Sunday, May 31, 2015

Paducah Sun looks at two local doctors who write many prescriptions for painkillers; such local data are easily available

The Paducah Sun has used some easily available information about two local doctors to shine a local light on their heavy prescribing of opioids.

The story by Laurel Black begins, "As narcotic painkiller abuse has drawn more public attention, two Paducah physicians  who have been ranked high among prescribers of such drugs  have found themselves defending their practices."

The story cites The Courier-Journal's analysis of 2012 Medicare data that showed Dr. Yogesh Malla of Paducah was "the No. 3 prescriber of narcotic painkillers in the commonwealth. A USA Today article listed Dr. Riley Love, also of Paducah, as 20th in the nation. Both reports used information the news organization ProPublica obtained under the Freedom of Information Act."

The Sun offers a quick retort from the medical director of the pain-management center where Malla practices, paraphrasung him as saying "the reports omit or minimize important factors, such as the specialty of the physicians and the morphine equivalence of the drugs they prescribe."

Dr. Laxmaiah Manchikanti also said in his written statement that his group emphasizes drugs with lower abuse potential and that more than 92 percent of patients at such centers "are already on long-term opioids; consequently, the best we can do (at these centers) is reduce the dosage."

Manchikani is CEO of the American Society of Interventional Pain Physicians, a lobbying group that advocates monitoring of painlkiller prescriptions, and a leading contributor to a wde range of political causes. The Sun doesn't note the latter point, but focuses on the issues of painkiller abuse, a major problem in Kentucky.

"With more than 1,000 deaths per year, Kentucky in 2013 had the third-highest drug overdose mortality rate in the United States, according to the Trust for America's Health," Black notes.

As for the other doctor, the Sun reports, "ProPublica's data on Love, who practices at the Lourdes Pain Management Center, reports that 59 percent of his 1,141 patients filled one or more prescriptions for a Schedule 2 drug and 51 percent filled for a Schedule 3 drug. Both figures are above the average of 45 percent and 41 percent, respectively, for his specialty in Kentucky.

"A spokeswoman for Love said Lourdes center represents the only location in the region where Medicaid patients receive inpatient pain consultations," the Sun reports, quoting her: "The patients we see are often very sick, and the treatments and medications we provide are the last resort comfort measures so the patients can spend quality time with family" as they near death.

The story is behind the Sun's paywall.

Herald-Leader reporter wins Nieman fellowship to study at Harvard; her goal is to help other papers cover Obamacare

Photo by Pablo Alcala,
Lexington Herald-Leader
Mary Meehan, a reporter for the Lexington Herald-Leader, has been selected for the 2016 class of Nieman fellows at Harvard University.
She is one of 24 journalists chosen for this prestigious honor and will begin her year of study at Harvard in September.

"I am going to Harvard to study for nine months. I hope to learn things I didn't know I yearn to learn, learn about healthcare and the massive social experiment underway." Meehan said in her shared blog, Menopausal Moms of Kentucky. "I also hope to learn something that can help in some small way to keep the newspaper industry upright."

Meehan has been with the Herald-Leader for 15 years, but began her career as a journalist 34 years ago as a columnist for The Voice of St. Mathews in Louisville at the age of 16. Before returning to Kentucky, she worked for the Tribune Newspapers in Phoenix, AZ, The Orlando Sentinel in Florida, and also as a freelance journalist in Florida.

She said that her "life changing" experience as a Blue Cross Blue Shield of Massachusetts Foundation Health Coverage Fellow last year is what prompted her to apply for the fellowship. She said she returned from the first fellowship energized to write about health, and has written "as many stories as I could" with information from that experience.

Still, she said, "I just came across stories that I couldn't get to, that were too complicated because I didn't have a good, deep foundation of health-care reform and the complex issues involving how people access health care, or what makes them seek it out even if they have insurance, and so that prompted me to file an application for the Nieman fellowship."

Meehan said that she made it clear on her application that she is not a full-time health journalist and that during any given week she has covered "a tractor parade, monster trucks and Salem the wonder cat." But she also said that while covering health, she has found that the Patient Protection and Affordable Care Act has accountability measures that apply everywhere, but are "very difficult to digest on the fly."

Each Nieman fellow proposes a study project. Meehan plans to examine the impact of the law and barriers to sustained health improvement among the previously uninsured.

"My goal is to help mid-size and small papers cover the Affordable Care Act in a meaningful way," she said. "The other part is highlighting positive things that are happening in communities, with a critical eye. Looking at not only what works, but also the challenges."

Meehan said being selected for the top fellowship in journalism hasn't really "soaked in yet," but she anticipates, based on previous fellows' comments, that she will discover "something that is amazing" that can't be predicted yet.

She said she is looking forward to working with the other fellows, half of whom will come from all over the world, and going back to college.

"I am a 50-year-old woman with white hair; I just love the visual of me sitting in a Harvard class," she said with pure joy in her voice. She earned her bachelor's degree at Western Kentucky University where she majored in political science and journalism.

In addition to taking classes, fellows attend Nieman seminars, workshops and master classes and work closely with Harvard scholars and other leading thinkers in the Cambridge, Mass., area.

The Nieman Foundation for Journalism has educated more than 1,400 accomplished journalists from 93 countries since 1938.

Friday, May 29, 2015

Kentucky's seniors rank 48th in insurance firm's health rankings

Click here to go to interactive map.
Kentucky seniors ranked in the bottom 10 states for 23 of the 35 measures ranked by the 2015 America's Health Ranking Seniors Report, placing Kentucky in 48th place for the second year in a row.

“The report is a call to action. We believe you can’t improve what you don’t measure,” Dr. Julie Daftari, market medical director for United Health Care of Kentucky told Alyssa Harvey of the Bowling Green Daily News. “It may start with seniors taking individual action. If we live long enough, we’ll be part of these statistics in the future."

Kentucky seniors ranked last in two areas, total health outcomes and preventable hospitalizations; next to last in premature deaths and education and in the bottom three states for smoking, seniors who are considered underweight, and poor mental health days.

The report notes that smoking is the leading cause of preventable death in the U.S. and "older smokers are at an increased risk of smoking-related illness as they tend to be heavy smokers with an average smoking duration of 40 years" and "are less likely than younger smokers to believe that smoking harms their health." Kentucky, with 11.8 percent of its seniors regularly smoking, ranked third highest in senior smoking, behind Nevada and Mississippi.

The report is intended to point out the health challenges facing today's seniors and offer a starting point to help states determine what needs to change. That being said, Kentucky ranks very low in an area that could help improve these outcomes: community support, where it ranks 45th.

The report did say that Kentucky seniors do have some strengths. They have a low prevalence of chronic drinking, low percentage of adults needing pain management, high flu vaccination coverage and a low percentage of low-care nursing home residents.

More Kentucky seniors also reported very good or excellent health since last year's report, up to 33.7 percent from 31.2 percent.

The report noted that a decrease in physical inactivity is a nationwide problem for seniors, with 33.1 percent of seniors nationwide reporting they did not get enough physical activity. This percentage was even higher in Kentucky at 40.2 percent, which is higher than the previous two years (34.5 percent in 2014 and 17 percent in 2013).

The report notes that today, one in seven Americans are aged 65 and older, and in the next two decades the rest of the 77 million baby boomers will move into this demographic. The report also projected the increase in Kentucky's senior population between 2015 to 2030 will be 41.8 percent.

“The fact that we were able to identify key strengths and challenges gives Kentucky an opportunity to address those specific issues,” Daftari told Harvey. “If these challenges aren’t addressed, there may be a significant strain on health care in the future.”

The rankings were based on 35 measures of senior health including behavior determinants like smoking and dental visits; micro and macro community and environmental determinants like poverty and social support; policy issues like percentage of seniors on SNAP; and measures of clinical care like the percentage of seniors who receive home health.; and outcomes like the percentage of seniors who have fallen. It also included measures like education and cognition.

University of Kentucky rural health expert, Ty Borders, appointed to national advisory committee on rural health

University of Kentucky College of Public Health Professor Ty Borders was recently appointed to the National Advisory Committee on Rural Health and Human Services.
Ty Borders

This committee is part of the Health Resources and Services Administration and includes a 21-member panel of nationally recognized rural health experts that is responsible for making recommendations to the Department of Health and Human Services on issues related to rural health. Borders's appointment will continue until April 2019.

“This appointment is an honor not only for Dr. Borders and his family, but also for Kentucky,” Rep. Andy Barr, R-Ky., said in a UK news release. “Dr. Borders possesses a broad and deep understanding of the health care challenges facing rural Kentucky and America. His unique insight about evidence-based strategies that could improve rural health and health care delivery will greatly benefit the committee.”

Borders is the chair of the Department of Health Services Management and the Foundation for a Healthy Kentucky endowed chair in Rural Health Policy. He also serves as a founding co-director of the UK Institute for Rural Health Policy and is the editor of the Journal of Rural Health, an academic publication devoted to rural health research.

Thursday, May 28, 2015

Feeling exhausted and not sure why? Ask your health-care provider to check your vitamin B12

Some doctors are adding a vitamin B check to their standard "baseline" workup, especially vitamin B12, the one most commonly deficient, Dr. Leigh Erin Connealy reports for Newport Natural Health.

"By some estimates, up to 40 percent of the population does not have sufficient levels of B12," Connealy writes.

The B vitamins work together as a family to  perform many important functions throughout the body, such as helping to convert our food to fuel, allowing us to stay energized through the day, helping maintain heart health, preventing birth defects, creating red blood cells or assisting with the production and repair of DNA, to name a few.

Vitamin B12, or cobalamin, keeps our blood, nervous system and heart healthy. It is found primarily in animal-sourced foods—all meats, dairy products, eggs, and shellfish. Liver, sardines, and salmon contain the greatest amount.

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While it is not uncommon for vegetarians and vegans to have low levels of B12, Connealy says that even meat eaters can lack it, usually because of poor absorption.

Absorption issues in younger people are often caused by acid-blocking medications, disorders such as Crohn's disease, leaky gut, diarrhea and other gastrointestinal problems.  Older people with a condition called hypocholorhydria, where the stomach does not produce enough acid to help with the absorption of nutrients, can have low levels as well, Connealy notes.

B12 deficiency can cause a wide variety of debilitating symptoms ranging from exhaustion and lethargy to depression, anxiety, memory loss, confusion, and other Alzheimer’s-like symptoms.

WebMD adds rapid heartbeat and breathing, pale skin, sore tongue, bleeding gums, stomach upset and weight loss and diarrhea or constipation to the list of symptoms.

Connealy notes that there are differing recommendations for the amount of B12 that should be in a supplement. The Dietary Reference Intake recommends between 2-3 micrograms daily, while the Center for Food Safety and Applied Nutrition recommends 6 mcg daily, based on a 2,000-calorie diet.

Connealy recommends the higher dosage, especially since "absorption problems are so common with age" and "it's nearly impossible to overdose." She also recommends B12 injections for severe deficiencies. In particular, she says that vegetarians, vegans and those age 50 and older should take an oral B12 supplement every day.

In-school health clinics not only meet the health-care needs of students and staff, but also their families

School-based health clinics in Kentucky could become a trend,  especially as the state searches for solutions to meet the health care needs of schools as budgets for school nurses continue to be slashed.

Southern Kentucky has Cumberland Family Medical, based in Burkesville, which has clinics at the five schools in Russell County and a deal to do likewise with the four in adjoining Adair County.

Western Kentucky has three such clinics, with two more likely to open next year, Genevieve Postlethwait reports for The Paducah Sun. 

The clinics are at McCracken County's Reidland Middle School, Lone Oak Elementary School, and Paducah's Morgan Elementary. Next school year a full-time clinic will open in McCracken County High School, hopefully followed by a clinic at McNabb Elementary.

These clinics exist as a partnership between Mercy Medical Associates and the local public school districts; the school districts supply the space, Mercy supplies and staff and the Lourdes Foundation helps with funding, Postlethwait reports.

An advanced practice registered nurse with Mercy Medical, Julie Higdon, said she has seen well over 30 patients at the Lone Oak clinic since it opened in mid-April. "That's not busy by ER standards," she said, "but that's busy for a little clinic that's just softly opened."

The clinics serve the entire "school family," from the students and their parents and siblings to the districts' teachers, staff and administrators, regardless of their ability to pay. "Their goal is to give the community the preventive, acute and critical health care it needs while reducing students' and teachers' time away from school, and parents' time away from work," Postlethwait writes.

"It's a big deal when you start talking about dollars and cents, too," Tennille Rushing, director of clinical operations for Mercy, told Postlethwait.  "Not only in the impact for the schools to have kids staying in the classroom and helping with attendance numbers, but for parents. If you only have a limited number of days that you can take off, and you have to take off half a day to go sit in a lobby somewhere with your child, you've missed a half day of pay."

These clinics will also help those without a primary-care provider, which are in short supply in the Paducah area. The Lone Oak clinic will remain open by appointment only this summer.

"I feel like these clinics really have the potential to meet a need for the community," Higdon told Postlethwait. "I feel like it has great potential to grow, I really do." (This story is behind a paywall.)

Free overdose-reversal kits are given to Kentucky hospitals with the highest recent rates of heroin-overdose deaths

Kentucky hospitals with the highest rates of heroin overdose deaths are receiving funding for heroin/opiate overdose reversal kits, which will be provided free of charge to every treated and discharged overdose victim at the pilot project hospitals, according to a state press release.

The funding for these kits is through the Substance Abuse Treatment Advisory Committee, which oversees the distribution of a $32 million pharmaceutical settlement fund that is used to expand treatment in Kentucky. The committee has allocated $105,000 to purchase these kits for the pilot hospitals: the University of Louisville Hospital, the University of Kentucky Medical Center in Lexington, and the St. Elizabeth Healthcare in Northern Kentucky.

In 2013, 230 Kentuckians died from heroin overdoses. Final numbers for heroin overdoses in 2014 are not yet available, but the Office of Drug Control Policy estimates heroin was involved in 30 percent of all drug-overdose deaths, according to the release.

Attorney General Jack Conway chairs the committee and First Lady Jane Beshear serves on it. They announced recently that about 500 of these kits will be made available to the St. Elizabeth system, which treated 545 people in 2013 and 745 people in 2014 for heroin overdoses.

“There is evidence the collaborative efforts in our community are having an effect,” St. Elizabeth interim president and CEO Garren Colvin said in the release. “A report earlier this month indicated that heroin-related overdose deaths are down in Northern Kentucky. ... To continue to battle heroin issues in our community and throughout Kentucky, it is going to take education and collaboration at the local and state levels.”

Naloxone, which is also known as Narcan, is the drug in the free Naloxone Rescue kits and "has no potential for abuse and immediately reverses the effects of heroin overdose by physiologically blocking the effects of opiates," says the release.

One of the challenges for access to these kits is that they are not covered by Medicaid or many private insurance companies and are too expensive for most people to purchase. Health experts anticipate that when the U.S. Food and Drug Administration approves the nasal mist form of the drug, most insurance companies and Medicaid will cover it.

“As Kentuckians expand access to mental health treatment, including addiction recovery, it’s more important than ever to have community access to tools like Narcan,” Jane Beshear said in the release. “Often, an overdose experience is what finally drives people suffering from addiction to seek help.”

Wednesday, May 27, 2015

Clay County 4th and 5th graders participate in UK research of circadian rhythms and obesity, little studied in children

The University of Kentucky recently partnered with over 100 fourth and fifth grade students in two Clay County schools to study the relationship between circadian rhythms and weight in children.

Sydney Sester, a fifth grade student at Manchester Elementary School, said in a UK news release that in addition to learning more about science and helping others by contributing to research, participating in the study showed her the importance of maintaining a healthy weight and eating well.

"It made me want to be more responsible with food and be patient with what I eat and only eat when I'm hungry," she said.

The project, "Circadian Rhythm Parameters and Metabolic Syndrome Associated Factors in Young Children," also known as the Clay County Clock Study, is led by Dr. Jody Clasey, associate professor of kinesiology and health promotion, and Dr. Karyn Esser, professor of physiology.

The research team says it hopes to learn about the relationship between circadian rhythms, eating, and activity behaviors and the incidence of overweight and obesity in children.

And while the team is in the process of analyzing the data, Esser told a group at the 10th annual Center for Clinical and Translational Science conference in March that early data show 33 percent of the students in the study are considered obese, their initial blood pressure measurements are on the high end of normal, and the students are less active on weekends and nights than during the school week.

The data was gathered through electronic devices that the students wore for seven days to measure activity, heart rate and skin temperature. The students also kept a daily journal to record their sleep and eating activities each day.

Previous studies have shown that disrupting an adult's circadian rhythm is associated with increased risk for metabolic disease, which is a combination of chronic health conditions that puts a person at a higher risk of heart disease and diabetes. Similar research with children has been limited.

Esser noted that "Clay County and many of the counties in Appalachia have a much higher rate of these chronic diseases."

She also said that while it is known that light exposure affects the body clock, recent findings show that the time that we do activities, like exercising and eating, also contribute to circadian health, and that this is also likely true in children.

This research "could not only influence an individual, but school start times, activity intervention, just so many different areas from personal practice or behavioral choices to public policy, all for the metabolic or physiological good of the individual or collective body," Clasey said.

Use of walking aids is increasing as population ages; study debunks notion that using them makes falls more likely

In the last 10 years, the use of walking aids—such as canes, wheelchairs and scooters—has increased by half, and is expected to grow as the number of seniors doubles in the next 35 years.

Research has shown a correlation between use of walking aids and falling, which is the leading cause of death resulting from injury for people 65 and older. However, a recent study in National Health and Aging Trends shows that people who employ mobility devices are not more likely to fall than those who do not use such devices.

Previous research that indicated the use of walking aids might increase the likelihood of falling "only looked within groups of people . . . who are already more likely to fall," said researcher Nancy Gell, assistant professor of rehabilitation and movement science at the University of Vermont. "This study is the most in-depth since 2004 and shows no link between mobility devices and falls as previously thought."

Gell reports that 16.4 percent of seniors use a cane, 11.6 percent use walkers, 6.1 percent use wheelchairs and 2.3 use scooters. Those who use canes are more likely to say they refrain from certain activities because of the fear of falling. "For many people, a cane is the appropriate device for their circumstance to stay mobile," Gell writes. "However, if worry about falling continues despite using a cane for support, it is worth considering a different device in order to be as active as possible."

"The question is if it's better to be active or sedentary and not risk falling," Gell writes. "We think it's better to be active."

Health care professionals strongly endorse new federal dietary guidelines, which say to eat less red and processed meat

A group of 700 physicians and other health care professionals sent a letter of strong endorsement to the secretaries of the Department of Agriculture and the Department of Health and Human Services praising the recommended federal dietary guidelines that emphasize eating less red and processed meat, Whitney Forman-Cook reports for Agri-Pulse, a Washington newsletter.

The letter said the “shift toward a more plant-based diet” in the Dietary Guidelines Advisory Committee's recommendations is a potentially “powerful tool for health promotion” that would help reduce healthcare costs, Forman-Cook writes.

“Three of the four leading causes of preventable death, heart disease, cancer, and stroke -- are diet-related,” the letter reads. “Heavy meat consumption, especially red and processed meat, is associated with increased risks of heart disease, diabetes and some cancers, while plant-based diets are associated with decreased risks of all three.”

They also noted that 75 percent of U.S. health-care costs and diminished labor supply and worker productivity is caused by chronic and preventable diseases, costing the country "$1 trillion in lost economic output and billions more in rising healthcare cost," Forman-Cook writes.

For the first time, the guidelines include environmental standards and sustainability language. Agriculture Secretary Tom Vilsack "has not said he is opposed to including sustainability concerns in the final guidelines," Forman-Cook writes. He told her that "he would be personally involved" in writing the new guidelines, keeping them "narrowly focused on nutrition."

U.S. meat producers and many farm organizations have pushed back against the recommendations and the sustainability language.

The health-care professionals also endorsed the DGAC's recommendations on sustainability and calls for the DGAC to "explicitly" list the "common names" of foods in the guidelines and identify appropriate "non-animal protein sources" to help consumers modify their eating habits.

The guidelines, which are revised every five years to reflect advancements in scientific knowledge, are used to guide federal nutrition programs, including school meal standards, and to inform consumers. They are expected to be published later this year.

Beshear is Communicator of the Year for efforts with Kynect

Governor Steve Beshear ​has been named 2014 Communicator of the Year by ​the Public Relations Society of America's Thoroughbred chapter.

He received the award for his communication to Kentucky residents about Kynect, the state's online healthcare marketplace created under federal health-care reform.

More than half a million Kentuckians have gotten coverage through Kynect, most of them through Medicaid, which Beshear expanded under the federal law.

Bluegrass Family Health changes name to Baptist Health Plan

Bluegrass Family Health, the insurance arm of Baptist Health, is changing its name to Baptist Health Plan.

This change will make the Lexington-based health insurance carrier, which has offered insurance through area employers for more than 20 years, be more readily identified with its parent organization, which is based in Louisville, a news release said. It will take a few months for the name transition to be completed.

“As health care continues to evolve, it’s important to bring together the different parts of the Baptist Health system so everyone knows our entire organization is working toward the same goals of improving the health of our communities,” Baptist CEO Stephen C. Hanson said.

Bluegrass Family Health has nearly 80,000 members in Kentucky and parts of adjoining states.

“We look forward to continuing to expand our insurance business, bringing our products and services to both existing and new markets in Kentucky, Indiana, Ohio, Illinois, West Virginia and Tennessee,” James Fritz, president of the plan, said in the release.

Tuesday, May 26, 2015

Obesity and depression may contribute to daytime sleepiness

Obesity and depression, not just lack of sleep, contribute to daytime drowsiness, according to Penn State College of Medicine researchers. Daytime drowsiness or sleepiness affects up to 30 percent of the U.S. population. It can reduce work productivity and cause car accidents. According to the States of Obesity report, 33.2 percent of Kentucky adults are obese.

The Penn State study used physiologic sleep data to show a connection between obesity and depression or sleepiness. Study participants filled out a comprehensive sleep history and physical examination and were evaluated in a sleep laboratory. "Obesity and weight gain predicted who was going to have daytime sleepiness," said Julio Fernandez-Mendoza, assistant professor of psychiatry at the Sleep Research and Treatment Center. "Weight loss predicted who was going to stop experiencing daytime sleepiness, reinforcing the causal relationship."

Body mass index and sleepiness association was independent of sleep duration, so obese people might be sleepy during the day regardless of how much sleep they get. Obesity is also associated with sleep apnea. The chief reason heavy people are more tired is that fat cells create immune compounds called cytokines that make one sleepy.

According to the study, depressed people have daytime drowsiness because they have trouble falling asleep and often wake up during the night. "The mechanism that we believe is playing a role here is hyperarousal, which is simply going to bed and being to alert; in other words, people with depression feel fatigued but do not necessarily fall asleep during the day, Fernandez-Mendoza said.

The study showed that a one-size-fits-all method for treating daytime drowsiness will not be effective. Daytime sleepiness doesn't always mean a person doesn't get enough sleep, Fernandez-Mendoza said. "The main causes of a sleepy society are an obese society, a depressed society and, to some extent, people who have a physiological disorder. By looking at our patients more closely, we can start personalizing sleep medicine."

How do diet and exercise influence risk of diabetes? Diet seems more important

Many people think exercising and eating properly are interchangeable, but a paper by Edwards Weiss, associate professor of nutrition and dietetics at Saint Louis University, asserts that exercising and restricting diet results in specific and cumulative benefits in reducing the risk of Type 2 diabetes. According to the 2013 Kentucky Diabetes Report, 6.9 percent of Kentucky adults have diabetes.

Participants in the study were sedentary, overweight middle-aged men and women who reduced their weight 6 to 8 percent through calorie restriction, exercise or both. Researchers measured their insulin sensitivity levels, which determines risk of diabetes. "Your blood sugar may be perfectly normal, but if your insulin sensitivity is low, you are on the way to blood sugar issues and, potentially, Type 2 diabetes," Weiss said.

The researchers measured twice the improvement of insulin sensitivity in the group of participants who both exercised and restricted their diets than in the other two groups. Weiss notes that exercise helps regulate glucose, even if a person isn't losing weight as a result. The researchers also found that exercised-induced weight loss didn't regulate glucoregulation more effectively than calorie restriction. "What we found is that calorie restriction, like exercise, may be providing benefits beyond those associated with weight loss alone," Weiss said.

Weiss said that though it might seem obvious that a combination of diet and exercise would engender the best results, "there are a lot of people who believe that if they maintain a healthy weight, it doesn't matter what they eat. And others have an appropriate food intake but don't exercise."

Sunday, May 24, 2015

Louisville's PharMerica is still a defendant in federal cases in which big drug makers have paid billions in fines

Abbott Laboratories has paid billions, and Amgen Inc. has paid millions, in fines for offering "rebates" or "kickbacks" to get pharmacy companies to increase their prescriptions of drugs in nursing homes, and PharMerica Corp. of Louisville is the remaining defendant in both civil cases, according to a detailed report by James McNair at the Kentucky Center for Investigative Reporting.

PharMerica manages drug benefits for nursing homes, hospitals and assisted living facilities. McNair paints a dismal picture of nursing homes and says they are ripe for this type of abuse, writing that they house "people with age-weakened bodies, multiple ailments and, often, severe mental impairment. Many are over-medicated. Many have no visitors. A third of them will die within a year of admission." (Click on chart for larger version)

McNair notes that a whistleblower lawsuit first called attention to Abbott Labs, which pled guilty in 2012 to a criminal charge, settled civil kickback and fraud claims, and paid $1.5 billion in fines for its role in paying millions of dollars in "rebates" to get pharmacy companies to increase prescriptions for an anti-seizure drug, Depakote, for uses beyond its Food and Drug Administration approval. Medicaid payments for this drug "went on to top $7 billion," McNair reports.

Amgen also enlisted these same pharmacy companies to promote its anemia drug, Aranesp, for uses beyond its FDA approval, and after pleading guilty settled civil kickback and fraud charges and paid a total of $762 million in fines.

These two cases brought more government attention to such schemes, which are "standard practice in the pharmaceutical industry," and also on the pharmacy companies that are on the receiving end of the payoffs, McNair writes.

McNair describes PharMerica as the "second-biggest operator of nursing home pharmacies in the country" and writes that it had " $1.9 billion in revenue last year," making it the "10th-biggest publicly traded company in Kentucky, according to rankings by The Lane Report." Since 2007, the chief executive has been Gregory Weishar (pronounced WISH-er) .

Companies like PharMerica, and its larger competitor Cincinnati-based Omnicare Inc., act on behalf of the nursing homes, buying drugs from the pharmaceutical companies in bulk and then dispensing them under the supervision of "consultant pharmacisits," McNair reports.

The Abbott Labs and Amgen lawsuits assert that PharMerica gave "certain drugs to nursing home patients in return for drug company kickbacks, not because they were the "right medication."" McNair reports that the suits were filed by drug company insiders who have knowledge of these payoffs disguised as "rebates" or "discounts."

"PharMerica denies the claims," writes McNair. But the company has been in this type of case many times since 2005, McNair reports: It has agreed to pay $40 million in fines to settle federal complaints, five additional closed cases connected to this company.

McNair also reports that just last week, the Justice Department said PharMerica will pay $31.5 million for dispensing addictive painkillers to nursing home patients without prescriptions, then falsely billing Medicare. As part of this settlement, PharMerica also agreed to a five year "corporate integrity agreement," which McNair notes later in the article are rarely enforced.

McNair goes on to list the details of several other cases PharMerica has been involved in, one of them "deemed so flagrant that the inspector general sought to ban PharMerica from federal health-care programs for 10 years."

PharMerica declined to make its executives available for an interview with the Kentucky Center for Investigative Reporting but said in a statement: “PharMerica is committed to outstanding compliance and the highest standards of ethical conduct, and we are diligent in ensuring that we comply with all applicable law and regulation,”

Jan Scherrer, vice president of Kentuckians for Nursing Home Reform, a non-profit advocacy group based in Lexington, told McNair that the CEOs of companies involved in kickback schemes should be held personally accountable, "These are not victimless crimes," he said.

“It’s the same players -- PharMerica and Omnicare,” Scherrer continued. “They keep doing this over and over and over, and all they get is a fine. And for them that fine is nothing more than the cost of doing business.” (Read more of this detailed report by clicking here.)

State health commissioner backs needle exchanges, most controversial part of anti-heroin legislation passed this year

The Kentucky General Assembly cracked down in 2012 on "pill mills" that dispense painkillers irresponsibly, and addicts responded by going for heroin, creating a big problem in much of the state. The 2015 legislature passed laws to crack down on heroin, including local needle-exchange programs, the most controversial feature of the package.

In a column distributed to Kentucky newspapers, state Health Commissioner Stephanie Mayfield defends and promotes the local programs, which are subject to local approval.

“To some, a needle exchange may sound like a program that helps intravenous drug users feed their habit,” Mayfield writes. “To the contrary, the intent of an NEP is to protect public health and create a path for heroin users to get treatment while preventing the spread of diseases through the sharing of needles.

Needle exchanges reduce the number of HIV/AIDS and hepatitis cases in a community, Mayfield writes. "The use or even the accidental stick of a dirty needle can lead to hepatitis, HIV/AIDS infection and other dangerous diseases. . . . About 15 percent of all HIV cases that have occurred in Kentucky have been among injecting drug users."

Stephanie M. Gibson
Mayfield also says needle exchanges protecting people from accidental sticks from dirty needles discarded in public places. "Intravenous drug users submit dirty needles to the NEP for proper disposal in exchange for clean needles," she writes. "Researchers have also found that injecting drug users who participated in an exchange were more likely to reduce or stop injecting than drug users who had not participated in a needle exchange."

Research has also shown that needle exchanges "do not encourage the initiation of drug use nor do they increase the frequency of drug use among current users," Mayfield writes, noting that there are 203 such programs in 34 states.

"The presence of NEPs in communities does not expand drug-related networks nor does it increase crime rates. . . . Needle exchange programs actually create a path for injecting drug users to get help because the programs offer information on how to find available treatment options. In fact, NEP participants are more likely to enter a drug treatment program than nonparticipants."

More recent studies show that needle exchanges "provide opportunities for disease testing and education leading to a decline of at-risk behaviors, resulting in HIV incidence dropping as much as 80 percent within this population," Mayfield writes. "Many Kentucky communities are desperate for the ability to reach out to members who suffer from addiction, to help slow the spread of diseases and provide treatment referrals to people they might otherwise never have the chance to reach. This law gives them that opportunity."

Many Americans still don't use sunscreen, which has been proven to prevent skin cancer, the most common cancer in the U.S.

Sunscreen has been proven to reduce the risk for all types of skin cancer and to prevent or delay signs of aging, but most Americans still don't use it regularly, according to a new study by the federal Centers for Disease Control and Prevention.

The study, published in the Journal of the American Academy of Dermatology, found that only 14 percent of men and 30 percent of women regularly use sunscreen both on their face and other exposed areas. It also showed that more than 40 percent of men and 27 percent of women never use sunscreen on their face or other areas of exposed skin when outdoors for an hour or more, Carrie Myers reports for HealthDay News.

"The overwhelming majority of melanomas -- the deadliest form of skin cancer -- and non-melanoma skin cancers are associated with exposure to ultraviolet radiation from the sun," Dr. Deborah Sarnoff, senior vice president of the Skin Cancer Foundation, told Myers. "That's why daily sun protection is critical," she said.

The foundation recommends that when you are out in the sun you should seek shade, wear protective clothing, including a broad-brimmed hat, wear UV-blocking sunglasses and wear a broad-spectrum daily sunscreen that has an SPF of 30 or higher and is water-resistant,of which you should check the expiration date, Sarnoff told Myers.

The study also found that nearly 40 percent of sunscreen users didn't know whether their sunscreen provided broad-spectrum protection.

"Broad-spectrum means that the sunscreen protects the skin from both UVA and UVB rays. UVB rays are responsible for sunburns, while UVA rays go deeper into the skin, causing sagging and wrinkling. It is believed that both UVA and UVB rays play a role in skin cancer," Myers writes.

"To take advantage of the full protection your sunscreen offers, it should be applied thickly to all exposed skin and reapplied every two hours and after swimming, sweating, and toweling off," Dawn Holman, lead author of the study, told Myers. "Sunscreen is most effective when paired with other forms of sun protection."

Holman recommended products with physical blocks, such as titanium dioxide and zinc oxide, for those who shy away from sunscreens because they fear the chemicals in them. She also told Myers that everyone should avoid midday sun exposure because that is when the UV rays are most intense and encouraged people to check the UV index before going outdoors, saying, "The higher the UV index, the more sun protection you will need."

Skin cancer is the most common cancer in the United States, according to the CDC. The most severe form, melanoma, causes more than 9,000 deaths a year in the United States, Myers reports.

Saturday, May 23, 2015

Congress is taking on opoid abuse and the nationwide increase in drug overdoses

Federal officials have become increasingly concerned about the rapid increase in drug overdoses across the country. The House Energy and Commerce Committee, in a series of hearings on the topic, is looking at how states are dealing with this problem. The next meeting is scheduled Thursday, May 28.

Senate Majority Leader Mitch McConnell and Sen. Ed Markey of Massachusetts, in a bipartisian effort, wrote a letter to Department of Health and Human Services Secretary Sylvia Mathews Burwell this week, asking her to call on the surgeon general to address opoid abuse and made a request for more information regarding its recently announced initiative to reduce opoid-related deaths and addictions, according to a press release.
"This crisis of opioid related overdoses strikes without regard to geography, age, race, or socio-economic status and it requires an immediate and sustained response," McConnell said in a statement, calling opioid abuse a "public health crisis."

In the final hours of the last legislative session, Kentucky passed a bipartisan heroin bill that included an emergency clause for it to take effect immediately. This new law allows judicial discretion to determine if low-level traffickers should go to jail or be ordered to treatment; stronger sentencing for high-volume dealers; increased money for treatment; optional needle exchange programs; a "good Samaritan" provision; and increased access to Naloxone, a drug that can reverse the effects of an overdose.

Opoid-related overdose deaths are largely caused by prescription drug and heroin.

In Kentucky, of the 722 deaths autopsied in 2013, 230, or 32 percent, were attributed to heroin, compared to 143, or 20 percent in 2012, according to the 2013 Overdose Fatality Report.

Nationwide, the death rate from painkiller overdoses nearly quadrupled between 1999 and 2013 and heroin related deaths increased by 39 percent and the number of Americans seeking treatment for painkiller addiction has increased by 900 percent since 1997, according to the release.

Indiana's health commissioner, Jerome Adams, is scheduled to speak at Thursday's House committee meeting to discuss the state's recent HIV and hepatitis C outbreaks, which is tied to needle sharing among drug users. Adams will discuss the state's needle exchange programs, which was put in place to help combat this problem.

Friday, May 22, 2015

Video streaming for consultation with doctors expands and becomes more popular; 2 Ky. insurers use it and another plans to

In the past, people had to go to the emergency room to receive medical attention if they required it outside the usual hours for doctors. Now telemedicine programs such as KentuckyOne Health's "Anywhere Care" and Anthem BlueCross BlueShield's "LiveHealth Online," Kentuckians can access a doctor 24/7 through a computer or mobile device.

Photo from The Lane Report
"Patients like telemedicine because it's fast and easy to use and cheaper because it's a low-overhead service," Esther Zunker writes for The Lane Report, a Lexington-based business magazine.

UnitedHealthCare, a Minnesota-based health benefits provider for many people in Kentucky, plans to cover Skype-based doctor visits through "NowClinic," "Doctor on Demand" and "American Well." Anywhere Care and Live Health Online give clients a list of certified doctors they can chat with through video on a computer or a mobile device. The doctors can provide diagnosis and treatment and even write a prescription. They can direct patients to an emergency department if necessary.

It's affordable, too. A LiveHealth Online appointment costs the same as an office visit for eligible members. LiveHealth doctors usually charge $49 per online "visit." Anywhere Care costs $35 per visit, even if patients don't have insurance.

"As we know, care can be limited and is based on being able to get someplace when [a doctor] has an opening," said John Jesser, Anthem's vice president of provider engagement strategy. "They only have certain hours, and that doesn't always work for when people don't feel well. [Telemedicine] expands access to care for the consumers, making it much more friendly to their schedule and lifestyles."

Telemedicine is also convenient for doctors. It saves money for hospitals and allows one doctor in one location to help patients in a variety of locations. Patients can receive help with chronic conditions over periods of time without having to travel to the doctor's office.

"We've had amazingly positive feedback from patients who have tried this service," said Kathy Love, director of strategy and business development for KentuckyOne Health's Central East Kentucky Market. "People have told me they've used it multiple times when they've needed it . . . either late at night or over the weekend."

She also said people who use telemedicine still need a primary-care physician: "It's something you can access 24 hours a day with a very minimal wait and very professional providers, but it shouldn't replace your very important relationship with your primary-care doctor." (Read more)

Thursday, May 21, 2015

Deep in the brain may lie the secret of why some smokers quit easily and some find it nearly impossible

When a person tries to quit smoking, the cravings, headaches and lethargy that come from the nicotine withdrawal makes it near impossible for many to be successful. But this lack of success could also be a result of how a smoker's brain is wired, according to a study from Duke University.

The study, published in the journal Neuropsychopharmacology, used magnetic resonance imaging to look at the brain activity of 85 smokers who smoked at least 10 cigarettes a day.

Image from CNN (Click on it to see a larger version)
MRI revealed that "people who had stronger connections between two regions of the brain -- one involved in reward and the other in controlling impulsive behavior-- were more likely to be successful at giving up smoking, at least for 10 weeks," Carina Storrs reports for CNN.

"This is the largest study to date where we've attempted to identify neural markers, or predictors, of later success in quitting smoking," Joseph McClernon, associate professor of psychiatry and behavioral sciences at Duke, who led the current study, told Storrs.

The scans were taken one month before the quit date. Then, on their quit date, participants were given nicotine patches and were asked to check in with the researchers to report any relapses over the following 10 weeks.

The study found that the "key difference" was that those who were able to quit had more activity in the insula, a prune-sized section that lies deep in the brain, than those who did not quit.

Researchers can't explain why,but speculate that the insula "acts like a bridge, connecting the reward region with the behavior control regions," Storrs reports, noting that it has also been linked to other types of drug addictions such as alcoholism.

This study offers hope that doctors might come to identify smokers who have poor connectivity in their insula and offer them treatment to strengthen this connectivity. That could be good news for Kentucky, where almost 30 percent of adults smoke and many are trying to quit. Forty-five percent of Kentuckians reported in the CDC's Behavioral Risk Factor Surveillance System that they had tried to quit in 2012.

Jonathan Foulds, professor of public health sciences and psychiatry at Penn State, was not so hopeful, telling Storrs that not enough is known about specific treatments to tell whether they will increase insula connectivity, and that any such treatments will likely "not be affordable options anyway."

One of every three U.S. adults have a combination of risk factors that increase their risk for heart disease and diabetes

More than one-third of adults in the U.S. have a combination of health conditions that put them at higher risk of heart disease and diabetes, and this condition affects nearly half of adults aged 60 and older, according to a new study recently published in the Journal of the American Medical Association.

This combination of health conditions, when found in one person, is called metabolic syndrome. It includes abdominal obesity, high blood pressure, increased fasting glucose levels and abnormal cholesterol levels.

The study collected data gathered by the federal Centers for Disease Control and Prevention from adults 20 and older from 2003 to 2012. It found that about a third had a metabolic symdrome in 2011-12, and nearly half of those 60 and older did. Among those 20 to 39, the rate was 18 percent.

The study report says these were "concerning observations" because of the country's aging population. Hispanics, at 39 percent, were found to have the highest prevalence of metabolic syndrome among ethnic groups. Women had a higher prevalence than men in all age groups.

The American Heart Association says the best way to control the risk factors contributing to metabolic syndrome are to lose weight and increase physical activity. It also encourages patients to routinely monitor their weight, blood glucose, cholesterol and blood pressure and treat these risk factors according to established guidelines.

Wednesday, May 20, 2015

Regan Hunt, executive director of Kentucky Voices for Health, leaves for a new position at insurer Humana Inc.

The executive director of Kentucky Voices for Health, a group that worked for the implementation of the Patient Protection and Affordable Care Act, is now working for Humana Inc. as a product development consultant.

Regan Hunt
Regan Hunt switched jobs after working in a way that won her the Consumer Health Advocate of the Year Award by Families USA, which cited her work for expansion of Medicaid in Kentucky and her efforts to increase health coverage under the Affordable Care Act. In her new job, she will be a product development consultant, working on design of benefits for those covered by the Medicaid expansion.

During her time at KVH, Hunt worked with a coalition of more than 200 partners to address the many health care needs of Kentuckians, including access, prevention, quality and value. Hunt said in an interview that she was most proud of  KVH's role in enrolling so many Kentuckians in coverage during 2013-15.

"Kentucky is one of those states that did it right," she said.

Hunt said that she was also proud of the group's collaboration between Gov. Steve Beshear, the state Cabinet for Health and Family Services: "We all worked together and that was an amazing thing ... all working together to make sure that people got the information that they needed and got covered. ... It was a once-in-a-lifetime sort of thing." KVH is not a lobbying group, but many of its members are.

At Humana, Hunt will research the Medicaid expansion landscape in other states to determine what new beneficiaries that population might need or want in a benefits package, beyond what is required by law.

"I am an advocate, probably until the day I die," she said, noting that she will now work as an individual advocate, instead of under the umbrella of KVH, to help people gain access to health coverage. "I've been doing that since I was 22, so it is not something that I am going to give up doing."

Hunt is a native of Pike County, She earned her undergraduate degree at Transylvania University and her Masters in Public Administration degree from the University of Kentucky. She also holds a certificate in health-care management from the University of North Carolina, according to the KVH website.

Sunday, May 17, 2015

Lexington Herald-Leader says Kentucky Hospital Association report on members' finances damages the group's credibility

The Kentucky Hospital Association's recent "Code Blue" report on its members' finances is a symptom of "financial hypochondria," the Lexington Herald-Leader said in a long editorial Sunday. It said the title, "signaling a patient needs resuscitation, is an unintentionally fitting title because the KHA's credibility could use a little CPR."

Read more here:

The report "voices a universal human desire: more money, less accountability. The association implies that federal financial penalties aimed at reducing harm to patients are too onerous for hospitals that care for Kentuckians," the editorial says. "Little more than anecdotes are offered with no acknowledgment that some Kentucky hospitals are recording record bottom lines and steep drops in uncompensated care."

The newspaper offered its own anecdote, a large one, noting that the University of Kentucky's medical center is a major beneficiary of the Medicaid expansion under federal health reform: "The 2014 period saw an 83 percent drop in non-paying inpatients, a 66 percent drop in non-paying outpatients and a $60 million increase in Medicaid revenue. UK Healthcare's annual net income through March is up $70 million over the same time last year. Not all of that increase is due to the Medicaid expansion or Kynect," the state exchange for enrolling in Medicaid or buying private insurance.

"The important point," the paper says, is that "Slowing down spending on hospital care is one of the best things we can do for the economy and our health. The United States spends the highest percentage of its GDP on health care of any country but gets worse outcomes. Even by U.S. standards, Kentuckians over-utilize hospital care."

Read more here:

Saturday, May 16, 2015

CDC says SOAR should focus on substance abuse, obesity and diabetes; idea of mountaintop mining study is largely ignored

By Melissa Patrick
Kentucky Health News

Shaping Our Appalachian Region, the bipartisan effort to revitalize and diversify Eastern Kentucky's economy, will focus its health efforts on substance abuse, obesity and diabetes, SOAR Executive Director Jared Arnett told Kentucky Health News.

"We believe they have the greatest impact on our ability to create jobs and build a world class workforce," Arnett said in an email. He said David Roberts of the federal Centers for Disease Control and Prevention, determined the priorities after spending three months at the SOAR office in Pikeville.

The priorities differ from those put forth by SOAR's Health Working Group, which made two major recommendations after a series of public forums: a coordinated health program in schools, and a study of the health effects of large-scale surface mining. However, when SOAR published the working groups' ideas a few weeks later, it listed only the "shortest-term recommendations" and did not include the mining study. No recommendations appear on the health group's webpage.

At the health session of SOAR's "Strategy Summit" May 11, Dee Davis of the Whitesburg-based Center for Rural Strategies asked the moderator/presenter, Jennifer "Jenna" Seymour of the CDC, what if anything was being done about the recommendation. Seymour replied that she wasn't aware of it, Al Cross reported for the Appalachian Kentucky page of The Rural Blog.  

"That dismayed me," Cross writes. Later, upon raising his hand and being recognized by Seymour, he told her and the audience that it was "disconcerting and almost unbelievable" that she was unaware of the recommendation about mountaintop mining. Seymour replied that she had, in fact, heard about it.

Cross wrote, "Noting that the Pike County Fiscal Court Room was nearly full, I told Seymour that a lot of people had attended meetings and made their concerns known, and that even though this issue was "a hot potato," because of the coal industry's role, she needed to "go back to the powers that be, and tell them there's a room full of people who want answers."

Cross wrote that he was not for or against a study on the health effects of mountaintop mining, and " Unless they're writing opinion pieces, journalists aren't supposed to take sides," he wrote. "But they do need to speak up when issues of broad community concern aren't being addressed, especially when those concerns have been solicited."

The SOAR working groups concluded their meetings last summer and submitted their final reports. Since then, the SOAR executive board has decided to launch a SOAR Advisory Council and hold annual roundtables, or more as needed. They have made a request for a community health representative to be appointed to serve on this council, and Arnett said he expects this person to be appointed by June 1 or so. 

In addition, a follow-up CDC representative will be assigned to the SOAR office for one year beginning in late summer to help put together a strategic plan to address the three areas of focus recommended by the CDC at the summit. This person will also lead a Community Health Action Team for SOAR to work on building a blueprint for improved public health in the region, Arnett said.

"We are focused on working with our corporate partners and the Community Health roundtable to address these issues identified by the CDC on what can have the broadest reach and the greatest impact," Arnett said. A full report of all of the CDCs recommendations is expected in the near future, he said.

Law requires equal access to mental-health and drug-abuse treatment, but is not always obeyed; Ky. says it's working on issue

By Melissa Patrick
Kentucky Health News

By law, mental health benefits must be offered equally to medical and surgical benefits if the plan offers them, but this isn't always the case.

Not only does a 2008 federal law require most employer-sponsored plans to provide equal access to mental health benefits, but that parity was expanded and strengthened in 2010 by the Patient Protection and Affordable Care Act. Twenty-three states, including Kentucky since 2000, require some level of parity.

Common requirements of these laws prohibit insurers from charging higher co-payments and deductibles for mental-health services; require insurers to pay for mental-health treatment in the same scope and duration as medical treatments; ban insurers from requiring additional authorizations for mental-health services; and says they must offer an equal number of mental-health providers and approved drugs.

While insurers typically keep track of the copayment and deductible requirements, they struggle with keeping track of the compliance requirements related to actual delivery of medical services, Michael Ollove reports for Stateline.

The spokeswoman for the Kentucky Department of Insurance, Ronda Sloan, said in an e-mail that Kentucky is very diligent about parity requirements. "Kentucky insurance companies must cover mental-health treatment like other covered services," she wrote. "We review both provider networks and drug formularies for compliance and (make sure) both meet the requirements of the ACA."

A recent report by the National Alliance on Mental Illness found that this isn't always the case. Nearly one-third of those surveyed were denied authorization for mental health and substance abuse treatment, with this rate nearly twice as high for those on ACA plans.

It also found other barriers to care including the number of mental health providers in health insurance plan networks; more than half of the health plans analyzed covered less than 50 percent of anti-psychotic medications; high out-of-pocket costs for prescription drugs; high co-pays, deductible and co-insurance rates; and a lack of information about mental health coverage to consumers to help them make informed decisions in choosing their health plans.

The survey was conducted by Avalere Health and is based on a survey of 2,720 individuals with mental illness or with someone in their family with mental illness and an analysis of 84 insurance plan drug formularies in 15 states.

Sloan said that in Kentucky, "Work is being done on many fronts to increase access and progress is being made to address some of the access issues."

She said Kentucky monitors provider networks to make sure they are meeting their minimum requirements. She also said that a recent law passed by the 2015 General Assembly, which created three levels of drug and alcohol counselors with varying degrees of  certification, will have a "positive impact" on access to treatment.

Gwenda Bond, spokeswoman for the state Cabinet for Health and Family Services, said in an e-mail, "We also opened the provider network for behavioral-health services in early 2014 to a range of private providers of such services, increasing the number of options available for members, who previously could only receive treatment through the community mental health centers."

One of the main obstacles for consumers and providers is that it is not clear what criteria insurance companies and managed-care Medicaid organizations use to determine medical necessity for mental-health and substance-abuse care, and aren't transparent with this information.

"Without that information," Ollove wrotes, "it is difficult for regulators and consumers to determine whether the denial of coverage is warranted." 

Ollove also notes other problems include the federal governments delay in creating regulation guidelines, the challenges states and the federal government have had in simply implementing the ACA, let alone regulating parity and the stigma that is still associated with mental illness and addictions that make regulators not want to get involved.

Two states, New York and California, are leading the way in enforcing parity rules, Patrick Kennedy, a former Democratic congressman from Rhode Island, told Ollove, saying that they were the "only states that consistently enforce mental health parity."

Sloan took issue with that, saying, "We believe Kentucky consistently enforces the rules related to mental health and substance abuse parity." 

Kentuckians who believe they have been improperly denied mental-health and substance-abuse care should contact the Department of Insurance.

Friday, May 15, 2015

3,047 got private health insurance in special March-April signup designed to avoid or reduce tax penalty for not being covered

More than 3,000 Kentuckians signed up for health coverage during a special March-April enrollment period that allowed them to avoid or reduce tax penalties for being uninsured.

"At the Feb. 15 close of the 2015 open enrollment period, 158,685 individuals had enrolled in health care coverage through Kynect for 2015," a state press release said. "That number included 102,830 Kentuckians who have either newly enrolled in a qualified health plan since Nov. 15, 2014, or renewed the private insurance plan they purchased through Kynect last year."

With the additional 3,047 enrollments, the final enrollment in private health insurance was 105,877. The federal tax penalty for being uninsured in 2014 was $95 for each adult household member or 1 percent of income, whichever is greater. In 2015, it will be $325 for each adult or two percent of income, whichever is greater. Penalties for not insuring children are half those for adults.

“Given that the personal risks of not having health coverage are even greater than the penalties, we decided to continue a special enrollment period to allow those individuals more time to sign up,” Gov. Steve Beshear said in the release.

Those who took advantage of the special enrollment period will still owe a penalty for any months they were uninsured and did not qualify for an exemption in 2014 and 2015. "This special enrollment period was designed to allow such individuals the opportunity to get covered for the remainder of the year and avoid additional fees for 2015," the release said.

Tuesday, May 12, 2015

Louisville elementaries part of 'up to date' health curriculum study

Jefferson County Public Schools have partnered with researchers at the University of Virginia to study how integrating bi-weekly health and wellness instruction into its elementary curriculum will affect students over the years.

“Our aim is to test – using the best scientific methods – a health education curriculum that is up to date on skills children need for the coming world, and that can have important impact on school engagement and achievement, mental and physical health, and long-term well-being," Patrick Tolan, project leader and professor and director of Youth-Nex, U.Va.'s center to promote effective youth development, associated with the Curry School of Education, told WVIR-TV in Charlottesville.

The Compassionate Schools Project will offer "a 21st-century health curriculum," which includes "mindfulness for stress management and self-control; contemplative movements for physical awareness and agility, nutrition knowledge for healthy eating, and social and emotional skills for effective interpersonal relationships," for all K-5 students in 25 schools by fall 2016. It is being preceded by an introductory year in three schools.

Twenty-five other schools will participate in the research as control schools, where the existing “practical living” curriculum will remain in effect. The Virginia researchers will evaluate the impact of the curriculum for six years, which is expected to include more than 10,000 students.

According to the researchers, "the ability to implement this curriculum at such a large scale will provide sound evidence of how the curriculum works, for whom, and in what areas of academic, behavioral and emotional well-being over the course of several years."

The program was created by the U.Va. in partnership with the Sonima Foundation and with support from the Hemera Foudation, and is funded by private donors.

Monday, May 11, 2015

Supporters of smoking bans fear letter from Ky. Association of Counties will halt local efforts to pass such measures

An insurer's letter has warned counties that they may face rate increases if they are sued about local ordinances, including those against smoking. According to a legal consultant to the Kentucky Center for Smoke-free Policy, the letter from the Kentucky Association of Counties "does not square with laws and a Supreme Court decision under which local governments have authority to bar smoking in public buildings," Bill Estep reports for the Lexington Herald-Leader.

In February, the McCreary County Fiscal Court voted 4-1 on first reading for an ordinance to ban smoking in public buildings. After KACo sent the governing body a letter warning them of higher premiums, the ordinance died on second reading, Judge-Executive Doug Stephens said. "Stephens said that some residents objected to the law after the first vote but that the notice from KACo was certainly a factor in the decision to drop the issue," Estep writes.

The letter may also discourage other counties and cities from passing ordinances to protect people from exposure to secondhand smoke, said Ellen Hahn, a professor of nursing at the University of Kentucky and head of the Center for Smoke-free Policy.

However, Denny Nunnelley, KACo's executive director and chief executive officer, said the association didn't intend to discourage counties from passing such laws, Estep reports: "Nunnelley said . . . KACo officials thought it made sense to send a reminder that lawsuits challenging ordinances could result in higher insurance costs."

The letter, which addressed smoking in public places, same-sex marriage, right-to-work laws and minimum wage, was sent to all 113 counties for which the organization provides coverage.

One issue with the letter is that the state constitution, state law and a state Supreme Court case all clearly state that counties have the authority to pass and enforce smoke-free laws, said Judy Owens, a lawyer and consultant for the smoke-free policy center. (Read more)

'Mind Matters' Health Fair in Lexington May 18 will focus on brain and nutrition; famous chef will make free "brain healthy" food

Ouita Michel
Nationally known Bluegrass chef Ouita Michel of Midway, who owns seven Lexington-area eateries, will be cooking up free "brain healthy" food at the seventh annual "Mind Matters" Health Fair Monday, May 18 at the Fayette County Extension Office, 1140 Red Mile Place, Lexington.

The fair, sponsored by the University of Kentucky's Sanders-Brown Center on Aging, will run from 10 a.m. to 2 p.m. Its focus of this year is proper nutrition for a healthy brain, providing information on how diet can help promote healthy brain aging and prevent age-related brain disease.

In addition to Michel's free "brain healthy" food, the event will also feature interactive exhibits, health and memory screenings, and presentations about healthy brain aging, Alzheimer's and music therapy.

The event is free and open to the public. For more information contact Sarah Tarrant at (859) 323-1331.

Kentucky led the nation in hepatitis C cases in 2013; state's rate rose 357 percent from 2007 to 2011

By Tim Mandell
Kentucky Health News

Kentucky had the nation's highest rate of hepatitis C in 2013, with 5.1 cases per every 100,000 people, says a report by the federal Centers for Disease Control and Prevention. As many as 3.5 million people in the U.S. have hepatitis C and more than 56,000 Kentucky resident may have chronic hepatitis C infection, according to the state Cabinet for Health and Family Services. The main cause of hepatitis C is shared needles among intravenous drug users.

Hepatitis C cases rose 364 percent in Kentucky, Tennessee, Virginia and West Virginia from 2006 to 2012. The big increase was in 2007-11, when the rate rose 357 percent, a CDC state health profile says.

"Of the cases that have been reported and researchers gathered data about potential risk factors, 73.1 percent reported injecting drugs," Brian Wu reports for Science Times. Among new cases, 44.8 percent were people under 30.

While officials said HIV rates are low in the four Appalachian states, they said they fear that the increase in hepatitis C cases could lead to a rise in HIV cases, Wu writes. Officials said needle-exchange programs are key to reduce the number of potential HIV cases. Kentucky recently authorized such programs if local officials agree to them.

"About 4.5 million Americans older than 12 abused prescription painkillers in 2013 and 289,000 used heroin, according to the Substance Abuse and Mental Health Services Administration," Liz Szabo reports for USA Today. "About 75 percent of new heroin users previously abused opioid painkillers. The number of first-time heroin users grew from 90,000 people in 2006 to 156,000 in 2012, according to the CDC."

Kentucky has the third highest drug overdose mortality rate in the U.S., with 23.6 deaths per 100,000 people, says the 2013 report "Prescription Drug Abuse: Strategies to Stop the Epidemic," reports Trust for America's Health. "The number of drug overdose deaths—a majority of which are from prescription drugs—in Kentucky quadrupled since 1999 when the rate was 4.9 per 100,000."

Sunday, May 10, 2015

Kentucky hospitals say they're losing money on Obamacare, as cost of treating new Medicaid patients exceeds reimbursements

By Melissa Patrick
Kentucky Health News

Kentucky hospitals are struggling financially because of the billions of dollars in cuts caused by the implementation of the Patient Protection and Affordable Care Act, and many aren't sure they will survive, the Kentucky Hospital Association said at its annual meeting May 8.

KHA applauded the successful implementation of the federal health reform in Kentucky, which has extended health insurance coverage to approximately 500,000 more Kentuckians, mainly through expansion of Medicaid, but said that has come at a "significant cost to our commonwealth hospitals."

"The expansion [of Medicaid] has infused money into some of our hospitals, which is good, but the rest of the story is the cuts," KHA President Michael Rust said.

KHA Chair Dennis Johnson, CEO of Hardin Memorial Health in Elizabethtown, said  the revenue from the expansion "is less than the cuts Kentucky hospitals will experience in order to finance the ACA."

Kevin Halter, KHA's incoming chair and CEO of Our Lady of Bellefonte Hospital in Ashland, said, “Much has been made about the fact that Kentucky hospitals have received an additional $506 million in Medicaid payments last year through the expansion, suggesting that hospitals' bottom lines are healthier as a result, but what is often not mentioned is that hospitals lose money on every Medicaid patient they treat.”

The report says that changes in the way hospitals are paid under Obamacare are projected to result in the loss of almost $7 billion in federal cuts to Kentucky hospitals through 2024:
  • Lower-than-cost Medicaid and Medicare reimbursements, 82 percent and 86 percent respectively, with actual Medicaid and Medicare payment cuts from 2010 to 2024 projected to be $4.6 billion
  • Readmission penalties, which can be as much as 3 percent of Medicare payments, imposed on hospitals that readmit patients within 30 days of discharge, regardless of the reason
  • Medicare cuts to hospitals that have any increase in hospital-acquired infections
  • Cuts, delayed until 2017, in extra payments to hospitals that have a "disproportionate share" of Medicare and Medicaid patients.
KHA also cited impacts that aren't associated with the reform law, such as sequestration, or automatic across-the-board federal budget cuts, and other cuts in Medicare.

Hospital officials said that rural hospitals have been hit hardest by these changes because 72 percent of their patients are on Medicaid or Medicare. A recent report by state Auditor Adam Edelen found that 68 percent of Kentucky's rural hospitals have below-average of poor financial health, with 34 percent of the total in the latter classification.

Part of the problem is that the law was built on the nationwide presumption that about half of the newly insured would have private health insurance and the other half Medicaid, but in Kentucky, a poor state, 75 percent of the newly insured are covered by the Medicaid expansion, which covers those earning less than 138 percent of the federal poverty line, or about $33,000 for a family of four.

Halter said while hospitals got $506 million for treating patients covered by the expansion, that treatment costs the hospitals $617 million to deliver that care. While low Medicaid reimbursement is not a new problem, Johnson said, "There's no question it's been accelerated under the ACA."

Gov. Steve Beshear said expanded Medicaid payments had "blunted the impact of other fiscal pressures on hospitals. . . . We are very aware of the challenges that medical providers face in Kentucky. Rather than trying to turn back the clock and return to old business practices, we are working directly with providers to help them develop new strategies for better, more efficient, quality health care delivery."

The challenges are real.

A September 2014 survey found that more than 65 percent of the 109 responding Kentucky hospitals had reduced staff since June 2013, eliminating more than 7,700 positions, with more jobs lost in rural hospitals than the urban ones. About 44 percent had frozen or reduced wages, and 40 percent of had cut costs by reducing or eliminating programs, such as closing psychiatric units and outpatient clinics.

"The reality is that hospitals are being forced to reduce costs to deal with these financial pressures," said Charles Lovell, CEO Caldwell Medical Center in Princeton. "This is the third year without our employees getting an increase."

While Obamacare has reduced hospitals' losses on patients who can't pay, Halter noted that 12 percent of Kentuckians remain uninsured, and the report said hospital emergency rooms are still the first choice for many new Medicaid patients because they have't found a regular physician. Many Kentucky counties are short of doctors.

Kentucky had biggest increases in binge drinking, heavy drinking and any drinking from 2005 to 2012, first county-level study shows

By Melissa Patrick
Kentucky Health News

Kentucky has a relatively small percentage of drinkers compared to the rest of the nation, but it appears it is leading the nation in the increases in the percentage of people who are drinking any alcohol, drinking heavily and binge drinking, especially among women, according to a new analysis of county-level drinking patterns in the U.S.

The study took a look at any drinking, heavy drinking and binge drinking at a state and county level and found that Kentucky leads the nation in the percentage of increase in all three categories. Kentucky showed a 17.6 percent increase in any drinking, compared to no national increase; a 60.8 percent increase in heavy drinking, compared to 17.2 percent nationally; and a 29 percent increase in binge drinking, compared to 8.9 percent nationwide, between 2005 and 2012.

"It is surprising that there has been such a big increase in Kentucky in more people drinking," Ty Borders, professor of health management and policy at the University of Kentucky, said in an interview. "I'm not sure why that would be, especially because it was the only state that had this really big increase in drinking and risky drinking. ... It just really doesn't make sense."

Borders was perplexed at these outcomes, especially for the "any drinking" category, saying that because there is a greater percentage of persons who are members of religious affiliations that forbid drinking in the Southeast, people in this region tend to drink less. He expressed more confidence in the state and national estimates than the county-level estimates because of the often low response rates generated by the Behavioral Risk Factor Surveillance System on which the county estimates are based, but he said, "This is the best we have at the county level." The system is a continuous national poll by the federal Centers for Disease Control and Prevention.

Allen Brenzel, medical director for the state Department for Behavioral Health, Developmental and Intellectual Disabilities, emphasized in an interview that while Kentucky is well below the national alcohol abuse averages, this report shows an "alarming trend, regarding women particularly."

“It really does show that we need to be careful to not become so preoccupied with prescription drug abuse and opiate abuse,” he said. “We need to realize that alcohol is still a major issue when we see trends like this, we need to rebuild our education, prevention and treatment efforts.”

Borders agreed. "If you think about the overall burden on the health of the population, alcohol is still the top in terms of the effect it has on our health status and other downstream factors such as loss work productivity and also health-care costs," he said. "A lot of attention has been focused on obesity and illicit drug use, but alcohol misuse really remains a very big public health concern and it should be at the forefront of issues that we are discussing."

Brenzel said that while the BRFSS data is “more intended to be used across states and across regions of the country,” which makes it “a little bit challenging to break it down specifically” to counties, this data does show a statewide “absolute increase from the 2005 levels.”

He also said that this report conflicted slightly with a recent state report that shows a consistent decline in alcohol use and abuse in both boys and girls during the same time period. “Typically, what we see is that trends in children are usually reflected later in trends in adults,” he said.

Brenzel offered several possible reasons for the increases found in the report, but said it would take a while to “drill down” the specifics. He suggested one thing to investigate regarding the increases shown in women is whether it has become more socially acceptable in Kentucky for women to drink, especially with the increased marketing of liquor to women.

He suggested that the increased number of Kentuckians who are in the active military might have influenced the increases shown in this study, saying studies have shown that if a family has someone actively in the military, it tends to have higher drinking rates. He also noted that the socioeconomic strains that occurred between 2005 and 2012 could have also influenced these increases.

The study, "Drinking patterns in U.S. counties from 2002 to 2012," by the Institute on Health Metrics and Evaluation at the University of Washington, was published in the American Journal of Public Health and is the first study to track trends in alcohol use at the county level.

It defined "any drinking" as one drink in the past 30 days, "heavy drinking" as more than one drink a day for women and two drinks per day for men, and "binge drinking" as at least five drinks for men and four for women on a single occasion during the previous 30 days.

The data are adjusted for age, and the county figures reflect statistical modeling to compensate for small sample sizes. Click here for an interactive map of the data, which shows the possible ranges of percentages, reflecting the poll's error margin.

Drinking in Kentucky

The study found that nationwide, Kentucky showed the greatest increase in drinking, with a 17.6 percent (possible range of 10.6 to 25) increase between 2005 and 2012. No other state was even close; Tennessee ranked second at 11.3 percent and Louisiana was third at 9.8 percent. Nationally, there was no percentage increase in drinking during this time frame.

Kentucky women led the nation in increased drinking, at 21.9 percent, with Tennessee women at 17 percent. Kentucky men also led the nation in this category with an increase of 14.6 percent, followed by Louisiana at 9 percent and Tennessee at 7.3 percent.

In 2012, 43.1 percent of Kentuckians drank at least one drink per month, including 36 percent of women and 50.4 percent of men. Nationwide, 56 percent of Americans have at least one drink a month.

Heavy drinking in Kentucky

Kentucky also showed the nation's largest increase in heavy drinking, up 60.8 percent (possible range 39 to 89.5) between 2005 and 2012. Once again, no other state was close. South Dakota came in at 46.5 percent, Nebraska 45 percent, Kansas 44.5 percent and Washington, D.C., 42.2 percent. Nationally, the increase in heavy drinking was 17.2 percent.

Kentucky's increase was driven largely by women, who showed a 68.2 percent increase in heavy drinking. Nebraska (63.8 percent) and Oklahoma's (60.1 percent) women had the next largest increases in this category. Kentucky men also led the nation in this category with a 57.6 percent increase in heavy drinking, followed by Washington, D.C., at 52.1 percent. Other states were nowhere close to these numbers.

In 2012, 7.2 percent of Kentuckians self-reported as heavy drinkers, including 4.6 percent of women and 10 percent of men. Nationwide, 8.2 percent of Americans identify as a heavy drinker.

Heavy drinking is a risk factor for long-term health effects like cancers, liver damage and heart disease, according to the study.

Binge drinking in Kentucky

Kentucky also led the nation in increased binge drinking, up 29 percent (possible range 17.9 to 42.7) between 2005 and 2012, compared to 8.9 percent nationally. Washington, D.C, up 21.4 percent, and Maryland, up 20.8 percent, were next in the rankings for increased binge drinking.

This increase in Kentucky was also driven by women, with 51.4 percent more of them binge drinking between 2005 and 2012, compared to 17.5 percent nationally. This was far ahead of the next two state leading this category, Maryland women at 34.7 percent and Vermont women at 32.3 percent. Men in Kentucky increased their binge drinking by 20.7 percent, followed by Washington, D.C., at 17.9 percent and Kansas at 17.6 percent. Other states were not close.

In 2012, 15.1 percent of Kentuckians self-reported as binge drinkers, compared to 18.3 percent nationally, including 9.5 percent of Kentucky women and 21 percent of Kentucky men.

Binge drinking is commonly linked to higher risk for serious bodily harm like car crashes, injuries and alcohol poisoning and acute organ damage, says the study.

Nationwide, women showed a much faster escalation in binge drinking than men, with rates rising 17.5 percent between 2005 and 2012; men, on the other hand, saw rates of binge drinking increase 4.9 percent, according to the release.

“We are seeing some very alarming trends in alcohol overconsumption, especially among women,” Dr. Ali Mokdad, a lead author of the study and professor at the Institute for Health Metrics and Evaluation, said in a press release. “We also can’t ignore the fact that in many U.S. counties a quarter of the people, or more, are binge drinkers.”

County data

This report is the first to track trends in alcohol use at the county level, and while the confidence level for the county data are lower than the state data, the report found that every Kentucky county experienced increases in rates of drinking since 2005, with Lawrence County recording the largest increase in drinking at 43.5 percent (possible range 21.4 to 67.8).

Kenton County posted the highest levels of heavy drinking in 2012 (13.1 percent, with a possible range of 10.2 to 16.4), and Bracken County experienced the fastest rise in heavy drinking between 2005 and 2012, increasing 94 percent (possible range 42 to 188.8).

Pike County experienced the largest increase in binge drinking for women, climbing 90 percent (possible range 45.9 to 166.6), says the release.

Campbell County had the highest percentage of binge-drinking residents (27.3 percent with a possible range of 23.9 to 31.8), and Lawrence County recorded the fastest increase in rates of binge drinking, rising 52.8 from 2005 to 2012 (possible range 24 to 88.8).

Kentucky Health News is an independent news 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.