of Kentucky's health care facilities have some shortcomings. A study by the Leapfrog Group finds that the vast majority of the state's hospitals score a B or C in overall patient safety, a term defined here by analysis of data on accidents, errors and infections as kept by the Centers for Disease Control, the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research. At least a dozen of the state's hospital earned an A rating. To check the grade of your own hospital, go here.

In this data analysis and grading system, 26 different points of criteria were used. Of the 2,618 hospitals reviewed, about 56 percent of the hospitals earned an A or B, and an additional 38 percent passed with a C grade. Only 6 percent of hospitals -- 146 total -- received a D or F. According to CBS News, at least 180,000 Americans die in hospitals every year from incidents that occur because of their stays there. (Read more)


Thursday, November 29, 2012

Task force recommends changes to protect safety and health of middle school students who play interscholastic sports

The boys of North Marshall Middle
School of Benton, Ky., after winning
a Christmas tournament last year.
Beth Musgrave of the Lexington Herald-Leader reports that the state Task Force on Interscholastic Athletics at the Middle School Level announced its preliminary recommendations this week to address concerns about young athletes' health and safety. It seems that middle school sports in Kentucky have never had the advantage of being governed by a unified code of rules and policies like their counterpart in high school sports. This has led to a confusing mish-mash of guidelines that the legislature is setting out to get right in the coming year.

Preliminary task force recommendations include requiring all middle school teams to follow high school rules on physical exams, medical coverage, concussions and practicing during extreme heat, and requiring the tracking of injuries and incidents for all sports. The task force also suggested that the Kentucky Board of Education look to create a single governing body, like the Kentucky High School Athletics Association that governs high school sports, to oversee all middle-school sports. Wilson Sears, executive director of the Kentucky Association of School Superintendents and a task force member, told Musgrave that the recommendations represent "real progress." (Read more)

The world is getting fatter, but Kentucky's rate of obesity is two and a half times the world rate

Take no solace from The Economist, which proclaims in its yearly analysis-and-prognostication issue that this is the year world leaders will take on worldwide obesity because, writes Charlotte Howard, "they will realize something must be done."

So, no, it is not just you, Kentucky. In fact, Howard, the health-care correspondent for the magazine, writes that 30 percent of Mexico's adult population is obese. That is precisely the same percentage of Kentuckians that were considered obese by a Robert Wood Johnson Foundation and Trust for America's Health analysis released in August. (We ranked sixth fattest state nationwide.) It is also the same percentage of Chinese adults that are, as Howard put it, "too wide" -- a term that Howard uses here to include the overweight as well as the obese.

But there is no room to crow here. Kentucky is far ahead of the trend. Only 12 percent of the world counts as obese today. We beat that two and half times over. (The number of Kentuckians who were merely overweight was not calculated or included in the figures in the study.) A study released in September by the same group found that if trends continue, 60 percent of Kentuckians will be obese by 2030. The World Health Organization's estimate of the world's obesity was at 15 percent by 2020.

The Economist folks favors an approach that a democratic path to better health and fiscal sanity, given the health care cost ramifications of obesity. They like a tax on soda -- it's pure sugar, no real nutrition. They like subsidies to make fresh produce cheaper. And they like better school lunches and labeling, labeling, labeling so consumers will make better choices.

UK study: Old, perhaps obsolete heart drug increases deaths in patients with atrial fibrillation

A drug widely used against heart disease can increase the possibility of death when used by patients with atrial fibrillation, a common heart rhythm problem, according to a study by University of Kentucky researchers. Digoxin, a derivative of the foxglove plant, is an old yet controversial heart drug. Though considered obsolete by some, it is still widely used.

The study, published in European Heart Journal, analyzed data from 4,060 atrial-fibrillation patients. It was led by Dr. Samy Claude Elayi, associate professor of medicine at UK HealthCare's Gill Heart Institute. The results of the study indicate that further review by the Food and Drug Administration is warranted to determine if stronger warnings about its use should be required. (Read more)