Wednesday, December 30, 2015

Bevin picks UK health executive to lead redesign of Medicaid, accuses Beshear administration of lying about expansion's costs

By Al Cross
Kentucky Health News

FRANKFORT, Ky. – Gov. Matt Bevin said Wednesday that a University of Kentucky health executive and former state health secretary, Mark Birdwhistell, will help him design a Medicaid program that "will be a model to the nation." He said he hopes to know by the middle of 2016 whether his new administration can reach an agreement with federal officials on the shape of the program that serves 1.3 million Kentuckians.

Beyond that, Bevin offered little new insight into his plans for Medicaid, which was a major issue in the race for governor. As a candidate, the Republican first said he would abolish Democratic Gov. Steve Beshear's expansion of eligibility for Medicaid under federal health reform, but after state Senate President Robert Stivers, R-Manchester, said the legislature would decide the future of Medicaid, and mentioned Indiana as a possible model to follow, Bevin started talking about modifying the program and using examples from other states including Indiana.

Birdwhistell is UK's vice president for health affairs and was health secretary under the last Republican governor, Ernie Fletcher. He and Bevin said they would work with various stakeholders, including health-care providers, to develop a plan in consultation with federal officials. Bevin said he had discussed the issue with federal Health and Human Services Secretary Sylvia Burwell, who has ultimate authority over the shape of state Medicaid programs because the federal government funds most of the program.

Birdwhistell in 2007 (Herald-
Leader photo by Pablo Alcala)
Bevin said Birdwhistell "will be working on what we can do to customize a solution, something that is truly transformative. . . . This transformation, I think, will be a model to the nation."

In talking about stakeholders, Bevin and Birdwhistell did not mention the General Assembly. Asked on his way out of a press conference what role the legislature would have in designing the program, Bevin said, "Obviously, until we have a plan, there's not much they can comment on."

Minutes later, Stivers went to Bevin's office for what appeared to be an unscheduled meeting, then emerged to say that the administration had been discussing Medicaid with him and other legislators, including Democrats, in the past few days. "He wants everybody to come to the table and have dialogue," Stivers said. "I told them that we could deal with it legislatively," he said, but noted that a 1966 law gives the governor the authority to restructure the program "without legislative approval."

Stivers said there is probably no better person to redesign Medicaid than Birdwhistell, and he said he was not concerned that whatever plan the UK official designs would help larger hospitals like UK's more than smaller hospitals.

Stivers said he hopes the program can include incentives for changes in health behavior, such as smoking, which is the leading cause of Kentucky's low health status. He said the managed-care companies that act like insurers for Medicaid patients are "managing dollars, not managing people." He concluded, "The ultimate goal is to make sure there is health care . . . that is sustainable and covers the same population."

Stivers's Eastern Kentucky district, and those of many other Republican senators, have large percentages of people on the Medicaid expansion, which made the program available to people in households with incomes up to 138 percent of the federal poverty level. About 400,000 are covered by the expansion. (For county-by-county data, go to

Bevin said in his campaign that the state would no longer be enrolling people in Medicaid at the 138 percent level, but the health-reform law makes extra federal dollars available only to states that enroll people up to that level. Federal officials have allowed no state waivers with any exemptions to the 138 percent rule. Asked if he was considering a request to reduce the eligibility level, Bevin said he did not plan to enroll people at 138 percent of poverty "under the existing reimbursement model."

Asked if currently eligible recipients, such as those between 100 and 138 percent of poverty, might be required to have "skin in the game," a term Bevin has used to encompass premiums, co-payments and deductibles, he said, "Ultimately we want to take people from full dependency to a point where they can sustain themselves. . . . I think it's important for us to empower people, because with this comes dignity. We owe people the dignity and self-respect that comes with being able to make decisions for themselves even while they are dependent upon the assistance of others. This is what we will do."

The federal government pays the entire cost of the Medicaid expansion through 2016. States begin paying 5 percent in 2017, rising in annual steps to the law's limit of 10 percent in 2020. Kentucky is expected to need $257 million for its share in the two-year budget that begins July 1.

The Beshear administration, citing a state-funded Deloitte Consulting study, said the expansion would pay for itself through jobs and tax revenue generated by bringing more people into the health-care system, but Health Secretary Vickie Yates Glisson said in Bevin's press release that "Leading Kentucky economists agree that the health-care jobs predicted by the Deloitte study have not materialized, rendering the suggestion that Medicaid expansion pays for itself invalid." The study no longer appears online.

Bevin said of the Beshear administration's claim, "That was a lie, a straight-up, straight-out lie." He added that traditional Medicaid, for which the state pays about 30 percent, will be $128 million over budget when the fiscal year ends June 30.

Beshear replied via Facebook, "All of Kentucky looks forward to the day when our new governor transitions from strident partisan rhetoric and petty name-calling to the real and more difficult business of governing. . . . Medicaid expansion was and remains a smart policy move; it's the most cost-effective way to get the poorest Kentuckians healthy, to shore up our local hospitals,  which were losing huge amounts of money providing indigent care; and to keep our workforce healthy so businesses can grow. And contrary to what Gov. Bevin alludes to, facts and figures show that the reform we implemented is both sustainable and effective. It’s paying for itself, and it’s paying off with better health. Today he proposed a vague solution to an unclear problem with hopes that it may or may not be implemented at some undetermined point in the future – all for reasons of political ideology. Kentuckians deserve better."

Bevin said the share of Kentuckians on Medicaid is "fast approaching" 30 percent, and "That is literally not sustainable financially. The only way in which we are going to allow it to continue in any form – traditional, expanded or otherwise – is to transform the way in which it is delivered." The ultimate purpose, he said, is to help Medicaid recipients "have better health outcomes. That is the purpose, that is the absolute intent behind everything that you're hearing today."

Susan Zepeda, President and CEO of the Foundation for a Healthy Kentucky, said in response to Bevin's press conference, “The governor 's announcement makes clear that current Medicaid rules will remain in place for 2016, as Mark Birdwhistell leads a Kentucky Medicaid waiver design process. The foundation looks forward to contributing to a thoughtful and inclusive process that builds on what other states have learned and on the expertise of Kentucky providers, payers and consumer advocates to assure that Kentucky sustains access to needed care for its residents.”

Tuesday, December 29, 2015

Small, rural hospitals doing more orthopedic surgeries, but their 30-day death rate is one-third higher than that of larger hospitals

Critical-access hospitals, a linchpin of health care in rural areas, are performing many more orthopedic surgeries. But the Medicare patients who get the five most common orthopedic procedures at such hospitals are one-third more likely to die within 30 days than those who get them at larger, general hospitals.

That's what The Wall Street Journal found by reviewing Medicare billing data from 2008 to 2013, which showed a 43 percent increase in surgeries at critical-access hospitals, "far outpacing the growth of those services at general hospitals" and raising "troubling implications for patient safety," says the Christmas Day story by Christopher Weaver, Anna Wilde Mathews and Tom McGinty. From 2010 to 2013, the death rate at such hospitals was 34 percent higher than at the larger facilities.

“Patients are getting bad outcomes, probably because they are getting procedures at hospitals without the experience to do it well,” Ashish Jha, a Harvard University public-health professor who has studied critical-access hospitals, told the Journal. He and his colleagues reviewed the Journal's data and concluded that "the 30-day mortality rate for inpatient joint replacements was about 9 per 1,000 at critical-access hospitals in 2013, compared with around 5 in 1,000 at general hospitals," the newspaper reports.

"Many studies suggest that patients generally get better results when their procedures are done at hospitals that perform them frequently," the Journal reports. "The average critical-access hospital performing inpatient joint replacements in 2013 did about 26 that year, compared to about 132 at general hospitals. Hospitals doing more than 100 procedures a year have the lowest risks, said Nelson SooHoo, an orthopedic surgeon at UCLA’s David Geffen School of Medicine who has studied the issue."

Kentucky has 29 critical-access hospitals. In general, such hospitals must have no more than 25 beds and keep patients no more than 72 hours. In return, the federal government gives them a small bonus on their Medicare and Medicaid payments, part of a policy Congress enacted to maintain the viability of hospitals in rural areas.

"Financial incentives can make doing more surgeries appealing to critical-access hospitals, thanks to their special status with Medicare, especially as the rural hospitals merge with larger rivals," the newspaper notes. "The Journal’s analysis shows that the fastest-growing procedures at critical-access hospitals are often-elective orthopedic surgeries that could otherwise be scheduled at facilities with more experience. Experts say that as the hospitals’ experience grows, patients’ outcomes should improve. But so far, mortality rates have held fast, according to the analyses by the Journal and Harvard researchers."

Sunday, December 27, 2015

Kynect will sell federally subsidized health insurance through Jan. 31, but there will be little or no advertising to tell people about it

Kynect, the online marketplace where Kentuckians can buy federally subsidized health insurance, will remain open for enrollment through Jan. 31. But you will see little if any more advertising for it.

The new administration of Gov. Matt Bevin directed Louisville advertising agency Doe-Anderson Inc. on Dec. 18 to cancel pending advertising, a Cabinet for Health and Family Services spokeswoman told Deborah Yetter of The Courier-Journal. "The campaign was funded with federal money," Yetter notes. The ad buys for January included more than $95,000 in 52 Kentucky newspapers, according to the Kentucky Press Association.

"Bevin spokeswoman Jessica Ditto said the administration of former Gov. Steve Beshear on Nov. 2 sought approval for an extension of the Doe-Anderson contract beyond Nov. 30, but it was rejected by the state Finance and Administration Cabinet," Yetter reports. "Ditto said the Bevin administration does not know why the Finance Cabinet rejected the extension 'but there does not appear to be any legal basis to continue the contract.' Pamela Trautner, a spokeswoman for the Finance Cabinet, was unable to provide further information Wednesday as to why the contract extension was rejected."

Bevin was elected Nov. 3 after promising to dismantle Kynect, a state-operated health-insurance exchange that has been cited as a national model. He says it adds no value that cannot be obtained through the federal exchange used by most states.

Kynect advocates note that Kentucky insurance companies and other stakeholders wanted a state-based exchange, partly to ease troubleshooting, and that moving to a federal exchange will reduce by 75 percent the funding for "kynectors," advisers who help people unfamiliar with health insurance buy it. They also note that the federal exchange charges a 3.5 percent fee on each policy sold, while Kynect is funded by a 1 percent fee on all health-insurance policies sold in the state.

Sheila Schuster, chairwoman of Kentucky Voices for Health, a coalition of health advocacy groups, told Yetter she was disappointed that the ad campaign was canceled before the end of the enrollment period. "It really makes no sense," she said. "Why would the state not want people to know they have this option?"

One critic of federal health-care reform, Lexington insurance agent John Bird, said on Facebook that ads after Dec. 15 were a waste of money because that was the deadline to buy policies that would take effect Jan. 1, and "the great majority of Kentuckians" who use Kynect buy policies to take effect at the start of the year.

Dan Burgess, director of public relations at Doe-Anderson, told Yetter that the agency had been asked to refer questions to state officials.

Wednesday, December 23, 2015

Conway gets $24 million from Purdue Pharma to settle Oxycontin claim, $15.5 million from J & J subsidiary in Risperdal case

Purdue Pharma will pay the state $24 million to settle a lawsuit that claimed the drug maker "illegally misrepresented and/or concealed the highly addictive nature of OxyContin and encouraged doctors who weren’t trained in pain management to overprescribe the opioid pain reliever to Kentucky patients," Attorney General Jack Conway announced Dec. 23.

The company did not admit liability, but Conway said, “Purdue Pharma created havoc in Kentucky, and I am glad it will be held accountable. Purdue lit a fire of addiction with OxyContin that spread across this state, and Kentucky is still reeling from its effects.” Bill Estep of the Lexington Herald-Leader notes, "Abuse of OxyContin snowballed in Eastern Kentucky beginning in the late 1990s, driving up overdose deaths."
Read more here:

In 2007, Purdue Pharma and three of its executives pleaded guilty to federal charges in Virginia that they had made misleading claims about OxyContin's potential for addiction. "A judge ordered the company to pay more than $630 million in that case," Estep notes. "The same year, 49 states settled their own claims against the company. Kentucky was the lone holdout. That was because the company offered the state only $500,000, Conway said."

Pike County joined then-Attorney General Greg Stumbo's lawsuit seeking an unspecified amount of damages, and reportedly settled in 2013 for $4 million. The case had been delayed after Purdue Pharma got it moved to federal court, where a judge sent it back to Pike Circuit Court.

Circuit Judge Steve Combs ruled the company had missed a deadline to deny allegations in the suit, meaning it had admitted the claims by default, "giving the state a huge advantage in the case," Estep writes. "The company appealed the ruling to the state Supreme Court, which has not ruled. The company will drop the appeal as part of the settlement."

The settlement calls for Purdue Pharma to make an initial payment of $12 million and eight annual payments of $1.5 million each, with the money after payment of legal fees to be used "to expand addiction treatment in Kentucky," Conway's news release said.

Conway, who was defeated in the November election for governor, is leaving office after the maximum two four-year terms.

Risperdal settlement

Concurrently, Conway announced that Janssen Pharmaceuticals will pay the state $15.5 million to settle a claim that the Johnson & Johnson subsidiary misled consumers about its dangers and marketed the drug for purposes other than those approved by the U.S. Food and Drug Administration.

"Janssen marketed Risperdal to children before it was approved to do so in 2007 by the FDA," the release said. "It failed to disclose to parents, physicians and patients that Risperdal may cause a hormonal imbalance, which could cause breast tissue development and infertility in both boys and girls. Janssen was aware of the risk and did not update the drug’s warning label because it felt awareness of the risks could cost the company up to $150 million per year.

"Janssen also marketed Risperdal for a non-FDA approved use in treating dementia in non-schizophrenic elderly patients. It even created an elder-care sales force, despite having its own study that showed Risperdal doubled the risk of death in the elderly. Risperdal’s label did not disclose this risk to the public until 2003, even though a Janssen-funded trial indicated the risk in 1997. In 2013, Janssen pleaded guilty to federal charges of misbranding the drug regarding the promotions to the elderly.

"Additionally, Janssen marketed Risperdal as an atypical anti-psychotic with low weight gain and diabetes risk. However, its internal studies indicated that after one year, patients on Risperdal had as much weight gain as its main competitor and a greater risk of diabetes."

Tuesday, December 22, 2015

Needle exchanges don't have to involve exchanges of needles, attorney general's opinion says

Users of needles don't have to trade in used ones to get new ones from needle-exchange programs authorized by this year's anti-heroin law, Attorney General Jack Conway said in a formal opinion Dec. 18 and released Dec. 21.

The opinion was requested by state Senate President Robert Stivers of Manchester. He and other Republicans have said the intent of the law was a needle-for-needle exchange, and they are expected to move legislation requiring that in the legislative session that begins Jan. 5.

"Needle exchanges surfaced as a contentious issue when Kentucky lawmakers worked on sweeping legislation this year to combat the state's heroin scourge," Bruce Schreiner notes for The Associated Press. "The goal of needle exchanges is to prevent the spread of HIV and hepatitis C and to steer drug users toward treatment. Kentucky has had the nation's highest rate of acute hepatitis C."

Dr. Sarah Moyer, Louisville's interim public health and wellness director, told the AP that the city's needle-exchange program is following a model that has proven effective across the country in reducing the spread of HIV and hepatitis C. AP reports, "The exchange ratio is down to two syringes handed out for every old needle turned in, she said. As expected, the ratio was much higher early on — about eight or nine syringes provided for every old needled turned in, health officials said."

The opinion, written by Assistant Attorney General Matt James, focused on the Louisville program. He wrote, "As applied in this context, 'exchange' does not require a quid pro quo exchange of syringes; it only requires a benefit to the party promising, or a loss to the party to whom the promise is made." Thus, a program "may exchange the loss of a needle for a promise to participate in the program, and that is sufficient for an exchange in the ordinary sense of the term."

James wrote that if legislators had wanted to require needle-for-needle exchanges, they could have done so.

In a final compromise to pass the bill, the General Assembly required needle-exchange programs to get local-government approval.

Only three programs have been established, in Louisville, Lexington and Pendleton County. Local health officials have failed to persuade officials in several other jurisdictions, including Northern Kentucky and Frankfort. The Frankfort City Commission deadlocked 2-2 on the issue when Commissioner Lynn Bowers, who had seconded the motion to allow the program, abstained after hearing arguments from opponents on the commission. Health officials say they will try again, and The State Journal editorialized in favor of the program.

U of L, Norton Healthcare end battle for control of Kosair Children's Hospital with cooperative agreement

A battle for control of Kosair Children's Hospital, between Norton Healthcare and the University of Louisville, has ended with agreements that give Norton clear control of the facility but give U of L 90 percent of the pediatric residency slots at the hospital.

"The dispute was ignited in August 2013 when Norton announced it would collaborate in pediatrics with the University of Kentucky and its Kentucky Children’s Hospital in Lexington – angering U of L medical school officials," notes Andrew Wolfson of The Courier-Journal. "U of L threatened in an Aug. 27, 2013 letter to evict Norton from Kosair, prompting Norton to file a lawsuit in Franklin Circuit Court. Norton built and operates Kosair Children's Hospital, but U of L uses it as its pediatric teaching and research hospital under a state land lease."

The 1981 lease will get an amendment that "secures Norton’s ownership and control of the hospital," the parties said in a press release. The agreement "says U of L will be Norton’s primary academic partner for pediatrics with at least 90 percent of the Norton’s residency positions at the children’s hospital being made available to U of L," Wolfson writes. "Norton can still pursue other third-party relationships, such as the previously announced intent to collaborate with UK Children’s Hospital, as long as its commitments to U of L are fulfilled."

The agreements became final upon approval by Gov. Matt Bevin and the University of Louisville Physicians group. The deal "also makes it possible for Norton to continue plans for more than $35 million in additional capital improvements to its children’s hospital over the next five years," the release said. "Those plans had been held up due to the litigation."

“This is great news for the Louisville community and the Commonwealth,” Donald H. Robinson, chair of the Norton Healthcare board of trustees, said in the release. “The agreements clear up critical land lease and ownership issues as well as bringing operational security to Norton while assuring stable financial support to the U of L School of Medicine in pediatrics. The real winners here are the families who depend on our children’s hospital for their child’s care.”

The agreement is for eight years and is automatically renewable. Norton will pay U of L $272 million over the next eight years for academic support and physician services, with an extra $3 million a year for "additional pediatric care investments" to be recommended by a committee with equal membership from each side. "U of L also will receive a one-time payment of $8 million to resolve any and all financial disputes from the past," the release said.

Monday, December 21, 2015

Northern Ky. health officials fight outbreak of whooping cough

Whooping cough is spreading in Northern Kentucky. The disease, formally known as pertussis, is mostly "being seen in school-aged youth, but whooping cough is concerning because of the risk of severe illness in infants under age 1," the Northern Kentucky Health Department reports.

The area has seen 31 cases of whooping cough since the start of November, "with 13 cases occurring in the last week of November alone," the department said in a news release. "Most of these cases have been in school age youth age 10 and over, although several cases have been reported in parents of school-aged children as well. Cases have been reported in Boone, Campbell, Grant and Kenton Counties. In comparison, the region had seven cases of whooping cough in all of November and December of 2014."

Dr. Lynne M. Saddler, director of the health agency, said, “This disease is one that spreads very easily through coughing and sneezing, so our concern is that families and friends will gather over the holidays and potentially infect one another. Plus, the early symptoms of whooping cough are similar to the common cold and whooping cough is not often suspected or diagnosed until more severe symptoms appear.”

The outbreak suggested that some children may not have had the required vaccination, which the department said is "the best way to prevent the spread of whooping cough. Parents of young children should make sure that their child has been vaccinated with DTaP, which includes vaccine for tetanus and diphtheria as well. The vaccine is usually given in five doses, administered at two months, four months, six months, 15 to 18 months and 4 to 6 years of age. A booster dose of Tdap is recommended for preteens at ages 11or 12. Vaccine protection fades over time; therefore adults and parents of teens age 10 years of age or older should ensure that Tdap vaccinations are up to date."

Saddler said, “Vaccination with a Tdap is especially critical for school teachers, pregnant women, parents, grandparents and caregivers for infants,” said Saddler. “Although vaccination protects most people against whooping cough, no vaccination is 100 percent effective. Some people who are fully vaccinated may still become infected and have a mild case of the illness. In those instances, it is still important for people who are ill to stay home and avoid contact with others.”

Early symptoms of whooping cough include runny nose, sneezing, low-grade fever and a mild cough. "After a week or two, a persistent cough develops which occurs in explosive bursts, sometimes ending with a high-pitched whoop and vomiting," the release said. "Individuals who have a cough lasting more than two weeks and/or one that progressively gets worse are advised to contact their health care provider for evaluation and avoid contact with others, especially infants, young children, the elderly, and the immunocompromised. If you live with someone who has been diagnosed with whooping cough, or have had prolonged close contact, contact your health care provider as well."

Sunday, December 20, 2015

Kentucky ranks first in deaths from cancer, a longtime fact given big play on the Sunday front page of The Courier-Journal

Kentucky has led the nation in cancer deaths for several years, but that fact hasn't been trumpeted on the front page of a major newspaper in quite the way The Courier-Journal did Sunday, publishing a long story by Laura Ungar that explains the problem in the state and ways to address it.

"The biggest culprit is lung cancer, which strikes and kills Kentuckians at rates 50 percent higher than the national average," Ungar writes, noting the state's high smoking rate. "But Kentucky’s death rates also rank in the Top 10 nationally for breast, colorectal and cervical cancers."

“It’s really been driven by three major things: obesity, smoking and lack of screening,” Louisville gastroenterologist Dr. Whitney Jones told Ungar. “Our state is completely inundated with risk factors.”

How most states rank in cancer deaths (C-J chart)
Other causes include poverty and limited education among many Kentuckians. That makes them less likely to be screened for cancer, and more likely to die from it because it is discovered too late. "Federal figures analyzed by the American Cancer Society show 46.8 percent of Kentucky women 40 and older got a mammogram and clinical breast exam in the past year, compared with around 60 percent in states with the best rates," Ungar writes.

Efforts to increase screening have had the most success against colon cancer. Since the Colon Cancer Prevention Project started 11 years ago, "The screening rate has more than doubled to 69.6 percent, and colorectal cancer deaths are down more than 25 percent statewide," Ungar notes.

A screen for lung cancer has been developed only recently, "and today’s preventive low-dose CT scans for longtime smokers are far less routine than tests like mammograms or colonoscopies and are not always covered by private insurance," Ungar reports.

While smoking is generally blamed for lung cancer, the disease can also be caused by environmental factors, and "up to 20 percent of those who succumb to lung cancer are non-smokers," Ungar notes. "The risk of lung cancer is much higher for smokers exposed to carcinogens such as radon, asbestos, arsenic or chromium. The U.S. Environmental Protection Agency classifies a wide swath of Central Kentucky as having the highest potential for indoor radon gas, the second-leading cause of lung cancer." Research has shown high rates of arsenic and chromium in Appalachia.

"Shortages of doctors and cancer screening and treatment facilities make things even worse," Ungar reports. "A workforce capacity study conducted for the state by Deloitte Consulting in 2013 found that Kentucky needed 3,790 more doctors just to meet pre-ACA demand and would need many more by 2017. Complicating matters, rural Kentuckians often live long distances from specialists and cancer centers, and may face transportation problems as well. . . . The longer the drive to medical facilities, the later cancer is diagnosed."

Some local officials reject needle exchanges and research showing that they don't encourage and enable drug abuse

By Melissa Patrick
Kentucky Health News

Needle-exchange programs were approved this year as part of a landmark heroin bill, but they require local consent, and this caveat is proving to be a challenge because local officials think the exchanges encourage and enable drug abuse, which health officials say is not so.

Syringe Access Exchange Programs, the official name for needle-exchange programs, allow people to exchange dirty needles for clean ones to cut down on needle-sharing among drug users, which contributes to the spread of infectious diseases, particularly hepatitis C and HIV.

Three programs are operating in Kentucky: in Louisville, Lexington and Falmouth in Pendleton County.

Northern Kentucky, hurt most by heroin, isn't ready for needle exchange

In late November, the Carrollton City Council voted 5-0 vote against allowing Three Rivers District Health Department to operate a needle exchange in the county, despite impassioned, fact-based arguments from local health officials, Kristin Beck reports for The News-Democrat in the Carroll County seat.

Jim Thaxton, coordinator of the Northern Kentucky Heroin Impact Response Task Force, made the presentation in favor of the needle exchange to the city council. He said, among other things, that Northern Kentucky has a high rate of intravenous drug use and that the hepatitis C rates in the region are among the highest in the nation.

“I know the gut, emotional feeling that many of you will have is this is enabling,” Thaxton said. “Syringe access exchange programs are not enabling. I thought they were; some people in this room still think they are, but they’re not. The research tells us they’re not. They do not encourage individuals to begin using drugs, they do not increase drug use among existing users and they do not increase crimes in neighborhoods in which the program operates.”

Thaxton argued, "The fear that you have is that you’re going to bring in people to this community that you don’t want here. Folks, they’re already here. They need your help and we’re here to help them."

Carrollton Mayor Robb Adams said he couldn't be persuaded, saying he believed the program will enable drug users and will increase crime in Carroll County, Beck reports.

Thaxton replied, “The people are going to continue to use and they’re going to still have the needles in their cars, in your parks and on the roads. This program, even though we’re giving them the needles, we’re keeping them from spreading the disease and we’re getting needles back."

Adams also said that he believed people from surrounding counties would come to Carrollton to exchange their needles if they were the only area county on board, Beck reports. Thaxton said there are similar concerns in Pendleton County, but that program has seen only seen one person so far.

"Whenever we make a decision from fear, it’s probably a bad decision," Thaxton said. "We have to make a decision based on the facts and the facts [of] over 30 years of research are these programs work" But it was to no avail.

Thaxton gave a similar presentation to the county Fiscal Court and was asked to come back in two months with an update on the status of needle exchanges in other counties, Beck reports.

Resistance to needle exchanges is consistent throughout the region. Similar sentiments were voiced at the Dec. 12 Kenton County mayors' group meeting, Mark Hansel reported for the Northern Kentucky Tribune.

St. Elizabeth Healthcare's CEO Garren Colvin "made a strong argument in support of needle exchange" at this meeting, offering financial support for the program, but not hospital property to house it, Hansel reports. The hospital supports the health department to run these programs.

Colvin made a plea on behalf of the first responders who are "definitely at risk for receiving hepatitis C and ultimately HIV," citing Northern Kentucky Health Department statistics that say there has been an increase of more than 80 percent in acute hepatitis C cases since 2010 due to increased heroin use in the region. He said the average cost of treatment for hepatitis C is about $86,000.

But still, there were no takers.

The Boone County Fiscal Court and the City of Florence "have no intention of approving needle exchange in their communities any time soon," Hansel writes.

In addition, Covington Mayor Sherry Carran said her city decided against supporting needle exchange out of concerns that other cities might not follow with their own exchanges and make Covington a megnet for drug abusers.

There is little support among Northern Kentucky judge-executives, who are needed to muster support for approval from fiscal courts, Hansel writes: "The primary argument against a needle exchange program is that it provides addicts with the tool they need to continue abusing drugs."

Some counties are talking about it

The process of educating law enforcement, other first responders, city officials and the public about needle exchange programs is underway in Daviess County, James Mayse reports for the Messenger-Inquirer in Owensboro.

"We have to educate the public that this is a containment strategy" to prevent the spread of disease, Gary Hall, temporary chairman of the Alliance for a Drug-Free Owensboro & Daviess County, said at a River Valley Behavioral Health meeting.

Hall said a needle exchange would best be established before local health officials see an increase in hepatitis C and HIV infections.

"One thing we need to educate our local officials on is, if we wait, it will be too late," Hall said. "We know there are intravenous users in our community."

Major Brock Peterson, field services supervisor for the Owensboro Police Department, said there will be a perception that a needle exchange "is going to encourage drug use," and said that there was going to be a "huge backlash" against the idea.

The Barren River District Health Department, which serves eight counties in Southern Kentucky, has started educating its county boards of health about the benefits of needle-exchange programs, Alyssa Harvey reports for the Bowling Green Daily News.

"Just to start talking out loud about it is a step forward," Dr. Brian Humble, a member of the Warren County and district boards of health. " Drug use doesn't go up when these programs are implemented. Anything we do is going to be an improvement on the lives of these people and the health of our community."

Other counties have resolutions

Frankfort is considering a resolution that would establish a needle exchange program, which will be up for a vote "at a future commission meeting," The State Journal reports, also noting that the Franklin County Fiscal Court approved a similar resolution last month.

Members of the Jessamine County Agency for Substance Abuse Policy committee signed a resolution in November to encourage the community and the local government to consider creating a needle-exchange program, Ben Kleppinger reports for The Jessamine Journal.

This proposal has the support of county Public Health Director Randy Gooch, but he noted several obstacles. including getting law enforcement on board and educating the community about the benefits of the program

“As the public health director for Jessamine County, this is certainly something that I think we need,” he said.

Programs in action

Louisville is adding a third needle-exchange location at the Redeemer Lutheran Church in western Louisville. The other ones are located at the downtown Public Health and Wellness headquarters and Lake Dreamland Fire Station in southwestern Louisville, Chris Kenning reports for The Courier-Journal.

As of Dec. 3, Louisville's needle exchange has served 1,329 participants and referred 88 people for drug treatment, Dr. Sarah Moyer, interim director of the Metro Department of Public Health, told Kenning. They have also tested 156 people for HIV, so far all negative. Since September, 86 people have been tested for hepatitis C with 52 testing.

Looking to the future, health department officials said they were researching ways to create safe drop boxes for needles in some parts of town.

According to a Nov. 17 Lexington Health Department tweet, Lexington's needle-exchange program has received 2,594 used needles and given out 3,724 clean ones since its opening in September.

Friday, December 18, 2015

Dangerous and stealthy, non-alcoholic fatty liver disease is on the rise, but is reversible with weight loss and exercise

Many Kentuckians and other Americans are walking around with a liver disease that has the potential of progressing to cirrhosis, which can then lead to liver failure, and don't even know it, according to a Houston Methodist Hospital news release.

It's called non-alcoholic fatty liver disease. NAFLD is caused by the buildup of extra fat in the liver that is not caused by alcohol. And while it is normal for the liver to contain some fat, if more than 5 to 10 percent of its total weight is fat, it is considered a fatty liver.

“Data has shown that nearly 30 million Americans have NAFLD. Many times it is missed until the person’s liver enzyme levels are high,” Dr. Howard Monsour, chief of hepatology at Houston Methodist Hospital, said in the release.

Alcohol, drugs, obesity, high cholesterol and diabetes, which are more common in Kentucky than the rest of the nation, can all be causes of fatty liver. The release notes that those with Metabolic Syndrome often also have fatty liver.

Metabolic Syndrome is a combination of health conditions in one person that include abdominal obesity, high blood pressure, increased fasting glucose levels and abnormal cholesterol levels. More than one-third of adults in the U.S. suffer from this syndrome.

Fatty liver in its early stages is harmless, but it can advance to a condition called nonalcoholic steatohepatitis (NASH), then to cirrhosis. But the good news is, if it is caught early, it is a totally reversible condition through slow, methodical weight loss and exercise.

“Much like Type 2 diabetes, NAFLD can be cured with proper diet and exercise,” Monsour said. “If you lose 12 percent of your current weight, no matter how much you weigh, you can eliminate fat from your liver.”

Most people with fatty liver or NASH have no symptoms, but some have fatigue, weakness and loss of appetite, or pain in the center or right upper part of the belly. "These symptoms might also get worse after heavy drinking," the release notes.

Those with fatty liver shouldn't overindulge in food or alcohol because it can make the condition worse, "and possibly lead them straight to a heart disease and/or liver failure," the release warns.

Fatty liver is the leading cause of chronic liver disease and is the third most common reason for liver transplants in the U.S., according to the American Liver Foundation. Between five and 20 percent of people with fatty liver will develop serious liver disease, according to the release

“The key is to catch it early and many times it may not be discovered until a routine checkup,” Monsour said. “If you start to experience symptoms, see a doctor as soon as you can. Letting it go without evaluation can lead to a very difficult, unhealthy life.”

Tips to help diabetics manage the holidays

The holiday season creates some challenging hurdles for those who have diabetes, but they shouldn't ruin the fun if you plan ahead, according to diabetes expert at New York's Stony Brook University.

“People living with diabetes can enjoy the holidays if they manage their disease wisely," Joshua D. Miller, endocrinologist and diabetes expert at the university's School of Medicine, said in the news release. Here are some tips to do just that:

Call your doctor: First, Miller said, make a holiday diabetes management plan with your doctor or dietitian. Let them help you figure out how to fit your favorite holiday treats into your meal plans.

Plan ahead: Especially during the holidays, it is important to pre-plan meals to control calories and carbohydrate content. “During a meal, having a protein and a fiber with your carbohydrate is a great way to control the post-meal high blood sugar that often occurs,” Miller said.

Speak up: Consider letting your host know that you have diabetes and that you might have some dietary requirements. Miller recommends the American Diabetes Association's website to find healthy holiday recipes. “There are plenty of ways to have a healthy, tasty meal that is ‘diabetes friendly’," he said.

Drink alcohol in moderation: Depending on the type of beverage, alcohol  "can raise or lower your blood sugar within hours after consumption," Miller said. He recommends monitoring blood sugars closely if you are drinking alcohol, limiting your intake to one or two servings, skip the mixers which are high in sugar, and talk to your doctor about possible side effects if you manage your insulin with insulin.

Manage your stress: Stress and inadequate sleep can impact blood sugar control, overall health and well-being in those who have diabetes. That's why it is important to make sure you are monitoring your blood sugar regularly and to make sure you carve out some time to "de-stress," Miller said.

Exercise: Keep up with your exercise routine through the business of the season, and as the weather gets cold. "All activity counts and improves both your mental and physical well-being," says the release.

"And remember, the best gift you can give yourself this holiday season is good health," says the release. "So plan ahead, have a good action plan, and enjoy the season."

Ky. inches up in national health ranking, due to more coverage, HPV vaccination; but at 44th, it still has much work to do

Graphics are from America's Health Ranking report
By Melissa Patrick
Kentucky Health News

Kentucky ranked in the bottom 10 states for 12 of the 34 measures ranked by the 2015 America's Health Ranking, placing it in 44th place, up three spots from 47th last year.

The 26th annual ranking, which calls itself "the country's annual health checkup," examines criteria such as behavior, community, environment, policy and clinical care. The report provides a benchmark for how a state's health changes from year to year, but is also meant to fuel dialogue that leads to action.

Kentucky leads the nation in cancer deaths (228.8 per 100,000 people) and preventable hospitalizations (85.1 per 1,000 Medicare beneficiaries). It ranks among the bottom five states for five other measures: smoking, drug deaths, children in poverty, poor mental-health days and poor physical-health days.

Additionally, the state ranked in the bottom 10 states for physical activity, air pollution, diabetes, cardiovascular deaths and premature deaths.

The report also noted Kentucky's strengths: the state has a low violent crime rate, a low prevalence of binge drinking, a high rate of high school graduation, a big decrease in the number of people without health insurance, and a 40 percent increase in female human papillomavirus vaccines, which target the HPVs that most commonly cause cervical cancer.

"A significant drop in the number of uninsured Kentuckians and an increase in preventive HPV vaccinations were two factors contributing to our rise in the annual rankings," Susan Zepeda, president of the Foundation for a Healthy Kentucky, said in news release. Here are some details from the report:

Kentucky has the nation's second highest smoking rate, 26.2 percent, barely trailing West Virginia's 26.7 percent. The national smoking rate is 18.1 percent, down from 19 percent last year. "Smoking is the U.S.'s leading cause of preventable death," says the report.

The state also has the second highest rate of children who live in poverty, at 30.3 percent, a decrease from last year's rate of 31.8 percent. The national rate is 21.1 percent, which is up from 19.9 percent last year. "Children in poverty are three times more likely to have unmet health needs than other children," says the report.

Kentucky's diabetes rate has hovered around 10.6 percent for the past three years, but this year it saw an 18 percent increase to 12.5 percent, causing it to rise to sixth in the nation for diabetes from 18th. The national diabetes rate is 10 percent. Diabetes is the seventh-leading cause of death in the U.S., says the report.

Kentucky's adult obesity rate dropped to 31.6 percent from 33.2 percent last year, causing it to drop to 12th in the nation for adult obesity from fifth. Nationally, 29.6 percent of adults are obese..

During a phone interview in November, state obesity-prevention coordinator Elaine Russell attributed thie drop in Kentucky's rate to the state's many obesity-related initiatives. "It is a comprehensive effort of many different programs, because we are all working toward the same goal to decrease chronic disease and obesity," she told Kentucky Health News.

Kentucky ranks third in drug overdose deaths at 24 deaths per 100,000 (the same rate as last year), compared to 13.5 nationally. Drug overdose is the leading cause of injury death in the U.S., says the report.

"This report is a call to action to make disease prevention a key component of our culture," Reed Tuckson, external senior medical adviser to United Health Foundation, said in the release. "We want to ensure everybody, no matter what state they call home, is empowered to make healthy decisions for themselves, their families and their communities."

Hawaii, for the fourth consecutive year, remains the healthiest state and Louisiana is ranked last.

The report, published by United Health in partnership with the American Public Health Association and Partnership for Prevention, uses data from well-recognized outside sources, such as the federal Centers for Disease Control and Prevention, American Medical Association, FBI, Dartmouth Atlas Project, U.S. Department of Education and Census Bureau.

To see the rankings in full, visit

Lifestyle and environment matter most when it comes to cancer, study suggests; Kentucky leads the nation in cancer deaths

Lifestyle choices and environment may matter most when it comes to your likelihood of getting cancer, according to a new study in the journal Nature, Jen Christensen and Kevin Flower report for CNN.

"Environmental factors play important roles in cancer incidence, and they are modifiable through lifestyle changes and/or vaccination," the authors write.

Basically, the study is a reminder that many of the things people have control over -- smoking, sun exposure, poor diet, use of tanning beds, air-pollution exposure, radiation exposure, and decisions to be vaccinated for a virus that causes cervical cancer -- can play a role in whether a person might get cancer or not.

Kentucky leads the U.S. in cancer deaths, and consistently leads the nation in lung cancer deaths, which kills Kentuckians at a rate 50 percent higher than the national average. It also is ranked in the top 10 nationally for deaths from breast, colorectal and cervical cancer.

“It’s really been driven by three major things: obesity, smoking and lack of screening,” Louisville gastroenterologist Dr. Whitney Jones, told Laura Ungar of The Courier-Journal in recent story about cancer and Kentucky. “Our state is completely inundated with risk factors.”

The good news is that Kentuckians have control over some of the external factors mentioned in the study. The World Health Organization says nearly half of cancers could be prevented if people changed their lifestyle or reduced their environmental exposure to cancer-causing agents.

The study builds on another released earlier this year in the journal Science that said many of the cancers people get are due to "bad luck," which set off a controversy. The authors of  the study have said they were "merely talking about a variety in cancers in 31 different tissue types," CNN reports.

The latest research, although still in its early stages, concluded that only 10 percent to 30 percent of cancers start because of the "bad luck" factor and that the greatest majority of cancer might be due to outside factors.

Tuesday, December 15, 2015

Holiday weight gain is usually permanent; here are some common myths de-bunked to help you manage the month-long celebration

On average, Americans gain one to two pounds between Thanksgiving and New Year's Day and unfortunately, most don't take them off,  says a Texas Tech University news release.

“Some may not think that is a serious amount, but research shows us people usually do not lose the weight they have gained after the holidays are over, which could lead to them gaining 10 to 20 pounds in the next 10 years or so,” said Allison Childress, an instructor, registered dietitian and nutritionist at the university.

So what can you do to prevent this weight gain? Childress and Professor Debra Reed, another registered dietitian and nutritionist, bust some of the myths many rely on to justify all of those extra calories:

Myth: Christmas is only once a year. Fact: Today, people often eat like it's Christmas a few times a week, compared to three or four decades ago when binge-eating really did only happen during the holidays. And now "the holidays" have evolved into a month-long food and drink fest.

Myth: Splurging on a high-fat food is always a bad idea. Fact: Not so, but do it wisely and in small portions. Reed recommends party-goers first assess all of the food available and decide on one special treat, fill the rest of your plate with healthy foods and then, don't get seconds!

“There isn’t any food to absolutely avoid in order to stay healthy during the holidays,” Childress writes. “But it is important to watch your portion intake and pay attention to what your body is telling you so you don’t overeat.”

Myth: If a host puts the food away too early, people will want more of it. Fact: Party-goers will make socializing the focus of the party instead of food if the hostess puts the food away after a reasonable length of time. Leave the food out, and people will "graze all day," they write.

Myth: The end of November is a great time to start a diet. Fact: Most who diet during the holidays will fail, instead, they write, the goal should be to not gain any weight.

“Even people who are very, very successful weight maintainers struggle in the holidays,” Reed said. “It’s not a good time to lose weight.”

Myth: Liquid calories don’t count. Fact: A couple of cocktails (alcoholic or non-alcoholic) can have more calories than one meal, they write. Reed recommends having a favorite drink at a party, drink it slowly, and then switch to water.

Myth: Skipping meals will help keep calories down. Fact: This will likely cause you to eat more.

Myth: There is no way to avoid gaining weight in the holiday season and still have fun. Fact: There is a way, Make sure gatherings include healthy choices alongside the treats. If you are hosting, include fresh fruits and vegetables and find ways to make your favorite holiday dishes healthier. For example, switch to whole wheat flour, reduce the amount of sugar in recipes or use low-fat dairy products. It is also important to shift the focus from food to activities and social events.

“There are a lot of easy things to do that make a little bit of difference,” Reed writes.

Monday, December 14, 2015

Most Kentuckians want Medicaid to cover as many people, and say Bevin should leave Kynect alone; advocates hopeful

By Melissa Patrick
Kentucky Health News

A recent poll found that a majority of Kentucky adults want new Gov. Matt Bevin to keep Medicaid as it is rather than change it to cover fewer people, as he has vowed to do.

All graphics from Kaiser Family Foundation report
The Kaiser Family Foundation poll found that 72 percent of Kentuckians said Bevin should keep Medicaid as is, and 20 percent said it should be scaled back to cover fewer people.

A majority of Democrats (89 percent), independents (75 percent) and Republicans (54 percent) said the Medicaid expansion should be kept as it is. Even among those who said they voted for Bevin, 43 percent said they wanted to it to cover as many people.

Kentucky was the only Southern state to fully embrace the federal health reform by creating its own health-insurance exchange and expanding Medicaid to those who make up to 138 percent of the federal poverty line. About 425,000 Kentuckians have signed up for insurance since the expansion, most of them for Medicaid. Overall, the poll found that 63 percent of Kentuckians have a favorable opinion of the state's Medicaid expansion to households with incomes up to 138 percent of the federal poverty level.

Bevin has said the state can't afford the expansion and has promised to scale it back, but that doesn't necessarily mean that it will cover fewer people.

In his inaugural address, Bevin said Kentucky would "copy the best parts" of Indiana's plan, which, through a federal waiver, created a modified expansion program that requires varying premiums and has provisions to remove those who don't pay them. Both of these features are in line with Bevin's desire to make sure this population has some "skin in the game."

Outgoing Gov. Steve Beshear maintained until his last days in office that the expansion is affordable, citing a state-funded Deloitte Consulting study that says it will pay for itself through 2020 by generating health care jobs and tax revenue. However, the total health-job gain since the expansion began appears to be about two-thirds of the number the study predicted at this point, and not all those jobs can be attributed to the expansion.

Bevin has also said he will dismantle the Kynect exchange, where Kentuckians buy federally subsidized insurance, and shift its users to the federal exchange. Kynect was built with $283 million in federal grants and its Beshear-appointed administrator estimated that it would cost about $23 million to dismantle.

The poll found that 52 percent of Kentuckians want to keep Kynect; 26 percent support a switch to the federal marketplace; and 19 percent weren't sure.

This support for Medicaid expansion and Kynect is good news to health advocates who hope to persuade Bevin to change his mind, Deborah Yetter reports for The Courier-Journal.

"I hope Gov. Bevin is paying attention to these findings and listens to the people," Bill Wagner, executive director of Family Health Centers in Louisville, told Yetter. "I hope we won't blindly follow the Indiana model. I think it's a race to the bottom." Wagner said he would rather Kentucky design its own program if Bevin's administration insists on changes.

More than half of Kentuckians (56 percent) said Medicaid is either "very important" or "somewhat important" for them and their family, with 46 percent of that group saying they felt so because they know someone who has received health care through the program. Even more Kentucky adults, 65 percent, said they know an adult with Medicaid coverage.

The poll also found that most Kentuckians still don't understand Medicaid and Kynect.

For example, only 16 percent of respondents were aware that the federal government pays for nearly all of the Medicaid expansion cost, with about a quarter (24 percent) of them thinking the state pays for most of it and 39 percent thinking the federal and state government share the cost equally.

In fact, the federal government pays for the expansion in full through 2016. In 2017 and 2018, Kentucky will be responsible for 5 and 6 percent, respectively, with its cost rising in two more steps to the reform law's cap of 10 percent in 2020.

Senate President Robert Stivers said at a Republican caucus retreat in early December that the Senate does not plan to block the estimated $257 million needed to cover the state's part of the expansion in the two-year budget that begins July 1.

Kentuckians also don't know much about Kynect, with only 12 percent saying they know "a lot" about it; 22 percent "some;" 31 percent "only a little;" and 34 percent "nothing at all."

In addition, 37 percent said they believe the reform law and Medicaid expansion have caused people to lose health insurance. While some people had to get new policies to replace those that didn't meet the law's requirements, Kentucky's uninsured rate has dropped from 20.4 percent to 9 percent since the implementation of health reform, the largest drop in the nation.

Although most Kentuckians have a favorable view of Medicaid expansion and Kynect, about half (49 percent) say they have an unfavorable view of the law, often called Obamacare, while 41 percent have a favorable view. These opinions were split along party lines.

Almost one-fourth (24 percent) of Kentuckians want health care to be the top priority of policy makers, with health-care costs and keeping the reform law, Kynect and the Medicaid expansion listed as their top two priorities.

The poll surveyed 1,017 Kentucky adults via both landline and cellphones between Nov. 18 and Dec. 1. The margin of error is plus or minus four percentage points.

Sunday, December 13, 2015

Report calls for statewide smoking ban to protect Kentucky youth

A new "Blueprint for Kentucky's Children" report says children and babies who live in communities without smoking bans are "subject to immense dangers from secondhand smoke," and calls for the almost 69 percent of Kentucky communities that still don't have such laws to implement them.

"The facts are pretty clear. Secondhand smoke causes problems for babies at birth, for children, and for teens," Dr. Terry Brooks, executive director at Kentucky Youth Advocates, said in the news release. "In order to give all children the chance to grow up healthy, we need to take steps to protect them from secondhand smoke. Smoke-free policies are the most cost-effective way to do this.”

For the first time, this year the Kentucky House of Representatives passed a bill for a statewide workplace smoke-free law during the last legislative session, but it did not gain any traction in the Republican led-Senate, which maintained that this should be a local decision. New Gov. Matt Bevin agrees.

Graphics from Blueprint for Kentucky's Children report
Kentucky has the second highest rate of adult smoking in the nation, 26.5 percent. The national average is 19 percent. And 87 counties (out of 120) in Kentucky don't have any smoke-free workplace laws.

The U.S. surgeon general says, "There is no safe level of exposure to tobacco smoke," because "when individuals inhale cigarette smoke, either directly or secondhand, they are inhaling more than 7,000 chemicals; hundreds of these are hazardous, and at least 69 are known to cause cancer."

The report presents four important ways smoke-free laws are proven to protect children and babies, including: fewer preterm births and fewer babies born with low birthweight; fewer asthma hospitalizations in children; reductions in the rate of maternal smoking; and increased protections for working teens, including exposure to residual toxins left on surfaces from tobacco smoke.

“We know smoke-free policies will improve the health of Kentucky newborns and children,” Brooks said in the release. “We need to protect all kids, not just those kids lucky enough to live in a smoke-free community. Kentucky babies can’t wait.”

Below are some details from the report:

Smoke-free policies cut preterm births, and thus low-birthweight babies

Kentucky, ranking 39th, is among the worst in the nation for low birthweight babies and exposure to secondhand smoke during pregnancy increases the likelihood of having a low birthweight baby (less than 5.5 pounds).

According to the report, low birthweight babies have an increased risk of of disabilities, cerebral palsy, vision and hearing loss and are 25 times more likely than those born at normal weight to die within their first year of life.

Smoke-free policies protect children with asthma

"Studies have found significant declines in inpatient asthma hospitalization rates of children following the implementation of comprehensive smoke-free laws," says the report. "For example, during the 32 months after Lexington’s smoke-free law was enacted, emergency department visits due to asthma declined by 18 percent for children."

Exposure to secondhand smoke in children causes middle ear infections, respiratory illness and is a common trigger for asthma attacks, says the report. Kentucky ranks 41st in the nation for children with asthma problems and asthma is the third-leading cause of hospitalization for children in the state.

Smoke-free policies reduce smoking during pregnancy

More than one in five of Kentucky babies are born to mothers who smoked during pregnancy, the highest rate in the nation. Smoking during pregnancy is associated with problems such as miscarriage, still birth, Sudden Infant Death Syndrome and  babies being born too soon, and cost the state "$5.6 million on neonatal services directly related to maternal smoking," says the report.

Smoke-free policies protect teens in the workplace

The report adds that smoke-free policies will also protect the almost 77,000 Kentucky teens in the workplace, also noting that these laws will  protect them from toxins left on indoor surfaces by tobacco smoke, called third-hand smoke,which can result in "substantial nicotine exposure" and cause further harm.

Twenty-four states have strong statewide workplace smoke-free laws, according to the report.

Saturday, December 12, 2015

Cold or flu? Know the difference because flu can be dangerous

Cold or flu, how do you know? And what should you do about it? CBS News and the Lexington Herald-Leader offer some tips.

"We often use the terms cold and flu interchangeably. But they are completely distinct illnesses with their own set of symptoms. The differences can actually be picked up right away," Dr. Holly Phillips, CBS medical contributor, said on "CBS This Morning."

Cold symptoms come on gradually, she said, and include a sore throat, congestion, sneezing and a cough. Flu symptoms, however, come on suddenly and include fever, body aches, chills and fatigue.

It's important to know the difference because while colds can be annoying, "they tend not to be very serious," she said, but the flu can be dangerous.

"The flu causes more than 24,000 deaths a year and about 200,000 hospitalizations, sometimes more," Phillips told CBS.

Getting a flu shot is the most effective way to protect yourself and others from getting the flu, according to the federal Centers for Disease Control and Prevention.

The CDC recommends a flu shot for every American age 6 months and older. And because the majority of Americans who die from the flu are seniors who develop complications like pneumonia, it is especially important for those 60 and older to flu shot.

As for treatment, Phillips says that first and foremost, the cold and flu are both caused by viruses and should not be treated with antibiotics, which are only effective against bacterial diseases. She also notes that overuse of antibiotics leads to the development of dangerous antibiotic resistance.

The flu, however, can be treated with antiviral medicines such as Tamiflu and Relenza, which are available only with a prescription and must be taken within two days of the onset of illness. These drugs will shorten the course of the illness and the severity of the symptoms, she said. Doctors' offices now carry test kits that are 99 percent accurate to determine whether it is the flu or a cold.

Otherwise, over-the-counter medications are available to treat symptoms for both colds and flu, she said.

Unfortunately, people are contagious within 24 to 72 hours of being infected with the flu, often before they feel sick, and remain contagious for at least 24 hours after their fever is gone, Dr. Paul Pedersen, a family medicine physician, writes for the Herald-Leader. But, he says, it is still important to use common-sense practices to protect yourself and others,

In general, he writes: make sure to use a tissue or handkerchief or cough into your elbow rather than your hand; wash your hands frequently with soap and water, but carry hand sanitizer that is at least 60 percent alcohol for times when this is not possible; stay at home if you think you are getting sick, or isolate yourself from others at work if you can't stay home; avoid crowds as much as possible during cold and flu season; and avoid sharing plates, glasses, utensils or even keyboards during the cold and flu season.

UK sets record for most heart transplants in a year

The University of Kentucky Transplant Center recently performed its 38th adult heart transplant for 2015 and set a record for the most heart transplants performed by a Kentucky medical center in a single year, according to a UKnews release.

"This has truly been a banner year for the UK Transplant Center and the UK Gill Heart Institute," Dr. Navin Rajagopalan, medical director of heart transplantation at UK HealthCare, said in the release. "Never before has a transplant center in Kentucky performed more than 30 heart transplants in one year. Our outcomes remain good, a testament to the strong team we have assembled at the University of Kentucky."

The previous state record was 27 heart transplants performed in a single year. Historically, only 20-25 medical centers in the country perform more than 30 heart transplants in a single year, says the release.

Transplants are a team effort that begins with the Kentucky Organ Donor Affiliates, who work "tirelessly" to encourage more Kentuckians to sign up, enabling more patients to receive the gift of life.

UK HealthCare's surgical transplant team, in conjunction with UK Gill Heart Institute's Advanced Heart Failure Program, offers a comprehensive and multidisciplinary approach to treating heart disease.

For example, some heart disease patients get what is called a left ventricular assist device (LVAD) for long-term, permanent support and some patients with advanced heart failure will receive a ventricular assist support device to serve as a "bridge" to transplant, enabling them to be more mobile and thus healthier and stronger, while they wait for a matching donor heart to become available. UK has implanted 29 durable LVADs this calendar year.

“Our program fulfills a need in Kentucky for many patients who otherwise may not have had the opportunity to receive a life-saving transplant,” Dr. Michael Karpf, UK executive vice president for health affairs, said in the release. “The commitment UK HealthCare has made to the program over the years has made a difference in the lives of many patients and their families and exemplifies the complex advanced subspecialty care it is important for our academic medical center to provide.”

Baptist Health joins national network that combines data to help patients get the best cancer care

Baptist Health has joined a national network that facilitates the sharing of health information with other hospitals in its network to improve and personalize cancer treatments, all while keeping its patient close to home, according to a Guardian Research Network news release.

With the addition of four new healthcare systems, including Baptist Health, GRN will now encompass 76 hospitals in nine states. By 2020, it expects to include one million patients with full clinical, imaging, laboratory and significant molecular profiles.

“Baptist Health is excited about the opportunity to be a member of the Guardian Research Network," Timothy Jahn, chief clinical officer of Baptist Health, said in the release. "Participation in GRN offers Baptist cancer patients a personalized approach to the care and treatment of their disease in their own communities,”

GRN collects data from "hundreds of thousands of patients'" electronic medical records and stores it so that they can evaluate and analyze it, which results in "bringing cutting-edge therapies specifically targeted to each patient's cancer" says the release.

Following strict HIPAA privacy regulations, GRN uses this data to identify patients who are eligible for clinical trials.

"This rapid patient-to-trial identification process will significantly reduce the time it takes to enroll a patient in the most advanced clinical trials available," says the release.

Friday, December 11, 2015

Get health coverage by Jan. 31 or pay penalty of up to 2.5% of income

The deadline to get health insurance for 2016 and avoid a penalty for not being insured is Jan. 31 and this year, unlike last, there will be no extension, Baylee Pulliam notes for Louisville Business First.

More than 3,000 Kentuckians missed the initial deadline this year but then gained coverage because of the extension, Jill Midkiff, executive director for communications for the Kentucky Cabinet for Health and Family Services, told Pulliam. This extension was meant to help those who weren't aware of the penalty for not having health insurance util they started to file their income-tax returns and saw it.

"A special enrollment period around the April 15 tax filing deadline will not be offered this year," Kevin Counihan, CEO of, the federal government health insurance exchange, wrote on The CMS Blog. "If you don’t enroll by then, you could have to wait another year to get coverage and may have to pay the fee when you file your 2016 income taxes.”

The penalty for not having health coverage in 2015 is $325 per adult and $162.50 per child (up to $975 for a family), or 2 percent of their annual household income, whichever is higher.

The penalty for next year is $695 per adult and $347.50 for each child (up to $2,085 per family), or 2.5 percent of annual household income, whichever is higher.

If you're not sure what your penalty could be, there's a calculator tool on the website.

Counihan said that for many the fee is greater than the yearly cost of a plan and that generally, "the higher your income, the higher the fee you will have to pay."

So far, 60,277 Kentuckians have enrolled in subsidized 2016 coverage through Kentucky's exchange, Kynect, and about 30,000 haven't renewed their plans, Midkiff told Pulliam in early December.

For coverage that takes effect Jan. 1, the deadline is Dec. 15.

Thursday, December 10, 2015

People with dementia benefit from singing and listening to music

People with dementia improve both cognitively and emotionally when their caregivers engage them regularly with singing and listening to music, according to a study published in the Journal of Alzheimer's Disease.

"Our findings suggest that musical leisure activities could be easily applied and widely used in dementia care and rehabilitation." Dr. Teppo Särkämö, lead author from the University of Helsinki, wrote in the journal.

The research involved 89 pairs of patients with mild to moderate dementia and their caregivers, who were randomly assigned to one of three groups. For 10 weeks, one group focused on singing, one on music listening and the third, the control, received only standard care.

Assessments taken 9 months prior to the intervention allowed the researchers to determine that the musical activities enhanced memory, abilities to focus and manage several tasks at the same time, orientation and mood in the groups that received musical coaching, compared with the standard care group.

The research found that singing most benefited patients in the early stages of dementia who were less than 80-years-old, and music listening most benefited those in the later stages. Singing and music listening helped both groups alleviate depression, but was especially beneficial to decrease depression in those with mild, Alzheimer-type dementia. The musical background of the person with dementia did not influence the study results.

According to the Alzheimer's Association, Kentucky has over 68,000 with Alzheimers disease and says that this number will climb to 86,000 by 2025.

"Given the increasing global prevalence and burden of dementia and the limited resources in public health care for persons with dementia and their family caregivers it is important to find alternative ways to maintain and stimulate cognitive, emotional and social well-being in this population," Särkämö said. "Especially stimulating and engaging activities, such as singing, seem to be very promising for maintaining memory functioning in the early stages of dementia."

Obamacare still divides Kentuckians, but opinion has firmed up; view of its personal impact on them is now even

By Melissa Patrick and Al Cross
Kentucky Health News

Kentuckians still have a marginally unfavorable opinion of the federal health-reform law, and their views about it have firmed up, according to the latest Kentucky Health Issues Poll.

However, the opinion of those who say the law has had an effect on their family has improved to the point that they are evenly divided on the controversial topic.

"Although many still report they do not have enough information to understand the impact of the law on themselves, and opinions remain split, the numbers reporting positive personal and family impacts have increased as provisions of the law have gone into effect," said Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, which sponsors the survey.

The poll has asked the same question of Kentucky adults since 2010: "Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it?"

Last year, opinion was almost evenly split, with 41 percent unfavorable and 39 percent favorable. This year, 46 percent were unfavorable and 41 percent favorable. Because the poll's error margin is plus or minus 2.4 percentage points, which applies to each number, there is little or no statistical difference in the two years' results.

The significant change was in the share of people who said they didn't have an opinion about the law. That dropped to 14 percent this year from 20 percent last year.

Political affiliation continues to be reflected in opinions of the law. The survey found that 61 percent of Democrats had favorable views of it and 66 percent of Republicans had unfavorable views. Among independents, 42 percent had unfavorable views and 43 percent were favorable.

Kentuckians' opinions are virtually the same as those found in a national survey taken at about the same time. The September 2015 Kaiser Health Tracking Poll found that 45 percent of U.S. adults had unfavorable views of the law; 41 percent were favorable; and 14 percent did not know or refused to answer.

The number of Kentucky adults who reported the law had a positive effect on their family increased to 23 percent, up from 18 percent in 2014. The percentage who said the law had negatively affected them or their family remained steady at 23 percent.

Kentucky's adoption of the law expanded eligibility for the Medicaid program to households with incomes up to 138 percent the federal poverty level. Among such people, 37 percent said the law had affected them positively.

People with incomes from 138 to 400 percent of the poverty level are eligible for private-insurance subsidies. Among those with incomes between 138 and 200 percent of the FPL, 27 percent said the law had positively affected them; it was 12 percent among above 200 percent of the FPL.

As for Kynect, the state's online marketplace for health insurance, 35 percent said they had heard a lot about it; 22 percent had heard "something" about it; and 43 percent had heard only a little or nothing at all.

The poll was conducted among a random sample of 1,608 Kentucky adults Sept. 17 through Oct. 7 for the foundation and Interact for Health, formerly the Health Foundation of Greater Cincinnati, by the Institute for Policy Research at the University of Cincinnati. It used landlines and cell phones.

National study and Paducah Sun story illustrate value of local Kynectors, who would be far away if exchange is abolished

Gwyn Artz, left, of Lexington talked with Miriam Fordham about
signing up for health insurance through Kynect during the opening
of a storefront in Lexington's Fayette Mall. (Herald-Leader photo)

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Critics of Republican Gov. Matt Bevin's plan to dismantle Kynect, the state's health insurance exchange, often cite the loss of most locally responsive "Kynectors" as a reason for him to reconsider. Now a study published in Health Affairs supports this argument, finding that programs with such local, in-person "assisters," as the study calls them, are the most successful at signing people up for coverage.

Kynectors are exchange employees in every county who help those unfamiliar with health insurance navigate the system. In 2014, they held more than 3,000 events for enrollment and education, and are credited with helping more than 500,000 Kentuckians sign up for health insurance.

Bevin said during his campaign and re-iterated at his inaugural speech Dec. 8 that he would dismantle Kynect and shift to the federal exchange, calling the state exchange "redundant."

If Kentucky does that, customers will still have access to assisters, but they will be located in a customer service center "hundreds of miles away," outgoing Gov. Steve Beshear said in a plea for Bevin to keep Kynect. Funding for exchange assisters would decrease by 75 percent.

The Health Affairs study found that consumers who received in-person assistance were more than twice as likely to successfully enroll compared to those who tried to enroll online without any assistance, and those who received local assistance were the most successful.

“Assister programs play a vital role in supporting consumers particularly when assisters maintain ongoing relationships with consumers,” lead researcher Rachel Grob told the Center for Patient Partnerships at the University of Wisconsin-Madison.

“Our synthesis of the evidence from the first two years of open enrollment also highlights that assister programs are successful when assisters come from, and are situated from within, communities that they serve; when local programs are well coordinated; and when post enrollment issues can be addressed," she said.

In brief, according to Grob, “evidence from the field suggests that enrolling cannot be separated from educating and engaging—and that assisters are positioned to do this work.”

Lindsay Nelson, state coordinator for outreach and enrollment with Kentucky Primary Care Association, told the Lexington Herald-Leader that this has also held true in Kentucky.

She told the Herald-Leader the system wouldn't have worked if it had hired people from outside Eastern Kentucky to work in the region that is the greatest beneficiary of the expanded Medicaid program.

"People in the counties with the higher rates of signups say personal connections have helped spur friends and neighbors to sign up," the Herald-Leader reported.

The Health Affairs study also found that in addition to clients needing an average of two to four hours of help, and more than half of them coming back for a second session, assisters were heavily involved in the post-enrollment work because many consumers did not understand their coverage provisions.

Bill Wagner, executive director of the Family Health Centers of Louisville, shared a similar story at the Friedell Committee for Health's annual meeting in October.

He said Kynectors often "end up becoming case managers" for their patients even after they have chosen their insurance, helping them find providers who accept Medicaid, helping them with their health literacy and helping them understand how to maintain eligibility.

"Having the boots on the ground from the Kynectors, having the close working relationship with the Kentucky Health Benefit Exchange [Kynect's official name], I think has really helped us provide more ongoing care and coordinated case management around insurance, so I worry about that if that were to change," Wagner said.

Genevieve Postlethwait of The Paducah Sun wrote recently about the role of Kynectors, including keeping their clients informed about regulatory changes, particularly the one that only allows 30 days to change their address when they move or they will loose Medicaid eligibility; the importance of not missing appointments; and understanding the penalties involved if they don't have insurance.

"It's not necessarily the case anymore that there aren't enough primary care providers,but the problem is that people who are newly insured don't have the knowledge of how to access providers, how to set up appointments. Or if they hit bumps along the road, they don't know how to manage an insurance company," Monique Zuber, executive director of the United Way of Paducah-McCracken County, told the Sun "It's hard enough for those of us who have been insured for a long time."

Jackie Eubanks, Kynector program manager with Mayfield-based West Kentucky Allied Services, concurred. "With the expanded Medicaid, there's this huge group of people who are covered now, but they don't know what to do," she told the Sun. Later adding that people need time to change "their paradigm and get into a new way of thinking. It doesn't happen overnight."  (The Paducah Sun is behind a paywall.)