Thursday, May 31, 2012

Coventry, ARH at impasse over Medicaid; state says service will not be interrupted for 25,000 affected

Though negotiations between Appalachian Regional Healthcare and Coventry Cares appear to be futile, the state is taking steps to make sure there won't be an interruption in care for the Medicaid recipients who will be affected by the impasse.

"The cabinet will assure the judge that, in the event that a notice is received from Coventry that ARH will not be in their network as of July 1, members will be able to call the Department for Medicaid Services to switch" to another managed-care organization, said Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services.

Coventry Cares is one of four companies chosen by the state to provide care to Medicaid recipients. The move to managed care — intended to save money — has been rocky, with providers complaining about delayed payments from the companies and cumbersome pre-approval processes for treatments. ARH sued Coventry, and another managed-care company, saying they owed the hospital chain more than $18 million for services. But Coventry says the state allowed another managed care company not to include ARH in its network, which means a lot of higher-risk, higher-cost patients covered by Coventry.

ARH operates eight hospitals and health clinics in Eastern Kentucky and serves 25,000 Medicaid patients, reports Valarie Honeycutt Spears for the Lexington Herald-Leader. Coventry agreed to extend its contract with ARH until June 30, but will likely not extend it again. A Coventry document filed in court last week says "it appears unlikely that these differences can be bridged." (Read more)


Improvements to Rx monitoring systems worth the expense, study finds; using systems influence doctors' prescribing decisions

A plan for an ideal prescription drug monitoring system was published today in the New England Journal of Medicine, with its authors concluding spending more money to improve systems is worth the expense.

To improve databases, the paper's authors recommended "standardization of the type of information submitted to the databases, and a move toward the use of bar-coded prescription paper to more quickly log entries, or a robust e-prescribing system that would eliminate paper and the resulting prescription fraud and 'doctor shopping' that contributes to illicit use of these controlled substances," reports research-reporting service Newswise. (Read more)

Forty-three states, including Kentucky, now have databases to monitor prescriptions for pain relievers and another five states have passed laws to create them, reports Mary Wisniewski for Reuters. Part of the reason for the push is prescription drug abuse is an increasingly big problem, with more people dying from prescription drug overdoses each year than cocaine and heroin combined. Kentucky is a hot spot, with nearly 1,000 people dying from prescription drug overdoses in 2010.

On July 12, a new law will take effect in Kentucky that will make it mandatory for a physician to consult the state drug-monitoring system before writing a prescription for certain drugs for a new patient. Doing so can influence how a doctor chooses to prescribe. A study by the emergency department of the University of Toledo's College of Medicine found "doctors or pharmacists who reviewed state prescription data changed how they managed cases 41 percent of the time," Wisniewski reports

The study found 61 percent of prescribed either no opioid medicine, or less than originally planned, while 39 percent decided to prescribe more. (Read more)

Wednesday, May 30, 2012

Significant management improvements at Passport Health Plan, audit finds

Passport Health Plan has improved significantly since a 2010 audit uncovered wasteful spending and other problems, a new audit has concluded.

The managed care organization that cares for Medicaid recipients in Jefferson and 15 surrounding counties "has made significant improvements in accountability and financial record-keeping," a press release from Audrey Tayse Haynes, the new secretary of the Cabinet for Health and Family Services. "Patient satisfaction with the health care provider remains high," she states.

"The audit is a follow-up to former State Auditor Crit Luallen's scathing report of November 2010 in which Luallen found lavish spending by Passport's former executives on travel, meals and other expenses," reports Tom Loftus for The Courier-Journal. "It also questioned transfers of about $30 million of reserve funds to the major health-care organizations represented on Passport's board of directors."

Gov. Steve Beshear ordered a plan to correct the problem, which involved replacing Passport's executives, among other changes. Though there has been improvement, "after having exclusive rights to the region for about 14 years, Passport will have to bid against other managed care organizations if it wants to be among those that will serve it in 2013," Loftus reports.

Still, since the state has switched to managed care for the rest of the state and severe problems have surfaced with the three companies that have been hired to serve those recipients, Passport's reputation has improved substantially. State Auditor Adam Edelen said in February the state was unprepared for the quick transition to managed care in the rest of the state. (Read more)

Task force to consider middle-school sports regulation

A task force made up of legislators, educators and athletic officials will examine what guidelines should be in place for sports at the middle school level, which are not regulated in Kentucky.

The task force was created by the 2012 General Assembly to "discuss 'best practice' guidelines for middle school sports and to take into consideration non-profit organizations that oversee some individual teams," reports Valarie Honeycutt Spears for the Lexington Herald-Leader.

"It remains to be seen" what the task force could recommend, Rep. Bob Damron, D-Nicholasville, told Spears. But Damron, who sponsored the resolution creating the task force, said "in the long run that's probably a good direction to have one entity standing for middle school athletics."

The Legislative Research Commission will name task force members by Aug. 1. Recommendations to legislative committees are expected by Dec. 7. (Read more)

New treatment first offered in Louisville is helping asthma sufferers

Shannon Denson, who has severe asthma, gets bronchial
thermoplasty. Courier-Journal photo.
Asthma sufferers can now benefit from an innovative treatment that was first offered at University Hospital in Louisville.

Patients like Shannon Denson are seeing improvement thanks to bronchial thermoplasty, "a minimally invasive, three-step procedure using heat to open airways in adults with severe asthma so they can breathe more easily," reports Laura Ungar of The Courier-Journal.

"Over the years, airways become very narrow. This opens them up," said Dr. Tanya Wiese, an interventional pulmonologist with University of Louisville Physicians, which partnered with UH to offer the treatment.

The treatment is not a cure but it does improve the condition of the lungs, which is good news since asthma rates are high in Kentucky. In the Ohio Valley, almost 15 percent of Kentucky adults said they had asthma, making it the seventh-highest rate in 2010, a survey by the U.S. Centers for Disease Control and Prevention found. (Read more)

Friday, May 25, 2012

U of L profs get $6.3 million to continue spinal cord research

Susan Harkema, a University of Louisville professor, talks
about epidural spinal stimulation. Courier-Journal photo.
Two University of Louisville professors have received a $6.3 million grant to continue their work helping paralyzed patients restore movement by using electrical stimulation.

The grant was awarded to Susan Harkema and Dr. Jonathan Hodes from the Leona M. and Harry B. Helmsley Charitable Trust.

Last year, they received much acclaim when they published a study in the journal The Lancet "showing that the use of continual, direct, electrical stimulation of a patient's lower spinal cord using technology designed for pain relief can allow a person using a wheelchair to stand and bear weight," reports Laura Ungar for The Courier-Journal.

With these new grant funds, Harkema said they will "be able to built a stimulator that will allow the individual to take advantage of these advances in their homes and communities."

One of the initial case studies involved Rob Summers, a former baseball player from Oregon who was paralyzed below the chest after a car accident. After the therapy, he was able to get to a standing position and stand as long as four minutes. "He was also able to take steps with help and move his toes, ankles, knees and hips." Harkema said he continues to improve.

Nationwide, more than 5 million Americans live with some type of paralysis, and more than 1.3 million have spinal-cord injuries. (Read more)

Federal panel says PSA screening for prostate cancer does more harm than good, but no better test is available

Prostate cancer cells. Getty Images photo by Abbey Michael.
An influential federal panel says testing healthy men's prostate-specific antigen levels to detect prostate cancer does more harm than good.

The PSA test can lead to unnecessary biopsies for men who turn out to be cancer-free. Those biopsies can also lead to men being treated for cancers that are so slow-growing (a characteristic of most prostate cancers) that they didn't need to be detected.

An estimated 1,000 to 1,300 men die annually from complications associated with treatments that are initiated because of PSA screening, reports Alice Park for Time magazine. Moreover, treating harmless prostate tumors increases the chances of making men impotent or incontinent.

The U.S. Preventive Services Task Force published the recommendation in the Annals of Internal Medicine. In 2009, the panel also recommended that women delay routine mammograms until the age of 50. That was controversial, and "The task force's recommendation goes against two decades of widespread use of the PSA test, a $35 blood test," Park reports.

"The recommendation is not just counter to what the lay public has been taught about cancer prevention but what physicians have been taught as well," said Dr. Michael LeFevre, co-vice chair of the USPSTF and a professor of family and community medicine at University of Missouri. "We've been told for decades to be afraid of cancer and that the only hope is early detection and treatment. So it's hard for physicians and patients alike to accept that not all cancers need to be detected or need to be treated and that there are harms associated with screening, not just benefits."

Through PSA testing, physicians "were finding the cancer earlier, so the time from diagnosis to death was longer, but the patient wasn't actually living longer," explained Dr. Otis Brawley, chief medical officer of the American Cancer Society.

But there isn't a better test to replace the PSA, and Ian Thompson, chairman of urology at the University of Texas Health Science Center, said to reject it completely is unwise. He said U.S. death rates from prostate cancer dropped between 30 and 50 percent since the screening became commonplace in the early 1990s, though those numbers could also have been influenced by more effective treatments. Thompson said he didn't want to go back to the "bad old days" when doctors only found prostate cancer when it was already unable to be cured, reports Liz Szabo for USA Today.  (Read more)

Louisville comes in third to last in fitness and health ranking of 50 largest cities

Rowing under California's Bay Bridge (Photo by City Kayak)
In a fitness ranking of the country's 50 largest cities, Louisville ranked an abysmal 48th, sitting just above Detroit and Oklahoma City.

These were some of the results of the American College of Sports Medicine's 2012 Fitness Index. Cities were assessed on preventive health behaviors; levels of chronic disease; health care access; and community resources and policies that support physical activity such as bike lanes and parks.

Minneapolis-St. Paul was ranked first for the second year in a row, scoring 77.2 out of a possible 100 points. Louisville got just 32.1 points, but it did climb up one ranking slot over 2011's assessment.

The index is gaining notoriety and "might well become the scorecard for cities looking to attract health-conscious companies and people to settle in for a spell," reports Melissa Healy for the Los Angeles Times. "It draws on parks and recreation data from the Trust for Public Land, on nutrition and health behavior collected by the Centers for Disease Control and Prevention, and on federally tallied school report cards to learn about school policies that promote fitness." (Read more)

Thursday, May 24, 2012

Nursing home chain says it will lease its Kentucky facilities because legislature didn't pass bill to filter lawsuits

A major nursing-home chain says it will lease all of its Kentucky properties to a Texas company because a bill to insulate nursing homes from lawsuits did not pass the General Assembly this year,

Extendicare Health Services owns Pembroke Nursing and Rehabilitation Center, Shady Lawn Nursing Home in Cadiz and 19 other facilities in Kentucky, reports Nick Tabor of the Kentucky New Era in Hopkinsville. The company has been riddled with problems. A 2009 study ranked three of its Kentucky facilities among the country's worst nursing homes.

"The combination of a worsening litigation environment and the lack of any likelihood of tort reform in the state of Kentucky has made this the prudent decision for our company and its unitholders," said Tim Lukenda, president and CEO of Extendicare.

In this year's legislative session, nursing homes lobbied for a law that would have created medical review panels to evaluate potential lawsuits against nursing homes, personal-care homes and some facilities for the intellectually and developmentally disabled. The goal of the panel was to help eliminate frivolous lawsuits against the long-term care industry.

The Pembroke facility has been sued 20 times in Christian Circuit Court since 2002, and seven of the suits are still pending, Tabor reports. The others were dismissed, most with confidential settlements. (Read more)

Care in rural hospitals is just as good as that in urban hospitals, study concludes

While rural Americans have less access to primary care and have worse health outcomes, the care at rural hospitals is equal to, if not better, than that at urban hospitals, a National Rural Health Association report says.

The study also found rural health care is not more expensive than urban care. "However, urban residents rarely out-migrate to rural settings for either routine or advanced treatments or care yet many rural patients are referred to or voluntarily travel to urban providers based on the myth of better care," a summary of the study says.

The study was compiled by iVantage Health Analysis, a private health-care research company. It collected data on Medicare costs and health outcomes for doctors and hospitals for 12 months and divided the results into rural and urban groups based on zip codes, to give a picture of the state-by-state importance of rural hospitals.

In Kentucky, nearly half of its Medicare beneficiaries lived in rural counties in 2010. Nationwide, just 21 percent of them do, though there were western states with much higher percentages. In Wyoming, for example, 69 percent of Medicare beneficiaries live in rural places. Spending per Medicare beneficiary in Kentucky was nearly $8,000 in both urban ($7,851) and rural ($7,879) settings in 2010. That spending is high compared to the rest of the country, however; only nine other states had higher spending.
The study could have wider wider ramifications given changes in the federal health-care reform law and the move toward accountable care organizations, in which doctors and other providers are encouraged to team up to give coordinated care for a population of people and be paid financial incentives to do so.

"Value in health care is created by doing a few things well and not by trying to do everything," the summary reads. "The rural findings may just suggest that by national selection, rural has figured out what it does well and has optimized those services for the patient's benefit." (Read more)

University Hospital's trust to pay for indigent care lacks oversight, state auditor finds

An audit of the trust that disburses more than $30 million in state and local funding to provide indigent care at University Hospital has found there is a lack of oversight. There is no evidence taxpayer dollars were abused, however.

"The audit, released by state Auditor Adam Edelen, found that the board structure wasn't suited for proper oversight and the agreement between University Medical Center, which runs the hospital, and state and local governments to administer the money is outdated," reports Laura Ungar of The Courier-Journal.

The audit also found there is insufficient record keeping. "The responsibility for providing a safety net for our most vulnerable is a critical one shared by the university, city and commonwealth," Edelen said. "While this audit underscores the need for modernization and reform of the governing structure, it does not provide justification for those who desire a retreat from that mission." (Read more)

Agriculture commissioner visits six counties to promote local food, better nutrition in school lunches

State Sen. David Givens, R-Greensburg, watches
as Commissioner James Comer speaks at Green
County High School.(Greensburg Record-Herald)
To encourage child nutrition and healthier school lunches, state Agriculture Commissioner James Comer visited six Kentucky school districts earlier this week. He met with school boards in Owsley, Jackson, Knox, Marion and Metcalfe counties, and visited Green County High School, according to a news release from his office.

Many Kentucky children consume more than half of their daily calories at schools. During a typical school day, 4 in 10 American students buy and eat snack foods and drinks, the Pew Health Group found. More than 23 million children and teens in the U.S. are overweight or obese.

"Children who are overweight and obese are at greater risk of chronic ailments that can damage their quality of life and even shorten their lives," Comer said. "Schools can help students eat better, but many schools simply don't have the resources, the equipment or the training necessary to serve healthy meals on a consistent basis. I want to talk to local leaders about how the Kentucky Department of Agriculture can help."

"Just a small amount of money would enable many school districts to make healthy and nutritious foods available to their students," he said. "The KDA can help these schools wade through federal bureaucracy and find the necessary funding. We can also help with our Farm-to-School Program, which connects schools with local producers who can provide fresh Kentucky Proud foods. That's food for our kids, and it helps local farmers make a living." (Read more)

Wednesday, May 23, 2012

Obama administration spent $25 million on health-care law publicity campaign, part of it exaggerating, McConnell complains


The Obama administration spent nearly $20 million on mailings to seniors touting the federal health-care reform law and another $5 million on postcards to small business owners informing them of a tax credit under the law, Senate Minority Leader Mitch McConnell, R-Ky., said in a floor speech today. He said the Government Accountability Office found that the mailing to seniors "overstated the law’s benefits."

"These are just a few of the way the administration is quietly promoting its own failed policies; how it's trying to change people's minds about the president's policies with their own money," McConnell said. "The larger point is the fact that we've got a nearly $16 trillion debt, the largest tax hike in history right around the corner, chronic unemployment, and sky-high gas prices, and this President things it's a good idea to spend $20 million to promote Obamacare."

McConnell's remarks can be heard in their entirety by clicking on the video above.

Tuesday, May 22, 2012

Injury prevention policies in Kentucky lacking, study finds

Kentucky scored a dismal 3 on a scale of 10 in a safety study that assessed states against the the top 10 injury indicators in the country. The state had the 10th highest injury rate, with 76.6 Kentuckians per 100,000 dying from intentional or unintentional injuries.

Injuries are the third leading cause of death nationally, and the leading cause of death for Americans between ages 1 and 44.

The survey assessed states on whether they:
• Have primary seat belt laws.
• Require mandatory ignition interlocks for all convicted drunk drivers, including first offenders
• Require all motorcycle riders to wear helmets.
• Require booster seats to at least the age of 8.
• Require children to wear bicycle helmets.
• Allow people in dating relationships to get protection orders.
• Receive an A in the Break the Cycle Report, which examines teen dating violence.
• Have a strong concussion law.
• Have an active prescription drug monitoring program.
• Have a strong policy in emergency departments that allows researchers and officials to understand injury trends.

Kentucky got points for having a seat-belt law, a strong concussion law and a drug monitoring program. The state was close to getting credit for the booster seat indicator; it requires the seats for children until they are 7. Kentucky also reported more than 85 percent of injury discharges in its emergency departments, but the indicator only gave credit to states that do it more than 90 percent of the time. But Kentucky was far was perfect when it came to teen dating violence, receiving a F grade in the Break the Cycle report.

Because of its injury rate, the study concluded Kentuckains pay $26.8 million in lifetime medical costs due to fatal injuries and $3.3 billion for total lifetime work loss due to fatal injuries.

The study shows how injury prevention policies can help save lives. The report points out that after Kentucky repealed its universal helmet law in 1998, motorcycle deaths rose by 50 percent. (Read more)

Revealing patient safety issues and medical errors are goals of Facebook page set up by ProPublica

Photo by iStockphoto.com/selimaksan
Interested in creating a venue for those who have been harmed while undergoing medical treatments, ProPublica, the nonprofit, investigative news organization, has set up a Facebook page on the issue.

"Group members have already shared stories of personal disability or the death of a loved one due to surgical mistakes, becoming infected with deadly drug-resistant bacteria and dental mishaps — including cases they claim were not properly addressed by health care providers," Daniel Victor and Marshall Allen report. The page will be moderated by Victor and Olga Pierce.

The page is also open to doctors, nurses, regulators, health-care executives and others interested in discussing medical errors, their causes and solutions. Question-and-answer sessions with experts will be posted, along with links to the latest reports and policy proposals. (Read more)


Monday, May 21, 2012

School nurses in Fayette cut as public-health dollars shrink

Takirah Sleet, 7, and school nurse Michelle Marra assess her
lunch to manage Takirah's diabetes. (H-L photo by 
Pablo Alcala)
As public health and education dollars shrink, school nurses are caught in the middle. The Lexington-Fayette County Health Department is among those scaling back its school-nurse program due to cuts, even as "more students with greater medical needs are appearing in classrooms," reports Mary Meehan for the Lexington Herald-Leader.

The cuts and the need present a difficult scenario: "In order to be educated, a student has to be healthy. How do you make that happen?" asked Mary Burch, president of the Kentucky School Nurse Association.

Schools nurses are not mandated in Kentucky, and the way school districts address the issue varies widely. Some districts use a nurse consultant to train school staff. The National Association of School Nurses recommends one school nurse for every 750 students. With 40,000 students, Fayette County falls short of meeting that level of care. The Fayette County school board helps to increase funding to keep nurses in place. About $600,000 would need to be reallocated. (Read more)

HPV-linked cancers on rise, more prevalent in Kentucky

The human papillomavirus, which is generally blamed for causing cervical cancer, is being linked to the formation of several other kinds of cancer, and Kentuckians are getting these diseases in unusually high numbers, reports Laura Ungar of The Courier-Journal.

HPV is being linked to cancers of the vagina, vulva, penis, anus and lung, as well as the head and neck. "It's turning out to be a pretty bad actor ... an extensive health problem," said Dr. Daniel Metzinger, a gynecological oncologist with University of Louisville Physicians.

Kentucky's rates for HPV-related cancer are among the highest in the country. Part of the reason may be that smoking is a risk factor and Kentucky has the nation's highest smoking rate, Ungar reports. "I'm seeing more of it for sure," said Metzinger. "It used to be a disease we'd see in older people. Now, we see it in younger and younger people."

One way to protect against the virus is to be immunized with the HPV vaccine. A federal committee recommends vaccinating 11- and 12-year-old girls through to women up to age 26. Boys and men should also be immunized from age 11 to age 21. The immunization must occur before the patient is sexually active, since HPV is sexually transmitted.

In 2010, just 49 percent of adolescent girls nationwide received at least the first of the vaccine's three doses, and only a third had gotten all three, which are required for full effectiveness. In Kentucky that year, only 25 percent of adolescent females had gotten the first dose, and fewer than 11 percent have received all three doses, according to Cervical Cancer-Free Kentucky.

National Cancer Institute numbers show more than half of sexually active people are infected with HPV at some point. Usually, it goes away on its own within a few years. "But it can also set the stage for cancer," Ungar reports. "Across the nation, about 26,000 new cancers attributed to HPV occur each year, with 18,000 in women and 8,000 in men." (Read more)


Health-care costs are a serious problem, nine of 10 adults say

Nearly nine of 10 American adults say the cost of health care is a serious problem (chart) and about two-thirds of the general public believe that cost has gone up in the last five years.

These are the results of a poll released by the Robert Wood Johnson Foundation, the Harvard School of Public Health and National Public Radio.

The poll asked additional questions of Americans who said they have had a serious illness, medical condition, injury or disability in the past year. More than 40 percent said the cost of their medical care caused a "very serious" (20 percent) or "somewhat serious" (23 percent) problem for their or their family's finances.

"The rising cost of medical care affects everyone, but people who have been unwell know firsthand that an illness or injury can mean financial hardship or ruin," said Risa Lavizzo-Mourey, president and CEO of the RWJF. "These findings confirm how thinly individuals and families have been stretched. Having access to high-quality, affordable, comprehensive health coverage is crucial, but we know that even with insurance, rising health care costs leave many Americans with the burden of higher out-of-pocket spending." (Read more)

HBO's 'Weight of the Nation' examines the obesity epidemic


A compelling four-part documentary delving into the obesity epidemic sweeping the country is being aired on HBO and can be watched free by clicking here. A reporter wanting to write a series of stories on the issue would find "weight of the Nation" a good reference.

The program is divided into four parts. The first segment, "Consequences," looks at the scope of the epidemic and the ramifications of being overweight or obese. "Choices" looks at the science behind how to lose weight, how to maintain weight loss and prevent weight gain. The third part, "Children in Crisis," looks at how the problem is affecting American children, exploring the decline of physical activity, school lunch, the demise of school recess and how marketing of unhealthy food targets children. The final segment, "Challenges," looks at the major forces driving obesity, including agriculture, economics, evolutionary biology, food marketing, racial and socioeconomic disparities, physical inactivity, American food culture, and the influence of the food and beverage industries.

The documentary is on a detailed website that answers questions that range from "What is obesity?" to "How do I know if I'm overweight or obese?"

The project is a presentation of HBO and the Institute of Medicine in association with the Centers for Disease Control and Prevention and the National Institutes of Health, with support from the Michael and Susan Dell Foundation and health insurer Kaiser Permanente.

Friday, May 18, 2012

Healthy food is less expensive than junk food, study finds

Though it's widely believed that healthy food is more expensive than junk food, a new government analysis shows that does not have to be the case.

"In fact, carrots, onions, pinto beans, lettuce, mashed potatoes, bananas and orange juice are all less expensive per portion than soft drinks, ice cream, chocolate candy, French fries, sweet rolls and deep-fat fried chicken patties," reports Nanci Hellmich for USA Today.

"We have all heard that eating a healthy diet is expensive, and people have used that as an excuse for not eating a healthy diet . . . but healthy foods do not necessarily cost more than less healthy foods," said Andrea Carlson, an economist and co-author of the report from the U.S. Department of Agriculture's Economic Research Service. "The price of potato chips is nearly twice as expensive as the price of carrots by portion size."

Carlson and colleague Elizabeth Frazão analyzed national pricing data on more than 4,000 foods and ranked them according to price based on calories, weight and portion size. The foods were placed in five food groups: grains, dairy, protein, fruit and vegetables. Another category was added for unhealthy items, which did not fall into any of the other calories or were high in sugar, sodium and/or saturated fat such as cookies, desserts, granola bars and many cereals. They found:

• Given portion size, the ranking from least expensive to most expensive is: grains, dairy, vegetables, fruit, protein and less healthy foods. Protein and less healthy foods cost nearly the same.

• Meat, chicken and fish are the most expensive sources of protein but there are low-cost options like eggs and beans.

• Fruit and vegetables are lower in cost overall than unhealthy foods.

• Grains, such as bread, oatmeal, pasta and rice, are the cheapest foods no matter how the portion is measured. (Read more)

For first time, annual health costs for families exceed $20,000

For the first time, the average annual costs of workplace-provided health insurance and other costs for a family of four has exceeded $20,000, a new study has found. Costs are $20,728 this year, an increase of $1,335 over 2011.

An average family will pay $5,114 in premiums for a preferred provider organization plan, plus $3,470 in out-of-pocket costs like co-pays and prescriptions,  Jeffrey Young reports on The Huffington Post. The rest of the costs are paid by employers, according to the report released by Milliman, a firm that consults with companies on employee benefits.

"The rate of increase is not as high as in the past but total dollar increase was still a record," the report states. "The dollar amount of the increase overshadows any relief consumers might derive from the slowing percentage increase."

The report also found health-care costs vary among 14 metropolitan areas Milliman analyzed. Miami and New York City are most expensive where costs are 20 percent higher than the national average. Louisville and Lexington were not among the areas studied. (Read more)

National effort to combat Alzheimer's disease begins; as research continues, there are preventive steps you can take

Country singer Glen Campbell, who has Alzheimer's disease,
stands with wife Kim during a national conference Tuesday.
Associated Press photo by Charles Dharapak.
With numbers expected to jump to 16 million Americans by 2050, research is being conducted in earnest to find a way to ward off Alzheimer's disease.

One plan of attack is testing therapies before people show symptoms of memory loss, since the disease starts attacking the brain at least 10 years before memory problems appear. An international study will see if an experimental drug can halt the disease in "people who appear healthy but are genetically destined to get a type of Alzheimer's that runs in the family," reports Lauran Neergaard for The Associated Press. In another study, researchers will see if a nasal spray that shoots insulin to the brain can help patients with early memory problems.

Part of the challenge in combatting the disease is researchers are still not sure what causes it. "The chief suspects are a sticky gunk called bata-amyloid, which makes up the disease's hallmark brain plaques, and tangles of a protein named tau that clogs up dying brain cells. One theory: "Amyloid may kick off the disease while tau speeds up the brain destruction," Neergaard reports.

Given the expected increase in the number of people with Alzheimer's, the Obama administration has adopted a national strategy to fight the disease, part of which is a website that is a "one-stop shop for families" to offer information about dementia and links to community resources. Today, there are 5.4 Americans with Alzheimer's or related dementias.

There are steps people can take to protect their brains from the disease, including intellectual and social stimulation to help build "cognitive reserve." Doing crossword puzzles, for example, can help. So can physical activity. "Any time your heart is healthier, your brain is healthier," said Dr. Elizabeth head of the University of Kentucky. Diet is another consideration, since foods that are heart healthy are brain healthy, including omega-3 fatty acids found in fish. (Read more)

Tuesday, May 15, 2012

How to take local action to improve health at the local level is outlined at Frankfort conference

By Tara Kaprowy
Kentucky Health News

A recipe for how to improve health at the local level in Kentucky was the capstone of a day-long seminar in Frankfort Monday, with experts stressing that partnerships are key and funding will remain tight.

Communities must mobilize, prioritize, "effectivize" their actions, publicize and evaluate, measure and report performance, Trudi Matthews, director of policy and public relations at HealthBridge, summed up at the end of the Kentucky Health Quality Collaborative Conference.

The gathering was hosted by Kentucky Voices for Health in partnership with the Friedell Committee for Health System Transformation. "No single actor or set of stakeholders can solve what's wrong," Matthews said. "We really need to think across silos. We really have to collaborate."

When it comes to funding, governments "have made it very clear they will not increase the number of dollars that will be put into health care," said keynote speaker Dr. Robert Graham, national program director for Aligning Forces for Quality. "We're in a perfect storm," agreed Sue Thomas-Cox, branch manager for chronic disease prevention at the Kentucky Department for Public Health. "Federal, state and local governments don't have enough money . . . so we must work together."

Luckily, health care happens at the local level, Graham said, with hospitals and clinics unique to communities, health insurance agents locally based and consumers grounded in their communities. While there is "no particular model for how to get (change) started," Graham said, the first step is getting all stakeholders — purchasers, insurance agents, providers, consumers, faith-based organizations — around the same table. "You've got to make sure there is a balance of interests," he said. 

Also key are local boards of health and health departments, whose members and staff are charged with safeguarding the health of the people of a county, under state law, and have the advantage of being "relatively untainted by the illness-for-dollars disease," pointed out Dr. Forrest Calico, a rural health consultant and longtime worker in the field.

Health departments must ensure they don't spread themselves too thin, said Dr. Steve Davis, acting commissioner for the Department for Public Health. "One of the biggest reasons why we have not moved the health needle in Kentucky is we need to be an inch wide and a mile deep," he said. Communities need to "come up with five or six things and let's hammer, hammer, hammer it," he said. Of those priorities, Davis pointed out the importance of tackling chronic disease: "That's what's killing our brethren and eating our financial lunch." For adults, he would like to see an increase in breast, cervical, colon and lung cancer screening, as well an increase in immunization rates especially for flu and pneumonia.

For children, Davis has six priorities: reduce preterm and low-birthrate babies; improve injury-prevention programs; decrease tobacco use; reduce obesity; increase immunization rates; and improve oral health.

To get more accomplished, health departments need to team up with local organizations to avoid duplication of services, which Davis said accounts for $300 billion in unnecessary spending nationwide. He added the goal is to make "1 plus 1 equal 3," with health departments needing to adopt a "do or assure" philosophy.

But there are challenges in health departments, with some local health board members failing to "roll up their sleeves," Davis said. "You can go in with nothing in your head and leave with nothing in your head," agreed Henry Bertram, chair of the Pendleton County and Three Rivers District Board of Health.

A survey of health departments showed just 46 percent of local boards of health have a vision for the next three years to improve the health status of their community and just 44 percent say they are tracking compliance for the 10 essential services they are charged with providing. And the real numbers might be worse, because the survey was voluntary.

While about half of the state's health departments are committed to working toward achieving national accreditation, only three departments — Franklin, Northern Kentucky and Three Rivers District — have actually applied for it. 

Also crucial for communities is using data to identify priorities, take action and measure performance, whether using county-specific numbers at www.kentuckyhealthfacts.org or using national data.

"We don't want to get stuck in analysis paralysis," but communities can use the data as "a story you can use as leverage," said Jan O'Neill, community engagement specialist for County Health Rankings & Roadmaps. The County Health Rankings evaluate the morbidity and mortality rates for nearly every county in the country and rank them within a state.  The rankings can act as a motivator for counties interested in effecting health changes, but "We have to be aware of their limitations" given their margins of error, especially for small counties, pointed out Al Cross, director of the Institute for Rural Journalism and Community Issues. 

O'Neill spoke of San Bernadino County in California, which used its low ranking to spur change. The county focused on its built environment, pressing hard for Walk or Wheel to School programs, community gardens and a kids community health center. O'Neill pointed out the changes are about more than infrastructure. "It's the relationships," she said. "It's the human capital ... It's many not all doing it all, but bringing what you do best. That's what mobilizing looks like."

Jodi Mitchell, executive director for Kentucky Voices for Health, said she is "starting to see a tide of change" already in Kentucky. What's important is to keep momentum building and, equally vital, ensure people are willing to participate. "If you're not at the table," she said, "you're on the menu."

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

531 deficiencies found in 80 Kentucky nursing homes in first quarter of 2012; worst one had 29; five had none

State inspectors found 531 deficiencies in 80 Kentucky nursing homes in the first quarter of this year, with one facility accounting for 29 of them alone: Life Care Center of Morehead. In five nursing homes, no deficiencies were found.

The information was released by Kentuckians for Nursing Home Reform, a nonprofit organization that advocates for nursing home residents and obtains the data regularly through open-records requests to the Cabinet for Health and Family Services and distributes it statewide. The information is posted as part of Medicare's nursing-home comparison data.

According to the Centers for Medicare and Medicaid Services, the average number of deficiencies for a nursing home inspected in the U.S. is eight and the average in Kentucky is seven. 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 first quarter were:
Life Care Center of Morehead (29 deficiencies)
Kindred Transitional Care & Rehab-Fountain Circle in Winchester (24)
Signature Health of Pikeville (19)
Hearthstone Place in Elkton (15)
Martin County Health Care Facility in Inez (14)
Wesley Manor Nursing Center in Louisville (13)
Pembroke Nursing & Rehabilitation Center in Pembroke (13)
Highlands Nursing & Rehabilitation Center in Louisville (11)
Mountain Manor of Paintsville (11)
Cumberland Valley Manor in Burkesville (10)
Klondike Care and Rehabilitation Center in Louisville (10)

The five nursing homes with no deficiencies were:
Clark Regional Medical Center in Winchester
Nazareth Home in Louisville
Essex Nursing and Rehabilitation Center in Louisville
Barren County Health Care Center in Glasgow
Cardinal Hill Rehabilitation Center in Lexington (initial inspection; under new ownership)

For more information about Kentuckians for Nursing Home Reform, click here.


Newspaper reporting contest for rural health coverage; deadline June 24

Journalists who have reported about rural health in the past year should start sifting through their clippings. The Kentucky Rural Health Association is awarding four writers $100 each for their efforts.

Entries will be judged on their relevance to rural health; the quality of the reporting; impact on health-care policy; and new insights that might have been generated by the reporting.

The contest features two divisions, daily and non-daily, with two categories in each division: series and single story. The contest period ranges from July 1, 2011 to June 15, 2012. Entries must be received by June 24. Winners will be announced during KRHA's annual conference in Aug. 16-17 in Bowling Green.

Entries can be submitted to David A. Gross, 222 Medical Circle, Morehead KY 40351. For more information, contract Gross at 606-783-6468 or e-mail at dagross@st-claire.org. (Read more)


Tobacco virus may be used to combat Parkinson's disease

A tobacco crop affected by drought. Courier-Journal photo
by David R. Lutman.
University of Louisville researchers say a virus that attacks tobacco plants may be used to develop a vaccine for Parkinson's disease.

The answer lies with the tobacco mosaic virus, which causes antibodies that "may be protective against Parkinson's," said Dr. Robert Friedland, a clinical and research neurologist at U of L.

Friedland's findings come after more than 60 studies have shown that smokers seem to have a reduced risk for developing Parkinson's, a motor system disorder that can cause tremors, stiffness and impaired balance. 

But Friedland and Dr. Honglei Chen, an investigator with the National Institute of Environmental Health Sciences, part of the National Institutes of Health, warn the findings should not be considered an excuse to smoke. Friedland's research is partly funded by the NIH, but not by any tobacco companies, reports Laura Ungar for The Courier-Journal. (Read more)

Monday, May 14, 2012

Coventry changes course, will pay for addiction-treatment drug

Reversing its decision, likely after it was pressured to do so, a Medicaid managed-care organization will continue to pay for a drug used to treat drug addiction.

Coventry Cares said it "decided to change course after talking to representatives of a chain of addition treatment clinics that threatened last week to sue Coventry," reports Beth Musgrave for the Lexington Herald-Leader.

Last week, the Cabinet for Health and Family Services sent Coventry a letter expressing its displeasure about the MCO's move, saying it would be a contractual violation. The drug in question is Suboxone, an expensive treatment option for addicts dependent on taking opioids such as Oxycontin and Vicodin. Coventry had said it was aligning its coverage in keeping with Medicaid policy, moving to only cover the full price of the drug for pregnant or recently pregnant women and youth under 21.

After the MCO discussed the issue with SelfRefind, the chain of addiction treatment clinics in question, "Coventry understands their concerns," said Coventry spokesman Eyles. "As a result, we will continue covering Suboxone and similar medicines for all Coventry members while we work through the cabinet's process to determine whether these drugs should be covered for certain categories of Medicaid recipients or everyone." (Read more)

Saturday, May 12, 2012

100 Kentucky hospitals join network to improve patient safety, fight hospital-acquired conditions such as infections

To help hospitals reduce preventable readmissions and hospital-acquired infections, 100 of Kentucky's 131 hospitals have joined the Kentucky Hospital Association's hospital engagement network. The group's goal is to help hospitals find ways to improve patient safety, reduce readmissions and hospital-acquired conditions such as infections, and share learning among hospitals.

The network hopes to reduce the incidence of adverse drug events; catheter-associated urinary tract infections; central-line-associated bloodstream infections; injuries from falls and immobility; obstetrical adverse events; pressure ulcers; surgical site infections; venous thromboembolisms or deep vein clots; ventilator-associated pneumonia; and preventable readmissions.

The two-year project is supported by a contract with the federal Centers for Medicare and Medicaid Services as part of the "Partnership for Patients" campaign, launched earlier this year by the U.S. Department of Health and Human Services. The goal for the project is to reduce preventable  readmissions that occur within 30 days of discharge by 20 percent and hospital-acquired infections by 40 percent (compared to 2010) by the end of 2013.

"The commitment to patient safety and quality by hospitals across Kentucky has resulted in lives saved, fewer complications and reduced costs," said Mark J. Neff, chair of the KHA board of trustees and president and CEO of St. Claire Regional Medical Center in Morehead. For a list of hospitals participating in the network, click here.

Friday, May 11, 2012

Hopkinsville paper examines doctor shortage, reasons for it

Albert Delaney waits for his wife Agnes in Hopkinsville.
(Photo by Kentucky New Era's Tom Kane)
Nick Tabor of the Kentucky New Era examines Christian County's doctor shortage, with the area averaging just one primary care physician for every 2,000 people. It's the latest health story in the small daily newspaper, which is committed to quality health reporting.

The shortage creates problems for residents, who must either travel to another area to see a doctor or go without preventive services because there is no one to see until serious illness occurs. When that happens, that "puts an undue burden" on the local hospital's emergency room.

The shortage is affected by the fact that "primary care physicians, which rural areas need in higher volumers than specialists, are entering the job market at alarmingly low rates," Tabor reports. "More medical students are becoming specialists, as these jobs promise better salaries and hours." Secondly, it is difficult to recruit doctors to rural areas. "Little old Hopkinsville is up against Boston and Chicago and all of these bigger cities," said Teresa Bowers, Jennie Stuart Medical Center's physician recruitment director. "They're not throwing darts at a map and saying, 'I'm going to Hopkinsville.'"

The problem is not a new one. A 2007 report by the Kentucky Institute of Medicine shows there have been shortage issues for decades. "Even if all the barriers that have prevented a sufficient and well-dispersed supply of physicians were suddenly to disappear, the task of recruiting and educating an ample cohort of doctors would take years to accomplish," it reads.

The problem is liken to worsen, however, if the federal health-reform law is upheld by the U.S. Supreme Court, as 30 million more Americans will have insurance to see the doctor. A recent report found medical school enrollment is up by 30 percent, but more residency placements are needed to accommodate the influx. (Read more)

Medicaid managed-care firm Coventry plans to stop paying for expensive drug that curtails addiction

Coventry Cares, one of the four firms that manage patient care for the state Medicaid program, has once again hit the headlines, this time for its plans to stop paying for medicine that helps addicts keep their opioid addiction at bay. State officials quickly condemned the move Thursday and called it a contract violation, reports Beth Musgrave of the Lexington Herald-Leader.

Coventry decided to stop paying for buprenorphine, more commonly known as Suboxone, which helps curtain cravings for drugs such as Oxycontin and Vicodin. A 30-day supply of the drug can cost more than $450, Musgrave reports.

"They will be at risk for relapsing and going back to using illegal opioids," Dr. Michelle Lofwall, an addiction specialist and assistant professor at the University of Kentucky, told Musgrave. "Whenever you are using illegal opioids, there is a risk of overdose and death."

Coventry said it will no longer offer the coverage because only pregnant women, women who recently gave birth and those under the age of 21 are eligible for addiction treatment in Kentucky's Medicaid program. "What we've done is align our coverage with the cabinet's Medicaid policy," said Matt Eyles, a Coventry spokesman.

However, the state Cabinet for Health and Family Services said the decision violates the contract and "cannot take this unilateral action without the cabinet's approval," said Jill Midkiff, a cabinet spokeswoman. 

A company that operates addiction treatment centers across the state was planning to file suit over the move Friday, but, after learning of the cabinet's reaction, "We are going to give them the chance to work this out," Anna Whites, an attorney who represents SelfRefind.

Coventry already caused controversy this week when it informed Baptist Health System wants to renegotiate its contract. The move comes just a week after Coventry and Appalachian Regional Healthcare came to a temporary agreement after Coventry threatened to terminate its contract and ARH sued Coventry. The company has also told King's Daughters Medical Center in Ashland it will terminate its contract after May 26. (Read more)

Cancer battle of UK faculty member to air on KET



A documentary chronicling a former University of Kentucky faculty member's battle with cancer will air six times in May on KET.

Nancy Clauder, an oboist whose research focused on arranging and performance, was diagnosed with multiple myeloma in 2008 when she went to the doctor with what she thought were symptoms of the flu. She was diagnosed with the disease, a rare, blood-related cancer with no cure. Clauder underwent a stem cell transplant, endured high-dose chemotherapy and lost her ability to play her instrument for six months, a UK press release says.

Eventually, she was able play again and recorded a CD with artists from UK and the Lexington Philharmonic. "This is the right time, and I'm so grateful that there was the opportunity to do it through UK, and a grant research program, because I would not be able to afford the musicians," she said.

The documentary "The Ascending Journey" will air at 4 p.m. and 10:30 p.m. May 13; at 10:30 p.m. Thursday, May 17 on KET2; midnight Monday, May 21 on KET2; 5 a.m. Monday, May 28 on KETKY; and 9:30 p.m. May 30 on KETKY. (Read more)

Thursday, May 10, 2012

42 percent of Americans will be obese by 2030, study predicts

If trends continue, 42 percent of American adults will be obese by 2030 and about one quarter of whom will be grossly obese, a new study warns. The results are only slightly less troubling than those published four years ago, which forecast that 51 percent of the population would be obese by 2030.

Right now, 34 percent of American adults are obese and some evidence indicates obesity rates have reached a plateau. "Regardless which is correct, we still have a very serious problem," said William H. Dietz, head of the Centers for Disease Control and Prevention's obesity program. The results were discussed Monday at the "Weight of the Nation" conference in Washington, D.C.

The study, published in the American Journal of Preventive Medicine, used obesity prevalence data from 1990 to 2008 to analyze trends. Information came from the widely regarded Behavioral Risk Factor Surveillance System, but because people tend to underestimate their weight when asked on the phone, a mathematical equation was used to compensate for the shortfalls, David Brown reports for The Washington Post. (Read more)

Without a partner, University Hospital's viability is 'questionable at best,' consulting group concludes

University Hospital in Louisville needs a partner that will help it grow, a consulting firm informed a committee reviewing the facility's operations Wednesday. "Even with operational and strategic improvements, the economic viability of University Hospital is questionable at best," they said.

"While the organization is working very hard to make improvements ... the gap between where you are as an organization and where you need to get to be a viable organization is very steep," said consultant Craig Anderson Sr. of Dixon Hughes Goodman of Hudson, Ohio. "At the end of the day, any organization need an access to capital."

Laura Ungar of The Courier-Journal notes that the findings are in keeping with University Hospital's search for a partner, which it has long been looking to find. Last year, Gov. Steve Beshear nixed plans for the publicly-owned hospital to join, among others, a Catholic-based organization that would have limited some procedures it could offer because of the organization's religious tenets.

University Hospital has delayed its selection of a new partner until the end of June to give more time for negotiation.

"The two major conclusions are what the university would like to have heard: That partners and capital are needed," said Dr. Peter Hasselbacher, a merger critic and former professor of medicine at U of L who attended the meeting. "We need to ask: How did we get here?" (Read more)

Managed-care firm Coventry threatens to terminate contracts of Baptist Healthcare and big Ashland hospital

Lexington Herald-Leader photo by Charles Bertram
Issues with the state's managed-care companies continue to mount. Now Coventry Cares has told Baptist Healthcare System, which has hospitals in Lexington, Louisville, La Grange, Paducah and Corbin, that it wants to renegotiate its contract. 

The move comes just a week after Coventry and Appalachian Regional Healthcare came to a temporary agreement after Coventry threatened to terminate its contract and ARH sued Coventry. The managed-care firm has also told King's Daughters Medical Center in Ashland it will terminate its contract after May 26.

Kentucky moved its Medicaid population to managed care Nov. 1, a move that is expected to save the state a lot of money. The three managed-care organizations that coordinate care for Medicaid recipients outside the Louisville area are paid on a per-month, per-patient basis, regardless of what care is needed. Coventry alleges "that it has too many high-risk patients and that the state needs to adjust the risk model so Coventry can receive more money for sicker patients," report Beth Musgrave and Valarie Honeycutt-Spears for the Lexington Herald-Leader.

Unlike the state's other two managed-care companies, Kentucky Spirit and Well Care, Coventry "opted not to charge patients a co-pay for pharmacy services. That business decision meant it got more people into the system who likely had more complicated health problems," Musgrave and Honeycutt-Spears report. House Speaker Greg Stumbo has questioned the move not to charge a co-pay and wondered if it was akin to Medicaid fraud. (Read more)

Former head of Massachusetts health exchange says it's better to offer fewer, well-defined plans than set general criteria

With  Kentucky stakeholders discussing their options to set up a state-run health insurance exchange — something Gov. Steve Beshear said last week he intends to do if the Affordable Care Act is upheld by the U.S. Supreme Court — research shows the fewer plans offered in the exchange, the better.

An article in Health Affairs says officials should follow the lead Massachusetts' health-reform system when creating their own exchanges. "A hands-on exchange with the power to set standards on top of the federal health-care law will help prevent consumers from being 'overwhelmed' by the process of buying insurance," reports Sam Baker for The Hill's global affairs blog.

The Health Affairs article's lead author, Rosemarie Day, is a former deputy director of the Massachusetts exchange. She said consumers prefer choosing from "a handful of carefully vetted, clearly described health-care plans," Baker reports. The model used in Utah to allow any plan that meets criteria to be featured in the exchange is less popular, the paper found, but was more popular among conservatives.

"Findings from consumer research emphasized the value of limiting insurance plan choices on the exchange," the analysis states. "Specifically, early focus groups showed that consumers wanted four to six carrier options at 'low, medium and high' benefit levels." (Read more)

Tuesday, May 8, 2012

Tea Party protesters object to state-run health insurance exchange; leader says if there is one, feds should run it

By Tara Kaprowy
Kentucky Health News

A public meeting in Frankfort to get stakeholders' input about development of a state-operated health insurance exchange Monday was attended by dozens of Tea Party activists taking issue with Gov. Steve Beshear's intention to create it.

"It was absolutely a formal protest," said organizer David Adams, who writes the blog Kentucky Progress and managed Louisville businessman Phil Moffett's campaign for the Republican nomination for governor last year. "We are very, very strongly opposed and we're just getting started with our protest."

Last week, Beshear announced his intention to create a state-run exchange if the Affordable Care Act is upheld in the U.S. Supreme Court. Since 30 million Americans who don't have coverage now would be required to buy insurance under the law's mandate, the exchange would act as a marketplace in which individuals and employees of small business can choose from several plans that have coverage packages pre-approved by state and federal governments. The people buying from the exchange would be given subsidies to help pay their premiums.

States have the option to create their own exchange or have the federal government run one for them. Through February, Kentucky had received nearly $60 million to help set up an exchange, money officials said would be used for planning.

Several major business lobbies have said the state should have its own exchange, but Adams argues that if there is an exchange, the federal government should run it.

"This idea that if the state does it then we have some kind of control is like saying since we run Medicaid, we have control over Medicaid, which is absolutely not the case," he said. "If we have a state-run health insurance exchange, we will run it in the exact way that the federal government wants us to." He said he fears that once a state-run exchange is set up, "when federal funds run out, we'll be responsible for financing it."

"There is a place for helping people who absolutely can't help themselves," Adams acknowledged, but since people with an income of up to 133 percent of the federal poverty level qualify for the exchange, "We've changed the definition of who can't help themselves. We've moved that line way up into the middle class. In every part of life that we've done that, that has been very counter-productive."

Though the Supreme Court's decision about whether to uphold the mandate won't be known until June, Adams said he felt it was necessary to protest Monday's meeting "to demand that the government send back the $60 million and stop any activities of setting up an exchange." "I don't think anybody really believes that we need $60 million in federal grant money to set up a website to help people buy health insurance," he said. "We need to return that money and operate on a more fiscally feasible path."

In response to a question, Adams said the protest was not held to stir anti-Obama sentiment that might help Kentucky Republican candidates in the November elections. He said the insurance exchange is "just the tip of the spear" and that "the best thing we can do in managing our health care problems is stop going in the wrong direction."

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

More residency placements will be needed as medical school enrollments rise, perhaps by 30 percent through 2016

Aimed at addressing expected physician shortages, enrollment at U.S. medical schools is on target to increase by 30 percent by 2016, the Medical School Enrollment Survey has found.

But even if enrollment rises through expansion of medical schools and construction of new ones, "This won't amount to a single new doctor in practice without an expansion of residency positions," said Dr. Darrell G. Kirch, president and CEO of the Association of American Medical Colleges.

First-year medical school enrollment is expected to reach 21,376 in 2016-17, a 29.6 percent increase over enrollment in 2002-03. Nearly 60 percent of the growth will happen in the 125 medical schools that were accredited in 2002; 25 percent will happen in schools accredited since then, and 17 percent will come from schools that are applicant or candidate schools.

The United States is facing a shortfall of more than 90,000 primary care and specialty doctors by 2020, the AAMC estimates. With medical schools stepping up, what's key is "an increase in federal funding to expand the number of residency training positions — which prepare new doctors for independent practice," research-reporting service Newswise reports.

"Otherwise it may become more difficult for medical students to complete their training and for patients to get the care they need — as our population continues to grow and age, more doctors retire, and 32 million Americans enter the health care system as a result of the Affordable Care Act," Kirch said. (Read more)

Local health care centers in Ky. get $16.5 million in federal grants

Kentucky recently received $16.5 million in grant for health care centers as part of the Affordable Care Act.

Recipients include Family Health Center Inc. in Louisville ($5 million); Cumberland Family Medical Center in Burkesville ($4.86 million); Grace Community Health Center Inc. in Knox County ($4.33 million); and Big Sandy Health Care Inc. in Prestonsburg ($977,375). The grants were made through a building-capacity program, reports Greg Kocher for the Lexington Herald-Leader.

Grants given under the "immediate facility improvement program" include $425,000 for Mountain Comprehensive Health Corp. in Whitesburg; $380,000 for Family Health Center Inc. in Louisville; $360,863 for Cumberland Family Medical Center in Burkesville; and $216,543 for Big Sandy Health Care in Prestonsburg.

The awards will help serve about 29,475 new patients, states a news release from the U.S. Department of Health and Human Services. Nationwide, $728 million was awarded for renovation and construction projects. (Read more)

Lessons in battling obesity can be learned from the anti-tobacco movement, but there are big differences

To make real headway in battling the obesity epidemic, lessons can be learned from the war on smoking — though the two public-health issues have certain unique challenges. Judith Graham, reporting for Kaiser Health News in collaboration with USA Today, delves into the similarities and differences.

Her piece deserves to be read in its entirety, which can be done by clicking here, but here's a summary of her analysis:

Children are central. The majority of people start using tobacco as teenagers, with one-third of kids who smoke daily set to die prematurely of tobacco-related illnesses. Likewise, overweight children are at a greater risk of a vast array of health problems, including diabetes, liver disease and obesity in adulthood.

Protecting children as at the heart of both the anti-tobacco and anti-obesity efforts. "First let's protect our children," said Dr. David Ludwig, a child-obesity expert at Harvard Medical School

Changing social norms is the goal. While smoking in a hospital or airplane has become inconceivable, the same shift in social norms is required to fight childhood obesity. "Our (eating and physical activity) tastes, our preferences and our behaviors are learned and can be changed," said Dr. Jeffrey Koplan, former head of the Centers for Disease Control and Prevention and vice president for global health at Emory University in Atlanta. It won't be easy, but at least "we're dealing with a population that would like to be thinner and that works in our favor."

We can't "just say no" to food. "Tobacco we can get rid of entirely," said Dr. David Katz, director of Yale University's Prevention Research Center. "But we have to eat to live and make terms with food as the enemy."

That makes fighting childhood obesity much more difficult, since the message can't be "stop, don't do this." It has to instead be "make good choices, set boundaries," which is more difficult to convey and adhere to, Graham reports.

Our biology works against us. "While smoking is highly addictive, the biological responses attached to eating food are even more deeply rooted in human evolution," Graham reports. Evolutionarily speaking, humans are "built" to eat food when it's available and "we're very good at storing calories and defending calories once we've got them," said Dr. Stephen Daniels, chair of the department of pediatrics at the University of Colorado School of Medicine. 

Shame and denial are greater among the obese. A person's self-image is tightly tied to his or her body weight in a way that isn't true of smoking. That can provide a compelling reason to stop over-eating, but people don't tend to think of themselves as obese. "Obesity is seen as a pejorative term that people don't connect with," said Dr. William Dietz, director of the division of nutrition, physical activity and obesity at the CDC. "They think, 'I'm just 30 or 40 pounds overweight, but I'm not obese.'"

There are more food products available. "Tobacco is a single substance," Graham reports. "By contrast, the food and beverage industry is enormous and makes a huge array of goods that extend into every home, restaurant, convenience store, and grocery store in America."

There is no second-hand smoke equivalent. "The notion that my behavior as a smoker can have an effect on you and can make you sick was critically important in accelerating people's intolerance of smoking and their willingness to see the government take action," said Michael Eriksen, director of the Institute of Public Health at Georgia State University. "Your being obese does not affect me in the same direct way."

The role of the food industry is less clear. While Big Tobacco was able to be demonized, "with obesity (as compared to tobacco) there's a much more nuanced relationship with industry," said Dr. James S. Marks, director of the health group at the Robert Wood Johnson Foundation.

4 of 5 Kentuckians think child obesity is a problem, and more than half favor a statewide smoking ban, poll finds

More than four out of five Kentuckians think too many children are overweight, and more than half want a statewide smoking ban. These are two of key findings of the Kentucky Health Issues Poll, which also asked respondents about prescription drug abuse, depression and access to health care.

Poll findings are available by clicking here. Findings have been broken down by region: Western Kentucky, greater Louisville, greater Lexington area, Northern Kentucky and Eastern Kentucky.

Statewide, the poll found 54 percent of Kentuckians favor a statewide smoking ban, up from 53 percent the year before. In 2010, Kentuckians were split down the middle, 48 percent to 48 percent.

A whopping 84 percent of Kentuckians feel childhood obesity is a problem, which is timely since 33 percent of children, 60 percent of women and 80 percent of men in Kentucky are overweight or obese, "Shaping Kentucky's Future: A Community Guide to Reducing Obesity" reports.

The poll also found more than one in three Kentuckians know someone who has misused prescription drugs; 65 percent of adults dispose of their prescription drugs in an unsafe way; nearly half keep guns in their homes; and 1 in 2 Kentuckians have a family member or friend with a serious problem of depression. Nearly 90 percent of people asked favor providing access to affordable, quality health care for all Americans.

"The Kentucky Health Issues Poll provides an excellent snapshot of how various health related issues are viewed throughout the commonwealth," said Dr. Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, which helped fund the poll. "The survey's methodology lets us compare responses and learn about regional differences in Kentucky views about health."

The poll was also funded by The Health Foundation of Greater Cincinnati. It was conducted Sept. 27 to Oct. 27 by the Institute for Policy Research at the University of Cincinnati. A random sample of adults across Kentucky were interviewed, including 1,313 landline interviews and 308 cell-phone interviews.

Report looks at ways Kentucky communities are battling obesity

Winchester residents walk the Traveling Trail, a walking
path meant to encourage residents to exercise.
A new report takes a hard look at obesity in Kentucky and highlights what individual communities are doing to combat the problem.

"Shaping Kentucky's Future: A Community Guide to Reducing Obesity" could be useful to readers, officials and advocates interested in effecting change, with some efforts relatively easy — and cheap — to implement.

Statewide, 33 percent of children, 60 percent of women and 80 percent of men are overweight or obese, ranking Kentucky's third highest in the country for children and sixth highest for adults. Health care costs attributable to obesity in Kentucky are estimated to be $2.3 billion in 2013.

The report highlights community efforts in:
• Berea, for its effort to make the city more accessible to pedestrians.
• Winchester, for mowing a walking trail on land owned by the community hospital.
• Louisville, for supporting breast-feeding mothers; selling healthy food at urban markets
• Madisonville, for Hopkins County's wellness program for its 150 county employees.
• Lexington, for serving the Better Bites menu at several pools and city facilities, rather than unhealthy meals and snacks.
• Hopkinsville, for its farmers' market being one of the first to accept SNAP nutrition assistance benefits.
• Tyner, for building a commercial kitchen so residents can process local food and package it for sale.
• Buckhorn, Lexington and Shelbyville, for opening up schools for exercise venues.

The report, which was funded by the Kentucky Department for Public Health, the Shaping Kentucky's Future Collaborative and the Tides Foundation, also looks at success stories in schools, from an effort at Science Hill in Pulaski County to the Healthy Monday program in Covington, which includes walking the Monday Mile and eating the Monday Meatless Meal. (Read more)

'Health for a Change' webinar training series starts May 16, with session on where to find and how to use health data

How to find county-specific health data and how to use it to make community changes will be the focus of an hour-long webinar May 16.

The free session is the first in the 2012 "Health for a Change" training series, meant to advance today's health issues in Kentucky. It is sponsored by the Foundation for a Healthy Kentucky. "We have procured excellent speakers to present best practices and proven models of these skills in a combination of electronic webinar format and in-person workshops," a foundation press release says.

The June 20 workshop will provide training on building and maintaining a local health coalition. Other webinars this summer will help identify differences between advocacy and lobbying, discuss evidence-based policies and programs, give instruction on budgeting and teach how apply for grant funding.

The May 16 webinar will be held from 3 to 4 p.m. To register for it or the entire "Health for a Change" series, click here.

Monday, May 7, 2012

Cabinet must 'wield the stick' to get managed care under control, state auditor says

Though the state has a solid contract "filled with all the mechanisms you need for enforcement, from the carrots to the sticks," the Cabinet for Health and Family Services has to be more aggressive in cracking down on the managed care organizations (MCOs) that run the state's $6 billion Medicaid system, state Auditor Adam Edelen says.

Edelen, who has been in office a little over four months, discussed managed care with Ryan Alessi, host of cn|2's "Pure Politics." Edelen is reviewing the new system and submitted 10 recommendations for improvement to the cabinet in February.

"The issues have been enormous — providers not being paid in a timely manner, a lack of communication between the cabinet and the MCOs and the providers, has created a system in which there is a lot of uncertainty and a lot of people are being squeezed out," Edelen said.

Couple that with the fact that Appalachian Regional Healthcare, which serves more than 25,000 Medicaid patients, sued two of the three MCOs in charge of the state, claiming they are owed $18 million for services that have been provided. Last week, ARH and MCO CoventryCares came to an agreement after being ordered by a federal judge to negotiate.

Edelen pointed out the broader ramifications of the situation. "If our largest Medicaid provider in the part of the state that needs it most for some reason is not able to operate within the system because they can't manage their relationship with Coventry or vice versa, that represents a structural threat to the system," he said. "We've got to figure out a way to make it work."

In order to do so, Edelen said "the cabinet has got to be willing to wield the stick" and is able to do under the terms of its contracts with the MCOs, which allow the cabinet to cancel contracts, "sanction and punish" the MCOs and make changes to the system. He said new cabinet Secretary Audrey Haynes has a tough job ahead and said "strong leadership" is critical.

When asked if his review looks into what work is being accomplished by the state's 200 employees who used to handle Medicaid — work that is now being managed by the MCOs — Edelen said it hasn't. (Read more)

Meanwhile, the Lexington Herald-Leader weighed in on the lawsuit between ARH and CoventryCares, saying in an April 24 editorial, "Coventry should keep working with Haynes and ARH on solutions. The editorial also stated, "Beshear, a former corporate lawyer, should bring the weight of the governor's office to bear and get busy making his Medicaid managed care contracts work." (Read more)

Saturday, May 5, 2012

New oral health coalition expected to spur changes in state

By Tara Kaprowy
Kentucky Health News

For the past 30 years, Dr. Fred Howard of Harlan has been seating patients in his blue dental chair and telling them to open up. When they do, he's seen all kinds of scenarios, from toddlers whose teeth are already rotten from sucking on bottle filled with soft drinks to 20-year-old adults with no teeth at all. On some occasions, children walk in with such a severe abscess in their mouth their eyes are swollen shut.

Though the view can be grim, Howard said he has seen some improvements in his decades of practice, but with new changes in Medicaid managed care, the overwhelming prevalence of children and teens drinking soda pop and an embedded cultural belief in some areas that "teeth are just something to get rid of," Howard concedes that making headway can feel like one step forward and two steps back.

Enter the newly re-established Kentucky Oral Health Coalition, a statewide force whose goal is to ensure Kentuckians have happy, healthy smiles.

Dozens of organizers and stakeholders met in March to discuss the coalition's aims, and a membership drive is underway to build financial momentum. The coalition will promote oral health education, statewide partnerships statewide and advocate oral-health legislation. "I think they will turn into the advocacy group for dental change," said Dr. Julie McKee, dental director for the state Department of Public Health. "They're working hard to come up with a plan. They've got their heads on straight."

One of the major issues facing the dental profession is possible expansion of the scope of practice for mid-level providers, such as dental therapists who can assess, clean teeth, replace sealants, provide fluoride as well as fill cavities and extract teeth. As nurse practitioners do in the medical field, having such providers could help address shortages in rural areas, said Dr. Jim Cecil, former state dental director and coalition steering committee chair. The concept is in practice in 54 other countries, but the only U.S. states with it are Minnesota and Alaska, mainly because of opposition form dentists.

Andrea Plummer, coalition member and senior policy analyst for Kentucky Youth Advocates, acknowledged that scope-of-practice issues "can be a very tense subject" and "there would have to be buy-in" from members of the committee, who include dentists, but discussion is ongoing. Cecil said the issue is "something we'll need to look at and take a stand on eventually."

Howard (pictured with Gov. Steve Beshear at signing of the bill that requires dental exams for students starting school) favors the expansion, but doesn't feel Kentucky's oral-health problems can be solved just by putting more boots on the ground.

"The bottom line is: We can have twice as many dentists, have more dental hygienists, but if we don't change the mindset, if we don't provide the education, I don't think we're going to solve the problem," he said.

To that end, the coalition is also investigating ways to expand school-based health and dental education, either by finding funding, collaborating with groups that are already in place or advocating legislation changes, Plummer said.

A recently enacted state law requires children to get a dental screening before entering kindergarten, but there is little else in the way of legislation that requires schools to offer services to help students with dental problems, Plummer said. "Kentucky law says that students' health does affect their learning and schools should take steps to affect their learning but it's fairly broad," she said.

An analysis by KYA last year showed school districts spend less than 1 percent of their budgets on school health services.

Examining how to get more dentists to accept Medicaid patients is another hot-button issue. Of about 2,200 dentists statewide, only about 600 are enrolled in Medicaid, Cecil said, and "They feel like they're working for free" because of the program's low reimbursements. "In many cases, they're really not meeting overhead."

The administrative burden that comes with these patients has also gotten worse since Medicaid transitioned to managed care, Cecil said. "Everything they do has to be pre-authorized," he said. "That delays approval, delays treatment, delays payment."

Under managed care, Howard said, patients now need to come in twice to get a full complement of X-rays and radiographs done, which can not only make it hard on dental practices, but for patients as well. "The more times they have to come, that gives them more opportunities to miss appointments," Howard said.

The Oral Health Coalition also sees a need for "quality, updated data," Plummer said. Getting data was one of the successes of the first coalition, formed in 1990. Run by volunteers and funded by the dental schools at the University of Kentucky and University of Louisville, it was formed after the General Assembly told the schools that they either needed to work together or one could "risk being shut down," Plummer said. The group had several successes, including working with the state to conduct an oral health survey, lobbying legislators for oral-health measures and holding an annual symposium. But after more than 15 years, "It kind of just fizzled out a little bit," Plummer said. The group went inactive in 2006 but had some assets that the new group will take over.

The group's rebirth began in 2009, when Kentucky Youth Advocates was approached by the DentaQuest Foundation, which is connected to DentaQuest, one of the largest managed-care organizations in the country that administers dental benefits. DentaQuest officials were interested in seeing the coalition resurrected and offered $80,000 to KYA so it could provide the manpower to run it, Plummer said. It was the first time the coalition had funding to back it up. The KYA talked to state stakeholders and discovered "there really did seem to be an interest in putting a coalition back together," Plummer said. Planning began in earnest and in January the steering committee drafted by-laws. In March, 70 people showed up to the first meeting.

That gathering was not just made up of dentists, oral-health advocates and experts, Howard said. Members of the media were present, along with parents, health department officials, school nurses, students and educators. That made all the difference to Howard, who said he is inspired by what changes might occur and what education can take place. "When we have people from all these different venues, we have more of an opportunity to make a difference," he said.

The coalition's next meeting will be July 25. Those interested in attending or becoming members of the coalition can contact Andrea Plummer at aplummer@kyyouth.org or 502-895-8167. Dues for individual members are $25. Government organizations pay $100, nonprofit organizations pay $250 and for-profit organizations pay $500.

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