Tuesday, October 30, 2012

Women who smoke triple their risk of dying early, but quitting early enough might just wipe out that risk

A new study of more than a million women found that smokers have more than triple the risk of early death than nonsmokers, and that quitting can virtually eliminate the increased risk. Smoking is still the most preventable cause of death in the United States and the United Kingdom.

The University of Oxford study, published this week in the British medical journal The Lancet, included 1.3 million women between the ages of 50 and 65, making it one of the largest ever conducted on smoking. At the start of the study, in 1996, 20 percent of the women were smokers, 28 percent were former smokers and 52 percent had never smoked. "Each of the women was registered in the U.K.’s national health system, so their deaths and cause of death were recorded," explains Alexandra Sifferlin of Time magazine. "By 2011, 66,000 had passed away." Researchers found that even smokers who smoked as few as nine cigarettes a day had twice the mortality rate of nonsmokers.

"More encouraging, however," writes Sifferlin, "was the positive effect that quitting seemed to have on the women’s life span. Those who quit smoking before they reached 40 avoided more than 90 percent of the increased risk of premature death from cigarettes, while women who stopped even earlier -- before age 30 -- avoided 97 percent of the added risk." (Read more)

Here are the seven factors driving health care cost increases

Escalating health care costs are everybody's problem and no one entity's fault. Julie Appleby at Kaiser Health News reports that the United States spends about18 percent of its gross domestic product -- or about $2.6 trillion a year -- on health care costs. So what's making that figure rise? A Bipartisan Policy Center study took on the task of finding out and came up with it believes are seven major factors:

1. Paying our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient. Even insurers like Medicare pay on a fee-for-service system. New efforts in the federal health law look to change that.
2. Growing older, sicker and fatter as a nation. Medicare is set to grow by an average of 1.6 million people annually. With two-thirds of adults are either overweight or obese, lots of additional medical spending looms.
3. Wanting the latest drugs, technologies, services and procedures. Prices for newer treatments are often higher than for the products they replace.
4. Employers and employees get tax breaks on health insurance, and it costs employees little to seek care. Appleby writes, "The majority of people with insurance get it through their jobs. The amount employers pay toward coverage is tax deductible for the firm and tax exempt to the worker, thus encouraging more expensive health plans with richer benefits, the report says. How that coverage is designed also plays a role: Low deductibles or small office co-payments can encourage overuse of care, the report says. Increasingly, however, employers are moving toward high-deductible coverage as a way to slow premium growth and require workers to pay more toward the cost of care."
5. Not having enough information to make decisions on which medical care is best for us.
6. Hospitals increasingly gain market share through consolidation and demand higher prices.
7. Legal issues complicate efforts to slow spending. Doctors sometimes prescribe tests or treatment out of fear of facing a lawsuit, the report says. Fraudulent billing is another concern. The report notes that laws sometimes limit the ability of medical professionals to do work for which they are trained but that more highly paid doctors must do. (Read more)

To read the entire Bipartisan Policy Center report here.

Monday, October 29, 2012

Kentucky to get $811,000 from drug company as settlement of federal suit alleging unfounded promotion of three medications

Attorney General Jack Conway has confirmed that the state will receive almost $811,000 for its share of recoveries in a settlement reached in a lawsuit filed by the federal government against Boehringer Ingelheim Pharmaceuticals Inc. In all, the drug company has agreed to pay $95 million to settle allegations that it promoted three drugs for uses in Kentucky and other states that were not medically accepted.  The Associated Press reports that the stroke-prevention drug Aggrenox, the chronic obstructive pulmonary disease drug Combivent, and the high-blood-pressure drug Micardis are the drugs named in the suit. The Justice Department said the company also promoted the use of the heart drug Atrovent at doses exceeding those covered by federal health programs. (Read more)

Anthem funds program to fight childhood obesity in Louisville area

A $35,000 Anthem Foundation grant to the American Academy of Pediatrics will allow a program that fights childhood obesity in Louisville and northern Kentucky counties to continue, reports Darla Carter of the The Courier-Journal. The grant provides free YMCA memberships and fitness and nutritional guidance to families of 9- to 17-year-olds with weight issues who have been referred by member physicians. The foundation is a philanthropic arm of Anthem Blue Cross and Blue Shield in Kentucky. 

Democratic ads accuse Republicans of supporting pill mills by voting against bill that all agree needs work

A bipartisan group of Kentucky lawmakers are looking ahead to fixing the much complained about "unintended consequences" of last spring's hastily passed bill aimed at curbing prescription drug abuse. Still, the House Democratic Caucus Committee has paid for political ads criticizing at least three Republican House members for not supporting the measure though they may have raised concerns about the very issues that now need legislative surgery.

Ryan Alessi of cn|2's "Pure Politics" reports that Rep. Mike Harmon of Boyle County and Rep. David Floyd of Bardstown are being targeted for not supporting the expansion of the use of the prescription monitoring system, KASPER, and requiring pain clinics to be run by physicians. Rep. Kim King of Harrodsburg has also been targeted; there may be othesr. Here is the ad:

Republican Floor Jeff Hoover of Jamestown, a supporter of HB 1, told Alessi that that need for changes in the bill now "vindicates lawmakers like Floyd and Harmon, who raised questions about whether the law would be overly restrictive for law abiding Kentuckians." (Read more, see more videos)

Friday, October 26, 2012

Health care is strong second to economy among concerns of Ky. registered voters; candidates compared on handling of issues

Health care ranks high among the concerns of Kentucky voters, according to the latest Kentucky Health Issues Poll taken for the Foundation for a Healthy Kentucky.

The poll, taken Sept. 20 through Oct. 14, asked registered voters to name the two most important issues in the Nov. 6 presidential election. The economy was mentioned by 65 percent; health care was second, with 42 percent. Foreign policy was a distant third, at 21 percent. The error margin on the sample of 1,160 voters is plus or minus 2.88 percentage points.

The poll did not ask voters whom they favored for president, but did ask which candidate they trusted to do a better job on certain issues. Romney, who is considered certain to win Kentucky, had a clear advantage on two issue areas, listed first:
• Dealing with the federal budget deficit: Romney 49%; Obama 36%
• Dealing with the economy and jobs: Romney 48%; Obama 36%
• Dealing with the future of the health reform law: Romney 45%; Obama 40%
• Addressing terrorism: Romney 43%; Obama 42%
• Dealing with the situation in Afghanistan: Romney 42%; Obama 40%
• Improving education: Obama 45%; Romney 40%
• Looking out for the best interests of women: Obama 42%; Romney 40%
• Making decisions about women's reproductive health choices and services: Obama 41%; Romney 38%

"This poll gives us a reliable snapshot of the issues most important to Kentucky voters as they decide who they will vote for on Nov. 6," said Dr. Susan Zepeda, president/CEO of the foundation. "Regardless of the outcomes of the election, our foundation believes it is essential for our elected officials to know what Kentuckians think about these issues." To download the full report by the Institute for Policy Research at the University of Cincinnati, click here.

Statewide trauma system established; called 'most significant advancement in health of Kentuckians for the last 20 years'

Dr. Andrew Bernard, chair,
State Trauma Advisory Committee
Ten Kentucky hospitals have been recognized as part of the state's first official statewide trauma system. The announcement came during the 2012 Statewide Trauma and Emergency Medicine Symposium Friday in Lexington. Dr. Andrew Bernard, a University of Kentucky trauma surgeon and chair of the State Trauma Advisory Committee, called this "the most significant advancement in the health of Kentuckians in the last 20 years and lives will be saved because of it."

More than half of the states have such systems.  "The goal of the state trauma system is getting the right patient to the right place at the right time," said Bernard, explaining that the system provides education so that proper assessment can be made of severely injured patients, so that they are taken to the most appropriate facility as quickly as possible.

Trauma centers are graded I through IV, with Level I hospitals able to treat the most severely injured and most at risk.  Level I trauma centers are UK Chandler Hospital (Lexington), Kentucky Children's Hospital (Lexington), Kosair Children's Hospital (Louisville), and University of Louisville Hospital.  Level III  are Ephraim McDowell Regional Medical Center (Danville) and Taylor Regional Medical Center (Campbellsville). Level IV are Ephraim McDowell Fort Logan Hospital (Stanford), James B. Haggin Memorial Hospital (Harrodsburg), Livingston Hospital (Salem) and Marcum & Wallace Hospital (Irvine).

More child-welfare indicators added to Kids Count data site

Kentucky Youth Advocates has added four new child welfare indicators to the agency's Kids Count Data Center. These four new indicators provide Kentuckians and those who report on them with more information on vulnerable children and families in the state.

One new indicator shows the prevalence of certain risk factors -- substance abuse, mental health issues, and income -- in cases where child abuse or neglect was found to have occurred after an investigation was done. Another new indicator include the numbers of children community members bring to the attention of the state Department for Community Based Services due to suspicions of child abuse or neglect. (Read more)

Kids Count provides information across states and for Kentucky counties and school districts on many measures of child well-being, including economic well-being, education, health, and safety. To find the data center, go here.

Rural states with declining immunization rates have increasing incidence of whooping cough

In the state that once had the highest immunization rate, Vermont's medical community is not so proud of anymore. Fewer people are vaccinating their children in the nation’s most rural state, reports Dr. Wendy Mahoney, a private practioner in the state. But Vermont isn't alone. Stories about declining immunization have come in from across rural America, Mahoney writes in the Daily Yonder, and they "come in the midst of a pertussis outbreak the likes of which Vermont has not seen in years, if ever." Pertussis is whooping cough.

Mahoney says she can find one reason for the recent outbreak: a new law in her state, like some in other rural states, that allows parents to exempt their children from required vaccinations "because of a personal, moral, or other belief." Mahoney says many rural residents use the exemption, which she finds hard to fathom in the face of scientific advances that prove that vaccination has ended smallpox, wiped out polio in most of the world, and controlled measles, rubella, tetanus, diphtheria, influenza type b and other infectious diseases.

The top map shows the estimated percentage of children enrolled in kindergarten who have been exempted from receiving one or more vaccines in the 2011–12 school year. Comparison with the other map shows that states with large numbers of exemptions are those where whooping cough is making a comeback. (Centers for Disease Control maps)

A comparison between states with low vaccination coverage rates and those reporting higher numbers of whooping cough cases shows some, though not consistent, overlap. (Read more)

Thursday, October 25, 2012

Association of Health Care Journalists' reporting fellowship application deadline is Nov. 9

The Association of Health Care Journalists is offering fellowships for reporting on health care performance to journalists who wish to pursue a significant year-long reporting project related to the U.S. health care system. It can be local or national in scope -- or a little of both, according to materials included with the announcement, which suggests a topic could be "an aspect of the Patient Protection and Affordable Care Act playing out in your community or subject specialty, or the impact of particular evidence-based treatments on health outcomes, or an analysis of a health care organization’s performance, using public data sets."

Newsrooms for which the fellows work need to commit to publish or air their work. Freelancers will also need to have that commitment from a news source. Guidance is provided by AHCJ fellowship leaders through seminars on health care systems, conference calls and email consultations. The fellowship covers the cost of attending the seminars and conferences, and a project allowance is available. Application deadline: Nov. 9, 2012. (Read more)

Here are some examples of the work done by those awarded fellowships in 2012:

CaldWELL County group campaigns for smoking ban

A committee dedicated to the wellness of Caldwell County, which makes the most of the county's name, is pushing for a smoking ban. The CaldWELL Committee's internal acronym stands for Wellness Education through Local Leadership, and members did some of that Tuesday when the group asked the county Fiscal Court for an ordinance banning cigarette smoking indoors in public buildings. The group was joined by representatives from the local health department, housing authority, Extension office, law enforcement, education, emergency services, mental health, senior services and other public and private agencies, reports Jared Nelson of The Times Leader.

The committee has been collecting survey data from residents about their health perceptions and needs. Their request to the fiscal court is a direct result of that data, said Allison Beshear, health educator and public information officer with the Pennyrile District Health Department. In Caldwell County, about 27 percent of adults are identified as smokers. That number is down from 34 percent reported in the results of a 2008-10 survey. The Times-Leader is behind a paywall. To credit an account, go here.

Wednesday, October 24, 2012

Infections, other safety issues plague hospitals, maybe more so when nursing is cut; here's a good series on it

The Centers for Disease Control has reported that nearly 1 million patient-safety incidents, including infections that patients acquired in hospitals, occurred among Medicare patients over the years 2006, 2007, 2008. In all, the incidents -- which represented 2.3 percent of Medicare admissions -- were associated with $8.9 billion in costs. One of every 10 patients involved died as a result, the "HealthGrades Patient Safety in American Hospitals" study reported.

Financially squeezed hospitals should be careful about reducing nursing staff, because the fewer such staff they have, the more likely they are to have a patient-safety incident, says Kevin Kavanagh, a Somerset doctor and board chairman of Health Watch USA, in "Moving Healthcare Quality Forward with Nursing-Sensitive Value-Based Purchasing," an article in the Journal of Nursing Scholarship. Kavanagh explains that research has shown that adverse events in hospitals and any subsequent mortality "are highly dependent on nurse staffing levels and skill mix." He cites studies in which nurse staffing levels were a clear indicator of whether or not patient-safety accidents or "sentinel" events occurred. (Examples of "sentinel" events include falls, pressure ulcers, urinary tract infections, postoperative infections, pneumonia, upper gastrointestinal bleeding, shock and cardiac arrest.)

Kavanagh's article notes that nursing is at serious risk from being cut in cost-driven healthcare delivery systems. He is quick to point out the dangers and financial costs of making that cut. (To read the study, go here.)

So, how to report on this issue? In 2011, The Las Vegas Sun revealed that during the second half of 2009 area hospitals had reported 44 preventable hospital injuries or hospital-acquired infections when, in fact, those facilities had experienced 342 such events. That revelation led the paper's staff to take on the issue of hospital accountability in an award-winning five-part series, "Do No Harm: Hospital Care in Las Vegas." When all was said and done, the newspaper not only unearthed repeated incidences where the hospitals' own records did not reconcile with what they reported to the state, but showed lawmakers and health-care professionals how to properly disclose the incidence of patient infection and accidents. Their work eventually forced Nevada lawmakers to pass legislation that requires hospital records in two of the state's largest counties to be transparent, consumer-friendly and readily available on the state's Health and Human Services Department website. (To read their remarkable work, go here.)

Health Watch USA will host its annual conference in Lexington on Nov. 9 at The Four Points Sheraton, 1938 Stanton Way. Cost is $35 including lunch. Over 6 hours of continuing education credits have been approved for doctors, nurses, physical therapists, occupational therapists and human resource managers  For more information or registration, go to www.healthconference.org.

Medicaid managed-care firm files suit, alleging the state's rush job resulted in unreliable financial information for bidders

Medicaid managed-care company Kentucky Spirit alleges in a lawsuit filed Monday that Gov. Steve Beshear so hurriedly privatized the service last year that he gave incorrect cost information to the bidders. The company said it relied on the bad information and thus has lost $120 million since its work began a year ago.

John Cheves of the Lexington Herald-Leader reports that Kentucky Spirit had hoped that it could let its contract terminate a year earlier than scheduled without paying the damages that Health and Family Services Secretary Audrey Haynes has now said the state will pursue. Cheves writes that Kentucky Spirit says they relied on a "data book" -- what managed-care companies used to estimate costs in their bids -- prepared by the accounting firm PricewaterhouseCoopers. (Read more)

Monday, October 22, 2012

Wellness programs looking good as business investments

Businesses should like these numbers a lot: Invest $1, get $3 back. That's the latest math on the return on employee wellness programs and experts are saying that may just be the start for the financial returns they can expect from targeted prevention efforts. Mark Green of The Lane Report writes that no less of an expert than Dr. William Frist of Nashville -- doctor, policy specialist, former U.S. Senate majority leader and venture capitalist -- has said: “No question in my mind, if we are to invest a dollar to have the greatest value in terms of outcome and results, we should put that dollar in prevention and wellness."

Frist, reports Green, "is a strong advocate of wellness -- as a business practice to adopt and a business sector to be in. Individual doctors, hospitals and the entire healthcare industry need to get involved, he said." Frist broke down for Green what factors most determine how long someone lives: “The numbers break down 30 percent genetic, 5 percent environmental, 15 percent socioeconomic, which is surprising to a lot of people, and then 40 percent behavioral: wellness, prevention. And then what is left (10 percent) is who your doctor is, what hospital you go to, what your emergency room is.” Those numbers  are important to Frist because to impact longevity healthcare spending over time, he said, resources should be on the 40-percent sector: behavior, wellness and prevention. Think smoking programs, weight loss, exercise, nutrition, seatbelt use. (Read more)

Opportunity for news stories: New federal rules mean all nonprofit hospitals must do a community health needs assessment

It's long been the rule that nonprofit hospitals have had to provide charitable benefits to their community in order to keep their nonprofit status. That's no small matter, given that 60 percent of the nation's almost 3,000 hospitals are nonprofits and those tax benefits equal $12.6 billion annually. The benefits those hospitals provide have usually come in form of care for those unable to afford it, but it's unclear how, and how much, hospitals spend on community benefits has led to increased oversight by the Internal Revenue Service and Congress.

This year, there's a new kink for nonprofit hospitals and one that is important to every community those hospitals serve -- and a golden opportunity for every news outlet that reports on them. The Patient Protection and Affordable Care Act requires each nonprofit hospital to conduct a community health needs assessment, which must include a wide variety of community stakeholder input, prioritize needs, and eventually, when completed, be made widely available to the public. As explained by the Robert Wood Johnson Foundation, the assessment does more. It "offers an opportunity for the entire community to work together to collectively improve health." Participants can include health systems, health departments and other government agencies, community organizations, employers, the faith community, the United Way and other non-profits, local funding organizations, academic institutions, and other community leaders.

To read the issue brief and find more resources about the benefit and programs associated with it, go here.

Breast cancer awareness: Testing urged, guidelines explained, misconceptions explored

Women with BRCA1 and BRCA2, the
genes most commonly involved in breast
cancer, have up to an 80 percent chance
of getting the disease.
October is Breast Cancer Awareness Month. Although Kentucky's breast cancer rate is slightly lower than the nationwide rate, almost 600 women die every year from breast cancer in the Commonwealth. The American Cancer Society predicts approximately 3,160 new cases of breast cancer will be diagnosed in Kentucky this year. Early detection and prompt treatment can significantly reduce suffering and death from the disease.

According to the Cabinet for Health and Family Services, all health plans serving Kentuckians must, by law, cover mammograms. Medical guidelines strongly recommend that women older than 40 have annual mammograms and women younger than 40 with a family history of breast cancer should also have regular screenings. Through local health departments, the Kentucky Women's Cancer Screening Program provides breast cancer screenings, mammograms and Pap tests to eligible women in every county. During the 2011 fiscal year, KWCSP provided breast cancer screenings to 14,212 women. Services are provided to low-income women through the Kentucky Department for Public Health. Those women must be uninsured with incomes less than 250 percent of federal poverty guidelines.  For more information about breast cancer or screening services, call your local health department.

There are many misconceptions about the risks of developing breast cancer. Genetics, of course, is a well-documented factor but lifestyle issues have gotten a lot of talk. So what's true? Wendy Chen, MD, MPH, a breast cancer expert at Dana-Farber Cancer Institute in Boston, a principal teaching affiliate of Harvard University, tackles some of the more common questions here:

1) Soy may increase the risk of breast cancer returning.
False. Chen, who was part of a study that looked at over 9,500 American and Chinese breast cancer survivors who ate soy every day, says that eating soy may be linked to a lower risk of recurrence of breast cancer.

2) Alcohol consumption can increase the risk of breast cancer.
True. Dana-Farber researchers found that women who consume one alcoholic drink a day may increase their risk for breast cancer.  Chen and her colleagues analyzed data from over 105,000 women in the Nurses’ Health Study. Those who consumed three to six glasses of wine a week were 15 percent more likely to receive a diagnosis of breast cancer. Those who drank fewer than three drinks a week had no increased risk.

3) Fertility treatments increase a woman’s risk of breast cancer.
False. According to a recent study from the National Institutes of Health, ovulation-inducing fertility treatments like Clomid and follicle stimulating hormone (FSH) do not significantly increase a woman's risk of developing breast cancer.

4) Wearing deodorant can increase the risk of breast cancer.
False. According to the National Cancer Institute, there is no conclusive research linking underarm deodorants to breast cancer.

5) The bigger the baby the bigger the risk of getting breast cancer.
Possibly true. “This is a tough one because the research is still evolving,” says Chen. "But the latest research shows that women who have larger babies have more than twice the risk of developing breast cancer than mothers who give birth to smaller infants. Researchers say that having a heavier baby may create a hormonal environment in pregnancy that could lead to the future development of breast cancer. They found that during pregnancy in women who have heavier babies, the ratio of estrogen to anti-estrogen is unusually high. The greater the level of estrogen, the higher the risk of breast cancer. However, Chen emphasizes, women who have larger babies should not panic. There is definitely a need for further research.” (Read more)

Northern Kentucky group forms in response to what some consider 'epidemic' of heroin use in their area

Ashel Kruetzkamp with a vial of Naloxone
HCl, used to treat those who overdose
on heroin. (Photo by Patrick Reddy)
Heroin use is reaching such high levels in Northern Kentucky that experts are calling it "a plague." The problem is so dire that local agencies are coming together to form the Northern Kentucky Heroin Impact and Response Workgroup.

Cincinnati Enquirer reporter Terry DeMio reports that the group includes leaders from St. Elizabeth Healthcare, law enforcement, addiction treatment programs, the Northern Kentucky Chamber of Commerce and those who have been impacted by heroin. The goal of the group is “to fight, treat and prevent the destructive force of heroin in our community,” said Dr. Jeremy Engel, a family doctor with St. Elizabeth Physicians, Bellevue. Engel spearheaded the effort based on his belief that heroin use in the area has hit “epidemic” levels.

Engel points to first nine months of 2012 when St. Elizabeth Healthcare treated 311 heroin overdose patients in the emergency rooms of its five hospitals. For the same time period in 2011, the heroin overdoses presented in those emergency rooms numbered 186. With help from the chamber, St. Elizabeth Healthcare and others, Engel is forming the task force under the NKY Vision 2015 umbrella. (Read more)

One of Humana's plans to get 5% more in Medicare payouts under bonus plan that rewards proof of preventive care

The Courier-Journal reports that Louisville-based Humana Inc. will get 5 percent more in Medicare payments and the highest rating for one of its health plans under a government program that is likely improving care for the elderly, according to an analysis. The program provides bonus payments to insurers that limit "how many members are readmitted to the hospital after a discharge, increasing the amount of preventive care and getting acceptable ratings on patient satisfaction surveys, among other criteria," according to the report. Separate analyses by the consulting firm Avalere Health LLC and the nonprofit Commonwealth Fund conclude that the bonus system, created by the 2010 Patient Protection and Affordable Care Act, is working. It has since been modified by the Obama administration to allow for bigger payments to more plans.

Friday, October 19, 2012

Obamacare is unpopular in nine swing states, but not when the law is described without that label

Party labels affect what rural voters think about the Patient Protection and Affordable Care Act, according to the latest National Rural Assembly and Center for Rural Strategies poll of rural voters in nine swing states in the presidential election, reports Bill Bishop of the Daily Yonder, which the center publishes.

When asked if they approved or disapproved of the "Affordable Care Act, sometimes called Obamacare," 60 percent of rural voters said they opposed the law, and 34 percent said they favored it. Without reference to "Obamacare," voters were asked if they approved or disapproved of the law, which "would give states the opportunity to extend Medicaid coverage to cover more low income families with health insurance, with the federal government picking up 90 percent of the costs," and 45 percent said they approved, while 42 percent disapproved.

Bishop concludes that partisanship is the culprit for such results. "Partisanship overwhelms issues in today's politics," he writes. "Voters are willing to change their beliefs -- even their religious affiliation ... in order to stay with their political tribe." (Read more)

Thursday, October 18, 2012

UK study definitively shows that meth labs proliferate in state's counties where pseudoephedrine sales are high

A University of Kentucky research study published in the Journal of the American Medical Association this week shows a direct correlation between pseudoephedrine sales and methamphetamine production in Kentucky counties. Pdeudoephedrine, the main ingredient in Sudafed and similar decongestants, is the key feedstock for meth labs. The General Assembly further limited its sale this year.

“We find that counties where more pseudoephedrine is sold, more methamphetamine lab seizures are reported. Even though Kentucky requires pseudoephedrine sales to be tracked electronically, in real-time, the per-capita sales in some counties appear to be aberrant. Our results indicate a 565-fold variation in pseudoephedrine sales between counties. It is highly improbable that demand for pseudoephedrine in these counties is solely due to cough/cold/allergy,” explained Jeffrey Talbert, director of the College of  Pharmacy's Institute for Pharmaceutical Outcomes and Policy.

The other authors of the study are College of Pharmacy faculty members Karen Blumenschein and Trish Freeman, staff member Amy Burke, and Arnold Stromberg of UK’s Department of Statistics. For a copy of their report, click here.

13-year-old with national following succumbs to rare cancer

A 13-year-old McLean County boy whose fight with a rare cancer gained national attention died last night. The death of Lane Goodwin was announced to 342,000 followers on his "Prayers for Lane" Facebook page, report Rich Suwanski and Megan Harris of the Messenger-Inquirer in Owensboro.

"In 2010, Lane was diagnosed with alveolar rhabdomyosarcoma Stage IV, a rare and aggressive childhood cancer that is only diagnosed in one out of 1 million children," the reporters write. "In 2010, he underwent 54 weeks of chemotherapy and radiation treatment. In 2011, 13 tumors were found in his bones. . . . The family regularly updated followers on Facebook with his condition. Almost half a million people worldwide 'liked,' posted words of encouragement or started fundraisers to help the family with medical expenses. Followers included celebrities, college and professional athletes and social media friends who were inspired by his fight against the deadly disease."

His mother, Angela Goodwin, told the newspaper last month, “We never expected this. We knew there was some good support and prayers for Lane the last couple of years, but this has been unbelievable.” (Read more)

Doctor's rejection of the willfully obese makes exercise expert ask: Who's responsible for your health? Who should pay for it?

Bryant Stamford, professor and chairman of the Department of Kinesiology and Integrative Physiology at Hanover College in Indiana, wrote in his weekly exercise-and-health column Thursday's edition of The Courier-Journal:

"I caught an interesting news story on TV about a physician who refuses to treat obese patients. That was the headline. In truth, when she was interviewed she made it clear that she had a number of obese patients and she was treating them," if they were willing to lose weight. She referred the other obese patients to physicians who specialized in care of the overweight.

Stamford asked: "Is this approach the rationing of health care? It’s rationing it to those who take responsibility for themselves by managing their weight. . . . I don’t support withholding health care to anyone, and that includes the obese and smokers. But it does raise the issue of who is responsible for your health. We spend far more on health care than other industrialized countries, and we are bankrupting our health-care systems, including Medicare and Medicaid. Why? We follow a health-destroying lifestyle, then we expect to jump into the health-care system and have it perform miracles. And, more often than not, it does, but it costs a fortune for each patient. Does this make any sense?"

He points to ways in which some countries have decided in what order people get heart surgeries -- those who smoke are not first in line. What it could mean in the future for us?  "I believe the writing is on the wall. ... If you engage in health-destroying behaviors, you will be required to pay a lot more for health insurance. It’s the model for life insurance, and there already are rumblings around the country supporting a move in this direction. Stay tuned." Read the column here.

Board of Medical Licensure to amend pill-mill regulations to address concerns of doctors and some patients

The Kentucky Board of Medical Licensure wants to change some of the more controversial requirements for urine screenings and digital monitoring in the state’s new prescription-drug regulations under the law aimed at fighting doctor shopping and "pill mills" that dispense painkillers indiscriminately.

Mike Wynn of The Courier-Journal reports that Dr. Preston Nunnelley, the board’s president, told state lawmakers Wednesday that the board plans to submit amendments to the regulations by Nov. 1 to address the concerns of doctors that the new law is proving too burdensome, and because patients are being charged for urine tests that insurance companies are refusing to cover. Nunnelley said the amendments would provide more flexibility on when patients must receive those screenings. He said "chronic pain patients would not face regular screenings unless they are considered high risk for abuse or diversion," Wynn reports. "The amendments are also likely to exempt certain patients, such as children, from checks through the Kentucky All Schedule Prescription Electronic Reporting system, or KASPER, he said."

Nunnelley called the changes “tune-ups." “This is a new experience for the board of licensure,” he testified. “This is the first time we’ve done anything on this scale and obviously we didn’t do it perfect.” Or perfectly. (Read more)

Georgia doctor prescribes pills to help in school -- whether or not the ADHD shoe fits -- to level the playing field for the poor

Amanda Rocafort and her son, Quintn,
who takes Adderall for his ADHD.
(NYT photo by Bryan Meltz)
In light of last week's news that the number of poor children on Medicaid in Kentucky are being prescribed anti-psychotic drugs at alarming rates for such diagnoses as attention-deficit and hyperactivity disorder and depression, the New York Times reports that some doctors are making "no excuses" for prescribing psychostimulants in other locales for children of the poor.  Dr. Michael Anderson, a pediatrician in a poor county north of Atlanta, Ga., said he thinks ADHD is "made up" and "an excuse" to prescribe pills to treat what he "considers the children’s true ill -- poor academic performance in inadequate schools." Still, "I don’t have a whole lot of choice,' said Anderson. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.'"

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining some ground: Prescribe drugs to struggling students in schools not to treat ADHD, necessarily, but to boost their focus and impulse control.  Alan Schwarz reports that Anderson figures that he is arming them with the only tool he has because these children can't afford family therapy or tutoring or behavior-based counseling or any of those other tools that other children might have at their disposal to help them learn.

Of course, Anderson is not without his critics. Many doctors, writes Schwarz, warn of the dangers of exposing children to the unwarranted physical and psychological risks of powerful drugs on everything from mood to blood pressure to the suppression of growth. (Read more)

Kentucky Spirit to terminate Medicaid contract with state early; Cabinet assures recipients no interruption in service

Kentucky Spirit, a Medicaid managed-care provider, will terminate its contract with the state's Cabinet for Health and Family Services a year earlier than scheduled, effective July 5, 2013. The company serves approximately 140,000 Medicaid recipients in 104 Kentucky counties. According to the CFHS, Kentuckians enrolled in Kentucky Spirit coverage "will continue to receive health care with no interruptions, and the Cabinet will ensure a smooth transition for those patients to another managed care organization in the coming months."

Kentucky Spirit said in a statement Wednesday that it is committed to helping its clients it serves transfer to one of Kentucky's three other Medicaid contractors. In addition, the move will cut some 200 jobs in Lexington, representing $12 million a year in wages and benefits.

The Courier-Journal's Tom Loftus writes that Kentucky Spirit has been in months of discussions with the Cabinet for Health and Family Services about its contract. The company also said it has filed a formal dispute with the cabinet for damages it has incurred throughout the process. Gov. Steve Beshear issued his own statement informing the company that the state "will hold this company accountable to its contractual commitments through whatever means necessary on behalf of both the members and the taxpayers.”

Overall, Kentucky’s transition to Medicaid managed care has not been smooth, explains the Lexington Herald-Leader's Beth Musgrave. Many doctors, hospitals and other providers have complained about late payments and cumbersome reimbursement processes; some of which have had to be resolved in court.

To see the Kentucky Spirit statement, go here.

Governor lauds HB 1 for closing 10 of the state's worst pain clinics, reducing the number of controlled-substance prescriptions

Gov. Steve Beshear gave credit this week to House Bill 1 for reducing the number of prescriptions written for frequently abused controlled substances and for closing the doors on 10 of the state's worst pain-management clinics. He also said the bill had promoted investigations into what he called "suspicious prescribing practices." Beshear, in a prepared statement, said: "We knew that this bill would have an immediate impact on thwarting the abuse and diversion of prescription drugs in our state, and the statistics over the last few months are already showing progress."

The governor also noted that Kentucky All Schedule Prescription Electronic Reporting (KASPER) accounts have increased from 7,911 in April to 21,542 in October. Account users are physicians, dentists, optometrists, advances practice nurses and podiatrists who then use those accounts to check on the drug records of patients daily. Beshear, responding to frequent criticism that the reporting of KASPER results is time-consuming, remarked that "the vast majority of those requests are processed in less than 15 seconds."
John Cheves of the Lexington Herald-Leader also reported that state regulators said this week that "they're working with private insurance companies and Medicaid managers to make sure health insurance plans help cover the cost of urine tests required under HB 1." Cheves had written earlier about consumer complaints that the costs of those tests, now required by the bill, were being borne by the patient. The
Kentucky Department of Insurance is communicating with insurers to guarantee that urine tests under HB 1 are classified as a medically necessary expense, Insurance Commissioner Sharon Clark told Cheves. The Kentucky Cabinet for Health and Family Services is doing the same for Medicaid clients.
(Read more)

Wednesday, October 17, 2012

Cigarette companies balking at Justice Dept's request for "confessional" advertising that they say goes too far

Calling them "forced public confessions," America's largest tobacco companies are asking a federal judge to reject the government's proposed corrective statements for cigarette advertising. Fred Frommer reports for the Associated Press that the Justice Department has responded by saying that such statements need to be strong enough to protect people from future false declarations made by cigarette makers. The statements that the tobacco industry views as "going too far" include admissions that the companies lied about the dangers of smoking, the addictiveness of nicotine, the lack of health benefits for "low-tar" and "light" cigarettes and the negative effect of second-hand smoke. U.S. District Judge Gladys Kessler, who is hearing the case, has already said "she wants the industry to pay for corrective statements in various types of ads," writes Frommer. (Associated Press photo)

Judge Kessler ruled in 2006 that America's largest cigarette makers had systematically concealed the dangers of smoking for decades and that, as assurance that the crime was not repeated, such statements as a requirement in tobacco advertising would be appropriate. An example of an advertising statement under consideration, as suggested by the Justice Dept.: "For decades, we denied that we controlled the level of nicotine delivered in cigarettes. Here's the truth: Cigarettes are a finely tuned nicotine delivery device designed to addict people." At Monday’s hearing, Kessler said she doesn’t have to take the government’s proposed statements word-for-word, and will come up with “modifications.” (Read more)

Open enrollment period for 2012 Medicare Part D continues now through Dec. 7

The open enrollment period for 2012 Medicare Part D began this week and will continue through Dec. 7. The open period is a time for seniors and persons with disabilities to take advantage of prescription drug benefits or, if they've been previously enrolled in the program, to modify their existing plans. The Part D program, now in its sixth year, was set up to assure those 65 and older, or those with disabilities, easy access to their medications.

According to the Medicare Rx Access Network of Kentucky, nearly 11 million Americans over 65 gained comprehensive prescription drug coverage as a result of Medicare Part D's implementation including 63 percent of Kentucky’s seniors. Currently, more than 40 million people with Medicare -- 90 percent of all beneficiaries and 89 percent of Kentucky seniors – now have comprehensive prescription drug coverage.

For additional information on the Medicare Part D program, or to view and compare Medicare plans, go here.

Monday, October 15, 2012

Calorie counts on your Coke and Pepsi machines coming in 2013

Coca-Cola, PepsiCo and the Dr Pepper Snapple Group, for starters, will start displaying calorie counts on vending machines in an effort to encourage consumers to make lower-calorie choices, starting in 2013. The plan, explains Time magazine, falls in line with the Patient Protection and Affordable Care Act’s requirement that vending machines and restaurant chains with more than 20 locations display calorie information. The labels will be marked "Check Then Choose" or "Try A Low-Calorie Beverage." The industry initiative, called the Calories Count Vending program, will begin its launch in city buildings in Chicago and San Antonio, where government employees are participating in a “wellness challenge.” The nationwide rollout will begin next year.

Time reporter Olivia B. Waxman asked whether this move will make a difference in calorie consumption. Early research didn't hold much hold, but later studies were more promising, she reports: "Studies have found that calorie information, when presented clearly — and at the point of sale — does tend to sway people’s eating and drinking behaviors. In a December study published in the American Journal of Public Health, for example, researchers at Johns Hopkins went to corner stores in predominantly black neighborhoods and posted signs with calorie information about sugary drinks (sodas, fruit drinks, energy drinks and the like) on refrigerated beverage cases. Overall, the study found, black teens — a population that is more likely to consume sugary drinks and is at higher risk of obesity than other groups — were 40 percent less likely to buy soft drinks when they saw the calorie signs. They were even less likely to buy them when the calorie labels put information in context: for instance, by noting that it would take 50 minutes of running to burn off the calories in one sugary drink. Those signs reduced soda consumption by 50 percent." (Read more)

Kaiser study estimates how changing Medicare to a premium-support plan like Ryan's would cost differently by state and region

A Kaiser Family Foundation study has looked into what Medicare beneficiaries might pay under a "premium support" system that relies on competitive bidding, like the one proposed by House Budget Committee Chairman and Republican vice-presidential candidate Paul Ryan. Presidential nominee Mitt Romney has also supported a premium-support system, which allows beneficiaries to choose among competing plans.

Under such plans, if subscribers choose to enroll in a more costly plan, for whatever reason, they would pay the additional premiums. This differs from the current Medicare system, explains Kaiser, "in which beneficiaries generally pay the same Medicare premium regardless of where they live, whether they choose traditional Medicare or a private plan, or whether they live in a high-cost or low-cost area." Assuming full implementation of such a premium support system, and assuming current plan preferences among beneficiaries, the Kaiser study "estimates that:
  • Nearly six in 10 Medicare beneficiaries nationally could face higher premiums, assuming current plan preferences, including more than half of the beneficiaries enrolled in traditional Medicare and almost nine in 10 Medicare Advantage. Even if as many as a fourth of all beneficiaries moved into a low-cost plan offered in their area, more than a third of all beneficiaries would still face higher premiums.
  • Premiums for traditional Medicare would vary widely based on geography, with no increase for beneficiaries living in Alaska, Delaware, Hawaii, Wyoming, or Washington, D.C., but an average increase of at least $100 per month in California, Florida, Michigan, Nevada, New Jersey and New York. Such variations would exist even within a state, with traditional Medicare premiums remaining unchanged in California's San Francisco and Sacramento counties and rising by more than $200 per month in Los Angeles and Orange counties.
  • At least nine in 10 Medicare beneficiaries in Connecticut, Florida, Massachusetts and New Jersey would face higher premiums to keep their current benefits.
"This analysis does not attempt to model all aspects of any specific premium-support proposal, which would require more details than are currently available and assumptions about shifts in demographics, spending, and enrollment," Kaiser says. "The analysis also differs from Chairman Ryan's most recent proposal by assuming full implementation in 2010 (rather than a phased-in implementation starting in 2023) and by not exempting everyone who is at least 55 years old now." (Read more) To read the full report, go here.

Health reform expected to hurt recruitment of rural doctors

Recruiting doctors to rural hospitals will get harder in the next few years as the Patient Protection and Affordable Care Act reaches full implementation and the demand for healthcare services increases, a new report suggests. An Association of Staff Physician Recruiters report, "In-House Physician Recruitment Benchmarking," says interview-to-hire ratios in rural areas are much higher than in urban, and rural recruiting officers are often responsible for several things, not just hiring new doctors, making them overworked. Both factors make it harder for rural hospitals to recruit, the authors concluded.

ASPR Benchmarking Committee Chair Shelly Tudor told John Commins of HealthLeaders Media that the cost of recruitment is rising, making it hard for rural hospitals to compete with their urban counterparts. "In lots of respects, the process favors urban providers. Physicians are coming to urban areas and they are looking for jobs, whereas rural providers have to go out and target physicians that are likely to come to their area," Tudor said. Rural recruiters have to "filter through a lot of people to find the right one who is willing to come in and even look at the opportunity," she said. (Read more)

Studies show that preteen girls who get the HPV vaccination are not more inclined toward promiscuity than those who don't

An electron micrograph of the
human papilloma virus.
(National Cancer Institute photo)


The most recent study of preteen girls who received the vaccine for the human papilloma virus (HPV) found that they were no more likely than unvaccinated girls to get pregnant, develop sexually transmitted infections or seek birth-control counseling. The findings in Monday's issue of Pediatrics are in line with recent studies on British teens, which also dismissed concerns that getting the vaccination might encourage promiscuity.  USA Today reporter Michael Healy writes that while the latest results were based on parental or self-reporting, the reports were corroborated by medical tests, clinical markers of sexual activity and other behavior markers.

Robert Bednarczyk, a clinical investigator with the Kaiser Permanente Center for Health Research-Southeast and an epidemiologist at Emory University in Atlanta., queried 1,398 girls, aged 11 and 12, and analyzed their medical records. He and colleagues divided the girls into two groups and followed them for three years. "One group of 493 girls received at least one dose of the HPV vaccine Gardasil, along with other recommended vaccines for tetanus and meningitis. A comparison group of 905 girls received the tetanus and meningitis vaccines, but not HPV," Healy writes. "There was a very similar rate of testing, diagnosis and counseling between both groups," with no increase in pregnancies, STIs or birth-control counseling, Bednarczyk reported. Fewer than 1 percent of all girls tested positively for a sexually transmitted infection, and fewer than 1 percent had a positive pregnancy test.  (Read more)

Home-health agency for Madison, Estill and Powell counties says it has to cut staff because of issues with Medicaid and Medicare

Declining reimbursements from Medicaid and Medicare are behind the Madison County Health Department's layoff of seven home-health employees last week. Director Nancy Crew said the cuts should not mean a reduction in care but that cuts were being made because "we've done all we can do without involuntary layoffs," Bill Robinson of the Richmond Register reports. The department's MEPCO subsidiary, which has offered home-health services in Madison, Estill and Powell counties since 1974, has been under financial pressure for two years despite cutting costs and not filling eight now-vacant positions. It had a deficit last year of $610,000.

Only about 15 percent of MEPCO's revenue comes from private insurance, said David Reed, the health department's financial director. That leaves MEPCO with a disproportionate number of Medicaid patients at a time when those re-reimbursements often are denied by managed-care companies, Reed said. Challenging those denials is a complicated process, sometimes requiring going to court to recover costs. The problem is not all with Medicaid. MEPCO’s Medicare reimbursements began a steep decline from nearly $3.24 million in 2008 to $2.55 million in 2012.  (Read more)

Friday, October 12, 2012

270 U of L freshmen have to vacate dorm because of mold

The University of Louisville has told 270 freshmen they have to move out in the middle of midterm exams after high levels of mold were found in their residence hall. The students were told remove everything they brought with them to Miller Hall. The dorm will be closed the rest of the semester. Those displaced are being moved to other dorms, university-affiliated housing and hotel rooms near campus.

U of L inspections found high levels of two types of mold spores, aspergillus and penicillium, that don’t normally present a threat but could affect people with allergies, asthma and upper respiratory problems if exposed to high levels in closed spaces, said Dr. Phillip Bressoud, director of student health. More residence halls could also have a mold problem, and the university is still awaiting the results from tests. Staten said. (Read more)

Univ. of Pikeville students hear of horrors of texting while driving, actively sign pledge to stop the practice

Alyson Gibson, a student at the
University of Pikeville, signs the 'No
Text on Board' pledge.
Maybe it was a surprise to some in the crowd but texting and driving has been illegal in Kentucky since April 15, 2010. Still, the folks at the University of Pikeville thought it was a message that bore repeating. On Thursday, they did so.  In recognition of the national “No Text on Board” effort, UPike professors, state legislators and AT&T representatives asked students to pledge to just not do it. The pledge was intended to be a lifetime choice. The only exception to the law is if drivers need to report illegal activity or need to summons medical or emergency aid. Fines for texting while driving in the state can be up to $50, plus court costs.

Students could watch a video of the aftermath of accidents where drivers had been preoccupied with texting. According to the AT&T rep on campus Thursday, someone is killed or injured in this country every five minutes in an accident where texting and driving is involved. (Read more)

Study: Stroke victims getting younger and, yes, risk factors include obesity, diabetes and high cholesterol

A study conducted on first-ever stroke patients in the Greater Cincinnati and northern Kentucky area may have some devastating repercussions for the nation. The results of the University of Cincinnati research, published this week in the online issue of Neurology, found that the average age of stroke victims has dropped and that this has great implications for lifetime disability. Study author Brett Kissela, MD, with the UC's College of Medicine explained that the rise in risk factors like diabetes, obesity and high cholesterol are the cause. Newswise reports that the study found that strokes among people under 55 made up a greater percentage of all strokes over time, growing from about 13 percent in 1993-94 to 19 percent in 2005. The study was funded by the National Institutes of Health.

"What [the study] means is that even though young people typically feel like they're healthy and that a stroke can't happen to them, the fact is that our study is evidence that that is not true," said Kissela.“The good news is that some of the possible contributing factors to these strokes can be modified with lifestyle changes, such as diet and exercise. However, given the increase in stroke among those younger than 55, younger adults should see a doctor regularly to monitor their overall health and risk for stroke and heart disease.” (Read more)

Wednesday, October 10, 2012

Testing out new school lunch guidelines yields unhappy customers, more trash and an effort to undo the mandate

The Healthy, Hunger-Free Kids Act, the Obama administration's effort to mandate more fresh fruit, vegetables and whole grains into the diets of school children, has some uphill climbing to do and it's not just the kids who are complaining. Though, admittedly, they were the first. Sarah Gonzales of Agri-Pulse took a look at some rural school districts trying to implement the law in advance of the law's implementation deadline, to see how the new science-based standards were working in real lunchrooms. What she found were complaints from student athletes who thought they needed more calories and more options, and substantial increases of good food thrown in the garbage. They also got this parody of "The Hunger Games" from some ingenious Kansas kids:

Dawn Matthews, director of food service for the rural Camdenton school district in Missouri, serves 3,200 school lunches every school day to kids in every grade level from K-12. The new standards, drawn from recommendations from an independent panel of doctors, nutritionists and other experts, require better nutrition and allow schools to serve between 550-650 calories for students in K-5, 600-700 calories of students for 6th through 8th grades, and 750-850 for high school lunches. Agri-Pulse reporters explain that a daily lunch costs $2.10, but almost 60 percent of the meals are offered for free for a reduced price in this rural district. Matthews notes that participation in the program is dropping with the new menu in place.

Even before the deadline for the act to be put into effect, Gonzales notes, Reps. Tim Huelskamp, R-Kans., and Steve King, R-Iowa, introduced the No Hungry Kids Act last month to repeal the new school guidelines. The National Association of State Departments of Agriculture also issued a recent policy statement saying the initial law was "well-intentioned, but falls short of providing a comprehensive policy for educating students in healthy living."

The results of the first few months of trial -- especially the waste -- have been "disheartening," said food director Matthews. It is also early. "I think it's going to evolve over time," said the chairman of Florida's Lake County School Board, Roseanne Brandeburg. "If you're in elementary school, and this is what you're going to be served, you're going to get used to it."

Agri-Pulse is subscription-only, but free trials are offered on its website.

Three or four more cases of fungal meningitis found in southern Pennyrile region -- two of those in Todd County

Kentucky now has five confirmed reports of fungal meningitis, and the Kentucky New Era reports that three or four have occurred in the southern Pennyrile region. The New Era's Nick Tabor writes that while no facilities in Kentucky have received the steroid responsible for the outbreak, the Centers for Disease Control confirms that the Saint Thomas Outpatient Neurosurgery Center in Nashville, Tenn., and two separate facilities in Crossville and Knoxville have distributed the steroid in injection form. All five Kentuckians who contracted the illness received medical care in Tennessee, the state reported.

The state’s Department for Public Health was notified this weekend of two cases in Todd County. One is Bill Johnson Sr., whose son ran against Rand Paul for U.S. Senate and Alison Lundergan Grimes for Kentucky Secretary of State. Carolyn Bland, director of the Trigg County Senior Center, was hospitalized Oct. 3 for meningitis, said her daughter, Beth Taylor. Eddie Lovelace, a longtime circuit judge from Clinton County, died of meningitis last month. He was being treated at St. Thomas when he died. 

As of Tuesday, health officials have reported 119 infections and 11 deaths across the nation, and six of those deaths were in Tennessee.

For the CDC’s complete list of the facilities that received the steroid, broken down by state, go here. 

State business and health groups team up for forums to answer the question: Do smoking bans help the bottom line?

Some of Kentucky’s leading health and business organizations will host a series of smoke-free forums throughout the state throughout the fall. A joint effort of the Kentucky Chamber of Commerce, the Kentucky Public Health Association, Foundation for the Healthy Kentucky and Smoke-Free Kentucky, the forums are designed to show individuals how they can protect themselves and others from secondhand smoke, improve Kentucky’s business image and lower health care costs related to tobacco use.

The schedule
Tuesday, Oct. 23: Louisville, Crowne Plaza Hotel, 830 Phillips Lane, 8-9 a.m., breakfast
Wednesday, Oct. 24: Ashland, Boyd County Health Department, 2924 Holt Street, Ashland, 8:30-9:30 a.m., breakfast
Wednesday, Nov. 14: Owensboro, River Park Center in the Berry Theater, 101 Daviess Street, 5 to 7 p.m., dinner.
Tuesday, Nov. 27: Paducah, Lourdes Hospital, Borders Conf. Room, 1530 Lone Oak Road, 8:30-9:30 a.m., breakfast.

There is no cost to attend the forums. Meal will be provided. An RSVP is requested by calling 502-797-0638 or emailing betsyjanes@ymail.com. 

Study: Prescriptions for antipsychotic drugs to state's poor kids increase 270% in 10 years; data also show painkiller patterns

By Amy Wilson and Al Cross
Kentucky Health News

A new report from the University of Kentucky has documented the rate at which the state's poor and disabled children are more and more frequently being prescribed very powerful drugs to treat what is assumed to be attention-deficit, schizophrenia, bi-polar disease and depression. The results indicate that males are more likely than females to be assigned those drugs by physicians, and minority males even more than their white counterparts. The study, conducted by the UK College of Communication and Information and Center for Business and Economic Research, shows that the amount of anti-psychotic drugs distributed to children on Medicaid in Kentucky jumped 270 percent in the decade from 2000 to 2010. Minority children were prescribed those medications at three times the rate of white children.

Beth Musgrave of the Lexington Herald-Leader reports that the study also "found unexplained geographical differences in how minority children are treated for mental illnesses. For example, minority children in Bath County in Eastern Kentucky are taking anti-psychotic medications at a rate nearly 26 times higher than minority children in Christian County in Western Kentucky. Yet the report found little difference in white children in those two counties.

The study also revealed wide geographical variances in prescriptions for drugs meant to treat attention deficit hyperactivity disorder, or ADHD. Poor children in Western Kentucky received much larger quantities of ADHD drugs than their counterparts in Eastern Kentucky. For example, Henderson County children take medications to treat ADHD at a rate 11 times higher than children in Leslie County."

Researcher Michael Childress looked at patterns for all drugs, and found a strong correlation between high use of painkillers and a high percentage of people who say they are in fair or poor health. He used that correlation to figure what level of painkiller use should be expected, and created a county-by-county map showing where the use is higher than expectation:

Childress told Musgrave that the study didn't try to answer why there are variances in prescription patterns. "This report provides data that should cause people to ask questions and to seek out answers," he said. "Health providers and people in these communities need to look at this data and start asking questions about what some of this data shows."

Cabinet for Health and Family Services Secretary Audrey Tayse Haynes called some of the report's findings "disturbing." "We're taking a hard look at behavioral health in children and youth in this state," Haynes said. "Clearly, we need to have some education and training with our providers about prescribing habits. These are powerful drugs."

Dr. Paul Glaser, a pediatrician and child and adult psychiatrist and associate professor at the UK College of Medicine, had a different perspective. He said the increase in antipsychotic drugs may show that the state is finally treating child and adolescent mental illness.  (Read more)

To read the report, including county-by-county maps and drug-by-drug county tables, go here. To read an issue brief on ADHD, go here. To read an issue brief of anti-psychotics, go here. To read an issue brief of analgesic narcotics, go here.

Tuesday, October 9, 2012

Covington police chief: New prescription-drug law has unintended consequence of encouraging pain pill addicts to use heroin, commit crimes

Black tar heroin
Kentucky's new prescription drug law may be having its desired effect of taking prescription painkillers off the streets, but could be forcing those very same addicts into using heroin. That's the view of Covington Police Chief Spike Jones, who took his case to the state Senate Judiciary Committee last week to complain about increased crime in his area and to ask for some money for help.

The drug law passed in April 2012, designated House Bill 1, requires Kentucky doctors to complete patients' medical histories, conduct physicals, check photo identifications and run names through the state's KASPER (Kentucky All Schedule Prescription Electronic Reporting) database before prescribing a controlled substance for pain relief. It has required a vast network of oversight of doctors and patients by government and licensing entities. This has reportedly caused some doctors to stop writing those prescriptions completely.

Tiffany Wilson of Cincinnati's WKRC-TV reports that Chief Jones reports more prostitution, theft, car thefts and car break-ins in his northern Kentucky region. He asked the state legislature for money to research how deep the problem is and to discuss the need for more treatment facilities. 

Jones pointed to the recent closure of the pain management clinic of Dr. Gary Shearer in Florence as adding to the problem. Shearer's license was suspended following the death of 15 patients from prescription-drug overdoses. These patients, Jones told Wilson, are exactly the ones at risk for taking the next step and turning to heroin. He added that heroin dealers will often give potential customers the first hit for free, "and from that point, there's no returning to prescription pills." (Read more)

Monday, October 8, 2012

State's hospitals see impressive growth spurt from nearly $1 billion in capital investment

Kentucky’s major hospital systems are going big, making high-profile, technology-forward capital investments across the commonwealth. Josh Shepherd of The Lane Report writes that every sector of the state is part of the hospital boom. The state's cumulative total of investment since 2010 is roughly a billion dollars, notes Shepherd, and has meant hundreds of construction and, soon, medical and other hospital-related jobs. Here's the list of the most notable construction projects now under way:

  • Owensboro Medical Health System,  $385 million, a new complex (pictured, above) that will allow expansion for the next 50 years, completion date: summer 2013.
  • Norton Healthcare System, Louisville, converting Suburban Hospital into Norton Women's Hospital and Kosair Children's Hospital, $120 million, completion date: 2013.
  • Pikeville Medical Center, new office building and parking facility, $130 million, completion soon.
  • Baptist Health, Lexington, expansion of Central Baptist Hospital medical services complex with parking structure, $200 million.
  • University of Kentucky Healthcare, Chandler Medical Center, $750 million, includes new plans for Shriners Hospital for Children.
  • Frankfort Regional Hospital,  $8 million expansion, emergency department.
  • Trigg County Hospital, $7 million, surgery and rehabilitation unit.
  • Lifepoint Hospitals-owned Clark Regional Medical Center, $60 million, 79-bed hospital. (Read more)
  • Friday, October 5, 2012

    First lady speaks out on behalf of domestic-violence victims; Ky. is one of four states without protection for date-violence victims

    First Lady Jane Beshear pointed out the accomplishments of the anti-domestic violence movement in Kentucky this week, and spoke the names of 26 women who had died at the hands of their abusers this year. With that, she then announced that October would again be Domestic Violence Awareness Month in Kentucky.

    “Nearly one-third of all American women report being abused at some point in their lives. Abuse affects more than just individuals -- families and communities suffer, too,” said Beshear. “Domestic Violence Awareness Month is the opportunity for all Kentuckians to learn how to recognize the signs of domestic abuse and to show support for victims as they work to regain control of their lives.”

    Kentucky is one of only four states that do not provide protection for victims of dating violence. “In celebrating the successes of the Violence Against Women Act, we must acknowledge the work still left to do,” said KDVA President Anne Perkins, who also serves as executive director of Safe Harbor, a regional domestic violence program in Ashland.  She called on state legislators to pass a new dating violence bill during the next legislative session. Research shows that young women between the ages of 20 to 24 are at greatest risk of intimate partner violence.

    Annual report for Cincinnati-Northern Kentucky region shows employee health care costs there will go up about $400 next year

    In an continuing effort to move health costs off the shoulders of employers and onto employees, workers in Greater Cincinnati and Northern Kentucky will likely pay an average $4,775 out of their own pockets for health care in 2013 -- about $400 more than this year. That's nearly $2,000 more than they paid in 2007. The payments include premiums through their employer, as well as office co-pays and deductibles, said Aon Hewitt, the consultant that produced its annual cost report. These payments are slightly less than the national average of $4,814.

    The trend toward "more employee accountability" means that nearly all companies are adjusting the designs of their employee plans, adding wellness programs and moving more employees to high-deductible plans with health savings accounts, reports Cliff Peale of the Cincinnati Enquirer. Penalties are now common for workers who smoke or who don’t take required health screenings.

    The report notes that companies continue to bear most of the cost of their employees’ health insurance. It also predicts that, counting the portion paid by both companies and workers, the cost of a health care policy will increase 6.4 percent next year to $11,566. That should return the region to numbers more aligned with the national average. About half of all Americans still get benefits through their employers, and there are nearly 50 million without health insurance at all. (Read more)

    Southern Kentucky circuit judge was probably the first to die in Tenn. from fungal meningitis outbreak stemming from tainted steroids

    Judge Eddie C. Lovelace
    The first person to die in Tennessee from the nine-state meningitis outbreak liked to bad steroids was most likely Kentucky Circuit Judge Eddie C. Lovelace of Albany, 78, who died at Vanderbilt University Medical Center Sept. 17. John Dreyzehner, Tennessee's commissioner of health, said Friday that the number of Tennesseans affected by the meningitis outbreak has now risen to 29. The number of deaths is unchanged at three. The search for more affected patients will continue "for some time," he said. Investigators haven't found evidence that the clinics or clinicians in Tennessee did anything to cause the outbreak, which has been reported in other states.

    In July and August, Lovelace received three rounds of the pain-relieving steroid injections suspected of causing the outbreak of the rare disease, Joyce Lovelace, his wife of 55 years, told Adam Tamburin of The Tennessean. Representatives of the Saint Thomas Hospital Outpatient Neurosurgery Center, where he received the injections, are reported to have called Joyce Lovelace twice after his death to discuss his condition. They did not mention the outbreak, she said, nor have they confirmed that that was his cause of death.

    Vanderbilt spokespeople have confirmed to the newspaper that "the first reported casualty of the outbreak was a 78-year-old man who died there on Sept. 17." Doctors told his family that his unexpected death was likely caused by a stroke, which is common among critically ill meningitis patients. His symptoms -- slurred speech, trouble walking and numbness -- are consistent with symptoms of fungal meningitis.

    Lovelace had been a circuit court judge for two decades, and commonwealth's attorney and county attorney before that. “He always wanted to be known as a judge who knew the law, and he certainly was.” Joyce Lovelace said. “His career was not over. He had years yet to work.” (Read more) Democratic Gov. Steve Beshear may fill Lovelace's nonpartisan vacancy with state Sen. David Williams of Burkesville, who has been president of the Senate since Republicans took formal control of the chamber in 2000.

    UPDATE, Oct. 6: The New York Times reports that nine states have reported meningitis cases connected to the steroids made by a Massachusetts company, which shipped the steroids to 14 other states. "Some doctors and clinics have turned away from major drug manufacturers and have taken their business to so-called compounding pharmacies, like New England Compounding, which mix up batches of drugs on their own, often for much lower prices than major manufacturers charge — and with little of the federal oversight of drug safety and quality that is routine for the big companies." (Read more) New England Compounding has recalled the steroids, The Tennessean reports.

    Four companies will oversee Medicaid coverage in 16-county Louisville region that includes 175,000 Kentuckians

    Beginning Jan. 1, four companies will share management of the health care of roughly 175,000 Medicaid patients in the Jefferson County region. This reflects a major, federally mandated change that some say raises concerns about disrupting care. The nonprofit Passport Health Plan has served all Medicaid recipients in the 16-county region for 15 years. On Thursday, the state Cabinet for Health and Family Services said it had signed 18-month contracts with Passport and three other companies -- Humana, Wellcare of Kentucky and Coventry Cares -- to manage Medicaid recipients’ care starting next year. Other details of the contracts were not released.

    The federal government has made it clear that the state it could no longer operate with a single managed-care company in the region and that it must give patients a choice among several providers. In addition to Jefferson, the region’s other counties are Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, LaRue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington.

    According to The Courier-Journal's Tom Loftus, "Passport had hoped that, if the state went with multiple companies, it initially would assign all recipients to it and then give them an option of moving to another company. Instead, the cabinet initially will assign recipients to one of the four companies. The cabinet said the state will use 'a high-tech matching system' that assigns a person based on 'available provider networks and any special health care needs.' (Read more)

    Andrea Bennett, deputy director of Kentucky Youth Advocates, said the new system raises concerns for child advocates. "While we still have threads of hope, we cannot ignore the ongoing Medicaid managed care issues that have occurred throughout the rest of the state over the past year.  . . . We’ve heard providers threaten to give up on Medicaid altogether because they are frustrated and still not receiving proper payment. We’ve seen lawsuits and fights between the state, the managed care companies, and the providers. And we still haven’t seen hard data showing how managed care is improving quality and access to care for children in the Commonwealth."

    Wednesday, October 3, 2012

    UK and Purdue researchers find a compound in watermelon that fights 'bad' cholesterol and arterial plaque in lab rats

    A study from the University of Kentucky and Purdue University showed that mice fed a diet including watermelon juice had lower weight, cholesterol and arterial plaque than a control group. The findings, reported in the Journal of Nutritional Biochemistry, suggest that citrulline, a compound found in watermelon, plays a role in cardiovascular health. "We were interested in citrulline because previous studies showed that it may lower blood pressure,"  Shubin Saha, a Purdue Extension vegetable specialist and study co-author, told Medical Xpress. "We didn't see a lowering of blood pressure, but these other changes are promising."

    "The researchers fed two groups of mice diets high in saturated fat and cholesterol," MX reports. "Half the mice received water containing 2 percent watermelon juice, while the others received the same amount of water supplemented with a solution that matched the carbohydrate content of the watermelon juice. The mice that consumed watermelon juice gained about 30 percent less weight than the control group and had about 50 percent less LDL cholesterol - the so-called bad cholesterol. The experimental group also had about a 50 percent reduction in plaque in their arteries, as well as elevated levels of citrulline." Sibu Saha, a professor of surgery at UK, explained that the researchers are not sure at what molecular level the citrulline is working, but that is their next step.

    Shubin Saha was excited about the dual benefit of the findings. "Twenty percent of each year's watermelon crop is wasted either because the fruit is visibly unappealing to consumers or because some growers find it too expensive to pay for harvesting as prices drop during the height of watermelon season." The wasted melons, he explained, could be put to use extracting these very beneficial compounds.  (Read more)

    Pharmacy student takes time to point out the "Top 10 things you didn't know your pharmacist could do for you"

    Imagine yourself hip deep in pharmacy school. You are sweating bullets over classes in pharmokinetics, chemotherapy and biostats. What, ho! You see the calendar reads October and you realize it's American Pharmacists Month and you graduate in 2014 from the University of Kentucky's College of Pharmacy and you want people to know you are acquiring mad skills. What to do? Write a primer about how much pharmacists can do for a community. And then put that primer -- via guest column -- in the Kentucky Kernel, the school's (sort-of) daily newspaper, where people who are consumers of good data like this will gobble it and put it to good use. Student Zachary Noel's list of "the top 10 things you didn't know your pharmacist could do for you" is worth repeating because Noel wants to do more than fill prescriptions, he wants to be a trustworthy health-care partner, something a lot of Kentucky communities could use.

    Here's Noel's list of what pharmacists can do:
    1) Immunize. Kentucky's pharmacists can provide flu shots and vaccinations, even for the human papilloma virus.
    2) Economize. Just ask if you find yourself paying too much for your meds, there might be something your pharmacist can do.
    3) Educate. Pharmacist are highly educated health-care providers who are often under utilized and more accessible than traditional sources. Don't feel you have to limit those questions to medication questions.
    4) Stand guard. Think of pharmacists as a super-filter and your last, best chance to check that a medication is right for you.
    5) Counsel. Vitamins, herbals, over-the-counter meds baffling? The evidence-based and experience-tested pharmacist will have some advice.
    6) Prescribe. Yes, some pharmacists, writes Noel, "can enter agreements with various providers allowing them to prescribe or alter medication regimens, such as within the Veteran's Affairs hospital system."
    7) Practice in interesting places. Like ERs, ORs, with vets.
    8) Complete a residency. Pharmacists can opt for more schooling so they can specialize.
    9) Medication therapy management. This means that pharmacists can review all your meds for interactions and make recommendations.
    10) Compound. This is where they make stuff not already available. Where they create eye drops or topical ointments specifically for your use as directed by your doctor.
    (Read more)