Wednesday, February 22, 2017

Poll finds that 22 percent of Kentucky adults say they delay or forgo health care due to cost

By Melissa Patrick
Kentucky Health News

Two in 10 Kentucky adults continue to report that someone in their household has delayed or skipped needed medical care because of cost, according to the latest Kentucky Health Issues Poll. The survey found that such struggles are greatest for the poor, people with the poorest health, and those without health insurance.

The poll, taken from Sept. 11 to Oct. 19, found that 22 percent of Kentucky adults said that did not get the medical care they needed, or delayed care because of cost in the past 12 months. That figure has remained about the same since full implementation of the Patient Protection and Affordable Care Act and Kentucky's expansion of Medicaid in 2014. The differences from year to year were not statistically significant.

"Delaying care is not only dangerous for our residents, it is costly to the state," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll. "Kentuckians who delay care, for whatever reason, are more likely to end up in the emergency room for treatment that costs far more and could be less effective than treatment at an earlier stage."

The poll found that Kentucky adults who reported fair or poor health were more likely to say someone in their household delayed or did without medical health care due to cost, compared to those who reported excellent or very good health, 33 percent and 17 percent respectively. The poll also reflects that Kentucky adults in poor health increasingly struggle paying for their medical care, up to 33 percent in 2016 from 28 percent the year before.

It also found that 34 percent of Kentucky adults who remain uninsured have someone in their household who has delayed or done without health care in the past 12 months due to cost. Among those with health insurance, the figure is 20 percent.

Kentucky's uninsured rate dropped from from 20.4 percent in 2013 to 7.8 percent in 2016, a decline of 12.6 percent, according to Gallup.

The poll found Kentucky adults who were below 200 percent of the federal poverty level ($23,760 for an individual in 2016) were more likely to report that they delayed health care that those who earned more than this amount: 28 percent and 17 percent, respectively.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati for the foundation and Interact for Health, a Cincinnati-area foundation. It surveyed a random sample of 1,580 adults via landlines and cell phones and has a margin of error of plus or minus 2.5 percentage points. The margin is larger for subsamples.

Monday, February 20, 2017

With Obama gone, emphasis is on 'care,' not him; Rep. Guthrie says voters want a replacement 'that creates a better opportunity'

"With President Barack Obama out of office, the debate over 'Obamacare' is becoming less about 'Obama' and more about 'care,' greatly complicating the issue for Republican lawmakers," writes Jonathan Martin, national political correspondent in the Washington Bureau of The New York Times. "Polling indicates that more Republicans want to make fixes to the law rather than do away with it. President Trump, who remains popular on the right, has mused about a replacement plan that is even more expansive than the original."

That's a contrast with the last seven years, when "few issues have animated conservative voters as much as the repeal of the Affordable Care Act," Martin notes. "As liberals overwhelm congressional town hall-style meetings and deluge the Capitol phone system with pleas to protect the health law, there is no similar clamor for dismantling it." Republicans in Congress told Martin that there is "significantly less intensity," as he puts it, among Obamacare opponents now that Obama is no longer president.

Rep. Brett Guthrie, R-2nd
Rep. Brett Guthrie of Bowling Green and Kentucky's 2nd District, who is on two health subcommittees in the House, said “I was here in 2009 and 2010, and we’re not getting the anti-Obamacare calls like that. I think people are going to hold us accountable for making sure we not only repeal, but we have a law in place that creates a better opportunity for people.”

Martin writes, "The demands from conservative-leaning constituents in districts like Mr. Guthrie’s are plainly shifting. In a nationwide CBS News poll last month, 53 percent of Republicans said they wanted to change the law to make it work better while 41 percent said they wanted to abolish it. Overhauling the law, however, is far more politically complicated than simply scrapping it."

The law passed with no votes from Republicans, and they have campaigned against it ever since. Now that they control the government, except the lack of a filibuster-proof majority in the Senate, the debate has "shifted from the theoretical to the tangible," Martin reports.

"It was easy for conservatives to rally against a law identified with a president they despised when he was capable of vetoing any repeal," he writes. "Now that he is gone and the law’s benefits appear to be on the chopping block, the people who stand to lose the most are the most vocal."

The "wild card" in the process is President Trump, who "has said multiple times that he is uneasy about depriving anybody of health insurance, and he may bridle if Democrats attack any Republican plan that may lead to that," Martin writes. "As Democrats note, Mr. Trump owes his victory in part to voters who have benefited from the law."

Kentucky is an example of that. More than half a million Kentuckians, the great majority of them on expanded Medicaid, are among the 20 million Americans who gained coverage under the law. By some measures, the state has had the largest percentage decrease of people without health insurance.

Senate Majority Leader Mitch McConnell said Friday that Republicans will have to repeal and replace the law without Democratic help or votes. “It’s clear that in the early months it’s going to be a Republicans-only exercise,” he said. “We don’t expect any Democratic cooperation on the replacement of Obamacare. . . . Clearly this is not one of those bipartisan ‘Kumbaya’ moments.”

But Republicans may still need Democrats. The GOP can pass budget- and tax-related measures with a simple majority, under budget-reconciliation rules, but it remains to be seen how that can be done with the rest of the law.

Friday, February 17, 2017

State Senate panel OKs bill to deny most taxpayer dollars to Planned Parenthood; Ky. affiliate gave up funding in 2015

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A bill that would effectively deny most tax dollars to Kentucky's Planned Parenthood locations in Louisville and Lexington passed out of a state Senate committee Feb. 17.

Senate Bill 8 would create a three-tier system to direct how federal family planning dollars are distributed in the state, with money first going to community health departments and federally qualified health centers, followed by private organizations that provide comprehensive primary and preventive health services, with Planned Parenthood third in line.

In 2015 Planned Parenthood's Kentucky affiliate stopped accepting its federal funding of about $300,000 per year, but Wise said the law is still necessary because "there is currently nothing in law that should prohibit them from in the future needing access to Title X family funds."

The bill would prohibit Planned Parenthood from receiving state or local funds, but it could still be paid by Medicaid, which is mainly funded by the federal government. Federal money does not pay for abortion.

Sen. Max Wise
The bill passed 8-3 along party lines out of the Senate Veterans, Military Affairs and Public Protection Committee, though Sen. Julian Carroll, D-Frankfort, said his vote was a "reluctant no" because of concern that it would reduce women's access to health services.

Texas, Kansas and Ohio have similar laws. The legislation wouldn't take effect until Congress repeals a regulation that prohibits family planning money from being allocated through a tiered structure. The U.S. House has already scheduled a vote on that, said Sen. Max Wise, R-Campbellsville, the bill's lead sponsor. It passed the measure Thursday.

“I come before you today thankfully more optimistic about the prospects of protecting unborn life than I was last year when the committee heard this similar bill,” Wise said.

Opponents of abortion have stepped up efforts to defund Planned Parenthood, which performs abortions but not in Kentucky, since undercover videos released in 2015 purported to show that it sells unborn baby parts for profit.

Wise cited the videos as a reason to support the bill, but they have been found to be heavily edited and misleading., a nonpartisan service of The Annenberg Center at the University of Pennsylvania, says, "The full, unedited video they cite as evidence shows a Planned Parenthood executive repeatedly saying its clinics want to cover their costs, not make money, when donating fetal tissue from abortions for scientific research." Experts also said the amount of money mentioned in the videos was not enough to create a profit.

Tamarra Wieder, director of external affairs at Planned Parenthood Advocates of Indianan and Kentucky, said in an interview after the meeting. "The ultimate agenda here is not women's health, it's about outlawing abortion and restricting people's ability to choose what's right for them."

Wise said another reason to withhold funding from Planned Parenthood is because it has a "vested, financial interest" in directing women toward abortion, noting that in 2013-14 the organization had provided 323,653 abortions and made 1,880 adoption referrals.

Federal and state law does not allow tax dollars to be used to pay for abortions, but Wise suggested that it is difficult to ensure that this money isn't crossing over for abortion services: "Under Title X grants, abortion providers can pro-rate expenses such as staff and waiting rooms, carving a portion of the fixed cost of the abortion related staff and facilities."

Opponents of SB 8 (L-R) Dr. Mary Sterrett, Sage Martin and
Tamarra Wieder speak to committee (Photo by Melissa Patrick)
The committee chair, Sen. Albert Robinson, R-London, chairman of the committee, had six opponents of the bill to speak for a little over 15 minutes before Wise presented it.

Wieder told the committee that as a military wife, she was referred to Planned Parenthood because the base was unable to care for her gynecological needs.

"As one of the state's leading and most trusted providers of comprehensive reproductive health care, Planned Parenthood in Kentucky serves more than 7,000 patients a year, a vast majority being low-income women of childbearing age," she said.

Sen. Denise Harper Angel, D-Louisville, the only woman on the committee, voted no and said, "With all the serious issues facing Kentucky, I don’t understand why we spend our time just taking away services for the women of Kentucky."

Wise said that if women need family-planning services, they could go to their local health department or federally qualified health center. But Wieder said, "They say you can go to the health department for this care ... and that's not true. Louisville and Lexington, there is no family planning services from the health department, they contract out. . . and that's not unique to just Louisville and Lexington."

The Louisville Metro Health Department confirmed that, and said it contracted with Planned Parenthood until it stopped taking Title X money. It now sends patients to Family Health Centers, which is a federally qualified health center.

Wieder said the FQHCs in Louisville often refers patients to Planned Parenthood for reproductive health services because "they are inundated with patients seeking other services and they don't have experts in the field that can manage that care, so we do get a lot of referrals from the FQHCs throughout the state, and specifically in Louisville and Lexington."

Thursday, February 16, 2017

Tobacco ban for public-school properties and activities heads to the House on 25-8 Senate vote

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The state Senate passed a bill Feb. 15 to ban the use of tobacco products and electronic cigarettes on public-school properties and during school activities, but not without debate about local control and overreach.

Senate Bill 78 would prohibit use of tobacco products by students, faculty, staff and visitors in schools, school vehicles, properties, and activities, and give one year to adopt, implement and enforce the policy. It passed 25-8, with two pass votes and now heads to the House for consideration.

Sen. Ralph Alvarado
The sponsor, Sen. Ralph Alvarado, R-Winchester, told the committee that the bill "is a beginning attempt to help reduce our youth smoking rates in Kentucky," which at 17 percent ranks third in the nation. "A strongly enforced tobacco free school policy can prevent or delay students from using tobacco. Some studies have shown up to a 30 percent reduction in student smoking."

Despite earlier comments by Alvarado that he didn't think others would "dare" oppose a bill to decrease Kentucky's youth smoking rates, several legislators voiced concerns about local control, overreach, unintended consequences and enforcement.

Sen. Paul Hornback, R-Shelbyville, acknowledged the bill's good intent and noted that Shelby County school district was smoke-free, but he also pointed out that the ban doesn't just concern students, "but also concerns the school bus drivers at the school bus garages and places where there aren't even any students around."

"So, I'd urge the members to think about this," Hornback said. "You know, we are in favor of local control until we are not, and this is one of those things where we want to come down and mandate to the local school boards what they need to do, rather than letting them decide like they are doing right now."

Hornback, who was a prominent tobacco farmer before becoming a senator, also wanted to know if a person would be in violation of the law if they had tobacco in their personal vehicle while on school property.

Alvarado replied, "If you would be on school property, you would be in violation, according to this. Again, the enforcement on the policy would be up to the local school boards."

Alvarado, a physician, said he changed the bill at the behest of the Kentucky School Boards Association and superintendents to allow school districts to develop their own enforcement policies.

Just over half of Kentucky's public-school students are in school districts with tobacco-free policies: 62 of the state's 173 districts, covering 654 schools.

Sen. Robin Webb, D-Grayson, said she also appreciated the intent of the bill, but had concerns about its overreach and enforcement, noting that as written, the bill would not allow volunteers or chaperones to use tobacco products in the privacy of their own hotel room on a school-sponsored trip.

"I just think it is a little far-reaching. I don't think it's enforceable," Webb said. "I don't know what the enforcement would be unless it would go back to that local control. I think there are some portions of this bill that are a little vague, undefined and extends beyond the scope of the intention of the bill."

Webb passed on the vote. So did Sen. Johnny Ray Turner, D-Prestonsburg, a basketball coach at a smoke-free school. He voiced concerns about the financial impact of the bill on schools if attendance decreases at outdoor sporting events because people can't smoke. He said tobacco policy should be a local decision.

Besides Hornback, senators who voted against the bill were Republicans Joe Bowen of Owensboro, Tom Buford of Nicholasville, Stan Humphries of Cadiz, John Schickel of Union and Wil Schroder of Wilder, and Democrats Julian Carroll of Frankfort and Perry Clark of Louisville.

Mark Pyle, Christian County health director, is named state's deputy commissioner of public health

Mark Pyle
The director of the Christian County Health Department in Hopkinsville will be the new deputy commissioner of the state Department for Public Health.

Mark Pyle will serve as the state's chief liaison with Kentucky's 63 district, county and independent health departments. The job was briefly held by Randy Gooch, who returned to his old job as health director in Jessamine County, saying it suited him better.

Pyle has headed the Christian County department for nine years, and led it to national accreditation. "Although national accreditation was a crowning achievement, it was not the most important," he told the Kentucky New Era. "The most important achievements were the development of community partnerships, implementing evidence based/population based health programs and forming a culture of above-the-line performance."

Legislature moving bills targeting fentanyl sales, shortening length of most opioid prescriptions to three days

The General Assembly is moving bills to increase penalties for the sale of fentanyl and put a three-day limit on prescriptions of other high-potency painkillers, in an effort to stem the state's opioid epidemic.

Kim P. Moser
"This is a public-health crisis," freshman Rep. Kimberly Poore Moser, R-Taylor Mill, a former nurse who reminded the House Judiciary Committee that Kentucky has the nation's third highest rate of deaths from opioid overdoses.

Her legislation would raise the penalty for selling any amount of fentanyl, "a powerful synthetic opioid," reports Bruce Schreiner of The Associated Press. "Current law allows lesser felony charges, with lighter penalties, for people convicted of trafficking less than 2 grams."

"The bill would create a new crime of trafficking in a misrepresented controlled substance, a felony punishable by one to five years in prison," Schreiner writes. "It's aimed at drug dealers who sell fentanyl to buyers who think they're getting less-potent painkillers, with sometimes deadly results."
Read more here:

Rep. Robert Benvenuti, R-Lexington, said at the House Judiciary Committee's Feb. 15 meeting, "We have people in this commonwealth who are actively marketing something that is the equivalent to shooting somebody. And we've got to have strict penalties for that. . . . And if it means longer terms of incarceration, there's one way not to get into that situation – don't traffic in this stuff."

The bill would also "direct licensure boards overseeing doctors and others with prescriptive authority to write regulations setting guidelines to generally limit a patient's supply of painkillers to three days," Schreiner reports. "There would be exemptions in cases of chronic pain, end-of-life and cancer care and if a provider believes there's a medical necessity for a longer prescription."

Gov. Matt Bevin told the committee, "We've got to make it harder to get addicted." Schreiner reports, "Bevin said no amount of government money or rehabilitation programs will fix Kentucky's drug woes until action is taken to reduce the state's acute drug addiction rate."

The committee approved the bill on a bipartisan vote. The day before, the state Senate passed and sent to the House a bill to toughen penalties for people caught trafficking smaller amounts of heroin or fentanyl.

About 3/4 of the Kentuckians getting free exams and screenings via Medicaid are covered by its expansion, study finds

More than three-fourths of the Kentuckians who got free medical screenings through Medicaid last summer were covered by the expansion of the program under the Patient Protection and Affordable Care Act, according to a study done for the Foundation for a Healthy Kentucky.

Likewise, almost three-fourths of Medicaid substance-abuse treatments were for people included in the expansion of the program to people with incomes up to 138 percent of the federal poverty level, $16,394 for an individual or $33,534 for a family of four.

Medicaid covered more than 44,000 dental exams, 10,143 screenings for breast cancer, 6,319 colorectal cancer screenings, 6,153 hepatitis C screenings and 4,495 diabetes screenings for non-elderly Kentucky adults during July, August and September 2016. It also covered 7,039 births, 22 percent of which were for for expansion patients.

"The dramatic growth in preventive health screenings for low-income Kentucky adults is one of the most meaningful benefits of Medicaid expansion in Kentucky," said Ben Chandler, CEO of the foundation. "Getting recommended tests such as colorectal cancer screenings, mammograms or dental exams gives Kentuckians the chance to either prevent chronic disease or get earlier treatment. These screenings can quite literally save lives. They can also lead to significant savings for Medicaid and other programs that pay the cost of caring for Kentuckians who otherwise would put off medical visits and just get sicker."

Since the Medicaid expansion began in January 2014, people covered by it have had 224,720 dental exams, 15,692 screenings for diabetes, 59,529 breast cancer screenings, 38,190 colorectal cancer screenings, 24,157 hepatitis C screenings and 53,465 substance-abuse treatments, according to the study by the Health Access Data Assistance Center at the University of Minnesota.

Wednesday, February 15, 2017

State Senate committee approves bill to remove insurance-company barriers to smoking-cessation treatments

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Kentuckians could get treatments to help them quit smoking without facing obstacles from their insurance companies, under a bill that a state Senate committee approved unanimously Feb. 15.

Sen. Julie Raque Adams
Senate Bill 89 would require all insurance policies sold in Kentucky to cover all smoking-cessation medications and counseling approved by the U.S. Food and Drug Administration "with no barriers to access," said Sen. Julie Raque Adams, the bill's sponsor. "The choice is simple: If Kentuckians want to quit smoking, they will have true access to the necessary tools. If they don't, no money or effort is expended."

The Patient Protection and Affordable Care Act requires all insurance policies to cover smoking-cessation treatment, but Adams said that doesn't mean they are readily available. The Louisville Republican said many insurers have barriers to treatment such as co-payments, prior authorization, limits on length of treatment, annual and lifetime limits on attempts to quit, and step-therapy requirements that dictate the order in which physicians can prescribe treatments. SB 89 would provide barrier-free access to all U.S. Preventive Services Task Force-recommended smoking cessation treatments in all Kentucky health plans, including Medicaid.

Dr. Shawn Jones, senior physician in the Ear, Nose and Throat Group at Baptist Health Paducah and past-president of the Kentucky Medical Association, said in a telephone interview that he runs into these barriers "all the time."

"A lot of times we will want to try certain medications, whether it is a medication that has been out for a long time, like Wellbutrin or [a newer one like] Chantix, and a lot of insurers won't pay for that, even though the studies say they are much more effective than the nicotine-replacement-therapy that the patient may have already tried over-the-counter, and that doesn't count because it wasn't from a prescription from the physician," he said.

Asked if he ran into annual limits on quit attempt barriers, Jones laughed and said, "I haven't been able to get a whole lot of people covered the first time, so I haven't had the trouble of getting them covered the second time. My experience has been more with the Medicaid population and it's very difficult to get them the treatment they need."

Dr. Shawn Jones
Jones, who spoke in favor of the bill at the Senate Health and Welfare Committee meeting, said smoking costs the state $1.92 billion in annual health-care costs, of which $590 million goes to Medicaid (most of which is federally funded), and kills almost 9,000 Kentuckians a year. The state leads the nation in smoking; 26 percent of Kentucky adults smoke.

"If we are going to use the word crisis with respect to the opioid epidemic in Kentucky, and I think we should, then we must do the same with regard to smoking," he said, noting that smoking kills many more people. "Smoking in Kentucky is nothing short of a catastrophic pandemic of gargantuan proportions, and that does not do it justice."

Jones said 70 percent of U.S. smokers say they want to quit, and 34 percent of those try to quit, but only about 10 percent are successful. "It's not easy to quit smoking," he said. "Many smokers simply cannot quit without true, barrier-free access to the treatments prescribed by their doctors, and physicians play a critical role in helping people quit."

Jones wrote in an op-ed in the Lexington Herald-Leader that the insurance companies' set of obstacles "makes it extremely difficult for smokers to stay motivated to quit."

Erica Palmer Smith, speaking on behalf of the American Cancer Society Cancer Action Network and other patient advocacy groups, told the committee that insurance companies' barriers to access "cause confusion among providers and patients about the availability of treatment, meaning fewer Kentuckians don't attempt to quit smoking."

Adams said after the meeting that the bill has the support of the state Cabinet for Health and Family Services, and noted that the state Department of Insurance estimated the financial impact of SB 89 to be minimal, $1.10 a year for the average policyholder. She said it will save insurance companies and Medicaid money in the long run.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, applauded the committee's vote. "If anyone wants to quit smoking, we ought to help them do it, instead of throwing up roadblocks," he said in a news release. "Senate Bill 89 will improve health in Kentucky and save taxpayer money."

Ky. uninsured rate has dropped significantly under Obamacare, but many struggle with maintaining stable coverage

By Melissa Patrick
Kentucky Health News

Many more Kentuckians have health insurance because of the Patient Protection and Affordable Care Act, but more than one in five Kentucky adults under 65 say they still don't have stable coverage, according to the latest Kentucky Health Issues Poll.

The Sept. 11-Oct. 19 survey found that 12 percent of Kentuckians aged 18 to 64 were uninsured. Another 9 percent reported they had health insurance, but had been uninsured at some point in the past 12 months.

"Health insurance is still an iffy proposition for more than one in five Kentucky adults who are 18 to 64," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll. "While the ACA has ensured coverage for over 355,000 Kentuckians from 2014 through 2015, there's still a significant number of Kentucky adults who can't rely on getting routine preventive and wellness care, let alone effective treatment for chronic conditions, because they can't rely on insurance to cover the cost."

The poll also found that the number of Kentuckians 18 to 64 on public insurance has dropped, while the number with employer-sponsored health insurance was about the same as last year.

Public insurance, such as Medicaid or military benefits, was reported by 29 percent of Kentucky adults under 65, down from 35 percent in 2015. Forty-five percent of Kentucky adults said they had employer-sponsored coverage in 2016, compared to 41 percent in 2015. The latter difference is not statistically significant, because the poll's error margin is plus or minus 2.5 percentage points, but chances are that fewer Kentuckians had such coverage.

The uninsured rate for Kentuckians 18 to 64 has dropped by more than half since the 2014 implementation of the ACA. The report notes that 97 percent of all Kentuckians 65 and older have health insurance.

Among Kentuckians aged 18 to 26 who reported having health insurance, 24 percent said they were covered on a parental plan, made possible by the ACA.

Chandler said, "As the Commonwealth moves forward to transform Medicaid, the foundation is working to help policymakers understand who has health insurance coverage and who doesn't. KHIP is one piece of the foundation's ongoing work to help sustain the gains Kentucky has made while identifying gaps we still need to fill."

The poll was conducted for the foundation and Interact for Health, a Cincinnati-area foundation, by the Institute for Policy Research at the University of Cincinnati. It interviewed a random sample of 1,580 adults on both landlines and cell phones.

Humana says it will pull out of government health-insurance exchanges next year

Humana Inc. announced Feb. 14 that it would stop selling health insurance through the government marketplaces created by federal health reform. That made the Louisville-based company "the first major insurer to cast a no-confidence vote over selling individual plans on the public exchanges for 2018," The New York Times noted.

The company said its early analysis of Obamacare enrollment for this year showed “further signs of an unbalanced risk pool,” meaning too many "customers with expensive medical conditions continued to enroll as compared with healthy people," Reed Abelson explains for the Times.

The change will mean relatively little to Kentucky, since Humana was selling on the federal exchange in only nine counties (Bourbon, Bullitt, Clark, Fayette, Jefferson, Jessamine, Oldham, Scott and Woodford) and off the exchange in nine (Boone, Bullitt, Campbell, Gallatin, Grant, Jefferson, Kenton, Oldham and Pendleton).

"Humana is not a major player in the individual exchanges and is among the national insurers, like Aetna and UnitedHealth Group, that have struggled to make money in the market," Abelson notes. Humana and Aetna abandoned their planned merger after a federal judge ruled it would violate antitrust laws.

On the Obamacare exchanges, "The company has steadily scaled back its presence, selling policies for 2017 in just 11 states," Abelson notes. "The company’s main focus has been selling private insurance under Medicare," under the brand Medicare Advantage.

Tuesday, February 14, 2017

Study analysis by Ky. critic of hospital safety estimates more than 200,000 preventable hospital-associated deaths each year

An analysis of two well-controlled studies estimates that the number of preventable hospital-associated deaths are over 200,000 each year, argues a commentary in the Journal of Patient Safety.

In an online review, Dr. Kevin Kavanagh, the lead analyst, acknowledges that critics of such studies will say the data is flawed because they often include older and sicker patients.

However, he adds they also don't include diagnostic errors, deaths that occur after the patient goes home from the hospital, or don't include data about patients whose deaths are imminent. Thus, he concludes, the number of deaths in these studies are more often underestimated, not overestimated.

"The onus is on the facilities to provide better data," he said, adding that his analysis looked at the two studies with the most rigorous data sets.

"We calculated an annual rate of 163,156 preventable deaths and when combined with diagnostic errors, non-captured events and deaths after hospitalization can be projected to approximate 200,000 preventable deaths annually," Kavanagh, a retired physician and chairman of HealthWatch USA, said in an e-mail.

The report says that despite having the knowledge to prevent many adverse events, "many health systems do not adequately invest in patient safety to put well-known safety improvement strategies in place." The report offers as an example resistance to mandatory nurse-to-patient ratios, which have been proven to decrease falls, pressure sores, urinary tract infections and decrease medication errors.

"Advocates are not calling to prevent problems for which solutions are not known, but calling to implement known solutions to prevent all too common problems," the report says. "What ties the occurrence of preventable adverse events and mortality together is the willingness and determination of facilities to adopt a culture of safety and to invest in patient safety."

It also points out that data from countries with nationalized health care systems and "well-defined and near-uniform implementation standards" cannot be compared to the United States' combination of non-profit, for-profit and government-systems.

Kavanagh said that even if the preventable hospital mortality rate from medical errors "is not the 163,156 that we have projected, but is as low as the 25,000 per year based on the United Kingdom's NHS data, that equates to approximately 5 potentially preventable deaths per year, per hospital in the United States, or one every two to three months.

"In addition, one could argue that this figure should be doubled by accounting for deaths from diagnostic errors," Kavanagh writes. "In what other industry would such a record be tolerated, let alone defended? Would the airline industry and public ever tolerate even a single preventable airline crash? We can and must do better."

Monday, February 13, 2017

KET examines successful recoveries from opioid addiction, airs a forum to discuss Kentucky's opioid crisis

Kentucky Educational Television is airing "Journey to Recovery," a documentary that looks at Kentucky's opioid epidemic and explores the state's available treatment options through personal stories of recovery.

The program, narrated by Grammy-winning recording artist and Kentucky native Sturgill Simpson, first aired Monday, Feb. 13. It will be air again Wednesday, Feb. 15 at 2 a.m. ET. KETKY will show it Feb. 16 at 3 p.m.; Feb. 18 at 2 a.m.; Feb. 27 at 11 a.m.; and March 8 at 10 a.m. (all ET). Go to for archived KET and national programs addressing the growing opioid epidemic.

Opioids, including heroin and many prescription painkillers, killed more than 33,000 people in the United states in 2015, according to the Centers for Disease Control and Prevention. In Kentucky, 1,248 died from drug overdose in 2015, up from 1,071 in 2014, according to a report from the Kentucky Office of Drug Control Policy. 

The documentary examines both abstinence-only programs as well as medication-assisted treatment programs. In addition to interviews with recovered addicts, the program also has interviews with several of the nation’s top addiction experts, including Dr. Nora Volkow, director of the National Institute on Drug Abuse and Dr. Robert DuPont, a former NIDA director and founding director of the Institute for Behavior and Health.

After the documentary's initial airing, Renee Shaw hosted an "Inside Opioid Addiction Forum" to discuss ways to battle the opioid crisis. Panelists included Justice Secretary John Tilley and Health Secretary Vickie Yates Brown Glisson.

The forum is available online and will air on KETKY Feb. 14 at 6 p.m., and on KET Feb. 15 at 3 a.m. It will also air on KETKY Feb. 15 at 5 a.m. and 11 a.m.; Feb. 16 at 4 p.m.; Feb. 18 at 3 a.m.; Feb. 27 at noon; and March 8 at 11 a.m. (all ET).

Sunday, February 12, 2017

Republicans will not only keep the Medicaid expansion, they will broaden it, says Lamar Alexander, Senate health panel chair

Sen. Lamar Alexander (Photo by M. Scott Mahaskey, Politico)
Republicans in Congress will not only keep the expansion of Medicaid, but will broaden it, says U.S. Sen. Lamar Alexander of Tennessee, a former governor who is a familiar figure to many Kentuckians and is close to Senate Majority Leader Mitch McConnell of Kentucky.

That's what Alexander told reporters Burgess Everett and Jennifer Haberkorn of Politico, which headlines their story by saying that he could be "the stealth Republican force behind Obamacare repeal" and replacement. But other senators may disagree and have more leverage.

The Patient Protection and Affordable Care Act allows states to expand Medicaid to people earning up to 138 percent of the federal poverty level, $16,394 for an individual or $33,534 for a family of four. Democrat Steve Beshear did that as governor in 2014, adding 440,000 people to the rolls; Republican Gov. Matt Bevin is trying to reduce the cost, now that the state has to pay a small part of it: 5 percent this year, which would rise to the current law's limit of 10 percent in 2020.

Alexander told Politico that Republicans need to first fix the subsidized insurance markets the ACA created, "which are suffering from high premiums and low competition, even if they represent just 4 percent of those insured in the United States," the reporters write. "From there, he wants Republicans to turn to Medicaid expansion — which Republicans will keep and potentially even broaden, he says — before eventually addressing problems with the country’s patchwork of employer-sponsored health care plans. In essence, Alexander is trying to triangulate an approach that can become law."

President Donald Trump campaigned on a promise to repeal the law soon after taking office, but said recently it might be next year before that happens. "Daily Senate Republican lunches regularly erupt in disagreement over strategy," Politico reports. "It’s now mid-February without a clear path forward, after years of Republican show votes to repeal the law. . . . Conservatives inside and outside Congress have already grown frustrated with the GOP’s plodding pace."

Alexander is not as conservative as other Republicans. but he is chairman of the Senate Health, Education, Labor and Pensions Committee, which makes him a major player in the discussions. He "was one of the first lawmakers to call on Republicans not to scrap Obamacare until a replacement is ready to go," the reporters note. "That’s now the GOP’s mantra."

"If there’s a softer side to Republicans’ plans to gut the law, it’s best represented by Alexander, a lawmaker who so loves cutting a deal that he voluntarily left the top ranks of Republican leadership to better work with Democrats," Everett and Haberkorn write. "The folksy Tennessee senator is quietly prevailing upon Republican lawmakers to take a deep breath. . . . His goal, in a nutshell: to reassure millions of Americans that Republicans aren’t trying to snatch away their health insurance."

Alexander "repeatedly stressed" in the Politico interview that he is on the same page as Trump and House Speaker Paul Ryan, the reporters note. "Those relationships have given other Republicans confidence in Alexander’s role." Sen. John McCain (R-Ariz.), told them: “That’s the key guy.”

But Finance Committee Chair Orrin Hatch of Utah, whose panel has jurisdiction over taxes, insurance subsidies and Medicaid, told Politico that Alexander “doesn't have much to do with it. He takes a great interest in it, and I’m glad he does, and I want to get his best ideas.” The two disagree, for example, on taxes that fund the subsidies; Hatch wants to repeal them quickly, but "Alexander urges caution: If Republicans repeal taxes now, how can they be sure they’ll have the revenue needed to pay for their replacement plan?"

Newspapers big and small tackle Kentucky's opioid epidemic

The opioid epidemic, and the growing concern about stronger and more lethal painkillers, is getting plenty of coverage by major news outlets in Kentucky, one of the states most troubled by it. But smaller news outlets are also tackling the issue.

Click on image for larger version
The Courier-Journal's latest effort, by Beth Warren and Matthew Glowicki, explored the spread of fentanyl, which they write "is blamed for causing or contributing to nearly 43 percent of [Jefferson] County's 325 fatal drug overdoses last year — and taking more lives than homicides." The pressed-pill form resembles oxycodone and other weaker painkillers, but "A dose as small as two milligrams — about the size of Abraham Lincoln's cheek on a penny — can be lethal. . . . It's cheaper than heroin and delivers a more powerful high, appealing to manufacturers and traffickers. It's often made in China and shipped to Canada or Mexico and then hauled into the United States, but it also has been sent directly from China."

Van Ingram, director of the the state Office of Drug Control Policy, told the Louisville newspaper that he expects fentanyl to be the biggest factor in fatal overdoses in 2016, once the data are compiled. "Last year, fentanyl surpassed the known number of heroin-related deaths in Kentucky — with 28 percent of all fatal overdoses linked to heroin, compared to 34 percent to fentanyl," the reporters write. The latest threat is from carfentanil, "an elephant tranquilizer up to 100 times more potent than fentanyl."

Two weeks earlier, The C-J published a story by Warren about how overdose sites have become crime scenes, leading to prosecutions against drug dealers. The story began with an online exchange between an accused dealer and a victim, in which they discussed the possibility of a fatal overdose. The exchange, captured from her cell phone, provided not only a compelling start to the story but a compelling illustration that dominated the newspaper's front page: an example of translating digital media into print media.

The stories of addiction can be told from the viewpoints of police and of survivors of overdose victims, but also from the view of those who have survived addiction and are in recovery. The weekly Adair County Community Voice is doing that with a series titled "Journey to Recovery," the latest installment of which tells the story of Misty May, a mother whose would-be nursing career was destroyed when she became addicted to crack cocaine after just one dose.

"We've all heard the phrase 'all it takes is one time' when it comes to drug addiction, but you never truly understand this phrase until you have been through it yourself," Adam Capps begins his story about May, who has been sober for 11 years with the help of drug court, which requires treatment. It was accompanied by a sidebar about Kentucky's high rate of overdoses, a phone number to get help, and a note from the newspaper saying in part that "There must be open conversation in developing new tactics and ideas to combat drug dependency issues in our community. Locking the issues behind bars is not addressing or helping to fix our problems." In an editorial the next week, Capps wrote, "I've had to rearrange the way I think about drug addicts, and I hope the stigmas associated with addicts can become a thing of the past."

Saturday, February 11, 2017

As Republicans wait to address Obamacare, Democrats and supporters of the law appear to gain new footing

This story has been updated.

"Republican efforts to repeal Obamacare could help Democrats do what they have been unable to for seven years: sell the American people on the benefits of the health law," James Hohmann writes for The Washington Post's "Daily 202" news briefing.

"Poll numbers are moving in their direction. Grassroots organizing – from protests to town halls – is en fuego [on fire]. For years, the national and local media focused on the problems with the rollout of the law. But reporters have begun writing much more, instead, about the people who stand to lose benefits they’ve obtained. . . . The tenor of press coverage has shifted dramatically since the election toward emphasizing plusses, rather than minuses, of the law."

Hohmann lists several news stories, some driven by activities of groups that favor the Patient Protection and Affordable Care Act, such as the "Save My Care Bus Tour" that stopped in Lexington. Meanwhile, Democrats say Republicans' lack of action has given supporters of the law time to mobilize.

The top Democrat on the tax-writing House Ways and Means Committee, Rep. Richard E. Neal of Massachusetts, told Hohmann that he expects that hospitals and health-care companies who benefit from the reform law will give public warnings about the dangers of repealing it: “Medicaid expansion has now become a middle-class benefit.”

The law allowed states to expand the program to people with household incomes up to 138 percent of the federal poverty level, $16,394 for an individual or $33,534 for a family of four. That added half a million Kentucky adults to the program. Republican Gov. Matt Bevin asked the federal government to approve changes that his administration forecasts would reduce Medicaid enrollment by 85,000, and the Trump administration is expected to approve.

But in Congress, "Many Republican politicians are speaking pretty openly about the political danger of scaling back coverage," Hohmann writes. "Lawmakers are getting nervous about facing the kind of contentious town halls that their Democratic counterparts faced in 2009," when the law was being debated, and several "have already faced big crowds of angry activists back home." Republican Gov. Paul LePage of Maine said at a town hall meeting, “I’m not sure you’re going to have anyone in Washington with the courage to repeal the ACA.”

That sort of talk may change now that former Rep. Tom Price of Georgia, a strong opponent of the law, has been confirmed as secretary of the Department of Health and Human Services. He and his fellow Republicans have had little to say about their plans for replacing the law since they gained almost full control of the federal government, and Sen. Bob Corker (R-Tenn.) told reporters Feb. 6 that he has “no idea” when Republicans might start drafting: “I don’t see any congealing around ideas yet.”

President Donald Trump said things would begin to happen once Price was sworn in, but he told Bill O’Reilly of Fox News last weekend, “Maybe it’ll take ’til sometime into next year” to develop a replacement plan, a process that will be “very complicated.” A week later, on CBS's "Face the Nation," Trump adviser Stephen Miller said, "We're a lot farther along than most people realize" and "We look forward to presenting details ... very soon."

Friday, February 10, 2017

Bill to ban tobacco products from school property and activities heads to full Senate after change to satisfy school officials

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The idea of a statewide ban on smoking in workplaces has hit roadblocks in the General Assembly, but a bill to ban tobacco use on school properties and at school events might be a mandate legislators can accept.

Sen. Ralph Alvarado
"I think even those who might want to oppose it – I don't think they dare. I think they are holding back and I think they are realizing that this is something good for kids, good for the state," Republican Sen. Ralph Alvarado, a physician from Winchester and the sponsor of Senate Bill 78, said in an interview.

The bill unanimously cleared the Senate Education Committee Feb. 9 and went to the full Senate. It would prohibit use of tobacco products by students, school personnel, and visitors in schools, school vehicles, properties, and activities, allowing schools one year to adopt, implement and enforce the policy.

Asked if he thought SB 78 will become law, Alvarado said: "At this point, what I'm looking for is momentum. I tell people that we try to swing and try to get the home run. I'll settle for the single and get on base and (then) start driving to score the runs we need to score."

Alvarado has advocated a statewide smoke-free law, but has not been able to garner enough support for one in the Senate. The House voted for a smoking ban in 2014, but in 2015 voters elected Gov. Matt Bevin, who has said the issue should be decided locally, and in 2016 they replaced the House's narrow Democratic majority with a Republican super-majority.

Alvarado told the committee that his bill "is a beginning attempt to help reduce our youth smoking rates in Kentucky," which ranks third in the nation for youth smoking.

The 2015 Youth Risk Behavior Survey reports that 17 percent of Kentucky's high-school students smoke. That is higher than the national adult smoking average of 15 percent, Alvarado pointed out. Even more, 24 percent, use electronic cigarettes. The survey also found that 22.5 percent of Kentucky's middle school students have tried smoking.

Alvarado said 3,200 Kentucky youth become daily smokers every year, and Kentucky's youth buy 11.4 million packs of cigarettes each year.

He also noted the health and academic consequences of youth tobacco use, including: increased lung infections, decreased physical fitness, poorer school performance and increased school absences than their non-smoking peers, to name a few.

Alvarado opened the meeting with some stark facts on how smoking affects the state, noting that 8,900 Kentuckians died from a smoking-related illness in 2015 and an estimated 950 die each year from exposure to second-hand smoke.

"Tobacco is the leading cause of preventable death in the U.S.," he said.

He also listed the financial consequences of smoking on the state, including: $1.92 billion in health care costs; $589.8 million in Medicaid costs; an annual, individual tax burden of $1,168; and $2.79 billion in annual productivity loss.

"It is time for Kentucky to step up to the plate to protect its kids. Let's get your children healthier, let's save tax-payer money, let's save Kentucky lives," he said.

Just over half of Kentucky's public-school students are in school districts with tobacco-free policies: 62 of the state's 173 districts, covering 654 schools.

Jamie Sparks, coordinated school health director at the state Department of Education, told the committee that 23 districts have enacted such policies in the last two years, largely because of teens' increased use of electronic cigarettes. "Strictly enforced tobacco-free school policies can reduce youth smoking by 30 percent," he said.

Tom Shelton, executive director of the Kentucky Association of School Superintendents, told Kentucky Health News after the meeting that the association fully supports Alvarado's bill, but was able to do so only after it was changed to allow local school boards to set their own policies without the education department's involvement.

Noting that he was superintendent in Daviess and Fayette counties, which implemented tobacco-free campuses, he said "You can implement the policy without having to have an enforcement or discipline measure. It is really a matter of concentrating on communication, so that people will understand it; having appropriate policies and procedures; having signage; and then at each event simply making an announcement that says, 'This is a reminder that our campus is tobacco-free,' and making sure that people understand that. That, we believe is adequate."

The bill still has language that would require school boards and their employees to enforce their policies. It would repeal a 1988 law that bans smoking in schools except by adults in designated smoking areas.

Sen. Reggie Thomas, D-Lexington, said he supports the bill, but he pointed to the stark health and financial statistics that Alvarado shared and said, "In my opinion your bill doesn't go far enough in terms of what we need to do to address that problem," indicating his support for a statewide smoking ban.

Heather Wehrheim, director of advocacy for the American Lung Association, who worked with Alvarado on the bill, said it is "getting us closer to a comprehensive smoke-free law." She said the best way to decrease Kentucky smoking rates would be a statewide comprehensive smoke-free law and to raise cigarette taxes by $1. She added that increasing the legal age to buy tobacco products to 21 and increasing state funds for prevention and cessation, would also help.

"The American Lung Association just released our State of Tobacco Control Report and Kentucky got "F's" in every single area so we have a ton of work to do," she said. "But we applaud this and Senator Alvarado's work on it."

Elizabeth Anderson Hoagland, a youth tobacco-policy specialist with the state Department for Public Health, said in an interview, "Tobacco-free school policies are very important for role modeling tobacco free lifestyles for youth. We really need to make sure all students are protected from second-hand smoke."

A 2016 Kentucky Health Issues Poll conducted by the Foundation for a Healthy Kentucky and Interact for Health found that 85 percent of Kentuckians support tobacco-free schools.

"We applaud the Senate Committee on Education for recommending a bill to make Kentucky school campuses smoke-free," said Ben Chandler, president and CEO of the foundation. "We must protect Kentucky's children, who spend seven hours or more of their day during much of the year in school, from the harmful effects of second-hand smoke" He added, "This bill is also a cancer-prevention bill."

Thursday, February 9, 2017

Pharmacies dispensing opioids thrive in Clay County, which leads Kentucky in doses of hydrocodone per person: 150 a year

Pharmacies dispensing opioids are thriving in an impoverished, coal-depressed county in Eastern Kentucky, Phil Galewitz reports for Kaiser Health News. In Clay County (Wikipedia map) the unemployment rate is 8.4 percent, well above state and national averages, and 47 percent of residents live below the poverty line. Despite the downturn in the economy in the region, in Manchester, the county's seat and largest town, with 1,500 residents, there are 11 pharmacies, mostly independently owned, with four opening in just the past three years.

"Drug manufacturers and distributors have pumped prescription opioid painkillers into rural America, in response to demand—much of it from adults who had become physically addicted," Galewitz writes. "The expansion of Medicaid through the Affordable Care Act increased the percentage of Clay County residents with Medicaid and gave more of them access to free prescription drugs, including pain pills. Though Clay County’s opioid problem long preceded the act, the improved legal access helped bring a long standing problem out from the shadows. Statistics show residents are swallowing the preferred prescription opioid more."

Clay County's hydrocodone dosage leads the state. (Kaiser map)
In Clay County, which has 21,364 residents, "2.2 million doses of hydrocodone and about 617,000 doses of oxycodone" where dispensed during a 12-month period ending in September 2016, Galewitz writes. That's 150 doses for every resident. Even before the ACA, prescription drugs were a problem. From 2009 to 2013, Clay County had the state's third highest rate of hospitalizations for pharmaceutical opioid overdoses.

Clay County's health status is one of the worst in the nation, Galewitz notes: "Four in 10 residents rate their health status as being fair or poor, twice the share for the entire state population. Close to half the county is obese. The rate of diabetes is also higher than average."

The inpatient drug-treatment facility closest to Manchester carries a waiting list of 100 that’s grown more than 50 percent in recent years, said Tim Cesario, director of substance abuse services at the Cumberland River Comprehensive Care Center in Corbin. The facility—with 41 beds for men and 15 for women—has been at capacity for several years, he said."

"About 60 percent of Clay’s residents are on Medicaid, up from 35 percent three years ago. It is among the most highly concentrated Medicaid populations in the country," Galewitz writes. Steve Shannon, executive director of the Kentucky Association of Regional Programs, says Medicaid’s expansion has not created more addicts. He told Galewitz, “People who were uninsured were pretty resourceful when it came to finding drugs."

Most adults on Medicaid qualify because Ky. expanded program; at risk as Republicans in Congress work to replace Obamacare

By Melissa Patrick
Kentucky Health News

More than three-fourths of Kentucky adults on Medicaid were eligible only because Kentucky expanded its Medicaid program in 2014, according to a study done for the Foundation for a Healthy Kentucky.

Then-Gov. Steve Beshear expanded Medicaid under federal health reform to include those who earn up to 138 percent of the federal poverty level, $16,394 for an individual or $33,534 for a family of four. Before expansion, the state's income limit for those who weren't disabled or pregnant was 69 percent or less of the poverty line.

The study found that in the third quarter of last year, 650,867 Kentucky adults were covered by Medicaid, 78 percent (506,317) were covered by the expansion, and 69 percent were under the age of 44. In all, Kentucky has about 1.3 million people on Medicaid and about half of them are children.

Foundation President and CEO Ben Chandler pointed out that many of these Kentuckians have incomes just above the poverty level, but still too low to otherwise afford health insurance.

"The latest available numbers continue to show that expansion of Medicaid in Kentucky has greatly increased the number of low-income people who have health insurance," Chandler said in the news release. "Improving the health of Kentucky means making sure no Kentuckians have to rely on the emergency room for health care."

The report also found that every region of the state has large numbers of Medicaid enrollees, but only in Eastern Kentucky does a region's share of the state's Medicaid enrollees (31 percent) exceed the region's share of the state's population (21.6 percent).

Gov. Matt Bevin has said that Kentucky can't afford to have a third of its population on Medicaid and has asked the federal government to approve changes that would encourage enrollees to be more involved in their health care through things like income-based premiums, health savings accounts and work and volunteer or work requirements for those who aren't primary caregivers. Meanwhile, Republicans in Congress are working to repeal and replace the law that allows the expansion.

The study was done by the State Health Assistance and Data Center at the University of Minnesota.

Wednesday, February 8, 2017

Dr. David Stevens of Lexington, who led successful effort for Kentucky's first local-government smoking ban, dies at 87

Dr. David Stevens (Lexington Herald-Leader photo)
Dr. David Stevens, a retired orthopedic surgeon who was instrumental in getting a smoking ban in Lexington, died Monday at age 87.

Stevens, a Republican, served on the nonpartisan Lexington-Fayette Urban County Council from 1992 to 2008 as an at-large and 5th District member. He was a member of the merger commission that drafted the charter for the merged government, Tom Eblen reports for the Lexington Herald-Leader.

“David Stevens lived a life that lifted up and cared for others,” Mayor Jim Gray said in a statement. “He was a touchstone for all things good and generous in Lexington. He epitomized what a citizen and a gentleman should be, and indeed in countless ways, he made our city a better and healthier place to live.”

Ellen Hahn, a nursing professor at the University of Kentucky, and a leader of smoke-free efforts in the state, told Eblen that Stevens became convinced of the need for a smoking ban in Lexington after attending a two-day conference that she helped organize in 2000 about the dangers of second-hand smoke. It took him three years to persuade the other council members to enact the region's first municipal smoking ban.

“He was a visionary,” Hahn said. “And he provided the leadership in a steady, calm way. He cared about public health.”

Stevens was involved with the Lexington-Fayette Board of Health and many other agencies and civic efforts. Stevens was a founding member and board chairman of the Central Kentucky Blood Center in 1968, and its first donor. He  taught at the University of Kentucky College of Medicine, was president of the Fayette County Medical Society and was a member of the University Community Caucus of the National League of Cities, Eblen reports.

He was in private practice as an orthopedic surgeon for 20 years, and then spent two more decades as chief of staff of Shriners Hospital for Children. And for many years, he was the sports physician for Henry Clay High School and Paul Laurence Dunbar High School.  He grew up in Louisville and graduated from DePauw University in Greencastle, Ind., in 1951.

Visitation will be 4 p.m. to 7 p.m. Friday at Milward Funeral Directors on Broadway and at 10 a.m. Saturday at Crestwood Christian Church, 1882 Bellefonte Drive. The funeral will be at the church at 11 a.m. Saturday, with a reception afterward. There will be a private burial at Lexington Cemetery. 

Illnesses and possible flu outbreaks close schools for the week

Several counties throughout Kentucky have closed schools for the remainder of the week due to multiple illnesses "in response to what public health officials are calling a possible flu outbreak among young people," Austin Ramsey and Bobbie Hayse report for the Messenger-Inquirer in Owensboro. Butler, Ohio and Todd County schools announced their closings Tuesday, just after two- and three-day closures in Muhlenberg and Hancock County, respectively. "Barbourville, Jenkins, and Williamsburg Independent Schools, along with Knox, Clay, and Mercer Counties all closed on Thursday," WKYT reports.

Jessica Austin, an epidemiologist with the Green River District Health Department, told Ramsey and Hayes that "tests in Ohio County seem to be pointing to seasonal influenza, a contagious respiratory illness caused by a group of related viruses that can be of real concern to high-risk populations such as the elderly or young."

February is typically the height of most flu cases, Ramsey and Hayse write. "Persons can protect themselves somewhat with an annual vaccine that the U.S. Centers for Disease Control and Prevention reports indicate is a good match for common strains seen in patients this year. Austin said it remains unclear whether patients treated for influenza in the region received vaccines within the last six months."

Austin says that almost all local health providers confirm influenza using 'rapid flu tests'-- mouth or nasal swabs that can yield results within 15 minutes -- but "CDC officials warn that the quick tests often produce false-positive results and that their sensitivity hovers somewhere between 50-70 percent," Ramsey and Hayse write.

It's too early to raise any public health crisis alarms, so Austin "is now calling on all local hospitals and clinics in the seven-county region to send test samples to the Kentucky Department for Public Health for more accurate results."

"That's the only way we're going to tell if this really is influenza, what kind it is and how widespread the problem really is," she said.

"But officials with One Health Infectious Disease, which is monitoring flu cases at Owensboro Health facilities in all of western Kentucky and southern Indiana, said there were 113 confirmed cases of flu in the region in January and already 69 in the first seven days of February, representing what one official called a 'significant jump' in a short period of time," Ramsey and Hayse write.

Officials in Mercer County told WKYT that the decision to close was a proactive one. "Attendance numbers started to decline throughout the week with many parents saying their children were sick. Many teachers and members of the staff were also ill. Mercer County school leaders say they will spend the next two days disinfecting each classroom and building," WKYT writes.

"Everything that kids are coming in contact with. Desks, water fountains, door knobs, light switches, all those things. So all the surfaces that they clean regularly anyway, but this is just a more thorough, deeper cleaning," Esther Hayslett, the director of pupil personnel, told WKTY.

Disinfecting classrooms isn't the only solution. Dr. Katrina Hood, a doctor with Pediatric & Adolescent Associates in Lexington, told WKYT: "I think as best we can trying to teach kids during the winter about the triangle in the face; So your eyes, your nose, your mouth, try not to touch those during the day."

Updated February 10, 2017 at 2:43pm

Liberal group's study says Obamacare repeal without replacement would cost the state jobs in 2019

Repealing the Patient Protection and Affordable Care Act would not only take away health insurance from thousands of Kentuckians, but would also cause the state to lose about 55,949 jobs or nearly 3 percent of the state's workforce, according to a new report from a liberal-leaning research group. However, the report presumes that there would be nothing to replace the law, which Republicans have said they will do.

The Economic Policy Institute, a Washington-based non-profit research group, report looked at how the combination of tax cuts and spending cuts in the ACA would affect employment in the U.S. if it is repealed. “This report adds to the mounting evidence that ACA repeal will be very bad for Kentucky," Dustin Pugel, research and policy associate for the Kentucky Center for Economic Policy, said in an e-mail. "Repeal would not only hurt our people, but our economy."
Graphic from report. Click here to go to interactive map.

Nationally, the report estimates that a repeal of the ACA would eliminate almost 1.2 million jobs in 2019. These losses would come from the loss of federal spending that pays for the tax subsidies people get to help pay for their coverage on the marketplace, and the loss of spending for Medicaid services.

"If this support were withdrawn, people would have less money to spend on other basic necessities like food and rent," says the report. "Fewer dollars spent at grocery stores and other businesses means 1.2 million jobs would be lost."

The report says that while every state would lose jobs if the ACA is repealed, the poorest and those that expanded Medicaid under the law would lose the most. It says Kentucky would lose more jobs as a share of its overall employment than any state but New Mexico.

The report says that Kentucky would lose $4.1 billion in federal Medicaid spending, or about 2 percent of the state's GDP, while the tax cuts would only put $677 million back into the economy (largely benefiting the most wealthy Kentuckians). Thus, less money would be going into the state's economy and fewer jobs would be created.

It also notes that 486,000 Kentuckians would lose their health insurance if the law is repealed, causing the number of people without insurance to increase by 200 percent.

"Our state’s decision to expand Medicaid and cover more people resulted in a huge increase in federal funding and the evaporation of those dollars is the primary cause of the job loss," says the KCEP news release.

A similar study by The Commonwealth Fund and the Milken Institute School of Public Health at the George Washington University estimated that 2.6 million people would lose their jobs in 2019 if the Medicaid expansion program and the premium tax credits were removed from the ACA. The report said Kentucky would lose 45,000 jobs.

"Bivens said his job-loss estimates are lower than those in the Commonwealth study because his projections reflect potential job gains resulting from termination of the ACA’s higher Medicare taxes and its surcharge on earnings above $200,000," Tony Pugh reports for the Lexington Herald-Leader.

Both reports note that job losses would not only come from health care, but also from construction, real estate, retail, finance, insurance and other industries.

The repeal and replacement of Obamacare remains uncertain. While the Republican-controlled Congress is working toward this goal, it hasn't come up with a plan. President Donald Trump said this week that it may be next year before they do so.

The report involves estimates based on modeling, much like Kentucky's Deloitte Consulting report that projected the expansion of Medicaid would create more jobs than it actually did. The 2015 Deloitte report estimated that in 2014, the first year of the expansion, it would created more than 12,000 jobs, including 5,400 in health care. But the Bureau of Labor Statistics found that health care and social assistance jobs rose by only 3,100 jobs, despite Medicaid enrollments that were larger than Deloitte projected.

Tuesday, February 7, 2017

Most Kentuckians support raising the age to buy tobacco to 21; studies say this would decrease youth and adult smoking rates

By Melissa Patrick
Kentucky Health News

If increasing the minimum legal age from 18 to 21 to buy tobacco products would help decrease the smoking rate in Kentucky and the majority of Kentuckians support such a change, perhaps the question for the General Assembly is: "Why wouldn't we do that?"

That's the attitude of the Foundation for a Healthy Kentucky, which co-funds the Kentucky Health Issues Poll that found that 58 percent of Kentucky adults support increasing the minimum age to buy tobacco products to 21.

"The research shows that most tobacco use starts in the teen and young-adult years and that making it a little bit harder to buy the products significantly reduces their use," foundation President and CEO Ben Chandler said in a news release. "We also know that smoking damages nearly every organ in the body and leads to a myriad of diseases later on. So raising the legal age to buy tobacco is one of the easiest policy changes Kentucky can make to improve health and shrink health care costs. Our poll shows that the majority of Kentuckians support it, so why wouldn't we do that?"

The poll, taken Sept. 11 through Oct. 19, found that support for a higher legal-tobacco age was equal among Democrats and Republicans, at 59 percent.

This was about the same as the the last time KHIP asked this question, in 2015, but the poll saw an increase in support among independents, increasing to 65 percent from 55 percent.

Kentucky has the third highest youth smoking rate in the nation, with 17 percent of its high-school students smoking, and use of electronic cigarettes growing,

"The longer we can keep our youth from smoking, and the harder we make it to buy cigarettes, the healthier Kentucky will be. It's that clear-cut," Chandler said. 

California and Hawaii, along with more than 200 local jurisdictions in 14 other states, have raised the minimum legal age to buy tobacco products to 21. Chandler notes that Kentucky law prohibits local jurisdictions in Kentucky from passing youth access legislation for tobacco.

Rep. David Watkins, a retired physician from Henderson, submitted such legislation (House Bill 299) during last year's legislative session, but it did not come to a vote.

While a majority in every region supported increasing the age to 21, support was higher in Western Kentucky (61 percent), Eastern Kentucky (60 percent) and the Louisville area (59 percent) than in Northern Kentucky (51 percent) and the Lexington area (53 percent). The regional sample sizes are smaller than the overall sample, so they have higher error margins than the full sample's margin of plus or minus 2.5 percentage points.

The poll surveyed a random sample of  1,580 Kentucky adults via landlines and cell phones. It was conducted by the Institute for Policy Research at the University of Cincinnati for the foundation and Interact for Health, a Cincinnati-area health foundation. 

Sunday, February 5, 2017

Comparing national ratings that compare Kentucky hospitals

A federal agency, magazines and a consulting group have compiled ratings that allow comparison of hospitals. Now Dr. Kevin Kavanagh of Somerset-based Health Watch USA has compiled the ratings, allowing comparison of hospitals across rating methods.

"It needs to be stated on the front end that the hospital industry is not happy with the current quality measurements," Kavanagh writes for the Lexington Herald-Leader. "However, the vast majority of these measures were derived from, or had extensive input from, the health-care industry. The industry criticizes these measures as not being accurate. Of course, the exception is when a facility scores No. 1; then there seems to be no limit to marketing the result."

Kavanagh does not include the often-advertised ratings of the Joint Commission, explaining, "This accreditation organization was forged out of the health-care industry and all too often gives a gold star of approval." He uses the "star system" of the Centers for Medicare and Medicaid Services; and ratings by the Leapfrog Group, a purchasing alliance that mainly measures safety; Consumer Reports, which primarily measures safety by readmissions, complications, communication, overuse of CT scans and infections; and U.S. News and World Report, "which uses a variety of measures, including reputation, to determine quality. This score not only reflects safety but also the ability to handle complex problems. Thus, larger hospitals and educational institutions often do better with this ranking system. The University of Louisville exemplifies this dichotomy."

Comparing the ratings with prior years, Kavanagh writes: "In the Lexington region, they overall have improved and are doing rather well. St. Joseph and St. Joseph East both showed marked improvement. Overall, these safety-ranking systems measure different aspects of care and will give different results. However, if a hospital performs in the lower tier of several systems, one needs to take notice. This appears to have happened with several facilities in Louisville, which had dismal results." He says the publicized problems of the U of L Hospital are "a testament to the accuracy and usefulness of these quality-ranking systems."

Kavanagh's comparison chart also includes data on hospital complaint investigations by CMS. It does not include most hospitals in Kentucky; CMS, for example, does not rate "critical access" hospitals, which are in rural areas. For the Kentucky Health News reports on the CMS ratings of 82 hospitals, click here; on Leapfrog Group's ranking of 52 hospitals, go here; on the U.S. News rankings, here.